Impact of different types of physical exercise on sleep quality in older population with insomnia: A systematic review and network meta-analysis of randomised controlled trials

Objective To measure the impact of each type of exercise on sleep quality and identify the exercise that enhances sleep quality the most. Study selection Eligible randomised controlled trials that compare physical exercise to routine activities, usual care, non-physical activity, or health education to measure the Pittsburgh Sleep Quality Index. Data source Studies retrieved from Medline, Embase, CINAHL, Scopus, ClinicalTrial.gov and ThaiJo from the database's inception to October 2022. Data extraction and synthesis Two reviewers independently identified studies, collected data and assessed bias. In the absence of heterogeneity, a fixed effect model was used for pairwise meta-analysis. Alternatively, a random effect model was used. A two-stage network meta-analysis used the surface under the cumulative ranking curve (SUCRA) to compare exercise efficacy. Main outcome Global Pittsburgh Sleep Quality Index (GPSQI) and subdomain score. Results This review comprised 2170 people from 25 trials. Direct meta-analysis revealed significant improvement in GPSQI with combined exercise (unstandardised mean difference (USMD) -2.35, 95% CI-3.13 to -1.57, p<0.001, I 2 =69.13%). GPSQI decreased considerably with aerobic activity (USMD -4.36, 95% CI -7.86 to -0.86, p=0.01, I 2 =97.83%). For the network meta-analysis, strengthening, aerobic and combination exercise significantly lowered GPSQI (USMD-5.75, -3.76 and -2.54, respectively). Strength training improved GPSQI scores most effectively (SUCRA 94.6%). Conclusion Exercise that strengthens muscles, rather than aerobic or combination exercises, is the most effective way to enhance sleep quality.