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Time of the day of exercise impact on cardiovascular disease risk factors in adults: a systematic review and meta-analysis.
Sevilla-Lorente, R, Carneiro-Barrera, A, Molina-Garcia, P, Ruiz, JR, Amaro-Gahete, FJ
Journal of science and medicine in sport. 2023;26(3):169-179
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In humans, shifted sleep patterns seem to interfere with several metabolic pathways. Shift work, short sleep duration, exposure to artificial light, inadequate eating time window, and lack of physical activity, are some characteristics of the modern lifestyle that contributes to the occurrence and worsening of cardiovascular disease (CVD). The aim of this study was to analyse the time of the day of exercise-induced effects on CVD risk factors in adults. This study was a systematic review and meta-analysis of twenty-two studies. Results showed that exercise produces an acute reduction of systolic blood pressure independently of the time of the day at which it is performed. Similarly, exercise produces an acute increase in blood glucose independently of the time of the day. Authors concluded that further research is needed to establish whether there is a diurnal variation of exercise on cardiovascular health and how it is related to health status, sex, or the type of exercise.
Abstract
OBJECTIVES To compare the effect of a single bout of morning vs. evening exercise on cardiovascular risk factors in adults. DESIGN Systematic review and meta-analysis. METHODS A systematic search of studies was conducted using PubMed and Web of Science from inception to June 2022. Selected studies accomplished the following criteria: crossover design, acute effect of exercise, blood pressure, blood glucose, and/or blood lipids as the study's endpoint, a washout period of at least 24 h, and adults. Meta-analysis was performed by analyzing: 1) separated effect of morning and evening exercise (pre vs. post); and 2) comparison between morning and evening exercise. RESULTS A total of 11 studies were included for systolic and diastolic blood pressure and 10 studies for blood glucose. Meta-analysis revealed no significant difference between morning vs. evening exercise for systolic blood pressure (g ∆ = 0.02), diastolic blood pressure (g ∆ = 0.01), or blood glucose (g ∆ = 0.15). Analysis of moderator variables (age, BMI, sex, health status, intensity and duration of exercise, and hour within the morning or evening) showed no significant morning vs. evening effect. CONCLUSIONS Overall, we found no influence of the time of the day on the acute effect of exercise on blood pressure neither on blood glucose.
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Sleep-Opt-In: A Randomized Controlled Pilot Study to Improve Sleep and Glycemic Variability in Adults With Type 1 Diabetes.
Martyn-Nemeth, P, Duffecy, J, Quinn, L, Steffen, A, Baron, K, Chapagai, S, Burke, L, Reutrakul, S
The science of diabetes self-management and care. 2023;49(1):11-22
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Insufficient sleep (insufficient total sleep time) and irregular sleep timing (variability in the occurrence of sleep within a 24-hour period) are increasingly recognized as important contributors to glycaemic control and variability in type 1 diabetes (T1D). The aims of this study were to evaluate the feasibility and acceptability of a sleep intervention (Sleep-Opt-In) targeted for adults with type 1 diabetes with short or irregular sleep and to examine the effects of Sleep-Opt-In on sleep duration and regularity, glucose indices, and patient-reported outcomes. This study was a randomised controlled parallel trial design. Participants (n=14) were randomly assigned to either the Sleep-Opt-In intervention or a Healthy Living attention control group. Results showed that: - Sleep-Opt-In was feasible and acceptable to the target population. - participants with objectively confirmed short or irregular sleep, sleep irregularity improved by 25 minutes on average, whereas sleep duration improved only negligibly (8 minutes). - the control group experienced an increase in sleep duration but no change in sleep regularity. Authors conclude that Sleep-Opt-In is feasible, acceptable, and promising for further evaluation to improve sleep duration or regularity, glucose parameters and important patient reported outcomes of diabetes distress, daytime sleepiness, fatigue and depressive mood in the T1D population.
Abstract
PURPOSE The purpose of this study was to evaluate the feasibility and acceptability of a technology-assisted behavioral sleep intervention (Sleep-Opt-In) and to examine the effects of Sleep-Opt-In on sleep duration and regularity, glucose indices, and patient-reported outcomes. Short sleep duration and irregular sleep schedules are associated with reduced glycemic control and greater glycemic variability. METHODS A randomized controlled parallel-arm pilot study was employed. Adults with type 1 diabetes (n = 14) were recruited from the Midwest and randomized 3:2 to the sleep-optimization (Sleep-Opt-In) or Healthy Living attention control group. Sleep-Opt-In was an 8-week, remotely delivered intervention consisting of digital lessons, sleep tracker, and weekly coaching phone calls by a trained sleep coach. Assessments of sleep (actigraphy), glucose (A1C, continuous glucose monitoring), and patient-reported outcomes (questionnaires for daytime sleepiness, fatigue, diabetes distress, and depressive mood) were completed at baseline and at completion of the intervention. RESULTS Sleep-Opt-In was feasible and acceptable. Those in Sleep-Opt-In with objectively confirmed short or irregular sleep demonstrated an improvement in sleep regularity (25 minutes), reduced glycemic variability (3.2%), and improved time in range (6.9%) compared to the Healthy Living attention control group. Patient-reported outcomes improved only for the Sleep-Opt-In group. Fatigue and depressive mood improved compared to the control. CONCLUSIONS Sleep-Opt-In is feasible, acceptable, and promising for further evaluation as a means to improve sleep duration or regularity in the population of people with type 1 diabetes.
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Enhancing Night and Day Circadian Contrast through Sleep Education in Prediabetes and Type 2 Diabetes Mellitus: A Randomized Controlled Trial.
García-Serrano, C, Pujol Salud, J, Aran-Solé, L, Sol, J, Ortiz-Congost, S, Artigues-Barberà, E, Ortega-Bravo, M
Biology. 2022;11(6)
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Diabetes mellitus is a chronic condition that occurs when blood glucose levels increase because the body cannot produce enough insulin or cannot effectively use the insulin it produces. Type 2 diabetes mellitus (T2DM) is the most common type of diabetes. It is a chronic metabolic disease that can be controlled when its pathophysiological factors are neutralised. The aim of this study was to analyse the effect of a sleep hygiene intervention in the management of impaired fasting glucose (IFG) and T2DM. This is an experimental study based on a parallel clinical trial using blocked randomization with equal allocation ratio. A total of 69 participants were included in the analysis (31 and 38 from the control and intervention groups, respectively). Results show a significant improvement in all the measured sleep parameters (sleep quality, time and efficiency). Furthermore, it also demonstrates that sleep health educational intervention, delivered during the regular check-ups of patients with T2DM or IFG, has a positive metabolic effect and is feasible as a complementary therapy in primary care settings. Authors conclude that sleep education improves T2DM metabolic management.
Expert Review
Conflicts of interest:
None
Take Home Message:
- Sleep has a restorative function that benefits glucose metabolism.
- Sleep education should emphasise that maintaining a regular and sufficient sleep schedule and establishing a series of routines and habits in the hours prior to going to sleep would prevent early awakenings.
- Education is an important part of clinical practice.
Evidence Category:
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A: Meta-analyses, position-stands, randomized-controlled trials (RCTs)
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B: Systematic reviews including RCTs of limited number
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C: Non-randomized trials, observational studies, narrative reviews
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D: Case-reports, evidence-based clinical findings
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E: Opinion piece, other
Summary Review:
Introduction
The aim of this study was to analyse the effect of a sleep hygiene intervention in the management of impaired fasting glucose (IFG) or type 2 diabetes mellitus (T2DM).
Methods
This experimental parallel open-label clinical trial included 69 adults with IFG or T2DM.
The intervention was individual informative education which aimed to develop skills to improve sleep, which consisted of:
1. Information: Reading of the educational sheet (9 tips for a healthy sleep) with subsequent discussion.
2. Verification: checking participants understood the advice.
3. Participant information: One telephone call after 1 month was made as educational reinforcement of the intervention.
The controlled group received no educational intervention. The main outcome variable measured was levels of HbA1c (%) 3 and 6 months post intervention. Secondary outcomes were fasting glucose (mg/dL) 3 and 6 months post intervention, Pittsburgh Sleep Quality Index (PSQI), declared sleep hours and sleeping efficiency 3 months post intervention.
Results
- . 84.2% participants from the intervention group and 14.0% in the control group reported a change in sleep habits.
- 3 months after the intervention, the control group did not report any change, while the intervention group reported a statistically significant improvement in all three: PSQI (−2.97 ± 2.93), hours of sleep (1.00 [0.00; 2.00] hours) and sleep efficiency (6.74 ± 12.9%).
- The intervention group achieved a significant reduction in 3 months post intervention fasting glucose levels (−14.69; CI 95%: −28.15, −1.22) and HbA1c levels (−0.39; 95% CI: −0.73, −0.05), as well as a reduction in 6 months post intervention HbA1c levels (−0.66; 95% CI: −0.96, −0.36).
Conclusion
- The results show a significant improvement in all the measured sleep parameters (sleep quality, time and efficiency).
- The PSQI score improvement in the intervention group was 3.6 points higher than the control group.
- The median sleep time in the intervention group was increased by 1.5 h, doubling the number of participants who reported sleeping more than 6 h.
Clinical practice applications:
- An educational intervention in sleep hygiene and circadian contrast may help to increase sleep quality, time and efficiency.
- The educational intervention helped lower HbA1c levels in patients with IFG and T2DM.
- Sleep education helps to improve T2DM metabolic management.
- The 9 tips for a healthy sleep, were developed from the latest guidelines from the American Academy of Sleep Medicine, the National Health Service, and the Health Department of Catalonia.
Considerations for future research:
- The open-labelled intervention and the use of subjective variables related to sleep quality could lead to biassed self-reports in the intervention group so further studies are required.
- Future studies should gather baseline parameters closer to the start of the intervention rather than wait 3 months to assess the immediate outcomes of the intervention.
- Future research could take the same approach with diet and exercise education.
Abstract
BACKGROUND Evidence supports a causal relationship between circadian disturbance and impaired glucose homeostasis. METHODS To determine the effect of an educational intervention delivered by primary care nurses to improve sleep hygiene, a parallel, open-label clinical trial in subjects aged 18 and older with impaired fasting glucose (IFG) or type 2 diabetes mellitus (T2DM) was performed. Study variables were sex, age, fasting glucose, glycated haemoglobin A1c (HbA1c), Pittsburgh Sleep Quality Index (PSQI), sleep duration and efficiency, body mass index, antidiabetic treatment, diet and physical exercise. An individual informative educational intervention was carried out following a bidirectional feedback method. The intervention aimed to develop skills to improve sleep through nine simple tips. An analysis of covariance was performed on all the mean centred outcome variables controlling for the respective baseline scores. RESULTS In the intervention group, PSQI dropped, the duration and quality of sleep increased, and a decrease in fasting glucose and in HbA1c levels was observed. CONCLUSION The proposed intervention is effective for improving sleep quality, length and efficiency, and for decreasing fasting glucose and HbA1c levels in only 3 months. These findings support the importance of sleep and circadian rhythm education focused on improving IFG and T2DM.
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Assessment of sleep and obesity in adults and children: Observational study.
Bonanno, L, Metro, D, Papa, M, Finzi, G, Maviglia, A, Sottile, F, Corallo, F, Manasseri, L
Medicine. 2019;98(46):e17642
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Sleep is essential to support the functions and health of the entire body. The aim of this study was to investigate the association between sleep duration and quality, and overweight risk and obesity in children and adults. The study was conducted on secondary school children. It involved 199 subjects of which 71 were adults (29 males and 42 females) with age between 29 and 65 years, and 128 children (73 males and 55 females) with age between 10 and 13 years. Results indicate that the duration and quality of sleep can represent a risk factor of overweight and obesity in examined subjects (both adults and children irrespective of their gender). Authors conclude that sufficient sleep is required to maintain a normal weight.
Abstract
The sleep allows many psychological processes, such as immune system activity, body metabolism and hormonal balance, emotional and mental health, learning, mnemonic processes. The lack of sleep could undermine mental and physical purposes, causing an alteration in cognitive functions or metabolic disorders. In our study, we have examined the irregular sleep effects with the overweight and obesity risk in children and adults.The sample was composed of 199 subjects, of which 71 adults, (29 males and 42 females), and 128 children (73 males and 55 females). We have measured the weight and height with standard techniques; we also have measured the body mass index dividing the weight in kg with the height square expressed in meters (kg/m). Subjects were divided into underweight, normal weight, overweight, and obese. Were administered some questionnaires to measure the quantity and quality of sleep, and eating habits and individual consumption of food.Analysis of demographic variables not showed significant differences between male and female groups but highlighted a significant trend differences in normal-weight score. The clinical condition has a substantial impact on body mass index score and sleep hours were significant predictor on this.Quantity and quality sleep can also represent a risk factor of overweight and obesity, so sufficient sleep is a factor that influence a normal weight. Adults and children that sleep less, have an increase in obesity and overweight risk with dysfunctional eating behaviors, decreased physical activity, and metabolic changes.