Objective: To estimate the dose–response associations between non-occupational physical activity and several chronic disease and mortality outcomes in the general adult population.Design: Systematic review and cohort-level dose-response meta-analysis.Data sources: PubMed, Scopus, Web of Science and reference lists of published studies.Eligibility criteria: Prospective cohort studies with (1) general population samples >10 000 adults, (2) ≥3 physical activity categories, and (3) risk measures and CIs for all-cause mortality or incident total cardiovascular disease, coronary heart disease, stroke, heart failure, total cancer and site-specific cancers (head and neck, myeloid leukaemia, myeloma, gastric cardia, lung, liver, endometrium, colon, breast, bladder, rectum, oesophagus, prostate, kidney).Results: 196 articles were included, covering 94 cohorts with >30 million participants. The evidence base was largest for all-cause mortality (50 separate results; 163 415 543 person-years, 811 616 events), and incidence of cardiovascular disease (37 results; 28 884 209 person-years, 74 757 events) and cancer (31 results; 35 500 867 person-years, 185 870 events). In general, higher activity levels were associated with lower risk of all outcomes. Differences in risk were greater between 0 and 8.75 marginal metabolic equivalent of task-hours per week (mMET-hours/week) (equivalent to the recommended 150 min/week of moderate-to-vigorous aerobic physical activity), with smaller marginal differences in risk above this level to 17.5 mMET-hours/week, beyond which additional differences were small and uncertain. Associations were stronger for all-cause (relative risk (RR) at 8.75 mMET-hours/week: 0.69, 95% CI 0.65 to 0.73) and cardiovascular disease (RR at 8.75 mMET-hours/week: 0.71, 95% CI 0.66 to 0.77) mortality than for cancer mortality (RR at 8.75 mMET-hours/week: 0.85, 95% CI 0.81 to 0.89). If all insufficiently active individuals had achieved 8.75 mMET-hours/week, 15.7% (95% CI 13.1 to 18.2) of all premature deaths would have been averted.Conclusions: Inverse non-linear dose–response associations suggest substantial protection against a range of chronic disease outcomes from small increases in non-occupational physical activity in inactive adults.PROSPERO registration numberCRD42018095481.

Background/objectives Walking has well-established positive relationships with, and effects on, physical health. In contrast, while poor mental health contributes substantially to global health burden, an overview of the benefits from walking has not previously been published. We aimed to scope the literature and present what is known, and highlight what is not known, about walking and mental health. Methods Design: Scoping review. Data sources: Ovid (Medline), ProQuest, Web of Science. Screening and reporting: 13 014 records were identified and screened by a team of researchers. Included full texts were analysed and reported according to mental health outcome. Results For the 8 mental health outcomes (identified a priori), there were a total of 5 systematic reviews and 50 individual papers included. Depression had the most evidence and existing systematic reviews were reported. Evidence for anxiety, psychological stress, psychological well-being, subjective well-being and social isolation and loneliness varied in volume and effectiveness, but no harmful effects were identified. There were no studies for walking and resilience. The setting and context of walking seems to be important variables. Conclusion The evidence base that suggests walking benefits mental health is growing, but remains fragmented and incomplete for some important outcomes. Policy and national guidelines should promote the known mental health benefits of increased walking and future research should directly address the gaps we have identified.

Mental health disorders are major contributors to the global burden of disease and their inverse relationship with physical activity is widely accepted. However, research on the association between physical activity and positive mental health outcomes is limited. Happiness is an example of a positive construct of mental health that may be promoted by physical activity and could increase resilience to emotional perturbations. The aim of this study is to use a large multi-country dataset to assess the association of happiness with physical activity volume and its specificity to intensity and/or activity domain. We analysed Eurobarometer 2002 data from 15 countries (n = 11,637). This comprised one question assessing self-reported happiness on a six point scale (dichotomised: happy/unhappy) and physical activity data collected using the IPAQ-short (i.e. walking, moderate, vigorous) and four domain specific items (i.e. domestic, leisure, transport, vocation). Logistic regression was used to examine the association between happiness and physical activity volume adjusted for sex, age, country, general health, relationship status, employment and education. Analyses of intensity and domain specificity were assessed by logistic regression adjusted for the same covariates and physical activity volume. When compared to inactive people, there was a positive dose–response association between physical activity volume and happiness (highly active: OR = 1.52 [1.28-1.80]; sufficiently active: OR = 1.29 [1.11-1.49]; insufficiently active: OR = 1.20 [1.03-1.39]). There were small positive associations with happiness for walking (OR = 1.02 [1.00-1.03]) and vigorous-intensity physical activity (OR = 1.03 [1.01-1.05). Moderate-intensity physical activity was not associated with happiness (OR = 1.01 [0.99-1.03]). The strongest domain specific associations with happiness were found for “a lot” of domestic (OR = 1.42 [1.20-1.68]) and “some” vocational (OR = 1.33 [1.08-1.64]) physical activity. Happiness was also associated with “a lot” of leisure physical activity (OR = 1.15 [1.02-1.30]), but there were no significant associations for the transport domain. Increasing physical activity volume was associated with higher levels of happiness. Although the influence of physical activity intensity appeared minimal, the association with happiness was domain specific and was strongest for “a lot” of domestic and/or “some” vocational physical activity. Future studies to establish causation are indicated and may prompt changes in how physical activity for improving mental health is promoted.

Yoga has been recommended as a muscle strengthening and balance activity in national and global physical activity guidelines. However, the evidence base establishing the effectiveness of yoga in improving physical function and health related quality of life (HRQoL) in an older adult population not recruited on the basis of any specific disease or condition, has not been systematically reviewed. The objective of this study was to synthesise existing evidence on the effects of yoga on physical function and HRQoL in older adults not characterised by any specific clinical condition. The following databases were systematically searched in September 2017: MEDLINE, PsycInfo, CINAHL Plus, Scopus, Web of Science, Cochrane Library, EMBASE, SPORTDiscus, AMED and ProQuest Dissertations & Theses Global. Study inclusion criteria: Older adult participants with mean age of 60 years and above, not recruited on the basis of any specific disease or condition; yoga intervention compared with inactive controls (example: wait-list control, education booklets) or active controls (example: walking, chair aerobics); physical function and HRQoL outcomes; and randomised/cluster randomised controlled trials published in English. A vote counting analysis and meta-analysis with standardised effect sizes (Hedges’ g) computed using random effects models were conducted. A total of 27 records from 22 RCTs were included (17 RCTs assessed physical function and 20 assessed HRQoL). The meta-analysis revealed significant effects (5% level of significance) favouring the yoga group for the following physical function outcomes compared with inactive controls: balance (effect size (ES) = 0.7), lower body flexibility (ES = 0.5), lower limb strength (ES = 0.45); compared with active controls: lower limb strength (ES = 0.49), lower body flexibility (ES = 0.28). For HRQoL, significant effects favouring yoga were found compared to inactive controls for: depression (ES = 0.64), perceived mental health (ES = 0.6), perceived physical health (ES = 0.61), sleep quality (ES = 0.65), and vitality (ES = 0.31); compared to active controls: depression (ES = 0.54). This review is the first to compare the effects of yoga with active and inactive controls in older adults not characterised by a specific clinical condition. Results indicate that yoga interventions improve multiple physical function and HRQoL outcomes in this population compared to both control conditions. This study provides robust evidence for promoting yoga in physical activity guidelines for older adults as a multimodal activity that improves aspects of fitness like strength, balance and flexibility, as well as mental wellbeing. PROSPERO registration number: CRD42016038052 .

The measurement of physical activity (PA) and sedentary behaviour (SB) is fundamental to health related research, policy, and practice but there are well known challenges to these measurements. Within the academic literature, the terms “validity” and “reliability” are frequently used when discussing PA and SB measurement to reassure the reader that they can trust the evidence. In this paper we argue that a lack of consensus about the best way to define, assess, or utilize the concepts of validity and reliability has led to inconsistencies and confusion within the PA and SB evidence base. Where possible we propose theoretical examples and solutions. Moreover we present an overarching framework (The Edinburgh Framework) which we believe will provide a process or pathway to help researchers and practitioners consider validity and reliability in a standardized way. Further work is required to identify all necessary and available solutions and generate consensus in our field to develop the Edinburgh Framework into a useful practical resource. We envisage that ultimately the proposed framework will benefit research, practice, policy, and teaching. We welcome critique, rebuttal, comment, and discussion on all ideas presented.