Women have typically been characterized as less physically active than men when activity levels were evaluated by a moderate to vigorous physical activity (MVPA) criterion.1–5 The global prevalence of physical inactivity has been reported to be higher in women than in men regardless of age and World Bank income group.1 The most recent international large-scale survey conducted across 168 countries in 2019 provided similar findings, with 23.4% and 31.7% of men and women being characterized as physically inactive, respectively.4 Based on these surveillance data, researchers and policymakers have encouraged interventions to close the gender gap by addressing social and cultural barriers that could restrict the access and opportunities for women to take part in physical activity (PA).5–7 Gender differences in PA have been reported in Japan, with the 2020 National Sports Life Survey showing that the prevalence of physical inactivity was 40.4% and 53.1% in adult men and women, respectively.8
Most of these previous studies have relied on self-reported questionnaires and defined PA/inactivity according to the World Health Organization’s (WHO) PA guidelines; these guidelines recommend that adults engage in at least 150 minutes of moderate-intensity PA; at least 75 minutes of vigorous-intensity PA; or an equivalent combination of MVPA per week.9 However, MVPA accounts for only a relatively small part of the waking hours per week (commonly less than 5%), whereas sedentary behavior (SB) and light-intensity PA (LPA) account for all of the remaining hours.10–12 Therefore, it remains unclear whether women will be considered less physically active when all intensities of activity are counted.
There is a growing body of evidence that demonstrates the detrimental effects of SB on various health outcomes.13–15 A systematic review by the 2020 WHO Guideline Development Group concluded that higher amounts of SB increase the risk of all-cause, cardiovascular disease, and cancer mortality, as well as incident cardiovascular disease, cancer, and type 2 diabetes.13 These findings have led to recommendations for adults to limit the time spent in SB and to replace such behaviors with PA of any intensity, including LPA, to gain health benefits.7 These recommendations were accompanied by the key message “Every Move Counts,” which was proposed by the WHO.7 Meanwhile, the development and widespread use of accelerometers has enabled the accumulation of evidence on the impacts of LPA on health.12,16–19 Previous systematic reviews suggest that longer time spent in LPA plays an important role in improving adult cardiometabolic health and reducing mortality risk.12,16–19 In a recent pooled analysis of 6 prospective cohorts with device-based measurements, combinations of less time spent in SB and higher PA of any intensity were associated with a lower all-cause mortality risk; still, increasing MVPA required less time and showed similar benefits.12 Given the health benefits of LPA, it may be necessary to assess levels of PA, including LPA, to more appropriately identify those who are truly insufficiently active.
Despite this comprehensive body of evidence on the relationship between PA and health, and the increasing evidence on the relationship between SB and health, little is known about how time spent in SB and in different PA intensities differ between men and women,10,11,20 after consideration of the co-dependence of time-use domains. In contrast to previous findings,1–5 our earlier study on community-dwelling older Japanese adults found that when analyzing any intensity and bouts of PA, it was actually greater among women than that among men; this was due to the longer time spent in LPA and intermittent MVPA lasting <10 minutes among women.21 Moreover, a study among Japanese adults living in rural areas yielded similar results after taking into consideration the co-dependence of time-use components.22 However, the generalizability of previous findings to middle-aged adults living in urban or regional cities—where the lifestyle and PA levels differ from those in rural areas—8,23,24 remains unclear.
In a sample of middle-aged Japanese men and women, we examined: (1) how time-use activity composition differs by gender and (2) whether women are more physically active than men when all PA intensities are examined.
Methods
Study Sample and Data Collection
A cross-sectional mail survey was carried out between July 2013 and February 2015 among middle-aged (40–64 y old) community-dwelling Japanese adults living in 2 cities: Koto Ward (Tokyo) and Matsuyama City (Ehime Prefecture).25–28 Koto Ward is a metropolitan city located in the eastern part of Tokyo (in 2015, area: 43.0 km2; population: 489,000), and Matsuyama City is a regional city located in the northwest part of the Shikoku region (in 2015, area: 429 km2; population: 515,000). This research project was originally designed to identify how the built environment related to PA and SB. The study design and methods are described in detail elsewhere.25,27
In summary, 6000 men and women (3000 in each city) were randomly selected from the residential registry and while stratifying by gender and age (40–49, 50–59, and 60–64 y). Of the 866 participants who expressed interest to participate in this study, 780 provided written informed consent. Participants were asked to wear an accelerometer and respond to a questionnaire. On completion of the study, 23 were excluded for not meeting the accelerometer wearing time criteria (n = 22) and refusing to wear an accelerometer (n = 1). Thus, the final sample comprised 757 (40.0% men) participants. This study was approved by the university ethics committee of Waseda University. Informed consent was obtained from all participants prior to the survey.
Measurement of SB and PA
Participants were instructed to wear a triaxial accelerometer, the Active style Pro HJA-350IT (Omron Healthcare), on the left side of their waist for 7 consecutive days while awake, except during underwater activities (eg, swimming). The accelerometer has been validated29,30 and shown to provide data comparable to that obtained by the ActiGraph GT3X (ActiGraph LLC) and the activPAL3 (PAL Technologies Ltd).31,32 We defined time as “non-wear” if there was no detection of an acceleration signal for more than 60 consecutive minutes, with allowance for interruptions of 1 or 2 minutes below the threshold (<1.0 metabolic equivalent of task [METs]); and we considered data as valid when participants wore the accelerometer for at least 10 hours per day.33 Participants with at least 4 valid wearing days were included in the analyses.34,35 We used 60-minute epoch length data, as this is a common standard in this field.36,37 Criteria based on MET were used to determine PA intensity: ≤1.5 METs for SB, 1.6 to 2.9 METs for LPA, and ≥3.0 METs for MVPA.38,39 A bout of MVPA was defined as 10 or more consecutive minutes above the moderate intensity threshold. A <10-minute bout of MVPA was calculated by subtracting ≥10-minute bouts of MVPA from the overall MVPA. The total volume of PA (MET hours per week) was computed by multiplying the MET score of an activity by the hours performed.
Sociodemographic, Biological, and Psychological Factors
Age, gender, and residential area data were obtained from the residential registry of each city. Participants reported their marital status (single/married), living arrangement (with others/alone), educational attainment (elementary, and junior high school/high school/junior college/university, and postgraduate), household income (in million yen: <3.00/3.00–4.99/5.00–6.99/7.00–9.99/≥10.00), occupational status (full-time work/part-time work/not employed/homemaker/student), occupational activity type (sitting/standing/walking/physical labor), height, weight, and self-rated health. The “workers” accounted for full- and part-time workers, while the “non-workers” accounted for those not employed, homemakers, and students. Self-rated health was assessed using the following question from the 8-item Short-Form Health Survey40: “Overall, how would you rate your health during the past 4 weeks?” Participants were asked to choose the answer that most accurately describes their health from a 6-point scale: excellent, very good, good, fair, poor, and very poor. The answers were dichotomized into “good” (excellent/very good/good) and “poor” (fair/poor/very poor). Body mass index was calculated using self-reported height and weight (in kilograms per meter square).
Statistical Analyses
T tests, chi-square tests, or Fisher exact test was performed to compare participants’ characteristics by gender. Regarding activity measures, we compared the total volume of PA (MET hours per week) by gender using analysis of covariance, and a compositional data analysis approach was used to analyze how time spent in SB and different PA intensities differed by gender after controlling for time spent in all activity measures, because waking hours in a day or week is finite and all time-use activity components are co-dependent.41–43 We used a 3-part composition, and the time spent in SB, LPA, and MVPA was transformed into isometric log-ratio coordinates.41–43 In particular, isometric log-ratio coordinate 1 represents MVPA relative to LPA and SB, and isometric log-ratio coordinate 2 represents the ratio between LPA and SB. We presented both pivot coordinates in the analysis as they are an important indicator related to health outcomes.12
Compositional multivariate analysis of covariance was used to test whether activity compositions differed by gender after adjusting for sociodemographic factors. Model 1 was adjusted for age; model 2 was further adjusted for residential area, educational attainment, household income, living arrangement, and occupational status; and model 3 was additionally adjusted for occupational activity type. We also conducted stratified analyses by working status (workers/nonworkers) and by day of the week (working days/nonworking days) for working participants only, as they were shown to be an important determinant of SB and PA in this cohort.24,25
To support the interpretation of which behaviors differed significantly by gender, we calculated 95% bootstrap percentile confidence intervals (CIs) for log-ratio differences by gender.44,45 Log-ratios were then back-transformed to simplify data interpretation. We generated 10,000 bootstrap samples. R (version 4.1.1, R Foundation for Statistical Computing) was used to perform all statistical analyses. The statistical significance level was set at a P < .05.
Results
Participant Characteristics
Overall, the mean (SD) age was 52.3 (7.1) years and the mean accelerometer wear time was 914.3 (90.6) minutes per day. Participants spent an average of 495.9 (123.0) minutes per day in SB, 348.3 (111.7) minutes per day in LPA, and 70.1 (39.4) minutes per day in MVPA, corresponding to 55.2%, 37.8%, and 6.9% of the wearing time, respectively.
Significant gender differences were found by household income, marital status, self-rated health, body mass index, occupational status, and activity type (Table 1). We did not find significant gender differences in the proportion of those adhering to the 2020 WHO PA guidelines (ie, ≥150 min/wk of MVPA, men: 93.1% and women: 95.8%) nor to the Japanese PA guidelines for health promotion 2013 (ie, ≥23 MET h/wk of MVPA, men: 63.0% and women: 63.2%).
Characteristics of Study Participants by Gender
| Men (N = 303) | Women (N = 454) | ||
|---|---|---|---|
| n (%)/mean (SD) | n (%)/mean (SD) | P | |
| Age, y | 52.5 (7.3) | 52.1 (7.0) | .461a |
| Body mass index, kg/m2 | 24.0 (3.3) | 21.4 (3.0) | <.001a |
| Residential area (urban city, Tokyo) | 137 (45.2%) | 229 (50.4%) | .159b |
| Educational attainment (>12 y) | 195 (64.6%) | 290 (64.3%) | .940b |
| Household income (≥5 million yen) | 178 (59.5%) | 227 (51.2%) | .026b |
| Marital status (married) | 261 (86.1%) | 339 (75.5%) | <.001b |
| Living arrangement (with others) | 271 (89.4%) | 403 (88.8%) | .772b |
| Self-rated health (good) | 249 (82.2%) | 342 (75.5%) | .029b |
| Adherence to the 2020 WHO PA guidelinesd (yes) | 282 (93.1%) | 435 (95.8%) | .098b |
| Adherence to the Japanese PA guidelines for health promotion 2013e (yes) | 191 (63.0%) | 287 (63.2%) | .960b |
| Occupational status | <.001c | ||
| Full-time work | 271 (89.7%) | 193 (42.7%) | |
| Part-time work | 10 (3.3%) | 147 (32.5%) | |
| Not employed | 19 (6.3%) | 18 (4.0%) | |
| Homemaker | 1 (0.3%) | 94 (20.8%) | |
| Student | 1 (0.3%) | 0 (0.0%) | |
| Occupational activity type (only workersf) | <.001b | ||
| Sitting | 185 (69.8%) | 166 (49.6%) | |
| Standing | 33 (12.5%) | 79 (23.6%) | |
| Walking | 34 (12.8%) | 83 (24.8%) | |
| Physical labor | 13 (4.9%) | 5 (1.5%) |
Note: Bold indicates statistical significance (P < .05). Abbreviations: MET, metabolic equivalents of task; MVPA, moderate to vigorous PA; PA, physical activity; WHO, World Health Organization. Note: Missing values: educational attainment, n = 4; income, n = 15; occupational activity type, n = 2; marital status, n = 5; self-rated health, n = 1; occupational status, n = 3.
aT test. bChi-squared test. cFisher exact test. d≥150 minutes per week of MVPA. e≥23 MET hours per week of MVPA. f“Workers” here accounted for full- and part-time workers.
Comparison of Time-Use Activity Composition by Gender
Table 2 presents the descriptive statistics of the time spent in SB and different PA intensities. There were gender differences in activity composition; the composition of SB, LPA, and MVPA was 59.6%, 33.4%, and 7.0% in men and 52.2%, 40.9%, and 6.9% in women, respectively (Figure 1). Women on average spent 12.6% (CI, 15.5% to 9.2%) less time in SB and 23.4% (CI, 16.5% to 29.1%) more time in LPA, compared with men. The difference by gender in time spent in MVPA was not statistically significant (mean difference: −3.5%; CI, −10.1% to 7.2%). In the stratified analysis, working women had less time spent in SB and more LPA than working men, both on working days and nonworking days (Table 3).
Descriptive Statistics of Accelerometer-Measured SB and Physical Activity Among Middle-Aged Japanese Men and Women by Working Status
| Overall | Workers | Nonworkers | ||||
|---|---|---|---|---|---|---|
| Men (n = 303) | Women(n = 454) | Men (n = 281) | Women (n = 340) | Men (n = 21) | Women (n = 112) | |
| Mean (SD)/% | Mean (SD)/% | Mean (SD)/% | Mean (SD)/% | Mean (SD)/% | Mean (SD)/% | |
| Accelerometer wear time | 889.9 (93.1) | 930.6 (85.1) | 890.3 (92.6) | 932.0 (85.9) | 889.5 (100.9) | 929.1 (81.3) |
| Time-use component (arithmetic mean) | ||||||
| SB, min/d | 518.0 (135.3) | 481.1 (111.7) | 515.8 (136.6) | 479.3 (116.5) | 544.1 (120.6) | 490.8 (91.4) |
| LPA, min/d | 301.5 (115.2) | 379.5 (97.6) | 303.1 (114.3) | 380.1 (102.4) | 285.2 (128.6) | 376.6 (81.9) |
| MVPA, min/d | 70.4 (44.9) | 69.9 (35.4) | 71.4 (45.1) | 72.6 (37.2) | 60.2 (42.5) | 61.6 (28.1) |
| <10 min bouts of MVPA, min/d | 56.0 (35.0) | 60.1 (29.4) | 57.4 (35.2) | 62.9 (31.0) | 38.1 (25.9) | 51.0 (21.6) |
| ≥10 min bouts of MVPA, min/d | 14.5 (21.0) | 9.9 (14.2) | 13.9 (20.3) | 9.7 (14.2) | 22.1 (28.4) | 10.6 (14.3) |
| Total volume of physical activity, MET h/wk | 15.1 (5.8) | 17.7 (4.7) | 15.2 (5.8) | 17.9 (5.0) | 14.0 (6.7) | 17.1 (3.9) |
| Percentages by activity (compositional mean) | ||||||
| SB | 59.6 | 52.2 | 59.3 | 52.0 | 63.7 | 53.4 |
| LPA | 33.4 | 40.9 | 33.6 | 40.9 | 31.2 | 40.6 |
| MVPA | 7.0 | 6.9 | 7.2 | 7.1 | 5.2 | 6.0 |
Abbreviations: LPA, light-intensity physical activity; MET, metabolic equivalent of task; MVPA, moderate to vigorous physical activity; SB, sedentary behavior. Note: Compositional means were calculated as geometric means rescaled to collectively add up to 100%.
—A ternary diagram of time-use activity composition among men and women. LPA indicates light-intensity physical activity; MVPA, moderate to vigorous physical activity; SB, sedentary behavior.
Citation: Journal of Physical Activity and Health 19, 7; 10.1123/jpah.2022-0098
Descriptive Statistics of Accelerometer-Measured SB and Physical Activity Among Middle-Aged Working Men and Women
| Working days | Nonworking days | |||
|---|---|---|---|---|
| Men (n = 225) | Women (n = 303) | Men (n = 225) | Women (n = 303) | |
| Mean (SD)/% | Mean (SD)/% | Mean (SD)/% | Mean (SD)/% | |
| Accelerometer wear time | 916.8 (99.9) | 956.8 (94.1) | 852.8 (119.7) | 894.8 (103.3) |
| Time-use component (arithmetic mean) | ||||
| SB, min/d | 536.2 (152.6) | 481.9 (130.2) | 519.9 (147.0) | 501.8 (123.6) |
| LPA, min/d | 304.8 (130.9) | 396.3 (117.6) | 274.8 (108.7) | 337.3 (104.1) |
| MVPA, min/d | 75.9 (51.3) | 78.6 (45.6) | 58.1 (41.6) | 55.7 (31.1) |
| <10 min bouts of MVPA, min/d | 61.4 (42.6) | 68.6 (38.3) | 45.5 (30.3) | 47.9 (25.1) |
| ≥10 min bouts of MVPA, min/d | 14.4 (19.8) | 10.0 (16.4) | 12.6 (25.0) | 7.8 (14.4) |
| Total volume of physical activity, MET h/wk | 15.5 (6.3) | 18.9 (5.8) | 13.7 (6.9) | 15.3 (4.8) |
| Percentage by activity (compositional mean) | ||||
| SB | 60.1 | 51.0 | 62.8 | 60.5 |
| LPA | 32.6 | 41.6 | 31.6 | 39.5 |
| MVPA | 7.4 | 7.4 | 5.6 | 5.4 |
Abbreviations: LPA, light-intensity physical activity; MET, metabolic equivalent of task; MVPA, moderate to vigorous physical activity; SB, sedentary behavior. Note: Compositional means were calculated as geometric means rescaled to collectively add up to 100%.
The compositional multivariate analysis of covariance showed that the ratio between LPA and SB relative to MVPA was statistically significantly different by gender, whereas the relative proportion of MVPA was not (see Supplementary Table S1 [available online]). The relative proportions of SB and LPA differed between men and women (see Supplementary Table S2 [available online]). Additional adjustments for sociodemographic factors did not change the main results, although the statistical significance was not apparent among workers in Model 3.
Comparison of the Total Volume of PA by Gender
After adjusting for age and residential area, women accumulated a greater total volume of PA than men (men: 15.0 [14.5–15.6] MET h/d and women: 17.8 [17.3–18.2] MET h/d; P < .001; Figure 2). Similar significant gender differences were observed after stratification by workers (men: 15.1 [14.5–15.8] MET h/d and women: 18.0 [17.4–18.5] MET h/d; P < .001) and nonworkers (men: 13.5 [11.5–15.5] MET h/d and women: 17.2 [16.3–18.0] MET h/d; P = .001). The degree of gender difference was larger for nonworkers compared with workers.
—Gender differences in total volume of physical activity among middle-aged Japanese adults. MET indicates metabolic equivalent of task.
Citation: Journal of Physical Activity and Health 19, 7; 10.1123/jpah.2022-0098
Discussion
The main finding of our study is that middle-aged Japanese women can be more physically active than their male counterparts. This gender difference was attributable to the time spent in LPA, but not in MVPA, among women. Our findings suggest that higher levels of PA among women may come from less variability in activity. Similar findings were observed for both workers and nonworkers, although the degree of gender difference differed slightly by working status.
This study among middle-aged adults in Japan confirmed the generalizability of our previous findings,21,22 which showed older Japanese women were more physically active than older men. Our finding that women spent more time in PA of lower intensity is also consistent with those of previous accelerometer studies conducted in Western countries.10,11,20 For example, a study conducted with a national sample in Norway reported that women spent significantly less time in SB (565 min/d vs 535 min/d) and more time in LPA (202 min/d vs 233 min/d) than men.11 The Norfolk arm of the European Prospective Investigation into Cancer (EPIC-Norfolk) study also provided a detailed description of activity by gender: women accumulated their total PA through activities of lower intensities, while men accumulated similar activity volumes by spending more time in SB and in activity intensities that were above 2000 counts per minute.10 The degree of gender difference in SB and LPA may be greater in the Japanese population than in populations from Western countries.21,22
The gender differences in activity time-use composition, particularly for SB and LPA, are attributable to sociocultural roles. Japanese women have traditionally been in charge of most household chores. Sociocultural norms may lead women to stay at home and engage in housework and childcare, leading them to accumulate more LPA.46,47 According to the most recent National Survey on Time Use and Leisure Activities, which was conducted in 2016 by the Statistics Bureau of Japan, Japanese wives in families with children under 6 years spend an average of 454 minutes per day on housework-related activities, while husbands spend 83 minutes per day.48 This gender gap has remained almost unchanged since 1996.48 In the World Economic Forum’s Global Report 2021, Japan ranked 120th among 156 countries in the gender gap rankings (ie, among 25% of countries with the largest gender gap).49 Traditional gender roles may have had a positive impact on Japanese women’s total of PA, although gender inequality is a serious social problem in Japan.
In the current study, time spent in LPA differed by approximately 80 minutes per day between men and women. Given the reported health benefits of LPA,12,16–19,50 it is possible that Japanese women’s level PA contributed to their health and longevity. For example, a recent meta-analysis estimated that, when MVPA was constant, the combination of approximately 50 minutes more of LPA and 50 minutes less of SB per day was associated with a risk reduction of 10% in all-cause mortality.12
Defining a physically active population depends on which indicator of PA is used.21,22 The current evidence showing that men are more physically active than women is primarily based on self-reported bouts of MVPA data.1–5 However, it may need to be reexamined with consideration of LPA and MVPA of shorter bouts to accurately identify groups that lack PA, if the evidence on the health benefits of these activities is well established in the future. In November 2020, WHO updated their PA guidelines, and MVPA bouts of any duration count toward these recommendations, reflecting new scientific evidence to support the value of overall MVPA, regardless of bout length.7 However, it can be difficult to evaluate overall MVPA including sporadic MVPA, using self-reported questionnaires. Accelerometer-based monitoring systems may be required for more accurate and detailed assessment of PA, although questionnaires have been widely used for PA surveillance since they are easy to administer in large-scale studies.1–5
Limitations
There are several limitations to this study that need to be considered when interpreting the results. First, differences in response rates between men and women (men 10.1% vs women 15.1%) may have influenced the comparison of activity by gender, even if this is likely to have led to underestimation of gender differences. In general, accelerometer responders may be more physically active than nonresponders.51 Moreover, although it may not directly be influenced by the results of gender differences in activities, the response rate was relatively low (12.6%); thus, there may be participation bias. Therefore, the time and amount of PA may have been overestimated in this study. Second, Koto Ward and Matsuyama City are not necessarily representative of urban and regional cities in Japan, respectively. Therefore, more research examining different populations from different geographic areas is needed. Third, although the accelerometer used in this study has been validated,29–32 it cannot accurately detect some types of PA (eg, water-based activities and cycling) and postures. A previous comparative study in free-living conditions reported that the Active style Pro underestimated total sedentary time by an average of 25.6 minutes per day (equivalent to 3.2% of the wearing time) compared with the thigh-worn activPAL.31 Thus, the time spent in SB in our study may be slightly underestimated. Fourth, the choice of epoch length affects outcome measures of SB and PA. Although accelerometer data with 60-second epoch was used in this study, according to standard measurement protocols to maximize, the comparability between studies, the higher intensity of PA could be underestimated and/or the very short bouts of activity are not considered. Finally, we did not include sleep duration in our analyses, which can affect the estimation of the time-use activity component during waking hours. Future research using the 24-hour wear protocol may be needed to describe differences in activity patterns between men and women more accurately.
Conclusions
Our findings suggest that Japanese middle-aged women have higher overall levels of PA than men because of the longer time spent in LPA. Similar gender differences were observed after stratification by workers and nonworkers. Given the health benefits of LPA, evaluating only MVPA may lead to an underestimation of women’s participation in physical activities.
Acknowledgments
Owen was supported by the National Health and Medical Research Council of Australia through a Senior Principal Research Fellowships no. 1003960) and by the Victorian Government’s Operational Infrastructure Support Program. Shibata was supported by the JSPS Grants-in-Aid for Scientific Research program (21K11693). Ishii was supported by the JSPS Grants-in-Aid for Scientific Research program (20K11473). Oka was supported by the JSPS Grants-in-Aid for Scientific Research program (20H04113). Amagasa was supported by the JSPS Grants-in-Aid for Scientific Research program (21K17551). This study was supported by the MEXT-Supported Program for the Strategic Research Foundation at Private Universities (S1511017) and the JSPS Grants-in-Aid for Scientific Research program (19H03910).
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