Journal of Exercise Science and Fitness · Oct 1, 2026

Comparative effects of exercise modalities on sleep quality in middle-aged and older adults with sleep disorders: A systematic review with pairwise, network, and dose-responsemeta-analyses

By Wang T, Ma Z, Zhu B et al.

BACKGROUND: Exercise may improve sleep quality in middle-aged and older adults with sleep disorders, but the comparative effects of different exercise modalities and the dose-response relationship remain unclear. METHODS: We systematically searched PubMed, Web of Science, Embase, and the Cochrane Library from inception to May 2026. Eligible studies were randomized controlled trials examining the effects of exercise interventions on sleep quality in middle-aged and older adults with sleep disorders. Two independent reviewers assessed study quality, and random-effects pairwise, network, and dose-response meta-analyses were performed to evaluate the effects of different exercise interventions and doses on sleep quality. RESULTS: The analysis included 23 randomized controlled trials involving 1,478 middle-aged and older adults with sleep disorders. Pairwise meta-analysis showed that exercise reduced Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) scores but had no significant effect on Epworth Sleepiness Scale (ESS) scores. Bayesian network meta-analysis showed that, compared with the control group, aerobic exercise (SMD = 1.34, 95% CrI: 0.86∼1.82), mind-body exercise (SMD = 0.64, 95% CrI: 0.30∼0.97), and combined exercise (SMD = 0.60, 95% CrI: 0.13∼1.07) may improve PSQI scores. The dose-response analysis suggested an inverted U-shaped association, with the largest predicted effect occurring near 539 MET-min/week within the observed dose range. CONCLUSIONS: Low-to moderate-certainty evidence suggests that aerobic, mind-body, and combined exercise may reduce PSQI scores, with a nonlinear dose-response relationship.

doi.org/10.1016/j.jesf.2026.200526 Open access PubMed 42898167 Interventions