Exercise as it relates to Disease/Physical Activity and Insomnia in Older Adults: Improved Sleep, Mood and Quality of Life after Aerobic Exercise

This Wiki Fact Sheet is an analysis and critique on the journal article "Aerobic exercise improves self-reported sleep and quality of life in older adults with insomnia" by Reid et al. (2011). Created by SID 3164690.

What is the background to this research?
Sleep disturbances and disorders have been shown to be associated with age. Sleep complaints are a growing concern for the elderly population. This study aimed to investigate whether an aerobic exercise intervention along with sleep education would improve the sleep quality in elderly individuals who were experiencing insomnia.

What is Insomnia?
Insomnia is characterised by the difficulty in falling asleep, broken sleep and waking up early. Such a debilitating illness can have adverse impacts on quality of life. Research has shown insomnia to have significant effects on physical and mental health, productivity in the workplace and attention and memory skills. Furthermore, individuals who suffer from insomnia are highly likely to also experience additional health issues, particularly mental illness such as depression and anxiety.

Treatment
Insomnia is commonly treated with behaviour modification, psychological treatment and medication. Although pharmaceutical interventions are the most popular treatment prescribed for insomnia, these medications are highly associated with negative side effects which can be threatening to health and well-being. Growing evidence suggests that exercise may be an inexpensive and beneficial alternative to treating symptoms of insomnia.

Where is the research from?
This study was carried out by researchers from Northwestern University Feinberg, School of Medicine Chicago and was approved by the NorthWestern University Institutional Review Board.

What kind of research was this?
The current study used a randomised controlled trial, conducted over sixteen weeks to investigate whether sleep education and aerobic physical activity had an effect on sleep, mood and quality of life for older adults with insomnia. Studies that use randomised trials aim to randomly distribute participants in either treatment or non-treatment conditions to address any issues of bias. The pre and post design of the study was used to compare the different groups and measure the degree of change that occurred from the exercise intervention. These measurements were taken from a range of questionnaires and psychological testing. There were two conditions in which participants were randomly placed:


 * 1) Sleep Hygiene Education and Non-Physical Activity (Non-PA)
 * 2) Sleep Hygiene Education and Aerobic Physical Activity (PA)

What did the research involve?
The study involved 17 sedentary men and women aged 55 years or older who had been experiencing insomnia symptoms for at least 3 months. Eligible participants had problems falling asleep, maintaining sleep and waking up early, total sleep duration of less than 6.5 hours per night and had impairments in daytime functioning. Participants were also required to undergo stringent screening for any other sleep disorders or underlying psychiatric illness, not be on any sedative medication, be a non smoker and sedentary for the validity of the study. Baseline measures on sleep quality and mood were taken prior to the study.


 * Sleep Hygiene - All participants received sleep hygiene education, which involved meeting with a sleep specialist who provided counselling and written instructions prior to bedtime. They were also given a check list and were encouraged to follow the pre-bedtime procedures.
 * Aerobic Physical Activity - Participants in this group had undergone a conditioning period for the first 4–6 weeks of the study. For the duration of the study, they exercised for either two 20 minute sessions or one 30-40 minute session at 75% of their maximum heart rate for 4 times a week. These activities included walking, a cycle ergometer or treadmill.
 * Non-Physical Activity - Participants in this group were given a selection of recreational/ education activities, consisting of YMCA (knitting groups, bookclubs), museum lectures or church activities. They met 3-5 times a week for 45 minutes, for the total duration of the study.

After the 16 week intervention, all participants were admitted to the Clinical Research Unit for post-testing.

What were the basic results?
The participants in the aerobic physical exercise group showed improvements in:


 * Sleep quality - The Pittsburgh Sleep Quality Index is a questionnaire which measures and assesses an individual's quality of sleep. Participants in the PA group showed improvements in sleep-onset latency and had a longer sleep duration time, indicating a significant improvement in sleep quality.
 * Daytime Sleepiness - The Epworth Sleepiness Scale used in the study is an assessment of the likelihood of falling asleep during different situations. Participants in the PA group showed a significant reduction in daytime sleepiness scores, while there were no improvements in daytime sleepiness for those in the non-PA group.
 * Depressive Symptoms - The CES-D is a screening test which measures depressive symptoms. When comparing the results from baseline and post measures, participants in the PA group showed a reduction in depressive symptoms, while the participants in the non-PA group showed no change.
 * Quality of Life - The SF-36 measures a range of general health factors from daily activities, physical health and mood. The PA group showed an improvement in several domains of quality of life.

Criticisms and Concerns
While the results of the study are strong, there are several limitations throughout. The studys biggest flaw is the reliance on self-reported measures from medical questionnaires. Self-reported data is often associated with inaccurate and invalid measures of responders. Secondly, of the 23 initial participants, 5 withdrew leaving only 17 participants for the study. Due to this small sample size, issues of making inferences from this sample can arise as it may not be representative of the wider population. Lastly, the study only compared the effect of one mode of exercise on insomnia - aerobic physical activity. Future research could focus on a bigger sample size and compare the possible effects of different exercise modalities such as resistance and circuit training on insomnia.

Conclusions and Implications
According to the authors, it is clear that physical activity may have an effect on improving the sleep quality, mood and quality of life for elderly people who suffer from insomnia. Physical activity and exercise has a positive effect on sleep quality - it can help you fall asleep faster and increase overall sleep duration. Numerous studies have illustrated the importance of physical activity in treating mental health conditions. This is particularly important for people with insomnia, as mental illness can either arise from insomnia or contribute to its's onset. This study yielded similar positive results of exercise and its role in improving depressive symptoms and mood. An exercise prescription program unique for each individual could be considered by health professionals who work with people who suffer from chronic insomnia. Future research could investigate the different/combined modes of exercise and its role in decreasing the symptoms of insomnia.

Further information/resources

 * Sleep Help -'Shuti': http://www.blackdoginstitute.org.au/public/gettinghelp/shuti.cfm
 * Sleep Hygiene - 'Snore Australia': http://www.snoreaustralia.com.au/resources/item17/snore%20australia%20-%20sleep%20habits.pdf
 * How sleepy are you? - 'Epworth Sleepiness Scale: https://web.stanford.edu/~dement/epworth.html