Risk factors for sedentary time and their mediation by sleep disturbances among depressed rural patients with cardiovascular disease: A path analysis

Purpose: The purposes of this study were to (1) identify predictors of sedentary time and (2) determine whether sociodemographic risk factors associated with sedentary time are mediated by sleep disturbances in younger (<60) and older (≥60) depressed rural patients with CVD. Methods: Depressed rural patients with CVD completed surveys and wore ActiGraph GT9X Link monitors to measure sedentary time and sleep parameters (total sleep time and wake-after-sleep-onset [WASO]). Hierarchical regression analysis was conducted to identify factors associated with sedentary time, followed by a multi-group path analysis to examine how significant factors identified in the regression were associated with sedentary time, comparing the two age groups, and whether this association was mediated by parameters reflecting sleep disturbances. Findings: Participants (n = 222) were predominantly White with an average age of 58 years and 52% were unemployed due to illness. Age, employment status, and WASO were significantly associated with sedentary time. Path analysis showed a significant mediating effect of age on sedentary time through WASO in the younger group (n = 115). However, the mediating effect of WASO on the relationship between age and sedentary time was not significant in the older group (n = 107). Conclusions: The findings highlight the critical roles of age and sleep disturbances in promoting physical inactivity, with sleep disturbances being particularly influential in younger patients. Tailoring interventions by age groups may enhance strategies to mitigate CVD risk associated with inactivity.