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Dose‒response associations of self-reported and device-measured physical activity with major adverse cardiovascular events in people with prevalent diseases
(2026) Sánchez Lastra, Miguel Adriano; Pozo Cruz, Borja del; Tarp, Jakob; Eirik Dalene, Knut; Ding Ding, Tormod S.; Ekelund, Ulf
Purpose: To investigate the dose response associations of self-reported and device-measured physical activity with major adverse cardiovascular events (MACE) and cardiovascular disease (CVD) mortality in individuals with a history of CVD, type 2 diabetes mellitus (T2DM), or cancer. Methods: We analyzed data from 34,183 UK Biobank participants (CVD: n=8703; T2DM: n=11,623; cancer: n=13,857; age=60.0§7.1 years, mean § SD; 45.3% women). Physical activity was assessed using self-reports and wrist-worn accelerometers in a subsample (n= 6077). Dose‒response associations with MACE and CVD mortality were evaluated using Fine-Gray competing-risk models with penalized splines, adjusting for confounders. Results: During a median follow-up of 13.1 years, 8729 MACE and 982 CVD deaths were recorded. Self-reported physical activity showed nonlinear inverse associations with MACE, with the optimal dose (nadir) observed at 4000 MET-min/week in CVD (hazard ratio (HR)=0.95) and cancer (HR =0.92) and 6000 MET-min/week in T2DM (HR=0.91), compared to participants in the 5th centiles of activity. For CVD mortality, the optimal dose was observed at 5000 MET-min/week in CVD (HR=0.86) and cancer (HR=0.62), respectively. Device-measured moderate-to-vigorous intensity physical activity showed stronger dose‒response associations with MACE for T2DM (optimal dose observed at 200 min/week, HR=0.88) and cancer (optimal dose at 700min/week, HR=0.27, wide confidence intervals). Conclusion: Physical activity could reduce MACE risk in people with a history of CVD, T2DM, or cancer. While a similar shape of doseresponse patterns was observed across these groups, self-reported data suggested the minimal effective dose might exceed current World Health Organization recommendations. However, device-measured data supported existing guidelines for people with T2DM and cancer survivors.
Health-related quality of life in school-aged boys and girls: longitudinal associations with physical activity and sedentary behaviour in the HAPPY study
(2026) Downing, Katherine L.; Pozo Cruz, Borja del; Arundell, Lauren; Hinkley, Trina; Salmon, Jo; Timperio, Anna; Hesketh, Kylie D.
Background: Health-related quality of life (HRQoL) is positively associated with physical activity (PA) and negatively associated with sedentary time (SED) assessed by self- and proxy-report in children. However, there is a dearth of longitudinal evidence using device-measured PA and SED in this population. This study aimed to examine longitudinal associations of device-measured PA and SED as well as parent-reported screen time with HRQoL in primary (elementary) school-aged boys and girls.
Methods: Data from waves 2 and 3 (child ages 6-8 and 9-11y, respectively) of the Healthy Active Preschool and Primary Years (HAPPY) Study were analysed. At wave 2, children wore ActiGraph GT1M accelerometers to assess time in SED and light-, moderate- and vigorous-intensity PA (LPA, MPA and VPA). Parents reported their child's usual screen time (television viewing, computer/internet use, computer/electronic games, handheld electronic games). At wave 3, parents reported their child's HRQoL using the Pediatric Quality of Life Inventory. Mixed-effects linear models were used to assess longitudinal associations of different intensities of PA, SED, and screen time with HRQoL scores. Analyses were stratified by sex of the child and adjusted for child age, BMI z-score and maternal education, with child and preschool/childcare centre of recruitment as random-effects.
Results: Boys had less SED and more MPA, VPA, TPA, electronic game use, handheld electronic game use and total screen time than girls (all p < 0.05); there were no sex differences in LPA, television viewing, computer/internet use, or HRQoL scores. For boys, VPA predicted better physical HRQoL (beta [β] = 0.18, 95%CI 0.02, 0.35). For girls, using electronic games predicted lower psychosocial HRQoL (β=-0.09, 95%CI -0.16, -0.01), while handheld electronic games and total screen time predicted lower physical HRQoL (β=-0.19, 95%CI -0.33, -0.06, and β=-0.04, 95%CI -0.07, -0.004, respectively) and total HRQoL (β=-0.12, 95%CI -0.23, -0.01, and β=-0.03, 95%CI -0.05, -0.001, respectively).
Conclusions: Higher VPA predicted better physical HRQoL for boys; since boys were more active than girls, girls may not have engaged in sufficient VPA to benefit their HRQoL. Further research is needed to examine specific types of screen use, given the observed detrimental associations with HRQoL for girls.
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