title: Associations of mutually exclusive categories of physical activity and sedentary time with markers of cardiometabolic health in English adults: a cross-sectional analysis of the Health Survey for England.
abstract: BACKGROUND
  Both physical activity and sedentary behaviour have been individually associated with health, however, the extent to which the combination of these behaviours influence health is less well-known. The aim of this study was to examine the associations of four mutually exclusive categories of objectively measured physical activity and sedentary time on markers of cardiometabolic health in a nationally representative sample of English adults.
  
  
  METHODS
  Using the 2008 Health Survey for England dataset, 2131 participants aged ≥ 18 years, who provided valid accelerometry data, were included for analysis and grouped into one of four behavioural categories: (1) 'Busy Bees': physically active & low sedentary, (2) 'Sedentary Exercisers': physically active & high sedentary, (3) 'Light Movers': physically inactive & low sedentary, and (4) 'Couch Potatoes': physically inactive & high sedentary. 'Physically active' was defined as accumulating at least 150 min of moderate-to-vigorous physical activity (MVPA) per week. 'Low sedentary' was defined as residing in the lowest quartile of the ratio between the average sedentary time and the average light-intensity physical activity time. Weighted multiple linear regression models, adjusting for measured confounders, investigated the differences in markers of health across the derived behavioural categories. The associations between continuous measures of physical activity and sedentary levels with markers of health were also explored, as well as a number of sensitivity analyses.
  
  
  RESULTS
  In comparison to 'Couch Potatoes', 'Busy Bees' [body mass index: -1.67 kg/m(2) (p < 0.001); waist circumference: -1.17 cm (p = 0.007); glycated haemoglobin: -0.12% (p = 0.003); HDL-cholesterol: 0.09 mmol/L (p = 0.001)], 'Sedentary Exercisers' [body mass index: -1.64 kg/m(2) (p < 0.001); glycated haemoglobin: -0.11 % (p = 0.009); HDL-cholesterol: 0.07 mmol/L (p < 0.001)] and 'Light Movers' [HDL-cholesterol: 0.11 mmol/L (p = 0.004)] had more favourable health markers. The continuous analyses showed consistency with the categorical analyses and the sensitivity analyses indicated robustness and stability.
  
  
  CONCLUSIONS
  In this national sample of English adults, being physically active was associated with a better health profile, even in those with concomitant high sedentary time. Low sedentary time independent of physical activity had a positive association with HDL-cholesterol.
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, United Kingdom. kb318@le.ac.uk.|Diabetes Research Centre, University of Leicester, Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK. kb318@le.ac.uk.|National Institute for Health Research (NIHR) Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit (BRU), Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK. kb318@le.ac.uk.
authors.forename: Kishan
authors.initials: K
authors.lastname: Bakrania
authors.affiliation: Diabetes Research Centre, University of Leicester, Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK. ce95@le.ac.uk.|National Institute for Health Research (NIHR) Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit (BRU), Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK. ce95@le.ac.uk.
authors.forename: Charlotte L
authors.initials: CL
authors.lastname: Edwardson
authors.affiliation: Diabetes Research Centre, University of Leicester, Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK. dhm6@le.ac.uk.
authors.forename: Danielle H
authors.initials: DH
authors.lastname: Bodicoat
authors.affiliation: National Institute for Health Research (NIHR) Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit (BRU), Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK. D.Esliger@lboro.ac.uk.|School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK. D.Esliger@lboro.ac.uk.
authors.forename: Dale W
authors.initials: DW
authors.lastname: Esliger
authors.affiliation: British Heart Foundation Glasgow Cardiovascular Research Centre (BHF GCRC), Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8TA, UK. Jason.Gill@glasgow.ac.uk.
authors.forename: Jason M R
authors.initials: JM
authors.lastname: Gill
authors.affiliation: Diabetes Research Centre, University of Leicester, Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK. Aadil.Kazi@uhl-tr.nhs.uk.|National Institute for Health Research (NIHR) Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit (BRU), Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK. Aadil.Kazi@uhl-tr.nhs.uk.
authors.forename: Aadil
authors.initials: A
authors.lastname: Kazi
authors.affiliation: Psychiatry for the Elderly, Department of Health Sciences, University of Leicester, Leicester, LE1 7RH, UK. lv24@le.ac.uk.
authors.forename: Latha
authors.initials: L
authors.lastname: Velayudhan
authors.affiliation: Diabetes Frail Ltd, University of Aston, Birmingham, B4 7ET, UK. sinclair.5@btinternet.com.
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Sinclair
authors.affiliation: British Heart Foundation Glasgow Cardiovascular Research Centre (BHF GCRC), Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8TA, UK. n.sattar@clinmed.gla.ac.uk.
authors.forename: Naveed
authors.initials: N
authors.lastname: Sattar
authors.affiliation: Institute of Sport, Exercise & Active Living, Victoria University, Melbourne, Australia. Stuart.Biddle@vu.edu.au.
authors.forename: Stuart J H
authors.initials: SJ
authors.lastname: Biddle
authors.affiliation: Diabetes Research Centre, University of Leicester, Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK. kk22@le.ac.uk.|National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care - East Midlands (CLAHRC - EM) Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK. kk22@le.ac.uk.
authors.forename: Kamlesh
authors.initials: K
authors.lastname: Khunti
authors.affiliation: Diabetes Research Centre, University of Leicester, Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK. melanie.davies@uhl-tr.nhs.uk.|National Institute for Health Research (NIHR) Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit (BRU), Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK. melanie.davies@uhl-tr.nhs.uk.
authors.forename: Melanie
authors.initials: M
authors.lastname: Davies
authors.affiliation: Diabetes Research Centre, University of Leicester, Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK. ty20@le.ac.uk.|National Institute for Health Research (NIHR) Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit (BRU), Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK. ty20@le.ac.uk.
authors.forename: Thomas
authors.initials: T
authors.lastname: Yates
mesh_terms: D061725:Accelerometry; D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D008076:Cholesterol, HDL / Q000097:blood; D003430:Cross-Sectional Studies; D004739:England; D015444:Exercise; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D057185:Sedentary Behavior; D055105:Waist Circumference; D055815:Young Adult
chemical_list: D015415:Biomarkers; D008076:Cholesterol, HDL; D006442:Glycated Hemoglobin