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Combined associa ion o physical
ac i i y and si ing ime
wi h ca diome abolic isk ac o s
in Chilean adul s
Es eban Es ada‑Saldaña
1, Adilson Ma ques
2,3, Danilo R. Sil a
4,5, Claudio Fa ías‑Valenzuela
6,
Paloma Fe e o‑He nández
7, Juan Guzman‑Habinge
8, Leand o F. M. Rezende
9 &
Ge son Fe a i
1*
In his s udy we examined he combined associa ion o physical ac i i y and si ing ime wi h
ca diome abolic isk ac o s in adul s in Chile. This is a c oss‑sec ional s udy based on 3201 adul s aged
om 18 o 98 yea s om he Chilean Na ional Heal h Su ey (2016–2017) who esponded o he GPAQ
ques ionnai e. Pa icipan s we e conside ed inac i e i spen < 600 METs‑min/wk−1 in physical ac i i y.
High si ing ime was de ined as ≥ 8 h/day. We classi ied pa icipan s in o he ollowing 4 g oups: ac i e
and low si ing ime; ac i e and high si ing ime; inac i e and low si ing ime; inac i e and high
si ing ime. The ca diome abolic isk ac o s conside ed we e me abolic synd ome, body mass index,
wais ci cum e ence, o al choles e ol, and iglyce ides. Mul i a iable logis ic eg ession models
we e pe o med. O e all, 16.1% we e classi ied as inac i e and high si ing ime. Compa ed o ac i e
pa icipan s wi h low si ing ime, bo h inac i e pa icipan s wi h low (OR: 1.51; 95% CI 1.10, 1.92)
and high si ing ime (1.66; 1.10, 2.22) had highe body mass index. Simila esul s we e ound o
high wais ci cum e ence: inac i e pa icipan s wi h low (1.57; 1.14, 2.00) and high si ing ime (1.84;
1.25, 2.43). We ound no combined associa ion o physical ac i i y and si ing ime wi h me abolic
synd ome, o al choles e ol, and iglyce ides. These indings may be use ul o in o m p og ams
ocused on obesi y p e en ion in Chile.
Mo e han 70% o dea hs wo ldwide a e caused by noncommunicable diseases1. The La in Ame ican egion has
unde gone an accele a ed p ocess o epidemiological and nu i ional ansi ion, wi h an inc easing p e alence o
noncommunicable diseases, such as ca dio ascula diseases, cance , diabe es and espi a o y diseases in all age
g oups om 2005 o 20151–3. Chile’s demog aphic and epidemiological ansi ions a e among he mos ad anced
in La in Ame ica4, and he noncommunicable diseases a e conside ed a majo conce n as hey con ibu e o 58%
o p ema u e dea hs in he coun y5–7.
Chile has achie ed a high p e alence o o e weigh /obesi y (76%), medium/high ca dio ascula isk (55%),
and me abolic synd ome (13%)8,9, wi h he la e beingde ined as a g oup o ca diome abolic isk ac o s includ-
ing abdominal obesi y, hype ension, hype glycemia, and dyslipidemia10. This high p e alence o ch onic diseases
may be explained in pa by li es yle isk ac o s such as physical inac i i y (78% do no mee ≥ 600 METs-min/
week−1) and high amoun s o si ing ime h oughou he day (84.8% spend > 8h/day in si ing)11.
Physical inac i i y and seden a y ime ha e been associa ed wi h obesi y, me abolic isk, and ch onic diseases,
such as ype-2 diabe es and ca dio ascula disease, as well as all-cause mo ali y12–15. O e he las decade, an
inc easing numbe o s udies h e shown associa ions o physical inac i i y and seden a y ime wi h se e al heal h
OPEN
1Escuela de Ciencias de la Ac i idad Física, el Depo e y la Salud, Uni e sidad de San iago de Chile (USACH),
San iago, Chile. 2CIPER, Faculdade de Mo icidade Humana, Uni e sidade de Lisboa, Lisbon, Po ugal. 3ISAMB,
Uni e sidade de Lisboa, Lisbon, Po ugal. 4Depa men o Physical Educa ion, Fede al Uni e si y o Se gipe, Sao
C is o ao, B azil. 5Depa men o Spo s and Compu e Science, Uni e sidad Pablo de Ola ide (UPO), 41013,
Se ille, Spain. 6Facul ad de Ciencias Pa a el Cuidado de la Salud, Uni e sidad San Sebas ián, Lo a 2465, P o idencia
7510157 San iago, Chile. 7Escuela de Pedagogía en Educación Física, Facul ad de Educación, Uni e sidad
Au ónoma de Chile, 8900000 San iago, Chile. 8Spo s Medicine and Physical Ac i i y Special y, Science Facul y,
Uni e sidad Mayo , 8580745 San iago, Chile. 9Depa men o P e en i e Medicine, Escola Paulis a de Medicina,
Uni e sidade Fede al de São Paulo, Sao Paulo, B azil. *email: [email p o ec ed]
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ou comes in child en, adolescen s, and adul s13,16–18. A ecen s udy om Chile ound no associa ion be ween
mee ing bo h physical ac i i y and sleep du a ion wi h ca diome abolic heal h compa ed o all h ee mee ing
24-h mo emen guidelines (e.g., ≥ 600 METs-min/wk−1 o physical ac i i y, spend ≤ 8h/day in si ing ime, and
ob ain be ween 7 and 9h/day o sleep du a ion)10. These indings sugges ha be e heal h ou comes may be
achie ed wi h ce ain combined beha io s o mo emen (e.g., high le els o physical ac i i y a any in ensi y and
low seden a y ime), bu ques ion on whe he some in e media e combina ions could be be e han e.g., low
physical ac i i y and low seden a y ime o ca diome abolic isk ac o s— emains unce ain19–21. O no e, bo h
in high-income and in low- and middle-income coun ies, he majo i y o published esea ch on he ela ion-
ship be ween physical ac i i y and seden a y ime and heal h has elied sel - epo ed measu es, which a e p one
o measu emen e o 22,23. Howe e , in popula ion-based s udies, ques ionnai es a e use ul, easy o adminis e
and inexpensi e ools, making hem well sui ed o la ge-scale in es iga ions24,25. In his s udy we examined he
combined associa ion be ween sel - epo ed physical ac i i y and si ing ime wi h se e al ca diome abolic isk
ac o s in Chilean adul s.
Me hods
S udy and sample design. The Na ional Heal h Su ey o Chile (NHS—Encues a Nacional de Salud de
Chile) 2016–2017 is a c oss-sec ional s udy including a ep esen a i e sample o esiden s om di e en egions
o Chile be ween 15 and 98yea s o age, which we ha e di ided in wo age ca ego ies (adul s: 18–64yea s; olde
adul s: ≥ 65yea s), acco ding o he Wo ld Heal h O ganiza ion guidelines17.
NHS used a s a i ied, complex mul is age sampling design o selec he pa icipan s. Thi y s a a we e con-
side ed, which ep esen ed u ban and u al a eas o 15 geog aphical egions. In he mul is age sampling, selec ion
was based on coun ies as he p ima y sampling uni s, households wi hin coun ies, and inally one pa icipan
om selec ed households using a Kish compu a ional algo i hm. Sampling weigh s om he su ey accoun ed
o di e ences in selec ion p obabili y and non- esponse a es, and he pos -s a i ica ion adjus men allowed o
expand he sample o he es ima ed inhabi an s in Chile. Da a collec ion was pe o med be ween Augus 2016
and Ma ch 2017. De ails o he NHS ha e been published elsewhe e8,9,11.
The equi ed sample size was calcula ed using he absolu e sampling e o o 2.6% a he na ional le el, 2.5%
a he u ban na ional le el and 5.9% a he u al na ional le el o a p opo ion in a ound 50% o 95% con idence,
esul ing in a equi ed sample size o 6027. To achie e 6027 in e iews, he o e size o he sample esponse a e
o he o al sample was 67% based on he NHS 2003–2004 and 2009–2010. Thus, was necessa y o conside
10,124 pa icipan s wi h he goal o achie ing 6,027 pa icipan s.
The NHS 2016–2017 included 6,233 pa icipan s. Fo his s udy, we excluded adolescen s aged 15 o 17yea s
(n = 238) and pa icipan s wi h missing o incomple e in o ma ion on sociodemog aphic a iables, physical
ac i i y, si ing ime, and ca diome abolic isk ac o s (n = 2794). Thus, ou inal analy ical sample included 3201
adul pa icipan s (2047 women) aged be ween 18 and 98yea s (Fig.1).
The NHS was app o ed by he E hics Commi ee o he Facul y o Medicine o he Pon i icia Uni e sidad
Ca ólica de Chile (No.:16-019). In o med consen was ob ained om all subjec s and/o hei legal gua dian(s).
All aspec s o he s udy we e in acco dance wi h he Decla a ion o Helsinki and we e pe o med in acco dance
wi h ele an guidelines and egula ions.
Assessmen o physical ac i i y and si ing ime. Sel - epo ed physical ac i i y and si ing ime we e
assessed using he Global Physical Ac i i y Ques ionnai e (GPAQ), alida ed in e na ionally26 and wi hin he
La in Ame ican popula ion27. The pa icipan s p o ided in o ma ion on he du a ion, equency, and in ensi y
Figu e1. Flow cha o he p ocess o ob ain he inal sample.
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o he physical ac i i y in h ee li e domains (occupa ional, anspo a ion, and leisu e). Each domaino physical
ac i i y was linked o i s a e age Me abolic Ene gy Equi alen s (METs; whe e 1 METs = ~ 3,5ml O2 kg−1 min−1)
acco ding o he GPAQ p o ocol (4-METs was used o mode a e ac i i y and ela ed o ac i e anspo a ion
and 8-METs, o igo ous ac i i y). To al sel - epo ed physical ac i i y was calcula ed as he sum o METs-min/
wk−1 in he h ee domains. Pa icipan s we e classi ied as physically inac i e (< 600 METs-min/wk−1) o ac i e
(≥ 600 METs-min/wk−1)28.
Si ing ime was e alua ed using GPAQ29,30 h ough he ollowing ques ion: (i) “How much ime do you ypi-
cally spend si ing o lying down a wo k, a home, going o and om places, o wi h iends, including ime spen
si ing a a desk, si ing wi h iends, a eling by ca , bus, o wo king ou , eading, playing ca ds, o wa ching ele i-
sion, bu does no include ime spen sleeping on a ypical day?” Pa icipan s esponded in hou s and minu es pe
day. This ques ion has shown an accep able alidi y, as i has been in o med simila ly in o he coun ies ( = 0,
23 a 0, 26)29,30. Cleland e al. showed a mode a e ag eemen be ween GPAQ and accele ome e o mode a e-
o- igo ous physical ac i i y min/day ( = 0.48) and poo ag eemen o si ing ime ( = 0.19)30. We applied he
cu o poin o ≥ 8h/day o si ing ime, which has been associa ed wi h highe isk o ca dio ascula diseases
and all-cause mo ali y20,31.
Pa icipan s we e classi ied acco ding o physical ac i i y and si ing ime using he ollowing combined
ca ego ies: (1) ac i e and low si ing ime; (2) ac i e and high si ing ime; (3) inac i e and low si ing ime; (4)
inac i e and high si ing ime.
Assessmen o ca diome abolic isk ac o s. Ca diome abolic isk ac o s included me abolic syn-
d ome, body mass index, wais ci cum e ence, o al choles e ol, and iglyce ides.
Me abolic synd ome was de ined acco ding o he c i e ia o he Chilean na ional guidelines, which equi es
p esen ing a leas h ee o he ollowing i e c i e ia: high sys olic/dias olic blood p essu e (> 135/85mm/Hg),
inc eased wais ci cum e ence (≥ 90cm in men o ≥ 80cm in women), ele a ed o al choles e ol (≥ 200mg/dL),
high glycemia (> 100mg/dL), and ele a ed iglyce ides (> 150mg/dL)8,11.
Heigh was measu ed wi h a po able s adiome e wi h an accu acy o 0.1cm. Weigh was measu ed wi h a
digi al scale (Tani a HD713) wi h an accu acy o 0.1kg. Weigh measu emen s we e aken ba e oo , and pa -
icipan s wo e ligh clo hing9. Body mass index (kg/m2) was calcula ed and pa icipan s we e classi ied in o low
weigh /no mal weigh (≤ 24.9kg/m2) o o e weigh (≥ 25.0kg/m2)32.
Wais ci cum e ence was measu ed a he midpoin be ween he lowes ib and he iliac c es , wi h a non-
de o mable plas ic band. Measu emen was aken on he pa ien in a s anding posi ion and a he end o a no mal
exhala ion. Cen al obesi y was de ined as > 88cm o women and > 102cm o men8,33.
Venous blood samples we e ob ained a e a leas 8h o as ing acco ding o s anda dized me hods desc ibed
be o e8. Pa icipan s wi h ci cula ing iglyce ides ≥ 150mg/dL o ele a ed o al choles e ol ≥ 200mg/dL we e
conside ed o ha e ele a ed iglyce ides o choles e ol.
Co a ia es. Co a ia es include sex (male and emale), age (adul s [18–64yea s], and olde adul s [≥ 65yea s]),
egion (no h, cen e , and sou h), a ea o esidence (u ban and u al), educa ional le el (p ima y [< 8yea s],
seconda y [8–12yea s], and highe educa ion [> 12yea s), mon hly household income (s a i ied in o e ciles:
low [< US$ 310.00], medium [US$ 310.00–705. 00] and high [> US$ 705.00]), heal h insu ance (public [Fonasa],
p i a e [Isap es] o o he /none), indigenous e hnici y (yes and no), smoking (smoke and ne e /ex-smoke ),
ui and ege able consump ion (≤ 4days/wk and > 4days/wk), and alcohol consump ion. Alcohol consump-
ion was assessed using he sho e sion o he Alcohol Use Diso de Iden i ica ion Tes (AUDIT-C), adap ed
and alida ed in Chile, h ough he ollowing ques ion: “Ha e you consumed any d ink con aining alcohol in he
las 12mon hs?”, accoun ed by he ca ego ies yes/no, adding also in o ma ion on equency and doses each ime
pa icipan consumed9,11,34.
S a is ical analysis. Desc ip i e da a we e p esen ed as equency and p opo ions acco ding o he com-
bined ca ego ies o physical ac i i y and si ing ime. Chi-squa e es s we e ca ied ou o compa e he di e -
ences be ween combined ca ego ies o sel - epo ed physical ac i i y and si ing ime (ac i e and low si ing
ime; ac i e and high si ing ime; inac i e and low si ing ime; inac i e and high si ing ime) in ega d o he
sociodemog aphic cha ac e is ics.
We pe o med mul i a iable logis ic eg ession models (odds a io: OR wi h hei espec i e 95% con idence
in e al: 95% CI) o es ima e he combined associa ion o physical ac i i y and si ing ime (independen a iable)
wi h ca diome abolic isk ac o s (dependen a iables) adjus ed o sex, age, egion, a ea o esidence, educa-
ional le el, mon hly income, heal h insu ance, indigenous e hnici y, smoking, ui and ege able consump ion,
and alcohol consump ion. We also pe o med subg oup analysis (bo h o desc ip i e and logis ic eg ession)
by di e en age g oups (adul s and olde adul s) and sensi i i y analysis using a di e en si ing ime cu o s
(6h/day and 10h/day). All s a is ical analyses we e pe o med wi h SPSS V28 so wa e (SPSS Inc., IBM Co p.,
A monk, New Yo k, NY, USA) and accoun ed o he NHS su ey design8,9,11. Fo all es s, a wo- ailed p < 0.05
was conside ed indica i e o s a is ical signi icance.
E hics app o al and consen o pa icipa e. The NHS was unded by he Chilean Minis y o Heal h
and app o ed by he Resea ch E hics Commi ee o he Facul y o Medicine o he Pon i icia Uni e sidad
Ca ólica de Chile (No. 16-019). All pa icipan s ga e hei w i en consen be o e pa icipa ing. All aspec s o
he s udy we e in acco dance wi h he Decla a ion o Helsinki and we e pe o med in acco dance wi h ele an
guidelines and egula ions.
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Resul s
A o al o 3201 adul s wi h an a e age age o 50.6yea s (s anda d de ia ion: 18.3) pa icipa ed in he s udy.
O e all, 73.9% we e be ween 18 and 64yea s o age, 44.5% we e smoke s, 57.9% consumed ui s and ege a-
bles ≤ 4days/week and 66.2% consumed alcohol, espec i ely (Table1).
Table1 p esen s he cha ac e is ics o he pa icipan s acco ding o combined physical ac i i y and si ing
ime. O e all, 16.1% we e classi ied as inac i e and high si ing ime. We ound s a is ically signi ican di e -
ences (p < 0.05) in he p opo ion o combined physical ac i i y and si ing ime by sex, age g oup, egion o
Chile, geog aphic a ea, educa ional le el, mon hly household income, heal h insu ance, obacco consump ion,
Table 1. Cha ac e is ics o he pa icipan s acco ding ocombined physical ac i i y and ime spen si ing in
Chilean adul s. Chi-squa e es s. Ac i e: ≥ 600 METs-min/wk−1; Inac i e: < 600 METs-min/wk−1. Low si ing
ime: < 8h/day; high si ing ime: ≥ 8h/day.
Va iables To al (n = 3201) Ac i e and lowsi ing ime
(n = 990; 31.0%) Ac i e and high si ing
ime(n = 222; 6.8%) Inac i e and low si ing
ime (n = 1475; 46.1%) Inac i e and high si ing
ime(n = 514; 16.1%) p alue
Sex, %
Men 36.1 34.7 43.7 34.3 40.3 0.024
Women 63.9 65.3 56.3 65.7 59.7
Age g oup, %
Adul s (18–64yea s) 73.9 72.7 82.4 73.2 74.3 0.006
Olde adul s (≥ 65yea s) 26.1 27.3 17.6 26.8 25.7
Region o Chile, %
No h 24.9 24.8 31.1 24.1 24.9 < 0.001
Cen e 26.2 25.3 32.0 23.1 34.6
Sou h 48.8 49.9 36.9 52.8 40.5
Geog aphic a ea, %
U ban 84.1 80.8 95.0 81.3 93.9 < 0.001
Ru al 15.9 19.2 5.0 18.7 6.2
Educa ion a ainmen , %
 < 8yea s 24.5 24.8 13.5 27.7 19.5 < 0.001
8–12yea s 53.0 56.1 48.6 55.2 43.0
 > 12yea s 22.5 19.1 37.8 17.2 37.5
Mon hly household income, %
Low 48.2 47.8 42.3 51.2 43.0 < 0.001
Middle 36.6 37.8 32.4 36.9 35.2
High 15.2 14.4 25.3 11.9 21.8
Heal h insu ance, %
Public 69.4 70.6 64.9 71.3 64.8 < 0.001
P i a e 3.7 2.4 7.2 3.0 7.0
O he /none 26.6 27.0 27.9 25.7 28.2
Indigenous e hnici y, %
Yes 11.3 11.4 9.9 11.3 12.1 0.869
No 88.4 88.6 90.1 88.7 87.9
Tabacco consump ion, %
Smoke 44.5 41.4 47.7 43.6 51.8 < 0.001
Ne e / o me 55.5 58.6 52.3 56.4 48.2
F ui and ege ables consump ion, %
 ≤ 4days/week 57.9 57.8 66.2 57.1 56.6 0.070
 > 4days/week 42.1 42.2 33.8 42.9 43.3
Alcohol consump ion, %
Yes 66.2 63.0 73.9 64.9 73.0 0.458
No 33.8 37.0 26.1 35.1 27.0
Ca diome abolic isk ac o s
Me abolic synd ome, % 46.0 46.6 42.8 46.5 44.7 0.025
O e weigh , % 77.3 75.3 73.0 79.4 76.8 0.038
Wais ci cum e ence abo e
h eshold, % 49.0 45.9 42.3 52.7 47.7 < 0.001
High o al choles e ol, % 30.8 32.4 27.5 30.6 29.6 0.431
High iglyce ides, % 35.0 36.3 35.1 33.9 35.4 0.678
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me abolic synd ome, body mass index, and wais ci cum e ence (Table1). Desc ip i e cha ac e is ics by age
g oup (adul s and olde adul s) a e displayed in Supplemen a y Ma e ial: TableS1–S2.
Figu es2 and 3 show hep e alence o combined physical ac i i y and si ing ime acco ding o sociodemo-
g aphic cha ac e is ics and ca diome abolic isk ac o s. O e all, he p e alenceo inac i e and high si ing ime
exceeded 40% in all subg oups analyzed. We ound a highe p e alence o physical inac i i y and high si ing
ime in men, adul s li ing in he Sou h and u al a eas, hose < 8yea s o educa ion and low mon hly household
income, and wi h access o public heal h insu ance.
We ound a combined associa ion o physical ac i i y and si ing ime wi hhighe odds o o e weigh and
high wais ci cum e ence. Compa ed o physically ac i e and low si ing ime, he OR o o e weigh we e
1.51 (95% CI 1.10; 1.92) o inac i e and low si ing ime and 1.66 (95% CI 1.10; 2.22) o inac i e and high
si ing ime. Conside ing he same compa isons, and he OR o high wais ci cum e ence we e 1.57 (95% CI
1.14, 2.00) o inac i e and low si ing ime and 1.84 (95% CI 1.25, 2.43) o inac i e and high si ing ime. We
ound no combined associa ion o physical ac i i y and si ing ime wi h me abolic synd ome, o al choles e ol,
and iglyce ides (Table2). Simila esul s we e obse ed o adul s and olde adul s (Supplemen a y Ma e ial:
TableS3). The combined associa ion o physical ac i i y and si ing ime (< 6 s. ≥ 6, and < 10 s. ≥ 10h/day)
wi h ca diome abolic isk ac o s we e simila compa ed o he < 8 s. ≥ 8h/day o si ing ime (Supplemen a y
Ma e ial: TableS4).
Figu e2. P e alence (%) o physical ac i i y and si ing ime acco ding o sociodemog aphic and li es yle
a iables in Chilean adul s. Ac i e: ≥ 600 METs-min/wk−1; Inac i e: < 600 METs-min/wk−1. Low si ing
ime: < 8h/day; high si ing ime: ≥ 8h/day.

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Discussion
The p esen c oss-sec ional s udy examined he combined associa ion o physical ac i i y and si ing ime wi h
ca diome abolic isk ac o s in Chilean adul s. We ound ha pa icipan s who we e physically inac i e, i e-
spec i e o high o low si ing ime, had highe odds o o e weigh and high wais ci cum e ence. On he o he
hand, we ound no combined associa ion o physical ac i i y and si ing ime wi h me abolic synd ome, o al
choles e ol, and iglyce ides.
Ou indings on body mass index and wais ci cum e ence a e consis en wi h o he s udies showing an
associa ion be ween physical ac i i y wi h lowe isk o o e weigh and obesi y35,36. In gene al, hese s udies do
no inco po a e he si ing ime as an independen isk ac o o o e weigh o obesi y. This is especially el-
e an since i has been p e iously epo ed ha bo h physical ac i i y and ime spen in seden a y beha io a e
independen isk ac o s o inc eased abdominal adiposi y37. Con a y o hese indings, a s udy ca ied ou in
he La in Ame ican popula ion showed ha only mode a e- o- igo ous physical ac i i y le els was associa ed
wi h lowe le els o obesi y, bu no ime spen in seden a y beha io 38.
P e ious s udies sugges ha physical ac i i y may no ha e an impo an ole on choles e ol le els39. This is
in ag eemen wi h ou indings sugges ing no combined associa ion be ween physical ac i i y and si ing ime
wi h o al choles e ol. On he o he hand, iglyce ides ha e been desc ibed as an indica o ha is mo e sensi-
i e o modi ica ions wi h physical ac i i y40. In e ms o age ca ego ies, we ound ha he associa ion be ween
physical ac i i y and ime si ing and ca diome abolic isk ac o s (me abolic synd ome, body mass index, wais
ci cum e ence, choles e ol and iglyce ides) was simila among adul s and olde adul s.
Va ious elec onic de ices ha e eme ged o p o ide accu a e measu emen s o physical ac i i y le els, one
o which is he accele ome e 41. P e ious s udies ha e used accele ome e s o es ablish ela ionships wi h ca -
diome abolic isk ac o s42,43. The s udy by Sil a e al.42 has sough o examine he combinedassocia ion o di -
e en in ensi ies o physical ac i i y and si ing ime wi h ca diome abolic isk ac o s.Thei indings sugges
no combinedassocia ions be ween he di e en o physical ac i i y and si ing ime wi h ca diome abolic isk
ac o s. On he o he hand, hey ound associa ions wi h compliance o ≥ 150min/week, e en es ablishing ha
hose people who emained sea ed o a long ime had a lowe ca diome abolic isk, compa ed o hose who
did no comply wi h he weekly olume o minu es desc ibed. Despi e he simila i y wi h ou esul s, hey a e
no compa able, and i is di icul o es ablish common elemen s due o he di e en p o ocols and assessmen
ins umen s used o measu e physical ac i i y (accele ome e s) and ca diome abolic isk (con inuous Me abolic
Synd ome sco e). In addi ion,, Maddison e al.44 sugges ed ha he in e ela ionships be ween physical ac i i y
and seden a y beha io measu ed wi h accele ome e s a e independen ac o s on ca diome abolic isk in 10-yea
p ojec ions and mus be adjus ed o he a ied p o iles p esen ed by use s.
Figu e3. P e alence(%) o physical ac i i y and si ing ime acco ding o ca diome abolic isk ac o s in
Chilean adul s. Ac i e: ≥ 600 METs-min/wk−1; Inac i e: < 600 METs-min/wk−1. Low si ing ime: < 8h/day; high
si ing ime: ≥ 8h/day.
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Finally, o he me hodological issues ha may explain he null associa ion wi h se e al ca diome abolic isk
ac o s may be ela ed o he assessmen o physical ac i i y. Physical ac i i y ques ionnai es a e p one o measu e-
men e o . In popula ion-based s udies, accele ome e s a e mo e alid o measu e physical ac i i y and especially
seden a y ime han ques ionnai es. The e o e, he associa ion be ween accele ome e -measu ed physical ac i i y
and heal h ou comes a e s onge han when physical ac i i y is measu ed wi h ques ionnai es25,45. This may be
due o he di e en ial measu emen e o o esidual con ounding associa ed wi h sel - epo ed measu emen s
and ins umen s. Cu en ly, he e is insu icien e idence o de e mine whe he , and o wha ex en , associa ions
be ween sel - epo ed and de ice-based assessmen s o seden a y ime di e om heal h indica o s and how
hey may a y wi hin popula ion subg oups25,46. Al hough physical ac i i y assessmen de i ed om sel - epo
is po en ially subjec o measu emen e o , ques ionnai es a e inexpensi e ool o measu e physical ac i i y,
making hem well sui ed o la ge-scale in es iga ions24. Po en ial con ounde s conside ed in ou s udy, such as
alcohol consump ion, we e also sel - epo ed and p one o ecall and social desi abili y biases. Howe e , alcohol
bioma ke s a e mo e speci ic and usually no conside ed in massi e heal h su eys. Mo eo e , sel - epo ed
measu e o alcohol consump ion demons a es eliabili y and alidi y47, likewise, hese da a collec ion echnique
can be imp o ed by inco po a ing he use o gene ic ins umen s o alcohol consump ion, which p o ide mo e
p ecisely he causal ela ionship be ween alcohol consump ion and ca dio ascula isk48.
The complex empo al and ecip ocal ela ionships be ween combined physical ac i i y and si ing ime wi h
ca diome abolic isk ac o s emains poo ly unde s ood. Coun ies need o de elop hese h ough longi udinal
s udies o allow g ea e measu emen , su eillance, and p omo ion o mo emen beha io s among adul s in he
La in Ame ica egion11. These indings a e essen ial o unde s anding he combined associa ion be ween physical
ac i i y and si ing ime wi h ca diome abolic isk ac o s in La in Ame ican adul s, and he e o e es ablishing
e idence-based in e en ions o p e en ing ca diome abolic diseases11. P e en ion should be a op p io i y o
heal h policy and p e en i e ca e should be an indispensable pa o he heal h ca e sys emin Chile.
The p esen s udy included a ep esen a i e sample o adul s in Chile and adjus ed o sociodemog aphic
a iables, smoking, ui and ege able consump ion, and alcohol consump ion o examine he combined asso-
cia ion o physical ac i i y and si ing ime wi h se e al ca diome abolic isk ac o s. Howe e , ou s udy has
some limi a ions. We used sel - epo ed in o ma ion on physical ac i i y and si ing ime, and hus measu emen
e o may ha e occu ed. P e ious esea ch has obse ed di e ences be ween sel - epo ed ques ionnai es and
Table 2. Combined associa ion o physical ac i i y and si ing ime wi h ca diome abolic isk ac o s in
Chilean adul s. Ac i e: ≥ 600 METs-min/wk−1; Inac i e: < 600 METs-min/wk−1. Low si ing ime: < 8h/day;
high si ing ime: ≥ 8h/day. OR odds a io, 95% CI con idence in e al 95%. *Logis ic eg ession adjus ed o
sex, age, egion, a ea o esidence, educa ional le el, mon hly income, heal h insu ance, indigenous e hnici y,
smoking, ui and ege able consump ion, and alcohol consump ion in he las wel e mon hs.
Risk ac o s OR 95% CI p alue
Me abolic synd ome
Ac i e and low si ing ime 1.00
Ac i e and high si ing ime 1.06 0.67; 1.45 0.791
Inac i e and low si ing ime 1.10 0.84; 1.36 0.463
Inac i e and high si ing ime 1.21 0.86; 1.56 0.264
O e weigh
Ac i e and low si ing ime 1.00
Ac i e and high si ing ime 1.18 0.71; 1.65 0.506
Inac i e and low si ing ime 1.51 1.10; 1.92 < 0.001
Inac i e and high si ing ime 1.66 1.10; 2.22 < 0.001
High wais ci cum e ence
Ac i e and low si ing ime 1.00
Ac i e and high si ing ime 1.12 0.75; 1.49 0.082
Inac i e and low si ing ime 1.57 1.14; 2.00 0.006
Inac i e and high si ing ime 1.84 1.25; 2.43 0.002
High o al choles e ol
Ac i e and low si ing ime 1.00
Ac i e and high si ing ime 2.71 0.59; 4.83 0.196
Inac i e and low si ing ime 2.59 0.85; 4.33 0.092
Inac i e and high si ing ime 1.25 0.27; 2.23 0.772
High iglyce ides
Ac i e and low si ing ime 1.00
Ac i e and high si ing ime 1.06 0.28; 1.84 0.924
Inac i e and low si ing ime 0.95 0.41; 1.49 0.904
Inac i e and high si ing ime 1.34 0.52; 2.16 0.542
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de ice-measu es o physical ac i i y40. We used c oss-sec ional da a o examine he associa ion be ween combined
physical ac i i y and si ing ime wi h ca diome abolic isk ac o s, so he e is a possibili y o e e se causali y
and esidual con ounding.
Conclusion
We ound a combinedassocia ion be ween physical inac i i y and high si ing ime wi h highe odds o o e -
weigh and high wais ci cum e ence in adul s li ing in Chile. Howe e , we ound noe idence o associa ion
wi h he o he ca diome abolic isk ac o s. These indings may be use ul o in o m p og ams ocused on obesi y
p e en ion in Chile. Fu u e coho s udies a e needed o con i m ou indings and o examine he associa ion
wi h o he ca diome abolic isk ac o s.
Da a a ailabili y
The da ase s gene a ed and/o analyzed du ing he cu en s udy a e a ailable in he da abase eposi o y o he
Epidemiology Depa men o he Chilean Minis y o Heal h: h p:// epi. minsal. cl/ bases- de- da os/. Da a a e
a ailable upon easonable eques om he co esponding au ho .
Recei ed: 3 Augus 2022; Accep ed: 3 June 2023
Re e ences
1. Wo ld Heal h O ganiza ion. Noncommunicable Diseases. h ps:// www. who. in / news- oom/ ac - shee s/ de ail/ nonco mmuni cable-
disea ses. Accessed 6 June 2022.
2. Wo ld Heal h O ganiza ion. Noncommunicable Diseases Coun y P o iles (2018). Accessed 20 July 2021.
3. O ganización Paname icana de la Salud. Salud en las Amé icas+, edición del 2017. Resumen: pano ama egional y pe iles de país
(Washing on, D.C: OPS 2017).
4. de Albuque que-A aujo, L., Quin iliano-Sca pelli, D., Mas e e Riquelme, D. & Fe ei a San os, J. L. In luence o sociodemo-
g aphic, heal h- ela ed, and beha io al ac o s on ood guidelines compliance in olde adul s: A hie a chical app oach om he
Chilean Na ional Heal h Su ey 2016–17 Da a. Ge ia ics (Basel) h ps:// doi. o g/ 10. 3390/ ge ia ics 70200 47 (2022).
5. Wo ld Heal h O ganiza ion (WHO). Non-Communicable Diseases. 2018. h ps:// ww w. w ho. in / news- oom/ ac - shee s/ de ail/
nonco mmuni cable- disea ses. Accessed 26 Feb 2021.
6. Gómez, E. J. & Méndez, C. A. Ins i u ions, policy, and non-communicable diseases (NCDs) in La in Ame ica. J. Poli ics La . Am.
13, 114–137 (2021).
7. Global Heal h Obse a o y (GHO) da a. Wo ld Heal h O ganiza ion. h ps:// www. who. in / gho/ coun ies/ chl/ coun y_ p o i les/
en/.
8. MINSAL. Encues a Nacional de Salud 2016–2017-Minis e io de Salud (MINSAL, San iago, 2017).
9. Abu o, M. J. e al. P e alence and co-occu ence o li es yle isk ac o s o non-communicable diseases acco ding o sociodemo-
g aphic cha ac e is ics among adul s Chilean esiden s. Sci. Rep. 11, 21702. h ps:// doi. o g/ 10. 1038/ s41598- 021- 01167-9 (2021).
10. Saklayen, M. G. The global epidemic o he me abolic synd ome. Cu . Hype ens. Rep. 20, 12. h ps:// doi. o g/ 10. 1007/ s11906-
018- 0812-z (2018).
11. Riquelme, R., Rezende, L. F. M., Ma ques, A., D enowa z, C. & Fe a i, G. Associa ion be ween 24-h mo emen guidelines and
ca diome abolic heal h in Chilean adul s. Sci. Rep. 12, 5805. h ps:// doi. o g/ 10. 1038/ s41598- 022- 09729-1 (2022).
12. Rezende, L. F. M. e al. Li es yle isk ac o s and all-cause and cause-speci ic mo ali y: Assessing he in luence o e e se causa ion
in a p ospec i e coho o 457,021 US adul s. Eu . J. Epidemiol. 37, 11–23. h ps:// doi. o g/ 10. 1007/ s10654- 021- 00829-2 (2022).
13. Rezende, L. F. M., Lee, D. H., Fe a i, G. & Gio annucci, E. Con ounding due o p e-exis ing diseases in epidemiologic s udies
on seden a y beha io and all-cause mo ali y: A me a-epidemiologic s udy. Ann. Epidemiol. 52, 7–14. h ps:// doi. o g/ 10. 1016/j.
annep idem. 2020. 09. 009 (2020).
14. Rezende, L. F. M. e al. Cance cases and dea hs a ibu able o li es yle isk ac o s in Chile. BMC Cance 20, 693. h ps:// doi. o g/
10. 1186/ s12885- 020- 07187-4 (2020).
15. Wang, Y., Nie, J., Fe a i, G., Rey-Lopez, J. P. & Rezende, L. F. M. Associa ion o physical ac i i y in ensi y wi h mo ali y: A na ional
coho s udy o 403681 US adul s. JAMA In e n. Med. 181, 203–211. h ps:// doi. o g/ 10. 1001/ jamai n e n med. 2020. 6331 (2021).
16. Wa bu on, D. E. R. & B edin, S. S. D. Heal h bene i s o physical ac i i y: A sys ema ic e iew o cu en sys ema ic e iews. Cu .
Opin. Ca diol. 32, 541–556. h ps:// doi. o g/ 10. 1097/ HCO. 00000 00000 000437 (2017).
17. Bull, F. C. e al. Wo ld Heal h O ganiza ion 2020 guidelines on physical ac i i y and seden a y beha iou . B . J. Spo s Med. 54,
1451–1462. h ps:// doi. o g/ 10. 1136/ bjspo s- 2020- 102955 (2020).
18. Rezende, L. F. M., Lee, D. H. & Gio annucci, E. Possible e e se causa ion and con ounding in s udy o he associa ion o seden a y
beha io wi h cance mo ali y. JAMA Oncol. 7, 138–139. h ps:// doi. o g/ 10. 1001/ jamao ncol. 2020. 5874 (2021).
19. Be uol, C., Toze o, W. R., S eb, A. R. & Del Duca, G. F. Combined ela ionship o physical inac i i y and seden a y beha iou
wi h he p e alence o noncommunicable ch onic diseases: Da a om 52,675 B azilian adul s and elde ly. Eu . J. Spo Sci. 22,
617–626. h ps:// doi. o g/ 10. 1080/ 17461 391. 2021. 18806 46 (2022).
20. S ama akis, E. e al. Si ing ime, physical ac i i y, and isk o mo ali y in adul s. J. Am. Coll. Ca diol. 73, 2062–2072. h ps:// doi.
o g/ 10. 1016/j. jacc. 2019. 02. 031 (2019).
21. Ekelund, U. e al. Does physical ac i i y a enua e, o e en elimina e, he de imen al associa ion o si ing ime wi h mo ali y? A
ha monised me a-analysis o da a om mo e han 1 million men and women. Lance 388, 1302–1310. h ps:// doi. o g/ 10. 1016/
S0140- 6736(16) 30370-1 (2016).
22. Gu hold, R., S e ens, G. A., Riley, L. M. & Bull, F. C. Wo ldwide ends in insu icien physical ac i i y om 2001 o 2016: A pooled
analysis o 358 popula ion-based su eys wi h 1.9 million pa icipan s. Lance Glob. Heal h 6, e1077–e1086. h ps:// doi. o g/ 10.
1016/ S2214- 109X(18) 30357-7 (2018).
23. Yusu , S. e al. Modi iable isk ac o s, ca dio ascula disease, and mo ali y in 155 722 indi iduals om 21 high-income, middle-
income, and low-income coun ies (PURE): A p ospec i e coho s udy. Lance 395, 795–808. h ps:// doi. o g/ 10. 1016/ S0140-
6736(19) 32008-2 (2020).
24. Celis-Mo ales, C. A. e al. Objec i e s. sel - epo ed physical ac i i y and seden a y ime: E ec s o measu emen me hod on
ela ionships wi h isk bioma ke s. PLoS ONE 7, e36345. h ps:// doi. o g/ 10. 1371/ jou n al. pone. 00363 45 (2012).
25. Fe a i, G. L. M. e al. Compa ison o sel - epo e sus accele ome e - measu ed physical ac i i y and seden a y beha io s and
hei associa ion wi h body composi ion in La in Ame ican coun ies. PLoS ONE 15, e0232420. h ps:// doi. o g/ 10. 1371/ jou n al.
pone. 02324 20 (2020).
26. Bull, F. C., Maslin, T. S. & A ms ong, T. Global physical ac i i y ques ionnai e (GPAQ): Nine coun y eliabili y and alidi y s udy.
J. Phys. Ac . Heal h 6, 790–804. h ps:// doi. o g/ 10. 1123/ jpah.6. 6. 790 (2009).
9
Vol.:(0123456789)
Scien i ic Repo s | (2023) 13:9236 | h ps://doi.o g/10.1038/s41598-023-36422-8
www.na u e.com/scien i ic epo s/
27. Hoos, T., Espinoza, N., Ma shall, S. & A edondo, E. M. Validi y o he Global Physical Ac i i y Ques ionnai e (GPAQ) in adul
La inas. J. Phys. Ac . Heal h 9, 698–705. h ps:// doi. o g/ 10. 1123/ jpah.9. 5. 698 (2012).
28. A ms ong, T. B. F. De elopmen o he wo ld heal h o ganiza ion global physical ac i i y ques ionnai e (GPAQ). J. Public Heal h
14, 66–70 (2006).
29. Aguila -Fa ias, N. & Leppe Zamo a, J. Is a single ques ion o he Global Physical Ac i i y Ques ionnai e (GPAQ) alid o measu -
ing seden a y beha iou in he Chilean popula ion?. J. Spo s Sci. 35, 1652–1657. h ps:// doi. o g/ 10. 1080/ 02640 414. 2016. 12290 10
(2017).
30. Cleland, C. L. e al. Validi y o he global physical ac i i y ques ionnai e (GPAQ) in assessing le els and change in mode a e-
igo ous physical ac i i y and seden a y beha iou . BMC Public Heal h 14, 1255. h ps:// doi. o g/ 10. 1186/ 1471- 2458- 14- 1255
(2014).
31. Owen, N. e al. Seden a y beha io and public heal h: In eg a ing he e idence and iden i ying po en ial solu ions. Annu. Re .
Public Heal h 41, 265–287. h ps:// doi. o g/ 10. 1146/ annu e - publh eal h- 040119- 094201 (2020).
32. Wo ld Heal h O ganiza ion. Obesi y: P e en ing and Managing he Global Epidemic 1–253 (Wo ld Heal h O ganiza ion, Gene a,
2000).
33. Ross, R. e al. Wais ci cum e ence as a i al sign in clinical p ac ice: A Consensus S a emen om he IAS and ICCR Wo king
G oup on Visce al Obesi y. Na . Re . Endoc inol. 16, 177–189. h ps:// doi. o g/ 10. 1038/ s41574- 019- 0310-7 (2020).
34. Al a ado, M. E., Ga mendia, M. L., Acuna, G., San is, R. & A eaga, O. Assessmen o he alcohol use diso de s iden i ica ion es
(AUDIT) o de ec p oblem d inke s. Re . Med. Chile 137, 1463–1468 (2009).
35. B adbu y, K. E., Guo, W., Cai ns, B. J., A ms ong, M. E. & Key, T. J. Associa ion be ween physical ac i i y and body a pe cen age,
wi h adjus men o BMI: A la ge c oss-sec ional analysis o UK Biobank. BMJ Open 7, e011843. h ps:// doi. o g/ 10. 1136/ bmjop
en- 2016- 011843 (2017).
36. Hansen, B. H., Holme, I., Ande ssen, S. A. & Kolle, E. Pa e ns o objec i ely measu ed physical ac i i y in no mal weigh , o e -
weigh , and obese indi iduals (20–85 yea s): A c oss-sec ional s udy. PLoS ONE 8, e53044. h ps:// doi. o g/ 10. 1371/ jou n al. pone.
00530 44 (2013).
37. Golubic, R. e al. Physical ac i i y, seden a y ime and gain in o e all and cen al body a : 7-yea ollow-up o he P oAc i e ial
coho . In . J. Obes. (Lond.) 39, 142–148. h ps:// doi. o g/ 10. 1038/ ijo. 2014. 66 (2015).
38. Van Dyck, D. e al. In e na ional s udy o objec i ely measu ed physical ac i i y and seden a y ime wi h body mass index and
obesi y: IPEN adul s udy. In . J. Obes. (Lond.) 39, 199–207. h ps:// doi. o g/ 10. 1038/ ijo. 2014. 115 (2015).
39. S asse , B. Physical ac i i y in obesi y and me abolic synd ome. Ann. N. Y. Acad. Sci. 1281, 141–159. h ps:// doi. o g/ 10. 1111/j.
1749- 6632. 2012. 06785.x (2013).
40. Wewege, M. A., Thom, J. M., Rye, K. A. & Pa men e , B. J. Ae obic, esis ance o combined aining: A sys ema ic e iew and
me a-analysis o exe cise o educe ca dio ascula isk in adul s wi h me abolic synd ome. A he oscle osis 274, 162–171. h ps://
doi. o g/ 10. 1016/j. a he oscle osis. 2018. 05. 002 (2018).
41. Ainswo h, B., Cahalin, L., Buman, M. & Ross, R. The cu en s a e o physical ac i i y assessmen ools. P og. Ca dio asc. Dis. 57,
387–395. h ps:// doi. o g/ 10. 1016/j. pcad. 2014. 10. 005 (2015).
42. Sil a, R. M. e al. Join associa ions o accele ome e -measu ed physical ac i i y and seden a y ime wi h ca diome abolic isk in
olde adul s: A c oss-sec ional s udy. Exp. Ge on ol. 165, 111839. h ps:// doi. o g/ 10. 1016/j. exge . 2022. 111839 (2022).
43. Boye , W. R. e al. Accele ome e -measu ed physical ac i i y and ca diome abolic isk ac o s by ace-e hnici y: 2003–2006
NHANES. J. Racial. E hn. Heal h Dispa i ies 9, 1607–1615. h ps:// doi. o g/ 10. 1007/ s40615- 021- 01100-w (2022).
44. Maddison, R. e al. The associa ion be ween he ac i i y p o ile and ca dio ascula isk. J. Sci. Med. Spo 19, 605–610. h ps:// doi.
o g/ 10. 1016/j. jsams. 2015. 08. 001 (2016).
45. Skende , S. e al. Accele ome y and physical ac i i y ques ionnai es—a sys ema ic e iew. BMC Public Heal h 16, 515. h ps:// doi.
o g/ 10. 1186/ s12889- 016- 3172-0 (2016).
46. Fe a i, G. e al. A compa ison o associa ions be ween sel - epo ed and de ice-based seden a y beha io and obesi y ma ke s in
adul s: A mul i-na ional c oss-sec ional s udy. Assessmen h ps:// doi. o g/ 10. 1177/ 10731 91121 10176 37 (2021).
47. Del Boca, F. K. & Da kes, J. The alidi y o sel - epo s o alcohol consump ion: S a e o he science and challenges o esea ch.
Addic ion 98(Suppl 2), 1–12. h ps:// doi. o g/ 10. 1046/j. 1359- 6357. 2003. 00586.x (2003).
48. Biddinge , K. J. e al. Associa ion o habi ual alcohol in ake wi h isk o ca dio ascula disease. JAMA Ne w. Open 5, e223849.
h ps:// doi. o g/ 10. 1001/ jaman e wo kopen. 2022. 3849 (2022).
Acknowledgemen s
We hank all pa icipan s o hei coope a ion, he Chilean Heal h Minis y, he Depa men o Public Heal h,
and he Pon i icia Uni e sidad Ca ólica de Chile o designing and conduc ing he hi d Na ional Heal h Su ey
(2016–2017).DRS is suppo ed by he Eu opean Union “Nex Gene a ionEU” o he Reco e y, T ans o ma ion
and Resilience Plan and by he Minis y o Uni e si ies, wi hin he amewo k o he g an s “Ma ia Zamb ano”
o he equali ica ion o he Spanish uni e si y sys em 2021-2023 con ened by he Pablo de Ola ide Uni e si y,
Se ille.
Au ho con ibu ions
E.E.-S., and G.F., concei ed, designed, and helped o w i e and e ise he manusc ip ; C.F.-V., P.F.-H. and G.F.,
we e esponsible o coo dina ing he s udy, con ibu ed o he in ellec ual con en , and e ised he manusc ip ,
and E.E-S., A.M., D.R.S., C.F-V., P.F.-H., J.G.H, L.F.M.R., and G.F., in e p e ed he da a, helped o w i e, and
e ised he manusc ip . All au ho s con ibu ed o he s udy design, c i ically e iewed he manusc ip , and
app o ed he inal e sion.
Compe ing in e es s
The au ho s decla e no compe ing in e es s.
Addi ional in o ma ion
Supplemen a y In o ma ion The online e sion con ains supplemen a y ma e ial a ailable a h ps:// doi. o g/
10. 1038/ s41598- 023- 36422-8.
Co espondence and eques s o ma e ials should be add essed o G.F.
Rep in s and pe missions in o ma ion is a ailable a www.na u e.com/ ep in s.