Programmed Exercise Improved Sleep in the Elderly
ABSTRACT & COMMENTARY
Source: King AC, et al. Moderate-intensity exercise and self-rated quality of sleep in older adults. JAMA 1997;277:32-37.
Geriatric insomnia, especially among patients with mild-to-moderate symptoms of degenerative cerebral disorders, often provides a bugbear complaint to neurologists. Day-time dozing, lack of either a focused job or a passionately pursued sport or hobby, and a rapidly developed tolerance to mild sedatives all contribute to the problem. Unquestionably, a degenerating hypothalamic sleep-wake regulator adds to the problem. Many neurologists recognize these problems, and many suggest increased exercise for their patients. But, it must be confessed that, when we do recommend increased exercise we seldom spell it out, know its scientific reputation, or even prescribe a specific pattern. If borne out by others’ observation, King et al’s recommendations appear useful.
Among 67 eligible subjects aged 50-76 years, King et al chose 43 for a moderate intensity exercise program. Excluded were persons in whom a musculoskeletal, neurologic, medical, psychiatric, or severe hyposomniac condition prevented a successful protocol. Twenty of the eligible persons received a standard 16-week physical activity program, and 23, who served as controls, were put on a 16-week wait list and continued in their pre-existing activities. All 43 had previously been sedentary and were included because of moderate sleep complaints, not taking any sedatives, were non-smokers, had alcohol drinks of less than four per day, weighed less than 40 kg/m2, did not recently start estrogens, and were willing to be randomized. The protocol included for all candidates a two-week prerandomized medical, social, and sleep review. The ensuing exercise program for the experimental group was gradually increased to reach monitored heart rate reserves up to 60-75% of peak rate. Each week, two exercise sessions were conducted in a class formation, and two sessions occurred at home. Each session consisted of a 60-minute program, including a 30-minute endurance achievement protocol. Activities for the last two weeks of the six-week course were conducted at home.
Four persons withdrew from the exercise group, three for new medical complaints and one because of family obligations. Otherwise, adherence to protocol was more than 93%. Results included 11 of 13 improved heart exercises, one of 20 improved treadmill functional capacity, and significant improvements in sleep scores. Sleep onset latency was reduced by 14 minutes in exercisers and by two minutes in controls (P = 0.007). Similarly, favorable results marked sleep duration: exercisers increased their sleep by approximately 50 minutes (P = 0.05). Sleep diaries indicated that exercisers felt improved in sleep quality and awakening restedness compared to controls (P = 0.03). Overall, the exercisers expressed a significant (P = 0.001) improvement in all-around quality of sleep compared to controls.
COMMENTARY
In their discussion, the authors emphasize that these studies were performed on relatively healthy persons with a mean age of about 60 years. In this respect, the study results differ from a study of older persons in nursing homes whose outlined exercise programs were less trying than those described here. Nevertheless, I have recommended programmed, increased exercise to non-invalided elderly persons for several years. At the least, the patients’ responses have been encouraging, but it’s impossible to rule out the placebo effect. More systematic efforts such as King et al’s should give greater, blinded attention to dissociate the specificity of the exercise compared to the non-directed activities of the non-exercised group. fp
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