Exploring Sleep and Physical Activity among Young Adults Across Asia: A Systematic Literature Review
Main Article Content
Abstract
Previous studies have examined the association between sleep and physical activity; however, few have systematically reviewed the studies on young adults in Asia. Therefore, the present study aimed to systematically summarise the research on sleep and physical activity among young adults in Asia and critically assess the methodological quality of existing studies. The review process adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, beginning with research question formulation and systematic searches through identification, screening, and eligibility in the Scopus, PubMed, and ScienceDirect databases. Subsequently, the studies underwent quality appraisal, data extraction, and analysis. Thematic analysis organised the findings into three main themes: i) the prevalence of sleep quality and physical activity in Asia; ii) the association between sleep quality and physical activity; and iii) sleep quality and physical activity during the COVID-19 outbreak. These findings reveal a high prevalence of sleep deprivation and poor sleep quality among young adults in Asia, whereas the prevalence of physical activity varies. Moreover, the COVID-19 outbreak negatively affected sleep quality and physical activity. Therefore, proactive measures should be implemented to improve sleep quality and promote physical activity, thereby improving physical and mental health.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
Al-Musharaf S. Prevalence and predictors of emotional eating among healthy young Saudi women during the COVID-19 pandemic. Nutrients. 2020;12(10):2923. https://doi.org/10.3390/nu12102923
Tao K, Liu W, Xiong S, Ken L, Zeng N, Peng Q, et al. Associations between self-determined motivation, accelerometer-determined physical activity, and quality of life in Chinese college students. Int J Environ Res Public Health. 2019;16(16):2941. https://doi.org/10.3390/ijerph16162941
Nurismadiana I, Lee K. Factors associated with sleep quality among undergraduate students at a Malaysian public university. Int J Public Health Clin Sci. 2018;5(6):373–391. https://doi.org/10.32827/ijphcs.5.6.373
Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, et al. Recommended amount of sleep for a healthy adult: a joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. J Clin Sleep Med. 2015;11(6):591–592. https://doi.org/10.5664/jcsm.4758
Skurvydas A, Zlibinaite L, Solianik R, Brazaitis M, Valanciene D, Baranauskiene N, et al. One night of sleep deprivation impairs executive function but does not affect psychomotor or motor performance. Biol Sport. 2020;37(1):7–14. https://doi.org/10.5114/biolsport.2020.89936
Wang F, Bíró É. Determinants of sleep quality in college students: a literature review. Explore. 2021;17(2):170–177. https://doi.org/10.1016/j.explore.2020.11.003
Chen Q, Dai W, Li G, Ma N. The impact of screen time changes on anxiety during the COVID-19 pandemic: sleep and physical activity as mediators. Sleep Biol Rhythms. 2022;20(4):521–531. https://doi.org/10.1007/s41105-022-00398-1
World Health Organization. WHO guidelines on physical activity and sedentary behavior. Geneva: World Health Organization; 2020.
Park H, Suh B. Association between sleep quality and physical activity according to gender and shift work. J Sleep Res. 2020;29(6):e12924. https://doi.org/10.1111/jsr.12924
World Health Organization. Physical activity. [Internet]. Geneva: World Health Organization; 2024. [Retrieved 2025 Jun 5]. Available at: https://www.who.int/news-room/fact-sheets/detail/physical-activity
Master L, Nye RT, Lee S, Nahmod NG, Mariani S, Hale L, et al. Bidirectional, daily temporal associations between sleep and physical activity in adolescents. Sci Rep. 2019;9:44059. https://doi.org/10.1038/s41598-019-44059-9
Seol J, Lee J, Park I, Tokuyama K, Fukusumi S, Kokubo T, et al. Bidirectional associations between physical activity and sleep in older adults: a multilevel analysis using polysomnography. Sci Rep. 2022;12(1):19841. https://doi.org/10.1038/s41598-022-19841-x
Linnenluecke MK, Marrone M, Singh AK. Conducting systematic literature reviews and bibliometric analyses. Aust J Manag. 2020;45(2):175–194. https://doi.org/10.1177/0312896219877678
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.https://doi.org/10.1136/bmj.n71
Hong QN, Pluye P, Fabregues S, Bartlett G, Boardman F, Cargo M, et al. Mixed methods appraisal tool (MMAT), version 2018. Canada: Canadian Intellectual Property Office, Industry Canada; 2018.
Mohamed Shaffril HA, Samsuddin SF, Abu Samah A. The ABC of systematic literature review: The basic methodological guidance for beginners. Qual Quant. 2021;55(4):1319–1346. https://doi.org/10.1007/s11135-020-01059-6
Kraus S, Breier M, Dasí-Rodríguez S. The art of crafting a systematic literature review in entrepreneurship research. Int Entrep Manag J. 2020;16:1023–1042. https://doi.org/10.1007/s11365-020-00635-4
American Psychological Association. Adulthood. [Internet]. [Retrieved 2025 Apr 20]. Available at: https://dictionary.apa.org/adulthood
Hirshkowitz M, Whiton K, Albert SM, Alessi C, Bruni O, DonCarlos L, et al. National Sleep Foundation’s sleep time duration recommendations: methodology and results summary. Sleep Health. 2015;1(1):40–43. https://doi.org/10.1016/j.sleh.2014.12.010
Ghrouz AK, Noohu MM, Manzar D, Bekele BB, Pandi-Perumal SR, Bahammam AS. Short-term insomnia symptoms are associated with level and not type of physical activity in a sample of Indian college students. J Prev Med Hyg. 2021;62(2):E447–E454.
Ge Y, Xin S, Luan D, Zou Z, Liu M, Bai X, et al. Association of physical activity, sedentary time, and sleep duration on the health-related quality of life of college students in Northeast China. Health Qual Life Outcomes. 2019;17:124. https://doi.org/10.1186/s12955-019-1194-x
Abdulrahman KA, Khalaf AM, Abbas FB, Alanezi OT. The lifestyle of Saudi medical students. Int J Environ Res Public Health. 2021;18(15):7869. https://doi.org/10.3390/ijerph18157869
Albikawi ZF. Perceived stress, physical activity, and insomnia of female nursing university students in Saudi Arabia: a cross-sectional study. Univ J Public Health. 2023;11(1):57–67. https://doi.org/10.13189/ujph.2023.110107
Alkatan M, Alsharji K, Akbar A, Alshareefi A, Alkhalaf S, Alabduljader K, et al. Physical activity and sedentary behaviors among active college students in Kuwait relative to gender status. Kuwait Med J. 2021;62(2):E407–E414.
Pengpid S, Peltzer K. Skipping breakfast and its association with health risk behaviour and mental health among university students in 28 countries. Diabetes Metab Syndr Obes. 2020;13:2889–2897.https://doi.org/10.2147/DMSO.S241670
Park I, Díaz J, Matsumoto S, Iwayama K, Nabekura Y, Ogata H, et al. Exercise improves the quality of slow wave sleep by increasing slow wave stability. Sci Rep. 2021;11:83817. https://doi.org/10.1038/s41598-021-83817-6
Chen H, Zhang G, Wang Z, Feng S, Li H. The associations between daytime physical activity, while-in-bed smartphone use, sleep delay, and sleep quality: a 24-h investigation among Chinese college students. Int J Environ Res Public Health. 2022;19(15):9693. https://doi.org/10.3390/ijerph19159693
Yuan MZ, Chen CC, Chen IS, Yang CC, Hsu CH. Research on the impact of regular exercise behavior of college students on academic stress and sleep quality during the COVID-19 pandemic. Healthcare. 2022;10(12):2534. https://doi.org/10.3390/healthcare10122534
Xu CY, Zhu KT, Ruan XY, Zhu XY, Zhang YS, Tong WX, et al. Effect of physical exercise on sleep quality in college students: mediating role of smartphone use. PLoS One. 2023;18(11):e0288226. https://doi.org/10.1371/journal.pone.0288226
Zhai X, Wu N, Koriyama S, Wang C, Shi M, Huang T, et al. Mediating effect of perceived stress on the association between physical activity and sleep quality among Chinese college students. Int J Environ Res Public Health. 2021;18(1):289. https://doi.org/10.3390/ijerph18010289
Li Y, Guo K. Research on the relationship between physical activity, sleep quality, psychological resilience, and social adaptation among Chinese college students: a cross-sectional study. Front Psychol. 2023;14:1104897. https://doi.org/10.3389/fpsyg.2023.1104897
Li L, Yu Q, Zhao W, Herold F, Cheval B, Kong Z, et al. Physical activity and inhibitory control: The mediating role of sleep quality and sleep efficiency. Brain Sci. 2021;11(5):618. https://doi.org/10.20944/preprints202105.0181.v1
Lu Y, Wiltshire HD, Baker JS, Wang Q. Effects of low-volume high-intensity interval exercise on 24 h movement behaviors in inactive female university students. Int J Environ Res Public Health. 2022;19(12):7177. https://doi.org/10.3390/ijerph19127177
Ezati M, Keshavarz M, Barandouzi ZA, Montazeri A. The effect of regular aerobic exercise on sleep quality and fatigue among female student dormitory residents. BMC Sports Sci Med Rehabil. 2020;12:132. https://doi.org/10.21203/rs.3.rs-1110166/v1
Park JS, Kim YJ, Heo W, Kim S. The study of variation of metabolites by sleep deficiency, and intervention possibility of aerobic exercise. Int J Environ Res Public Health. 2022;19(5):2774. https://doi.org/10.3390/ijerph19052774
Kojima S, Abe T, Morishita S, Inagaki Y, Qin W, Hotta K, et al. Acute moderate-intensity exercise improves 24-h sleep deprivation-induced cognitive decline and cerebral oxygenation: a near-infrared spectroscopy study. Respir Physiol Neurobiol. 2019;265:103354. https://doi.org/10.1016/j.resp.2019.103354
Liu S, Zhang R. Aerobic exercise alleviates the impairment of cognitive control ability induced by sleep deprivation in college students: research based on Go/NoGo Task. Front Psychol. 2022;13:914568. https://doi.org/10.3389/fpsyg.2022.914568
Lu L, Dong M, Jian SY, Gao J, Ye LZ, Chen HR, et al. Sex differences in the factors associated with sleep duration in university students: a cross-sectional study. J Affect Disord. 2021;290:345–352. https://doi.org/10.1016/j.jad.2021.04.025
Mato M, Tsukasaki K. Relationship between breakfast consumption and health-related habits among university students in Japan. Jpn J Public Health. 2020;67(11):791–799.
Pengpid S, Peltzer K. Prevalence and associated factors of skipping breakfast among university students from 28 countries: a cross-sectional study. Int J Adolesc Med Health. 2019;33(5):20190256. https://doi.org/10.1515/ijamh-2019-0256
Haddad M. Physical activity as a mediator between sleep, mental health, and well-being in active individuals. In: Menhas R, editor. Physical activity and sports as preventive medicine for psychosocial health and well-being. IntechOpen; 2025. https://doi.org/10.5772/intechopen.1009111
Wang X, Lei SM, Le S, Yang Y, Zhang B, Yao W, et al. Bidirectional influence of the COVID-19 pandemic lockdowns on health behaviors and quality of life among Chinese adults. Int J Environ Res Public Health. 2020;17(15):5575. https://doi.org/10.3390/ijerph17155575
Zhang Y, Liu J, Zhang Y, Ke L, Liu R. Interactive compensation effects of physical activity and sleep on mental health: a longitudinal panel study among Chinese college students during the COVID-19 pandemic. Int J Environ Res Public Health. 2022;19(19):12323. https://doi.org/10.3390/ijerph191912323
Zhang B, Lei SM, Le S, Gong Q, Cheng S, Wang X. Changes in health behaviors and conditions during COVID-19 pandemic strict campus lockdown among Chinese university students. Front Psychol. 2022;13:1022966. https://doi.org/10.3389/fpsyg.2022.1022966
Hammoudi SF, Mreydem HW, Ali BTA, Saleh NO, Chung S, Hallit S, et al. Smartphone screen time among university students in Lebanon and its association with insomnia, bedtime procrastination, and body mass index during the COVID-19 pandemic: a cross-sectional study. Psychiatry Investig. 2021;18(9):871–878. https://doi.org/10.30773/pi.2021.0120
Iqbal S, Alanazi RF, Alahmed AH, Alnakhli AF, Alghanim MH, Alghamdi MA, et al. Prevalence of sleep disturbance and anxiety due to the COVID-19 pandemic in Saudi Arabia. Sleep Sci. 2021;14(Special 1):56–62. https://doi.org/10.5935/1984-0063.20200079
Xiao P, Chen L, Dong X, Zhao Z, Yu J, Wang D, et al. Anxiety, depression, and satisfaction with life among college students in China: nine months after initiation of the outbreak of COVID-19. Front Psychiatry. 2022;12:777190. https://doi.org/10.3389/fpsyt.2021.777190
Ren Z, Xin Y, Ge J, Zhao Z, Liu D, Ho RCM, et al. Psychological impact of COVID-19 on college students after school reopening: a cross-sectional study based on machine learning. Front Psychol. 2021;12:641806. https://doi.org/10.3389/fpsyg.2021.641806
Hosen I, Mamun F, Mamun MA. The role of sociodemographics, behavioral factors, and internet use behaviors in students’ psychological health amid COVID-19 pandemic in Bangladesh. Health Sci Rep. 2021;4:e398. https://doi.org/10.1002/hsr2.398
Su J, Wei E, Clark C, Liang K, Sun X. Physical exercise, sedentary behaviour, sleep and depression symptoms in Chinese young adults during the COVID-19 pandemic: a compositional isotemporal analysis. Int J Ment Health Promot. 2022;24(5):759–769. https://doi.org/10.32604/ijmhp.2022.020152
Nakahara-Gondoh Y, Tsunoda K, Fujimoto T, Ikeda T. Effect of encouraging greater physical activity on number of steps and psychological well-being of university freshmen during the first COVID-19-related emergency in Japan. J Phys Educ Sport. 2022;22(10):2598–2603.
Al-Musharaf S, Aljuraiban G, Bogis R, Alnafisah R, Aldhwayan M, Tahrani A. Lifestyle changes associated with COVID-19 quarantine among young Saudi women: a prospective study. PLoS One. 2021;16(4):e0250625. https://doi.org/10.1371/journal.pone.0250625
Rafraf M, Molani-Gol R, Sahebjam M. Effect of COVID-19 pandemic on eating habits and lifestyle of college students in Tabriz, Iran: a cross-sectional study. Front Public Health. 2023;11:1185681. https://doi.org/10.3389/fpubh.2023.1185681
Tian V, Ramlee F, Hamzah H. Relationship between physical activity, mood and sleep quality: ecological momentary assessment study among young adults. Int J Dev Sci. 2025;19(1–2):46–56. https://doi.org/10.1177/2192001X251325388
Pankowska MM, Lu H, Wheaton AG, Liu Y, Lee B, Greenlund KJ, et al. Prevalence and geographic patterns of self-reported short sleep duration among US adults, 2020. Prev Chronic Dis. 2023;20:E20. https://doi.org/10.5888/pcd20.220400
Australian Institute of Health and Welfare. Sleep problems as a risk factor for chronic conditions. Canberra: AIHW; 2021.
Zhang Y, Zhang H, Ma X, Di Q. Mental health problems during the COVID-19 pandemics and the mitigation effects of exercise: a longitudinal study of college students in China. Int J Environ Res Public Health. 2020;17(10):3722. https://doi.org/10.3390/ijerph17103722
Qaiser S, Daud MNM, Ibrahim MY, Gan SH, Rahman MS, Sani MHM, et al. Prevalence and risk factors of prehypertension in university students in Sabah, Borneo Island of East Malaysia. Medicine. 2020;99(21):e20287. https://doi.org/10.1097/MD.0000000000020287
Wang L, Li N, Heizhati M, Li M, Pan F, Yang Z, et al. Prevalence and predictive nomogram of depression among hypertensive patients in primary care: a cross-sectional study in less developed Northwest China. Medicine. 2021;100(4):e24422. https://doi.org/10.1097/MD.0000000000024422
Maestri M, Romigi A, Schirru A, Fabbrini M, Gori S, Bonuccelli U, et al. Excessive daytime sleepiness and fatigue in neurological disorders. Sleep Breath. 2019;24(2):413–424. https://doi.org/10.1007/s11325-019-01921-4
Lee DW, Jang TW, Kim HR, Kang MY. The relationship between working hours and lifestyle behaviors: evidence from a population-based panel study in Korea. J Occup Health. 2021;63(1):e12280. https://doi.org/10.1002/1348-9585.12280
Schumacher M, Sipes D. The effects of sleep deprivation on memory, problem solving and critical thinking: an ex-post facto experimental study. Virginia: Nothern Virginia Community College, Loudoun Campus; 2015.
Wise MJ. Naps and sleep deprivation: why academic libraries should consider adding nap stations to their services for students. New Rev Acad Librariansh. 2018;24(2):192–210. https://doi.org/10.1080/13614533.2018.1431948
Albqoor MA, Shaheen AM. Sleep quality, sleep latency, and sleep duration: a national comparative study of university students in Jordan. Sleep Breath. 2021;25(2):1147–1154. https://doi.org/10.1007/s11325-020-02188-w
Sook Huey L, Ramlee F, Othman A. Battling sleep disturbances and academic procrastination in undergraduates: a pilot study on acceptance and commitment therapy vs. motivational interviewing. Behav Sleep Med. 2025;23(2):283–300. https://doi.org/10.1080/15402002.2025.2467151
Ghrouz AK, Noohu MM, Manzar MD, Spence DW, BaHammam AS, Pandi-Perumal SR. Physical activity and sleep quality in relation to mental health among college students. Sleep Breath. 2019;23(2):627–634. https://doi.org/10.1007/s11325-019-01780-z
Pengpid S, Peltzer K. Vigorous physical activity, perceived stress, sleep and mental health among university students from 23 low- and middle-income countries. Int J Adolesc Med Health. 2020;32(2):20190256.
Balhareth A, Jafer M, van der Borgh-Sleddens E, Kremers S, Meertens R. Determinants of weight-related behaviors in male Saudi university students: a qualitative approach using focus group discussions. Int J Environ Res Public Health. 2021;18(7):3697. https://doi.org/10.3390/ijerph18073697
Bisson ANS, Lachman ME. The relationship of daily physical activity and sleep in adults: variations by age, sex, and race. J Behav Med. 2023;46(4):642–654. https://doi.org/10.1007/s10865-022-00387-2
Wang R, He L, Xue B, Wang X, Ye S. Sleep quality of college students during COVID-19 outbreak in China: A cross-sectional study. Altern Ther Health Med. 2022;28(3):58–64.
Tang NKY, McEnery KAM, Chandler L, Toro C, Walasek L, Friend H, et al. Pandemic and student mental health: mental health symptoms among university students and young adults after the first cycle of lockdown in the UK. BJPsych Open. 2022;8(4):e123. https://doi.org/10.1192/bjo.2022.523
Yang GY, Lin XL, Fang AP, Zhu HL. Eating habits and lifestyles during the initial stage of the COVID-19 lockdown in China: a cross-sectional study. Nutrients. 2021;13(3):970. https://doi.org/10.3390/nu13030970
Zheng C, Huang WY, Sheridan S, Sit CHP, Chen XK, Wong SHS. COVID-19 pandemic brings a sedentary lifestyle in young adults: a cross-sectional and longitudinal study. Int J Environ Res Public Health. 2020;17(17):6035. https://doi.org/10.1101/2020.05.22.20110825
Abouzid M, El-Sherif DM, Eltewacy NK, Dahman NBH, Okasha SA, Ghozy S, et al. Influence of COVID-19 on lifestyle behaviors in the Middle East and North Africa Region: a survey of 5896 individuals. J Transl Med. 2021;19(1):178. https://doi.org/10.1186/s12967-021-02767-9
Salman A, Sigodo KO, Al-Ghadban F, Al-Lahou B, Alnashmi M, Hermassi S, et al. Effects of COVID-19 lockdown on physical activity and dietary behaviors in Kuwait: a cross-sectional study. Nutrients. 2021;13(7):2252. https://doi.org/10.3390/nu13072252
Dai W, Zhou J, Li G, Zhang B, Ma N. Maintaining normal sleep patterns, lifestyles and emotion during the COVID-19 pandemic: The stabilizing effect of daytime napping. J Sleep Res. 2021;30(4):e13259. https://doi.org/10.1111/jsr.13259