title: The Association Between Insomnia Symptoms and Mood Changes During Exercise Among Patients Enrolled in Cardiac Rehabilitation.
abstract: OBJECTIVE
  Insomnia symptoms (ie, difficulty falling asleep, difficulty staying asleep, and early awakenings) are common among patients with cardiovascular disease and may interfere with the beneficial impact of exercise on mood state. This study investigated the association of insomnia symptom severity with mood disturbance and with changes in mood state during exercise in a cardiac rehabilitation (CR) population.
  
  
  METHODS
  Insomnia symptom severity was measured using the Insomnia Severity Index upon admission to a 12-week CR program (n = 57). The Physical Activity Affect Scale was administered before and during a single bout of moderate intensity exercise to measure changes in mood state. Indices of mood disturbance included depressive symptoms (Hospital Anxiety and Depression Scale) and pre-exercise mood state (Physical Activity Affect Scale).
  
  
  RESULTS
  Greater severity of insomnia symptoms was associated with less pleasant mood overall (r = -0.45, P < .001), including less tranquility (r = -0.37, P = .005), lower positive affect (r = -0.39, P = .003), and worse fatigue (r = 0.36, P = .005); greater insomnia symptom severity also predicted greater improvements during exercise in both overall mood state (b = 0.26, standard error = 0.10, P = .009) and tranquility (b = 0.09, standard error = 0.04, P = .04), following statistical adjustment for demographic variables and pre-exercise mood state.
  
  
  CONCLUSIONS
  Although CR patients reporting insomnia symptoms tend to experience daytime mood disturbance, they may benefit from mood-elevating properties of exercise. Future research is needed to help optimize mood during exercise, which may have implications for improving psychological distress and CR adherence.
authors.affiliation: Department of Psychology, University of Calgary, Calgary, Alberta, Canada (Ms Rouleau and Dr Campbell); Department of Psychology, McGill University, Montréal, Quebec, Canada (Ms Horsley); TotalCardiology Rehabilitation, Calgary, Alberta, Canada (Ms Morse and Dr Aggarwal); and Department of Exercise Science, Concordia University, Montréal, Québec, Canada (Dr Bacon).
authors.forename: Codie R
authors.initials: CR
authors.lastname: Rouleau
authors.forename: Kristin J
authors.initials: KJ
authors.lastname: Horsley
authors.forename: Erin
authors.initials: E
authors.lastname: Morse
authors.forename: Sandeep
authors.initials: S
authors.lastname: Aggarwal
authors.forename: Simon L
authors.initials: SL
authors.lastname: Bacon
authors.forename: Tavis S
authors.initials: TS
authors.lastname: Campbell
mesh_terms: D000339:Affect; D000368:Aged; D015444:Exercise / Q000523:psychology*; D005081:Exercise Therapy / Q000523:psychology*; D006331:Heart Diseases / Q000523:psychology* / Q000628:therapy*; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D007319:Sleep Initiation and Maintenance Disorders / Q000523:psychology*