Associations of physical activity and sedentary behavior with insomnia in middle-aged and older adults: a cross-sectional study

To explore the relationships between physical activity (PA) and sedentary behavior (SB) levels and insomnia among middle-aged and older adults.

This cross-sectional study involved 3,752 middle-aged and older adults aged 50 years or older from Wuhan, China. PA and SB levels were assessed via the International Physical Activity Questionnaire (IPAQ)-Short Form. Insomnia severity was evaluated by the Insomnia Severity Index (ISI). Multivariate logistic regression was employed to estimate the impact of PA and SB on insomnia.

A total of 3,752 middle-aged and older adults in Wuhan were included. Among them, 18.0% reported insomnia symptoms, with 13.6% classified as mild insomnia and 4.4% as moderate-to-severe insomnia. After adjustment for confounders, high levels of physical activity were found to be associated with lower odds ratios for mild insomnia than low levels of PA (OR (95% CIs) = 0.67 (0.50, 0.90)), whereas 3-6 h/day and ≥6 h/day of sedentary behavior were associated with higher odds ratios for mild insomnia than were <3 h/day of sedentary behavior (OR (95% CIs) = 1.41 (1.09, 1.83) and 1.71 (1.19, 2.45), respectively). Similarly, moderate and high levels of physical activity were associated with lower odds ratios for moderate insomnia (OR (95% CIs) = 0.45 (0.28, 0.72) and 0.47 (0.30, 0.73), respectively), whereas ≥6 h per day of sedentary behavior was associated with higher odds ratios for moderate insomnia (OR (95% CIs) = 2.47 (1.37, 4.45)).

High PA levels were associated with a reduced risk of both mild and moderate-to-severe insomnia in middle-aged and older adults, while SB ≥ 3 h/day increased insomnia risk-with the highest risk observed at SB ≥ 6 h/day. Clinically, these findings support non-pharmacological interventions for insomnia prevention and management in this population: recommending achievement of high PA levels (e.g., ≥1,500 MET-minutes/week of vigorous activity or ≥3,000 MET-minutes/week of combined activity) and limiting daily SB to <3 h. Targeted PA/SB intervention programs should be prioritized for high-risk subgroups, such as women and low-income individuals.