Does exercise improve the sleep quality of older overweight or obese adults?

Abstract

Dear Editor, Human life expectancy is increasing and is generally projected to continue to rise. However, ageing can cause functional incapacities which present a growing challenge to health professionals. One significant problem associated with ageing is a reduction in sleep duration and quality as the areas of the brain that regulate sleep tend to slowly degenerate with age. This can negatively affect the body’s homeostasis, which is restored by a good night’s sleep. The reduced sleep quality and duration associated with ageing may have a significant impact on body weight in older adults. The endocrine system is influenced by both circadian rhythms and sleep– wake state, and sleep disorders can lead to hormonal dysregulation, resulting in endocrine abnormalities that affect the control of hunger and satiety. These include a decrease in the levels of the hormone leptin, responsible for notifying the central nervous system how much fat is available within the cell, and an increase in ghrelin, responsible for stimulating appetite, food intake and fat storage. There has, therefore, been a search for strategies that can help to improve sleep in this population without resorting to the use of medications, which can themselves have significant negative impacts. The review by Vanderlinden et al. reported that moderate intensity exercise programs, with a frequency of three times per week and a duration of between 12 weeks and 6 months, were associated with the greatest number of significant improvements in different sleep outcomes in older adults. In respect of adults with obesity, a systematic review found that exercise reduced the apnoea/ hypopnoea index in cases of mild and severe obstructive sleep apnoea (OSA). OSA is associated with excess adipose tissue present in the pharyngeal airway. However, the effects of exercise training on OSA appear to be superior to weight loss, that is, patients improved their OSA levels without a significant change in body mass index. One hypothesis to explain this phenomenon would be that the increase in slow wave sleep, caused by exercise, would facilitate the activation of motor units of the genioglossus muscle, decreasing OSA. On the other hand, it is possible that there is a complex interaction of factors associated with exercise training that leads to improvement in the severity of sleep apnoea. Besides that, these reviews were of studies of adults aged 18 years or older, rather than specifically being on older adults. Unfortunately, there are few studies on the effects of exercise programs on the sleep quality of overweight older adults. Although it is known that sleep disorders are caused by several factors, particularly in older individuals, their treatment is often neglected by many professionals due to a lack of information, treatment difficulties and the absence of relevant health policies and resources.