Effects of various exercise interventions in insomnia patients: a systematic review and network meta-analysis

OBJECTIVES: To compare the effectiveness of different exercise interventions in improving sleep quality and alleviating insomnia severity among patients with insomnia. DESIGN: Our study design was a systematic review and network meta-analysis. ELIGIBILITY CRITERIA: Our study eligibility criteria was restricted to include randomised controlled trials (RCTs) involving adults with insomnia that evaluated exercise-based interventions. DATA SOURCES: PubMed, Cochrane Library, Embase, Web of Science, SPORTDiscus, and PsycINFO databases were systematically searched from inception to 1 April 2025. RISK OF BIAS AND CERTAINTY ASSESSMENT: Risk of bias was assessed using the Cochrane Risk of Bias 2 Tool. The certainty of the evidence was evaluated using the Confidence in Network Meta-Analysis (CINeMA) platform. SYNTHESIS OF RESULTS: A frequentist network meta-analysis was performed to assess the effectiveness of interventions, with outcomes presented as mean differences (MDs) and 95% confidence intervals (95% CIs). Sleep outcomes were measured using validated tools, including the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), sleep diaries, and combined objective sleep measures such as polysomnography or actigraphy. RESULTS: The review included 1348 participants from 22 RCTs, examining 13 distinct interventions, of which seven were exercise-based: yoga, Tai Chi, walking or jogging, aerobic plus strength exercise, strength training alone, aerobic exercise combined with therapy, and mixed aerobic exercises. Among the included trials, four (18%) were rated as low risk of bias, 15 (68%) had some concerns, and three (14%) were considered to have a high risk. Compared with active controls (eg, usual care, lifestyle modifications), yoga likely results in a large increase in total sleep time (MD 110.88 minutes (min), 95% CI 58.66 to 163.09; moderate-certainty evidence) and may improve sleep efficiency (MD 15.59%, 95% CI 5.76 to 25.42; low-certainty evidence), reduce wake after sleep onset (MD -55.91 min, 95% CI -98.14 to -13.68; low-certainty evidence), and shorten sleep onset latency (MD -29.27 min, 95% CI -50.09 to -8.45; low-certainty evidence), all based on sleep diary data. Walking or jogging may result in a large reduction in ISI scores (MD -9.57 points, 95% CI -12.12 to -7.02; low-certainty evidence). Tai Chi may reduce PSQI scores (MD -4.57 points, 95% CI -7.50 to -1.63; low-certainty evidence), increase total sleep time (MD 52.07 min, 95% CI 25.53 to 78.61; low-certainty evidence), reduce wake after sleep onset (MD -36.11 min, 95% CI -62.81 to -9.42; low-certainty evidence), and shorten sleep onset latency (MD -24.76 min, 95% CI -41.07 to -8.46; low-certainty evidence), also based on sleep diary data. Additionally, Tai Chi may increase total sleep time as measured by combined objective sleep measures (MD 24.09 min, 95% CI 4.66 to 43.52; low-certainty evidence). CONCLUSION: Exercise is an effective treatment for improving sleep in patients with insomnia. Among the various exercise interventions, yoga, Tai Chi and walking or jogging are more effective than other exercises. To further validate and strengthen these conclusions, large-scale, high-quality and well-designed RCTs are needed. TRIAL REGISTRATION NUMBER: CRD42024541899.