Exercise intervention on sleep quality in Alzheimer's disease: a systematic review and meta-analysis

Patients with Alzheimer's disease (AD) are often accompanied by severe sleep disorders, which exacerbate with disease progression. Currently, pharmacological treatments have limitations, and the effect of exercise as a non-pharmacological intervention on improving sleep quality in AD patients requires systematic evaluation.

This study systematically searched six databases up to December 31, 2025, and included randomized controlled trials (RCTs) investigating the effects of exercise interventions on sleep quality in patients with Alzheimer's disease. Two researchers independently completed literature screening, data extraction, and risk of bias assessment. Data analysis and literature quality evaluation were performed using Review Manager 5.4 software, and effect sizes were pooled using standardized mean differences (SMD).

A total of 12 RCTs involving 893 patients were finally included. Meta-analysis results showed that exercise interventions significantly improved patients' subjective sleep quality, with a pooled effect size (SMD) of -0.81 for the Pittsburgh Sleep Quality Index (PSQI) score (95%CI: -1.55 to -0.06, p = 0.030). However, regarding objective sleep indicators, the improving effects of exercise on sleep efficiency (SMD = -0.23, 95%CI: -0.98 to 0.52, p = 0.850) and total sleep duration (SMD = 0.25, 95%CI: -0.53 to 1.03, p = 0.530) did not reach statistical significance. Subgroup analyses showed that the intervention effects were more significant in the subgroup with baseline PSQI > 10 (SMD = -1.92, 95% CI: -3.61 to -0.24, p = 0.03), the subgroup with single exercise duration ≥ 1 h (SMD = -1.34, 95% CI: -2.65 to -0.02, p = 0.05), and the aerobic exercise intervention subgroup (SMD = -1.34, 95% CI: -2.65 to -0.02, p = 0.05).

Exercise interventions may improve subjective sleep quality in patients with Alzheimer's disease, with potentially greater benefits observed in those with more severe baseline sleep disturbances or exercise sessions lasting ≥1 h; however, their effects on objective sleep outcomes have not yet been fully established. Further large-scale studies with more rigorous methodology and combined subjective and objective assessments are needed to clarify the true benefits of exercise on sleep in patients with Alzheimer's disease and to determine the optimal intervention regimen.

https://www.crd.york.ac.uk/PROSPERO/view/CRD420251270397.