Elsevier

Sleep Medicine

Volume 12, Issue 10, December 2011, Pages 1018-1027
Sleep Medicine

Original Article
Effects of moderate aerobic exercise training on chronic primary insomnia

https://doi.org/10.1016/j.sleep.2011.02.007Get rights and content

Abstract

Objective

To evaluate the effect of long-term moderate aerobic exercise on sleep, quality of life, and mood of individuals with chronic primary insomnia, and to examine whether these effects differed between exercise in the morning and exercise in the late afternoon.

Methods

Nineteen sedentary individuals with chronic primary insomnia, mean age 45.0 (standard error [SE] 1.9) years, completed a 6-month exercise training protocol, randomized to morning and late-afternoon exercise groups.

Results

Combining polysomnographic data across both time points, this study found a significant decrease in sleep onset latency (from 17.1 [SE 2.6] min to 8.7 [SE 1.4] min; P < 0.01) and wake time after sleep onset (from 63.2 [SE 12.8] min to 40.1 [SE 6.0] min), and a significant increase in sleep efficiency (from 79.8 [SE 3.0]% to 87.2 [SE 1.6]%) following exercise. Data from sleep diaries revealed significant improvement in sleep onset latency (from 76.2 [SE 21.5] min to 80.3 [SE 7.4] min) sleep quality (from 41.5 [SE 5.2]% to 59.4 [SE 6.6]%) and feeling rested in the morning (from 50.8 [SE 5.3] to 65.1 [SE 5.0]). There were generally no significant differences in response between morning and late-afternoon exercise. Following exercise, some quality-of-life measures improved significantly, and a significant decrease was seen in the following Profile of Mood State measures: tension–anxiety (from 7.2 [SE 1.0] to 3.5 [SE 1.0]), depression (from 5.9 [SE 1.2] to 3.3 [SE 1.1]) and total mood disturbance (from 9.2 [SE 4.8] to −1.7 [SE 4.8]). These effects did not vary between morning and late-afternoon exercise.

Conclusion

Long-term moderate aerobic exercise elicited significant improvements in sleep, quality of life and mood in individuals with chronic primary insomnia.

Introduction

Chronic primary insomnia is a sleep disorder characterized by long-term difficulties with initiating and maintaining sleep, waking up too early, non-restorative sleep, and daytime impairment, including fatigue, poor mood, impaired concentration, and poor quality of life [1], [2], [3], [4]. The prevalence of chronic insomnia worldwide is between 10% and 15% [5]. In Brazil, a recent study in the city of São Paulo demonstrated that approximately 35% of the population complained of insomnia, with the problem being more prevalent among women (40%) [6].

Drug therapy is the most commonly prescribed treatment for insomnia. However, sleep medications may cause side effects and are not recommended for long-term use [7]. Thus, various non-pharmacological therapies have been proposed in the literature, especially cognitive and behavioural therapies [8], [9], [10], [11].

However, cognitive or behavioural therapies may be very expensive as frequent treatment is required. As such, physical exercise as a non-pharmacological, low cost, and easily accessed treatment alternative has been suggested [10], [12], [13]. The well-established anxiolytic and antidepressant effects of exercise could help to alleviate psychological comorbidities, which may also be involved in the aetiology and perpetuation of insomnia [14].

Epidemiological studies have reported an association between exercise and decreased complaints of insomnia [15], [16], as well as a relationship between low levels of physical activity and a greater prevalence of insomnia [17]. However, there has been very limited experimental investigation of the effects of aerobic exercise training on sleep in individuals with insomnia [18], [19]. The studies have been limited primarily to subjective sleep assessments; however, positive effects of exercise on both subjective and actigraphic measures of sleep have been found.

The optimal time of day for performing exercise to promote sleep is not clear. Earlier reviews, mainly from literature involving acute exercise and normal sleepers, suggested a slight advantage for exercise in the late-afternoon [12], [13], [20], and a recent study by the present authors found a significant improvement in sleep among insomniacs following acute afternoon exercise [21]. However, it is plausible that morning exercise may be at least as beneficial for promoting chronic sleep improvement for insomniacs (e.g., by promoting phase advances and stabilization of the circadian system).

The aim of this study was to expand on previous findings by evaluating the influence of long-term aerobic exercise on polysomnographic and subjective sleep measures, and on measures of quality of life and mood in individuals diagnosed with chronic primary insomnia. Additionally, the authors assessed whether these effects differed between exercise in the morning and exercise in the late afternoon, and whether sleep changes were associated with mood changes.

Section snippets

Recruitment and sample selection

Ethical approval for all experimental procedures was granted by the University Human Research Ethics Committee and conformed to the principles outlined in the Declaration of Helsinki. The participants were recruited through advertisements in newspapers, magazines, and radio shows. The inclusion criteria were: (1) 30–55 years of age; (2) clinical diagnosis of primary insomnia according to the Diagnostic and Statistical Manual of Mental Disorders [1]; (3) complaints of insomnia for more than 6 

Recruitment, drop-outs, and adherence to the exercise protocol

Two hundred and sixty-seven people were interested in taking part in the study, and contacted the researchers by telephone or e-mail. Of these, 229 did not meet the initial inclusion criteria and were excluded (Fig. 1). Thirty-eight participants (29 women, 9 men) passed the initial screening and were randomized to the morning exercise group (n = 19) or the late-afternoon exercise group (n = 19). However, 3 men and 5 women withdrew from the study during the baseline period before commencing exercise

Discussion

This study showed significant improvements in objective and subjective sleep, as well as quality of life and mood measures, following exercise training in individuals with chronic primary insomnia. The results are consistent with other research showing the benefits of exercise training for individuals with disturbed sleep.

Much of the research on the effects of exercise training on sleep has focused on older adults, often under the assumption that exercise may have the greatest potential to

Conflicts of Interest

The ICMJE Uniform Disclosure Form for Potential Conflicts of Interest associated with this article can be viewed by clicking on the following link: doi:10.1016/j.sleep.2011.02.007.

. ICMJE Form for Disclosure of Potential Conflicts of Interest form.

Acknowledgements

The authors would like to thank all participants who volunteered their time to take part in the study. Giselle Soares Passos had a fellowship from the FAPESP (2008/02862-1). The authors would like to thank the institutions that made this manuscript possible: AFIP, FAPESP, CEPID/FAPESP, CEPE and FADA/UNIFESP.

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