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Emmanuel Stamatakis, Kelechi Nnoaham, Charlie Foster, and Peter Scarborough

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Jordan Andre Martenstyn, Lauren Powell, Natasha Nassar, Mark Hamer, and Emmanuel Stamatakis

Background: Previous epidemiological studies examining the association between physical activity (PA) and mortality risk have measured absolute PA intensity using standard resting metabolic rate reference values that fail to consider individual differences. This study compared the risk of all-cause and cardiovascular mortality between absolute and corrected estimates of PA volume. Methods: 49,982 adults aged ≥40 years who participated in the Health Survey for England and Scottish Health Survey in 1994–2008 were included in our study. PA was classified as absolute or corrected metabolic equivalent (MET)-hours per week, taking participant’s weight, height, age, and sex into account. Cox regression models were used to examine the association between absolute and corrected PA volumes and all-cause and cardiovascular mortality. Results: The authors found no difference in the association between levels of PA and risk of all-cause and cardiovascular mortality for absolute and corrected MET-hours per week, although there was a consistent decrease in mortality risk with increasing PA. There was no difference in mortality when analyses were stratified by sex, age, and body mass index. Conclusions: The association between PA volume and risk of mortality was similar regardless of whether PA volume was estimated using absolute or corrected METs. There is no empirical justification against the use of absolute METs to estimate PA volume from questionnaires.

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Marko T. Kantomaa, Tuija Tammelin, Hanna Ebeling, Emmanuel Stamatakis, and Anja Taanila


Adolescent self-rated health is a strong predictor of future illness. In this study we investigated whether physical activity and cardiorespiratory fitness are associated with self-rated health among adolescents aged 16 years.


The study sample comprised 7,063 adolescents from the Northern Finland Birth Cohort 1986 (NFBC 1986) who responded to a postal questionnaire in 2001 to 2002. Self-rated health was measured by a single-item question, while physical activity was evaluated by a set of questions concerning the intensity and volume of physical activity outside school hours. Cardiorespiratory fitness was measured with a submaximal cycle ergometer test. Odds ratios (OR) and their 95% confidence intervals (95% CI) for good self-rated health were obtained from multinomial logistic regression.


High levels of physical activity (boys: OR 5.50, 95% CI 3.16 to 9.58; girls: OR 4.25, 95% CI 2.37 to 7.61) and cardiorespiratory fitness (boys: OR 1.85, 95% CI 1.05 to 3.24; girls: OR 2.62, 95% CI 1.47 to 4.66) were associated with very good self-rated health in adolescents.


High levels of physical activity and cardiorespiratory fitness are positively associated with adolescents’ self-rated health. Public health promotion activities that foster physical activity and cardiorespiratory fitness may benefit young people’s overall health and well-being.

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Hosam Alzahrani, Sonia W.M. Cheng, Debra Shirley, Martin Mackey, and Emmanuel Stamatakis

Background: To investigate the association between moderate- to vigorous-intensity physical activity (MVPA) and health-related quality of life (HRQoL) in people with back pain. Methods: The sample comprised adults aged 16 years and older who participated in the Welsh Health Survey (2011–2015). The HRQoL was evaluated using the 36-item short form. Participants were categorized into 4 groups based on minutes per week of MVPA: inactive (no MVPA), insufficiently active (<150 min/wk), sufficiently active (≥150 and <300 min/wk), and very active (≥300 min/wk). The authors investigated the association between MVPA and HRQoL using generalized linear models and multiple linear regression. Results: Of the 74,578 adults in the survey cohorts, 27,273 participants diagnosed with back pain were included in the analyses. Consistent direct curvilinear associations between MVPA and HRQoL were demonstrated for all 36-item short form domains (P < .001), in both the minimally and fully adjusted models, with the highest scores observed for sufficiently active and very active participants. Compared with the inactive group, those who were insufficiently active; sufficiently active; and very active had an average difference of 6.31 (95% confidence interval, 5.70–6.92), 7.72 (95% confidence interval, 7.04–8.41), and 8.00 (95% confidence interval, 7.12–8.89) points in the overall HRQoL, respectively. Conclusion: The authors found a consistent direct curvilinear association between MVPA and HRQoL.

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Rawan Hashem, Juan P. Rey-López, Mark Hamer, Anne McMunn, Peter H. Whincup, Christopher G. Owen, Alex Rowlands, and Emmanuel Stamatakis

Background: There is only scarce number of studies available describing the lifestyle of adolescents living in Arab countries. Hence, we described physical activity (PA) and sedentary behaviors patterns among Kuwaiti adolescents and the associations with parental education. Methods: Cross-sectional data from 435 adolescents (201 boys and 234 girls) were collected from the Study of Health and Activity among Adolescents in Kuwait conducted between 2012 and 2013. Outcome variables included PA (ActiGraph GT1M accelerometers) and sedentary behaviors. Exposure variable was parental education. Descriptive and multiple logistic regression analyses were used to examine the association between parental education and outcome variables. Results: Total sedentary time (minutes per day) was higher in girls [568.2 (111.6)] than in boys [500.0 (102.0)], whereas boys accumulated more minutes in light, moderate, and vigorous PA (all Ps ≤ .001). In total, 3.4% of adolescents spent ≥60 minutes per day of moderate to vigorous PA (by accelerometry), while only 21% met the screen time guidelines. Low/medium maternal education was associated with a higher odds of exceeding screen time guidelines (odds ratio = 2.09; 95% confidence interval, 1.09–4.02). Conclusions: Most Kuwaiti adolescents in this sample were physically inactive and exceeded screen time guidelines. Objective PA was not socially patterned, yet an inverse association between maternal education and screen time behaviors was found.

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Mohammad Sahebkar, Hamid Heidarian Miri, Pardis Noormohammadpour, Amir Tiyuri, Reza Pakzad, Nasrin Mansournia, Zahra Heidari, Mohammad Ali Mansournia, and Emmanuel Stamatakis

Background: To investigate the geographical distribution of physical activity (PA) prevalence among adults aged 15–64 years old across Iran provinces using geographic maps. Methods: Data from 4 consecutive national surveys conducted between 2007 and 2010 were pooled to determine the geographical distribution. Prevalence of low PA with 95% confidence interval was estimated by sociodemographic subpopulations over provinces using complex survey design. Results: In total, 119,560 participants (49.9% females) were included in the analyses. The mean (SD) age of participants was 39.5 (14.3) years. The prevalence of the low PA in the pooled 2007–2010 was 35.8% (95% confidence interval, 34.1–37.6). The 3 provinces with the highest prevalence of low PA were Sistan and Baluchestan, Yazd, and Hormozgan. The results of hot spot analysis showed that the Kerman province was a hot spot, and Ilam, Kermanshah, Hamedan, and Markazi were cold spots for low PA. Ilam, Kohgiluyeh and Boyer-Ahmad, and Mazandaran had the highest total PA volume (metabolic equivalent minutes per week). Hot spot analysis showed that Ilam and Khuzestan provinces were hot spots for the total PA volume. Conclusions: The regions with low and high PA are predominately situated in the near center/southeast and west, respectively.

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Elif Inan-Eroglu, Bo-Huei Huang, Leah Shepherd, Natalie Pearson, Annemarie Koster, Peter Palm, Peter A. Cistulli, Mark Hamer, and Emmanuel Stamatakis

Background: Thigh-worn accelerometers have established reliability and validity for measurement of free-living physical activity-related behaviors. However, comparisons of methods for measuring sleep and time in bed using the thigh-worn accelerometer are rare. The authors compared the thigh-worn accelerometer algorithm that estimates time in bed with the output of a sleep diary (time in bed and time asleep). Methods: Participants (N = 5,498), from the 1970 British Cohort Study, wore an activPAL device on their thigh continuously for 7 days and completed a sleep diary. Bland–Altman plots and Pearson correlation coefficients were used to examine associations between the algorithm derived and diary time in bed and asleep. Results: The algorithm estimated acceptable levels of agreement with time in bed when compared with diary time in bed (mean bias of −11.4 min; limits of agreement −264.6 to 241.8). The algorithm-derived time in bed overestimated diary sleep time (mean bias of 55.2 min; limits of agreement −204.5 to 314.8 min). Algorithm and sleep diary are reasonably correlated (ρ = .48, 95% confidence interval [.45, .52] for women and ρ = .51, 95% confidence interval [.47, .55] for men) and provide broadly comparable estimates of time in bed but not for sleep time. Conclusions: The algorithm showed acceptable estimates of time in bed compared with diary at the group level. However, about half of the participants were outside of the ±30 min difference of a clinically relevant limit at an individual level.

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Jessica Gugusheff, Bridget C. Foley, Katherine B. Owen, Bradley Drayton, Ding Ding, Emmanuel Stamatakis, Charlotte Lund Rasmussen, Adrian E. Bauman, and Margaret Thomas

Background: A combination of walking, other moderate physical activity, and vigorous physical activity is recommended for achieving good health. Vigorous activity has unique health benefits but may be less accessible to disadvantaged people. To reduce health inequity, we need to understand the differences in physical activity participation among socioeconomic subgroups and whether this is changing over time. Methods: Data from the 2002 to 2015 Adult New South Wales Population Health Surveys (164,652 responses) were analyzed to investigate trends in walking, moderate and vigorous physical activity participation by socioeconomic status as measured by educational attainment. Analysis used age- and sex-adjusted multivariable linear models that accounted for complex survey design. Results: In 2002, the highest socioeconomic group spent 18.5 (95% confidence interval, 8.2–28.8) minutes per week more than the lowest socioeconomic group being vigorously active. By 2015, this gap had steadily increased to 41.4 (95% confidence interval, 27.6–55.1) minutes per week. Inequity between groups was also found for duration of moderate activity but not for time spent walking. Conclusions: Low participation in vigorous activity in the lowest socioeconomic group is likely driving increasing inequities in physical activity and widening participation gaps over time. Barriers preventing the most disadvantaged people in New South Wales from engaging in vigorous activity should be addressed urgently.