Exercise-based interventions for smoking cessation: A systematic review and meta-analysis

BACKGROUND: Tobacco smoking and e-cigarette use remain major global public health challenges, with current cessation strategies often limited by poor adherence, modest effectiveness, and accessibility barriers. Exercise is a promising behavioral strategy for nicotine cessation, but its effects on smoking and vaping outcomes are unclear. This systematic review and meta-analysis aimed to synthesize evidence on the effects of single-bout and long-term exercise interventions on smoking and vaping cessation, cravings, withdrawal symptoms, and mood in adults. METHODS: Eleven databases were searched up to March 28, 2025. Eligible studies were randomized controlled trials (RCTs) evaluating exercise interventions in adults reporting smoking- or vaping-related outcomes. Outcomes included continuous and point prevalence abstinence, cigarette consumption, and cravings. Risk of bias and certainty of evidence (Grading of Recommendations Assessment, Development and Evaluation) were assessed. Random-effects meta-analyses and subgroup analyses were conducted. RESULTS: Fifty-nine RCTs (n = 9083) were included: 43 exercise training studies (n = 8548) and 16 single-bout studies (n = 535). Exercise training increased continuous abstinence (risk ratio (RR) = 1.15, 95% confidence interval (95%CI): 1.01‒1.32; p = 0.04; 23 RCTs; n = 5512) and 7-day point prevalence abstinence (RR = 1.21, 95%CI: 1.03-1.43; p = 0.02; 18 RCTs; n = 4455), and reduced cigarettes/day (mean difference = -2.12, 95%CI: -3.30 to -0.93). Single-bout exercise reduced acute cravings immediately and up to 30 min post-exercise (standardized mean difference range: -0.88 to -0.52) but not longer-term cravings. Aerobic exercise improved continuous abstinence in training studies, while higher-intensity bouts produced greater craving reductions in single-bout studies. Evidence for resistance training, yoga, and other non-aerobic modalities was more limited but suggested potential benefits for cravings and smoking outcomes, although data were insufficient for modality-specific pooled estimates. No trials assessed vaping cessation outcomes. CONCLUSION: Exercise is associated with modest improvements in cigarette consumption and acute suppression of cravings, supporting its potential as a low-risk behavioral aid for nicotine cessation. Future research should target vaping-specific outcomes and optimal intervention delivery. Exercise represents a promising smoking cessation intervention.