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

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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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Poor sleep is really bad for your health. But we found exercise can offset some of these harms
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Clinically meaningful combined improvements of sleep, physical activity, and nutrition (SPAN) in relation to major adverse cardiovascular eventsPreprint
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Sleep deprivation enhances self-protective behavior after negative social feedback
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Additional file 2 of Sleep quality and influencing factors and correlation with T-lymphocyte subpopulation counts in patients with pulmonary tuberculosis: a cross-sectional study
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Additional file 2 of Associations of sleep disorders with all-cause and cause-specific mortality in cancer survivors: a cross-sectional analysis of the NHANES 2005–2016
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Additional file 8 of Association of depressive symptoms and sleep disturbances with survival among US adult cancer survivors
Lan, A., Li, H., Shen, M., Li, D., Shu, D., Liu, Y., Tang, H., Li, K., Peng, Y., & Liu, S. (2024) · Figshare · doi:10.6084/m9.figshare.26729752
Additional file 1 of 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) · Figshare · doi:10.6084/m9.figshare.26680073
Additional file 2 of Association of depressive symptoms and sleep disturbances with survival among US adult cancer survivors
Lan, A., Li, H., Shen, M., Li, D., Shu, D., Liu, Y., Tang, H., Li, K., Peng, Y., & Liu, S. (2024) · Figshare · doi:10.6084/m9.figshare.25971794
Additional file 1 of Sleep quality and influencing factors and correlation with T-lymphocyte subpopulation counts in patients with pulmonary tuberculosis: a cross-sectional study
Zhang, H., Li, A., Jiang, Y., Chen, W., Wang, J., Zhang, P., Deng, G., Wang, W., Chen, J., & Lin, Y. (2023) · Figshare · doi:10.6084/m9.figshare.22611583
Additional file 4 of Association of depressive symptoms and sleep disturbances with survival among US adult cancer survivors
Lan, A., Li, H., Shen, M., Li, D., Shu, D., Liu, Y., Tang, H., Li, K., Peng, Y., & Liu, S. (2024) · Figshare · doi:10.6084/m9.figshare.26729740
Additional file 1 of 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) · Figshare · doi:10.6084/m9.figshare.26094340
Additional file 1 of Association of depressive symptoms and sleep disturbances with survival among US adult cancer survivors
Lan, A., Li, H., Shen, M., Li, D., Shu, D., Liu, Y., Tang, H., Li, K., Peng, Y., & Liu, S. (2024) · Figshare · doi:10.6084/m9.figshare.25971715
Additional file 1 of Assoication between self-reported sleep duration, physcial activity and the risk of all cause and cardiovascular diseases mortality from the NHANES database
Wang, W., Yang, J., Wang, K., Niu, J., Wang, J., Luo, Z., Liu, H., Chen, X., & Ge, H. (2023) · Figshare · doi:10.6084/m9.figshare.24159456
Additional file 5 of Association of depressive symptoms and sleep disturbances with survival among US adult cancer survivors
Lan, A., Li, H., Shen, M., Li, D., Shu, D., Liu, Y., Tang, H., Li, K., Peng, Y., & Liu, S. (2024) · Figshare · doi:10.6084/m9.figshare.26729743
Additional file 1 of 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) · Figshare · doi:10.6084/m9.figshare.25698207
Additional file 7 of Association of depressive symptoms and sleep disturbances with survival among US adult cancer survivors
Lan, A., Li, H., Shen, M., Li, D., Shu, D., Liu, Y., Tang, H., Li, K., Peng, Y., & Liu, S. (2024) · Figshare · doi:10.6084/m9.figshare.26729749
Additional file 1 of 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. (2024) · Figshare · doi:10.6084/m9.figshare.26584500
Additional file 6 of Association of depressive symptoms and sleep disturbances with survival among US adult cancer survivors
Lan, A., Li, H., Shen, M., Li, D., Shu, D., Liu, Y., Tang, H., Li, K., Peng, Y., & Liu, S. (2024) · Figshare · doi:10.6084/m9.figshare.26729746
Additional file 2 of 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) · Figshare · doi:10.6084/m9.figshare.21332828
Additional file 1 of Influence of poor sleep on cardiovascular disease-free life expectancy: a multi-resource-based population cohort study
Huang, B.-H., del Pozo Cruz, B., Teixeira-Pinto, A. M., Cistulli, P. A., & Stamatakis, E. A. (2023) · Figshare · doi:10.6084/m9.figshare.22616882
Additional file 1 of 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) · Figshare · doi:10.6084/m9.figshare.21332825
Additional file 2 of 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. (2024) · Figshare · doi:10.6084/m9.figshare.26584503
Additional file 3 of Association of depressive symptoms and sleep disturbances with survival among US adult cancer survivors
Lan, A., Li, H., Shen, M., Li, D., Shu, D., Liu, Y., Tang, H., Li, K., Peng, Y., & Liu, S. (2024) · Figshare · doi:10.6084/m9.figshare.26729737
Relationship Between Workplace Noise Exposure and Sleep in Tanzania
Axwesso, W. J., Sakwari, G. H., Nyarubeli, I. P., Moen, B. E., Pallesen, S., & Mamuya, S. (2025) · Noise and Health · doi:10.4103/nah.nah_107_25 · Cited by 1
“[6,7] Exposure to noise during daytime work has, for many years, been suspected to cause sleep disturbances amongst workers.”

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 › Public Health, Environmental and Occupational Health › 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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Sleep and physical activity in relation to all-cause, cardiovascular disease and cancer mortality risk

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