General Medicine · Medical Literature
Exercise interventions to improve sleep quality in university students: a systematic review and meta-analysis of randomized controlled trials.
Abstract
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. 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. 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. 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. www.crd.york.ac.uk/prospero, identifier: CRD420261384510.
Clinical relevance
In university students with poor sleep quality, do structured exercise interventions compared to non-exercise controls improve the Pittsburgh Sleep Quality Index (PSQI) global score and component scores for sleep latency, sleep duration, habitual sleep efficiency, and sleep disturbances? __SNAPSHOT__ {"studyDesign":"Systematic review and meta-analysis of randomized controlled trials (RCTs)","setting":"Multi-database search (PubMed, Web of Science, Embase, CENTRAL, CINAHL, PsycINFO, ProQuest Dissertations & Theses); inception to April 30, 2026; institutional setting of individual trials not reported at the abstract level","sampleSize":"Not reported (number of included RCTs and total participant count not stated in the abstract)","population":"University students (undergraduate and/or graduate); specific inclusion criteria regarding baseline sleep status, age range, sex distribution, and clinical comorbidities not detailed in the abstract","intervention":"Structured exercise interventions (modalities, intensity, frequency, and duration not specified in the abstract)","comparator":"Non-exercise controls (specific control conditions — e.g., waitlist, usual activity, health education — not described in the abstract)","primaryOutcome":"PSQI global score (Pittsburgh Sleep Quality Index total score)","followUp":"Not reported","fundingSource":"Not reported"}
Key findings
The abstract does not report quantitative results. No pooled effect sizes (mean differences, standardized mean differences), confidence intervals, p-values, heterogeneity statistics (I², τ²), or subgroup findings for any PSQI outcome (global score, sleep latency, sleep duration, habitual sleep efficiency, or sleep disturbances) are provided. The direction, magnitude, and statistical significance of the primary and secondary outcomes, the number of included trials, total sample size, risk-of-bias assessment summary, and publication bias evaluation are all not reported in the available abstract. No NNT, NNH, or clinically important difference threshold analysis can be calculated or cited. All quantitative interpretation is deferred pending full-text review.
Practice implications
This meta-analysis addresses a clinically meaningful and underserved evidence gap: the synthesis of RCT-level evidence on structured exercise for sleep in university students using a standardized, validated instrument (PSQI). Prior reviews have been broader in design or population scope, so a university-student-specific, RCT-only synthesis using PSQI is a methodologically appropriate contribution. However, because only the abstract is available, it is not possible to determine: (1) what the pooled effect on PSQI global score was or whether it reached the reported minimal clinically important difference (MCID) for the PSQI, estimated at approximately 1.14–1.80 points in related populations; (2) which exercise modalities, intensities, or durations drove any observed effect; (3) the degree of heterogeneity across included trials; (4) whether findings are generalizable beyond the populations, settings, and exercise types represented in included RCTs; (5) whether male and female students, students with clinical insomnia versus subclinical poor sleep, and students from diverse geographic and cultural contexts were adequately represented. Practice implications cannot be determined from the abstract alone. Full-text review is required before any change in clinical recommendation is warranted. __LIMITATIONS__ The following methodological limitations are anticipated based on the study design and are common to this literature, though they cannot be confirmed or refuted from the abstract alone: (1) blinding of participants to exercise allocation is inherently impossible in exercise trials, introducing performance bias; (2) objective sleep measures (polysomnography, actigraphy) were not included as outcomes, limiting conclusions to subjective sleep perception; (3) the PSQI reflects recall over the past month and is susceptible to recall and social desirability bias; (4) heterogeneity in exercise type, dose, frequency, intensity, and duration across included trials may limit the interpretability of pooled estimates; (5) the university student population is predominantly young adults in structured academic environments, limiting generalizability to other settings; (6) inclusion of gray literature (ProQuest Dissertations & Theses) may introduce variability in methodological quality; (7) most RCTs in this field have short follow-up durations, precluding conclusions about durability of benefit; (8) funding sources and risk of bias across included primary trials are not reported in the abstract; (9) publication bias toward positive exercise trials is well-documented in this literature and may inflate pooled effect estimates. __BOTTOM_LINE_CATEGORY__ low_certainty __BOTTOM_LINE__ This systematic review and meta-analysis of RCTs targets a well-defined clinical question — the effect of structured exercise on PSQI-measured sleep in university students — using a rigorous, multi-database search strategy through April 2026. Because only the abstract is currently available, no quantitative conclusions about effect size, clinical significance, or optimal exercise prescription can be drawn. Full-text review is necessary before this evidence can inform clinical practice or public health recommendations for university students with poor sleep.