Physical activity to the current recommended guidelines and sleep quality of adults with insomnia

Systematic reviews have consistently found that moderate intensity physical activity levels at or above a threshold value of 150 minutes per week reliably deliver cardiovascular, metabolic and musculo-skeletal health benefits. As a result, this threshold value has been widely adopted as an aspirational, public health goal throughout the world. However, while epidemiological and laboratory studies have established clear links between physical activity and sleep outcomes, the evidence base does not yet provide guidelines on minimum levels of exercise likely to reduce insomnia symptoms and improve sleep quality. Such a guideline, if evidence based, could greatly clarify advice, and accelerate the use of physical activity goals to improve sleep outcomes in behavioural sleep medicine and public health. This thesis examined the current public-health recommendation of 150 minutes of moderate intensity activity per week in relation to sleep outcomes. To commence, it established a population-level pattern of the relationship between levels of physical activity and sleep quality by reviewing relevant epidemiological evidence. Exploratory analyses were then conducted using data from an ongoing longitudinal study of physical activity and health outcomes among older people (aged 65 years and above) in which respondents were classified as walking at or above, or below the recommended threshold of 150 minutes per week. In regression models controlling for health and demographic factors, these analyses showed that higher levels of walking were significantly and independently associated with a lower likelihood of either reporting insomnia symptoms (OR = 0.67 (95% CI = 0.45 0.91) p=0.04), or experiencing poor sleep efficiency (OR = 0.70 (95% CI = 0.52 0.94 p=0.02). Using the same data, the predictive validity of this activity threshold was then confirmed in a 27-year survival analysis which showed a significantly decreased all-cause mortality risk associated with the higher level of walking (HR = 0.75 (95% CI = 0.65 - 0.86) p<0.01). These findings offered proof of concept that physical activity-sleep relationships operated on a continuum, with sleep benefits possible even at relatively low levels of activity. Experimental evidence on the acute and sustained effects of physical activity on sleep quality was then analysed and discussed. Outcomes from this review, together with the preliminary analyses described above, were then used to inform the design of a randomised controlled trial to investigate the effects on sleep quality of increasing physical activity to currently recommended levels among sedentary people with insomnia. A total of 41 sedentary adults meeting DSM-IV criteria for insomnia (30 female; mean age 59.8±9.5) were randomised to a physical activity group (≥150 minutes moderate intensity activity/week) or a waiting list control group. The principal outcome was Insomnia Severity Index (ISI) change 6 months post baseline; secondary outcomes were anxiety (using the State Trait Anxiety Inventory) and depression (Beck Depression Inventory II). Physical activity was assessed using Actigraph GTX3+ accelerometers. Outcomes were assessed in univariate general linear models, adjusted for baseline confounders. Activity and sleep assessments did not differ at baseline. At 6 months post baseline the intervention group engaged in 213 min/week of moderate intensity PA, compared to the control group (82 min/week). Compared to the control group, the intervention group showed significant improvement in the ISI score at 6 months F(1,28) = 5.16, p=0.03), adjusted means difference = 3.37, with an adjusted Cohen's d =.78 (95% CI 0.10 1.45). There was a significant improvement in trait anxiety, and depression outcomes post-intervention, F(6,28)=4.41, p=0.05, and F(6,28)=5.61, p=0.02, respectively. The results showed that increasing activity in line with current guidelines could deliver clinically significant improvements in sleep quality and mood outcomes among inactive adults with insomnia. While the effect sizes are modest, the pattern of results reported here allow for two conclusions with clear implications for public health: 1) measures to increase levels of physical activity above the currently recommended threshold of 150 minutes per week could usefully be added to other approaches to insomnia management; and 2) the likelihood of improved sleep quality should be routinely added to those evidence-based cardiovascular and metabolic benefits most frequently associated with increased physical activity in behaviour change initiatives

Sleep duration and all-cause mortality: links to physical activity and prefrailty in a 27-year follow up of older adults in the UK

Objectives: To assess sleep duration-mortality relationships across a 27-year follow-up period in a well characterized random sample of older people, and to test the hypothesis that mortality risks associated with long sleep duration confound with, and can be explained by, low levels of functional capacity indicative of frailty. Methods: Face-to-face interviews conducted among 1002 randomly sampled older (65+) people in 1985 provided baseline profiles of health, functional capacity, physical activity, and sleep quality and duration. Health and functional status in each of 6 sleep duration categories (≤4, 5, 6, 7, 8, ≥9 h) was examined. At censorship in 2012, 927 deaths were recorded. Relationships between sleep duration and 27-year all-cause mortality were then examined in a series of incrementally adjusted Cox regression models. Results: Associations between sleep duration and measures of sleep quality were predominantly linear, with longer sleep times indicating superior sleep quality. Relationships between sleep duration and functional capacity, on the other hand, were predominantly quadratic, with most approximating a U-shaped function. Adjusted for age, gender, social class, insomnia symptoms, physical health, depression, BMI and smoking status, long sleep duration and continuous hypnotic drug use at baseline were significantly and independently associated with elevated mortality risk (HR: 1.37; 95% CI: 1.05–1.78; HR: 1.24; 95% CI: 1.01–1.51). When indices of frailty were added to the model, hazard ratios for long sleep duration and hypnotic drug became non-significant, while the lowest physical activity quintile and very slow walking speed significantly increased mortality risk (HR: 1.79; 95% CI: 1.40–2.30; HR: 1.41; 95% CI: 1.15–1.73 respectively). Conclusions: In analyses of sleep-related mortality outcomes long sleep durations confound with, and may be indicative of, incipient frailty among older participants

Regular physical activity and insomnia: an international perspective

Very low, and very high levels of regular physical activity have been associated with degraded sleep quality. Cross-national variations in habitual physical activity levels may contribute to cross-national differences in insomnia prevalence. The present study assesses and compares the extent to which weekly durations of moderate intensity physical activity contribute to insomnia risk. Demographic, sleep, physical activity and general health profiles were obtained from a convenience sample of 9238 adults drawn from 5 countries (South Africa, Australia, China, South Korea and the UK) using social media. Insomnia prevalence ranged from 4.1% (China) to 14.8% (UK). In logistic regression adjusted only for age and gender, the lowest level of activity was associated with significant insomnia risk (OR = 1.37 (95%CI =1.05-1.79;p300 min/week) was associated with significantly increased insomnia risk (OR = 1.30 (95%CI =1.03–2.51;p< 0.05). Risk associated with high activity remained after the addition of ‘country’ to the model (OR = 1.31 (95%CI =1.02–1.69;p< 0.05). Across all models, female gender, low rated health, low education, and older age consistently increased insomnia risk. These cross-national data indicate that extremes of inactivity/activity can significantly influence insomnia risk independent of country. Insomnia risk associated with very low levels of activity may be mediated by poorer health and disadvantageous social status. However, while very high levels of activity increase insomnia risk independent of health and demographic factors, they may also confound with personally and occupationally demanding lifestyles

Project-based learning and the development of students' professional identity:A case study of an instructional design course with real clients in Romania

Instructional design (ID) education is increasingly moving from a modelbased to a design-based approach, prompting renewed attention on requirements to align students’ and practitioners’ professional identities. Yet there is little current understanding of how traditionally-used pedagogies, such as project-based learning (PjBL), contribute to the necessary identity development of students. This project aims to identify connections between students’ development of professional identity and elements of PjBL, based on a two-year case study of an ID graduate course in Romania. Data was generated via observations, focus groups, written reflections and questionnaires. First, using established PjBL concepts, such as related cases, cognitive tools and contextual support, I examine how the course design was deployed and received by the students. Second, using Communities of Practice concepts, such as mutuality of engagement and trajectories, I analyse how students developed their professional identity during the course. Third, I integrate the two perspectives to identify connections emerging throughout the stages of the course. The findings suggest that incorporating interactions with clients in student projects benefits students’ development of professional identity, by facilitating a more complex accountability to a joint enterprise which, in turn, lessens the need for contextual support from teachers. Yet students’ existing repertoire of problem-solving, reflection and teamworking skills influences how they use and benefit from elements of PjBL, such as related cases and cognitive and collaboration tools. Additionally, those student teams engaging in joint effort, as opposed to dividing labour, make richer use of the cognitive tools provided, leading to a more inbound trajectory into ID identity. The analysis has implications for the effectiveness of PjBL courses, as well as for interventions designed to develop students’ professional identity. Moreover, the theoretical analysis widens current perspectives about the dilemmas and difficulties experienced by students trying to make the transition into professional life

Changes in diet, sleep, and physical activity are associated with differences in negative mood during COVID-19 lockdown

The United Kingdom and Scottish governments instigated a societal lockdown in response to the COVID-19 pandemic. Subsequently, many experienced substantial lifestyle changes alongside the stresses of potentially catching the virus or experiencing bereavement. Stressful situations and poorer health behaviors (e.g., higher alcohol consumption, unhealthy diet, poorer sleep quality, physical inactivity) are frequently linked to poor mental health. Our objective was to examine changes in health behaviors and their relationship with negative mood during COVID-19 lockdown. We also considered associations between health behaviors and socio-demographic differences and COVID-19-induced changes. 399 participants completed a questionnaire asking about their personal situation and health behaviors during lockdown as well as a negative mood scale. The significance threshold for all analyses was α = 0.05. Poorer diet was linked to more-negative mood, and to changes to working status. Poorer sleep quality was linked with more-negative mood, and with ‘shielding’ from the virus. Being less physically active was related to more-negative mood and student status, whereas being more physically active was linked to having or suspecting COVID-19 infection within the household. Increased alcohol consumption was linked to living with children, but not to negative mood. Changes to diet, sleep quality, and physical activity related to differences in negative mood during COVID-19 lockdown. This study adds to reports on poor mental health during lockdown and identifies lifestyle restrictions and changes to health behaviors which may, to some extent, be responsible for higher negative mood. Our data suggests that it is advisable to maintain or improve health behaviors during pandemic-associated restrictions

Regular physical activity and insomnia: An international perspective

This paper is in closed access until 16th August 2019.Very low, and very high levels of regular physical activity have been associated with degraded sleep quality. Cross-national variations in habitual physical activity levels may contribute to cross-national differences in insomnia prevalence. The present study assesses and compares the extent to which weekly durations of moderate intensity physical activity contribute to insomnia risk. Demographic, sleep, physical activity and general health profiles were obtained from a convenience sample of 9238 adults drawn from 5 countries (South Africa, Australia, China, South Korea and the UK) using social media. Insomnia prevalence ranged from 4.1% (China) to 14.8% (UK). In logistic regression adjusted only for age and gender, the lowest level of activity was associated with significant insomnia risk (OR = 1.37 (95%CI =1.05-1.79;p< 0.05). When adjusted for all covariates except country, only the highest level of physical activity (>300 min/week) was associated with significantly increased insomnia risk (OR = 1.30 (95%CI =1.03–2.51;p< 0.05). Risk associated with high activity remained after the addition of ‘country’ to the model (OR = 1.31 (95%CI =1.02–1.69;p< 0.05). Across all models, female gender, low rated health, low education, and older age consistently increased insomnia risk. These cross-national data indicate that extremes of inactivity/activity can significantly influence insomnia risk independent of country. Insomnia risk associated with very low levels of activity may be mediated by poorer health and disadvantageous social status. However, while very high levels of activity increase insomnia risk independent of health and demographic factors, they may also confound with personally and occupationally demanding lifestyles

Sleep quality and recommended levels of physical activity in older people

A minimum level of activity likely to improve sleep outcomes among older people has not previously been explored. In a representative UK sample aged 65+ (n = 926), cross-sectional regressions controlling for appropriate confounders showed that walking at or above the internationally recommended threshold of ≥150 minutes per week was significantly associated with a lower likelihood of reporting insomnia symptoms (OR = 0.67 (95% CI = 0.45 – 0.91) p<0.05). At 4-year follow-up (n=577), higher walking levels at baseline significantly predicted a lower likelihood of reporting sleep onset (OR = 0.64 (95% CI = 0.42-0.97 p<0.05) or sleep maintenance (OR = 0.63 (95% CI = 0.41-0.95 p<0.05) problems. These results are consistent with the conclusion that current physical activity guidelines can support sleep quality in older adults