Jostein Steene-Johannessen

• Ekelund, Ulf; Tarp, Jakob; Ding, Ding; Sanchez-Lastra, Miguel Adriano; Dalene, Knut Eirik & Anderssen, Sigmund Alfred [Show all 20 contributors for this article] (2026). Deaths potentially averted by small changes in physical activity and sedentary time: an individual participant data meta-analysis of prospective cohort studies. The Lancet. ISSN 0140-6736. 407(10526), p. 339–349. doi: 10.1016/S0140-6736(25)02219-6. Full text in Research Archive
• Husøy, Anders; Kolle, Elin; Steene-Johannessen, Jostein; Andersen, Lars Bo; Ekelund, Ulf & Anderssen, Sigmund Alfred (2025). Tracking of device-measured sedentary time, cardiorespiratory fitness, and cardiometabolic risk factors from childhood to young adulthood. American Journal of Preventive Cardiology. 24. doi: 10.1016/j.ajpc.2025.101313. Full text in Research Archive Show summary

  Background The tracking of clustered cardiometabolic risk from childhood to young adulthood, i.e., whether an unfavourable cardiometabolic risk profile persists from childhood into young adulthood, remain uncertain and has previously not included factors like sedentary time and cardiorespiratory fitness. Methods We used longitudinal data from the Physical Activity among Norwegian Children Studies (PANCS), where 731 participants participated at age 9 (2005–2006) and 258 of these again at age 24 (2019–2021). Multiple imputation was performed for all eligible participants at age 24 (n = 708). The cardiometabolic risk factors comprised body mass index (BMI), waist circumference, device-measured sedentary time, directly measured peak oxygen uptake (VO2peak), systolic blood pressure, LDL-cholesterol, insulin, high-sensitivity CRP, and a clustered risk Z-score. Tracking was analysed using regression models. Results Waist circumference and BMI demonstrated strong tracking, whereas moderate tracking was observed for VO2peak, LDL-cholesterol, systolic blood pressure, and clustered cardiometabolic risk. Insulin, high-sensitivity CRP, and sedentary time exhibited no tracking. Unfavourable childhood levels of risk factors demonstrating moderate to strong tracking were highly predictive, with those in the least favourable quartile of clustered risk at age 9 almost six times more likely than their peers to be in the least favourable quartile at age 24 years. Tracking was generally similar between sexes, but waist circumference tracked somewhat stronger among females while VO2peak tracked stronger among males. Conclusions Several cardiometabolic risk factors demonstrated moderate to strong tracking from childhood to young adulthood, supporting early intervention. However, sedentary behaviour may be less stable and easier to modify compared with more stable cardiometabolic risk factors.

• Husøy, Anders; Kolle, Elin; Steene-Johannessen, Jostein; Andersen, Lars Bo; Anderssen, Sigmund Alfred & Ekelund, Ulf (2025). Prospective Associatons of Physical Activity and Sedentary Time in Adolescence with Cardiometabolic Risk in Young Adulthood. Medicine & Science in Sports & Exercise. ISSN 0195-9131. 57(3), p. 535–543. doi: 10.1249/MSS.0000000000003595. Full text in Research Archive Show summary

  Purpose The relationship between sedentary time, physical activity, and cardiometabolic risk factors during the transition from adolescence to adulthood remains uncertain. We examined the prospective associations of sedentary time and physical activity at age 15 yr with cardiometabolic risk markers at age 24 yr. Methods We used data from the Physical Activity among Norwegian Children Studies. Sedentary time, moderate-to-vigorous physical activity (MVPA), and vigorous physical activity (VPA) were measured by accelerometry. Outcomes included body mass index (BMI), waist circumference, visceral fat, maximal oxygen uptake (V̇O2max), systolic blood pressure, LDL-cholesterol, insulin, high-sensitivity C-reactive protein, and a clustered risk Z-score. The prospective associations were modeled through regression. Results A total of 731 boys and girls participated at ages 9 yr (2005–2006) and 15 yr (2011–2012), and 258 of these participated again at age 24 yr (2019–2021). Multiple imputation was performed for all eligible individuals (n = 708). Each standard deviation increase (minutes per day) in sedentary time at age 15 yr was associated with lower V̇O2max at age 24 yr (β = −1.6 mL·kg−1·min−1; 95% confidence interval (CI), −2.8 to −0.5). Each standard deviation increase (minutes per day) in MVPA (β = 1.6 mL·kg−1·min−1; 95% CI, 0.8 to 2.4) and VPA (β = 1.6 mL·kg−1·min−1; 95% CI, 0.8 to 2.4) at age 15 yr were associated with higher V̇O2max at age 24 yr. VPA in adolescence was further inversely associated with visceral fat mass (β = −41 g; 95% CI, −78 to −3), insulin level (β = −4.3 pmol·L−1; 95% CI, −8.2 to −0.4), and the clustered risk Z-score (β = −0.09; 95% CI, −0.18 to −0.01) in young adulthood. Childhood BMI modified the association of both MVPA and VPA with clustered risk, with the greatest magnitude of association observed in the highest BMI tertile. Conclusions Physical activity, especially of vigorous intensity, during adolescence appears to beneficially affect cardiometabolic health in young adulthood. These health benefits may be most pronounced among overweight/obese youth.

• Engh, Anette; Rueegg, Corina Silvia; Trent, Pernille Kristina Bjerre; Opheim, Linn Øvstebø; Engeskaug, Ida & Nordskar, Nina Jebens [Show all 10 contributors for this article] (2025). Physical activity and lower extremity lymphedema among endometrial cancer survivors: A population-based cross-sectional study. Gynecologic Oncology. ISSN 0090-8258. 195, p. 82–88. doi: 10.1016/j.ygyno.2025.03.009. Full text in Research Archive Show summary

  Objective The aims of this cross-sectional study were to describe the prevalence of self-reported lower extremity lymphedema (LEL) by different physical activity (PA) levels and to examine if higher levels of PA are associated with lower odds of self-reported LEL among endometrial cancer survivors. Methods Women treated for assumed early-stage endometrial cancer between 2006 and 2021 were invited to complete the Lower Extremity Lymphedema Screening Questionnaire (LELSQ) and the Physical Activity Frequency, Intensity, and Duration (PAFID) questionnaire. Responses of PAFID were converted into metabolic equivalent of task minutes per week (MET-min/week), and participants were categorized into different PA levels: meeting (≥500 MET-min/week) versus not meeting PA guidelines; low active (<500 MET-min/week), active (500–1000 MET-min/week), and high active (>1000 MET-min/week); and PA quartiles. Results Among 1077 included, the prevalence of LEL was 48 %, 32 %, and 32 % among the low active, active, and high active survivors, respectively. Compared to the low active, the active survivors had 40 % lower odds of LEL (OR 0.60, 95 % CI 0.44–0.81), but no further reduction was observed among the high active survivors (OR 0.71, 95 % CI 0.47–1.06). According to PA quartiles, higher PA levels were associated with lower odds of LEL, but not in a linear dose-response way. Conclusion Findings suggest that regular PA according to the current PA guidelines is associated with decreased the odds of self-reported LEL among endometrial cancer survivors; however, causality of association needs to be verified in a longitudinal setting.

• Hammer, Stian; Toussaint, Michel; Kvidaland, Haakon Kristian; Røksund, Ola Drange; Hansen, Bjørge Hermann & Bovim, Lars Peder Vatshelle [Show all 10 contributors for this article] (2025). Physical Activity and Sedentary Behavior in Norwegian Boys With Duchenne Muscular Dystrophy: A Cross-Sectional Study. Muscle and Nerve. ISSN 0148-639X. 72(1), p. 82–92. doi: 10.1002/mus.28418. Full text in Research Archive Show summary

  Introduction/Aims: The World Health Organization (WHO) recommends that all children, including those with disabilities, should be physically active for optimal health benefits. The primary aim of this study was to quantify and describe overall physical activity (PA) levels and sedentary behavior in Norwegian boys with Duchenne muscular dystrophy (DMD), in comparison with healthy controls. Methods: Boys aged 5–18 years with DMD were enrolled in this cross-sectional study. Sedentary time, light PA, and moderate-to-vigorous physical activity (MVPA) were measured with use of an accelerometer for seven consecutive days. Data on PA were obtained via self-report questionnaires. Comparisons were drawn between ambulatory and non-ambulatory boys with DMD, and between ambulatory boys with DMD and healthy controls, with data retrieved from a database. Results: Twenty-eight boys with DMD participated, with a mean age of 12.6 (standard deviation 3.6) years, of whom 24 had accelerometry data. Ambulatory boys had higher PA levels compared with non-ambulatory boys (p = 0.008), and 53% of ambulatory boys met the WHO's recommendation for daily MVPA, whereas none of their non-ambulatory counterparts did. Boys with DMD were less physically active compared with healthy peers. Sedentary time was higher over weekends compared with weekdays, and increased with age both in the DMD group and in healthy controls. Discussion: Further research is needed to improve participation in PA by exploring barriers and facilitators, with a particular focus on non-ambulatory boys with DMD.

• Dohrn, Ing-Mari; Tarp, Jakob; Steene-Johannessen, Jostein; Vasankari, Tommi & Hagströmer, Maria (2024). Device-measured physical activity and sedentary time in the Nordic countries: A scoping review of population-based studies. Journal of Sport and Health Science. ISSN 2095-2546. 13(5), p. 650–660. doi: 10.1016/j.jshs.2024.04.003. Full text in Research Archive Show summary

  Purpose: The purpose of this scoping review was to summarize and describe the methodology and results from population-based studies of physical activity and sedentary time measured with devices in the Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden) and published in 2000 or later. Methods: A systematic search was carried out in PubMed and Web of Science in June 2023 using predefined search terms. Results: Fourteen unique research projects or surveillance studies were identified. Additionally, 2 surveillance studies published by national agencies were included, resulting in a total of 16 studies for inclusion. National surveillance systems exist in Finland and Norway, with regular survey waves in school-aged children/adolescents and adults. In Denmark, recent nationally representative data have been collected in school children only. So far, Sweden has no regular national surveillance system using device-based data collection. No studies were found from Iceland. The first study was conducted in 2001 and the most recent in 2022, with most data collected from 2016 to date. Five studies included children/adolescents 6–18 years, no study included preschoolers. In total 11 studies included adults, of which 8 also covered older adults. No study focused specifically on older adults. The analytical sample size ranged from 205 to 27,890. Detailed methodology is presented, such as information on sampling strategy, device type and placement, wear protocols, and physical activity classification schemes. Levels of physical activity and sedentary time in children/adolescents, adults, and older adults across the Nordic countries are presented. Conclusion: A growing implementation of device-based population surveillance of physical activity and sedentary behavior in the Nordic countries has been identified. The variety of devices, placement, and data procedures both within and between the Nordic countries highlights the challenges when it comes to comparing study outcomes as well as the need for more standardized data collection.

• Zhou, Bin; Cesare, Mariachiara Di; Aguilar-Salinas, Carlos A; Ahmad, Nor Ani; Bovet, Pascal & Chen, Zhengming [Show all 51 contributors for this article] (2024). General and abdominal adiposity and hypertension in eight world regions: a pooled analysis of 837 population-based studies with 7·5 million participants. The Lancet. ISSN 0140-6736. 404(10455), p. 851–863. doi: 10.1016/S0140-6736(24)01405-3. Full text in Research Archive Show summary

  Background: Adiposity can be measured using BMI (which is based on weight and height) as well as indices of abdominal adiposity. We examined the association between BMI and waist-to-height ratio (WHtR) within and across populations of different world regions and quantified how well these two metrics discriminate between people with and without hypertension. Methods: We used data from studies carried out from 1990 to 2023 on BMI, WHtR and hypertension in people aged 20–64 years in representative samples of the general population in eight world regions. We graphically compared the regional distributions of BMI and WHtR, and calculated Pearson's correlation coefficients between BMI and WHtR within each region. We used mixed-effects linear regression to estimate the extent to which WHtR varies across regions at the same BMI. We graphically examined the prevalence of hypertension and the distribution of people who have hypertension both in relation to BMI and WHtR, and we assessed how closely BMI and WHtR discriminate between participants with and without hypertension using C-statistic and net reclassification improvement (NRI). Findings: The correlation between BMI and WHtR ranged from 0·76 to 0·89 within different regions. After adjusting for age and BMI, mean WHtR was highest in south Asia for both sexes, followed by Latin America and the Caribbean and the region of central Asia, Middle East and north Africa. Mean WHtR was lowest in central and eastern Europe for both sexes, in the high-income western region for women, and in Oceania for men. Conversely, to achieve an equivalent WHtR, the BMI of the population of south Asia would need to be, on average, 2·79 kg/m2 (95% CI 2·31–3·28) lower for women and 1·28 kg/m2 (1·02–1·54) lower for men than in the high-income western region. In every region, hypertension prevalence increased with both BMI and WHtR. Models with either of these two adiposity metrics had virtually identical C-statistics and NRIs for every region and sex, with C-statistics ranging from 0·72 to 0·81 and NRIs ranging from 0·34 to 0·57 in different region and sex combinations. When both BMI and WHtR were used, performance improved only slightly compared with using either adiposity measure alone. Interpretation: BMI can distinguish young and middle-aged adults with higher versus lower amounts of abdominal adiposity with moderate-to-high accuracy, and both BMI and WHtR distinguish people with or without hypertension. However, at the same BMI level, people in south Asia, Latin America and the Caribbean, and the region of central Asia, Middle East and north Africa, have higher WHtR than in the other regions. Funding: UK Medical Research Council and UK Research and Innovation (Innovate UK).

• Zhou, Bin; Rayner, Archie W.; Gregg, Edvard W; Sheffer, Kate E.; Carrillo-Larco, Rodrigo M & Bennett, James E [Show all 49 contributors for this article] (2024). Worldwide trends in diabetes prevalence and treatment from 1990 to 2022: a pooled analysis of 1108 population-representative studies with 141 million participants. The Lancet. ISSN 0140-6736. 404(10467), p. 2077–2093. doi: 10.1016/S0140-6736(24)02317-1. Full text in Research Archive Show summary

  Background Diabetes can be detected at the primary health-care level, and effective treatments lower the risk of complications. There are insufficient data on the coverage of treatment for diabetes and how it has changed. We estimated trends from 1990 to 2022 in diabetes prevalence and treatment for 200 countries and territories. Methods We used data from 1108 population-representative studies with 141 million participants aged 18 years and older with measurements of fasting glucose and glycated haemoglobin (HbA1c), and information on diabetes treatment. We defined diabetes as having a fasting plasma glucose (FPG) of 7·0 mmol/L or higher, having an HbA1c of 6·5% or higher, or taking medication for diabetes. We defined diabetes treatment as the proportion of people with diabetes who were taking medication for diabetes. We analysed the data in a Bayesian hierarchical meta-regression model to estimate diabetes prevalence and treatment. Findings In 2022, an estimated 828 million (95% credible interval [CrI] 757–908) adults (those aged 18 years and older) had diabetes, an increase of 630 million (554–713) from 1990. From 1990 to 2022, the age-standardised prevalence of diabetes increased in 131 countries for women and in 155 countries for men with a posterior probability of more than 0·80. The largest increases were in low-income and middle-income countries in southeast Asia (eg, Malaysia), south Asia (eg, Pakistan), the Middle East and north Africa (eg, Egypt), and Latin America and the Caribbean (eg, Jamaica, Trinidad and Tobago, and Costa Rica). Age-standardised prevalence neither increased nor decreased with a posterior probability of more than 0·80 in some countries in western and central Europe, sub-Saharan Africa, east Asia and the Pacific, Canada, and some Pacific island nations where prevalence was already high in 1990; it decreased with a posterior probability of more than 0·80 in women in Japan, Spain, and France, and in men in Nauru. The lowest prevalence in the world in 2022 was in western Europe and east Africa for both sexes, and in Japan and Canada for women, and the highest prevalence in the world in 2022 was in countries in Polynesia and Micronesia, some countries in the Caribbean and the Middle East and north Africa, as well as Pakistan and Malaysia. In 2022, 445 million (95% CrI 401–496) adults aged 30 years or older with diabetes did not receive treatment (59% of adults aged 30 years or older with diabetes), 3·5 times the number in 1990. From 1990 to 2022, diabetes treatment coverage increased in 118 countries for women and 98 countries for men with a posterior probability of more than 0·80. The largest improvement in treatment coverage was in some countries from central and western Europe and Latin America (Mexico, Colombia, Chile, and Costa Rica), Canada, South Korea, Russia, Seychelles, and Jordan. There was no increase in treatment coverage in most countries in sub-Saharan Africa; the Caribbean; Pacific island nations; and south, southeast, and central Asia. In 2022, age-standardised treatment coverage was lowest in countries in sub-Saharan Africa and south Asia, and treatment coverage was less than 10% in some African countries. Treatment coverage was 55% or higher in South Korea, many high-income western countries, and some countries in central and eastern Europe (eg, Poland, Czechia, and Russia), Latin America (eg, Costa Rica, Chile, and Mexico), and the Middle East and north Africa (eg, Jordan, Qatar, and Kuwait). Interpretation In most countries, especially in low-income and middle-income countries, diabetes treatment has not increased at all or has not increased sufficiently in comparison with the rise in prevalence. The burden of diabetes and untreated diabetes is increasingly borne by low-income and middle-income countries. The expansion of health insurance and primary health care should be accompanied with diabetes programmes that realign and resource health services to enhance the early detection and effective treatment of diabetes.

• Tarp, Jakob; Dalene, Knut Eirik; Fagerland, Morten; Steene-Johannessen, Jostein; Hansen, Bjørge Hermann & Anderssen, Sigmund Alfred [Show all 23 contributors for this article] (2024). Physical Activity Volume, Intensity, and Mortality: Harmonized Meta-Analysis of Prospective Cohort Studies. American Journal of Preventive Medicine. ISSN 0749-3797. 67(6), p. 887–896. doi: 10.1016/j.amepre.2024.07.022. Full text in Research Archive Show summary

  Introduction: It is unclear whether moderate-to-vigorous physical activity (MVPA) is associated with a lower mortality risk, over and above its contribution to total physical activity volume. Methods: 46,682 adults (mean age: 64 years) were included in a meta-analysis of nine prospective cohort studies. Each cohort generated tertiles of accelerometry-measured physical activity volume and volume-adjusted MVPA. Hazard ratios (HR, with 95% confidence intervals) for mortality were estimated separately and in joint models combining volume and MVPA. Data was collected between 2001 and 2019 and analyzed in 2023. Results: During a mean follow-up of 9 years, 4,666 deaths were recorded. Higher physical activity volume, and a greater contribution from volume-adjusted MVPA, were each associated with lower mortality hazard in multivariable-adjusted models. Compared to the least active tertile, higher physical activity volume was associated with a lower mortality (HRs: 0.62; 0.58, 0.67 and 0.50; 0.42, 0.60 for ascending tertiles). Similarly, a greater contribution from MVPA was associated with a lower mortality (HRs: 0.94; 0.85, 1.04 and 0.88; 0.79, 0.98). In joint analysis, a lower mortality from higher volume-adjusted MVPA was only observed for the middle tertile of physical activity volume. Conclusions: The total volume of physical activity was associated with a lower risk of mortality to a greater extent than the contribution of MVPA to physical activity volume. Integrating any intensity of physical activity into daily life may lower mortality risk in middle-aged and older adults, with a small added benefit if the same amount of activity is performed with a higher intensity.

• Ostojic, Sergej; Phelps, Nowell H.; Singleton, Rosie K.; Zhou, Bin; Heap, Rachel & Mishra, Anu [Show all 54 contributors for this article] (2024). Worldwide trends in the underweight and obesity from 1990 to 2022: a pooled analysis of 3,633 population-representative studies with 222 million school-aged children, adolescents, and adults. The Lancet. ISSN 0140-6736. 403(10431), p. 1027–1050. doi: 10.1016/S0140-6736(23)02750-2. Full text in Research Archive Show summary

  Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For school-aged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity.

• 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. 21(1). doi: 10.1186/s12966-024-01578-7. Full text in Research Archive Show summary

  Background There is a lack of longitudinal studies examining changes in device-measured physical activity and sedentary time from childhood to young adulthood. We aimed to assess changes in device-measured physical activity and sedentary time from childhood, through adolescence, into young adulthood in a Norwegian sample of ostensibly healthy men and women. Methods A longitudinal cohort of 731 Norwegian boys and girls (49% girls) participated at age 9 years (2005–2006) and 15 years (2011–2012), and 258 of these participated again at age 24 years (2019–2021; including the COVID-19 pandemic period). Physical activity and sedentary time were measured using ActiGraph accelerometers. Linear mixed models were used to analyse changes in physical activity and sedentary time and whether low levels of childhood physical activity track, i.e., persist into young adulthood (nchange=721; ntracking=640). Results The most prominent change occurred between the ages of 9 to 15 years, with an increase in sedentary time (150 min/day) and less time spent in light (125 min/day), moderate (16 min/day), and vigorous physical activity (8 min/day). Only smaller changes were observed between the ages of 15 and 24 years. Changes in moderate-to-vigorous physical activity from childhood to young adulthood differed between subgroups of sex, tertiles of body mass index at baseline and tertiles of peak oxygen uptake at baseline. While the tracking models indicated low absolute stability of physical activity from childhood to young adulthood, children in the lowest quartiles of moderate-to-vigorous (OR:1.88; 95%CI: 1.23, 2.86) and total physical activity (OR: 1.87; 95%CI: 1.21, 2.87) at age 9 years were almost 90% more likely to be in these quartiles at age 24 years compared to those belonging to the upper three quartiles at baseline. Conclusions We found a substantial reduction in physical activity and increase in time spent sedentary between age 9 and 15 years. Contrary to previous studies, using mainly self-reported physical activity, little change was observed between adolescence and young adulthood. The least active children were more likely to remain the least active adults and could be targeted for early intervention.

• Mishra, Anu; Zhou, Bin; Rodriguez-Martinez, Andrea; Bixby, Honor; Singleton, Rosie K. & Carrillo-Larco, Rodrigo M. [Show all 1,626 contributors for this article] (2023). Diminishing benefits of urban living for children and adolescents’ growth and development. Nature. ISSN 0028-0836. 615(7954), p. 874–883. doi: 10.1038/s41586-023-05772-8. Full text in Research Archive Show summary

  Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1,2,3,4,5,6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5–19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was <1.1 kg m–2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified.

• 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 Show summary

  Objectives - To examine whether moderate-to-vigorous physical activity (MVPA) modifies the association between sedentary time and mortality and vice versa, and estimate the joint associations of MVPA and sedentary time on mortality risk.<p> <p>Methods - This study involved individual participant data analysis of four prospective cohort studies (Norway, Sweden, USA, baseline: 2003–2016, 11 989 participants ≥50 years, 50.5% women) with hip-accelerometry-measured physical activity and sedentary time. Associations were examined using restricted cubic splines and fractional polynomials in Cox regressions adjusted for sex, education, body mass index, smoking, alcohol, study cohort, cardiovascular disease, cancer, and/or diabetes, accelerometry wear time and age.<p> <p>Results - 6.7% (n=805) died during follow-up (median 5.2 years, IQR 4.2 years). More than 12 daily sedentary hours (reference 8 hours) was associated with mortality risk only among those accumulating <22 min of MVPA per day (HR 1.38, 95% CI 1.10 to 1.74). Higher MVPA levels were associated with lower mortality risk irrespective of sedentary time, for example, HR for 10 versus 0 daily min of MVPA was 0.85 (95% CI 0.74 to 0.96) in those accumulating <10.5 daily sedentary hours and 0.65 (95% CI 0.53 to 0.79) in those accumulating ≥10.5 daily sedentary hours. Joint association analyses confirmed that higher MVPA was superior to lower sedentary time in lowering mortality risk, for example, 10 versus 0 daily min of MVPA was associated with 28–55% lower mortality risk across the sedentary time spectrum (lowest risk, 10 daily sedentary hours: HR 0.45, 95% CI 0.31 to 0.65).<p> <p>Conclusions - Sedentary time was associated with higher mortality risk but only in individuals accumulating less than 22 min of MVPA per day. Higher MVPA levels were associated with lower mortality risk irrespective of the amount of sedentary time.

• Thorsen, Lene; Courneya, Kerry S.; Steene-Johannessen, Jostein; Gran, Jon Michael; Haugnes, Hege Sagstuen & Negaard, Helene Francisca Stigter [Show all 8 contributors for this article] (2023). Association of physical activity with overall mortality among long-term testicular cancer survivors: A longitudinal study. International Journal of Cancer. ISSN 0020-7136. 153(8), p. 1512–1519. doi: 10.1002/ijc.34625. Full text in Research Archive Show summary

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

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

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

• Jones, Paul Remy; Rajalahti, Tarja; Resaland, Geir Kåre; Aadland, Eivind; Steene-Johannessen, Jostein & Anderssen, Sigmund Alfred [Show all 10 contributors for this article] (2022). Associations of lipoprotein particle profile and objectively measured physical activity and sedentary time in schoolchildren: a prospective cohort study. International Journal of Behavioral Nutrition and Physical Activity. 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.

• 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. 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.

• 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. 24. doi: 10.1016/j.pmedr.2021.101648. Full text in Research Archive Show summary

  Little information exists on the mechanism of how physical activity interventions effects academic performance. We examined whether the effects of a school-based physical activity intervention on academic performance were mediated by aerobic fitness. The School in Motion study was a nine-month cluster randomized controlled trial between September 2017 and June 2018. Students from 30 Norwegian lower secondary schools (N = 2,084, mean age [SD] = 14 [0.3] years) were randomly assigned into three groups: the Physically Active Learning (PAL) intervention (n = 10), the Don’t Worry—Be Happy (DWBH) intervention (n = 10), or control (n = 10). Aerobic fitness was assessed by the Andersen test and academic performance by national tests in reading and numeracy. Mediation was assessed according to the causal steps approach using linear mixed models. In the PAL intervention, aerobic fitness partially mediated the intervention effect on numeracy by 28% from a total effect of 1.73 points (95% CI: 1.13 to 2.33) to a natural direct effect of 1.24 points (95% CI: 0.58 to 1.91), and fully mediated the intervention effect on reading, with the total effect of 0.89 points (95% CI: 0.15 to 1.62) reduced to the natural direct effect of 0.40 points (95% CI: −0.48 to 1.28). Aerobic fitness did not mediate the effects on academic performance in the DWBH intervention. As aerobic fitness mediated the intervention effect on academic performance in one intervention, physical activity of an intensity that increases aerobic fitness is one strategy to improve academic performance among adolescents.

• 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. Full text in Research Archive 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 Show summary

  Background: The joint associations of total and intensity-specific physical activity with obesity in relation to all-cause mortality risk are unclear. Methods: We included 34 492 adults (72% women, median age 62.1 years, 2034 deaths during follow-up) in a harmonised meta-analysis of eight population-based prospective cohort studies with mean follow-up ranging from 6.0 to 14.5 years. Standard body mass index categories were cross-classified with sample tertiles of device-measured total, light-to-vigorous and moderate-to-vigorous physical activity and sedentary time. In five cohorts with waist circumference available, high and low waist circumference was combined with tertiles of moderate-to-vigorous physical activity. Results: There was an inverse dose–response relationship between higher levels of total and intensity-specific physical activity and mortality risk in those who were normal weight and overweight. In individuals with obesity, the inverse dose–response relationship was only observed for total physical activity. Similarly, lower levels of sedentary time were associated with lower mortality risk in normal weight and overweight individuals but there was no association between sedentary time and risk of mortality in those who were obese. Compared with the obese-low total physical activity reference, the HRs were 0.59 (95% CI 0.44 to 0.79) for normal weight-high total activity and 0.67 (95% CI 0.48 to 0.94) for obese-high total activity. In contrast, normal weight-low total physical activity was associated with a higher risk of mortality compared with the obese-low total physical activity reference (1.28; 95% CI 0.99 to 1.67). Conclusions: Higher levels of physical activity were associated with lower risk of mortality irrespective of weight status. Compared with obesity-low physical activity, there was no survival benefit of being normal weight if physical activity levels were low.

• 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 Show summary

  Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30–79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30–79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306–359) million women and 317 (292–344) million men in 1990 to 626 (584–668) million women and 652 (604–698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55–62) of women and 49% (46–52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43–51) of women and 38% (35–41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20–27) for women and 18% (16–21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. Funding WHO.

• 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.

• 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. 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.

• 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. 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.

• 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 Show summary

  Background and aims The associations between aerobic fitness and traditional measures of lipid metabolism in children are uncertain. We investigated whether higher levels of aerobic fitness benefit lipoprotein metabolism by exploring associations with a comprehensive lipoprotein particle profile. Methods In our prospective cohort study, we used targeted proton nuclear magnetic resonance (1H NMR) spectroscopy to profile 57 measures of lipoprotein metabolism from fasting serum samples of 858 fifth-grade Norwegian schoolchildren (49.0% girls; mean age 10.0 years). Aerobic fitness was measured using an intermittent shuttle run aerobic fitness test. We used multiple linear regression adjusted for potential confounders to examine cross-sectional and prospective associations between aerobic fitness and lipoprotein particle profile. Results Higher levels of aerobic fitness were associated with a favourable lipoprotein particle profile in the cross-sectional analysis, which included inverse associations with all measures of very low-density lipoprotein (VLDL) particles (e.g., −0.06 mmol·L−1 or –0.23 SD units; 95% CI = −0.31, −0.16 for VLDL cholesterol concentration). In the prospective analysis, the favourable pattern of associations persisted, though the individual associations tended to be more consistent with those of the cross-sectional analysis for the VLDL subclass measures compared to the low-density lipoproteins and high-density lipoproteins. Adjustment for adiposity attenuated the associations in both cross-sectional and prospective models. Nevertheless, an independent effect of aerobic fitness remained for some measures. Conclusions Improving children's aerobic fitness levels should benefit lipoprotein metabolism, though a concomitant reduction in adiposity would likely potentiate this effect.

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

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

• Taddei, Cristina; Jackson, Rod; Zhou, Bin; Bixby, Honor; Danaei, Goodarz & Cesare, Mariachiara Di [Show all 361 contributors for this article] (2020). National trends in total cholesterol obscure heterogeneous changes in HDL and non-HDL cholesterol and total-to-HDL cholesterol ratio: A pooled analysis of 458 population-based studies in Asian and Western countries. International Journal of Epidemiology. ISSN 0300-5771. 49(1), p. 173–192. doi: 10.1093/ije/dyz099. Full text in Research Archive
• Husøy, Anders; Dalene, Knut Eirik; Steene-Johannessen, Jostein; Anderssen, Sigmund Alfred; Ekelund, Ulf & Tarp, Jakob (2020). Effect modification by cardiorespiratory fitness on the association between physical activity and cardiometabolic health in youth: A systematic review. Journal of Sports Sciences. ISSN 0264-0414. doi: 10.1080/02640414.2020.1847919. Full text in Research Archive Show summary

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

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

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

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

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

• 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 Show summary

  Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m². In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in subSaharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks. Funding Wellcome Trust, AstraZeneca Young Health Programme, EU.

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

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

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

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

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

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

• 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(7810), p. 73–77. doi: 10.1038/s41586-020-2338-1. Full text in Research Archive Show summary

  High blood cholesterol is typically considered a feature of wealthy western countries1,2. However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world3 and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health4,5. However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol—which is a marker of cardiovascular risk—changed from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million–4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.

• Kolle, Elin; Solberg, Runar Barstad; Säfvenbom, Reidar; Dyrstad, Sindre Mikal; Berntsen, Sveinung & Resaland, Geir Kåre [Show all 10 contributors for this article] (2020). The effect of a school-based intervention on physical activity, cardiorespiratory fitness and muscle strength: the School in Motion cluster randomized trial. International Journal of Behavioral Nutrition and Physical Activity. 17(1). doi: 10.1186/s12966-020-01060-0. Full text in Research Archive Show summary

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

• Bixby, Honor; Bentham, James; Zhou, Bin; Cesare, Mariachiara Di; Paciorek, Christopher J. & Bennett, James E. [Show all 51 contributors for this article] (2019). Rising rural body-mass index is the main driver of the global obesity epidemic in adults. Nature. ISSN 0028-0836. 569, p. 260–264. doi: 10.1038/s41586-019-1171-x. Full text in Research Archive Show summary

  Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities1,2. This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity3,4,5,6. Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017—and more than 80% in some low- and middle-income regions—was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing—and in some countries reversal—of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.

• Renninger, Marius; Hansen, Bjørge Hermann; Steene-Johannessen, Jostein; Kriemler, Susi; Froberg, Karsten & Northstone, Kate [Show all 10 contributors for this article] (2019). Associations between accelerometry measured physical activity and sedentary time and the metabolic syndrome: A meta-analysis of more than 6000 children and adolescents. Pediatric Obesity. ISSN 2047-6302. 15, p. 1–9. doi: 10.1111/ijpo.12578. Full text in Research Archive Show summary

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

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

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

• Ekelund, Ulf; Tarp, Jakob; Steene-Johannessen, Jostein; Hansen, Bjørge Hermann; Jefferis, Barbara & Fagerland, Morten [Show all 20 contributors for this article] (2019). Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: systematic review and harmonised meta-analysis. The BMJ. 366. doi: 10.1136/bmj.l4570. Full text in Research Archive Show summary

  Objective: To examine the dose-response associations between accelerometer assessed total physical activity, different intensities of physical activity, and sedentary time and all cause mortality. Design: Systematic review and harmonised meta-analysis. Data sources: PubMed, PsycINFO, Embase, Web of Science, Sport Discus from inception to 31 July 2018. Eligibility criteria: Prospective cohort studies assessing physical activity and sedentary time by accelerometry and associations with all cause mortality and reported effect estimates as hazard ratios, odds ratios, or relative risks with 95% confidence intervals. Data extraction and analysis: Guidelines for meta-analyses and systematic reviews for observational studies and PRISMA guidelines were followed. Two authors independently screened the titles and abstracts. One author performed a full text review and another extracted the data. Two authors independently assessed the risk of bias. Individual level participant data were harmonised and analysed at study level. Data on physical activity were categorised by quarters at study level, and study specific associations with all cause mortality were analysed using Cox proportional hazards regression analyses. Study specific results were summarised using random effects meta-analysis. Main outcome measure: All cause mortality. Results: 39 studies were retrieved for full text review; 10 were eligible for inclusion, three were excluded owing to harmonisation challenges (eg, wrist placement of the accelerometer), and one study did not participate. Two additional studies with unpublished mortality data were also included. Thus, individual level data from eight studies (n=36 383; mean age 62.6 years; 72.8% women), with median follow-up of 5.8 years (range 3.0-14.5 years) and 2149 (5.9%) deaths were analysed. Any physical activity, regardless of intensity, was associated with lower risk of mortality, with a non-linear dose-response. Hazards ratios for mortality were 1.00 (referent) in the first quarter (least active), 0.48 (95% confidence interval 0.43 to 0.54) in the second quarter, 0.34 (0.26 to 0.45) in the third quarter, and 0.27 (0.23 to 0.32) in the fourth quarter (most active). Corresponding hazards ratios for light physical activity were 1.00, 0.60 (0.54 to 0.68), 0.44 (0.38 to 0.51), and 0.38 (0.28 to 0.51), and for moderate-to-vigorous physical activity were 1.00, 0.64 (0.55 to 0.74), 0.55 (0.40 to 0.74), and 0.52 (0.43 to 0.61). For sedentary time, hazards ratios were 1.00 (referent; least sedentary), 1.28 (1.09 to 1.51), 1.71 (1.36 to 2.15), and 2.63 (1.94 to 3.56). Conclusion: Higher levels of total physical activity, at any intensity, and less time spent sedentary, are associated with substantially reduced risk for premature mortality, with evidence of a non-linear dose-response pattern in middle aged and older adults.

• Jones, Paul Remy; Rajalahti, Tarja; Resaland, Geir Kåre; Aadland, Eivind; Steene-Johannessen, Jostein & Anderssen, Sigmund Alfred [Show all 10 contributors for this article] (2019). Associations of physical activity and sedentary time with lipoprotein subclasses in Norwegian schoolchildren: The Active Smarter Kids (ASK) study. Atherosclerosis. ISSN 0021-9150. 288, p. 186–193. doi: 10.1016/j.atherosclerosis.2019.05.023. Full text in Research Archive Show summary

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

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

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

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

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

• Aadland, Eivind; Anderssen, Sigmund Alfred; Andersen, Lars Bo; Resaland, Geir Kåre; Kolle, Elin & Steene-Johannessen, Jostein (2018). Aerobic fitness thresholds to define poor cardiometabolic health in children and youth. Scandinavian Journal of Medicine & Science in Sports. ISSN 0905-7188. 29(2), p. 240–250. doi: 10.1111/sms.13330. Full text in Research Archive Show summary

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

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

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

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

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

• Zhou, Bin; Bentham, James; Cesare, Mariachiara Di; Bixby, Honor; Danaei, Goodarz & Hajifathalian, Kaveh [Show all 847 contributors for this article] (2018). Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: A pooled analysis of 1018 population-based measurement studies with 88.6 million participants. International Journal of Epidemiology. ISSN 0300-5771. 47(3), p. 872–883i. doi: 10.1093/ije/dyy016. Full text in Research Archive Show summary

  Background Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure. Methods We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20–29 years to 70–79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probit-transformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure. Results In 2005–16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the high-income Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association. Conclusions Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups.

• Stavnsbo, Mette; Resaland, Geir Kåre; Anderssen, Sigmund Alfred; Steene-Johannessen, Jostein; Domazet, Sidsel Louise & Skrede, Turid [Show all 11 contributors for this article] (2018). Reference values for cardiometabolic risk scores in children and adolescents: Suggesting a common standard. Atherosclerosis. ISSN 0021-9150. 278, p. 299–306. doi: 10.1016/j.atherosclerosis.2018.10.003. Full text in Research Archive Show summary

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

• Hansen, Bjørge Hermann; Steene-Johannessen, Jostein & Kolle, Elin (2018). Status fysisk aktivitet og fysisk form i befolkningen. In Torstveit, Monica Klungland; Lohne-Seiler, Hilde; Berntsen, Sveinung & Anderssen, Sigmund Alfred (Ed.), Fysisk aktivitet og helse: Fra begrepsforståelse til implementering av kunnskap. Cappelen Damm Akademisk. ISSN 9788202568313. p. 92–113. Full text in Research Archive
• Steene-Johannessen, Jostein; Grydeland, May & Hansen, Bjørge Hermann (2018). Måling av fysisk aktivitet og fysisk form. In Torstveit, Monica Klungland; Lohne-Seiler, Hilde; Berntsen, Sveinung & Anderssen, Sigmund Alfred (Ed.), Fysisk aktivitet og helse: Fra begrepsforståelse til implementering av kunnskap. Cappelen Damm Akademisk. ISSN 9788202568313. p. 62–91. Full text in Research Archive
• Skrede, Turid; Steene-Johannessen, Jostein; Anderssen, Sigmund Alfred; Resaland, Geir Kåre & Ekelund, Ulf (2018). The prospective association between objectively measured sedentary time, moderate-to-vigorous physical activity and cardiometabolic risk factors in youth: a systematic review and meta-analysis. Obesity Reviews. ISSN 1467-7881. p. 1–20. doi: 10.1111/obr.12758. Full text in Research Archive Show summary

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

• Zhou, Bin; Bentham, James; Cesare, Mariachiara Di; Bixby, Honor; Danaei, Goodarz & Cowan, Melanie J. [Show all 114 contributors for this article] (2017). Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19·1 million participants. The Lancet. ISSN 0140-6736. 389(10064), p. 37–55. doi: 10.1016/S0140-6736(16)31919-5. Full text in Research Archive Show summary

  Background Raised blood pressure is an important risk factor for cardiovascular diseases and chronic kidney disease. We estimated worldwide trends in mean systolic and mean diastolic blood pressure, and the prevalence of, and number of people with, raised blood pressure, defined as systolic blood pressure of 140 mm Hg or higher or diastolic blood pressure of 90 mm Hg or higher. Methods For this analysis, we pooled national, subnational, or community population-based studies that had measured blood pressure in adults aged 18 years and older. We used a Bayesian hierarchical model to estimate trends from 1975 to 2015 in mean systolic and mean diastolic blood pressure, and the prevalence of raised blood pressure for 200 countries. We calculated the contributions of changes in prevalence versus population growth and ageing to the increase in the number of adults with raised blood pressure. Findings We pooled 1479 studies that had measured the blood pressures of 19·1 million adults. Global age-standardised mean systolic blood pressure in 2015 was 127·0 mm Hg (95% credible interval 125·7–128·3) in men and 122·3 mm Hg (121·0–123·6) in women; age-standardised mean diastolic blood pressure was 78·7 mm Hg (77·9–79·5) for men and 76·7 mm Hg (75·9–77·6) for women. Global age-standardised prevalence of raised blood pressure was 24·1% (21·4–27·1) in men and 20·1% (17·8–22·5) in women in 2015. Mean systolic and mean diastolic blood pressure decreased substantially from 1975 to 2015 in high-income western and Asia Pacific countries, moving these countries from having some of the highest worldwide blood pressure in 1975 to the lowest in 2015. Mean blood pressure also decreased in women in central and eastern Europe, Latin America and the Caribbean, and, more recently, central Asia, Middle East, and north Africa, but the estimated trends in these super-regions had larger uncertainty than in high-income super-regions. By contrast, mean blood pressure might have increased in east and southeast Asia, south Asia, Oceania, and sub-Saharan Africa. In 2015, central and eastern Europe, sub-Saharan Africa, and south Asia had the highest blood pressure levels. Prevalence of raised blood pressure decreased in high-income and some middle-income countries; it remained unchanged elsewhere. The number of adults with raised blood pressure increased from 594 million in 1975 to 1·13 billion in 2015, with the increase largely in low-income and middle-income countries. The global increase in the number of adults with raised blood pressure is a net effect of increase due to population growth and ageing, and decrease due to declining age-specific prevalence. Interpretation During the past four decades, the highest worldwide blood pressure levels have shifted from high-income countries to low-income countries in south Asia and sub-Saharan Africa due to opposite trends, while blood pressure has been persistently high in central and eastern Europe.

• Dalene, Knut Eirik; Anderssen, Sigmund Alfred; Andersen, Lars Bo; Steene-Johannessen, Jostein; Ekelund, Ulf & Hansen, Bjørge Hermann [Show all 7 contributors for this article] (2017). Secular and longitudinal physical activity changes in population-based samples of children and adolescents. Scandinavian Journal of Medicine & Science in Sports. ISSN 0905-7188. 28(1), p. 161–171. doi: 10.1111/sms.12876. Full text in Research Archive Show summary

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

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

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

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

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

• Aadland, Eivind; Solbraa, Ane; Resaland, Geir Kåre; Steene-Johannessen, Jostein; Edvardsen, Elisabeth & Hansen, Bjørge Hermann [Show all 7 contributors for this article] (2017). Reference values for and cross-validation of time to exhaustion on a modified Balke protocol in Norwegian men and women. Scandinavian Journal of Medicine & Science in Sports. ISSN 0905-7188. 27(11), p. 1248–1257. doi: 10.1111/sms.12750. Full text in Research Archive Show summary

  The aims of the present study were to provide reference values for time to exhaustion (TTE) on a modified Balke treadmill protocol, and to perform a cross‐validation of TTE as a measure of maximal oxygen consumption (VO2max), in Norwegian men and women 20–85 years of age. Reference values for TTE were derived from a national sample of 765 subjects. An additional sample of 119 subjects was included in the cross‐validation (total n = 884), where prediction equations for VO2max was established. A decline in TTE was seen with increased age. Prediction of VO2max in an independent dataset (n = 319) resulted in a R2 = 0.78 and standard error of the estimate = 4.55 mL/kg/min. The observed–predicted bias was small (mean difference <1.24 mL/kg/min), whereas random error was considerable (95% limits of agreement ± 7.11–9.70 mL/kg/min) across age in both men and women. Despite limitations concerning the prediction of VO2max on an individual level, TTE from the Balke protocol is a good measure of aerobic fitness in adults across a range of settings, and could be evaluated according to the suggested reference values.

• Bentham, James; Cesare, Mariachiara Di; Bilano, Ver; Bixby, Honor; Zhou, Bin & Stevens, Gretchen A. [Show all 110 contributors for this article] (2017). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. The Lancet. ISSN 0140-6736. 390(10113), p. 2627–2642. doi: 10.1016/S0140-6736(17)32129-3. Full text in Research Archive Show summary

  Background Underweight, overweight, and obesity in childhood and adolescence are associated with adverse health consequences throughout the life-course. Our aim was to estimate worldwide trends in mean body-mass index (BMI) and a comprehensive set of BMI categories that cover underweight to obesity in children and adolescents, and to compare trends with those of adults. Methods We pooled 2416 population-based studies with measurements of height and weight on 128·9 million participants aged 5 years and older, including 31·5 million aged 5–19 years. We used a Bayesian hierarchical model to estimate trends from 1975 to 2016 in 200 countries for mean BMI and for prevalence of BMI in the following categories for children and adolescents aged 5–19 years: more than 2 SD below the median of the WHO growth reference for children and adolescents (referred to as moderate and severe underweight hereafter), 2 SD to more than 1 SD below the median (mild underweight), 1 SD below the median to 1 SD above the median (healthy weight), more than 1 SD to 2 SD above the median (overweight but not obese), and more than 2 SD above the median (obesity). Findings Regional change in age-standardised mean BMI in girls from 1975 to 2016 ranged from virtually no change (−0·01 kg/m2 per decade; 95% credible interval −0·42 to 0·39, posterior probability [PP] of the observed decrease being a true decrease=0·5098) in eastern Europe to an increase of 1·00 kg/m2 per decade (0·69–1·35, PP>0·9999) in central Latin America and an increase of 0·95 kg/m2 per decade (0·64–1·25, PP>0·9999) in Polynesia and Micronesia. The range for boys was from a non-significant increase of 0·09 kg/m2 per decade (−0·33 to 0·49, PP=0·6926) in eastern Europe to an increase of 0·77 kg/m2 per decade (0·50–1·06, PP>0·9999) in Polynesia and Micronesia. Trends in mean BMI have recently flattened in northwestern Europe and the high-income English-speaking and Asia-Pacific regions for both sexes, southwestern Europe for boys, and central and Andean Latin America for girls. By contrast, the rise in BMI has accelerated in east and south Asia for both sexes, and southeast Asia for boys. Global age-standardised prevalence of obesity increased from 0·7% (0·4–1·2) in 1975 to 5·6% (4·8–6·5) in 2016 in girls, and from 0·9% (0·5–1·3) in 1975 to 7·8% (6·7–9·1) in 2016 in boys; the prevalence of moderate and severe underweight decreased from 9·2% (6·0–12·9) in 1975 to 8·4% (6·8–10·1) in 2016 in girls and from 14·8% (10·4–19·5) in 1975 to 12·4% (10·3–14·5) in 2016 in boys. Prevalence of moderate and severe underweight was highest in India, at 22·7% (16·7–29·6) among girls and 30·7% (23·5–38·0) among boys. Prevalence of obesity was more than 30% in girls in Nauru, the Cook Islands, and Palau; and boys in the Cook Islands, Nauru, Palau, Niue, and American Samoa in 2016. Prevalence of obesity was about 20% or more in several countries in Polynesia and Micronesia, the Middle East and north Africa, the Caribbean, and the USA. In 2016, 75 (44–117) million girls and 117 (70–178) million boys worldwide were moderately or severely underweight. In the same year, 50 (24–89) million girls and 74 (39–125) million boys worldwide were obese. Interpretation The rising trends in children's and adolescents' BMI have plateaued in many high-income countries, albeit at high levels, but have accelerated in parts of Asia, with trends no longer correlated with those of adults.

• Cesare, Mariachiara Di; Bentham, James; Stevens, Gretchen A; Zhou, Bin; Danaei, Goodarz & Lu, Yuan [Show all 740 contributors for this article] (2016). Trends in adult body-mass index in 200 countries from 1975 to 2014: A pooled analysis of 1698 population-based measurement studies with 19.2 million participants. The Lancet. ISSN 0140-6736. 387(10026), p. 1377–1396. doi: 10.1016/S0140-6736(16)30054-X. Full text in Research Archive Show summary

  Background Underweight and severe and morbid obesity are associated with highly elevated risks of adverse health outcomes. We estimated trends in mean body-mass index (BMI), which characterises its population distribution, and in the prevalences of a complete set of BMI categories for adults in all countries. Methods We analysed, with use of a consistent protocol, population-based studies that had measured height and weight in adults aged 18 years and older. We applied a Bayesian hierarchical model to these data to estimate trends from 1975 to 2014 in mean BMI and in the prevalences of BMI categories (<18·5 kg/m2 [underweight], 18·5 kg/m2 to <20 kg/m2, 20 kg/m2 to <25 kg/m2, 25 kg/m2 to <30 kg/m2, 30 kg/m2 to <35 kg/m2, 35 kg/m2 to <40 kg/m2, ≥40 kg/m2 [morbid obesity]), by sex in 200 countries and territories, organised in 21 regions. We calculated the posterior probability of meeting the target of halting by 2025 the rise in obesity at its 2010 levels, if post-2000 trends continue. Findings We used 1698 population-based data sources, with more than 19·2 million adult participants (9·9 million men and 9·3 million women) in 186 of 200 countries for which estimates were made. Global age-standardised mean BMI increased from 21·7 kg/m2 (95% credible interval 21·3–22·1) in 1975 to 24·2 kg/m2 (24·0–24·4) in 2014 in men, and from 22·1 kg/m2 (21·7–22·5) in 1975 to 24·4 kg/m2 (24·2–24·6) in 2014 in women. Regional mean BMIs in 2014 for men ranged from 21·4 kg/m2 in central Africa and south Asia to 29·2 kg/m2 (28·6–29·8) in Polynesia and Micronesia; for women the range was from 21·8 kg/m2 (21·4–22·3) in south Asia to 32·2 kg/m2 (31·5–32·8) in Polynesia and Micronesia. Over these four decades, age-standardised global prevalence of underweight decreased from 13·8% (10·5–17·4) to 8·8% (7·4–10·3) in men and from 14·6% (11·6–17·9) to 9·7% (8·3–11·1) in women. South Asia had the highest prevalence of underweight in 2014, 23·4% (17·8–29·2) in men and 24·0% (18·9–29·3) in women. Age-standardised prevalence of obesity increased from 3·2% (2·4–4·1) in 1975 to 10·8% (9·7–12·0) in 2014 in men, and from 6·4% (5·1–7·8) to 14·9% (13·6–16·1) in women. 2·3% (2·0–2·7) of the world's men and 5·0% (4·4–5·6) of women were severely obese (ie, have BMI ≥35 kg/m2). Globally, prevalence of morbid obesity was 0·64% (0·46–0·86) in men and 1·6% (1·3–1·9) in women. Interpretation If post-2000 trends continue, the probability of meeting the global obesity target is virtually zero. Rather, if these trends continue, by 2025, global obesity prevalence will reach 18% in men and surpass 21% in women; severe obesity will surpass 6% in men and 9% in women. Nonetheless, underweight remains prevalent in the world's poorest regions, especially in south Asia.

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

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

• Steene-Johannessen, Jostein; Anderssen, Sigmund Alfred; Ploeg, Hidde P van der; Hendriksen, Ingrid; Donnelly, Alan & Brage, Søren [Show all 7 contributors for this article] (2016). Are self-report measures able to define individuals as physically active or inactive? Medicine & Science in Sports & Exercise. ISSN 0195-9131. 48(2), p. 235–244. doi: 10.1249/MSS.0000000000000760. Full text in Research Archive Show summary

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

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

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

• Loyen, Anne; Hecke, Linde Van; Verloigne, Maïté; Hendriksen, Ingrid; Lakerveld, Jeroen & Steene-Johannessen, Jostein [Show all 14 contributors for this article] (2016). Variation in population levels of physical activity in European adults according to cross-European studies: a systematic literature review within DEDIPAC. International Journal of Behavioral Nutrition and Physical Activity. 13:72, p. 1–18. doi: 10.1186/s12966-016-0398-2. Full text in Research Archive Show summary

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

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

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

• Zhou, Bin; Lu, Yuan; Hajifathalian, Kaveh; Bentham, James; Cesare, Mariachiara Di & Danaei, Goodarz [Show all 502 contributors for this article] (2016). Worldwide trends in diabetes since 1980: A pooled analysis of 751 population-based studies with 4.4 million participants. The Lancet. ISSN 0140-6736. 387(10027), p. 1513–1530. doi: 10.1016/S0140-6736(16)00618-8. Full text in Research Archive Show summary

  Background:<br>One of the global targets for non-communicable diseases is to halt, by 2025, the rise in the agestandardised adult prevalence of diabetes at its 2010 levels. We aimed to estimate worldwide trends in diabetes, how likely it is for countries to achieve the global target, and how changes in prevalence, together with population growth and ageing, are aff ecting the number of adults with diabetes.<br> Methods:<br>We pooled data from population-based studies that had collected data on diabetes through measurement of its biomarkers. We used a Bayesian hierarchical model to estimate trends in diabetes prevalence—defi ned as fasting plasma glucose of 7·0 mmol/L or higher, or history of diagnosis with diabetes, or use of insulin or oral hypoglycaemic drugs—in 200 countries and territories in 21 regions, by sex and from 1980 to 2014. We also calculated the posterior probability of meeting the global diabetes target if post-2000 trends continue.<br> Findings:<br> We used data from 751 studies including 4 372 000 adults from 146 of the 200 countries we make estimates for. Global age-standardised diabetes prevalence increased from 4·3% (95% credible interval 2·4–7·0) in 1980 to 9·0% (7·2–11·1) in 2014 in men, and from 5·0% (2·9–7·9) to 7·9% (6·4–9·7) in women. The number of adults with diabetes in the world increased from 108 million in 1980 to 422 million in 2014 (28·5% due to the rise in prevalence, 39·7% due to population growth and ageing, and 31·8% due to interaction of these two factors). Age-standardised adult diabetes prevalence in 2014 was lowest in northwestern Europe, and highest in Polynesia and Micronesia, at nearly 25%, followed by Melanesia and the Middle East and north Africa. Between 1980 and 2014 there was little change in age-standardised diabetes prevalence in adult women in continental western Europe, although crude prevalence rose because of ageing of the population. By contrast, age-standardised adult prevalence rose by 15 percentage points in men and women in Polynesia and Micronesia. In 2014, American Samoa had the highest national prevalence of diabetes (>30% in both sexes), with age-standardised adult prevalence also higher than 25% in some other islands in Polynesia and Micronesia. If post-2000 trends continue, the probability of meeting the global target of halting the rise in the prevalence of diabetes by 2025 at the 2010 level worldwide is lower than 1% for men and is 1% for women. Only nine countries for men and 29 countries for women, mostly in western Europe, have a 50% or higher probability of meeting the global target.<br> Interpretation:<br> Since 1980, age-standardised diabetes prevalence in adults has increased, or at best remained unchanged, in every country. Together with population growth and ageing, this rise has led to a near quadrupling of the number of adults with diabetes worldwide. The burden of diabetes, both in terms of prevalence and number of adults aff ected, has increased faster in low-income and middle-income countries than in high-income countries.

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

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

• Resaland, Geir Kåre; Moe, Vegard Fusche; Aadland, Eivind; Steene-Johannessen, Jostein; Glosvik, Øyvind & Andersen, John Roger [Show all 9 contributors for this article] (2015). Active Smarter Kids (ASK): Rationale and design of a cluster-randomized controlled trial investigating the effects of daily physical activity on children's academic performance and risk factors for non-communicable diseases. BMC Public Health. 15:709(1). doi: 10.1186/s12889-015-2049-y. Full text in Research Archive Show summary

  Background Evidence is emerging from school-based studies that physical activity might favorably affect children’s academic performance. However, there is a need for high-quality studies to support this. Therefore, the main objective of the Active Smarter Kids (ASK) study is to investigate the effect of daily physical activity on children’s academic performance. Because of the complexity of the relation between physical activity and academic performance it is important to identify mediating and moderating variables such as cognitive function, fitness, adiposity, motor skills and quality of life (QoL). Further, there are global concerns regarding the high prevalence of lifestyle-related non-communicable diseases (NCDs). The best means to address this challenge could be through primary prevention. Physical activity is known to play a key role in preventing a host of NCDs. Therefore, we investigated as a secondary objective the effect of the intervention on risk factors related to NCDs. The purpose of this paper is to describe the design of the ASK study, the ASK intervention as well as the scope and details of the methods we adopted to evaluate the effect of the ASK intervention on 5 th grade children. Methods & design The ASK study is a cluster randomized controlled trial that includes 1145 fifth graders (aged 10 years) from 57 schools (28 intervention schools; 29 control schools) in Sogn and Fjordane County, Norway. This represents 95.3 % of total possible recruitment. Children in all 57 participating schools took part in a curriculum-prescribed physical activity intervention (90 min/week of physical education (PE) and 45 min/week physical activity, in total; 135 min/week). In addition, children from intervention schools also participated in the ASK intervention model (165 min/week), i.e. a total of 300 min/week of physical activity/PE. The ASK study was implemented over 7 months, from November 2014 to June 2015. We assessed academic performance in reading, numeracy and English using Norwegian National tests delivered by The Norwegian Directorate for Education and Training. We assessed physical activity objectively at baseline, midpoint and at the end of the intervention. All other variables were measured at baseline and post-intervention. In addition, we used qualitative methodologies to obtain an in-depth understanding of children’s embodied experiences and pedagogical processes taking place during the intervention. Discussion If successful, ASK could provide strong evidence of a relation between physical activity and academic performance that could potentially inform the process of learning in elementary schools. Schools might also be identified as effective settings for large scale public health initiatives for the prevention of NCDs.

• Andersen, Lars Bo; Lauersen, Jeppe Bo; Brønd, Jan Christian; Anderssen, Sigmund Alfred; Sardinha, Luís B. & Steene-Johannessen, Jostein [Show all 15 contributors for this article] (2015). A new approach to define and diagnose cardiometabolic disorder in children. Journal of Diabetes Research. ISSN 2314-6745. 2015. doi: 10.1155/2015/539835. Full text in Research Archive
• Solbraa, Ane; Ekelund, Ulf; Holme, Ingar Morten K; Graff-Iversen, Sidsel; Steene-Johannessen, Jostein & Aadland, Eivind [Show all 7 contributors for this article] (2015). Long-term correlates of objectively measured physical activity and sedentary time in norwegian men and women. Journal of Physical Activity and Health. ISSN 1543-3080. 12(11), p. 1500–1507. doi: 10.1123/jpah.2014-0390. Full text in Research Archive Show summary

  Background: Sex, age, body mass index (BMI), perceived health and health behavior are correlates known to affect physical activity and sedentary time. However, studies have often been cross-sectional, and less is known about long-term correlates. Thus, the aims were to investigate 1) the associations between a set of characteristics (demographic, biological, psychological and behavioral) and objectively measured physical activity and sedentary time at 13 year follow-up, and 2) the association between changes in these characteristics over time and physical activity and sedentary time. Methods: Baseline characteristics were collected in 40-year-olds in 1996, and follow-up data on objectively measured physical activity and sedentary time were obtained in 2009 (n=240). Data were analyzed by multiple linear regressions. Results: Self-reported physical activity (p<0.001) and improved perceived health (p=0.046) were positively associated with moderate-to-vigorous physical activity (MVPA) whereas BMI (p=0.034) and increased BMI (p=0.014) were negatively associated with MVPA at follow-up. Women spent less time being sedentary than men (p=0.019). Education (p<0.001) was positively associated and improved perceived health (p=0.010) was negatively associated with sedentary time at follow-up. Conclusions: MVPA and sedentary time at follow-up were associated with behavioral, biological and demographic correlates. However, the nature of our analyses prevents us from inferring causality.

• Danaei, Goodarz; Fahimi, Saman; Lu, Yuan; Zhou, Bin; Hajifathalian, Kaveh & Cesare, Mariachiara Di [Show all 23 contributors for this article] (2015). Effects of diabetes definition on global surveillance of diabetes prevalence and diagnosis: A pooled analysis of 96 population-based studies with 331 288 participants. The Lancet Diabetes and Endocrinology. ISSN 2213-8587. 3(8), p. 624–637. doi: 10.1016/S2213-8587(15)00129-1. Full text in Research Archive
• Østergaard, Lars; Kolle, Elin; Steene-Johannessen, Jostein; Anderssen, Sigmund Alfred & Andersen, Lars Bo (2013). Cross sectional analysis of the association between mode of school transportation and physical fitness in children and adolescents. International Journal of Behavioral Nutrition and Physical Activity. 10. doi: 10.1186/1479-5868-10-91. Full text in Research Archive Show summary

  Objective: To investigate the associations between body composition, cardiorespiratory and muscular fitness in relation to travel mode to school in children and adolescents. Method: Children and adolescents from 40 elementary schools and 23 high schools representing all regions in Norway were invited to participate in the study. Anthropometry, cardiorespiratory and muscular fitness were tested at the school location. Questionnaires were used in order to register mode of transport to school, age, gender and levels of leisure time physical activity. Results: A total of 1694 (i.e. 60% of all invited participants) children and adolescents at a mean age of 9.6 and 15.6 respectively (SD = 0.4 for both groups) were analyzed for associations with physical fitness variables. Males cycling to school had lower sum of skin folds than adolescents walking to school. Higher cardiorespiratory fitness in adolescents and male cyclists compared to walkers and passive commuters were observed. Among children, cycling and walking to school, higher isometric muscle endurance in the back extensors compared to passive commuters was observed. Conclusion: Based on this national representative cross-sectional examination of randomly selected children and adolescents there is evidence that active commuting, especially cycling, is associated with a favourable body composition and better cardiorespiratory and muscular fitness as compared to passive commuting.

• Steene-Johannessen, Jostein; Kolle, Elin; Andersen, Lars Bo & Anderssen, Sigmund Alfred (2013). Adiposity, Aerobic Fitness, Muscle Fitness, and Markers of Inflammation in Children. Medicine & Science in Sports & Exercise. ISSN 0195-9131. 45(4), p. 714–721. doi: 10.1249/MSS.0b013e318279707a. Full text in Research Archive Show summary

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

• Aadland, Eivind & Steene-Johannessen, Jostein (2012). The use of individual cut points from treadmill walking to assess free-living moderate to vigorous physical activity in obese subjects by accelerometry: is it useful? BMC Medical Research Methodology. 12(1), p. 172–172. doi: 10.1186/1471-2288-12-172. Full text in Research Archive
• Adegboye, Amanda R. A.; Anderssen, Sigmund Alfred; Froberg, Karsten; Sardinha, Luis B.; Heitmann, Berit L. & Steene-Johannessen, Jostein [Show all 8 contributors for this article] (2011). Recommended aerobic fitness level for metabolic health in children and adolescents: a study of diagnostic accuracy. British Journal of Sports Medicine. ISSN 0306-3674. 45(9), p. 722–728. doi: 10.1136/bjsm.2009.068346. Full text in Research Archive Show summary

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

• Solbraa, Ane; Mamen, Asgeir; Resaland, Geir Kåre; Steene-Johannessen, Jostein; Ylvisåker, Einar & Holme, Ingar Morten K [Show all 7 contributors for this article] (2011). Level of physical activity, cardiorespiratory fitness and cardiovascular disease risk factors in a rural adult population in Sogn og Fjordane :. Norsk Epidemiologi. ISSN 0803-2491. 20(2), p. 179–188. doi: 10.5324/nje.v20i2.1339. Full text in Research Archive
• Grøntvedt, Anders; Steene-Johannessen, Jostein; Kynde, Iben; Franks, Paul W; Helge, Jørn Wulff & Froberg, Karsten [Show all 8 contributors for this article] (2011). Association between plasma leptin and blood pressure in two population-based samples of children and adolescents. Journal of Hypertension. ISSN 0263-6352. 29(6), p. 1093–1100. doi: 10.1097/HJH.0b013e328346d787. Full text in Research Archive Show summary

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

• Steene-Johannessen, Jostein; Kolle, Elin; Reseland, Janne Elin; Anderssen, Sigmund A. & Andersen, Lars Bo (2010). Waist circumference is related to low-grade inflammation in youth. International Journal of Pediatric Obesity. ISSN 1747-7166. 5(4), p. 313–319. doi: 10.3109/17477160903497035. Full text in Research Archive
• Kolle, Elin; Steene-Johannessen, Jostein; Andersen, Lars Bo & Anderssen, Sigmund A. (2010). Objectively assessed physical activity and aerobic fitness in a population-based sample of Norwegian 9- and 15-year-olds. Scandinavian Journal of Medicine & Science in Sports. ISSN 0905-7188. 20(1), p. 41–47. Full text in Research Archive Show summary

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

• Kolle, Elin; Steene-Johannessen, Jostein; Holme, Ingar Morten K; Andersen, Lars Bo & Anderssen, Sigmund A. (2009). Secular trends in adiposity in Norwegian 9-year-olds from 1999-2000 to 2005. BMC Public Health. 9. doi: 10.1186/1471-2458-9-389. Full text in Research Archive Show summary

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

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• Grindaker, Eirik; Steene-Johannessen, Jostein; Valnes, Thomas André & Lognseth, Stig (2026). Generasjon stillesittende? Barn og unges fysiske kapasitet og beredskapsevne. doi: https:/share.transistor.fm/s/bfd302ed. Full text in Research Archive Show summary

  I denne episoden ser vi nærmere på fysisk form og aktivitetsnivå blant norske barn og unge – og hvordan utviklingen de siste 20 årene påvirker helse, beredskapsevne og Forsvarets rekrutteringsgrunnlag. Med utgangspunkt i ungKan-studiene diskuterer vi hva nasjonale kartlegginger viser om aktivitetsnivå, stillesitting, fysisk form, kjønns- og aldersforskjeller – og hvilke tydelige trender som har vokst frem over tid. Vi drøfter sammenhengen mellom fysisk aktivitet, fysisk form og kardiometabolske risikofaktorer, og hva aktivitetsvaner i barne- og ungdomsårene kan bety for helse senere i livet. Til slutt ser vi på konsekvensene for Forsvaret: Har gapet mellom operative krav og ungdommens fysiske kapasitet økt? Og hvilken rolle kan skolen spille som strukturell motvekt til økende inaktivitet?

• Kolle, Elin; Steene-Johannessen, Jostein & Anderssen, Sigmund Alfred (2025). The Impact of Screen Time and Social Media Use on Physical Activity. Nordic Journal of Digital Literacy. 20(1), p. 40–44. doi: 10.18261/njdl.20.1.7. Full text in Research Archive
• 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. Full text in Research Archive
• Tarp, Jakob; Dalene, Knut Eirik; Hansen, Bjørge Hermann; Steene-Johannessen, Jostein & Ekelund, Ulf (2020). Double counting individuals in meta‐analysis artificially inflates precision. Comment on “Device‐measured light‐intensity physical activity and mortality: A meta‐analysis”. Scandinavian Journal of Medicine & Science in Sports. ISSN 0905-7188. 30(6), p. 1083–1084. doi: 10.1111/sms.13693. Full text in Research Archive
• Tarp, Jakob; Dalene, Knut Eirik; Steene-Johannessen, Jostein & Ekelund, Ulf (2019). Comment on: "Cardiorespiratory Fitness in Childhood and Adolescence Affects Future Cardiovascular Risk Factors: A Systematic Review of Longitudinal Studies". Sports Medicine. ISSN 0112-1642. 49(1), p. 159–161. doi: 10.1007/s40279-018-01035-z. Full text in Research Archive
• Steene-Johannessen, Jostein; Resaland, Geir Kåre; Aadland, Katrine Nyvoll & Anderssen, Sigmund Alfred (2016). Muscle Fitness, Executive Function And Academic Performance In 10-year-old Children: The Ask-study. Medicine & Science in Sports & Exercise. ISSN 0195-9131. Full text in Research Archive
• Steene-Johannessen, Jostein; Resaland, Geir Kåre; Aadland, Katrine Nyvoll & Anderssen, Sigmund Alfred (2016). Muscle Fitness, Executive Function And Academic Performance In 10-year-old Children: The Ask-study. Full text in Research Archive
• Hansen, Bjørge Hermann; Nilsen, Ada Kristine Ofrim; Dalene, Knut Eirik; Steene-Johannessen, Jostein; Kolle, Elin & Ekelund, Ulf [Show all 7 contributors for this article] (2016). Cross-sectional and Longitudinal Associations of Replacing Sedentary Time with Active Behaviors on the Body Mass Index. Medicine & Science in Sports & Exercise. ISSN 0195-9131. 48, p. 232–232. doi: 10.1249/01.mss.0000485698.85376.e6. Full text in Research Archive
• Solbraa, Ane; Holme, Ingar Morten K; Graff-Iversen, Sidsel; Steene-Johannessen, Jostein; Aadland, Eivind & Anderssen, Sigmund Alfred (2013). Fysisk aktivitet og kroppsmasseindeks, 13 års oppfølging av voksne i Sogn og Fjordane. Full text in Research Archive
• Kolle, Elin; Steene-Johannessen, Jostein; Andersen, Lars Bo & Anderssen, Sigmund Alfred (2012). Sedentary Behavior And Overweight In Children And Adolescents. Medicine & Science in Sports & Exercise. ISSN 0195-9131. 44, p. 664–664. Full text in Research Archive
• Kjær, Ingirid Geirsdatter Heald; Seiler, Hilde Lohne; Kolle, Elin; Hansen, Bjørge Hermann; Pedersen, Freddy & Steene-Johannessen, Jostein [Show all 9 contributors for this article] (2011). Musculoskeletal and motor fitness in Norwegian adults and elderly; Status and the development of reference values. KAN 1. Full text in Research Archive
• Solbraa, Ane; Mamen, Asgeir; Resaland, Geir Kåre; Steene-Johannessen, Jostein; Ylvisåker, Einar & Holme, Ingar Morten K [Show all 7 contributors for this article] (2011). The population in Sogn og Fjordane, Norway – fittest there is? Full text in Research Archive
• Steene-Johannessen, Jostein (2010). Korleis står?e til med aktivitetsnivået og den fysiske formen blant barn og unge i Noreg? Full text in Research Archive
• Steene-Johannessen, Jostein (2010). Hvordan får man barn og unge i bevegelse? Full text in Research Archive
• Stangeland, Ingirid; Stangeland, Ingirid; Torstveit, Monica Klungland; Torstveit, Monica Klungland; Lohne-Seiler, Hilde & Lohne-Seiler, Hilde [Show all 13 contributors for this article] (2010). Overvekt og fedme blant voksne og eldre nordmenn (KAN1). Full text in Research Archive Show summary

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

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

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

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

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

• Steene-Johannessen, Jostein; Hansen, Bjørge Hermann; Teinung, Elisabeth; Kolle, Elin; Riiser, Amund & Mølmen, Knut Sindre [Show all 12 contributors for this article] (2024). Fysisk form blant voksne og eldre i Norge 2022-2023 (Kan3). Folkehelseinstituttet. Full text in Research Archive Show summary

  <b>Sammendrag av hovedfunn</b> - Kartleggingen av fysisk form blant voksne og eldre i Norge 2022-23 (Kan3 fase 2) er utført ved Norges idrettshøgskole i samarbeid med Folkehelseinstituttet. Kan3 fase 2 inngår som en del av det nasjonale kartleggingssystemet for fysisk aktivitet og fysisk form der formålet er å følge opp tidligere undersøkelser av voksne og eldre for å øke kunnskapen om status, trender og utviklingen av fysisk form i den norske befolkingen. Datainnsamlingen i Kan3 fase 2 er gjennomført i samarbeid med Universitetet i Stavanger, Universitetet i Agder, UiT Norges arktiske universitet, Høgskulen på Vestlandet og Høgskolen i Innlandet i perioden august 2022 til april 2023.<p> <p>Et tilfeldig utvalg av deltakere som deltok i Kan3 fase 1 (hovedutvalg) ble invitert til fysisk oppmøte for gjennomføring av tester for å måle fysisk form i Kan3 fase 2. Som beskrevet i Kan 3 fase 1 rapport ble det også rekruttert deltakere som var 67+ år gjennom egne rekrutteringsstrategier mot seniorsenter i de store byene. Disse deltakerne gjennomførte tester av gripestyrke, balanse og bevegelighet, men de gjennomførte ikke test av maksimalt oksygenopptak.<p> <p>Av totalt 2001 personer som ble invitert, samtykket 1503 personer til deltakelse i Kan3 fase 2. Som vist i Kan 3 fase 1 er utvalget noe selektert da det er forholdsvis flere med høy sosioøkonomisk status i utvalget sammenlignet med den øvrige befolkningen. Den samme selekteringen er følgelig med videre inn i fase 2, og det betyr at beregninger for fysisk form trolig vil være noe overestimert.<p> <p><b>Maksimalt oksygenopptak (VO2max)</b> - Menn hadde høyere maksimalt oksygenopptak enn kvinner i alle aldergrupper. Oksygenopptaket falt med henholdsvis 2.8 ml∙kg-1∙min-1 og 3.9 ml∙kg-1∙min-1 blant kvinner og menn per 10 års økning i alder. Blant både menn og kvinner, hadde den femtedelen av deltakerne med høyest oksygenopptak et oksygenopptak som var omtrent dobbelt så høyt som den femtedelen av deltakerne med lavest oksygenopptak. Deltakere som tilfredsstilte Helsedirektoratets anbefaling for fysisk aktivitet, hadde høyere oksygenopptak sammenlignet med de som ikke tilfredsstilte anbefalingen. Oksygenopptaket økte med høyere utdanningsnivå blant menn, men ikke blant kvinner.<p> <p><b>Gripestyrke, balanse og bevegelighet</b> - Yngre hadde høyere gripestyrke enn eldre, og menn hadde høyere gripestyrke enn kvinner. Balansen reduseres med økende alder og en stor reduksjon sees etter fylte 60 år. Generelt var bevegeligheten i hofte og skulderledd bedre blant kvinner enn menn. For begge kjønn reduseres bevegeligheten med økende alder. Det var ingen sammenheng mellom gripestyrke, balanse og utdanning, men bevegelighet i hofteledd økte med høyere utdanning blant kvinner.<p> <p><b>Trender</b> - Både menn og kvinner i Kan3 fase 2 hadde et høyere maksimalt oksygenopptak enn menn og kvinner som deltok i Kan1 fase 2 i 2008-09. Menn hadde et oksygenopptak som var 2.3 ml∙kg-1∙min-1 (95% KI: 1.1 – 3.4) høyere i Kan3 sammenliknet med i Kan1, og tilsvarende forskjell for kvinner var 2.6 ml∙kg-1∙min-1 (95% KI: 1.6 – 3.5). Dette tilsvarer en prosentuell forskjell mellom Kan1 og Kan3 på 6-7%. Data må dog tolkes med forsiktighet fordi utvalget i Kan 1 er noe ulikt utvalget i Kan 3. Det var ingen forskjeller i gripestyrke når vi sammenlignet deltakere i Kan3 med deltakere i Kan1.<p> <p><b>Praktiske implikasjoner</b> - I gjennomsnitt har deltakere i Kan3 et oksygenopptak som er godt over eller på nivå med foreslåtte internasjonale og nasjonale grenseverdier for anbefalt VO2max. Spredningen i materialet er imidlertid betydelig og for den femtedelen av deltakerne med lavest oksygenopptak ligger verdiene betydelig lavere enn anbefalte verdier, noe som kan gi økt risiko for sykdom og tidlig død. I denne gruppen vil selv dagligdagse aktiviteter, som det å gå i trapper eller å sykle kreve en så stor andel av det maksimale oksygenopptaket at det vil være vanskelig å delta i slike aktiviteter i mer enn noen få minutter. Oksygenopptaket er imidlertid trenbart uansett alder og utgangspunkt. En økning i det maksimale oksygenopptaket hos denne gruppen vil kunne ha stor betydning for å sikre en god fysisk funksjon, det vil si gi økt mestring av dagliglivets aktiviteter.<p> <p>Lav gripestyrke er også assosiert med økt risiko for sykelighet og tidlig død. Selv om muskelmassen og maksimal styrke faller naturlig med økende alder, vil regelmessig styrketrening kunne forebygge mye av dette fallet. Styrketrening er spesielt viktig fra 50–60-årsalderen, og selv personer over 70 år vil kunne øke både muskelmassen og styrken betraktelig ved å starte med regelmessig styrketrening.

• Hansen, Bjørge Hermann; Steene-Johannessen, Jostein; Kolle, Elin; Udahl, Karine; Kaupang, Oda Bjørge & Andersen, Inge Dehli [Show all 10 contributors for this article] (2023). Kartlegging av fysisk aktivitet blant voksne og eldre 2020-22 (Kan3). Folkehelseinstituttet. Full text in Research Archive Show summary

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

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

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

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