Clinical ReviewThe effect of resistance exercise on sleep: A systematic review of randomized controlled trials
Introduction
Sufficient high quality sleep is needed for good health and wellbeing. The National Sleep Foundation recommends that adults sleep for seven to nine hours each night [1]. However, it is estimated that more than one-third of Americans are not meeting these recommendations [2], with individuals aged 30–65 y old reporting the shortest sleep duration [3]. It is estimated 5%–15% of Americans suffer from insomnia [4], while one-third report three awakenings per night [5]. These sleep disturbances reduce overall sleep quality, sleep efficiency [5] and perceived sleep quality, while increasing the risk of cardiovascular disease [6], [7], stroke [8], depression/anxiety [9] and mortality [10]. Additionally, poor sleep quality can result in sleepiness and dysfunction during the day [11]. At a public health level, excessive daytime sleepiness from a single night of impaired sleep can lead to errors in judgement and focus, lost productivity at work, and a greater risk for vehicular accidents [12], [13].
Sedative hypnotic medications such as benzodiazepines are the primary pharmacological management of sleep dysfunction. Although these drugs help to induce sleep [14], they decrease non-rapid eye movement (NREM) sleep stages 3 and 4, known as slow wave sleep (SWS), thus reducing the restorative effects of sleep [15]. Additionally, long-term use of these drugs is not recommended due to their adverse effects such as rebound insomnia, depression and anxiety, cognitive impairment [14], and an increased risk of falls [14], cancer, and overall mortality [16]. Thus, alternative therapies are required for long-term management of sleep disturbance.
Exercise is a promising non-pharmacological treatment to improve sleep, with aerobic exercise shown to improve both sleep quantity and quality [17], [18], [19], [20], [21]. Progressive resistance exercise is an alternative modality that has also been shown to improve sleep quality [22]. Like aerobic exercise, resistance exercise has been shown to improve comorbidities commonly associated with poor sleep, such as depression [23] and cardiovascular disease [24], and may be suitable in those for whom aerobic exercise is not feasible or desirable. To our knowledge, a review on the effects of resistance exercise on sleep outcomes has not been published. Thus, the purpose of this investigation was to systematically review the effects of acute and chronic resistance exercise on sleep quantity and quality.
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Data sources and searches
A systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement guidelines [25]. An electronic database search was performed on June 20 2016 using the following databases: allied and complementary medicine (AMED), Cochrane central register of controlled trials, EBM reviews – Cochrane methodology register, Embase, PsycINFO, CINAHL, Sportdiscus, Ageline, Web of Science and Medline (including Medline epub ahead of print,
Results
A flow chart of study selection is presented in Fig. 1. The combined search yielded 3340 potentially eligible papers, which were reduced to 129 after reviewing titles and abstracts. Upon full-text review to determine eligibility, 13 studies (published in 14 citations) met the criteria, comprising a total of 652 participants.
Among the identified studies, three were acute exercise interventions [19], [36], [37] and 10 were chronic exercise interventions ∗[22], [29], [30], [31], [33], ∗[38], [39],
Discussion
To our knowledge, this is the first systematic review to determine the acute and chronic effects of resistance exercise on sleep, representing a substantive addition to existing literature. We have included 10 additional studies of resistance exercise beyond those reported in a recent review of exercise on sleep [44]. Our primary finding from the limited data available is that chronic resistance exercise may improve subjective sleep quality, with minimal effects observed on sleep quantity.
Conflicts of interest
The authors do not have any conflicts of interest to disclose.
Acknowledgements
AK was supported by a Canada Graduate Scholarship-Master's from the Natural Sciences and Engineering Research Council of Canada. The McMaster University Graduate Students Association Travel Assistance Award and the James F. Harvey and Helen S. Harvey Travel Scholarships helped fund AK's travel to the University of Sydney, Australia. This research was supported by the Natural Sciences and Engineering Research Council of Canada Discovery Grant #296518 to JJH. YM was supported by the CRN for
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