Several exercise modalities improve sleep quality in patients with sleep disorders

[sl8]

https://www.2minutemedicine.com/several-exercise-modalities-improve-sleep-quality-in-patients-with-sleep-disorders/

Several exercise modalities improve sleep quality in patients with sleep disorders

by Ashley Jackson December 1, 2023 in Lifestyle, Wellness
Reading Time: 2 mins read

1. In this systematic review and network meta-analysis, mind-body exercise, moderate aerobic exercise combined with light strength exercise, and moderate aerobic exercise alone were more effective than passive controls in improving sleep quality in those with sleep disorders.

2. However, the most effective treatment for improving sleep quality was mind-body exercise combined with treatment as usual.

Evidence Rating Level: 1 (Excellent)

Sleep disorders are highly prevalent and can be associated with impaired health and lower quality of life. Exercise has been investigated as a potential low-cost and easily accessible treatment to aid those with sleep disorders. Although prior studies have suggested a benefit of exercise in improving the symptoms of sleep disorders, there is still much to be discovered regarding the benefits of different exercise modalities on sleep quality in these patients. Thus, this study aimed to assess the current literature on the impact of various exercise types on sleep quality in patients with sleep disorders.

[...]

The results demonstrated that there was moderate-to-low certainty evidence to suggest that mind-body exercise, moderate aerobic exercise combined with light strength exercise, and moderate aerobic exercise alone were more effective than passive controls in improving sleep quality in patients with sleep disorders. However, the most effective treatment for improving sleep quality was mind-body exercise combined with treatment as usual. These results remained consistent after accounting for potential modifiers, such as region, age, and type of sleep disorder. However, the review was limited by the fact that most of the study participants were female, which may have affected the generalizability of the study findings. Nonetheless, the present study demonstrated that a wide range of exercise modalities can be effective in improving sleep quality in patients with sleep disorders.


Click to read the study in Sleep Medicine Reviews

[hlthe2b]

1. Definitions, in this case, really matter:

Exercise, as a complementary and alternative therapy, is defined as any planned, structed and repetitive physical movement produced by skeletal muscles that results in energy expenditure, and correlates strongly with physical fitness and considered as a minimal risk, low-cost, and easily accessible to the patients [11,12]. Usually, exercise can be categorized into three main types: aerobic exercises, which is continuous movement of large muscles in the body over time to improve cardiorespiratory fitness; [13] resistance exercises, which increase skeletal muscle strength, power, endurance, and mass; [13] and mind-body exercises, which aim to relieve physical tension and emotional anxiety through techniques such as breathing, body relaxation, and self-awareness [14]. Existing systematic reviews (SRs) and/or meta-analyses suggested that various exercise modalities are effective in improving sleep quality for people with sleep disorders. For example, Banno et al. [15] found that aerobic exercise can relieve insomnia and improve sleep quality in people with insomnia. Kovacevic et al. [16] conducted a SR of 13 studies and concluded that resistance exercise can improve all aspects of sleep, with the greatest benefit for sleep quality in population with sleep disorders. Additionally, an umbrella review investigating the effects of Pilates on physical health showed that Pilates had a positive effect on improving sleep disorders compared to passive interventions [17].

While I agree with the conclusions that all modalities were helpful, I do not believe there is sufficient strength of evidence based on these study methods to conclude that one (i.e., mind-body exercise) was superior to the others. Still, the conclusion that sleep disorders can be addressed by behavior interventions (and especially exercise) is valid.

[Bernardo de La Paz]

2. Yes, I had to look at article for defn of "mind-body exercises", but I am not surprised by the result

... showing mind-body most effective.

As they define it, mind-body exercises are not what we would generally call "exercise". It sounds like meditation. I had to look at the study summary for the definition they use (article page had a paywall rise up after a minute).

However there does not seem to be any examination of timing. It is well-known that physical exercise too close to bedtime is overly stimulating and interferes with sleep. On the flip side, the mind-body thing might benefit from being closer to bedtime than earlier.

[hlthe2b]

4. I really don't want to get into a detailed methodological discussion on the

conduct of these studies, which I do in my own career and would launch me into pages of detailed discussion. But let it suffice to say the amount of overlap that can not be teased out between "mind-body" and moderate exercise leads to confounding that impacts the findings. True aerobic exercise that causes endorphin release might be easier to separate as an effect from the somewhat nebulous "mind-body" effects.

Regardless, there are physiological and mental impacts that can influence sleep, no doubt. And that should be the point. I do disagree with the likely conclusions by many that exercise (even low impact minimally aerobic) should not be stressed every bit as much as so-called mind-body efforts--for multiple reasons, including relief of pain, overall health, and the fact that movement of any kind has feedback on the risk of depressive illness--all which are independently linked to poor sleep and insomnia.

[Bernardo de La Paz]

5. Agree, and you are not obligated!

Potentially some 'ancient Asian meditation' bias subtly creeping in. Personally, I try to be as broadly mindful as I can in all my activities. I do not seek regular exercise, but embrace any exercise when it comes my way.

I certainly agree that exercise has good benefits impacting all aspects of daily life and mental health. I also agree that all these factors and regimens are complexly intertwined.

I saw a video interview of a running doctor (who many would term "elderly", though clearly fit, healthy, and happy). He said that only lately he has realized the benefits of strength training for older people and wishes he had incorporated it earlier.

[Bernardo de La Paz]

3. To your point about sufficiency of evidence, study authors have low confidence level

However, in view of the risk of bias in individual trials and small sample sizes, certainty in these evidences is mostly moderate to low.