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Emerging collaborative research platforms for the next generation of physical activity, sleep and exercise medicine guidelines: the Prospective Physical Activity, Sitting, and Sleep consortium (ProPASS)
  1. Emmanuel Stamatakis1,
  2. Annemarie Koster2,
  3. Mark Hamer3,4,
  4. Vegar Rangul5,
  5. I-Min Lee6,
  6. Adrian E Bauman1,7,
  7. Andrew J Atkin8,
  8. Mette Aadahl9,
  9. Charles E Matthews10,
  10. Paul Jarle Mork11,
  11. Lisa Askie12,
  12. Peter Cistulli13,
  13. Malcolm Granat14,
  14. Peter Palm15,
  15. Patrick Joseph Crowley16,
  16. Matthew Stevens16,
  17. Nidhi Gupta16,
  18. Anna Pulakka17,
  19. Sari Stenholm17,
  20. Daniel Arvidsson18,
  21. Gita Mishra19,
  22. Patrik Wennberg20,
  23. Sebastien Chastin21,22,
  24. Ulf Ekelund23,
  25. Andreas Holtermann16
  1. 1 Prevention Research Collaboration, Charles Perkins Centre, Faculty of Medicine and Health, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
  2. 2 Department of Social Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Limburg, The Netherlands
  3. 3 Department of Epidemiology and Public Health, University College London, London, UK
  4. 4 School of Sport Exercise and Health Sciences, Loughborough University, Loughborough, UK
  5. 5 Department of Public Health and Nursing, HUNT Research Centre, Norwegian University of Science and Technology, Trondheim, Norway
  6. 6 Division of Preventive Medicine, Brigham and Women’s Hospital and Harvard Medical School, Harvard University, Cambridge, Massachusetts, USA
  7. 7 Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia
  8. 8 Faculty of Medicine and Health Sciences, School of Health Sciences, University of East Anglia, Norwich, UK
  9. 9 Research Centre for Prevention and Health, Copenhagen, Denmark
  10. 10 Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
  11. 11 Department of Public Health and Nursing, The Norwegian University of Science and Technology, Trondheim, Norway
  12. 12 NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
  13. 13 Sleep Research Group, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
  14. 14 School of Health Sciences, University of Salford, Salford, UK
  15. 15 Occupational and Environmental Medicine, Department of Medical Sciences, Uppsala Universitet, Uppsala, Sweden
  16. 16 National Research Centre for the Working Environment, Copenhagen, Denmark
  17. 17 Department of Public Health, University of Turku, Turku, Finland
  18. 18 Department of Food and Nutrition and Sport Science, Centre for Health and Performance, University of Gothenburg, Gothenburg, Sweden
  19. 19 School of Public Health, University of Queensland, Brisbane, Queensland, Australia
  20. 20 Family Medicine, Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden
  21. 21 School of Health and Life Science, Institute for Applied Health Research, Glasgow Caledonian University, Glasgow, UK
  22. 22 Department of Movement and Sports Sciences, Universiteit Gent, Gent, Belgium
  23. 23 Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway
  1. Correspondence to Emmanuel Stamatakis, Prevention Research Collaboration, Charles Perkins Centre, Faculty of Medicine and Health, School of Public Health, University of Sydney, Sydney, NSW 2006, Australia; emmanuel.stamatakis{at}sydney.edu.au

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Galileo Galilei’s quote ‘measure what is measurable, and make measurable what is not so’ has particular relevance to health behaviours, such as physical activity (PA), sitting and sleep, whose measurement during free living is notoriously difficult. To date, much of what we know about how these behaviours affect our health is based on self-report by questionnaires which have limited validity, are prone to bias and inquire about selective aspects of these behaviours. Although self-reported evidence has made great contributions to shaping public health and exercise medicine policy and guidelines until now,1 the ongoing advancements of accelerometry-based measurement and evidence synthesis methods are set to change the landscape. The aim of this editorial is to outline new directions in PA and sleep-related epidemiology that open new horizons for guideline development and improvement; and to describe a new research collaboration platform: the Prospective Physical Activity, Sitting, and Sleep consortium (ProPASS) (figure 1).

Feasible research technology at scale, big consortia

Measurement technology used in epidemiology has made measurable what was not so until recently. Several population-based studies use accelerometers that are worn by participants for 24 hours a day for a whole week, offering unprecedented insights into the health attributes of PA, sitting and sleep. One of the most exciting aspects of accelerometers is that they show great promise for capturing nearly complete accounts of movement behaviour, including posture and activity type detection.2

However, advanced measurement methods and optimal evidence synthesis are not synonymous. Individual accelerometry studies have limited generalisability beyond the specific country, population and setting, and usually have low statistical power to address detailed research questions. For example, none of the National Health and Nutrition Examination Survey (NHANES) accelerometry studies3 have been able to study potentially metabolic health-enhancing sporadic short (<2–3 min) bursts of higher intensity incidental PA,4 likely because of the sparsity of such data. Like any other field, classic systematic reviews of accelerometry inherit the problems of source studies and their conclusions may not be robust.5 We need to think differently when it comes to consolidating, analysing and interpreting new formats of accelerometry data. As John Ioannidis’ BJSM editorial succinctly put it, the next generation of evidence in exercise medicine and PA involves large consortia of individual participant data that are harmonised retrospectively or prospectively.5 Prospective harmonisation (ie, agree on same or similar measurements across different studies prior to data collection), in particular, is an extremely powerful tool as it can overcome heterogeneity, which is one of the largest obstacles for rigorous evidence synthesis.5 The value of consortia goes beyond producing more robust and generalisable knowledge, there is also a strong economic argument. The value of every dollar, pound or euro tax payers and research funders invested in the original studies is multiplied through further use of the data resources to inform better public health and clinical practice guidelines.

A new consortium

The momentum generated by successful accelerometry consortia (eg, International Children’s Accelerometry Database6) and large epidemiological studies like NHANES3 and the UK Biobank6 that used waist or wrist mounted accelerometers inspired the genesis of the ProPASS.7 ProPASS is a research collaboration platform that aims to bring together existing and future observational studies of thigh-worn accelerometry. Although each accelerometer placement site has both strengths and challenges, the ProPASS choice of site was far from accidental: the unique appeal of the thigh-worn method is that it provides information on multiple dimentions of movement behaviour, including movement intensity (eg, light, moderate and vigorous PA) and posture (eg, sitting/lying, standing). Activity types such as cycling, running and stair climbing can also be extrapolated by thigh-attached sensors2 and integration with other important behaviours such as duration and timing of sleep can provide unique insights on lifestyle and health.8 Information about such tangible aspects of human behaviour has immediate relevance to people’s daily lives; and is easier for clinicians, policymakers and the public alike to understand, ‘digest’ and hopefully seek to improve.

The ultimate scientific objective of ProPASS is to produce evidence on the associations of PA, sitting, and sleep and long-term health outcomes and longevity. As of February 2019, ProPASS is supported by 12 international cohorts totalling over 70 000 participants (table 1). To safeguard consortium feasibility, longevity and faster growth, ProPASS is not restricted to one specific model of accelerometer; any triaxial device that outputs raw acceleration and is worn on the thigh is suitable—an approach we have validated empirically.9 The ProPASS cohorts are rich in health outcome data, many contain genotypic information, and most can be linked to administrative health and mortality records, opening up a huge variety of possibilities to generate new knowledge.

Table 1

Accelerometry studies supporting the Prospective Physical Activity, Sitting, and Sleep consortium (ProPASS)

Call for collaboration

New research collaboration platforms have paved the way for the next generation of evidence on PA-related behaviours and health. Recording detailed and accurate objective accounts of daily movement behaviour and posture is now feasible in large epidemiological studies. To fully capitalise on the opportunities offered by such methodological progress at least two essential conditions need to be met: breaking down silos to integrate research paradigms across PA domains, and tight interdisciplinary collaboration. Meeting ProPASS’ objectives is dependent on these conditions.

In this editorial we invite researchers from any discipline who have collected or are considering to collect thigh-worn accelerometry data in observational studies to contact us. We also invite scientists with an interest in health-related data consortia, as well as health professionals and policymakers to help us form a ProPASS research agenda with maximal relevance to patients, the public and health policy. There is no question in our mind that such a research agenda is a prerequisite for the success of ProPASS and any other effort aimed at shaping the next generation of PA, sitting, sleep and exercise medicine guidelines.

Get in touch to discuss opportunities for your existing or future studies to join ProPASS (email: propass.consortium@sydney.edu.au). Join our mailing list (www.propassconsortium.org) to stay updated about future events and activities.

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Footnotes

  • Contributors ES conceived the idea and drafted the first draft of the manuscript and carried out all revisions. AH, AK, MH and VR contributed to the idea. All authors reviewed critically the manuscript and provided detailed suggestions for revisions. AP, VR, AH, MA, PP, PW, DA, AK, GM and ES provided the data presented in table 1.

  • Funding The ProPASS consortium has received financial support from the following organisations: an unrestricted grant by PAL Technologies, Scotland, UK; a grant by the Worldwide Universities Network–Research Development Fund 2018; an internal seed grant by the University of Sydney; a National Health and Medical Research Council (Australia) equipment grant; in-kind support by the National Research Centre for the Working Environment, Copenhagen; and financial support by Loughborough University.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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