Impact of physical activity and social support on mental health, quality of life and substance use in adults with dual diagnosis: a systematic review

Purpose This study aims to synthesize empirical evidence on the impact of physical activity and social support on clinical outcomes in adults with dual diagnosis, including psychiatric symptoms, substance use, craving and quality of life. Design/methodology/approach The review followed PRISMA 2020 guidelines and was prospectively registered in PROSPERO (CRD420251041091). Searches were conducted in PubMed, Scopus, Web of Science and PsycINFO for studies published between January 2014 and April 2025. Eligible studies were randomized or quasi-experimental trials involving adults with co-occurring mental and substance use disorders (SUDs) who received structured physical activity or social support interventions. Risk of bias was assessed using the Cochrane RoB 2.0 tool, and the certainty of evidence was evaluated with GRADE. Given study heterogeneity, results were synthesized narratively. Findings Sixteen randomized controlled trials were included, covering diverse populations with mood, psychotic and trauma-related disorders. Physical activity interventions – particularly high-intensity or structured programs – showed significant reductions in craving, depressive and anxiety symptoms and substance use frequency. Social support interventions improved treatment adherence, emotional regulation and perceived well-being, though effects on social functioning were more variable. Combined interventions integrating both components produced the most consistent improvements across outcomes. Certainty of evidence was rated as moderate for psychiatric symptoms and substance use, and low for craving and social functioning due to heterogeneity and imprecision. Research limitations/implications This review was limited by the heterogeneity of interventions, outcome measures and study populations, which prevented quantitative synthesis. Some included studies had small samples and moderate risk of bias. Follow-up durations were generally short, and few trials evaluated long-term effects. Despite these limitations, the review provides a comprehensive synthesis of recent evidence. Future studies should use larger, multicenter samples and standardized intervention protocols to clarify causal mechanisms and strengthen the evidence base for physical activity and social support as adjunctive strategies in dual diagnosis rehabilitation. Practical implications The findings support integrating structured physical activity and enhanced social support into treatment programs for adults with dual diagnosis. These interventions can complement pharmacological and psychotherapeutic approaches, improving adherence, emotional regulation and relapse prevention. Their low cost and scalability make them feasible in both inpatient and community settings. Mental health professionals should consider individualized, culturally adapted programs that align with patients’ motivation and capacity, fostering sustainable recovery and quality of life improvements in clinical practice. Social implications Individuals with dual diagnosis often face stigma, marginalization and limited access to social networks. Interventions that promote physical activity and social connectedness may reduce isolation, enhance self-efficacy and rebuild interpersonal trust. Encouraging participation in structured group activities and peer-based programs can strengthen community reintegration and social functioning. These strategies contribute to greater inclusion and autonomy, supporting recovery-oriented approaches in mental health services for people with cooccurring psychiatric and SUDs. Originality/value This review is the first to synthesize evidence from randomized controlled trials on the combined impact of physical activity and social support in dual diagnosis. It highlights the potential of nonpharmacological, person-centered interventions as protective factors that enhance mental health outcomes and quality of life. The review provides evidence to inform integrative and rehabilitative treatment approaches tailored to the needs of this underserved population.