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.