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Exercise plus cognitive behavioral therapy improves subjective sleep quality and sleep continuity in insomnia patients

In a network meta-analysis of 31 RCTs with 2,457 participants, exercise combined with cognitive behavioral therapy (EX + CBT) ranked highest for improving Pittsburgh Sleep Quality Index (PSQI), sleep onset latency (SOL), and wake after sleep onset (WASO). Compared to conventional control, EX + CBT showed significant effects on PSQI, SOL, and WASO, but no intervention significantly increased total sleep time.

Last updated: Jul 8, 2026•0 RCTs•1 Meta-analyses•📖 Read as article →

Evidence Score

Evidence Score49/100
Human RCT☆☆☆☆☆
Meta-analysis★★★☆☆
Mechanism★★★★★
Safety★★★★☆
Confidencelow

Study Evidence

Study 1. Effects of different intervention modalities combined with exercise in patients with insomnia: a systematic review and network meta-analysis.

observational

Zhou X, Chen L, Chen W, Zhou Y, Li Z, Li A, Zhou J · Frontiers in public health (2026)

Participants: N/A
Duration: N/A
Intervention: Exercise combined with cognitive behavioral therapy (EX + CBT)
Outcome: Pittsburgh Sleep Quality Index (PSQI), sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST)
Effect Size: N/A (SUCRA rankings reported, not effect sizes)
Population: Adults with insomnia (2,457 participants across 31 RCTs)

Result:

PubMed: 42395307DOI: 10.3389/fpubh.2026.1873034

Mechanism Graph

Exercise improves sleep through thermoregulation and circadian rhythm regulation
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CBT addresses maladaptive sleep behaviors and cognitive arousal
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Combined intervention targets both physiological and psychological factors
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Result: Enhanced sleep quality and reduced sleep onset latency

Limitations

  • ⚠Evidence certainty was generally limited across comparisons
  • ⚠Only 31 RCTs included, with potential heterogeneity in exercise modalities and CBT protocols

Frequently Asked Questions

What is the most effective exercise-based combination for insomnia?▼

Exercise combined with cognitive behavioral therapy (EX + CBT) ranked highest for improving sleep quality, sleep onset latency, and wake after sleep onset.

Did any intervention significantly increase total sleep time?▼

No intervention significantly increased total sleep time compared to conventional control.

How many participants were included in this analysis?▼

A total of 2,457 participants from 31 randomized controlled trials were included.

What outcomes were measured in this study?▼

The study measured Pittsburgh Sleep Quality Index (PSQI), sleep onset latency (SOL), total sleep time (TST), and wake after sleep onset (WASO).

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References

  1. 1.Zhou X, Chen L, Chen W, Zhou Y, Li Z, Li A, Zhou J. "Effects of different intervention modalities combined with exercise in patients with insomnia: a systematic review and network meta-analysis.." Frontiers in public health, 2026. PMID: 42395307 DOI: 10.3389/fpubh.2026.1873034
Disclaimer: This content is for educational purposes only and is not medical advice. Evidence scores reflect the quality and quantity of available research, not clinical recommendations. Always consult a healthcare professional before starting any supplement or intervention.