Physical Activity, Sedentary Behavior, and Sleep in Sexual and Gender Minority Adults: A Systematic Review With Meta-Analysis.

Background: Sexual and gender minority adults experience health inequities, including poorer health and reduced participation in health-promoting behaviors. This systematic review aims to (1) examine adherence to physical activity, sedentary behavior, and sleep guidelines within these communities and (2) compare participation and guideline attainment with cisgender and heterosexual adults.

Methods: Studies published before January 2024 were included if they reported physical activity, sedentary behavior, and/or sleep outcomes for gender and/or sexual minority adults. Proportional meta-analyses were performed using random effects models.

Results: Ninety-five studies were included; 79% were rated "fair" quality. Most studies were cross-sectional (76%), conducted in North America (76%), and focused on sexual orientation (80%) and physical activity (77%). Sexual minority women had higher odds of meeting aerobic physical activity guidelines compared with heterosexual women (odd ratios 1.18; 95% CI, 1.02-1.37), with no significant differences identified between sexual minority and heterosexual men (1.03; 0.86-1.23). Gender minority adults had lower odds of participating in aerobic physical activity compared with cisgender adults (0.63; 0.45-0.88). Sexual minority women, but not men, had lower odds of meeting sleep guidelines than their heterosexual counterparts (0.85; 0.74-0.97). Sedentary behavior data were limited, with no differences detected.

Conclusions: Movement behaviors varied within sexual and gender minority groups, highlighting the limitation of considering the "LGBTQIA+ community" a homogenous cohort. Tailored approaches for improving movement behaviors are warranted, particularly for gender minority adults. Further research is needed for sedentary behavior, sleep, and more nuanced categorizations of gender and sexuality using representative samples.