International Journal of Behavioral Medicine

, Volume 23, Issue 2, pp 143–152 | Cite as

Leisure-Time Physical Activity and Sedentary Behavior and Their Cross-Sectional Associations with Excessive Daytime Sleepiness in the French SU.VI.MAX-2 Study

  • Roland M. Andrianasolo
  • Mehdi Menai
  • Pilar Galan
  • Serge Hercberg
  • Jean-Michel Oppert
  • Emmanuelle Kesse-Guyot
  • Valentina A. Andreeva



The potential benefit of physical activity in terms of decreasing excessive daytime sleepiness (EDS) prevalence is unclear, especially in aging adults.


We aimed to elucidate the associations among physical activity, sedentariness, and EDS in middle-aged and older adults.


We conducted a cross-sectional analysis using data from a subsample of participants in the SU.VI.MAX-2 observational study (2007–2009; N = 4179; mean age = 61.9 years). EDS was defined as a score >10 on the Epworth Sleepiness Scale. Leisure-time physical activity and different types of sedentary behavior were assessed with the Modifiable Activity Questionnaire. The associations were examined with multivariable logistic regression models.


In the adjusted multivariable model, total leisure-time physical activity (modeled in quartiles, Q) was significantly, inversely associated with EDS (odds ratios (OR)Q4 vs Q1 = 0.70, 95 % confidence interval (CI) = 0.54–0.89). The association persisted in analyses restricted to individuals not taking sleep medication (ORQ4 vs Q1 = 0.72, 95 % CI = 0.54–0.95). In turn, time spent watching television and time spent reading appeared protective against EDS (ORQ4 vs Q1 = 0.73, 95 % CI = 0.57–0.94; ORQ4 vs Q1 = 0.76, 95 % CI = 0.60–0.97, respectively), whereas time spent on a computer appeared to confer an increased risk for EDS (ORQ4 vs Q1 = 1.30, 95 % CI = 1.05–1.62). When physical activity and sedentariness were modeled jointly, using WHO recommendation-based cutoffs for high/low levels, no significant associations were observed in the fully adjusted models.


The findings reinforce public health recommendations promoting behavior modification and specifically moderate-intensity exercise in middle-aged and older adults. The association of high physical activity/low sedentariness with EDS, which was not supported by the data, merits further investigation before firm conclusions could be drawn.


Health behavior Physical activity Sedentariness Sleepiness 



The study was funded by the French National Research Agency (no. ANR-05-PNRA-010) and the French Ministry of Health (DGS). The funding bodies did not have any involvement in the design/conduct of the research, or in data analysis/interpretation, or in writing/approval of the manuscript. The authors wish to thank Nathalie Arnault and Laurent Bourhis (statisticians) who coordinated data management of the SU.VI.MAX study. The SU.VI.MAX trial is registered at under # NCT00272428.

Conflict of Interest

The authors declare that they have no conflict of interest.

Compliance with Ethical Standards

All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Author’s Contributions

PG, SH, and EKG were responsible for developing the concept, design, and protocol of the study and for coordinating data collection; JMO was involved with the physical activity and sedentary behavior data collection; RMA and MM performed the literature review; RMA led the writing; RMA and MM performed the statistical analyses; VAA and EKG provided methodological guidance; MM, PG, SH, JMO, EKG, and VAA were involved in interpreting the results and editing the manuscript for important intellectual content. All authors read and approved the final version of the manuscript.


  1. 1.
    Liviya Ng W, Freak-Poli R, Peeters A. The prevalence and characteristics associated with excessive daytime sleepiness among Australian workers. J Occup Environ Med. 2014;56:935–45.CrossRefPubMedGoogle Scholar
  2. 2.
    Melamed S, Oksenberg A. Excessive daytime sleepiness and risk of occupational injuries in non-shift daytime workers. Sleep. 2002;25:315–22.PubMedGoogle Scholar
  3. 3.
    Connor J, Whitlock G, Norton R, Jackson R. The role of driver sleepiness in car crashes: a systematic review of epidemiological studies. Accid Anal Prev. 2001;33:31–41.CrossRefPubMedGoogle Scholar
  4. 4.
    Gooneratne NS, Weaver TE, Cater JR, Pack FM, Arner HM, Greenberg AS, et al. Functional outcomes of excessive daytime sleepiness in older adults. J Am Geriatr Soc. 2003;51:642–49.CrossRefPubMedGoogle Scholar
  5. 5.
    Chasens ER, Sereika SM, Weaver TE, Umlauf MG. Daytime sleepiness, exercise, and physical function in older adults. J Sleep Res. 2007;16:60–5.CrossRefPubMedGoogle Scholar
  6. 6.
    Reid KJ, Martinovich Z, Finkel S, Statsinger J, Golden R, Harter K, et al. Sleep: a marker of physical and mental health in the elderly. Am J Geriatr Psychiatr. 2006;14:860–6.CrossRefGoogle Scholar
  7. 7.
    Goldstein IB, Ancoli-Israel S, Shapiro D. Relationship between daytime sleepiness and blood pressure in healthy older adults. Am J Hypertens. 2004;17:787–92.CrossRefPubMedGoogle Scholar
  8. 8.
    Empana JP, Dauvilliers Y, Dartigues JF, Ritchie K, Gariepy J, Jouven X, et al. Excessive daytime sleepiness is an independent risk indicator for cardiovascular mortality in community-dwelling elderly: the three city study. Stroke. 2009;40:1219–24.CrossRefPubMedGoogle Scholar
  9. 9.
    Jaussent I, Bouyer J, Ancelin ML, Akbaraly T, Peres K, Ritchie K, et al. Insomnia and daytime sleepiness are risk factors for depressive symptoms in the elderly. Sleep. 2011;34:1103–10.PubMedPubMedCentralGoogle Scholar
  10. 10.
    Endeshaw Y, Rice TB, Schwartz AV, Stone KL, Manini TM, Satterfield S, et al. Snoring, daytime sleepiness, and incident cardiovascular disease in the health, aging, and body composition study. Sleep. 2013;36:1737–45.PubMedPubMedCentralGoogle Scholar
  11. 11.
    Ohayon MM, Vecchierini MF. Daytime sleepiness and cognitive impairment in the elderly population. Arch Intern Med. 2002;162:201–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Teodorescu M, Consens FB, Bria WF, Coffey MJ, McMorris MS, Weatherwax KJ, et al. Correlates of daytime sleepiness in patients with asthma. Sleep Med. 2006;7:607–13.CrossRefPubMedGoogle Scholar
  13. 13.
    Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14:540–5.PubMedGoogle Scholar
  14. 14.
    Hara C, Stewart R, Lima-Costa MF, Rocha FL, Fuzikawa C, Uchoa E, et al. Insomnia subtypes and their relationship to excessive daytime sleepiness in Brazilian community-dwelling older adults. Sleep. 2011;34:1111–7.PubMedPubMedCentralGoogle Scholar
  15. 15.
    Ohayon MM. Epidemiology of excessive daytime sleepiness. Sleep Med Clin. 2006;1:9–16.CrossRefGoogle Scholar
  16. 16.
    Tsuno N, Jaussent I, Dauvilliers Y, Touchon J, Ritchie K, Besset A. Determinants of excessive daytime sleepiness in a French community-dwelling elderly population. J Sleep Res. 2007;16:364–71.CrossRefPubMedGoogle Scholar
  17. 17.
    Hamer M, Lavoie KL, Bacon SL. Taking up physical activity in later life and healthy ageing: the English longitudinal study of ageing. Br J Sports Med. 2014;48:239–43.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Warburton DE, Nicol CW, Bredin SS. Health benefits of physical activity: the evidence. CMAJ. 2006;174:801–9.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Youngstedt SD. Effects of exercise on sleep. Clin Sports Med. 2005;24:355–65.CrossRefPubMedGoogle Scholar
  20. 20.
    de Castro Toledo Guimaraes LH, de Carvalho LB, Yanaguibashi G, do Prado GF. Physically active elderly women sleep more and better than sedentary women. Sleep Med. 2008;9:488–93.CrossRefPubMedGoogle Scholar
  21. 21.
    Li F, Fisher KJ, Harmer P, Irbe D, Tearse RG, Weimer C. Tai chi and self-rated quality of sleep and daytime sleepiness in older adults: a randomized controlled trial. J Am Geriatr Soc. 2004;52:892–900.CrossRefPubMedGoogle Scholar
  22. 22.
    Buman MP, Hekler EB, Bliwise DL, King AC. Exercise effects on night-to-night fluctuations in self-rated sleep among older adults with sleep complaints. J Sleep Res. 2011;20:28–37.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Tsunoda K, Kitano N, Kai Y, Uchida K, Kuchiki T, Okura T, et al. Prospective study of physical activity and sleep in middle-aged and older adults. Am J Prev Med. 2015;48:662–73.CrossRefPubMedGoogle Scholar
  24. 24.
    McClain JJ, Lewin DS, Laposky AD, Kahle L, Berrigan D. Associations between physical activity, sedentary time, sleep duration and daytime sleepiness in US adults. Prev Med. 2014;66:68–73.CrossRefPubMedGoogle Scholar
  25. 25.
    Thorp AA, Owen N, Neuhaus M, Dunstan DW. Sedentary behaviors and subsequent health outcomes in adults a systematic review of longitudinal studies, 1996–2011. Am J Prev Med. 2011;41:207–15.CrossRefPubMedGoogle Scholar
  26. 26.
    Healy GN, Matthews CE, Dunstan DW, Winkler EA, Owen N. Sedentary time and cardio-metabolic biomarkers in US adults: NHANES 2003–06. Eur Heart J. 2011;32:590–7.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Hamilton MT, Hamilton DG, Zderic TW. Role of low energy expenditure and sitting in obesity, metabolic syndrome, type 2 diabetes, and cardiovascular disease. Diabetes. 2007;56:2655–67.CrossRefPubMedGoogle Scholar
  28. 28.
    Farnsworth JL, Kim Y, Kang M. Sleep disorders, physical activity, and sedentary behavior among U.S. adults: National Health and Nutrition Examination Survey. J Phys Act Health. 2015. doi: 10.1123/jpah.2014-0251.PubMedGoogle Scholar
  29. 29.
    King AC, Oman RF, Brassington GS, Bliwise DL, Haskell WL. Moderate-intensity exercise and self-rated quality of sleep in older adults. a randomized controlled trial. JAMA. 1997;277:32–7.CrossRefPubMedGoogle Scholar
  30. 30.
    Bixler EO, Vgontzas AN, Lin HM, Calhoun SL, Vela-Bueno A, Kales A. Excessive daytime sleepiness in a general population sample: the role of sleep apnea, age, obesity, diabetes, and depression. J Clin Endocrinol Metab. 2005;90:4510–5.CrossRefPubMedGoogle Scholar
  31. 31.
    Hercberg S, Galan P, Preziosi P, Bertrais S, Mennen L, Malvy D, et al. The SU.VI.MAX Study: a randomized, placebo-controlled trial of the health effects of antioxidant vitamins and minerals. Arch Intern Med. 2004;164:2335–42.CrossRefPubMedGoogle Scholar
  32. 32.
    Hercberg S, Preziosi P, Briancon S, Galan P, Triol I, Malvy D, et al. A primary prevention trial using nutritional doses of antioxidant vitamins and minerals in cardiovascular diseases and cancers in a general population: the SU.VI.MAX study: design, methods, and participant characteristics. SUpplementation en VItamines et Mineraux AntioXydants. Control Clin Trials. 1998;19:336–51.CrossRefPubMedGoogle Scholar
  33. 33.
    Malvy DJ, Favier A, Faure H, Preziosi P, Galan P, Arnaud J, et al. Effect of two years’ supplementation with natural antioxidants on vitamin and trace element status biomarkers: preliminary data of the SU.VI.MAX study. Cancer Detect Prev. 2001;25:479–85.PubMedGoogle Scholar
  34. 34.
    Johns MW. Reliability and factor analysis of the Epworth Sleepiness Scale. Sleep. 1992;15:376–81.PubMedGoogle Scholar
  35. 35.
    Kaminska M, Jobin V, Mayer P, Amyot R, Perraton-Brillon M, Bellemare F. The Epworth Sleepiness Scale: self-administration versus administration by the physician, and validation of a French version. Can Respir J. 2010;17:e27–34.PubMedPubMedCentralGoogle Scholar
  36. 36.
    Kriska AM, Knowler WC, LaPorte RE, Drash AL, Wing RR, Blair SN, et al. Development of questionnaire to examine relationship of physical activity and diabetes in Pima Indians. Diabetes Care. 1990;13:401–11.CrossRefPubMedGoogle Scholar
  37. 37.
    Vuillemin A, Oppert JM, Guillemin F, Essermeant L, Fontvieille AM, Galan P, et al. Self-administered questionnaire compared with interview to assess past-year physical activity. Med Sci Sports Exerc. 2000;32:1119–24.CrossRefPubMedGoogle Scholar
  38. 38.
    Guillemin F, Rat AC, Roux CH, Fautrel B, Mazieres B, Chevalier X, et al. The KHOALA cohort of knee and hip osteoarthritis in France. Joint Bone Spine. 2012;79:597–603.CrossRefPubMedGoogle Scholar
  39. 39.
    Bauer PW, Pivarnik JM, Feltz DL, Paneth N, Womack CJ. Validation of an historical physical activity recall tool in postpartum women. J Phys Act Health. 2010;7:658–61.PubMedGoogle Scholar
  40. 40.
    Kuller LH, Kriska AM, Kinzel LS, Simkin-Silverman LR, Sutton-Tyrrell K, Johnson BD, et al. The clinical trial of women on the move through activity and nutrition (WOMAN) study. Contemp Clin Trial. 2007;28:370–81.CrossRefGoogle Scholar
  41. 41.
    Delahanty LM, Peyrot M, Shrader PJ, Williamson DA, Meigs JB, Nathan DM. Pretreatment, psychological, and behavioral predictors of weight outcomes among lifestyle intervention participants in the Diabetes Prevention Program (DPP). Diabetes Care. 2013;36:34–40.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Schulz LO, Harper IT, Smith CJ, Kriska AM, Ravussin E. Energy intake and physical activity in Pima Indians: comparison with energy expenditure measured by doubly-labeled water. Obes Res. 1994;2:541–8.CrossRefPubMedGoogle Scholar
  43. 43.
    Kriska AM, Edelstein SL, Hamman RF, Otto A, Bray GA, Mayer-Davis EJ, et al. Physical activity in individuals at risk for diabetes: Diabetes Prevention Program. Med Sci Sports Exerc. 2006;38:826–32.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Pettee Gabriel K, McClain JJ, Schmid KK, Storti KL, Ainsworth BE. Reliability and convergent validity of the past-week modifiable activity questionnaire. Public Health Nutr. 2010;14:435–42.CrossRefPubMedGoogle Scholar
  45. 45.
    Jacobi D, Charles MA, Tafflet M, Lommez A, Borys JM, Oppert JM. Relationships of self-reported physical activity domains with accelerometry recordings in French adults. Eur J Epidemiol. 2009;24:171–9.CrossRefPubMedGoogle Scholar
  46. 46.
    Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, et al. Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc. 2000;32:S498–504.CrossRefPubMedGoogle Scholar
  47. 47.
    World Health Organization. Global recommendations on physical activity for health. Geneva: WHO; 2011.Google Scholar
  48. 48.
    Mansoubi M, Pearson N, Biddle SJ, Clemes S. The relationship between sedentary behaviour and physical activity in adults: a systematic review. Prev Med. 2014;69C:28–35.CrossRefGoogle Scholar
  49. 49.
    Whitney CW, Enright PL, Newman AB, Bonekat W, Foley D, Quan SF. Correlates of daytime sleepiness in 4578 elderly persons: the Cardiovascular Health Study. Sleep. 1998;21:27–36.PubMedGoogle Scholar
  50. 50.
    Bartel KA, Gradisar M, Williamson P. Protective and risk factors for adolescent sleep: a meta-analytic review. Sleep Med Rev. 2015;21:72–85.CrossRefPubMedGoogle Scholar
  51. 51.
    Cajochen C, Frey S, Anders D, Spati J, Bues M, Pross A, et al. Evening exposure to a light-emitting diodes (LED)-backlit computer screen affects circadian physiology and cognitive performance. J Appl Physiol. 2011;110:1432–8.CrossRefPubMedGoogle Scholar
  52. 52.
    Chang AM, Aeschbach D, Duffy JF, Czeisler CA. Evening use of light-emitting eReaders negatively affects sleep, circadian timing, and next-morning alertness. Proc Natl Acad Sci U S A. 2015;112:1232–7.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Hays JC, Blazer DG, Foley DJ. Risk of napping: excessive daytime sleepiness and mortality in an older community population. J Am Geriatr Soc. 1996;44:693–8.CrossRefPubMedGoogle Scholar
  54. 54.
    Loprinzi PD, Cardinal BJ. Association between objectively-measured physical activity and sleep, NHANES 2005–2006. Ment Health Phys Act. 2011;4:65–9.CrossRefGoogle Scholar
  55. 55.
    U.S. Department of Health and Human Services. Physical activity guidelines for Americans. Rockville: US DHHS Office of Disease Prevention and Health Promotion; 2008.Google Scholar
  56. 56.
    Shephard RJ. Absolute versus relative intensity of physical activity in a dose–response context. Med Sci Sports Exerc. 2001;33:S400–18.CrossRefPubMedGoogle Scholar
  57. 57.
    Burton DA, Stokes K, Hall GM. Physiological effects of exercise. Contin Educ Anaesth Crit Care Pain. 2004;4:185–8.CrossRefGoogle Scholar
  58. 58.
    Kemppainen J, Aalto S, Fujimoto T, Kalliokoski KK, Langsjo J, Oikonen V, et al. High intensity exercise decreases global brain glucose uptake in humans. J Physiol. 2005;568:323–32.CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Ide K, Horn A, Secher NH. Cerebral metabolic response to submaximal exercise. J Appl Physiol. 1999;87:1604–8.PubMedGoogle Scholar
  60. 60.
    Bergouignan A, Rudwill F, Simon C, Blanc S. Physical inactivity as the culprit of metabolic inflexibility: evidence from bed-rest studies. J Appl Physiol. 2011;111:1201–10.CrossRefPubMedGoogle Scholar
  61. 61.
    Guilleminault C, Brooks SN. Excessive daytime sleepiness: a challenge for the practising neurologist. Brain. 2001;124:1482–91.CrossRefPubMedGoogle Scholar
  62. 62.
    Horne JA. The effects of exercise upon sleep: a critical review. Biol Psychol. 1981;12:241–90.CrossRefPubMedGoogle Scholar
  63. 63.
    Horne JA, Staff LH. Exercise and sleep: body-heating effects. Sleep. 1983;6:36–46.PubMedGoogle Scholar
  64. 64.
    Roopa M, Deepa M, Indulekha K, Mohan V. Prevalence of sleep abnormalities and their association with metabolic syndrome among Asian Indians: Chennai Urban Rural Epidemiology Study (CURES-67). J Diabetes Sci Technol. 2010;4:1524–31.CrossRefPubMedPubMedCentralGoogle Scholar
  65. 65.
    Hayley AC, Williams LJ, Kennedy GA, Berk M, Brennan SL, Pasco JA. Excessive daytime sleepiness and metabolic syndrome: a cross-sectional study. Metabolism. 2015;64:244–52.CrossRefPubMedGoogle Scholar
  66. 66.
    Strand LB, Laugsand LE, Wisloff U, Nes BM, Vatten L, Janszky I. Insomnia symptoms and cardiorespiratory fitness in healthy individuals: the Nord-Trondelag Health Study (HUNT). Sleep. 2013;36:99–108.PubMedPubMedCentralGoogle Scholar
  67. 67.
    Cajochen C, Munch M, Knoblauch V, Blatter K, Wirz-Justice A. Age-related changes in the circadian and homeostatic regulation of human sleep. Chronobiol Int. 2006;23:461–74.CrossRefPubMedGoogle Scholar

Copyright information

© International Society of Behavioral Medicine 2015

Authors and Affiliations

  • Roland M. Andrianasolo
    • 1
  • Mehdi Menai
    • 1
  • Pilar Galan
    • 1
  • Serge Hercberg
    • 1
    • 2
  • Jean-Michel Oppert
    • 1
    • 3
  • Emmanuelle Kesse-Guyot
    • 1
  • Valentina A. Andreeva
    • 1
  1. 1.Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre de Recherche en Epidémiologie et Statistiques, Inserm U1153, Inra U1125, CnamBobignyFrance
  2. 2.Département de Santé PubliqueHôpital AvicenneBobignyFrance
  3. 3.Université Pierre et Marie Curie - Paris 6, Service de Nutrition, Hôpital Pitié-Salpêtrière (AP-HP), Institut de Cardiométabolisme et Nutrition (ICAN)ParisFrance

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