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Am Fam Physician. 2005;71(6):1203-1204

About one half of older adults do not sleep well, most commonly because they cannot fall asleep or stay asleep, or because they wake up too early. Thus, many are tired during the day. Poor sleep is associated with significant morbidity, including poor physical function, depression, and cardiovascular disease. Regular exercise is thought to improve sleep quality. Exercise has been observed to reduce sleep latency and lengthen time spent asleep. Tai chi has been shown to have multiple benefits, including improvement of muscle strength, balance, and cardiovascular fitness. Li and associates studied the effects of tai chi on sleep quality and daytime sleepiness.

The randomized controlled trial compared a tai chi program with a low-impact exercise program to determine the effects of each on sleep quality and daytime sleepiness. Patients enrolled in the study were at least 60 years of age, had sleep complaints, had been physically inactive for three months, and were sufficiently healthy to participate in an exercise program. Both groups of patients attended a one-hour exercise session three times a week for 24 weeks. The outcome measures were self-rated quality of sleep and daytime sleepiness, using the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS), as well as a physical performance measure and a quality-of-life scale assessing function, well-being, and health status.

Of the 118 eligible participants, 62 were randomized to tai chi and 56 to low-impact exercise. Tai chi participants had significant improvement in subjective sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbances, and sleep dysfunction, and improvements in the ESS scale. The low-impact exercise group did not have any improvements in these areas. Compared with the low-impact group, the tai chi group reported more improvement in several sleep quality areas—quality, latency, duration, efficiency, and sleep disturbance. Patients in the tai chi group had better overall PSQI scores than the low-impact participants. There were no differences between the groups in several subscales. Tai chi participants reported less daytime sleepiness as measured by the ESS scores. Similarly, tai chi participants had significant and better improvement than the low-impact group in physical performance measures.

In this study of older persons with moderate sleep problems, tai chi helped improve sleep, whereas low-impact exercise did not. The authors speculate that tai chi exerts its benefit by modifying circadian rhythms, and enhancing overall well-being through relaxation and diaphragmatic breathing

editor’s note: This study is important in that it adds to the limited armamentarium of studies assessing the effects of exercise in the elderly. One randomized controlled trial1 studied patients 50 to 76 years of age and found that mild to moderate exercise improved sleep, although the regimen only showed benefit after eight weeks. Several systematic reviews have concurred that exercise can improve sleep, but studies have been limited by a failure to restrict participants to ages older than 60, small sample size, and a focus on good sleepers. In addition, the type of exercise required (e.g., brisk walking) may not be feasible for the majority of elderly persons with sleep problems. Bright-light therapy, which has been useful in younger groups, has yet to be conclusively investigated in the older population. The benefits of cognitive behavior therapy are mixed.2—c.w.

REFERENCESKingACOmanRFBrassingtonGSBliwiseDLHaskellWLModerate-intensity exercise and self-rated quality of sleep in older adults. A randomized controlled trial.JAMA1997;277:32–7.MontgomeryPDennisJPhysical exercise for sleep problems in adults aged 60+.Cochrane Database Syst Rev2002;(4):CD003404.

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