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Cited by 64Sleep and related disordersPhysical Activity and HealthTreatment of Major Depression

The effects of exercise on sleep in unipolar depression: a systematic review and network meta-analysis

Open access
Brupbacher, Gavin, Gerger, Heike, Zander-Schellenberg, Thea, Straus, Doris, Porschke, Hildburg, Gerber, Markus, von Känel, Roland, Schmidt-Trucksäss, Arno·2021·Sleep Medicine Reviews
DOI 10.1016/j.smrv.2021.101452
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Abstract

Insomnia predicts the onset, course, and reoccurrence of unipolar depression. However, systematic reviews of treatment options for insomnia in unipolar depression are lacking. After screening 7725 records, 17 trials comprising 1645 patients randomized to 13 treatments were included for quantitative synthesis. Network meta-analysis showed that compared to a passive control condition, all exercise interventions except moderate aerobic exercise alone resulted in significantly better sleep outcomes. Compared with treatment as usual, mind-body exercise plus treatment as usual (SMD: -0.46; 95% CI: -0.80, -0.12) and vigorous strength exercise (SMD: -0.61; 95% CI: -1.12, -0.10) were significantly more effective. Pairwise meta-analyses showed that mind-body exercise (SMD: -0.54; 95% CI: -0.85, -0.23) had beneficial effects compared to passive control. The network meta-analysis is statistically very robust with low heterogeneity, incoherence, and indirectness. However, confidence in the findings was moderate to very low, primarily due to within-study bias. This is the first network meta-analysis to assess exercise's efficacy to improve sleep quality in patients with depression. The findings confirm the benefits of exercise as an add-on treatment for depression. This consolidation of the current state of evidence can help clinicians make evidence-based decisions.

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Written from the paper’s full text.

TL;DR

This systematic review and network meta-analysis of 17 RCTs (1645 patients, 13 treatments) found that most exercise interventions improved subjective sleep quality in unipolar depression compared with passive control, and mind-body exercise plus treatment as usual and vigorous strength exercise outperformed treatment as usual. Confidence in findings was moderate to very low, primarily due to within-study bias, and no objective sleep measures were available.

Key findings

  • In network meta-analysis, all exercise interventions except moderate aerobic exercise alone and meditation improved sleep quality versus passive control; moderate aerobic exercise alone was SMD −0.31 (95% CI −0.62, 0.00) and meditation was SMD −0.31 (95% CI −0.99, 0.37).
  • Compared with treatment as usual, only mind-body exercise plus treatment as usual (SMD −0.46; 95% CI −0.80, −0.12) and vigorous strength exercise (SMD −0.61; 95% CI −1.12, −0.10) were significantly more effective.
  • Pairwise meta-analysis showed mind-body exercise had beneficial effects versus passive control (SMD −0.54; 95% CI −0.85, −0.23), and combining mind-body exercise with treatment as usual showed an additive effect versus passive control (SMD −0.94; 95% CI −1.35, −0.54).
  • Global heterogeneity was low (τ² = 0.003; I² = 4.3% [0.0%; 56.9%]), with no evidence of global inconsistency (Q(10) = 3.27, p = 0.97); confidence in evidence was moderate for 43% of comparisons, low for 39%, and very low for 18%.

Methods

  • Prospectively registered systematic review and network meta-analysis (PROSPERO CRD42019115705), reported per PRISMA network meta-analysis extension and AMSTAR2; searched 10 databases and trial registries from inception to April 24, 2019, updated February 12, 2020.
  • Included 17 randomized trials comprising 1645 adults (≥18 years) with unipolar depression diagnosis or significant symptoms, randomized to 13 treatments yielding 35 comparisons; sleep quality was measured with self- or observer-reported questionnaires.
  • Random-effects network meta-analysis used R package netmeta, with standardized mean differences (Hedge’s g) and 95% confidence intervals; pairwise meta-analyses were run for comparisons with two or more studies; risk of bias was assessed with the Cochrane tool and confidence with CINeMA.

Limitations

  • Stated: patients with significant physical disorders were excluded, limiting external validity; overall risk of bias was high for all trials, primarily due to lack of blinding of participants, personnel, and outcome assessors; sample sizes were relatively small; confidence in findings was moderate to very low; follow-up and secondary outcome data were insufficient for quantitative synthesis.
  • Evident from the text: no included trial reported objective sleep measurements, so evidence relates only to subjective sleep quality; no trial compared CBT-I with exercise while reporting sleep outcomes; secondary outcomes such as hypnotic use, daytime sleepiness, and adverse events were underreported; no subgroup analyses were performed because low between-study heterogeneity suggested absence of effect modifiers.

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Crossref · 10.1016/j.smrv.2021.101452

Cites

Statistics

Nothing to recompute.

Claims the paper makes

0 of 95 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Sleep quality at follow-up was reported only by four trials.

    “Sleep quality at follow-up was reported only by four trials [61,72,74,77].”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [61] Chan, 2017, Effects of the integrative mind-body intervention on depression, sleep disturbances and plasma IL-6, Psychother Psychosom source

      Not checked in the free run.

    • cites [72] Pinniger, 2013, Tango dance can reduce distress and insomnia in people with self-referred affective symptoms, J Dance Ther

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    • cites [74] Schuver, 2014

      Not checked in the free run.

    • cites [77] Strid, 2016, Internet-based cognitive behaviour therapy and physical exercise - effects studied by automated telephone assessments in mental ill-health patients; a randomized controlled trial, Br J Clin Psychol source

      Not checked in the free run.

  • Findingown data

    17 trials comprising 1645 patients randomized to 13 treatments were included for quantitative synthesis.

    “After screening 7725 records, 17 trials comprising 1645 patients randomized to 13 treatments were included for quantitative synthesis.”
    • Also stated in: § Results · plain
      “These 17 trials yielded post-intervention sleep quality measures for our analyses, including a total of N ¼ 1645 patients, which had been randomized to 13 treatments yielding 35 comparisons.”
    Quote in the paperSubstantial claim
  • Findingown data

    Adverse events were reported only by three trials.

    “Adverse events were reported only by three trials [62,70,76].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [62] Afonso, 2012, Yoga decreases insomnia in postmenopausal women: a randomized clinical trial, Menopause News N source

      Not checked in the free run.

    • cites [70] Lavretsky, 2011, Complementary use of tai chi chih augments escitalopram treatment of geriatric depression: a randomized controlled trial, Am J Geriatr Psychiatry Off J Am Assoc Geriatr Psychiatry source

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    • cites [76] Singh, 2005, A randomized controlled trial of high versus low intensity weight training versus general practitioner care for clinical depression in older adults, J Gerontol A Biol Sci Med Sci source

      Not checked in the free run.

  • Findingreasoning

    This is the first network meta-analysis to assess exercise's efficacy to improve sleep quality in patients with depression.

    “This is the first network meta-analysis to assess exercise's efficacy to improve sleep quality in patients with depression.”
    • Also stated in: § Comparison with other studies · hedged
      “To our knowledge, this is the first systematic review and network meta-analysis of the effects of exercise on indicators of sleep quality in patients with depression.”
    Quote in the paperSubstantial claim
  • Findingown data

    Combining mind-body exercise with treatment as usual showed an additive effect compared to passive control.

    “Combining mind-body exercise (SMD: À0.44; 95 %CI: À0.65, À0.24) with treatment as usual (SMD: À0.48; 95% CI: À0.75, À0.22) showed an additive effect (SMD: À0.94; 95% CI: À1.35, À0.54) compared to passive control.”
    • Also stated in: § Principal findings · plain
      “Combining mind-body exercise with treatment as usual had an additive effect.”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 21
  • May combine two claims. 29
  • The quote only partly states this claim. 1

  • Probably not a substantial claim: may not pass S4 (based).

    Findingnone given

    There is no systematic review on this topic focusing on patients with depression.

    “To the best of our knowledge, there is no systematic review on this topic focusing on patients with depression.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Sleep duration, daytime functioning, and daytime sleepiness were each reported by one study, whereas hypnotic use was not reported by any trial.

    “Sleep duration [75], daytime functioning [63], and daytime sleepiness [62] were each reported by one study, whereas hypnotic use was not reported by any trial.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [75] Singh, 1997, A randomized controlled trial of the effect of exercise on sleep, J Sleep Res

      Not checked in the free run.

    • cites [63] Chan, 2012, A Chinese Chan-based mind-body intervention for patients with depression, J Affect Disord source

      Not checked in the free run.

    • cites [62] Afonso, 2012, Yoga decreases insomnia in postmenopausal women: a randomized clinical trial, Menopause News N source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Mind-body combined with treatment as usual and vigorous strength exercise were the only treatments superior when compared to treatment as usual.

    “Compared with treatment as usual, mind-body exercise plus treatment as usual (SMD: À0.46; 95% CI: À0.80, À0.12) and vigorous strength exercise (SMD: À0.61; 95% CI: À1.12, À0.10) were significantly more effective.”
    • Also stated in: § Results · plain
      “Mind-body combined with treatment as usual (SMD: À0.46; 95% CI: À0.80, À0.12) and vigorous strength (SMD: À0.61; 95% CI: À1.12, À0.10) were the only treatments which were superior when compared to treatment as usual (see Fig. 4 and Table 1).”
    • Also stated in: § Principal findings · plain
      “Vigorous strength exercise and mind-body exercise in combination with treatment as usual were the only two treatments that were more efficacious than treatment as usual alone.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Sleep disturbances are associated with lower quality of life, role impairment, and need for disability retirement in patients with depression.

    “Sleep disturbances are associated with a lower quality of life [15], role impairment [16], and the need for disability retirement in patients with depression [17].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [15] Sunderajan, 2010, Insomnia in patients with depression: a STAR∗D report, CNS Spectr source

      Not checked in the free run.

    • cites [16] Soehner, 2012, Prevalence and functional consequences of severe insomnia symptoms in mood and anxiety disorders: results from a nationally representative sample, Sleep source

      Not checked in the free run.

    • cites [17] Paunio, 2015, Poor sleep predicts symptoms of depression and disability retirement due to depression, J Affect Disord source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Insomnia symptoms co-occurring with depression increase the risk of suicide and are associated with myocardial infarction.

    “Insomnia symptoms co-occurring with depression increase the risk of suicide [13] and are associated with myocardial infarction [14].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [13] Woznica, 2015, The insomnia and suicide link: toward an enhanced understanding of this relationship, Sleep Med Rev source

      Not checked in the free run.

    • cites [14] Carney, 1990, Insomnia and depression prior to myocardial infarction, Psychosom Med source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Current treatment guidelines for unipolar depression recommend psychotherapy and pharmacotherapy.

    “Current treatment guidelines for unipolar depression recommend psychotherapy and pharmacotherapy [18].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [18]

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    Premisecitation

    Insomnia symptoms and insomnia disorder predict the onset, course, and recurrence of unipolar depression and unipolar depressive symptoms.

    “Insomnia symptoms and insomnia disorder predict the onset, course, and recurrence of unipolar depression and unipolar depressive symptoms.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [1e3]

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    Premisecitation

    Sleep disturbances increase the risk for and seem to be a prodromal symptom of relapse.

    “They increase the risk for [10] and seem to be a prodromal symptom of relapse [11].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [10] Nierenberg, 2010, Residual symptoms after remission of major depressive disorder with citalopram and risk of relapse: a STAR∗D report, Psychol Med source

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    • cites [11] Perlis, 1997, Self-reported sleep disturbance as a prodromal symptom in recurrent depression, J Affect Disord source

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  • May combine two claims.

    Premisecitation

    Aerobic, resistance, and meditative movement exercise decrease psycho-physiological arousal by reducing anxiety and depression.

    “Aerobic [40], resistance [41], and meditative movement [42] exercise decrease psycho-physiological arousal by reducing anxiety and depression.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [40] Cooney, 2013, Exercise for depression, Cochrane Database Syst Rev

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    • cites [41] Kovacevic, 2018, The effect of resistance exercise on sleep: a systematic review of randomized controlled trials, Sleep Med Rev source

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    • cites [42] Zou, 2018, Effects of meditative movements on major depressive disorder: a systematic review and meta-analysis of randomized controlled trials, J Clin Med

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    Study design and conductown data

    Data were extracted independently by two reviewers.

    “Both reviewers (GB and TZS) extracted data independently.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Aerobic, resistance, and meditative movement exercises improve sleep quality in non-depressed individuals.

    “Indeed, aerobic [43e45], resistance [41], and meditative movement exercises improve sleep quality [46e48] in non-depressed individuals.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [43e45]

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    • cites [41] Kovacevic, 2018, The effect of resistance exercise on sleep: a systematic review of randomized controlled trials, Sleep Med Rev source

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    • cites [46e48]

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    Premisecitation

    CBT-I improves subjective sleep quality.

    “although CBT-I improves subjective sleep quality [22]”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [22] Wu, 2015, Cognitive behavioral therapy for insomnia comorbid with psychiatric and medical conditions: a meta-analysis, JAMA Intern Med source

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  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Study design and conductnone given

    The authors were confident that treatment nodes were defined in a clinically meaningful way and such that transitivity holds.

    “However, we are confident to have defined treatment nodes in a clinically meaningful way and such that transitivity holds.”
    Quote in the paperNot a substantial claim

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    Study design and conductown data

    The review was prospectively registered in PROSPERO.

    “We prospectively registered this systematic review in the International Prospective Register of Systematic Reviews database (PROSPERO) on February 13th 2019 (PROSPERO CRD42019115705).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Records were screened independently by two reviewers in two stages.

    “We screened the deduplicated records independently by two reviewers (GB and TZS) in two stages (title and abstract as well as full text) using Covidence [52].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [52] Veritas Health Innovation. Covidence systematic review software. Melbourne, Australia: [n.d].

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Two reviewers independently evaluated risk of bias at the study level using the Cochrane RoB tool.

    “Two reviewers (GB and TZS) independently evaluated the risk of bias at the study level using the Cochrane risk of bias (RoB) tool [50].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [50] Higgins, 2011, The Cochrane Collaboration's tool for assessing risk of bias in randomised trials, BMJ source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The report follows the PRISMA network meta-analysis extension and AMSTAR2 guidelines.

    “This report follows the PRISMA network meta-analysis extension [53] and AMSTAR2 guidelines [54].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [53] Hutton, 2015, The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations, Ann Intern Med source

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    • cites [54] Shea, 2017, AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both, BMJ

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  • May combine two claims.

    Premisecitation

    Acute exercise increases the levels of circulating pro-inflammatory cytokines, growth hormone, and brain-derived neurotrophic factor, which are involved in sleep regulation.

    “Acute exercise also increases the levels of circulating pro-inflammatory cytokines [38], growth hormone, and brainderived neurotrophic factor, which are involved in sleep regulation [39].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [38] Moldoveanu, 2001, The cytokine response to physical activity and training, Sports Med Auckl NZ source

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    • cites [39] Chennaoui, 2015, Sleep and exercise: a reciprocal issue?, Sleep Med Rev source

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    Study design and conductcitation

    The search strategy was reviewed by an information scientist using the PRESS guideline.

    “The search strategy was reviewed by an information scientist from the Basel Medical University Library using the Peer Review of Electronic Search Strategies (PRESS) guideline [55].”
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    • cites [55] McGowan, 2016, PRESS peer review of electronic search Strategies: 2015 guideline statement, J Clin Epidemiol source

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    Study design and conductown data

    Interrater agreement was good at title and abstract and full text levels.

    “Interrater-agreement was good at both title and abstract (Cohen's Kappa: 0.61; percentage agreement: 97%) as well as full text (Cohen's Kappa: 0.81; percentage agreement: 97%) level.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Treatment guidelines for insomnia specifically recommend cognitive behavioral therapy for insomnia (CBT-I) and pharmacotherapy.

    “Treatment guidelines for insomnia specifically recommend cognitive behavioral therapy for insomnia (CBT-I) and pharmacotherapy [21].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [21] Medalie, 2017, Management of chronic insomnia disorder in adults, J Am Med Assoc source

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    Study design and conductown data

    All findings were confirmed in sensitivity analyses; however, some effect sizes substantially increased when restricting analyses to trials which only included participants with a formal diagnosis of depression.

    “All findings were confirmed; however, some effect sizes substantially increased when restricting analyses to trials which only included participants if they had a formal diagnosis of depression (i.e., according to DSM or ICD), see supplementary file 2 section 9.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Despite vastly different populations, our findings are similar to previous analyses on aerobic exercise, albeit with somewhat smaller effect sizes.

    “Despite these vastly different populations, our findings are similar, albeit with somewhat smaller effect sizes.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Confidence in the evidence was moderate (43% of comparisons), low (39% of comparisons), or very low (18% of comparisons).

    “confidence in the evidence was moderate (43% of comparisons), low (39% of comparisons), or very low (18% of comparisons)”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    Kovacevic et al. is the only other meta-analysis that specifically focused on resistance exercise interventions.

    “Kovacevic et al. [41] is the only other meta-analysis that specifically focused on resistance exercise interventions.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [41] Kovacevic, 2018, The effect of resistance exercise on sleep: a systematic review of randomized controlled trials, Sleep Med Rev source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    The network meta-analysis was statistically robust with low heterogeneity, incoherence, and indirectness.

    “The network meta-analysis is statistically very robust with low heterogeneity, incoherence, and indirectness.”
    • Also stated in: § Results · plain
      “Global heterogeneity was low (t 2 ¼ 0.003; I 2 ¼ 4.3% [0.0%; 56.9%]), and there was no evidence for local (see supplementary file 2 section 6) or global inconsistency in the model under the assumption of a full design-by-treatment interaction randomeffects model, Q (10) ¼ 3.27, p ¼ 0.97.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductnone given

    Vigorous strength was the only comparator which had significant differences at baseline, and if anything, this difference would lead to smaller effects compared to passive control.

    “Vigorous strength was the only comparator which had significant differences at baseline, and if anything, this difference would lead to smaller effects compared to passive control.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Previous reviews focused on populations that were either very heterogeneous, had insomnia but no depression, or were healthy individuals.

    “Reviews focused on populations that were either very heterogeneous (e.g., individuals with and without specific disorders [41,45] or patients with different mental disorders [78]), had insomnia but no depression [43,79], or were healthy individuals [80].”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [41] Kovacevic, 2018, The effect of resistance exercise on sleep: a systematic review of randomized controlled trials, Sleep Med Rev source

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    • cites [45] Banno, 2018, Exercise can improve sleep quality: a systematic review and meta-analysis, PeerJ source

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    • cites [78] Lederman, 2019, Does exercise improve sleep quality in individuals with mental illness? A systematic review and meta-analysis, J Psychiatr Res source

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    • cites [43] Yang, 2012, Exercise training improves sleep quality in middle-aged and older adults with sleep problems: a systematic review, J Physiother

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    • cites [79] Lowe, 2018, Does exercise improve sleep for adults with insomnia? A systematic review with quality appraisal, Clin Psychol Rev source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductreasoning

    Confidence in the findings was moderate to very low, primarily because outcome assessors were not blinded and methods to avoid selection and reporting bias were not clearly described.

    “However, confidence in the findings was moderate to very low, primarily due to within-study bias.”
    • Also stated in: § Strengths and limitations of the study · plain
      “Confidence in the findings was moderate to very low.This is primarily because outcome assessors were not blinded and methods to avoid selection as well as reporting bias were not clearly described which led to higher risk of within-study bias.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    Sleep quality data at follow-up and data on important secondary outcomes were insufficient to perform quantitative synthesis.

    “Sleep quality data at follow-up and data on important secondary outcomes (e.g.hypnotic use, daytime sleepiness) was insufficient to perform quantitative synthesis.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Five meta-analyses have previously reported the effects of mind-body exercise.

    “Five metaanalyses have previously reported the effects of mind-body exercise.”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [46] Zou, 2018, A systematic review and meta-analysis of mindfulness-based (Baduanjin) exercise for alleviating musculoskeletal pain and improving sleep quality in people with chronic diseases, Int J Environ Res Publ Health

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    • cites [82] Rubio-Arias JÁ, 2017, Effect of exercise on sleep quality and insomnia in middle-aged women: a systematic review and meta-analysis of randomized controlled trials, Maturitas source

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    • cites [84] Zou, 2017, A systematic review and meta-analysis Baduanjin qigong for health benefits: randomized controlled trials, Evid-Based Complement Altern Med ECAM source

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    • cites [80] Kredlow, 2015, The effects of physical activity on sleep: a meta-analytic review, J Behav Med source

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    • cites [85] Du, 2015, Taichi exercise for self-rated sleep quality in older people: a systematic review and meta-analysis, Int J Nurs Stud source

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  • May combine two claims.

    Premisereasoning

    Previous reviews and meta-analyses have assessed the effect of exercise on sleep, but it remains unclear whether these previous findings are directly applicable to sleep problems in patients with depression.

    “Previous reviews and meta-analyses have assessed the effect of exercise on sleep.However, it remains unclear whether these previous findings are directly applicable to sleep problems in the specific population of patients with depression.”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [41] Kovacevic, 2018, The effect of resistance exercise on sleep: a systematic review of randomized controlled trials, Sleep Med Rev source

      Not checked in the free run.

    • cites [45] Banno, 2018, Exercise can improve sleep quality: a systematic review and meta-analysis, PeerJ source

      Not checked in the free run.

    • cites [78] Lederman, 2019, Does exercise improve sleep quality in individuals with mental illness? A systematic review and meta-analysis, J Psychiatr Res source

      Not checked in the free run.

    • cites [43] Yang, 2012, Exercise training improves sleep quality in middle-aged and older adults with sleep problems: a systematic review, J Physiother

      Not checked in the free run.

    • cites [79] Lowe, 2018, Does exercise improve sleep for adults with insomnia? A systematic review with quality appraisal, Clin Psychol Rev source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Three meta-analyses' effect size estimates for mind-body exercise are consistent with our findings, while two reported larger effect sizes.

    “While three [46,82,84] effect size estimates are consistent with our findings, two [80,85] reported larger effect sizes.”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [46] Zou, 2018, A systematic review and meta-analysis of mindfulness-based (Baduanjin) exercise for alleviating musculoskeletal pain and improving sleep quality in people with chronic diseases, Int J Environ Res Publ Health

      Not checked in the free run.

    • cites [82] Rubio-Arias JÁ, 2017, Effect of exercise on sleep quality and insomnia in middle-aged women: a systematic review and meta-analysis of randomized controlled trials, Maturitas source

      Not checked in the free run.

    • cites [84] Zou, 2017, A systematic review and meta-analysis Baduanjin qigong for health benefits: randomized controlled trials, Evid-Based Complement Altern Med ECAM source

      Not checked in the free run.

    • cites [80] Kredlow, 2015, The effects of physical activity on sleep: a meta-analytic review, J Behav Med source

      Not checked in the free run.

    • cites [85] Du, 2015, Taichi exercise for self-rated sleep quality in older people: a systematic review and meta-analysis, Int J Nurs Stud source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Our findings indicate that the effect sizes of aerobic, strength, and mind-body exercises are similar to those of tricyclic antidepressants and trazadone, but smaller than those of CBT-I.

    “Therefore, our findings indicate that the effect sizes of aerobic, strength, and mind-body exercises are similar to those of tricyclic antidepressants and trazadone, but smaller than those of CBT-I.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [87] Everitt, 2018, Antidepressants for insomnia in adults, Cochrane Database Syst Rev

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    • cites [88] van Straten, 2018, Cognitive and behavioral therapies in the treatment of insomnia: a meta-analysis, Sleep Med Rev source

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  • May combine two claims. The quote only partly states this claim.

    Interpretationown data

    We found slightly larger effect sizes in our meta-analytic sample, especially for vigorous strength, compared to Kovacevic et al.

    “We found slightly larger effect sizes in our metaanalytic sample, especially for vigorous strength.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [41] Kovacevic, 2018, The effect of resistance exercise on sleep: a systematic review of randomized controlled trials, Sleep Med Rev source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    The strengths of this review include the comprehensive and updated search, complying with established reporting guidelines, and simultaneously analyzing multiple comparators using network meta-analysis.

    “The strengths of this review include the comprehensive and updated search, complying with established reporting guidelines, and simultaneously analyzing multiple comparators using network meta-analysis.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Aerobic, strength, and mind-body exercises have an antidepressant effect of a moderate-to-large size, comparable to that of antidepressant medication.

    “Moreover, aerobic, strength, and mind-body exercises have an antidepressant effect of a moderate-to-large size, comparable to that of antidepressant medication [40,93e97].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [40,93e97]

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Meta-analyses that did not differentiate exercise type generally found similar effect size estimates, except in Mercier et al.

    “Meta-analyses that did not differentiate exercise type [43,78,80e83] generally found similar effect size estimates, except in Mercier et al. [86].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [43,78,80e83]

      Not checked in the free run.

    • cites [86] Mercier, 2017, Exercise interventions to improve sleep in cancer patients: a systematic review and meta-analysis, Sleep Med Rev source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationcitation

    Mercier et al. only included patients with cancer, which might explain the discrepancy.

    “However, they only included patients with cancer, which might explain the discrepancy.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [86] Mercier, 2017, Exercise interventions to improve sleep in cancer patients: a systematic review and meta-analysis, Sleep Med Rev source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The review did not have to exclude any trials due to language restrictions.

    “Furthermore, we did not have to exclude any trials due to language restrictions.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    None of the included studies reported objective sleep measurements, so current evidence can only relate to subjective sleep quality.

    “None of these studies reported objective sleep measurements, which means that current evidence can only relate to subjective sleep quality.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductreasoning

    The review excluded all patients suffering from another significant physical disorder, which decreases indirectness but limits external validity.

    “We excluded all patients suffering from another significant physical disorder (e.g., cancer), although comorbid depression [89] and insomnia [90] are frequent in these patients.While this decision decreases indirectness, it also limits external validity.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [89] Read, 2017, Multimorbidity and depression: a systematic review and meta-analysis, J Affect Disord source

      Not checked in the free run.

    • cites [90] Taylor, 2007, Comorbidity of chronic insomnia with medical problems, Sleep source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Self-selected exercise intensity seems to elicit the strongest positive affective response in healthy individuals.

    “This is especially interesting since self-selected exercise intensity seems to elicit the strongest positive affective response in healthy individuals [103].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [103] Ekkekakis, 2009, Let them roam free?, Sports Med source

      Not checked in the free run.

43 of 43

  • The paper relies on this without support.

    Network meta-analysis is more informative compared to a conventional pairwise meta-analysis in situations where more than one treatment option is available for a particular clinical condition or if treatments are implemented in various versions.

    “5) Network meta-analysis is more informative compared to a conventional pairwise meta-analysis in situations where more than one treatment option is available for a particular clinical condition or if treatments are implemented in various versions (e.g., different intensities or including different additional treatment components).”

  • The paper relies on this without support.

    Blinding of patients and personnel is impossible in exercise trials.

    “While blinding patients and personnel is impossible in exercise trials, outcome assessors can be blinded.”

  • The paper relies on this without support.

    Outcome assessors can be blinded in exercise trials.

    “While blinding patients and personnel is impossible in exercise trials, outcome assessors can be blinded.”

  • The paper relies on this without support.

    The neuromuscular and cardiorespiratory challenges posed by aerobic, resistance, and mind-body exercises are very different.

    “The neuromuscular and cardiorespiratory challenges posed by aerobic, resistance, and mind-body exercises are very different.”

  • The paper relies on this without support.

    Mind-body exercise does not require special equipment and relatively little training.

    “it does not require special equipment and relatively little training”

  • The paper relies on this without support.

    Sleep plays a pivotal role during treatment and in the prevention of relapse of a depressive episode.

    “the pivotal role sleep plays during treatment and in the prevention of relapse of a depressive episode”
6 of 6

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Hypnotics meta-analysis cites a cancer exercise review

    Minor

    The discussion attributes effect estimates for hypnotics to reference [87], but the paper's reference [87] is a review of exercise interventions in cancer patients.

1 of 1

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References 100 · Cited by 64

Research works printed but not linked: 1

  1. Veritas Health Innovation. Covidence systematic review software. Melbourne, Australia: [n.d].

Authors
Brupbacher, G., Gerger, H., Zander-Schellenberg, T., Straus, D., Porschke, H., Gerber, M., von Känel, R., & Schmidt-Trucksäss, A.
Affiliations
University of Basel (CH)
Corresponding author
Brupbacher, Gavin
ORCID
Venue
Sleep Medicine Reviews
Publisher
Elsevier BV
Published
2021-10
Volume
59
Pages
101452
ISSN
1087-0792 (ISSN-L)
DOI
10.1016/j.smrv.2021.101452
OpenAlex
W3125203018
Cited by
64
References
100
Citations by year
2026: 12 · 2025: 17 · 2024: 14 · 2023: 6 · 2022: 7 · 2021: 8
FWCI
1.44
Type
journal article
Language
en
Open access
Licence
Locations
  • Sleep Medicine Reviews (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, other-oa)
  • Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, cc-by)
  • EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, other-oa)
  • RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
  • Zurich Open Repository and Archive (University of Zurich) (submittedVersion, cc-by)
  • Zurich Open Repository and Archive (University of Zurich)
Funders
Universität Basel
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
Keywords
physical activity, sleep quality, major depressive disorder, insomnia, mind-body exercise, resistance training, aerobic exercise, adjunctive therapy, depression treatment
MeSH terms
Network Meta-Analysis, Depression, Depressive Disorder, Exercise Therapy, Humans, Quality of Life, Sleep, Exercise, Randomized Controlled Trials as Topic

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Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

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