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OBJECTIVE To investigate the association between accelerometer-derived physical activity energy expenditure (PAEE) and incident type 2 diabetes (T2D) in a cohort of middle-aged adults and within subgroups. RESEARCH DESIGN AND METHODS Data were from 90,096 UK Biobank participants without prevalent diabetes (mean 62 years of age; 57% women) who wore a wrist accelerometer for 7 days. PAEE was derived from wrist acceleration using a population-specific method validated against doubly labeled water. Logistic regressions were used to assess associations between PAEE, its underlying intensity, and incident T2D, ascertained using hospital episode and mortality data up to November 2020. Models were progressively adjusted for demographic, lifestyle factors, and BMI. RESULTS The association between PAEE and T2D was approximately linear (n = 2,018 events). We observed 19% (95% CI 17–21) lower odds of T2D per 5 kJ · kg−1 · day−1 in PAEE without adjustment for BMI and 11% (9–13) with BMI adjustment. The association was stronger in men than women and weaker in those with obesity and higher genetic susceptibility to obesity. There was no evidence of effect modification by genetic susceptibility to T2D or insulin resistance. For a given level of PAEE, odds of T2D were lower among those engaging in more moderate-to-vigorous activity. CONCLUSIONS There was a strong linear relationship between PAEE and incident T2D. A difference in PAEE equivalent to an additional daily 20-min brisk walk was associated with 19% lower odds of T2D. The association was broadly similar across population subgroups, supporting physical activity for diabetes prevention in the whole population.

As smartphone and wearable device ownership increase, interest in their utility to monitor physical activity has risen concurrently. Numerous examples of the application of wearables in clinical and epidemiological research settings already exist. However, whether these devices are all suitable for physical activity surveillance is open for debate. In this commentary, we respond to a commentary by Mair et al. (2021) and discuss four key issues specifically relevant to surveillance that we believe need to be tackled before consumer wearables can be considered for this measurement purpose: representative sampling, representative wear time, validity and reliability, and compatibility between devices. A recurring theme is how to deal with systematic biases by demographic groups. We suggest some potential solutions to the issues of concern such as providing individuals with standardized devices, considering summary metrics of physical activity less prone to wear time biases, and the development of a framework to harmonize estimates between device types and their inbuilt algorithms. We encourage collaborative efforts from researchers and consumer wearable manufacturers in this area. In the meantime, we caution against the use of consumer wearable device data for inference of population-level activity without the consideration of these issues.

ObjectiveTo estimate the dose–response associations between non-occupational physical activity and several chronic disease and mortality outcomes in the general adult population.DesignSystematic review and cohort-level dose-response meta-analysis.Data sourcesPubMed, Scopus, Web of Science and reference lists of published studies.Eligibility criteriaProspective cohort studies with (1) general population samples >10 000 adults, (2) ≥3 physical activity categories, and (3) risk measures and CIs for all-cause mortality or incident total cardiovascular disease, coronary heart disease, stroke, heart failure, total cancer and site-specific cancers (head and neck, myeloid leukaemia, myeloma, gastric cardia, lung, liver, endometrium, colon, breast, bladder, rectum, oesophagus, prostate, kidney).Results196 articles were included, covering 94 cohorts with >30 million participants. The evidence base was largest for all-cause mortality (50 separate results; 163 415 543 person-years, 811 616 events), and incidence of cardiovascular disease (37 results; 28 884 209 person-years, 74 757 events) and cancer (31 results; 35 500 867 person-years, 185 870 events). In general, higher activity levels were associated with lower risk of all outcomes. Differences in risk were greater between 0 and 8.75 marginal metabolic equivalent of task-hours per week (mMET-hours/week) (equivalent to the recommended 150 min/week of moderate-to-vigorous aerobic physical activity), with smaller marginal differences in risk above this level to 17.5 mMET-hours/week, beyond which additional differences were small and uncertain. Associations were stronger for all-cause (relative risk (RR) at 8.75 mMET-hours/week: 0.69, 95% CI 0.65 to 0.73) and cardiovascular disease (RR at 8.75 mMET-hours/week: 0.71, 95% CI 0.66 to 0.77) mortality than for cancer mortality (RR at 8.75 mMET-hours/week: 0.85, 95% CI 0.81 to 0.89). If all insufficiently active individuals had achieved 8.75 mMET-hours/week, 15.7% (95% CI 13.1 to 18.2) of all premature deaths would have been averted.ConclusionsInverse non-linear dose–response associations suggest substantial protection against a range of chronic disease outcomes from small increases in non-occupational physical activity in inactive adults.PROSPERO registration numberCRD42018095481.

BACKGROUND/OBJECTIVES: Physical activity energy expenditure (PAEE) represents the total volume of all physical activity. This can be accumulated as different underlying intensity profiles. Although volume and intensity have been studied in isolation, less is known about their joint association with health. We examined this association with body fatness in a population-based sample of middle-aged British adults. METHODS: In total, 6148 women and 5320 men from the Fenland study with objectively measured physical activity from individually calibrated combined heart rate and movement sensing and DXA-derived body fat percentage (BF%) were included in the analyses. We used linear and compositional isocaloric substitution analysis to examine associations of PAEE and its intensity composition with body fatness. Sex-stratified models were adjusted for socio-economic and dietary covariates. RESULTS: PAEE was inversely associated with body fatness in women (beta = -0.16 (95% CI: -0.17; -0.15) BF% per kJ day-1 kg-1) and men (beta = -0.09 (95% CI: -0.10; -0.08) BF% per kJ day-1 kg-1). Intensity composition was significantly associated with body fatness, beyond that of PAEE; the reallocation of energy to vigorous physical activity (>6 METs) from other intensities was associated with less body fatness, whereas light activity (1.5-3 METs) was positively associated. However, light activity was the main driver of overall PAEE volume, and the relative importance of intensity was marginal compared to that of volume; the difference between PAEE in tertile 1 and 2 in women was associated with 3 percentage-point lower BF%. Higher vigorous physical activity in the same group to the maximum observed value was associated with 1 percentage-point lower BF%. CONCLUSIONS: In this large, population-based cohort study with objective measures, PAEE was inversely associated with body fatness. Beyond the PAEE association, greater levels of intense activity were also associated with lower body fatness. This contribution was marginal relative to PAEE. These findings support current guidelines for physical activity which emphasise that any movement is beneficial, rather than specific activity intensity or duration targets., The Fenland study was funded by the Medical Research Council and the Wellcome Trust. The current work was supported by the Medical Research Council (S.B., K.Wi., T.S., K.We, P.C.D., grant number MC_UU_12015/3, MC_UU_00006/4), (S.G., grant number MC_UU_12015/4, MC_UU_00006/6), (N.J.W., grant number MC_UU_12015/1, MC_UU_00006/1), (N.G.F., grant number MC_UU_12015/5, MC_UU_00006/3); the National Institute of Health Research Cambridge (NIHR) Biomedical Research Centre (K.We., E.D.L.R., S.B., N.G.F., and N.J.W., grant number IS-BRC-1215-20014); National Health and Medical Research Council of Australia Research Fellowship (P.C.D., grant number 1142685), and the Cambridge Trust and St Catharine���s College (T.L.). The funders had no role in the design, analysis or writing of this article.

Importance Depression is the leading cause of mental health–related disease burden and may be reduced by physical activity, but the dose-response relationship between activity and depression is uncertain.Objective To systematically review and meta-analyze the dose-response association between physical activity and incident depression from published prospective studies of adults.Data Sources PubMed, SCOPUS, Web of Science, PsycINFO, and the reference lists of systematic reviews retrieved by a systematic search up to December 11, 2020, with no language limits. The date of the search was November 12, 2020.Study Selection We included prospective cohort studies reporting physical activity at 3 or more exposure levels and risk estimates for depression with 3000 or more adults and 3 years or longer of follow-up.Data Extraction and Synthesis Data extraction was completed independently by 2 extractors and cross-checked for errors. A 2-stage random-effects dose-response meta-analysis was used to synthesize data. Study-specific associations were estimated using generalized least-squares regression and the pooled association was estimated by combining the study-specific coefficients using restricted maximum likelihood.Main Outcomes and Measures The outcome of interest was depression, including (1) presence of major depressive disorder indicated by self-report of physician diagnosis, registry data, or diagnostic interviews and (2) elevated depressive symptoms established using validated cutoffs for a depressive screening instrument.Results Fifteen studies comprising 191 130 participants and 2 110 588 person-years were included. An inverse curvilinear dose-response association between physical activity and depression was observed, with steeper association gradients at lower activity volumes; heterogeneity was large and significant (I2 = 74%; P Conclusions and Relevance This systematic review and meta-analysis of associations between physical activity and depression suggests significant mental health benefits from being physically active, even at levels below the public health recommendations. Health practitioners should therefore encourage any increase in physical activity to improve mental health.

Background Emerging evidence suggests accruing sedentary behavior (SB) in relatively more prolonged periods may convey additional cardiometabolic risks, but few studies have examined prospective outcomes. We examined the association of SB accumulation patterns with incident cardiovascular disease (CVD), cancer, and all-cause mortality (ACM). Methods and Results Data were from 7671 EPIC-Norfolk (European Prospective Investigation Into Cancer and Nutrition-Norfolk) cohort middle- to older-aged adults who wore accelerometers on the right hip for 4 to 7 days. Cox proportional hazards regression modeled associations between 2 measures of SB accumulation and incident CVD, cancer, and ACM. These were usual SB bout duration (the midpoint of each individual's SB accumulation curve, fitted using nonlinear regression) and alpha (hybrid measure of bout frequency and duration, with higher values indicating relatively shorter bouts and fewer long bouts). Models were adjusted for potential confounders, then further for 24-hour time-use compositions. During mean follow-up time of 6.4 years, 339 ACM, 1106 CVD, and 516 cancer events occurred. Elevated rates of incident cancer and ACM were seen with more prolonged SB accumulation (lower alpha, higher usual SB bout duration) but not CVD. For usual SB bout duration and alpha, respectively, the confounder-adjusted hazard ratios per SD of the exposure were 1.12 (95% CI, 1.02-1.23) and 0.88 (95% CI, 0.79-0.98) with incident cancer and 1.16 (95% CI, 1.07-1.26) and 0.80 (95% CI, 0.72-0.89) with ACM (all P

ObjectiveTo compare the country-level absolute and relative contributions of physical activity at work and in the household, for travel, and during leisure-time to total moderate-to-vigorous physical activity (MVPA).MethodsWe used data collected between 2002 and 2019 from 327 789 participants across 104 countries and territories (n=24 low, n=34 lower-middle, n=30 upper-middle, n=16 high-income) from all six World Health Organization (WHO) regions. We calculated mean min/week of work/household, travel and leisure MVPA and compared their relative contributions to total MVPA using Global Physical Activity Questionnaire data. We compared patterns by country, sex and age group (25–44 and 45–64 years).ResultsMean MVPA in work/household, travel and leisure domains across the 104 countries was 950 (IQR 618–1198), 327 (190–405) and 104 (51–131) min/week, respectively. Corresponding relative contributions to total MVPA were 52% (IQR 44%–63%), 36% (25%–45%) and 12% (4%–15%), respectively. Work/household was the highest contributor in 80 countries; travel in 23; leisure in just one. In both absolute and relative terms, low-income countries tended to show higher work/household (1233 min/week, 57%) and lower leisure MVPA levels (72 min/week, 4%). Travel MVPA duration was higher in low-income countries but there was no obvious pattern in the relative contributions. Women tended to have relatively less work/household and more travel MVPA; age groups were generally similar.ConclusionIn the largest domain-specific physical activity study to date, we found considerable country-level variation in how MVPA is accumulated. Such information is essential to inform national and global policy and future investments to provide opportunities to be active, accounting for country context.

Background: To limit the spread of COVID-19 in March 2020, the population of England was instructed to stay home, leaving only for essential shopping, health-care, work, or exercise. The impact on population activity behaviours is not clear. We describe changes in duration and types of activity undertaken by adults ≥16 years in England between March and May 2016-19 and 2020, by socio-demographic strata.Methods: Using nationally representative data collected between November 2015 and May 2020 by the Sport England Active Lives Surveys (n=726,257) we assessed trends in amount and type of non-occupational moderate-to-vigorous physical activity. Using data from n=74,430 mid-April to mid-May respondents, we then estimated the odds ratios of reporting any activity in the four-week recall period in 2020 compared to 2016-19. Gamma regressions estimated the mean ratios (MR) of duration amongst those reporting any activity in 2020 compared to 2016-19.Findings: Population activity declined substantially after the restrictions were introduced. Compared to 2016-19 levels, the odds of reporting any activity in 2020 were 30% lower (95% confidence interval (CI) 26-34%). The largest declines were amongst non-white ethnicities, the youngest and oldest age groups, and the unemployed; no socio-demographic subgroup had higher odds. Amongst those undertaking activity, weekly duration was similar in the two periods (MR 0.99, 95%CI (0.96-1.01%)). The odds of participating in walking for leisure and gardening were 11% (6-16%) and 15% (9-21%) higher, respectively, whereas the odds for team and racket sport and walking for travel participation were 76% (73-79%) and 66% (64-68%) lower, respectively.Interpretation: Restrictions introduced in Spring 2020 likely reduced physical activity levels in England. The magnitude of the declines were not uniform by demographic groups or by activity type, which future policies should consider.Funding: TS, KW, SJS, and SB are supported by UK Medical Research Council [grant numbers MC_UU_00006/4 and MC_UU_12015/3] and SB is supported by the NIHR Biomedical Research Centre in Cambridge (IS-BRC-1215-20014).

Accelerometers provide detailed data about physical activity (PA) across the full intensity spectrum. However, when examining associations with health, results are often aggregated to only a few summary measures [e.g. time spent “sedentary” or “moderate-to-vigorous” intensity PA]. Using multivariate pattern analysis, which can handle collinear exposure variables, we examined associations between the full PA intensity spectrum and cardiometabolic risk (CMR) in a population-based sample of middle-aged to older adults. Participants (n = 3660; mean ± SD age = 69 ± 8y and BMI = 26.7 ± 4.2 kg/m2; 55% female) from the EPIC-Norfolk study (UK) with valid accelerometry (ActiGraph-GT1M) data were included. We used multivariate pattern analysis with partial least squares regression to examine cross-sectional multivariate associations (r) across the full PA intensity spectrum [minutes/day at 0–5000 counts-per-minute (cpm); 5 s epoch] with a continuous CMR score (reflecting waist, blood pressure, lipid, and glucose metabolism). Models were sex-stratified and adjusted for potential confounders. There was a positive (detrimental) association between PA and CMR at 0-12 cpm (maximally-adjusted r = 0.08 (95%CI 0.06–0.10). PA was negatively (favourably) associated with CMR at all intensities above 13 cpm ranging between r = −0.09 (0.07–0.12) at 800-999 cpm and r = −0.14 (0.11–0.16) at 75–99 and 4000-4999 cpm. The strongest favourable associations were from 50 to 800 cpm (r = 0.10–0.12) in men, but from ≥2500 cpm (r = 0.18–0.20) in women; with higher proportions of model explained variance for women (R2 = 7.4% vs. 2.3%). Most of the PA intensity spectrum was beneficially associated with CMR in middle-aged to older adults, even at intensities lower than what has traditionally been considered “sedentary” or “light-intensity” activity. This supports encouragement of PA at almost any intensity in this age-group. publishedVersion

Cardiorespiratory fitness (CRF) is associated with mortality and cardiovascular disease, but assessing CRF in the population is challenging. Here we develop and validate a novel framework to estimate CRF (as maximal oxygen consumption, VO2max) from heart rate response to low-risk personalised exercise tests. We apply the method to examine associations between CRF and health outcomes in the UK Biobank study, one of the world’s largest and most inclusive studies of CRF, showing that risk of all-cause mortality is 8% lower (95%CI 5–11%, 2670 deaths among 79,981 participants) and cardiovascular mortality is 9% lower (95%CI 4–14%, 854 deaths) per 1-metabolic equivalent difference in CRF. Associations obtained with the novel validated CRF estimation method are stronger than those obtained using previous methodology, suggesting previous methods may have underestimated the importance of fitness for human health.

Introduction The Propensity to Cycle Tool (PCT) is a widely used free, open source and publicly available tool for modelling cycling uptake and corresponding health and carbon impacts in England and Wales. In this paper we present the methods for our new individual-level modelling representing all commuters in England and Wales. Methods Scenario commuter cycling potential in the PCT is modelled as a function of route distance and hilliness between home and work. Our new individual-level approach has allowed us to create an additional “Near Market” scenario where age, gender, ethnicity, car ownership and area level deprivation also affect an individual's likelihood of switching to cycling. For this and other scenarios, we calculate the carbon benefits of cycling uptake based on the trip distance and previous mode, while health benefits are additionally affected by hilliness and baseline average mortality risk. This allows the estimation of how health and carbon benefits differ by demographic group as well as by scenario. Results While cycle commuting in England and Wales is demographically skewed towards men and white people, women and people from ethnic minorities have greater cycling potential based on route distance and hilliness. Benefits from cycling uptake are distributed differently again. For example, while increasing female cycling mode share is good for equity, each additional female cyclist generates a smaller average health and carbon benefit than a male cyclist. This is based on women's lower baseline mortality risk, shorter commute travel distances, and lower propensity to commute by car than men. Conclusion We have demonstrated a new approach to modelling that allows for more sophisticated and nuanced assessment of cycling uptake and subsequent benefits, under different scenarios. Health and carbon are increasingly incorporated into appraisal of active travel schemes, valuing important outcomes. However, especially with better representation of demographic factors, this can act as a barrier to equity goals., Highlights • A sophisticated model underlies the Propensity to Cycle Tool (PCT) for England and Wales. • Cycling uptake-test and its health and carbon impacts are simulated under a range of scenarios. • Microsimulation allows analysis of demographic variation in uptake and benefits. • While women and ethnic minorities cycle less, they make shorter more ‘cyclable’ trips. • However, active mode appraisal methods risk placing lower value on their cycling uptake.

Use of wearable devices that monitor physical activity is projected to increase more than fivefold per half-decade1. We investigated how device-based physical activity energy expenditure (PAEE) and different intensity profiles were associated with all-cause mortality. We used a network harmonization approach to map dominant-wrist acceleration to PAEE in 96,476 UK Biobank participants (mean age 62 years, 56% female). We also calculated the fraction of PAEE accumulated from moderate-to-vigorous-intensity physical activity (MVPA). Over the median 3.1-year follow-up period (302,526 person-years), 732 deaths were recorded. Higher PAEE was associated with a lower hazard of all-cause mortality for a constant fraction of MVPA (for example, 21% (95% confidence interval 4-35%) lower hazard for 20 versus 15 kJ kg-1 d-1 PAEE with 10% from MVPA). Similarly, a higher MVPA fraction was associated with a lower hazard when PAEE remained constant (for example, 30% (8-47%) lower hazard when 20% versus 10% of a fixed 15 kJ kg-1 d-1 PAEE volume was from MVPA). Our results show that higher volumes of PAEE are associated with reduced mortality rates, and achieving the same volume through higher-intensity activity is associated with greater reductions than through lower-intensity activity. The linkage of device-measured activity to energy expenditure creates a framework for using wearables for personalized prevention.

Background: The disease or mortality burdens of unhealthy lifestyle behaviours are often reported. The positive side of the story, the burden that existing levels have averted, is rarely discussed. We present what we believe to be global application of the Prevented Fraction for the Population to obtain estimates of the percentage of premature mortality and number of premature deaths averted by total physical activity levels for 168 countries. Methods: We combined previously published activity prevalence data (2001-2016) and relative risks of mortality in Monte-Carlo simulations to estimate country-specific Prevented Fractions for the Population (percentage of mortality averted) and their 95% confidence intervals. Higher Prevented Fractions indicate a greater proportion of deaths averted due to physical activity. Using mortality data for 40-74 year olds, we estimated the number of premature deaths averted due to activity levels for all adults and by sex. We presented the median and range of the Prevented Fractions globally, by region, and by income classification. Results: The global median Prevented Fraction for the Population was 15.0% (range 6.6-20.5%), conservatively equating to 3.9 million (95% confidence interval: 2.5-5.6) premature deaths averted annually. The African region had the highest median (16.6%, range 12.1-20.5%), the Americas had the lowest (13.1%, range 10.8-16.6%). Low income countries tended to have higher median Prevented Fractions (17.9%, range 12.3-20.5%) than high income countries (14.1%, range 6.6-17.8%). Globally, the median Prevented Fraction was higher for men than women (16.0% (range 7.8-20.7% and 14.1% (range 5.0-20.4%), respectively). Interpretation: Existing physical activity levels have contributed to averting premature mortality across all countries. The Prevented Fraction for the Population has utility as an advocacy tool to promote healthy lifestyle behaviours as, by making the case of what has been achieved, it could demonstrate the value of current investment and services. This may be more conducive to political support., TS, SJS, and SB are funded by the UK Medical Research Council (MC_UU_12015/1 and MC_UU_12015/3). DD is funded by a Future Leader Fellowship by Heart Foundation Australia (No. 101234). At the time of this work, MT was a member of the Centre for Diet and Activity Research (MR/K023187/1), a UKCRC Public Health Research Centre of Excellence. Funding from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, National Institute for Health Research (NIHR), and Wellcome Trust, under the auspices of the UKClinical Research Collaboration, is gratefully acknowledged. MT was also funded on the METAHIT project (Medical Research Council grant MR/P02663X/1).

Insufficient moderate-to-vigorous-intensity physical activity (MVPA) and high volumes of sedentary time (ST) have both been associated with increased risk of all-cause mortality, cardiovascular disease (CVD), and some cancers1. However, epidemiological evidence has mostly relied on self-reported physical activity (PA) measures, which are prone to reporting bias and measurement error. Cohort studies incorporating objective assessments of PA are emerging2-4; but few investigate relationships of accelerometer-measured PA and ST with clinical endpoints, particularly incident CVD, and include both men and women5. Additionally, the relevance of light-intensity physical activity (LIPA) in this context, which is an important contributor to total physical activity and may be a more feasible target for middle-to-older aged adults, remains unclear. Here, we examine the prospective associations of accelerometer-measured PA and ST with incident CVD (primary outcome), incident cancer, and all-cause mortality.

Background The advent of very large cohort studies (n > 500 000) has given rise to prospective analyses of health outcomes being undertaken after short ( Methods Data were from n = 452 933 UK Biobank participants, aged 38–73 years at baseline. Median available follow-up time was 7 years (for all-cause and CVD mortality) and 6.1 years (for incident CVD). We additionally analysed associations at 1-, 2- and 4-year cut-offs after baseline. We fit up to four models: (1) adjusting for prevalent CVD and cancer, (2) excluding prevalent disease, (3) and (4) Model 2 excluding incident cases in the first 12 and 24 months, respectively. Results The strength of associations decreased as follow-up time cut-off increased. For all-cause mortality, Model 1 hazard ratios were 0.73 (0.69–0.78) after 1 year and 0.86 (0.84–0.87) after 7 years. Associations were weaker with increasing control for possible reverse causality. After 7-years follow-up, the hazard ratios were 0.86 (0.84–0.87) and 0.88 (0.86–0.90) for Models 1 and 4, respectively. Associations with CVD outcomes followed similar trends. Conclusions As analyses with longer follow-up times and increased control for reverse causality showed weaker associations, there are implications for the decision about when to analyse a cohort study with ongoing data collection, the interpretation of study results and their contribution to meta-analyses.

Background/objectivesTo explore and describe the comparability between the surveys of the UK home nations (England, Northern Ireland, Scotland, Wales) that monitor compliance with the Chief Medical Officers’ physical activity (PA) recommendations. We also suggest ways to improve the UK national PA and sedentary behaviour (SB) surveillance systems.MethodsWe identified national surveys that monitor PA and SB through searching UK-wide and devolved administration websites, the Global Observatory for Physical Activity Country Cards and the Active Healthy Kids Report Cards. Subsequently, we extracted information from survey documentation on the survey commissioners and contractors, method of administration, current questionnaire details relevant to the PA recommendations, questionnaire changes over the previous decade and the most recent prevalence figures.ResultsFor adults and older adults, five surveys assess the moderate-to-vigorous PA (MVPA) recommendation, three assess muscle strengthening and three assess SB. For older adults only, three assess balance and co-ordination. For children, seven assess MVPA, none assess muscle strengthening and five assess SB. Only one survey reports on the under 5 PA recommendation. There is no part of the recommendations for which comparable estimates can be calculated across all four home nations. The greatest variation is among the SB questions and reporting. No survey has regularly used device-based measures.ConclusionUK surveillance of the PA recommendations is complex, undertaken separately in the home nations, using multiple surveys that cover adults and children separately. We recommend that the costs and benefits of harmonising the existing questionnaires are considered, along with the potential introduction of device-based measures.

BackgroundThe percentage of children in Scotland and England meeting the aerobic physical activity recommendation differ greatly according to the estimates derived from the respective national health surveys. The Scottish Health Survey (SHeS) usually estimates that over 70% meet the guidelines; Health Survey for England (HSE) estimates are usually below 25%. It is plausible that these differences originate from different analysis methods. The HSE monitor the percentage of children that undertake 60 minutes of moderate-to-vigorous physical activity on each day of the week (‘the daily minimum method’ (DMM)). The SHeS monitor the proportion that undertake at least seven sessions of moderate-to-vigorous physical activity, with an average daily duration over 60 minutes (‘the average method’ (WAM)). We aimed to establish how great an influence this difference in analysis methods has on the prevalence estimates.MethodsPhysical activity data from 5-15 year olds in the 2015 HSE and SHeS were reanalysed (weighted n=3840 and 965, respectively). Two comparable pairs of estimates were derived: a DMM and WAM estimate from the HSE not including travel to/from school, and WAM estimates from the HSE and the SHeS including travel to/from school. It is not possible to calculate a DMM estimate from the SHeS due to the way the questions are asked. Results were presented for the total samples, and by sex and age sub-groups.ResultsThe HSE WAM estimate was 31.7 (95% CI: 30.2-33.3) percentage points higher than the DMM estimate (54.3% (95% CI: 52.6-56.0) and 22.6% (95% CI: 21.2-24.1) respectively). The magnitude of this difference differed by age group but not sex. When comparable WAM estimates were derived from the SHeS and the HSE, the SHeS was 11.8 percentage points higher (73.6% (95% CI: 69.8-77.1) and 61.8% (95% CI: 60.2-63.5) respectively). The magnitude of this difference differed by age group and sex.ConclusionsThe results indicate that the difference in the analysis method explains the majority (approximately 30 percentage points) of the difference in the child physical activity prevalence estimates between Scotland and England. These results will help those involved in national surveillance to determine how to increase comparability between the U.K. home nations.

BackgroundSmartphones and wearable activity trackers present opportunities for large-scale physical activity (PA) surveillance that overcome some limitations of questionnaires or researcher-administered devices. However, it remains unknown whether current users of such technologies are representative of the UK population. ObjectiveThe objective of this study was to investigate potential sociodemographic biases in individuals using, or with the potential to use, smartphone apps or wearable activity trackers for PA surveillance in the United Kingdom. MethodsWe used data of adults (aged ≥16 years) from two nationally representative surveys. Using the UK-wide 2018 Ofcom Technology Tracker (unweighted N=3688), we derived mutually adjusted odds ratios (ORs; 95% CI) of personal use or household ownership of a smartwatch or fitness tracker and personal use of a smartphone by age, sex, social grade, activity- or work-limiting disability, urban or rural, and home nation. Using the 2016 Health Survey for England (unweighted N=4539), we derived mutually adjusted ORs of the use of wearable trackers or websites or smartphone apps for weight management. The explanatory variables were age, sex, PA, deprivation, and body mass index (BMI). Furthermore, we stratified these analyses by BMI, as these questions were asked in the context of weight management. ResultsSmartphone use was the most prevalent of all technology outcomes, with 79.01% (weighted 2085/2639) of the Technology Tracker sample responding affirmatively. All other outcomes were

Background/objectivesWalking pace is associated with risk of premature mortality. However, whether this relationship is independent of total volume of physical activity and highest physical activity intensity remains unclear. We examined the associations between walking pace and cause-specific mortality, investigating the potential modifying effect of factors such as total physical activity volume, highest physical activity intensity, age, sex and body mass index (BMI).MethodsProspective pooled analysis of 11 population-based baseline surveys in England and Scotland between 1994 and2008 that were linked with mortality records. Multivariate-adjusted Cox proportional hazards models examined associations between walking pace (slow, average, brisk/fast) and all-cause, cancer and cardiovascular disease (CVD) mortality.Results50 225 walkers were entered in the core analyses. Among participants who did not experience an event in the first 2 years of follow-up (n=49 731), walking at an average or brisk/fast pace was associated with a reduced risk of all-cause (20% (95% CI 12% to 28%) and 24% (95% CI 13% to 33%), respectively) and CVD mortality (24% (95% CI 9% to 36%) and 21% (95% CI 1% to 38%), respectively), compared with reporting walking at a slow pace. In stratified analyses, such associations were evident among those over 50 years, those not meeting the physical activity recommendations and those who did not undertake vigorous-intensity activity. There were no interactions by sex or BMI. No associations were seen between pace and cancer mortality.ConclusionWalking benefits health. Assuming causality, these analyses suggest that increasing walking pace could reduce risk for all-cause and CVD mortality. Walking pace could be emphasised in public health messages, especially in situations when increase in walking volume or frequency is less feasible.

Introduction: Despite the importance of muscle strengthening and balance activities for health, these elements of the physical activity recommendations are often omitted from communication campaigns and national surveillance systems. This paper reviews national physical activity surveillance systems to determine which tools assess muscle strengthening and balance activities. Methods: We reviewed each tool that was used to inform the Global Observatory for Physical Activity (GoPA) country card prevalence estimates.Results: Of the 139 countries with GoPA country cards, 21 countries reported having no physical activity prevalence data. The prevalence estimates for 74 countries came from the World Health Organization 2014 Global Status Report on Non-communicable Diseases. For the remaining 44 countries, a range of national and international surveys were used. A limited number of tools sought to assess muscle strengthening activities, and even fewer assessed balance and coordination activities. Discussion: Several issues arise from this review, including the need to: verify the strength of the evidence to inform whether muscle strength and balance should be given equal prominence to the aerobic recommendation; establish which activities count towards different aspects of the guidelines; and confirm whether the muscle strengthening and balance components of the guidelines are ‘in addition’ to the aerobic component.

Background In 2011, the UK physical activity guidelines were updated to include recommendations for muscle strengthening and balance & coordination (at least two sessions of relevant activities per week). However, monitoring and policy efforts remain focussed on aerobic activity. This study aimed to assess differences by gender and age in the a) prevalence of muscle strengthening and balance & co-ordination guidelines, and b) participation in guideline-specific activities. Methods The sample for the muscle strengthening analyses was 10,488 adult (16–64 years) and 3857 older adult (≥65 years) 2012–2014 Scottish Health Survey respondents. The balance & co-ordination analyses used only the older adult responses. Differences by gender and (where possible) age in guideline prevalence and activity participation were assessed using logistic regression and t-tests. Results Thirty-one percent of men and 24 % of women met the muscle strengthening guideline, approximately half that of published figures for aerobic physical activity. Nineteen percent of older men and 12 % of older women met the balance & co-ordination guidelines. The oldest age groups were less likely to meet both guidelines compared to the youngest age groups. Differences by gender were only evident for muscle strengthening: more men met the guidelines than women in all age groups, with the largest difference amongst 16–24 year olds (55 % men compared with 40 % women). Participation in relevant activities differed by gender for both guidelines. ‘Workout at gym’ was the most popular activity to improve muscle strength for men (18 % participated), while swimming was for women (15 % participated). Golf was the most popular activity to improve balance & co-ordination for older men (11 % participated) and aerobics was for older women (6 % participated). Participation decreased in most muscle strengthening activities for both men and women. One exception was golf, where participation levels were as high amongst older men as in younger age groups, although overall levels were low (3 % of all men). Conclusions Physical activity policy should aim to increase prevalence of these ‘forgotten’ guidelines, particularly amongst young women (for muscle strengthening) and older age groups (both guidelines). Gender and age participation differences should be considered when designing population-level interventions. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3774-6) contains supplementary material, which is available to authorized users.

Objective To investigate the age-related differences in the contributions of the domains of physical activity (PA) for men and women in Scotland who met the current PA guidelines or who were insufficiently active. Methods We analysed data from the 2013 Scottish Health Survey (4885 adults (≥ 16 years)). Average weekly minutes of moderate or vigorous PA (MVPA) and the relative contributions to total MVPA were calculated for the domains of: walking, cycling, domestic, leisure, occupational, outdoor, non-team sport, team sport, and exercise & fitness. We performed linear regression analyses to assess differences by 10-year age group, stratified by sex and activity status (1–149 or ≥ 150 min of MVPA per week). These were repeated excluding occupational activity due to concerns with its measurement. Results For the 64.3% of the sample that met the guidelines, occupational activity was the most prevalent domain accounting for 18–26% of all MVPA for those under 65 years. When excluded, there was no age-related decline in total MVPA (p > 0.05). For the 18.6% of the sample that reported 1–149 min of MVPA per week, domestic activity was the most prevalent domain. Across both sexes and activity statuses, exercise & fitness declined with age and walking was most prevalent in the oldest age group. Conclusion The domains in which adults in Scotland undertake MVPA vary by age group. Policies designed to increase PA should take this into account. Our findings challenge current thinking on age-related changes in activity, with the exclusion of occupational activity mitigating any age-related decline in MVPA., Highlights • Domains of physical activity vary by age for men and women in Scotland. • Domestic activity was the most prevalent domain amongst the insufficiently active. • Walking and occupational activitywere most prevalent for the sufficiently active. • Occupational activity may distort our understanding of the age-related variations. • Data from the nationally representative Scottish Health Survey