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Objective: To examine whether sedentary behavior, obesity, smoking, and depression are risk factors for persistent fatigue in adolescents. Design: Longitudinal population-based survey. Setting: Twenty-eight randomly selected schools in east London, England, in 2001 and 2003. Participants: A total of 1880 adolescents (49% male; 81% nonwhite British) aged 11 to 12 years and 13 to 14 years in 2000. Intervention: Confidential questionnaires completed in class. Main Outcome Measures: Persistent fatigue (extreme tiredness twice weekly or more often in the previous month at both surveys), sedentary behavior, physical activity, depressive symptoms, body mass index, and smoking. Results: Severe fatigue was reported in 11% of participants aged 11 to 14 years and 17% of participants aged 13 to 16 years. Eighty-four participants (4%) reported persistent fatigue. Across both surveys, only 3 pupils reported chronic fatigue syndrome. In multivariate logistic regression, risk of persistent fatigue was independently associated with being sedentary for more than 4 hours per day (odds ratio=1.6; 95% confidence interval, 1.1-2.3; P=.01), being physically active (odds ratio=1.5; 95% confidence interval, 1.1-2.3; P=.004), and depressive symptoms (odds ratio=2.0; 95% confidence interval, 1.5-2.7; P

Original publication




Journal article


Archives of Pediatrics and Adolescent Medicine

Publication Date





469 - 475