Impact of physical activity and sleep quality on quality of life of rural residents with and without a history of cancer: findings of the Day and Night Study

Background: Lifestyle behaviors may impact quality of life (QoL) in cancer survivors. The impact of physical activity and sleep quality on QoL in rural cancer survivors has not been well studied, however. Methods: Individuals with and without a history of cancer were recruited from rural Virginia. We collected information on physical activity (PAL), sleep quality (psqi), and QoL (Short Form-36). Additional dimensions of physical activity and sleep were measured including ambient light exposure and sleep duration via Actiwatch2, and serum vitamin D and urine melatonin, which are markers of outdoor activity and sleep. Results: 124 cancer survivors and 48 cancer-free individuals enrolled in the study. Mean age was 59, with majority women (89%) and Caucasian (76%). Breast cancer was most common (72%), and mean time from diagnosis to the survey was 8.1 years. Survivors were more sedentary and had significantly worse sleep quality and physical and mental health, relative to cancer-free individuals (p<0.05l). Quality of sleep of survivors and those cancer-free was significantly associated with physical (r=-0.335,p<0.001; r=-0.340,p<0.049 ) and mental health (r=-0.406,p=<0.001; r=-0.483,p<0.004) independent of age, gender, BMI, diabetes and CVD. In survivors, PAL was associated with physical and mental health (r=0.201,p=0.033; r=0.200,p=0.034), and outdoor activity was associated with mental health (r=0.271,p=0.005). Vitamin D3 was associated with physical health (rs=0.238, p=0.010) and outdoor activity (rs=0.236, p=0.012) in survivors. No association was found between melatonin, sleep quality or QoL. Physical activity, sleep quality, cancer status, BMI, and diabetes were predictive of physical health while physical activity and sleep quality were predictive of mental health. Conclusion: Quality of sleep and physical activity are significant predictors of mental and physical health in cancer survivors. Outdoor activity should be encouraged to improve mental health and vitamin D status. Sleep and outdoor activity interventions should have special consideration in rural cancer survivor care planning.