Sleep and physical activity in relation to all-cause, cardiovascular disease and cancer mortality risk

Huang, Bo-Huei; Duncan, Mitch J; Cistulli, Peter A; Nassar, Natasha; Hamer, Mark; Stamatakis, Emmanuel

doi:10.1136/bjsports-2021-104046

Cited by 345Sleep and related disordersPhysical Activity and HealthCircadian rhythm and melatonin

Sleep and physical activity in relation to all-cause, cardiovascular disease and cancer mortality risk

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Huang, Bo-Huei, Duncan, Mitch J, Cistulli, Peter A, Nassar, Natasha, Hamer, Mark, Stamatakis, Emmanuel·2022·British Journal of Sports Medicine

DOI 10.1136/bjsports-2021-104046

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Abstract

OBJECTIVES: Although both physical inactivity and poor sleep are deleteriously associated with mortality, the joint effects of these two behaviours remain unknown. This study aimed to investigate the joint association of physical activity (PA) and sleep with all-cause and cause-specific mortality risks. METHODS: 380 055 participants aged 55.9 (8.1) years (55% women) from the UK Biobank were included. Baseline PA levels were categorised as high, medium, low and no moderate-to-vigorous PA (MVPA) based on current public health guidelines. We categorised sleep into healthy, intermediate and poor with an established composited sleep score of chronotype, sleep duration, insomnia, snoring and daytime sleepiness. We derived 12 PA-sleep combinations, accordingly. Mortality risks were ascertained to May 2020 for all-cause, total cardiovascular disease (CVD), CVD subtypes (coronary heart disease, haemorrhagic stroke, ischaemic stroke), as well as total cancer and lung cancer. RESULTS: After an average follow-up of 11.1 years, sleep scores showed dose-response associations with all-cause, total CVD and ischaemic stroke mortality. Compared with high PA-healthy sleep group (reference), the no MVPA-poor sleep group had the highest mortality risks for all-cause (HR (95% CIs), (1.57 (1.35 to 1.82)), total CVD (1.67 (1.27 to 2.19)), total cancer (1.45 (1.18 to 1.77)) and lung cancer (1.91 (1.30 to 2.81))). The deleterious associations of poor sleep with all outcomes, except for stroke, was amplified with lower PA. CONCLUSION: The detrimental associations of poor sleep with all-cause and cause-specific mortality risks are exacerbated by low PA, suggesting likely synergistic effects. Our study supports the need to target both behaviours in research and clinical practice.

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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”
From Joint association of physical activity and sleep duration with risk of all-cause and cause-specific mortality: A population-based cohort study using accelerometry (2023) · cites this paper as [9]
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”
From Joint association of physical activity and sleep duration with risk of all-cause and cause-specific mortality: A population-based cohort study using accelerometry (2023) · cites this paper as [9]

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Background
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
Role of sleep disorders in patients with cardiovascular disease: A systematic review
Zhang, L., Li, G., Bao, Y., & Liu, M. (2024) · International Journal of Cardiology Cardiovascular Risk and Prevention · doi:10.1016/j.ijcrp.2024.200257 · Cited by 27 · see citing works
“Poor sleep increases risk and mortality of CVD (hazard ratio (HR):1.67, 95% confidence interval (CI): 1.27 – 2.19) [-11,12].”
BackgroundInfluential
JCS 2023 Guideline on Diagnosis and Treatment of Sleep Disordered Breathing in Cardiovascular Disease
Kasai, T., Kohno, T., Shimizu, W., Ando, S., Joho, S., Osada, N., Kato, M., Kario, K., Shiina, K., Tamura, A., et al. (2024) · Circulation Journal · doi:10.1253/circj.cj-23-0489 · Cited by 25 · see citing works
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
“The stable levels of sleep and PA in both baseline and follow-up survey have been validated in existing studies [44, 45].”
Background
The associations of physical activity and lifetime depression with all-cause and cause-specific mortality: evidence from a prospective cohort study
Liu, B.-P., & Jia, C.-X. (2023) · Psychiatry Research · doi:10.1016/j.psychres.2023.115206 · Cited by 25 · see citing works
Shift work schedule and sleep patterns in relation to incident depression: Evidence from a prospective cohort study
Liu, B.-P., & Jia, C.-X. (2023) · Psychiatry Research · doi:10.1016/j.psychres.2023.115076 · Cited by 24 · see citing works
Sleep disturbances are associated with anxiety, depression, and decreased quality of life in patients with coronary heart disease
Zheng, D., Tan, R.-J., Liu, W. Y., Song, P.-C., & Li, F.-D. (2023) · World Journal of Psychiatry · doi:10.5498/wjp.v13.i10.732 · Cited by 22 · see citing works
Bidirectional associations of sleep and discretionary screen time in adults: Longitudinal analysis of the UK biobank
Sampasa‐Kanyinga, H., Chaput, J., Huang, B., Duncan, M. J., Hamer, M., & Stamatakis, E. A. (2022) · Journal of Sleep Research · doi:10.1111/jsr.13727 · Cited by 17 · see citing works
The effects of dexmedetomidine for patient-controlled analgesia on postoperative sleep quality and gastrointestinal motility function after surgery: A prospective, randomized, double-blind, and controlled trial
Sui, X., Wang, Y., Jin, M., Li, K., Jiang, G., Song, A., He, Z., Yin, C., Zhao, J., Wang, L., et al. (2022) · Frontiers in Pharmacology · doi:10.3389/fphar.2022.990358 · Cited by 19 · see citing works
“Poor sleep quality increases the incidence of postoperative delirium and postoperative cognitive dysfunction, increases the incidence of cardiovascular events and delays the postoperative recovery process (Aldecoa et al., 2017; Huang et al., 2021).”
Background
Sleep and risk of hypertension in general American adults: the National Health and Nutrition Examination Surveys (2015–2018)
Li, C., Shang, S., & Liang, W. (2022) · Journal of Hypertension · doi:10.1097/hjh.0000000000003299 · Cited by 18 · see citing works
“A cardiovascular disease study based on two large cohorts proposed taking into account the overall complexity of sleep and integrating multiple sleep factors (including chronotype, sleepduration, insomnia, snoring, and daytime sleepiness) into a single sleep measurement (definedasa ‘‘sleeppattern’’) [11], indicated th…”
Background
Association between metabolically healthy obesity and risk of atrial fibrillation: taking physical activity into consideration
Wang, R., Olier, I., Ortega‐Martorell, S., Liu, Y., Ye, Z., Lip, G. Y. H., & Li, G. (2022) · Cardiovascular Diabetology · doi:10.1186/s12933-022-01644-z · Cited by 18 · see citing works
“PA information, including the frequency and duration of activities, was collected at baseline with the short form International Physical Activity Questionnaire (IPAQ) [26].”
BackgroundMethod
Association between Physical Activity and 32 Chronic Conditions among Spanish Adults
Sánchez, G. F. L., Mendiola, J., & Torres-Cantero, A. M. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192013596 · Cited by 18 · see citing works
Prevalence and association of sleep duration and different volumes of physical activity with type 2 diabetes: the first evidence from CHARLS
Zhou, Z., & Tian, X. (2024) · BMC Public Health · doi:10.1186/s12889-024-20743-y · Cited by 17 · see citing works
Within-Person Temporal Associations Among Self-Reported Physical Activity, Sleep, and Well-Being in College Students
McGowan, A. L., Boyd, Z. M., Kang, Y., Bennett, L., Mucha, P. J., Ochsner, K. N., Bassett, D. S., Falk, E. B., & Lydon‐Staley, D. M. (2022) · Psychosomatic Medicine · doi:10.1097/psy.0000000000001159 · Cited by 18 · see citing works
“cal activity at or above recommended levels mitigates the detrimental effects of poor sleep on well-being (79), and a single bout of physical activity increases neuroelectrical indices of relaxation in individuals”
Background
Development of a 24-hour movement behaviors questionnaire (24HMBQ) for Chinese college students: validity and reliability testing
Zheng, J., Tan, T. C., Zheng, K., & Huang, T. (2023) · BMC Public Health · doi:10.1186/s12889-023-15393-5 · Cited by 17 · see citing works
Physical activity and sleep pattern in relation to incident Parkinson’s disease: a cohort study
Chen, L., Sun, S., Li, G., Gao, X., Luo, W., Tian, H., Zhang, X., Yin, X., Liu, Z., Chen, G., et al. (2024) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-024-01568-9 · Cited by 17 · see citing works
“For sleep pattern, a sleep score including five sleep characteristics was applied based on previous studies [25, 26].”
Method
Sleep and liver function biomarkers in relation to risk of incident liver cancer: a nationwide prospective cohort study
Song, J., Fan, L., Shi, D., Lai, X., Wang, H., Liu, W., Yu, L., Liang, R., Zhang, Y., Wan, S., et al. (2024) · BMC Medicine · doi:10.1186/s12916-024-03440-w · Cited by 17 · see citing works
“The sleep score was obtained by summing up the 5 independent sleep traits, and all participants were subsequently categorized into two sleep groups accordingly: “healthy sleep” (sleep score ≥ 4) and “unhealthy sleep” (sleep score 0 ~ 3) [20–22].”
Method
Exercise-mediated modulation of autonomic nervous system and inflammatory response in sleep-deprived individuals: A narrative reviews of implications for cardiovascular health
Saputro, R. E., Chou, C., Lin, Y.-Y., Tarumi, T., & Liao, Y. (2025) · Autonomic Neuroscience · doi:10.1016/j.autneu.2025.103256 · Cited by 16 · see citing works
Associations of metabolic syndrome with depression are mediated by inflammation and oxidative stress: Findings from NHANES 2005–2018
Li, M., & Zhai, Z. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.119470 · Cited by 15 · see citing works
The association between electronic cigarettes, sleep duration, and the adverse cardiovascular outcomes: Findings from behavioral risk factor surveillance system, 2020
Liu, X., Yuan, Z., & Ji, Y. (2022) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2022.909383 · Cited by 15 · see citing works
Mechanism of the association between sleep quality and mortality in middle-aged and older adults: A prospective study analysis of the UK Biobank
Hu, W., Han, Q., Chu, J., Sun, N., Li, T., Feng, Z., He, Q., Ma, Z., Wang, Y., & Shen, Y. (2023) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2023.105051 · Cited by 15 · see citing works
Relationship between metabolic status, physical activity and cardiovascular disease in participants with obesity
Liu, Y., Zhao, A., Sun, G., Wang, R., Zhang, J., Lip, G. Y. H., & Li, G. (2024) · International Journal of Obesity · doi:10.1038/s41366-024-01469-8 · Cited by 15 · see citing works
Sleep Patterns and Traditional Cardiovascular Health Metrics: Joint Impact on Major Adverse Cardiovascular Events in a Prospective Cohort Study
You, S., Zhang, H.-F., Zhang, S.-L., Gao, Q.-Y., Cai, Y.-W., Huang, Z.-G., Wu, Y.-B., Chen, Y.-X., Wang, J.-F., Gao, J.-W., et al. (2024) · Journal of the American Heart Association : Cardiovascular and Cerebrovascular Disease · doi:10.1161/jaha.123.033043 · Cited by 11 · see citing works
“38,39 These findings can be partially explained by the close relationship between sleep behaviors and lifestyle factors.”
Background
Association between Lifestyle Modification and All-Cause, Cardiovascular, and Premature Mortality in Individuals with Non-Alcoholic Fatty Liver Disease
Huang, Y., Xu, J., Yang, Y., Wan, T., Wang, H., & Li, X. (2024) · Nutrients · doi:10.3390/nu16132063 · Cited by 15 · see citing works
“As an emerging lifestyle, the increased risk of cardiovascular death from inadequate sleep duration has been demonstrated in multiple cohorts [29,30], and maintaining a healthy sleep duration reduced the risk of all-cause mortality from NAFLD by 36%.”
Background
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
Distinct sleep disturbance and cognitive dysfunction profiles in oncology outpatients receiving chemotherapy
Huang, V., Mackin, L. A., Kober, K. M., Paul, S. M., Cooper, B. A., Conley, Y. P., Hammer, M. J., Levine, J. D., & Miaskowski, C. A. (2022) · Supportive Care in Cancer · doi:10.1007/s00520-022-07350-6 · Cited by 14 · see citing works
Diurnal patterns of accelerometer-measured physical activity and sleep and risk of all-cause mortality: a follow-up of the National Health and Nutrition Examination Surveys (NHANES)
Zhang, Y., Mika Kivimaki, B., Carrillo-Larco, R. M., Cheng, Y., Zhou, Y., Wang, H., Yuan, C., & Xu, X. (2024) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-024-01673-9 · Cited by 14 · see citing works
“The observed joint associations of PA and sleep with cognitive decline and all-cause, CVD and cancer mortality [21, 22] support this hypothesis.”
Background
Interactive Associations between Physical Activity and Sleep Duration in Relation to Adolescent Academic Achievement
Brown, D. M. Y., Porter, C. D., Hamilton, F., Almanza, F., Narvid, C., Pish, M., & Arizabalo, D. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192315604 · Cited by 14 · see citing works
“We hypothesized that we would observe: (1) a positive linear relationship between physical activity and academic achievement [29]; (2) an inverted-U relationship between sleep and academic achievement with optimal grades occurring at the public health recommended range of 8–10 h of sleep each night [30]; and (3) based…”
Background
Reduced left hippocampal perfusion is associated with insomnia in patients with cerebral small vessel disease
Yan, W., Hou, D., Li, Z., Tang, W., Han, X., & Tang, Y. (2023) · CNS Spectrums · doi:10.1017/s1092852923002250 · Cited by 13 · see citing works
Hypoxia Induces Alterations in the Circadian Rhythm in Patients with Chronic Respiratory Diseases
Castillejos-López, M. D. J., Romero, Y., Varela-Ordoñez, A., Flores‐Soto, E., Romero-Martínez, B. S., Velázquez‐Cruz, R., Vázquez-Pérez, J. A., Ruiz, V., Gómez-Verján, J. C., Rivero-Segura, N. A., et al. (2023) · Cells · doi:10.3390/cells12232724 · Cited by 13 · see citing works
Health and Economic Value of Eliminating Socioeconomic Disparities in US Youth Physical Activity
Powell‐Wiley, T. M., Martinez, M. F., Heneghan, J. L., Weatherwax, C., Baah, F. O., Velmurugan, K., Chin, K. L., Ayers, C. R., Cintron, M., Ortiz-Whittingham, L. R., et al. (2024) · JAMA Health Forum · doi:10.1001/jamahealthforum.2024.0088 · Cited by 13 · see citing works
Traumatic brain injury persistently increases the incidence of both ischemic and hemorrhagic strokes: Potential mechanisms
Barbour, M. A., Whitehead, B. J., Gumbo, C. T., Karelina, K., & Weil, Z. M. (2025) · Progress in Neurobiology · doi:10.1016/j.pneurobio.2025.102749 · Cited by 12 · see citing works
Effects of different Chinese traditional exercises on sleep quality and mental health of adults: systematic review and meta-analysis
Dong, J., Wang, D., Li, H., & Ni, H. (2023) · Sleep And Breathing · doi:10.1007/s11325-023-02881-6 · Cited by 12 · see citing works
Sleep, physical activity, and sedentary behaviors in relation to overall cancer and site-specific cancer risk: A prospective cohort study
Zhang, R., Lu, Y., Bian, Z., Zhou, S., Xu, L., Jiang, F., Yuan, S., Tan, X., Chen, X., Ding, Y., et al. (2024) · iScience · doi:10.1016/j.isci.2024.109931 · Cited by 12 · see citing works
Validation of intrinsic capacity and healthy sleep pattern in middle-aged and older adults: a longitudinal Chinese study assessing healthy ageing
Chen, X.-L., Li, J., Sun, S., Zhang, X., Chen, J., Wang, L., Yang, Z.-Q., Ni, S.-H., & Lu, L. (2024) · The journal of nutrition health & aging · doi:10.1016/j.jnha.2024.100365 · Cited by 14 · see citing works
Intranasal Dexmedetomidine for the Management of Preoperative Anxiety-Related Insomnia: A Randomized, Three-Blinded, Clinical Trial Compared with Lorazepam and Placebo
Yang, W., Huang, K.-T., Lin, Z.-J., Zeng, W., Liu, X., Liu, H.-B., Zhong, M., Wei, J., Liang, W., Wang, L.-F., et al. (2024) · Drug Design Development and Therapy · doi:10.2147/dddt.s487463 · Cited by 15 · see citing works
Development and validation of a novel screening tool for osteoporosis in older US adults: The NHANES cross-sectional study
Tang, Y., Liu, Z., Wang, S., Yi, Q., Xia, Y., & Geng, B. (2022) · Endocrine · doi:10.1007/s12020-022-03001-2 · Cited by 12 · see citing works
“Twelve candidate predictors selected included: age (continuity variable; years); sex (categorical variable; male or female); race (categorical variable; Mexican American, other Hispanic, non-Hispanic white, non-Hispanic black, or other races); body mass index (BMI; categorical variable; normal: <25 kg/m2, overweight:…”
Method
Physical, Mental, and Health Empowerment Disparities Across Chronic Obstructive Pulmonary Disease, Asthma, and Combined Groups and the Moderating Role of eHealth Literacy: Cross-Sectional Study
Li, J., Wu, X., Wu, Y., Fong, D., Song, Y., Xu, S., Kim, C., Lin, X., & Pandian, V. (2025) · Journal of Medical Internet Research · doi:10.2196/70822 · Cited by 11 · see citing works
“For each activity level, METs were multiplied by the average daily duration and the number of days per week, and total weekly MET minutes were calculated [29].”
Associations Among Sleep Duration, Sleep Quality, and Age-Related Ocular Diseases: Insights From Longitudinal and Mediation Analyses
Huang, Z., Chen, C., Meng, J., Liu, S., Zhang, K., Du, Y., & Zhu, X. (2025) · Investigative Ophthalmology & Visual Science · doi:10.1167/iovs.66.11.15 · Cited by 11 · see citing works
Relationship between diet-related inflammation and bone health under different levels of body mass index
Zeng, G., Chen, X., Jiang, Z., Lin, J., Wu, Y., & Wei, J. (2023) · Journal of Orthopaedic Surgery and Research · doi:10.1186/s13018-022-03481-y · Cited by 11 · see citing works
“PA < 600 METmins/week was defined as low, 600-1200MET-mins/ week as medium and ≥ 1200 MET-mins/week as high [29].”
Background
Rest–activity rhythm as a clinical biomarker: what are the next steps?
Brito, L. C., & Thosar, S. S. (2023) · The Lancet Healthy Longevity · doi:10.1016/s2666-7568(23)00065-x · Cited by 11 · see citing works
“9 Despite its potential for widespread use and its importance for clinical practice and public health, the development of rest–activity rhythm amplitude as a clinical biomarker is still in the early stages.”
Background
Associations of sleep disorders with all-cause and cause-specific mortality in cancer survivors: a cross-sectional analysis of the NHANES 2005–2016
Nong, J., Tong, J., Wang, R., Shi, K., & Zhang, Y. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-05589-3 · Cited by 11 · see citing works
“For the general population, a study of 380,055 general participants from the UK Biobank demonstrated that poor sleep was associated with increased risk for total cancer mortality [9].”
Background
Association of methyl donor nutrients dietary intake and sleep disorders in the elderly revealed by the intestinal microbiome
Chen, Q., Fan, R., Song, L., Wang, S., You, M., Cai, M., Wu, Y., Li, Y., & Xu, M. (2024) · Food & Function · doi:10.1039/d4fo01303d · Cited by 12 · see citing works
Depressive symptoms mediate the association between dietary inflammatory index and sleep: A cross-sectional study of NHANES 2005–2014
Ren, R., Huang, R., Li, Y., Wang, W., Ye, X., Li, X., Zhang, R., Peng, Y., & Wang, D. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.12.020 · Cited by 11 · see citing works
Association between physical activity, trouble sleeping, and obesity among older Americans: a cross-sectional study based on NHANES data from 2007 to 2018
Hou, X., Wang, H.-H., Yang, Z., Jia, Y., Lv, Y., & Dong, X. (2025) · BMC Geriatrics · doi:10.1186/s12877-025-05832-w · Cited by 11 · see citing works
“Total weekly energy expenditure was calculated by multiplying the MET value by the number of PA minutes per week (MET-minutes/week) [45].”
Self-Reported Sleep Disturbance is an Independent Predictor of All-Cause Mortality and Respiratory Disease Mortality in US Adults: A Population-Based Prospective Cohort Study
Hou, X., Hu, J., Wang, E., Wang, J., Song, Z., Hu, J. H., Shi, J., & Zhang, C. (2023) · International Journal of Public Health · doi:10.3389/ijph.2023.1605538 · Cited by 12 · see citing works
Causal associations of sleep traits with cancer incidence and mortality
Tian, S., Huangfu, L., Bao, Y., Ai, S., Chang, S., Wang, Q., Zhu, X., Yan, W., Shi, J., Shi, L., et al. (2023) · Frontiers in Genetics · doi:10.3389/fgene.2023.1309069 · Cited by 11 · see citing works
Age Differences in the Association of Sleep Duration Trajectory With Cancer Risk and Cancer-Specific Mortality: Prospective Cohort Study
Liu, C., Zhang, Q., Liu, C., Liu, T., Song, M., Zhang, Q., Xie, H., Lin, S., Ren, J., Chen, Y., et al. (2024) · JMIR Public Health and Surveillance · doi:10.2196/50836 · Cited by 11 · see citing works
“For subgroup analysis, previously reported potential modifiers, such as snoring, sex [19], BMI [20], and regular physical exercise [21], were selected.”
Post-Operative Poor Sleep Quality and Its Associated Factors Among Non-Small Cell Lung Cancer Patients: A Cross-Sectional Study
Chen, X., Hu, Y., Fan, J., & Li, Y. (2023) · Cancer Management and Research · doi:10.2147/cmar.s430436 · Cited by 10 · see citing works
“42 Therefore, an accurate assessment of factors leading to poor post-operative sleep quality is crucial for risk stratification and planning of post-operative care of NSCLC patients.”
Background
The association between physical activity and sleep in adult ADHD patients with stimulant medication use
Zhu, F., Liu, B., Kuang, D., Zhu, X., Bi, X., Song, Y., Quan, T., Yang, Y., & Ren, Y. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1236636 · Cited by 11 · see citing works
Association between healthy lifestyle on life course and multimorbidity in adults: results from two national prospective cohort studies
Ye, X., Liang, M., Chen, Z., Jiang, X., Xie, M., Xie, X., Lan, G., Lu, X., Huang, Z., Xu, T., et al. (2024) · BMC Public Health · doi:10.1186/s12889-024-20443-7 · Cited by 13 · see citing works
“Low PA exacerbated the harmful association of sleep deprivation with the risk of all-cause and cause-specific mortality [31].”
Background
Combined healthy lifestyle behaviors and all-cause mortality risk in middle-aged and older US adults: A longitudinal cohort study
Qiao, L., Wang, Y., Deng, Y., Peng, J., Li, Y., Li, M., & Tang, Z. (2024) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2024.105702 · Cited by 10 · see citing works
A Closer Look at Paediatric Sleep: Sleep Health and Sleep Behavioural Disorders in Children and Adolescents
Meneo, D., Gavriloff, D., Cerolini, S., Baldi, E., Schlarb, A. A., Nobili, L., & Baglioni, C. (2025) · Journal of Sleep Research · doi:10.1111/jsr.70078 · Cited by 13 · see citing works
“…between poor sleep health and disordered eating behaviours (e.g., Cerolini 2023; da Luz et al. 2023; Degasperi et al. 2024), (e) studies documenting the relationship between sleep duration or eating patterns and physical activity/sedentary activity (e.g., Huang et al. 2022; Keane et al. 2017).”
Physical activity and sleep moderate the relationship between stress and screen time in college-aged adults
Chandler, M. C., Ellison, O. K., McGowan, A. L., Fenn, K. M., & Pontifex, M. B. (2022) · Journal of American College Health · doi:10.1080/07448481.2022.2077110 · Cited by 10 · see citing works
Association Between Bedroom Light Pollution With Subjectively and Objectively Measured Sleep Parameters Among Chinese Young Adults
Xu, Y.-X., Huang, Y., Zhou, Y., Wan, Y., Su, P., Tao, F., & Sun, Y. (2023) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2023.08.010 · Cited by 10 · see citing works
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
Influence of Regular Physical Activity on Sleep
McGranahan, M. J., & O’Connor, P. J. (2024) · Current topics in behavioral neurosciences · doi:10.1007/7854_2024_503 · Cited by 11 · see citing works
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
Sleep duration and quality, physical activity and cardiometabolic multimorbidity: findings from the English Longitudinal study of Ageing
Kunutsor, S. K., & Laukkanen, J. A. (2025) · Scandinavian Cardiovascular Journal · doi:10.1080/14017431.2025.2550279 · Cited by 9 · see citing works
“Emerging evidence suggests that physical activity may mitigate the adverse effects of common cardiovascular risk factors, including poor sleep patterns [20].”
Physical activity and sleep quality among Chinese college students: the serial mediating roles of anxiety and depression
Zhang, Z., Liu, Z., Lin, Y., Guo, M., Xu, X., & Peng, L. H. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1635406 · Cited by 9 · see citing works
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
Association of baseline Life’s Essential 8 score and trajectories with carotid intima-media thickness
Liu, Q., Cui, H., Chen, S., Zhang, D., Huang, W. C., & Wu, S. (2023) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1186880 · Cited by 9 · see citing works
“Due to the role of sleep health in cardiometabolic health and health outcomes, sleep health was added as a new component of LE8 (26, 27).”
Background
The Causal Association Between Blood Lead and Sleep Disorders: Evidence from National Health and Nutrition Examination Survey and Mendelian Randomization Analysis
Chen, S., Zhang, M., Zhang, W., Shao, X., Yang, X., Yang, Z. G., & Nan, K. (2024) · Journal of Epidemiology and Global Health · doi:10.1007/s44197-024-00199-4 · Cited by 9 · see citing works
“Nonetheless, poor sleep has become a worldwide public health issue in today’s society [3–5].”
Background
Night shift work, genetic risk, and the risk of depression: A prospective cohort study
Chen, Y., Yang, H., Zhang, Y., Zhou, L., Lin, J., & Wang, Y. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.03.134 · Cited by 9 · see citing works
Associations of light exposure patterns with sleep among Dutch children: The ABCD cohort study
Stefanopoulou, M., Ruhé, N., Portengen, L., van Wel, L., Vrijkotte, T. G. M., Vermeulen, R. C. H., & Huss, A. (2024) · Journal of Sleep Research · doi:10.1111/jsr.14184 · Cited by 8 · see citing works
“Sleep problems have been associated with, for example, obesity (Mercy et al., 2022), cardiovascular disease (Huang et al., 2022), cancer (Peeri et al., 2022), and depressive or anxiety symptoms (Joo et al., 2022; Oakes et al., 2022).”
Sleep duration and leisure activities are involved in regulating the association of depressive symptoms, muscle strength, physical function and mild cognitive impairment
Chen, L., Li, D., Tang, K., Li, Z., & Huang, X. (2024) · Heliyon · doi:10.1016/j.heliyon.2024.e33832 · Cited by 8 · 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
Examining the factor structure of the Pittsburgh Sleep Quality Index and its determinants among GI cancer patients
Sohrabi, M., Gholami, A., Hassanzadeh, P., Hatami, S., Ajdarkosh, H., Zamani, F., & Doustmohammadian, A. (2024) · BMC Cancer · doi:10.1186/s12885-024-13347-7 · Cited by 8 · see citing works
Multidimensional sleep impairment predicts steatotic liver disease spectrum risk
Wang, D., Zhang, X. L., Cai, Y., Dong, H., & Zhang, Y. (2025) · Scientific Reports · doi:10.1038/s41598-025-95336-9 · Cited by 8 · see citing works
Sleep deprivation-induced sympathetic activation promotes pro-tumoral macrophage phenotype via the ADRB2/KLF4 pathway to facilitate NSCLC metastasis
Yin, S., Wang, J., Jia, Y., Wang, X., Zhao, Y., Liu, T., Lv, W., Duan, Y., Song, Z., Wang, S., et al. (2025) · iScience · doi:10.1016/j.isci.2025.112321 · Cited by 8 · see citing works

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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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
Can physical activity eliminate the mortality risk associated with poor sleep? A 15-year follow-up of 341,248 MJ Cohort participant
Chen, L.-J., Hamer, M., Lai, Y.-J., Huang, B.-H., Ku, P., & Stamatakis, E. A. (2021) · UCL Discovery (University College London)
Joint association of physical activity and sleep duration with all-cause and cause-specific mortality: A prospective study of 153,866 Mexican adults.
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Authors: Huang, B.-H., Duncan, M. J., Cistulli, P. A., Nassar, N., Hamer, M., & Stamatakis, E.
Affiliations: The University of Sydney (AU)
University of Newcastle Australia (AU)
University College London (GB)
Corresponding author: Stamatakis, Emmanuel
ORCID: Huang, Bo-Huei
Duncan, Mitch J
Cistulli, Peter A
Nassar, Natasha
Hamer, Mark
Stamatakis, Emmanuel
Venue: British Journal of Sports Medicine
Publisher: BMJ
Published: 2021-06-29
Volume: 56
Issue: 13
Pages: 718-724
ISSN: 0306-3674 (ISSN-L)
1473-0480
DOI: 10.1136/bjsports-2021-104046
OpenAlex: W3173761420
Cited by: 345
References: 33
Citations by year: 2026: 57 · 2025: 111 · 2024: 87 · 2023: 52 · 2022: 36 · 2021: 2
FWCI: 42.77
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: other-oa
Locations: British Journal of Sports Medicine (publishedVersion, other-oa)
PubMed (publishedVersion)
UCL Discovery (University College London) (submittedVersion)
NOVA (University of Newcastle Australia) (submittedVersion)
Funders: National Health and Medical Research Council (APP1141606, APP1194510)
Topics: Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Health Sciences › Medicine › Physiology › Physical Activity and Health
Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
Keywords: sleep, physical activity, all-cause mortality, cardiovascular mortality, cancer mortality, lung cancer, ischemic stroke, coronary artery disease, hemorrhagic stroke, moderate-to-vigorous physical activity, insomnia, snoring, daytime sleepiness, chronotype, sleep duration, synergistic effect, older adults
MeSH terms: Ischemic Stroke, Cardiovascular Diseases, Brain Ischemia, Female, Humans, Sleep Initiation and Maintenance Disorders, Lung Neoplasms, Male, Prospective Studies, Risk Factors, Sleep, Exercise, Stroke

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