Publications by authors named "Sigmund A Anderssen"

84 Publications

Aerobic fitness mediates the intervention effects of a school-based physical activity intervention on academic performance. The school in Motion study - A cluster randomized controlled trial.

Prev Med Rep 2021 Dec 24;24:101648. Epub 2021 Nov 24.

Department of Sports Medicine, Norwegian School of Sport Sciences, PB 4014, Ullevål Stadion, 0806 Oslo, Norway.

Little information exists on the mechanism of how physical activity interventions effects academic performance. We examined whether the effects of a school-based physical activity intervention on academic performance were mediated by aerobic fitness. The School in Motion study was a nine-month cluster randomized controlled trial between September 2017 and June 2018. Students from 30 Norwegian lower secondary schools ( = 2,084, mean age [] = 14 [0.3] years) were randomly assigned into three groups: the Physically Active Learning (PAL) intervention ( = 10), the Don't Worry-Be Happy (DWBH) intervention ( = 10), or control ( = 10). Aerobic fitness was assessed by the Andersen test and academic performance by national tests in reading and numeracy. Mediation was assessed according to the causal steps approach using linear mixed models. In the PAL intervention, aerobic fitness partially mediated the intervention effect on numeracy by 28% from a total effect of 1.73 points (95% CI: 1.13 to 2.33) to a natural direct effect of 1.24 points (95% CI: 0.58 to 1.91), and fully mediated the intervention effect on reading, with the total effect of 0.89 points (95% CI: 0.15 to 1.62) reduced to the natural direct effect of 0.40 points (95% CI: -0.48 to 1.28). Aerobic fitness did not mediate the effects on academic performance in the DWBH intervention. As aerobic fitness mediated the intervention effect on academic performance in one intervention, physical activity of an intensity that increases aerobic fitness is one strategy to improve academic performance among adolescents.
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http://dx.doi.org/10.1016/j.pmedr.2021.101648DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8684017PMC
December 2021

Device-measured physical activity, adiposity and mortality: a harmonised meta-analysis of eight prospective cohort studies.

Br J Sports Med 2021 Dec 7. Epub 2021 Dec 7.

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

Background: The joint associations of total and intensity-specific physical activity with obesity in relation to all-cause mortality risk are unclear.

Methods: We included 34 492 adults (72% women, median age 62.1 years, 2034 deaths during follow-up) in a harmonised meta-analysis of eight population-based prospective cohort studies with mean follow-up ranging from 6.0 to 14.5 years. Standard body mass index categories were cross-classified with sample tertiles of device-measured total, light-to-vigorous and moderate-to-vigorous physical activity and sedentary time. In five cohorts with waist circumference available, high and low waist circumference was combined with tertiles of moderate-to-vigorous physical activity.

Results: There was an inverse dose-response relationship between higher levels of total and intensity-specific physical activity and mortality risk in those who were normal weight and overweight. In individuals with obesity, the inverse dose-response relationship was only observed for total physical activity. Similarly, lower levels of sedentary time were associated with lower mortality risk in normal weight and overweight individuals but there was no association between sedentary time and risk of mortality in those who were obese. Compared with the obese-low total physical activity reference, the HRs were 0.59 (95% CI 0.44 to 0.79) for normal weight-high total activity and 0.67 (95% CI 0.48 to 0.94) for obese-high total activity. In contrast, normal weight-low total physical activity was associated with a higher risk of mortality compared with the obese-low total physical activity reference (1.28; 95% CI 0.99 to 1.67).

Conclusions: Higher levels of physical activity were associated with lower risk of mortality irrespective of weight status. Compared with obesity-low physical activity, there was no survival benefit of being normal weight if physical activity levels were low.
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http://dx.doi.org/10.1136/bjsports-2021-104827DOI Listing
December 2021

Effect of 5 years of exercise training on the cardiovascular risk profile of older adults: the Generation 100 randomized trial.

Eur Heart J 2021 Nov 8. Epub 2021 Nov 8.

Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Post Box 8905, Trondheim 7491, Norway.

Aims: The aim of this study was to compare the effects of 5 years of supervised exercise training (ExComb), and the differential effects of subgroups of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT), with control on the cardiovascular risk profile in older adults.

Methods And Results: Older adults aged 70-77 years from Trondheim, Norway (n = 1567, 50% women), able to safely perform exercise training were randomized to 5 years of two weekly sessions of HIIT [∼90% of peak heart rate (HR), n = 400] or MICT (∼70% of peak HR, n = 387), together forming ExComb (n = 787), or control (instructed to follow physical activity recommendations, n = 780). The main outcome was a continuous cardiovascular risk score (CCR), individual cardiovascular risk factors, and peak oxygen uptake (VO2peak). CCR was not significantly lower [-0.19, 99% confidence interval (CI) -0.46 to 0.07] and VO2peak was not significantly higher (0.39 mL/kg/min, 99% CI -0.22 to 1.00) for ExComb vs. control. HIIT showed higher VO2peak (0.76 mL/kg/min, 99% CI 0.02-1.51), but not lower CCR (-0.32, 99% CI -0.64 to 0.01) vs. control. MICT did not show significant differences compared to control or HIIT. Individual risk factors mostly did not show significant between-group differences, with some exceptions for HIIT being better than control. There was no significant effect modification by sex. The number of cardiovascular events was similar across groups. The healthy and fit study sample, and contamination and cross-over between intervention groups, challenged the possibility of detecting between-group differences.

Conclusions: Five years of supervised exercise training in older adults had little effect on cardiovascular risk profile and did not reduce cardiovascular events.

Registration: ClinicalTrials.gov: NCT01666340.
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http://dx.doi.org/10.1093/eurheartj/ehab721DOI Listing
November 2021

The Long-term Effect of Different Exercise Intensities on High-Density Lipoprotein Cholesterol in Older Men and Women Using the Per Protocol Approach: The Generation 100 Study.

Mayo Clin Proc Innov Qual Outcomes 2021 Oct 16;5(5):859-871. Epub 2021 Sep 16.

Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.

Objective: To examine whether 5 years of high-intensity interval training (HIIT) increases high-density lipoprotein cholesterol (HDL-C) concentration more than moderate-intensity continuous training (MICT) and control (CON) in older men and women.

Methods: A total of 1567 older adults (790 [50.4%] women) were randomized (2:1:1) to either CON (n=780; asked to follow the national recommendations for physical activity) or 2 weekly sessions of HIIT (10-minute warm-up followed by 4×4-minute intervals at ∼90% of peak heart rate) or MICT (50 minutes of continuous work at ∼70% of peak heart rate). Serum HDL-C concentration was measured by standard procedures at baseline and at 1 year, 3 years, and 5 years. The study took place between August 21, 2012, and June 31, 2018. Linear mixed models were used to determine between-group differences during 5 years using the per protocol approach.

Results: Men in HIIT had a smaller reduction in HDL-C (-1.2%) than men in CON (-6.9%) and MICT (-7.8%) after 5 years (=.01 and =.03 for CON vs HIIT and MICT vs HIIT, respectively). No effect of exercise intensity on HDL-C was seen in women. Changes in peak oxygen uptake were associated with changes in HDL-C in both men and women, whereas changes in body weight and fat mass were not.

Conclusion: In men, HIIT seems to be the best strategy to prevent a decline in HDL-C during a 5-year period. No effect of exercise intensity was seen for older women.

Trial Registration: ClinicalTrials.gov identifier: NCT01666340.
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http://dx.doi.org/10.1016/j.mayocpiqo.2021.07.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8452785PMC
October 2021

The effect of a school-based intervention on physical activity, cardiorespiratory fitness and muscle strength: the School in Motion cluster randomized trial.

Int J Behav Nutr Phys Act 2020 11 26;17(1):154. Epub 2020 Nov 26.

Department of Physical Performance, Norwegian School of Sport Sciences, Ullevål Stadion, PB 4014, 0806, Oslo, Norway.

Background: Physical activity (PA) declines throughout adolescence, therefore PA promotion during this period is important. We analyzed the effect of two school-based PA interventions on daily PA levels, cardiorespiratory fitness (CRF) and muscle strength among adolescents.

Methods: For the nine-month School in Motion intervention study (ScIM), we cluster-randomized 30 Norwegian secondary schools (N = 2084, mean age [SD] = 14 [0.3] years) to one of three study arms. The physically active learning (PAL) intervention included 30 min physically active learning, 30 min PA and a 60 min physical education (PE) lesson per week. The Don't worry-Be happy (DWBH) intervention included a 60 min PA lesson and a 60 min PE lesson per week, both tailored to promote friendships and wellbeing. Both intervention arms were designed to engage the adolescents in 120 min of PA per week in addition to recess and mandatory PE lessons. The control group continued as per usual, including the standard amount of mandatory PE. PA (main outcome) was assessed by accelerometers, CRF and muscle strength (secondary outcomes) were assessed by an intermittent running test and selected tests from the Eurofit test battery.

Results: Daily PA and time spent in moderate- to vigorous-intensity PA (MVPA) decreased in all groups throughout the intervention. The mean difference in PA level and MVPA for participants in the PAL-intervention arm was 34.7 cpm (95% CI: 4.1, 65.3) and 4.7 min/day (95% CI: 0.6, 8.8) higher, respectively, compared to the control arm. There were no significant intervention effects on daily PA level, MVPA or time spent sedentary for adolescents in the DWBH-intervention arm. Adolescents in the PAL-intervention arm increased distance covered in the running test compared to controls (19.8 m, 95% CI: 10.4, 29.1), whilst a negative intervention effect was observed among adolescents in the DWBH-intervention arm (- 11.6 m, 95% CI: - 22.0, - 1.1).

Conclusion: The PAL-intervention resulted in a significantly smaller decrease in daily PA level, time spent in MVPA, and increased CRF compared to controls. Our results indicate that a teacher-led intervention, including three unique intervention components, is effective in curbing the decline in PA observed across our cohort and improving CRF.

Trial Registration: ClinicalTrials.gov ID nr: NCT03817047 . Registered 01/25/2019 'retrospectively registered'.
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http://dx.doi.org/10.1186/s12966-020-01060-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7690135PMC
November 2020

Joint associations of accelero-meter measured physical activity and sedentary time with all-cause mortality: a harmonised meta-analysis in more than 44 000 middle-aged and older individuals.

Br J Sports Med 2020 Dec;54(24):1499-1506

Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.

Objectives: To examine the joint associations of accelerometer-measured physical activity and sedentary time with all-cause mortality.

Methods: We conducted a harmonised meta-analysis including nine prospective cohort studies from four countries. 44 370 men and women were followed for 4.0 to 14.5 years during which 3451 participants died (7.8% mortality rate). Associations between different combinations of moderate-to-vigorous intensity physical activity (MVPA) and sedentary time were analysed at study level using Cox proportional hazards regression analysis and summarised using random effects meta-analysis.

Results: Across cohorts, the average time spent sedentary ranged from 8.5 hours/day to 10.5 hours/day and 8 min/day to 35 min/day for MVPA. Compared with the referent group (highest physical activity/lowest sedentary time), the risk of death increased with lower levels of MVPA and greater amounts of sedentary time. Among those in the highest third of MVPA, the risk of death was not statistically different from the referent for those in the middle (16%; 95% CI 0.87% to 1.54%) and highest (40%; 95% CI 0.87% to 2.26%) thirds of sedentary time. Those in the lowest third of MVPA had a greater risk of death in all combinations with sedentary time; 65% (95% CI 1.25% to 2.19%), 65% (95% CI 1.24% to 2.21%) and 263% (95% CI 1.93% to 3.57%), respectively.

Conclusion: Higher sedentary time is associated with higher mortality in less active individuals when measured by accelerometry. About 30-40 min of MVPA per day attenuate the association between sedentary time and risk of death, which is lower than previous estimates from self-reported data.
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http://dx.doi.org/10.1136/bjsports-2020-103270DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7719907PMC
December 2020

Effect of exercise training for five years on all cause mortality in older adults-the Generation 100 study: randomised controlled trial.

BMJ 2020 10 7;371:m3485. Epub 2020 Oct 7.

Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Post Box 8905, 7491 Trondheim, Norway

Objective: To evaluate the effect of five years of supervised exercise training compared with recommendations for physical activity on mortality in older adults (70-77 years).

Design: Randomised controlled trial.

Setting: General population of older adults in Trondheim, Norway.

Participants: 1567 of 6966 individuals born between 1936 and 1942.

Intervention: Participants were randomised to two sessions weekly of high intensity interval training at about 90% of peak heart rate (HIIT, n=400), moderate intensity continuous training at about 70% of peak heart rate (MICT, n=387), or to follow the national guidelines for physical activity (n=780; control group); all for five years.

Main Outcome Measure: All cause mortality. An exploratory hypothesis was that HIIT lowers mortality more than MICT.

Results: Mean age of the 1567 participants (790 women) was 72.8 (SD 2.1) years. Overall, 87.5% of participants reported to have overall good health, with 80% reporting medium or high physical activity levels at baseline. All cause mortality did not differ between the control group and combined MICT and HIIT group. When MICT and HIIT were analysed separately, with the control group as reference (observed mortality of 4.7%), an absolute risk reduction of 1.7 percentage points was observed after HIIT (hazard ratio 0.63, 95% confidence interval 0.33 to 1.20) and an absolute increased risk of 1.2 percentage points after MICT (1.24, 0.73 to 2.10). When HIIT was compared with MICT as reference group an absolute risk reduction of 2.9 percentage points was observed (0.51, 0.25 to 1.02) for all cause mortality. Control participants chose to perform more of their physical activity as HIIT than the physical activity undertaken by participants in the MICT group. This meant that the controls achieved an exercise dose at an intensity between the MICT and HIIT groups.

Conclusion: This study suggests that combined MICT and HIIT has no effect on all cause mortality compared with recommended physical activity levels. However, we observed a lower all cause mortality trend after HIIT compared with controls and MICT.

Trial Registration: ClinicalTrials.gov NCT01666340.
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http://dx.doi.org/10.1136/bmj.m3485DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7539760PMC
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

Carotid Intima-Media Thickness Progression as Surrogate Marker for Cardiovascular Risk: Meta-Analysis of 119 Clinical Trials Involving 100 667 Patients.

Circulation 2020 08 17;142(7):621-642. Epub 2020 Jun 17.

Atherosclerosis Department (M. Safarova), National Medical Research Center of Cardiology, Moscow, Russia.

Background: To quantify the association between effects of interventions on carotid intima-media thickness (cIMT) progression and their effects on cardiovascular disease (CVD) risk.

Methods: We systematically collated data from randomized, controlled trials. cIMT was assessed as the mean value at the common-carotid-artery; if unavailable, the maximum value at the common-carotid-artery or other cIMT measures were used. The primary outcome was a combined CVD end point defined as myocardial infarction, stroke, revascularization procedures, or fatal CVD. We estimated intervention effects on cIMT progression and incident CVD for each trial, before relating the 2 using a Bayesian meta-regression approach.

Results: We analyzed data of 119 randomized, controlled trials involving 100 667 patients (mean age 62 years, 42% female). Over an average follow-up of 3.7 years, 12 038 patients developed the combined CVD end point. Across all interventions, each 10 μm/y reduction of cIMT progression resulted in a relative risk for CVD of 0.91 (95% Credible Interval, 0.87-0.94), with an additional relative risk for CVD of 0.92 (0.87-0.97) being achieved independent of cIMT progression. Taken together, we estimated that interventions reducing cIMT progression by 10, 20, 30, or 40 μm/y would yield relative risks of 0.84 (0.75-0.93), 0.76 (0.67-0.85), 0.69 (0.59-0.79), or 0.63 (0.52-0.74), respectively. Results were similar when grouping trials by type of intervention, time of conduct, time to ultrasound follow-up, availability of individual-participant data, primary versus secondary prevention trials, type of cIMT measurement, and proportion of female patients.

Conclusions: The extent of intervention effects on cIMT progression predicted the degree of CVD risk reduction. This provides a missing link supporting the usefulness of cIMT progression as a surrogate marker for CVD risk in clinical trials.
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http://dx.doi.org/10.1161/CIRCULATIONAHA.120.046361DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7115957PMC
August 2020

Associations between accelerometry measured physical activity and sedentary time and the metabolic syndrome: A meta-analysis of more than 6000 children and adolescents.

Pediatr Obes 2020 01 10;15(1):e12578. Epub 2019 Nov 10.

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

Background: Metabolic syndrome is increasingly prevalent in the pediatric population. To prevent an early onset, knowledge about its association with modifiable lifestyle factors is needed.

Objectives: To estimate the prevalence of the metabolic syndrome and examine its cross-sectional associations with physical activity and sedentary time.

Methods: Participants were 6009 children and adolescents from 8 studies of the International Children's Accelerometry Database. Physical activity and sedentary time were measured by accelerometer. Metabolic syndrome was defined based on International Diabetes Federation criteria. Logistic regression models adjusted for sex, age and monitor wear time were used to examine the associations between physical activity, sedentary time and the metabolic syndrome in each study and effect estimates were combined using random-effects meta-analysis.

Results: The overall prevalence of the metabolic syndrome was 2.9%. In crude models, a 10 min increase in moderate-to-vigorous intensity physical activity and vigorous-intensity physical activity were inversely associated with the metabolic syndrome [OR 0.88, 95% CI 0.82-0.94, OR 0.80, 95% CI 0.70-0.92]. One hour increase in sedentary time was positively associated with the metabolic syndrome [OR 1.28, 95% CI 1.13-1.45]. After adjustment for sedentary time, the association between moderate-to-vigorous-intensity physical activity and the metabolic syndrome remained significant [OR 0.91, 95% CI 0.84-0.99]. Sedentary time was not associated with the metabolic syndrome after adjustment for moderate-to-vigorous intensity physical activity [OR 1.14 95% CI 0.96-1.36].

Conclusions: Physical activity of at least moderate intensity but not sedentary time is independently associated with the metabolic syndrome.
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http://dx.doi.org/10.1111/ijpo.12578DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7003500PMC
January 2020

Effects of the Active Smarter Kids (ASK) physical activity intervention on cardiometabolic risk factors in children: A cluster-randomized controlled trial.

Prev Med 2020 01 22;130:105868. Epub 2019 Oct 22.

Western Norway University of Applied Sciences, Center for Physically Active Learning, Faculty of Education, Arts and Sports, Sogndal, Norway.

The onset of cardiometabolic diseases are recognized to occur in childhood. We aimed to investigate the effect of a school-based cluster-randomized controlled trial of physical activity (PA) on single and clustered cardiometabolic risk factors. We included 1129 fifth-grade children from 57 schools (≥seven children in each class) in Sogn and Fjordane County, Norway, randomized to 28 intervention schools and 29 control schools. The PA intervention was conducted between November 2014 and June 2015. Cardiometabolic risk factors were waist circumference (WC), systolic blood pressure (SBP), total cholesterol (TC):high-density lipoprotein (HDL)-ratio, triglycerides (TG), homeostatic model assessment (HOMA)-score, and cardiorespiratory fitness (CRF). PA was measured by accelerometry. No significant intervention effects were found for single or clustered cardiometabolic risk factors. However, in children with the less favorable baseline values, beneficial effects were found for SBP (p = 0.07 for group ∗ tertile interaction), TC:HDL ratio (p = 0.03 for group ∗ tertile interaction) and the clustered cardiometabolic risk score (p = 0.01 for group ∗ tertile interaction). Compared to boys, girls had a greater effect of the intervention on WC (p = 0.03 for group ∗ sex interaction) and CRF (p < 0.001 for group ∗ sex interaction). The majority of the children had high PA levels, thus limited potential for change, and we found no effects of the PA intervention on cardiometabolic risk in the total sample. However, the intervention had a significantly enhanced effect on fatness and fitness of girls compared to boys. Furthermore, the data suggest that children with the least favorable cardiometabolic risk profile and therefore most in need of change can benefit from school-based PA interventions. Trial registration number: Clinicaltrials.gov ID no.: NCT02132494.
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http://dx.doi.org/10.1016/j.ypmed.2019.105868DOI Listing
January 2020

Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: systematic review and harmonised meta-analysis.

BMJ 2019 08 21;366:l4570. Epub 2019 Aug 21.

Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.

Objective: To examine the dose-response associations between accelerometer assessed total physical activity, different intensities of physical activity, and sedentary time and all cause mortality.

Design: Systematic review and harmonised meta-analysis.

Data Sources: PubMed, PsycINFO, Embase, Web of Science, Sport Discus from inception to 31 July 2018.

Eligibility Criteria: Prospective cohort studies assessing physical activity and sedentary time by accelerometry and associations with all cause mortality and reported effect estimates as hazard ratios, odds ratios, or relative risks with 95% confidence intervals.

Data Extraction And Analysis: Guidelines for meta-analyses and systematic reviews for observational studies and PRISMA guidelines were followed. Two authors independently screened the titles and abstracts. One author performed a full text review and another extracted the data. Two authors independently assessed the risk of bias. Individual level participant data were harmonised and analysed at study level. Data on physical activity were categorised by quarters at study level, and study specific associations with all cause mortality were analysed using Cox proportional hazards regression analyses. Study specific results were summarised using random effects meta-analysis.

Main Outcome Measure: All cause mortality.

Results: 39 studies were retrieved for full text review; 10 were eligible for inclusion, three were excluded owing to harmonisation challenges (eg, wrist placement of the accelerometer), and one study did not participate. Two additional studies with unpublished mortality data were also included. Thus, individual level data from eight studies (n=36 383; mean age 62.6 years; 72.8% women), with median follow-up of 5.8 years (range 3.0-14.5 years) and 2149 (5.9%) deaths were analysed. Any physical activity, regardless of intensity, was associated with lower risk of mortality, with a non-linear dose-response. Hazards ratios for mortality were 1.00 (referent) in the first quarter (least active), 0.48 (95% confidence interval 0.43 to 0.54) in the second quarter, 0.34 (0.26 to 0.45) in the third quarter, and 0.27 (0.23 to 0.32) in the fourth quarter (most active). Corresponding hazards ratios for light physical activity were 1.00, 0.60 (0.54 to 0.68), 0.44 (0.38 to 0.51), and 0.38 (0.28 to 0.51), and for moderate-to-vigorous physical activity were 1.00, 0.64 (0.55 to 0.74), 0.55 (0.40 to 0.74), and 0.52 (0.43 to 0.61). For sedentary time, hazards ratios were 1.00 (referent; least sedentary), 1.28 (1.09 to 1.51), 1.71 (1.36 to 2.15), and 2.63 (1.94 to 3.56).

Conclusion: Higher levels of total physical activity, at any intensity, and less time spent sedentary, are associated with substantially reduced risk for premature mortality, with evidence of a non-linear dose-response pattern in middle aged and older adults.

Systematic Review Registration: PROSPERO CRD42018091808.
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http://dx.doi.org/10.1136/bmj.l4570DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6699591PMC
August 2019

Cardiometabolic risk factor levels in Norwegian children compared to international reference values: The ASK study.

PLoS One 2019 19;14(8):e0220239. Epub 2019 Aug 19.

Center for Physically Active Learning, Faculty of Education, Arts and Sports, Western Norway University of Applied Sciences, Sogndal, Norway.

Objective: To investigate cardiometabolic risk factor levels in a group of Norwegian 10-year-old children compared to international values and examine the association between cardiorespiratory fitness (CRF) and the reference-standardized clustered risk score.

Methods: 913 children (49% girls) were included from the Active Smarter Kids (ASK) study. Body mass index (BMI), waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC) to HDL-C ratio, triglyceride (TG), glucose, insulin, homeostatic model assessment (HOMA) score and CRF, were standardized according to international age-and sex-specific reference values.

Results: The Norwegian children had significantly more favorable WC, DBP, glucose, HDL-C and CRF levels compared to the international reference values, but similar or less favorable levels of other cardiometabolic risk factors. CRF was the variable that differed the most from the international values (mean (95% CI) 1.20 (1.16 to 1.24) SD). The clustered risk score (excluding CRF) was higher in the Norwegian children, but decreased to below international levels when including CRF (mean (95% CI) - 0.08 (- 0.12 to -0.05) SD). CRF had a significant inverse association with the clustered risk score (excluding CRF) (β - 0.37 SD, 95% CI -0.43 to -0.31).

Conclusions: Norwegian children have substantially higher CRF levels than international standards, and including CRF in clustered risk scores reduces overall risk in Norwegian children below that of international levels. CRF is associated with improved cardiometabolic health in children.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0220239PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6699667PMC
March 2020

Waist circumference thresholds and cardiorespiratory fitness.

J Sport Health Sci 2019 Jan 6;8(1):17-22. Epub 2017 Apr 6.

Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo 0806, Norway.

Purpose: This study's purpose was to examine whether established risk categories of waist circumference (WC)-normal, high risk, and very high health risk-reflected significant differences in cardiorespiratory fitness (CRF) and physical activity (PA) level.

Methods: CRF was directly measured as maximal oxygen uptake during a progressive graded treadmill test to exhaustion in 722 individuals (349 women) aged 20-85 years. WC was measured between the lower rib and the iliac crest. Objectively measured PA was assessed using an accelerometer.

Results: Men in the normal risk group (WC < 94 cm) had a 31% higher CRF and 43% higher level of moderate-to-vigorous PA than men in the very high risk group (with a WC > 102 cm). Corresponding numbers for women within normal (WC < 80 cm) and very high risk group (WC > 88 cm) were 25% and 18% ( < 0.05). There was a high negative correlation between CRF and WC in men ( = -0.68), and a moderate correlation for women ( = -0.49;  < 0.001). For each cm increase in WC, CRF was reduced by 0.48 and 0.27 mL/kg/min in men and women, respectively ( < 0.001).

Conclusion: The recommended WC thresholds for abdominal obesity reflected significant differences in CRF for both men and women, and could serve as a useful instrument for estimating health-related differences in CRF.
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http://dx.doi.org/10.1016/j.jshs.2017.03.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6349586PMC
January 2019

Do Obese Children Achieve Maximal Heart Rate during Treadmill Running?

Sports (Basel) 2019 Jan 19;7(1). Epub 2019 Jan 19.

Department of Sports Medicine, Norwegian School of Sport Sciences, 0806 Oslo, Norway.

Objective: Maximal heart rate (HR) is commonly defined as the highest HR obtained during a progressive exercise test to exhaustion. Maximal HR is considered one of the criteria to assess maximum exertion in exercise tests, and is broadly used when prescribing exercise intensity. The aim of the present study was to compare peak HR measurements during maximal treadmill running and active play in obese children and adolescents.

Design: Comparison of peak heart rate during active play vs. maximal treadmill running in 39 (7⁻17 years old, 18 males) obese children and adolescents.

Methods: Heart rate was recorded during intensive active play sessions, as well as during a progressive running test on a treadmill until exhaustion. HR, respiratory exchange ratio (RER), and oxygen uptake were continuously measured during the test. The criteria for having reached maximal effort was a subjective assessment by the technician that the participants had reached his or her maximal effort, and a RER above 1.00 or reporting perceived exertion (RPE) above 17 using the Borg-RPE-Scale.

Results: Thirty-four children had a RER ≥1.00, and 37 reported a RPE ≥ 17. Thirty-two children fulfilled both criteria. During active play, peak HR was significantly ( < 0.0001) increased (4%) (mean and 95% confidence intervals; 204 (201, 207) beats/min), compared to during maximal treadmill running (196 (194, 199) beats/min), respectively.

Conclusion: The results of the present study indicate that peak heart rate measurements during progressive running to exhaustion in obese children and adolescents cannot necessarily be determined as maximal heart rate.
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http://dx.doi.org/10.3390/sports7010026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6359420PMC
January 2019

Reference values for cardiometabolic risk scores in children and adolescents: Suggesting a common standard.

Atherosclerosis 2018 11 6;278:299-306. Epub 2018 Oct 6.

Western Norway University of Applied Sciences, Department of Sport, Food and Natural Sciences, PO BOX 133, N-6856, Sogndal, Norway.

Background And Aims: International reference values for cardiometabolic risk variables, to allow for standardization of continuous risk scores in children, are not currently available. The aim of this study was to provide international age- and gender-specific reference values for cardiometabolic risk factors in children and adolescents.

Methods: Cohorts of children sampled from different parts of Europe (North, South, Mid and Eastern) and from the United States were pooled. In total, 22,479 observations (48.7% European vs. 51.3% American), 11,234 from girls and 11,245 from boys, aged 6-18 years were included in the study. Linear mixed-model regression analysis was used to analyze the associations between age and each cardiometabolic risk factor.

Results: Reference values for 14 of the most commonly used cardiometabolic risk variables in clustered risk scores were calculated and presented by age and gender: systolic blood pressure (SBP), diastolic blood pressure (DBP), waist circumference (WC), body mass index (BMI), sum of 4 skinfolds (sum4skin), triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), TC:HDL-C ratio, glucose, insulin, homeostatic model assessment-score (HOMA-score), and cardiorespiratory fitness (CRF).

Conclusions: This study suggests a common standard to define cardiometabolic risk in children. Adapting this approach makes single risk factors and clustered cardiometabolic disease risk scores comparable to the reference material itself and comparable to cardiometabolic risk values in studies using the same strategy. This unified approach therefore increases the prospect to estimate and compare prevalence and trends of cardiometabolic risk in children when using continuous cardiometabolic risk scores.
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http://dx.doi.org/10.1016/j.atherosclerosis.2018.10.003DOI Listing
November 2018

Effects of a physical activity intervention on schoolchildren's health-related quality of life: The active smarter kids (ASK) cluster-randomized controlled trial.

Prev Med Rep 2019 Mar 7;13:1-4. Epub 2018 Nov 7.

Western Norway University of Applied Sciences, Førde, Norway.

We investigated whether a seven-month (November 2014 to June 2015), school-based cluster-randomized controlled physical activity intervention improved health-related quality of life (HRQoL) in 10-year old children. The participants ( = 1229) from 57 elementary schools in Sogn og Fjordane County, Norway, were cluster-randomized by school either to the intervention (I) or control (C) group. The planned intervention in the 28 I-schools was 300 min of physical activity per week, compared to 135 min in the 29C-schools. HRQoL was assessed by self-report, using the Kidscreen-27 questionnaire. Objectively measured physical activity did not differ between the I-schools and C-schools during the intervention. No effect of the intervention was found for HRQoL: Physical well-being ( = 0.789), Psychological well-being ( = 0.682), Autonomy & parents ( = 0.662), Social support & peers ( = 0.828) and School environment ( = 0.074). In conclusion, the ASK school-based physical activity intervention showed no significant effect on HRQoL.
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http://dx.doi.org/10.1016/j.pmedr.2018.11.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6234767PMC
March 2019

Cross-sectional and prospective associations between sleep, screen time, active school travel, sports/exercise participation and physical activity in children and adolescents.

BMC Public Health 2018 06 7;18(1):705. Epub 2018 Jun 7.

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

Background: The aim of this study was to investigate how sleep, screen time, active school travel and sport and/or exercise participation associates with moderate-to-vigorous physical activity (MVPA) in nationally representative samples of Norwegian 9- and 15-y-olds, and whether these four behaviors at age nine predict change in MVPA from age nine to 15 years.

Method: We pooled cross-sectional accelerometer and questionnaire data from 9- (n = 2366) and 15-y-olds (n = 1554) that participated in the first (2005/06) and second (2011/12) wave of the Physical Activity among Norwegian Children Study to investigate cross-sectional associations. To investigate prospective associations, we used data from a sub-sample that participated in both waves (at age nine and 15 years, n = 517).

Results: Cross-sectional analyses indicated a modest, inverse association between screen time and MVPA among 9- (- 2.2 min/d (95% CI: -3.1, - 1.3)) and 15-y-olds (- 1.7 min/d (95% CI: -2.7, - 0.8)). Compared to their peers with 0-5 min/d of active travel to school, 9- and 15-y-olds with ≥16 min/d accumulated 7.2 (95% CI: 4.0, 10.4) and 9.0 (95% CI: 3.8, 14.1) more min/d of MVPA, respectively. Nine-y-old boys and 15-y-olds reporting ≥8 h/week of sports and/or exercise participation accumulated 14.7 (95% CI: 8.2, 21.3) and 17.9 (95% CI: 14.0, 21.8) more min/d of MVPA, respectively, than those reporting ≤2 h/week. We found no cross-sectional association between sleep duration and MVPA in either age group. None of the four behaviors predicted change in MVPA from age nine to 15 years (p ≥ 0.102).

Conclusion: Active travel to school and sport/exercise participation may be important targets for future interventions aimed at increasing MVPA in children and adolescents. However, future studies are needed to determine causality.
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http://dx.doi.org/10.1186/s12889-018-5610-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5992852PMC
June 2018

Associations between health-related quality of life, cardiorespiratory fitness, muscle strength, physical activity and waist circumference in 10-year-old children: the ASK study.

Qual Life Res 2017 12 27;26(12):3421-3428. Epub 2017 Jun 27.

Centre of Health Research, Førde Hospital Trust, Førde, Norway.

Purpose: To examine the associations between cardiorespiratory fitness, muscle strength, physical activity and waist circumference with self-reported health-related quality of life (HRQoL) in children.

Methods: We conducted a cross-sectional analysis that included 1129 school children aged 10 years from 57 schools in Sogn and Fjordane County, Norway. The HRQoL outcome was assessed by the self-reported KIDSCREEN-27 questionnaire, which covers five life domains. Independent variables were cardiorespiratory fitness assessed by the Andersen intermittent field running test, handgrip strength measured by a hand dynamometer, explosive strength in the lower body using a standing broad jump test, physical activity (counts per minute) using an accelerometer and abdominal adiposity measured by waist circumference. Statistical analyses were performed using linear mixed-effect models including school site as a random effect. Age and sex were entered as covariates.

Results: Only cardiorespiratory fitness was positively associated with higher scores on all five KIDSCREEN-27 domains (P < 0.047 for all). Explosive strength in the lower body was positively associated with higher autonomy and parents scores (P = 0.018), while physical activity was positively associated with higher physical well-being scores (P = 0.008).

Conclusions: Improving cardiorespiratory fitness might be especially useful for improving HRQoL in children.
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http://dx.doi.org/10.1007/s11136-017-1634-1DOI Listing
December 2017

Moderate-to-vigorous physical activity, but not sedentary time, predicts changes in cardiometabolic risk factors in 10-y-old children: the Active Smarter Kids Study.

Am J Clin Nutr 2017 06 5;105(6):1391-1398. Epub 2017 Apr 5.

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

Cross-sectional data have suggested an inverse relation between physical activity and cardiometabolic risk factors that is independent of sedentary time. However, little is known about which subcomponent of physical activity may predict cardiometabolic risk factors in youths. We examined the independent prospective associations between objectively measured sedentary time and subcomponents of physical activity with individual and clustered cardiometabolic risk factors in healthy children aged 10 y. We included 700 children (49.1% males; 50.9% females) in which sedentary time and physical activity were measured with the use of accelerometry. Systolic blood pressure, waist circumference (WC), and fasting blood sample (total cholesterol, high-density lipoprotein cholesterol, triglycerides, glucose, fasting insulin) were measured with the use of standard clinical methods and analyzed individually and as a clustered cardiometabolic risk score standardized by age and sex ( score). Exposure and outcome variables were measured at baseline and at follow-up 7 mo later. Sedentary time was not associated with any of the individual cardiometabolic risk factors or clustered cardiometabolic risk in prospective analyses. Moderate physical activity at baseline predicted lower concentrations of triglycerides ( = 0.021) and homeostatic model assessment for insulin resistance ( = 0.027) at follow-up independent of sex, socioeconomic status, Tanner stage, monitor wear time, or WC. Moderate-to-vigorous physical activity ( = 0.043) and vigorous physical activity ( = 0.028) predicted clustered cardiometabolic risk at follow-up, but these associations were attenuated after adjusting for WC. Physical activity, but not sedentary time, is prospectively associated with cardiometabolic risk in healthy children. Public health strategies aimed at improving children's cardiometabolic profile should strive for increasing physical activity of at least moderate intensity rather than reducing sedentary time. This trial was registered at clinicaltrials.gov as NCT02132494.
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http://dx.doi.org/10.3945/ajcn.116.150540DOI Listing
June 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

Sedentary Time and Physical Activity Surveillance Through Accelerometer Pooling in Four European Countries.

Sports Med 2017 Jul;47(7):1421-1435

Department of Public and Occupational Health and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.

Objective: The objective of this study was to pool, harmonise and re-analyse national accelerometer data from adults in four European countries in order to describe population levels of sedentary time and physical inactivity.

Methods: Five cross-sectional studies were included from England, Portugal, Norway and Sweden. ActiGraph accelerometer count data were centrally processed using the same algorithms. Multivariable logistic regression analyses were conducted to study the associations of sedentary time and physical inactivity with sex, age, weight status and educational level, in both the pooled sample and the separate study samples.

Results: Data from 9509 participants were used. On average, participants were sedentary for 530 min/day, and accumulated 36 min/day of moderate to vigorous intensity physical activity. Twenty-three percent accumulated more than 10 h of sedentary time/day, and 72% did not meet the physical activity recommendations. Nine percent of all participants were classified as high sedentary and low active. Participants from Norway showed the highest levels of sedentary time, while participants from England were the least physically active. Age and weight status were positively associated with sedentary time and not meeting the physical activity recommendations. Men and higher-educated people were more likely to be highly sedentary, while women and lower-educated people were more likely to be inactive.

Conclusions: We found high levels of sedentary time and physical inactivity in four European countries. Older people and obese people were most likely to display these behaviours and thus deserve special attention in interventions and policy planning. In order to monitor these behaviours, accelerometer-based cross-European surveillance is recommended.
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http://dx.doi.org/10.1007/s40279-016-0658-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5488150PMC
July 2017

Effects of physical activity on schoolchildren's academic performance: The Active Smarter Kids (ASK) cluster-randomized controlled trial.

Prev Med 2016 10 7;91:322-328. Epub 2016 Sep 7.

Sogn og Fjordane University College, Faculty of Teacher Education and Sports, Sogndal, Norway; Norwegian School of Sport Sciences, Department of Sports Medicine, Oslo, Norway. Electronic address:

Objective: To investigate the effect of a seven-month, school-based cluster-randomized controlled trial on academic performance in 10-year-old children.

Methods: In total, 1129 fifth-grade children from 57 elementary schools in Sogn og Fjordane County, Norway, were cluster-randomized by school either to the intervention group or to the control group. The children in the 28 intervention schools participated in a physical activity intervention between November 2014 and June 2015 consisting of three components: 1) 90min/week of physically active educational lessons mainly carried out in the school playground; 2) 5min/day of physical activity breaks during classroom lessons; 3) 10min/day physical activity homework. Academic performance in numeracy, reading and English was measured using standardized Norwegian national tests. Physical activity was measured objectively by accelerometry.

Results: We found no effect of the intervention on academic performance in primary analyses (standardized difference 0.01-0.06, p>0.358). Subgroup analyses, however, revealed a favorable intervention effect for those who performed the poorest at baseline (lowest tertile) for numeracy (p=0.005 for the subgroup∗group interaction), compared to controls (standardized difference 0.62, 95% CI 0.19-1.07).

Conclusions: This large, rigorously conducted cluster RCT in 10-year-old children supports the notion that there is still inadequate evidence to conclude that increased physical activity in school enhances academic achievement in all children. Still, combining physical activity and learning seems a viable model to stimulate learning in those academically weakest schoolchildren.
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http://dx.doi.org/10.1016/j.ypmed.2016.09.005DOI Listing
October 2016

Permanent play facility provision is associated with children's time spent sedentary and in light physical activity during school hours: A cross-sectional study.

Prev Med Rep 2016 Dec 13;4:429-34. Epub 2016 Aug 13.

Department of Sports Medicine, The Norwegian School of Sport Sciences, P.O. Box 4014, Ullevål Stadion, N-0806 Oslo, Norway.

Objective: To study the associations between: 1) number of permanent outdoor play facilities per pupil and 2) the size of the outdoor play area per pupil with sedentary time and physical activity (PA) during school hours in six-, nine-, and 15-year olds. We conducted a cross-sectional study of nationally representative samples of Norwegian six- (n = 1071), nine- (n = 1421) and 15-year-olds (n = 1106) in 2011 (the Physical Activity Among Norwegian Children Study). The participation rates were 56.4%, 73.1% and 57.8% for six-, nine- and 15-year olds, respectively. We assessed PA objectively for seven consecutive days using accelerometers, the size of a school's outdoor play area (SOPA) using an online map service and the permanent play facility (PPF) provision using a standardized form during school site visits. We successfully measured SOPA and PPF in 99 schools, from which 3040 participants provided valid accelerometer data. We used generalized least-squares random-effects models with robust variance estimation to assess associations. Our results indicate that better provision of permanent play facilities may reduce sedentary time and increase time spent in light PA among six-year-olds. Permanent play facility provision was not associated with sedentary time or PA among nine- and 15-year-olds. Associations found between outdoor play area size, physical activity and sedentary time were negligible. Future research should investigate what types of permanent play facilities may be associated with physical activity in both children and adolescents.
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http://dx.doi.org/10.1016/j.pmedr.2016.08.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4995570PMC
December 2016

Objectively Measured Physical Activity in Home Guard Soldiers During Military Service and Civilian Life.

Mil Med 2016 07;181(7):693-700

Department of Sports Medicine, The Norwegian School of Sport Sciences, P.O. Box 4014, Ullevaal Stadion, N-0806 Oslo, Norway.

Soldiers are encouraged to be physically active, and thereby maintain or increase their fitness level to meet job-related physical demands. However, studies on objectively measured physical activity (PA) in soldiers are scarce, particular for reserve soldiers. Hence, the aim of this study was to present PA data on Norwegian Home Guard (HG) soldiers. A total of 411 HG soldiers produced acceptable PA measurements (SenseWear Armband Pro2) during civilian life, of which 299 soldiers also produced acceptable data during HG military training. Reference data on total energy expenditure, metabolic equivalents, steps per day, and minutes of PA in three different metabolic equivalent categories are presented. The HG soldiers produced more minutes of moderate PA during HG military training compared to civilian life, but less vigorous and very vigorous PA. Furthermore, HG soldiers were more physically active during civilian week days compared to weekend days. The presented reference data can be used for comparisons against other groups of soldiers. Our data indicate that aerobic demands during HG military training were not very high. Promoting PA and exercise could still be important to ensure HG soldiers are physically prepared for more unforeseen job tasks.
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http://dx.doi.org/10.7205/MILMED-D-15-00147DOI Listing
July 2016

[Physical activity--new paths and choices in the recommendations for adults].

Lakartidningen 2015 Nov 17;112. Epub 2015 Nov 17.

Norges Idrottshögskola - Idrottsmedicin Oslo, Norway Norges Idrottshögskola - Idrottsmedicin Oslo, Norway.

Recommendations for physical activity have been prepared by Professional Associations for Physical Activity and approved by the Swedish Society of Medicine in 2011. All adults are recommended regular aerobic and muscle strengthening physical activity. Lowest recommended dose (intensity x time) of aerobic physical activity is 150 minutes at moderate or 75 minutes at high intensity per week. More health benefits are achieved if the dose is higher than the lowest recommended dose. Longer periods of sedentary behavior should be avoided. Elderly are also recommended balance training. The benefits of physical activity outweigh the risks. The Swedish National Board of Health and Welfare recommends that the healthcare system offer counselling with the adjunct of exercise on prescription or a pedometer to persons with insufficient physical activity, i.e. less than the lowest recommended dose in the current recommendations for physical activity.
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November 2015

Reduction in cardiorespiratory fitness after lung resection is not related to the number of lung segments removed.

BMJ Open Sport Exerc Med 2015 5;1(1):e000032. Epub 2015 Oct 5.

Department of Pulmonary Medicine , Oslo University Hospital , Oslo , Norway.

Aim: To evaluate the effect of lung cancer surgery on cardiorespiratory fitness (CRF), and to assess the agreement between the predicted postoperative (ppo) V̇O and actually measured postoperative peak oxygen uptake (V̇O).

Methods: Before and 4-6 weeks after lung cancer surgery, 70 patients (35 women) underwent measurements of pulmonary function and CRF via a cardiopulmonary exercise test. In addition, the 23 non-exercising patients underwent measurements after 6 months. The ppo V̇O calculated from the number of functional segments removed was compared with the actually measured postoperative values of V̇O for accuracy and precision.

Results: After surgery, the V̇O decreased from 23.9±5.8 to 19.2±5.5 mL/kg/min (-19.6±15.7%) (p<0.001). The breathing reserve increased by 5% (p=0.001); the oxygen saturation remained unchanged (p=0.30); the oxygen pulse decreased by -1.9 mL/beat (p<0.001); the haemoglobin concentration decreased by 0.7 g/dL (p=0.001). The oxygen pulse was the strongest predictor for change in V̇O; adjusted linear squared: r=0.77. Six months after surgery, the V̇O remained unchanged (-3±15%, p=0.27). The ppo V̇O (mL/kg/min) was 18.6±5.4, and the actually measured V̇O was 19.2±5.5 (p=0.24). However, the limits of agreement were large (CI -7.4 to 8.2). The segment method miscalculated the ppo V̇O by more than ±10 and ±20% in 54% and 25% of the patients, respectively.

Conclusions: The reduction in V̇O and lack of improvement 6 months after lung cancer surgery cannot be explained by the loss of functional lung tissue. Predicting postoperative V̇O based on the amount of lung tissue removed is not recommendable due to poor precision.

Trial Registration Number: NCT01748981.
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http://dx.doi.org/10.1136/bmjsem-2015-000032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5117018PMC
October 2015

Are Self-report Measures Able to Define Individuals as Physically Active or Inactive?

Med Sci Sports Exerc 2016 Feb;48(2):235-44

1Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, NORWAY; 2VU University Medical Center, Department of Public and Occupational Health, EMGO Institute for Health and Care Research, Amsterdam, THE NETHERLANDS; 3TNO Expertise Centre Lifestyle, Leiden, THE NETHERLANDS; [email protected] TNO-VUmc, Research Center Physical Activity, Work and Health, Amsterdam, THE NETHERLANDS; 5Department of Physical Education and Sport Sciences, University of Limerick, Limerick, IRELAND; and 6Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UNITED KINGDOM.

Purpose: Assess the agreement between commonly used self-report methods compared with objectively measured physical activity (PA) in defining the prevalence of individuals compliant with PA recommendations.

Methods: Time spent in moderate and vigorous PA (MVPA) was measured at two time points in 1713 healthy individuals from nine European countries using individually calibrated combined heart rate and movement sensing. Participants also completed the Recent Physical Activity Questionnaire (RPAQ), short form of the International Physical Activity Questionnaire (IPAQ), and short European Prospective Investigation into Cancer and Nutrition Physical Activity Questionnaire (EPIC-PAQ). Individuals were categorized as active (e.g., reporting ≥150 min of MVPA per week) or inactive, based on the information derived from the different measures. Sensitivity and specificity analyses and Kappa statistics were performed to evaluate the ability of the three PA questionnaires to correctly categorize individuals as active or inactive.

Results: Prevalence estimates of being sufficiently active varied significantly (P for all <0.001) between self-report measures (IPAQ 84.2% [95% confidence interval {CI}, 82.5-85.9], RPAQ 87.6% [95% CI, 85.9-89.1], EPIC-PAQ 39.9% [95% CI, 37.5-42.1] and objective measure 48.5% [95% CI, 41.6-50.9]. All self-report methods showed low or moderate sensitivity (IPAQ 20.0%, RPAQ 18.7%, and EPIC-PAQ 69.8%) to correctly classify inactive people and the agreement between objective and self-reported PA was low (ĸ = 0.07 [95% CI, 0.02-0.12], 0.12 [95% CI, 0.06-0.18], and 0.19 [95% CI, 0.13-0.24] for IPAQ, RPAQ, and EPIC-PAQ, respectively).

Conclusions: The modest agreement between self-reported and objectively measured PA suggests that population levels of PA derived from self-report should be interpreted cautiously. Implementation of objective measures in large-scale cohort studies and surveillance systems is recommended.
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http://dx.doi.org/10.1249/MSS.0000000000000760DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6235100PMC
February 2016

Active Smarter Kids (ASK): Rationale and design of a cluster-randomized controlled trial investigating the effects of daily physical activity on children's academic performance and risk factors for non-communicable diseases.

BMC Public Health 2015 Jul 28;15:709. Epub 2015 Jul 28.

Faculty of Teacher Education and Sports, Sogn og Fjordane University College, Sogndal, Norway.

Background: Evidence is emerging from school-based studies that physical activity might favorably affect children's academic performance. However, there is a need for high-quality studies to support this. Therefore, the main objective of the Active Smarter Kids (ASK) study is to investigate the effect of daily physical activity on children's academic performance. Because of the complexity of the relation between physical activity and academic performance it is important to identify mediating and moderating variables such as cognitive function, fitness, adiposity, motor skills and quality of life (QoL). Further, there are global concerns regarding the high prevalence of lifestyle-related non-communicable diseases (NCDs). The best means to address this challenge could be through primary prevention. Physical activity is known to play a key role in preventing a host of NCDs. Therefore, we investigated as a secondary objective the effect of the intervention on risk factors related to NCDs. The purpose of this paper is to describe the design of the ASK study, the ASK intervention as well as the scope and details of the methods we adopted to evaluate the effect of the ASK intervention on 5 (th) grade children.

Methods & Design: The ASK study is a cluster randomized controlled trial that includes 1145 fifth graders (aged 10 years) from 57 schools (28 intervention schools; 29 control schools) in Sogn and Fjordane County, Norway. This represents 95.3 % of total possible recruitment. Children in all 57 participating schools took part in a curriculum-prescribed physical activity intervention (90 min/week of physical education (PE) and 45 min/week physical activity, in total; 135 min/week). In addition, children from intervention schools also participated in the ASK intervention model (165 min/week), i.e. a total of 300 min/week of physical activity/PE. The ASK study was implemented over 7 months, from November 2014 to June 2015. We assessed academic performance in reading, numeracy and English using Norwegian National tests delivered by The Norwegian Directorate for Education and Training. We assessed physical activity objectively at baseline, midpoint and at the end of the intervention. All other variables were measured at baseline and post-intervention. In addition, we used qualitative methodologies to obtain an in-depth understanding of children's embodied experiences and pedagogical processes taking place during the intervention.

Discussion: If successful, ASK could provide strong evidence of a relation between physical activity and academic performance that could potentially inform the process of learning in elementary schools. Schools might also be identified as effective settings for large scale public health initiatives for the prevention of NCDs.

Trial Registration: Clinicaltrials.gov ID nr: NCT02132494 . Date of registration, 6(th) of May, 2014.
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http://dx.doi.org/10.1186/s12889-015-2049-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4517398PMC
July 2015

Equating accelerometer estimates among youth: The Rosetta Stone 2.

J Sci Med Sport 2016 Mar 23;19(3):242-249. Epub 2015 Feb 23.

University of Cambridge, MRC Epidemiology Unit, UK.

Objectives: Different accelerometer cutpoints used by different researchers often yields vastly different estimates of moderate-to-vigorous intensity physical activity (MVPA). This is recognized as cutpoint non-equivalence (CNE), which reduces the ability to accurately compare youth MVPA across studies. The objective of this research is to develop a cutpoint conversion system that standardizes minutes of MVPA for six different sets of published cutpoints.

Design: Secondary data analysis.

Methods: Data from the International Children's Accelerometer Database (ICAD; Spring 2014) consisting of 43,112 Actigraph accelerometer data files from 21 worldwide studies (children 3-18 years, 61.5% female) were used to develop prediction equations for six sets of published cutpoints. Linear and non-linear modeling, using a leave one out cross-validation technique, was employed to develop equations to convert MVPA from one set of cutpoints into another. Bland Altman plots illustrate the agreement between actual MVPA and predicted MVPA values.

Results: Across the total sample, mean MVPA ranged from 29.7MVPAmind(-1) (Puyau) to 126.1MVPAmind(-1) (Freedson 3 METs). Across conversion equations, median absolute percent error was 12.6% (range: 1.3 to 30.1) and the proportion of variance explained ranged from 66.7% to 99.8%. Mean difference for the best performing prediction equation (VC from EV) was -0.110mind(-1) (limits of agreement (LOA), -2.623 to 2.402). The mean difference for the worst performing prediction equation (FR3 from PY) was 34.76mind(-1) (LOA, -60.392 to 129.910).

Conclusions: For six different sets of published cutpoints, the use of this equating system can assist individuals attempting to synthesize the growing body of literature on Actigraph, accelerometry-derived MVPA.
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http://dx.doi.org/10.1016/j.jsams.2015.02.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5381708PMC
March 2016
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