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Cited by 246Sleep and related disordersPhysical Activity and HealthCircadian rhythm and melatonin

Effects of moderate-intensity exercise on polysomnographic and subjective sleep quality in older adults with mild to moderate sleep complaints

Open access
King, A. C., Pruitt, L. A., Woo, S., Castro, C. M., Ahn, D. K., Vitiello, M. V., Woodward, S. H., Bliwise, D. L.·2008·The Journals of Gerontology Series A: Biological Sciences and Medical Sciences
DOI 10.1093/gerona/63.9.997PMC PMC7182081
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Abstract

BACKGROUND: This study sought to determine the 12-month effects of exercise increases on objective and subjective sleep quality in initially inactive older persons with mild to moderate sleep complaints. METHODS: A nonclinical sample of underactive adults 55 years old or older (n=66) with mild to moderate chronic sleep complaints were randomly assigned to a 12-month program of primarily moderate-intensity endurance exercise (n=36) or a health education control program (n=30). The main outcome measure was polysomnographic sleep recordings, with additional measures of subjective sleep quality, physical activity, and physical fitness. Directional hypotheses were tested. RESULTS: Using intent-to-treat methods, at 12 months exercisers, relative to controls, spent significantly less time in polysomnographically measured Stage 1 sleep (between-arm difference=2.3, 95% confidence interval [CI], 0.7-4.0; p=003), spent more time in Stage 2 sleep (between-arm difference=3.2, 95% CI, 0.6-5.7; p=.04), and had fewer awakenings during the first third of the sleep period (between-arm difference=1.0, 95% CI, 0.39-1.55; p=.03). Exercisers also reported greater 12-month improvements relative to controls in Pittsburgh Sleep Quality Index (PSQI) sleep disturbance subscale score (p=.009), sleep diary-based minutes to fall asleep (p=.01), and feeling more rested in the morning (p=.02). CONCLUSIONS: Compared with general health education, a 12-month moderate-intensity exercise program that met current physical activity recommendations for older adults improved some objective and subjective dimensions of sleep to a modest degree. The results suggest additional areas for investigation in this understudied area.

Integrity signals

Registry

Crossref · 10.1093/gerona/63.9.997

Cites

41 of 41 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 23 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    At 12 months, exercisers reported feeling more rested in the morning than controls (Results report p = .03 one-tailed; abstract reports p = .02).

    “feeling more rested in the morning (p = .02)”
    • Also stated in: § Changes in 12-Month Secondary Sleep Outcomes: Self-Reported Sleep Quality · plain
      “feeling more rested in the morning (F[1,62] = 3.6; p = .03, one-tailed, effect size = 0.47)”
    Quote in the paperSubstantial claim
  • Findingown data

    At 12 months, exercisers spent less time in polysomnographically measured Stage 1 sleep than controls (between-arm difference 2.3, 95% CI 0.7-4.0, p = .003).

    “at 12 months exercisers, relative to controls, spent significantly less time in polysomnographically measured Stage 1 sleep (between-arm difference = 2.3, 95% confidence interval [CI], 0.7–4.0; p = .003)”
    • Also stated in: § Change in 12-Month Primary Sleep Outcomes: Home PSG · plain
      “Exercisers showed significantly less percentages of time spent in Stage 1 sleep relative to controls (F[1,65] = 8.0, p = .003, one-tailed; group difference = 2.3, 95% confidence interval [CI], 0.7–4.0, effect size = 0.66).”
    Quote in the paperSubstantial claim
  • Findingown data

    At 12 months, exercisers reported reduced sleep-onset latency on sleep diaries compared with controls (Results report p = .008 one-tailed; abstract reports p = .01).

    “sleep diary–based minutes to fall asleep (p = .01)”
    • Also stated in: § Changes in 12-Month Secondary Sleep Outcomes: Self-Reported Sleep Quality · plain
      “exercisers, compared to controls, reported reduced sleep-onset latency (F[1,62] = 6.1, p = .008, one-tailed, effect size = 0.63)”
    Quote in the paperSubstantial claim
  • Findingown data

    At 12 months, exercisers had lower BMI than controls (baseline-adjusted mean 27.1 vs 28.0, F[1,65] = 8.5, p = .002 one-tailed).

    “Exercisers also had significantly lower BMI (baseline-adjusted mean = 27.1 ± 1.2) compared to controls (baseline-adjusted mean = 28.0 ± 1.3) (F[1,65] = 8.5, p = .002, one-tailed).”
    Quote in the paperNot a substantial claim
  • Findingown data

    At 12 months, exercisers had fewer awakenings during the first third of the sleep period than controls (between-arm difference 1.0, 95% CI 0.39-1.55, p = .03).

    “had fewer awakenings during the first third of the sleep period (between-arm difference = 1.0, 95% CI, 0.39–1.55; p = .03)”
    • Also stated in: § Change in 12-Month Primary Sleep Outcomes: Home PSG · plain
      “exercisers had significantly fewer awakenings during the first third of the sleep period relative to controls (F[1,65] = 3.5, p = .03, one-tailed; group difference = 1.0, 95% CI, 0.39–1.55, effect size = 0.50).”
    Quote in the paperSubstantial claim
  • May combine two claims. 7
  • The quote only partly states this claim. 1
  • Classified as probably not a substantial claim. 13

  • May combine two claims.

    Findingown data

    No between-group differences were reported for bedtime, daytime napping, or behavioral variables such as alcohol or caffeine intake, timing or number of warm baths or showers, or use of sleep medications (all p values > .05, one-tailed).

    “There were no between-group differences reported for bedtime, daytime napping, or behavioral variables such as alcohol or caffeine intake, the timing or number of warm baths or showers, or use of sleep medications (all p values > .05, one-tailed).”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    No statistically significant 12-month group differences were found for the other PSG variables besides Stage 1, Stage 2, and awakenings during the first third of sleep.

    “No statistically significant 12-month group differences were observed for other PSG variables.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    No significant correlations were found for Stage 1 sleep percentage.

    “No significant correlations were found for Stage 1 sleep percentage.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Participants spent an average of 1% or less of their baseline sleep time in slow-wave sleep.

    “participants spent an average of 1% or less of their baseline sleep time in SWS sleep (Table 2).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationnone given

    The applicability of the findings to very old adults remains uncertain.

    “The applicability of our findings to very old adults remains uncertain.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    The 12-month shift from Stage 1 to Stage 2 sleep and the reduced awakenings during early sleep represent a small to moderate effect size, similar to those in a meta-analysis of exercise associations with increased Stage 2 and SWS in individuals without insomnia.

    “The significant 12-month shift observed from Stage 1 to Stage 2 sleep and the reduced number of awakenings observed during this early phase of sleep represents a small to moderate effect size (32), similar to those reported in a meta-analysis of the associations of exercise with increased Stage 2 and SWS in individuals without insomnia (33).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [32]

      Not checked in the free run.

    • cites [33]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Median inter-rater reliability (intra-class correlation coefficient) across two trained and blinded PSG technologists was .90 for sleep stages.

    “Median inter-rater reliability (intra-class correlation coefficient) across the two trained and blinded PSG technologists was .90 for sleep stages.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Stage 1 sleep decreased with exercise and was converted to a sleep EEG pattern consistent with more stable sleep (increased Stage 2).

    “Stage 1 sleep, typically considered a transition state from waking to sleep, was decreased with exercise and was converted to a sleep EEG pattern consistent with more stable sleep (i.e., increased Stage 2).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    The results suggest that increases in moderate-intensity primarily endurance exercise may have modest positive effects on several dimensions of objectively measured sleep architecture and on subjective aspects of sleep.

    “The results suggest that increases in moderate-intensity primarily endurance exercise may have modest positive effects on several dimensions of objectively measured sleep architecture as well as on subjective aspects of sleep.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    An observational study including many individuals older than 80 years showed that regular physical activity was protective for insomnia.

    “An observational study including many individuals older than 80 years showed that regular physical activity was protective for insomnia (35).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [35]

      Not checked in the free run.

  • May combine two claims.

    Study design and conductreasoning

    The study may have lacked statistical power for some objectively measured sleep variables (e.g., sleep latency, SWS) and for discerning acute effects of exercise on sleep architecture.

    “it is quite possible that we still lacked statistical power for some objectively measured sleep variables (e.g., sleep latency, SWS), as well as discerning acute effects of exercise on sleep architecture.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    The intervention produced physical activity and fitness changes of similar magnitude to other community-based studies targeting younger populations.

    “the intervention resulted in physical activity and fitness changes of similar magnitude to other community-based studies targeting younger populations (21,29).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [21] source

      Not checked in the free run.

    • cites [29]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Twelve-month retention rates were comparable between arms: 89% for exercise and 90% for control.

    “Twelve-month retention rates were comparable across the two study arms (exercise = 32/36, or 89%; control = 27/30, or 90%).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The intent-to-treat analyses produced results reasonably comparable to those using available data only.

    “The intent-to-treat analyses led to results that were reasonably comparable to those conducted using the available data only.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    Intent-to-treat principles were used for all outcomes, with baseline values substituted for missing or incomplete 12-month data.

    “We incorporated intent-to-treat principles for all outcomes whereby, for participants with missing or incomplete data at 12 months, baseline values were used.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Prevalence studies suggest that more than half of the older population report some degree of sleep problems.

    “Prevalence studies suggest that more than half of the older population report some degree of sleep problems (2).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A sizeable proportion of the general midlife and older adult population reports chronic, albeit milder, sleep complaints that impair quality of life and lead to health care visits.

    “However, a sizeable proportion of the general midlife and older adult population reports chronic, albeit milder, sleep complaints that impair quality of life and result in health care visits (2).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    A total of 17 participant nights were eliminated from analysis because of technical considerations, giving a technical failure rate of 4.2%.

    “A total of 17 participant nights were eliminated from further analysis because of technical considerations (e.g., >25% of recording was unscoreable because of artifact, weak battery, etc.), resulting in a technical failure rate of 4.2%.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Participants in the health education control arm attended 80% of weekly sessions across 12 months.

    “Participants randomized to the health education control arm had similarly good attendance (80%) at the weekly health education sessions across the 12-month period.”
    Quote in the paperNot a substantial claim
19 of 19

  • The paper relies on this without support.

    No published evidence has shown that moderate physical activity during the first half of the day negatively impacts sleep quality.

    “to our knowledge, no published evidence has shown that participating in moderate physical activity during the first half of the day negatively impacts sleep quality”

  • The paper relies on this without support.

    There are no well-accepted pharmacologic or nonpharmacologic interventions to increase slow-wave sleep.

    “Notably, there are no well-accepted pharmacologic or nonpharmacologic interventions to increase SWS.”

  • The paper relies on this without support.

    This study is the first to evaluate the sustained effects of a moderate-intensity exercise program on home-based PSG in older adults with sleep complaints.

    “To our knowledge, this study is the first to evaluate the sustained effects of a moderate-intensity exercise program on home-based PSG in older adults with sleep complaints.”

  • The paper relies on this without support.

    The current investigation has a sample size two- to threefold larger than trials typically undertaken in the sleep-exercise field.

    “Although the current investigation represents a sample size two- to threefold larger than trials typically undertaken in the sleep-exercise field”

  • The paper relies on this without support.

    Increases in visually scored slow-wave sleep following exercise in younger participants have been reported.

    “Increases in visually scored SWS following exercise in younger participants, for example, have been reported and were expected here.”

  • The paper relies on this without support.

    No comparable exercise intervention data for sleep-impaired older adults were available for PSG-derived sample size determinations.

    “No comparable exercise intervention data for sleep-impaired older adults were available for PSG-derived sample size determinations.”
6 of 6

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The effect sizes for improvements in sleep duration and subjective sleep quality in this study were similar to or greater than those reported for cognitive behavioral intervention and other physical activity studies.

    “The effect size for the improvements in sleep duration and subjective sleep quality in this study were similar or even greater than that reported for cognitive behavioral intervention and other physical activity studies [18, 30, 36-38].”

    From Aerobic exercise improves self-reported sleep and quality of life in older adults with insomnia (2010) · cites this paper as [30]

  • The exercise plus sleep hygiene group increased self-reported sleep duration by 1.25 hours, which is higher than reported for other non-pharmacological interventions for insomnia.

    “The increase in self reported sleep duration by 1.25 hours in the exercise plus sleep hygiene education group is higher than what has been reported for other non-pharmacological interventions for insomnia [30, 40]”

    From Aerobic exercise improves self-reported sleep and quality of life in older adults with insomnia (2010) · cites this paper as [30]

  • In older adults with sleep complaints, long-term exercise (16 weeks to 12 months) significantly decreases sleep onset latency but does not significantly increase total sleep time.

    “After long-term exercise (16 weeks - 12 months), older adults with sleep complaints experienced a significant decrease in SOL (mean [SD], from 33.42 [7.1] min to 20.31 [8.1] min, p = 0.03) but no significant increase in TST (mean [SD], from 6.76 [1.1] h to 7.19 [0.5] h, p = 0.46) after (30,31).”

    From Is exercise an alternative treatment for chronic insomnia? (2012) · cites this paper as [31]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Awakenings confidence interval conflicts with its one-tailed p-value

    Minor

    The reported 95% confidence interval excludes zero, which corresponds to a one-tailed p-value below .025 for the same comparison. The stated p-value is .03.

  • Morning-restedness p-values differ

    Minor

    The abstract reports p = .02 for feeling more rested in the morning, whereas the results section reports p = .03.

  • PSQI sleep-disturbance p-values differ

    Minor

    The abstract gives p = .009 for the exercise-versus-control sleep-disturbance result, while the results section gives p = .014 for that outcome.

  • Diary PCA variance is below the stated eigenvalue minimum

    Minor

    For a standardized PCA of five variables, four components with eigenvalues of at least 1 must explain at least 80% of total variance, not 66%.

    Reported 66 · recomputed 80

  • Stage 2 confidence interval conflicts with its one-tailed p-value

    Minor

    A two-sided 95% confidence interval entirely above zero corresponds to a one-tailed p-value below .025 for the same comparison. The reported one-tailed p-value is .04.

5 of 5

Cites

Flagged first, then by citations

3 of the 44 references couldn’t be matched to a known paper.

Research works printed but not linked: 4

  1. 1996, SLEEP RES, 25, 288
  2. 1999, 54, 47
  3. 2000, The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 55A, M74
  4. Buysse, 1991, Sleep, 14, 331

Cited by

Sorted by citations

Related

Authors
King, A. C., Pruitt, L. A., Woo, S., Castro, C. M., Ahn, D. K., Vitiello, M. V., Woodward, S. H., & Bliwise, D. L.
Affiliations
  • Stanford Medicine (US)
  • University of Washington (US)
  • VA Palo Alto Health Care System (US)
  • Emory University (US)
Corresponding author
King, A. C.
ORCID
Venue
The Journals of Gerontology Series A: Biological Sciences and Medical Sciences
Publisher
Oxford University Press (OUP)
Published
2008-09-01
Volume
63
Issue
9
Pages
997-1004
ISSN
  • 1079-5006 (ISSN-L)
  • 1758-535X
DOI
10.1093/gerona/63.9.997
PMC
PMC7182081
OpenAlex
W2097763492
Semantic Scholar
89d51071de95f3e9f45dc240b435572ab4398a9b
Cited by
246
References
44
Citations by year
2026: 7 · 2025: 18 · 2024: 17 · 2023: 12 · 2022: 8 · 2021: 16 · 2020: 16 · 2019: 12 · 2018: 13 · 2017: 11 · 2016: 18 · 2015: 19 · 2014: 17 · 2013: 12 · 2012: 13
FWCI
16.33
Type
journal article
Language
en
Open access
Locations
  • The Journals of Gerontology Series A (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • U.S. Public Health Service
  • National Institute of Mental Health (R01MH058853, R01MH58853)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
  • Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
Keywords
moderate-intensity exercise, endurance exercise, sleep quality, older adults, sleep complaints, polysomnography, sleep stages, awakening, subjective sleep quality, physical activity, physical fitness, health education, sleep disorders
MeSH terms
Aged, Exercise Therapy, Humans, Middle Aged, Sleep, Sleep Wake Disorders, Polysomnography

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