Background Exercise may improve sleep quality in middle-aged and older adults with sleep disorders, but the comparative effects of different exercise modalities and the dose–response relationship remain unclear. Methods We systematically searched PubMed, Web of Science, Embase, and the Cochrane Library from inception to May 2026. Eligible studies were randomized controlled trials examining the effects of exercise interventions on sleep quality in middle-aged and older adults with sleep disorders. Two independent reviewers assessed study quality, and random-effects pairwise, network, and dose-response meta-analyses were performed to evaluate the effects of different exercise interventions and doses on sleep quality. Results The analysis included 23 randomized controlled trials involving 1478 middle-aged and older adults with sleep disorders. Pairwise meta-analysis showed that exercise reduced PSQI and ISI scores but had no significant effect on ESS scores. Bayesian network meta-analysis showed that, compared with the control group, aerobic exercise (SMD = 1.34, 95% CrI: 0.86∼1.82), mind–body exercise (SMD = 0.64, 95% CrI: 0.30∼0.97), and combined exercise (SMD = 0.60, 95% CrI: 0.13∼1.07) may improve PSQI scores. The dose-response analysis suggested an inverted U-shaped association, with the largest predicted effect occurring near 539 MET-min/week within the observed dose range. Conclusions Low- to moderate-certainty evidence suggests that aerobic, mind–body, and combined exercise may reduce PSQI scores, with a nonlinear dose–response relationship.
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