Posters 2

Background: Short, frequent active breaks to sedentary behavior (SB) lead to greater reductions in postprandial glucose and insulin responses compared to a continuous bout of activity in adults over the short-term (4d). The longer-term effects of active breaks to SB are unknown. Purpose: To compare effects of active breaks to SB vs continuous walking physical activity (PA) and SB on markers of glucose metabolism in adults with overweight/obesity. Methods: In a 6-wk randomized trial, 28 sedentary adults with overweight/obesity (15F/13M, 34±8 yr, 29.6±3.3 kg/m2) were randomized to: BREAK, 9 hourly 5-min brisk walking bouts, 5 d/wk; or ONE, single 45-min brisk walking bout, 5 d/wk. Habitual PA/SB and glycemic variability were assessed with ActiGraph GT3X and ActivPAL, and continuous glucose monitors for 14d. Fasting and postprandial glucose and insulin, and fasting lipid profile were assessed during 23-h study visits. Group-by-time interaction for dependent variables were tested using linear mixed effect models. Results: Both groups increased time in moderate-to-vigorous PA (+22.5 min/d; time: p=0.001). Although total sedentary time did not change (time: p=0.097), BREAK reduced time in prolonged sitting bouts >60min (-1.1 h/d; group*time: p=0.018). Both groups improved fasting insulin concentrations (-17%; time: p=0.016) and insulin sensitivity (-15%; time: p=0.042). Fasting LDL concentrations decreased in BREAK (-12%; group*time: p=0.032). Several indices of glycemic variability were decreased in BREAK but not in ONE (group*time: all p<0.086). Conclusions: Both interventions increased PA and improved insulin sensitivity. However, breaking up SB was more effective at reducing prolonged SB and lowering glycemic variability and fasting LDL concentrations than continuous walking. Practical implications: Both types of physical activity improve insulin sensitivity. Breaking up SB should be considered over continuous walking when targeting improvement in glucose control for people at risk for type 2 diabetes. Funding: NIH (R00DK100465 and F31DK125061), NIH/NCATS Colorado CTSA (UL1TR002535), and NORC (P30-DK48520).

Background: The new paradigm of most sedentary jobs, combining office with home-office work, rises the needs of implementing and evaluating interventions for reducing sedentary behaviours (SB) and thereby the associated harmful effects among those hybrid workers. Purpose: The aim of the study is to evaluate the effectiveness of a digital intervention among home-office workers in reducing SB and its impact on employee’s health and wellbeing at work. Additionally, we will assess the process of implementation and its eventual mechanism of impact. Methods: A two-arm cluster randomised controlled trial will be undertaken among home-office employees at four European companies from The Netherlands, Spain, Ireland, and Slovenia. In total, 200 employees will be recruited across the four countries. Participants will be randomly allocated within each company in the intervention or control group at the unit level. The intervention group will receive the multicomponent Click2Move (C2M) intervention (including environmental, organisational, and individual strategies) delivered through a mobile phone application (C2M-App) with an activity tracker. Employees’ activity and SB will be objectively measured (activPAL3TM) at baseline, and at 3-, 6- and 12-months follow-up. Self-reported data on activity and SB, health- and work-related outcomes will be collected at the same time points. using a combination of questionnaires, checklists, and Likert scales; and semi-structured interviews and focus groups will be conducted with employees and managers post-intervention. Linear mixed models, accounting for covariates, will be employed to determine the effects of the intervention. Practical implications: The proposed study will offer a comprehensive description of a co-created digital intervention aimed at reducing SB among home-office workers, as well as guidance on its implementation and evaluation in real-life settings. Funding: The Click2Move project is supported by the European Commission under the Erasmus+ programme (ERASMUS-SPORT-2021-SCP-101050490).

Background: Physical activity (PA) and sedentary behaviour (SB) are major determinants of the risk and management of chronic diseases. A limited number of large-scale studies compare objectively measured PA and SB in people with and without chronic diseases. Purpose: This study aimed to compare levels of PA and SB in individuals with and without chronic diseases, acknowledging sociodemographic factors. Methods: A cross-sectional analysis was conducted with data from 24,826 participants (53% women), aged 50- 64, from the Swedish CArdioPulmonary bioImage Study (SCAPIS) cohort. Chronic disease diagnoses were retrieved from national registries, using ICD codes. Participants were classified into a chronic disease group and a multi-morbidity group. PA and SB were measured with a triaxial hip-worn accelerometer, worn for seven consecutive days. General linear models, adjusted for sociodemographic factors, were used to acquire estimated means of average daily minutes of PA and SB intensities in chronic disease and multi-morbidity groups. Results: Time spent in light-intensity PA (LIPA), moderate-to-vigorous PA (MVPA) or SB did not differ between participants with a chronic disease and participants without. However, participants with four or more chronic diseases had significantly lower MVPA (5 minutes/day) and higher time in SB (6 minutes/day) compared to participants without chronic diseases. Women had significantly higher LIPA, lower MVPA and lower SB than men, regardless of chronic disease status. Participants with a higher education had significantly lower LIPA and higher SB than participants with a lower education, regardless of chronic disease status. Conclusions: when using an extensive set of diagnoses in chronic disease and multi-morbidity groups, marginal differences in PA and SB were seen between individuals living with and without chronic diseases. Moreover, sociodemographic factors, rather than living with chronic disease, seem to be significantly associated with time spent in PA and SB.

Background: Understanding what school actors think about the implementation of health promotion actions may support Health-Promoting Schools (HPS) at a large scale. Objective: To compare the perception of different school actors (policymakers/school managers, researchers, teachers, and health professionals) about acceptability and feasibility of health promotion actions based on the World Health Organization’s HPS framework. Methods: This cross-sectional, online survey was performed from July to September 2023 using the SurveyMonkey® platform. The “snowball” strategy was used, considering an initial list of individual and institutional contacts from all five regions from Brazil. A standardized list with 20 HPS actions was used considering four dimensions: government policies and resources (n=8), school policies and resources (n=5), school governance and leadership (n=3) and school-community partnerships (n=4). An instrument with indicators of acceptability and feasibility was considered and applied to four groups of actors. Generalized Linear Models were used (p<0.05). Results: A total of 15 policymakers/school managers, 23 researchers, 37 teachers and 46 health professionals answered the survey. In 3 of 4 HPS dimensions, policymakers/ school managers had lower scores of acceptability and feasibility indicators (easiness, time and training needed, and general satisfaction) when compared to their peers from other groups (p<0.05). Conclusions: Policymakers/school managers had the worst perception of the acceptability and feasibility of HPS actions on government and school policies and resources, as well as partnerships with the community. Practical implications: Implementing HPS at a large scale should improve resources and skills of governance of health promotion actions in schools. Training policymakers and school managers on governance of HPS may be a strategy on health promotion agenda in countries with diverse territories and high vulnerabilities, such as Brazil. Funding: Grants from the Fortaleza’s Secretary of Education (Agreement n. 01/2022/FUNECE/SME) and from the Brazilian National Council for Scientific and Technological Development (312091/2021-4).

Background: Schools aspire to help every child reach their maximum potential, through development of their cognitive, physical and social skills. Primary school class teachers typically support between one and three children managing extra challenges, for example symptoms of attention deficit/ hyperactivity disorder (ADHD). This research team showed that regular, moderate-to-vigorous physical activities (PAs) designed to increase children’s enjoyment and engagement with the activities in physical education (PE) lessons, were associated with increased engagement in other lessons and school activities, with significant improvement for the children with ADHD. The Active bodies, Active minds (AbAm) scheme was designed to be quick and easy for teachers to use, with or without specialist PE training. To enable wider implementation, the AbAm scheme should be adapted for use within PE curricula. Purpose: Feasibility study for implementing the AbAm scheme within regular PE curriculum lessons. Methods: The PE lesson plans were co-created by the researcher and class teacher by selecting the PAs from the PE curriculum that met the AbAm scheme criteria. The class teacher led the sessions and the researcher collected weekly data from the 8-9yr old children (study group with ADHD and control group of classmates). Measures included Children’s perceived exertion and enjoyment of each PA, and teacher-reported attention and behaviour in non-PE lessons. Results: There was a significant improvement in attention and behaviour in the study group in non-PE lessons including maths, science and English. Children in the study and control group reported equal enjoyment of the PAs and engagement at moderate to vigorous intensity. Conclusions: Regular moderate-to-vigorous PA through applying the AbAm scheme to the PE curriculum may help children with ADHD engage with their school activities, while providing and engaging PAs for all the class. Practical implications: The results suggest the AbAm scheme might be implemented in other primary schools.

Background: Previous research highlights the 24-hour activity cycle as a key framework for exploring how physical activity, sedentary behaviour, and sleep interact to affect health. This approach emphasizes the need to examine all daily activities for promoting health and preventing illness. Challenges in accurately capturing this remain, especially concerning posture allocation and how this is influenced by activity levels. Purpose: This study explored the relationship between time spent in primary postures and step count-defined activity level in a working-age population. Methods: We selected all individuals from the BCS70 study with 7 days of valid data (3,457). Days were categorised into three activity levels, inactive (10k steps/day). Daily time in the different primary postures of lying, sedentary and upright were calculated. Mean daily time in each posture was summarised by activity level. ANOVA with Tukey post-hoc testing was used to identify significant differences in posture allocation across activity levels. Results: From 24,829 days of posture data, increased daily activity levels were associated with significant decreases in sitting (F(2,24826)=2658, p<0.05) and lying time (F(2,24826)=203, p<0.05) and a significant increase in upright time (F(2,24826)=6123, p<0.05). For days when the activity level exceeded 10,000 steps (8,784 days), participants exhibited a balance of time spent lying(8.23h), sitting(7.76h) and upright(8.01h). Conclusions: We observed a reduction in sitting time and increased time in an upright posture with increasing daily step count. In this population of ~3500 individuals aged 46, for days where stepping was over 10,000 steps, we found a balanced distribution of daily time across lying, sitting, and upright postures, giving an 8:8:8 hour ratio in the 24-hour period. Practical implications: We have demonstrated a relationship between sedentary behaviour and activity level. This relationship will be important for researchers interested in “sit less and move more” interventions.

Background: It is widely recognized that higher levels of physical activity are associated with lower rates of all-cause mortality and morbidity. It is unclear whether these benefits vary by the context in which physical activity is accumulated, such as during occupational versus non-occupational activities. Recent research has shown that small increases in non-occupational physical activity provide a large protection against a range of non-communicable diseases. Purpose: We sought to explore whether this context-dependent variation is consistent across populations with varying occupational norms. Methods: We conducted a sex-stratified ecological analysis of self-reported physical activity and its association with the prevalence of diabetes, obesity, smoking, CVD mortality, and all-cause mortality in 67 countries. World Health Organization data on travel, work, and leisure physical activity were used to derive an estimate of total occupational and non-occupational physical activity. We used Poisson regression to model associations between physical activity and diabetes, obesity, smoking, and all-cause mortality. Results: In pooled analyses, we found moderate inverse associations between physical activity in all time domains for diabetes, obesity, and smoking. Differential associations were observed by sex. In men, we found an inverse association between physical activity in all time domains with smoking and obesity. In women, we found a positive association with smoking. Conclusions: Our findings for diabetes and obesity support the current literature on the relationship between physical activity and metabolic disease. We acknowledge the limitations of ecological fallacy and large heterogeneity in the diagnosis and classification of events between countries. Thus, our findings warrant an individual-level analysis to investigate the association between physical activity domain, diabetes, and other cardiometabolic risk factors. Practical implications: These findings suggest differential effects of physical activity patterns in different populations. Further research would inform precision prevention strategies tailored to populations beyond europe.

Background: Physical activity (PA) at work is regularly studied and intervened upon, with those in manual labour occupations often identified as having physically active jobs. However, most of these workforces have variation in the physical demands between roles but little has been reported on the extent of this variation. Purpose: To assess PA intensity and type within a manual labour workforce and the variation between roles. Methods: 47 participants, within a Scottish workplace, in manual labour occupations, volunteered to take part in this study. PA was measured over a 7-day period using wrist-worn accelerometers (Actigraph wGT3X-BT) and heart rate monitors (Polar H10). Accelerometer data was classified into activity types (sedentary, stationary+, walking and running) using a random forest model (randomForest package, R software), with intensity bands (light, moderate and vigorous) mapped to each activity using established heart rate reserve thresholds. Descriptive data is presented as minutes per day (mins/day) for PA intensity bands and PA type. Participants were assigned to job role subgroups (stationary and walking) using a job exposure matrix. Results: Median total PA and moderate-to-vigorous PA during work time were 272.2 (interquartile range 183.7-355.6) and 9.1 (interquartile range 3.1-29.0) mins/day, respectively. Workers in stationary roles spent 84.4% of their PA at work in stationary activities (sitting or standing), while the other 15.6% was ambulatory (walking or running). In comparison, for those in walking roles 77.6% of their PA at work was in stationary activities and 22.4% was ambulatory. Conclusions: There is substantial variation of PA within manual labour workers. Choosing an appropriate PA measurement protocol is essential in evaluating physically active work roles. Practical Implications: By identifying differences in the PA demands between workers and roles, researchers and practitioners can better tailor interventions and policies for specific contexts. Funding: Medical Research Scotland and ACS Clothing Ltd.

Background Many students transitioning to university face challenges, in particular international students where language barriers and acculturation may cause additional stress. Physical activity (PA) and exercise can be neglected in the face of competing priorities with international students potentially more adversely affected than their domestic peers. Purpose The objective of this study was to determine the PA levels and the barriers to PA in international university students. Methods An anonymous, Qualtrics survey was distributed via social media and email to international students registered at Trinity College Dublin during 2022/2023. Demographics, course details and country of origin were collected. PA was assessed using a validated single-item question and additional questions addressed sports engagement, barriers and facilitators to PA, and changes to PA since starting university. Results One hundred and forty-one responses were included (141/204, 69% completion rate). Over half of all participants (54%, n=76) were failing to meet the PA guidelines, with no difference between genders or course of study. Asian students were significantly less active than their European and North American peers (p=0.022), with 68% (n=23) of Asian, 53% (n=26) of North American and 48% (n=22) of European students failing to meet the PA guidelines. The most common barrier cited was “lack of time due to study or work commitments”. Thirty five percent of students (n=48) were doing less PA and 41% (n=57) had given up a sport since starting university. Conclusions When compared with the Irish national student population (inactivity rate 36%, Murphy et al. 2015), international students, and Asian students in particular were less likely to meet the PA guidelines. Practical Implications A targeted approach towards overcoming barriers and promoting PA specifically in international students is warranted, to ensure equitable access to PA and sport, as a key component of a Health Promoting University. Funding Nil

Background: Cities are a major source of greenhouse gas emissions and urban populations face catastrophic, escalating health and economic impacts from climate change. Globally, cities have been developing and implementing Climate Action Plans (CAPs) with the stated goal of making emission cuts. Though such plans have the potential to produce large effects, to date, these initiatives have noticeably failed to yield substantial progress. Research that could evaluate and improve CAPs is in its infancy, held back by the lack of rigorous, realistic methods for assessing the content and quality of these plans. Purpose: This project provides a solution by developing a novel transdisciplinary methodology to systematically evaluate CAPs integrating environmental, economic, social, health, and behavioural sciences. Methods: The proposed methodology is based on the Intergovernmental Panel on Climate Change (IPCC) analyses and recommendations and uses quantitative policy analysis. Results: Our preliminary review of CAPs underscores that despite common and strong rhetoric expressing commitment to addressing climate change, there is a lack of actionable policy measures. There is a substantial knowledge gap and misalignment between CAP components, priority areas, and detailed steps for meeting and tracking emission reduction targets. While some CAPs are presented as aspirational documents, others consist of interconnected plans with clear, specific, measurable, and budgeted actions and targets. Implications: An overwhelming majority of cities are formulating CAPs in a fragmented, piecemeal manner. This comparative analysis of CAPs provides valuable insights into cities’ capacity to enact and implement effective climate policies. This lays the groundwork for understanding diversity and patterns in existing CAP language and policies, informing future impact assessments of CAPs. Funding: This project is supported by the TU Delft Climate Action Programme and a Dutch Research Council Open Science Award.

Background: Active transportation represents an opportunity to promote physical activity in adolescents, especially in low- and middle-income countries (LMIC). Perceptions of the characteristics of the built environment can either limit or promote its use. However, Mexican adolescents’ perceptions have not been fully explored; furthermore, there are no culturally relevant instruments to measure these perceptions. Purpose: To adapt and evaluate the Neighborhood Environment Walkability Scale for Youth for the IPEN Project (NEWS-Y-IPEN) in Mexican adolescents. Methods: A cross-cultural assessment was conducted to determine relevancy of an adaptation of the NEWS-Y-IPEN questionnaire (Spain version) for the Mexican context among adolescents aged 15 to 20 years from a high school in Zapopan, México. The adaptation process involved researchers and adolescents reviewing and replacing unsuitable words for the Mexican context. Sociodemographic, socioeconomic, and active transportation information was collected via a REDCap questionnaire. Internal consistency of the five scales was assessed using Cronbach’s α. Factor structure of the instrument was examined with confirmatory factor analysis. Results: A total of 735 students completed the questionnaire (M= 16.3 years). Only two NEWS-Y-IPEN subscales showed acceptable internal consistency: crime safety (α = 0.887) and neighborhood surroundings (α = 0.724). The five-factor model showed an acceptable fit to the data and factor structure (χ2 = 318.37, p < 0.001; CFI = 0.94; RMSEA = 0.046, 95% CI =0.040 a 0.050; SRMR = 0.049). Conclusions: The adapted NEWS-Y-IPEN showed a good factor structure; nevertheless, only two of the five scales appeared to be reliable and useful for the Mexican context. Practical implications: Assessment of adolescents' perception of the built environment needs context-suitable instruments. Developing culturally relevant methods for LMIC rather than adapting them from high-income countries may be a good alternative. Funding: Programa para el Aseguramiento de la Calidad de los Posgrados (PROAC) – CONAHCYT, Universidad de Guadalajara, 2024.

Background: Inequality in access and opportunity is a predominant factor affecting PA participation. However, the evidence of PA inequality is mostly focused on the disparities in the level of MVPA. Purpose: This study assessed PA inequality by using three measures to construct an inequality index: (1) Proportion of the population with sufficient MVPA; (2) Cumulative minutes of MVPA; and (3) The Gini coefficient. Methods: Three rounds of data from Thailand’s Surveillance on Physical Activity (SPA) 2019–2021 were employed. In each round, over 6,000 individuals aged 18–64 years were included in the analysis. PA was measured subjectively by using GPAQ version 2.0. PA inequality was constructed by using three measures, with a combination of the three as the final index, to identify the sub-groups of the Thai adults who are most vulnerable. Results: The three measures provided a different group of vulnerable population in different periods of the COVID-19 epidemic. Within-group analysis suggested the gap in the proportion of sufficient MVPA and cumulative minutes MVPA was the largest between those employed in the agricultural sector and the unemployed: Δ 17.3% vs 15.2%; 275 min vs 199 min in 2020 and 2021, respectively. The refined index identified the most vulnerable groups as follows: (1) Those with no income; (2) The unemployed; (3) Those who have no access to PA facilities; (4) Older adults aged 60+years; and (5) Those earning<3,500 Baht per month. Conclusion: Socioeconomic inequalities in PA was more profound than biologically driven inequalities during the pandemic, indicated by the lowest level of MVPA among socioeconomically deprived population. Practical implications: The refined index should aid better in determining the most vulnerable groups of the population. This method can be applied in various settings since the baseline data used to assess inequality are widely available. Funding: Thai Health Promotion Foundation

Background : Studies considering differences between male and female workers in both occupational physical activity (OPA) and leisure-time physical activity (LTPA) have been scarce. The aim of this study was to describe OPA and LTPA and work organization in on-line retail warehousing and consider the extent to which differences exist between male and female workers. Methods: OPA and LTPA were assessed objectively over five consecutive days on 57 workers (24 females and 33 males) at three warehouses and semi-structured focus-group interviews conducted with 49 workers (15 groups). Analysis of data was performed within each warehouse since the extent of digitalization and subsequently the amount of walking required differed between warehouses as did the proportion of male and female workers. Accelerometer data were analysed using AcitiPass algorithms (Uppsala University) to determine variables at work and during leisure including: number of steps and percent time in sit, stand, walk and active categories. Results: In general, warehousing involved low proportions of time sitting (x̄ =23%), but high standing (x̄ = 52%) and walking (x̄=23%) times, and a high step count (x̄ = 13 143). At the two warehouses with some production automation, men and women OPA did not differ significantly; however, at leisure women sat less than men (54% vs 62% – warehouse 1; 58% vs 67% warehouse 2). At the third warehouse (minimal automation), interview data suggested gendered division of seated work tasks, and women sat less (14% vs 21%) and stood more than men (53% vs 47%); women also stood more at leisure (29% vs 22%). Conclusions/Implications: Results suggest similar OPA between men and women in warehouses with some extent of automation, even if the specific tasks performed may differ. Despite similar OPA, LTPA differences were found, with women sitting less: this may represent decreased opportunity for recovery.

Background: Maintaining good work ability is important for both individuals and the economy. Purpose: To examine association between recommended levels of physical activity and work ability among Finnish adult population. Methods: In a national Healthy Finland 2022 survey, population representative sample (N= 61 600, response rate 46 %) of adults (20-99-year-olds) reported weekly amount of moderate- and vigorous aerobic physical activity (work, leisure-time and commuting), and frequency of muscle-strengthening activity. Physical activity was classified into five groups based on physical activity recommendations. Perceived work ability was dichotomized into limited and good. Age, gender, marital status, education, smoking, alcohol use, limiting longstanding illness and BMI were included as confounders. Those retired due to disability were excluded from the analyses (n=665). The analytical sample included under 75-year-old participants (n=16 373). SPSS 29 were used for the logistic regression analyzes. Results: In total, 19.1% had limited work ability. 8% had no physical activity, 16% had activity below recommendations, 11% had muscle-strengthening activity at least twice a week, 21% had recommended level of aerobic activity and 43% had fully recommended activity level. Compared with those meeting the physical activity recommendations, those meeting only the aerobic recommendation (OR 1.41, 95% CI 1.18-1.69) had higher likelihood of limited work ability as well as those meeting only the muscle-strengthening recommendation (OR 1.96, 95% CI 1.62-2.38) and those with activity below the recommendations (OR 1.65, 95% CI 1.38-1.99) and those with no physical activity (OR 2.46, 95% CI 1.86-3.25) when adjusting for confounders. Conclusions: Lower than recommended levels of physical activity associated with a higher likelihood of limited work ability. Practical implications: Promoting physical activity may prove useful in maintaining population work ability. Support/Funding Source: Juho Vainio Foundation

Background. In recent years, epidemiological studies have focused on identifying the association between physical activity, sedentary behavior, and sleep individually, and sociodemographic characteristics and health outcomes in the entire population. However, recently, there has been a paradigm shift in the study of these behaviors, recognizing their combined effect on healthy lifestyles. Purpose. To examine the association between movement behaviors (MB), individually and as a group, and sociodemographic characteristics and health indicators in Mexican adults. Methods. Cross-sectional study that used data from the ENSANUT 2022. Information was obtained on physical activity (PA), sedentary behavior and sleep, sociodemographic characteristics, and health indicators in adults aged 20-78 years. Logistic and linear regressions adjusted and not by covariates were used for the analysis. Results. Those who live in urban areas, with a high level of well-being and schooling, were more likely to not comply with the recommendations for physical activity, sedentary lifestyle, and sleep. Not complying with the recommendations of any of the MBs was associated with higher levels of glucose, cholesterol, insulin, and elevated blood pressure. Conclusion. Individual and group MBs are associated with sociodemographic characteristics and health outcomes. Practical implications. The results of this study should alert health professionals, researchers, decision-makers, and civil society organizations about the importance of promoting MBs. However, it will not be enough to alert the population, but rather policies and environments that favor forms of active and safe recreation are required, in addition to appropriate places where these behaviors take place. Funding. This study was funded by the ministry of health Mexico.

Background. Metabolic syndrome (MS) increases type 2 diabetes, cardiovascular disease and is associated with age, gender, ethnicity, body mass index (BMI), systolic blood pressure, low high-density cholesterol (HDL), high serum triglycerides, elevated fasting glucose levels. Association of physical activity (PA) with MS is unclear. Purpose: to clarify MS-risk of Estonian women with different PA level and compare results to USA white non-Hispanic population using calculator developed on US population (https://metscalc.org/metscalc/). Methods. Study groups: physically active (PAW; PA/week >5h; n= 33); controls (CW; PA/week ≤5h). Tools: questionnaire, blood analysis, MS-calculator which considerers all above-mentioned factors. Z-score allows to compare Estonian study groups to US population: “0” – greater risk. Descriptive statistics, t-test or Mann-Whitney test, χ2 test (p-value 0. Considering different scores of studied groups (1); there were more 0, no difference between groups. There were more whose value was <1 (lower risk) in PAW compared to CW (36.4 vs 19.5; p=0.004). Conclusions. Practical implications. PA slightly reduces risk of MS. Z-scores designed for US population aren`t suitable for Estonian population. Funding. Tartu Health Care College