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Total volume versus bouts: prospective relationship of physical activity and sedentary time with cardiometabolic risk in children

International Journal of Obesity (2018) | Download Citation



Examine the prospective relationship of total volume versus bouts of sedentary behaviour (SB) and moderate-to-vigorous physical activity (MVPA) with cardiometabolic risk in children. In addition, the moderating effects of weight status and MVPA were explored.


Longitudinal study including 454 primary school children (mean age 10.3 years). Total volume and bouts (i.e. ≥10 min consecutive minutes) of MVPA and SB were assessed by accelerometry in Nov 2009/Jan 2010 (T1) and Aug/Oct 2010 (T2). Triglycerides, total cholesterol/HDL cholesterol ratio (TC:HDLC ratio), homoeostatic model assessment of insulin resistance, systolic blood pressure and waist circumference were assessed at T2 (Sept/Oct 2010) and combined in a composite cardiometabolic risk score. Associations of total time and uninterrupted MVPA and SB were examined using multilevel mixed linear models, with or without mutual adjustments between MVPA and SB. The moderating effects of weight status and MVPA (for SB only) were examined by adding interaction terms.


Children engaged daily in about 60 min of total MVPA and 0–15 min/week in MVPA bouts. Mean total sedentary time was around 7 h/day with over 3 h/day accumulated in bouts. Higher mean levels of MVPA were significantly associated with a lower waist circumference, triglycerides, insulin resistance, TC:HDLC ratio and composite cardiometabolic risk, with non-significant associations for uninterrupted MVPA. Associations with sedentary time were much smaller and inconsistent: higher total sedentary time was associated with higher insulin resistance; after adjusting for MVPA, higher mean total and bouts of sedentary time were associated with lower waist circumference, and sedentary bouts with lower composite cardiometabolic risk.


Children accumulated MVPA intermittently and rarely in bouts, and about half their total sedentary time in bouts. Total MVPA is important for lowering cardiometabolic risk in children, whereas both total and uninterrupted sedentary time seem of less importance.

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The CHAMPS-study was funded by: The TRYG Foundation, University College Lillebaelt, University of Southern Denmark, The Nordea Foundation, The IMK foundation, The Region of Southern Denmark, The Egmont Foundation, The A.J. Andersen Foundation, The Danish Rheumatism Association, Østifternes Foundation, Brd. Hartmann’s Foundation, TEAM Denmark, The Danish Chiropractor Foundation, The Nordic Institute of Chiropractic and Clinical Biomechanics.

Author contributions

MC had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: MC and TA. Acquisition of data: HK, NCM. Drafting of the manuscript: MC and TA. Critical revision of the manuscript for important intellectual content: All authors. Statistical analyses: MC. Obtained funding: NW and LBA.

Author information


  1. Department of Public and Occupational Health and Amsterdam Public Health research Institute, VU University Medical Center, Amsterdam, The Netherlands

    • Mai Chinapaw
    •  & Teatske Altenburg
  2. Centre of Research in Childhood Health, Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark

    • Heidi Klakk
    • , Niels Christian Møller
    •  & Niels Wedderkopp
  3. University College Lillebaelt, Odense, Denmark

    • Heidi Klakk
  4. Department of Teacher Education and Sport, Western Norway University of Applied Sciences, Campus Sogndal, Sogndal, Norway

    • Lars Bo Andersen
  5. Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway

    • Lars Bo Andersen
  6. Orthopedic Department, Institute of Regional Health Services Research, Hospital of Southern Denmark, Esbjerg, Denmark

    • Niels Wedderkopp


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Conflict of interest

The contributions of Altenburg and Chinapaw were funded by the Netherlands Organization for Health Research and Development (ZonMw; Project No. 91211057). The remaining authors declare that they have no conflict of interest.

Corresponding author

Correspondence to Mai Chinapaw.

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