BACKGROUND: This study examined the strength, shape and direction of associations of accelerometer-assessed overall, school- and non-school-based moderate-to-vigorous physical activity (MVPA) and sedentary time (ST) with BMI among adolescents across the world. Second, we examined whether these associations differed by study site and sex. METHODS: Cross-sectional data from the IPEN Adolescent study, an observational multi-country study, were used. Participants wore an accelerometer for seven days, reported height and weight, and completed a socio-demographic survey. In total, 4852 adolescents (46.6% boys), aged 11-19 years (mean age = 14.6, SD = 1.7 years) were included in the analyses, using generalized additive mixed models. RESULTS: Adolescents accumulated on average 41.3 (SD = 22.6) min/day of MVPA and 531.8 (SD = 81.1) min/day of ST, and the prevalence of overweight and obesity was 17.2% (IOTF), but these mean values differed by country. Linear negative associations of accelerometer-based MVPA and ST with standardized BMI scores and the likelihood of being overweight/obese were found. School-based ST and non-school-based MVPA were more strongly negatively associated to the outcomes than non-school based ST and school-based MVPA. Study site moderated the associations; adolescent sex did not. No curvilinear associations were found. CONCLUSIONS: This multi-country study confirmed the importance of MVPA as a potential protective factor against overweight/obesity in adolescents. Non-school-based MVPA seemed to be the main driver of these associations. Unexpected results were found for ST, calling for further examination in methodologically sound international studies but using inclinometers or pressure sensors to provide more precise ST measures.

AFIPS Research Group Department of Musical Visual and Corporal Expression Teaching University of Valencia Valencia Spain

Baker Health and Diabetes Institute Melbourne Australia

Department of Architecture Bangladesh University of Engineering and Technology Dhaka Bangladesh

Department of Physical Education and Sport Faculty of Science Humanities and Education Technical University of Liberec Liberec Czech Republic

Department of Physiotherapy College of Medical Sciences University of Maiduguri Maiduguri Nigeria

Department of Sports Science and Clinical Biomechanics University of Southern Denmark Odense Denmark

Department of Sports Science and Physical Education The Chinese University of Hong Kong Hong Kong China

Faculty of Health and Environmental Science School of Sport and Recreation Auckland University of Technology Auckland New Zealand

Faculty of Medicine and Health Sciences Department of Movement and Sports Sciences Ghent University Ghent Belgium

Faculty of Sport Research Centre in Physical Activity Health and Leisure University of Porto Porto Portugal

Graduate Program in Urban Management Pontifical Catholic University of Parana Curitiba Brazil

Graduate School of Public Health Alma Ata University Yogyakarta Indonesia

Herbert Wertheim School of Public Health and Human Longevity Science University of California San Diego La Jolla San Diego CA USA

Institute for Physical Activity and Nutrition School of Exercise and Nutrition Sciences Deakin University Geelong Australia

Institute of Active Lifestyle Faculty of Physical Culture Palacký University Olomouc Olomouc Czech Republic

Madras Diabetes Research Foundation Chennai India

Mary MacKillop Institute for Health Research Australian Catholic University Melbourne Australia

Prevention Research Center Brown School Washington University St Louis USA

PROmoting FITness and Health Through Physical Activity Research Group Department of Physical Education and Sports Faculty of Sport Sciences Sport and Health University Research Institute University of Granada Granada Spain

School of Public Health The University of Hong Kong Hong Kong China

University of Haifa Haifa Israel

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