Effect of Exercise on Sleep in the Middle-aged and Older adult: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

PURPOSE: This study evaluated the influence of exercise on improving sleep quality in middle-aged and older patients with sleep disorders using subjective (PSQI and ISI) and physiological indicators (ActiGraph). The relationships between various moderators by which exercise affects sleep-disorder improvement were investigated.METHODS: From the study’s inception to December 31, 2021, the PubMed, ScienceDirect, MEDLINE, and Google Scholar databases were searched for relevant studies. A meta-analysis was conducted with Comprehensive Meta-Analysis 2.0, using the random-effects model.RESULTS: The meta-analysis of 21 studies showed that exercise improves sleep quality (ES=-0.42, p=.00), insomnia severity (ES= -0.54, p=.00), and sleep efficiency (ES=0.37, p=.00). A walking-based exercise was effective in improving sleep quality (ES=-0.38, p=.00), insomnia severity (ES=-0.55, p=.03), and sleep efficiency (ES=-0.39, p=.00) in middle-aged and older patients with sleep disorders. A mind–body exercise was effective in improving sleep quality (ES=-0.52, p=.00). Regardless of exercise frequency, 90-120 min of exercise per week was important, and moderate-intensity exercise of more than 30 min/day improved sleep in middle-aged and older adults.CONCLUSIONS: Exercise is an effective intervention for improving sleep quality in middle-aged and older adults with sleep disorders. The walking-based and mind–body exercises were effective, and differences according to the exercise intervention components were observed. Customized exercise interventions are possible depending on individuals’ physical strength and can be safe and economical.