# Exercise as it relates to Disease/Aerobic exercise and Chronic Primary Insomnia

The purpose of this Wikibook is to discuss the journal article 'Effects of moderate aerobic exercise training on chronic primary insomnia' by Passos et al. (2011).

## What is the background of the research?

Chronic Primary Insomnia is a condition that affects a persons ability fall asleep, stay asleep and wake up feeling rested. The condition affects 10% to 15% of the population worldwide, predominantly women.
Exercise has been explored by multiple studies as a low-cost, non pharmaceautical treatment option. Results of these studies have consistently shown moderate intensity aerobic exercise to be the most useful form of exercise.
Chronic Primary Insomnia has been linked to a variety of other conditions and risk factors including;
* Depression
* Anxiety
* Heart disease
* Diabetes
* Higher incidence of Substance abuse
These conditions and risk factors can have drastic effects on daily living and health. It is important to have an understanding of effective measure that may address more than just the issue of poor sleep. Exercise can lead to improvements in these conditions and risk factors, providing a holistic effect. This study helps promote the effectiveness of exercise as a treatment.

## Where was the research conducted?

The research was conducted in Sao Paulo, Brazil.

### Contributions

1. Department of Exercise Science, University of South Carolina, U.S.A.
2. William Jennings Bryan Dorn Veterans Affairs Medical Center, South Carolina, U.S.A.

## What kind or research was this?

The researchers conducted a randomized, quantitative trial with a very strict inclusion/exclusion criteria.

## What did the research involve?

The research involved 19 participant (4 male, 15 female) who had been living with diagnose Chronic Primary Insomnia for a minimum of 6 months.
Each participant completed an initial phone interview. Applicable candidates were invited to the lab for further interviewing and orientation. Those eligible for the study complete baseline assessments (Table 1) and were randomly assigned to the morning or afternoon exercise group.
Table 1. Baseline assessments
| Baseline assessment | Information Collected |
| Cardiopulmonary Exercise Test | Used to determine exercise intensity, exercise suitability and peak VO2 |
| Body composition | Body fat percent and fat free mass |
| SF-36 Questionnaire | Determines physical, mental and emotional functioning in 8 areas of daily living |
| POMS questionnaire | Used for mood profiling related to anger, depression, fatigue etc. |
| Polysomnography | Clinical sleep assessment including Heart Rate responses, respiration, sleep latency and time in stages of sleep |
| 7 day sleep diary | Objective measures of sleep, recorded by the participants |
The participants kept a 7 day objective sleep diary while undertaking no exercise. Each participant then completed 6 months of moderate intensity aerobic treadmill exercise (50 minutes of steady state walking, 3 days/ week).either in the morning or late afternoon.The participants completed re-assessments 48 hours after completing training (polysomnograph was completed at 96 hours also) followed by another 7 day sleep diary.

## What were the basic results of the research?

Improvements were noted in peak VO2 but not body composition. POMS measures of anxiety, depression, anger, total mood disturbance, fatigue and confusion improved. The polysomnography showed reductions in sleep onset latency (time to fall asleep) and latency across all stage of sleep indicating better sleep quality. Waking during sleep was less frequent and total sleep time improved. There were no significant differences noticed between the morning and afternoon exercise groups.
Objective measures of sleep reported in the sleep diary showed greater improvements in sleep quality and feeling rested with the morning group than the afternoon group.

## How did the researchers interpret the information?

The researchers identified a clear link between aerobic exercise and improved sleep, mood and general life quality. The study concluded that there is significant benefit in using exercise as a non-pharmaceutical treatment. The research identified few significant difference between morning and afternoon exercise. Other general health improvements included improved cardiovascular function and general fatigue, both factors contributing to better quality of life.
This study tightly controlled for significant symptoms of depression and anxiety. It was identified that further research should be done to better understand the effects exercise has on the interaction between depression and anxiety and sleep. Both factors have been identified as possible contributing factors of Insomnia.

## What conclusions can be taken from the research?

Moderate intensity aerobic exercise is an appropriate non-pharmacological treatment option in the treatment of Chronic Primary Insomnia. This may be due the holistic approach that exercise provides towards improving symptoms of depression and anxiety and other associated conditions. More specific research on the mechanism of exercise improvement are required.

## What are the implications of the research?

Aerobic exercise has been consistently linked with improvements in Chronic Primary Insomnia sleep conditions. This research also implies that the benefits of aerobic exercise is not limited to obvious improvements in sleep. Aerobic exercise is also associated with improvements in depression and anxiety symptoms and cardiovascular fitness, co-conditions that have been consistently linked with Chronic Primary Insomnia.

## Further reading

National Sleep Foundation - Insomnia Learn more
Chronic Primary Insomnia fact sheet: Fact Sheet
How exercise can help us sleep better - New York Times article
Getting into a sleeping routine: ReachOut.com

## References

* 1 2 3 4 5 1. Passos G, Poyares D, Santana M, D’Aurea C, Youngstedt S, Tufik S et al. Effects of moderate aerobic exercise training on chronic primary insomnia. Sleep Medicine. 2011;12(10):1018-1027.
* 1 2 3 Passos G, Poyares D, Santana M, Tufik S, de Mello M, Garbuio S. Effect of Acute Physical Exercise on Patients with Chronic Primary Insomnia. Journal of Clinical Sleep Medicine. 2010;6(3):270-275.
* 1 2 3 4 5 6 7 Jurysta F, Lanquart J, Sputaels V, Dumont M, Migeotte P, Leistedt S et al. The impact of chronic primary insomnia on the heart rate – EEG variability link. Clinical Neurophysiology. 2009;120(6):1054-1060.
* 1 2 3 Reid K, Baron K, Lu B, Naylor E, Wolfe L, Zee P. Aerobic exercise improves self-reported sleep and quality of life in adults with insomnia. Sleep Medicine. 2010;11(9):934-940.
* ↑ Riemann D. Primary insomnia: a risk factor to develop depression?. Journal of Affective Disorders. 2003;76(1-3):255-259.
* ↑ Lanfranchi P, Pennestri M, Fradette L, Dumont M, Morin C, Montplaisir J. Nighttime Blood Pressure in Normotensive Subjects With Chronic Insomnia: Implications for Cardiovascular Risk. Sleep. 2009;32(6):760-766.