Changes in sleep, physical activity, and health behaviors among Nigerian fasting adults in Ramadan during the COVID-19 pandemic

There is limited data on sleep, physical activity, and health-related behaviors among the general public during Ramadan, particularly during the COVID-19 pandemic. This study aimed to assess the factors associated with sleep and physical activity changes among Nigerian Muslims during Ramadan fasting. A nationwide web-based cross-sectional study was conducted among Nigerians aged ≥18 years who performed diurnal fasting during Ramadan. The target sample size was obtained using Fisher's formula, and snowball sampling was employed. Adapted versions of the International Physical Activity Questionnaire Short Form and Copenhagen Psychosocial Questionnaire II were used to evaluate sleep and physical activity. Correlates of change in physical activity and sleep quality were assessed using logistic regression analysis. Seven hundred and seventy individuals participated in the study. During Ramadan, 39.1% (95% confidence interval (CI): 35.6%-42.6%) reported decreased physical activity, and 56.6% (95% CI; 53.0%-60.2%) stated having self-reported good sleep. The independent correlates of physical activity were female sex (adjusted odds ratio (aOR):0.5, 95% CI: 0.4-0.8), having very good sleep (aOR: 0.4, 95% CI: 0.2-0.7), and obesity (aOR: 2.0, 95% CI: 1.1-3.7). In addition, factors associated with improved self-reported sleep quality were perceived good health state (aOR: 8.8, 95% CI: 1.1-72.4), sleeping 7-9 h per day (aOR: 5.5, 95% CI: 2.6-10.3), and sleeping for over 9 h per day (aOR: 4.6, 95% CI: 2.1-14.1). Although physical activity decreased by about a third, over half of the respondents lost weight and slept well during Ramadan. Strategies to include intermittent fasting in positive lifestyle changes could improve the health and well-being of the population.