Abstract
OBJECTIVE:
To examine the prevalence of ≥150 min/wk of moderate-to-vigorous physical activity (MVPA) using different criteria for bout length, and to examine associations with measures of obesity, cardiorespiratory fitness, and cardiometabolic risk factors in healthy adults with overweight or obesity.
METHODS:
Baseline data from healthy adults (N=375; age=45.2±7.7 years; BMI=32.3±3.8 kg/m2) enrolled in a behavioral weight loss intervention were examined cross-sectionally. Categorization was by objectively measured MVPA as 1) LOW-MVPA: <150 min/wk [N=122, 32.5%]; 2) MVPA-NON-BOUTED: ≥150 min/wk in bouts <10 minutes [N=72, 19.2%]; 3) MVPA-COMBINED: ≥150 min/wk with a combination of bouts <10 and ≥10 minutes [N=50, 13.3%]; 4) MVPA-BOUTED: ≥150 min/wk with bouts ≥10 minutes [N=131, 34.9%].
RESULTS:
Weight, BMI, and waist circumference were higher in LOW-MVPA versus the other categories. Body fatness was significantly lower in MVPA-BOUTED compared to LOW-MVPA (p<0.05). Differences by category for cardiorespiratory fitness and cardiometabolic risk factors were limited.
CONCLUSIONS:
Some adults with overweight or obesity may be more active than they perceived themselves to be and accumulation of ≥150 min/week of MVPA may have favorable effects on weight and adiposity status. Findings may influence physical activity recommendations, and confirmation with prospective and randomized studies is needed.
Keywords: physical activity, exercise, obesity, adiposity
INTRODUCTION
The health benefits of habitual physical activity are well established (1). The risk of developing a variety of lifestyle-related health conditions including hypertension, stroke, diabetes, coronary heart disease, and obesity are reduced with routine physical activity (1). Physical activity can also reduce depression, improve mood, and enhance performance of daily tasks throughout the life span (1).
Excess weight resulting in overweight or obesity is a public health concern (2). Physical activity is inversely related to weight gain, and low levels of physical activity may be associated with the development of obesity (3). There is a dose-response relationship between physical activity and magnitude of weight loss, and physical activity is associated with enhanced long-term weight loss (4).
In the mid-1990s there was a paradigm shift within physical activity recommendations, which allowed for the accumulation of short-bouts of activity of 8–10 minutes in duration, rather than requiring longer continuous periods of physical activity to achieve public health recommendations (5). The recommendation of accumulation of physical activity in bouts of at least 10 minutes was retained in subsequent guidelines (6). However, more recent evidence has suggested that physical activity accumulated in bouts even shorter than 8–10 minutes in duration can elicit health benefits, which includes weight regulation (7, 8). This evidence was included in the 2018 Physical Activity Guidelines Advisory Committee Report (7, 8) and resulted in the recommendation that all moderate-to-vigorous physical activity (MVPA), regardless of bout length, contributes to the public health recommendation to accumulate ≥150 minutes per week of MVPA. This recommendation was also a component of the Canadian 24-Hour Movement Guidelines (9). However, there is limited research on how this paradigm shift influences the identification of adults who meet or do not meet this recommended level of physical activity. Moreover, there is a need for additional research to examine whether the length of a bout of physical activity is associated with health benefits, and this may be particularly of interest in adults with overweight or obesity.
This study examined objectively measured physical activity in adults with overweight or obesity to compare whether the prevalence of achieving ≥150 minutes per week of MVPA differs when MVPA is defined as total minutes regardless of bout length versus minutes accumulated in bouts of ≥10 minutes. Moreover, we also examined whether measures of obesity, cardiorespiratory fitness, and selective cardiometabolic risk factors in adults with overweight or obesity differed based on categories of meeting the criteria of 150 minutes per week of MVPA.
METHODS
Participants
Baseline data from 375 adults with overweight or obesity (age=45.2±7.7 years; BMI=32.3±3.8 kg/m2) who enrolled in a behavioral weight loss program, and who provided objectively measured physical activity, were analyzed. Demographic characteristics are presented in Table 1. Inclusion and exclusion criteria for the parent study have previously been published (10, 11). These include an age of 18 to 55 years and within a BMI range of 25 to <40 kg/m2, which was determined at a baseline eligibility visit. Ineligibility criteria included: 1) self-reporting ≥60 minutes per week of structured moderate-to-vigorous intensity PA (MVPA) on a telephone screening, 2) weight loss of ≥5% within the prior 6 months or a history of bariatric surgery, 3) history of cardiometabolic disease, diabetes mellitus, or cancer, 4) taking medication that could affect heart rate or blood pressure, 5) taking medication that could influence weight, 6) treatment for psychological conditions that included medication or counseling, 7) currently pregnant, pregnant within the prior 6 months, or planning a pregnancy within the next 12 months, 8) planning on geographical relocation outside of the region within 12 months, 9) inability to comply with the components of the interventions, 10) or had a contraindication that would prohibit MRI scanning due to that measure being included as an outcome in the parent study. Participants provided written informed consent and medical clearance from their physician, and procedures were approved by the University of Pittsburgh Institutional Review Board and Human Research Protection Office.
Table 1.
Baseline characteristics of participants.
| Variable | Total (N=375) [% of sample] |
Category of MVPA | ||||
|---|---|---|---|---|---|---|
| LOW-MVPA (N=122) [32.5%] |
MVPA-NON-BOUTED (N=72) [19.2%] |
MVPA-COMBINED (N=50) [13.3%] |
MVPA-BOUTED (N=131) [34.9%] |
P-Value | ||
| Age, years* | 45.2±7.8 | 46.2±6.9 | 44.8±7.5 | 45.9±7.0 | 44.2±8.9 | 0.179 |
| Weight, kg* | 90.9±13.7 | 95.2±12.4A,B,C | 88.8±12.4A | 88.5±13.2B | 88.9±15.0C | <0.001 |
| Body mass index, kg/m2 * | 32.3±3.8 | 34.2±4.0A,B,C | 31.6±3.0A | 31.8±3.5B | 31.1±3.4C | <0.001 |
| Sex** | ||||||
| Male | N=77 (20.5%) |
N=4 (3.3%) |
N=16 (22.2%) |
N=6 (12.0%) |
N=51 (38.9%) |
<0.001## |
| Female | N=298 (79.5%) |
N=118 (96.7%) |
N=56 (77.8%) |
N=44 (88.0%) |
N=80 (61.1%) |
|
| Race** | ||||||
| White | N=275 (73.3%) |
N=79 (64.8%) |
N=54 (75.0%) |
N=40 (80.0%) |
N=102 (77.9%) |
0.066## |
| Non-white | N=100 (26.7%) |
N=43 (35.2%) |
N=18 (25.0%) |
N=10 (20.0%) |
N=29 (22.1%) |
|
| Hispanic/Latino** | ||||||
| Yes | N=13 (3.5%) |
N=1 (0.8%) |
N=5 (6.9%) |
N=1 (2.0%) |
N=6 (4.6) |
0.113## |
| No | N=362 (96.5%) |
N=121 (99.2%) |
N=67 (93.1%) |
N=49 (98.0%) |
N=125 (95.4%) |
|
indicates data presented as Mean ± Standard Deviation
indicates data presented as N (%)
indicates P-value based on independent t-test
indicates P-value based on Chi-Square analysis
MVPA: moderate-to-vigorous physical activity; LOW-MVPA: <150 min/wk of MVPA; MVPA-NON-BOUTED: ≥150 min/wk accumulated in bouts <10 minutes in duration; MVPA-COMBINED: ≥150 min/wk accumulated with a combination of bouts <10 minutes and ≥10 minutes; MVPA-NON-BOUTED: ≥150 min/wk accumulated in bouts ≥10 minutes
Assessments
Physical activity
As previously described (10) baseline physical activity was assessed with an activity monitor (SenseWear, BodyMedia, Pittsburgh, PA) worn for 7 days and participants instructed to maintain their regular pattern of activity. Data were considered valid if the activity monitor was worn for ≥10 hours per day on at least 4 days. Activity monitor data were used to identify total minutes of MVPA that met the criteria of ≥3 METs (7, 8). Minutes were used to compute total minutes of MVPA and the total minutes that were accumulated in bouts ≥10 minutes. For eligibility, participants were excluded from participation if they reported ≥60 minutes per week of MVPA during a telephone screening in response to being asked “on average how many minutes per week do you exercise?” After eligibility was determined, participants completed an interviewer guided assessment of self-reported physical activity using the a modified version of the Paffenbarger Questionnaire as previously reported (12).
Weight, Height, and BMI
As previously described (10), weight was assessed to the nearest 0.1 kg with the participant clothed in a hospital gown or lightweight clothing, with duplicate measure differing by ≤0.2 kg. Height was assessed using a wall-mounted stadiometer to the nearest 0.1 cm with duplicate measures differing by ≤0.5 cm. BMI was computed from weight and height as kg·m−2.
Body composition
As previously described (10), total body composition was assessed using dual-energy x-ray absorptiometry (GE Lunar iDXA, Madison, WI). Participants were clothed in a light-weight hospital gown, and female participants completed a urine pregnancy test just prior to this assessment to confirm non-pregnancy. Participants with a positive urine pregnancy test were ineligible for further participation in this study. Horizontal waist circumference was measured at the iliac crest using a Gulick anthropometric measuring tape, with measures taken to the nearest 0.1 cm with duplicate measures differing by ≤1.0 cm.
Cardiorespiratory fitness
As previously described (10), a submaximal graded exercise test performed on a motorized treadmill was used to assess cardiorespiratory fitness. Speed of the treadmill was held constant at 80.4 m·min−1 with the incline starting at 0% and progressing at 1% per minute. Test termination criteria required the participant to achieve 85% of age-predicted maximal heart rate. Indirect calorimetry using a calibrated metabolic cart was used to measure oxygen consumption (L·min−1 and mL·kg−1·min−1). Submaximal fitness was represented by oxygen consumption, achieved during the final 20 seconds prior to test termination, and by the duration of the test until termination.
Resting blood pressure
Resting blood pressure was measured following a 5-min seated resting period using a automated system (Dinamap, GE Heathcare) (10). Participants with resting systolic blood pressure of ≥140 mmHg or resting diastolic blood pressure ≥90 mmHg were referred to their physician for follow-up evaluation.
Blood Samples
Blood samples were collected using venipuncture. Participants were instructed to fast for a period of 12 hours prior to sample collection. Samples were stored at −80° C until the time of analysis by a CLIA certified laboratory. Samples were analyzed for total cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL-C), glucose, insulin, and c-reactive protein (CRP).
Statistical Analysis
Statistical analyses were performed using IBM SPSS version 29.0. Statistical significance was defined at p≤0.05. Objectively measured physical activity data was used to group participants into categories based on accumulating or not accumulating ≥150 min/wk of MVPA. Categories included: 1) LOW-MVPA: <150 min/wk of MVPA; 2) MVPA-NON-BOUTED: ≥150 min/wk accumulated in bouts <10 minutes in duration; 3) MVPA-COMBINED: ≥150 min/wk accumulated with a combination of bouts <10 minutes and ≥10 minutes; 4) MVPA-BOUTED: ≥150 min/wk accumulated in bouts ≥10 minutes.
Differences in demographic characteristics across categories were analyzed using one-way analysis of variance (ANOVA) for continuous variables and chi-square for categorical variables. Physical activity data were analyzed and determined to not be normally distributed, and therefore comparisons across categories of MVPA accumulation were analyzed using the Kruskal-Wallis tests with significant effects being further explored with Mann-Whitney U tests for pairwise comparisons.
Continuous outcomes including weight, BMI, waist circumference, body composition, cardiorespiratory fitness, and cardiometabolic risk factors were analyzed using the ANCOVA approach to examine differences across categories of MVPA accumulation with adjustment for total MVPA and sex. Significant effects were explored with post-hoc analysis. For cardiometabolic risk factors that were not normally distributed (triglycerides, insulin, CRP), data were log-transformed prior to analysis.
RESULTS
Demographic characteristics and the comparison of these characteristics based on category of achieving the objectively measured criteria of ≥150 minutes per week are shown in Table 1.
Prevalence of Meeting the Criteria of >150 minutes per week of MVPA
The prevalence of achieving ≥150 minutes per week of physical activity based on objective or self-report measurements are shown in Figure 1. When total MVPA was examined, which reflects contemporary public health guidelines for physical activity,(8, 9) the prevalence of achieving this criterion is 67.5%. By comparison, when based on self-reported leisure-time physical activity assessed by questionnaire, the prevalence was 14.0%.
Figure 1.
Percent of participants meeting the criteria of ≥150 minutes per week of objectively measured moderate-to-vigorous physical activity or self-reported leisure-time physical activity.
The participants meeting the criteria of ≥150 minutes per week of MVPA based on objective measurement were further examined (Figure 2) based on how the MVPA was accumulated. This showed 19.2% of participants would have achieved the criteria based solely on MVPA accumulated in bouts <10 minutes in duration (MVPA-NON-BOUTED), 13.3% of participants would have achieved the criteria based on needing to combine some MVPA from bouts <10 minutes and some from ≥10 minutes in duration (MVPA-COMBINED), and 34.9% of participants would have achieved the criteria based solely on MVPA accumulated in bouts ≥10 minutes in duration (MVPA-BOUTED), with 32.5% not meeting the criteria (LOW-MVPA).
Figure 2.
Percent of participants meeting the criteria of ≥150 minutes per week of objectively measured moderate-to-vigorous physical activity by the pattern of accumulation.
Physical Activity
Physical activity is shown in Table 2. Objectively measured Total MVPA was significantly different between the physical activity categories (p<0.001). Total MVPA was significantly greater in MVPA-BOUTED when compared to the other groupings, was significantly greater in MVPA-NON-BOUTED compared to both MVPA-COMBINED and LOW-MVPA, and significantly greater in MVPA-COMBINED compared to LOW-MVPA (p<0.05).
Table 2.
Comparison of components of MVPA by category of achieving ≥150 minutes per week of moderate-to-vigorous physical activity.
| Variable | Category of Achieving ≥150 minutes per week of MVPA (Median [25th, 75th Percentile]) | ||||
|---|---|---|---|---|---|
| LOW-MVPA (N=122) [32.5%] |
MVPA-NON-BOUTED (N=72) [19.2%] |
MVPA-COMBINED (N=50) [13.3%] |
MVPA-BOUTED (N=131) [34.9%] |
P-Value* | |
| Objectively Measured Total MVPA (minutes per week) | 82.0 [41.5, 118.3]A,B,C |
301.5 [245.3, 374.9]A,D,E |
197.0 [167.3, 217.0]B,D,F |
538.0 [401.0, 793.0]C,E,F |
<0.001 |
| Objectively Measured MVPA in bouts <10 minutes (minutes per week) | 56.4 [30.8, 83.0]A,B,C |
216.0 [183.3, 279.4]A,D |
116.5 [95.5, 128.3]B,D,E |
262.0 [174.0, 364.0]C,E |
<0.001 |
| Objectively Measured MVPA in bouts ≥10 minutes (minutes per week) | 11.0 [0.0, 30.0]A,B,C |
85.5 [44.5, 119.3]A,D |
85.5 [60.0, 109.3]B,E |
272.0 [183.0, 474.0]C,D,E |
<0.001 |
| Self-Reported Physical Activity (minutes per week) | 30.0 [0.0, 66.3]A |
22.5 [0.0, 80.0]B |
60.0 [7.5, 120.0] |
60.0 [0.0, 140.0]A,B |
0.002 |
MVPA: moderate-to-vigorous physical activity; LOW-MVPA: <150 min/wk of MVPA; MVPA-NON-BOUTED: ≥150 min/wk accumulated in bouts <10 minutes in duration; MVPA-COMBINED: ≥150 min/wk accumulated with a combination of bouts <10 minutes and ≥10 minutes; MVPA-BOUTED: ≥150 min/wk accumulated in bouts ≥10 minutes.
P-value based on Kruskal-Wallis test. Categories of MVPA with the same superscript are significantly different at p<0.05 based on Mann-Whitney U test.
Objectively measured MVPA in bouts <10 minutes in duration was significantly different between the physical activity categories (p<0.001) (Table 2). In post-hoc analyses, MVPA in bouts <10 minutes was significantly greater in MVPA-BOUTED when compared to MVPA-COMBINED and LOW-MVPA, was significantly greater in MVPA-NON-BOUTED compared to MVPA-COMBINED and LOW-MVPA, and significantly greater in MVPA-COMBINED compared to LOW-MVPA (p<0.05).
Objectively measured MVPA in bouts ≥10 minutes in duration was significantly different between the physical activity categories (p<0.001) (Table 2). MVPA in bouts ≥10 minutes was significantly greater in MVPA-BOUTED when compared to all the other categories, was significantly greater in MVPA-NON-BOUTED compared to LOW-MVPA, and significantly greater in MVPA-COMBINED compared to LOW-MVPA (p<0.05).
Min/wk of self-reported physical activity obtained from a structured questionnaire was significantly different between categories (p<0.001). Post-hoc analysis revealed that self-reported physical activity in MVPA-BOUTED was significantly greater than both LOW-MVPA and NON-BOUTED-MVPA (p<0.05). No other differences between categories were statistically significant for self-reported physical activity.
Weight, BMI, Waist Circumference, and Percent Body Fat
Weight, BMI, waist circumference, and percent body fat are shown in Table 3. Weight was significantly lower in MVPA-NON-BOUTED, MVPA-COMBINED, and MVPA-BOUTED compared to LOW-MVPA (p<0.001). The same pattern was shown for BMI (p<0.001). For percent body fat, MVPA-BOUTED was significantly lower than LOW-MVPA (p<0.05), while the difference in percent body fat was not significant for all other pairwise comparisons. Waist circumference was significantly lower in MVPA-BOUTED, MVPA-NON-BOUTED, and MVPA-COMBINED compared to LOW-MVPA (p<0.05).
Table 3.
Comparison of weight, body composition, cardiorespiratory fitness, and cardiometabolic risk factors by achieving ≥150 minutes per week of moderate-to-vigorous physical activity.
| Variable | Category of MVPA | ||||
|---|---|---|---|---|---|
| LOW-MVPA (N=122) [mean(95%CI)] |
MVPA-NON-BOUTED (N=72) [mean(95%CI)] |
MVPA-COMBINED (N=50) [mean(95%CI)] |
MVPA-BOUTED (N=131) [mean(95%CI)] |
P-Value | |
| Weight, kg | 97.3 (94.9, 99.6)A,B,C | 88.4 (85.8, 91.1)A | 89.4 (86.2, 92.7)B | 86.8 (84.4, 89.3)C | <0.001** |
| Body mass index, kg/m2 | 34.2 (33.5, 34.9)A,B,C | 31.6 (30.8, 32.4)A | 31.8 (30.8, 32.8)B | 31.2 (30.4, 31.9)C | <0.001** |
| Percent body fat, % | 44.6 (43.8, 45.5)A | 43.2 (42.3, 44.2) | 43.2 (42.0, 44.3) | 41.9 (41.1, 42.8)A | <0.001** |
| Waist circumference, cm | 110.6 (108.8, 112.4)A,B,C | 106.1 (104.1, 108.2)A | 104.5 (102.0, 107.0)B | 103.4 (101.5, 105.2)C | <0.001** |
| Cardiorespiratory fitness | |||||
| ml/kg/min* | 21.9 (21.1, 22.6)A | 23.7 (22.9, 24.5)A | 22.4 (21.4, 23.4) | 22.7 (21.9, 23.4) | 0.013** |
| L/min* | 2.1 (2.1, 2.2) | 2.1 (2.0, 2.2) | 2.0 (1.9, 2.1) | 2.0 (1.9, 2.1) | 0.047** |
| Termination time, minutes | 7.3 (6.8, 7.8) | 8.3 (7.7, 8.9) | 7.6 (6.9, 8.4) | 7.7 (7.2, 13.3) | 0.116** |
| Fasting blood measures | |||||
| Total cholesterol, mg/dl* | 195.4 (188.3, 202.4) | 202.3 (194.5, 210.1) | 202.9 (193.2, 212.5) | 198.2 (191.1, 205.4) | 0.441** |
| LDL Cholesterol, mg/dl* | 118.2 (112.3, 124.0) | 124.6 (118.0, 131.1) | 120.4 (112.3, 128.4) | 121.0 (115.0, 127.0) | 0.550** |
| HDL cholesterol, mg/dl* | 53.3 (51.0, 55.7) | 53.1 (50.5, 55.7) | 55.2 (52.0, 58.3) | 52.9 (50.5, 55.3) | 0.710** |
| Triglycerides, mg/dl* | 119.5 (105.8, 133.2) | 122.5 (107.2, 137.7) | 137.3 (118.6, 156.1) | 122.1 (108.1, 136.1) | 0.445*** |
| Glucose, mg/dl* | 94.1 (91.5, 96.7) | 95.8 (92.9, 98.8) | 94.5 (91.0, 98.1) | 95.7 (93.0, 98.4) | 0.827** |
| Insulin, mIU/mL* | 16.5 (14.6, 18.4) | 16.4 (14.3, 18.6) | 18.3 (15.7, 20.9) | 15.2 (13.2, 17.1) | 0.312*** |
| CRP, mg/L* | 5.1 (4.2, 6.0) | 3.8 (2.7, 4.8) | 3.8 (2.5, 5.1) | 4.0 (3.0, 5.0) | 0.972*** |
| Resting blood pressure | |||||
| Systolic, mmHg | 122.8 (120.5, 125.2)A | 120.4 (117.8, 123.0) | 122.3 (119.1, 125.5) | 117.2 (114.8, 119.6)A | 0.027** |
| Diastolic, mmHg | 72.6 (70.8, 74.3) | 72.5 (70.6, 74.4) | 73.8 (71.5, 76.2) | 71.4 (69.6, 73.1) | 0.486** |
MVPA: moderate-to-vigorous physical activity; LOW-MVPA: <150 min/wk of MVPA; MVPA-NON-BOUTED: ≥150 min/wk accumulated in bouts <10 minutes in duration; MVPA-COMBINED: ≥150 min/wk accumulated with a combination of bouts <10 minutes and ≥10 minutes; MVPA-BOUTED: ≥150 min/wk accumulated in bouts ≥10 minutes
N=121 for LOW-MVPA due to missing indirect calorimetry data for cardiorespiratory fitness measures and missing blood sample for fasting blood measures
ANCOVA adjusted for Total MVPA
ANCOVA of log transformed data and adjusted for Total MVPA.
Categories of MVPA with the same superscript are significantly different at p<0.05 based on post-hoc comparison.
Cardiorespiratory Fitness
Cardiorespiratory fitness is shown in Table 3. Cardiorespiratory fitness (ml∙kg−1∙min−1) was significantly greater in MVPA-NON-BOUTED compared to LOW-MVPA (p<0.05), with no differences observed between other comparisons of categories. There was a significant main effect for the comparison of MVPA categories for cardiorespiratory fitness expressed as L∙min−1 (p=0.047); however, post-hoc analysis revealed no significant differences between any of the pairwise comparisons. There was no significant difference between categories of MVPA when cardiorespiratory fitness was expressed as termination time.
Cardiovascular Disease Risk Factors
Comparison of cardiovascular disease risk factors based on the physical activity categories are shown in Table 3. There were no significant differences between the categories for total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, fasting glucose, fasting insulin, CRP, or resting diastolic blood pressure. However, resting systolic blood pressure was significantly lower in MVPA-BOUTED compared to LOW-MVPA (p<0.05), with no other differences between categories observed for resting systolic blood pressure.
Results Stratified by Sex
As shown in Table 1, the representation by sex is unbalanced in the categories of achieving the objectively measured criteria of ≥150 minutes per week. Therefore, in addition to presenting the findings based on analyses controlling for sex, sex-specific analyses were also performed. These results are described in the Supplement with data presented in Supplement Tables 1–4.
DISCUSSION
Prior to the 2018 Physical Activity Guidelines for Americans, it was recommended to accumulate ≥150 minutes per week of MVPA in bouts ≥10 minutes. Based on this criterion, in the sample examined in this study, 34.9% of adults with overweight or obesity who self-report <60 min/wk of structured MVPA during eligibility screening were meeting the recommended public health level of physical activity when it was objectively measured. However, the 2018 Physical Activity Guidelines for Americans and the 2020 Canadian 24-Hour Movement Guidelines now recommend that the accumulation of MVPA does not require the stipulation of being accumulated in bouts ≥10 minutes (7, 8, 9). When this criterion was applied to the data in this study, an additional 32.3% of adults with overweight or obesity met the recommendation of ≥150 minutes per week of MVPA. Thus, the elimination of the stipulation that MVPA be accumulated in bouts ≥10 minutes resulted in a greater percentage of participants meeting the public health recommendation for physical activity, despite these participants not reporting engaging in ≥60 min/wk of structured MVPA during initial eligibility screening.
Results from the National Health and Nutrition Examination Survey showed that the prevalence of meeting the guideline of ≥150 min/wk of MVPA increased from 57.9% to 95.6% for lifestyle activity when represented with bouts of ≥10 minutes per bout compared to when this 10-minute criteria was not required (13). By comparison, this current study is unique because it presents data for adults with overweight and obesity seeking weight loss who, during eligibility screening, self-report <60 min/wk of structured MVPA and outcomes of weight, body composition, cardiorespiratory fitness, and cardiometabolic risk factors were also examined.
Despite the classifications based on achieving specific criteria for MVPA, the data show that there may have been additional MVPA that contributed to the total MVPA, and this may have important public health implications for recommendations of MVPA. For example, the participants classified as MVPA-NON-BOUTED also engaged in some MVPA in bouts ≥10 minutes, which contributed to the total MVPA. For MVPA-COMBINED to achieve ≥150 min/wk, a portion of the MVPA was accumulated <10-minute bouts with the remainder consisting of ≥10-minute bouts. Even MVPA-BOUTED engaged in additional MVPA that was accumulated in bouts <10 minutes. Thus, it is unclear if achieving only 150 min/wk, regardless of how the MVPA was accumulated, would have resulted in different findings for weight, BMI, body composition, cardiorespiratory fitness, or any of the cardiometobolic risk factors. We attempted to address this by controlling for total MVPA in the analyses. However, these findings may provide insight to further refine the public health recommendation for the accumulation of MVPA, particularly for how MVPA in bouts <10 minutes and ≥10 minutes should be combined to enhance health-related outcomes in adults with overweight and obesity. An additional potentially important discovery is that even though the minimum threshold for MVPA was set at 150 min/wk, MVPA-NON-BOUTED, MVPA-COMBINED, and MVPA-BOUTED far exceeded this threshold. Within this context, this may highlight the important contribution of non-structured leisure-time physical activity (e.g., household, occupational, active transportation) to the accumulation of an adequate amount of MVPA to impact health-related outcomes. Moreover, studies are also needed to examine the health benefits of MVPA accumulated solely in bouts <10 minutes MVPA.
This study contributes to the body of science related the association of accumulated MVPA with measures of weight and adiposity, cardiorespiratory fitness, and selective cardiovascular disease risk factors. The findings suggest that accumulating ≥150 min/wk is associated with lower weight, BMI, and waist circumference compared to not accumulating this amount of MVPA, but that there may be differential effects on body fatness based on how the MVPA is accumulated. Physical activity has been shown to have effects on pathways that may influence body fatness such as fat oxidation in muscle (14), total energy expenditure (15), and satiety and hunger that influence eating behavior and energy intake (16). Whether these factors are differentially affected by how MVPA is accumulated which may influence body fatness warrants further investigation.
We suggest from these findings that in healthy adults with overweight or obesity who self-report low amounts of leisure-time physical activity, the pattern of how MVPA is accumulated may have a modest influence of cardiorespiratory fitness. The accumulation of MVPA in bouts <10 minutes was associated with a modestly higher level in cardiorespiratory fitness compared to LOW-MVPA (approximately 2 ml∙kg−1∙min−1 difference). Prior studies showed that within the context of an intervention, physical activity accumulated in multiple 10-minute daily bouts resulted in a blunted improvement in cardiorespiratory fitness compared to physical activity accumulated in longer bouts (e.g., ≥20 minutes) (17, 18, 19). However, studies of high-intensity interval training (HIIT) have supported that even shorter periods of higher intensity activity may be effective at improving cardiorespiratory fitness (20). Within the context of this study, we are not able to determine if this reflects a pattern of short periods of high-intensity physical activity, which may be similar to HIIT. This may also reflect patterns of occupational or household activity rather than leisure-time physical activity that cannot be determined from the objective monitor. This finding related to cardiorespiratory fitness may reflect the limitations of the cross-sectional design of these analyses. Therefore, to better understanding the potential implication of this finding, there is a need for prospective and randomized studies of adults with obesity to examine the effect of MVPA accumulated in bouts <10 minutes on change in cardiorespiratory fitness, and this warrants further investigation.
The results of this study are not consistent with other studies that have shown associations with physical activity and selective cardiometabolic risk factors (21, 22). This may reflect the eligibility criteria used, with participants in this study not reporting a history of cardiometabolic diseases such as cardiovascular disease or diabetes, and all participants met the clinical classification for either overweight or obesity.
The finding that CRP did not differ by MVPA category is consistent with other studies that have examined the effects of structured exercise on CRP. The INFLAME Study showed that supervised exercise did not result in a reduction in CRP; however, there was an association between reduction in body fatness and CRP (23). We also recently showed in the parent study, which provided the data for the analyses presented here, that weight loss resulted in a reduction in CRP; however, varying amounts of physical activity coupled with this weight loss did not further alter the reductions in CRP in adults with overweight or obesity (10). This may suggest that body fatness, rather than physical activity, contributes to the level of CRP. In the current study body fatness was found to be lower in MVPA-BOUTED compared to LOW-MVPA but it does not appear that this contributed to lower CRP in this study.
The 2018 Physical Activity Guidelines Advisory Committee defined MVPA as physical activity that was ≥3 METs (7, 8). However, use of this criterion represents an absolute level of energy expenditure, and it is possible that this coincides with different levels of relative physical activity intensity based on individual physiological work capacity. The use of the criterion of ≥3 METs may represent a lower than intended relative intensity of physical activity, which may partially contribute to the lack of an association with some of the cardiometabolic risk factors observed in this study.
This study reflects strengths that include objective assessment of physical activity. This study also included the rigorous assessment of weight, body composition, cardiorespiratory fitness, and cardiovascular disease risk factors. Despite these potential strengths, there are potential limitations that warrant consideration. The assessment of physical activity was conducted over a period of 1 week and data were considered valid if the activity monitor was worn for ≥10 hours per day on at least 4 days. However, this may not accurately reflect the regular pattern of physical activity of the participants in this study, and therefore future studies may need to assess physical activity for more than 1 week and with different wear criteria that may better reflect the typical pattern of physical activity. The physical activity monitor may also not have accurately measured all forms of physical activity, which may have contributed to less than optimal assessment of MVPA that could have impacted the results of this study. Moreover, the specific activities that contributed to the patterns of MVPA observed are unclear.
The sample of this study included adults with overweight or obesity without the presence of many other chronic health conditions, and it is unclear if these results would be similar if participants with other chronic health conditions would be examined. It is also unclear whether these findings would be representative of adults with overweight or obesity who are not seeking weight loss treatment.
Another limitation is that this study used a cross-sectional design for participants at baseline prior to initiating a weight loss program. Thus, the direction of the relationship between physical activity and the outcomes examined, particularly measures of weight status and body composition cannot be determined. While it is possible that physical activity is contributing to lower weight and body fatness it is also possible that those participants who are at a lower weight or body fatness are capable of engaging in more MVPA. To disentangle these relationships, prospective observational or randomized designs are needed.
We also recognize that objective measures of physical activity may either overestimate or underestimate energy expenditure, and this may influence the magnitude of physical activity defined as MVPA. We used the SenseWear armband, which Santos-Lozano et al. reported to overestimate energy expenditure compared to indirect calorimetry (24).
CONCLUSIONS
We suggest from these findings that some healthy adults with overweight or obesity who do not self-report regular participation ≥60 min/wk of structure periods of leisure-time physical activity may be more active than they perceived themselves to be. This may also suggest that the physical activity that is accumulated is resulting from a variety of lifestyle forms of physical activity, and not just structured periods of physical activity that might be classified as exercise. Regardless of how MVPA is accumulated, meeting the public health recommendation of ≥150 min/week may have favorable effects on weight, BMI, and selective measures of adiposity. However, this modestly more favorable weight or adiposity status may not necessarily translate into a more favorable cardiometabolic profile, which warrants further investigation. These findings may have the potential to influence physical activity recommendations, and how the pattern of physical activity that includes shorter (<10 minutes) and longer (≥10 minutes) periods accumulated across the day has on health outcomes in adults with obesity. These findings warrant further examination of how MVPA accumulated in bouts of varying length influence health outcomes with prospective or randomized designs in adults with overweight or obesity.
Supplementary Material
STUDY IMPORTANCE QUESTIONS.
What is already known about this subject?
Physical activity is associated with health outcomes including prevention of weight gain and obesity, and physical activity contributes to enhanced weight loss.
Current guidelines recommend that physical activity can be accumulated in bouts as short as 1 minute to achieve meaningful health benefits; however, these recommendations are based primarily on cross-sectional evidence and the impact of this recommendation on patients with overweight or obesity who present for weight loss is unknown.
What are the new findings in your manuscript?
Including moderate-to-vigorous physical activity (MVPA) in bouts <10 minutes substantially increases the proportion of individuals classified as meeting the public health recommendation of ≥150 minutes per week of MVPA.
≥150 minutes per week of MVPA is associated with lower weight, body mass index, and waist circumference regardless of bout length of the MVPA, and MVPA accumulated in bouts ≥10 minutes is associated with lower body fatness but not other measures of cardiometabolic risk.
How might your results change the direction of research or the focus of clinical practice?
Prospective and randomized studies are needed to examine if MVPA in bouts <10 minutes is as effective as bouts ≥10 minutes for changes in weight, measures of adiposity, fitness, and other health-related outcomes in adults with overweight or obesity.
For healthy adults with overweight or obesity, the use of objective measures of physical activity to assess both the amount and pattern of physical activity may provide valuable information to guide clinical and public health recommendations.
Acknowledgements:
We recognize the staff and graduate students at the University of Pittsburgh who contributed to this project.
FUNDING:
National Institutes of Health (R01 HL103646 and UL1 TR001857)
Footnotes
DISCLOSURE: Dr. Jakicic is a Scientific Advisor for Wondr Health, Inc. and the Principal Investigator for a research grant from Epitomee Medical, Inc. awarded to the University of Kansas Medical Center, and was a consultant for Education Initiatives, Inc. Dr. Rogers is a consultant for Wondr Health, Inc. No conflicts of interest were declared by the other authors.
CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT01500356
Contributor Information
Ronald E. Jackson, University of Illinois – Chicago, Chicago, IL USA.
Wei Lang, Department of Aging Medicine and Center on Aging and Mobility, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
Renee J. Rogers, University of Kansas Medical Center, Department of Internal Medicine, Division of Physical Activity and Weight Management, Kansas City, KS USA.
Erik B. Schelbert, Minneapolis Heart Institute East, Saint Paul, MN USA.
Sara J. Kovacs, Temple University, College of Public Health, Department of Kinesiology, Philadelphia, PA USA.
Seth A. Creasy, University of Colorado Denver – Anschutz Medical Campus, Division of Endocrinology, Metabolism and Diabetes, Aurora, CO USA.
John M. Jakicic, University of Kansas Medical Center, Department of Internal Medicine, Division of Physical Activity and Weight Management, Kansas City, KS USA.
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