Jostein Steene-Johannessen

• Dohrn, Ing-Mari; Tarp, Jakob; Steene-Johannessen, Jostein; Vasankari, Tommi & Hagströmer, Maria (2024). Device-measured physical activity and sedentary time in the Nordic countries: A scoping review of population-based studies. Journal of Sport and Health Science. ISSN 2095-2546. doi: 10.1016/j.jshs.2024.04.003.
• Husøy, Anders; Kolle, Elin; Steene-Johannessen, Jostein; Dalene, Knut Eirik; Andersen, Lars Bo & Ekelund, Ulf [Show all 7 contributors for this article] (2024). Longitudinal changes in device-measured physical activity from childhood to young adulthood: the PANCS follow-up study. International Journal of Behavioral Nutrition and Physical Activity. ISSN 1479-5868. 21(1). doi: 10.1186/s12966-024-01578-7.
• Sagelv, Edvard Hamnvik; Hopstock, Laila Arnesdatter; Morseth, Bente; Hansen, Bjørge Hermann; Steene-Johannessen, Jostein & Johansson, Jonas Lars [Show all 12 contributors for this article] (2023). Device-measured physical activity, sedentary time, and risk of all-cause mortality: an individual participant data analysis of four prospective cohort studies. British Journal of Sports Medicine. ISSN 0306-3674. 57(22), p. 1457–1463. doi: 10.1136/bjsports-2022-106568. Full text in Research Archive
• Thorsen, Lene; Courneya, Kerry S.; Steene-Johannessen, Jostein; Gran, Jon Michael; Haugnes, Hege Sagstuen & Negaard, Helene Francisca Stigter [Show all 8 contributors for this article] (2023). Association of physical activity with overall mortality among long-term testicular cancer survivors: A longitudinal study. International Journal of Cancer. ISSN 0020-7136. 153(8), p. 1512–1519. doi: 10.1002/ijc.34625. Full text in Research Archive Show summary

  Physical activity (PA) has been associated with reduced mortality among cancer survivors, but no study has focused on testicular cancer survivors (TCSs). We aimed to investigate the association of PA measured twice during survivorship with overall mortality in TCSs. TCSs treated during 1980 to 1994 participated in a nationwide longitudinal survey between 1998 to 2002 (S1: n = 1392) and 2007 to 2009 (S2: n = 1011). PA was self-reported by asking for the average hours per week of leisure-time PA in the past year. Responses were converted into metabolic equivalent task hours/week (MET-h/wk) and participants were categorized into: Inactives (0 MET-h/wk), Low-Actives (2-6 MET-h/wk), Actives (10-18 MET-h/wk) and High-Actives (20-48 MET-h/wk). Mortality from S1 and S2, respectively, was analyzed using the Kaplan-Meier estimator and Cox proportional hazards models until the End of Study (December 31, 2020). Mean age at S1 was 45 years (SD 10.2). Nineteen percent (n = 268) of TCSs died between S1 and EoS, with 138 dying after S2. Compared to Inactives at S1, the mortality risk among Actives was 51% lower (HR 0.49, 95% CI: 0.29-0.84) with no further mortality reduction among High-Actives. At S2, the mortality risk was at least 60% lower among the Actives, High-Actives and even the Low-Actives compared to the Inactives. Persistent Actives (≥10 MET-h/wk at S1 and S2) had a 51% lower mortality risk compared to Persistent Inactives (<10 MET-h/wk at S1 and S2; HR 0.49, 95% CI: 0.30-0.82). During long-term survivorship after TC treatment, regular and maintained PA were associated with an overall mortality risk reduction of at least 50%.

• Dalene, Knut Eirik; Kolle, Elin; Steene-Johannessen, Jostein; Hansen, Bjørge Hermann; Ekelund, Ulf & Grydeland, May [Show all 8 contributors for this article] (2022). Device-measured sedentary time in Norwegian children and adolescents in the era of ubiquitous internet access: secular changes between 2005, 2011 and 2018. International Journal of Epidemiology. ISSN 0300-5771. 51(5), p. 1556–1567. doi: 10.1093/ije/dyac063. Full text in Research Archive Show summary

  Background: Access to screen-based media has been revolutionized during the past two decades. How this has affected sedentary time (ST) accumulation in children is poorly understood. Methods: This study, based on the Physical Activity among Norwegian Children Study (PANCS), uses accelerometer data from population-based samples of 9- and 15‐year-olds, collected in 2005 (n = 1722), 2011 (n = 1587) and 2018 (n = 1859). Secular changes between surveys were analysed using random-effects linear regression models adjusted for survey-specific factors. Data on ST were collected using hip-worn ActiGraphs and ST was defined using a threshold equivalent to <100 counts/min. Sedentary bouts were grouped by duration: <1, 1–5, 5–15, 15–30 and ≥30 min. Results: Between 2005 and 2018, ST increased by 29 min/day in 9-year-old boys (95% CI: 19, 39; P <0.001), by 21 min/day in 15-year-old boys (95% CI: 8, 34; P = 0.002) and by 22 min/day in 15-year-old girls (95% CI: 10, 35; P <0.001), but not in 9-year-old girls at 6 min/day (95% CI: -3, 16; P = 0.191). All age-sex groups accumulated less ST in bouts lasting <5 min and more ST in longer bouts, particularly in 5–15-min bouts. Adolescent girls also increased ST accumulation in 15–30-min and ≥30-min bouts. Changes were largely mirrored before, during and after school on weekdays and during weekend days. Conclusions: Coinciding with the introduction of smartphones, tablets and near-universal internet access, total daily ST and ST accumulated in prolonged sedentary bouts increased between 2005 and 2018 in children and adolescents.

• Jones, Paul Remy; Rajalahti, Tarja; Resaland, Geir Kåre; Aadland, Eivind; Steene-Johannessen, Jostein & Anderssen, Sigmund Alfred [Show all 10 contributors for this article] (2022). Associations of lipoprotein particle profile and objectively measured physical activity and sedentary time in schoolchildren: a prospective cohort study. International Journal of Behavioral Nutrition and Physical Activity. ISSN 1479-5868. 19(1). doi: 10.1186/s12966-022-01244-w. Full text in Research Archive Show summary

  Background: Our understanding of the mechanisms through which physical activity might benefit lipoprotein metabolism is inadequate. Here we characterise the continuous associations between physical activity of different intensities, sedentary time, and a comprehensive lipoprotein particle profile. Methods: Our cohort included 762 fifth grade (mean [SD] age = 10.0 [0.3] y) Norwegian schoolchildren (49.6% girls) measured on two separate occasions across one school year. We used targeted proton nuclear magnetic resonance (1H NMR) spectroscopy to produce 57 lipoprotein measures from fasted blood serum samples. The children wore accelerometers for seven consecutive days to record time spent in light-, moderate-, and vigorous-intensity physical activity, and sedentary time. We used separate multivariable linear regression models to analyse associations between the device-measured activity variables—modelled both prospectively (baseline value) and as change scores (follow-up minus baseline value)—and each lipoprotein measure at follow-up. Results: Higher baseline levels of moderate-intensity and vigorous-intensity physical activity were associated with a favourable lipoprotein particle profile at follow-up. The strongest associations were with the larger subclasses of triglyceride-rich lipoproteins. Sedentary time was associated with an unfavourable lipoprotein particle profile, the pattern of associations being the inverse of those in the moderate-intensity and vigorous-intensity physical activity analyses. The associations with light-intensity physical activity were more modest; those of the change models were weak. Conclusion: We provide evidence of a prospective association between time spent active or sedentary and lipoprotein metabolism in schoolchildren. Change in activity levels across the school year is of limited influence in our young, healthy cohort.

• Collings, Paul J.; Grøntved, Anders; Jago, Russell; Kriemler, Susi; Northstone, Kate & Puder, Jardena J. [Show all 13 contributors for this article] (2021). Cross-sectional and prospective associations of sleep duration and bedtimes with adiposity and obesity risk in 15 810 youth from 11 international cohorts. Pediatric Obesity. ISSN 2047-6302. doi: 10.1111/ijpo.12873. Show summary

  Objectives: To investigate associations of bedtimes and sleep durations with adiposity levels in children and adolescents. Methods: Individual data were pooled for 12 247 children (5819 with follow-up adiposity at 2.3 ± 1.4 years post-baseline) and 3563 adolescents from 11 international studies. Associations between questionnaire-based sleep durations, bedtimes and four groups of combined bedtimes and sleep lengths (later-shorter [reference]/earlier-shorter/later-longer/earlier-longer) with measured adiposity (body mass index [BMI] and waist circumference z-scores) and weight status, were investigated. Results: In children, longer sleep durations were consistently associated with lower adiposity markers, and earlier bedtimes were related to lower BMI z-score. Compared to sleeping <10 h, longer baseline sleep duration favourably predicted Δwaist z-score in girls (≥10 and <11 h (β-coefficient (95% confidence interval [CI])): −0.06 (−0.12 to −0.01)) and boys (≥11 h: −0.10 [−0.18 to −0.01]). Combined groups that were defined by longer sleep (later-longer and earlier-longer sleep patterns) were associated with lower adiposity, and later-longer sleep favourably predicted Δwaist z-score in girls (−0.09 [−0.15 to −0.02]). In adolescents, longer sleep durations and earlier bedtimes were associated with lower BMI z-score in the whole sample, and also with lower waist z-score in boys. Combined groups that were characterized by earlier bedtimes were associated with the same outcomes. For example, earlier-shorter (−0.22 (−0.43 to −0.01) and earlier-longer (−0.16 (−0.25 to −0.06) sleep were both associated with lower BMI z-score. Conclusions: If the associations are causal, longer sleep duration and earlier bedtimes should be targeted for obesity prevention, emphasizing longer sleep for children and earlier bedtimes for adolescents.

• Tarp, Jakob; Fagerland, Morten Wang; Dalene, Knut Eirik; Steene-Johannessen, Jostein; Hansen, Bjørge Hermann & Jefferis, Barbara [Show all 24 contributors for this article] (2021). Device-measured physical activity, adiposity and mortality: a harmonised meta-analysis of eight prospective cohort studies. British Journal of Sports Medicine. ISSN 0306-3674. 56(13), p. 725–732. doi: 10.1136/bjsports-2021-104827. Full text in Research Archive
• Zhou, Bin; Carrillo-Larco, Rodrigo M.; Danaei, Goodarz; Riley, Leanne M.; Paciorek, Christopher J. & Stevens, Gretchen A. [Show all 100 contributors for this article] (2021). Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. The Lancet. ISSN 0140-6736. 398(10304), p. 957–980. doi: 10.1016/S0140-6736(21)01330-1. Full text in Research Archive
• Solberg, Runar Barstad; Steene-Johannessen, Jostein; Fagerland, Morten; Anderssen, Sigmund Alfred; Berntsen, Sveinung & Resaland, Geir Kåre [Show all 9 contributors for this article] (2021). Aerobic fitness mediates the intervention effects of a school-based physical activity intervention on academic performance. The school in Motion study – A cluster randomized controlled trial. Preventive Medicine Reports. ISSN 2211-3355. 24. doi: 10.1016/j.pmedr.2021.101648. Full text in Research Archive
• Iurilli, Maria Laura Caminia; Zhou, Bin; Bennett, James E.; Carrillo-Larco, Rodrigo M.; Sophiea, Marisa K. & Rodriguez-Martinez, Andrea [Show all 77 contributors for this article] (2021). Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight. eLIFE. ISSN 2050-084X. 10. doi: 10.7554/eLife.60060. Full text in Research Archive Show summary

  From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions.

• Steene-Johannessen, Jostein; Anderssen, Sigmund Alfred; Kolle, Elin; Hansen, Bjørge Hermann; Bratteteig, Mari & Dalhaug, Emilie Frederikke Mass [Show all 10 contributors for this article] (2021). Temporal trends in physical activity levels across more than a decade – a national physical activity surveillance system among Norwegian children and adolescents. International Journal of Behavioral Nutrition and Physical Activity. ISSN 1479-5868. 18. doi: 10.1186/s12966-021-01120-z. Full text in Research Archive Show summary

  Background: There is a scarcity of device measured data on temporal changes in physical activity (PA) in large population-based samples. The purpose of this study is to describe gender and age-group specific temporal trends in device measured PA between 2005, 2011 and 2018 by comparing three nationally representative samples of children and adolescents. Methods: Norwegian children and adolescents (6, 9 and 15-year-olds) were invited to participate in 2005 (only 9- and 15-year-olds), 2011 and 2018 through cluster sampling (schools primary sampling units). A combined sample of 9500 individuals participated. Physical activity was assessed by hip worn accelerometers, with PA indices including overall PA (counts per minute), moderate-to-vigorous intensity PA (MVPA), and PA guideline adherence (achieving on average ≥ 60 min/day of moderate-to-vigorous PA). Random-effects linear regressions and logistic regressions adjusted for school-level clusters were used to analyse temporal trends. Findings: In total, 8186 of the participating children and adolescents provided valid PA data. Proportions of sufficiently active 6-year-olds were almost identical in 2011 and 2018; boys 95% (95% CI: 92, 97) and 94% (95%CI: 92, 96) and girls 86% (95% CI: 83, 90) and 86% (95% CI: 82, 90). Proportions of sufficiently active 15-year-olds in 2005 and 2018 were 52% (95% CI: 46, 59) and 55% (95% CI: 48, 62) in boys, and 48% (95% CI: 42, 55) and 44% (95% CI: 37, 51) in girls, respectively, resulting from small differences in min/day of MVPA. Among 9-year-old boys and girls, proportions of sufficiently active declined between 2005 and 2018, from 90% (95% CI: 87, 93) to 84% (95% CI: 80, 87)) and 74% (95% CI: 69, 79) to 68% (95% CI: 64, 72), respectively. This resulted from 9.7 min/day less MVPA in boys (95% CI: − 14.8, − 4.7; p < 0.001) and 3.2 min/day less MVPA (95% CI: − 7.0, 0.7; p = 0.106) in girls. Conclusions: PA levels have been fairly stable between 2005, 2011 and 2018 in Norwegian youth. However, the declining PA level among 9-year-old boys and the low proportion of 15-year-olds sufficiently active is concerning. To evaluate the effect of, and plan for new, PA promoting strategies, it is important to ensure more frequent, systematic, device-based monitoring of population-levels of PA.

• Solberg, Runar Barstad; Steene-Johannessen, Jostein; Anderssen, Sigmund Alfred; Ekelund, Ulf; Säfvenbom, Reidar & Haugen, Tommy [Show all 11 contributors for this article] (2021). Effects of a school-based physical activity intervention on academic performance in 14-year old adolescents: a cluster randomized controlled trial – the School in Motion study. BMC Public Health. ISSN 1471-2458. 21. doi: 10.1186/s12889-021-10901-x. Full text in Research Archive Show summary

  Background: School-based physical activity interventions evaluating the effect on academic performance usually includes children. We aimed to investigate the effect of a nine-month, school-based physical activity intervention titled School in Motion (ScIM) on academic performance in adolescents. Methods: Thirty secondary schools in Norway were cluster-randomized into three groups: the Physically active learning (PAL) group (n = 10), the Don’t worry – Be Happy (DWBH) group (n = 10) or control (n = 10). Target dose in both intervention groups was 120 min/week of additional PA during school hours. Parental consent was obtained from 2084 adolescent students (76%). Standardized national tests in reading and numeracy was conducted at baseline and at the end of the intervention. We used linear mixed model to test intervention effects. We found significant intervention effects in numeracy and reading among students in both interventions when compared with controls. Results: The mean difference in change in numeracy was 1.7 (95% CI: 0.9 to 2.5; Cohen’s d = 0.12) and 2.0 (95% CI: 1.4 to 2.7; Cohen’s d = 0.23) points in favour of students in the PAL and DWBH intervention, respectively. Similar results were found for reading, where the mean difference in change was 0.9 (95% CI 0.2 to 1.6; Cohen’s d = 0.06) and 1.1 (95% CI 0.3 to 1.9; Cohen’s d = 0.18) points in favour of students in the PAL and DWBH intervention, respectively. When conducting intention to treat analysis with imputed data the estimates were attenuated and some no longer significant. Conclusion: The ScIM study demonstrates that two different school-based PA interventions providing approximately 120 min of additional PA weekly over nine months, significantly improved numeracy and reading performance in 14-year old students compared with controls. However, the results should be interpreted with caution as the effect sizes reported were very small or small and the estimates were attenuated when conducting intention to treat analysis. Despite this, our results are still positive and suggest that PA interventions are viable models to increase academic performance among adolescents.

• Dalene, Knut Eirik; Tarp, Jakob; Selmer, Randi Marie; Ariansen, Inger Kristine Holtermann; Nystad, Wenche & Coenen, Pieter [Show all 9 contributors for this article] (2021). Occupational physical activity and longevity in working men and women in Norway: a prospective cohort study. The Lancet Public Health. ISSN 2468-2667. 6(6), p. e386–e395. doi: 10.1016/S2468-2667(21)00032-3. Full text in Research Archive Show summary

  Background: Studies suggest that high occupational physical activity increases mortality risk. However, it is unclear whether this association is causal or can be explained by a complex network of socioeconomic and behavioural factors. We aimed to examine the association between occupational physical activity and longevity, taking a complex network of confounding variables into account. Methods: In this prospective cohort study, we linked data from Norwegian population-based health examination surveys, covering all parts of Norway with data from the National Population and Housing Censuses and the Norwegian Cause of Death Registry. 437 378 participants (aged 18–65 years; 48·7% men) self-reported occupational physical activity (mutually exclusive groups: sedentary, walking, walking and lifting, and heavy labour) and were followed up from study entry (between February, 1974, and November, 2002) to death or end of follow-up on Dec 31, 2018, whichever came first. We estimated differences in survival time (death from all causes, cardiovascular disease, and cancer) between occupational physical activity categories using flexible parametric survival models adjusted for confounding factors. Findings: During a median of 28 years (IQR 25–31) from study entry to the end of follow-up, 74 203 (17·0%) of the participants died (all-cause mortality), of which 20 111 (27·1%) of the deaths were due to cardiovascular disease and 29 886 (40·3%) were due to cancer. Crude modelling indicated shorter mean survival times among men in physically active occupations than in those with sedentary occupations. However, this finding was reversed following adjustment for confounding factors (birth cohort, education, income, ethnicity, prevalent cardiovascular disease, smoking, leisure-time physical activity, body-mass index), with estimates suggesting that men in occupations characterised by walking, walking and lifting, and heavy labour had life expectancies equivalent to 0·4 (95% CI −0·1 to 1·0), 0·8 (0·3 to 1·3), and 1·7 (1·2 to 2·3) years longer, respectively, than men in the sedentary referent category. Results for mortality from cardiovascular disease and cancer showed a similar pattern. No clear differences in survival times were observed between occupational physical activity groups in women. Interpretation: Our results suggest that moderate to high occupational physical activity contributes to longevity in men. However, occupational physical activity does not seem to affect longevity in women. These results might inform future physical activity guidelines for public health.

• Jones, Paul Remy; Rajalahti, Tarja; Resaland, Geir Kåre; Aadland, Eivind; Steene-Johannessen, Jostein & Anderssen, Sigmund Alfred [Show all 10 contributors for this article] (2021). Cross-sectional and prospective associations between aerobic fitness and lipoprotein particle profile in a cohort of Norwegian schoolchildren. Atherosclerosis. ISSN 0021-9150. 321, p. 21–29. doi: 10.1016/j.atherosclerosis.2021.02.002. Full text in Research Archive
• Taddei, Cristina; Jackson, Rod; Zhou, Bin; Bixby, Honor; Danaei, Goodarz & Di Cesare, Mariachiara [Show all 361 contributors for this article] (2020). National trends in total cholesterol obscure heterogeneous changes in HDL and non-HDL cholesterol and total-to-HDL cholesterol ratio: A pooled analysis of 458 population-based studies in Asian and Western countries. International Journal of Epidemiology. ISSN 0300-5771. 49(1), p. 173–192. doi: 10.1093/ije/dyz099.
• Taddei, Cristina; Zhou, Bin; Bixby, Honor; Carrillo-Larco, Rodrigo M.; Danaei, Goodarz & Jackson, Rod T. [Show all 55 contributors for this article] (2020). Repositioning of the global epicentre of non-optimal cholesterol . Nature. ISSN 0028-0836. 582, p. 73–77. doi: 10.1038/s41586-020-2338-1. Full text in Research Archive
• Rodriguez-Martinez, Andrea; Zhou, Bin; Sophiea, Marisa K.; Bentham, James; Paciorek, Christopher J. & Turilli, Maria L.C. [Show all 54 contributors for this article] (2020). Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants. The Lancet. ISSN 0140-6736. 396(10261), p. 1511–1524. doi: 10.1016/S0140-6736(20)31859-6. Full text in Research Archive
• Husøy, Anders; Dalene, Knut Eirik; Steene-Johannessen, Jostein; Anderssen, Sigmund Alfred; Ekelund, Ulf & Tarp, Jakob (2020). Effect modification by cardiorespiratory fitness on the association between physical activity and cardiometabolic health in youth: A systematic review. Journal of Sports Sciences. ISSN 0264-0414. doi: 10.1080/02640414.2020.1847919. Full text in Research Archive Show summary

  Physical activity and cardiorespiratory fitness are inversely associated with markers of cardiometabolic risk in children and adolescents, but the interplay between these variables in relation to the cardiometabolic risk profile is unclear. We systematically reviewed the literature to examine whether the association between physical activity and cardiometabolic health differs by levels of cardiorespiratory fitness in youth. A literature search was conducted in PubMed and EMBASE, filtered from 2001 up until July 2019. We obtained 8980 citations, with 6915 remaining after removal of duplicates. Estimates were retrieved from 18 studies. All included articles went through a risk of bias assessment. We found that 14 out of 20 (70%) effect-estimates supported stronger associations between physical activity and cardiometabolic health markers among low-fit youth as compared to their high-fit peers. The most consistent findings were observed with biochemical markers and blood pressure as outcomes. However, substantial uncertainty is associated with these findings as most of the included studies (~72%) had a high risk of bias. More than two-thirds of the findings supported greatest benefits of physical activity on cardiometabolic risk markers in youth with low cardiorespiratory fitness, although the clinical importance of this difference is unclear.

• Ekelund, Ulf; Tarp, Jakob; Fagerland, Morten Wang; Steene-Johannessen, Jostein; Hansen, Bjørge Hermann & Jefferis, Barbara [Show all 23 contributors for this article] (2020). Joint associations of accelerometer-measured physical activity and sedentary time with all-cause mortality: a harmonised meta-analysis in more than 44 000 middle-aged and older individuals. British Journal of Sports Medicine. ISSN 0306-3674. 54(24), p. 1499–1506. doi: 10.1136/bjsports-2020-103270. Full text in Research Archive Show summary

  Objectives: To examine the joint associations of accelerometer-measured physical activity and sedentary time with all-cause mortality. Methods: We conducted a harmonised meta-analysis including nine prospective cohort studies from four countries. 44 370 men and women were followed for 4.0 to 14.5 years during which 3451 participants died (7.8% mortality rate). Associations between different combinations of moderate-to-vigorous intensity physical activity (MVPA) and sedentary time were analysed at study level using Cox proportional hazards regression analysis and summarised using random effects meta-analysis. Results: Across cohorts, the average time spent sedentary ranged from 8.5 hours/day to 10.5 hours/day and 8 min/day to 35 min/day for MVPA. Compared with the referent group (highest physical activity/lowest sedentary time), the risk of death increased with lower levels of MVPA and greater amounts of sedentary time. Among those in the highest third of MVPA, the risk of death was not statistically different from the referent for those in the middle (16%; 95% CI 0.87% to 1.54%) and highest (40%; 95% CI 0.87% to 2.26%) thirds of sedentary time. Those in the lowest third of MVPA had a greater risk of death in all combinations with sedentary time; 65% (95% CI 1.25% to 2.19%), 65% (95% CI 1.24% to 2.21%) and 263% (95% CI 1.93% to 3.57%), respectively. Conclusion: Higher sedentary time is associated with higher mortality in less active individuals when measured by accelerometry. About 30–40 min of MVPA per day attenuate the association between sedentary time and risk of death, which is lower than previous estimates from self-reported data.

• Kolle, Elin; Solberg, Runar Barstad; Säfvenbom, Reidar; Dyrstad, Sindre Mikal; Berntsen, Sveinung & Resaland, Geir Kåre [Show all 10 contributors for this article] (2020). The effect of a school-based intervention on physical activity, cardiorespiratory fitness and muscle strength: the School in Motion cluster randomized trial. International Journal of Behavioral Nutrition and Physical Activity. ISSN 1479-5868. 17. doi: 10.1186/s12966-020-01060-0. Full text in Research Archive Show summary

  Background: Physical activity (PA) declines throughout adolescence, therefore PA promotion during this period is important. We analyzed the effect of two school-based PA interventions on daily PA levels, cardiorespiratory fitness (CRF) and muscle strength among adolescents. Methods: For the nine-month School in Motion intervention study (ScIM), we cluster-randomized 30 Norwegian secondary schools (N = 2084, mean age [SD] = 14 [0.3] years) to one of three study arms. The physically active learning (PAL) intervention included 30 min physically active learning, 30 min PA and a 60 min physical education (PE) lesson per week. The Don’t worry-Be happy (DWBH) intervention included a 60 min PA lesson and a 60 min PE lesson per week, both tailored to promote friendships and wellbeing. Both intervention arms were designed to engage the adolescents in 120 min of PA per week in addition to recess and mandatory PE lessons. The control group continued as per usual, including the standard amount of mandatory PE. PA (main outcome) was assessed by accelerometers, CRF and muscle strength (secondary outcomes) were assessed by an intermittent running test and selected tests from the Eurofit test battery. Results: Daily PA and time spent in moderate- to vigorous-intensity PA (MVPA) decreased in all groups throughout the intervention. The mean difference in PA level and MVPA for participants in the PAL-intervention arm was 34.7 cpm (95% CI: 4.1, 65.3) and 4.7 min/day (95% CI: 0.6, 8.8) higher, respectively, compared to the control arm. There were no significant intervention effects on daily PA level, MVPA or time spent sedentary for adolescents in the DWBH-intervention arm. Adolescents in the PAL-intervention arm increased distance covered in the running test compared to controls (19.8 m, 95% CI: 10.4, 29.1), whilst a negative intervention effect was observed among adolescents in the DWBH-intervention arm (− 11.6 m, 95% CI: − 22.0, − 1.1). Conclusion: The PAL-intervention resulted in a significantly smaller decrease in daily PA level, time spent in MVPA, and increased CRF compared to controls. Our results indicate that a teacher-led intervention, including three unique intervention components, is effective in curbing the decline in PA observed across our cohort and improving CRF.

• Steene-Johannessen, Jostein; Hansen, Bjørge Hermann; Dalene, Knut Eirik; Kolle, Elin; Northstone, Kate & Møller, Niels Christian [Show all 51 contributors for this article] (2020). Variations in accelerometry measured physical activity and sedentary time across Europe – harmonized analyses of 47,497 children and adolescents. International Journal of Behavioral Nutrition and Physical Activity. ISSN 1479-5868. 17. doi: 10.1186/s12966-020-00930-x. Full text in Research Archive Show summary

  Background: Levels of physical activity and variation in physical activity and sedentary time by place and person in European children and adolescents are largely unknown. The objective of the study was to assess the variations in objectively measured physical activity and sedentary time in children and adolescents across Europe. Methods: Six databases were systematically searched to identify pan-European and national data sets on physical activity and sedentary time assessed by the same accelerometer in children (2 to 9.9 years) and adolescents (≥10 to 18 years). We harmonized individual-level data by reprocessing hip-worn raw accelerometer data files from 30 different studies conducted between 1997 and 2014, representing 47,497 individuals (2–18 years) from 18 different European countries. Results: Overall, a maximum of 29% (95% CI: 25, 33) of children and 29% (95% CI: 25, 32) of adolescents were categorized as sufficiently physically active. We observed substantial country- and region-specific differences in physical activity and sedentary time, with lower physical activity levels and prevalence estimates in Southern European countries. Boys were more active and less sedentary in all age-categories. The onset of age-related lowering or leveling-off of physical activity and increase in sedentary time seems to become apparent at around 6 to 7 years of age. Conclusions: Two third of European children and adolescents are not sufficiently active. Our findings suggest substantial gender-, country- and region-specific differences in physical activity. These results should encourage policymakers, governments, and local and national stakeholders to take action to facilitate an increase in the physical activity levels of young people across Europe.

• Hansen, Bjørge Hermann; Dalene, Knut Eirik; Ekelund, Ulf; Fagerland, Morten; Kolle, Elin & Steene-Johannessen, Jostein [Show all 8 contributors for this article] (2020). Step by step: Association of device‐measured daily steps with all‐cause mortality - A prospective cohort Study. Scandinavian Journal of Medicine & Science in Sports. ISSN 0905-7188. 30(9), p. 1705–1711. doi: 10.1111/sms.13726. Full text in Research Archive Show summary

  Introduction: Walking is free, does not require special training, and can be done almost everywhere. Therefore, walking is a feasible behavior on which to tailor public health messages. This study assesses the prospective association and dose‐response relationship between daily steps and all‐cause mortality. Materials and Methods: Daily steps were measured by waist‐mounted accelerometers in 2183 individuals (53% women) for seven consecutive days at baseline (2008‐09). Participants were followed for a median period of 9.1 years and associations between steps and all‐cause mortality determined by registry linkage were assessed using Cox proportional hazard regression with adjustment for relevant covariates. Results: Mean age was 57.0 (SD 10.9) years at baseline. Median (IQR) daily steps across ascending quartiles were 4651 (3495‐5325), 6862 (6388‐7350), 8670 (8215‐9186), and 11 467 (10 556‐13 110), respectively. During follow‐up, 119 individuals died (68% men). Higher number of daily steps was associated with a lower risk of all‐cause mortality with hazard ratios of 1.00 (referent), 0.52 (0.29‐0.93), 0.50 (0.27‐0.94), and 0.43 (0.21‐0.88) across ascending quartiles of daily steps in the multivariable‐adjusted model with follow‐up commencing 2 years after baseline. Risk differences per 1000 individuals for ascending quartiles were 6.8 (2.9‐9.3), 7.1 (0.8‐11.1), and 8.0 (1.7‐12.1), respectively. Conclusions: Daily steps were associated with lower mortality risk in a non‐linear dose‐response pattern. The risk is almost halved when comparing the least active referent against the second quartile equivalent to a difference of about 2200 daily steps. Encouraging those least active to increase their daily steps may have substantial public health implications.

• Bernhardsen, Guro Pauck; Stensrud, Trine; Hansen, Bjørge Hermann; Steene-Johannessen, Jostein; Kolle, Elin & Nystad, Wenche [Show all 17 contributors for this article] (2020). Birth weight, cardiometabolic risk factors and effect modification of physical activity in children and adolescents: pooled data from 12 international studies. International Journal of Obesity. ISSN 0307-0565. 44(10), p. 2052–2063. doi: 10.1038/s41366-020-0612-9. Full text in Research Archive Show summary

  Objectives: Low and high birth weight is associated with higher levels of cardiometabolic risk factors and adiposity in children and adolescents, and increases the risk of cardiovascular diseases, obesity, and early mortality later in life. Moderate-to-vigorous physical activity (MVPA) is associated with lower cardiometabolic risk factors and may mitigate the detrimental consequences of high or low birth weight. Thus, we examined whether MVPA modified the associations between birth weight and cardiometabolic risk factors in children and adolescents. Methods: We used pooled individual data from 12 cohort- or cross-sectional studies including 9,100 children and adolescents. Birth weight was measured at birth or maternally reported retrospectively. Device-measured physical activity (PA) and cardiometabolic risk factors were measured in childhood or adolescence. We tested for associations between birth weight, MVPA, and cardiometabolic risk factors using multilevel linear regression, including study as a random factor. We tested for interaction between birth weight and MVPA by introducing the interaction term in the models (birth weight x MVPA). Results: Most of the associations between birth weight (kg) and cardiometabolic risk factors were not modified by MVPA (min/day), except between birth weight and waist circumference (cm) in children (p = 0.005) and HDL-cholesterol (mmol/l) in adolescents (p = 0.040). Sensitivity analyses suggested that some of the associations were modified by VPA, i.e., the associations between birth weight and diastolic blood pressure (mmHg) in children (p = 0.009) and LDL- cholesterol (mmol/l) (p = 0.009) and triglycerides (mmol/l) in adolescents (p = 0.028). Conclusion: MVPA appears not to consistently modify the associations between low birth weight and cardiometabolic risk. In contrast, MVPA may mitigate the association between higher birth weight and higher waist circumference in children. MVPA is consistently associated with a lower cardiometabolic risk across the birth weight spectrum. Optimal prenatal growth and subsequent PA are both important in relation to cardiometabolic health in children and adolescents.

• Tarp, Jakob; Hansen, Bjørge Hermann; Fagerland, Morten; Steene-Johannessen, Jostein; Anderssen, Sigmund Alfred & Ekelund, Ulf (2020). Accelerometer-measured physical activity and sedentary time in a cohort of US adults followed for up to 13 years: The influence of removing early follow-up on associations with mortality. International Journal of Behavioral Nutrition and Physical Activity. ISSN 1479-5868. 17. doi: 10.1186/s12966-020-00945-4. Full text in Research Archive Show summary

  Background: Observational studies linking physical activity with mortality are susceptible to reverse causation bias from undiagnosed and prevalent diseases. Researchers often attempt to deal with reverse causation bias by excluding deaths occurring within the first 1 or 2 years from the analysis, but it is unclear if excluding deaths within this time-frame is sufficient to remove bias. Methods: We examined associations between total and intensity-specific physical activity and sedentary time with all-cause mortality in a prospective cohort of 3542 individuals from the 2003–2006 NHANES cycles. In order to yield measures of association hypothesized as minimally influenced by reverse causation bias the primary analysis excluded individuals with < 5 years of follow-up. Accelerometer-measured physical activity was linked with recently updated vital status from the National Death Index with a median follow-up of 10.8 years. Results: Hazard ratios (95% confidence intervals) were 0.74 (0.53, 1.04), 0.52 (0.37, 0.73), and 0.61 (0.38, 1.01) for ascending quartiles of total physical activity against the least active reference. Hazard ratios for ascending moderate-to-vigorous physical activity quartiles against the reference were 0.67 (0.47, 1.96), 0.67 (0.47, 0.95), and 0.68 (0.39, 1.18). Associations for light intensity physical activity and sedentary time were smaller in magnitude and all confidence intervals included unity. Total activity and moderate-to-vigorous physical activity hazard ratios from analyses only excluding deaths within the first 2 years were inflated by 13 and 26% relative to analysis restricted to ≥5 years of follow-up. Conclusions: The pattern of associations suggested total physical activity and moderate-to-vigorous physical activity were associated with lower mortality after more than 10 years of follow-up and excluding the first 5 years of observation time to minimize the impact of reverse causation bias. Excluding deaths within the first 2 years appeared insufficient to minimize the impact of reserve causation bias.

• Werneck, André O.; Silva, Danilo R.; Oyeyemi, Adewale L.; Fernandes, Rômulo A.; Steene-Johannessen, Jostein & Andersen, Lars Bo [Show all 8 contributors for this article] (2020). Physical activity attenuates metabolic risk of adolescents with overweight or obesity: the ICAD multi-country study. International Journal of Obesity. ISSN 0307-0565. 44, p. 823–829. doi: 10.1038/s41366-020-0521-y. Full text in Research Archive Show summary

  Background: Although the benefits of physical activity (PA) at an early age are well established, there is no robust evidence of the role of PA as well as its intensities in attenuating the association between weight status and metabolic risk among adolescents. In this investigation, we analyzed the association between weight status, intensities of PA, and metabolic risk among adolescents. Methods: Data from six cross-sectional studies in the International Children’s Accelerometry Database were used (N = 5216 adolescents; boys 14.6 ± 2.1 years and girls 14.7 ± 2.0 years). Weight status was assessed and classified according to body mass index. Fasting glucose, triglycerides, inverse high-density lipoprotein cholesterol, and blood pressure composed the metabolic risk indicator (z-score). PA was measured by accelerometers. The estimated age of peak height velocity was used as a covariate for somatic maturation. Results: We observed that increase in weight status showed a strong positive relationship with metabolic risk. However, adolescents with overweight or obesity in the highest tertile of PA (moderate-to-vigorous and vigorous intensity) showed a similar metabolic risk score as the normal weight groups. Moderate intensity PA seemed related to metabolic risk even within some categories of vigorous PA. Conclusions: We conclude that PA attenuates the metabolic risk of adolescents with overweight or obesity. Although this attenuation is largely explained by vigorous PA, moderate intensity seems also important for better metabolic profile.

• Stavnsbo, Mette; Aadland, Eivind; Anderssen, Sigmund Alfred; Chinapaw, Mai; Steene-Johannessen, Jostein & Andersen, Lars Bo [Show all 7 contributors for this article] (2019). Effects of the Active Smarter Kids (ASK) physical activity intervention on cardiometabolic risk factors in children: A cluster-randomized controlled trial. Preventive Medicine. ISSN 0091-7435. 130. doi: 10.1016/j.ypmed.2019.105868. Full text in Research Archive Show summary

  The onset of cardiometabolic diseases are recognized to occur in childhood. We aimed to investigate the effect of a school-based cluster-randomized controlled trial of physical activity (PA) on single and clustered cardiometabolic risk factors. We included 1129 fifth-grade children from 57 schools (≥seven children in each class) in Sogn and Fjordane County, Norway, randomized to 28 intervention schools and 29 control schools. The PA intervention was conducted between November 2014 and June 2015. Cardiometabolic risk factors were waist circumference (WC), systolic blood pressure (SBP), total cholesterol (TC):high-density lipoprotein (HDL)-ratio, triglycerides (TG), homeostatic model assessment (HOMA)-score, and cardiorespiratory fitness (CRF). PA was measured by accelerometry. No significant intervention effects were found for single or clustered cardiometabolic risk factors. However, in children with the less favorable baseline values, beneficial effects were found for SBP (p = 0.07 for group ∗ tertile interaction), TC:HDL ratio (p = 0.03 for group ∗ tertile interaction) and the clustered cardiometabolic risk score (p = 0.01 for group ∗ tertile interaction). Compared to boys, girls had a greater effect of the intervention on WC (p = 0.03 for group ∗ sex interaction) and CRF (p < 0.001 for group ∗ sex interaction). The majority of the children had high PA levels, thus limited potential for change, and we found no effects of the PA intervention on cardiometabolic risk in the total sample. However, the intervention had a significantly enhanced effect on fatness and fitness of girls compared to boys. Furthermore, the data suggest that children with the least favorable cardiometabolic risk profile and therefore most in need of change can benefit from school-based PA interventions.

• Bixby, Honor; Bentham, James; Zhou, Bin; Di Cesare, Mariachiara; Paciorek, Christopher J. & Bennett, James E. [Show all 51 contributors for this article] (2019). Rising rural body-mass index is the main driver of the global obesity epidemic in adults. Nature. ISSN 0028-0836. 569, p. 260–264. doi: 10.1038/s41586-019-1171-x. Full text in Research Archive
• Renninger, Marius; Hansen, Bjørge Hermann; Steene-Johannessen, Jostein; Kriemler, Susi; Froberg, Karsten & Northstone, Kate [Show all 10 contributors for this article] (2019). Associations between accelerometry measured physical activity and sedentary time and the metabolic syndrome: A meta-analysis of more than 6000 children and adolescents. Pediatric Obesity. ISSN 2047-6302. 15, p. 1–9. doi: 10.1111/ijpo.12578. Full text in Research Archive Show summary

  Background: Metabolic syndrome is increasingly prevalent in the pediatric population. To prevent an early onset, knowledge about its association with modifiable lifestyle factors is needed. Objectives: To estimate the prevalence of the metabolic syndrome and examine its cross‐sectional associations with physical activity and sedentary time. Methods: Participants were 6009 children and adolescents from 8 studies of the International Children's Accelerometry Database. Physical activity and sedentary time were measured by accelerometer. Metabolic syndrome was defined based on International Diabetes Federation criteria. Logistic regression models adjusted for sex, age and monitor wear time were used to examine the associations between physical activity, sedentary time and the metabolic syndrome in each study and effect estimates were combined using random‐effects meta‐analysis. Results: The overall prevalence of the metabolic syndrome was 2.9%. In crude models, a 10 min increase in moderate‐to‐vigorous intensity physical activity and vigorous‐intensity physical activity were inversely associated with the metabolic syndrome [OR 0.88, 95% CI 0.82‐0.94, OR 0.80, 95% CI 0.70‐0.92]. One hour increase in sedentary time was positively associated with the metabolic syndrome [OR 1.28, 95% CI 1.13‐1.45]. After adjustment for sedentary time, the association between moderate‐to‐vigorous‐intensity physical activity and the metabolic syndrome remained significant [OR 0.91, 95% CI 0.84‐0.99]. Sedentary time was not associated with the metabolic syndrome after adjustment for moderate‐to‐vigorous intensity physical activity [OR 1.14 95% CI 0.96‐1.36]. Conclusions: Physical activity of at least moderate intensity but not sedentary time is independently associated with the metabolic syndrome.

• Ekelund, Ulf; Tarp, Jakob; Steene-Johannessen, Jostein; Hansen, Bjørge Hermann; Jefferis, Barbara & Fagerland, Morten [Show all 20 contributors for this article] (2019). Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: systematic review and harmonised meta-analysis. The BMJ. ISSN 1756-1833. 366. doi: 10.1136/bmj.l4570. Full text in Research Archive
• Jones, Paul Remy; Rajalahti, Tarja; Resaland, Geir Kåre; Aadland, Eivind; Steene-Johannessen, Jostein & Anderssen, Sigmund Alfred [Show all 10 contributors for this article] (2019). Associations of physical activity and sedentary time with lipoprotein subclasses in Norwegian schoolchildren: The Active Smarter Kids (ASK) study. Atherosclerosis. ISSN 0021-9150. 288, p. 186–193. doi: 10.1016/j.atherosclerosis.2019.05.023. Full text in Research Archive Show summary

  Background and aims: Physical activity is favourably associated with certain markers of lipid metabolism. The relationship of physical activity with lipoprotein particle profiles in children is not known. Here we examine cross-sectional associations between objectively measured physical activity and sedentary time with serum markers of lipoprotein metabolism. Methods: Our cohort included 880 children (49.0% girls, mean age 10.2 years). Physical activity intensity and time spent sedentary were measured objectively using accelerometers. 30 measures of lipoprotein metabolism were quantified using nuclear magnetic resonance spectroscopy. Multiple linear regression models adjusted for age, sex, sexual maturity and socioeconomic status were used to determine associations of physical activity and sedentary time with lipoprotein measures. Additional models were adjusted for adiposity. Isotemporal substitution models quantified theoretical associations of replacing 30 min of sedentary time with 30 min of moderate- to vigorous-intensity physical activity (MVPA). Results: Time spent in MVPA was associated with a favourable lipoprotein profile independent of sedentary time. There were inverse associations with a number of lipoprotein measures, including most apolipoprotein B-containing lipoprotein subclasses and triglyceride measures, the ratio of total to high-density lipoprotein (HDL) cholesterol, and non-HDL cholesterol concentration. There were positive associations with larger HDL subclasses, HDL cholesterol concentration and particle size. Reallocating 30 min of sedentary time to MVPA had broadly similar associations. Sedentary time was only partly and weakly associated with an unfavourable lipoprotein profile. Conclusions: Physical activity of at least moderate-intensity is associated with a favourable lipoprotein profile in schoolchildren, independent of time spent sedentary, adiposity and other confounders.

• Hansen, Bjørge Hermann; Steene-Johannessen, Jostein & Kolle, Elin (2018). Status fysisk aktivitet og fysisk form i befolkningen. In Torstveit, Monica Klungland; Lohne-Seiler, Hilde; Berntsen, Sveinung & Anderssen, Sigmund Alfred (Ed.), Fysisk aktivitet og helse: Fra begrepsforståelse til implementering av kunnskap. Cappelen Damm Akademisk. ISSN 9788202568313. p. 92–113.
• Steene-Johannessen, Jostein; Grydeland, May & Hansen, Bjørge Hermann (2018). Måling av fysisk aktivitet og fysisk form. In Torstveit, Monica Klungland; Lohne-Seiler, Hilde; Berntsen, Sveinung & Anderssen, Sigmund Alfred (Ed.), Fysisk aktivitet og helse: Fra begrepsforståelse til implementering av kunnskap. Cappelen Damm Akademisk. ISSN 9788202568313. p. 62–91.
• Stavnsbo, Mette; Resaland, Geir Kåre; Anderssen, Sigmund Alfred; Steene-Johannessen, Jostein; Domazet, Sidsel Louise & Skrede, Turid [Show all 11 contributors for this article] (2018). Reference values for cardiometabolic risk scores in children and adolescents: Suggesting a common standard. Atherosclerosis. ISSN 0021-9150. 278, p. 299–306. doi: 10.1016/j.atherosclerosis.2018.10.003. Show summary

  Background and aims: International reference values for cardiometabolic risk variables, to allow for standardization of continuous risk scores in children, are not currently available. The aim of this study was to provide international age- and gender-specific reference values for cardiometabolic risk factors in children and adolescents. Methods: Cohorts of children sampled from different parts of Europe (North, South, Mid and Eastern) and from the United States were pooled. In total, 22,479 observations (48.7% European vs. 51.3% American), 11,234 from girls and 11,245 from boys, aged 6–18 years were included in the study. Linear mixed-model regression analysis was used to analyze the associations between age and each cardiometabolic risk factor. Results: Reference values for 14 of the most commonly used cardiometabolic risk variables in clustered risk scores were calculated and presented by age and gender: systolic blood pressure (SBP), diastolic blood pressure (DBP), waist circumference (WC), body mass index (BMI), sum of 4 skinfolds (sum4skin), triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), TC:HDL-C ratio, glucose, insulin, homeostatic model assessment-score (HOMA-score), and cardiorespiratory fitness (CRF). Conclusions: This study suggests a common standard to define cardiometabolic risk in children. Adapting this approach makes single risk factors and clustered cardiometabolic disease risk scores comparable to the reference material itself and comparable to cardiometabolic risk values in studies using the same strategy. This unified approach therefore increases the prospect to estimate and compare prevalence and trends of cardiometabolic risk in children when using continuous cardiometabolic risk scores.

• Hansen, Bjørge Hermann; Kolle, Elin; Steene-Johannessen, Jostein; Dalene, Knut Eirik; Ekelund, Ulf & Anderssen, Sigmund Alfred (2018). Monitoring population levels of physical activity and sedentary time in Norway across the lifespan. Scandinavian Journal of Medicine & Science in Sports. ISSN 0905-7188. doi: 10.1111/sms.13314. Show summary

  Purpose: The pandemic of physical inactivity is recognized globally but there is a scarcity of studies employing valid and reliable assessment methods of physical activity (PA) across the lifespan. The purpose of this study is to provide a comprehensive description of objectively measured PA, sedentary time, and prevalence of meeting PA recommendations, in a population‐based sample of Norwegian children, adolescents and adults. Methods: Children and adolescents (6, 9 and 15‐year‐olds) were surveyed in 2011, and adults and older people (20‐85‐year‐olds) were surveyed in 2014/15, including more than 8000 individuals. Anthropometric data were measured in children and adolescents and self‐reported in the adult sample. PA was assessed by ActiGraph accelerometers for seven consecutive days, and PA indices include total PA (counts per minute), intensity‐specific PA, and adherence to PA recommendations. Results: Six‐year‐olds are 21% and 70% more active than 9‐ and 15‐year‐olds, respectively (P < 0.001). Nine‐year‐olds are 40% more active compared to 15‐year‐olds (P < 0.001). Moving from adolescence (15‐year‐olds) into adulthood (20‐65 years) yields a further reduction in total PA by 18%. Among six‐, nine‐ and 15‐year olds, 90%, 77%, and 48% meet the current PA recommendations, respectively, while adherence among adults and older people are 33% and 31%, respectively. Overweight and obese individuals had lower odds of meeting PA recommendations. Conclusions: The results from the Norwegian surveillance system indicate a strong association between age and indices of physical activity. The vast majority of Norwegian adults do not meet the PA recommendations and public health action are needed to increase PA in Norway.

• Aadland, Eivind; Anderssen, Sigmund Alfred; Andersen, Lars Bo; Resaland, Geir Kåre; Kolle, Elin & Steene-Johannessen, Jostein (2018). Aerobic fitness thresholds to define poor cardiometabolic health in children and youth. Scandinavian Journal of Medicine & Science in Sports. ISSN 0905-7188. 29, p. 240–250. doi: 10.1111/sms.13330. Full text in Research Archive Show summary

  Aerobic fitness is an apparent candidate for screening children and youth for poor cardiometabolic health and future risk of cardiovascular disease (CVD). Yet, age‐ and sex‐specific cut points for children and youth determined using a maximal protocol and directly measured peak oxygen consumption (VO2peak) does not exist. We used a nationally representative sample of 1462 Norwegian children and youth (788 boys and 674 girls aged 8.7–10.4 years and 14.7–16.7 years) who in 2005–2006 performed a maximal cycle ergometer test with direct measurement of VO2peak, along with measurement of several other risk factors for CVD (systolic blood pressure, waist circumference:height ratio, total:high density lipoprotein cholesterol ratio, triglycerides, Homeostasis Model Assessment for Insulin Resistance). Based on the proportion of children having clustering (least favorable quartile) of 6 (1.6%), ≥ 5 (5.2%), and ≥ 4 (10.6%) CVD risk factors, we established the 2nd, 5th, and 10th percentile cut points for VO2peak (ml/kg/min) for children and youth aged 8–18 years. Classification accuracy was determined using the Kappa coefficient (k), sensitivity and specificity. For boys, the 2nd, 5th, and 10th percentile VO2peak cut points were 33.6–36.4, 36.3–39.8, and 38.7–43.0 ml/kg/min, respectively. For girls, the corresponding cut points were 29.7–29.1, 32.4–31.4, and 34.8–33.5 ml/kg/min, respectively. Together with BMI, but without more invasive measures of traditional risk factors for CVD, these cut points can be used to screen schoolchildren for poor cardiometabolic health with moderate discriminating ability (k ≤ 0.53).

• Skrede, Turid; Steene-Johannessen, Jostein; Anderssen, Sigmund Alfred; Resaland, Geir Kåre & Ekelund, Ulf (2018). The prospective association between objectively measured sedentary time, moderate-to-vigorous physical activity and cardiometabolic risk factors in youth: a systematic review and meta-analysis. Obesity Reviews. ISSN 1467-7881. p. 1–20. doi: 10.1111/obr.12758. Show summary

  Sedentary time and moderate‐to‐vigorous physical activity (MVPA) may be uniquely related to cardiometabolic health. Excessive sedentary time is suggested as an independent cardiometabolic risk factor, while MVPA is favourably associated with cardiometabolic health. This systematic review and meta‐analysis summarizes the evidence on a prospective relationship between objectively measured sedentary time, MVPA and cardiometabolic health indicators in youth. PubMed, Embase, CINAHL, PhyscINFO and SPORTDiscus were systematically searched from January 2000 until April 2018. Studies were included if sedentary time and physical activity were measured objectively and examined associations with body mass index, waist circumference, triglycerides, high‐density lipoprotein, insulin, blood pressure or the clustering of these cardiometabolic risk factors. We identified 30 studies, of which 21 were of high quality. No evidence was found for an association between sedentary time and cardiometabolic outcomes. The association between MVPA and individual cardiometabolic risk factors was inconsistent. The meta‐analysis for prospective studies found a small but significant effect size between MVPA at baseline and clustered cardiometabolic risk at follow‐up (ES –0.014 [95% CI, −0.024 to −0.004]). We conclude that there is no prospective association between sedentary time and cardiometabolic health, while MVPA is beneficially associated with cardiometabolic health in youth.

• Ekelund, Ulf; Brown, Wendy J; Steene-Johannessen, Jostein; Fagerland, Morten; Owen, Neville & Powell, Kenneth E. [Show all 8 contributors for this article] (2018). Do the associations of sedentary behaviour with cardiovascular disease mortality and cancer mortality differ by physical activity level? A systematic review and harmonised meta-analysis of data from 850 060 participants. British Journal of Sports Medicine. ISSN 0306-3674. 53(14), p. 886–894. doi: 10.1136/bjsports-2017-098963. Show summary

  Objective: To examine whether the associations between sedentary behaviours (ie, daily sitting/TV-viewing time) and mortality from cardiovascular disease (CVD) and cancer differ by different levels of physical activity (PA). Design: Harmonised meta-analysis of prospective cohort studies. Data on exposure variables were harmonised according to a predefined protocol and categorised into four groups for sedentary behaviours and into quartiles of PA (MET-hour/week). Data sources: PubMed, PsycINFO, Embase, Web of Science, Sport Discus and Scopus. Eligibility criteria for selecting studies: Individual level data on both sedentary behaviours and PA and reported effect estimates for CVD or cancer mortality. Results: Nine studies (n=850 060; deaths=25 730) and eight studies (n=777 696; deaths=30 851) provided data on sitting time and CVD and cancer mortality, respectively. Five studies had data on TV-viewing time and CVD (n=458 127; deaths=13 230) and cancer (n=458 091; deaths=16 430) mortality. A dose–response association between sitting time (9%–32% higher risk; p for trend <0.001) and TV time (3%–59% higher risk; p for trend <0.001) with CVD mortality was observed in the ‘inactive’, lowest quartile of PA. Associations were less consistent in the second and third quartiles of PA, and there was no increased risk for CVD mortality with increasing sedentary behaviours in the most active quartile. Associations between sedentary behaviours and cancer mortality were generally weaker; 6%–21% higher risk with longer sitting time observed only in the lowest quartile of PA. Conclusion: PA modifies the associations between sedentary behaviours and CVD and cancer mortality. These findings emphasise the importance of higher volumes of moderate and vigorous activity to reduce, or even eliminate these risks, especially for those who sit a lot in their daily lives.

• Dalene, Knut Eirik; Anderssen, Sigmund Alfred; Andersen, Lars Bo; Steene-Johannessen, Jostein; Ekelund, Ulf & Hansen, Bjørge Hermann [Show all 7 contributors for this article] (2018). Cross-sectional and prospective associations between sleep, screen time, active school travel, sports/exercise participation and physical activity in children and adolescents. BMC Public Health. ISSN 1471-2458. 18(1). doi: 10.1186/s12889-018-5610-7. Full text in Research Archive Show summary

  Background: The aim of this study was to investigate how sleep, screen time, active school travel and sport and/or exercise participation associates with moderate-to-vigorous physical activity (MVPA) in nationally representative samples of Norwegian 9- and 15-y-olds, and whether these four behaviors at age nine predict change in MVPA from age nine to 15 years. Method: We pooled cross-sectional accelerometer and questionnaire data from 9- (n = 2366) and 15-y-olds (n = 1554) that participated in the first (2005/06) and second (2011/12) wave of the Physical Activity among Norwegian Children Study to investigate cross-sectional associations. To investigate prospective associations, we used data from a sub-sample that participated in both waves (at age nine and 15 years, n = 517). Results: Cross-sectional analyses indicated a modest, inverse association between screen time and MVPA among 9- (− 2.2 min/d (95% CI: -3.1, − 1.3)) and 15-y-olds (− 1.7 min/d (95% CI: -2.7, − 0.8)). Compared to their peers with 0–5 min/d of active travel to school, 9- and 15-y-olds with ≥16 min/d accumulated 7.2 (95% CI: 4.0, 10.4) and 9.0 (95% CI: 3.8, 14.1) more min/d of MVPA, respectively. Nine-y-old boys and 15-y-olds reporting ≥8 h/week of sports and/or exercise participation accumulated 14.7 (95% CI: 8.2, 21.3) and 17.9 (95% CI: 14.0, 21.8) more min/d of MVPA, respectively, than those reporting ≤2 h/week. We found no cross-sectional association between sleep duration and MVPA in either age group. None of the four behaviors predicted change in MVPA from age nine to 15 years (p ≥ 0.102). Conclusion: Active travel to school and sport/exercise participation may be important targets for future interventions aimed at increasing MVPA in children and adolescents. However, future studies are needed to determine causality.

• Hansen, Bjørge Hermann; Anderssen, Sigmund Alfred; Andersen, Lars Bo; Hildebrand, Maria; Kolle, Elin & Steene-Johannessen, Jostein [Show all 14 contributors for this article] (2018). Cross-sectional associations of reallocating time between sedentary and active behaviours on cardiometabolic risk factors in young people : an International Children’s Accelerometry Database (ICAD) analysis. Sports Medicine. ISSN 0112-1642. 48(10), p. 2401–2412. doi: 10.1007/s40279-018-0909-1. Full text in Research Archive Show summary

  Introduction Sedentary time and time spent in various intensity-specific physical activity are co-dependent, and increasing time spent in one behaviour requires decreased time in another. Objective The aim of the present study was to examine the theoretical associations with reallocating time between categories of intensities and cardiometabolic risk factors in a large and heterogeneous sample of children and adolescents. Methods We analysed pooled data from 13 studies comprising 18,200 children and adolescents aged 4–18 years from the International Children’s Accelerometry Database (ICAD). Waist-mounted accelerometers measured sedentary time, light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA). Cardiometabolic risk factors included waist circumference (WC), systolic blood pressure (SBP), fasting high- and low-density lipoprotein cholesterol (HDL-C and LDL-C), triglycerides, insulin, and glucose. Associations of reallocating time between the various intensity categories with cardiometabolic risk factors were explored using isotemporal substitution modelling. Results Replacing 10 min of sedentary time with 10 min of MVPA showed favourable associations with WC, SBP, LDL-C, insulin, triglycerides, and glucose; the greatest magnitude was observed for insulin (reduction of 2–4%), WC (reduction of 0.5–1%), and triglycerides (1–2%). In addition, replacing 10 min of sedentary time with an equal amount of LPA showed beneficial associations with WC, although only in adolescents. Conclusions Replacing sedentary time and/or LPA with MVPA in children and adolescents is favourably associated with most markers of cardiometabolic risk. Efforts aimed at replacing sedentary time with active behaviours, particularly those of at least moderate intensity, appear to be an effective strategy to reduce cardiometabolic risk in young people.

• Agostinis-Sobrinho, C; Moreira, C; Abreu, S; Lopes, L; Oliveira-Santos, J & Steene-Johannessen, Jostein [Show all 8 contributors for this article] (2017). Serum Adiponectin Levels and Cardiorespiratory Fitness in Nonowerweight and overweight Portugese Adolescents: The LabMed Physical Activity Study. Pediatric Exercise Science. ISSN 0899-8493. 29(2), p. 237–244. doi: 10.1123/pes.2016-0162.
• Ekelund, Ulf; Kolle, Elin; Steene-Johannessen, Jostein; Dalene, Knut Eirik; Nilsen, Ada Kristine Ofrim & Anderssen, Sigmund Alfred [Show all 7 contributors for this article] (2017). Objectively measured sedentary time and physical activity and associations with body weight gain: does body weight determine a decline in moderate and vigorous intensity physical activity? International Journal of Obesity. ISSN 0307-0565. 41(12), p. 1769–1774. doi: 10.1038/ijo.2017.186. Show summary

  OBJECTIVES: High levels of physical activity (PA) may prevent the development of obesity. However, the magnitude and direction of the association between PA of various intensities, sedentary time and weight status remain unclear. Thus, we examined whether objectively measured sedentary time and PA independently predict gain in body weight, change in body weight and to examine the possibility of reverse causation. METHODS: We examined the prospective associations between sedentary time, PA and body weight (BW). Baseline measurements were conducted in 2008/2009 and follow-up measurements in 2014/2015 in a random sample of the adult Norwegian population (N = 1710, 45.1% men). Moderate and vigorous intensity PA (MVPA) and sedentary time were measured by accelerometry and BW and height self-reported. We first modelled the associations between baseline sedentary time and PA with BW at follow-up. We then modelled the reverse associations (BW as the exposure) and sedentary time and PA (as outcomes) in separate models. All models were adjusted for age, sex, baseline value of the outcome, socio-economic status, alcohol consumption, smoking, monitor wear time and follow-up time. RESULTS: Body mass index (BMI) increased by 0.2 units (P = 0.003) between baseline and follow-up, and 46.5% of participants were either overweight (36.4%) or obese (10.1%) at baseline increasing to 49.6% (11.7% obese) at follow-up. Baseline sedentary time, MVPA and vigorous PA were not associated with BW at follow-up after adjustment for covariates. In contrast, baseline BW was inversely associated with MVPA (β = − 0.11; 95% confidence interval (CI); − 0.21, − 0.009) and VPA (β = − 0.035; 95% CI; − 0.059, − 0.011) in adjusted models. These associations were unchanged when BW was substituted by BMI. CONCLUSIONS: Baseline BW seems to determine a decrease in MVPA in healthy adult Norwegian men and women, more so than the reverse.

• Bentham, James; Di Cesare, Mariachiara; Bilano, Ver; Bixby, Honor; Zhou, Bin & Stevens, Gretchen A. [Show all 110 contributors for this article] (2017). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. The Lancet. ISSN 0140-6736. 390(10113), p. 2627–2642. doi: 10.1016/S0140-6736(17)32129-3. Full text in Research Archive
• Dalene, Knut Eirik; Anderssen, Sigmund Alfred; Andersen, Lars Bo; Steene-Johannessen, Jostein; Ekelund, Ulf & Hansen, Bjørge Hermann [Show all 7 contributors for this article] (2017). Secular and longitudinal physical activity changes in population-based samples of children and adolescents. Scandinavian Journal of Medicine & Science in Sports. ISSN 0905-7188. 28(1), p. 161–171. doi: 10.1111/sms.12876. Show summary

  The aims of this study were to investigate whether physical activity (PA) and sedentary time (ST) in 9-and 15-year- olds differed between 2005-2006 and 2011-2012 (secular change), and to investigate changes in PA and ST from age 9 to 15 (longitudinal change). In 2005-2006, we invited nationally representative samples of Norwegian 9-( n=1470) and 15-year- olds (n=1348) to participate. In 2011-2012, we invited a new nationally representative sample of 9-year- olds (n=1945), whereas 15-year- olds (n=1759) were invited to participate either based on previous participation in 2005-2006 or from a random sample of schools. We assessed PA and ST objectively using accelerometers. In 2011-2012, both 9-and 15-year- olds spent more time sedentary (≥35.7 min/d, P<.001) and less time in light PA (≥35.2 min/d, P<.001) compared to their peers in 2005-2006. Nine-year- old girls also spent less time in moderate-to- vigorous PA (MVPA) (4.2 min/d, P=.041). In both age groups, the proportion accumulating an average of 60 min/d of MVPA did not differ between the two cohorts. From age 9 to 15, girls and boys decreased their time spent in LPA (≥106.7 min/d, P<.001) and in MVPA (≥20.8 min/d, P<.001). During the same period, ST increased by a mean of >2 h/d (P<.011). We observed an adverse secular change in PA from 2005-2006 to 2011-2012 among 9-and 15-year- olds, and a large decline in PA in the participants followed longitudinally from age 9 to 15 years.

• Dalene, Knut Eirik; Anderssen, Sigmund Alfred; Andersen, Lars Bo; Steene-Johannessen, Jostein; Ekelund, Ulf & Hansen, Bjørge Hermann [Show all 7 contributors for this article] (2017). Cross-sectional and prospective associations between physical activity, body mass index and waist circumference in children and adolescents. Obesity Science & Practice. ISSN 2055-2238. 3(3), p. 249–257. doi: 10.1002/osp4.114. Full text in Research Archive Show summary

  Objective: To study the cross-sectional and prospective associations between physical activity (PA) of different intensities, body mass index (BMI) and waist circumference (WC) in children and adolescents using isotemporal substitution modelling. Methods: Physical activity (accelerometry), BMI and WC were assessed in 6- (n = 970), 9- (n = 2,423) and 15-year-olds (n = 1,544) in 2005/2006 and 2011/2012. Participants aged 9 years in 2005/2006 were followed prospectively to 2011/12 (age 15). Associations between PA of different intensities (light, moderate and vigorous), BMI and WC were examined using isotemporal substitution models. Results: Substituting 10 min per day of sedentary time with light PA was associated with higher WC (0.17 to 0.29 cm, p ≤ 0.003)) in all age groups. Substituting 10 min per day of sedentary time with moderate PA was associated with lower WC in 6- and 9-year-olds (−0.32 to −0.47 cm, p ≤ 0.013)). Substituting 10 min per day of sedentary time with vigorous PA was associated with lower WC in 9- and 15-year-olds (−1.08 to −1.79 cm, p ≤ 0.015)). Associations were similar with BMI as the outcome. In prospective analyses, substituting sedentary time with light, moderate or vigorous PA at age 9 was not associated with BMI or WC at age 15. Conclusion: Substituting sedentary time with moderate PA appears favourably associated with adiposity in children, whereas vigorous PA may be required in adolescents. Cross-sectional associations were not replicated in prospective analyses.

• Aadland, Eivind; Solbraa, Ane; Resaland, Geir Kåre; Steene-Johannessen, Jostein; Edvardsen, Elisabeth & Hansen, Bjørge Hermann [Show all 7 contributors for this article] (2017). Reference values for and cross-validation of time to exhaustion on a modified Balke protocol in Norwegian men and women. Scandinavian Journal of Medicine & Science in Sports. ISSN 0905-7188. 27(11), p. 1248–1257. doi: 10.1111/sms.12750. Full text in Research Archive
• Zhou, Bin; Bentham, James; Di Cesare, Mariachiara; Bixby, Honor; Danaei, Goodarz & Cowan, Melanie J. [Show all 114 contributors for this article] (2017). Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19·1 million participants. The Lancet. ISSN 0140-6736. 389(10064), p. 37–55. doi: 10.1016/S0140-6736(16)31919-5. Full text in Research Archive
• Loyen, Anne; Van Hecke, Linde; Verloigne, Maïté; Hendriksen, Ingrid; Lakerveld, Jeroen & Steene-Johannessen, Jostein [Show all 14 contributors for this article] (2016). Variation in population levels of physical activity in European adults according to cross-European studies: a systematic literature review within DEDIPAC. International Journal of Behavioral Nutrition and Physical Activity. ISSN 1479-5868. 13:72, p. 1–18. doi: 10.1186/s12966-016-0398-2. Show summary

  Background: Physical inactivity is a well-known public health risk that should be monitored at the population level. Physical activity levels are often surveyed across Europe. This systematic literature review aims to provide an overview of all existing cross-European studies that assess physical activity in European adults, describe the variation in population levels according to these studies, and discuss the impact of the assessment methods. Methods: Six literature databases (PubMed, EMBASE, CINAHL, PsycINFO, SportDiscus and OpenGrey) were searched, supplemented with backward- and forward tracking and searching authors’ and experts’ literature databases. Articles were included if they reported on observational studies measuring total physical activity and/or physical activity in leisure time in the general population in two or more European countries. Each record was reviewed, extracted and assessed by two independent researchers and disagreements were resolved by a third researcher. The review protocol of this review is registered in the PROSPERO database under registration number CRD42014010334. Results: Of the 9,756 unique identified articles, twenty-five were included in this review, reporting on sixteen different studies, including 2 to 35 countries and 321 to 274,740 participants. All but two of the studies used questionnaires to assess physical activity, with the majority of studies using the IPAQ-short questionnaire. The remaining studies used accelerometers. The percentage of participants who either were or were not meeting the physical activity recommendations was the most commonly reported outcome variable, with the percentage of participants meeting the recommendations ranging from 7 % to 96 % across studies and countries. Conclusions: The included studies showed substantial variation in the assessment methods, reported outcome variables and, consequently, the presented physical activity levels. Because of this, absolute population levels of physical activity in European adults are currently unknown. However, when ranking countries, Ireland, Italy, Malta, Portugal, and Spain generally appear to be among the less active countries. Objective data of adults across Europe is currently limited. These findings highlight the need for standardisation of the measurement methods, as well as cross-European monitoring of physical activity levels.

• Loyen, Anne; Clarke-Cornwell, Alexandra M.; Anderssen, Sigmund Alfred; Hagströmer, Maria; Sardinha, Luis B. & Sundquist, Kristina [Show all 15 contributors for this article] (2016). Sedentary time and physical activity surveillance through accelerometer pooling in four European countries. Sports Medicine. ISSN 0112-1642. 47(7), p. 1421–1435. doi: 10.1007/s40279-016-0658-y. Show summary

  Objective: The objective of this study was to pool, harmonise and re-analyse national accelerometer data from adults in four European countries in order to describe population levels of sedentary time and physical inactivity. Methods: Five cross-sectional studies were included from England, Portugal, Norway and Sweden. ActiGraph accelerometer count data were centrally processed using the same algorithms. Multivariable logistic regression analyses were conducted to study the associations of sedentary time and physical inactivity with sex, age, weight status and educational level, in both the pooled sample and the separate study samples. Results: Data from 9509 participants were used. On average, participants were sedentary for 530 min/day, and accumulated 36 min/day of moderate to vigorous intensity physical activity. Twenty-three percent accumulated more than 10 h of sedentary time/day, and 72% did not meet the physical activity recommendations. Nine percent of all participants were classified as high sedentary and low active. Participants from Norway showed the highest levels of sedentary time, while participants from England were the least physically active. Age and weight status were positively associated with sedentary time and not meeting the physical activity recommendations. Men and higher-educated people were more likely to be highly sedentary, while women and lower-educated people were more likely to be inactive. Conclusions: We found high levels of sedentary time and physical inactivity in four European countries. Older people and obese people were most likely to display these behaviours and thus deserve special attention in interventions and policy planning. In order to monitor these behaviours, accelerometer-based cross-European surveillance is recommended.

• Ekelund, Ulf; Steene-Johannessen, Jostein; Brown, Wendy J.; Fagerland, Morten; Owen, Neville & Powell, Kenneth E. [Show all 8 contributors for this article] (2016). Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women. The Lancet. ISSN 0140-6736. 388(10051), p. 1302–1310. doi: 10.1016/S0140-6736(16)30370-1. Show summary

  Background: High amounts of sedentary behaviour have been associated with increased risks of several chronic conditions and mortality. However, it is unclear whether physical activity attenuates or even eliminates the detrimental eff ects of prolonged sitting. We examined the associations of sedentary behaviour and physical activity with all-cause mortality. Methods: We did a systematic review, searching six databases (PubMed, PsycINFO, Embase, Web of Science, Sport Discus, and Scopus) from database inception until October, 2015, for prospective cohort studies that had individual level exposure and outcome data, provided data on both daily sitting or TV-viewing time and physical activity, and reported eff ect estimates for all-cause mortality, cardiovascular disease mortality, or breast, colon, and colorectal cancer mortality. We included data from 16 studies, of which 14 were identifi ed through a systematic review and two were additional unpublished studies where pertinent data were available. All study data were analysed according to a harmonised protocol, which categorised reported daily sitting time and TV-viewing time into four standardised groups each, and physical activity into quartiles (in metabolic equivalent of task [MET]-hours per week). We then combined data across all studies to analyse the association of daily sitting time and physical activity with all-cause mortality, and estimated summary hazard ratios using Cox regression. We repeated these analyses using TV-viewing time instead of daily sitting time. Findings: Of the 16 studies included in the meta-analysis, 13 studies provided data on sitting time and all-cause mortality. These studies included 1 005 791 individuals who were followed up for 2–18·1 years, during which 84 609 (8·4%) died. Compared with the referent group (ie, those sitting <4 h/day and in the most active quartile [>35·5 MET-h per week]), mortality rates during follow-up were 12–59% higher in the two lowest quartiles of physical activity (from HR=1·12, 95% CI 1·08–1·16, for the second lowest quartile of physical activity [<16 MET-h per week] and sitting <4 h/day; to HR=1·59, 1·52–1·66, for the lowest quartile of physical activity [<2·5 MET-h per week] and sitting >8 h/day). Daily sitting time was not associated with increased all-cause mortality in those in the most active quartile of physical activity. Compared with the referent (<4 h of sitting per day and highest quartile of physical activity [>35·5 MET-h per week]), there was no increased risk of mortality during follow-up in those who sat for more than 8 h/day but who also reported >35·5 MET-h per week of activity (HR=1·04; 95% CI 0·99–1·10). By contrast, those who sat the least (<4 h/day) and were in the lowest activity quartile (<2·5 MET-h per week) had a signifi cantly increased risk of dying during follow-up (HR=1·27, 95% CI 1·22–1·31). Six studies had data on TV-viewing time (N=465 450; 43 740 deaths). Watching TV for 3 h or more per day was associated with increased mortality regardless of physical activity, except in the most active quartile, where mortality was signifi cantly increased only in people who watched TV for 5 h/day or more (HR=1·16, 1·05–1·28). Interpretation: High levels of moderate intensity physical activity (ie, about 60–75 min per day) seem to eliminate the increased risk of death associated with high sitting time. However, this high activity level attenuates, but does not eliminate the increased risk associated with high TV-viewing time. These results provide further evidence on the benefits of physical activity, particularly in societies where increasing numbers of people have to sit for long hours for work and may also inform future public health recommendations.

• Resaland, Geir Kåre; Aadland, Eivind; Moe, Vegard Fusche; Aadland, Katrine Nyvoll; Skrede, Turid & Stavnsbo, Mette [Show all 20 contributors for this article] (2016). Effects of physical activity on schoolchildren's academic performance: The Active Smarter Kids (ASK) cluster-randomized controlled trial. Preventive Medicine. ISSN 0091-7435. 91, p. 322–328. doi: 10.1016/j.ypmed.2016.09.005. Full text in Research Archive Show summary

  Objective: To investigate the effect of a seven-month, school-based cluster-randomized controlled trial on academic performance in 10-year-old children. Methods: In total, 1129 fifth-grade children from 57 elementary schools in Sogn og Fjordane County, Norway, were cluster-randomized by school either to the intervention group or to the control group. The children in the 28 intervention schools participated in a physical activity intervention between November 2014 and June 2015 consisting of three components: 1) 90 min/week of physically active educational lessons mainly carried out in the school playground; 2) 5 min/day of physical activity breaks during classroom lessons; 3) 10 min/day physical activity homework. Academic performance in numeracy, reading and English was measured using standardized Norwegian national tests. Physical activity was measured objectively by accelerometry. Results: We found no effect of the intervention on academic performance in primary analyses (standardized difference 0.01–0.06, p > 0.358). Subgroup analyses, however, revealed a favorable intervention effect for those who performed the poorest at baseline (lowest tertile) for numeracy (p = 0.005 for the subgroup ∗ group interaction), compared to controls (standardized difference 0.62, 95% CI 0.19–1.07). Conclusions: This large, rigorously conducted cluster RCT in 10-year-old children supports the notion that there is still inadequate evidence to conclude that increased physical activity in school enhances academic achievement in all children. Still, combining physical activity and learning seems a viable model to stimulate learning in those academically weakest schoolchildren.

• Loyen, Anne; Verloigne, Maite; Van Hecke, Linde; Hendriksen, Ingrid; Lakerveld, Jeroen & Steene-Johannessen, Jostein [Show all 13 contributors for this article] (2016). Variation in population levels of sedentary time in European adults according to cross-European studies: A systematic literature review within DEDIPAC. International Journal of Behavioral Nutrition and Physical Activity. ISSN 1479-5868. 13:71. doi: 10.1186/s12966-016-0397-3. Show summary

  Background: Sedentary behaviour is increasingly recognized as a public health risk that needs to be monitored at the population level. Across Europe, there is increasing interest in assessing population levels of sedentary time. This systematic literature review aims to provide an overview of all existing cross-European studies that measure sedentary time in adults, to describe the variation in population levels across these studies and to discuss the impact of assessment methods. Methods: Six literature databases (PubMed, EMBASE, CINAHL, PsycINFO, SportDiscus and OpenGrey) were searched, supplemented with backward- and forward tracking and searching authors’ and experts’ literature databases. Articles were included if they reported on observational studies measuring any form of sedentary time in the general population in two or more European countries. Each record was reviewed, extracted and assessed by two independent researchers, and disagreements were resolved by a third researcher. The review protocol of this review is registered in the PROSPERO database under registration number CRD42014010335. Results: Of the 9,756 unique articles that were identified in the search, twelve articles were eligible for inclusion in this review, reporting on six individual studies and three Eurobarometer surveys. These studies represented 2 to 29 countries, and 321 to 65,790 participants. Eleven studies focused on total sedentary time, while one studied screen time. The majority of studies used questionnaires to assess sedentary time, while two studies used accelerometers. Total sedentary time was reported most frequently and varied from 150 (median) to 620 (mean) minutes per day across studies and countries. Conclusions: One third of European countries were not included in any of the studies. Objective measures of European adults are currently limited, and most studies used single-item self-reported questions without assessing sedentary behaviour types or domains. Findings varied substantially between studies, meaning that population levels of sedentary time in European adults are currently unknown. In general, people living in northern Europe countries appear to report more sedentary time than southern Europeans. The findings of this review highlight the need for standardisation of the measurement methods and the added value of cross-European surveillance of sedentary behaviour.

• Zhou, Bin; Lu, Yuan; Hajifathalian, Kaveh; Bentham, James; Di Cesare, Mariachiara & Danaei, Goodarz [Show all 502 contributors for this article] (2016). Worldwide trends in diabetes since 1980: A pooled analysis of 751 population-based studies with 4.4 million participants. The Lancet. ISSN 0140-6736. 387(10027), p. 1513–1530. doi: 10.1016/S0140-6736(16)00618-8. Full text in Research Archive
• Steene-Johannessen, Jostein; Anderssen, Sigmund Alfred; van der Ploeg, Hidde P; Hendriksen, Ingrid; Donnelly, Alan & Brage, Søren [Show all 7 contributors for this article] (2016). Are self-report measures able to define individuals as physically active or inactive? Medicine & Science in Sports & Exercise. ISSN 0195-9131. 48(2), p. 235–244. doi: 10.1249/MSS.0000000000000760. Show summary

  Purpose: Assess the agreement between commonly used self-report methods compared with objectively measured physical activity (PA) in defining the prevalence of individuals compliant with PA recommendations. Methods: Time spent in moderate and vigorous PA (MVPA) was measured at two time points in 1713 healthy individuals from 9 European countries using individually-calibrated combined heart-rate and movement sensing. Participants also completed the Recent Physical Activity Questionnaire (RPAQ), the short form of the International Physical Activity Questionnaire (IPAQ) and the short European Prospective Investigation into Cancer and Nutrition Physical Activity Questionnaire (EPIC-PAQ). Individuals were categorized as active (e.g. reporting >=150 min of MVPA per week) or inactive, based on the information derived from the different measures. Sensitivity and specificity analyses and Kappa statistics were performed to evaluate the three PAQs ability to correctly categorize individuals as active or inactive. Results: Prevalence estimates of being sufficiently active varied significantly (p for all <0.001) between self-report measures (IPAQ 84.2 % [95% CI 82.5 to 85.9], RPAQ 87.6% [95% CI 85.9 to 89.1], EPIC-PAQ 39.9% [95% CI 37.5 to 42.1] and objective measure 48.5% [95% CI 41.6 to 50.9]. All self-report methods showed low or moderate sensitivity (IPAQ 20.0 %, RPAQ 18.7% and EPIC-PAQ 69.8%) to correctly classify inactive people and the agreement between objective and self-reported PA was low ([latin kra] =0.07 [95% CI 0.02 to 0.12], 0.12 [95% CI 0.06 to 0.18] and 0.19 [95% CI 0.13 to 0.24] for IPAQ, RPAQ, and EPIC-PAQ, respectively). Conclusion: The modest agreement between self-reported and objectively measured PA suggests that population levels of PA derived from self-report should be interpreted cautiously. Implementation of objective measures in large-scale cohort studies and surveillance systems is recommended.

• Danaei, Goodarz; Fahimi, Saman; Lu, Yuan; Zhou, Bin; Hajifathalian, Kaveh & Cesare, Mariachiara Di [Show all 23 contributors for this article] (2015). Effects of diabetes definition on global surveillance of diabetes prevalence and diagnosis: A pooled analysis of 96 population-based studies with 331 288 participants. The Lancet Diabetes and Endocrinology. ISSN 2213-8587. 3(8), p. 624–637. doi: 10.1016/S2213-8587(15)00129-1.
• Resaland, Geir Kåre; Moe, Vegard Fusche; Aadland, Eivind; Steene-Johannessen, Jostein; Glosvik, Øyvind & Andersen, John Roger [Show all 9 contributors for this article] (2015). Active Smarter Kids (ASK): Rationale and design of a cluster-randomized controlled trial investigating the effects of daily physical activity on children's academic performance and risk factors for non-communicable diseases. BMC Public Health. ISSN 1471-2458. 15:709(1). doi: 10.1186/s12889-015-2049-y. Full text in Research Archive
• Andersen, Lars Bo; Lauersen, Jeppe Bo; Brønd, Jan Christian; Anderssen, Sigmund Alfred; Sardinha, Luís B. & Steene-Johannessen, Jostein [Show all 15 contributors for this article] (2015). A new approach to define and diagnose cardiometabolic disorder in children. Journal of Diabetes Research. ISSN 2314-6745. 2015. doi: 10.1155/2015/539835.
• Solbraa, Ane; Ekelund, Ulf; Holme, Ingar Morten K; Graff-Iversen, Sidsel; Steene-Johannessen, Jostein & Aadland, Eivind [Show all 7 contributors for this article] (2015). Long-term correlates of objectively measured physical activity and sedentary time in norwegian men and women. Journal of Physical Activity and Health. ISSN 1543-3080. 12(11), p. 1500–1507. doi: 10.1123/jpah.2014-0390.
• Steene-Johannessen, Jostein; Kolle, Elin; Andersen, Lars Bo & Anderssen, Sigmund Alfred (2013). Adiposity, Aerobic Fitness, Muscle Fitness, and Markers of Inflammation in Children. Medicine & Science in Sports & Exercise. ISSN 0195-9131. 45(4), p. 714–721. doi: 10.1249/MSS.0b013e318279707a. Show summary

  Purpose: The purpose of this study was to describe levels of inflammation markers in Norwegian children and to examine the associations of adiposity, aerobic fitness and muscle fitness with markers of inflammation. Methods: In 2005-2006, 1467 9-year-olds wererandomly selected from all regions in Norway. The participation rate was 89%. The inflammatory markers evaluated included C-reactive protein (CRP), leptin, adiponectin, plasminogen activator inhibitor-1, tumor necrosis factor- [alpha] (TNF-[alpha]), hepatocyte growth factor, resistin and interleukin-6. We assessed muscular strength by measuring explosive, isometric and endurance strength. Aerobic fitness was measured directly during a maximal cycle ergometer test. Adiposity was expressed as waist circumference (WC). Results: The girls had significantly higher levels of CRP, leptin, adiponectin and resistin and lower levels of TNF-[alpha] compared to the boys. We observed a graded association of CRP and leptin levels across quintiles of WC, aerobic fitness and muscle fitness (P <=0.001 for all participants). The regression analyses revealed that WC, aerobic fitness and muscle fitness were independently associated with the CRP (WC [beta]= 0.158, P < 0.001; aerobic fitness [beta]= -0.190, P < 0.001; muscle fitness [beta]= -0.158, P < 0.002) after adjustments for gender, age, Tanner pubertal stage and the other independent variables. The same pattern was observed for leptin levels (WC [beta]= 0.406, P < 0.001; aerobic fitness [beta]= -0.298, P < 0.001; muscle fitness [beta]= -0.064, P < 0.036). Conclusions: These data represent a reference material with respect to inflammatory markers. Our results show that adiposity, aerobic and muscle fitness were independently associated with the CRP and leptin levels.

• Østergaard, Lars; Kolle, Elin; Steene-Johannessen, Jostein; Anderssen, Sigmund Alfred & Andersen, Lars Bo (2013). Cross sectional analysis of the association between mode of school transportation and physical fitness in children and adolescents. International Journal of Behavioral Nutrition and Physical Activity. ISSN 1479-5868. 10. doi: 10.1186/1479-5868-10-91.
• Aadland, Eivind & Steene-Johannessen, Jostein (2012). The use of individual cut points from treadmill walking to assess free-living moderate to vigorous physical activity in obese subjects by accelerometry: is it useful? BMC Medical Research Methodology. ISSN 1471-2288. 12(1). doi: 10.1186/1471-2288-12-172.
• Solbraa, Ane; Mamen, Asgeir; Resaland, Geir Kåre; Steene-Johannessen, Jostein; Ylvisåker, Einar & Holme, Ingar Morten K [Show all 7 contributors for this article] (2011). Level of physical activity, cardiorespiratory fitness and cardiovascular disease risk factors in a rural adult population in Sogn og Fjordane :. Norsk Epidemiologi. ISSN 0803-2491. 20(2), p. 179–188. doi: 10.5324/nje.v20i2.1339.
• Adegboye, Amanda R. A.; Anderssen, Sigmund Alfred; Froberg, Karsten; Sardinha, Luis B.; Heitmann, Berit L. & Steene-Johannessen, Jostein [Show all 8 contributors for this article] (2011). Recommended aerobic fitness level for metabolic health in children and adolescents: a study of diagnostic accuracy. British Journal of Sports Medicine. ISSN 0306-3674. 45(9), p. 722–728. doi: 10.1136/bjsm.2009.068346. Show summary

  Objective: To define the optimal cut-off for low aerobic fitness and to evaluate its accuracy to predict clustering of risk factors for cardiovascular disease in children and adolescents. Design: Study of diagnostic accuracy using a cross-sectional database. Setting: European Youth Heart Study including Denmark, Portugal, Estonia and Norway. Participants: 4500 schoolchildren aged 9 or 15 years. Main Outcome Measure: Aerobic fitness was expressed as peak oxygen consumption relative to bodyweight (mlO2/min/kg). Results: Risk factors included in the composite risk score (mean of z-scores) were systolic blood pressure, triglyceride, total cholesterol/HDL-cholesterol ratio, insulin resistance and sum of four skinfolds. 14.5% of the sample, with a risk score above one SD, were defined as being at risk. Receiver operating characteristic analysis was used to define the optimal cut-off for sex and age-specific distribution. In girls, the optimal cut-offs for identifying individuals at risk were: 37.4 mlO2/min/kg (9-year-old) and 33.0 mlO2/min/kg (15-year-old). In boys, the optimal cut-offs were 43.6 mlO2/min/kg (9-year-old) and 46.0 mlO2/min/kg (15-year-old). Specificity (range 79.3–86.4%) was markedly higher than sensitivity (range 29.7–55.6%) for all cut-offs. Positive predictive values ranged from 19% to 41% and negative predictive values ranged from 88% to 90%. The diagnostic accuracy for identifying children at risk, measured by the area under the curve (AUC), was significantly higher than what would be expected by chance (AUC >0.5) for all cut-offs. Conclusions: Aerobic fitness is easy to measure, and is an accurate tool for screening children with clustering of cardiovascular risk factors. Promoting physical activity in children with aerobic fitness level lower than the suggested cut-points might improve their health.

• Grøntvedt, Anders; Steene-Johannessen, Jostein; Kynde, Iben; Franks, Paul W; Helge, Jørn Wulff & Froberg, Karsten [Show all 8 contributors for this article] (2011). Association between plasma leptin and blood pressure in two population-based samples of children and adolescents. Journal of Hypertension. ISSN 0263-6352. 29(6), p. 1093–1100. doi: 10.1097/HJH.0b013e328346d787. Show summary

  Objectives: In this study we examined the association between leptin and blood pressure in a population-based study of Danish and Norwegian children and adolescents. Because of the putative bidirectional relationship between leptin and adiposity we formally tested (i) the mediating effect of body mass index in the association between leptin and blood pressure, and (ii) the mediating effect of leptin in the association between body mass index and blood pressure. Methods: To examine these aims we used a cross-sectional random sample of children and adolescents from Denmark and Norway (n = 1993) who had measures of leptin, anthropometry, blood pressure and other personal and biological risk factors for raised blood pressure available. Results: Both body mass index and leptin were positively associated with blood pressure (P < 0.001). The association with leptin was stronger in pre- and early-pubertal children compared to late- and post-pubertal adolescents (P < 0.01 for interaction). The association between leptin and blood pressure was almost completely mediated by body mass index, whereas the association between body mass index and blood pressure was modestly mediated by leptin. Conclusion: Leptin was strongly associated with blood pressure, a relationship that to a large extent was mediated by body mass index. Conversely, the association between body mass index and blood pressure was only modestly mediated by leptin. This indicates that the influence of adiposity on blood pressure is also driven by other biological risk factors beyond leptin. Such factors could include insulin, glucose, and triglycerides although residual confounding also could account for the observed relationships.

• Kolle, Elin; Steene-Johannessen, Jostein; Andersen, Lars Bo & Anderssen, Sigmund A. (2010). Objectively assessed physical activity and aerobic fitness in a population-based sample of Norwegian 9- and 15-year-olds. Scandinavian Journal of Medicine & Science in Sports. ISSN 0905-7188. 20(1), p. 41–47. Show summary

  The present study described current physical activity, determined compliance with physical activity guidelines and assessed aerobic fitness in a nationally representative sample of 9- and 15-year-olds in Norway. In 2005?2006, 2299 children and adolescents were randomly recruited. The participation rate was 89% and 74% among the 9- and 15-year-olds, respectively. Physical activity was assessed objectively by accelerometry, and aerobic fitness was measured directly as peak oxygen uptake during a cycle ergometry test. Boys were more physically active than girls, and 9-year-olds were substantially more active than 15-year-olds. Physical activity was higher during weekdays than weekends, and 9-year-olds were most active during spring. While four out of five children met current physical activity guidelines, only half of the adolescents did. The mean (SD) values for peak VO2 were: 9-year-old boys, 48.2 (7.1) mL/min/kg; 9-year-old girls, 42.9 (6.7) mL/min/kg; and 15-year-old girls 41.1 (6.0) mL/min/kg and 15-year-old boys 51.9 (8.0) mL/min/kg. Because of the high participation rate, this study provides a good description of the physical activity and aerobic fitness in the young population. Finally, girls and adolescents seem appropriate targets when promoting physical activity in order to increase the proportion meeting the recommendations.

• Steene-Johannessen, Jostein; Kolle, Elin; Reseland, Janne Elin; Anderssen, Sigmund A. & Andersen, Lars Bo (2010). Waist circumference is related to low-grade inflammation in youth. International Journal of Pediatric Obesity. ISSN 1747-7166. 5(4), p. 313–319. doi: 10.3109/17477160903497035.
• Kolle, Elin; Steene-Johannessen, Jostein; Holme, Ingar Morten K; Andersen, Lars Bo & Anderssen, Sigmund A. (2009). Secular trends in adiposity in Norwegian 9-year-olds from 1999-2000 to 2005. BMC Public Health. ISSN 1471-2458. 9. doi: 10.1186/1471-2458-9-389. Show summary

  Background: Due to the negative health consequences of childhood obesity monitoring trends in body mass and adiposity is essential. The purpose of this study was to describe secular trends in the prevalence of overweight and obesity among 9-year-old children, and to study changes in adiposity and fat distribution by investigating changes in waist circumference (WC) and skinfold thicknesses. Methods: A total of 859 9-year-olds were included in two cross-sectional studies conducted in 1999-2000 and 2005. Measurements of body mass index (BMI; in kg/m2), WC and skinfold thicknesses were taken by trained investigators. The International Obesity Task Force cut-offs were used to define overweight and obese subjects. Results: The overall prevalence of overweight (including obesity) did not change over the five year period. However, a shift may have occurred as the prevalence of overweight (including obesity) increased by 6.4% in girls and 5.5% in boys over the five year period. In both study periods, logistic regression analyses revealed that children of non-Western origin had 2 times higher odds of being overweight/obese than those of Western origin. However, neither the children of Western origin nor the children of non-Western origin showed a significant increase in the prevalence of overweight over the five-year period. No changes were observed for mean BMI, while a significant increase in WC was reported for both girls and boys, and an increase in all skinfold measurements was observed in girls only. Shifts in percentile distribution were observed for BMI, WC and sum of 4 skinfold thickness, however, the shift appeared to be faster in the upper end of the population distribution (p < 0.001 for interactions). Conclusion: From 1999-2000 to 2005, there have been increases in 9-year-olds measures of adiposity even though the BMI did not change. The results indicate the need of a large-scale monitoring of adiposity, in addition to BMI, in children.

• Steene-Johannessen, Jostein; Kolle, Elin; Anderssen, Sigmund A. & Andersen, Lars Bo (2009). Cardiovascular disease risk factors in a population-based sample of Norwegian children and adolescents. Scandinavian Journal of Clinical and Laboratory Investigation. ISSN 0036-5513. 69(3), p. 380–386. doi: 10.1080/00365510802691771. Show summary

  Objective. The objective of the study was to describe the distribution of cardiovascular disease (CVD) risk factors, and to evaluate the extent of clustering of CVD risk factors in Norwegian children and adolescents. Material and methods. A randomly selected cohort of 9-year-olds and 15-year-olds from all regions of the country was sampled. Of 2,818 subjects invited to participate, 2,299 accepted, giving an overall participation rate of 82 %. Results. Mean (SD) values for the main risk factors for 9-year-old and 15-year-old girls and boys were: total cholesterol (TC) (mmol/L) 4.49 (0.73), 4.37 (0.68), 4.19 (0.76) and 3.80 (0.69), respectively; triglycerides (TG) (mmol/L) 0.72 (0.33), 0.63 (0.32), 0.79 (0.32) and 0.82 (0.47), respectively; high density lipoprotein cholesterol (HDL-c) (mmol/L) 1.70 (0.35), 1.79 (0.40), 1.61 (0.34) and 1.42 (0.30), respectively; systolic blood pressure (mmHg) 102.6 (7.7), 103.3 (7.7), 109.0 (8.8) and 115.3 (9.0), respectively; and homeostasis model assessment score (HOMA) 1.29 (0.83), 1.19 (0.78), 2.10 (1.37) and 2.14 (1.49), respectively. At least five risk factors were found in 11.1 (95 % confidence interval (CI) 8.76 to 13.44) times as many participants as expected. A significant degree of clustering of CVD risk factors was found in 11.4 % (95 % CI, 9.8 to 13.0) of the study population, and these had mean Z scores of 1.24 (0.06) and 1.04 (0.08) for the 9-year-olds and 15-year-olds, respectively. Conclusion. This study presents national reference data on selected CVD risk factors in children and adolescents.

• Kolle, Elin; Steene-Johannessen, Jostein; Andersen, Lars Bo & Anderssen, Sigmund A. (2009). Seasonal variation in objectively assessed physical activity among children and adolescents in Norway: a cross-sectional study. International Journal of Behavioral Nutrition and Physical Activity. ISSN 1479-5868. 6. doi: 10.1186/1479-5868-6-36. Show summary

  Conclusion: In a large population-based sample, we observed substantial seasonal differences in physical activity among 9-year-olds, and the activity pattern varied across the seasons. The results emphasize the need to take season into account when developing physical activity interventions for children. Season appears to have less influence on adolescent's physical activity; interventions for increasing physical activity in this group could therefore be implemented throughout the year.

• Kolle, Elin; Steene-Johannessen, Jostein; Klasson-Heggebø, Lena; Andersen, Lars Bo & Anderssen, Sigmund A. (2009). A 5-yr Change in Norwegian 9-yr-Olds' Objectively Assessed Physical Activity Level. Medicine & Science in Sports & Exercise. ISSN 0195-9131. 41(7), p. 1368–1373. doi: 10.1249/MSS.0b013e31819a5e65. Show summary

  KOLLE, E., J. STEEN E-JOHANNESSEN, L. KLASSON-HEGGEBO, L. B. ANDERSEN, and S. A. ANDERSSEN. A 5-yr Change in Norwegian 9-yr-Olds' Objectively Assessed Physical Activity Level. Med. Sci. Sports Exerc., Vol. 41, No. 7. pp. 1368-1373, 2009. Purpose: To describe changes in objectively assessed physical activity by socioeconomic status (SES) between 1999-2000 and 2005 in 9-yr-old children living in Oslo, Norway. Methods: Two cross-sectional studies were conducted in 1999-2000 and 2005. The participation rate was 70.9% in 1999-2000 and 91.4% in 2005. Participants were identified by SES based on whether the school they attended was in an area designated as high, middle, or low mean income. Physical activity was assessed objectively by accelerometers. A total of 718 children (1999-2000, n = 340; 2005, n = 378) provided valid physical activity assessments that met all inclusion criteria. General linear models were used to assess the changes in physical activity between 1999-2000 and 2005. Results: A significant increase in mean physical activity level and physical activity during weekends was observed between the two study periods (P = 0.02 and <0.001, respectively), with the patterns being similar for girls and boys. Interactions were found between change in physical activity and SES. Although the mean physical activity level and moderate-to-vigorous physical activity (MVPA) among children from low-SES groups showed no change over time, an increase was seen among children from middle-SES groups. Moreover, in high-SES groups, an increase was observed for mean physical activity level (girls only) between study periods, whereas no change was seen for MVPA participation. Conclusions: Nine-year-old children living in Oslo, Norway, have increased both their mean and weekend physical activity level between 1999-2000 and 2005. However, because these opportunities are not equal across SES groups, interventions are required to focus on the needs of children from low-SES groups.

• Steene-Johannessen, Jostein; Anderssen, Sigmund A.; Kolle, Elin & Andersen, Lars Bo (2009). Low Muscle Fitness Is Associated with Metabolic Risk in Youth. Medicine & Science in Sports & Exercise. ISSN 0195-9131. 41(7), p. 1361–1367. doi: 10.1249/MSS.0b013e31819aaae5. Show summary

  STEENE-JOHANNESSEN, J., S. A. ANDFRSSEN, E. KOLLE, and L. B. ANDERSEN. Low Muscle Fitness Is Associated with Metabolic Risk in Youth. Med. Sci. Sports Exerc., Vol. 41, No. 7, pp. 1361-1367, 2009. Purpose: To examine the independent associations Of muscle fitness and cardiorespiratory fitness With clustered metabolic risk in youth. Methods: In 2005-2006, a cohort of 9- and 15-yr-olds (N=2818) was randomly selected from all regions of Norway. The participation rate was 89% and 74% among the 9- and 15-yr-olds, respectively. We assessed muscular strength by measuring explosive, isometric, and endurance strength. Cardiorespiratory fitness was measured directly as peak oxygen uptake during a cycle ergometry test. Risk factors included in the composite risk factor score (sum of z-scores) were systolic blood pressure, triglyceride, high-density lipoprotein cholesterol, insulin resistance, and waist circumference. Results: Muscle fitness was negatively associated with clustered metabolic risk, independent of cardiorespiratory fitness, and after adjustment forage, sex, and pubertal stage (beta = -0.112, P<0.001). Independent of muscle fitness, an inverse association was found between cardiorespiratory fitness and Clustered metabolic risk (beta = -0.337, P<0.001). Moreover, the odds ratios for having clustered risk in the least fit quartile compared with the most fit quartile were 7.2 (95% confidence interval (CI) = 4.3-12.0) and 17.3 (95% CI = 9.2-32.7) for muscle fitness and cardiorespiratory fitness, respectively. Conclusions: Our results show that muscle fitness and cardiorespiratory fitness are independently associated with metabolic risk in youth.

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• Sagelv, Edvard Hamnvik; Hopstock, Laila Arnesdatter; Morseth, Bente; Hansen, Bjørge Hermann; Steene-Johannessen, Jostein & Anderssen, Sigmund Alfred [Show all 13 contributors for this article] (2022). Physical activity and mortality: Effect modification by sedentary time. An individual participant data analysis of four cohorts with accelerometry measured physical activity.
• Tarp, Jakob; Dalene, Knut Eirik; Hansen, Bjørge Hermann; Steene-Johannessen, Jostein & Ekelund, Ulf (2020). Double counting individuals in meta‐analysis artificially inflates precision. Comment on “Device‐measured light‐intensity physical activity and mortality: A meta‐analysis”. Scandinavian Journal of Medicine & Science in Sports. ISSN 0905-7188. 30(6), p. 1083–1084. doi: 10.1111/sms.13693.
• Tarp, Jakob; Dalene, Knut Eirik; Steene-Johannessen, Jostein & Ekelund, Ulf (2019). Comment on: "Cardiorespiratory Fitness in Childhood and Adolescence Affects Future Cardiovascular Risk Factors: A Systematic Review of Longitudinal Studies". Sports Medicine. ISSN 0112-1642. 49(1), p. 159–161. doi: 10.1007/s40279-018-01035-z.
• Hansen, Bjørge Hermann; Nilsen, Ada Kristine Ofrim; Dalene, Knut Eirik; Steene-Johannessen, Jostein; Kolle, Elin & Ekelund, Ulf [Show all 7 contributors for this article] (2016). Cross-sectional and Longitudinal Associations of Replacing Sedentary Time with Active Behaviors on the Body Mass Index. Medicine & Science in Sports & Exercise. ISSN 0195-9131. 48. doi: 10.1249/01.mss.0000485698.85376.e6.
• Steene-Johannessen, Jostein; Resaland, Geir Kåre; Aadland, Katrine Nyvoll & Anderssen, Sigmund Alfred (2016). Muscle Fitness, Executive Function And Academic Performance In 10-year-old Children: The Ask-study. Medicine & Science in Sports & Exercise. ISSN 0195-9131.
• Steene-Johannessen, Jostein; Resaland, Geir Kåre; Aadland, Katrine Nyvoll & Anderssen, Sigmund Alfred (2016). Muscle Fitness, Executive Function And Academic Performance In 10-year-old Children: The Ask-study.
• Solbraa, Ane; Holme, Ingar Morten K; Graff-Iversen, Sidsel; Steene-Johannessen, Jostein; Aadland, Eivind & Anderssen, Sigmund Alfred (2013). Fysisk aktivitet og kroppsmasseindeks, 13 års oppfølging av voksne i Sogn og Fjordane.
• Kolle, Elin; Steene-Johannessen, Jostein; Andersen, Lars Bo & Anderssen, Sigmund Alfred (2012). Sedentary Behavior And Overweight In Children And Adolescents. Medicine & Science in Sports & Exercise. ISSN 0195-9131. 44, p. 664–664.
• Kjær, Ingirid Geirsdatter Heald; Seiler, Hilde Lohne; Kolle, Elin; Hansen, Bjørge Hermann; Pedersen, Freddy & Steene-Johannessen, Jostein [Show all 9 contributors for this article] (2011). Musculoskeletal and motor fitness in Norwegian adults and elderly; Status and the development of reference values. KAN 1.
• Solbraa, Ane; Mamen, Asgeir; Resaland, Geir Kåre; Steene-Johannessen, Jostein; Ylvisåker, Einar & Holme, Ingar Morten K [Show all 7 contributors for this article] (2011). The population in Sogn og Fjordane, Norway – fittest there is?
• Steene-Johannessen, Jostein (2010). Korleis står?e til med aktivitetsnivået og den fysiske formen blant barn og unge i Noreg?
• Steene-Johannessen, Jostein (2010). Hvordan får man barn og unge i bevegelse?
• Stangeland, Ingirid; Stangeland, Ingirid; Torstveit, Monica Klungland; Torstveit, Monica Klungland; Lohne-Seiler, Hilde & Lohne-Seiler, Hilde [Show all 13 contributors for this article] (2010). Overvekt og fedme blant voksne og eldre nordmenn (KAN1). Show summary

  INNLEDNING Overvekt og fedme representerer en alvorlig folkehelseutfordring for Verdens Helseorganisasjons (WHO) Europeiske region. WHO har klart gitt uttrykk for et økende behov for kartlegging for å illustrere dimensjonen av denne fedmeepidemien. Formålet med denne studien var å kartlegge forekomsten av overvekt og fedme uttrykt som kroppsmasseindeks (KMI), midjeomkrets og hudfoldsmålinger. METODER Totalt 904 (441 kvinner og 463 menn) nordmenn (20 ? 85 år, gjennomsnitt; 51,3 år, SD; ±14,8 år) ble tilfeldig utvalgt for å delta i det nasjonale KAN1prosjektets fase II. Kroppsvekt, høyde, midjeomkrets, hudfoldsmål og KMI ble målt. RESULTATER Gjennomsnittlig KMI var 25,8 ±3,9 kg/m2. Totalt 39,9 % (29,9 % kvinner og 49,5 % menn) ble karakterisert som overvektige i tillegg til 12,7 % som ble klassifisert som fete (13,4 % kvinner og 12,1 % menn). Mennene hadde en høyere gjennomsnittlig midjeomkrets (94,7 ± 10,3 cm) sammenliknet med kvinnene (85,2 ± 11,9 cm) (p=0,001). Totalt 66,3 % av kvinnene og 51,3 % av mennene hadde en økt risiko for vektrelaterte metabolske komplikasjoner (WRMC) basert på WHO sine grenseverdier for midjeomkrets. Av disse hadde 37,6 % av kvinnene og 24,3 % av mennene en kraftig økt risiko for WRMC. DISKUSJON Resultatene indikerer at den norske befolkningen har en høyere andel overvektige og fete enn tidligere antatt og at mer enn halvparten av den norske befolkningen har en økt risiko for WRMC. Flere menn enn kvinner er karakterisert som overvektige, mens flere kvinner har en økt og kraftig økt risiko for WRMC sammenliknet med menn.

• Solbraa, Ane Kristiansen; Ylvisåker, Einar; Mamen, Asgeir; Resaland, Geir Kåre; Steene-Johannessen, Jostein & Holme, Ingar [Show all 7 contributors for this article] (2010). Hvem er sprekest i landet (Kan1)? Show summary

  Innledning: Sogn og Fjordane er fylket med landets lengstlevende innbyggere og er blant fylkene med lavest dødelighet av hjerte- og karsykdom (HKS). Fysisk aktivitet (FA) og fysisk form (FF) er positivt assosiert med lav forekomst av risikofaktorer for HKS. Det eksisterer imidlertid minimalt med presise data om FA og FF hos voksne i dette fylket. Hensikten med denne tverrsnittsstudien er derfor å kartlegge objektivt målt FA nivå, direkte målt FF og risikofaktorer for HKS hos kvinner og menn i Sogn og Fjordane. Metode: Totalt deltok 314 40-42 åringer (57% kvinner) og 309 54-56 åringer (57% kvinner) i studien som gir en deltagelse på 60%. FA nivå (n=609) ble registrert med akselerometer (ActiGraph GT1M). FF (n=192) ble med målt direkte ved test på tredemølle til utmattelse. Av risikofaktorer for HKS (n=217) ble blodtrykk, total kolesterol, HDL, LDL, triglyserider og glukose registrert. Resultat: Preliminære data viser følgende resultater for kvinnene: FA nivå 400±143 tellinger?min-1, FF 35±8 ml?kg-1?min-1, blodtrykk 133±15/80±9 mmHg, total kolesterol 5,5±1,0 mmol/L, HDL 1,76±0,51 mmol/L, LDL 3,22±0,89 mmol/L, triglyserider 1,09±0,49 mmol/L og glukose 5,2±0,9 mmol/L. For mennene viser dataene følgende resultater: FA nivå 402±156 tellinger?min-1, FF 42±9 ml?kg-1?min-1, blodtrykk 140±14/83±10 mmHg, total kolesterol 5,5±0,9 mmol/L, HDL 1,36±0,37 mmol/L, LDL 3,35±0,75 mmol/L, triglyserider 1,85±1,31 mmol/L og glukose 5,2±1,1mmol/L. Det er ingen signifikante forkjeller mellom kjønnene med hensyn til fysisk aktivitet, og kvinnene har 17 % lavere VO2max enn mennene. Konklusjon: Sammenholdt med data fra andre steder i Norge viser disse data at folk i Sogn og Fjordane både er mer fysisk aktive og har bedre fysisk form. Risikofaktorene for HKS er imidlertid stort sett på samme nivå som rapportert tidligere.

• Steene-Johannessen, Jostein; Kolle, Elin; Kolle, Elin; Reseland, Janne E.; Anderssen, Sigmund A. & Anderssen, Sigmund A. [Show all 7 contributors for this article] (2010). Levels of inflammatory markers in a population-based sample of Norwegian children and adolescents. Show summary

  Background: Adipose tissue is more than a storage depot- it also serves as an endocrine organ that secrets inflammatory cytokines and growth factors. Prospective studies in adults have shown that low-grade inflammation may contribute to the development of insulin resistance, atherosclerosis, diabetes and cancer. Previous studies investigating inflammatory markers in children have been limited by small non-representative samples, and no Norwegian representative data exist. Representative data are needed to describe levels of inflammatory markers in a population. Aim: To describe the distribution of inflammatory markers among Norwegian children and adolescents. Methods: Cross-sectional analysis of data from 2299 Norwegian 9- and 15-year-olds participating in the study ?Physical activity among Norwegian children?. Inflammatory markers included C-reactive protein (CRP), leptin, adiponectin, plasminogen activator inhibitor-1 (PAI-1), tumor necrosis factor-? (TNF-?), hepatocyte growth factor (HGF), and interleukin-6 (IL-6). Skinfold thicknesses were taken by trained investigators. Results: After adjustment for sex and puberty the results showed that 9-year-olds had significantly higher levels of adiponectin (P<0.001), PAI-1 (P<0.001) and TNF-? (P<0.001) but lower levels of leptin (P<0.001) compared to 15-year-olds. A graded association of body composition with PAI-1 (P<0.001), leptin (P<0.001), adiponectin (P=0.004), HGF (P=0.04), and CRP (P<0.001) were observed across quartiles of sum of four skinfolds. In addition, a similar graded associations between physical fitness and PAI-1 (P<0.001), leptin (P<0.001), IL-6 (P=0.04), and CRP (P<0.001) were observed. Conclusions: In the current study, we provide reference values on selected inflammatory markers in a representative cohort of Norwegian children and adolescents. In addition, both body composition and physical fitness showed graded associations with several inflammatory markers.

• Steene-Johannessen, Jostein; Kolle, Elin; Anderssen, Sigmund A. & Andersen, Lars Bo (2009). Muscular fitness is associated with metabolic risk in youth. Medicine & Science in Sports & Exercise. ISSN 0195-9131.
• Steene-Johannessen, Jostein; Kolle, Elin; Anderssen, Sigmund A. & Andersen, Lars Bo (2009). Muscular fitness is associated with metabolic risk in youth.
• Kolle, Elin; Steene-Johannessen, Jostein; Andersen, Lars Bo & Anderssen, Sigmund A. (2009). Changes in fatmass in Norwegian children, 2000-2005. Medicine & Science in Sports & Exercise. ISSN 0195-9131. Show summary

  The prevalence of overweight and obesity among children is increasing worldwide. There is, however, a lack of studies investigating change in the distribution of body fat. This knowledge is essential as central adiposity has been shown to be more strongly associated with type 2 diabetes and dyslipidaemia, than overall fatness in adults. Moreover, visceral adipose tissue is directly associated with low density lipoprotein cholesterol and triglycerides, and inversely related to high density lipoprotein cholesterol among children. PURPOSE: To investigate 5-year changes in waist girth, skinfold measures, and body mass index (BMI) among 9- year-old children living in Oslo, Norway. METHODS: A total of 854 9-year-olds measured in the European Youth Heart Study (2000) and in the Physical Activity in Norwegian Children Study (2005) were included in the analyses. Indicators of body fatness were skinfold thickness (triceps, biceps, subscapular and suprailiac), waist circumference and body mass index (BMI; in kg/m2). The International Obesity Tak Force (IOTF) cut-offs were used to define overweight and obese subjects. Changes in fatness were tested by using general linear models, adjusted for age and sexual maturity. RESULTS: In 2005, 9-year-old girls had significantly higher BMI (p = 0.04), waist girth (p < 0.001), and all 4 skinfold measures (p<0.001) than girls in 2000. Nine-year-old boys increased their waist girth by 2.2 cm (p = 0.002), and their triceps (p=0.02) and suprailiac (p=0.02) skinfold measures between the study periods. The overall prevalence of overweight and obesity was slightly higher in 2005, however, chi-square analysis revealed that the increase was significant in girls only (p = 0.04). CONCLUSION: In 9-year-old children living in Oslo, there have been increases in measures of fatness and central adiposity over the last 5 years. The increase was more pronounced in girls than boys. The results indicate that the reported increases in BMI under-estimates the increase in body fatness among children.

• Kolle, Elin; Steene-Johannessen, Jostein; Andersen, Lars Bo & Anderssen, Sigmund A. (2009). Changes in fatmass in Norwegian children, 2000-2005. Show summary

  The prevalence of overweight and obesity among children is increasing worldwide. There is, however, a lack of studies investigating change in the distribution of body fat. This knowledge is essential as central adiposity has been shown to be more strongly associated with type 2 diabetes and dyslipidaemia, than overall fatness in adults. Moreover, visceral adipose tissue is directly associated with low density lipoprotein cholesterol and triglycerides, and inversely related to high density lipoprotein cholesterol among children. PURPOSE: To investigate 5-year changes in waist girth, skinfold measures, and body mass index (BMI) among 9- year-old children living in Oslo, Norway. METHODS: A total of 854 9-year-olds measured in the European Youth Heart Study (2000) and in the Physical Activity in Norwegian Children Study (2005) were included in the analyses. Indicators of body fatness were skinfold thickness (triceps, biceps, subscapular and suprailiac), waist circumference and body mass index (BMI; in kg/m2). The International Obesity Tak Force (IOTF) cut-offs were used to define overweight and obese subjects. Changes in fatness were tested by using general linear models, adjusted for age and sexual maturity. RESULTS: In 2005, 9-year-old girls had significantly higher BMI (p = 0.04), waist girth (p < 0.001), and all 4 skinfold measures (p<0.001) than girls in 2000. Nine-year-old boys increased their waist girth by 2.2 cm (p = 0.002), and their triceps (p=0.02) and suprailiac (p=0.02) skinfold measures between the study periods. The overall prevalence of overweight and obesity was slightly higher in 2005, however, chi-square analysis revealed that the increase was significant in girls only (p = 0.04). CONCLUSION: In 9-year-old children living in Oslo, there have been increases in measures of fatness and central adiposity over the last 5 years. The increase was more pronounced in girls than boys. The results indicate that the reported increases in BMI under-estimates the increase in body fatness among children.

• Steene-Johannessen, Jostein; Kolle, Elin; Anderssen, Sigmund A. & Andersen, Lars Bo (2009). Low muscle fitness is associated with metabolic risk in youth.
• Steene-Johannessen, Jostein (2009). Fysisk aktivitet og metabolsk syndrom.
• Steene-Johannessen, Jostein; Anderssen, Sigmund A.; Kolle, Elin & Andersen, Lars Bo (2008). Muscular fitness is associated with metabolic risk in youth. Norsk idrettsmedisin. ISSN 0806-9328. Show summary

  In adults, low physical fitness is known to contribute to the early onset and progression of cardiovascular disease. Recent findings have shown close relationship between metabolic risk factors and physical fitness in children and youth. Whilst these studies mainly focus on the effect of cardiorespiratory fitness (CRF), few studies have examined the independent effect of muscular fitness (MF). Purpose:To investigate the associations of MF with clustered metabolic risk score in youth. Methods: This cross-sectional study included 2299 Norwegian 9- and 15-year-olds. A continuous score representing a metabolic risk profile was derived by computing standardized residuals for HOMA score, waist circumferences, triglycerides, high-density lipoprotein cholesterol, and systolic blood pressure. MF was evaluated by measuring lower limb explosive strength (standing broad jump), upper limb muscle strength (hand grip), abdominal muscular endurance (sit-ups) and endurance of the trunk extensor muscle (modified Biering-Sørensen test). MF score was computed by combining the standardized values of these four tests. CRF was measured directly during a maximal cycle ergometer test. Metabolic risk, MF and CRF were analyzed as continuous variables using multiple linear regression. Results: Metabolic risk was inversely associated with MF, independent of CRF, and after adjustment for age, sex and pubertal stage (_b= -.112, P<0.001). CRF was, independent of MF, inversely aociated with clustered metabolic risk (_b= -.337, P<0.001). However, eore adjusting for CRF/MF, the associations of MF and CRF with metabolic risk were almost equally strong (_b= -.315, P<0.001; _b= -.443, P<00for MF and CRF, respectively). Conclusions: Both MF and CRF were independently associated with metabolic risk in youth. Whilst measuring CRF directly is time-consuming and expensive, determining MF is cheap and feasible. Our results suggest that determination of MF might be a favourable method when investigating the association between physical fitness and metabolic risk in large populations.

• Kolle, Elin & Steene-Johannessen, Jostein (2008). Hvor aktive er norske barn og unge egentlig? og hva har skjedd de siste årene?
• Hansen, Bjørge Hermann; Steene-Johannessen, Jostein; Kolle, Elin; Udahl, Karine; Kaupang, Oda Bjørge & Andersen, Inge Dehli [Show all 10 contributors for this article] (2023). Kartlegging av fysisk aktivitet blant voksne og eldre 2020-22 (Kan3). Folkehelseinstituttet. Full text in Research Archive Show summary

  Kartlegging av fysisk aktivitet og stillesittende tid blant voksne og eldre (Kan3) er utført ved Norges idrettshøgskole i samarbeid med Folkehelseinstituttet. Formålet med Kan3 er å følge opp tidligere undersøkelser av voksne og eldre for å øke kunnskapen om status, trender og utviklingen av fysisk aktivitet i den norske befolkingen. Kan3 inngår som en del av det nasjonale kartleggingssystemet av fysisk aktivitet og fysisk form. De norske ungKan- og Kan-undersøkelsene er unike ved at fysisk aktivitet er målt objektivt ved hjelp av akselerometre i populasjonsbaserte utvalg ved flere tidspunkt. Dette gir mer nøyaktige estimater av befolkingens fysiske aktivitetsnivå enn ved spørreskjemabaserte undersøkelser. Slik kunnskap er nødvendig for å kunne iverksette tiltak for å redusere stillesitting og øke det fysiske aktivitetsnivået.

• Kolle, Elin; Steene-Johannessen, Jostein; Säfvenbom, Reidar; Anderssen, Sigmund Alfred; Grydeland, May & Ekelund, Ulf [Show all 17 contributors for this article] (2019). Hovedrapport: School in motion. Utdanningsdirektoratet.
• Steene-Johannessen, Jostein; Fretland, Frode & Moe, Vegard Fusche (2013). Forprosjekt Individualisering av lagidrett. Høgskulen i Sogn og Fjordane. ISSN 0806-1696. Full text in Research Archive Show summary

  Sogndal Fotball (SF) ønskjer å systematisere talentutvikling ved faktainnsamling og forsking av korleis den einskilde kan utvikle seg i eit lagspel. Høgskulen i Sogn og Fjordane (HiSF) ønskjer å satse meir på fotballforsking. SF og HiSF har mål om at dei innan ein femårsperiode skal stå fram som dei fremste nasjonalt innan fotballforsking og talentutvikling .Målet skal nåast gjennom eit samspel der SF skal syte for teknologisk tilrettelegging og testing, tilgjengelegheit av utøvarar og ressurspersonar. HiSF skal saman med SF definere fagområder medan HiSF skal syte for forskinga på området, og gjennom databruk, studentoppgåver, forsking og undervisning, vise retningar som kan utvikle fotballtalenta. Hovudmål med forprosjektet er å definere Fagområde, teknologi og organisasjon ein bør satse på for i løpet av fem år og vera fremst nasjonalt innan fotballforsking og talentutvikling.

• Steene-Johannessen, Jostein (2009). Physical activity, physical fitness and cardiovascular disease risk factors in Norwegian children and adolescents : The Physical Activity among Norwegian Children Study. Norges idrettshøgskole. ISSN 9788250204324.
• Anderssen, Sigmund A.; Hansen, Bjørge Herman; Kolle, Elin; Steene-Johannessen, Jostein; Børsheim, Elisabeth & Holme, Ingar [Show all 14 contributors for this article] (2009). Fysisk aktivitet blant voksne og eldre i Norge : resultater fra en kartlegging i 2008 og 2009. Helsedirektoratet. ISSN 978-82-8081-187-5. 2009(IS-1754).
• Anderssen, Sigmund A.; Hansen, Bjørge Herman; Kolle, Elin; Steene-Johannessen, Jostein; Børsheim, Elisabeth & Holme, Ingar (2009). Fysisk aktivitet blant voksne og eldre i Norge. Resultater fra en kartlegging i 2008 og 2009. Helsedirektoratet. ISSN 9788280811875.

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