Associations of Activity and Sleep With Quality of Life: A Compositional Data Analysis

Association between physical activity and quality of life in Japanese adults aged 85 to 89 years: a cross-sectional study

BACKGROUND

Associations between physical activity (PA) and quality of life (QOL) have usually been studied in people in their 60s and 70s, however little is known about these associations in older age groups. We aimed to examine the association between PA and QOL in Japanese adults aged 85-89 years and investigate the types of exercises/sports in this population.

METHODS

This cross-sectional study (n = 914) used baseline data from the Kawasaki Aging and Well-being Project (KAWP), a longitudinal cohort study of older adults aged 85-89 years. Health-related QOL and psychological well-being were assessed using the EuroQoL 5D-5L (EQ-5D-5L) and the WHO Five Well-Being Index (WHO-5), respectively. PA was objectively and subjectively measured using a triaxial accelerometer and modified Zutphen Physical Activity Questionnaire, respectively. Associations were analyzed using multivariable regression analysis.

RESULTS

Higher PA was significantly associated with a higher EQ-5D-5L index score (coefficient, 0.004; 95%CI [0.001, 0.008], standardized coefficient, 0.142). In contrast, no association was observed between PA and the WHO-5 total score (coefficient, 0.103; 95%CI [-0.066, 0.271], standardized coefficient, 0.068). Calisthenics were the most commonly performed sports or exercises (27.4% of male and 47.6% of female participants). The subgroup of participants with > median PA had a longer walking duration than their counterparts, and the following sports/exercises were more frequently performed in addition to calisthenics; resistance training and others among male participants: stretching/yoga among female participants.

CONCLUSIONS

Our findings suggest that PA is associated with a better health-related QOL. However, no association was observed between PA and psychological well-being in this population. We found that calisthenics were the most commonly performed and that more physically active older adults performed several types of exercises/sports in addition to calisthenics and walking for longer durations. Since few studies have investigated the types of exercises/sports in this age group, these findings would be helpful for interventions to maintain PA and QOL in this age group.

TRIAL REGISTRATION

UMIN000026053.

Methodological Choices on 24-h Movement Behavior Assessment by Accelerometry: A Scoping Review

BACKGROUND

There are no reviews describing current measurement protocols and accelerometer processing decisions that are being used in 24-h MovBeh studies, across the lifespan. We aim to synthesise information on methods for assessing 24-h movement behaviors using accelerometry across all age groups.

MAIN BODY

PubMed, PsycINFO, SPORTDiscus, and EMBASE were searched until December 2022. Observational or intervention reports describing accelerometry methods in studies on combinations of movement behaviors, with a 24-h protocol across all ages, were included. This review included 102 studies: three studies in toddlers, 15 in preschoolers, 17 in children, 23 in adolescents and 44 in adults and older adults. The Actigraph GT3X was the most commonly used device; the majority of the included reports collected data for seven days, including three weekdays and one weekend day, with a ≥ 16 h/day per 24-h period for valid data. The criteria for non-wear time varied between ≥ 20 and  ≥ 90 min of consecutive zero counts, depending on the age group. The most common epoch used was 15 or 60 s for youth and adults, respectively. The choice of sleep algorithms and SB/PA cut-points, of the included reports, depended on age and the original validation/calibration study. To deal with non-compliant participants, exclusion of non-compliant participants from the analysis was most frequently used. Most studies used diaries/logs to complement the accelerometer data.

CONCLUSIONS

Accelerometer protocols and methodological decisions varied considerably between reports. Therefore, consensus on methodological decisions is needed to improve precision and comparability between studies, which is challenging given the complexity of the procedures, the number of available brands and types of accelerometers, and the plethora of programming options.

Associations between 24-h movement behaviors and health-related quality of life(HRQoL) in preschool children: a cross-sectional study

PURPOSE

To investigate the association between preschool children's 24-h movement behaviors and health-related quality of life (HRQoL), exploring the impact of time reallocation among these behaviors and examining gender differences.

METHODS

This study analysed HRQoL and 24-h movement behaviors of 349 preschool children in three kindergartens in Beijing, China, selected through convenience sampling using a cross-sectional study design. A t-test and multivariate analysis of variance methods were used to investigate gender differences. The study examined the relationship between 24-h movement behaviors and HRQoL using component data analysis and component isochronic substitution model methods, with an investigation into gender differences in the overall association.

RESULTS

The study found a negative correlation between sedentary behavior (SB) and overall HRQoL score (γ = - 11.92, p < 0.05) in the entire sample, particularly affecting physical health score (γ = - 14.39, p < 0.01). Among boys, SB was negatively correlated with the HRQoL total score (γ = - 15.83, p < 0.05), while sleep was positively correlated with psychosocial health scores (γ = 17.814, p = 0.01). However, there was no significant association found between 24-h movement behaviors and HRQoL in girls. When using the component isochronic substitution model, reallocating 30 min from sedentary behavior to sleep increased the total HRQoL score of preschool children by 0.865 points (95% CI 0.071, 1.658). In contrast, reallocating 30 min from sleep to sedentary behavior resulted in a decrease of 0.850 points (95% CI - 1.638, - 0.062) in the total HRQoL score.

CONCLUSIONS

To improve preschool children's HRQoL, it is recommended to reduce their sedentary behavior time and increase their sleep time. Public health policymakers should consider this when developing 24-h movement behavior guidelines for preschoolers.

A compositional analysis of time spent in physical activity, sedentary behaviour, and sleep with quality of life in Canadian older adults aged 65 years and above: findings from the Canadian Longitudinal Study on Aging

Associations between daily time spent in physical activity (PA), sedentary behaviour (SB), and sleep (collectively referred to as "movement behaviour") and quality of life (QOL) are typically studied without considering they are compositional, co-dependant variables. Study objectives were to use compositional data analysis to: (1) examine the relationship between movement behaviour composition and QOL, (2) estimate the degree to which changing time spent in any movement behaviour within the movement behaviour composition is associated with QOL. 7918 older Canadian adults ≥65 years of age from the Canadian Longitudinal Study on Aging were studied using a quasi-longitudinal study design. Daily time spent in PA and SB were derived from self-reported Physical Activity Scale for the Elderly responses. Nighttime sleep was self-reported separately. QOL was assessed through the Satisfaction with Life Scale. Movement behaviour composition was significantly associated with QOL. Relative time spent in SB was negatively associated with QOL (HR = 0.89 (95% CI: 0.86-0.93)). Relative time spent in sleep was positively associated with QOL (HR = 1.10 (95% CI: 1.05-1.16)). Time displacement estimates revealed that greatest change in QOL occurred when time spent in PA was decreased and replaced with SB (HR = 0.96 (95% CI: 0.92-0.99) for 45 min/day displacement). Using compositional data analysis is advantageous because it shows how reduction in SB and increase in PA and sleep can lead to improvements in QOL for older Canadian adults.

The Effect of Muscle Cramps During Hemodialysis on Quality of Life and Habitual Physical Activity

Background and Objectives: This study aimed to evaluate the association between QoL, self-assessed physical activity, and the presence and severity of muscle spasms in chronic hemodialysis patients. Patients undergoing regular in-center hemodialysis (HD) have much lower quality of life (QoL) than healthy individuals. However, there is limited knowledge about the impact of specific common complications of hemodialysis, particularly muscle spasms on the overall well-being of patients. Materials and Methods: In this prospective, single-center study, 67 chronic HD patients were surveyed regarding the prevalence of muscle spasms using a validated 9-multiple-choice-question survey, alongside the Physical Activity Questionnaire (IPAQ) and The Short Form (36) Health Survey (SF-36). Based on the muscle spasms survey answers, patients were divided into two subgroups: with (n = 39) and without muscle spasms (n = 28). Results: The findings revealed that patients with muscle spasms had a higher body mass index (BMI) (p = 0.005), a shorter dialysis vintage (p = 0.063), and significantly longer sitting times (p = 0.017). Multivariate analysis identified BMI (p = 0.034), sitting time (p = 0.009), physical functioning scores (p = 0.032), and dialysis vintage (p = 0.040) as significant predictors of muscle spasms. Conclusions: This study concluded that muscle spasms are associated with lower QoL among HD patients. The contributing factors to this dependance are BMI, dialysis vintage, physical functioning, and sitting time.

24-hour movement behaviors and changes in quality of life over time among community-dwelling older adults: a compositional data analysis

BACKGROUND

Favorable movement behavior patterns, comprising more physical activity, less sedentary behavior, and sufficient sleep, may promote the maintenance of good quality of life (QoL) with advancing age. The aim of the present study was to investigate whether movement behaviors predict future changes in QoL among community-dwelling older adults over a four-year follow-up.

METHODS

Participants were 75-, 80- and 85-year-old community-dwelling older adults (n = 203) followed up for 4 years. Participants wore thigh- and trunk-mounted accelerometers for 3-7 days at baseline. Proportion of time-use in physical activity, standing and sedentary behavior were assessed based on body posture and movement intensity. Time in bed was determined using an automated algorithm. QoL was assessed during a home interview using the short Older People's Quality of Life Questionnaire at baseline and follow-up (range 13-65, higher scores indicate higher QoL). Compositional linear regression analysis was used to study whether baseline time-use composition predicts changes in QoL.

RESULTS

Over the 4-year follow-up, QoL scores decreased by 5% on average. Higher physical activity in relation to the other movement behaviors was associated with increase in QoL over time (βilr 0.94, p = 0.013), but this association attenuated after adding baseline physical function into the model. Sedentary behavior, standing, and time in bed were not associated with changes in QoL. Theoretical reallocation of 30 min of physical activity into sedentary behavior, standing or time in bed was estimated to decrease QoL by 0.5 (CI 95% -0.6 to -0.4), 0.6 (-0.7 to -0.5) and 0.4 (-0.5 to -0.3) points, respectively.

CONCLUSIONS

Theoretical reallocation of physical activity into sedentary behavior, standing, and time in bed was found to be associated with prospective decline in QoL among older adults. Engaging more in physical activity and less in more passive activities may promote better QoL with advancing age.

A systematic review of research reporting practices in observational studies examining associations between 24-h movement behaviors and indicators of health using compositional data analysis

Background

Compositional data analysis (CoDA) techniques are well suited for examining associations between 24-h movement behaviors (i.e., sleep, sedentary behavior, physical activity) and indicators of health given they recognize these behaviors are co-dependent, representing relative parts that make up a whole day. Accordingly, CoDA techniques have seen increased adoption in the past decade, however, heterogeneity in research reporting practices may hinder efforts to synthesize and quantify these relationships via meta-analysis. This systematic review described reporting practices in studies that used CoDA techniques to investigate associations between 24-h movement behaviors and indicators of health.

Methods

A systematic search of eight databases was conducted, in addition to supplementary searches (e.g., forward/backward citations, expert consultation). Observational studies that used CoDA techniques involving log-ratio transformation of behavioral data to examine associations between time-based estimates of 24-h movement behaviors and indicators of health were included. Reporting practices were extracted and classified into seven areas: (1) methodological justification, (2) behavioral measurement and data handling strategies, (3) composition construction, (4) analytic plan, (5) composition-specific descriptive statistics, (6) model results, and (7) auxiliary information. Study quality and risk of bias were assessed by the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-sectional Studies.

Results

102 studies met our inclusion criteria. Reporting practices varied considerably across areas, with most achieving high standards in methodological justification, but inconsistent reporting across all other domains. Some items were reported in all studies (e.g., how many parts the daily composition was partitioned into), whereas others seldom reported (e.g., definition of a day: midnight-to-midnight versus wake-to-wake). Study quality and risk of bias was fair in most studies (85%).

Conclusions

Current studies generally demonstrate inconsistent reporting practices. Consistent, clear and detailed reporting practices are evidently needed moving forward as the field of time-use epidemiology aims to accurately capture and analyze movement behavior data in relation to health outcomes, facilitate comparisons across studies, and inform public health interventions and policy decisions. Achieving consensus regarding reporting recommendations is a key next step.

Supplementary Information

The online version contains supplementary material available at 10.1186/s44167-024-00062-8.

Impacts of physical activity, sedentary behaviour, and sleep on depression symptoms in Canadian older adults 65 years of age and above: a compositional data analysis of the Canadian Longitudinal Study on Aging

BACKGROUND

Daily time spent in moderate-to-vigorous physical activity (MVPA), light-intensity physical activity (LIPA), sedentary behaviour (SB) and sleep (collectively known as 'movement behaviours') are compositional, co-dependent variables. However, most studies examining effects of these behaviours on depression outcomes in older adults do not account for this. Study objectives were to use compositional data analysis methods to (1) examine the relationship between movement behaviour composition (daily time spent in MVPA, LIPA, SB, sleep) and depression symptoms, (2) estimate the extent to which changing time spent in any given movement behaviour within the movement behaviour composition was associated with changes in depression symptoms.

METHODS

5643 older Canadian adults ≥ 65 years of age from the Canadian Longitudinal Study on Aging were studied using a quasi-longitudinal study design. Exposure was baseline daily movement behaviours; time spent in MVPA, LIPA and SB were derived from self-reported Physical Activity Scale for the Elderly responses. Night-time sleep was self-reported separately. Outcome was depression symptoms at follow-up obtained using the ten item Center for Epidemiologic Studies Depression Scale. Compositional data analysis was used to investigate associations between movement behaviours and depression symptoms.

RESULTS

Movement behaviour composition was significantly associated with depression symptoms. Time spent in MVPA [exp(B) = 0.97 (95% CI: 0.94, 0.99)] and sleep [exp(B) = 0.91 (95% CI: 0.85, 0.97)] relative to the remaining movement behaviours were associated with lower depression symptoms scores. Relative time spent in SB was associated with higher depression symptoms scores [exp(B) = 1.09 (95% CI: 1.04, 1.15)]. Time displacement estimates revealed that the greatest change in depression symptoms scores occurred when time spent in MVPA was decreased and replaced with LIPA, SB, sleep or combination of these behaviours (+ 0.22 to 0.26 points increase on depression symptoms scores for 30 min/day displacements).

CONCLUSIONS

Daily movement behaviour composition was associated with depression symptoms in older Canadians. Replacing time in MVPA with equivalent time from any other behaviour was associated with increased depression symptoms. Preserving time spent in MVPA may play a key role in mitigating and improving mental health in this demographic.

The Rotterdam Study. Design update and major findings between 2020 and 2024

The Rotterdam Study is a population-based cohort study, started in 1990 in the district of Ommoord in the city of Rotterdam, the Netherlands, with the aim to describe the prevalence and incidence, unravel the etiology, and identify targets for prediction, prevention or intervention of multifactorial diseases in mid-life and elderly. The study currently includes 17,931 participants (overall response rate 65%), aged 40 years and over, who are examined in-person every 3 to 5 years in a dedicated research facility, and who are followed-up continuously through automated linkage with health care providers, both regionally and nationally. Research within the Rotterdam Study is carried out along two axes. First, research lines are oriented around diseases and clinical conditions, which are reflective of medical specializations. Second, cross-cutting research lines transverse these clinical demarcations allowing for inter- and multidisciplinary research. These research lines generally reflect subdomains within epidemiology. This paper describes recent methodological updates and main findings from each of these research lines. Also, future perspective for coming years highlighted.

The association between reallocations of time and health using compositional data analysis: a systematic scoping review with an interactive data exploration interface

BACKGROUND

How time is allocated influences health. However, any increase in time allocated to one behaviour must be offset by a decrease in others. Recently, studies have used compositional data analysis (CoDA) to estimate the associations with health when reallocating time between different behaviours. The aim of this scoping review was to provide an overview of studies that have used CoDA to model how reallocating time between different time-use components is associated with health.

METHODS

A systematic search of four electronic databases (MEDLINE, Embase, Scopus, SPORTDiscus) was conducted in October 2022. Studies were eligible if they used CoDA to examine the associations of time reallocations and health. Reallocations were considered between movement behaviours (sedentary behaviour (SB), light physical activity (LPA), moderate-to-vigorous physical activity (MVPA)) or various activities of daily living (screen time, work, household chores etc.). The review considered all populations, including clinical populations, as well as all health-related outcomes.

RESULTS

One hundred and three studies were included. Adiposity was the most commonly studied health outcome (n = 41). Most studies (n = 75) reported reallocations amongst daily sleep, SB, LPA and MVPA. While other studies reported reallocations amongst sub-compositions of these (work MVPA vs. leisure MVPA), activity types determined by recall (screen time, household chores, passive transport etc.) or bouted behaviours (short vs. long bouts of SB). In general, when considering cross-sectional results, reallocating time to MVPA from any behaviour(s) was favourably associated with health and reallocating time away from MVPA to any behaviour(s) was unfavourably associated with health. Some beneficial associations were seen when reallocating time from SB to both LPA and sleep; however, the strength of the association was much lower than for any reallocations involving MVPA. However, there were many null findings. Notably, most of the longitudinal studies found no associations between reallocations of time and health. Some evidence also suggested the context of behaviours was important, with reallocations of leisure time toward MVPA having a stronger favourable association for health than reallocating work time towards MVPA.

CONCLUSIONS

Evidence suggests that reallocating time towards MVPA from any behaviour(s) has the strongest favourable association with health, and reallocating time away from MVPA toward any behaviour(s) has the strongest unfavourable association with health. Future studies should use longitudinal and experimental study designs, and for a wider range of outcomes.

A systematic review examining associations between physical activity, sedentary behaviour, and sleep duration with quality of life in older adults aged 65 years and above

This systematic review examined the associations between movement behaviours (i.e., physical activity, sedentary behaviour, and sleep duration) and quality of life (QOL) in adults ≥65 years of age. Four databases were searched in June 2021. Studies were eligible for inclusion if published within the last 20 years, peer-reviewed, examined apparently healthy older adults, and analysed ≥2 movement behaviours together. QOL was represented by the World Health Organization Quality of Life measure which conceptualizes QOL by distinct domains. Study results were categorized and presented by domain. Risk of bias was completed for all included studies using methods described in the Cochrane Handbook. Thirty-one studies with 307 292 participants were included that examined QOL outcomes across seven domains: superdomain (composite measures), perceived physical health, mental and psychological states, level of independence, social relationships, environment, and general health. Findings indicated that moderate-to-vigorous intensity physical activity was favourably associated with QOL. Time re-allocation studies that showed moving time into physical activity from sedentary behaviour were associated with favourable QOL changes. The evidence regarding sedentary behaviour and sleep duration was inconsistent. The quality of evidence was very low for all domains. In conclusion, there is consistent evidence that physical activity improves QOL in adults ≥65 years of age. International Prospective Register of Ongoing Systematic Reviews (PROSPERO) registration No.: CRD42021260566.

Objective and subjective measures of sleep in men with Muscular Dystrophy

Purpose

Despite poor sleep quality being recognised in Duchenne Muscular Dystrophy, reports from milder forms of Muscular Dystrophy (MD), and accompanied associations with quality of life (QoL), pain and fatigue, remain limited however.

Methods

Adult males (n = 15 Beckers MD (BMD), n = 12 Limb-Girdle MD (LGMD), n = 12 Fascioscapulohumeral (FSHD), n = 14 non-MD (CTRL)) completed assessments of body composition (Bio-electrical impedance), sleep (7-day 24-hour tri-axial accelerometer, Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index, QoL (SF36-v2), pain (Visual analogue scale), fatigue (Modified Fatigue Index Scale) and functional assessments (Brookes and Vignos).

Results

FSHD and BMD reported worse sleep than CTRL on the PSQI. FSHD scored worse than CTRL on the Insomnia Severity Index (P<0.05). 25–63% and 50–81% of adults with MD reported poor sleep quality using the Insomnia Severity Index and PSQI, respectively. Accelerometery identified no difference in sleep quality between groups. Associations were identified between sleep measures (PSQI global and insomnia severity) with mental or physical QoL in LGMD, BMD and FSHD. Multiple regression identified associations between sleep impairment and fatigue severity (all MDs), body composition (BMD & LGMD), upper and lower limb function (LGMD, FSHD) and age (FSHD).

Conclusions

25–81% of men with MD, depending on classification, experience sleep impairment, using self-report sleep measures. Whilst BMD and FSHD showed worse sleep outcomes than CTRL, no group difference was observed between LGMD and CTRL, however all groups showed associations with sleep impairment and higher levels of fatigue. These findings, and associations with measures of health and wellbeing, highlight an area for further research which could impact QoL in adults with MD.

A compositional analysis of time spent in sleep, sedentary behaviour and physical activity with all-cause mortality risk

BACKGROUND

Daily time spent in sleep, sedentary behaviour (SED), light intensity physical activity (LIPA), and moderate-to-vigorous intensity physical activity (MVPA) are compositional, co-dependent variables. The objectives of this study were to use compositional data analysis to: (1) examine the relationship between the movement behaviour composition (daily time spent in sleep, SED, LIPA and MVPA) and all-cause mortality risk, and (2) estimate the extent to which changing time spent in any given movement behaviour (sleep, SED, LIPA, or MVPA) within the movement behaviour composition was associated with changes in risk of all-cause mortality.

METHODS

2838 adult participants from the 2005-2006 cycle of the U.S. National Health and Nutrition Examination Survey were studied using a prospective cohort design. Daily time spent in SED, LIPA and MVPA were determined by accelerometer. Nightly time spent sleeping was self-reported. Survey data were linked with mortality data through to the end of December 2015. Compositional data analysis was used to investigate relationships between the movement behaviour composition and mortality.

RESULTS

The movement behaviour composition was significantly associated with mortality risk. Time spent in MVPA relative to other movement behaviours was negatively associated with mortality risk (HR = .74; 95% CI [.67, .83]) while relative time spent in SED was positively associated with mortality risk (HR = 1.75; 95% CI [1.10, 2.79]). Time displacement estimates revealed that the greatest estimated changes in mortality risk occurred when time spent in MVPA was decreased and replaced with sleep, SED, LIPA or a combination of these behaviours (HRs of 1.76 to 1.80 for 15 min/day displacements).

CONCLUSIONS

The daily movement behaviour composition was related to mortality. Replacing time in MVPA or SED with equivalent time from any other movement behaviour was associated with an increase and decrease in mortality risk, respectively.