Sports Mad.

1996 Apr; 21 (4); 277·291

REVIEW ARTICLE o112·1642/96/WJMJ277/ S07 .fiJ/O
© Adis International limited. All rights reserved .

The Effects of Acute and Chronic

Exercise on Sleep
A Meta-Analytic Review
Karla A. Kubitz,l Daniel M. Landers,2 Steven J. Petruzzello3 and Myungwoo Han 4
1 Department of Kinesiology, Kansas State University, Manhattan, Kansas, USA
2 Exercise and Sport Research Institute, Department of Exercise Science and Physical Education,
Arizona State University, Tempe, Arizona, USA
3 Department of Kinesiology, University of Illinois, Urbana, Illinois, USA
4 Korea Sport Science Institute, Seoul, Korea

Contents
Summary ........ . 277
1. Review Procedures. . . . 280
1.1 Problem Formation . 280
1.2 Selection of Studies . 281
1.3 Coding the Studies . 281
1.3.1 Study Characteristics 281
1.3.2 Individual Descriptors . 281
1.3.3 Exercise Characteristics 282
1.4 Data Analysis Procedures . . . 282
2. Results and Discussion . . . . . . . . 282
2.1 Studies Without Data Available . 282
2.2 Studies With Data Available . 283
2.2.1 Acute Exercise .. 283
2.2.2 Chronic Exercise. 285
3. General Discussion . . . . . . 285
3.1 Summary of Findings . . 285
3.2 Suggested Underlying Mechanisms 286
4. Conclusions . . . . . . . . . . . . . . . . . 287

Summary Studies attempting to ascertain the effects of acute and chronic exercise on
measures of sleep have yielded conflicting results and interpretations. Methodo-
logical differences among studies may explain this lack of consensus; however,
small sample sizes and subsequently low statistical power may also have contrib-
uted. In an attempt to resolve these issues, this review used meta-analytical tech-
niques to: (a) re-examine the effects of exercise on sleep; and (b) examine possible
moderators of these effects. Studies meeting the selection criteria were included
in the analysis. Analyses of moderating factors were performed for stage 4 sleep
and rapid eye movement (REM) sleep. The results indicated that acute and
chronic exercise increased slow wave sleep (SWS) and total sleep time but de-
creased sleep onset latency and REM sleep. Moderating variables influencing the
278 Kubitz et al.

magnitude and direction of these effects were related to characteristics of the

individual (e.g. sex, age, fitness level) and the exercise (e.g. time of day exercise
was completed, type of exercise, exercise duration). Mechanisms which have
been suggested to explain the relationship between exercise and sleep are dis-
cussed and directions for further research are provided.

The effects of exercise, which is a waking
behaviour, have most often been related to other
waking behaviours (e.g. stress reactivity, depres-
sion, self-esteem). Less attention has been given to
examining the effects of exercise on non waking
behaviours. However, individuals cycle between
activity (i.e. waking) and inactivity (i.e. sleeping)
and it is often believed that since sleeping and wak-
ing constitute alternate phases of the same cycle,
changes in one portion of the cycle significantly
affect the other.
The position, or 'theory' , that emphasises the
reciprocal nature of sleep in relation to wakefulness
has been called 'complemental'!ll or 'compen-
satory' .12] According to this position, 'those sys-
tems which are most fatigued during wakefulness
automatically slow down the most during sleep and
thus achieve the most rest' .[1] Fatiguing daytime
activity (e.g. exercise) would probably result in a
compensatory increase in the need for and depth of
night-time sleep,!2] thereby facilitating recupera-
tive,!I] restorative!3] and/or energy conservation!4]
processes. Operationally, sleep researchers have
predicted that measures such as sleep duration,
self-reports of sleep quality and the amount of high
amplitude, slow wave electroencephalographic
(EEG) activity, [i.e. slow wave sleep (SWS)] would
be higher in physically fit individuals than in those
who are unfit (i.e. chronic effect) and higher on
nights following exercise than on nights following
no exercise (i.e. acute effect).
An alternative to the compensatory position is
the 'continuity' position which maintains that sleep
is determined by activity levels during the sleep
period. As such, sleep is seen as a resting state
where physiological and psychological excitation
gradually tapers off from waking activity. Its ben-
efits (i.e. in terms of facilitating the resting state)
'stem mainly from the scarcity of both internal and
external impulses to act during sleep' .II] Thus, ex-
ercise would be likely to influence sleep only to the
extent that it alters physiological and/or psycholog-
ical excitation during sleep. Operationally, sleep
researchers have predicted that physiological
measures such as heart rate, temperature, galvanic
skin response and/or respiration would be higher
on nights following exercise than on nights follow-
ing no exercise (i.e. acute effect).
Researchers interested in the effects of phys-
ical activity on sleep have examined a number of
operational measures of sleep (e.g. behavioural,
physiological and psychological measures). Psycho-
physiological recordings (i.e. the EEG, electro-
oculogram and electromyogram [EMG]) have
been compared between nights with and without
exercise. Furthermore, these recordings have also
been used to quantify other indices of sleep, includ-
ing length of sleep (total sleep time), time taken to
fall asleep (sleep onset latency), the quietness or
restfulness of sleep (movement time) and the per-
centages of time spent in particular types of sleep
[i.e. rapid eye movement (REM) or SWS] . Heart
rate, temperature, biochemical and retrospective
self-report measures have also been employed in
studies examining the effects of physical activity
on sleep.
In the exercise and sleep literature, the most
common measure is the sleep EEG and researchers
make inferences concerning sleep based on various
characteristics of the scalp-recorded EEG (e.g.
waveform morphology, amplitude and/or fre-
quency). For example, in terms of frequency, the
typical spontaneous EEG is composed of a mixture
of ~ (12 to 30Hz), a. (8 to 12Hz), e (4 to 8Hz) and
8 (0 to 4Hz) waves. The waking EEG has a greater
proportion of faster frequency (a. and ~) activity
than the sleep EEG. Furthermore, standard scoring
procedures!5] classify sleep into 5 distinct stages

© Adis International limited. All rights reserved. Sports Med. 1996 Apr; 21 (4)
Effects of Exercise on Sleep
based on characteristic waveform morphology,
amplitude and frequency criteria, previous EEG
activity, ocular motions and EMG activity. These
include stages 1,2,3,4 and REM. More specific-
ally, the Manual of Standardised Terminology,
Techniques and Scoring Systemfor Sleep Stages in
Human Subjects[51 describes the following criteria:
• 'Stage I - A relatively low voltage, mixed fre-
quency EEG without rapid eye movements
(REMs).
• Stage 2 - 12 to 14Hz sleep spindles and K com-
plexes on a background of relatively low volt-
age, mixed frequency EEG.
• Stage 3 - Moderate amounts of high amplitude,
slow wave activity.
• Stage 4 - Large amounts of high amplitude,
slow wave activity.
• Stage REM - A relatively low voltage, mixed
frequency EEG in conjunction with episodic
REMs and low amplitude EMG.'
Baekeland and Lasky[61 were among the first to
examine the effects of strenuous exercise on sub-
sequent sleep. They concluded that exercise re-
sulted in an increased amount of 8 sleep (0 to 4Hz)
in the post-exercise sleep period. Although sub-
sequent investigators have demonstrated similar
effects, others have suggested that the reported
effects are not consistent or occur only in certain
circumstances. Hence, the 5 narrative reviews that
have examined this literature have had little suc-
cess in reaching a consensus regarding the effects
of exercise on sleep.
In 1981, 3 reviews of the literature (e.g. covering
approximately 30 studies) examining the effects
of physical activity on sleep were published.[7-91
Horne[71 and TorsvaW81 concluded that, although the
exercise/sleep literature was plagued by methodo-
logical problems (i.e. varying exercise stimuli,
within-individual variability in the sleep EEG,
weak experimental designs, varying EEG scoring
criteria and insufficient recording nights), exercise
appeared to reliably increase SWS (i.e. stages 3
and 4) in physically fit individuals. Shapiro,[91 Iike-
wise, concluded in favour of the compensatory po-
sition. Not only did he find that exercise reliably
© Adis International Limited. All rights reserved.
279
increased SWS but he also reported additional
effects of exercise on sleep, including increased
subjective tiredness, increased sleep duration, in-
creased growth hormone release and decreased
sleep onset latency.
In 1988, 2 additional reviews of the literature,
covering approximately 50 studies, were publish-
edJ2, IO I Shapiro and Driver[lOI basically recon-
firmed the findings of Shapiro's earlier review;
Trinder et alPI found the literature less consistent,
particularly with regard to the acute effects of ex-
ercise. Trinder and his colleagues reported that
only 3 of the 21 papers considered in the earlier
reviews showed that acute exercise significantly
increased SWS. Similarly, only 2 of 14 studies and
4 of 19 showed that acute exercise significantly
increased sleep duration or decreased the amount
of REM activity, respectively. Trinder et aU21 also
found very little support for the compensatory hy-
pothesis in either more recent acute exercise stud-
ies (i.e. those published between 1982 and 1988)
or in chronic exercise studies. However, they did
conclude in favour of a chronic effect of endurance
training (i.e. aerobic training increased SWS and
total sleep time).
One of the potential strengths of the review by
Trinder et alPI was its objectivity. Their conclu-
sions were based on statistical (i.e. probability
value) outcomes. Significant (p < 0.05) and non-
significant (p > 0.05) effects of exercise on various
measures of sleep were tallied. This 'counting
method' is ideal when the statistical power is high
in the studies being counted. However, it may be
problematic when statistical power is compro-
mised, either by small sample sizes and/or by mod-
est treatment effects. In these conditions, the type
II error rate is often compromised.
To circumvent the problems associated with the
'counting method', we contrasted the effect sizes
(ESs) from studies comparing an exercise treat-
ment or a fit group!condition with a comparison
group/condition using meta-analytic procedures.
Meta-analysis, as defined by Glass,[111 is a method-
ology for combining the results of independent in-
vestigations with the purpose of integrating their
Sports Med. 1996 Apr; 21 (4)
280 Kubitz et al.

findings. It is a systematic, replicable, statistical pro- rative summary of study conclusions were exam-
cedure that was designed to overcome many of the ined when ES information was not available.
problems inherent in traditional narrative reviews.
Meta-analysis has 2 advantages over other types 1.1 Problem Formation
of reviews. The first is that it quantifies the magni-
tude of treatment effects. Moreover, because an ES A pilot meta-analysis was completed!13] which
is a standardised estimate of treatment effects, the provided a basis for refining research questions and
relative efficacy of various treatments can be com- for developing the coding form used in the present
pared across meta-analyses. The second advantage review. In particular, the pilot meta-analysis: (a)
is that meta-analysis facilitates examination of po- identified 21 different measures of sleep (e.g.
tential moderators of treatment effects. It does so SWS, REM sleep, sleep onset latency, sleep effi-
by coding individual studies according to potential ciency) common to this literature (see table I); and
moderating factors (e.g. study quality) and statisti- (b) suggested that acute (i.e. exercise vs nonexerc-
cally examining the influence of these factors on ise) and chronic (e.g. athlete vs non-athlete, fit vs
treatment outcomes. Because of these 2 advan- unfit, trained vs untrained) effects be examined
tages, meta-analysis is ideal for increasing statisti- separately.
cal power, resolving conflicts among studies with
Fairly typical operational definitions for some
contradictory results and addressing research ques-
of the sleep measures identified included: 'sleep
tions (e.g. those related to potential moderators of
onset latency as the time from lights out to the be-
treatment effects) not posed by the authors of indi- ginning of the first period of 15 minutes of contin-
vidual studies. [12]
uous stage 2 sleep; sleep period time as the time
Thus, a meta-analysis of the exercise/sleep lit- from sleep onset to final awakening; total sleep
erature will not only provide insight into the con- time as sleep period time minus interim wakeful-
flicting conclusions reached by previous reviewers, ness and REM latency as the time from sleep onset
but also will quantify the magnitude of exercise/
sleep effects and address questions regarding po-
tential moderators of these effects. Quantifying the Table I. Types of sleep measure
magnitude of exercise/sleep effects will allow com- Stage 1
parisons of the effects of exercise with those of Stage 2
other health-related interventions. Meta-analytical Stage 3
data exist regarding the effects of a variety of med- Stage 4
Slow wave sleep (SWS)
ical and behavioural interventions. Examining po-
Rapid eye movement (REM) sleep
tential moderating factors will assist in providing Movement time
answers to questions raised in previous reviews, Sleep onset latency
including the effects of various study (e.g. study Total sleep time
validity), individual (age, sex and fitness) and ex- Self report
ercise characteristics (time of day, exercise type Heart rate
and exercise duration) on sleep outcomes. Biochemical
Temperature
REM latency
1. Review Procedures Awake time
lime in bed
An attempt was made in this review to include Sleep period time
all the published and unpublished English-language Stage 1 + movement
studies that could be located. Although the review SWS latency
was primarily based on meta-analytical informa- Sleep efficiency
tion derived from ESs, mean differences or a nar- Sleep cycle length

© Adis Intemational Limited. All rights reserved. Sports Med. 1996 Apr; 21 (4)
Effects of Exercise on Sleep 281

to the onset of the first REM sleep period longer Table II. Moderator variables for effect size data
than a 3-minute duration.'[ 141 Study characteristics
Also typical was sleep efficiency, as the propor- Validity (high, medium or low)
tion of time spent asleep out of the total recording Individual descriptors
period. Self-report measures included a number of Sex (male, female or mixed)
questionnaires reflecting sleepiness/alertness or Fitness (mIlkg/min)
perceived sleep quality (e.g. Stanford Sleepiness Age(y)
Scale). Biochemical measures included catechola- Body mass index

mine, cortisol and human growth hormone. Exercise characteristics

Exercise type (aerobic, nonaerobic, mixed or not reported)
1.2 Selection of Studies Exercise situation (lab or field)
Duration (min)
Studies were located through manual and com- Intensity (%V02max)
puterised searches (ERIC, PsychLit, Dissertation Time of day exercise completed (h)
Abbreviations: V02max = maximum oxygen uptake.
Abstracts International and Medline) of research
journals, conference proceedings and dissertation
abstracts. The key terms used in these searches
on suggestions in the previous literature about po-
were 'sleep', 'sleep deprivation', 'exercise', 'physi-
tential moderating factors. These characteristics
cal activity', 'physical fitness' and 'fitness'. The
were divided into 3 areas: study characteristics, in-
more recent publications were identified and their
dividual descriptors, and exercise characteristics.
reference lists were examined for further studies.
The factors examined within each of these catego-
In addition, a bibliography of studies (n = 1400)
ries are listed in table II.
examining psychological consequences of exer-
cise was obtained from Dr Michael Sachs (personal
' .3. 1 Study Characteristics
communication) and compared with the studies
Using the procedure outlined by Glass et al.,[15 1
already located.
studies were coded as having high, medium or low
The majority of the studies located (n = 73)
internal validity. High internal validity ratings
came from either the fields of psychophysiology or
were given to studies that randomly assigned indi-
exercise science and included published articles
viduals to conditions and had mortality rates ofless
(n =64), abstracts (n =4) and unpublished disser-
than 15%, medium ratings to studies with higher
tations/theses/reports (n = 5). The articles were read
or nonequivalent mortality and low ratings to stud-
and if clarification was needed, a letter requesting
ies with other design flaws (i.e. the use of intact
the necessary information was sent to the authors.
convenience samples). Furthermore, high ratings
There were 3 criteria for inclusion of studies in
were assigned to studies with repeated measures
the meta-analysis. First, each study had to have at
designs that counterbalanced exposure to exercise
least one outcome measure of sleep related to ex-
and nonexercise conditions, and low ratings were
ercise or fitness. Secondly, studies had to have
assigned to studies that did not counterbalance ex-
studied sleep in humans. Thirdly, studies published
posure to exercise and nonexercise conditions.
in English must have been available prior to De-
Studies were rated on internal validity by 2 inde-
cember, 1992. Thus, this review included cross-
pendent raters. Initial agreement was 73% and dif-
sectional, longitudinal, published and unpublished
ferences were resolved by clarifying points of dis-
studies.
agreement in order to reach 100% agreement.
1.3 Coding the Studies
'.3.2 Individual Descriptors
The studies/ESs were coded on several charac- Individual characteristics coded included sex
teristics which reflected a priori decisions based (male, female or mixed), age (in years), body mass

© Adis International Limited. All rights reserved. Sports Med. 1996 Apr; 21 (4)
282
index (i.e. kg/m2) and fitness level (in mllkg/min).
Sex was coded as a categorical variable - the remain-
ing characteristics were coded as continuous vari-
ables.
1.3.3 Exercise Characteristics
Exercise characteristics coded included exer-
cise duration (in minutes), exercise intensity (as a
percentage of maximum oxygen uptake [V0 2max ])
time of day when exercise was completed (0 to
2400 hours), exercise type (aerobic, nonaerobic or
mixed) and exercise situation (alone, in laboratory,
in race). The first three were coded as continuous
variables, the remaining two as categorical vari-
ables.
1.4 Data Analysis Procedures
The results of the studies were handled in 3
ways. First, if the study did not present means and
standard deviations/errors, the findings were dis-
cussed in a narrative review. Secondly, if the study
presented means, but not standard deviations/
errors, mean difference scores were calculated.
Thirdly, if the study presented both means and
standard deviations/errors, ESs were calculated.
The narrative and mean difference information, al-
though less conclusive, was compared with the ES
data, thereby minimising elimination of studies
from the meta-analysis. However, once these com-
parisons were made, follow-up analyses of moder-
ating variables were done only for studies provid-
ing ES information.
The ES was calculated using the following for-
mula: 1161
. _ Mtreatment - Mcomparison
Eff
eet sIze - SD
pooled
Thus, a positive ES reflects a higher level of the
sleep measure for the treatment group mean, in
comparison with the control group mean. A pooled
standard deviation was used in this calculation
since it provides a more precise estimate of the pop-
ulation variance'! 171 Additionally, the ESs were
corrected for positive bias, using the formula sug-
gested by Hedges.!171
© Adis International Limited. All rights reserved.
Kubitz et al.
The ESs were examined using the following
procedures. Stouffer meta-analytic Z-tests l181 were
used to determine whether the mean ESs were sig-
nificantly different from zero. A mean ES that is
significantly different from zero is comparable to
rejecting the null hypothesis in an experimental
study. H-statistics l191 were used to determine whether
the mean ESs for each of the sleep measures were
homogeneous. For sleep measures with an H-
statistic indicating ES heterogeneity, examination
of possible moderating effects was carried out us-
ing a variety of parametric techniques [i.e. one-way
analysis of variance tests (with Tukey post hoc tests
where indicated), t-tests or Pearson correlations].
Finally, either (02 or r2 was calculated as indices of
the percentage of variance accounted for by the ob-
served statistics.
2. Results and Discussion
Of the 73 studies located, 64 contained informa-
tion that could be used in this review. Effect sizes
were calculated for 38 of these studies, mean dif-
ferences were derived for 12 others and findings
were summarised for 14 studies in which means
and standard deviations were unavailable. Nine
studies were excluded from this review either be-
cause the data were also reported in another study
already included in this review,[1 .20-22J or because
we were unable to obtain the studies,123- 25 1 or be-
cause, upon closer inspection, the study did not
meet the inclusion criteria.126.271
2.1 Studies Without Data Available
Many of the studies without means and standard
deviations available involved epidemiological or
qualitative research. The epidemiological stud-
ies128-301 were designed to examine lifestyle choices
either promoting or disturbing sleep, and supported
a view of exercise facilitating sleep. For example,
Vuori et aI.l 301 found that 1 of every 3 people sur-
veyed felt that exercise had a positive impact on
sleep quality. Similarly, Hasan et al.l 281 found that
20% of the population surveyed felt that they slept
more deeply and soundly after exercise (i.e. day-
time rather than evening exercise).
Sports Med. 1996 Apr; 21 (4)
Effects of Exercise on Sleep 283

Table III. Difference scores (n =456) by sleep measure type

No. of studies No. of difference scores Mean difference score Standard error
Stage 1 5 25 -<>.25 1.0
Stage 2 6 28 2.16 1.6
Stage 3 7 33 3.00 1.4
Stage 4 7 33 1.32 1.0
SWS 9 42 3.00 1.4
REM sleep 9 41 -2.25 1.1
Movement time 2 9 0.13 0.1
Sleep onset latency 5 13 -1.72 1.9
Total sleep time 6 19 2.77 4.2
Self report 3 14 0.61 0.2
Heart rate 2 8 5.09 0.9
Biochemical 0
Temperature 1 6 0.02 0.0
REM latency 3 10 10.96 7.2
Awake time 5 20 -<>.19 2.9
Time in bed 3 9 13.00 4.2
Sleep period time 4 12 8.49 4.2
Stage 1 + movement 2 9 2.61 1.9
SWS latency 4 9 1.53 1.9
Sleep efficiency 3 5.97 2.2
Sleep cycle length 16 -5.78 2.0
Abbreviations: REM =rapid eye movement; SWS =slow wave sleep.

The qualitative studies[31,32] were designed to
examine self-reported effects of regular exercise
and found that fit individuals reported sleeping
better than unfit individuals. Furthermore, 6 pilot
studies available only as abstracts had no data avail-
able. Five of these were also consistent with the
meta-analytical results (i .e. they showed exercise/
fitness effects);[33-37] one was not.[38]
Finally,3 studies[39-41] which also failed to report
means and standard deviations addressed slightly
different exercise-related questions. Roussel and
Buguet[40J found that heart rates were increased
about 10% during sleep after exercise. Iguchi et
al.[39] found that the method of quantifying SWS
influenced the likelihood of exercise-induced SWS
increases. SWS increases were found only when
the EEG power was examined. Ryback and Lewis[41]
found that individuals confined to bed increased
SWS, regardless of whether or not they were al-
lowed to exercise during bedrest periods.
2.2 Studies With Data Available
From the 38 studies with means and standard
deviations/errors available, 1124 ESs were calcu-
lated. The majority (n = 32) of the studies provided
acute ESs. Somewhat fewer (n = 12) provided
chronic ESs (i.e. including 6 studies contributing
both acute and chronic ESs). From the 1124 ESs,
22 that were more than 3 standard deviations from
the grand mean were eliminated from the analyses
and 19 of these came from the same study.l42] The
aforementioned study may have been particularly
likely to yield outlying ESs because of its small
sample size (n = 2), highly trained individuals and
long duration (e.g. 2-,4- and 6-hour) exercise ses-
sions. The 12 studies without standard devia-
tions[43-54] yielded 456 mean difference scores (see
table III).
2.2. 1 Acute Exercise
From the 32 studies examining the effects of
acute exercise, 828 ESs were calculated. The mean

© Adis International Limited. All rights reserved. Sports Med. 1996 Apr; 21 (4)
284 Kubitz et al.

Table IV. Effect sizes by sleep measure type. In order to minimise the likelihood of spurious findings, ESs were not tested for significance
(Stouffer meta-analytical Z-test) or heterogeneity (Hedges H-statistic) unless n > 10
Acute exercise Chronic exercise
no. of no. of ESs mean ES SE no. of no. of ESs mean ES SE
studies studies
Stage 1 14 52 -{l.08 0.09 3 6 0.06 0.15
Stage 2 17 60 -{l.07 0.08 4 10 0.17 0.09
Stage 3 14 48 0.34" 0.13 4 10 0.34 0.10
Stage 4 13 47 0.75.. t 0.22 4 10 0.23 0.19
SWS 29 125 0.26" 0.08 9 33 0.43.. t 0.10
REM sleep 21 110 -{l.14't 0.08 5 30 -{l.57*' 0.12
Movement time 6 39 0.03 0.06 2 5 0.72 0.25
Sleep onset latency 14 36 -{l.20" 0.06 7 18 -{l.45" 0.09
Total sleep time 15 33 0.31" 0.08 6 15 0.94" 0.40
Self report 7 42 -{l.16 0.10 5 14 0.12 0.31
Heart rate 4 0.81 0.16 0
Biochemical 4 15 0.22 0.17 2 6 0.45 0.27
Temperature 0 0
REM latency 15 34 0.29" 0.10 6 12 0.06 0.13
Awake time 12 42 0.02 0.08 6 19 -{l.40" 0.17
Time in bed 6 9 -{l.07 0.14 4 9 0.18 0.12
Sleep period time 3 6 0.31 0.21 3 6 0.29 0.18
Stage 1 + movement 2 4 0.18 0.14 1 2 0.07 0.03
SWS latency 1 2 0.05 0.46 2 5 -{).12 0.21
Sleep efficiency 3 7 0.42 0.21 3 7 0.12 0.10
Sleep cycle length 2 -{l.10 0.10 0
Abbreviations and symbols: ESs = effect sizes; REM = rapid eye movement; SE = standard error; SWS = slow wave sleep; , indicates
significant Z-test, p < 0.05; " indicates significant Z-test, p < 0.01 ; t indicates significant H-statistic, p < 0.05.

ESs were significantly different from zero (p <
0.05) for stage 3, stage 4, SWS, REM sleep, sleep
onset latency, total sleep time and REM latency
(see table IV). Positive ESs were observed for stage
3, stage 4, SWS, total sleep time and REM latency.
Negative ESs were observed for REM sleep and
sleep onset latency. The largest effect was for stage
4 (ES = 0.75), while the smallest was for REM
sleep (ES = -0.14). These ESs were associated with
mean difference scores of 2 to 5 minutes for stage
3, stage 4, SWS, REM sleep, and sleep onset la-
tency; and of 10 minutes for total sleep time and
REM latency. Thus, exercise individuals not only
fell asleep faster, but also slept somewhat longer
and deeper than nonexercise individuals.
Although most of the mean ESs for acute exer-
cise were homogeneous, the H-statistics were sig-
nificant for stage 4 sleep, X2(78 degrees of freedom)
= 69.4, p < 0.05 and REM sleep, X2(l40) = 136.7,
p < 0.05 (see table IV). Moderating variables were
examined for these sleep measures. Individual
characteristics found to significantly influence ES
included sex and fitness levels. The mean ES for
REM sleep was larger for women than for men,
F(2, 107) = 3.10, p < 0.05,0)2 = 0.06. The mean ES
for women was -0.37 (ESs n = 12), while for men
it was -0.23 CESs n = 67). With regard to fitness ,
the mean ESs for both REM sleep, r(38) =-0.55,
p < 0.000 1, r2 = 0.30 and stage 4 sleep, r(22) = -0.57,
p < 0.003, r2 = 0.32, were larger for less fit than for
more fit individuals. Additionally, examination of
the correlations among the various moderating fac-
tors showed no significant relationship between fit-
ness and sex, r(281) =0.007, p > 0.05. There was,
however, a significant relationship between fitness
and age, r(205) = -0.40, P < 0.0001. Less fit indi-
viduals tended to be older than those which were
more fit.
Exercise characteristics found to significantly
influence ES included exercise type, exercise situ-

© Adis International Limited. All rights reserved. Sports Med. 1996 Apr; 21 (4)
Effects of Exercise on Sleep
ation, exercise duration and time of day. The mean
ES for REM sleep was negative (consistent with
overall findings) for aerobic exercise and positive
(inconsistent with overall findings) for anaerobic
exercise, F(3,106) = 13.3, P < 0.0001,0)2 = 0.27.
The mean ES for aerobic exercise was -0.28 (ESs
n = 83), while for anaerobic exercise it was 1.12
(ESs n = 10). The mean ES for REM sleep was
larger when exercise took place in a laboratory set-
ting than it was when exercise took place in a field
setting, F(2,99) = 4.32, P < 0.02, 0)2 = 0.08. The
mean ES for laboratory exercise was -0.45 (ESs
n = 48), while for field exercise it was -0.10 (ESs
n = 58). Moreover, stage 4 ESs were larger when
exercise: (a) was longer in duration, r(34) = 0.61,
p < 0.0001, r2 = 0.37; and (b) was completed earlier
in the day, r(65) = -0.37, p < 0.001, r2 = 0.14.
2.2.2 Chronic Exercise
From the 12 studies examining the effects of
chronic exercise, 274 ESs were calculated. The
mean ESs were significantly different from zero
(p < 0.05) for SWS, REM sleep, sleep onset latency,
total sleep time and awake time (see table IV). Pos-
itive ESs were observed for SWS and total sleep
time. Negative ESs were observed for REM sleep,
sleep onset latency and awake time. The largest
effect was for total sleep time (ES = 0.94), while
the smallest was for awake time (ES = -0.40).
Thus, fit individuals not only fell asleep faster, but
also slept somewhat deeper and longer (with less
awake time) than unfit individuals.
The mean ESs for chronic exercise were mostly
homogeneous. As table IV indicates, the H-statis-
tics were significant only for REM sleep, X2(88) =
60.9, P < 0.01. Consequently, moderating variables
were examined for this sleep measure. The only
characteristics found to significantly influence ES
were sex and age. The mean ES was larger for
women than for men, F(l,28) = 6.25, P < 0.02,
0)2 = 0.18. The mean ES for women was -1.29 (ESs
n = 4), while for men it was -0.46 (ESs n = 26).
With regard to age, the ESs were larger for older
than for younger individuals, r(26) = 0.50, P < 0.004,
r2 = 0.25.
© Adis International limited. All rights reserved .
285
3. General Discussion
3.1 Summary of Findings
In contrast to the conclusions of Trinder et al.,[2]
the meta-analysis revealed significant acute, as
well as chronic, effects of exercise on sleep. The
acute effects of exercise included increases in stage
3, stage 4, slow wave sleep, total sleep time and
REM sleep latency, and decreases in sleep onset
latency and REM sleep. The chronic effects of ex-
ercise included increases in slow wave sleep and
total sleep time, as well as decreases in sleep onset
latency, REM sleep and awake time. Both acute
and chronic exercise had similar effects with re-
gard to slow wave sleep, total sleep time, REM
sleep and sleep onset latency. Moreover, the mean
ESs were for the most part small to moderate in
magnitude. Mean difference scores and narrative
review conclusions, where available, were direction-
ally consistent with the mean ESs (i.e. those signif-
icantly different from zero).
The conflicting findings are probably not due to
the impact of new data because 79% of the studies
included in the meta-analysis were also included in
the review by Trinder et alP] It is more likely that
they are due to inadequate statistical power in
individual exercise/sleep studies. Given the mag-
nitude of the typical exercise/sleep effect (i.e.
small to moderate ESs), relatively large samples
would be necessary for adequate statistical power.
For example, exercise/sleep effects with an ES of
approximately 0.30 (i.e. total sleep time and REM
latency) would need 83 individuals to achieve sta-
tistical significance. Unfortunately, sample sizes in
the exercise/sleep literature average only 9 ± 3 in-
dividuals. Given the size of the average exercise/
sleep effect and the sample sizes typically used to
examine these effects, it would appear that statis-
tical power has probably been routinely compro-
mised. The conclusions reached by Trinder et al.
seem largely to reflect this weakness.
In light of the seemingly modest ESs observed,
the practical effects of exercise on sleep remain to
be seen. With regard to potential health effects,
exercise/sleep ESs are the same magnitude as those
Sports Med. 1996 Apr; 21 (4)
286
from a variety of medical interventions. For exam-
ple, the mean ESs for medical interventions deemed
effective for mortality reduction range from 0.08
to 0.47, while those for medical interventions
deemed effective for other health threatening prob-
lems range from 0.24 to 0.80.[55] Additionally, the
effects of exercise on sleep are fairly similar to
those of exercise on depression, ES = 0.78,f56] stress
reactivity, ES = 0.48[57] and anxiety, ESs = 0.24 to
0.56.l58 ] Thus, exercise/fitness effects on sleep
compare favourably with those of other health-
related interventions. Moreover, the observed ESs
may be somewhat conservative since exercise/
sleep studies have generally examined individuals
without sleep difficulties.
Theoretically, exercise/sleep effects appear to
be generally consistent with the compensatory
position on sleep. Sleep after exercise was longer,
deeper and more readily achieved. This was true
for both short and long term exercise involvement.
In fact, where both ESs were significant (SWS,
REM sleep, total sleep time and sleep onset la-
tency) the chronic effects were larger than acute
effects, suggesting that long term involvement
maximises the beneficial effects of exercise. This
has also been shown to be true for the effects of
exercise on anxiety and depression.l 56.58 ]
With a few exceptions, the concerns expressed
by previous reviewers[7,8,IO] about methodological
influences on exercise/sleep outcomes were not
substantiated by the examination of moderating
variables. Where moderating effects were signifi-
cant, they accounted for small to moderate (6 to
37%) amounts of the variance in ES. Among those
accounting for at least 25% of the variance in ESs
were the individual's fitness and age, as well as the
type and duration of exercise. The effects of the
individual's sex, the exercise situation and the time
of day were more limited, accounting for no more
than 10 to 20% of the variance in ESs. ESs were
not influenced by either the internal validity of the
study, the individual's body mass index, or the in-
tensity of exercise.
In general, the moderating variable analyses
suggest that exercise has the biggest impact on
© Adis International limited. All rights reserved.
Kubitz et al.
sleep when: (a) the individuals are female, low fit,
or older; and (b) the exercise is longer duration,
aerobic exercise that is completed earlier in the day.
It seems important to keep in mind that the link
between fitness and the effects of acute exercise
(i.e. that higher fitness was associated with smaller
effects) is consistent with what would be expected
given the 'law of initial values' common to psycho-
physiological research. Fit individuals have al-
ready achieved the sleep pattern associated with
chronic exercise (i.e. falling asleep faster, sleeping
deeper and sleeping longer). Therefore, they may
simply have less 'room for improvement' .
Furthermore, the analysis of moderating vari-
ables allows several suggestions regarding future
research. First, experimental design should pro-
ceed with an eye towards obtaining satisfactory
statistical power. The meta-analytic ESs, which
have quantified the magnitude of the expected
exercise/sleep effects, should facilitate optimal
experimental design. Secondly, it is important to
consider the influence of individual characteristics.
For example, even though the individual's sex and
age do not have very far reaching effects, they do
influence certain sleep measures (e.g. REM sleep),
as does the cardiorespiratory fitness level. Thirdly,
it is also important to appropriately quantify and
administer the exercise stimulus. Exercise duration
appears to be particularly important, as does the
time of day when exercise is completed.
3.2 Suggested Underlying Mechanisms
Previous reviews[7,59] have hypothesised that
exercise-induced peripheral and/or brain heating
underlies effects on sleep. The evidence for the hy-
pothesis is based on studies in which manipulations
of the thermogenic effects of exercise have differ-
entially influenced sleep,[14,60] as well as on studies
in which passive warming (e.g. warm baths) has
produced exercise-like sleep effects.[61,62] Unfortu-
nately, only 1 study[l] in the meta-analysis actually
examined the effects of exercise on temperature
during sleep and it lacked the data necessary for ES
calculation. However, the mean difference score,
Mdiff =0.02°F, suggested that there were no exer-
Sports Med. 1996 Apr; 21 (4)
Effects of Exercise on Sleep
cise-related increases in temperature during sleep.
These data are consistent with other work demon-
strating that elevations in body temperature fol-
lowing exercise typically return to normal within
90 minutes.l 63l Thus, it appears unlikely that tem-
perature during sleep would still be elevated, espe-
cially for morning or afternoon exercise, and if
body heating underlies exercise/sleep effects, the
relationship is unlikely to be a direct one.
Others have suggested that certain fitness ef-
fects (i.e. increases in lean body mass and maximal
oxygen consumption) underlie effects on sleep.
The evidence for lean body mass is based on stud-
ies[64- 66 l showing significant, albeit contradictory,
relationships between lean body mass and sleep.
The evidence for cardiorespiratory fitness is mostly
based on studies[67- 70 l showing significant cross-
sectional differences in the sleep of fit and unfit
individuals. However, the cross-sectional stud-
ies[70,71 1 that failed to replicate these differences
and the mixed results from longitudinal stud-
ies[69.72-74] leave the overall findings inconclusive.
Although the meta-analysis did not show a signif-
icant relationship between the individual's body
mass index and ES, there was a significant relation-
ship between the individual's V'02max and ES. The
relationship was an inverse one, in that as fitness
increased, REM sleep and stage 4 sleep ESs de-
creased. Thus, the meta-analysis provided some
support for the fitness effects hypothesis.
Nonetheless, the question remains regarding the
mechanism by which exercise (and ultimately fit-
ness) influences sleep. As mentioned above, the
effects of exercise appear unlikely to be directly
related to exercise-induced temperature increases
that linger on into and thereby influence sleep. How-
ever this does not necessarily mean that exercise-
induced temperature increases are not part of the
mechanism by which exercise influences sleep. As
Trinder et al. [2] suggested, exercise-related temper-
ature increases may indirectly influence sleep by
altering circadian temperature rhythms. Moreover,
although there were not enough ESs available to
examine the effects of exercise on heart rate and
biochemical activity during sleep, the mean ESs
© Adis International Limited. All rights reserved.
287
calculated were positive, suggesting that exercise-
induced changes in heart rate and/or biochemical
activity may also be worthy of further attention.
4. Conclusions
A strength of the meta-analytic review process
is the fact that it synthesises the literature (all that
can be located) on a topic. Thus, in the present
review, exercise/sleep effects were combined across
studies using, for example, different designs, types
of individuals and exercise types. Nonetheless,
exercise/sleep effects emerged in a manner consis-
tent with expectations derived from most of the
previous reviews. In terms of magnitude, the ef-
fects of exercise on sleep are fairly similar to the
other known psychophysiological effects of exer-
cise.l56-581 Moreover, meta-analytical procedures
also facilitate a very useful teasing apart of metho-
dological moderating factors. Certain study, indi-
vidual and exercise characteristics were found to
moderate exercise/sleep effects. Those with the
strongest effects were the individual's age and fit-
ness level, as well as the type and duration of ex-
ercise. The characteristics of these studies are out-
lined in table V.
Questions that remain to be addressed in future
research were also highlighted. Counting the num-
ber of studies and/or ESs per sleep measure reveals
a paucity of evidence regarding the effects of ex-
ercise on temperature, heart rate, sleep efficiency,
self-reported sleep quality, biochemical measures
and movement during sleep. Counting the number
of studies and/or ESs for each of the moderating
variables shows a need for attention to exercise/
sleep effects in women, with anaerobic exercise,
with morning/evening exercise and in competitive
situations. Also needed are additional training
studies, particularly studies in which exercise stim-
uli and the corresponding fitness effects (i.e.
V'02max, body composition changes) are carefully
monitored. Moreover, there is still a need to under-
stand the mechanisms underlying exercise/sleep
effects. Hypotheses regarding temperature re-
ceived little direct support, mostly due to the pau-
city of research available. It appears that the effects
Sports Med. 1996 Apr; 21 (4)
@ Table V. Characteristics of studies used in the meta·analysis N
00
» Exercise stimulus No, of individuals Age (y)
00
Q. Reference No, of ES type Sex V02max Exercise type Time of day
"'" ESs (mVkglmin) when exercise (minancl/or [mean/s or range]
~ completed (h) % of maximum)

~
0"
Browman & Tepasl75]
Adamson et alP 61
30
7
A
A
M
M
NR
NR
Aerobic
Mixed
NR
1400
45 (5 workl5 rest)
NR
9
12
18,9
19-31
::J
Q. Ziret alF7J 12 A M NR Mixed 1600 120; 360 10 17-23
r BaeklandI7. ) 14
104 A NR NR NR NR NR NR
3
Bunnell et a1.l79) 18 A M, F 48 Aerobic 1630 28 8 21-30
~ Bunnell et al. l' O] 38 A M,F 47 Aerobic 1700 151 (50 @50%,60%,70%) 9 21-30
~ Browman[81 ) 18 A M, F NR Nonaerobic NR 80 7 19·22
cO" Baekeland & Lasky(6) 16 A M NR NR NR NR 10 NR
-::r
or Shapiro et al.l42] 21 A M NR Aerobic 1400 120; 180; 240; 360 @ 50%; 160 @ 75% 2 24-26
Buguet et a1. 182] 4 A M 63 Aerobic 1700 35% 6 20,1
m
Torsvall et a1.l83]
~
Q.
66 A M NR Aerobic 1900 NR 6 30·35
Home & Moor"'4) 72 A F 55 Aerobic 1730 80@75% 6 20-23
Walker et alF' ] 134 A,C M NR Aerobic 1600 14;36 20 18-22
Paxton et al.l841 27 A M,F 29,32 Aerobic 1800 45 @ 50%; 60 @ 75% 24 21 ,7
A M 59 Aerobic 1800 60, 360(?%) 11 19,5
Kupfer et a1.l85] 42 A M NR Aerobic NR NR 10 24,8
Paxton et a1.l69) 6 A,C M 38,53 Aerobic NR NR 17 18-22
Griffin & Trinde~67] 4 A,C M, F 14, 22 Aerobic 1800 NR 8 23,0
Trinder et al.l86] 42 C M 68 Aerobic 40 22,3
46 Nonaerobic 22,5
55 Mixed 21 .1
Paxton et al.l64 ] 32 C M 32,47 Mixed 34 20.0
Home & StafflSO) 65 A M, F 62 Aerobic 1800 160 @ 40%; 80@ 80% 8 25.4
Matsumoto et a1. 187] 14 A M NR Aerobic 1700 140@ 50% 6 20-24
Walsh et a1.l88] 18 C F NR 11 20·33
Shapiro et a1F4) 12 C NR 51 , 55 8 17-21
Shapiro/89) 4 A NR NR Aerobic NR NR 6 NR
Montgomery et al.l68] 120 A,C M NR Aerobic NR 90 41 22,41
Montgomery et al.l90] 9 A M,F 51,59 Mixed NR NR 14 23.0
M 57 Aerobic NR NR 22 22,41
NR 46 Nonaerobic NR NR 10 23,0
Shapiro et a1.l9 ' ) 32 A M 43 Aerobic NR 15; 240 4 18-24
Meintjes et a1F3 ] 18 C F 32, 35 Mixed 8 20·28
Matsumoto et al.l92) 46 A M NR Aerobic 140@50%(over9h) 6 20-24
Jennings(93) 20 A, C F 26, 30 Aerobic NR 20@75% 9 27-43
Moses et al.l94) 11 A M NR Aerobic 600 (over 40h) 9 18·22
~ Driver et a1.l72) 28 A,C F 32, 45 Aerobic 1900 60@70% 8 18·28
a- Bevie~95) 68 A M, F 35 Aerobic 1600 6O@60% 14 57-72
'5::
~ Montgomery et al. (96) 4 A NR 59 Aerobic 1800 90; 171 8 40,8
Weydahl197J 3 C F NR 14 16-18
~» Buchegger et aI. 19.) 24 A M, F NR Nonaerobic 1500 NR 16 21-24 :><:
::::
sr.
Bunnell et al.l99) 8 A M, F 40,55 Aerobic 1700 149 @ 50-70% 9 21-30
~ Buchegger & Meier-KolIlHlOl 6 A M, F NR Nonaerobic 1900 NR 8 21-25
N
~
'" Abbreviations and symbol: A =acute; C =chronic; ESs =effect sizes; F =female; M =male; NR =not reported; ? =unknown,
~ ~
Effects of Exercise on Sleep
of exercise on circadian temperature rhythms may
be a viable hypothesis, as is the influence of exer-
cise on cardiorespiratory fitness. Additional hypoth-
eses suggested by the meta-analysis include the ef-
fects of exercise on heart rate and/or biochemical
activity during sleep.
Additionally, recent reviews of the exercise/
sleep literature complement our findings . Driver
and Taylor[lOl] completed a narrative review cov-
ering 12 studies included in our paper, as well as 3
studies published since 1992. They focused on sev-
eral exercise-related questions, including the gen-
eral effects of sleep, the disrupting effects of in-
tense exercise of sleep, the effects of overtraining
of sleep, and effects of disrupted sleep of exercise
performance. Driver and Taylor's conclusions
were consistent with our findings. They reported a
beneficial effect of exercise on sleep that was mod-
erated by factors related to the intensity and dura-
tion of the exercise, as well as by factors related to
the time of day that the exercise was completed.
O'Connor and Youngstedt[102] completed a combi-
nation narrative/meta-analytic review of28 studies
included in our paper, as well as 4 studies pub-
lished since 1992. Although only a brief summary
of the meta-analysis was presented in the paper,
their results were generally consistent with our
findings. O'Connor and Youngstedt reported a sig-
nificant increase in total sleep time (mean ES =0.31),
stage 2 sleep (mean ES = 0.19), SWS (mean ES =
0.25), and REM latency (mean ES = 0.48), as well
as a decrease in REM sleep (mean ES = -0.48).
Thus, the exercise/sleep literature seems to con-
tinue to demonstrate small to moderate effects of
exercise on sleep moderated by various methodo-
logical factors.
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