| Summary: | 碩士 === 國立臺灣大學 === 物理治療學研究所 === 106 === Background and purpose: Poor sleep quality is common in older adults. Population studies have shown that both short and long duration of sleep are associated with an increased risk of developing cardiovascular diseases. Recently, cardiac autonomic dysfunction has been measured by means of heart rate variability (HRV) analysis. Some studies have demonstrated that regular exercise training can improve sleep quality. However, the efficacy of exercise on autonomic modulation in middle-aged and older adults with poor sleep quality has not been established. Therefore, the purpose of this study is to investigate the effect of exercise training on sleep quality and HRV in middle-aged and older adults with poor sleep quality. Methods: Forty middle-age and older adults with poor sleep quality (mean age 61.7±7.0 years; 33 women and 7 men) participated in this study. They are randomized assigned into exercise group or control group. Each exercise training program consisted of 30 minutes of supervised aerobic exercise training and 20 minutes of stretching class three times a week for 12 weeks. All the subjects were instructed not to change their dietary intake, daily activity, and medication during 12-week period. Outcome measures include body composition (bioelectrical impedance analysis, BIA), sleep quality (Pittsburgh sleep quality index (PSQI) and actigraph recordings), maximal exercise testing, HRV analysis, and physical activity measurements (7-day Physical Activity Recall Scale). SPSS version 19.0 was used for data analysis. Two-way ANOVA repeated measures test was used to analysis between-group differences of all parameters. Spearman''s rank correlation coefficient was used to test the correlations between the outcome parameters. Multiple regression analysis was used to examine the factors associated with sleep quality improvements. The α level was set at 0.05. Results: The exercise training group got improvements in sleep quality on the global PSQI (p=0.003) and PSQI sub-scores (p<0.05) compared to the control group. Sleep latency measured by wrist actigraph monitor was also shown significantly decreased in the exercise group compared to those of the control group. Resting HRV was significantly improved in normalization of lower frequency (p＜0.001), normalization of higher frequency (p=0.001) and LF/HF (p=0.043). However, HRV after maximal exercise testing did not differ significantly between two groups. The exercise training group also had reductions in systolic blood pressure (p=0.037), depression scales (p=0.014), and improvements in maximal oxygen uptake (p=0.003) after exercise training. Spearman''s rank correlation coefficient analysis showed weak to moderate correlation exists between sleep quality and the normalization of lower frequency, normalization of higher frequency and LF/HF (r=0.34-0.49). Multiple regression analysis indicated that only exercise participation can predict the change of sleep quality (β=-0.628, p<0.001;F=6,543,p<0.001). Conclusion：Our findings indicated that moderate-intensity exercise training has a significantly effect on sleep quality and normalized cardiac autonomic function. These findings suggest that physical exercise therapy could be an alternative or complementary approach to existing therapies for sleep problems.
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