• Ulf Ekelund, Jian'an Luan, Lauren B Sherar, Dale W Esliger, Pippa Griew, Ashley Cooper, and International Children's Accelerometry Database (ICAD) Collaborators.
• MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrookes Hospital, PO Box 285, Cambridge, CB2 0QQ, Cambridge, United Kingdom. ulf.ekelund@mrc-epid.cam.ac.uk
• JAMA. 2012 Feb 15; 307 (7): 704-12.

ContextSparse data exist on the combined associations between physical activity and sedentary time with cardiometabolic risk factors in healthy children.ObjectiveTo examine the independent and combined associations between objectively measured time in moderate- to vigorous-intensity physical activity (MVPA) and sedentary time with cardiometabolic risk factors.Design, Setting, And ParticipantsPooled data from 14 studies between 1998 and 2009 comprising 20 871 children (aged 4-18 years) from the International Children's Accelerometry Database. Time spent in MVPA and sedentary time were measured using accelerometry after reanalyzing raw data. The independent associations between time in MVPA and sedentary time, with outcomes, were examined using meta-analysis. Participants were stratified by tertiles of MVPA and sedentary time.Main Outcome MeasuresWaist circumference, systolic blood pressure, fasting triglycerides, high-density lipoprotein cholesterol, and insulin.ResultsTimes (mean [SD] min/d) accumulated by children in MVPA and being sedentary were 30 (21) and 354 (96), respectively. Time in MVPA was significantly associated with all cardiometabolic outcomes independent of sex, age, monitor wear time, time spent sedentary, and waist circumference (when not the outcome). Sedentary time was not associated with any outcome independent of time in MVPA. In the combined analyses, higher levels of MVPA were associated with better cardiometabolic risk factors across tertiles of sedentary time. The differences in outcomes between higher and lower MVPA were greater with lower sedentary time. Mean differences in waist circumference between the bottom and top tertiles of MVPA were 5.6 cm (95% CI, 4.8-6.4 cm) for high sedentary time and 3.6 cm (95% CI, 2.8-4.3 cm) for low sedentary time. Mean differences in systolic blood pressure for high and low sedentary time were 0.7 mm Hg (95% CI, -0.07 to 1.6) and 2.5 mm Hg (95% CI, 1.7-3.3), and for high-density lipoprotein cholesterol, differences were -2.6 mg/dL (95% CI, -1.4 to -3.9) and -4.5 mg/dL (95% CI, -3.3 to -5.6), respectively. Geometric mean differences for insulin and triglycerides showed similar variation. Those in the top tertile of MVPA accumulated more than 35 minutes per day in this intensity level compared with fewer than 18 minutes per day for those in the bottom tertile. In prospective analyses (N = 6413 at 2.1 years' follow-up), MVPA and sedentary time were not associated with waist circumference at follow-up, but a higher waist circumference at baseline was associated with higher amounts of sedentary time at follow-up.ConclusionHigher MVPA time by children and adolescents was associated with better cardiometabolic risk factors regardless of the amount of sedentary time.

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