Effects of exercise on executive function in individuals with drug addiction: a systematic review and three-level meta-analysis.

Objective: This systematic review and three-level meta-analysis sought to examine the effectiveness of exercise-based interventions on EF among individuals with drug addiction and to determine the role of key moderating factors in this association. Methods: A systematic database exploration across Embase, Scopus, PubMed, and Web of Science databases was conducted up to April 30, 2025. Eligible studies were randomized controlled trials (RCTs), and their methodological quality was examined utilizing the cochrane risk of bias tool (RoB 2.0). A three-level meta-analysis applying random-effects models was implemented through R software to synthesize findings from RCTs exploring the effects of exercise on EF in individuals with drug addiction. Results: Eleven RCTs encompassing 906 adult participants with drug addiction were included. Four of the studies were rated as high risk. The findings revealed significant improvements in overall EF [Hedges' g [g] = 0.40; 95% confidence interval [CI] = 0.28, 0.53], as well as in specific EF subdomains: inhibitory control (g = 0.25; 95% CI = 0.09, 0.42), cognitive flexibility (g = 0.58; 95% CI = 0.27, 0.88), and working memory (g = 0.57; 95% CI = 0.34, 0.79). Subgroup analyses identified that aerobic exercise (g = 0.38; 95% CI = 0.23, 0.53) and aerobic exercise combined with attentional bias training (g = 0.59; 95% CI = 0.33, 0.85) markedly improved EF. Notable improvements of EF were also associated with moderate to vigorous physical activity (g = 0.43; 95% CI = 0.30, 0.56), a frequency of 5 times per week (g = 0.42; 95% CI = 0.23, 0.60), sessions lasting ≥40 min (g = 0.45; 95% CI = 0.30, 0.59), and 12-week interventions (g = 0.48; 95% CI = 0.33, 0.64). Conclusion: Exercise appears to be an efficacious method for improving overall EF and its constituent subdomains among individuals with drug addiction. The effects of exercise on EF are modulated by the specific EF subdomains targeted. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251012748, identifier CRD420251012748.