Associations of Physical Activity, Sedentary Behavior, and Sleep with Risk of Incident Parkinson’s Disease: A Prospective Cohort Study of 401,697 Participants
Authors:
Haishan Jiao¹, Shuyi Huang¹, Wei Cheng²,³,⁴,⁵, Jianfeng Feng²,³, Jintai Yu¹,²
Affiliations:
¹Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai 200040, China;
²Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai 200433, China;
³Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Ministry of Education, Shanghai 200433, China;
⁴Fudan ISTBI-ZJNU Algorithm Centre for Brain-Inspired Intelligence, Zhejiang Normal University, Jinhua, Zhejiang 321004, China;
⁵Shanghai Medical College and Zhongshan Hospital Immunotherapy Technology Transfer Center, Shanghai 200032, China
Introduction
Parkinson’s disease (PD) is a progressive neurodegenerative disorder characterized by the loss of dopaminergic neurons, affecting approximately 6.1 million individuals worldwide. It imposes a significant burden on society, both economically and socially. While therapeutic interventions exist to manage PD and its complications, there is growing interest in understanding how lifestyle factors, such as physical activity (PA), sedentary behavior (SB), and sleep, may influence the risk of developing PD. Observational studies have suggested that these lifestyle factors may play a role in PD prevention and management, but the evidence remains inconclusive.
This study aimed to examine the independent and joint associations of PA, SB, and sleep duration with the risk of incident PD in a large-scale prospective cohort. The research utilized data from the UK Biobank (UKB), a population-based cohort of over 500,000 individuals aged 37 to 73 years, enrolled between 2006 and 2010. The findings provide valuable insights into how modifiable behaviors may influence PD risk and offer potential strategies for prevention.
Methods
Study Population
The study analyzed data from 401,697 participants in the UK Biobank cohort after excluding individuals with missing baseline or follow-up data, as well as outliers. Participants were followed from their baseline assessment until the first diagnosis of PD, death, loss to follow-up, or the last available date with health records, whichever occurred first. PD diagnoses were identified using the International Classification of Diseases coding system (G20) from hospital inpatient records and death registries.
Exposure Measurements
Physical activity (PA) was measured using a modified version of the International Physical Activity Questionnaire (IPAQ), with activity levels categorized into low, moderate, and high based on metabolic equivalents (METs). Sedentary behavior (SB) was defined as the total number of hours spent on television (TV) viewing and computer use per day, excluding work-related computer use. Sleep duration was self-reported and categorized into low (0–6 hours), moderate (7 hours), and high (>8 hours) groups.
Statistical Analysis
Cox proportional hazards regression models were used to estimate the associations between PA, SB, sleep duration, and PD risk. Restricted cubic spline models were employed to test for linear and non-linear relationships. Sensitivity analyses were conducted to adjust for covariates such as age, sex, education, Townsend deprivation index (TDI), body mass index (BMI), smoking status, and alcohol intake. Stratified analyses were performed based on age and sex to explore potential differences in associations.
Results
Baseline Characteristics
The study included 401,697 participants, with 3,030 incident cases of PD identified over a median follow-up of 7.7 years. The mean age at enrollment was 57 years, and the mean age at PD diagnosis was 63 years. Participants with PD were more likely to be male, have lower education levels, and report higher TV viewing and sleep duration compared to those without PD.
Independent Associations
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Physical Activity:
- High total physical activity (TPA) was associated with an 18% lower risk of PD (HR, 0.82; 95% CI, 0.75–0.90) compared to low TPA.
- High leisure-time physical activity (LTPA) was associated with a 22% lower risk of PD (HR, 0.78; 95% CI, 0.71–0.86) compared to low LTPA.
- For every 600 MET-min/week increase in TPA and LTPA, the risk of PD decreased by 2% and 5%, respectively.
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Sedentary Behavior:
- Total SB time was not significantly associated with PD risk.
- High TV viewing (>3 hours/day) was associated with a 12% higher risk of PD (HR, 1.12; 95% CI, 1.02–1.22) compared to low TV viewing.
- Low computer use (0 hours/day) was associated with a 14% higher risk of PD (HR, 1.14; 95% CI, 1.04–1.26) compared to moderate use (1 hour/day).
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Sleep Duration:
- High sleep duration (>8 hours/day) was associated with a 14% higher risk of PD (HR, 1.14; 95% CI, 1.05–1.24) compared to moderate sleep duration (7 hours/day).
Joint Associations
The study explored the combined effects of PA, SB, and sleep on PD risk:
- A combination of moderate sleep (7 hours/day), moderate-to-high computer use (≥1 hour/day), and moderate-to-vigorous LTPA (≥400 MET-min/week) was associated with the lowest PD risk (HR, 0.70; 95% CI, 0.57–0.85).
- Similarly, moderate sleep, moderate-to-low TV viewing (≤3 hours/day), and moderate-to-vigorous LTPA were associated with a 28% lower PD risk (HR, 0.72; 95% CI, 0.60–0.87).
Sensitivity and Stratified Analyses
The associations remained consistent after adjusting for additional covariates and excluding participants with less than 3 years of follow-up. Stratified analyses revealed that the protective effects of PA were more pronounced in males and older adults (≥60 years). Sleep and SB associations were also stronger in older adults.
Discussion
This study is the largest prospective cohort study to date examining the associations of PA, SB, and sleep with PD risk. The findings highlight the importance of maintaining an active lifestyle, reducing sedentary time, and achieving moderate sleep duration for PD prevention.
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Physical Activity:
The inverse association between PA and PD risk aligns with previous studies, suggesting that PA may have neuroprotective effects through mechanisms such as reducing inflammation, oxidative stress, and enhancing dopamine release. The gender disparity in PA effects may be due to differences in estrogen-related dopamine metabolism and anti-neuroinflammation. -
Sedentary Behavior:
The study found that excessive TV viewing increased PD risk, while moderate computer use was protective. This suggests that the type of sedentary activity matters, with mentally engaging activities like computer use potentially offering cognitive benefits. -
Sleep Duration:
The J-shaped relationship between sleep and PD risk indicates that both insufficient and excessive sleep may be detrimental. Sleep disturbances are common in PD and may contribute to disease progression through mechanisms such as neuroinflammation and oxidative stress. -
Joint Effects:
The combination of moderate sleep, moderate-to-high computer use, and moderate-to-vigorous PA was associated with the lowest PD risk. This underscores the importance of a balanced lifestyle that incorporates physical, mental, and restorative activities.
Limitations
- Self-reported exposure data may introduce measurement bias.
- The UK Biobank cohort is predominantly White, limiting the generalizability of findings to other populations.
- Approximately 13.8% of participants were excluded due to missing follow-up data, though this is unlikely to introduce significant bias.
- The possibility of reverse causality cannot be entirely ruled out, as the prodromal phase of PD may start years before diagnosis.
Conclusion
This study provides robust evidence that physical activity, sedentary behavior, and sleep duration are independently and jointly associated with the risk of Parkinson’s disease. Engaging in regular physical activity, reducing TV viewing, and maintaining moderate sleep duration may lower PD risk. These findings emphasize the potential for lifestyle modifications to play a role in PD prevention and promote healthier aging.
DOI: doi.org/10.1097/CM9.0000000000003399
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