Publications by authors named "Pedro C Hallal"

205 Publications

Children's moderate-to-vigorous physical activity on weekdays versus weekend days: a multi-country analysis.

Int J Behav Nutr Phys Act 2021 02 10;18(1):28. Epub 2021 Feb 10.

MRC Epidemiology Unit & Centre for Diet and Activity Research, University of Cambridge, Cambridge, UK.

Purpose: The Structured Days Hypothesis (SDH) posits that children's behaviors associated with obesity - such as physical activity - are more favorable on days that contain more 'structure' (i.e., a pre-planned, segmented, and adult-supervised environment) such as school weekdays, compared to days with less structure, such as weekend days. The purpose of this study was to compare children's moderate-to-vigorous physical activity (MVPA) levels on weekdays versus weekend days using a large, multi-country, accelerometer-measured physical activity dataset.

Methods: Data were received from the International Children's Accelerometer Database (ICAD) July 2019. The ICAD inclusion criteria for a valid day of wear, only non-intervention data (e.g., baseline intervention data), children with at least 1 weekday and 1 weekend day, and ICAD studies with data collected exclusively during school months, were included for analyses. Mixed effects models accounting for the nested nature of the data (i.e., days within children) assessed MVPA minutes per day (min/day MVPA) differences between weekdays and weekend days by region/country, adjusted for age, sex, and total wear time. Separate meta-analytical models explored differences by age and country/region for sex and child weight-status.

Results/findings: Valid data from 15 studies representing 5794 children (61% female, 10.7 ± 2.1 yrs., 24% with overweight/obesity) and 35,263 days of valid accelerometer data from 5 distinct countries/regions were used. Boys and girls accumulated 12.6 min/day (95% CI: 9.0, 16.2) and 9.4 min/day (95% CI: 7.2, 11.6) more MVPA on weekdays versus weekend days, respectively. Children from mainland Europe had the largest differences (17.1 min/day more MVPA on weekdays versus weekend days, 95% CI: 15.3, 19.0) compared to the other countries/regions. Children who were classified as overweight/obese or normal weight/underweight accumulated 9.5 min/day (95% CI: 6.9, 12.2) and 10.9 min/day (95% CI: 8.3, 13.5) of additional MVPA on weekdays versus weekend days, respectively.

Conclusions: Children from multiple countries/regions accumulated significantly more MVPA on weekdays versus weekend days during school months. This finding aligns with the SDH and warrants future intervention studies to prioritize less-structured days, such as weekend days, and to consider providing opportunities for all children to access additional opportunities to be active.
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http://dx.doi.org/10.1186/s12966-021-01095-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7877033PMC
February 2021

SOS Brazil: science under attack.

Authors:
Pedro C Hallal

Lancet 2021 Jan 22;397(10272):373-374. Epub 2021 Jan 22.

Universidade Federal de Pelotas, Pelotas 96083-466, Brazil. Electronic address:

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http://dx.doi.org/10.1016/S0140-6736(21)00141-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7825897PMC
January 2021

Going Global as JPAH Enters Adulthood.

Authors:
Pedro C Hallal

J Phys Act Health 2020 Dec 22;18(1). Epub 2020 Dec 22.

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http://dx.doi.org/10.1123/jpah.2020-0845DOI Listing
December 2020

Prevalence of antibodies against SARS-CoV-2 according to socioeconomic and ethnic status in a nationwide Brazilian survey.

Rev Panam Salud Publica 2020 29;44:e135. Epub 2020 Oct 29.

Universidade Federal de Pelotas Pelotas Brazil Universidade Federal de Pelotas, Pelotas, Brazil.

Objectives: To investigate socioeconomic and ethnic group inequalities in prevalence of antibodies against SARS-CoV-2 in the 27 federative units of Brazil.

Methods: In this cross-sectional study, three household surveys were carried out on May 14-21, June 4-7, and June 21-24, 2020 in 133 Brazilian urban areas. Multi-stage sampling was used to select 250 individuals in each city to undergo a rapid antibody test. Subjects answered a questionnaire on household assets, schooling and self-reported skin color/ethnicity using the standard Brazilian classification in five categories: white, black, brown, Asian or indigenous. Principal component analyses of assets was used to classify socioeconomic position into five wealth quintiles. Poisson regression was used for the analyses.

Results: 25 025 subjects were tested in the first, 31 165 in the second, and 33 207 in the third wave of the survey, with prevalence of positive results equal to 1.4%, 2.4%, and 2.9% respectively. Individuals in the poorest quintile were 2.16 times (95% confidence interval 1.86; 2.51) more likely to test positive than those in the wealthiest quintile, and those with 12 or more years of schooling had lower prevalence than subjects with less education. Indigenous individuals had 4.71 (3.65; 6.08) times higher prevalence than whites, as did those with black or brown skin color. Adjustment for region of the country reduced the prevalence ratios according to wealth, education and ethnicity, but results remained statistically significant.

Conclusions: The prevalence of antibodies against SARS-CoV-2 in Brazil shows steep class and ethnic gradients, with lowest risks among white, educated and wealthy individuals.
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http://dx.doi.org/10.26633/RPSP.2020.135DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7595003PMC
October 2020

The multivariate physical activity signature associated with metabolic health in children and youth: An International Children's Accelerometry Database (ICAD) analysis.

Prev Med 2020 12 3;141:106266. Epub 2020 Oct 3.

Department of Sport, Food and Natural Sciences, Faculty of Education, Arts and Sports, Western Norway University of Applied Sciences, Sogndal, Norway. Electronic address:

There is solid evidence for an association between physical activity and metabolic health outcomes in children and youth, but for methodological reasons most studies describe the intensity spectrum using only a few summary measures. We aimed to determine the multivariate physical activity intensity signature associated with metabolic health in a large and diverse sample of children and youth, by investigating the association pattern for the entire physical intensity spectrum. We used pooled data from 11 studies and 11,853 participants aged 5.8-18.4 years included in the International Children's Accelerometry Database. We derived 14 accelerometry-derived (ActiGraph) physical activity variables covering the intensity spectrum (from 0-99 to ≥8000 counts per minute). To handle the multicollinearity among these variables, we used multivariate pattern analysis to establish the associations with indices of metabolic health (abdominal fatness, insulin sensitivity, lipid metabolism, blood pressure). A composite metabolic health score was used as the main outcome variable. Associations with the composite metabolic health score were weak for sedentary time and light physical activity, but gradually strengthened with increasing time spent in moderate and vigorous intensities (up to 4000-5000 counts per minute). Association patterns were fairly consistent across sex and age groups, but varied across different metabolic health outcomes. This novel analytic approach suggests that vigorous intensity, rather than less intense activities or sedentary behavior, are related to metabolic health in children and youth.
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http://dx.doi.org/10.1016/j.ypmed.2020.106266DOI Listing
December 2020

SARS-CoV-2 antibody prevalence in Brazil: results from two successive nationwide serological household surveys.

Lancet Glob Health 2020 11 23;8(11):e1390-e1398. Epub 2020 Sep 23.

Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil. Electronic address:

Background: Population-based data on COVID-19 are essential for guiding policies. There are few such studies, particularly from low or middle-income countries. Brazil is currently a hotspot for COVID-19 globally. We aimed to investigate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody prevalence by city and according to sex, age, ethnicity group, and socioeconomic status, and compare seroprevalence estimates with official statistics on deaths and cases.

Methods: In this repeated cross-sectional study, we did two seroprevalence surveys in 133 sentinel cities in all Brazilian states. We randomly selected households and randomly selected one individual from all household members. We excluded children younger than 1 year. Presence of antibodies against SARS-CoV-2 was assessed using a lateral flow point-of-care test, the WONDFO SARS-CoV-2 Antibody Test (Wondfo Biotech, Guangzhou, China), using two drops of blood from finger prick samples. This lateral-flow assay detects IgG and IgM isotypes that are specific to the SARS-CoV-2 receptor binding domain of the spike protein. Participants also answered short questionnaires on sociodemographic information (sex, age, education, ethnicity, household size, and household assets) and compliance with physical distancing measures.

Findings: We included 25 025 participants in the first survey (May 14-21) and 31 165 in the second (June 4-7). For the 83 (62%) cities with sample sizes of more than 200 participants in both surveys, the pooled seroprevalence increased from 1·9% (95% CI 1·7-2·1) to 3·1% (2·8-3·4). City-level prevalence ranged from 0% to 25·4% in both surveys. 11 (69%) of 16 cities with prevalence above 2·0% in the first survey were located in a stretch along a 2000 km of the Amazon river in the northern region. In the second survey, we found 34 cities with prevalence above 2·0%, which included the same 11 Amazon cities plus 14 from the northeast region, where prevalence was increasing rapidly. Prevalence levels were lower in the south and centre-west, and intermediate in the southeast, where the highest level was found in Rio de Janeiro (7·5% [4·2-12·2]). In the second survey, prevalence was similar in men and women, but an increased prevalence was observed in participants aged 20-59 years and those living in crowded conditions (4·4% [3·5-5·6] for those living with households with six or more people). Prevalence among Indigenous people was 6·4% (4·1-9·4) compared with 1·4% (1·2-1·7) among White people. Prevalence in the poorest socioeconomic quintile was 3·7% (3·2-4·3) compared with 1·7% (1·4-2·2) in the wealthiest quintile.

Interpretation: Antibody prevalence was highly heterogeneous by country region, with rapid initial escalation in Brazil's north and northeast. Prevalence is strongly associated with Indigenous ancestry and low socioeconomic status. These population subgroups are unlikely to be protected if the policy response to the pandemic by the national government continues to downplay scientific evidence.

Funding: Brazilian Ministry of Health, Instituto Serrapilheira, Brazilian Collective Health Association, and the JBS Fazer o Bem Faz Bem.
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http://dx.doi.org/10.1016/S2214-109X(20)30387-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7511212PMC
November 2020

Population-based surveys of antibodies against SARS-CoV-2 in Southern Brazil.

Nat Med 2020 08 8;26(8):1196-1199. Epub 2020 Jul 8.

Universidade Federal de Pelotas, Pelotas, Brazil.

Population-based data on COVID-19 are urgently needed. We report on three rounds of probability sample household surveys in the state of Rio Grande do Sul (Brazil), carried out in nine large municipalities using the Wondfo lateral flow point-of-care test for immunoglobulin M and G antibodies against SARS-CoV-2 (https://en.wondfo.com.cn/product/wondfo-sars-cov-2-antibody-test-lateral-flow-method-2/). Before survey use, the assay underwent four validation studies with pooled estimates of sensitivity (84.8%; 95% confidence interval (CI) = 81.4-87.8%) and specificity (99.0%; 95% CI = 97.8-99.7%). We calculated that the seroprevalence was 0.048% (2/4,151; 95% CI = 0.006-0.174) on 11-13 April (round 1), 0.135% (6/4,460; 95% CI = 0.049-0.293%) on 25-27 April (round 2) and 0.222% (10/4,500; 95% CI = 0.107-0.408) on 9-11 May (round 3), with a significant upward trend over the course of the surveys. Of 37 family members of positive individuals, 17 (35%) were also positive. The epidemic is at an early stage in the state, and there is high compliance with social distancing, unlike in other parts of Brazil. Periodic survey rounds will continue to monitor trends until at least the end of September, and our population-based data will inform decisions on preventive policies and health system preparedness at the state level.
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http://dx.doi.org/10.1038/s41591-020-0992-3DOI Listing
August 2020

Physical activity: moving from words to action.

Lancet Glob Health 2020 07;8(7):e867-e868

University of California San Diego, La Jolla, CA, USA.

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http://dx.doi.org/10.1016/S2214-109X(20)30256-4DOI Listing
July 2020

Birth weight, cardiometabolic risk factors and effect modification of physical activity in children and adolescents: pooled data from 12 international studies.

Int J Obes (Lond) 2020 10 3;44(10):2052-2063. Epub 2020 Jun 3.

Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.

Objectives: Low and high birth weight is associated with higher levels of cardiometabolic risk factors and adiposity in children and adolescents, and increases the risk of cardiovascular diseases, obesity, and early mortality later in life. Moderate-to-vigorous physical activity (MVPA) is associated with lower cardiometabolic risk factors and may mitigate the detrimental consequences of high or low birth weight. Thus, we examined whether MVPA modified the associations between birth weight and cardiometabolic risk factors in children and adolescents.

Methods: We used pooled individual data from 12 cohort- or cross-sectional studies including 9,100 children and adolescents. Birth weight was measured at birth or maternally reported retrospectively. Device-measured physical activity (PA) and cardiometabolic risk factors were measured in childhood or adolescence. We tested for associations between birth weight, MVPA, and cardiometabolic risk factors using multilevel linear regression, including study as a random factor. We tested for interaction between birth weight and MVPA by introducing the interaction term in the models (birth weight x MVPA).

Results: Most of the associations between birth weight (kg) and cardiometabolic risk factors were not modified by MVPA (min/day), except between birth weight and waist circumference (cm) in children (p = 0.005) and HDL-cholesterol (mmol/l) in adolescents (p = 0.040). Sensitivity analyses suggested that some of the associations were modified by VPA, i.e., the associations between birth weight and diastolic blood pressure (mmHg) in children (p = 0.009) and LDL- cholesterol (mmol/l) (p = 0.009) and triglycerides (mmol/l) in adolescents (p = 0.028).

Conclusion: MVPA appears not to consistently modify the associations between low birth weight and cardiometabolic risk. In contrast, MVPA may mitigate the association between higher birth weight and higher waist circumference in children. MVPA is consistently associated with a lower cardiometabolic risk across the birth weight spectrum. Optimal prenatal growth and subsequent PA are both important in relation to cardiometabolic health in children and adolescents.
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http://dx.doi.org/10.1038/s41366-020-0612-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7508671PMC
October 2020

Prenatal and birth predictors of objectively measured physical activity and sedentary time in three population-based birth cohorts in Brazil.

Sci Rep 2020 01 21;10(1):786. Epub 2020 Jan 21.

Norwegian School of Sports Sciences, PO Box 4014, Ulleval Stadion 0806, Oslo, Norway.

Physical inactivity is a global pandemic with no signs of improvement. Prolonged sitting time is an emerging risk factor that exacerbates the health consequences of physical inactivity. Both behaviours are influenced by various individual and environmental factors but it remains unknown whether early-life exposures "program" these behaviours in later life. The current evidence is limited by a small number of studies which were primarily conducted in high-income countries, and a narrow range of early-life variables examined. Using data from three population-based Brazilian birth cohorts (analytical samples: n = 2740 for 1982 cohort, aged 30 years; n = 3592 for 1993 cohort, aged 18; n = 2603 for 2004 cohort, aged 6), we show that being female and higher family socioeconomic status at birth are strong and consistent predictors of lower physical activity and higher sedentary time from childhood to adulthood. Meanwhile, higher birth weight and lower birth order may also predict lower physical activity and higher sedentary time. Our findings are distinct from evidence from high-income countries, suggesting the importance of broader socioeconomic context in determining individual's activity patterns through the life- course. Such evidence is essential for understanding the biological etiology and socioeconomic context of physical activity and sedentary behaviour at an early stage in life.
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http://dx.doi.org/10.1038/s41598-019-57070-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6972919PMC
January 2020

Reliability of a multi-domain sedentary behaviour questionnaire and comparability to an overall sitting time estimate.

J Sports Sci 2020 Feb 9;38(3):351-356. Epub 2019 Dec 9.

Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.

This study evaluated the test-retest reliability of a questionnaire assessing five domains of sedentary behaviour, and compared an overall indicator of sitting time with measures obtained by a multi-domain questionnaire, among adults living in Brazil. Data from two different studies carried out in Pelotas, Brazil, were used. : evaluated 7-day reliability of a multi-domain sedentary behaviour questionnaire among 78 adults (≥18 years). was a population-based study (n = 2,871 adults aged 20+ years) where a score of sedentary behaviour based on time spent sitting in five domains was compared with overall sitting time. Lin's Concordance Correlation coefficients (CCC) and Bland-Altman plots were used to assess agreement between measures. The 7-day reliability of multi-domain questionnaire did not show marked differences in the median of minutes spent in each domain (). For the total score, the Lin's CCC was 0.87. When sitting time was measured by a single question, participants reported on average less sedentary time compared to the multiple-domain questionnaire (). There was a slightly greater difference between measures among participants who reported higher sedentary time. Assessing sedentary behaviour in different domains would appear to be preferable to employing a general question on the total time spent sitting per day.
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http://dx.doi.org/10.1080/02640414.2019.1701794DOI Listing
February 2020

Associations between self-reported physical activity and screen time with cardiometabolic risk factors in adolescents: Findings from the 1993 Pelotas (Brazil) Birth Cohort Study.

Prev Med 2019 02 19;119:31-36. Epub 2018 Dec 19.

Postgraduate Program in Epidemiology, Federal University of Pelotas, Brazil.

The overall aim of this study was to examine the association of physical activity (PA) and screen time (ST) on indicators of cardio-metabolic risk during adolescence, by examining the combined association of PA and ST at ages 11, 15 and 18 on cardio-metabolic risk factors at 18 years. Data from the 1993 Pelotas (Brazil) Birth Cohort Study (N = 3613) were analysed in 2017. Self-reported PA and ST data were collected at 11, 15 and 18 years. Cardio-metabolic risk factors (fat mass index, waist circumference, triglycerides, blood glucose, non-HDL cholesterol and resting diastolic blood pressure) were examined at age 18. Multivariate linear regression was used to examine the associations between four mutually exclusive PA/ST groups: 1) active (≥1 h/day PA) and low ST (<5 h/day ST); 2) active (≥1 h/day PA) and high ST (≥5 h/day ST); 3) inactive (<1 h/day PA) and low ST (<5 h/day ST); 4) inactive (<1 h/day PA) and high ST (≥5 h/day ST) at each age, and outcomes at age 18. There were no significant associations between PA/ST at ages 11 and 15 with outcomes at 18 years. In the cross-sectional analyses, adolescents in the most active group had significantly better levels of all the outcomes, regardless of ST. Inactive participants with high ST had the highest levels of glucose and non-HDL-C. For diastolic blood pressure, values were higher among inactive participants. Overall, higher levels of physical activity appeared to be more important than low levels of ST for cardio-metabolic health in adolescents.
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http://dx.doi.org/10.1016/j.ypmed.2018.12.008DOI Listing
February 2019

Mapping the historical development of physical activity and health research: A structured literature review and citation network analysis.

Prev Med 2018 06;111:466-472

Post-Graduate Program in Epidemiology, Federal University of Pelotas, Brazil.

Little has been published about the historical development of scientific evidence in the physical activity (PA) and public health research field. The study aimed to examine the evolution of knowledge in this field. A structured literature review using formal citation network analysis methods was conducted in June-2016. Using a list of influential PA publications identified by domain experts, a snowball sampling technique was used to build a compact citation network of 141 publications that represents the backbone of the field. Articles were coded by study type and research team characteristics, then analyzed by visualizing the citation network and identifying research clusters to trace the evolution of the field. The field started in the 1950s, with a health sciences focus and strong North American and European leadership. Health outcome studies appeared most frequently in the network and policy and interventions least. Critical articles on objective measurement and public policy have influenced the progress from an emphasis on health outcomes research at early stages in the field to the more recent emerging built environment and global monitoring foci. There is only modest cross-citation across types of study. To our knowledge, this paper is the first to systematically describe the development of research on PA and public health. The key publications include fundamental ideas that remain citable over time, but notable research and dissemination gaps exist and should be addressed. Increasing collaboration and communication between study areas, encouraging female researchers, and increasing studies on interventions, evaluation of interventions and policy are recommended.
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http://dx.doi.org/10.1016/j.ypmed.2017.10.020DOI Listing
June 2018

Exercise in patients with hypertension and chronic kidney disease: a randomized controlled trial.

J Hum Hypertens 2018 06 4;32(6):397-407. Epub 2018 Apr 4.

Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.

Hypertension and chronic kidney disease (CKD) are global public health problems, both associated with higher risk of cardiovascular (CV) and renal events. This trial randomized non-diabetic adult patients with hypertension and CKD stages 2-4 to 16 weeks of aerobic and resistance training or usual care. The primary outcome was the change in estimated glomerular filtration rate (eGFR). Secondary outcomes included changes in systolic and diastolic blood pressure (BP), body weight, fasting blood glucose, lipid profile, high-sensitivity C-reactive protein (hs-CRP), and functional capacity. The analysis was performed by intention-to-treat, using linear mixed-effects models for repeated measures over time. A hundred fifty patients were included in the intervention (76) or control (74) groups. No difference was found in eGFR, BP, body weight, or lipid profile changes between the groups. However, there were significant decreases in hs-CRP [-6.7(-11.7 to -1.8) mg/L] and fasting blood glucose [-11.3(-20.0 to -1.8) mg/dL], and an increase in functional capacity [2' Step Test 33.9 (17.7-50.0); 30″ Stand Test 2.3 (0.9-3.7)] in exercise group compared with control group. The results of this RCT show that combined aerobic and resistance training could reduce inflammation and insulin resistance in hypertensive patients with earlier stages of CKD, without a significant effect on kidney disease progression. Clinical trials.gov NCT01155128.
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http://dx.doi.org/10.1038/s41371-018-0055-0DOI Listing
June 2018

Worldwide use of the first set of physical activity Country Cards: The Global Observatory for Physical Activity - GoPA!

Int J Behav Nutr Phys Act 2018 03 27;15(1):29. Epub 2018 Mar 27.

Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.

Background: The work of The Global Observatory for Physical Activity-GoPA! is the first global effort to compile standardized country-level surveillance, policy and research data for physical activity in order to better understand how countries and regions address promoting physical activity. GoPA! developed standardized country-specific physical activity profiles ("Country Cards") to summarize country-level data through 2013. The aim of this study was to assess use of the Country Cards, identify the factors associated with their use, and develop recommendations for supporting country-level physical activity promotion.

Methods: Cross sectional internet-based survey conducted between August-October 2016. Target study participants were national physical activity leaders and advocates in academia, government and practice from the GoPA! countries, and members of the International Society of Physical Activity and Health. A Country Card use composite score was created based on the diversity and frequency of use. Statistical analyses on the associations between the composite score and respondent characteristics, country characteristics, barriers and opinions were conducted (including descriptive analyses and a logistic regression with robust standard errors).

Results: One hundred forty three participants from 68 countries completed the survey. Use of the Country Cards was associated with being part of the GoPA! network, knowing about the Country Cards, and on the stage of country capacity for physical activity promotion. Country Card knowledge varied by country income group, region and the country specific context. More diverse and frequent use of the cards (highest tertile of the composite score for use) was associated with: 1. Being a country contact vs general participant (OR 18.32-95% CI 5.63-59.55, p = 0.002), and 2. Collaborating with a government representative working in NCDs on a monthly or more frequent contact vs less frequent contact (OR 3.39-95% CI 1.00-11.54, P < 0.05).

Conclusions: For the Country Cards to have a broader impact, GoPA! will need to widen its reach beyond the academic sector. With further refinement of the cards, and training in their implementation, they could be an important tool for advancing country capacity for contextually-relevant strategies, actions and timelines for PA promotion.
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http://dx.doi.org/10.1186/s12966-018-0663-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5869782PMC
March 2018

Socioeconomic position and sedentary behavior in Brazilian adolescents: A life-course approach.

Prev Med 2018 02 22;107:29-35. Epub 2017 Dec 22.

Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.

Socioeconomic position (SEP) is a potential correlate of sedentary behavior in adolescents. The aim of this study was to examine the associations between SEP and self-reported and objective measures of sedentary behavior in adolescents, using a life-course approach. Data from the 1993 Pelotas (Brazil) Birth Cohort Study were analyzed (N=5249). Cross-sectional and longitudinal associations between multiple SEP indicators (maternal education, family income, SEP composite, cumulative family income) at birth, 11, 15 and 18years, and five sedentary behavior outcomes (≥4h/day screen time; ≥4h/day TV; ≥2h/day computer; ≥2h/day video game; ≥12.7h/day objectively measured sedentary time) at 11, 15 and 18years, were examined. In cross-sectional analyses, higher SEP was positively associated with more screen time at ages 11 and 15years. There was a consistent and positive association between higher SEP with time spent using a computer, and with sedentary time assessed through accelerometry. SEP at birth had a positive and direct effect on screen, computer and total sedentary time at 18years. Participants in the highest cumulative income group had higher odds of high sedentary behavior in screen (OR: 2.40; 95% CI: 1.50-3.54), computer (OR: 7.35; 95% CI: 4.19-12.89) and total sedentary time (OR: 5.40; 95% CI: 3.53-10.35), respectively, compared with their counterparts with lower cumulative income. Our findings showed that SEP is an early determinant of sedentary behavior in adolescents.
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http://dx.doi.org/10.1016/j.ypmed.2017.12.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6195187PMC
February 2018

Does objectively measured physical activity modify the association between early weight gain and fat mass in young adulthood?

BMC Public Health 2017 11 25;17(1):905. Epub 2017 Nov 25.

Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.

Background: Substantial evidence suggests that weight gain in early life is associated with increased adiposity and other metabolic disorders later in life. It is, however, unknown whether physical activity (PA) may modify these associations. We aimed to examine whether objectively measured PA at 30 years modified the associations between conditional weight gain in infancy (0-2 y) and childhood (2-4 y) with fat mass index (FMI) and visceral abdominal fat measured at age 30 years.

Methods: Prospective birth cohort study in Pelotas, Brazil, including 1874 participants with weight data at birth, two and four years of age, and measures of FMI, visceral abdominal fat and PA at a mean age of 30.2 years. At age 30, time spent (min/day) in moderate-to-vigorous physical activity (MVPA) was measured objectively using a wrist-worn accelerometer worn for four to seven consecutive days.. Multiple linear regression analyses was performed to assess the associations between conditional weight gain and outcome variables at 30 years, adjusting for covariates. We examined whether PA modified the association between conditional weight gain and the outcomes of interest by introducing an interaction term (conditional weight gain × PA) in the models.

Results: Conditional weight gain in infancy and childhood were both positively associated with later FMI (infancy weight gain: β = 0.68, 95% CI: 0.48, 0.88; P < 0.001; childhood weight gain: β = 0.91, 95% CI: 0.70, 1.11; P < 0.001). A formal test for interaction suggested that MVPA at 30 years of age modified the association between childhood relative weight gain and later FMI (β = -0.006, 95% CI: -0.011, -0.001; P = 0.029), suggesting stronger associations between weight gain and FMI in those with lower levels of MVPA. Conditional weight gain in childhood was also positively associated with visceral abdominal fat (β = 0.24, 95% CI: 0.15, 0424, P < 0.001). There was no evidence for a modification of the latter association after adjustment for physical activity.

Conclusion: Conditional weight gain between 2 and 4 years of age is associated with increased FMI at age 30 years. However, higher levels of MVPA appear to attenuate this detrimental association.
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http://dx.doi.org/10.1186/s12889-017-4924-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5702210PMC
November 2017

Overall and Leisure-Time Physical Activity Among Brazilian Adults: National Survey Based on the Global Physical Activity Questionnaire.

J Phys Act Health 2018 03 7;15(3):212-218. Epub 2018 Feb 7.

Background: To describe overall physical activity prevalence measured by the Global Physical Activity Questionnaire as well as inequalities in leisure-time physical activity among Brazilian adults (15 y and older).

Methods: Data from the Brazilian Survey on Medicine Access, Utilization, and Rational Use of Medicines were analyzed. The study was carried out between September 2013 and February 2014. Physical activity was measured through Global Physical Activity Questionnaire and classified according to the recommendations of the World Health Organization. Additional analysis determined the contribution of each physical activity domain to the total amount of physical activity. Inequalities in terms of sex, age, and socioeconomic position were explored.

Results: About one-third of the participants (37.1%; 95% confidence interval, 35.5-38.8) were physically inactive. Work-based activities were responsible for 75.7% of the overall physical activity. The prevalence of participants achieving physical activity guidelines considering only leisure-time activities was 17.8% (95% confidence interval, 16.7-19.2). Females and older participants were less active than their counterparts for both overall and leisure-time physical activity; socioeconomic status was positively associated to leisure-time physical activity.

Conclusions: Major overall physical activity is attributed to work-related physical activity. Leisure-time physical activity, a key domain for public health, presents important gender and socioeconomic inequalities.
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http://dx.doi.org/10.1123/jpah.2017-0262DOI Listing
March 2018

Worldwide Surveillance, Policy, and Research on Physical Activity and Health: The Global Observatory for Physical Activity.

J Phys Act Health 2017 09 17;14(9):701-709. Epub 2017 May 17.

Background: The Global Observatory for Physical Activity (GoPA!) was launched in response to the physical inactivity pandemic. The aim of this article is to present current information about surveillance, policy, and research on physical activity (PA) and health worldwide.

Methods: Information was collected for 217 countries. For 139 of these nations we identified a contact who confirmed information's accuracy and completeness. Associations were calculated among surveillance, policy and research categories.

Results: Of the 139 countries, 90.6% reported having completed 1 or more PA survey, but less than one-third had 3 or more. 106 included PA on a national plan, but only one-quarter of these were PA-specific. At least 1 peer reviewed publication was identified for 63.3% of the countries. Positive associations (P < .001) were found between research and policy (ρ = 0.35), research and surveillance (ρ = 0.41), and surveillance and policy (ρ = 0.31). Countries with a standalone plan were more likely to have surveillance. Countries with more research were more likely to have a standalone plan and surveillance.

Conclusions: Surveillance, policy, and research indicators were positively correlated, suggesting that action at multiple levels tends to stimulate progress in other areas. Efforts to expand PA-related surveillance, policy, and research in lower income countries are needed.
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http://dx.doi.org/10.1123/jpah.2016-0626DOI Listing
September 2017

Associations of Vigorous-Intensity Physical Activity with Biomarkers in Youth.

Med Sci Sports Exerc 2017 07;49(7):1366-1374

1Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC; 2Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC; 3Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC; 4Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, DENMARK; 5Department of Sport Medicine, Norwegian School of Sport Science, Oslo, NORWAY; 6Federal University of Pelotas, Pelotas, BRAZIL; 7School of Social and Community Medicine, University of Bristol, Bristol, UNITED KINGDOM; 8Epidemiology, Biostatistics and Public Health Institute, University of Zürich, Zürich, SWITZERLAND; 9Physical Activity for Health Group, School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UNITED KINGDOM; and 10Exercise and Health Laboratory, CIPER, Faculty of Human Kinetics, University of Lisbon, Cruz-Quebrada, PORTUGAL.

Introduction: Physical activity (PA) conveys known cardiometabolic benefits to youth, but the contribution of vigorous-intensity PA (VPA) to these benefits is unknown. Therefore, we sought to determine (a) the associations between VPA and cardiometabolic biomarkers independent of moderate-intensity PA (MPA) and time sedentary and (b) the accelerometer cut point that best represents the threshold for health-promoting VPA in youth.

Methods: Data from the International Children's Accelerometry Database (ICAD) were analyzed in 2015. The relationship between cardiometabolic biomarkers and four categories of VPA estimated via three sets of cut points were examined using isotemporal substitution quantile regression modeling at the 10th, 25th, 50th, 75th, and 90th percentile of the distribution of each biomarker, separately. Age, sex, accelerometer wear time, sedentary time, and MPA were controlled for while allowing substitution for light-intensity PA. Data from 11,588 youth (4-18 yr) from 11 ICAD studies (collected 1998-2009) were analyzed.

Results: Only 32 of 360 significant associations were observed. Significant, negative relationships were observed for VPA with waist circumference and insulin. Replacing light-intensity PA with VPA (corresponding to at the 25th to 90th percentiles of VPA) was associated with 0.67 (-1.33 to -0.01; P = 0.048) to 7.30 cm (-11.01 to -3.58; P < 0.001) lower waist circumference using Evenson and ICAD cut points (i.e., higher counts per minute). VPA levels were associated with 12.60 (-21.28 to -3.92; P = 0.004) to 27.03 pmol·L (-45.03 to -9.03; P = 0.003) lower insulin levels at the 75th to 90th percentiles using Evenson and ICAD cut points when substituted for light PA.

Conclusions: Substituting light PA with VPA was inversely associated with waist circumference and insulin. However, VPA was inconsistently related to the remaining biomarkers after controlling for time sedentary and MPA.
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http://dx.doi.org/10.1249/MSS.0000000000001249DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5472198PMC
July 2017

Physical Activity Throughout Adolescence and Hba1c in Early Adulthood: Birth Cohort Study.

J Phys Act Health 2017 05 7;14(5):375-381. Epub 2017 Feb 7.

Background: Physical inactivity is responsible for 7% of diabetes deaths worldwide, but little is known whether low levels of physical activity (PA) during adolescence increase the risk of diabetes in early adulthood. We evaluated the cross-sectional and longitudinal associations between PA throughout adolescence and HbA1c concentration in early adulthood.

Methods: HbA1c was measured by high performance liquid chromatography. PA was assessed by self-report at the ages of 11, 15, and 18 years and by accelerometry at the ages of 13 (subsample) and 18 years. The loss percentages of follow up were 12.5% at 11 years, 14.4% at 15 years, and 18.7% at 18 years.

Results: At 18 years, boys showed higher HbA1c than girls. At age 18 years, accelerometrybased PA at 18 years was inversely related to HbA1c levels in boys. Self-reported leisure-time PA at ages 11, 15, and 18 were unrelated to HbA1c in both genders. PA at 13 years of age was unrelated to HbA1c among both genders. In trajectory analysis, PA and accelerometer PA trajectories were not associated with later HbA1c.

Conclusions: Objectively measured PA at 18 years was cross-sectionally inversely associated with HbA1c in boys only. No prospective associations were identified.
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http://dx.doi.org/10.1123/jpah.2016-0245DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6101207PMC
May 2017

One-year Stability of Objectively Measured Physical Activity in Young Brazilian Adults.

J Phys Act Health 2017 03 20;14(3):208-212. Epub 2016 Dec 20.

Background: To evaluate the 1-year stability of objectively measured physical activity among young adults living in South Brazil, as well as assessing the influences of temperature, humidity and precipitation on physical activity.

Methods: A longitudinal study was conducted over 12 consecutive months (October 2012 to September 2013). Sixteen participants (8 men) used GT3X+ accelerometers 1 week per month for the entire year. Climate variables were obtained from an official climate information provider.

Results: Physical activity was remarkably stable over the year-the proportion of the day spent in moderate-to-vigorous intensity physical activity (MVPA) was around 5% in every month. Average temperature (ρ = -0.64; P = .007), humidity (ρ = -0.68; P = .004) and rain (ρ = -0.67; P = .004) were inversely correlated to MVPA in the Summer. Rain was also inversely correlated to MVPA in the Spring (ρ = -0.54; P = .03).

Conclusions: Objectively measured physical activity was stable over a 1-year period. Climate variables consistently influenced physical activity practice in the Summer, but not in the other seasons.
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http://dx.doi.org/10.1123/jpah.2015-0384DOI Listing
March 2017

Global participation in sport and leisure-time physical activities: A systematic review and meta-analysis.

Prev Med 2017 02 6;95:14-25. Epub 2016 Dec 6.

School of Education, University of Newcastle, Newcastle, Australia. Electronic address:

This review aimed to determine the most popular physical activities performed by children, adolescents, and adults globally. Statistic bureau websites and article databases Scopus, ProQuest, SPORTDiscus, and Science Direct were searched between November 17th, 2014 and April 31st, 2015. Eligible studies were published in the last 10years with participation rates for specific physical activities among individuals five years or older. Data extraction for included articles (n=64) was assessed independently and agreed upon by two authors. A random-effects model was used to calculate participation rates in specific activities for each age group and region. In total 73,304 articles were retrieved and 64 articles representing 47 countries were included in the final meta-analysis. Among adults, walking was the most popular activity in the Americas (18.9%; 95% CI 10.2 to 32.5), Eastern Mediterranean (15.0%; 95% CI 5.8 to 33.6), Southeast Asia (39.3%; 95% CI 0.9 to 98.0) and Western Pacific (41.8%; 95% CI 25.2 to 60.6). In Europe and Africa, soccer (10.0%; 95% CI 6.5 to 15.1) and running (9.3%; 95% CI 0.9 to 53.9), respectively, were top activities. Child and adolescent participation results were highly dependent upon region. American youth team sport participation was high, while youth from the Eastern Mediterranean and Western Pacific were more likely to report participation in lifelong physical activities. Global data for adults reflects a consistent pattern of participation in running and walking. Among all age groups and regions soccer was popular. In children and adolescents, preferences were variable between regions.
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http://dx.doi.org/10.1016/j.ypmed.2016.11.027DOI Listing
February 2017

Heart rate reactivity and antisocial behaviour.

Int J Epidemiol 2016 10;45(5):1687-1689

Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil.

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http://dx.doi.org/10.1093/ije/dyw261DOI Listing
October 2016

Health promoting practices and personal lifestyle behaviors of Brazilian health professionals.

BMC Public Health 2016 10 24;16(1):1114. Epub 2016 Oct 24.

Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.

Background: This study was conducted to examine the lifestyle behaviors and health promoting practices of physicians, nurses, and community health workers in Brazil.

Methods: A random sample of primary health care units in Brazil was selected, and a pretested questionnaire was administered via phone interviews, in 2011, to 182 physicians, 347 nurses, and 269 community health workers, totaling 798 health professionals. The total initial sample included 1600 eligible health professionals. Variables measured included physical activity, alcohol intake, hours of sleep, diet, and perceived self-efficacy to provide preventive counseling on related lifestyle behaviors.

Results: More than 25 % of physicians, nurses, and community health workers reported eating 0-2 portions of fruits and vegetables per day. In terms of cervical and breast cancer, nurses reported to be 'very prepared' to advise patients on these topics more frequently than physicians. The prevalence of smoking ranged from 4.9 % among nurses to 7.4 % among community health workers. The proportion of physical inactivity ranged from 40.3 % among nurses to 52.1 % among community health workers.

Conclusion: A reasonably high proportion of physicians, nurses, and community health workers report not engaging in healthy lifestyle behaviors that impact chronic diseases, thus, they may be less likely to encourage such behaviors in their patients.
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http://dx.doi.org/10.1186/s12889-016-3778-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5078940PMC
October 2016

Effectiveness of a scaled up physical activity intervention in Brazil: A natural experiment.

Prev Med 2017 10 28;103S:S66-S72. Epub 2016 Sep 28.

School of Health and Biosciences, Pontificia Universidade Catolica do Parana, Parana, Brazil; Postgraduate Program in Physical Education, Federal University of Parana, Rua XV de Novembro, 1299, Centro, Curitiba, PR 80060-000, Brazil. Electronic address:

Physical inactivity causes 5.3 million deaths annually worldwide. We evaluated the impact on population leisure-time physical activity (LTPA) of scaling up an intervention in Brazil, Academia das Cidades program (AC-P). AC-P is a health promotion program classified as physical activity classes in community settings which started in the state of Pernambuco state in 2008. We surveyed households from 80 cities of Pernambuco state in 2011, 2012 and 2013, using monitoring data to classify city-level exposure to AC-P. We targeted 2370 individuals in 2011; 3824 individuals in 2012; and 3835 individuals in 2013. We measured participation in AC-P and whether respondents had seen an AC-P activity or heard about AC-P. We measured LTPA using the International Physical Activity Questionnaire. We estimated the odds of reaching recommended LTPA by levels of exposure to the three AC-P measures. For women, the odds of reaching recommended LTPA were 1.10 for those living in cities with AC-P activity for less than three years, and 1.46 for those living in cities with AC-P activity for more than three years compared to those living in cities that had not adopted AC-P. The odds of reaching recommended LTPA increased with AC-P participation and knowledge about AC-P. AC-P exposure is associated with increased population LTPA. Extending AC-P to all cities could potentially impact non-communicable diseases in Brazil.
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http://dx.doi.org/10.1016/j.ypmed.2016.09.032DOI Listing
October 2017

Infant sleep hygiene counseling (sleep trial): protocol of a randomized controlled trial.

BMC Psychiatry 2016 Sep 2;16(1):307. Epub 2016 Sep 2.

Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro 1160, 3rd floor, 96220020, Pelotas, RS, Brazil.

Background: Sleep problems in childhood have been found to be associated with memory and learning impairments, irritability, difficulties in mood modulation, attention and behavioral problems, hyperactivity and impulsivity. Short sleep duration has been found to be associated with overweight and obesity in childhood. This paper describes the protocol of a behavioral intervention planned to promote healthier sleep in infants.

Methods: The study is a 1:1 parallel group single-blinded randomized controlled trial enrolling a total of 552 infants at 3 months of age. The main eligibility criterion is maternal report of the infant's sleep lasting on average less than 15 h per 24 h (daytime and nighttime sleep). Following block randomization, trained fieldworkers conduct home visits of the intervention group mothers and provide standardized advice on general practices that promote infant's self-regulated sleep. A booklet with the intervention content to aid the mother in implementing the intervention was developed and is given to the mothers in the intervention arm. In the two days following the home visit the intervention mothers receive daily telephone calls for intervention reinforcement and at day 3 the fieldworkers conduct a reinforcement visit to support mothers' compliance with the intervention. The main outcome assessed is the between group difference in average nighttime self-regulated sleep duration (the maximum amount of time the child stays asleep or awake without awakening the parents), at ages 6, 12 and 24 months, evaluated by means of actigraphy, activity diary records and questionnaires. The secondary outcomes are conditional linear growth between age 3-12 and 12-24 months and neurocognitive development at ages 12 and 24 months.

Discussion: The negative impact of inadequate and insufficient sleep on children's physical and mental health are unquestionable, as well as its impact on cognitive function, academic performance and behavior, all of these being factors to which children in low- and middle-income countries are at higher risk. Behavioral interventions targeting mothers and young children that can be delivered inexpensively and not requiring specialized training can help prevent future issues by reducing the risk to which these children are exposed.

Trial Registration: ClinicalTrial.gov NCT02788630 registered on 14 June 2016 (retrospectively registered).
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http://dx.doi.org/10.1186/s12888-016-1016-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5010682PMC
September 2016

Progress in physical activity over the Olympic quadrennium.

Lancet 2016 Sep 28;388(10051):1325-36. Epub 2016 Jul 28.

Federal University of Pelotas, Pelotas, Brazil.

On the eve of the 2012 summer Olympic Games, the first Lancet Series on physical activity established that physical inactivity was a global pandemic, and global public health action was urgently needed. The present paper summarises progress on the topics covered in the first Series. In the past 4 years, more countries have been monitoring the prevalence of physical inactivity, although evidence of any improvements in prevalence is still scarce. According to emerging evidence on brain health, physical inactivity accounts for about 3·8% of cases of dementia worldwide. An increase in research on the correlates of physical activity in low-income and middle-income countries (LMICs) is providing a better evidence base for development of context-relevant interventions. A finding specific to LMICs was that physical inactivity was higher in urban (vs rural) residents, which is a cause for concern because of the global trends toward urbanisation. A small but increasing number of intervention studies from LMICs provide initial evidence that community-based interventions can be effective. Although about 80% of countries reported having national physical activity policies or plans, such policies were operational in only about 56% of countries. There are important barriers to policy implementation that must be overcome before progress in increasing physical activity can be expected. Despite signs of progress, efforts to improve physical activity surveillance, research, capacity for intervention, and policy implementation are needed, especially among LMICs.
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http://dx.doi.org/10.1016/S0140-6736(16)30581-5DOI Listing
September 2016

Age-related patterns of vigorous-intensity physical activity in youth: The International Children's Accelerometry Database.

Prev Med Rep 2016 Dec 16;4:17-22. Epub 2016 May 16.

MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, United Kingdom.

Physical activity declines during youth but most evidence reports on combined moderate and vigorous-intensity physical activity. We investigated how vigorous-intensity activity varies with age. Cross-sectional data from 24,025 participants (5.0-18.0 y; from 20 studies in 10 countries obtained 2008-2010) providing ≥ 1 day accelerometer data (International Children's Accelerometry Database (ICAD)). Linear regression was used to investigate age-related patterns in vigorous-intensity activity; models included age (exposure), adjustments for monitor wear-time and study. Moderate-intensity activity was examined for comparison. Interactions were used to investigate whether the age/vigorous-activity association differed by sex, weight status, ethnicity, maternal education and region. A 6.9% (95% CI 6.2, 7.5) relative reduction in mean vigorous-intensity activity with every year of age was observed; for moderate activity the relative reduction was 6.0% (5.6%, 6.4%). The age-related decrease in vigorous-intensity activity remained after adjustment for moderate activity. A larger age-related decrease in vigorous activity was observed for girls (- 10.7%) versus boys (- 2.9%), non-white (- 12.9% to - 9.4%) versus white individuals (- 6.1%), lowest maternal education (high school (- 2.0%)) versus college/university (ns) and for overweight/obese (- 6.1%) versus healthy-weight participants (- 8.1%). In addition to larger annual decreases in vigorous-intensity activity, overweight/obese individuals, girls and North Americans had comparatively lower average vigorous-intensity activity at 5.0-5.9 y. Age-related declines in vigorous-intensity activity during youth appear relatively greater than those of moderate activity. However, due to a higher baseline, absolute moderate-intensity activity decreases more than vigorous. Overweight/obese individuals, girls, and North Americans appear especially in need of vigorous-intensity activity promotion due to low levels at 5.0-5.9 y and larger negative annual differences.
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http://dx.doi.org/10.1016/j.pmedr.2016.05.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4929125PMC
December 2016