Associations of sedentary time and physical activity with adverse health conditions: Outcome-wide analyses using isotemporal substitution model

Prolonged sitting time and all-cause mortality: the mediating and predictive role of kidney function markers

OBJECTIVE

To investigate the association between daily sitting time and all-cause mortality, with a focus on the mediating effect and predictive value of the makers relating to kidney.

METHODS

The cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2020. The makers relating to kidney were assessed through estimated glomerular filtration rate (eGFR), urine albumin creatinine ratio (UACR), and other relevant markers.

RESULTS

A total of 9,707 adults were included in the analysis. There was a significant increase in the levels of blood urea nitrogen (BUN), creatinine, uric acid, osmolality, and UACR with extended daily sitting time, while eGFR significantly decreased. Notably, individuals sitting ≥ 8 h per day exhibited a 67% higher risk of all-cause mortality (HR = 1.67, 95% CI: 1.43-1.94). A nonlinear (L-shaped) relationship was observed between eGFR (p < 0.001) or UACR (p < 0.001) and all-cause mortality. Mediation analysis revealed that eGFR accounted for 20.98% of the association between sitting time and mortality (p < 0.01). An addition of eGFR or UACR would increase the AUC from 0.585 to 0.762 and 0.656, respectively(p < 0.001). The main mortality caused by daily sitting time included chronic lower respiratory diseases, diabetes mellitus, cerebrovascular diseases and heart diseases.

CONCLUSIONS

Prolonged daily sitting time is significantly associated with an increased risk of all-cause mortality, potentially mediated by impaired kidney function. Incorporating kidney function markers such as eGFR and UACR enhances the predictive value for mortality risk assessment in sedentary populations.

Effectiveness of Mobile Health Interventions for Reducing Sitting Time in Older Adults: Systematic Review and Meta-Analysis

BACKGROUND

Mobile health (mHealth) provides health information through electronic devices, even at home. The escalating prevalence of sedentary behaviors among older adults, which leads to increased adverse health outcomes, underscores the pressing need for a comprehensive understanding of the effectiveness of mHealth interventions.

OBJECTIVE

This study aims to examine the effectiveness of mHealth interventions in the sitting time of older adults (age 55 years).

METHODS

A systematic review and meta-analysis of randomized controlled trials was conducted to evaluate the effects of mHealth interventions on total sitting time during waking hours, excluding sleep. A literature search was conducted using multiple databases, including PubMed, Embase, Web of Science, and Cochrane, covering articles published from the inception of each database through October 2023. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were explicitly applied to structure this report. Methodological quality was assessed using the Cochrane Risk of Bias (ROB 2) tool for randomized controlled trials and the Methodological Index for Non-Randomized Studies (MINORS) tool for nonrandomized studies. Two independent reviewers screened the studies, extracted data, and assessed methodological quality using established criteria. Meta-analyses were performed using Review Manager (version 5.4; Cochrane Collaboration).

RESULTS

Ten studies were identified, of which 3 were included in the meta-analysis, while the remaining 7 were assessed exclusively in the systematic review. The interventions predominantly took place in community settings (n=3) and home-based settings (n=3). Three studies aimed to decrease sedentary behavior and 7 aimed to increase physical activity. The interventions were primarily conducted once daily (n=7) via mobile devices such as smartphones (n=7) and typically involved a single intervention delivered at different time intervals, such as every 15, 20, or 30 minutes (n=4). The interventions typically lasted 12 weeks (n=4) and used objective assessment tools, such as the ActiGraph GT3X+ (n=8). The included studies applied the habit formation theory (n=1), the self-efficacy theory (n=1), the social cognitive theory (n=1), and the social-ecological theory (n=1) as frameworks. Additionally, behavior change techniques, including "goal setting," "problem-solving," "action planning," and "review behavior goal(s)" (n=6), were used. Meta-analysis of the 3 studies included showed a significant decrease in sedentary behavior with mHealth interventions compared with conventional or no interventions (weighted mean difference [WMD]=59.1 min/d, 95% CI 99.1 to 20.2; P=.003).

CONCLUSIONS

mHealth interventions effectively reduce sitting time in older adults. Strategies using interventions with specific frequencies and durations, dedicated mobile monitoring devices, and behavior change techniques showed the potential to reduce sedentary behavior among older adults. These results also underscore the potential of mHealth as a key tool for promoting the well-being of older adults through technology-driven public health efforts.

TRIAL REGISTRATION

PROSPERO CRD42023443926; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023443926.

Global, regional and national burden of ischaemic heart disease attributable to high body mass index and low physical activity from 1990 to 2021

AIM

This study aimed to estimate the distribution of and changes in the global burden of ischaemic heart disease (IHD) attributable to high body mass index (BMI) and low physical activity (PA) from 1990 to 2021.

METHODS

Data on deaths, disability-adjusted life years (DALYs) and age-standardized rates for IHD attributable to high BMI and low PA were extracted from the Global Burden of Disease 2021 study. Temporal trends by gender, region and Socio-Demographic Index (SDI) were analysed using joinpoint regression. Decomposition, health inequality analysis and Bayesian model were utilized.

RESULTS

From 1990 to 2021, global DALYs and deaths for IHD attributable to high BMI and low PA nearly doubled, despite a decline in age-standardized DALYs ([average annual percent change (AAPC) = -0.26, 95% uncertainty interval (95% UI): -0.45, -0.07), (AAPC = -1.03, 95% UI:-1.18, -0.88]) and deaths rates ([AAPC = -0.53, 95% UI: -0.72, -0.33], [AAPC = -1.13,95% UI: -1.34, -0.92]), respectively. The burden of IHD due to high BMI was predominantly seen in males, while low PA was more prevalent in females. Significant regional and national variation was observed, with the burden shifting from high SDI regions to middle or low SDI regions. Population growth and aging have exacerbated this burden. Health inequities have shown improvement between 1990 and 2021. Projections for the next 15 years suggest rising global age-standardized DALYs and death rates of IHD attributable to high BMI, while those attributable to low PA may decrease.

CONCLUSIONS

Since 1990, the global and regional impact of IHD attributable to high BMI and low PA remains significant, with disparities by gender, age, region and SDI. Countries should implement effective measures to control BMI and promote PA to reduce the IHD burden.

A potential environmental paradox in India: Associations between air pollution precautions and sedentary behaviour among children and youth

The negative impact of ambient air pollution on movement behaviours in the global south is a significant concern. Yet, evidence about this complex relationship is limited. This study assessed how precautions taken to prevent ambient air pollution exposure are associated with sedentary behaviour among children and youth in India. Participants aged 5-17 years (N = 986) from 41 schools in 28 urban and rural areas across India completed online surveys to provide information on movement behaviours, including precautions taken to avoid exposure to air pollution, perception of built environment, and sedentary behaviour. Multivariate gamma regression models were developed, adjusting for sociodemographic variables with sedentary behaviour as the primary criterion variable. Apart from an overall sample model, six segregated models were built to understand age, gender, and geographical variations. Children and youth who reported taking precautions to prevent ambient air pollution exposure were associated with significantly higher daily minutes of sedentary behaviour in both the overall sample (β = 0.085, 95 % CI = 0.001, 0.169) and the 13 to 17 age group (β = 0.110, 95 % CI = 0.007, 0.227). However, being able to access outdoor physical activity facilities before or after school was associated with lower sedentary behaviour in the following models: overall, rural, 5 to 12 and 13 to 17 age groups, and boys and girls. To our knowledge, this is the first study to depict a potential paradoxical relationship between precautions taken to avoid exposure to ambient air pollution and higher sedentary behaviour among children and youth in India i.e., a health-preserving behaviour is perpetuating another chronic disease risk factor.

Association of reallocating time between physical activity and sedentary behavior on the risk of depression: a systematic review and meta-analysis

Background and aims

Sedentary behavior (SB) is a prevalent lifestyle factor and a risk factor for various health conditions, including depression (encompassing both clinically diagnosed depressive disorders and depressive symptoms). This study aimed to summarize the estimated impact of reallocating time spent in SB to light-intensity physical activity (LPA) or moderate-to-vigorous physical activity (MVPA) on the risk of depression from observational studies, as well as the impact of reallocating time spent in MVPA and LPA to SB.

Methods

Four databases [PubMed, Scopus, SPORTdiscus, and PsycINFO (via EBSCOhost platform)] were searched and analyzed for relevant studies published up to August 2024. Meta-analyses were performed on the estimated regression coefficients (b) and 95% confidence intervals (CIs) for depression symptom scores. All statistical analyses were performed using STATA 16.0.

Results

Twenty-seven studies involving 702,755 participants met the inclusion criteria. Reallocating SB to LPA and MVPA was significantly associated with reductions in depression risk (b = -0.04, 95% CI = -0.06 to -0.03, p < 0.001; b = -0.11, 95% CI = -0.19 to -0.03, p = 0.004). Subgroup analyses indicated that reallocating 30 and 60 min of SB to LPA or MVPA was significantly associated with reduced depression risk, with significant differences in PA intensity and age, but not for 10 and 15 min groups. Conversely, reallocating LPA and MVPA to SB was significantly associated with increased depression risk (b = 0.11, 95% CI = 0.01 to 0.21, p = 0.039; b = 0.17, 95% CI = 0.08 to 0.25, p < 0.001). Subgroup analyses indicated that reallocating 30 min of LPA or MVPA to SB was significantly associated with increased depression risk, with no difference in PA intensity.

Conclusions

Reallocating SB to PA was beneficial, whereas reallocating PA to SB was detrimental to the risk of depression. The results highlight the importance of considering PA intensity and duration in the development of behavioral guidelines aimed at reducing the risk of depression.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=546666, identifier: CRD42024546666.

Sedentary behavior and risk of chronic kidney disease: a systematic review and meta-analysis

BACKGROUND

Sedentary behavior has been considered a particular risk factor for adverse health outcomes independent of exercise, becoming a widespread public health issue globally. Many studies have analyzed the effect of sedentary behavior levels on the risk of chronic kidney disease (CKD), however, previous findings have been inconsistent. This study aims to evaluate the association between sedentary behavior and the risk of CKD.

METHODS

Eleven databases were searched for relevant cohort studies that were published between September 2024 and the databases' inception. To assess the association between sedentary behavior and risk of CKD, we calculated pooled effect sizes as relative risk (RR) with 95% CI using a random effects model. Subgroup analysis, sensitivity analysis, and publication bias analysis were performed.

RESULTS

Eight cohort studies involving 996,489 participants were identified. There was significant heterogeneity in the study (I2 = 58.0%, P = 0.02). Pooled results of the random effects model showed a positive correlation between sedentary behavior and the risk of CKD (RR = 1.15, 95% CI 1.08, 1.21). In addition, subgroup analysis revealed that the study area was a source of heterogeneity. Leisure-time sedentary behavior (RR = 1.26, 95% CI 1.16, 1.37) and combined sedentary behavior (RR = 1.16, 95% CI 1.08, 1.25) were positively related to risk of CKD. The result for occupational sedentary behavior (RR = 1.08, 95% CI 1.00, 1.16) suggested a borderline statistical significance.

CONCLUSIONS

Prolonged sedentary behavior, particularly during leisure time, is associated with an increased risk of CKD in adults, though residual confounding should be considered.

Association Between Physical Activity, Sedentary Behavior and Sleep Disorders in Chronic Obstructive Pulmonary Disease Patients: A Cross-Sectional Study

Objective

Sleep disorder is a common comorbidity in chronic obstructive pulmonary disease (COPD). We aim to explore the potential association between daily sitting time (DST), leisure-time physical activity (LTPA) and sleep disorders in COPD patients.

Methods

The sleep, LTPA, and DST data of participants with COPD were extracted from the National Health and Nutrition Examination Survey (NHANES) portal (2007-2012), basing on Global Physical Activity Questionnaire. The t-test, Mann-Whitney test, or chi-square test were employed to analyze the differences between two groups. The weighted binomial logistic regression model was used to estimate the odds ratio (OR) and 95% confidence interval (CI) of DST and LTPA on sleep disorders. The analyses were conducted from April 1 to July 1, 2023.

Results

A total of 2063 COPD samples were included in this work, of which 58% had LTPA < 150 min/wk and 48% had DST > 6h. Patients with sleep disorders had longer sedentary time (DST > 6h: 151, DST > 8h: 105) and less physical activity (LTPA < 150min/wk: 185). Longer sedentary time was correlated with a higher risk of sleep disorders, while LTPA showed no significant correlation with sleep disorders. The conjoint analysis revealed that the risk of sleep disorders in patients with LTPA <150 min/wk and DST > 8h was 5.88 times (95% CI: 1.80-19.2) great than that of patients with LTPA≥150 min/wk and DST < 4h.

Conclusion

COPD patients often lacked physical activity and exhibited sedentary behaviors. Long-term sedentary behavior was associated with elevated risk of sleep disorders in COPD patients. More light intensity physical activity and supervised exercise programs are probably good choices to prevent sleep disorders in COPD population.

Prolonged leisure time television watching as a risk factor for chronic obstructive pulmonary disease: Insights from Mendelian randomization

Leisure sedentary behaviors are associated with an increased risk of chronic obstructive pulmonary disease (COPD), but whether this relationship is causal remains unknown. This study aimed to identify genetic determinants associated with leisure sedentary behaviors and estimate their potential causal effect on COPD risk. COPD case-control data were obtained from the Finnish biobank. Genome wide association analyses of leisure television watching, leisure computer use, and driving behavior in the UK Biobank identify 110, 82 and 6 genetic loci (P ＜ 5 × 10-8), respectively. A 2-sample Mendelian randomization (MR) analysis estimated a causal relationship between a 1.5-hour increase in television watching and a rise in COPD risk (OR = 2.725, 95% CI = 1.989-3.777, P = 7.113 × 10-10). This relationship persisted independently of age at smoking initiation, daily cigarette consumption, educational years, and body mass index in comprehensive MR analyses. However, multivariate MR analyses showed that genetically predicted leisure time spent on computers and driving did not robustly influence COPD risk. In conclusion, this MR study suggests that a genetic predisposition for prolonged time spent watching television significantly increases the risk of COPD, corroborating findings from observational studies.

Burnout Risk Profiles in Psychology Students: An Exploratory Study with Machine Learning

University students are at increased risk of developing burnout and psychological distress from high academic workloads and performance expectations. The purpose of this study is to analyze the relationship between psychological and lifestyle variables and academic burnout, as well as to identify burnout risk profiles in psychology students. This study used a cross-sectional design and included 274 Portuguese psychology students, the majority being undergraduates (72.6%). Participants were assessed on psychological well-being, psychological distress, difficulties in emotional regulation, type of diet, physical activity, sleep quality, and burnout. The results showed that psychological distress, difficulties in emotional regulation, and sleep quality were positively associated with burnout, while psychological well-being was negatively associated. Using machine learning algorithms, two distinct profiles were found: "Burnout Risk" and "No Risk". A total of 62 participants were identified as belonging to the burnout risk profile, showing higher levels of distress, emotional regulation difficulties, poor psychological well-being and sleep quality, pro-inflammatory diet, and less physical activity. The accuracy of the three machine learning models-Random Forest, XGBoost, and Support Vector Machine-was 95.06%, 93.82%, and 97.53%, respectively. These results suggest the importance of health promotion within university settings, together with mental health strategies focused on adaptive psychological functioning, to prevent the risk of burnout.

Isotemporal substitution of sedentary time with physical activity and sleeping time: associations with body composition among individuals with prediabetes

Aim

To assess the association between physical activity (PA), sedentary time (ST), and sleep with body composition, and to explore the effects of reallocating ST to PA or sleep on body composition in individuals with prediabetes and overweight/obesity.

Material methods and results

Baseline data from the PREDIPHONE trial, including 159 participants (mean age 59.6 years) with prediabetes (Fasting Plasma Glucose 100-125 mg/dl) and overweight/obesity (Body Mass Index 27-40 kg/m²), were analyzed. Body composition was assessed via bioelectrical impedance, while PA, ST, and sleep were measured with accelerometry. Linear regression and isotemporal substitution models evaluated associations. Increased ST was positively associated with body fat mass (kg) (β = 0.016; CI 95%: 0.003-0.030), body fat mass (%) (β = 0.009; 0.001-0.018), and visceral adipose tissue (β = 0.005; 0.001-0.010). Moderate-to-vigorous PA (MVPA) was negatively associated with body fat mass (kg) [β = -0.031; 0.055- (-0.008)], body fat mass (%) [β = -0.017; -0.032-(-0.003)], and Visceral adipose tissue [β = -0.009; -0.02-(-0.002)]. Replacing ST with MVPA was linked to lower Visceral adipose tissue [β = -0.012; -0.024-(-0.001)] and body fat mass (kg) [β = -0.039; -0.074-(-0.006)], but not with lean mass. No significant associations were found when substituting ST with light PA or sleep.

Discussion

In individuals with prediabetes and overweight/obesity, replacing ST with MVPA could reduce body fat and VAT but not increases lean mass.

Screen-based sedentary behavior, physical activity, and the risk of chronic spinal pain: a cross-sectional and cohort study

BACKGROUND

Sedentary behavior (SB) is associated with chronic musculoskeletal pain, but limited evidence exists about its impact on chronic spinal pain (CSP).

AIM

This study aims to explore the relationship between SB, physical activity, and the risk of CSP.

DESIGN

Cross-sectional and cohort study design.

SETTING

United Kingdom (UK).

POPULATION

We included 481872 data collected between 2006 and 2010 for cross-sectional analysis and 45,096 data with the longest follow-up up to 2019 for longitudinal analysis of data from the UK.

METHODS

Screen-based SB was defined as self-reported television (TV) viewing time, computer usage time, and total screen time. CSP was characterized as self-reported neck/shoulder or back pain for more than 3 months.

RESULTS

Cross-sectional analyses suggested that screen-based SB is associated with a high risk of chronic neck/shoulder (OR [95%CI]=1.43 [1.31 to 1.57]) and back pain (OR [95%CI]=1.39 [1.28 to 1.52]). The longitudinal analysis showed that an increase of 1 h in daily screen-based SB was correlated with chronic back pain risk (RR [95% CI]=1.05 [1.03 to 1.07]). Replacing an equivalent amount of TV viewing time with 1 h of walking per day exhibited a connection with a lower potential for chronic neck/shoulder pain (4.82% reduction) and chronic back pain (5.26% reduction). Even replacing 10 min of TV viewing time with 10 min of physical activity demonstrated a similar trend.

CONCLUSIONS

Daily screen-based SB is associated with CSP, but a causal relationship cannot be established. Replacing sedentary TV time with 10 minutes of physical activity per day shows potential benefits for CSP.

CLINICAL REHABILITATION IMPACT

The public should be encouraged to reduce screen-based sedentary behavior and increase physical activity to mitigate the risk of chronic spinal pain.

Exploring the Impact of PA and Sedentary Behavior on Gout Risk in Hyperuricemia: Insights From Machine Learning and SHAP Analysis

BACKGROUND

Individuals with hyperuricemia (HUA) are widely recognized as being at increased risk for gout. This study aimed to investigate how physical activity (PA) duration and sedentary duration impact gout risk in individuals with HUA and to develop predictive models to assess their risk of developing gout.

METHODS

We retrospectively collected clinical characteristics of 8057 individuals with HUA from the National Health and Nutrition Examination Survey (NHANES) consortium for the period 2007-2018. By developing and comparing four classic machine learning algorithms, the best-performing Random Forest (RF) model was selected and combined with the SHAP interpreting algorithm to analyze the dose-response relationship between PA duration, sedentary time, and gout risk. Additionally, the RF model was used to identify the most critical factors influencing gout risk and to develop a free online tool for predicting gout risk in HUA individuals.

RESULTS

The RF model outperformed others, achieving a Receiver Operating Characteristic (ROC) of 0.957 in the training cohort and 0.799 in the testing cohort. In the test cohort, it demonstrated an accuracy of 0.778, a Kappa of 0.247, a sensitivity of 0.701, a specificity of 0.785, a positive predictive value of 0.224, a negative predictive value of 0.967, and an F1 score of 0.340. SHAP analysis revealed the following insights: (1) hypertension, serum uric acid, age, gender, and BMI were identified as the top five factors for gout risk; (2) factors such as higher serum uric acid levels, age, BMI, creatinine, sedentary duration, lower PA, hypertension, male sex, and diabetes were associated with an elevated risk of gout; and (3) a PA duration of 1-7 h per week was linked to a lower risk of gout, while sedentary time exceeding 6 h per day increased gout risk, regardless of age, sex, or comorbidities.

CONCLUSION

We encourage individuals with HUA to engage in 1-7 h of PA per week and limit daily sedentary time to less than 6 h to reduce gout risk. The developed prediction model is freely available as a web-based app at: https://sasuki.shinyapps.io/GoutRisk/.

Time reallocation to moderate-to-vigorous physical activity and its association with chronic kidney disease prevalence in Chinese adults with type 2 diabetes

AIMS

To examine the isotemporal substitution association of replacing moderate-to-vigorous physical activity (MVPA) with other behaviors on the prevalence of chronic kidney disease (CKD) among Chinese adults with type 2 diabetes mellitus (T2DM).

METHODS

This study included 5421 adults with T2DM from the National Metabolic Management Centre Ningbo Branch. Data on physical activity, sedentary behavior, and sleep were collected using a standardized questionnaire through face-to-face interviews. Isotemporal substitution models were employed to evaluate the associations of reallocating time from other behaviors to MVPA with the risk of CKD.

RESULTS

Substitution of 30 min per day of sleeping or sitting with MVPA was associated with a lower CKD prevalence (OR: 0.87 for sleep substitution; 0.90 for sitting substitution). Among individuals with inadequate MVPA levels (less than 150 min per week), the association of replacing 30 min of sleeping, sitting, or low-intensity physical activity with MVPA was particularly strong, cutting the risk of CKD by more than 60%. Stratified analysis among participants with inadequate MVPA revealed that the association of reallocating time to MVPA with lower CKD prevalence were predominantly observed among men, individuals with prolonged sleep duration (sleep duration more than 7.5 h per day), and those with better glycemic control (HbA1c levels below 7%).

CONCLUSIONS

This study revealed that replacing sleep or sedentary time with MVPA was associated with a lower prevalence of CKD among Chinese adults with T2DM, especially those with low MVPA. Incorporating MVPA into daily routines is potentially beneficial for improving renal health in people with T2DM.

Associations of reallocating sedentary leisure-time to alternative discretionary movement behaviours with incident cardiometabolic diseases in 0.5 million Chinese adults

Background

In Chinese adults, there is a considerable burden of sedentary behaviour. This study aimed to estimate the implications of reallocating sedentary leisure-time to non-sedentary behaviours for incident cardiometabolic diseases.

Methods

A prospective cohort study of 462,370 Chinese adults (mean age 51 years; 59% female) who were free from diabetes and cardiovascular diseases at baseline. Isotemporal substitution Cox regression models were used to estimate the associations of reallocating self-reported sedentary leisure-time to the same amount of sleep, housework, Taichi, or conventional exercise (e.g., walking, jogging, ball games, swimming) with the risk of incident diabetes, stroke, and myocardial infarction (MI). The results are reported as adjusted hazard ratios and 95% confidence intervals per 30 min/day time exchanges. Potential impact fractions were calculated to estimate the proportional reductions in incident disease cases associated with time substitutions, assuming causality.

Findings

During >5.25 million person-years of follow-up, 19,738 incident diabetes, 51,460 stroke, and 6767 MI cases were accrued. Lower disease risks were found for replacement of sedentary leisure-time by sleep (diabetes: 0.97 [0.95-0.99], stroke: 0.98 [0.97-0.99], MI: 0.97 [0.94-0.99]; in participants who slept <7 h/day), housework (diabetes: 0.97 [0.97-0.98], stroke: 0.99 [0.98-0.99], MI: 0.97 [0.95-0.98]), Taichi (diabetes: 0.97 [0.95-0.99], stroke: 0.98 [0.97-0.99], MI: 0.95 [0.92-0.98]), or conventional exercise (diabetes: 0.97 [0.95-0.99], stroke: 0.97 [0.95-0.98], MI: 0.92 [0.88-0.96]). Potential impact fractions ranged from an estimated 3.5% (95% confidence interval: 3.1-3.9%) fewer cases of incident stroke when replacing sedentary leisure-time with housework, to an estimated 9.6% (5.9-13.3%) fewer cases of incident MI when reallocating sedentary leisure-time to conventional exercise.

Interpretation

Replacing sedentary leisure-time with behaviours such as housework, Taichi, sleep (in short sleepers) and conventional exercise is associated with lower risks of common cardiometabolic diseases in Chinese adults. Prevention strategies should be developed to promote movement behaviours and optimal levels of sleep at the expense of sedentary leisure-time.

Funding

This analysis was supported by a Health and Medical Research Fund (HMRF) Research Fellowship (grant no: 06200087).

Defining Health Movements and Health Needs Across the Life Course: A Qualitative Study

BACKGROUND

In an effort to improve population health, communities are being enabled to take charge of their health through the Movements for Health (M4H) programme in Singapore. The present study seeks to understand what characterises a health movement and explores health narratives which resonate over the different life stages.

METHODS

A multi-component qualitative formative study was undertaken. Focus group discussions (FGDs, n = 12) and one semi-structured interview (altogether involving n = 52 individuals) were carried out with government and community implementation stakeholders, alongside go-along interviews (n = 24, involving 11 volunteers, 13 programme participants) and e-diaries (n = 37, with 22 programme participants and 15 volunteers).

RESULTS

Themes are reported in bold, with subthemes in italics. Health movement building was defined as an evolving process marked by co-creation, emotional investment and framed by a shared understanding founded on explicit theory. Furthermore, health movements were characterised as taking root in the community, needing a shared 'cause' to be self-sustaining. They should be able to garner momentum and be replicable, and thus ultimately far-reaching and inclusive of all walks of life. Themes cross-cutting life stages include concerns about chronic illness, which are not limited to seniors. Positive role modelling is crucial in encouraging hesitant participants towards healthier behaviours. Additionally, the importance of building supportive, emotional connections with implementers was emphasised. Priority areas for changing health behaviours and informing health literacy planning across various life stages have also been identified. For youths, mental health struggles, such as mood regulation issues, are prevalent and often exacerbated by parental invalidation. Adults tend to deprioritize social health due to responsibilities like breadwinning and childminding, coping through social connections forged among programme participants. Seniors expressed trepidation regarding their physical health, fearing a loss of independence and verbalising how limited mobility affects their ability to exercise and socialise.

CONCLUSION

The present study has provided insights into the early phases of the novel M4H community-led programmatic approach. Our findings defined health movements and health needs across the life course, whilst expanding on related theoretical and applied community development traditions.

PATIENT OR PUBLIC CONTRIBUTION

This study mixes participatory data (i.e. go-along interviews) with other qualitative data to provide insights into the co-creation process of health movement building. The study also adopted a user-centred approach, and the content appropriateness of the programmes was fed back to the community-level implementers (i.e. Community Movement Champions [CMCs]) and the M4H administrating committee to inform future programming. Future CMCs have taken up the recommendations extracted from stakeholder engagement, where components on sleep, mental health, etc., have been added. Community coaches and commissioning stakeholders are involved in authorship.

Association between movement behaviors and depression among vocational school students with different sleep duration - a study based on the isotemporal substitution model

The isotemporal substitution model can be used to explore the impact of the isotemporal substitution of different behaviors on human health. The association between sleep duration and mental health may be non-linear, but the relationship between the isotemporal substitution of movement behaviors and mental health in different sleep duration groups has not been explored. A questionnaire survey was conducted among Grade 1-3 students in 14 vocational schools in China, and 8149 valid questionnaires were obtained, of which 58.80% were in sleep-insufficient group, and 32.56% were detected with depression symptoms. The isotemporal substitution model was used for analysis. In the sleep-insufficient group, substituting 10 minutes/day of vigorous physical activity (β=-0.318, 95%I = -0.498~-0.138), walking (β=-0.254, 95%I = -0.381~-0.126) and sedentary behavior (β=-0.234, 95%I = -0.337~-0.130) with isotemporal moderate physical activity, or substituting vigorous physical activity (β=-0.465, 95%I = -0.577~-0.353), moderate physical activity (β=-0.147, 95%I = -0.263~-0.031), walking (β=-0.400,95%I = -0.476~-0.324) and sedentary behavior (β=-0.380,95%I = -0.434~-0.327) with isotemporal sleep, were negatively associated with depression; and substituting moderate physical activity (β = 0.318, 95%CI = 0.138 ~ 0.498) and sleep (β = 0.465, 95%CI = 0.353 ~ 0.577) with isotemporal vigorous physical activity was positively associated with depression. In the sleep-sufficient group, replacing sedentary behavior (β=-0.129, 95%I = -0.244~-0.013) with equivalent moderate physical activity was negatively associated with depression; replacing moderate physical activity (β = 0.219, 95%CI = 0.101 ~ 0.338), walking (β = 0.112, 95%CI = 0.040 ~ 0.185) and sedentary behavior (β = 0.091, 95%CI = 0.058 ~ 0.124) with equivalent sleep was positively associated with depression. For the sleep-insufficient group, substituting vigorous physical activity, walking, and sedentary behavior with isotemporal moderate physical activity and sleep had greater negative association with depression than the sleep-sufficient group. In conclusion, for the sleep-insufficient group, the substitution that was largest negatively associated with depression was sleep for other behaviors, and for sleep-sufficient group it was moderate physical activity for other behaviors. In future interventions, the sleep-insufficient group may achieve greater effects than the sleep-sufficient group if they use moderate physical activity and sleep instead of other behaviors.

Amount and intensity of daily total physical activity, step count and risk of incident cancer in the UK Biobank

OBJECTIVES

To investigate associations between daily physical activity, activity intensity and step counts with incident cancer risk.

METHODS

Prospective analysis of UK Biobank participants who wore wrist-based accelerometers for 7 days, followed for cancer incidence (mean follow-up 5.8 years, SD 1.3). Time-series machine-learning models derived total physical activity, sedentary behaviour (SB), light-intensity physical activity (LIPA), moderate-vigorous-intensity physical activity (MVPA) and step counts. The outcome was a composite of 13 cancers previously associated with low physical activity in questionnaire-based studies. Cox proportional hazard models estimated HRs and 95% CIs, adjusted for demographic, health and lifestyle factors. We also explored associations of LIPA, MVPA and SB with cancer risk.

RESULTS

Among 85 394 participants (median age 63 (IQR 56-68)), 2633 were diagnosed with cancer during follow-up. Compared with individuals in the lowest quintile of total physical activity (<21.6 milligravity units), those in the highest (34.3+) had a 26% lower cancer risk (HR=0.74 (95% CI 0.65 to 0.84)). After mutual adjustment, LIPA (HR=0.94 (95% CI 0.90 to 0.98)) and MVPA (HR=0.87 (95% CI 0.79 to 0.94)) were associated with lower risk, but SB was not. Similar associations were observed for substituting 1 hour/day of SB with LIPA or MVPA. Daily step counts were inversely associated with cancer, with the dose-response beginning to plateau at around 9 000 steps/day (HR=0.89 (95% CI 0.83 to 0.96) 7000 vs 5000 steps; HR=0.84 (95% CI 0.76 to 0.93) 9000 vs 5000 steps). There was no significant association between stepping intensity (peak 30-minute cadence) and cancer after adjusting for step count.

CONCLUSION

Total physical activity, LIPA, MVPA and step counts were inversely associated with incident cancer.

Accelerometer-derived "weekend warrior" physical activity, sedentary behavior, and risk of dementia

BACKGROUND

Research has shown that sedentary behavior (SB) may increase dementia risk, but it remains unclear whether concentrated moderate to vigorous physical activity (MVPA) can compensate such negative effects. This study aimed to explore the association between different MVPA patterns combined with SB time and the risk of dementia.

METHODS

This prospective study used data from the UK Biobank cohort, which provided accelerometer-based physical activity data for a full week from February 2013 to December 2015. Participants were categorized into "weekend warriors (WW)" group, engaged in more than 50% MVPA (≥ 150 min/week) on 1 to 2 days; inactive group (total MVPA < 150 min/week); and regular group, who met the recommended MVPA (≥ 150 min/week) but not WW. The participants were further divided into six groups based on SB duration (≥ 8.52 h/day or < 8.52 h/day). A multivariable Cox model was used to assess the relationship between these patterns and the risk of dementia, adjusted by age, gender, ethnicity, Townsend deprivation index, education level, employment status, alcohol consumption, smoking, BMI, and baseline comorbidities (including cardiovascular disease, hypertension, and diabetes).

RESULTS

We included 91,948 participants without dementia at baseline. During a median follow-up of 7.93 years, 736 participants developed all-cause dementia. When the MVPA threshold was set at 150 min per week, 16,149 participants (17.5%) were classified as WW with long SB, 19,055 (20.7%) as regular with long SB, and 21,909 (23.8%) as inactive with long SB. Compared to inactive and long SB time, the WW group showed a reduction in dementia risk (WW with long SB time: HR = 0.69, 95% CI: 0.54-0.87, P = 0.002; WW with short SB time: HR = 0.74, 95% CI: 0.56-0.97, P = 0.029). And regular group with shorter SB time was associated with a lower dementia risk (HR = 0.75, 95% CI: 0.59-0.96, P = 0.021), but not in the group with longer SB time.

CONCLUSIONS

The WW pattern may help mitigate the dementia risk associated with prolonged SB, suggesting that the quality and intensity of physical activity are also important factors.

Associations of moderate-to-vigorous physical activity and sitting time with risk of disability and mortality among Japanese older adults

BACKGROUND

The interaction and substitution effects of physical activity (PA) and sitting time (ST) living in non-western countries have not been well investigated. This study aimed to examine the association of moderate-to-vigorous physical activity (MVPA) and ST with disability and mortality in older adults.

METHODS

This prospective study analyzed data from 10,164 adults over 65 who participated in the Kyoto-Kameoka study in Japan. We evaluated MVPA and ST using the validated International Physical Activity Questionnaire-Short Form. Participants were categorized into four groups based on their levels of MVPA (150 min/week) and ST (300 min/day): low MVPA/high ST, low MVPA/low ST, high MVPA/high ST, and high MVPA/low ST. Outcomes were gathered between July 30, 2011, and November 30, 2016.

RESULTS

Over a median follow-up of 5.3 years (45,461 person-years), 2,273 disability cases were documented. The low MVPA/high ST groups were associated with higher disability risk than those in the high MVPA/low ST groups (hazard ratios [HRs], 1.52; 95% confidence interval [CI], 1.31-1.75), and the interaction between MVPA and ST accounted for 48.5% of the relative excess risk of disability in the low MVPA/high ST group (p for interaction = 0.006). Replacing daily 10 min of ST with 10 min of MVPA was associated with a reduced risk of disability (HR, 0.980; 95% CI, 0.971-0.989) and all-cause mortality (HR, 0.975; 95% CI, 0.962-0.988).

CONCLUSIONS

These findings indicate that even a small substitution of ST with MVPA could help lower both the risk of disability and mortality.

Development and validation of the Chinese version of the adult sedentary behavior reduction intention questionnaire based on the theory of planned behavior

PROM: The Chinese version of the Adult Sedentary Behavior Reduction Intention Questionnaire, a 16-item self-reported tool based on the Theory of Planned Behavior (TPB), was developed to assess adults' intentions to reduce sedentary behavior.

MEASUREMENT PROPERTY

Internal consistency is used to measure the reliability of the questionnaire, while content and structural validity are studied to assess its validity.

DESIGN

A mixed-methods exploratory sequential design with two phases.

SAMPLE

Adults aged over 18 years diagnosed with coronary heart disease, with a total daily sedentary time exceeding 6 h, normal cognitive function, and willingness to participate in the study were included.

METHODS

The study was conducted in two phases. In Phase 1, an initial item pool was developed through a literature review and refined using two rounds of Delphi expert consultation. Expert positivity, authority levels (Cr), coefficients of variation (CV), and Kendall's W coefficient were calculated to assess representativeness, credibility, and consensus. A pilot study evaluated face validity and finalized the scale. In Phase 2, a cross-sectional study involving 316 participants was conducted to assess psychometric properties. Reliability was evaluated using Cronbach's α and split-half reliability, while content validity was assessed using the content validity index (I-CVI). Construct validity was examined through confirmatory factor analysis (CFA).

RESULTS

Phase 1 resulted in a preliminary questionnaire with four dimensions and 16 items. Sixteen experts completed two rounds of Delphi consultation, with high response rates (85% and 94.1%) and authority levels (Cr = 0.88 and 0.91). Consensus was strong (CV = 0.05 ~ 0.23; Kendall's W = 0.338 and 0.382, p < 0.001). Phase 2 validation showed a Cronbach's α of 0.967, with individual dimensions ranging from 0.911 to 0.950. I-CVI ranged from 0.813 to 1. The adjusted model indices met the fitting criteria.

CONCLUSIONS

The developed questionnaire is a reliable and valid tool for assessing Chinese adults' intentions to reduce sedentary behavior. Grounded in TPB, it provides a theoretical foundation for future intervention studies aimed at addressing sedentary lifestyles.

Assessing the relationship between space-time behaviours and personal noise exposure using isotemporal substitution models in the Grand Paris area

BACKGROUND

The individual exposure to environmental noise in cities is usually assessed at the residential neighbourhood level with static, year-averaged strategic maps. This representation may underestimate noise exposure, given the mobility of individuals within the city and proximate sources of exposure.

OBJECTIVE

Our study employs high-resolution sensor analysis to observe how personal noise exposure differs from modelled noise map metrics, identify socioeconomical and behavioural determinants of exposure, and explore the impact of reallocating certain behaviours to others on daily personal noise exposure (LAeq,24h).

METHOD

Data on daily activities of 259 participants of the MobiliSense cohort living in the metropolitan area of Paris were collected between 2018 and 2020. Participants were equipped of a personal monitor for sound pressure, and of a GPS receiver and an accelerometer. Modes of transport were collected during a mobility survey.

RESULTS

Results showed that noise exposure based on personal monitoring during space-time behaviours differed from modelled noise levels at residence. Participants were exposed to values below the recommended critical value for health of 55 dB(A) in urban areas in only 36% of the days. Individual socioeconomic characteristics and residential factors explained very little variance in personal noise exposure. Noise exposure varied among performed activities and transport modes, with public transport associated with the highest sound levels. While time spent in the underground public transport was on average 1.4% of the total daily time-budget, it contributes on average to 9.5% of the daily noise dose.

IMPACT

This research reveals that individual mobility behaviours significantly influence daily noise exposure in urban environments. By analysing how people move throughout their day, we found that traditional static assessments, limited to residential noise, underestimate actual exposure. Notably, despite limited time spent in it (1,4%), underground transport contributed substantially to daily noise (9.5%). Furthermore, participants experienced noise levels below recommended health thresholds in only 36% of days. These findings underscore the need for policy changes that prioritize walkable cities and minimize commuting time, alongside the design of "quiet areas" within urban spaces for recovering from the city noise stress.

Genetically Predicted Frailty Index Is Associated With Increased Risk of Multiple Metabolic Diseases: 175 226 European Participants in a Mendelian Randomization Study

BACKGROUND

A relationship between frailty index (FI) and metabolic diseases (MDs) has been reported in previous observational studies. However, the causality between them remains unclear. This study aimed to examine the causal effect of FI on MDs.

METHODS

We performed a bidirectional two-sample Mendelian randomization (MR) study. A recent large-scale genome-wide association study (GWAS) provided available data associated with FI, and summary statistics on eight MDs were collected from the IEU OpenGWAS database. Inverse variance weighted (IVW) was used as the main analysis to estimate causal effects, together with MR pleiotropy residual sum and outlier (MR-PRESSO), MR-Egger, Cochran's Q test, pleiotropy test, leave-one-out method, and MR Steiger analysis were used in the sensitivity analyses.

RESULTS

Our MR study demonstrated for the first time that elevated FI was causally associated with an increased risk of MDs including obesity (odds ratio [OR] = 1.78; 95% confidence interval [CI]: 1.17-2.70; p = 0.0075), T2DM (OR = 1.67; 95% CI: 1.24-2.24; p = 6.95 × 10-4), gout (OR = 2.45; 95% CI: 1.29-4.64; p = 0.006), hypothyroidism (OR = 1.96; 95% CI: 1.47-2.60; p = 3.47 × 10-6), and HTN (OR = 2.17; 95% CI: 1.72-2.74; p = 5.25 × 10-11). However, no causal association was found between FI and osteoporosis, vitamin D deficiency, and hyperthyroidism.

CONCLUSIONS

Our findings support a causal relationship between FI and multiple MDs. This is crucial for the prevention of associated MDs in patients with frailty.

Dose-dependent association between physical activity and mental health, and mitigation effects on risk behaviors

Understanding the dose-response effects of physical activity on mental health and risk behavior mitigation is crucial for mental health promotion. This study using restricted cubic spline and piecewise regression analyses based on a representative national sample of 30,054 Chinese adults, revealed reverse J-shaped (p for nonlinear <0.001) but monotonic beneficial associations between physical activity and depression, anxiety, and stress symptoms, with optimal thresholds identified at 2.15 METs-hour/day for depression and anxiety, and 3.25 METs-hour/day for stress. Engaging in 1-3 METs-hour/day of physical activity appeared to mitigate the adverse effects of unhealthy food intake on depression and anxiety, whereas 4-6 METs-hour/day could offset the impact of short sleep duration on depression, anxiety, and stress. The findings suggest that physical activity prescription could be effective in mitigating the adverse effects of certain risk behaviors on common mental symptoms, and excessive physical activity might not be necessary for mental health promotion.

Isotemporal substitution of sedentary time with different physical activity intensities and sleep in obesity parameters across eight latin American countries

This study aimed to examine the associations between substituting sedentary time (ST) with physical activity and sleep with obesity parameters in adults from eight Latin American countries. The sample consisted of 2173 adults aged 18-65 years. Physical activity, ST and sleep were objectively measured using accelerometers. The parameters of obesity were defined using body mass index (BMI) and waist circumference (WC). Regression analyses were conducted for isotemporal analysis of the association between substituting 30 min/day of ST with light physical activity (LPA), moderate to vigorous physical activity (MVPA) and sleep in relation to BMI and WC. Substituting light physical activity with higher intensity was also analyzed. Substituting 30 min/day of ST with MVPA was significantly associated with lower odds of a higher BMI (OR: 0.993, 95%CI 0.990-0.998) and WC (OR: 0.998, 95%CI 0.998-0.999). Conversely, substituting ST with LPA did not show a significant impact on obesity parameters. However, the substitution of 30 min/day of LPA with MVPA was also associated with lower odds of a higher BMI (OR: 0.993, 95%CI 0.989-0.997). The results highlight the importance of replacing ST and increasing the intensity of physical activity as an effective strategy for preventing and managing obesity in Latin America.

Associations of 24-h Movement Behaviors With Incidence of Cardiovascular Risk Factors: The Finnish Retirement and Aging Study

Low physical activity, high sedentary time (SED), and inadequate sleep increase cardiovascular disease risk, but the codependency between these 24-h movement behaviors has often been neglected. This study examined associations between 24-h movement behaviors and incidence of cardiovascular risk factors. The study included 866 adults (mean age 62.4 years, SD 1.1) from the Finnish Retirement and Aging study who participated in wrist-accelerometry measurements between 2014 and 2018. Incident register-based cardiovascular risk factors including hypertension, dyslipidemia, type 2 diabetes, and questionnaire-based obesity were followed up over on average 3-year follow-up. Compositional Cox regression models were adjusted for age, sex, occupation, smoking, and heavy alcohol consumption. We recorded 84 (17%) new cases of hypertension, 66 (9%) dyslipidemia, 28 (3%) type 2 diabetes, 43 (6%) obesity, and 94 (26%) any of these cardiovascular risk factors. Compared to mean composition (7.8 h sleep, 11.0 h SED, 4.2 h light physical activity [LPA], 60 min moderate-to-vigorous physical activity [MVPA]), having 10 min more MVPA at the cost of other behaviors was associated with 5%-7% risk reduction in hypertension, 10%-13% in obesity, and 6%-7% in any cardiovascular risk factor. Among the least active (sleep 7.9 h, SED 12.1 h, LPA 3.6 h, MVPA 24 min), the risk reductions were nearly twofold. In conclusion, when accounting the interdependence of movement behaviors, MVPA associated with highest risk reduction in hypertension and obesity, especially among the least active participants. This suggests that even a small increase in daily MVPA could help prevent development of cardiovascular risk factors.

Associations between sedentary behaviour and sarcopenia among patients aged 40 and older with chronic obstructive pulmonary disease: a cross-sectional study

BACKGROUND

Patients with chronic obstructive pulmonary disease (COPD) and sarcopenia experience poorer clinical prognosis. Although sedentary behaviour (SB) is common risk factor for COPD, its relationship with sarcopenia in this specific population remains unclear.

METHODS

This is a cross-sectional survey of participants aged 40 and above with COPD, involving 27 communities and 2 hospitals' outpatient departments. The definition of sarcopenia was in accordance with the Asian Expert Consensus Criteria for sarcopenia. SB and physical activity (PA) were evaluated using the short form of the international physical activity questionnaires (IPAQ-SF). SB was categorized into 4 categories: less than 4 h/day, 4 to 6 h/day, 6 to 8 h/day, and 8 h or more per day. PA was classified into light-intensity and moderate-to-vigorous intensity physical activity (LPA and MVPA). Multiple logistic regression and restricted cubic spline (RCS) were performed to investigate the rates of association between sarcopenia and SB. Subgroups was analysed by gender.

RESULTS

A total of 414 COPD patients with complete information were included in this trial. The overall prevalence of sarcopenia was 22.9%. Participants with sarcopenia had longer of SB (P = 0.008) and less MVPA (P < 0.001) compared to those without sarcopenia. After adjustment for confounders, SB showed a significant association with sarcopenia (adjusted β = 1.47, 95% CI = 1.28-1.68). The participants who spent 6 or more hours on SB had a greater odds ratio for sarcopenia (= 6-8 h: adjusted OR = 2.97, 95% CI = 1.14-7.70; > 8 h: OR = 9.14, 95% CI = 3.59-23.22) than the participants who spent less than 4 h. The results of RCS indicated that when SB exceeded 5.7 h/day, a trend towards a significant increasing prevalence of sarcopenia was observed with increased SB. This trend was also observed across genders, differing only in the threshold values (male: SB = 5.7 h; female: SB = 8.0 h).

CONCLUSION

SB was an independent determinant of sarcopenia, independent of MVPA, and the prevalence of sarcopenia increases as SB increases within a certain range. This study advocated for the integration of SB in the self-management strategies for patients with COPD. Regardless of their engagement in MVPA, it was crucial to regulate SB.

Sedentary lifestyle induces oxidative stress and atrophy in rat skeletal muscle

Abundant evidence indicates that skeletal muscle plays a key role in regulating metabolic homeostasis. Therefore, maintaining healthy skeletal muscles is essential to good health. While prolonged muscle inactivity is known to cause oxidative stress and muscle loss, it remains unclear whether a shift from an active to a sedentary lifestyle induces similar effects. This study tested the hypothesis that transitioning to a sedentary lifestyle rapidly leads to oxidative stress and muscle loss in the load-bearing soleus muscle. Adult Wistar rats were randomly divided into control (CON; n = 8) and sedentary (SED; n = 8) groups. During a 7-day experimental period, CON rats were housed in standard cages allowing free movement, while SED rats were confined to smaller cages promoting sedentary behaviour. Soleus muscles were analysed for antioxidant enzyme activities (superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPX)), as well as two oxidative stress biomarkers (advanced protein oxidation products (AOPPs) and 4-hydroxynonenal (4-HNE)). Sedentary behaviour caused a 17.2% reduction in the soleus-to-body weight ratio (P < 0.001). Moreover, the activities of SOD, CAT and GPX were significantly lower in the soleus muscle of SED animals (P < 0.05), while AOPPs and 4-HNE levels were higher (P < 0.001 and P < 0.05) compared to CON animals. These findings provide the first evidence that transitioning from an active to a sedentary lifestyle leads to the rapid onset of oxidative stress and atrophy in the soleus muscle. Importantly, the results suggest that impaired antioxidant defences contribute to sedentary behaviour-induced oxidative stress in load-bearing muscles.

Oxidative balance score and its association with chronic inflammatory airway diseases and mortality: a population-based study

Objective

The aim of this research was to explore the possible connection between combined Oxidative Balance Score (OBS) and the prevalence of chronic inflammatory airway diseases (CIAD), including asthma, chronic obstructive pulmonary disease (COPD), and chronic bronchitis, along with the mortality rate among individuals with CIAD.

Methods

Data were gathered from the National Health and Nutrition Examination Survey (NHANES) 2013-2018 cycles. The Oxidative Balance Score (OBS) was calculated using 16 different nutrients and 4 different lifestyles, which was then categorized into four groups. The CIAD included individuals with self-reported asthma, chronic bronchitis, or COPD. Mortality data up to December 31, 2019, was obtained from the National Death Index. In cross-sectional studies, the association between OBS and the prevalence of total and specific CIAD was examined using multiple logistic regressions. Dose-response relationships were analyzed through restricted cubic spline regression (RCS). In prospective cohort studies, cumulative survival rates were determined using the Kaplan-Meier method and compared with log-rank tests. Multiple COX regressions were conducted to evaluate the relationship between OBS and all-cause as well as respiratory diseases mortality among participants with CIAD.

Results

A total of 12,458 adults were enrolled in this study. The demographic characteristics of the study population revealed a mean age of 52.25 ± 15.8 years, 47.73% being male, and the majority identified as Non-Hispanic White (66.87%). We found that 20.26% of the participants were suffered from CIAD, followed by asthma (15.41%), chronic bronchitis (6.10%) and COPD (3.80%), respectively. The median OBS levels were 20.98 with a standard deviation of 0.17. After adjusting for all confounders, we found that the highest quartile of OBS was significantly associated with lower prevalence of total CIAD (OR = 0.71, 95% CI 0.64-0.81), asthma (OR = 0.62, 95% CI 0.52-0.73), chronic bronchitis (OR = 0.64, 95% CI 0.44-0.92), and COPD (OR = 0.48, 95% CI 0.31-0.77) compared to the lowest quartile. Additionally, a linear and inverse relationship was found between OBS and the incidence of various respiratory disorders. Kaplan-Meier survival analysis showed that individuals in the highest quartile of OBS had the lowest risk of both all-cause mortality (log-rank test p = 0.017) and respiratory diseases mortality (log-rank test p < 0.001). Furthermore, after adjusting for multiple factors, individuals in the fourth quartile continued to show a significantly reduced risk of all-cause mortality (HR = 0.71, 95% CI 0.55-0.93) and respiratory diseases mortality (HR = 0.53, 95% CI 0.43-0.74) in comparison to those in the lowest quartile of OBS levels.

Conclusion

The findings revealed that a higher OBS was significantly linked to a decreased prevalence of total and specific CIAD, including asthma, chronic bronchitis, and COPD. Higher OBS levels were also associated with reduced mortality from both all causes and respiratory diseases among CIAD patients. These findings offer valuable information on the role of diet and lifestyle in preventing CIAD.

Dose-response relationship between sedentary time and anxiety and the moderating effect of a 10-min walk: a cross-sectional study

BACKGROUND

The effectiveness and generalisability of conventional anxiety treatment programmes is low across the population, and it is important to explore the research evidence for preventing and improving anxiety from a physical activity perspective. This study examined sedentary activity's impact on anxiety, its dose-response relationship, and the interactive effects of 10-min walks and sedentary duration on anxiety.

METHODS

A total of 28,977 individuals were chosen from the Chinese Psychological and Behavioural Study of the Population (PBICR) 2022. Binary logistic regression analyzed the association between sedentary time and anxiety and the interaction effect of daily 10-min walks and sedentary time on anxiety. Restricted cubic spline model explored the dose-response relationship between sedentary time and anxiety risk.

RESULTS

Participants who were sedentary for > 6 h had a 25.1% increased risk of anxiety (OR = 1.251). Among those sedentary for > 6 h, each additional hour of sedentary time increased the risk of anxiety by 4.3%. However, for participants sedentary for ≤ 6 h, sedentary time did not increase the risk of anxiety. A non-linear J-shaped relationship between sedentary time and the risk of anxiety (non-linear trend p < 0.001). Among individuals who were sedentary for > 6 h, those who walked more than 10 min on ≤ 5 days per week had a 67.1% increased risk of anxiety (OR = 1.671), whereas those who walked more than 10 min on > 5 days per week experienced a 19% decreased risk of anxiety (OR = 0.810). For individuals sedentary for ≤ 6 h, each additional day of walking for > 10 min reduced the risk of anxiety by 9.8%. Among those sedentary for > 6 h, each additional day of walking for > 10 min reduced the risk of anxiety by 10.3%.

CONCLUSIONS

A non-linear J-shaped relationship between sedentary time and anxiety risk. Walking for more than 10 min was associated with fewer negative effects of sedentary activity on anxiety. It is recommended that future empirical studies with a higher level of evidence be conducted to further confirm the effect of 10-min walking days on anxiety risk through empirical studies and to use specialized wearable devices to improve the accuracy of the measurements. By further exploring the effects of sedentary time and 10-min walking days on anxiety risk, the most effective treatment programs based on physical activity interventions can be established to reduce the prevalence of anxiety in the whole population.

Isotemporal substitution of physical activity patterns and sitting time with obesity indicators among workers in São Paulo

This study aimed to evaluate the association between substituting 10, 30, and 60 min/day of physical activity and sitting time with obesity indicators among workers. It is a cross-sectional study involving 394 adults (76.6% women) from São Paulo, Brazil. Physical activity and sitting time (min/day) were measured using the short version of the International Physical Activity Questionnaire (IPAQ) to determine physical activity levels. Obesity indicators included body mass index (BMI; kg/m²), waist circumference (cm), and body fat (kg). Isotemporal substitution models were analyzed using multivariate linear regression, adjusted for sociodemographic variables. Participants reported median values of 150.0 min/day (IQR: 60.0-360.0) for walking and 445.7 min/day (IQR: 317.1-565.7) for sitting time. The median values for BMI, waist circumference, and body fat were 27.1 kg/m², 91.0 cm, and 23.5 kg, respectively. Substituting 10 min/day of sitting time for 10 min/day of walking was associated with waist circumference (β: -0.216: 95% CI: -0.041; -0.007). In addition, substituting 60 min/day of sitting time for moderate physical activity (β -0.206; 95% CI: -0.123; -0.008) was negatively associated with body fat. The equivalent substitution of different periods of sitting time for more active behaviors was favorably associated with obesity indicators. These findings suggest that lifestyle interventions based on replacing sitting time with physical activity can reduce the obesity epidemic in adults.

Prevalence of locomotive syndrome and associated factors in patients receiving hemodialysis

Muscle strength and joint and nervous system functions decline with age and in patients undergoing hemodialysis. The Japanese Orthopaedic Association has defined locomotive syndrome (LoS) as a musculoskeletal disorder primarily caused by aging. Therefore, this study aimed to investigate the prevalence of LoS and identify factors associated with its development in patients undergoing hemodialysis. Patients receiving outpatient hemodialysis at Kurume University Hospital were categorized into LoS and non-LoS groups using the cutoff value of 25-question Geriatric Locomotive Function Scale (GLFS-25). We analyzed differences in malnutrition, biochemical examinations, and Kt/V (a measure of dialysis adequacy) between the 2 groups using Wilcoxon rank-sum tests. Additionally, we evaluated factors that correlated with GLFS-25 through pairwise correlations. Multivariate analysis was performed to determine the independent factors associated with LoS. Nineteen patients were included. The median GLFS-25 score was 18. The LoS group (n = 11) had a significantly higher age (P = .0056) and chloride levels than the non-LoS group (n = 8) (P = .0175). Furthermore, the Nutritional Risk Index for Japanese Hemodialysis patients, creatinine levels, and Kt/V were significantly lower in the LoS group than in the non-LoS group (P = .0156, .0026, and .0163, respectively). The GLFS-25 showed significant correlations with age, total protein levels, C-reactive protein, chloride, creatinine, Nutritional Risk Index for Japanese Hemodialysis patients, and Kt/V (with correlation coefficients of -0.6133, -0.4779, 0.4738, 0.5381, -0.7923, 0.6508, and 0.5747, respectively). Multivariate analysis identified life-space assessment (odds ratio [OR], 3.06; 95% confidence interval [CI], -676 to 674; P < .0001) and age (OR, 31.29; 95% CI, -2061 to 2067; P = .0007) as risk factors for LoS. Age and physical activity were found to be associated with the development of LoS in patients with end-stage renal disease undergoing outpatient hemodialysis at our hospital. This emphasizes the importance of implementing preventative measures for LoS, especially for older and less physically active patients.

Proteomic signatures of healthy dietary patterns are associated with lower risks of major chronic diseases and mortality

Healthy dietary patterns have been linked to a decreased risk of chronic diseases. However, it remains uncertain whether proteomic signatures can reflect proteome response to healthy diet patterns, and whether these proteomic signatures are associated with health outcomes. Using data from the UK Biobank including Olink plasma proteins, we identified substantial proteomic variation in relation to adherence to eight healthy dietary patterns. The proteomic signatures, reflecting adherence and proteome response to healthy dietary patterns, were prospectively associated with lower risks of diabetes, cardiovascular diseases, chronic respiratory diseases, chronic kidney diseases and cancers, along with longer life expectancy, even after adjusting for corresponding dietary patterns. These findings suggest proteomic signatures have the potential to complement traditional dietary assessments and deepen our understanding of the relationships between dietary patterns and chronic diseases.

Substituting time spent in physical activity and sedentary time and its association with cardiovascular disease among northwest Chinese adults

Objectives

To examine the association between physical activity (PA) and leisure-time sedentary time and cardiovascular disease (CVD).

Methods

This cross-sectional study used baseline data from the Regional Ethnic Cohort Study in Northwest China from June 2018 to May 2019. PA and leisure-time sedentary time were self-reported. Logistic regression models analyzed the association of PA and leisure-time sedentary time with CVD prevalence individually and jointly. Restricted cubic spline analyses assessed dose-response relationships. Isotemporal substitution models were used to investigate substituting leisure-time sedentary time, light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) with CVD prevalence.

Results

The prevalence of CVD was 31.8 %. Compared to the lowest quartile, participants in the highest quartile of total PA had a 32 % lower CVD prevalence (odds ratio [OR]: 0.68, 95 % confidence interval [CI]: 0.62-0.74; P for trend <0.001). The fully adjusted OR for the highest quartile of leisure-time sedentary time compared to the lowest quartile was 1.09 (1.01-1.18; P for trend =0.04). An L-shaped dose-response relationship was observed between PA and CVD prevalence. An active lifestyle and reduced daily leisure-time sedentary time were associated with a 26 % (0.74 [0.63-0.86]) lower CVD prevalence. Additionally, substituting 30 min/day of leisure-time sedentary time with equivalent MVPA was associated with a 2 % (0.98 [0.97-0.99]) reduction in CVD prevalence. Substituting sedentary time with LPA was associated with a lower CVD prevalence in females.

Conclusions

An active lifestyle was associated with a lower prevalence of CVD in regional populations, suggesting a feasible strategy for CVD prevention and regional health promotion.

Impaired physical ability in patients with transfusion-dependent β-thalassaemia: Can regular physical activity be a countermeasure?

Transfusion-dependent β-thalassaemia (TDβT) is a genetic disorder characterised by reduced or absent β-globin chain synthesis, resulting in chronic anaemia. Treatment consists of regular blood transfusions and chelation therapy to limit iron overload and its negative effects on organs (e.g. heart, lungs and liver). Despite improved life expectancy with transfusions and chelation therapy, TDβT patients experience poor quality of life and impaired exercise capacity (mainly due to muscle deconditioning and reduced cardiac inotropism). The aims of this review are (i) to discuss the role of organ dysfunction in the impairment of exercise capacity and reduced quality of life of TDβT patients; and (ii) to discuss physical activity as a potential therapeutic strategy to alleviate the multifactorial impact of the disease.

Association of daily physical activity with hypertension, depressive symptoms, loneliness, and poor sleep quality in aged 60-79 older adults

This study aimed to assess its relationship between physical activity with health-related indicators in older population of the China. Cross-sectional data of 1,327 individuals aged 60-79 years were analyzed. Based on the Fifth National Physical Fitness Monitoring Program, depressive symptom and loneliness were measured using the Patient Health Questionnaire-9 and Emotional versus Social Loneliness Scales, respectively. Sleep quality was evaluated through self-designed questionnaire and hypertension was defined as blood pressure > 140/90 mmHg. International Physical Activity Questionnaire-Long Form was conducted to assess the physical activity (minutes and frequency) in different domains (domestic, transport, work, and leisure). Multivariable-adjusted binary logistic regression models estimated for the prevalence of health-related indicators, considering PA level, duration, frequency, and combinations of different domains of PA. In the study, favorable associations were observed between moderate to high level PA and reductions in 4 health-related indicators, especially for active frequency. Moreover, a combination of transport, domestic, and leisure PA was found to be a general protective factor for health-related indicators. In summary, this study highlights the positive impact of PA on older adults' health and provides valuable insights into the role of different PA patterns, offering a theoretical basis for developing PA guidelines, policies, and health interventions.

Association of sedentary behaviour with gout and the interaction effect of hyperuricemia: a cross-sectional study from 2007 to 2018

BACKGROUND

The increasing prevalence of sedentary lifestyles has raised concerns about its health impacts. This study sought to explore the association between sedentary behaviour and gout, a condition historically linked with affluent lifestyles but now increasingly prevalent in the general population.

METHODS

Utilizing data from the National Health and Nutrition Examination Survey database, this cross-sectional study analysed 34,526 participants from 2007 to 2018. The study focused on identifying any potential relationships between sedentary behaviour and the incidence of gout while adjusting for various confounders.

RESULTS

The study found a significant increase in the prevalence of gout from 2017 to 2018 and identified a reversed L-shaped relationship between sedentary behaviour and gout (OR = 1.03; 95% CI 1.00, 1.06; P = 0.0198), especially among individuals without hyperuricemia. Body Mass Index (BMI) may act as a key mediator in the relationship between sedentary behaviour and gout. In those with hyperuricemia, more than 12 h per day of sedentary behaviour substantially increased the prevalence of gout.

CONCLUSION

Prolonged sedentary behaviour emerged as an independent risk factor for gout. This association was particularly pronounced in individuals without hyperuricemia, suggesting the need for lifestyle modifications in this group. However, further research using prospective cohort studies is necessary to establish causality.

Complex patterns and determinants of regional multiple chronic conditions across the United States

Noncommunicable chronic diseases (NCDs) are a rapidly growing global public health concern, posing substantial challenges to healthcare systems. The presence of multiple (≥2) chronic conditions (MCC) exacerbates these challenges. In this study, we constructed an integrated MCC network to comprehensively evaluate the impact of NCD prevalence and associated factors on MCC patterns. We identified four distinct MCC patterns, each with its unique set of associated risk factors. Firstly, we found that race, sedentary lifestyles, and smoking habits were significant contributors to the co-occurrence of diabetes, chronic kidney disease, and cancer. Secondly, smoking habits and mental health were identified as risk factors associated with the clusters of high cholesterol, hypertension, coronary heart disease, and arthritis. Furthermore, the comorbidity of chronic obstructive pulmonary disease and asthma was affected by socioeconomic status, smoking habits, and educational attainment, and a noteworthy reciprocal relationship existed between these two MCC combinations. Thirdly, the combination of asthma and obesity is associated with risk factors such as mental health, smoking habits, sedentary lifestyles, and binge drinking behaviors. Finally, the pattern of depression-stroke comorbidity was influenced by risk factors including mental health, age, and sleep duration. Our findings hold valuable implications for healthcare system optimization, offering a pathway to mitigate the escalating burden of NCDs. Additionally, they provide a foundation for scientific strategies aimed at the joint prevention and management of these complex conditions, ultimately enhancing public health and safety on a global scale.

The role of physical activity in mitigating stress-induced internet addiction among Chinese college students

BACKGROUND

This study addresses the nexus of stress, physical exercise, and internet addiction in college students, aiming to unravel their complex interactions. With prior research hinting at correlations, this study seeks deeper insights into the optimal exercise duration and the mediating role of physical activity in the stress-internet addiction relationship.

METHODS

We examined 2892 Chinese college students, assessing psychosocial traits via established scales: the Chinese Internet Addiction Scale (CIAS-R), International Physical Activity Questionnaire (IPAQ), and DASS-21 for stress. We adopted a questionnaire survey method to collect data, and through convenience sampling, participants were selected. Analysis involved Structural Equation Model (SEM) and restricted cubic splines (RCS).

RESULTS

Among participants, 22.0 % self-reported internet addiction symptoms. Notably, a non-linear correlation between moderate (MPA) and vigorous physical activity (VPA) and internet addiction was evident (P < 0.001), while light physical activity (LPA) showed no significant association (P = 0.182). MPA initially reduced internet addiction as activity hours increased, but its efficacy lessened after 0.8 h/day. Conversely, VPA's impact fluctuated, declining from 0 to 0.18 h/day, then stabilizing. SEM analysis highlighted VPA and MPA's partial mediation in the stress-internet addiction relationship. Specifically, the path coefficient from stress to MPA was -0.037 (P < 0.05), and the path coefficient from MPA to internet addiction was -0.056 (P < 0.01). Additionally, the path coefficient from stress to VPA was -0.067 (P < 0.001), and the path coefficient from VPA to internet addiction was -0.102 (P < 0.001).

CONCLUSION

This study unveils the intricate interplay between physical activity, stress, and internet addiction among college students. With 22.0 % reporting addiction symptoms, urgent interventions tailored to promoting healthy physical activity levels are imperative to mitigate internet addiction risks.

LIMITATIONS

The cross-sectional nature of our design precludes the establishment of causal relationships between psychological stress and internet addiction.

Replacement of sedentary behavior with various physical activities and the risk of incident depression: a prospective analysis of accelerator-measured and self-reported UK Biobank data

PURPOSE

To examine the dose‒response relationships of sedentary behavior (SB) and physical activities (PAs) with depression, and to explore the effects of replacing SB with PAs on depression risk.

METHODS

The study used data from UK Biobank aged 37 to 73 years. Light physical activity (LPA), moderate-to-vigorous activity (MVPA), sleep duration, and total sedentary behavior (TSB) were measured by accelerometers. Self-reported SB was also adopted when daily screen-sedentary behavior time (SSB) and leisure-sedentary behavior time (LSB) were the focus. Incident depression was obtained from the part of mental and behavioral disorders in the "first occurrence fields" of UK Biobank. A Cox proportional hazard model and isotemporal substitution model were performed to explore the associations of LPA, MVPA, TSB, LSB, SSB, and sleep on depression and the effects of replacing SB time with equal PA time.

RESULTS

Highest levels of MVPA (HR = 0.58, 95%CI: 0.50-0.68) were associated with decreased depression risk compared with the lowest level (Q1). Longer SSB time (HR = 1.18, 95%CI: 1.06-1.32), LSB time (HR = 1.19, 95%CI: 1.07-1.32), and TSB time (HR = 1.17, 95%CI: 1.00-1.38) could increase depression risk significantly. Replacing 1h/day TSB, SSB, and LSB with MVPA brought the greatest risk reductions [31% (HR = 0.69, 95%CI: 0.62-0.77), 30% (HR = 0.70, 95%CI: 0.65-0.77), and 29% (HR = 0.71, 95%CI: 0.65-0.77)]. Under the same conditions, the effects of LPA replacement were also significant, but weaker than those of MVPA. Subgroup analyses showed that replacing 1h/d TSB with LPA could significantly decrease the depression risk for the females, but not for the males.

CONCLUSION

Large benefits for reducing the risk of incident depression could be attained by replacing a period of TSB, SSB, or LSB with equal PA time, especially for MVPA. Regular PA and less SB were recommended for improving mental health.

Association between oxidative balance score and chronic obstructive pulmonary disease: A cross-sectional study

Oxidative stress is an essential contributor to the progression of chronic obstructive pulmonary disease (COPD). A systematic assessment of diet patterns and lifestyle with the oxidative balance score (OBS) to reflect oxidative stress levels will help predict the risk of COPD. This study conducted a cross-sectional analysis to assess the link between OBS and COPD. 5162 participants were collected from 2013 to 2018 from the National Health and Nutrition Examination Survey (NHANES). Multivariate logistic regression models were applied to assess the relationship between OBS and COPD prevalence. The linearity of the association was explored using smoothed curve fitting. In addition, further subgroup analysis and interaction tests were conducted to ascertain the consistency of the relationship across diverse populations. Results of the multivariate logistic regression models indicated a negative association between OBS and the odds of COPD prevalence. Each incremental unit in OBS correlated with a 3% reduction in the odds of COPD in the fully adjusted model (OR 0.97, 95% CI 0.95-0.99). Further analysis by OBS tertiles indicated that individuals in the highest OBS tertile (T3) had a 17% lower probability of COPD compared to those in the lowest tertile (T1) in the fully adjusted model (OR 0.83, 95% CI 0.64-0.97). The smoothed curve fitting supported the negative association between OBS and COPD. Subgroup analyses revealed that the protective effect of OBS was notably pronounced among the non-hypertensive and non-diabetic populations. These findings suggest a negative link between OBS and COPD, underscoring the importance of antioxidant-rich diets and lifestyles in preventing COPD.

Does sedentary time and physical activity predict chronic back pain and morphological brain changes? A UK biobank cohort study in 33,402 participants

BACKGROUND

The relationship between sedentary time, physical activity, and chronic back pain remains unclear. The study aims to investigate whether sedentary time and physical activity predict chronic back pain and morphological brain changes.

METHODS

This cohort study recruited adults aged 37-73 years enrolled between 2006 and 2010, with follow-up until 2014. The total cohort comprised 33,402 participants (mean age: 54.53). Data were collected on daily sedentary time, physical activity, lifestyle factors, and health outcomes.

RESULTS

After nearly 8-year follow-up, 3,006 individuals (9.00%) reported chronic back pain in total. Individuals with daily sedentary time exceeding 6 h had a 33% higher risk of chronic back pain compared to those with sedentary time of 2 h or less (RR, 1.33, 95%CI, 1.17-1.52). Sedentary time was also associated with decreased grey matter volume in several brain regions, including bilateral primary somatosensory cortex (S1), secondary somatosensory cortex, putamen, primary motor cortex (M1), insula, hippocampus, amygdala, as well as right supplementary motor area, left medial frontal cortex, and right anterior cingulate cortex (FDR-corrected p-value < 0.05). Compared to individuals who sat for more than 6 h with light physical activity, those engaging in moderate physical activity with sedentary time of 2 h or less (RR, 0.71, 95%CI, 0.52-0.99) exhibited a significant decrease in chronic back pain risk. In addition, replacing sedentary time with equivalent amount of physical activity also demonstrated a reduction in the risk of chronic back pain (RR, 0.87, 95%CI, 0.77-0.99) and increased the reginal grey matter volumes including the amygdala, insula, M1, putamen and S1.

CONCLUSIONS

Prolonged sedentary time is associated with heightened risks of chronic back pain and deterioration in brain health.

Associations of Sedentary Behavior with Risks of Cardiovascular Disease Events among Chinese Adults

AIMS

Evidence regarding the modification effects of age, sex, ethnicity, socioeconomic status, or weight status on the associations of sedentary behavior (SB) with cardiovascular diseases (CVDs) is limited. Moreover, the mechanisms for the associations also remain unclear. We aimed to investigate the possible influence of these factors on the associations of SB with CVD events and whether the associations are mediated by metabolic phenotypes.

METHODS

This study included 42,619 participants aged 20-74 years, recruited from the Shanghai Suburban Adult Cohort and Biobank study. SB was assessed at baseline and integrated with health information systems to predict future CVD events. Cox proportional hazards models, interaction analyses, restricted cubic splines and causal mediation analyses were used for assessments.

RESULTS

Compared to those with ＜3 h/d sedentary time, participants having SB ≥ 5 h/d had significantly higher risks of CVD (HR[95%CI]: 1.27[1.12-1.44]), coronary heart disease (CHD, 1.35[1.14-1.60]), and ischemic stroke (IS, 1.30[1.06-1.60]). The association of CHD was more pronounced in the retired individuals than their counterparts (1.45[1.20-1.76] versus 1.06[0.74-1.52], pinteraction=0.046). When SB was expressed as a continuous variable, a 1 h/d increment in SB was positively associated with risks of CVD (1.03[1.01-1.05]), CHD (1.04[1.01-1.07]), and IS (1.05[1.01-1.08]). High-density lipoprotein cholesterol (HDL-C, proportion mediated: 12.54%, 12.23%, and 11.36%, all p＜0.001), followed by triglyceride (TG, 5.28%, 4.77%, and 4.86%, all p＜0.01) and serum uric acid (SUA, 3.64%, 4.24%, and 2.29%, all p＜0.05) were major mediators through metabolic phenotypes.

CONCLUSIONS

Higher SB was associated with elevated risks of CVD events. The detrimental effect of SB on CHD risk was more pronounced among retired individuals. Moreover, HDL-C, TG and SUA partially mediated the relationships between SB and CVD events. Our findings may have implications for preventing and controlling CVD associated with SB.

Causal effects of sedentary behaviours on the risk of migraine: A univariable and multivariable Mendelian randomization study

BACKGROUND

Migraine is a common and burdensome neurological disorder. The causal relationship between sedentary behaviours (SBs) and migraine remains instinct. We aimed to evaluate the roles of SBs including watching TV, using computer and driving in the risk of migraine.

METHODS

We conducted a univariable and multivariable Mendelian randomization (MR) study based on summary datasets of large genome-wide association studies. The inverse variance weighted method was utilized as the primary analytical tool. Cochran's Q, MR-Egger intercept test, MR pleiotropy residual sum and outlier and leave-one-out were conducted as sensitivity analysis. Additionally, we performed a meta-analysis to combine the causal estimates.

RESULTS

In the discovery analysis, we identified causal associations between time spent watching TV and an increased risk of migraine (p = 0.015) and migraine without aura (MO) (p = 0.002). Such causalities with increasing risk of migraine (p = 0.005), and MO (p = 0.006) were further verified using summary datasets from another study in the replication analysis. There was no significant causal association found between time spent using computer, driving and migraine or its two subtypes. The meta-analysis and multivariable MR analysis also strongly supported the causal relationships between time spent watching TV and an increased risk of migraine (p = 0.0003 and p = 0.034), as well as MO (p < 0.0001 and p = 0.0004), respectively. These findings were robust under all sensitivity analysis.

CONCLUSIONS

Our study suggested that time spent watching TV may be causally associated with an increased risk of migraine, particularly MO. Large-scale and well-designed cohort studies may be warranted for further validation.

SIGNIFICANCE STATEMENT

This study represents the first attempt to investigate whether a causal relationship exists between SBs and migraine. Utilizing MR analysis helps mitigate reverse causation bias and confounding factors commonly encountered in observational cohorts, thereby enhancing the robustness of derived causal associations. Our MR analysis revealed that time spent watching TV may serve as a potential risk factor for migraine, particularly MO.

The association of sedentary time with sleep disturbances among the US population, 2005 to 2014

BACKGROUND

Sleep problems increase the risk of premature illness and death. We evaluated the association between sedentary time and sleep disturbances.

METHODS

A cross-sectional analysis of the US nationally representative data of 21,414 adults (aged > = 18 years) from National Health and Nutrition Examination Survey (NHANES) (2005-2014) was performed. The data of sleep disturbances were assessed using NHANES questionnaire results, which included the question, "{Have you/has sp} ever been told by a doctor or other health professional that {you have/s/he has} a sleep disorder?". All participants were stratified by quartiles of sedentary behavior distribution, which was the explanatory variable (sedentary time quartile cut points: Q1, 0 < = Q1 < 3 h; Q2, 3 < = Q2 < 5 h; Q3, 5 < = Q3 < 8 h; Q4, 8 < = Q4 < 20 h). We used multivariable logistic regression and the restricted cubic splines (RCS) model to assess the relationship between sedentary time and sleep disturbances.

RESULTS

In the unadjusted multivariable logistic regression model (crude model), there was a demonstrated tendency for the odds of sleep disturbances to increase with the sedentary time (Q1 as reference, Q2: OR, 1.31 [95% CI 1.09-1.58] P = 0.005; Q3: OR, 1.62 [95% CI 1.39-1.88] P < 0.001; Q4: OR, 1.75 [95% CI 1.48-2.06] P < 0.001; P for trend < 0.001). In the adjusted model 4, adjustment for gender, age, marital type, education type, race, family poverty index ratio, waist circumference, recreational type, smoke status, drink status, diabetes mellitus status, cardiovascular disease status, sleep duration type, body mass index, the OR in Q2 subgroup didn't significantly increase (Q1 as reference. Q2: OR, 1.18 [95% CI 0.96-1.44] P = 0.1). However, the ORs in Q3 and Q4 (Q3: OR, 1.35 [95% CI 1.14-1.59] P < 0.001; Q4: OR, 1.45 [95% CI 1.21-1.75] P < 0.001) both revealed that the risk of sleep disturbances increased with increasing sedentary time, P for trend < 0.001. The unadjusted RCS model revealed that the risk of sleep disturbances increased non-linearly with increasing sedentary time for total participants (P for non-linearity < 0.001). After adjusting for all covariates, the RCS results revealed that the risk of sleep disturbances increased non-linearly with increasing sedentary time for total participants (P for non-linearity = 0.012).

CONCLUSIONS

This study suggested that the longer sedentary time was strongly associated with the sleep disturbances. The protective effect of recreational activities on sleep disturbance, has not been significantly demonstrated.

Replacement of sedentary behavior with various physical activities and the risk of all-cause and cause-specific mortality

BACKGROUND

Sedentary behavior (SB) has emerged as a significant health concern that deserves attention. This study aimed to examine the associations between prolonged sedentary behavior and the risk of all-cause and cause-specific mortality as well as to explore desirable alternatives to sitting in terms of physical activity (PA).

METHODS

Two prospective cohort investigations were conducted using the UK Biobank and NHANES datasets, with a total of 490,659 and 33,534 participants, respectively. Cox proportional hazards regression models were used to estimate the associations between SB and the risk of all-cause and cause-specific mortality due to cancer, cardiovascular disease (CVD), respiratory diseases, and digestive diseases. In addition, we employed isotemporal substitution models to examine the protective effect of replacing sitting with various forms of PA.

RESULTS

During the average follow-up times of 13.5 and 6.7 years, 36,109 and 3057 deaths were documented in the UK Biobank and NHANES, respectively. Both cohorts demonstrated that, compared with individuals sitting less than 5 h per day, individuals with longer periods of sitting had higher risks of all-cause and cause-specific mortality due to cancer, CVD, and respiratory diseases but not digestive diseases. Moreover, replacing SB per day with PA, even substituting 30 min of walking for pleasure, reduced the risk of all-cause mortality by 3.5% (hazard ratio [HR] 0.965, 95% confidence interval [CI] 0.954-0.977), whereas cause-specific mortality from cancer, CVD, and respiratory diseases was reduced by 1.6% (HR 0.984, 95% CI 0.968-1.000), 4.4% (HR 0.956, 95% CI 0.930-0.982), and 15.5% (HR 0.845, 95% CI 0.795-0.899), respectively. Furthermore, the protective effects of substitution became more pronounced as the intensity of exercise increased or the alternative duration was extended to 1 h.

CONCLUSIONS

SB was significantly correlated with substantially increased risks of all-cause mortality and cause-specific mortality from cancer, CVD, and respiratory diseases. However, substituting sitting with various forms of PA, even for short periods involving relatively light and relaxing physical activity, effectively reduced the risk of both overall and cause-specific mortality.

Enhancing clinical and public health interpretation of accelerometer-assessed physical activity with age-referenced values based on UK Biobank data

BACKGROUND

Higher accelerometer-assessed volume and intensity of physical activity (PA) have been associated with a longer life expectancy but can be difficult to translate into recommended doses of PA. We aimed to: (a) improve interpretability by producing UK Biobank age-referenced centiles for PA volume and intensity; (b) inform public-health messaging by examining how adding recommended quantities of moderate and vigorous PA affect PA volume and intensity.

METHODS

92,480 UK Biobank participants aged 43-80 years with wrist-worn accelerometer data were included. Average acceleration and intensity gradient were derived as proxies for PA volume and intensity. We generated sex-specific centile curves using Generalized Additive Models for Location Scale and Shape (GAMLSS) and modeled the effect of adding moderate (walking) or vigorous (running) activity on the combined change in the volume and intensity centiles (change in PA profile).

RESULTS

In men, volume was lower as age increased while intensity was lower after age 55; in women, both volume and intensity were lower as age increased. Adding 150 min of moderate PA weekly (5 × 30 min walking) increased the PA profile by 4 percentage points. Defining moderate PA as brisk walking approximately doubled the increase (9 percentage points) while 75 min of vigorous PA weekly (5 × 15 min running) trebled the increase (13 percentage points).

CONCLUSION

These UK Biobank reference centiles provide a benchmark for interpretation of accelerometer data. Application of our translational methods demonstrate that meeting PA guidelines through shorter duration vigorous activity is more beneficial to the PA profile (volume and intensity) than longer duration moderate activity.

Association between inflammatory biomarkers and hypertension among sedentary adults in US: NHANES 2009-2018

Our study focuses on the relationship between inflammatory biomarkers and hypertension among sedentary adults in the United States, using data from the National Health and Nutrition Examination Survey (NHANES) from 2009 to 2018. We categorized 24,614 participants into two groups based on their daily sedentary time: 9607 individuals in the sedentary group (≥7 h) and 15,007 in the non-sedentary group (<7 h). We found that the sedentary group had a significantly higher prevalence of hypertension than the non-sedentary group. Using weighted multiple logistic regression and smoothing curves, we assessed the correlation between inflammatory biomarkers and hypertension among the sedentary adults. The odds ratios for hypertension were 1.92 for the monocyte to high-density lipoprotein ratio (MHR), 1.15 for the systemic inflammation response index (SIRI), and 1.19 for the natural logarithm of the systemic immune-inflammation index (lnSII), all showing nonlinear associations. Furthermore, a significant positive correlation was found between sedentary time and inflammatory biomarkers (MHR, SIRI, and lnSII). Our findings suggest that prolonged sedentary behavior in the US significantly increases hypertension risk, likely due to marked increases in inflammation markers.

Isotemporal Substitution Modeling on Sedentary Behaviors and Physical Activity With Mortality Among People With Different Diabetes Statuses: A Prospective Cohort Study From the National Health and Nutrition Examination Survey Analysis 2007-2018

BACKGROUND

To assess the associations of replacing sedentary behavior with different types of physical activity with mortality among the US adults of varying diabetes statuses.

METHODS

This prospective cohort study included 21,637 participants (mean age, 48.5 y) from the National Health and Nutrition Examination Survey 2007-2018. Physical activity including leisure-time moderate-vigorous-intensity activity (MVPA), walking/bicycling, worktime MVPA, and sedentary behavior. We conducted an isotemporal substitution analysis using Cox regression to estimate the associations between replacements and mortality risks.

RESULTS

We found significant protective associations between replacing 30 minutes per day sedentary behavior with 3 types of physical activity and all-cause, cardiovascular disease (CVD) mortality risk (except worktime MVPA for CVD mortality) among total participants, with hazard ratio (HR; 95% confidence interval [CI]) ranging from 0.86 (0.77-0.95) to 0.96 (0.94-0.98). Among participants with diagnosed diabetes, replacing sedentary behavior with leisure-time MVPA was associated with a lower all-cause mortality risk (HR 0.81, 95% CI, 0.70-0.94), which was also observed in other subgroups, with HRs (95% CI) ranging from 0.87 (0.80-0.94) to 0.89 (0.81-0.99). Among those with prediabetes/undiagnosed diabetes, replacing sedentary behavior with walking/bicycling was associated with lower CVD mortality risk, and replacement to work-time MVPA was associated with lower all-cause and CVD mortality risk, with HRs (95% CI) ranging from 0.72 (0.63-0.83) to 0.96 (0.92-0.99).

CONCLUSIONS

Replacing sedentary behaviors with 30 minutes per day leisure-time MVPA was associated with lower all-cause mortality, regardless of diabetes statuses. Among people with prediabetes/undiagnosed diabetes, walking/bicycling was additionally associated with lower CVD mortality, and worktime MVPA was associated with lower all-cause and CVD mortality.

Intensity-specific physical activity measured by accelerometer and the risk of mortality among individuals with cardiometabolic diseases: A prospective study from the UK Biobank

BACKGROUND

While the health benefits of physical activity for general population are well-recognized, the prospective associations of physical activity volume and intensity with mortality among cardiometabolic disease individuals remain unclear.

OBJECTIVE

The objective of this study was to investigate the associations of accelerometer-measured intensity-specific physical activity with mortality risk among population with cardiometabolic disease.

DESIGN

Prospective cohort study.

SETTING

Participants were recruited from the United Kingdom (UK) across 22 assessment centers from 2006 to 2010.

PARTICIPANTS

A total of 9524 participants from the UK Biobank (median: 67.00 years, interquartile range: 61.00-70.00 years) were included in final study.

METHODS

Accelerometer-measured total volume, moderate-to-vigorous and light intensity physical activity collecting from 2013 to 2015 were quantified using a machine learning model. Multivariable restricted cubic splines and Cox proportional hazard models with hazard ratios (HRs) and 95 % confidence intervals (CIs) were employed to examine the associations of interests.

RESULTS

During the follow-up period (median: 6.87 years; interquartile range: 6.32-7.39 years), there were 659 (6.92 %) death events with 218 (2.29 %) cardiovascular disease-related deaths and 441 (4.63 %) non-cardiovascular disease-related deaths separately. In the fully adjusted models, compared with participants in the lowest quartiles of total volume, moderate-to-vigorous and light physical activities, the adjusted HRs (95 % CIs) of all-cause mortality for those in the highest quartiles were 0.40 (0.31, 0.52), 0.48 (0.37, 0.61), and 0.56 (0.44, 0.71) while those for cardiovascular diseases-related mortality were 0.35 (0.22, 0.55), 0.52 (0.35, 0.78) and 0.59 (0.39, 0.88), and for non-cardiovascular diseases-related mortality, they were 0.42 (0.30, 0.59), 0.40 (0.29, 0.54) and 0.54 (0.40, 0.73), separately. The optimal moderate-to-vigorous-intensity physical activity level for cardiovascular diseases-related mortality reduction was found to be in the third quartile (17.75-35.33 min/day). Furthermore, the observed inverse associations were mainly non-linear.

CONCLUSIONS

Promoting physical activity, regardless of intensity, is essential for individuals with cardiometabolic disease to reduce mortality risk. For both all-cause and cardiovascular disease-related and non-cardiovascular disease-related mortality, the observed decrease in risk seems to level off at a moderate level. The current findings deriving from precise device-based physical activity data provide inference for secondary prevention of cardiometabolic disease.

Analytic Methods for Understanding the Temporal Patterning of Dietary and 24-H Movement Behaviors: A Scoping Review

Dietary and movement behaviors [physical activity (PA), sedentary behavior (SED), and sleep] occur throughout a 24-h day and involve multiple contexts. Understanding the temporal patterning of these 24-h behaviors and their contextual determinants is key to determining their combined effect on health. A scoping review was conducted to identify novel analytic methods for determining temporal behavior patterns and their contextual correlates. We searched Embase, ProQuest, and EBSCOhost databases in July 2022 to identify studies published between 1997 and 2022 on temporal patterns and their contextual correlates (e.g., locational, social, environmental, personal). We included 14 studies after title and abstract (n = 33,292) and full-text (n = 135) screening, of which 11 were published after 2018. Most studies (n = 4 in adults; n = 5 in children and adolescents), examined waking behavior patterns (i.e., both PA and SED) of which 3 also included sleep and 6 included contextual correlates. PA and diet were examined together in only 1 study of adults. Contextual correlates of dietary, PA, and sleep temporal behavior patterns were also examined. Machine learning with various clustering algorithms and model-based clustering techniques were most used to determine 24-h temporal behavior patterns. Although the included studies used a diverse range of methods, behavioral variables, and assessment periods, results showed that temporal patterns characterized by high SED and low PA were linked to poorer health outcomes, than those with low SED and high PA. This review identified temporal behavior patterns, and their contextual correlates, which were associated with adiposity and cardiometabolic disease risk, suggesting these methods hold promise for the discovery of holistic lifestyle exposures important to health. Standardized reporting of methods and patterns and multidisciplinary collaboration among nutrition, PA, and sleep researchers; statisticians; and computer scientists were identified as key pathways to advance future research on temporal behavior patterns in relation to health.