{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T18:31:45Z","timestamp":1774031505327,"version":"3.50.1"},"reference-count":19,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T00:00:00Z","timestamp":1773964800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Regular physical activity (PA) is recommended for cardiometabolic prevention, yet emerging evidence suggests that meeting PA guidelines alone does not guarantee metabolic health. Pandemic-related disruptions may have intensified behavior\u2013biology discrepancies. This study examined the prevalence and sociodemographic determinants of the physically active but metabolically unhealthy (PA\u2013NH) group before, during, and after the COVID-19 pandemic in Korea.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed 17,719 adults aged \u226519 years using the 2019\u20132022 Korea National Health and Nutrition Examination Survey. Participants were classified into four groups: PA\u2013H, NPA\u2013H, NPA\u2013NH, and PA\u2013NH. Temporal patterns across the pre- (2019), during- (2020\u20132021), and post-pandemic period (2022) were assessed using \u03c7\u00b2 tests and ANOVA. Multinomial logistic regression identified determinants of PA\u2013NH membership.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>From 2019 to 2022, PA\u2013H declined during the pandemic and rebounded thereafter, whereas PA\u2013NH increased from 31.2% to 34.0%. Older adults had markedly higher odds of PA\u2013NH (OR 7.30 for \u226570 y vs 19\u201329 y). Women were less likely to belong to PA\u2013NH. Higher education reduced the odds of mismatch relative to PA\u2013H but increased them compared with NPA\u2013NH. Metabolic risk factors such as hypertension and hypercholesterolemia rose despite recovery in PA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The persistence and rise of PA\u2013NH after the pandemic show an association suggesting that adherence to PA guidelines alone is insufficient for cardiometabolic protection. Post-pandemic public health strategies should integrate aerobic and resistance exercise with dietary modification, stress management, and routine screening, prioritizing older adults and other high-risk groups.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0344918","type":"journal-article","created":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T17:48:13Z","timestamp":1774028893000},"page":"e0344918","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Behavior\u2013biological mismatch in metabolic health: Evidence from South Korean adults before, during, and after COVID-19 (KNHANES 2019\u20132022)"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2538-8294","authenticated-orcid":true,"given":"Yoo Mi","family":"Jeong","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Minjeong","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6283-4671","authenticated-orcid":true,"given":"Jae Yeon","family":"Jeong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,3,20]]},"reference":[{"issue":"2","key":"pone.0344918.ref001","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1002\/j.2040-4603.2012.tb00425.x","article-title":"Lack of exercise is a major cause of chronic diseases","volume":"2","author":"FW Booth","year":"2012","journal-title":"Compr Physiol"},{"issue":"9838","key":"pone.0344918.ref002","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/S0140-6736(12)61031-9","article-title":"Effect of physical inactivity on major noncommunicable diseases worldwide","volume":"380","author":"IM Lee","year":"2012","journal-title":"Lancet"},{"issue":"4","key":"pone.0344918.ref003","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1016\/j.pcad.2014.09.011","article-title":"Physical activity and cardiorespiratory fitness as major markers of cardiovascular risk","volume":"57","author":"J Myers","year":"2015","journal-title":"Prog Cardiovasc Dis"},{"issue":"14","key":"pone.0344918.ref004","first-page":"1526","article-title":"Cardiorespiratory fitness and long-term survival in \u201clow-risk\u201d adults","volume":"68","author":"CE Barlow","year":"2016","journal-title":"J Am Coll Cardiol"},{"issue":"9","key":"pone.0344918.ref005","first-page":"566","article-title":"Behavioral and biological determinants of obesity","volume":"9","author":"KD Hall","year":"2021","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"4","key":"pone.0344918.ref006","first-page":"181","article-title":"Impact of the COVID-19 pandemic on physical activity among Korean adults","volume":"21","author":"J Choi","year":"2021","journal-title":"Korean J Health Promot"},{"issue":"1","key":"pone.0344918.ref007","first-page":"15","article-title":"Changes in exercise participation during the COVID-19 pandemic","volume":"39","author":"Y Kim","year":"2022","journal-title":"Korean J Health Educ Promot"},{"issue":"4","key":"pone.0344918.ref008","first-page":"565","article-title":"Changes in physical activity, dietary habits, and mental health during COVID-19","volume":"28","author":"S Kang","year":"2021","journal-title":"J Korean Soc Living Environ Syst"},{"key":"pone.0344918.ref009","article-title":"Development of stringency indices for nonpharmacological policies in Korea","volume":"10","author":"C Apio","year":"2024","journal-title":"JMIR Public Health Surveill"},{"key":"pone.0344918.ref010","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1186\/s12916-020-01791-8","article-title":"Response to COVID-19 in South Korea","volume":"18","author":"A Dighe","year":"2020","journal-title":"BMC Med"},{"issue":"24","key":"pone.0344918.ref011","doi-asserted-by":"crossref","first-page":"1451","DOI":"10.1136\/bjsports-2020-102955","article-title":"WHO 2020 guidelines on physical activity","volume":"54","author":"FC Bull","year":"2020","journal-title":"Br J Sports Med"},{"key":"pone.0344918.ref012","volume-title":"WHO guidelines on physical activity and sedentary behavior","author":"World Health Organization","year":"2020"},{"issue":"2","key":"pone.0344918.ref013","first-page":"74","article-title":"Socioeconomic status and metabolic syndrome in Korea","volume":"19","author":"YJ Kim","year":"2021","journal-title":"Metab Syndr Relat Disord"},{"issue":"8","key":"pone.0344918.ref014","first-page":"471","article-title":"Is the COVID-19 lockdown nudging people to be more active?","volume":"56","author":"D Ding","year":"2022","journal-title":"Br J Sports Med"},{"key":"pone.0344918.ref015","first-page":"1302","article-title":"Sitting time and mortality","volume":"388","author":"U Ekelund","year":"2016","journal-title":"Lancet"},{"key":"pone.0344918.ref016","article-title":"Changes in metabolic syndrome after COVID-19","volume":"44","author":"JY Kwon","year":"2022","journal-title":"Epidemiol Health"},{"issue":"5","key":"pone.0344918.ref017","first-page":"743","article-title":"Impact of COVID-19 on metabolic syndrome","volume":"46","author":"YS Yoon","year":"2022","journal-title":"Diabetes Metab J"},{"issue":"23","key":"pone.0344918.ref018","first-page":"5605","article-title":"Physiological geroscience: targeting healthspan","volume":"592","author":"DR Seals","year":"2014","journal-title":"J Physiol"},{"issue":"6","key":"pone.0344918.ref019","doi-asserted-by":"crossref","first-page":"1262","DOI":"10.1249\/MSS.0000000000001938","article-title":"PA and prevention of weight gain in adults","volume":"51","author":"JM Jakicic","year":"2019","journal-title":"Med Sci Sports Exerc"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0344918","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T17:48:17Z","timestamp":1774028897000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0344918"}},"subtitle":[],"editor":[{"given":"Kwang-Sig","family":"Lee","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,3,20]]},"references-count":19,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3,20]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0344918","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,20]]}}}