Associations of reallocating time between physical activity, sedentary behavior, and sleep with mental health among Chinese adolescents: an isotemporal substitution analysis
Aug 2026· Health and Quality of Life Outcomes· Vol 24· 0 citations· 45 references
Medicine
TL;DR
Reallocating time toward sleep and PA was associated with reduced depressive and anxiety symptoms, particularly among adolescents with insufficient sleep, and accounting for sleep status may help advance understanding of the associations between movement behavior reallocations and adolescent mental health.
Abstract
Depression and anxiety are important adolescent mental health concerns and may be linked to modifiable movement behaviors, including physical activity (PA), sedentary behavior (SB), and sleep. As mental health outcomes depend not only on time spent in specific behaviors but also on the trade-offs between them, this study examined the associations of reallocating 30 min between these behaviors with adolescent psychological symptoms. This cross-sectional study included 7,767 adolescents from Henan Province, Central China, in 2023. Daily PA, SB, and sleep duration were self-reported. Depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression Scale, and anxiety symptoms were measured with the 7-item Generalized Anxiety Disorder Scale. Isotemporal substitution models estimated the associations of 30-minute reallocations with depressive and anxiety symptoms. Interaction tests and subgroup analyses were conducted according to sleep status. Replacing 30 min of SB with sleep or PA was associated with lower levels of depression (sleep, B = -0.47, 95%CI = -0.53~-0.41; PA, B = -0.12, 95%CI = -0.16~-0.08) and anxiety (sleep, B = -0.31, 95%CI = -0.36~-0.25; PA, B = -0.07, 95%CI = -0.10~-0.04). Reallocating PA to sleep also related to reduced depressive symptoms (B = -0.35, 95%CI = -0.42~-0.28) and anxiety symptoms (B = -0.24, 95%CI = -0.30~-0.18). Among adolescents with insufficient sleep, the associations were stronger when reallocating SB to sleep (for depression: B = -0.52, 95%CI = -0.64~-0.39; for anxiety: B = -0.40, 95%CI = -0.50~-0.28) or PA to sleep (for depression: B = -0.39, 95%CI = -0.50~-0.25; for anxiety: B = -0.32, 95%CI = -0.41~-0.19). Among those with sufficient sleep, reallocating SB to PA or sleep remained associated with lower depressive symptoms, but no significant association was observed for anxiety. Reallocating time toward sleep and PA was associated with reduced depressive and anxiety symptoms, particularly among adolescents with insufficient sleep. Accounting for sleep status may help advance understanding of the associations between movement behavior reallocations and adolescent mental health.
Previous studies have shown that outdoor activity, sedentary behavior, and sleep duration are associated with psychological distress in children and adolescents. Using an isotemporal substitution model, this study examined the simulated effects of reallocating time among these behaviors with the risk of high psychological distress and whether sex differences exist.
From March 2023 to May 2023, 6132 students aged 9–19 years (mean age = 14.0 years, 48.9% males) in Anhui Province were selected. Basic information, outdoor activity, sedentary behavior, and sleep, were collected through a questionnaire survey. The Kessler Psychological Distress Scale was used to measure the psychological distress of the study subjects. The isotemporal substitution model was used to analyze the associations of outdoor activity, sedentary behavior, and sleep duration with high psychological distress, and stratified analysis was performed by gender.
The results of this survey indicate that among 6,132 primary and secondary school students, the detection rate of high psychological distress was 38.57%. Compared with students without psychological distress, those with high psychological distress reported significantly less daily outdoor activity (1.24 and 1.45 h/day, respectively) and shorter sleep duration (8.5 and 9.1 h/day, respectively). They also spent significantly more time in sedentary behavior (8.02 and 7.01 h/day, respectively). Replacing 1 h per day of sedentary behavior with the same duration of outdoor activity and sleep is associated with an 18.8% (
P
< 0.001) and 26.8% (
P
< 0.001) reduction in the risk of high psychological distress, respectively. Replacing 1 h per day of outdoor activity or sleep with the same duration of sedentary behavior is associated with a 23.2% (
P
< 0.001) and 36.6% (
P
< 0.001) increase respectively in the risk of high psychological distress. After gender stratification, replacing one hour of daily sedentary behavior with equal-duration outdoor activity or sleep was associated with reduced risk of high psychological distress: 11.5% (
P
= 0.011) and 28.0% (
P
< 0.001) in girls, and 25.8% (
P
< 0.001) and 25.6% (
P
< 0.001) in boys. Replacing one hour per day of outdoor activity or sleep with sedentary behavior was associated with a 13.0% (
P
= 0.010) and 38.8% (
P
< 0.001) increase in girls and a 34.7% (
P
< 0.001) and 34.3% (
P
< 0.001) increase in boys in the risk of high psychological distress, respectively. Therefore, outdoor activity and sleep duration were negatively associated with psychological distress, while sedentary behavior was positively associated with psychological distress among children and adolescents.
Reallocating time from sedentary behavior to outdoor activity or sleep was associated with a lower risk of high psychological distress among children and adolescents, with associations differing by sex.
Among healthier adults, physical activity modified the association between moderate alcohol use and symptoms of anxiety or depression on additive and multiplicative scales, suggesting sedentary behavior may amplify mental health vulnerability associated with moderate drinking.
J. Sanborn, D. Nash, M. Robertson et al.· medRxiv· 0 citations
Physical activity did not show significant associations with psychological symptoms or sleep quality, and higher depression and stress scores predicted poorer sleep quality.
Sleep disturbances are common among older adults and are often closely associated with anxiety symptoms, which together can substantially compromise physical and mental health.A cross-sectional analysis was conducted using data from the 2017/2018 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). The study included 6,106 Chinese older adults (aged ≥65 years) living in empty-nest households. Physical exercise was measured based on self-reported regular engagement in exercise, and social participation was defined as involvement in organized social activities (e.g., community or group-based events). Associations between sleep quality and duration and anxiety were estimated using multivariable logistic regression, and mediation effects of physical exercise and social participation were tested using bootstrap resampling.Among the 6,106 participants, 593 (9.7%) reported anxiety symptoms. Multivariable logistic regression analysis indicated that poor sleep quality was significantly associated with a higher risk of anxiety (OR = 3.23, 95% CI: 2.62–4.01, P < 0.001). Short sleep duration was also an independent risk factor for anxiety (OR = 1.34, 95% CI: 1.04–1.74, P = 0.025), whereas long sleep duration showed no significant association. Subgroup analyses stratified by sex, marital status, and economic status consistently revealed significant associations between sleep (both quality and duration) and anxiety, with no statistically significant interactions observed. Mediation analyses demonstrated that physical exercise significantly mediated the relationships of both sleep quality and long sleep duration with anxiety (all P < 0.01, with bootstrap confidence intervals excluding zero). Similarly, social participation significantly mediated the relationships of both short and long sleep duration with anxiety (all P < 0.01, with bootstrap confidence intervals excluding zero).In Chinese empty-nest older adults, both poor sleep quality and short sleep duration are independent risk factors for anxiety symptoms, with sleep quality exerting a stronger influence. Physical exercise partially mediated the associations between sleep quality and anxiety and between long sleep duration and anxiety, whereas social participation mediated the association between sleep duration (short and long) and anxiety. Improving sleep quality and ensuring adequate sleep duration may help reduce anxiety risk, and interventions promoting physical exercise and social participation could enhance these protective effects.
Yiming Ma, Quan Zhou, Jiaran Jiang et al.· bioRxiv· 0 citations
Findings support muscle-strengthening activities and healthy sleep habits as potential targets for mental health promotion and support muscle-strengthening activities and healthy sleep habits as potential targets for mental health promotion.
Samuel Ofei-Dodoo, Y. Khan, Ibrahim Touffaha et al.· Kansas journal of medicine· 0 citations
Physical activity may promote sleep, but few studies examined whether vigorous exercise is associated with difficulty falling asleep or waking in the middle of the night. This study examined the relationship between these variables. The Adventist Health Study-2 (AHS-2) questionnaireline was completed by approximately 97000 churchgoers in North America to investigate relationships between lifestyle, including exercise habits, and chronic disease. A randomly selected subset participated in the Biopsychosocial Religion and Health Study (BRHS), including about 11 000 respondents who answered questions about psychosocial and religious issues, including sleep patterns. After excluding participants with chronic disease, 3960 remained: 2502 women (1502 Whites and 1000 Blacks) and 1458 men (1038 Whites and 420 Blacks). Logistic regressions were adjusted for age, gender, race, body mass index (BMI), diet, education, alcohol, caffeinated-beverage use, hours of sleep, and napping. Increased frequency of vigorous physical activity was protective against difficulty falling asleep (OR = 0.97; 95% CI = 0.94-0.98; P = 0.03). Higher odds of difficulty falling asleep were observed among female participants, increasing age, weekday napping, and sleeping 9 hours or more per night. Vigorous physical activity was associated with reduced difficulty falling asleepline but showed no relation to waking during the night.
Michael Paalani, Drph, Daijah Rdn et al.· American Journal of Lifestyl...· 0 citations
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