Device-measured physical activity type, posture, and cardiometabolic health markers: pooled dose-response associations from the ProPASS Consortium

Aims/hypothesis To examine the dose-response associations between device-measured physical activity types and posture (sitting and standing time) with cardiometabolic health. Methods An individual participant harmonised meta-analysis of 12,095 adults (mean age±SD= 54.5±9.6 years; Female=54.8%) from 6 cohorts with thigh-worn accelerometry. Associations of average daily duration of walking, stair climbing, running, standing and sitting with composite cardiometabolic health score (based on standardised z-scores) and individual cardiometabolic markers (body mass index, waist circumference, triglycerides, high-density lipoprotein cholesterol, glycated haemoglobin, and total cholesterol) were examined cross-sectionally using generalised linear modelling and cubic splines. Results We observed more favourable composite cardiometabolic health (i.e. z-score <0) at approximately 64 minutes/day walking (z-score [95%CI] = -0.14 [-0.25, - 0.02]) and 5 minutes/day stair climbing (-0.14 [-0.24, -0.03]). We observed an equivalent magnitude of association at 2.6 hours/day standing. Any amount of running was associated with better composite cardiometabolic health. We did not observe an upper limit to the magnitude of the dose-response associations for any activity type or standing. There was an inverse dose-response association between sitting time and composite cardiometabolic health that became markedly less favourable when daily durations exceeded 12.1 hours/day. Associations for sitting time were no longer significant after excluding participants with prevalent cardiovascular disease or medication use. The dose-response pattern was generally consistent between activity and posture types and individual cardiometabolic health markers. Conclusions/interpretation In the first activity-type specific analysis of device-based physical activity, ∼64 minutes/day of walking and ∼5.0 minutes/day of stair climbing, was associated with a favourable cardiometabolic risk profile. The deleterious associations of sitting time were fully attenuated after exclusion of participants with prevalent cardiovascular disease and medication use. Our findings on cardiometabolic health and durations in different activity-types and posture may inform clinicians and future interventions to provide personalised prescription options. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was funded by British Heart Foundation (SP/F/20/150002). The establishment of the ProPASS consortium was supported by an unrestricted 2018-20 grant by PAL Technologies (Glasgow, UK). MH supported through NIHR University College London Hospitals Biomedical Research Centre (NIHR203328). ES is funded by a National Health and Medical Research Council Investigator Grant (APP1194510). BdPC is supported by the Government of Andalusia, Research Talent Recruitment Programme (EMERGIA 2020/00158). FIREA is supported by the Academy of Finland (286294, 294154, 319246, 332030), Ministry of Education and Culture, Juho Vainio Foundation and Finnish State Grants for Clinical Research. ActiPASS development was partly funded by FORTE, Swedish Research Council for Health, Working Life and Welfare (2021 01561) GIM is supported by a National Health and Medical Research Council Investigator Grant (APP2008702). GDM is supported by a National Health and Medical Research Council Principal Research Fellowship (APP1121844). The ALSWH is funded by the Australian Government Department of Health and Aged Care and its substudy, from which accelerometry and clinical data were obtained, was funded by the National Health and Medical Research Council Project Grant (APP1129592). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The ethics committee of the University of Sydney gave ethical approval for this work I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors