Does exercise help you sleep? What a new review found

Ask a room full of people in their forties, fifties and sixties how they slept last night and you'll get plenty of groans. Lying awake at 3am, waking too early, feeling tired before the day has started. It comes up with my clients all the time, and the question is usually the same: will training more help me sleep?

A new review, published in October in the Journal of Exercise Science & Fitness, gives a fairly encouraging answer, with some sensible limits.

What the review looked at

Researchers from Beijing Sport University, Tianjin University of Sport and East China Normal University pulled together 23 randomised controlled trials. Between them, the trials included 1,478 adults aged 45 to 77 who all had some kind of sleep problem. Some had diagnosed insomnia, some had obstructive sleep apnoea, and others had scored as poor sleepers on a standard questionnaire.

The exercise varied a lot. It included walking, general aerobic exercise, mind-body exercise such as tai chi, high-intensity interval training and mixed programmes. Each was compared with people who didn't do a structured exercise programme.

The main measure was the Pittsburgh Sleep Quality Index, a questionnaire where people rate their own sleep. The researchers also looked at insomnia severity and daytime sleepiness scores.

What it found

Overall, exercise improved how well people said they slept and reduced how severe their insomnia symptoms were. It didn't make a clear difference to daytime sleepiness.

When the researchers compared types of exercise, aerobic exercise had the largest estimated effect. Mind-body exercise and combined programmes also improved sleep scores compared with doing nothing. The authors are careful to say the rankings are uncertain, because there weren't many trials of each type.

In the smaller group of trials in people with sleep apnoea, there was no significant improvement in sleep quality scores.

The review also looked at how much exercise was linked to the biggest benefit. Rather than "more is always better", the pattern was an inverted U. Benefits were seen across a middle range of weekly exercise, peaking at a moderate amount, then tailing off at the highest amounts. The authors stress that their peak figure is an early, model-based estimate that "should not be interpreted as a definitive optimal dose".

The caveats

This is useful, but it isn't the final word.

• The authors rated the certainty of the evidence as low to moderate.
• Five of the 23 trials were judged at high risk of bias, and the rest had some concerns.
• Sleep was mostly self-reported, and people knew whether they were exercising, so expectations may have played a part.
• Many of the trials were small, and the programmes, groups and sleep problems varied a lot.

What this means in practice

Most of the trials used about three sessions a week, often 40 to 60 minutes each, and most ran for eight weeks or more. That's a realistic routine, not an extreme one, and it's a reminder that better sleep from exercise is likely to build over weeks rather than overnight.

If you sleep badly, here's how I'd put this into practice:

1. Pick something that gets you a bit out of breath. Brisk walking, cycling, swimming or a gym cardio machine all count as aerobic exercise. Our post on how many steps a day you need is a good place to start with walking.
2. Aim for regular and moderate, not punishing. Three steady sessions a week you can keep up will do more for you than one huge session you dread.
3. Try something calmer too. If hard cardio isn't for you, gentle mind-body work also helped in this review. A few minutes of slow breathing in child's pose is an easy way to wind down after a session, and gentle moves like cat-cow and open books sit nicely alongside it. If your hips feel tight after a day of sitting, a deep squat hold with support is another gentle one to try. Slow neck rotations, turning your head from side to side only as far as is comfortable, are a calm way to finish too.
4. Mind the timing. The NHS advice on insomnia is to exercise regularly during the day but not in the 4 hours before bed.

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When to speak to your GP

Exercise is a helpful part of the picture, not a treatment on its own. The NHS suggests seeing a GP if changing your sleep habits hasn't helped, you've had trouble sleeping for months, or it's making it hard to cope day to day. Loud snoring or pauses in your breathing at night can be signs of sleep apnoea, which needs checking by a GP. If you're already being treated for a sleep problem, keep following your care team's advice.

If you'd like a simple weekly plan to fit regular exercise into your week, a FitFitCity membership gives you full plans and a workout log in one place.