Effect of exercise intervention on primary insomnia: a meta-analysis

Exercise can have a positive effect on body functioning and immunity. This study systematically evaluated the effect of exercise intervention on patients diagnosed with primary insomnia. Based on the meta-analysis, we developed exercise recommendations to help improving sleep quality in these patients.

Using a combination of manual and electronic retrieval strategies, we examined the CNKI, VIP, Wanfang, Web of Science, SpringerLink, EBSCO, PubMed, Cochrane Library, and Embase databases; and identified randomized controlled trials that addressed the effects of exercise intervention on primary insomnia and were published before October 2019. Risk of bias was assessed based on the Cochrane Handbook 5.1.0, and meta-analysis was conducted using STATA 13.0 (StataCorp LLC; College Station, TX, USA).

Data were included for 1269 patients who received exercise interventions and 1203 patients who received drug therapy or no intervention (controls) in 23 trials of high quality. Meta-analysis showed that exercise intervention had a significant effect on the treatment of primary insomnia (SMD: -1.64, 95% CI: -2.08 to -1.19, P<0.001). Subgroup analysis showed significant effect sizes for older patients (>60 years) (SMD: -1.69, 95% CI: -2.40 to -0.97, P<0.001), aerobic exercise (SMD: -2.21, 95% CI: -2.89 to -1.53, P<0.001), interventions lasting 8-12 weeks (SMD: -2.58, 95% CI: -3.61 to -1.54, P<0.001), interventions lasting ≤60 min (SMD: -2.29, 95% CI: -3.66 to -0.92, P=0.001), Asian patients (SMD: -1.86, 95% CI: -2.42 to -1.31, P<0.001), and interventions ≤4 times/week (SMD: -1.70, 95% CI: -2.29 to -1.11, P<0.001). Both bias and sensitivity analyses suggested that our meta-analysis gave robust results.

Our results indicate that exercise intervention has a significant positive influence on primary insomnia, especially for older patients. We recommend that an exercise regimen of 60 min 4-5 times a week for 8-12 weeks can improve sleep quality and treat the symptoms of primary insomnia. Future studies should focus on verifying and extending our results by increasing sample size and improving the quality of studies included.