Comparative and Dose-Response Effects of Exercise Modalities on Sleep Quality in Individuals With Breast Cancer: A Bayesian Network Meta-Analysis.

OBJECTIVE

To compare the effects of exercise modalities on sleep quality in individuals with breast cancer, and to examine dose-response associations between exercise dose and sleep improvement.

METHODS

PubMed, Web of Science, Embase, the Cochrane Library, and EBSCO were searched from inception to March 2026. Risk of bias was assessed using RoB 2. Bayesian multilevel network meta-analysis compared exercise modalities against active controls. Meta-regression and nonlinear dose-response analyses explored effect modifiers and dose-response patterns.

RESULTS

Thirty-nine randomized controlled trials involving 4066 participants were included. Compared with active controls, Tai Chi/Qigong showed the largest sleep benefit (Hedges' g = -0.45, 95% CrI: -0.86 to -0.04), followed by yoga and combined exercise (COM; both g = -0.30). Aerobic exercise suggested possible benefit but with uncertainty, whereas resistance training, dance, and stretching showed no clear advantage. Dose-response analyses suggested greater benefits around potentially beneficial moderate-dose ranges, with exploratory estimated values of approximately 4.5 METs, 281.3 MET·min/session, and 910 MET·min/week. Higher baseline Pittsburgh Sleep Quality Index scores were associated with greater sleep improvement.

CONCLUSIONS

Tai Chi/Qigong, yoga, and COM may be promising exercise modalities for improving sleep quality in this population. Exercise-related sleep benefits may occur within a moderate dose window. Given the very low certainty of evidence and limited head-to-head comparisons, these findings should be interpreted cautiously and confirmed by high-quality randomized controlled trials.