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Sleep Med. 2018 Aug;48:140-147. doi: 10.1016/j.sleep.2018.04.013. Epub 2018 May 24.

Physical activity and sleep problems in 38 low- and middle-income countries.

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KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium; KU Leuven, University Psychiatric Center KU Leuven, Kortenberg, Belgium. Electronic address:
Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK; Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK.
The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK.
Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
NICM, School of Science and Health, University of Western Sydney, Australia; Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK.
Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland.
KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium.
Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr. Antoni Pujadas, Barcelona, Spain.



Although physical activity (PA) is associated with a reduction of a wide range of sleep problems, it remains uncertain whether complying with the international guidelines of 150 min of moderate to vigorous PA per week can reduce sleep problems in adults. This research investigated the relationship between compliance with the PA recommendations of the World Health Organization and sleep problems in 38 low- and middle-income countries (LMICs).


Cross-sectional, community-based data from the World Health Survey were analyzed. Adjusted logistic regression analyses were undertaken to explore the relationship between PA levels using the International Physical Activity Questionnaire and self-reported sleep problems (such as difficulties falling asleep, waking up frequently during the night or waking up too early in the morning) in the last 30 days.


Across 204,315 individuals (38.6 ± 16.1 years; 49.3% males), the overall prevalence (95% CI) of low PA and sleep problems were 29.9% (29.1-30.8%) and 7.5% (7.2-7.9%), respectively. After adjusting for socio-demographics, obesity, chronic physical conditions, depression, and anxiety; not complying with PA recommendations was associated with higher odds for sleep problems overall [odds ratio (OR) = 1.23, 95% CI = 1.10-1.38] as well as across the entire age range: 18-34 years (OR = 1.26; 95% CI = 1.02-1.57); 35-64 years (OR = 1.17; 95% CI = 1.01-1.35); and age ≥65 years (OR = 1.40; 95% CI = 1.11-1.76).


Not complying with international PA recommendations is associated with higher odds of sleep problems, independently of depression and anxiety in LMICs. Future longitudinal and interventional studies are warranted to assess whether increasing PA levels may improve sleep problems in this setting.


Exercise; Insomnia; Physical activity; Sleep

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