Walking and Sleep Quality of Nepalese Older Adults Residing in an Old Age Home

There is no universal way of defining when a person becomes old. Factors like biological, psychological, chronological and social play an important role when a person is considered old. For all practical purposes, 60 years old is considered as a cutoff point to refer to the older population in developing countries [1]. Changes in physical, mental and social aspects is experienced as people age [2]. One such a change is seen on the quality of sleep [3]. Changes in sleep duration, pattern and quality differ with age [4]. These changes in sleep patterns are reflected in the common sleep-related complaints of older adults, such as taking longer to fall asleep, waking more often and being sleepy during the day. Sleep disorders can result in tiredness, fatigue, depression, greater anxiety, irritability, pain sensitivity, muscle tremors, immunosuppressant and lack of daytime alertness [5,6].

The prevalence of sleep disturbances increases with age. Studies show more than 50% of people over the age of 65 experience sleep disturbances [7,8]. Poor sleep quality also becomes common during old age [9,10]. Sleep disturbances and the occurrence of illnesses or death are highly correlated [11]. Physical inactivity has been identified as a risk factor leading to many chronic diseases. One study also demonstrates that greater physical activity is associated with longevity and an Improved Quality of Life (QOL) [12]. The importance of physical activity in older adults, however, has often been neglected and given a lower priority compared to physical activity in the general population. One study found physical activity can even lower the death rate in people aged seventy to eighty-five years [13].

Walking is an affordable physical activity for older adults. Very little is known about what types of walking improve sleep the most, how much walking is needed to improve sleep and what time of day is best for walking to improve sleep in people with insomnia. Walking is a convenient, inexpensive, safe and effective exercise that can be undertaken by almost all people, at almost any time and in almost any place [13]. Most people can walk. Individuals are generally not hurt by walking and walking has benefits for wellness. Piepkorn determined that as little as 30 minutes of walking may be sufficient to keep individuals moderately physically active [14]. Very little research is carried out focusing older adults of Nepal [15-17]. More than 80% of older individuals still live with their children and many who are not cared for by their children prefer to live in a Briddasharam (Homes for elderly) run by government, religious community or community people [18]. Therefore, the main objective of this study is to study whether the activity of walking inside the Briddashram by individuals who reside there will improve the quality of their sleep.

Description of participants

Table 1: General characteristics of respondents.

Walking and sleep quality measured by the PSQI

With the increasing life expectancy ageing is a worldwide issue of importance and less active lifestyle has created a variety of physical, mental, social and economic problems [15,20-22]. Sleep disorder in old age is a very common phenomenon but it is not understood well whether it can be improved through simple physical activities like walking. This study found, after a month long walking activity baseline combined global PSQI score of 331 dropped to 274. This decrease in PSQI score (by one fifth) was statistically significant showing one month’s walking was improved the quality nightmare sleep of participants. It was significant for both male and female when calculated separately. A similar study carried out by Brightman shows decrease in PSQI score means walking was good for sleep but the result was not statistically significant [23]. His study carried out in Nepal also shows the result was not significant to improve sleep quality.

Further analyzing the seven components of PSQI scale sleep latency, sleep duration, subjective sleep quality, habitual sleep efficiency and sleep disturbance were found improved significantly. On the other hand there was not significant improvement in the sleep quality on two components use of sleep medicine and day time dysfunction. Similar to this study of Brightman shows sleep latency, sleep duration and sleep disturbance improved significantly [23]. Thus, for this particular sample, causal walking in the area inside the Pashupati Briddashram three times per week for one month significantly improved the participants’ self-perceived aggregate sleep quality scores. Therefore, this research confirms the results of previous research [24-29] that indicates walking improves nighttime sleep quality for older adults. Further, this result is consistent with the study of Ferris et al., [30] King et al., and Elavsky et al., that supported the effectiveness of physical activity on quality of sleep [30-32]. In addition, Rahmaninia et al., reported that a walking program of 8 weeks was effective in improving the quality of sleep of the older adults [33].

There are some considerations that may have constituted limitations in this research. These factors might have limited the possible inferences that can be made from these results. First, this is one time quasi experimental study and causality cannot be assumed. Second, participants were not selected randomly and each volunteer participant was their own control. Third, the use of this pre-post quasi-experimental design may affect the results and influenced the ability to make inferences to the greater population of older adults. Fourth, the sample size was not calculated using any standard sample size calculation formula. Fifth residents were not monitored at all times during the day time and there was not control group. They may have napped or been physically active on their own. So, it’s difficult to say whether the actual change was from walking alone. Sixth, Face to face interview may have some biased while reporting their perception.

The findings of this research clearly show that walking improve nighttime sleep quality of older adults. This finding can’t be generalized to whole population, further in-depth study in a large sample size is required with control group.

We would like to express our sincere gratitude to University Grant Commission, Sanothimi Bhaktapur for financial support to carry out this research.

1. WHO (2002) Proposed working definition of an older person in Africa for the MDS Project. WHO, Geneva, Switzerland.
2. Daglar G, Pinar SE, Sabanciogullari S, Kav S (2014) Sleep quality in the elderly either living at home or in a nursing home. Australian Journal of Advanced Nursing 31: 6-13.
3. Lindstrom V, Andersson K, Lintrup M, Holst G, Berglund J (2012) Prevalence of sleep problems and pain among the elderly in Sweden. J Nutr Health Aging 16: 180-183.
4. Gökta? K, Özkan I (2006) Sleep disorders in old Age. Türk Geriatri Dergisi 9: 226-233.
5. Pandi-Perumal SR, Seils LK, Kayumov L, Ralph MR, Lowe A, et al. (2002) Senescence, sleep, and circadian rhythms. Ageing Res Rev 1: 559-604.
6. Barthlen GM (2002) Sleep disorders. Obstructive sleep apnea syndrome, restless legs syndrome, and insomnia in geriatric patients. Geriatrics 57: 34-39.
7. Fad?lo?lu Ç, ?lkbay Y, Y?ld?r?m YK (2006) Sleep quality in the nursing age. Türk Geriatri Dergisi 9: 165-169.
8. Zeitlhofer J, Schmeiser-Rieder A, Tribl G, Rosenberger A, Bolitschek J, et al. (2000) Sleep and quality of life in the Austrian population. Acta Neurol Scand 102: 249-257.
9. Ancoli-Israel S (2004) Sleep disorders in older adults. A primary care guide to assessing 4 common sleep problems in geriatric patients. Geriatrics 59: 37-40.
10. Neubauer DN (1999) Sleep problems in the elderly. American Family Physician 59: 2551-2558.
11. Corrêa K, Ceolim MF (2008) Sleep quality in aged patients with peripheral vascular diseases. Revista da Escola de Enfermagem da USP 42.
12. Lam CT (2014) The effect of walking on quality of elderly people. Master of Public Health, The University of Hong Kong, Sandy Bay, Hong Kong.
13. Gingbold R (1992) Successful ageing. Oxford University Press, New York, USA.
14. Piepkorn MB (1990) An examination of the motivational differences between adults in structured and unstructured exercise programs. Unpublished Thesis, Purdue University, USA.
15. Chalise HN (2014) Depression among elderly living in Briddashram (old age home). Advances in Aging Research 3: 6-11.
16. Chalise HN, Kai I, Saito T (2010) Social support and its correlation with loneliness: A cross-cultural study of Nepalese older adults. Int J Aging Hum Dev 71: 115-138.
17. Chalise HN, Saito T, Takahashi M, Kai I (2007) Relationship specialization amongst sources and receivers of social support and its correlations with loneliness and subjective well-being: a cross sectional study of Nepalese older adults. Arch Gerontol Geriatr 44: 299-314.
18. Chalise HN, Brightman JD (2006) Aging trends: Population aging in Nepal. Geriatrics & Gerontology International 6: 199-204.
19. Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28: 193-213.
20. Chalise HN, Basnet M (2017) Abuse of older adults residing in the community of Nepal. J Gerontol Geriatr Res 6: 415.
21. Narang I, Manlhiot C, Davies-Shaw J, Gibson D, Chahal N, et al. (2012) Sleep disturbance and cardiovascular risk in adolescents. CMAJ 184: 913-920.
22. Asadnia S, Sepehrianazar F, Mosarrezaii Aghdam A, Saadatmand S (2013) Comparison of sleep quality and migraine headaches in people with proper and improper and poor sleep. Urmia Med J 23: 799-806.
23. Brightman JD (2012) Casual walking and nighttime sleep quality among older adults: Evidence from Kaneohe, Hawai‘i utilizing the Pittsburgh Sleep Quality Index. University of Hawaii at Manoa, Honolulu, Hawaii.
24. Butler RN, Davis R, Lewis CB, Nelson ME, Strauss E (1998) Physical fitness: benefits of exercise for the older patient. 2. Geriatrics 53: 46-52.
25. King AC, Oman RF, Brassington GS, Bliwise DL, Haskell WL (1997) Moderate-intensity exercise and self-rated quality of sleep in older adults. A randomized controlled trial. JAMA 277: 32-37.
26. Kligman EW, Hewitt MJ, Crowell DL (1999) Recommending Exercise to Healthy Older Adults: The preparticipation evaluation and exercise prescription. The Physician and Sportsmedicine 27: 42-62.
27. [No authors listed] American College of Sports Medicine Position Stand. Exercise and physical activity for older adults. Med Sci Sports Exerc 30: 992-1008.
28. O'Connor PJ, Youngstedt SD (1997) Sleep quality in elderly: Effects of exercise training and influence of sunlight exposure. JAMA 277: 1034-1035.
29. Pinkowish MD (1998) Exercise more, sleep better. Patient Care 32: 188.
30. Ferris LT, Williams JS, Shen CL, Albus KA, Hale KB (2004) Resistance training improves sleep quality in older adults. Med Sci Sports Exerc 36: 287.
31. King AC, Pruitt LA, Woo S, Castro CM, Ahn DK, et al. (2008) Effects of moderate-intensity exercise on polysomnographic and subjective sleep quality in older adults with mild to moderate sleep complaints. J Gerontol A Biol Sci Med Sci 63: 997-1004.
32. Elavsky S, McAuley E (2007) Lack of perceived sleep improvement after 4-month structured exercise programs. Menopause 14: 535-540.
33. Rahmaninia F, Mohebi H, Saberian Brojeni M (2010) Effect of walking on quality, quantity and some physiological parameters related to sleep in old men. J Sport Bio Sci 1: 111-126.