A comprehensive systematic review and network meta-analysis of randomized controlled trials indicates that engaging in physical activity, especially resistance training and aerobic conditioning, yields significant improvements in self-reported sleep quality, outperforming routine activities to a clinically meaningful extent, aligning with prior research; resistance training demonstrated the highest efficacy, followed by aerobic exercise and combined modalities.
Resistance or muscle strengthening exercise, using weights or the body itself, may be the best type of exercise for tackling insomnia in older age. Image credit: Engin Akyurt.
The incidence of diminished sleep quality is a common characteristic of aging. Elderly individuals experience insomnia with greater frequency than younger demographics.
A substantial portion of seniors, ranging from 30% to 48%, express concerns about somnolence, while 12-20% grapple with persistent insomnia.
Primary care physicians address approximately 5.5 million annual consultations pertaining to insomnia.
There exists robust empirical evidence establishing a correlation between sleep deprivation and a spectrum of psychological conditions, including depression and anxiety.
Multiple investigations have posited links between insufficient sleep and maladies such as metabolic syndrome, hypertension, and cardiovascular disease. Furthermore, cognitive decline and an elevated risk of prostate cancer have been associated with insomnia.
Insomnia also exacerbates the probability of vocational impairment, increased absenteeism, and suboptimal performance, thereby imposing considerable economic burdens on healthcare systems and society at large.
Prior scholarly contributions suggest that physical exertion can contribute to the amelioration of insomnia symptoms, yet the specific type of exercise most conducive to this outcome remains underexplored.
In an effort to elucidate this matter, Dr. Thunyarat Anothaisintawee and her team at Mahidol University undertook an exhaustive search of research repositories for pertinent clinical trials, with data collected up to October 2022. These trials were evaluated if they compared physical exercise interventions against routine activities, standard care, other non-exercise interventions, or health education among individuals formally diagnosed with insomnia, utilizing the Global Pittsburgh Sleep Quality Index (GPSQI) as the primary outcome measure.
The spectrum of exercise modalities investigated encompassed: aerobic activities, such as cycling, dancing, swimming, brisk walking, and gardening; resistance exercises, including the use of weights, push-ups, and planks; balance exercises, like step-ups and heel-to-toe walking; flexibility exercises, such as gymnastics, yoga, and Pilates; and composite exercise regimens incorporating a blend of these modalities.
A total of twenty-four studies, involving 2,045 adults aged 60 years and above (with an average age of 70), were incorporated into the aggregated data analysis.
The geographical distribution of these studies was predominantly from Asia (56%), followed by North America (16%), South America (16%), and Europe (12%). A notable proportion, one in five, were conducted within residential care facilities.
The reported exercise intensities were primarily categorized as mild to moderate or moderate, with the average session duration slightly exceeding 50 minutes and a frequency of approximately 2 to 3 sessions per week.
The duration of these exercise interventions averaged 14 weeks.
The pooled data analysis was constrained to include only studies examining combination exercise and aerobic exercise due to an insufficient number of trials focusing on other exercise types.
This analysis revealed that combined exercise protocols led to a significant enhancement of the GPSQI score by 2.35 points, while aerobic activity resulted in an improvement of 4.35 points.
When the data were synthesized through a network meta-analysis, strength/resistance exercise emerged as the most efficacious intervention, yielding a 5.75-point improvement in the GPSQI.
Aerobic exercise demonstrated an improvement of 3.76 points in the GPQSI, while combination exercise contributed to a 2.54-point enhancement.
Among the control interventions, sleep education proved to be the most beneficial, although the specifics of these educational programs were not clearly delineated in the included studies; nonetheless, even sleep education did not achieve the same level of efficacy as muscle strengthening/resistance exercise, as indicated by the analysis.
“Exercise, particularly strengthening exercise and aerobic exercise, is beneficial for enhancing subjective sleep quality at a clinically significant level compared with normal activities,” the authors concluded.
These findings were formally published in the esteemed journal Family Medicine and Community Health.
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Pakwan Bahalayothin et al. 2025. 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. Family Medicine and Community Health 13: e003056; doi: 10.1136/fmch-2024-003056
