Adherence to 24-hour Movement Guidelines and Self-rated Health among U.S. Adults with and without Disabilities

Self-rated health (SRH) reflects individuals' perceptions of their overall health status and is a strong predictor of morbidity and mortality. This study examined the associations between adherence to 24-hour movement guidelines and SRH among U.S adults with and without disabilities.

This cross-sectional study utilized data from the 2021-2023 National Health and Nutrition Examination Survey (NHANES), a nationally representative sample of U.S. adults (n = 8,153). Survey-weighted logistic regression with multiple imputation assessed associations between meeting individual and combined 24-hour movement guidelines and SRH by disability status. Sensitivity analysis was conducted using complete-case analysis with (1) survey-weighted complex-sample logistic regression and (2) unweighted logistic regression to assess the robustness of the findings.

Meeting full 24-hour movement guidelines was associated with higher odds of good-to-excellent SRH compared with meeting none, among adults without disabilities (AOR = 4.63, 95% CI: 3.00-7.16), and adults with disabilities (AOR = 2.69, 95% CI: 1.73-4.17). Among adults without disabilities, meeting all three guidelines showed the greatest associations with good-to-excellent SRH (AOR = 4.63), while among adults with disabilities, the highest associations were observed for meeting physical activity (PA) + sedentary behavior (SB) (AOR = 3.47, 95% CI: 2.11-5.68) and PA + sleep (AOR = 3.10, 95% CI: 1.18-8.14) guidelines. The odds ratios of good-to-excellent SRH increased progressively with the number of guidelines met across all adults (met 1: AOR = 1.38; met 2: AOR = 2.24; met 3: AOR = 4.18; all P < 0.05).

Adherence to multiple compositions of the 24-hour movement guidelines, especially those including PA, was positively associated with SRH. For adults with disabilities, meeting at least two guidelines was associated with better SRH than meeting none.