Journal of

Functional Morphology
and Kinesiology

Review
Insights into Non-Exercise Physical Activity on Control of Body
Mass: A Review with Practical Recommendations
Diego A. Bonilla 1,2,3 , Javier O. Peralta-Alzate 1,4 , Jhonny A. Bonilla-Henao 1,5 , Roberto Cannataro 1,6 ,
Luis A. Cardozo 7 , Salvador Vargas-Molina 1,8 , Jeffrey R. Stout 9 , Richard B. Kreider 10, *
and Jorge L. Petro 1,2

1 Research Division, Dynamical Business & Science Society—DBSS International SAS, Bogota 110311, Colombia
2 Research Group in Physical Activity, Sports and Health Sciences (GICAFS), Universidad de Córdoba,
Monteria 230002, Colombia
3 Research Group in Biochemistry and Molecular Biology, Faculty of Sciences and Education,
Universidad Distrital Francisco José de Caldas, Bogota 110311, Colombia
4 Programa Talentos Colombia, Ministerio del Deporte, Apartado 057840, Colombia
5 Semillero de Investigación en Ciencias de la Actividad Física y el Entrenamiento Deportivo (SISCAFED),
Complejo Tecnológico, Agroindustrial, Pecuario y Turístico SENA, Apartado 057841, Colombia
6 Galascreen Laboratories, Department of Pharmacy Health and Nutritional Sciences, University of Calabria,
Via Savinio, Edificio Polifunzionale, 87036 Rende, Italy
7 Research and Measurement Group in Sports Training (IMED), Faculty of Health Sciences and Sports,
Fundación Universitaria del Área Andina, Bogota 111221, Colombia
8 Faculty of Sport Sciences, EADE-University of Wales Trinity Saint David, 29018 Malaga, Spain
9 Physiology of Work and Exercise Response (POWER) Laboratory, Institute of Exercise Physiology and
Rehabilitation Science, University of Central Florida, Orlando, FL 32816, USA
10 Exercise & Sport Nutrition Laboratory, Human Clinical Research Facility,
Texas A&M University, College Station, TX 77843, USA
* Correspondence: rbkreider@tamu.edu; Tel.: +1-979-458-1498

Abstract: Non-exercise physical activity (NEPA), also called unstructured or informal physical
Citation: Bonilla, D.A.;
activity, refers to those daily activities that require movement of the human body without planning
Peralta-Alzate, J.O.; Bonilla-Henao,
or strict control of the physical effort made. Due to new technologies and motorized transportation
J.A.; Cannataro, R.; Cardozo, L.A.;
devices, the general population has significantly decreased its NEPA. This increase in sedentary
Vargas-Molina, S.; Stout, J.R.; Kreider,
R.B.; Petro, J.L. Insights into
lifestyles, physical inactivity, and excessive energy intake is considered a risk factor for obesity,
Non-Exercise Physical Activity on non-communicable diseases (NCDs), and all-cause mortality. Searching in PubMed/MEDLINE and
Control of Body Mass: A Review Web of Science databases, a narrative review of NEPA was carried out to address its conceptualization,
with Practical Recommendations. J. promotion strategies for the general population, and monitoring through wearable devices. It is
Funct. Morphol. Kinesiol. 2023, 8, 44. strongly recommended that governmental entities, health practitioners, and the construction industry
https://doi.org/10.3390/ adhere to “The Global Action Plan on Physical Activity 2018–2030: More Active People for a Healthier
jfmk8020044 World” and implement different salutogenic urban strategies. These strategies aim to generate
Academic Editor: Helmi Chaabene environments that motivate increases in NEPA, such as cycling and walking transportation (between
5000–12,500 steps per day), and the progression to physical exercise. There is a wide variety of
Received: 4 March 2023
electronic devices for personal use, such as accelerometers, smartphone apps, or “smart clothes”,
Revised: 5 April 2023
that allow for the monitoring of NEPA, some with a wide range of analysis variables contributing
Accepted: 7 April 2023
to the estimation of total daily energy expenditure and the promotion of healthy habits. In general,
Published: 11 April 2023
the further promotion and monitoring of NEPA is required as part of a strategy to promote healthy
habits sustainable over time for the prevention and control of obesity and NCDs.

Copyright: © 2023 by the authors. Keywords: sedentary behavior; physical inactivity; non-communicable diseases; activity trackers
Licensee MDPI, Basel, Switzerland.
This article is an open access article
distributed under the terms and
conditions of the Creative Commons 1. Introduction
Attribution (CC BY) license (https://
Obesity is multifactorial, highlighting factors such as genetics, age, sex, and nutrition,
creativecommons.org/licenses/by/
among many others [1]. Physical inactivity is one of the main causes of this condition
4.0/).

J. Funct. Morphol. Kinesiol. 2023, 8, 44. https://doi.org/10.3390/jfmk8020044 https://www.mdpi.com/journal/jfmk

J. Funct. Morphol. Kinesiol. 2023, 8, 44 2 of 16

that leads to metabolic alterations, considering the importance of the locomotor system
and physical effort in the communication between tissues and organs (cross-talking) at a
systemic level [2]. The combination of excessive energy intake and physical inactivity act
synergistically as the main causes of obesity [3]. Over time, adaptation to a positive caloric
balance and physical inactivity generates physiological negative feedback mechanisms
to an eventual reduction in energy intake, which is common in body fat loss programs.
This is mainly due to the decrease in resting energy expenditure and the fluctuation in the
serum concentration of orexigenic/anorexigenic hormones [4]. Besides effective fat mass
reduction, another challenge is to avoid regaining it after a diet or exercise intervention.
Many people who lose fat mass eventually regain most of it in the long term [5,6]. In recent
decades, emphasis was placed on strategies that seek to increase non-exercise physical
activity (NEPA), such as walking or active transportation [7], to increase physical activity
levels and the subsequent levels of non-exercise activity thermogenesis (NEAT). However,
in most people, NEAT is the second largest contributor to total caloric expenditure, and
it was reported that individuals with obesity, compared to lean individuals, have a lower
NEAT [8], which increases the risk of obesity.
It should be considered that physical inactivity results in a decrease in physical fit-
ness [9], which has an impact on the health of the individual because the latter is also a
risk factor for all-cause cardiovascular morbidity and mortality [10,11]. Considering the
importance of NEPA in the control of excess weight and obesity, the aim of this review
was (i) to evaluate the impact of NEAT on obesity management and indicators, and (ii) to
address aspects of NEPA related to conceptualization, promotion strategies for the general
population, and quantification through portable devices.

2. Methods
Taking into account that narrative synthesis often lacks transparency and that synthesis
methods are rarely reported [12], previous guidelines on the development of a narrative
review outlined by Dixon-Woods et al. [13] and Peters et al. [14] were followed. In brief, the
identification, selection, evaluation, and synthesis of the available literature were performed
to summarize the body of knowledge related to NEPA to be used for practitioners [15].
The first version of the manuscript was conducted as part of the capstone project required
by the ‘Specialization in Physical Activity and Health’ degree program at Universidad de
Córdoba (Montería, Colombia). Experts and researchers in the field collaborated remotely
on revising the draft before final approval.

2.1. Information Sources

The primary sources for the articles were the following online databases: PubMed/
MEDLINE, Web of Science, and Google Scholar.

2.2. Search Strategy

The following Boolean algorithm was used: (“NEAT” OR “non-exercise activity
thermogenesis” OR “unstructured physical activity” OR “non-exercise physical activity”)
AND obesity. In order to perform some search specifications, reserved symbols were taken
into account (e.g., quotation marks to track keywords literally). Additionally, a manual
search was performed in Google Scholar.

2.3. Findings Presentation

The narrative discussion was aligned with individual articles and interpretations of
relevant articles by organizing it into sections: (i) non-exercise physical activity; (ii) energy
expenditure from non-exercise physical activity; (iii) promotion strategies; (iv) technological
monitoring of non-exercise physical activity.
J. Funct. Morphol. Kinesiol. 2023, 8, 44 3 of 16

3. Non-Exercise Physical Activity

From a classical perspective, physical activity is defined as “any bodily movement
produced by skeletal muscles that results in an expenditure of energy”, a definition that
was adopted by the World Health Organization (WHO) [16] and several organizations
and researchers [17–20]. However, for Piggin [21], this definition may be reductionist or
simplistic; therefore, a more holistic definition with implications in the educational context,
research, and public policies is required. This author states that physical activity “implies
that people move, act, and perform within culturally specific spaces and contexts, and are
influenced by a unique variety of interests, emotions, ideas, instructions, and relationships”.
We consider that this definition complements the classic concept (mechanical view), as it
invites practitioners to reflect on aspects related to why, for what purpose, or how a person
performs (or does not perform) physical activity.
Physical activity comprises a wide range of categories or types. In particular, NEPA,
which is also described as unstructured or informal physical activity, refers to those activities
that require movement of the human body and thereby generate energy expenditure
(which depends on the activities’ duration and intensity, among other variables) and that
are performed daily without planning or strict control of the physical effort made. This
includes climbing stairs, dancing, domestic or work activities, walking, cycling to work,
playing, gardening, and walking pets, among many other activities [7]. Unlike physical
exercise, NEPA does not have systematic programming that is planned, structured, and
purposeful physical activity (e.g., improving physical fitness). However, physical activity
includes NEPA, exercise, and other types of body movement [22].
The effects of physical activity on health have been consistently evidenced. In this
regard, the reduction of cardiovascular risk and the improvement of body composition with
physical exercise programs, both strength and endurance, are widely documented [23–26].
However, NEPA has not received the same attention, and it is important to consider it
as a necessary complement when seeking to control excess body fat and different types
of pathologies related to physical inactivity. This has a very important connotation, con-
sidering that more than half of the world’s population has insufficient levels of physical
activity. This represents a public health problem because physical inactivity is one of
the main factors causing mortality worldwide (~6%); in addition, it is the main cause of
ischemic heart disease (~30%), diabetes (~27%), and breast and colon cancer (~21% and
25%, respectively) [27].
Besides physical inactivity, sedentary behavior increases the risk of non-communicable
disease and mortality. At this point, it should be noted that although often used interchange-
ably, physical inactivity and sedentary behavior are not the same, which is important for
risk factor analysis and intervention strategy purposes. Sedentary behavior is any waking
behavior characterized by an energy expenditure of 1.5 metabolic equivalents (METs) while
sitting, reclining, or lying down (e.g., watching TV, driving). In contrast, physical inactivity
is a level of physical activity insufficient to meet current recommendations for substantial
health benefits, which, in adults, the WHO states is “150 to 300 min of moderate-intensity
physical activity; or at least 75–150 min of vigorous-intensity physical activity; or an equivalent
combination of moderate- and vigorous-intensity activity during the week” [28]. Under this
perspective, sedentary behavior and physical inactivity are two behavioral risk factors that are
closely related, but each exerts and interacts with each other, affecting health. This has been
highlighted in observational studies, in which high sedentary behavior (>8 h/day) and low
levels of physical activity (2–5 MET-hours/week) were associated with higher mortality. How-
ever, with higher levels of physical activity (35.5 MET-hours/week), this mortality is lower. In
particular, people with low sedentary behavior (<4 h/day) and high levels of physical activity
(35.5 MET-hours/week) show low mortality compared to the aforementioned conditions [29]
(Figure 1).
J. Funct. Morphol.
J. Funct. Kinesiol.
Morphol. 2023,
Kinesiol. 8, 44
2023, 8, x FOR PEER REVIEW 4 of 417
of 16

Figure
Figure1.1.Associations
Associationsofofsitting
sitting time,
time, television viewingtime,
television viewing time,and
andphysical
physical activity
activity with
with all-cause
all-cause
mortality.
mortality. (A)Analysis
(A) Analysisofofsitting
sittingtime
time (n
(n = 1,005,791)
1,005,791)and
and(B)
(B)television
televisionviewing
viewingtime
time(n (n
= 465,450) as as
= 465,450)
well
well asas theirrelationship
their relationshiptotophysical
physical activity
activity levels
levels and
andmortality risk[29]
mortalityrisk .
[29].

4. 4.Energy
EnergyExpenditure
Expenditurefrom
from Non-Exercise PhysicalActivity
Non-Exercise Physical Activity
TheThereduction
reductionof ofbody
body mass,
mass, or more
more specifically,
specifically,body bodyfat,fat,isisa afunction
function of of a negative
a negative
caloric
caloricbalance
balance induced
induced by by dietary
dietarymanipulation
manipulation andand physical
physical activity,
activity, whichwhich
mustmustbe in be
inaccordance
accordance with
with thethe needs
needs of each
of each subjectsubject and sustained
and sustained over time over
[30].time [30]. control-
However, However,
controlling
ling the energy the energy
balance balance
is difficultis difficult due to factors
due to several severalthatfactors that arelinked
are mainly mainly to linked
caloric to
expenditure.
caloric expenditure.
TheThetraditional
traditionalmodelmodelofoftotal
totaldaily
dailyenergy
energyexpenditure
expenditureininhumans humansisiscomposed
composedofofthe
theof
sum sum theofenergy
the energy allocated
allocated to thetomaintenance
the maintenance ofbasal
of the the basal metabolic
metabolic rate,rate,
the the thermic
thermic effect
ofeffect
food, of andfood,
the and the physical
physical activity expenditure.
activity energy energy expenditure. Basal metabolic
Basal metabolic rate is therate is the
minimum
minimum
amount amount
of energy of energyinexpended
expended in all homeostatic
all homeostatic processes ofprocesses
the body.ofItthe body. It the
represents repre-
basic
sents the
energy basic energyofrequirements
requirements our body’s organs of our body(e.g.,sbrain,
organsgut,(e.g., brain, gut,
kidneys, kidneys,
heart, liver,heart,
muscle,
liver,
etc.) and muscle,
comprisesetc.) and
thecomprises the largest of
largest proportion proportion
total dailyof total
energy daily energy expenditure
expenditure (~60–70%).
Basal metabolic rate is assessed after rest and fasting (10–12 h) with theh)subject
(~60–70%). Basal metabolic rate is assessed after rest and fasting (10–12 with the subjectin a
awake,
awake, in a prone position, and under thermoneutral conditions.
prone position, and under thermoneutral conditions. It should be noted that the evaluation It should be noted that
the evaluation of resting energy expenditure is more frequent due
of resting energy expenditure is more frequent due to practical considerations that are not to practical considera-
tions
met whenthat evaluating
are not met whenbasal evaluating
metabolic basal metabolic
rate [31]. rate [31].effect
The thermic The thermic
of food effect of food
is the energy
is the energy expenditure associated with the process of the
expenditure associated with the process of the digestion, absorption, and assimilation digestion, absorption, and
assimilation processes of food; it represents between ~6–12% of total daily energy ex-
processes of food; it represents between ~6–12% of total daily energy expenditure and
penditure and is a relatively stable component. The thermic effect of food is proportional
is a relatively stable component. The thermic effect of food is proportional to caloric
to caloric intake, and the differences between lean and obese subjects are small; further-
intake, and the differences between lean and obese subjects are small; furthermore, there
more, there is insufficient evidence to demonstrate a relationship between the thermic ef-
is insufficient evidence to demonstrate a relationship between the thermic effect of food
fect of food and the development of obesity [32]. The physical activity energy expenditure
and the development of obesity [32]. The physical activity energy expenditure comprises
comprises energy expenditure from physical exercise (structured PA) and NEPA; both
energy expenditure from physical exercise (structured PA) and NEPA; both components
components vary widely within and between individuals.
vary widely within and between individuals.
It is important to note that both NEAT and NEPA are not interchangeable but repre-
It is important
sent complementary to note that both
concepts; NEAT NEAT andtoNEPA
refers energy areexpenditure,
not interchangeablewhereas but NEPArepresent
de-
complementary concepts; NEAT refers to energy expenditure,
scribes types of body activity that are not defined as purposeful movements but contribute whereas NEPA describes
types of body
to NEAT. activity NEAT
Specifically, that are not defined
corresponds to as
all purposeful
of the energymovements
expenditurebut contribute
of all activities to
NEAT. Specifically, NEAT corresponds to all of the energy expenditure
that are not physical exercise, such as daily chores or work, leisure activities, sitting, stand- of all activities that
are not physical exercise, such as daily chores or work, leisure activities,
ing, walking, singing, dancing, and others [8]. It should be noted that a certain percentage sitting, standing,
walking, singing,physical
of spontaneous dancing, and others
activity, which[8]. It should
is part of NEAT,be is
noted
beyondthatvoluntary
a certaincontrol
percentage
(e.g., of
spontaneous physical activity,
ʺrestless leg movementʺ while sitting). which is part of NEAT, is beyond voluntary control (e.g.,
"restless leg movement" while sitting).
Studies on NEAT have focused their attention on the prevention and control of obesity.
In this regard, a study by Levine et al. [33] showed that obese subjects sat 164 min more
per day than lean subjects; also in addition, lean people were reported to be upright and
J. Funct. Morphol. Kinesiol. 2023, 8, 44 5 of 16

walking for 152 min more per day than obese participants. According to the authors, if obese
individuals adopted behaviors to increase NEAT (e.g., increasing NEPA by walking) similar
to lean subjects, then they could expend an additional ~350 kcal per day. In particular, obese
people are described to have an innate predisposition to sit for 2.5 h per day more than lean
sedentary people, possibly due to factors that induce this, mainly environmental factors [34].
NEAT varies up to 2000 kcal per day among individuals; therefore, its modulation may
play an important role in increasing body mass, as obese subjects show low NEAT values.
The increased use of motorized transportation, mechanized manufacturing, and the
prevalence of labor-saving technology at home and at work, combined with high sedentary
behavior, decrease NEAT [35]. Modifying many of these issues is complex, but strategies
can be employed to increase NEPA. For example, adding 2.5 h of walking per day for office
workers (i.e., people with high sedentary activity) brings benefits for body composition
and increases total physical activity without a compensatory overall effect [36]. There are
potential benefits to increasing NEPA in controlling body fat, but it is important to consider
the limitations of relying solely on this approach. For example, a systematic review by
Silva et al. [37] found that compensatory phenomena were observed in 15 out of 36 clinical
studies, such as increases in NEAT, NEPA, or both, after diet-only, combined diet/exercise,
and exercise-only interventions. The degree and duration of energy imbalance generated
can affect energy conservation in response to increased NEPA. Research has shown that
short-duration continuous exercise programs (<40 min) can increase NEPA as a compen-
satory mechanism, whereas longer protocols (180 min) can lead to a decrease in NEPA. This
response is more pronounced and delayed in overweight than in normal-weight individu-
als [38]. However, despite concerns that an increase in NEPA can lead to compensatory
increases in energy intake, no increases in food cravings have been confirmed with both
protocols. Furthermore, studies by Castro et al. [39] and Romero et al. [40] show that in
obese populations, there is no compensatory increase in caloric intake during physical
exercise programs as long as adequate nutritional guidance is provided. Therefore, an
active lifestyle intervention that involves increasing NEPA and gradually progressing to
physical exercise to increase caloric expenditure is a promising approach to controlling
excess fat mass.

5. Promotion Strategies
As mentioned, physical inactivity and sedentary behavior are of high public health
concern, as there is an interaction between behavioral risk factors that increase risk. For
example, the constant exposure to food advertising during television viewing contributes
to some extent to the modification of diet behavior, that is, the consumption of unhealthy
foods (e.g., processed foods with added sugar) in both children [41] and adults [42]. In
addition, a lifestyle that reduces NEPA and, thereby, energy expenditure may promote an
obesogenic environment; therefore, it was reported that increasing active transportation
(e.g., cycling or walking) and reducing automobile use may reduce the prevalence of obesity
and NCDs [43]. In this sense, each government’s policies should encourage the use of
active means of transportation in addition to incorporating measures to reduce the use
of automobiles. For example, a study by Courtemanche [44] evaluated the relationship
between fuel prices, body mass, and obesity rates. Higher gasoline prices were associated
with a reduction in restaurant use and an increase in walking, which, in turn, was related to
a decrease in body mass. Similarly, the association between fuel prices and physical activity
levels in young adults (18–30 years old) was reported. For example, a $0.25 increase in fuel
price is associated with increased energy expenditure (1.3 METs), which is equivalent to an
increase of three min of walking per week [45].
Strategies to promote NEPA in the general population seek to increase physical activity
levels and reduce sedentary behavior because drastically reducing NEPA increases the
risk of coronary, muscular, nervous system, reproductive, digestive, immune, bone, and
endocrine diseases [46,47] (Figure 2).
 Strategies to promote NEPA in the general population seek to increase physical ac-
tivity levels and reduce sedentary behavior because drastically reducing NEPA increases
J. Funct. Morphol. Kinesiol. 2023, 8, 44 6 of 16
the risk of coronary, muscular, nervous system, reproductive, digestive, immune, bone,
and endocrine diseases [46,47] (Figure 2).

Figure
Figure 2. Effects when
2. Effects when moving
moving from
from high
high to
to low
low levels
levels of
of physical
physical activity,
activity, including
including significant
significant
reductions
reductions in NEPA. Source: designed by the authors (D.A.B.) based on published materials
in NEPA. Source: designed by the authors (D.A.B.) based on published materials [46].
[46].
One of the barriers to physical activity is screen time (TV, PC, smartphone), and
One of the barriers to physical activity is screen time (TV, PC, smartphone), and pro-
promoting NEPA is one strategy to reduce it. To achieve this, individuals can modify the
moting NEPA is one strategy to reduce it. To achieve this, individuals can modify the
configuration of their electronic devices by adjusting the time of use for each application or
configuration of their electronic devices by adjusting the time of use for each application
setting an on/off schedule to generate a pause in their usage period. Blocking smartphone
or setting an on/off schedule to generate a pause in their usage period. Blocking
notifications and uninstalling unnecessary applications (e.g., games and social networks)
smartphone
are notifications
also helpful strategies.and uninstalling
However, unnecessary
for children applicationspositive
and adolescents, (e.g., games and so-
engagement,
cial networks)
guidance, and are also helpful
parental strategies.
influence are keyHowever,
factors in for children
reducing and adolescents,
media-related riskspositive
[48,49].
engagement, guidance, and parental influence are key factors in reducing
In cases where it is not feasible to remove social networking apps for work or academic media-related
risks [48,49].
reasons, peopleIn cases wheregroups
can remove it is notthat
feasible to remove
encourage social networking
polarization, apps for
misinformation, work
outrage,
or academic reasons, people can remove groups that encourage polarization,
and distraction [50]. Another useful strategy is enabling the grayscale display mode in misinfor-
mation, outrage,
Android and iOSand distraction
operating system [50]. Another
devices. useful
This makesstrategy is enabling
browsing the grayscale
social networks less
display mode
attractive and in Android
reduces theand iOS operating
positive system
reinforcement devices. This
generated by the makes
colorbrowsing
ranges used social
in
networks less attractive and reduces the positive reinforcement generated
video games and social networks, thereby reducing screen time [51]. Additional strategies by the color
ranges
for used in population
the general video games and social
include: networks,
establishing thereby
specific reducing
schedules screenany
without time [51]. Ad-
technology;
ditional strategies for the general population include: establishing
creating shared spaces at home for recharging electronic devices; avoiding the use specific schedules with-
of
out any technology; creating shared spaces at home for recharging
electronic devices in bedrooms; using traditional alarm clocks to restrict smartphone electronic devices;
avoiding
use early the usemorning
in the of electronic
and devices in bedrooms;
before going using traditional
to bed; scheduling one day alarm
a weekclocks to re-
without
strict smartphone
smartphone use early smartphone
use; avoiding in the morning useand before
during going
meal to bed;
times; scheduling
taking one day
a walk every daya
week
in without
outdoor smartphone
spaces without use; avoiding
carrying mobilesmartphone
devices oruse during meal
restricting theirtimes;
use intaking a walk
these leisure
every day
spaces in outdoor spaces without carrying mobile devices or restricting their use in
[52,53].
theseOnleisure spaceshand,
the other [52,53].
the progression of time and intensity of NEPA, such as active
transportation (e.g., walking), will not only identify health risk but also encourage physical
activity in subjects with low adherence to physical conditioning programs [54]. For example,
increasing physical activity at the expense of NEPA has clinically relevant effects for healthy
(e.g., untrained) individuals and NCDs, even, in some settings, without reaching the
minimum recommended physical activity [55]. Because of this, and as supported by the
J. Funct. Morphol. Kinesiol. 2023, 8, 44 7 of 16

accumulated evidence on the multiple benefits of physical activity, not only in terms of
health but also in social and economic terms, “The Global Action Plan on Physical Activity
2018–2030: More Active People for a Healthier World” [56] urges countries to implement,
based on normative solutions, actions to promote physical activity and reduce sedentary
lifestyles (Table 1).

Table 1. Public health objectives and actions to promote physical activity and reduce sedentary lifestyles.

Target Components Descriptions/Actions

To achieve a paradigm shift throughout
society by improving the knowledge,
Creating physically Social norms
understanding, and appreciation of the
active societies and attitudes
multiple benefits of regular physical
activity according to ability and at all ages.
To create and maintain environments that
promote and safeguard the rights of all
people, of all ages, to enjoy equitable access
Creating active
Spaces and places to safe places and spaces in their cities and
environments
communities where they can engage in
regular physical activity according to
their abilities.
To create and promote access to
opportunities and programs, in multiple
Promoting active Programs and settings, to help people of all ages and
populations opportunities abilities participate regularly in physical
activity, either alone or with their families
and communities.
To enable elements of governance and
policy to build and strengthen leadership,
governance, multisectoral partnerships,
workforce capacities, advocacy, and
Creating active Governance and policy information systems across sectors to
systems enablers achieve excellence in resource mobilization
and the implementation of coordinated
international, national, and subnational
actions to increase physical activity and
reduce sedentary lifestyles.
Adapted from WHO [56].

It is well-established that green infrastructure in urban environments is an important

element for improving health, as walking in green areas increases NEPA. Governmental
entities and the construction industry should collaborate to design and develop healthy
urban infrastructures that promote NEPA and improve health, not just outside residences
(e.g., pedestrian walkways, parks, sports and recreational areas, and green areas). They
should also consider interior design principles that promote NEPA [57]. Local public
administrations can also take other measures such as closing streets for vehicular transport
on certain days of the week or permanently, creating outdoor lanes for the exclusive use of
cyclists and pedestrians, and relocating parking lots located within urban parks. Building
a road network for the exclusive use of active transportation within cities has also been
repeatedly emphasized [58,59].
Lastly, cities that have these spaces and projects should promote their use through
different local media and encourage their implementation in daily routines. The develop-
ment of salutogenic spaces within homes, workplaces, and educational facilities and their
impact on health, NEPA, and NEAT should be highlighted. Designers and manufacturers
are becoming more aware of the importance of creating suitable environments that promote
the free mobility of older adults with functional limitations and people with disabilities or
excess adiposity [60]. However, given the low implementation of spaces within homes in
J. Funct. Morphol. Kinesiol. 2023, 8, 44 8 of 16

developing countries, the use of devices and sensors that monitor the behavior and track
daily activity is recommended. Various apps can be used on cell phones to promote NEPA
and facilitate the progression to regular physical exercise. Evidence suggests that individ-
uals of different ages and sexes respond positively to using these apps as a persuasive
element, facilitating a synergistic and sequential process of positive behavioral change [61].
This topic is discussed in the next section.

6. Technological Monitoring of Non-Exercise Physical Activity

Although the principle of NEPA does not obey a program in the strict sense, its
evaluation is necessary to control the physical activity performed during a period of time,
estimate caloric expenditure, set goals, and motivate people to increase NEPA. This is highly
relevant for the sedentary population and for those with insufficient physical activity. For
these types of populations, physical activity monitoring is often done using self-reporting
methods (e.g., diaries, questionnaires, and surveys), which are very inexpensive, but
their main error is recall bias [62]; therefore, the information reported by individuals may
present certain impressions. For this reason, new wearable device technologies, including
pedometers, accelerometers, heart rate monitors, and mobile devices, can facilitate the
programming and control of physical activity [63]. Receiving information on various
parameters (e.g., distances and steps taken) from these wearable devices is motivating for
the user, which could be useful in facilitating the adherence to physical activity practice [64].
Moreover, this can motivate behavioral change, particularly due to the opportunities that
arise to provide instant feedback [65].
Several types of wearable devices are available on the market to measure physical
activity, such as accelerometers that measure the magnitude of acceleration and derived
variables [66], and report the information as “counts” per unit of time [67]. Accelerometers
can measure acceleration in one (unixial), two (biaxial), or three planes (triaxial) and are
generally placed as close as possible to the body mass center or at the hip at the level of the
mid-axillary line [67]. These devices provide an objective measure of physical activity that
does not rely on self-reporting; moreover, they are superior to other wearable devices (i.e.,
pedometers) because they measure physical activity intensity and frequency [68]. It should
be noted that movement acceleration is directly proportional to muscle strength and is re-
lated to energy expenditure [69]. Recent advances in accelerometer-based wearable devices
make them a valid technology for the automatic, continuous, long-term measurement of
physical activity and sedentary behavior [66,70,71]. The Michigan Predictive Activity &
Clinical Trajectories in Health (MIPACT) study is a good example of how data collected
from wearable devices can inform clinical trial design, interpretation in clinical practice,
and health-care interventions [72]. Wearable devices represent an important element that
offers new opportunities for conducting decentralized clinical trials [73], which have been
shown to be effective and feasible regarding recruitment, data collection from various
electronic devices, and participant engagement to monitor physiological and behaviometric
(physical activity and sleep patterns) parameters [74]. For practical purposes, Table 2
summarizes some characteristics of commercially available accelerometer-based wearable
devices, many of which are used in research for physical activity quantification.
Pedometers are another type of device usually used to measure physical activity. They
detect vertical accelerations of the hip by activating a lever arm to move vertically and a
ratchet to rotate. They are widely used to measure the number of steps taken by a person
(e.g., steps per day). This is an important consideration, given that walking is a preferred
physical activity during leisure time as well as being a form of transportation, and it is
recommended for most of the population, including older adults and people with NCDs.
J. Funct. Morphol. Kinesiol. 2023, 8, 44 9 of 16

Table 2. Characteristics of some accelerometer-based portable devices.

Device Sensor Sensor Location Advantages/Disadvantages Variables

High concordance to assess PA and EE. Requires
SenseWear,
BodyMedia Inc. (CAM) 2-axis accelerometer Upper arm specific software to interpret data. Low sensitivity in Acceleration and EE (METs).
subjects with functional mobility limitations.
Detailed information on activities of daily living.
CT1/RT3, StayHealthy Inc. May present difficulties in manipulation (switching Activities of daily living (NEPA) and displacements
Wrist or
(CAM/ 3-axis accelerometer hip (RT3)
RGAM) on/off) in older individuals or persons with (as vector magnitude units).
disabilities or mobility difficulties.
Due to its dimensions, it is comfortable to use for Activities of daily living (NEPA), vertical and
AMP331, Dynastream
2-axis accelerometer Ankle several consecutive days. Useful to control the horizontal accelerations, number of steps, frequency
Innovations Inc. (CAM)
intensity of physical exercise. and stride speed, and EE.
High concordance to assess PA and EE. Small device
wGT3X-BT, Actigraph LLC 3-axis accelerometer, and easy location. Requires specific software to
time-of-use sensor, Wrist or hip Acceleration (as vector magnitude units) and EE.
(RGAM) ambient light sensor interpret data. Overestimates EE when using motor
vehicle transportation.
Portable device designed to track and monitor
physical activity. Useful for persons with lower-limb
disabilities or mobility difficulties. High precision Activities of daily living, duration and pause time
StepWatch, Orthocare and measures PA on different surfaces such as soil, between them (walking, jogging, running or
2-axis accelerometer Ankle
Innovations (CAM) grass, carpets, etc. High cost compared to other sprinting, and sitting or standing), EE, steps per
devices. It needs to be calibrated to ensure accurate minute, moderate-to-vigorous PA, and total PA.
results. Some people find it uncomfortable to wear
the device on their ankle or wrist all day.
Useful for different populations (children, older
Activities of daily living (NEPA) and displacements
adults, and patients with chronic diseases) and more
activPAL, PAL Technologies (body inclinations in degrees). Light and
Accelerometer Thigh user-friendly. Expensive device. Must be placed on
Ltd. (CAM) moderate-to-
upper thigh, which is uncomfortable for some users. vigorous PA.
Not water-resistant.
Uses several sensors on different parts of the body at
the same time (foot, ankle, thigh, and chest).
Requires constant adjustment of the sensors to avoid
Chest, thigh, or loss of information. Underestimates EE in Activities of daily living (NEPA), HR, EE, and
IDEEA, MiniSun (CAM) 2-axis accelerometer
ankle continuous static arm activities such as cycling or acceleration.
arm exercises and slow walking. Slightly
overestimates EE in other NEPA activities. Not
water-resistant.
J. Funct. Morphol. Kinesiol. 2023, 8, 44 10 of 16

Table 2. Cont.

Device Sensor Sensor Location Advantages/Disadvantages Variables

Compatible with a variety of applications (apps) and
fitness platforms. Low cost. Not very accurate in PA Activities of daily living, duration and pause time
Inspire, Fitbit Inc. (CAM) 3-Axis Accelerometer Wrist or hip measurement and does not measure HR between them (walking, jogging, running or
continuously, limiting the measurement of sprinting, and sitting or standing), and EE.
moderate-to-vigorous PA. Low battery life.
VivoFit 4, Garming Ltd. Compatible with the Garmin Connect app and is Activities of daily living (NEPA), sleep quality, EE,
Accelerometer Wrist
(CAM) water-resistant. No GPS and no HR. and total PA.

Vivomove HR, Garming Ltd. Accelerometer, barometer, Compatible with the Garmin Connect app, long Activities of daily living (NEPA), EE and total PA,
photoplethysmography, Wrist
(CAM) ambient light sensor battery life, and water-resistant. and sleep monitoring.

Mi Band 3, Xiami Corp. 3-axis accelerometer, Compatible with the Mi Fit app, water-resistant, and
Wrist Activities of daily living (NEPA), EE, and total PA.
(CAM) photoplethysmography affordable price. No GPS and no HR.
3-axis accelerometer, Multisport tracking, connected GPS, and an OLED
Pulse HR, Withings (CAM) photoplethysmography, Wrist screen that displays full smartphone notifications for HR, training zones, and sleep quality.
ambient light sensor calls, texts, events, and all of your favorite apps.
3-axis accelerometer, day Compatible with the Health Mate app, Activities of daily living (NEPA), EE and total PA,
Steel HR, Withings (CAM) Wrist
and night motion sensor water-resistant, and call and message notification. sleep monitoring, EE, and HR.
Good concordance to assess PA and EE during
physical exercise. Very high correlation when
TriTrac-R3D, Madison, WI, Activities of daily living (NEPA),
3-Axis Accelerometer Hip evaluating HR in children. Does not show good
USA EE, and acceleration.
accuracy in sedentary individuals. Requires software
to estimate total EE (kJ/min).
CAM: consumer activity monitor; EE: energy expenditure; GPS: Global Positioning System; HR: heart rate; METs: metabolic equivalents; PA: physical activity; RAM: research-grade
activity monitor. Based on [71,75].
J. Funct. Morphol. Kinesiol. 2023, 8, 44 11 of 16

Pedometer use was shown to be associated with increased physical activity, decreased
body mass, and lower blood pressure [76]. Furthermore, the promotion of physical activity
through walking can be promoted using these devices so that monitoring the number of
steps per day allows the recommended levels of physical activity to be achieved. In this
regard, recommendations were made on how many steps per day are sufficient to obtain
health benefits in the healthy adult population [77] (Table 3).

Table 3. Classification of physical activity based on the number of steps per day.

Steps per Day Physical Activity Level

<5000 Insufficiently active
5000–7499 Somewhat active
7500–9999 Moderately active
>10,000 Active
>12,500 Highly active
Adapted from Tudor-Locke and Bassett [77].

Many recommendations on “steps per day” to increase physical activity have as

criteria the 10,000 steps per day documented by Hultquist et al. [78] in physically inactive
women, who walked more when advised to achieve 10,000 steps per day compared to those
instructed to walk 30 min per day. Nevertheless, several clarifications should be made: first,
the initial level of physical activity, physical condition, and state of health of the individuals
should be considered, given that for some, this will be an attainable goal without major
problems, but for others, it could represent a difficulty (e.g., people with very poor physical
condition, musculoskeletal limitations, or some pathology that limits walking). Therefore,
this should be done progressively. On the other hand, the generic recommendation of
10,000 steps per day only focuses on the number of steps taken and not on the intensity
of physical activity. Given this, then, we must emphasize that the recommendations to
increase the number of steps per day represent one more way to promote and increase the
amount of physical activity, and in this way, it should be a complementary way within the
strategies to improve health and prevent or control excess body fat.
Of the two types of wearable devices mentioned previously, pedometers may be
the most feasible, due to their practicality and cost-effectiveness, to determine NEPA in
people’s daily lives [62]. However, the pedometer, compared to the accelerometer, cannot
provide any temporal information about NEPA patterns because it does not store data [66].
Additionally, the “shuffling” gait pattern, which may be present in some older adults
and in the obese population, may also contribute to pedometer errors in detecting actual
steps taken; however, the use of pedometers and even smartphones that have sensors
(e.g., accelerometers and gyroscopes) is recommended in the apparently healthy and obese
adult population [75]. People have a greater preference for user-friendly smartphone apps
because they allow automatic tracking, generate greater motivation, offer individualized
feedback, and facilitate the establishment of goals, such as steps taken, distance traveled,
calories expended, time of activity performed, and comparison with other users [79,80].
Among the various available apps, SMART MOVE, POWeR and POWeR Tracker, SMART
MOVE GPS, short messaging service (SMS), My Meal Mate, Mobile Pounds Off Digitally
(Mobile POD), Endomondo, Speedo Fit, Nike + Fuel, Pedometer++, Runkeeper, and Fitbit
are some of the most popular platforms that require external sensors and personal computer
use [81]. For a comprehensive review of wearable devices research trends, readers are
encouraged to refer to Kageyama et al. (2022) [82].
For children or the elderly population with permanent pathologies or disabilities, the
use of “smart clothing” can be a potential alternative. This technology is discreet and based
on hetero-core fiber optic sensors, textile electrodes, and inertial measurement units that
transmit and process information on mobile devices such as tablets or smartphones [83].
These devices monitor NEPA and other important physiological vital signs, such as heart
J. Funct. Morphol. Kinesiol. 2023, 8, 44 12 of 16

rate, blood pressure, respiratory rate, body temperature, arterial oxygen saturation, and
blood glucose, among others. Additionally, it allows for permanent biomechanical monitor-
ing of the person through location algorithms, sensors such as gyroscopes, magnetometers,
and barometric pressure sensors, among other systems, for preventing or developing a
fall, body imbalance, hours of rest, and other activities of daily life. Smart shirts from
HeddokoTM , Hexoskin, Cityzen Sciences, Ralph Lauren Polo, and Athos are good examples
of this technology [84].

7. Conclusions
There is consistent evidence that shows the benefits of physical exercise on health
and, specifically, their effects on the reduction of fat mass of the overweight and obese
populations. However, the recovery from body mass loss, after a physical exercise pro-
gram, constitutes an important challenge in the intervention of excess weight and obesity;
additionally, strategies are required at the public health level to promote regular activity
practice. In the general population, NEPA should be increased as a strategy for preventing
and controlling excess fat mass by promoting the use of active transportation (e.g., walking
and cycling) to increase NEAT and, thereby, total daily energy expenditure. Likewise,
sedentary activities should be reduced by modifying or replacing them with activities that
involve NEPA (e.g., family walks, traditional games, musical activities, and creating active
environments and systems, among others). The evaluation and control of NEPA can be
done through wearable devices such as smartphones, which allow tracking activity and, in
this way, establishing goals regarding the fulfillment of “steps per day” and progression
to physical exercise according to the individual’s ability or limitations. In line with this,
improvements to NEPA should consider aspects of motivation, tastes for types of activity,
and the ease with which it can be carried out (e.g., schedules, working hours, facilities, and
urban designs), with which the aim is to achieve adherence and changes in the subject’s
habits and lifestyles. Thus, NEPA constitutes a sustainable long-term strategy for prevent-
ing and controlling obesity as a complement to physical exercise (which should include
strength training) and nutrition programs.
Although promoting NEPA is an important strategy for preventing and controlling
obesity, addressing the systemic factors contributing to sedentary behavior and physical
inactivity is also critical. Creating active environments, such as safe and accessible parks
and bike lanes, and promoting policies that incentivize physical activity, such as workplace
wellness programs and school physical education requirements, are examples of how this
can be done. Additionally, efforts should be made to address structural inequities and
barriers that prevent certain populations, such as low-income and minority communities,
from participating in physical activity. We can work toward a more comprehensive and
effective approach to reducing excess weight and obesity and promoting health for all by
addressing these broader factors and promoting NEPA at the individual level.

Author Contributions: Conceptualization, J.O.P.-A., J.A.B.-H. and D.A.B.; writing—original draft

preparation, J.O.P.-A., J.A.B.-H., D.A.B. and J.L.P.; visualization, D.A.B.; writing—critical review and
editing, L.A.C., S.V.-M., J.R.S., R.C. and R.B.K. All authors have read and agreed to the published
version of the manuscript.
Funding: This research received no external funding.
Institutional Review Board Statement: Not applicable.
Informed Consent Statement: Not applicable.
Data Availability Statement: Not applicable.
Acknowledgments: We would like to thank the research assistants at DBSS International.
Conflicts of Interest: D.A.B. is a certified Anthropometrist (Instructor) of the International Society
for the Advancement of Kinanthropometry and has conducted academic-sponsored physical activity
research. S.V.-M. receives honoraria for personalized training services and is the manager of a physical
J. Funct. Morphol. Kinesiol. 2023, 8, 44 13 of 16

fitness center. J.R.S. conducted industry-sponsored research on exercise science over the past 25 years.
R.B.K. has conducted sponsored studies on the safety and efficacy of the Curves® fitness and weight
loss program that examined its short and long-term effects on health-related outcomes. The other
authors declare no conflicts of interest. All authors are responsible for the content of this article.

References
1. Hruby, A.; Hu, F.B. The Epidemiology of Obesity: A Big Picture. Pharmacoeconomics 2014, 33, 673–689. [CrossRef] [PubMed]
2. Argilés, J.M.; Campos, N.; Lopez-Pedrosa, J.M.; Rueda, R.; Rodriguez-Mañas, L. Skeletal Muscle Regulates Metabolism via
Interorgan Crosstalk: Roles in Health and Disease. J. Am. Med. Dir. Assoc. 2016, 17, 789–796. [CrossRef]
3. Chakravarthy, M.V.; Booth, F.W. Eating, exercise, and “thrifty” genotypes: Connecting the dots toward an evolutionary under-
standing of modern chronic diseases. J. Appl. Physiol. 2004, 96, 3–10. [CrossRef] [PubMed]
4. Rosenbaum, M.; Leibel, R.L. 20 years of leptin: Role of leptin in energy homeostasis in humans. J. Endocrinol. 2014, 223, T83–T96.
[CrossRef] [PubMed]
5. Sawamoto, R.; Nozaki, T.; Nishihara, T.; Furukawa, T.; Hata, T.; Komaki, G.; Sudo, N. Predictors of successful long-term weight
loss maintenance: A two-year follow-up. BioPsychoSocial Med. 2017, 11, 14. [CrossRef]
6. Kruger, J.; Blanck, H.M.; Gillespie, C. Dietary and physical activity behaviors among adults successful at weight loss maintenance.
Int. J. Behav. Nutr. Phys. Act. 2006, 3, 17. [CrossRef]
7. Laddu, D.; Paluch, A.E.; LaMonte, M.J. The role of the built environment in promoting movement and physical activity across the
lifespan: Implications for public health. Prog. Cardiovasc. Dis. 2021, 64, 33–40. [CrossRef]
8. Von Loeffelholz, C.; Birkenfeld, A. The role of non-exercise activity thermogenesis in human obesity. In Endotext; Feingold, F., Ed.;
MDText.Com, Inc: South Dartmouth, MA, USA, 2018.
9. Caspersen, C.J.; Powell, K.E.; Christenson, G.M. Physical activity, exercise, and physical fitness: Definitions and distinctions for
health-related research. Public Health Rep. 1985, 100, 126–131. [PubMed]
10. Castillo-Garzón, M.J.; Ruiz, J.R.; Ortega, F.B.; Gutiérrez, Á. Anti-aging therapy through fitness enhancement. Clin. Interv. Aging
2006, 1, 213–220. [CrossRef] [PubMed]
11. Kyu, H.H.; Bachman, V.F.; Alexander, L.T.; Mumford, J.E.; Afshin, A.; Estep, K.; Veerman, J.L.; Delwiche, K.; Iannarone, M.L.;
Moyer, M.L.; et al. Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke
events: Systematic review and dose-response meta-analysis for the Global Burden of Disease Study 2013. BMJ (Clin. Res. Ed.)
2016, 354, i3857. [CrossRef] [PubMed]
12. Campbell, M.; Katikireddi, S.V.; Sowden, A.; Thomson, H. Lack of transparency in reporting narrative synthesis of quantitative
data: A methodological assessment of systematic reviews. J. Clin. Epidemiol. 2019, 105, 1–9. [CrossRef] [PubMed]
13. Dixon-Woods, M.; Bonas, S.; Booth, A.; Jones, D.R.; Miller, T.; Sutton, A.J.; Shaw, R.L.; Smith, J.A.; Young, B. How can systematic
reviews incorporate qualitative research? A critical perspective. Qual. Res. 2016, 6, 27–44. [CrossRef]
14. Peters, M.D.J.; Marnie, C.; Tricco, A.C.; Pollock, D.; Munn, Z.; Alexander, L.; McInerney, P.; Godfrey, C.M.; Khalil, H. Updated
methodological guidance for the conduct of scoping reviews. JBI Evid. Implement. 2021, 19, 3–10. [CrossRef]
15. Lisy, K.; Porritt, K. Narrative Synthesis. Int. J. Evid.-Based Healthc. 2016, 14, 201. [CrossRef]
16. World Health Organization. Physical Activity. Available online: https://www.who.int/news-room/fact-sheets/detail/physical-
activity (accessed on 14 January 2023).
17. Westerterp, K. Physical Activity and Physical Activity Induced Energy Expenditure in Humans: Measurement, Determinants,
and Effects. Front. Physiol. 2013, 4, 90. [CrossRef]
18. American College of Sports Medicine. ACSM’s Guidelines for Exercise Testing and Prescription; Lippincott Williams & Wilkins:
Philadelphia, PA, USA, 2014.
19. Wärnberg, J.; Cunningham, K.; Romeo, J.; Marcos, A. Physical activity, exercise and low-grade systemic inflammation. Proc. Nutr.
Soc. 2010, 69, 400–406. [CrossRef]
20. Centers for Disease Control and Prevention. Glossary. Available online: https://www.cdc.gov/nchs/nhis/physical_activity/pa_
glossary.htm (accessed on 14 January 2023).
21. Piggin, J. What Is Physical Activity? A Holistic Definition for Teachers, Researchers and Policy Makers. Front. Sport. Act. Living
2020, 2, 72. [CrossRef] [PubMed]
22. Organización Mundial de la Salud. Estrategia Mundial Sobre Régimen Alimentario, Actividad Física y Salud. Actividad Física.
Available online: https://www.who.int/dietphysicalactivity/pa/es/ (accessed on 14 January 2023).
23. Beltaifa, L.; Chaouachi, A.; Zérifi, R.; Boussaidi, L.; Bouzrati, I.; Abid, A.; Elkhadi, A.; Chamari, K.; Raies, A. Walk-Run Transition
Speed Training as an Efficient Exercise Adjunct to Dietary Restriction in the Management of Obesity: A Prospective Intervention
Pilot Study. Obes. Facts 2011, 4, 45–52. [CrossRef] [PubMed]
24. Villareal, D.T.; Aguirre, L.; Gurney, A.B.; Waters, D.L.; Sinacore, D.R.; Colombo, E.; Armamento-Villareal, R.; Qualls, C. Aerobic or
Resistance Exercise, or Both, in Dieting Obese Older Adults. N. Engl. J. Med. 2017, 376, 1943–1955. [CrossRef]
25. Cauza, E.; Hanusch-Enserer, U.; Strasser, B.; Ludvik, B.; Metz-Schimmerl, S.; Pacini, G.; Wagner, O.; Georg, P.; Prager, R.;
Kostner, K.; et al. The Relative Benefits of Endurance and Strength Training on the Metabolic Factors and Muscle Function of
People With Type 2 Diabetes Mellitus. Arch. Phys. Med. Rehabil. 2005, 86, 1527–1533. [CrossRef] [PubMed]
J. Funct. Morphol. Kinesiol. 2023, 8, 44 14 of 16

26. Görner, K.; Reineke, A. The influence of endurance and strength training on body composition and physical fitness in female
students. J. Phys. Educ. Sport 2020, 2020, 8. [CrossRef]
27. World Health Organization. Noncommunicable Diseases Country Profiles 2014; World Health Organization: Geneva, Switzerland, 2014.
28. World Health Organization. WHO Guidelines on Physical Activity and Sedentary Behaviour: At a Glance; World Health Organization:
Geneva, Switzerland, 2020.
29. Ekelund, U.; Steene-Johannessen, J.; Brown, W.J.; Fagerland, M.W.; Owen, N.; Powell, K.E.; Bauman, A.; Lee, I.M. Does physical
activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of
data from more than 1 million men and women. Lancet 2016, 388, 1302–1310. [CrossRef] [PubMed]
30. Aragon, A.A.; Schoenfeld, B.J.; Wildman, R.; Kleiner, S.; VanDusseldorp, T.; Taylor, L.; Earnest, C.P.; Arciero, P.J.; Wilborn, C.;
Kalman, D.S.; et al. International society of sports nutrition position stand: Diets and body composition. J. Int. Soc. Sport. Nutr.
2017, 14, 16. [CrossRef] [PubMed]
31. Herrera-Amante, C.A.; Ramos-Garcia, C.O.; Alacid, F.; Quiroga-Morales, L.A.; Martinez-Rubio, A.J.; Bonilla, D.A. Development
of alternatives to estimate resting metabolic rate from anthropometric variables in paralympic swimmers. J. Sport. Sci. 2021, 39,
2133–2143. [CrossRef] [PubMed]
32. Granata, G.P.; Brandon, L.J. The thermic effect of food and obesity: Discrepant results and methodological variations. Nutr. Rev.
2002, 60, 223–233. [CrossRef] [PubMed]
33. Levine, J.A.; Lanningham-Foster, L.M.; McCrady, S.K.; Krizan, A.C.; Olson, L.R.; Kane, P.H.; Jensen, M.D.; Clark, M.M. Interindi-
vidual Variation in Posture Allocation: Possible Role in Human Obesity. Science 2005, 307, 584–586. [CrossRef]
34. Levine, J.A.; Vander, M.W.; Hill, J.O.; Klesges, R.C. Non-Exercise Activity Thermogenesis. Arterioscler. Thromb. Vasc. Biol.
2006, 26, 729–736. [CrossRef]
35. Chung, N.; Park, M.-Y.; Kim, J.; Park, H.-Y.; Hwang, H.; Lee, C.-H.; Han, J.-S.; So, J.; Park, J.; Lim, K. Non-exercise activity
thermogenesis (NEAT): A component of total daily energy expenditure. J. Exerc. Nutr. Biochem. 2018, 22, 23–30. [CrossRef]
36. Malaeb, S.; Perez-Leighton, C.E.; Noble, E.E.; Billington, C. A “NEAT” Approach to Obesity Prevention in the Modern Work
Environment. Workplace Health Saf. 2019, 67, 102–110. [CrossRef]
37. Silva, A.M.; Judice, P.B.; Carraca, E.V.; King, N.; Teixeira, P.J.; Sardinha, L.B. What is the effect of diet and/or exercise interventions
on behavioural compensation in non-exercise physical activity and related energy expenditure of free-living adults? A systematic
review. Br. J. Nutr. 2018, 119, 1327–1345. [CrossRef]
38. Liu, X.M.; Wang, K.; Zhu, Z.; Cao, Z.B. Compensatory effects of different exercise durations on non-exercise physical activity,
appetite, and energy intake in normal weight and overweight adults. Front. Physiol. 2022, 13, 932846. [CrossRef] [PubMed]
39. Castro, E.A.; Peinado, A.B.; Benito, P.J.; Galindo, M.; Gonzalez-Gross, M.; Cupeiro, R.; Group, P.S. What is the most effective
exercise protocol to improve cardiovascular fitness in overweight and obese subjects? J. Sport Health Sci. 2017, 6, 454–461.
[CrossRef] [PubMed]
40. Romero Moraleda, B.; Morencos, E.; Peinado, A.B.; Bermejo, L.; Gomez Candela, C.; Benito, P.J.; on behalf of the PRONAF Study
Group. Can the exercise mode determine lipid profile improvements in obese patients? Nutr. Hosp. 2013, 28, 607–617. [CrossRef]
[PubMed]
41. Gomez-Miranda, L.M.; Briones-Villalba, R.A.; Ortiz-Ortiz, M.; Aburto-Corona, J.A.; Bonilla, D.A.; Pozos-Parra, P.; Espinoza-
Gutierrez, R.; Calleja-Nunez, J.J.; Moncada-Jimenez, J.; Hernandez-Lepe, M.A. Association between Body Mass Index with
Sugar-Sweetened and Dairy Beverages Consumption in Children from the Mexico-USA Border. Int. J. Environ. Res. Public Health
2022, 19, 6403. [CrossRef]
42. Harris, J.L.; Bargh, J.A.; Brownell, K.D. Priming effects of television food advertising on eating behavior. Health Psychol. 2009,
28, 404–413. [CrossRef]
43. Brown, V.; Moodie, M.; Cobiac, L.; Mantilla Herrera, A.M.; Carter, R. Obesity-related health impacts of fuel excise taxation- an
evidence review and cost-effectiveness study. BMC Public Health 2017, 17, 359. [CrossRef]
44. Courtemanche, C. A Silver Lining? The Connection between Gasoline Prices and Obesity. Econ. Inq. 2011, 49, 935–957. [CrossRef]
45. Hou, N.; Popkin, B.M.; Jacobs, D.R.; Song, Y.; Guilkey, D.K.; He, K.; Lewis, C.E.; Gordon-Larsen, P. Longitudinal trends in gasoline
price and physical activity: The CARDIA study. Prev. Med. 2011, 52, 365–369. [CrossRef]
46. Booth, F.W.; Laye, M. Lack of adequate appreciation of physical exercise’s complexities can pre-empt appropriate design and
interpretation in scientific discovery. J. Physiol. 2009, 587, 5527–5539. [CrossRef] [PubMed]
47. Booth, F.W.; Roberts, C.K.; Thyfault, J.P.; Ruegsegger, G.N.; Toedebusch, R.G. Role of Inactivity in Chronic Diseases: Evolutionary
Insight and Pathophysiological Mechanisms. Physiol. Rev. 2017, 97, 1351–1402. [CrossRef]
48. Abi-Jaoude, E.; Naylor, K.T.; Pignatiello, A. Smartphones, social media use and youth mental health. CMAJ 2020, 192, E136–E141.
[CrossRef]
49. Chen, L.; Shi, J. Reducing Harm From Media: A Meta-Analysis of Parental Mediation. J. Mass Commun. Q. 2018, 96, 173–193.
[CrossRef]
50. Ochs, C.; Sauer, J. Curtailing smartphone use: A field experiment evaluating two interventions. Behav. Inf. Technol.
2021, 41, 3598–3616. [CrossRef]
51. Myers, E.; Drees, E.T.; Cain, J. An Intervention Utilizing the Salience Principle to Reduce Pharmacy Students’ Psychological
Attraction to Smartphones. Am. J. Pharm. Educ. 2022, 86, 8717. [CrossRef]
J. Funct. Morphol. Kinesiol. 2023, 8, 44 15 of 16

52. Choksi, S.T. A Study to Find Out the Correlation of Mobile Phone Addiction with Anxiety, Depression, Stress and Sleep Quality
in the College Students of Surat City. Int. J. Curr. Res. Rev. 2021, 13, 137–142. [CrossRef]
53. Oswald, T.K.; Rumbold, A.R.; Kedzior, S.G.E.; Moore, V.M. Psychological impacts of “screen time” and “green time” for children
and adolescents: A systematic scoping review. PLoS ONE 2020, 15, e0237725. [CrossRef]
54. Tudor-Locke, C.; Hatano, Y.; Pangrazi, R.P.; Kang, M. Revisiting “How Many Steps Are Enough?”. Med. Sci. Sport. Exerc. 2008,
40, S537–S543. [CrossRef] [PubMed]
55. Warburton, D.E.R.; Bredin, S.S.D. Health benefits of physical activity: A systematic review of current systematic reviews.
Curr. Opin. Cardiol. 2017, 32, 541–556. [CrossRef] [PubMed]
56. Organización Mundial de la Salud. Actividad Física para la Salud: Más Personas Activas para un Mundo más Sano: Proyecto de
Plan de Acción Mundial sobre Actividad Física 2018–2030: Informe del Director General; Organización Mundial de la Salud: Geneva,
Switzerland, 2018.
57. Hansen, M.M.; Jones, R.; Tocchini, K. Shinrin-Yoku (Forest Bathing) and Nature Therapy: A State-of-the-Art Review. Int. J.
Environ. Res. Public Health 2017, 14, 851. [CrossRef] [PubMed]
58. Marselle, M.R.; Stadler, J.; Korn, H.; Irvine, K.N.; Bonn, A. Biodiversity and Health in the Face of Climate Change; Springer: Cham,
Switzerland, 2019.
59. Després, C.; Larivière-Lajoie, A.A.; Tremblay-Lemieux, S.; Legault, M.; Piché, D. Healthy Schools, Healthy Lifestyles: Literature
Review. In Health and Well-Being for Interior Architecture, 1st ed.; Kopec, D., Ed.; Routledge: Oxfordshire, UK, 2017; pp. 123–136.
60. Sanford, J.A.; Hernandez, S.C. Universal design, design for aging in place, and habilitative design in residential environments. In
Health and Well-Being for Interior Architecture, 1st ed.; Kopec, D., Ed.; Routledge: Oxfordshire, UK, 2017; pp. 137–147.
61. Coughlin, S.S.; Whitehead, M.; Sheats, J.Q.; Mastromonico, J.; Smith, S. A Review of Smartphone Applications for Promoting
Physical Activity. Jacobs J. Community Med. 2016, 2, 021.
62. Sallis, J.F.; Saelens, B.E. Assessment of Physical Activity by Self-Report: Status, Limitations, and Future Directions. Res. Q. Exerc.
Sport 2015, 71, 1–14. [CrossRef] [PubMed]
63. Thakkar, H.K.; Chowdhury, S.R.; Bhoi, A.K.; Barsocchi, P. Applications of wearable technologies in healthcare: An analytical
study. In 5G IoT and Edge Computing for Smart Healthcare; Kumar Bhoi, A., Nath Sur, S., Costa de Albuquerque, V.H., Barsocchi, P.,
Eds.; Academic Press: London, UK, 2022; Volume 1, pp. 279–299.
64. Western, M.J.; Peacock, O.J.; Stathi, A.; Thompson, D. The understanding and interpretation of innovative technology-enabled
multidimensional physical activity feedback in patients at risk of future chronic disease. PLoS ONE 2015, 10, e0126156. [CrossRef]
65. Patel, M.S.; Asch, D.A.; Volpp, K.G. Wearable devices as facilitators, not drivers, of health behavior change. JAMA
2015, 313, 459–460. [CrossRef] [PubMed]
66. Freedson, P.S.; Miller, K. Objective monitoring of physical activity using motion sensors and heart rate. Res. Q. Exerc. Sport 2000,
71, S21–S29. [CrossRef] [PubMed]
67. Broderick, J.M.; Ryan, J.; O’Donnell, D.M.; Hussey, J. A guide to assessing physical activity using accelerometry in cancer patients.
Support. Care Cancer 2014, 22, 1121–1130. [CrossRef]
68. Robertson, W.; Stewart-Brown, S.; Wilcock, E.; Oldfield, M.; Thorogood, M. Utility of accelerometers to measure physical activity
in children attending an obesity treatment intervention. J. Obes. 2011, 2011, 398918. [CrossRef]
69. Hills, A.P.; Mokhtar, N.; Byrne, N.M. Assessment of physical activity and energy expenditure: An overview of objective measures.
Front. Nutr. 2014, 1, 5. [CrossRef]
70. Yang, Y.; Schumann, M.; Le, S.; Cheng, S. Reliability and validity of a new accelerometer-based device for detecting physical
activities and energy expenditure. PeerJ 2018, 6, e5775. [CrossRef]
71. Yang, C.; Hsu, Y. A Review of Accelerometry-Based Wearable Motion Detectors for Physical Activity Monitoring. Sensors 2010,
10, 7772–7788. [CrossRef]
72. Golbus, J.R.; Pescatore, N.A.; Nallamothu, B.K.; Shah, N.; Kheterpal, S. Wearable device signals and home blood pressure data
across age, sex, race, ethnicity, and clinical phenotypes in the Michigan Predictive Activity & Clinical Trajectories in Health
(MIPACT) study: A prospective, community-based observational study. Lancet Digit. Health 2021, 3, e707–e715. [CrossRef]
73. Pennestri, F.; Banfi, G.; Tomaiuolo, R. Remote decentralized clinical trials: A new opportunity for laboratory medicine. Clin. Chem.
Lab. Med. 2023; Online ahead of print. [CrossRef] [PubMed]
74. Ali, Z.; Valk, T.J.; Bjerre-Christensen, T.; Brandt, S.; Isberg, A.P.; Jensen, M.L.; Helledi, L.S.; Kaas, A.; Thomsen, S.F.; Andersen,
A.D.; et al. Exploring Decentralized Glucose and Behaviometric Monitoring of Persons with Type 2 Diabetes in the Setting of a
Clinical Trial. J. Diabetes Sci. Technol. 2023, 17, 117–124. [CrossRef]
75. Hartung, V.; Sarshar, M.; Karle, V.; Shammas, L.; Rashid, A.; Roullier, P.; Eilers, C.; Maurer, M.; Flachenecker, P.; Pfeifer, K.; et al.
Validity of Consumer Activity Monitors and an Algorithm Using Smartphone Data for Measuring Steps during Different Activity
Types. Int. J. Environ. Res. Public Health 2020, 17, 9314. [CrossRef]
76. Bravata, D.M.; Smith-Spangler, C.; Sundaram, V.; Gienger, A.L.; Lin, N.; Lewis, R.; Stave, C.D.; Olkin, I.; Sirard, J.R. Using
pedometers to increase physical activity and improve health: A systematic review. JAMA 2007, 298, 2296–2304. [CrossRef]
77. Tudor-Locke, C.; Bassett, D.R. How Many Steps/Day Are Enough? Sport. Med. 2004, 34, 1–8. [CrossRef] [PubMed]
78. Hultquist, C.N.; Albright, C.; Thompson, D.L. Comparison of walking recommendations in previously inactive women. Med. Sci.
Sport. Exerc. 2005, 37, 676–683. [CrossRef] [PubMed]
J. Funct. Morphol. Kinesiol. 2023, 8, 44 16 of 16

79. Jiang, X.; Ming, W.K.; You, J.H. The Cost-Effectiveness of Digital Health Interventions on the Management of Cardiovascular
Diseases: Systematic Review. J. Med. Internet Res. 2019, 21, e13166. [CrossRef]
80. Gentili, A.; Failla, G.; Melnyk, A.; Puleo, V.; Tanna, G.L.D.; Ricciardi, W.; Cascini, F. The cost-effectiveness of digital health
interventions: A systematic review of the literature. Front. Public Health 2022, 10, 787135. [CrossRef] [PubMed]
81. Mollee, J.S.; Middelweerd, A.; Kurvers, R.L.; Klein, M.C.A. What technological features are used in smartphone apps that promote
physical activity? A review and content analysis. Pers. Ubiquitous Comput. 2017, 21, 633–643. [CrossRef]
82. Kageyama, I.; Kurata, K.; Miyashita, S.; Lim, Y.; Sengoku, S.; Kodama, K. A Bibliometric Analysis of Wearable Device Research
Trends 2001-2022-A Study on the Reversal of Number of Publications and Research Trends in China and the USA. Int. J. Environ.
Res. Public Health 2022, 19, 16427. [CrossRef] [PubMed]
83. Koyama, Y.; Nishiyama, M.; Watanabe, K. Physical activity recognition using hetero-core optical fiber sensors embedded in a
smart clothing. In Proceedings of the 2018 IEEE 7th Global Conference on Consumer Electronics (GCCE), Nara, Japan, 9–12
October 2018; pp. 71–72.
84. Wang, Z.; Yang, Z.; Dong, T. A Review of Wearable Technologies for Elderly Care that Can Accurately Track Indoor Position,
Recognize Physical Activities and Monitor Vital Signs in Real Time. Sensors 2017, 17, 341. [CrossRef] [PubMed]

Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual
author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to
people or property resulting from any ideas, methods, instructions or products referred to in the content.