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      Exercise as a favorable non-pharmacologic treatment to Sleep-Related Movement Disorders: a review

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          Abstract

          Non-pharmacologic treatments of Sleep-Related Movement Disorders (SRMD) are already well described in the literature. The physical activity has been presented as a factor to improve quality of life and in several aspects related to sleep disorders. Thus, the purpose of this review was to analyze the benefits of physical exercise and your indication to improve to SRMD. In the research, 19 studies were found that evaluate the efficacy of physical exercise on SRMD in both human and animal models. The results demonstrate that both acute and chronic physical exercises are effective in reducing symptoms of SRMD. However, most studies were performed with aerobic exercise. Three studies evaluated the efficacy of combined exercise, and no studies have investigated the relationship of resistance exercise. Regarding the mechanisms involved, a study discusses the relationship between the release of beta-endorphin and the exercise practice, and two studies with animal models show the changes of the dopaminergic system after physical exercise. From this evidences, we suggested that physical exercise is a favorable non-pharmacological treatment for SRMD. However, more studies should be available for a better understanding of the molecular mechanisms involved, as well of the type, duration and better time of the day to practice.

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          Clinical, polysomnographic, and genetic characteristics of restless legs syndrome: a study of 133 patients diagnosed with new standard criteria.

          J. Montplaisir, S Boucher, G. Poirier … (1997)
          One hundred thirty-three cases of restless legs syndrome (RLS), diagnosed with criteria recently formulated by an international study group, were studied by questionnaire and with all-night polysomnographic recordings. Results show that RLS starts at a mean age of 27.2 years and before age 20 in 38.3% of patients. Symptoms often appear in one leg only and also involve upper limbs in about half of all cases. Most patients (94%) report sleep-onset insomnia or numerous nocturnal awakenings due to RLS symptoms. A strong relationship was found between these complaints and polysomnographic findings; increasing sleep latency and number of awakenings and decreasing sleep efficiency were associated with worsening symptoms. Periodic leg movements in sleep (index > 5 movements/h sleep) were found in 80.2% of patients. This study shows that this percentage is increased when 2 recording nights are considered (most severe score). Eighty patients of 127 (63%) reported the presence of RLS in at least one of their first-degree relatives. In these families, 221 of 568 first-degree relatives (39%) were reported by the patients to be affected with RLS.
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            A genetic risk factor for periodic limb movements in sleep.

            Hreinn Stefansson, David B. Rye, Andrew Hicks … (2007)
            The restless legs syndrome (RLS) is a common neurologic disorder characterized by an irresistible urge to move the legs. It is a major cause of sleep disruption. Periodic limb movements in sleep are detectable in most patients with RLS and represent an objective physiological metric. To search for sequence variants contributing to RLS, we performed a genomewide association study and two replication studies. To minimize phenotypic heterogeneity, we focused on patients with RLS who had objectively documented periodic limb movements in sleep. We measured serum ferritin levels, since iron depletion has been associated with the pathogenesis of RLS. In an Icelandic discovery sample of patients with RLS and periodic limb movements in sleep, we observed a genomewide significant association with a common variant in an intron of BTBD9 on chromosome 6p21.2 (odds ratio, 1.8; P=2x10(-9)). This association was replicated in a second Icelandic sample (odds ratio, 1.8; P=4x10(-4)) and a U.S. sample (odds ratio, 1.5; P=4x10(-3)). With this variant, the population attributable risk of RLS with periodic limb movements was approximately 50%. An association between the variant and periodic limb movements in sleep without RLS (and the absence of such an association for RLS without periodic limb movements) suggests that we have identified a genetic determinant of periodic limb movements in sleep (odds ratio, 1.9; P=1x10(-17)). Serum ferritin levels were decreased by 13% per allele of the at-risk variant (95% confidence interval, 5 to 20; P=0.002). We have discovered a variant associated with susceptibility to periodic limb movements in sleep. The inverse correlation of the variant with iron stores is consistent with the suspected involvement of iron depletion in the pathogenesis of the disease. Copyright 2007 Massachusetts Medical Society.
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              Altered brain iron homeostasis and dopaminergic function in Restless Legs Syndrome (Willis-Ekbom Disease).

              Christopher Earley, James Connor, Diego García-Borreguero … (2014)
              Restless legs syndrome (RLS), also known as Willis-Ekbom Disease (WED), is a sensorimotor disorder for which the exact pathophysiology remains unclear. Brain iron insufficiency and altered dopaminergic function appear to play important roles in the etiology of the disorder. This concept is based partly on extensive research studies using cerebrospinal fluid (CSF), autopsy material, and brain imaging indicating reduced regional brain iron and on the clinical efficacy of dopamine receptor agonists for alleviating RLS symptoms. Finding causal relations, linking low brain iron to altered dopaminergic function in RLS, has required however the use of animal models. These models have provided insights into how alterations in brain iron homeostasis and dopaminergic system may be involved in RLS. The results of animal models of RLS and biochemical, postmortem, and imaging studies in patients with the disease suggest that disruptions in brain iron trafficking lead to disturbances in striatal dopamine neurotransmission for at least some patients with RLS. This review examines the data supporting an iron deficiency-dopamine metabolic theory of RLS by relating the results from animal model investigations of the influence of brain iron deficiency on dopaminergic systems to data from clinical studies in patients with RLS.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Sleep Sci
                Journal ID (iso-abbrev): Sleep Sci
                Journal ID (publisher-id): ssci
                Title: Sleep Science
                Publisher: Brazilian Association of Sleep and Latin American Federation of Sleep
                ISSN (Print): 1984-0659
                ISSN (Electronic): 1984-0063
                Publication date (Print and electronic): Apr-Jun 2019
                Publication date (Print): Apr-Jun 2019
                Volume: 12
                Issue: 2
                Pages: 116-121
                Affiliations
                [1 ] Universidade Estadual de Campinas, Faculdade de Educação Física - Campinas - São Paulo - Brazil.
                [2 ] Universidade Estadual de Campinas, Faculdade de Ciências Aplicadas - Limeira - São Paulo - Brazil.
                [3 ] Universidade Federal de Minas Gerais, Professor Associado II do Departamento de Esportes, da Escola de Educação Física, Fisioterapia e Terapia Ocupacional - Belo Horizonte - Minas Gerais - Brazil.
                Author notes
                Corresponding author: Andrea Maculano Esteves. E-mail: andrea.esteves@ 123456fca.unicamp.br
                Article
                DOI: 10.5935/1984-0063.20190064
                PMC ID: 6922544
                SO-VID: 52c39505-a8ce-4177-bddf-ee034d3e99b7
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivative License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium provided the original work is properly cited and the work is not changed in any way.

                History
                Date received : 22 January 2018
                Date accepted : 03 April 2019
                Categories
                Subject: Review

                Keywords: restless legs syndrome,movement disorders,physical exercise,sleep wake disorders
                Data availability:
                Keywords: restless legs syndrome, movement disorders, physical exercise, sleep wake disorders

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