Sleep quality in perimenopausal and postmenopausal women: which exercise therapy is the most effective? A systematic review and network meta-analysis of 31 RCTs

The effectiveness of various exercise types in improving sleep quality in menopausal women remains controversial. This network meta-analysis was designed to evaluate and rank the efficacy of five exercise modalities on sleep quality in peri-postmenopausal women. Five English databases and three Chinese databases were searched for randomized controlled trials (RCTs) published from inception to July 2024. Pairwise meta-analysis and frequentist network meta-analyses were performed based on the random effects model. The analysis revealed that younger menopausal women (age ≤55 years) (standardized mean difference [SMD] = -2.00; 95% confidence interval [CI] [-2.70, -1.31]), those with sleep disorders (SMD = -2.29; 95% CI [-2.79, -1.78]) and those from Asia (SMD = -2.50, 95% CI [-3.62, -1.38]) were able to derive greater health benefits. Flexibility exercise (low certainty) and aerobic exercise (low certainty), combined exercise (moderate certainty) and mind-body exercise (moderate certainty) significantly improved sleep quality. Combined exercise showed the highest efficacy (surface under the cumulative ranking curve [SUCRA] = 93.5%), followed by flexibility exercise (SUCRA = 76%), and these exercises also showed a positive effect on women's quality of life (SMD = 0.49; 95% CI [0.13, 0.84]; p = 0.007). Future research should develop more acceptable exercise intervention models and use combined and flexibility exercises to explore the optimal parameters of exercise for menopausal women.