Associations of domain-specific physical activities with insomnia symptoms among 0.5 million Chinese adults

Revitalizing your sleep: the impact of daytime physical activity and balneotherapy during a spa stay

Background

In modern society, achieving high-quality sleep is increasingly challenging. We conducted a study to explore the potential benefits of daytime physical activity and balneotherapy, including mud application and thermal-water bathing, on sleep quality.

Methods

To assess daytime physical activity and sleep parameters, we actigraphically monitored 127 healthy participants (34.6% male, average age 64.61 ± 0.89 years) during a one-week stay at a spa resort, where they received mud application and thermal-water bathings.

Results

Participants were divided into three groups based on the timing of mud application. Those receiving mud application before 8:30 a.m. tended to have shorter sleep durations compared to those with later application, especially if it occurred before 7:45 a.m. However, mud application did not significantly affect sleep quality. Three-way ANCOVA revealed a significant effect of daytime physical activity on delta Sleep Efficiency, but post-hoc tests were insignificant. Furthermore, analyzing the duration of daily thermal-water bathings, individuals bathing for over 75 min per day experienced a noteworthy improvement in sleep quality, particularly in terms of delta Sleep Efficiency (2.15 ± 0.9% vs. -0.34 ± 0.31%, p = 0.007).

Conclusion

Our findings suggest that extended thermal-water bathing may enhance objective aspects of sleep quality. Since balneotherapy is mainly prescribed for individuals with musculoskeletal pathologies or psychological disorders, these findings may encourage doctors to recommend bathing in thermal water also to healthy subjects. Future researchers need to investigate the role of daytime physical activity in depth.

Using structural equation modeling to explore the influences of physical activity, mental health, well-being, and loneliness on Douyin usage at bedtime

Douyin is the Chinese version of TikTok. Using Douyin at bedtime is a very common behavior among Douyin users. However, the reasons why users like using Douyin before sleep are yet unclear. We conducted a cross-section survey from January 1st to January 16th, 2023 to capture data to examine the associations of depression, anxiety, life satisfaction, well-being, loneliness, and physical activity with Douyin usage at bedtime. The mediation role of insomnia in these associations was examined. A total of 3,392 participants who met the inclusion criteria were included for analysis. Our structural equation modeling analysis showed that depression on (β = 0.08; p < 0.05), anxiety (β = 0.06; p < 0.05), and loneliness (β = 0.14; p < 0.05) were directly associated with increased Douyin usage at bedtime, and were also indirectly associated with Douyin usage through insomnia (depression: β = 0.18; p < 0.05, anxiety: β = 0.16; p < 0.05, and loneliness: β = 0.12; p < 0.05). Life satisfaction (β = -0.05; p < 0.05) and well-being (β = -0.20; p < 0.05) were directly associated with decreased Douyin usage at bedtime, and were also indirectly associated with Douyin usage through insomnia (life satisfaction: β = -0.09; p < 0.05, and well-being: β = -0.11; p < 0.05). However, physical activity was unexpectedly associated with increased Douyin usage at bedtime (β = 0.20; p < 0.05). In conclusion, our findings shed new light on the specific reasons why Douyin users like using Douyin at bedtime.

Long-term exposure to ambient air pollutants and their interaction with physical activity on insomnia: A prospective cohort study

Exposure to air pollution or lack of physical activity (PA) increases the risk of insomnia. However, evidence on joint exposure to air pollutants is limited, and the interaction of joint air pollutants and PA on insomnia is unknown. This prospective cohort study included 40,315 participants with related data from the UK Biobank, which recruited participants from 2006 to 2010. Insomnia was assessed by self-reported symptoms. The annual average air pollutant concentrations of particulate matter (PM_2.5, PM₁₀), nitrogen oxides (NO₂, NO_X), sulfur dioxide (SO₂) and carbon monoxide (CO) were calculated based on participants' addresses. We applied a weighted Cox regression model to evaluate the correlation between air pollutants and insomnia and newly proposed an air pollution score to assess joint air pollutants effect using a weighted concentration summation after obtaining the weights of each pollutant in the Weighted-quantile sum regression. With a median follow-up of 8.7 years, 8511 participants developed insomnia. For each 10 μg/m³ increase in NO₂, NO_X, PM₁₀, SO₂, the average hazard ratios (AHRs) and 95% confidence interval (CI) of insomnia were 1.10 (1.06, 1.14), 1.06 (1.04, 1.08), 1.35 (1.25, 1.45) and 2.58 (2.31, 2.89), respectively; For each 5 μg/m³ increase in PM_2.5 and each 1 mg/m³ increase in CO, the corresponding AHRs (95%CI) were 1.27 (1.21, 1.34) and 1.83 (1.10, 3.04), respectively. The AHR (95%CI) for insomnia associated with per interquartile range (IQR) increase in air pollution scores were 1.20 (1.15, 1.23). In addition, potential interactions were examined by setting cross-product terms of air pollution score with PA in the models. We observed an interaction between air pollution scores and PA (P = 0.032). The associations between joint air pollutants and insomnia were attenuated among participants with higher PA. Our study provides evidence on developing strategies for improving healthy sleep by promoting PA and reducing air pollution.

An Investigation on the Effect of Exercise on Insomnia Symptoms

Background

Insomnia affects the daily activities of the sufferers and reduces attention and memory. Cognitive behavioral therapy is an expensive treatment and is not applicable to all patients, and long-term treatment with sleep medication can have side effects such as drug dependency. As an alternative form of non-pharmacological treatments, the effect of exercise therapy on improving the symptoms of insomnia is addressed in the current study.

Methods

A total of 32 patients diagnosed with insomnia participated in the study, from which 16 received combined resistance-aerobic exercise therapy. The rest of the patients comprised the control group. The intervention group went through a 12-week intervention in the form of aerobic exercise for 3 days a week and resistance training for another 3 days a week. Patients' sleep quality was assessed by the Pittsburgh test before and after the intervention.

Results

The results showed that combined aerobic-resistance exercise can improve sleep quality in patients with insomnia as well as increase subjective sleep quality and actual sleep duration, and decrease daytime dysfunction due to sleeping problems.

Conclusions

This study shows that, along with other insomnia treatments, exercise can improve the sleep quality of patients.

Prevalence and risk factors associated with poor sleep among firefighters in Taiwan: An observational study

Sleep quality is directly correlated with overall health and quality of life. Firefighters have a higher workload and injury rate than those in other occupations. This study investigated the prevalence of and risk factors for poor sleep quality among firefighters in Taiwan. This cross-sectional study was conducted between November 2019 and August 2020. Sociodemographic information of the study participants was collected using a structured self-administered questionnaire. The Chinese version of the Pittsburgh Sleep Quality Index (PSQI) was used to evaluate the subjective sleep quantity and quality of firefighters during the previous month. A t test for continuous variables and χ2 test for categorical variables were performed for univariate analysis. Logistic regression analysis was conducted for multivariate analysis. Eight hundred eighty-nine firefighters completed the questionnaire during the study period, with a response rate of 88.9%. Among them, 447 (50.3%) reported poor sleep quality. Logistic regression analysis showed that female sex, longer work duration (>5 years) for firefighters, on-call shift work, and no leisure-time physical activity (LTPA) was significantly correlated with an increased risk of poor sleep quality. Advanced analysis of partaking in LTPA revealed that high-intensity LTPA is significantly associated with higher rates of poor sleep quality. In contrast, adequate rest after LTPA correlated with lower rates of poor sleep quality. Firefighters are at higher risk of poor sleep quality. Emphasis should be placed on firefighters' regular LTPA, particularly when experiencing sleep problems.

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.

Association between sleep duration and hypertension in southwest China: a population-based cross-sectional study

OBJECTIVE

Hypertension is a major risk factor and cause of many non-communicable diseases in China. While there have been studies on various diet and lifestyle risk factors, we do not know whether sleep duration has an association to blood pressure in southwest China. This predictor is useful in low-resource rural settings. We examined the association between sleep duration and hypertension in southwest China.

DESIGN

Population-based cross-sectional study.

SETTING

This study was part of the baseline survey of a large ongoing prospective cohort study, the China Kadoorie Biobank. Participants were enrolled in 15 townships of Pengzhou city in Sichuan province during 2004-2008.

PARTICIPANTS

55 687 participants aged 30-79 years were included. Sleep duration was assessed by a self-reported questionnaire.

MAIN OUTCOME MEASURES

Hypertension was defined as systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg, or prior physician-diagnosed hypertension in hospitals at the township (community) level or above.

RESULTS

The prevalence of hypertension was 25.17%. The percentages of subjects with sleep durations of <6, 6, 7, 8 and ≥9 hours were 17.20%, 16.14%, 20.04%, 31.95% and 14.67%, respectively. In multivariable-adjusted analyses, the increased ORs of having hypertension were across those who reported ≥9 hours of sleep (men: 1.16, 95% CI 1.04 to 1.30; women: 1.19, 95% CI 1.08 to 1.32; general population: 1.17, 95% CI 1.08 to 1.26). The odds of hypertension was relatively flat until around 6.81 hours of sleep duration and then started to increase rapidly afterwards in subjects and a J-shaped pattern was observed. There was a U-shaped relationship between sleep duration and hypertension in females.

CONCLUSION

Long sleep duration was significantly associated with hypertension and a J-shaped pattern was observed among rural adults in southwest China, independent of potential confounders. However, this association was not obvious between short sleep duration and hypertension.

Combined effect of daily physical activity and social relationships on sleep disorder among older adults: cross-sectional and longitudinal study based on data from the Kasama study

Background

This study investigated whether daily physical activity of older adults, combined with social relationships, is associated with the risk of sleep disorder. Further, it determined whether a high level of one variable with a low level of the other, leads to a significantly lower risk of sleep disorder than low levels of both.

Methods

The sample comprised 1339 community-dwelling older Japanese adults: 988 in Study 1 and 351 in Study 2. The level of daily physical activity and range of social relationships were assessed using the Physical Activity Scale for the Elderly and the Lubben Social Network Scale, respectively. The Pittsburgh Sleep Quality Index was used to assess sleep disorder. To test the combined relationships and effects in Studies 1 and 2, the medians for the respective scores of each of the following four groups that the participants were categorized into, were calculated: (1) low activity group with low social relationships, (2) low activity group with high social relationships, (3) high activity group with low social relationships, and (4) high activity group with high social relationships. After adjusting for potential confounders, a logistic regression analysis was conducted in Study 1. After adjusting for potential confounders, a Cox proportional hazards regression analysis was conducted in Study 2.

Results

Study 1 revealed that the high activity group with high social relationships showed a significantly lower risk of sleep disorder (ORs: 0.585, 95% CI: 0.404–0.847) than the low activity group with low social relationships. Study 2 also revealed that the high activity group with high social relationships showed a significantly lower prevalence of sleep disorder (HRs: 0.564, 95% CI: 0.327–0.974) than the low activity group with low social relationships.

Conclusions

Our findings suggest that for older adults with high social relationships, being physically active is favorably associated with sleep quality. However, a high level of one variable with a low level of the other has not been confirmed in improving sleep quality among older adults.

Associations of long-term exposure to ambient air pollution and physical activity with insomnia in Chinese adults

BACKGROUND

Air pollution is a potential environmental risk for sleep disturbance. However, the evidence is very limited in China. On the other hand, physical activity (PA) is a preventive behavior that can improve insomnia, but whether PA mitigates the negative impact of air pollution on insomnia is unknown.

METHODS

We obtained data from the baseline of China Multi-Ethnic Cohort (CMEC) survey, and examined the association between air pollution and insomnia, as well as PA's modification effect of on this association. We included 70,668 respondents and assessed insomnia by self-reported symptoms collected using electronic questionnaires. Using satellite data, we estimated the residence-specified, three-year average PM₁, PM_2.5, PM₁₀ (particulate matter with aerodynamic diameters of ≤1 μm, ≤2.5 μm and 10 μm, respectively), O₃ (ozone), and NO₂ (nitrogen dioxide) concentrations. We established the associations between air pollutants and insomnia through logistic regression. We evaluated the modification impact of total and domain-specific PA (leisure, occupation, housework, transportation) by introducing an interaction term.

RESULTS

Positive associations were observed between long-term exposure to PM₁, PM_2.5, PM₁₀, and O₃ and insomnia symptoms, with ORs (95% CI) of 1.09 (1.03-1.16), 1.11 (1.07-1.15), 1.07 (1.05-1.10) and 1.15 (1.11-1.20), respectively. As total PA increased, the ORs of air pollution for insomnia tended to decrease and then rise. We observed varying modification effects of domain-specific PA. With an increase in leisure PA, the ORs for PM_2.5 and PM₁₀ significantly declined. However, increased ORs of air pollutants were related to insomnia among participants with higher levels of occupational and housework PA.

CONCLUSION

Long-term exposure to higher concentrations of PM₁, PM_2.5, PM₁₀, and O₃ increases the risk of insomnia symptoms. Moderate to high levels of leisure PA alleviate the harmful effects of air pollution on insomnia, while high levels of occupation and housework PA intensify such effects.

Domain-Specific Active and Sedentary Behaviors in Relation to Workers' Presenteeism and Absenteeism

OBJECTIVES

To examine the associations between domain-specific sedentary and active behaviors and workers' presenteeism and absenteeism in a sample of company employees.

METHODS

This study recruited participants (n = 2466) from a nationwide online survey database (Japan, 2019). Participants completed a questionnaire that captured data on relative and absolute presenteeism and absenteeism and domain-specific physical activity and sedentary behaviors.

RESULTS

Daily minutes of work-related physical activity were negatively associated with relative absenteeism. Daily minutes of leisure-related physical activity were positively associated with absolute presenteeism (ie, better productivity). Daily minutes of total physical activity were negatively and positively associated with relative absenteeism and absolute presenteeism (ie, better productivity). There was also a positive association between car sitting time and absolute absenteeism.

CONCLUSIONS

A change in work culture and practices that support active behaviors at work and outside of work may improve employee's productivity indices.

Daily associations between sleep and physical activity: A systematic review and meta-analysis

The day-to-day variations of sleep and physical activity are associated with various health outcomes in adults, and previous studies suggested a bidirectional association between these behaviors. The daily associations between sleep and physical activity have been examined in observational or interventional contexts. The primary goal of the current systematic review and meta-analysis was to summarize existing evidence about daily associations between sleep and physical activity outcomes at inter- and intra-individual level in adults. A systematic search of records in eight databases from inception to July 2019 identified 33 peer-reviewed empirical publications that examined daily sleep-physical activity association in adults. The qualitative and quantitative analyses of included studies did not support a bidirectional daily association between sleep outcomes and physical activity. Multilevel meta-analyses showed that three sleep parameters were associated with physical activity the following day: sleep quality, sleep efficiency, and wake after sleep onset. However, the associations were small, and varied in terms of direction and level of variability (e.g., inter- or intra-individual). Daytime physical activity was associated with lower total sleep time the following night at an inter-person level with a small effect size. From a clinical perspective, care providers should monitor the effects of better sleep promotion on physical activity behaviors in their patients. Future studies should examine sleep and physical activity during a longer period and perform additional sophisticated statistical analyses. SYSTEMATIC REVIEW REGISTRATION: https://osf.io/w6uy5/.

Distinct effects of low-intensity physical activity in the evening on sleep quality in older women: A comparison of exercise and housework

BACKGROUND

The effects of intensity, type, and time of day of physical activity on sleep are not well understood. An appropriate increase in core body temperature, due to physical activity during daytime, aids sleep in older adults. Our previous study showed that evening exercise has more positive effects on sleep quality in older adults when compared with morning exercise. However, older adults who do not exercise form a large part of the population. This study aimed to examine the distinct effects of low-intensity exercise and housework during the evening on sleep quality in older women.

METHODS

This randomized crossover study included 10 healthy older women aged 65-79 years. The participants engaged in low-intensity physical activity for 30 min, either aerobic exercise (70 steps per minute), housework (at the same intensity), or remained sedentary (control) 3 h before bedtime. Sleep was recorded polysomnographically, and self-reported sleep quality was assessed the next morning using the Oguri-Shirakawa-Azumi sleep inventory, Middle-Aged and Aged version (OSA-MA) questionnaire.

RESULTS

Compared with the control trial, core body temperature was significantly elevated in participants after each activity trial (0.5 ± 0.4 and 0.4 ± 0.4 °C for housework and aerobic exercise, respectively). There was a significant difference in sleep latency (14.2 ± 19.1, 9.9 ± 15.6, and 4.2 ± 3.5 min for control, housework, and aerobic exercise, respectively; ANOVA P = 0.011) among the trials. The delta power density after aerobic exercise was significantly higher than that after the control trial. We observed an increase of 53% and 15% in delta power during the 1st hour of sleep as a result of aerobic exercise and housework, respectively. The total score on OSA-MA was significantly higher after aerobic exercise (91.0 ± 5.4, 88.1 ± 6.9, and 108.6 ± 5.9 points for control, housework, and exercise, respectively).

CONCLUSIONS

Engaging in low-intensity aerobic exercise in the evening improved polysomnographic and self-reported sleep quality. Although housework increased core body temperature to the same level as that observed after aerobic exercise, self-reported sleep quality after housework was lower than that after aerobic exercise.

Factors associated with the remission of insomnia after traumatic brain injury: a traumatic brain injury model systems study

Objective: To examine the factors associated with the remission of insomnia by examining a sample of individuals who had insomnia within the first two years after traumatic brain injury (TBI) and assessing their status at a secondary time point.Design and Methods: Secondary data analysis from a multicenter longitudinal cohort study. A sample of 40 individuals meeting inclusion criteria completed a number of self-report scales measuring sleep/wake characteristics (Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Insomnia Severity Index, Sleep Hygiene Index), fatigue and depression (Multidimensional Assessment of Fatigue, Patient Health Questionnaire-9), and community participation (Participation Assessment with Recombined Tools-Objective). One cohort was followed at 1 and 2 years post-injury (n = 19) while a second cohort was followed at 2 and 5 years post-injury (n = 21).Results: Remission of insomnia was noted in 60% of the sample. Those with persistent insomnia had significantly higher levels of fatigue and depression at their final follow-up and poorer sleep hygiene across both follow-up time-points. A trend toward reduced community participation among those with persistent insomnia was also found.Conclusion: Individuals with persistent post-TBI insomnia had poorer psychosocial outcomes. The chronicity of post-TBI insomnia may be associated with sleep-related behaviors that serve as perpetuating factors.

High physical activity is associated with post-traumatic stress disorder among individuals aged 15 years and older in South Africa

Background

Some research seems to suggest that physical activity (PA) was beneficial for post-traumatic stress disorder (PTSD).

Aim

This study examined the association between levels of PA and PTSD among individuals 15 years and above in South Africa.

Setting

Community-based survey sample representative of the national population in South Africa.

Methods

In all, 15 201 individuals (mean age 36.9 years) responded to the cross-sectional South African National Health and Nutrition Examination Survey (SANHANES-1) in 2012.

Results

One in five (20.1%) of participants reported exposure to at least one traumatic event in a lifetime, and 2.1% were classified as having a PTSD, 7.9% fulfilled PTSD re-experiencing criteria, 3.0% PTSD avoidance criteria and 4.3% PTSD hyperarousal criteria. Almost half (48.1%) of respondents had low PA, 17.4% moderate PA and 34.5% high PA. In logistic regression analysis, adjusted for age, sex, population group, employment status, residence status, number of trauma types, problem drinking, current tobacco use, sleep problems and depressive symptoms, high PA was associated with PTSD (odds ratio [OR] = 1.75, confidence interval [CI] = 1.11–2.75), PTSD re-experiencing symptom criteria (OR = 1.43, CI = 1.09–1.86) and PTSD avoidance symptom criteria (OR = 1.74, CI = 1.18–2.59), but high PA was not associated with PTSD hyperarousal symptom criteria. In generalised structural equation modelling, total trauma events had a positive direct and indirect effect on PTSD mediated by high PA, and high PA had a positive indirect effect on PTSD, mediated by psychological distress and problem drinking.

Conclusion

After controlling for relevant covariates, high PA was associated with increased PTSD symptomatology.

Interrelationship between Sleep and Exercise: A Systematic Review

Although a substantial body of literature has explored the relationship between sleep and exercise, comprehensive reviews and definitive conclusions about the impact of exercise interventions on sleep are lacking. Electronic databases were searched for articles published between January 2013 and March 2017. Studies were included if they possessed either objective or subjective measures of sleep and an exercise intervention that followed the guidelines recommended by the American College of Sports Medicine. Thirty-four studies met these inclusion criteria. Twenty-nine studies concluded that exercise improved sleep quality or duration; however, four found no difference and one reported a negative impact of exercise on sleep. Study results varied most significantly due to participants' age, health status, and the mode and intensity of exercise intervention. Mixed findings were reported for children, adolescents, and young adults. Interventions conducted with middle-aged and elderly adults reported more robust results. In these cases, exercise promoted increased sleep efficiency and duration regardless of the mode and intensity of activity, especially in populations suffering from disease. Our review suggests that sleep and exercise exert substantial positive effects on one another; however, to reach a true consensus, the mechanisms behind these observations must first be elucidated.