We do not know which type, duration or intensity of training is best suited to improve sleep during neurological rehab. But a new systematic review has tried to find out.
Sleep is vital for maintaining essential body functions as well as for emotional and cognitive well-being. Bad sleep is associated with a multitude of problems such as endocrine, metabolic and immune disorders as well as an increased risk of secondary diseases.
Explore the importance of sleep
Several studies have shown that sleep disorders are frequent in patients with neurological diseases due to changes in the pathophysiological mechanisms of sleep regulation and side effects of drugs.
This sleep reduction causes problems during neurorehabilitation as recovery processes are impaired and patients have less energy and exertion to contribute to rehabilitation sessions. Fortunately, it has been shown that exercise itself improves the sleep of neuropatients.
The problem is that we don't know what type, duration, or intensity of exercise is best for improving sleep during neurorehabilitation. Fortunately, a new systematic review published in Brain Sciences has attempted to answer this question.
Methods
This systematic review followed both the PRISMA guidelines and was pre-registered on PROSPERO. The search strategy was created with PICO and is fully available. Pubmed, PEDro and Cochrane Library were the databases used in the April 2021 search.
(((sleep disorder *) AND (rehabilitation)) AND (physical therapy modalities)
Articles were included in the results that included neurological patients treated with supervised training, manual therapy, or robotic rehabilitation. Again, these interventions were compared with no intervention, unsupervised home exercise, and usual care. The primary endpoint was changes in sleep scores. and secondary measures included the quality and quantity of sleep.
There were no restrictions on research design, publication date or research location. Only articles published in English or Italian have been included. Eligibility and data extraction were carried out by two co-authors, with a third available for consensus building. The risk of bias was assessed using RoB 2.0 or modified NOS.
Results
A total of 10 studies came into question, all of which were published in English and a total of 747 patients were included. Of these, 490 had a stroke diagnosis, 133 with PD and 13 with spinal cord injury. Six of the studies were RCTs, the rest were cohort studies.
Brief summary of the relationship between exercise and sleep for people with neurological diseases
Regular monitored resistance training or high-intensity training leads to better sleep in patients with neurological diseases
Endurance and strength training lead to a reduction in fatigue and the incidence of insomnia
Overall, any period of regular physical activity of at least 30 minutes three times a week leads to an increase in the total sleep time
The articles included in the review were of moderate quality on average, with performance and attrition bias being the main methodological reasons for concern.
Four studies used the Pittsburgh Sleep Quality Index (PSQI) as the primary endpoint and all four were suitable for a meta-analysis. This analysis showed that patients with neurological diseases who participated in regular (2-3x / week) monitored resistance or high-intensity training lasting at least 30 minutes had more and better sleep than those who did not.
In addition, three studies have shown that regular endurance or strength training (3x / week) of 30-60 minutes duration led to a reduction on the Fatigue Severity Scale (FSS) and Insomnia Severity Scale (ISI). All in all, regular sport of any kind leads to an increase in the total sleep time.
Total exercise is a useful strategy for treating sleep disorders in neurorehabilitation. You can learn more by taking Dale Whelehan's course below.
