General Interest Articles

Exercise, Not Drugs, Best Insomnia Rx

By Marina Rowbotham
The Medical Post, Jan. 21, 1997

Researchers find sleep benefits for older adults

STANFORD, CALIF. - Researchers at the University of Stanford have found moderate-intensity exercise improves quality of sleep in adults aged 50 to 76 years.

Although conventional wisdom is that exercise enhances sleep there are few controlled experimental studies that verify this. Sleep difficulties in older adults are common and often treated with prescribed sedative-hypnotics. In the U.S., older adults make up 12% of the population but receive 35% to 40% of all prescribed hypnotics, usually on a long-term basis. There is concern sedative-hypnotics in this age group may cause confusion, falls, extended drowsiness, agitation or harmful interactions with other medications.

Regular moderate-intensity exercise may be a nonpharmacological alternative for older adults who report moderate sleep complaints (mean sleep-onset latency longer than 25 minutes, mean sleep duration about six hours) that cannot be explained by known medical conditions.

Researchers enrolled 29 women and 14 men aged 50 to 76 in a 16-week randomized controlled trial. They were sedentary, free of cardiovascular disease and reported moderate sleep complaints. Endurance training sessions, including brisk walks and low impact aerobics of 30 to 40 minutes were performed four times per week by half the group while the control group continued with their regular daily routine. All subjects kept a daily sleep diary and were scored on the Pittsburgh Sleep Quality Index before and at the end of 16 weeks.

The results, which appeared in a January issue of Journal of the American Medical Association (JAMA) showed improvement in general quality of sleep, quicker sleep-onset, longer sleep duration and feeling rested in the morning, although there was only a small improvement in physical fitness. Dr. Abby King (PhD) of the Department of Health Research and Policy at Stanford University School of Medicine and colleagues think it may take more than eight weeks before regular exercise shows an improvement in sleep.

Since the study was not designed to find the physiological, psychological and behavioral variables of exercise that may enhance sleep, Dr. King suggested further research is needed in this area. She also wrote: "It is additionally important to note that it is the perceptual aspect of sleep quality that motivate physician visits, use of pharmacological sleep aids and other forms of medical utilization. These dimensions thus merit continued investigation."

Hypnotic drugs

In an editorial in the same issue of JAMA, Dr. David Buchner at the department of health services at the University of Washington wrote that more research is needed to answer questions such as, "What percentage of older adults have exercise-responsive sleep complaints? Can physical activity reduce use of sedative-hypnotic drugs for sleep complaints? As improvement in physical fitness was small, what is the physiological basis for exercise-related improvement in sleep?"

Dr. King warned in her study that at least one study of nursing home residents did not find appreciable changes in sleep measures with two types of lower-intensity physical activity programs and therefore, it is important to understand "the often multifactorial nature of sleep disruptions in different subgroups of elderly persons, and identifying for which subgroups physical activity increases may be able to play a useful role."

Dr. Buchner wrote that 70% to 80% of older women reported physical activity less than recommended in the U.S. public health guidelines. "The role of the clinician remains as stated by the U.S. Preventive Services Task-force: to counsel adults to promote regular physical activity, with emphasis on regular, moderate-intensity activity that achieves cardiovascular fitness," he wrote.

Clinicians when counselling older adults to exercise usually suggest self-supervised exercise at home or supervised exercise classes, however, home supervised exercise should be an option, wrote Dr. Buchner. "Given the public health importance of increasing physical activity in older adults and given legitimate concerns about recommending unsupervised exercise to chronically ill adults who dislike exercise classes, I and others have argued that developing and promoting supervised home programs is an important public health goal."

Copyright 1997 Maclean Hunter Publishing Limited
Reprinted with permission.

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