Effects of Exercise on Sleep Quality and Insomnia in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

Study Objectives: We conducted a meta-analysis to assess the effects of different regular exercise (lasting at least 2 months on a regular basis) on self-reported and physiological sleep quality in adults. Varied exercise interventions contained traditional physical exercise (e.g., walking, cycling) and mind–body exercise characterized by gentle exercise with coordination of the body (e.g., yoga).Methods: Procedures followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Systematical searches were conducted in three electronic databases (PubMed, Embase, and Web of Science) for relevant research that involved adult participants without pathological diseases receiving exercise intervention. The search strategy was based on the population, intervention, comparison, and outcome study design (PICOS) framework. The self-reported outcomes included varied rating scales of Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and Epworth Sleepiness Scale (ESS). Subgroup meta-analyses of PSQI scores were conducted based on type of exercise, duration of intervention, and participants' age and gender. The physiological outcomes were measured by Actigraph. All meta-analyses were performed in a fixed or random statistic model using Revman software.Results: Twenty-two randomized controlled trials were included in the analysis. The overall analysis on subjective outcomes suggests that exercise interventions significantly improved sleep quality in adults compared with control interventions with lower PSQI (MD −2.19; 95% CI −2.96 to −1.41), ISI (MD −1.52; 95% CI −2.63 to −0.41), and ESS (MD −2.55; 95% CI −3.32 to −1.78) scores. Subgroup analyses of PSQI scores showed both physical and mind–body exercise interventions resulted in improvements of subjective sleep to the same extent. Interestingly, short-term interventions (≤3 months) had a significantly greater reduction in sleep disturbance vs. long-term interventions (>3 months). Regarding physiological sleep, few significant effects were found in various sleep parameters except the increased sleep efficiency in the exercise group vs. control group.Conclusions: Results of this systematic review suggest that regular physical as well as mind–body exercise primarily improved subjective sleep quality rather than physiological sleep quality in adults. Specifically, self-reported sleep quality, insomnia severity, and daytime sleepiness could be improved or ameliorated with treatment of exercise, respectively, evaluated by PSQI, ISI, and ESS sleep rating scales.

Distúrbios do sono e exercício físico regular na atenção primária à saúde: estudo observacional

“…Studies on physical exercise and sleep show that participation in regular physical exercise programs has positive effects on sleep quality, mood and cognitive skills, further suggesting that high levels of exercise prevent insomnia 25,26 . Our findings also corroborate the systematic review conducted by Xie et al 27 who analyzed the effects of physical exercise on sleep quality and insomnia in adults, noting a greater risk of insomnia for those who do not exercise and a reduction in the severity of insomnia and improvements in sleep quality after its practice.…”

Effect of Physical Exercise on Sleep Quality in Elderly Adults: A Systematic Review with a Meta-Analysis of Controlled and Randomized Studies

“…Rubio-Arias [40] et al, in a study evaluating middleaged women, found different results according to the exercise protocol applied: while there was no significant improvement in groups that performed low-intensity exercise (yoga), groups that engaged in moderate exercise (aerobic exercise) showed improvement in sleep quality. Xie et al [41], in a systematic review of 22 randomized clinical trials that included adults over 18 years of age, showed that overall, both classical exercises (walking, cycling) and mind-body exercises (yoga) improved sleep quality to the same degree.…”

Practice recommendations for the role of physiotherapy in the management of sleep disorders: the 2022 Brazilian Sleep Association Guidelines

“…The practice of physical exercise improved subjective sleep quality in people with insomnia (symptom and disorder), but the objective improvement was observed only in individuals with insomnia symptoms 350 . There is evidence of the benefits of regular practice (duration of at least 2 months) of different types of physical exercises (physical and body-mind) in the quality of sleep and insomnia 361 . The most recent systematic review on the effects of exercise identified improvements in subjective sleep parameters, as well as decreased severity of insomnia, with a moderate power of effect 362 .…”