## 4 Discussion  
The primary findings of our study are discussed. The overall analyses indicate that exercise interventions, particularly aerobic and resistance exercises, lead to notable improvements in sleep quality among adults with obesity. Moreover, exercise interventions, including Nordic walking and combined aerobic and resistance exercises, significantly contribute to weight loss in adults with obesity. This study focused on sleep quality and weight loss to provide foundational data for intervention research in individuals with obesity. Consequently, the inclusion criteria were centered on aerobic and resistance exercises that are commonly used and effective in obesity intervention programs. Our data showed relatively higher heterogeneity (\(l^{2}=74.71\%\)), reflecting variations in intensity, frequency, and exercise modalities among the exercise interventions related to sleep quality included in this study. Despite this higher heterogeneity, the overall meta-analysis demonstrated a substantially positive effect of exercise interventions on sleep quality, with effects observed to be 3.93 times higher in the treatment group than in the control group. The effects of the present study are similar to the data from  
Figure 4: Effects of exercise on weight loss [30; 31; 33; 34]. \begin{table}
\begin{tabular}{l c c c c c c c c c} \hline \hline
**Model** & \multicolumn{4}{c}{**Effect Size and 95\% Interval**} & \multicolumn{4}{c}{**Test of Null (\(\Omega\)-Tail)**} & \multicolumn{4}{c}{**Other Heterogeneity Statistics**} \\ \hline Model & Number studies & Point estimate & Lower limit & Upper limit & Z-value & \(p\)-value & Q-value & Df (Q) & \(p\)-value & I-squared \\ Fixed & 4 & 2.390 & 1.583 & 3.606 & 4.148 & 0.000 & 2.243 & 3 & 0.524 & 0.000 \\ Random & 4 & 2.390 & 1.583 & 3.606 & 4.148 & 0.000 & & & & \\ \hline \hline \end{tabular}
\end{table} 
Table 3: Overall status of exercise intervention on weight loss. a meta-analysis to assess the effects of exercise interventions contained aerobic exercise (e.g., walking, cycling) among an adult to elderly population on sleep quality control, with a pooled mean difference of \(-2.19\), indicating a larger reduction in PSQI score [36]. Heterogeneity in exercise interventions arises from the diversity of exercise types, including single aerobic exercise, combined aerobic and resistance regimens, variations in adherence, and participant characteristics. Notably, our study showed that combined aerobic resistance exercises demonstrated a larger effect size in improving sleep quality, making them highly recommended for individuals with obesity [28; 30]. Aerobic exercise primarily enhances the respiratory and cardiovascular systems, thereby reducing body temperature and inflammation, which promotes better sleep quality [37; 38]. Additionally, aerobic exercise reduces stress and anxiety, promotes relaxation [39], and has shown promise in lowering cortisol levels, further enhancing sleep patterns [40]. One remarkable aspect of resistance exercise is its ability to improve sleep quality, which is essential for overall well-being [41]. Research has uncovered several mechanisms through which resistance exercise positively affects sleep. Resistance training can reduce sleep-disordered breathing, such as sleep apnea, by strengthening the muscles involved in respiration, thus maintaining open airways during sleep and preventing breathing interruptions. Further research is necessary to investigate the impact of combined aerobic and resistance exercises on sleep quality and to uncover the underlying mechanisms. Our data showed that moderate-to high-intensity exercises yielded the most notable improvements in sleep quality, consistent with existing literature highlighting their superiority over lower-intensity programs [42; 43]. Therefore, the inclusion of both aerobic and resistance exercises may provide a broader range of benefits to sleep quality.