EVIDENCE ON PHYSICAL ACTIVITY FOR ADULTS (18 TO UNDER 65 YEARS OF AGE)

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WHO Guidelines on Physical Activity and Sedentary Behaviour. Geneva: World Health Organization; 2020.

WHO Guidelines on Physical Activity and Sedentary Behaviour.

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B1EVIDENCE ON PHYSICAL ACTIVITY FOR ADULTS (18 TO UNDER 65 YEARS OF AGE)

Guiding Questions

B1.

What is the association between physical activity and health-related outcomes?

Is there a dose response association (volume, duration, frequency, intensity)?
Does the association vary by type or domain of physical activity?

Inclusion Criteria

Population: Adults 18 years of age and older

Exposure: Greater volume, duration, frequency or intensity of physical activity

Comparison: No physical activity or lesser volume, duration, frequency, or intensity of physical activity.

Outcomes	Importance
All-cause and cause-specific mortality	Critical
Incidence of CVD	Critical
Incidence of cancer	Critical
Incidence of Type 2 Diabetes	Critical
Adiposity/Prevention of weight gain/Body composition	Critical
Mental health outcomes (e.g. depressive symptoms, anxiety symptoms)	Critical
Cognitive outcomes (e.g. dementia, cognition)	Critical
Adverse events	Critical
Sleep duration and quality	Important
Incidence of hypertension	Important
Health-related quality of life	Important

: Abbreviations: CVD = cardiovascular disease; NA = not applicable; PA = physical activity

Evidence identified

Seventy-five reviews (published from 2017 to 2019) were initially identified that examined the association between physical activity and health-related outcomes among adults (1–75). However, 35 reviews were excluded from further evaluation given the study design, populations, exposures, or outcomes that were out-of-scope or other concerns regarding the quality or relevance of the review. Table B1.1 presents the reviews that were excluded and their reason for exclusion.

Table B1.2 presents the ratings for each remaining review according to all the AMSTAR 2 main domains. In general, the included reviews had many limitations in their design, execution, and reporting. Only two systematic reviews were rated as having high credibility based on the AMSTAR 2 instrument. Fifteen were rated as having moderate credibility, 11 were rated as having low credibility, and the remaining 9 were rated as having critically low credibility. Given concerns regarding the comprehensiveness and the validity of the results presented in reviews rated as having critically low credibility, they were not incorporated into the final Evidence Profiles. All 3 pooled cohort studies were rated as good quality according to the Newcastle-Ottawa Scale (Table B1.3).

Table B1.4 lists the 28 reviews and 3 pooled cohort studies that were included in the evidence profiles by outcome. Most of the included reviews searched for evidence through 2016 or 2017; very few reviews searched for evidence into 2018 or 2019. As a result, very few individual studies represented within the reviews were published in 2018 or 2019. Most reviews had narrow foci in terms of study designs, exposures (limited to specific types of physical activity), and outcomes. Extracted data for each included review is presented in Appendix 2.

Table B1.1Excluded Systematic Reviews, with Reasons for Exclusion

Author, Year	Reason for Exclusion	Rationale
Al Tunaiji 2019 (1)	Design	Includes no studies published after 2017
Amirfaiz 2019 (3)	Outcome	Outcome (metabolic syndrome) out of scope
Banno 2018 (5)	Population	Review limited to persons with insomnia; not generalizable
Coenen 2018 (16)	Exposure	Occupational physical activity
Colpani 2018 (17)	Exposure	Any lifestyle factor, not physical activity independently
Del Pozo-Cruz 2018 (18)	Exposure	Replacing sedentary time
Fernandes 2018 (22)	Exposure	Acute exercise only
Flahr 2018 (23)	Population	Review limited to studies of shift workers; not generalizable
Fuezeki 2017 (24)	Design	Analysis of NHANES data only
Guo 2017 (27)	Exposure	Any cardiovascular health metric
Halloway 2017 (28)	Outcome	MRI brain imaging
Herold 2019 (30)	Outcome	Required measures of functional or structural brain changes
Hussenoeder 2018 (32)	Design	Overview-of-reviews
Igarashi 2018a (33)	Outcome	Continuous blood pressure
Igarashi 2018b (34)	Outcome	Continuous blood pressure
Jiang 2017 (35)	Population	Review limited to persons with insomnia; not generalizable
Lewis 2018 (37)	Outcome	Outcome (zeitebers/circadian system time cues) out of scope
Lipnicki 2019 (38)	Design	Not a systematic review
Liu 2018 (40)	Design	Pooled data from Asia consortium; study is included in the review by Blond (11)
Lopez-Valenciano 2019 (41)	Outcome	Continuous blood pressure
Loprinzi 2018a (44)	Exercise	Acute exercise
Loprinzi 2018c (42)	Population	Most studies conducted with rodents
Lowe 2019 (45)	Population	Review limited to persons with insomnia; not generalizable
Murphy 2019 (48)	Outcome	Continuous blood pressure
Nordengen 2019 (49)	Outcome	Continuous blood pressure
Oja 2018 (52)	Outcome	Continuous blood pressure
Origua Rios 2017 (53)	Outcome	Results not presented by study nor in format amendable to GRADE evaluation
Prince 2019 (56)	Relevance	Aim is to examine the prevalence of different types of PA according to various occupational types
Shepherd-Banigan 2017 (62)	Relevance	Only 3 new trials identified that examined the effects of yoga on the incidence of hot flashes among peri- and post-menopausal women
Smart 2019 (64)	Outcome	Continuous blood pressure
Stringhini 2017 (67)	Design	Not a systematic review
Viana 2019 (71)	Quality	Statement of concern published by journal to alert readers of uncertainty about the weight and significance reported by authors
Wang 2019 (72)	Population	Review limited to persons with active sleep disturbances or insomnia; not generalizable
Wewege 2018 (74)	Redundancy	Review by Andreato 2018 is more recent, more comprehensive, and better quality and includes all included studies by Wewege; similar results were found with both reviews.
Zhang 2018 (75)	Outcome	Continuous blood pressure

Table B1.2Credibility Ratings (based on AMSTAR 2 (76))

Author, Year	PICO¹	Apriori Methods²	Study Design Selection³	Lit Search Strategy⁴	Study Selection⁵	Data Extraction⁶	Excluded Studies⁷	Included Studies⁸	RoB Assessment⁹	Funding Sources¹⁰	Statistical Methods¹¹	Impact of RoB¹²	RoB Results¹³	Heterogeneity¹⁴	Publication Bias¹⁵	COI¹⁶	Overall Rating¹⁷
Amagasa 2018 (2)	Y	Y	N	PY	N	Y	PY	Y	N	N	N/A	N/A	N	Y	N/A	Y	Low
Andreato 2019 (4)	Y	PY	N	PY	Y	Y	PY	Y	Y	N	Y	N	Y	Y	N	Y	Moderate
Barredo 2017 (6)	N	N	N	N	N	Y	N	N	PY	N	N/A	N/A	N	N	N/A	N	Critically Low
Baumeister 2019 (7)	Y	N	N	PY	Y	Y	PY	Y	Y	N	Y	Y	Y	Y	Y	Y	Moderate
Behrens 2019 (8)	Y	PY	N	PY	Y	Y	PY	PY	PY	N	Y	Y	Y	Y	Y	Y	Moderate
Benke 2018 (9)	Y	PY	N	PY	N	Y	PY	PY	Y	N	Y	Y	Y	Y	Y	Y	Moderate
Binkley 2019 (10)	N	N	N	N	N	N	N	Y	Y	N	N/A	N/A	N	N	N/A	N	Critically Low
Blond 2019 (11)	Y	PY	N	PY	Y	N	PY	Y	Y	N	Y	Y	Y	Y	Y	Y	Moderate
Boyer 2019 (12)	Y	N	N	N	N	N	N	Y	Y	N	Y	Y	Y	N	Y	N	Low
Brasure 2018 (13)	Y	Y	Y	PY	Y	Y	Y	Y	Y	N	N/A	N/A	Y	Y	N/A	Y	High
Chastin 2019 (14)	Y	Y	Y	PY	Y	Y	N	Y	PY	N	Y	Y	N	N	Y	Y	Moderate
Cocchiara 2019 (15)	N	N	N	PY	Y	Y	N	N	Y	N	N/A	N/A	N	N	N/A	Y	Critically Low
Dinu 2019 (19)	Y	N	N	PY	Y	Y	PY	PY	Y	N	N	Y	Y	Y	N	Y	Low
Ekelund 2019 (20)	Y	PY	N	PY	N	Y	PY	Y	Y	N	Y	N	N	N	Y	Y	Moderate
Engeroff 2018 (21)	Y	N	N	PY	Y	Y	PY	Y	PY	N	N/A	N/A	Y	N	N/A	Y	Moderate
Gordon 2017 (26)	Y	PY	N	PY	N	N	PY	PY	PY	N	Y	Y	Y	Y	Y	Y	Low
Gordon 2018 (25)	Y	PY	N	PY	N	Y	N	PY	PY	N	Y	Y	Y	Y	Y	N	Low
Hart 2019 (29)	Y	N	N	N	Y	Y	N	PY	PY	N	Y	Y	Y	Y	Y	Y	Critically Low
Hidayat 2019 (31)	Y	PY	N	PY	Y	Y	PY	N	N	N	Y	N	N	Y	Y	Y	Critically Low
Kovacevic 2018 (36)	Y	PY	N	Y	Y	N	PY	Y	PY	N	N/A	N/A	Y	Y	N/A	Y	Moderate
Liu 2019 (39)	Y	PY	N	PY	Y	Y	PY	PY	Y	N	Y	Y	Y	Y	Y	N	Moderate
Loprinzi 2018 (43)	Y	N	N	PY	N	N	N	PY	N	N	N/A	N/A	N	Y	N/A	Y	Critically Low
Maillard 2018 (46)	N	N	N	PY	N	N	PY	N	N	N	N	N	N	Y	N	Y	Critically Low
Martinez-Dominguez 2018 (47)	Y	PY	N	PY	N	N	PY	PY	Y	N	Y	Y	Y	Y	Y	Y	Moderate
Northey 2018 (50)	Y	PY	N	PY	Y	Y	PY	PY	Y	N	Y	Y	Y	Y	Y	Y	Moderate
Paudel 2019 (54)	Y	Y	N	PY	Y	Y	PY	PY	PY	N	N	Y	Y	Y	Y	Y	Low
Perez-Lopez 2017 (55)	Y	PY	N	PY	Y	Y	PY	PY	Y	N	Y	N	N	Y	Y	Y	Moderate
Rathore 2017 (57)	Y	N	Y	PY	N	N	N	Y	Y	N	Y	Y	Y	Y	N	Y	Low
Robbins 2019 (58)	Y	PY	N	PY	Y	Y	PY	PY	PY	N	N/A	N/A	N	Y	N/A	Y	Low
Saeidifard 2019 (59)	Y	N	N	PY	Y	Y	PY	Y	Y	N	N	N	N	N	N	Y	Critically Low
Schuch 2018 (61)	Y	PY	Y	Y	Y	N	Y	Y	Y	N	Y	Y	Y	Y	Y	Y	High
Schuch 2019 (60)	Y	PY	Y	PY	Y	Y	Y	Y	PY	N	Y	Y	Y	Y	Y	Y	Moderate
Stanmore 2017 (66)	Y	N	N	PY	Y	N	N	Y	Y	N	Y	Y	Y	Y	Y	Y	Low
Stutz 2019 (68)	Y	PY	N	PY	Y	Y	N	Y	Y	N	Y	Y	Y	Y	Y	Y	Moderate
Su 2019 (69)	Y	PY	N	PY	Y	N	PY	PY	N	N	Y	N	N	Y	Y	Y	Critically Low
Sultana 2019 (70)	Y	N	N	PY	Y	Y	N	Y	PY	N	Y	N	Y	Y	Y	Y	Low
Wang 2017 (73)	Y	N	Y	PY	N	Y	N	Y	Y	N	Y	N	Y	Y	N	N	Low

: Abbreviations: COI = conflict of interest; N = no; N/A = not applicable; PICO = population, intervention, comparator, outcome; PY = partial yes; RoB = risk of bias; Y = yes
1: Did the research questions and inclusion criteria for the review include the components of PICO?
2: Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justify any significant deviations from the protocol?
3: Did the review authors explain their selection of the study designs for inclusion in the review?
4: Did the review authors use a comprehensive literature search strategy?
5: Did the review authors perform study selection in duplicate?
6: Did the review authors perform data extraction in duplicate?
7: Did the review authors provide a list of excluded studies and justify the exclusions?
8: Did the review authors describe the included studies in adequate detail?
9: Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review?
10: Did the review authors report on the sources of funding for the studies included in the review?
11: If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results?
12: If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or other evidence synthesis?
13: Did the review authors account for RoB in individual studies when interpreting/ discussing the results of the review?
14: Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review?
15: If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss its likely impact on the results of the review?
16: Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review?
17: Shea et al. 2017. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both.

Table B1.3Quality Ratings of Included Pooled Cohort Studies (based on Newcastle-Ottawa scale (77))

Author, Year	Representativeness of the exposed cohort	Selection of the non-exposed cohort	Ascertainment of exposure	Outcome of interest was not present at start of study	Bias in selection of the exposed cohort	Comparability of cohorts on the basis of the design or analysis	Bias due to confounding	Assessment of outcome	Was follow-up long enough for outcome to occur	Adequacy of follow-up of cohorts	Bias due to outcome ascertainment	Quality Rating
O’Donovan 2017 (51)	Truly representative of the target populations of the corresponding countries	Drawn from the same community as the exposed cohort	Structured interview	Yes	Low	Controlled foo age, sex, smoking, total cholesterol, SBP, BMI, longstanding illness, and SES	Low	Record linkage	Yes	No statement	Low	Good
Siahpush 2019 (63)	Truly representative of the civilian noninstitutional population of the US	Drawn from the same community as the exposed cohort	Structured interview	Yes	Low	Controlled for BMI, alcohol consumption, presence of chronic condition, sex, age, poverty status, education, home ownership, marital status, race/ethnicity, nativity, and survey year	Low	Record linkage	Yes	Subjects lost to follow up unlikely to introduce bias	Low	Good
Stamatakis 2017 (65)	Truly representative of the target populations of the corresponding countries	Drawn from the same community as the exposed cohort	Structured interview	Yes	Low	Analysis controlled for BMI, age, educational attainment, presence of longstanding illness, weekly frequency of alcohol consumption, smoking habits, psychological distress/depression, number of servings of fruit and vegetables	Low	Record linkage	Yes	No statement	Low	Good

Table B1.4Systematic Reviews Assessed, by Author

	Outcomes
Author, Year	All-cause mortality	CVD mortality	Incidence of CVD	Incidence of cancer	Incidence of Type 2 Diabetes	Adiposity-related outcomes	Mental health-related outcomes	Cognitive function	Sleep	Incidence of HYP	Health-related QOL	Last Search Date	Credibility/Quality
Amagasa 2018 (2)	✕					✕	✕	✕				Jan-2017	Low
Andreato 2019 (4)						✕						May-2018	Moderate
Barredo 2017 (6)											✕	Nov-2015	Critically Low
Baumeister 2019 (7)				✕								Aug-2018	Moderate
Behrens 2019 (8)				✕								Mar-2018	Moderate
Benke 2018 (9)				✕								July-2017	Moderate
Binkley 2019 (10)						✕					✕	Jan-2015	Critically Low
Blond 2019 (11)	✕	✕										Mar-2019	Moderate
Boyer 2019 (12)					✕							Jun-2016	Low
Brasure 2018 (13)								✕				Jul-2017	High
Chastin 2019 (14)	✕					✕						Feb-2018	Moderate
Cocchiara 2019 (15)							✕		✕			Feb-2017	Critically Low
Dinu 2019 (19)	✕	✕	✕		✕							Feb-2018	Low
Ekelund 2019 (20)	✕											Jul-2018	Moderate
Engeroff 2018 (21)								✕				Nov-2017	Moderate
Gordon 2017 (26)							✕					Feb-2017	Low
Gordon 2018 (25)							✕					Aug-2017	Low
Hart 2019 (29)											✕	Dec-2017	Critically Low
Hidayat 2019 (31)												Jul-2018	Critically Low
Kovacevic 2018 (36)									✕			Jun-2016	Moderate
Liu 2019 (39)												Aug-2018	Moderate
Loprinzi 2018 (43)								✕				Sep-2017	Critically Low
Maillard 2018 (46)						✕						Jul-2017	Critically Low
Martinez-Dominguez 2018 (47)							✕					Jul-2017	Moderate
Northey 2018 (50)								✕				Nov-2016	Moderate
O’Donovan 2017^a (51)	✕	✕										NA	Good quality
Paudel 2019 (54)					✕	✕				✕		Mar-2018	Low
Perez-Lopez 2017 (55)							✕		✕		✕	Jun-2017	Low
Rathore 2017 (57)								✕				Dec-2016	Low
Robbins 2019 (58)									✕			Sep-2018	Low
Saeidifard 2019 (59)	✕	✕	✕									Sep-2017	Critically Low
Schuch 2018 (61)							✕					Oct-2017	High
Schuch 2019 (60)							✕					Oct-2018	Moderate
Siahpush 2019^a (63)	✕	✕										NA	Good quality
Stamatakis 2017^a (65)	✕	✕										NA	Good quality
Stanmore 2017 (66)								✕				Jan-2017	Low
Stutz 2019 (68)									✕			Jun-2017	Moderate
Su 2019 (69)						✕						Jul-2018	Critically Low
Sultana 2019 (70)						✕						Jun-2019	Low
Wang 2017 (73)											✕	Jan-2015	Low

a: Not a systematic review. Pooled cohort analysis.

B. Adults

B.1. Physical Activity

Questions: What is the association between physical activity and health-related outcomes? Is there a dose response association (volume, duration, frequency, intensity)? Does the association vary by type or domain of PA?

Population: Adults 18 years of age and older

Exposure: Greater volume, duration, frequency, or intensity of physical activity

Comparison: No physical activity or lesser volume, duration, frequency, or intensity of physical activity

Table B.1.a. All-cause mortality: Association between physical activity and all-cause mortality among adults (in alphabetical order by author) (PDF, 205K)

See the Supplementary materials for description of evidence of US PAGAC by outcome

Table B.1.b. CVD mortality: Association between physical activity and CVD mortality among adults (in alphabetical order by author) (PDF, 117K)

See the Supplementary materials for description of evidence of US PAGAC by outcome

Table B.1.c. CVD incidence: Association between physical activity and CVD incidence among adults (in alphabetical order by author) (PDF, 70K)

See the Supplementary materials for description of evidence of US PAGAC by outcome

Table B.1.d. Cancer incidence: Association between physical activity and cancer incidence among adults (in alphabetical order by author) (PDF, 76K)

See the Supplementary materials for description of evidence of US PAGAC by outcome

Table B.1.e. Type 2 diabetes incidence: Association between physical activity and Type 2 diabetes incidence among adults (PDF, 67K)

See the Supplementary materials for description of evidence of US PAGAC by outcome

Table B.1.e. Adiposity-related outcomes: Association between physical activity and measures of adiposity among adults, by comparison and author (PDF, 93K)

See the Supplementary materials for description of evidence of US PAGAC by outcome

Table B.1.f. Mental health outcomes: Association between physical activity and measures of mental health among adults, by comparison and author (PDF, 85K)

See the Supplementary materials for description of evidence of US PAGAC by outcome

Table B.1.g. Cognitive function outcomes: Association between physical activity and measures of cognitive function among adults (PDF, 84K)

See the Supplementary materials for description of evidence of US PAGAC by outcome

Table B.1.h. Adverse events (PDF, 47K)

Outcome-specific AMSTAR 2 summary rating of the included systematic reviews

Author, Year	PECO¹	A priori Methods²	Study Design Selection³	Search Strategy⁴	Study Selection⁵	Data Extraction⁶	Excluded Studies⁷	Included Studies⁸	RoB Assess-ment⁹	Funding Sources¹⁰	Statistical Methods¹¹	Impact of RoB¹²	RoB Results¹³	Heterogeneity¹⁴	Publication Bias¹⁵	COI¹⁶	Overall Rating¹⁷
Injury
Borel, 2019 (82)	Y	PY	N	PY	PY	PY	PY	N	Y	N	PY	PY	PY	Y	Y	PY	Low
Damsted, 2018 (83)	Y	N	PY	Y	PY	PY	PY	Y	Y	N	N/A	N/A	N/A	N/A	N/A	PY	Low
Johnston, 2018 (84)	PY	Y	PY	Y	PY	PY	PY	Y	Y	Y	N/A	N/A	N/A	N/A	N/A	PY	Low
Lopes, 2012 (85)	Y	N	Y	Y	PY	N	PY	PY	Y	Y	N/A	N/A	N/A	N/A	N/A	Y	Low
Neubauer, 2016 (86)	PY	N	N	PY	PY	N	N	N	N	N	N/A	N/A	N/A	N/A	N/A	PY	Critically Low
Nielsen, 2012 (87)	Y	N	PY	Y	PY	N	Y	PY	Y	N	N/A	N/A	N/A	N/A	N/A	N	Low
Qu, 2014 (88)	Y	N	PY	PY	Y	PY	N	Y	PY	Y	PY	PY	N	N	Y	Y	Low
Saragiotto, 2014 (89)	PY	N	Y	PY	PY	PY	PY	PY	Y	Y	N/A	N/A	N/A	N/A	N/A	Y	Low
Sobhani, 2013 (90)	PY	N	N	Y	Y	N	Y	Y	Y	Y	N/A	N/A	N/A	N/A	N/A	PY	Low
Tonoli, 2010 (91)	PY	N	N	PY	N	N	N	N	PY	N	N/A	N/A	N/A	N/A	N/A	N	Critically Low
Van der Worp, 2015 (92)	PY	N	PY	Y	PY	Y	N	Y	Y	Y	N/A	N/A	N/A	N/A	N/A	Y	Low
Videbaek, 2015 (93)	PY	N	PY	Y	PY	N	PY	PY	Y	Y	PY	Y	Y	Y	PY	Y	Low
Osteoarthritis
Alentorn-Geli, 2017 (94)	PY	N	PY	Y	PY	PY	PY	Y	Y	Y	Y	N	PY	Y	N	PY	Low
Timmins, 2017 (95)	Y	Y	PY	Y	PY	PY	PY	Y	Y	Y	Y	Y	Y	Y	Y	Y	Moderate
Erectile Dysfunction
Sommer, 2016 (96)	PY	N	N	N	N	N	N	PY	N	N	N/A	N/A	N/A	N/A	N/A	PY	Critically Low

: Abbreviations: COI = conflict of interest; N = no; PECO = population, exposure, comparator, outcome; PY = partial yes; RoB = risk of bias; Y = yes
1: Did the research questions and inclusion criteria for the review include the components of PECO?
2: Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justify any significant deviations from the protocol?
3: Did the review authors explain their selection of the study designs for inclusion in the review?
4: Did the review authors use a comprehensive literature search strategy?
5: Did the review authors perform study selection in duplicate?
6: Did the review authors perform data extraction in duplicate?
7: Did the review authors provide a list of excluded studies and justify the exclusions?
8: Did the review authors describe the included studies in adequate detail?
9: Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review?
10: Did the review authors report on the sources of funding for the studies included in the review?
11: If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results?
12: If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or other evidence synthesis?
13: Did the review authors account for RoB in individual studies when interpreting/ discussing the results of the review?
14: Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review?
15: If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss its likely impact on the results of the review?
16: Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review?
17: Shea et al. 2017. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. (81) For each Yes, 1.0 point was given, and for each Partial Yes, 0.5 points was given. The total sum was then divided by the number of questions answered (i.e. 11 or 16). The rating ranges were described in the Methods above.

Supplementary file 2. GRADE: Grading the body of evidence (PDF, 179K)

Table B.1.i. Sleep outcomes: Association between physical activity and sleep outcomes among adults (PDF, 69K)

See the Supplementary materials for description of evidence of US PAGAC by outcome

Table B.1.j. Incidence of hypertension: Association between physical activity and incidence of hypertension among adults (PDF, 61K)

See the Supplementary materials for description of evidence of US PAGAC by outcome

Table B.1.k. Health-related quality of life: Association between physical activity and measures of HRQOL among adults (PDF, 56K)

See the Supplementary materials for description of evidence of US PAGAC by outcome

Table B.1.l. Occupational physical activity domain (PDF, 66K)

Criterion-specific AMSTAR 2 credibility rating, over-all rating score, overall rating, for each included review. See supplementary material 7 for all considerations

Author, Year	PECO¹	A-priori Methods²	Study Design Selection³	Search Strategy⁴	Study Selection⁵	Data Extraction⁶	Excluded Studies⁷	Included Studies⁸	RoB Assess-ment⁹	Funding Sources¹⁰	Statistical Methods¹¹	Impact of RoB¹²	RoB Results¹³	Heterogeneity¹⁴	Publication Bias¹⁵	COI¹⁶	Rating score¹⁷	Overall Rating¹⁸
Samitz 2011	Yes	No	Yes	Yes	PY	PY	Yes	Yes	No	Yes	Yes	Yes	No	PY	Yes	Yes	0.71	Low
Coenen 2018	Yes	Yes	Yes	Yes	PY	PY	Yes	Yes	Yes	Yes	Yes	No	Yes	No	Yes	Yes	0.78	Moderate
Wendel Vos 2004	Yes	No	PY	No	No	Yes	No	Yes	Yes	No	Yes	Yes	Yes	Yes	Yes	No	0.59	Low
Jian Li 2013	Yes	No	Yes	PY	No	No	No	Yes	No	No	PY	No	No	No	PY	Yes	0.34	Critically low
Sattelmair 2011	Yes	No	Yes	PY	PY	PY	PY	Yes	No	Yes	Yes	No	No	no	Yes	Yes	0.56	Low
Wolin 2009	Yes	No	Yes	PY	PY	No	No	PY	No	No	PY	PY	PY	PY	Yes	No	0.41	Critically low
Mahmood, 2017	Yes	Yes	Yes	PY	PY	PY	PY	Yes	No	No	Yes	No	No	PY	Yes	Yes	0.59	Low
Boyle 2012	Yes	No	Yes	PY	PY	PY	PY	Yes	Yes	Yes	Yes	Yes	Yes	PY	Yes	Yes	0.78	Moderate
Samad 2005	Yes	No	Yes	PY	No	No	No	Yes	No	No	Yes	No	No	No	No	No	0.28	Critically low
Robsahm 2013	Yes	No	Yes	PY	No	No	No	Yes	PY	No	Yes	Yes	Yes	Yes	No	Yes	0.56	Low
Wu Y, 2013	Yes	No	Yes	PY	PY	PY	No	Yes	No	No	Yes	No	No	Yes	Yes	PY	0.5	Low
Pizot 2016	Yes	No	Yes	PY	PY	No	No	Yes	No	Yes	No	no	No	Yes	Yes	Yes	0.5	Low
Chen X 2019	Yes	No	Yes	PY	PY	PY	No	Yes	Yes	Yes	Yes	N/A	N/A	Yes	Yes	Yes	0.75	Moderate
Voskuil 2007	Yes	No	Yes	No	No	Yes	No	Yes	Yes	Yes	Yes	No	No	PY	Yes	No	0.53	Low
Schmid 2015	Yes	No	Yes	PY	No	PY	No	Yes	Yes	No	Yes	Yes	Yes	Yes	Yes	Yes	0.69	Low
Vermaete 2013	Yes	No	Yes	PY	No	Yes	PY	Yes	Yes	Yes	Yes	No	No	PY	No	Yes	0.56	Low
Singh 2014	Yes	Yes	Yes	PY	Yes	PY	No	Yes	Yes	Yes	Yes	Yes	PY	PY	Yes	Yes	0.75	Moderate
Psaltopoulou 2015	Yes	No	Yes	PY	PY	PY	PY	Yes	Yes	No	Yes	No	No	PY	Yes	Yes	0.81	Moderate
Chen Y 2014	Yes	No	Yes	PY	PY	PY	PY	Yes	Yes	Yes	Yes	Yes	Yes	No	Yes	Yes	0.69	Low
Behrens 2014	Yes	No	Yes	Yes	No	No	No	Yes	Yes	No	Yes	Yes	PY	PY	No	No	0.5	Low
Behrens, 2013	Yes	no	Yes	Yes	No	No	PY	Yes	Yes	No	Yes	Yes	No	Yes	Yes	no	0.59	Low
Shephard 2016	Yes	No	Yes	PY	No	No	No	Yes	No	Yes	N/A	N/A	N/A	N/A	N/A	Yes	0.5	Low
Krstev 2019	Yes	No	Yes	PY	No	no	PY	Yes	no	Yes	NO	No	No	PY	no	Yes	0.41	Critically low
Benke, 2018	Yes	No	Yes	PY	No	PY	PY	Yes	Yes	Yes	Yes	Yes	No	PY	Yes	Yes	0.69	Low
Shephard, 2017	Yes	No	Yes	PY	No	No	No	Yes	No	Yes	N/A	N/A	N/A	N/A	No	Yes	0.5	Low
Liu 2011	Yes	No	Yes	Yes	No	Yes	PY	Yes	Yes	Yes	Yes	Yes	Yes	PY	Yes	Yes	0.81	Moderate
O Rorke, 2010	Yes	No	Yes	Yes	PY	PY	No	No	No	Yes	Yes	No	No	PY	Yes	No	0.41	Critically low
Bao 2008	Yes	No	Yes	PY	No	No	PY	Yes	No	Yes	Yes	No	PY	No	Yes	Yes	0.53	Low
Keimling 2014	Yes	No	Yes	PY	PY	No	PY	Yes	No	No	Yes	No	No	Yes	Yes	No	0.47	Critically low
Aune 2015	Yes	No	Yes	Yes	No	No	Yes	Yes	Yes	Yes	Yes	PY	PY	Yes	Yes	Yes	0.75	Moderate
McWilliams 2011	Yes	No	Yes	Yes	No	PY	PY	Yes	Yes	Yes	No	No	No	No	No	Yes	0.5	Low
Gignac 2019	Yes	No	Yes	Yes	Yes	No	No	Yes	Yes	Yes	N/A	N/A	N/A	N/A	No	no	0.58	Low
Palmer 2012	Yes	No	No	PY	No	No	No	Yes	Yes	Yes	N/A	N/A	No	No	No	no	0.32	Critically low
White 2017	Yes	Yes	Yes	Yes	Yes	Yes	PY	Yes	Yes	Yes	Yes	PY	Yes	PY	PY	Yes	0.88	Moderate
Yang B, 2018	Yes	No	Yes	PY	PY	No	No	Yes	No	PY	Yes	No	No	Yes	Yes	No	0.5	Low
Huai 2013	Yes	No	Yes	PY	No	PY	PY	Yes	Yes	Yes	Yes	No	No	Yes	Yes	no	0.59	Low

: Abbreviations: COI = conflict of interest; PICO = population, intervention, comparator, outcome; PY = partial yes; RoB = risk of bias
1: Did the research questions and inclusion criteria for the review include the components of PICO?
2: Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justify any significant deviations from the protocol?
3: Did the review authors explain their selection of the study designs for inclusion in the review?
4: Did the review authors use a comprehensive literature search strategy?
5: Did the review authors perform study selection in duplicate?
6: Did the review authors perform data extraction in duplicate?
7: Did the review authors provide a list of excluded studies and justify the exclusions?
8: Did the review authors describe the included studies in adequate detail?
9: Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review?
10: Did the review authors report on the sources of funding for the studies included in the review?
11: If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results?
12: If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or other evidence synthesis?
13: Did the review authors account for RoB in individual studies when interpreting/ discussing the results of the review?
14: Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review?
15: If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss its likely impact on the results of the review?
16: Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review?
17: This score is based on the following calculation (Yes=1point, PY=0.5 point). Take the total amount of points and divide these the number of questions answered.
17: Shea et al. 2017. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both (76).

1.0. All-cause mortality (PDF, 89K)

Population: Adults (aged 18–64 years)

Exposure: Duration, frequency and/or intensity of OPA, or a compositional score reflecting total volume of OPA.

Comparison: No OPA, or a lesser duration, frequency and/or intensity, no or a smaller compositional score of total volume of OPA.

Outcome: All-cause mortality.

2.0. Cardio-vascular disease (PDF, 100K)

3.0. Cancer (PDF, 233K)

4.0. Diabetes Mellitus type 2 (PDF, 88K)

Population: Adults (aged 18–64 years)

Exposure: Duration, frequency and/or intensity of OPA, or a compositional score reflecting total volume of OPA.

Comparison: No OPA, or a lesser duration, frequency and/or intensity, no or a smaller compositional score of total volume of OPA.

Outcome: Diabetes type 2

5.0. Osteoarthritis (PDF, 92K)

Population: Adults (aged 18–64 years)

Exposure: Duration, frequency and/or intensity of OPA, or a compositional score reflecting total volume of OPA.

Comparison: No OPA, or a lesser duration, frequency and/or intensity, no or a smaller compositional score of total volume of OPA.

Outcome: Osteoarthritis

6.0. Mental Health (PDF, 85K)

Population: Adults (aged 18–64 years)

Exposure: Duration, frequency and/or intensity of OPA, or a compositional score reflecting total volume of OPA.

Comparison: No OPA, or a lesser duration, frequency and/or intensity, no or a smaller compositional score of total volume of OPA.

Outcome: Osteoarthritis

7.0. Sleep quality and/or duration (PDF, 89K)

Population: Adults (aged 18–64 years)

Exposure: Duration, frequency and/or intensity of OPA, or a compositional score reflecting total volume of OPA.

Comparison: No OPA, or a lesser duration, frequency and/or intensity, no or a smaller compositional score of total volume of OPA.

Outcome: Sleep quality/and or duration

8.0. Hypertension (PDF, 85K)

Population: Adults (aged 18–64 years)

Exposure: Duration, frequency and/or intensity of OPA, or a compositional score reflecting total volume of OPA.

Comparison: No OPA, or a lesser duration, frequency and/or intensity, no or a smaller compositional score of total volume of OPA.

Outcome: Hypertension

9.0. Abbreviation list (PDF, 44K)

Data Extractions of Included Evidence (in alphabetical order by author)

Download PDF (227K)

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WHO Guidelines on Physical Activity and Sedentary Behaviour. Geneva: World Health Organization; 2020. B1, EVIDENCE ON PHYSICAL ACTIVITY FOR ADULTS (18 TO UNDER 65 YEARS OF AGE)
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Guiding Questions
Inclusion Criteria
Evidence identified
Adults
Data Extractions of Included Evidence (in alphabetical order by author)
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WHO Guidelines on Physical Activity and Sedentary Behaviour.

B1EVIDENCE ON PHYSICAL ACTIVITY FOR ADULTS (18 TO UNDER 65 YEARS OF AGE)

Guiding Questions

Inclusion Criteria

Evidence identified

Table B1.1Excluded Systematic Reviews, with Reasons for Exclusion

Table B1.2Credibility Ratings (based on AMSTAR 2 (76))

Table B1.3Quality Ratings of Included Pooled Cohort Studies (based on Newcastle-Ottawa scale (77))

Table B1.4Systematic Reviews Assessed, by Author

B. Adults

B.1. Physical Activity

Outcome-specific AMSTAR 2 summary rating of the included systematic reviews

Criterion-specific AMSTAR 2 credibility rating, over-all rating score, overall rating, for each included review. See supplementary material 7 for all considerations

Data Extractions of Included Evidence (in alphabetical order by author)

References

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