A Summary of the article on “Effects of various exercise interventions in insomnia patients: a systematic review and network meta-analysis”
Background
This systematic review and network meta-analysis, titled “Effects of various exercise interventions in insomnia patients” by Bu Z, Liu F, Shahjalal M et al (2025), aimed to compare the effectiveness of different exercise interventions in improving sleep quality and alleviating insomnia severity. The study, conducted by Zhi-jun Bu and colleagues, and published in BMJ Evidence-Based Medicine highlights that exercise serves as an effective treatment for improving sleep in patients suffering from insomnia.
Methods
The research design involved a systematic review and network meta-analysis (NMA) of randomised controlled trials (RCTs). Researchers systematically searched multiple databases, including PubMed and Cochrane Library, for studies involving adults diagnosed with insomnia or exhibiting symptoms (Insomnia Severity Index (ISI) score ≥8). Data from 22 RCTs, encompassing 1348 participants, were included in the final analysis. These trials evaluated 13 distinct interventions, with seven being exercise-based: yoga, Tai Chi, walking or jogging, aerobic plus strength exercise, strength training alone, aerobic exercise combined with therapy, and mixed aerobic exercises. Non-exercise controls included cognitive-behavioural therapy (CBT), sleep hygiene, and usual care. Sleep outcomes were measured using validated tools like the Pittsburgh Sleep Quality Index (PSQI) and ISI, as well as subjective sleep diaries and objective measures such as polysomnography (PSG) or actigraphy.
Results
The findings indicate that yoga, Tai Chi, and walking or jogging are particularly effective compared to other exercise types.
- Yoga likely results in a large increase in total sleep time (MD 110.88 minutes) and may improve sleep efficiency, reduce wake after sleep onset, and shorten sleep onset latency, based on sleep diary data (moderate-certainty to low-certainty evidence). Yoga also consistently ranked highest for improving total sleep time, sleep efficiency, and wake after sleep onset in sleep diary parameters. Its effectiveness may stem from enhancing GABAergic activity and inhibiting amygdala hyperactivation, which alleviates anxiety and depression often linked to sleep issues.
- Tai Chi may significantly reduce PSQI scores and improve various sleep diary outcomes, including increasing total sleep time, reducing wake after sleep onset, and shortening sleep onset latency (low-certainty evidence). Objectively, Tai Chi may also increase total sleep time (MD 24.09 minutes) and slightly reduce sleep onset latency. Notably, some improvements associated with Tai Chi persisted during long-term follow-up (1–2 years). This is attributed to its ability to enhance parasympathetic tone, promote emotional regulation, and possibly influence neuroplasticity and circadian regulation.
- Walking or jogging may result in a large reduction in ISI scores (MD −9.57 points), addressing daytime dysfunction associated with insomnia. This is likely due to physiological and psychological benefits such as increased energy expenditure and improved emotional regulation.
The study also included CBT for insomnia as a reference, given its established effectiveness. As expected, CBT demonstrated broad-spectrum and durable effects, significantly reducing PSQI scores and leading to a large increase in total sleep time, alongside improvements in other sleep diary outcomes.
Conclusions
Despite the positive findings, the authors acknowledge limitations, including the inability to blind participants and researchers, leading to a considerable proportion of studies having ‘some concerns’ or ‘high risk’ of bias. There was also limited standardisation of intervention doses and potential inconsistencies in some outcome measures.
These findings support the integration of exercise as a primary treatment strategy for insomnia in clinical guidelines, offering accessible and low-cost alternatives to pharmacological treatments. The study suggests that personalised treatment approaches can be developed, with yoga being suitable for increasing sleep duration, Tai Chi for enhancing sleep architecture and long-term benefits, and walking or jogging for alleviating daytime dysfunction.
Think of this study as a well-organised library of sleep-improving exercises, where different types of exercise are like unique books. While some traditional methods are proven classics (like CBT), this research helps us discover which “books” (yoga, Tai Chi, jogging) are most effective for specific readers (insomnia patients) and for addressing particular sleep “genres” (total sleep time, sleep onset latency, daytime severity), offering a tailored reading list for better rest.
References
Bu, Z., Liu, F., Shahjalal, M., Song, Y., Li, M., Zhuo, R., Zhong, Q., Du, Y., Lu, C., Yang, Z., Yang, H., Zhong, P., Liu, J., & Liu, Z. (2025). Effects of various exercise interventions in insomnia patients: A systematic review and network meta-analysis. BMJ Evidence-Based Medicine. https://doi.org/10.1136/bmjebm-2024-113512
This post is based on Open Access research and is for informational purposes only.
