Skip to main content
Top
Published in: BMC Musculoskeletal Disorders 1/2014

Open Access 01-12-2014 | Study protocol

Effect of intermittent aerobic exercise on sleep quality and sleep disturbances in patients with rheumatoid arthritis – design of a randomized controlled trial

Published in: BMC Musculoskeletal Disorders | Issue 1/2014

Login to get access

Abstract

Background

Poor sleep is prevalent in patients with systemic inflammatory disorders, including rheumatoid arthritis, and, in addition to fatigue, pain, depression and inflammation, is associated with an increased risk of co-morbidity and all-cause mortality. Whereas non-pharmacological interventions in patients with rheumatoid arthritis have been shown to reduce pain and fatigue, no randomized controlled trials have examined the effect of non-pharmacological interventions on improvement of sleep in patients with rheumatoid arthritis. The aim of this trial was to evaluate the efficacy of an intermittent aerobic exercise intervention on sleep, assessed both objectively and subjectively in patients with rheumatoid arthritis.

Methods/design

A randomized controlled trial including 44 patients with rheumatoid arthritis randomly assigned to an exercise training intervention or to a control group. The intervention consists of 18 session intermittent aerobic exercise training on a bicycle ergometer three times a week. Patients are evaluated according to objective changes in sleep as measured by polysomnography (primary outcome). Secondary outcomes include changes in subjective sleep quality and sleep disturbances, fatigue, pain, depressive symptoms, physical function, health-related quality of life and cardiorespiratory fitness.

Discussion

This trial will provide evidence of the effect of intermittent aerobic exercise on the improvement of sleep in patients with rheumatoid arthritis, which is considered important in promotion of health and well-being. As such, the trial meets a currently unmet need for the provision of non-pharmacological treatment initiatives of poor sleep in patients with rheumatoid arthritis.

Trial registration

ClinicalTrials.gov Identifier: NCT01966835
Appendix
Available only for authorised users
Literature
2.
go back to reference Cappuccio FP, Cooper D, D'Elia L, Strazzullo P, Miller MA: Sleep duration predicts cardiovascular outcomes: a systematic review and meta-analysis of prospective studies. Eur Heart J. 2011, 32 (12): 1484-1492.PubMedCrossRef Cappuccio FP, Cooper D, D'Elia L, Strazzullo P, Miller MA: Sleep duration predicts cardiovascular outcomes: a systematic review and meta-analysis of prospective studies. Eur Heart J. 2011, 32 (12): 1484-1492.PubMedCrossRef
3.
go back to reference Guo X, Zheng L, Wang J, Zhang X, Zhang X, Li J, Sun Y: Epidemiological evidence for the link between sleep duration and high blood pressure: a systematic review and meta-analysis. Sleep Med. 2013, 14 (4): 324-332.PubMedCrossRef Guo X, Zheng L, Wang J, Zhang X, Zhang X, Li J, Sun Y: Epidemiological evidence for the link between sleep duration and high blood pressure: a systematic review and meta-analysis. Sleep Med. 2013, 14 (4): 324-332.PubMedCrossRef
4.
go back to reference Cappuccio FP, D'Elia L, Strazzullo P, Miller MA: Sleep duration and all-cause mortality: a systematic review and meta-analysis of prospective studies. Sleep. 2010, 33 (5): 585-592.PubMedPubMedCentral Cappuccio FP, D'Elia L, Strazzullo P, Miller MA: Sleep duration and all-cause mortality: a systematic review and meta-analysis of prospective studies. Sleep. 2010, 33 (5): 585-592.PubMedPubMedCentral
5.
6.
go back to reference Ogdie A, Haynes K, Troxel AB, Love TJ, Hennessy S, Choi H, Gelfand JM: Risk of mortality in patients with psoriatic arthritis, rheumatoid arthritis and psoriasis: a longitudinal cohort study. Ann Rheum Dis. 2014, 73 (1): 149-153.PubMedCrossRef Ogdie A, Haynes K, Troxel AB, Love TJ, Hennessy S, Choi H, Gelfand JM: Risk of mortality in patients with psoriatic arthritis, rheumatoid arthritis and psoriasis: a longitudinal cohort study. Ann Rheum Dis. 2014, 73 (1): 149-153.PubMedCrossRef
7.
go back to reference Michaud K, Wolfe F: Comorbidities in rheumatoid arthritis. Best Pract Res Clin Rheumatol. 2007, 21 (5): 885-906.PubMedCrossRef Michaud K, Wolfe F: Comorbidities in rheumatoid arthritis. Best Pract Res Clin Rheumatol. 2007, 21 (5): 885-906.PubMedCrossRef
8.
go back to reference Kirwan JR, Hewlett SE, Heiberg T, Hughes RA, Carr M, Hehir M, Kvien TK, Minnock P, Newman SP, Quest EM, Taal E, Wale J: Incorporating the patient perspective into outcome assessment in rheumatoid arthritis–progress at OMERACT 7. J Rheumatol. 2005, 32 (11): 2250-2256.PubMed Kirwan JR, Hewlett SE, Heiberg T, Hughes RA, Carr M, Hehir M, Kvien TK, Minnock P, Newman SP, Quest EM, Taal E, Wale J: Incorporating the patient perspective into outcome assessment in rheumatoid arthritis–progress at OMERACT 7. J Rheumatol. 2005, 32 (11): 2250-2256.PubMed
9.
go back to reference Abad VC, Sarinas PS, Guilleminault C: Sleep and rheumatologic disorders. Sleep Med Rev. 2008, 12 (3): 211-228.PubMedCrossRef Abad VC, Sarinas PS, Guilleminault C: Sleep and rheumatologic disorders. Sleep Med Rev. 2008, 12 (3): 211-228.PubMedCrossRef
10.
go back to reference Lee YC, Chibnik LB, Lu B, Wasan AD, Edwards RR, Fossel AH, Helfgott SM, Solomon DH, Clauw DJ, Karlson EW: The relationship between disease activity, sleep, psychiatric distress and pain sensitivity in rheumatoid arthritis: a cross-sectional study. Arthritis Res Ther. 2009, 11 (5): R160-PubMedPubMedCentralCrossRef Lee YC, Chibnik LB, Lu B, Wasan AD, Edwards RR, Fossel AH, Helfgott SM, Solomon DH, Clauw DJ, Karlson EW: The relationship between disease activity, sleep, psychiatric distress and pain sensitivity in rheumatoid arthritis: a cross-sectional study. Arthritis Res Ther. 2009, 11 (5): R160-PubMedPubMedCentralCrossRef
11.
go back to reference Power JD, Perruccio AV, Badley EM: Pain as a mediator of sleep problems in arthritis and other chronic conditions. Arthritis Rheum. 2005, 53 (6): 911-919.PubMedCrossRef Power JD, Perruccio AV, Badley EM: Pain as a mediator of sleep problems in arthritis and other chronic conditions. Arthritis Rheum. 2005, 53 (6): 911-919.PubMedCrossRef
12.
go back to reference Luyster FS, Chasens ER, Wasko MC, Dunbar-Jacob J: Sleep quality and functional disability in patients with rheumatoid arthritis. J Clin Sleep Med. 2011, 7 (1): 49-55.PubMedPubMedCentral Luyster FS, Chasens ER, Wasko MC, Dunbar-Jacob J: Sleep quality and functional disability in patients with rheumatoid arthritis. J Clin Sleep Med. 2011, 7 (1): 49-55.PubMedPubMedCentral
13.
go back to reference Ulus Y, Akyol Y, Tander B, Durmus D, Bilgici A, Kuru O: Sleep quality in fibromyalgia and rheumatoid arthritis: associations with pain, fatigue, depression, and disease activity. Clin Exp Rheumatol. 2011, 29 (6 Suppl 69): S92-S96.PubMed Ulus Y, Akyol Y, Tander B, Durmus D, Bilgici A, Kuru O: Sleep quality in fibromyalgia and rheumatoid arthritis: associations with pain, fatigue, depression, and disease activity. Clin Exp Rheumatol. 2011, 29 (6 Suppl 69): S92-S96.PubMed
14.
go back to reference Cakirbay H, Bilici M, Kavakci O, Cebi A, Guler M, Tan U: Sleep quality and immune functions in rheumatoid arthritis patients with and without major depression. Int J Neurosci. 2004, 114 (2): 245-256.PubMedCrossRef Cakirbay H, Bilici M, Kavakci O, Cebi A, Guler M, Tan U: Sleep quality and immune functions in rheumatoid arthritis patients with and without major depression. Int J Neurosci. 2004, 114 (2): 245-256.PubMedCrossRef
15.
go back to reference Nicassio PM, Wallston KA: Longitudinal relationships among pain, sleep problems, and depression in rheumatoid arthritis. J Abnorm Psychol. 1992, 101 (3): 514-520.PubMedCrossRef Nicassio PM, Wallston KA: Longitudinal relationships among pain, sleep problems, and depression in rheumatoid arthritis. J Abnorm Psychol. 1992, 101 (3): 514-520.PubMedCrossRef
16.
go back to reference Drewes AM, Nielsen KD, Hansen B, Taagholt SJ, Bjerregard K, Svendsen L: A longitudinal study of clinical symptoms and sleep parameters in rheumatoid arthritis. Rheumatology (Oxford). 2000, 39 (11): 1287-1289.CrossRef Drewes AM, Nielsen KD, Hansen B, Taagholt SJ, Bjerregard K, Svendsen L: A longitudinal study of clinical symptoms and sleep parameters in rheumatoid arthritis. Rheumatology (Oxford). 2000, 39 (11): 1287-1289.CrossRef
17.
go back to reference Roth T, Price JM, Amato DA, Rubens RP, Roach JM, Schnitzer TJ: The effect of eszopiclone in patients with insomnia and coexisting rheumatoid arthritis: a pilot study. Prim Care Companion J Clin Psychiatry. 2009, 11 (6): 292-301.PubMedPubMedCentralCrossRef Roth T, Price JM, Amato DA, Rubens RP, Roach JM, Schnitzer TJ: The effect of eszopiclone in patients with insomnia and coexisting rheumatoid arthritis: a pilot study. Prim Care Companion J Clin Psychiatry. 2009, 11 (6): 292-301.PubMedPubMedCentralCrossRef
18.
go back to reference Taibi DM, Bourguignon C, Taylor AG: Valerian use for sleep disturbances related to rheumatoid arthritis. Holist Nurs Pract. 2004, 18 (3): 120-126.PubMedCrossRef Taibi DM, Bourguignon C, Taylor AG: Valerian use for sleep disturbances related to rheumatoid arthritis. Holist Nurs Pract. 2004, 18 (3): 120-126.PubMedCrossRef
19.
go back to reference Drewes AM, Bjerregard K, Taagholt SJ, Svendsen L, Nielsen KD: Zopiclone as night medication in rheumatoid arthritis. Scand J Rheumatol. 1998, 27 (3): 180-187.PubMedCrossRef Drewes AM, Bjerregard K, Taagholt SJ, Svendsen L, Nielsen KD: Zopiclone as night medication in rheumatoid arthritis. Scand J Rheumatol. 1998, 27 (3): 180-187.PubMedCrossRef
20.
go back to reference Fragiadaki K, Tektonidou MG, Konsta M, Chrousos GP, Sfikakis PP: Sleep disturbances and interleukin 6 receptor inhibition in rheumatoid arthritis. J Rheumatol. 2012, 39 (1): 60-62.PubMedCrossRef Fragiadaki K, Tektonidou MG, Konsta M, Chrousos GP, Sfikakis PP: Sleep disturbances and interleukin 6 receptor inhibition in rheumatoid arthritis. J Rheumatol. 2012, 39 (1): 60-62.PubMedCrossRef
21.
go back to reference Wells G, Li T, Tugwell P: Investigation into the impact of abatacept on sleep quality in patients with rheumatoid arthritis, and the validity of the MOS-sleep questionnaire sleep disturbance scale. Ann Rheum Dis. 2010, 69 (10): 1768-1773.PubMedCrossRef Wells G, Li T, Tugwell P: Investigation into the impact of abatacept on sleep quality in patients with rheumatoid arthritis, and the validity of the MOS-sleep questionnaire sleep disturbance scale. Ann Rheum Dis. 2010, 69 (10): 1768-1773.PubMedCrossRef
22.
go back to reference Zamarron C, Maceiras F, Mera A, Gomez-Reino JJ: Effect of the first infliximab infusion on sleep and alertness in patients with active rheumatoid arthritis. Ann Rheum Dis. 2004, 63 (1): 88-90.PubMedPubMedCentralCrossRef Zamarron C, Maceiras F, Mera A, Gomez-Reino JJ: Effect of the first infliximab infusion on sleep and alertness in patients with active rheumatoid arthritis. Ann Rheum Dis. 2004, 63 (1): 88-90.PubMedPubMedCentralCrossRef
23.
go back to reference Taylor-Gjevre RM, Gjevre JA, Nair BV, Skomro RP, Lim HJ: Improved sleep efficiency after anti-tumor necrosis factor alpha therapy in rheumatoid arthritis patients. Ther Adv Musculoskelet Dis. 2011, 3 (5): 227-233.PubMedPubMedCentralCrossRef Taylor-Gjevre RM, Gjevre JA, Nair BV, Skomro RP, Lim HJ: Improved sleep efficiency after anti-tumor necrosis factor alpha therapy in rheumatoid arthritis patients. Ther Adv Musculoskelet Dis. 2011, 3 (5): 227-233.PubMedPubMedCentralCrossRef
24.
go back to reference Montgomery P, Dennis J: Cognitive behavioural interventions for sleep problems in adults aged 60+. Cochrane Database Syst Rev. 2003, 1: CD003161-PubMed Montgomery P, Dennis J: Cognitive behavioural interventions for sleep problems in adults aged 60+. Cochrane Database Syst Rev. 2003, 1: CD003161-PubMed
25.
go back to reference Chasens ER, Yang K: Insomnia and physical activity in adults with prediabetes. Clin Nurs Res. 2012, 21 (3): 294-308.PubMedCrossRef Chasens ER, Yang K: Insomnia and physical activity in adults with prediabetes. Clin Nurs Res. 2012, 21 (3): 294-308.PubMedCrossRef
26.
go back to reference Paparrigopoulos T, Tzavara C, Theleritis C, Psarros C, Soldatos C, Tountas Y: Insomnia and its correlates in a representative sample of the greek population. BMC Public Health. 2010, 10: 531-PubMedPubMedCentralCrossRef Paparrigopoulos T, Tzavara C, Theleritis C, Psarros C, Soldatos C, Tountas Y: Insomnia and its correlates in a representative sample of the greek population. BMC Public Health. 2010, 10: 531-PubMedPubMedCentralCrossRef
27.
go back to reference Strand LB, Laugsand LE, Wisloff U, Nes BM, Vatten L, Janszky I: Insomnia symptoms and cardiorespiratory fitness in healthy individuals: the nord-trondelag health study (HUNT). Sleep. 2013, 36 (1): 99-108.PubMedPubMedCentral Strand LB, Laugsand LE, Wisloff U, Nes BM, Vatten L, Janszky I: Insomnia symptoms and cardiorespiratory fitness in healthy individuals: the nord-trondelag health study (HUNT). Sleep. 2013, 36 (1): 99-108.PubMedPubMedCentral
29.
go back to reference Passos GS, Poyares D, Santana MG, D'Aurea CV, Youngstedt SD, Tufik S, de Mello MT: Effects of moderate aerobic exercise training on chronic primary insomnia. Sleep Med. 2011, 12 (10): 1018-1027.PubMedCrossRef Passos GS, Poyares D, Santana MG, D'Aurea CV, Youngstedt SD, Tufik S, de Mello MT: Effects of moderate aerobic exercise training on chronic primary insomnia. Sleep Med. 2011, 12 (10): 1018-1027.PubMedCrossRef
30.
go back to reference Reid KJ, Baron KG, Lu B, Naylor E, Wolfe L, Zee PC: Aerobic exercise improves self-reported sleep and quality of life in older adults with insomnia. Sleep Med. 2010, 11 (9): 934-940.PubMedPubMedCentralCrossRef Reid KJ, Baron KG, Lu B, Naylor E, Wolfe L, Zee PC: Aerobic exercise improves self-reported sleep and quality of life in older adults with insomnia. Sleep Med. 2010, 11 (9): 934-940.PubMedPubMedCentralCrossRef
31.
go back to reference Yang PY, Ho KH, Chen HC, Chien MY: Exercise training improves sleep quality in middle-aged and older adults with sleep problems: a systematic review. J Physiother. 2012, 58 (3): 157-163.PubMedCrossRef Yang PY, Ho KH, Chen HC, Chien MY: Exercise training improves sleep quality in middle-aged and older adults with sleep problems: a systematic review. J Physiother. 2012, 58 (3): 157-163.PubMedCrossRef
32.
go back to reference Hurkmans E, van der Giesen FJ, Vliet Vlieland TP, Schoones J, Van den Ende EC: Dynamic exercise programs (aerobic capacity and/or muscle strength training) in patients with rheumatoid arthritis. Cochrane Database Syst Rev. 2009, 4: CD006853 Hurkmans E, van der Giesen FJ, Vliet Vlieland TP, Schoones J, Van den Ende EC: Dynamic exercise programs (aerobic capacity and/or muscle strength training) in patients with rheumatoid arthritis. Cochrane Database Syst Rev. 2009, 4: CD006853
33.
go back to reference Goksel KA, Gunaydin R, Turkmen G, Kaya T: Effects of home-based exercise program on the functional status and the quality of life in patients with rheumatoid arthritis: 1-year follow-up study. Rheumatol Int. 2011, 31 (2): 171-176.CrossRef Goksel KA, Gunaydin R, Turkmen G, Kaya T: Effects of home-based exercise program on the functional status and the quality of life in patients with rheumatoid arthritis: 1-year follow-up study. Rheumatol Int. 2011, 31 (2): 171-176.CrossRef
34.
go back to reference Stavropoulos-Kalinoglou A, Metsios GS, van Zanten VJJ, Nightingale P, Kitas GD, Koutedakis Y: Individualised aerobic and resistance exercise training improves cardiorespiratory fitness and reduces cardiovascular risk in patients with rheumatoid arthritis. Ann Rheum Dis. 2013, 72 (11): 1819-1825.PubMedCrossRef Stavropoulos-Kalinoglou A, Metsios GS, van Zanten VJJ, Nightingale P, Kitas GD, Koutedakis Y: Individualised aerobic and resistance exercise training improves cardiorespiratory fitness and reduces cardiovascular risk in patients with rheumatoid arthritis. Ann Rheum Dis. 2013, 72 (11): 1819-1825.PubMedCrossRef
35.
go back to reference King AC, Pruitt LA, Woo S, Castro CM, Ahn DK, Vitiello MV, Woodward SH, Bliwise DL: 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. 2008, 63 (9): 997-1004.PubMedCrossRef King AC, Pruitt LA, Woo S, Castro CM, Ahn DK, Vitiello MV, Woodward SH, Bliwise DL: 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. 2008, 63 (9): 997-1004.PubMedCrossRef
36.
go back to reference Kessler HS, Sisson SB, Short KR: The potential for high-intensity interval training to reduce cardiometabolic disease risk. Sports Med. 2012, 42 (6): 489-509.PubMedCrossRef Kessler HS, Sisson SB, Short KR: The potential for high-intensity interval training to reduce cardiometabolic disease risk. Sports Med. 2012, 42 (6): 489-509.PubMedCrossRef
37.
go back to reference Sivertsen B, Omvik S, Pallesen S, Bjorvatn B, Havik OE, Kvale G, Nielsen GH, Nordhus IH: Cognitive behavioral therapy vs zopiclone for treatment of chronic primary insomnia in older adults: a randomized controlled trial. JAMA. 2006, 295 (24): 2851-2858.PubMedCrossRef Sivertsen B, Omvik S, Pallesen S, Bjorvatn B, Havik OE, Kvale G, Nielsen GH, Nordhus IH: Cognitive behavioral therapy vs zopiclone for treatment of chronic primary insomnia in older adults: a randomized controlled trial. JAMA. 2006, 295 (24): 2851-2858.PubMedCrossRef
38.
go back to reference Gibala MJ, McGee SL: Metabolic adaptations to short-term high-intensity interval training: a little pain for a lot of gain?. Exerc Sport Sci Rev. 2008, 36 (2): 58-63.PubMedCrossRef Gibala MJ, McGee SL: Metabolic adaptations to short-term high-intensity interval training: a little pain for a lot of gain?. Exerc Sport Sci Rev. 2008, 36 (2): 58-63.PubMedCrossRef
39.
go back to reference American Academy of Sleep Medicine: The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. 2007, America Acadamy of Sleep Medicine IL, USA: Darian American Academy of Sleep Medicine: The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. 2007, America Acadamy of Sleep Medicine IL, USA: Darian
40.
go back to reference Andersen LB: A maximal cycle exercise protocol to predict maximal oxygen uptake. Scand J Med Sci Sports. 1995, 5 (3): 143-146.PubMedCrossRef Andersen LB: A maximal cycle exercise protocol to predict maximal oxygen uptake. Scand J Med Sci Sports. 1995, 5 (3): 143-146.PubMedCrossRef
41.
go back to reference Adamsen L, Quist M, Andersen C, Moller T, Herrstedt J, Kronborg D, Baadsgaard MT, Vistisen K, Midtgaard J, Christiansen B, Stage M, Kronborg MT, Rorth M: Effect of a multimodal high intensity exercise intervention in cancer patients undergoing chemotherapy: randomised controlled trial. BMJ. 2009, 339: b3410-PubMedPubMedCentralCrossRef Adamsen L, Quist M, Andersen C, Moller T, Herrstedt J, Kronborg D, Baadsgaard MT, Vistisen K, Midtgaard J, Christiansen B, Stage M, Kronborg MT, Rorth M: Effect of a multimodal high intensity exercise intervention in cancer patients undergoing chemotherapy: randomised controlled trial. BMJ. 2009, 339: b3410-PubMedPubMedCentralCrossRef
42.
go back to reference Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ: The pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989, 28 (2): 193-213.PubMedCrossRef Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ: The pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989, 28 (2): 193-213.PubMedCrossRef
43.
go back to reference Johns MW: A new method for measuring daytime sleepiness: the epworth sleepiness scale. Sleep. 1991, 14 (6): 540-545.PubMed Johns MW: A new method for measuring daytime sleepiness: the epworth sleepiness scale. Sleep. 1991, 14 (6): 540-545.PubMed
44.
go back to reference Nicklin J, Cramp F, Kirwan J, Greenwood R, Urban M, Hewlett S: Measuring fatigue in rheumatoid arthritis: a cross-sectional study to evaluate the bristol rheumatoid arthritis fatigue multi-dimensional questionnaire, visual analog scales, and numerical rating scales. Arthritis Care Res (Hoboken ). 2010, 62 (11): 1559-1568.CrossRef Nicklin J, Cramp F, Kirwan J, Greenwood R, Urban M, Hewlett S: Measuring fatigue in rheumatoid arthritis: a cross-sectional study to evaluate the bristol rheumatoid arthritis fatigue multi-dimensional questionnaire, visual analog scales, and numerical rating scales. Arthritis Care Res (Hoboken ). 2010, 62 (11): 1559-1568.CrossRef
45.
go back to reference Radloff LS: The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977, 1: 385-401.CrossRef Radloff LS: The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977, 1: 385-401.CrossRef
46.
go back to reference Fries JF, Spitz P, Kraines RG, Holman HR: Measurement of patient outcomes in arthritis. Arthritis Rheum. 1980, 23: 137-145.PubMedCrossRef Fries JF, Spitz P, Kraines RG, Holman HR: Measurement of patient outcomes in arthritis. Arthritis Rheum. 1980, 23: 137-145.PubMedCrossRef
47.
go back to reference EuroQol--a new facility for the measurement of health-related quality of life. The EuroQol group. Health Policy. 1990, 16 (3): 199-208. EuroQol--a new facility for the measurement of health-related quality of life. The EuroQol group. Health Policy. 1990, 16 (3): 199-208.
48.
go back to reference Herring MP, Puetz TW, O'Connor PJ, Dishman RK: Effect of exercise training on depressive symptoms among patients with a chronic illness: a systematic review and meta-analysis of randomized controlled trials. Arch Intern Med. 2012, 172 (2): 101-111.PubMedCrossRef Herring MP, Puetz TW, O'Connor PJ, Dishman RK: Effect of exercise training on depressive symptoms among patients with a chronic illness: a systematic review and meta-analysis of randomized controlled trials. Arch Intern Med. 2012, 172 (2): 101-111.PubMedCrossRef
49.
go back to reference Weinert D, Waterhouse J: The circadian rhythm of core temperature: effects of physical activity and aging. Physiol Behav. 2007, 90 (2–3): 246-256.PubMedCrossRef Weinert D, Waterhouse J: The circadian rhythm of core temperature: effects of physical activity and aging. Physiol Behav. 2007, 90 (2–3): 246-256.PubMedCrossRef
50.
go back to reference Shapiro CM, Bortz R, Mitchell D, Bartel P, Jooste P: Slow-wave sleep: a recovery period after exercise. Science. 1981, 214 (4526): 1253-1254.PubMedCrossRef Shapiro CM, Bortz R, Mitchell D, Bartel P, Jooste P: Slow-wave sleep: a recovery period after exercise. Science. 1981, 214 (4526): 1253-1254.PubMedCrossRef
51.
go back to reference Raymann RJ, Swaab DF, Van Someren EJ: Skin deep: enhanced sleep depth by cutaneous temperature manipulation. Brain. 2008, 131 (Pt 2): 500-513.PubMedCrossRef Raymann RJ, Swaab DF, Van Someren EJ: Skin deep: enhanced sleep depth by cutaneous temperature manipulation. Brain. 2008, 131 (Pt 2): 500-513.PubMedCrossRef
Metadata
Title
Effect of intermittent aerobic exercise on sleep quality and sleep disturbances in patients with rheumatoid arthritis – design of a randomized controlled trial
Publication date
01-12-2014
Published in
BMC Musculoskeletal Disorders / Issue 1/2014
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/1471-2474-15-49

Other articles of this Issue 1/2014

BMC Musculoskeletal Disorders 1/2014 Go to the issue