Sedentary behavior and sleep efficiency in active community-dwelling older adults

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.

The effect of replacing prolonged sitting with intermittent standing during a simulated workday on the subsequent night's sleep

A bout of leisure-time physical activity improves sleep on the subsequent night. However, whether breaking up sedentary time during the workday improves sleep is unknown. The purpose of this study was to examine whether breaking up prolonged sitting by standing during the workday leads to better sleep the following night. 25 inactive adults (16 males, 42.4 ± 11.8 years, body mass index: 31.9 ± 5.0 kg/m2) participated in a randomized crossover trial consisting of two simulated 8-h workdays involving prolonged sitting (SIT) or alternating sitting and standing every 30 min (SIT-STAND). Sleep was assessed on the night following each workday. Participants completed a diary and wore a wrist accelerometer (Actiwatch Spectrum) to assess multiple dimensions of sleep (e.g., timing, duration, wakefulness, quality). Paired t-tests and Hedges' g effect sizes evaluated differences in sleep across conditions. Self-reported wakefulness after sleep onset (WASO) was significantly lower following SIT-STAND compared to SIT (13.9 ± 30.1 min vs. 23.2 ± 38.6 min; p = 0.03, g = - 0.51), mirrored by a small-sized nonsignificant reduction in accelerometer-assessed WASO following SIT-STAND compared to SIT (32.7 ± 13.6 min vs. 40.8 ± 25.8 min; p = 0.06, g = - 0.38). Mean accelerometer-based activity levels during sleep were also lower following SIT-STAND compared to SIT (10.8 ± 14.5 vs. 14.7 ± 10.4 counts/min; p = 0.03, g = - 0.47). Other sleep outcomes (e.g., bed- and wake-time, total sleep time, sleep onset latency) were not different between conditions. Alternating sitting and standing rather than prolonged sitting during a simulated workday modestly reduces night-time wakefulness. Whether similar benefits occur with long-term reduction in workplace sedentary behavior deserves further exploration.

Associations between meeting 24-h movement guidelines and sarcopenia risk among adults aged ≥ 55 years in five low- and middle-income countries

OBJECTIVE

To diminish the negative influence of sarcopenia on senior adults, the study aimed to investigate the association between adherence to 24-h movement behavior guidelines (physical activity, sedentary behavior, sleep duration) and the risk of sarcopenia among individuals aged ≥55 years in five low- and middle-income countries (LMICs).

METHODS

A total of 16,503 adults aged ≥55 years were included in this cross-sectional study. The study utilized data from Global Aging and Adult Health Survey (SAGE). Participants reported their information about physical activity, sedentary behavior, and sleep duration using the questionnaire. Sarcopenia was identified as low skeletal muscle mass with a diminished gait speed or weakened handgrip strength. Multiple logistic regression models were used to investigate the association between adherence to 24-h movement behavior guidelines and the risk of sarcopenia.

RESULTS

Merely 32.73 % of participants met all three 24-h movement behavior guidelines (physical activity, less sedentary behavior, sleep). Meeting all three guidelines (p < 0.01) was significantly associated with a lower risk of sarcopenia. Meeting physical activity only (p < 0.05), or meeting both physical activity and sedentary behaivor (p < 0.05), or meeting both physical activity and sleep duration (p < 0.01) guidelines were also associated with a reduced risk of sarcopenia. Moreover, adults aged 65+ years who adhered to 24-h movement behavior guidelines exhibited a significantly reduced risk of developing sarcopenia.

CONCLUSION

The findings suggest that the adherence to 24-h movement behavior guidelines for regular physical activity, limited sedentary behavior, and sufficient sleep duration was associated with a reduced risk of sarcopenia in adults aged ≥55 years in five LMICs.

Objectively Measured Physical Activity and Sedentary Behaviors Among Older Adults in Assisted Living Facilities: A Scoping Review

Older adults in assisted living facilities (ALF) are at risk for low physical activity (PA) and high sedentary behavior (SB), both of which place them at risk for negative health outcomes. The purpose of this scoping review was to synthesize evidence describing the volume of device-measured PA/SB, factors associated with PA/SB, and interventions designed to change PA/SB in older adults living in ALF. Twenty articles representing 15 unique studies were identified from eight electronic databases and grey literature. Residents in ALF spent 96-201 min/day in light PA (n = 2 studies), 1-9.74 min/day in moderate to vigorous PA (n = 2 studies), and 8.5-11.01 hr/day of SB during waking hours (n = 3 studies). Factors associated with PA included 16 personal factors (n = 6 articles), one social factor (n = 2 articles), and two environmental factors (n = 2 articles). Factors associated with SB included 14 personal factors (n = 4 articles) and one social factor (n = 1 article). No intervention successfully changed PA/SB.

Effects of daily sleep on physical activity after cardiac surgery

BACKGROUND

Maintaining physical activity is challenging after cardiac surgery. Postsurgical cardiac patients often experience sleep problems showing a reciprocal interaction with physical activity. As sleep and physical activity show day-to-day variations, their daily relationships need to be assessed. However, no studies have examined daily sleep-physical activity relationships in postsurgical cardiac patients.

OBJECTIVES

This study aimed to examine the effects of daily sleep factors on daily physical activity after cardiac surgery.

METHODS

Among 33 patients who underwent cardiac surgery at least 10 weeks earlier, 5 sleep and 4 physical activity variables were measured using a wrist-worn ActiGraph for 7 days. Mixed-effects models were applied for data analyses.

RESULTS

Most participants were male (57.6 %), non-Hispanic whites (63.6 %) who had coronary artery bypass graft surgery (54.6 %). Participants averaged 60.8 ± 10.1 years of age and 85.7 ± 91.2 months since surgery. They slept for an average of 385.6 ± 74.6 min (6.4 ± 1.2 h). Among sleep factors, greater number of awakenings (NOA) predicted lower next-day sedentary time. Higher sleep efficiency (SE) was associated with lower next-day sedentary time when not controlling for covariates. Among the psychosocial, demographic, and clinical covariates, higher comorbidity index was associated with fewer kcals expended, less daily moderate-to-vigorous physical activity, and more daily sedentary time.

CONCLUSIONS

Daily SE and NOA and individual health status, including comorbidity, should be assessed over time to support improvement of daily physical activity after cardiac surgery. Researchers should examine the relationship between NOA and next-day sedentary time with larger samples. Such research should address multiple psychosocial, demographic, and clinical factors and the potential mediating role of sleep.

Associations of endurance, muscle strength, and balanced exercise with subjective sleep quality in sedentary workers: A cross-sectional study

BACKGROUND

The optimal exercise combination for improving sleep quality among sedentary workers is unclear.

OBJECTIVE

To reveal what combination of exercises contributes to good sleep quality.

METHODS

In this cross-sectional study, we enrolled 5,201 sedentary workers who underwent health examinations in 2019. Data on sleep quality, basic attributes, energy expenditure, and lifestyle aspects such as exercise and physical activity, supper time close to bedtime, and alcohol intake were obtained. The subjects reported their exercise habits by selecting up to three forms of exercise from a list of 182 options, which were classified into three types: endurance (e.g., jogging), muscle strength (e.g., bench pressing), and balanced types which combined both endurance and muscle strength characteristics. (e.g., walking). These forms were then categorized into eight combination patterns: endurance only; muscle strength only; balanced only; endurance and muscle strength; endurance and balanced; muscle strength and balanced; all types; and absence of any exercise habits. Binary logistic regression analysis was used to examine the associations between the exercise combination patterns and sleep quality.

RESULTS

Good sleep quality was significantly associated with "endurance" (OR = 1.419; 95% CI 1.110-1.814), "balanced only" (OR = 1.474; 95% CI 1.248-1.741), and "endurance and balance" (OR = 1.782; 95% CI 1.085-2.926) exercise patterns. No significant associations were found between the combinations that included muscle strength exercises and sleep quality.

CONCLUSION

The endurance or balanced-type exercises, or a combination of both, may help to improve the sleep quality of sedentary workers as part of occupational health management.

Sleep characteristics and pain in middle-aged and older adults: Sex-specific impact of physical and sitting activity

OBJECTIVES

The relationship between poor sleep health and worse pain is established. Physical activity has been successful in reducing chronic pain and improving sleep in aging adults. Despite known sex differences (more women than men experiencing chronic pain and insomnia), sex-specific patterns of interactive associations between physical activity, sleep, and pain remain unexplored. This study tested whether physical and sitting activity moderated associations between sleep characteristics and pain intensity, and whether sex further moderated these relationships.

METHODS

Participants aged 50+ (N = 170, Mage = 64.34, 72 women) completed an online survey measuring pre-sleep arousal (Pre-sleep Arousal Scale), sleep (Pittsburgh Sleep Quality Index), past month average pain intensity, and physical activity (International Physical Activity Questionnaire). Multiple regressions evaluated whether minutes of physical activity (total, vigorous, moderate, walking) or sitting activity, pre-sleep arousal, sleep, sex, or their interaction was associated with pain. Analyses controlled for education, difficulty walking, body mass index, total medical conditions, pain medication, and depressive/anxiety symptoms.

RESULTS

In women, vigorous activity interacted with total pre-sleep arousal and somatic pre-sleep arousal in its association with pain. Higher total arousal and somatic arousal were associated with worse pain intensity only for women who reported highest levels of vigorous activity. No such associations were observed for men or for other physical or sitting activity levels.

CONCLUSIONS

Vigorous physical activity may exacerbate the association between more pre-sleep arousal and worse pain in middle-aged and older women. Research should explore potential sex-specific mechanisms (e.g., inflammatory cytokines, arousal neural networks) underlying these results.

Physical activity measurements in individuals with interstitial lung disease: a systematic review and meta-analysis

BACKGROUND

Physical activity (PA) measurements are becoming common in interstitial lung disease (ILD); however, standardisation has not been achieved. We aimed to systematically review PA measurement methods, present PA levels and provide practical recommendations on PA measurement in ILD.

METHODS

We searched four databases up to November 2022 for studies assessing PA in ILD. We collected information about the studies and participants, the methods used to measure PA, and the PA metrics. Studies were scored using 12 items regarding PA measurements to evaluate the reporting quality of activity monitor use.

RESULTS

In 40 of the included studies, PA was measured using various devices or questionnaires with numerous metrics. Of the 33 studies that utilised activity monitors, a median of five out of 12 items were not reported, with the definition of nonwear time being the most frequently omitted. The meta-analyses showed that the pooled means (95% CI) of steps, time spent in moderate to vigorous PA, total energy expenditure and sedentary time were 5215 (4640-5791) steps·day^-1, 82 (58-106) min·day^-1, 2130 (1847-2412) kcal·day^-1 and 605 (323-887) min·day^-1, respectively, with considerable heterogeneity.

CONCLUSION

The use of activity monitors and questionnaires in ILD lacks consistency. Improvement is required in the reporting quality of PA measurement methods using activity monitors.

Patterns of sedentary behaviour in adults with acute insomnia derived from actigraphy data

BACKGROUND

Sleep disorders, such as insomnia, have been associated with extended periods of inactive, sedentary behaviour. Many factors contribute to insomnia, including stress, irregular sleep patterns, mental health issues, inadequate sleeping schedules, diseases, neurological disorders and prescription medications.

OBJECTIVES

Identification of the patterns of sedentary time and its duration in adults with acute insomnia and healthy controls to determine the statistically significant sedentary bouts; comparison of the sedentary behaviour patterns in acute insomnia adults with healthy controls.

METHODS

We investigate the daytime actigraphy data and identify temporal patterns of inactivity among adults with acute insomnia and healthy adults. Seven days of actigraphy data were utilised to calculate sedentary time and bouts of variable duration based on a threshold of activity counts (<100 counts per minute). Statistical analysis was applied to investigate sedentary bouts and total sedentary time during weekdays and weekend. A logistic regression model has been used to determine the significance of sedentary bouts.

RESULTS

We found that individuals with acute insomnia accumulate a significant amount of their sedentary time in medium (6-30 minutes and 31-60 minutes) and longer (more than 60 minutes) duration bouts in comparison to healthy adults. Furthermore, a low p value for total sedentary time (2.54 ⋅ 10-4) association with acute insomnia supports the finding that acute insomnia individuals are significantly more engaged in sedentary activities compared to healthy controls. Also, as shown by the weekend vs weekday analysis, the physical and sedentary activity patterns of acute insomnia adults demonstrate higher variability during the weekdays in comparison to the weekend.

CONCLUSION

The results of the present study demonstrate that adults with acute insomnia spend more time in low-intensity daily physical activities compared to healthy adults.

Validation of an Algorithm for Measurement of Sedentary Behaviour in Community-Dwelling Older Adults

Accurate measurement of sedentary behaviour in older adults is informative and relevant. Yet, activities such as sitting are not accurately distinguished from non-sedentary activities (e.g., upright activities), especially in real-world conditions. This study examines the accuracy of a novel algorithm to identify sitting, lying, and upright activities in community-dwelling older people in real-world conditions. Eighteen older adults wore a single triaxial accelerometer with an onboard triaxial gyroscope on their lower back and performed a range of scripted and non-scripted activities in their homes/retirement villages whilst being videoed. A novel algorithm was developed to identify sitting, lying, and upright activities. The algorithm's sensitivity, specificity, positive predictive value, and negative predictive value for identifying scripted sitting activities ranged from 76.9% to 94.8%. For scripted lying activities: 70.4% to 95.7%. For scripted upright activities: 75.9% to 93.1%. For non-scripted sitting activities: 92.3% to 99.5%. No non-scripted lying activities were captured. For non-scripted upright activities: 94.3% to 99.5%. The algorithm could, at worst, overestimate or underestimate sedentary behaviour bouts by ±40 s, which is within a 5% error for sedentary behaviour bouts. These results indicate good to excellent agreement for the novel algorithm, providing a valid measure of sedentary behaviour in community-dwelling older adults.

Association of physical activity, sedentary behaviour, and daylight exposure with sleep in an ageing population: findings from the Whitehall accelerometer sub-study

BACKGROUND

Ageing is accompanied by changes in sleep, while poor sleep is suggested as a risk factor for several health outcomes. Non-pharmacological approaches have been proposed to improve sleep in elderly; their impact remains to be investigated. The aim of this study was to examine the independent day-to-day associations of physical behaviours and daylight exposure with sleep characteristics among older adults.

METHODS

Data were drawn from 3942 participants (age range: 60-83 years; 27% women) from the Whitehall II accelerometer sub-study. Day-to-day associations of objectively-assessed daytime physical behaviours (sedentary behaviour, light-intensity physical activity (LIPA), moderate-to-vigorous physical activity (MVPA), mean acceleration, physical activity chronotype) and daylight exposure (proportion of waking window with light exposure > 1000 lx and light chronotype) with sleep characteristics were examined using mixed models.

RESULTS

A 10%-increase in proportion of the waking period spent sedentary was associated with 5.12-minute (4.31, 5.92) later sleep onset and 1.76-minute shorter sleep duration (95%confidence interval: 0.86, 2.66). Similar increases in LIPA and MVPA were associated with 6.69 (5.67, 7.71) and 4.15 (2.49, 5.81) earlier sleep onset respectively and around 2-minute longer sleep duration (2.02 (0.87, 3.17) and 2.23 (0.36, 4.11), respectively), although the association was attenuated for MVPA after adjustment for daylight exposure (1.11 (- 0.84, 3.06)). A 3-hour later physical activity chronotype was associated with a 4.79-minute later sleep onset (4.15, 5.43) and 2.73-minute shorter sleep duration (1.99, 3.47). A 10%-increase in proportion of waking period exposed to light> 1000 lx was associated with 1.36-minute longer sleep (0.69, 2.03), independently from mean acceleration. Associations found for sleep duration were also evident for duration of the sleep windows with slightly larger effect size (for example, 3.60 (2.37, 4.82) minutes for 10%-increase in LIPA), resulting in associations with sleep efficiency in the opposite direction (for example, - 0.29% (- 0.42, - 0.16) for 10%-increase in LIPA). Overall, associations were stronger for women than for men.

CONCLUSIONS

In this study, higher levels of physical activity and daylight exposure were associated with slightly longer sleep in older adults. Given the small effect sizes of the associations, increased physical activity and daylight exposure might not be enough to improve sleep.

Bidirectional associations between physical activity and sleep in older adults: a multilevel analysis using polysomnography

Although recent studies have examined the bidirectional associations between physical activity and sleep parameters, few have focused on older adults utilizing objective assessments, such as polysomnography. This micro-longitudinal observational study included 92 Japanese older adults (aged 65–86 years) who underwent objective evaluations of sleep quality using polysomnography and completed subjective sleep-related questionnaires. Activity levels were assessed using an accelerometer. Polysomnography, subjective sleep-related questionnaires, and accelerometer were administered for 7 consecutive days. Multilevel models (participant-, day-level) were used to examine the temporal associations of objective and subjective sleep parameters with sedentary behavior and physical activity. In the day-level analysis, higher levels of sedentary behavior during daytime were associated with longer rapid eye movement (REM) sleep, shorter REM latency, lower levels of non-REM sleep (stage N3), and reduced delta power during daytime. Higher levels of low-intensity physical activity during daytime were associated with lower levels of REM sleep, longer REM latency, and increased stage N3 sleep in the day-level analysis. Higher levels of moderate-to-vigorous physical activity were associated with increased REM latency. Longer subjective sleep time was associated with increased next-day moderate-to-vigorous physical activity. Thus, low-intensity physical activity may provide objective benefits related to deep sleep parameters in older adults.

The association between sleep deficits and sedentary behavior in people with mild Parkinson disease

Purpose: Sleep deficits are a common nonmotor symptom of Parkinson disease (PD). People with mild PD also achieve less physical activity (PA) than healthy older adults (HOA), but the relationship between sleep and PA in PD is unclear. This study examined associations between sleep and PA in participants with PD and HOA.Materials and Methods: Secondary analysis of a prospective observational study. Participants wore a commercially available activity monitor for two weeks. Wilcoxon Rank-Sum tests compared nighttime sleep, wakenings after sleep onset, number of wakenings, naps, step count, and PA intensity between PD and HOA groups. Age-adjusted regression models calculated associations between nighttime sleep and PA.Results: Per day, participants with PD slept 75 fewer minutes (p < 0.01), took 5,792 fewer steps (p < 0.001), achieved less PA at all intensities, and had 32% more sedentary time (p < 0.001) compared to HOA. Thirty minutes more sleep was associated with 26 fewer sedentary minutes for HOA (p = 0.01) and 25 fewer sedentary minutes for the PD group (p < 0.001).Conclusions: Sleep and PA are reduced in mild PD compared to HOA. Both groups demonstrated similar associations between reduced sleep and increased sedentary behavior. Results may encourage providers to screen for sleep deficits when promoting PA.IMPLICATIONS FOR REHABILITATIONThe use of a wrist-worn commercial activity and sleep monitor was well tolerated by both healthy older adults and people with mild Parkinson Disease in this study.People with mild Parkinson Disease slept less and were less active than a group of healthy older adults.Less sleep was associated with more sedentary behavior in both groups.The relationship between poor sleep and sedentary behavior in mild Parkinson Disease suggests that rehabilitation interventions may be optimized by targeting both physical activity and sleep deficits.

As diferentes tipologias do comportamento sedentário estão associadas ao histórico de problemas no sono em idosos comunitários?

Alterações no sono são comuns em idosos e alguns fatores de risco podem agravar essa condição. Entender a associação do comportamento sedentário com o histórico de problemas de sono poderá auxiliar na elaboração de programas de intervenção. Verificar a associação entre tipologias do comportamento sedentário e histórico de problemas no sono em idosos comunitários brasileiros. Estudo transversal, com dados de 43.554 idosos participantes da Pesquisa Nacional de Saúde (PNS), de 2019. As tipologias do comportamento sedentário foram avaliadas por: (1) tempo assistindo televisão; (2) atividades de lazer; e (3) tempo despendido total (televisão + lazer). O comportamento sedentário foi categorizado em < 3; 3-6 e > 6 horas/dia. O desfecho foi histórico de problemas de sono (dificuldade para adormecer, acordar frequentemente à noite ou dormir mais do que de costume) avaliados por meio do autorrelato nos últimos 15 dias. As associações foram verificadas pela regressão logística multivariável. Idosos que permaneceram tempo > 6 horas/dia em comportamento sedentário assistindo televisão tiveram 13% (OR = 1,13; IC95%: 1,02; 1,26) maiores probabilidades de relatarem problemas de sono. Referente ao comportamento sedentário total, idosos que permaneceram entre 3-6 horas e mais do que 6 horas/dia apresentaram 13% (OR = 1,13; IC95%: 1,04; 1,22) e 11% (OR = 1,11; IC95%: 1,01; 1,23) maiores probabilidades de problemas de sono, respectivamente. Os idosos amostrados que relataram permanecer por períodos superiores a 6 horas por dia em comportamento sedentário assistindo à televisão e > 3 horas em comportamento sedentário total tiveram maiores chances de terem problemas no sono. Estes achados podem contribuir nas orientações sobre a necessidade de redução no comportamento sedentário em idosos.

Non-Right Handedness is Associated with More Time Awake After Sleep Onset and Higher Daytime Sleepiness Than Right Handedness: Objective (Actigraphic) and Subjective Data from a Large Community Sample

PURPOSE

Handedness has been linked to various physiological and pathological phenomena including memory function and psychiatric disorders. Also for sleep, several studies have reported associations. However, large-scale studies including a broad age span of participants and studies analyzing women and men separately are lacking.

METHODS

Therefore, objective sleep data were determined using at-home actigraphy from 1764 healthy participants (18 to 80 years, 908 women), averaging five consecutive nights. In addition, subjective sleep-related data were captured by self-report diaries, the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS) and the Morningness-Eveningness-Questionnaire (MEQ). Handedness was determined with the Edinburgh Handedness Inventory (EHI) providing information on the direction (left vs right) and the degree of handedness (strong vs weak). To address the potential endocrine effects, premenopausal women (≤45 years) and postmenopausal women (≥55 years) were analyzed separately. This was also done for men.

RESULTS

The degree and direction of handedness were correlated with "wake after sleep onset" (WASO) in the total sample and all women (the more right-handed/lateralized the shorter WASO). In postmenopausal women, additionally, time in bed (TIB) and total sleep time (TST) were correlated. There were no other significant associations between an objective sleep variable and handedness. In both premenopausal women and >55-year-old men subjective quality of sleep (PSQI) was correlated with direction and degree of handedness (the more right-handed/lateralized the better). In the total sample and postmenopausal women, the degree and direction of handedness were negatively correlated with daytime sleepiness. The chronotype was not associated with handedness in any group.

CONCLUSION

While associations were not consistent in all groups, overall, right-handedness tended to be associated with better sleep and less daytime sleepiness. Handedness and sleep seemed to be differentially associated in women and men, being in line with endocrine interactions.

Meta-analysis of age and actigraphy assessed sleep characteristics across the lifespan

STUDY OBJECTIVES

Sleep quantity and continuity vary across the lifespan. Actigraphy is a reliable and widely-used behavioral measure of sleep in research and personal health monitoring. This meta-analysis provides a novel examination of whether age (in years) is associated with actigraphy-assessed sleep across the lifespan.

METHODS

A systematic search of PubMed, Embase.com, Cochrane CENTRAL, and PsycINFO using "actigraphy" and "sleep" terms provided 7,079 titles/abstracts; studies of individuals with known psychiatric or medical comorbidities were excluded. Ninety-one articles (N = 23,365) provided data for six meta-analyses examining sleep duration (k = 89), sleep efficiency (k = 58), bedtime (k = 19) and waketime (k = 9) for individuals ages 6-21, and bedtime (k = 7) and waketime (k = 7) for individuals ages 22 and older.

RESULTS

At older ages, sleep duration was shorter (r = -0.12) and sleep efficiency was lower (r = -0.05). Older age was associated with later bedtime (r = 0.37) and wake-up time (r = 0.24) from ages 6-21, whereas older age was associated with earlier bedtime (r = -0.66) and wake-up time (r = -0.59) for ages 22 and above. The strength of these associations was modified by study continent, but not by any other moderator.

CONCLUSIONS

Age was negatively associated with actigraphy-assessed sleep duration and efficiency, but the effects were small in magnitude. On the other hand, large associations were observed between age and sleep timing, despite a smaller literature and the absence of analyzable data for ages 30-60. Changes in sleep timing, rather than changes in sleep duration or continuity, may better characterize the effects of age on human sleep.

Shorter Sleep Predicts Longer Subsequent Day Sedentary Duration in Healthy Midlife Adults, but Not in Those with Sleep Apnea

PURPOSE

Sedentary behavior and suboptimal sleep increase risks for chronic diseases. We hypothesized that sedentary behavior and sleep affect each other and that an underlying sleep disorder would alter these relationships. To test these hypotheses, we studied the bidirectional relationships between sedentary behavior and sleep (duration and efficiency) in healthy controls (HC) and people with untreated obstructive sleep apnea (OSA).

PATIENTS AND METHODS

Fifty-two volunteers (18 HC, 19 mild OSA [apnea/hypopnea index [AHI] range 5-14.9/hour], 15 moderate OSA [AHI range 15-29.9/hour]) were studied with actigraphy and sleep diaries across ~9 consecutive nights of self-selected consistent ~8-hour sleep episodes at home (range 4-21/nights per person). We analyzed whether total time asleep and sleep efficiency affected the subsequent daytime sedentary duration while controlling for body mass index and whether the severity of OSA altered this relationship. We also tested the reverse relationship, namely whether daytime sedentary duration affected the subsequent night's sleep and if any such relationship differed with OSA severity.

RESULTS

Overnight sleep duration and efficiency negatively predicted the subsequent day's sedentary duration in HC (p<0.02), but not in people with mild or moderate OSA (p>0.05). There was no significant reverse relationship between daytime sedentary duration and the subsequent night's sleep duration or efficiency (p≥0.2).

CONCLUSION

In healthy adults, short nighttime sleep predicts a longer duration of sedentary behavior on a subsequent day, but we did not observe this relationship in people with OSA. The mechanisms underlying this association in healthy individuals and its disruption in the presence of OSA need to be studied.

Are Reallocations between Sedentary Behaviour and Physical Activity Associated with Better Sleep in Adults Aged 55+ Years? An Isotemporal Substitution Analysis

Physical activity has been proposed as an effective alternative treatment option for the increasing occurrence of sleep problems in older adults. Although higher physical activity levels are associated with better sleep, the association between specific physical activity intensities and sedentary behaviour (SB) with sleep remains unclear. This study examines the associations of statistically modelled time reallocations between sedentary time and different physical activity intensities with sleep outcomes using isotemporal substitution analysis. Device-measured physical activity data and both objective and subjective sleep data were collected from 439 adults aged 55+ years. Replacing 30 min of SB with moderate to vigorous intensity physical activity (MVPA) was significantly associated with an increased number of awakenings. Moreover, a reallocation of 30 min between light physical activity (LPA) and MVPA was significantly associated with increased sleep efficiency. Furthermore, reallocating 30 min of SB to LPA showed a significant association with decreased sleep efficiency. There were no significant associations of time reallocations for wake time after sleep onset, length of awakenings, and sleep quality. These results improve our understanding of the interrelationships between different intensities of movement behaviours and several aspects of sleep in older adults.

Screen Time and Cardiovascular Risks Among Middle-Aged Women

BACKGROUND

Screen time is a marker of sedentary behavior that threatens the health of women. Extended screen time is associated with depression, insomnia, cardiovascular disease, and decreased quality of life.

OBJECTIVE

In this study, we examined the factors associated with screen time and whether screen time is associated with the physiological and psychosocial health of middle-aged women. We applied a psycho-socioeconomic biobehavioral model of health and studied the outcomes of cardiometabolic biomarkers, insomnia, and quality of life.

METHODS

Secondary data analysis was performed using data from a cross-sectional study conducted with 423 women between 40 and 65 years of age. Socioeconomic, physiological, psychosocial, and behavioral characteristics were measured. Self-reported screen time during the past week was measured using an ordinal scale. The data were analyzed using multivariate analysis of covariance, analysis of covariance, and logistic regression analysis.

RESULTS

Twenty-four percent of subjects had at least 3 hours per day of screen time on weekdays, whereas 30.7% had at least 3 hours per day on weekends. Older women, unemployed women, and those who do not perform regular exercise were more likely to have at least 3 hours per day of screen time (P < .05). Screen time was associated with total cholesterol and low-density lipoprotein cholesterol levels, insomnia, and menopause-specific quality of life (P < .05).

CONCLUSIONS

Based on a psycho-socioeconomic biobehavioral framework, we found that screen time is associated with the physiological and psychosocial health of women independent of socioeconomic and biobehavioral variables. Efforts to reduce the amount of screen time targeting middle-aged women will help improve cardiometabolic biomarkers and quality of life.

Effects of physical activity programs on sleep outcomes in older adults: a systematic review

BACKGROUND

One in two older adults report sleep problems, which not only cause fatigue, but also negatively affect general functioning, activities of daily living, and physical and mental health. Although it is known that physical activity is positively associated with sleep in older adults, the effects of physical activity programs on sleep in older adults has not been reviewed. The aim of this systematic review was to systematically review the effects of physical activity programs on sleep in generally healthy older adults aged 60+ years.

METHODS

Searches were performed in PubMed, Embase, Web of Science, SPORTDiscus, PEDro and CINAHL. The methodological quality of the included studies was rated using the 'Quality Assessment Tool for Quantitative Studies'. Only studies of moderate and strong quality were included. This review was registered in PROSPERO (CRD42018094007).

RESULTS

Fourteen studies met the inclusion criteria (six randomised controlled trials and eight pretest-posttest studies). Of these studies, five were moderate and nine were strong quality studies. Mean age of study samples ranged from 64 to 76 years. Exercise programs included various activities aimed at improving mobility, endurance and strength. Intervention duration ranged from 2 weeks to 12 months. Eleven studies used subjective measures of sleep, two used objective measures and one used both. Sixteen different sleep outcomes were reported. All but one study, found at least one significant improvement on sleep outcomes. No significantly detrimental effects were reported. Effect sizes, calculated in ten studies, ranged from 0,34-1,55 and were substantial (≥0,8) in four studies.

CONCLUSIONS

This systematic review suggests that exercise programs positively affect various aspects of sleep in generally healthy older adults. More specifically, moderate intensity exercise programs, with a frequency of three times per week and a duration of 12 weeks up to 6 months, showed the highest number of significant improvements in different sleep outcomes in older adults. Furthermore, programs that offered single exercise types, such as Baduanjin, Tai chi and the silver yoga program, or a combination of exercises showed the highest proportion of significant versus reported effects on sleep outcomes.

Effects of sedentary behavior and physical activity on sleep quality in older people: A cross-sectional study

The aim of this cross-sectional study was to investigate the influence of replacing sedentary time with time engaged in one of two levels of physical activity on sleep quality using an isotemporal substitution model. The participants were 70 community-dwelling older Japanese adults (approximately 70% female). Physical activity types were measured using a triaxial accelerometer and categorized based on intensity as sedentary, light-intensity, and vigorous-intensity. The Pittsburgh Sleep Quality Index assessed subjective sleep quality. Objective sleep parameters were assessed using an actigraph. A series of multi-linear regression models analyzed the statistical relationships. Our findings showed that replacing 30 min of sedentary activity per day with an equal period of light-intensity physical activity significantly influenced sleep quality parameters. However, there was no significant difference in sleep quality when light-intensity activity was replaced with vigorous-intensity activity. Engaging in one activity type means less available time for other types of activity; habitual replacement of sedentary activity with light-intensity physical activity might have long-term benefits on the sleep quality of older people.

Prevalence and risk factors of type 2 diabetes in insomnia sufferers: a study on 1311 individuals referred for sleep examinations

BACKGROUND

Several studies have investigated the particular relationship between insomnia and type 2 diabetes. However, few studies have investigated the prevalence and risk factors for type 2 diabetes in insomnia sufferers. The aim of this study was to examine the prevalence and risk factors of type 2 diabetes in a large sample of insomnia sufferers.

METHODS

Data from 1311 insomnia sufferers recruited from the research database of the Erasme Hospital sleep laboratory were analyzed. Only individuals with a diagnosis of type 2 diabetes according to the diagnostic criteria of the American Diabetes Association at admission were included in the diabetes group. Logistic regression analyses were conducted to examine clinical and demographic risk factors of type 2 diabetes in insomnia sufferers.

RESULTS

The prevalence of type 2 diabetes in insomnia sufferers is 21.13%. Multivariate logistic regression analysis revealed that significant risk factors of type 2 diabetes in insomnia sufferers were as follows: being male, Z-drugs use, high blood pressure, hypertriglyceridemia, alcohol consumption of ≥4 units/day, BMI ≥25 & <30 kg/m², BMI ≥30 kg/m², age ≥50 years, C-reactive protein ≥4.5 mg/L, a sleep duration of <6.5 h, apnea-hypopnea index ≥15/hour, periodic limb movements index ≥26/hour, and severe complaints of early morning awakening.

CONCLUSION

Type 2 diabetes is a common pathology in insomnia sufferers. In this subpopulation, most of the risk factors for type 2 diabetes are reversible, which justifies better prevention and management of this pathology in order to avoid its negative consequences.

Sedentary time in older adults: a critical review of measurement, associations with health, and interventions

Sedentary time (ST) is an important risk factor for a variety of health outcomes in older adults. Consensus is needed on future research directions so that collaborative and timely efforts can be made globally to address this modifiable risk factor. In this review, we examined current literature to identify gaps and inform future research priorities on ST and healthy ageing. We reviewed three primary topics:(1) the validity/reliability of self-report measurement tools, (2) the consequences of prolonged ST on geriatric-relevant health outcomes (physical function, cognitive function, mental health, incontinence and quality of life) and(3) the effectiveness of interventions to reduce ST in older adults.

METHODS

A trained librarian created a search strategy that was peer reviewed for completeness.

RESULTS

Self-report assessment of the context and type of ST is important but the tools tend to underestimate total ST. There appears to be an association between ST and geriatric-relevant health outcomes, although there is insufficient longitudinal evidence to determine a dose-response relationship or a threshold for clinically relevant risk. The type of ST may also affect health; some cognitively engaging sedentary behaviours appear to benefit health, while time spent in more passive activities may be detrimental. Short-term feasibility studies of individual-level ST interventions have been conducted; however, few studies have appropriately assessed the impact of these interventions on geriatric-relevant health outcomes, nor have they addressed organisation or environment level changes. Research is specifically needed to inform evidence-based interventions that help maintain functional autonomy among older adults.This consensus statement has been endorsed by the following societies: Academy of Geriatric Physical Therapy, Exercise & Sports Science Australia, Canadian Centre for Activity and Aging, Society of Behavioral Medicine, and the National Centre for Sport and Exercise Medicine.

Sleep Duration, Sedentary Behavior, Physical Activity, and Quality of Life after Inpatient Stroke Rehabilitation

OBJECTIVE

The aim of this study was to describe accelerometer-derived sleep duration, sedentary behavior, physical activity, and quality of life and their association with demographic and clinical factors within the first month after inpatient stroke rehabilitation.

MATERIALS AND METHODS

Thirty people with stroke (mean ± standard deviation, age: 63.8 ± 12.3 years, time since stroke: 3.6 ± 1.1 months) wore an activPAL3 Micro accelerometer (PAL Technologies, Glasgow, Scotland) continuously for 7 days to measure whole-day activity behavior. The Stroke Impact Scale and the Functional Independence Measure were used to assess quality of life and function, respectively.

RESULTS

Sleep duration ranged from 6.6 to 11.6 hours/day. Fifteen participants engaged in long sleep greater than 9 hours/day. Participants spent 74.8% of waking hours in sedentary behavior, 17.9% standing, and 7.3% stepping. Of stepping time, only a median of 1.1 (interquartile range: .3-5.8) minutes were spent walking at a moderate-to-vigorous intensity (≥100 steps/minute). The time spent sedentary, the stepping time, and the number of steps differed significantly by the hemiparetic side (P < .05), but not by sex or the type of stroke. There were moderate to strong correlations between the stepping time and the number of steps with gait speed (Spearman r = .49 and .61 respectively, P < .01). Correlations between accelerometer-derived variables and age, time since stroke, and cognition were not significant.

CONCLUSIONS

People with stroke sleep for longer than the normal duration, spend about three quarters of their waking hours in sedentary behaviors, and engage in minimal walking following stroke rehabilitation. Our findings provide a rationale for the development of behavior change strategies after stroke.

Behavioral Characteristics and Cardiovascular Disease Risks Associated With Insomnia and Sleep Quality Among Middle-Aged Women in South Korea

Insomnia is the most common sleep problem in women. Increasing evidence suggests an association between insomnia and cardiovascular disease (CVD). However, information is limited on lifestyle and socio-environmental factors associated with sleep problems in women. In this study directed by Social Cognitive Theory, we examined the personal, behavioral, socio-environmental, and CVD risk factors associated with sleep characteristics (insomnia and sleep quality) in middle-aged women using a cross-sectional design. The study instruments included the Insomnia Severity Index (ISI), the Pittsburg Sleep Quality Index (PSQI), the Center for Epidemiological Studies Depression Scale (CES-D), and measures of social support and behavioral characteristics. Blood was drawn to assess serum glucose and lipids, and BMI was measured. Data were analyzed using hierarchical multiple regression and analysis of covariance (ANCOVA). Of 423 middle-aged women, 25% experienced insomnia (ISI ≥ 10) and 41.3% reported poor sleep quality (PSQI ≥ 5). Lesser education (≤middle school), more depressive symptoms, more screen time (≥ 3 hours/day), and severe stress were associated with greater severity of insomnia and/or poorer sleep quality. Total and LDL cholesterol levels were higher in women with insomnia than normal sleepers, whereas the BMI was higher in those who reported poor sleep quality. Because personal, behavioral, and socio-environmental factors were significantly associated with insomnia and poor sleep quality, multifactorial approaches should be considered in developing sleep interventions and reducing cardiovascular risk. © 2017 Wiley Periodicals, Inc.

Associations of sedentary time and moderate-vigorous physical activity with sleep-disordered breathing and polysomnographic sleep in community-dwelling adults

PURPOSE

The purpose of this study was to evaluate the relationship between daytime activity (sedentary time, moderate- to vigorous-intensity physical activity [MVPA]) and indices of polysomnographically (PSG) assessed sleep, including sleep-disordered breathing (SDB).

METHODS

One hundred and thirty-six adults (65% female, 59.8 ± 9.1 years, body mass index [BMI] 30.3 ± 6.9 kg m-2) provided daily estimates of time spent in light-, moderate-, and vigorous-intensity activity for 6-14 days (mean 9.9 ± 1.8 days) prior to laboratory PSG. Daily sedentary time was calculated as the amount of time spent awake and not in light-, moderate-, or vigorous-intensity activity; time spent in moderate- and vigorous-intensity activity were combined for MVPA. Indices of PSG sleep included timing (sleep midpoint), duration (total sleep time), continuity (sleep efficiency), depth (% slow-wave sleep), and SDB (apnea-hypopnea index [AHI]). Using median splits of sedentary time and MVPA, analyses of covariance examined their relationship with sleep following adjustment for age, sex, race, employment, education, BMI, existing cardiovascular disease, depression history, and mean daily wake time. Binary logistic regression examined the odds of having at least mild-severity SDB (AHI ≥ 5) according to sedentary time, MVPA, and their combination.

RESULTS

Adults with above-median sedentary time (i.e., >841.9 min/day) had significantly greater AHI (P = .04) and lower odds of mild SDB (P = .03) compared to adults with low sedentary time; adults with high MVPA (>30.5 min/day) had significantly lower AHI compared to adults with low MVPA (P = .04). When examined in the same model, adults with high sedentary time and low MVPA had significantly higher AHI (P < .01) and higher odds of having mild SDB (P = .03) than all the other groups. No other sleep measures were related to sedentary time, MVPA, or their combination.

CONCLUSIONS

Sedentary time and MVPA were associated with SDB. Whether reducing sedentary time leads to lower SDB severity deserves future exploration.

Balanced: a randomised trial examining the efficacy of two self-monitoring methods for an app-based multi-behaviour intervention to improve physical activity, sitting and sleep in adults

BACKGROUND

Many adults are insufficiently physically active, have prolonged sedentary behaviour and report poor sleep. These behaviours can be improved by interventions that include education, goal setting, self-monitoring, and feedback strategies. Few interventions have explicitly targeted these behaviours simultaneously or examined the relative efficacy of different self-monitoring methods.

METHODS/DESIGN

This study aims to compare the efficacy of two self-monitoring methods in an app-based multi-behaviour intervention to improve objectively measured physical activity, sedentary, and sleep behaviours, in a 9 week 2-arm randomised trial. Participants will be adults (n = 64) who report being physically inactive, sitting >8 h/day and frequent insufficient sleep (≥14 days out of last 30). The "Balanced" intervention is delivered via a smartphone 'app', and includes education materials (guidelines, strategies to promote change in behaviour), goal setting, self-monitoring and feedback support. Participants will be randomly allocated to either a device-entered or user-entered self-monitoring method. The device-entered group will be provided with a activity tracker to self-monitor behaviours. The user-entered group will recall and manually record behaviours. Assessments will be conducted at 0, 3, 6, and 9 weeks. Physical activity, sedentary behaviour and sleep-wake behaviours will be measured using the wrist worn Geneactiv accelerometer. Linear mixed models will be used to examine differences between groups and over time using an alpha of 0.01.

DISCUSSION

This study will evaluate an app-based multi-behavioural intervention to improve physical activity, sedentary behaviour and sleep; and the relative efficacy of two different approaches to self-monitoring these behaviours. Outcomes will provide information to inform future interventions and self-monitoring targeting these behaviours.

TRIAL REGISTRATION

ACTRN12615000182594 (Australian New Zealand Clinical Trials Registry. Registry URL: www.anzctr.org.au ; registered prospectively on 25 February 2015).

Genome-wide association analysis of actigraphic sleep phenotypes in the LIFE Adult Study

The genetic basis of sleep is still poorly understood. Despite the moderate to high heritability of sleep-related phenotypes, known genetic variants explain only a small proportion of the phenotypical variance. However, most previous studies were based solely upon self-report measures. The present study aimed to conduct the first genome-wide association (GWA) of actigraphic sleep phenotypes. The analyses included 956 middle- to older-aged subjects (40-79 years) from the LIFE Adult Study. The SenseWear Pro 3 Armband was used to collect 11 actigraphic parameters of night- and daytime sleep and three parameters of rest (lying down). The parameters comprised measures of sleep timing, quantity and quality. A total of 7 141 204 single nucleotide polymorphisms (SNPs) were analysed after imputation and quality control. We identified several variants below the significance threshold of P ≤ 5× 10^-8 (not corrected for analysis of multiple traits). The most significant was a hit near UFL1 associated with sleep efficiency on weekdays (P = 1.39 × 10^-8 ). Further SNPs were close to significance, including an association between sleep latency and a variant in CSNK2A1 (P = 8.20 × 10^-8 ), a gene known to be involved in the regulation of circadian rhythm. In summary, our GWAS identified novel candidate genes with biological plausibility being promising candidates for replication and further follow-up studies.