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, 6, e5172

Exercise Can Improve Sleep Quality: A Systematic Review and Meta-Analysis


Exercise Can Improve Sleep Quality: A Systematic Review and Meta-Analysis

Masahiro Banno et al. PeerJ.


Background: Insomnia is common. However, no systematic reviews have examined the effect of exercise on patients with primary and secondary insomnia, defined as both sleep disruption and daytime impairment. This systematic review and meta-analysis aimed to examine the effectiveness/efficacy of exercise in patients with insomnia.

Methods: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, PsycINFO, World Health Organization International Clinical Trials Registry Platform, and to identify all randomized controlled trials that examined the effects of exercise on various sleep parameters in patients with insomnia. All participants were diagnosed with insomnia, using standard diagnostic criteria or predetermined criteria and standard measures. Data on outcome measures were subjected to meta-analyses using random-effects models. The Cochrane Risk of Bias Tool and Grading of Recommendations, Assessment, Development, and Evaluation approach were used to assess the quality of the individual studies and the body of evidence, respectively.

Results: We included nine studies with a total of 557 participants. According to the Pittsburgh Sleep Quality Index (mean difference [MD], 2.87 points lower in the intervention group; 95% confidence interval [CI], 3.95 points lower to 1.79 points lower; low-quality evidence) and the Insomnia Severity Index (MD, 3.22 points lower in the intervention group; 95% CI, 5.36 points lower to 1.07 points lower; very low-quality evidence), exercise was beneficial. However, exercise interventions were not associated with improved sleep efficiency (MD, 0.56% lower in the intervention group; 95% CI, 3.42% lower to 2.31% higher; moderate-quality evidence). Only four studies noted adverse effects. Most studies had a high or unclear risk of selection bias.

Discussion: Our findings suggest that exercise can improve sleep quality without notable adverse effects. Most trials had a high risk of selection bias. Higher quality research is needed.

Keywords: Exercise; Meta-analysis; Physical activity; Sleep disorders; Systematic reviews.

Conflict of interest statement

Masahiro Banno has received speaker honoraria from Dainippon Sumitomo, Eli Lilly, and Otsuka; honoraria for a manuscript from Seiwa Shoten Co., Ltd, SENTAN IGAKU-SHA Ltd and Kagakuhyoronsha Co., Ltd.; and travel fees from Yoshitomi Pharmaceutical Industries Ltd. Yuki Kataoka received research funds from Eli Lilly. The other authors declare no competing interests.


Figure 1
Figure 1. PRISMA 2009 flow diagram.
CENTRAL: Cochrane Central Register of Controlled Trials; ICTRP, International Clinical Trials Registry Platform; RCTs, randomized controlled trials
Figure 2
Figure 2. (A) Risk of bias graph (B) Risk of bias summary.
(A) Review author judgments about the risk for each bias item presented as percentages across all included trials. (B) Review author judgments about the risk for each bias item in all included trials.
Figure 3
Figure 3. (A) Forest plot of comparison: Total PSQI score (B) Forest plot of comparison: Sleep efficiency (%) (C) Forest plot of comparison: Total ISI score.
(A) Total PSQI score was measured subjectively. IV, inverse variance; PSQI, Pittsburgh Sleep Quality Index (B) Sleep efficiency was measured objectively by the devices (e.g., PSG, actigraphy). IV, inverse variance; PSG, polysomnograph (C) Total ISI score was measured subjectively. ISI, Insomnia Severity Index; IV, inverse variance

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Grant support

This work was supported by Japan Society for the Promotion of Science (KAKENHI Grant Number 25282210), Nagoya University Academy of Psychiatry, and self-funding. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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