Exercise and Other Non-Drug Approaches to Sleep: What the Reviews Compared
Sella 2022 reports that only physical activity improved objectively measured sleep in older adults, Riedel 2024 reports exercise improved objective and subjective sleep in insomnia with larger effects at higher intensity, and the reviews of other non-drug approaches report results ranging from effective (acupuncture, Hu 2023) to mixed (nutrition, Knowlden 2016) and inconclusive (single-plant herbal aids, Kim 2018).
- Loud snoring with witnessed gasping/choking or breathing pauses plus daytime sleepiness (possible obstructive sleep apnea), refer to a clinician
- Difficulty falling or staying asleep at least 3 nights/week for 3+ months with daytime impairment (possible chronic insomnia disorder), refer to a clinician
- Excessive daytime sleepiness despite adequate time in bed, or falling asleep involuntarily during activities, refer to a clinician
What the evidence says
The sources on this entry are reviews and meta-analyses of non-pharmacological approaches to sleep, exercise among them, with self-reported and objectively measured sleep quality as the outcomes. Sella 2022 (meta-analysis, 31 studies, 2224 participants) reports that all non-pharmacological interventions improved self-reported sleep quality in older adults but only physical activity improved objective sleep (d = 0.31), with findings to be interpreted with caution given methodological weaknesses. Riedel 2024 (meta-analysis, 19 randomised trials) reports that exercise interventions significantly improved objective (SMD 0.37) and subjective (SMD 0.90) sleep parameters in insomnia, with the effect increasing with intervention intensity, and calls for larger trials. Hirohama 2024 (network meta-analysis, 24 randomised trials, 2,649 participants) reports that resistance training “was the most effective intervention for improving sleep quality in nonelderly individuals”. Hasan 2022 (network meta-analysis, 35 trials, 3519 older adults) reports that CBT-I, several exercise programmes and resistance training significantly improved sleep quality against usual care, with muscle endurance training combined with walking the optimal programme. Hwang 2016 (meta-analysis, 37 studies) reports non-pharmacological interventions, especially exercise, effective for improving sleep quality in older adults. De Nys 2022 (meta-analysis, 10 studies) reports that physical activity lowered cortisol and improved sleep quality, with moderate- and low-certainty evidence respectively. Thondala 2023 (meta-analysis, 16 trials, 1885 participants) reports significant reductions in global PSQI for yoga, CBT, music and light, with resistance training not significant. On other approaches, Chang 2025 (meta-analysis, 18 studies, 950 older adults) reports warm footbaths significantly improved subjective sleep quality against controls and concludes they may enhance perceived sleep quality in older adults. Iyer 2025 (scoping review of 57 systematic reviews) reports that 80.9% of meta-analyses favoured melatonin for sleep quality, with only 8.8% of reviews meeting all rigour criteria. Hu 2023 (meta-analysis, 20 studies, 1677 patients) reports acupuncture or moxibustion effective for senile insomnia. Yu 2025 (umbrella review, 19 systematic reviews) reports that non-pharmacological interventions, particularly CBT and Tai Chi, effectively improve sleep in older adults. Song 2026 (network meta-analysis, 34 randomised trials, 3078 participants) reports 11 interventions significantly improved sleep quality in older adults, with CBT-I plus positive mood strategies and CBT-I having the largest effects. Chang 2024 (network meta-analysis, 71 randomised trials) reports that a joint, combined intervention “may be the most effective non-pharmacological intervention to enhance sleep quality”. de Niet 2009 (review of 16 reviews) reports a moderate effect for music-assisted relaxation and weak evidence of a large effect for multicomponent cognitive behavioural therapy, with the evidence limited by few high-quality reviews. Knowlden 2016 (systematic review, 21 studies) reports the evidence for nutrition improving sleep as mixed. Fallah 2024 (systematic review of 20 observational studies) reports Mediterranean diet adherence associated with better sleep. Kim 2018 (systematic review, 79 articles) reports the evidence for single-plant natural sleep aids as limited and inconclusive.
- Do not claim to diagnose, treat, or cure insomnia, sleep apnea, or any sleep disorder
- Do not promise guaranteed, instant, or permanent improvements in sleep
- Do not present these general hygiene techniques as clinical therapy (e.g., CBT-I) or a substitute for medical care
- Agreement
- Direction recorded for 0 of 17 sources; not yet recorded for the rest.
- The claim's outcome
- Outcome not yet recorded
- Certainty
- A source states a certainty rating for 2 outcomes.
- How the sources were read
- Some sources are based on abstracts, not full texts.
What each source measured and concluded (17)
- What it measured
- Sleep behavior in response to dietary/nutritional intervention
- How it was read
- based on the abstract, not the full text
- What the review says it includes
- Systematic review
- Studies and participants, as stated
- 21 studies (17 in vivo, 4 in natura)
- What it measured
- Subjective sleep quality
- How it was read
- based on the abstract, not the full text
- What the review says it includes
- Systematic review and meta-analysis
- Studies and participants, as stated
- 18 studies, 950 older adults
- What it measured
- Self-reported and objectively-measured sleep quality
- How it was read
- based on the abstract, not the full text
- What the review says it includes
- Systematic review and meta-analysis
- Studies and participants, as stated
- 31 studies, N=2224
- What it measured
- Sleep quality.
- How it measured it
- Standardized mean differences (SMD) and standard errors.
- Its conclusion, in its own words
- “The present results showed that resistance training was the most effective intervention for improving sleep quality in nonelderly individuals.”
- How it was read
- read in full text
- What the review says it includes
- Systematic review and network meta-analysis of 24 RCTs
- Studies and participants, as stated
- N=2,649 participants across 24 studies
- What it measured
- Sleep quality measured by Pittsburgh Sleep Quality Index (PSQI)
- How it was read
- based on the abstract, not the full text
- What the review says it includes
- Systematic review and meta-analysis of RCTs and cohort studies
- Studies and participants, as stated
- N=1885 across 16 trials
- What it measured
- Sleep quality
- How it was read
- screened only, not extracted
- What the review says it includes
- Systematic review and network meta-analysis of RCTs
- Studies and participants, as stated
- 35 trials; 3519 older adults
- What it measured
- Objective and subjective sleep parameters
- How it was read
- screened only, not extracted
- What the review says it includes
- Systematic review and meta-analysis of RCTs
- Studies and participants, as stated
- 19 studies
- What it measured
- Effects of exogenously administered melatonin on sleep quality
- How it was read
- screened only, not extracted
- What the review says it includes
- Scoping review of systematic reviews with meta-analyses
- Studies and participants, as stated
- 57 systematic reviews comprising 227 meta-analyses
- Heterogeneity, as stated
- The direction of evidence consistently favors melatonin for sleep quality despite heterogeneity; adverse events generally mild.
- What it measured
- Cortisol levels and sleep (subjective/objective)
- How it was read
- screened only, not extracted
- What the review says it includes
- Systematic review and meta-analysis (RCTs and non-RCTs with control)
- Studies and participants, as stated
- 10 studies
- What it measured
- Association between Mediterranean diet adherence and sleep patterns
- How it was read
- screened only, not extracted
- What the review says it includes
- Systematic review of observational studies
- Studies and participants, as stated
- 20 studies (2 cohort, 18 cross-sectional); 21,714 participants
- What it measured
- Effects of single plant-derived extracts on sleep-related outcomes
- How it was read
- screened only, not extracted
- What the review says it includes
- Systematic review
- Studies and participants, as stated
- 79 articles (21 plants identified)
- What it measured
- Sleep quality (standardized mean differences, P-scores)
- How it was read
- screened only, not extracted
- What the review says it includes
- Systematic review and network meta-analysis of RCTs
- Studies and participants, as stated
- 34 RCTs, 3078 participants, 21 interventions
- What it measured
- Efficacy (response rate) and Pittsburgh Sleep Quality Index (PSQI) scores
- How it was read
- screened only, not extracted
- What the review says it includes
- Systematic review and meta-analysis of RCTs
- Studies and participants, as stated
- 20 studies (2007-2022), 1677 patients
- What it measured
- Sleep quality
- How it was read
- screened only, not extracted
- What the review says it includes
- Systematic review of systematic reviews/meta-analyses
- Studies and participants, as stated
- 16 reviews (17 interventions); 6 of adequate quality
- What it measured
- Sleep improvement (effect size)
- How it was read
- screened only, not extracted
- What the review says it includes
- Systematic review and meta-analysis
- Studies and participants, as stated
- 37 studies (from 343 reviewed)
- What it measured
- Sleep quality
- How it was read
- screened only, not extracted
- What the review says it includes
- Systematic review and network meta-analysis (PRISMA-NMA)
- Studies and participants, as stated
- 71 RCTs (9 non-pharmacological interventions)
- What it measured
- Sleep improvement (effectiveness of non-pharmacological interventions)
- How it was read
- screened only, not extracted
- What the review says it includes
- Umbrella review of systematic reviews with meta-analyses of RCTs (with evidence map)
- Studies and participants, as stated
- 19 systematic reviews comprising 160 RCTs
Certainty ratings the sources state (2)
- Rating, as the source states it
- low
- Framework
- not named by the source
- Applies to
- Limitations: Variations in study characteristics affecting internal validity, limited studies on certain interventions affecting statistical power, varied intervention durations, concerns about risk of bias, low quality of evidence.
- Stated by
- Hirohama et al. (2024)
- Rating, as the source states it
- low
- Framework
- not named by the source
- Applies to
- Physical activity effectively lowered cortisol (SMD=-0.37, 95% CI -0.52 to -0.21, p<0.001) and improved sleep quality (SMD=-0.30, 95% CI -0.56 to -0.04, p=0.02), with moderate- and low-certainty evidence respectively
- Stated by
- Nys et al. (2022)
Every source below is shown with its study design and links to the original study. This is the audit trail.
“Abstract only” means the review read that paper’s abstract, not its full text; “screened only” means it was included at re-screening and not extracted. Both stay in the trail with their DOI, because how a source was read is part of the audit.