Preprint has been submitted for publication in journal
Preprint / Version 2

24-hour movement guideline adherence and mental health: A cross-sectional study of emerging adults with chronic health conditions and disabilities




physical activity, screen time, sitting time, sleep, college students


Background. Recent work has shown that individuals with chronic health conditions and disabilities (CCD) meet the 24-hr movement guidelines at lower rates than population norms; however, the evidence base remains limited across different stages of the lifespan and very few studies have examined associations with mental health outcomes.

Objective. This study examined 24-hour movement guideline adherence among emerging adults with CCD compared to those without and associations between guideline adherence and indicators of mental health.

Methods. This cross-sectional study used data from the 2020 cycle of the Canadian Campus Wellbeing Survey. A total of 17,874 emerging adults enrolled at 20 post-secondary institutions (Mean age=21.6±2.94 years; 65.2% female), including 3,336 who identified with a CCD, self-reported their movement behaviors (physical activity, sedentary behaviors, sleep) and completed measures of psychological distress and mental wellbeing. Logistic regressions models were computed to examine differences in guideline adherence. Propensity score weighted linear regression models were computed to examine associations between guideline adherence and indicators of mental health.

Results. Emerging adults with CCD had significantly lower odds of meeting the 24-hr movement guidelines compared to their peers, and disparities in guideline adherence were most pronounced among those with multimorbidity, developmental and physical disabilities. Guideline adherence was associated with significantly more favorable scores for psychological distress and mental wellbeing among those with and without CCD.

Conclusions. Findings suggest emerging adults with CCD engage in less healthy movement behavior patterns than their peers, yet they appear to experience similar mental health benefits when they do meet the 24-hr movement guidelines.


Metrics Loading ...


Arnett JJ, Žukauskienė R, Sugimura K. The new life stage of emerging adulthood at ages 18–29 years: implications for mental health. Lancet Psychiatry. 2014;1(7):569-576. doi:10.1016/S2215-0366(14)00080-7

Auerbach RP, Alonso J, Axinn WG, et al. Mental disorders among college students in the World Health Organization World Mental Health Surveys. Psychol Med. 2016;46(14):2955-2970. doi:10.1017/S0033291716001665

Linden B, Boyes R, Stuart H. Cross-sectional trend analysis of the NCHA II survey data on Canadian post-secondary student mental health and wellbeing from 2013 to 2019. BMC Public Health. 2021;21(1):1-13.

Hunt J, Eisenberg D. Mental Health Problems and Help-Seeking Behavior Among College Students. J Adolesc Health. 2010;46(1):3-10. doi:

Mortier P, Cuijpers P, Kiekens G, et al. The prevalence of suicidal thoughts and behaviours among college students: a meta-analysis. Psychol Med. 2018;48(4):554-565.

Coduti WA, Hayes JA, Locke BD, Youn SJ. Mental health and professional help-seeking among college students with disabilities. Rehabil Psychol. 2016;61(3):288-296. doi:10.1037/rep0000101

Ferro MA. Major depressive disorder, suicidal behaviour, bipolar disorder, and generalised anxiety disorder among emerging adults with and without chronic health conditions. Epidemiol Psychiatr Sci. 2016;25(5):462-474. doi:10.1017/S2045796015000700

Firth J, Solmi M, Wootton RE, et al. A meta-review of “lifestyle psychiatry”: the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders. World Psychiatry. 2020;19(3):360-380. doi:10.1002/wps.20773

Rollo S, Antsygina O, Tremblay MS. The whole day matters: Understanding 24-hour movement guideline adherence and relationships with health indicators across the lifespan. J Sport Health Sci. Published online July 22, 2020. doi:10.1016/j.jshs.2020.07.004

Sampasa-Kanyinga H, Colman I, Goldfield GS, et al. Combinations of physical activity, sedentary time, and sleep duration and their associations with depressive symptoms and other mental health problems in children and adolescents: a systematic review. Int J Behav Nutr Phys Act. 2020;17:72. doi:10.1186/s12966-020-00976-x

Tremblay MS, Carson V, Chaput JP, et al. Canadian 24-hour movement guidelines for children and youth: An integration of physical activity, sedentary behaviour, and sleep. Appl Physiol Nutr Metab. 2016;41(6 (Suppl. 3)):S311-S327. doi:10.1139/apnm-2016-0151

Ross R, Chaput JP, Giangregorio LM, et al. Canadian 24-Hour Movement Guidelines for Adults aged 18–64 years and Adults aged 65 years or older: an integration of physical activity, sedentary behaviour, and sleep. Appl Physiol Nutr Metab. 2020;45(10):S57-S102. doi:10.1139/apnm-2020-0467

Sampasa-Kanyinga H, Colman I, Goldfield GS, et al. 24-hour movement behaviors and internalizing and externalizing behaviors among youth. J Adolesc Health. 2021;68(5):969-977.

Wang W, Haegele JA, Wu Y, Li C. Meeting the 24-Hour Movement Guidelines and Outcomes in Adolescents with ADHD: A Cross-Sectional Observational Study. Int J Environ Res Public Health. 2022;19(4):2132.

Liang K, de Lucena Martins CM, Chen ST, et al. Sleep as a Priority: 24-Hour Movement Guidelines and Mental Health of Chinese College Students during the COVID-19 Pandemic. In: Vol 9. Multidisciplinary Digital Publishing Institute; 2021:1166.

Weatherson KA, Joopally H, Wunderlich K, Kwan MYW, Tomasone JR, Faulkner G. Post-secondary students’ adherence to the Canadian 24-Hour Movement Guidelines for Adults: Results from the first deployment of the Canadian Campus Wellbeing Survey (CCWS). Health Promot Chronic Dis Prev Can Res Policy Pract. 2021;41(6):173-181. doi:10.24095/hpcdp.41.6.01

Atkin AJ, Carr S, Friedenreich C, Biddle SJ, Milton K. Behavioural epidemiology of physical activity in people living with chronic conditions. Br J Sports Med. Published online 2022.

Faulkner G, Ramanathan S, Kwan M, et al. Developing a coordinated Canadian post-secondary surveillance system: a Delphi survey to identify measurement priorities for the Canadian Campus Wellbeing Survey (CCWS). BMC Public Health. 2019;19(1):935. doi:10.1186/s12889-019-7255-6

World Health Organization. International Statistical Classification of Diseases and Related Health Problems. 11th ed.; 2019.

Booth M. Assessment of physical activity: An international perspective. Res Q Exerc Sport. 2000;71:114-120. doi:10.1080/02701367.2000.11082794

Craig CL, Marshall AL, Sjöström M, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;35(8):1381-1395. doi:10.1249/01.MSS.0000078924.61453.FB

Prince SA, LeBlanc AG, Colley RC, Saunders TJ. Measurement of sedentary behaviour in population health surveys: a review and recommendations. PeerJ. 2017;5:e4130. doi:10.7717/peerj.4130

Kessler RC, Andrews G, Colpe LJ, et al. Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med. 2002;32(6):959-976.

Tennant R, Hiller L, Fishwick R, et al. The Warwick-Edinburgh mental well-being scale (WEMWBS): development and UK validation. Health Qual Life Outcomes. 2007;5(1):1-13.

van Buuren S, Groothuis-Oudshoorn K. mice: Multivariate imputation by chained equations in R. J Stat Softw. 2011;45(1):1-67. doi:10.18637/jss.v045.i03

White IR, Royston P, Wood AM. Multiple imputation using chained equations: Issues and guidance for practice. Stat Med. 2011;30(4):377-399. doi:10/cmwhtz

Rizopoulos D. Generalized linear mixed models using adaptive gaussian quadrature. Published online 2022. Accessed February 9, 2022.

Lüdecke D, Ben-Shachar MS, Patil I, Makowski D. Extracting, Computing and Exploring the Parameters of Statistical Models using R. J Open Source Softw. 2020;5(53):2445. doi:10.21105/joss.02445

Rubin DB. Multiple Imputation for Nonresponse in Surveys. John Wiley & Sons, Ltd; 1987. doi:10.1002/9780470316696.fmatter

Pirracchio R, Carone M, Rigon MR, Caruana E, Mebazaa A, Chevret S. Propensity score estimators for the average treatment effect and the average treatment effect on the treated may yield very different estimates. Stat Methods Med Res. 2016;25(5):1938-1954. doi:10.1177/0962280213507034

Pishgar F, Greifer N, Leyrat C, Stuart E. MatchThem:: Matching and weighting after multiple imputation. R J. 2021;13:292-305. doi:10.32614/RJ-2021-073

Imai K, Ratkovic M. Covariate balancing propensity score. J R Stat Soc Ser B Stat Methodol. 2014;76(1):243-263. doi:10.1111/rssb.12027

Li F, Morgan KL, Zaslavsky AM. Balancing covariates via propensity score weighting. J Am Stat Assoc. 2018;113(521):390-400. doi:10.1080/01621459.2016.1260466

Lumley T. Analysis of complex survey samples. J Stat Softw. 2004;9:1-19. doi:10.18637/jss.v009.i08

Funk MJ, Westreich D, Wiesen C, Stürmer T, Brookhart MA, Davidian M. Doubly robust estimation of causal effects. Am J Epidemiol. 2011;173(7):761-767. doi:10.1093/aje/kwq439

Arbour-Nicitopoulos KP, Bassett-Gunter RL, Leo J, et al. A cross-sectional examination of the 24-hour movement behaviours in Canadian youth with physical and sensory disabilities. Disabil Health J. Published online August 5, 2020:100980. doi:10.1016/j.dhjo.2020.100980

Brown D, McPhee P, Kwan M, Timmons B. Implications of disability severity on 24-hour movement guideline adherence among children with neurodevelopmental disorders in the United States. Published online April 30, 2021. doi:10.31236/

Brown DMY, Ronen GM. Associations between 24-hour movement guideline adherence and mental health disorders among young people with active and inactive epilepsy. Epilepsy Behav. 2021;125:108386. doi:10.1016/j.yebeh.2021.108386

Healy S, Foley J, Haegele JA. Physical activity, screen time, and sleep duration among youth with chronic health conditions in the United States. Am J Health Promot. 2020;34(5):505-511. doi:10.1177/0890117120915687

Sallis JF, Saelens BE. Assessment of physical activity by self-report: status, limitations, and future directions. Res Q Exerc Sport. 2000;71(sup2):1-14.

Additional Files


2022-09-09 — Updated on 2023-04-19