Table 1. Summary of findings.
| Outcomes (time frame) | Number of participants (studies) in follow-up | Quality of evidence (GRADE) | Relative effect (95% CI) | Anticipated absolute effectsa (95% CI) | |
|---|---|---|---|---|---|
| Risk with control | Risk difference with exercise | ||||
| Total PSQI score (8 wks to 6 mos) | 361 | ⊕⊕⊝⊝ | – | MD 2.87 point lower | |
| Scale: 0 to 21 | (6 RCTs) | LOWb,c,d | (3.95 lower to 1.79 lower) | ||
| Sleep efficiency (%) (1 d to 6 mos) | 186 | ⊕⊕⊕⊝ | – | MD 0.56% lower | |
| assessed with: polysomnography and actigraphy | (4 RCTs) | MODERATEd | (3.42 lower to 2.31 higher) | ||
| Scale: 0 to 100 | |||||
| Total ISI score(4–6 mos) | 66 | ⊕⊝⊝⊝ | – | MD 3.22 point lower | |
| Scale: 0 to 28 | (2 RCTs) | VERY LOWb,c,d,e,f | (5.36 lower to 1.07 lower) | ||
| Sleep onset latency (minute) (1 d to 6 mos) | 206 | ⊕⊕⊝⊝ | – | MD 1.9 minutes higher | |
| (5 RCTs) | LOWd,g | (3.63 lower to 7.43 higher) | |||
| Total sleep time (minute) (1 d to 6 mos) | 206 | ⊕⊕⊝⊝ | – | MD 4.32 minutes higher | |
| (5 RCTs) | LOWd,g | (9.19 lower to 17.84 higher) | |||
| All adverse events (2–6 mos) | 150 | ⊕⊝⊝⊝ | – | ||
| (4 RCTs) | VERY LOWb,c,d,h,i |
Notes.
a
The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
b
Participants were not blinded.
c
The outcome assessors were not blinded.
d
Sample size was small. Sample size did not meet criteria of optimal information size (OIS) (400). OIS was 400 if alpha =0.05, beta =0.2, delta =0.2.
e
Allocation concealment was not done in 40% of participants.
f
There were incomplete outcome data in 40% of participants.
g
There were incomplete outcome data in 25% of participants.
h
There were incomplete outcome data in 50% of participants.
i
Allocation concealment was not done in 30% of participants.
- ISI
- Insomnia Severity Index
- MD
- mean differences
- OIS
- optimal information size
- GRADE
- Grading of Recommendations, Assessment, Development, and Evaluation
- OR
- odds ratio
- PSQI
- Pittsburgh Sleep Quality Index
- RCTs
- randomized controlled trials
- RR
- risk ratio
GRADE working group grades of evidence
- High quality
- We are very confident that the true effect lies close to that of the estimate of the effect
- Moderate quality
- We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but a substantial difference is possible
- Low quality
- Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
- Very low quality
- We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect