Sigmund Alfred Anderssen

• Bergum, Hilde Marie; Grimsmo, Jostein; Anderssen, Sigmund Alfred & Klemsdal, Tor Ole (2024). Effects on physical activity, physical fitness and well-being in a 36-months randomized controlled study, comparing a multimodal hospital-based intervention programme for primary cardiovascular prevention with usual care. BMC Cardiovascular Disorders. ISSN 1471-2261. 24(1). doi: 10.1186/s12872-024-03892-1.
• 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.
• Bratteteig, Mari; Rüegg, Corina Silvia; Raastad, Truls; Grydeland, May; Torsvik, Ingrid Kristin & Schindera, Christina [Show all 8 contributors for this article] (2023). Physical Activity, Fitness, and Cardiovascular Disease Risk in Adolescent Childhood Cancer Survivors Compared to Controls: The Physical Activity in Childhood Cancer Survivors Study. Journal of Adolescent and Young Adult Oncology. ISSN 2156-5333. p. 1–9. doi: 10.1089/jayao.2023.0063. Show summary

  Purpose: Childhood cancer survivors have increased risk of cardiac late effects that can be potentially mitigated by physical activity and fitness. We aimed to (1) compare cardiovascular disease (CVD) risk between survivors and controls, and (2) examine whether the associations of moderate-to-vigorous physical activity (MVPA), cardiorespiratory fitness (CRF), and musculoskeletal fitness (MSF) with CVD risk factors differed between survivors and controls. Methods: Within the Physical Activity in Childhood Cancer Survivors (PACCS) study, we assessed CVD risk factors (android fat mass, systolic blood pressure [SBP], total cholesterol/high-density lipoprotein [HDL]-cholesterol, and glycosylated hemoglobin) in 157 childhood cancer survivors and 113 age- and sex-matched controls aged 9–18 years. We used multivariable mixed linear regression models to compare CVD risk factors between survivors and controls, and assess associations of MVPA, CRF, and MSF with CVD risk factors. Results: Compared with controls, survivors had more android fat mass (861 vs. 648 g, p = 0.001) and lower SBP (114 vs. 118 mmHg, p = 0.002). MVPA, CRF, and MSF were associated with lower levels of android fat mass and total cholesterol/HDL-cholesterol, and higher SBP in survivors. Associations of MVPA, CRF, and MSF with CVD risk factors were similar in survivors and controls (Pinteraction > 0.05), except the associations of CRF and MSF with android fat mass, which were stronger in survivors than in controls (Pinteraction ≤ 0.001). Conclusion: Owing to higher levels of android fat mass and its stronger association with physical fitness in childhood cancer survivors compared with controls, survivors should get targeted interventions to increase fitness to reduce future risk of CVD.

• Borodulin, Katja & Anderssen, Sigmund Alfred (2023). Physical activity: associations with health and summary of guidelines. Food & Nutrition Research (FNR). ISSN 1654-6628. 67. doi: 10.29219/fnr.v67.9719. Full text in Research Archive
• Grydeland, May; Bratteteig, Mari; Rüegg, Corina Silvia; Lie, Hanne Cathrine; Thorsen, Lene & Larsen, Elna Hamilton [Show all 14 contributors for this article] (2023). Physical Activity Among Adolescent Cancer Survivors: The PACCS Study. Pediatrics. ISSN 0031-4005. 152(3). doi: 10.1542/peds.2023-061778. Full text in Research Archive Show summary

  OBJECTIVES: Physical activity (PA) may modify risks of late effects after cancer. We aimed to examine levels of PA and sedentary time (ST) in a large, international sample of adolescent childhood cancer survivors in relation to sociodemographic and cancer-related factors and compare levels of PA and ST to reference cohorts. METHODS: Survivors from any cancer diagnosis who had completed cancer treatment ≥1 year ago, aged 9 to 16 years, were eligible for the multicenter Physical Activity in Childhood Cancer Survivors study. PA and ST were measured by ActiGraph GT3X+ accelerometers. We performed linear regression analyses to assess factors associated with moderate-to-vigorous PA (MVPA) and ST, and compared marginal means of total PA, MVPA, and ST in 432 survivors to sex- and age-stratified references (2-year intervals) using immediate t-tests for aggregated data. RESULTS: Among survivors, 34% fulfilled the World Health Organization’s PA recommendation of ≥60 min of daily MVPA on average and their ST was 8.7 hours per day. Being female, older, overweight, a survivor of central nervous system tumor, or having experienced relapse were associated with lower MVPA and/or higher ST. Generally, male survivors spent less time in MVPA compared with references, whereas female survivors had similar levels. Both male and female survivors had higher ST than references in nearly all age groups. CONCLUSIONS: The low PA and high ST in this large sample of adolescent childhood cancer survivors is worrisome. Combined, our results call for targeted interventions addressing both PA and ST in follow-up care after childhood cancer.

• Resaland, Geir Kåre; Bartholomew, J.B.; Andersen, Lars Bo; Anderssen, Sigmund Alfred & Aadland, Eivind (2023). Effects of a school-based physical activity intervention on cardiometabolic health 5 years after cessation. Scandinavian Journal of Medicine & Science in Sports. ISSN 0905-7188. 33(7), p. 1177–1189. doi: 10.1111/sms.14350. Show summary

  Background: While there have been several school-based physical activity (PA) interventions targeting improvement in cardiovascular disease (CVD) risk factors, few have assessed long-term effects. The aim of this paper was therefore to determine intervention effects on CVD risk factors 5 years after cessation. Methods: Two schools were assigned to intervention (n = 125) or control (n = 134). The intervention school offered 210 min/week more PA than the control school over two consecutive years (fourth and fifth grades). Follow-up assessment was conducted 5-year post-intervention (10th grade) where 180–210 (73%–85%) children provided valid data. Outcomes were CVD risk factors: triglyceride, total-to-high-density-lipoprotein-cholesterol ratio (TC:HDL ratio), insulin resistance, blood pressure (BP), waist circumference, and cardiorespiratory fitness (VO2peak). Variables were analyzed individually and as a composite score through linear mixed models, including random intercepts for children. Results: Analyses revealed significant sustained 5-year intervention effects for HDL (effect sizes [ES] = 0.22), diastolic BP (ES = 0.48), VO2peak (ES = 0.29), and composite risk score (ES = 0.38). These effects were similar to the immediate results following the intervention. In contrast, while TC:HDL ratio initially decreased post-intervention (ES = 0.27), this decrease was not maintained at 5-year follow-up (ES = 0.09), whereas WC was initially unchanged post-intervention (ES = 0.02), but decreased at 5-year follow-up (ES = 0.44). Conclusion: The significant effects of a 2-year school-based PA intervention remained for CVD risk factors 5 years after cessation of the intervention. As cardiometabolic health can be maintained long-term after school-based PA, this paper demonstrates the sustainability and potential of schools in the primary prevention of future CVD risk in children.

• Bergum, Hilde Marie; Sandven, Irene; Abdelnoor, Michael; Anderssen, Sigmund Alfred; Grimsmo, Jostein & Rivrud, Dag Elle [Show all 12 contributors for this article] (2022). Randomized trial of cardiovascular prevention in Norway combining an in-hospital lifestyle course with primary care follow-up: the Hjerteløftet study. European Journal of Preventive Cardiology (EJPC). ISSN 2047-4873. 29(17), p. 2252–2263. doi: 10.1093/eurjpc/zwac211. Full text in Research Archive Show summary

  Aims Cardiovascular risk factor control is suboptimal in Europe, including Norway. The present study examined the efficacy of a multimodal primary prevention intervention programme based on the existing Norwegian health care system. Methods and results In this open-label randomized controlled trial, adult patients with elevated cardiovascular risk were randomly assigned to an intervention programme including a hospital-based lifestyle course and primary care follow-up or to a control group (CG). The participants were recruited between 2011 and 2015. Primary outcome was change in validated cardiovascular risk scores, national and international (NORRISK, NORRISK 2, Framingham, PROCAM) between baseline and follow-up. Secondary outcomes included major cardiovascular risk factors. After 36 months the NORRISK score was significantly improved in patients assigned to the intervention group (IG) compared to patients assigned to the CG; absolute difference in mean delta score in the IG (n = 305) compared to mean delta score in the CG (n = 296): −0.92, 95% CI: −1.48 to −0.36, P = 0.001. The results for NORRISK 2, Framingham and PROCAM showed similar significant effects. The secondary endpoints including total cholesterol and blood pressure were only minimally, and non-significantly, reduced in the IG, but the proportion of smokers (P = 0.0028) and with metabolic syndrome (P < 0.0001) were significantly reduced. A limited number of cardiovascular events were observed, IG (n = 9), CG (n = 16). Conclusion In subjects with elevated cardiovascular risk, a newly developed prevention programme, combining a hospital-based lifestyle course and primary care follow-up, significantly reduced cardiovascular risk scores after 36 months. This benefit appeared achievable primarily through improvements in metabolic syndrome characteristics and smoking habits. The study protocol was registered in ClinicalTrials.gov (NCT01741428). Primary prevention, Cardiovascular disease, Cardiovascular risk, Metabolic syndrome, Smoking cessation, Lifestyle intervention Issue Section: Prevention In Practice

• Bratteteig, Mari; Anderssen, Sigmund Alfred; Rueegg, Corina Silvia; Ruud, Ellen; Torsvik, Ingrid Kristin & Kriemler, Susi [Show all 7 contributors for this article] (2022). Device-measured physical activity and cardiovascular disease risk in adolescent childhood cancer survivors. A physical activity in childhood cancer survivors (PACCS) study. Frontiers in pediatrics. ISSN 2296-2360. 10. doi: 10.3389/fped.2022.977365. Full text in Research Archive Show summary

  Objectives: We aimed to compare cardiovascular disease (CVD) risk factors in childhood cancer survivors (CCS) with age- and sex-stratified reference material and examine the association between physical activity (PA) intensities and CVD risk factors in CCS. Materials and methods: Within the cross-sectional, multicenter Physical Activity in Childhood Cancer Survivors (PACCS) study, we collected data on CVD risk factors [VO2–peak (mL⋅kg–1⋅min–1), body mass index (BMI, kg/m2), systolic blood pressure (SBP, mmHg), and total-cholesterol/HDL-cholesterol (Total/HDL)] among CCS aged 9–18 years. CVD risk factors were compared to references with immediate t-tests. We transformed CVD risk factors into z-scores based on international references and generated an individual CVD risk score: [inverse ZVO2–peak + ZBMI + ZSBP + ZTotal/HDL)/4]. Multivariable mixed linear regression models were used to analyze the associations between device-measured PA intensities and CVD risk factors. Results: We included 157 CCS aged on average 13.4 years at inclusion and 8.2 years from diagnosis. Male CCS had lower VO2–peak compared to references (45.4 vs. 49.4 mL⋅kg–1⋅min–1, P = 0.001), higher diastolic BP (67 vs. 63 mmHg, P < 0.001), lower HDL (1.35 vs. 1.44 mmol/L, P = 0.012), as well as a tendency to higher CVD risk score (z-score=0.14 vs. 0.00, P = .075). Female CCS’ CVD risk factors were comparable to references. Vigorous-intensity PA (VPA) was associated with CVD risk factors. A 10-min increase in VPA was associated with higher VO2–peak (β = 4.9, 95% CI, 2.1–7.7), lower Total/HDL (β = −0.3, 95% CI, −0.6 to −0.1) and a lower CVD risk score (β = −0.4, 95% CI, −0.6 to −0.2). Conclusion: Male adolescent CCS had less favorable values of CVD risk factors compared to references. VPA in adolescent CCS is associated with clinically meaningful favorable values of CVD risk factors.

• Gammon, Catherine; Atkin, Andrew J.; Corder, Kirsten; Ekelund, Ulf; Hansen, Bjørge Hermann & Sherar, Lauren B. [Show all 19 contributors for this article] (2022). Influence of Guideline Operationalization on Youth Activity Prevalence in the International Children's Accelerometry Database. Medicine & Science in Sports & Exercise. ISSN 0195-9131. 54(7), p. 1114–1122. doi: 10.1249/MSS.0000000000002884. Full text in Research Archive Show summary

  Introduction The United Kingdom and World Health Organization recently changed their youth physical activity (PA) guidelines from 60 min of moderate- to vigorous-intensity PA (MVPA) every day, to an average of 60 min of MVPA per day, over a week. The changes are based on expert opinion due to insufficient evidence comparing health outcomes associated with different guideline definitions. This study used the International Children’s Accelerometry Database to compare approaches to calculating youth PA compliance and associations with health indicators. Methods Cross-sectional accelerometer data (n = 21,612, 5–18 yr) were used to examine compliance with four guideline definitions: daily method (DM; ≥60 min MVPA every day), average method (AM; average of ≥60 min MVPA per day), AM5 (AM compliance and ≥5 min of vigorous PA [VPA] on ≥3 d), and AM15 (AM compliance and ≥15 min VPA on ≥3 d). Associations between compliance and health indicators were examined for all definitions. Results Compliance varied from 5.3% (DM) to 29.9% (AM). Associations between compliance and health indicators were similar for AM, AM5, and AM15. For example, compliance with AM, AM5, and AM15 was associated with a lower BMI z-score (statistics are coefficient [95% CI]): AM (−0.28 [−0.33 to −0.23]), AM5 (−0.28 [−0.33 to −0.23], and AM15 (−0.30 [−0.35 to −0.25]). Associations between compliance and health indicators for DM were similar/weaker, possibly reflecting fewer DM-compliant participants with health data and lower variability in exposure/outcome data. Conclusions Youth completing 60 min of MVPA every day do not experience superior health benefits to youth completing an average of 60 min of MVPA per day. Guidelines should encourage youth to achieve an average of 60 min of MVPA per day. Different guideline definitions affect inactivity prevalence estimates; this must be considered when analyzing data and comparing studies.

• 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.

• Paluch, Amanda E; Bajpai, Shivangi; Bassett, David R; Carnethon, Mercedes R; Ekelund, Ulf & Evenson, Kelly R [Show all 45 contributors for this article] (2022). Daily steps and all-cause mortality: a meta-analysis of 15 international cohorts. The Lancet Public Health. ISSN 2468-2667. 7(3), p. e219–e228. doi: 10.1016/S2468-2667(21)00302-9. 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] (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.

• 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.

• Berglund, Ida Johnsen; Vesterbekkmo, Elisabeth Kleivhaug; Retterstøl, Kjetil; Anderssen, Sigmund Alfred; Singh, Maria A. Fiatarone & Helge, Jørn Wulff [Show all 9 contributors for this article] (2021). The Long-term Effect of Different Exercise Intensities on High-Density Lipoprotein Cholesterol in Older Men and Women Using the Per Protocol Approach: The Generation 100 Study. Mayo Clinic Proceedings: Innovations, Quality & Outcomes (MCP:IQ&O). ISSN 2542-4548. 5(5), p. 859–871. doi: 10.1016/j.mayocpiqo.2021.07.002. Full text in Research Archive Show summary

  Objective: To examine whether 5 years of high-intensity interval training (HIIT) increases high-density lipoprotein cholesterol (HDL-C) concentration more than moderate-intensity continuous training (MICT) and control (CON) in older men and women. Methods: A total of 1567 older adults (790 [50.4%] women) were randomized (2:1:1) to either CON (n=780; asked to follow the national recommendations for physical activity) or 2 weekly sessions of HIIT (10-minute warm-up followed by 4×4-minute intervals at ∼90% of peak heart rate) or MICT (50 minutes of continuous work at ∼70% of peak heart rate). Serum HDL-C concentration was measured by standard procedures at baseline and at 1 year, 3 years, and 5 years. The study took place between August 21, 2012, and June 31, 2018. Linear mixed models were used to determine between-group differences during 5 years using the per protocol approach. Results: Men in HIIT had a smaller reduction in HDL-C (−1.2%) than men in CON (−6.9%) and MICT (−7.8%) after 5 years (P=.01 and P=.03 for CON vs HIIT and MICT vs HIIT, respectively). No effect of exercise intensity on HDL-C was seen in women. Changes in peak oxygen uptake were associated with changes in HDL-C in both men and women, whereas changes in body weight and fat mass were not. Conclusion: In men, HIIT seems to be the best strategy to prevent a decline in HDL-C during a 5-year period. No effect of exercise intensity was seen for older women.

• Vedøy, Ingeborg Barth; Skulberg, Knut Ragnvald; Anderssen, Sigmund Alfred; Fagerland, Morten Wang; Tjomsland, Hege Eikeland & Thurston, Miranda N. (2021). The longitudinal association between objectively measured physical activity and mental health among Norwegian adolescents. International Journal of Behavioral Nutrition and Physical Activity. ISSN 1479-5868. 18:149, p. 1–11. doi: 10.1186/s12966-021-01211-x. Full text in Research Archive Show summary

  Background: Mental health among young people in many countries, including Norway, seems to be deteriorating. Physical activity (PA) has been positively associated with mental health. However, methodological issues related to study design and measurement of PA and mental health outcomes currently limits our understanding of the relationship. The purpose of the present study is to explore the prospective relationship between objectively measured PA and mental health outcomes. More specifically, volume (total PA), intensity (moderate-to-vigorous PA [MVPA]) and sedentary behaviour (SED) were explored in relation to mental health problems (MHP) and mental wellbeing (MWB). Methods: Data from 599 adolescents (54.4% female, mean age at baseline ±SD 13.3 ± 0.3 years) were collected annually during their 3 years (T1, T2 and T3) at lower secondary school. PA was measured using accelerometry. MWB was measured using the ‘Warwick-Edinburgh Mental Wellbeing Scale’ and MHP by the ‘Strengths and Difficulties Questionnaire’. Multiple linear regression was performed to explore relationships between changes in PA/SED (between T1-T3) and MWB/MHP (at T3). The term ‘movement categories’ was used to refer to components on the movement continuum and includes volume (total PA), intensity (MVPA) and SED. Results: Among boys, any increase in SED was positively associated with MWB (β = 0.05, 95% CI: 0.01 to 0.10), whereas a small positive association between an increase in total PA (volume) and MWB was found among girls (β = 1.13, 95% CI: 0.05 to 2.21). There were no associations between changes in any movement categories [total PA (volume), MVPA, SED] and score on MHP at T3, neither for girls nor boys. Conclusion: This study provided no clear evidence of any association between change in volume or intensity of PA and MHP among an overall healthy adolescent study sample. There was, however, evidence of a relationship between increased SED and MWB among boys and increased volume of PA and MWB among girls. The relationship between movement categories and mental health may depend on the measurement used to assess both PA/SED and variables of mental health. Future research would be strengthened by researchers clarifying what construct of mental health is being used and measured.

• Letnes, Jon Magne; Berglund, Ida Johnsen; Johnson, Kristin Espolin; Dalen, Håvard; Nes, Bjarne & Lydersen, Stian [Show all 25 contributors for this article] (2021). Effect of 5 years of exercise training on the cardiovascular risk profile of older adults: the Generation 100 randomized trial. European Heart Journal. ISSN 0195-668X. 43(21), p. 2065–2075. doi: 10.1093/eurheartj/ehab721. Full text in Research Archive
• Rajalahti, Tarja; Aadland, Eivind; Resaland, Geir Kåre; Anderssen, Sigmund Alfred & Kvalheim, Olav Martin (2021). Influence of adiposity and physical activity on the cardiometabolic association pattern of lipoprotein subclasses to aerobic fitness in prepubertal children. PLOS ONE. ISSN 1932-6203. 16(11). doi: 10.1371/journal.pone.0259901. Full text in Research Archive
• Rajalahti, Tarja; Aadland, Eivind; Resaland, Geir Kåre; Anderssen, Sigmund Alfred & Kvalheim, Olav Martin (2021). Cardiometabolic associations between physical activity, adiposity, and lipoprotein subclasses in prepubertal norwegian children. Nutrients. ISSN 2072-6643. 13(6), p. 1–14. doi: 10.3390/nu13062095. Full text in Research Archive Show summary

  Lipoprotein subclasses possess crucial cardiometabolic information. Due to strong multicollinearity among variables, little is known about the strength of influence of physical activity (PA) and adiposity upon this cardiometabolic pattern. Using a novel approach to adjust for covariates, we aimed at determining the “net” patterns and strength for PA and adiposity to the lipoprotein profile. Principal component and multivariate pattern analysis were used for the analysis of 841 prepubertal children characterized by 26 lipoprotein features determined by proton nuclear magnetic resonance spectroscopy, a high-resolution PA descriptor derived from accelerometry, and three adiposity measures: body mass index, waist circumference to height, and skinfold thickness. Our approach focuses on revealing and validating the underlying predictive association patterns in the metabolic, anthropologic, and PA data to acknowledge the inherent multi-collinear nature of such data. PA associates to a favorable cardiometabolic pattern of increased high-density lipoproteins (HDL), very large and large HDL particles, and large size of HDL particles, and decreased triglyceride, chylomicrons, very low-density lipoproteins (VLDL), and their subclasses, and to low size of VLDL particles. Although weakened in strength, this pattern resists adjustment for adiposity. Adiposity is inversely associated to this pattern and exhibits unfavorable associations to low-density lipoprotein (LDL) features, including atherogenic small and very small LDL particles. The observed associations are still strong after adjustment for PA. Thus, lipoproteins explain 26.0% in adiposity after adjustment for PA compared to 2.3% in PA after adjustment for adiposity.

• 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.

• Skrede, Turid; Aadland, Eivind; Anderssen, Sigmund Alfred; Resaland, Geir Kåre & Ekelund, Ulf (2021). Bi-directional prospective associations between sedentary time, physical activity and adiposity in 10-year old Norwegian children. Journal of Sports Sciences. ISSN 0264-0414. 39(15), p. 1772–1779. doi: 10.1080/02640414.2021.1898114. Full text in Research Archive Show summary

  There is an adverse cross-sectional association between sedentary time, physical activity (PA) and adiposity, but weak and inconsistent estimates raise question to the direction of associations. The present study aims to examine whether the prospective association between sedentary time, different PA intensities and indicators of adiposity is bi-directional. The Active Smarter Kids Study obtained data from 869 ten-year-old children with valid measurements for sedentary time, PA, and adiposity at baseline and follow-up. Time spent sedentary and PA was measured by accelerometry, adiposity was assessed by three different measures: body mass index (BMI), waist circumference (WC) and sum of four skinfolds (S4SF). Neither overall PA nor time spent sedentary predicted lower BMI or WC at follow-up, but the time spent in moderate-and-vigorous PA (MVPA) and vigorous PA (VPA) predicted lower S4SF at follow-up among boys (MVPA β − 0.066 [95% CI −0.105, −0.027] p = 0.001). Baseline BMI and WC predicted less overall PA, MVPA and VPA in boys. All adiposity measures predicted more time spent sedentary at follow-up in boys. The results suggest that overall PA and sedentary time do not predict future adiposity. Baseline adiposity may rather predict more sedentary time and less higher intensity activity.

• 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
• Vedøy, Ingeborg Barth; Skulberg, Knut Ragnvald; Anderssen, Sigmund Alfred; Tjomsland, Hege Eikeland & Thurston, Miranda (2021). Physical activity and academic achievement among Norwegian adolescents: Findings from a longitudinal study. Preventive Medicine Reports. ISSN 2211-3355. 21:101312, p. 1–7. doi: 10.1016/j.pmedr.2021.101312. Full text in Research Archive Show summary

  Regular physical activity (PA) has been associated with academic achievement, but the evidence is mainly based on cross-sectional research and self-reported measures of PA. The purpose of the current study was to explore the longitudinal relationship between objectively measured PA and academic achievement among a cohort of adolescents in Norway between 2016 and 2018. As a secondary aim, an indirect relationship via waist circumference (WC) and sleep duration was assessed. Data from 599 adolescents (54.4% female, mean age at baseline ± SD 13.3 ± 0.3 years) were collected annually during their three years at lower secondary school. PA was measured objectively using accelerometry. Academic achievement was assessed using grade point average (GPA) from school records. Linear regression analysis was performed to explore associations between longitudinal changes in measures of PA (Total PA and moderate-to-vigorous PA [MVPA]) and academic achievement directly or via mediators. Results showed no significant associations between Total PA or MVPA and academic achievement, either in the main analyses or through mediation of WC and sleep duration. The results contribute to a growing evidence base of studies showing no association between objectively measured PA and academic achievement among adolescents.

• 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.

• Willeit, Peter; Tschiderer, Lena; Allara, Elias; Reuber, Kathrin; Seekircher, Lisa & Gao, Lu [Show all 76 contributors for this article] (2020). Carotid Intima-Media Thickness Progression as Surrogate Marker for Cardiovascular Risk : Meta-Analysis of 119 Clinical Trials Involving 100 667 Patients. Circulation. ISSN 0009-7322. 142(7), p. 621–642. doi: 10.1161/CIRCULATIONAHA.120.046361. Show summary

  Background: To quantify the association between effects of interventions on carotid intima-media thickness (cIMT) progression and their effects on cardiovascular disease (CVD) risk. Methods: We systematically collated data from randomized, controlled trials. cIMT was assessed as the mean value at the common-carotid-artery; if unavailable, the maximum value at the common-carotid-artery or other cIMT measures were used. The primary outcome was a combined CVD end point defined as myocardial infarction, stroke, revascularization procedures, or fatal CVD. We estimated intervention effects on cIMT progression and incident CVD for each trial, before relating the 2 using a Bayesian meta-regression approach. Results: We analyzed data of 119 randomized, controlled trials involving 100 667 patients (mean age 62 years, 42% female). Over an average follow-up of 3.7 years, 12 038 patients developed the combined CVD end point. Across all interventions, each 10 μm/y reduction of cIMT progression resulted in a relative risk for CVD of 0.91 (95% Credible Interval, 0.87–0.94), with an additional relative risk for CVD of 0.92 (0.87–0.97) being achieved independent of cIMT progression. Taken together, we estimated that interventions reducing cIMT progression by 10, 20, 30, or 40 μm/y would yield relative risks of 0.84 (0.75–0.93), 0.76 (0.67–0.85), 0.69 (0.59–0.79), or 0.63 (0.52–0.74), respectively. Results were similar when grouping trials by type of intervention, time of conduct, time to ultrasound follow-up, availability of individual-participant data, primary versus secondary prevention trials, type of cIMT measurement, and proportion of female patients. Conclusions: The extent of intervention effects on cIMT progression predicted the degree of CVD risk reduction. This provides a missing link supporting the usefulness of cIMT progression as a surrogate marker for CVD risk in clinical trials.

• 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.

• Stensvold, Dorthe; Viken, Hallgeir; Steinshamn, Sigurd Loe; Dalen, Håvard; Støylen, Asbjørn & Loennechen, Jan Pål [Show all 23 contributors for this article] (2020). Effect of exercise training for five years on all cause mortality in older adults-The Generation 100 study: Randomised controlled trial. The BMJ. ISSN 1756-1833. 371. doi: 10.1136/bmj.m3485. Full text in Research Archive
• Aadland, Eivind; Kvalheim, Olav Martin; Hansen, Bjørge Hermann; Kriemler, Susi; Ried-Larsen, Mathias & Wedderkopp, Niels [Show all 12 contributors for this article] (2020). The multivariate physical activity signature associated with metabolic health in children and youth: An International Children's Accelerometry Database (ICAD) analysis. Preventive Medicine. ISSN 0091-7435. 141. doi: 10.1016/j.ypmed.2020.106266. Full text in Research Archive Show summary

  There is solid evidence for an association between physical activity and metabolic health outcomes in children and youth, but for methodological reasons most studies describe the intensity spectrum using only a few summary measures. We aimed to determine the multivariate physical activity intensity signature associated with metabolic health in a large and diverse sample of children and youth, by investigating the association pattern for the entire physical intensity spectrum. We used pooled data from 11 studies and 11,853 participants aged 5.8–18.4 years included in the International Children's Accelerometry Database. We derived 14 accelerometry-derived (ActiGraph) physical activity variables covering the intensity spectrum (from 0–99 to ≥8000 counts per minute). To handle the multicollinearity among these variables, we used multivariate pattern analysis to establish the associations with indices of metabolic health (abdominal fatness, insulin sensitivity, lipid metabolism, blood pressure). A composite metabolic health score was used as the main outcome variable. Associations with the composite metabolic health score were weak for sedentary time and light physical activity, but gradually strengthened with increasing time spent in moderate and vigorous intensities (up to 4000–5000 counts per minute). Association patterns were fairly consistent across sex and age groups, but varied across different metabolic health outcomes. This novel analytic approach suggests that vigorous intensity, rather than less intense activities or sedentary behavior, are related to metabolic health in children and youth.

• 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.

• Aadland, Eivind; Nilsen, Ada Kristine Ofrim; Ylvisåker, Einar; Johannessen, Kjersti & Anderssen, Sigmund Alfred (2020). Reproducibility of objectively measured physical activity: Reconsideration needed. Journal of Sports Sciences. ISSN 0264-0414. 38(10), p. 1132–1139. doi: 10.1080/02640414.2020.1743054. Full text in Research Archive Show summary

  Reliability of accelerometer-determined physical activity (PA), and thus the required length of a monitoring period, appears to depend on the analytic approach used for its calculation. We compared reliability of objectively measured PA using different resolution of data in a sample of 221 Norwegian 2–6-year-old children providing 2–3 valid 14-day periods of accelerometer monitoring (ActiGraph GT3X+) during September–October, January–February, and May–June 2015–2016. Reliability (intra-class correlation [ICC]) was measured for 1–14 days of monitoring across the measurement periods using linear mixed effect modelling. These results were compared to reliability estimated using different resolution of data using the Spearman–Brown formula. The measured reliability improved only marginally with increased monitoring length and levelled off after 5–6 days. Estimated reliability differed substantially when derived from different resolution of data: 3.9–5.4, 6.7–9.2, 13.4–26.7 and 26.3–87.7 days of monitoring was required to achieve an ICC = 0.80 using an hour-by-hour, a day-by-day, a week-by-week and a period-by-period approach, respectively. Reliability could not be correctly estimated from any single resolution of data. We conclude that reconsideration is needed with regard to how reproducibility of objectively measured PA is analysed and interpreted.

• Aadland, Eivind; Tjomsland, Hege Eikeland; Johannessen, Kjersti; Nilsen, Ada Kristine Ofrim; Resaland, Geir Kåre & Glosvik, Øyvind [Show all 18 contributors for this article] (2020). Active Learning Norwegian Preschool(er)s (ACTNOW) – Design of a Cluster Randomized Controlled Trial of Staff Professional Development to Promote Physical Activity, Motor Skills, and Cognition in Preschoolers [Study protocol]. Frontiers in Psychology. ISSN 1664-1078. 11. doi: 10.3389/fpsyg.2020.01382. Full text in Research Archive Show summary

  Introduction: There is a dearth of high-quality evidence on effective, sustainable, and scalable interventions to increase physical activity (PA) and concomitant outcomes in preschoolers. Specifically, there is a need to better understand how the preschool context can be used to increase various types of physically active play to promote holistic child development. The implementation of such interventions requires highly competent preschool staffs, however, the competence in promoting PA is often low. The main aim of the ACTNOW study is therefore to investigate the effects of professional development for preschool staffs on child PA and developmental outcomes. Methods: The study will be conducted in Norway 2019–2022 and is designed as a two-arm (intervention, control) cluster randomized controlled trial (RCT) with 7- and 18-months follow-ups. We aim to recruit 60 preschools and 1,200 3- to 5-years-old children to provide sufficient power to detect effect sizes (ESs) between 0.20 and 0.30. The intervention is nested within two levels: the preschool and the child. Central to the ACTNOW intervention are opportunities for children to engage in a variety of “enriched,” meaningful, and enjoyable physically active play that supports the development of the whole child. To this end, the main intervention is a 7-month professional development/education module for preschool staff, aimed to provide them with the necessary capacity to deliver four core PA components to the children (moderate-to-vigorous PA, motor-challenging PA, cognitively engaging play, and physically active learning). We will include a range of child-level outcomes, including PA, physical fitness, adiposity, motor skills, socioemotional health, self-regulation, executive function, and learning. At the preschool level, we will describe implementation and adaptation processes using quantitative and qualitative data. Discussion: Professional development of staff and a whole-child approach that integrates PA with cognitively engaging play and learning activities in the preschool setting may provide a feasible vehicle to enhance both physical and cognitive development in young children. ACTNOW is designed to test this hypothesis to provide a sustainable way to build human capital and provide an early solution to lifelong public health and developmental challenges.

• Aarsland, Vera Vårin Birkemo; Borda, Miguel Germán; Aarsland, Dag; Garcia-Cifuentes, Elkin; Anderssen, Sigmund Alfred & Tover-Rios, Diego Alejandro [Show all 8 contributors for this article] (2020). Association between physical activity and cognition in Mexican and Korean older adults. Archives of gerontology and geriatrics (Print). ISSN 0167-4943. 89. doi: 10.1016/j.archger.2020.104047. Full text in Research Archive
• Vedøy, Ingeborg Barth; Anderssen, Sigmund Alfred; Tjomsland, Hege Eikeland; Skulberg, Knut Ragnvald & Thurston, Miranda (2020). Physical activity, mental health and academic achievement: a cross-sectional study of Norwegian adolescents. Mental Health and Physical Activity. ISSN 1755-2966. doi: 10.1016/j.mhpa.2020.100322. Full text in Research Archive Show summary

  Background The purpose of this study was to describe associations between physical activity (PA), mental health and academic achievement in a Norwegian adolescent cohort. Methods In total, 1001 adolescents were invited to participate, of whom 599 (54.4% female, mean age ± SD 13.3 ± 0.3y) entered the study. PA was measured objectively using accelerometers, variables on mental health were assessed through an online questionnaire and academic achievement was assessed using grade point average (GPA) collected through school records. The associations between PA, mental health and academic achievement were modelled using multiple linear regression. Results PA was positively associated with mental wellbeing (p ≤ .05), self-perception of athletic competence (p ≤ .001) and self-perception of social acceptance (p ≤ .001). It was not associated with global self-esteem or mental health complaints. No significant association between PA and GPA was found. However, results showed a significant association between PA and grade in physical education among girls (p ≤ .001). Conclusion PA was associated with mental wellbeing and domain specific self-esteem although the causal significance of the association requires further investigation. The current study does not support associations between PA and mental health problems or PA and academic achievement. Further studies are necessary to investigate the longitudinal relationship between PA, variables of mental health and academic achievement amongst adolescents.

• Nilsen, Ada Kristine Ofrim; Anderssen, Sigmund Alfred; Johannessen, Kjersti; Aadland, Katrine Nyvoll; Ylvisåker, Einar & Loftesnes, Jan Morten [Show all 7 contributors for this article] (2020). Bi-directional prospective associations between objectively measured physical activity and fundamental motor skills in children: a two-year follow-up. International Journal of Behavioral Nutrition and Physical Activity. ISSN 1479-5868. 17. doi: 10.1186/s12966-019-0902-6. Full text in Research Archive Show summary

  Background: The direction of the longitudinal relationship between physical activity (PA) and fundamental motor skills (FMS) remains unclear. We evaluated the bi-directional, prospective relationships between intensity-specific physical activity (PA) and domain-specific fundamental motor skills (FMS) over 2 years in children attending preschool at baseline. Methods: A sample of 230 children (mean age at baseline 4.7 yr, 52% boys) from the 'Sogn og Fjordane Preschool Physical Activity Study' was measured 2 years apart. PA was assessed using ActiGraph accelerometers (GT3X+). FMS were evaluated by a test battery guided by the 'Test of Gross Motor Development 3' and the 'Preschooler Gross Motor Quality Scale'. PA outcomes were total PA (TPA [counts per minute]) and intensity specific PA and sedentary behaviour (SED) (min/day). FMS outcomes were locomotor, object control, and balance skills. Linear mixed model adjusting for potential co-variates was used to evaluate the bi-directional prospective associations between these variables, including the moderating effect of sex and age. Results: Baseline total PA, moderate-to-vigorous PA (MVPA), and vigorous PA predicted higher locomotor, object control, and balance skills at follow-up (standardized regression coefficient (β): 0.17 to 0.26, p = 0.002–0.017). Baseline SED predicted lower locomotor skills at follow-up (β: − 0.27, p = 0.012). Baseline light PA did not predict FMS at follow-up. Baseline FMS were not associated with PA or SED at follow-up. Conclusions: MVPA was positively associated with development of FMS in young children. In contrast, FMS were not related to future PA levels. Our results suggest promotion of MVPA is important for FMS development in young children.

• Berntsen, Sveinung; Edvardsen, Elisabeth; Gerbi, Shlomi; Pollestad, Magnhild Louise & Anderssen, Sigmund Alfred (2019). Do obese children achieve maximal heart rate during treadmill running? Sports. ISSN 2075-4663. 7(1). doi: 10.3390/sports7010026. Full text in Research Archive
• 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
• Nilsen, Ada Kristine Ofrim; Anderssen, Sigmund Alfred; Loftesnes, Jan Morten; Johannessen, Kjersti; Ylvisåker, Einar & Aadland, Eivind (2019). The multivariate physical activity signature associated with fundamental motor skills in preschoolers. Journal of Sports Sciences. ISSN 0264-0414. 38(3), p. 264–272. doi: 10.1080/02640414.2019.1694128. Show summary

  Physical activity (PA) is essential for development of fundamental motor skills (FMS) in children, but it is uncertain which PA intensities are most influential. A limitation to current evidence is the reliance on analytic approaches that cannot handle collinearity. The aim of this study was to determine the PA signature related to FMS in preschoolers, by investigating the association pattern for the whole spectrum of PA intensities using multivariate pattern analysis. We used a sample of N = 1081 Norwegian preschoolers (4.7 yr; 52% boys) who provided valid accelerometer (ActiGraph GT3X+) and FMS data (TGMD-3, modified version). We created 33 PA variables (from 0–100 to ≥15,000 counts per minute [cpm]), and used partial least squares regression to analyse the associations between PA and FMS, after controlling for potential covariates. PA was positively associated with locomotor- and object control skills (explained variances for vertical axes; R2 = 9.7% and 3.9%, respectively). The strongest associations were found for PA between 5000–8000 cpm. No association pattern was found for PA and balance skills. This study is the first to determine the multivariate PA intensity signature related to FMS. This approach shows that PA within the vigorous range is strongest related to FMS in preschoolers.

• 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.

• Aadland, Eivind; Andersen, Lars Bo; Anderssen, Sigmund Alfred; Resaland, Geir Kåre & Kvalheim, Olav Martin (2019). Accelerometer epoch setting is decisive for associations between physical activity and metabolic health in children. Journal of Sports Sciences. ISSN 0264-0414. 38(3), p. 256–263. doi: 10.1080/02640414.2019.1693320. Full text in Research Archive Show summary

  When analysing physical activity (PA) levels using accelerometry, the epoch setting is critical to capture intensity-specific PA correctly. The aim of the present study was to investigate the PA intensity signatures related to metabolic health in children using different epoch settings. A sample of 841 Norwegian children (age 10.2 ± 0.3 years; BMI 18.0 ± 3.0; 50% boys) provided data on accelerometry (ActiGraph GT3X+) and several indices of metabolic health (aerobic fitness, abdominal fatness, insulin sensitivity, lipid metabolism, blood pressure) that were used to create a composite metabolic health score. We created intensity spectra from 0–99 to ≥ 10000 counts per minute (cpm) for files aggregated using 1, 10, and 60-second epoch periods and used multivariate pattern analysis to analyse the data. The association patterns with metabolic health differed substantially between epoch settings. The intensity intervals most strongly associated with metabolic health were 7000–8000 cpm for data analysed using 1-second epoch, 5500–6500 cpm for data analysed using 10-second epoch, and 4000–5000 cpm analysed using 60-second epoch. Aggregation of data over different epoch periods has a clear impact on how PA intensities in the moderate and vigorous range are associated with childhood metabolic health.

• 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
• Lerum, Øystein; Bartholomew, John; McKay, Heather; Resaland, Geir Kåre; Tjomsland, Hege Eikeland & Anderssen, Sigmund Alfred [Show all 8 contributors for this article] (2019). Active Smarter Teachers: Primary School Teachers’ Perceptions and Maintenance of a School-Based Physical Activity Intervention. Translational Journal of The American College of Sports Medicine. ISSN 2379-2868. 4(17), p. 141–147. doi: 10.1249/TJX.0000000000000104.
• Aadland, Eivind; Kvalheim, Olav Martin; Anderssen, Sigmund Alfred; Resaland, Geir Kåre & Andersen, Lars Bo (2019). Multicollinear physical activity accelerometry data and associations to cardiometabolic health: Challenges, pitfalls, and potential solutions. International Journal of Behavioral Nutrition and Physical Activity. ISSN 1479-5868. 16. doi: 10.1186/s12966-019-0836-z. Full text in Research Archive Show summary

  Background: The analysis of associations between accelerometer-derived physical activity (PA) intensities and cardiometabolic health is a major challenge due to multicollinearity between the explanatory variables. This challenge has facilitated the application of different analytic approaches within the field. The aim of the present study was to compare association patterns of PA intensities with cardiometabolic health in children obtained from multiple linear regression, compositional data analysis, and multivariate pattern analysis. Methods: A sample of 841 children (age 10.2 ± 0.3 years; BMI 18.0 ± 3.0; 50% boys) provided valid accelerometry and cardiometabolic health data. Accelerometry (ActiGraph GT3X+) data were characterized into traditional (four PA intensity variables) and more detailed categories (23 PA intensity variables covering the intensity spectrum; 0–99 to ≥10,000 counts per minute). Several indices of cardiometabolic health were used to create a composite cardiometabolic health score. Multiple linear regression and multivariate pattern analyses were used to analyze both raw and compositional data. Results: Besides a consistent negative (favorable) association between vigorous PA and the cardiometabolic health measure using the traditional description of PA data, associations between PA intensities and cardiometabolic health differed substantially depending on the analytic approaches used. Multiple linear regression lead to instable and spurious associations, while compositional data analysis showed distorted association patterns. Multivariate pattern analysis appeared to handle the raw PA data correctly, leading to more plausible interpretations of the associations between PA intensities and cardiometabolic health. Conclusions: Future studies should consider multivariate pattern analysis without any transformation of PA data when examining relationships between PA intensity patterns and health outcomes.

• Aadland, Eivind; Kvalheim, Olav Martin; Anderssen, Sigmund Alfred; Resaland, Geir Kåre & Andersen, Lars Bo (2019). The triaxial physical activity signature associated with metabolic health in children. Medicine & Science in Sports & Exercise. ISSN 0195-9131. 51(10), p. 2173–2179. doi: 10.1249/MSS.0000000000002021. Show summary

  Purpose The use of uniaxial summary measures from accelerometry (i.e., counts per minute or minutes spent in moderate-to-vigorous intensity) substantially restricts information about physical activity (PA), and is probably a result of reliance on analytic approaches that cannot handle collinear variables. In the present study, we aimed to determine the multivariate triaxial PA intensity signature related to metabolic health in children, by investigating associations of the whole spectra of PA intensities from all axes using multivariate pattern analysis. Methods We included 841 children (age, 10.2 ± 0.3 yr; body mass index, 18.0 ± 3.0; 50% boys) from the Active Smarter Kids study conducted in Norway 2014 to 2015 providing valid data on accelerometry (ActiGraph GT3X+) and several indices of metabolic health (aerobic fitness, abdominal fatness, insulin sensitivity, lipid metabolism, blood pressure) that were used to create a composite metabolic health score. We created intensity spectra from 0 to 100 to ≥10,000 counts per minute for separate axes and used multivariate pattern analysis to analyze the data. Results The explained variance of metabolic health was 3.2% for counts per minute from the vertical axis, 17.0% for the vertical axis intensity spectrum, and 29.5% for the full model including all axes. Thus, including full triaxial intensity spectra improved the model for metabolic health tenfold compared with using overall PA (counts per minute) from the vertical axis only. The intensity signature associated with metabolic health differed across the axes. Conclusions Our findings show that the three different axes carry distinct information about children’s PA and the relation of PA to their health and demonstrate a great potential for triaxial accelerometry and a multivariate analytic approach to advance the field of PA epidemiology.

• Stavnsbo, Mette; Skrede, Turid; Aadland, Eivind; Aadland, Katrine Nyvoll; Chinapaw, Mai & Anderssen, Sigmund Alfred [Show all 8 contributors for this article] (2019). Cardiometabolic risk factor levels in Norwegian children compared to international reference values: The ASK study. PLOS ONE. ISSN 1932-6203. 14(8). doi: 10.1371/journal.pone.0220239. Full text in Research Archive Show summary

  Objective To investigate cardiometabolic risk factor levels in a group of Norwegian 10-year-old children compared to international values and examine the association between cardiorespiratory fitness (CRF) and the reference-standardized clustered risk score. Methods 913 children (49% girls) were included from the Active Smarter Kids (ASK) study. Body mass index (BMI), waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC) to HDL-C ratio, triglyceride (TG), glucose, insulin, homeostatic model assessment (HOMA) score and CRF, were standardized according to international age-and sex-specific reference values. Results The Norwegian children had significantly more favorable WC, DBP, glucose, HDL-C and CRF levels compared to the international reference values, but similar or less favorable levels of other cardiometabolic risk factors. CRF was the variable that differed the most from the international values (mean (95% CI) 1.20 (1.16 to 1.24) SD). The clustered risk score (excluding CRF) was higher in the Norwegian children, but decreased to below international levels when including CRF (mean (95% CI) - 0.08 (- 0.12 to –0.05) SD). CRF had a significant inverse association with the clustered risk score (excluding CRF) (β - 0.37 SD, 95% CI –0.43 to –0.31). Conclusions Norwegian children have substantially higher CRF levels than international standards, and including CRF in clustered risk scores reduces overall risk in Norwegian children below that of international levels. CRF is associated with improved cardiometabolic health in children.

• 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.

• Brønd, Jan Christian; Aadland, Eivind; Andersen, Lars Bo; Resaland, Geir Kåre; Anderssen, Sigmund Alfred & Arvidsson, Daniel (2019). The ActiGraph counts processing and the assessment of vigorous activity. Clinical Physiology and Functional Imaging. ISSN 1475-0961. 39(4), p. 276–283. doi: 10.1111/cpf.12571. Full text in Research Archive Show summary

  The purpose of this study was to investigate the effect of different band‐pass filters on the measurement bias with ActiGraph counts during high speed running and for estimating free‐living vigorous physical activity (VPA). Two alternative band‐pass filters were designed, extending the original frequency range from 0·29 to 1·66 Hz (AG) to 0·29–4 Hz (AC4) and 0·29–10 Hz (AC10). Sixty‐two subjects in three age groups participated in a structured locomotion protocol consisting of multiple walking and running speeds. The time spent in free‐living VPA using the three different band‐pass filters were evaluated in 1121 children. Band‐pass filter specific intensity cut‐points from both linear regression and ROC analysis was identified from a calibration experiment using indirect calorimetry. The ActiGraph GT3X+ device recording raw acceleration at 30 Hz was used in all experiments. The linear association between counts and running speed was negative for AG but positive for AC4 and AC10 across all age groups. The time spent in free‐living VPA was similar for all band‐pass filters. Considering higher frequency information in the generation of ActiGraph counts with a hip/waist worn device reduces the measurement bias with running above 10 km·h−1. However, additional developments are required to accurately capture all VPA, including intermittent activities.

• Nilsen, Ada Kristine Ofrim; Anderssen, Sigmund Alfred; Resaland, Geir Kåre; Johannessen, Kjersti; Ylvisåker, Einar & Aadland, Eivind (2019). Boys, older children, and highly active children benefit most from the preschool arena regarding moderate-to-vigorous physical activity: A cross-sectional study of Norwegian preschoolers. Preventive Medicine Reports. ISSN 2211-3355. 14. doi: 10.1016/j.pmedr.2019.100837. Full text in Research Archive Show summary

  The preschool environment exerts an important influence on children's behaviour, including physical activity (PA). However, information is lacking regarding where and when most of children's PA is undertaken. This study aimed to describe PA and sedentary time (SED) during preschool hours and time out-of-care, and on weekdays and weekend days, and to investigate differences in PA patterns according to sex, age, and MVPA levels. From September 2015 to June 2016, we measured PA levels of 1109 children (age range, 2.7–6.5 years; mean age 4.7 years; boys, 52%) using ActiGraph GT3X+ accelerometers for up to 14 consecutive days. We applied a linear mixed model to analyse associations and interactions between total PA (counts per minute [cpm]), light PA (LPA), moderate-to-vigorous PA (MVPA), SED, sex, age, and overall MVPA regardless of setting, during preschool hours versus time out-of-care, and on weekdays versus weekend days. Children undertook more PA and less SED on weekdays compared to weekend days (p < 0.01). For boys, MVPA levels were higher during preschool hours than during time out-of-care (p < 0.05). Differences in total PA and MVPA between preschool hours versus time out-of-care, and between weekdays and weekend days, were greater in boys, older children, and highly active children than in girls, younger children, and children with lower overall MVPA levels (p < 0.01). The preschool arena is important for children's PA. Concerning MVPA, this study showed that boys, older children, and highly active children benefit more from this environment compared to girls, younger preschoolers, and children with lower MVPA levels.

• Nilsen, Ada Kristine Ofrim; Anderssen, Sigmund Alfred; Ylvisåker, Einar; Johannessen, Kjersti & Aadland, Eivind (2019). Physical activity among Norwegian preschoolers varies by sex, age, and season. Scandinavian Journal of Medicine & Science in Sports. ISSN 0905-7188. 29(6), p. 862–873. doi: 10.1111/sms.13405. Show summary

  Background: Knowledge of physical activity (PA) in preschool populations is im-portant for public health promotion. We investigated levels of PA in a large sample of Norwegian preschoolers and explored variations and development in PA by sex, age, and season.Methods: Physical activity levels of 1154 children (mean age 4.7 years, 52% boys) were measured by accelerometry (ActiGraph GT3X+) for 14 consecutive days be-tween autumn 2015 and summer 2016. Additionally, 330 children provided up to 3 repeated measurements of PA across seasons. A linear mixed model was applied to analyze associations and interactions of total PA (cpm), light PA (LPA), moderate PA (MPA), vigorous PA (VPA), moderate‐to‐vigorous PA (MVPA), sedentary time (SED), sex, age, and season.Results: Boys and girls spent mean (standard deviation) 72 (21) and 59 (18) min/d in MVPA and had a total PA of 790 (202) and 714 (192) cpm/d, respectively. Boys had higher PA levels than girls, PA increased with age, and PA was higher during spring/summer than autumn/winter (P< 0.001). Boys had a greater increase in PA by age than girls (P< 0.05), mainly due to increased MVPA during spring/summer (p for sex × age × season=0.009).Conclusions: Boys were consistently more active and less sedentary than girls, and PA increased with age for both sexes. Boys exhibited a greater increase than girls in PA by age, and PA differed across seasons, with higher levels of MVPA during spring/summer. Differences in MVPA between boys and girls, among age groups, and among seasons seem to be interrelated, indicating that many factors influence preschoolers’ PA.

• Resaland, Geir Kåre; Aadland, Eivind; Moe, Vegard Fusche; Kolotkin, Ronette L.; Anderssen, Sigmund Alfred & Andersen, John Roger (2019). Effects of a physical activity intervention on schoolchildren's health-related quality of life: The active smarter kids (ASK) cluster-randomized controlled trial. Preventive Medicine Reports. ISSN 2211-3355. 13, p. 1–4. doi: 10.1016/j.pmedr.2018.11.002. Full text in Research Archive Show summary

  We investigated whether a seven-month (November 2014 to June 2015), school-based cluster-randomized controlled physical activity intervention improved health-related quality of life (HRQoL) in 10-year old children. The participants (N = 1229) from 57 elementary schools in Sogn og Fjordane County, Norway, were cluster-randomized by school either to the intervention (I) or control (C) group. The planned intervention in the 28 I-schools was 300 min of physical activity per week, compared to 135 min in the 29C-schools. HRQoL was assessed by self-report, using the Kidscreen-27 questionnaire. Objectively measured physical activity did not differ between the I–schools and C-schools during the intervention. No effect of the intervention was found for HRQoL: Physical well-being (P = 0.789), Psychological well-being (P = 0.682), Autonomy & parents (P = 0.662), Social support & peers (P = 0.828) and School environment (P = 0.074). In conclusion, the ASK school-based physical activity intervention showed no significant effect on HRQoL.

• Resaland, Geir Kåre; Aadland, Eivind; Andersen, John Roger; Bartholomew, J.B.; Anderssen, Sigmund Alfred & Moe, Vegard Fusche (2019). Physical activity preferences of 10‐year‐old children and identified activities with positive and negative associations to cardiorespiratory fitness. Acta Paediatrica. ISSN 0803-5253. 108(2), p. 354–360. doi: 10.1111/apa.14487. Full text in Research Archive Show summary

  Aim: This study investigated children's physical activity (PA) preferences, as these can aid the design of school‐based interventions. Methods: Data were collected in 2014 as a part of the Active Smarter Kids study and 1026 students (52% boys) from 57 Norwegian primary schools completed a questionnaire about their favourite physical activities at a mean age of 10.2 ± 0.3 years. We identified five patterns of PA and studied whether gender, cardiorespiratory fitness and abdominal adiposity were associated with these patterns. Results: Soccer and slalom skiing were the favourite activities, and the most pronounced gender differences were for activities favoured by girls, which included dancing, gymnastics, exercising to music and jumping rope (p < 0.001). When the five component patterns were analysed using linear mixed‐effect models, this showed a strong female preference for dancing, gymnastics, exercising to music and climbing. Cardiovascular fitness was negatively associated with frisbee, dodgeball, baseball and floorball, and positively associated with team handball, volleyball and basketball and with slalom skiing and cross‐country skiing. It was interesting that the children's preferences were not related to their abdominal adiposity. Conclusion: The results showed different gender‐based PA preferences and positive and negative associations with cardiovascular fitness, but no relationship with abdominal adiposity.

• Aadland, Katrine Nyvoll; Ommundsen, Yngvar; Anderssen, Sigmund Alfred; Brønnick, Kolbjørn Selvåg; Moe, Vegard Fusche & Resaland, Geir Kåre [Show all 9 contributors for this article] (2019). Effects of the Active Smarter Kids (ASK) Physical Activity Schoolbased Intervention on Executive Functions: A Cluster-Randomized Controlled Trial. Scandinavian Journal of Educational Research. ISSN 0031-3831. 63(2), p. 214–228. doi: 10.1080/00313831.2017.1336477. Show summary

  The purpose of this study was to examine the effects of a seven-month curriculum prescribed physical activity (PA) intervention (the Active Smarter Kids [ASK] intervention) on executive functions in 10-year-old Norwegian children. A linear mixed model was used to analyze data from 971–1,123 fifth grade children at 28 intervention schools and 29 control schools. The intervention constituted three PA elements: PA educational lessons, PA breaks, and PA homework, adding 165 minutes of PA to the mandatory 135 minutes of PA and physical education. There was no effect of the intervention on executive functions in the intention-to-treat analyses. Per protocol analyses (n = 776–850) revealed small effects of the intervention on the composite score of executive functions, cognitive flexibility, and motor skills. Cognitively engaging and coordinative demanding activities/games seem viable options to increase executive functions and possibly improve academic performance in children.

• Ried-Larsen, Mathias & Anderssen, Sigmund Alfred (2018). Fysisk aktivitet og diabetes type 2. 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. 168–192.
• Anderssen, Sigmund Alfred & Ekelund, Ulf (2018). Anbefalinger for fysisk aktivitet. 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. 55–61.
• Berntsen, Sveinung & Anderssen, Sigmund Alfred (2018). Et historisk blikk på fysisk aktivitet. 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. 21–39.
• 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.

• Aadland, Eivind; Kvalheim, Olav Martin; Anderssen, Sigmund Alfred; Resaland, Geir Kåre & Andersen, Lars Bo (2018). The multivariate physical activity signature associated with metabolic health in children. International Journal of Behavioral Nutrition and Physical Activity. ISSN 1479-5868. 15(77). doi: 10.1186/s12966-018-0707-z. Full text in Research Archive Show summary

  Background: Physical activity is a cornerstone for promoting good metabolic health in children, but it is heavily debated which intensities (including sedentary time) are most influential. A fundamental limitation to current evidence for this relationship is the reliance on analytic approaches that cannot handle collinear variables. The aim of the present study was to determine the physical activity signature related to metabolic health in children, by investigating the association pattern for the whole spectrum of physical activity intensities using multivariate pattern analysis. Methods: We used a sample of 841 children (age 10.2 ± 0.3 years; BMI 18.0 ± 3.0; 50% boys) from the Active Smarter Kids study, who provided valid data on accelerometry (ActiGraph GT3X+) and several indices of metabolic health (aerobic fitness, abdominal fatness, insulin sensitivity, lipid metabolism, blood pressure) that were used to create a composite metabolic health score. We created 16 physical activity variables covering the whole intensity spectrum (from 0–100 to ≥ 8000 counts per minute) and used multivariate pattern analysis to analyze the data. Results: Physical activity intensities in the vigorous range (5000–7000 counts per minute) were most strongly associated with metabolic health. Moderate intensity physical activity was weakly related to health, and sedentary time and light physical activity were not related to health. Conclusions: This study is the first to determine the multivariate physical activity signature related to metabolic health in children across the whole intensity spectrum. This novel approach shows that vigorous physical activity is strongest related to metabolic health. We recommend future studies adapt a multivariate analytic approach to further develop the field of physical activity epidemiology.

• Aadland, Eivind; Andersen, Lars Bo; Ekelund, Ulf; Anderssen, Sigmund Alfred & Resaland, Geir Kåre (2018). Reproducibility of domain-specific physical activity over two seasons in children. BMC Public Health. ISSN 1471-2458. 18(821). doi: 10.1186/s12889-018-5743-8. Full text in Research Archive Show summary

  Background: Knowledge of the reproducibility of domain-specific accelerometer-determined physical activity (PA) estimates are a prerequisite to conduct high-quality epidemiological studies. The aim of this study was to determine the reproducibility of objectively measured PA level in children during school hours, afternoon hours, weekdays, weekend days, and total leisure time over two different seasons. Methods: Six hundred seventy six children from the Active Smarter Kids study conducted in Sogn og Fjordane, Norway, were monitored for 7 days by accelerometry (ActiGraph GT3X+) during January–February and April–May 2015. Reproducibility was estimated week-by-week using intra-class correlation (ICC) and Bland-Altman plots with 95% limits of agreement (LoA). Results: When controlling for season, reliability (ICC) was 0.51–0.66 for a 7-day week, 0.55–0.64 for weekdays, 0.11–0.43 for weekend days, 0.57–0.63 for school hours, 0.42–0.53 for afternoon hours, and 0.42–0.61 for total leisure time. LoA across models approximated a factor of 1.3–2.5 standard deviations of the sample PA levels. 3–6 weeks of monitoring were required to achieve a reliability of 0.80 across all domains but weekend days, which required 5–32 weeks. Conclusion: Reproducibility of PA during leisure time and weekend days were lower than for school hours and weekdays, and estimates were lower when analyzed using a week-by-week approach over different seasons compared to previous studies relying on a single short monitoring period. To avoid type 2-errors, researchers should consider increasing the monitoring period beyond a single 7-day period in future studies.

• Aadland, Eivind; Andersen, Lars Bo; Anderssen, Sigmund Alfred; Resaland, Geir Kåre & Kvalheim, Olav Martin (2018). Associations of volumes and patterns of physical activity with metabolic health in children: A multivariate pattern analysis approach. Preventive Medicine. ISSN 0091-7435. 115, p. 12–18. doi: 10.1016/j.ypmed.2018.08.001. Full text in Research Archive Show summary

  Physical activity (PA) favorably affects metabolic health in children, but it is unclear how total volumes versus patterns (bouts and breaks) of PA relate to health. By means of multivariate pattern analysis that can handle collinear variables, we determined the associations of PA volumes and patterns with children's metabolic health using different epoch settings. A sample of 841 Norwegian children (age 10.2 ± 0.3 years) provided in 2014 data on accelerometry (ActiGraph GT3X+), using epoch settings of 1, 10, and 60 s and several indices of metabolic health used to create a composite metabolic health score. We created 355 PA indices covering the whole intensity and bout duration spectrum, and used multivariate pattern analysis to analyze the data. Findings showed that bouts of PA added information about childhood health beyond total volumes of PA for all epoch settings. Yet, associations of PA patterns with metabolic health were completely dependent on the epoch settings used. Vigorous PA was strongly associated with metabolic health, while associations of light and moderate PA were weak to moderate, and associations of sedentary time with metabolic health was non-existing. Short intermittent bursts of PA were favorably associated with children's metabolic health, whereas associations of prolonged bouts were weak. This study is the first to determine the multivariate physical activity association pattern related to metabolic health in children across the whole PA intensity and bout duration spectrum. The findings challenge our understanding of PA patterns, and are of major importance for the analysis of accelerometry data.

• Kjær, Ingirid Geirsdatter Heald; Anderssen, Sigmund Alfred & Torstveit, Monica Klungland (2018). A tailored telephone and email based exercise intervention induced reductions in various measures of body composition in physically inactive adults: A randomized controlled trial. Preventive Medicine Reports. ISSN 2211-3355. 11, p. 160–168. doi: 10.1016/j.pmedr.2018.06.011. Show summary

  Obesity prevalence has increased the past decades and has become a serious public health problem. The aim of this six-month assessor-blinded, parallel-group randomized controlled trial was to assess the effect of a tailored telephone and email-based exercise intervention on various measures of body composition in a sample of apparently healthy and physically inactive adults. A total of 111 volunteering adults (40–55 yr) in Southern Norway were randomly assigned to an intervention group (IG; n = 39) or a no-information control group (CG; n = 50), by random allocation numbering. The IG received feedback on their health-related physical fitness, information on guidelines and recommendations for physical activity, a leaflet on national dietary recommendations, prompts and reminders in addition to three tailored exercise programs, one every two months, and fortnightly motivational counselling by email or telephone, alternately. The CG received no follow-up during the intervention period. The main outcome measures: weight, body mass index (BMI), waist circumference (WC) and fat percentage by skinfolds (FPskf) were assessed objectively at baseline and posttest. A one-way ANCOVA analysis, adjusted for baseline scores, gender, age, and educational level, revealed a larger reduction on all body compositional measures in the IG compared to the CG (p ≤ 0.043), except for BMI when adjusted for baseline scores. Additionally, a significantly higher percentage of the IG (64.1%) achieved a clinically significant reduction in FPskf compared to the CG (36.2%, p = 0.018). This six-month tailored telephone and email-based exercise intervention induced significant reductions on several measures of body composition in physically inactive adults.

• Skrede, Turid; Aadland, Eivind; Andersen, Lars Bo; Stavnsbo, Mette; Anderssen, Sigmund Alfred & Resaland, Geir Kåre [Show all 7 contributors for this article] (2018). Does cardiorespiratory fitness moderate the prospective association between physical activity and cardiometabolic risk factors in children? International Journal of Obesity. ISSN 0307-0565. 42, p. 1029–1038. doi: 10.1038/s41366-018-0108-z. Show summary

  Background/Objectives: Physical activity (PA) and cardiorespiratory fitness (CRF) are independently associated with reduced cardiometabolic risk in children, and may affect risk through different pathways. This study aims to examine if CRF moderate the prospective association between PA, sedentary time, and cardiometabolic outcomes in 10-year-old children. Subjects/Methods: In total, 718 children of 1129 (drop out n = 7) had valid measures of PA (accelerometry), CRF (the Andersen running test), and a cardiometabolic risk profile measured at baseline and follow-up 7 months later. Cardiometabolic outcomes were systolic blood pressure, waist circumference (WC), total cholesterol, high-density lipoprotein, triglycerides, glucose, and insulin (HOMA-IR). The cardiometabolic risk factors were analysed individually, and as a clustered risk score (z score). A linear mixed model was used to examine the prospective associations between different PA exposures (overall PA, sedentary time, moderate-to-vigorous PA (MVPA), vigorous PA) and cardiometabolic outcomes, including the interaction term PA × CRF in the model to assess moderation by CRF. Results: CRF modified the association for baseline overall PA (P < 0.039) and MVPA (min/day) with clustered cardiometabolic risk at follow-up (P < 0.023). Moreover, CRF modified the association between overall PA and MVPA with HOMA-IR independent of WC (P < 0.022). When stratified by CRF level (median split; high/low), MVPA predicted lower HOMA-IR [MVPA β −0.133 (95% CI: −0.223, −0.043); P = 0.004] and clustered cardiometabolic risk [MVPA β −0.094 (95% CI: −0.169, −0.019); P = 0.014] in children with low CRF, but not among their fitter peers (P > 0.232). There was neither direct association between sedentary time and cardiometabolic risk factors in any analyses, nor moderation by CRF. Conclusion: CRF significantly moderated the prospective association between PA and the clustered cardiometabolic risk, but not for time spent sedentary. The magnitude of association between MVPA and clustered cardiometabolic risk was stronger in children with low CRF, and no associations appeared present in their high-fit peers.

• 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.

• Andersen, Eivind; Holmen, Tom Langerud; Egeland, Jens; Martinsen, Egil Wilhelm; Bigseth, Therese Torgersen & Bang-Kittilsen, Gry [Show all 9 contributors for this article] (2018). Physical activity pattern and cardiorespiratory fitness in individuals with schizophrenia compared with a population-based sample. Schizophrenia Research. ISSN 0920-9964. doi: 10.1016/j.schres.2018.05.038. Full text in Research Archive Show summary

  Objective: Thorough description of objectively assessed physical activity (PA) and sedentary time in people with schizophrenia is lacking, and previous studies comparing PA and cardiorespiratory fitness levels with healthy controls are limited by their small sample size and/or poor methodology. Method: PA, sedentary behavior, and cardiorespiratory fitness level were assessed in 67 adults diagnosed with schizophrenia (EPHAPS study) and compared with a population-based sample of 2809 adults (NPASS study). Results: Fifty-five percent of the participants with schizophrenia had the unhealthy combination of not meeting the PA recommendations and sitting >7.5 h per day compared to 32% in the population-based sample. The PA level was especially low on weekday afternoons and evenings and throughout most of the day on weekends. The peak oxygen uptake for EPHAPS women was on average 23% lower than that for NPASS women, while EPHAPS men achieved on average 34% lower oxygen uptake on the exercise test compared with NPASS men. Conclusion: People with schizophrenia are significantly less physically active, more sedentary, and have a poorer cardiorespiratory fitness level compared with the general population. Tailor-made PA interventions for people with schizophrenia should target their PA and sedentary behavior on afternoons and weekends especially.

• 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.

• Aadland, Eivind; Andersen, Lars Bo; Anderssen, Sigmund Alfred & Resaland, Geir Kåre (2018). A comparison of 10 accelerometer non-wear time criteria and logbooks in children. BMC Public Health. ISSN 1471-2458. 18:323, p. 1–9. doi: 10.1186/s12889-018-5212-4. Full text in Research Archive Show summary

  Background: There are many unresolved issues regarding data reduction algorithms for accelerometry. The choice of criterion for removal of non-wear time might have a profound influence on physical activity (PA) and sedentary time (SED) estimates. The aim of the present study was to compare 10 different non-wear criteria and a log of non-wear periods in 11-year-old children. Methods: Children from the Active Smarter Kids study performed 7-days of hip-worn accelerometer monitoring (Actigraph GT3X+) and logged the number of non-wear periods each day, along with the approximate duration and reason for non-wear. Accelerometers were analyzed using 10 different non-wear criteria: ≥ 10, 20, 30, 45, 60, and 90 min of consecutive zero counts without allowance for interruptions, and ≥60 and 90 min with allowance for 1 and 2 min of interruptions. Results: 891 children provided 5203 measurement days, and reported 1232 non-wear periods ranging from 0 to 3 periods per day: on most days children reported no non-wear periods (77.1% of days). The maximum number of non-wear periods per day was 2 for the 90-min criterion, 3 to 5 for most criteria, 7 for the 20-min criterion, and 20 for the 10-min criterion. The non-wear criteria influenced overall PA (mean values across all criteria: 591 to 649 cpm; 10% difference) and SED time (461 to 539 min/day; 17% difference) estimates, especially for the most prolonged SED bouts. Estimates were similar for time spent in intensity-specific (light, moderate, vigorous, and moderate-to-vigorous) PA, but varied 6–9% among the non-wear criteria for proportions of time spent in intensity-specific PA (% of total wear time). Conclusions: Population level estimates of PA and SED differed between different accelerometer non-wear criteria, meaning that non-wear time algorithms should be standardized across studies to reduce confusion and improve comparability of children’s PA level. Based on the numbers and reasons for non-wear periods, we suggest a 45 or 60-min consecutive zero count-criterion not allowing any interruptions to be applied in future pediatric studies, at least for children older than 10 years. Trial Registration: The study is registered in Clinicaltrials.gov with identification number NCT02132494. Registered 7 April 2014.

• Resaland, Geir Kåre; Moe, Vegard Fusche; Bartholomew, John; Andersen, Lars Bo; McKay, Heather A. & Anderssen, Sigmund Alfred [Show all 7 contributors for this article] (2018). Gender-specific effects of physical activity on children’s academic performance: the Active Smarter Kids cluster randomized controlled trial. Preventive Medicine. ISSN 0091-7435. 106, p. 171–176. doi: 10.1016/j.ypmed.2017.10.034.

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• Torstveit, Monica Klungland; Lohne-Seiler, Hilde; Berntsen, Sveinung & Anderssen, Sigmund Alfred (2018). Fysisk aktivitet og helse: Fra begrepsforståelse til implementering av kunnskap. Cappelen Damm Akademisk. ISBN 9788202568313. 453 p.

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• Mathisen, Therese Fostervold; Anderssen, Sigmund Alfred; Tangen, Marte Kvittum & Brækhus, Leni Aurora (2023). Fysisk aktivitet og forebygging: – Viktig å starte med barna og følge dem gjennom livet. [Internet]. Dagens Medisin.
• 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.
• Jansson, Eva; Wennberg, Patrik; Anderssen, Sigmund Alfred; Ekelund, Ulf; Dohrn, Ing-Mari & Hagströmer, Maria (2022). Recommendations on physical activity and sedentary behaviour. Läkartidningen. ISSN 0023-7205. 119.
• Kjær, Ingirid Geirsdatter Heald; Anderssen, Sigmund Alfred & Torstveit, Monica Klungland (2022). A SIX- MONTH TAILORED TELEPHONE AND EMAIL-BASED EXERCISE INTERVENTION INCREASED PHYSICAL FITNESS IN PHYSICALLY INACTIVE ADULT:A RANDOMIZED CONTROLLED TRIAL.
• Lie, Hanne Cathrine; Anderssen, Sigmund Alfred; Rueegg, Corina Silvia; Raastad, Truls; Grydeland, May & Thorsen, Lene [Show all 21 contributors for this article] (2022). The Physical Activity and Fitness in Childhood Cancer Survivors (PACCS) Study: Protocol for an International Mixed Methods Study. JMIR Research Protocols. ISSN 1929-0748. 11(3). doi: 10.2196/35838. Show summary

  Methods Results Discussion References Abbreviations Copyright Abstract Background: Survivors of childhood cancer represent a growing population with a long life expectancy but high risks of treatment-induced morbidity and premature mortality. Regular physical activity (PA) may improve their long-term health; however, high-quality empirical knowledge is sparse. Objective: The Physical Activity and Fitness in Childhood Cancer Survivors (PACCS) study comprises 4 work packages (WPs) aiming for the objective determination of PA and self-reported health behavior, fatigue, and quality of life (WP 1); physical fitness determination (WP 2); the evaluation of barriers to and facilitators of PA (WP 1 and 3); and the feasibility testing of an intervention to increase PA and physical fitness (WP 4). Methods: The PACCS study will use a mixed methods design, combining patient-reported outcome measures and objective clinical and physiological assessments with qualitative data gathering methods. A total of 500 survivors of childhood cancer aged 9 to 18 years with ≥1 year after treatment completion will be recruited in follow-up care clinics in Norway, Denmark, Finland, Germany, and Switzerland. All participants will participate in WP 1, of which approximately 150, 40, and 30 will be recruited to WP 2, WP3, and WP 4, respectively. The reference material for WP 1 is available from existing studies, whereas WP 2 will recruit healthy controls. PA levels will be measured using ActiGraph accelerometers and self-reports. Validated questionnaires will be used to assess health behaviors, fatigue, and quality of life. Physical fitness will be measured by a cardiopulmonary exercise test, isometric muscle strength tests, and muscle power and endurance tests. Limiting factors will be identified via neurological, pulmonary, and cardiac evaluations and the assessment of body composition and muscle size. Semistructured, qualitative interviews, analyzed using systematic text condensation, will identify the perceived barriers to and facilitators of PA for survivors of childhood cancer. In WP 4, we will evaluate the feasibility of a 6-month personalized PA intervention with the involvement of local structures. Results: Ethical approvals have been secured at all participating sites (Norwegian Regional Committee for Medical Research Ethics [2016/953 and 2018/739]; the Oslo University Hospital Data Protection Officer; equivalent institutions in Finland, Denmark [file H-19032270], Germany, and Switzerland [Ethics Committee of Northwestern and Central Switzerland, project ID: 2019-00410]). Data collection for WP 1 to 3 is complete. This will be completed by July 2022 for WP 4. Several publications are already in preparation, and 2 have been published. Conclusions: The PACCS study will generate high-quality knowledge that will contribute to the development of an evidence-based PA intervention for young survivors of childhood cancer to improve their long-term care and health. We will identify physiological, psychological, and social barriers to PA that can be targeted in interventions with immediate benefits for young survivors of childhood cancer in need of rehabilitation.

• Aadland, Katrine Nyvoll; Aadland, Eivind; Tjomsland, Hege Eikeland; Johannessen, Kjersti; Nilsen, Ada Kristine Ofrim & Resaland, Geir Kåre [Show all 18 contributors for this article] (2020). Visste du at barnehagelærarar i Sogn og Fjordane utviklar modellar for fysisk aktivitet i barnehagen? .
• Kjær, Ingirid Geirsdatter Heald; Anderssen, Sigmund Alfred; Hansen, Bjørge Hermann & Torstveit, Monica Klungland (2020). A six- month tailored telephone- and email-based exercise intervention increased physical activity levels among inactive adults: A randomized controlled trial.
• Aadland, Eivind; Anderssen, Sigmund Alfred & Andersen, Lars Bo (2018). The multivariate physical activity signature associated with metabolic health in children.
• Jones, Paul Remy; Kvalheim, Olav Martin; Resaland, Geir Kåre; Anderssen, Sigmund Alfred & Ekelund, Ulf (2018). Lipoprotein subclasses and their associations with physical activity and sedentary time in Norwegian schoolchildren: The Active Smarter Kids study. Journal of Physical Activity and Health. ISSN 1543-3080. 15(10), p. 109–110.
• Aadland, Eivind; Kvalheim, Olav Martin; Anderssen, Sigmund Alfred; Resaland, Geir Kåre & Andersen, Lars Bo (2018). The multivariate physical activity signature associated with metabolic health in children. Journal of Physical Activity and Health. ISSN 1543-3080. 15(10), p. 248–249.
• Aadland, Eivind; Andersen, Lars Bo; Anderssen, Sigmund Alfred; Resaland, Geir Kåre & Kvalheim, Olav Martin (2018). Associations for volumes and patterns of physical activity with metabolic health in children: a multivariate pattern analysis approach. Preventive Medicine. ISSN 0091-7435.
• Nilsen, Ada Kristine Ofrim; Anderssen, Sigmund Alfred; Johannessen, Kjersti; Ylvisåker, Einar & Aadland, Eivind (2018). Boys, older children and highly active children accumulates more MVPA during preschool hours, than girls, younger children and less active children. Results from Sogn og Fjordane Preschool Physical Activity Study– A cross-sectional study of Norwegian pre-schoolers. .
• Vedøy, Ingeborg Barth; Anderssen, Sigmund Alfred; Tjomsland, Hege Eikeland; Skulberg, Knut Ragnvald & Thurston, Miranda (2017). Fysisk aktivitet, psykisk helse of skoleprestasjoner blant ungdomsskoleelever. .
• Stavnsbo, Mette; Resaland, Geir Kåre; Anderssen, Sigmund Alfred; Domazet, SL; Skrede, Turid & Kriemler, S [Show all 10 contributors for this article] (2017). Referanse verdier for kardiometabolske risikovariabler for barn og ungdommer.
• Lerum, Øystein; Aadland, Eivind; Andersen, Lars Bo; Anderssen, Sigmund Alfred & Resaland, Geir Kåre (2017). Validity of noninvasive composite scores to assess cardiovascular risk in ten-year-old children.
• 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.

• Mandelid, Mathias Brekke; Dyngeland, Espen Søreide; Stokke, Rasmus; Wergeland, Tom Christian; Sandal, Marion Østenstad & Stein, Hege [Show all 25 contributors for this article] (2023). Senter for fysisk aktiv læring: Sluttrapport 2018-2023. Høgskulen på Vestlandet. Full text in Research Archive
• 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.
• Kjær, Ingirid Geirsdatter Heald; Torstveit, Monica Klungland & Anderssen, Sigmund Alfred (2019). Health-related physical fitness - Status of body composition, musculoskeletal and neuromotor fitness, and the effect of a tailored, telephone and email based exercise intervention on body composition and physical fitness. Norwegian School of Sport Sciences. ISSN 978-82-502-0566-6.

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