Dose–response relationship of exercise interventions on sleep quality in patients with depression: a systematic review and meta-analysis

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Background: This meta-analysis aimed to systematically evaluate the effects of exercise interventions on sleep quality in patients with depression and to explore the dose-response relationships of key intervention parameters. Methods: A comprehensive search was conducted in PubMed, Web of Science, Embase, Scopus, and the Cochrane Library to identify randomized controlled trials (RCTs). Standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated using a random-effects model. Subgroup and sensitivity analyses were performed to examine potential dose-response relationships. Results: A total of 17 publications, including 19 randomized controlled trial comparisons and 1,457 participants, were included in this systematic review and meta-analysis. Pooled estimates indicated that exercise interventions significantly improved sleep quality [SMD = -0.37, 95% CI: -0.48 to -0.27]. Dose-response modeling suggested that exercise doses around 312.75 MET·min/week may be associated with greater improvements [Hedges' g = -0.51, 95% CI: -0.71 to -0.31]. Subgroup analyses suggested that mind-body exercise [SMD = -0.49, 95% CI: -0.63 to -0.35], durations of 9-12 weeks [SMD = -0.49, 95% CI: -0.74 to -0.24], fewer than two sessions per week [SMD = -0.47, 95% CI: -0.65 to -0.29], and sessions longer than 90 minutes [SMD = -0.42, 95% CI: -0.66 to -0.18] may be associated with favorable changes. Conclusions: Exercise interventions may improve sleep quality in individuals with depression, with potential benefits at low doses. These findings support individualized exercise prescriptions, but larger multicenter RCTs with long-term follow-up are needed to confirm the dose-response pattern and subgroup findings. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420251105568, identifier PROSPERO (CRD420251105568).

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