Comparative efficacy of various exercise interventions on sleep in patients with cognitive impairment: a systematic review and meta-analysis

Junlei Zhang; Yan Liu; Qingling Sun; Jing Shi; Jingnian Ni; Ting Li; Ziyi Long; Mingqing Wei; Jinzhou Tian

doi:10.3389/fneur.2024.1300459

Comparative efficacy of various exercise interventions on sleep in patients with cognitive impairment: a systematic review and meta-analysis

Front Neurol. 2024 Feb 1:15:1300459. doi: 10.3389/fneur.2024.1300459. eCollection 2024.

Authors

Junlei Zhang^#^{1

2}, Yan Liu^#¹, Qingling Sun^{1

2}, Jing Shi², Jingnian Ni², Ting Li², Ziyi Long², Mingqing Wei², Jinzhou Tian²

Affiliations

¹ Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
² Neurology Center, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.

^# Contributed equally.

Abstract

Background: Sleep disturbances are an early indicator of cognitive impairment and exacerbate its progression. While pharmacological treatments for sleep disorders exist, their side-effect profile includes an increased risk of falls and the potential to exacerbate cognitive impairment. Non-pharmacological treatments such as physical exercise should be considered. However, uncertainties persist. We aimed to assess the potential benefits of exercise interventions on sleep in patients with cognitive impairment and determine the specific effects of various exercise modalities.

Materials and methods: A systematic search was performed on seven databases for eligible studies published before Nov 2022. Randomized controlled trials of exercise for patients with cognitive impairment (mild cognitive impairment and Alzheimer's disease) were included. All analyses were conducted using RevMan version 5.4. Meta-analysis and The Grading of Recommendations Assessment Development and Evaluations (GRADE) quality ratings were performed on sleep quality and objective sleep data.

Results: A total of 8 randomized controlled trials were included with a sample size of 486 subjects. For patients with cognitive impairment, physical exercise had a beneficial effect on sleep quality [MD = -3.55 (-5.57, -1.32), Z = 3.13, p = 0.002] and total sleep time [MD = 33.77 (23.92, 43.62), Z = 6.72, P < 0.00001]. No improvement was found in sleep efficiency and nocturnal awakening time. Subgroup analysis showed that multi-component exercise produced superior results.

Conclusion: Physical exercise may improve sleep quality and total sleep time for patients with cognitive impairment. Multi-component exercise designed individually is more effective. Large-scale randomized controlled trials with objective sleep outcome measurements are warranted.Clinical trial registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD42022377221.

Keywords: Alzheimer’s disease; cognitive impairment; exercise; randomized controlled trials; sleep quality; systematic review and meta-analysis.

Publication types

Systematic Review

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was supported by the program of Beijing University of Chinese medicine (nos. 2023-JYB-KYPT-04 and BZY-JMZY-2022-002). This funding source had no role in the design and execution of this systematic review, neither during the literature search, study selection, analysis and interpretation of the data nor in writing the manuscript.