Effects of exercise on sleep in children with overweight/obesity: A randomized clinical trial

Effects of exercise on sleep in children with overweight/obesity: A randomized clinical trial

Objectives: To examine 1) the chronic effects of a 20-week physical exercise program on device-assessed sleep and on sleep-disordered breathing (SDB); and 2) whether attending to a session of the exercise program had effects on device-assessed sleep the subsequent night in children with overweight/obesity. Methods: A total of 99 children with overweight/obesity (n=47 in the exercise group) participated in this secondary analysis of the ActiveBrains randomized clinical trial. The exercise program included a combination of aerobic and resistance exercise training, 3-5 days/week (90 min/session). The control group was asked to maintain usual lifestyle. Sleep outcomes were measured using wrist actigraphy and included: total sleep time, total time in bed, sleep efficiency, and wake after sleep onset (WASO) time. SDB was assessed via the Paediatric Sleep Questionnaire. Results: The ActiveBrains exercise program had a statistically significant effect on WASO time (-10.8 min/day, -0.5 standard deviations (SD), P=0.040). Furthermore, we observed a small non-statistically significant effect on sleep efficiency (+2%, 0.4 SD, P=0.1). No other chronic effects were observed on the other sleep outcomes. The nights (at maximum of 4) after attending the ActiveBrains exercise sessions, children showed higher total sleep time (+8 min, P=0.17), sleep efficiency (+1%, P=0.15), and lower WASO time (-6 min, P=0.18) although did not reach statistical significance. Conclusion: A 20-week physical exercise program reduced WASO time in children with overweight/obesity in comparison with control group peers, yet we did not observe effects on SDB. Future randomized trials that include a clinical sample of children with poor sleep health at baseline are needed to better appreciate the role of exercise in sleep health.

### Competing Interest Statement

The authors have declared no competing interest.

### Clinical Trial


### Funding Statement

This work is part of a PhD thesis conducted in the Official Doctoral Programme in Biomedicine of the University of Granada, Spain. The ActiveBrains project was funded by the Spanish Ministry of Economy and Competitiveness and the Fondo Europeo de Desarrollo Regional (FEDER) (DEP2013 47540, DEP2016 79512 R, DEP2017 91544 EXP and RYC 2011 09011). L.V.TL is supported by a Grant from the Spanish Ministry of Science, Innovation and Universities (FPU17/04802). C.CS is supported by the Spanish Ministry of Science and Innovation (FJC2018 037925 I). Additional support was obtained from the Alicia Koplowitz Foundation (ALICIAK 2018), the University of Granada, Plan Propio de Investigacion 2016, Excellence actions: Units of Excellence, Scientific Excellence Unit on Exercise and Health (UCEES), by the Junta de Andalucia, Consejeria de Conocimiento, Investigacion y Universidades, and European Regional Development Funds (ref. SOMM17/6107/UGR). In addition, funding was provided by the SAMID III network, RETICS, funded by the PNI + D + I 2017 2021 (Spain), ISCIII Sub Directorate General for Research Assessment and Promotion, the European Regional Development Fund (ERDF) (Ref. RD16/0022), the EXERNET Research Network on Exercise and Health (DEP2005 00046/ACTI; 09/UPB/19; 45/UPB/20; 27/UPB/21), the European Unions 2020 research and innovation program under grant agreement No.667302, and the HL PIVOT network Healthy Living for Pandemic Event Protection. Additional funding was obtained from the Andalusian Operational Programme supported with European Regional Development Funds (ERDF in English, FEDER in Spanish, project ref: B CTS 355 UGR18).

### Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.


The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The ActiveBrains RCT was approved by the Human Research Ethics Committee of the University of Granada.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.


I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).


I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.


We did not obtain children parents consent to widely share the data nor was it included in the IRB protocol.

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