Reallocating Time Between 24-h Movement Behaviors for Obesity Management Across the Lifespan: A Pooled Data Meta-Analysis of More Than 9800 Participants from Seven Countries
Authors: Gába Aleš , Hartwig Timothy B. , Jašková Paulína , Sanders Taren , Dygrýn Jan , Vencálek Ondřej , Antczak Devan , Conigrave James , Parker Phillip , del Pozo Cruz Borja , Fairclough Stuart J. , Halson Shona , Hron Karel , Noetel Michael , Ávila-García Manuel , Cabanas-Sánchez Veronica , Cavero-Redondo Iván , Curtis Rachel G. , da Costa Bruno G. G. , del Pozo-Cruz Jesus , García-Hermoso Antonio , Leahy Angus A. , Lubans David R. , Maher Carol A. , Martínez-Gómez David , Meredith-Jones Kim , Redondo-Tébar Andrés , Sabia Séverine , Silva Kelly S. , Skidmore Paula , Villa-González Emilio , Yerramalla Manasa S. , Lonsdale Chris 
Published: December 2024

Abstract
Background
The distribution of time across physical activity, sedentary behaviors, and sleep appears to be essential for the management of obesity. However, the impact of reallocating time among these behaviors, collectively known as 24-h movement behaviors, remains underexplored.

Objective
This study examines the theoretical effects of reallocating time between 24-h movement behaviors on obesity indicators across different age groups.

Methods
We performed a pooled data meta-analysis of 9818 participants from 11 observational and experimental studies. To estimate the time spent in movement behaviors, we reprocessed and harmonized individual-level raw accelerometer-derived data. Isotemporal substitution models estimated theoretical changes in body mass index (BMI) and waist circumference (WC) associated with time reallocation between movement behaviors. We performed the analysis separately for children, adolescents, adults, and older adults.

Results
Even minor reallocations of 10 min led to significant changes in obesity indicators, with pronounced effects observed when 30 min were reallocated. The most substantial adverse effects on BMI and WC occurred when moderate-to-vigorous physical activity (MVPA) was reallocated to other movement behaviors. For 30-min reallocations, the largest increase in BMI (or BMI z-score for children) occurred when MVPA was reallocated to light-intensity physical activity (LPA) in children (0.26 units, 95% confidence interval [CI] 0.15, 0.37) and to sedentary behavior (SB) in adults (0.72 kg/m2, 95% CI 0.47, 0.96) and older adults (0.73 kg/m2, 95% CI 0.59, 0.87). The largest increase in WC was observed when MVPA was substituted with LPA in adults (2.66 cm, 95% CI 1.42, 3.90) and with SB in older adults (2.43 cm, 95% CI 2.07, 2.79). Conversely, the highest magnitude of the decrease in obesity indicators was observed when SB was substituted with MVPA. Specifically, substituting 30 min of SB with MVPA was associated with a decrease in BMI z-score by − 0.15 units (95% CI − 0.21, − 0.10) in children and lower BMI by − 0.56 kg/m2 (95% CI − 0.74, − 0.39) in adults and by − 0.52 kg/m2 (95% CI − 0.61, − 0.43) in older adults. Reallocating time away from sleep and LPA showed several significant changes but lacked a consistent pattern. While the predicted changes in obesity indicators were generally consistent across age groups, inconsistent findings were observed in adolescents, particularly for reallocations between MVPA and other behaviors.

Conclusions
This investigation emphasizes the crucial role of MVPA in mitigating obesity risk across the lifespan, and the benefit of substituting SB with low-intensity movement behaviors. The distinct patterns observed in adolescents suggest a need for age-specific lifestyle interventions to effectively address obesity. Emphasizing manageable shifts, such as 10-min reallocations, could have significant public health implications, promoting sustainable lifestyle changes that accommodate individuals with diverse needs, including those with severe obesity.