The Impact of Exercise and the Potential Role of Exerkine Irisin on Sleep Quality: A Review
Background
Physical activity has been shown to positively affect sleep performance and is increasingly acknowledged as an evidence-based, non-pharmacologic intervention for insomnia. Physically active individuals report better sleep quality, fewer sleep disorders, and reduced daytime fatigue and sleepiness.
Objective
This review provides an overview of different physical therapies to improve sleep quality in patients with insomnia. It seeks to understand whether irisin, a molecular mediator of exercise, may be involved in improving sleep quality. This article examines the documented impact of exercise on sleep quality and the possible involvement of myokine irisin.
Conclusion
Based on the literature reviewed, exercise appears to be a promising non-pharmacological option for treating insomnia and improving sleep quality in adults. Overall, current data indicate that irisin, produced during physical activity, may be one of the molecular mediators involved in this process. However, further studies are needed to better clarify its specific regulatory role on sleep.
- Araujo T, Jarrin DC, Leanza Y, Vallieres A, Morin CM. Qualitative studies of insomnia: Current state of knowledge in the field. Sleep Med Rev. 2017;31:58-69. doi: 10.1016/j.smrv.2016.01.003
- Morin CM, Benca R. Chronic insomnia. Lancet. 2012;379(9821):1129-1141. doi: 10.1016/ S0140-6736(11)60750-2
- Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629-634. doi: 10.1136/bmj.315.7109.629
- Ibanez V, Silva J, Cauli O. A survey on sleep assessment methods. PeerJ. 2018;6:e4849. doi: 10.7717/peerj.4849
- Reed DL, Sacco WP. Measuring sleep efficiency: What should the denominator be? J Clin Sleep Med. 2016;12(2):263-266. doi: 10.5664/jcsm.5498
- Ezati M, Keshavarz M, Barandouzi ZA, Montazeri A. The effect of regular aerobic exercise on sleep quality and fatigue among female student dormitory residents. BMC Sports Sci Med Rehabil. 2020;12:44. doi: 10.1186/s13102-020-00190-z
- Alnawwar MA, Alraddadi MI, Algethmi RA, Salem GA, Salem MA, Alharbi AA. The effect of physical activity on sleep quality and sleep disorder: A systematic review. Cureus. 2023;15(8):e43595. doi: 10.7759/cureus.43595
- Saidi O, Davenne D, Lehorgne C, Duche P. Effects of timing of moderate exercise in the evening on sleep and subsequent dietary intake in lean, young, healthy adults: Randomized crossover study. Eur J Appl Physiol. 2020;120(7):1551-1562. doi: 10.1007/ s00421-020-04386-6
- Park I, Diaz J, Matsumoto S, et al. Exercise improves the quality of slow-wave sleep by increasing slow-wave stability. Sci Rep. 2021;11(1):4410. doi: 10.1038/s41598-021-83817-6
- Abd El-Kader SM, Al-Jiffri OH. Aerobic exercise affects sleep, psychological wellbeing and immune system parameters among subjects with chronic primary insomnia. Afr Health Sci. 2020;20(4):1761- 1769. doi: 10.4314/ahs.v20i4.29
- Singh NA, Clements KM, Fiatarone MA. A randomized controlled trial of the effect of exercise on sleep. Sleep. 1997;20(2):95-101. doi: 10.1093/ sleep/20.2.95
- Woods JA, Ceddia MA, Wolters BW, Evans JK, Lu Q, McAuley E. Effects of 6 months of moderate aerobic exercise training on immune function in the elderly. Mech Ageing Dev. 1999;109(1):1-19. doi: 10.1016/s0047-6374(99)00014-7
- Karacabey K, Saygin O, Ozmerdivenli R, Zorba E, Godekmerdan A, Bulut V. The effects of exercise on the immune system and stress hormones in sportswomen. Neuro Endocrinol Lett. 2005;26(4):361-366.
- Buyukyazi G, Kutukculer N, Kutlu N, Genel F, Karadeniz G, Ozkutuk N. Differences in the cellular and humoral immune system between middle-aged men with different intensity and duration of physically training. J Sports Med Phys Fitness. 2004;44(2):207-214.
- King AC, Pruitt LA, Woo S, et al. Effects of moderate-intensity exercise on polysomnographic and subjective sleep quality in older adults with mild to moderate sleep complaints. J Gerontol A Biol Sci Med Sci. 2008;63(9):997-1004. doi: 10.1093/ gerona/63.9.997
- Reid KJ, Baron KG, Lu B, Naylor E, Wolfe L, Zee PC. Aerobic exercise improves self-reported sleep and quality of life in older adults with insomnia. Sleep Med. 2010;11(9):934-940. doi: 10.1016/j. sleep.2010.04.014
- Takahashi JS, Hong HK, Ko CH, McDearmon EL. The genetics of mammalian circadian order and disorder: Implications for physiology and disease. Nat Rev Genet. 2008;9(10):764-775. doi: 10.1038/ nrg2430
- Sinha P, Meng M. Superimposed hemifields in primary visual cortex of achiasmic individuals. Neuron. 2012;75(3):353-355. doi: 10.1016/j. neuron.2012.07.003
- Gallego M, Virshup DM. Post-translational modifications regulate the ticking of the circadian clock. Nat Rev Mol Cell Biol. 2007;8(2):139-148. doi: 10.1038/nrm2106
- Gekakis N, Staknis D, Nguyen HB, et al. Role of the CLOCK protein in the mammalian circadian mechanism. Science. 1998;280(5369):1564-1569. doi: 10.1126/science.280.5369.1564
- van der Horst GT, Muijtjens M, Kobayashi K, et al. Mammalian Cry1 and Cry2 are essential for maintenance of circadian rhythms. Nature. 1999;398(6728):627-630. doi: 10.1038/19323
- Zheng B, Albrecht U, Kaasik K, et al. Nonredundant roles of the mPer1 and mPer2 genes in the mammalian circadian clock. Cell. 2001;105(5):683- 694. doi: 10.1016/s0092-8674(01)00380-4
- McCarthy MJ, Gottlieb JF, Gonzalez R, et al. Neurobiological and behavioral mechanisms of circadian rhythm disruption in bipolar disorder: A critical multi-disciplinary literature review and agenda for future research from the ISBD task force on chronobiology. Bipolar Disord. 2022;24(3):232-263. doi: 10.1111/bdi.13165
- Otsuka Y, Kaneita Y, Itani O, et al. The relationship between subjective happiness and sleep problems in Japanese adolescents. Sleep Med. 2020;69:120-126. doi: 10.1016/j.sleep.2020.01.008
- Torquati L, Mielke GI, Brown WJ, Burton NW, Kolbe-Alexander TL. Shift work and poor mental health: A meta-analysis of longitudinal studies. Am J Public Health. 2019;109(11):e13-e20. doi: 10.2105/ AJPH.2019.305278
- Alterman T, Luckhaupt SE, Dahlhamer JM, Ward BW, Calvert GM. Prevalence rates of work organization characteristics among workers in the U.S.: Data from the 2010 National Health Interview Survey. Am J Ind Med. 2013;56(6):647-659. doi: 10.1002/ajim.22108
- Hawkes RE, Sugavanam T, Benton JS, et al. Which individually-directed non-pharmacological interventions are effective at improving sleep outcomes in shift workers? A systematic review of systematic reviews. Sleep Med Rev. 2025;82:102110. doi: 10.1016/j.smrv.2025.102110
- Sudy AR, Ella K, Bodizs R, Kaldi K. Association of social jetlag with sleep quality and autonomic cardiac control during sleep in young healthy men. Front Neurosci. 2019;13:950. doi: 10.3389/ fnins.2019.00950
- Bao JF, She QY, Hu PP, Jia N, Li A. Irisin, a fascinating field in our times. Trends Endocrinol Metab. 2022;33(9):601-613. doi: 10.1016/j.tem.2022.06.003
- Gamal RM, Mohamed ME, Hammam N, El Fetoh NA, Rashed AM, Furst DE. Preliminary study of the association of serum irisin levels with poor sleep quality in rheumatoid arthritis patients. Sleep Med. 2020;67:71-76. doi: 10.1016/j. sleep.2019.10.021
- Li Y, Li X, Sun D, Cai S. Association of serum irisin concentrations with the presence and severity of obstructive sleep apnea syndrome. J Clin Lab Anal. 2017;31(5):e22077. doi: 10.1002/jcla.22077
- More CE, Papp C, Harsanyi S, et al. Altered irisin/BDNF axis parallels excessive daytime sleepiness in obstructive sleep apnea patients. Respir Res. 2019;20(1):67. doi: 10.1186/s12931-019-1033-y
- Pignataro P, Dicarlo M, Suriano C, et al. Once-daily subcutaneous irisin administration mitigates depression- and anxiety-like behavior in young mice. Int J Mol Sci. 2023;24(7):6715. doi: 10.3390/ ijms24076715
- Porsolt RD, Bertin A, Jalfre M. Behavioral despair in mice: A primary screening test for antidepressants. Arch Int Pharmacodyn Ther. 1977;229(2):327-336.
- Steru L, Chermat R, Thierry B, Simon P. The tail suspension test: A new method for screening antidepressants in mice. Psychopharmacology (Berl). 1985;85(3):367-370. doi: 10.1007/BF00428203
- Can A, Dao DT, Terrillion CE, Piantadosi SC, Bhat S, Gould TD. The tail suspension test. J Vis Exp. 2012(59):e3769. doi: 10.3791/3769
- Yankelevitch-Yahav R, Franko M, Huly A, Doron R. The forced swim test as a model of depressive-like behavior. J Vis Exp. 2015(97):52587. doi: 10.3791/52587
- Pignataro P, Dicarlo M, Zerlotin R, et al. Antidepressant effect of intermittent long-term systemic administration of irisin in mice. Int J Mol Sci. 2022;23(14):7596. doi: 10.3390/ijms23147596
- Tiller JW. Depression and anxiety. Med J Aust. 2013;199(S6):S28-31. doi: 10.5694/mja12.10628
- Islam MR, Valaris S, Young MF, et al. Exercise hormone irisin is a critical regulator of cognitive function. Nat Metab. 2021;3(8):1058-1070. doi: 10.1038/s42255-021-00438-z
- Wrann CD, White JP, Salogiannnis J, et al. Exercise induces hippocampal BDNF through a PGC-1α/ FNDC5 pathway. Cell Metab. 2013;18(5):649-659. doi: 10.1016/j.cmet.2013.09.008
- Wang S, Pan J. Irisin ameliorates depressive-like behaviors in rats by regulating energy metabolism. Biochem Biophys Res Commun. 2016;474(1):22-28. doi: 10.1016/j.bbrc.2016.04.047
- Siteneski A, Cunha MP, Lieberknecht V, et al. Central irisin administration affords antidepressant-like effect and modulates neuroplasticity-related genes in the hippocampus and prefrontal cortex of mice. Prog Neuropsychopharmacol Biol Psychiatry. 2018;84:294-303. doi: 10.1016/j. pnpbp.2018.03.004
- Hardeland R, Cardinali DP, Srinivasan V, Spence DW, Brown GM, Pandi-Perumal SR. Melatonin--a pleiotropic, orchestrating regulator molecule. Prog Neurobiol. 2011;93(3):350-384. doi: 10.1016/j.pneurobio.2010.12.004
- Reiter RJ, Mayo JC, Tan DX, Sainz RM, Alatorre-Jimenez M, Qin L. Melatonin as an antioxidant: Under promises but over delivers. J Pineal Res. 2016;61(3):253-278. doi: 10.1111/jpi.12360
- Gul-Kahraman K, Yilmaz-Bozoglan M, Sahna E. Physiological and pharmacological effects of melatonin on remote ischemic perconditioning after myocardial ischemia-reperfusion injury in rats: Role of Cybb, Fas, NfkappaB, Irisin signaling pathway. J Pineal Res. 2019;67(2):e12589. doi: 10.1111/ jpi.12589
- Ouyang H, Li Q, Zhong J, et al. Combination of melatonin and irisin ameliorates lipopolysaccharide-induced cardiac dysfunction through suppressing the Mst1-JNK pathways. J Cell Physiol. 2020;235(10):6647-6659. doi: 10.1002/jcp.29561
- Tobeiha M, Jafari A, Fadaei S, et al. Evidence for the benefits of melatonin in cardiovascular disease. Front Cardiovasc Med. 2022;9:888319. doi: 10.3389/ fcvm.2022.888319
- Gabriel BM, Zierath JR. Circadian rhythms and exercise - re-setting the clock in metabolic disease. Nat Rev Endocrinol. 2019;15(4):197-206. doi: 10.1038/s41574-018-0150-x
- Guo M, Shen F, Guo X, et al. BMAL1/PGC1alpha4- FNDC5/irisin axis impacts distinct outcomes of time-of-day resistance exercise. J Sport Health Sci. 2024;14:100968. doi: 10.1016/j.jshs.2024.100968
- Hiragaki S, Baba K, Coulson E, Kunst S, Spessert R, Tosini G. Melatonin signaling modulates clock genes expression in the mouse retina. PLoS One. 2014;9(9):e106819. doi: 10.1371/journal. pone.0106819
- Dong B, Xie C, Jing X, Lin L, Tian L. Yoga has a solid effect on cancer-related fatigue in patients with breast cancer: A meta-analysis. Breast Cancer Res Treat. 2019;177(1):5-16. doi: 10.1007/ s10549-019-05278-w
- Kishan P. Yoga and spirituality in mental health: Illness to wellness. Indian J Psychol Med. 2020;42(5):411-420. doi: 10.1177/0253717620946995
- Bower JE, Garet D, Sternlieb B, et al. Yoga for persistent fatigue in breast cancer survivors: A randomized controlled trial. Cancer. 2012;118(15):3766- 3775. doi: 10.1002/cncr.26702
- Banasik J, Williams H, Haberman M, Blank SE, Bendel R. Effect of Iyengar yoga practice on fatigue and diurnal salivary cortisol concentration in breast cancer survivors. J Am Acad Nurse Pract. 2011;23(3):135-142. doi: 10.1111/j.1745-7599.2010.00573.x
- Banerjee B, Vadiraj HS, Ram A, et al. Effects of an integrated yoga program in modulating psychological stress and radiation-induced genotoxic stress in breast cancer patients undergoing radiotherapy. Integr Cancer Ther. 2007;6(3):242-250. doi: 10.1177/1534735407306214
- Mustian KM. Yoga as treatment for insomnia among cancer patients and survivors: A systematic review. Eur Med J Oncol. 2013;1:106-115.
- Zhu J, Chen X, Zhen X, et al. Meta-analysis of effects of yoga exercise intervention on sleep quality in breast cancer patients. Front Oncol. 2023;13:1146433. doi: 10.3389/fonc.2023.1146433
- Carson JW, Carson KM, Porter LS, Keefe FJ, Seewaldt VL. Yoga of Awareness program for menopausal symptoms in breast cancer survivors: Results from a randomized trial. Support Care Cancer. 2009;17(10):1301-1309. doi: 10.1007/ s00520-009-0587-5
- Yagli NV, Ulger O. The effects of yoga on the quality of life and depression in elderly breast cancer patients. Complement Ther Clin Pract. 2015;21(1):7-10. doi: 10.1016/j.ctcp.2015.01.002
- Rao RM, Vadiraja HS, Nagaratna R, et al. Effect of yoga on sleep quality and neuroendocrine immune response in metastatic breast cancer patients. Indian J Palliat Care. 2017;23(3):253-260. doi: 10.4103/IJPC.IJPC_102_17
- Wang WL, Chen KH, Pan YC, Yang SN, Chan YY. The effect of yoga on sleep quality and insomnia in women with sleep problems: A systematic review and meta-analysis. BMC Psychiatry. 2020;20(1):195. doi: 10.1186/ s12888-020-02566-4
- Sadokpam B, Bera TK. Effect of yoga exercises on irisin hormone in obese people. Int J Health Sci Res. 2018;8(6):158-163.
- Budhrani-Shani P, Berry DL, Arcari P, Langevin H, Wayne PM. Mind-body exercises for nurses with chronic low back pain: An evidence-based review. Nurs Res Pract. 2016;2016:9018036. doi: 10.1155/2016/9018036
- Han D, Cheng J, Qu J, et al. Effectiveness of Taijiquan in treating insomnia: A systematic review and meta-analysis of randomized controlled studies. Front Psychiatry. 2022;13:892453. doi: 10.3389/fpsyt.2022.892453
- Li H, Chen J, Xu G, et al. The effect of Tai Chi for improving sleep quality: A systematic review and meta-analysis. J Affect Disord. 2020;274:1102-1112. doi: 10.1016/j.jad.2020.05.076
- Yang Z, Zhai H, Yang Z, Ning B. Comparing the efficacy of traditional Chinese exercises and general aerobic exercises in university students with sleep disorders: A systematic review and meta-analysis. Medicine (Baltimore). 2024;103(23):e38521. doi: 10.1097/MD.0000000000038521
- Vanderlinden J, Boen F, van Uffelen JGZ. Effects of physical activity programs on sleep outcomes in older adults: A systematic review. Int J Behav Nutr Phys Act. 2020;17(1):11. doi: 10.1186/ s12966-020-0913-3
- Guazzarini AG, Mancinetti F, Bastiani P, et al. Tai chi, irisin and cognitive performance: A clinical and biological investigation in older adults. Aging Clin Exp Res. 2024;36(1):90. doi: 10.1007/ s40520-024-02743-5
- Lyu L, Li Y, Fan X, Seo J, Eunna O. The effect of Tai Chi exercise intervention on sleep quality in community residing older adults: A systematic review and meta-analysis. Eur Geriatr Med. 2024;15(2):381-396. doi: 10.1007/ s41999-023-00923-6
- Whitworth JW, Nosrat S, SantaBarbara NJ, Ciccolo JT. Feasibility of resistance exercise for posttraumatic stress and anxiety symptoms: A randomized controlled pilot study. J Trauma Stress. 2019;32(6):977-984. doi: 10.1002/jts.22464
- Syed-Abdul MM. Benefits of resistance training in older adults. Curr Aging Sci. 2021;14(1):5-9. doi: 10.2174/1874609813999201110192221
- Langlais CS, Chen YH, Van Blarigan EL, et al. Quality of life for men with metastatic castrate-resistant prostate cancer participating in an aerobic and resistance exercise pilot intervention. Urol Oncol. 2023;41(3):146.e1-e111. doi: 10.1016/j. urolonc.2022.11.016
- Piraux E, Reychler G, Vancraeynest D, Geets X, Leonard D, Caty G. High-intensity aerobic interval training and resistance training are feasible in rectal cancer patients undergoing chemoradiotherapy: A feasibility randomized controlled study. Rep Pract Oncol Radiother. 2022;27(2):198-208. doi: 10.5603/ RPOR.a2022.0036
- Piraux E, Caty G, Renard L, et al. Effects of high-intensity interval training compared with resistance training in prostate cancer patients undergoing radiotherapy: A randomized controlled trial. Prostate Cancer Prostatic Dis. 2021;24(1):156-165. doi: 10.1038/ s41391-020-0259-6
- Maric D, Ficarra S, Di Bartolo L, et al. Effects of resistance training on sleep quality and disorders among individuals diagnosed with cancer: A systematic review and meta-analysis of randomized controlled trials. Cancer Med. 2024;13(8):e7179. doi: 10.1002/cam4.7179
- Kovacevic A, Mavros Y, Heisz JJ, Fiatarone Singh MA. The effect of resistance exercise on sleep: A systematic review of randomized controlled trials. Sleep Med Rev. 2018;39:52-68. doi: 10.1016/j. smrv.2017.07.002
- Monico-Neto M, Antunes HK, Lee KS, et al. Resistance training minimizes catabolic effects induced by sleep deprivation in rats. Appl Physiol Nutr Metab. 2015;40(11):1143-1150. doi: 10.1139/ apnm-2015-0061
- Kim HJ, So B, Choi M, Kang D, Song W. Resistance exercise training increases the expression of irisin concomitant with improvement of muscle function in aging mice and humans. Exp Gerontol. 2015;70:11-17. doi: 10.1016/j.exger.2015.07.006
- Cosio PL, Crespo-Posadas M, Velarde-Sotres A, Pelaez M. Effect of chronic resistance training on circulating irisin: Systematic review and meta-analysis of randomized controlled trials. Int J Environ Res Public Health. 2021;18(5):2476. doi: 10.3390/ ijerph18052476
- Faraguna U, Vyazovskiy VV, Nelson AB, Tononi G, Cirelli C. A causal role for brain-derived neurotrophic factor in the homeostatic regulation of sleep. J Neurosci. 2008;28(15):4088-4095. doi: 10.1523/JNEUROSCI.5510-07.2008
- Frimpong E, Mograss M, Zvionow T, Dang-Vu TT. The effects of evening high-intensity exercise on sleep in healthy adults: A systematic review and meta-analysis. Sleep Med Rev. 2021;60:101535. doi: 10.1016/j.smrv.2021.101535
- Weinert D, Gubin D. The impact of physical activity on the circadian system: Benefits for health, performance and wellbeing. Appl Sci. 2022;12(18):9220.
- Edwards B, Waterhouse J, Atkinson G, Reilly T. Exercise does not necessarily influence the phase of the circadian rhythm in temperature in healthy humans. J Sports Sci. 2002;20(9):725-732. doi: 10.1080/026404102320219437
- Youngstedt SD, Elliott JA, Kripke DF. Human circadian phase-response curves for exercise. J Physiol. 2019;597(8):2253-2268. doi: 10.1113/JP276943
- Buxton OM, Lee CW, L’Hermite-Baleriaux M, Turek FW, Van Cauter E. Exercise elicits phase shifts and acute alterations of melatonin that vary with circadian phase. Am J Physiol Regul Integr Comp Physiol. 2003;284(3):R714-R724. doi: 10.1152/ ajpregu.00355.2002
- Yamanaka Y, Hashimoto S, Takasu NN, et al. Morning and evening physical exercise differentially regulate the autonomic nervous system during nocturnal sleep in humans. Am J Physiol Regul Integr Comp Physiol. 2015;309(9):R1112-R1121. doi: 10.1152/ajpregu.00127.2015
- Hunter GR, Brock DW, Byrne NM, Chandler- Laney PC, Del Corral P, Gower BA. Exercise training prevents regain of visceral fat for 1 year following weight loss. Obesity (Silver Spring). 2010;18(4):690-695. doi: 10.1038/oby.2009.316
- Rubio-Sastre P, Gomez-Abellan P, Martinez-Nicolas A, Ordovas JM, Madrid JA, Garaulet M. Evening physical activity alters wrist temperature circadian rhythmicity. Chronobiol Int. 2014;31(2):276-282. doi: 10.3109/07420528.2013.833215
- Anastasilakis AD, Polyzos SA, Saridakis ZG, et al. Circulating irisin in healthy, young individuals: Day-night rhythm, effects of food intake and exercise, and associations with gender, physical activity, diet, and body composition. J Clin Endocrinol Metab. 2014;99(9):3247-3255. doi: 10.1210/jc.2014-1367
- Takemura N, Cheung DST, Smith R, et al. Effectiveness of aerobic exercise and mind-body exercise in cancer patients with poor sleep quality: A systematic review and meta-analysis of randomized controlled trials. Sleep Med Rev. 2020;53:101334. doi: 10.1016/j.smrv.2020.101334
- Aton SJ, Herzog ED. Come together, right. now: Synchronization of rhythms in a mammalian circadian clock. Neuron. 2005;48(4):531-534. doi: 10.1016/j.neuron.2005.11.001
- Liu C, Li S, Liu T, Borjigin J, Lin JD. Transcriptional coactivator PGC-1alpha integrates the mammalian clock and energy metabolism. Nature. 2007;447(7143):477-481. doi: 10.1038/nature05767
- Ferrell JM, Chiang JY. Circadian rhythms in liver metabolism and disease. Acta Pharm Sin B. 2015;5(2):113-122. doi: 10.1016/j.apsb.2015.01.003
- Khan S, Nobili L, Khatami R, et al. Circadian rhythm and epilepsy. Lancet Neurol. 2018;17(12):1098-1108. doi: 10.1016/S1474-4422(18)30335-1
- Boström P, Wu J, Jedrychowski MP, et al. A PGC1-α-dependent myokine that drives brown-fat-like development of white fat and thermogenesis. Nature. 2012;481(7382):463-468. doi: 10.1038/ nature10777
- Ruas JL, White JP, Rao RR, et al. A PGC- 1alpha isoform induced by resistance training regulates skeletal muscle hypertrophy. Cell. 2012;151(6):1319-1331. doi: 10.1016/j. cell.2012.10.050
- Martinez-Redondo V, Pettersson AT, Ruas JL. The hitchhiker’s guide to PGC-1alpha isoform structure and biological functions. Diabetologia. 2015;58(9):1969-1977. doi: 10.1007/ s00125-015-3671-z
- Puigserver P, Wu Z, Park CW, Graves R, Wright M, Spiegelman BM. A cold-inducible coactivator of nuclear receptors linked to adaptive thermogenesis. Cell. 1998;92(6):829-839. doi: 10.1016/ s0092-8674(00)81410-5
- Ryan MT, Hoogenraad NJ. Mitochondrial-nuclear communications. Annu Rev Biochem. 2007;76:701-722. doi: 10.1146/annurev. biochem.76.052305.091720
- Masri S, Sassone-Corsi P. The emerging link between cancer, metabolism, and circadian rhythms. Nat Med. 2018;24(12):1795-1803. doi: 10.1038/s41591-018-0271-8
- Sedliak M, Zeman M, Buzgo G, et al. Morphological, molecular and hormonal adaptations to early morning versus afternoon resistance training. Chronobiol Int. 2018;35(4):450-464. doi: 10.1080/07420528.2017.1411360
- Savikj M, Gabriel BM, Alm PS, et al. Afternoon exercise is more efficacious than morning exercise at improving blood glucose levels in individuals with type 2 diabetes: A randomised crossover trial. Diabetologia. 2019;62(2):233-237. doi: 10.1007/ s00125-018-4767-z
- Zhang B, Wing YK. Sex differences in insomnia: A meta-analysis. Sleep. 2006;29(1):85-93. doi: 10.1093/sleep/29.1.85
- Kische H, Ewert R, Fietze I, et al. Sex Hormones and sleep in men and women from the general population: A cross-sectional observational study. J Clin Endocrinol Metab. 2016;101(11):3968-3977. doi: 10.1210/jc.2016-1832
- Calhoun SL, Fernandez-Mendoza J, Vgontzas AN, Liao D, Bixler EO. Prevalence of insomnia symptoms in a general population sample of young children and preadolescents: gender effects. Sleep Med. 2014;15(1):91-95. doi: 10.1016/j. sleep.2013.08.787
- Kizilirmak A, Timur S, Kartal B. Insomnia in pregnancy and factors related to insomnia. ScientificWorldJournal. 2012;2012:197093. doi: 10.1100/2012/197093
- Pengo MF, Won CH, Bourjeily G. Sleep in women across the life span. Chest. 2018;154(1):196-206. doi: 10.1016/j.chest.2018.04.005
- Dorsey A, de Lecea L, Jennings KJ. Neurobiological and hormonal mechanisms regulating women’s sleep. Front Neurosci. 2020;14:625397. doi: 10.3389/fnins.2020.625397
- Andersen ML, Hachul H, Ishikura IA, Tufik S. Sleep in women: A narrative review of hormonal influences, sex differences and health implications. Front Sleep. 2023;2:1271827. doi: 10.3389/ frsle.2023.1271827
- Rubio-Arias JA, Marin-Cascales E, Ramos-Campo DJ, Hernandez AV, Perez-Lopez FR. Effect of exercise on sleep quality and insomnia in middle-aged women: A systematic review and meta-analysis of randomized controlled trials. Maturitas. 2017;100:49-56. doi: 10.1016/j.maturitas.2017.04.003
- Yang SY, Lan SJ, Yen YY, Hsieh YP, Kung PT, Lan SH. Effects of exercise on sleep quality in pregnant women: A systematic review and meta-analysis of randomized controlled trials. Asian Nurs Res (Korean Soc Nurs Sci). 2020;14(1):1- 10. doi: 10.1016/j.anr.2020.01.003
- Luo Y, Qiao X, Xu L, Huang G. Irisin: Circulating levels in serum and its relation to gonadal axis. Endocrine. 2022;75(3):663-671. doi: 10.1007/s12020-022-02981-5
- Hadjimarkou MM, Benham R, Schwarz JM, Holder MK, Mong JA. Estradiol suppresses rapid eye movement sleep and activation of sleep-active neurons in the ventrolateral preoptic area. Eur J Neurosci. 2008;27(7):1780-1792. doi: 10.1111/j.1460-9568.2008.06142.x
- Beekly B, Furman K, Burgess C, Elias C. KNDy innervation of MCH neurons modulates sleep in an estradiol-dependent manner. Physiology. 2023;38:5732862. doi: 10.1152/physiol.2023.38. S1.5732862
- Furukawa TA, Noma H, Caldwell DM, et al. Waiting list may be a nocebo condition in psychotherapy trials: A contribution from network meta-analysis. Acta Psychiatr Scand. 2014;130(3):181-192. doi: 10.1111/acps.12275
- Xie Y, Liu S, Chen XJ, Yu HH, Yang Y, Wang W. Effects of exercise on sleep quality and insomnia in adults: A systematic review and meta-analysis of randomized controlled trials. Front Psychiatry. 2021;12:664499. doi: 10.3389/fpsyt.2021.66449
