Adherence to 24-hour movement guidelines in adolescence and its association with lower risk of hypertension in adulthood

Globally, hypertension persists as a significant contributor to mortality, responsible for 10.4 million deaths and plays a prominent role in driving cardiovascular disease complications and fatalities [1, 2]. While various lifestyle factors, such as diet, sleep patterns, and physical activity (PA), have been extensively studied for their roles in hypertension prevention and management, emerging evidence highlights the importance of considering a holistic approach to daily movement behaviors [3, 4]. The 24 hour movement guidelines propose an integrated framework that includes PA, sedentary behavior, and sleep duration, emphasizing that health benefits arise from the balanced combination of these behaviors throughout an entire day [5, 6].

Adolescence represents a pivotal period for developing lifelong health behaviors, and maintaining healthy movement patterns during this time can have profound implications for health in adulthood [7]. Previous studies have reported that adherence to 24 hour movement guidelines during early life promotes both physical and mental benefits in adulthood, including lower rates of obesity [8], type 2 diabetes [9], and even lower midlife mortality [10]. However, there is limited research on how adherence to 24 hour movement guidelines from adolescence to adulthood affects long-term hypertension outcomes. Notably, a cross-sectional study of Chilean adults revealed that failing to meet any of the 24 hour movement guidelines was linked to a greater likelihood of hypertension [11]. Although the ideal regimen for vascular health is still under investigation, existing evidence indicates that maintaining physical activity and optimizing both the quantity and quality of sleep are advantageous for vascular health in older adults [4]. This highlights the importance of having balanced daily movement behavior to mitigate the risk of hypertension and to promote overall cardiovascular health.

The objective of the present study was to analyze the association between adherence to 24 hour movement guidelines in adolescence and the risk of hypertension in adulthood. We hypothesize that individuals who consistently meet PA guidelines, sedentary behavior, and sleep in adolescence and in adulthood will have a lower risk of hypertension than those who do not.

The average age of the participants during adolescence in Wave I was 15.30 years, whereas in adulthood, it was 37.65 years. Table 1 displays the general characteristics of the study sample by hypertension status at Wave V. Significant differences were observed between individuals with hypertension and those without hypertension in terms of age, sex, BMI, race/ethnicity, and smoking habits (P < 0.001). However, alcohol consumption did not significantly vary between groups (P = 0.748). Only 40 subjects met all three guidelines at both time points, with 33 individuals without hypertension and 7 with hypertension (P = 0.031).

Table 2 illustrates the significant mean differences in systolic and diastolic BP at Wave V based on adherence to 24 h movement guidelines. At Wave I, meeting the sleep duration guidelines was associated with a significant mean reduction in systolic BP of − 0.568 mmHg [95% bias-corrected and accelerated (BCa) confidence interval (CI) − 2.128 to − 0.011, P = 0.044] and a decrease in diastolic BP of − 0.331 mmHg (95% BCa CI − 1.506 to − 0.071, P = 0.043). Adherence to PA or screen time guidelines alone did not yield significant changes in BP. When adherence to guidelines at both Wave I and Wave V was examined, significant reductions in BP were observed for the PA and sleep duration guidelines. Meeting the PA guidelines at both waves was linked to a mean decrease of − 0.912 mmHg in systolic BP (95% BCa CI − 2.111 to − 1.101, P = 0.020) and − 1.121 mmHg in diastolic BP (95% BCa CI − 2.143 to − 0.094, P = 0.049). Similarly, adherence to the sleep duration guidelines at both waves led to a decrease of − 1.173 mmHg in systolic BP (95% BCa CI − 2.114 to − 0.239, P = 0.037). Importantly, meeting all three movement behavior guidelines at both Wave I and Wave V resulted in the largest reductions: − 6.184 mmHg in systolic BP (95% BCa CI − 13.45 to − 0.915, P = 0.040) and − 3.156 mmHg in diastolic BP (95% BCa CI − 6.413 to − 0.120, P = 0.047).

Finally, Table 3 presents the relative risks (RRs) for hypertension at Wave V on the basis of adherence to 24 h movement behavior guidelines. In wave I, adherence to the PA guidelines was significantly associated with a reduced risk of hypertension, with an RR of 0.801 (95% CI 0.716 to 0.918, P = 0.020). However, no significant associations were observed for screen time, sleep duration, or adherence to all three guidelines at this time point. In contrast, adherence to guidelines at both Wave I and Wave V revealed stronger and more consistent reductions in hypertension risk. Participants meeting the PA guidelines across both waves had a significantly reduced RR of 0.710 (95% CI 0.516 to 0.976, P = 0.035). The most substantial benefit was observed among those meeting all three guidelines at both time points, with an RR of 0.699 (95% CI 0.311 to 0.899, P = 0.030).

Our study highlights the significant association between adhering to 24-hour movement guidelines and BP levels, as well as the risk of hypertension, from adolescence into adulthood. The results particularly highlight the importance of consistently maintaining all three behaviors—PA, sleep duration, and limited screen time—across both waves, from adolescence to adulthood.

First, our findings align with existing evidence that identifies adequate sleep as a crucial factor in cardiovascular health [18]. The amount of sleep has an impact on BP management through a number of mechanisms, such as the control of stress hormones like cortisol and the alteration of autonomic nervous system activity [19]. Adequate sleep also helps maintain a balanced circadian rhythm, which is essential for BP homeostasis [20].

Regular PA from baseline and across both waves is associated with reduced BP, emphasizing the importance of maintaining an active lifestyle over the years. PA has long been recognized for its role in cardiovascular health, improving endothelial function, reducing arterial stiffness, and enhancing overall vascular function [21]. Regular PA contributes to lower BP by increasing nitric oxide availability [22], which promotes vasodilation, and by reducing the activity of the sympathetic nervous branch, which reduces vascular resistance [23]. When combined with adequate sleep, the synergistic effects of these behaviors further amplify their positive impact on BP regulation [24].

Moreover, adherence to all three guidelines (PA, sedentary behavior, and sleep duration) across both waves led to substantial decreases in both systolic and diastolic BP, as well as a lower RR for hypertension. These findings emphasize the importance of a comprehensive approach to daily movement recommendations for long-term cardiovascular health [5, 6]. The 24 hour movement guidelines highlight the integration of PA, limited sedentary behavior, and adequate sleep, recognizing that each component plays a critical role in maintaining optimal cardiovascular function [25]. By adhering to these guidelines from adolescence into adulthood, individuals can significantly mitigate the likelihood of developing hypertension later in life, confirming the findings from a study on Chilean adults, which showed that, compared with those who met all the guidelines, not meeting any was associated with greater odds of hypertension [11].

There are several limitations to acknowledge. First, the longitudinal study design prevents us from establishing causal-effect relationships. Second, participants may have overestimated or underestimated their behavior because information about 24 hour movement guidelines was self-reported. Self-reported measures may be biased, and PA questions lacked details on duration or typicality. Assumptions were made about activity intensity and duration, using “5 or more MVPA sessions per week” as a proxy for meeting PA guidelines. Fourth, we used data from 1994 to 1996 to gauge adherence to the guidelines established later. Over the past 20 years, there has been a substantial shift in how people use screens (from traditional television content to streaming), which has resulted in an increase in screen time. Therefore, the study’s findings should be interpreted with caution. Fifth, while the prescription dose for PA is clear, the recommended prescriptions for the other movement behaviors (screen time and sleep) are much vaguer [25]. This lack of clarity can complicate efforts to precisely gauge and prescribe balanced movement behaviors for optimal cardiovascular health. Sixth, there are no data on BP outcomes during adolescence, so we could not adjust the analysis for baseline levels. However, we excluded adolescents who were diagnosed with hypertension before 19 years of age (n = 73). Seventh, one minor limitation is the generalizability of the findings, as the cohort may not represent the full diversity of populations. Another limitation is the lack of information on whether any participants had sleep disorders, which could have significantly influenced the results. Sleep disorders such as insomnia or sleep apnea can affect both sleep quality and BP [26], potentially confounding the relationship between adherence to sleep guidelines and hypertension risk.

In conclusion, our study revealed that adhering to 24 hour movement guidelines significantly reduces BP and hypertension risk over time, especially when these behaviors are maintained consistently at both waves. Educational programs and interventions should focus on encouraging regular PA, reducing screen time, and ensuring adequate sleep among adolescents to foster lifelong vascular health. Further studies should investigate the specific factors through which these behaviors interact and contribute to BP regulation and identify strategies to enhance adherence to these guidelines in various populations.