Optimal exercise type and dose to improve sleep quality in older adults: a systematic review and network meta-analysis

Abstract Background Sleep quality decreased can result in a major health issue in older people with age. While not all sleep changes are pathological in older people’s life, severe disturbances may lead to depression, cognitive impairments, deterioration of quality of life, significant stresses for careers and increased healthcare costs. Despite the known benefits of exercise for improving sleep quality, it is necessary to identify the optimal exercise type and dose. Objective This systematic review and network meta-analysis (NMA) combined to examine evaluated the existing evidence on the effectiveness of different exercises, and to examine the dose and response relationship between overall and specific types with improving sleep quality in older people. Methods PubMed, Cochrane Central, Web of Science, and Embase were systematically searched for this review, including studies up to April 2025. Only randomized controlled trials were included. Studies involved at least one type of exercise intervention and reported changes in sleep quality assessments. To address the limitations of relying solely on statistical significance, we also calculated the minimal clinically important difference (MCID) to determine the smallest meaningful improvement in sleep quality among older people, both overall and across different exercise doses. Data analysis and visualization were conducted using the “meta”, “netmeta”, “MBNMA”, and “ggplot2” packages in the R environment. Results A total of 62 RCTs involving 5005 older adults were included. Overall, exercise significantly improved sleep quality, with clinically meaningful improvements achieved from as early as 5 weeks of intervention. The optimal exercise type was combined aerobic and resistance training, followed by aerobic exercise, resistance training, walking, and yoga. The estimated optimal exercise dose was around 660 to 990 METs*min/week, with longer durations at 15 weeks producing the greatest benefits. Improvements were more pronounced among participants with poorer baseline sleep quality. Conclusion If older people receive the most appropriate exercise intervention, they can obtain clinically meaningful benefits of improving sleep in the elderly within the WHO guidelines for exercise doses. The results support the WHO recommendation that combine aerobic exercise and resistance training should be an important part of interventions for the older people. Protocol registration PROSPERO registration number: CRD42024566751. Graphical Abstract