Physical Activity, Healthy Lifestyle Behaviors, and Sleep Quality in Adolescents: A Cross-Sectional Study

INTRODUCTION

Adolescence refers to a critical period of life for physical and biological growth, sexual development, psychosocial maturation, as well as the establishment of lifestyle patterns.^[1,2] In this period, parental control over adolescents’ behaviour decreases, and their decision-making power increases. Therefore, it is crucial to identify the factors that negatively affect health behaviours during adolescence, as these may lead to unfavourable health and well-being consequences in adulthood.^[3,4]

Physical activity is described as any movement involving muscular contraction, such as exercise, gardening, walking, dancing, daily chores, play, and sport, that requires energy expenditure. It is a complex and multidimensional phenomenon that impacts learning, enjoyment, social interactions, and self-awareness.^[5] The World Health Organization (WHO) recommends that adolescents engage in more than 60 minutes of physical activity daily. It is also emphasised that this activity should be of moderate to vigorous intensity and primarily aerobic in nature.^[6]

Better healthy lifestyle behaviours contribute to improved mental and emotional health, especially during adolescence when mental health issues often first emerge.^[7] Unhealthy lifestyles, including physical inactivity, poor dietary habits, addictions such as tobacco use, drugs, and alcohol, stress, poor interpersonal relationships, and digital addictions, are increasing globally among young people. These behaviours have significant lifelong consequences.^[3,4]

Poor sleep quality has been shown to diminish academic performance and impair lifestyle behaviours in adolescents.^[8,9] If poor sleep behaviours are sustained, they can affect cardiometabolic risk over time, potentially increasing the risk of depression, anxiety, and other conditions.^[4,10]

Although unhealthy lifestyles are increasing globally, this research was designed to explore the relationship between physical activity, healthy lifestyle behaviours, and sleep quality in adolescents, who are more likely to develop risky behaviours compared to other populations.

MATERIAL AND METHODS

RESULTS

Fifty-one girls and thirty-three boys (mean age: 14.96 ± 2.37 years) completed the study. The mean IPAQ-METs, ALP global, and PSQI global scores were 2439.80 ± 1751.55, 123.69 ± 12.36, and 4.43 ± 2.53, respectively.

No significant correlation was observed between IPAQ-METs and PSQI global (r = -0.61, p = 0.581). A negative correlation was found between PSQI and ALP global scores (r = -0.366, p < 0.001). Statistically significant differences were found in the ‘interpersonal relations’ (p = 0.004), ‘positive life perspective’ (p = 0.048), and global (p = 0.005) scores of ALP in favour of the good sleep group. However, no difference was found for IPAQ-METs between the sleep groups (p = 0.797). The ‘physical activity’ (p = 0.011) score of ALP was higher in the regular sports group. Boys had better ‘physical activity’ (p = 0.028) and ‘nutrition’ scores (p = 0.032), while girls had better ‘health responsibility’ (p = 0.036), ‘interpersonal relations’ (p = 0.011), and ‘stress management’ (p = 0.026) scores. A significant difference was observed in ‘health responsibility’ (p = 0.021), ‘interpersonal relations’ (p = 0.042), and ‘stress management’ (p = 0.043) scores of ALP according to the mother’s education level. A significant difference was also found in ‘nutrition’ (p = 0.016) and ‘interpersonal relations’ (p = 0.040) scores according to the father’s education level. Only a weak negative correlation was found between IPAQ-METs and the ‘stress management’ score of ALP (r = -0.265, p = 0.015). A negative correlation was found between PSQI global and the ‘health responsibility’ (r = -0.339, p = 0.002) and ‘positive life perspective’ (r = -0.224, p = 0.041) scores of ALP.

Additionally, the descriptive characteristics of the participants, as well as the comparison of IPAQ-MET scores, ALP global scores, and PSQI global scores, are presented in Table 1. The gender differences in the scales are represented in Table 2. Although there was no statistically significant difference in IPAQ-METs, the results of the physical activity subheading in the ALP scale revealed that boys were more physically active than girls [Table 3].

DISCUSSION

The findings of this study revealed that more than half of the adolescents did not meet the WHO recommended minimum weekly physical activity target. Additionally, girls exhibited healthier lifestyle behaviours than boys, yet they were less physically active compared to their male counterparts. Contrary to most studies, no significant correlation was observed between physical activity levels and sleep quality. However, it is worth noting that the adolescents in our cohort had good sleep quality.

Several studies have reported that boys tend to engage in higher levels of physical activity and participate in more sports compared to girls.^[16,17] A review also indicated that physical activity scores were higher in boys than in girls, which could be attributed to factors such as involvement in social activities, perceptions of health, the educational status of parents, and relationships with peers and family members.^[18] A recent study conducted in Iran found that female adolescents had lower physical activity levels than their male counterparts, which is consistent with our findings.^[19] The current study found no significant difference in IPAQ-METs scores according to gender; however, boys scored better in physical activity levels and the ‘physical activity’ subdimension of the ALP compared to girls. Potential reasons for the lack of regular exercise and sports participation among girls include the absence of role models within families, concerns that involvement in sports may negatively impact academic performance, and limited access to adequate sports facilities.

Several studies have shown a positive correlation between physical activity levels and sleep quality, often using questionnaires such as the IPAQ-SF and PSQI, or online surveys to examine these relationships.^[20-24] One study reported that individuals who adhered to physical activity recommendations experienced less adequate sleep compared to those who did not follow them.^[25] While our results differ from most of the existing literature, some studies align with our findings, indicating no correlation between physical activity and sleep quality in young adults.^[26,27]

In addition to physical activity, various other factors can influence sleep quality. For instance, studies have shown that excessive screen time, particularly before bed, can negatively impact sleep by disrupting circadian rhythms and increasing alertness.^[28,29] Furthermore, poor dietary habits, such as high caffeine or sugar intake, may interfere with sleep patterns.^[30] Psychological factors, including stress and anxiety, have also been found to significantly affect sleep quality in adolescents.^[31,32] These factors could explain the lack of significant correlation observed between physical activity and sleep quality in our study. While physical activity is beneficial for overall well-being, its effect on sleep quality may be moderated or confounded by these other factors, highlighting the complexity of sleep regulation.

Additionally, some studies have reported no relationship between physical activity and sleep duration in adolescents.^[33,34] In our study, we also found no statistically significant difference in IPAQ-METs based on sleep quality (≤ 5 indicating good quality sleep). The differences observed between studies may be attributed to cultural factors and the use of various assessment tools.

Consistent with studies^[35-37], the current study suggests a connection between sleep quality and overall well-being. One study found that physical activity on both school days and weekend days was associated with improved sleep quality and higher life satisfaction in adolescents.^[35] Our results also indicate a link between sleep quality and overall well-being, although we did not specifically measure life satisfaction. However, while we did not find a direct relationship between physical activity and sleep quality, we observed that better sleep quality was associated with a better lifestyle profile, suggesting an overall improvement in health quality.

The mean global score of the ALP in the current study was 123.69 ± 12.36, which is higher than the scores reported in studies conducted in Turkey ^[17,38,39] indicating that the adolescents in the present study exhibited a pleasingly higher level of healthy lifestyle habits. The findings also suggest statistically significant differences between girls (125.90 ± 11.39) and boys (120.27 ± 13.17) in the ALP global score. A study in Turkey found that female students had higher healthy lifestyle behaviour scores compared to male students,^[40] which aligns with our results. This supports the notion that girls tend to have a generally healthier lifestyle than boys. A possible explanation for this difference could be that girls perceive themselves as more at risk for health problems than boys, whereas boys are more likely to engage in risk-taking behaviours.^[41] One possible explanation for girls scoring higher in healthy lifestyle behaviours but lower in physical activity could be the influence of social norms and cultural expectations.^[42] In many societies, girls may be more likely to adopt healthy behaviours, such as better nutrition and stress management, due to societal expectations around health and well-being.^[43] However, they may face more barriers to physical activity, such as limited access to sports opportunities, concerns about body image, or social norms that prioritise academic success over physical activity. Parental influence can also play a role, as families may encourage girls to focus on academics or domestic responsibilities, which may reduce the time available for physical activity.^[44] Additionally, environmental factors, such as the availability of safe spaces for exercise or sports programs, can limit girls’ opportunities to engage in physical activity.^[45] These factors may help explain why girls have higher scores in the overall healthy lifestyle behaviours but lower scores in physical activity.

The scores in the ALP subdimensions also vary across studies. Some studies have reported that the lowest scores were in ‘health responsibility’ and ‘spiritual health,’ while the highest scores were in ‘interpersonal relations’ and ‘positive life perspective.^[46,47] In contrast, other studies have found that adolescents scored highest in ‘spiritual health’ and ‘health responsibility,’ and the lowest score was in ‘physical activity’.^[48-50] The adolescents in this study obtained the highest score in the ‘positive life perspective’ subdimension and the lowest score in ‘physical activity.’ Since different sample groups were studied, it is reasonable that the results from the subgroups of the ALP scale used in this study may vary. Adolescence, being a crucial transition period, is particularly influenced by factors such as school, family, and environment, which can have a greater impact on health-related lifestyle behaviours compared to adulthood. The results from this study can guide interventions aimed at helping adolescents develop healthy lifestyle behaviours. However, achieving significant changes in lifestyle behaviours may require close monitoring and follow-up of the sample. Since a cut-off point for the scale has not been established, the highest possible score on the ALP scale is 160. In our study, the average score was 123.69 ± 12.36, which indicates that adolescents’ healthy lifestyle behaviours are generally favourable. However, the ‘physical activity’ subdimension, which received the lowest score in our study, highlights the need for careful attention to physical activity in adolescents, as physical inactivity is a known primary risk factor for numerous health issues. Additionally, the highest score in the ‘positive life perspective’ subdimension suggests that adolescents may be more likely to develop positive coping strategies, approach challenges with optimism, and strengthen their sense of self-responsibility. Some studies have reported that the ALP global score did not differ according to gender,^[17,38] while others found that the score was higher in females than in males.^[47] Gender norms and societal attitudes may influence these differences in healthy lifestyle behaviours between girls and boys.

Ardic and Esin found that a father’s education level and health perception influenced the ALP global score.^[51] The current study revealed statistically significant differences in the ‘health responsibility,’ ‘interpersonal relations,’ and ‘stress management’ scores of the ALP according to the mother’s education level. Additionally, there was a significant difference in ‘nutrition’ and ‘interpersonal relations’ scores based on the father’s education level. As previously mentioned, the scores for some healthy lifestyle behaviours improved with increasing parental education, suggesting that higher levels of parental education may positively impact adolescents’ healthy lifestyle behaviours. These findings underscore the pivotal role of the environment and parents in shaping the physical, mental, and spiritual well-being of adolescents.

Studies have reported different results: some found that girls experienced more sleep problems than boys ^[52,53] while others found that boys complained more about sleep problems.^[54] In Turkey, studies have shown varying mean PSQI scores ranging from 5.15 to 6.90.^[55,56] In contrast, the current study found a mean PSQI score of 4.43 ± 2.53, with 60.71% of the participants having good sleep quality. There were no statistically significant differences between girls and boys in terms of sleep quality. The inconsistency in results may be attributed to variables such as age range, environmental factors, sociocultural influences, and the recruitment of adolescents from a single region of the country.

The study has several limitations. First, although a priori power analysis was conducted to determine the appropriate sample size, the relatively small sample (n=84) may limit the generalisability of the findings. Second, the lack of data on family, socioeconomic, parenting, school, and environmental factors restricts a comprehensive understanding of the contextual influences on adolescent lifestyle behaviours. Third, since our study was conducted with adolescents living in a metropolitan city in Turkey, the applicability of the findings may be limited to other regions or countries with different socio-cultural contexts.

Future research should include a larger and more diverse sample to enhance generalisability and adopt a longitudinal design to establish causal relationships. Collecting data on family dynamics, parental support, and socioeconomic factors would offer a more comprehensive understanding of adolescent health. Utilising objective measures, such as actigraphy for sleep and accelerometers for physical activity, could reduce reporting bias. Furthermore, investigating the impact of screen time on physical activity and sleep, developing gender-specific interventions, and incorporating mental health variables like anxiety and stress would deepen the insights of future studies. As our study was cross-sectional, future longitudinal research is recommended to explore the directionality and causality of the relationships between physical activity, lifestyle behaviours, and sleep quality.

CONCLUSION

Physical activity levels, healthy lifestyle behaviours, and sleep quality in adolescents are influenced by various physiological, psychological, social, and environmental factors. A comprehensive examination of these factors can help develop effective strategies and approaches to promote physical activity, healthy lifestyle choices, and improved sleep quality in adolescents.