Burden of chronic kidney disease and its attributable risk factors in 204 countries and territories, 1990-2021: Results from the Global Burden of Disease study 2021.

Sleep is a fundamental physiological process that plays a vital role in the physical growth, cognitive development, emotional regulation, and overall health of children and adolescents. Adequate and high-quality sleep during these developmental periods is essential for optimal academic performance and psychosocial well-being. However, accumulating evidence shows that insufficient sleep and related problems are highly prevalent among adolescents worldwide. Recent data from 239,816 adolescents across 46 countries showed that the prevalence of individual poor-sleep indicators, including difficulties falling asleep, insufficient sleep, and social jetlag, ranged from 16.3% to 48.3%. Such deficits have been linked to a wide range of adverse outcomes, including impaired attention, emotional instability, increased risk of obesity, and reduced quality of life. These trends have raised growing concerns in both clinical and public health contexts. Aerobic exercise, as a non-pharmacological and easily accessible lifestyle intervention, has been recognized as a potential strategy to improve sleep quality. Previous studies in adults have consistently demonstrated that regular aerobic activity can reduce sleep latency, increase total sleep time, and enhance sleep efficiency. The underlying mechanisms are thought to involve modulation of circadian rhythms, increased energy expenditure, and improved psychological resilience. Given concerns regarding the pharmacological management of sleep problems in young people, exercise may represent a feasible and low-risk adjunctive strategy. More broadly, recent studies in adult populations have highlighted associations between physical activity and sleep behavior and demonstrated the feasibility of structured mind–body exercise interventions, although their findings cannot be directly generalized to children and adolescents. Despite these promising findings, evidence on the effectiveness of aerobic exercise in improving sleep quality among children and adolescents remains inconsistent. While some randomized controlled trials (RCTs) have reported significant benefits of exercise interventions, others have failed to detect meaningful improvements in sleep outcomes. Such discrepancies may be attributable to variations in intervention type, intensity, duration, outcome measures, and sample characteristics. Although previous reviews have examined exercise and sleep in adolescents, uncertainty remains regarding the effects of predominantly aerobic interventions in randomized trials across childhood and adolescence, particularly when Chinese-language evidence, prediction intervals, and prespecified exploratory subgroup analyses are considered. Therefore, this systematic review and meta-analysis aimed to estimate the effects of predominantly aerobic exercise interventions on sleep-related outcomes in children and adolescents. We also explored potential sources of between-study heterogeneity according to intervention duration, sleep measurement modality, and participant age.