Sleep, Sedentary Behavior, Physical Activity, and Cardiovascular Health

MESA

Charles German; Nour Makarem; Jason Fanning; Susan Redline; Tali Elfassy; Amanda Mcclain; Marwah Abdalla; Brooke Aggarwal; Norrina Allen; Mercedes Carnethon

Disclosures

Med Sci Sports Exerc. 2021;53(4):724-731. 

In This Article

Abstract and Introduction

Abstract

Introduction: Sleep, sedentary behavior, and physical activity are each independently associated with cardiovascular health (CVH). It is unknown how substituting time in sedentary behavior with sleep or physical activity affects overall CVH.

Methods: Data for this analysis were taken from the Multi-Ethnic Study on Atherosclerosis Sleep Ancillary Study. Eligible participants (N = 1718) wore Actiwatch accelerometers for 24 h and had at least 3 d of valid accelerometry. The American Heart Association's Life's Simple 7 was used to represent the CVH score after excluding the physical activity component, with higher scores indicating more favorable CVH. Isotemporal substitution modeling was conducted to examine the effect of substituting 30 min of sedentary time for an equivalent amount of sleep, light-intensity physical activity (LIPA), or moderate to vigorous physical activity (MVPA).

Results: Substituting 30 min of sedentary time to sleep, LIPA, and MVPA was associated with a significantly higher CVH score [β (95% confidence interval) = 0.077 (0.056), 0.039 (0.033), and 0.485 (0.127), respectively]. Substituting 30 min of sedentary time to sleep was associated with lower body mass index (BMI). Substituting 30 min of sedentary time to LIPA was associated with higher diastolic blood pressure and total cholesterol, and lower BMI. Substituting 30 min of sedentary time to MVPA was associated with lower systolic and diastolic blood pressure, and lower BMI.

Conclusions: Sleep, LIPA, and MVPA are all associated with more favorable overall CVH and several key risk factors for cardiovascular disease. These findings underscore the importance of lifestyle modifications in improving CVH.

Introduction

Sleep, sedentary behavior, and physical activity are each independently associated with cardiovascular health (CVH).[1,2] Evidence-based guidelines recommend seven or more hours of sleep, low levels of sustained sedentary behavior, and high levels of physical activity for optimal CVH.[3–5] A significant limitation of research to date is that the relationship of these behaviors with CVH is investigated in isolation, although a change in any given behavior will affect time spent in others.

The 24-h activity cycle was developed as a paradigm for exploring the effects of time spent in each of four domains: sleep, sedentary behavior, light-intensity physical activity (LIPA), and moderate to vigorous physical activity (MVPA) on health outcomes.[6] Isotemporal substitution modeling can be used to estimate the effect of substituting a specific duration of one type of activity with an equivalent duration of another.[7] For example, Buman et al.[8] used this analytic approach to demonstrate that substituting 30 min·d−1 of sedentary time to sleep, LIPA, or MVPA is associated with improvements in various cardiovascular disease (CVD) risk biomarkers.[8] Importantly, although many of these studies have used objectively measured physical activity information, few have used objectively measured sleep, and many have focused on single cardiometabolic risk factors on health outcomes rather than overall CVH.

To our knowledge, no study has evaluated the complex interrelationships of accelerometer-measured sleep, sedentary behavior, LIPA, and MVPA with overall CVH. In addition, these relationships have not been explored in an ethnically diverse cohort of middle-age and older U.S. adults, a population known to have high rates of sedentary behavior and a low prevalence of ideal CVH.[9,10] In light of these gaps in the literature, this study aimed to use partition and isotemporal substitution modeling to understand how relationships between these health behaviors influence CVH assessed using the American Heart Association Life's Simple 7 (AHA LS7) score[11] in the Multi-Ethnic Study on Atherosclerosis (MESA) Sleep Ancillary Study.[12,13] We hypothesized that substituting sedentary behavior for an equivalent amount of sleep or physical activity would result in a higher overall CVH score, facilitated by increases in its component metrics.

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