Exercise-based interventions for smoking cessation: A systematic review and meta-analysis

BACKGROUND: Tobacco smoking and e-cigarette use remain major global public health challenges, with current cessation strategies often limited by poor adherence, modest effectiveness, and accessibility barriers. Exercise is a promising behavioral strategy for nicotine cessation, but its effects on smoking and vaping outcomes are unclear. This systematic review and meta-analysis aimed to synthesize evidence on the effects of single-bout and long-term exercise interventions on smoking and vaping cessation, cravings, withdrawal symptoms, and mood in adults. METHODS: Eleven databases were searched up to March 28, 2025. Eligible studies were randomized controlled trials (RCTs) evaluating exercise interventions in adults reporting smoking- or vaping-related outcomes. Outcomes included continuous and point prevalence abstinence, cigarette consumption, and cravings. Risk of bias (ROB2) and certainty of evidence (Grading of Recommendations Assessment, Development and Evaluation (GRADE)) were assessed. Random-effects meta-analyses and subgroup analyses were conducted. RESULTS: Fifty-nine RCTs (n = 9083) were included: 43 exercise training studies (n = 8548) and 16 single-bout studies (n = 535). Exercise training increased continuous abstinence (risk ratio (RR) = 1.15; 95% confidence interval (95%CI): 1.01‒1.32; p = 0.04; 23 RCTs; n = 5512) and 7-day point prevalence abstinence (RR = 1.21; 95%CI: 1.03 to 1.43; p = 0.02; 18 RCTs; n = 4455), and reduced cigarettes/day (mean difference = -2.12; 95%CI: -3.30 to -0.93). Single-bout exercise reduced acute cravings immediately and up to 30 min post-exercise (standardized mean difference range: -0.88 to -0.52) but not longer-term cravings. Aerobic exercise improved continuous abstinence in training studies, while higher-intensity bouts produced greater craving reductions in single-bout studies. Evidence for resistance training, yoga, and other non-aerobic modalities was more limited but suggested potential benefits for cravings and smoking outcomes, although data were insufficient for modality-specific pooled estimates. No trials assessed vaping cessation outcomes. CONCLUSION: Exercise is associated with modest improvements in cigarette consumption and acute suppression of cravings, supporting its potential as a low-risk behavioral aid for nicotine cessation. Future research should target vaping-specific outcomes and optimal intervention delivery. Exercise represents a promising smoking cessation intervention.