Comparative efficacy of exercise modalities on sleep architecture in adults with sleep disorders: a systematic review...

This study aims to evaluate the efficacy of exercise interventions on sleep architecture in individuals with sleep disorders and to determine the optimal exercise modalities.

A comprehensive search of PubMed, Embase, EBSCO, Scopus, PsycINFO, and Web of Science was performed for randomized controlled trials (RCTs) published up to March 2025. Meta-analyses and Bayesian network meta-analyses (NMA) were performed using a random-effects model, with mean differences (MDs) as the effect size measure. Subgroup analyses were performed to explore potential moderating factors. The GRADE framework and Cochrane Risk of Bias 2.0 Tool were used to assesse evidence certainty and risk of bias, respectively.

Eighteen studies involving 1214 individuals were included. Exercise interventions improved sleep efficiency (SE) (MD = 2.85; 95 % CI = 0.85, 4.84), reduced wake after sleep onset (WASO) (MD = -10.16; 95 % CI = -15.68, -4.64) and extended slow wave sleep (SWS) (MD = 2.19; 95 % CI = 0.35, 4.03). Short-term interventions (8-12 weeks) with medium frequency (3 times/week) and duration (45-60 min/session) improved SE and WASO, while high frequency (≥4 times/week) were more effective in enhancing SWS, especially in individuals with obstructive sleep apnea (OSA). The NMA indicated that moderate-intensity aerobic exercise (MIAE) was most effective in improving SE and WASO.

Exercise interventions improve sleep architecture in adults with sleep disorders. Optimal exercise parameters in SE and WASO improved most with 8-12 week interventions of 3 weekly 45-60 min sessions. Interventions of four or more times per week were more effective at increasing SWS, especially in individuals with OSA. MIAE is recommended for clinical application to optimize sleep outcomes.