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Sleep and physical activity in relation to all-cause, cardiovascular disease and cancer mortality risk
Open accessAbstract
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 PA and sleep duration on mortality risk has been inconclusive.7,8,9,10”
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“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”
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“Computedmodelsconsideredsex,age,smokingstatus,alcoholintake, alcohol frequency, quali fi cation (education), physical activity, history of depression and Townsend deprivation index as covariates (refer to Supplementary materials) 3,76,77 .”
Metadata
- 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
- 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
- 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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