Revista Adolescência e Saúde

Revista Oficial do Núcleo de Estudos da Saúde do Adolescente / UERJ

NESA Publicação oficial
ISSN: 2177-5281 (Online)

Vol. 14 nº 4 - Oct/Dec - 2017

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Páginas 150 a 156


Sleep, health perception and physical activity in university adolescents

Sueño, percepción de salud y actividad física en adolescentes universitarios

Sono, percepção de saúde e atividade física em adolescentes universitários

Autores: Rubian Diego Andrade1; Érico Pereira Gomes Felden2; Clarissa Steffani Teixeira3; Andreia Pelegrinil4

1. Doctor in Human Movement Sciences. Master in Science of Human Movement from the State University of Santa Catarina (UDESC). Florianópolis, SC, Brazil
2. PhD in Physical Education from the Federal University of Paraná (UFPR). Adjunct Professor of the State University of Santa Catarina (UDESC). Florianópolis, SC, Brazil
3. Ph.D. PhD in Production Engineering. Adjunct Professor, Department of Knowledge Engineering, Federal University of Santa Catarina (UFSC). Florianópolis, SC, Brazil
4. PhD in Physical Education, Federal University of Santa Catarina (UFSC). Florianópolis, SC, Brazil. Adjunct Professor, Department of Physical Education, State University of Santa Catarina (UDESC). Florianópolis, SC, Brazil

Correspondência
Érico Pereira Gomes Pereira
Universidade do Estado de Santa Catarina (UDESC), Centro de Ciências da Saúde e do Esporte (CEFID)
Rua Paschoal Simoni, 358, Coqueiros
Florianópolis, SC, Brasil. CEP: 88080-350
ericofelden@gmail.com

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Keywords: Motor activity, health status, adolescent health, sleep.
Palabra Clave: Actividad motriz, nivel de salud, salud del adolescente, sueño.
Descritores: Atividade motora, nível de saúde, saúde do adolescente, sono.

Abstract:
OBJECTIVE: This study aimed to analyze sleep and physical activity indicators according to self-reported health in university adolescents.
METHODS: 84 adolescents participated in the study with ages between 17-21 years (52.4% boys), who answered questionnaires with inquiries about sleep, physical activity and self-reported health.
RESULTS: The average sleep duration was 7.2 (1.4) hours and 56.3% were classified as insufficiently active. Among the adolescents surveyed, 57.8% and 28.9% have good and excellent perception of their health, respectively, only 13.3% perceived it as regular. Academics with longer sleep duration showed more positive perception of their health (p=0.010), as well as those with more time devoted to vigorous physical activity (p=0.002). Nonetheless, sleep duration and time of physical activity, moderate (p=0.902) or vigorous (p=0.738), were not correlated.
CONCLUSION: Sleep duration and length of physical activity are important factors for a positive self-reported health. However, both variables have complex relationships that could not be explained by direct correlations. Moreover, vigorous physical activity seems to be more relevant to a positive perception of health.

Resumen:
OBJETIVO: El presente estudio tuvo como objetivo analizar indicadores de sueño y actividad física de acuerdo con la percepción de salud en adolescentes universitarios.
MÉTODOS: Participaron del estudio 84 adolescentes con edades de 17 a 21 años (52,4% jóvenes), los cueles respondieron a cuestionarios con preguntas sobre sueño, actividad física y percepción de salud.
RESULTADOS: El promedio de duración de sueño fue de 7,2 (1,4) horas y 56,3% fueron clasificados como insuficientemente activos. De los adolescentes investigados, 57,8% y 28,9% poseen una percepción buena y excelente de su salud, respectivamente, y apenas 13,3% la percibieron como regular. Académicos con mayor duración de sueño presentaron percepción más positiva de su salud (p=0,010), así como aquellos con mayor tiempo dedicado a las actividades físicas vigorosas (p=0,002). A pesar de eso, la duración del sueño y el tiempo de actividades físicas moderadas (p=0,902) o vigorosas (p=0,738) no presentaron correlación significativa.
CONCLUSIÓN: Duración del sueño y tiempo de actividad física son factores relevantes para una percepción positiva de salud. Sin embargo, ambas variables poseen relaciones complejas y no pudieron ser explicadas por correlaciones directas. Además de eso, la actividad física vigorosa parece ser más relevante para una percepción positiva de salud.

Resumo:
OBJETIVO: O presente estudo teve como objetivo analisar indicadores de sono e atividade física de acordo com a percepção de saúde em adolescentes universitários.
MÉTODOS: Participaram do estudo 84 adolescentes com idades de 17 a 21 anos (52,4% rapazes), os quais responderam a questionários com perguntas sobre sono, atividade física e percepção de saúde.
RESULTADOS: A média da duração do sono foi de 7,2 (1,4) horas e 56,3% foram classificados como insuficientemente ativos. Dos adolescentes investigados, 57,8% e 28,9% possuem uma percepção boa e excelente da sua saúde, respectivamente, e apenas 13,3% a perceberam como regular. Acadêmicos com maior duração de sono apresentaram percepção mais positiva de sua saúde (p=0,010), assim como aqueles com maior tempo dedicado às atividades físicas vigorosas (p=0,002). Apesar disso, a duração do sono e o tempo de atividades físicas moderadas (p=0,902) ou vigorosas (p=0,738) não apresentaram correlação significativa.
CONCLUSÃO: Duração do sono e tempo de atividade física são fatores relevantes para uma percepção positiva de saúde. No entanto, ambas as variáveis possuem relações complexas não puderam ser explicadas por correlações diretas. Além disso, a atividade física vigorosa parece ser mais relevante para uma percepção positiva de saúde.

INTRODUCTION

Sleep is one of the most relevant physiological functions for the life and health of people. During sleep, numerous physiological processes essential for survival are performed including the secretion of neurohormones1, memory consolidation1,2 and the organization of neural networks3. In addition, although sleep presents a biological rhythm regulated basically by endogenous factors, several environmental and behavioral factors may influence or regulate the expression of this and other cyclic rhythms4-7.

In this context, different expressions of the wake-sleep cycle can be verified in different phases of life. The study by Carskadon et al.8 reported that important changes in the wake-sleep cycle occur, such as the biological process called delayed sleep phase in adolescence, which is characterized by later hours, both at bedtime and wakefulness. This, coupled with the onset of school activities and the use of media at night, can have important reductions in sleep duration until late adolescence.

Physical activity is indicated as a potential factor related to sleep, but the results of this association are divergent. Among the most accepted theories to explain this possible relationship is the thesis that physical exercise would lead to changes in body temperature6 which would imply the possibility of physical exercise, especially the aerobic, to assume the role of a non-photic synchronizer of biological rhythms, including sleep7.

In view of this, it can be pointed out that the relationships between health, sleep and physical activity, especially in adolescence, constitute an important knowledge gap to be filled considering the possibilities of intervention that such relationships can contribute to the planning and execution of interventions. It is important to discuss possible differences in the relationships between sleep and physical activity according to the intensity of these activities. Thus, the objective of this study was to analyze sleep and physical activity indicators according to the perception of health in adolescents entering university higher education.


METHODS

Participating in the study were recent university students in the Bachelor's and Bachelor's degrees in Physical Education of a public university in the South of Brazil in the academic semesters 2012.2 and 2013.1. In these semesters, 120 undergraduates entered the courses. Of these, the sample comprised 84 university students present on the day of the class in which the collection was made and who answered correctly the questionnaires. In addition, only those aged 17 to 21 years were included in the sample.

The project was analyzed and approved by the Committee of Ethics in Research with Human Beings of the institution of origin (Opinion No. 83192/2012). This research was conducted in accordance with Resolution 466/12 of the National Health Council of the Ministry of Health that establishes criteria for research involving human beings. The academics were previously informed about the objectives and procedures of the study and signed the Free and Informed Consent Term.Participants were asked to respond to questionnaires with questions related to their perception of health, sleep habits, and physical activity.

The study participants were allocated in three age groups considering the distribution of data: 17 and 18 years, 19 and 20 years, and 21 years. In addition, the students were analyzed according to the shift of the upper course (morning or night).

The duration of sleep was quantified by considering the sleeping and waking hours during the school days. Adolescents with less than eight hours of sleep were classified with low duration according to recommendations of Perez-Chada et al. 8and Pereira et al.9. The perception of sleep quality was investigated from the question "during the last thirty days (in general) how would you rate the quality of your sleep?" Having as alternatives: "very good", "good", "bad" and " too bad". For the classification of poor sleep quality we considered the answers to the alternatives "bad" and "very bad".

The students were classified in different chronotypes according to the individual preference for morning and night periods through the questionnaire already validated for Brazil10 composed of 19 questions that involve daily life situations and personal preference for carrying out these activities. His score varies from 16 to 86 points, classifying the individual in evening, morning or indifferent.

The level of physical activity was evaluated through the short version of the International Physical Activity Questionnaire (IPAQ), in which the individuals indicated the number of days and minutes of moderate and vigorous physical activity, which were classified by the total time in minutes per week11. The cut-off point of 300 minutes was considered in vigorous and moderate physical activities to identify the under-active subjects12-13. Finally, health perception was investigated through the question "how do you rate your current health status?" Considering the "excellent", "good", "fair", or "bad" answers.

The data collected were first analyzed through descriptive statistics (frequency distribution, mean and standard deviation). The differences between averages were calculated using the Kruskal-wallis test, with post-hoc analysis using the Dunntest, and the associations between proportions using the Chi-square test. For analyzes with an expected frequency of less than five Fisher's Exact Test was used . The statistical program SPSS 20.0 was used and a statistical significance level of 5% was adopted for all statistical analyzes.


RESULTS

The investigated group had an average age of 18.4 (1.2) years, being 52.4% male. The majority of college students (52.4%) attend the morning shift and the rest at night (47.6%). The average sleep duration was 7.2 (1.4) hours on the days with class. It was identified that 87.7% of university students had low sleep duration (less than 8 hours of sleep per night) and 34.6% had low sleep quality. Regarding physical activity, it was verified that college students performed, on average, 161.8 (218.0) minutes of moderate physical activity per week, 145.5 (216.5) minutes of vigorous physical activity per week and one total of 309.0 (333.7) minutes per week. Considering the cut-off point of 300 minutes of moderate or vigorous physical activities, the percentage of under-active university students was 56.3%. Of the students surveyed, 86.7% perceived their health as good or excellent (Table 1). It is also worth noting that no university student indicated to have "bad" health.




Sleep duration was different between shifts (p <0.001), while night shift students slept 7.8 (1.4) hours, those of the morning shift slept 6.5 (1.1) hours. No differences were observed between the number of minutes in moderate physical activities (p = 0.076) and vigorous (p=0.105) between the shifts. However, when considering the sum of moderate and vigorous physical activities, the difference between the shifts was observed, in which the students of the night shift had a longer time of activity (p=0.041). There were no differences in sleep indicators, health perception and physical activity in the age groups evaluated.

In the analysis of sleep duration and sleep quality in relation to health perception, it was found that university students with greater sleep duration presented a more positive perception of health (excellent) (p=0.010). Regarding poor sleep quality, no differences were observed (Table 2).




In the analyzes of the duration of physical activity, considering the moderate and vigorous intensities, it was verified that only the vigorous physical activity presented differences between the categories of health perception (p=0.002) (Figure 1). With post-hoc analysis, the differences were more evident between the excellent and regular categories, that is, university students with positive health perception (excellent) participate in a greater amount of vigorous physical activities when compared to those with negative health perception (regular). As for moderate physical activity, this difference was not observed (p=0.842). There were also no associations between the chronotype, considering both the health perception and the level and intensity of physical activities.



Figure 1. Vigorous physical activity regarding the categories of health perception in university adolescents.



DISCUSSION

This study aimed to analyze sleep and physical activity indicators according to the health perception in university students entering higher education. Both sleep 4 and physical activity have proven importance for good health, but their relationships are not yet clear in the literature. In addition, the interrelationships of these variables with the general perception of health can contribute to a better understanding of the importance of sleep and physical activity in people's lives.

The results of the sleep analysis pointed to a low sleep duration in most of the university students (87%), which refers to the need to increase the hours of sleep in the sample as a whole. The prevalence of low sleep duration observed in university students was higher than those observed in Perez-Chada et al.8 and Bernardo et al.14 that identified prevalence of 49% and 39%, respectively, considering the same cutoff point for hours of sleep. In addition, it was found that night shift students had significantly longer sleep times than those on the morning shift, probably indicating that adolescents with academic appointments in the morning were not able to advance bedtimes.

When analyzing sleep duration in relation to health perception, it was identified that university students with greater sleep duration had a more positive health perception. These results corroborate the findings of Do Young et al.15 who verified that sleep quality was significantly associated with the negative perception of health in 5,226 Chinese students. According to Geiger et al.16, the subjective perception of health is considered a potential predictor of several pathologies and, although there are not many studies available, there seems to be an association between insufficient sleep time and negative health perception. The study by Geiger et al.16 also pointed out that the more days of insufficient sleep, the greater the negative perception of health, thus strengthening the results observed in the university students analyzed.

Regarding the analysis of health perception, it was identified that the majority of university students (86.5%) presented good or excellent health perception. This result corroborates the investigations of Sousa et al.17 that verified in upper secondary students of Santa Catarina, frequencies above 85% of positive perception of health. It should also be noted that in the present study, none of the researchers investigated referred to their health as "bad", and the "negative health" variable was defined only with the "regular" response option.

The prevalence of insufficiently active undergraduates (56.3%) was higher than that observed in studies by Silva et al.18 who identified that approximately 30% of adolescents in the population sample of the state of Santa Catarina were insufficiently active. In addition, the results observed also diverge from the findings of Sousa et al.17 e Silva et al.18 the association between physical activity and health perception was not found. Nevertheless, the present study advanced in these analyzes investigating separately the levels of physical activity being observed that the university adolescents with greater amount of vigorous physical activity presented a more positive perception of health.

The results observed by Page et al.19 reinforce the observed difference between vigorous physical activity and positive health perception, since it identified that Thai adolescents who performed more intense physical sports activities presented lower frequencies of negative perception of health. The results observed in the analyzed students also corroborate with those observed by Janssen and Ross20, who verified superior effects of vigorous physical activity compared to moderate in the control of the metabolic syndrome.

In the present study, no differences were identified between physical activity and sleep. Regarding this theme, the literature suggests that regular physical activity presents a favorable practice for sleep habits7. Despite this, studies that seek to correlate sleep and physical activity variables still find some barriers, indicating the need for deepening the details of the sample and the real effect of interventions based on the practice of physical activities considering different intensities.

The main limitations of the study are the number of adolescents investigated and the fact that they belong to only one undergraduate course, which should be improved in future investigations. In addition, comparative analyzes between subjective perception of health, physical activity by means of objective measurements and sleep evaluations using actimeter and polysomnography may indicate with greater clarity the value of this question in sleep investigations and even in clinical practice.


CONCLUSION

Both sleep duration and physical activity practice were shown to be relevant factors for a positive perception of health. However, both variables have a complex relationship and can´t be explained by a direct association between sleep duration and time of physical activity. In addition, vigorous physical activity seems to be more relevant to a positive perception of health. It is necessary to deepen the studies of the association between sleep and physical activities, which need to be more rigorous in detailing issues such as behavioral characteristics (if they have, for example, low or high sleep duration), physical activity practices in leisure, work and displacement, type and intensity of physical activity, schedules and environments in which physical activities are performed, among others.


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