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In a nutshell
- Strength training outperforms other exercise types for improving sleep in older adults with insomnia, reducing sleep quality scores by 5.75 points—nearly twice the improvement seen with combination exercises and significantly better than aerobic activities.
- Three major exercise types all helped sleep quality when compared to routine activities, but strength training crossed the threshold for meaningful improvement (3+ points), making it a potentially valuable non-drug approach for insomnia.
- No expensive equipment needed to get started with strength training—many effective exercises can be done at home using body weight, resistance bands, or household items as weights, making this sleep solution accessible for most older adults.
BANGKOK — Looking for a better night’s sleep as you age? The answer might be found in the weight room, not on the treadmill. A review from Mahidol University in Thailand suggests that strength training may be the most effective exercise for improving sleep quality in older adults with insomnia, outperforming aerobic and combination exercises.
The study, published in Family Medicine and Community Health, analyzed data from 25 clinical trials involving over 2,100 participants aged 60 and older. While we’ve known exercise helps with sleep problems, this research went further by comparing different types of physical activity head-to-head.
The researchers found that exercise, particularly strength and aerobic training, showed the greatest improvements in sleep quality compared to other forms of physical activity. This suggests that strength training may be an even better first-line recommendation for improving sleep than traditionally favored activities like walking, swimming, or cycling.
The Sleep Crisis Among Older Adults
Insomnia is a major health concern for seniors, with 30% to 48% reporting sleep problems, and 12-20% specifically experiencing insomnia. Doctors see roughly 5.5 million patients yearly for sleep-related complaints.
These sleep issues aren’t just annoying; they’re linked to depression, anxiety, heart disease, cognitive decline, and even increased prostate cancer risk in older men.
Currently, cognitive behavioral therapy stands as the recommended first-line treatment for insomnia. However, it’s often unavailable due to time constraints and shortage of qualified therapists. This makes alternative methods like exercise particularly useful.
Different Types of Exercise for Better Sleep
The researchers sorted physical activities into five categories:
- Aerobic exercise (walking, cycling, swimming)
- Strength training (weights, resistance bands)
- Balance exercises (activities improving stability)
- Flexibility exercises (stretching, yoga)
- Combination approaches (mixing different types)
Each was measured for its effect on sleep quality using the Pittsburgh Sleep Quality Index (PSQI), which evaluates seven aspects of sleep. All three major exercise types—strength training, aerobic, and combination exercise—improved sleep quality compared to routine activities. But strength training emerged as the clear winner, showing almost twice the improvement of combination exercises and much better results than aerobic activities alone.
The Numbers That Matter
In concrete terms, strength training improved PSQI scores by 5.75 points, compared to 3.76 for aerobic exercise and 2.54 for combination exercise. Since a 3-point reduction is considered clinically meaningful, strength training not only surpasses this threshold but also translates into a real-world improvement in sleep quality that patients can feel in their daily lives.
Interestingly, educational programs about sleep hygiene also performed well, ranking second overall. However, as the researchers noted, these educational interventions weren’t clearly defined in the studies, and still didn’t match the benefits of strength training.
Beyond Just Feeling Rested
Exercise benefits went beyond overall sleep quality. When examining specific aspects of sleep, combination exercises improved five key areas:
- How well people felt they slept
- How quickly they fell asleep
- How long they slept
- How much of their time in bed was actually spent sleeping
- Reduced need for sleep medications
However, they didn’t significantly improve sleep disturbance or daytime tiredness.
Making It Work in Real Life
The good news? Strength training doesn’t require expensive equipment. Many effective exercises can be done at home using body weight, resistance bands, or household items as weights. This makes it accessible for most older adults, regardless of income or gym access. Make sure to go at your own pace, as some exercises may be challenging at first. Start with lighter resistance and gradually build up strength to avoid strain or injury.
For aging adults tired of counting sheep, adding strength training to your routine may offer a promising, research-backed way to improve sleep. While medications are commonly prescribed for insomnia, they come with significant risks for older populations. Strength training represents a safer alternative with additional health benefits. So next time you’re staring at the ceiling at 3 a.m., the solution might not be an earlier bedtime or another walk, it might be those dumbbells gathering dust in the corner.
Paper Summary
Methodology
Researchers searched medical databases for studies published through October 2022 comparing physical exercise with routine activities in people aged 60+ with insomnia, using the Pittsburgh Sleep Quality Index for measurement. Twenty-five randomized controlled trials were included, with most participants around 70 years old (72% women). Exercise sessions typically lasted 50 minutes, occurred 2-3 times weekly, and continued for 14 weeks on average. The team used network meta-analysis to compare all exercise types simultaneously.
Results
Strength training emerged as most effective, improving PSQI scores by 5.75 points, followed by sleep education (-4.63), aerobic exercise (-3.76), and combination exercise (-2.54). For comparison, a 3-point reduction is considered clinically meaningful. Combination exercises significantly improved subjective sleep quality, time to fall asleep, sleep duration, sleep efficiency, and reduced need for sleep medications, but didn’t significantly improve sleep disturbance or daytime function.
Limitations
The included studies varied considerably in design and methodology. Few studies focused on isolated exercise types, and many didn’t report exercise intensity. The research relied on self-reported sleep quality rather than objective measurements. Some exercises might be challenging for older adults with mobility limitations, potentially affecting real-world applicability.
Discussion and Takeaways
This study provides evidence that strength training offers the most significant benefits for sleep quality in older adults with insomnia, challenging assumptions that aerobic exercise should be the default recommendation. Since many older adults struggle with medication side effects, this non-pharmacological approach offers a safer alternative with additional benefits for muscle maintenance and overall health. The findings give healthcare providers more specific guidance when recommending physical activity for sleep improvement.
Funding and Disclosures
The authors declared no specific funding for this research from public, commercial, or not-for-profit sectors and disclosed no competing interests. The study was exempted from ethical review at Ramathibodi Hospital due to its nature as a systematic review rather than primary research.
Publication Information
The study, “Impact of different types of physical exercise on sleep quality in older population with insomnia: a systematic review and network meta-analysis of randomized controlled trials,” was published in Family Medicine and Community Health (March 2025, volume 13, e003056). It was authored by Pakwan Bahalayothin, Kittiphon Nagaviroj, and Thunyarat Anothaisintawee from Ramathibodi Hospital, Mahidol University in Thailand. The article is available as open-access under Creative Commons Attribution Non Commercial license.
