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Objective <p>Population aging is accelerating in China, making falls a critical public health challenge. This study aimed to examine the independent and joint associations of physical activity (PA) and sleep duration with the risk of falls among Chinese older adults.</p> Method <p>We analyzed 10,232 participants aged 60 years and older from the 2020 China Health and Retirement Longitudinal Study (CHARLS) wave. The occurrence of falls was identified based on self-reported incidents since the previous interview wave (2018) for returning participants or at the time of entry for new participants. Sleep duration was classified into three categories: short (&lt; 6&#xa0;h/night), optimal (6–8&#xa0;h/night), and long (&gt; 8&#xa0;h/night). Physical activity was assessed using the International Physical Activity Questionnaire (IPAQ) short form and dichotomized into low physical activity (LPA) and moderate-to-vigorous physical activity (MVPA). Chi-square tests and multivariate logistic regression models were employed to estimate the independent and joint associations of sleep duration and PA with falls. Subgroup and sensitivity analyses were further conducted to evaluate the robustness of the findings.</p> Results <p>The prevalence of falls among the participants was 20.1%. Compared with LPA, MVPA was associated with a lower odds of falls (OR = 0.842, 95% CI: 0.745–0.952). Compared with optimal sleep duration, those with short sleep duration (OR = 1.582, 95% CI: 1.424–1.756) and long sleep duration (OR = 1.200, 95% CI: 1.003–1.436) had a higher likelihood of falls. The risk of falls was approximately 46.4% lower for individuals with LPA and optimal sleep duration compared to those with short sleep and LPA (Model 3, OR = 0.536, 95% CI: 0.425 = 0.677). In MVPA group, the mitigation effect of exercise on falls was observed regardless of sleep duration (Model 3, short: OR = 0.797, 95% CI: 0.669–0.949; optimal: OR = 0.524, 95% CI: 0.440–0.626; long: OR = 0.564, 95% CI: 0.440–0.722). Subgroup analyses confirmed that the protective association of MVPA and optimal sleep duration was particularly pronounced among males and those aged 60–74 years. Sensitivity analyses demonstrated the consistent robustness of these findings.</p> Conclusion <p>Both physical activity and sleep duration are significantly associated with the risk of falls in Chinese older adults. Our findings suggest that the combination of MVPA and optimal sleep duration (6–8&#xa0;h) is associated with the lowest risk of falling. While the cross-sectional nature of this study limits causal inference, integrated interventions targeting both sleep hygiene and physical activity may be beneficial for fall prevention strategies in the older adults. Future studies should employ prospective designs and objective measures to investigate the causal relationships and underlying mechanisms in greater depth.</p>

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Joint associations of physical activity and sleep duration with falls: evidence from the China health and retirement longitudinal study

  • 期刊论文

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  • 发表日期：

    2026年7月9日

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  • Jiani Wen,
  • Fu Yuan

摘要

Objective

Population aging is accelerating in China, making falls a critical public health challenge. This study aimed to examine the independent and joint associations of physical activity (PA) and sleep duration with the risk of falls among Chinese older adults.

Method

We analyzed 10,232 participants aged 60 years and older from the 2020 China Health and Retirement Longitudinal Study (CHARLS) wave. The occurrence of falls was identified based on self-reported incidents since the previous interview wave (2018) for returning participants or at the time of entry for new participants. Sleep duration was classified into three categories: short (< 6 h/night), optimal (6–8 h/night), and long (> 8 h/night). Physical activity was assessed using the International Physical Activity Questionnaire (IPAQ) short form and dichotomized into low physical activity (LPA) and moderate-to-vigorous physical activity (MVPA). Chi-square tests and multivariate logistic regression models were employed to estimate the independent and joint associations of sleep duration and PA with falls. Subgroup and sensitivity analyses were further conducted to evaluate the robustness of the findings.

Results

The prevalence of falls among the participants was 20.1%. Compared with LPA, MVPA was associated with a lower odds of falls (OR = 0.842, 95% CI: 0.745–0.952). Compared with optimal sleep duration, those with short sleep duration (OR = 1.582, 95% CI: 1.424–1.756) and long sleep duration (OR = 1.200, 95% CI: 1.003–1.436) had a higher likelihood of falls. The risk of falls was approximately 46.4% lower for individuals with LPA and optimal sleep duration compared to those with short sleep and LPA (Model 3, OR = 0.536, 95% CI: 0.425 = 0.677). In MVPA group, the mitigation effect of exercise on falls was observed regardless of sleep duration (Model 3, short: OR = 0.797, 95% CI: 0.669–0.949; optimal: OR = 0.524, 95% CI: 0.440–0.626; long: OR = 0.564, 95% CI: 0.440–0.722). Subgroup analyses confirmed that the protective association of MVPA and optimal sleep duration was particularly pronounced among males and those aged 60–74 years. Sensitivity analyses demonstrated the consistent robustness of these findings.

Conclusion

Both physical activity and sleep duration are significantly associated with the risk of falls in Chinese older adults. Our findings suggest that the combination of MVPA and optimal sleep duration (6–8 h) is associated with the lowest risk of falling. While the cross-sectional nature of this study limits causal inference, integrated interventions targeting both sleep hygiene and physical activity may be beneficial for fall prevention strategies in the older adults. Future studies should employ prospective designs and objective measures to investigate the causal relationships and underlying mechanisms in greater depth.