Elsevier

Sleep Medicine

Volume 11, Issue 9, October 2010, Pages 934-940
Sleep Medicine

Original Article
Aerobic exercise improves self-reported sleep and quality of life in older adults with insomnia

https://doi.org/10.1016/j.sleep.2010.04.014Get rights and content

Abstract

Objective

To assess the efficacy of moderate aerobic physical activity with sleep hygiene education to improve sleep, mood and quality of life in older adults with chronic insomnia.

Methods

Seventeen sedentary adults aged ⩾55 years with insomnia (mean age 61.6 [SD ± 4.3] years; 16 female) participated in a randomized controlled trial comparing 16 weeks of aerobic physical activity plus sleep hygiene to non-physical activity plus sleep hygiene. Eligibility included primary insomnia for at least 3 months, habitual sleep duration <6.5 h and a Pittsburgh Sleep Quality Index (PSQI) score >5. Outcomes included sleep quality, mood and quality of life questionnaires (PSQI, Epworth Sleepiness Scale [ESS], Short-form 36 [SF-36], Center for Epidemiological Studies Depression Scale [CES-D]).

Results

The physical activity group improved in sleep quality on the global PSQI (p < .0001), sleep latency (p = .049), sleep duration (p = .04), daytime dysfunction (p = .027), and sleep efficiency (p = .036) PSQI sub-scores compared to the control group. The physical activity group also had reductions in depressive symptoms (p = .044), daytime sleepiness (p = .02) and improvements in vitality (p = .017) compared to baseline scores.

Conclusion

Aerobic physical activity with sleep hygiene education is an effective treatment approach to improve sleep quality, mood and quality of life in older adults with chronic insomnia.

Introduction

Chronic sleep disturbance is reported by nearly 50% of the elderly population [1]. Particularly common in this age group is chronic insomnia, characterized by fragmented sleep and early morning awakening [2], [3], [4]. Insomnia in older adults is associated with mood and anxiety disorders [5], [6], falls [7], [8], [9] and cognitive impairment [10]. The significant morbidity associated with insomnia coupled with the potential adverse effects of commonly prescribed sedative medications creates the need to develop non-pharmacological treatment approaches for the management of insomnia in older adults.

The sedentary lifestyle of older adults may contribute to the decline in health that often accompanies aging. The maintenance of high physical function is one of the key factors for successful aging [11]. Staying physically and mentally active can not only delay the development of some chronic illnesses and disabilities, but also improve mental and physical health in older adults [12], [13], [14], [15], [16], [17].

Recent studies from our group indicate that increased levels of structured social and physical activity have positive effects on sleep and performance in older adults [18], [19]. In addition, participation in a regular exercise program can also have positive effects on sleep quality [16], [20], [21], [22], mood [16], and cognitive abilities [20], [21], [22], [23]. A meta-analysis of 12 studies indicates that regular exercise increases total sleep time and, in some studies, slow wave sleep (SWS) [24]. In addition, epidemiological data based on self-reports consistently support the view that acute and chronic exercise promotes sleep [20]. Furthermore data suggest that higher levels of physical activity in older adults are protective against incident and chronic insomnia [25].

Most studies examining the effects of exercise on sleep have focused on young good sleepers or fit athletes [20], [26]. The limited data available in older adults also indicate an association between physical activity levels and sleep quality. For example, older physically fit men had shorter sleep onset latencies, less wake time after sleep onset, higher sleep efficiency and more total slow wave sleep than sedentary older men [27]. There is also evidence that increasing physical activity level can improve sleep quality in older adults [19], [21], [27], [28], [29], [30]. For example, in sedentary older adults, a 16 week program of mild to moderate intense physical activity improved self-rated sleep quality [21]. In another study, exposure to daily physical and social activity for just 2 weeks also had positive effects on sleep quality in older adults [19]. Furthermore, in older adults with depression, progressive weight training significantly improved measures of both subjective sleep quality and depression [16].

Taken together, these results indicate a potential for exercise as a means to improve sleep quality and comorbid depressive symptoms in older adults with insomnia. However, the efficacy of exercise to improve sleep quality in older adults with chronic insomnia has not been established. Therefore, the aim of this study was to test the hypothesis that a structured physical exercise program can improve self-reported sleep quality, mood, daytime function and quality of life in late middle age and older adults with chronic insomnia.

Section snippets

Design

This study used a randomized parallel pre-post design. Participants were randomly assigned to either an aerobic physical activity or non-physical activity intervention group and measurements were collected at baseline and post-treatment (16 weeks). Data from this study are part of a larger ongoing study on the effects of exercise as a countermeasure for sleep loss in aging. This report presents only the results of self-reported sleep quality, quality of life, and mood at baseline and post

Participants

Participant characteristics are described in Table 1. Rest/activity recorded from actigraphy (average of 7 days) and sleep parameters from PSG (night 2) are presented in Table 2. There were no significant differences in any of the sleep parameters between the two groups.

Physical activity compliance

On average participants exercised 3.27 (±0.52) times a week for an average of 32.3 (±12.5) minutes each session. Exercise was mostly completed in a gym or recreation center (76.7%) or at home or work (17.6%); the remainder was

Discussion

Results from this study indicate that a 16 week program of moderate intensity aerobic physical activity plus sleep hygiene education is effective in improving self-reported sleep quality, mood and quality of life in older adults with chronic insomnia. These results highlight the potential of structured physical activity programs to improve the effectiveness of standard behavioral approaches for the treatment of insomnia, particularly in a sedentary older adult population.

The effect size for the

Acknowledgements

The authors would like to thank all of the study participants for their participation and Rosemary Ortiz for assistance with data collection. This research was supported by a National Institute of Aging grant P01 AG11412, General Clinical Research Center grant M01 RR00048, K23 HL091508, T32AG020506.

References (48)

  • R. Stewart et al.

    Insomnia comorbidity and impact and hypnotic use by age group in a national survey population aged 16–74 years

    Sleep

    (2006)
  • Ancoli-Israel S. Insomnia in the elderly: a review for the primary care practitioner. Sleep 2000;23(Suppl. 1):S23–30;...
  • K.L. Stone et al.

    Self-reported sleep and nap habits and risk of falls and fractures in older women: the study of osteoporotic fractures

    J Am Geriatr Soc

    (2006)
  • A.Y. Avidan et al.

    Insomnia and hypnotic use, recorded in the minimum data set, as predictors of falls and hip fractures in Michigan nursing homes

    J Am Geriatr Soc

    (2005)
  • G.S. Brassington et al.

    Sleep problems as a risk factor for falls in a sample of community-dwelling adults aged 64–99 years

    J Am Geriatr Soc

    (2000)
  • M. Cricco et al.

    The impact of insomnia on cognitive functioning in older adults

    J Am Geriatr Soc

    (2001)
  • J.W. Rowe et al.

    Successful aging

    Gerontologist

    (1997)
  • L. Clarkson-Smith et al.

    Relationships between physical exercise and cognitive abilities in older adults

    Psychol Aging

    (1989)
  • Department of Health and Human Services US. Exercise: A guide from the National Institute on Aging2001. Report No.: NIH...
  • A.F. Kramer et al.

    Ageing, fitness and neurocognitive function

    Nature

    (1999)
  • N.A. Singh et al.

    A randomized controlled trial of the effect of exercise on sleep

    Sleep

    (1997)
  • J.S. Stevenson et al.

    Effects of moderate and low intensity long-term exercise by older adults

    Res Nurs Health

    (1990)
  • S. Benloucif et al.

    Morning or evening activity improves neuropsychological performance and subjective sleep quality in older adults

    Sleep

    (2004)
  • E. Naylor et al.

    Daily social and physical activity increases slow-wave sleep and daytime neuropsychological performance in the elderly

    Sleep

    (2000)
  • Cited by (410)

    View all citing articles on Scopus
    View full text