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Background: Blood pressure (BP)-lowering effects of structured exercise are well-established. Effects of 24-hour movement behaviors captured in free-living settings have received less attention. This cross-sectional study investigated associations between a 24-hour behavior composition comprising 6 parts (sleeping, sedentary behavior, standing, slow walking, fast walking, and combined exercise-like activity [eg, running and cycling]) and systolic BP (SBP) and diastolic BP (DBP)., Methods: Data from thigh-worn accelerometers and BP measurements were collected from 6 cohorts in the Prospective Physical Activity, Sitting and Sleep consortium (ProPASS) (n=14 761; mean±SD, 54.2±9.6 years). Individual participant analysis using compositional data analysis was conducted with adjustments for relevant harmonized covariates. Based on the average sample composition, reallocation plots examined estimated BP reductions through behavioral replacement; the theoretical benefits of optimal (ie, clinically meaningful improvement in SBP [2 mm Hg] or DBP [1 mm Hg]) and minimal (ie, 5-minute reallocation) behavioral replacements were identified., Results: The average 24-hour composition consisted of sleeping (7.13±1.19 hours), sedentary behavior (10.7±1.9 hours), standing (3.2±1.1 hours), slow walking (1.6±0.6 hours), fast walking (1.1±0.5 hours), and exercise-like activity (16.0±16.3 minutes). More time spent exercising or sleeping, relative to other behaviors, was associated with lower BP. An additional 5 minutes of exercise-like activity was associated with estimated reductions of -0.68 mm Hg (95% CI, -0.15, -1.21) SBP and -0.54 mm Hg (95% CI, -0.19, 0.89) DBP. Clinically meaningful improvements in SBP and DBP were estimated after 20 to 27 minutes and 10 to 15 minutes of reallocation of time in other behaviors into additional exercise. Although more time spent being sedentary was adversely associated with SBP and DBP, there was minimal impact of standing or walking., Conclusions: Study findings reiterate the importance of exercise for BP control, suggesting that small additional amounts of exercise are associated with lower BP in a free-living setting., Competing Interests: E.S. is a paid consultant and holds equity in Complement Theory Inc, a US-based startup company for which products and services relate to the contents of this article. The other authors report no conflicts.

Aims: Incidental physical activity as part of daily living may offer feasibility advantages over traditional exercise. We examined the joint associations of incidental physical activity and sedentary behaviour with major adverse cardiovascular events (MACE) risk., Methods and Results: Analyses included 22 368 non-exercising adults from the UK Biobank accelerometry sub-study (median age [IQR]: 62.9 [11.6] years; 41.8% male). Physical activity and sedentary behaviour exposures were derived using a machine learning-based intensity and posture classification schema. We assessed the tertile-based joint associations of sedentary behaviour and the following: a) incidental vigorous (VPA), b) incidental moderate to vigorous (MVPA), c) vigorous intermittent lifestyle physical activity (VILPA; bouts lasting up to 1 min), and d) moderate to vigorous intermittent lifestyle physical activity (MV-ILPA; bouts lasting up to 3 min) with MACE risk. Over an 8.0-year median follow-up, 819 MACE events occurred. Compared to the highest physical activity and lowest sedentary time, high sedentary behaviour (>11.4 h/day) with low incidental VPA (<2.1 min/day) had an HR of 1.34 (95% CI: 0.98, 1.84) and low incidental MVPA (<21.8 min/day) had a 1.89 HR (95% CI: 1.42, 2.52) for MACE. Sedentary behaviour was not associated with MACE at medium and high levels of VPA or VILPA. Completing 4.1 min/day of VPA or VILPA may offset the MACE risk associated with high sedentary behaviour. Conversely, 31-65 min of incidental MVPA or 26-52 min of MV-ILPA per day largely attenuated the associations with MACE., Conclusion: Brief intermittent bursts of vigorous incidental physical activity may offset cardiovascular risks from high sedentary behaviour., Lay Summary: Literature to date has examined the role of total or leisure time physical activity in mitigating the health risks associated with high sedentary behaviour. However, the vast majority of adults achieve their daily physical activity incidentally through day-to-day activities. In this study of 22 368 adults from the UK Biobank accelerometry sub-study, we provide the first investigation into whether a) incidental vigorous (VPA), b) incidental moderate to vigorous (MVPA), c) vigorous intermittent lifestyle physical activity (VILPA; bouts lasting up to 1 min), and d) moderate to vigorous intermittent lifestyle physical activity (MV-ILPA; bouts lasting up to 3 min) completed through normal daily living can offset the risk of major adverse cardiovascular events (MACE) associated with high sedentary behaviour (>11.4 h per day). We demonstrate that incidental VPA and MVPA may offset the MACE risk associated with high-sedentary behaviour even if accrued in brief bursts lasting <3 min. Completing 4.1 min/day of VPA or VILPA may offset the MACE risk associated with high sedentary behaviour.A daily duration of 31-65 min of incidental MVPA or 26-52 min of MV-ILPA per day largely attenuated the associations with MACE., Competing Interests: Conflict of interest: ES is a paid consultant and holds equity in Complement Theory Inc., a US-based company whose products and services relate to physical activity. All other authors disclose no conflict of interest for this work., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)