Association of Sleep Quality, Screen Time, and Physical Activity with Health-Related Quality of Life among Rural and Urban Athletes: A Comparative Cross-Sectional Study

Abstract

Sleep quality, screen time, and physical activity are modifiable behaviors linked to health-related quality of life (HRQoL) in athletes, but rural–urban comparisons among athletes remain limited. This cross-sectional study compared sleep quality, screen time, physical activity, and HRQoL between rural (n=100) and urban (n=100) athletes aged 18-30 years, and examined how these behaviors relate to HRQoL. Sleep quality, physical activity, screen time, and HRQoL were assessed with the Pittsburgh Sleep Quality Index (PSQI), International Physical Activity Questionnaire–Short Form (IPAQ-SF), Android Digital Wellbeing, and WHOQOL-BREF. Independent-samples t-tests, Pearson correlations, and multiple linear regression (α = .05) were used. Compared with urban athletes, rural athletes reported better sleep quality (PSQI M = 4.80 vs. 6.11, d = 0.72), lower screen time (3.16 vs. 4.56 h/day, d = 1.22), higher physical activity (3,778 vs. 2,835 MET-min/week, d = 0.82), and higher HRQoL (71.01 vs. 64.70, d = 1.05; all p < .001). HRQoL correlated negatively with PSQI (r = −.54) and screen time (r = −.53), and positively with physical activity (r = .42; all p < .001). After adjusting for residence, age, and sex, PSQI, screen time, and physical activity remained independent predictors of the investigator-derived Global HRQoL composite (all p < .001), and the model explained 56.7% of variance (adjusted R² = .554); the residence effect became non-significant once these behaviors were entered. These findings suggest sleep quality, screen time, and physical activity are associated with the rural–urban HRQoL gap among athletes and may be modifiable targets for residence-sensitive lifestyle interventions, pending longitudinal confirmation.