Resistance or muscle strengthening exercise appears to help in tackling insomnia in older age, according to an article published today (5 March) in the open access journal Family Medicine and Community Health.

The paper, based on a pooled data analysis of the available research, found that aerobic exercise or a mix of strength, aerobic, balance, and flexibility exercises also seem to be effective.

Written by first author is Pakwan Bahalayothin from Ramathibodi Hospital, Mahidol University in Bangkok, Thailand and colleagues, the article states that sleep quality tends to decline with age.

In a bid to find out which exercise might be most useful, the team scoured research databases for relevant clinical trials, published up to October 2022. The trials compared physical exercise with routine activities, usual care, other non-physical activity, or health education in people formally diagnosed with insomnia, using The Global Pittsburgh Sleep Quality Index (GPSQI). 

The types of exercise covered by the studies included: aerobic, such as cycling, dancing, swimming, brisk walking, and gardening; resistance, such as using weights, push-ups, and planks; balance, such as step-ups, heel to toe walking; flexibility, such as gymnastics, yoga, and Pilates; and combination exercise encompassing a mix. 

‘Exercise, particularly strengthening exercise and aerobic exercise, is beneficial for enhancing subjective sleep quality at a clinically significant level compared with normal activities’ [Pakwan Bahalayothin]

A total of 24 studies, involving 2,045 adults aged at least 60 (average 70), were included in the pooled data analysis. Most were carried out in Asia (56 per cent), North America (16 per cent), south America (16 per cent), and Europe (12 per cent). One in five were carried out in nursing homes. 

Over half of the reported exercise intensity was mild to moderate and moderate, with average length of a session just over 50 minutes, and frequency around two to three times a week. On average, the exercise programmes lasted 14 weeks.

The pooled data analysis included only studies looking at combination exercise and aerobic exercise, because there weren’t enough studies covering the other exercise types.

Network meta analysis: the findings

The analysis carried out by Dr Bahalayothin and colleagues showed that combined exercise significantly improved the GPSQI by 2.35 points while aerobic activity improved it by 4.35 points. When the data were pooled using a network meta analysis – a statistical method that looks at several different ‘treatments’ and combines both direct and indirect effects – strength/resistance exercise was the most effective, improving the GPSQI by 5.75 points.

Aerobic exercise improved the GPQSI by 3.76 points, while combination exercise improved it by 2.54. Of the comparators, sleep education was the most effective, although what this entailed wasn’t clearly defined in the included studies, and it still wasn’t as good as muscle strengthening/resistance exercise, the analysis showed.

Caveats and conclusions

Dr Bahalayothin and colleagues warn that the design and methodology of the included studies varied considerably, and only a few looked at particular types of exercise. Several failed to include any information on exercise intensity. 

Some exercises may prove challenging for older people because of restricted physical capabilities, suggest Dr Bahalayothin and colleagues. Nevertheless they conclude: ‘Exercise, particularly strengthening exercise and aerobic exercise, is beneficial for enhancing subjective sleep quality at a clinically significant level compared with normal activities.’

Fact file

Sleep quality tends to decline with age. As many as one older adult in five has insomnia, say the researchers. Poor quality sleep is not only linked to a range of serious health problems and cognitive impairment, but it also increases the likelihood of workplace underperformance and absenteeism, they add.

Previously published research suggested that exercise helps to alleviate the symptoms of insomnia, but it has been unclear which type of exercise might be most helpful.

To access the full version of the article – titled Impact of different types of physical exercise on sleep quality in older population with insomnia: a systematic review and network meta-analysis of randomised controlled trials Doi: 10.1136/fmch-2024-003056 – see: https://fmch.bmj.com/lookup/doi/10.1136/fmch-2024-003056

Image: Shutterstock