Research
Mixed
Optimal combined SPAN behaviors (high sleep 8.0-9.4h, high MVPA 42-104min, high diet quality 57.5-72.5) are associated with a 57% lower risk of MACE compared to the lowest tertile of all behaviors.
To maximize cardiovascular protection, aim for 8-9.5 hours of sleep, 42-104 minutes of moderate-to-vigorous exercise daily, and a high-quality diet (score 32.5-50.0). This combination is associated with a 57% lower risk of major cardiovascular events compared to having low levels of all three behaviors.
GoodSupportsHIGH confidence
the optimal SPAN combination involving high sleep duration (8.0-9.4 hours/day), high MVPA (42-104 mins/day), and a DQS between 32.5 and 50.0 was associated with an HR of 0.43 (95%CI: 0.30, 0.62).
Why this rating
Large prospective cohort with objective measures.
Source
Clinically meaningful combined improvements of sleep, physical activity, and nutrition (SPAN) in relation to major adverse cardiovascular events
Nicholas A. Koemel et al. · medRxiv · 2025
DOI 10.1101/2025.09.10.25335537
preprint · n=53242
Read the paper DOI resolved against Crossref · corpus check 2026-06-10
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- Modest combined improvements in sleep (11 min/day), physical activity (4.5 min/day MVPA), and nutrition (3 DQS points) are associated with a clinically meaningful 10% reduction in major adverse cardiovascular events (MACE).Good
- Sleep duration has a non-linear (L-shaped or U-shaped) relationship with MACE subtypes, with optimal benefits for heart failure but potential risks for myocardial infarction and stroke at longer durations.Good
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