Effect of physical exercise on executive function in individuals with substance use disorder: A systematic review and meta-analysis

Clinical Snapshot

Key Findings

• P Value: Inhibition: P < .001; Working memory: P = .002; Cognitive flexibility: P = .170 (non-significant)

• Effect Size: Inhibition: Hedges's g = 0.47 (small-to-moderate); Working memory: Hedges's g = 0.42 (small-to-moderate); Cognitive flexibility: Hedges's g = 0.51 (non-significant, wide CI)

• Primary Outcome: Executive function in individuals with SUD, assessed across three subdomains: inhibition, working memory, and cognitive flexibility

• Nnt Or Sensitivity: No NNT reported. Subgroup analysis suggests working memory benefit may be optimised with sessions of 46–60 minutes (g = 0.39), 5 times per week (g = 0.45), over 8 weeks (g = 0.46) — all exploratory findings only

• Confidence Interval: Inhibition: 95% CI 0.29–0.65; Working memory: 95% CI 0.16–0.69; Cognitive flexibility: 95% CI −0.22 to 1.24

Clinical Application

Physical exercise is a low-cost, low-risk, and widely accessible intervention. Implementation in SUD rehabilitation settings is feasible with appropriate supervision. The suggested parameters (46–60 min sessions, 5×/week, 8-week duration) are achievable in residential rehabilitation programmes but may be challenging in community-based or outpatient settings with high dropout rates. Exercise modality is not specified, limiting protocol standardisation. In Australia, SUD rehabilitation is supported through a network of publicly funded residential and community-based services, with oversight from the Australian Government Department of Health and Aged Care. Physical activity is consistent with RACGP guidelines for chronic disease management and mental health comorbidities. Exercise physiology services are accessible via Medicare (Chronic Disease Management plans, up to 5 allied health visits per year), though this may be insufficient for an 8-week, 5×/week programme. Accredited Exercise Physiologists (AEPs) registered with Exercise and Sports Science Australia (ESSA) are the appropriate practitioners to deliver such programmes. No TGA regulatory considerations apply to exercise as an intervention. PBS listing is not relevant. The findings are broadly consistent with the RACGP's 'Smoking, Nutrition, Alcohol, Physical activity (SNAP)' framework, which supports physical activity as a component of addiction management. Australian residential rehabilitation programmes (e.g., those funded under the Drug and Alcohol Treatment Program) could feasibly integrate structured exercise protocols, pending higher-certainty evidence. Adults undergoing rehabilitation for substance use disorder, particularly those with documented executive function deficits. Most applicable to structured inpatient or outpatient rehabilitation settings where supervised exercise programmes can be implemented. Generalisability across specific substance types (alcohol, opioids, stimulants) remains uncertain.

Abstract

BACKGROUND: The increasing number of individuals with substance use disorder (SUD) has a serious impact on individuals, families, and society. As a complementary therapy, physical exercise has been used in the rehabilitation of individuals with SUD. This study systematically aimed to evaluate the effect of physical exercise interventions on enhancing executive function in individuals with SUD. METHODS: Electronic databases were searched, covering the period from their inception to December 26, 2024. The Cochrane Risk of Bias Assessment Tool was utilized to assess the methodological quality of the included literature. Data were extracted from study graphs using GetData Graph Digitizer 2.26, and Stata 17.0 was also employed to conduct analysis. Grading of recommendations assessment, development and evaluation pro was utilized to evaluate the quality of evidence of outcome indicators. RESULTS: Nine studies, encompassing 752 participants, were included in the analysis. Compared with the control group, physical exercise improved inhibition (Hedges's g = 0.47, 95% CI: 0.29 to 0.65, P < .001) and working memory (Hedges's g = 0.42, 95% CI: 0.16 to 0.69, P = .002), but did not significantly affect cognitive flexibility (Hedges's g = 0.51, 95% CI: -0.22 to 1.24, P = .170). Subgroup analysis revealed that physical exercise with single time of 46 to 60 minutes (Hedges's g = 0.39, 95% CI: 0.05 to 0.73, P = .024), 5 times per week (Hedges's g = 0.45, 95% CI: 0.07 to 0.83, P = .020), duration of 8 weeks (Hedges's g = 0.46, 95% CI: 0.14 to 0.77, P = .004) may improve working memory in individuals with SUD (these subgroup findings are exploratory and should be interpreted as hypothesis-generating). CONCLUSION: Evidence from this study suggests physical exercise may enhance inhibition and working memory in individuals with SUD. However, the improvement in cognitive flexibility requires further investigation in future studies.

References

1. 1.Chen, J., Zhang, X., Kabachkova, A. V., Zeng, S., & Xiao, W. (2026). Effect of physical exercise on executive function in individuals with substance use disorder: A systematic review and meta-analysis. Medicine. https://doi.org/10.1097/MD.0000000000049771