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Sarah Kozey Keadle, Shirley Bluethmann, Charles E. Matthews, Barry I. Graubard, and Frank M. Perna


This paper tested whether a physical activity index (PAI) that integrates PA-related behaviors (ie, moderate-to-vigorous physical activity [MVPA] and TV viewing) and performance measures (ie, cardiorespiratory fitness and muscle strength) improves prediction of health status.


Participants were a nationally representative sample of US adults from 2011 to 2012 NHANES. Dependent variables (self-reported health status, multimorbidity, functional limitations, and metabolic syndrome) were dichotomized. Wald-F tests tested whether the model with all PAI components had statistically significantly higher area under the curve (AUC) values than the models with behavior or performance scores alone, adjusting for covariates and complex survey design.


The AUC (95% CI) for PAI in relation to health status was 0.72 (0.68, 0.76), and PAI-AUC for multimorbidity was 0.72 (0.69, 0.75), which were significantly higher than the behavior or performance scores alone. For functional limitations, the PAI AUC was 0.71 (0.67, 0.74), significantly higher than performance, but not behavior scores, while the PAI AUC for metabolic syndrome was 0.69 (0.66, 0.73), higher than behavior but not performance scores.


These results provide empirical support that an integrated PAI may improve prediction of health and disease. Future research should examine the clinical utility of a PAI and verify these findings in prospective studies.