Effects of aerobic exercise and resistance training on obstructive sleep apnea: a systematic review and meta-analysis

Study Objectives: We investigated the therapeutic effects of exercise in patients with obstructive sleep apnea, aiming to identify the subgroups that benefit the most and determine the optimal exercise protocol. Methods: Major databases were searched for randomized controlled trials involving patients with obstructive sleep apnea performing aerobic exercise and/or resistance training. The investigated outcomes included apnea-hypopnea index (AHI), Epworth Sleepiness Scale, body mass index, and peak oxygen consumption during exercise (VO(2)peak). The pre- and postintervention unstandardized mean difference (USMD) of these parameters was compared between the exercise and control groups. Results: Twelve studies involving 526 patients were included. Exercise training significantly reduced AHI (USMD = -7.08 events/h, 95% confidence interval: -9.98 to -4.17, P < .00001), Epworth Sleepiness Scale (USMD = -2.37, 95% confidence interval: -3.21 to -1.54, P < .00001), and body mass index (USMD = -0.72 kg/m(2), 95% confidence interval: -1.22 to -0.22, P = .005) and enhanced VO(2)peak (USMD = 3.46 ml<middle dot>kg(-1)<middle dot>min(-1), 95% confidence interval: 1.20 to 5.71, P = .003). Subgroup analyses revealed that in continuous positive airway pressure-adherent patients, exercise significantly improved VO(2)peak but did not reduce AHI and Epworth Sleepiness Scale. A trend was observed that combining resistance training with aerobic exercise resulted in greater AHI reduction and VO(2)peak enhancement. Notably, exercise improved AHI, Epworth Sleepiness Scale, body mass index, and VO(2)peak regardless of the baseline AHI or body mass index. Conclusions: Exercise, including resistance and aerobic training, should be part of treatment for patients with obstructive sleep apnea of all severities, regardless of obesity status, and even for those who are already under continuous positive airway pressure.