Moderate Exercise Plus Sleep Education Improves Self-Reported Sleep Quality, Daytime Mood, and Vitality in Adults with Chronic Sleep Complaints: A Waiting List-Controlled Trial
Research indicates that physical exercise can contribute to better sleep quality. This study investigates the six-week influence of a combined intervention on self-rated sleep quality, daytime mood, and quality of life. A nonclinical sample of 114 adults with chronic initiating and the maintaining of sleep complaints participated in the study. The intervention group of 70 adults underwent moderate physical exercise, conducted weekly, plus sleep education sessions. Improvements among participants assigned to the intervention group relative to the waiting-list control group ( ) were noted for subjective sleep quality, daytime mood, depressive symptoms and vitality. Derived from PSQI subscores, the intervention group reported increased sleep duration, shortened sleep latency, fewer awakenings after sleep onset, and overall better sleep efficiency compared to controls. The attained scores were well sustained and enhanced over a time that lasted through to the follow-up 18 weeks later. These findings have implications in treatment programs concerning healthy lifestyle approaches for adults with chronic sleep complaints. 1. Introduction Nocturnal sleeplessness in terms of prolonged initiation of sleep times, frequent nightly awakenings, early morning awakenings, or sleep that are chronically nonrestorative and the consequences on daytime functioning is referred to as insomnia (ICSD-2, 2005). In a review of 21 representative studies by Ohayon [1], the prevalence of insomnia symptoms ranges from 10% to 48% in the general population across the world, and 9% to 15% report additional daytime consequences (e.g., depressive mood and irritability). Insomnia, therefore, can be seen as being a notable public health problem. Disorders of the sleep-wake cycle not only have an acutely negative impact on daytime functioning but also, in the long run, heighten the risk of overall health-related quality-of-life impairment [2–4]. Chronic sleep problems are associated with serious health problems like psychological disorders, particularly depression [5, 6] and anxiety disorders [7] as well as medical consequences, for example, hypertension [8], diabetes [9], or obesity [10]. Insomnia has been treated either pharmacologically or with cognitive behavioural therapy. As a fact endorsed by the National Institute of Health [11], pharmacotherapy is effective for the acute management of chronic insomnia [12] although side effects must be taken into consideration, for example, dependence, tolerance, and daytime sedation [13]. Several meta-analyses of cognitive behavioural therapy have
References
[1]
M. M. Ohayon, “Epidemiology of insomnia: what we know and what we still need to learn,” Sleep Medicine Reviews, vol. 6, no. 2, pp. 97–111, 2002.
[2]
D. A. Katz and C. A. McHorney, “The relationship between insomnia and health-related quality of life in patients with chronic illness,” Journal of Family Practice, vol. 51, no. 3, pp. 229–235, 2002.
[3]
D. Léger, K. Scheuermaier, P. Philip, M. Paillard, and C. Guilleminault, “SF-36: evaluation of quality of life in severe and mild insomniacs compared with good sleepers,” Psychosomatic Medicine, vol. 63, no. 1, pp. 49–55, 2001.
[4]
G. K. Zammit, J. Weiner, N. Damato, G. P. Sillup, and C. A. McMillan, “Quality of life in people with insomnia,” Sleep, vol. 22, supplement 2, pp. S379–S385, 1999.
[5]
D. J. Buysse, J. Angst, A. Gamma, V. Ajdacic, D. Eich, and W. R？ssler, “Prevalence, course, and comorbidity of insomnia and depression in young adults,” Sleep, vol. 31, no. 4, pp. 473–480, 2008.
[6]
L. Staner, “Comorbidity of insomnia and depression,” Sleep Medicine Reviews, vol. 14, no. 1, pp. 35–46, 2010.
[7]
J. D. Buckner, R. A. Bernert, K. R. Cromer, T. E. Joiner, and N. B. Schmidt, “Social anxiety and insomnia: the mediating role of depressive symptoms,” Depression and Anxiety, vol. 25, no. 2, pp. 124–130, 2008.
[8]
K. L. Knutson, E. Van Cauter, P. J. Rathouz et al., “Association between sleep and blood pressure in midlife: the CARDIA sleep study,” Archives of Internal Medicine, vol. 169, no. 11, pp. 1055–1061, 2009.
[9]
A. Fiorentini, R. Valente, A. Perciaccante, and L. Tubani, “Sleep's quality disorders in patients with hypertension and type 2 diabetes mellitus,” International Journal of Cardiology, vol. 114, no. 2, pp. E50–E52, 2007.
[10]
F. P. Cappuccio, F. M. Taggart, N. B. Kandala et al., “Meta-analysis of short sleep duration and obesity in children and adults,” Sleep, vol. 31, no. 5, pp. 619–626, 2008.
[11]
NIH, “National Institutes of health state of the science conference statement. Manifestations and management of chronic insomnia in adults,” Sleep, vol. 28, no. 9, pp. 1049–1057, 2005.
[12]
P. D. Nowell, S. Mazumdar, D. J. Buysse, M. A. Dew, C. F. Reynolds, and D. J. Kupfer, “Benzodiazepines and zolpidem for chronic insomnia: a meta-analysis of treatment efficacy,” JAMA, vol. 278, no. 24, pp. 2170–2177, 1997.
[13]
D. F. Kripke, “Chronic hypnotic use: deadly risks, doubtful benefit,” Sleep Medicine Reviews, vol. 4, no. 1, pp. 5–20, 2000.
[14]
C. M. Morin, J. P. Culbert, and S. M. Schwartz, “Nonpharmacological interventions for insomnia: a meta-analysis of treatment efficacy,” American Journal of Psychiatry, vol. 151, no. 8, pp. 1172–1180, 1994.
[15]
D. R. R. Murtagh and K. M. Greenwood, “Identifying effective psychological treatments for insomnia: a meta- analysis,” Journal of Consulting and Clinical Psychology, vol. 63, no. 1, pp. 79–89, 1995.
[16]
S. Pallesen, I. H. Nordhus, and G. Kvale, “Nonpharmacological interventions for insomnia in older adults: a meta- analysis of treatment efficacy,” Psychotherapy, vol. 35, no. 4, pp. 472–482, 1998.
[17]
G. D. Jacobs, E. F. Pace-Schott, R. Stickgold, and M. W. Otto, “Cognitive behavior therapy and pharmacotherapy for insomnia: a randomized controlled trial and direct comparison,” Archives of Internal Medicine, vol. 164, no. 17, pp. 1888–1896, 2004.
[18]
C. M. Morin, A. Vallières, B. Guay et al., “Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia: a randomized controlled trial,” JAMA, vol. 301, no. 19, pp. 2005–2015, 2009.
[19]
B. Sivertsen, S. Omvik, S. Pallesen et al., “Cognitive behavioral therapy vs zopiclone for treatment of chronic primary insomnia in older adults: a randomized controlled trial,” JAMA, vol. 295, no. 24, pp. 2851–2858, 2006.
[20]
R. M. Benca, “Diagnosis and treatment of chronic insomnia: a review,” Psychiatric Services, vol. 56, no. 3, pp. 332–343, 2005.
[21]
L. Baillargeon, M. Demers, R. Ladouceur, and M. Pépin, “Study on insomnia treatment by family physicians,” Canadian Family Physician, vol. 42, pp. 426–432, 1998.
[22]
M. K. Means, M. D. Lineberger, and J. D. Edinger, “Nonpharmacologic treatment of insomnia,” Current Treatment Options in Neurology, vol. 10, no. 5, pp. 342–349, 2008.
[23]
W. C. Dement and C. Vaughan, Der Schlaf und Unsere Gesundheit: über Schlafst？rungen, Schlaflosigkeit und die Heilkraft des Schlafs, Limes, München, Germany, 2000.
[24]
J. Zulley, Mein Buch vom Guten Schlaf, Mohn Media, Gütersloh, Germany, 2005.
[25]
H. Urponen, I. Vuori, J. Hasan, and M. Partinen, “Self-evaluations of factors promoting and disturbing sleep: an epidemiological survey in Finland,” Social Science and Medicine, vol. 26, no. 4, pp. 443–450, 1988.
[26]
S. Brand, M. Gerber, J. Beck, M. Hatzinger, U. Pühse, and E. Holsboer-Trachsler, “High exercise levels are related to favorable sleep patterns and psychological functioning in adolescents: a comparison of athletes and controls,” Journal of Adolescent Health, vol. 46, no. 2, pp. 133–141, 2010.
[27]
S. Brand, M. Gerber, J. Beck, M. Hatzinger, U. Phse, and E. Holsboer-Trachsler, “Exercising, sleep-EEG patterns, and psychological functioning are related among adolescents,” World Journal of Biological Psychiatry, vol. 11, no. 2, pp. 129–140, 2010.
[28]
C. R. Drew, “Self-reported sleep disturbance among African-American elderly: The effects of depression, health status, exercise, and social support,” International Journal of Aging and Human Development, vol. 42, no. 2, pp. 143–160, 1996.
[29]
K. Kim, M. Uchiyama, M. Okawa, X. Liu, and R. Ogihara, “An epidemiological study of insomnia among the Japanese general population,” Sleep, vol. 23, no. 1, pp. 41–47, 2000.
[30]
K. Morgan, “Daytime activity and risk factors for late-life insomnia,” Journal of Sleep Research, vol. 12, no. 3, pp. 231–238, 2003.
[31]
A. C. King, R. F. Oman, G. S. Brassington, D. L. Bliwise, and W. L. Haskell, “Moderate-intensity exercise and self-rated quality of sleep in older adults: a randomized controlled trial,” JAMA, vol. 277, no. 1, pp. 32–37, 1997.
[32]
K. J. Reid, K. G. Baron, B. Lu, E. Naylor, L. Wolfe, and P. C. Zee, “Aerobic exercise improves self-reported sleep and quality of life in older adults with insomnia,” Sleep Medicine, vol. 11, no. 9, pp. 934–940, 2010.
[33]
C. Guilleminault, A. Clerk, J. Black, M. Labanowski, R. Pelayo, and D. Claman, “Nondrug treatment trials in psychophysiologic insomnia,” Archives of Internal Medicine, vol. 155, no. 8, pp. 838–844, 1995.
[34]
A. C. King, L. A. Pruitt, S. Woo et al., “Effects of moderate-intensity exercise on polysomnographic and subjective sleep quality in older adults with mild to moderate sleep complaints,” Journals of Gerontology, vol. 63, no. 9, pp. 997–1004, 2008.
[35]
D. Riemann and J. Backhaus, Behandlung von Schlafst？rungen. Ein psychologisches Gruppenprogramm, Psychologie, Weinheim, Germany, 1996.
[36]
W. L. Haskell, I. M. Lee, R. R. Pate et al., “Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association,” Circulation, vol. 116, no. 9, pp. 1081–1093, 2007.
[37]
G. Borg, Perceived Exertion and Pain Scales, Human Kinetics, Champaign, Ill, USA, 1998.
[38]
D. J. Buysse, C. F. Reynolds III, T. H. Monk, S. R. Berman, and D. J. Kupfer, “The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research,” Psychiatry Research, vol. 28, no. 2, pp. 193–213, 1989.
[39]
R. G？rtelmeyer, Schlaffragebogen A und B CIPS: Internationale Skalen für Psychiatrie, vol. 5, Beltz PVU, Weinheim, Germany, 2005.
[40]
G. Franke, Die Symptom-Checkliste von Derogatis—Deutsche Version—(SCL-90-R). Manual, Beltz Test GmbH, G？ttingen, Germany, 1995.
[41]
L. R. Derogatis, SCL-90-R, Administration, Scoring, and Procedures Manual for the Revised Version, Johns Hopkins University, School of Medicine, Baltimore, Md, USA, 1977.
[42]
M. Bullinger and I. Kirchberger, SF-36. Fragebogen zum Gesundheitszustand. Handanweisung, Hogrefe, G？ttingen, Germany, 1998.
[43]
J. Cohen, Statistical Power Analysis for the Behavioural Sciences, Lawrence Erlbaum Associates, Hillsdale, NJ, USA, 2nd edition, 1988.
[44]
J. Cohen, “The earth is round (P < .05),” American Psychologist, vol. 49, no. 12, pp. 997–1003, 1994.
[45]
B. Rybarczyk, M. Lopez, K. Schelble, and E. Stepanski, “Home-based video CBT for comorbid geriatric insomnia: a pilot study using secondary data analyses,” Behavioral Sleep Medicine, vol. 3, no. 3, pp. 158–175, 2005.
[46]
M. Sato, W. Yamadera, M. Matsushima, H. Itoh, and K. Nakayama, “Clinical efficacy of individual cognitive behavior therapy for psychophysiological insomnia in 20 outpatients,” Psychiatry and Clinical Neurosciences, vol. 64, no. 2, pp. 187–195, 2010.
[47]
K. L. Lichstein, “A general index of self-reported sleep: the sleep quotient,” Behaviour Research and Therapy, vol. 35, no. 12, pp. 1133–1137, 1997.
[48]
M. R. Irwin, J. C. Cole, and P. M. Nicassio, “Comparative meta-analysis of behavioral interventions for insomnia and their efficacy in middle-aged adults and in older adults 55+ years of age,” Health Psychology, vol. 25, no. 1, pp. 3–14, 2006.
[49]
C. M. Morin, C. Bastien, B. Guay, M. Radouco-Thomas, J. Leblanc, and A. Vallières, “Randomized clinical trial of supervised tapering and cognitive behavior therapy to facilitate benzodiazepine discontinuation in older adults with chronic insomnia,” American Journal of Psychiatry, vol. 161, no. 2, pp. 332–342, 2004.
[50]
M. Gerber, S. Brand, E. Holsboer-Trachsler, and U. Pühse, “Fitness and exercise as correlates of sleep complaints: is it all in our minds?” Medicine and Science in Sports and Exercise, vol. 42, no. 5, pp. 893–901, 2010.
[51]
B. Rybarczyk, M. Lopez, R. Benson, C. Alsten, and E. Stepanski, “Efficacy of two behavioral treatment programs for comorbid geriatric insomnia,” Psychology and Aging, vol. 17, no. 2, pp. 288–298, 2002.
[52]
A. G. Harvey, “A cognitive theory and therapy for chronic insomnia,” Journal of Cognitive Psychotherapy, vol. 19, no. 1, pp. 41–59, 2005.
[53]
J. Mota-Pereira, J. Silverio, S. Carvalho, J. C. Ribeiro, D. Fonte, and J. Ramos, “Moderate exercise improves depression parameters in treatment-resistant patients with major depressive disorder,” Journal of Psychiatric Research, vol. 45, no. 8, pp. 1005–1011, 2011.
[54]
A. Deslandes, H. Moraes, C. Ferreira et al., “Exercise and mental health: many reasons to move,” Neuropsychobiology, vol. 59, no. 4, pp. 191–198, 2009.
[55]
E. Puterman, J. Lin, E. Blackburn, A. O'Donovan, N. Adler, and E. Epel, “The power of exercise: buffering the effect of chronic stress on telomere length,” PLoS One, vol. 5, no. 5, Article ID e10837, 2010.
[56]
H. S. Driver and S. R. Taylor, “Exercise and sleep,” Sleep Medicine Reviews, vol. 4, no. 4, pp. 387–402, 2000.
[57]
C. M. Morin, R. R. Bootzin, D. J. Buysse, J. D. Edinger, C. A. Espie, and K. L. Lichstein, “Psychological and behavioral treatment of insomnia: update of the recent evidence (1998–2004),” Sleep, vol. 29, no. 11, pp. 1398–1414, 2006.
[58]
G. B. M. Mensink, N. Loose, and C. M. Oomen, “Physical activity and its association with other lifestyle factors,” European Journal of Epidemiology, vol. 13, no. 7, pp. 771–778, 1997.
[59]
S. D. Youngstedt, “Effects of exercise on sleep,” Clinics in Sports Medicine, vol. 24, no. 2, pp. 355–365, 2005.
[60]
C. M. Shapiro, “Sleep and the athlete,” British Journal of Sports Medicine, vol. 15, no. 1, pp. 51–55, 1981.
[61]
M. Dattilo, H. K. M. Antunes, A. Medeiros et al., “Sleep and muscle recovery: endocrinological and molecular basis for a new and promising hypothesis,” Medical Hypotheses, vol. 77, no. 2, pp. 220–222, 2011.
[62]
J. Bucksch and W. Schlicht, “Health-enhancing physical activity and the prevention of chronic diseases—an epidemiological review,” Sozial- und Praventivmedizin, vol. 51, no. 5, pp. 281–301, 2006.
[63]
S. M. Arent, T. J. Rogers, and D. M. Landers, “Mental Health and Physical Activity. The effects of physical activity on selected mental health variables: determining causation,” Sportwissenschaft, vol. 31, pp. 239–254, 2001.
[64]
S. Hong and J. E. Dimsdale, “Physical activity and perception of energy and fatigue in obstructive sleep apnea,” Medicine and Science in Sports and Exercise, vol. 35, no. 7, pp. 1088–1092, 2003.
[65]
W. A. Arrindell, “Changes in waiting-list patients over time: data on some commonly-used measures. Beware!,” Behaviour Research and Therapy, vol. 39, no. 10, pp. 1227–1247, 2001.
[66]
J. Glass, K. L. Lanct？t, N. Herrmann, B. A. Sproule, and U. E. Busto, “Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits,” British Medical Journal, vol. 331, no. 7526, pp. 1169–1173, 2005.
[67]
W. Chodzko-Zajko, A. Schwingel, and C. H. Park, “Successful aging: the role of physical activity,” American Journal of Lifestyle Medicine, vol. 3, no. 1, pp. 20–28, 2009.
[68]
W. R. Pigeon, “Diagnosis, prevalence, pathways, consequences & treatment of insomnia,” Indian Journal of Medical Research, vol. 131, no. 2, pp. 321–332, 2010.
[69]
A. G. Harvey, “Insomnia: symptom or diagnosis?” Clinical Psychology Review, vol. 21, no. 7, pp. 1037–1059, 2001.
[70]
T. Ohida, A. Kamal, M. Uchiyama et al., “The influence of lifestyle and health status factors on sleep loss among the japanese general population,” Sleep, vol. 24, no. 3, pp. 333–338, 2001.
[71]
D. L. Sherrill, K. Kotchou, and S. F. Quan, “Association of physical activity and human sleep disorders,” Archives of Internal Medicine, vol. 158, no. 17, pp. 1894–1898, 1998.
[72]
R. M. Merrill, S. G. Aldana, R. L. Greenlaw, H. A. Diehl, and A. Salberg, “The effects of an intensive lifestyle modification program on sleep and stress disorders,” Journal of Nutrition, Health and Aging, vol. 11, no. 3, pp. 242–248, 2007.
