Regular exercise reduces anxiety and depression in people with chronic insomnia

Regular physical activity provides evidence of being an effective way to relieve symptoms of anxiety and depression in people who struggle with chronic insomnia. A recent review of multiple independent studies suggests that exercise also improves overall sleep quality and reduces the severity of sleep disruptions. These findings were recently published in the journal Physiology & Behavior.

Insomnia is a highly common condition where people have persistent difficulty falling asleep or staying asleep. This lack of rest frequently leads to severe daytime impairments, affecting a person’s social life, occupational functioning, and overall well-being. People diagnosed with this sleep disorder often experience high levels of psychological distress.

This distress frequently shows up as symptoms of anxiety and depression. Medical professionals notice that insomnia, anxiety, and depression often feed into each other. Poor sleep worsens mood, and negative mood disrupts sleep, creating a cycle that is notoriously difficult to treat.

Some evidence suggests that improving sleep quality can lead to better mental health, and improving mental health can lead to better sleep. Scientists wanted to explore non-drug treatments that might tackle all three interconnected issues at once. Physical activity is known to benefit sleep quality and lower symptoms of poor mental health in the general population.

The researchers set out to determine if these mental health benefits of exercise specifically hold true for patients formally diagnosed with insomnia. They wanted to see if working out could serve as a potential alternative to sleep medications and antidepressants.

“Previous reviews published by us and our colleagues suggested that anxiety reduction and antidepressant effect could be possible mechanisms to explain the effects of exercise on sleep. Also, some of our other previous studies investigated the effects of exercise on anxiety and depression symptoms of patients with chronic insomnia, and we have found significant decrease in these variables. In this way, we motivated ourselves to do a meta-analysis investigating the level of evidence,” said study author Giselle Soares Passos, an associate professor at the Federal University of Jataí.

A meta-analysis is a statistical technique that combines the mathematical results of multiple independent studies to find overall trends. The team searched eight large academic databases for research published up to May 2022. They looked specifically for studies comparing exercise interventions against a non-exercise control group in adults over eighteen.

The researchers ultimately selected six randomized controlled trials and one quasi-randomized trial. A randomized controlled trial is a study design where participants are randomly assigned to either receive the treatment or be part of a control group, which helps eliminate bias. In total, these seven studies included 336 participants.

The exercise programs varied widely across the selected studies, featuring different modes, intensities, and durations. Participants engaged in activities like brisk walking, treadmill running, stationary cycling, resistance training, yoga, and tai chi. The workout routines ranged from a frequency of once a week up to daily sessions.

The duration of these exercise programs lasted anywhere from eight weeks to twenty-four weeks. In contrast, the control groups typically received standard sleep hygiene education, basic attention from researchers, or no intervention at all. To measure the results, the original studies used a variety of standardized psychological questionnaires.

These questionnaires included tools like the Beck Anxiety Inventory and the Center for Epidemiologic Studies Depression Scale, which ask patients to rate their psychological symptoms. The studies also used specific surveys to gauge subjective sleep quality, such as the Insomnia Severity Index. Some studies tracked objective sleep data using a technique called actigraphy.

Actigraphy involves participants wearing a small sensor device, similar to a smartwatch, on their wrist to monitor physical movement and rest patterns throughout the night. The researchers found that engaging in regular physical activity significantly reduced symptoms of anxiety compared to the control groups. Similarly, participants who exercised experienced a significant decrease in depressed mood.

The statistical analysis provides evidence that the psychological benefits of working out are consistent and measurable for people suffering from chronic sleep issues. The physical activity also improved the participants’ subjective experience of rest. The scientists noted significant reductions in scores on the specific insomnia scales, indicating that the condition became much less intense.

Many participants saw their scores drop to levels indicating only mild, sub-threshold insomnia. Participants also reported significant improvements in their overall sleep quality on self-rated surveys. When looking at the objective data gathered from the wrist sensors, the scientists found specific improvements in nightly rest patterns.

Exercise significantly decreased the amount of time participants spent awake after initially falling asleep. On average, participants who exercised spent nearly nine fewer minutes tossing and turning in the middle of the night. This reduction suggests that physical activity helps consolidate sleep, making it more continuous.

However, the exercise interventions did not alter every aspect of sleep architecture. The wrist sensors showed no significant improvements in the time it took participants to initially fall asleep once they got into bed. The total amount of time spent sleeping and overall sleep efficiency also remained relatively unchanged according to the objective sensors.

The results indicate that “practicing regular exercise can improve symptoms of anxiety and depression in patients with insomnia, in addition to reducing insomnia severity, improve sleep quality, and decrease waking after sleep onset,” Passos told PsyPost.

While these findings are promising, there are some limitations to consider. The researchers note that the total number of included studies was relatively small, and the total sample size was just over three hundred people. Some of the original trials also had methodological challenges.

For example, it is generally impossible to keep participants unaware of whether they are in an exercise group or a non-exercise group. This lack of blinding might impact the reliability of the psychological results. Because the pool of available research is limited, there was not enough data to determine the ideal exercise routine.

It is currently unclear which specific type, intensity, frequency, or duration of exercise works best for reducing anxiety and depression in insomnia patients. People should not assume that every single workout routine will yield the exact same mental health benefits. Future research will likely address these gaps by conducting larger studies with more rigorous designs.

The scientists are currently planning to investigate how exercise compares directly to cognitive behavioral therapy, a highly effective type of talk therapy used to treat insomnia. They also plan to explore how physical activity might be combined with non-invasive brain stimulation techniques. Past work from this team has also looked at how exercise pairs with treatments like acupuncture and common sleep medications.

The study, “Effects of exercise on anxiety and depression in patients with insomnia: a systematic review and meta-analysis,” was authored by Daniela Pantaleão Ferreira, Giselle Soares Passos, Shawn D. Youngstedt, and Marcos Gonçalves Santana.