Back to the Basics - Exercise and Sleep

Heather Hydzik, ND | March 29, 2022

Sleep problems have become more prevalent over the last 2 years during the COVID-19 pandemic. Recent issues with sleep have been associated with higher levels of psychological distress. By treating insomnia, psychological distress can be reduced and vice versa. Exercise is a low-cost, easily accessible and non-pharmacologic treatment alternative that has the potential to help anyone willing and able to adopt the habit.

In order to make specific recommendations to patients, it’s important to know if exercise works for everyone, the duration and frequency required for benefits, which sleep parameters are improved, and how this intervention compares to standard treatments for insomnia. All too often, providers and patients are stuck on ‘what drug or supplement is going to fix this?’ rather than starting from a foundation of good self-care, which should always be the starting point when approaching insomnia.

Which aspects of sleep does exercise help?

When 4 weeks of regular moderate-paced walking was compared to sleep hygiene therapy for the same duration, it was found that exercise increased total sleep time, decreased sleep onset latency (SOL) and incidents of awakening. In addition to those benefits, various RCTs implementing moderate aerobic exercise to treat insomnia have found that it also improves depressive symptoms and leads to subjective measures of improvement such as feeling more rested in the morning and experiencing less daytime drowsiness. Engaging in regular exercise may also be preventive of insomnia and sleep complaints as multiple observational studies have found a correlation between maintaining a moderate level of physical activity and reduced likelihood of suffering from sleep difficulties.

Which types of exercise are effective?

Moderate aerobic exercise: Most studies on this subject have utilized moderate aerobic training which has been shown to improve all aspects of sleep.

Weight training: A 10 week randomized controlled trial involving adults with depression over the age of 60 showed that weight training 3 times per week resulted in significant improvements in all subjective sleep quality and depression measures.1

Stretching: Compared with a control treatment, resistance exercise and, separately, stretching led to significantly greater improvements in Insomnia Severity Index scores and these two treatment groups did not differ significantly.2

HIIT: A systematic review including 6 trials of adults over age 40 with sleep problems found that compared to the control group, both high intensity resistance exercise and moderate aerobic exercise improved Pittsburgh Sleep Quality Index Score and reduced SOL and medication use. However, the groups did not differ significantly in sleep duration, sleep efficiency or daytime functioning.3

TRX: TRX involves leaning from straps attached to the ceiling in order to utilize a person’s own bodyweight and gravity to provide a full body strength and cardio workout. A group of older adults showed improvements in sleep quality and fatigue after performing a 12-week high intensity intervention using 45 minute sessions of TRX suspension training twice per week.4

Session length, frequency, duration: Following a meta-analysis in 2021, researchers concluded that an exercise regimen of 60 minutes 4 to 5 times a week for 8 to 12 weeks can improve sleep quality and treat the symptoms of primary insomnia.5 However, some studies show positive effects from just 2 or 3 times per week and other studies show that workout sessions of only 30 minutes are sufficient to improve sleep.

Are the benefits short or long-term?

In fact, exercise has both acute and chronic benefits for those with sleep difficulties. People who engage in at least 30 minutes of moderate aerobic exercise see improvement in sleep quality the same night,6 and regular exercise can be an effective treatment for chronic insomnia. Exercise presented similar results when compared with hypnotics; “however,” concluded the researchers, “prospective studies comparing the effects of exercise with medical and non-medical treatments may be warranted before including exercise as a first-line treatment for chronic insomnia.”7

Does exercise work for everyone?

In a 2017 review of the literature, twenty-nine studies concluded that exercise improved sleep quality or duration; however, four found no difference and one reported a negative impact of exercise on sleep. Mixed findings were reported for children, adolescents, and young adults. Interventions conducted with middle-aged and elderly adults reported more robust results.8 

What if a person cannot engage in moderate aerobic training or lift weights?

An RCT comparing aerobic exercise to tai chi found modest improvements in objective sleep parameters, which did not differ between the 2 groups.9

What else to consider?

If exercise and standard sleep hygiene recommendations are not leading to the expected improvements, consider diurnal cortisol testing or melatonin testing to see if there may be a hormonal imbalance contributing to the insomnia.

 

References

  1. Singh NA, Clements KM, Fiatarone MA. A randomized controlled trial of the effect of exercise on sleep. Sleep. 1997;20(2):95–101.
  2. D'Aurea CVR, Poyares D, Passos GS, et al. Effects of resistance exercise training and stretching on chronic insomnia. Braz J Psychiatry. 2019;41(1):51-57. doi:10.1590/1516-4446-2018-0030
  3. Yang PY, Ho KH, Chen HC, Chien MY. Exercise training improves sleep quality in middle-aged and older adults with sleep problems: a systematic review. J Physiother. 2012;58(3):157-163. doi:10.1016/S1836-9553(12)70106-6
  4. Jiménez-García JD, Hita-Contreras F, de la Torre-Cruz MJ, et al. Effects of HIIT and MIIT Suspension Training Programs on Sleep Quality and Fatigue in Older Adults: Randomized Controlled Clinical Trial. Int J Environ Res Public Health. 2021;18(3):1211. Published 2021 Jan 29.
  5. Li S, Li Z, Wu Q, et al. Effect of exercise intervention on primary insomnia: a meta-analysis. J Sports Med Phys Fitness. 2021;61(6):857-866. doi:10.23736/S0022-4707.21.11443-4
  6. Exercising for better sleep. Available at https://www.hopkinsmedicine.org/health/wellness-and-prevention/exercising-for-better-sleep. Access verified 2/28/2022.
  7. Passos GS, Poyares DL, Santana MG, Tufik S, Mello MT. Is exercise an alternative treatment for chronic insomnia?. Clinics (Sao Paulo). 2012;67(6):653-660. doi:10.6061/clinics/2012(06)17
  8. Dolezal BA, Neufeld EV, Boland DM, Martin JL, Cooper CB. Interrelationship between Sleep and Exercise: A Systematic Review [published correction appears in Adv Prev Med. 2017;2017:5979510]. Adv Prev Med. 2017;2017:1364387. doi:10.1155/2017/1364387
  9. Siu PM, Yu AP, Tam BT, et al. Effects of Tai Chi or Exercise on Sleep in Older Adults With Insomnia: A Randomized Clinical Trial. JAMA Netw Open. 2021;4(2):e2037199. Published 2021 Feb 1.

Practical and Clinically-Applicable Strategies for Comprehensive Neurotransmitter Testing and Optimization

Heather Hydzik, ND

April 6, 2022 at 9:30 AM and 12 PM Pacific

Approximately 60 minutes with Q&A

Learning Objectives:
  1. Review general treatment concepts for optimizing neurotransmitter (NT) levels
  2. Discuss typical clinical presentations of individual neurotransmitter deficiencies and elevations
  3. Understand the physiology of neurotransmitter NT secretion and metabolism in order to support these processes to balance NT levels without the use of prescription medications
  4. Become familiar with genetic and lifestyle factors that influence NT levels
  5. Learn to incorporate NT evaluation and treatment in your practice utilizing either the Neurobasic profile or the Comprehensive Neurotransmitter Profile
  6. See how testing NT precursors and metabolites along with the NTs can help your interpretation and fine tune your treatment strategy

Disclaimer: All information given about health conditions, treatment, products, and dosages are for educational purposes only and do not constitute medical advice.

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