Associations between emotional/behavioral problems and physical activity among Chinese adolescents: the mediating role of sleep quality

This study aimed to investigate the associations of emotional and behavioral problems with physical activity (PA), as well as the mediated role of sleep quality in these associations. Additionally, we also examined whether sex-based disparity could be observed in the aforementioned associations. A multi-stage random cluster sampling method was adopted to recruit 15,071 adolescents (response rate: 99.8%) from 20 junior and senior high schools across 10 districts in Guangzhou, China. Information on emotional and behavioral problems, sleep quality, and PA were collected. Generalized linear mixed models and mediation analyses were utilized for analysis. Results showed that after adjusting for significant covariates, emotional and behavioral problems were found to be negatively associated with PA scores (β estimate = -0.019, 95% CI: -0.021 to -0.017). Among the various emotional and behavioral problems examined, hyperactivity exhibited a greater impact on PA among girls than boys, while peer problems showed the opposite trend in boys (P < 0.05). Sleep quality partially mediated the association between emotional/behavioral problems and PA scores (indirect effect = -0.006, 95% CI: -0.007 to -0.005), with the most considerable mediating effect observed in the relationship between emotional symptoms and PA scores (38.7%). This mediating effect of sleep quality was similarly observed in both boys and girls. These findings highlight the importance of mitigating emotional and behavioral problems as well as improving sleep quality, which could contribute positively to increased levels of PA among adolescents.