Feasibility of a brief sequential sleep and physical activity behavioral intervention in African American adults with overweight or obesity.

Abstract

Background: Short sleep duration and low physical activity commonly co-occur among African American (AA) adults with overweight or obesity and are associated with adverse health outcomes, including type 2 diabetes, coronary heart disease, stroke, and premature mortality. However, limited evidence addresses whether the sequence of sleep and physical activity intervention components is feasible or associated with short-term behavioral outcomes.

Purpose: To evaluate the feasibility of delivering sequential sleep and physical activity interventions in alternate order and to descriptively characterize changes in sleep, sedentary behavior, and moderate-to-vigorous physical activity (MVPA) in a randomized pilot sequencing trial.

Methods: Thirty AA adults with body mass index ≥25 kg m², short sleep duration, and low physical activity were randomized to Sleep → Physical Activity, Physical Activity → Sleep, or a contact-matched control condition. Each active intervention sequence included two 4-week phases separated by a 1-week interval. Assessments at baseline, week 5, and week 9 included 7-day wrist actigraphy, daily sleep diary, online questionnaires, and anthropometrics. Feasibility outcomes included recruitment, retention, adherence, and participant satisfaction. Baseline-adjusted ANCOVA models examined exploratory week 9 outcomes.

Results: Recruitment (75%) approached the prespecified benchmark (80%), retention met the ≥70% benchmark (70% for Sleep → Physical Activity; 100% for Physical Activity → Sleep; 90% for Control), and mean adherence met the ≥66% criterion (66.7% and 91.7%, respectively). No adverse events occurred. Among respondents with available week 9 satisfaction data, ratings of study procedures, materials, and study service were favorable. In exploratory baseline-adjusted models, no condition effects were observed for actigraphy-measured sleep, sedentary time, MVPA, or Pittsburgh Sleep Quality Index global score. Insomnia Severity Index scores at week 9 were lower in Sleep → Physical Activity compared with Physical Activity → Sleep; this finding was exploratory and not adjusted for multiple testing.

Conclusions: Sequential delivery of sleep and physical activity intervention components was feasible in AA adults with overweight or obesity, short sleep duration, and low physical activity. Behavioral outcome findings should be interpreted as hypothesis-generating. Larger trials are needed to evaluate sequencing effects on insomnia symptoms, objective sleep, sedentary behavior, and physical activity.