Prevalence, Trends, and Correlates of Joint Patterns of Aerobic and Muscle-Strengthening Activity and Sleep Duration: A Pooled Analysis of 359,019 Adults in the National Health Interview Survey 2004–2018

in Journal of Physical Activity and Health
Restricted access

Background: Physical activity (PA) and sleep duration have established associations with health outcomes individually but tend to co-occur and may be better targeted jointly. This study aimed to describe the cross-sectional prevalence, trends, and population characteristic correlates of activity-sleep patterns in a population-representative sample of US adults from the National Health Interview Survey (2004–2018). Methods: Participants (N = 359,019) self-reported aerobic and muscle-strengthening activity and sleep duration. They were categorized as “meeting both”/“meeting PA only”/“meeting sleep only”/“meeting neither” of the 2018 US PA guidelines and age-based sleep duration recommendations. Trends in activity-sleep patterns were analyzed using weighted multinomial logistic regression, and correlates were identified using weighted binary Poisson regressions, with P ≤ .001 considered significant. Results: “Meet sleep only” was most prevalent (46.4%) by 2018, followed by “meet neither” (30.3%), “meet both” (15.6%), and “meet PA only” (7.7%). Many significant sociodemographic, biological, and health-behavior correlates of the activity-sleep groups were identified, and the direction and magnitude of these associations differed between groups. Conclusions: Public health campaigns should emphasize the importance of both sufficient PA and sleep; target women and older adults, current smokers, and those with lower education and poorer physical and mental health; and consider specific barriers experienced by minority ethnic groups.

Oftedal, Holliday, and Duncan are with the School of Medicine & Public Health, College of Health, Medicine and Wellness, The University of Newcastle, Callaghan, NSW, Australia. Oftedal and Duncan are also with the Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW, Australia. Reynolds is with the Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia. Bennie is with the Physically Active Lifestyles Research Group (USQ PALs), Institute for Resilient Regions, University of Southern Queensland, Springfield, QLD, Australia. Kline is with the Department of Health and Human Development, University of Pittsburgh, Pittsburgh, PA, USA.

Oftedal (stina.oftedal@newcastle.edu.au) is corresponding author.

Supplementary Materials

    • Supplementary Figure S1 (PDF 646 KB)
    • Supplementary Figure S2 (PDF 659 KB)
    • Supplementary Figure S3 (PDF 673 KB)
    • Supplementary Table S1 (PDF 677 KB)
    • Supplementary Table S2 (PDF 641 KB)
    • Supplementary Table S3 (PDF 463 KB)
  • 1.

    Woodcock J, Franco OH, Orsini N, Roberts I. Non-vigorous physical activity and all-cause mortality: systematic review and meta-analysis of cohort studies. Int J Epidemiol. 2010;40(1):121138. PubMed ID: 20630992 doi:10.1093/ije/dyq104

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Wahid A, Manek N, Nichols M, et al. Quantifying the association between physical activity and cardiovascular disease and diabetes: a systematic review and meta‐analysis. J Am Heart Ass. 2016;5(9):e002495. doi:10.1161/JAHA.115.002495

    • Search Google Scholar
    • Export Citation
  • 3.

    Mammen G, Faulkner G. Physical activity and the prevention of depression: a systematic review of prospective studies. Am J Prev Med. 2013;45(5):649657. PubMed ID: 24139780 doi:10.1016/j.amepre.2013.08.001

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Itani O, Jike M, Watanabe N, Kaneita Y. Short sleep duration and health outcomes: a systematic review, meta-analysis, and meta-regression. Sleep Med. 2017;32:246256. PubMed ID: 27743803 doi:10.1016/j.sleep.2016.08.006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Jike M, Itani O, Watanabe N, Buysse DJ, Kaneita Y. Long sleep duration and health outcomes: a systematic review, meta-analysis and meta-regression. Sleep Med Rev. 2018;39:2536. PubMed ID: 28890167 doi:10.1016/j.smrv.2017.06.011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Kwok CS, Kontopantelis E, Kuligowski G, et al. Self-reported sleep duration and quality and cardiovascular disease and mortality: a dose-response meta-analysis. J Am Heart Ass. 2018;7(15):e008552. doi:10.1161/JAHA.118.008552

    • Search Google Scholar
    • Export Citation
  • 7.

    Yin J, Jin X, Shan Z, et al. Relationship of sleep duration with all-cause mortality and cardiovascular events: a systematic review and dose-response meta-analysis of prospective cohort studies. J Am Heart Assoc. 2017;6(9):e005947. doi:10.1161/JAHA.117.005947

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Rayward AT, Duncan MJ, Brown WJ, Plotnikoff RC, Burton NW. A cross-sectional cluster analysis of the combined association of physical activity and sleep with sociodemographic and health characteristics in mid-aged and older adults. Maturitas. 2017;102:5661. PubMed ID: 28610684 doi:10.1016/j.maturitas.2017.05.013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Duncan MJ, Oftedal S, Rebar AL, et al. Patterns of physical activity, sitting time, and sleep in Australian adults: a latent class analysis. Sleep Health. 2020;6(6):828834. PubMed ID: 32819888 doi:10.1016/j.sleh.2020.04.006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Bennie JA, De Cocker K, Duncan MJ. Associations of muscle-strengthening and aerobic exercise with self-reported components of sleep health among a nationally representative sample of 47,564 US adults. Sleep Health. 2021;7(2):281288. PubMed ID: 33071201 doi:10.1016/j.sleh.2020.08.004

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Chen L-J, Hamer M, Lai Y-J, Huang B-H, Ku P-W, Stamatakis E. Can physical activity eliminate the mortality risk associated with poor sleep? A 15-year follow-up of 341,248 MJ Cohort participants. J Sport Health Sci. 2021;14:40634072. doi:10.2147/RMHP.S332098

    • Search Google Scholar
    • Export Citation
  • 12.

    Huang BH, Inan-Eroglu E, Hamer M, Stamatakis E. Joint associations of device-measured physical activity and sleep duration with cardiometabolic health in the 1970 British Cohort Study. J Sci Med Sport. 2020;23(12):11911196. PubMed ID: 32859521 doi:10.1016/j.jsams.2020.07.012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Ding D, Rogers K, van der Ploeg H, Stamatakis E, Bauman AE. Traditional and emerging lifestyle risk behaviors and all-cause mortality in middle-aged and older adults: evidence from a large population-based Australian cohort. PLoS Med. 2015;12(12):e1001917. doi:10.1371/journal.pmed.1001917

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    St-Onge M-P, Grandner MA, Brown D, et al. Sleep duration and quality: impact on lifestyle behaviors and cardiometabolic health: a scientific statement from the American heart association. Circulation. 2016;134(18):e367e386. PubMed ID: 27647451 doi:10.1161/CIR.0000000000000444

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Huang B, Duncan MJ, Cistulli PA, Nassar N, Hamer M, Stamatakis E. Sleep and physical activity in relation to all-cause, cardiovascular disease and cancer mortality risk. Br J Sports Med. Published online June 29, 2021. doi:10.1136/bjsports-2021-104046

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Bennie JA, De Cocker K, Teychenne MJ, Brown WJ, Biddle SJH. The epidemiology of aerobic physical activity and muscle-strengthening activity guideline adherence among 383,928 U.S. adults. Int J Behav Nutr Phys Act. 2019;16(1):34. PubMed ID: 30999896 doi:10.1186/s12966-019-0797-2

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Whitfield GP, Carlson SA, Ussery EN, Fulton JE, Galuska DA, Petersen R. Trends in meeting physical activity guidelines among urban and rural dwelling adults—United States, 2008–2017. MMWR Morb Mortal Wkly Rep. 2019;68(23):513518. PubMed ID: 31194722 doi:10.15585/mmwr.mm6823a1

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18.

    Sheehan CM, Frochen SE, Walsemann KM, Ailshire JA. Are U.S. adults reporting less sleep? Findings from sleep duration trends in the National Health Interview Survey, 2004–2017. Sleep. 2019;42(2):zsy221. doi:10.1093/sleep/zsy221

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Centers for Disease Control and Prevention (CDC). Effect of short sleep duration on daily activities—United States, 2005–2008. MMWR Morb Mortal Wkly Rep. 2011;60(8):239242.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Oja P, Titze S. Physical activity recommendations for public health: development and policy context. EPMA J. 2011;2(3):253259. PubMed ID: 23199160 doi:10.1007/s13167-011-0090-1

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Stamatakis E, Lee IM, Bennie J, et al. Does strength-promoting exercise confer unique health benefits? A pooled analysis of data on 11 population cohorts with all-cause, cancer, and cardiovascular mortality endpoints. Am J Epidemiol. 2018;187(5):11021112. PubMed ID: 29099919 doi:10.1093/aje/kwx345

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Bennie JA, Shakespear-Druery J, De Cocker K. Muscle-strengthening exercise epidemiology: a new frontier in chronic disease prevention. Sports Med Open. 2020;6(1):40. PubMed ID: 32844333 doi:10.1186/s40798-020-00271-w

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Zhao M, Veeranki SP, Magnussen CG, Xi B. Recommended physical activity and all cause and cause specific mortality in US adults: prospective cohort study. BMJ. 2020;370:m2031. PubMed ID: 32611588 doi:10.1136/bmj.m2031

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Vincent GE, Jay SM, Sargent C, Vandelanotte C, Ridgers ND, Ferguson SA. Improving cardiometabolic health with diet, physical activity, and breaking up sitting: what about sleep? Front Physiol. 2017;8:865865. PubMed ID: 29167645 doi:10.3389/fphys.2017.00865

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Institute of Medicine (US) Committee on Sleep Medicine and Research. Sleep Disorders and Sleep Deprivation:An Unmet Public Health Problem. Washington (DC): National Academic Press (US); 2006.

    • Search Google Scholar
    • Export Citation
  • 26.

    Gottlieb DJ, Ellenbogen JM, Bianchi MT, Czeisler CA. Sleep deficiency and motor vehicle crash risk in the general population: a prospective cohort study. BMC Med. 2018;16(1):44. PubMed ID: 29554902 doi:10.1186/s12916-018-1025-7

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Burton WN, Chen CY, Schultz AB, Li X. Association between employee sleep with workplace health and economic outcomes. J Occup Environ Med. 2017;59(2):177183. PubMed ID: 28166124 doi:10.1097/JOM.0000000000000934

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Huang BH, Hamer M, Duncan MJ, Cistulli PA, Stamatakis E. The bidirectional association between sleep and physical activity: a 6.9 years longitudinal analysis of 38,601 UK Biobank participants. Prev Med. Published online November 7, 2020. doi:10.1016/j.ypmed.2020.106315

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Kline CE. The bidirectional relationship between exercise and sleep: implications for exercise adherence and sleep improvement. Am J Lifestyle Med. 2014;8(6):375379. PubMed ID: 25729341 doi:10.1177/1559827614544437

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Bennie JA, Kolbe-Alexander T, Seghers J, Biddle SJH, De Cocker K. Trends in muscle-strengthening exercise among nationally representative samples of united states adults between 2011 and 2017. J Phys Act Health. 2020;17(5):512518. PubMed ID: 32283540 doi:10.1123/jpah.2019-0472

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    National Center for Health Statistics. National health survey interview. Centers for Disease Control and Prevention. Accessed August 11, 2021. https://www.cdc.gov/nchs/nhis/index.htm

    • Search Google Scholar
    • Export Citation
  • 32.

    Blewett LRDJ, King ML, Williams KCW. Data from: IPUMS Health Surveys: National Health Interview Survey, Version 6.4. Minneapolis, MN: IPUMS, Instutute fo Social Research and Data Innovation, The University of Minnesota; 2019.

    • Search Google Scholar
    • Export Citation
  • 33.

    National Center for Health Statistics. Leisure-time physical activity recodes. Center for Disease Control and Prevention. https://www.cdc.gov/nchs/nhis/physical_activity/pa_recodes.htm. Accessed August 24, 2021.

    • Search Google Scholar
    • Export Citation
  • 34.

    Carlson SA, Densmore D, Fulton JE, Yore MM, Kohl HW III. Differences in physical activity prevalence and trends from 3 U.S. surveillance systems: NHIS, NHANES, and BRFSS. J Phys Act Health. 2009;6(suppl 1):S18S27. doi:10.1123/jpah.6.s1.s18

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35.

    Wang Y, Nie J, Ferrari G, Rey-Lopez JP, Rezende LFM. Association of physical activity intensity with mortality: a national cohort study of 403 681 US adults. JAMA Int Med. 2021;181(2):203211. doi:10.1001/jamainternmed.2020.6331

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 36.

    2018 Physical activity guidelines advisory committee report. 2018.

  • 37.

    Hirshkowitz M, Whiton K, Albert SM, et al. National sleep foundation’s sleep time duration recommendations: methodology and results summary. Sleep Health. 2015;1(1):4043. PubMed ID: 29073412 doi:10.1016/j.sleh.2014.12.010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38.

    World Health Organization. Body Mass Index—BMI. World Health Organisation. https://www.euro.who.int/en/health-topics/disease-prevention/nutrition/a-healthy-lifestyle/body-mass-index-bmi. Accessed August 9, 2021.

    • Search Google Scholar
    • Export Citation
  • 39.

    Kessler RC, Barker PR, Colpe LJ, et al. Screening for serious mental illness in the general population. Arch Gen Psychiatry. 2003;60(2):184189. PubMed ID: 12578436 doi:10.1001/archpsyc.60.2.184

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40.

    Surveys IH. Use of sampling weights with IPUMS NHIS. Integrated Public Use Microdata Series (IPUMS). https://nhis.ipums.org/nhis/userNotes_weights.shtml. Accessed August 11, 2021.

    • Search Google Scholar
    • Export Citation
  • 41.

    Barros AJD, Hirakata VN. Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio. BMC Med Res Methodol. 2003;3(1):21. doi:10.1186/1471-2288-3-21

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 42.

    Sullivan GM, Feinn R. Using effect size-or why the P value is not enough. J Grad Med Educ. 2012;4(3):279282. PubMed ID: 23997866 doi:10.4300/JGME-D-12-00156.1

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 43.

    Lakens D, Adolfi FG, Albers CJ, et al. Justify your alpha. Nat Hum Behav. 2018;2(3):168171. doi:10.1038/s41562-018-0311-x

  • 44.

    Xiao Q, Keadle SK, Hollenbeck AR, Matthews CE. Sleep duration and total and cause-specific mortality in a large US cohort: interrelationships with physical activity, sedentary behavior, and body mass index. Am J Epidemiol. 2014;180(10):9971006. doi:10.1093/aje/kwu222

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 45.

    Wennman H, Kronholm E, Heinonen OJ, et al. Leisure time physical activity and sleep predict mortality in men irrespective of background in competitive sports. Prog Prev Med. 2017;2(6):e0009. doi:10.1097/pp9.0000000000000009

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 46.

    Rebar AL, Reynolds AC, Ferguson SA, Gardner B. Accounting for automatic processes in sleep health. J Sleep Res. 2020;29(5):e12987. doi:10.1111/jsr.12987

  • 47.

    Mead MP, Irish LA. Application of health behaviour theory to sleep health improvement. J Sleep Res. 2020;29(5):e12950. doi:10.1111/jsr.12950

  • 48.

    Mead MP, Irish LA. The theory of planned behaviour and sleep opportunity: an ecological momentary assessment. J Sleep Res. 2021;31(1):e13420. doi:10.1111/jsr.13420

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 49.

    Duncan MJ, Holliday EG, Oftedal S, Buman M, Brown WJ. Joint association of physical activity and sleep difficulties with the incidence of hypertension in mid-age Australian women. Maturitas. 2021;149:17. PubMed ID: 34134885 doi:10.1016/j.maturitas.2021.04.006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 50.

    Gupta CC, Duncan MJ, Ferguson SA, et al. The discrepancy between knowledge of sleep recommendations and the actual sleep behaviour of Australian adults. Behav Sleep Med. 2021:19(6):828839. doi:10.1080/15402002.2021.1876693

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 51.

    Jackson CL, Redline S, Kawachi I, Williams MA, Hu FB. Racial disparities in short sleep duration by occupation and industry. Am J Epidemiol. 2013;178(9):14421451. PubMed ID: 24018914 doi:10.1093/aje/kwt159

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 52.

    Petrov ME, Lichstein KL. Differences in sleep between black and white adults: an update and future directions. Sleep Med. 2016;18:7481. doi:10.1016/j.sleep.2015.01.011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 53.

    Chattu VK, Chattu SK, Spence DW, Manzar MD, Burman D, Pandi-Perumal SR. Do disparities in sleep duration among racial and ethnic minorities contribute to differences in disease prevalence? J Racial Ethn Health Disparities. 2019;6(6):10531061. PubMed ID: 31264064 doi:10.1007/s40615-019-00607-7

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 54.

    Sheehan CM, Walsemann KM, Ailshire JA. Race/ethnic differences in educational gradients in sleep duration and quality among U.S. adults. SSM Popul Health. 2020;12:100685. PubMed ID: 33204809 doi:10.1016/j.ssmph.2020.100685

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 55.

    Farmer MM, Ferraro KF. Are racial disparities in health conditional on socioeconomic status? Soc Sci Med. 2005;60(1):191204. PubMed ID: 15482878 doi:10.1016/j.socscimed.2004.04.026

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 56.

    National Academies of Sciences, Engineering, and Medicine, Health and Medicine Division, Board on Population Health and Public Health Practice, et al. Communities in action: pathways to health equity. 2017. https://www.ncbi.nlm.nih.gov/books/NBK425844/

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 57.

    Hicken MT, Lee H, Ailshire J, Burgard SA, Williams DR. “Every shut eye, ain’t sleep”: the role of racism-related vigilance in racial/ethnic disparities in sleep difficulty. Race Soc Probl. 2013;5(2):100112. PubMed ID: 23894254 doi:10.1007/s12552-013-9095-9

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 58.

    Kline CE, Hillman CH, Bloodgood Sheppard B, et al. Physical activity and sleep: an updated umbrella review of the 2018 physical activity guidelines advisory committee report. Sleep Med Rev. 2021;58:101489. doi:10.1016/j.smrv.2021.101489

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 59.

    Buysse DJ. Sleep health: can we define it? Does it matter? Sleep. 2014;37(1):917. PubMed ID: 24470692 doi:10.5665/sleep.3298

All Time Past Year Past 30 Days
Abstract Views 7 7 0
Full Text Views 1324 1324 384
PDF Downloads 360 360 53