Joint association of physical activity and sleep duration with risk of all-cause and cause-specific mortality: A population-based cohort study using accelerometry

Liang, Yannis Yan; Feng, Hongliang; Chen, Yilin; Jin, Xinyi; Xue, Huachen; Zhou, Mingqing; Ma, Huan; Ai, Sizhi; Wing, Yun-Kwok; Geng, Qingshan; Zhang, Jihui

doi:10.1093/eurjpc/zwad060

Cited by 102Physical Activity and HealthSleep and related disordersCircadian rhythm and melatonin

Joint association of physical activity and sleep duration with risk of all-cause and cause-specific mortality: A population-based cohort study using accelerometry

Open access

Liang, Yannis Yan, Feng, Hongliang, Chen, Yilin, Jin, Xinyi, Xue, Huachen, Zhou, Mingqing, Ma, Huan, Ai, Sizhi +3 more·2023·European Journal of Preventive Cardiology

DOI 10.1093/eurjpc/zwad060

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Abstract

Aims: To investigate the joint association of accelerometer-measured physical activity (PA) and sleep duration with mortality risk. Methods and results: A 7-day accelerometer recording was performed on 92 221 participants (age 62.4 ± 7.8 years; 56.4% women) from the UK Biobank between February 2013 and December 2015. We divided sleep duration into three groups (short, normal, and long), total volume of PA into three levels according to tertiles (high, intermediate, low), and moderate-to-vigorous PA (MVPA) into two groups based on the World Health Organization guidelines. The mortality outcomes were prospectively collected through the death registry. Over a median follow-up of 7.0 years, 3080 adults died, of which 1074 died from cardiovascular disease (CVD) and 1871 from cancer. The associations of PA and sleep duration with mortality risk were all in a curvilinear dose–response pattern (Pnonlinearity <0.001). PA and sleep duration had additive and multiplicative interactions on mortality risk (Pinteraction <0.05). Compared with the participants with guideline-recommended MVPA and normal sleep duration, those without recommended MVPA but having short or long sleep duration were at a higher risk for all-cause mortality [short sleep: hazard ratio (HR) = 1.88; 95% confidence interval (CI), 1.61–2.20; long sleep: HR = 1.69; 95% CI, 1.49–1.90]. A higher volume of PA or recommended MVPA attenuated the detrimental effects of short or long sleep duration on all-cause and CVD mortality risks. Conclusion: MVPA meeting recommendations or a higher volume of PA at any intensity potentially diminished the adverse effects on all-cause and cause-specific mortality associated with short and long sleep duration.

AI snapshot

Written from the paper’s full text.

TL;DR

In a UK Biobank accelerometry cohort, physical activity and sleep duration were independently and jointly associated with all-cause, cardiovascular disease (CVD), and cancer mortality. Meeting moderate-to-vigorous physical activity (MVPA) recommendations or achieving a higher total physical activity volume attenuated the excess mortality risk associated with short or long sleep duration.

Key findings

Among 92,221 participants over a median 7.0-year follow-up, 3,080 died (1,074 from CVD, 1,871 from cancer); physical activity and sleep duration showed curvilinear dose-response associations with mortality (P nonlinearity <0.001).
Physical activity and sleep duration had additive and multiplicative interactions on mortality risk (P interaction <0.05).
Compared with guideline-recommended MVPA and normal sleep duration, participants without recommended MVPA and with short sleep had higher all-cause mortality (HR = 1.88; 95% CI, 1.61–2.20), as did those with long sleep (HR = 1.69; 95% CI, 1.49–1.90).
In joint categories, low physical activity plus short sleep (HR = 2.51; 95% CI, 2.07–3.05) and low physical activity plus long sleep (HR = 2.06; 95% CI, 1.80–2.36) were associated with the highest all-cause mortality risk versus high physical activity plus normal sleep; higher physical activity or recommended MVPA attenuated short- and long-sleep mortality risks for all-cause and CVD mortality.

Methods

Population-based prospective UK Biobank cohort of 92,221 participants (mean age 62.4 ± 7.8 years; 56.4% women) with valid 7-day wrist-worn Axivity AX3 accelerometer data collected February 2013–December 2015.
Sleep duration was categorized as short (<6 h/day), normal (6–8 h/day), or long (>8 h/day); total physical activity was categorized by tertiles as low (≤24.0 mg), intermediate (24.0–30.4 mg), or high (≥30.4 mg); MVPA was categorized as recommended or not recommended according to WHO guidelines (≥150 min moderate, or ≥75 min vigorous, or equivalent per week).
Mortality outcomes were prospectively collected from death registries; multivariable Cox proportional hazards models with restricted cubic splines, interaction analyses, and joint-category analyses were used, with sensitivity analyses for missing data, accelerometer wear time, prevalent illness, reverse causation, and COVID-19 censoring.

Limitations

Paper-stated limitations include no accounting for prospective changes in sleep duration and physical activity; unusual sleep duration was not age-adjusted; observational residual confounding and reverse causation could not be fully ruled out; covariates were assessed nearly six years before baseline; sedentary behavior was not included due to correlation with physical activity and sleep; only sleep duration, not other sleep patterns, was examined; and the UK Biobank sample is not representative of the UK population.
Evident from the text: the reported all-cause mortality HR for MVPA exceeding the WHO recommendation is 0.67 with a 95% CI of 0.48–0.59, which is internally inconsistent and likely a typographical error.

Model-written summary. Check it against the paper before relying on it.

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Crossref · 10.1093/eurjpc/zwad060

Cites

43 of 43 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 58 cited sources checked · 0 supported · 0 flagged

Findingown data
Sleep duration was associated with all-cause mortality in a U-shaped pattern in non-linear analyses (P nonlinearity <0.001).
“Sleep duration was associated with all-cause and CVD mortality in U-and L-shaped patterns, respectively, in the non-linear analyses (both P nonlinearity <0.001) (Figure 1A and B).”
Quote in the paperSubstantial claim
Findingown data
The combinations of a low volume of PA with short sleep duration (HR, 2.51; 95% CI, 2.07-3.05) and long sleep duration (HR, 2.06; 95% CI, 1.80-2.36) were associated with the highest risk of all-cause mortality.
“The combinations of a low volume of PA with short (HR, 2.51; 95% CI, 2.07-3.05)and long sleep duration (HR, 2.06; 95% CI, 1.80-2.36)were associated with the highest risk of all-cause mortality”
Quote in the paperSubstantial claim
Findingown data
A higher volume of PA or recommended MVPA attenuated the detrimental effects of short or long sleep duration on CVD mortality risk.
“A higher volume of PA or recommended MVPA attenuated the detrimental effects of short or long sleep duration on all-cause and CVD mortality risks.”
Quote in the paperSubstantial claim
Findingown data
Engagement of MVPA above the recommended target (150 min/week), compared with below the target, showed a trend of completely reducing the excess risks of all-cause, CVD, and cancer mortality associated with short and long sleep duration.
“Engagement of MVPA above the recommended target (150 min/ week), compared with below the target, showed a trend of completely reducing the excess risks of all-cause, CVD, and cancer mortality associated with short and long sleep duration.”
Quote in the paperSubstantial claim
Findingown data
Compared with normal sleep duration, short sleep duration increased the risk of all-cause mortality (HR, 1.34; 95% CI, 1.18-1.51) in additional adjusted multivariate Cox models.
“As a categorized variable, compared with normal sleep duration, only short sleep duration dra- matically increased the risk of all-cause [hazard ratio (HR), 1.34; 95% CI, 1.18-1.51]and CVD (HR, 1.56; 95% CI, 1.29-1.89)mortality in the additional adjusted multivariate Cox models (see Supplementary material online, Model S2, Supplementary material online, eTable S6).”
Quote in the paperSubstantial claim

Findingown data
Compared with participants with guideline-recommended MVPA and normal sleep duration, those without recommended MVPA but having long sleep duration were at higher risk for all-cause mortality (HR = 1.69; 95% CI, 1.49-1.90).
“Compared with the participants with guideline-recommended MVPA and normal sleep duration, those without recommended MVPA but having short or long sleep duration were at a higher risk for all-cause mortality [short sleep: hazard ratio (HR) = 1.88; 95% confidence interval (CI), 1.61-2.20;long sleep: HR = 1.69; 95% CI, 1.49-1.90].”
Quote in the paperSubstantial claim
Findingown data
When stratified by categories of total PA, a decreasing trend of mortality risk associated with both short and long sleep duration was observed following a higher volume of PA.
“When stratified by categories of the total volume of PA, a decreasing trend of mortality risk associated with both short and long sleep duration was observed following a higher volume of PA.”
Quote in the paperSubstantial claim
Findingown data
A higher volume of PA, compared with a low volume of PA, was associated with almost 50% reduced all-cause, CVD, and cancer mortality risks.
“A higher volume of PA, compared with a low volume of PA, achieved a dramatic benefit of almost 50% reduced all-cause, CVD, and cancer mortality risks (see Supplementary material online, eTable S7).”
Quote in the paperSubstantial claim
Findingown data
Sleep duration was not significantly associated with cancer mortality.
“However, sleep duration was not significantly associated with cancer mortality (Figure 1C).”
Quote in the paperSubstantial claim
Findingown data
When categorized by total PA, the lowest risk of death occurred in the group with normal sleep duration and a high volume of PA (reference group).
“When categorized by the total volume of PA, the lowest risk of death occurred in the group with normal sleep duration and a high volume of PA (reference group) (Figure 3A).”
Quote in the paperSubstantial claim
Findingown data
Similar gradient patterns were observed regarding the outcomes of CVD and cancer mortality.
“Similar gradient patterns were observed regarding the outcomes of CVD and cancer mortality.”
Quote in the paperNot a substantial claim
Findingown data
A higher volume of PA or recommended MVPA attenuated the detrimental effects of short or long sleep duration on all-cause mortality risk.
“A higher volume of PA or recommended MVPA attenuated the detrimental effects of short or long sleep duration on all-cause and CVD mortality risks.”
- Also stated in: § Joint associations of accelerometer-measured physical activity and sleep duration with mortality · plain
  “When stratified by categories of the total volume of PA, a decreasing trend of mortality risk associated with both short and long sleep duration was observed following a higher volume of PA.”
- Also stated in: § Discussion · plain
  “In contrast, the mortality risks of short and long sleep duration were similar to those of normal sleep duration among participants with a higher volume of total PA.”
Quote in the paperSubstantial claim
Findingown data
Sleep duration was associated with CVD mortality in an L-shaped pattern in non-linear analyses (P nonlinearity <0.001).
“Sleep duration was associated with all-cause and CVD mortality in U-and L-shaped patterns, respectively, in the non-linear analyses (both P nonlinearity <0.001) (Figure 1A and B).”
Quote in the paperSubstantial claim
Findingown data
Compared with participants with guideline-recommended MVPA and normal sleep duration, those without recommended MVPA but having short sleep duration were at higher risk for all-cause mortality (HR = 1.88; 95% CI, 1.61-2.20).
“Compared with the participants with guideline-recommended MVPA and normal sleep duration, those without recommended MVPA but having short or long sleep duration were at a higher risk for all-cause mortality [short sleep: hazard ratio (HR) = 1.88; 95% confidence interval (CI), 1.61-2.20;long sleep: HR = 1.69; 95% CI, 1.49-1.90].”
Quote in the paperSubstantial claim
Findingown data
Compared with normal sleep duration, short sleep duration increased the risk of CVD mortality (HR, 1.56; 95% CI, 1.29-1.89) in additional adjusted multivariate Cox models.
“As a categorized variable, compared with normal sleep duration, only short sleep duration dra- matically increased the risk of all-cause [hazard ratio (HR), 1.34; 95% CI, 1.18-1.51]and CVD (HR, 1.56; 95% CI, 1.29-1.89)mortality in the additional adjusted multivariate Cox models (see Supplementary material online, Model S2, Supplementary material online, eTable S6).”
Quote in the paperSubstantial claim
Findingown data
Meeting the guideline-recommended physical activity target (150 min/week for moderate-to-vigorous physical activity) can diminish the most detrimental effects on all-cause and cardiovascular disease mortality associated with either short or long sleep duration.
“Another important finding was that meeting the guidelinerecommended PA target (150 min/week for MVPA) can diminish the most detrimental effects on all-cause and CVD mortality associated with either short or long sleep duration.”
Quote in the paperSubstantial claim
Findingreasoning
We found a steeper decline in mortality risk immediately after improving physical activity levels among long sleepers compared with short sleepers.
“Of note, we found a steeper decline in mortality risk immediately after improving PA levels among long sleepers compared with short sleepers.”
Quote in the paperSubstantial claim
Findingown data
By using accelerometer-measured sleep duration and physical activity, our study revealed directly that the detrimental effect of short or long sleep could be fully eliminated by recommended level of moderate-to-vigorous physical activity or by a higher volume of physical activity at any intensity.
“By using accelerometer-measured sleep duration and PA, our study revealed directly that the detrimental effect of short or long sleep could be fully eliminated by recommended level of MVPA or by a higher volume of PA at any intensity.”
Quote in the paperSubstantial claim
Findingown data
We did find a significant correlation between sedentary behaviour and physical activity (Spearman's correlation: ρtotal volume of PA = -0.706, ρMVPA = -0.357).
“We analysed the association of sedentary behaviour with PA by defining sedentary as any epoch with a mean acceleration <30 mg outside the SPT window according to similar studies, 41 and did find a significant correlation between them (Spearman's correlation: ρtotal volume of PA = -0.706,ρMVPA = -0.357).”
Quote in the paperSubstantial claim
Findingown data
The majority of the detrimental associations of unusual sleep duration with mortality may be mitigated by engaging in a higher volume of physical activity or meeting the lower threshold of the WHO recommendation for moderate-to-vigorous physical activity.
“The majority of the detrimental associations of unusual sleep duration with mortality may be mitigated by engaging in a higher volume of PA or meeting the lower threshold of the WHO recommendation for MVPA.”
Quote in the paperSubstantial claim
Findingown data
This population-based cohort study suggested that physical activity and sleep duration were jointly associated with all-cause, cardiovascular disease, and cancer-caused mortality risks among middle-aged and older adults, by using objective measures.
“This population-based cohort study suggested that PA and sleep duration were jointly associated with all-cause, CVD, and cancer-caused mortality risks among middle-aged and older adults, by using objective measures.”
Quote in the paperSubstantial claim
Interpretationown data
MVPA meeting recommendations or a higher volume of PA at any intensity potentially diminished the adverse effects on all-cause and cause-specific mortality associated with short and long sleep duration.
“MVPA meeting recommendations or a higher volume of PA at any intensity potentially diminished the adverse effects on allcause and cause-specific mortality associated with short and long sleep duration.”
Quote in the paperSubstantial claim
Study design and conductown data
The results of joint analyses remained consistently significant even after multiple testing correction using the FDR method.
“The results of joint analyses remained consistently significant even after multiple testing correction using the FDR method.”
Quote in the paperSubstantial claim
Study design and conductown data
Most of the results remained robustly consistent in all the sensitivity analyses.
“However, most of the results remained robustly consistent in all the sensitivity analyses”
Quote in the paperSubstantial claim
Study design and conductown data
The independent associations remained significant after multiple testing correction using the FDR method (all FDR-adjusted P < 0.05).
“The independent associations remained significant after multiple testing correction using the FDR method (all FDR-adjusted P < 0.05).”
Quote in the paperSubstantial claim
Premisecitation
Evidence on the combined effects of physical activity and sleep duration on mortality risk has been inconclusive.
“Evidence on the combined effects of PA and sleep duration on mortality risk has been inconclusive.7,8,9,10”
Quote in the paperSubstantial claim0 of 4 sources checked
- cites [7] Bellavia, 2014, Sleep duration and survival percentiles across categories of physical activity, Am J Epidemiol source
  Not checked in the free run.
- cites [8] Wennman, 2017, Leisure time physical activity and sleep predict mortality in men irrespective of background in competitive sports, Prog Prev Med source
  Not checked in the free run.
- cites [9] Huang, 2022, Sleep and physical activity in relation to all-cause, cardiovascular disease and cancer mortality risk, Br J Sports Med source
  Not checked in the free run.
- cites [10] Duncan, 2023, Associations between aerobic and muscle-strengthening physical activity, sleep duration, and risk of all-cause mortality: a prospective cohort study of 282,473 U. S. Adults, J Sport Health Sci source
  Not checked in the free run.
Premisecitation
Time spent in physical activity and sleep is co-dependent.
“Time spent in PA and sleep is co-dependent.5”
Quote in the paperSubstantial claim0 of 1 sources checked
- cites [5] Chastin, 2021, Joint association between accelerometry-measured daily combination of time spent in physical activity, sedentary behaviour and sleep and all-cause mortality: a pooled analysis of six prospective cohorts using compositional analysis, Br J Sports Med source
  Not checked in the free run.
Premisecitation
In a cohort of former elite male athletes, Wennman H et al. observed that leisure time physical activity levels modified the associations of short sleep duration, but not long sleep duration, with all-cause mortality.
“Conversely, in a cohort of former elite male athletes, Wennman H et al. observed that leisure time PA levels modified the associations of short sleep duration, but not long sleep duration, with all-cause mortality.8”
Quote in the paperNot a substantial claim0 of 1 sources checked
- cites [8] Wennman, 2017, Leisure time physical activity and sleep predict mortality in men irrespective of background in competitive sports, Prog Prev Med source
  Not checked in the free run.
Premisecitation
Physical activity reinforces cardiorespiratory fitness.
“Instead, PA reinforces cardiorespiratory fitness, 31 inhibits inflammatory responses, 32 and improves glucose metabolism.33”
Quote in the paperNot a substantial claim0 of 1 sources checked
- cites [31] Nayor, 2021, Physical activity and fitness in the community: the Framingham Heart Study, Eur Heart J source
  Not checked in the free run.
Study design and conductcitation
An accelerometer largely offsets the recall bias occurring in the application of self-reported questionnaires.
“An accelerometer largely offsets the recall bias occurring in the application of self-reported questionnaires.11”
Quote in the paperSubstantial claim0 of 1 sources checked
- cites [11] Sabia, 2014, Association between questionnaire- and accelerometer-assessed physical activity: the role of sociodemographic factors, Am J Epidemiol source
  Not checked in the free run.
Premisecitation
Physical activity improves glucose metabolism.
“Instead, PA reinforces cardiorespiratory fitness, 31 inhibits inflammatory responses, 32 and improves glucose metabolism.33”
Quote in the paperSubstantial claim0 of 1 sources checked
- cites [33] Loh, 2020, Effects of interrupting prolonged sitting with physical activity breaks on blood glucose, insulin and triacylglycerol measures: a systematic review and meta-analysis, Sports Med source
  Not checked in the free run.
Interpretationown data
Long-term engagement in physical activity meeting recommendations combined with healthy sleep may yield greater benefits in maintaining longevity.
“Maintaining normal sleep duration is important but not sufficient; long-term engagement in PA meeting recommendations combined with healthy sleep may yield greater benefits in maintaining longevity.”
Quote in the paperSubstantial claim
Premisecitation
Previous analyses of the data from the UK Biobank suggest that the pattern of sleep and physical activity remain relatively stable over time.
“However, previous analyses of the data from the UK Biobank suggest that the pattern of sleep and PA remain relatively stable over time.37,38”
Quote in the paperSubstantial claim0 of 2 sources checked
- cites [37] Dwyer, 2015, Objectively measured daily steps and subsequent long term all-cause mortality: the Tasped prospective cohort study, PLoS One
  Not checked in the free run.
- cites [38] Fatima, 2020, Sleep trajectories and mediators of poor sleep: findings from the longitudinal analysis of 41,094 participants of the UK Biobank cohort, Sleep Med source
  Not checked in the free run.
Study design and conductown data
The proportional hazards assumption was confirmed with Schoenfeld residuals for all Cox models.
“The proportional hazards assumption was confirmed with Schoenfeld residuals for all Cox models.”
Quote in the paperSubstantial claim
Premisecitation
Unlike short sleep, long sleep may act as a surrogate marker of residual confounding due to poor health.
“However, unlike short sleep, long sleep may act as a surrogate marker of residual confounding due to poor health.35”
Quote in the paperNot a substantial claim0 of 1 sources checked
- cites [35] Boal, 2020, Shorter sleep: a new potential target to address cardiovascular and metabolic risk?, Cardiovasc Res source
  Not checked in the free run.
Premisecitation
Subjective measures likely underestimate the total amount of physical activity.
“The subjective measures likely underestimate the total amount of PA, 13 which may be attributed to the lack of consideration of light-intensity PA with an unstructured nature and dispersion during the day.14”
Quote in the paperSubstantial claim0 of 1 sources checked
- cites [13] Lee, 2014, Using accelerometers to measure physical activity in large-scale epidemiological studies: issues and challenges, Br J Sports Med source
  Not checked in the free run.
Interpretationcitation
The threshold of 150 min/week for moderate-to-vigorous physical activity also nearly approached the turning point reported by the Taiwanese cohort study (15 metabolic equivalent of task-hours per week).
“This threshold also nearly approached the turning point, as reported by the Taiwanese cohort study (15 MET-h/week).25”
Quote in the paperNot a substantial claim0 of 1 sources checked
- cites [25] Chen, 2022, 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 source
  Not checked in the free run.
Interpretationnone given
This is the first study to reveal an interactive joint association of physical activity and sleep duration, objectively measured by accelerometer, with mortality risk.
“To our knowledge, this is the first study to reveal an interactive joint association of the two time-dependent lifestyles, PA and sleep duration as objectively measured by an accelerometer, with mortality risk.”
Quote in the paperSubstantial claim
Premisecitation
Subjective sleep duration may be biased by current mental or physical health status.
“Subjective sleep duration may be biased by the current mental or physical health status.12”
Quote in the paperSubstantial claim0 of 1 sources checked
- cites [12] Jackowska, 2011, Psychosocial factors and sleep efficiency: discrepancies between subjective and objective evaluations of sleep, Psychosom Med source
  Not checked in the free run.
Premisecitation
The key limitation of previous studies is self-reported physical activity and sleep measures, commonly subject to recall and response bias.
“Notably, the key limitation of all these studies is selfreported PA and sleep measures, commonly subject to recall and response bias.11,12”
Quote in the paperSubstantial claim0 of 2 sources checked
- cites [11] Sabia, 2014, Association between questionnaire- and accelerometer-assessed physical activity: the role of sociodemographic factors, Am J Epidemiol source
  Not checked in the free run.
- cites [12] Jackowska, 2011, Psychosocial factors and sleep efficiency: discrepancies between subjective and objective evaluations of sleep, Psychosom Med source
  Not checked in the free run.
Premisecitation
In the same cohort as in the current study, Huang BH et al. found that the association of a composited sleep score that included self-reported sleep duration with all-cause and cardiovascular disease mortality risks was only partly attenuated by even the highest level of moderate-to-vigorous physical activity.
“In the same cohort as in the current study, Huang BH et al. found that the association of a composited sleep score that included self-reported sleep duration with all-cause and CVD mortality risks was only partly attenuated by even the highest level of MVPA. 9”
Quote in the paperSubstantial claim0 of 1 sources checked
- cites [9] Huang, 2022, Sleep and physical activity in relation to all-cause, cardiovascular disease and cancer mortality risk, Br J Sports Med source
  Not checked in the free run.
Interpretationown data
These findings likely support the hypothesis that the detrimental associations between long sleep duration and death might partly be compensated by prolonging the time for engaging in physical activity.
“These findings likely support the hypothesis that the detrimental associations between long sleep duration and death might partly be compensated by prolonging the time for engaging in PA.”
Quote in the paperSubstantial claim
Premisecitation
Physical activity inhibits inflammatory responses.
“Instead, PA reinforces cardiorespiratory fitness, 31 inhibits inflammatory responses, 32 and improves glucose metabolism.33”
Quote in the paperSubstantial claim0 of 1 sources checked
- cites [32] Frodermann, 2019, Exercise reduces inflammatory cell production and cardiovascular inflammation via instruction of hematopoietic progenitor cells, Nat Med source
  Not checked in the free run.
Study design and conductreasoning
Due to the observational nature of the study, the issues of residual confounding and reverse causation could not be completely ruled out.
“Third, despite careful consideration of confounding factors, due to the observational nature of the study, the issues of residual confounding and reverse causation could not be completely ruled out.”
Quote in the paperNot a substantial claim
Premisecitation
A previous analysis revealed that the exposure-outcome associations of the UK Biobank are comparable to observations from other more representative samples.
“A previous analysis, however, revealed that the exposure-outcome associations of the UK Biobank are comparable to observations from other more representative samples.43”
Quote in the paperNot a substantial claim0 of 1 sources checked
- cites [43] Batty, 2020, Comparison of risk factor associations in UK Biobank against representative, general population based studies with conventional response rates: prospective cohort study and individual participant meta-analysis, Bmj source
  Not checked in the free run.
Study design and conductnone given
Most covariates were assessed during the physical visits to the assessment centres, nearly six years before the present study baseline (date of accelerometer mail-out).
“Fourth, most covariates were assessed during the physical visits to the assessment centres, nearly six years before the present study baseline (date of accelerometer mail-out).”
Quote in the paperNot a substantial claim

May combine two claims. 14
Classified as probably not a substantial claim. 37

May combine two claims.
Findingown data
The spline analyses suggested that the maximal risk reduction was observed at about 25 mg for the total volume of PA and 150 min per week for MVPA, nearly meeting the lower threshold of the WHO recommendation for PA.
“The spline analyses suggested that the maximal risk reduction was observed at about 25 mg for the total volume of PA and 150 min per week for MVPA, nearly meeting the lower threshold of the WHO recommendation for PA.21”
Quote in the paperNot a substantial claim0 of 1 sources checked
- cites [21] Bull, 2020, World health organization 2020 guidelines on physical activity and sedentary behaviour, Br J Sports Med source
  Not checked in the free run.
May combine two claims.
Findingown data
Physical activity and sleep duration had additive and multiplicative interactions on mortality risk (P interaction <0.05).
“PA and sleep duration had additive and multiplicative interactions on mortality risk (P interaction <0.05).”
- Also stated in: § Joint associations of accelerometer-measured physical activity and sleep duration with mortality · plain
  “we found significant additive and/or multiplicative interactions of short sleep duration, the total volume of PA, and MVPA with all mortality outcomes (see Supplementary material online, eTables S8 and S9).”
- Also stated in: § Discussion · plain
  “The most striking finding was that objectively measured PA and sleep duration had significantly additive and interactive effects on mortality risks.”
Quote in the paperSubstantial claim
May combine two claims.
Findingown data
Physical activity (total volume and MVPA) and sleep duration were independently associated with mortality in a curvilinear dose-response manner.
“The associations of PA and sleep duration with mortality risk were all in a curvilinear dose-response pattern (P nonlinearity <0.001).”
- Also stated in: § Independent associations of accelerometer-measured physical activity and sleep duration with mortality · plain
  “Non-linear dose-response patterns were observed in the associations of a higher amount of total PA or MVPA with a reduced risk of all-cause, CVD, and cancer mortality (all P overall <0.001; all P nonlinearity <0.001) (Figure 1).”
- Also stated in: § Discussion · plain
  “First, accelerometer-measured PA (total volume of PA and time spent in MVPA) and sleep duration were independently associated with mortality in a curvilinear dose-response manner.”
Quote in the paperSubstantial claim
Probably not a substantial claim: may not pass S3 (load-bearing).
Findingcitation
We analysed the association of sedentary behaviour with physical activity by defining sedentary as any epoch with a mean acceleration <30 mg outside the SPT window according to similar studies.
“We analysed the association of sedentary behaviour with PA by defining sedentary as any epoch with a mean acceleration <30 mg outside the SPT window according to similar studies, 41 and did find a significant correlation between them (Spearman's correlation: ρtotal volume of PA = -0.706,ρMVPA = -0.357).”
Quote in the paperNot a substantial claim0 of 1 sources checked
- cites [41] Kandola, 2021, Impact of replacing sedentary behaviour with other movement behaviours on depression and anxiety symptoms: a prospective cohort study in the UK Biobank, BMC Med source
  Not checked in the free run.
May combine two claims.
Interpretationreasoning
Our study replicated previous observations in a much larger sample using accelerometer-measured data, which can substantially offset the pitfalls of self-reported data and provide more reliable estimates of prospective associations of sleep and PA with mortality.
“Our study replicated the previous observations in a much larger sample using .accelerometer-measured data, which can substantially offset the pitfalls of self-reported data and provide more reliable estimates of prospective associations of sleep and PA with mortality.”
Quote in the paperSubstantial claim
Probably not a substantial claim: may not pass S1 (asserted). May combine two claims.
Premisecitation
A higher level of physical activity modifies mortality risks associated with only short sleep duration, only long sleep duration, or both.
“a higher level of PA was reported to modify mortality risks associated with either only short sleep duration, 8 only long sleep duration, 7 or both.10”
Quote in the paperNot a substantial claim0 of 3 sources checked
- cites [8] Wennman, 2017, Leisure time physical activity and sleep predict mortality in men irrespective of background in competitive sports, Prog Prev Med source
  Not checked in the free run.
- cites [7] Bellavia, 2014, Sleep duration and survival percentiles across categories of physical activity, Am J Epidemiol source
  Not checked in the free run.
- cites [10] Duncan, 2023, Associations between aerobic and muscle-strengthening physical activity, sleep duration, and risk of all-cause mortality: a prospective cohort study of 282,473 U. S. Adults, J Sport Health Sci source
  Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation
Physical activity exerts short-term effects on sleep duration.
“PA is also suggested to exert short-term effects on sleep duration.6”
Quote in the paperNot a substantial claim0 of 1 sources checked
- cites [6] Wendt, 2022, Short-term effect of physical activity on sleep health: a population-based study using accelerometry, J Sport Health Sci source
  Not checked in the free run.
Classified as probably not a substantial claim.
Premisecitation
Short or long sleep duration significantly increases mortality risk in a U- or J-shaped pattern.
“mounting evidence has suggested that short or long sleep duration significantly increases mortality risk in a U-or J-shaped pattern.3,4”
Quote in the paperSubstantial claim0 of 2 sources checked
- cites [3] Liu, 2017, Sleep duration and risk of all-cause mortality: a flexible, non-linear, meta-regression of 40 prospective cohort studies, Sleep Med Rev source
  Not checked in the free run.
- cites [4] Svensson, 2021, Association of sleep duration with all- and major-cause mortality among adults in Japan, China, Singapore, and Korea, JAMA Netw Open source
  Not checked in the free run.
May combine two claims.
Interpretationown data
Our study using accelerometry offered robust evidence supporting the large body of research relying on self-reported data, showing independent associations of PA and sleep duration with mortality.
“Our study using accelerometry offered robust evidence supporting the large body of research relying on self-reported data, showing independent associations of PA and sleep duration with mortality.3,4”
Quote in the paperSubstantial claim0 of 2 sources checked
- cites [3] Liu, 2017, Sleep duration and risk of all-cause mortality: a flexible, non-linear, meta-regression of 40 prospective cohort studies, Sleep Med Rev source
  Not checked in the free run.
- cites [4] Svensson, 2021, Association of sleep duration with all- and major-cause mortality among adults in Japan, China, Singapore, and Korea, JAMA Netw Open source
  Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation
Physical activity is a beneficial factor that can reduce up to 70% risk for premature mortality.
“PA is well recognized as a beneficial factor that can reduce up to 70% risk for premature mortality.2”
Quote in the paperNot a substantial claim0 of 1 sources checked
- cites [2] Ekelund, 2019, Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: systematic review and harmonised meta-analysis, BMJ source
  Not checked in the free run.
Classified as probably not a substantial claim.
Premisecitation
Several studies exploring the additive effects of sleep duration and physical activity on mortality risk have reproduced some conflicting findings.
“To date, several studies have attempted to explore the additive effects of sleep duration and PA on mortality risk, reproducing some conflicting findings.7,8,25”
Quote in the paperSubstantial claim0 of 3 sources checked
- cites [7] Bellavia, 2014, Sleep duration and survival percentiles across categories of physical activity, Am J Epidemiol source
  Not checked in the free run.
- cites [8] Wennman, 2017, Leisure time physical activity and sleep predict mortality in men irrespective of background in competitive sports, Prog Prev Med source
  Not checked in the free run.
- cites [25] Chen, 2022, 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 source
  Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone given
Missing data of covariates (missing rate <5%) were imputed with multiple imputations by chained equations to minimize potential inferential bias.
“Missing data of covariates (missing rate <5%, Supplementary material online, eTable S3) were inputted with multiple imputations by chained equations to minimize the potential inferential.”
Quote in the paperNot a substantial claim
May combine two claims.
Interpretationreasoning
Maintaining normal sleep duration is important but not sufficient.
“Maintaining normal sleep duration is important but not sufficient; long-term engagement in PA meeting recommendations combined with healthy sleep may yield greater benefits in maintaining longevity.”
Quote in the paperSubstantial claim
Probably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation
Suggested causal links to adverse health outcomes for short sleep duration include insulin resistance.
“As for short sleep duration, the suggested causal links to adverse health outcomes included a series of pathologies including, hyperactivation of the sympathetic nervous system, 26 insulin resistance, 27 endothelial dysfunctions, 28 and inflammation.29”
Quote in the paperNot a substantial claim0 of 1 sources checked
- cites [27] Dorenbos, 2015, Sleep efficiency as a determinant of insulin sensitivity in overweight and obese adolescents, Diabetes Obes Metab source
  Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation
Several studies have attempted to explore the additive effects of sleep duration and physical activity on mortality risk.
“To date, several studies have attempted to explore the additive effects of sleep duration and PA on mortality risk, reproducing some conflicting findings.7,8,25”
Quote in the paperNot a substantial claim0 of 3 sources checked
- cites [7] Bellavia, 2014, Sleep duration and survival percentiles across categories of physical activity, Am J Epidemiol source
  Not checked in the free run.
- cites [8] Wennman, 2017, Leisure time physical activity and sleep predict mortality in men irrespective of background in competitive sports, Prog Prev Med source
  Not checked in the free run.
- cites [25] Chen, 2022, 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 source
  Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation
An earlier Swedish cohort with a 15-year follow-up demonstrated that the detrimental effects on survival associated with long sleep duration, but not short sleep duration, were most evident among individuals with low levels of physical activity.
“An earlier Swedish cohort with a 15-year follow-up demonstrated that the detrimental effects on survival associated with long sleep duration, but not short sleep duration, were most evident among individuals with low levels of PA. 7”
Quote in the paperNot a substantial claim0 of 1 sources checked
- cites [7] Bellavia, 2014, Sleep duration and survival percentiles across categories of physical activity, Am J Epidemiol source
  Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone given
The present study had a large sample size.
“The present study had some strengths, including a large sample size and the adoption of accelerometer.”
Quote in the paperNot a substantial claim
Probably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation
Exercise training effectively alleviates endothelial dysfunction triggered by sleep loss, possibly through inflammation pathways.
“Exercise training effectively alleviates endothelial Figure 3 Continued dysfunction triggered by sleep loss, possibly through inflammation pathways.34”
Quote in the paperNot a substantial claim0 of 1 sources checked
- cites [34] Sauvet, 2017, Protective effects of exercise training on endothelial dysfunction induced by total sleep deprivation in healthy subjects, Int J Cardiol source
  Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation
Suggested causal links to adverse health outcomes for short sleep duration include hyperactivation of the sympathetic nervous system.
“As for short sleep duration, the suggested causal links to adverse health outcomes included a series of pathologies including, hyperactivation of the sympathetic nervous system, 26 insulin resistance, 27 endothelial dysfunctions, 28 and inflammation.29”
Quote in the paperNot a substantial claim0 of 1 sources checked
- cites [26] Zhang, 2011, Relationship of sleep quantity and quality with 24-hour urinary catecholamines and salivary awakening cortisol in healthy middle-aged adults, Sleep source
  Not checked in the free run.
Classified as probably not a substantial claim.
Interpretationown data
Our findings support the need to encourage the maintenance of guideline-recommended physical activity levels to improve longevity, especially among individuals with extremely short or long sleep duration.
“Our findings support the need to encourage the maintenance of guideline-recommended PA levels to improve longevity, especially among individuals with extremely short or long sleep duration.”
Quote in the paperSubstantial claim
Probably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation
Another study in a Taiwan Chinese population-based cohort showed that short and long sleep duration was no longer associated with the risk of all-cause and cardiovascular disease mortality when achieving a physical activity level of 15 metabolic equivalent of task-hours per week or above.
“Another study in a Taiwan Chinese population-based cohort showed that short and long sleep duration was no longer associated with the risk of all-cause and CVD mortality when achieving a PA level of 15 metabolic equivalent of task (MET)-h/week or above.9,25”
Quote in the paperNot a substantial claim0 of 2 sources checked
- cites [9] Huang, 2022, Sleep and physical activity in relation to all-cause, cardiovascular disease and cancer mortality risk, Br J Sports Med source
  Not checked in the free run.
- cites [25] Chen, 2022, 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 source
  Not checked in the free run.
Classified as probably not a substantial claim.
Interpretationreasoning
Our findings highlight that promotions targeting both physical activity and sleep duration may be more effective in preventing or delaying premature death among the middle-aged population than solely targeting either behaviour.
“Our findings highlight that the promotions targeting both PA and sleep duration may be more effective in preventing or delaying premature death among the middle-aged population than solely targeting either behaviour.”
Quote in the paperSubstantial claim
Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.
Interpretationnone given
The inconsistent observations concerning short or long sleep duration possibly arise from heterogeneities of study populations or daily light exposure associated with the geographical location.
“The inconsistent observations concerning short or long sleep duration possibly arise from heterogeneities of study populations or daily light exposure associated with the geographical location, insufficient statistical power due to smaller sample size, or measurement bias.”
Quote in the paperNot a substantial claim
Probably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation
Suggested causal links to adverse health outcomes for short sleep duration include endothelial dysfunctions.
“As for short sleep duration, the suggested causal links to adverse health outcomes included a series of pathologies including, hyperactivation of the sympathetic nervous system, 26 insulin resistance, 27 endothelial dysfunctions, 28 and inflammation.29”
Quote in the paperNot a substantial claim0 of 1 sources checked
- cites [28] Holmer, 2021, Effects of sleep deprivation on endothelial function in adult humans: a systematic review, Geroscience source
  Not checked in the free run.
May combine two claims.
Premisecitation
Sleep deprivation significantly promotes excess energy intake and visceral obesity.
“Sleep deprivation significantly promotes excess energy intake and visceral obesity.30”
Quote in the paperNot a substantial claim0 of 1 sources checked
- cites [30] Covassin, 2022, Effects of experimental sleep restriction on energy intake, energy expenditure, and visceral obesity, J Am Coll Cardiol source
  Not checked in the free run.
Classified as probably not a substantial claim. May combine two claims.
Study design and conductnone given
Our study tested the research question in a larger population with more reliable measures of sleep duration and physical activity using an accelerometer.
“Our study testified the research question in a larger population with more reliable measures of sleep duration and PA using an accelerometer.”
Quote in the paperSubstantial claim
Probably not a substantial claim: may not pass S1 (asserted).
Premisecitation
Sufficient physical activity attenuates the mortality risk related to unhealthy sleep.
“these studies have implied that sufficient PA attenuates the mortality risk related to unhealthy sleep.”
Quote in the paperNot a substantial claim0 of 4 sources checked
- cites [7] Bellavia, 2014, Sleep duration and survival percentiles across categories of physical activity, Am J Epidemiol source
  Not checked in the free run.
- cites [8] Wennman, 2017, Leisure time physical activity and sleep predict mortality in men irrespective of background in competitive sports, Prog Prev Med source
  Not checked in the free run.
- cites [9] Huang, 2022, Sleep and physical activity in relation to all-cause, cardiovascular disease and cancer mortality risk, Br J Sports Med source
  Not checked in the free run.
- cites [10] Duncan, 2023, Associations between aerobic and muscle-strengthening physical activity, sleep duration, and risk of all-cause mortality: a prospective cohort study of 282,473 U. S. Adults, J Sport Health Sci source
  Not checked in the free run.
May combine two claims.
Study design and conductnone given
The definition of unusual sleep duration was not adjusted according to age, which may introduce a misclassification bias.
“Second, the definition of unusual sleep duration was not adjusted according to age, which may introduce a misclassification bias.”
Quote in the paperNot a substantial claim
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone given
Our study did not account for prospective changes in sleep duration and physical activity.
“First, our study did not account for prospective changes in sleep duration and PA.”
Quote in the paperNot a substantial claim
Probably not a substantial claim: may not pass S3 (load-bearing).
Interpretationnone given
The inconsistent observations concerning short or long sleep duration possibly arise from insufficient statistical power due to smaller sample size.
“The inconsistent observations concerning short or long sleep duration possibly arise from heterogeneities of study populations or daily light exposure associated with the geographical location, insufficient statistical power due to smaller sample size, or measurement bias.”
Quote in the paperNot a substantial claim
Classified as probably not a substantial claim.
Study design and conductnone given
The present study adopted an accelerometer.
“The present study had some strengths, including a large sample size and the adoption of accelerometer.”
Quote in the paperSubstantial claim
Classified as probably not a substantial claim.
Interpretationreasoning
The multiple health benefits of physical activity may potentially serve as a mechanism for attenuation or elimination of the detrimental association of short sleep duration with mortality.
“The multiple health benefits of PA may potentially serve as a mechanism for attenuation of PA or elimination of the detrimental association of short sleep duration with mortality.”
Quote in the paperSubstantial claim
Classified as probably not a substantial claim.
Premisecitation
Since physical activity and sleep are time-dependent behaviours, sleeping for extremely long durations might compromise the time available for physical activity.
“Since PA and sleep are timedependent behaviours, sleeping for extremely long durations might compromise the time available for PA.36”
Quote in the paperSubstantial claim0 of 1 sources checked
- cites [36] Cassidy, 2016, Cross-sectional study of diet, physical activity, television viewing and sleep duration in 233,110 adults from the UK Biobank; the behavioural phenotype of cardiovascular disease and type 2 diabetes, BMJ Open source
  Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitation
The distributions of normal, short, and long sleep duration in this study were similar to that in other middle-aged and older populations.
“However, the distributions of normal, short, and long sleep duration in this study were similar to that in other middle-aged and older populations.39”
Quote in the paperNot a substantial claim0 of 1 sources checked
- cites [39] Abdalla, 2020, Objective short sleep duration and 24-hour blood pressure, Int J Cardiol Hypertens source
  Not checked in the free run.
Probably not a substantial claim: may not pass S2 (checkable).
Interpretationown data
If sleep restriction or excessive time spent in bed is inevitably avoided, engaging a sufficient amount of physical activity would be considered as a practical and feasible strategy to partly compensate for the harmful effects resulting from unhealthy sleep.
“Notably, if sleep restriction or excessive time spent in bed is inevitably avoided, engaging a sufficient amount of PA would be considered as a practical and feasible strategy to partly compensate for the harmful effects resulting from unhealthy sleep.”
Quote in the paperNot a substantial claim
Probably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation
Suggested causal links to adverse health outcomes for short sleep duration include inflammation.
“As for short sleep duration, the suggested causal links to adverse health outcomes included a series of pathologies including, hyperactivation of the sympathetic nervous system, 26 insulin resistance, 27 endothelial dysfunctions, 28 and inflammation.29”
Quote in the paperNot a substantial claim0 of 1 sources checked
- cites [29] Irwin, 2016, Sleep disturbance, sleep duration, and inflammation: a systematic review and meta-analysis of cohort studies and experimental sleep deprivation, Biol Psychiatry source
  Not checked in the free run.
Classified as probably not a substantial claim. May combine two claims.
Study design and conductcitation
The total volume of physical activity was measured as the weekly average vector magnitude in milligravity units, a well-validated surrogate for global physical activity.
“The total volume of PA was measured as the weekly average vector magnitude in milligravity (mg) units (field ID 90012), which is a wellvalidated surrogate for global PA.17,18”
Quote in the paperSubstantial claim0 of 2 sources checked
- cites [17] White, 2016, Estimation of physical activity energy expenditure during free-living from wrist accelerometry in UK adults, PLoS One source
  Not checked in the free run.
- cites [18] White, 2019, Estimating energy expenditure from wrist and thigh accelerometry in free-living adults: a doubly labelled water study, Int J Obes (Lond) source
  Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Interpretationnone given
The inconsistent observations concerning short or long sleep duration possibly arise from measurement bias.
“The inconsistent observations concerning short or long sleep duration possibly arise from heterogeneities of study populations or daily light exposure associated with the geographical location, insufficient statistical power due to smaller sample size, or measurement bias.”
Quote in the paperNot a substantial claim
Classified as probably not a substantial claim.
Study design and conductreasoning
P values and 95% confidence intervals were adjusted using a false discovery rate method in the main analyses to address multiple testing issues.
“The P values and 95% confidence intervals (CIs) were further adjusted using a false discovery rate (FDR) method in the main analyses to address the multiple testing issues.”
Quote in the paperSubstantial claim
May combine two claims.
Study design and conductnone given
The sample from the UK Biobank is not representative of the population of the UK, which may limit the generalization of the current findings.
“Last, the sample from the UK Biobank is not representative of the population of the UK, which may limit the generalization of the current findings.”
Quote in the paperNot a substantial claim
Classified as probably not a substantial claim.
Study design and conductreasoning
Sedentary behaviour is not included in the current analyses due to its possible association with physical activity and sleep, which would violate the premise of Cox proportional hazards regression models.
“Fifth, sedentary behaviour is not included in the current analyses due to its possible association with PA and sleep, which would violate the premise of Cox proportional hazards regression models.”
Quote in the paperSubstantial claim
Classified as probably not a substantial claim.
Study design and conductcitation
These parameters are not investigated in the current study because accelerometer is limited in measuring parameters other than sleep/wake states.
“These parameters are not investigated in the current study because accelerometer is limited in measuring parameters other than sleep/wake states.42”
Quote in the paperSubstantial claim0 of 1 sources checked
- cites [42] Depner, 2020, Wearable technologies for developing sleep and circadian biomarkers: a summary of workshop discussions, Sleep source
  Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductreasoning
We excluded participants with baseline cardiovascular disease and cancer in the sensitivity analyses.
“Therefore, we further adjusted for prevalent illness at baseline, removed deaths in the first two years of followup, and excluded participants with baseline CVD and cancer in the sensitivity analyses.”
Quote in the paperNot a substantial claim
May combine two claims.
Premisecitation
These covariates have been proven to be stable over time, indicating that such a time lag is not likely to affect the reliability of the current findings.
“However, these covariates have been proven to be stable over time, 40 indicating that such a time lag is not likely to affect the reliability of the current findings.”
Quote in the paperNot a substantial claim0 of 1 sources checked
- cites [40] Strain, 2020, Wearable-device-measured physical activity and future health risk, Nat Med source
  Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation
Besides sleep duration, various sleep patterns and sleep behavioural issues have been found to be associated with excessive mortality risks.
“Sixth, besides sleep duration, various sleep patterns and sleep behavioural issues have been found to be associated with excessive mortality risks.9,25”
Quote in the paperNot a substantial claim0 of 2 sources checked
- cites [9] Huang, 2022, Sleep and physical activity in relation to all-cause, cardiovascular disease and cancer mortality risk, Br J Sports Med source
  Not checked in the free run.
- cites [25] Chen, 2022, 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 source
  Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductreasoning
We removed deaths in the first two years of follow-up in the sensitivity analyses.
“Therefore, we further adjusted for prevalent illness at baseline, removed deaths in the first two years of followup, and excluded participants with baseline CVD and cancer in the sensitivity analyses.”
Quote in the paperNot a substantial claim
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductreasoning
We further adjusted for prevalent illness at baseline in the sensitivity analyses.
“Therefore, we further adjusted for prevalent illness at baseline, removed deaths in the first two years of followup, and excluded participants with baseline CVD and cancer in the sensitivity analyses.”
Quote in the paperNot a substantial claim

47 of 47

The paper relies on this without support.
No prior study has examined the joint effects of physical activity and sleep duration on mortality risk using accelerometry.
“To the best of our knowledge, no study till date has examined the joint effects of PA and sleep duration on mortality risk using accelerometry.”
The paper relies on this without support.
Accelerometer measurements provide reliable and objective estimates of physical activity and sleep duration across consecutive days.
“In contrast to subjective measures, the accelerometer provides reliable and objective estimates of PA and sleep duration across consecutive days.”
The paper relies on this without support.
A 7-day accelerometer recording adequately represents habitual physical activity and sleep duration for estimating long-term mortality risk.
“A 7-day accelerometer recording was performed on 92 221 participants (age 62.4 ± 7.8 years; 56.4% women) from the UK Biobank between February 2013 and December 2015.”

3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Undertaking accelerometer-measured light-intensity physical activity at intensity levels lower than 3.0 metabolic equivalents could be an easier choice than moderate-to-vigorous intensity physical activity for enhancing health.
“Instead, undertaking accelerometer-measured light-intensity PA (LPA) at intensity levels lower than 3.0 metabolite equivalents (METs) could be an easier choice than MVPA for enhancing health.10, 11, 12”
From Accelerometer-measured physical activity, sedentary behavior, and incidence of macrovascular and microvascular events in individuals with type 2 diabetes mellitus and prediabetes (2025) · cites this paper as [11]
The Discussion (page not available in our copy) says that a higher volume of accelerometer-measured physical activity at any intensity could diminish mortality risks associated with short or long sleep. That includes light activity in principle, but the paper does not identify activity below 3.0 METs as an easier choice than MVPA or assess that comparison. (LLM, conf=0.78)
Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

All-cause mortality hazard ratio falls outside its confidence interval
Major
The reported hazard ratio of 0.67 is greater than the upper bound of its reported 95% confidence interval, 0.59. At least one of these conclusion-bearing values is wrong.
Short sleepers are described as having more prevalent cancer
Minor
Relative to normal sleepers, short sleepers had a lower, not higher, proportion with a cancer history: 12.1% versus 14.2%.
Total PA volume is defined using incompatible measures
Minor
The methods first define total PA volume as average acceleration measured in mg, then say it is formed by summing minutes of moderate and vigorous activity while retaining mg cutoffs. Those procedures do not produce the same measure.
Long sleepers are described as more likely to be obese
Minor
The comparison is with normal sleepers, but Table 1 reports obesity in 17.8% of long sleepers versus 19.1% of normal sleepers.
Proportion not meeting MVPA recommendations is reversed
Minor
The text says 39.1% did not meet the target, but Table 1 assigns 39.1% to the recommended group and 60.9% to the not-recommended group.
Spline caption specifies five knots but lists four
Minor
The Figure 1 caption says five knots were used but identifies only four percentile locations. The Figure 2 caption repeats the same description.

6 of 6

UK Biobank: An Open Access Resource for Identifying the Causes of a Wide Range of Complex Diseases of Middle and Old Age
Sudlow, C., Gallacher, J., Allen, N., Beral, V., Burton, P., Danesh, J., Downey, P., Elliott, P., Green, J., Landray, M., et al. (2015) · PLOS Medicine · doi:10.1371/journal.pmed.1001779 · Cited by 12,728 · see citing works
World Health Organization 2020 guidelines on physical activity and sedentary behaviour
Bull, F. C., Al-Ansari, S. S., Biddle, S., Borodulin, K., Buman, M. P., Cardon, G., Carty, C., Chaput, J.-P., Chastin, S., Chou, R., et al. (2020) · British Journal of Sports Medicine · doi:10.1136/bjsports-2020-102955 · Cited by 11,657 · see citing works
Sleep disturbance, sleep duration, and inflammation: A systematic review and meta-analysis of cohort studies and experimental sleep deprivation
Irwin, M. R., Olmstead, R., & Carroll, J. E. (2016) · Biological Psychiatry · doi:10.1016/j.biopsych.2015.05.014 · Cited by 2,085 · see citing works
Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: systematic review and harmonised meta-analysis
Ekelund, U., Tarp, J., Steene-Johannessen, J., Hansen, B. H., Jefferis, B., Fagerland, M. W., Whincup, P., Diaz, K. M., Hooker, S. P., Chernofsky, A., et al. (2019) · BMJ · doi:10.1136/bmj.l4570 · Cited by 1,769 · see citing works
Large Scale Population Assessment of Physical Activity Using Wrist Worn Accelerometers: The UK Biobank Study
Doherty, A., Jackson, D., Hammerla, N., Plötz, T., Olivier, P., Granat, M. H., White, T., van Hees, V. T., Trenell, M. I., Owen, C. G., et al. (2017) · PLOS ONE · doi:10.1371/journal.pone.0169649 · Cited by 1,250 · see citing works
Sleep and exercise: A reciprocal issue?
Chennaoui, M., Arnal, P. J., Sauvet, F., & Léger, D. (2014) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2014.06.008 · Cited by 724 · see citing works
Genome-wide association analyses of chronotype in 697,828 individuals provides insights into circadian rhythms
Jones, S. E., Lane, J. M., Wood, A. R., van Hees, V. T., Tyrrell, J., Beaumont, R. N., Jeffries, A. R., Dashti, H. S., Hillsdon, M., Ruth, K. S., et al. (2019) · Nature Communications · doi:10.1038/s41467-018-08259-7 · Cited by 691 · see citing works
Comparison of risk factor associations in UK Biobank against representative, general population based studies with conventional response rates: prospective cohort study and individual participant meta-analysis
Batty, G. D., Gale, C. R., Kivimäki, M., Deary, I. J., & Bell, S. (2020) · BMJ · doi:10.1136/bmj.m131 · Cited by 635 · see citing works
Using accelerometers to measure physical activity in large-scale epidemiological studies: issues and challenges
Lee, I.-M., & Shiroma, E. J. (2014) · British Journal of Sports Medicine · doi:10.1136/bjsports-2013-093154 · Cited by 415 · see citing works
Wearable-device-measured physical activity and future health risk
Strain, T., Wijndaele, K., Dempsey, P. C., Sharp, S. J., Pearce, M., Jeon, J., Lindsay, T., Wareham, N., & Brage, S. (2020) · Nature Medicine · doi:10.1038/s41591-020-1012-3 · Cited by 355 · see citing works
Sleep and physical activity in relation to all-cause, cardiovascular disease and cancer mortality risk
Huang, B.-H., Duncan, M. J., Cistulli, P. A., Nassar, N., Hamer, M., & Stamatakis, E. (2022) · British Journal of Sports Medicine · doi:10.1136/bjsports-2021-104046 · Cited by 345 · see citing works
Effects of interrupting prolonged sitting with physical activity breaks on blood glucose, insulin and triacylglycerol measures: A systematic review and meta-analysis
Loh, R., Stamatakis, E., Folkerts, D., Allgrove, J. E., & Moir, H. J. (2020) · Sports Medicine · doi:10.1007/s40279-019-01183-w · Cited by 326 · see citing works
Association Between Questionnaire- and Accelerometer-Assessed Physical Activity: The Role of Sociodemographic Factors
Sabia, S., van Hees, V. T., Shipley, M. J., Trenell, M. I., Hagger-Johnson, G., Elbaz, A., Kivimaki, M., & Singh-Manoux, A. (2014) · American Journal of Epidemiology · doi:10.1093/aje/kwt330 · Cited by 304 · see citing works
Sleep duration and risk of all-cause mortality: A flexible, non-linear, meta-regression of 40 prospective cohort studies
Liu, T.-Z., Xu, C., Rota, M., Cai, H., Zhang, C., Shi, M.-J., Yuan, R.-X., Weng, H., Meng, X.-Y., Kwong, J. S. W., et al. (2017) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2016.02.005 · Cited by 302 · see citing works
Exercise reduces inflammatory cell production and cardiovascular inflammation via instruction of hematopoietic progenitor cells
Frodermann, V., Rohde, D., Courties, G., Severe, N., Schloss, M. J., Amatullah, H., McAlpine, C. S., Cremer, S., Hoyer, F. F., Ji, F., et al. (2019) · Nature Medicine · doi:10.1038/s41591-019-0633-x · Cited by 292 · see citing works
Wearable technologies for developing sleep and circadian biomarkers: a summary of workshop discussions
Depner, C. M., Cheng, P., Devine, J. K., Khosla, S., de Zambotti, M., Robillard, R., Vakulin, A., & Drummond, S. P. A. (2019) · SLEEP · doi:10.1093/sleep/zsz254 · Cited by 245 · see citing works
Objectively Measured Daily Steps and Subsequent Long Term All-Cause Mortality: The Tasped Prospective Cohort Study
Dwyer, T., Pezic, A., Sun, C., Cochrane, J., Venn, A., Srikanth, V., Jones, G., Shook, R., Sui, X., Ortaglia, A., et al. (2015) · PLOS ONE · doi:10.1371/journal.pone.0141274 · Cited by 239 · see citing works
Cross-sectional study of diet, physical activity, television viewing and sleep duration in 233 110 adults from the UK Biobank; the behavioural phenotype of cardiovascular disease and type 2 diabetes
Cassidy, S., Chau, J. Y., Catt, M., Bauman, A. E., & Trenell, M. I. (2016) · BMJ Open · doi:10.1136/bmjopen-2015-010038 · Cited by 223 · see citing works
Association of Sleep Duration and Quality With Subclinical Atherosclerosis
Domínguez, F., Fuster, V., Fernández-Alvira, J. M., Fernández‐Friera, L., López‐Melgar, B., Blanco-Rojo, R., Fernández‐Ortíz, A., García‐Pavía, P., Sanz, J., Mendiguren, J. M., et al. (2019) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2018.10.060 · Cited by 221 · see citing works
Improving self-reports of active and sedentary behaviors in large epidemiologic studies
Matthews, C. E., Moore, S. C., George, S. M., Sampson, J., & Bowles, H. R. (2012) · Exercise and Sport Sciences Reviews · doi:10.1097/jes.0b013e31825b34a0 · Cited by 211 · see citing works
Association of Sleep Duration With All- and Major-Cause Mortality Among Adults in Japan, China, Singapore, and Korea
Svensson, T., Saito, E., Svensson, A. K., Melander, O., Orho‐Melander, M., Mimura, M., Rahman, M. S., Sawada, N., Koh, W., Shu, X., et al. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.22837 · Cited by 194 · see citing works
Psychosocial Factors and Sleep Efficiency: Discrepancies Between Subjective and Objective Evaluations of Sleep
Jackowska, M., Dockray, S., Hendrickx, H., & Steptoe, A. (2011) · Psychosomatic Medicine · doi:10.1097/psy.0b013e3182359e77 · Cited by 188 · see citing works
Accelerometer measured physical activity and the incidence of cardiovascular disease: Evidence from the UK Biobank cohort study
Ramakrishnan, R., Doherty, A., Smith-Byrne, K., Rahimi, K., Bennett, D., Woodward, M., Walmsley, R., & Dwyer, T. (2021) · PLOS Medicine · doi:10.1371/journal.pmed.1003487 · Cited by 183 · see citing works
Estimation of Physical Activity Energy Expenditure during Free-Living from Wrist Accelerometry in UK Adults
White, T., Westgate, K., Wareham, N. J., & Brage, S. (2016) · PLOS ONE · doi:10.1371/journal.pone.0167472 · Cited by 169 · see citing works
Joint association between accelerometry-measured daily combination of time spent in physical activity, sedentary behaviour and sleep and all-cause mortality: a pooled analysis of six prospective cohorts using compositional analysis
Chastin, S., McGregor, D., Palarea-Albaladejo, J., Diaz, K. M., Hagströmer, M., Hallal, P. C., van Hees, V. T., Hooker, S., Howard, V. J., Lee, I.-M., et al. (2021) · British Journal of Sports Medicine · doi:10.1136/bjsports-2020-102345 · Cited by 162 · see citing works
Estimating energy expenditure from wrist and thigh accelerometry in free-living adults: a doubly labelled water study
White, T., Westgate, K. L., Hollidge, S. E., Venables, M., Olivier, P. L., Wareham, N. J., & Brage, S. (2019) · International Journal of Obesity · doi:10.1038/s41366-019-0352-x · Cited by 158 · see citing works
Effect of exercise training for five years on all cause mortality in older adults—the Generation 100 study: randomised controlled trial
Stensvold, D., Viken, H., Steinshamn, S. L., Dalen, H., Støylen, A., Loennechen, J. P., Reitlo, L. S., Zisko, N., Bækkerud, F. H., Tari, A. R., et al. (2020) · BMJ · doi:10.1136/bmj.m3485 · Cited by 154 · see citing works
Relationship of Sleep Quantity and Quality with 24-Hour Urinary Catecholamines and Salivary Awakening Cortisol in Healthy Middle-Aged Adults
Zhang, J., Ronald, C. W., Kong, A. P. S., So, W. Y., Li, A. M., Lam, S. P., Li, S. X., Yu, M. W. M., Ho, C. S., Chan, M. H. M., et al. (2011) · SLEEP · doi:10.1093/sleep/34.2.225 · Cited by 136 · see citing works
Self-citation
Effects of Experimental Sleep Restriction on Energy Intake, Energy Expenditure, and Visceral Obesity
Covassin, N., Singh, P., McCrady-Spitzer, S. K., St Louis, E. K., Calvin, A. D., Levine, J. A., & Somers, V. K. (2022) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2022.01.038 · Cited by 125 · see citing works
Accelerometer-derived physical activity and risk of atrial fibrillation
Khurshid, S. S., Weng, L.-C. C., Al‐Alusi, M. A., Halford, J. L., Haimovich, J. S., Benjamin, E. J., Trinquart, L., Ellinor, P. T., McManus, D. D., & Lubitz, S. A. (2021) · European Heart Journal · doi:10.1093/eurheartj/ehab250 · Cited by 98 · see citing works
Impact of replacing sedentary behaviour with other movement behaviours on depression and anxiety symptoms: a prospective cohort study in the UK Biobank
Kandola, A. A., Cruz, B. D. P., Osborn, D., Stubbs, B., Choi, K. W., & Hayes, J. (2021) · BMC Medicine · doi:10.1186/s12916-021-02007-3 · Cited by 98 · see citing works
Can physical activity eliminate the mortality risk associated with poor sleep? A 15-year follow-up of 341,248 MJ cohort participants
Chen, L.-J., Hamer, M., Lai, Y.-J., Huang, B.-H., Ku, P.-W., & Stamatakis, E. (2022) · Journal of Sport and Health Science · doi:10.1016/j.jshs.2021.03.001 · Cited by 82 · see citing works
Sleep duration and survival percentiles across categories of physical activity
Bellavia, A., Akerstedt, T., Bottai, M., Wolk, A., & Orsini, N. (2014) · American Journal of Epidemiology · doi:10.1093/aje/kwt280 · Cited by 81 · see citing works
Effects of sleep deprivation on endothelial function in adult humans: a systematic review
Holmer, B. J., Lapierre, S., Jake‐Schoffman, D. E., & Christou, D. D. (2021) · GeroScience · doi:10.1007/s11357-020-00312-y · Cited by 81 · see citing works
Physical activity and fitness in the community: the Framingham Heart Study
Nayor, M., Chernofsky, A., Spartano, N. L., Tanguay, M., Blodgett, J. B., Murthy, V. L., Malhotra, R., Houstis, N. E., Velagaleti, R. S., Murabito, J. M., et al. (2021) · European Heart Journal · doi:10.1093/eurheartj/ehab580 · Cited by 78 · see citing works
Short-term effect of physical activity on sleep health: A population-based study using accelerometry
Wendt, A., da Silva, I. C. M., Gonçalves, H., Menezes, A., Barros, F., & Wehrmeister, F. (2020) · Journal of Sport and Health Science · doi:10.1016/j.jshs.2020.04.007 · Cited by 38 · see citing works
Sleep trajectories and mediators of poor sleep: findings from the longitudinal analysis of 41,094 participants of the UK Biobank cohort
Fatima, Y., Bucks, R. S., Mamun, A. A., Skinner, I., Rosenzweig, I., Leschziner, G., & Skinner, T. C. (2020) · Sleep Medicine · doi:10.1016/j.sleep.2020.10.020 · Cited by 38 · see citing works
Sleep efficiency as a determinant of insulin sensitivity in overweight and obese adolescents
Dorenbos, E., Rijks, J. H. J., Adam, T. C., Westerterp‐Plantenga, M. S., & Vreugdenhil, A. C. E. (2015) · Diabetes Obesity and Metabolism · doi:10.1111/dom.12515 · Cited by 37 · see citing works
Protective effects of exercise training on endothelial dysfunction induced by total sleep deprivation in healthy subjects
Sauvet, F., Arnal, P. J., Tardo-Dino, P. E., Drogou, C., Van Beers, P., Bougard, C., Rabat, A., Dispersyn, G., Malgoyre, A., Leger, D., et al. (2017) · International Journal of Cardiology · doi:10.1016/j.ijcard.2017.01.049 · Cited by 32 · see citing works
Leisure time physical activity and sleep predict mortality in men irrespective of background in competitive sports
Wennman, H., Kronholm, E., Heinonen, O. J., Kujala, U. M., Kaprio, J., Partonen, T., Bäckmand, H., Sarna, S., & Borodulin, K. (2017) · Progress in Preventive Medicine · doi:10.1097/pp9.0000000000000009 · Cited by 26 · see citing works
Associations between aerobic and muscle-strengthening physical activity, sleep duration, and risk of all-cause mortality: a prospective cohort study of 282,473 U. S. Adults
Duncan, M. J., Oftedal, S., Kline, C. E., Plotnikoff, R. C., & Holliday, E. G. (2023) · Journal of Sport and Health Science · doi:10.1016/j.jshs.2022.07.003 · Cited by 24 · see citing works
Objective short sleep duration and 24-hour blood pressure
Abdalla, M., Schwartz, J. E., Cornelius, T. M., Chang, B., Alcántara, C., & Shechter, A. (2020) · International Journal of Cardiology Hypertension · doi:10.1016/j.ijchy.2020.100062 · Cited by 16 · see citing works
Shorter sleep: a new potential target to address cardiovascular and metabolic risk?
Boal, A. H., Gill, J. M. R., & Sattar, N. (2020) · Cardiovascular Research · doi:10.1093/cvr/cvz330 · Cited by 5 · see citing works

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Saturation effects of the relationship between physical exercise and systemic immune inflammation index in the short-sleep population: a cross-sectional study
You, Y., Ablitip, A., Chen, Y., Ding, H., Chen, K., Cui, Y., & Ma, X. (2024) · BMC Public Health · doi:10.1186/s12889-024-19432-7 · Cited by 74 · see citing works
“These areas encompass aging process [23], metabolic health [24], cognitive performance [25–27], cardiovascular function [28–30], insulin resistance [31], mental health [32–34], mitochondrial function [31, 35], and all-cause and cause-specific mortality risks [36].”
BackgroundSelf-citation
Wearables in Chronomedicine and Interpretation of Circadian Health
Gubin, D. G., Weinert, D., Stefani, O., Otsuka, K., Borisenkov, M. F., & Cornélissen, G. (2025) · Diagnostics · doi:10.3390/diagnostics15030327 · Cited by 72 · see citing works
“Recent UK Biobank-based studies found that engaging in moderate physical activity can help reduce the negative influence of both short and long sleep duration on the risk of all-cause mortality and cardiovascular disease [265] and the effect of short sleep on the incidence of type 2 diabetes [266].”
The effects of sleep disruption on metabolism, hunger, and satiety, and the influence of psychosocial stress and exercise: A narrative review
Rogers, E. M., Banks, N. F., & Jenkins, N. D. M. (2024) · Diabetes/Metabolism Research and Reviews · doi:10.1002/dmrr.3667 · Cited by 62 · see citing works
“160 It can be hypothesised that these individuals, that is, those performing higher ‐ intensity physical activity, would have greater cardiorespiratory fitness.”
Background
Transforming the cardiometabolic disease landscape: multimodal AI-powered approaches in prevention and management
Muse, E. D., & Topol, E. J. (2024) · Cell Metabolism · doi:10.1016/j.cmet.2024.02.002 · Cited by 50 · see citing works
Associations between sleep duration, depression status, and cognitive function among Chinese elderly: A community-based study
Ding, R., Ding, P., Tian, L., Kuang, X., Huang, B., & Lin, C. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.08.200 · Cited by 43 · see citing works
Associations between actigraphy-measured sleep duration, continuity, and timing with mortality in the UK Biobank
Saint‐Maurice, P. F., Freeman, J. R., Russ, D. E., Almeida, J. S., Shams‐White, M., Patel, S., Wolff‐Hughes, D. L., Watts, E. L., Loftfield, E., Hong, H. G., et al. (2023) · SLEEP · doi:10.1093/sleep/zsad312 · Cited by 31 · see citing works
Minimum and optimal combined variations in sleep, physical activity, and nutrition in relation to all-cause mortality risk
Stamatakis, E. A., Koemel, N. A., Biswas, R. K., Ahmadi, M. N., Allman-Farinelli, M. A., Trost, S. G., Eroglu, E. I., Cruz, B. D. P., Bin, Y. S., Postnova, S., et al. (2025) · BMC Medicine · doi:10.1186/s12916-024-03833-x · Cited by 26 · see citing works
“A small number of studies have explored joint associations of pairs of these behaviours with all-cause, cardiovascular disease, and cancer mortality, for example diet and physical activity [20, 21], or sleep and physical activity [22, 23].”
Device-measured weekend catch-up sleep, mortality, and cardiovascular disease incidence in adults
Chaput, J., Biswas, R. K., Ahmadi, M. N., Cistulli, P. A., Rajaratnam, S. M. W., Hamer, M., & Stamatakis, E. A. (2024) · SLEEP · doi:10.1093/sleep/zsae135 · Cited by 25 · see citing works
Data Analytics in Physical Activity Studies With Accelerometers: Scoping Review
Liang, Y., Wang, C. I., & Hsiao, C. K. (2024) · Journal of Medical Internet Research · doi:10.2196/59497 · Cited by 25 · see citing works
Self-citation
Sleep patterns, physical activity, genetic susceptibility, and incident rheumatoid arthritis: a prospective cohort study
Ni, J., Zhou, Q., Meng, S., Zhou, T.-D., Tian, T., & Pan, H.-F. (2024) · BMC Medicine · doi:10.1186/s12916-024-03615-5 · Cited by 27 · see citing works
“In agreement with this, Liang et al. reported that both sleep duration and PA had additive and multiplicative interactions on the risk of mortality [40].”
Accelerometer-measured physical activity, sedentary behavior, and incidence of macrovascular and microvascular events in individuals with type 2 diabetes mellitus and prediabetes
Liang, Y. Y., He, Y., Huang, P., Feng, H., Li, H., Ai, S., Du, J., Xue, H., Liu, Y., Zhang, J., et al. (2025) · Journal of Sport and Health Science · doi:10.1016/j.jshs.2024.100973 · Cited by 23 · see citing works
Self-citation
Sleep duration and its association with adiposity markers in adolescence: a cross-sectional and longitudinal study
Martínez‐Gómez, J., Fernández-Alvira, J. M., de Cos-Gandoy, A., Bodega, P., de Miguel, M., Tresserra‐Rimbau, A., Santos, E. P. L., Carral, V., Carvajal, I., Estruch, R., et al. (2023) · European Journal of Preventive Cardiology · doi:10.1093/eurjpc/zwad137 · Cited by 22 · see citing works
Evaluation of Changes in Social Isolation and Loneliness with Incident Cardiovascular Events and Mortality
Chen, Y., Xue, H., Nie, Y., Zhou, Y., Ai, S., Liu, Y., Zhang, J., & Liang, Y. Y. (2024) · Journal of Epidemiology and Global Health · doi:10.1007/s44197-024-00243-3 · Cited by 18 · see citing works
Self-citation
Association of accelerometer-derived physical activity with all-cause and cause-specific mortality among individuals with cardiovascular diseases: a prospective cohort study
Cao, Z., Min, J., Hou, Y., Si, K., Wang, M., & Xu, C. (2024) · European Journal of Preventive Cardiology · doi:10.1093/eurjpc/zwae248 · Cited by 17 · see citing works
Association of Sleep Duration with Risk of All-Cause and Cause-Specific Mortality Among American Adults: A Population-Based Cohort Study
Gu, J., Wu, H., Diao, W., Ji, Y., Li, J., & Huo, J. (2024) · Nature and Science of Sleep · doi:10.2147/nss.s469638 · Cited by 14 · see citing works
“44,45 Therefore, subsequent research should investigate the interplay between sleep duration and these behavioral factors to comprehensively comprehend the intricate associations with mortality outcomes.”
Background
The Relationship between Sleep and Physical Activity by Age, Race, and Gender
McCoy, T., Sochan, A. J., & Spaeth, A. M. (2024) · Reviews in Cardiovascular Medicine · doi:10.31083/j.rcm2510378 · Cited by 13 · see citing works
“Thus, these two health behaviors appear to be mutually reinforcing and may have important interactive effects for brain [83] and cardiovascular health [84].”
Background
Combinations of physical activity, sedentary behavior and sleep and their associations with cardiovascular risk
de Moura, S. S., de Menezes-Júnior, L. A. A., Carraro, J. C. C., Machado-Coelho, G. L. L., & Meireles, A. L. (2025) · BMC Public Health · doi:10.1186/s12889-024-20829-7 · Cited by 11 · see citing works
“They concluded that both physical activity and adequate sleep duration are crucial for reducing mortality risks, highlighting the importance of balancing different movement behaviors for overall health [62].”
Physical Activity, Sleep, and Risk of Late-Onset Severe Mental Illness: A Prospective Cohort Study From UK Biobank
Zheng, X., Jiang, M., Ren, X., Han, L., Yang, P., Jia, Y., Sun, L., Wang, R., Shi, M., Zhu, Z., et al. (2024) · Schizophrenia Bulletin · doi:10.1093/schbul/sbae070 · Cited by 9 · see citing works
The chronobiology of human heart failure: clinical implications and therapeutic opportunities
Gentile, F., Emdin, M., Passino, C., Montuoro, S., Tognini, P., Floras, J. S., O'Neill, J. M., & Giannoni, A. (2024) · Heart Failure Reviews · doi:10.1007/s10741-024-10447-1 · Cited by 9 · see citing works
Association of blood cadmium and physical activity with mortality: A prospective cohort study
Chen, Y., Zhen, C., Zeng, L., Feng, H., Wang, J., Ai, Q. Y. H., Ai, S., Zhang, J., Liang, Y. Y., Xue, H., et al. (2024) · Ecotoxicology and Environmental Safety · doi:10.1016/j.ecoenv.2024.117541 · Cited by 9 · see citing works
Self-citation
Interaction between sleep duration and physical activity on mortality among cancer survivors: findings from National Health and Nutrition Examination Surveys 2007–2018
Chen, R., Han, J., Li, S., Deng, H., Jian, T., Huang, Z., Wei, Y., & Fu, Z. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2025.1532320 · Cited by 9 · see citing works
Endothelial Dysfunction in Acute Myocardial Infarction: A Complex Association With Sleep Health, Traditional Cardiovascular Risk Factors and Prognostic Markers
Hbaieb, M. A., Charfeddine, S., Driss, T., Bosquet, L., Dugué, B., Makni, A., Turki, M., Abid, L., & Hammouda, O. (2025) · Clinical Cardiology · doi:10.1002/clc.70080 · Cited by 10 · see citing works
“Additionally, a most recent study demonstrated that engaging in moderate to vigorous physical activity above the recommended threshold can mitigate the adverse effects of sleep disorders, as well as all ‐ cause and CV mortality [45].”
Device-Measured Sleep Characteristics, Daily Step Count, and Cardiometabolic Health Markers: Findings From the Prospective Physical Activity, Sitting, and Sleep (ProPASS) Consortium
Bian, W., Ahmadi, M. N., Biswas, R. K., Blodgett, J. M., Atkin, A. J., Chan, H., Cruz, B. D. P., Suorsa, K., Bakker, E. A., Pulsford, R. M., et al. (2025) · Circulation Cardiovascular Quality and Outcomes · doi:10.1161/circoutcomes.124.011873 · Cited by 9 · see citing works
“62,63”
Combined variations in sleep, physical activity, and nutrition and the risk of major adverse cardiovascular events
Koemel, N. A., Biswas, R. K., Simpson, S., Rezende, L. F. M., Wang, T., Bauman, A. E., Raubenheimer, D., Allman-Farinelli, M. A., Cistulli, P. A., Ahmadi, M. N., et al. (2026) · European Journal of Preventive Cardiology · doi:10.1093/eurjpc/zwag141 · Cited by 9 · see citing works
Joint association of sleep quality and physical activity with metabolic dysfunction-associated fatty liver disease: a population-based cross-sectional study in Western China
Wang, Y., Zhao, Q., Yang, J., Wang, Y., Deng, L., Hamulati, X., Gulijiehere, T., Mutalifu, M., Liu, F., Li, X., et al. (2024) · Nutrition and Diabetes · doi:10.1038/s41387-024-00312-3 · Cited by 8 · see citing works
Insomnia and sleep duration for kidney function: Mendelian randomization study
Zhang, Y., Zhong, Z., Tang, Z., Wang, R., Wu, J., Na, N., & Zhang, J. (2024) · Renal Failure · doi:10.1080/0886022x.2024.2387430 · Cited by 8 · see citing works
Self-citation
Associations of nighttime sleep, midday napping, and physical activity with all-cause mortality in older adults: the Seniors-ENRICA cohorts
Duarte, M. A. D. S., Martínez‐Gómez, D., Pintos‐Carrillo, S., López‐García, E., Rodríguez‐Artalejo, F., & Cabanas‐Sánchez, V. (2024) · GeroScience · doi:10.1007/s11357-024-01351-5 · Cited by 8 · see citing works
“Some inconsistencies persist with studies finding associations only for shorter nighttime sleeping durations [7] or only for longer nighttime sleeping time [8–11].”
Accelerometer-derived movement behaviours and risk of mortality among individuals with pre-existing depression: prospective cohort study
Duan, T., Cao, Z., Wang, X., Min, J., Sun, T., Hong, L., & Xu, C. (2024) · The British Journal of Psychiatry · doi:10.1192/bjp.2024.227 · Cited by 8 · see citing works
“We considered the following covariates for inclusion in the analysis as potential confounders, which have been used in previously related studies: 13,25 self-reported age, gender (female/male), ethnicity (white/other), recruitment centres, season of accelerometer wearing…”
Device‐Measured Physical Activity, Sedentary Behaviour and Risk of Chronic Kidney Diseases Across Levels of Grip Strength
He, Y., Wang, J., Zhang, W., Chen, X., Wu, Q., Li, Y., Ou, Y., Liu, Y., Feng, H., Zhang, J., et al. (2025) · Journal of Cachexia Sarcopenia and Muscle · doi:10.1002/jcsm.13726 · Cited by 9 · see citing works
Self-citation
Joint effects of physical activity and sleep quality on all-cause and cardiovascular disease mortality in stroke survivors: a population-based cohort study from the UK-Biobank
Zhu, Y., Chen, B., Qin, M., Yang, J., Hu, M. Y., Zeng, J., Fan, M., Wang, K., Liying, C., & Xu, S. (2025) · BMC Public Health · doi:10.1186/s12889-025-22588-5 · Cited by 8 · see citing works
“Our study echoes this, indicating that meeting guide-line-recommended PA levels may mitigate some health consequences of poor/intermediate sleep score in stroke survivors [23], reducing the risk of all-cause mortality by 15.1–39.8%.”
Influential
Depressive symptoms among middle-aged and older adults in China: The interaction of physical activity and sleep duration
Dong, J., Huang, J., Parisi, J. M., Zhou, Z. E., Li, M., Calderon, R., & Li, J. (2025) · Sleep Health · doi:10.1016/j.sleh.2024.12.004 · Cited by 8 · see citing works
A replicate crossover trial on the interindividual variability of sleep indices in response to acute exercise undertaken by healthy men
Yang, Y., Thackray, A. E., Shen, T., Alotaibi, T. F., Alanazi, T. M., Clifford, T., Hartescu, I., King, J. A., Roberts, M. J., Willis, S. A., et al. (2024) · SLEEP · doi:10.1093/sleep/zsae250 · Cited by 7 · see citing works
“Evidence from observational work has demonstrated that higher levels of physical activity may mitigate the elevated cardiometabolic health and mortality risk associated with poor sleep patterns [12, 13].”
Interactive effect of sleep duration, lifestyle factors and comorbidity on depressive symptoms: Insights from the China health and retirement longitudinal study
Ju, C., Huang, C., Liu, X., & Liu, J. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.01.024 · Cited by 7 · see citing works
Meeting 24-Hour Movement Guidelines and Mortality Risk in Older Adults: Cross-Sectional and Longitudinal Pooled Analysis in the Seniors-ENRICA Cohorts
Duarte, M. A. D. S., Pintos‐Carrillo, S., Hernández‐Martínez, A., López-Gil, J. F., Graciani, A., Banegas, J. R. B., Rodríguez‐Artalejo, F., Cabanas‐Sánchez, V., & Martínez‐Gómez, D. (2024) · The Journals of Gerontology Series A · doi:10.1093/gerona/glae291 · Cited by 6 · see citing works
Associations between white matter hyperintensities and physical activity: A sectional study in UK Biobank participants
Chen, Y., Yang, M. J., Huang, H., Fang, Y., Zhou, X., Yu, Z., Wang, M., Bohnet-Joschko, S., & Luo, X. (2025) · Journal of Clinical Neuroscience · doi:10.1016/j.jocn.2025.111181 · Cited by 6 · see citing works
Self-citation
Association between movement behavior patterns and cardiovascular risk among Chinese adults aged 40–75: a sex-specific latent class analysis
Chen, Y., Song, Y., Zhou, N., Wang, W., & Hong, X. (2024) · BMC Public Health · doi:10.1186/s12889-024-18573-z · Cited by 6 · see citing works
“Consistent with prior research, higher PA or recommended moderate to vigorous physical activity (MVPA) mitigated the detrimental effects of short or long sleep duration on CVD mortality risks [28].”
Self-citation
Sleeping and the risk of atrial fibrillation: a prospective study in the SUN cohort
Díaz‐Gutiérrez, J., Goñi, L., Martínez‐González, M. Á., Barón‐Esquivias, G., Bazal, P., de la Fuente‐Arrillaga, C., Barrio-López, M. T., Bes‐Rastrollo, M., & Ruiz‐Canela, M. (2025) · European Journal of Preventive Cardiology · doi:10.1093/eurjpc/zwaf377 · Cited by 5 · see citing works
Exploring the Interaction Between Sleep Patterns, Cardiac Autonomic Function, and Traditional Cardiovascular Risk Factors Following Acute Myocardial Infarction
Hbaieb, M. A., Bosquet, L., Hammouda, O., Hbaieb, R., Mezghani, I., Charfeddine, S., Abid, L., Turki, M., Driss, T., & Dugué, B. (2025) · Clinical Cardiology · doi:10.1002/clc.70183 · Cited by 5 · see citing works
“Additionally, a most recent study demonstrated that meeting the recommended threshold of MVPA can mitigate the adverse effects of both short and long sleep duration [66].”
The role of sleep in cardiovascular health and disease risk
Bian, W., Cistulli, P. A., Chaput, J., Biswas, R. K., Koemel, N. A., Ahmadi, M., & Stamatakis, E. A. (2026) · Trends in Cardiovascular Medicine · doi:10.1016/j.tcm.2026.07.001 · Cited by 5 · see citing works
Associations of objective sleep duration and physical activity with risk of heart failure: A prospective cohort study
Chen, X., Zhou, M., Wang, J., Liu, M., Zhu, C., Wu, C., Dong, M., Liu, Y., Ai, S., Feng, H., et al. (2024) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2024.08.005 · Cited by 4 · see citing works
Self-citation
The joint effects of sleep duration and exercise habit on all-cause mortality among Chinese older adult: a national community-based cohort study
Li, N., Ren, K., & Tao, Y. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2025.1538513 · Cited by 4 · see citing works
Joint association of physical activity and sleep duration with all-cause and cause-specific mortality: A prospective study of 153,866 Mexican adults.
da Silva, W. A., Christofaro, D., Martín, P. D. V., Marques, A., Peralta, M., Cristi-Montero, C., Rezende, L., Chiappa, G., & Ferrari, G. (2025) · Maturitas · doi:10.1016/j.maturitas.2025.108656 · Cited by 3 · see citing works
Effects of a structured after-school physical activity program on physical fitness, body composition, and sleep in primary school students: a pilot quasi-experimental study
Huang, G., Yao, J., Deng, L., Huang, P., Hong, P., & Li, X. (2025) · BMC Public Health · doi:10.1186/s12889-025-25843-x · Cited by 3 · see citing works
Joint association of physical activity and night sleep duration with the risk of atherosclerotic cardiovascular disease
Yang, Y., Guo, L., Li, M., Li, Z., Xiao, Y., Wang, Y., Li, Y., Deng, J., Wu, S., & Zhang, H. (2025) · Journal of Stroke and Cerebrovascular Diseases · doi:10.1016/j.jstrokecerebrovasdis.2025.108258 · Cited by 3 · see citing works
Cardiovascular Health in Black and Latino Adults With Type 2 Diabetes
McCarthy, M. M., Giudice, I. M. D., Wong, A., Fletcher, J., Dickson, V. V., & Melkus, G. D. (2024) · Nursing Research · doi:10.1097/nnr.0000000000000730 · Cited by 3 · see citing works
Association between hypertriglyceridemic-waist phenotype and circadian syndrome risk: a longitudinal cohort study
Hu, L.-K., Liu, Y.-H., Yang, K., Chen, N., Ma, L.-L., & Yan, Y.-X. (2023) · HORMONES · doi:10.1007/s42000-023-00462-6 · Cited by 2 · see citing works
Sleep patterns and long-term mortality among older Israeli adults: a population-based study
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Background
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Method
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“27 Future studies incorporating objective data are warranted to clarify the causal pathways linking sleep duration, and cardiovascular dysfunction.”
Accelerometer-Measured Physical Activity, Mediterranean Diet, and Premature Mortality and Life Expectancy Among Night Shift Workers: A UK Biobank Longitudinal Study
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Impact of Sleep Disturbances on Metabolic and Cardiovascular Risk Factors
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Sleep, Stress, and Cardiometabolic Health in Women of Childbearing Age with Overweight and Obesity
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Minimum concurrent sleep, physical activity, and nutrition variations associated with lifeSPAN and healthSPAN improvements: a population cohort studyPreprint
Koemel, N. A., Biswas, R. K., Ahmadi, M. N., Teixeira-Pinto, A. M., Hamer, M., Rezende, L. F. M., Mitchell, J. J., Leech, R. M., Sawan, M. J., Allman-Farinelli, M. A., et al. (2025) · medRxiv · doi:10.1101/2025.04.24.25326344 · Cited by 1 · see citing works
Issue 30.09. Focus on cardiac rehabilitation, exercise, and sport cardiology
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Minimum changes in sleep, physical activity, and nutrition associated with clinically important reductions in all-cause mortality risk: a prospective cohort studyPreprint
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Do not take their word for it—moving towards objective measures in sleep epidemiology
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“The relationship between sleep duration and mortality had previously been analyzed in the UK Biobank sample [11, 12].”
Background
Accelerometer-Derived Movement Behaviors and Risk of Mortality Among Individuals With Depression: A Prospective Cohort StudyPreprint
Duan, T., Cao, Z., Wang, X., Min, J., Sun, T., Luo, H., & Xu, C. (2024) · SSRN Electronic Journal · doi:10.2139/ssrn.4812481
Relationship between physical activity, sleep quality, and frailty in middle-aged and older adults: a cross-sectional study Running title: The correlation between physical activity, sleep quality, and frailtyPreprint
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Authors: Liang, Y. Y., Feng, H., Chen, Y., Jin, X., Xue, H., Zhou, M., Ma, H., Ai, S., Wing, Y.-K., Geng, Q., & Zhang, J.
Affiliations: Guangdong Academy of Medical Sciences (CN)
Guangzhou Medical University (CN)
Chinese University of Hong Kong (HK)
Jinan University (CN)
Corresponding author: Geng, Qingshan
Zhang, Jihui
ORCID: Liang, Yannis Yan
Feng, Hongliang
Chen, Yilin
Jin, Xinyi
Xue, Huachen
Zhou, Mingqing
Ma, Huan
Ai, Sizhi
Wing, Yun-Kwok
Geng, Qingshan
Zhang, Jihui
Venue: European Journal of Preventive Cardiology
Publisher: Oxford University Press (OUP)
Published: 2023-03-29
Volume: 30
Issue: 9
Pages: 832-843
ISSN: 2047-4873 (ISSN-L)
2047-4881
DOI: 10.1093/eurjpc/zwad060
OpenAlex: W4361269354
Semantic Scholar: 2409518e63bc600f512609cfa7a92113933c517b
Cited by: 102
References: 43
Citations by year: 2026: 18 · 2025: 40 · 2024: 37 · 2023: 7
FWCI: 18.02
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: other-oa
academic.oup.com/pages/standard-publication-reuse-rights (vor)
Locations: European Journal of Preventive Cardiology (publishedVersion, other-oa)
PubMed (publishedVersion)
Funders: National Key (2021YFC2501500)
National Natural Science Foundation (82101558, DFJH201811)
Topics: Health Sciences › Medicine › Physiology › Physical Activity and Health
Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
Keywords: physical activity, sleep duration, all-cause mortality, cardiovascular mortality, cancer mortality, moderate-to-vigorous physical activity, short sleep duration, long sleep, dose-response relationship, interaction effects, UK Biobank
MeSH terms: Sleep Duration, Adult, Aged, Cardiovascular Diseases, Cause of Death, Female, Humans, Male, Middle Aged, Cohort Studies, Exercise, Accelerometry

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Joint association of physical activity and sleep duration with risk of all-cause and cause-specific mortality: A population-based cohort study using accelerometry

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