Association between sleep quality and physical activity in postpartum women

Published:September 12, 2019DOI:



      To describe sleep quality and sleep duration in primiparous women 6 months postpartum and to determine whether sleep quality is associated with 24-hour physical activity assessed using triaxial wrist accelerometry and a novel analytic technique, functional data analysis (FDA).


      Six months postpartum, participants wore a triaxial wrist accelerometer for 7 days and completed the Pittsburgh Sleep Quality Index (PSQI). We categorized sleep quality as good (score ≤5) or poor (>5). Data were summarized as vector magnitude of accelerations net of local gravity, or “Euclidean Norm Minus One” (ENMO, mg), in 5-second epochs. Using FDA, we modeled ENMO as a continuously changing, functional outcome predicted by sleep quality. We also compared mean total ENMO per 24-hour day, mean minutes of moderate to vigorous physical activity (MVPA) and of light activity/day, and mean minutes of MVPA in 10-minute bouts/day by sleep quality.


      Of 365 women that completed the PSQI, 215 (59%) reported poor sleep quality. Two hundred ninety-six women completed both the PSQI and valid accelerometry. With the exception of one brief period around noon, sleep quality was not significantly associated with 24-hour physical activity according to FDA. Women with poor sleep quality had slightly greater total mean activity, minutes of light activity, and minutes of MVPA per day, but no difference in minutes of MVPA in at least 10-minute bouts.


      Poor sleep quality is common 6 months postpartum. We identified no clinically significant differences in physical activity metrics between women with good and poor quality sleep.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Sleep Health: Journal of the National Sleep Foundation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • US Department of Health and Human Services
        Physical Activity Guidelines for Americans.
        2nd ed. US Dept of Health and Human Services, Washington, DC2018
        • Shelton S.L.
        • Lee S.S.
        Women's self-reported factors that influence their postpartum exercise levels.
        Nurs Womens Health. 2018; 22: 148-157
        • Evenson K.R.
        • Herring A.H.
        • Wen F.
        Self-reported and objectively measured physical activity among cohort of postpartum women: the PIN postpartum study.
        J Phys Act Health. 2012; 9: 5-20
        • Horiuchi S.
        • Nishihara K.
        Analyses of mothers' sleep logs in postpartum periods.
        Psychiatry Clin Neurosci. 1999; 53: 137-139
        • Lee K.A.
        • McEnany G.
        • Zaffke M.E.
        REM sleep and mood state in childbearing women: sleepy or weepy?.
        Sleep. 2000; 23: 877-885
        • Lawson A.
        • Murphy K.E.
        Relationship between sleep and postpartum mental disorders: a systematic review.
        J Affect Disorder. 2015; 176: 65-77
        • Yang C.L.
        • Chen C.H.
        Effectiveness of aerobic gymnastic exercise on stress, fatigue, and sleep quality during postpartum: a pilot randomized controlled trial.
        Int J Nurs Stud. 2018; 77: 1-7
        • Pettee Gabriel K.
        • Sternfeld B.
        • Shiroma E.J.
        • Pérez A.
        • Cheung J.
        • Lee I.M.
        Bidirectional associations of accelerometer-determined sedentary behavior and physical activity with reported time in bed: Women's Health Study.
        Sleep Health. 2017; 3: 49-55
        • Holfeld B.
        • Ruthig J.C.
        A longitudinal examination of sleep quality and physical actually in older adults.
        J Appl Gerontol. 2014; 33: 791-807
      1. 2018 Physical Activity Guidelines Advisory Committee. 2018 Physical Activity Guidelines Advisory Committee Scientific Report. Washington, DC: US Department of Health and Human Services; 2018.

        • Okun M.L.
        Distrubed sleep and postpartum depression.
        Curr Psychiatry Rep. 2016; 18: 66
        • Bassett D.R.
        • Troiano R.P.
        • McClain J.J.
        • Wolff D.L.
        Accelerometer-based physical activity: total volume per day and standardized measures.
        Med Sci Sports Exerc. 2015; 47: 833-838
        • Rosenberger M.E.
        • Fulton J.E.
        • Buman M.P.
        • Troiano R.P.
        • Grandner M.A.
        • Buchner D.M.
        • Haskell W.L.
        The 24-hour activity cycle: a new paradigm for physical activity.
        Med Sci Sports Exerc. 2019; 51: 454-464
        • Nygaard I.E.
        • Clark E.
        • Clark L.
        • et al.
        Physical and cultural determinants of postpartum pelvic floor support and symptoms following a vaginal delivery: a protocol for a mixed-methods prospective cohort study.
        BMJ Open. 2017; 7: 113
        • Buysse D.J.
        • Reynolds C.F.
        • Monk T.H.
        • Berman S.R.
        • Kupfer D.J.
        The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research.
        Psychiatry Res. 1989; 28: 193-213
        • Dolan S.H.
        • Williams D.P.
        • Ainsworth B.E.
        • Shaw J.M.
        Development and reproducibility of the bone loading history questionnaire.
        Med Sci Sports Exerc. 2006; 38: 1121-1131
        • Wolpern A.E.
        • Sherwin K.J.
        • Moss W.D.
        • et al.
        Compliance with wrist-worn accelerometers in primiparous early postpartum women.
        Heliyon. 2019; 5
        • Troiano R.P.
        • McClain J.J.
        • Brychta R.J.
        • Chen K.Y.
        Evolution of accelerometer methods for physical activity research.
        Br J Sports Med. 2014; 48: 1019-1023
        • van Hees V.T.
        • Gorzelniak L.
        • Dean Leon E.C.
        • et al.
        Separating movement and gravity components in an acceleration signal and implications for the assessment of human daily physical activity.
        PLoS One. 2013; 8e61691
        • Rowlands A.V.
        • Cliff D.P.
        • Fairclough S.J.
        • et al.
        Moving forward with backward compatibility: translating wrist accelerometer data.
        Med Sci Sports Exerc. 2016; 48: 2142-2149
        • Bakrania K.
        • Yates T.
        • Rowlands A.V.
        • Esliger D.W.
        • Bunnewell S.
        • Sanders J.
        • Davies M.
        • Khunti K.
        • Edwardson C.L.
        Intensity thresholds on raw acceleration data: Euclidean norm minus one (ENMO) and mean amplitude deviation (MAD) approaches.
        PLoS ONE. 2016; 11e016045
        • Hildebrand M.
        • Van Hees V.T.
        • Hansen B.H.
        • Ekelund U.
        Age group comparability of raw accelerometer output from wrist- and hip-worn monitors.
        Med Sci Sports Exerc. 2014; 46: 1816-1824
        • Ramsay R.
        • Hooker G.
        • Graves S.
        Functional Data Analysis with R and MATLAB.
        Springer, New York, NY2009
        • Vladutiu C.J.
        • Evenson K.R.
        • Borodulin K.
        • Deng Y.
        • Dole N.
        The association between physical activity and maternal sleep during the postpartum period.
        Matern Child Health J. 2014; 18: 2106-2114
        • Semplonius T.
        • Willoughby T.
        Long-term links between physical activity and sleep quality.
        Med Sci Sports Exerc. 2018; 50: 2418-2424
        • Mitchell J.A.
        • Godbole S.
        • Moran K.
        No evidence of reciprocal associations between daily sleep and physical activity.
        Med Sci Sports Exerc. 2016; 48: 1950-1956
        • Štefan L.
        • Sporiš G.
        • Krističević T.
        The associations between sleep duration and sleep quality with self-rated health in young adults: a population-based study.
        Int J Adolesc Med Health. 2018;
        • Silva-Costa A.
        • Griep R.H.
        • Rotenberg L.
        Associations of a short sleep duration, insufficient sleep, and insomnia with self-rated health among nurses.
        PLoS One. 2015; 10e0126844 eCollection 2015
      2. Facco FL, Grobman WA, Reid KJ, et al. Objectively measured short sleep duration and later sleeping midpoint in pregnancy are associated with a higher risk of gestational diabetes. Am J Obstet Gynecol 2017;217(4):447.e1-447.e13. doi:

      Linked Article