Physical exercise has emerged as a promising complementary intervention for individuals with substance use disorders (SUD). This comprehensive review examines the neurobiological, psychological, and social benefits of exercise in improving quality of life (QOL), mental health, sleep quality, craving, physical fitness, and cognitive function among individuals with SUD. Aerobic exercises, particularly those of moderate intensity, demonstrate a consistent efficacy in reducing anxiety, depression, and cravings, while also enhancing cardiovascular health and psychosocial well-being. Strength training and concurrent programs provide additional benefits for muscular and cognitive function, although their effects on mental health are less consistent. Mind–body disciplines like yoga and Tai Chi offer accessible entry points for individuals with low baseline fitness but exhibit variable outcomes, especially in sleep and craving management. High-intensity interval training (HIIT) shows potential for craving reduction and cardiovascular improvements but may pose challenges for individuals with low initial fitness. This review underscores the importance of tailored, well-structured programs that align with participants’ needs and capabilities. Future research should prioritize standardizing protocols, incorporating technological tools, and exploring hybrid intervention models to maximize adherence and therapeutic impact. Physical exercise remains a vital, multifaceted tool in comprehensive SUD rehabilitation strategies.

Background: Substance use disorders pose unique challenges, affecting individuals physiologically and socially. This study addresses the fundamental question of how adherence to exercise programs impacts those with substance use disorders, examining both in-person and online interventions. Methods: A 12-week analysis involving 26 participants assessed physical fitness, strength, and quality of life. Participants were categorized into in-person and online exercise groups, with their adherence tracked through attendance and a dedicated app. Results: The in-person group exhibited higher adherence rates and significant improvements, in contrast to the challenges encountered by the online groups, particularly in substance use disorder cohorts. Statistical analyses highlighted these differences, emphasizing the pivotal role of the exercise program delivery format. Conclusions: This research advocates for hybrid models, blending professional supervision with online flexibility, recognizing the distinct challenges of substance use disorders. Insights from this study will contribute to shaping more effective, personalized interventions in the complex landscape of substance use disorders, offering guidance for advancing treatment strategies.