title: The combined effect of physical activity and sedentary behaviors on a clustered cardio-metabolic risk score: The Helena study.
abstract: OBJECTIVE
  Increased physical activity (PA) and decreased sedentary behaviors (SBs) may have beneficial effects on cardio-metabolic risk in adolescents. The aim of this study was to examine the associations between independent/combined effects of PA and SB with individual/clustered cardio-metabolic risk factors.
  
  
  METHODS
  A sample of 769 adolescents (12.5-17.5 years) from the HELENA cross-sectional study (Healthy Lifestyle in Europe by Nutrition in Adolescence) and with valid data on metabolic risk factors were included.
  
  
  RESULTS
  Concerning moderate-to-vigorous-PA (MVPA) and vigorous-PA (VPA), measured with accelerometers, girls tended to do more MVPA (36%) and VPA (114%) than boys. Unadjusted analyses show a positive association between "PA ≥ 60 min/d; SB ≥ 2 h" and the ratio TC/HDL-c (β = 0.27; 95%CI 0.01 to 0.52; p < 0.05), and a negative association between "MVPA ≥ 60 min/d; SB < 2h" with the ∑ 4Skinfolds (β = -0.32; 95%CI -0.61 to -0.02; p<0.05). Moreover, "SB ≥ 2 h/d" was associated with increased cardio-metabolic risk (PR 1.59; 95%CI 1.05 to 2.39; p < 0.05), while "PA ≥ 60 min/d; SB < 2h" had a protective effect against cardio-metabolic risk (PR 0.48; 95%CI 0.25 to 0.91; p < 0.05). After adjustment for potential confounders, a positive association between SB and ∑ 4Skinfolds was shown (β = 0.28; 95%CI 0.04 to 0.53; p < 0.05). Furthermore, VO2max (mL/kg/min) tends to increase in those participants who do higher VPA and less SB (p = 0.042), and there was a protective effect of "VPA ≥ 30 min/d; SB < 2h" against cardio-metabolic risk (PR 0.24; 95%CI 0.07 to 0.85; p < 0.05).
  
  
  CONCLUSIONS
  The current study suggests that adolescents should be encouraged to decrease sedentary lifestyle and increase physical activity, especially vigorous physical activity, in order to reduce cardio-metabolic risk.
authors.affiliation: Youth/Child and cARdiovascular Risk and Environmental (YCARE) Research Group, School of Medicine, University of São Paulo, São Paulo, Brazil; Growth, Exercise, NUtrition and Development (GENUD) Research Group, School of Health Science (EUCS), University of Zaragoza, Zaragoza, Spain. Electronic address: trendo@usp.br.
authors.forename: Tara
authors.initials: T
authors.lastname: Rendo-Urteaga
authors.affiliation: Youth/Child and cARdiovascular Risk and Environmental (YCARE) Research Group, School of Medicine, University of São Paulo, São Paulo, Brazil; Growth, Exercise, NUtrition and Development (GENUD) Research Group, School of Health Science (EUCS), University of Zaragoza, Zaragoza, Spain.
authors.forename: Augusto César Ferreira
authors.initials: AC
authors.lastname: de Moraes
authors.affiliation: Youth/Child and cARdiovascular Risk and Environmental (YCARE) Research Group, School of Medicine, University of São Paulo, São Paulo, Brazil; Growth, Exercise, NUtrition and Development (GENUD) Research Group, School of Health Science (EUCS), University of Zaragoza, Zaragoza, Spain.
authors.forename: Tatiana Sadalla
authors.initials: TS
authors.lastname: Collese
authors.affiliation: Department of Nutrition & Dietetics, School of Health Science & Education, Harokopio University, Athens, Greece.
authors.forename: Yannis
authors.initials: Y
authors.lastname: Manios
authors.affiliation: Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
authors.forename: María
authors.initials: M
authors.lastname: Hagströmer
authors.affiliation: Unit for Preventive Nutrition, Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden.
authors.forename: Michael
authors.initials: M
authors.lastname: Sjöström
authors.affiliation: Department of Social Medicine, School of Medicine, Preventive Medicine and Nutrition Clinic, University of Crete, Crete, Greece.
authors.forename: Anthony
authors.initials: A
authors.lastname: Kafatos
authors.affiliation: Department of Pediatrics, Private Medical University, Salzburg, Austria.
authors.forename: Kurt
authors.initials: K
authors.lastname: Widhalm
authors.affiliation: INSERM U995, University Lille Nord de France, Lille, France; CIC-PT-1403-INSERM-CH&U, University Hospital, Lille, France.
authors.forename: Jérémy
authors.initials: J
authors.lastname: Vanhelst
authors.affiliation: Inmunonutrition Research Group, Department of Metabolism and Nutrition, Instituto del Frío, Institute of Food Science and Technology an Nutrition (ICTAN), Spanish National Research Council (CSIC), Madrid, Spain.
authors.forename: Ascensión
authors.initials: A
authors.lastname: Marcos
authors.affiliation: ImFINE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport-INEF, Technical University of Madrid, Madrid, Spain; Institut für Ernährungs- und Lebensmittelwissenschaften - Ernährungphysiologie, Rheinische Friedrich Wilhelms Universität, Bonn, Germany.
authors.forename: Marcela
authors.initials: M
authors.lastname: González-Gross
authors.affiliation: Department of Public Health, Ghent University, Ghent, Belgium; University College Ghent Vesalius, Ghent, Belgium.
authors.forename: Stefaan
authors.initials: S
authors.lastname: De Henauw
authors.affiliation: Agricultural Research Council, Research Centre for Food and Nutrition (CRA-NUT), Rome, Italy.
authors.forename: Donatella
authors.initials: D
authors.lastname: Ciarapica
authors.affiliation: Unit for Preventive Nutrition, Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden; PROFITH "PROmoting FITness and Health through physical activity" Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain.
authors.forename: Jonatan R
authors.initials: JR
authors.lastname: Ruiz
authors.affiliation: Department of Physical Education, School of Education, University of Cádiz, Puerto Real, Cádiz, Spain.
authors.forename: Vanesa
authors.initials: V
authors.lastname: España-Romero
authors.affiliation: Department of Pediatrics, Medical Faculty, University of Pécs, Pécs, Hungary.
authors.forename: Dénes
authors.initials: D
authors.lastname: Molnár
authors.affiliation: Youth/Child and cARdiovascular Risk and Environmental (YCARE) Research Group, School of Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Heráclito B
authors.initials: HB
authors.lastname: Carvalho
authors.affiliation: Growth, Exercise, NUtrition and Development (GENUD) Research Group, School of Health Science (EUCS), University of Zaragoza, Zaragoza, Spain; School of Medicine of the University of São Paulo, Department of Preventive Medicine, São Paulo, Brazil.
authors.forename: Luis A
authors.initials: LA
authors.lastname: Moreno
mesh_terms: D000293:Adolescent; D000886:Anthropometry / Q000379:methods; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000378:metabolism*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008659:Metabolic Diseases / Q000453:epidemiology / Q000378:metabolism*; D009043:Motor Activity / Q000502:physiology*; D012307:Risk Factors; D057185:Sedentary Behavior
keywords: Adolescents; Cardiometabolic risk; Physical activity; Sedentary lifestyle