Chronic effects of different exercise modalities on executive function in Chinese individuals with substance use disorders: a systematic review and network meta-analysis

Objective To systematically evaluate the chronic effects of different exercise modalities on executive function in Chinese individuals with substance use disorders (SUD) through a network meta-analysis. Methods PubMed, Web of Science, Embase, Cochrane Library, MEDLINE, CNKI, Wanfang Data, and VIP databases were systematically searched from inception to January 2026. The risk of bias of included randomized controlled trials (RCTs) was assessed using the Cochrane ROB 2.0 tool, and the certainty of evidence was evaluated using CINeMA. Statistical analyses were performed using Stata 15.0 and RevMan 5.4. Results Traditional pairwise meta-analysis showed that aerobic exercise (AE) significantly improved inhibitory control in Chinese individuals with SUD. Subgroup analysis indicated that, compared with treatment as usual (TAU), a single 30-min session possibly had no significant effect. The network meta-analysis revealed that: for inhibitory control, resistance exercise (RE) potentially ranked highest (SUCRA = 96.7%); for working memory, mind–body exercise (MBE) potentially ranked highest (SUCRA = 99.4%); and for cognitive flexibility, AE potentially ranked highest (SUCRA = 68.3%). Pairwise comparisons suggested that RE was possibly superior to AE in improving inhibitory control, and MBE was possibly superior to RE and AE in improving working memory. The certainty of evidence was mostly low or very low. Importantly, SUCRA ranking estimates should be interpreted with considerable caution. Conclusion Different exercise modalities may exert differential effects on specific executive function subdomains in Chinese individuals with SUD. However, given the sparse network structure, clinically fragile transitivity, and low certainty of evidence, all findings should be considered exploratory and hypothesis-generating rather than definitive clinical guidance. Future large-scale, multicenter RCTs are warranted to validate the stability of these results. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420261351367 , CRD420261351367.