By Ellen Feldman, MD
SYNOPSIS: This small, randomized crossover trial demonstrates that short, repetitive bouts of early evening exercise lead to an increase in total sleep time compared to prolonged sitting.
SOURCE: Gale JT, Haszard JJ, Wei DL, et al. Evening regular activity breaks extend subsequent free-living sleep time in healthy adults: A randomised crossover trial. BMJ Open Sport Exerc Med 2024;10:e001774.
Sleep, a cornerstone of both mental and physical health, plays a central role in cognitive function, emotional regulation, and immune system performance. Quality sleep is strongly associated with a lower risk of developing chronic conditions such as cardiovascular disease, diabetes, and obesity. Insufficient sleep, on the other hand, can contribute to increased stress, impaired decision-making, and a higher susceptibility to illness.1,2
Traditionally, sleep hygiene guidelines have emphasized the importance of daytime activity while advising against evening exercise, fearing that elevations in body temperature and heart rate from nighttime activity would result in poorer quality of sleep. However, there is emerging evidence that suggests evening exercise does not disrupt sleep — and may, in fact, enhance sleep quality.3,4
To explore the relationship between evening exercise and sleep, Gale et al conducted a randomized crossover trial with 28 healthy adults. Participants alternated between two evening conditions: four hours of sitting and four hours of sitting interrupted every 30 minutes by three-minute bouts of body weight resistance exercises.
While the interventions were conducted in a controlled laboratory setting, participants returned to their normal environments afterward, wearing accelerometers for 48 hours to monitor sleep duration and physical activity following each session. This approach allowed the researchers to capture real-world effects of the interventions on sleep and activity.
Participants were all New Zealand residents, mostly female between the ages of 18 and 40 years, in relatively good health with a mean body mass index of 29.5 kg/m2. Each participant completed four sessions of four hours each. Two sessions took place in the early evening (starting at 5 p.m.) and two sessions took place at a later time (starting at 9 p.m.).
Resistance exercises included body weight squats and standing knee raises; each exercise was intentionally designed to be universally available without any required equipment.
Key findings showed that regular activity breaks were associated with a significant increase in both sleep period time (defined as the time between self-reported sleep onset and final awakening) and total sleep time (total time actually asleep). Specifically, participants who engaged in exercise breaks slept an average of 27-29 minutes longer than those who remained sedentary (P = 0.033).
The study found no significant change in sleep efficiency or the number of awakenings during the night associated with either condition.
The study also explored the impact of the evening activity breaks on subsequent physical activity patterns over the 48 hours following the intervention period. Results showed no significant change in overall physical activity or sedentary time following either of the four-hour sessions.
Commentary
The study also explored the impact of the evening activity breaks on subsequent physical patterns over the 48 hours following the intervention period. Results showed no significant change in overall physical activity or sedentary time following either of the four-hour sessions.
Gale et al’s study provides valuable insights into the evolving understanding of sleep hygiene and exercise, particularly the role of evening exercise. By demonstrating that short, low-intensity resistance exercises performed in the evening can extend sleep duration without negatively impacting sleep quality or overall daily activity, this research challenges the traditional thinking that exercise before bed is detrimental to sleep.
For those struggling with insufficient sleep — a common issue today — this finding is especially promising. It offers a simple, practical intervention that easily can be integrated into daily routines, applicable even for those unable or unwilling to participate in more vigorous exercise.
A noteworthy aspect of this study is its methodological rigor. The crossover design is a significant strength, as it allows each participant to act as their own control, thereby reducing variability and strengthening the reliability of the findings. The use of accelerometers to objectively measure sleep and activity patterns further enhances the credibility of the results, providing clear and quantifiable data that supports the conclusions.
However, the study does have some significant limitations. The relatively small sample size, coupled with the homogeneity of the participant group — predominately young, healthy women — limits the generalizability of the findings. Additionally, the short follow-up period means that the long-term effects of regular evening bursts of exercise on sleep and overall health remain unclear. Future studies should aim to include more diverse populations, with longer follow-up periods, to better understand how these findings apply across different demographics and over time.
As medical researchers continue to explore the relationship between sleep and exercise, it is essential that studies not only expand the findings from this investigation but also explore the underlying mechanisms that make evening exercise beneficial for sleep. Understanding why and how these short bursts of physical activity influence sleep could lead to more targeted and effective interventions, further enhancing patient care.
For now, Gale et al’s study serves as an important reminder that our understanding of sleep hygiene still is evolving and that challenging long-held beliefs with new evidence often is key to advancing health outcomes.4,5
Despite limitations, the implications of this study are significant. For internal medicine providers, incorporating recommendations for brief evening exercise breaks into patient care plans could offer a straightforward and effective way to improve sleep duration, potentially leading to broader health benefits. Given the strong link between sleep and chronic health conditions, this approach could be a valuable addition to strategies aimed at reducing sedentary behavior and promoting overall wellness. Providers may want to remain open to incorporating these insights into their practice, particularly when advising patients on how to optimize sleep and wellness.
References
- Ramar K, Malhotra RK, Carden KA, et al. Sleep is essential to health: An American Academy of Sleep Medicine position statement. J Clin Sleep Med 2021;17:2115-2119.
- Hou XZ, Li YS, Wu Q, et al. Association of sleep characteristics with cardiovascular disease risk in adults over 40 years of age: A cross-sectional survey. Front Cardiovasc Med 2024;11:1308592.
- Stutz J, Eiholzer Spengler CM. Effects of evening exercise on sleep in healthy participants: A systematic review and meta-analysis. Sports Med 2019;49:269-287.
- Yue T, Liu X, Gao Q, Wang Y. Different intensities of evening exercise on sleep in healthy adults: A systematic review and network meta-analysis. Nat Sci Sleep 2022;14:2157-2177.
- Frimpong E, Mograss M, Zvionow T, Dang-Vu TT. The effects of evening high-intensity exercise on sleep in healthy adults: A systematic review and meta-analysis. Sleep Med Rev 2021;60:101535.
This small, randomized crossover trial demonstrates that short, repetitive bouts of early evening exercise lead to an increase in total sleep time compared to prolonged sitting.
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