4.3. Limitations and Strengths
MetS
This study has a few limitations. First, as this was a cross-sectional analysis, we could not determine the causal associations between MetS and PA. Second, the cross-sectional analysis does not take into account the temporal change in activity for the 3 exposure groups during the 3-month study period. Third, the definition of pre-MetS and MetS relies on a combination of specific components (i.e., waist circumference, lipids, blood pressure, and blood glucose). Consequently, this may result in the heterogeneity of participants within the pre-MetS and MetS groups, respectively. However, the decomposition of the pre-MetS and MetS groups into component-specific classifications are beyond the scope of the present study. Moreover, the definitions of pre-MetS and MetS are in accord with Japanese national guidelines. Finally, the results of this study may not be generalizable to the Japanese general population given that the majority of participants were male office workers in Tokyo.Despite these limitations, this study has several strengths. First, to our knowledge, this was the first analysis to use 3 MetS categories, namely no-MetS, pre-MetS and MetS, to investigate the association of MetS status with PA. Second, we examined real-world data objectively measured using a wearable device instead of relying on questionnaires to assess PA level. Third, this study also used anthropometric and biomarker data from AHCs. Finally, we investigated the impact of weekday/weekend PA level, which was made possible by using the wearable device.