Increase in Physical Activity Energy Expenditure Is Associated With Reduced Metabolic Risk Independent of Change in Fatness and Fitness

  1. Ulf Ekelund, PHD1,
  2. Paul W. Franks, PHD12,
  3. Stephen Sharp, PHD1,
  4. Søren Brage, PHD1 and
  5. Nicholas J. Wareham, PHD1
  1. 1Medical Research Council Epidemiology Unit, Cambridge, U.K.
  2. 2Genetic Epidemiology and Clinical Research Group, Umeå University Hospital, Umeå, Sweden
  1. Address correspondence and reprint requests to Ulf Ekelund, MRC Epidemiology Unit, Elsie Widdowson Laboratory, Fulbourne Road, CB1 9NL, Cambridge, U.K. E-mail: ulf.ekelund{at}


OBJECTIVE—We sought to examine whether change in physical activity energy expenditure (PAEE) is associated with change in metabolic risk factors and whether this association is independent of change in fat mass and aerobic fitness.

RESEARCH DESIGN AND METHODS—In a population-based sample of 176 men and 217 women followed prospectively for 5.6 years, we measured PAEE by individually calibrated heart rate monitoring, aerobic fitness, total body fat (fat mass), and metabolic risk factors (blood pressure, fasting triglycerides, HDL cholesterol, insulin, and 2-h glucose) at baseline and follow-up.

RESULTS—A 100 J · kg fat-free mass (FFM)−1 · min−1 increase in PAEE from baseline to follow-up reduced triglycerides by 3.5% (95% CI 0.03–5.7) in men and 3.2% (0.02–5.4) in women, fasting insulin by 5.3% (1.0–7.5) in men and women, and 2-h glucose by 3.2% (0.3–5.3) in men and 3.1% (0.3–5.2) in women, after adjustment for sex, age, smoking status, aerobic fitness, baseline phenotype, and change in fat mass. In general, the magnitudes of association for change in fat mass with metabolic risk factors were two to three times stronger than for PAEE.

CONCLUSIONS—Increasing levels of physical activity may protect against metabolic disease even in the absence of improved aerobic fitness and reduced body fatness. Therefore, the combination of increasing levels of physical activity and avoidance of gain in fat mass is likely to be the most successful approach for preventing cardiovascular and metabolic disease.


  • Published ahead of print at on 29 May 2007. DOI: 10.2337/dc07-0719.

    A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

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    • Accepted May 18, 2007.
    • Received April 12, 2007.
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  1. Diabetes Care vol. 30 no. 8 2101-2106
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