14 studies reported on the association between HbA_1c and PAct scores.6 18 48–51 62 64–66 68–70 72

This included two large high-quality studies with moderate design,49 51 one large high-quality cross-sectional study18 and one small high-quality cross-sectional study that reported lower HbA_1c levels with higher PAct scores.66

One large high-quality study with moderate design50 and two large high-quality cross-sectional studies65 72 reported no association between HbA_1c and PAct scores.

• Moderate evidence that higher PAct scores are associated with better HbA_1c values because two out of three high-quality studies with moderate designs and large sample sizes reported this finding.49 51

All four studies reported no association between blood pressure and PAct scores6 48 62 72 and had uniformly weak designs

Only one was high-quality.72

• Inconclusive evidence

Only one study high-quality study with a weak design assessed the association between LDL and PAct scores and reported no association.72

• Inconclusive evidence

No studies reported on the association between HDL and PAct scores.

Three studies evaluated the association between total cholesterol and serum triglycerides with PAct scores,48 50 62 all reported no association.

The only high-quality study had a moderate design and large sample size,50 while the remaining studies were low-quality and had weak designs, including one with a large sample size.62

• Very limited evidence that PAct has no association with total cholesterol and serum triglycerides.

Four high-quality studies reported lower BMI with increased PAct scores,49 65 66 74 three of which had large sample sizes,49 65 74 including one with a moderate design49 and the rest with weak designs.65 66 74

One large low-quality study with moderate design reported lower BMI with high PAct scores.63

Two other high-quality studies, one large with a weak design,72 and one large study with a moderate design50 found no association between PAct scores and BMI.

• Inconclusive evidence because both the large high-quality studies with moderate designs49 50 are not in agreement.

Only one large high-quality study with moderate design reported a lower body weight with higher PAct scores.49

• Inconclusive evidence