ars.els-cdn.com€¦ · Web viewMET h/wk doses were assigned from descriptions identified within the individual studies.wk, week; EE: energy expenditure (in kcal); MET: metabolic

Table S1. Systematic literature review search terms and strategy

Search terms for PubMed

#1 ("motor Activity" [Mesh] OR "exercise" [Mesh] OR "physical activity"

[Title/Abstract] OR "physical activities" [Title/Abstract] OR "exercise"

[Title/Abstract] OR "exercises" [Title/Abstract])

#2 ("Cohort Studies"[Mesh] OR cohort [Title/Abstract] OR prospective

[Title/Abstract] OR longitudinal [Title/Abstract])

#3 ("Metabolic Syndrome X"[Mesh] OR “metabolic syndrome” [Title/Abstract] OR

“syndrome X” [Title/Abstract] OR “insulin resistance syndrome” [Title/Abstract]

OR MetS [Title/Abstract])

#1 AND #2 AND #3

Search terms for Embase

#1 exercise/ OR physical activity/ OR "physical activity" mp. OR "physical

activities" mp. OR "exercise" mp. OR "exercises" mp.

#2 cohort analysis/ OR prospective study/ OR longitudinal study/ OR cohort mp.

OR prospective mp. OR longitudinal mp.

#3 metabolic syndrome X/ OR “Metabolic Syndrome X” mp. OR “metabolic

syndrome” mp. OR “syndrome X” mp. OR “insulin resistance syndrome” mp. OR

MetS mp.

#1 AND #2 AND #3

Table S2. Meta-analysis of leisure-time physical activity (LTPA) and metabolic

syndrome: list of excluded studies and exclusion reason

Exclusion reason Reference number

Cross-sectional study or trials (n=19) [1-19]

Not relevant exposure (n=64) [20-83]

Not relevant outcome (n=8) [84-91]

Repeated publication on already included cohort (n=1) [92]

Insufficiently defined PA exposure categories (n=6) [93-98]

Could not obtain the full text (n=3) [99-101]

Could not obtain the required data (n=16) [102-117]

Reviews or meta-analysis (n=5) [118-122]

Other language (n=3) [123-125]

conference article or abstract (n=2) [126, 127]

Table S3. Summary of metabolic equivalent of task (MET) h/week dose-assignment calculations for the cohort studies included in the

dose–response meta-analysis

Study Frequency Duration Intensity Assigned

MET h/wk

Additional information

Kim et al. Non-exerciser (0 kcal/kg/wk) 0 Conversion from EE/ wk to

MET h/wk according to the

following formula: LTPA

EE/wk/weight (kg)=LTPA

MET h/wk

Low-moderate (15 kcal/kg/wk) 7.5

High (>15 kcal/kg/wk) 22.5

Kuwahara et al. No exercise (0 MET h/wk) 0

Very low (0-3.75 MET h/wk) 1.875

Low (3.75-7.5 MET h/wk) 5.625

Medium (7.5-16.5 MET h/wk) 12

High (16.5-25.5 MET h/wk) 21

Very high (≥25.5 MET h/wk) 30


MET h/wk


Pham et al. Low (<10 MET h/wk)

Moderate (10-20 MET h/wk)

5

15

High (>20 MET h/wk) 25

Chen et al. No exercise: 0 At least 30 min (45

min/session)

MVPA=4.5 MET 0

Insufficient: 0-3

times/wk (1.5)

5.0625

Recommended: ≥3

times/wk (4.5)

15.1875

Bell et al. Low (0-1.50 h/wk)

(0.75)

≥3 MET (4.5 MET) 3.375

Intermediate (1.56-

4.25 h/wk) (2.905)

13.0725

High (4.27-20.56

h/wk) (12.415)

55.8675


MET h/wk


Wennberg et al. Daily (7x/wk) 45 min/session MVPA=4.5 MET 23.625

Several times/wk

(3.5x/wk)

11.8125

Once a week (1x/wk) 3.375

Several times/month or

less (0.5x/wk)

1.6875

Laursen et al. Sedentary: sedentary

or LPA (eg, slow

walking/biking, light

gardening work) <2

h/wk (1 h)

LPA=3 MET

3

Light: LPA 2–4 h/wk

(3 h)

LPA=3MET 9

Moderate+high:

moderate: LPA>4

MPA=4 MET 20


MET h/wk


h/wk or 2–4 h/wk of

vigorous PA; high:

more than 4 h/wk of

moderate PA or

regular heavy

exercise or

competitive sports

several times per

week (5 h)

Puustinen et al. Low activity: 1–2

times/month (0.5x/wk)

at least 30 min per

session (45

min/session)

MVPA=4.5 MET 1.6875

Moderate activity: 1–3

times/wk (2x/wk)

6.75

High activity: >3 16.875


MET h/wk


times/wk (5x/wk)

Ingelsson et al. Sedentary: spend most

of reading, or engaging

in other mostly

sedentary activities

0 Physical activity information

source：[128]

Moderate: often go

walking or cycling for

pleasure (4x/wk)

45 min/session MPA=4 MET 12

Regular: engage in any

active recreational

sports for at least 3 h

every week

at least 3 h every

week (4.5 h)

MVPA=4.5 MET 20.25

Athletic: regularly

engage in hard physical

training or competitive

45 min/session VPA=8 MET 24


MET h/wk


sport (4x/wk)

Hsiao et al. None/mild: < 1 h of

exercise/wk

(0.5 h/wk)

MVPA = 4.5 MET 2.25

Moderate: 1–3 h of

exercise/wk (2 h/wk)

9

Vigorous: > 3 h of

exercise/wk (4 h/wk)

18

Wilsgaard et al. Sedentary: reading or

other sedentary

activity

0 0 Physical activity information

source:

[http://tromsoundersokelsen.u

it.no/tromso/]

Moderate: walking,

cycling at least 4 h a

week?

MPA = 4.0 MET 20


MET h/wk


(5 h/wk)

Regular training:

participation in

recreational sports,

(duration of activity

at least 4 hr/wk (5

h/wk)

MVPA = 4.5 MET 22.5

Hard training:

participation in hard

training, regularly

several times a week?

(4 times/wk)


Holme et al. Sedentary: reading,

or other sedentary

activity

0 0


MET h/wk


Moderate: walking,

cycling, or other

forms of exercise at

least 4 h a week? (5

h/wk)

MPA = 4.0 MET 20

Moderately vigorous:

exercise, sports,

heavy gardening and

similar activities

totaling at least 4

h/wk

(5 h/wk)

MVPA = 4.5 MET 22.5

Vigorous: hard training

or sports competitions,

regularly several times



MET h/wk


a week? (4 times/wk)

Carnethon et al. 5 sessions of 300 kcal of

energy expenditure weekly

19.69 Conversion from EE/wk to

MET h/wk according to the

following formula:

LTPA EE/wk/76.19=LTPA

MET h/wk

weight information source:

[129]

Palaniappan et

al.

2,709 kcal /kg/year 52 Physical activity information

source: [130]

Laaksonen et al. ＜270 min/wk (162

min/wk)

6 MET 16.2

270-486 min/wk

(378 min/wk)

37.8

≥487 min/wk (595 59.5


MET h/wk


min/wk)

MET h/wk doses were assigned from descriptions identified within the individual studies.

wk, week; EE: energy expenditure (in kcal); MET: metabolic equivalent of task; MET unit accounting for the individual basal metabolic rate;

LPA: light physical activity; MPA: moderate physical activity; MVPA: moderate to vigorous physical activity; VPA: vigorous physical activity;

Black font: Reported PA duration, frequency or intensity; Red: Assumed; Green: Calculated; Blue: Data received upon correspondence with the

authors.

Table S4 Summary of sensitivity analysis dose-assignment calculations for the prospective cohort studies included

in the dose-response meta-analysis

AuthorScenario A: Assigned

MET h/week

Scenario B: Assigned

MMET h/week

Scenario C: Assigned

MET h/week

Scenario D: Assigned

MMET h/week

Hidalgo-Santamaria

et al.17.3 13.46 17.3 13.46

32 24.89 32 24.89

49.4 38.42 49.4 38.42

76 59.11 76 59.11

Kim et al. 0 0 0 0

7.5 5.83 7.5 5.83

22.5 17.5 22.5 17.5

Kuwahara et al. 0 0 0 0

1.875 1.46 1.875 1.46

5.625 4.375 5.625 4.375

12 9.33 12 9.33

21 16.33 21 16.33

Pham et al. 5 3.89 5 3.89

15 11.67 15 11.67

25 19.44 25 19.44

Chen et al. 0 0 0 0

5.0625 3.9375 5.0625 3.9375

15.1875 11.8125 15.1875 11.8125

Bell et al. 3.375 2.625 3.375 2.625

13.0725 10.1675 13.0725 10.1675

55.8675 43.4525 55.8675 43.4525

Wennberg et al. 23.625 18.375 15.75 12.25

11.8125 9.1875 7.875 6.125

3.375 2.625 2.25 1.75

1.6875 1.3125 1.125 0.875

Laursen et al. 3 2 3 2

9 6 9 6

20 15 20 15

Puustinen et al. 1.6875 1.3125 1.6875 1.3125

6.75 5.25 6.75 5.25

16.875 13.125 16.875 13.125

Ingelsson et al. 0 0 0 0

12 9 8 6

20.25 15.75 20.25 15.75

24 21 16 14

Hsiao et al. 2.25 1.75 2.25 1.75

9 7 9 7

18 14 18 14

Wilsgaard et al. 0 0 0 0

20 15 20 15

22.5 17.5 22.5 17.5

24 21 16 14

Holme et al. 0 0 0 0

20 15 20 15

22.5 17.5 22.5 17.5

24 21 16 14

Carnethon et al 19.69 15.31 19.69 15.31

Palaniappan et al. 52 40.44 52 40.44

Laaksonen et al. 0 0 0 0

12 9 8 6

20.25 15.75 20.25 15.75

24 21 16 14

Scenario A: Session duration: 45 min Intensity: LPA= 3 MET/h; MPA=4 MET/h; MVPA = 4.5 MET/h; VPA= 8 MET/hScenario B: Session duration: 45 min Intensity: LPA= 2 MMET/h; MPA=3 MMET/h; MVPA = 3.5 MMET/h; VPA= 7 MMET/hScenario C: Session duration: 30 min Intensity: LPA= 3 MET/h; MPA=4 MET/h; MVPA = 4.5 MET/h; VPA= 8 MET/hScenario D: Session duration: 30 min Intensity: LPA= 2 MMET/h; MPA=3 MMET/h; MVPA = 3.5 MMET/h; VPA= 7 MMET/hMET: metabolic equivalent of task; MMET unit of marginalized PA (by subtracting the individual basal metabolic rate); LPA: light physical

activity; MPA: moderate physical activity; MVPA: moderate to vigorous physical activity; VPA: vigorous physical activity; Green: Calculated;

Blue: Data received upon correspondence with the authors.

Table S5. Summary of the characteristics of included studies investigating the association of level of LTPA and incident MetS

Author, year,

country/region

Follow-up

(year)

Sex Age

(years)

Cohort

size

PA exposure (dose*

in MET h/week)

ORs/RRs/HRs Covariates NOS

Hidalgo-

Santamaria et al,

2016, Spain

6 M/W 36.4 10114 Q1 (17.3)

Q2 (32.0)

Q3 (49.4)

Q4 (76.0)

1

0.79 (0.59-1.06)

0.80 (0.59-1.08)

0.63 (0.44-0.89)

age, sex, smoking, baseline

BMI, total energy intake,

adherence to the Mediterranean

diet, following any special diet,

snacking, sugar-sweetened soda

consumption, alcohol, French

fries consumption, fast-food

consumption, education,

computer use, TV watching,

house chores, sleeping, napping,

physical activity at work,

prevalence of cardiovascular

disease and cancer

8

Kim et al, 2016, 4 W 45.01 1228 non-exercise (0) 1.55 (1.14-2.13) study point, age, education, 7

Korea (3.02) low, moderate (7.5)

high (22.5)

1.02 (0.70-1.50)

1

religion, marital status,

employment, monthly income,

BMI, alcohol, ever smoking,

indirect smoking, exercise level,

eats breakfast, menopausal status

Kuwahara et al,

2016, Japan

4.1 M/W 45.1 22383 no exercise (0)

very low (1.875)

low (5.625)

medium (12)

high (21)

very high (30)

1

1.01 (0.91-1.13)

0.94 (0.85-1.04)

0.91 (0.84-0.99)

0.88 (0.77-1.00)

0.88 (0.77-1.01)

age, sex, shift work, sleep

duration, alcohol consumption,

smoking, occupational activity,

walking for commuting to and

from work, and BMI (category)

9

Pham et al, 2015,

Canada

1.1 M/W 51 (15) 4821 low (5)

moderate (15)

high (25)

1

0.79 (0.65–0.97)

0.57 (0.45–0.71)

sex, age, baseline 25(OHD),

changes in 25(OH)D during

follow up compared with

baseline, baseline metabolic

syndrome, season at baseline,

season at follow up, tobacco

4

smoking status, alcohol drinking

status, physical activity change

during follow up

Chen et al, 2015,

China

1 M/W > 65 388 no exercise (0)

insufficient (5.0625)

recommended

(15.1875)

1.84 (0.96-3.52)

0.84 (0.50-1.43)

1

age group, smoke, alcohol,

insomnia, sedentary time,

exercise, body fatness, balance,

hand grip strength, waist

circumference, SBP/DBP, HDL-

C, FG, TG at baseline.

6

Bell et al, 2014,

Britain

10 M/W 55.5 (6) 2254 low (3.375)

intermediate

(13.0725)

High (55.8675)

1

0.76 (0.60-0.95)

0.85 (0.67-1.07)

age, sex, ethnicity, occupational

position, frequency of fruit and

vegetable consumption, smoking

status, alcohol consumption and

the presence of a long-standing

illness, leisure time sitting level

7

Wennberg et al,

2013, Sweden

27 M/W 43 869 daily (23.625)

several times/week

1

1.32 (0.67–1.59)

TV viewing, sex, socioeconomic

disadvantage, family history of

9

(11.8125)

once a week (3.375)

several times/month

or less (1.6875)

1.55 (0.77–3.12)

1.82 (0.88–3.77)

diabetes, BMI, intake of

sweets/pastries, alcohol

consumption, smoking, and TV

viewing at age 16 years, physical

activity at age 43 years

Laursen et al, 2012,

Denmark

10 M/W 51.9 3968 sedentary (3)

light (9)

moderate+high (20)

1

0.99 (0.71-1.38)

0.71 (0.50-1.01)

jogging, walking speed and

volume, alcohol, smoking,

income, duration of schooling,

education, cohabitation and age

8

Puustinen et al,

2011, Finland

6.4 M/W 45.6 466 low (1.6875)

moderate (6.75)

high (16.875)

0.97 (0.44–2.14)

1.26 (0.75–2.13)

1

psychological distress, age,

gender, socioeconomic status,

smoking, use of alcohol, leisure

time physical activity, high-

sensitivity C-reactive protein

8

Ingelsson et al,

2009, Sweden

20 M 50 862 sedentary (0)

moderate (12)

regular (20.25)

1

0.60 (0.31–1.19)

0.65 (0.34–1.25)

BMI, age at baseline and follow-

up examinations, triglycerides,

systolic and diastolic blood

9

athletic (24) 0.45 (0.13–1.57) pressure, hypertension treatment,

fasting glucose, and erythrocyte

sedimentation rate, and HDL

cholesterol and HOMA-IR

Hsiao et al, 2010,

China

2 M/W 43.3 450 none/mild (2.25)

moderate (9)

vigorous (18)

3.41(1.03-11.32)

2.07 (0.53-8.11)

1

age, sex, BMI, FEV1, alcohol

drinking, smoking

7

Wilsgaard et al,

2008, Norway

13.8 M NA 8536 sedentary (0)

moderate (20)

regular training

(22.5)

hard training (24)

1

0.93 (0.79, 1.09)

0.75 (0.62, 0.90)

0.58 (0.41, 0.82)

age, baseline examination,

alcohol, coffee consumption,

smoking, education

7

Wilsgaard et al,

2008, Norway

13.8 W NA 8463 sedentary (0)

moderate (20)

regular training

(22.5)

hard training (24)

1

0.97 (0.82, 1.15)

0.68 (0.51, 0.90)

0.51 (0.16, 1.60)

age, baseline examination,

alcohol, coffee consumption,

smoking, education

7

Holme et al, 2007,

Norway

28 M 40-49 6379 sedentary (0)

moderate (20)

moderately vigorous

(22.5)

vigorous (24)

1

0.98 (0.83–1.17)

0.83 (0.67–1.02)

0.73 (0.44–1.22)

age, education, smoking,

glucose, triglycerides, body

mass index, treated hypertension

and systolic blood pressure

8

Carnethon et al,

2004, America

13.6 M 24.83 1869 per 297 EU (19.69) 0.95 (0.84, 1.09) age, race, education, BMI,

smoking, alcohol, carbohydrate

intake, crude fiber, total fat

intake

9

Carnethon et al,

2004, America

13.6 W 24.94 2323 per 298 EU (19.69) 1.02 (0.87, 1.20) age, race, education, BMI,

smoking, alcohol, carbohydrate

intake, crude fiber, total fat

intake

9

Palaniappan et al,

2004, America

5 M/W 54.4 714 per 2709kcal/kg/year

(52)

1.0 (0.8–1.2) age, sex, study site, ethnicity,

and IGT status

8

Laaksonen et al,

2002, Finland

4 M 51.2 612 <270 min/week

(16.2)

1

0.83 (0.45-1.52)

age, BMI, waist-to-hip ratio, use

of antihypertensive medications,

9

270-486 min/week

(37.8)

≥487 min/week

(59.5)

0.54 (0.28-1.04) systolic and diastolic blood

pressure, HDL, triglycerides,

insulin, glucose levels, and

family history of diabetes*Full details of MET h dose assignment are in Table S3;

PA: physical activity; LTPA: leisure-time physical activity; MET h/wk: metabolic equivalent of task (MET) h/week; M: men; W: women; NA:

not applicable; OR: odds ratio; RR: relative risk; HR: hazard ratio; NOS: Newcastle-Ottawa Scale; BMI, body mass index; FG, fasting glucose;

SBP, systolic blood pressure; DBP, diastolic blood pressure; TG, triglycerides; HDL, high-density lipoprotein; IGT, impaired glucose tolerance;

HOMA-IR, homeostasis model assessment insulin resistance index

Table S6. Quality assessment of the included cohort studies

Author

(Publication Year)

Newcastle-Ottawa Scale

Selection Comparability OutcomeTotal

1a 2b 3c 4d 5e 6f 7g 8h 9i

Hidalgo-Santamaria et al. (2016) 1 1 1 1 1 1 0 1 1 8

Kim et al. (2016) 0 1 1 0 1 1 1 1 1 7

Kuwahara et al. (2016) 1 1 1 1 1 1 1 1 1 9

Pham et al. (2015) 0 1 1 0 1 0 1 0 0 4

Chen et al. (2015) 0 1 1 1 1 0 1 0 1 6

Bell et al. (2014) 0 1 1 1 1 0 1 1 1 7

Wennberg et al. (2013) 1 1 1 1 1 1 1 1 1 9

Laursen et al. (2012) 1 1 1 1 1 0 1 1 1 8

Puustinen et al. (2011) 1 1 1 1 1 0 1 1 1 8

Hsiao et al. (2010) 0 1 1 1 1 1 1 0 1 7

Author

(Publication Year)

Newcastle-Ottawa Scale

Selection Comparability OutcomeTotal

1a 2b 3c 4d 5e 6f 7g 8h 9i

Ingelsson et al. (2009) 1 1 1 1 1 1 1 1 1 9

Wilsgaard et al. (2008) 1 1 0 1 1 0 1 1 1 7

Holme et al. (2007) 1 1 1 0 1 1 1 1 1 8

Carnethon et al. (2004) 1 1 1 1 1 1 1 1 1 9

Palaniappan et al. (2004) 1 1 1 1 1 0 1 1 1 8

Laaksonen et al. (2002) 1 1 1 1 1 1 1 1 1 9

a Representativeness of the exposed cohort

b Selection of the non-exposed cohort

c Ascertainment of exposure

d Demonstration that outcome of interest was not present at start of study

e Comparability of cohorts on the basis of the design or analysis (adjusted for age)

f Comparability of cohorts on the basis of the design or analysis (adjusted for any other factor)

g Assessment of outcome

h Was follow-up long enough for outcomes to occur

i Adequacy of follow-up of cohorts

Figure S1. Leisure-time physical activity (LTPA) and risk of metabolic syndrome

(MetS) (high/low)

Figure S2. Association of LTPA and MetS risk, dose-response analyses (A, LTPA

and MetS risk with BMI adjustment, per 10 MET h/week; B, LTPA and MetS risk

without BMI adjustment, per 10 MET h/week; C, LTPA and MetS risk with BMI

adjustment, dose–response analysis; D, LTPA and MetS risk without BMI

adjustment, dose–response analysis)

Figure S3. Funnel plot of LTPA and MetS risk (Begg’s test for publication bias: P =

0.025)

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