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Moderators and mediators of exercise-induced objective sleep improvements in midlife and older adults with sleep complaints.

ABSTRACT: Exercise can improve sleep quality, but for whom and by what means remains unclear. We examined moderators and mediators of objective sleep improvements in a 12-month randomized controlled trial among underactive midlife and older adults reporting mild/moderate sleep complaints.Participants (N = 66, 67% women, 55-79 years) were randomized to moderate-intensity exercise or health education control. Putative moderators were gender, age, physical function, self-reported global sleep quality, and physical activity levels. Putative mediators were changes in BMI, depressive symptoms, and physical function at 6 months. Objective sleep outcomes measured by in-home polysomnography were percent time in Stage I sleep, percent time in Stage II sleep, and number of awakenings during the first third of sleep at 12 months.Baseline physical function and sleep quality moderated changes in Stage I sleep; individuals with higher initial physical function (p = .01) and poorer sleep quality (p = .03) had greater improvements. Baseline physical activity level moderated changes in Stage II sleep (p = .04) and number of awakenings (p = .01); more sedentary individuals had greater improvements. Decreased depressive symptoms (CI:-1.57 to -0.02) mediated change in Stage I sleep. Decreased depressive symptoms (CI:-0.75 to -0.01), decreased BMI (CI:-1.08 to -0.06), and increased physical function (CI: 0.01 to 0.72) mediated change in number of awakenings.Initially less active individuals with higher initial physical function and poorer sleep quality improved the most. Affective, functional, and metabolic mediators specific to sleep architecture parameters were suggested. These results indicate strategies to more efficiently treat poor sleep through exercise in older adults.

SUBMITTER: Buman MP

PROVIDER: S-EPMC3210555 | biostudies-literature | 2011 Sep

REPOSITORIES: biostudies-literature

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Moderators and mediators of exercise-induced objective sleep improvements in midlife and older adults with sleep complaints.

Buman Matthew P MP Hekler Eric B EB Bliwise Donald L DL King Abby C AC

Health psychology : official journal of the Division of Health Psychology, American Psychological Association 20110901 5

<h4>Objective</h4>Exercise can improve sleep quality, but for whom and by what means remains unclear. We examined moderators and mediators of objective sleep improvements in a 12-month randomized controlled trial among underactive midlife and older adults reporting mild/moderate sleep complaints.<h4>Methods</h4>Participants (N = 66, 67% women, 55-79 years) were randomized to moderate-intensity exercise or health education control. Putative moderators were gender, age, physical function, self-rep ...[more]

PMID: 21688915

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Project description:Study objectivesPoor sleep quality, a frequent problem in older adults, has been shown to be associated with reduced physical function and wellbeing. However, little is known about the relationship between sleep quality and the recovery of physical function following hospitalization. Thus, we conducted this study to examine the association between sleep quality and functional recovery after an acute hospitalization in community dwelling older adults.MethodsOlder adult patients (N = 23, mean age = 74 ± 9 years) were recruited during an acute hospitalization (average length of stay 3.9 days) with a cardiovascular (56%), pulmonary (22%), or metabolic (13%) admission diagnosis. Objective physical function was measured using the Short Physical Performance Battery (SPPB) and self-reported function was assessed with Katz Index of Independence in Activities of Daily Living (ADL) and Lawton Instrumental Activities of Daily Living Scale (IADL). Sleep quality was measured using Pittsburgh Sleep Quality Index (PSQI) global score and Iowa Fatigue Score (IFS). Testing was performed prior to discharge (baseline) and 4-weeks post-discharge (follow-up).ResultsRegression models showed PSQI Subjective Sleep Quality change scores from baseline to 4-week follow-up predicted a change in ADL (β = -0.22); PSQI Use of Sleep Medications change scores predicted a change in SPPB Total (β = 1.62) and SPPB Chair Stand (β = 0.63); IFS change scores predicted SPPB Total (β = -0.16) and SPPB Chair Stand performance (β = -0.07) change scores.ConclusionsFor older adults, changes in sleep medication use, daytime dysfunction, and fatigue were associated with improvements in functional recovery (including physical performance and independence) from acute hospitalization to 4-week follow-up. These results suggest that interventions focused on improving sleep quality, daytime consequences, and fatigue might help enhance physical functioning following hospitalization.Clinical trial registrationClinicalTrials.gov, identifier: NCT02203656.

Project description:Sleep quality decreases with aging and thus sleep complaints are prevalent in older adults, particularly for those with cognitive impairment and dementia. For older adults, emerging evidence suggests poor sleep quality increases risk of developing cognitive impairment and dementia. Given the aging population-and the impending economic burden associated with increasing numbers of dementia patients-there is pressing need to improve sleep quality among older adults. As such, research efforts have increased focus on investigating the association between age-related sleep changes and cognitive decline in older adults. Sleep quality is a complex construct to evaluate empirically, and yet the Pittsburg Sleep Quality Index (PSQI) is commonly used in studies as their only measure of sleep quality. Furthermore, the PSQI may not be the best sleep quality measure for older adults, due to its reliance on the cognitive capacity to reflect on the past month. Further study is needed to determine the PSQI's validity among older adults. Thus, the current study examined sleep quality for 78 community dwelling adults 55+ to determine the PSQI's predictive validity for objective sleep quality (as measured by actigraphy). We compared two subjective measures of sleep quality-the PSQI and Consensus Sleep Diary (CSD)-with actigraphy (MotionWatch 8©; camntech). Our results suggest perceived sleep quality is quite different from objective reality, at least for adults 55+. Importantly, we show this difference is unrelated to age, gender, education, or cognitive status (assessed using standard screens). Previous studies have shown the PSQI to be a valuable tool for assessing subjective sleep quality; however, our findings indicate for older adults the PSQI should not be used as a substitute for actigraphy, or vice versa. Hence, we conclude best practice is to include both subjective and objective measures when examining sleep quality in older adults (i.e., the PSQI, CSD, and actigraphy).

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Moderators and mediators of exercise-induced objective sleep improvements in midlife and older adults with sleep complaints.

Publications

Moderators and mediators of exercise-induced objective sleep improvements in midlife and older adults with sleep complaints.

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