Association of Physical Activity with Sleep Quality in Indian Medical Students: A Mixed-Methods Study

Medical students are at high risk for poor sleep quality because of academic pressures. Physical activity improves sleep in general populations but has been understudied by medical students. This study aimed 1) to assess the association between physical activity levels and sleep quality among Indian medical students and 2) to explore student perceptions about barriers/facilitators influencing sleep and exercise patterns through a mixed methods design.

A mixed-method study (cross-sectional and qualitative study) was conducted among 380 medical students who completed the Pittsburgh Sleep Quality Index (PSQI), International Physical Activity Questionnaire (IPAQ), and sociodemographics. A sub-sample of 20 students also participated in semistructured interviews regarding sleep health and barriers/motivators for physical activity. Multivariate logistic regression analysis was used in the quantitative strand. Inductive coding identified themes from qualitative interviews.

380 medical students participated (mean age 21.5 ± 1.8 years, 60% female). Overall, 57% had poor sleep quality (PSQI > 5). In univariate analyses, students with low physical activity (PA) had worse PSQI scores than moderate and high PA groups (mean PSQI 7.8 vs 6.1 vs 4.9, P < 0.001). Male gender, clinical training years, and overweight/obesity were also associated with higher PSQI scores (all P < 0.05). In multivariate logistic regression, compared with low PA, moderate PA (AOR = 0.40, 95% CI: 0.25-0.64), and high PA (AOR = 0.15, 95% CI: 0.08-0.28) were associated with significantly lower odds of poor sleep quality after adjusting for covariates. Qualitative interviews with students (n = 20) revealed perceived barriers to academic workload interfering with sleep and exercise behaviors.

Higher physical activity correlates with superior self-reported sleep quality in this medical student sample. Integrating activity promotion into medical school curricula may improve sleep health among students facing considerable lifestyle challenges.