# Exercise as it relates to Disease/Exercise and Activities: Improving the sleep of those in Nursing Homes

Lack of sleep and insomnia is a common complaint of the elderly, and in nursing homes it is no different. Lack of sleep has been shown to reduce the quality of life, affecting their mental health as well as physical health. As such, there is currently lots of research being undertaken to combat this, to try and increase the quality of life of the elderly, particularly those in nursing homes.
Current treatment for treating nursing home residents with these issues are mainly medications, however these have side effects, such as increasing falls and affecting brain function.
As such, there is a need to find alternative treatments to try and combat this issue.

## Where is the research from?

The research detailed in this article is from “Strength Training, Walking, and Social Activity Improve Sleep in Nursing Home and Assisted Living Residents: Randomized Controlled Trial” by Kathy C. Richards, PhD, Corinne Lambert, EdD, Cornelia K. Beck, PhD, Donald L. Bliwise, PhD, William J. Evans, PhD, Gurpreet K. Kalra, MS, Morton H. Kleban, PhD, Rebecca Lorenz, PhD, Karen Rose, PhD, Nalaka S. Gooneratne, MD, MnSc, Dennis H. Sullivan, MD.
In this article we aim to build a greater understanding of what the implications of their research are, and how we can try to use them.
This research was undertaken in the United States and was approved by the University of Arkansas.

## Type of research

This study is an example of a randomised control trial or RCT. This means that all participants were randomly placed into a group to test the hypothesis of the scientists, and one of these groups have to be a ‘control’ group, which means testing the other interventions to what is already being done or nothing at all. This type of study is useful in the scientific world, as it allows for less bias to be brought into the study and the results that are obtained are more likely to be trusted.
However, when reading literature, one should always read more than one research article to determine what is the overall consensus in the literature, as the findings on one study could differ greatly.
Findings from a randomised control trial, can be relied upon, but should always be compared to the larger research base and care should always be taken.

## What did the research involve?

This study was undertaken across 10 nursing homes and assisted living units in America. In the study the 193 participants were put into four groups, a control group, social activities and social activities and exercise had on improving their sleep over 7 weeks.
The exercise group: did walking for 45minutes 2 days a week and high intensity resistance training three times a week.
The social activities group: received 1 hour of social activities 5 days a week.
The social activities and exercise group: did both the exercise regime and social activities.
The control group: had no change to their daily routine.
The researchers conducted sleep studies for 2 nights before and after the study, they also measured sleep efficiency, which is how long someone is actually asleep for whilst in bed, non-rapid eye movement sleep, rapid-eye movement sleep and how long it took for participants to fall asleep.
This is a large trial, with a good number of participants, claims that the researchers make in this trial can be trusted more so than smaller studies. As they are comparing lots of different areas, they can determine which area is most effective for treating sleep in the elderly population.

## What were the basic results?

The results compared the different activities to the quality of the participants sleep. Although 193 commenced the study, only 165 completed it. Results taken from a study with a drop out rate should be taken with care, as this could affect its reliability.
The researchers found that a combination of exercise and social activities improved the sleep of nursing home residents. However, by themselves, the other interventions had no improvement in sleep.
Overall over 46% of the participants in the exercise and social activity group had an increase in their total sleep time as well as their non-rapid eye movement sleep. The authors also stated that this was clinically significant as well as statistically significant. This means that within the realms of this study, the findings are trustworthy and the intervention of exercising as well and social activities had a positive effect on sleeping.

## How did the researchers interpret the results?

The researchers concluded that using exercise and social activities could improve the sleep of nursing home residents. They suggested that future research was required to determine how much exercise and social activities was needed to increase the sleep quality of these patients. They also suggested that more study was needed to assess the effect of these activities on the overall quality of life of nursing home residents and what the other effects of this might have.

## What are the implications of the research?

This research is helpful for anyone involved in the life of older adults, particularly those in nursing homes, whom you may know has difficulty with sleeping. It offers another form of treatment outside of medications that are usually offered. This research outlines the importance of engaging nursing home residents in social activities as well as exercise throughout their week in the effort to improve their sleep quality. It shows that combining these two activities may improve the quality of life of nursing home residents who suffer with poor sleep.
This is an area that still requires more research, as such monitoring the current research in this area and ensuring its quality is of high importance to be sure that the appropriate exercise and social activities is delivered to nursing home residents.
Currently there is more research being undertaken looking at exercise and sleep in nursing home residents and the elderly indicating that moderate exercise has positive effects on sleep quality.
Therefore, where safe and the elderly have been given the appropriate clearance by a medical professional, the current research suggests that moderate exercise as well as social activity will have a positive effect on sleep quality in elderly adults and nursing home residents.

## References

* ↑ Wolkove N, Elkholy O, Baltzan M, Palayew M. Sleep and aging: 1. Sleep disorders commonly found in older people. Canadian Medical Association Journal. 2007;176(9):1299-1304.
* ↑ Ancoli-Israel SCooke J. Prevalence and Comorbidity of Insomnia and Effect on Functioning in Elderly Populations. Journal of the American Geriatrics Society. 2005;53(S7):S264-S271.
* ↑ Koch S, Haesler E, Tiziani A, Wilson J. Effectiveness of sleep management strategies for residents of aged care facilities: findings of a systematic review. J Clin Nurs. 2006;15(10):1267-1275.
* ↑ Bartlett G, Abrahamowicz M, Grad R, Sylvestre M, Tamblyn R. Association between risk factors for injurious falls and new benzodiazepine prescribing in elderly persons. BMC Fam Pract. 2009;10(1).
* 1 2 3 4 5 6 7 Richards K, Lambert C, Beck C, Bliwise D, Evans W, Kalra G et al. Strength Training, Walking, and Social Activity Improve Sleep in Nursing Home and Assisted Living Residents: Randomized Controlled Trial. Journal of the American Geriatrics Society. 2011;59(2):214-223.
* 1 2 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. 2010;11(9):934-940.
1. Wolkove N, Elkholy O, Baltzan M, Palayew M. Sleep and aging: 1. Sleep disorders commonly found in older people. Canadian Medical Association Journal. 2007;176(9):1299-1304.
2. Ancoli-Israel SCooke J. Prevalence and Comorbidity of Insomnia and Effect on Functioning in Elderly Populations. Journal of the American Geriatrics Society. 2005;53(S7):S264-S271.
3. Koch S, Haesler E, Tiziani A, Wilson J. Effectiveness of sleep management strategies for residents of aged care facilities: findings
4. Bartlett G, Abrahamowicz M, Grad R, Sylvestre M, Tamblyn R. Association between risk factors for injurious falls and new benzodiazepine prescribing in elderly persons. BMC Fam Pract. 2009;10(1).
5. Richards K, Lambert C, Beck C, Bliwise D, Evans W, Kalra G et al. Strength Training, Walking, and Social Activity Improve Sleep in Nursing Home and Assisted Living Residents: Randomized Controlled Trial. Journal of the American Geriatrics Society. 2011;59(2):214-223.
6. 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. 2010;11(9):934-940.
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