DOI: 10.1097/md.0000000000050049 ISSN: 0025-7974

Aerobic exercise and sleep-related outcomes in children and adolescents: A systematic review and meta-analysis of randomized controlled trials

Qi-Shuai Ma, Buong-O Chun, Rong Zhang
Show PDF Cite

Background:

Sleep problems are increasingly prevalent among children and adolescents, contributing to impaired daytime functioning, reduced academic performance, and long-term health risks. Aerobic exercise has been proposed as a promising behavioral strategy to promote sleep health in youth; yet, evidence from randomized controlled trials (RCTs) remains variable. This systematic review and meta-analysis synthesized randomized controlled trials to estimate the effects of aerobic exercise on sleep-related outcomes in children and adolescents and to explore potential sources of heterogeneity.

Methods:

Several major English and Chinese databases, including PubMed, Web of Science, EBSCO, Cochrane Library, Scopus, and CNKI, were systematically searched up to August 2025. Fourteen studies were included. Effect sizes were expressed as standardized mean differences (SMDs) and oriented so that positive values indicated improvement in sleep-related outcomes. A random-effects meta-analysis using restricted maximum likelihood estimation and the Hartung–Knapp adjustment was performed, with 95% prediction intervals calculated. Prespecified exploratory subgroup analyses examined intervention duration, measurement modality, and age group, with formal tests for subgroup differences where feasible.

Results:

Aerobic exercise was associated with improved sleep-related outcomes (SMD = 0.91, 95% CI: 0.40–1.43), with considerable heterogeneity ( I 2  = 91.5%) and a 95% prediction interval of −0.98 to 2.80. Exploratory subgroup estimates varied by intervention duration, measurement modality, and age; however, tests for subgroup differences were not statistically significant ( P  = .291, P  = .868, and P  = .873, respectively). These findings should be interpreted cautiously because several subgroups contained few studies.

Conclusions:

Aerobic exercise may improve sleep-related outcomes in children and adolescents. However, the magnitude and consistency of the benefit remain uncertain because of considerable heterogeneity, a prediction interval crossing the null, heterogeneous outcome definitions, and the limited number of studies in several subgroups. Further well-designed RCTs using standardized sleep outcomes and objective measures, where feasible, are needed.

More from our Archive