European Journal of Physiotherapy

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The effect of physical activity on sleep quality: a

systematic review

Feifei Wang & Szilvia Boros

To cite this article: Feifei Wang & Szilvia Boros (2019): The effect of physical activity
on sleep quality: a systematic review, European Journal of Physiotherapy, DOI:
10.1080/21679169.2019.1623314

To link to this article: https://doi.org/10.1080/21679169.2019.1623314

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EUROPEAN JOURNAL OF PHYSIOTHERAPY
https://doi.org/10.1080/21679169.2019.1623314

REVIEW ARTICLE

The effect of physical activity on sleep quality: a systematic review

Feifei Wang and Szilvia Boros
Institute of Health Promotion & Sport Sciences, Faculty of Education & Psychology, E€otv€os Lorand University (ELTE), Budapest, Hungary

ABSTRACT ARTICLE HISTORY

Introduction: Numerous studies have explored the interaction between physical activity (PA) and Received 4 January 2019
sleep quality illustrating the effect of physical exercise on sleep, yet previous researches have not Revised 14 May 2019
investigated the relationship between physical exercise intensity and sleep quality. Accepted 19 May 2019
Aim: This systematic review aims to examine the effect PA intensity on sleep quality in healthy Published online 20 June
2019
populations.
Methods: We conducted a systematic review by searching latest 8 years publications. PubMed and KEYWORDS
Scopus were used to identify eligible studies with the searching terms, ‘sleep quality’ AND ‘physical Sleep quality; physical
activity’, within the timeframe between January 2010 and June 2018. All the included articles were sys- activity; exercise; health;
tematically reviewed and analysed. The comparison of physical intensity and sleep quality was con- insomnia; sleep hygiene
ducted based on the threshold of moderate PA and vigorous PA.
Results: Fourteen studies were included in the review. Analyses revealed that moderate PA seems to
be more effective than vigorous activity in improving sleep quality. Furthermore, moderate physical
exercise is beneficial to sleep quality in both young and old populations.
Conclusions: Moderate exercise showed more promising outcome on sleep quality than vigorous
exercise. Future studies are suggested to elaborate detailed exercise suggestions by considering age
groups in order to make accurate recommendations for health promotion.

Abbreviations: NSF: National Sleep Foundation; PA: Physical Activity; CDC: Centers for Disease Control
and Prevention; ACSM: American College of Sports Medicine; METs: Metabolic rates; REM: Rapid Eye
Movement; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; RCTs:
Randomized Control Trials; MMAT: Mixed Method Appraisal Tool; QUAL: Qualitative; QUAN:
Quantitative; MM: Mixed Methods; PSQI: Pittsburgh Sleep Quality Index

Introduction and being awake for 20 minutes or less after initially falling
asleep [4].
Sleep quality has a critical role in promoting health since
It is essential to clearly understand the relationship PA has
researches over the past decade has documented that sleep
with sleep quality, accurate and detailed PA intensity classifi-
disturbance has a powerful influence on the risk of medical
cation. The intensity of physical activity (PA) is related to how
illnesses including cardiovascular disease and cancer, and the
hard our body works while doing that activity. In accordance
incidence of depression [1]. Even though the term ‘sleep
with Centers for Disease Control and Prevention (CDC) and
quality’ has been commonly used in sleep medicine, the
term ‘sleep quality’ has not been clearly defined. The American College of Sports Medicine (ACSM) guidelines, mod-
National Sleep Foundation (NSF) reported the key determi- erate activity is defined as below 3.0–6.0 exercise metabolic
nants (sleep latency, number of awakenings >5 minutes, rates (METs) (3.5–7 kcal/min), and vigorous activity is defined
wake after sleep onset and sleep efficiency) of quality sleep as greater than 6.0 METs (more than 7 kcal/min) [5]. To benefit
among healthy individuals without regarding sleep architec- health, CDC recommend a variety of moderate and vigorous
ture or nap-related variables [2]. Previous study demon- intensity physical activities. Physical activity is considered an
strated that the meaning of sleep quality among individuals effective, non-pharmacological approach to improve sleep. In
with insomnia and normal sleepers was broadly similar by addition, physical exercise is recommended as an alternative
comparing between individuals with and without insomnia, or complementary approach to existing therapies for sleep
given that poor sleep quality is a key feature of insomnia [3]. problems [6]. Evidence from cross-sectional studies indicated
Nevertheless, the NSF defined the key indicators of good that physically active adolescents have more favourable sleep
sleep quality, which include: sleeping more time while in quality than those physically inactive [7,8]. A recent systematic
bed (at least 85% of the total time), falling asleep in review revealed that evening exercise may positively affect
30 minutes or less, waking up no more than once per night sleep, but vigorous exercise might impair sleep-onset latency,

CONTACT Feifei Wang [email protected] ELTE E€

otv€
os Lorand University, Kazinczy u. 23-27, Budapest 1075, Hungary
ß 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/),
which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in
any way.
2 F. WANG AND S. BOROS

total sleep time [9]. The relationship between PA intensity (i.e. between PA intensity and sleep quality in general popula-
moderate exercise, vigorous exercise) and sleep quality needs tion. Second, to explore the interaction of age as a mediator
to be specified even though the benefits of physical exercise of the exercise effects on sleep quality.
and sleep quality has been highly regarded.
According to present knowledge, good sleep quality is
fundamental to wellbeing and known to be influenced by
Materials and methods
biological factors and lifestyle. The benefits of physical exer- Search strategy
cise have been examined from both biological and physio-
logical perspective. However, the prevalence of sleep loss is Two search engines, PubMed and Scopus, were used to iden-
increasing nowadays [10]. Insufficient sleep and irregular tify studies for inclusion from January 2010 to June 2018.
sleep–wake patterns documented in younger adolescents, The two databases were search separately. In PubMed, we
presented alarming in college population [11]. Impaired used the term ‘sleep quality’ AND ‘physical activity’ OR ‘sleep
sleep quality is adversely associated with neurocognitive and quality’ AND ‘exercise’ to search for the studies. Whereas, in
academic performance [12]. Poor sleep quality is negatively Scopus, due to the searching box in Scopus is different from
associated with academic performance in adolescents from PubMed, we manually typed in our searching terms by
middle school through the college years [13]. Despite the selecting proper connections on the webpage. In both data-
biological necessity of sleep, it has been traded off in mod- bases, only English articles were taken into consideration.
ern societies to accommodate social and work schedules. Additionally, the available studies related to PA (e.g. Taichi,
Additionally, sufficient sleep is important to personal Baduanjin, etc.) with sleep quality were manually screened
achievements [14]. for any additional possibly relevant studies.
It is generally thought that physical exercise constitutes a
therapeutic behaviour which promotes sleep [6,15]. We now Study selection
know that the quantity and/or quality of sleep is involved in
the manifestation of various alterations in physical exercise Articles from PubMed (n ¼ 482) and Scopus (n ¼ 926) online
functions. Leisure time physical exercise contributes to went into selection process. According to the search strategy,
increased total energy expenditure [16]. Moreover, it was a total of 81 articles went through full-text check from 1408
demonstrated that activity can improve neuropsychological retrieved records after titles and abstracts screening.
performance and subjective sleep quality in older adults [17]. Followed by careful full-text examination, 67 articles were
Rapid eye movement (REM) sleep is considered a sensitive excluded due to multiple reasons (listed in Figure 1).
marker of the exercise effects on sleep. Exercise is signifi- The database search was conducted in one week in
cantly correlated with the decrease of REM sleep [18], which November 2018. With the search results listed on computer
explained the mechanism of PA effect on sleep. screen, the studies conducted with non-eligible participants
Both vigorous and moderate activities may be beneficial were kicked out by screening the title and abstract. Those
to metabolic issue among middle-aged populations [19]. The studies that were potentially relevant to the inclusion criteria
intensities of activity need to be taken into consideration were selected and waited for the second-round check. After
when elaborating the relationship between PA and sleep screening by title and abstract, all selected studies from the
quality. Low to moderate intensity Tai Chi program was dem- two databases were pooled together for full-text check.
onstrated to be beneficial in improving self-rated sleep qual- Articles that retrieved on the basis of the tittle and abstract
ity [20]. It revealed that participating in an exercise training or when the decision could not be made based on the
programme has positive effects on sleep quality in middle- inapparent abstract, were gone through full-text assessment.
aged and older adults [6]. In this regards, this would indicate After full-text check, studies have been included into the sys-
that physical exercise may elicits larger changes in sleep. tematic review. The duplication check was performed manu-
Given that age is likely an important mediating factor ally within the eligible studies after full-text check. Mendeley
influencing the intensity of physical exercise, it is important (version: 1.19.2) was used to store and manage the included
to examine the incidental effect of age. The aging population studies. The librarian helped with full-text access.
is faced with a high prevalence of physical disability. It has The PRISMA flow diagram [23] was used to elaborate the
been examined that poor physical function is associated with study selection process.
sleep fragmentation and hypoxia in older men [21].
However, it was suggested that vigorous exercise is posi-
Eligibility criteria
tively related to adolescents’ sleep, in which the adolescents
are athletes. The interaction of age in the functioning of Studies were included if they met the following criteria: (1)
physical intensities on sleep requests more exploration. observational studies, including randomised control trial, lon-
As reported, physical inactivity is prominent in the causal gitudinal, cross-sectional, pre-post and case-control studies.
constellation for factors predisposing to cardiovascular dis- (2) Participants were neither hospitalised patients, nor people
ease [22]. What kind of intensities of PA is recommended for with medical assistance (e.g. pregnant women, people with
the general population? It is consequential to address a com- facilities, etc.). (3) Studies were not included if participants
mon conclusion for general population. Thus, the aim of the suffered with psychiatric disorders (e.g. hypomania, etc.). (4)
present review is twofold. First, to reveal the association Shift working personnel were also not included, since it has
 EUROPEAN JOURNAL OF PHYSIOTHERAPY 3

Identification
Records identified through
PubMed(n=482)
database searching
Scopus(n=926)
(n=1408)

Records screened Records excluded by le,

(n=1408) abstract
Screening

PubMed (n=447)
Scopus (n=880)

Full-text arcles excluded, with

reasons
(n=67)
Full-text articles assessed
Special populaon (insomnia,
Eligibility

for eligibility
(n=81) shi-working personnel, with
hypomania, athletes, pregnant
women, older people with
faciliesetc.) (n=19)
Lifestyle as mediator (n=9)
Mental health as mediator (n=6)
Weight control program (n=1)
Sleep physiology (n=1)
Studies included in Mix-methods (n=4)
quantitative synthesis
Included

Non-intervenon study (n=13)

(meta-analysis) Protocol (n=4)
(n=14) Sleep disorder invesgaon
(n=10)

Figure 1. Study selection process.

already disrupted. (5) Study protocols were excluded. (6) For each retained study, an overall quality score will be
Studies illustrated non-relevant factors (e.g. mental health, calculated by using the MMAT. The score can be presented
life style) on sleep or taken sleep as risk factor. All the other using quartile descriptors. The questions in each domain in
studies were excluded if they could not meet the inclu- the appraisal are answered by ‘yes’, ‘no’ or ‘can’t tell’, since
sion criteria. there are four questions in each domain (except mixed
methods domain), the score varies from 1 (one criteria met)
to 4 (all criteria met). For qualitative and quantitative studies,
Quality assessment this final score (score of quality) was calculated from the
number of criteria met. For mixed methods research studies,
Incorporating with the study inclusion criteria that the cur- the overall quality score takes the lowest score of the study
rent review is not only limited to RCTs, but also put eyes on components. For example, the score is 1 when QUAL ¼ 1 or
other study designs (e.g. cross-over study, pre-post study, QUAN ¼ 1 or MM ¼ 0; it is 2 when QUAL ¼ 2 or QUAN ¼ 2
longitude study, etc.), we used the Mixed Method Appraisal or MM ¼ 1; it is 3 when QUAL ¼ 3 or QUAN ¼ 3 or MM ¼
Tool (MMAT-version 2011), which was developed for the 2; and it is 4 when QUAL ¼ 4 and QUAN ¼ 4 and MM ¼ 3
quality appraisal of qualitative, quantitative and mixed meth- (QUAL being the score of the qualitative component; QUAN
ods reviews [24,25]. The MMAT was designed for the the score of the quantitative component; and MM the score
appraisal stage of complex systematic literature reviews. of the mixed methods component) [24].
There are five domains following with five scoring metrics The questions in each domain were coded by Q1–Q4
individually, four items in each domain in qualitative, quanti- based on the sequence from the original scale. We code 1 if
tative randomised controlled, quantitative non-randomised, the answer is ‘yes’, 0 if the answer is ‘no’, and CT if the answer
quantitative descriptive studies, three items in the domain of is ‘cannot tell’. A summary of the number of ‘yes’ was made to
mixed methods. show the proportion of study quality in different strata.
4 F. WANG AND S. BOROS

Data extraction on menopausal women [33]. Not only in menopausal

women, but also in secondary school students, walking exer-
We redefined the study by the following standards: (1) is the
cise showed significant improvement of subjective sleep
study a randomised control trial? (2) Did the study use PSQI
quality [31]. Moreover, in a real-world study added additional
as the measurement for sleep quality? (3) Are there complete
evidence that daily walking exercise is beneficial to improve
outcome data? (4) Are the samples properly selected? (5) Are
subjective sleep quality in people both physically active and
there case and control groups? These questions were taken
as risk factors when investigating the relationship between non-active [28]. Aerobic exercises, such as Tai Chi and home
PA and sleep quality. exercise, were examined within community-dwelling elderly
in a randomised controlled trial, and exercisers reported bet-
ter sleep quality than non-exercisers [26,27,32]. Rather than
Results and discussion slow movement exercise, participation of moderate-intensity
Summary of the studies physical activities (e.g. included roller skating, bicycling, base-
ball and walking/running) launched in college students (nine
Finally, 14 studies including RCTs and non-RCTs were
exercisers and 10 non-exercisers), indicated that participation
included in the systematic review. The extracted standardised
in such a programme improves sleep [30]. Physical exercise
headings include: authors, publication years, number of par-
may partially improve sleep components. As evidence
ticipants, age range, interventions, study design, measures
showed that home-based 30-min Pilate’s exercises also
for sleep, and results (Table 1). The intervention duration of
showed significant improvement in subjective sleep quality,
the included studies ranges from 35 minutes to 24 weeks
sleep latency, daytime dysfunction and global PSQI score,
conducted in vigorous physical exercise and moderate exer-
but not in sleep duration, habitual sleep efficiency and sleep
cise among different age groups. Moderate physical exercise
was more frequently launched (e.g. walking, Tai chi, daily disturbance [34]. Physical activity interventions that showed
home exercise, Pilates, etc.). Half of the participants were positive results were mostly moderate exercise or moderate
young adults (18–45 years old), 36% of the participants were to vigorous exercise. The implementation of physical exercise
elderly people above 45 years old, while 14% of the partici- need to take into participants’ age and health status into
pants were under 18 years old. Most of the studies showed consideration. Intensity and duration of PA for sleep benefits
positive results toward global sleep score by PSQI. The two are under discussion.
studies that worked on vigorous PA demonstrated that vigor-
ous physical exercise does not affect sleep quality, of which
the two studies were qualitative and cross-sectional study. Negative/novel results of moderate exercise
Even though more positive results were found in the
Quality appraisal included articles, negative or novel results are still existed. A
The quality appraisal presents three quantitative descriptive floor-seated exercise programme conducted in 77 old partici-
study (cross-sectional studies) and one qualitative study. Ten pants (between 71 and 85 years old) found no significant
articles were experimental studies organised either RCT or effect on sleep quality [36]. As illustrated from a cross-sec-
non-RCT. The non-RCT studies were all pre-post studies tional study launched in low socioeconomic status urban
except one prospective study. The result of quality assess- area, decreased PA may be associated with poor sleep
ment is listed in Table 2. In the selected studies, only [35,37]. It was recommended that PA may be modifiable risk
‘quantitative non-randomized control trail’, ‘quantitative factors to improve sleep [35].
randomized control trail’, ‘quantitative descriptive’ and
‘qualitative’ study domains were found. In total, 43% of the
included articles met three criteria. The number of studies Vigorous exercise and sleep quality
identified by meeting four criteria (29%) was slightly higher
than the number of studies met two criteria (21%). Only 7% In a cross-sectional study, covered participants from 23 coun-
study (n ¼ 1) met only one criteria. tries, it was demonstrated that there was no association
between vigorous PA and sleep quality and quantity [38]. A
qualitative study examined the effects of acute exercise on
Positive results of moderate exercise sleep; however, it found no effect of vigorous PA on sleep
Physical activity was popular in scientific research in promot- quality [29]. Nevertheless, there were findings that did not
ing health conditions. Sleep quality and sleep health draw a support the result. Among people with insomnia, acute
lot of attention among health professions and researchers. morning exercise turned out to improve nocturnal sleep
The trials of physical exercise on sleep quality were diverse. quality in individuals with difficulty initiating sleep [39]. In
But, more positive results received from previous studies des- addition, it was indicated that increased PA is favourably
pite the types and dedicated samples. Physical exercise is associated with restoring sleep and vigorous PA levels tend
supposed to benefit sleep quality in a wide spectrum of to be a better predictor for good sleep than moderate PA
exercise types. An increase of walking distance by 500 steps [40]. To our best acknowledgement, the number of studies
per week showed positive effect in improving sleep quality defining the effect of vigorous PA on sleep quality is limited.
Table 1. The details of included studies.
Study Participants Duration Study design Activity Measurements Outcome
[33] 112 women 12 weeks Case-control study Walking Pittsburgh Sleep Quality The total sleep quality score, subjective sleep quality, sleep
(51–93 years-old) Index (PSQI) latency, sleep duration, habitual sleep efficiency, sleep
disturbances, use of sleeping medication, and daytime
dysfunction improved to a significantly greater extent in the
intervention group than in the control group
[34] 80 postpartum women 8 weeks Case-control study Pilates exercise Pittsburgh Sleep Quality The intervention group showed a significant improvement in
Index (PSQI) total sleep quality score, subjective sleep quality, sleep
latency, daytime dysfunction and global PSQI score;
however, there was no difference in sleep duration, habitual
sleep efficiency and sleep disturbance between the groups.
[36] 77 participants 12 weeks Case-control study Floor-seated exercise Pittsburgh Sleep Quality No significant effect on sleep quality.
(71–85 years-old) Index (PSQI)
[27] 131 participants 12 weeks RCT Daily home activity Pittsburgh Sleep Quality The intervention group showed significant improvement in
(age 68 ± 7 years) Index (PSQI) total PSQI, and in its 7 components.
[41] 658 young adults Cross-sectional study Pittsburgh Sleep Quality Sedentary behaviour was not associated with sleep quantity.
Index (PSQI) PA intensity and duration were not associated with sleep
quality or quantity.
[35] 55 girls 12 weeks Pre-post study (DASH) programs Children’s Sleep Habits There were negative correlations between PA and the number
(7–12 years-old) Questionnaire of awakenings per night.
[31] 53 students 3 weeks Case-control study Walking Subjective sleep quality (SSQ) Subjective sleep quality improved over time in the intervention
aged 15–16 years group but not in the control group.
[28] 490 healthy workers 4 weeks Case-control study Walking Pittsburgh Sleep Quality Walking intervention improved the participants’ PSQI global
Index (PSQI) score, sleep latency, sleep duration, perceived sleep quality
factor and daily disturbance.
[26] 102 elderly 24 weeks RCT Tai chi Pittsburgh Sleep Quality Tai chi participants reported better scores in PSQI than the
participants Index (PSQI) control group.
[30] 19 female students 12 weeks Case-control study Moderate-intensity Pittsburgh Sleep Quality Physical activity group showed better sleep quality than
(18–24 years-old) physical activities Index (PSQI) control group.
[32] 15 middle 8 weeks Pre-post study Aerobic exercise Pittsburgh Sleep Quality The results showed that the sleep duration, sleep disturbance,
aged females Index (PSQI) sleep latency and sleep efficiency significantly reduced.
[37] 4747 college students Cross-sectional study Pittsburgh Sleep Quality High PA was insignificantly connected with good sleep quality.
Index (PSQI) Low PA associated with increased risks of poor sleep quality.
[29] 11 participants 35 ± 3 min Qualitative study Vigorous late- Subjective sleep quality was Vigorous late-night exercise does not disturb sleep quality.
(age 26 ± 3 years) night exercise assessed with question: how did
you sleep last night? Answered
by 1–5 (1 ¼ well, 5 ¼ poorly).
[38] 15,122 Cross-sectional study Self-administrated questions There was no association between vigorous physical activity
University students (VPA) and sleep quality and quantity.
EUROPEAN JOURNAL OF PHYSIOTHERAPY
5
6 F. WANG AND S. BOROS

Table 2. The quality assessment of selected articles.

Studies Domain Q1 Q2 Q3 Q4 Percentage of meeting criteria
[33] Quantitative non-randomised control trail CT 0 1 0 25%
[34] Quantitative randomised control trail 1 1 1 1 100%
[36] Quantitative randomised control trail 1 1 1 0 75%
[27] Quantitative randomised control trail 1 1 1 1 100%
[41] Quantitative descriptive 1 CT 1 0 50%
[35] Quantitative non-randomised control trail CT 1 0 1 50%
[31] Quantitative randomised control trail 1 1 1 0 75%
[28] Quantitative non-randomised control trail 0 1 1 1 75%
[26] Quantitative randomised control trail 1 1 1 1 100%
[30] Quantitative non-randomised control trail 1 1 1 1 100%
[32] Quantitative non-randomised control trail CT 1 1 1 75%
[37] Quantitative descriptive 1 CT 1 1 75%
[29] Qualitative 1 1 1 0 75%
[38] Quantitative descriptive 1 CT 1 CT 50%
1: the answer is yes; 0: the answer is no; CT: cannot tell.

Analysis of physical activity and sleep quality figuring out the exercise examples from the CDC recommen-
dations. Second, obesity was indicated as moderate factor
Moderate physical activities were more popular in scientific
between PA and sleep quality [46]. In this review, body-
research as physiotherapy method to improve sleep quality.
weight of the participants was not taken into consideration.
It is a good idea to discuss the effects of physical intensity
In the study selection, we only considered the English lan-
and duration on sleep quality. A cross-sectional study
guage articles, which technically narrowed down the selec-
showed that neither intensity, nor duration of PA was associ-
tion scope.
ated with sleep quality or quantity [41]. It was highly sug-
gested that regular moderate-intensity exercise programme
improves self-rated sleep quality in older adults with moder- Conclusions
ate sleep complaints [42]. According to the results illustrated
above, it is reasonable to assume that physical intensity may From the present review, the relationship between physical
be related to sleep quality, which still needs more evi- intensity and sleep quality is lack of experimental evidence.
dence [43]. The aspects discussed in this review were important in
Sleepiness was suggested to associated with age in day- improving sleep quality. In addition, no exhaustive data were
time workers [44]. Age, as a moderator of PA, did not show available about the possible age factors in interacting
enough clue moderating the relationship between PA and between PA and sleep quality. There were ambiguous data
sleep quality in this review. illustrating the effect of acute exercise on sleep and sleep dis-
orders [39,47]. Little evidence supports the vigorous PA bene-
fit sleep quality. Cultural and religious beliefs may influence
Risk of bias beliefs of sleep since it was predicted that spiritual and reli-
The examination of home exercise on sleep quality and day- gious activity associate with different components of sleep
time sleepiness of elderly people consisted 88% females [28], quality [48]. This review demonstrates that moderate physical
in which a gender bias may not be avoided. Gender differ- exercise benefits sleep quality in all age groups in healthy
ence in motivation of physical exercise is dominant in sports population, given that physical intensity is well acknowledged.
participation [45]. In the case control study, a 12-week phys- However, the data available do not really support the gender
ical activities programme on sleep [30], involved 19 partici- interaction when conducting physical exercise. There were
pants (10 participants in intervention group, nine few scientific data addressed how physical exercise duration is
participants in control group), the sample size is small to sufficient in terms of moderate activity, which was a specific
receive confidential results, which could lead to a potential aspect has not yet been explicitly investigated in scientific
risk to bias the extracted results. In the cross-sectional study, research. Physical exercise is subjective and individual, in this
which analysed the vigorous PA, perceived stress, sleep and context, people are free to carry out any kinds of activities.
mental health among university students from 23 low- and Qualitative recommendations, guidelines are essential.
middle-income countries, it may be helpful to take regional The present study demonstrated that moderate PA is
difference in sleep habits into consideration. impactful in sleep quality; however, specified suggestions of
structured physical exercise types are lack of experimental
verification. Future studies are suggested to clarify the
Limitations
proper amount of moderate physical exercise in improving
Although all of the studies were strictly selected by the inclu- sleep quality and elaborate the relationship between physical
sion criteria, limitations exist. First, the classification of phys- intensity and sleep quality. Further studies also suggested to
ical activity levels are poorly defined and not specify explore detailed exercise suggestions by considering differ-
explained in scientific research. We classified the term ent age groups in order to make accurate evidence-based
‘moderate physical activity’ and ‘vigorous physical activity’ recommendations for health promotion.
 EUROPEAN JOURNAL OF PHYSIOTHERAPY 7

Disclosure statement [20] Li F, Fisher K, Harmer P, et al. Tai Chi and self-rated quality of
sleep and daytime sleepiness in older adults: a randomized con-
No potential conflict of interest was reported by the authors. trolled trial. J Am Geriatr Soc. 2004;52:892–900.
[21] Dam T, Ewing S, Ancoli-Israel S, et al. Association between sleep
and physical function in older men: the osteoporotic fractures in
ORCID men sleep study. J Am Geriatr Soc. 2008;56:1665–1673.
[22] Kohl H. Physical activity and cardiovascular disease: evidence for
Feifei Wang http://orcid.org/0000-0001-7781-8722
a dose response. Med Sci Sports Exerc. 2001;33:S472–S483.
Szilvia Boros http://orcid.org/0000-0001-7212-3067
[23] Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for
systematic reviews and meta-analyses: the PRISMA statement.
J Clin Epidemiol. 2009;62:1006–1012.
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