Different Intensities of Evening Exercise on Sleep in Healthy Adults: A Systematic Review and Network Meta-Analysis

Figures & data

Figure 1 PRISMA flow diagram of systematic search and included trials.

Notes: PRISMA figure adapted from Liberati A, Altman D, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Journal of clinical epidemiology. 2009;62(10). Creative Commons.²⁹

Table 1 Descriptive Characteristics of the Included Studies

Study	Participants	Design	Arms	Outcomes	Timing of Exercise interventions (Start – end Time)	Sleep Time
Arias et al 2016^Citation30	N = 9 young non-professional sportsmen (performing exercise about 3 times per week) M = all males Age = 18–38 years	Crossover trial	HIE: 5 sets of 20m-SRT interspersed with 6 min breaks CON: no exercise	Actigraphy: SE, SOL, Movement and fragmentation index Subjective sleep quality: NSFSD	17:00 - NR / 21:00 - NR ended > 4 h before bedtime	Usual bedtime/ad libitum
Aloulou et al 2020^Citation31	N = 11 well-trained male runners M: all males Age (mean ± SD) = 32.3 ± 5.2 years Chronotype: neither-types	Crossover trial 1 week washout period	HIE: 45 min running at uphill (+10%) at 65% MAS; downhill (−12.5%) at 80% MAS & level treadmill (0%) at 60% MAS to maximal speed. Average HR was 83% HRmax CON: no exercise	PSG: TIB, TST, WASO, SE, SOL, REM-L, %N1, %N2, %N3, %REM Actigraphy: TST, WASO, SOL, SE Subjective sleep quality: SSI score	21:00–22:00 ended 2 h before bedtime	00:46–9:00
Browman & Tepas 1976^Citation16	N = 9 male undergraduates, average physical fitness M: all males Mean age = 18.89 years	Crossover trial	LIE: 45 min cycling alternating 5 min of cycling with a load of 0.5 kg and 3-min breaks CON: no exercise	PSG: TST, %N1, %N2, %SWS, % REM, REM-L	Started 2.5 h prior to bedtime; ended 2 h before bedtime	Usual bedtime/ad libitum, 7.5 h sleep duration
Bulckaert et al 2011^Citation32	N = 9 young adults with good physical health M: 4 males Age (mean ± SD) = 23 ± 3.4 years	Crossover trial	MIE: 60 min cycling at 65–75% HRmax CON: reference night	PSG: SOL, %N2, %SWS, %REM	Started 2 h before bedtime ended 1h before bedtime	22:30–23:00 to 7:00
Driver et al 1988^Citation33	N = 9 young sedentary women M: 0 male Age (mean ± SD) = 24 ± 3 years	Crossover trial 1 day washout period	HIE: 60 min cycling at 70% VO2peak CON: no exercise	PSG: SOL, REM-L, N2, SWS Subjective sleep quality	16:00–19:00	NR
Flausino et al 2012^Citation46	N = 17 healthy young good sleepers with no regular exercise habits M = all males Age (mean ± SD) = 27.2 ± 3.6 years	Crossover trial ≥ 1 week washout period	HIE: 30 and 60min running at Delta 50 (50% above VT1) MIE: 30 and 60 min running at VT1 CON: no exercise	PSG: TST, WASO, SOL, SE, % N1, %N2, %SWS, % REM, REM-L	20:00–20:30 ended 2 h before bedtime	22:30–23:00 to 06:00–07:00
Hayashi et al 2014^Citation50	N = 9 sedentary college students M = all males Age (mean ± SD) = 22.8 ± 2.0 years	Crossover trial ≥ 3 days washout period	HIE: 60 min cycling at 80% HRmax MIE: 60 min cycling at 65% HRmax LIE: 60 min at 50% HRmax CON: no exercise	PSG: TIB, TST, SE, SOL, REM-L, WASO, %N1, %N2, %N3, %REM	Ended 2 h before bedtime	Go to bed 2 h after exercise
Kern et al 1995^Citation47	N = 10 healthy non-professional male triathletes M = all males Age = 20–26 years	Crossover trial ≥1 week washout period	MIE: 120–150 km cycling at moderate intensity LIE: 40 km cycling at low intensity CON: no exercise	PSG: TST, SOL, %N1, %N2, SWS, %REM, REM-L	16:00–20:30 (LIE) 18:00–20:30 (MIE) ended 2.5 before bedtime	23:00–7:00
Larsen et al 2019^Citation34	N = 11 inactive men M = all males Age (mean ± SD) = 49 ± 5 years	Crossover trial ≥5 days washout period	HIE: 30 min HIIT (60s cycling at 100% VO2peak, interspersed with 240s active recovery at 50% VO2peak) CON: baseline or no exercise	PSG: TIB, TST, SE, SOL, REM-L, WASO, %N1, %N2, %N3, %REM Actigraphy: TIB, TST, SE, SOL, WASO, number of awakenings	19:00–20:00 3 h before bedtime	Ad libitum bedtimes and wake time
Miura et al 2016^Citation35	N = 10 young sedentary adults M = all males Age = 18–25 years	Crossover trial 1 week washout period	MIE: 60-min upright cycling at 60 rpm at an intensity of 50% HRR CON: no exercise	Actigraphy: TST, WASO, SE, SOL, REM, stage 1and2 sleep, stage 3 and 4 sleep	17:00–18:00 ended > 4 h before bedtime	23:00–00:00
Myllymäki et al 2011^Citation36	N = 11 physically fit young adults M = 7 males Age (mean ± SD) = 26 ± 3 years	Crossover trial 1 week washout period	HIE: 30 min incremental cycling until exhaustion at 100 W for men and 25 W for women CON: no exercise	PSG: TST, SOL, %N1, %N2, %N3, %REM Actigraphy: TST, SE, FI, total activity Subjective sleep quality: questionnaire	21:00 - ended 2 h before bedtime	NR
Myllymäki et al 2012^Citation20	N = 14 physically healthy young adults M = all males Age (mean ± SD) = 35.9 ± 4.3 years	Crossover trail ≥ 48h washout period	HIE: 30 min running at 75% VO2max MIE: 30 min running at 60% VO2max LIE: 30 min running at 45% VO2max CON: no exercise	Actigraphy: TST, SE, FI, activity counts Subjective sleep quality: VAS	18:00–19:00, ended 4 h before bedtime	23:28–07:04
Miller et al 2020^Citation11	N = 12 healthy young males with regular exercise at least 3 times per week M = all males Age (mean ± SD) = 21.9 ± 2.7 years	Crossover trail 1 day washout period	MIE: 30 min cycling at 75% HRmax CON: no exercise	PSG: TST, SOL, N1, N2, N3, REM, SE Subjective sleep quality: Karolinska Sleep Scale	20:45–21:30 ended 1.5 h before bedtime	23:00–8:00
O’Connor et al 1998^Citation48	N = 8 physically active college students M = all males Age (mean ± SD) = 20.8 ± 2 years	Crossover trial	MIE: 60 min cycling at 60% VO2peak LIE: 60 min cycling at 20% VO2peak CON: no exercise	Sleep Assessment Device: SOL, TST, SE, awakenings	Late evening ended 1.5 h before bedtime	23:00–8:00
Oda & Shirakawa 2014^Citation15	N = 12 active young adults M = all males Age (mean ± SD) = 19.8 ± 0.9 years	Crossover trial 4–7 days washout period	HIE: 30 min running at 80% HRR MIE: 30 min running at 60% HRR CON: no exercise	PSG: TST, WASO, SOL, SE, N1, N2, SWS and REM, REM-L Subjective sleep quality: Sleep Inventory of Oguri-Shirakawa-Azumi	21:20–22:00 ended 1 h before bedtime	23:00–7:00
Park et al 2021^Citation37	N = 9 healthy young men with regular exercise no more than twice a week M = all males Age (mean ± SD) = 23.8 ± 2.7 years	Crossover trial 1 week washout period	MIE: 60 min running at 60% VO2max CON: no exercise	PSG: TIB, TST, SOL, SE, N1, N2, SWS, REM-LSubjective sleep quality: Sleep Inventory of Oguri-Shirakawa-Azumi	17:00–18:00 ended 6 h before bedtime	23:30–24:30 to 8:00
Robey et al 2013^Citation38	N = 11 athletes M = all males Age (mean ± SD) = 26 ± 4.4 years	Crossover trial 1 week washout period	HIE: 30 min cycling at 75% peak power + maximal time trial CON: no exercise	PSG: TIB, TST, SE, SOL, %WASO, %N1, %N2, %N3, %REM, REM-L, %NERM Actigraphy: TST, SOL, WASO, SE	19:00–20:00 ended 2.5 h before bed	22:30–6:00
Ramos-Campo et al 2019^Citation17	N = 14 recreational ultra-endurance male runners M = all males Age (mean ± SD) = 27.6 ± 7.4 years Chronotype: neither-types	Crossover trial ≥ 72h washout period	HIE: 7 x 3 min running at 100% VO2max, interspersed with 3 min passive rest MIE: 60 min running at 60% VO2max	Actigraphy: TIB, TST, SE, wake of time, number of awakenings, average time of each awakening Subjective sleep quality: Karolinska Sleep Diary	20:00–21:00 ended 2–4 h before bedtime	NR
Saidi et al 2020^Citation39	N = 16 healthy college students M: 8 males Age (mean ± SD) = 22.31 ± 1.44 years Chronotype: neither-types	Crossover trial	MIE: 50 min running at 60% HRmax CON: no exercise	Actigraphy: TIB, TST, SE, WASO, SOL	18:30–19: 30 ended 4h before bedtime 20:30–21:30 ended 2h before bedtime	22:00–8:00
Thomas et al 2020^Citation19	N = 8 endurance trained runners M = all males Age (mean ± SD) = 27.8 ± 6.9 years Chronotype: neither-types	Crossover trial ≥ 4 days washout period	HIE: 6×5 min running at 90% VO2peak, interspersed with 5 min at 60% VO2peak LIE: 60 min running at 45% VO2peak CON: no exercise	PSG: TIB, TST, SOL, REM latency, WASO, %N1, %N2, SWS, %REMActigraphy: TST, SOL, activity counts, FISubjective sleep quality: Likert scale from the Consensus sleep diary	17:50 - ended 3.5h before bedtime	22:30–7:00
Ucar et al 2017^Citation40	N = 20 healthy male college students M = all males Age = 20–24 years	Crossover trial	HIE: 90 min hard football match CON: no exercise	Subjective sleep quality: Karolinska Sleep Diary, PSQI	21:30–23:00 ended 2.5 h before bedtime	1:39–8:08
Vitale et al 2017^Citation42	N = 23 college soccer players M = all males Age (mean ± SD) = 21.7 ± 2.72 years Chronotype: both morning-type and evening-type	Crossover trial 1 week washout period	HIE: 4×4 min running at 90–95% HRmax, interspersed with 3 min recovery at 70% HRmax CON: pre exercise	Actigraphy: SE, SOL, activity counts, MFI, moving time, immobility time	20:00 - NR	NR
Vincent et al 2020^Citation41	N = 12 healthy males with regular exercise at least 3 times per week M = all males Age (mean ± SD) = 27.3 ± 3.4 years	Crossover trial 4 days washout period	MIE: 30 min cycling at 75% HRmax CON: no exercise	PSG: TST Subjective sleep quality: Karolinska Sleep Diary	20:45–21:30 ended 1.5h before bedtime	23:00–8:00
Vlahoyiannis et al 2021^Citation18	N = 10 recreationally trained young males M = all males Age (mean ± SD) = 23.9 ± 3.3 years Chronotype: neither-types	Crossover trial 1 week washout period	HIE: 10×1 min cycling at 90% Wmax interspersed with 1 min recovery at 20% Wmax / 6×20 s cycling at 140% Wmax, interspersed with 140s active recovery at 20% Wmax MIE: 45 min cycling at 70% Wmax CON: no exercise	PSG: TIB, TST, SE, SOL, WASO, METs	19:00–20:00 ended 3 h before bedtime	Ad libitum sleep duration
Wong et al 2013^Citation49	N = 12 healthy sedentary young adults M = 3 males Age (mean ± SD) = 25.2 ± 4.0 years	Crossover trial ≥ 2 days washout period	HIE: 40 min running at 65% VO2max / 75% VO2max MIE: 40 min running at 55% VO2max LIE: 40 min running at 45% VO2max CON: no exercise	PSG: TST, SOL, WASO, REM-L, SE, %SWS, %REM	Started 6 h prior to bedtime; ended 4–5 h before bedtime	Bedtime 22:30–01:30 (majority 23:30), ad libitum wake time
Yoshida et al 1998^Citation43	N = 5 healthy university male students with no exercise habits M = all males Age (mean ± SD) = 21.0 ± 0.7 years	Crossover trial 1–3 weeks washout period	MIE: 50 min aerobic exercise at AT CON: no exercise	PSG: SWS Subjective sleep quality: Sleep Inventory of Oguri-Shirakawa-Azumi	16:30–17:30 ended > 4 h before bedtime 20:30–21:30 ended 2 h before bedtime	23:30–7:30
Youngstedt et al 1999^Citation44	N = 16 highly fit cyclists M = all males Age (mean ± SD) = 27.3 ± 4.3 years	Crossover trial 2–4 weeks washout period	HIE: 3 h cycling at 65–75% of HRR under bright light (3000 lux) in a laboratory CON: no exercise or bright light alone	Actigraphy: TST, SOL, WASO Subjective sleep quality: SOL, WASO, subjective rating of insomnia	Ended 30 min before bedtime	30 min after exercise and were awakened at their usual time
Yamanaka et al 2015^Citation45	N = 8 healthy young males, paid volunteers, with a habit of light exercise once or twice a week M: all males	Crossover trial	MIE: 90 min cycling at 65–75% HRmax (2 x 45 min interspersed with a 10-min recovery) CON: no exercise	PSG: TST, SOL, SE, WASO	18:00–20:00 ended 4h before bedtime	24:00–8:00

Abbreviations: M, male; LIE, low-intensity exercise; MIE, moderate-intensity exercise; HIE, high-intensity exercise; TIB, time in bed; TST, total sleep time; SOL, sleep onset latency; WASO, wake time after sleep onset; SE, sleep efficiency; REM, rapid eye movement; REM-L, rapid eye movement latency; SWS, slow-wave sleep; NERM, non-rapid eye movement; N1, stage N1 sleep; N2, stage N2 sleep; N3, stage N3 sleep; SQ, sleep quality; SSQ, subjective sleep quality; PSG, polysomnography; SRT, Shuttle-Run-Test; NSFSD, National Sleep Foundation-Sleep Diary; SSI, Spiegel Sleep Inventory; KSS, Karolinska Sleep Scale; HR, heart rate; MAS, maximal aerobic speed; VT1, ventilatory threshold 1; PSQI, Pittsburgh Sleep Quality Index; VO_2peak, peak oxygen uptake; FI, fragmentation index; NR, not reported; METs, metabolic equivalent of tasks; Wmax, maximal power output; MAS, Maximal Aerobic Speed.

Figure 2 Network plots for comparisons of outcomes.

Abbreviations: LIE, low-intensity exercise; MIE, moderate-intensity exercise; HIE, high-intensity exercise; TST, total sleep time; SOL, sleep onset latency; WASO, wake time after sleep onset; SE, sleep efficiency; REM, rapid eye movement; REM-L, rapid eye movement latency; N1, stage N1 sleep; N2, stage N2 sleep; N3, stage N3 sleep; SSQ, subjective sleep quality.

Table 2 SUCRA Values of Different Intensities of Acute Evening Exercise for Sleep Outcomes

	TST	SOL	WASO	SE	REM-L	N1	N2	N3	REM	SSQ
No exercise	71.5%	27.5%	26.4%	40.2%	12.8%	20.1%	9.3%	55.0%	17.9%	71.8%
LIE	37.0%	61.7%	59.4%	60.2%	69.3%	47.4%	55.2%	25.0%	23.1%	43.9%
MIE	47.3%	60.3%	74.8%	72.1%	46.9%	67.2%	66.6%	86.2%	73.6%	73.1%
HIE	44.2%	50.4%	39.4%	27.4%	71.0%	65.3%	68.9%	33.9%	85.4%	11.2%

Abbreviations: LIE, low-intensity exercise; MIE, moderate-intensity exercise; HIE, high-intensity exercise; TST, total sleep time; SOL, sleep onset latency; WASO, wake time after sleep onset; SE, sleep efficiency; REM, rapid eye movement; REM-L, rapid eye movement latency; N1, stage N1 sleep; N2, stage N2 sleep; N3, stage N3 sleep; SSQ, subjective sleep quality.

Figure 3 Forest plots of network meta-analysis of all comparisons for TST, SOL, WASO, REM-L, and SE.

Abbreviations: TST, total sleep time; SOL, sleep onset latency; WASO, wake time after sleep onset; REM-L, rapid eye movement latency; SE, sleep efficiency.

Figure 4 Forest plots of network meta-analysis of all comparisons for N1, N2, N3, and REM sleep.

Abbreviations: N1, stage N1 sleep; N2, stage N2 sleep; N3, stage N3 sleep (slow-wave sleep); REM, rapid eye movement.

Figure 5 A forest plot of network meta-analysis of all comparisons for SSQ.

Abbreviation: SSQ, subjective sleep quality.

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