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Meta-Analysis
. 2012 Feb 15;307(7):704-12.
doi: 10.1001/jama.2012.156.

Moderate to vigorous physical activity and sedentary time and cardiometabolic risk factors in children and adolescents

Ulf Ekelund  1 , Jian'an Luan, Lauren B Sherar, Dale W Esliger, Pippa Griew, Ashley Cooper; International Children's Accelerometry Database (ICAD) Collaborators
Collaborators, Affiliations
Meta-Analysis

Moderate to vigorous physical activity and sedentary time and cardiometabolic risk factors in children and adolescents

Ulf Ekelund et al. JAMA. .

Erratum in

  • JAMA. 2012 May 9;307(18):1915. Sardinha L [corrected to Sardinha, L B]; Anderssen, S A [corrected to Anderson, L B]

Abstract

Context: Sparse data exist on the combined associations between physical activity and sedentary time with cardiometabolic risk factors in healthy children.

Objective: To examine the independent and combined associations between objectively measured time in moderate- to vigorous-intensity physical activity (MVPA) and sedentary time with cardiometabolic risk factors.

Design, setting, and participants: Pooled data from 14 studies between 1998 and 2009 comprising 20 871 children (aged 4-18 years) from the International Children's Accelerometry Database. Time spent in MVPA and sedentary time were measured using accelerometry after reanalyzing raw data. The independent associations between time in MVPA and sedentary time, with outcomes, were examined using meta-analysis. Participants were stratified by tertiles of MVPA and sedentary time.

Main outcome measures: Waist circumference, systolic blood pressure, fasting triglycerides, high-density lipoprotein cholesterol, and insulin.

Results: Times (mean [SD] min/d) accumulated by children in MVPA and being sedentary were 30 (21) and 354 (96), respectively. Time in MVPA was significantly associated with all cardiometabolic outcomes independent of sex, age, monitor wear time, time spent sedentary, and waist circumference (when not the outcome). Sedentary time was not associated with any outcome independent of time in MVPA. In the combined analyses, higher levels of MVPA were associated with better cardiometabolic risk factors across tertiles of sedentary time. The differences in outcomes between higher and lower MVPA were greater with lower sedentary time. Mean differences in waist circumference between the bottom and top tertiles of MVPA were 5.6 cm (95% CI, 4.8-6.4 cm) for high sedentary time and 3.6 cm (95% CI, 2.8-4.3 cm) for low sedentary time. Mean differences in systolic blood pressure for high and low sedentary time were 0.7 mm Hg (95% CI, -0.07 to 1.6) and 2.5 mm Hg (95% CI, 1.7-3.3), and for high-density lipoprotein cholesterol, differences were -2.6 mg/dL (95% CI, -1.4 to -3.9) and -4.5 mg/dL (95% CI, -3.3 to -5.6), respectively. Geometric mean differences for insulin and triglycerides showed similar variation. Those in the top tertile of MVPA accumulated more than 35 minutes per day in this intensity level compared with fewer than 18 minutes per day for those in the bottom tertile. In prospective analyses (N = 6413 at 2.1 years' follow-up), MVPA and sedentary time were not associated with waist circumference at follow-up, but a higher waist circumference at baseline was associated with higher amounts of sedentary time at follow-up.

Conclusion: Higher MVPA time by children and adolescents was associated with better cardiometabolic risk factors regardless of the amount of sedentary time.

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Figures

Figure 1
Figure 1
Combined associations of time spent sedentary and in MVPA on waist circumference (Figure 1a), systolic blood pressure (Figure 1b) fasting insulin (Figure 1c), fasting triglycerides (Figure 1d), and fasting HDL-Cholesterol (Figure 1e) stratified by tertiles of sedentary time and time in MVPA. Mean time (min/d) spent sedentary in the low, middle and high tertile groups were 268.0 (range 28.0 to 399) min/d; 351.6 (range 203.0 to 479.8) min/d; and 433.3 (range 262.3 to 755.8) min/d, respectively. Mean time spent in MVPA was 12.0 (range 0 to 27.2) min/d; 27.0 (range 8.4 to 45.7) min/d; and 52.5 (range 20.6 to 185.0) min/d in the low, middle and high MVPA groups. The mean age ranged between 11.2 yrs and 11.4 yrs across tertile groups. Data for each group are sex and age adjusted means (geometric means for fasting insulin and triglycerides) and 95% CI (P for trend<0.0001 for all outcomes across all sedentary tertiles except for systolic blood pressure in the high sedentary group; P for trend=0.11).
Figure 1
Figure 1
Combined associations of time spent sedentary and in MVPA on waist circumference (Figure 1a), systolic blood pressure (Figure 1b) fasting insulin (Figure 1c), fasting triglycerides (Figure 1d), and fasting HDL-Cholesterol (Figure 1e) stratified by tertiles of sedentary time and time in MVPA. Mean time (min/d) spent sedentary in the low, middle and high tertile groups were 268.0 (range 28.0 to 399) min/d; 351.6 (range 203.0 to 479.8) min/d; and 433.3 (range 262.3 to 755.8) min/d, respectively. Mean time spent in MVPA was 12.0 (range 0 to 27.2) min/d; 27.0 (range 8.4 to 45.7) min/d; and 52.5 (range 20.6 to 185.0) min/d in the low, middle and high MVPA groups. The mean age ranged between 11.2 yrs and 11.4 yrs across tertile groups. Data for each group are sex and age adjusted means (geometric means for fasting insulin and triglycerides) and 95% CI (P for trend<0.0001 for all outcomes across all sedentary tertiles except for systolic blood pressure in the high sedentary group; P for trend=0.11).
Figure 1
Figure 1
Combined associations of time spent sedentary and in MVPA on waist circumference (Figure 1a), systolic blood pressure (Figure 1b) fasting insulin (Figure 1c), fasting triglycerides (Figure 1d), and fasting HDL-Cholesterol (Figure 1e) stratified by tertiles of sedentary time and time in MVPA. Mean time (min/d) spent sedentary in the low, middle and high tertile groups were 268.0 (range 28.0 to 399) min/d; 351.6 (range 203.0 to 479.8) min/d; and 433.3 (range 262.3 to 755.8) min/d, respectively. Mean time spent in MVPA was 12.0 (range 0 to 27.2) min/d; 27.0 (range 8.4 to 45.7) min/d; and 52.5 (range 20.6 to 185.0) min/d in the low, middle and high MVPA groups. The mean age ranged between 11.2 yrs and 11.4 yrs across tertile groups. Data for each group are sex and age adjusted means (geometric means for fasting insulin and triglycerides) and 95% CI (P for trend<0.0001 for all outcomes across all sedentary tertiles except for systolic blood pressure in the high sedentary group; P for trend=0.11).
Figure 1
Figure 1
Combined associations of time spent sedentary and in MVPA on waist circumference (Figure 1a), systolic blood pressure (Figure 1b) fasting insulin (Figure 1c), fasting triglycerides (Figure 1d), and fasting HDL-Cholesterol (Figure 1e) stratified by tertiles of sedentary time and time in MVPA. Mean time (min/d) spent sedentary in the low, middle and high tertile groups were 268.0 (range 28.0 to 399) min/d; 351.6 (range 203.0 to 479.8) min/d; and 433.3 (range 262.3 to 755.8) min/d, respectively. Mean time spent in MVPA was 12.0 (range 0 to 27.2) min/d; 27.0 (range 8.4 to 45.7) min/d; and 52.5 (range 20.6 to 185.0) min/d in the low, middle and high MVPA groups. The mean age ranged between 11.2 yrs and 11.4 yrs across tertile groups. Data for each group are sex and age adjusted means (geometric means for fasting insulin and triglycerides) and 95% CI (P for trend<0.0001 for all outcomes across all sedentary tertiles except for systolic blood pressure in the high sedentary group; P for trend=0.11).
Figure 1
Figure 1
Combined associations of time spent sedentary and in MVPA on waist circumference (Figure 1a), systolic blood pressure (Figure 1b) fasting insulin (Figure 1c), fasting triglycerides (Figure 1d), and fasting HDL-Cholesterol (Figure 1e) stratified by tertiles of sedentary time and time in MVPA. Mean time (min/d) spent sedentary in the low, middle and high tertile groups were 268.0 (range 28.0 to 399) min/d; 351.6 (range 203.0 to 479.8) min/d; and 433.3 (range 262.3 to 755.8) min/d, respectively. Mean time spent in MVPA was 12.0 (range 0 to 27.2) min/d; 27.0 (range 8.4 to 45.7) min/d; and 52.5 (range 20.6 to 185.0) min/d in the low, middle and high MVPA groups. The mean age ranged between 11.2 yrs and 11.4 yrs across tertile groups. Data for each group are sex and age adjusted means (geometric means for fasting insulin and triglycerides) and 95% CI (P for trend<0.0001 for all outcomes across all sedentary tertiles except for systolic blood pressure in the high sedentary group; P for trend=0.11).
Figure 2
Figure 2
Meta analysis of the prospective associations (β-coefficients and 95% CI) between baseline waist circumference and time spent sedentary at follow up. The β-coefficients represent the difference in time spent sedentary (min per day) for one cm difference in baseline waist circumference. The model is adjusted for sex, age, monitor wear time, baseline time spent sedentary, and follow up time.
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