Overall evidence shows no clear sleep improvement (SMD = −0.12, 95% CI: −0.37, 0.12, p = 0.32), despite borderline significance in the high-adherence subgroup ( p = 0.05) and near-significant subgroup differences ( p = 0.06).
Overall evidence shows no clear sleep improvement (SMD = −0.12, 95% CI: −0.37, 0.12, p = 0.32), despite borderline significance in the high-adherence subgroup ( p = 0.05) and near-significant subgroup differences ( p = 0.06).
Notably, the between-group difference reached near significance ( p = 0.06; Figure 10 ), suggesting that a dose-related trend may exist but remains uncertain.
However, the between-subgroup difference did not reach statistical significance, indicating that higher adherence to the ACSM guidelines could not be confirmed to confer additional benefits in anxiety reduction ( p = 0.37; Figure 7 ).
Notably, the findings for sleep quality should not be interpreted as a mere lack of effect; rather, a clear dose-related trend was observed, with high-adherence exercise demonstrating borderline significance and the difference between levels approaching significance.