Received: 26 May 2022 Revised: 13 November 2022 Accepted: 13 January 2023

DOI: 10.1111/obr.13554

REVIEW
Obesity Management / Intervention

Life course research in physical activity: Pathway to Global

Action Plan 2030

Chitra Sharma 1 | Kiran D. K. Ahuja 1 | Bharati Kulkarni 2 | Nuala M. Byrne 2 |

1
Andrew P. Hills

1
School of Health Sciences, College of Health
and Medicine, University of Tasmania, Summary
Launceston, Tasmania, Australia
Current global trends in physical activity levels demonstrate that the world is not on
2
Division of Reproductive Biology Maternal
and Child Health and Nutrition, Indian Council
track to achieve the 2030 target set by the Global Action Plan. The Action Plan pos-
of Medical Research, Ansari Nagar, New Delhi, ited that physical activity should be an integral component of “daily lives” of all indi-
India
viduals “across the life course.” Potential contributions to achieve global physical
Correspondence activity goals include the utilization of compositional data analysis and life course epi-
Prof. Andrew P. Hills, School of Health
Sciences, College of Health and Medicine,
demiology to provide a framework for the composite nature of physical activity and
University of Tasmania, Locked Bag 1322, complex life course relationships. Combining these two traditionally disconnected
Launceston, Tasmania 7250, Australia.
Email: andrew.hills@utas.edu.au fields represents a paradigm shift in physical activity research. Here, we discuss how
these combined fields enable a reinterpretation of previous research findings and
Funding information
This is a review; hence, there is no funding
explore their impact on policy and potential advantages and challenges. Careful con-
source. sideration needs to be given to the implications of both fields remaining discon-
nected and the alternate option of consolidation to realize ambitions.

KEYWORDS
compositional data analysis, Global Action Plan on Physical Activity 2030, life course, physical
activity

1 | I N T RO DU CT I O N underscores the importance of physical activity (PA) in maximizing the

health status at all ages, including prevention and management of
Public health priorities have been impacted by two important transi- NCDs.5 Recent initiatives, including the Global Action Plan on Physical
tions over past decades, namely, a significant increase in life expec- Activity (GAPPA) 2030, highlights the international stature of PA and
tancy1 and a dramatic increase in prevalence of noncommunicable suggestion that PA be a component of “daily lives” of all individuals
2
diseases (NCDs) at almost all ages, and across income settings. As “across the life course.”6 Current trends demonstrate that global
3,4
these trends are projected to continue, public health systems must levels of PA have stalled since at least 2001 with over a quarter of
rapidly evolve to meet the unique needs of each age group and adults and four-fifths of adolescents not meeting PA guidelines in
extend the healthspan of populations. Consistent evidence 2016.7,8
Against this backdrop, life course epidemiology and compositional
data analysis (CoDa) underline the importance of addressing the
Abbreviations: BEE, basal energy expenditure; CoDa, compositional data analysis; DAG,
directed acyclic graphs; DLW, doubly labeled water; GAPPA 2030, Global Action Plan on dynamic and time-varying nature of PA at the core of the research
Physical Activity 2030; LIPA, light intensity physical activity; MVPA, moderate and vigorous framework.9,10 Life course epidemiology provides a framework to
physical activity; NCDs, noncommunicable diseases; PA, physical activity; PAEE, physical
activity energy expenditure; SB, sedentary behavior; TEE, total energy expenditure; WHO,
understand the variation in PA across one's lifetime and generations
World Health Organization. and its association with health.9 CoDa, an analytical method of time-

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium,
provided the original work is properly cited.
© 2023 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of World Obesity Federation.

Obesity Reviews. 2023;24:e13554. wileyonlinelibrary.com/journal/obr 1 of 9

https://doi.org/10.1111/obr.13554

2 of 9
use epidemiology, accounts for PA, for example, performed via differ-
ent intensities, to be constrained within a fixed amount of time, usu-
ally a 24-h day, along with sleep.10 Importantly, these two disciplines
together provide an enhanced approach to address the evidence gaps
highlighted by the World Health Organization (WHO) 2020 PA guide-
lines group. Evidence gaps are related to assessing complex associa-
tions between PA components with multiple, often interrelated,
lifespan health effects such as development and maintenance of phys-
11
ical and cognitive function. The analogy of a 24-h day and lifetime
are consistent with GAPPA's mandate outlined earlier.6 Despite the
emergence of life course epidemiology and CoDa in the 1980–1990s,
and introduction into PA research in late 2000s, both fields are still
underutilized. Both disciplines have been developing on separate
tracks (see Figure 1)12–28 with little evidence of attempts to bring
them together in PA research.
This paper critically evaluates current PA research methods and
their adequacy to support evolving public health priorities, critical
gaps, existing opportunities in an integrated model of life course epi-
demiology and CoDa, plus future challenges. PA research methods
may be considered from the perspective of three interrelated compo-
nents, conceptual models, statistical methods, and data acquisition
tools. Here, we discuss the first two components.
F I G U R E 1 Physical activity research is developing in two separate streams, namely, life course epidemiology and compositional data analysis
(CoDa). Is it time they merged?
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SHARMA ET AL.
1.1 | Re-evaluation of current research methods
against life course epidemiology
Observational cohorts and interventions are the commonly used con-
ceptual models to assess associations between PA and mortality.19
These models are applied to study one or more life stages,19 such as
midlife or elderly, and the evidence is sequentially arranged to create
a life course picture.29 This might lead to aberrations, like an
inexplicable change in PA guidelines at 18 years, such as moderate
and vigorous PA (MVPA) of an average of 60 min per day changes to
150–300 min per week.29,30 Alternatively, studies with decades of
follow-up spanning multiple life stages are limited to assessing
summary associations over the longitudinal cohort time.31–33 Notably,
these studies recognize the need to assess pathways to a health
endpoint, in this case mortality, by attempting to assess variations by
health status like blood pressure, BMI, or PA itself.31,33,34
Further, recent research has attempted to describe the life course
trajectory of PA by combining individual studies with participants of
different age-groups, conducted at different time periods over the
past two to four decades.20,35,36 PA energy expenditure (PAEE) trajec-
tory quickly rose from neonate to middle childhood, followed by a
steep decline up to young adulthood, thereafter stabilizing and finally

SHARMA ET AL.
declining at varying rates from midlife to nonagenarian.20 This PAEE
trajectory was predicted based on observed life course trajectory of
total energy expenditure (TEE) and basal energy expenditure (BEE),
obtained by combining 120 studies of doubly labeled water (DLW)
and indirect calorimetry.20 These findings are supported by two meta-
analyses of accelerometer-based longitudinal observational studies, in
35,36
children aged 3–18 and 5–18 years, respectively. They show a
36
declining trajectory of MVPA, especially at middle childhood, and an
inclined trajectory of sedentary behavior (SB) from middle
childhood.35
Despite these attempts, existing conceptual models are overly
simplistic to understand the PA variation across the life course and its
association with the health characteristics of interest.9 At a basic level,
none of the PA life course trajectory studies account for the variation
9,37
by income settings or birth cohort effect. For instance, the latter
were seen in worsening BMI trajectories from the 1940s to 2000s for
people of white ethnicity living in the United Kingdom with newer
birth cohorts having a higher probability of overweight or obesity dur-
ing childhood and adulthood, experiencing overweight as adults a
decade earlier, and people with overweight or obesity having much
38
higher BMI thresholds.
1.2 | Why life course epidemiology?
Life course epidemiology operationalizes the idea of “life course”
where exposures across one's lifetime, and by extension generations,
are assimilated into lifestyle behaviors and body system structure and
physiology.9,39 Consider the case of transitioning rural South Asia
where rapid changes are being seen in the built environment, at least
40–42
since the 1980s. These changes are brought about by economic
development, globalization, and increased mechanization and are
associated with reduced PA and adverse health outcomes.40–42 Socio-
economic surveys of household assets and occupation vividly capture
this phenomenon. Standard approaches are rudimentary in their
ability to assess the effect of a determinant that changes over time,
for example, shift in occupation, on the health outcome of interest,
such as PA.9 Further, standard approaches do not account for com-
plex relationships where the determinant itself influences one or more
covariates to change over time, say, shift in occupation associated
with use of motorized transport or screen time.9 Standard approaches
introduce bias as illustrated in the following paragraphs. An enhanced
approach can address these issues and, in addition, provide life stage
specific insights on the role of a determinant such as shift in occupa-
tion, in life course trajectories of PA for population subgroups.9
Recently, life course epidemiology was highlighted for its recogni-
19
tion of the complex nature of multilevel determinants that com-
monly vary across the life span, and by extension, generations,
influencing each other.9 For instance, a common phenomenon of life
course studies is time-dependent confounding, where a future covari-
ate, say, adult health status, is influenced by the determinant of inter-
est, for example, adolescent BMI.9,19,43 Using standard analytical
1467789x, 2023, 5, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13554 by CAPES, Wiley Online Library on [16/05/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
3 of 9
techniques results in bias and instead requires g-methods, provided all
the variables have been measured at requisite time points.9,19,43
Another often repeated bias is the reversal paradox where a
future covariate on the causal pathway is erroneously adjusted while
assessing the effect of a baseline determinant, say, adult BMI is
adjusted when assessing the association between adolescent BMI and
adult PA.44 Intuitively, this removes the effect of the baseline determi-
nant via the future covariate and further induces other erroneous rela-
tionships depending on the causal diagram at hand.44,45 Life course
analytical methods based on Bayesian or counterfactual theory are
required to isolate the effect of a determinant at each life stage.43,46
For instance, a seminal life course analysis based on Bayesian
methods, using the United States's nationwide longitudinal study
(1994–2014), found a >90% probability that body weight at midlife
was associated to a larger degree with colorectal cancer genes, com-
pared with weight at earlier life stages, namely, birth, adolescence,
and young adulthood.46
By extension, such complex relationships can exist in relatively
short-term intervention trials aiming to improve cardiometabolic
health by targeting interconnected lifestyle determinants.12,47 Using
standard analysis techniques leads to counterintuitive conclusions
that are inconsistent with other evidence5,12 such as PA acting solely
through change in body weight to improve cardiometabolic health.47
Beyond addressing the complex nature of determinants, life
course epidemiology provides a framework to assess the life course
trajectories of a health characteristic of interest. It is vital to assess life
course trajectories, such as for blood pressure, rather than endpoints,
like incidence of hypertension or a cardiovascular event, to under-
stand the key life stages where adverse changes occur and the associ-
ated determinants at each life stage and consequently identify
opportunities for early intervention.9 Additional insights are gained
from studying trajectories that highlight the different pathways taken
by population subgroups, due to differing contributions of determi-
nants at different life stages, to reach the same disease endpoint such
as incidence of hypertension.9,48 For instance, blood pressure trajec-
tories diverge in subgroups due to determinants across the life course
such as socioeconomic status.48 Additionally, determinants act at spe-
cific life stages such as in utero associated with mother's smoking,
pre-eclampsia status, and gestational diabetes and hypertension, or at
adolescence associated with pubertal growth, or at adulthood associ-
ated with cardiorespiratory fitness, pregnancy complications, and
treatment interventions.48
It follows that life course epidemiology gives due importance to
mechanisms and is reflected in its models that quantify the effect of
exposure at each life stage such as critical, sensitive, and accumulation
or direct, indirect, and total effects.9,43,49 Life course epidemiology
improves both the validity of findings and feasibility and effectiveness
of interventions by highlighting key determinants at each life stage for
population subgroups.9,19,39 Finally, it can be used to predict hypo-
thetical complex interventions.12 For instance, Taubman et al12
through the Nurses' Health Study estimated that the effect of a hypo-
thetical lifestyle intervention, including improved diet, PA, tobacco

4 of 9
and alcohol use, and BMI, would reduce coronary heart disease risk
from the current 3
5% to 1
9% over two decades (1982–2002).
1.3 | Status accorded to life course epidemiology
The PA field is yet to capitalize on the idea of “life course” to tap into
a rapidly evolving discipline that has developed specific theoretical
frameworks, analytical techniques, and long-term data acquisition
methods.9 Evidence from a handful of life course epidemiology stud-
ies broadly concurs with findings from standard research on the pro-
tective role of MVPA for all-cause and cardiovascular-related
19
mortality. However, life course epidemiology was applied to a lim-
ited extent in their design and analysis, missing core concepts like
including three or more life stages important to the research ques-
50,51 43
tion and using directed acyclic graphs (DAGs). Notably, none of
these studies used CoDa or objective PA data. On the policy side, the
term “life course” is prominent in the WHO 2020 PA guidelines29;
5
however, the evidence base for all-cause and cardiovascular mortal-
ity in adults contains no studies based on “life course
epidemiology.”19
1.4 | Re-evaluation of current research methods
against CoDa
The evidence gaps highlighted in the WHO 2020 PA guidelines are
related to understanding individual or joint effects of components of
one or more PA dimensions, including energy expenditure, intensity,
aerobic, posture and its control, exerting force on muscle or bone,
11
behavior or type, and context or domain. PA dimensions are often
assessed as absolute unbounded values either individually or in com-
bination, say, MVPA or muscle strengthening exercises.10 Importantly,
standard generalized linear models used to assess the effect of
component(s) of a PA dimension, such as intensity categorized based
on its relevance to health as SB, light intensity PA (LIPA), and MVPA,
cannot account for all PA components due to issues of multicollinear-
ity, resulting in residual confounding.10,28
1.5 | Why CoDa?
CoDa overcomes this analytical impediment by recognizing the inher-
ent nature of PA being a proportion, forming a subcomponent of a
fixed 24-h day, along with sleep.10,28 PA can be further divided and
commonly used are PA intensities SB, LIPA, and MVPA.10,28 It follows
that these subcomponents are mutually exclusive forming an exhaus-
tive list of the whole 24-h day and co-dependent with any change in a
subcomponent occurring relative to others.10 This essentially trans-
lates to analyzing and interpreting results associated with a PA sub-
component relative to others in a 24-h day, as per geometric rules of
10,28
the simplex space. Common practice is to analyze the data using
standard generalized linear models after transforming absolute PA
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SHARMA ET AL.
values to isometric log ratios of relevant pairs of PA subcompo-
nents.10,28 An unintended benefit is that these transformed values are
less likely to be affected by multicollinearity enabling inclusion of all
PA covariates in a single model.28
PA central tendency and dispersion are usually plotted on a trian-
gle, called a ternary diagram, or tetrahedron representing the simplex
sample space.10 Predictive region from a standard Gaussian distribu-
tion were shown to lie outside the ternary diagram of the simplex
sample space, akin to lying outside the limits of a 24-h day.10 Further,
MVPA was beneficially associated with BMI if level of MVPA
increased by reducing SB and maintaining adequate sleep time using
the Longitudinal Study of Australian Children (2013–2014).10 Stan-
dard methods do not acknowledge the trade-off in risks and benefits
when MVPA is increased over other behaviours.10
It follows that CoDa improves both the validity of findings10,28
and feasibility of PA interventions by giving due credence to practical
constraints of a 24-h day in day-to-day living.25 CoDa-based conclu-
sions complement previous research on the effect of PA on all-cause
mortality, providing an expanded menu of options to individuals.26
For instance, CoDa-based research, in midlife to elderly residents in
the United States, provided customized MVPA and LIPA guidelines
based on the SB duration of a population subgroup to achieve a spe-
cific level of all-cause mortality risk reduction.26
1.6 | Status accorded to CoDa
CoDa has been limited to research and policy in high-income
countries,52 receiving impetus by a global consensus statement on
analytical approaches of composite PA data.28 Notably, CoDa-based
research did not inform the WHO 2020 PA guidelines for all-cause
and cardiovascular mortality in adults, a health outcome prioritized by
the guidelines.5,29 Similarly, CoDa-based research did not inform
WHO PA guidelines for children under 5 years of age, albeit guide-
lines were framed for a 24-h day and CoDa-based research was
highlighted in some background reviews.53 Finally, future research
requirements outlined by the WHO guidelines made no mention of
CoDa.11
2 | POTENTIAL SYNERGY OF COMBINING
LIFE CO URSE EP IDEM IOL OGY AND CODA
To date, life course epidemiology and CoDa have been disconnected,
and therefore, operated independently (see Figure 1). What are the
benefits of moving toward a consolidated approach? (See Table 1.)
The consolidation of both fields would allow a unified evidence
base to inform policy and interventions. To illustrate, an integrated
model would comprehensively address the evidence gaps highlighted
by the WHO 2020 PA guidelines related to multiple, often interre-
lated, health effects of PA components across one's life.11 At the basic
level, research validity will be substantially improved by employing
statistical methods to concurrently address PA as a composite variable
 TABLE 1 Applying the integrated model of life course epidemiology and compositional data analysis in physical activity research.
Research scenarios
Life course studies
Functional or behavioural life course
trajectories, for example, blood
pressure, PA
Multiple pathways across the life
course to a health endpoint, for
example, incidence of hypertension
Effect of a single determinant, that
changes across life stages, on body
structure, physiology, or lifestyle,
for example, life course PA on adult
cardiovascular risk
Short-term studies
Observational cohort studies with
interconnected determinants that
influence each other across time, for
example, PA and body weight on
cardiometabolic health
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Resources needed
Advantages of using an integrated model Conceptual diagrams, for Life course Compositional
SHARMA ET AL.
of life course and CoDa example, DAGs data data on PAa Statistical methodsa
• Early intervention, primordial ✓ ✓ Latent Growth Model (LGM), Multilevel
prevention Model (MLM), or Growth Mixture Model
• Underscores GAPPA's aim of “PA (GMM) integrated with CoDa
across life” and “in daily lives”
• Validity of analysis is improved (e.g.,
change in PA is within the simplex
space)
• Equitable research that serves all ✓ ✓ Growth mixture model (GMM) integrated
population subgroups with CoDa
• Improves effectiveness of interventions
• Underscores GAPPA's aim of “PA
across life” and “in daily lives” and “PA
for all”
• Validity of analysis is improved (e.g.,
change in PA is within the simplex
space)
• Validity of analysis is improved (e.g., ✓ ✓ ✓ Counterfactual or Bayesian methods
treatment-confounder feedback, no integrated with CoDa
residual confounding as all PA
components are included)
• Identifies life stage(s) where the
determinant has most effect, and
improves effectiveness of intervention
• Identifies different combinations of PA
at a life stage that has an acceptable
level of effect, and improves the
effectiveness of interventions
• Underscores GAPPA's aim of “PA
across life” and “in daily lives” and “PA
for all”
• Validity of analysis is improved (e.g., ✓ ✓ g-methods integrated with CoDa
treatment-confounder feedback, no
residual confounding as all PA
components are included)
• Albeit residual confounding from
covariates of previous life stages
remains
(Continues)
5 of 9
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6 of 9 SHARMA ET AL.

and secondly the interconnected and time-varying nature of determi-

nants and covariates over the life course.9,10

Composite PA data and analysis (e.g., CoDa) is not applicable if the research question warrants treating PA as non-composite, for example, multicomponent PA with overlapping categories such as aerobic,
Understanding pathways and contribution of determinants across
the life course will avoid the pitfall of patching together “life course”

g-methods integrated with CoDa

evidence from studies that address individual life stages.39 Likewise,
studies that address individual PA subparts, say, MVPA, LIPA, and SB,
cannot be used for an integrated evidence base for “composite” PA.10
Statistical methodsa

Consistent methods across studies will allow synthesis of findings, like

meta-analysis, and opportunity to analyze any heterogeneity in
findings by explanatory variables beyond study methods, such as
country-income group. Finally, the effectiveness and efficiency of
interventions will improve by concurrently focusing on key
determinants specific to each life stage and recognizing the diverse
demands on an individual's time within the limits of a 24-h day.25,39
Compositional

Abbreviations: CoDa, compositional data analysis; DAG, directed acyclic graphs; GAPPA, Global Action Plan on Physical Activity 2030; PA, physical activity.
data on PAa

3 | FO U N D A T I O NA L W O R K R E Q U I RE D
✓

FO R A N I N T EG R A TE D M OD E L
Life course

A first step toward a consolidated approach is to recognize multiple

data

levels at which life course epidemiology and CoDa would need to be

integrated (see Figure 2*). The three interconnected levels of this dia-
gram are conceptual models and statistical and data acquisition tools
Conceptual diagrams, for

that operationalize each in the field. Life course epidemiology would

naturally encompass time-use epidemiology, the conceptual basis of
Resources needed

CoDa, at each level including in its integrated model of aging.9

example, DAGs

A consolidated approach can be developed by adapting and learn-

ing from current practice in these two or other fields. For instance, at
the statistical level, CoDa works in tandem with standard generalized
✓

linear models by using transformed values of PA such as isometric log

ratios.10,28 Could a similar approach be used for life course analytical
• Identifies different combinations of PA

• Identifies different combinations of PA

Advantages of using an integrated model

that has an acceptable level of effect,

that has an acceptable level of effect

• Validity of analysis is improved (e.g.,

models that use Bayesian or counterfactual theory?54 Interpretation

treatment-confounder feedback, no
and improves the effectiveness of

and improves the effectiveness of

of evidence from a combined model can be learnt from other fields54

residual confounding as all PA

and guided by the research question being answered.

components are included)

Maturing birth cohorts in high-income countries provide the

of life course and CoDa

• Prediction modelling

opportunity for life course research.39 However, developments in

interventions

interventions

*A first step toward a consolidated approach is to recognize multiple levels at which life
course epidemiology and compositional data analysis (CoDa) would need to be integrated.
The three interconnected levels of this diagram are conceptual models and statistical and
data acquisition tools that operationalize each in the field. Life course epidemiology would
naturally encompass time-use epidemiology, the conceptual basis of CoDa, at each level
strengthening, balance, and flexibility components.

including in its integrated model of aging. While developing a consolidated approach, we

should appreciate that each discipline, life course epidemiology and CoDa, is dynamic and
undergoing rapid development at each level of the diagram. Public health research aims drive
the need for the conceptual models to evolve, which in turn direct the development of
interconnected determinants, for

statistical and data acquisition tools; the tools delimit the operationalization of the
example, lifestyle change on

conceptual models on the ground (solid arrow). It follows that the limitations of these three
levels—conceptual, statistical, and data tools—determine the research aims that can be
cardiometabolic health

answered. Finally, for a given research question, directed acyclic graphs (DAGs) are invaluable
Interventions targeting
(Continued)

in bringing together the conceptual models and the statistical and data tools to create a
working model (dotted arrow). DAGs are informed at the base by existing causal knowledge
Research scenarios

of the research question, overlaid with data limitations, such as availability and comparability
across life stages, and measurement bias relevant to the particular study. Given this visual
representation, DAGs guide decisions for statistical analysis such as covariates to include in
the model to address confounding or need for g-methods if treatment-confounder feedback
TABLE 1

is identified. Public policy changes and funding are required to propel the field from the
current status quo to an integrated model of life course epidemiology and CoDa. This would
help to prioritize the development of conceptual and statistical tools, future data acquisition,
and researcher capacity development toward an integrated model.
a

SHARMA ET AL.
FIGURE 2 An integrated model of life course epidemiology and time-use epidemiology.
measurement tools for PA and sleep across a 24-h day would need to
be balanced by comparability across lifetime or birth cohorts.55 A cri-
terion method has been suggested where the PA variable of interest,
say, PAEE, is derived separately for each type of PA tool, such as for
55
uniaxial and triaxial accelerometers. The method to derive the PA
variable of interest should be pre-validated against a suitable gold
55
standard in the population of interest. Importantly, the validity of
the PA tool is given due weight by calculating the “uncertainty of the
estimate” for both the derived variable of interest, say, PAEE, and any
subsequent association, such as PAEE and cardiovascular risk.55
While developing a consolidated approach, we should appreciate
that each discipline, life course epidemiology and CoDa, is dynamic
9,10
and undergoing rapid development at each level of the diagram.
This makes it challenging to be skilled in the best practice of both
fields at once. Public health research aims drive the need for the con-
ceptual models to evolve, which in turn direct the development of sta-
tistical and data acquisition tools9,10; the tools delimit the
operationalization of the conceptual models on the ground (see
Figure 2, solid arrow).9,10 Both fields have seen rapid development in
statistical methods over the past few decades9,10; however, several
challenges remain. To illustrate, CoDa has the issue of true zeros, that
is, when values are truly absent as opposed to missing, that either
results in loss of the particular sample or other less than satisfactory
approaches.10 Similarly, availability of data and its comparability
9
across the life course significantly impact the feasibility of research.
It follows that the limitations of these three levels determine the
research aims that can be answered.
Finally, for a given research question, DAGs are invaluable in
bringing together the conceptual models and the statistical and data
tools to create a working model (see Figure 2, dotted arrow). DAGs
are informed at the base by existing causal knowledge of the research
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7 of 9
question, overlaid with data limitations, such as availability and com-
parability across life stages, and measurement bias relevant to the par-
ticular study.43 Given this visual representation, DAGs guide decisions
for statistical analysis such as covariates to include in the model to
address confounding or need for g-methods if time-dependent con-
founding is identified.43 Thus, DAGs are a transparent and effective
communication mode of study methods employed and their strengths
and limitations, invaluable in complex life course research.
Public policy changes and funding are required to propel the field
from the current status quo to an integrated model of life course epi-
demiology and CoDa (see Figure 2). This would help to prioritize the
development of conceptual and statistical tools, future data acquisi-
tion, and researcher capacity development toward an integrated
model. Researchers and universities can review how current research
can adopt an integrated approach (see Table 1). Short-term studies
can improve their validity by using g-methods for time-dependent
confounding. Research on life course determinants of 24-h PA data
can benefit from using counterfactual theory and related analysis,
with individual and household-level determinants usually available.
Research assessing the effect of life course MVPA can be assessed
with CoDa using a composite form of MVPA domains. Depending on
the research question, lack of LIPA, SB, and sleep data would result in
residual confounding, as they currently do in studies using standard
methods.
4 | CONC LU SION
PA research is only beginning to benefit from two relatively underuti-
lized disciplines, life course epidemiology and CoDa. Implications of
maintaining the status quo, that is, both fields remaining disconnected,

8 of 9
are illustrated in Figure 1. The alternate option of consolidation holds
promise for achieving the mandate of the 2030 PA Action Plan (see
Table 1). A robust discussion at both research and policy levels around
the potential synergy of combining both fields, and pathways to
achieving an integrated approach, is urgently required.
AUTHOR CONTRIBUTIONS
Chitra Sharma conceptualized, wrote the original draft, and edited the
subsequent drafts. Kiran D. K. Ahuja, Bharati Kulkarni, Nuala
M. Byrne, and Andrew P. Hills critically reviewed and edited the draft.
ACKNOWLEDGMENTS
Open access publishing facilitated by University of Tasmania, as part
of the Wiley - University of Tasmania agreement via the Council of
Australian University Librarians.
CONF LICT OF IN TE RE ST ST AT E MENT
None declared.
ORCID
Chitra Sharma https://orcid.org/0000-0002-8942-9692
Kiran D. K. Ahuja https://orcid.org/0000-0002-0323-4692
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How to cite this article: Sharma C, Ahuja KDK, Kulkarni B,
Byrne NM, Hills AP. Life course research in physical activity:
Pathway to Global Action Plan 2030. Obesity Reviews. 2023;
24(5):e13554. doi:10.1111/obr.13554