Adolescence is the period of transition between childhood and adulthood. It is a phase when adolescents experience rapid physical, cognitive and psychosocial growth, thus affecting how they feel, think, make decisions, and interact with the world around them (1). It is also the time when there is change in how an individual responds to stressors (2). Specifically, adolescence is marked by significant shifts in the hypothalamic-pituitary-adrenal axis reactivity, resulting in heightened stress-induced hormonal responses (3). Stress is a normal response to situational pressures or demands and is a part of everyday life, but it can have devastating effects when it becomes chronic. Self-esteem represents an overall reflection of an individual's self-worth, and encompasses beliefs about oneself as well as an emotional response to those beliefs (4). Self-esteem affects many of the developmental challenges adolescents have to deal with, such as identity formation and reshaping social relations (5, 6). Research has shown that stress and lower self-esteem increase the risk of developing mental health problems, such as depression, anxiety, suicidal ideation as well as health-compromising behaviors such as drug abuse, violent behavior, or disordered eating behaviors during adolescence (7–12). It is therefore crucial to identify factors that may enhance the ability to cope with life stressors and increase self-esteem among adolescents to inform prevention and intervention efforts.

Prior research has shown that movement behaviors, including physical activity, screen time, and sleep duration are individually associated with less stress and self-esteem. For instance, there has been consistent evidence potentiating a positive relationship between physical activity and lower stress levels and better self-esteem in adolescents (13–15), though a more recent review suggests that the long-term relationship between physical activity and self-esteem needs to be explored further as there remains a paucity of high-quality evidence (16). In terms of screen time, some relationships have been established, with higher screen time being associated with lower self-esteem and greater perceived stress in adolescents (17–21). Similarly, less stress and better self-esteem were also observed among adolescents that had longer sleep durations (22–25). For example, Fredriksen et al. (23) found that getting enough sleep prospectively predicted better self-esteem in a sample of adolescents. Although relationships between each of the individual movement behaviors and stress and self-esteem have been explored, expanding the scope of understanding to encompass the relationship between these outcomes with combinations of movement behaviors is important because physical activity, screen time, and sleep duration are codependent and can have a combined influence (26). Considering movement behaviors performed over the entire 24-h period can help inform and improve initiatives, programs, and campaigns targeted toward promoting adolescent self-esteem and alleviating stress.

The Canadian 24-h movement guidelines for children and adolescents are the first evidence-based movement guidelines that address an entire day (27). The guidelines recommend that children and adolescents have at least 60 min of moderate-to-vigorous physical activity per day involving a variety of aerobic activities. Vigorous physical activities, and muscle and bone strengthening activities should each be incorporated at least 3 days per week. Children and adolescents should also spend several hours a day engaging in a variety of structured and unstructured light physical activities. The guidelines also recommend that children and adolescents limit their recreational screen time to no more than 2-h per day, limit their sitting for extended periods, and sleep for 9 to 11-h per night (children aged 5 to 13 years) or 8- to 10-h per night (adolescents aged 14 to 17 years) (27). Meeting the guidelines has not only been positively associated with various measures of physical health such as reduced obesity and cardiometabolic risk (28), but also with measures of cognitive, social, and mental health (29–34).

From a holistic perspective, meeting the guidelines has been associated with positive global measures of health, including self-rated health and mental health (35). These global measures are shaped not only by factors of physical well-being, but also by their interplay with psychological factors and those of social functioning (36). Two such psychosocial factors that have been linked to health and health behaviors include stress and self-esteem (9–12). Despite relationships having been established between meeting the 24-h movement guidelines and health as well as between health and stress and self-esteem, the link between meeting the 24-h movement guidelines with stress and self-esteem among adolescents remains largely unknown.

Therefore, this study aims to examine the association between meeting combinations of the 24-h movement guidelines for physical activity, recreational screen time, and sleep duration with life stress and self-esteem among Ontario adolescents. We hypothesized that adherence to the 24-h movement guidelines would be associated with less life stress and better self-esteem.

The sample characteristics are outlined in Table 1. More than half of the sample was girls, and 51% reported that they were of White ethnoracial background. Overall, 19.8% of participants met the physical activity recommendation, 24.3% met the screen time recommendation, and 34.2% met the sleep duration recommendation. A total of 44.5% met none of the recommendations, whereas 3.5% of participants met all 3 recommendations. Boys were more likely than girls to meet the physical activity and sleep duration recommendations. They were also more likely to meet all 3 recommendations than girls (p < 0.001). Girls were more likely than boys to report higher levels of life stress (p < 0.001) and lower self-esteem (p < 0.001).

Results of the univariable and multivariable ordered logistic regression models examining the association of meeting the 24-h movement guidelines with life stress and self-esteem are presented in Table 2. After adjusting for age, gender, ethnoracial background, subjective socioeconomic status and BMI z-score, results indicate that meeting all 3 recommendations was associated with lower life stress (OR: 0.40; 95% CI: 0.30–0.53; p < 0.001) and better self-esteem (OR: 0.29; 95% CI: 0.21–0.40; p < 0.001). Other combinations of movement behavior recommendations were also associated with lower life stress and better self-esteem, except meeting the physical activity only and screen time only recommendations, which were not associated with life stress. Results from one-way ANOVA and post-hoc comparisons between estimates of physical activity, screen time, and sleep duration suggest that sleep duration is the strongest correlate of high life stress compared physical activity (t = −3.29; p = 0.022) or screen time (t = −5.55; p < 0.001). However, for lower self-esteem, sleep duration was more strongly associated with this outcome than screen-time (t = −4.13; p = 0.001), but not physical activity (t = −1.83; p = 0.596). There were no significant differences between sleep duration and physical activity in their associations with self-esteem.

Table 3 outlines results of the univariable and multivariable ordered logistic regression models examining the association of number of movement behavior recommendations met with life stress and self-esteem. There was a dose-response gradient between the number of recommendations met (3 > 2 > 1) and lower life stress (p < 0.001) and better self-esteem (p < 0.001), with meeting all 3 recommendations being the best combination. Gender was not a significant moderator of these relationships.

Results of analyses including life stress and self-esteem in the same models are summarized in Table 4. The association between meeting different combinations of movement behavior recommendations and self-esteem was independent of life stress and other important covariates. Meeting all 3 recommendations (OR: 0.35; 95% CI: 0.25–0.49; p < 0.001) or different combinations of movement behavior recommendations were associated with better self-esteem. Findings also indicate that high life stress is a significant correlate of low self-esteem before and after adjusting for other important covariates (OR: 1.62; 95% CI: 1.52–1.71; p < 0.001).

The objective of this study was to examine the association between meeting combinations of the 24-h movement behavior recommendations for physical activity, recreational screen time, and sleep duration with life stress and self-esteem in a representative and province-wide sample of Ontario adolescents. Consistent with our hypothesis, we found that adherence to the 24-h movement guidelines is associated with less life stress and better self-esteem. Intermediate combinations of movement behavior recommendations were also associated with lower life stress and better self-esteem, with a few exceptions. Moreover, there was a dose-response gradient between the number of recommendations met and lower life stress and better self-esteem, in that adherence to a greater number of recommendations was more strongly associated with less life stress and better self-esteem among adolescents. Although girls were more likely than boys to report higher levels of life stress and lower self-esteem, gender was not a significant moderator of the associations of meeting the 24-h movement guidelines with life stress or self-esteem, suggesting that the associations did not differ between boys and girls. Results further indicated that sleep duration had the strongest association with life stress and self-esteem among the three movement behaviors. The only exception was the association with self-esteem where sleep duration and physical activity were similar correlates.

Many studies have investigated the relationships between physical activity, recreational screen time, and sleep duration with life stress and self-esteem among adolescents (13–15, 17–25), though most considered the movement behaviors individually and in isolation of each other, ignoring the intrinsic and empirical interactions between these behaviors. To our knowledge, we are the first to investigate these associations in the context of the 24-h movement guidelines (27) at the population level of adolescents. Our findings highlight the importance of being active, limiting recreational screen time, and getting enough sleep as possible strategies to better cope with life stressors and increase self-esteem. These novel findings support the need to promote adherence to the 24-h movement guidelines in children and adolescents as a possible means for promoting less life stress and better self-esteem.

Several mechanisms could explain the associations of regular physical activity, low screen time, and adequate sleep duration with low life stress and better self-esteem. Regular physical activity is thought to be associated with stress reduction and better mood (13–15). It reduces levels of the body's stress hormones, such as adrenaline and cortisol (53). It also stimulates the production of endorphins, which are chemicals in the brain that are the body's natural painkillers and mood elevators (54). Regular physical activity is also associated with better self-esteem, because sometimes self-esteem issues among adolescents are tied to body perception (55, 56). Regular physical activity helps build confidence by improving body image, and thus contributes to a better self-esteem (15). Physical activity also generates a sense of accomplishment that boosts confidence and puts one's mind in a more positive state.

Excessive recreational screen time is known to be associated with a wide range of negative outcomes, including but not limited to physical (e.g., excess body weight, cardiometabolic problems), social (e.g., aggressive behaviors and cyberbullying victimization), and mental health (e.g., depressive symptoms and suicidality) problems (32, 57–59). These negative outcomes could certainly constitute an important source of stress. However, it is also possible that high stress levels lead to excessive electronic media use as a possible coping strategy (60). The mechanism explaining the link between recreational screen time and self-esteem could be explained by a dissatisfaction with body weight (55, 56). Indeed, recreational screen time may expose users to unrealistic and idealized body types that are based on the stereotype of a lean body for girls and a muscular body for boys. Although perceived body image does not always reflect reality (61, 62), having a negative body image is usually related not only to a lower self-esteem, but also to unhealthy eating and weight control behaviors (63, 64), which could be an important source of stress as well.

Short sleep duration can lead to a dysregulation of the hypothalamic-pituitary-adrenal axis involving changes in cortisol secretion (3), which, in turn, increases stress (23) and affects self-esteem (65). Short sleep duration can also drive higher stress and lower self-esteem via daytime sleepiness and fatigue, which in turn could lead to difficulty concentrating or learning, increased risk of academic failure, and impaired mood (66). Another mechanism that could explain the association of short sleep duration with high stress and low self-esteem could be dissatisfaction with body weight. Research has shown that short sleep duration is associated with dieting and unhealthy weight-control behaviors among adolescents (67). Finally, short sleep duration can lead to high stress and lower self-esteem via increased depressive symptoms and anxiety (25). Inversely, research has shown that experiencing higher stress enhances the risk of sleep problems. It is also possible that less stress and better self-esteem facilitate better sleep by their beneficial influence on physical and mental well-being (68). The findings that sleep duration was the most strongly associated with life stress and self-esteem among the three movement behaviors are consistent with previous findings indicating that meeting the sleep duration recommendation has generally more incremental benefits to adolescent mental health indicators than the remaining movement behaviors (33, 69, 70).

Our results indicated that sleep duration had the strongest association with life stress and self-esteem among the three movement behaviors. The only exception was the association with self-esteem where sleep duration and physical activity were similar correlates. These findings are somewhat consistent with those from previous studies suggesting that sleep duration may be the most important correlate of mental health outcomes compared to screen time and physical activity (33, 34, 70). For example, Sampasa-Kanyinga et al. (69) found that meeting the sleep duration recommendations was the strongest predictor of depressive and anxiety symptoms using the 2017 cycle of the OSDUHS. Similarly, Patte et al. (71) found that meeting the sleep duration recommendations was more strongly associated with depressive symptoms in a longitudinal sample of Canadian adolescents. Nevertheless, meeting the physical activity and screen time recommendations should not be neglected because of their proven multiple health benefits among children and youth (21, 72). These findings underscore the need to promote adherence to the 24-h movement guidelines, particularly sleep duration among adolescents as a possible means to protect their mental health. The finding that there are no significant differences between sleep duration and physical activity in their association with low self-esteem is interesting and deserves further investigation. It is possible that physical activity is as important as sleep duration in relation to self-esteem. In their systematic review and meta-analysis, Liu et al. (73) provided evidence that physical activity interventions are associated with increased self-esteem in children and adolescents. While it is difficult to explain why sleep duration is the most important correlate of mental health indicators among adolescents and why there were no differences between sleep duration and physical activity in their association with low self-esteem in the present study, it is possible that some methodological factors, such as the use of self-reported or single item measures of movement behaviors explain these findings. Future studies using objective measures of sleep duration and physical activity in a large and representative sample of adolescents are needed to replicate these findings.

Several limitations of this study should be noted. First, given the cross-sectional nature of the data, our findings can only provide information about associations among variables rather than indicating causal relationships. Therefore, reserve causation among the observed associations is always a possibility. For example, it is possible that adolescents meet the physical activity recommendation because they have high stress (53). Second, the data are based entirely on self-reports and may be subject to recall errors and desirability bias. For example, differential reporting of movement behaviors may have occurred if participants tended to systematically overestimate physical activity and/or sleep duration or underestimate screen time due to social desirability. Despite these limitations of self-reported measures of movement behaviors, they have been indicated to have good validity in comparison with objective measures among children and adolescents (44–46, 48). Third, this study includes students in grade 7 to 12 within the regular school system in Ontario and is not representative of all students in Canada. Fourth, the present study did not examine other components of the 24-h movement behaviors, such as light and vigorous physical activity, muscle and bone strengthening activities, and prolonged sitting. Future research capturing these indicators is needed to replicate our analyses. Finally, residual confounding by unmeasured factors (e.g., medication use, chronic conditions, family involvement) is always a possibility in epidemiology.

Despite limitations, this study provides evidence that meeting the recommendations of the 24-h movement guidelines is associated with lower life stress and better self-esteem among adolescents. These results highlight the importance of meeting the 24-h movement guidelines, and public health interventions are needed to encourage adolescents to meet these guidelines. All stakeholders that interact with youth, including health service providers, educators, schools, and parents and adolescents themselves should be aware of these findings. Future studies using a longitudinal design are needed to replicate these findings and clarify the nature of the causal pathways involved.

The datasets presented in this article are not readily available because of the Centre for Addiction and Mental Health's and the Ontario Public and Catholic School Board's institutional Research Ethics Board agreements. Requests to access the datasets should be directed to the Centre for Addiction and Mental Health at info@camh.ca.

The studies involving human participants were reviewed and approved by Research Ethics Boards of the Centre for Addiction and Mental Health and York University, as well as 34 school board research review committees. Written informed consent to participate in this study was provided by the participants' legal guardian/next of kin.

HS-K, AL, HH, and J-PC participated in the conception of the study. HS-K conducted statistical analyses. HS-K and AL wrote the first version of the manuscript. HH and J-PC substantially contributed to the methods and interpretation of results. AL, HH, and J-PC critically reviewed the manuscript. All authors read and approved the final manuscript.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.