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Effects of moderate aerobic exercise training on chronic primary insomnia

OBJECTIVE To evaluate the effect of long-term moderate aerobic exercise on sleep, quality of life, and mood of individuals with chronic primary insomnia, and to examine whether these effects differed between exercise in the morning and exercise in the late afternoon. METHODS Nineteen sedentary individuals with chronic primary insomnia, mean age 45.0 (standard error [SE] 1.9) years, completed a 6-month exercise training protocol, randomized to morning and late-afternoon exercise groups. RESULTS Combining polysomnographic data across both time points, this study found a significant decrease in sleep onset latency (from 17.1 [SE 2.6] min to 8.7 [SE 1.4] min; P<0.01) and wake time after sleep onset (from 63.2 [SE 12.8] min to 40.1 [SE 6.0] min), and a significant increase in sleep efficiency (from 79.8 [SE 3.0]% to 87.2 [SE 1.6]%) following exercise. Data from sleep diaries revealed significant improvement in sleep onset latency (from 76.2 [SE 21.5] min to 80.3 [SE 7.4] min) sleep quality (from 41.5 [SE 5.2]% to 59.4 [SE 6.6]%) and feeling rested in the morning (from 50.8 [SE 5.3] to 65.1 [SE 5.0]). There were generally no significant differences in response between morning and late-afternoon exercise. Following exercise, some quality-of-life measures improved significantly, and a significant decrease was seen in the following Profile of Mood State measures: tension-anxiety (from 7.2 [SE 1.0] to 3.5 [SE 1.0]), depression (from 5.9 [SE 1.2] to 3.3 [SE 1.1]) and total mood disturbance (from 9.2 [SE 4.8] to -1.7 [SE 4.8]). These effects did not vary between morning and late-afternoon exercise. CONCLUSION Long-term moderate aerobic exercise elicited significant improvements in sleep, quality of life and mood in individuals with chronic primary insomnia.

Is exercise an alternative treatment for chronic insomnia

The purposes of this systematic/critical review are: 1) to identify studies on the effects of exercise on chronic insomnia and sleep complaints in middle-aged and older adults and to compare the results of exercise with those obtained with hypnotic medications and 2) to discuss potential mechanisms by which exercise could promote sleep in insomniac patients. We identified studies from 1983 through 2011 using MEDLINE, SCOPUS and Web of Science. For systematic analyses, only studies assessing the chronic effects of exercise on sleep in people with sleep complaints or chronic insomnia were considered. We used the following keywords when searching for articles: insomnia, sleep, sleep complaints, exercise and physical activity. For a critical review, studies were selected on the effects of exercise and possible mechanisms that may explain the effects of exercise on insomnia. We identified five studies that met our inclusion criteria for systematic review. Exercise training is effective at decreasing sleep complaints and insomnia. Aerobic exercise has been more extensively studied, and its effects are similar to those observed after hypnotic medication use. Mechanisms are proposed to explain the effects of exercise on insomnia. There is additional documented evidence on the antidepressant and anti-anxiety effects of exercise. Exercise is effective to decrease sleep complaints and to treat chronic insomnia. Exercise presented similar results when compared with hypnotics; however, prospective studies comparing the effects of exercise with medical and non-medical treatments are warranted before including exercise as a first-line treatment for chronic insomnia are necessary.

Exercise Improves Immune Function, Antidepressive Response, and Sleep Quality in Patients with Chronic Primary Insomnia

The aim of this study was to evaluate the effects of moderate aerobic exercise training on sleep, depression, cortisol, and markers of immune function in patients with chronic primary insomnia. Twenty-one sedentary participants (16 women aged 44.7 ± 9 years) with chronic primary insomnia completed a 4-month intervention of moderate aerobic exercise. Compared with baseline, polysomnographic data showed improvements following exercise training. Also observed were reductions in depression symptoms and plasma cortisol. Immunologic assays revealed a significant increase in plasma apolipoprotein A (140.9 ± 22 to 151.2 ± 22 mg/dL) and decreases in CD4 (915.6 ± 361 to 789.6 ± 310 mm3) and CD8 (532.4 ± 259 to 435.7 ± 204 mm3). Decreases in cortisol were significantly correlated with increases in total sleep time (r = −0.51) and REM sleep (r = −0.52). In summary, long-term moderate aerobic exercise training improved sleep, reduced depression and cortisol, and promoted significant changes in immunologic variables.

Tratamento não farmacológico para a insônia crônica

The purpose of this manuscript is to briefly describe the main modalities of non-pharmacological therapy and its utilization on the chronic insomnia treatment. Insomnia is the most frequent sleep disorder and that is more associated with psychiatry disorders. The pharmacotherapy is the most frequent treatment, but the nonpharmacologic therapy has been studied. The most common therapy modalities include behavioral approaches, stimulus control, sleep restriction, paradoxical intention, sleep hygiene, progressive muscle relaxation and biofeedback and, more recently, physical exercise practices. At first behavioral therapy aimed to improve sleep quality, however, recent studies have been emphasizing the effect of behavioral and cognitive approaches on quality of life, on decrease of dosage and frequency of drugs intake. Since insomnia is a chronic condition, long-term and safe treatments are warranted.

Is the six-minute walk test appropriate for detecting changes in cardiorespiratory fitness in healthy elderly men?

OBJECTIVES The purpose of this study was to determine whether the six-minute walk test (6-MWT) can detect changes in cardiorespiratory fitness (CRF) induced by exercise training in healthy elderly men. DESIGN Randomized and prospective controlled trial. METHODS Thirty-two healthy untrained men, between 65 and 75 years of age, were randomly assigned to one of three groups: control (C, n = 12), endurance training (E, n = 10), or concurrent training (ER, n = 10). Training groups underwent 24 weeks of exercise, 3 times a week. All participants were subjected to cardiopulmonary exercise testing and the 6-MWT, before and after the training period. RESULTS At follow-up, the E and ER groups had significantly higher peak oxygen uptake (VO(2)peak) (15.0 ± 9.1 and 12.6 ± 10.4%, respectively) and 6-MWT distances (5.5 ± 5.3 and 4.6 ± 2.8%, respectively) compared to the C group. In pre-intervention (n = 32), the 6-MWT distance correlated positively with (VO(2)peak) (r = 0.51, p = 0.001) and VO(2) at anaerobic threshold (r = 0.39, p = 0.010). On the other hand, there was no significant correlation between the changes (after-before) in the 6-MWT distance and VO(2) peak (E and ER groups: r = 0.38, p = 0.097). CONCLUSIONS The 6-MWT is not appropriate to evaluate changes in CRF in healthy elderly men who performed endurance and concurrent training for 24 weeks.

Objective short sleep duration is associated with the activity of the hypothalamic-pituitary-adrenal axis in insomnia.

OBJECTIVE To evaluate the association between objective short sleep duration in patients with insomnia and changes in blood parameters related to hypothalamic-pituitary-adrenal (HPA) axis activity. METHOD A cross-sectional pilot study was conducted in 30 middle-aged adults with chronic insomnia who were divided into 2 groups according to polysomnography (PSG) total sleep time (TST) (TST > 5h and < 5h). All patients underwent subjective analysis of sleep quality, anthropometric measurements, PSG, and determination off asting blood parameters. RESULTS The results revealed lower sleep efficiency and higher sleep latency for those with a TST < 5h. The subjective sleep quality was worse in the TST < 5h. Significantly, higher glucose and cortisol levels were observed with a TST < 5h. Glucose, cortisol and ACTH levels were inversely correlated with the PSG total sleep time. CONCLUSION Patients with insomnia with objective short sleep duration had HPA-associated endocrine and metabolic imbalances chronically linked to increases in cardiovascular risk observed with this more severe insomnia phenotype.

Chronotype and anxiety are associated in patients with chronic primary insomnia

Objective: To assess the interaction of chronotype with anxiety in patients with chronic primary insomnia. Methods: Sixty-four patients (50 women) with mean age 43.9±8.1 years were investigated with the Horne and Östberg Morningness-Eveningness Questionnaire (MEQ) and State-Trait Anxiety Inventory (STAI). Results: Significant negative correlations of chronotype-MEQ score with STAI state-anxiety (r = -0.40, p < 0.05), STAI trait-anxiety (r = -0.40, p < 0.05), and STAI pre-sleep state anxiety (r = -0.30, p < 0.05) were observed. Eveningness preference was associated with higher trait, state, and pre-sleep state anxiety. Conclusions: These results suggest that chronotype may be an important parameter to identifying the origin and significance of a vicious anxiety-insomnia-depression cycle in patients with chronic primary insomnia.

Variação diurna e resposta da cinética do VO2 de ciclistas durante exercício muito intenso

The objective of the present study was to evaluate the influence of the time of day on the parameters of oxygen uptake kinetics of trained cyclists during high intensity exercise. Nine male volunteers repeated bouts at constant loads at 08:00, 13:00 and 18:00 h on different days. These exercise bouts were performed twice on each occasion, with an interval of 1 h between them. The load intensity used was 75%Δ (75% of the difference between the VO2 at the lactate threshold and the VO2max). The primary VO2 amplitude (2597 ± 273 ml.min-1, 2513 ± 268 ml.min-1 and 2609 ± 370 ml.min-1), the primary VO2 time constant (19.3 ± 2.5 s, 18.4 ± 3.0 s and 19.7 ± 3.9 s), the VO2 slow component (735 ± 81 ml.min-1, 764 ± 99 ml.min-1 and 680 ± 121 ml.min-1) and the mean response time (51.8 ± 4.2 s, 51.2 ± 4.2 s and 51.4 ± 3.4 s) did not present significant differences at the different times (08:00, 13:00 and 18:00 h), neither did the other parameters of the VO2 kinetics. These results suggest that the response of the VO2 kinetics of cyclists exercising at high intensity (75%Δ) is not influenced by the time of day.