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Prospective Associations Between Physical Activity Level and Body Composition in Adolescence: 1993 Pelotas (Brazil) Birth Cohort

Felipe Fossati Reichert, Jonathan Charles Kingdom Wells, Ulf Ekelund, Ana Maria Baptista Menezes, Cesar Gomes Victora, and Pedro C. Hallal

Background:

Physical activity may influence both fat and lean body mass. This study investigated the association between physical activity in children between the ages of 11 and 13 years and both fat and lean mass.

Methods:

A subsample of the 1993 Pelotas (Brazil) Birth Cohort was visited in 2004–2005 and 2006–2007. Physical activity was estimated through standardized questionnaires. Body composition (ie, fat and lean mass) was measured using deuterium dilution. Those with moderate-to-vigorous activity greater than 420 min/wk were classified as active, and physical activity trajectory was defined as being above or below the cutoff at each visit.

Results:

Four hundred eighty-eight adolescents (51.8% boys) were evaluated. The mean difference in fat mass in boys and girls who reported ≥ 420 min/wk of physical activity in both visits compared with those who were consistently inactive was –4.8 kg (P ≤ .001). There was an inverse association between physical activity and fat mass among boys in both crude and confounder-adjusted analyses, whereas for girls, the association was evident only in the crude analysis. There was no significant association between physical activity and lean mass.

Conclusion:

Physical activity may contribute to tackling the growing epidemic of adolescent obesity in low- and middle-income countries.

Open access

Predictive Validity of a Thigh-Worn Accelerometer METs Algorithm in 5- to 12-Year-old Children

Christiana M.T. van Loo, Anthony D. Okely, Marijka Batterham, Tina Hinkley, Ulf Ekelund, Soren Brage, John J. Reilly, Gregory E. Peoples, Rachel Jones, Xanne Janssen, and Dylan P. Cliff

Background:

To validate the activPAL3 algorithm for predicting metabolic equivalents (TAMETs) and classifying MVPA in 5- to 12-year-old children.

Methods:

Fifty-seven children (9.2 ± 2.3y, 49.1% boys) completed 14 activities including sedentary behaviors (SB), light (LPA) and moderate-to-vigorous physical activities (MVPA). Indirect calorimetry (IC) was used as the criterion measure. Analyses included equivalence testing, Bland-Altman procedures and area under the receiver operating curve (ROC-AUC).

Results:

At the group level, TAMETs were significantly equivalent to IC for handheld e-game, writing/coloring, and standing class activity (P < .05). Overall, TAMETs were overestimated for SB (7.9 ± 6.7%) and LPA (1.9 ± 20.2%) and underestimated for MVPA (27.7 ± 26.6%); however, classification accuracy of MVPA was good (ROC-AUC = 0.86). Limits of agreement were wide for all activities, indicating large individual error (SB: −27.6% to 44.7%; LPA: −47.1% to 51.0%; MVPA: −88.8% to 33.9%).

Conclusions:

TAMETs were accurate for some SB and standing, but were overestimated for overall SB and LPA, and underestimated for MVPA. Accuracy for classifying MVPA was, however, acceptable.

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Correlates of Leisure-Time Physical Activity Differ by Body-Mass-Index Status in Brazilian Adults

Pedro Curi Hallal, Felipe Fossati Reichert, Fernando Vinholes Siqueira, Samuel Carvalho Dumith, Juliano Peixoto Bastos, Marcelo Cozzensa da Silva, Marlos Rodrigues Domingues, Mario Renato Azevedo, and Ulf Ekelund

Objectives:

The objective of this study was to evaluate physical activity (PA) levels in adults and their association with sex, age, and education level across categories of body mass index (BMI).

Methods:

We conducted a population-based, cross-sectional study including 3100 individuals age ≥20 years living in Pelotas, Brazil. PA was assessed using the leisure-time section of the long International Physical Activity Questionnaire. “No PA” was defined as zero minutes of activity/week; “insuffcient PA” was defined as <150 minutes of activity/week; “high PA” was defined as ≥500 minutes of activity/week. BMI was categorized into normal (<25 kg/m2), overweight (25–29.9 kg/m2), and obesity (≥30 kg/m2).

Results:

The prevalence of insufficient PA was 71.6% among normal BMI subjects, 71.3% among overweight individuals, and 73.7% among obese ones (P = .67). No PA and high PA were also not associated with BMI. The associations between sex, age, and education level and PA levels tended to be stronger among normal-weight individuals compared with overweight and obese individuals. Among the obese, most associations were not significant. Among normal-weight individuals, higher PA levels were observed in men, young adults, and those with higher education.

Conclusions:

Variables associated with leisure-time PA differed between normal-weight, overweight, and obese individuals. Studies on PA correlates might benefit from stratifying by BMI.

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Cross-Sectional and Longitudinal Associations Between Physical Activity and Blood Pressure in Adolescence: Birth Cohort Study

Pedro C. Hallal, Samuel Carvalho Dumith, Felipe Fossati Reichert, Ana M.B. Menezes, Cora L. Araújo, Jonathan C.K. Wells, Ulf Ekelund, and Cesar G. Victora

Objectives:

To explore cross-sectional and longitudinal associations between self-reported and accelerometry-based physical activity (PA) and blood pressure (BP) between 11 and 14 years of age.

Methods:

Prospective birth cohort study in Pelotas, Brazil. Participants were 427 cohort members who were followed up with at 11, 12, and 14 years of age, and had questionnaire data on PA and BP at 11 and 14 years, as well as accelerometry and questionnaire data on PA at 12 years. Outcome measures were continuous systolic and diastolic BP at 14 years, and change in BP from 11 to 14 years.

Results:

PA was unrelated to systolic BP in any analyses. PA measured by accelerometry at 12 years, but not questionnaire-derived PA, was inversely associated with diastolic BP at 14 years of age in fully adjusted models. Those who exceeded the 300-minutes PA threshold at all 3 visits had a 2.6 mmHg lower mean increase in DBP from 11 to 14 years compared with those classified below the threshold in all visits.

Conclusions:

Accelerometry-based PA was longitudinally inversely associated with diastolic BP. This finding was not evident when analyzing self-reported PA at a given age, suggesting a possible underestimation of the association when using subjective data.

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Physical Activity Throughout Adolescence and Hba1c in Early Adulthood: Birth Cohort Study

Priscila M. Nakamura, Grégore I. Mielke, Bernardo L. Horta, Maria Cecília Assunção, Helen Gonçalves, Ana M.B. Menezes, Fernando C. Barros, Ulf Ekelund, Soren Brage, Fernando C. Wehrmeister, Isabel O. Oliveira, and Pedro C. Hallal

Background:

Physical inactivity is responsible for 7% of diabetes deaths worldwide, but little is known whether low levels of physical activity (PA) during adolescence increase the risk of diabetes in early adulthood. We evaluated the cross-sectional and longitudinal associations between PA throughout adolescence and HbA1c concentration in early adulthood.

Methods:

HbA1c was measured by high performance liquid chromatography. PA was assessed by self-report at the ages of 11, 15, and 18 years and by accelerometry at the ages of 13 (subsample) and 18 years. The loss percentages of follow up were 12.5% at 11 years, 14.4% at 15 years, and 18.7% at 18 years.

Results:

At 18 years, boys showed higher HbA1c than girls. At age 18 years, accelerometrybased PA at 18 years was inversely related to HbA1c levels in boys. Self-reported leisure-time PA at ages 11, 15, and 18 were unrelated to HbA1c in both genders. PA at 13 years of age was unrelated to HbA1c among both genders. In trajectory analysis, PA and accelerometer PA trajectories were not associated with later HbA1c.

Conclusions:

Objectively measured PA at 18 years was cross-sectionally inversely associated with HbA1c in boys only. No prospective associations were identified.

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The European Youth Heart Study—Cardiovascular Disease Risk Factors in Children: Rationale, Aims, Study Design, and Validation of Methods

Chris Riddoch, Dawn Edwards, Angie Page, Karsten Froberg, Sigmund A. Anderssen, Niels Wedderkopp, Søren Brage, Ashley R. Cooper, Luis B. Sardinha, Maarike Harro, Lena Klasson-Heggebø, Willem van Mechelen, Colin Boreham, Ulf Ekelund, Lars Bo Andersen, and The European Youth Heart Study Team*

Background:

The aim of the European Youth Heart Study (EYHS) is to establish the nature, strength, and interactions between personal, environmental, and lifestyle influences on cardiovascular disease (CVD) risk factors in European children.

Methods:

The EYHS is an international study measuring CVD risk factors, and their associated influences, in children. Relationships between these independent factors and risk of disease will inform the design of CVD interventions in children. A minimum of 1000 boys and girls ages 9 and 15 y were recruited from four European countries—Denmark, Estonia, Norway, and Portugal. Variables measured included physical, biochemical, lifestyle, psychosocial, and sociodemographic data.

Results:

Of the 5664 children invited to participate, 4169 (74%) accepted. Response rates for most individual tests were moderate to high. All test protocols were well received by the children.

Conclusions:

EYHS protocols are valid, reliable, acceptable to children, and feasible for use in large, field-based studies.

Open access

Striking the Right Balance: Evidence to Inform Combined Physical Activity and Sedentary Behavior Recommendations

Sebastien F.M. Chastin, Duncan E. McGregor, Stuart J.H. Biddle, Greet Cardon, Jean-Philippe Chaput, Philippa M. Dall, Paddy C. Dempsey, Loretta DiPietro, Ulf Ekelund, Peter T. Katzmarzyk, Michael Leitzmann, Emmanuel Stamatakis, and Hidde P. Van der Ploeg

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

Open access

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

Andrea Ramírez Varela, Pedro C. Hallal, Juliana Mejía Grueso, Željko Pedišić, Deborah Salvo, Anita Nguyen, Bojana Klepac, Adrian Bauman, Katja Siefken, Erica Hinckson, Adewale L. Oyeyemi, Justin Richards, Elena Daniela Salih Khidir, Shigeru Inoue, Shiho Amagasa, Alejandra Jauregui, Marcelo Cozzensa da Silva, I-Min Lee, Melody Ding, Harold W. Kohl III, Ulf Ekelund, Gregory W. Heath, Kenneth E. Powell, Charlie Foster, Aamir Raoof Memon, Abdoulaye Doumbia, Abdul Roof Rather, Abdur Razzaque, Adama Diouf, Adriano Akira Hino, Albertino Damasceno, Alem Deksisa Abebe, Alex Antonio Florindo, Alice Mannocci, Altyn Aringazina, Andrea Backović Juričan, Andrea Poffet, Andrew Decelis, Angela Carlin, Angelica Enescu, Angélica María Ochoa Avilés, Anna Kontsevaya, Annamaria Somhegyi, Anne Vuillemin, Asmaa El Hamdouchi, Asse Amangoua Théodore, Bojan Masanovic, Brigid M. Lynch, Catalina Medina, Cecilia del Campo, Chalchisa Abdeta, Changa Moreways, Chathuranga Ranasinghe, Christina Howitt, Christine Cameron, Danijel Jurakić, David Martinez-Gomez, Dawn Tladi, Debrework Tesfaye Diro, Deepti Adlakha, Dušan Mitić, Duško Bjelica, Elżbieta Biernat, Enock M. Chisati, Estelle Victoria Lambert, Ester Cerin, Eun-Young Lee, Eva-Maria Riso, Felicia Cañete Villalba, Felix Assah, Franjo Lovrić, Gerardo A. Araya-Vargas, Giuseppe La Torre, Gloria Isabel Niño Cruz, Gul Baltaci, Haleama Al Sabbah, Hanna Nalecz, Hilde Liisa Nashandi, Hyuntae Park, Inés Revuelta-Sánchez, Jackline Jema Nusurupia, Jaime Leppe Zamora, Jaroslava Kopcakova, Javier Brazo-Sayavera, Jean-Michel Oppert, Jinlei Nie, John C. Spence, John Stewart Bradley, Jorge Mota, Josef Mitáš, Junshi Chen, Kamilah S Hylton, Karel Fromel, Karen Milton, Katja Borodulin, Keita Amadou Moustapha, Kevin Martinez-Folgar, Lara Nasreddine, Lars Breum Christiansen, Laurent Malisoux, Leapetswe Malete, Lorelie C. Grepo-Jalao, Luciana Zaranza Monteiro, Lyutha K. Al Subhi, Maja Dakskobler, Majed Alnaji, Margarita Claramunt Garro, Maria Hagströmer, Marie H. Murphy, Matthew  Mclaughlin, Mercedes Rivera-Morales, Mickey Scheinowitz, Mimoza Shkodra, Monika Piątkowska, Moushumi Chaudhury, Naif Ziyad Alrashdi, Nanette Mutrie, Niamh Murphy, Norhayati Haji Ahmad, Nour A. Obeidat, Nubia Yaneth Ruiz Gómez, Nucharapon Liangruenrom, Oscar Díaz Arnesto, Oscar Flores-Flores, Oscar Incarbone, Oyun Chimeddamba, Pascal Bovet, Pedro Magalhães, Pekka Jousilahti, Piyawat Katewongsa, Rafael Alexander Leandro Gómez, Rawan Awni Shihab, Reginald Ocansey, Réka Veress, Richard Marine, Rolando Carrizales-Ramos, Saad Younis Saeed, Said El-Ashker, Samuel Green, Sandra Kasoma, Santiago Beretervide, Se-Sergio Baldew, Selby Nichols, Selina Khoo, Seyed Ali Hosseini, Shifalika Goenka, Shima Gholamalishahi, Soewarta Kosen, Sofie Compernolle, Stefan Paul Enescu, Stevo Popovic, Susan Paudel, Susana Andrade, Sylvia Titze, Tamu Davidson, Theogene Dusingizimana, Thomas E. Dorner, Tracy L. Kolbe-Alexander, Tran Thanh Huong, Vanphanom Sychareun, Vera Jarevska-Simovska, Viliami Kulikefu Puloka, Vincent Onywera, Wanda Wendel-Vos, Yannis Dionyssiotis, and Michael Pratt

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.