The importance of physical activity in the therapy of disorders related to the use of psychoactive substances: a literature analysis in the light of Evidence-Based Medicine (EBM) principles

Background
In the available literature, there is increasing attention to the usefulness of physical rehabilitation in addiction treatment. Unfortunately, a fully-fledged consensus consistent with the EBM paradigm has not yet been established, which hampers the implementation of a unified and scientifically grounded physiotherapeutic treatment algorithm.

Aims
This study conducts a critical review of the literature in accordance with EBM principles concerning the potential use of dosed physical exercise in addiction treatment, along with an evaluation of the scientific evidence.

Material and methods
A bibliographic data analysis from the past ten years was used for the literature query. The resources of the following medical search engines were explored: Cochrane, PubMed, MEDLINE, Physiotherapy Evidence Database (PEDro), and the Web of Science Core Collection.

Results
The review identifies a limited number of scientific reports on the role of physical exercise in addiction therapy, with findings dispersed across studies. For example, a 2022 study showed that music and movement therapy reduced drug cravings, but its results were limited by simultaneous detox treatments. A 2023 meta-analysis indicated that moderate-intensity exercise improved depression and anxiety symptoms in individuals with withdrawal syndrome, while higher-intensity exercise was more effective in reducing withdrawal symptoms. Research also revealed that moderate-intensity exercise may activate dopamine pathways and improve the function of the endocannabinoid system, which could mitigate withdrawal symptoms. A different meta-analysis found that aerobic exercises, combined with mental training, had lasting positive effects on abstinence rates and depression in addiction treatment. Additionally, randomized clinical trials suggest that virtual reality may also have potential in reducing cravings and enhancing therapy effectiveness.

Conclusions
In light of the literature review, physical exercise appears to be a significant therapeutic procedure for individuals with addiction. However, there is still no consensus regarding precise methodological recommendations for the choice of physical activity forms and exercise intensity levels. The emergence of artificial intelligence and virtual reality may contribute to scientific advancements in this area. More high-quality clinical research is needed for proper reference