Exercise training effects on sleep quality and symptoms of anxiety and depression in post-traumatic stress disorder: A systematic review and meta-analysis of randomized control trials

Sleep problems are common in post-traumatic stress disorder (PTSD). Exercise can improve sleep quality, but whether this occurs among those with PTSD is unclear. We conducted a systematic review and meta-analysis to estimate the magnitude of the effect of exercise training on overall sleep quality in patients with PTSD. Secondarily, the impact of exercise training on symptoms of PTSD, anxiety, and depression were evaluated. Articles published before April 1, 2020, were located through PubMed, Web of Science, PsycINFO, and Google Scholar. Exercise training interventions that measured sleep quality in patients with PTSD were evaluated for inclusion. In total, 1,948 articles were screened, 40 were further appraised, and four were analyzed. Hedges’ d effect sizes were calculated for sleep quality. Due to the relationship between poor sleep and symptoms of PTSD, anxiety, and depression, symptom changes with exercise training were analyzed. The four studies involved a total of 149 participants (61% males) with a mean (SD) age of 44.7 (16.3) years. The exercise intervention duration ranged from 3 to 12 weeks. All 5 effect sizes for overall sleep quality supported a favorable effect of exercise training; the mean Hedges'd (95% CI) was −0.47 (−0.18, −0.75), p