Walking and subjective sleep quality in adults: a Bayesian three-level meta-analysis with probabilistic clinical relevance assessment and dose-response modeling.

Objective: To evaluate the effect of walking on subjective sleep quality in adults using a Bayesian three-level meta-analysis and to identify moderators of treatment response. Methods: PubMed, Embase, the Cochrane Library, and Web of Science were searched from inception through March 2026 for randomized controlled trials (RCTs) comparing walking interventions with inactive or non-aerobic controls. Effect sizes were calculated as Hedges' g. A Bayesian three-level random-effects model was fitted to handle dependent effect sizes. Clinical relevance was assessed using posterior probabilities of exceeding the minimal clinically important difference (MCID, defined as g ≤ -0.39). Moderators were examined through subgroup analyses and meta-regressions. Results: Twenty-one RCTs (1,707 participants, 66 effect sizes) were included. Walking produced a medium-to-large improvement in subjective sleep quality (g = -0.76, 95% credible interval: -0.99 to -0.55), with extreme Bayesian evidence (Bayes factor > 10 Conclusion: Current evidence suggests that walking may improve subjective sleep quality in adults, with a 99.97% posterior probability of reaching the prespecified minimal clinically important difference, although evidence certainty is very low. Moderate-intensity walking three to five times weekly, 30 to 60 min per session, for 12 to 24 weeks may serve as a feasible prescription window, particularly for those with poorer baseline sleep. Future RCTs incorporating objective sleep measures are needed. Systematic review registration: PROSPERO, CRD420261351897.