Abstract
Objective:
This study aimed to determine whether the timing of exercise influenced the effects of home-based low-intensity stepping exercises on the sleep parameters of older adults.
Method:
For 8 weeks, 60 healthy older adults participated in a randomized controlled trial, performing low-intensity aerobic exercise (70-80 bpm) for about 30 minutes every day at home, either in the morning (from waking until 12:00) or evening (18:00 to bedtime).
Results:
In the evening exercise group, both subjectively and objectively measured sleep latency significantly improved throughout the intervention. Further, postintervention subjective sleep satisfaction was significantly higher in the evening group (6.2 ± 1.3 points) than in the morning group (5.2 ± 1.4 points; P = .006). Additionally, sleep variables related to evening exercise had larger effect sizes (Cohen d) than those performed in the morning.
References
| 1. |
Mander, BA, Winer, JR, Walker, MP. Sleep and human aging. Neuron. 2017;94(1):19–36. doi:10.1016/j.neuron.2017.02.004 Google Scholar | Crossref | Medline |
| 2. |
Kripke, DF, Garfinkel, L, Wingard, DL, Klauber, MR, Marler, MR. Mortality associated with sleep duration and insomnia. Arch Gen Psychiatry. 2002;59(2):131–136. doi:10.1001/archpsyc.59.2.131 Google Scholar | Crossref | Medline |
| 3. |
Stone, KL, Ancoli-Israel, S, Blackwell, T, et al. Actigraphy-measured sleep characteristics and risk of falls in older women. Arch Intern Med. 2008;168(16):1768–1975. doi:10.1001/archinte.168.16.1768 Google Scholar | Crossref | Medline |
| 4. |
Yaffe, K, Falvey, CM, Hoang, T. Connections between sleep and cognition in older adults. Lancet Neurol. 2014;13(10):1017–1028. doi:10.1016/S1474-4422(14)70172-3 Google Scholar | Crossref | Medline |
| 5. |
Okajima, I, Komada, Y, Nomura, T, Nakashima, K, Inoue, Y. Insomnia as a risk for depression: a longitudinal epidemiologic study on a Japanese rural cohort. J Clin Psychiatry. 2012;73(3):377–383. doi:10.4088/JCP.10m06286 Google Scholar | Crossref | Medline |
| 6. |
Lader, M . Benzodiazepine harm: how can it be reduced? Br J Clin Pharmacol. 2014;77(2):295–301. doi:10.1111/j.1365-2125.2012.04418.x Google Scholar | Crossref | Medline | ISI |
| 7. |
McCall, WV. Sleep in the elderly: burden, diagnosis, and treatment. Prim Care Companion J Clin Psychiatry. 2004;6(1):9–20. doi:10.4088/pcc.v06n0104 Google Scholar | Crossref | Medline |
| 8. |
Ray, WA, Thapa, PB, Gideon, P. Benzodiazepines and the risk of falls in nursing home residents. J Am Geriatr Soc. 2000;48(6):682–685. doi:10.1111/j.1532-5415.2000.tb04729.x Google Scholar | Crossref | Medline |
| 9. |
By the 2019 American Geriatrics Society Beers Criteria® Update Expert Panel . American Geriatrics Society 2019 updated AGS beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2019;67(4):674–694. doi:10.1111/jgs.15767 Google Scholar | Crossref | Medline |
| 10. |
Alessi, C, Martin, JL, Fiorentino, L, et al. Cognitive behavioral therapy for insomnia in older veterans using nonclinician sleep coaches: randomized controlled trial. J Am Geriatr Soc. 2016;64(9):1830–1838. doi:10.1111/jgs.14304 Google Scholar | Crossref | Medline |
| 11. |
Irwin, MR, Olmstead, R, Motivala, SJ. Improving sleep quality in older adults with moderate sleep complaints: a randomized controlled trial of Tai Chi Chih. Sleep. 2008;31(7):1001–1008. Google Scholar | Medline |
| 12. |
Buman, MP, King, AC. Exercise as a treatment to enhance sleep. Am J Lifestyle Med. 2010;4(6):500–514. doi:10.1177/1559827610375532 Google Scholar | SAGE Journals |
| 13. |
King, AC, Oman, RF, Brassington, GS, et al. Moderate-intensity exercise and self-rated quality of sleep in older adults. A randomized controlled trial. JAMA. 1997;277(1):32–37. Google Scholar | Crossref | Medline | ISI |
| 14. |
King, AC, Pruitt, LA, Woo, S, et al. Effects of moderate-intensity exercise on polysomnographic and subjective sleep quality in older adults with mild to moderate sleep complaints. J Gerontol A Biol Sci Med Sci. 2008;63(9):997–1004. doi:10.1093/gerona/63.9.997 Google Scholar | Crossref | Medline |
| 15. |
United Nations Department of Economic and Social Affairs, Population Division . World Population Ageing 2019-Highlights (ST/ESA/SER.A/430). 2019. Accessed August 25, 2019. https://www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPopulationAgeing2019-Highlights.pdf Google Scholar |
| 16. |
Brandão, GS, Gomes, GSBF, Brandão, GS, et al. Home exercise improves the quality of sleep and daytime sleepiness of elderlies: a randomized controlled trial. Multidiscip Respir Med. 2018;13:2. doi:10.1186/s40248-017-0114-3 Google Scholar | Crossref | Medline |
| 17. |
Stathokostas, L, Theou, O, Little, RM, Vandervoort, AA, Raina, P. Physical activity-related injuries in older adults: a scoping review. Sports Med. 2013;43(10):955–963. doi:10.1007/s40279-013-0076-3 Google Scholar | Crossref | Medline |
| 18. |
Riemann, D, Baglioni, C, Bassetti, C, et al. European guideline for the diagnosis and treatment of insomnia. J Sleep Res. 2017;26(6):675–700. doi:10.1111/jsr.12594 Google Scholar | Crossref | Medline |
| 19. |
Alessi, C, Vitiello, MV. Insomnia (primary) in older people: non-drug treatments. BMJ Clin.Evid. 2015;pii:2302. Google Scholar |
| 20. |
Driver, HS, Taylor, SR. Exercise and sleep. Sleep Med Rev. 2000;4(4):387–402. doi:10.1053/smrv.2000.0110 Google Scholar | Crossref | Medline | ISI |
| 21. |
Stutz, J, Eiholzer, R, Spengler, CM. Effects of evening exercise on sleep in healthy participants: a systematic review and meta-analysis. Sports Med. 2019;49(2):269–287. doi:10.1007/s40279-018-1015-0 Google Scholar | Crossref | Medline |
| 22. |
Morita, Y, Sasai-Sakuma, T, Inoue, Y. Effects of acute morning and evening exercise on subjective and objective sleep quality in older individuals with insomnia. Sleep Med. 2017;34:200–208. doi:10.1016/j.sleep.2017.03.014 Google Scholar | Crossref | Medline |
| 23. |
Edinger, JD, Morey, MC, Sullivan, RJ, et al. Aerobic fitness, acute exercise and sleep in older men. Sleep. 1993;16(4):351–359. doi:10.1093/sleep/16.4.351 Google Scholar | Crossref | Medline |
| 24. |
Tsunoda, K, Kitano, N, Kai, Y, et al. Prospective study of physical activity and sleep in middle-aged and older adults. Am J Prev Med. 2015;48(6):662–673. doi:10.1016/j.amepre.2014.12.006 Google Scholar | Crossref | Medline |
| 25. |
Doi, Y, Minowa, M, Uchiyama, M, et al. Psychometric assessment of subjective sleep quality using the Japanese version of the Pittsburgh Sleep Quality Index (PSQI-J) in psychiatric disordered and control subjects. Psychiatry Res. 2000;97(2-3):165–172. doi:10.1016/s0165-1781(00)00232-8 Google Scholar | Crossref | Medline |
| 26. |
Tudor-Locke, C, Han, H, Aguiar, EJ, et al. How fast is fast enough? Walking cadence (step/min) as a practical estimate of intensity in adults: a narrative review. Br J Sports Med. 2018;52(12):776–788. doi:10.1136/bjsports-2017-097628 Google Scholar | Crossref | Medline |
| 27. |
Santos, RV, Tufik, S, Mello, MT. Exercise, sleep and cytokines: is there a relation? Sleep Med Rev. 2007 11(3):231–239. doi:10.1016/j.smrv.2007.03.003 Google Scholar | Crossref | Medline |
| 28. |
Kurita, S, Yano, S, Ishii, K, et al. Comparability of activity monitors used in Asian and Western-country studies for assessing free-living sedentary behaviour. PLoS One. 2017;12(10): e0186523. doi:10.1371/journal.pone.0186523 Google Scholar | Crossref | Medline |
| 29. |
Glass, S, Gregory, B. ACSM’s Metabolic Calculations Handbook. Lippincott Willams & Wilkins, 2007;68–69. Google Scholar |
| 30. |
Beltrame, T, Amelard, R, Wong, A, et al. Prediction of oxygen uptake dynamics by machine learning analysis of wearable sensors during activities of daily living. Sci Rep. 2017;7:45738. doi:10.1038/srep45738 Google Scholar | Crossref | Medline |
| 31. |
Mâsse, LC, Fuemmeler, BF, Anderson, CB, et al. Accelerometer data reduction: a comparison of four reduction algorithms on select outcome variables. Med Sci Sports Exerc. 2005;37(suppl 11):S544–S554. doi:10.1249/01.mss.0000185674.09066.8a Google Scholar | Crossref | Medline |
| 32. |
Cole, RJ, Kripke, DF, Gruen, W, et al. Automatic sleep/wake identification from wrist activity. Sleep. 1992;15(5):461–469. doi:10.1093/sleep/15.5.461 Google Scholar | Crossref | Medline | ISI |
| 33. |
SA . Sleep and aging: prevalence of disturbed sleep and treatment considerations in older adults. J Clin Psychiatry. 2005;66(suppl 9):24–30. Google Scholar |
| 34. |
Sheikh, JI, Yesavage, JA. Geriatric Depression Scale (GDS) recent evidence and development of a shorter version. Clin Gerontol. 1986;5(1-2):165–173. doi:10.3109/09638288.2010.503835 Google Scholar | Crossref |
| 35. |
Harvie, MN, Pegington, M, Mattson, MP, et al. The effects of intermittent or continuous energy restriction on weight loss and metabolic disease risk markers: a randomized trial in young overweight women. Int J Obes (Lond). 2011;35(5):714–727. doi:10.1038/ijo.2010.171 Google Scholar | Crossref | Medline |
| 36. |
Cohen, J . Statistical Power Analysis for the Behavioral Sciences. Routledge Academic; 1988. Google Scholar |
| 37. |
Espie, CA, Emsley, R, Kyle, SD, et al. Effect of digital cognitive behavioral therapy for insomnia on health, psychological well-being, and sleep-related quality of life: a randomized clinical trial. JAMA Psychiatry. 2019;76(1):21–30. doi:10.1001/jamapsychiatry.2018.2745 Google Scholar | Crossref | Medline |
| 38. |
Buman, MP, Hekler, EB, Haskell, WL, et al. Objective light-intensity physical activity associations with rated health in older adults. Am J Epidemiol. 2010;172(10):1155–1165. doi:10.1093/aje/kwq249 Google Scholar | Crossref | Medline | ISI |
| 39. |
Buxton, OM, Lee, CW, Hermite Baleriaux, ML, et al. Exercise elicits phase shifts and acute alterations of melatonin that vary with circadian phase. Am J Physiol Requl Integr Comp Physiol. 2003;284(3):R714–R724. doi:10.1152/ajpregu.00355.2002 Google Scholar | Crossref | Medline | ISI |
| 40. |
Hauri, P . Effects of evening activity on early night sleep. Psychophysiology. 1968;4(3):266–277. doi:10.1111/j.1469-8986.1968.tb02767.x Google Scholar | Crossref | Medline |
| 41. |
Youngstedt, SD, Elliott, JA, Kripke, DF. Human circadian phase-response curves for exercise. J Physiol. 2019; 597(8):2253–2268. doi:10.1113/JP276943 Google Scholar | Crossref | Medline |
| 42. |
Buman, MP, Philips, BA, Youngstedt, SD, et al. Does nighttime exercise really disturb sleep? Results from the 2013 National Sleep Foundation Sleep in America Poll. Sleep Med. 2014;15(7):755–761. doi:10.1016/j.sleep.2014.01.008 Google Scholar | Crossref | Medline |
| 43. |
Silva, GE, Goodwin, JL, Sherrill, DL, et al. Relationship between reported and measured sleep times: the Sleep Heart Health Study (SHHS). J Clin Sleep Med. 2007;3(6):622–630. Google Scholar | Crossref | Medline |
| 44. |
Geiger-Brown, JM, Rogers, VE, Liu, W, et al. Cognitive behavioral therapy in persons with comorbid insomnia: a meta-analysis. Sleep Med Rev. 2015;23:54–67. doi:10.1016/j.smrv.2014.11.007 Google Scholar | Crossref | Medline |
| 45. |
Hill, KD, Hunter, SW, Batchelor, FA, et al. Individualized home-based exercise programs for older people to reduce falls and improve physical performance: a systematic review and meta-analysis. Maturitas. 2015;82:72–84. doi:10.1016/j.maturitas.2015.04.005 Google Scholar | Crossref | Medline |
| 46. |
van den Berg, JF, Miedema, HM, Tulen, JH, et al. Sex differences in subjective and actigraphic sleep measures: a population-based study of elderly persons. Sleep. 2009;32(10):1367–1375. doi:10.1093/sleep/32.10.1367 Google Scholar | Crossref | Medline | ISI |

