# Exercise as it relates to Disease/Exercise and chronic insomnia

This page is a critique of: Reid K, Baron K, Lu B, Naylor E, Wolfe L, Zee P. Aerobic exercise improves self-reported sleep and quality of life in older adults with insomnia. Sleep Medicine [Internet]. 2010 [cited 23 September 2017];11(9):934-940. Available from: http://ac.els-cdn.com.ezproxy.canberra.edu.au/S1389945710002868/1-s2.0-S1389945710002868-main.pdf?_tid=de85cf4a-9d96-11e7-bbac-00000aacb35f&acdnat=1505865876_6b700cac20f8d10248d6a000f0992af0

## Insomnia

Insomnia can come with 3 different circumstances, in which a person can present all 3
* When a person regularly finds it difficult to fall asleep and stay asleep.
* Having trouble to initially fall asleep
* Waking up during the night and not be able to get to sleep for a long time.
Insomnia is can be caused by many factors:
* Medicines and drugs,
* Chronic pain,
* Stress,
* Depression,
* Anxiety,
* Another sleep problems
Insomnia has a prevalence of 13-33%of adults in Australia which can be classified as a primary disorder or a comorbid of a mental or physical disorder. As there is such a high number of cases within Australia the results from the study could be able to help a large number of people suffering from insomnia. The study addresses if whether exercise is suitable of helping to prevent and reduce insomnia symptoms and increase the quality of life in older adults with chronic insomnia.

## Article Critique
### Where is the research from?

The study was conducted by 5 authors from the Department of Neurology, North western University, Chicago with a 6th corresponding author.
* Kathryn J. Reid, PhD, has published over 60 studies on sleep and circadian systems and factors affecting. She is currently research the relationship between sleep and risk of metabolic and cardiovascular disease.
* Kelly Glazer Baron, PhD, Kelly is involved with research in the role of sleep and circadian rhythm disruption in the development of obesity.
* Brandon S. Lu, M.D. has professional interests in sleep medicine (restless leg syndrome, sleep apnea, sleep disordered breathing, sleep pharmacology)
* Lisa F Wolfe, MD. Specialises in neuromuscular disorders and sleep related breathing disorders
* Erik Naylor, PhD. Expertise is in Sleep disorders
* Phyllis C Zee, MD, PhD. Specialises in circadian rhythm disorders, insomnia, nocturnal seizures, parasomnias, restless leg, sleep apnea, sleep disorders, snoring and increased upper airways.

### What kind of research was this?

The Study was conducted as a Randomised Controlled Trail (RCT) meaning they assigned participants to groups (2 or more) one as a control one or more as trials from different methods. In this case exercise to help combat chronic insomnia and no exercise (control). The evidence from the results of the study doesn’t not differ with other results from previous studies researching the links between exercise and insomnia, in which both state that aerobic exercise does help the quality of sleep and with increasing benefits the longer its partaken.

### What did the research involve?

Sedentary adults aged 55 and older with insomnia (3 months before commencement) participated in a 16-week aerobic physical activity and sleep hygiene, and non-physical activity plus sleep hygiene. Baseline measures of self-reported sleep quality, quality of life and mood was taken and monitored throughout. Exercise was conducted 4 times a week, with a 4-6-week conditioning phase which included progression of time and increasing percentage of maximal hear rate. After the conditioning phase, participants exercised 4 times a week, with either one 30-40-minute session at 75% of max HR or two 20 min sessions at 75% max HR for the remaining weeks of the study. Sleep hygiene education consisted of an appointment with a sleep specialist, in which verbal and written sleep hygiene instructions, and counselling occurred. All participants received sleep hygiene education. Non-physical activity participants were required to partake in activities (recreational or educational) such as YMCA, museum lectures and church activities. These activities needed to be 45 minutes + in duration and meet 3-5 times a week. Sleep quality as measured using the Pittsburgh Sleep Quality index (PSQI). Day time sleepiness was measured using the Epworth Sleepiness Scale (ESS). Health related quality of life was measured by SF-36, depressive symptoms was measured by CES-D. The results from both groups Non-physical activity and Physical activity were collected and recorded and analysed.
As with every study limitations are unavoidable. This studies limitation included the reliance on self-reporting measurements, the low number of people with in the study and have a high female dominance in numbers. The authors stated, “although the gender imbalance may affect the generalisability of the study, our findings remain relevant to patients with insomnia because insomnia is more prevalent in women than men”. There was also a high dropout rate within the non-physical activity as participants wanted to be in the physical activity condition. Considering the limitations of the study and the type of study the methodology was the best approach

### Basic results

The results showed that moderate intensity exercise and sleep hygiene was an effective way to improve self-reported sleep quality, mood and their quality of life with chronic insomnia. Depressive symptoms were greatly reduced within the physical activity group, a trend was seen in association with depressive symptoms and PSQI scores. A decreasing in depressive symptoms showed a decrease in PSQI scores. Meaning there was a greater sleep quality with low depressive symptoms.

#### How did the researchers interpret the results?

The authors interpreted the results as they were on paper, however from the limitations in the study they also acknowledged that results could differ in a bias towards the physical activity group because of the low number and high drop-out rate within the non-physical conditions. The authors have not appeared to over exaggerate the results or over-emphasis the implication of their findings.

### Conclusions

As the study is based off completed research and is refining the methods of treatment, there is no large scale real world implications as exercise has been a treatment method for insomnia prior to the commencement of the study. The study is only serving to reinforce the point of the successfulness of exercise as a treatment method. From my reading and analysis of the results aerobic exercise is a suitable method of improving sleep quality within older adults with chronic insomnia. However, there are no results showing if sleep hygiene itself was an effective method behaviour and to improve sleep quality and quality of life. The study’s results align with the results of new research and studies on the topic. The only addition to results being, recent studies show that long-term aerobic exercise positively affects sleep quality, rather than short-term aerobic exercise.

## Practical advice

In this study, exercise was conducted with an accredited exercise physiologist and all participants went through pre-screening protocols prior to exercise commencing. It is strongly recommended to seek advice from a medical professional prior to commencing exercise as a treatment. Below are links to learn more and a pre-screening tool.
ESSA exercise pre-screening questionnaire: https://www.essa.org.au/wp-content/uploads/2011/09/Screen-tool-version-v1.1.pdf
Sleep Health Foundation Australia: http://www.sleephealthfoundation.org.au/fact-sheets-a-z/188-insomnia.html
Aerobic exercise improves self-reported sleep and quality of life in older adults with insomnia:
* Passos G, Poyares D, Santana M, Teixeira A, Lira F, Youngstedt S et al. Exercise Improves Immune Function, Antidepressive Response, and Sleep Quality in Patients with Chronic Primary Insomnia. BioMed Research International [Internet]. 2014 [cited 23 September 2017];2014:1-7. Available from: http://zh9bf5sp6t.scholar.serialssolutions.com/?sid=google&auinit=GS&aulast=Passos&atitle=Exercise+improves+immune+function,+antidepressive+response,+and+sleep+quality+in+patients+with+chronic+primary+insomnia&id=pmid:25328886

## References

* 1 2 . Insomnia [Internet]. Sleephealthfoundation.org.au. 2017 [cited 23 September 2017]. Available from: http://www.sleephealthfoundation.org.au/fact-sheets-a-z/188-insomnia.html
* ↑ Victoria C. Prevalence of Insomnia in Australia | CPAP Victoria Blog [Internet]. Cpapvictoria.com.au. 2017 [cited 23 September 2017]. Available from: https://cpapvictoria.com.au/blog/general/prevalence-of-insomnia-in-australia/
* ↑ Kathryn Jean Reid, PhD : Faculty Profile: Northwestern Comprehensive Center on Obesity: Feinberg School of Medicine: Northwestern University [Internet]. Feinberg.northwestern.edu. 2017 [cited 23 September 2017]. Available from: http://www.feinberg.northwestern.edu/sites/diabetes/members/profile.html?xid=17459
* ↑ Kelly Glazer Baron, PhD, MPH | Faculty | Rush University [Internet]. Rushu.rush.edu. 2017 [cited 23 September 2017]. Available from: https://www.rushu.rush.edu/faculty/kelly-glazer-baron-phd-mph
* ↑ Brandon S. Lu M. Dr. Brandon S. Lu, MD | California Pacific Medical Center | Sutter Health [Internet]. Cpmc.org. 2017 [cited 23 September 2017]. Available from: http://www.cpmc.org/dr-brandon-lu.html
* ↑ Lisa F Wolfe, MD: Faculty Profile: Feinberg School of Medicine: Northwestern University [Internet]. Feinberg.northwestern.edu. 2017 [cited 23 September 2017]. Available from: http://www.feinberg.northwestern.edu/faculty-profiles/az/profile.html?xid=13981
* ↑ 6. Erik Naylor [Internet]. Research Gate. 2017 [cited 23 September 2017]. Available from: https://www.researchgate.net/profile/Erik_Naylor/info
* ↑ Phyllis C Zee, MD, PhD: Faculty Profile: Feinberg School of Medicine: Northwestern University [Internet]. Feinberg.northwestern.edu. 2017 [cited 23 September 2017]. Available from: http://www.feinberg.northwestern.edu/faculty-profiles/az/profile.html?xid=13785
* 1 2 9. Passos G, Poyares D, Santana M, Teixeira A, Lira F, Youngstedt S et al. Exercise Improves Immune Function, Antidepressive Response, and Sleep Quality in Patients with Chronic Primary Insomnia. BioMed Research International [Internet]. 2014 [cited 23 September 2017];2014:1-7. Available from: http://zh9bf5sp6t.scholar.serialssolutions.com/?sid=google&auinit=GS&aulast=Passos&atitle=Exercise+improves+immune+function,+antidepressive+response,+and+sleep+quality+in+patients+with+chronic+primary+insomnia&id=pmid:25328886