Exercise as it relates to Disease/Aerobic Exercise and its effect on Insomnia

Insomnia is a common sleeping disorder that displays symptoms of;
 * 1) Increased sleep onset latency[7][9][13].
 * 2) Frequent awakenings during sleep with difficulty getting back to sleep[7][8][9][13].
 * 3) Non-restorative sleep[7][8].

Insomnia is often diagnosed as either acute or chronic[12]. Acute insomnia involves difficulties with sleep lasting less than a month while chronic insomnia is associated with problems persisting longer than a month[12]. Insomnia can also be catergorised as primary or secondary[12]. Primary is the term given to subjects who cannot sleep for no apparent reason while secondary members cannot sleep due to an underlying condition[12].

Issue
Insomnia is more common in women and the elderly[8][12]. With chronic insomnia affecting approximately 15% of adults[8][12], while some studies have reported that insomnia incidence rises to 50% in the elderly population[10]. Given the widespread occurrence of insomnia, it is now the most prevalent sleep disorder[8]. Severe sleep deprivation also induces stress on carers and is a common cause for instigating institutional care[6]. If chronic insomnia is not treated effectively it can lead to a magnitude of other conditions including;


 * High blood pressure[2][9]
 * Type ‖ Diabetes[2][6][9]
 * Heart Disease[2][6][9]
 * Depression[2][6][9][12],
 * Cancer[2][9]
 * Mortality[2][6][8][9][12]

Aerobic exercise and insomnia
The most common treatment for insomnia is pharmacological which may lead to a drug related tolerance or dependency[6][8]. However, benefits can be achieved through regular moderate aerobic exercise[1][2][3][4][5][7][8][9][10][11][12][13]. A regular aerobic exercise regime displays better sleep quality in the form of greater sleep duration, less sleep onset latency and a more restorative sleep[1][4][5][8][10][11]. Aerobic exercise also promotes relaxation[6] and reduces anxiety and stress levels[1][8], depressive symptoms and daytime sleepiness[10]. Participants who undertook aerobic exercise as a treatment also reported improvements in mood, vitality, slow wave sleep or greater restorative sleep and quality of life[10].

Recommendations
The following table is a general aerobic exercise regime that is applicable to the wider population.

Moderate Intensity: 75% of maximum heart rate[10].

Vigorous Intensity: 85% of maximum heart rate[3]

To obtain the maximum benefit from aerobic exercise subjects should also adhere to the subsequent guidelines;


 * Exercise 4–8 hours before going to sleep[8][13].
 * Undertake sleep hygiene education which provides instructions or help to maximize beneficial sleeping habits[10].
 * Maintaining a sleep log[1][8][10].
 * Avoiding drinking alcohol before going to bed[9].

Finally exercise need not be intense to attain significant results[8][9][13]. While the greatest benefits were seen in participants who exercised for over an hour, moderate exercise reduced total time awake compared to intense exercise[9]. In fact research shows that prolonged intense exercise actually increased insomnia symptoms[8][9]

Reference List

 * 1) Brassington, S., & Hicks, A. (1995). Aerobic exercise and self-reported sleep quality in elderly individuals. Journal Of Aging & Physical Activity, 3(2), 120-134.
 * 2) Dowdle, H. (2013). Sweet Surrender. Yoga Journal, (259), 88-110.
 * 3) Inoue, S., Yorifuji, T., Sugiyama, M., Ohta, T., Ishikawa-Takata, K., & Doi, H. (2013). Does Habitual Physical Activity Prevent Insomnia? A Cross-Sectional and Longitudinal Study of Elderly Japanese. Journal Of Aging & Physical Activity, 21(2), 119-139.
 * 4) King, C., Oman, F., Brassington, S., Bliwise, L., & Haskell, L. (1997). Moderate-intensity exercise and self-rated quality of sleep in older adults. A randomized controlled trial. Journal Of The American Medical Association, 277(1), 32-37.
 * 5) King, A., Pruitt, L., Woo, S., Castro, C., Ahn, D., Vitiello, M., Woodward, S., & Bliwise, D. (2007). Effects of moderate intensity on polysomnographic and subjective sleep quality in older adults with mild to moderate sleep complaints. The Journals of Gerontology, 63 (9), 997-1004.
 * 6) Montgomery, P., & Dennis, A. (2002) Physical exercise for sleep problems in adults aged 60+. Cochrane Database of Systematic Reviews, 1(4), 1-12
 * 7) Nieman, D. C. (1998). Chapter 16: SLEEP. Exercise-Health Connection, 217-226.
 * 8) Passos, GS., Poyares, D., Santana, MG., Garbuio, SA., Tufik, S, & Mello MT. (2010). Effect of acute physical exercise on patients with chronic primary insomnia. Journal Clinical Sleep Medicine, 6(3), 270-275.
 * 9) Physical Activity: Nature's Sleep Aid. (2009). Running & FitNews, 27(5), 3-4.
 * 10) Reid, K., Baron, K., Lu, B., Naylor, E., Wolfe, L., & Zee, P. (2010). Aerobic exercise improves self-reported sleep and quality of life in older adults with insomnia. Journal of Sleep Medicine, 11(9), 934-940.
 * 11) Roveda, E., Sciolla, C., Montaruli, A., Calogiuri, G., Angeli, A., & Carandente, F. (2011). Effects of endurance and strength acute exercise on night sleep quality. International Sportmed Journal, 12(3), 113-124.
 * 12) Silber, H. (2005). Chronic Insomnia. The New England Journal of Medicine, 2(353) 803-810
 * 13) Taylor, R. (2001). The Influence of Exercise on Sleep Quality. International Sportmed Journal, 2(3), 1-10.
 * 14) Wong, N., Halaki, M., & Chow, C. (2013). The effects of moderate to vigorous aerobic exercise on the sleep need of sedentary young adults. Journal Of Sports Sciences, 31(4), 381-386.