Asian-American Midlife Women's Physical Activity and Their Relationships to Sleep-Related Symptoms

Friday, 25 July 2014

Youjeong Kang, MPH, CCRN1
Ok Kyung Ham, PhD, RN2
Yaelim Lee, MSN, RN3
Wonshik Chee, PhD4
Eun-Ok Im, RN, MPH, PhD, CNS, FAAN3
Helen Teng, MSN, CRNP3
(1)Nursing, Univeresity of Pennsylvania, Philadelphia, PA
(2)Department of Nursing, Inha University, Incheon, South Korea
(3)School of Nursing, University of Pennsylvania, Philadelphia, PA
(4)Department of Family and Community Health, Univ. of Pennsylvania, Philadelphia, PA


Midlife women are reportedly experiencing a set of symptoms during their menopausal transition as their estrogen declines (Avis et al., 2001). The symptoms include both physical and psychological symptoms, and sleep difficulties are one of the physical symptoms that midlife women are frequently experiencing (Avis et al., 2001). Indeed, the National Library of Medicine (2013) reported that about 16% to 42% of premenopausal women and 35% to 60% of postmenopausal women experience sleep-related symptoms during their menopausal transition. Physical activities reportedly improve the sleep disturbances experienced by midlife women in the menopausal transition (Mansikkamäki et al., 2012). However, the findings on the association between physical activity and sleep disturbances reported in the literature are inconsistent. Some reported that sleep problems were positively correlated with high exercise or leisure time physical activity (Tu et al., 2012). Others reported that physical activity negatively influences sleep problems, subsequently improving sleep quality of midlife women (Tworoger et al., 2003). Occupational physical activity was positively related to increased rates of moderately poor sleep quality, but women with moderate physical activity were less likely to experience sleep problems (Soltani et al., 2012). However, no statistically significant association of physical activity and sleep disturbances was also reported (Casas, Pettee Gabriel, Kriska, Kuller, & Conroy, 2012).

When race/ethnicity is considered in determining the relationship between physical activity and sleep, the relationship gets more complicated.  A large number of studies reported racial/ethnic differences in physical activity (Centers for Disease Control and Prevention, 2008; Whitt, DuBose, Ainsworth, & Tudor-Locke, 2004), but few studies reported racial/ethnic differences in sleep-related symptoms that midlife women experience during their menopausal transition (Ramos et al., 2011). Subsequently, very little is still known about the relationships between physical activity and sleep-related problems in ethnic minority midlife women including Asian American midlife women. Thus, the purpose of this study is to explore sleep-related symptoms that Asian American midlife women experience during their menopausal transition and determine the relationships between their physical activity and sleep disturbances while considering other influencing factors.


This was a secondary analysis of the data from a larger study on midlife women’s attitudes toward physical activity. Only the data on 123 Asian American midlife women were included for this secondary analysis. The instruments included questions on background characteristics and health and menopausal status, the Sleep Index for Midlife Women (SIMW), and the Kaiser Physical Activity Survey. The SIMW was derived from the Midlife Women’s Symptom Index (MSI) (Im, 2006). The SIMW is a 24 item sub-scale of the MSI to measure sleep-related symptoms, and the individual item of the SIMW includes two parts: (a) symptom prevalence part using dichotomous scale (1 = yes; 0 = no) and (b) symptom severity part using 6-point Likert scale (0 = no symptom; 5 = extremely). The Cronbach's alpha for the SIMW was .89 in this study. The KPAS (Ainsworth, Sternfeld, Richardson, & Jackson, 2000) includes four subscales on household/caring index, occupational index, active living index, and sports/exercise index, and each item is a 5-point Likert scale. The Cronbach's alpha for the KPAS was .84 in this study. The data were analyzed using descriptive statistics and inferential statistics including correlation and hierarchical multiple regression analyses.


There were significant correlations between the three subscale scores of physical activity (household activity [r=.24, p<.01], occupational activity [r=.24, p<.01], and active living activity [r=-.18, p<.05]) and the total number and total severity of sleep-related symptoms. When controlling other influencing factors, only household activity (β=1.94, p<.05) and active living activity (β=-2.3, p<.01) significantly contributed to the total variances in total number of sleep-related symptoms (R2=.09, p<.01). The only other significant predictor of the total number of sleep-related symptoms among Asian American midlife women was perceived general health (β=-1.99, p<.01).

While household activity and occupational activity are positively related to the sleep-related symptoms, only active living activity is negatively related to sleep-related symptoms. In other words, some physical activity such as household activity and occupational activity could increase sleep-related symptoms during menopausal transition. This finding agrees with some previous studies that reported negative influences of occupational physical activity on the quality of sleep (Soltani et al., 2012). Health care providers need to consider in their research and practice that increasing active living activity (leisure-time physical activity) would improve Asian American midlife women’s sleep-related symptoms, but increased household activity and occupational activity could be detrimental to sleep-related symptoms.


Considering the inconsistent findings on the relationships between physical activity and sleep problems in the literature, further studies on sleep problems experienced by midlife women need to be conducted while considering different types and amount of physical activity.

Acknowledgement: This analysis was conducted as a part of a larger study funded by NIH/NINR (1R01NR010568-01) entitled "Ethnic-Specific Midlife Women's Attitudes Toward Physical Activity.”