Exercise interventions to improve sleep quality in university students: a systematic review and meta-analysis of randomized controlled trials

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Abstract

BACKGROUND AND OBJECTIVE: Poor sleep quality is common among university students and is associated with adverse academic, psychological, and cardiometabolic outcomes. Exercise may provide a scalable, low-cost, non-pharmacological approach to improving sleep. Although previous reviews have examined physical activity and sleep in university students, evidence specifically derived from randomized controlled trials of structured exercise interventions using the Pittsburgh Sleep Quality Index (PSQI) has not been adequately synthesized. This systematic review and meta-analysis therefore evaluated the effects of structured exercise interventions on the PSQI global score and PSQI-derived component scores in university students. METHODS: We searched PubMed, Web of Science, Embase, CENTRAL, CINAHL, PsycINFO, and ProQuest Dissertations & Theses from inception to April 30, 2026. Randomized controlled trials comparing structured exercise interventions with non-exercise controls in university students and reporting PSQI-based outcomes were eligible. The primary outcome was the PSQI global score. Secondary outcomes were the PSQI component scores for sleep latency, sleep duration, habitual sleep efficiency, and sleep disturbances. Mean differences (MDs) with 95% confidence intervals (CIs) were pooled using DerSimonian-Laird random-effects models. Heterogeneity was assessed using I2 and τ2. Robustness was examined using leave-one-out analyses, change-from-baseline analyses, prediction intervals, restricted maximum-likelihood estimation, and the Hartung-Knapp adjustment. Certainty of evidence was assessed using GRADE. RESULTS: Seven randomized controlled trials involving 701 participants contributed eight exercise-vs.-control comparisons. Six trials contributing seven comparisons and 602 participants were included in the primary meta-analysis of the PSQI global score. Exercise reduced the PSQI global score compared with non-exercise controls (MD = -2.43, 95% CI -3.72 to -1.14; p < 0.001; I 2 = 91.7%). This finding remained statistically significant in leave-one-out and change-from-baseline sensitivity analyses, as well as under restricted maximum-likelihood estimation (MD = -2.43, 95% CI -3.68 to -1.18) and the Hartung-Knapp adjustment (MD = -2.43, 95% CI -3.98 to -0.88; p = 0.009). However, the 95% prediction interval ranged from -6.98 to 2.12 and included the null value, indicating substantial variation in the likely effects across settings. Three trials contributing three comparisons and 290 participants were included in each analysis of the PSQI-derived component scores. Exercise reduced the PSQI sleep-duration component score (MD = -0.74, 95% CI -1.02 to -0.46; I 2 = 56.9%) and the PSQI habitual sleep-efficiency component score (MD = -0.43, 95% CI -0.64 to -0.22; I 2 = 44.9%). Effects on the PSQI sleep-latency component score (MD = -0.53, 95% CI -1.36 to 0.30; I 2 = 96.2%) and the PSQI sleep-disturbance component score (MD = -0.54, 95% CI -1.23 to 0.15; I 2 = 94.5%) favored exercise but were not statistically significant. Certainty of evidence was very low for the PSQI global score and the sleep-duration, sleep-latency, and sleep-disturbance component scores, and low for the habitual sleep-efficiency component score. CONCLUSION: Structured exercise interventions may improve overall sleep quality in university students, with the most consistent benefits observed for the PSQI sleep-duration and habitual sleep-efficiency component scores. However, substantial heterogeneity, a prediction interval that included no effect, and very low to low certainty of evidence limit confidence in the pooled findings. Larger, rigorously designed randomized trials using standardized intervention protocols and both subjective and objective sleep measures are needed before definitive practice recommendations can be made. SYSTEMATIC REVIEW REGISTRATION: www.crd.york.ac.uk/prospero, identifier: CRD420261384510.

Abstract as published, via PubMed.