Sedentary behaviour and health in adults: an overview of systematic reviews

Behavioral Medicine for Sedentary Behavior, Daily Physical Activity, and Exercise to Prevent Cardiovascular Disease: A Review

PURPOSE OF REVIEW

Behavioral medicine is a multidisciplinary field that has a key role in reducing risk factors for cardiovascular disease (CVD). The purpose of this review is to describe the role of behavioral medicine for CVD prevention, using physical activity behaviors (e.g., sedentary behavior, daily physical activity, or exercise) as an exemplar. Application of behavioral medicine to improve dietary behaviors is also briefly discussed.

RECENT FINDINGS

Behavioral medicine interventions that address physical activity behaviors are associated with improved cardiovascular risk factors. Interventions framed in behavior change theory that integrate behavior change techniques to reduce sedentary behavior and promote daily physical activity and exercise have similarly been applied to improve certain dietary behaviors and show promise for reducing CVD risk factors. Behavioral medicine has an important role in improving various physical activity behaviors for all populations, which is essential for preventing or managing CVD. Further investigation into behavioral medicine interventions that address personal, environmental, and social factors that influence participation in physical activity behaviors, as well as the adoption of a more optimal dietary pattern, is warranted.

Exposure to prolonged sedentary behavior on weekdays rather than weekends in white-collar workers in comparison with blue-collar workers

OBJECTIVES

Objectively measured sedentary behavior (SB) on weekdays and weekends has been mainly assessed in white-collar workers, while data in blue-collar workers are sparse. Therefore, this study presented the difference in accelerometer-measured SB levels between weekdays and weekends, stratified by white- and blue-collar occupations.

METHODS

This study was a sub-analysis of accelerometer data from 73 workers (31 blue-collar and 42 white-collar) at a Japanese manufacturing plant. SB was defined as ≤1.5 metabolic equivalents estimated using an accelerometer, and compared between weekdays and weekends by using mixed models adjusted for confounders. The proportion of workers who sat for ≤8 h/day on weekdays and weekends were compared using McNemar's test.

RESULTS

In white-collar workers, SB time on weekdays was significantly longer than that on weekends (598 vs 479 min/day, P < .001). In blue-collar workers, there was no significant difference in SB time between weekdays and weekends (462 vs 485 min/day, P = .43). The proportion of workers who achieved the recommended SB levels (≤8 h) was only 4.8% for white-collar workers on weekdays and 54.8% on weekends (P = .04), while that of blue-collar workers was 45.2% and 58.1% respectively (P > .99).

CONCLUSIONS

White-collar workers were exposed to significantly longer SB time on weekdays than on weekends, which was not the case in blue-collar workers. It may be rather challenging for white-collar workers to limit their SB time to the level recommended by the latest guidelines for better health, especially on weekdays.

Changes in Physical Activity, Sitting and Sleep across the COVID-19 National Lockdown Period in Scotland

We examine the impact of the COVID-19 outbreak and concomitant restrictions (i.e., lockdown) on 24-hour movement behaviors (i.e., physical activity, sitting, sleep) in a purposive sample of people (n = 3230) reporting change recruited online. Participants' self-reported time spent in moderate-to-vigorous physical activity (MVPA), walking, sitting and sleep prior to lockdown (T1), during the first national lockdown (T2) and as restrictions initially started to ease (T3). For each 24-hour movement behavior, category-shifts are reported (positive, negative or did not change), as well as the percentage of participants recording positive/negative changes across clusters of behaviors and the percentage of participants recording improvement or maintenance of change across time. From T1 to T2 walking decreased, whereas MVPA, sitting and sleep increased, from T2 to T3 levels returned to pre-lockdown for all but MVPA. Participants who changed one behavior positively were more likely to report a positive change in another and 50% of those who reported positive changes from T1 to T2 maintained or improved further when restrictions started to ease. The current study showed that a large proportion of the sample reported positive changes, most notably those displaying initially poor levels of each behavior. These findings will inform salutogenic intervention development.

Canadian 24-Hour Movement Guidelines for Adults aged 18–64 years and Adults aged 65 years or older: an integration of physical activity, sedentary behaviour, and sleep

The Canadian Society for Exercise Physiology assembled a Consensus Panel representing national organizations, content experts, methodologists, stakeholders, and end-users and followed an established guideline development procedure to create the Canadian 24-Hour Movement Guidelines for Adults aged 18–64 years and Adults aged 65 years or older: An Integration of Physical Activity, Sedentary Behaviour, and Sleep. These guidelines underscore the importance of movement behaviours across the whole 24-h day. The development process followed the strategy outlined in the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. A large body of evidence was used to inform the guidelines including 2 de novo systematic reviews and 4 overviews of reviews examining the relationships among movement behaviours (physical activity, sedentary behaviour, sleep, and all behaviours together) and several health outcomes. Draft guideline recommendations were discussed at a 4-day in-person Consensus Panel meeting. Feedback from stakeholders was obtained by survey (n = 877) and the draft guidelines were revised accordingly. The final guidelines provide evidence-based recommendations for a healthy day (24-h), comprising a combination of sleep, sedentary behaviours, and light-intensity and moderate-to-vigorous-intensity physical activity. Dissemination and implementation efforts with corresponding evaluation plans are in place to help ensure that guideline awareness and use are optimized.

Novelty First ever 24-Hour Movement Guidelines for Adults aged 18–64 years and Adults aged 65 years or older with consideration of a balanced approach to physical activity, sedentary behaviour, and sleep Finalizes the suite of 24-Hour Movement Guidelines for Canadians across the lifespan

Development and application of an outcome-centric approach for conducting overviews of reviews

There are gaps in current guidance concerning how to conduct overviews of systematic reviews in an outcome-centric manner. Herein we summarize the methods and lessons learned from conducting 4 outcome-centric overviews to help inform the Canadian 24-Hour Movement Guidelines for Adults aged 18–64 years and Adults aged 65 years or older on the topics of resistance training, balance and functional training, sedentary behaviour, sleep duration. We defined “critical” and “important” outcomes a priori. We used AMSTAR 2 to assess review quality and sought 1 systematic review per outcome. If multiple reviews were required to address subgroups for an outcome, we calculated the corrected covered area (CCA) to quantify overlap. We report our methodology in a PRISMA table. Across the 4 overviews, authors reviewed 1110 full texts; 45 were retained (low to high quality per AMSTAR 2), representing 950 primary studies, enrolling over 5 385 500 participants. Of 46 outcomes, we identified data for 35. Nineteen outcomes required >1 review (CCA range: 0% to 71.4%). Our outcome-centric overviews addressed unique aspects of overviews, including selection and quality assessment of included reviews, and overlap. Lessons learned included consistent application of methodological principles to minimize bias and optimize reporting transparency.

Novelty Overviews of reviews synthesize systematic reviews in a rigorous and transparent manner. Outcome-centric systematic reviews assess the quality of evidence for primary studies contributing to an outcome. This manuscript describes the development and application of extending the concept of outcome-centric systematic reviews to the design and conduct of outcome-centric overviews.