The purpose of this paper was to determine whether participation in high school sports was associated with concurrently and independently achieving the recommended levels of sleep and physical activity among a nationally representative sample of American adolescents. Significant associations were found between sports participation and meeting sleep and physical activity (aerobic and muscle-strengthening) guidelines. Furthermore, a dose-response relation was seen for the number of sports played in the past year and the relative odds of meeting all three guidelines, with a strong association between sports participation and meeting physical activity guidelines.
The significant associations for sports participation and meeting guidelines align with those from a study by Mäkelä et al, who compared physical activity, sleep time, and screen time between Finnish sports club participants and non-participants (ages 14–16).(15) They found that sports participants (versus non-participants) had significantly higher odds of meeting aerobic physical activity guidelines, sleeping ≥ 9 hours on the weekends, and having < 2 hours daily screen time. Sports provide an opportunity for youth to be physically active, so it follows that students who participate in sports have been found to be more likely to meet aerobic physical activity guidelines than non-participants.(16) Further, it has been found that adolescents with higher (versus lower) physical activity levels are more likely to have better sleep quality and quantity,(6) including among athletes versus non-athletes,(17–20) which also aligns with the presented findings. The strong association between sports participation and meeting muscle-strengthening guidelines may be due to more opportunities for athletes (versus non-athletes) to engage in muscle-strengthening activities within both training and game sessions. Muscle-strengthening activities (e.g., push-ups, sit-ups, weight-lifting) are often incorporated into sports-related training, but are less frequently seen in the other common physical activities that youth engage in outside of sports (e.g., walking, cycling, running).(21)
The association between sports participation and meeting sleep and physical activity guidelines had not previously been examined with consideration for the number of sports played, as done in the present study. The dose-response relationship that emerged for all guidelines among males and all but sleep among females is a valuable contribution to the literature. These findings suggest there are more benefits with playing multiple sports during the year, versus single-sport or non-participation, although additional research is needed to examine whether this dose-response relation holds when adolescents play multiple sports concurrently, versus at different times throughout the year. These findings also suggest that the binary categorization of sports participation (yes/no) often seen in research may not adequately capture this construct, and future research should take this into consideration.
The findings for racial/ethnic and sex differences, with a higher prevalence of sport participation among non-Hispanic whites (versus all other racial/ethnic groups) and among males (versus females), align with those often seen for physical activity levels and sports participation among these sociodemographic groups.(15, 22) However, future research should further examine why such disparities persist within the associations of sports participation and meeting guidelines. For example, although a significant association between sports participation and meeting sleep guidelines was found among males, this association was not significant for females. Increasing the understanding of these sex and racial/ethnic disparities, as well as reducing barriers to sports participation, could help efforts to equitably increase the prevalence of youth sports participation and the associated health benefits.
Strengths and Limitations.
The strengths of this study include the inclusion of a large, population-based sample, which provides external study validity, as well as the use of multiple imputation to address potential bias due to missing data. This study also addresses numerous gaps in the literature. Few studies have examined the association of sports participation with sleep and physical activity, both independently and concurrently. Furthermore, the number of sports played was included in the measure of sports participation, allowing for a greater understanding of its relationship with meeting guidelines – namely, the dose-response relation that emerged. Such findings highlight sports participation as a potential method for addressing the low prevalence of youth meeting sleep and physical activity guidelines. For example, although sleep interventions have been implemented among elite athletes,(23) few school-based policies aiming to improve sleep among students exist. However, schools could consider sports participation as a method for increasing sleep quantity, as well as reducing screen time, among this population.
The limitations of this study must also be noted. First, the YRBS is a cross-sectional survey, which limits the ability to make causal inferences between the exposures and outcomes under study. Second, the self-reported items in YRBS are prone to recall bias and potential social desirability bias. Third, the YRBS does not contain a measure of socioeconomic status (SES) so it was not possible to examine potential differences by SES. Fourth, the time-frame recall was different for physical activity (past 7 days), sleep (average for school night), and sports participation (past 12 months), and it was not possible to determine if any of the sports were played concurrently. However, although some respondents classified as sports participants may not have been actively engaged in sports at the time of the survey, significant associations were found. This could suggest that sports participants are engaging in healthy sleep and physical activity behaviors during non-sport periods as well, although additional research is needed to explore this hypothesis. Finally, neither the sport type nor competitive level (e.g., recreational, club, etc.) were included within the YRBS, and findings may differ across these groups due to the variations in intensity.(24) This may have also played a role in the disparities seen for sex, considering the distribution of males and females across sports played and level of participation.(22) Future research could expand on the few studies examining youth demographics by type of sport, with additional consideration for its role in the association of sports participation and meeting guidelines.
The reported findings demonstrate significant associations of sports participation and achieving the recommended levels of sleep and physical activity (both independently and concurrently). Efforts to increase the prevalence of youth meeting guidelines should consider promoting sports participation while reducing barriers to participate, particularly among females and racial/ethnic minorities. Practitioners can respond to concerns from parents and youth about potential risk of injury by emphasizing the benefits of sports participation, including those related to screen time and mental and physical health.