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This study examined the longitudinal effect of sedentary time (ST), light PA (LPA) and MVPA on BP in 11\u2010year\u2010old children followed up for 13\u2009years to determine the confounding and mediating role of body composition.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data included 2513 children from the Avon Longitudinal Study of Parents and Children (ALSPAC), UK birth cohort who had data on at least one time\u2010point measure of accelerometer\u2010based movement behaviour across the follow\u2010up and complete BP measures at ages 11, 15 and 24\u2009years. Body composition was assessed with dual\u2010energy x\u2010ray absorptiometry at all time points. Multivariate adjusted generalized linear mixed\u2010effect model and structural equation causal mediation model analyses were conducted.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 2513 participants (61% female, mean [SD] age 11.72 [0.21] years), ST steadily increased from ~6\u2009h\/day in childhood (age 11\u2009years) to ~9\u2009h\/day in young adulthood (age 24\u2009years), whereas LPA and MVPA decreased, but BP had an inverted U\u2010shaped increase. In the longitudinal analysis, after full adjustment, a 1\u2010min cumulative ST from ages 11 to 24\u2009years was positively associated with increased systolic BP (0.009\u2009mmHg [95% CI 0.007\u20130.011]; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and diastolic BP. A 1\u2010min cumulative LPA was inversely associated with systolic BP (\u22120.007\u2009mmHg [\u22120.009 to \u22120.004]; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), but not diastolic BP. In isotemporal substitution analyses, longitudinal replacement of 10\u2009min of ST with equal time in LPA during childhood, adolescence and young adulthood cumulatively decreased systolic BP by \u22122.63\u2009mmHg [95% CI \u22123.17 to \u22122.08] (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001) and diastolic BP by \u22121.93\u2009mmHg [95% CI \u22122.36 to \u22121.50] (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001). Replacing 10\u2009min of ST with 10\u2009min of MVPA had no statistically significant effect due to an absolute confounding effect of lean mass. The association of ST with systolic BP was fully mediated by increased lean mass (93% mediation). Increased total fat mass partially mediated (19%\u201327%) the inverse associations of cumulative MVPA with cumulative systolic and diastolic BP.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Theoretically replacing 10\u2009min\/day spent sedentary with 10\u2009min\/day of LPA during growth from childhood through young adulthood may lower systolic BP by \u22123\u2009mmHg and diastolic BP by \u22122\u2009mmHg. Lean mass seems more significant than fat mass in the relations of ST and PA with BP and should be accounted for in future intervention studies in the paediatric and young adult population.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jcsm.13639","type":"journal-article","created":{"date-parts":[[2024,11,13]],"date-time":"2024-11-13T12:14:59Z","timestamp":1731500099000},"page":"2826-2841","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Lean Mass Longitudinally Confounds Sedentary Time and Physical Activity With Blood Pressure Progression in 2513 Children"],"prefix":"10.1002","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5138-3441","authenticated-orcid":false,"given":"Andrew\u00a0O.","family":"Agbaje","sequence":"first","affiliation":[{"name":"Institute of Public Health and Clinical Nutrition, School of Medicine, Faculty of Health Sciences University of Eastern Finland  Kuopio 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