Day-to-day Relationships between Physical Activity and Sleep Characteristics among People with Heart Failure and Insomnia

Garrett Ash, Sangchoon Jeon, Samantha Conley, Andrea K. Knies, Henry K. Yaggi, Daniel Jacoby, Christopher S. Hollenbeak, Sarah Linsky, Meghan O’Connell, Nancy S. Redeker

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Objective: Examine the bidirectional relationships between within-person day-to-day fluctuations in physical activity (PA) and sleep characteristics among people with heart failure (HF) and insomnia. Participants: Ninety-seven community-dwelling adults [median age 61.9 (interquartile range 55.3,70.9) years, female 41%] with stable HF and insomnia (insomnia severity index >7). Methods: This sub-study longitudinally analyzed 15 consecutive days and nights of wrist actigraphy recordings, that were collected for baseline data prior to participation in a randomized controlled trial of cognitive behavioral therapy for insomnia. We used two-level mixed models of within- (daily) and between-participants variation to predict daytime PA counts/minutes from sleep variables (total sleep time, sleep efficiency) and predict sleep variables from PA. Results: PA counts/minutes were low compared to prior cohorts that did not have HF (209 (166,259)) and negatively associated with NYHA class (standardized coefficient βs = −0.14, p < .01), age (βs = −0.13, p = .01), comorbidities (βs = −0.19, p < .01), and body mass index (βs = −0.12, p = .04). After adjustment for all significant covariates, the within-participant association of total sleep time with next-day PA was estimated to be positive among participants with NYHA class II–IV HF (βs = 0.09, p = .01), while the within-participant association of PA with same-night total sleep time was estimated to be positive among participants aged ≥60 years (βs = 0.10, p = .03). Conclusions: Depending upon age and HF class, daytime PA was associated with longer same-night sleep and/or longer sleep was associated with greater next-day PA. Among those with more advanced HF, realistic sleep improvements were associated with clinically meaningful PA gains the next day.

Original languageEnglish (US)
Pages (from-to)602-614
Number of pages13
JournalBehavioral Sleep Medicine
Issue number5
StatePublished - 2021

All Science Journal Classification (ASJC) codes

  • Neuroscience (miscellaneous)
  • Medicine (miscellaneous)
  • Psychology (miscellaneous)
  • Clinical Neurology


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