DOES PHYSICAL-ACTIVITY IMPROVE SLEEP IN IMPAIRED NURSING-HOME RESIDENTS

OBJECTIVES: To determine if two physical activity programs of varying intensity would result in improved sleep among incontinent and physica lly restrained nursing home residents. DESIGN: Controlled trials of tw o physical activity programs. SETTING: Seven community nursing homes i n the Los Angeles area. PARTICIPANTS: Residents were included if they had urinary incontinence or were physically restrained. Sixty-five sub jects were studied. Mean age was 84.8 years, 85% were female, mean len gth of residency in the nursing home was 19.9 months, and mean Mean Mi ni-Mental State Exam score was 13.1. INTERVENTION: The first physical activity program involved sit-to-stand repetitions and/or transferring and walking or wheelchair propulsion. These activities were performed every 2 hours during the daytime, 5 days per week for 9 weeks. The se cond, less frequent physical activity program involved rowing in a whe elchair-accessible rowing machine plus walking or wheelchair propulsio n once per day three times per week for 9 weeks. MEASUREMENTS: The phy sical function measures reported here include mobility endurance (maxi mum time walking or wheeling) and physical activity as measured by mot ion sensors (Caltrac). Nighttime sleep was estimated by wrist activity monitors. Nighttime sleep measures included total time asleep, percen t sleep, average duration of sleep, and peak duration of sleep. Daytim e sleep was measured by timed behavioral observations of sleep versus wakefulness performed every 15 minutes during the day. RESULTS: Nightt ime sleep was markedly disrupted in both groups at baseline. Across al l subjects at baseline, the average total sleep time was 6.2 hours and the percent sleep was 72.0%, but the average duration of sleep episod es was only 21.2 minutes and the peak duration of sleep episode averag ed only 83.8 minutes. During the daytime, subjects were observed aslee p during 14.5% of observations. Although there was improvement in mobi lity endurance in the intervention subjects compared with controls (MA NOVA F = 4.36, P = .042), there were no differences in the night and d ay sleep measures at follow-up testing. Even among a subgroup of inter vention subjects who showed a 30% or greater improvement in mobility e ndurance, sleep did not improve at follow-up compared with baseline. C ONCLUSION: This study supports our previous findings of marked sleep d isruption in impaired nursing home residents. In addition, despite doc umented improvements in physical function with activity, we did not fi nd improvements in sleep in the intervention versus control groups. Th ese results suggest that increasing daytime physical activity alone is not adequate to improve sleep in impaired NH residents. Future effort s to improve sleep in this population should take into account the mul tifactorial nature of sleep disruption, including individual health pr oblems that effect sleep and the disruptive nature of the nighttime NH environment.