The present study aimed to assess the effect of an eight-week Pilates exercise on sleep quality and fatigue among female student dormitory residents. After four weeks, findings showed an improvement in sleep quality and two of its components (subjective sleep quality and daytime dysfunction). However, eight weeks of intervention had an additional effect on sleep duration, habitual sleep efficiency, and daytime dysfunction. It is noteworthy that with increasing the time of Pilates exercises, a significant improvement has been achieved in most components of sleep quality. Comparison of the two groups at different periods showed eight weeks of Pilates exercises improved the total scores of sleep quality and its' components (except sleep duration, sleep latency, and sleep disturbance).
In an intervention that has been conducted in parallel with a recent study, eight weeks of aerobic exercise had a positive effect on all components of students' sleep quality compared to the control group. The exercise was not part of the students' routine, and the exercise intensity was designed from mild to severe. The positive effect of the intervention could be related to the design of the intervention, which undoubtedly, such a design was not possible in the recent study. The result of a systematic review and meta-analysis of five RCTs (n= 660 women, with a mean age range from 48.6 to 55.8 years) showed that moderate physical activity (aerobic exercise) for 12-16 weeks improved sleep quality, but not with yoga [37].
The current study results showed that four and eight weeks of Pilates exercises improved fatigue levels and components, so even four weeks of Pilates exercises can also significantly improve fatigue components. This result consists of a study conducted parallel with a recent study. After four weeks of intervention, aerobic exercise positively reduced the total fatigue score and its components [29].
As for Pilates exercises, randomized clinical trials that have examined the effects on the sleep quality and fatigue of college students are scarce. However, after a fifteen-week Pilates exercise, which is implemented in two different time methods (twice a week for 75 min each class period or three times per week for 50 min each class period), improved sleep quality in college students [28]. In one study, a 12-week (60 min, twice per week) Pilates exercises program significantly increased sleep quality in a sedentary young population between 18 and 30 years [19]. In another study, after eight weeks of home-based 30-min Pilates exercises, improvement in subjective sleep quality, daytime dysfunction, and global PSQI score in primigravida postpartum women have been achieved [21].
Improvements in sleep quality and all domains in 110 postmenopausal women age 60 and older after twelve weeks of Pilates exercise have been reported [4]. In another study Pilates exercises twice a week in 60-min sessions in older women (at least 60 years old) improved PSQI total score, sleep latency, and use of sleeping medication [20]. A recent systematic reviews support the beneficial effects of Pilates exercise on the quality of sleep. In contrast, no significant improvement in the use of sleep medication was observed [2]. In our study, none of the participants took sleeping medication, so all received a score of zero for area six of the PSQI (the use of sleeping medications), which was removed from the list of sleep quality questionnaires
College years are when students gain critical knowledge, skills, human capital, and credentials to become successfully employed and contribute to society after graduation [6]. Sleep is a complex physiological and behavioral process that is important for both physical and mental health. Epidemiologic investigations identify college students as a population at risk for insufficient sleep [1]; also, fatigue dramatically affects many aspects of people's lives through performing activities and precious living roles [12].
Physical exercise has different biological and physiological aspects [13]. Activity constitutes a therapeutic behavior, can improve body composition and fitness, which is critical in enhancing sleep quality [2, 13]. It has been suggested that increased brain serotonin levels due to exercise can affect circadian rhythm to improve sleep quality [19]. Pilates is a mind-body exercise approach that can be considered a complementary and alternative medicine therapy that requires core stability, strength, flexibility, and attention to muscle control, posture, and breathing [38]. Breathing is one of the primary rules in Pilates exercises. As a result of the breathing in pilates activity, sympathetic nervous system activity can decrease, and parasympathetic nervous activity can increase [39]. In dormitory students, due to the high level of inactivity and lack of access to sports facilities, Pilates exercises due to low cost, availability, no side effect, and effectiveness can be a practical step in improving the quality of sleep and health of this group of young people.