Contents lists available at ScienceDirect Preventive Medicine journal homepage: www.elsevier.com/locate/ypmed Regular physical activity eliminates the harmful association of television watching with multimorbidity. A cross-sectional study from the European Social Survey Adilson Marques a,b,c, ⁎ , Diana A. Santos a , Miguel Peralta a , Luís B. Sardinha a , Miguel González Valeiro c a Centro Interdisciplinar de Estudo da Performance Humana, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal b Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal c Facultad de Ciencias del Deporte y la Educación Física, Universidad de A Coruña, A Coruña, Spain ARTICLE INFO Keywords: Exercise Non-communicable diseases Sedentary behaviour ABSTRACT The aims of the study were to analyse the association of television viewing, physical activity (PA), and multi- morbidity; and to understand if PA attenuates or eliminates the detrimental associations between television viewing and multimorbidity. This is a cross-sectional study based on data from the European Social Survey round 7, 2014. Participants were 32,931 adults (15,784 men), aged 18–114 years old, from 18 European countries. Self-reported information regarding chronic diseases (CD), PA and time watching television were collected through interview. Logistic regression analysis was conducted to analyse the association between watching television and PA with the presence of multimorbidity (≥1 CD). Men and women who watched television had increased odds of having multimorbidity. When considering PA it was observed that, independently of television viewing, compared to engaging in PA for ≤1 day/week, engaging in 2–4 days/week and in ≥5 days/week was inversely associated with multimorbidity. Increased odds of multimorbidity were observed for men spending > 3 h/day watching television in the 2–3 days/week and ≤1 day/week categories of PA. For women engaged in 30 min of physical activity 2–3 days/week, spending > 3 h/day watching television was associated with higher odds for multimorbidity. For adults who practiced physical activity on ≥ 5 days/week watching television was not associated with multimorbidity. Time spent watching television is associated with multi- morbidity. However, physical activity participation can attenuate or even eliminate this association. 1. Introduction The prevalence of sedentary behaviours has increased (Hansen et al., 2012; Kohl 3rd et al., 2012). In high-income countries most adults spend their awake time in sedentary behaviours (Dumith et al., 2011), being television viewing time reported as the most prevalent leisure- time sedentary behaviour (Clark et al., 2009; Harvey et al., 2013). Several studies have demonstrated that sedentary behaviours, and particularly the time spent watching television, is associated with in- creased risk for mortality and chronic diseases, such as obesity, dia- betes, cardiovascular diseases, and some cancers (Ekelund et al., 2016; Keadle et al., 2015; Pinto Pereira et al., 2012). The deleterious associations of television viewing with mortality and chronic diseases in adults have been investigated to be independent of physical activity (Wijndaele et al., 2011). Interestingly, although the detrimental impact of time watching television has been also observed in active people (Healy et al., 2008), higher levels of physical activity may attenuate or even eliminate the increased risk associated with se- dentary behaviours (Ekelund et al., 2016; Rao et al., 2016). Several studies have addressed the association of television viewing and physical activity with specific chronic diseases (Ekelund et al., 2016; Keadle et al., 2015; Pinto Pereira et al., 2012) but few studies have investigated this issue with the presence of multimorbidity. The World Health Organization defines multimorbidity as the coexistence of two or more chronic conditions (WHO, 2016). The prevalence of mul- timorbidity is considering high (Barnett et al., 2012; Prazeres and Santiago, 2015; Puth et al., 2017), and evidence suggests that the most patients with chronic health conditions do not have a single diagnosis, but various diagnoses coexist within one person (Violan et al., 2014). Furthermore, multimorbidity becomes increasingly more common with age (Barnett et al., 2012; Prazeres and Santiago, 2015; Puth et al., 2017), is linked with high disability and mortality (Barnett et al., 2012), https://doi.org/10.1016/j.ypmed.2018.01.015 Received 31 July 2017; Received in revised form 9 January 2018; Accepted 16 January 2018 ⁎ Corresponding author at: Faculdade de Motricidade Humana, Universidade de Lisboa, Estrada da Costa, 1499-002 Cruz Quebrada, Portugal. E-mail address: amarques@fmh.ulisboa.pt (A. Marques). Preventive Medicine 109 (2018) 28–33 0091-7435/ © 2018 Elsevier Inc. All rights reserved. T