Sleep quality in perimenopausal and postmenopausal women: which exercise therapy is the most effective? A systematic review and network meta-analysis of 31 RCTs

The effectiveness of various exercise types in improving sleep quality in menopausal women remains controversial. This network meta-analysis was designed to evaluate and rank the efficacy of five exercise modalities on sleep quality in peri-postmenopausal women. Five English databases and three Chinese databases were searched for randomized controlled trials (RCTs) published from inception to July 2024. Pairwise meta-analysis and frequentist network meta-analyses were performed based on the random effects model. The analysis revealed that younger menopausal women (age ≤55 years) (standardized mean difference [SMD] = −2.00; 95% confidence interval [CI] [–2.70, –1.31]), those with sleep disorders (SMD = –2.29; 95% CI [–2.79, –1.78]) and those from Asia (SMD = −2.50, 95% CI [–3.62, –1.38]) were able to derive greater health benefits. Flexibility exercise (low certainty) and aerobic exercise (low certainty), combined exercise (moderate certainty) and mind–body exercise (moderate certainty) significantly improved sleep quality. Combined exercise showed the highest efficacy (surface under the cumulative ranking curve [SUCRA] = 93.5%), followed by flexibility exercise (SUCRA = 76%), and these exercises also showed a positive effect on women’s quality of life (SMD = 0.49; 95% CI [0.13, 0.84]; <i>p</i> = 0.007). Future research should develop more acceptable exercise intervention models and use combined and flexibility exercises to explore the optimal parameters of exercise for menopausal women.