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Physical Exercise on Sleep Quality in Elderly Adults
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Aging is directly related to sleep problems. Primary insomnia has a negative impact on the lives of elderly adults, altering cognitive and metabolic functions. Physical activity is positively related to improvement in sleep quality. The systematic and continuous practice of physical exercise significantly improves perceived sleep quality in elderly individuals. Therefore, physical activities can be used as a tool to prevent sleep disorders and improve health in general. 

physical exercise elderly aging sleep sleep wake disorders
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Update Date: 28 Apr 2022
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    1. Introduction

    The increased longevity of the world’s population is related to changes in sleep patterns [1]. These changes serve as a tool for assessing the quality of life and are directly linked to some organic issues, such as physical and mental health, well-being and general vitality [2]. Many studies show that changes in sleep patterns have a negative impact on cognitive function and quality of life [3].
    Aging can be characterized as a time-dependent process of losing organic functions, and the brain is not spared. Sleep, dependent on several pathways and mechanisms, also has its full functioning altered [4]. The ability to initiate and maintain sleep is compromised, and the electroencephalogram shows less deep sleep. These changes may be associated with reduced white matter density, reduced gray matter volume in some regions, diminishment in functional synapses and impact on the production and degradation of neurotransmitters and neuropeptides [4][5].
    Middle age is directly related to an increased prevalence of common sleep problems, such as insomnia [6]. Sleep patterns change with aging. The duration of the more superficial phases of sleep increases, while the durations of deep and Rapid Eye Movement (REM) sleep decrease. For this reason, sleep is less restorative for elderly adults, and they are more vulnerable to being awakened by external stimuli [7]. The production of melatonin, an important regulator of sleep, is decreased in the elderly [8].
    The association between insomnia and decreased quality of life is most notable in elderly adults [7]. Sleep disorders affect metabolism, causing weight gain between early adulthood and old age and simultaneously promoting metabolic and immunological disorganization and the resulting emergence of some diseases, such as hypertension, diabetes mellitus, cancer and depression [8].
    Sleep disorders are underdiagnosed and undertreated, and more than half of the individuals affected do not receive any type of treatment to resolve the condition [9]. The approach to insomnia in elderly adults is usually complex and multifactorial. In addition to primary insomnia, adverse effects of drugs, psychiatric diseases and other comorbidities can be direct or aggravating causes. Conventional treatment consists of mitigating secondary causes, cognitive-behavioral therapy and medications. However, the risk of treatment failure is still high, and the main drug treatments cause side effects such as dizziness, memory loss, falls, daytime sleepiness and disinhibition [10]. There are less expensive and effective ways to treat this problem that can be added to conventional treatment.
    The performance of physical exercise is a positive step toward changes in lifestyle and may comprise a nonpharmacological treatment for sleep disorders and their organic consequences [11]. One way to evaluate sleep quality is using the Pittsburgh Sleep Quality Index (PSQI). This index evaluates sleep quality through a standardized questionnaire consisting of 19 items grouped into 7 components based on sleep in the past month and is able to differentiate between those who sleep well and those who sleep poorly [12].

    2. Physical Exercise on Sleep Quality in Elderly Adults

    Physical activity had a favorable effect on sleep. There was a significant positive effect of exercise on sleep quality in the exercise group compared to the control group, as measured using the PSQI. However, there was no significant difference in the improvement of sleep quality between the group with insomnia and the group without insomnia.

    Rubio-Arias [13] et al., in a study evaluating middle-aged women, found different results according to the exercise protocol applied: while there was no significant improvement in groups that performed low-intensity exercise (yoga), groups that engaged in moderate exercise (aerobic exercise) showed improvement in sleep quality. Xie et al. [14] included adults over 18 years of age, showed that overall, both classical exercises (walking, cycling) and mind–body exercises (yoga) improved sleep quality to the same degree.

    The mechanisms by which exercise affects sleep are still widely discussed. Hughes et al. [15] reported that exercise improves the circadian cycle in mice through VIP and GABA signaling on clock cells. The effect of exercise on melatonin secretion is controversial, with some studies showing that exercise increased melatonin secretion in the short term [16] and others showing that nocturnal exercise decreased [17] or did not affect the secretion of this hormone [18]. According to Uchida et al. [19], exercise causes increased secretion of brain-derived neurotrophic factor (BDNF) and growth hormone. However, as the same scholars also emphasized, the effects of these exercise-related changes need further study.

    Sleep quality can be positively impacted through the release of molecules secreted from myocytes and adipocytes in response to exercise [20][21]. Changes in leptin and ghrelin levels are associated with sleep disorders, and physical exercise modulates their levels [22]. Exercise increases the muscle expression of BDNF, Irisin, IL-6 and TNF-α. These substances have circadian behavior and, in animal experiments, change the depth of slow-wave sleep and the total sleep duration [20]. According to Abd El-Kader, IL-6 and TNF-α levels significantly reduce after aerobic training [23].
    Physical activity can improve sleep by regulating the circadian cycle, which is often altered with aging. Physical exercise can work like a Zeitgeber, adjusting the biological clock [24]. Aging decreases parasympathetic tone, while exercise can modulate vagus nerve activity, increasing parasympathetic tone. This function can be associated with improved sleep quality both by neural mechanism and by altering blood pressure levels and heart rate [25]. Physical exercise impacts not only the circadian fluctuations of cortisol but also the density of receptors for this hormone on brain and muscle tissue, decreasing tissular sensitivity to glucocorticoids and increasing its metabolic degradation rate [26].

    Future Work

    Future studies may deepen the comparison between aerobic and resistance exercises, compare the elements of the PSQI in addition to the overall score, use objective measures of sleep quality (such as polysomnography parameters), evaluate the dose–response relationship in a more elaborate way and include more participants with a diagnosis of primary insomnia.

    3. Conclusions

    Physical exercise improves sleep quality in both patients with previous complaints of insomnia and patients without previous complaints and has few adverse effects, making it a valuable adjuvant approach in the treatment of elderly patients with complaints of insomnia that may even reduce the number of medications used to sleep. Further studies are needed to investigate a greater number of participants diagnosed with insomnia, compare aerobic and resistance exercises, and use other scores of sleep quality.

    References

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    2. Ohayon, M.; Wickwire, E.M.; Hirshkowitz, M.; Albert, S.M.; Avidan, A.; Daly, F.J.; Dauvilliers, Y.; Ferri, R.; Fung, C.; Gozal, D.; et al. National Sleep Foundation’s sleep quality recommendations: First report. Sleep Health 2017, 3, 6–19.
    3. Wennberg, A.M.V.; Wu, M.N.; Rosenberg, P.B.; Spira, A.P. Sleep Disturbance, Cognitive Decline, and Dementia: A Review. Semin. Neurol. 2017, 37, 395–406.
    4. Panagiotou, M.; Michel, S.; Meijer, J.H.; Deboer, T. The aging brain: Sleep, the circadian clock and exercise. Biochem. Pharmacol. 2021, 191, 114563.
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    8. Wetterberg, L.; Bratlid, T.; von Knorring, L.; Eberhard, G.; Yuwiler, A. A multinational study of the relationships between nighttime urinary melatonina production, age, gender, body size, and latitude. Eur. Arch. Psychiatry Clin. Neurosci. 1999, 249, 256–262.
    9. Stewart, R.; Besset, A.; Bebbington, P.; Brugha, T.; Lindesay, J.; Jenkins, R.; Singleton, N.; Meltzer, H. Insomnia comorbidity and impact and hypnotic use by age group in a national survey population aged 16 to 74 years. Sleep 2006, 29, 1391–1397.
    10. Matheson, E.; Hainer, B.L. Insomnia: Pharmacologic Therapy. Am. Fam. Physician 2017, 96, 29–35.
    11. Léger, D.; Poursain, B.; Neubauer, D.; Uchiyama, M. An international survey of sleeping problems in the general population. Curr. Med. Res. Opin. 2008, 24, 307–317.
    12. Bertolazi, A.N.; Fagondes, S.C.; Hoff, L.S.; Dartora, E.G.; Miozzo, I.C.; de Barba, M.E.; Barreto, S.S. Validation of the Brazilian Portuguese version of the Pittsburgh Sleep Quality Index. Sleep Med. 2011, 12, 70–75.
    13. Rubio-Arias, J.; Marín-Cascales, E.; Ramos-Campo, D.J.; Hernandez, A.V.; Pérez-López, F.R. Effect of exercise on sleep quality and insomnia in middle-aged women: A systematic review and meta-analysis of randomized controlled trials. Maturitas 2017, 100, 49–56.
    14. Xie, Y.; Liu, S.; Chen, X.J.; Yu, H.H.; Yang, Y.; Wang, W. Effects of Exercise on Sleep Quality and Insomnia in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front. Psychiatry 2021, 12, 664499.
    15. Hughes, A.T.L.; Samuels, R.E.; Baño-Otálora, B.; Belle, M.D.C.; Wegner, S.; Guilding, C.; Northeast, R.C.; Loudon, A.S.I.; Gigg, J.; Piggins, H.D. Timed daily exercise remodels circadian rhythms in mice. Commun. Biol. 2021, 4, 761.
    16. Theron, J.J.; Oosthuizen, J.M.; Rautenbach, M.M. Effect of physical exercise on plasma melatonin levels in normal volunteers. S. Afr. Med. J. 1984, 66, 838–841.
    17. Monteleone, P.; Maj, M.; Fusco, M.; Orazzo, C.; Kemali, D. Physical exercise at night blunts the nocturnal increase of plasma melatonin levels in healthy humans. Life Sci. 1990, 47, 1989–1995.
    18. Miyazaki, T.; Hashimoto, S.; Masubuchi, S.; Honma, S.; Honma, K.I. Phase-advance shifts of human circadian pacemaker are accelerated by daytime physical exercise. Am. J. Physiol. Regul. Integr. Comp. Physiol. 2001, 281, 197–205.
    19. Uchida, S.; Shioda, K.; Morita, Y.; Kubota, C.; Ganeko, M.; Takeda, N. Exercise Effects on Sleep Physiology. Front. Neurol. 2012, 3, 48.
    20. Tan, X.; van Egmond, L.T.; Cedernaes, J.; Benedict, C. The role of exercise-induced peripheral factors in sleep regulation. Mol. Metab. 2020, 42, 101096.
    21. Dundar, A.; Kocahan, S.; Sahin, L. Associations of apelin, leptin, irisin, ghrelin, insulin, glucose levels, and lipid parameters with physical activity during eight weeks of regular exercise training. Arch. Physiol. Biochem. 2019, 127, 291–295.
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    23. Abd El-Kader, S.M.; Al-Jiffri, O.H. Aerobic exercise modulates cytokine profile and sleep quality in elderly. Afr. Health Sci. 2019, 19, 2198–2207.
    24. Sewell, K.R.; Erickson, K.I.; Rainey-Smith, S.R.; Peiffer, J.J.; Sohrabi, H.R.; Brown, B.M. Relationships between physical activity, sleep and cognitive function: A narrative review. Neurosci. Biobehav. Rev. 2021, 130, 369–378.
    25. Sato, M.; Betriana, F.; Tanioka, R.; Osaka, K.; Tanioka, T.; Schoenhofer, S. Balance of Autonomic Nervous Activity, Exercise, and Sleep Status in Older Adults: A Review of the Literature. Int. J. Environ. Res. Public Health 2021, 18, 12896.
    26. Kraemer, W.J.; Ratamess, N.A.; Hymer, W.C.; Nindl, B.C.; Fragala, M.S. Growth Hormone(s), Testosterone, Insulin-Like Growth Factors, and Cortisol: Roles and Integration for Cellular Development and Growth With Exercise. Front. Endocrinol. 2020, 11, 33.
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    View Times: 202
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    Update Date: 28 Apr 2022
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      Melo, H.M.D.A.; Palmares, M.; Palmares, V.; Silva, V.L.D.S.; Pessoa, J.P. Physical Exercise on Sleep Quality in Elderly Adults. Encyclopedia. Available online: https://encyclopedia.pub/entry/22405 (accessed on 03 February 2023).
      Melo HMDA, Palmares M, Palmares V, Silva VLDS, Pessoa JP. Physical Exercise on Sleep Quality in Elderly Adults. Encyclopedia. Available at: https://encyclopedia.pub/entry/22405. Accessed February 03, 2023.
      Melo, Hugo Moura De Albuquerque, Marcelo Palmares, Vitor Palmares, Vítor Lourival De Sousa Silva, João Paulo Pessoa. "Physical Exercise on Sleep Quality in Elderly Adults," Encyclopedia, https://encyclopedia.pub/entry/22405 (accessed February 03, 2023).
      Melo, H.M.D.A., Palmares, M., Palmares, V., Silva, V.L.D.S., & Pessoa, J.P. (2022, April 27). Physical Exercise on Sleep Quality in Elderly Adults. In Encyclopedia. https://encyclopedia.pub/entry/22405
      Melo, Hugo Moura De Albuquerque, et al. ''Physical Exercise on Sleep Quality in Elderly Adults.'' Encyclopedia. Web. 27 April, 2022.
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