Effectiveness of exercise interventions on sperm quality: a systematic review and network meta-analysis

Background: Infertility affects about 10% to 15% of the world's population, thus making it a global concern. Although there are a large number of studies to develop treatment for infertility in men, there are no studies to illustrate the effect of exercise on male sperm treatment in a well rationalized and aggregated manner, therefore the aim of this study was to validate the comparative effectiveness of different exercise interventions for treating sperm quality in men by using a network Meta-analysis. Methods: All randomized clinical trials (RCT) were obtained from PubMed, Cochrane Library, EMBASE, Web of Science, CNKI, Wanfang, and VIP databases, and network meta-analysis was used to assess the effectiveness of exercise interventions on sperm quality. Results: Fourteen studies with 1079 subjects were finally included in this study. Compared with the physical inactivity group, indoor aerobic, outdoor aerobic, and resistance training significantly reduced sperm density (P<0.05); indoor aerobic, outdoor aerobic, and resistance training significantly reduced the number of necrotic spermatozoa and the number of active spermatozoa (P>0.05).Outdoor aerobic[MD=1.84,95%CI:(1.56,2.14),P<0.05], multi-component motion [MD=1.37,95%CI:(0.85,1.89),P<0.05],competitive sports[MD=1.04,95%CI:(0.46,1.60),P<0.05],indoor aerobic [MD=0.32, 95%CI:(0.21,0.44), P<0.05], effectively enhanced sperm volume; other sports [MD=9.49,95%CI:(6.17,12.84),P<0.05], indoor aerobic[MD=4.43,95%CI:(3.12,5.74),P<0.05],resistance training [MD=3.93, 95%CI:(0.49,7.37), P<0.05], competitive sports [MD=5.44,95%CI:(0.10,10.79), P<0.05], and bicycle aerobics[MD=27.29,95%CI:(22.45,32.06),P<0.05], significantly enhanced sperm motility; other sports [MD=17.20,95%CI:(3.12,31.19), P<0.05], effectively enhanced total sperm count;resistance training[MD=10.90,95%CI:(8.44,13.36), P<0.05],other sports [MD=1.97,95%CI:(1.41,2.54),P<0.05], indoor aerobic [MD=2.43,95%CI:(1.13,3.73), P<0.05],and bicycle aerobic [MD=12.18, 95%CI:(10.19,14.18),P<0.05], significantly enhanced sperm morphology; bicycle aerobic (MD=18.87, 95%CI:11.70,25.86, P<0.05), and indoor aerobic (MD=9.53, 95%CI:8.97,10.09, P<0.05),effectively enhanced sperm concentration. Conclusion: In conclusion, outdoor aerobics had a significant effect on improving sperm volume in infertile patients; other sports had a significant effect on enhancing sperm motility and total sperm count in infertile patients; resistance training had a significant effect on enhancing sperm morphology in infertile patients, and bicycle aerobic has a significant impact on improving sperm concentration in infertile patients. Systematic review registration: https://www.crd.york.ac.uk/prospero/#myprospero, identifier CRD42024534582.