Integration of Chinese herbal medicines and exercise for insomnia: a systematic review and meta-analysis

Background: As a disease, insomnia is often ignored by the general public. Insomnia, which not directly fatal, may be equivalent to chronic suicide if it is not paid attention to. However, there are many theories on how to treat insomnia, and researchers have been searching for a cure. Chinese herbal medicine (CHM) and exercise therapy (ET) are relatively effective, and have been used since ancient times to treat insomnia. This study aimed to examine the effect of CHM combined with ET (CHM-ET) on patients with insomnia. Methods: We searched eight electronic databases including PubMed, Web of Science, EMBASE, the Cochrane Library, the China National Knowledge Infrastructure (CNKI), the China Biology Medicine disc (CBMdisc), the China Science and Technology Journal Database (VIP), the Wanfang Database to find randomized controlled trials (RCTs) evaluating CHM-ET in the treatment of insomnia patients up to September 13, 2022. Two researchers read and screened the publications to extract data. We used the pittsburgh sleep quality index (PSQI) as the evaluation indicators for each study, and the other was the total effective rate (TER). The Cochrane risk-of-bias assessment tool was used to assess the risk of bias of the included literature. The level of evidence for this result was assessed by GARDE method. The meta-analysis was performed using STATA 14 software and RevMan 5.3. The research method was registered with PROSPERO (CRD42022350926). Results: We included fourteen randomized controlled trials, which including a total of 1,126 participants. Compared with the control group, the experimental group showed significantly improvements in sleep effect as reflected by the reduced PSQI score [mean difference (MD) = −2.47, 95% confidence interval (CI) (−3.15, −1.78), I 2 = 92%] with low quality of evidence, and increased TER [risk ratio (RR) = 1.23, 95% CI (1.14, 1.33), I 2 = 40%] with moderate quality of evidence. Compared with hypnotic drugs, CHM-ET significantly reduced the PSQI score [mean difference (MD) = −3.18, 95% CI (−5.48, −0.89), I 2 = 73%] with low quality of evidence. The PSQI of CHM-ET significantly decreased compared with single CHM [mean difference (MD) = −3.04, 95% CI (−5.84, −0.25), I 2 = 98%] with low quality of evidence, and ET [mean difference (MD) = −2.44, 95% CI (−2.87, −2.02), I 2 = 0%] with moderate quality of evidence. No serious adverse reactions were observed. Conclusion: This review suggested that CHM-ET may be an effective treatment for insomnia. However, given the limited quality of the studies and methodologies included in the trials, further rigorous randomized controlled trials are needed for more accurate results.