Ulf Ekelund

• Dalene, Knut Eirik; Lergenmuller, Simon; Stigum, Hein; Meyer, Haakon Eduard; Nystad, Wenche & Larsen, Inger Kristin [Show all 12 contributors for this article] (2026). Joint association of risk factor clustering and socioeconomic position with non-communicable disease mortality risk: a prospective cohort study of 576 299 Norwegian men and women in the NCDNOR project. BMJ Public Health. 4(2). doi: 10.1136/bmjph-2025-004101. Full text in Research Archive Show summary

  Introduction: Well-known non-communicable disease (NCD) risk factors tend to cluster, forming groups with similar ‘risk factor phenotypes’. However, the characterisation of such clusters and the role of socioeconomic position (SEP) in modifying their associations with NCDs still remain unclear. Methods: We utilised data on smoking, physical activity, alcohol consumption, body mass index, blood pressure, cholesterol and triglyceride from health examination surveys conducted in Norwegian adults from 1974 to 2019 (n=5 76 299; age 20–65 years; 64% participation; 52% women) linked to registry data on education, income and mortality (follow-up through 2020). We identified risk factor clusters using latent profile analyses and used flexible parametric survival models to estimate differences in mean age at NCD death across sex, different birth years and SEP (education and income levels). Results: We identified four distinct clusters containing 44% (‘healthy’), 45% (‘suboptimal’), 4% (‘dyslipidaemics’) and 7% (‘hypertensives’) of the study sample, respectively. During a mean follow-up of 26 years, 61 241 died from an NCD. Compared with the cluster with the healthiest profile, other clusters had markedly shorter survival across sex and different birth cohorts. However, differences were also substantially modified by SEP: we estimated that individuals with primary education or low income died several years earlier than individuals with tertiary education or high income within each of the four risk factor clusters. Conclusions: Our findings show how NCD risk factors cluster and how SEP modifies the association between this clustering and NCD mortality. The substantial influence of SEP highlights the need for public health strategies that focus not only on changing behavioural and metabolic risk factors but also on addressing socioeconomic disparities to effectively reduce the burden of NCDs.

• Vaaramo, Mikko; Kari, Jaana T.; Korpelainen, Raija; Palviainen, Teemu; Niemelä, Mikko & Ekelund, Ulf [Show all 9 contributors for this article] (2026). The Effect of Cardiorespiratory and Muscular Fitness on Healthcare Costs Among Adults: A Triangulation Study. Medicine & Science in Sports & Exercise. ISSN 0195-9131. doi: 10.1249/MSS.0000000000004115. Full text in Research Archive
• Tarp, Jakob; Sanchez-Lastra, Miguel Adriano; Dalene, Knut Eirik; Luo, Mengyun; Nguyen, Binh & Mielke, Gregore Iven [Show all 9 contributors for this article] (2026). Long-term physical activity and risk of obesity in Australian women using target-trial emulation: an OBCT study. International Journal of Epidemiology. ISSN 0300-5771. 55(5). doi: 10.1093/ije/dyag174. Full text in Research Archive Show summary

  Background: Physical activity is recommended for obesity prevention, but the evidence is limited by possible biases from reverse causation and confounding, and there are limited data on the long-term effects of physical activity through middle age on the development of obesity. Methods: We emulated a target trial by using 10 waves of observational data from the 1946–51 Australian Longitudinal Study on Women’s Health collected between 1996 and 2022. The target trial would determine the effect of randomizing women to either meeting or not meeting the World Health Organization’s recommended level of physical activity over an 18-year period on the 21-year incidence of obesity. Targeted maximum-likelihood estimation controlling for time-constant and time-varying confounders was used to emulate the target trial, assuming conditional exchangeability, positivity, consistency, and no interference. Results: In total, 779 women aged 47–52 years at study entry were included. The cumulative incidence of obesity was 9.9% [99.5% confidence interval (CI): 8.6%, 11.1%] in the scenario with 18-year adherence to the recommendation and 15.1% (99.5% CI: 12.8%, 17.4%) with consistent non-adherence (risk ratio: 1.5, 99.5% CI: 1.2, 1.9; risk difference: 5.3%-point, 99.5% CI: 2.3%, 8.3%). Each additional survey with non-adherence increased the risk of obesity (risk ratio: 1.1, 99.5% CI: 1.0, 1.1). There was no additional benefit of meeting a higher physical-activity target. Conclusion: The results of our analysis, designed specifically to address the key limitations of previous evidence, underscore the benefits of long-term adherence to the recommended ≥150 minutes of moderate-to-vigorous physical activity per week for obesity prevention in middle-aged women.

• Luo, Mengyun; Clare, Philip James; Tarp, Jakob; Dalene, Knut Eirik; Sanchez-Lastra, Miguel Adriano & Nguyen, Binh [Show all 11 contributors for this article] (2026). Dose-response interplay between light and moderate-to-vigorous physical activity on all-cause mortality risk: a causal inference analysis. British Journal of Sports Medicine. ISSN 0306-3674. doi: 10.1136/bjsports-2025-110782. Full text in Research Archive
• 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
• Paluch, Amanda E.; Matthews, Charles E.; Doherty, Aiden; Ekelund, Ulf; Evenson, Kelly R. & Galuska, Deborah A. [Show all 16 contributors for this article] (2026). Daily Steps as a Public Health Metric for Physical Activity Monitoring and Promotion. Exercise and sport sciences reviews. ISSN 0091-6331. 54(1), p. 15–25. doi: 10.1249/JES.0000000000000375. Full text in Research Archive
• Salvo, Deborah; Crochemore-Silva, Inacio; Wendt, Andrea; Tarp, Jakob; Shiroma, Eric J. & Simpson, Richard J. [Show all 19 contributors for this article] (2026). Physical activity for public health in the 21st century. Nature Medicine. ISSN 1078-8956. doi: 10.1038/s41591-026-04237-5. Full text in Research Archive
• Sanchez-Lastra, Miguel Adriano; Cruz, Borja del Pozo; Tarp, Jakob; Dalene, Knut Eirik; Nilsen, Tormod Skogstad & Ding, Ding [Show all 7 contributors for this article] (2026). Dose‒response associations of self-reported and device-measured physical activity with major adverse cardiovascular events in people with prevalent diseases. Journal of Sport and Health Science. ISSN 2095-2546. 15. doi: 10.1016/j.jshs.2025.101116. Full text in Research Archive Show summary

  Purpose: To investigate the dose-response associations of self-reported and device-measured physical activity with major adverse cardiovascular events (MACE) and cardiovascular disease (CVD) mortality in individuals with a history of CVD, type 2 diabetes mellitus (T2DM), or cancer. Methods: We analyzed data from 34,183 UK Biobank participants (CVD: n = 8703; T2DM: n = 11,623; cancer: n = 13,857; age = 60.0 ± 7.1 years, mean ± SD; 45.3% women). Physical activity was assessed using self-reports and wrist-worn accelerometers in a subsample (n = 6077). Dose‒response associations with MACE and CVD mortality were evaluated using Fine-Gray competing-risk models with penalized splines, adjusting for confounders. Results: During a median follow-up of 13.1 years, 8729 MACE and 982 CVD deaths were recorded. Self-reported physical activity showed non-linear inverse associations with MACE, with the optimal dose (nadir) observed at ≈4000 MET-min/week in CVD (hazard ratio (HR) = 0.95) and cancer (HR = 0.92) and ≈6000 MET-min/week in T2DM (HR = 0.91), compared to participants in the 5th centiles of activity. For CVD mortality, the optimal dose was observed at ≈5000 MET-min/week in CVD (HR = 0.86) and cancer (HR = 0.62), respectively. Device-measured moderate-to-vigorous intensity physical activity showed stronger dose‒response associations with MACE for T2DM (optimal dose observed at ≈200 min/week, HR = 0.88) and cancer (optimal dose at ≈700 min/week, HR = 0.27, wide confidence intervals). Conclusion: Physical activity could reduce MACE risk in people with a history of CVD, T2DM, or cancer. While a similar shape of dose-response patterns was observed across these groups, self-reported data suggested the minimal effective dose might exceed current World Health Organization recommendations. However, device-measured data supported existing guidelines for people with T2DM and cancer survivors.

• Joensuu, Laura; Lukander, Volter; Herranen, Päivi; Tynkkynen, Niko Paavo; Kujala, Urho & López-Bueno, Rubén [Show all 13 contributors for this article] (2026). Evaluation of Genetics in the Association Between Cardiorespiratory Fitness and Health: Insights from a Genome‐Wide Polygenic Score for Cardiorespiratory Fitness in the FinnGen and HUNT cohorts. Scandinavian Journal of Sports Science. ISSN 0357-5632. doi: 10.1111/sms.70291. Full text in Research Archive
• Ding, Ding; Nguyen, Binh; Nau, Tracy; Luo, Mengyun; Cruz, Borja del Pozo & Dempsey, Paddy C. [Show all 20 contributors for this article] (2025). Daily steps and health outcomes in adults: a systematic review and dose-response meta-analysis. The Lancet Public Health. ISSN 2468-2667. 10(8), p. e668–e681. doi: 10.1016/S2468-2667(25)00164-1. Full text in Research Archive Show summary

  Background Despite the rapid increase in evidence from the past decade on daily steps and health-related outcomes, existing systematic reviews primarily focused on few outcomes, such as all-cause mortality. This study synthesised the prospective dose-response relationship between daily steps and health outcomes including all-cause mortality, cardiovascular disease, cancer, type 2 diabetes, cognitive outcomes, mental health outcomes, physical function, and falls. Methods For this systematic review and meta-analysis, we searched PubMed and EBSCO CINAHL for literature published between Jan 1, 2014, and Feb 14, 2025, supplemented by other search strategies. Eligible prospective studies examined the relationship between device-measured daily steps and health outcomes among adults without restrictions on language or publication type. Pairs of reviewers (BN, KO, ML, and TN) independently did the study selection, data extraction, and risk of bias assessment using the 9-point Newcastle-Ottawa Scale. Hazard ratios (HRs) from individual studies were synthesised using random-effects dose-response meta-analysis where possible. Certainty of evidence was assessed using GRADE. This trial is registered with PROSPERO (CRD42024529706). Findings 57 studies from 35 cohorts were included in the systematic review and 31 studies from 24 cohorts were included in meta-analyses. For all-cause mortality, cardiovascular disease incidence, dementia, and falls, an inverse non-linear dose-response association was found, with inflection points at around 5000–7000 steps per day. An inverse linear association was found for cardiovascular disease mortality, cancer incidence, cancer mortality, type 2 diabetes incidence, and depressive symptoms. Based on our meta-analyses, compared with 2000 steps per day, 7000 steps per day was associated with a 47% lower risk of all-cause mortality (HR 0·53 [95% CI 0·46–0·60]; I2=36·3; 14 studies), a 25% lower risk of cardiovascular disease incidence (HR 0·75 [0·67–0·85]; I2=38·3%; six studies), a 47% lower risk of cardiovascular disease mortality (HR 0·53 [0·37–0·77]; I2=78·2%; three studies), a non-significant 6% lower risk of cancer incidence (HR 0·94 [0·87–1·01]; I2=73·7%; two studies), a 37% lower risk of cancer mortality (HR 0·63 [0·55–0·72]; I2=64·5%; three studies), a 14% lower risk of type 2 diabetes (HR 0·86 [0·74–0·99]; I2=48·5%; four studies), a 38% lower risk of dementia (HR 0·62 [0·53–0·73]; I2=0%; two studies), a 22% lower risk of depressive symptoms (HR 0·78 [0·73–0·83]; I2=36·2%; three studies), and a 28% lower risk of falls (HR 0·72 [0·65–0·81]; I2=47·5%; four studies). Studies on physical function (not based on meta-analysis) reported similar inverse associations. The evidence certainty was moderate for all outcomes except for cardiovascular disease mortality (low), cancer incidence (low), physical function (low), and falls (very low). Interpretation Although 10 000 steps per day can still be a viable target for those who are more active, 7000 steps per day is associated with clinically meaningful improvements in health outcomes and might be a more realistic and achievable target for some. The findings of the study should be interpreted in light of limitations, such as the small number of studies available for most outcomes, a lack of age-specific analysis and biases at the individual study level, including residual confounding.

• Tornquist, Debora; Tornquist, Luciana; Crochemore-Silva, Inácio; Mielke, Grégore Iven; Ekelund, Ulf & Hallal, Pedro Curi [Show all 7 contributors for this article] (2025). Associations of Early Childhood Correlates With Device-Measured Physical Activity in the First Years of Life: Findings From the 2015 Pelotas (Brazil) Birth Cohort Study. Journal of Physical Activity and Health. ISSN 1543-3080. 22(8), p. 1028–1041. doi: 10.1123/jpah.2024-0565. Full text in Research Archive Show summary

  Background: The study aimed to examine the associations between breastfeeding, home environmental and childcare characteristics, and maternal and child behaviors and physical activity (PA) in the first years of life in the 2015 Pelotas (Brazil) Birth Cohort. Methods: PA was measured with wrist accelerometers at 1 (n = 2974), 2 (n = 2645), and 4 years (n = 2955), and PA trajectories were estimated using group-based trajectory modeling (n = 1798). Results: At the age of 1 year, partially breastfed children had higher levels of PA, whereas children with excessive screen time had lower PA. At 2 years, children whose mothers went for leisure walks had higher levels of PA, and children who attended childcare had lower levels of PA. At 4 years, higher PA was associated with breastfeeding for >6 months, maternal leisure-time PA, and having ≥2 siblings, whereas attendance at public childcare was associated with lower PA. Attendance at childcare in at least one follow-up and public childcare reduced the probability of the child presenting a trajectory of high PA in the early years. Children of mothers who performed some leisure-time PA and other leisure-time PA (except walking) in more than 1 follow-up were more likely to present a high PA trajectory. Conclusions: Breastfeeding, childcare, number of siblings, maternal PA, and screen time were shown to be correlates of PA levels in early childhood.

• Cadenas-Sanchez, Cristina; Sanchez-Lastra, Miguel Adriano; Tarp, Jakob; Ekelund, Ulf & Dalene, Knut Eirik (2025). Occupational physical activity and incidence and mortality of 14 cancers in 404,249 adults. Nature Communications. 16. doi: 10.1038/s41467-025-65326-6. Full text in Research Archive Show summary

  Leisure physical activity is considered protective against several cancers, but the impact of physical activity at work remains unclear. We analyze data from over 400,000 Norwegian adults followed for a median of 27 years to examine how different levels of occupational physical activity are associated with cancer incidence and mortality. Participants report their typical work activity as sedentary, walking, walking-and-lifting, or heavy labor. Here we show that individuals with more physically active jobs have a lower risk of developing several cancers (i.e., endometrial, colon, breast, rectal, and prostate), and to a lesser extent, the risk of breast cancer mortality. However, occupational physical activity is also associated with increased risk of esophageal and kidney cancer death. These findings suggest that occupational physical activity may lower the incidence of some cancers but are associated with a higher mortality from other cancer types. Understanding these patterns could help tailor public health recommendations related to physical activity and occupational health.

• 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.

• Atkin, Andrew J.; Sherar, Lauren B.; Ekelund, Ulf; Hansen, Bjørge Hermann; Andersen, Lars Bo & Anderssen, Sigmund Alfred [Show all 17 contributors for this article] (2025). Age-related change in children’s physical activity and sedentary time: The International Children’s Accelerometry Database (ICAD). PLOS ONE. 20(9). doi: 10.1371/journal.pone.0327394. Full text in Research Archive Show summary

  Background Many young people fail to achieve the minimum recommended amount of physical activity to benefit their health. Understanding the nature of age-related changes in behaviour and how this varies for population sub-groups is informative for intervention design. The aim of this study was to describe age-related changes in physical activity and sedentary time and examine variability in patterns of change across demographic sub-groups. Methods Data are from 13 studies in the International Children’s Accelerometry Database (ICAD), all of which provided ≥2 waves of waist-worn accelerometer data. Annual change in sedentary time, light intensity physical activity (LPA) and moderate to vigorous intensity physical activity (MVPA) were estimated using three level mixed effects linear regression models, using participant age as the exposure variable. In interaction models, we examined whether changes in behaviour differed by day of the week (weekday/ weekend), age at baseline assessment (<10/ ≥ 10 years), sex, weight category, maternal education and ethnicity. Results In total, 6567 participants provided two or more waves of valid accelerometer data (44.5% boys, mean (SD) baseline age 10.6 (2.1) years (range 4.1–15.8 years)). Across the week and for all studied sub-groups, sedentary time increased by approximately 25 minutes/day/year of age, LPA decreased by approximately 22 minutes/day/year of age and MVPA decreased by approximately 3 minutes/day/year of age. The annual increase in sedentary time was greater in girls compared to boys (β (95% confidence interval) change (min) for each additional year of age: girls, 25.9 (25.4, 26.4); boys, 23.6 (23.0, 24.2)) and in adolescents compared to children (adolescents, 27.0 (26.5, 27.6); children, (23.5 (22.9, 24.2)). The annual decrease in MVPA was greater in boys compared to girls (boys, −2.7 (−3.0, −2.5); girls, −2.2 (−2.4, −2.0)) and at the weekend compared to during the week (weekend, −3.0 (−3.3, −2.8); weekday −2.3 (−2.5, −2.1)). Conclusion Accelerometer assessed sedentary time increased whilst LPA and MVPA decreased during childhood and adolescence. This overall pattern was observed across the week and in all studied sub-groups, but small differences in the magnitude of changes can be used to guide the timing and targeting of behaviour change interventions, such as designing physical activity interventions which focus on weekends where a child’s time is less structured.

• McGrosky, Amanda; Luke, Amy; Arab, Leonore; Bedu-Addo, Kweku; Bonomi, Alberto G. & Bovet, Pascal [Show all 98 contributors for this article] (2025). Energy expenditure and obesity across the economic spectrum. Proceedings of the National Academy of Sciences of the United States of America (PNAS). ISSN 0027-8424. 122(29). doi: 10.1073/pnas.2420902122. Full text in Research Archive Show summary

  Global economic development has been associated with an increased prevalence of obesity and related health problems. Increased caloric intake and reduced energy expenditure are both cited as development-related contributors to the obesity crisis, but their relative importance remains unresolved. Here, we examine energy expenditure and two measures of obesity (body fat percentage and body mass index, BMI) for 4,213 adults from 34 populations across six continents and a wide range of lifestyles and economies, including hunter-gatherer, pastoralist, farming, and industrialized populations. Economic development was positively associated with greater body mass, BMI, and body fat, but also with greater total, basal, and activity energy expenditure. Body size–adjusted total and basal energy expenditures both decreased approximately 6 to 11% with increasing economic development, but were highly variable among populations and did not correspond closely with lifestyle. Body size–adjusted total energy expenditure was negatively, but weakly, associated with measures of obesity, accounting for roughly one-tenth of the elevated body fat percentage and BMI associated with economic development. In contrast, estimated energy intake was greater in economically developed populations, and in populations with available data (n = 25), the percentage of ultraprocessed food in the diet was associated with body fat percentage, suggesting that dietary intake plays a far greater role than reduced energy expenditure in obesity related to economic development.

• Bian, Wenxin; Ahmadi, Matthew N.; Biswas, Raaj Kishore; Blodgett, Joanna M.; Atkin, Andrew J. & Chan, Hsiu-Wen [Show all 28 contributors for this article] (2025). Device-Measured Sleep Characteristics, Daily Step Count, and Cardiometabolic Health Markers: Findings From the Prospective Physical Activity, Sitting, and Sleep (ProPASS) Consortium. Circulation. Cardiovascular Quality and Outcomes. ISSN 1941-7713. 18(8), p. e011873–e011873. doi: 10.1161/circoutcomes.124.011873. Full text in Research Archive Show summary

  BACKGROUND: Sleep and physical activity (PA) are important lifestyle-related behaviors that impact cardiometabolic health. This study investigated the joint associations of daily step count and sleep patterns (regularity and duration) with cardiometabolic biomarkers in adults. METHODS: We conducted a cross-sectional study using pooled data from the Prospective PA, Sitting, and Sleep Consortium, comprising 6 cohorts across Europe and Australia with thigh-worn accelerometry data collected between 2011 and 2021. The sleep regularity index, a metric that quantifies day-to-day sleep consistency, sleep duration (h/d), and steps (per day), was derived from the accelerometer data and categorized based on tertiles and sleep duration guidelines. We used multivariate generalized linear models to examine joint associations of sleep patterns and total daily step count with individual cardiometabolic biomarkers, including body mass index, waist circumference, total cholesterol, HDL (high-density lipoprotein) cholesterol, triglycerides, HbA1c (glycated hemoglobin), and a composite cardiometabolic health score (mean of the 6 standardized biomarker Z scores). RESULTS: The sample included 11 903 adults with a mean±SD age of 54.7±9.5 years, 54.9% female, a sleep regularity index of 78.7±10.4, and 10 206.4±3442.2 daily steps. Lower PA (<8475 steps/d) combined with either lower sleep regularity (sleep regularity index <75.9) or short sleep duration (<7 h/d) was associated with the least favorable composite cardiometabolic health. The corresponding Z scores (95% CI) were 0.34 (0.30–0.38) and 0.26 (0.22–0.31) compared with those with optimal sleep (sleep regularity index >84.5 or 7–8 h/d) and high step count (>11 553 steps/d). The combination of low sleep regularity and low daily steps was associated with higher body mass index (2.92 [2.61–3.24] kg/m 2 ), waist circumference (8.58 [7.78–9.38] cm), total cholesterol (0.15 [0.07–0.23] mmol/L), and lower HDL levels (0.17 [0.14–0.2] mmol/L), regardless of sleep duration. The combination of short sleep and low step count had the strongest unfavorable associations for body mass index (2.31 [1.98–2.65] kg/m 2 ) and waist circumference (7.01 [6.15–7.87] cm). CONCLUSIONS: Our findings suggest that the potential deleterious associations of irregular or insufficient sleep with cardiometabolic health outcomes may be exaggerated by lower daily PA. Investigation of the prospective joint association of sleep patterns and PA with cardiometabolic health may be warranted.

• Lam, Thao Minh; Aarestrup, Julie; Akker, Erica L. T. van den; Baker, Jennifer L.; Banik, Anna & Berntzen, Bram J. [Show all 56 contributors for this article] (2025). Advancing knowledge, maps and tools to address obesity and related socio-economic disparities in Europe: the OBCT project. Global health action. ISSN 1654-9716. 18(1). doi: 10.1080/16549716.2025.2517492. Full text in Research Archive Show summary

  The steady rise in overweight and obesity in Europe disproportionately affects people and communities with a lower socio-economic position (SEP). Many obesity prevention approaches exist, but these have had limited reach and unsatisfactory effects thus far, especially in low-SEP populations. In this context, there is a need for implementation of effective individual-level and population-based preventive strategies that also tackle health inequalities. Effective strategies require consideration of the complex and cross-domain obesity risk factors across the life course. Feasible and acceptable strategies require multisectoral collaborations and innovative approaches, including a whole-of community and systems perspective. With the Horizon Europe-funded OBCT project, we aim to quantify the relative contribution of biological, socio-cultural and built environment factors to obesity and the interactions of these risks within and across various life course stages; and translate the resulting knowledge into practical, equitable, and effective tools for action. These tools will include: a comprehensive obesity risk screener; a map of the obesogenicity of neighbourhood environments as well as trends in obesity prevalence of each European country; recommendations for lifestyle behaviours (diet, physical activity, sedentary behaviours) to prevent obesity during key life transition stages; a decision support dashboard for policy makers; and co-developed toolboxes to support implementation of policy recommendations in low-SEP communities. OBCT’s outputs will highlight the areas and domains in which obesity should be targeted and will empower the research community, policymakers, health professionals and residents in Europe to adapt and implement strategies to effectively reduce obesity risk, particularly in low-SEP communities.

• Bajunaid, Rania; Niu, Chaoqun; Hambly, Catherine; Liu, Zongfang; Yamada, Yosuke & Aleman-Mateo, Heliodoro [Show all 98 contributors for this article] (2025). Predictive equation derived from 6,497 doubly labelled water measurements enables the detection of erroneous self-reported energy intake. Nature Food. 6, p. 58–71. doi: 10.1038/s43016-024-01089-5. Full text in Research Archive Show summary

  Nutritional epidemiology aims to link dietary exposures to chronic disease, but the instruments for evaluating dietary intake are inaccurate. One way to identify unreliable data and the sources of errors is to compare estimated intakes with the total energy expenditure (TEE). In this study, we used the International Atomic Energy Agency Doubly Labeled Water Database to derive a predictive equation for TEE using 6,497 measures of TEE in individuals aged 4 to 96 years. The resultant regression equation predicts expected TEE from easily acquired variables, such as body weight, age and sex, with 95% predictive limits that can be used to screen for misreporting by participants in dietary studies. We applied the equation to two large datasets (National Diet and Nutrition Survey and National Health and Nutrition Examination Survey) and found that the level of misreporting was 27.4%. The macronutrient composition from dietary reports in these studies was systematically biased as the level of misreporting increased, leading to potentially spurious associations between diet components and body mass index.

• Schumann, Moritz; Feuerbacher, Joshua F.; Heinrich, Lars; Olvera-Rojas, Marcos; Sclafani, Alessandro & Brønd, Jan Christian [Show all 13 contributors for this article] (2025). Using Free-Living Heart Rate Data as an Objective Method to Assess Physical Activity: A Scoping Review and Recommendations by the INTERLIVE-Network Targeting Consumer Wearables. Sports Medicine. ISSN 0112-1642. 55, p. 275–300. doi: 10.1007/s40279-024-02159-1. Full text in Research Archive
• 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.

• Zaccardi, Francesco; Rowlands, Alex V.; Dempsey, Paddy C.; Razieh, Cameron; Henson, Joe & Goldney, Jonathan [Show all 15 contributors for this article] (2025). Interplay between physical activity volume and intensity with modeled life expectancy in women and men: A prospective cohort analysis. Journal of Sport and Health Science. ISSN 2095-2546. 14. doi: 10.1016/j.jshs.2024.100970. Full text in Research Archive Show summary

  Background There is a lack of research examining the interplay between objectively measured physical activity volume and intensity with life expectancy. The purpose of the study was to investigate the interplay between objectively measured PA volume and intensity profiles with modeled life expectancy in women and men within the UK Biobank cohort study and interpret findings in relation to brisk walking. Methods Individuals from UK Biobank with wrist-worn accelerometer data were included. The average acceleration and intensity gradient were extracted to describe the physical activity volume and intensity profile. Mortality data were obtained from national registries. Adjusted life expectancies were estimated using parametric flexible survival models. Results 40,953 (57.1%) women (median age = 61.9 years) and 30,820 (42.9%) men (63.1 years) were included. Over a median follow-up of 6.9 years, there were 1719 (2.4%) deaths (733 in women; 986 in men). At 60 years, life expectancy was progressively longer for higher physical activity volume and intensity profiles, reaching 95.6 years in women and 94.5 years in men at the 90th centile for both volume and intensity, corresponding to 3.4 additional years (95% confidence interval (95%CI): 2.4–4.4) in women and 4.6 additional years (95%CI: 3.6–5.6) in men compared to those at the 10th centiles. An additional 10-min or 30-min daily brisk walk was associated with 0.9 (95%CI: 0.5–1.3) and 1.4 years (95%CI: 0.9–1.9) longer life expectancy, respectively, in inactive women; and 1.4 years (95%CI: 1.0–1.8) and 2.5 (95%CI: 1.9–3.1) in inactive men. Conclusion Higher physical activity volumes were associated with longer life expectancy, with a higher physical activity intensity profile further adding to a longer life. Adding as little as a 10-min brisk walk to daily activity patterns may result in a meaningful benefit to life expectancy.

• Joensuu, Laura; Koivunen, Kaisa; Tynkkynen, Niko Paavo; Palviainen, Teemu; Kaprio, Jaakko & Consortium, FinnGen [Show all 12 contributors for this article] (2025). Genetic liability to sedentary behaviour and cardiovascular disease incidence in the FinnGen and HUNT cohorts. British Journal of Sports Medicine. ISSN 0306-3674. 59(11), p. 783–790. doi: 10.1136/bjsports-2024-109491. Full text in Research Archive Show summary

  Objective: Energy-saving sedentary behaviour may be an evolutionarily selected trait that is no longer advantageous. We investigated the associations between genetic liability to sedentary behaviour and the incidence of the most common cardiovascular disease (CVD). Methods: We constructed and validated a genome-wide polygenic score for leisure screen time (PGS LST) as a measure of genetic liability to sedentary behaviour. We performed survival analyses between higher PGS LST and register-based CVDs using the FinnGen cohort (N=293 250–333 012). Replication and exploratory analyses were conducted in an independent Norwegian Trøndelag Health Study (HUNT) cohort (N=35 289). Results: In FinnGen, each SD increase in PGS LST was associated with a higher risk of incident CVD (HR: 1.05 (95% CI 1.05 to 1.06)) (168 770 cases over 17 101 133 person-years). The magnitudes of association for the three most common CVDs were 1.09 ((95% CI 1.08 to 1.09), 1.06 ((95% CI 1.05 to 1.07) and 1.05 ((95% CI 1.04 to 1.06) for hypertensive disease, ischaemic heart disease and cerebrovascular disease, respectively. Those in the top decile of PGS LST had 21%, 35%, 26% and 19% higher risk of any CVD, hypertensive disease, ischaemic heart disease and cerebrovascular disease, respectively, than those in the bottom decile. Associations were replicated in HUNT and remained independent of covariates (socioeconomic status, body mass index and smoking) except for cerebrovascular disease. Besides direct effects, reduced physical activity served as a potential mediating pathway for the observed associations. Conclusions: We found that genetic liability to sedentary behaviour is associated with incident CVD, although effect sizes with current PGS remained small. These findings suggest that genetic liability to sedentary behaviour is an under-recognised driver of common CVDs.

• Wendt, Andrea; Leite, Giulia Salaberry; Contreira, Renata; Mielke, Grégore Iven; Horta, Bernardo Lessa & Motta, Janaína Vieira Dos Santos [Show all 19 contributors for this article] (2025). Lessons from 13 years of accelerometry measurements in five Brazilian cohorts: methodological aspects. Cadernos de Saúde Pública. ISSN 0102-311X. 41(3), p. e00011724–e00011724. doi: 10.1590/0102-311XEN011724. Full text in Research Archive
• Sanchez-Lastra, Miguel Adriano; Cruz, Borja del Pozo; Ekelund, Ulf; Tarp, Jakob & Ding, Ding (2025). Physical Activity and Life Expectancy Free of Cancer: Prospective Evidence From the UK Biobank Study. Journal of Physical Activity and Health. ISSN 1543-3080. 22(5), p. 636–639. doi: 10.1123/jpah.2024-0390. Full text in Research Archive
• Sanchez-Lastra, Miguel Adriano; Strain, Tessa; Ding, Ding; Dalene, Knut Eirik; Cruz, Borja del Pozo & Ekelund, Ulf [Show all 7 contributors for this article] (2025). Associations of adiposity and device-measured physical activity with cancer incidence: UK Biobank prospective cohort study. Journal of Sport and Health Science. ISSN 2095-2546. 14. doi: 10.1016/j.jshs.2024.101018. Full text in Research Archive
• Ricardo, Luiza I.C.; Wendt, Andrea; Tornquist, Debora; Gonçalves, Helen; Wehrmeister, Fernando & Silva, Bruna Gonçalves C. da [Show all 15 contributors for this article] (2024). Gender Gap for Accelerometry-Based Physical Activity Across Different Age Groups in 5 Brazilian Cohort Studies. Journal of Physical Activity and Health. ISSN 1543-3080. 21(11), p. 1158–1166. doi: 10.1123/jpah.2024-0018. Full text in Research Archive Show summary

  Objectives: This study aims to evaluate the gender inequalities in accelerometer-based physical activity (PA) across different age groups using data from 5 Pelotas (Brazil) cohorts. Methods: The data come from 4 birth cohort studies, covering all live births in the urban area of Pelotas for each respective year (1982, 1993, 2004, and 2015), and the Como vai? cohort study focusing on 60 years and above. Raw accelerometry data were collected on the nondominant wrist using GENEActive/ActiGraph devices and processed with the GGIR package. Overall PA was calculated at ages 1, 2, 4, 6, 11, 15, 18, 23, 30, and 60+ years, while moderate to vigorous PA was calculated from 6 years onward. Absolute (difference) and relative (ratio) gender inequalities were calculated and intersectionality between gender and wealth was also evaluated. Results: The sample sizes per cohort ranged from 965 to 3462 participants. The mean absolute gender gap was 19.3 minutes (95% confidence interval, 12.7–25.9), with the widest gap at 18 years (32.9 min; 95% confidence interval, 30.1–35.7) for moderate to vigorous PA. The highest relative inequality was found in older adults (ratio 2.0; 95% confidence interval, 1.92–2.08). Our intersectionality results showed that the poorest men being the most active group, accumulating around 60 minutes more moderate to vigorous PA per day compared with the wealthiest women at age 18. Conclusions: Men were more physically active than women in all ages evaluated. PA gender inequalities start at an early age and intensify in transition periods of life. Relative inequalities were marked among older adults.

• Joensuu, Laura; Koivunen, Kaisa; Tynkkynen, Niko Paavo; Palviainen, Teemu; Kaprio, Jaakko & Klevjer, Marie [Show all 11 contributors for this article] (2024). Genetic liability to sedentary behavior increases the risk of cardiovascular disease incidence: Evidence from the FinnGen cohort with 293,250 individuals. medRxiv. doi: 10.1101/2024.06.20.24309213. Full text in Research Archive
• Martinez-Gomez, David; Rodriguez-Artalejo, Fernando; Ding, Ding; Ekelund, Ulf & Cabanas-Sanchez, Veronica (2024). Trends in the association between meeting the physical activity guidelines and risk of mortality in US adults. Progress in cardiovascular diseases. ISSN 0033-0620. 83, p. 116–123. doi: 10.1016/j.pcad.2024.02.011. Full text in Research Archive Show summary

  Objective: To examine the trends in the association between meeting the physical activity (PA) guidelines and mortality in adults. Methods: We included seventeen annual representative samples of US adults 1998–2014 (n = 482,756) and all-cause and cause-specific mortality ascertained through December 2019. Participants were grouped according to PA Guidelines: 150 or more min/week in aerobic PA and muscle-strengthening activities 2 or more times/week. To provide further context, we also examined the trends in mortality risk associated with other modifiable health factors. Results: Meeting the PA guidelines was associated with lower 5-year mortality risk (HR = 0.59, 95%CI, 0.55, 0.63) based on the pooled analyses. We consistently observed an inverse association in all years, but there was a nonsignificant trend association (P for trend = 0.305) between meeting PA guidelines and 5-year mortality across the seventeen annual surveys. Meeting aerobic (HR = 0.58, 95%CI, 0.56, 0.61) and muscle-strengthening (HR = 0.86, 95%CI, 0.81, 0.90) guidelines were independently associated with 5-year mortality risk in pooled analyses, without any evidence for trends in the associations. Similar results were found with cause-specific mortality and 10-year mortality risk. In pooled analyses, attaining a high educational level, body mass index

• Sluijs, Esther M.F. Van; Ekelund, Ulf; Hallal, Pedro C.; Hansen, Bjørge Hermann; Panter, Jenna & Salmon, Jo [Show all 9 contributors for this article] (2024). Family Car Ownership: Driving Inactivity in Young People? Cross-Sectional and Longitudinal Analyses in the International Children's Accelerometry Database. Journal of Physical Activity and Health. ISSN 1543-3080. 21(12), p. 1391–1400. doi: 10.1123/jpah.2024-0044. Full text in Research Archive Show summary

  Background: Ubiquitous car ownership may affect children’s activity and health. We assessed the cross-sectional and longitudinal associations between household car ownership and children’s daily time spent sedentary (SED) and in moderate to vigorous physical activity (MVPA). Methods: Pooled cohort data were from the International Children’s Accelerometry Database. Outcome measures were average daily accelerometer-measured SED and MVPA (in minutes per day). Exposures were household car ownership (none, 1, and ≥2) and change in car ownership. Associations were examined using multivariable mixed-effects linear regression. Results: Mean age of participants (N = 4193) was 10.4 years (SD = 2.0), 53.4% were girls, and mean follow-up duration (N = 1333) was 3.3 years (SD = 1.1). Cross-sectionally, household car ownership was associated with higher SED (vs none: 1 car: β = 14.1 min/d, 95% CI, 6.7–21.5; ≥2 cars: 12.8, 95% CI, 5.3–20.4) and lower MVPA (vs none: 1 car: β = –8.8, 95% CI, −11.9 to −5.7; ≥2 cars: β = –8.8, 95% CI, −12.0 to −5.7). Associations were stronger in boys than girls and in children from lower socioeconomic backgrounds (SED only). Prospectively, there were no associations with increased car ownership. Reductions in household car ownership (of which 93.1% had ≥ 2 cars at baseline) were associated with a greater reduction in MVPA (vs no change: β = −8.4, 95% CI, −13.9 to −3.0) but not SED. Conclusions: Children in households with car access were more SED and less active than those without. Losing access to a second car was associated with greater decreases in MVPA, potentially related to losing access to activity-enabling environments. Reducing car access and use are important public health targets (eg, reducing air pollution), but their potential impact on children’s activity opportunities should be mitigated.

• Blodgett, Joanna M.; Ahmadi, Matthew N.; Atkin, Andrew J; Pulsford, Richard M.; Rangul, Vegar & Chastin, Sebastian [Show all 26 contributors for this article] (2024). Device-Measured 24-Hour Movement Behaviors and Blood Pressure: A 6-Part Compositional Individual Participant Data Analysis in the ProPASS Consortium. Circulation. ISSN 0009-7322. 151(2), p. 159–170. doi: 10.1161/CIRCULATIONAHA.124.069820. Full text in Research Archive Show summary

  Background: Blood pressure (BP)–lowering effects of structured exercise are well-established. Effects of 24-hour movement behaviors captured in free-living settings have received less attention. This cross-sectional study investigated associations between a 24-hour behavior composition comprising 6 parts (sleeping, sedentary behavior, standing, slow walking, fast walking, and combined exercise-like activity [eg, running and cycling]) and systolic BP (SBP) and diastolic BP (DBP). Methods: Data from thigh-worn accelerometers and BP measurements were collected from 6 cohorts in the Prospective Physical Activity, Sitting and Sleep consortium (ProPASS) (n=14 761; mean±SD, 54.2±9.6 years). Individual participant analysis using compositional data analysis was conducted with adjustments for relevant harmonized covariates. Based on the average sample composition, reallocation plots examined estimated BP reductions through behavioral replacement; the theoretical benefits of optimal (ie, clinically meaningful improvement in SBP [2 mm Hg] or DBP [1 mm Hg]) and minimal (ie, 5-minute reallocation) behavioral replacements were identified. Results: The average 24-hour composition consisted of sleeping (7.13±1.19 hours), sedentary behavior (10.7±1.9 hours), standing (3.2±1.1 hours), slow walking (1.6±0.6 hours), fast walking (1.1±0.5 hours), and exercise-like activity (16.0±16.3 minutes). More time spent exercising or sleeping, relative to other behaviors, was associated with lower BP. An additional 5 minutes of exercise-like activity was associated with estimated reductions of –0.68 mm Hg (95% CI, –0.15, –1.21) SBP and –0.54 mm Hg (95% CI, –0.19, 0.89) DBP. Clinically meaningful improvements in SBP and DBP were estimated after 20 to 27 minutes and 10 to 15 minutes of reallocation of time in other behaviors into additional exercise. Although more time spent being sedentary was adversely associated with SBP and DBP, there was minimal impact of standing or walking. Conclusions: Study findings reiterate the importance of exercise for BP control, suggesting that small additional amounts of exercise are associated with lower BP in a free-living setting.

• 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).

• Martinez-Gomez, David; Luo, Mengyun; Huang, Yu; Rodríguez-Artalejo, Fernando; Ekelund, Ulf & Sotos-Prieto, Mercedes [Show all 9 contributors for this article] (2024). Physical Activity and All-Cause Mortality by Age in 4 Multinational Megacohorts. JAMA Network Open. 7(11). doi: 10.1001/jamanetworkopen.2024.46802. Full text in Research Archive Show summary

  Importance: Physical activity (PA) guidelines recommend the same amount of PA through adulthood to live longer. Objective: To explore whether there is an age-dependent association between PA and all-cause mortality and to investigate the age-dependent associations between other modifiable health factors (high educational level, not smoking, not regularly consuming alcohol, healthy body weight, and living without hypertension and diabetes) and mortality. Design, Setting, and Participants: This cohort study used a pooled analysis of 4 population-based prospective cohorts (National Health Interview Survey, 1997-2018; UK Biobank, 2006-2010; China Kadoorie Biobank, 2004-2008; and Mei Jau, 1997-2016). Data were analyzed from June 2022 to September 2024. Exposures: Self-reported leisure-time PA. Main Outcomes and Measures: The primary outcome was deaths identified through follow-up linkage to national death registries. Analyses were performed for the total sample and by age groups (20-29, 30-39, 40-49, 50-59, 60-69, 70-79, and ≥80 years). Cox proportional hazards regression models with stratification by study were used to calculate mortality hazard ratios and their 95% CIs for the pooled dataset and by age group. Results: A heterogeneous sample of 2 011 186 individuals (mean [SD] age, 49.1 [14.3] years; age range, 20-97 years; 1 105 581 women [55.0%]) were included. After a median (IQR) follow-up of 11.5 (9.3-13.5) years, 177 436 deaths occurred. The association between PA and mortality in the total sample showed a nonlinear dose-response pattern, but age modified this association (P for interaction

• Cillekens, Bart; Coenen, Pieter; Huysmans, Maaike A.; Holtermann, Andreas; Troiano, Richard P. & Mork, Paul Jarle [Show all 43 contributors for this article] (2024). Should workers be physically active after work? Associations of leisure-time physical activity with cardiovascular and all-cause mortality across occupational physical activity levels—An individual participant data meta-analysis. Journal of Sport and Health Science. ISSN 2095-2546. 14, p. 1–12. doi: 10.1016/j.jshs.2024.100987. Full text in Research Archive Show summary

  Background There is insufficient evidence to provide recommendations for leisure-time physical activity among workers across various occupational physical activity levels. This study aimed to assess the association of leisure-time physical activity with cardiovascular and all-cause mortality across occupational physical activity levels. Methods This study utilized individual participant data from 21 cohort studies, comprising both published and unpublished data. Eligibility criteria included individual-level data on leisure-time and occupational physical activity (categorized as sedentary, low, moderate, and high) along with data on all-cause and/or cardiovascular mortality. A 2-stage individual participant data meta-analysis was conducted, with separate analysis of each study using Cox proportional hazards models (Stage 1). These results were combined using random-effects models (Stage 2). Results Higher leisure-time physical activity levels were associated with lower all-cause and cardiovascular mortality risk across most occupational physical activity levels, for both males and females. Among males with sedentary work, high compared to sedentary leisure-time physical activity was associated with lower all-cause (hazard ratios (HR) = 0.77, 95% confidence interval (95%CI): 0.70–0.85) and cardiovascular mortality (HR = 0.76, 95%CI: 0.66–0.87) risk. Among males with high levels of occupational physical activity, high compared to sedentary leisure-time physical activity was associated with lower all-cause (HR = 0.84, 95%CI: 0.74–0.97) and cardiovascular mortality (HR = 0.79, 95%CI: 0.60–1.04) risk, while HRs for low and moderate levels of leisure-time physical activity ranged between 0.87 and 0.97 and were not statistically significant. Among females, most effects were similar but more imprecise, especially in the higher occupational physical activity levels. Conclusion Higher levels of leisure-time physical activity were generally associated with lower mortality risks. However, results for workers with moderate and high occupational physical activity levels, especially women, were more imprecise. Our findings suggests that workers may benefit from engaging in high levels of leisure-time physical activity, irrespective of their level of occupational physical activity.

• Wong, William W; Speakman, John R; Ainslie, Philip N; Anderson, Liam J; Arab, Leonore & Baddou, Issad [Show all 76 contributors for this article] (2024). Decline in Isotope Dilution Space Ratio Above Age 60 Could Affect Energy Estimates Using the Doubly Labeled Water Method. Journal of Nutrition. ISSN 0022-3166. 154(12), p. 3824–3831. doi: 10.1016/j.tjnut.2024.10.016. Full text in Research Archive Show summary

  Background Doubly labeled water is gold standard for measuring total energy expenditure (TEE). Measurements using the method are sensitive to the isotope dilution space ratio (DSR). Accuracy and precision of the method might be improved if we could identify factors influencing DSR. Objectives We evaluated the potential associations of age, sex, ethnicity, anthropometry, body composition, turnover rates of the isotopes, and geographical elevation with DSR. Methods We used univariate regression analysis to explore the relationships between the continuous variables and analysis of variance to test the relationships between the categorical variables with DSR. Subsequently, we used general linear model (GLM) and 1-way analysis of variance to evaluate the simultaneous associations of age, sex, ethnicity, fat-free mass (FFM) and fat mass (FM) on DSR. Results From 5678 measurements complied from studies around the world with diverse ethnicity and living at various elevations, the mean DSR was 1.0364 ± 0.0141. No meaningful physiologic effect of any of the continuous and categorical variable on DSR was detected. General linear model analysis revealed no effect of FFM and FM (P > 0.33) on DSR, but DSR decreased with age (P

• Ekelund, Ulf; Tarp, Jakob; Sanchez-Lastra, Miguel Adriano & Dalene, Knut Eirik (2024). Physical activity, sedentary time and health – a narrative review with new insights. Danish Medical Journal. 71(11). doi: 10.61409/A06240433. Full text in Research Archive Show summary

  Physical activity and sedentary time are associated with multiple health outcomes, and benefits also extend to those living with chronic conditions. These observations are primarily based on data from studies in which self-reported data assessed physical activity. Recent data where physical activity and sedentary time are measured with devices suggest that the dose-response association between device-measured physical activity and risk of incident diseases and mortality is greater and observed at lower levels of physical activity than indicated by self-reported data.

• Nordlund, David; Lav, Theodor; Jablonowski, Robert; Khoshnood, Ardavan; Ekelund, Ulf & Atar, Dan [Show all 9 contributors for this article] (2024). Contractility, ventriculoarterial coupling, and stroke work after acute myocardial infarction using CMR-derived pressure-volume loop data. Clinical Cardiology. ISSN 0160-9289. 47(1). doi: 10.1002/clc.24216. Full text in Research Archive Show summary

  Background Noninvasive left ventricular (LV) pressure-volume (PV) loops derived by cardiac magnetic resonance (CMR) have recently been shown to enable characterization of cardiac hemodynamics. Thus, such PV loops could potentially provide additional diagnostic information such as contractility, arterial elastance (Ea) and stroke work (SW) currently not available in clinical routine. This study sought to investigate to what extent PV-loop variables derived with a novel noninvasive method can provide incremental physiological information over cardiac dimensions and blood pressure in patients with acute myocardial infarction (MI). Methods A total of 100 patients with acute MI and 75 controls were included in the study. All patients underwent CMR 2−6 days after MI including assessment of myocardium at risk (MaR) and infarct size (IS). Noninvasive PV loops were generated from CMR derived LV volumes and brachial blood pressure measurements. The following variables were quantified: Maximal elastance (Emax) reflecting contractility, Ea, ventriculoarterial coupling (Ea/Emax), SW, potential energy, external power, energy per ejected volume, and efficiency. Results All PV-loop variables were significantly different in MI patients compared to healthy volunteers, including contractility (Emax: 1.34 ± 0.48 versus 1.50 ± 0.41 mmHg/mL, p = .024), ventriculoarterial coupling (Ea/Emax: 1.27 ± 0.61 versus 0.73 ± 0.17, p < .001) and SW (0.96 ± 0.32 versus 1.38 ± 0.32 J, p < .001). These variables correlated to both MaR and IS (Emax: r2 = 0.25 and r2 = 0.29; Ea/Emax: r2 = 0.36 and r2 = 0.41; SW: r2 = 0.21 and r2 = 0.25). Conclusions Noninvasive PV-loops provide physiological information beyond conventional diagnostic variables, such as ejection fraction, early after MI, including measures of contractility, ventriculoarterial coupling, and SW.

• Coenen, Pieter; Huysmans, Maaike A.; Holtermann, Andreas; Troiano, Richard P.; Mork, Paul Jarle & Krokstad, Steinar [Show all 46 contributors for this article] (2024). Associations of occupational and leisure-time physical activity with all-cause mortality: an individual participant data meta-analysis. British Journal of Sports Medicine. ISSN 0306-3674. 58(4), p. 1527–1538. doi: 10.1136/bjsports-2024-108117. Full text in Research Archive Show summary

  Objective: Health effects of different physical activity domains (ie, during leisure time, work and transport) are generally considered positive. Using Active Worker consortium data, we assessed independent associations of occupational and leisure-time physical activity (OPA and LTPA) with all-cause mortality. Design: Two-stage individual participant data meta-analysis. Data source: Published and unpublished cohort study data. Eligibility criteria: Working participants aged 18–65 years. Methods: After data harmonisation, we assessed associations of OPA and LTPA with all-cause mortality. In stage 1, we analysed data from each study separately using Cox survival regression, and in stage 2, we pooled individual study findings with random-effects modelling. Results: In 22 studies with up to 590 497 participants from 11 countries, during a mean follow-up of 23.1 (SD: 6.8) years, 99 743 (16%) participants died. Adjusted for LTPA, body mass index, age, smoking and education level, summary (ie, stage 2) hazard ration (HRs) and 95% confidence interval (95% CI) for low, moderate and high OPA among men (n=2 96 134) were 1.01 (0.99 to 1.03), 1.05 (1.01 to 1.10) and 1.12 (1.03 to 1.23), respectively. For women (n=2 94 364), HRs (95% CI) were 0.98 (0.92 to 1.04), 0.96 (0.92 to 1.00) and 0.97 (0.86 to 1.10), respectively. In contrast, higher levels of LTPA were inversely associated with mortality for both genders. For example, for women HR for low, moderate and high compared with sedentary LTPA were 0.85 (0.81 to 0.89), 0.78 (0.74 to 0.81) and 0.75 (0.65 to 0.88), respectively. Effects were attenuated when adjusting for income (although data on income were available from only 9 and 6 studies, for men and women, respectively). Conclusion: Our findings indicate that OPA may not result in the same beneficial health effects as LTPA.

• 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.

• Zou, Liye; Herold, Fabian; Cheval, Boris; Wheeler, Michael J.; Pindus, Dominika M. & Erickson, Kirk I. [Show all 16 contributors for this article] (2024). Sedentary behavior and lifespan brain health. Trends in Cognitive Sciences. ISSN 1364-6613. 28(4), p. 369–382. doi: 10.1016/j.tics.2024.02.003. Full text in Research Archive
• Jalanko, Petri; Bond, Bert; Laukkanen, Jari A.; Brage, Søren Karl; Ekelund, Ulf & Laitinen, Tomi [Show all 10 contributors for this article] (2024). Association between arterial health and cognition in adolescents: The PANIC study. Physiological Reports. 12(9). doi: 10.14814/phy2.16024. Full text in Research Archive Show summary

  We investigated the associations of the measures of arterial health with cognition in adolescents and whether physical activity (PA) or sedentary time (ST) confounds these associations. One hundred sixteen adolescents (71 boys) aged 15.9 ± 0.4 participated in the study. PA and ST were assessed using a combined accelerometer/heart rate monitor. Overall cognition was computed from the results of psychomotor function, attention, working memory, and paired-associate learning tests. Pulse wave velocity was measured by impedance cardiography, carotid intima-media thickness, and carotid artery distensibility by carotid ultrasonography. Systolic and diastolic blood pressure (SBP and DBP) were measured using an aneroid sphygmomanometer. SBP was inversely associated with overall cognition (standardized regression coefficient [β] = −0.216, 95% confidence interval (CI) −0.406 to −0.027, p = 0.025). Pulse wave velocity (β = −0.199, 95% CI −0.382 to −0.017, p = 0.033) was inversely associated with working memory task accuracy. SBP was directly associated with reaction time in the attention (β = 0.256, 95% CI 0.069 to 0.443, p = 0.008) and errors in the paired-associate learning tasks (β = 0.308, 95% CI 0.126 to 0.489, p = 0.001). Blood pressure was inversely associated with overall cognition. PA or ST did not confound the associations. Results suggest that preventing high blood pressure is important for promoting cognition in adolescents.

• Alves, Charles Phillipe de Lucena; Leão, Otávio Amaral de Andrade; Delpino, Felipe Mendes; Mielke, Gregore Iven; Ekelund, Ulf & Costa, Eduardo Caldas [Show all 7 contributors for this article] (2024). Independent, Stratified, and Joint Associations of Sedentary Time and Physical Activity With Cardiovascular Disease: A Systematic Review. Journal of Physical Activity and Health. ISSN 1543-3080. 21(10), p. 980–989. doi: 10.1123/jpah.2024-0019. Full text in Research Archive Show summary

  Background: Recent statistics highlight cardiovascular diseases (CVD) as a major global cause of death. This review examines the methodological approaches and the main results of independent, stratified, and joint association of sedentary time (ST) and physical activity (PA) on CVD outcomes. Methods: We searched PubMed, Embase, Web of Science, and Scopus for prospective cohorts that examined the independent, stratified, or joint associations of ST and PA with CVD outcomes. Independent associations were defined as analyses mutually adjusted for PA and ST. Stratified associations were considered when there was a reference group in each stratum of PA or ST, and joint associations were defined by a single reference group for all other combined categories of ST and PA levels. Results: Of 45 articles, 69% explored independent association of ST or PA on CVD outcomes, while 31% using a stratified/joint approach. Most studies used self-reports for ST and PA and focused on CVD mortality. Mutually adjusted analyses identified ST positively and PA inversely associated to CVD outcomes. Stratified studies showed higher ST’s pronounced impact on CVD for lower PA levels. High PA mitigated but did not eliminate ST’s negative impact. Joint analyses revealed highest CVD risk in those with both high ST and low PA, and elevated risk in various intermediate combinations. Conclusions: Employing independent, stratified, and joint association approaches can yield distinct and complementary public health messages aimed at promoting cardiovascular health. Recommendations should aim to not only to encourage boosting PA levels, but also, concurrently decrease ST.

• Rezende, Leandro F. M.; Ahmadi, Matthew; Ferrari, Gerson; Cruz, Borja del Pozo; Lee, I-Min & Ekelund, Ulf [Show all 7 contributors for this article] (2024). Device-measured sedentary time and intensity-specific physical activity in relation to all-cause and cardiovascular disease mortality: the UK Biobank cohort study. International Journal of Behavioral Nutrition and Physical Activity. 21(1). doi: 10.1186/s12966-024-01615-5. Full text in Research Archive Show summary

  Background and aims: Understanding the amounts of intensity-specific movement needed to attenuate the association between sedentary time and mortality may help to inform personalized prescription and behavioral counselling. Herein, we examined the joint associations of sedentary time and intensity-specific physical activity with all-cause and cardiovascular disease (CVD) mortality. Methods: Prospective cohort study including 73,729 adults from the UK Biobank who wore an Axivity AX3 accelerometer on their dominant wrist for at least 3 days, being one a weekend day, between June 2013 and December 2015. We considered the median tertile values of sedentary time and physical activity in each intensity band to determine the amount of physical activity needed to attenuate the association between sedentary time and mortality. Results: During a median of 6.9 years of follow-up (628,807 person-years), we documented 1521 deaths, including 388 from CVD. Physical activity of any intensity attenuated the detrimental association of sedentary time with mortality. Overall, at least a median of 6 min/day of vigorous physical activity, 30 min/day of MVPA, 64 min/day of moderate physical activity, or 163 min/day of light physical activity (mutually-adjusted for other intensities) attenuated the association between sedentary time and mortality. High sedentary time was associated with higher risk of CVD mortality only among participants with low MVPA (HR 1.96; 95% CI 1.23 to 3.14). Conclusions: Different amounts of each physical activity intensity may attenuate the association between high sedentary time and mortality.

• Ahmadi, Matthew N.; Blodgett, Joanna M.; Atkin, Andrew J; Chan, Hsiu-Wen; Cruz, Borja del Pozo & Suorsa, Kristin [Show all 24 contributors for this article] (2024). Relationship of device-measured physical activity type and posture with cardiometabolic health markers: pooled dose–response associations from the Prospective Physical Activity, Sitting and Sleep Consortium. Diabetologia. ISSN 0012-186X. 67(6), p. 1051–1065. doi: 10.1007/s00125-024-06090-y. Full text in Research Archive Show summary

  Aims/hypothesis: The aim of this study was to examine the dose–response associations of device-measured physical activity types and postures (sitting and standing time) with cardiometabolic health. Methods: We conducted an individual participant harmonised meta-analysis of 12,095 adults (mean ± SD age 54.5±9.6 years; female participants 54.8%) from six cohorts with thigh-worn accelerometry data from the Prospective Physical Activity, Sitting and Sleep (ProPASS) Consortium. Associations of daily walking, stair climbing, running, standing and sitting time with a composite cardiometabolic health score (based on standardised z scores) and individual cardiometabolic markers (BMI, waist circumference, triglycerides, HDL-cholesterol, HbA1c and total cholesterol) were examined cross-sectionally using generalised linear modelling and cubic splines. Results: We observed more favourable composite cardiometabolic health (i.e. z score [95% CI] −0.14 [−0.25, −0.02]) and 5 min/day stair climbing (−0.14 [−0.24, −0.03]). We observed an equivalent magnitude of association at 2.6 h/day standing. Any amount of running was associated with better composite cardiometabolic health. We did not observe an upper limit to the magnitude of the dose–response associations for any activity type or standing. There was an inverse dose–response association between sitting time and composite cardiometabolic health that became markedly less favourable when daily durations exceeded 12.1 h/day. Associations for sitting time were no longer significant after excluding participants with prevalent CVD or medication use. The dose–response pattern was generally consistent between activity and posture types and individual cardiometabolic health markers. Conclusions/interpretation: In this first activity type-specific analysis of device-based physical activity, ~64 min/day of walking and ~5.0 min/day of stair climbing were associated with a favourable cardiometabolic risk profile. The deleterious associations of sitting time were fully attenuated after exclusion of participants with prevalent CVD and medication use. Our findings on cardiometabolic health and durations of different activities of daily living and posture may guide future interventions involving lifestyle modification.

• Wendt, Andrea; Bielemann, Renata Moraes; Wehrmeister, Fernando C.; Ricardo, Luiza I.C.; Müller, Werner de Andrade & Machado, Adriana Kramer Fiala [Show all 12 contributors for this article] (2024). Is rest-activity rhythm prospectively associated with all-cause mortality in older people regardless of sleep and physical activity level? The ‘Como Vai?’ Cohort study. PLOS ONE. 19(2). doi: 10.1371/journal.pone.0298031. Full text in Research Archive Show summary

  Objective: This study aims to test the association of rest-activity rhythm (intradaily variability and interdaily stability) with all-cause mortality in an older adult cohort in Brazil. It also assesses whether the amount of time spent at each intensity level (i.e., physical activity and nocturnal sleep) interferes with this association. Methods: This cohort study started in 2014 with older adults (≥60 years). We investigated deaths from all causes that occurred until April 2017. Rest-activity rhythm variables were obtained using accelerometry at baseline. Intradaily variability indicates higher rhythm fragmentation, while interdaily stability indicates higher rhythm stability. Cox proportional-hazard models were used to test the associations controlling for confounders. Results: Among the 1451 older adults interviewed in 2014, 965 presented valid accelerometry data. During the follow-up period, 80 individuals died. After adjusting the analysis for sociodemographic, smoking, morbidity score, and number of medicines, an increase of one standard deviation in interdaily stability decreased 26% the risk of death. The adjustment for total sleep time and inactivity did not change this association. On the other hand, the association was no longer significant after adjusting for overall physical activity and moderate to vigorous physical activity. Conclusion: Rest-activity rhythm pattern was not associated with mortality when physical activity was considered, possibly because this pattern could be driven by regular exercise. Promoting physical activity remains a relevant strategy to improve population health.

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

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

• Oliveira, Arão Belitardo de; Katzmarzyk, Peter T.; Dantas, Wagner Silva; Benseñor, Isabela Judith Martins; Goulart, Alessandra de Carvalho & Ekelund, Ulf (2023). Profile of leisure-time physical activity and sedentary behavior in adults in Brazil: a nationwide survey, 2019. Epidemiologia e Serviços de Saúde. ISSN 1679-4974. 32(2). doi: 10.1590/S2237-96222023000200016. Full text in Research Archive Show summary

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

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

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

• Dalene, Knut Eirik & Ekelund, Ulf (2023). Assessment of physical activity behaviours: methods, levels, and time trends. In Armstrong, Neil & Mechelen, Willem van (Ed.), Oxford Textbook of Children’s Sport and Exercise Medicine. Fourth Edition. Oxford University Press. ISSN 9780191926556. Full text in Research Archive
• Zarbo, Cristina; Rota, Matteo; Calza, Stefano; Crouter, Scott E; Ekelund, Ulf & Barlati, Stefano [Show all 17 contributors for this article] (2023). Ecological monitoring of physical activity, emotions and daily life activities in schizophrenia: The DiAPAson study. BMJ Mental Health. 26(1), p. 1–8. doi: 10.1136/bmjment-2023-300836. Full text in Research Archive Show summary

  Background: Schizophrenia spectrum disorders (SSD) compromise psychosocial functioning, including daily time use, emotional expression and physical activity (PA). Objective: We performed a cohort study aimed at investigating: (1) the differences in PA, daily activities and emotions between patients with SSD and healthy controls (HC); (2) the strength of the association between these variables and clinical features among patients with SSD. Methods: Ninety-nine patients with SSD (53 residential patients, 46 outpatients) and 111 matched HC were assessed for several clinical variables, and levels of functioning by means of standardised clinical measures. Self-reported daily activities and emotions were assessed with a smartphone application for ecological momentary assessment (EMA), and PA levels were assessed with a wearable accelerometer for 7 consecutive days. Findings: Patients with SSD, especially those living in residential facilities, spent more time being sedentary, and self-reported more sedentary and self-care activities, experiencing higher levels of negative emotions compared with HC. Moreover, higher functioning levels among patients were associated with more time spent in moderate-to-vigorous activity. Conclusions: Sedentary behaviour and negative emotions are particularly critical among patients with SSD and are associated with more impaired clinical outcomes. Clinical implications: Mobile-EMA and wearable sensors are useful for monitoring the daily life of patients with SSD and the level of PA. This population needs to be targeted with specific rehabilitative programmes aimed at improving their commitment to structured daily activities.

• Leão, Otávio Amaral de Andrade; Flores, Thaynã Ramos; Barratt, Jaime; Bertoldi, Andréa Dâmaso; Domingues, Marlos Rodrigues & Cairney, John [Show all 10 contributors for this article] (2023). Bi-directional associations between physical activity and growth indicators of pre-school aged children. Journal of Sports Sciences. ISSN 0264-0414. 41(8), p. 766–773. doi: 10.1080/02640414.2023.2240167. Full text in Research Archive Show summary

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

• Halsey, Lewis G.; Careau, Vincent; Ainslie, Philip N.; Alemán-Mateo, Heliodoro; Andersen, Lene Frost & Anderson, Liam J. [Show all 110 contributors for this article] (2023). Greater male variability in daily energy expenditure develops through puberty. Biology Letters. ISSN 1744-9561. 19(9). doi: 10.1098/rsbl.2023.0152. Full text in Research Archive Show summary

  There is considerably greater variation in metabolic rates between men than between women, in terms of basal, activity and total (daily) energy expenditure (EE). One possible explanation is that EE is associated with male sexual characteristics (which are known to vary more than other traits) such as musculature and athletic capacity. Such traits might be predicted to be most prominent during periods of adolescence and young adulthood, when sexual behaviour develops and peaks. We tested this hypothesis on a large dataset by comparing the amount of male variation and female variation in total EE, activity EE and basal EE, at different life stages, along with several morphological traits: height, fat free mass and fat mass. Total EE, and to some degree also activity EE, exhibit considerable greater male variation (GMV) in young adults, and then a decrease in the degree of GMV in progressively older individuals. Arguably, basal EE, and also morphometrics, do not exhibit this pattern. These findings suggest that single male sexual characteristics may not exhibit peak GMV in young adulthood, however total and perhaps also activity EE, associated with many morphological and physiological traits combined, do exhibit GMV most prominently during the reproductive life stages.

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

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

• Tarp, Jakob; Luo, Mengyun; Sanchez-Lastra, Miguel Adriano; Dalene, Knut Eirik; Cruz, Borja Del Pozo & Ried-Larsen, Mathias [Show all 9 contributors for this article] (2023). Leisure-time physical activity and all-cause mortality and cardiovascular disease in adults with type 2 diabetes: Cross-country comparison of cohort studies. Journal of Sport and Health Science. ISSN 2095-2546. 13(2), p. 212–221. doi: 10.1016/j.jshs.2023.10.004. Full text in Research Archive Show summary

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

• 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; Dalene, Knut Eirik; Eggen, Anne Elise; Ekelund, Ulf; Fimland, Marius Steiro & Heitmann, Kim Arne [Show all 11 contributors for this article] (2023). Occupational physical activity and risk of mortality in women and men: the Tromsø Study 1986–2021. British Journal of Sports Medicine. ISSN 0306-3674. 58(2), p. 81–88. doi: 10.1136/bjsports-2023-107282. Full text in Research Archive Show summary

  Objective Associations between occupational physical activity (OPA) and mortality risks are inconclusive. We aimed to examine associations between (1) OPA separately and (2) jointly with leisure time physical activity (LTPA), and risk of all-cause, cardiovascular disease (CVD) and cancer mortality, over four decades with updated exposure and covariates every 6–8 years. Methods Adults aged 20–65 years from the Tromsø Study surveys Tromsø3-Tromsø7 (1986–2016) were included. We categorised OPA as low (sedentary), moderate (walking work), high (walking+lifting work) or very high (heavy manual labour) and LTPA as inactive, moderate and vigorous. We used Cox/Fine and Gray regressions to examine associations, adjusted for age, body mass index, smoking, education, diet, alcohol and LTPA (aim 1 only). Results Of 29 605 participants with 44 140 total observations, 4131 (14.0%) died, 1057 (25.6%) from CVD and 1660 (40.4%) from cancer, during follow-up (median: 29.1 years, 25th–75th: 16.5.1–35.3). In men, compared with low OPA, high OPA was associated with lower all-cause (HR 0.83, 95% CI 0.74 to 0.92) and CVD (subdistributed HR (SHR) 0.68, 95% CI 0.54 to 0.84) but not cancer mortality (SHR 0.99, 95% CI 0.84 to 1.19), while no association was observed for moderate or very high OPA. In joint analyses using inactive LTPA and low OPA as reference, vigorous LTPA was associated with lower all-cause mortality combined with low (HR 0.75, 95% CI 0.64 to 0.89), high (HR 0.67, 95% CI 0.54 to 0.82) and very high OPA (HR 0.74, 95% CI 0.58 to 0.94), but not with moderate OPA. In women, there were no associations between OPA, or combined OPA and LTPA, with mortality. Conclusion High OPA, but not moderate and very high OPA, was associated with lower all-cause and CVD mortality risk in men but not in women. Vigorous LTPA was associated with lower mortality risk in men with low, high and very high OPA, but not moderate OPA.

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

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

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

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

• Ekelund, Ulf; Sanchez-Lastra, Miguel Adriano; Dalene, Knut Eirik & Tarp, Jakob (2023). Dose–response associations, physical activity intensity and mortality risk: A narrative review. Journal of Sport and Health Science. ISSN 2095-2546. 13(1), p. 24–29. doi: 10.1016/j.jshs.2023.09.006. Full text in Research Archive Show summary

  Physical activity is consistently associated with reduced mortality, decreased risk for non-communicable diseases, and improved mental health in observational studies. Randomized controlled trials and observational Mendelian randomization studies support causal links between physical activity and health outcomes. However, the scarcity of evidence from randomized controlled trials, along with their inherent challenges like exposure contrasts, healthy volunteer biases, loss to follow-up, and limited real-world dose–response data, warrants a comprehensive approach. This review advocates synthesizing insights from diverse study designs to better understand the causal relationship between physical activity, mortality risk, and other health outcomes. Additionally, it summarizes recent research since the publication of current physical activity recommendations. Novel observational studies utilizing device-measured physical activity underscore the importance of every minute of activity and suggest that all intensity levels confer health benefits, with vigorous-intensity potentially requiring lower volumes for substantial benefits. Future guidelines, informed by device-measured physical activity studies, may offer refined age-specific recommendations, emphasize vigorous-intensity physical activity, and include daily step counts as a simple, easily assessable metric using commercial wearables.

• Lundin, Magnus; Heiberg, Einar; Nordlund, David; Gyllenhammar, Tom; Steding-Ehrenborg, Katarina & Engblom, Henrik [Show all 26 contributors for this article] (2023). Prognostic utility and characterization of left ventricular hypertrophy using global thickness. Scientific Reports. 13(1). doi: 10.1038/s41598-023-48173-7. Full text in Research Archive Show summary

  Abstract Cardiovascular magnetic resonance (CMR) can accurately measure left ventricular (LV) mass, and several measures related to LV wall thickness exist. We hypothesized that prognosis can be used to select an optimal measure of wall thickness for characterizing LV hypertrophy. Subjects having undergone CMR were studied (cardiac patients, n = 2543; healthy volunteers, n = 100). A new measure, global wall thickness (GT, GTI if indexed to body surface area) was accurately calculated from LV mass and end-diastolic volume. Among patients with follow-up (n = 1575, median follow-up 5.4 years), the most predictive measure of death or hospitalization for heart failure was LV mass index (LVMI) (hazard ratio (HR)[95% confidence interval] 1.16[1.12–1.20], p &lt; 0.001), followed by GTI (HR 1.14[1.09–1.19], p &lt; 0.001). Among patients with normal findings (n = 326, median follow-up 5.8 years), the most predictive measure was GT (HR 1.62[1.35–1.94], p &lt; 0.001). GT and LVMI could characterize patients as having a normal LV mass and wall thickness, concentric remodeling, concentric hypertrophy, or eccentric hypertrophy, and the three abnormal groups had worse prognosis than the normal group (p &lt; 0.05 for all). LV mass is highly prognostic when mass is elevated, but GT is easily and accurately calculated, and adds value and discrimination amongst those with normal LV mass (early disease).

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

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

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

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

• 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.

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

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

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

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

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

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

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

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

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

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

• 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.

• Yamada, Yosuke; Zhang, Xueying; Henderson, Mary E T; Sagayama, Hiroyuki; Pontzer, Herman & Watanabe, Daiki [Show all 92 contributors for this article] (2022). Variation in human water turnover associated with environmental and lifestyle factors. Science. ISSN 0036-8075. 378(6622), p. 909–915. doi: 10.1126/science.abm8668. Full text in Research Archive Show summary

  Water is essential for survival, but one in three individuals worldwide (2.2 billion people) lacks access to safe drinking water. Water intake requirements largely reflect water turnover (WT), the water used by the body each day. We investigated the determinants of human WT in 5604 people from the ages of 8 days to 96 years from 23 countries using isotope-tracking (2H) methods. Age, body size, and composition were significantly associated with WT, as were physical activity, athletic status, pregnancy, socioeconomic status, and environmental characteristics (latitude, altitude, air temperature, and humidity). People who lived in countries with a low human development index (HDI) had higher WT than people in high-HDI countries. On the basis of this extensive dataset, we provide equations to predict human WT in relation to anthropometric, economic, and environmental factors.

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

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

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

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

• Bielemann, Renata M.; Oliveira, Ricardo; Bertoldi, Andréa D.; Tomasi, Elaine; Demarco, Flávio F. & Gonzalez, Maria Cristina [Show all 9 contributors for this article] (2022). Objective and Self-Reported Physical Activity and Risk of Falling Among Community-Dwelling Older Adults From Southern Brazil. Journal of Aging and Physical Activity. ISSN 1063-8652. 30(6), p. 972–979. doi: 10.1123/japa.2021-0148. Full text in Research Archive Show summary

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

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

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

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

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

• 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.

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

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

• Wang, Zhe; Emmerich, Andrew; Pillon, Nicolas J.; Moore, Tim; Hemerich, Daiane & Cornelis, Marilyn C. [Show all 227 contributors for this article] (2022). Genome-wide association analyses of physical activity and sedentary behavior provide insights into underlying mechanisms and roles in disease prevention. Nature Genetics. ISSN 1061-4036. 54(9), p. 1332–1344. doi: 10.1038/s41588-022-01165-1. Full text in Research Archive Show summary

  Although physical activity and sedentary behavior are moderately heritable, little is known about the mechanisms that influence these traits. Combining data for up to 703,901 individuals from 51 studies in a multi-ancestry meta-analysis of genome-wide association studies yields 99 loci that associate with self-reported moderate-to-vigorous intensity physical activity during leisure time (MVPA), leisure screen time (LST) and/or sedentary behavior at work. Loci associated with LST are enriched for genes whose expression in skeletal muscle is altered by resistance training. A missense variant in ACTN3 makes the alpha-actinin-3 filaments more flexible, resulting in lower maximal force in isolated type IIA muscle fibers, and possibly protection from exercise-induced muscle damage. Finally, Mendelian randomization analyses show that beneficial effects of lower LST and higher MVPA on several risk factors and diseases are mediated or confounded by body mass index (BMI). Our results provide insights into physical activity mechanisms and its role in disease prevention.

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

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

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

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

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

  Aims: This study aimed to evaluate the association between physical activity and the incidence of coronary heart disease (CHD) in individuals with and without CHD risk factors. Methods and results: EPIC-CVD is a case-cohort study of 29 333 participants that included 13 582 incident CHD cases and a randomly selected sub-cohort nested within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Self-reported physical activity was summarized using the Cambridge physical activity index (inactive, moderately inactive, moderately active, and active). Participants were categorized into sub-groups based on the presence or the absence of the following risk factors: obesity (body mass index ≥30 kg/m2), hypercholesterolaemia (total cholesterol ≥6.2 mmol/L), history of diabetes, hypertension (self-reported or ≥140/90 mmHg), and current smoking. Prentice-weighted Cox regression was used to assess the association between physical activity and incident CHD events (non-fatal and fatal). Compared to inactive participants without the respective CHD risk factor (referent), excess CHD risk was highest in physically inactive and lowest in moderately active participants with CHD risk factors. Corresponding excess CHD risk estimates amongst those with obesity were 47% [95% confidence interval (CI) 32–64%] and 21% (95%CI 2–44%), with hypercholesterolaemia were 80% (95%CI 55–108%) and 48% (95%CI 22–81%), with hypertension were 80% (95%CI 65–96%) and 49% (95%CI 28–74%), with diabetes were 142% (95%CI 63–260%), and 100% (95%CI 32–204%), and amongst smokers were 152% (95%CI 122–186%) and 109% (95%CI 74–150%). Conclusions: In people with CHD risk factors, moderate physical activity, equivalent to 40 mins of walking per day, attenuates but does not completely offset CHD risk.

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

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

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

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

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• Jakobsen, Siw Ellen; Ekelund, Ulf & Aukan, Marthe Isaksen (2025). Fedme handler lite om stillesitting, mener forskere. [Internet]. Forskning.no. Full text in Research Archive Show summary

  Nesten alt handler om hva vi putter i munnen, fastslår en ny studie.

• Cillekens, Bart; Coenen, Pieter; Huysmans, Maaike A.; Holtermann, Andreas; Troiano, Richard P. & Mork, Paul Jarle [Show all 43 contributors for this article] (2025). Corrigendum to “Should workers be physically active after work? Associations of leisure-time physical activity with cardiovascular and all-cause mortality across occupational physical activity levels—An individual participant data meta-analysis” (J Sport Health Sci 14 [2025] 100987) (Journal of Sport and Health Science (2025) 14, (S2095254624001431), (10.1016/j.jshs.2024.100987)). Journal of Sport and Health Science. ISSN 2095-2546. 14. doi: 10.1016/j.jshs.2025.101037. Full text in Research Archive
• Bajunaid, Rania; Niu, Chaoqun; Hambly, Catherine; Liu, Zongfang; Yamada, Yosuke & Aleman-Mateo, Heliodoro [Show all 98 contributors for this article] (2025). Correction to: Predictive equation derived from 6,497 doubly labelled water measurements enables the detection of erroneous self-reported energy intake (Nature Food, (2025), 6, 1, (58-71), 10.1038/s43016-024-01089-5). Nature Food. doi: 10.1038/s43016-025-01175-2. Full text in Research Archive
• Bratland-Sanda, Solfrid & Ekelund, Ulf (2025). Kan du bli i form av å gå på mølle på kontoret? [Internet]. Forskning.no. Full text in Research Archive
• Dalene, Knut Eirik; Lergenmuller, Simon; Hjellvik, Vidar; Stigum, Hein; Meyer, Haakon Eduard & Nystad, Wenche [Show all 13 contributors for this article] (2024). Noncommunicable disease risk factor groups, socioeconomic position and longevity in Norway: a prospective cohort study of 576 299 men and women – the NCDNOR project. Full text in Research Archive
• Dalene, Knut Eirik; Lergenmuller, Simon; Sund, Erik Reidar; Krokstad, Steinar; Hopstock, Laila Arnesdatter & Nystad, Wenche [Show all 13 contributors for this article] (2024). Latent risk factor profiles in the Norwegian adult population over time and their association with premature NCD mortality – the NCDNOR project. Full text in Research Archive
• Gill, Jason M.R.; Chico, Timothy J.; Doherty, Aiden; Dunn, Jessilyn; Ekelund, Ulf & Katzmarzyk, Peter T. [Show all 9 contributors for this article] (2023). Potential impact of wearables on physical activity guidelines and interventions: Opportunities and challenges. British Journal of Sports Medicine. ISSN 0306-3674. doi: 10.1136/bjsports-2023-106822. Full text in Research Archive
• Wang, Eivind; Ekelund, Ulf & Solberg, Trine (2022). Treningsforsker lei trendene - dette er treningen som virkelig fungerer. [Journal]. Nidaros Pluss. Full text in Research Archive
• Jansson, Eva; Wennberg, Patrik; Anderssen, Sigmund Alfred; Ekelund, Ulf; Dohrn, Ing-Mari & Hagströmer, Maria (2022). Sitt mindre – all rörelse räknas. Läkartidningen. ISSN 0023-7205. 119. Full text in Research Archive
• Mañas, Asier; Cruz, Borja del Pozo; Ekelund, Ulf; Reyna, José Losa; Gómez, Irene Rodríguez & Carreño, José Antonio Carnicero [Show all 9 contributors for this article] (2022). Response to McAvoy and Tudor-Locke on their commentary on our manuscript: “Association of accelerometer-derived step volume and intensity with hospitalizations and mortality in older adults: A prospective cohort study”. Journal of Sport and Health Science. ISSN 2095-2546. 11(6), p. 639–640. doi: 10.1016/j.jshs.2022.09.001. Full text in Research Archive
• Wang, Eivind; Ekelund, Ulf & Solberg, Trine (2022). Treningsforsker lei trendene - dette er treningen som virkelig fungerer. [Journal]. Bygdeposten Pluss. Full text in Research Archive
• Wang, Eivind; Ekelund, Ulf & Solberg, Trine (2022). Treningsforsker lei trendene - dette er treningen som virkelig fungerer. [Journal]. Sandefjords Blad Pluss. Full text in Research Archive
• Wang, Eivind; Ekelund, Ulf & Solberg, Trine (2022). Treningsforsker lei trendene – dette er treningen som virkelig fungerer. [Internet]. ifinnmark.no. 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
• 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.

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