# Effects of Physical Exercise on Substance Use Disorder: A Comprehensive Review
## 5 Future Perspectives and Areas for Improvement  
The integration of physical exercise into rehabilitation programs for individuals with SUD represents a viable and effective strategy, not only for improving treatment adherence but also for fostering comprehensive recovery. However, significant challenges remain that require attention:  
Heterogeneity in Interventions: The variability in exercise types, intensities, frequencies, and duration limits the comparability of results and makes it difficult to establish standardized recommendations. Well-defined protocols would optimize interventions and ensure replicable outcomes.  
Need for Comprehensive Evaluation: The diversity of measurement instruments and the lack of studies focusing on strength-based programs highlight areas requiring further investigation. Comprehensive evaluations combining physical, cognitive, and emotional parameters would facilitate the design of more holistic interventions.  
Technology and Adherence: Incorporating wearable devices, such as daily HRV monitoring via smartphones or pulse bands, can provide valuable insights into participants' physiological responses and overall adaptation to the exercise program. They offer a more comprehensive understanding of changes in the autonomic nervous system, sleep quality, and mood states. Moreover, hybrid models (combining in-person and autonomous sessions) could enhance adherence to programs and ensure their sustainability. This approach may be particularly beneficial for populations struggling to maintain consistent routines.  
While moderate-intensity aerobic programs currently represent the most effective modality, mind-body disciplines, HIIT, and concurrent programs also play important roles in an integrative therapeutic approach. Moving toward standardized protocols, incorporating technology, and addressing diverse populations will maximize their therapeutic impact and improve the quality of life for this population.  
The following supporting information can be downloaded at: [[https://www.mdpi.com/article/10.3390/app15031481/s1](https://www.mdpi.com/article/10.3390/app15031481/s1)]([https://www.mdpi.com/article/10.3390/app15031481/s1](https://www.mdpi.com/article/10.3390/app15031481/s1)), Table S1: Quality assessment of reviewed articles using the PEDro scale.  
Conceptualization, R.M.-M., A.R. and M.M.-R.; methodology, R.M.-M., A.J., I.P.-G., D.P. and M.M.-R.; formal analysis, R.M.-M., I.C.-G., I.P.-G., A.R. and M.M.-R.; resources, R.M.-M., A.R. and J.M.S.; writing--original draft preparation, R.M.-M., I.C.-G., D.P. and A.R.; writing--review and editing, R.M.-M., A.J., I.P.-G., D.P., A.R., J.M.S. and M.M.-R.; supervision, A.R. and M.M.-R.; project administration, M.M.-R.; funding acquisition, M.M.-R. All authors have read and agreed to the published version of the manuscript.  
**Funding:** This publication is part of the projects PID2019-107721 RB-I00 and EXP_74973 funded by MICIU/AEI/10.13039/501100011033 and European Union NextGenerationEU/PRTR.  
**Institutional Review Board Statement:** Not applicable.  
**Informed Consent Statement:** Not applicable.  
**Data Availability Statement:** No new data were created or analyzed.  
**Conflicts of Interest:** The authors declare no conflicts of interest.