Evidence summary (Updated 2022)
Strong evidence demonstrates that moderate-to-vigorous physical activity improves the quality of sleep. It does so by reducing the length of time it takes to go to sleep and reducing the time one is awake after going to sleep and before arising in the morning. It also can increase the time in deep sleep and reduce daytime sleepiness.
A small number of observational, population-based studies discussed below, provide initial evidence supporting a positive association of regular participation in physical activity with lower odds of disrupted or insufficient sleep, including sleep apnoea
Population-based studies have found that physically active people report better sleep than inactive people [1] but most of the studies used a cross-sectional design and do not permit conclusions about the temporal sequence of physical activity and sleep. One prospective cohort study [2] found that those who reported more physical activity had nearly 40% lower odds of incident insomnia. Eleven of 13 cross-sectional studies show that the chances of having insufficient or interrupted sleep are lower (mean OR = 0.73 95% CI = 0.66 to 0.81) among adults who are engaged in more physical activity than among those who have less physical activity or are sedentary [2-9]. At least 2 population-based, cross-sectional studies found that men and women who exercise at least 3 hours per week had lower odds of sleep apnoea measured by polysomnography [10-11].
Review of recent systematic reviews provides general consensus that exercise performed regularly over a longer period improves the length spent sleeping, quality of sleep and time to sleep [12]. However, a recent large systematic review evaluating the existing evidence base for the association between sleep and physical activity in adults reported that daytime physical activity was associated with lower total sleep time the following night although the effect size was small [13].
Previous evidence suggests that exercising 1.8hours (Range 0.12 to 4 hours) before bedtime may have negative effects on sleep. There continues to be a mixed picture in this regard and a recent large systematic review and meta- analysis found that sleep-onset latency, total sleep time and sleep efficiency may be negatively affected by completion of vigorous exercise within one hour of sleeping, however that exercising at night does not have a negative impact on overall sleep quality [14].
When thinking about the optimal exercise regime, both aerobic and strength training are reportedly beneficial and it appears to be important to modify the intensity and timing and frequency of exercise according to individual sleep responses [12].
Quality of evidence
Grade B – Moderate to high quality
Strength of recommendation
Grade 1 – Strong
Conclusion
Strong evidence demonstrates that moderate-to-vigorous physical activity improves the quality of sleep. Consensus of existing evidence suggests that regular exercise has a beneficial effect on sleep quality, time to sleep and total length of sleep. No specific exercise has been proven more beneficial than another but aligning the exercise programme to individual needs is important. However, further research is required to evaluate the magnitude of such a relationship as well as the effects of acute exercise on sleep quality.
References
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