Exercise Training Interventions as Therapeutic Approaches in Substance Use Disorder Treatment: A Scoping Review of Direct Clinical Outcomes and Implementation Strategies

Background/Objectives: Substance use disorders (SUDs) remain a major public health challenge, with high relapse rates despite established pharmacological and behavioral treatments. This scoping review maps evidence on structured exercise interventions as therapeutic approaches in SUD treatment, focusing on direct clinical outcomes, substance-specific effects, and implementation strategies. Methods: Following PRISMA-ScR and JBI guidance, searches of PubMed, Scopus, PsycINFO, and SPORTDiscus identified human studies published from 2000 to 31 December 2024 that evaluated supervised exercise interventions in adults with SUDs. Results: Evidence from randomized trials and recent network meta-analyses indicates clinically relevant benefits for abstinence, craving reduction, mood symptoms, cognitive function, treatment retention, and withdrawal management. Moderate-to-vigorous aerobic exercise delivered three to four times weekly for at least 12 weeks, at approximately 180 MET-minutes per week, appears particularly effective, while combined aerobic and muscle-performance protocols may yield broader benefits. Conclusions: Exercise interventions show strong potential as adjuncts to SUD care. Implementation should incorporate individualized prescription, substance-specific safety screening, cardiovascular and psychiatric monitoring, and multidisciplinary coordination. Further long-term randomized trials, mechanistic studies, and cost-effectiveness evaluations are needed.