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      GRANADA consensus on analytical approaches to assess associations with accelerometer-determined physical behaviours (physical activity, sedentary behaviour and sleep) in epidemiological studies

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          Abstract

          The inter-relationship between physical activity, sedentary behaviour and sleep (collectively defined as physical behaviours) is of interest to researchers from different fields. Each of these physical behaviours has been investigated in epidemiological studies, yet their codependency and interactions need to be further explored and accounted for in data analysis. Modern accelerometers capture continuous movement through the day, which presents the challenge of how to best use the richness of these data. In recent years, analytical approaches first applied in other scientific fields have been applied to physical behaviour epidemiology (eg, isotemporal substitution models, compositional data analysis, multivariate pattern analysis, functional data analysis and machine learning). A comprehensive description, discussion, and consensus on the strengths and limitations of these analytical approaches will help researchers decide which approach to use in different situations. In this context, a scientific workshop and meeting were held in Granada to discuss: (1) analytical approaches currently used in the scientific literature on physical behaviour, highlighting strengths and limitations, providing practical recommendations on their use and including a decision tree for assisting researchers’ decision-making; and (2) current gaps and future research directions around the analysis and use of accelerometer data. Advances in analytical approaches to accelerometer-determined physical behaviours in epidemiological studies are expected to influence the interpretation of current and future evidence, and ultimately impact on future physical behaviour guidelines.

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          World Health Organization 2020 guidelines on physical activity and sedentary behaviour

          Objectives To describe new WHO 2020 guidelines on physical activity and sedentary behaviour. Methods The guidelines were developed in accordance with WHO protocols. An expert Guideline Development Group reviewed evidence to assess associations between physical activity and sedentary behaviour for an agreed set of health outcomes and population groups. The assessment used and systematically updated recent relevant systematic reviews; new primary reviews addressed additional health outcomes or subpopulations. Results The new guidelines address children, adolescents, adults, older adults and include new specific recommendations for pregnant and postpartum women and people living with chronic conditions or disability. All adults should undertake 150–300 min of moderate-intensity, or 75–150 min of vigorous-intensity physical activity, or some equivalent combination of moderate-intensity and vigorous-intensity aerobic physical activity, per week. Among children and adolescents, an average of 60 min/day of moderate-to-vigorous intensity aerobic physical activity across the week provides health benefits. The guidelines recommend regular muscle-strengthening activity for all age groups. Additionally, reducing sedentary behaviours is recommended across all age groups and abilities, although evidence was insufficient to quantify a sedentary behaviour threshold. Conclusion These 2020 WHO guidelines update previous WHO recommendations released in 2010. They reaffirm messages that some physical activity is better than none, that more physical activity is better for optimal health outcomes and provide a new recommendation on reducing sedentary behaviours. These guidelines highlight the importance of regularly undertaking both aerobic and muscle strengthening activities and for the first time, there are specific recommendations for specific populations including for pregnant and postpartum women and people living with chronic conditions or disability. These guidelines should be used to inform national health policies aligned with the WHO Global Action Plan on Physical Activity 2018–2030 and to strengthen surveillance systems that track progress towards national and global targets.
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            Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women.

            High amounts of sedentary behaviour have been associated with increased risks of several chronic conditions and mortality. However, it is unclear whether physical activity attenuates or even eliminates the detrimental effects of prolonged sitting. We examined the associations of sedentary behaviour and physical activity with all-cause mortality.
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              Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: systematic review and harmonised meta-analysis

              Abstract 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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                Author and article information

                Journal
                Br J Sports Med
                Br J Sports Med
                bjsports
                bjsm
                British Journal of Sports Medicine
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                0306-3674
                1473-0480
                April 2022
                12 April 2021
                : 56
                : 7
                : 376-384
                Affiliations
                [1 ] departmentPROFITH “PROmoting FITness and Health through physical activity” Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical Education and Sports, Faculty of Sport Sciences , University of Granada , Granada, Spain
                [2 ] departmentDepartment of Health, Medicine and Caring Sciences , Linköping University , Linköping, Sweden
                [3 ] departmentFaculty of Education, Arts and Sports , Western Norway University of Applied Sciences , Sogndal, Norway
                [4 ] departmentDepartment of Sport Science and Biomechanics , University of Southern Denmark , Odense, Denmark
                [5 ] departmentSchool of Health and Life Science , Glasgow Caledonian University , Glasgow, UK
                [6 ] departmentDepartment of Movement and Sport Science , Ghent University , Ghent, Belgium
                [7 ] departmentDepartment of Sports Medicine , Norwegian School of Sport Sciences , Osloål, Norway
                [8 ] departmentDepartement of Sport Science and Physical Education , University of Agder , Kristiansand, Norway
                [9 ] departmentDepartment of Chronic Diseases , National Institute for Health Development , Tallinn, Estonia
                [10 ] departmentSchool of Natural Sciences and Health , Tallinn University , Tallinn, Estonia
                [11 ] departmentInstitute of Psychology , University of Tartu , Tartu, Estonia
                [12 ] departmentDepartment of Chemistry , University of Bergen , Bergen, Norway
                [13 ] Biomathematics and Statistics Scotland , Edinburgh, UK
                [14 ] departmentDiabetes Research Centre , University of Leicester, Leicester General Hospital , Leicester, UK
                [15 ] departmentNIHR Leicester Biomedical Research Centre , Leicester General Hospital , Leicester, UK
                [16 ] departmentAlliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, Division of Health Sciences , University of South Australia , Adelaide, SA, Australia
                [17 ] departmentUniversité de Paris, Inserm U1153 , Epidemiology of Ageing and Neurodegenerative diseases , Paris, France
                [18 ] departmentDepartment of Epidemiology and Public Health , University College London , London, UK
                [19 ] Accelting , Almere, The Netherlands
                [20 ] departmentAmsterdam UMC, Vrije Universiteit Amsterdam , Department of Public and Occupational Health, Amsterdam Public Health research institute , Amsterdam, The Netherlands
                [21 ] departmentNuffield Department of Population Health , University of Oxford , Oxford, UK
                [22 ] departmentBig Data Institute, Li Ka Shing Centre for Health Information and Discovery , University of Oxford , Oxford, UK
                [23 ] departmentDepartment of Biosciences and Nutrition , Karolinska Institutet , Huddinge, Sweden
                Author notes
                [Correspondence to ] Jairo H Migueles, Department of physical education and sport, University of Granada, 18071 Granada, Spain; jairohm@ 123456ugr.es ; Dr Francisco B Ortega, Department of physical education and sport, University of Granada, 18071 Granada, Spain; ortegaf@ 123456ugr.es
                Author information
                http://orcid.org/0000-0003-0366-6935
                http://orcid.org/0000-0001-9654-2653
                http://orcid.org/0000-0002-9800-029X
                http://orcid.org/0000-0001-6718-3022
                http://orcid.org/0000-0003-1421-9348
                http://orcid.org/0000-0001-8445-8227
                http://orcid.org/0000-0002-9673-8469
                http://orcid.org/0000-0001-9432-8776
                http://orcid.org/0000-0003-2575-7547
                http://orcid.org/0000-0002-1463-697X
                http://orcid.org/0000-0003-3109-9720
                http://orcid.org/0000-0003-0182-9008
                http://orcid.org/0000-0002-1916-2478
                http://orcid.org/0000-0003-2001-1121
                Article
                bjsports-2020-103604
                10.1136/bjsports-2020-103604
                8938657
                33846158
                71999278-ab93-4ff9-98b8-9a9745e1b08a
                © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 20 March 2021
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100008530, European Regional Development Fund;
                Award ID: B-CTS-355-UGR18
                Award ID: RD16/0022
                Funded by: Medical Research Council Industrial Strategy Studentship;
                Award ID: MR/S502509/1
                Funded by: FundRef http://dx.doi.org/10.13039/501100001665, Agence Nationale de la Recherche;
                Award ID: ANR-19-CE36-0004-01
                Funded by: SAMID III network;
                Funded by: FundRef http://dx.doi.org/10.13039/100010681, H2020 Environment;
                Award ID: 667302
                Funded by: FundRef http://dx.doi.org/10.13039/501100006393, Universidad de Granada;
                Funded by: FundRef http://dx.doi.org/10.13039/501100011011, Junta de Andalucía;
                Award ID: SOMM17/6107/UGR
                Funded by: FundRef http://dx.doi.org/10.13039/501100003329, Ministerio de Economía y Competitividad;
                Award ID: DEP2013‐47540
                Award ID: DEP2016‐79512‐R
                Award ID: RYC‐2011‐09011
                Funded by: FundRef http://dx.doi.org/10.13039/100014461, NIHR Biomedical Research Centre, Royal Marsden NHS Foundation Trust/Institute of Cancer Research;
                Funded by: FundRef http://dx.doi.org/10.13039/501100004587, Instituto de Salud Carlos III;
                Funded by: FundRef http://dx.doi.org/10.13039/501100003176, Ministerio de Educación, Cultura y Deporte;
                Award ID: FPU15/02645
                Funded by: EXERNET research network;
                Award ID: DEP2005‐00046/ACTI
                Categories
                Consensus Statement
                1506
                2314
                Custom metadata
                unlocked

                Sports medicine
                physical activity,epidemiology,statistics,accelerometer,sedentary
                Sports medicine
                physical activity, epidemiology, statistics, accelerometer, sedentary

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