Original ArticleEffects of moderate aerobic exercise training on 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.
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.
References (56)
- et al.
Recent developments in the classification, evaluation, and treatment of insomnia
Chest
(2006) Epidemiology of insomnia: what we know and what we still need to learn
Sleep Med Rev
(2002)Pharmacologic and nonpharmacologic treatments of insomnia
Neurol Clin
(2005)- et al.
Exercise and sleep
Sleep Med Rev
(2000) - et al.
Aerobic exercise improves self-reported sleep and quality of life in older adults with insomnia
Sleep Med
(2010) - et al.
Assessment of exercise intensity formulas by use of ventilatory threshold
Chest
(1988) - et al.
Sleep perception in insomniacs, sleep-disordered breathing patients, and healthy volunteers – an important biologic parameter of sleep
Sleep Med
(2009) - et al.
The long-term benefits of outpatient pulmonary rehabilitation on exercise endurance and quality of life
Chest
(1993) - et al.
A sedentary day: effects on subsequent sleep and body temperatures in trained athletes
Physiol Behav
(2003) - American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-IV). Washington: American...
Prevalence, burden, and treatment of insomnia in primary care
Am J Psychiatry
Sleep complaints in the adult Brazilian population: a national survey based on screening questions
J Clin Sleep Med
Treatment of primary insomnia
J Am Board Fam Pract
Nonpharmacologic treatment of chronic insomnia. An American Academy of Sleep Medicine review
Sleep
Nonpharmacologic treatment of chronic insomnia
Rev Bras Psiquiatr
Treatment of insomnia in patients with mood disorders
Depress Anxiety
Levantamento Epidemiológico da prática de atividade física na cidade de São Paulo
Rev Bras Med Esporte
Epidemiology of exercise and sleep
Sleep Biol Rhythms
Daytime activity and risk factors for late-life insomnia
J Sleep Res
Nondrug treatment trials in psychophysiologic insomnia
Arch Intern Med
The effects of acute exercise on sleep: a quantitative synthesis
Sleep
Effect of acute physical exercise on patients with chronic primary insomnia
J Clin Sleep Med
An inventory for measuring depression
Arch Gen Psychiatry
Validation of a portuguese version of the beck depression inventory and the state–trait anxiety inventory in Brazilian subjects
Braz J Med Biol Res
Cited by (111)
Exercise as an Adjunct Treatment to Cognitive Behavior Therapy for Insomnia
2023, Sleep Medicine ClinicsThe impact of physical activity on objective sleep of people with insomnia
2023, Psychiatry ResearchCitation Excerpt :A recent study by Youngstedt et al. (2021) also did not found that aerobic exercise intervention ending two hours before bedtime improved or impaired sleep of subjects experiencing insomnia. Most studies were based on samples which were mainly female (Chen et al., 2016; Gubelmann et al., 2018; Morita et al., 2017; Passos et al., 2010, 2011, 2014; Tseng et al., 2020 Yeung et al., 2018) or entirely female (Baron et al., 2013; Cheek et al., 2004; Gubelmann et al., 2018; Kline et al., 2013). The study by Youngstedt et al. (2021) included a balanced male/female participation (50%), Al-Jiffri and Abd El-Kader (2021) study involved more male participants and the study of D'Aurea et al. (2019) did not mention participants’ gender.
Nighttime vigorous exercise: Is lack of sleep disruption good enough?
2021, Sleep Medicine ReviewsTime use: The role of sleep
2020, Transportation Research Part A: Policy and Practice