Effect of aerobic exercise on sleep quality in patients with mental disorders: A systematic review and meta-analysis

Aerobic exercise represents a viable non-pharmacological approach for enhancing sleep quality. This meta-analysis quantitatively synthesizes evidence on its efficacy in adults with mental disorders.

Comprehensive searches of PubMed/MEDLINE, Web of Science, Embase, and Cochrane Library were conducted from database inception to June 10, 2025. This systematic review included randomized controlled trials (RCTs) evaluating aerobic exercise interventions on sleep quality in patients with mental disorders. Study quality was assessed using the Cochrane RoB 2 tool. Treatment effects were pooled using random-effects models, with Hedges' g estimating effect sizes. Subgroup analyses followed the FITT principle (frequency, intensity, time).

Meta-analysis of 15 RCTs (n = 775 adults with mental disorders) demonstrated that aerobic exercise significantly improved sleep quality with a moderate effect size (g = -0.67, 95% CI: 0.95 to -0.40, p < 0.0001). Subgroup analysis by diagnostic category revealed that significant effects were observed in patients with depression (g = -0.73, p = 0.0008) and anxiety disorders (g = -0.36, p = 0.0396), but not in substance use disorder or schizophrenia subgroups. Subgroup analyses indicated larger effect sizes for interventions featuring: frequency ≥3 sessions/week (g = -0.68, p < 0.0001), low-to-moderate intensity (g = -0.73, p < 0.0001), exercise period ≥10 weeks (g = -0.64, p < 0.0001), session duration ≥30 min (g = -0.75, p = 0.0002), and weekly exercise volume >90 min (g = -0.68, p = 0.0007).

Aerobic exercise demonstrates both efficacy and safety in improving sleep quality for patients with mental disorders. Exercise prescriptions suggest long-term (≥10 weeks) low-to-moderate intensity aerobic exercise, characterized by ≥ 3 sessions/week, ≥30 min/session, and >90 min weekly volume.