The main purpose of the present study was to compare differences in PAs and sedentary time between individuals with and those without cardiometabolic risk factors, and we focused on a population of young adults. The study found that healthy young adults and young adults who were overweight had higher PAs than those with cardiometabolic risk factors. The severity of cardiometabolic risk factors impacted the level of PAs. Most previous studies showed that healthy control groups had a longer duration and a higher level of PAs and more days that they achieved MVPAs than groups with cardiometabolic diseases (23). The PA level was negatively associated with an individual’s number of diagnoses of chronic diseases (36). When the history of chronic diseases, including diabetes and cardiovascular diseases, was longer, individuals’ PAs were lower (5, 37). Chronic diseases are a trigger of changes in PAs (38). In the present study, the cutoff point reflecting a difference in PAs was between being overweight and obese. Therefore, it is important to be aware of changes in body weight which could be a danger sign of a lack of PAs.
The study also found that healthy young adults and young adults with cardiometabolic diseases had longer sedentary times than other risk groups. Previous studies presented no marked differences and did not reach a conclusion about sedentary times between healthy groups and groups with chronic diseases. The difference between strengthening and lightening PAs is more common than between being sedentary and initiating PAs (23, 38). Healthy young adults share a lifestyle with simultaneous high PAs and long sedentary times. There is a balance between PAs and sedentary behaviors for now. But it is possible to develop cardiometabolic risk factors when lifestyle changes cause an imbalance (4). Young adults with cardiometabolic diseases have an inactive lifestyle which threatens their own health and future life. Deceasing sedentary behaviors and increasing PAs are both important in delaying pathological processes of current diseases.
Regarding environmental differences among young adults, only one indicator of walkability exhibited a significant difference. Young adults with cardiometabolic diseases had the lowest score of perceived residential density. Individuals with cardiometabolic diseases had different insights as to their neighborhood environment (39). However, there was no difference between healthy young adults and other cardiometabolic risk groups. Overall, PAs are an important mediator between the environment and chronic illnesses (14). Walkability is a modifiable neighborhood featur which can promote PAs.
Regarding psychological differences among young adults, there were two domains in the HBPA with significant differences. Young adults in the obese, high-risk, and diseased groups were more susceptible to health problems and barriers to exercise than were healthy young adults and overweight young adults. A person’s health and illness status impacted their health beliefs, especially with chronic diseases. Patients with chronic diseases are more susceptible to health problem than are healthy adults (11, 40). Interestingly, the cutoff point of reflecting on the difference in the HBPA was also between being overweight and obese.
The second main purpose of the present study was to determine the influence of cardiometabolic risk factors, walkability, and health beliefs on MVPAs. This study found that gender, age, and educational level had interactions with MVPAs. Previous studies also showed that personal demographic variables, such as age, gender, race, and years of education, have interactions with chronic risk factors and disease in population-based studies (36). Young adults with hypertension, hyperlipidemia, or hyperglycemia were less likely to participate in MVPAs in model 1. However, the predictive power of model 1 was low, so that environmental and psychological factors should be considered in the logistic regression model for predicting MVPAs.
Walkability impacts residents’ leisure-time PAs, transportation choices, and an active lifestyle (41). Poor walkability causes long-term consequences of cardiometabolic diseases (42). In predictive models 2 and 3, only recreational facilities was a significant predictor of MVPAs. The accessibility, distance, density, and utility of recreation facilities had positive associations with the level of PAs in residents (43). However, previous studies also found that not every indicator of walkability has a direct association with PAs or the risk of cardiometabolic diseases (44). Creating an activity-friendly environment to change physical and social characteristics is effective in promoting PAs (45). NCDs are related to health inequalities (46). Governments should pay attention to designing healthy places to encourage residents’ PAs to maintain a positive health status and low diseases status (47).
The psychological domain is important for the self-determination of MVPAs. In predictive model 3, the benefits of exercise and barriers to exercise significantly predicted the OR of MVPAs. Benefits of exercise were positively associated with MVPAs. In contrast, barriers to exercise were negatively associated with MVPAs (40). HBPAs are a motivation to increase PA participation. Previous studies also showed that indicators of health beliefs significantly predicted the odds of MVPAs or achievement of minimal requirements of PAs (11, 48). An individual’s susceptibility to chronic disease influences their health behavior decisions. Once an individual has enough cues to action and perceives more benefits of than barriers to exercise, they are more likely to engage in MVPAs (49).
Overall, more indicators of HBPA had significant impacts on MVPAs than walkability in this study. Between models 2 and 3, the R2 value increased by about 9.5%. Young adults’ thoughts impacted their PAs. Therefore, it is important to increase MVPAs beginning with health education for young adults. Young adults’ lifestyles are not settled and can easily be modified. Increasing knowledge and awareness of diseases can help young adults understand the benefits of PAs and overcome barriers to exercise. MVPAs can become a part of one's lifestyle that is beneficial for preventing chronic diseases and promoting health in their future lives.
There are some limitations in this study, a case-control study which focused on PAs and associated factors and compared differences between a healthy control group and cardiometabolic groups. However, there are other cardiometabolic risk factors, such as eating behaviors, an unbalanced diet, smoking, and alcohol consumption, which should be taken into consideration. An internet survey using structural questionnaires has potential sampling and self-reported recall biases. All citizens were welcome to complete the questionnaires, and only one open question of “Do you have any other diseases, besides chronic diseases” was used to screen participants. Young adults with other diseases or mental problems might have been recruited in this study. Only 37.90% of participants had cardiometabolic risk factors, so that small sizes of samples in groups were used to compare PAs, sedentary behaviors, and environmental and psychological differences. Finally, the explanatory power of the final model was not high (16.0%). Future studies should consider other environmental or psychological models as predictors of participation in MVPAs.