Development of an accelerometer age- and sex-specific approach based on population-standardized values for physical activity surveillance: A proof of concept Hidalgo Migueles, Jairo Cadenas Sánchez, Cristina Physical activity Exercise Mortality Devices Movement sensors This research was supported in part by the intramural research programs at the National Institute on Aging and National Cancer Institute (USA). JHM is supported by the Spanish Ministry of Science, Innovation and Universities under Beatriz Galindo's 2022 fellowship program (BG22/00075). Supplementary materials associated with this article can be found in the online version at doi:10.1016/j.jshs.2024.100995 Background A shift from self-reports to wearable sensors for global physical activity (PA) surveillance has been recommended. The conventional use of a generic cut-point to assess moderate-to-vigorous PA (MVPA) is problematic as these cut-points are often derived from non-representative samples under non-ecological laboratory conditions. This study aimed to develop age- and sex- (age-sex) specific cut-points for MVPA based on population-standardized values as a feasible approach to assess the adherence to PA guidelines and to investigate its associations with all-cause mortality. Methods A total of 7601 participants (20–85+ years) were drawn from the 2003–2004 and 2005–2006 National Health and Nutrition Examination Surveys (NHANES). Minutes per week of MVPA were assessed with a hip-worn accelerometer. Counts per minute (CPM) were used to define an age-sex specific target intensity, representing the intensity each person should be able to reach based on their age and sex. Age-sex specific MVPA cut-points were defined as any activity above 40% of the target intensity. These population- and free-living-based age-sex specific cut-points overcome many of the limitations of the standard generic cut-point approach. For comparison, we also calculated MVPA with a generic cut-point of 1952 CPM. Both approaches were compared for assessing adherence to PA guidelines and association of MVPA with all-cause mortality (ascertained through December 2015). Results Both approaches indicated that 37% of the sample met the 150+ min/week guideline. The generic cut-point approach showed a trend to inactivity with age, which was less pronounced using the age-sex specific cut-points. Overall mortality rates were comparable using generic cut-point (hazard ratio (HR) = 0.61, 95% confidence interval (95%CI): 0.50‒0.73) or age-sex specific cut-points (HR = 0.57, 95%CI: 0.50‒0.66) for the entire sample. The generic cut-point method revealed an age- and sex-related gap in the benefits of achieving 150+ min/week of MVPA, with older adults showing an 18% greater reduction in mortality rates than younger adults, and a larger difference in women than in men. This disparity disappeared when using age-sex specific cut-points. Conclusion Our findings underscore the value of age-sex specific cut-points for global PA surveillance. MVPA defined with age-sex specific thresholds was associated with all-cause mortality and the dose‒response was similar for all ages and sexes. This aligns with the single recommendation of accumulating 150+ min/week MVPA for all adults, irrespective of age and sex. This study serves as a proof of concept to develop this methodology for PA surveillance over more advanced open-source acceleration metrics and other national and international cohorts. 2025-02-12T07:45:35Z 2025-02-12T07:45:35Z 2025-12 journal article J.H. Migueles et al. J Sport Health Sci 2025;14:100995. https://doi.org/10.1016/j.jshs.2024.100995 https://hdl.handle.net/10481/102207 10.1016/j.jshs.2024.100995 eng http://creativecommons.org/licenses/by-nc-nd/4.0/ open access Attribution-NonCommercial-NoDerivatives 4.0 Internacional Elsevier