The interplay of physical activity, sleep, and chronotype on physical and mental health in Italian university students: a moderated mediation analysis Lucia Castelli, Letizia Galasso, Marta Borrelli, Fabio Esposito, Andrea Caumo, Giovanni Michielon, Eliana Roveda, Angela Montaruli BMC Public Health, 2026 Background Physical and mental health are receiving increasing attention among university students. This study aims to evaluate the relationship between physical activity level, chronotype, and sleep quality in influencing physical and mental health in a sample of 691 active Italian university students. Methods Participants completed the GSL-TPAQ, MEQ, PSQI, and SF-12 questionnaires and were divided into three categories based on physical activity level (low, medium, high). A three-way ANCOVA assessed the main effects of physical activity, chronotype, and sleep quality on physical and mental health. A moderated mediation model tested whether sleep quality mediated the relationship between chronotype and health, and whether physical activity moderated the effect of sleep quality on health. Results A three-way ANCOVA revealed that high physical activity, morningness, and good sleep quality were associated with better mental health. Specifically, students with high physical activity reported higher mental health (43.23 ± 8.97 a.u.) than those with low activity (40.65 ± 10.21 a.u.; p < 0.05). Morning-types reported better mental health (43.6 ± 9 a.u.) compared to evening-types (39.08 ± 10.05 a.u.; p < 0.001), and good sleepers scored significantly higher on mental health (43.64 ± 9.04 a.u.) than bad sleepers (37.7 ± 9.68 a.u.; p < 0.001). Good sleepers also had better physical health (52.55 ± 5.32 a.u.) than bad sleepers (50.14 ± 5.97 a.u.; p < 0.001). A moderated mediation model confirmed that sleep quality mediated the relationship between chronotype and mental health (indirect effect: B = –0.08, 95% CI [–0.12, –0.04]), with morningness associated with better sleep, and in turn, better mental health. Physical activity significantly moderated this effect: the index of moderated mediation was significant for medium activity (Index = –0.04, 95% CI [–0.08, –0.01]) and high activity (Index = –0.04, 95% CI [–0.07, –0.01]), suggesting that individuals with medium and high activity levels benefit most from the protective role of sleep in the chronotype–mental health pathway. Conclusion These findings underscore the need to promote both good sleep hygiene and regular, sustained physical activity to support mental well-being among university students, especially those with an evening chronotype or bad sleep quality.
Muscle Strength and Functional Performance as Predictors of Metabolic and Body Composition Improvement in Anorexia Nervosa Eugenia Dozio, Sofia Gritti, Lorenzo Niego, Elisa Sartorello, Edoardo Scuttari, Gianluca Tori, Arianna Ruggiero, Letizia Galasso, Lucia Castelli, Angela Montaruli, Eliana Roveda, Rina Giuseppa Russo, Andrea Caumo, Ileana Terruzzi Nutrients, 2026 Background/Objectives: Anorexia nervosa (AN) is a severe psychiatric disorder characterized by energy restriction and associated with profound metabolic and body composition alterations. The loss of Body Cell Mass (BCM) leads to impaired muscle strength and functional capacity. Traditional monitoring based on body mass index (BMI, kg/m2) and weight primarily captures quantitative recovery, failing to reflect early qualitative metabolic and functional restoration. This study evaluated the longitudinal associations between improvements in physical performance and metabolic and structural recovery during intensive rehabilitation. Methods: A prospective longitudinal study was conducted on 21 AN patients undergoing a four-month intensive nutritional and functional rehabilitation program at Villa Miralago. Anthropometry, BIVA-derived parameters, indirect calorimetry and physical performance tests were assessed at baseline (T0), 2 months (T1) and 4 months (T2). Longitudinal associations were explored using Generalized Estimating Equations (GEE). Results: Improvements in functional performance (KPI-SUSS) were significantly associated with metabolic recovery, with a positive association with resting metabolic rate (β = +0.3635; p = 0.0088), indicating early metabolic reactivation before full structural reconstruction. Grip strength (KPI-grip) was significantly associated with cellular integrity (Xc β = +0.4129; p = 0.0088) and with favorable fluid redistribution (↑ intracellular water percentage (ICWp), ↓ extracellular water percentage (ECWp)). Structural recovery markers (Fat-Free Mass (FFM, kg), Fat-Free Mass Index (FFMI, kg/m2), BCM) increased significantly over time, confirming a time-dependent restoration of metabolically active mass. Fat mass (FM, kg) and fat mass percentage (FMp) were positively associated with functional improvement, although this effect attenuated longitudinally. These findings support strength performance as a sensitive functional indicator longitudinally associated with qualitative metabolic and cellular recovery. Conclusions: Muscle strength and functional performance tests are simple, non-invasive and cost-effective tools longitudinally associated with metabolic and structural normalization in AN. Their integration into clinical practice may enable the monitoring of meaningful recovery, personalized rehabilitation strategies and improving long-term outcomes.
A novel index for actigraphic studies: The core sleep efficiency Letizia Galasso, Giovanna Calogiuri, Lucia Castelli, Antonino Mulè, Fabio Esposito, Angela Montaruli, Eliana Roveda, Andrea Caumo Chronobiology International, 2025 Sleep efficiency is a widely used indicator of sleep quality in actigraphy studies. Nevertheless, it is a composite metric integrating data derived from actigraphic recordings alongside information about bedtime and wake-up time, typically obtained from self-reported sleep logs. The aim of this report is to propose a novel sleep efficiency index, denoted as core sleep efficiency, that relies solely on actigraphic data and focuses on the quality of sleep after its onset. Using a database of actigraphic recordings obtained in 40 young subjects (22 ± 3 yrs, Mean±SD) and in 45 middle-aged subjects (63 ± 11 yrs, Mean±SD), we evaluated the interrelationship between the two metrics of sleep efficiency and investigated the extent of their correlation with other crucial actigraphic indicators of sleep quality, such as sleep onset latency, fragmentation index and mean activity score. We provided evidence suggesting that the novel index may be suitable for specifically assessing the quality of sleep once it has begun. We propose that the newly introduced core sleep efficiency has the potential to serve as a valuable adjunct to the classic sleep efficiency, thus enriching the parametric characterisation of sleep obtained through actigraphy.
The moderating effect of physical activity in the relationship between sleep quality and BMI in adults with overweight and obesity Letizia Galasso, Ramona De Amicis, Lucia Castelli, Andrea Ciorciari, Antonino Mulè, Alberto Battezzati, Simona Bertoli, Andrea Foppiani, Alessandro Leone, Fabio Esposito, Angela Montaruli, Eliana Roveda Frontiers in Sports and Active Living, 2025 Inadequate sleep quality is a significant risk factor for overweight and obesity, which in turn may predispose individuals to adverse health outcomes. The aim of the present study was to evaluate the moderating effect of physical activity on the relationship between sleep quality and BMI in adults with overweight and obesity. In the current cross-sectional study, 589 white European participants (mean age 50 ± 12.2 years; 65% women; mean BMI 31.4 ± 5.5 kg/m2) were recruited from the International Center for the Assessment of Nutritional Status in Italy between October 2021 and July 2022. They completed the Godin–Shephard Leisure Time Physical Activity Questionnaire and the Pittsburgh Sleep Quality Index. The significant moderation model analysis performed on the entire sample [F(3, 585) = 4.4, p = 0.0045, r = 0.15, r2 = 0.02] found a statistically significant association between sleep quality and BMI (β = −0.16, p = 0.05), between physical activity and BMI (β = −0.08, p = 0.0018), and between the interaction of sleep quality and physical activity and BMI (β = 0.01, p = 0.01), particularly for physical activity values equal or higher than 49 Leisure Score Index (p = 0.004). The moderation analysis revealed a significant effect of physical activity on the relationship between sleep quality and BMI; better sleep quality was associated with lower BMI in individuals with higher levels of physical activity. The present findings suggest new aspects relating to the effect of physical activity in the relationship between sleep quality and overweight/obesity. Therefore, focusing on maintaining adequate levels of physical activity may represent an effective complementary strategy.
Editorial: Roles of the Circadian Rhythms in Metabolic Disease and Health Letizia Galasso, Lucia Castelli, Eleonora Bruno Metabolites, 2024 Chronobiology is the field of study focused on understanding the temporal patterns of biological functions, specifically examining the regular cycles or oscillations in these processes [...]
Social jetlag affects jump skills in sub-elite volleyball players Andrea Ciorciari, Lucia Castelli, Letizia Galasso, Antonino Mulè, Fabio Esposito, Eliana Roveda, Angela Montaruli Frontiers in Sports and Active Living, 2024 Social jetlag (SJL), resulting from misalignment between biological rhythms and social schedules, has emerged as a prevalent phenomenon in modern society, particularly among young athletes. However, the effect of SJL on performance is poorly studied. Jump and dynamic balance are two key skills in volleyball, as the first allows the player to perform better both during the offense and defense phase, and the second is fundamental in landing and in injury prevention. Therefore, our aim was to investigate the effect of SJL on jump skill performance and balance in female volleyball players. Thirty female volleyball players (mean age: 17.3 ± 0.88 years) participated in the study. SJL was assessed using the Munich ChronoType Questionnaire (MCTQ), integrated with Jankowsky's sleep-corrected formula. Jump skill performance was evaluated using a standardized jump test, the Vertec Jump Test, while balance was assessed with the Y Balance Test. The tests were performed at 09:00 a.m. and at 06:00 p.m. The results revealed that players with greater SJL exhibited decreased jump performance, characterized by lower vertical jump height (p = 0.02). Furthermore, players with lower SJL showed the typical difference between morning and afternoon performance (p = 0.001), demonstrating their synchronization between biological rhythms and social commitments, while no statistically significant difference between the two sessions was shown in players with higher SJL. Regarding balance, no significant association with SJL was found, but the morning session yielded lower results than the afternoon one (p = 0.01). These findings highlight the detrimental impact of SJL on jump skill performance, underscoring the importance of optimizing sleep-wake schedules and circadian alignment to enhance athletic performance. Future research should explore targeted interventions, such as sleep hygiene education, to minimize social jetlag and promote optimal performance in adolescent athletes.
Revitalizing your sleep: the impact of daytime physical activity and balneotherapy during a spa stay Lucia Castelli, Andrea Michele Ciorciari, Letizia Galasso, Antonino Mulè, Francesca Fornasini, Angela Montaruli, Eliana Roveda, Fabio Esposito Frontiers in Public Health, 2024 BackgroundIn modern society, achieving high-quality sleep is increasingly challenging. We conducted a study to explore the potential benefits of daytime physical activity and balneotherapy, including mud application and thermal-water bathing, on sleep quality.MethodsTo assess daytime physical activity and sleep parameters, we actigraphically monitored 127 healthy participants (34.6% male, average age 64.61 ± 0.89 years) during a one-week stay at a spa resort, where they received mud application and thermal-water bathings.ResultsParticipants were divided into three groups based on the timing of mud application. Those receiving mud application before 8:30 a.m. tended to have shorter sleep durations compared to those with later application, especially if it occurred before 7:45 a.m. However, mud application did not significantly affect sleep quality. Three-way ANCOVA revealed a significant effect of daytime physical activity on delta Sleep Efficiency, but post-hoc tests were insignificant. Furthermore, analyzing the duration of daily thermal-water bathings, individuals bathing for over 75 min per day experienced a noteworthy improvement in sleep quality, particularly in terms of delta Sleep Efficiency (2.15 ± 0.9% vs. −0.34 ± 0.31%, p = 0.007).ConclusionOur findings suggest that extended thermal-water bathing may enhance objective aspects of sleep quality. Since balneotherapy is mainly prescribed for individuals with musculoskeletal pathologies or psychological disorders, these findings may encourage doctors to recommend bathing in thermal water also to healthy subjects. Future researchers need to investigate the role of daytime physical activity in depth.
Sex Differences in the Relationship between Chronotype and Eating Behaviour: A Focus on Binge Eating and Food Addiction Ramona De Amicis, Letizia Galasso, Riccardo Cavallaro, Sara Paola Mambrini, Lucia Castelli, Angela Montaruli, Eliana Roveda, Fabio Esposito, Alessandro Leone, Andrea Foppiani, Alberto Battezzati, Simona Bertoli Nutrients, 2023 Background: Men are more likely than women to have subthreshold overeating disorders. Lifestyle plays a role as a determinant, while chronotype is an emerging factor. Chronotype explains the natural preferences of wakefulness and activity throughout the day: evening chronotypes (E-Types), those most productive in the evening, have been linked with unhealthy dietary patterns and a higher propensity to substance addiction than morning types (M-Types). Methods: We carried out a cross-sectional study on 750 overweight or obese adults (70% females, 48 ± 10 years, BMI 31.7 ± 5.8 kg/m2). The Binge-Eating Scale, the Yale Food Addiction Scale 2.0 (YFAS 2.0), the reduced Morningness-Eveningness Questionnaire (rMEQ), and the MEDAS questionnaire were used to assess binge eating, food addiction, chronotype, and adherence to the Mediterranean diet, respectively. Results: No differences in BES binge-eating and FA food-addiction scores occurred between chronotypes, but we found significant interactions between sex × rMEQ score. While women showed the same prevalence for binge eating and food addiction across all chronotypes, binge eating and food addiction risk increased with reducing rMEQ score in men, indicating that being male and E-Type increases the risk association of binge eating and/or food addiction prevalence. Conclusions: chronotype is associated with binge eating and food addiction in men, emphasizing the link between chronobiology and sex differences as determinants in appetite and eating behaviour dysregulation and in overweight and obesity.
Theoretical construct into blocks of actigraphic-derived sleep parameters L Galasso, G Calogiuri, L Castelli, A Mulè, F Esposito, A Caumo, ... Chronobiology International 40 (2), 174-185 , 2023 2023 Citations: 7
Author Correction: Physical activity and sleep behaviour in women carrying BRCA1/2 mutations L Galasso, L Castelli, E Roveda, A Oliverio, I Baldassari, F Esposito, ... Scientific Reports 12, 20516 , 2022 2022 Citations: 4
Lifestyle of Italian university students attending different degree courses: a survey on physical activity, sleep and eating behaviors during the COVID-19 pandemic A Mulè, L Galasso, L Castelli, A Ciorciari, G Michielon, F Esposito, ... Sustainability 14 (22), 15340 , 2022 2022 Citations: 17
Effect of sleep and fatigue on cardiovascular performance in young, healthy subjects L Castelli, D Walzik, N Joisten, M Watson, A Montaruli, M Oberste, ... Physiology & behavior 256, 113963 , 2022 2022 Citations: 15
Sleep and spa therapies: What is the role of balneotherapy associated with exercise? A systematic review L Castelli, L Galasso, A Mule, A Ciorciari, F Fornasini, A Montaruli, ... Frontiers in Physiology 13, 964232 , 2022 2022 Citations: 54
Physical activity and sleep behaviour in women carrying BRCA1/2 mutations L Galasso, L Castelli, E Roveda, A Oliverio, I Baldassari, F Esposito, ... Scientific Reports 12 (1), 12873 , 2022 2022 Citations: 4
Effect of chronotype on academic achievement in a sample of Italian University students: An update on sex effect L Castelli, L Galasso, A Mulè, A Caumo, E Roveda, A Montaruli Chronobiology International 39 (5), 613-615 , 2022 2022 Citations: 6
Effects of shift work in a sample of Italian nurses: analysis of rest-activity circadian rhythm L Galasso, A Mulè, L Castelli, E Cè, V Condemi, G Banfi, E Roveda, ... International journal of environmental research and public health 18 (16), 8378 , 2021 2021 Citations: 25
Sleep problems and their interaction with physical activity and fatigue in hematological cancer patients during onset of high dose chemotherapy L Castelli, T Elter, F Wolf, M Watson, A Schenk, K Steindorf, W Bloch, ... Supportive care in Cancer , 2021 2021 Citations: 41
Biological rhythm and chronotype: new perspectives in health A Montaruli, L Castelli, A Mulè, R Scurati, F Esposito, L Galasso, ... Biomolecules 11 (4), 487 , 2021 2021 Citations: 472
Sex differences in rest-activity circadian rhythm in patients with metabolic syndrome A Mulè, E Bruno, P Pasanisi, L Galasso, L Castelli, A Caumo, F Esposito, ... Frontiers in Physiology 12, 641461 , 2021 2021 Citations: 18
Differences in daytime activity levels and daytime sleep between night and day duty: an observational study in Italian orthopedic nurses E Roveda, L Castelli, L Galasso, A Mulè, E Cè, V Condemi, G Banfi, ... Frontiers in physiology 12, 628231 , 2021 2021 Citations: 14
Sleep influeunces VO2MAX, fatigue and mood in active young subjects L Castelli, L Galasso, A Mule, P Zimmer European college of sport science: book of abstracts, 206-207 , 2021 2021
Binge eating disorder: what is the role of physical activity associated with dietary and psychological treatment? L Galasso, A Montaruli, KS Jankowski, E Bruno, L Castelli, A Mulè, ... Nutrients 12 (12), 3622 , 2020 2020 Citations: 43
Reduced neuromuscular performance in night shift orthopedic nurses: new insights from a combined electromyographic and force signals approach E Cè, C Doria, E Roveda, A Montaruli, L Galasso, L Castelli, A Mulè, ... Frontiers in physiology 11, 693 , 2020 2020 Citations: 20
Rest-activity rhythm in breast cancer survivors: an update based on non-parametric indices L Galasso, A Montaruli, A Mulè, L Castelli, E Bruno, P Pasanisi, A Caumo, ... Chronobiology International 37 (6), 946-951 , 2020 2020 Citations: 16
Effect of chronotype on rating of perceived exertion in active young people A Mulè, L Galasso, L Castelli, V Condemi, AV Bisconti, F Esposito, ... Sport Sciences for Health 16 (2), 331-336 , 2020 2020 Citations: 29
Effect of chronotype on motor skills specific to soccer in adolescent players E Roveda, A Mulè, L Galasso, L Castelli, R Scurati, G Michielon, ... Chronobiology international 37 (4), 552-563 , 2020 2020 Citations: 61
Physical activity, chronotype and sleep in a sample of Italian elderly population L Castelli, L Galasso, A Mulè, E Bruno, S Shokohyar, F Esposito, ... Sport Sciences for Health 16 (1), 55-64 , 2020 2020 Citations: 26
Effect of chronotype on academic achievement in a sample of Italian University students A Montaruli, L Castelli, L Galasso, A Mulè, E Bruno, F Esposito, A Caumo, ... Chronobiology international 36 (11), 1482-1495 , 2019 2019 Citations: 70
MOST CITED SCHOLAR PUBLICATIONS
Biological rhythm and chronotype: new perspectives in health A Montaruli, L Castelli, A Mulè, R Scurati, F Esposito, L Galasso, ... Biomolecules 11 (4), 487 , 2021 2021 Citations: 472
Effect of chronotype on academic achievement in a sample of Italian University students A Montaruli, L Castelli, L Galasso, A Mulè, E Bruno, F Esposito, A Caumo, ... Chronobiology international 36 (11), 1482-1495 , 2019 2019 Citations: 70
Effect of chronotype on motor skills specific to soccer in adolescent players E Roveda, A Mulè, L Galasso, L Castelli, R Scurati, G Michielon, ... Chronobiology international 37 (4), 552-563 , 2020 2020 Citations: 61
Sleep and spa therapies: What is the role of balneotherapy associated with exercise? A systematic review L Castelli, L Galasso, A Mule, A Ciorciari, F Fornasini, A Montaruli, ... Frontiers in Physiology 13, 964232 , 2022 2022 Citations: 54
Binge eating disorder: what is the role of physical activity associated with dietary and psychological treatment? L Galasso, A Montaruli, KS Jankowski, E Bruno, L Castelli, A Mulè, ... Nutrients 12 (12), 3622 , 2020 2020 Citations: 43
Rest-activity circadian rhythm in breast cancer survivors at 5 years after the primary diagnosis E Roveda, E Bruno, L Galasso, A Mulè, L Castelli, A Villarini, A Caumo, ... Chronobiology International 36 (8), 1156-1165 , 2019 2019 Citations: 42
Sleep problems and their interaction with physical activity and fatigue in hematological cancer patients during onset of high dose chemotherapy L Castelli, T Elter, F Wolf, M Watson, A Schenk, K Steindorf, W Bloch, ... Supportive care in Cancer , 2021 2021 Citations: 41
Effect of chronotype on rating of perceived exertion in active young people A Mulè, L Galasso, L Castelli, V Condemi, AV Bisconti, F Esposito, ... Sport Sciences for Health 16 (2), 331-336 , 2020 2020 Citations: 29
The multidisciplinary therapy in binge eating disorder is able to influence the interdaily stability and sleep quality? L Galasso, A Montaruli, A Mulè, L Castelli, E Bruno, A Caumo, F Esposito, ... Chronobiology International 36 (10), 1311-1315 , 2019 2019 Citations: 27
Physical activity, chronotype and sleep in a sample of Italian elderly population L Castelli, L Galasso, A Mulè, E Bruno, S Shokohyar, F Esposito, ... Sport Sciences for Health 16 (1), 55-64 , 2020 2020 Citations: 26
Effects of shift work in a sample of Italian nurses: analysis of rest-activity circadian rhythm L Galasso, A Mulè, L Castelli, E Cè, V Condemi, G Banfi, E Roveda, ... International journal of environmental research and public health 18 (16), 8378 , 2021 2021 Citations: 25
Reduced neuromuscular performance in night shift orthopedic nurses: new insights from a combined electromyographic and force signals approach E Cè, C Doria, E Roveda, A Montaruli, L Galasso, L Castelli, A Mulè, ... Frontiers in physiology 11, 693 , 2020 2020 Citations: 20
Sex differences in rest-activity circadian rhythm in patients with metabolic syndrome A Mulè, E Bruno, P Pasanisi, L Galasso, L Castelli, A Caumo, F Esposito, ... Frontiers in Physiology 12, 641461 , 2021 2021 Citations: 18
Lifestyle of Italian university students attending different degree courses: a survey on physical activity, sleep and eating behaviors during the COVID-19 pandemic A Mulè, L Galasso, L Castelli, A Ciorciari, G Michielon, F Esposito, ... Sustainability 14 (22), 15340 , 2022 2022 Citations: 17
Rest-activity rhythm in breast cancer survivors: an update based on non-parametric indices L Galasso, A Montaruli, A Mulè, L Castelli, E Bruno, P Pasanisi, A Caumo, ... Chronobiology International 37 (6), 946-951 , 2020 2020 Citations: 16
Effect of sleep and fatigue on cardiovascular performance in young, healthy subjects L Castelli, D Walzik, N Joisten, M Watson, A Montaruli, M Oberste, ... Physiology & behavior 256, 113963 , 2022 2022 Citations: 15
Differences in daytime activity levels and daytime sleep between night and day duty: an observational study in Italian orthopedic nurses E Roveda, L Castelli, L Galasso, A Mulè, E Cè, V Condemi, G Banfi, ... Frontiers in physiology 12, 628231 , 2021 2021 Citations: 14
Theoretical construct into blocks of actigraphic-derived sleep parameters L Galasso, G Calogiuri, L Castelli, A Mulè, F Esposito, A Caumo, ... Chronobiology International 40 (2), 174-185 , 2023 2023 Citations: 7
Effect of chronotype on academic achievement in a sample of Italian University students: An update on sex effect L Castelli, L Galasso, A Mulè, A Caumo, E Roveda, A Montaruli Chronobiology International 39 (5), 613-615 , 2022 2022 Citations: 6
Author Correction: Physical activity and sleep behaviour in women carrying BRCA1/2 mutations L Galasso, L Castelli, E Roveda, A Oliverio, I Baldassari, F Esposito, ... Scientific Reports 12, 20516 , 2022 2022 Citations: 4
