Combinations of physical activity, sedentary behavior and sleep and their associations with cardiovascular risk

Background Cardiovascular diseases (CVD) are the primary cause of global morbidity and mortality. Movement behaviors; physical activity (PA), sedentary behavior (SB) and sleep are essential for cardiovascular health, yet they are often studied separately. Objective To investigate the association between the movement behaviors with cardiovascular risk (CVR) mediated by sleep quality. Methods Population-based survey in two Brazilian municipalities, collected through face-to-face interview. Participants' daily moderate to vigorous physical activity (MVPA) and SB were measured, and a ratio of MVPA to SB was calculated, dichotomized into less than < 2.5 or ≥ 2.5 or more minutes of MVPA per hour of SB. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), and CVR was estimated via the Framingham risk score (FRS), categorized as low risk (< 5%) or intermediate to high risk (≥ 5%). Results The study involved 1,550 individuals, 46.3% aged 35–59 years and 50.7% female. Multivariate analysis, adjusted for confounders, indicated that individuals with ≥ 2.5 minutes of MVPA per hour of SB had a lower likelihood of intermediate to high CVR (OR: 0.60; 95%CI: 0.39–0.92), and 16.6% of this effect was mediated by sleep quality (OR: 0.65; 95%CI: 0.43–0.99). In the combined analysis, individuals with MPVA per hour SB adequate and good sleep qualitywere less likely to have intermediate to high CVR (OR: 0.38; 95%CI: 0.21–0.69). Conclusions The combination of high MVPA, low SB and good sleep quality, was associated with a less CVR. These findings highlight the importance of integrated interventions addressing multiple movement behaviors to prevent and treat CVR.