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Background: Risk factors including smoking, alcohol intake, physical activity (PA), and sleep patterns have been associated with cancer risk. Clonal hematopoiesis (CH), including mosaic chromosomal alterations and clonal hematopoiesis of indeterminate potential, is linked to increased hematopoietic cancer risk and could be used as common preclinical intermediates for the better understanding of associations of risk factors with rare hematologic malignancies., Methods: We analyzed cross-sectional data from 478,513 UK Biobank participants without hematologic malignancies using multivariable-adjusted analyses to assess the associations between lifestyle factors and CH types., Results: Smoking was reinforced as a potent modifiable risk factor for multiple CH types, with dose-dependent relationships persisting after cessation. Males in socially deprived areas of England had a lower risk of mosaic loss of chromosome Y (mLOY), females with moderate/high alcohol consumption (2-3 drinks/day) had increased mosaic loss of the X chromosome risk [OR = 1.17; 95% confidence interval (CI), 1.09-1.25; P = 8.31 × 10-6] compared with light drinkers, active males (moderate-high PA) had elevated risks of mLOY (PA category 3: OR = 1.06; 95% CI, 1.03-1.08; P = 7.57 × 10-6), and men with high body mass index (≥40) had reduced risk of mLOY (OR = 0.57; 95% CI, 0.51-0.65; P = 3.30 × 10-20). Sensitivity analyses with body mass index adjustment attenuated the effect in the mLOY-PA associations (IPAQ2: OR = 1.03; 95% CI, 1.00-1.06; P = 2.13 × 10-2 and IPAQ3: OR = 1.03; 95% CI, 1.01-1.06; P = 7.77 × 10-3)., Conclusions: Our study reveals associations between social deprivation, smoking, and alcohol consumption and CH risk, suggesting that these exposures could contribute to common types of CH and potentially rare hematologic cancers., Impact: This study underscores the impact of lifestyle factors on CH frequency, emphasizing social, behavioral, and clinical influences and the importance of sociobehavioral contexts when investigating CH risk factors., (©2024 American Association for Cancer Research.)

Background: A shift from self-reports to wearable sensors for global physical activity (PA) surveillance has been recommended. The conventional use of a generic cut-point to assess moderate-to-vigorous PA (MVPA) is problematic as these cut-points are often derived from non-representative samples under non-ecological laboratory conditions. This study aimed to develop age- and sex-specific (age-sex) cut-points for MVPA based on population-standardized values as a feasible approach to assess the adherence to PA guidelines and to investigate its associations with all-cause mortality., Methods: A total of 7601 participants (20-85+ years) were drawn from the 2003-2004 and 2005-2006 National Health and Nutrition Examination Surveys (NHANES). Minutes per week of MVPA were assessed with a hip-worn accelerometer. Counts per minute (CPM) were used to define an age- and sex-specific target intensity, representing the intensity each person should be able to reach based on their age and sex. Age- and sex-specific MVPA cut-points were defined as any activity above 40% of the target intensity. These population- and free-living-based age-sex specific cut-points overcome many of the limitations of the standard generic cut-point approach. For comparison, we also calculated MVPA with a generic cut-point of 1952 CPM. Both approaches were compared for assessing adherence to PA guidelines and association of MVPA with all-cause mortality (ascertained through December 2015)., Results: Both approaches indicated that 37% of the sample met the 150+ min/week guideline. The generic cut-point approach showed a trend to inactivity with age, which was less pronounced using the age-sex cut-points. Overall mortality rates were comparable using generic cut-point (hazard ratio (HR) = 0.61, 95% confidence interval (95%CI): 0.50‒0.73) or age-sex cut-points (HR = 0.57, 95%CI: 0.50‒0.66) for the entire sample. The generic cut-point method revealed an age- and sex-related gap in the benefits of achieving 150+ min/week of MVPA, with older adults showing an 18% greater reduction in mortality rates than younger adults, and a larger difference in women than in men. This disparity disappeared when using age-sex-specific cut-points., Conclusion: Our findings underscore the value of age-sex cut-points for global PA surveillance. MVPA defined with age-sex thresholds was associated with all-cause mortality and the dose‒response was similar for all ages and sexes. This aligns with the single recommendation of accumulating 150+ min/week MVPA for all adults, irrespective of age and sex. This study serves as a proof of concept to develop this methodology for PA surveillance over more advanced open-source acceleration metrics and other national and international cohorts., Competing Interests: Competing interests The authors declare that they have no competing interests., (Copyright © 2024. Production and hosting by Elsevier B.V.)

Background: The effects of usual physical activity on physiology and disease prevention are not fully understood. We examined the associations between physical activity, metabolites, and breast cancer risk., Methods: Physical activity levels were assessed using doubly labeled water, accelerometers, and 24-hr recalls in the IDATA study (N = 707 participants, ages 50-74 years, 51% women), with 1-6 assessments over 12 months and two blood sample collections. Partial Spearman correlations were used to estimate associations between physical activity and 843 serum metabolites, corrected for multiple testing. Conditional logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of metabolites with postmenopausal breast cancer in a nested case-control study (621 cases, 621 controls), all statistical tests were 2-sided., Results: Physical activity was associated with 164 metabolites spanning numerous pathways, including amino acid and fatty acid metabolism. Twelve of these metabolites were also associated with breast cancer risk, ten of which supported a protective role of physical activity. Notably, higher physical activity was associated with lower 16alpha-hydroxy DHEA 3-sulfate (androgen) and adipoylcarnitine (fatty acid), both of which were associated with increased breast cancer risk (OR per 1 standard deviation (SD)=1.34, 95% CI = 1.16-1.55 and 1.26,1.11-1.42, respectively). Higher physical activity energy expenditure was also associated with lower sphingomyelin (d18:1/20:1, d18:2/20:0), which was associated with a reduced breast cancer risk (0.82,0.73-0.93)., Conclusion: Physical activity is associated with a broad range of metabolites, many of which are consistent with a protective effect against breast cancer. Our findings highlight potential metabolic pathways for cancer prevention., (Published by Oxford University Press 2024.)

The relationship between racial/ethnic residential segregation and physical activity (PA) remains unclear with both positive and negative associations between segregation and PA recently reported. We aimed to examine the relationship between county-level residential segregation and total daily PA and domain-specific PA and whether these associations varied by gender. Participants (N = 2625, mean age [SD] = 45.2 [15.4]) were recruited from the AmeriSpeak panel who completed up to two Activities Completed over Time in 24 Hours (ACT24) previous day recalls in 2019. PA outcomes were created for the following: (1) light PA (LPA), (2) moderate-to-vigorous PA (MVPA), (3) total active time, and (4) domain-specific PA, including leisure, work, household, transport, personal, and other activities. County-level residential segregation based on isolation. Weighted generalized linear models were used to examine the relationship between county-level segregation and each PA outcome, controlling for age, gender, race/ethnicity, income, employment, body mass index, county-level poverty, and census region. Overall, results showed no association between county-level residential segregation and LPA, MVPA, total active time, and domain-specific PA among NH Black and Hispanic populations. Among NH Black females, greater residential segregation was associated with more total hours/day of activity (β = 3.54, 95% CI [0.23, 6.85]). Only NH Black females living in segregated neighborhoods had more total active time. Additionally, it is important to acknowledge that these relationships may vary among NH Black and Hispanic populations. Future studies should examine the interaction between segregation and a broader range of individual, contextual, and environmental factors in relation to PA and domain-specific PA., (© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Abstract: Early observations that only a small proportion of U.S. adults were engaging in enough aerobic physical activity to provide substantial health benefit helped shape our public health messaging for physical activity. This messaging has consistently indicated that most adults should increase their activity levels. However, it has been difficult to accurately estimate the proportion of adults who engage in sufficient levels of aerobic activity in the population, with survey-based estimates ranging from 22% in 1994 to 54% in 2018 and widely differing estimates from device-based measures. Recent accelerometer-based studies of physical activity and mortality risk provide new evidence that at least 50% of U.S. adults engage in enough aerobic physical activity to be at low risk for premature mortality. We argue that this observation should lend greater confidence to our current survey-based surveillance estimates, which indicate that a large proportion of adults is physically active. This new insight may also provide clues that could further strengthen our public health messaging for physical activity by placing more emphasis on the maintenance of healthy activity levels throughout life and possibly by using descriptive social norms as an additional intervention element-while continuing current efforts to encourage the adoption of healthy activity levels for less active adults in the population., (Copyright © 2024 Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a “work of the United States Government” for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of the Federal Government.)

Background: Light at night, which may cause circadian disruption, is a potential pancreatic cancer risk factor. However, evidence from related exposures such as poor sleep health and shift work remains inconclusive and sparsely investigated., Methods: We evaluated associations between self-reported typical sleep duration, chronotype, shift work, insomnia symptoms, snoring, and daytime sleeping and pancreatic ductal adenocarcinomas (PDAC) incidence among 475,286 UK Biobank participants. We used Cox proportional hazards models to estimate HRs and 95% confidence intervals (CI) adjusting for age, sex, body mass index, smoking status, duration, and frequency, alcohol intake, diabetes status, race, and employment/shift work., Results: Over 14 years of follow-up, 1,079 adults were diagnosed with PDAC. There were no associations observed between sleep characteristics, including sleep duration [<7 vs. 7-<9 hours; HR, 1.03; 95% CI, 0.90-1.19; ≥9 hours; HR, 1.00 (0.81-1.24), evening chronotype ("definitely" an evening person vs. "definitely" a morning person; HR, 0.99 (0.77-1.29)], shift work, insomnia symptoms, snoring, or daytime sleep and PDAC risk., Conclusions: Self-reported typical sleep characteristics and shift work were not associated with PDAC risk., Impact: Considering the role of light at night and shift work in circadian disruption and cancer risk, it is plausible that poor sleep health among a general population may be related to cancer risk through similar sleep and circadian disrupting processes. This work may suggest that typical sleep characteristics and shift work are not associated with PDAC, although additional work is needed to confirm these findings., (©2024 American Association for Cancer Research.)

Study Objectives: To examine the associations between sleep duration, continuity, timing, and mortality using actigraphy among adults., Methods: Data were from a cohort of 88 282 adults (40-69 years) in UK Biobank that wore a wrist-worn triaxial accelerometer for 7 days. Actigraphy data were processed to generate estimates of sleep duration and other sleep characteristics including wake after sleep onset (WASO), number of 5-minute awakenings, and midpoint for sleep onset/wake-up and the least active 5 hours (L5). Data were linked to mortality outcomes with follow-up to October 31, 2021. We implemented Cox models (hazard ratio, confidence intervals [HR, 95% CI]) to quantify sleep associations with mortality. Models were adjusted for demographics, lifestyle factors, and medical conditions., Results: Over an average of 6.8 years 2973 deaths occurred (1700 cancer, 586 CVD deaths). Overall sleep duration was significantly associated with risk for all-cause (p < 0.01), cancer (p < 0.01), and CVD (p = 0.03) mortality. For example, when compared to sleep durations of 7.0 hrs/d, durations of 5 hrs/d were associated with a 29% higher risk for all-cause mortality (HR: 1.29 [1.09, 1.52]). WASO and number of awakenings were not associated with mortality. Individuals with L5 early or late midpoints (<2:30 or ≥ 3:30) had a ~20% higher risk for all-cause mortality, compared to those with intermediate L5 midpoints (3:00-3:29; p ≤ 0.01; e.g. HR ≥ 3:30: 1.19 [1.07, 1.32])., Conclusions: Shorter sleep duration and both early and late sleep timing were associated with a higher mortality risk. These findings reinforce the importance of public health efforts to promote healthy sleep patterns in adults., (Published by Oxford University Press on behalf of Sleep Research Society (SRS) 2023.)

Background: Studies of sleep and prostate cancer are almost entirely based on self-report, with limited research using actigraphy. Our goal was to evaluate actigraphy-measured sleep and prostate cancer and to expand on findings from prior studies of self-reported sleep., Methods: We prospectively examined 34 260 men without a history of prostate cancer in the UK Biobank. Sleep characteristics were measured over 7 days using actigraphy. We calculated sleep duration, onset, midpoint, wake-up time, social jetlag (difference in weekend-weekday sleep midpoints), sleep efficiency (percentage of time spent asleep between onset and wake-up time), and wakefulness after sleep onset. Cox proportional hazards models were used to estimate covariate-adjusted hazards ratios (HRs) and 95% confidence intervals (CIs)., Results: Over 7.6 years, 1152 men were diagnosed with prostate cancer. Sleep duration was not associated with prostate cancer risk. Sleep midpoint earlier than 4:00 am was not associated with prostate cancer risk, though sleep midpoint of 5:00 am or later was suggestively associated with lower prostate cancer risk but had limited precision (earlier than 4:00 am vs 4:00-4:59 am HR = 1.00, 95% CI = 0.87 to 1.16; 5:00 am or later vs 4:00-4:59 am HR = 0.79, 95% CI = 0.57 to 1.10). Social jetlag was not associated with greater prostate cancer risk (1 to <2 hours vs <1 hour HR = 1.06, 95% CI = 0.89 to 1.25; ≥2 hours vs <1 hour HR = 0.90, 95% CI = 0.65 to 1.26). Compared with men who averaged less than 30 minutes of wakefulness after sleep onset per day, men with 60 minutes or more had a higher risk of prostate cancer (HR = 1.20, 95% CI = 1.00 to 1.43)., Conclusions: Of the sleep characteristics studied, higher wakefulness after sleep onset-a measure of poor sleep quality-was associated with greater prostate cancer risk. Replication of our findings between wakefulness after sleep onset and prostate cancer are warranted., (Published by Oxford University Press 2023.)

Purpose: Accelerometers are used to objectively measure physical behaviors in free-living environments, typically for seven consecutive days or more. We examined whether participants experience "wear fatigue," a decline in wear time day over day, during typical assessment period acquired in a nationally representative sample of 6- to 80-yr-olds in the United States., Methods: Participants were instructed to wear an ActiGraph GT3X+ on their nondominant wrist continuously for seven consecutive days. Participants with seven complete days of recorded data, regardless of wear status, were included in the analyses ( N = 13,649). Wear was scored with the sleep, wake, and nonwear algorithm., Results: Participants averaged 1248 ± 3.6 min·d -1 (mean ± SE) of wear over the assessment, but wear time linearly decreased from day 1 (1295 ± 3.2 min) to day 7 (1170 ± 5.3 min), resulting in a wear fatigue of -18.1 ± 0.7 min·d -1 ( β ± SE). Wear fatigue did not differ by sex but varied by age-group-highest in adolescents (-26.8 ± 2.4 min·d -1 ) and lowest in older adults (-9.3 ± 0.9 min·d -1 ). Wear was lower in evening (1800-2359 h) and early morning (0000-0559 h) compared with the middle of the day and on weekend days compared with weekdays. We verified similar wear fatigue (-23.5 ± 0.7 min·d -1 ) in a separate sample ( N = 14,631) with hip-worn devices and different wear scoring. Applying minimum wear criteria of ≥10 h·d -1 for ≥4 d reduced wear fatigue to -5.3 and -18.7 min·d -1 for the wrist and hip, respectively., Conclusions: Patterns of wear suggest noncompliance may disproportionately affect estimates of sleep and sedentary behavior, particularly for adolescents. Further study is needed to determine the effect of wear fatigue on longer assessments., (Copyright © 2023 by the American College of Sports Medicine.)

Background: The association of fitness with cancer risk is not clear., Methods: We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for risk of lung, colorectal, endometrial, breast, and prostate cancer in a subset of UK Biobank participants who completed a submaximal fitness test in 2009-12 (N = 72,572). We also investigated relationships using two-sample Mendelian randomisation (MR), odds ratios (ORs) were estimated using the inverse-variance weighted method., Results: After a median of 11 years of follow-up, 4290 cancers of interest were diagnosed. A 3.5 ml O 2 ⋅min -1 ⋅kg -1 total-body mass increase in fitness (equivalent to 1 metabolic equivalent of task (MET), approximately 0.5 standard deviation (SD)) was associated with lower risks of endometrial (HR = 0.81, 95% CI: 0.73-0.89), colorectal (0.94, 0.90-0.99), and breast cancer (0.96, 0.92-0.99). In MR analyses, a 0.5 SD increase in genetically predicted O 2 ⋅min -1 ⋅kg -1 fat-free mass was associated with a lower risk of breast cancer (OR = 0.92, 95% CI: 0.86-0.98). After adjusting for adiposity, both the observational and genetic associations were attenuated., Discussion: Higher fitness levels may reduce risks of endometrial, colorectal, and breast cancer, though relationships with adiposity are complex and may mediate these relationships. Increasing fitness, including via changes in body composition, may be an effective strategy for cancer prevention., (© 2023. The Author(s).)

Objectives: To examine whether moderate-to-vigorous physical activity (MVPA) modifies the association between sedentary time and mortality and vice versa, and estimate the joint associations of MVPA and sedentary time on mortality risk., Methods: This study involved individual participant data analysis of four prospective cohort studies (Norway, Sweden, USA, baseline: 2003-2016, 11 989 participants ≥50 years, 50.5% women) with hip-accelerometry-measured physical activity and sedentary time. Associations were examined using restricted cubic splines and fractional polynomials in Cox regressions adjusted for sex, education, body mass index, smoking, alcohol, study cohort, cardiovascular disease, cancer, and/or diabetes, accelerometry wear time and age., Results: 6.7% (n=805) died during follow-up (median 5.2 years, IQR 4.2 years). More than 12 daily sedentary hours (reference 8 hours) was associated with mortality risk only among those accumulating <22 min of MVPA per day (HR 1.38, 95% CI 1.10 to 1.74). Higher MVPA levels were associated with lower mortality risk irrespective of sedentary time, for example, HR for 10 versus 0 daily min of MVPA was 0.85 (95% CI 0.74 to 0.96) in those accumulating <10.5 daily sedentary hours and 0.65 (95% CI 0.53 to 0.79) in those accumulating ≥10.5 daily sedentary hours. Joint association analyses confirmed that higher MVPA was superior to lower sedentary time in lowering mortality risk, for example, 10 versus 0 daily min of MVPA was associated with 28-55% lower mortality risk across the sedentary time spectrum (lowest risk, 10 daily sedentary hours: HR 0.45, 95% CI 0.31 to 0.65)., Conclusions: Sedentary time was associated with higher mortality risk but only in individuals accumulating less than 22 min of MVPA per day. Higher MVPA levels were associated with lower mortality risk irrespective of the amount of sedentary time., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: The purpose of this study was to determine the criterion validity of Activities Completed over Time (ACT24), an automated previous-day recall tool designed for mobile devices for 1) estimating sedentary versus active time compared with an activPAL, and 2) estimating time spent in activity domains (e.g., work, household, leisure) compared with direct observation (DO)., Methods: Over a 7-d study period, 53 participants were sent invitations to complete three automated ACT24 recalls and to wear an activPAL device. A subset ( N = 24) consented to two, 3-h video-recorded DO sessions. activPAL and ACT24 data were matched by date, and agreement for sedentary versus active time was compared between methods using paired t -tests for mean differences and spearman correlations. We compared DO and ACT24 results by domain for overall time use and separately for sedentary and active time using κ statistics and tested mean differences with linear mixed models., Results: Compared with the activPAL, the mean difference in ACT24 sedentary time was 1.9% (mean (95% confidence interval), -0.17 (-0.75 to 0.40) h·d -1 ), and the mean difference for ACT24 active time was 2.2% (0.14 (-0.32 to 0.60) h·d -1 ). Correlations were R = 0.61 (95% confidence interval, 0.39 to 0.76) and R = 0.65 (0.44 to0.78) for sedentary and active time, respectively. Domain-specific agreement was substantial for leisure-time, work, and shopping/errands ( κ range, 0.63-0.79), moderate for transportation ( κ = 0.49), and fair for personal care and household activities ( κ = 0.24 and 0.33). ACT24 estimates of average time within each domain were not significantly different from DO., Conclusions: The present study confirms that ACT24 is accurate for group-level estimation of active and sedentary time. Domain-specific agreement tended to be higher for more commonly reported activities and those that were of longer duration., (Copyright © 2023 by the American College of Sports Medicine.)

Purpose: Physical activity levels (PAL) are associated with mortality risk and were instrumental in estimating national energy requirements, but we are unaware of population-based estimates of PAL in US adults. Thus, we conducted a nationwide survey using a validated previous-day recall method to estimate PAL and the behavioral determinants of low and higher PAL., Methods: Participants from the AmeriSpeak panel 20-75 yr of age ( N = 2640) completed Activities Completed over Time in 24-hours previous-day recalls. PAL values were estimated as the average metabolic equivalent value over 24 h. Recalls were conducted on randomly selected days in October and November 2019. Survey sample design weights were applied to reflect the US population., Results: Mean age was 45.3 yr, 51% were female, 67% were non-Hispanic White, and 37% had a body mass index of ≥30 kg·m -2 . US adults reported a mean PAL of 1.63 (95% confidence interval, 1.60-1.65), and 39% (37%-42%) of adults reported PAL ≥1.6 on a given day. Men reported higher PAL than women (1.67 vs 1.59), and older adults reported lower PAL. Adults with PAL <1.4 spent 81% (12.1 h·d -1 ) of their waking day sedentary and 19% (2.7 h·d -1 ) in total physical activity. Adults with PAL considered to be "active"(1.6-1.89) spent only 49% (8.0 h·d -1 ) of their waking day sedentary, and 51% (8.3 h·d -1 ) physically active., Conclusions: Our study provides novel estimates of PAL in a nationwide sample of US adults and a description of the type and intensity of sedentary and physically active behaviors contributing to low and higher PAL. These findings may inform public health messages aimed at increasing physical activity in adults and potentially contribute to obesity prevention efforts., (Copyright © 2022 by the American College of Sports Medicine.)

We examined associations of neighborhood walkability with the prevalence, type, timing, and temporal characteristics of walking in a representative sample of United States adults. Adults (N = 2649) completed the ACT24 previous-day recall. Home address was linked to block-group National Walkability Index. Survey-adjusted Poisson and logistic regression examined the association of walkability with outcomes. Those who lived in more walkable neighborhoods were more likely to walk overall, for transport, or in the evening. In those who walked, higher walkability was associated with less morning but more evening walking. There were no associations of walkability with the frequency or duration of walking episodes., (Published by Elsevier Ltd.)

Background: Survival benefits of self-reported recreational physical activity (PA) during cancer survivorship are well-documented in common cancer types, yet there are limited data on the associations between accelerometer-derived PA of all domains, sedentary behavior, and mortality in large, diverse cohorts of cancer survivors., Methods: Participants included adults who reported a cancer diagnosis in the National Health and Nutrition Examination Survey and wore an accelerometer for up to 7 days in 2003-2006. Participants were followed for subsequent mortality through 2015. We examined the association of light PA, moderate to vigorous PA, total PA, and sedentary behavior, with all-cause mortality. Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for demographics and health indicators., Results: A total of 480 participants (mean age of 68.8 years [SD = 12.4] at the time of National Health and Nutrition Examination Survey assessment) reported a history of cancer. A total of 215 deaths occurred over the follow-up period. For every 1-h/d increase in light PA and moderate to vigorous PA (MVPA), cancer survivors had 49% (HR = 0.51, 95% CI = 0.34 to 0.76) and 37% (HR = 0.63 , 95% CI = 0.40 to 0.99) lower hazards of all-cause mortality, respectively. Total PA demonstrated similar associations with statistically significantly lower hazards of death for each additional hour per day (HR = 0.68, 95% CI = 0.54 to 0.85), as did every metabolic equivalents of task-hour per day increase in total PA estimations of energy expenditure (HR = 0.88, 95% CI = 0.82 to 0.95). Conversely, more sedentary time (1 h/d) was not associated with statistically significantly higher hazards (HR = 1.08, 95% CI = 0.94 to 1.23)., Conclusions: These findings reinforce the current recommendations for cancer survivors to be physically active and underscore the continued need for widespread PA promotion for long-term survival in older cancer survivors., (© The Author(s) 2023. Published by Oxford University Press.)

Importance: Higher physical activity levels are associated with lower risks of cancer, cardiovascular disease, and diabetes, but associations with many common and less severe health conditions are not known. These conditions impose large health care burdens and reduce quality of life., Objectives: To investigate the association between accelerometer-measured physical activity and the subsequent risk of hospitalization for 25 common reasons for hospitalization and to estimate the proportion of these hospitalizations that might have been prevented if participants had higher levels of physical activity., Design, Setting, and Participants: This prospective cohort study used data from a subset of 81 717 UK Biobank participants aged 42 to 78 years. Participants wore an accelerometer for 1 week (between June 1, 2013, and December 23, 2015) and were followed up over a median (IQR) of 6.8 (6.2-7.3) years; follow-up for the current study ended in 2021 (exact date varied by location)., Exposures: Mean total and intensity-specific accelerometer-measured physical activity., Main Outcomes and Measures: Hospitalization for the most common health conditions. Cox proportional hazards regression analysis was used to estimate hazard ratios (HRs) and 95% CIs for mean accelerometer-measured physical activity (per 1-SD increment) and risks of hospitalization for 25 conditions. Population-attributable risks were used to estimate the proportion of hospitalizations for each condition that might be prevented if participants increased their moderate to vigorous physical activity (MVPA) by 20 minutes per day., Results: Among 81 717 participants, the mean (SD) age at accelerometer assessment was 61.5 (7.9) years; 56.4% were female, and 97.0% self-identified as White. Higher levels of accelerometer-measured physical activity were associated with lower risks of hospitalization for 9 conditions: gallbladder disease (HR per 1 SD, 0.74; 95% CI, 0.69-0.79), urinary tract infections (HR per 1 SD, 0.76; 95% CI, 0.69-0.84), diabetes (HR per 1 SD, 0.79; 95% CI, 0.74-0.84), venous thromboembolism (HR per 1 SD, 0.82; 95% CI, 0.75-0.90), pneumonia (HR per 1 SD, 0.83; 95% CI, 0.77-0.89), ischemic stroke (HR per 1 SD, 0.85; 95% CI, 0.76-0.95), iron deficiency anemia (HR per 1 SD, 0.91; 95% CI, 0.84-0.98), diverticular disease (HR per 1 SD, 0.94; 95% CI, 0.90-0.99), and colon polyps (HR per 1 SD, 0.96; 95% CI, 0.94-0.99). Positive associations were observed between overall physical activity and carpal tunnel syndrome (HR per 1 SD, 1.28; 95% CI, 1.18-1.40), osteoarthritis (HR per 1 SD, 1.15; 95% CI, 1.10-1.19), and inguinal hernia (HR per 1 SD, 1.13; 95% CI, 1.07-1.19), which were primarily induced by light physical activity. Increasing MVPA by 20 minutes per day was associated with reductions in hospitalization ranging from 3.8% (95% CI, 1.8%-5.7%) for colon polyps to 23.0% (95% CI, 17.1%-28.9%) for diabetes., Conclusions and Relevance: In this cohort study of UK Biobank participants, those with higher physical activity levels had lower risks of hospitalization across a broad range of health conditions. These findings suggest that aiming to increase MVPA by 20 minutes per day may be a useful nonpharmaceutical intervention to reduce health care burdens and improve quality of life.

Background: Moderate-vigorous physical activity (MVPA) reduces colon cancer risk; however, it is unclear how the timing of MVPA throughout the adult life course impacts colon cancer risk. We evaluated whether maintenance and changes in MVPA levels over time are associated with colon cancer risk., Methods: We assessed 293,198 adults ages 50 to 71 years in the NIH-AARP Diet and Health Study. Participants completed baseline health and physical activity questionnaires between 1995 and 1997 and were followed through 2011, (average follow-up of 13.1 years). There were 5,072 colon cancer cases over the study period. Using latent class trajectory models, we identified seven distinct MVPA trajectories across the adult life course (15-18, 19-29, 30-35, and past 10-years) and ran Cox proportional hazards regression models., Results: Compared with those who maintained low MVPA levels, those who maintained high and moderate levels of MVPA had a lower risk of colon cancer [HR, 0.85; confidence interval (CI), 0.78-0.93; HR = 0.87; CI, 0.76-1.00)], and those who increased MVPA levels early and later during adulthood had a lower colon cancer risk (HR, 0.90; CI, 0.80-1.01) and (HR, 0.92; CI, 0.80-1.06), respectively. Those who decreased MVPA early in adulthood had an increased risk of colon cancer (HR, 1.12; CI, 1.02-1.23). These associations were stronger in adults ages <65 years at baseline and in men (P < 0.001)., Conclusions: Consistent participation in MVPA throughout life may reduce colon cancer risk., Impact: These findings emphasize that engaging in MVPA throughout adulthood lowers risk of colon cancer., (©2022 American Association for Cancer Research.)

Background: Body mass index (BMI) during adulthood has been associated with pancreatic ductal adenocarcinoma (PDAC), however, patterns of body size across the adult life course have not been studied extensively. We comprehensively evaluated the association between adiposity across adulthood and PDAC., Methods: We conducted a prospective analysis of 269 480 (162 735 males, 106 745 females) National Institutes of Health-AARP Diet and Health Study participants, aged 50-71 years (1995-1996) who self-reported height and weight history. Participants were followed through December 31, 2011. We examined associations between BMI (kg/m2) at ages 18, 35, 50, and 50-71 (baseline) years, their trajectories determined from latent-class trajectory modeling, and incident PDAC. Cox proportional hazard models were used to calculate multivariable adjusted hazards ratios (HRs) and 95% confidence intervals (CIs)., Results: During up to 15.2 years of follow-up, 3092 (2020 males, 1072 females) patients with incident PDAC were identified. BMI at all 4 ages were statistically significantly associated with increased PDAC (per 5-unit increase, HR = 1.09-1.13) with higher magnitude associations in males than females at ages 35 years and older (Pinteraction < .05). Four BMI trajectories were created. Compared with normal-weight maintainers, normal-to-overweight, normal-to-obese class I, and overweight-to-obese class III trajectories had hazard ratios of 1.15 (95% CI = 1.06 to 1.25), 1.39 (95% CI = 1.25 to 1.54), and 1.48 (95% CI = 1.18 to 1.87), respectively (Pinteraction by sex = .07)., Conclusions: High BMI and BMI trajectories that result in overweight or obesity during adulthood were positively associated with PDAC, with stronger associations among those with early onset adiposity and those with male sex. Avoidance of excess body weight throughout the adult life course may prevent PDAC., (Published by Oxford University Press 2022.)

Importance: Higher amounts of physical activity are associated with increased longevity. However, whether different leisure time physical activity types are differentially associated with mortality risk is not established., Objectives: To examine whether participation in equivalent amounts of physical activity (7.5 to <15 metabolic equivalent of task [MET] hours per week) through different activity types is associated with mortality risk and to investigate the shape of the dose-response association., Design, Setting, and Participants: Participants in this cohort were respondents from the National Institutes of Health-AARP Diet and Health Study who completed the follow-up questionnaire between 2004 and 2005. This questionnaire collected data on weekly durations of different types of physical activities. Mortality was ascertained through December 31, 2019., Exposures: MET hours per week spent participating in the following activities: running, cycling, swimming, other aerobic exercise, racquet sports, golf, and walking for exercise., Main Outcomes and Measures: All-cause, cardiovascular, and cancer mortality. Separate multivariable-adjusted Cox proportional hazards regression models were fitted to estimate hazard ratios (HRs) and 95% CIs of mortality for each of the 7 types of leisure time physical activities, as well as the sum of these activities., Results: A total of 272 550 participants (157 415 men [58%]; mean [SD] age at baseline, 70.5 [5.4] years [range, 59-82 years]) provided information on types of leisure time activity, and 118 153 (43%) died during a mean (SD) follow-up of 12.4 (3.9) years. In comparison with those who did not participate in each activity, 7.5 to less than 15 MET hours per week of racquet sports (HR, 0.84; 95% CI, 0.75-0.93) and running (HR, 0.85; 95% CI, 0.78-0.92) were associated with the greatest relative risk reductions for all-cause mortality, followed by walking for exercise (HR, 0.91; 95% CI, 0.89-0.93), other aerobic activity (HR, 0.93; 95% CI, 0.90-0.95), golf (HR, 0.93; 95% CI, 0.90-0.97), swimming (HR, 0.95; 95% CI, 0.92-0.98), and cycling (HR, 0.97; 95% CI, 0.95-0.99). Each activity showed a curvilinear dose-response association with mortality risk; low MET hours per week of physical activity for any given activity type were associated with a large reduction in mortality risk, with diminishing returns for each increment in activity thereafter. Associations were similar for cardiovascular and cancer mortality., Conclusions and Relevance: This cohort study of older individuals found differences between different types of leisure time activities and mortality risk, but there were significant associations between participating in 7.5 to less than 15 MET hours per week of any activity and mortality risk.

Background: The 24-h rest and activity behaviors (i.e., physical activity, sedentary behaviors and sleep) are fundamental human behaviors essential to health and well-being. Functional principal component analysis (fPCA) is a flexible approach for characterizing rest-activity rhythms and does not rely on a priori assumptions about the activity shape. The objective of our study is to apply fPCA to a nationally representative sample of American adults to characterize variations in the 24-h rest-activity pattern, determine how the pattern differs according to demographic, socioeconomic and work characteristics, and examine its associations with general health status., Methods: The current analysis used data from adults 25 or older in the National Health and Nutrition Examination Survey (NHANES, 2011-2014). Using 7-day 24-h actigraphy recordings, we applied fPCA to derive profiles for overall, weekday and weekend rest-activity patterns. We examined the association between each rest-activity profile in relation to age, gender, race/ethnicity, education, income and working status using multiple linear regression. We also used multiple logistic regression to determine the relationship between each rest-activity profile and the likelihood of reporting poor or fair health., Results: We identified four distinct profiles (i.e., high amplitude, early rise, prolonged activity window, biphasic pattern) that together accounted for 86.8% of total variation in the study sample. We identified numerous associations between each rest-activity profile and multiple sociodemographic characteristics. We also found evidence suggesting the associations differed between weekdays and weekends. Finally, we reported that the rest-activity profiles were associated with self-rated health., Conclusions: Our study provided evidence suggesting that rest-activity patterns in human populations are shaped by multiple demographic, socioeconomic and work factors, and are correlated with health status., (© 2022. The Author(s).)

Objectives: We examined the associations of history and duration in high occupational physical activity (OPA) with long-term total and cause-specific mortality., Methods: The sample included 322 126 participants (135 254 women) from the National Institutes of Health-AARP Diet and Health Study, established in 1995-1996. History and duration in high OPA were reported by participants. All-cause, cardiovascular, cancer and other cause mortality records available through 31 December 2011., Results: The prevalence of high OPA was 52.1% in men and 16.1% in women. During 13.6 years (SD, 3.3) of follow-up, 73 563 participants (25 219 women) died. In age-adjusted models, the risk of death was higher among men (HR 1.14, 95% CI 1.12 to 1.16) and women (HR 1.22, 95% CI 1.18 to 1.26) with a history of high OPA. However, these associations were substantially attenuated in women (HR 1.04, 95% CI 1.00 to 1.07, an 81.8% attenuation) and eliminated in men (HR 1.02, 95% CI 0.99 to 1.04, 85.7% attenuation) after multivariable adjustments. Similar important attenuation results were found when examining duration in high OPA, as well as using cause-specific deaths as the outcomes. Educational attainment and smoking patterns were the main contributors in the excess mortality among people working in highly physically active jobs in both men and women., Conclusion: Participating in high OPA was not consistently associated with a higher mortality risk, after adjustments for education and smoking factors. Workers in high OPA should be aware that they might not be getting all well-known health benefits of being physically active if they are only very active at work., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Although 10 000 steps per day is widely promoted to have health benefits, there is little evidence to support this recommendation. We aimed to determine the association between number of steps per day and stepping rate with all-cause mortality., Methods: In this meta-analysis, we identified studies investigating the effect of daily step count on all-cause mortality in adults (aged ≥18 years), via a previously published systematic review and expert knowledge of the field. We asked participating study investigators to process their participant-level data following a standardised protocol. The primary outcome was all-cause mortality collected from death certificates and country registries. We analysed the dose-response association of steps per day and stepping rate with all-cause mortality. We did Cox proportional hazards regression analyses using study-specific quartiles of steps per day and calculated hazard ratios (HRs) with inverse-variance weighted random effects models., Findings: We identified 15 studies, of which seven were published and eight were unpublished, with study start dates between 1999 and 2018. The total sample included 47 471 adults, among whom there were 3013 deaths (10·1 per 1000 participant-years) over a median follow-up of 7·1 years ([IQR 4·3-9·9]; total sum of follow-up across studies was 297 837 person-years). Quartile median steps per day were 3553 for quartile 1, 5801 for quartile 2, 7842 for quartile 3, and 10 901 for quartile 4. Compared with the lowest quartile, the adjusted HR for all-cause mortality was 0·60 (95% CI 0·51-0·71) for quartile 2, 0·55 (0·49-0·62) for quartile 3, and 0·47 (0·39-0·57) for quartile 4. Restricted cubic splines showed progressively decreasing risk of mortality among adults aged 60 years and older with increasing number of steps per day until 6000-8000 steps per day and among adults younger than 60 years until 8000-10 000 steps per day. Adjusting for number of steps per day, comparing quartile 1 with quartile 4, the association between higher stepping rates and mortality was attenuated but remained significant for a peak of 30 min (HR 0·67 [95% CI 0·56-0·83]) and a peak of 60 min (0·67 [0·50-0·90]), but not significant for time (min per day) spent walking at 40 steps per min or faster (1·12 [0·96-1·32]) and 100 steps per min or faster (0·86 [0·58-1·28])., Interpretation: Taking more steps per day was associated with a progressively lower risk of all-cause mortality, up to a level that varied by age. The findings from this meta-analysis can be used to inform step guidelines for public health promotion of physical activity., Funding: US Centers for Disease Control and Prevention., Competing Interests: Declaration of interests AEP and CFP received funding for this project from US Centers for Disease Control and Prevention (CDC) Intergovernmental Personnel Act Agreement. BJJ receives grant funding through the British Heart Foundation. MRC and RSV have received grant funding through National Heart Lung and Blood Institute, National Institutes of Health (NIH). I-ML, KPG, and PP receive grant funding through NIH. KRE receives grant funding through NIH, Robert Wood Johnson Foundation, US Department of Transportation, and North Carolina Department of Transportation; receives consulting fees from NIH; and is on the Board of Trustees with the American College of Sports Medicine. DD has received grant funding through German Research Foundation, travel expenses for 10th International Meeting on Ageing, honoraria for being an instructor at Boston University School of Public Health, been an unpaid speaker for German Society of Epidemiology, and been an unpaid member of the Alumni Leadership Council of Boston University School of Public Health. JS receives grant funding through National Institutes on Aging, NIH. All other authors declare no competing interests., (Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Purpose: This study aimed to examine the shape of the relationship between physical activity (PA) and total energy expenditure (TEE) and to explore the role of energy balance status (negative, stable, positive) in influencing this association., Methods: Cross-sectional. Participants were 584 older adults (50-74 yr) participating in the Interactive Diet and Activity Tracking in AARP study. TEE was assessed by doubly labeled water and PA by accelerometer. The relationship between PA and TEE was assessed visually and using nonlinear methods (restricted cubic splines). Percent weight change (>3%) over a 6-month period was used as a proxy measurement of energy balance status., Results: TEE generally increased with increasing deciles of PA averaging 2354 (SD, 351) kcal·d-1 in the bottom decile to 2693 (SD, 480) kcal·d-1 in the top decile. Cubic spline models showed an approximate linear association between PA and TEE (linear relation, P < 0.0001; curvature, P = 0.920). Results were similar in subgroup analyses for individuals classified as stable or positive energy balance. For those in negative energy balance, TEE was generally flat with increasing deciles of PA averaging 2428 (SD, 285) kcal·d-1 in the bottom decile to 2372 (SD, 560) kcal·d-1 in the top decile., Conclusions: Energy balance status seems to play an important role in the relationship between PA and TEE. When in a positive energy balance, the relationship between TEE and PA was consistent with an additive model; however, when energy balance was negative, TEE seems to be consistent with a constrained model. These findings support PA for weight gain prevention by increasing TEE; however, the effect of PA on TEE during periods of weight loss may be limited. An adequately powered, prospective study is warranted to confirm these exploratory findings., (Copyright © 2021 by the American College of Sports Medicine.)

Objective: The Intuitive Eating Scale-2 (IES-2) has been shown to be a valid tool to assess the capability of eating in reaction to natural hunger/satiety cues. However, its factor structure seems to differ in function of cultural/socioeconomic backgrounds, and its psychometric properties among the adolescents with overweight/obesity (BMI-for-age percentile >85th) have not been examined yet. Thus, this study aims to 1) investigating the factorial structure/psychometric properties of IES-2 in adolescents with overweight/obesity; and 2) exploring the associations between impulsivity, quality of life disordered and intuitive eating., Methods: A total of 202 Portuguese adolescents (124 girls; 78 boys; 12-19 years) under weight-loss treatment with a mean BMI z-score of 2.41 (SD = 0.75) participated in this study. The IES-2 factor structure was explored by confirmatory factor analysis and bifactor models. Test-retest reliability analyses were performed over 6 months (n = 41) and associations between the variables under study were explored., Results: Confirmatory factor analyses with posthoc modifications resulted in a bifactor model with acceptable fit supporting one general factor (intuitive eating) and three specific factors (IES-2 subscales). The "Unconditional Permission to Eat" subscale could not be replicated in this sample. Test-retest reliability analyses suggested good temporal stability. Intuitive eating scores were negatively associated with grazing eating behavior and impulsivity (negative urgency) and positively linked to quality of life., Conclusions: An adjusted version of IES-2 can be an appropriate measure for assessing intuitive eating levels in adolescents with overweight/obesity. Research on intuitive eating has the potential to enhance pediatric weight-loss interventions., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Purpose: Higher levels of sedentary behavior are associated with early mortality, but the distribution of sedentary time by classes of behavior and demographic groups is poorly described in U.S. adults. To quantify the amount and sources of sedentary time in U.S. adults, we conducted a nationwide survey using a novel validated self-administered previous-day recall method and compared these values with a commonly used sitting time question., Methods: Participants from the AmeriSpeak panel 20 to 75 yr of age (N = 2640) completed up to two activities completed over time in 24 h (ACT24) previous-day recalls. Recalls were conducted on randomly selected days in October and November 2019. Survey sample designs were applied to reflect the U.S. population., Results: Mean age was 45.3 yr, 51% were female, 67% non-Hispanic White, and 37% had a body mass index of ≥30 kg·m-2. U.S. adults reported a mean 9.5 h·d-1 of sedentary time (95% confidence interval = 9.4, 9.7 h·d-1), which was 34% more than reported using a common surveillance measure (P < 0.01). Most daily sedentary time was accumulated in the leisure and work life domains, with leisure accounting for 47% (4.3 h·d-1, 95% confidence interval = 4.2, 4.5 h·d-1) of the total sedentary time. Eighty-two percent of leisure time was spent sedentary, mainly watching television/videos or engaged in Internet/computer use., Conclusions: U.S. adults appear to spend more time in sedentary behavior than previously thought, and the majority of this time is accumulated at work and in leisure time. Reducing sedentary screen time during leisure in favor of physically active could be an important intervention target in the effort to increase physical activity in U.S. adults., (Copyright © 2021 by the American College of Sports Medicine.)

A balance between the feasibility and validity of measures is an important consideration for physical activity research - particularly in school-based research with youth. The present study extends previously tested calibration methods to develop and test new equations for an online version of the Youth Activity Profile (YAP) tool, a self-report tool designed for school applications. Data were collected across different regions and seasons to develop more robust, generalizable equations. The study involved a total of 717 youth from 33 schools (374 elementary (ages 9-11), 224 middle (ages 11-14), and 119 high school (ages 14-18)) in two different states in the U.S. Participants wore a Sensewear monitor for a full week and then completed the online YAP at school to report physical activity (PA) and sedentary behaviors (SB) in school and at home. Accelerometer data were processed using an R-based segmentation program to compute PA and SB levels. Quantile regression models were used with half of the sample to develop item-specific YAP calibration equations and these were cross validated with the remaining half of the sample. Computed values of Mean Absolute Percent Error (MAPE) ranged from 15-25% with slightly lower error observed for the middle school sample. The new equations had improved precision compared to the previous versions when tested on the same sample. The online version of the YAP provides an efficient and effective way to capture school level estimates of PA and SB in youth.

Background: Surveillance of domain-specific physical activity in the United States is lacking. Thus, the authors describe domain-specific moderate to vigorous physical activity (MVPA) in a nationwide sample of US adults., Methods: Participants from the AmeriSpeak panel (n = 2649; 20-75 y; 50% female) completed the Activities Completed Over Time in 24-Hours previous-day recall. The authors estimated average MVPA duration (in hours per day) overall and in major life domains by sex, age, race/ethnicity, and education. They also described the most commonly reported MVPAs and timing of MVPA during the day., Results: Across all life domains, participants reported an average of 2.5 hours per day in MVPA. Most MVPA was accumulated during work (50% of total, 1.2 h/d) and household activities (28%, 0.7 h/d) with less MVPA reported in leisure time (15%, 0.4 h/d). Time reported in MVPA varied by sex, and race/ethnicity (P < .05). Walking at work and for exercise, childcare, and walking for transportation were the most commonly reported domain-specific MVPAs. A greater proportion of MVPA took place in the morning (∼06:00 h) and evening (∼18:00 h)., Conclusions: Work and household activities accounted for 78% of overall MVPA reported, while leisure-time MVPA accounted for only 15% of the total. Encouraging MVPA during leisure time and transportation remain important targets for promoting MVPA in US adults.

Background: Physical activity is associated with lower risk for endometrial cancer, but the extent to which the association is mediated by body mass index (BMI) in midlife is unclear. This study describes the physical activity-endometrial cancer association and whether BMI mediates this relationship., Methods: Participants were 67 705 women in the National Institutes of Health-AARP Diet and Health Study (50-71 years) who recalled their physical activity patterns starting at age 15-18 years. We identified 5 long-term physical activity patterns between adolescence and cohort entry (ie, inactive, maintained low, maintained high, increasers, decreasers). We used Cox regression to assess the relationship between these patterns and midlife BMI and endometrial cancer, adjusting for covariates. Mediation analysis was used to estimate the proportion of the physical activity-endometrial cancer association that was mediated by midlife BMI., Results: During an average 12.4 years of follow-up 1468 endometrial cancers occurred. Compared with long-term inactive women, women who maintained high or increased activity levels had a 19% to 26% lower risk for endometrial cancer (maintained high activity: hazard ratio = 0.81, 95% confidence interval [CI] = 0.67 to 0.98; increasers: hazard ratio = 0.74, 95% CI = 0.61 to 0.91). They also had a 50% to 77% lower risk for obesity in midlife (eg, maintained high activity: odds ratio for a BMI of 30-39.9 kg/m 2 = 0.50, 95% CI = 0.46 to 0.55; and maintained high activity, odds ratio for a BMI of ≥40 kg/m 2 = 0.32, 95% CI = 0.26 to 0.39). BMI was a statistically significant mediator accounting for 55.5% to 62.7% of the physical activity-endometrial cancer associations observed., Conclusions: Both maintaining physical activity throughout adulthood and adopting activity later in adulthood can play a role in preventing obesity and lowering the risk for endometrial cancer., (Published by Oxford University Press 2021. This work is written by US Government employees and is in the public domain in the US.)

Background: Understanding how participation is changing across domains of physical activity is important for monitoring progress and informing promotion efforts. The authors examined changes in physical activity participation in the National Health and Nutrition Examination Survey 2007/2008 to 2017/2018., Methods: The prevalence of inactivity, insufficient activity, and meeting the aerobic physical activity guideline in multidomain physical activity and each domain (leisure time, occupational/household, and transportation) was estimated for each cycle and stratified by selected characteristics. The authors tested trends over time and overall changes (2017/2018 vs 2007/2008)., Results: For multidomain physical activity, the prevalence of inactivity decreased linearly; meeting the aerobic guideline increased nonmonotonically, and the 2017/2018 prevalence (68.1%) was higher than 2007/2008 (64.1%). Similar findings were observed for adults aged ≥65 years, non-Hispanic Blacks, Hispanics, high school graduates, and adults with obesity. Domain-specific results varied, but decreasing trends in inactivity and increasing trends in meeting the guideline were consistently observed across subgroups for occupational/household activity. Meeting the guideline through transportation activity was rare., Conclusions: Increases in meeting the guideline and decreases in inactivity in multidomain activity and selected domains are encouraging results, especially among subgroups historically reporting low activity participation. Activity promotion efforts are important to maintain progress, and the transportation domain may be an underutilized source of physical activity.

Considerable public health efforts across the globe have focused on promoting physical activity (PA) and minimizing sedentary behaviour (SB) in youths. However, it is important to have valid, reliable and feasible methods to assess these behaviours in youths. The purpose of this study was to analyse the feasibility and reliability of the Spanish version of the previously validated Youth Activity Profile questionnaire (YAP) in children and adolescents. The YAP-S is a 15-item self-report instrument designed to capture PA and SB in youths. A total of 604 children (5-12 years old) and 346 adolescents (12-17 years old) filled out the questionnaire twice (14 days apart). Feasibility was evaluated through required time and number of misunderstood questions by participants. The test-retest reliability was examined using the weighted kappa coefficient (κ) and intraclass correlation coefficient. The average time to complete the questionnaire was 28.85 ± 14.28 and 12.24 ± 9.84 minutes in children and adolescents, respectively. No misunderstanding of questions was reported. The questionnaire showed an adequate reliability for activity at school, out-of-school and sedentary behaviours (k = 0.61-0.77; ICC = 0.77-0.89) in children and adolescents. The YAP-S might be considered a feasible and reliable questionnaire for assessing PA and SB in Spanish children and adolescents.

Background: There is limited evidence describing associations between cancer and function in diverse cancer types and its relationship with mortality. We investigated the relationship between cancer and poor ambulatory function and associations between ambulatory function and subsequent mortality., Methods: Participants included 233,135 adults ( n = 30,403 cancer and n = 202,732 cancer free) in the NIH-American Association of Retired Persons Diet and Health Study (1994-1996) who self-reported ambulatory function (e.g., walking pace and mobility disability: being unable to walk or walking at the slowest pace) in 2004-2006. Participants were followed for mortality from the assessment of ambulatory function through 2011. Multinomial logistic regression quantified the association between cancer and ambulatory function. We then explored the independent effects of walking pace and mobility disability in cancer survivors, and the joint effects of both a cancer diagnosis and poor ambulatory function on mortality using Cox proportional hazards models. Models explored type-specific associations across 15 cancer types., Results: Survivors had 42% greater odds of walking at the slowest pace [OR, 1.42 (confidence interval (CI), 1.30-1.54)] and 24% greater odds of mobility disability [OR, 1.24 (CI, 1.17-1.31)], compared with cancer-free participants, adjusting for baseline demographics, health indicators, and cancer type. Survivors reporting the slowest pace were at increased hazards than those who walked the fastest: all-cause mortality [HR, 2.22 (CI, 2.06-2.39)] and cancer mortality [HR, 2.12 (CI, 1.83-2.45)]. Similar trends emerged for mobility disability (HRs > 1.64). All-cause mortality associations were significant for more than nine cancer types., Conclusions: A diagnosis of cancer is associated with poorer ambulatory function, which is subsequently associated with increased mortality., Impact: Widespread efforts should target ambulatory function during cancer survivorship for survival benefits., (©2021 American Association for Cancer Research.)

Background: There is limited information about the association between long-term leisure time physical activity (LTPA) participation and healthcare costs. The purpose of this study was to investigate the association between LTPA over adulthood with later life healthcare costs in the USA., Methods: Using Medicare claims data (between 1999 and 2008) linked to the National Institutes of Health-American Association of Retired Persons (NIH-AARP) Diet and Health Study, we examined associations between nine trajectories of physical activity participation throughout adulthood with Medicare costs., Results: Compared with adults who were consistently inactive from adolescence into middle age, average annual healthcare costs were significantly lower for maintainers, adults who maintained moderate (-US$1350 (95% CI: -US$2009 to -US$690) or -15.9% (95% CI: -23.6% to -8.1%)) or high physical activity levels (-US$1200 (95% CI: -US$1777 to -US$622) or -14.1% (95% CI: -20.9% to -7.3%)) and increasers, adults who increased physical activity levels in early adulthood (-US$1874 (95% CI: US$2691 to -US$1057) or -22.0% (95% CI: -31.6% to -12.4%)) or in middle age (-US$824 (95% CI: -US$1580 to -US$69 or -9.7% (95% CI -18.6% to -0.8%)). For the four trajectories where physical activity decreased, the only significant difference was for adults who increased physical activity levels during early adulthood with a decline in middle age (-US$861 (95% CI:-US$1678 to -US$45) or -10.1% (95% CI: -19.7% to -0.5%))., Conclusion: Our analyses suggest the healthcare cost burden in later life could be reduced through promotion efforts supporting physical activity participation throughout adulthood., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: Confounding due to poor health is a concern in accelerometer-based studies of physical activity and health, but detailed investigations of this source of bias are lacking., Methods: US adults (n = 4840) from the National Health and Nutrition Examination Survey (2003 to 2006) wore an accelerometer for 1 to 7 d (mean = 5.7 d) and were followed for mortality through 2015. Logistic regression was used to examine odds ratios between poor health (chronic conditions, self-reported health, mobility limitations, frailty) and low physical activity levels; Cox models were used to estimate adjusted hazard ratios (HR) and 95% CI for mortality associations for a 1 h·d increase in moderate-to-vigorous-intensity physical activity (MVPA) using two commonly used cut-points (MVPA760, MVPA2020). Modeling scenarios with shorter and longer follow-up time, increasing adjustment for poor health, by age group, and after excluding early years of follow-up were used to assess bias., Results: Over a mean of 10.1 yr of follow-up, 1165 deaths occurred. Poor health was associated with low MVPA760 levels and increased mortality risk. In fully adjusted MVPA760 models, HR was 26% stronger comparing 0 to 4 yr (HR = 0.46) with 0 to 12 yr of follow-up (HR = 0.62), particularly in older adults (65 yr and older). Increasing statistical adjustment for poor health attenuated MVPA760 associations by 13% to 15%, and exclusion of the first 2 yr of follow-up had limited effects. Comparable results were obtained with the MVPA2020 cut-point., Conclusions: We did not find evidence that confounding by health status resulted in entirely spurious MVPA-mortality associations; however, potential bias was appreciable in modeling scenarios involving shorter follow-up (<6 yr), older adults, and more limited statistical adjustment for poor health. The strength of MVPA-mortality associations in studies reflecting these scenarios should be interpreted cautiously.

Background: Due to the high prevalence of obesity and the difficulty in maintaining weight loss, repeated bouts of weight loss are a common occurrence. However, there are inconsistencies in epidemiological studies regarding repetitive weight fluctuations being associated with increased risk of mortality. Therefore, the purpose of this prospective cohort analysis was to determine the long-term association of the frequency of weight loss attempts on mortality., Methods: This prospective cohort study used data collected from adult AARP members living in 6 states (California, Florida, Louisiana, New Jersey, North Carolina, or Pennsylvania) or 2 metropolitan areas (Atlanta, Georgia, or Detroit, Michigan) and participating in the National Institutes of Health-AARP Diet and Health Study between 2004 and 2006. Self-reported data were analyzed for 161,738 middle-aged adults. During an average 7 years of follow-up, 21,194 deaths were recorded. Hazard ratios of all-cause, cardiovascular, and cancer mortality were estimated adjusting for demographic, lifestyle, and behavioral risk factors., Results: Increased frequency of weight loss attempts of at least five pounds was associated with lower mortality (p trend  < 0.010). Multivariate hazard ratios (95% confidence intervals) for all-cause death among individuals who successfully attempted weight loss compared with those who did not make any attempts were 0.94 (0.90-0.98) for 1-2 attempts, 0.96 (0.91-1.01) for 3-4 attempts, 0.91 (0.85-0.96) for 5-6 attempts, 0.91 (0.85-0.98) for 7-8 attempts, 0.87 (0.80-0.95) for 9-10 attempts, and 0.88 (0.82-0.94) for 11+ attempts. Similar results were noted for men and women, participants with healthy weight and overweight/obesity, and even among those who gained weight over time. Protective associations were also observed for deaths due to cardiovascular disease and cancer., Conclusions: Increased frequency of intentionally losing at least five pounds in mid-life was associated with a lower risk of future death. Repeated attempts with moderate amounts of weight loss may provide benefit in terms of longevity., Trial Registration Number: ClinicalTrials.gov number, NCT00340015.

Purpose: The present study estimated the long-term reproducibility of accelerometer-based measures over 6 months in adults and the implications for statistical power, and attenuation in regression coefficients for future activity-disease studies., Methods: We used data from 914 adults in the Interactive Diet and Activity Tracking in AARP study. Participants wore an activPAL 3 (AP) and an ActiGraph GT3X (AG) twice, 6 months apart. AP measures included time spent sitting or lying, standing, and stepping, whereas AG measures included time spent in sedentary, light, and moderate-to-vigorous physical activity (PA). Reproducibility of each metric and implications for epidemiological studies were determined based on intraclass correlation coefficients (ICC; 95% confidence interval)., Results: The ICC values for AP estimates were 0.58 (95% confidence interval, 0.53-0.63) for sitting, 0.62 (0.57-0.67) for standing, and 0.57 (0.51-0.62) for stepping. The ICC values for AG were 0.56 (0.50-0.61) for sedentary, 0.54 (0.49-0.60) for light PA, and 0.58 (0.52-0.63) for moderate-to-vigorous PA. Modeling showed that increasing the number of replicate administrations to two or three resulted in the most noticeable increases in ICC values, statistical power, and reductions in attenuation coefficients. For example, administering the AP twice reduced within-subject variability by half and resulted in an increase in the ICC associated with sitting time from 0.58 to 0.74. Similar comparisons for AG and measure of sedentary time resulted in an increase in ICC values from 0.56 to 0.72. Increasing the number of replicate administrations from one to two reduced the attenuation in activity-outcome associations from 40% to 25%., Conclusion: Accelerometer-based classifications of activity are moderately stable over time, but there is considerable within-subject variability that needs to be considered when estimating usual activity in future studies.

Purpose: APOLO-Teens is an ongoing web-based program combining a manualized intervention delivered by Facebook ® , a self-monitoring web application and monthly chat sessions to optimize treatment as usual for adolescents with overweight and obesity. The aims of this paper are twofold: (1) to describe the study protocol of the APOLO-Teens randomized controlled effectiveness trial and (2) to present baseline descriptive information of the Portuguese sample., Methods: APOLO-Teens includes adolescents aged between 13 and 18 years with BMI percentile ≥ 85 (N = 210; 60.00% girls, BMI z-score 2.40 ± 0.75) undergoing hospital ambulatory treatment for overweight/obesity. Participants completed a set of self-report measures regarding eating behaviors and habits, psychological functioning (depression, anxiety, stress, and impulsivity), physical activity, and quality of life., Results: Depression, anxiety, stress, impulsivity, and percentage body fat were inversely associated with health-related quality of life (r s  = - 0.39 to - 0.62), while physical activity out-of-school was positively correlated with health-related quality of life (r s  = 0.22). When compared to boys, girls demonstrated statistically significant higher scores on psychological distress, disturbed eating behaviors, impulsivity, were less active at school and had lower scores on the health-related quality of life (p < 0.05)., Conclusion: The results showed that there were gender differences in key psychological constructs that are likely to determine success with the treatment and that, therefore, need to be considered in future interventions. The results of APOLO-Teens randomized controlled trial will determine the impact of these constructs on the efficacy and adherence to a web-based intervention for weight loss in the Portuguese population., Level of Evidence: Level V, cross-sectional descriptive study.

Importance: It is unclear whether the number of steps per day and the intensity of stepping are associated with lower mortality., Objective: Describe the dose-response relationship between step count and intensity and mortality., Design, Setting, and Participants: Representative sample of US adults aged at least 40 years in the National Health and Nutrition Examination Survey who wore an accelerometer for up to 7 days ( from 2003-2006). Mortality was ascertained through December 2015., Exposures: Accelerometer-measured number of steps per day and 3 step intensity measures (extended bout cadence, peak 30-minute cadence, and peak 1-minute cadence [steps/min]). Accelerometer data were based on measurements obtained during a 7-day period at baseline., Main Outcomes and Measures: The primary outcome was all-cause mortality. Secondary outcomes were cardiovascular disease (CVD) and cancer mortality. Hazard ratios (HRs), mortality rates, and 95% CIs were estimated using cubic splines and quartile classifications adjusting for age; sex; race/ethnicity; education; diet; smoking status; body mass index; self-reported health; mobility limitations; and diagnoses of diabetes, stroke, heart disease, heart failure, cancer, chronic bronchitis, and emphysema., Results: A total of 4840 participants (mean age, 56.8 years; 2435 [54%] women; 1732 [36%] individuals with obesity) wore accelerometers for a mean of 5.7 days for a mean of 14.4 hours per day. The mean number of steps per day was 9124. There were 1165 deaths over a mean 10.1 years of follow-up, including 406 CVD and 283 cancer deaths. The unadjusted incidence density for all-cause mortality was 76.7 per 1000 person-years (419 deaths) for the 655 individuals who took less than 4000 steps per day; 21.4 per 1000 person-years (488 deaths) for the 1727 individuals who took 4000 to 7999 steps per day; 6.9 per 1000 person-years (176 deaths) for the 1539 individuals who took 8000 to 11 999 steps per day; and 4.8 per 1000 person-years (82 deaths) for the 919 individuals who took at least 12 000 steps per day. Compared with taking 4000 steps per day, taking 8000 steps per day was associated with significantly lower all-cause mortality (HR, 0.49 [95% CI, 0.44-0.55]), as was taking 12 000 steps per day (HR, 0.35 [95% CI, 0.28-0.45]). Unadjusted incidence density for all-cause mortality by peak 30 cadence was 32.9 per 1000 person-years (406 deaths) for the 1080 individuals who took 18.5 to 56.0 steps per minute; 12.6 per 1000 person-years (207 deaths) for the 1153 individuals who took 56.1 to 69.2 steps per minute; 6.8 per 1000 person-years (124 deaths) for the 1074 individuals who took 69.3 to 82.8 steps per minute; and 5.3 per 1000 person-years (108 deaths) for the 1037 individuals who took 82.9 to 149.5 steps per minute. Greater step intensity was not significantly associated with lower mortality after adjustment for total steps per day (eg, highest vs lowest quartile of peak 30 cadence: HR, 0.90 [95% CI, 0.65-1.27]; P value for trend = .34)., Conclusions and Relevance: Based on a representative sample of US adults, a greater number of daily steps was significantly associated with lower all-cause mortality. There was no significant association between step intensity and mortality after adjusting for total steps per day.

Self-reported youth physical activity (PA) is typically overestimated. We aimed to calibrate and validate a self-report tool among English youth. Four-hundred-and-two participants (aged 9-16 years; 212 boys) wore SenseWear Armband Mini devices (SWA) for eight days and completed the self-report Youth Activity Profile (YAP) on the eighth day. Calibration algorithms for temporally matched segments were generated from the YAP data using quantile regression. The algorithms were applied in an independent cross-validation sample, and student- and school-level agreement were assessed. The utility of the YAP algorithms to assess compliance to PA guidelines was also examined. The school-level bias for the YAP estimates of in-school, out-of-school, and weekend moderate-to-vigorous PA (MVPA) were 17.2 (34.4), 31.6 (14.0), and -4.9 (3.6) min·week -1 , respectively. Out-of-school sedentary behaviour (SB) was over-predicted by 109.2 (11.8) min·week -1 . Predicted YAP values were within 15%-20% equivalence of the SWA estimates. The classification accuracy of the YAP MVPA estimates for compliance to 60 min·day -1 and 30 min·school-day -1 MVPA recommendations were 91%/37% and 89%/57% sensitivity/specificity, respectively. The YAP generated robust school-level estimates of MVPA and SB and has potential for surveillance to monitor compliance with PA guidelines. The accuracy of the YAP may be further improved through research with more representative UK samples to enhance the calibration process and to refine the resultant algorithms.

Introduction: A lack of standardization with accelerometry-based monitors has made it hard to advance applications for both research and practice. Resolving these challenges is essential for developing methods for consistent, agnostic reporting of physical activity outcomes from wearable monitors in clinical applications., Methods: This article reviewed the literature on the methods used to evaluate the validity of contemporary consumer activity monitors. A rationale for focusing on energy expenditure as a key outcome measure in validation studies was provided followed by a summary of the strengths and limitations of different analytical methods. The primary review included 23 recent validation studies that collectively reported energy expenditure estimates from 58 monitors relative to values from appropriate criterion measures., Results: The majority of studies reported weak indicators such as correlation coefficients (87%), but only half (52%) reported the recommended summary statistic of mean absolute percent error needed to evaluate actual individual error. Fewer used appropriate tests of agreement such as equivalence testing (22%)., Conclusions: The use of inappropriate analytic methods and incomplete reporting of outcomes is a major limitation for systematically advancing research with both research grade and consumer-grade activity monitors. Guidelines are provided to standardize analytic methods and reporting in these types of studies to enhance the utility of the devices for clinical mHealth applications.

This study used accelerometer and self-report measures of overall sedentary time (ST) and screen time behaviours to examine their respective associations with adiposity among UK youth. Participants (Year groups 5, 8, and 10;  n =292, 148 girls) wore the SenseWear Armband Mini accelerometer for eight days and completed the Youth Activity Profile, an online report tool designed to estimate physical activity and ST.Stature, body mass and waist circumference were measured to classify adiposity outcomes (overweight/obese and central obesity). One-way between groups ANOVA and adjusted linear, logistic and multinomial logistic regression analyses were conducted. There was a significant main effect of age on total ST across the whole week ( F (2, 289)=41.64,  p ≤0.001). ST increased monotonically across Year 5 (581.09±107.81 min·d-¹), 8 (671.96±112.59 min·d-¹) and 10 (725.80±115.20 min·d-¹), and all pairwise comparisons were significant at  p ≤0.001. A steep age-related gradient to mobile phone use was present ( p ≤0.001). ST was positively associated with adiposity outcomes independent of moderate-to-vigorous intensity physical activity (MVPA;  p ≤0.001). Engaging in >3 hours of video gaming daily was positively associated with central obesity (OR=2.12,  p ≤0.05) but not after adjustment for MVPA. Results further demonstrate the importance of reducing overall ST to maintain healthy weight status among UK youth.

Importance: Although the benefits of leisure-time physical activity (LTPA) in middle age are established, the health effects of long-term participation and changes in LTPA between adolescence and middle age have not been documented., Objective: To determine whether an association exists between LTPA life course patterns and mortality., Design, Setting, and Participants: This prospective cohort study used data from the National Institutes of Health-AARP (formerly American Association of Retired Persons) Diet and Health Study established in 1995 to 1996. Data analysis was conducted from March 2017 through February 2018. Data were analyzed for 315 059 adult AARP members living in 6 states, namely, California, Florida, Louisiana, New Jersey, North Carolina, or Pennsylvania, or 2 metropolitan areas, Atlanta, Georgia, or Detroit, Michigan., Exposures: Self-reported LTPA (hours per week) at the baseline interview for ages grouped as 15 to 18, 19 to 29, 35 to 39, and 40 to 61 years., Main Outcomes and Measures: All-cause, cardiovascular disease (CVD)-related, and cancer-related mortality records available through December 31, 2011., Results: Of 315 059 participants, 183 451 (58.2%) were men, and the participants were 50 to 71 years of age at enrollment. Ten LTPA trajectories (categorized as maintaining, increasing, and decreasing LTPA across time) were identified, and 71 377 deaths due to all causes, 22 219 deaths due to CVD, and 16 388 deaths due to cancer occurred. Compared with participants who were consistently inactive throughout adulthood, participants who maintained the highest amount of LTPA in each age period were at lower risks for all-cause, CVD-related, and cancer-related mortality. For example, compared with participants who were consistently inactive, maintaining higher amounts of LTPA was associated with lower all-cause (hazard ratio [HR], 0.64; 95% CI, 0.60-0.68), CVD-related (HR, 0.58; 95% CI, 0.53-0.64), and cancer-related (HR, 0.86; 95% CI, 0.77-0.97) mortality. Adults who were less active throughout most of the adult life course but increased LTPA in later adulthood (40-61 years of age) also had lower risk for all-cause (HR, 0.65; 95% CI, 0.62-0.68), CVD-related (HR, 0.57; 95% CI, 0.53-0.61), and cancer-related (HR, 0.84; 95% CI, 0.77-0.92) mortality., Conclusions and Relevance: Maintaining higher LTPA levels and increasing LTPA in later adulthood were associated with comparable low risk of mortality, suggesting that midlife is not too late to start physical activity. Inactive adults may be encouraged to be more active, whereas young adults who are already active may strive to maintain their activity level as they get older.

Background: One of the promising strategies for increasing physical activity (PA) at school is to integrate it with academic learning. The purposes of this study were: (a) to examine differences in objectively measured PA levels between integrated PA with mathematics and traditional lessons, and (b) to evaluate the PA levels of different integrated PAs., Methods: Seventy-seven 4th grade students (41 males) were included in an intervention (Move for Thought program: M4T) group ( n = 46) that utilized PA integrated with mathematics or a control group ( n = 31). Accelerometer data from each student were collected during five complete school days. M4T and control classroom sessions were identified using teachers' logs. Accelerometer data were extracted, processed separately, and aggregated into a single data set. Minutes and percent time at different PA intensities were obtained using accelerometer minute-by-minute predicted METs., Results: One-way ANOVAs on PA levels showed a significant group effect ( F = 5.33, p < 0.05) on moderate-to-vigorous PA (MVPA) in favor of the M4T group, but not on sedentary and light PA. The most active integrated PA provided 10.88 min of MVPA ( SD = 11.87; 21.38 ± 24.38%) in a 50 min class period., Conclusion: Integrating PA with mathematics in the classroom can contribute to increasing MVPA levels in children.

Introduction: The goal of this study was to describe differences in time use and energy expenditure associated with exercise, prolonged TV viewing, and work days in a longitudinal study of older adults., Methods: Participants were 1,020 adults who completed previous-day recalls that provided a profile of the use of time in sedentary and physical activity. Time use and physical activity energy expenditure were predicted for each type of day (exercise, prolonged TV, work) using linear mixed models, adjusting for age, sex, season of the year, and day of the week. Data were collected in 2012-2013; analysis was completed in 2017., Results: Exercise days had less sedentary time (-0.37 hours/day) and light activity (-0.29 hours/day), and less household, work, and shopping activities, such that the increase in total physical activity energy expenditure on exercise days (2.83 MET-hours/day) was only about half that expended during exercise (5.98 MET-hours/day). Prolonged TV viewing days had more total sedentary time (0.86 hours/days) and less light (-0.45 hours/day) and moderate-vigorous intensity activity (-0.41 hours/day), and thus lower total physical activity energy expenditure (-2.43 MET-hours/day). Work days had less sleep (-0.91 hours/day) and more total sedentary time (1.32 hours/day)., Conclusions: Exercise days had more physical activity energy expenditure, but because of reductions in other activities, only about half of the energy expended during exercise was added to total daily physical activity energy expenditure. Prolonged TV viewing days had less physical activity energy expenditure and less moderate-vigorous activity. These findings provide new insights into possible compensation associated with exercise, and suggest a strong link between TV viewing and physical inactivity., (Published by Elsevier Inc.)

This study describes age, sex, and season patterns in children's physical activity behaviors during discrete time periods, both in school and at home. Participants were 135 elementary, 67 middle, and 89 high-school students (128 boys and 163 girls) involved in a larger school activity monitoring project. We examined time spent in moderate-to-vigorous physical activity (MVPA) at recess, physical education (PE), lunch, commuting to/from school, before-school, after-school, evening, and weekend segments. Differences in MVPA by age, sex, and season were examined using a three-way analysis of variance and separately for each individual segment. Moderate-to-vigorous physical activity levels varied by context and were higher during recess (15.4 ± 8.5 min) while at school, and on Saturdays (97.4 ± 89.5 min) when youth were out-of-school. Elementary children were more active than their older counterparts only during lunch time, after-school, and Sunday ( p < 0.05). Boys were consistently more active than girls at all segments. Participants were only more active during non-winter than winter months during PE ( p = 0.006), after-school ( p < 0.001), and Sunday ( p = 0.008) segments. These findings showed that activity levels in youth vary during the day and season. The segments reflect discrete time periods that can potentially be targeted and evaluated to promote physical activity in this population.