Moderate to vigorous physical activity (MVPA)
Objective PA was measured via a small wrist-worn accelerometer, the ActiGraph GT9X Link (ActiGraph, LLC, Pensacola, FL, USA). During the yearlong intervention, participants were asked to wear the accelerometer for at least 10 hours daily (instructed to remove the device during bathing/swimming/contact sports). Vector magnitude (VM) was calculated at 1-minute epoch intervals for vertical, antero-posterior, and medio-lateral planes. An individualized VM counts/minute threshold for MVPA was calibrated for each participant at baseline via breath-by-breath indirect calorimetry during a continuous treadmill walk test at speeds of 2, 3, and 4 mph. MVPA was defined by meeting or exceeding the individualized VM threshold (intensity > 3 METS) and GT9X step count for the corresponding 1-minute epoch ≥ 30 [