Exercise training improves sleep quality in middle-aged and older adults with sleep problems: A systematic review. Journal of Physiotherapy, 58, 157-163

College of Medicine, National Taiwan University, Taipei, Taiwan.
Journal of physiotherapy (Impact Factor: 3.71). 09/2012; 58(3):157-63. DOI: 10.1016/S1836-9553(12)70106-6
Source: PubMed


Does an exercise training program improve the quality of sleep in middle-aged and older adults with sleep problems?
Systematic review with meta-analysis of randomised trials.
Adults aged over 40 years with sleep problems.
A formal exercise training program consisting of either aerobic or resistance exercise.
Self-reported sleep quality or polysomnography.
Six trials were eligible for inclusion and provided data on 305 participants (241 female). Each of the studies examined an exercise training program that consisted of either moderate intensity aerobic exercise or high intensity resistance exercise. The duration of most of the training programs was between 10 and 16 weeks. All of the studies used the self-reported Pittsburgh Sleep Quality Index to assess sleep quality. Compared to the control group, the participants who were randomised to an exercise program had a better global Pittsburgh Sleep Quality Index score, with a standardised mean difference (SMD) of 0.47 (95% CI 0.08 to 0.86). The exercise group also had significantly reduced sleep latency (SMD 0.58, 95% CI 0.08 to 1.08), and medication use (SMD 0.44, 95% CI 0.14 to 0.74). However, the groups did not differ significantly in sleep duration, sleep efficiency, sleep disturbance, or daytime functioning.
Participation in an exercise training program has moderately positive effects on sleep quality in middle-aged and older adults. Physical exercise could be an alternative or complementary approach to existing therapies for sleep problems.

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    • "The evidence also suggests causal and therapeutic linkages between exercise and sleep quality (Youngstedt, 2005). While earlier studies tended to focus on sleep outcomes following relatively high-intensity activities and athletic performance (Driver and Taylor, 2000), recent clinical trial findings have demonstrated moderate, but significant, sleep benefits for lower-intensity exercise (for a recent systematic review, see Yang et al., 2012). Programs requiring 100 min (Reid et al., 2010) to 210 min (King et al., 2008) of weekly activity, delivered over periods ranging from 16 weeks (King et al., 1997) to 54 weeks (King et al., 2008), have shown significant improvements in sleep quality among those with 'mild' to 'moderate' sleep complaints (Irwin et al., 2008), or 'chronic' insomnia symptoms (Li et al., 2004; Reid et al., 2010). "
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    ABSTRACT: While high levels of activity and exercise training have been associated with improvements in sleep quality, minimum levels of activity likely to improve sleep outcomes have not been explored. A two-armed parallel randomized controlled trial (N=41; 30 females) was designed to assess whether increasing physical activity to the level recommended in public health guidelines can improve sleep quality among inactive adults meeting research diagnostic criteria for insomnia. The intervention consisted of a monitored program of ≥150 min of moderate- to vigorous-intensity physical activity per week, for 6 months. The principal end-point was the Insomnia Severity Index at 6 months post-baseline. Secondary outcomes included measures of mood, fatigue and daytime sleepiness. Activity and light exposure were monitored throughout the trial using accelerometry and actigraphy. At 6 months post-baseline, the physical activity group showed significantly reduced insomnia symptom severity (F8,26 = 5.16, P = 0.03), with an average reduction of four points on the Insomnia Severity Index; and significantly reduced depression and anxiety scores (F6,28 = 5.61, P = 0.02; and F6,28 = 4.41, P = 0.05, respectively). All of the changes were independent of daily light exposure. Daytime fatigue showed no significant effect of the intervention (F8,26 = 1.84, P = 0.18). Adherence and retention were high. Internationally recommended minimum levels of physical activity improve daytime and night-time symptoms of chronic insomnia independent of daily light exposure levels. © 2015 European Sleep Research Society.
    Journal of Sleep Research 04/2015; 24(5). DOI:10.1111/jsr.12297 · 3.35 Impact Factor
    • "Whatexercisetorecommendtosleep-disorderpatients? Asdescribedpreviously,exercisehasbeenrecommendedasa non-pharmacologicaltreatmentforinsomnia[5] [22] [36] [184] [185]or sleep-disorderedbreathing[197].However,physicalactivityneeds tobeprogressiveinpatientssufferingfromsleepdisorders,starting atlowintensityandprecededbyaphysical/cardiovascularcheckup .Indeed,growingepidemiologicalevidenceindicatesthatshort durationsleepersandthosewithsleepdisordersareatgreaterrisk ofsuddencardiacdeath[204],coronaryheartdisease,myocardial infarction,angina,stroke[205]ordiabetes[206]. Everyheartdiseaseisariskfactorforexercise-inducedacute cardiacevents,duringtheexerciseitselfortheimmediaterecovery period[207],soweneedtobecautiouswhenrecommendingacute intenseexercisetosubjectswithsleepdisorders. "
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    ABSTRACT: Sleep and exercise influence each other through complex, bilateral interactions that involve multiple physiological and psychological pathways. Physical activity is usually considered as beneficial in aiding sleep although this link may be subject to multiple moderating factors such as sex, age, fitness level, sleep quality and the characteristics of the exercise (intensity, duration, time of day, environment). It is therefore vital to improve knowledge in fundamental physiology in order to understand the benefits of exercise on the quantity and quality of sleep in healthy subjects and patients. Conversely, sleep disturbances could also impair a person’s cognitive performance or their capacity for exercise and increase the risk of exercise-induced injuries either during extreme and/or prolonged exercise or during team sports. This review aims to describe the reciprocal fundamental physiological effects linking sleep and exercise in order to improve the pertinent use of exercise in sleep medicine and prevent sleep disorders in sportsmen.
    Sleep Medicine Reviews 06/2014; 20. DOI:10.1016/j.smrv.2014.06.008 · 8.51 Impact Factor
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    • "OSA is associated with significant morbidity and mortality due to accidents, cardiovascular diseases, and stroke [7,8]. In addition, insomnia is a common sleep disorder that impairs quality of life from both physiological and psychological aspects, with prevalence range from 10% to 40% in Western countries [9-11]. Besides insomnia, a considerable proportion of the general adult population reports chronic mild to moderate sleep complaints which result in long-term poor quality of sleep, as well as increased health care visits [12]. "
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    ABSTRACT: Sleep is essential for normal and healthy living. Lack of good quality sleep affects physical, mental and emotional functions. Currently, the treatments of obesity-related sleep disorders focus more on suppressing sleep-related symptoms pharmaceutically and are often accompanied by side effects. Thus, there is urgent need for alternative ways to combat chronic sleep disorders. This study will investigate underlying mechanisms of the effects of exercise and diet intervention on obesity-related sleep disorders, the role of gut microbiota in relation to poor quality of sleep and day-time sleepiness, as well as the levels of hormones responsible for sleep-wake cycle regulation.Methods/design: Participants consist of 330 (target sample) Finnish men aged 30 to 65 years. Among them, we attempt to randomize 180 (target sample) with sleep disorders into exercise and diet intervention. After screening and physician examination, 101 men with sleep disorders are included and are randomly assigned into three groups: exercise (n = 33), diet (n = 35), and control (n = 33). In addition, we attempt to recruit a target number of 150 healthy men without sleep disorders as the reference group. The exercise group undergoes a six-month individualized progressive aerobic exercise program based on initial fitness level. The diet group follows a six month specific individualized diet program. The control group and reference group are asked to maintain their normal activity and diet during intervention. Measurements are taken before and after the intervention. Primary outcomes include objective sleep measurements by polysomnography and a home-based non-contact sleep monitoring system, and subjective sleep evaluation by questionnaires. Secondary outcome measures include anthropometry, body composition, fitness, sleep disorder-related lifestyle risk factors, composition of gut microbiota and adipose tissue metabolism, as well as specific hormone and neurotranmitter levels and inflammatory biomarkers from venous blood samples. It is expected that the improvement of sleep quality after exercise and diet intervention will be evident both in subjective and objective measures of quality of sleep. Additionally, the change of sleep quality induced by exercise and diet intervention is expected to be related to the changes in specific hormones and inflammatory biomarkers, and in the composition of gut microbiota.Trial registration: Current Controlled Trials ISRCTN77172005.
    Trials 07/2013; 14(1):235. DOI:10.1186/1745-6215-14-235 · 1.73 Impact Factor
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