Device-Measured Physical Activity, Sedentary Time, and Cardiometabolic Risk Markers in Youth

Importance The evidence for benefits of higher physical activity and lower sedentary time on the cardiometabolic risk profile in youth is based on cross-sectional and small prospective studies. Objective To determine the prospective associations between device-measured physical activity and sedentary time with later cardiometabolic risk profiles in youth. Data Sources The International Children’s Accelerometry Database and cohorts identified from a systematic literature search (final search performed December 2024). Study Selection Studies measured physical activity and sedentary time with an accelerometer at baseline and had prospective data on at least 1 cardiometabolic risk marker. Data Extraction and Synthesis Individual participant data were transferred to a secure network, harmonized, and analyzed as a single dataset using mixed linear regression models with different statistical adjustment based on directed acyclic graphs. Effect sizes are β coefficients per SD exposure increment. Main Outcomes and Measures Body mass index (BMI); insulin, glucose, low-density lipoprotein (LDL) cholesterol, and triglyceride levels; and systolic blood pressure, analyzed individually and as composite scores. Results Of 5432 records screened, 12 relevant studies were identified, of which 8 provided individual participant data. Fourteen cohorts (12 874 participants; mean [range] age, 10.4 [5.0-17.9] years; 6577 female [52%]) with a mean (SD) follow-up of 3.1 (2.0) years were included. Moderate to vigorous physical activity (per SD, 26 minutes/day) was inversely associated with insulin (−0.24 µIU/mL; 95% CI, −0.38 to −0.10 µIU/mL), LDL cholesterol level (−1.54 mg/dL; 95% CI, −1.93 to −0.77 mg/dL), triglyceride level (−1.77 mg/dL, 95% CI, −2.65 to −0.88 mg/dL), and the composite risk scores (−0.04; 95% CI, −0.06 to −0.02). However, moderate to vigorous physical activity was not associated with BMI (0.00; 95% CI, −0.005 to 0.005) and associated with a higher systolic blood pressure (0.25 mm Hg; 95% CI, 0.04-0.46 mm Hg). Associations for vigorous intensity activity were similar, except that there was no association with systolic blood pressure. Higher sedentary time was not associated with a worse cardiometabolic profile but was associated with lower blood glucose concentration (−0.36 mg/dL; 95% CI, −0.72 to 0 mg/dL) and lower systolic blood pressure (−0.90 mm Hg; 95% CI, −1.22 to −0.58 mm Hg). The magnitude and direction of associations were modified by modeling approach, sex, BMI, age, and follow-up time. Conclusions and Relevance Results of this harmonized individual participant data meta-analysis suggest that physical activity of moderate and vigorous intensity was beneficially associated with some cardiometabolic risk markers during childhood and adolescence. However, associations were weak, sensitive to the modeling approach, and heterogeneous across subgroups. Sedentary time is unlikely an important determinant of cardiometabolic risk in youth.

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Journal
Archives of Pediatrics and Adolescent Medicine
Published
2026-10-06
DOI
https://doi.org/10.1001/jamapediatrics.2026.5176
Primary Topic
Physical Activity and Health
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article
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article

Device-Measured Physical Activity, Sedentary Time, and Cardiometabolic Risk Markers in Youth

Pedro Curi Hallal, Lauren B. Sherar, Óscar L. Veiga, Luis Alberto Moreno et al.
Archives of Pediatrics and Adolescent Medicine
Physical Activity and Health
article

Device-Measured Physical Activity, Sedentary Time, and Cardiometabolic Risk Markers in Youth

Pedro Curi Hallal, Lauren B. Sherar, Óscar L. Veiga, Luis Alberto Moreno, Luís Bettencourt Sardinha, Jardena J. Puder, Knut Eirik Dalene, Andrew J. Atkin, Anders Husøy, Dénes Molnár, Antje Hebestreit, Soren Harnois‐Leblanc, José Castro‐Piñero, Toomas Veidebaum, Simone J.J.M. Verswijveren, Anna Bugge, Niels Wedderkopp, Jakob Tarp, Lauren Lissner, Eva Corpeleijn, Kate Northstone, Peter Lund Kristensen, Esther M. F. van Sluijs, Sigmund A. Anderssen, Bjørge Herman Hansen, Ulf Ekelund, Geir Kåre Resaland, Camilla Trab Damsgaard, Marie‐Ève Mathieu, John Reilly, Fabio Lauria, Mélanie Henderson, Christoph Buck, Niels Christian Møller, Inácio Crochemore‐Silva, Jostein Steene-Johannessen, Charalambos A. Hadjigeorgiou, Stefaan De Henauw, Russ Jago, International Children’s Accelerometry Database (ICAD) Collaborators, Lars B Andersen, Rachel Davey, Soyang Kwon, Russell R Pate, Jo Salmon, Dale W Esliger, Susi Kriemler, Lu Yang, Greet Cardon
article en

Abstract

Importance The evidence for benefits of higher physical activity and lower sedentary time on the cardiometabolic risk profile in youth is based on cross-sectional and small prospective studies. Objective To determine the prospective associations between device-measured physical activity and sedentary time with later cardiometabolic risk profiles in youth. Data Sources The International Children’s Accelerometry Database and cohorts identified from a systematic literature search (final search performed December 2024). Study Selection Studies measured physical activity and sedentary time with an accelerometer at baseline and had prospective data on at least 1 cardiometabolic risk marker. Data Extraction and Synthesis Individual participant data were transferred to a secure network, harmonized, and analyzed as a single dataset using mixed linear regression models with different statistical adjustment based on directed acyclic graphs. Effect sizes are β coefficients per SD exposure increment. Main Outcomes and Measures Body mass index (BMI); insulin, glucose, low-density lipoprotein (LDL) cholesterol, and triglyceride levels; and systolic blood pressure, analyzed individually and as composite scores. Results Of 5432 records screened, 12 relevant studies were identified, of which 8 provided individual participant data. Fourteen cohorts (12 874 participants; mean [range] age, 10.4 [5.0-17.9] years; 6577 female [52%]) with a mean (SD) follow-up of 3.1 (2.0) years were included. Moderate to vigorous physical activity (per SD, 26 minutes/day) was inversely associated with insulin (−0.24 µIU/mL; 95% CI, −0.38 to −0.10 µIU/mL), LDL cholesterol level (−1.54 mg/dL; 95% CI, −1.93 to −0.77 mg/dL), triglyceride level (−1.77 mg/dL, 95% CI, −2.65 to −0.88 mg/dL), and the composite risk scores (−0.04; 95% CI, −0.06 to −0.02). However, moderate to vigorous physical activity was not associated with BMI (0.00; 95% CI, −0.005 to 0.005) and associated with a higher systolic blood pressure (0.25 mm Hg; 95% CI, 0.04-0.46 mm Hg). Associations for vigorous intensity activity were similar, except that there was no association with systolic blood pressure. Higher sedentary time was not associated with a worse cardiometabolic profile but was associated with lower blood glucose concentration (−0.36 mg/dL; 95% CI, −0.72 to 0 mg/dL) and lower systolic blood pressure (−0.90 mm Hg; 95% CI, −1.22 to −0.58 mm Hg). The magnitude and direction of associations were modified by modeling approach, sex, BMI, age, and follow-up time. Conclusions and Relevance Results of this harmonized individual participant data meta-analysis suggest that physical activity of moderate and vigorous intensity was beneficially associated with some cardiometabolic risk markers during childhood and adolescence. However, associations were weak, sensitive to the modeling approach, and heterogeneous across subgroups. Sedentary time is unlikely an important determinant of cardiometabolic risk in youth.

Archives of Pediatrics and Adolescent Medicine
University of Copenhagen (DK), Norwegian Institute of Public Health (NO), University Medical Center Groningen (NL), Harvard University (US), University of Lisbon (PT), Loughborough University (GB), Deakin University (AU), University of Illinois Urbana-Champaign (US), Universidade Federal de Pelotas (BR), University of Groningen (NL), University of Southern Denmark (DK), Western Norway University of Applied Sciences (NO), University of Agder (NO), University of Zurich (CH), University of Cambridge (GB), Instituto de Salud Carlos III (ES), Centre Hospitalier Universitaire Sainte-Justine (CA), Ghent University (BE), University of Bristol (GB), Universidad de Cádiz (ES), Institute of Food Science (IT), University College Copenhagen (DK), Harvard Pilgrim Health Care (US), Leibniz Institute for Prevention Research and Epidemiology - BIPS (DE), Biomedical Research and Innovation Institute of Cadiz (ES), Instituto de Investigación Sanitaria Aragón (ES), National Institute for Health Development (EE), National Research Council (IT), Centro Interdisciplinar de Estudo da Performance Humana (PT), CHU Sainte-Justine Research Center (CA), Universidad Autónoma de Madrid (ES), Université de Montréal (CA), Norwegian School of Sport Sciences (NO), University of Pecs (HU), University of Gothenburg (SE)
Openalex Percentile: Top 12%
Physical Activity and Health
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