Ulf Ekelund

• Jalanko, Petri; Bond, Bert; Laukkanen, Jari A.; Brage, Søren Karl; Ekelund, Ulf & Laitinen, Tomi [Show all 10 contributors for this article] (2024). Association between arterial health and cognition in adolescents: The PANIC study. Physiological Reports. ISSN 2051-817X. 12(9). doi: 10.14814/phy2.16024.
• Martinez-Gomez, David; Rodriguez-Artalejo, Fernando; Ding, Ding; Ekelund, Ulf & Cabanas-Sanchez, Veronica (2024). Trends in the association between meeting the physical activity guidelines and risk of mortality in US adults. Progress in cardiovascular diseases. ISSN 0033-0620. doi: 10.1016/j.pcad.2024.02.011.
• Zou, Liye; Herold, Fabian; Cheval, Boris; Wheeler, Michael J.; Pindus, Dominika M. & Erickson, Kirk I. [Show all 16 contributors for this article] (2024). Sedentary behavior and lifespan brain health. Trends in Cognitive Sciences. ISSN 1364-6613. 28(4), p. 369–382. doi: 10.1016/j.tics.2024.02.003.
• Husøy, Anders; Kolle, Elin; Steene-Johannessen, Jostein; Dalene, Knut Eirik; Andersen, Lars Bo & Ekelund, Ulf [Show all 7 contributors for this article] (2024). Longitudinal changes in device-measured physical activity from childhood to young adulthood: the PANCS follow-up study. International Journal of Behavioral Nutrition and Physical Activity. ISSN 1479-5868. 21(1). doi: 10.1186/s12966-024-01578-7.
• Ahmadi, Matthew N.; Blodgett, Joanna M.; Atkin, Andrew J; Chan, Hsiu-Wen; del Pozo Cruz, Borja & Suorsa, Kristin [Show all 24 contributors for this article] (2024). Relationship of device measured physical activity type and posture with cardiometabolic health markers: pooled dose–response associations from the Prospective Physical Activity, Sitting and Sleep Consortium. Diabetologia. ISSN 0012-186X. doi: 10.1007/s00125-024-06090-y.
• Wendt, Andrea; Bielemann, Renata Moraes; Wehrmeister, Fernando C.; Ricardo, Luiza I.C.; de Andrade Müller, Werner & Machado, Adriana Kramer Fiala [Show all 12 contributors for this article] (2024). Is rest-activity rhythm prospectively associated with all-cause mortality in older people regardless of sleep and physical activity level? The ‘Como Vai?’ Cohort study. PLOS ONE. ISSN 1932-6203. 19(2). doi: 10.1371/journal.pone.0298031.
• Nordlund, David; Lav, Theodor; Jablonowski, Robert; Khoshnood, Ardavan; Ekelund, Ulf & Atar, Dan [Show all 9 contributors for this article] (2024). Contractility, ventriculoarterial coupling, and stroke work after acute myocardial infarction using CMR-derived pressure-volume loop data. Clinical Cardiology. ISSN 0160-9289. 47(1). doi: 10.1002/clc.24216.
• Lundin, Magnus; Heiberg, Einar; Nordlund, David; Gyllenhammar, Tom; Steding-Ehrenborg, Katarina & Engblom, Henrik [Show all 26 contributors for this article] (2023). Prognostic utility and characterization of left ventricular hypertrophy using global thickness. Scientific Reports. ISSN 2045-2322. 13(1). doi: 10.1038/s41598-023-48173-7. Full text in Research Archive
• Dalene, Knut Eirik & Ekelund, Ulf (2023). Assessment of physical activity behaviours: methods, levels, and time trends. In Armstrong, Neil & van Mechelen, Willem (Ed.), Oxford Textbook of Children’s Sport and Exercise Medicine. Fourth Edition. Oxford University Press. ISSN 9780191926556.
• Tarp, Jakob; Luo, Mengyun; Sanchez-Lastra, Miguel Adriano; Dalene, Knut Eirik; Del Pozo Cruz, Borja & Ried-Larsen, Mathias [Show all 9 contributors for this article] (2023). Leisure-time physical activity and all-cause mortality and cardiovascular disease in adults with type 2 diabetes: Cross-country comparison of cohort studies. Journal of Sport and Health Science. ISSN 2095-2546. 13(2), p. 212–221. doi: 10.1016/j.jshs.2023.10.004. Show summary

  Background: This study aimed to quantify the dose–response association and the minimal effective dose of leisure-time physical activity (PA) to prevent mortality and cardiovascular disease in adults with type 2 diabetes. Methods: Cross-country comparison of 2 prospective cohort studies including 14,913 and 17,457 population-based adults with type 2 diabetes from the UK and China. Baseline leisure-time PA was self-reported and categorized by metabolic equivalent hours per week (MET-h/week) according to World Health Organization recommendations: none, below recommendation (>0–7.49 MET-h/week); at recommended level (7.5–14.9 MET-h/week); above recommendation (≥15 MET-h/week). Mortality and cardiovascular disease data were obtained from national registries. Results: During a median follow-up of 12.4 and 9.7 years, higher levels of leisure-time PA were inversely associated with all-cause (1571 and 2351 events) and cardiovascular mortality (392 and 1060 events) in both cohorts, mostly consistent with a linear dose–response relationship. PA below, at, and above recommendations, compared with no activity, yielded all-cause mortality hazard ratios of 0.94 (95% confidence interval (95%CI): 0.79–1.12), 0.90 (95%CI: 0.74–1.10), and 0.85 (95%CI: 0.70–1.02) in British adults and 0.87 (95%CI: 0.68–1.10), 0.88 (95%CI: 0.74–1.03), and 0.77 (95%CI: 0.70–0.85) in Chinese adults. Associations with cardiovascular mortality were more pronounced in British adults (0.80 (95%CI: 0.58–1.11), 0.75 (95%CI: 0.52–1.09), and 0.69 (95%CI: 0.48–0.97)) but less pronounced in Chinese adults (1.06 (95%CI: 0.76–1.47), 1.01 (95%CI: 0.80–1.28), and 0.79 (95%CI: 0.69–0.92)). PA at recommended levels was not associated with lower rates of major adverse cardiovascular events (2345 and 4458 events). Conclusion: Leisure-time PA at the recommended levels was not convincingly associated with lower mortality and had no association with risk of major adverse cardiovascular events in British or Chinese adults with type 2 diabetes. Leisure-time PA above current recommendations may be needed to prevent cardiovascular disease and premature mortality in adults with type 2 diabetes.

• Sanchez-Lastra, Miguel Adriano; Ding, Ding; Del Pozo Cruz, Borja; Dalene, Knut Eirik; Ayán, Carlos & Ekelund, Ulf [Show all 7 contributors for this article] (2023). Joint associations of device-measured physical activity and abdominal obesity with incident cardiovascular disease: a prospective cohort study. British Journal of Sports Medicine. ISSN 0306-3674. 58(4), p. 196–203. doi: 10.1136/bjsports-2023-107252. Full text in Research Archive Show summary

  Objective: To examine the joint associations between physical activity and abdominal obesity with the risk of cardiovascular disease (CVD) events. Methods: We included 70 830 UK Biobank participants (mean age±SD=61.6 ± 7.9 years; 56.4% women) with physical activity measured by wrist-worn accelerometers and without major chronic diseases. Participants were jointly categorised into six groups based on their physical activity level (tertiles of total volume and specific intensity levels) and presence or absence of abdominal obesity based on measured waist circumference. Associations with incident CVD (fatal and non-fatal events) were determined using proportional subdistribution hazard models with multivariable adjustment. Results: After excluding events during the first 2 years of follow-up, participants were followed for a median of 6.8 years, during which 2795 CVD events were recorded. Compared with the low abdominal adiposity and highest tertile of physical activity, abdominal obesity was associated with higher risk of incident CVD, especially in those with low levels of vigorous-intensity physical activity (HR 1.42, 95% CI 1.22 to 1.64). Approximately 500 min per week of moderate-to-vigorous intensity and approximately 30–35 min of vigorous-intensity physical activity offset the association of abdominal obesity and the risk of having a CVD event. Conclusion: Physical activity equivalent to approximately 30–35 min of vigorous intensity per week appears to offset the association between abdominal obesity and incident CVD. About 15 times more physical activity of at least moderate intensity is needed to achieve similar results.

• Blodgett, Joanna M.; Ahmadi, Matthew N.; Atkin, Andrew J.; Chastin, Sebastian; Chan, Hsiu-Wen & Suorsa, Kristin [Show all 29 contributors for this article] (2023). Device-measured physical activity and cardiometabolic health: the Prospective Physical Activity, Sitting, and Sleep (ProPASS) consortium. European Heart Journal. ISSN 0195-668X. 45(6), p. 458–471. doi: 10.1093/eurheartj/ehad717. Full text in Research Archive Show summary

  Background and Aims: Physical inactivity, sedentary behaviour (SB), and inadequate sleep are key behavioural risk factors of cardiometabolic diseases. Each behaviour is mainly considered in isolation, despite clear behavioural and biological interdependencies. The aim of this study was to investigate associations of five-part movement compositions with adiposity and cardiometabolic biomarkers. Methods: Cross-sectional data from six studies (n = 15 253 participants; five countries) from the Prospective Physical Activity, Sitting and Sleep consortium were analysed. Device-measured time spent in sleep, SB, standing, light-intensity physical activity (LIPA), and moderate-vigorous physical activity (MVPA) made up the composition. Outcomes included body mass index (BMI), waist circumference, HDL cholesterol, total:HDL cholesterol ratio, triglycerides, and glycated haemoglobin (HbA1c). Compositional linear regression examined associations between compositions and outcomes, including modelling time reallocation between behaviours. Results: The average daily composition of the sample (age: 53.7 ± 9.7 years; 54.7% female) was 7.7 h sleeping, 10.4 h sedentary, 3.1 h standing, 1.5 h LIPA, and 1.3 h MVPA. A greater MVPA proportion and smaller SB proportion were associated with better outcomes. Reallocating time from SB, standing, LIPA, or sleep into MVPA resulted in better scores across all outcomes. For example, replacing 30 min of SB, sleep, standing, or LIPA with MVPA was associated with −0.63 (95% confidence interval −0.48, −0.79), −0.43 (−0.25, −0.59), −0.40 (−0.25, −0.56), and −0.15 (0.05, −0.34) kg/m2 lower BMI, respectively. Greater relative standing time was beneficial, whereas sleep had a detrimental association when replacing LIPA/MVPA and positive association when replacing SB. The minimal displacement of any behaviour into MVPA for improved cardiometabolic health ranged from 3.8 (HbA1c) to 12.7 (triglycerides) min/day. Conclusions: Compositional data analyses revealed a distinct hierarchy of behaviours. Moderate-vigorous physical activity demonstrated the strongest, most time-efficient protective associations with cardiometabolic outcomes. Theoretical benefits from reallocating SB into sleep, standing, or LIPA required substantial changes in daily activity.

• Ekelund, Ulf; Sanchez-Lastra, Miguel Adriano; Dalene, Knut Eirik & Tarp, Jakob (2023). Dose–response associations, physical activity intensity and mortality risk: A narrative review. Journal of Sport and Health Science. ISSN 2095-2546. 13(1), p. 24–29. doi: 10.1016/j.jshs.2023.09.006. Full text in Research Archive
• Sagelv, Edvard Hamnvik; Dalene, Knut Eirik; Eggen, Anne Elise; Ekelund, Ulf; Fimland, Marius Steiro & Heitmann, Kim Arne [Show all 11 contributors for this article] (2023). Occupational physical activity and risk of mortality in women and men: the Tromsø Study 1986–2021. British Journal of Sports Medicine. ISSN 0306-3674. 58(2), p. 81–88. doi: 10.1136/bjsports-2023-107282. Full text in Research Archive
• Sagelv, Edvard Hamnvik; Hopstock, Laila Arnesdatter; Morseth, Bente; Hansen, Bjørge Hermann; Steene-Johannessen, Jostein & Johansson, Jonas Lars [Show all 12 contributors for this article] (2023). Device-measured physical activity, sedentary time, and risk of all-cause mortality: an individual participant data analysis of four prospective cohort studies. British Journal of Sports Medicine. ISSN 0306-3674. 57(22), p. 1457–1463. doi: 10.1136/bjsports-2022-106568. Full text in Research Archive
• Zarbo, Cristina; Rota, Matteo; Calza, Stefano; Crouter, Scott E; Ekelund, Ulf & Barlati, Stefano [Show all 17 contributors for this article] (2023). Ecological monitoring of physical activity, emotions and daily life activities in schizophrenia: The DiAPAson study. BMJ Mental Health. ISSN 2755-9734. 26(1). doi: 10.1136/bmjment-2023-300836.
• de Oliveira, Arão Belitardo; Katzmarzyk, Peter T.; Dantas, Wagner Silva; Benseñor, Isabela Judith Martins; Goulart, Alessandra de Carvalho & Ekelund, Ulf (2023). Profile of leisure-time physical activity and sedentary behavior in adults in Brazil: a nationwide survey, 2019. Epidemiologia e Serviços de Saúde. ISSN 1679-4974. 32(2). doi: 10.1590/S2237-96222023000200016. Show summary

  Objectives: to estimate the prevalence of leisure-time physical activity and sedentary behavior in adults in Brazil. Methods: this was a cross-sectional, population-based study carried out in a sample of 88,531 Brazilians, using data from the 2019 National Health Survey; leisure-time physical activity (overall and aerobic exercise) was measured according to the World Health Organization guidelines; the weighted prevalence and respective 95% confidence intervals (95%CI) of physical activity, physical inactivity and sedentary behavior were estimated. Results: according to the selected sample, 26.4% (95%CI 25.9;27.1) of Brazilian adults were physically active, 14.0% (95%CI 13.5;14.4) were insufficiently physically active and 59.5% (95%CI 58.8;60.2) were physically inactive; sedentary behavior ≥ 6 hours was reported by 30.1% (95%CI 29.5;30.8) of the population; only 8.6% (95%CI 8.2;8.9) met the recommendations for muscle-strengthening activities. Conclusion: most Brazilian adults were physically inactive and did not meet international recommendations for leisure-time physical activity and reduction in sedentary behavior.

• Kristensen, Frederik Pagh Bredahl; Sanchez-Lastra, Miguel Adriano; Dalene, Knut Eirik; Del Pozo Cruz, Borja; Ried-Larsen, Mathias & Thomsen, Reimar Wernich [Show all 9 contributors for this article] (2023). Leisure-Time Physical Activity and Risk of Microvascular Complications in Individuals With Type 2 Diabetes: A UK Biobank Study. Diabetes Care. ISSN 0149-5992. 46(10), p. 1816–1824. doi: 10.2337/dc23-0937. Show summary

  OBJECTIVE: The aim of this study was to determine dose-response associations, including the minimal effective level, between leisure-time physical activity and risk of incident neuropathy, nephropathy, and retinopathy. RESEARCH DESIGN AND METHODS: This cohort study included 18,092 individuals with type 2 diabetes from the UK Biobank. Self-reported leisure-time physical activity was converted into MET-hours per week. Participants were categorized into no physical activity (0 MET-h/week), below recommendations (0–7.49 MET-h/week), at recommendations (7.5–14.9 MET-h/week), and above recommendations (≥15 MET-h/week). Microvascular complications were identified from hospital inpatient records using diagnosis codes. We used Cox proportional hazards regression analysis to calculate adjusted hazard ratios (aHRs) and restricted cubic splines to identify the minimal effective level of physical activity. RESULTS: During a median follow-up of 12.1 years, 672 individuals (3.7%) were diagnosed with neuropathy, 1,839 (10.2%) with nephropathy, and 2,099 (11.7%) with retinopathy. Any level of physical activity was associated with a lower risk of neuropathy and nephropathy but not retinopathy. Compared with those reporting no physical activity, the aHR of neuropathy was 0.71 (95% CI 0.53, 0.90) below recommendations, 0.73 (0.56, 0.96) at recommendations, and 0.67 (0.52, 0.87) above recommendations. Corresponding aHRs for nephropathy were 0.79 (0.68, 0.92), 0.80 (0.67, 0.95), and 0.80 (0.68, 0.95). The association with retinopathy was weaker, with aHRs of 0.91 (0.78, 1.06), 0.91 (0.77, 1.08), and 0.98 (0.84, 1.15), respectively. CONCLUSIONS: Any level of leisure-time physical activity was associated with a lower risk of neuropathy and nephropathy but not retinopathy in individuals with type 2 diabetes. For both neuropathy and nephropathy, the minimal effective physical activity level may correspond to <1.5 h of walking per week.

• Stamatakis, Emmanuel; Ahmadi, Matthew N.; Friedenreich, Christine M.; Blodgett, Joanna M.; Koster, Annemarie & Holtermann, Andreas [Show all 13 contributors for this article] (2023). Vigorous Intermittent Lifestyle Physical Activity and Cancer Incidence Among Nonexercising Adults: The UK Biobank Accelerometry Study. JAMA Oncology. ISSN 2374-2437. 9(9), p. 1255–1259. doi: 10.1001/jamaoncol.2023.1830. Full text in Research Archive Show summary

  IMPORTANCE Vigorous physical activity (VPA) is a time-efficient way to achieve recommended physical activity (PA) for cancer prevention, although structured longer bouts of VPA (via traditional exercise) are unappealing or inaccessible to many individuals. OBJECTIVES To evaluate the dose-response association of device-measured daily vigorous intermittent lifestyle physical activity (VILPA) with incident cancer, and to estimate the minimal dose required for a risk reduction of 50% of the maximum reduction. DESIGN, SETTING, AND PARTICIPANTS This was a prospective cohort analysis of 22 398 self-reported nonexercising adults from the UK Biobank accelerometry subsample. Participants were followed up through October 30, 2021 (mortality and hospitalizations), or June 30, 2021 (cancer registrations). EXPOSURES Daily VILPA of up to 1 and up to 2 minutes, assessed by accelerometers worn on participants’ dominant wrist. MAIN OUTCOMES AND MEASURES Incidence of total cancer and PA-related cancer (a composite outcome of 13 cancer sites associated with low PA levels). Hazard ratios and 95% CIs were estimated using cubic splines adjusted for age, sex, education level, smoking status, alcohol consumption, sleep duration, fruit and vegetable consumption, parental cancer history, light- and moderate-intensity PA, and VPA from bouts of more than 1 or 2 minute(s), as appropriate. RESULTS The study sample comprised 22 398 participants (mean [SD] age, 62.0 [7.6] years; 10 122 [45.2%] men and 12 276 [54.8%] women; 21 509 [96.0%] White individuals). During a mean (SD) follow-up of 6.7 (1.2) years (149 650 person-years), 2356 total incident cancer events occurred, 1084 owing to PA-related cancer. Almost all (92.3%) of VILPA was accrued in bouts of up to 1 minute. Daily VILPA duration was associated with outcomes in a near-linear manner, with steeper dose-response curves for PA-related cancer than total cancer incidence. Compared with no VILPA, the median daily VILPA duration of bouts up to 1 minute (4.5 minutes per day) was associated with an HR of 0.80 (95% CI, 0.69-0.92) for total cancer and 0.69 (95% CI, 0.55-0.86) for PA-related cancer. The minimal dose was 3.4 minutes per day for total (HR, 0.83; 95% CI, 0.73-0.93) and 3.7 minutes for PA-related (HR, 0.72; 95% CI, 0.59-0.88) cancer incidence. Findings were similar for VILPA bout of up to 2 minutes. CONCLUSIONS AND RELEVANCE The findings of this prospective cohort study indicate that small amounts of VILPA were associated with lower incident cancer risk. Daily VILPA may be a promising intervention for cancer prevention in populations not able or motivated to exercise in leisure time.

• Halsey, Lewis G.; Careau, Vincent; Ainslie, Philip N.; Alemán-Mateo, Heliodoro; Andersen, Lene Frost & Anderson, Liam J. [Show all 110 contributors for this article] (2023). Greater male variability in daily energy expenditure develops through puberty. Biology Letters. ISSN 1744-9561. 19(9). doi: 10.1098/rsbl.2023.0152. Full text in Research Archive
• Amaral de Andrade Leão, Otávio; Flores, Thaynã Ramos; Barratt, Jaime; Bertoldi, Andréa Dâmaso; Domingues, Marlos Rodrigues & Cairney, John [Show all 10 contributors for this article] (2023). Bi-directional associations between physical activity and growth indicators of pre-school aged children. Journal of Sports Sciences. ISSN 0264-0414. 41(8), p. 766–773. doi: 10.1080/02640414.2023.2240167. Show summary

  Physical activity for young children provides a wealth of benefits for health and development. However, little is known about the inter-relationship of physical activity and growth indicators. The aim of this study was to test the bi-directional associations of physical activity and growth indicators in children under five years of age. This prospective study included 1,575 children with data on physical activity and growth indicators at ages 12, 24 and 48 months. Accelerometers were used to measure physical activity. Z-scores for length/height-for-age, weight-for-length/height, weight-for-age and body mass index (BMI)-for-age were calculated. Bi-directional associations between physical activity and growth indicators were evaluated using cross-lagged panels based on Generalized Estimating Equations and cross-lagged structural equation models. Physical activity was consistently associated with lower weight-related growth indicators: BMI-for-age: β=-0.12; Weight-for-age: β=-0.11; Weight-for-length/height: β=-0.12. Higher BMI-for-age indicated lower physical activity (β=-0.06). When the exposure was lagged, the association of physical activity on weight-related growth indicators remained, but weight-related growth indicators showed a negative association on physical activity. A bi-directional association between physical activity and weight-related growth indicators was observed. The magnitude of associations were stronger when physical activity was modelled as exposure. These results reinforce the importance of physical activity since early years.

• Tornquist, Debora; Crochemore-Silva, Inácio; Tornquist, Luciana; Mielke, Grégore I; Ekelund, Ulf & Murray, Joseph [Show all 7 contributors for this article] (2023). Trajectories of Device-Measured Physical Activity During Early Childhood and Its Determinants: Findings From the 2015 Pelotas (Brazil) Birth Cohort Study. Journal of Physical Activity and Health. ISSN 1543-3080. 20(9), p. 840–849. doi: 10.1123/jpah.2022-0608. Show summary

  Background: The objective was to describe trajectories of physical activity (PA) measured by accelerometry during early childhood and to test associations with sociodemographic, gestational, maternal, and perinatal determinants. Methods: Data from 1798 children from the 2015 Pelotas (Brazil) Birth Cohort were analyzed. PA was measured with wrist accelerometers at 1, 2, and 4 years. PA trajectories were estimated using group-based trajectory modeling, and associations with determinants were tested using Poisson regression with robust variance. Results: Two trajectories were identified: Moderate and high PA, both showing a linear increase in PA in the first years but differing in volume. Girls (prevalence ratio [PR]: 0.91; 95% confidence interval [CI], 0.88–0.94), highly educated mothers (PR: 0.93; 95% CI, 0.88–0.97), and high birth weight children (PR: 0.91; 95% CI, 0.85–0.97) showed less probability of high PA trajectory. Birth order ≥3 (PR: 1.06; 95% CI, 1.01–1.11) was associated with higher likelihood of high PA trajectory. Conclusions: Children showed an increase in PA during the first years, with 2 trajectories that differ in PA levels. Female sex, high maternal schooling, and high birth weight reduced the probability of having a high PA trajectory, while higher birth order increased this probability. These characteristics should be considered when planning PA interventions for children in early childhood.

• Naveed, Sehrish; Sallinen, Taisa; Eloranta, Aino-Maija; Skog, Hannamari; Jalkanen, Henna & Brage, Søren Karl [Show all 11 contributors for this article] (2023). Effects of 2-year dietary and physical activity intervention on cognition in children—a nonrandomized controlled trial. Scandinavian Journal of Medicine & Science in Sports. ISSN 0905-7188. 33(11), p. 2340–2350. doi: 10.1111/sms.14464. Full text in Research Archive Show summary

  Background and Objective: We investigated the effects of a combined dietary and PA intervention on cognition in children and whether changes in diet quality, PA, sedentary behavior (SB), and sedentary time (ST) are associated with changes in cognition. Methods: We conducted a 2-year nonrandomized controlled trial in 504 children aged 6–9 years at baseline. The children were allocated to a combined dietary and PA intervention group (n = 237) or a control group (n = 160) without blinding. Interventions: The children and their parents allocated to the intervention group had six dietary counseling sessions of 30–45 min and six PA counseling sessions of 30–45 min during the 2-year intervention period. The children were also encouraged to participate in after-school exercise clubs. Cognition was assessed by the Raven's Colored Progressive Matrices. We assessed dietary factors by 4 days food records and computed the Baltic Sea Diet Score (BSDS) as a measure of diet quality. PA and ST were assessed by a combined heart rate and body movement monitor, types of PA and SB by a questionnaire. Results: The intervention had no effect on cognition. Increased BSDS and consumption of low-fat milk and decreased consumption of red meat and sausages were associated with improved cognition over 2 years. Increased organized sports, ST, and reading were positively, while unsupervised PA, computer use, and writing were negatively associated with cognition. Conclusion: Combined dietary and PA intervention had no effect on cognition. Improved diet quality and increased organized sports and reading were associated with improved cognition.

• Mielke, Gregore Iven; de Almeida Mendes, Márcio; Ekelund, Ulf; Rowlands, Alex V.; Reichert, Felipe Fossati & Crochemore-Silva, Inacio (2023). Absolute intensity thresholds for tri-axial wrist and waist accelerometer-measured movement behaviors in adults. Scandinavian Journal of Medicine & Science in Sports. ISSN 0905-7188. 33(9), p. 1752–1764. doi: 10.1111/sms.14416. Full text in Research Archive Show summary

  Aim: This study was aimed to: (1) compare raw triaxial acceleration data from GENEActiv (GA) and ActiGraph GT3X+ (AG) placed on the non-dominant wrist; (2) compare AG placed on the non-dominant and dominant wrist, and waist; (3) derive brand- and placement-specific absolute intensity thresholds for inactive and sedentary time, and physical activity intensity in adults. Methods: Eighty-six adults (44 men; 34.6 ± 10.8 years) performed nine activities while simultaneously wearing GA and AG on wrist and waist. Acceleration (in gravitational equivalent units; mg) was compared with oxygen uptake (measured with indirect calorimetry). Results: Increases in acceleration mirrored increases in intensity of activities, regardless of device brand and placement. Differences in acceleration between GA and AG worn at the non-dominant wrist were small but tended to be high at lower intensity activities. Thresholds for differentiating inactivity (<1.5 MET) from activity (≥1.5 MET) ranged from 25 mg (AG non-dominant wrist; sensitivity 93%, specificity 95%) to 40 mg (AG waist; sensitivity 78%, specificity 100%). For moderate intensity (≥3 METs), thresholds ranged from 65 mg (AG waist; sensitivity 96%, specificity 94%) to 92 mg (GA non-dominant; sensitivity 93%, specificity 98%); vigorous intensity (≥6 METs) thresholds ranged from 190 mg (AG waist; sensitivity 82%, specificity 92%) to 283 mg (GA non-dominant; sensitivity 93%, specificity 98%). Conclusion: Raw triaxial acceleration outputs from two widely used accelerometer brands may have limited comparability in low intensity activities. Thresholds derived in this study can be utilized in adults to reasonably classify movement behaviors into categories of intensity.

• Speakman, John R.; de Jong, Jasper M A; Sinha, Srishti; Westerterp, Klaas R.; Yamada, Yosuke & Sagayama, Hiroyuki [Show all 80 contributors for this article] (2023). Total daily energy expenditure has declined over the past three decades due to declining basal expenditure, not reduced activity expenditure. Nature Metabolism. 5(4), p. 579–588. doi: 10.1038/s42255-023-00782-2. Show summary

  Obesity is caused by a prolonged positive energy balance1,2. Whether reduced energy expenditure stemming from reduced activity levels contributes is debated3,4. Here we show that in both sexes, total energy expenditure (TEE) adjusted for body composition and age declined since the late 1980s, while adjusted activity energy expenditure increased over time. We use the International Atomic Energy Agency Doubly Labelled Water database on energy expenditure of adults in the United States and Europe (n = 4,799) to explore patterns in total (TEE: n = 4,799), basal (BEE: n = 1,432) and physical activity energy expenditure (n = 1,432) over time. In males, adjusted BEE decreased significantly, but in females this did not reach significance. A larger dataset of basal metabolic rate (equivalent to BEE) measurements of 9,912 adults across 163 studies spanning 100 years replicates the decline in BEE in both sexes. We conclude that increasing obesity in the United States/Europe has probably not been fuelled by reduced physical activity leading to lowered TEE. We identify here a decline in adjusted BEE as a previously unrecognized factor.

• Varela, Andrea Ramírez; Hallal, Pedro C.; Grueso, Juliana Mejía; Pedišić, Željko; Salvo, Deborah & Nguyen, Anita [Show all 166 contributors for this article] (2023). Status and Trends of Physical Activity Surveillance, Policy, and Research in 164 Countries: Findings From the Global Observatory for Physical Activity—GoPA! 2015 and 2020 Surveys. Journal of Physical Activity and Health. ISSN 1543-3080. 20(2), p. 112–128. doi: 10.1123/jpah.2022-0464. Full text in Research Archive Show summary

  Background: Physical activity (PA) surveillance, policy, and research efforts need to be periodically appraised to gain insight into national and global capacities for PA promotion. The aim of this paper was to assess the status and trends in PA surveillance, policy, and research in 164 countries. Methods: We used data from the Global Observatory for Physical Activity (GoPA!) 2015 and 2020 surveys. Comprehensive searches were performed for each country to determine the level of development of their PA surveillance, policy, and research, and the findings were verified by the GoPA! Country Contacts. Trends were analyzed based on the data available for both survey years. Results: The global 5-year progress in all 3 indicators was modest, with most countries either improving or staying at the same level. PA surveillance, policy, and research improved or remained at a high level in 48.1%, 40.6%, and 42.1% of the countries, respectively. PA surveillance, policy, and research scores decreased or remained at a low level in 8.3%, 15.8%, and 28.6% of the countries, respectively. The highest capacity for PA promotion was found in Europe, the lowest in Africa and low- and lower-middle-income countries. Although a large percentage of the world’s population benefit from at least some PA policy, surveillance, and research efforts in their countries, 49.6 million people are without PA surveillance, 629.4 million people are without PA policy, and 108.7 million live in countries without any PA research output. A total of 6.3 billion people or 88.2% of the world’s population live in countries where PA promotion capacity should be significantly improved. Conclusion: Despite PA is essential for health, there are large inequalities between countries and world regions in their capacity to promote PA. Coordinated efforts are needed to reduce the inequalities and improve the global capacity for PA promotion.

• Sanchez-Lastra, Miguel Adriano; Ding, Ding; Dalene, Knut Eirik; del Pozo Cruz, Borja; Ekelund, Ulf & Tarp, Jakob (2023). Body composition and mortality from middle to old age: a prospective cohort study from the UK Biobank. International Journal of Obesity. ISSN 0307-0565. 47(8), p. 709–716. doi: 10.1038/s41366-023-01314-4. Full text in Research Archive Show summary

  Background: How the association between adiposity and the risk of death changes with age, and which is the optimal level of adiposity to reduce mortality in older ages, is still not completely understood. We aimed to ascertain the age-specific risks of mortality associated with different measures of adiposity. Methods: This was a prospective UK Biobank cohort study. Participants were categorized based on five different adiposity and body composition metrics. We explored the age-varying associations between body composition indices and all-cause mortality from 45 to 85 years of age at follow-up using hazard ratios (HR) from flexible parametric survival models with multivariable adjustment and age as timescale. Participants were followed from baseline (2006–2010) through 31 March 2020. Results: We included 369,752 participants (mean baseline age = 56.3 ± 8.1 years; range 38.9–73.7 years; 54.1% women) and 10,660 deaths during a median follow-up of 11.4 years. Associations between body mass index and mortality were similar when using the fat mass index in magnitude and shape. Compared to participants with normal weight, overweight was not associated with the risk of death regardless of age and the adiposity measure used. Participants with obesity class I showed an HR of 1.20 (95% confidence interval [CI]: 1.08, 1.33) and 1.14 (95%CI: 0.98, 1.30) at ages 60 and 80, respectively, and participants with obesity class II an HR about 1.55 across all age. More attenuated associations with higher age were found in individuals with the highest obesity using the fat mass index. Very high lean mass was associated with an increased risk of mortality in those aged 55–75 years (HR about 1.20 across all ages). Conclusion: Obesity should be prevented at any age. Attenuated associations with older age were observed only among the individuals with the highest obesity, but the risk remained higher compared to normal-weight participants. Lean mass did not reduce mortality risk at any age.

• Paluch, Amanda E.; Bajpai, Shivangi; Ballin, Marcel; Bassett, David R.; Buford, Thomas W. & Carnethon, Mercedes R. [Show all 31 contributors for this article] (2023). Prospective Association of Daily Steps with Cardiovascular Disease: A Harmonized Meta-Analysis. Circulation. ISSN 0009-7322. 147(2), p. 122–131. doi: 10.1161/CIRCULATIONAHA.122.061288. Full text in Research Archive Show summary

  Background: Taking fewer than the widely promoted “10 000 steps per day” has recently been associated with lower risk of all-cause mortality. The relationship of steps and cardiovascular disease (CVD) risk remains poorly described. A meta-analysis examining the dose–response relationship between steps per day and CVD can help inform clinical and public health guidelines. Methods: Eight prospective studies (20 152 adults [ie, ≥18 years of age]) were included with device-measured steps and participants followed for CVD events. Studies quantified steps per day and CVD events were defined as fatal and nonfatal coronary heart disease, stroke, and heart failure. Cox proportional hazards regression analyses were completed using study-specific quartiles and hazard ratios (HR) and 95% CI were meta-analyzed with inverse-variance–weighted random effects models. Results: The mean age of participants was 63.2±12.4 years and 52% were women. The mean follow-up was 6.2 years (123 209 person-years), with a total of 1523 CVD events (12.4 per 1000 participant-years) reported. There was a significant difference in the association of steps per day and CVD between older (ie, ≥60 years of age) and younger adults (ie, <60 years of age). For older adults, the HR for quartile 2 was 0.80 (95% CI, 0.69 to 0.93), 0.62 for quartile 3 (95% CI, 0.52 to 0.74), and 0.51 for quartile 4 (95% CI, 0.41 to 0.63) compared with the lowest quartile. For younger adults, the HR for quartile 2 was 0.79 (95% CI, 0.46 to 1.35), 0.90 for quartile 3 (95% CI, 0.64 to 1.25), and 0.95 for quartile 4 (95% CI, 0.61 to 1.48) compared with the lowest quartile. Restricted cubic splines demonstrated a nonlinear association whereby more steps were associated with decreased risk of CVD among older adults. Conclusions: For older adults, taking more daily steps was associated with a progressively decreased risk of CVD. Monitoring and promoting steps per day is a simple metric for clinician–patient communication and population health to reduce the risk of CVD.

• Tarp, Jakob; Rossen, Jenny; Ekelund, Ulf & Dohrn, Ing-Mari (2022). Joint associations of physical activity and sedentary time with body mass index: A prospective study of mortality risk. Scandinavian Journal of Medicine & Science in Sports. ISSN 0905-7188. doi: 10.1111/sms.14297. Full text in Research Archive Show summary

  Device-measured physical activity and sedentary time are suggested to be more important determinants of all-cause mortality compared to body mass index (BMI) in mainly older adults. However, the joint associations of physical activity and sedentary time with BMI in relation to mortality risk in relatively healthy middle-aged individuals are unclear. We followed 770 adults (56% women, mean age 55.6 years) from a population-based cohort study for up to 15.3 years. BMI categories were combined with tertiles of total, light, and moderate-to-vigorous physical activity and sedentary time. Cox proportional hazards models estimated hazard ratios (HR) of all-cause mortality with 95% confidence intervals (CI). High total and light intensity physical activity and low sedentary time were associated with a lower risk of mortality in normal weight individuals compared with low active overweight/obese; HR: 0.35 (CI: 0.14, 0.86), HR: 0.33 (CI: 0.12, 0.89), and HR: 0.34 (CI: 0.13, 0.92). Among overweight/obese individuals, those who were medium active in light physical activity had a lower mortality risk, HR: 0.36 (CI: 0.15, 0.83), compared with low active. Medium sedentary individuals had a lower risk, HR: 0.43 (CI: 0.20, 0.94) compared with those who were most sedentary. Associations among the most active or least sedentary tertiles were similar irrespective of BMI category. In conclusion, higher physical activity and lower sedentary time were associated with lower mortality risk irrespective of BMI. Physical activity should be promoted and prescribed to individuals with low physical activity levels irrespective of weight status.

• Yamada, Yosuke; Zhang, Xueying; Henderson, Mary E T; Sagayama, Hiroyuki; Pontzer, Herman & Watanabe, Daiki [Show all 92 contributors for this article] (2022). Variation in human water turnover associated with environmental and lifestyle factors. Science. ISSN 0036-8075. 378(6622), p. 909–915. doi: 10.1126/science.abm8668. Full text in Research Archive
• Bielemann, Renata M.; Oliveira, Ricardo; Bertoldi, Andréa D.; Tomasi, Elaine; Demarco, Flávio F. & Gonzalez, Maria Cristina [Show all 9 contributors for this article] (2022). Objective and Self-Reported Physical Activity and Risk of Falling Among Community-Dwelling Older Adults From Southern Brazil. Journal of Aging and Physical Activity. ISSN 1063-8652. 30(6), p. 972–979. doi: 10.1123/japa.2021-0148. Full text in Research Archive Show summary

  This study evaluated prospective associations between self-reported and objectively measured physical activity (PA) and risk of falls among older adults. A cohort study started in 2014 with 1,451 community-dwelling older adults living in Pelotas, Brazil. Leisure-time PA was obtained by the International Physical Activity Questionnaire and 7-day raw accelerometer data evaluated for total, light PA, and moderate to vigorous PA. In 2016–2017, participants recorded their falls in the previous 12 months. Around 23% of the 1,161 participants followed-up in 2016–2017 experienced a fall in the last 12 months. Participants who did not spend any time in self-reported leisure-time PA at baseline had on average 34% higher risk of falls, and individuals in the lowest tertile for moderate to vigorous PA had on average 51% higher risk of falls compared to those in the highest tertile. Low levels of self-reported and objectively measured moderate to vigorous PA were related to higher risk of falling among Brazilian older adults.

• Argent, Rob; Hetherington-Rauth, Megan; Stang, Julie; Tarp, Jakob; Ortega, Francisco B. & Molina-Garcia, Pablo [Show all 14 contributors for this article] (2022). Recommendations for Determining the Validity of Consumer Wearables and Smartphones for the Estimation of Energy Expenditure: Expert Statement and Checklist of the INTERLIVE Network. Sports Medicine. ISSN 0112-1642. 52(8), p. 1817–1832. doi: 10.1007/s40279-022-01665-4. Full text in Research Archive Show summary

  Background: Consumer wearables and smartphone devices commonly offer an estimate of energy expenditure (EE) to assist in the objective monitoring of physical activity to the general population. Alongside consumers, healthcare professionals and researchers are seeking to utilise these devices for the monitoring of training and improving human health. However, the methods of validation and reporting of EE estimation in these devices lacks rigour, negatively impacting on the ability to make comparisons between devices and provide transparent accuracy. Objectives: The Towards Intelligent Health and Well-Being Network of Physical Activity Assessment (INTERLIVE) is a joint European initiative of six universities and one industrial partner. The network was founded in 2019 and strives towards developing best-practice recommendations for evaluating the validity of consumer wearables and smartphones. This expert statement presents a best-practice validation protocol for consumer wearables and smartphones in the estimation of EE. Methods: The recommendations were developed through (1) a systematic literature review; (2) an unstructured review of the wider literature discussing the potential factors that may introduce bias during validation studies; and (3) evidence-informed expert opinions from members of the INTERLIVE network. Results: The systematic literature review process identified 1645 potential articles, of which 62 were deemed eligible for the final dataset. Based on these studies and the wider literature search, a validation framework is proposed encompassing six key domains for validation: the target population, criterion measure, index measure, testing conditions, data processing and the statistical analysis. Conclusions: The INTERLIVE network recommends that the proposed protocol, and checklists provided, are used to standardise the testing and reporting of the validation of any consumer wearable or smartphone device to estimate EE. This in turn will maximise the potential utility of these technologies for clinicians, researchers, consumers, and manufacturers/developers, while ensuring transparency, comparability, and replicability in validation.

• Halsey, Lewis G.; Careau, Vincent; Pontzer, Herman; Ainslie, Philip N.; Andersen, Lene Frost & Anderson, Liam J. [Show all 83 contributors for this article] (2022). Variability in energy expenditure is much greater in males than females. Journal of Human Evolution. ISSN 0047-2484. 171. doi: 10.1016/j.jhevol.2022.103229. Full text in Research Archive Show summary

  In mammals, trait variation is often reported to be greater among males than females. However, to date, mainly only morphological traits have been studied. Energy expenditure represents the metabolic costs of multiple physical, physiological, and behavioral traits. Energy expenditure could exhibit particularly high greater male variation through a cumulative effect if those traits mostly exhibit greater male variation, or a lack of greater male variation if many of them do not. Sex differences in energy expenditure variation have been little explored. We analyzed a large database on energy expenditure in adult humans (1494 males and 3108 females) to investigate whether humans have evolved sex differences in the degree of interindividual variation in energy expenditure. We found that, even when statistically comparing males and females of the same age, height, and body composition, there is much more variation in total, activity, and basal energy expenditure among males. However, with aging, variation in total energy expenditure decreases, and because this happens more rapidly in males, the magnitude of greater male variation, though still large, is attenuated in older age groups. Considerably greater male variation in both total and activity energy expenditure could be explained by greater male variation in levels of daily activity. The considerably greater male variation in basal energy expenditure is remarkable and may be explained, at least in part, by greater male variation in the size of energy-demanding organs. If energy expenditure is a trait that is of indirect interest to females when choosing a sexual partner, this would suggest that energy expenditure is under sexual selection. However, we present a novel energetics model demonstrating that it is also possible that females have been under stabilizing selection pressure for an intermediate basal energy expenditure to maximize energy available for reproduction.

• Fortuin-de Smidt, Melony C.; Sewe, Maquins Odhiambo; Lassale, Camille; Weiderpass, Elisabete; Andersson, Jonas & Huerta, José María [Show all 41 contributors for this article] (2022). Physical activity attenuates but does not eliminate coronary heart disease risk amongst adults with risk factors: EPIC-CVD case-cohort study. European Journal of Preventive Cardiology (EJPC). ISSN 2047-4873. 29(12), p. 1618–1629. doi: 10.1093/eurjpc/zwac055. Full text in Research Archive
• 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.

• Kwon, Soyang; Ekelund, Ulf; Kandula, Namratha R. & Janz, Kathleen F. (2022). Joint associations of physical activity and sedentary time with adiposity during adolescence: ALSPAC. European Journal of Public Health. ISSN 1101-1262. 32(3), p. 347–353. doi: 10.1093/eurpub/ckac023. Full text in Research Archive Show summary

  Background: In developing evidence-based physical activity (PA) guidelines for youth, a knowledge gap exists regarding the health effects of sedentary time (SED). The aim of this study was to determine the joint associations of moderate- and vigorous-intensity PA (MVPA) and SED with adiposity during adolescence. Methods: The study sample was 2619 non-obese participants (56.7% female) from the UK Avon Longitudinal Study of Parents and Children. Accelerometer-measured MVPA and SED at age 11, 13, 15 years and self-reported TV viewing at age 13 and 16 years were used to create two exposure variables: six MVPA&SED combinations based on two MVPA patterns [≥60 (active) and <60 min/day (inactive)] and three SED patterns [≈25 (low), ≈30 (middle) and ≈35 min/h (high)] and six MVPA&TV combinations based on two MVPA patterns and three TV viewing patterns [<1–2 (low), 1–2 (middle) and >1–2 h/day (high)]. Adiposity was evaluated using fat mass index (FMI) at age 17 years. Results: SED was not significantly associated with FMI in either active or inactive adolescents. However, higher TV viewing was associated with higher FMI in both active [adjusted FMI = 4.53 vs. 5.09 (95% CI = 4.87, 5.33) for low TV vs. high TV] and inactive adolescents [adjusted FMI = 4.91 vs. 5.21 (95% CI = 5.02, 5.39) for low TV vs. high TV]. Conclusions: Higher TV viewing time, but not total SED, was prospectively associated with higher adiposity among both active and inactive adolescents, suggesting a specific sedentary behavior target for public health.

• Kwon, Soyang; Menezes, Ana M. B.; Ekelund, Ulf; Wehrmeister, Fernando C.; Gonçalves, Helen & da Silva, Bruna Gonçalves C. [Show all 7 contributors for this article] (2022). Longitudinal change in physical activity and adiposity in the transition from adolescence to early adulthood: the 1993 Pelotas cohort study. International Journal of Behavioral Nutrition and Physical Activity. ISSN 1479-5868. 19. doi: 10.1186/s12966-022-01321-0. Full text in Research Archive Show summary

  Background: In the current Physical Activity Guidelines (PAG) for moderate- and vigorous-intensity physical activity (MVPA), abrupt transition from ≥ 60 min/day [youth PAG] to ≥ 150 min/week (≥ 22 min/day on average) [adult PAG] during emerging adulthood is poorly justified. The aim of this study was to examine body fat mass changes according to whether meeting the youth and adult PAGs in late adolescence (age 18 years) to early adulthood (age 22 years). Methods: The study sample included 2,099 participants (1,113 females) from the 1993 Pelotas (Brazil) Study. At ages 18 and 22 years, MVPA was measured using wrist-worn accelerometry and fat mass was measured using dual-energy X-ray absorptiometry. MVPA at age 18 was categorized into two groups: 0–59 or ≥ 60 min/day (no [N] or yes [Y] for meeting the youth recommendation, respectively). MVPA at age 22 was categorized into three groups: 0–21, 22–59, or ≥ 60 min/day (N, Y22, or Y60 for not meeting the adult recommendation, meeting the adult recommendation, or meeting the youth recommendation, respectively). The combination of these groups created six MVPA groups (N&N, N&Y22, N&Y60, Y&N, Y&Y22, and Y&Y60). Sex-specific multivariable linear regression analyses were conducted to estimate change in fat mass index (FMI) from age 18 to 22 years in the six MVPA groups. Results: Among males, compared to Y&Y60 (FMI increase = 1.2 kg/m2 [95% CI = 1.0, 1.4]), Y&Y22 and Y&N had larger FMI increases (1.9 [1.6, 2.1] and 1.9 [1.2, 2.5], respectively). Among females, Y&Y60 and Y&Y22 had an equal FMI increase (1.6 [1.4, 1.9] for both groups), while Y&N had a larger FMI increase (2.4 [1.8, 3.0]). Conclusions: These findings suggest that among those who were active in late adolescence, engaging in ≥ 22 min/day of MVPA in adulthood is associated with lower body fat gain for females, but not for males.

• Ding, Ding; Van Buskirk, Joe; Nguyen, Binh; Stamatakis, Emmanuel; Elbarbary, Mona & Veronese, Nicola [Show all 10 contributors for this article] (2022). Physical activity, diet quality and all-cause cardiovascular disease and cancer mortality: A prospective study of 346 627 UK Biobank participants. British Journal of Sports Medicine. ISSN 0306-3674. 56(20), p. 1148–1156. doi: 10.1136/bjsports-2021-105195. Full text in Research Archive Show summary

  Objectives: To examine independent and interactive associations of physical activity and diet with all-cause, cardiovascular disease (CVD) and physical activity, diet and adiposity-related (PDAR) cancer mortality. Methods: This population-based prospective cohort study (n=346 627) is based on the UK Biobank data with linkage to the National Health Service death records to 30 April 2020. A left-truncated Cox proportional hazards model was fitted to examine the associations between exposures (self-reported total moderate-to-vigorous intensity physical activity (MVPA), vigorous-intensity physical activity (VPA) and a diet quality index (score ranged 0–3)) and outcomes (all-cause, CVD and PDAR cancer mortality). Results: During a median follow-up of 11.2 years, 13 869 participants died from all causes, 2650 from CVD and 4522 from PDAR cancers. Compared with quartile 1 (Q1, 0–210 min/week), Q2–Q4 of MVPA were associated with lower risks of all-cause (HR ranged from 0.87 (95% CI: 0.83 to 0.91) to 0.91 (95% CI: 0.87 to 0.96)), CVD (HR ranged from 0.85 (95% CI: 0.76 to 0.95) to 0.90 (95% CI: 0.81 to 1.00)) and PDAR cancer mortality (HR ranged from 0.86 (95% CI: 0.79 to 0.93) to 0.94 (95% CI: 0.86 to 1.02)). Compared with no VPA, any VPA was associated with lower risk for all-cause and CVD mortality (HR ranged from 0.85 (95% CI: 0.80 to 0.89) to 0.88 (95% CI: 0.84 to 0.93) and from 0.75 (95% CI: 0.68 to 0.83) to 0.90 (95% CI: 0.80 to 1.02), respectively). Although not reaching statistical significance for all-cause and CVD mortality, being in the best dietary category (diet quality index=2–3) was associated with a reduction in PDAR cancer mortality (HR=0.86, 95% CI: 0.78 to 0.93). No additive or multiplicative interactions between physical activity categories and dietary quality was found. When comparing across physical activity and diet combinations, the lowest risk combinations consistently included the higher levels of physical activity and the highest diet quality score. Conclusions: Adhering to both quality diet and sufficient physical activity is important for optimally reducing the risk of mortality from all causes, CVD and PDAR cancers.

• 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.

• Ikeda, Erika; Guagliano, Justin M.; Atkin, Andrew J.; Sherar, Lauren B.; Ekelund, Ulf & Hansen, Bjørge Hermann [Show all 8 contributors for this article] (2022). Cross-sectional and longitudinal associations of active travel, organised sport and physical education with accelerometer-assessed moderate-to-vigorous physical activity in young people: the International Children’s Accelerometry Database. International Journal of Behavioral Nutrition and Physical Activity. ISSN 1479-5868. 19. doi: 10.1186/s12966-022-01282-4. Full text in Research Archive Show summary

  Background Physical activity (PA) declines during childhood. Important sources of PA are active travel, organised sport and physical education (PE), but it is unclear how these domain-specific PA sources contribute to (changes in) daily moderate-to-vigorous PA (MVPA) in young people. This study aimed to examine (1) the cross-sectional association between domain-specific physical activity (i.e., active travel, organised sport and PE) and daily minutes in accelerometer-assessed MVPA; and (2) the longitudinal association between domain-specific physical activity at baseline and change in daily minutes in MVPA. Methods Participants (baseline age 11.3 ± .1.2 years) were drawn from three studies in the International Children’s Accelerometry Database. The contribution of self-reported standardised active travel, organised sport and PE to accelerometer-measured daily minutes in MVPA was examined using linear regression. In cross-sectional analyses, MVPA was regressed on each PA domain in separate models, adjusted for study, age, sex, maternal education, season, and monitor wear time. In longitudinal analyses, change in MVPA was regressed on each of the baseline PA domains, additionally adjusting for changes in season and wear time, follow-up duration, and baseline MVPA. R-squared was used to compare variance explained by each PA domain. Results In the cross-sectional analyses (n = 3871), organised sport (standardised β = 3.81, 95% confidence interval [95%CI] = 3.06, 4.56) and active travel (β = 3.46, 95%CI = 2.73, 4.19) contributed more to daily MVPA than PE (β = 0.82, 95%CI = -0.02, 1.66). Compared to the base model which included only covariates (R2 = 21.5%), organised sport (absolute change: + 1.9%) and active travel (+ 1.7%) models explained more of the variance than the PE model (± < 0.1%). Associations followed a similar pattern in the longitudinal analyses (n = 2302), but none of the PA domains predicted change in MVPA (organised sport: standardised β = 0.85, 95%CI = -0.03, 1.72; active travel: β = 0.68, 95%CI = -0.14, 1.50; PE: β = 0.02, 95%CI = -0.87, 0.91). Conclusions A multi-sectoral approach covering a wide range of PA domains should be promoted to minimise the age-related decline in MVPA during childhood.

• 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
• Martinez-Gomez, David; Cabanas-Sanchez, Veronica; Yu, Tsung; Rodriguez-Artalejo, Fernando; Ding, Ding & Lee, I-Min [Show all 7 contributors for this article] (2022). Long-term leisure-time physical activity and risk of all-cause and cardiovascular mortality: Dose-response associations in a prospective cohort study of 210 327 Taiwanese adults. British Journal of Sports Medicine. ISSN 0306-3674. 56, p. 919–926. doi: 10.1136/bjsports-2021-104961. Full text in Research Archive Show summary

  Objectives: We aimed to investigate the dose–response associations of long-term leisure-time physical activity (LTPA) obtained from repeated measures with all-cause and cardiovascular disease (CVD) mortality outcomes in Taiwanese adults. Methods: We included 210 327 participants with self-reported LTPA at least in two medical examinations (867 968 data points) for up to 20 years (median, IQR: 4.8 years, 2.3–9.0). Dose–response relationships were modelled with restricted cubic spline functions and Cox regressions HRs (95% CIs) adjusted for main covariates. Results: During up to 23 years of follow-up (3 655 734 person-years), 10 539 participants died, of which 1919 of CVD. We observed an inverse, non-linear dose–response association between long-term LTPA and all-cause and CVD mortality. Compared with the referent (0 metabolic equivalent of task (MET) hours/week), insufficient (0.01–7.49 MET hours/week), recommended (7.50–15.00 MET hours/week) and additional (>15 MET hours/week) amounts of LTPA had a lower mortality risk of 0.74 (0.69–0.80), 0.64 (0.60–0.70) and 0.59 (0.54–0.64) for all-cause mortality and 0.68 (0.60–0.84), 0.56 (0.47–0.67) and 0.56 (0.47–0.68) for CVD mortality. When using only baseline measures of LTPA, the corresponding mortality risk was 0.88 (0.84–0.93), 0.83 (0.78–0.88) and 0.78 (0.73–0.83) for all-cause and 0.91 (0.81–1.02), 0.78 (0.68–0.89) and 0.80 (0.70–0.92) for CVD mortality. Conclusion: Long-term LTPA was associated with lower risks of all-cause and CVD mortality. The magnitude of risk reductions was larger when modelling repeated measures of LTPA compared with one measure of LTPA at baseline.

• Molina-Garcia, Pablo; Notbohm, Hannah L.; Schumann, Moritz; Argent, Rob; Hetherington-Rauth, Megan & Stang, Julie [Show all 14 contributors for this article] (2022). Validity of Estimating the Maximal Oxygen Consumption by Consumer Wearables: A Systematic Review with Meta-analysis and Expert Statement of the INTERLIVE Network. Sports Medicine. ISSN 0112-1642. doi: 10.1007/s40279-021-01639-y. Full text in Research Archive Show summary

  Background: Technological advances have recently made possible the estimation of maximal oxygen consumption (VO2max) by consumer wearables. However, the validity of such estimations has not been systematically summarized using meta-analytic methods and there are no standards guiding the validation protocols. Objective: The aim was to (1) quantitatively summarize previous studies investigating the validity of the VO2max estimated by consumer wearables and (2) provide best-practice recommendations for future validation studies. Methods: First, we conducted a systematic review and meta-analysis of studies validating the estimation of VO2max by wearables. Second, based on the state of knowledge (derived from the systematic review) combined with the expert discussion between the members of the Towards Intelligent Health and Well-Being Network of Physical Activity Assessment (INTERLIVE) consortium, we provided a set of best-practice recommendations for validation protocols. Results: Fourteen validation studies were included in the systematic review and meta-analysis. Meta-analysis results revealed that wearables using resting condition information in their algorithms significantly overestimated VO2max (bias 2.17 ml·kg−1·min−1; limits of agreement − 13.07 to 17.41 ml·kg−1·min−1), while devices using exercise-based information in their algorithms showed a lower systematic and random error (bias − 0.09 ml·kg−1·min−1; limits of agreement − 9.92 to 9.74 ml·kg−1·min−1). The INTERLIVE consortium proposed six key domains to be considered for validating wearable devices estimating VO2max, concerning the following: the target population, reference standard, index measure, testing conditions, data processing, and statistical analysis. Conclusions: Our meta-analysis suggests that the estimations of VO2max by wearables that use exercise-based algorithms provide higher accuracy than those based on resting conditions. The exercise-based estimation seems to be optimal for measuring VO2max at the population level, yet the estimation error at the individual level is large, and, therefore, for sport/clinical purposes these methods still need improvement. The INTERLIVE network hereby provides best-practice recommendations to be used in future protocols to move towards a more accurate, transparent and comparable validation of VO2max derived from wearables.

• Rimbach, Rebecca; Yamada, Yosuke; Sagayama, Hiroyuki; Ainslie, Philip N.; Andersen, Lene Frost & Anderson, Liam J. [Show all 82 contributors for this article] (2022). Total energy expenditure is repeatable in adults but not associated with short-term changes in body composition. Nature Communications. ISSN 2041-1723. 13. doi: 10.1038/s41467-021-27246-z. Full text in Research Archive Show summary

  Low total energy expenditure (TEE, MJ/d) has been a hypothesized risk factor for weight gain, but repeatability of TEE, a critical variable in longitudinal studies of energy balance, is understudied. We examine repeated doubly labeled water (DLW) measurements of TEE in 348 adults and 47 children from the IAEA DLW Database (mean ± SD time interval: 1.9 ± 2.9 y) to assess repeatability of TEE, and to examine if TEE adjusted for age, sex, fat-free mass, and fat mass is associated with changes in weight or body composition. Here, we report that repeatability of TEE is high for adults, but not children. Bivariate Bayesian mixed models show no among or within-individual correlation between body composition (fat mass or percentage) and unadjusted TEE in adults. For adults aged 20–60 y (N = 267; time interval: 7.4 ± 12.2 weeks), increases in adjusted TEE are associated with weight gain but not with changes in body composition; results are similar for subjects with intervals >4 weeks (N = 53; 29.1 ± 12.8 weeks). This suggests low TEE is not a risk factor for, and high TEE is not protective against, weight or body fat gain over the time intervals tested.

• 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.

• Mielke, Gregore I.; Menezes, Ana Maria B.; da Silva, Bruna Gonçalves Cordeiro; Ekelund, Ulf; Crochemore-Silva, Inacio & Wehrmeister, Fernando César [Show all 8 contributors for this article] (2021). Associations between Device-measured Physical Activity and Cardiometabolic Health in the Transition to Early Adulthood. Medicine & Science in Sports & Exercise. ISSN 0195-9131. 53(10), p. 2076–2085. doi: 10.1249/MSS.0000000000002696. Full text in Research Archive Show summary

  Purposes: The aims of this study were to investigate the cross-sectional and prospective associations between accelerometer-measured physical activity and cardiometabolic health in the transition to adulthood. Methods: Data from the 1993 Pelotas (Brazil) Birth Cohort were analyzed (n = 2280). Moderate-to-vigorous intensity physical activity (MVPA) (measured using a triaxial accelerometer) and cardiometabolic health (total fat mass, blood glucose, non-high-density lipoprotein cholesterol, triglycerides, and mean resting blood pressure) were examined at age 18 and 22 yr. Results: Overall, inverse dose–response associations between MVPA and cardiometabolic health at age 18 and 22 yr were observed in cross-sectional analyses of data from men and women. Prospective analyses showed that, in general, MVPA declined, and cardiometabolic health worsened in this 4-yr period in both men and women. Cardiometabolic health at age 22 yr reflected both MVPA at age 18 yr (β, −0.007; 95% confidence interval [CI], −0.014 to 0.000) and changes in MVPA from 18 to 22 yr (β, −0.030; 95% CI, −0.043 to −0.016) in men, but only changes in MVPA in women (β, −0.035; 95% CI, −0.058 to −0.011). In analyses of change over time, men who improved MVPA by 20 to 30 min·d−1 showed significant improvements in cardiometabolic health over 4 yr. The magnitude of association was slightly stronger for MVPA in 10-min bouts than for MVPA accumulated in bouts of 1 min, especially in women. Conclusions: Moderate-to-vigorous intensity physical activity is an important predictor of cardiometabolic health in early adulthood. Strategies to prevent declines in MVPA at this life stage are required to prevent deteriorating cardiometabolic health profiles.

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

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

• Tarp, Jakob; Fagerland, Morten Wang; Dalene, Knut Eirik; Steene-Johannessen, Jostein; Hansen, Bjørge Hermann & Jefferis, Barbara [Show all 24 contributors for this article] (2021). Device-measured physical activity, adiposity and mortality: a harmonised meta-analysis of eight prospective cohort studies. British Journal of Sports Medicine. ISSN 0306-3674. 56(13), p. 725–732. doi: 10.1136/bjsports-2021-104827. Full text in Research Archive
• Zhou, Bin; Carrillo-Larco, Rodrigo M.; Danaei, Goodarz; Riley, Leanne M.; Paciorek, Christopher J. & Stevens, Gretchen A. [Show all 100 contributors for this article] (2021). Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. The Lancet. ISSN 0140-6736. 398(10304), p. 957–980. doi: 10.1016/S0140-6736(21)01330-1. Full text in Research Archive
• Pontzer, Herman; Yamada, Yosuke; Sagayama, Hiroyuki; Ainslie, Philip N.; Andersen, Lene Frost & Anderson, Liam J. [Show all 82 contributors for this article] (2021). Daily energy expenditure through the human life course. Science. ISSN 0036-8075. 373(6556), p. 808–812. doi: 10.1126/science.abe5017. 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
• Westerterp, Klaas R.; Yamada, Yosuke; Sagayama, Hiroyuki; Ainslie, Philip N.; Andersen, Lene F. & Anderson, Liam J. [Show all 82 contributors for this article] (2021). Physical activity and fat-free mass during growth and in later life. American Journal of Clinical Nutrition. ISSN 0002-9165. 114(5), p. 1583–1589. doi: 10.1093/ajcn/nqab260. 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.

• Careau, Vincent; Halsey, Lewis G.; Pontzer, Herman; Ainslie, Philip N.; Andersen, Lene F. & Anderson, Liam J. [Show all 84 contributors for this article] (2021). Energy compensation and adiposity in humans. Current Biology. ISSN 0960-9822. 31(20). doi: 10.1016/j.cub.2021.08.016. Full text in Research Archive
• Chiang, Cho-Han; Chiang, Cho-Hung; Pickering, John W; Stoyanov, Kiril M.; Chew,, Derek P. & Neumann, Johannes T. [Show all 38 contributors for this article] (2021). Performance of the European Society of Cardiology 0/1-Hour, 0/2-Hour, and 0/3-Hour Algorithms for Rapid Triage of Acute Myocardial Infarction. An International Collaborative Meta-analysis. Annals of Internal Medicine. ISSN 0003-4819. doi: 10.7326/M21-1499.
• Leppänen, Marja H.; Haapala, Eero A.; Väistö, Juuso; Ekelund, Ulf; Brage, Søren & Kilpeläinen, Tuomas O. [Show all 7 contributors for this article] (2021). Longitudinal and cross-sectional associations of adherence to 24-hour movement guidelines with cardiometabolic risk. Scandinavian Journal of Medicine & Science in Sports. ISSN 0905-7188. 32(1), p. 255–266. doi: 10.1111/sms.14081. Show summary

  This study aimed to examine (1) adherence to 24 h movement guidelines over a 2 years follow-up in children aged 6–8 years and (2) association of this adherence with cardiometabolic risk factors. Physical activity and sleep were assessed by a monitor combining heart rate and accelerometry measurements. Screen time was reported by the parents. Body fat percentage, waist circumference, blood glucose, serum insulin, plasma lipids, and blood pressure were assessed, and a cardiometabolic risk score was calculated using z-scores. Children were classified as meeting the guidelines if they had on average ≥60 min/day of moderate-to-vigorous physical activity during the valid days; ≤120 min/day of screen time; and 9–11 h/day of sleep. In total, 485 children had valid data at baseline or at 2 years follow-up. Analyses were conducted using adjusted logistic and linear regression models. Most children adhered to the 24 h movement guidelines at baseline, but the adherence decreased over the 2 years follow-up. Meeting physical activity guidelines individually, or in combination with screen time and/or sleep, was longitudinally associated with a lower cardiometabolic risk score, insulin and waist circumference, and cross-sectionally additionally with lower diastolic blood pressure and higher high-density lipoprotein cholesterol. However, these associations became statistically non-significant after adjustment for body fat. In conclusion, meeting 24 h movement guidelines at baseline increases the odds of meeting them at 2 years follow-up in school-aged children. Furthermore, meeting 24 h movement guidelines is associated with lower levels of cardiometabolic risk factors, but these associations are partly explained by lower body fat. Thus, promoting movement behaviors, especially physical activity, and healthy weight in early childhood is important in supporting cardiometabolic health in children.

• Mañas, Asier; del Pozo-Cruz, Borja; Ekelund, Ulf; Reyna, José Losa; Gómez, Irene Rodríguez & Carreño, José Antonio Carnicero [Show all 9 contributors for this article] (2021). Association of accelerometer-derived step volume and intensity with hospitalizations and mortality in older adults: A prospective cohort study. Journal of Sport and Health Science. ISSN 2095-2546. doi: 10.1016/j.jshs.2021.05.004. Full text in Research Archive Show summary

  Purpose: To examine the associations of accelerometer-derived steps volume and intensity with hospitalizations and all-cause mortality in older adults. Methods: This prospective cohort study involved 768 community-dwelling Spanish older adults (78.8 ± 4.9 years, mean ± SD; 53.9% females) from the Toledo Study for Healthy Aging (2012–2017). The number of steps per day and step cadence (steps/min) were derived from a hip-mounted accelerometer worn for at least 4 days at baseline. Participants were followed-up over a mean period of 3.1 years for hospitalization and 5.7 years for all-cause mortality. Cox proportional hazards regression models were used to estimate the individual and joint associations between daily steps and stepping intensity with hospitalizations and all-cause mortality. Results: Included participants walked 5835 ± 3445 steps/day (mean ± SD) with an intensity of 7.3 ± 4.1 steps/min. After adjusting for age, sex, body mass index (BMI), education, income, marital status and comorbidities, higher step count (hazard ratio (HR) = 0.95, 95% confidence intervals (95%CI: 0.90–1.00, and HR = 0.87, 95%CI: 0.81–0.95 per additional 1000 steps) and higher step intensity (HR = 0.95, 95%CI: 0.91–0.99, and HR = 0.89, 95%CI: 0.84–0.95 per each additional step/min) were associated with fewer hospitalizations and all-cause mortality risk, respectively. Compared to the group having low step volume and intensity, individuals in the group having high step volume and intensity had a lower risk of hospitalization (HR = 0.72, 95%CI: 0.52–0.98) and all-cause mortality (HR = 0.60, 95%CI: 0.37–0.98). Conclusion: Among older adults, both high step volume and step intensity were significantly associated with lower hospitalization and all-cause mortality risk. Increasing step volume and intensity may benefit older people.

• Andreassen, Silje Malen; Ekelund, Ulf & Bernhardsen, Guro Pauck (2021). No association between maternal exercise during pregnancy and the child’s weight status at age 7 years: The MoBa study. Scandinavian Journal of Medicine & Science in Sports. ISSN 0905-7188. 31(10), p. 1991–2001. doi: 10.1111/sms.14015. Full text in Research Archive Show summary

  Introduction: Maternal lifestyle during pregnancy may affect the development of overweight and obesity in the child. We examined whether maternal exercise during pregnancy is associated with offspring overweight and obesity in childhood. A secondary aim was to examine whether the association is affected by the child's physical activity level. Materials and methods: This study is based on data from the Norwegian Mother, Father and Child Cohort Study (MoBa), including 44 352 pregnancies and children (n = 32 304 in week 17 and n = 32 419 in week 30 in the final adjusted model). Maternal exercise during pregnancy was self-reported in gestational weeks 17 and 30. We conducted linear and logistic regression separately for girls and boys, and outcomes were the child's body mass index (BMI) and weight status (overweight/obese) at age 7 years. We further examined the additive joint association between maternal exercise during pregnancy and the child's leisure time physical activity on weight status at age 7 years. Results: In total, 12.4% of the children were classified as overweight or obese, and 1.7% as obese. The results suggest no association between maternal exercise in both gestational weeks 17 and 30 and the weight status of the child at age 7 years. The association between maternal exercise and the child's weight status at age 7 years appears not to be affected by the child's physical activity level. Conclusion: Maternal exercise level during pregnancy does not appear to be associated with the child's BMI or odds of being overweight or obese in childhood.

• Lee, Seung Won; Lee, Jinhee; Moon, Sung Yong; Jin, Hyun Young; Yang, Jee Myung & Ogino, Shuji [Show all 25 contributors for this article] (2021). Physical activity and the risk of SARS-CoV-2 infection, severe COVID-19 illness and COVID-19 related mortality in South Korea: A nationwide cohort study. British Journal of Sports Medicine. ISSN 0306-3674. doi: 10.1136/bjsports-2021-104203. Full text in Research Archive Show summary

  Purpose: To determine the potential associations between physical activity and risk of SARS-CoV-2 infection, severe illness from COVID-19 and COVID-19 related death using a nationwide cohort from South Korea. Methods: Data regarding 212 768 Korean adults (age ≥20 years), who tested for SARS-CoV-2, from 1 January 2020 to 30 May 2020, were obtained from the National Health Insurance Service of South Korea and further linked with the national general health examination from 1 January 2018 to 31 December 2019 to assess physical activity levels. SARS-CoV-2 positivity, severe COVID-19 illness and COVID-19 related death were the main outcomes. The observation period was between 1 January 2020 and 31 July 2020. Results: Out of 76 395 participants who completed the general health examination and were tested for SARS-CoV-2, 2295 (3.0%) were positive for SARS-CoV-2, 446 (0.58%) had severe illness from COVID-19 and 45 (0.059%) died from COVID-19. Adults who engaged in both aerobic and muscle strengthening activities according to the 2018 physical activity guidelines had a lower risk of SARS-CoV-2 infection (2.6% vs 3.1%; adjusted relative risk (aRR), 0.85; 95% CI 0.72 to 0.96), severe COVID-19 illness (0.35% vs 0.66%; aRR 0.42; 95% CI 0.19 to 0.91) and COVID-19 related death (0.02% vs 0.08%; aRR 0.24; 95% CI 0.05 to 0.99) than those who engaged in insufficient aerobic and muscle strengthening activities. Furthermore, the recommended range of metabolic equivalent task (MET; 500–1000 MET min/week) was associated with the maximum beneficial effect size for reduced risk of SARS-CoV-2 infection (aRR 0.78; 95% CI 0.66 to 0.92), severe COVID-19 illness (aRR 0.62; 95% CI 0.43 to 0.90) and COVID-19 related death (aRR 0.17; 95% CI 0.07 to 0.98). Similar patterns of association were observed in different sensitivity analyses. Conclusion: Adults who engaged in the recommended levels of physical activity were associated with a decreased likelihood of SARS-CoV-2 infection, severe COVID-19 illness and COVID-19 related death. Our findings suggest that engaging in physical activity has substantial public health value and demonstrates potential benefits to combat COVID-19.

• van Sluijs, Esther M.F.; Ekelund, Ulf; Crochemore-Silva, Inacio; Guthold, Regina; Ha, Amy & Lubans, David [Show all 9 contributors for this article] (2021). Physical activity behaviours in adolescence: current evidence and opportunities for intervention. The Lancet. ISSN 0140-6736. 398(10298), p. 429–442. doi: 10.1016/S0140-6736(21)01259-9. Full text in Research Archive Show summary

  Young people aged 10–24 years constitute 24% of the world's population; investing in their health could yield a triple benefit—eg, today, into adulthood, and for the next generation. However, in physical activity research, this life stage is poorly understood, with the evidence dominated by research in younger adolescents (aged 10–14 years), school settings, and high-income countries. Globally, 80% of adolescents are insufficiently active, and many adolescents engage in 2 h or more daily recreational screen time. In this Series paper, we present the most up-to-date global evidence on adolescent physical activity and discuss directions for identifying potential solutions to enhance physical activity in the adolescent population. Adolescent physical inactivity probably contributes to key global health problems, including cardiometabolic and mental health disorders, but the evidence is methodologically weak. Evidence-based solutions focus on three key components of the adolescent physical activity system: supportive schools, the social and digital environment, and multipurpose urban environments. Despite an increasing volume of research focused on adolescents, there are still important knowledge gaps, and efforts to improve adolescent physical activity surveillance, research, intervention implementation, and policy development are urgently needed.

• Haapala, Eero A.; Väistö, Juuso; Ihalainen, Johanna K.; González, Claudia Tomaselli; Leppänen, Marja H. & Veijalainen, Aapo [Show all 13 contributors for this article] (2021). Associations of physical activity, sedentary time, and diet quality with biomarkers of inflammation in children. European Journal of Sport Science (EJSS). ISSN 1746-1391. doi: 10.1080/17461391.2021.1892830. Full text in Research Archive Show summary

  We investigated the associations of physical activity (PA), sedentary time (ST), and diet quality with biomarkers of inflammation in 390 children (192 girls, 198 boys) aged 6–8 years. PA energy expenditure (PAEE), light PA, moderate PA (MPA), vigorous PA (VPA), moderate-to-vigorous PA (MVPA), and ST were assessed by combined movement and heart rate sensor. Finnish Children Healthy Eating Index was calculated using data from 4 d food records. Body fat percentage (BF%) was measured by dual-energy X-ray absorptiometry. High-sensitivity C-reactive protein (Hs-CRP), leptin, interleukin-6 (IL-6), adiponectin, tumour necrosis factor-α, and glycoprotein acetyls were measured from fasting blood samples. PAEE, MPA, VPA, and MVPA were inversely associated with hs-CRP (β=−191 to −139, 95% CI=−0.294 to −0.024), leptin (β=−0.409 to −0.301, 95% CI=−0.499 to −0.107), IL-6 (β=−0.136 to −0.104, 95% CI=−0.240 to −0.001) and PAEE, MPA, and MVPA were inversely associated with glycoprotein acetyls (β=−0.117 to −0.103, 95% CI=−0.213 to −0.001). ST was directly associated with hs-CRP (β=0.170, 95% CI=0.070–0.269), leptin (β=0.355, 95% CI=0.265–0.445), and IL-6 (β=0.105, 95% CI=0.005–0.205). VPA was inversely associated with hs-CRP, leptin, and IL-6 in children with higher BF% (β=−0.344 to −0.181, 95% CI=−0.477 to −0.033) but not among children with lower BF% (β=−0.007–0.033, 95% CI=−0.183–0.184). In conclusion, PA was inversely and ST directly associated with circulating levels of biomarkers of inflammation among children. Furthermore, we observed that PA was inversely associated with these biomarkers for inflammation in children with a higher BF%.

• Korhonen, Marika; Väistö, Juuso; Veijalainen, Aapo; Leppänen, Marja H.; Ekelund, Ulf & Laukkanen, Jari A. [Show all 10 contributors for this article] (2021). Longitudinal associations of physical activity, sedentary time, and cardiorespiratory fitness with arterial health in children–the PANIC study. Journal of Sports Sciences. ISSN 0264-0414. 39(17), p. 1980–1987. doi: 10.1080/02640414.2021.1912450. Full text in Research Archive Show summary

  We investigated the longitudinal associations of physical activity (PA), sedentary time (ST), and cardiorespiratory fitness (CRF) with arterial health among children. In our primary analyses, we investigated 245 children (girls 51.8%) aged 6-9 years participating in the baseline examinations who had data on arterial health at 2-year follow-up. We also utilized a subsample of 90 children who had a complete arterial health data at baseline and 2-year follow-up. ST (≤1.5 METs), light PA (>1.5-4 METs), moderate PA (>4-7 METs), vigorous PA (>7METs), and moderate-to-vigorous PA (MVPA, >4 METs) were assessed by combined movement and heart rate monitoring and CRF by maximal exercise testing on a cycle ergometer at baseline and 2-year follow-up. Stiffness index (SI) as a measure of arterial stiffness and change in reflection index during exercise test (DRI) as a measure of arterial dilation capacity were assessed by pulse contour analysis. Two-year change in vigorous PA was associated with DRI in boys but not in girls (p=0.021 for interaction). In a subsample analyses, 2-year changes in MPA, VPA, and MVPA were inversely associated with 2-year change in SI. In conclusion, promoting PA at higher intensities may confer larger benefits on arterial health than reducing ST and increasing LPA.

• 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.

• Chastin, Sebastien F.M.; McGregor, Duncan E.; Biddle, Stuart J.H.; Cardon, Greet; Chaput, Jean-Philippe & Dall, Philippa M. [Show all 13 contributors for this article] (2021). Striking the right balance: Evidence to inform combined physical activity and sedentary behavior recommendations. Journal of Physical Activity and Health. ISSN 1543-3080. 18(6), p. 631–637. doi: 10.1123/jpah.2020-0635. Full text in Research Archive Show summary

  Background: Crucial evidence gaps regarding: (1) the joint association of physical activity and sedentary time with health outcomes and (2) the benefits of light-intensity physical activity were identified during the development of recommendations for the World Health Organization Guidelines on physical activity and sedentary behavior (SB). The authors present alternative ways to evidence the relationship between health outcomes and time spent in physical activity and SB and examine how this could be translated into a combined recommendation in future guidelines. Methods: We used compositional data analysis to quantify the dose–response associations between the balance of time spent in physical activity and SB with all-cause mortality. The authors applied this approach using 2005–2006 National Health and Nutrition Examination Survey accelerometer data. Results: Different combinations of time spent in moderate- to vigorous-intensity physical activity, light-intensity physical activity, and SB are associated with similar all-cause mortality risk level. A balance of more than 2.5 minutes of moderate- to vigorous-intensity physical activity per hour of daily sedentary time is associated with the same magnitude of risk reduction for all-cause mortality as obtained by being physically active according to the current recommendations. Conclusion: This method could be applied to provide evidence for more flexible recommendations in the future with options to act on different behaviors depending on individuals’ circumstances and capacity.

• Speakman, John R.; Yamada, Yosuke; Sagayama, Hiroyuki; Berman, Elena S.F.; Ainslie, Philip N. & Andersen, Lene Frost [Show all 87 contributors for this article] (2021). A standard calculation methodology for human doubly labeled water studies. Cell Reports Medicine. ISSN 2666-3791. 2(2). doi: 10.1016/j.xcrm.2021.100203. Full text in Research Archive
• Sagelv, Edvard Hamnvik; Ekelund, Ulf; Hopstock, Laila Arnesdatter; Fimland, Marius Steiro; Løvsletten, Ola & Wilsgaard, Tom [Show all 7 contributors for this article] (2021). The bidirectional associations between leisure time physical activity change and body mass index gain. The Tromsø Study 1974–2016. International Journal of Obesity. ISSN 0307-0565. 45(8), p. 1830–1843. doi: 10.1038/s41366-021-00853-y. Full text in Research Archive Show summary

  Objectives To examine whether leisure time physical activity changes predict subsequent body mass index (BMI) changes, and conversely, whether BMI changes predict subsequent leisure time physical activity changes. Methods: This prospective cohort study included adults attending ≥3 consecutive Tromsø Study surveys (time: T1, T2, T3) during 1974–2016 (n = 10779). If participants attended >3 surveys, we used the three most recent surveys. We computed physical activity change (assessed by the Saltin-Grimby Physical Activity Level Scale) from T1 to T2, categorized as Persistently Inactive (n = 992), Persistently Active (n = 7314), Active to Inactive (n = 1167) and Inactive to Active (n = 1306). We computed BMI change from T2 to T3, which regressed on preceding physical activity changes using analyses of covariance. The reverse association (BMI change from T1 to T2 and physical activity change from T2 to T3; n = 4385) was assessed using multinomial regression. Results: Average BMI increase was 0.86 kg/m2 (95% CI: 0.82–0.90) from T2 to T3. With adjustment for sex, birth year, education, smoking and BMI at T2, there was no association between physical activity change from T1 to T2 and BMI change from T2 to T3 (Persistently Inactive: 0.89 kg/m2 (95% CI: 0.77–1.00), Persistently Active: 0.85 kg/m2 (95% CI: 0.81–0.89), Active to Inactive: 0.90 kg/m2 (95% CI: 0.79–1.00), Inactive to Active 0.85 kg/m2 (95% CI: 0.75–0.95), p = 0.84). Conversely, increasing BMI was associated with Persistently Inactive (odds ratio (OR): 1.17, 95% CI: 1.08–1.27, p < 0.001) and changing from Active to Inactive (OR: 1.16, 95% CI: 1.07–1.25, p < 0.001) compared with being Persistently Active. Conclusions: We found no association between leisure time physical activity changes and subsequent BMI changes, whereas BMI change predicted subsequent physical activity change. These findings indicate that BMI change predicts subsequent physical activity change at population level and not vice versa.

• Sanchez-Lastra, Miguel A.; Ding, Ding; Dalene, Knut Eirik; Del Pozo-Cruz, Borja; Ekelund, Ulf & Tarp, Jakob (2021). Stair climbing and mortality: a prospective cohort study from the UK Biobank. Journal of Cachexia, Sarcopenia and Muscle. ISSN 2190-5991. 12(2), p. 298–307. doi: 10.1002/jcsm.12679. Full text in Research Archive Show summary

  Background: Regular stair climbing has the potential to lower the risk of premature death, but current evidence is scarce. We aimed to examine whether daily stair climbing is associated with lower risk of all-cause, cancer, and cardiovascular disease (CVD) mortality. Methods: Using the UK Biobank cohort, we extracted information of self-reported daily flights of stairs climbed at home, categorized as none, 1 to 5, 6 to 10, 11 to 15, and ≥16 flights per day. Associations between flights of stair climbed per day and mortality were examined as hazard ratios (HRs) from Cox proportional hazards models adjusted for demographic, clinical, and behavioural covariates including time spent in other physical activities. We calculated the restricted mean survival time as an absolute measure of association. The risk of residual confounding was examined using propensity score matching and by using lung cancer as negative control outcome. Participants were followed from baseline (2006–2010) through 31 March 2020. Results: A total of 280 423 participants (median follow-up 11.1 years, during which 9445 deaths occurred) were included. Compared with not climbing any stairs, climbing more than five flights of stairs at home per day was associated with lower risk of premature mortality. The lowest risk was found for those climbing 6–10 flights per day: 0.91; 95% confidence interval (CI): 0.85, 0.98, translated to approximately 44 to 55 days of additional survival. A similar pattern was found after applying propensity score matching and for cancer mortality (6–10 flights per day HR: 0.88; 95% CI: 0.80, 0.97), but not for CVD mortality (6–10 flights per day HR: 1.08; 95% CI: 0.91, 1.29). The association between stair climbing and lung cancer was similar to that of all-cause mortality. Conclusions: Climbing more than five flights of stairs at home per day was associated with a lower risk of all-cause and cancer mortality, but not CVD mortality, compared with those who did not take the stairs. The magnitude of the association was small and appeared susceptible to residual confounding. It is unlikely that at-home stair climbing is sufficient physical activity stimuli to lower the risk of premature mortality.

• Kieffer, Sophie Kvalheim; Nauman, Javaid; Syverud, Kari; Selboskar, Hege; Lydersen, Stian & Ekelund, Ulf [Show all 7 contributors for this article] (2021). Association between Personal Activity Intelligence (PAI) and body weight in a population free from cardiovascular disease - The HUNT study . The Lancet Regional Health - Europe. ISSN 2666-7762. 5. doi: 10.1016/j.lanepe.2021.100091. Full text in Research Archive Show summary

  Background: Personal Activity Intelligence (PAI) is a new metric for physical activity tracking, and is associated with reduced risk of all-cause and cardiovascular mortality. We prospectively investigated whether PAI is associated with lower body weight gain in a healthy population. Methods: We included 85,243 participants (40,037 men and 45,206 women) who participated in at least one of three waves of the Trøndelag Health Study (HUNT1: 1984-86, HUNT2: 1995-97, and HUNT3: 2006-08). We used questionnaires to estimate PAI, and linear mixed models to examine body weight according to PAI levels at three study waves. We also conducted regression analyses to assess separate relationships between change in PAI and the combined changes in PAI and physical activity recommendations, according to body weight from HUNT1 to HUNT3. Findings: Compared with HUNT1, body weight was 8.6 and 6.7 kg higher at HUNT3 for men and women, respectively, but was lower among those with ≥200 PAI at HUNT3. For both sexes, a change from inactive (0 PAI) at HUNT1 to ≥100 weekly PAI-score at HUNT2 and HUNT3, and a ≥100 PAI-score at all three occasions were associated with lower body weight gain, compared with the reference group (0 PAI at all three waves). Importantly, among both sexes, obtaining ≥100 weekly PAI at HUNT1 and HUNT3 was associated with lower body weight gain regardless of adhering to physical activity guidelines. Interpretation: Adhering to a high PAI over time may be a useful tool to attenuate excessive body weight gain in a population free from cardiovascular disease.

• 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.

• Tarp, Jakob; Grøntved, Anders; Sanchez-Lastra, Miguel A.; Dalene, Knut Eirik; Ding, Ding & Ekelund, Ulf (2021). Fitness, fatness, and mortality in men and women from the UK biobank: Prospective cohort study. Journal of the American Heart Association (JAHA). ISSN 2047-9980. 10(6). doi: 10.1161/JAHA.120.019605. Full text in Research Archive Show summary

  Background: Cardiorespiratory fitness may moderate the association between obesity and all‐cause mortality (ie, the “fat‐but‐fit” hypothesis), but unaddressed sources of bias are a concern. Methods and Results: Cardiorespiratory fitness was estimated as watts per kilogram from a submaximal bicycle test in 77 169 men and women from the UK Biobank cohort and combined with World Health Organization standard body mass index categories, yielding 9 unique fitness‐fatness combinations. We also formed fitness‐fatness combinations based on bioimpedance as a direct measure of body composition. All‐cause mortality was ascertained from death registries. Multivariable‐adjusted Cox regression models were used to estimate hazard ratios and 95% CIs. We examined the association between fitness‐fatness combinations and all‐cause mortality in models with progressively more conservative approaches for accounting for reverse causation, misclassification of body composition, and confounding. Over a median follow‐up of 7.7 years, 1731 participants died. In our base model, unfit men and women had higher risk of premature mortality irrespective of levels of adiposity, compared with the normal weight–fit reference. This pattern was attenuated but maintained with more conservative approaches in men, but not in women. In analysis stratified by sex and excluding individuals with prevalent major chronic disease and short follow‐up and using direct measures of body composition, mortality risk was 1.78 (95% CI, 1.17–2.71) times higher in unfit‐obese men but not higher in obese‐fit men (0.94 [95% CI, 0.60–1.48]). In contrast, there was no increased risk in obese‐unfit women (1.09 [95% CI, 0.44–1.05]) as compared with the reference. Conclusions: Cardiorespiratory fitness modified the association between obesity and mortality in men, but this pattern appeared susceptible to biases in women.

• Mühlen, Jan M.; Stang, Julie; Lykke Skovgaard, Esben; Júdice, Pedro B.; Molina-Garcia, Pablo & Johnston, William [Show all 15 contributors for this article] (2021). Recommendations for determining the validity of consumer wearable heart rate devices: Expert statement and checklist of the INTERLIVE Network. British Journal of Sports Medicine. ISSN 0306-3674. 55(14), p. 767–779. doi: 10.1136/bjsports-2020-103148. Full text in Research Archive Show summary

  Assessing vital signs such as heart rate (HR) by wearable devices in a lifestyle-related environment provides widespread opportunities for public health related research and applications. Commonly, consumer wearable devices assessing HR are based on photoplethysmography (PPG), where HR is determined by absorption and reflection of emitted light by the blood. However, methodological differences and shortcomings in the validation process hamper the comparability of the validity of various wearable devices assessing HR. Towards Intelligent Health and Well-Being: Network of Physical Activity Assessment (INTERLIVE) is a joint European initiative of six universities and one industrial partner. The consortium was founded in 2019 and strives towards developing best-practice recommendations for evaluating the validity of consumer wearables and smartphones. This expert statement presents a best-practice validation protocol for consumer wearables assessing HR by PPG. The recommendations were developed through the following multi-stage process: (1) a systematic literature review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, (2) an unstructured review of the wider literature pertaining to factors that may introduce bias during the validation of these devices and (3) evidence-informed expert opinions of the INTERLIVE Network. A total of 44 articles were deemed eligible and retrieved through our systematic literature review. Based on these studies, a wider literature review and our evidence-informed expert opinions, we propose a validation framework with standardised recommendations using six domains: considerations for the target population, criterion measure, index measure, testing conditions, data processing and the statistical analysis. As such, this paper presents recommendations to standardise the validity testing and reporting of PPG-based HR wearables used by consumers. Moreover, checklists are provided to guide the validation protocol development and reporting. This will ensure that manufacturers, consumers, healthcare providers and researchers use wearables safely and to its full potential.

• 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
• Júdice, Pedro B.; Magalhães, João P.; Rosa, Gil B.; Correia, Inês R.; Ekelund, Ulf & Sardinha, Luís B. (2020). Sedentary behavior compensation to 1-year exercise RCT in patients with type 2 diabetes. Translational Sports Medicine (TSM). ISSN 2573-8488. 3(2), p. 154–163. doi: 10.1002/tsm2.96.
• Johnston, William; Júdice, Pedro B.; Molina-Garcia, Pablo; Mühlen, Jan M; Lykke Skovgaard, Esben & Stang, Julie [Show all 15 contributors for this article] (2020). Recommendations for determining the validity of consumer wearable and smartphone step count: Expert statement and checklist of the INTERLIVE network. British Journal of Sports Medicine. ISSN 0306-3674. doi: 10.1136/bjsports-2020-103147. Full text in Research Archive
• 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
• Ricardo, Luiza Isnardi Cardoso; Wendt, Andrea; Galliano, Leony; Muller, Werner de Andrade; Cruz, Gloria Izabel Niño & Wehrmeister, Fernando [Show all 9 contributors for this article] (2020). Number of days required to estimate physical activity constructs objectively measured in different age groups: Findings from three Brazilian (Pelotas) population-based birth cohorts. PLOS ONE. ISSN 1932-6203. doi: 10.1371/journal.pone.0216017. Full text in Research Archive Show summary

  Purpose: The present study aims to estimate the minimum number of accelerometer measurement days needed to estimate habitual physical activity (PA) among 6- (2010), 18- (2011) and 30- (2012) year-old participants, belonging to three population-based Brazilian birth cohorts. Method: PA was assessed by triaxial wrist-worn GENEActiv accelerometers and the present analysis is restricted to participants with at least 6 consecutive days of measurement. Accelerometer raw data were analyzed with R-package GGIR. Description of PA measures (overall PA, moderate-to-vigorous PA (MVPA), light PA (LPA)) on weekdays and weekend days were conducted, and statistical differences were tested with chi-squared and Kruskal-Wallis tests. Spearman Brown Formulae was applied to test reliability of different number of days of accelerometer use. Results: Differences between week and weekend days regarding LPA, MVPA and overall PA, were only observed among 30-year-olds. Higher levels of MVPA (p = 0.006) and overall PA (p<0.001) were identified on weekdays. For overall PA, to achieve a reliability coefficient >0.70, two and three days of measurement were needed in adults and children, respectively. For LPA, a reliability coefficient >0.70 was achieved with five days in 6-year-old children, three days in 18-year-old young adults, and four days in 30-year-old adults. Considering MVPA, four days would be necessary to represent a week of measurement among all cohort groups. Conclusion: Our results show that four and five measurement days are needed to estimate all habitual PA constructs, for children and adults, respectively. Also, among 30-year-old adults, it is important to make efforts towards weekend days measurement.

• Ding, Ding; Mielke, Gregore I.; Silva, Inácio Crochemore M.; Wehrmeister, Fernando César; Horta, Bernardo L. & Brage, Soren [Show all 8 contributors for this article] (2020). Prenatal and birth predictors of objectively measured physical activity and sedentary time in three population-based birth cohorts in Brazil. Scientific Reports. ISSN 2045-2322. 10. doi: 10.1038/s41598-019-57070-x. Full text in Research Archive Show summary

  Physical inactivity is a global pandemic with no signs of improvement. Prolonged sitting time is an emerging risk factor that exacerbates the health consequences of physical inactivity. Both behaviours are influenced by various individual and environmental factors but it remains unknown whether early-life exposures “program” these behaviours in later life. The current evidence is limited by a small number of studies which were primarily conducted in high-income countries, and a narrow range of early-life variables examined. Using data from three population-based Brazilian birth cohorts (analytical samples: n = 2740 for 1982 cohort, aged 30 years; n = 3592 for 1993 cohort, aged 18; n = 2603 for 2004 cohort, aged 6), we show that being female and higher family socioeconomic status at birth are strong and consistent predictors of lower physical activity and higher sedentary time from childhood to adulthood. Meanwhile, higher birth weight and lower birth order may also predict lower physical activity and higher sedentary time. Our findings are distinct from evidence from high-income countries, suggesting the importance of broader socioeconomic context in determining individual’s activity patterns through the life- course. Such evidence is essential for understanding the biological etiology and socioeconomic context of physical activity and sedentary behaviour at an early stage in life.

• Kallio, Jouni; Hakonen, Harto; Syväoja, Heidi; Kulmala, Janne; Kankaanpää, Anna & Ekelund, Ulf [Show all 7 contributors for this article] (2020). Changes in physical activity and sedentary time during adolescence: Gender differences during weekdays and weekend days. Scandinavian Journal of Medicine & Science in Sports. ISSN 0905-7188. 30(7), p. 1265–1275. doi: 10.1111/sms.13668. Full text in Research Archive Show summary

  Objectives: The objective of this study was to determine the gender‐specific and time‐segmented changes in accelerometer measured physical activity (PA) and sedentary time (ST) during adolescence. Methods: The study population (N = 970) consisted of children from nine schools throughout Finland. At the baseline, the children were in grades 4‐7 (ages 10‐13). Five times during the two‐year follow‐up period, hip‐worn accelerometers (ActiGraph GT3X+) were deployed for seven consecutive days in order to monitor the pupils’ PA. The daily time spent in vigorous (VPA), moderate to vigorous (MVPA), and light physical activity(LPA), as well as sedentary time(ST), were assessed. Results: Significant gender differences were observed in terms of the changes in MVPA and ST during the follow‐up period. The total MVPA declined significantly in boys (by 2.2min/day/year from 60 min/d at baseline) but not in girls (49 min/d at baseline). The total ST increased both in boys (by 20.7%‐points/y) and in girls (by 16.1%‐points/y, P < .001). However, when we compared the results during the weekdays and weekend days separately, we observed that the declines in MVPA and increases in ST were greater in boys than in girls during the weekend days. Conclusion: A greater decrease in PA and a greater increase in ST during adolescence were observed among boys than among girls, especially during weekend days. In order to diminish these unfavorable behavioral changes during adolescence, we encourage the separate tailoring of interventions for boys and girls and for weekdays and weekends.

• Bielemann, Renata M.; Silveira, Marysabel P. T.; Lutz, Bárbara H.; Miranda, Vanessa I. A.; Gonzalez, Maria Cristina & Brage, Soren [Show all 8 contributors for this article] (2020). Objectively Measured Physical Activity and Polypharmacy Among Brazilian Community-Dwelling Older Adults. Journal of Physical Activity and Health. ISSN 1543-3080. 17(7), p. 729–735. doi: 10.1123/jpah.2019-0461. Full text in Research Archive Show summary

  Background: Previous observations regarding association between physical activity (PA) and use of medicines among older adults are derived from self-reported PA. This study aimed to evaluate the association between objectively measured PA and polypharmacy among older adults with multimorbidity in Southern Brazil. Methods: This study included 875 noninstitutionalized older people, aged ≥60 years. Prescribed medicines used in the 15 days prior to the interview, socioeconomic data, and the presence of comorbidities were self-reported. Accelerometers were used to evaluate PA following the interview. Results: Prevalence of polypharmacy (≥5 medicines) was 38.3% (95% confidence interval, 35.0–41.5); those belonging to the lowest tertile of PA used more medicines. The authors observed a significant inverse association for polypharmacy between men belonging to the second and third tertiles of PA for objectively measured overall PA and light PA compared with the most inactive tertile. For women, the association between PA and polypharmacy was significant for overall, light, and moderate to vigorous PA only in the third tertile. Conclusions: Overall, light and moderate to vigorous PA were inversely associated to polypharmacy and differed by gender. Promotion of PA in older adults may be an effective intervention to reduce the number of medicines used independent of the number of comorbidities.

• Hall, Katherine S.; Hyde, Eric T.; Bassett, David R.; Carlson, Susan A.; Carnethon, Mercedes & Ekelund, Ulf [Show all 15 contributors for this article] (2020). Systematic review of the prospective association of daily step counts with risk of mortality, cardiovascular disease, and dysglycemia. International Journal of Behavioral Nutrition and Physical Activity. ISSN 1479-5868. 17. doi: 10.1186/s12966-020-00978-9. Full text in Research Archive Show summary

  Background: Daily step counts is an intuitive metric that has demonstrated success in motivating physical activity in adults and may hold potential for future public health physical activity recommendations. This review seeks to clarify the pattern of the associations between daily steps and subsequent all-cause mortality, cardiovascular disease (CVD) morbidity and mortality, and dysglycemia, as well as the number of daily steps needed for health outcomes. Methods: A systematic review was conducted to identify prospective studies assessing daily step count measured by pedometer or accelerometer and their associations with all-cause mortality, CVD morbidity or mortality, and dysglycemia (dysglycemia or diabetes incidence, insulin sensitivity, fasting glucose, HbA1c). The search was performed across the Medline, Embase, CINAHL, and the Cochrane Library databases from inception to August 1, 2019. Eligibility criteria included longitudinal design with health outcomes assessed at baseline and subsequent timepoints; defining steps per day as the exposure; reporting all-cause mortality, CVD morbidity or mortality, and/or dysglycemia outcomes; adults ≥18 years old; and non-patient populations. Results: Seventeen prospective studies involving over 30,000 adults were identified. Five studies reported on all-cause mortality (follow-up time 4–10 years), four on cardiovascular risk or events (6 months to 6 years), and eight on dysglycemia outcomes (3 months to 5 years). For each 1000 daily step count increase at baseline, risk reductions in all-cause mortality (6–36%) and CVD (5–21%) at follow-up were estimated across a subsample of included studies. There was no evidence of significant interaction by age, sex, health conditions or behaviors (e.g., alcohol use, smoking status, diet) among studies that tested for interactions. Studies examining dysglycemia outcomes report inconsistent findings, partially due to heterogeneity across studies of glycemia-related biomarker outcomes, analytic approaches, and sample characteristics. Conclusions: Evidence from longitudinal data consistently demonstrated that walking an additional 1000 steps per day can help lower the risk of all-cause mortality, and CVD morbidity and mortality in adults, and that health benefits are present below 10,000 steps per day. However, the shape of the dose-response relation is not yet clear. Data are currently lacking to identify a specific minimum threshold of daily step counts needed to obtain overall health benefit.

• 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.

• Chaput, Jean-Philippe; Willumsen, Juana F.; Bull, Fiona; Chou, Roger; Ekelund, Ulf & Firth, Joseph [Show all 9 contributors for this article] (2020). 2020 WHO guidelines on physical activity and sedentary behaviour for children and adolescents aged 5–17 years: summary of the evidence. International Journal of Behavioral Nutrition and Physical Activity. ISSN 1479-5868. 17. doi: 10.1186/s12966-020-01037-z. Full text in Research Archive Show summary

  Background: The World Health Organization (WHO) released in 2020 updated global guidelines on physical activity and sedentary behaviour for children, adolescents, adults, older adults and sub-populations such as pregnant and postpartum women and those living with chronic conditions or disabilities. Objective: To summarize the evidence on the associations between physical activity, sedentary behaviour, and health-related outcomes used to inform the 2020 WHO guidelines on physical activity and sedentary behaviour for children and adolescents aged 5–17 years. Methods: The update of the WHO guideline recommendations for children and adolescents utilized and systematically updated the evidence syntheses on physical activity and sedentary behaviour conducted for the 2016 Canadian 24-Hour Movement Guidelines for Children and Youth, the 2019 Australian 24-Hour Movement Guidelines for Children and Young People (5–17 years), and the 2018 Physical Activity Guidelines for Americans, Second Edition. Systematic reviews published from 2017 up to July 2019 that addressed the key questions were identified, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to rate the certainty of the evidence for the entire body of evidence. Results: The updated literature search yielded 21 relevant systematic reviews. The evidence base reviewed (i.e., existing and new systematic reviews) provided evidence that greater amounts and higher intensities of physical activity as well as different types of physical activity (i.e., aerobic and muscle and bone strengthening activities) are associated with improved health outcomes (primarily intermediate outcomes). There was sufficient evidence to support recommendations on limiting sedentary behaviours, which was not addressed in the 2010 WHO guidelines. However, there is still insufficient evidence available to fully describe the dose-response relationships between physical activity or sedentary behaviour and health outcomes, and whether the associations vary by type or domain of physical activity or sedentary behaviour. Conclusions: Addressing the identified research gaps will better inform guideline recommendations in children and adolescents, and future work should aim to prioritize these areas of research. In the meantime, investment and leadership is needed to scale up known effective policies and programs aimed at increasing activity in children and adolescents.

• Dempsey, Paddy; Biddle, Stuart JH; Buman, Matthew P.; Chastin, Sebastian; Ekelund, Ulf & Friedenreich, Christine M. [Show all 12 contributors for this article] (2020). New global guidelines on sedentary behaviour and health for adults: broadening the behavioural targets. International Journal of Behavioral Nutrition and Physical Activity. ISSN 1479-5868. 17. doi: 10.1186/s12966-020-01044-0. Full text in Research Archive Show summary

  Background: In 2018, the World Health Organisation (WHO) commenced a program of work to update the 2010 Global Recommendations on Physical Activity for Health, for the first-time providing population-based guidelines on sedentary behaviour. This paper briefly summarizes and highlights the scientific evidence behind the new sedentary behaviour guidelines for all adults and discusses its strengths and limitations, including evidence gaps/research needs and potential implications for public health practice. Methods: An overview of the scope and methods used to update the evidence is provided, along with quality assessment and grading methods for the eligible new systematic reviews. The literature search update was conducted for WHO by an external team and reviewers used the AMSTAR 2 (Assessment of Multiple Systematic Reviews) tool for critical appraisal of the systematic reviews under consideration for inclusion. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) method was used to rate the certainty (i.e. very low to high) of the evidence. Results: The updated systematic review identified 22 new reviews published from 2017 up to August 2019, 14 of which were incorporated into the final evidence profiles. Overall, there was moderate certainty evidence that higher amounts of sedentary behaviour increase the risk for all-cause, cardiovascular disease (CVD) and cancer mortality, as well as incidence of CVD, cancer, and type 2 diabetes. However, evidence was deemed insufficient at present to set quantified (time-based) recommendations for sedentary time. Moderate certainty evidence also showed that associations between sedentary behaviour and all-cause, CVD and cancer mortality vary by level of moderate-to-vigorous physical activity (MVPA), which underpinned additional guidance around MVPA in the context of high sedentary time. Finally, there was insufficient or low-certainty systematic review evidence on the type or domain of sedentary behaviour, or the frequency and/or duration of bouts or breaks in sedentary behaviour, to make specific recommendations for the health outcomes examined. Conclusions: The WHO 2020 guidelines are based on the latest evidence on sedentary behaviour and health, along with interactions between sedentary behaviour and MVPA, and support implementing public health programmes and policies aimed at increasing MVPA and limiting sedentary behaviour. Important evidence gaps and research opportunities are identified.

• Haapala, Eero A.; Wiklund, Petri; Lintu, Niina; Tompuri, Tuomo; Väistö, Juuso & Finni, Taija [Show all 12 contributors for this article] (2020). Cardiorespiratory Fitness, Physical Activity, and Insulin Resistance in Children. Medicine & Science in Sports & Exercise. ISSN 0195-9131. 52(5), p. 1144–1152. doi: 10.1249/MSS.0000000000002216. Full text in Research Archive Show summary

  Purpose: Few studies have investigated the independent and joint associations of cardiorespiratory fitness (CRF) and body fat percentage (BF%) with insulin resistance in children. We investigated the independent and combined associations of CRF and BF% with fasting glycemia and insulin resistance and their interactions with physical activity (PA) and sedentary time among 452 children age 6 to 8 yr. Methods: We assessed CRF with a maximal cycle ergometer exercise test and used allometrically scaled maximal power output (Wmax) for lean body mass (LM1.13) and body mass (BM1) as measures of CRF. The BF% and LM were measured by dual-energy X-ray absorptiometry, fasting glycemia by fasting plasma glucose, and insulin resistance by fasting serum insulin and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). The PA energy expenditure, moderate-to-vigorous PA (MVPA), and sedentary time were assessed by combined movement and heart rate sensor. Results: Wmax/LM1.13 was not associated with glucose (β = 0.065, 95% confidence interval [CI] = −0.031 to 0.161), insulin (β = −0.079, 95% CI = −0.172 to 0.015), or HOMA-IR (β = −0.065, 95% CI = −0.161 to 0.030). Wmax/BM1 was inversely associated with insulin (β = −0.289, 95% CI = −0.377 to −0.200) and HOMA-IR (β = −0.269, 95% CI = −0.359 to −0.180). The BF% was directly associated with insulin (β = 0.409, 95% CI = 0.325 to 0.494) and HOMA-IR (β = 0.390, 95% CI = 0.304 to 0.475). Higher Wmax/BM1, but not Wmax/LM1.13, was associated with lower insulin and HOMA-IR in children with higher BF%. Children with higher BF% and who had lower levels of MVPA or higher levels of sedentary time had the highest insulin and HOMA-IR. Conclusions: Children with higher BF% together with less MVPA or higher levels of sedentary time had the highest insulin and HOMA-IR. Cardiorespiratory fitness appropriately controlled for body size and composition using LM was not related to insulin resistance among children.

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• Gill, Jason M.R.; Chico, Timothy J.; Doherty, Aiden; Dunn, Jessilyn; Ekelund, Ulf & Katzmarzyk, Peter T. [Show all 9 contributors for this article] (2023). Potential impact of wearables on physical activity guidelines and interventions: Opportunities and challenges. British Journal of Sports Medicine. ISSN 0306-3674. doi: 10.1136/bjsports-2023-106822.
• Mañas, Asier; del Pozo Cruz, Borja; Ekelund, Ulf; Losa Reyna, José; Rodríguez Gómez, Irene & Carnicero Carreño, José Antonio [Show all 9 contributors for this article] (2022). Response to McAvoy and Tudor-Locke on their commentary on our manuscript: “Association of accelerometer-derived step volume and intensity with hospitalizations and mortality in older adults: A prospective cohort study”. Journal of Sport and Health Science. ISSN 2095-2546. 11(6), p. 639–640. doi: 10.1016/j.jshs.2022.09.001.
• 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.
• Wang, Eivind; Ekelund, Ulf & Solberg, Trine (2022). Treningsforsker lei trendene - dette er treningen som virkelig fungerer. [Newspaper]. Nidaros Pluss.
• Wang, Eivind; Ekelund, Ulf & Solberg, Trine (2022). Treningsforsker lei trendene - dette er treningen som virkelig fungerer. [Newspaper]. Bygdeposten Pluss.
• Wang, Eivind; Ekelund, Ulf & Solberg, Trine (2022). Treningsforsker lei trendene - dette er treningen som virkelig fungerer. [Newspaper]. Sandefjords Blad Pluss.
• Wang, Eivind; Ekelund, Ulf & Solberg, Trine (2022). Treningsforsker lei trendene – dette er treningen som virkelig fungerer. [Internet]. ifinnmark.no.
• Stamatakis, Emmanuel; Ding, Ding; Ekelund, Ulf & Bauman, Adrian (2021). Sliding down the risk factor rankings: Reasons for and consequences of the dramatic downgrading of physical activity in the Global Burden of Disease 2019. British Journal of Sports Medicine. ISSN 0306-3674. 55(21), p. 1222–1223. doi: 10.1136/bjsports-2021-104064.
• Dalene, Knut Eirik; Tarp, Jakob & Ekelund, Ulf (2021). The role of occupational physical activity on longevity – Authors' reply. The Lancet Public Health. ISSN 2468-2667. 6(8), p. E545–E545. doi: 10.1016/S2468-2667(21)00155-9.
• Ding, Ding; Lee, I-Min; Bauman, Adrian; Ekelund, Ulf & Stamatakis, Emmanuel (2021). Dietary risk versus physical inactivity: a forced comparison with policy implications? The Lancet. ISSN 0140-6736. 397(10286), p. 1709–1710. doi: 10.1016/S0140-6736(21)00801-1.
• DiPietro, Loretta; Al-Ansari, Salih S.; Biddle, Stuart JH; Borodulin, Katja; Bull, Fiona C. & Buman, Matthew P. [Show all 29 contributors for this article] (2020). Advancing the global physical activity agenda: recommendations for future research by the 2020 WHO physical activity and sedentary behavior guidelines development group. International Journal of Behavioral Nutrition and Physical Activity. ISSN 1479-5868. 17. doi: 10.1186/s12966-020-01042-2. Show summary

  Background: In July, 2019, the World Health Organization (WHO) commenced work to update the 2010 Global Recommendations on Physical Activity for Health and established a Guideline Development Group (GDG) comprising expert public health scientists and practitioners to inform the drafting of the 2020 Guidelines on Physical Activity and Sedentary Behavior. The overall task of the GDG was to review the scientific evidence and provide expert advice to the WHO on the amount of physical activity and sedentary behavior associated with optimal health in children and adolescents, adults, older adults (> 64 years), and also specifically in pregnant and postpartum women and people living with chronic conditions or disabilities. Methods: The GDG reviewed the available evidence specific to each sub-population using systematic protocols and in doing so, identified a number of gaps in the existing literature. These proposed research gaps were discussed and verified by expert consensus among the entire GDG. Results: Evidence gaps across population sub-groups included a lack of information on: 1) the precise shape of the dose-response curve between physical activity and/or sedentary behavior and several of the health outcomes studied; 2) the health benefits of light-intensity physical activity and of breaking up sedentary time with light-intensity activity; 3) differences in the health effects of different types and domains of physical activity (leisure-time; occupational; transportation; household; education) and of sedentary behavior (occupational; screen time; television viewing); and 4) the joint association between physical activity and sedentary time with health outcomes across the life course. In addition, we acknowledge the need to conduct more population-based studies in low- and middle-income countries and in people living with disabilities and/or chronic disease, and to identify how various sociodemographic factors (age, sex, race/ethnicity, socioeconomic status) modify the health effects of physical activity, in order to address global health disparities. Conclusions: Although the 2020 WHO Guidelines for Physical Activity and Sedentary Behavior were informed by the most up-to-date research on the health effects of physical activity and sedentary time, there is still substantial work to be done in advancing the global physical activity agenda.

• 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.

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