Background: Time spent in different intensity-specific physical activities is codependent, but the substitution effect of different activities on weight status changes in children remains unclear. This study aims to investigate the prospective association between reallocating time in different intensities of physical activity and weight status changes among Chinese children. Methods: A national sample of 15,100 normal-weight children aged 7-18 years (46.7% boys) were recruited in September 2013 and followed up for nine months. Vigorous-intensity physical activity (VPA), moderate-intensity physical activity (MPA), walking, and sedentary time were obtained by International Physical Activity Questionnaire Short Form (IPAQ-SF). Height and weight were objectively measured, by which body mass index (BMI) and BMI z-score were calculated. Weight status was classified by the Chinese criteria for 7- to 18-year-old children. Isotemporal substitution analyses (including single-factor model, partition model, and isotemporal substitution model) were applied to examine the association of time allocation with weight status changes. Results: Each 30 min/day of increase in VPA was favorably associated with a 13.2% reduced risk of incident overweight/obesity in a single-factor model and a 15.6% reduced risk in a partition model. Negative associations were found between VPA, MPA, walking and the risk of being underweight in the single-factor model, but not in the partition model. In substitution models, replacing 30 min/day sedentary time with an equal amount of VPA was favorably associated with a 16.1% reduction of the risk of being overweight/obese. Conclusion: These findings highlight the need for promoting vigorous-intensity physical activity in children.
Keywords: children; isotemporal substitution; obesity; physical activity; sedentary behavior.