Background
Major Depressive Disorder (MDD) is a leading cause of global disability, contributing to substantial individual, social, and economic burdens. While antidepressant therapy remains the cornerstone of treatment, complementary lifestyle-based interventions, such as multimodal exercise and mindfulness, have shown promise in alleviating mood symptoms. However, their specific impact on sleep quality, a critical therapeutic target in MDD, remains underexplored. 

Methods
In a 12-week randomized controlled trial, 88 patients with MDD were assigned to three groups: pharmacotherapy alone (control group-CG), pharmacotherapy plus home-based multimodal exercise (exercise group-EG), or pharmacotherapy plus home-based mindfulness training (mindfulness group-MF). Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI) at baseline, week 5, and week 12. 

Results
A Linear Mixed-Model (LMM) was performed, and significant group-by-time interactions were observed. At baseline, the EG exhibited lower PSQI scores compared to the MF (p=.002, d=.75) and CG (p=.001, d=.83). At week 5, the EG continued to show superior sleep quality relative to mindfulness (p=.018, d=.64) and CG (p=.001, d=.89). At week 12, the MF also demonstrated better sleep quality than the CG (p=.002, d=.80). All groups improved over time, with exercise yielding rapid benefits and MF showing progressive, sustained improvements.

Conclusion
Lifestyle-based interventions enhance sleep quality in MDD when combined with antidepressant therapy. Multimodal exercise offers immediate improvements, while mindfulness provides gradual, long-term benefits. These findings underscore the value of adjunctive lifestyle interventions in MDD management and highlight the need for further research into their long-term efficacy and potential synergistic effects.