Skip to main content
Download PDF

The effect of exercise on sleep habits of children with type 1 diabetic: a randomized clinical trial

BMC Pediatrics volume 24, Article number: 283 (2024) Cite this article

Abstract

Background

Adequate sleep and exercise are important components of the human lifestyle. Paying attention to these two factors is very important to improve the condition of children with type 1 diabetes. Therefore, this study aimed to investigate the effect of exercise on sleep habits in children with type 1 diabetes.

Material & methods

62 children with type 1 diabetes participated in this clinical trial. They will be divided into the intervention group (31) and the control group (31). Sleep habits were measured using the Children’s Sleep Habits Questionnaire (CSHQ). All children’s parents completed the CSHQ. The intervention for the experimental group consisted of 8 weeks of regular exercise program. The exercise program was prepared as an educational video and provided to parents. Paired sample t-test and ANCOVA test were used with SPSS 23.

Results

62 children with an average age of 9.32 ± 2.02 were studied. Fifty-four and eight% of the children were girls and the rest were boys. The analysis of the variance test showed a significant difference (F = 144.72, P ≤ 0.01) between the average score of the sleep habits of the control group (62.45 ± 5.12) and the experimental group (47.06 ± 4.39).

Conclusion

Sleep habits in the experimental group improved after 8 weeks of exercise training using educational videos. Exercise as a non-pharmacological treatment is an effective way to manage diabetes and improve sleep quality in diabetic children.

Peer Review reports

Background

Type 1 diabetes (T1D) is one of the most common endocrine diseases in children, and its incidence has been increasing in the last two decades [1]. The average annual incidence of T1D in Iran is estimated to be 3.7 cases per one hundred thousand people. In 2021, the global number of people with diabetes is reported to be 8.4 million, and it is predicted to reach 13.5 to 17.4 million by 2040 [2,3,4]. One of the problems of diabetic patients is sleep disorders. Sleep is based on physiological and mental processes and is important in promoting health [5]. According to studies, sleep disorder is one of the complications of diabetes and can lead to an increase in blood sugar [6, 7]. To improve sleeping habits in diabetic patients, some experimental evidence has shown that non-pharmacological treatments are the best way to improve sleeping habits due to balance and improvement of energy in the body, as well as promoting health and relaxation in the person [8]. Exercise is one of the non-pharmacological interventions. In this regard, the results of a systematic review show that exercise can improve sleep habits without having negative effects [9]. Exercise can also have a positive effect on the quantity of sleep. People who exercise regularly sleep longer than those who do not exercise [10].

Exercise and regular physical activities are vital components in changing the lifestyle, prevention, and management of diabetes and they play a very important role in controlling blood sugar, reducing cardiovascular complications, weight control, and improving the mental and physical health of children [11, 12]. The findings of some studies indicate that exercise can benefit diabetic patients by reducing inflammation and improving antioxidant defense [13], blood glucose regulation, and lipid profile [14].

As mentioned, one of the complications of T1D is a sleep disorder. Therefore, exercise therapy and other treatments can be used to prevent and treat many complications of this T1D [15]. Exercising children is not only a hobby for them but is also studied as a tool to improve their health [16]. The spread of infectious diseases such as Covid-19 has limited the presence of children in sports clubs and crowded places such as parks. Using educational videos of sports exercises should be an effective solution to overcome this challenge. In many studies on adults, exercise has been confirmed as an effective way to improve sleep habits. However, the studies conducted on the sleep habits of children with type 1 diabetes and the role of physical activities in improving the quality of sleep of these children are relatively limited. Therefore, the present study aims to investigate the effect of exercises using educational videos on the sleeping habits of children with T1D.

Materials and methods

This study was conducted on children with T1D referred to the clinics of Mohammad Kermanshahi and Taleghani Kermanshah teaching hospitals in western Iran from December 2021 to January 2023. This study was registered in Iran’s clinical trial site with the number IRCT20221112056480N1, (29-10-2021).

The sample size was calculated based on the statistical indicators reported in Wan Yunus’s study [17] and using G*power sample size software. Considering an effect size of 0.87, an alpha coefficient of 0.05, and a test power of 90%, the required sample size of 31 children with T1D in each group and a total of 62 eligible samples were randomly selected in 2 equal groups (31 in each group). The samples were assigned to two groups using the permuted block randomization method. The randomization unit was children and the block size was 4. This study followed the CONSORT 2010 guidelines for reporting randomized controlled trials.

The entry criteria were: children ranging in age from 6 to 12 years, having a history of diabetes for one year or more, the residence of the child’s parents in Kermanshah city, having the literacy of the child’s parents, having a smartphone, not having mental and skeletal-muscular disease, not participating in another diabetes-related educational program. Exclusion criteria included: non-activity in a professional sport, non-completion of the questionnaire, children who have a disease other than diabetes, children who take drugs that affect blood sugar, and children who have autoimmune diseases that affect diabetes.

The data collection tool included a demographic profile questionnaire and a children’s sleep habits questionnaire (CSHQ). This questionnaire has 33 items and 8 subscales including bedtime resistance, sleep onset delay, sleep duration, sleep anxiety, night wakings, parasomnias, sleep-disordered breathing, and daytime sleepiness. The scoring range of the questions is from 1 (rarely) to 3 (always) and the total marks are from 33 to 99. High scores indicate the unfavorable state of sleeping habits in children. The CSHQ has good reliability with high internal consistency (0.56 until 0.93) as well as test-retest reliability (0.62 until 0.79). The present study evaluated the internal correlation using Cronbach’s alpha coefficient of 0.77.

Data gathering

Lorestan University of Medical Sciences Ethics Committee granted ethical approval for the study (IR.LUMS.REC.1401.174, 2022-10-19) and the Declaration of Helsinki maintained the study protocol. After obtaining permission, a training session was held for the mothers of children in the intervention group to explain the objectives of the study. According to the type of membership of the mothers in one of the virtual social networks (including Telegram, WhatsApp, or the internal social network with the name Shad), the exercise training video was sent to the mothers. In addition to sending the video, the exercise program was also sent to the mothers. Mothers were suggested to accompany their children while watching the video. The exercise program was designed with the opinion of a physical education specialist. In the design of exercises, criteria including intensity of exercises, enjoyment, and safety were considered [18, 19].

The recorded video was edited using TechSmith Camtasia Studio software and its sounds and extra parts were removed. The prepared video was sent to mothers using virtual social networks. In terms of time, the sports training protocol consisted of 8 weeks. There were 3 training sessions per week and each session consisted of 17 to 40 min. The type of exercise included slow walking and fast walking. Each training session was performed in three time periods including warm-up, fast walking, and cool-down (Table 1).

To effectively perform sports exercises by children, recommendations were given to mothers: (1) If they see signs of weakness and lethargy in their children, they should stop exercising and prepare them to do exercises after recovery. (2) It was emphasized that the children’s routine meals and snacks should remain unchanged. (3) They were advised to provide their children with food containing appropriate carbohydrates and calories if they noticed symptoms of hypoglycemia during exercise. (4) It was emphasized that the exercise program should be done at a specific time, for example, in the evening. (5) Mothers were asked to measure their children’s blood sugar using a Glucose meter (glucometer) before exercise and after exercise. (6) The mothers were requested to keep a record of the insulin regimen program during the intervention and share the results with the researcher.

Table 1 Exercise activity program for eight weeks
Full size table

Statistical analysis

Data was analyzed using a statistical package for the social sciences (SPSS version 23). The normality of the data was evaluated using the K-S test. The result of the test showed that the data are normally distributed. Independent t-test and chi-square test were used to check the demographic data. Paired t-test was used to compare the average score of each group in the pre-test and the post-test. Analysis of variance test was used to check the difference between the average of the control and intervention groups. Alpha was set at 0.05.

Results

The results showed all individual characteristics were homogeneous in both control and experimental groups (Table 2). 68% of the children were managed with one basal insulin injection and one mealtime insulin injection. The rest of the participants (32%) used 2 basal insulin injections and 1 mealtime insulin injection for diabetes control. Table 3 shows the results of statistical analysis related to sleep habits and its subscales in both control and experimental groups in the pre-test and post-intervention stages. The results of the paired t-test showed that there is no statistically significant difference between the average score of sleep habits and its subscales in the pre-test and post-test stages in the control group (P > 0.05). In the pre-test stage, no statistically significant difference was found between the score of sleep habits of the control group and the experimental group (P > 0.05). A statistically significant difference was found between the average scores of the children of the experimental group in the pre-test and post-test stages (P < 0.05) (Table 3).

Table 2 Comparison of socio-demographic characteristics of the studied subjects in both groups
Full size table
Table 3 Results of paired t-test and analysis of covariance (covariance) analysis of sleep habits and its sub-scales in both control and experimental groups
Full size table

There is a statistically significant difference between the average score of sleeping habits in the experimental and control groups (F = 144.72, P < 0.01). Among the sleep habits subscales, there was no significant difference between the mean of the two groups only in the breathing disorder subscale (F = 1.07, P = 0.30) (Table 3). A significant difference was found (P ≤ 0.05) between the mean blood sugar of children in the intervention group before (155.38 ± 40.43) and after exercise (124.03 ± 32.25).

Discussion

In this study, designed exercises showed a positive and significant effect on improving sleeping habits. This result is in line with some other research results. According to a study, yoga and aerobics can enhance sleep quality for individuals with diabetes [20]. Another study showed that high-intensity interval training improves the sleep quality of individuals with type 1 diabetes [21]. The study by Sharma et al. demonstrated the significant impact of Pilates-based mat exercises on sleep quality and overall quality of life for diabetic patients [22].

Exercise and physical activity can improve sleep habits in diabetic patients by increasing the non-rapid eye movement sleep phase, decreasing the rapid eye movement phase, and reducing the sleep latency period [23, 24]. Evidence indicates that individuals with type 1 diabetes experience reduced sleep duration, which results in peripheral insulin resistance [25]. Therefore, selecting the appropriate time, intensity, and type of exercise training can enhance the sleep quality of individuals with diabetes [24].

Sleep resistance is one of the subscales of sleep habits. The findings of this study showed that the average score of this subscale in the children of the experimental group after the intervention was significantly lower than the children of the control group. This finding indicates the effect of exercise training on improving sleep resistance. Evidence from other studies shows that exercise can be a useful way to get better sleep [26, 27]. Exercises increase the initial temperature of the body and gradually decrease it. As a result, it can affect the reduction of resistance to falling asleep and the reduction of the delay in the onset of sleep. One of the primary reasons for improving sleep habits after physical activity is the physical fatigue caused by exercising. Also, the increase in sleep waves is directly related to the brain’s energy metabolism, which decreases during sleep. An increase in physical activity leads to biological and biochemical changes, such as a shift in the body’s central temperature and an impact on the quality of sleep by stimulating the anterior hypothalamus. In addition, changes in hormonal levels caused by physical activity, including melatonin, cytokines, prolactin, and D2 prostaglandin, have a positive effect on sleep quality [28, 29]. Exercises play an important role in regulating circadian rhythms and improving sleep quality by releasing serotonin. The effect of exercise on increasing brain serotonin concentration has been reported in some studies [30, 31]. Also, serotonin released in the diencephalon and cerebrum can have a positive effect on improving sleep quality and sleeping habits in people [32, 33].

The results related to the subscale of delay in starting to fall asleep showed that the score of this subscale decreased after the intervention. That is, from the point of view of mothers, the time for children to fall asleep has improved after performing sports exercises. The results of Liu et al.‘s study also showed that physical activity improves sleep efficiency, delay in sleep onset, and wake-up time after sleep onset. According to the results of another study, there is a significant relationship between sports training and a shorter sleep delay [34]. Regular participation in sports activities has a positive effect on sleep time. People who exercise regularly experience shorter sleep latency compared to people who do not exercise regularly [35].

According to another finding of the present study, the average score of sleep duration in intervention group children improved significantly. In this regard, the results of studies indicate that regular exercise has a significant impact on increasing the duration of sleep [36, 37]. Inadequate and short sleep has become a common aspect of modern lifestyles across all age groups [38, 39]. Furthermore, the results of a systematic review indicate that individuals with type 1 diabetes may experience poor sleep quality and irregular sleep duration [40]. Physical fatigue and mental happiness caused by exercise [41] can physically and mentally put a person in a condition to have enough sleep during the night.

Based on the results of our study, the average score of sleep anxiety in the children of the experimental group after the intervention was significantly lower than that of the children in the control group. According to the results of studies, physical activity reduces anxiety, reduces symptoms of depression, and improves sleep quality [42, 43]. Insufficient sleep duration increases oxidative stress in the brain and anxiety-like behaviors [44]. Regular exercise plays an effective role in increasing brain-derived neurotrophic factor (BDNF). Increasing this factor can increase neural flexibility, growth, and differentiation of neurons. Therefore, participating in sports exercises can be an effective solution in relieving sleep anxiety [45].

According to mothers’ reports, the average score of frequent night awakenings in the experimental group after the intervention was lower than the control group. Williams et al. also showed in their study that physical activity may lead to better sleep rather than more sleep [46]. The results of a study conducted on children aged 8 to 13 showed that 12.2% of children woke up more than once at night. Therefore, physical activity may be one of the most effective solutions to improve sleep and reduce frequent awakenings at night [47].

The average score of parasomnia in the children of the experimental group after the intervention was significantly lower than that of the children in the control group. Parasomnia, insomnia, and narcolepsy are sleep disorders in children and the understanding of their neurophysiology is evolving [48]. In the literature review, no study was found on the effect of exercise on parasomnia. Considering non-pharmacological techniques, such as behavioral approaches, have been proposed for treating parasomnia, using exercise as a complementary and non-pharmacological treatment may be effective.

The average score of respiratory disorder in the children of the experimental group was lower than that of the children in the control group, but this finding was not statistically significant. Sleep-disordered breathing is associated with an increased risk of cardiovascular disease and mortality. Some studies indicate that the effect of exercise on sleep-disordered breathing is unknown. However, the effect of diet and weight loss on reducing this disorder has been shown in studies [49]. Awad et al. showed that exercise is associated with a reduction in the incidence of sleep-disordered breathing and that reducing physical activity can lead to worsening of sleep-disordered breathing [49]. The results of a meta-analysis also showed that exercise reduces the severity of sleep apnea [50]. In general, it can be said that sports and physical activity are related to sleep-breathing disorders.

The average score of daily sleepiness in children of the experimental group improved significantly after the intervention. The findings of a study showed that exercise is one of the factors that can prevent daytime sleepiness in children. This study showed that children who have daytime sleepiness do less physical activity compared to other children. Therefore, there may be a bidirectional relationship between exercise and daily sleepiness. Severe daytime sleepiness can lead to reduced physical activity levels. Also, people who are physically active during the day show less sleepiness. Designing an exercise program and presenting it to the parents of children referring to medical centers can be effective in managing diabetes and improving the quality of children’s sleep. The program designed in this study can be used as a guideline. According to the findings of this study, it is suggested that doctors, nurses, and treatment staff pay serious attention to the importance of exercise as a non-pharmacological treatment in improving the sleeping habits of diabetic children.

The present study faced limitations in some areas. One of the limitations in the implementation process was related to the insufficient cooperation of children and their parents with the researcher. For this purpose, an effort was made to clearly explain the purpose of the study to them. Also, mothers were assured that their child’s information would be used only for research purposes. The data collection tool was a self-report questionnaire. Therefore, mothers may not have answered the items carefully enough. We suggest that researchers use objective methods such as polysomnography in future studies. The study sample included only boys and girls with type 1 diabetes as participants; therefore, the findings cannot be generalized to other populations.

Conclusion

The results of this study showed that exercise has a positive and significant effect on improving sleep habits in children with T1D. Experimental evidence suggests that sleep disorders can be one of the problems of diabetic children. Sports exercises as a non-drug treatment can be taken seriously as an effective and joyful solution for children. This effective solution can have a reassuring function both in managing diabetes and improving sleeping habits. Exercises should be designed and implemented based on the recommendations of sports experts and detailed sports protocols. In this regard, it is suggested to engage in aerobic sports with moderate intensity for 2 to 4 times a week (for 40 to 60 min each time), brisk walking, and participation in recreational sports. Paying attention to this important issue improves the effectiveness of sports training.

Data availability

The data are available from the corresponding author upon request.

Abbreviations

CSHQ:

Children’s Sleep Habits Questionnaire

T1D:

Type 1 diabetes

BDNF:

Brain-derived neurotrophic factor

References

  1. Barnard K, Thomas S, Royle P, Noyes K, Waugh N. Fear of hypoglycaemia in parents of young children with type 1 diabetes: a systematic review. BMC Pediatr. 2010;10(1):50.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Corbin KD, Driscoll KA, Pratley RE, Smith SR, Maahs DM, Mayer-Davis EJ, Diabetes ACT, Network O. Obesity in type 1 diabetes: pathophysiology, clinical impact, and mechanisms. Endocr Rev. 2018;39(5):629–63.

    Article  PubMed  Google Scholar 

  3. Ogrotis I, Koufakis T, Kotsa K. Changes in the Global Epidemiology of Type 1 diabetes in an Evolving Landscape of Environmental factors: causes, challenges, and opportunities. Medicina. 2023;59(4):668.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Gregory GA, Robinson TIG, Linklater SE, Wang F, Colagiuri S, de Beaufort C, Donaghue KC, Magliano DJ, Maniam J, Orchard TJ, et al. Global incidence, prevalence, and mortality of type 1 diabetes in 2021 with projection to 2040: a modelling study. Lancet Diabetes Endocrinol. 2022;10(10):741–60.

    Article  PubMed  Google Scholar 

  5. Huang Y-S, Paiva T, Hsu J-F, Kuo M-C, Guilleminault C. Sleep and breathing in premature infants at 6 months post-natal age. BMC Pediatr. 2014;14(1):303.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Khalil M, Power N, Graham E, Deschênes SS, Schmitz N. The association between sleep and diabetes outcomes–A systematic review. Diabetes Res Clin Pract. 2020;161:108035.

    Article  PubMed  Google Scholar 

  7. Adler A, Gavan MY, Tauman R, Phillip M, Shalitin S. Do children, adolescents, and young adults with type 1 diabetes have increased prevalence of sleep disorders? Pediatr Diabetes. 2017;18(6):450–8.

    Article  CAS  PubMed  Google Scholar 

  8. hoseini A. Survey of the effect of non pharmacological intervention to improve of sleep in pediatric, that suffering of chronic illness. Iran J Nurs Res. 2012;7(27):60–72.

    Google Scholar 

  9. Banno M, Harada Y, Taniguchi M, Tobita R, Tsujimoto H, Tsujimoto Y, Kataoka Y, Noda A. Exercise can improve sleep quality: a systematic review and meta-analysis. PeerJ. 2018;6:e5172.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Baron KG, Reid KJ, Zee PC. Exercise to improve sleep in insomnia: exploration of the bidirectional effects. J Clin Sleep Med. 2013;9(8):819–24.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Zahalka SJ, Abushamat LA, Scalzo RL, Reusch JE. The role of exercise in diabetes. Endotext [Internet] 2023.

  12. Nadella S, Indyk JA, Kamboj MK. Management of diabetes mellitus in children and adolescents: engaging in physical activity. Translational Pediatr. 2017;6(3):215.

    Article  Google Scholar 

  13. Farinha JB, Krause M, Rodrigues-Krause J, Reischak-Oliveira A. Exercise for type 1 diabetes mellitus management: General considerations and new directions. Med Hypotheses. 2017;104:147–53.

    Article  PubMed  Google Scholar 

  14. Aljawarneh YM, Wardell DW, Wood GL, Rozmus CL. A systematic review of Physical Activity and Exercise on physiological and biochemical outcomes in children and adolescents with type 1 diabetes. J Nurs Scholarsh. 2019;51(3):337–45.

    Article  PubMed  Google Scholar 

  15. Lu X, Zhao C. Exercise and Type 1 diabetes. Adv Exp Med Biol. 2020;1228:107–21.

    Article  CAS  PubMed  Google Scholar 

  16. Landry BW, Driscoll SW. Physical activity in children and adolescents. PM R: J Injury Function Rehabilitation. 2012;4(11):826–32.

    Article  Google Scholar 

  17. Wan Yunus F, Tan XZ, Romli MH. Investigating the feasibility of Exergame on sleep and emotion among University students. Games Health J. 2020;9(6):415–24.

    Article  PubMed  Google Scholar 

  18. Davis CL, Pollock NK, Waller JL, Allison JD, Dennis BA, Bassali R, Meléndez A, Boyle CA, Gower BA. Exercise dose and diabetes risk in overweight and obese children: a randomized controlled trial. JAMA. 2012;308(11):1103–12.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Tsalikian E, Mauras N, Beck RW, Tamborlane WV, Janz KF, Chase HP, Wysocki T, Weinzimer SA, Buckingham BA, Kollman C. Impact of exercise on overnight glycemic control in children with type 1 diabetes mellitus. J Pediatr. 2005;147(4):528–34.

    Article  PubMed  Google Scholar 

  20. Ebrahimi M, Guilan-Nejad TN, Pordanjani AF. Effect of yoga and aerobics exercise on sleep quality in women with type 2 diabetes: a randomized controlled trial. Sleep Sci. 2017;10(02):68–72.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Alarcón-Gómez J, Chulvi-Medrano I, Martin-Rivera F, Calatayud J. Effect of high-intensity interval training on quality of life, sleep quality, exercise motivation and enjoyment in sedentary people with type 1 diabetes mellitus. Int J Environ Res Public Health. 2021;18(23):12612.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Sharma D, Kaur J, Rani M, Bansal A, Malik M, Kulandaivelan S. Efficacy of Pilates based mat exercise on quality of life, quality of sleep and satisfaction with life in type 2 diabetes mellitus. Romanian J Diabetes Nutr Metabolic Dis. 2018;25(2):149–56.

    Article  Google Scholar 

  23. Sargolzaei MS, Kohestani D. Sleep quality in diabetic patients in Iran: a review. Payesh (Health Monitor) J. 2020;19(4):391–404.

    Google Scholar 

  24. Fitzpatrick R, Davison G, Wilson JJ, McMahon G, McClean C. Exercise, type 1 diabetes mellitus and blood glucose: the implications of exercise timing. Front Endocrinol. 2022;13:1021800.

    Article  Google Scholar 

  25. Jacobs PG, Reddy R. Exercise, Sleep, and type 1 diabetes. Neurological modulation of Sleep. edn.: Elsevier; 2020. pp. 145–57.

  26. Saidi O, Davenne D, Lehorgne C, Duché P. Effects of timing of moderate exercise in the evening on sleep and subsequent dietary intake in lean, young, healthy adults: randomized crossover study. Eur J Appl Physiol. 2020;120:1551–62.

    Article  CAS  PubMed  Google Scholar 

  27. Tse CYA, Lee HP, Chan KSK, Edgar VB, Wilkinson-Smith A, Lai WHE. Examining the impact of physical activity on sleep quality and executive functions in children with autism spectrum disorder: a randomized controlled trial. Autism: Int J Res Pract. 2019;23(7):1699–710.

    Article  Google Scholar 

  28. Azarniveh MS, Tavakoli Khormizi SA. Effect of physical activity on quality of sleep in female students. J Gorgan Univ Med Sci. 2016;18(2):108–14.

    Google Scholar 

  29. Adib Saber F, Shojaei MS, Daneshfar A, Hossein Khanzadeh AA. The Effect of Kata Techniques Training on Sleep habits in boys with Autism Spectrum Disorder. Q J Child Mental Health. 2021;7(4):112–28.

    Article  Google Scholar 

  30. Saeed NB, Melhem MB, Al-Ababneh H. The impact of some types of physical activity on the level of releasing serotonin hormone (a comparative study). Educational Psychol Sci Ser. 2023;2(1):119–34.

    Google Scholar 

  31. Sharifi M, Hamedinia M, Hosseini-Kakhak S. The effect of an exhaustive aerobic, anaerobic and resistance exercise on serotonin, beta-endorphin and BDnf in students. Phys Educ Students 2018(5):272–7.

  32. Melancon MO, Lorrain D, Dionne IJ. Exercise and sleep in aging: emphasis on serotonin. Pathol Biol. 2014;62(5):276–83.

    Article  CAS  PubMed  Google Scholar 

  33. Monti JM, Jantos H. The roles of dopamine and serotonin, and of their receptors, in regulating sleep and waking. Prog Brain Res. 2008;172:625–46.

    Article  CAS  PubMed  Google Scholar 

  34. Nixon GM, Thompson JM, Han DY, Becroft DM, Clark PM, Robinson E, Waldie KE, Wild CJ, Black PN, Mitchell EA. Falling asleep: the determinants of sleep latency. Arch Dis Child. 2009;94(9):686–9.

    Article  CAS  PubMed  Google Scholar 

  35. Kredlow MA, Capozzoli MC, Hearon BA, Calkins AW, Otto MW. The effects of physical activity on sleep: a meta-analytic review. J Behav Med. 2015;38:427–49.

    Article  PubMed  Google Scholar 

  36. Mendelson M, Borowik A, Michallet AS, Perrin C, Monneret D, Faure P, Levy P, Pépin JL, Wuyam B, Flore P. Sleep quality, sleep duration and physical activity in obese adolescents: effects of exercise training. Pediatr Obes. 2016;11(1):26–32.

    Article  CAS  PubMed  Google Scholar 

  37. Kjeldsen JS, Rosenkilde M, Nielsen SW, Reichkendler M, Auerbach P, Ploug T, Stallknecht B, Sjodin AM, Chaput J-P. Effect of different doses of exercise on sleep duration, sleep efficiency and sleep quality in sedentary, overweight men. 2012.

  38. Owens J, Group ASW, Adolescence Co, Au R, Carskadon M, Millman R, Wolfson A, Braverman PK, Adelman WP, Breuner CC. Insufficient sleep in adolescents and young adults: an update on causes and consequences. Pediatrics. 2014;134(3):e921–32.

    Article  PubMed  Google Scholar 

  39. Toyoura M, Miike T, Tajima S, Matsuzawa S, Konishi Y. Inadequate sleep as a contributor to impaired glucose tolerance: a cross-sectional study in children, adolescents, and young adults with circadian rhythm sleep‐wake disorder. Pediatr Diabetes. 2020;21(4):557–64.

    Article  CAS  PubMed  Google Scholar 

  40. Ji X, Wang Y, Saylor J. Sleep and type 1 diabetes mellitus management among children, adolescents, and emerging young adults: a systematic review. J Pediatr Nurs. 2021;61:245–53.

    Article  PubMed  Google Scholar 

  41. Zhang Z, Chen W. A systematic review of the relationship between physical activity and happiness. J Happiness Stud. 2019;20(4):1305–22.

    Article  Google Scholar 

  42. Passos GS, Poyares D, Santana MG, Garbuio SA, Tufik S, Mello MT. Effect of acute physical exercise on patients with chronic primary insomnia. J Clin Sleep Med. 2010;6(3):270–5.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Ji C, Yang J, Lin L, Chen S. Physical Exercise ameliorates anxiety, Depression and Sleep Quality in College students: experimental evidence from Exercise intensity and frequency. Behav Sci (Basel Switzerland) 2022, 12(3).

  44. Vollert C, Zagaar M, Hovatta I, Taneja M, Vu A, Dao A, Levine A, Alkadhi K, Salim S. Exercise prevents sleep deprivation-associated anxiety-like behavior in rats: potential role of oxidative stress mechanisms. Behav Brain Res. 2011;224(2):233–40.

    Article  CAS  PubMed  Google Scholar 

  45. Szuhany KL, Otto MW. Assessing BDNF as a mediator of the effects of exercise on depression. J Psychiatr Res. 2020;123:114–8.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Williams SM, Farmer VL, Taylor BJ, Taylor RW. Do more active children sleep more? A repeated cross-sectional analysis using accelerometry. PLoS ONE. 2014;9(4):e93117.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Warburton DE, Nicol CW, Bredin SS. Health benefits of physical activity: the evidence. CMAJ. 2006;174(6):801–9.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Maski K, Owens JA. Insomnia, parasomnias, and narcolepsy in children: clinical features, diagnosis, and management. Lancet Neurol. 2016;15(11):1170–81.

    Article  PubMed  Google Scholar 

  49. Awad KM, Malhotra A, Barnet JH, Quan SF, Peppard PE. Exercise is associated with a reduced incidence of sleep-disordered breathing. Am J Med. 2012;125(5):485–90.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Peng J, Yuan Y, Zhao Y, Ren H. Effects of Exercise on patients with obstructive sleep apnea: a systematic review and Meta-analysis. Int J Environ Res Public Health 2022, 19(17).

Download references

Acknowledgements

The authors thank all the parents who participated in this study.

Funding

Not Applicable.

Author information

Authors and Affiliations

  1. Department of Pediatrics Nursing, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran

    Nastaran Amiri

  2. Social Determinants of Health Research Center, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran

    Kimia Karami

  3. Razi Herbal Medicines Research Center, Department of Pediatrics Nursing, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran

    Fatemeh Valizadeh

  4. Cardiovascular Research Center, Shahid Rahimi Hospital, Lorestan University of Medical Sciences, Khorramabad, Iran

    Yaser Mokhayeri

Authors
  1. Nastaran Amiri
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kimia Karami
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fatemeh Valizadeh
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yaser Mokhayeri
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

NA, KM, and FV wrote the manuscript draft. NA, KK, and FV designed the study. NA and KK conducted the intervention. Y.M. Conducted statistical analyses. All authors reviewed the final manuscript. The author(s) read and approved the final manuscript.

Corresponding authors

Correspondence to Nastaran Amiri or Kimia Karami.

Ethics declarations

Ethics approval and consent to participate

The study protocol was approved by the Ethics Committees of the Lorestan University of Medical Sciences (IR.LUMS.REC.1401.174). The trial is registered in the Iranian Registry of Clinical Trials (IRCT20221112056480N1). written informed consent was obtained from the parents of each child.

Consent for publication

Not Applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Amiri, N., Karami, K., Valizadeh, F. et al. The effect of exercise on sleep habits of children with type 1 diabetic: a randomized clinical trial. BMC Pediatr 24, 283 (2024). https://doi.org/10.1186/s12887-024-04760-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12887-024-04760-9

Keywords

BMC Pediatrics

ISSN: 1471-2431

Contact us