Equivalence Curves for Healthy Lifestyle Choices

Pediatrics. 2021 Apr;147(4):e2020025395. doi: 10.1542/peds.2020-025395.


Background: Understanding equivalence of time-use trade-offs may inform tailored lifestyle choices. We explored which time reallocations were associated with equivalent changes in children's health outcomes.

Methods: Participants were from the cross-sectional Child Health CheckPoint Study (N = 1179; 11-12 years; 50% boys) nested within the population-based Longitudinal Study of Australian Children. Outcomes were adiposity (bioelectrical impedance analysis, BMI and waist girth), self-reported health-related quality of life (HRQoL; Pediatric Quality of Life Inventory), and academic achievement (standardized national tests). Participants' 24-hour time use (sleep, sedentary behavior, light physical activity, and moderate-to-vigorous physical activity [MVPA]) from 8-day 24-hour accelerometry was regressed against outcomes by using compositional log-ratio linear regression models.

Results: Children with lower adiposity and higher HRQoL had more MVPA (both P ≤ .001) and sleep (P = .001; P < .02), and less sedentary time (both P < .001) and light physical activity (adiposity only; P = .03), each relative to remaining activities. Children with better academic achievement had less light physical activity, relative to remaining activities (P = .003). A 0.1 standardized decrease in adiposity was associated with either 52 minutes more sleep, 56 minutes less sedentary time, 65 minutes less light physical activity, or 17 minutes more MVPA. A 0.1 standardized increase in HRQoL was associated with either 68 minutes more sleep, 54 minutes less sedentary time, or 35 minutes more MVPA.

Conclusions: Equivalent differences in outcomes were associated with several time reallocations. On a minute-for-minute basis, MVPA was 2 to 6 times as potent as sleep or sedentary time.

Publication types

  • Research Support, Non-U.S. Gov't
  • Video-Audio Media

MeSH terms

  • Academic Success
  • Australia
  • Body Mass Index
  • Child
  • Cross-Sectional Studies
  • Exercise
  • Female
  • Healthy Lifestyle*
  • Humans
  • Longitudinal Studies
  • Male
  • Quality of Life
  • Sleep