How do relative time in moderate-to-vigorous physical activity corresponds to the 2020 guidelines on physical activity and sedentary behaviour?

doi:10.21203/rs.3.rs-2801102/v1

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How do relative time in moderate-to-vigorous physical activity corresponds to the 2020 guidelines on physical activity and sedentary behaviour?

https://doi.org/10.21203/rs.3.rs-2801102/v1

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Background

More and more researchers have started to analyse physical activity data using compositional data analysis (CoDA), which has led to that the effect of relative time in different behaviours can be explored. However, there are challenges related to interpretation of the results based on CoDA. This is partly related to that CoDA provides estimates based on relative time that is difficult to interpret in relation to the 2020 guidelines of physical activity and sedentary behaviour. Since many data cohorts do not have data on sleep, the proportion of time in physical activity may vary depending on how large part of the day in awaken behaviours is recorded. Therefore, there is a need of explore cut-points for relative time to distinguish between individuals that do and do not reach 150–300min of moderate-intensity physical activity (MVPA).

Method

To estimate the cut-off points of relative time in MVPA, the publicly available data of NHANES 2003–2006 was used and cut-off points were explored in different subsets of the total population. Values for sensitivity, specificity and cut-off values were explored in; i) total sample, ii) tertiles of wear time, iii) individuals with ± 5 min from physical activity recommendation, iiii) individuals with 5 min from PA recommendation in the middle tertile of wear time.

Results

Overall, the analyses show high values for sensitivity (88–100%) and specificity (66–99%) for different cut-off values associated with 150–300min of MVPA. Spending 2.4–4.7% of the time awake in MVPA was found to correspond to the 2020 guidelines of physical activity and sedentary behaviour.

Conclusion

This finding is helpful when analysing physical activity data using CODA in datasets where sleep is not available and when interpreting diagrams depicting relative time in different behaviours.

Compositional data analysis

guidelines

moderate-to-vigorous physical activity

physical activity

recommendation

The recent years, compositional data analysis (CoDA) has drawn significant attention from researchers in the field of physical activity, which is illustrated by a dramatical increase in number of publications using CoDA. Combining the search terms “compositional data analysis” & “physical activity” in PubMed, show a distinct increase in the number of publications; zero studies were published before 2015, one study was published in 2015 and between 2020–2022 37–41 studies were published per year. Clearly, researchers have started to apply CoDA to explore different research aims related to physical activity and health outcomes.

Using CoDA, the co-dependent relationship among time in different behaviours such as sedentary behaviour, light-intensity physical activity and moderate-to-vigorous intensity physical activity (MVPA) is acknowledged (1). Even if there are several other methodologies for handling the co-dependent relationship between different behaviour, i.e. related to isotemporal substitution (2), modified hierarchical regression or stratification by different behaviours (3), CoDA is one of the most flexible methods for this kind of data (4). Even so, there are several challenges when using CoDA, where one of these is related to the interpretation of the results.

It is well known that engaging in physical activity is associated with health benefits (e.g. cognitive health, sleep etc) and does mitigate health risks such as reduced risk of all-cause mortality, cardiovascular disease mortality, incident hypertension, cancer, etc (5, 6). The 2020 guidelines of physical activity and sedentary behaviour emphasizes that adults should undertake 150–300min of moderate-intensity, or 75–150min of vigorous-intensity physical activity, or some equivalent combination of moderate-intensity and vigorous-intensity aerobic physical activity, per week (7). The guideline also emphasizes that ”some physical activity is better than none” and “adults should limit the amount of time spent being sedentary” are the main messages.

The 2020 guidelines of physical activity and sedentary behaviour (now called “2020 guidelines of PA and SB”) refers to absolute time, while disregarding a recommendation based on relative time. There are also 24-hours guidelines based on physical activity, sedentary behaviour and sleep, such as the Canadian 24-Hour Movement Guidelines for Adults (8) and the Australian 24-Hour Movement Guidelines for Children and Young People (9). Although these provide 24-hour guidelines, these recommendations do not provide guidelines based on relative values. As the relative time is affected by the time in all behaviours it is more difficult to provide an optimal composition about how an individual should spend their day from a health perspective. In addition, there are far more publications on absolute time of physical activity, compared to relative time (10). Applying CoDA, leads normally to an output of relative time for a specific behaviour, which is often quite difficult to interpret relative to the 2020 guidelines of PA and SB. Even if percent could be transformed to absolute time, and rescaled to sum up to 24 hours (11), identifying reference values associated with the 2020 guidelines of PA and SB may help in interpreting which values correspond to the strongest health benefits. It might also help when visualizing diagrams, e.g. ternary plots (12), where relative values are depicted.

If data on complete 24 hours is available, the recommended guidelines of 150–300 min should correspond to that an adult individual should spend between 1.5-3.0% of total time in MVPA. However, in most cases, data on sleep is not recorded and only time in awaken behaviours can be modelled. If not 24 hours of data is recorded, the fraction of MVPA may vary depending on how large part of the day in awaken behaviours is recorded. Considering that most guidelines recommend including days with at least 10 hours of valid data (13), it is important to estimate how this could influence the relative time of MVPA that corresponds to the 2020 guidelines of PA and SB. For instance, if sleep time is ignored and an individual spend 30 min of time in MVPA, the proportion of time will vary between 3.1–6.3% if awaken time is between 8–16 hours.

Please insert Fig. 1 here

If time in different behaviours is unbiased, estimates of relative time will be correct as well. However, if time is classified as non-wear time that corresponds to time in a behaviour, the estimates of relative time will be inaccurate. This pattern could be explored in a scatter plot with wear time against the relative time in a specific behaviour. If the relative time of a behaviour deviates across wear time it could be suspected that the time in a behaviour is biased. In Fig. 1A, based on publicly available data from NHANES 2003–2006, the proportion of time spent in MVPA and reaching the recommended level of the 2020 guidelines of PA and SB across wear time were rather constant. In Fig. 1B, based on randomly generated data, the individuals that reached the recommended level of the 2020 guidelines of PA and SB had the lowest amount of wear time, illustrating that time in at least one behaviour is not accurately estimated. The figure also highlights that the proportion of individuals reaching the recommended level of the 2020 guidelines of PA and SB should be rather constant across wear time. Since individuals often have different wear time it is important to estimate which cut-off value can identify the majority of individuals reaching the recommendation (sensitivity) and distinguish between the ones that do not achieve the recommendation (specificity).

To estimate the cut-off points associated with the 2020 guidelines of PA and SB, the publicly available data of NHANES 2003–2006 was used. Accounting for the complex survey design of NHANES, values for sensitivity and specificity were explored in package WeightedROC in the statistical software R (R Core Team, 2022). Cut-off values were chosen based on the Youden score. Several different subsets of the total population were used when estimating cut-off values that correspond to 150–300min of moderate-intensity physical activity. Specifically, cut-off values were explored in; i) total sample, ii) tertiles of wear time, iii) individuals with ± 5 min from physical activity recommendation, iiii) individuals with 5 min from PA recommendation in the middle tertile of wear time.

Overall, the analyses show very high values for sensitivity and specificity for different cut-off values associated with the recommendation of physical activity (Table 1). The lowest sensitivity (88%) and specificity (66–85%) values were associated with investigating individuals that were ± 5 min from the physical activity recommendation. Taking the median value of the cut-off values shows that the recommended level of physical activity (150-300min) corresponds to that 2.4–4.7% of awaken time should be spent in MVPA, based on the NHANES 2003–2006.

Table 1

Sensitivity, specificity, cut-off values for reaching 150–300 min of moderate-intensity physical activity (MVPA) for different subset of sample based on wear-time and minutes of MVPA.
	PA 150 min^a	Sensitivity (%)	Specificity (%)	Cut-off mvpa (%)	PA 300 min^a	Sensitivity (%)	Specificity (%)	Cut-off mvpa (%)
Complete sample	1128	98	98	2.4	387	99	97	4.4
Wear-time 1–33 perc 34–67 perc 68–100 perc	245 383 500	99 99 98	98 99 99	2.6 2.5 2.3	74 139 174	100 100 98	99 99 98	5.5 4.7 4.4
± 5 min from PA recommendation^b	251	88	85	2.4	90	88	66	4.7
Wear-time 34–67 perc and ± 5 min from PA recommendation^b	82	95	97	2.5	38	96	87	4.8
Perc, percentile; PA, physical activity ^a Reaching the recommended level of physical activity. ^b 5 min apart from the physical activity recommendation, i.e. 145-155min and 295-305min.

Please insert Table 1 here

The 2020 guidelines of PA and SB for adults specify now a target range of moderate-intensity and vigorous-intensity physical activity (7). The cut-off findings should be interpreted that an individual should spend between 2.4–4.7% of awaken time in MVPA to reach this target range. There was no dramatic change in cut-off values across different values for wear time, indicating the derived cut-off values to be quite robust. However, if spending 2.4–4.7% of the time in MVPA corresponds to the physical activity guidelines in other populations needs to be explored. Even so, the cut-off interval overlaps with the 1.5-3.0% range of MVPA time that is accurate for individuals having 24 hours of data available, suggesting that a wider range of relative time spent in MVPA should be allowed when investigating data on only awaken behaviours.

In summary, more and more researchers have started to analyse physical activity data using CoDA. However, there are challenges related to the interpretation of the results, partly related to that CoDA provides estimates based on relative time, which is not applicable with the 2020 guidelines of PA and SB. Based on estimations of cut-points using different subsets of the NHANES 2003–2006 population, spending 2.4–4.7% of the time awake in MVPA was found to correspond to the 150-300min of physical activity. This finding could help when analysing physical activity data using CODA in datasets where sleep is not available and when interpreting diagrams depicting relative time in different behaviours.

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Conflict of interest statement

The author declares that there are no conflicts of interest.

Availability of data and materials

Data are available in a public, open-access repository and can be accessed at the https://www.cdc.gov/nchs/nhanes/index.htm.

Competing interests

The author declares that there are no conflicts of interest.

Funding

Not applicable.

Authors' contributions

PvR designed the study, performed the analysis and drafted the manuscript.

Acknowledgements

Not applicable.

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No competing interests reported.

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You are reading this latest preprint version

How do relative time in moderate-to-vigorous physical activity corresponds to the 2020 guidelines on physical activity and sedentary behaviour?

Status:

Version 1

Abstract

Figures

Background

Guidelines Of Physical Activity And Sedentary Behaviour

Estimating Cut-off Points Associated With The 2020 Guidelines Of Pa And Sb

Conclusion

Declarations

Ethics approval and consent to participate

Consent for publication

Availability of data and materials

Competing interests

Funding

Authors' contributions

Acknowledgements

References

Additional Declarations

Status:

Version 1