Effects of exercise on anxiety and depression in patients with insomnia: a systematic review and meta-analysis

Chronic insomnia can negatively influence physical health and mental health, including symptoms of anxiety and depression, which have a bidirectional association with insomnia. In separate studies, exercise has elicited significant improvements in insomnia and reductions in anxiety and depressed mood. The objective of this systematic review and meta-analysis was to evaluate the effects of exercise on symptoms of anxiety and depression as primary outcomes in patients with insomnia. Secondary outcomes were improvements in sleep. A systematic literature review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search was conducted in Embase, Scopus, Web of Science, CINAHL, PsycINFO, CENTRAL, MEDLINE and SPORTDiscus databases. Six randomized controlled trials (RCT) and one Quasi-RCT, published between 2010 and 2022 (with a total of 336 participants), were selected. The results showed that exercise interventions significantly improved anxiety (SMD -0.44, 95% CI = -0.72 to -0.15), depressed mood (SMD -0.53, 95% CI = -0,78 to -0.29), the Insomnia Severity Index (SMD -0.62, 95% CI = -0.87 to -0.37) and the Pittsburg Sleep Quality Index (MD -2.94, 95% CI = -3.85 to -2.03). In actigraphic assessments, a significant reduction in wake after sleep onset was found (MD -8.67, 95% CI = -16.17 to -1.17). The meta-analysis results indicate that exercise in patients with insomnia significantly improved anxiety and depression, reduced insomnia severity, increased sleep quality, and decreased wake after sleep onset (PROSPERO, CRD42022374853).