Understanding the Positive Associations of Sleep, Physical Activity, Fruit and Vegetable Intake as Predictors of Quality of Life and Subjective Health Across Age Groups: A Theory Based, Cross-Sectional Web-Based Study

Background: Due to the increase in unhealthy lifestyles and associated health risks, the promotion of healthy lifestyles to improve the prevention of non-communicable diseases is imperative. Thus, research aiming to identify strategies to modify health behaviors has been encouraged. Little is known about addressing multiple health behaviors across age groups (i.e., young, middle-aged, and older adults) and the underlying mechanisms. The theoretical framework of this study is Compensatory Carry-Over Action Model which postulates that different health behaviors (i.e., physical activity and fruit and vegetable intake) are interrelated, and they are driven by underlying mechanisms (more details in the main text). Additionally, restful sleep as one of the main indicators of good sleep quality has been suggested as a mechanism that relates to other health behaviors and well-being, and should therefore also be investigated within this study. The present study aims to identify the interrelations of restful sleep, physical activity, fruit and vegetable intake, and their associations with sleep quality as well as overall quality of life and subjective health in different age groups. Methods: A web-based cross-sectional study was conducted in Germany and the Netherlands. 790 participants aged 20-85 years filled in the web-based baseline questionnaire about their restful sleep, physical activity, fruit and vegetable intake, sleep quality, quality of life, and subjective health. Descriptive analysis, multivariate analysis of covariance, path analysis, and multi-group analysis were conducted. Results: Restful sleep, physical activity, and fruit and vegetable intake were associated with increased sleep quality, which in turn was associated with increased overall quality of life and subjective health. The path analysis model fitted the data well, and there were age-group differences regarding multiple health behaviors and sleep quality, quality of life, and subjective health. Compared to young and older adults, middle-aged adults showed poorest sleep quality and overall quality of life and subjective health, which were associated with less engagement in multiple health behaviors. Conclusion: A better understanding of age-group differences in clustering of health behaviors may set the stage for designing effective customized age-specific interventions to improve health and well-being in general and clinical settings.