Psychological recovery: Progressive muscle relaxation (PMR), anxiety, and sleep in dancers
Introduction
This study was conceptualised in response to the assistance given to athletes by the sports science and psychology staff at the Australian Olympic team's recovery centre during the London 2012 Olympic Games. Sleep was viewed as vital for athletes’ recovery at the games, and progressive muscle relaxation (PMR) was employed as a relaxation strategy to offset the psychological (cognitive) and physical (somatic) stressors experienced. There is evidence for the use of PMR in the general population as an effective treatment for sleep issues, but little evidence exists to support the use of PMR for performers. For the purpose of this study, “elite” refers to highly skilled, and “performers” refers to those who perform or execute a physical skill. The present study was a preliminary pilot evaluation of PMR in full time dancers with the view to replication with an athlete sample and a larger randomised controlled trial in the future.
Recovery is defined as the re-establishment of psychological and physiological resources to allow for future use (Kellman & Kallus, 1999). Different performance contexts involve different physical and mental stressors in training and performance, and individuals differ in their abilities to cope with stressors. Responsible for the secretion of the stress hormone cortisol, the hypothalamic–pituitary–adrenal (HPA) axis is primarily activated when the body responds to stress (Miller & O’Callaghan, 2002). Socio-evaluative threat (the threat of negative evaluation from others) during training and performance can activate the HPA axis (Suay et al., 1999). During stress, elite performers experience a deviation from the homeostasis state, requiring restoration during recovery for training and performance standards to be maintained (Beckmann & Kellmann, 2004).
Athletes, coaches, and trainers identify sleep as an important aspect of the recovery process and crucial for optimal performance (Postolache et al., 2005, Samuels, 2008). Physically, sleep is critical for protein synthesis, growth hormone release, and for the facilitation of glucose metabolism (Davenne, 2009, Spiegel et al., 2009). Sleep also has been identified as the most important factor in performance on cognitive tasks (Pilcher and Huffcutt, 1996, Rosekind, 2005). Research on the effects of sleep loss on athletic performance has found that mood, psychomotor, and cognitive function decline more rapidly than physical capabilities (Davenne, 2009, Mougin et al., 1991, Souissi et al., 2003). The benefits of sleep extension have demonstrated measurably improved athletic performance (Mah, Mah, Kezirian, & Dement, 2011). Therefore, sleep appears to have a vital role in recovery, and the sleep needs of elite performers may differ from other populations (Davenne, 2009).
Theorists have suggested that sleep quality and patterns differ for athletes compared to nonathletic populations (Davenne, 2009, Leger et al., 2005, Savis, 1994). Wristwatch actigraphy has been used to measure the sleep of elite athletes (Leeder, Glaister, Pizzoferro, Dawson, & Pedlar, 2012). Actigraphy is an objective measure of sleep involving a device worn on the wrist of the user to record the number and amplitude of movements. Used in conjunction with a sleep diary, actigraphy provides a validated alternative to laboratory-based polysomnography (PSG) recording of some sleep parameters (Kushida et al., 2001, Vallieres and Morin, 2003). Significant differences have been reported between athletes and age- and sex-matched controls across time in bed, sleep onset latency (SOL), time awake, sleep efficiency, actual sleep, moving minutes, and moving time (Leeder et al., 2012). Greater individual variance was found within each variable for the athletes, suggested to be due to differential physiological and psychological stress (Leeder et al., 2012). A study of elite dancers recorded similar baseline data to athletes during a normal training phase (Fietze et al., 2009, Leeder et al., 2012).
Psychological factors such as trait anxiety have been found to affect sleep quantity and quality (Du et al., 2009, Kajimura et al., 1998, Savis, 1994). In several studies of both clinical and general populations, individuals with high trait anxiety have demonstrated chronically poor SOL and a higher number of awakenings during the night (Du et al., 2009, Kajimura et al., 1998, Viens et al., 2003). Pre-performance sleep problems are widely reported by elite athletes and in elite dance populations (Erlacher et al., 2009, Fietze et al., 2009). Recent research demonstrated a strong negative association between pre-sleep state anxiety and self-reported sleep quality of athletes (Romyn, Robey, Dimmock, Halson, & Peeling, 2015). In a review of sleep and sport, it was concluded that more sophisticated research was required because current interventions have been based largely on clinical experience and evidence derived from fields not relevant to athletes (Postolache et al., 2005). Sleep medication is not ideal for athletes due to possible effects on physical and cognitive performance during subsequent training and performance (Leger et al., 2005). For the management of insomnia and sleep disruption in athletes, relaxation may greatly help during regular training periods and before competitions (Leger et al., 2005).
PMR has been one of the most widely investigated of all relaxation strategies and is recognised by the American Psychological Association as an empirically supported treatment for insomnia (de Niet et al., 2009, McCallie et al., 2006, Morin et al., 1999). The mechanisms of its efficacy are suggested to be based upon the known connection between stress and sleep issues (Van Reeth et al., 2000). The conscious directed initiation of the homeostasis-restoring parasympathetic nervous system (PNS) branch of the autonomic nervous system down-regulates the over-active HPA axis, supported by evidence of a post PMR reduction in salivary cortisol and increased heart rate variability (Dolbier & Rush, 2012).
PMR is the use of scripts (in-person, audio, or video) involving tensing (4–7 s) and then relaxing (20–45 s) different muscle groups throughout the body (McCallie et al., 2006, Mezo et al., 2011, Taylor and Roane, 2010). PMR is undertaken seated on a chair with the feet on the floor next to each other, knees in a 90° angle, arms resting on upper legs; or, laying down with arms next to body and support under knees or knees bent; takes between 8 and 30 minutes; and may or may not involve daytime practice as well as use before bedtime (Taylor & Roane, 2010). The feelings of relaxation and the contrast between feelings of tension and relaxation raise individuals’ awareness and recognition of tension, allowing conscious relaxation.
In summary, evidence has indicated that elite performers have different sleep requirements than the general population. Sleep is an important recovery strategy after physical and psychological stress for elite performers to return to homeostasis (Halson, 2008). Trait anxiety has been found to influence poor sleep quality, in particular SOL, in general and clinical populations with sleep issues. The efficacy of PMR in enhancing the sleep of elite performers has not been established. The current study was designed to test the efficacy of PMR in improving the SOL of full time dancers. It was hypothesised that full time dancers would record shorter sleep durations with less efficient sleep than general populations in line with published data; and that a PMR intervention would improve the SOL of full time dancers with poor SOL and high trait anxiety.
Section snippets
Method
Participants were recruited from the Queensland University of Technology (QUT) Dance programme (n = 12; mean age 20.09 years, SD = 1.45; 84% identifying as Caucasian, 8% South African, and 8% Asian). Participation was voluntary. Inclusion criteria for the study comprised age of at least 18 years of age, female gender, and full-time participation at an elite performance level. All participants were in a stable training phase (daily average = 3 h 39 m, SD = 33 m) during the study. A single gender sample was
Results
There were no missing data and all data were inspected to ensure that scores were within scale response limits. Normality was evaluated by examining skewness and kurtosis values and data were screened for potential outliers. All variables met the assumptions of normality except sleep onset was positively skewed. An inverse transformation to normalise the distribution was performed (Tabachnick & Fidell, 2007). The transformation failed to improve the skewness therefore analyses of the
Discussion
The aim of the current study was to test the efficacy of PMR as a natural sleep aide and recovery strategy for full time dancers to assist applied performance psychologists in preparing performers mentally with empirically sound techniques to ensure quality recovery and performance/s. PMR is widely used by athletes, although the efficacy of its application in this context has not been evaluated.
Hypothesis 1, that elite performers would record shorter sleep durations with less efficient sleep
Conclusion
General findings of physical, cognitive, and mood effects due to sleep loss are widely reported in clinical, general, and performance samples (Fietze et al., 2009, Postolache et al., 2005, Savis, 1994). Despite indicators of quality sleep, athletes may require more sleep than they achieve on average (Davenne, 2009, Mah et al., 2011). Sub-optimal sleep duration can be further exacerbated for individuals with sleep problems, affecting recovery from training and performance stressors. The use of
Acknowledgements
The Australian Institute of Sport supplied the actigraphy devices and the computers and software for data processing and analysis. Acknowledgement to Laura Juliff (Australian Institute of Sport) and Assoc Prof Gene Moyle (Queensland University of Technology, Dance). There has been no financial assistance with this project.
References (42)
- et al.
Comparison of actigraphic, polysomnographic, and subjective assessment of sleep parameters in sleep-disordered patients
Sleep Medicine
(2001) - et al.
Insomnia and sleep disruption: Relevance for athletic performance
Clinics in Sports Medicine
(2005) - et al.
Neuroendocrine aspects of the response to stress
Metabolism: Clinical and Experimental
(2002) - et al.
Sports chronobiology consultation: from the lab to the arena
Clinics in Sports Medicine
(2005) Underestimating the societal costs of impaired alertness: Safety, health and productivity risks
Sleep Medicine
(2005)Sleep, recovery, and performance: The new frontier in high-performance athletics
Neurologic Clinics
(2008)- et al.
Effects of competition and its outcome on serum testosterone, cortisol and prolactin
Psychoneuroendocrinology
(1999) - et al.
Interactions between stress and sleep: From basic research to clinical situations
Sleep Medicine Reviews
(2000) - et al.
Trait anxiety and sleep-onset insomnia: Evaluation of treatment using anxiety management training
Journal of Psychosomatic Research
(2003) - et al.
Selected issues in the design and analysis of sport performance research
Journal of Sports Sciences
(2001)
Self-regulation and recovery: Approaching an understanding of the process of recovery from stress
Psychological Reports
A power primer
Psychological Bulletin
Sleep of athletes: Problems and possible solutions
Biological Rhythm Research
Review of systematic reviews about the efficacy of non-pharmacological interventions to improve sleep quality in insomnia
International Journal of Evidence-Based Healthcare
An investigation of subjective sleep and fatigue measures for use with elite athletes
Journal of Clinical Sport Psychology
Efficacy of abbreviated progressive muscle relaxation in a high-stress college sample
International Journal of Stress Management
Correlation between state-trait anxiety and sleep structure in patients with insomnia
Chinese Mental Health Journal
Assessment of state and trait anxiety: Endler multidimensional anxiety scales
Anxiety Research
Endler multidimensional anxiety scales: Manual.
Multidimensionality of state and trait anxiety: Factor structure of the endler multidimensional anxiety scales
Journal of Personality and Social Psychology
Subjective sleep quality prior to home and away games for female volleyball players
International Journal of Dream Research
Cited by (16)
Dancing dreams: The intersection of ballet and sleep
2024, Sleep HealthRelaxation techniques in sports: A systematic review on acute effects on performance
2016, Performance Enhancement and HealthCitation Excerpt :The application of standardized versions of these methods in clinical settings is ubiquitous and brings along an exact and differentiated understanding of relaxation which should be transferred to sports settings. Effects include a shortening of healing time and/or the reduction of stress (Broadbent et al., 2012), a positive influence on the cardiac parasympathetic tone (Sakakibara, Takeuchi, & Hayano, 1994), a positive impact on rehabilitation following sport injury (Schwab Reese, Pittsinger, & Yang, 2012) and improving the sleep onset latency (McCloughan, Hanrahan, Anderson, & Halson, 2015). Crawford et al.’s 2012 review on the use of PMR in clinical trials revealed moderate to large effect sizes on the effectiveness of PMR.
Expertise in Contemporary Dance: The Roles of Cognition, Talent, and Deliberate Practice
2024, Journal of Dance EducationSleep and the Young Athlete
2023, Sports Health