Moderate-Intensity Exercise and Self-Rated Quality of Sleep in Older Adults

ABSTRACT & COMMENTARY

Synopsis: Older adults with moderate sleep complaints can improve self-rated sleep quality by initiating a regular moderate-intensity exercise program.

Source: King AC, et al. JAMA 1997;277:32-37.

Sleep complaints are one of the most common difficulties facing middle-aged and older adults. Furthermore, physical inactivity is said to be the most important health problem in this group. King et al therefore sought to determine whether exercise would provide a nonpharmacological therapy for mild insomnia. Eligible sedentary men and women between the ages of 50 and 76 with moderate sleep complaints were randomized to 16 weeks of community-based, moderate-intensity exercise training or to a wait-listed condition. The exercise condition consisted of four 30- to 40-minute endurance training session each week. Forty-eight people were randomized and exercise adherence monitored with a portable microprocessor (Vitalog) and diaries.

Overall sleep quality was improved in exercisers vs. controls. Reported sleep duration was increased by almost an hour among exercising subjects. Possible mechanisms include perceived reduction in stress or anxiety and physiological variables such as muscular relaxation, decreases in sympathetic tone, or thermal effects from exercise. As the authors note, while other types of social, cognitive, or recreational activities may provide benefits in some of these areas, few have the potential for influencing all of these dimensions simultaneously.

COMMENT BY SARAH L. BERGA, MD

It is generally believed that exercise promotes better sleep, but well-controlled experimental studies documenting this belief are rare. Despite this belief, the majority of sedative-hypnotic prescriptions are written for older adults. This is unfortunate, because the use of sedative-hypnotics is associated with confusion, falls, extended drowsiness, agitation, and untoward medication interactions. Although the results of this study initially might seem to be a confirmation of the obvious, they are important and deserve dissemination. The exercise intervention used in this study was highly structured for experimental purposes, but there is every reason to believe that nonstructured physical activity will have similar benefits. Importantly, the exercise activity does not have to promote physical conditioning to facilitate sleep. Walking will do. Another benefit of moderate exercise is that it increases caloric requirements, thus providing older adults with an opportunity to consume a balanced and nutrient-rich diet. As we age, we need to remember to walk whenever we can and to counsel our patients to do the same. By the same token, we need to structure our living arrangements so that we have safe opportunities for staying active.