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Purpose: The purpose of this scoping review was to summarize and describe the methodology and results from population-based studies of physical activity and sedentary time measured with devices in the Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden) and published in 2000 or later., Methods: A systematic search was carried out in PubMed and Web of Science in June 2023 using predefined search terms., Results: Fourteen unique research projects or surveillance studies were identified. Additionally, 2 surveillance studies published by national agencies were included, resulting in a total of 16 studies for inclusion. National surveillance systems exist in Finland and Norway, with regular survey waves in school-aged children/adolescents and adults. In Denmark, recent nationally representative data have been collected in school children only. So far, Sweden has no regular national surveillance system using device-based data collection. No studies were found from Iceland. The first study was conducted in 2001 and the most recent in 2022, with most data collected from 2016 to date. Five studies included children/adolescents 6-18 years, no study included preschoolers. In total 11 studies included adults, of which 8 also covered older adults. No study focused specifically on older adults. The analytical sample size ranged from 205 to 27,890. Detailed methodology is presented, such as information on sampling strategy, device type and placement, wear protocols, and physical activity classification schemes. Levels of physical activity and sedentary time in children/adolescents, adults, and older adults across the Nordic countries are presented., Conclusion: A growing implementation of device-based population surveillance of physical activity and sedentary behavior in the Nordic countries has been identified. The variety of devices, placement, and data procedures both within and between the Nordic countries highlights the challenges when it comes to comparing study outcomes as well as the need for more standardized data collection., Competing Interests: Competing interests The authors declare that they have no competing interests., (Copyright © 2024. Production and hosting by Elsevier B.V.)

Regular physical activity (PA) and limited sedentary time (SED) are highly recommended in international guidelines for patients after a myocardial infarction (MI). Data on PA and SED are often self-reported in clinical practice and, hence, reliable and valid questionnaires are crucial. This study aimed to assess the test-retest reliability, criterion validity and agreement of two PA and one SED questionnaire commonly used in clinical practice, developed by the Swedish National Board of Health and Welfare (BHW) and the Swedish national quality register SWEDEHEART. Data from 57 patients (mean age 66 ± 9.2 years, 42 males) was included in this multi-centre study. The patients answered three questionnaires on PA and SED at seven-day intervals and wore an accelerometer for seven days. Test-retest reliability, criterion validity and agreement were assessed using Spearman's rho and linearly weighted kappa. Test-retest reliability was moderate for three of the six-sub questions (k = 0.43-0.54) within the PA questionnaires. For criterion validity, the correlation was fair within three of the six sub-questions (r = 0.41-0.50) within the PA questionnaires. The SED questionnaire had low agreement (k = 0.12) and criterion validity (r = 0.30). The studied questionnaires for PA could be used in clinical practice as a screening tool and/or to evaluate the level of PA in patients with an MI. Future research is recommended to develop and/or evaluate SED questionnaires in patients with an MI.

Recommendations on physical activity and sedentary behaviour for improved health have been prepared by Professional Associations for Physical Activity (YFA) and approved by the Swedish Society of Medicine. All adults should do aerobic physical activity 150-300 minutes at moderate or 75-150 minutes at high intensity, or combined, at a weekly basis. For additional health benefits, muscle-strengthening activity should be performed on at least 2 days a week, and sedentary time should be limited and replaced by physical activity. Older adults should, as part of their weekly physical activity, do multicomponent physical activity that emphasizes balance and strength on at least 2-3 days a week to enhance functional capacity and prevent falls. The benefits of physical activity outweigh the risks. The Swedish National Board of Health and Welfare recommends that healthcare providers offer counselling with exercise on prescription to individuals with physical activity under the recommended dose.

Objective: To examine the joint associations of daily time spent in different intensities of physical activity, sedentary behaviour and sleep with all-cause mortality., Methods: Federated pooled analysis of six prospective cohorts with device-measured time spent in different intensities of physical activity, sedentary behaviour and sleep following a standardised compositional Cox regression analysis., Participants: 130 239 people from general population samples of adults (average age 54 years) from the UK, USA and Sweden., Main Outcome: All-cause mortality (follow-up 4.3-14.5 years)., Results: Studies using wrist and hip accelerometer provided statistically different results (I 2 =92.2%, Q-test p<0.001). There was no association between duration of sleep and all-cause mortality, HR=0.96 (95% CI 0.67 to 1.12). The proportion of time spent in moderate to vigorous physical activity was significantly associated with lower risk of all-cause mortality (HR=0.63 (95% CI 0.55 to 0.71) wrist; HR=0.93 (95% CI 0.87 to 0.98) hip). A significant association for the ratio of time spent in light physical activity and sedentary time was only found in hip accelerometer-based studies (HR=0.5, 95% CI 0.42 to 0.62). In studies based on hip accelerometer, the association between moderate to vigorous physical activity and mortality was modified by the balance of time spent in light physical activity and sedentary time., Conclusion: This federated analysis shows a joint dose-response association between the daily balance of time spent in physical activity of different intensities and sedentary behaviour with all-cause mortality, while sleep duration does not appear to be significant. The strongest association is with time spent in moderate to vigorous physical activity, but it is modified by the balance of time spent in light physical activity relative to sedentary behaviour., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.)

Sedentary behaviour is an emergent public health topic, but there is still no method to simultaneously measure both components of sedentary behaviour-posture and energy expenditure-with one sensor. This study investigated the accuracy and precision of measuring sedentary time when combining the proprietary processing of a posture sensor (activPAL) with a new energy expenditure algorithm and the proprietary processing of a movement sensor (ActiGraph) with a published posture algorithm. One hundred office workers wore both sensors for an average of 7 days. The activPAL algorithm development used 38 and the subsequent independent method comparison 62 participants. The single sensor sedentary estimates were compared with Bland-Atman statistics to the Posture and Physical Activity Index, a combined measurement with both sensors. All single-sensor methods overestimated sedentary time. However, adding the algorithms reduced the overestimation from 129 to 21 (activPAL) and from 84 to 7 min a day (ActiGraph), with far narrower 95% limits of agreements. Thus, combining the proprietary data with the algorithms is an easy way to increase the accuracy and precision of the single sensor sedentary estimates and leads to sedentary estimates that are more precise at the individual level than those of the proprietary processing are at the group level.

Background: Identifying physical activity (PA) profiles of people with Parkinson's Disease (PD) could provide clinically meaningful knowledge concerning how to tailor PA interventions. Our objectives were therefore to i) identify distinct PA profiles in people with PD based on accelerometer data, ii) explore differences between the profiles regarding personal characteristics and physical function., Methods: Accelerometer data from 301 participants (43% women, mean age: 71 years) was analysed using latent profile analyses of 15 derived PA variables. Physical function measurements included balance performance, comfortable gait speed and single and dual-task functional mobility., Results: Three distinct profiles were identified; "Sedentary" (N = 68), "Light Movers" (N = 115), "Steady Movers" (N = 118). "Sedentary" included people with PD with high absolute and relative time spent in Sedentary behaviour (SB), little time light intensity physical activity (LIPA) and negligible moderate-to-vigorous physical activity (MVPA). "Light Movers" were people with PD with values close to the mean for all activity variables. "Steady Movers" spent less time in SB during midday, and more time in LIPA and MVPA throughout the day, compared to the other profiles. "Sedentary" people had poorer balance (P = 0.006), poorer functional mobility (P = 0.027) and were more likely to have fallen previously (P = 0.027), compared to "Light Movers. The Timed Up and Go test, an easily performed clinical test of functional mobility, was the only test that could distinguish between all three profiles., Conclusion: Distinct PA profiles, with clear differences in how the time awake is spent exist among people with mild-moderate PD.

Background: Sedentary Behaviour (SB) gets an increasing attention from ergonomics and public health due to its associated detrimental health effects. A large number of studies record SB with ActiGraph counts-per-minute cut-points, but we still lack valid information about what the cut-points tell us about office work. This study therefore analysed the concurrent and discriminant validity of commonly used cut-points to measure SB, activity level, and posture., Methods: Thirty office workers completed four office tasks at three workplaces (conventional chair, activity-promoting chair, and standing desk) while wearing two ActiGraphs (waist and wrist). Indirect calorimetry and prescribed posture served as reference criteria. Generalized Estimation Equations analysed workplace and task effects on the activity level and counts-per-minute, and kappa statistics and ROC curves analysed the cut-point validity., Results: The activity-promoting chair (p < 0.001, ES ≥ 0.66) but not the standing desk (p = 1.0) increased the activity level, and both these workplaces increased the waist (p ≤ 0.003, ES ≥ 0.63) but not the wrist counts-per-minute (p = 0.74) compared to the conventional chair. The concurrent and discriminant validity was higher for activity level (kappa: 0.52-0.56 and 0.38-0.45, respectively) than for SB and posture (kappa ≤0.35 and ≤ 0.19, respectively). Furthermore, the discriminant validity for activity level was higher for task effects (kappa: 0.42-0.48) than for workplace effects (0.13-0.24)., Conclusions: ActiGraph counts-per-minute for waist and wrist placement were - independently of the chosen cut-point - a measure for activity level and not for SB or posture, and the cut-points performed better to detect task effects than workplace effects. Waist cut-points were most valid to measure the activity level in conventional seated office work, but they showed severe limitations for sit-stand desks. None of the placements was valid to detect the increased activity on the activity-promoting chair. Caution should therefore be paid when analysing the effect of workplace interventions on activity level with ActiGraph waist and wrist cut-points.

Objectives: To examine the joint associations of accelerometer-measured physical activity and sedentary time with all-cause mortality., Methods: We conducted a harmonised meta-analysis including nine prospective cohort studies from four countries. 44 370 men and women were followed for 4.0 to 14.5 years during which 3451 participants died (7.8% mortality rate). Associations between different combinations of moderate-to-vigorous intensity physical activity (MVPA) and sedentary time were analysed at study level using Cox proportional hazards regression analysis and summarised using random effects meta-analysis., Results: Across cohorts, the average time spent sedentary ranged from 8.5 hours/day to 10.5 hours/day and 8 min/day to 35 min/day for MVPA. Compared with the referent group (highest physical activity/lowest sedentary time), the risk of death increased with lower levels of MVPA and greater amounts of sedentary time. Among those in the highest third of MVPA, the risk of death was not statistically different from the referent for those in the middle (16%; 95% CI 0.87% to 1.54%) and highest (40%; 95% CI 0.87% to 2.26%) thirds of sedentary time. Those in the lowest third of MVPA had a greater risk of death in all combinations with sedentary time; 65% (95% CI 1.25% to 2.19%), 65% (95% CI 1.24% to 2.21%) and 263% (95% CI 1.93% to 3.57%), respectively., Conclusion: Higher sedentary time is associated with higher mortality in less active individuals when measured by accelerometry. About 30-40 min of MVPA per day attenuate the association between sedentary time and risk of death, which is lower than previous estimates from self-reported data., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Sedentary Behavior (SB), defined as sitting with minimal physical activity, is an emergent public health topic. However, the measurement of SB considers either posture (e.g., activPal) or physical activity (e.g., ActiGraph), and thus neglects either active sitting or inactive standing. The aim of this study was to determine the true amount of active sitting and inactive standing in daily life, and to analyze by how much these behaviors falsify the single sensors' sedentary estimates. Sedentary time of 100 office workers estimated with activPal and ActiGraph was therefore compared with Bland-Altman statistics to a combined sensor analysis, the posture and physical activity index (POPAI). POPAI classified each activPal sitting and standing event into inactive or active using the ActiGraph counts. Participants spent 45.0% [32.2%-59.1%] of the waking hours inactive sitting (equal to SB), 13.7% [7.8%-21.6%] active sitting, and 12.0% [5.7%-24.1%] inactive standing (mean [5th-95th percentile]). The activPal overestimated sedentary time by 30.3% [12.3%-48.4%] and the ActiGraph by 22.5% [3.2%-41.8%] (bias [95% limit-of-agreement]). The results showed that sitting is not always inactive, and standing is not always active. Caution should therefore be paid when interpreting the activPal (ignoring active sitting) and ActiGraph (ignoring inactive standing) measured time as SB.

By exploring multiple characteristics of physical activity and sedentary behavior (SB), different physical activity profiles could be obtained, which may be beneficial for health and targeted physical activity interventions. The aim of this study was to identify distinct physical activity profiles based on accelerometer-derived activity characteristics and to determine whether these profiles are associated with all-cause mortality. Eight hundred fifty-one participants (56% women, mean age: 53 years) provided objectively assessed physical activity data using an ActiGraph accelerometer and were followed for 15 years. Physical activity profiles were determined using latent profile analyses of 14 derived activity variables, resulting in that three profiles were identified: "Low Active" (n = 147), "Average Active" (n = 397), and "High Active" (n = 307). "Low Active" was characterized by participants with low absolute, relative, and limited variation of time spent in physical activity, and high time spent in SB. "Average Active" had the most balanced movement behavior with values close to the mean for all activity variables. "High Active" was characterized by participants with high absolute, relative, and great variation of time spent in physical activity. Overall, a potentially non-linear pattern between multiple activity variables and all-cause mortality was found as "Low Active" was significantly (P < .05) positively associated with all-cause mortality, and no difference in mortality risk was found between "High Active" and "Average Active." Our data suggest that day-to-day variation in SB is not associated with all-cause mortality. The important message is to keep the overall time spent in SB low and replace this behavior with physical activity., (© 2020 The Authors. Scandinavian Journal of Medicine & Science In Sports published by John Wiley & Sons Ltd.)

The associations between 24 h movement behavior, i.e., the way people distribute their time in different movement-related behaviors, on mental health are not well understood. This study applied a compositional data analysis approach to explore cross-sectional associations between device-measured moderate to vigorous physical activity (MVPA), light intensity physical activity (LIPA), sedentary behavior (SED), self-reported time in bed and mental health outcomes, i.e., depression or anxiety symptoms, burnout, mental wellbeing and stress, in office workers. ActiGraph accelerometers were worn for 24 h for at least 4 days to assess MVPA, LIPA, and SED. Sleep diaries were used in addition to identify time in bed. Analytic sample sizes for the different outcomes ranged from N = 345-370 participants. In this population of office workers with high levels of MVPA, the entire movement behavior composition was not associated to any of the mental health outcomes, but MVPA relative to all other behaviors was positively associated with mental wellbeing. This confirms the importance of MVPA for health relative to other movement-related behaviors.

Background: Measuring physical activity and sedentary behavior accurately remains a challenge. When describing the uncertainty of mean values or when making group comparisons, minimising Standard Error of the Mean (SEM) is important. The sample size and the number of repeated observations within each subject influence the size of the SEM. In this study we have investigated how different combinations of sample sizes and repeated observations influence the magnitude of the SEM., Methods: A convenience sample were asked to wear an accelerometer for 28 consecutive days. Based on the within and between subject variances the SEM for the different combinations of sample sizes and number of monitored days was calculated., Results: Fifty subjects (67% women, mean ± SD age 41 ± 19 years) were included. The analyses showed, independent of which intensity level of physical activity or how measurement protocol was designed, that the largest reductions in SEM was seen as the sample size were increased. The same magnitude in reductions to SEM was not seen for increasing the number of repeated measurement days within each subject., Conclusion: The most effective way of reducing the SEM is to have a large sample size rather than a long observation period within each individual. Even though the importance of reducing the SEM to increase the power of detecting differences between groups is well-known it is seldom considered when developing appropriate protocols for accelerometer based research. Therefore the results presented herein serves to highlight this fact and have the potential to stimulate debate and challenge current best practice recommendations of accelerometer based physical activity research.

Objectives: To assess the stability and determinants of total and context specific sitting in a follow-up of adults., Design: Longitudinal study., Methods: Participants in the DILGOM cohort (n=3735, men 45%), reported daily sitting in five contexts (work-related, in vehicle, at home by the TV, at home at the computer, and elsewhere) in 2007 and 2014. Sociodemographic background, lifestyle and health were assessed in 2007. Total sitting comprised the sum of context specific sitting. Changes in, and determinants of context specific sitting, stratified by baseline age into young middle-aged (<53 years); late middle-aged (53-68 years) and older-aged (>68 years) were estimated by generalized linear mixed models., Results: In 2007, total daily sitting was 7h 26min, 6h 16min, and 6h 3min in young middle-aged, late middle-aged and older-aged groups, respectively. Over 7 years, total sitting decreased on average by 26min. Sitting at the computer increased by 7-17min. The late middle-aged group also increased sitting by the TV, and decreased total, work-related, vehicle and elsewhere sitting. Occupational status determined context specific sitting, but somewhat differently in young and late middle-aged groups. Poor self-rated health determined less work-related and more sitting by the TV in the young, whereas good health determined less work-related sitting in the late middle-aged group., Conclusions: Self-reported sitting is a fairly stable behavior, with the exception for the late middle-aged group, where all context specific and total sitting changed significantly. Occupational status and health determined changes in sitting; however, somewhat differently by age group., (Copyright © 2019 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Objectives : To investigate the associations between objectively measured sedentary behavior (SB), light-intensity physical activity (LIPA) and moderate-to-vigorous physical activity (MVPA) and cardiometabolic and endocrine biomarkers, and to estimate the associations of reallocating time from one behavior to another with cardiometabolic and endocrine biomarkers. Methods : Baseline data from participants diagnosed with prediabetes or type 2 diabetes, n = 175, 58% men, mean (SD) age = 64.4 (7.7), recruited to a physical activity intervention was used. Time spent in SB, LIPA and MVPA was measured by accelerometer and transformed into isometric log-ratio coordinates. The associations between time spent in SB, LIPA and MVPA and biomarkers were examined by linear regression models. The change in each outcome of reallocating time between the three behaviors was estimated. Results : The findings show strong positive associations of time spent in MVPA and negative associations of time spent in SB relative to time spent in the other behaviors with sagittal abdominal diameter (SAD) and homeostasis model assessment for insulin resistance (HOMA-IR) and negative associations of time spent in SB with high-density lipoprotein (HDL) cholesterol. Theoretically, reallocation of 19 minutes MVPA to SB or to LIPA was associated with a 17% and 17% larger SAD, 39% and 36% larger HOMA-IR values and 3.3% and 2.3% lower levels of HDL, respectively. Conclusion : In conclusion, our analysis from a time-use perspective supports the current evidence that sedentary time is devastating for the cardiometabolic health. While LIPA probably requires more time, maintaining or increasing time in MVPA are the most important features of the time use behaviors when promoting a favorable cardiometabolic risk profile in adults with prediabetes and type 2 diabetes. Trial registration : ClinicalTrials.gov, NCT02374788. Registered 2 March 2015 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02374788.

The ActiGraph has a high ability to measure physical activity; however, it lacks an accurate posture classification to measure sedentary behavior. The aim of the present study was to develop an ActiGraph (waist-worn, 30 Hz) posture classification to detect prolonged sitting bouts, and to compare the classification to proprietary ActiGraph data. The activPAL, a highly valid posture classification device, served as reference criterion. Both sensors were worn by 38 office workers over a median duration of 9 days. An automated feature selection extracted the relevant signal information for a minute-based posture classification. The machine learning algorithm with optimal feature number to predict the time in prolonged sitting bouts (≥5 and ≥10 minutes) was searched and compared to the activPAL using Bland-Altman statistics. The comparison included optimized and frequently used cut-points (100 and 150 counts per minute (cpm), with and without low-frequency-extension (LFE) filtering). The new algorithm predicted the time in prolonged sitting bouts most accurate (bias ≤ 7 minutes/d). Of all proprietary ActiGraph methods, only 150 cpm without LFE predicted the time in prolonged sitting bouts non-significantly different from the activPAL (bias ≤ 18 minutes/d). However, the frequently used 100 cpm with LFE accurately predicted total sitting time (bias ≤ 7 minutes/d). To study the health effects of ActiGraph measured prolonged sitting, we recommend using the new algorithm. In case a cut-point is used, we recommend 150 cpm without LFE to measure prolonged sitting and 100 cpm with LFE to measure total sitting time. However, both cpm cut-points are not recommended for a detailed bout analysis., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Associations of objectively assessed physical activity in different intensities and risk of developing chronic disease that requires hospital care have not yet been examined in long term population-based studies. Studies addressing the link between physical activity and sedentary time and subsequent hospital admissions are lacking., Objective: To examine the prospective associations between physical activity and sedentary time with morbidity defined as: 1) a registered main diagnosis of cardiovascular disease, cancer, type-2 diabetes, dementia, obesity or depression; 2) number of in- and outpatient hospital visits; and 3) number of in-hospital days., Methods: In total, 1220 women and men, 18-75 years, from the population-based Sweden Attitude Behaviour and Change study 2000-2001 were included. Time spent sedentary, in light-intensity physical activity and in moderate-to-vigorous physical activity, and total accelerometer counts were assessed using the ActiGraph 7164 accelerometer. Morbidity data were obtained 2016 from Swedish registers. Cox proportional hazards models estimated hazard ratios (HR) of morbidity with 95% confidence intervals (CI) and negative binomial regression estimated incidence rate ratio (IRR) with 95% CI for number of hospital visits, and length of hospital stay., Results: Over a follow-up of 14.4 years (SD = 1.6), 342 persons had at least one registered hospital visit due to any of the included diagnoses. Higher moderate-to-vigorous physical activity was associated with significant risk reductions for combined morbidity (all included diagnoses) (HR: 0.65, 95% CI: 0.48-0.88) and cardiovascular disease (HR: 0.52, 95% CI: 0.33-0.82). Higher total counts showed similar results, and was also associated with fewer hospital visits (IRR = 0.56, 95% CI: 0.37-0.85). Higher sedentary time increased the risk of in-hospital days. (IRR = 2.38, 95% CI: 1.20-4.74)., Conclusion: This study supports the importance of moderate-to-vigorous physical activity for preventing chronic disease that requires hospital care, especially cardiovascular disease. High volumes of sedentary behavior may increase the risk of future hospitalization. Our results support the public health message "sit less and move more".

Background and Purpose: Accelerometer threshold values to detect physical activity intensity in the oldest old persons with coronary artery disease (CAD) are lacking as well as knowledge about their free-living physical activity behavior. The purpose of this study was 2-fold. (1) To assess the sensitivity and specificity of 3 existing intensity threshold values for ActiGraph accelerometers for the oldest old persons with CAD. (2) To assess free-living physical activity, applying the threshold values with the highest sensitivity and specificity for assessing at least moderate intensity, among these persons., Methods: In a cross-sectional design, a total of 24 persons with CAD, mean age 87.5 (3.7) years, participated in the study at a university hospital in Sweden. To assess the sensitivity and specificity of the existing threshold values, the participants walked at different speeds wearing the accelerometer at a pace corresponding to individualized perceived exertion at light, moderate, and high intensity according to the Borg Rating of Perceived Exertion Scale. For the free-living physical activity assessment, the persons wore the accelerometer for 7 consecutive days. The percentage agreement for light-, moderate-, and high-intensity threshold values, as well as receiver operating characteristic curves, was used to identify the sensitivity and specificity of the existing threshold values for moderate intensity., Results and Discussion: The threshold values for at least moderate intensity at 1041 counts per minute according to Copeland had the highest sensitivity (0.739) and specificity (0.609) to identify at least moderate intensity for the ActiGraph GT3X+ accelerometer. In a free-living setting, the oldest old persons with CAD spent 11 of 13.5 (81%) waking hours in a sedentary position and, of the 2.5 hours of being active, 19 minutes (2%) were at least at moderate intensity. Nine of 24 persons (38%) reached 20 minutes of moderate- to vigorous-intensity physical activity 3 days a week, according to guidelines for exercise-based cardiac rehabilitation., Conclusions: The existing threshold values according to Copeland had the highest sensitivity and specificity to identify at least moderate intensity and are valid for use in the oldest old persons with CAD. Using accelerometry as an objective measurement for physical activity can help further improve our understanding of free-living physical activity behavior and to assess relationships between free-living physical activity and health outcomes among the oldest old persons with CAD.

Objective: To examine the dose-response associations between accelerometer assessed total physical activity, different intensities of physical activity, and sedentary time and all cause mortality., Design: Systematic review and harmonised meta-analysis., Data Sources: PubMed, PsycINFO, Embase, Web of Science, Sport Discus from inception to 31 July 2018., Eligibility Criteria: Prospective cohort studies assessing physical activity and sedentary time by accelerometry and associations with all cause mortality and reported effect estimates as hazard ratios, odds ratios, or relative risks with 95% confidence intervals., Data Extraction and Analysis: Guidelines for meta-analyses and systematic reviews for observational studies and PRISMA guidelines were followed. Two authors independently screened the titles and abstracts. One author performed a full text review and another extracted the data. Two authors independently assessed the risk of bias. Individual level participant data were harmonised and analysed at study level. Data on physical activity were categorised by quarters at study level, and study specific associations with all cause mortality were analysed using Cox proportional hazards regression analyses. Study specific results were summarised using random effects meta-analysis., Main Outcome Measure: All cause mortality., Results: 39 studies were retrieved for full text review; 10 were eligible for inclusion, three were excluded owing to harmonisation challenges (eg, wrist placement of the accelerometer), and one study did not participate. Two additional studies with unpublished mortality data were also included. Thus, individual level data from eight studies (n=36 383; mean age 62.6 years; 72.8% women), with median follow-up of 5.8 years (range 3.0-14.5 years) and 2149 (5.9%) deaths were analysed. Any physical activity, regardless of intensity, was associated with lower risk of mortality, with a non-linear dose-response. Hazards ratios for mortality were 1.00 (referent) in the first quarter (least active), 0.48 (95% confidence interval 0.43 to 0.54) in the second quarter, 0.34 (0.26 to 0.45) in the third quarter, and 0.27 (0.23 to 0.32) in the fourth quarter (most active). Corresponding hazards ratios for light physical activity were 1.00, 0.60 (0.54 to 0.68), 0.44 (0.38 to 0.51), and 0.38 (0.28 to 0.51), and for moderate-to-vigorous physical activity were 1.00, 0.64 (0.55 to 0.74), 0.55 (0.40 to 0.74), and 0.52 (0.43 to 0.61). For sedentary time, hazards ratios were 1.00 (referent; least sedentary), 1.28 (1.09 to 1.51), 1.71 (1.36 to 2.15), and 2.63 (1.94 to 3.56)., Conclusion: Higher levels of total physical activity, at any intensity, and less time spent sedentary, are associated with substantially reduced risk for premature mortality, with evidence of a non-linear dose-response pattern in middle aged and older adults., Systematic Review Registration: PROSPERO CRD42018091808., Competing Interests: Competing interests: All authors have completed the ICMJE uniform disclosure form and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Sedentary Behavior (SB) is among the most frequent human behaviors and is associated with a plethora of serious chronic lifestyle diseases as well as premature death. Office workers in particular are at an increased risk due to their extensive amounts of occupational SB. However, we still lack an objective method to measure SB consistent with its definition. We have therefore developed a new measurement system based on muscular activity and accelerometry. The primary aim of the present study was to calibrate the new-developed 8-CH-EMG+ for measuring occupational SB against an indirect calorimeter during typical desk-based office work activities. In total, 25 volunteers performed nine office tasks at three typical workplaces. Minute-by-minute posture and activity classification was performed using subsequent decision trees developed with artificial intelligence data processing techniques. The 8-CH-EMG+ successfully identified all sitting episodes (AUC = 1.0). Furthermore, depending on the number of electromyography channels included, the device has a sensitivity of 83⁻98% and 74⁻98% to detect SB and active sitting (AUC = 0.85⁻0.91). The 8-CH-EMG+ advances the field of objective SB measurements by combining accelerometry with muscular activity. Future field studies should consider the use of EMG sensors to record SB in line with its definition.

Background: People with severe low back pain are at higher risk of poor health. Patients scheduled for lumbar fusion surgery are assumed to have low levels of physical activity, but few data exist. The aim of the study was firstly to investigate preoperative levels of objectively measured physical activity in patients with severe low back pain waiting for lumbar fusion surgery, and secondly to investigate whether factors in the fear-avoidance model were associated with these levels., Methods: We included 118 patients waiting for lumbar fusion surgery (63 women and 55 men; mean age 46 years). Physical activity expressed as steps per day and total time spent in at least moderate-intensity physical activity was assessed with ActiGraph GT3X+ accelerometers. The data were compared to the WHO recommendations on physical activity for health. Whether factors in the fear-avoidance model were associated with physical activity was evaluated by two different multiple linear regression models., Results: Ninety-six patients (83%) did not reach the WHO recommendations on physical activity for health, and 19 (16%) patients took fewer than 5000 steps per day, which indicates a sedentary lifestyle. On a group level, higher scores for fear of movement and disability were associated with lower numbers of steps per day., Conclusion: A high proportion of the patients did not reach the WHO recommendations on physical activity and are therefore at risk of poor health due to insufficient physical activity. We also found a negative association between both fear of movement and disability, and the number of steps per day. Action needs to be taken to motivate patients to be more physically active before surgery, to improve health postoperatively. There is a need for interventions aimed at increasing physical activity levels and reducing barriers to physical activity in the prehabilitation phase of this patient group., Trial Registration: Current Controlled Trials ISCRTN 17115599 , retrospectively Registered 18 may 2015.

Purpose: To investigate objectively measured physical activity in stroke survivors living in low-income areas of Cape Town, South Africa, specifically to: (a) describe the volume of daily physical activity and time spent in different intensity levels and (b) investigate the association of factors covering the International Classification of Functioning, Disability and Health with sedentary behavior., Materials and Methods: A cross-sectional design was used, where forty-five ambulatory community-dwelling stroke survivors participated. Volume and intensity of physical activity were assessed with accelerometers for three to five consecutive days. Personal and environmental factors, along with body function and activity, were captured. Multiple linear regression was used to investigate factors associated with the percentage of days spent sedentary., Results: The median number of steps per day was 2393, and of the average 703 minutes of wear time, 80% were spent in sedentary, 15% in light, and 5% in moderate-to-vigorous intensity physical activity. Age, stroke severity, and failing to receive outpatient rehabilitation were independently associated with sedentary, which, taken together, explained 52% of the variance., Conclusions: Low volumes of physical activity and high amount of sedentary time emphasize the need to develop strategies that will increase physical activity. Providing outpatient rehabilitation in a systematic manner post-stroke is a potential target of health care programs in order to reduce sedentary behavior. Implications for rehabilitation Objectively measured physical activity among community-dwelling survivors of stroke in Cape Town, South Africa was low in volume, and the majority did not meet the recommendations of 150 minutes of at least moderate intensity physical activity. The majority of stroke survivors in South Africa spent most of their time sedentary, which could further increase the risk of cardiovascular impairments. Outpatient rehabilitation should be provided to all patients after stroke since it appears to reduce sedentary time.

Objectives: To investigate the associations of objectively assessed sedentary time, light intensity physical activity (PA), moderate to vigorous intensity PA (MVPA), and total PA with all-cause mortality and mortality from cardiovascular disease (CVD) or cancer in a Swedish population-based cohort with 15 years follow-up time., Design: Longitudinal prospective cohort study., Methods: Data from 851 persons (56% women) ≥35 years at baseline were included. Primary exposure variables were time (min/day) spent sedentary, in light intensity PA and in MVPA, and total counts from an Actigraph 7164 accelerometer. Data on all-cause mortality and mortality from CVD or cancer were obtained from Swedish registers. Cox proportional hazards models estimated hazard ratios (HR) of mortality with 95% confidence intervals (CI)., Results: Compared with the least sedentary participants, those in the most sedentary tertile had an increased risk of all-cause mortality, HR: 2.7 (1.4, 5.3), CVD mortality, HR: 5.5 (1.4, 21.2) and cancer mortality, HR: 4.3 (1.2, 16.0). For all-cause mortality, those in the highest light intensity PA tertile had a HR 0.34 (0.17, 0.67) compared with the lowest tertile. A similar pattern was found for CVD and cancer mortality. More time spent in MVPA was associated with the largest risk reduction for CVD mortality, with an almost 90% lower risk in the tertile with the most time in MVPA., Conclusions: This study confirms a strong inverse relationship between MVPA and mortality, and adds new insight for the understanding of the associations between sedentary time and light intensity PA and mortality., (Copyright © 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Aim: The aim of this study was to investigate the potential associations of reallocating 30 minutes sedentary time in long bouts (>60 min) to sedentary time in non-bouts, light intensity physical activity (LPA) and moderate- to vigorous physical activity (MVPA) with cardiometabolic risk factors in a population diagnosed with prediabetes or type 2 diabetes., Methods: Participants diagnosed with prediabetes and type 2 diabetes (n = 124, 50% men, mean [SD] age = 63.8 [7.5] years) were recruited to the physical activity intervention Sophia Step Study. For this study baseline data was used with a cross-sectional design. Time spent in sedentary behaviors in bouts (>60 min) and non-bouts (accrued in <60 min bouts) and physical activity was measured using the ActiGraph GT1M. Associations of reallocating bouted sedentary time to non-bouted sedentary time, LPA and MVPA with cardiometabolic risk factors were examined using an isotemporal substitution framework with linear regression models., Results: Reallocating 30 minutes sedentary time in bouts to MVPA was associated with lower waist circumference (b = -4.30 95% CI:-7.23, -1.38 cm), lower BMI (b = -1.46 95% CI:-2.60, -0.33 kg/m2) and higher HDL cholesterol levels (b = 0.11 95% CI: 0.02, 0.21 kg/m2. Similar associations were seen for reallocation of sedentary time in non-bouts to MVPA. Reallocating sedentary time in bouts to LPA was associated only with lower waist circumference., Conclusion: Reallocation of sedentary time in bouts as well as non-bouts to MVPA, but not to LPA, was beneficially associated with waist circumference, BMI and HDL cholesterol in individuals with prediabetes and type 2 diabetes. The results of this study confirm the importance of reallocation sedentary time to MVPA.

Objective: The objective of this study was to pool, harmonise and re-analyse national accelerometer data from adults in four European countries in order to describe population levels of sedentary time and physical inactivity., Methods: Five cross-sectional studies were included from England, Portugal, Norway and Sweden. ActiGraph accelerometer count data were centrally processed using the same algorithms. Multivariable logistic regression analyses were conducted to study the associations of sedentary time and physical inactivity with sex, age, weight status and educational level, in both the pooled sample and the separate study samples., Results: Data from 9509 participants were used. On average, participants were sedentary for 530 min/day, and accumulated 36 min/day of moderate to vigorous intensity physical activity. Twenty-three percent accumulated more than 10 h of sedentary time/day, and 72% did not meet the physical activity recommendations. Nine percent of all participants were classified as high sedentary and low active. Participants from Norway showed the highest levels of sedentary time, while participants from England were the least physically active. Age and weight status were positively associated with sedentary time and not meeting the physical activity recommendations. Men and higher-educated people were more likely to be highly sedentary, while women and lower-educated people were more likely to be inactive., Conclusions: We found high levels of sedentary time and physical inactivity in four European countries. Older people and obese people were most likely to display these behaviours and thus deserve special attention in interventions and policy planning. In order to monitor these behaviours, accelerometer-based cross-European surveillance is recommended.

Aim: To describe objectively-measured physical activity levels and patterns among community-dwelling older adults with osteoporosis, impaired balance, and fear of falling, and to explore the associations with gait, balance performance, falls self-efficacy, and health-related quality of life (HRQoL)., Methods: Ninety-four individuals (75.6 ± 5.4 years) were included. Physical activity was assessed with pedometers and accelerometers. Mean steps/day, dichotomized into < 5,000 or ≥ 5,000 steps/day, and time spent in different physical activity intensities were analyzed. Gait was assessed with a GAITRite walkway, balance performance was assessed with the modified figure-eight test and one-leg stance, falls self-efficacy was assessed with the Falls Efficacy Scale International, and HRQoL was assessed with Short Form-36., Results: Mean steps/day were 6,201 (991-17,156) and 40% reported < 5,000 steps/day. Participants with < 5,000 steps/day spent more time sedentary, had slower gait speed, poorer balance performance, and lower HRQoL than participants with ≥ 5,000 steps/day. No participants with < 5,000 met the recommended level of physical activity.

Objectives: The aim of this study was to investigate changes over six years in physical activity and sedentary behavior assessed with accelerometry in a representative sample of Swedish adults., Design: A longitudinal study over six years., Methods: The cohort consisted of 1172 participants (46% males) in 2002 and 511 participants (46% males) in 2008, of which 478 (45% males) had valid data on both occasions. Mean (SD) age at baseline was 45 (15) years. To analyze changes over time, a mixed linear model for average intensity physical activity (counts/min) and time in sedentary behavior and light- and moderate- or higher-intensity physical activity was conducted, stratified for sex and age, and adjusted for BMI, education, self-rated health and Δ wear time., Results: Over a six year period no significant changes were seen in the total cohort for average intensity and time in moderate- or higher intensity physical activity. A significant decrease in average intensity physical activity was found for men (p=0.006) and those aged 60+ years at baseline (p<0.001). A significant increase (26 min/day) for sedentary time in the total cohort (p<0.001) and for time in moderate or higher intensity physical activity among women (p<0.001) and those aged 40-59 years at baseline (p=0.014) was found over the follow-up period., Conclusions: The overall increase in sedentary time and decrease in average physical activity among men and the elderly are of concern, since they might result in an elevated risk of developing chronic diseases., (Copyright © 2014 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Background: Decreased movement ability, one of the hallmarks of Parkinson disease (PD), may lead to inadequate physical activity (PA) and excessive time spent in sedentary behaviors-2 factors associated with an elevated risk for lifestyle-related diseases, poor management of PD, and premature death. To identify the extent to which people with PD are physically active, a comprehensive characterization of PA in this population is needed., Objective: The study objective was to describe levels and patterns of PA and sedentary behaviors in elderly people with PD., Design: This cross-sectional study involved a free-living setting and 53 men and 42 women (mean age=73.4 years) with mild to moderate idiopathic PD., Methods: Time spent in PA and sedentary behaviors was assessed for 1 week with accelerometers., Results: Mean daily step counts were 4,765; participants spent 589 minutes in sedentary behaviors, 141 minutes in low-intensity activities, 30 minutes in moderate-intensity lifestyle activities, and 16 minutes in moderate- to vigorous-intensity ambulatory activities. No differences were found between weekdays and weekend days. Patterns were characterized by a rise in total PA in the morning, peaking between 10 am and 3 pm, and a gradual decline toward the late evening. The proportion achieving 150 minutes of moderate- to vigorous-intensity PA per week was 27%, and 16% achieved 7,000 or more steps per day., Limitations: Nonrandomized selection of participants may limit the generalizability of the results., Conclusions: Physical activity levels were generally low, in terms of both total volume and intensity, with only minor variations over the course of a day or between days. These results emphasize the need to develop strategies to increase PA and reduce time spent in sedentary behaviors in elderly people with mild to moderate PD., (© 2015 American Physical Therapy Association.)

Background: The aim was to describe levels, patterns and correlates of physical activity and sedentary behavior in a sample of Swedish children, two years of age, with normal weight, overweight and obese parents., Methods: Data from 123 children, 37 with normal-weight parents and 86 with overweight/obese parents, enrolled in the Early Stockholm Obesity Prevention Project study was used. Children wore an Actigraph GT3X+ accelerometer for seven days. Average activity (counts per minute), number of steps and time spent in low and high-intensity physical activity and in sedentary was assessed. Differences between weekdays and weekend days were examined as were correlations with sex, body mass index (BMI), motor skills and family-related factors., Results: Children were active at high intensity 11% of the day. On average 55% of the day was spent being sedentary. Number of steps and time in low-intensity physical activity differed between weekdays and weekend days: on weekdays, 363 more steps (p = 0.01) and six more minutes in low physical activity (p = 0.04). No differences were found for any physical activity or sedentary behavior variable by sex, BMI, motor skills or any family-related variable (p = 0.07 - 0.95)., Conclusions: Two-year-old children have an intermittent activity pattern, that is almost similar on weekdays and they spend about half of the daytime active. The absence of any association with sex, BMI, motor skills or parental factors indicates that the individual variation in this age group is primarily due to endogenous factors., Trial Registration: Clinicaltrials.gov: NCT01198847 .

Seasonal and regional variation may influence physical activity (PA) patterns. These associations are in need of further investigation. The objective of the current study was to examine the association of season and region on objectively measured PA. The study was designed as a cross-sectional study with 1172 participants living in Sweden. Data on PA were collected throughout a calendar year using accelerometry. Regions were categorised as south (Götaland), central (Svealand) and north (Norrland). Outcome variables included accelerometer-measured mean counts per minute, sedentary time and time in low intensity and moderate-intensity physical activity (MVPA) or greater. ANCOVA was used to determine the associations of season and region with PA, adjusting for sex, age, body mass index (BMI) and education. The results showed that during the Spring season more time was spent in MVPA than during the Autumn. For participants living in the south of Sweden, a significant trend for season was found for MVPA, with Spring having the highest MVPA (P = 0.025). Season had a borderline significant association with MVPA or higher intensity activities (P = 0.051). No significant effects of region or season on total PA, low-intensity PA and sedentary periods of time were observed. The results indicate that studies conducted in a population living in high latitudes, may not be significantly affected by seasonality or region when assessing PA.

This report aims (1) to examine the association between seasonality and physical activity (PA) and sedentary time in European adolescents and (2) to investigate whether this association was influenced by geographical location (Central-North versus South of Europe), which implies more or less extreme weather and daylight hours. Valid data on PA, sedentary time and seasonality were obtained in 2173 adolescents (1175 females; 12.5-17.5 years) included in this study. Physical activity and sedentary time were measured by accelerometers. ANCOVA was conducted to analyse the differences in PA and sedentary time across seasons. Results showed that girls had lower levels of moderate to vigorous PA (MVPA) and average PA, and spent more time in sedentary activities in winter compared with spring (all P < 0.05). Stratified analyses showed differences in PA and sedentary time between winter and spring in European girls from Central-North of Europe (P < 0.05 for sedentary time). There were no differences between PA and sedentary time across seasonality in boys. In conclusion, winter is related with less time spent in MVPA, lower average PA and higher time spent in sedentary activities in European adolescent girls, compared with spring. These differences seem to mainly occur in Central-North Europe.

Context: The quality of methodological papers assessing physical activity instruments depends upon the rigor of a study's design., Objectives: We present a checklist to assess key criteria for instrument validation studies., Process: A Medline/PubMed search was performed to identify guidelines for evaluating the methodological quality of instrument validation studies. Based upon the literature, a pilot version of a checklist was developed consisting of 21 items with 3 subscales: 1) quality of the reported data (9 items: assess whether the reported information is sufficient to make an unbiased assessment of the findings); 2) external validity of the results (3 items: assess the extent to which the findings are generalizable); 3) internal validity of the study (9 items: assess the rigor of the study design). The checklist was tested for interrater reliability and feasibility with 6 raters., Findings: Raters viewed the checklist as helpful for reviewing studies. They suggested minor wording changes for 8 items to clarify intent. One item was divided into 2 items for a total of 22 items., Discussion: Checklists may be useful to assess the quality of studies designed to validate physical activity instruments. Future research should test checklist internal consistency, test-retest reliability, and criterion validity.

Background: Recent epidemiologic evidence points to the health risks of prolonged sitting, that are independent of physical activity, but few papers have reported the descriptive epidemiology of sitting in population studies with adults., Purpose: This paper reports the prevalence of "high sitting time" and its correlates in an international study in 20 countries., Methods: Representative population samples from 20 countries were collected 2002-2004, and a question was asked on usual weekday hours spent sitting. This question was part of the International Prevalence Study, using the International Physical Activity Questionnaire (IPAQ). The sitting measure has acceptable reliability and validity. Daily sitting time was compared among countries, and by age group, gender, educational attainment, and physical activity., Results: Data were available for 49,493 adults aged 18-65 years from 20 countries. The median reported sitting time was 300 minutes/day, with an interquartile range of 180-480 minutes. Countries reporting the lowest amount of sitting included Portugal, Brazil, and Colombia (medians ≤180 min/day), whereas adults in Taiwan, Norway, Hong Kong, Saudi Arabia, and Japan reported the highest sitting times (medians ≥360 min/day). In adjusted analyses, adults aged 40-65 years were significantly less likely to be in the highest quintile for sitting than adults aged 18-39 years (AOR=0.796), and those with postschool education had higher sitting times compared with those with high school or less education (OR=1.349). Physical activity showed an inverse relationship, with those reporting low activity on the IPAQ three times more likely to be in the highest-sitting quintile compared to those reporting high physical activity., Conclusions: Median sitting time varied widely across countries. Assessing sitting time is an important new area for preventive medicine, in addition to assessing physical activity and sedentary behaviors. Population surveys that monitor lifestyle behaviors should add measures of sitting time to physical activity surveillance. Moreover, the use of objective measures to capture the spectrum of sedentary (sitting) and physical activity behaviors is encouraged, particularly in low- and middle-income countries commencing new surveillance activities., (Copyright © 2011 American Journal of Preventive Medicine. All rights reserved.)

This study compares levels and patterns of objectively assessed physical activity in Sweden and the United States by using identical accelerometer metrics. Data of adult respondents with > or =4 days with > or =10 hours per day of accelerometer wear from Sweden (2001-2002, n = 1,172) and the United States (2003-2004, n = 2,925) were compared. Outcomes reported by age and body mass index within sex include accelerometer counts per minute and amounts and bouts of activity at different intensities, that is, sedentary, low, lifestyle, and moderate or higher intensity physical activity. The mean counts per minute were 375 (95% confidence interval (CI): 360, 390) and 377 (95% CI: 363, 391) for Swedish and US males, respectively, and 363 (95% CI: 347, 379) and 298 (95% CI: 289, 307) for Swedish and US females. Older respondents and those with higher body mass index had lower activity levels. Swedish and US males spent 36 (95% CI: 34, 38) and 33 (95% CI: 31, 36) minutes per day, and Swedish and US females spent 32 (95% CI: 29, 34) and 19 (95% CI: 17, 21) minutes per day in moderate or higher intensity physical activity. Older Swedes were more active in moderate or higher intensity activities than were older US respondents. However, younger Swedish males had more sedentary behavior time than did younger US males. These results provide a framework for international comparisons of physical activity levels and patterns, and they represent strong evidence for the importance of investment in objective measurement of physical activity.

Background: Movement behaviours, such as sedentary behaviour (SB) and moderate to vigorous physical activity (MVPA), are linked with multiple aspects of health and can be influenced by various pain-related psychological factors, such as fear of movement, pain catastrophising and self-efficacy for exercise. However, the relationships between these factors and postoperative SB and MVPA remain unclear in patients undergoing surgery for lumbar degenerative conditions. This study aimed to investigate the association between preoperative pain-related psychological factors and postoperative SB and MVPA in patients with low back pain (LBP) and degenerative disc disorder at 6 and 12 months after lumbar fusion surgery. Methods: Secondary data were collected from 118 patients (63 women and 55 men; mean age 46 years) who underwent lumbar fusion surgery in a randomised controlled trial. SB and MVPA were measured using the triaxial accelerometer ActiGraph GT3X+. Fear of movement, pain catastrophising and self-efficacy for exercise served as predictors. The association between these factors and the relative time spent in SB and MVPA 6 and 12 months after surgery was analysed via linear regression models, adjusting for potential confounders. Results: Preoperative fear of movement was significantly associated with relative time spent in SB at 6 and 12 months after surgery (β = 0.013, 95% confidence interval = 0.004 to 0.022, p = 0.007). Neither pain catastrophising nor self-efficacy for exercise showed significant associations with relative time spent in SB and MVPA at these time points. Conclusions: Our study demonstrated that preoperative fear of movement was significantly associated with postoperative SB in patients with LBP and degenerative disc disorder. This finding underscores the potential benefits of preoperative screening for pain-related psychological factors, including fear of movement, preoperatively. Such screenings could aid in identifying patients who might benefit from targeted interventions to promote healthier postoperative movement behaviour and improved health outcomes. [ABSTRACT FROM AUTHOR]

Objective The impact of exercise interventions on physical activity (PA) remains undetermined in intermittent claudication, which is why it is important to include objectively measured PA as an additional endpoint. The aim of this prespecified secondary analysis of a randomized clinical trial was to investigate the impact of unsupervised Nordic pole walk advice (WA) alone or in combination with hospital-based supervised exercise (SEP) or home-based structured exercise (HSEP) on PA in patients with intermittent claudication. Methods In total, 166 patients with intermittent claudication (mean age = 72 [SD = 7.4] y; 41% women) were randomized to 3 intermittent claudication-treatment strategies: WA, WA + SEP, or WA + HSEP. All patients received Nordic poles and standardized WA (≥30 min, 3 times weekly). Patients randomized to HSEP and SEP accepted participation in an additional 6-months exercise program. PA was measured with an accelerometer-based activPAL3 monitor for 7 days at baseline and at 3, 6, and 12 months. PA outcomes were steps per day, time spent within a stepping cadence ≥100 steps per minute, time spent upright, number of body transitions from sitting to standing, and number of sitting bouts of >30 minutes and >60 minutes. Results At 1 year, no intergroup differences were observed in any of the PA variables, whereas significant intergroup differences were observed at 3 months regarding time spent within a stepping time cadence ≥100 steps per minute. The mean change for HSEP (2.47 [SD = 10.85] min) was significantly different from the mean change for WA (−3.20 [SD = 6.24] min). At 6 months, the number of sitting bouts (>60 min) for SEP was significantly different from WA (mean change = 0.24 [SD = 0.69] vs −0.23 [SD = 0.81]). Conclusion This study indicates that the addition of 6 months of HSEP or SEP does not improve PA at 1 year, as compared to unsupervised WA alone. Factors of importance for increasing PA in patients with intermittent claudication require further investigation. Impact At the 1-year follow-up, the addition of intermittent claudication-tailored additional exercise strategies did not improve daily PA in patients with intermittent claudication compared with unsupervised Nordic pole WA alone. Future studies may explore the role of behavior change techniques to increase PA in this patient group. [ABSTRACT FROM AUTHOR]

Background: This study investigates the association between self-rated health and the time spent in sedentary behavior (SB), low light-intensity physical activity (LLPA), high light-intensity physical activity (HLPA), and moderate to vigorous physical activity (MVPA), by controlling for demographics, socioeconomic status, and chronic diseases. Methods: A total of 1665 participants (55% women) completed a questionnaire about demographics, chronic diseases, and anthropometric characteristics and provided objective physical activity data on time in SB, LLPA, HLPA, and MVPA, using an ActiGraph 7164 accelerometer. Association between self-rated health and activity data was explored in a compositional data analysis. Results: The multinomial logistic regression analysis showed a significantly lower time spent in MVPA in proportion to time in other movement behaviors (SB, LLPA, and HLPA) for participants who rated their health as alright or poor compared with excellent (P < .001). Participants with poor, compared with excellent health, spent about a third of the time in MVPA (17 vs 50 min), marginally higher time in HLPA (134 vs 125 min), more time in LLPA (324 vs 300 min), and similar time in SB (383 vs 383 min), accounting for confounders and time in other movement behaviors. Conclusions: Promoting MVPA, as opposed to time in other movement behaviors, is suggested to be beneficial for excellent self-rated health. [ABSTRACT FROM AUTHOR]

Background: People with prediabetes or type 2 diabetes (T2D) need to be physically active, including moderate-to-vigorous intensity physical activity (MVPA) and light-intensity physical activity (LIPA) and reduce time in sedentary behaviour (SB). Few studies have evaluated the effect of randomised controlled trials taking all movement behaviours into account. This study aimed to investigate the effects of a 2-year pedometer-based intervention in people with prediabetes or T2D on relative time in movement behaviours. Methods: Secondary analysis of longitudinal data on individuals with prediabetes or T2D from a three-armed randomised controlled trial, the Sophia Step Study, was conducted. The three groups were (1) a multi‑component group (self‑monitoring of steps with a pedometer plus counselling), (2) a single‑component group (self‑monitoring of steps with a pedometer, without counselling), and (3) a standard care group (control). The three behaviours MVPA, LIPA and SB during waking hours were measured with an ActiGraph GT1M accelerometer at baseline, 6, 12, 18 and 24 months. Relative time in MVPA, LIPA and SB for each participant at each time point was calculated and used as outcome measures. Linear mixed models assessed the effect of the intervention over time. Results: In total 184 participants with mean (SD) age 64.3 (7.6) years and 41% female was included. In the multi-component group, compared to the control group, a significant group-by-time interaction effect for relative time in all three behaviours was found at 6 and 18 months and for MVPA and SB at 24 months. In the single-component group, compared to the control group, an effect occurred in the MVPA and SB behaviours at 6 months and MVPA and LIPA at 24 months. The estimated marginal means ranged from 0.9 to 1.5% of more MVPA, 1.9–3.9% of less LIPA and from 0.5% of less SB to 1.7 more SB in the intervention groups compared to the control group. Conclusions: The findings show a beneficial effect on all behaviours over time in the two intervention groups compared to the control group. A more pronounced effect occurred in the multi-component intervention compared to the single-component intervention, implicating the importance of counselling in pedometer-based interventions. Trial registration ClinicalTrials.gov, NCT02374788 [ABSTRACT FROM AUTHOR]

The article presents results from Sweden's 2018 Report Card on Physical Activity for Children and Youth. It mentions indicators on the basis of which grades are assigned including organized sport participation, active transportation, and sedentary behavior. The report card reveals that overall physical activity is low and sedentary behavior is high despite the conducive environment for physical activity in Sweden.

Background: Sedentary behavior is associated with health risks in adults. The potential benefits of reducing sedentary time may be dependent not only on decrease per se, but also on the type of activity it replaces. Few longitudinal studies have investigated the effects on mortality when replacing objectively assessed sedentary time with another physical activity (PA) behavior. Objective: To investigate the effects of replacing objectively assessed sedentary time with time in light-intensity PA or moderate-vigorous PA (MVPA) on all-cause mortality, cardiovascular disease (CVD) mortality or cancer mortality in a cohort with 15 years follow-up time. Methods: In total, 851 women and men from the population-based Sweden Attitude Behaviour and Change study were included. Time spent sedentary, in light-intensity PA and in MVPA were assessed using an Actigraph 7164 accelerometer. Mortality data were obtained from Swedish registers. Cox proportional hazards models estimated hazard ratios (HR) of mortality with 95% confidence intervals (CI) and isotemporal substitution models were used to estimate the effect of replacing sedentary behavior with PA for the same amount of time. Results: Over a follow-up of 14.2 years (SD 1.9) with 12,117 person-years at risk, 79 deaths occurred, 24 deaths from CVD, 27 from cancer, and 28 from other causes. Replacing 30 minutes/day of sedentary time with light-intensity PA was associated with significant reduction in all-cause mortality risk (HR: 0.89, 95% CI: 0.81-0.98) and CVD mortality risk (HR: 0.76, 95% CI: 0.63-0.92). Replacing 10 minutes of sedentary time with MVPA was associated with reduction in CVD mortality risk (HR: 0.62, 95% CI: 0.42-0.91). No statistically significant reductions were found for cancer mortality. Conclusion: This statistical modelling study suggests that replacing sedentary time with light-intensity PA could have beneficial effect on both all-cause mortality and CVD mortality. Replacing sedentary time with MVPA could reduce CVD mortality. [ABSTRACT FROM AUTHOR]