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Systematic Review Effects of Physical and Mind-body Exercise on Sleep Quality in Individuals With Diabetes Mellitus: A Systematic Review and Meta‐analysis
Yohanes Andy Rias1, Renny Wulan Apriliyasari2, Made Satya Nugraha Gautama3, Faizul Hasan1, Margareta Teli4, Hsiao-Yen Chiu5, Ratsiri Thato1corresp_iconorcid

DOI: https://doi.org/10.3961/jpmph.24.354 [Accepted]
Published online: October 7, 2024
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1Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand
2School of Nursing, College of Nursing, Taipei Medical University, Taipei , Taiwan
3Department of Nursing, Faculty of Medicine, Universitas Pendidikan Ganesha, Singaraja, Indonesia
4Faculty of Nursing, Chulalongkorn University , Bangkok, Thailand
5School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
Corresponding author:  Ratsiri Thato,
Email: yohanes.andi@iik.ac.id
Received: 6 July 2024   • Revised: 27 August 2024   • Accepted: 10 September 2024

Objectives
Physical and mind-body exercises represent distinct intervention strategies that may improve sleep quality by influencing physiological and psychological factors. Nevertheless, their effectiveness in individuals with diabetes is not well-established. This systematic review and meta-analysis aimed to examine the impacts of physical and mind-body exercise interventions on sleep quality in patients with diabetes mellitus.
Methods
Six randomized controlled trials (RCTs) that met the inclusion criteria were identified from PubMed, CINAHL, Embase, Scopus, Web of Science, Cochrane, and Ovid-Medline Library. The effect size for sleep quality was calculated using the standardized mean difference (SMD) with a 95% confidence interval (CI), employing a random-effects model. Heterogeneity and publication bias were also examined, and subgroup, meta-regression, and sensitivity analyses were performed.
Results
Physical and mind-body exercise interventions significantly improved sleep quality, with an SMD of −1.040 (95% CI, −1.686 to −0.394). Subgroup analysis revealed significant differences with respect to the type of intervention (p=0.047), or its duration (p=0.282). Meta-regression analysis indicated that mean hemoglobin A1c level was the only factor to be significantly related to the effect size for sleep quality, demonstrating a negative association (p=0.033). The assessment of publication bias and the sensitivity analysis suggested that the findings were reliable and robust.
Conclusions
Physical and mind-body exercises may serve as effective interventions for patients with diabetes mellitus who experience poor sleep quality. However, to substantiate these findings, additional rigorous RCTs with larger sample sizes, longer follow-up periods, and standardized interventions are required.


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