Enhancing Sleep Quality Through Exercise: Insights from a Network Meta-Analysis

As physical therapists, we frequently encounter patients whose recovery and overall well-being are hampered by poor sleep quality. While exercise is widely recognized as a beneficial non-pharmacological intervention for sleep disturbances, questions remain about which types of exercise are most effective and what the optimal "dose" should be. A recent network meta-analysis and dose-response study published in BMC Public Health sheds valuable light on these questions, offering evidence-based guidance for our clinical practice.

Study Overview

This comprehensive study analyzed data from 86 randomized controlled trials (RCTs) involving over 7,200 adult participants (aged 18-75). Researchers systematically evaluated and compared the effects of six different exercise modalities on sleep quality against control groups (no intervention):

• Aerobic Exercise (AE)

• Resistance Training (RT)

• Combined Aerobic and Resistance Training (AE+RT)

• Yoga

• Pilates

• Traditional Chinese Sports (TCS) (e.g., Tai Chi, Qigong)

Using network meta-analysis, the study compared the relative effectiveness of these interventions. Furthermore, it employed a Bayesian dose-response analysis based on Metabolic Equivalents (MET-min/week) to explore the relationship between exercise volume and sleep quality improvements.

Key Findings for Clinical Practice

1. All Exercise Types Help: The analysis confirmed that all six exercise modalities investigated led to significant improvements in sleep quality compared to control groups. This reinforces the value of exercise as a therapeutic tool for sleep issues.

2. Pilates and Aerobic Exercise Rank Highest: While all tested forms were beneficial, the cumulative ranking probability (SUCRA) suggested that Pilates demonstrated the highest likelihood of being the most effective intervention for improving sleep quality (SUCRA = 91.7%), followed closely by Aerobic Exercise (SUCRA = 69.7%). Yoga ranked lowest among the active interventions, though still significantly better than no exercise.

3. Dose Matters (It's Non-Linear): The relationship between the total weekly exercise dose (measured in MET-min/week) and sleep quality improvement follows a non-linear, U-shaped curve overall. This implies that while some exercise is good, more is not always linearly better, and there's an optimal range.

4. Optimal Dosage:

   • Overall: The study identified an overall optimal exercise dose for improving sleep quality at approximately 920 MET-min/week. Significant benefits begin to appear at doses as low as 180 MET-min/week. The effects seem to plateau around 1500 MET-min/week.

   • Modality-Specific Doses: The optimal dose varied depending on the type of exercise. The predicted peak effects were observed at:

     • Pilates: ~390 MET-min/week (lowest dose for significant effect)

     • Yoga: ~510 MET-min/week

     • TCS: ~730 MET-min/week

     • AE+RT: ~1000 MET-min/week

     • AE: ~1100 MET-min/week

     
     

   • Resistance Training (RT) also showed a U-shaped curve, but the dose-response relationship did not reach statistical significance in this analysis.

Implications for Physical Therapists

This research provides strong evidence supporting exercise prescription for sleep quality enhancement.

• Recommendation: When advising patients seeking to improve sleep through exercise, Pilates and Aerobic Exercise emerge as potentially the most effective modalities based on this analysis. However, given that RT, AE+RT, Yoga, and TCS also showed significant benefits, patient preference and accessibility remain crucial factors in exercise selection.

• Prescription: Guiding patients toward an appropriate exercise volume is key. Aiming for a total weekly dose within the optimal range identified (around 920 MET-min/week overall, or modality-specific targets) could significantly enhance outcomes. Clinicians can use MET values from resources like the Compendium of Physical Activities to help quantify exercise programs. Starting patients at lower doses (e.g., >180 MET-min/week) and gradually progressing is a sensible approach.

• Context: Remember that MET-min/week combines intensity, duration, and frequency. For example, 900 MET-min/week could be achieved through ~150 minutes/week of moderate-intensity activity (approx. 6 METs) or ~75 minutes/week of vigorous-intensity activity (approx. 12 METs). Tailoring the combination to the individual is essential.

By incorporating these evidence-based insights into exercise type selection and dosage, physical therapists can better support patients in harnessing the sleep-enhancing benefits of physical activity.

Reference

Wang, H., Xin, X., & Pan, Y. (2025). The best approaches and doses of exercise for improving sleep quality: a network meta-analysis and dose-response relationship study. BMC Public Health, 25(1371).https://doi.org/10.1186/s12889-025-22570-1

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