Original ArticleAerobic exercise improves self-reported sleep and quality of life in older adults with 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.
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