The acute effects of aerobic exercise on sleep in patients with unipolar depression: a randomized controlled trial

Gavin Brupbacher, Thea Zander-Schellenberg, Doris Straus, Hildburg Porschke, Denis Infanger, Markus Gerber, Roland von Känel, Arno Schmidt-Trucksäss, Gavin Brupbacher, Thea Zander-Schellenberg, Doris Straus, Hildburg Porschke, Denis Infanger, Markus Gerber, Roland von Känel, Arno Schmidt-Trucksäss

Abstract

Study objectives: Insomnia increases the risk of negative disease trajectory, relapse, and suicide in patients with depression. We aimed at investigating the effects of a single bout of aerobic exercise, performed after 02:00 pm, on the subsequent night's sleep in patients with depression.

Methods: The study was designed as a two-arm parallel-group, randomized, outcome assessor-blinded, controlled, superiority trial. Patients between 18 and 65 years of age with a primary diagnosis of unipolar depression were included. The intervention was a single 30-minute bout of moderate aerobic exercise. The control group sat and read for 30 minutes. The primary outcome was sleep efficiency measured by polysomnography. Secondary outcomes were other polysomnographic variables, subjective sleep quality, daytime sleepiness, mood states, and adverse events.

Results: Ninety-two patients were randomized to the exercise (N = 46) or control group (N = 46). There were no clinically relevant differences at baseline. Intent-to-treat analysis ANCOVA of follow-up sleep efficiency, adjusted for baseline levels and minimization factors, did not detect a significant effect of the allocation (β = -0.93, p = 0.59). There was no evidence for significant differences between both groups in any other objective or subjective sleep outcomes, daytime sleepiness, or adverse events. The intervention had an immediate positive effect on mood states, including depressiveness (β = -0.40, p = 0.003).

Conclusions: This is the first trial to study the effects of a single bout of aerobic exercise on sleep in patients with depression to the best of our knowledge. Aerobic exercise had no effect on sleep efficiency but had a strong beneficial effect on mood and did not increase adverse outcomes. These results add to the growing body of evidence that, contrary to sleep hygiene recommendations, exercise after 02:00 pm is not detrimental for sleep.

Clinical trial registration: Clinicaltrials.gov, https://ichgcp.net/clinical-trials-registry/NCT03673397. Protocol registered on September 17, 2018.

Keywords: depression; exercise; mood; polysomnography; randomized controlled trial; sleep.

© Sleep Research Society 2021. Published by Oxford University Press on behalf of the Sleep Research Society.

Figures

Figure 1.
Figure 1.
Trial design.
Figure 2.
Figure 2.
CONSORT participant flow.
Figure 3.
Figure 3.
Baseline and follow-up sleep efficiency by allocation.

References

    1. Edinger JD, et al. ; American Academy of Sleep Medicine Work Group. Derivation of research diagnostic criteria for insomnia: report of an American Academy of Sleep Medicine Work Group. Sleep. 2004;27(8):1567–1596. doi:10.1093/sleep/27.8.1567.
    1. Li L, et al. . Insomnia and the risk of depression: a meta-analysis of prospective cohort studies. BMC Psychiatry. 2016;16(1):375.
    1. Blanken TF, et al. . Network outcome analysis identifies difficulty initiating sleep as a primary target for prevention of depression: a 6-year prospective study. Sleep. 2020;43(5). doi:10.1093/sleep/zsz288.
    1. Spiegelhalder K, et al. . Comorbid sleep disorders in neuropsychiatric disorders across the life cycle. Curr Psychiatry Rep. 2013;15(6):364.
    1. Alvaro PK, et al. . A systematic review assessing bidirectionality between sleep disturbances, anxiety, and depression. Sleep. 2013;36(7):1059–1068. doi:10.5665/sleep.2810.
    1. Franzen PL, et al. . Sleep disturbances and depression: risk relationships for subsequent depression and therapeutic implications. Dialogues Clin Neurosci. 2008;10(4):473–481.
    1. Boland EM, et al. . Is sleep disturbance linked to short- and long-term outcomes following treatments for recurrent depression? J Affect Disord. 2020;262:323–332.
    1. Troxel WM, et al. . Insomnia and objectively measured sleep disturbances predict treatment outcome in depressed patients treated with psychotherapy or psychotherapy-pharmacotherapy combinations. J Clin Psychiatry. 2012;73(4):478–485.
    1. Mason BL, et al. . Focusing on insomnia symptoms to better understand depression: a STAR*D report. J Affect Disord. 2020;260:183–186.
    1. Cepeda MS, et al. . Finding factors that predict treatment-resistant depression: results of a cohort study. Depress Anxiety. 2018;35(7):668–673.
    1. Wang X, et al. . Systematic review and meta-analysis of the relationship between sleep disorders and suicidal behaviour in patients with depression. BMC Psychiatry. 2019;19(1):303.
    1. Carney RM, et al. . Insomnia and depression prior to myocardial infarction. Psychosom Med. 1990;52(6):603–609.
    1. van Mill JG, et al. . Insomnia and sleep duration in a large cohort of patients with major depressive disorder and anxiety disorders. J Clin Psychiatry. 2010;71(3):239–246.
    1. Perlis ML, et al. . Self-reported sleep disturbance as a prodromal symptom in recurrent depression. J Affect Disord. 1997;42(2-3):209–212.
    1. Nierenberg AA, et al. . Residual symptoms after remission of major depressive disorder with citalopram and risk of relapse: a STAR*D report. Psychol Med. 2010;40(1):41–50.
    1. Norton K, et al. . Position statement on physical activity and exercise intensity terminology. J Sci Med Sport. 2010;13(5):496–502.
    1. Brupbacher G, et al. . The effects of exercise on sleep in unipolar depression: a systematic review and network meta-analysis. Sleep Med Rev. 2021;59:101452.
    1. Morres ID, et al. . Aerobic exercise for adult patients with major depressive disorder in mental health services: a systematic review and meta-analysis. Depress Anxiety. 2019;36(1):39–53.
    1. Stubbs B, et al. . Exercise improves cardiorespiratory fitness in people with depression: a meta-analysis of randomized control trials. J Affect Disord. 2016;190:249–253.
    1. Gan Y, et al. . Depression and the risk of coronary heart disease: a meta-analysis of prospective cohort studies. BMC Psychiatry. 2014;14:371.
    1. American Sleep Association. Sleep Hygiene Tips. Boston, MA: American Sleep Association. . Accessed May 18, 2021.
    1. Buman MP, et al. . Does nighttime exercise really disturb sleep? Results from the 2013 National Sleep Foundation Sleep in America Poll. Sleep Med. 2014;15(7):755–761.
    1. Stutz J, et al. . Effects of evening exercise on sleep in healthy participants: a systematic review and meta-analysis. Sports Med. 2019;49(2):269–287.
    1. Haskell WL, et al. ; American College of Sports Medicine; American Heart Association. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation. 2007;116(9):1081–1093.
    1. Brupbacher G, et al. . The acute effects of aerobic exercise on sleep in patients with depression: study protocol for a randomized controlled trial. Trials. 2019;20(1):352.
    1. Schulz KF, et al. ; CONSORT Group. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMC Med. 2010;8:18.
    1. Dickhuth HH, et al. . Ventilatory, lactate-derived and catecholamine thresholds during incremental treadmill running: relationship and reproducibility. Int J Sports Med. 1999;20(2):122–127.
    1. Kroenke K, et al. . The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms. Psychosom Med. 2002;64(2):258–266.
    1. Linn BS, et al. . Cumulative illness rating scale. J Am Geriatr Soc. 1968;16(5):622–626.
    1. Obbarius A, et al. . Standardization of health outcomes assessment for depression and anxiety: recommendations from the ICHOM Depression and Anxiety Working Group. Qual Life Res. 2017;26(12):3211–3225.
    1. Herrmann C, et al. . HADS-D – Hospital Anxiety and Depression Scale – Deutsche Version (HADS-D – Hospital Anxiety and Depression Scale – German Version). Bern, Switzerland: Huber; 2011.
    1. Brennan C, et al. . The Hospital Anxiety and Depression Scale: a diagnostic meta-analysis of case-finding ability. J Psychosom Res. 2010;69(4):371–378.
    1. Klein EM, et al. . The German version of the Perceived Stress Scale – psychometric characteristics in a representative German community sample. BMC Psychiatry. 2016;16:159.
    1. Drake C, et al. . Vulnerability to stress-related sleep disturbance and hyperarousal. Sleep. 2004;27(2):285–291. doi:10.1093/sleep/27.2.28.
    1. Kalmbach DA, et al. . Identifying at-risk individuals for insomnia using the Ford Insomnia Response to Stress Test. Sleep. 2016;39(2):449–456. doi:10.5665/sleep.5462.
    1. Dieck A, et al. . Validation of the German version of the Ford Insomnia Response to Stress Test. J Sleep Res. 2018;27(3):e12621.
    1. Lang C, et al. . Validation of the German version of the short form of the dysfunctional beliefs and attitudes about sleep scale (DBAS-16). Neurol Sci. 2017;38(6):1047–1058. doi:10.1007/s10072-017-2921-x.
    1. Horne JA, et al. . A self-assessment questionnaire to determine morningness-eveningness in human circadian rhythms. Int J Chronobiol. 1976;4(2):97–110.
    1. Kantermann T, et al. . Comparing the Morningness-Eveningness Questionnaire and Munich ChronoType Questionnaire to the dim light melatonin onset. J Biol Rhythms. 2015;30(5):449–453.
    1. Griefahn B, et al. . Zur Validität der deutschen Übersetzung des Morningness-Eveningness-Questionnaires von Horne und Östberg. Somnologie. 2001;5(2):71–80. doi:10.1046/j.1439-054X.2001.01149.x.
    1. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14(6):540–545. doi:10.1093/sleep/14.6.540.
    1. Bloch KE, et al. . German version of the Epworth Sleepiness Scale. Respiration. 1999;66(5):440–447.
    1. Buysse DJ, et al. . The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213.
    1. Backhaus J, et al. . Schlafstörungen Bewältigen [Coping with Sleep Disorders]. Weinheim, Germany: Beltz Psychologie Verlags Union; 1996. . Accessed February 20, 2018.
    1. Chiu HY, et al. . A meta-analysis of diagnostic accuracy of three screening tools for insomnia. J Psychosom Res. 2016;87:85–92.
    1. Sateia MJ, et al. . Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: an American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med. 2017;13(2):307–349.
    1. Morgenthaler T, et al. ; American Academy of Sleep Medicine. Practice parameters for the psychological and behavioral treatment of insomnia: an update. An American Academy of Sleep Medicine report. Sleep. 2006;29(11):1415–1419. doi:10.1093/sleep/29.11.1415.
    1. Devilly GJ, et al. . Psychometric properties of the credibility/expectancy questionnaire. J Behav Ther Exp Psychiatry. 2000;31(2):73–86.
    1. Williams AD, et al. . Combining imagination and reason in the treatment of depression: a randomized controlled trial of internet-based cognitive-bias modification and internet-CBT for depression. J Consult Clin Psychol. 2013;81(5):793–799.
    1. Fietze I, et al. . Actigraphy combined with EEG compared to polysomnography in sleep apnea patients. Physiol Meas. 2015;36(3):385–396.
    1. Berry RB, et al. . The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications. Darien, IL: American Academy of Sleep Medicine; 2012. . Accessed May 5, 2017.
    1. Kendrick AH, et al. . Quality assurance of full polysomnography scoring using the American Academy of Sleep Medicine (AASM) inter-scorer reliability (ISR) program. Eur Respir J. 2017;50(Suppl 61):PA2485. doi:10.1183/1393003.congress-2017.PA2485.
    1. Rosenberg RS, et al. . The American Academy of Sleep Medicine inter-scorer reliability program: sleep stage scoring. J Clin Sleep Med. 2013;9(1):81–87.
    1. Görtelmeyer R. Schlaffragebogen A Und B: SF-A/R Und SF-B/R. Göttingen, Germany: Hogrefe; 2011.
    1. Riemann D, et al. . S3-Leitlinie Nicht erholsamer Schlaf/Schlafstörungen. Somnologie. 2017;21(1):2–44.
    1. O’Callaghan CA. OxMaR: open source free software for online minimization and randomization for clinical trials. PLoS One. 2014;9(10):e110761.
    1. Chan AW, et al. . SPIRIT 2013 statement: defining standard protocol items for clinical trials. Ann Intern Med. 2013;158(3):200–207.
    1. Abele-Brehm A, Brehm W. Zur Konzeptualisierung und Messung von Befindlichkeit: Die Entwicklung der “Befindlichkeitsskalen” (BFS) [The conceptualization and measurement of mood: the development of the “Mood Survey.”]. Diagnostica. 1986;32(3):209–228.
    1. Höchsmann C, et al. . Validity of activity trackers, smartphones, and phone applications to measure steps in various walking conditions. Scand J Med Sci Sports. 2018;28(7):1818–1827.
    1. MacLean AW, et al. . Psychometric evaluation of the Stanford Sleepiness Scale. J Sleep Res. 1992;1(1):35–39.
    1. Baglioni C, et al. . Sleep and mental disorders: a meta-analysis of polysomnographic research. Psychol Bull. 2016;142(9):969–990.
    1. Kahan BC, et al. . Reporting and analysis of trials using stratified randomisation in leading medical journals: review and reanalysis. BMJ. 2012;345:e5840.
    1. Long JS, Ervin LH. Using heteroscedasticity consistent standard errors in the linear regression model. Am Stat. 2000;54(3):217–224. doi:10.1080/00031305.2000.10474549
    1. van Buuren S, Groothuis-Oudshoorn K. MICE: multivariate imputation by chained equations in R. J Stat Softw. 2011;45(1):1–67. doi:10.18637/jss.v045.i03
    1. R Core Team. R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing; 2020. .
    1. Borm GF, et al. . A simple sample size formula for analysis of covariance in randomized clinical trials. J Clin Epidemiol. 2007;60(12):1234–1238.
    1. Passos GS, et al. . Effect of acute physical exercise on patients with chronic primary insomnia. J Clin Sleep Med. 2010;6(3):270–275.
    1. Stubbs B, et al. . Dropout from exercise randomized controlled trials among people with depression: a meta-analysis and meta regression. J Affect Disord. 2016;190:457–466.
    1. Benjamini Y, Hochberg Y. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J R Stat Soc Series B Stat Methodol. 1995;5(1):289–300.
    1. Youngstedt SD, et al. . Testing the sleep hygiene recommendation against nighttime exercise. Sleep Breath. 2021. doi:10.1007/s11325-020-02284-x.
    1. Baron KG, et al. . Exercise to improve sleep in insomnia: exploration of the bidirectional effects. J Clin Sleep Med. 2013;9(8):819–824.
    1. Morita Y, et al. . Effects of acute morning and evening exercise on subjective and objective sleep quality in older individuals with insomnia. Sleep Med. 2017;34:200–208.
    1. Chen LJ, et al. . Effects of an acute bout of light-intensity walking on sleep in older women with sleep impairment: a randomized controlled trial. J Clin Sleep Med. 2019;15(4):581–586.
    1. Hertenstein E, et al. . Reference data for polysomnography-measured and subjective sleep in healthy adults. J Clin Sleep Med. 14(04):523–532. doi:10.5664/jcsm.7036
    1. Boulos MI, et al. . Normal polysomnography parameters in healthy adults: a systematic review and meta-analysis. Lancet Respir Med. 2019;7(6):533–543.
    1. Kredlow MA, et al. . The effects of physical activity on sleep: a meta-analytic review. J Behav Med. 2015;38(3):427–449.
    1. Niedermeier M, et al. . Acute effects of a single bout of walking on affective responses in patients with major depressive disorder. Int J Environ Res Public Health. 2021;18(4):1524. doi:10.3390/ijerph18041524.
    1. Stark R, et al. . Acute effects of a single bout of moderate exercise on psychological well-being in patients with affective disorder during hospital treatment. Neuropsychiatr. 2012;26(4):166–170.
    1. Frühauf A, et al. . Acute effects of outdoor physical activity on affect and psychological well-being in depressed patients – a preliminary study. Ment Health Phys Act. 2016;10:4–9. doi:10.1016/j.mhpa.2016.02.002.
    1. Bartholomew JB, et al. . Effects of acute exercise on mood and well-being in patients with major depressive disorder. Med Sci Sports Exerc. 2005;37(12):2032–2037.
    1. Legrand FD, et al. . Acute effects of outdoor and indoor exercise on feelings of energy and fatigue in people with depressive symptoms. J Environ Psychol. 2018;56:91–96. doi:10.1016/j.jenvp.2018.03.005.
    1. Niemeijer A, et al. . Adverse events of exercise therapy in randomised controlled trials: a systematic review and meta-analysis. Br J Sports Med. 2020;54(18):1073–1080.
    1. Krogh J, et al. . Exercise for patients with major depression: a systematic review with meta-analysis and trial sequential analysis. BMJ Open. 2017;7(9):e014820.
    1. Danker-Hopfe H, et al. . Interrater reliability for sleep scoring according to the Rechtschaffen & Kales and the new AASM standard. J Sleep Res. 2009;18(1):74–84.
    1. Zhang X, et al. . Process and outcome for international reliability in sleep scoring. Sleep Breath. 2015;19(1):191–195.
    1. Carlson LA, et al. . Influence of exercise time of day on salivary melatonin responses. Int J Sports Physiol Perform. 2019;14(3):351–353.
    1. Thomas JM, et al. . Circadian rhythm phase shifts caused by timed exercise vary with chronotype. JCI Insight. 2020;5(3). doi:10.1172/jci.insight.134270.
    1. Seol J, et al. . Effects of morning versus evening home-based exercise on subjective and objective sleep parameters in older adults: a randomized controlled trial. J Geriatr Psychiatry Neurol. 2020;34(3):232–242. doi:10.1177/0891988720924709.

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