Association of physical activity and screen time with cardiovascular disease risk in the Adolescent Brain Cognitive Development Study

Abstract

Background: According to the Physical Activity Guidelines Advisory Committee Scientific Report, limited evidence is available on sedentary behaviors (screen time) and their joint associations with physical activity (steps) for cardiovascular health in adolescence. The objective of this study was to identify joint associations of screen time and physical activity categories with cardiovascular disease (CVD) risk factors (blood pressure, hemoglobin A1c, cholesterol) in adolescence.

Methods: This study analyzed data from the Adolescent Brain Cognitive Development (ABCD) Study, comprising a diverse sample of 4,718 U.S. adolescents aged 10-15 years between 2018 and 2021. Steps were measured by a Fitbit wearable device and levels were categorized as low (1,000-6,000), medium (> 6,000-12,000), and high (> 12,000) averaged daily step counts. Self-reported recreational screen time hours per day were classified as low (0-4), medium (> 4-8), and high (> 8) hours per day. CVD risk factors including blood pressure, hemoglobin A1c, and cholesterol (total and HDL) were measured.

Results: The analytical sample averaged 6.6 h of screen time per day and 9,722 steps per day. In models including both screen time and steps, the high screen time category was associated with a 4.27 higher diastolic blood pressure percentile (95% CI 1.83-6.73) and lower HDL cholesterol (B= -2.85, 95% CI -4.77 to -0.94 mg/dL) compared to the low screen time category. Medium (B = 3.68, 95% CI 1.24-6.11) and low (B = 7.64, 95% CI 4.07-11.20) step categories were associated with higher diastolic blood pressure percentile compared to the high step category. The medium step category was associated with lower HDL cholesterol (B= -1.99, 95% CI -3.80 to -0.19 mg/dL) compared to the high step category. Findings were similar when screen time and step counts were analyzed as continuous variables; higher continuous step count was additionally associated with lower total cholesterol (mg/dL).

Conclusions: Combinations of low screen time and high steps were generally associated with favorable cardiovascular health markers including lower diastolic blood pressure and higher HDL cholesterol, which can inform future adolescent health guidelines.

Keywords: Adolescent; Blood pressure; Cardiovascular disease; Cholesterol; Diabetes; Digital media; Dyslipidemia; Hemoglobin A1c; Hypertension; Physical activity; Screen use.

Fig. 1

Associations between screen time and step count category combinations and diastolic blood pressure percentile. Legend: Results correspond to coefficients from a linear regression model with nine categories of screen time and step combinations as the independent variable and diastolic blood pressure percentile as the dependent variable, adjusting for age, sex, race/ethnicity, household income, parental education, parent marital status, data collection period, and month. Daily step categories included: high (> 12,000), medium (6,000–12,000), and low (1,000–6,000). Daily screen time categories (hours) included: low (0–4); medium (4–8), high (> 8). The low screen time and high step category was the reference category

Fig. 2

Associations between screen time and step count category combinations and HDL cholesterol. Legend: Results correspond to coefficients from a linear regression model with nine categories of screen time and step combinations as the independent variable and HDL cholesterol as the dependent variable, adjusting for age, sex, race/ethnicity, household income, parental education, parent marital status, data collection period, month, and study year. Daily step categories included: high (> 12,000), medium (6,000–12,000), and low (1,000–6,000). Daily screen time categories (hours) included: low (0–4); medium (4–8), high (> 8). The low screen time and high step category was the reference category