# Effects of Physical Exercise on Substance Use Disorder: A Comprehensive Review
## 3 Results
### Assessment and Impact of Physical Exercise on Crawings in Individuals with SUD
#### 3.3.1. Craving and Types of Physical Exercise in Intervention Programs  
Various studies have analyzed the impact of exercise type on the desire to consume substances, identifying three main comparisons between modalities [37; 51; 57]. One study evaluated the \"Chan-Chuang\" modality (combining mindfulness, isometric exercises, and strength training) [57]. Another one compared moderate-intensity aerobic exercise with strength training [51]. A third one investigated the difference between low-intensity aerobic exercise, such as walking, and moderate-intensity aerobic exercise, such as treadmill running [37]. In the literature, aerobic interventions are the most frequently employed for reducing cravings in individuals with SUD [45]. These include activities such as cycling, outdoor running, treadmill running, walking, and dancing. Aerobic exercises are the most common due to their simplicity and accessibility, requiring minimal equipment and being feasible in rehabilitation centers, gyms, or supervised sessions without advanced technical demands (e.g., strength-based programs). Moreover, group aerobic exercises provide physical and social benefits. Group settings promote social interaction, improve psychological factors, and enhance treatment adherence, all of which are crucial for recovery. Evidence suggests that aerobic-based interventions are more effective than mind-body exercises (e.g., Yoga, Qigong, Tai Chi) in reducing craving levels [92; 97; 100]. This effect may be related to the release of neurotransmitters, such as dopamine and endorphins, which are not as strongly stimulated by mind-body exercises [101]. The effectiveness of mind-body therapies in individuals with SUD remains unclear in the current literature due to inconsistent results. Only two out of the four studies using mind-body therapies reported significant reductions in craving scores compared to control groups. In one study, the Tai Chi group demonstrated a significantly greater reduction than the control group (\(p<0.05\)), with differences observed at three and six months post-intervention (\(p=0.01\); \(p<0.05\)) [70]. Another study using Tai Chi reported significant improvements in cravings in both the standard therapy and the Tai Chi groups, with greater improvements in the latter (\(p<0.05\)) [94]. However, the latest meta-analysis did not support mind-body therapies, finding no significant differences compared to standard therapy (SMD = \(-0.33\); \(Z\) = \(1.76\); \(p=0.08\)) [45]. Mind-body programs show considerable variability in their techniques (e.g., Yoga, Tai Chi, Qigong, Chan-Chuang), which often combine breathing, meditation, and mental focus to promote physical and mental well-being. While they may benefit individuals with low physical activity levels, they likely fail to meet the minimum physical demands necessary to induce the biophysiological responses required to reduce cravings in SUD populations. This raises questions about their suitability as effective physical exercise interventions for this issue. Programs focusing on muscle strength development are typically not standalone interventions but are combined with aerobic exercises [15; 44; 54; 55; 75]. Two distinct concurrent exercise program structures are noted: sequential programs (aerobic training followed by strength training) [55] and simultaneous or combined approaches [102]. In one study by [PERSON] et al. (2015) [37], a 12-week program focused on improving muscular endurance and aerobic capacity. Qualitative analyses (interviews) supported incorporatingphysical exercise into SUD rehabilitation programs, achieving significant improvements in parameters such as quality of life across various dimensions, including physical functioning (F(1,35) = 8.72; \(p<0.01\); ES = 0.20), general health (F(1,35) = 4.16; \(p<0.05\); ES = 0.10), vitality (F(1,35) = 17.00; \(p<0.01\); ES = 0.33), social functioning (F(1,35) = 15.74; \(p<0.01\); ES = 0.31), and mental health (F(1,35) = 14.74; \(p<0.01\); ES = 0.30) compared to the control group.