Effects on Sleep Quality of Physical Exercise Programs in Older Adults: A Systematic Review and Meta-Analysis

Empowering Fall Prevention Through Integrated Lifestyle Medicine Strategies-From Recognition of Fall Risks to Implementation of Prevention of Falls for all in Practice

Falls remain the leading cause of unintentional injuries across all age groups, prompting many emergency room visits. The annual estimated cost associated with falls is believed to exceed 100 billion dollars. In addressing this trend, health professional team members emerge as key players and can assume a crucial role in bridging the gap between lifestyle medicine and fall prevention. By imparting strategies aligned with the 6 pillars of lifestyle medicine, these professionals can educate individuals on risk factors, assess fall risk, and offer activities to mitigate the likelihood of future falls. This collaborative approach empowers all to take immediate and informed action, fostering a proactive stance against the prevalent issue of fall-related injuries. Through the background and practical strategies described in this paper, health professionals of various disciplines will have access to tools and knowledge to enhance their role in preventing falls using the lens of lifestyle medicine.

Effects of an exercise program with augmented reality on functional fitness and physical activity of community-dwelling older adults

Background

This study aims to investigate the effects of a multimodal program using augmented reality on the functional fitness and physical activity of older adults living in the community.

Method

Seventy-eight older adults living in the community participated in this study. Participants were divided into three groups: a control group that maintained their usual activities, and two experimental groups, one with multimodal training (EG1) and the other with multimodal training combined with augmented reality (EG2). Participants were assessed at baseline and post-intervention, after 12 weeks. Functional fitness was assessed using the Rikli and Jones Senior Fitness Test, handgrip strength, the functional reach test, and the Fullerton Advanced Balance Scale. Physical activity was measured using accelerometry.

Results

In EG1, lower limb flexibility, agility, cardiorespiratory fitness, and balance improved significantly between baseline and the 12-week outcome (p ≤ 0.001 for all). In EG2, improvements were observed in upper and lower limb strength, lower limb flexibility, agility, cardiorespiratory fitness, handgrip strength, and balance (p < 0.05 for all). Sedentary behavior increased in EG1 after the intervention. The clinical effect sizes of the interventions were large for balance (ES = 1.19) in EG1 and for upper limb strength (ES = 1.24) in EG2, and medium for cardiorespiratory fitness (ES = 0.74), agility (ES = 0.50), and lower limb flexibility (ES = 0.65) in EG1, and lower limb strength (ES = 0.61) and cardiorespiratory fitness (ES = 0.79) in EG2.

Conclusion

Both intervention programs led to improvements in several functional domains. However, the multimodal training combined with augmented reality program showed improvements across more domains, resulting in greater changes. Physical activity did not show significant improvements.

The relationship between physical activity level and timing and sleep quality and hygiene in healthy individuals: a cross-sectional study

The current study focused on investigating the relationship between level and timing of physical activity and sleep quality and hygiene in healthy individuals. This cross-sectional study design recruited 175 participants (male: 98, 56%, female: 77, 44%, and BMI: 23.87 ± 3.92) aged between 18 and 65, 157 of whom were physically active and 18 of whom were physically inactive. The study recruited healthy participants from various sports facilities, fitness centers, and walking parks to ensure a diverse sample of physically active individuals in a metropolitan city. The study excluded people with sleep disorders, rheumatoid arthritis, heart or neurological problems, and those who had shift work. The study employed the Demographic Information Form, International Physical Activity Questionnaire (Short Form), Pittsburgh Sleep Quality Scale, and Sleep Hygiene Questionnaire. A one-way MANOVA was employed to compare sleep quality and hygiene in different physical activity levels. A second MANOVA compared sleep quality and hygiene in different physical activity timing, including only the minimally active and very active participants. One-way MANOVA showed a significant difference F (4, 171) = 7.532, Pillai's trace = 0.161, partial eta squared = 0.081 between sleep quality and hygiene scores among inactive, minimally active, and very active participants. A post hoc analysis showed sleep quality was significantly better in minimal active (6.42 ± 2.55, p = 0.002, Cohen's d = 0.867) and very active participants (5.99 ± 2.29, p < 0.001, Cohen's d = 1.092) than inactive (8.61 ± 2.50) participants. Also, sleep hygiene was significantly better in minimal active (28.50 ± 6.74, p = 0.001, Cohen's d = 0.867) and very active participants (29.52 ± 6.56, p < 0.001, Cohen's d = 0.992) than inactive (36.05 ± 8.39) participants. The one-way MANOVA revealed no statistically significant differences in sleep quality and hygiene scores based on physical activity time. Our study showed that physically active individuals had significantly better sleep quality and hygiene scores, while there was no difference based on the timing of physical activity. Healthy individuals may be encouraged to participate in physical activity in the morning, afternoon, or evening to improve sleep parameters.

The Effects of an 8-Month Multicomponent Training Program in Body Composition, Functional Fitness, and Sleep Quality in Aged People: A Randomized Controlled Trial

Background/Objectives: This study examined the effects of an intervention on anthropometrics, body composition, physical fitness, and sleep quality in aged individuals, comparing a control group (N = 11) and an experimental group (N = 13) across two measurement points. Methods: A multicomponent training program of 8 months was adopted as the intervention group. A bioimpedance balance, functional fitness test, and Pittsburgh Sleep Quality Index measured body composition, functional fitness, and sleep quality. Results: Both groups showed minimal changes in body mass and hand grip strength. However, the experimental group experienced significant improvements in physical fitness, including a 26% increase in arm curl repetitions, an 18% reduction in 5 times sit-to-stand (5TSTS) completion time, and a 29% rise in 2-min step test (2MST) steps, indicating enhanced muscle endurance and cardiovascular fitness. Flexibility decreased significantly in the experimental group, while body fat percentage was reduced by 10%. Sleep quality improved by 47% in the experimental group but declined by 14% in the control group. Correlational analysis revealed that better sleep quality was linked to improved fitness performance and reduced body fat in the experimental group, with post-intervention results further confirming the connection between sleep and fat reduction. In the control group, improved sleep quality was associated with higher metabolic rates after 8 months. Conclusions: These findings suggest that the intervention positively impacted physical fitness and sleep quality, with potential benefits for overall health.

Analysis of Physical Activity on Mental Hyperactivity, Sleep Quality, and Bodily Pain in Higher Education Students-A Structural Equation Model

The university population is at a vital stage of human development for acquiring an active lifestyle. Following this lifestyle will bring benefits in adulthood. This study seeks to analyse the relationship between physical activity and bodily pain, mental hyperactivity, and sleep quality as a function of the intensity of physical activity. A comparative, descriptive, and exploratory study is presented in a sample of 506 university students. The International Physical Activity Questionnaire, the Chronic Pain Grade Questionnaire, the Mental Hyperactivity Questionnaire, and the Pittsburgh Sleep Quality Index were used. The proposed model analyses the relationships of physical activity to bodily pain, mental hyperactivity, sleep disturbances, and time to fall asleep. The fit of the different adjustment indices is satisfactory (X2 = 0.47, df = 1, pl = 0.48, IFI = 0.99, CFI = 0.97; NFI = 0.91; RMSEA = 0.01). The relational analysis shows a positive relationship of physical activity to bodily pain (r = 0.02; p < 0.01), mental hyperactivity (r = 0.054; p < 0.01), sleep disturbances (r = 0.029; p < 0.01), and time to fall asleep (r = 0.047; p < 0.01). Multi-group structural equation analysis indicates that there are differences in the causal relationships of physical activity to sleep quality, mental hyperactivity, and bodily pain as a function of exercise intensity. The conclusion is that the intensity at which physical activity is performed plays a key role in mental and physical health.

Effects of life-story review on quality of life, depression, and life satisfaction in older adults in Oman: a randomized controlled study

BACKGROUND

There is a need for healthcare providers to develop life-story review interventions to enhance the mental well-being and quality of life of older adults. The primary aim of this study is to examine the effects of telling their life stories and creating a life-story book intervention on QoL, depressive symptoms, and life satisfaction in a group of older adults in Oman.

METHODS

A repeated-measures randomized controlled design was conducted in Oman. A total of 75 older adults (response rate = 40.1%) were randomly assigned to the intervention (n = 38) or control (n = 37) groups. Demographic data were collected as the baseline. Depression, life satisfaction, and quality of life scores were collected from each participant at weeks 1, 2, 3, 4, and 8.

RESULTS

Their average age is 67.3 ± 5.5 years (range 60-82 years). There are more women (n = 50, 66.7%) than men. Over the 8 weeks, the intervention group exhibited a notable decrease in depression (intervention: 2.5 ± 1.2 vs. control: 5.3 ± 2.1, p < .001) but an increase in life satisfaction (24.6 ± 3.1 vs. 21.9 ± 6.1, p < .001) and quality of life (physical: 76.2 ± 12.7 vs. 53.6 ± 15.5, p < .001; psychological: 76.4 ± 12.1 vs. 59.9 ± 21.5, p < .001; Social relation: 78.3 ± 11.7 vs. 61.8 ± 16.6, p < .001; environment: 70.8 ± 10.2 vs. 58.6 ± 16.1, p < .001) compared to the control group.

CONCLUSION

The life-story review intervention proved effective in diminishing depression and boosting life satisfaction and quality of life among the older sample within the 8-week study. Healthcare providers can apply such interventions to improve older adults' mental health and well-being.

Study on the Profiles of Sleep Disorders, Associated Factors, and Pathways Among Gynecological Cancer Patients - A Latent Profile Analysis

Background

Gynecological cancer generally refers to malignant tumors in gynecology, commonly including cervical cancer, endometrial cancer, and ovarian cancer. Patients with gynecological cancer often suffer from sleep disorders after clinical treatment. Except for serious sleep disorders, female characteristics, family roles, and feudal beliefs make their self-stigma at a medium to high level, leading to huge pressure. This study aims to identify potential categories of sleep disorders, and analyze the relationship between self-stigma, perceived stress, and sleep disorders.

Methods

A cross-sectional study was conducted in 2021-2022. Two hundred and two patients' data were collected from ShengJing Hospital Affiliated to China Medical University in Liaoning, Shenyang by using paper questionnaires for face-to-face surveys. The survey tools included the Pittsburgh Sleep Quality Index (PSQI), the Perceived Stress Scale (PSS), and the Social Impact Scale (SIS). Potential profile analysis (LPA), multiple logistic regression analysis, and structural equation modeling (SEM) were performed by Mplus 8.3, SPSS 26.0, and Amos 24.0 statistical tools, respectively.

Results

Three latent patterns of sleep disorders were found: "Good Sleep group (42.5%)", "Sleep Deficiency group (32.4%)", and "Sleep Disturbance group (25.1%)". Patients with high perceived stress were more likely to report a moderate (OR=1.142, 95% CI: 1.061-1.230) or high (OR=1.455, 95% CI: 1.291-1.640) level of sleep disorders. Self-stigma did not have a direct effect on sleep disorders (0.055, P>0.05), but it could have indirect effect on sleep disorders through perceived stress (0.172, P<0.01).

Conclusion

The perceptions of sleep disorders among gynecological cancer patients varies and exhibits individual differences. Gynecological cancer patients who feels alienated or discriminated may cause high pressure. This internal pressure can exacerbate sleep disorders.

The effects of exercise programs on sleep architecture in obstructive sleep apnea: a meta-analysis of randomized controlled trials

OBJECTIVES

Exercise is an effective intervention for obstructive sleep apnea (OSA). However, the effects of exercise on objective sleep architecture in patients with OSA remain unknown. This meta-analysis aimed to collect data from randomized controlled trials of exercise interventions in patients with OSA, with a specific focus on objective sleep parameters derived from polysomnography.

METHODS

Randomized control trials that targeted patients with OSA aged >18 years, measured sleep using polysomnography after exercise programs, and reported the proportion of sleep stages were included for meta-analysis. Bias was assessed using the revised Cochrane risk-of-bias tool and funnel plots. The random effects model was applied.

RESULTS

Six studies with a total of 236 patients were included in the meta-analysis. There were no significant differences in the total sleep time (TST), sleep efficiency, sleep onset latency, stage N1 sleep, or rapid eye movement sleep between the exercise and control groups. Participation in an exercise program lasting >12 weeks significantly decreased stage N2 and increased stage N3 sleep as observed in the subgroup analysis. Although this tendency did not reach statistical significance in the total-group analysis, it was significant after excluding the possible confounding effects of heart disease.

CONCLUSIONS

The exercise program decreased N2 and increased N3 proportions over the TST among patients with OSA, which may correspond to subjective sleep quality. The beneficial effects were significant when the program lasted >12 weeks and after excluding the confounding effects of heart disease. Exercise program duration should be considered when providing clinical advice.

Influence of Regular Physical Activity on Sleep

Good sleep and adequate physical activity are essential to health. Yet, large numbers of people are chronically deficient in sleep and physical activity. About 1 in 3 Americans get less than 7 h of sleep per night and only 1 of 4 adults regularly complete weekly physical activity in amounts recommended for good health. This chapter reviews research that has examined relationships between regular physical activity and sleep. The overall weight of evidence supports that regular physical activity is associated with better sleep quality among healthy adults, with epidemiological studies showing moderate-sized effects and more well-controlled randomized controlled trial experiments often showing larger effects. Large epidemiology studies suggest that the relationship between regular physical activity and better sleep quality may partially mediate the well-established associations between physical activity and reduced risk of mortality, cardiovascular diseases, and dementia. There is evidence that the completion of regular physical activity also is associated with better sleep quality among those with certain sleep disorders (i.e., insomnia, obstructive sleep apnea, and restless legs syndrome), mental health disorders (i.e., depression and posttraumatic stress disorder), and medical illnesses (i.e., breast cancer survivors). The evidence is inadequate to support that regular physical activity substantially improves sleep quality either (i) in children, adolescents, and older adults, (ii) in those with cancers except for breast cancer, (iii) in those with fibromyalgia, or (iv) among those with chronic kidney disease. Also, there is inadequate evidence to conclude that sleep quality is disrupted during weeks when competitive athletes engage in periods of overtraining.

Community-based exercise program, self-reported health-related symptoms, and quality of life in persons with traumatic brain injury 45 + years old

BACKGROUND

Individuals with moderate to severe traumatic brain injury (msTBI) have reported a lack of motivation, lack of time, and fatigue as perceived barriers to exercise.

OBJECTIVE

To evaluate the effects of an exercise program on self-reported health-related symptoms and quality of life in persons 45-years and older with msTBI.

METHODS

Post-hoc analysis of a prospective community-based 12-week exercise program of 20 adults, age 45-80 years, with msTBI. Ten were in aerobic exercise training (AET) program and 10 in a stretching and toning (SAT) program. The AET group was instructed to exercise based on their estimated maximal heart rate (HR) for 150 minutes weekly. The SAT group was to stretch for the same target time without significantly increasing HR or level of exertion. Outcome measures were Traumatic Brain Injury Quality of Life (TBI-QOL) for global, cognitive, emotional, and social health, Patient Health Questionnaire-9 (PHQ-9) for depressive symptoms, and Pittsburgh Sleep Quality Index (PSQI) for sleep quality.

RESULTS

AET was associated with improved self-reported cognitive health and sleep compared to SAT. Moderate to large, positive effect sizes were also observed in the AET group in the QOL categories of global, emotional, and social health, and depressive symptoms.

CONCLUSIONS

This study offers preliminary evidence that AET may improve health-related QOL, especially for cognition and sleep, in middle-aged and older adults with msTBI.

Aerobic exercise interventions to address impaired quality of life in patients with pituitary tumors

Patients with pituitary tumors may experience persistent fatigue and reduced physical activity, based on subjective measures after treatment. These symptoms may persist despite gross total resection of their tumors and biochemical normalization of pituitary function. While reduced quality of life has been commonly acknowledged in pituitary tumor patients, there is a lack of studies on what interventions may be best implemented to ameliorate these issues, particularly when hormonal levels have otherwise normalized. Aerobic exercise programs have been previously described to ameliorate symptoms of chronic fatigue and reduced physical capacity across a variety of pathologies in the literature. As such, a prescribed aerobic exercise program may be an underrecognized but potentially impactful intervention to address quality of life in pituitary tumor patients. This review seeks to summarize the existing literature on aerobic exercise interventions in patients with pituitary tumors. In addition, future areas of study are discussed, including tailoring exercise programs to the hormonal status of the patient and incorporating more objective measures in monitoring response to interventions.

Effects of an educational intervention on frailty status, physical function, physical activity, sleep patterns, and nutritional status of older adults with frailty or pre-frailty: the FRAGSALUD study

Introduction

The prevalence of frailty is increasing worldwide, emphasizing the importance of prioritizing healthy ageing. To address this, cost-effective and minimally supervised interventions are being sought. This study aimed to assess the impact of an educational program on frailty status, physical function, physical activity, sleep patterns, and nutritional status in community-dwelling older adults with at least 1 Fried's frailty criteria.

Methods

A 6-month multicentre randomized controlled trial was conducted from March 2022 to February 2023 in 14 health centres located in Cadiz and Malaga, Spain. The educational intervention consisted of 4 group sessions and 6 follow-up phone calls spread over 6 months. The program focused on educating participants about frailty and its impact on health, providing guidelines for physical activity, healthy dietary habits, cognitive training, psychological well-being and social activities. A total of 163 participants, divided into control (n = 80) and educational groups (n = 83) were assessed before and after the intervention.

Results

The results showed a significant group-time interaction in the physical function evaluated with a large effect on Short Physical Performance Battery score (η2p = 0.179, -0.1 [-1.2-1.0] points for control group vs. 1.0 [0.0-3.0] points for educational group, p < 0.001), and an effect on the 4-meter gait test ((η2p = 0.122, 0.5 [0.1-0.0] s for control group vs. -0.4 [-0.5- -0.3] s for educational group, p < 0.001), and the 5-repetition sit-to-stand test (η2p = 0.136, 1.0 [0.0-1.2] s for control group vs. -4.3 [-7.0- -2.3] for educational group, p < 0.001). Additionally, the use of accelerometers to assess physical activity, inactivity, and sleep patterns revealed a significant small effect in the number of awakenings at night ((η2p = 0.040, 1.1 [-0.5-3.4] awakenings for control group vs. 0.0 [-2.2-0.0] awakenings for educational group, p = 0.009). The findings also highlighted a significant medium effect regarding malnutrition risk, which was assessed using the Mini-Nutritional Assessment score (η2p = 0.088, -0.7 [-2.3-1.5] points for control group vs. 1.5 [-0.5-3.0] points for educational group, p < 0.001).

Discussion

Thus, the 6-month educational program effectively improved physical function, sleep patterns, and nutritional status compared to usual healthcare attendance in community-dwelling older adults with frailty or pre-frailty. These findings underscore the potential of minimally supervised interventions in promoting a healthy lifestyle in this vulnerable population.