Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.


Relations between physical activity, sedentary time, and body fat from childhood to adolescence: Do they differ by sex?



Efforts to reveal the direction of influence between physical activity (PA), sedentary time (ST) and body fat in youth have produced inconsistent results, possibly due to a lack of adjustment for confounders and other factors. Sex-specific associations have rarely been studied.


A sample from two Norwegian birth cohorts (n = 809) were followed biennially over five waves from the age of 6–14 years. Physical activity and ST were recorded by accelerometers, and body fat was assessed by bioelectrical impedance measurements.


By applying a dynamic panel model (DPM) that adjusts for all time-invariant confounding factors, it was found that among boys, increased fat mass index (FMI) at ages 8, 10 and 12 years predicted decreased PA two years later (8–10 years: B = −0.67, (95% CI: −1.1, −0.24); 10–12 years: B = −0.33, (95% CI: −0.61, −0.05); 12–14 years: B = −0.29, (95% CI: −0.52, −0.06)). Regarding the opposite direction of influence, more PA at age 12 forecasted reduced FMI at age 14 (B = −0.16, (95% CI: −0.24, −0.07)), whereas increased FMI predicted increased ST across all time points in boys only (6–8 years: B = 0.23, (95% CI:0.02.43); 8–10 years: B = 0.23, (95% CI:.08.39); 10–12 years: B = 0.13, (95% CI:.03.23); 12–14 years: B = 0.17, (95% CI:.07, 26)). The revealed relationships were significantly stronger in boys compared to the (absent) relations in girls. Sensitivity analyses examining moderate to vigorous PA (MVPA) rather than total PA were in accordance with the main findings.


In boys, increased FMI predicted reduced PA and increased ST two years later from childhood to adolescence. The opposite direction of influence was evident from only ages 12–14. There were no prospective relationships between FMI and PA or ST among girls.

This is a preview of subscription content, access via your institution

Access options

Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Fig. 1: Flow chart of recruitment and follow-up.
Fig. 2: Dynamic panel model of the relations between physical activity (total), sedentary time and body fat. Standardized estimates are shown for boys and girls.

Data availability

The present inquiry uses data from the Trondheim Early Secure Study (TESS). Because TESS is still ongoing and consent restrictions from the participants apply, data cannot be made available. However, the TESS research group collaborates with a number of national and international researchers and welcomes potential collaborators to contact the principal investigator Lars Wichstrøm ( or co-PI Silje Steinsbekk (

Code availability

The Mplus coding of the estimated models can be sent upon request.


  1. Jiménez-Pavón D, Kelly J, Reilly JJ. Associations between objectively measured habitual physical activity and adiposity in children and adolescents: systematic review. Int J Pediatr Obes. 2010;5:3–18.

    PubMed  Article  Google Scholar 

  2. Mitchell JA, Pate RR, Beets MW, Nader PR. Time spent in sedentary behavior and changes in childhood BMI: a longitudinal study from ages 9 to 15 years. Int J Obes. 2013;37:54–60.

    CAS  Article  Google Scholar 

  3. Biddle SJH, García Bengoechea E, Wiesner G. Sedentary behaviour and adiposity in youth: a systematic review of reviews and analysis of causality. Int J Behav Nutr Phys Act. 2017;14:43.

    PubMed  PubMed Central  Article  Google Scholar 

  4. Lee JE, Pope Z, Gao Z. The role of youth sports in promoting children’s physical activity and preventing pediatric obesity: a systematic review. Behav Med. 2018;44:62–76.

    PubMed  Article  Google Scholar 

  5. Fröberg A. “Couch-potatoeism” and childhood obesity: the inverse causality hypothesis. Prev Med. 2015;73:53–4.

    PubMed  Article  Google Scholar 

  6. Babic MJ, Morgan PJ, Plotnikoff RC, Lonsdale C, White RL, Lubans DR. Physical activity and physical self-concept in youth: systematic review and meta-analysis. Sports Med. 2014;44:1589–601.

    PubMed  Article  Google Scholar 

  7. Davelaar CMF. Body image and its role in physical activity: A Systematic Review. Cureus. 2021;13:e13379.

    Google Scholar 

  8. Schwarzfischer P, Gruszfeld D, Socha P, Luque V, Closa-Monasterolo R, Rousseaux D, et al. Longitudinal analysis of physical activity, sedentary behaviour and anthropometric measures from ages 6 to 11 years. Int J Behav Nutr Phys Act. 2018;15:126.

    PubMed  PubMed Central  Article  Google Scholar 

  9. Basterfield L, Pearce MS, Adamson AJ, Frary JK, Parkinson KN, Wright CM, et al. Physical activity, sedentary behavior, and adiposity in English children. Am J Prev Med. 2012;42:445–51.

    PubMed  Article  Google Scholar 

  10. Marques A, Minderico C, Martins S, Palmeira A, Ekelund U, Sardinha LB. Cross-sectional and prospective associations between moderate to vigorous physical activity and sedentary time with adiposity in children. International journal of obesity (2005). 2016;40:28–33.

    CAS  Article  Google Scholar 

  11. Hallal PC, Reichert FF, Ekelund U, Dumith SC, Menezes AM, Victora CG, et al. Bidirectional cross-sectional and prospective associations between physical activity and body composition in adolescence: birth cohort study. J Sports Sci. 2012;30:183–90.

    PubMed  Article  Google Scholar 

  12. Wilks DC, Besson H, Lindroos AK, Ekelund U. Objectively measured physical activity and obesity prevention in children, adolescents and adults: a systematic review of prospective studies. Obes Rev. 2011;12:e119–29.

    CAS  PubMed  Article  Google Scholar 

  13. Skrede T, Aadland E, Anderssen SA, Resaland GK, Ekelund U. Bi-directional prospective associations between sedentary time, physical activity and adiposity in 10-year old Norwegian children. J Sports Sci. 2021;39:1772–9.

    PubMed  Article  Google Scholar 

  14. Tanaka C, Janssen X, Pearce M, Parkinson K, Basterfield L, Adamson A, et al. Bidirectional associations between adiposity, sedentary behavior, and physical activity: a longitudinal study in children. J Phys Act Health. 2018;15:918–26.

    Article  Google Scholar 

  15. Skrede T, Steene-Johannessen J, Anderssen SA, Resaland GK, Ekelund U. The prospective association between objectively measured sedentary time, moderate-to-vigorous physical activity and cardiometabolic risk factors in youth: a systematic review and meta-analysis. Obesity Reviews. 2019;20:55–74.

    CAS  PubMed  Article  Google Scholar 

  16. Hjorth MF, Chaput JP, Ritz C, Dalskov SM, Andersen R, Astrup A, et al. Fatness predicts decreased physical activity and increased sedentary time, but not vice versa: support from a longitudinal study in 8- to 11-year-old children. Int J Obes (Lond). 2014;38:959–65.

    CAS  Article  Google Scholar 

  17. Metcalf BS, Hosking J, Jeffery AN, Voss LD, Henley W, Wilkin TJ. Fatness leads to inactivity, but inactivity does not lead to fatness: a longitudinal study in children (EarlyBird 45). Arch Dis Child. 2011;96:942–7.

    CAS  PubMed  Article  Google Scholar 

  18. Richmond RC, Davey Smith G, Ness AR, den Hoed M, McMahon G, Timpson NJ. Assessing causality in the association between child adiposity and physical activity levels: a Mendelian randomization analysis. PLoS Med. 2014;11:e1001618.

    PubMed  PubMed Central  Article  Google Scholar 

  19. Bürgi F, Meyer U, Granacher U, Schindler C, Marques-Vidal P, Kriemler S, et al. Relationship of physical activity with motor skills, aerobic fitness and body fat in preschool children: a cross-sectional and longitudinal study (Ballabeina). Int J Obes. 2011;35:937–44.

    Article  Google Scholar 

  20. Riddoch CJ, Leary SD, Ness AR, Blair SN, Deere K, Mattocks C, et al. Prospective associations between objective measures of physical activity and fat mass in 12-14 year old children: the Avon Longitudinal Study of Parents and Children (ALSPAC). BMJ. 2009;339:b4544.

    PubMed  PubMed Central  Article  Google Scholar 

  21. Organization WH. WHO guidelines on physical activity and sedentary behaviour: World Health Organization; 2020 Available from:

  22. Steene-Johannessen J, Hansen BH, Dalene KE, Kolle E, Northstone K, Moller NC, et al. Variations in accelerometry measured physical activity and sedentary time across Europe-harmonized analyses of 47,497 children and adolescents. Int J Behav Nutr Phys Act. 2020;17:38.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Kirchengast S. Gender differences in body composition from childhood to old age: an evolutionary point of view. J Life Sci. 2010;2:1–10.

    Article  Google Scholar 

  24. Kwon S, Janz KF, Burns TL, Levy SM. Effects of adiposity on physical activity in childhood: Iowa bone development study. Med Sci Sports Exerc. 2011;43:443–8.

    PubMed  PubMed Central  Article  Google Scholar 

  25. Allison P. Fixed effects regression models. Thousand Oaks, CA: Sage Publications; 2009. 2018/05/16.

    Book  Google Scholar 

  26. Murphy E, Wickramaratne P, Weissman M. The stability of parental bonding reports: a 20-year follow-up. Journal of affective disorders. 2010;125:307–15.

    PubMed  PubMed Central  Article  Google Scholar 

  27. Poitras VJ, Gray CE, Borghese MM, Carson V, Chaput JP, Janssen I, et al. Systematic review of the relationships between objectively measured physical activity and health indicators in school-aged children and youth. Applied Physiology Nutrition and Metabolism. 2016;41:S197–S239.

    Article  Google Scholar 

  28. Steinsbekk S, Wichstrøm L. Cohort profile: the trondheim early secure study (TESS)-a study of mental health, psychosocial development and health behaviour from preschool to adolescence. Int J Epidemiol. 2018;47:1401.

    PubMed  Article  Google Scholar 

  29. Goodman R. The strengths and difficulties questionnaire: a research note. J Child Psychol Psychiatry. 1997;38:581–6.

    CAS  PubMed  Article  Google Scholar 

  30. International Obesity Task Force. Extended International (IOTF) Body Mass Index Cut-Offs for Thinness, Overweight and Obesity in Children: World Obesity Federation; 2011. Available from:

  31. Migueles JH, Cadenas-Sanchez C, Ekelund U, Nystrom CD, Mora-Gonzalez J, Lof M, et al. Accelerometer data collection and processing criteria to assess physical activity and other outcomes: a systematic review and practical considerations. Sports Med. 2017;47:1821–45.

    PubMed  PubMed Central  Article  Google Scholar 

  32. Cain KL, Sallis JF, Conway TL, Van Dyck D, Calhoon L. Using accelerometers in youth physical activity studies: a review of methods. J Phys Act Health. 2013;10:437–50.

    PubMed  PubMed Central  Article  Google Scholar 

  33. Evenson KR, Catellier DJ, Gill K, Ondrak KS, McMurray RG. Calibration of two objective measures of physical activity for children. J Sports Sci. 2008;26:1557–65.

    PubMed  Article  Google Scholar 

  34. Trost SG, Loprinzi PD, Moore R, Pfeiffer KA. Comparison of accelerometer cut points for predicting activity intensity in youth. Med Sci Sport Exer. 2011;43:1360–8.

    Article  Google Scholar 

  35. Dulloo AG, Jacquet J, Solinas G, Montani JP, Schutz Y. Body composition phenotypes in pathways to obesity and the metabolic syndrome. Int J Obes. 2010;34:S4–17.

    Article  Google Scholar 

  36. Wang YF, Lim HJ. The global childhood obesity epidemic and the association between socio-economic status and childhood obesity. International Review of Psychiatry. 2012;24:176–88.

    PubMed  Article  Google Scholar 

  37. Muthén LK, Muthén BO. Mplus User’s Guide. 7th ed. Los Angeles, CA: Muthén & Muthén; 1998–2013.

  38. Satorra A, Bentler P. A scaled difference chi-square test statistic for moment structure analysis. Psychometrika. 2001;66:507–14.

    Article  Google Scholar 

  39. ten Velde G, Plasqui G, Dorenbos E, Winkens B, Vreugdenhil A. Objectively measured physical activity and sedentary time in children with overweight, obesity and morbid obesity: a cross-sectional analysis. BMC Public Health. 2021;21:1558.

    PubMed  PubMed Central  Article  Google Scholar 

  40. Jago R, Salway R, Emm-Collison L, Sebire SJ, Thompson JL, Lawlor DA. Association of BMI category with change in children’s physical activity between ages 6 and 11 years: a longitudinal study. International journal of obesity (2005). 2020;44:104–13.

    CAS  Article  Google Scholar 

  41. Purslow LR, Hill C, Saxton J, Corder K, Wardle J. Differences in physical activity and sedentary time in relation to weight in 8-9 year old children. The international journal of behavioral nutrition and physical activity. 2008;5:67.

    PubMed  PubMed Central  Article  Google Scholar 

  42. Voelker DK, Reel JJ, Greenleaf C. Weight status and body image perceptions in adolescents: current perspectives. Adolescent Health Medicine and Therapeutics. 2015;6:149–58.

    PubMed  PubMed Central  Google Scholar 

  43. Kopcakova J, Veselska ZD, Geckova AM, van Dijk JP, Reijneveld SA. Is being a boy and feeling fat a barrier for physical activity? The association between body image, gender and physical activity among adolescents. Int J Environ Res Public Health. 2014;11:11167–76.

    PubMed  PubMed Central  Article  Google Scholar 

  44. Tebar WR, Gil FCS, Werneck AO, Delfino LD, Silva DAS, Christofaro DGD. Sports participation from childhood to adolescence is associated with lower body dissatisfaction in boys-a sex-specific analysis. Maternal and Child Health Journal. 2021;25:1465–73.

    PubMed  Article  Google Scholar 

  45. Allender S, Cowburn G, Foster C. Understanding participation in sport and physical activity among children and adults: a review of qualitative studies. Health Educ Res. 2006;21:826–35.

    PubMed  Article  Google Scholar 

  46. Hastings EC, Karas TL, Winsler A, Way E, Madigan A, Tyler S. Young children’s video/computer game use: relations with school performance and behavior. Issues Ment Health Nurs. 2009;30:638–49.

    PubMed  PubMed Central  Article  Google Scholar 

  47. Hygen BW, Belsky J, Stenseng F, Skalicka V, Kvande MN, Zahl-Thanem T, et al. Time spent gaming and social competence in children: reciprocal effects across childhood. Child Dev. 2020;91:861–75.

    PubMed  Article  Google Scholar 

  48. Vicente-Rodriguez G, Rey-Lopez JP, Martin-Matillas M, Moreno LA, Warnberg J, Redondo C, et al. Television watching, videogames, and excess of body fat in Spanish adolescents: The AVENA study. Nutrition. 2008;24:654–62.

    PubMed  Article  Google Scholar 

  49. Stiglic N, Viner RM. Effects of screentime on the health and well-being of children and adolescents: a systematic review of reviews. BMJ Open 2019;9:e023191.

    PubMed  PubMed Central  Article  Google Scholar 

  50. Chaput JP, Willumsen J, Bull F, Chou R, Ekelund U, Firth J, et al. 2020 WHO guidelines on physical activity and sedentary behaviour for children and adolescents aged 5–17years: summary of the evidence. Int J Behav Nutr Phys Act. 2020;17:141.

    PubMed  PubMed Central  Article  Google Scholar 

  51. Biddle SJH, Pearson N, Salmon J. Sedentary behaviors and adiposity in young people: causality and conceptual model. Exerc Sport Sci Rev. 2018;46:18–25.

    PubMed  Article  Google Scholar 

  52. van Ekris E, Altenburg TM, Singh AS, Proper KI, Heymans MW, Chinapaw MJM. An evidence-update on the prospective relationship between childhood sedentary behaviour and biomedical health indicators: a systematic review and meta-analysis. Obesity Reviews. 2016;17:833–49.

    PubMed  Article  Google Scholar 

  53. Tanaka C, Reilly J, Huang W. Longitudinal changes in objectively measured sedentary behaviour and their relationship with adiposity in children and adolescents: systematic review and evidence appraisal. Obes Rev. 2014;15:791–803.

    CAS  PubMed  Article  Google Scholar 

  54. Metcalf B, Henley W, Wilkin T. Effectiveness of intervention on physical activity of children: systematic review and meta-analysis of controlled trials with objectively measured outcomes (EarlyBird 54). BMJ. 2012;345:e5888.

    PubMed  Article  Google Scholar 

  55. Warren JM, Ekelund U, Besson H, Mezzani A, Geladas N, Vanhees L, et al. Assessment of physical activity - a review of methodologies with reference to epidemiological research: a report of the exercise physiology section of the European Association of Cardiovascular Prevention and Rehabilitation. Eur J of Cardiovasc Prev & Rehabil. 2010;17:127–39.

    Article  Google Scholar 

  56. Adamo KB, Prince SA, Tricco AC, Connor-Gorber S, Tremblay M. A comparison of indirect versus direct measures for assessing physical activity in the pediatric population: a systematic review. Int J Pediatr Obes. 2009;4:2–27.

    PubMed  Article  Google Scholar 

  57. Robertson W, Stewart-Brown S, Wilcock E, Oldfield M, Thorogood M. Utility of accelerometers to measure physical activity in children attending an obesity treatment intervention. J Obes. 2011;2011:398918.

    PubMed  Article  Google Scholar 

  58. Brooke HL, Corder K, Atkin AJ, van Sluijs EM. A systematic literature review with meta-analyses of within- and between-day differences in objectively measured physical activity in school-aged children. Sports Med. 2014;44:1427–38.

    PubMed  PubMed Central  Article  Google Scholar 

  59. Hutcheon JA, Chiolero A, Hanley JA. Random measurement error and regression dilution bias. BMJ. 2010;340:c2289.

    PubMed  Article  Google Scholar 

  60. Roemmich JN, Rogol AD. Hormonal changes during puberty and their relationship to fat distribution. Am J Hum Biol. 1999;11:209–24.

    PubMed  Article  Google Scholar 

  61. Silva AL, Teles J, Olivares LF, Fragoso I. Energy intake and expenditure in children and adolescents, contributions of biological maturity. Am J Hum Biol. 2021;33:e23529.

    PubMed  Article  Google Scholar 

Download references


We would like to thank the participants of the TESS, which the current study is based on, and the research assistants who collected the data.


This research was supported by Grants 228685, 213793 and 301446 from the Research Council of Norway, a grant from The Liaison Committee between Central Norway RHA and NTNU, and Grant FO5148 from the Norwegian ExtraFoundation for Health and Rehabilitation.

Author information

Authors and Affiliations



TZT drafted the original manuscript, performed the data analysis, and approved the final manuscript as submitted. LW contributed to the statistical analyses, reviewed and revised the original manuscript, and approved the final manuscript as submitted. SS conceptualized and designed the study, contributed to the data analyses, reviewed and revised the original manuscript, and approved the final manuscript as submitted.

Corresponding author

Correspondence to Silje Steinsbekk.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Table S1. Correlations between SES and study variables


Table S2. Sensitivity analysis. Sex-specific two-year relations between body fat, MVPA and sedentary time from childhood to adolescence

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Zahl-Thanem, T., Wichstrøm, L. & Steinsbekk, S. Relations between physical activity, sedentary time, and body fat from childhood to adolescence: Do they differ by sex?. Int J Obes 46, 1615–1623 (2022).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


Quick links