Moving More and Sitting Less as Healthy Lifestyle Behaviors are Protective Factors for Insomnia, Depression, and Anxiety Among Adolescents During the COVID-19 Pandemic

Chunping Lu,1,* Xinli Chi,2,* Kaixin Liang,2 Si-Tong Chen,3 Liuyue Huang,2 Tianyou Guo,2 Can Jiao,2 Qian Yu,4 Nicola Veronese,5 Fernanda Cunha Soares,6 Igor Grabovac,7 Albert Yeung,8 Liye Zou4 1The Greater Bay Area Institute of Educational Research, Shenzhen University, Shenzhen 518060, People’s Republic of China; 2Center for Lifestyle and Mental Health, Shenzhen University, Shenzhen 518060, People’s Republic of China; 3Institute for Health and Sport, Victoria University, Melbourne 8001, Australia; 4Exercise and Mental Health Laboratory, Shenzhen University, Shenzhen 518060, People’s Republic of China; 5Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy; 6School of Physical Education, University of Pernambuco, Recife, PE, Brazil; 7Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Wien 1090, Austria; 8Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA 02114, USA*These authors contributed equally to this workCorrespondence: Liye ZouExercise and Mental Health Laboratory, Shenzhen University, Shenzhen 518060, People’s Republic of ChinaTel +86 188-2343-7684Email liyezou123@gmail.comPurpose: This study aimed to investigate associations of physical activity time (PAT) and sitting time (ST) independently and jointly with insomnia, depressive and anxiety symptoms among Chinese adolescents in the context of COVID-19.Methods: A cross-sectional study including 965 adolescents (mean age = 15.26, SD = 0.46) was conducted in May 2020. PAT, ST and the symptoms of insomnia, depression and anxiety were assessed with the International Physical Activity Questionnaire Short Form, the Youth Self-Rating Insomnia Scales, the 9-item Patient Health Questionnaire and the Generalized Anxiety Disorder scale via an online survey platform. Logistic regression was used to analyze the association between COVID-19-related fear, PAT, ST and combinations of PAT and ST with insomnia, depressive and anxiety symptoms.Results: COVID-19-related fear was associated with higher odds of insomnia, depressive and anxiety symptoms. PAT was associated with lower odds of insomnia and depressive symptoms, while ST was associated with higher odds of these three symptoms. After combining PAT and ST, the group with both low PAT and high ST was set as the referent. For insomnia, groups with low ST reported significantly lower odds of symptoms. For depression, groups with high PAT and/or low ST reported lower odds of symptoms. Regarding anxiety, only the group with both high PAT and low ST reported lower odds of symptoms. Generally, group with both high PAT and low ST reported lower odds of the three symptoms than the referent.Conclusion: COVID-19-related fear was a risk factor for developing insomnia, depressive and anxiety symptoms among Chinese adolescents. Fortunately, moving more and sitting less were good for sleep and mental health in Chinese adolescents during the pandemic. Educators should help adolescents to be more physically active in their daily life in the primary prevention of adolescent insomnia, depression and anxiety.Keywords: exercise, physical activity, sedentary behavior, sleep, mental health