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Izawa KP, Shibata A, Ishii K, Miyawaki R, Oka K. Associations of low-intensity light physical activity with physical performance in community-dwelling elderly Japanese: A cross-sectional study. PLoS One 2017; 12:e0178654. [PMID: 28598993 PMCID: PMC5466305 DOI: 10.1371/journal.pone.0178654] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 05/16/2017] [Indexed: 12/05/2022] Open
Abstract
Background Physical activity and physical performance relate to quality of life, mortality, and morbidity in elderly people. However, little is known about differences in physical performance related to low-intensity light physical activity (LLPA), high-intensity light physical activity (HLPA), and moderate-intensity physical activity (MPA) and how they are separated by sex in elderly populations. Aims This study aimed to determine differences in LLPA, HLPA, MPA, and physical performance, and associations between these measures in community-dwelling elderly men and women. Methods Physical activity and physical performance such as timed-up-and-go test, one-leg standing time, and maximum gait speed were measured in 181 community-dwelling elderly men (mean age, 75.1 ± 5.3 years) and 109 women (mean age, 73.4 ± 4.8 years) in 2013. Physical activity was classified as LLPA (1.6~1.9 METs of physical activity), HLPA (2.0~2.9 METs of physical activity), and MPA (over 3 METs of physical activity). The association between the values of these three intensities of physical activity in the participants was assessed by Pearson’s correlation coefficients. Multiple linear regression analyses were used to assess the association of physical performance values with the three groups defined by accelerometer-measured physical activity intensity adjusted for sociographic, behavioral, and multiple diseases in the participants. Results MPA was beneficially associated with all physical performance indicators in the men (all P<0.05) and women (all P<0.05). Only HLPA showed significant associations with the timed-up-and-go test (P = 0.001) and maximum gait speed (P = 0.006) in women. Discussion These results may support the notion that not only HLPA in women but MPA in both sexes appears to improve physical performance in elderly populations. Conclusion The present study findings provide novel epidemiological evidence for the potential benefits of HLPA in women and also reinforce the potential benefits of MPA in both sexes, which is the mainstay of public health recommendations.
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Affiliation(s)
- Kazuhiro P. Izawa
- Graduate School of Health Sciences, Kobe University, Suma, Kobe, Japan
| | - Ai Shibata
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kaori Ishii
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
| | - Rina Miyawaki
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
| | - Koichiro Oka
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
- * E-mail:
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202
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Saunders TJ, Vallance JK. Screen Time and Health Indicators Among Children and Youth: Current Evidence, Limitations and Future Directions. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2017; 15:323-331. [PMID: 27798796 DOI: 10.1007/s40258-016-0289-3] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Despite accumulating evidence linking screen-based sedentary behaviours (i.e. screen time) with poorer health outcomes among children and youth <18 years of age, the prevalence of these behaviours continues to increase, with roughly half of children and youth exceeding the public health screen time recommendation of 2 h per day or less. The purpose of this article is to provide an overview of key research initiatives aimed at understanding the associations between screen time and health indicators including physical health, quality of life and psychosocial health. Available evidence suggests that screen time is deleteriously associated with numerous health indicators in child and youth populations, including adiposity, aerobic fitness, quality of life, self-esteem, pro-social behaviour, academic achievement, depression and anxiety. However, few longitudinal or intervention studies have been conducted, with most of these studies focusing on physical health indicators. While most studies have used self-reported assessments of screen time, the availability of more objective assessment methods presents important opportunities (e.g. more accurate and precise assessment of sedentary time and screen time) and challenges (e.g. privacy and participant burden). Novel statistical approaches such as isotemporal substitution modelling and compositional analysis, as well as studies using longitudinal and experimental methodologies, are needed to better understand the health impact of excessive screen time, and to develop strategies to minimise or reverse the negative impacts of these behaviours. The evidence to date suggests a clear need for policy aimed at minimising the hazardous health consequences associated with screen time among children and youth.
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Affiliation(s)
- Travis J Saunders
- Department of Applied Human Sciences, Faculty of Science, University of Prince Edward Island, Charlottetown, PEI, Canada
| | - Jeff K Vallance
- Faculty of Health Disciplines, Centre for Nursing and Health Studies, Athabasca University, Athabasca, AB, Canada.
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Sex and age differences in the associations between sleep behaviors and all-cause mortality in older adults: results from the National Health and Nutrition Examination Surveys. Sleep Med 2017; 36:141-151. [PMID: 28735912 DOI: 10.1016/j.sleep.2017.05.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 05/09/2017] [Accepted: 05/10/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Our aim was to examine sex- and age-specific relationships of sleep behaviors with all-cause mortality rates. METHODS A retrospective cohort study was conducted among 5288 adults (≥50 years) from the 2005-2008 National Health and Nutrition Examination Surveys who were followed-up for 54.9 ± 1.2 months. Sleep duration was categorized as < 7 h, 7-8 h and >8 h. Two sleep quality indices were generated through factor analyses. 'Help-seeking behavior for sleep problems' and 'diagnosis with sleep disorders' were defined as yes/no questions. Sociodemographic covariates-adjusted Cox regression models were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS A positive relationship was observed between long sleep and all-cause mortality rate in the overall sample (HR = 1.90, 95% CI: 1.38, 2.60), among males (HR = 1.48, 95% CI: 1.05, 2.09), females (HR = 2.32, 95% CI: 1.48, 3.61) and elderly (≥65 years) people (HR = 1.80, 95% CI: 1.30, 2.50). 'Sleepiness/sleep disturbance' (Factor I) and all-cause mortality rate were positively associated among males (HR = 1.22, 95% CI: 1.03, 1.45), whereas 'poor sleep-related daytime dysfunction' (Factor II) and all-cause mortality (HR = 0.75, 95% CI: 0.62, 0.91) were negatively associated among elderly people. CONCLUSIONS Sex- and age-specific relationships were observed between all-cause mortality rate and specific sleep behaviors among older adults.
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204
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Wang X, Strizich G, Hua S, Sotres-Alvarez D, Buelna C, Gallo LC, Gellman MD, Mossavar-Rahmani Y, O'Brien MJ, Stoutenberg M, Wang T, Avilés-Santa ML, Kaplan RC, Qi Q. Objectively Measured Sedentary Time and Cardiovascular Risk Factor Control in US Hispanics/Latinos With Diabetes Mellitus: Results From the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). J Am Heart Assoc 2017; 6:e004324. [PMID: 28546455 PMCID: PMC5669141 DOI: 10.1161/jaha.116.004324] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 01/04/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) risk factor control is a cornerstone of diabetes mellitus management. Little is known about relationships of objectively measured sedentary time and physical activity with major CVD risk factor control in individuals with diabetes mellitus. We examined associations of objectively measured sedentary time and moderate-to-vigorous physical activity with reaching major CVD risk factor control goals among US Hispanic/Latino adults with diabetes mellitus. METHODS AND RESULTS This cross-sectional analysis included 1699 participants with diabetes mellitus from the Hispanic Community Health Study/Study of Latinos (2008-2011). Logistic regression models were used to estimate the odds ratios (ORs) of meeting the following 5 major CVD risk factor control goals: hemoglobin A1c <7.0%; systolic/diastolic blood pressure <140/80 mm Hg; triglycerides <150 mg/dL; low-density lipoprotein cholesterol <100 mg/dL; and high-density lipoprotein cholesterol >40/50 mg/dL for men/women. After adjustment for covariates including moderate-to-vigorous physical activity, less sedentary time was associated with increased odds of reaching hemoglobin A1c (OR=1.76 [95% CI: 1.10, 2.82]) and triglyceride control goals (OR=2.16 [1.36, 3.46]), and reaching ≥3 CVD risk factor control goals (OR=2.08 [1.34, 3.23]) (all ORs for comparisons of extreme tertiles of sedentary time). Moderate-to-vigorous physical activity was not associated with reaching any CVD risk factor control goals. Substituting 60-min/day of sedentary time with light-intensity physical activity was associated with increased odds of reaching hemoglobin A1c (OR=1.18 [1.04, 1.35]), high-density lipoprotein cholesterol (OR=1.17 [1.04, 1.32]), and triglyceride (OR=1.20 [1.05, 1.36]) control goals. CONCLUSIONS Among US Hispanic/Latino adults with diabetes mellitus, less sedentary time, but not moderate-to-vigorous physical activity, was associated with improved CVD risk factor control, specifically in reaching hemoglobin A1c and triglyceride control goals.
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Affiliation(s)
- Xueyin Wang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Garrett Strizich
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Simin Hua
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Daniela Sotres-Alvarez
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC
| | - Christina Buelna
- South Bay Latino Research Center, Graduate School of Public Health, San Diego State University, San Diego, CA
| | - Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, CA
| | - Marc D Gellman
- Behavioral Medicine Research Center, Miller School of Medicine, University of Miami, FL
| | - Yasmin Mossavar-Rahmani
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Matthew J O'Brien
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Mark Stoutenberg
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, FL
| | - Tao Wang
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - M Larissa Avilés-Santa
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Robert C Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Qibin Qi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
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205
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Abstract
BACKGROUND Limited data exist on the benefits of, barriers to, and potential strategies to break up time spent sitting in cancer survivors. Such data will be meaningful given the consequences of prolonged sitting. OBJECTIVES The aim of this study was to conduct a mixed-method research study consisting of semistructured telephone interviews to identify recurrent themes associated with prolonged sitting in cancer survivors. METHODS African American breast cancer survivors (N = 31) were recruited from a local tumor registry. Telephone interviews were conducted and group consensus processes were used to identify recurrent themes. The a priori categories were benefits, barriers, and potential strategies to breaking up prolonged periods of sitting. RESULTS Recurrent themes contributing most to prolonged sitting were leisure time interest (45%: eg, watching television and reading) and health challenges (27%: eg, pain and fatigue). Most (66%) women perceived improved health as benefits to breaking up time spent sitting. Nonetheless, many (41%) survivors reported health (eg, pain and fatigue) as the biggest challenge to interrupt time spent sitting. Engaging in light intensity activities (eg, staying active, keep moving) was the most commonly reported strategy for breaking up prolonged sitting. CONCLUSIONS African American breast cancer survivors identified the benefits and barriers to breaking up time spent sitting as well as potential strategies to interrupt time-spent sitting. IMPLICATIONS FOR PRACTICE Clinicians are integral in promoting breaks from prolonged sitting throughout the initial phases of the cancer continuum. Successful studies will begin with early intervention in the clinical setting, with increasing intensity as survivors transition to the recovery phase.
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206
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Puig-Ribera A, Bort-Roig J, Giné-Garriga M, González-Suárez AM, Martínez-Lemos I, Fortuño J, Martori JC, Muñoz-Ortiz L, Milà R, Gilson ND, McKenna J. Impact of a workplace 'sit less, move more' program on efficiency-related outcomes of office employees. BMC Public Health 2017; 17:455. [PMID: 28511642 PMCID: PMC5434625 DOI: 10.1186/s12889-017-4367-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 05/04/2017] [Indexed: 11/10/2022] Open
Abstract
Background Few studies have examined the impact of ‘sit less, move more’ interventions on workplace performance. This study assessed the short and mid-term impacts of and patterns of change within, a 19-week workplace web-based intervention (Walk@WorkSpain; W@WS; 2010–11) on employees´ presenteeism, mental well-being and lost work performance. Methods A site randomised control trial recruited employees at six Spanish university campuses (n = 264; 42 ± 10 years; 171 female), assigned by worksite and campus to an Intervention (IG; used W@WS; n = 129; 87 female) or an active Comparison group (A-CG; pedometer, paper diary and self-reported sitting time; n = 135; 84 female). A linear mixed model assessed changes between the baseline, ramping (8 weeks), maintenance (11 weeks) and follow-up (two months) phases for the IG versus A-CG on (i) % of lost work productivity (Work Limitations Questionnaire; WLQ); (ii) three scales for presenteeism (WLQ) assessing difficulty meeting scheduling demands (Time), performing cognitive and inter-personal tasks (Mental-Interpersonal) and decrements in meeting the quantity, quality and timeliness of completed work (Output); and (iii) mental well-being (Warwick-Edinburgh Mental Well-being Scale). T-tests assessed differences between groups for changes on the main outcomes. In the IG, a multivariate logistic regression model identified patterns of response according to baseline socio-demographic variables, physical activity and sitting time. Results There was a significant 2 (group) × 2 (program time points) interaction for the Time (F [3]=8.69, p = 0.005), Mental-Interpersonal (F [3]=10.01, p = 0.0185), Output scales for presenteeism (F [3]=8.56, p = 0.0357), and for % of lost work performance (F [3]=10.31, p = 0.0161). Presenteeism and lost performance rose significantly in both groups across all study time points; after baseline performance was consistently better in the IG than in the A-CG. Better performance was linked to employees being more active (Time, p = 0.041) and younger (Mental-interpersonal, p = 0.057; Output, p = 0.017). Higher total sitting time during nonworking days (Mental-interpersonal, p = 0.019) and lower sitting time during workdays (WLQ Index, p = 0.013) also improved performance. Conclusion Versus an active comparison condition, a ‘sit less, move more` workplace intervention effectively reduced an array of markers of lost workday productivity. Trial registration NCT02960750; Date of registration: 07/11/2016.
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Affiliation(s)
- Anna Puig-Ribera
- Departament de Ciències de l'Activitat Física, Centre d'Estudis Socials i Socio Sanitaris, Universitat de Vic-Universitat Central de Catalunya, c/ Sagrada Família 7, 08500, Vic (Barcelona), Spain.
| | - Judit Bort-Roig
- Departament de Ciències de l'Activitat Física, Centre d'Estudis Socials i Socio Sanitaris, Universitat de Vic-Universitat Central de Catalunya, c/ Sagrada Família 7, 08500, Vic (Barcelona), Spain
| | - Maria Giné-Garriga
- Physical Activity and Sport Sciences Department, FPCEE Blanquerna, Universitat Ramon Llull, c/Císter 34, 08022, Barcelona, Spain.,Physical Therapy Department, FCS Blanquerna, Universitat Ramon Llull, c/Padilla 326-332, 08025, Barcelona, Spain
| | - Angel M González-Suárez
- Departamento de Educación Física y Deportiva, Universidad del País Vasco, Portal de Lasarte 71, 01007, Vitoria, Spain
| | - Iván Martínez-Lemos
- Facultad CC.EE. e do Deporte, Universidad de Vigo, Campus A Xunqueira s/n, 36005, Pontevedra, Spain
| | - Jesús Fortuño
- Physical Activity and Sport Sciences Department, FPCEE Blanquerna, Universitat Ramon Llull, c/Císter 34, 08022, Barcelona, Spain
| | - Joan C Martori
- Department of Economics and Business, Universitat de Vic-Universitat Central de Catalunya, c/Sagrada Família 7, 08500, Vic (Barcelona), Spain
| | - Laura Muñoz-Ortiz
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), c/Roc Boronat 81-95 (edifici Salvany), 2a planta, 08005, Barcelona, Spain
| | - Raimon Milà
- Departament de Salut i AccióSocial, Universitat de Vic-Universitat Central de Catalunya, Vic (Barcelona), Spain
| | - Nicholas D Gilson
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, St. Lucia Campus, 4072, Australia
| | - Jim McKenna
- Carnegie School of Sport, Leeds Beckett University, Fairfax Hall, Headingley Campus, Leeds, LS6 3QS, UK
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Fanning J, Porter G, Awick EA, Ehlers DK, Roberts SA, Cooke G, Burzynska AZ, Voss MW, Kramer AF, McAuley E. Replacing sedentary time with sleep, light, or moderate-to-vigorous physical activity: effects on self-regulation and executive functioning. J Behav Med 2017; 40:332-342. [PMID: 27586134 PMCID: PMC5332375 DOI: 10.1007/s10865-016-9788-9] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 08/16/2016] [Indexed: 12/16/2022]
Abstract
Recent attention has highlighted the importance of reducing sedentary time for maintaining health and quality of life. However, it is unclear how changing sedentary behavior may influence executive functions and self-regulatory strategy use, which are vital for the long-term maintenance of a health behavior regimen. The purpose of this cross-sectional study is to examine the estimated self-regulatory and executive functioning effects of substituting 30 min of sedentary behavior with 30 min of light activity, moderate-to-vigorous physical activity (MVPA), or sleep in a sample of older adults. This study reports baseline data collected from low-active healthy older adults (N = 247, mean age 65.4 ± 4.6 years) recruited to participate in a 6 month randomized controlled exercise trial examining the effects of various modes of exercise on brain health and function. Each participant completed assessments of physical activity self-regulatory strategy use (i.e., self-monitoring, goal-setting, social support, reinforcement, time management, and relapse prevention) and executive functioning. Physical activity and sedentary behaviors were measured using accelerometers during waking hours for seven consecutive days at each time point. Isotemporal substitution analyses were conducted to examine the effect on self-regulation and executive functioning should an individual substitute sedentary time with light activity, MVPA, or sleep. The substitution of sedentary time with both sleep and MVPA influenced both self-regulatory strategy use and executive functioning. Sleep was associated with greater self-monitoring (B = .23, p = .02), goal-setting (B = .32, p < .01), and social support (B = .18, p = .01) behaviors. Substitution of sedentary time with MVPA was associated with higher accuracy on 2-item (B = .03, p = .01) and 3-item (B = .02, p = .04) spatial working memory tasks, and with faster reaction times on single (B = -23.12, p = .03) and mixed-repeated task-switching blocks (B = -27.06, p = .04). Substitution of sedentary time with sleep was associated with marginally faster reaction time on mixed-repeated task-switching blocks (B = -12.20, p = .07) and faster reaction time on mixed-switch blocks (B = 17.21, p = .05), as well as reduced global reaction time switch cost (B = -16.86, p = .01). Substitution for light intensity physical activity did not produce significant effects. By replacing sedentary time with sleep and MVPA, individuals may bolster several important domains of self-regulatory behavior and executive functioning. This has important implications for the design of long-lasting health behavior interventions. Trial Registration clinicaltrials.gov identifier NCT00438347.
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Affiliation(s)
- J Fanning
- Department of Kinesiology, University of Illinois at Urbana-Champaign, 906 S. Goodwin Avenue, Urbana, IL, 61801, USA.
| | - G Porter
- Department of Kinesiology, University of Illinois at Urbana-Champaign, 906 S. Goodwin Avenue, Urbana, IL, 61801, USA
| | - E A Awick
- Department of Kinesiology, University of Illinois at Urbana-Champaign, 906 S. Goodwin Avenue, Urbana, IL, 61801, USA
| | - D K Ehlers
- Department of Kinesiology, University of Illinois at Urbana-Champaign, 906 S. Goodwin Avenue, Urbana, IL, 61801, USA
| | - S A Roberts
- Department of Kinesiology, University of Illinois at Urbana-Champaign, 906 S. Goodwin Avenue, Urbana, IL, 61801, USA
| | - G Cooke
- The Beckman Institute for Advanced Science and Technology at the University of Illinois, Urbana, IL, 61801, USA
| | - A Z Burzynska
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, CO, USA
| | - M W Voss
- Department of Psychological & Brain Sciences, The University of Iowa, 11 Seashore Hall E., Iowa City, IA, 52242, USA
| | - A F Kramer
- The Beckman Institute for Advanced Science and Technology at the University of Illinois, Urbana, IL, 61801, USA
| | - E McAuley
- Department of Kinesiology, University of Illinois at Urbana-Champaign, 906 S. Goodwin Avenue, Urbana, IL, 61801, USA
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208
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Fenton SAM, Veldhuijzen van Zanten JJCS, Kitas GD, Duda JL, Rouse PC, Yu CA, Metsios GS. Sedentary behaviour is associated with increased long-term cardiovascular risk in patients with rheumatoid arthritis independently of moderate-to-vigorous physical activity. BMC Musculoskelet Disord 2017; 18:131. [PMID: 28356089 PMCID: PMC5404687 DOI: 10.1186/s12891-017-1473-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 03/06/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Rheumatoid Arthritis (RA) is associated with an increased risk of cardiovascular disease (CVD). The physical dysfunction symptomatic of RA means people living with this disease spend large periods of the day sedentary, which may further elevate their risk of CVD. The primary aim of this study was to investigate relationships between objectively assessed sedentary behaviour patterns and light physical activity (LPA) with 10-year risk of CVD. Secondary aims were to explore the role of sedentary behaviour patterns and LPA for individual CVD risk factors and functional disability in RA. The extent to which associations were independent of moderate-to-vigorous physical activity (MVPA) engagement was also examined. METHODS Baseline data from a subsample of participants recruited to the Physical Activity in Rheumatoid Arthritis (PARA) study were used to answer current research questions. Sixty-one patients with RA (mean age (± SD) = 54.92 ± 12.39 years) provided a fasted blood sample and underwent physical assessments to evaluate factors associated with their cardiovascular health. Sedentary behaviour patterns (sedentary time, sedentary bouts, sedentary breaks), LPA and MVPA were measured via 7-days of accelerometry. Ten-year CVD risk was computed (Q-risk-score2), and functional disability determined via questionnaire. RESULTS Regressions revealed significant positive associations between sedentary time and the number of sedentary bouts per day ≥20 min with 10-year CVD risk, with the reverse true for LPA participation. Associations were independent of MVPA engagement. CONCLUSIONS Promoting LPA participation and restricting sedentary bouts to <20 min may attenuate long-term CVD risk in RA, independent of MVPA engagement. TRIAL REGISTRATION ISRCTN04121489 (retrospectively registered 19/10/2012).
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Affiliation(s)
- Sally A M Fenton
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK. .,Department of Rheumatology, Russells Hall Hospital, Dudley Group NHS Foundation Trust, Dudley, UK.
| | - Jet J C S Veldhuijzen van Zanten
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.,Department of Rheumatology, Russells Hall Hospital, Dudley Group NHS Foundation Trust, Dudley, UK
| | - George D Kitas
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.,Department of Rheumatology, Russells Hall Hospital, Dudley Group NHS Foundation Trust, Dudley, UK
| | - Joan L Duda
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | | | - Chen-An Yu
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.,Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - George S Metsios
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.,Faculty of Health Education and Wellbeing, University of Wolverhampton, West Midlands, UK.,Department of Rheumatology, Russells Hall Hospital, Dudley Group NHS Foundation Trust, Dudley, UK
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209
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Examining sedentary time as a risk factor for cardiometabolic diseases and their markers in South Asian adults: a systematic review. Int J Public Health 2017; 62:503-515. [PMID: 28299392 DOI: 10.1007/s00038-017-0947-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 12/28/2016] [Accepted: 01/11/2017] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES The objective was to systematically review the literature to determine whether sedentary time was associated with cardiometabolic diseases and their risk factors among South Asian adults. METHODS Six electronic databases were searched to identify all studies that examined the association between sedentary time and cardiometabolic diseases (e.g., diabetes, cardiovascular disease) and their risk factors [e.g., body mass index (BMI), waist circumference (WC), lipids, blood pressure (BP), glucose] among South Asian adults. Two independent reviewers performed abstract/full-text screening, data abstraction, and quality assessments. RESULTS Searching identified 1757 potential articles; 22 were used in the analysis. Greater sedentary time was associated with an increased likelihood of diabetes (n = 5), higher BMI (n = 13), WC (n = 3), BP (n = 2), and glucose (n = 4). Thirteen out of 22 studies were of higher quality. CONCLUSION Results identified a trend whereby greater sedentary time was associated with an increased risk for diabetes, and several other cardiometabolic risk factors among South Asian adults. High quality studies are needed to identify whether risk factors are independent of physical activity levels to inform culturally-specific interventions for South Asians.
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210
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Rosique-Esteban N, Díaz-López A, Martínez-González MA, Corella D, Goday A, Martínez JA, Romaguera D, Vioque J, Arós F, Garcia-Rios A, Tinahones F, Estruch R, Fernández-García JC, Lapetra J, Serra-Majem L, Pinto X, Tur JA, Bueno-Cavanillas A, Vidal J, Delgado-Rodríguez M, Daimiel L, Vázquez C, Rubio MÁ, Ros E, Salas-Salvadó J. Leisure-time physical activity, sedentary behaviors, sleep, and cardiometabolic risk factors at baseline in the PREDIMED-PLUS intervention trial: A cross-sectional analysis. PLoS One 2017; 12:e0172253. [PMID: 28273154 PMCID: PMC5342184 DOI: 10.1371/journal.pone.0172253] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 02/02/2017] [Indexed: 01/12/2023] Open
Abstract
Limited data exists on the interrelationships between physical activity (PA), sedentary behaviors and sleep concerning cardiometabolic risk factors in aged adults at high cardiovascular disease risk. Our aim was to examine independent and joint associations between time spent in leisure-time PA, sedentary behaviors and sleep on the prevalence of obesity, type 2 diabetes (T2D) and components of the metabolic syndrome (MetS) in Mediterranean individuals at high cardiovascular risk. Cross-sectional analyses were performed on baseline data from 5776 Spanish adults (aged 55-75y in men; 60-75y in women) with overweight/obesity and MetS, from October 2013 to October 2016, in the PREDIMED-PLUS trial. Employing multivariable-adjusted Cox regression with robust variance and constant time (given the cross-sectional design), higher prevalence of obesity, T2D and abdominal obesity as component of the MetS were associated with greater time in TV-viewing (Relative Risk, RR: 1.02, 95%CI: 1.01, 1.03; RR:1.04, 95%CI: 1.02, 1.06 and RR: 1.01 95%CI: 1.00, 1.02; respectively, all P < .01). Conversely, greater time in moderate-vigorous PA (MVPA) was associated with lower prevalence of obesity, T2D, abdominal obesity and low HDL-cholesterol (RR: 0.95, 95%CI: 0.93, 0.97; RR: 0.94, 95%CI: 0.89, 0.99; RR: 0.97, 95%CI: 0.96, 0.98; and RR: 0.95, 95%CI: 0.91, 0.99, respectively, all P < .05). For these outcomes, theoretically substituting 1-h/day of MVPA for 1-h/day TV-viewing was also significantly associated with lower prevalence (RR 0.91 to 0.97, all P < .05). Similar lower RR in these outcomes was observed when substituting 1-h/day of MVPA for 1-h/day of sleeping. Longer time watching TV and not meeting MVPA recommendations were jointly associated with higher RR of the prevalence of obesity and T2D. We concluded that, in senior individuals at high cardiovascular risk, greater time spent on MVPA and fewer on sedentary behaviors was inversely associated with prevalence of obesity, T2D, and some of the components of MetS.
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Affiliation(s)
- Nuria Rosique-Esteban
- Human Nutrition Unit, University Hospital of Sant Joan de Reus, Department of Biochemistry and Biotechnology, Pere Virgili Institute for Health Research, Rovira i Virgili University, Reus, Spain
- CIBER de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Andrés Díaz-López
- Human Nutrition Unit, University Hospital of Sant Joan de Reus, Department of Biochemistry and Biotechnology, Pere Virgili Institute for Health Research, Rovira i Virgili University, Reus, Spain
- CIBER de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Miguel A. Martínez-González
- CIBER de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Navarra-Navarra Institute for Health Research, Pamplona, Spain
| | - Dolores Corella
- CIBER de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Department of Preventive Medicine, University of Valencia, Valencia, Spain
| | - Albert Goday
- CIBER de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Servicio de Endocrinología, Hospital del Mar, Barcelona, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J. Alfredo Martínez
- CIBER de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Department of Nutrition, Food Sciences, and Physiology, Center for Nutrition Research, University of Navarra, Pamplona, Spain
| | - Dora Romaguera
- CIBER de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Instituto de Investigación Sanitaria de Palma (IdISPa), University Hospital of Son Espases, Palma de Mallorca, Spain
| | - Jesus Vioque
- University of Miguel Hernández, Alicante, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Fernando Arós
- CIBER de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Department of Cardiology, University Hospital Araba, Vitoria, Spain
| | - Antonio Garcia-Rios
- CIBER de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Reina Sofia University Hospital, IMIBIC, University of Córdoba, Córdoba, Spain
| | - Francisco Tinahones
- CIBER de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Department of Endocrinology and Nutrition, Virgen de la Victoria Hospital, Malaga University, Malaga, Spain
| | - Ramon Estruch
- CIBER de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Department of Internal Medicine, Hospital Clínic, IDIBAPS August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain
| | - José Carlos Fernández-García
- CIBER de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Facultad de Ciencias de la Educación, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
| | - José Lapetra
- CIBER de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Department of Family Medicine, Distrito Sanitario Atencion Primaria Sevilla, Sevilla, Spain
| | - Luís Serra-Majem
- CIBER de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Xavier Pinto
- CIBER de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Lipid Unit, Department of Internal Medicine, Bellvitge Biomedical Research Institute (IDIBELL)-Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Josep A. Tur
- CIBER de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Research Group on Community Nutrition and Oxidative Stress, University of the Balearic Islands, Palma de Mallorca, Spain
| | - Aurora Bueno-Cavanillas
- Departament of Preventive Medicine and Public Health, University of Granada; CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Josep Vidal
- Department of Endocrinology and Nutrition, Hospital Clínic, Barcelona, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Miguel Delgado-Rodríguez
- Department of Health Sciences, University of Jaen; Jaen, Spain; CIBERESP, Instituto de Salud Carlos III, Madrid, Spain
| | - Lidia Daimiel
- Department of Cardiovascular Epidemiology and Population Genetics, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Madrid Institute for Advanced Studies (IMDEA) Food Institute, Madrid, Spain
| | - Clotilde Vázquez
- CIBER de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Department of Endocrinology and Nutrition, University Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Miguel Ángel Rubio
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos-IdISSC, Madrid, Spain
| | - Emilio Ros
- CIBER de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Department of Lipids, Hospital Clínic, Institut d'Investigacions Biomediques August Pi Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Jordi Salas-Salvadó
- Human Nutrition Unit, University Hospital of Sant Joan de Reus, Department of Biochemistry and Biotechnology, Pere Virgili Institute for Health Research, Rovira i Virgili University, Reus, Spain
- CIBER de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
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211
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Vallance JK, Buman MP, Lynch BM, Boyle T. Reallocating time to sleep, sedentary, and active behaviours in non-Hodgkin lymphoma survivors: associations with patient-reported outcomes. Ann Hematol 2017; 96:749-755. [PMID: 28197722 DOI: 10.1007/s00277-017-2942-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 02/02/2017] [Indexed: 01/19/2023]
Abstract
The purpose of this study was to examine potential effects of reallocating time between sleep, sedentary and active behaviours on fatigue symptoms and quality of life in a sample of non-Hodgkin lymphoma survivors. Non-Hodgkin lymphoma survivors identified from the Western Australian Cancer Registry (N = 149) (response rate = 36%; median age = 64 years) wore an Actigraph® GT3X+ accelerometer for 7 days and completed the Fatigue Scale, the Functional Assessment of Cancer Therapy-General and the Pittsburgh Sleep Quality Index. We used isotemporal substitution methods in linear regression models to examine the potential effects of reallocating time between sleep, sedentary and activity behaviours on fatigue and quality of life. Data collection was conducted in Western Australia in 2013. Significant differences were observed for fatigue symptoms when 30 min per day of bouted moderate-to-vigorous physical activity (10 min) was reallocated from 30 min per day of sleep (5.7 points, 95% CI = 1.8, 9.7), sedentary time bouts (20 min) (5.7 points, 95% CI = 1.6, 9.7), sedentary time non-bouts (5.1 points, 95% CI = 1.0, 9.3) or light intensity activity (5.5 points, 95% CI = 1.5, 9.5). Isotemporal substitution effects of reallocating sedentary time, sleep and light physical activity with bouted physical activity was significantly associated with fatigue, but not quality of life. Findings from the present study may aid in the development and delivery of health behaviour interventions that are more likely to influence the health outcome of interest.
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Affiliation(s)
- Jeff K Vallance
- Faculty of Health Disciplines, Centre for Nursing and Health Studies, Athabasca University, 1 University Drive, Athabasca, AB, Canada.
| | - Matthew P Buman
- School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ, USA
| | - Brigid M Lynch
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, VIC, Australia.,Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VC, Australia.,Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Terry Boyle
- British Columbia Cancer Agency, University of British Columbia, Vancouver, BC, Canada.,School of Public Health, Curtin University, Perth, WA, Australia
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212
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Ryan CG, Wellburn S, McDonough S, Martin DJ, Batterham AM. The association between displacement of sedentary time and chronic musculoskeletal pain: an isotemporal substitution analysis. Physiotherapy 2017; 103:471-477. [PMID: 28818451 DOI: 10.1016/j.physio.2017.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 01/19/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Physical activity is an effective intervention for the prevention and management of chronic musculoskeletal pain (CMP). However, there is a lack of research to inform the intensity of physical activity that should be recommended. The aim of this study was to investigate the association between substituting 10minutes of sedentary time with either 10minutes of light physical activity (LPA) or moderate-to-vigorous physical activity (MVPA) and the CMP prevalence ratio. DESIGN Secondary Analysis (November 2015) of data from the Health Survey for England (2008). PARTICIPANTS 2313 adults (≥16years). MAIN OUTCOME MEASURES Sedentary time, LPA and MVPA were measured using accelerometry. We used isotemporal models to quantify the prevalence ratio for CMP of replacing 10minutes of sedentary time with 10minutes of LPA or MVPA. RESULTS The prevalence of CMP in this sample was 17%. The unadjusted prevalence ratio was 0.99 (95% CI: 0.97 to 1.01) for LPA and 0.76 (0.70 to 0.84) for MVPA. The fully adjusted prevalence ratio was 1.01 (95% CI: 0.99 to 1.02) for LPA and 0.89 (0.82 to 0.96) for MVPA. CONCLUSIONS Substituting 10minutes of sedentary time with an equivalent period of LPA was not associated with a reduction in the prevalence ratio for CMP, whereas the equivalent replacement with MVPA showed a small protective relationship. Regarding CMP prevalence, physical activity intensity appears to be important, with MVPA rather than LPA showing a protective relationship. Prospective studies are needed to investigate causality.
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Affiliation(s)
- Cormac G Ryan
- Health and Social Care Institute, Teesside University, Middlesbrough, TS1 3BA, UK.
| | - Shaun Wellburn
- Health and Social Care Institute, Teesside University, Middlesbrough, TS1 3BA, UK
| | - Suzanne McDonough
- Institute of Nursing and Health Research, School of Health Sciences, Ulster University, Jordanstown, UK
| | - Denis J Martin
- Health and Social Care Institute, Teesside University, Middlesbrough, TS1 3BA, UK
| | - Alan M Batterham
- Health and Social Care Institute, Teesside University, Middlesbrough, TS1 3BA, UK
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213
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Carson V, Chaput JP, Janssen I, Tremblay MS. Health associations with meeting new 24-hour movement guidelines for Canadian children and youth. Prev Med 2017; 95:7-13. [PMID: 27923668 DOI: 10.1016/j.ypmed.2016.12.005] [Citation(s) in RCA: 137] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 11/29/2016] [Accepted: 12/01/2016] [Indexed: 11/20/2022]
Abstract
The study objective was to examine whether meeting the new Canadian 24-hour movement guidelines was associated with health indicators in a representative sample of Canadian children and youth. Cross-sectional findings are based on 4157 (1239 fasting subsample) children and youth aged 6-17years from cycles 1-3 of the Canadian Health Measures Survey (CHMS). Sleep and screen time were subjectively measured while moderate- to vigorous-intensity physical activity (MVPA) was accelerometer-determined. Health indicators in the full sample (body mass index (BMI) z-scores, waist circumference, blood pressure, behavioral strengths and difficulties score (lower=better), and aerobic fitness) and fasting subsample (triglycerides, high-density lipoprotein (HDL)-cholesterol, C-reactive protein, and insulin) were measured. Meeting the overall guidelines was defined as: 9-11 hour/night (5-13years) or 8-10 hour/day (14-17years) of sleep, ≤2 hour/day of screen time, and ≥60 minute/day of MVPA. Compared to meeting all three recommendations, meeting none, one, and two recommendations were associated with a higher BMI z-score, waist circumference, and behavioral strengths and difficulties score and lower aerobic fitness in a gradient pattern (Ptrend<0.05). Additionally, compared to meeting all three recommendations, meeting none and one recommendation were associated with higher systolic blood pressure and insulin (Ptrend<0.05). Finally, compared to meeting all three recommendations, meeting no recommendations was associated with higher triglycerides and lower HDL-cholesterol (Ptrend<0.05). Collectively, meeting more recommendations within the 24-hour movement guidelines was associated with better overall health. Since a small proportion (17%) of this representative sample was meeting the overall guidelines, efforts to promote adoption are needed.
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Affiliation(s)
- Valerie Carson
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB T6G 2H9, Canada.
| | - Jean-Philippe Chaput
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada
| | - Ian Janssen
- School of Kinesiology and Health Studies and Department of Public Health Sciences, Queen's University, Kingston, ON, K7L 3N6, Canada
| | - Mark S Tremblay
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada
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214
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Lewis BA, Napolitano MA, Buman MP, Williams DM, Nigg CR. Future directions in physical activity intervention research: expanding our focus to sedentary behaviors, technology, and dissemination. J Behav Med 2017; 40:112-126. [PMID: 27722907 PMCID: PMC5296224 DOI: 10.1007/s10865-016-9797-8] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 09/20/2016] [Indexed: 12/22/2022]
Abstract
Despite the increased health risks of a sedentary lifestyle, only 49 % of American adults participate in physical activity (PA) at the recommended levels. In an effort to move the PA field forward, we briefly review three emerging areas of PA intervention research. First, new intervention research has focused on not only increasing PA but also on decreasing sedentary behavior. Researchers should utilize randomized controlled trials, common terminology, investigate which behaviors should replace sedentary behaviors, evaluate long-term outcomes, and focus across the lifespan. Second, technology has contributed to an increase in sedentary behavior but has also led to innovative PA interventions. PA technology research should focus on large randomized trials with evidence-based components, explore social networking and innovative apps, improve PA monitoring, consider the lifespan, and be grounded in theory. Finally, in an effort to maximize public health impact, dissemination efforts should address the RE-AIM model, health disparities, and intervention costs.
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Affiliation(s)
- Beth A Lewis
- School of Kinesiology, University of Minnesota, 1900 University Avenue SE, Cooke Hall, Minneapolis, MN, 55455, USA.
| | - Melissa A Napolitano
- Departments of Prevention and Community Health/Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave, 3rd Floor, Washington, DC, 20052, USA
| | - Matthew P Buman
- School of Nutrition and Health Promotion, College of Health Solutions, 500 North 3rd Street, Phoenix, AZ, 85004, USA
| | - David M Williams
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Box G-S121-4, Providence, RI, 02912, USA
| | - Claudio R Nigg
- Department of Public Health Sciences, University of Hawaii, 1960 East-West Road, Honolulu, HI, 96822, USA
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215
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Buman MP, Mullane SL, Toledo MJ, Rydell SA, Gaesser GA, Crespo NC, Hannan P, Feltes L, Vuong B, Pereira MA. An intervention to reduce sitting and increase light-intensity physical activity at work: Design and rationale of the 'Stand & Move at Work' group randomized trial. Contemp Clin Trials 2017; 53:11-19. [PMID: 27940181 PMCID: PMC5274555 DOI: 10.1016/j.cct.2016.12.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 11/29/2016] [Accepted: 12/03/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND American workers spend 70-80% of their time at work being sedentary. Traditional approaches to increase moderate-vigorous physical activity (MVPA) may be perceived to be harmful to productivity. Approaches that target reductions in sedentary behavior and/or increases in standing or light-intensity physical activity [LPA] may not interfere with productivity and may be more feasible to achieve through small changes accumulated throughout the workday METHODS/DESIGN: This group randomized trial (i.e., cluster randomized trial) will test the relative efficacy of two sedentary behavior focused interventions in 24 worksites across two states (N=720 workers). The MOVE+ intervention is a multilevel individual, social, environmental, and organizational intervention targeting increases in light-intensity physical activity in the workplace. The STAND+ intervention is the MOVE+ intervention with the addition of the installation and use of sit-stand workstations to reduce sedentary behavior and enhance light-intensity physical activity opportunities. Our primary outcome will be objectively-measured changes in sedentary behavior and light-intensity physical activity over 12months, with additional process measures at 3months and longer-term sustainability outcomes at 24months. Our secondary outcomes will be a clustered cardiometabolic risk score (comprised of fasting glucose, insulin, triglycerides, HDL-cholesterol, and blood pressure), workplace productivity, and job satisfaction DISCUSSION: This study will determine the efficacy of a multi-level workplace intervention (including the use of a sit-stand workstation) to reduce sedentary behavior and increase LPA and concomitant impact on cardiometabolic health, workplace productivity, and satisfaction. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02566317 (date of registration: 10/1/2015).
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Affiliation(s)
- Matthew P Buman
- School of Nutrition and Health Promotion, Arizona State University, 550 N 3rd Street, Phoenix, AZ 85004, United States.
| | - Sarah L Mullane
- School of Nutrition and Health Promotion, Arizona State University, 550 N 3rd Street, Phoenix, AZ 85004, United States
| | - Meynard J Toledo
- School of Nutrition and Health Promotion, Arizona State University, 550 N 3rd Street, Phoenix, AZ 85004, United States
| | - Sarah A Rydell
- Division of Epidemiology and Community Health, University of Minnesota, 1300 S. 2nd Street, Minneapolis, MN 55454, United States
| | - Glenn A Gaesser
- School of Nutrition and Health Promotion, Arizona State University, 550 N 3rd Street, Phoenix, AZ 85004, United States
| | - Noe C Crespo
- School of Nutrition and Health Promotion, Arizona State University, 550 N 3rd Street, Phoenix, AZ 85004, United States; Graduate School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, United States
| | - Peter Hannan
- Division of Epidemiology and Community Health, University of Minnesota, 1300 S. 2nd Street, Minneapolis, MN 55454, United States
| | - Linda Feltes
- State of Minnesota Management and Budget, 400 Centennial Office Building, Saint Paul, MN 55155, United States
| | - Brenna Vuong
- Fairview Health Services, 2344 Energy Park Drive, Saint Paul, MN 55108, United States
| | - Mark A Pereira
- Division of Epidemiology and Community Health, University of Minnesota, 1300 S. 2nd Street, Minneapolis, MN 55454, United States
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216
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Chaput JP, Saunders TJ, Carson V. Interactions between sleep, movement and other non-movement behaviours in the pathogenesis of childhood obesity. Obes Rev 2017; 18 Suppl 1:7-14. [PMID: 28164448 DOI: 10.1111/obr.12508] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 12/06/2016] [Indexed: 12/16/2022]
Abstract
Research examining the health effects of physical activity, sedentary behaviour and sleep on different health outcomes has largely been conducted independently or in isolation of the other behaviours. However, the fact that time is finite (i.e. 24 h) suggests that the debate on whether or not the influence of a single behaviour is independent of another one is conceptually incorrect. Time spent in one behaviour should naturally depend on the composition of the rest of the day. Recent evidence using more appropriate analytical approaches to deal with this methodological issue shows that the combination of sleep, movement and non-movement behaviours matters and all components of the 24-h movement continuum should be targeted to enhance health and prevent childhood obesity. The objective of this review is to discuss research investigating how combinations of physical activity, sedentary behaviour and sleep are related to childhood obesity. Emerging statistical approaches (e.g. compositional data analysis) that can provide a good understanding of the best 'cocktail' of behaviours associated with lower adiposity and improved health are also discussed. Finally, future research directions are provided. Collectively, it becomes clearer that guidelines and public health interventions should target all movement behaviours synergistically to optimize health of children and youth around the world.
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Affiliation(s)
- J-P Chaput
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - T J Saunders
- Applied Human Sciences, Faculty of Science, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - V Carson
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada
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217
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Tremblay MS, Carson V, Chaput JP, Connor Gorber S, Dinh T, Duggan M, Faulkner G, Gray CE, Gruber R, Janson K, Janssen I, Katzmarzyk PT, Kho ME, Latimer-Cheung AE, LeBlanc C, Okely AD, Olds T, Pate RR, Phillips A, Poitras VJ, Rodenburg S, Sampson M, Saunders TJ, Stone JA, Stratton G, Weiss SK, Zehr L. Canadian 24-Hour Movement Guidelines for Children and Youth: An Integration of Physical Activity, Sedentary Behaviour, and Sleep. Appl Physiol Nutr Metab 2017; 41:S311-27. [PMID: 27306437 DOI: 10.1139/apnm-2016-0151] [Citation(s) in RCA: 992] [Impact Index Per Article: 141.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Leaders from the Canadian Society for Exercise Physiology convened representatives of national organizations, content experts, methodologists, stakeholders, and end-users who followed rigorous and transparent guideline development procedures to create the Canadian 24-Hour Movement Guidelines for Children and Youth: An Integration of Physical Activity, Sedentary Behaviour, and Sleep. These novel guidelines for children and youth aged 5-17 years respect the natural and intuitive integration of movement behaviours across the whole day (24-h period). The development process was guided by the Appraisal of Guidelines for Research Evaluation (AGREE) II instrument and systematic reviews of evidence informing the guidelines were assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Four systematic reviews (physical activity, sedentary behaviour, sleep, integrated behaviours) examining the relationships between and among movement behaviours and several health indicators were completed and interpreted by expert consensus. Complementary compositional analyses were performed using Canadian Health Measures Survey data to examine the relationships between movement behaviours and health indicators. A stakeholder survey was employed (n = 590) and 28 focus groups/stakeholder interviews (n = 104) were completed to gather feedback on draft guidelines. Following an introductory preamble, the guidelines provide evidence-informed recommendations for a healthy day (24 h), comprising a combination of sleep, sedentary behaviours, light-, moderate-, and vigorous-intensity physical activity. Proactive dissemination, promotion, implementation, and evaluation plans have been prepared in an effort to optimize uptake and activation of the new guidelines. Future research should consider the integrated relationships among movement behaviours, and similar integrated guidelines for other age groups should be developed.
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Affiliation(s)
- Mark S Tremblay
- a Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Pediatrics, University of Ottawa, ON K1H 8L1, Canada
| | - Valerie Carson
- c Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB T6G 2H9, Canada
| | - Jean-Philippe Chaput
- a Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Pediatrics, University of Ottawa, ON K1H 8L1, Canada
| | | | - Thy Dinh
- e The Conference Board of Canada, Ottawa, ON K1H 8M7, Canada
| | - Mary Duggan
- f Canadian Society for Exercise Physiology, Ottawa, ON K1R 6Y6, Canada
| | - Guy Faulkner
- g School of Kinesiology, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Casey E Gray
- a Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada
| | - Reut Gruber
- h Attention, Behavior, and Sleep Laboratory, Douglas Mental Health University Institute, Verdun, QC H4H 1R3, Canada
| | | | - Ian Janssen
- j School of Kinesiology and Health Studies, Queen's University, Kingston, ON K7L 3N6, Canada.,k Department of Public Health Sciences, Queen's University, Kingston, ON K7L 3N6, Canada
| | | | - Michelle E Kho
- m School of Rehabilitation Science, McMaster University, Hamilton, ON L8S 1C7, Canada
| | - Amy E Latimer-Cheung
- a Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,j School of Kinesiology and Health Studies, Queen's University, Kingston, ON K7L 3N6, Canada
| | - Claire LeBlanc
- n Department of Pediatrics, McGill University, Montreal, QC H4A 3J1, Canada
| | - Anthony D Okely
- o Early Start Research Institute, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales 2522, Australia
| | - Timothy Olds
- p Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute of Health Research, University of South Australia, Adelaide 5001, Australia
| | - Russell R Pate
- q Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | | | - Veronica J Poitras
- a Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada
| | | | - Margaret Sampson
- a Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada
| | - Travis J Saunders
- s Applied Human Sciences, Faculty of Science, University of Prince Edward Island, Charlottetown, PE C1A 4P3, Canada
| | - James A Stone
- t Cardiovascular Health and Stroke Strategic Clinical Network, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Gareth Stratton
- u Applied Sport Technology Exercise and Medicine Research Centre, College of Engineering, Swansea University, Wales, SA2 8PP, UK
| | - Shelly K Weiss
- v Division of Neurology, The Hospital for Sick Children, University of Toronto, Toronto, ON M5G 1X8, Canada
| | - Lori Zehr
- f Canadian Society for Exercise Physiology, Ottawa, ON K1R 6Y6, Canada.,w Camosun College, Victoria, BC V9E 2C1, Canada
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Edwardson CL, Henson J, Bodicoat DH, Bakrania K, Khunti K, Davies MJ, Yates T. Associations of reallocating sitting time into standing or stepping with glucose, insulin and insulin sensitivity: a cross-sectional analysis of adults at risk of type 2 diabetes. BMJ Open 2017; 7:e014267. [PMID: 28087555 PMCID: PMC5253585 DOI: 10.1136/bmjopen-2016-014267] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To quantify associations between sitting time and glucose, insulin and insulin sensitivity by considering reallocation of time into standing or stepping. DESIGN Cross-sectional. SETTING Leicestershire, UK, 2013. PARTICIPANTS Adults aged 30-75 years at high risk of impaired glucose regulation (IGR) or type 2 diabetes. 435 adults (age 66.8±7.4 years; 61.7% male; 89.2% white European) were included. METHODS Participants wore an activPAL3 monitor 24 hours/day for 7 days to capture time spent sitting, standing and stepping. Fasting and 2-hour postchallenge glucose and insulin were assessed; insulin sensitivity was calculated by Homeostasis Model Assessment of Insulin Secretion (HOMA-IS) and Matsuda-Insulin Sensitivity Index (Matsuda-ISI). Isotemporal substitution regression modelling was used to quantify associations of substituting 30 min of waking sitting time (accumulated in prolonged (≥30 min) or short (<30 min) bouts) for standing or stepping on glucose regulation and insulin sensitivity. Interaction terms were fitted to assess whether the associations with measures of glucose regulation and insulin sensitivity was modified by sex or IGR status. RESULTS After adjustment for confounders, including waist circumference, reallocation of prolonged sitting to short sitting time and to standing was associated with 4% lower fasting insulin and 4% higher HOMA-IS; reallocation of prolonged sitting to standing was also associated with a 5% higher Matsuda-ISI. Reallocation to stepping was associated with 5% lower 2-hour glucose, 7% lower fasting insulin, 13% lower 2-hour insulin and a 9% and 16% higher HOMA-IS and Matsuda-ISI, respectively. Reallocation of short sitting time to stepping was associated with 5% and 10% lower 2-hour glucose and 2-hour insulin and 12% higher Matsuda-ISI. Results were not modified by IGR status or sex. CONCLUSIONS Reallocating a small amount of short or prolonged sitting time with standing or stepping may improve 2-hour glucose, fasting and 2-hour insulin and insulin sensitivity. Findings should be confirmed through prospective and intervention research. TRIAL REGISTRATION NUMBER ISRCTN31392913, Post-results.
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Affiliation(s)
- Charlotte L Edwardson
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit, Leicester, UK
- Leicester Diabetes Centre, Leicester General Hospital, University Hospitals of Leicester, Leicester, UK
| | - Joe Henson
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit, Leicester, UK
- Leicester Diabetes Centre, Leicester General Hospital, University Hospitals of Leicester, Leicester, UK
| | - Danielle H Bodicoat
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Leicester Diabetes Centre, Leicester General Hospital, University Hospitals of Leicester, Leicester, UK
- NIHR Collaboration for Leadership in Applied Health Research and Care East Midlands, Leicester, UK
| | - Kishan Bakrania
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit, Leicester, UK
- Leicester Diabetes Centre, Leicester General Hospital, University Hospitals of Leicester, Leicester, UK
- NIHR Collaboration for Leadership in Applied Health Research and Care East Midlands, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Leicester Diabetes Centre, Leicester General Hospital, University Hospitals of Leicester, Leicester, UK
- NIHR Collaboration for Leadership in Applied Health Research and Care East Midlands, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit, Leicester, UK
- Leicester Diabetes Centre, Leicester General Hospital, University Hospitals of Leicester, Leicester, UK
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit, Leicester, UK
- Leicester Diabetes Centre, Leicester General Hospital, University Hospitals of Leicester, Leicester, UK
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219
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Roskoden FC, Krüger J, Vogt LJ, Gärtner S, Hannich HJ, Steveling A, Lerch MM, Aghdassi AA. Physical Activity, Energy Expenditure, Nutritional Habits, Quality of Sleep and Stress Levels in Shift-Working Health Care Personnel. PLoS One 2017; 12:e0169983. [PMID: 28081231 PMCID: PMC5231338 DOI: 10.1371/journal.pone.0169983] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 12/27/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Among health care personnel working regular hours or rotating shifts can affect parameters of general health and nutrition. We have investigated physical activity, sleep quality, metabolic activity and stress levels in health care workers from both groups. METHODS We prospectively recruited 46 volunteer participants from the workforce of a University Medical Department of which 23 worked in rotating shifts (all nursing) and 21 non-shift regular hours (10 nursing, 13 clerical staff). All were investigated over 7 days by multisensory accelerometer (SenseWear Bodymedia® armband) and kept a detailed food diary. Physical activity and resting energy expenditure (REE) were measured in metabolic equivalents of task (METs). Quality of sleep was assessed as Pittsburgh Sleeping Quality Index and stress load using the Trier Inventory for Chronic Stress questionnaire (TICS). RESULTS No significant differences were found for overall physical activity, steps per minute, time of exceeding the 3 METs level or sleep quality. A significant difference for physical activity during working hours was found between shift-workers vs. non-shift-workers (p<0.01) and for shift-working nurses (median = 2.1 METs SE = 0.1) vs. non-shift-working clerical personnel (median = 1.5 METs SE = 0.07, p<0.05). Non-shift-working nurses had a significantly lower REE than the other groups (p<0.05). The proportion of fat in the diet was significantly higher (p<0.05) in the office worker group (median = 42% SE = 1.2) whereas shift-working nurses consumed significantly more carbohydrates (median = 46% SE = 1.4) than clerical staff (median = 41% SE = 1.7). Stress assessment by TICS confirmed a significantly higher level of social overload in the shift working group (p<0.05). CONCLUSION In this prospective cohort study shift-working had no influence on overall physical activity. Lower physical activity during working hours appears to be compensated for during off-hours. Differences in nutritional habits and stress load warrant larger scale trials to determine the effect on implicit health-associated conditions.
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Affiliation(s)
| | - Janine Krüger
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Lena Johanna Vogt
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Simone Gärtner
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Hans Joachim Hannich
- Institute of Medical Psychology, University Medicine Greifswald, Greifswald, Germany
| | - Antje Steveling
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Markus M. Lerch
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
- * E-mail:
| | - Ali A. Aghdassi
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
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220
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Wellburn S, Ryan CG, Azevedo LB, Ells L, Martin DJ, Atkinson G, Batterham AM. Displacing Sedentary Time: Association with Cardiovascular Disease Prevalence. Med Sci Sports Exerc 2016; 48:641-7. [PMID: 26559454 DOI: 10.1249/mss.0000000000000816] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Isotemporal substitution analysis offers new insights for public health but has only recently been applied to sedentary behavior research. We aimed to quantify associations between the substitution of 10 min of sedentary behavior with 10 min of light physical activity (LPA) or moderate-to-vigorous physical activity (MVPA) and the prevalence of cardiovascular disease (CVD). Age was also explored as a potential effect modifier. METHODS We completed a secondary analysis of data from 1477 adults from the Health Survey for England (2008). Sedentary time, LPA, and MVPA were measured using accelerometry. We applied isotemporal models to quantify the relationship with CVD prevalence of replacing 10 min of sedentary time with equivalent amounts of LPA or MVPA. Prevalence risk ratios (RR) with 95% confidence intervals (CI) are presented, adjusted for covariates. The role of age as an effect modifier was explored via age-MVPA and age-LPA interactions. CVD was defined as per the International Classification of Diseases. RESULTS The prevalence of CVD was 24%. The RR was 0.97 (95% CI, 0.96-0.99) for LPA and 0.88 (0.81-0.96) for MVPA. Substitution of approximately 50 min of LPA would be required for an association equivalent to 10 min of MVPA. The beneficial association of MVPA was attenuated with age, with a decrease in the relative risk reduction of approximately 7% per decade. CONCLUSIONS Isotemporal substitution of sedentary time with LPA was associated with a trivial relative risk reduction for CVD, whereas the equivalent replacement with MVPA had a small beneficial relationship. With respect to CVD prevalence, MVPA might become decreasingly important in older individuals. Prospective studies are needed to investigate causality.
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Affiliation(s)
- Shaun Wellburn
- Health and Social Care Institute, Teesside University, Middlesbrough, UNITED KINGDOM
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221
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Mansoubi M, Pearson N, Biddle SJH, Clemes SA. Using Sit-to-Stand Workstations in Offices: Is There a Compensation Effect? Med Sci Sports Exerc 2016; 48:720-5. [PMID: 26496419 DOI: 10.1249/mss.0000000000000802] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Sit-to-stand workstations are becoming common in modern offices and are increasingly being implemented in sedentary behavior interventions. The purpose of this study was to examine whether the introduction of such a workstation among office workers leads to reductions in sitting during working hours, and whether office workers compensate for any reduction in sitting at work by increasing sedentary time and decreasing physical activity (PA) outside work. METHODS Office workers (n = 40; 55% female) were given a WorkFit-S, sit-to-stand workstation for 3 months. Participants completed assessments at baseline (before workstation installation), 1 wk and 6 wk after the introduction of the workstation, and again at 3 months (postintervention). Posture and PA were assessed using the activPAL inclinometer and ActiGraph GT3X+ accelerometer, which participants wore for 7 d during each measurement phase. RESULTS Compared with baseline, the proportion of time spent sitting significantly decreased (75% ± 13% vs 52% ± 16% to 56% ± 13%), and time spent standing and in light activity significantly increased (standing: 19% ± 12% vs 32% ± 12% to 37% ± 15%, light PA: 14% ± 4% vs 16% ± 5%) during working hours at all follow-up assessments. However, compared with baseline, the proportion of time spent sitting significantly increased (60% ± 11% vs 66% ± 12% to 68% ± 12%) and light activity significantly decreased (21% ± 5% vs 19% ± 5%) during nonworking hours across the follow-up measurements. No differences were seen in moderate-to-vigorous activity during nonworking hours throughout the study. CONCLUSION The findings suggest that introducing a sit-to-stand workstation can significantly reduce sedentary time and increase light activity levels during working hours. However, these changes were compensated for by reducing activity and increasing sitting outside of working hours. An intervention of a sit-to-stand workstation should be accompanied by an intervention outside of working hours to limit behavior compensation.
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Affiliation(s)
- Maedeh Mansoubi
- 1School of Sport, Exercise & Health Sciences, Loughborough University, UNITED KINGDOM; 2Institute of Sport, Exercise & Active Living, Victoria University, Melbourne, AUSTRALIA; and 3The NIHR Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit, Loughborough University, UNITED KINGDOM
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van der Berg JD, Koster A, Stehouwer CD. Sedentary Behaviour: A New Target in the Prevention and Management of Diabetes? EUROPEAN MEDICAL JOURNAL 2016. [DOI: 10.33590/emj/10312247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Julianne D. van der Berg
- Department of Social Medicine, Maastricht University, Maastricht, Netherlands; CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands; Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Annemarie Koster
- Department of Social Medicine, Maastricht University, Maastricht, Netherlands; CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands
| | - Coen D.A. Stehouwer
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Netherlands
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Kanagasabai T, Riddell MC, Ardern CI. Physical Activity Contributes to Several Sleep-Cardiometabolic Health Relationships. Metab Syndr Relat Disord 2016; 15:44-51. [PMID: 27925858 DOI: 10.1089/met.2016.0103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To estimate the contribution of accelerometer-derived physical activity to the relationship between sleep and cardiometabolic health. METHODS Data from the 2005 to 2006 US National Health and Nutritional Examination Survey were used (N = 1226; 20 years+). Metabolic syndrome (MetS) was defined by the Joint Interim Statement, and sleep quality and quantity by the Sleep Disorders Questionnaire. Physical activity intensities were defined by activity thresholds (counts per minute) as sedentary activity (0-99), light intensity (100-759), lifestyle activity (760-2019), moderate intensity (2020-5996), and vigorous intensity (≥5999). Outcomes were MetS, number of MetS components, waist circumference (WC), systolic and diastolic blood pressure (BP), triglycerides, HDL-cholesterol, fasting plasma glucose, and fasting insulin concentration. The bootstrap method was used to estimate the amount of mediation or contribution of activity intensities (ab) to the sleep-cardiometabolic health relationships, which were quantified as large (≥0.25) or moderate (≥0.09). RESULTS Lifestyle activity level contributes to several sleep duration and cardiometabolic health relationships, most notably for WC (ab: 0.28), systolic BP (0.39), and fasting insulin concentration (0.85). While moderate intensity and lifestyle activity intensities were large contributors to the sleep quality-fasting insulin concentration relationship (0.47 and 0.48, respectively), light intensity activity only moderately contributed to the relationship between sleep duration and quality with abdominal obesity (0.15). CONCLUSION Lifestyle and moderate intensity physical activity have a large effect on the relationship between sleep and cardiometabolic health, including WC, BP, and fasting insulin concentration. Appropriate sleep hygiene, in combination with regular physical activity should be considered mutually beneficial targets for cardiometabolic health.
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Affiliation(s)
| | - Michael C Riddell
- School of Kinesiology and Health Science, York University , Toronto, Canada
| | - Chris I Ardern
- School of Kinesiology and Health Science, York University , Toronto, Canada
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Fedewa MV, Hathaway ED, Williams TD, Schmidt MD. Effect of Exercise Training on Non-Exercise Physical Activity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Sports Med 2016; 47:1171-1182. [DOI: 10.1007/s40279-016-0649-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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225
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HUANG WENDYYAJUN, WONG STEPHENHEUNGSANG, HE GANG, SALMON JO. Isotemporal Substitution Analysis for Sedentary Behavior and Body Mass Index. Med Sci Sports Exerc 2016. [DOI: 10.1249/mss.0000000000001002 pmid: 27760071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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226
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Matthews CE, Keadle SK, Troiano RP, Kahle L, Koster A, Brychta R, Van Domelen D, Caserotti P, Chen KY, Harris TB, Berrigan D. Accelerometer-measured dose-response for physical activity, sedentary time, and mortality in US adults. Am J Clin Nutr 2016; 104:1424-1432. [PMID: 27707702 PMCID: PMC5081718 DOI: 10.3945/ajcn.116.135129] [Citation(s) in RCA: 202] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 09/07/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Moderate-to-vigorous-intensity physical activity is recommended to maintain and improve health, but the mortality benefits of light activity and risk for sedentary time remain uncertain. OBJECTIVES Using accelerometer-based measures, we 1) described the mortality dose-response for sedentary time and light- and moderate-to-vigorous-intensity activity using restricted cubic splines, and 2) estimated the mortality benefits associated with replacing sedentary time with physical activity, accounting for total activity. DESIGN US adults (n = 4840) from NHANES (2003-2006) wore an accelerometer for ≤7 d and were followed prospectively for mortality. Proportional hazards models were used to estimate adjusted HRs and 95% CIs for mortality associations with time spent sedentary and in light- and moderate-to-vigorous-intensity physical activity. Splines were used to graphically present behavior-mortality relation. Isotemporal models estimated replacement associations for sedentary time, and separate models were fit for low- (<5.8 h total activity/d) and high-active participants to account for nonlinear associations. RESULTS Over a mean of 6.6 y, 700 deaths occurred. Compared with less-sedentary adults (6 sedentary h/d), those who spent 10 sedentary h/d had 29% greater risk (HR: 1.29; 95% CI: 1.1, 1.5). Compared with those who did less light activity (3 h/d), those who did 5 h of light activity/d had 23% lower risk (HR: 0.77; 95% CI: 0.6, 1.0). There was no association with mortality for sedentary time or light or moderate-to-vigorous activity in highly active adults. In less-active adults, replacing 1 h of sedentary time with either light- or moderate-to-vigorous-intensity activity was associated with 18% and 42% lower mortality, respectively. CONCLUSIONS Health promotion efforts for physical activity have mostly focused on moderate-to-vigorous activity. However, our findings derived from accelerometer-based measurements suggest that increasing light-intensity activity and reducing sedentary time are also important, particularly for inactive adults.
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Affiliation(s)
- Charles E Matthews
- Division of Cancer Epidemiology and Genetics, Nutritional Epidemiology Branch,
| | - Sarah Kozey Keadle
- Division of Cancer Epidemiology and Genetics, Nutritional Epidemiology Branch
| | | | - Lisa Kahle
- Information Management Services Inc., Silver Spring, MD
| | - Annemarie Koster
- Care and Public Health Research Institute School for Public Health and Primary Care, Department of Social Medicine, Maastricht University, Maastricht, Netherlands
| | - Robert Brychta
- National Institute of Diabetes and Digestive and Kidney Diseases, Diabetes, Endocrinology, and Obesity Branch, Bethesda, MD
| | - Dane Van Domelen
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Paolo Caserotti
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Kong Y Chen
- National Institute of Diabetes and Digestive and Kidney Diseases, Diabetes, Endocrinology, and Obesity Branch, Bethesda, MD
| | - Tamara B Harris
- National Institute on Aging, Intramural Research Program, Laboratory of Epidemiology, Demography, and Biometry, Bethesda, MD
| | - David Berrigan
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
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Dempsey PC, Owen N, Yates TE, Kingwell BA, Dunstan DW. Sitting Less and Moving More: Improved Glycaemic Control for Type 2 Diabetes Prevention and Management. Curr Diab Rep 2016; 16:114. [PMID: 27699700 DOI: 10.1007/s11892-016-0797-4] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Epidemiological evidence indicates that excessive time spent in sedentary behaviours (too much sitting) is associated with an increased risk of type 2 diabetes (T2D). Here, we highlight findings of experimental studies corroborating and extending the epidemiological evidence and showing the potential benefits for T2D of reducing and breaking up sitting time across the whole day. We also discuss future research opportunities and consider emerging implications for T2D prevention and management. This new evidence is stimulating an expansion of diabetes-related physical activity guidelines-suggesting that in addition to moderate-vigorous physical activity, reducing and regularly interrupting prolonged sitting time is likely to have important and varied benefits across the spectrum of diabetes risk.
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Affiliation(s)
- Paddy C Dempsey
- Physical Activity, Behavioural Epidemiology, and Metabolic & Vascular Physiology Laboratories, Baker IDI Heart and Diabetes Institute, Level 4, 99 Commercial Rd, Melbourne, VIC 3004, Australia.
- Central Clinical School, Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia.
| | - Neville Owen
- Physical Activity, Behavioural Epidemiology, and Metabolic & Vascular Physiology Laboratories, Baker IDI Heart and Diabetes Institute, Level 4, 99 Commercial Rd, Melbourne, VIC 3004, Australia
- Central Clinical School, Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia
- Swinburne University of Technology, Melbourne, Australia
| | - Thomas E Yates
- Diabetes Research Centre, University of Leicester and NIHR Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit, Leicester, UK
| | - Bronwyn A Kingwell
- Physical Activity, Behavioural Epidemiology, and Metabolic & Vascular Physiology Laboratories, Baker IDI Heart and Diabetes Institute, Level 4, 99 Commercial Rd, Melbourne, VIC 3004, Australia
- Central Clinical School, Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia
| | - David W Dunstan
- Physical Activity, Behavioural Epidemiology, and Metabolic & Vascular Physiology Laboratories, Baker IDI Heart and Diabetes Institute, Level 4, 99 Commercial Rd, Melbourne, VIC 3004, Australia
- Central Clinical School, Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia
- Mary MacKillop Institute of Health Research, Australian Catholic University, Melbourne, Australia
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Boyle T, Vallance JK, Buman MP, Lynch BM. Reallocating Time to Sleep, Sedentary Time, or Physical Activity: Associations with Waist Circumference and Body Mass Index in Breast Cancer Survivors. Cancer Epidemiol Biomarkers Prev 2016; 26:254-260. [PMID: 27780817 DOI: 10.1158/1055-9965.epi-16-0545] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 09/27/2016] [Accepted: 10/10/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Moderate-to-vigorous intensity physical activity (MVPA) is inversely associated with waist circumference and body mass index (BMI) among breast cancer survivors. Limited research has focused on behaviors that account for larger portions of the day [sleep, sedentary time, and light-intensity physical activity (LPA)]. We investigated the interdependent associations of self-reported sleep, objectively assessed prolonged and short bouts of sedentary time, total LPA, and total MVPA with waist circumference and BMI. METHODS A cross-sectional sample of breast cancer survivors (N = 256, mean age = 60 years; mean time since diagnosis = 3 years) wore an Actigraph GT3X+ accelerometer during waking hours for 7 days. Participants completed the Pittsburgh Sleep Quality Index and self-reported their waist circumference, height, and weight. An isotemporal substitution approach was used in linear regression models to explore the associations of reallocating time to sleep, sedentary and active behaviors on waist circumference, and BMI, after adjusting for potential confounders. RESULTS Reallocating 30 minutes to MVPA was significantly associated with lower waist circumference when allocated from sleep (-2.50 cm), prolonged sedentary time (-2.51 cm), or LPA (-2.71 cm). Reallocating 30 minutes of prolonged sedentary time to nonprolonged sedentary time was significantly associated with lower waist circumference (-0.94 cm). Similar results were observed for BMI. CONCLUSIONS Reallocating 30 minutes to MVPA was associated with significantly lower waist circumference and BMI, as was reallocating 30 minutes of prolonged sedentary time to 30 minutes of nonprolonged sedentary time. IMPACT Increasing MVPA levels and decreasing time spent in prolonged, unbroken sedentary bouts may be avenues for improving body composition in this population. Cancer Epidemiol Biomarkers Prev; 26(2); 254-60. ©2016 AACR.
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Affiliation(s)
- Terry Boyle
- School of Public Health, Curtin University, Perth, Western Australia, Australia. .,Cancer Control Research, British Columbia Cancer Agency, Vancouver, British Columbia, Canada.,Centre for Medical Research, The University of Western Australia, Perth, Western Australia, Australia
| | - Jeff K Vallance
- Faculty of Health Disciplines, Athabasca University, Athabasca, Canada
| | - Matthew P Buman
- School of Nutrition and Health Promotion, Arizona State University, Phoenix, Arizona
| | - Brigid M Lynch
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Victoria, Australia.,School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,Physical Activity Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
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Cellini N, McDevitt EA, Mednick SC, Buman MP. Response to the letter to the editor from Dr. Kawada, "Comparison of two accelerometers for monitoring sleep: Agreement and validity". Physiol Behav 2016; 163:333. [PMID: 27109190 DOI: 10.1016/j.physbeh.2016.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 04/15/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Nicola Cellini
- Department of General Psychology, University of Padova, Via Venezia 8, 35131 Padova, Italy; Department of Psychology, University of California, Riverside, 900 University Ave., 92521 Riverside, CA, USA.
| | - Elizabeth A McDevitt
- Department of Psychology, University of California, Riverside, 900 University Ave., 92521 Riverside, CA, USA.
| | - Sara C Mednick
- Department of Psychology, University of California, Riverside, 900 University Ave., 92521 Riverside, CA, USA.
| | - Matthew P Buman
- School of Nutrition & Health Promotion, Arizona State University, 550 N 3rd St, 85004 Phoenix, AZ, USA.
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Zhu W, Chi A, Sun Y. Physical activity among older Chinese adults living in urban and rural areas: A review. JOURNAL OF SPORT AND HEALTH SCIENCE 2016; 5:281-286. [PMID: 30356525 PMCID: PMC6188614 DOI: 10.1016/j.jshs.2016.07.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/20/2016] [Accepted: 05/21/2016] [Indexed: 05/21/2023]
Abstract
With an increase in rural-to-urban migration, a rapidly aging population, and the rising risk of developing noncommunicable diseases in China, it is important to understand the epidemiology of physical activity (PA) and health in the context of disease prevention and population health. Despite its public health importance, there is a significant lack of knowledge about PA in older Chinese adults that may hamper primary prevention efforts of health promotion in an increasingly aging population. To fill this gap, this article presents a narrative review of PA in the older Chinese adult population with a special focus on residential settings (i.e., urban and rural). Using existing studies, the review examines overall PA patterns and their correlates and discusses public health implications and future research. Although there are some preliminary indications of urban and rural differences in PA in the aging population in China, continued research efforts are needed to facilitate primary prevention efforts aimed at reducing noncommunicable diseases and promoting an active lifestyle among the largest population of older people in the world.
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231
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Buman MP, Epstein DR, Gutierrez M, Herb C, Hollingshead K, Huberty JL, Hekler EB, Vega-López S, Ohri-Vachaspati P, Hekler AC, Baldwin CM. BeWell24: development and process evaluation of a smartphone "app" to improve sleep, sedentary, and active behaviors in US Veterans with increased metabolic risk. Transl Behav Med 2016; 6:438-48. [PMID: 27528532 PMCID: PMC4987607 DOI: 10.1007/s13142-015-0359-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Lifestyle behaviors across the 24-h spectrum (i.e., sleep, sedentary, and active behaviors) drive metabolic risk. We describe the development and process evaluation of BeWell24, a multicomponent smartphone application (or "app") that targets behavior change in these interdependent behaviors. A community-embedded iterative design framework was used to develop the app. An 8-week multiphase optimization strategy design study was used to test the initial efficacy of the sleep, sedentary, and exercise components of the app. Process evaluation outcomes included objectively measured app usage statistics (e.g., minutes of usage, self-monitoring patterns), user experience interviews, and satisfaction ratings. Participants (N = 26) logged approximately 60 % of their sleep, sedentary, and exercise behaviors, which took 3-4 min/day to complete. Usage of the sleep and sedentary components peaked at week 2 and remained high throughout the intervention. Exercise component use was low. User experiences were mixed, and overall satisfaction was modest.
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Affiliation(s)
- Matthew P. Buman
- School of Nutrition and Health Promotion, Arizona State University, 500 N. 3rd Street, Mail Code 9020, Phoenix, AZ 85004-2135 USA
| | - Dana R. Epstein
- Phoenix Veterans Affairs Health Care System, Phoenix, AZ 85012 USA
- College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ 85004 USA
| | - Monica Gutierrez
- School of Nutrition and Health Promotion, Arizona State University, 500 N. 3rd Street, Mail Code 9020, Phoenix, AZ 85004-2135 USA
| | - Christine Herb
- Phoenix Veterans Affairs Health Care System, Phoenix, AZ 85012 USA
| | - Kevin Hollingshead
- School of Nutrition and Health Promotion, Arizona State University, 500 N. 3rd Street, Mail Code 9020, Phoenix, AZ 85004-2135 USA
| | - Jennifer L. Huberty
- School of Nutrition and Health Promotion, Arizona State University, 500 N. 3rd Street, Mail Code 9020, Phoenix, AZ 85004-2135 USA
| | - Eric B. Hekler
- School of Nutrition and Health Promotion, Arizona State University, 500 N. 3rd Street, Mail Code 9020, Phoenix, AZ 85004-2135 USA
| | - Sonia Vega-López
- School of Nutrition and Health Promotion, Arizona State University, 500 N. 3rd Street, Mail Code 9020, Phoenix, AZ 85004-2135 USA
| | - Punam Ohri-Vachaspati
- School of Nutrition and Health Promotion, Arizona State University, 500 N. 3rd Street, Mail Code 9020, Phoenix, AZ 85004-2135 USA
| | - Andrea C. Hekler
- Phoenix Veterans Affairs Health Care System, Phoenix, AZ 85012 USA
| | - Carol M. Baldwin
- College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ 85004 USA
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Young DR, Hivert MF, Alhassan S, Camhi SM, Ferguson JF, Katzmarzyk PT, Lewis CE, Owen N, Perry CK, Siddique J, Yong CM. Sedentary Behavior and Cardiovascular Morbidity and Mortality: A Science Advisory From the American Heart Association. Circulation 2016; 134:e262-79. [PMID: 27528691 DOI: 10.1161/cir.0000000000000440] [Citation(s) in RCA: 424] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Epidemiological evidence is accumulating that indicates greater time spent in sedentary behavior is associated with all-cause and cardiovascular morbidity and mortality in adults such that some countries have disseminated broad guidelines that recommend minimizing sedentary behaviors. Research examining the possible deleterious consequences of excess sedentary behavior is rapidly evolving, with the epidemiology-based literature ahead of potential biological mechanisms that might explain the observed associations. This American Heart Association science advisory reviews the current evidence on sedentary behavior in terms of assessment methods, population prevalence, determinants, associations with cardiovascular disease incidence and mortality, potential underlying mechanisms, and interventions. Recommendations for future research on this emerging cardiovascular health topic are included. Further evidence is required to better inform public health interventions and future quantitative guidelines on sedentary behavior and cardiovascular health outcomes.
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233
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Shifting away from sedentary time, and FITTing exercise into the treatment of hypertension. J Hypertens 2016; 34:830-2. [PMID: 27027376 DOI: 10.1097/hjh.0000000000000904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Biddle SJH, Bennie JA, Bauman AE, Chau JY, Dunstan D, Owen N, Stamatakis E, van Uffelen JGZ. Too much sitting and all-cause mortality: is there a causal link? BMC Public Health 2016; 16:635. [PMID: 27456959 PMCID: PMC4960753 DOI: 10.1186/s12889-016-3307-3] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 07/14/2016] [Indexed: 11/28/2022] Open
Abstract
Background Sedentary behaviours (time spent sitting, with low energy expenditure) are associated with deleterious health outcomes, including all-cause mortality. Whether this association can be considered causal has yet to be established. Using systematic reviews and primary studies from those reviews, we drew upon Bradford Hill’s criteria to consider the likelihood that sedentary behaviour in epidemiological studies is likely to be causally related to all-cause (premature) mortality. Methods Searches for systematic reviews on sedentary behaviours and all-cause mortality yielded 386 records which, when judged against eligibility criteria, left eight reviews (addressing 17 primary studies) for analysis. Exposure measures included self-reported total sitting time, TV viewing time, and screen time. Studies included comparisons of a low-sedentary reference group with several higher sedentary categories, or compared the highest versus lowest sedentary behaviour groups. We employed four Bradford Hill criteria: strength of association, consistency, temporality, and dose–response. Evidence supporting causality at the level of each systematic review and primary study was judged using a traffic light system depicting green for causal evidence, amber for mixed or inconclusive evidence, and red for no evidence for causality (either evidence of no effect or no evidence reported). Results The eight systematic reviews showed evidence for consistency (7 green) and temporality (6 green), and some evidence for strength of association (4 green). There was no evidence for a dose–response relationship (5 red). Five reviews were rated green overall. Twelve (67 %) of the primary studies were rated green, with evidence for strength and temporality. Conclusions There is reasonable evidence for a likely causal relationship between sedentary behaviour and all-cause mortality based on the epidemiological criteria of strength of association, consistency of effect, and temporality. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3307-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stuart J H Biddle
- Active Living & Public Health, Institute of Sport, Exercise & Active Living (ISEAL), Victoria University, Footscray Park, Melbourne, VIC, 8001, Australia. .,Baker IDI Heart and Diabetes Institute, Melbourne, Australia.
| | - Jason A Bennie
- Active Living & Public Health, Institute of Sport, Exercise & Active Living (ISEAL), Victoria University, Footscray Park, Melbourne, VIC, 8001, Australia
| | | | | | - David Dunstan
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia.,University of Queensland, Brisbane, Australia.,Monash University, Melbourne, Australia.,University of Melbourne, Melbourne, Australia.,Deakin University, Melbourne, Australia.,University of Western Australia, Perth, Australia.,The Australian Catholic University, Sydney, Australia
| | - Neville Owen
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia.,Swinburne University of Technology, Melbourne, Australia
| | - Emmanuel Stamatakis
- University of Sydney, Sydney, Australia.,University College London, London, UK
| | - Jannique G Z van Uffelen
- Active Living & Public Health, Institute of Sport, Exercise & Active Living (ISEAL), Victoria University, Footscray Park, Melbourne, VIC, 8001, Australia.,Baker IDI Heart and Diabetes Institute, Melbourne, Australia
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235
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Beck J, Chard CA, Hilzendegen C, Hill J, Stroebele-Benschop N. In-school versus out-of-school sedentary behavior patterns in U.S. children. BMC OBESITY 2016; 3:34. [PMID: 27437117 PMCID: PMC4944493 DOI: 10.1186/s40608-016-0115-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 06/28/2016] [Indexed: 12/22/2022]
Abstract
Background This study contributes to the literature by using accelerometers to describe sedentary behavior (SB) patterns in US children. The purpose of this study was to examine SB patterns in fifth-graders by specifically focusing on in-school versus out-of-school SB patterns to identify when (during the school day or outside of the school day) interventions should take place in order to decrease SB in children. Methods Data were collected from 206 fifth-graders (9–11 years old) in the Cherry Creek School District in metro Denver, Colorado (USA) during the spring of the 2010–2011 school year and fall of the 2011–2012 school year. Children wore Actical accelerometers continuously over an eight-day period. Data were analyzed using Wilcoxon rank tests, paired samples t-tests, and independent samples t-tests. Awake time was 6 AM–11 PM. We compared the percent of time spent in SB before school, during school, at recess/lunch and after school, as well as differences between boys and girls, and between children from low and high socioeconomic status schools. Children were classified as ‘non-sedentary’ or ‘sedentary’ if they participated in <360 min or ≥360 min per day of SB, respectively and were classified as ‘inactive’ or ‘active’ if they participated in <60 min or ≥ 60 min per day of MVPA, respectively. Cross-tabs were used (and Fisher’s exact test) to identify the proportion of children in the following categories: 1) non-sedentary/inactive; 2) sedentary/inactive; 3) non-sedentary/active; and 4) sedentary/active. Statistical significance was set at p < 0.05. Results All children (boys and girls and children from low and high socioeconomic status schools) participated in significantly more SB outside of school hours versus during school hours and on weekend days compared to weekdays (p < 0.001). Girls participated in significantly more SB than boys during weekdays (p = 0.015). The majority of children (65.3 %) were classified as sedentary/active. Conclusions Given that children appear to be more sedentary during the weekend, where more opportunities to be physically active with the whole family can easily be implemented, future interventions should focus on time periods outside of school hours in order to decrease sedentary behavior and increase light physical activity in particular.
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Affiliation(s)
- Jimikaye Beck
- Colorado State University, 234 Gifford Building, Fort Collins, CO 80523-1571 USA
| | - Christine A Chard
- Colorado School of Public Health, Colorado State University, 1879 Sage Hall, Fort Collins, CO 80523 USA
| | - Carolin Hilzendegen
- Institute of Nutritional Medicine, University of Hohenheim, Fruwirthstr. 12, Stuttgart, 70599 Germany
| | - James Hill
- Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, 12348 E. Montview Blvd, Aurora, CO 80247 USA
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Meiring RM, Frimpong E, Mokete L, Pietrzak J, Van Der Jagt D, Tikly M, McVeigh JA. Rationale, design and protocol of a longitudinal study assessing the effect of total knee arthroplasty on habitual physical activity and sedentary behavior in adults with osteoarthritis. BMC Musculoskelet Disord 2016; 17:281. [PMID: 27411316 PMCID: PMC4944438 DOI: 10.1186/s12891-016-1141-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 06/29/2016] [Indexed: 01/11/2023] Open
Abstract
Background Physical activity levels are decreased and sedentary behaviour levels are increased in patients with knee osteoarthritis (OA). However, previous studies have shown that following total knee arthroplasty (TKA), objectively measured physical activity levels do not change compared to before the surgery. Very few studies have objectively assessed sedentary behaviour following TKA. This study aims to assess patterns of objective habitual physical activity and sedentary behaviour in patients with knee OA and to determine whether these change following TKA. Methods Patients diagnosed with knee osteoarthritis and scheduled for unilateral primary total knee arthroplasty will be recruited from the Orthopaedic Division at the Charlotte Maxeke Johannesburg Academic Hospital. Eligible participants will have assessments completed one week before the scheduled arthroplasty, six weeks, and six months post-operatively. The primary outcomes are habitual physical activity and sedentary behaviour which will be measured using accelerometry (Actigraph GTX3+ and activPal monitors) at the specific time points. The secondary outcomes will be improvements in osteoarthritis-specific quality of life measures using the following questionnaires: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee injury and Osteoarthritis Outcome Score (KOOS), Oxford Knee Score (OKS), Knee Society Clinical Rating System (KSS), UCLA activity index; subjective pain scores, and self reported sleep quality. Discussion The present study will contribute to the field of musculoskeletal health by providing a rich detailed description of the patterns of accumulation of physical activity and sedentary behaviour in patients with knee OA. These data will contribute to existing knowledge using an objective measurement for the assessment of functional ability after total knee arthroplasty. Although studies have used accelerometry to measure physical activity in knee OA patients, the data provided thus far have not delved into the detailed patterns of how and when physical activity is accumulated before and after TKA. Accurate assessment of physical activity is important for physical activity interventions that target special populations. Trial registration NCT02675062 (4 February 2016).
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Affiliation(s)
- Rebecca M Meiring
- Exercise Physiology Laboratory, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Rd, Parktown, Johannesburg, South Africa.
| | - Emmanuel Frimpong
- Exercise Physiology Laboratory, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Rd, Parktown, Johannesburg, South Africa
| | - Lipalo Mokete
- Division of Orthopaedics, Faculty of Health Sciences, University of the Witwatersrand, 7 York Rd, Parktown, Johannesburg, South Africa
| | - Jurek Pietrzak
- Division of Orthopaedics, Faculty of Health Sciences, University of the Witwatersrand, 7 York Rd, Parktown, Johannesburg, South Africa
| | - Dick Van Der Jagt
- Division of Orthopaedics, Faculty of Health Sciences, University of the Witwatersrand, 7 York Rd, Parktown, Johannesburg, South Africa
| | - Mohammed Tikly
- Division of Rheumatology, Department of Medicine, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, 7 York Rd, Parktown, Johannesburg, South Africa
| | - Joanne A McVeigh
- Exercise Physiology Laboratory, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Rd, Parktown, Johannesburg, South Africa.,School of Physiotherapy and Exercise Science, Curtin University, Kent St, Bentley, Western Australia
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237
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Brewer W, Ogbazi R, Ohl D, Daniels J, Ortiz A. A comparison of work-related physical activity levels between inpatient and outpatient physical therapists: an observational cohort trial. BMC Res Notes 2016; 9:313. [PMID: 27306457 PMCID: PMC4910207 DOI: 10.1186/s13104-016-2119-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 06/06/2016] [Indexed: 11/10/2022] Open
Abstract
Background Physical therapists (PTs) work in a variety of healthcare settings with varied levels of physical activity demands placed on them. The purpose of this study is to compare the physical activity (PA) levels between PTs in inpatient versus outpatient environments for one work week using a cross-sectional design. Methods Sixty-one PTs (30 inpatient, 31 outpatient) wore a tri-axial accelerometer and inclinometer for one work-week. The number steps-per-day, PA intensities, energy expenditures and postural positions adopted during the work day were recorded. Result Significantly longer amounts of time spent sitting was found for inpatient PTs regardless of the significantly higher number of steps-per-day. Outpatient PTs had a higher number of breaks from sedentary activity with those breaks being longer than the inpatient PTs. The percentage of time spent performing moderate-vigorous PA approached significance implying more time was spent performing these types of activities for outpatient PTs. The energy expenditures between the two groups of PTs were not different. Conclusion This study compared the differences in physical activity levels between physical therapists who worked at inpatient versus outpatient environment as little is known about their activity levels. Inpatient physical therapists took more steps per day than outpatient physical therapists but the outpatient physical therapists were less sedentary and took more frequent and longer breaks from sedentary activities. The energy expenditures were similar between both types of therapists and this may be reflective of the gender and bodyweight differences between the groups that equalizes the energy expenditures. The findings of this study suggests that there are differences in the physical activity demands between inpatient and outpatient physical therapists. The results of this study may serve dual purposes: (1) employers may be able to more accurately describe the expected physical activity demands to future employees; (2) individuals tasked with preparing PTs to physically manage their work environment can outline training programs that are diverse based on the specific work environment of PTs. Electronic supplementary material The online version of this article (doi:10.1186/s13104-016-2119-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wayne Brewer
- Texas Woman's University 6124 Institute of Health Sciences-Houston, 7600 Fannin Street, Houston, TX, 77030, USA.
| | - Raluchukwu Ogbazi
- Texas Woman's University 6124 Institute of Health Sciences-Houston, 7600 Fannin Street, Houston, TX, 77030, USA
| | - Devan Ohl
- Texas Woman's University 6124 Institute of Health Sciences-Houston, 7600 Fannin Street, Houston, TX, 77030, USA
| | - Jeffry Daniels
- Texas Woman's University 6124 Institute of Health Sciences-Houston, 7600 Fannin Street, Houston, TX, 77030, USA
| | - Alexis Ortiz
- Texas Woman's University 6124 Institute of Health Sciences-Houston, 7600 Fannin Street, Houston, TX, 77030, USA
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238
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Falconer CL, Page AS, Andrews RC, Cooper AR. The Potential Impact of Displacing Sedentary Time in Adults with Type 2 Diabetes. Med Sci Sports Exerc 2016; 47:2070-5. [PMID: 26378943 PMCID: PMC5131683 DOI: 10.1249/mss.0000000000000651] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Purpose Sedentary time, in particular, prolonged unbroken sedentary time, is detrimental to health and displaces time spent in either light or moderate intensity physical activity. This cross-sectional study aimed to identify the potential impact of reallocating time from sedentary behaviors to more active behaviors on measures of body composition and metabolic health in people with type 2 diabetes. Methods Participants were 519 adults with newly diagnosed type 2 diabetes who had been recruited to the Early Activity in Diabetes (Early ACTID) randomized controlled trial. Waist-worn accelerometers were used to obtain objective measurement of sedentary time, light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) at baseline alongside clinical measurements and fasting blood samples to determine cholesterol, triglycerides, HOMA-IR, and glucose. Isotemporal substitution modeling was performed to determine the potential impact of reallocating 30 min of sedentary time accumulated in a single bout (long bout) with 30 min of interrupted sedentary time, LPA, or MVPA. Results Sedentary time accounted for 65% of the waking day, of which 45% was accumulated in prolonged (≥30 min) bouts. Reallocation of 30 min of long-bout sedentary time with 30 min of short-bout sedentary time was associated with lower body mass index (BMI) (adjusted β, −0.60; 95% confidence interval [CI], −1.00, −0.21) and waist circumference (WC) (adjusted β, −1.16; 95% CI, −2.08, −0.25). Stronger effects were seen for LPA and MVPA. Reallocation of 30 min of long-bout sedentary time with LPA was associated with higher HDL-cholesterol (adjusted β, 0.02; 95% CI, 0.00–0.03 mmol·L−1). Conclusions Encouraging adults with newly diagnosed type 2 diabetes to break up prolonged periods of sedentary time may be an effective strategy for improving body composition and metabolic health.
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Affiliation(s)
- Catherine L Falconer
- 1National Institute for Health Research, Biomedical Research Unit in Nutrition, Diet and Lifestyle, University of Bristol, Bristol, UNITED KINGDOM; 2Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UNITED KINGDOM, and 3School of Clinical Sciences, University of Bristol, Bristol, UNITED KINGDOM
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Howard B, Winkler EAH, Sethi P, Carson V, Ridgers ND, Salmon JO, Healy GN, Owen N, Dunstan DW. Associations of Low- and High-Intensity Light Activity with Cardiometabolic Biomarkers. Med Sci Sports Exerc 2016; 47:2093-101. [PMID: 25668400 DOI: 10.1249/mss.0000000000000631] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Light-intensity physical activity (LIPA) accounts for much of adults' waking hours (≈40%) and substantially contributes to overall daily energy expenditure. Encompassing activity behaviors of low intensity (standing with little movement) to those of higher intensity (slow walking), LIPA is ubiquitous, yet little is known about how associations with health may vary depending on its intensity. We examined the associations of objectively assessed LIPA (categorized as either low LIPA [LLPA] or high LIPA [HLPA]) and moderate- to vigorous-intensity activity with cardiometabolic risk biomarkers. METHODS Cardiometabolic biomarkers were measured in 4614 US adults (47 ± 17 yr) who participated in the 2003-2004 and 2005-2006 National Health and Nutrition Examination Survey cycles. Multiple linear regression analyses examined the associations of three accelerometer-derived physical activity (SD increment per day) intensity categories (LLPA, 100-761 counts per minute; HLPA, 762-1951 counts per minute; moderate-intensity physical activity [MPA], 1952-5724 counts per minute; vigorous-intensity physical activity [VPA], ≥5725 counts per minute) with cardiometabolic biomarkers, adjusting for potential sociodemographic, behavioral, and medical confounders. RESULTS All intensities of physical activity were beneficially associated with waist circumference, C-reactive protein, triglycerides, fasting insulin, β-cell function, and insulin sensitivity (P < 0.05); only some activity intensities showed significant associations with systolic blood pressure (LLPA), body mass index, HDL cholesterol, fasting glucose, and 2-h plasma glucose (HLPA, MPA, and VPA). Generally, effect size increased with intensity of physical activity. Overall, further adjustment for waist circumference attenuated associations with MPA and VPA to a greater extent than associations with LLPA and HLPA. CONCLUSIONS The cross-sectional findings provide novel evidence for the potential benefits of increasing both LLPA and HLPA. They further reinforce the established importance of moderate- to vigorous-intensity activity, the mainstay of public health recommendations.
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Affiliation(s)
- Bethany Howard
- 1Baker IDI Heart and Diabetes Institute, Melbourne, AUSTRALIA; 2School of Public Health and Preventive Medicine, Monash University, Melbourne, AUSTRALIA; 3Cancer Prevention Research Center, School of Population Health, The University of Queensland, Brisbane, AUSTRALIA; 4Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB, CANADA; 5Center for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, AUSTRALIA; 6Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, AUSTRALIA; 7Department of Medicine, Alfred Hospital, Monash University, Melbourne, AUSTRALIA; and 8School of Sport Science, Exercise, and Health, University of Western Australia, Perth, AUSTRALIA
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Gupta N, Heiden M, Aadahl M, Korshøj M, Jørgensen MB, Holtermann A. What Is the Effect on Obesity Indicators from Replacing Prolonged Sedentary Time with Brief Sedentary Bouts, Standing and Different Types of Physical Activity during Working Days? A Cross-Sectional Accelerometer-Based Study among Blue-Collar Workers. PLoS One 2016; 11:e0154935. [PMID: 27187777 PMCID: PMC4871331 DOI: 10.1371/journal.pone.0154935] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 04/21/2016] [Indexed: 01/22/2023] Open
Abstract
Introduction The aim of the study was to investigate if (a) substituting total sedentary time or long sedentary bouts with standing or various types of physical activity and (b) substituting long sedentary bouts with brief sedentary bouts; is associated with obesity indicators using a cross sectional isotemporal substitution approach among blue-collar workers. Methods A total of 692 workers from transportation, manufacturing and cleaning sectors wore an Actigraph GT3X+ accelerometer on the thigh for 1–4 working days. The sedentary (sit and lie), standing, walking, and moderate to vigorous physical activity (MVPA) time on working days was computed using validated Acti4 software. The total sedentary time and uninterrupted sedentary time spent in brief (≤5 mins), moderate (>5 and ≤30 mins), and long (>30mins) bouts, were determined for the whole day and during work and non-work time separately. The obesity indicators, BMI (kg/m2), waist circumference (cm) and fat percentage were objectively measured. Isotemporal substitution modelling was utilized to determine the linear association with obesity indicators of replacing 30 min of total sedentary time or long sedentary bouts with standing, walking or MVPA and separately replacing 30 min of long sedentary bouts with brief sedentary bouts. Results Workers [mean (standard deviation, SD); age = 45.1 (9.9) years, BMI = 27.5 (4.9) kg/m2, %BF = 29.6 (9.5), waist circumference = 94.4 (13.0) cm] sat for 2.4 hours (~32% of the measured time, SD = 1.8 hours) across the day during work period and 5.5 hours (~62% of the measured time, SD = 1.5 hours) during non-work period. Most of the sedentary time was accrued in moderate bouts [work = 1.40 (SD = 1.09) hours] during work and in long bouts during non-work [2.7 (SD = 1.4) hours], while least in long sedentary bouts during work [work = 0.5 (SD = 0.9)] and in brief sedentary bouts [0.5 hours (SD = 0.3)] during non-work. Significant associations with all obesity indicators were found when 30 min of total sedentary time or long sedentary bouts were replaced with standing time (~1–2% lower) or MVPA (~4–9% lower) during whole day, work, and non-work periods. The exception was that a statistically significant association was not observed with any obesity indicator when replacing total sedentary time or long sedentary bouts with standing time during the work period. Significant beneficial associations were found when replacing the long sedentary bouts with brief sedentary bouts (~3–5% lower) during all domains. Conclusion Replacing total sedentary time and long sedentary bouts, respectively, not only with MVPA but also standing time appears to be beneficially associated with obesity indicators among blue-collar workers. Additionally, replacing long sedentary bouts with brief sedentary bouts was also beneficially associated with obesity indicators. Studies using prospective design are needed to confirm the findings.
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Affiliation(s)
- Nidhi Gupta
- National Research Centre for the Working Environment, Copenhagen, Denmark
- * E-mail:
| | - Marina Heiden
- Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden
| | - Mette Aadahl
- Research Centre for Prevention and Health, The Capital Region of Denmark, Glostrup, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mette Korshøj
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | | | - Andreas Holtermann
- National Research Centre for the Working Environment, Copenhagen, Denmark
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Veldhuijzen van Zanten JJ, Pilutti LA, Duda JL, Motl RW. Sedentary behaviour in people with multiple sclerosis: Is it time to stand up against MS? Mult Scler 2016; 22:1250-6. [PMID: 27072688 DOI: 10.1177/1352458516644340] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 03/18/2016] [Indexed: 01/14/2023]
Abstract
Historically, people with multiple sclerosis (MS) have been considered sedentary, although the actual scientific study of sedentary behaviour in MS did not originate until 2011. Sedentary behaviour, which is conceptually distinct from physical inactivity, is defined as any waking activity characterised by an energy expenditure ⩽ 1.5 metabolic equivalents and in a sitting or reclining posture. In the general population, the volume of sitting time is associated with increased risks of morbidity and mortality, independent of physical activity, and has been suggested to carry a greater risk of mortality than smoking behaviour. There are many symptoms of MS (e.g. mobility disability and fatigue) that could increase the prevalence of sedentary behaviour, and sedentary behaviour may have considerable implications for the development of comorbid conditions prevalent in MS. This review provides a summary of the rates, correlates, consequences and interventions attempting to reduce sedentary behaviour in MS. We provide a research agenda that guides future research on sedentary behaviour in MS. This paper provides a clarion call that it is time to 'stand up against MS'.
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Affiliation(s)
| | - Lara A Pilutti
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Joan L Duda
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Robert W Motl
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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242
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van Roekel EH, Bours MJL, Breedveld-Peters JJL, Willems PJB, Meijer K, Kant I, van den Brandt PA, Beets GL, Sanduleanu S, Weijenberg MP. Modeling how substitution of sedentary behavior with standing or physical activity is associated with health-related quality of life in colorectal cancer survivors. Cancer Causes Control 2016; 27:513-25. [PMID: 26892604 PMCID: PMC4796364 DOI: 10.1007/s10552-016-0725-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 01/28/2016] [Indexed: 12/01/2022]
Abstract
PURPOSE Previous research indicates that sedentary behavior is unfavorably associated with health-related quality of life (HRQoL) of colorectal cancer (CRC) survivors. Using isotemporal substitution modeling, we studied how substituting sedentary behavior with standing or physical activity was associated with HRQoL in CRC survivors, 2-10 years post-diagnosis. METHODS A cross-sectional study was conducted in stage I-III CRC survivors (n = 145) diagnosed at Maastricht University Medical Center+, the Netherlands (2002-2010). Sedentary, standing, and physical activity time were measured by the thigh-mounted MOX activity monitor. HRQoL outcomes comprised global quality of life, physical, role, and social functioning, and disability (scales: 0-100), fatigue (20-140), and depression and anxiety (0-21). Isotemporal substitution modeling was applied to analyze associations with HRQoL of substituting sedentary time with equal time in standing or physical activity. RESULTS On average, participants spent 10.2 h/day sedentary (SD, 1.7), 3.4 h/day standing (1.3), and 1.7 h/day in physical activity (0.8). In confounder-adjusted isotemporal models, substituting sedentary time with standing or with physical activity was associated with significantly better physical functioning (regression coefficient [β], i.e., difference in outcome score per 1 h/day of sedentary time substituted with standing or physical activity, 3.1; 95% confidence interval [CI] 0.5, 5.7; and 5.6; 0.7, 10.6, respectively). Substituting sedentary time with standing was also associated with significantly lower disability (β, -3.0; 95% CI -4.9, -1.1) and fatigue (-4.0; -7.6, -0.3). CONCLUSIONS Our results suggest that substituting sedentary behavior with standing or physical activity may be beneficially associated with certain HRQoL outcomes in CRC survivors. Prospective studies are warranted to confirm whether actual substitution of sedentary behavior with these activities may improve HRQoL in CRC survivors.
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Affiliation(s)
- Eline H van Roekel
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Martijn J L Bours
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - José J L Breedveld-Peters
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Paul J B Willems
- Department of Human Movement Science, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Kenneth Meijer
- Department of Human Movement Science, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Ijmert Kant
- Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Piet A van den Brandt
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Geerard L Beets
- Department of Surgery, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Silvia Sanduleanu
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Matty P Weijenberg
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
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243
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McVeigh JA, Winkler EAH, Howie EK, Tremblay MS, Smith A, Abbott RA, Eastwood PR, Healy GN, Straker LM. Objectively measured patterns of sedentary time and physical activity in young adults of the Raine study cohort. Int J Behav Nutr Phys Act 2016; 13:41. [PMID: 27009327 PMCID: PMC4806520 DOI: 10.1186/s12966-016-0363-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 03/16/2016] [Indexed: 01/08/2023] Open
Abstract
Background To provide a detailed description of young adults’ sedentary time and physical activity. Methods 384 young women and 389 young men aged 22.1 ± 0.6 years, all participants in the 22 year old follow-up of the Raine Study pregnancy cohort, wore Actigraph GT3X+ monitors on the hip for 24 h/day over a one-week period for at least one ‘valid’ day (≥10 h of waking wear time). Each minute epoch was classified as sedentary, light, moderate or vigorous intensity using 100 count and Freedson cut-points. Mixed models assessed hourly and daily variation; t-tests assessed gender differences. Results The average (mean ± SD) waking wear time was 15.0 ± 1.6 h/day, of which 61.4 ± 10.1 % was spent sedentary, 34.6 ± 9.1 % in light-, 3.7 ± 5.3 % in moderate- and, 0.3 ± 0.6 % in vigorous-intensity activity. Average time spent in moderate to vigorous activity (MVPA) was 36.2 ± 27.5 min/day. Relative to men, women had higher sedentary time, but also higher vigorous activity time. The ‘usual’ bout duration of sedentary time was 11.8 ± 4.5 min in women and 11.7 ± 5.2 min in men. By contrast, other activities were accumulated in shorter bout durations. There was large variation by hour of the day and by day of the week in both sedentary time and MVPA. Evenings and Sundays through Wednesdays tended to be particularly sedentary and/or inactive. Conclusion For these young adults, much of the waking day was spent sedentary and many participants were physically inactive (low levels of MVPA). We provide novel evidence on the time for which activities were performed and on the time periods when young adults were more sedentary and/or less active. With high sedentary time and low MVPA, young adults may be at risk for the life-course sequelae of these behaviours. Electronic supplementary material The online version of this article (doi:10.1186/s12966-016-0363-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Joanne A McVeigh
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia.
| | | | - Erin K Howie
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
| | - Mark S Tremblay
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Anne Smith
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
| | - Rebecca A Abbott
- ESMI, University of Exeter Medical School, St.Luke's Campus, Exeter, UK
| | - Peter R Eastwood
- Centre for Sleep Science, School of Anatomy, Physiology & Human Biology, University of Western Australia, Perth, Western Australia, Australia
| | - Genevieve N Healy
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia.,The University of Queensland, School of Public Health, Brisbane, Australia.,Baker IDI Heart & Diabetes Institute Melbourne, Victoria, Australia
| | - Leon M Straker
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
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Jefferis BJ, Parsons TJ, Sartini C, Ash S, Lennon LT, Wannamethee SG, Lee IM, Whincup PH. Does duration of physical activity bouts matter for adiposity and metabolic syndrome? A cross-sectional study of older British men. Int J Behav Nutr Phys Act 2016; 13:36. [PMID: 26980183 PMCID: PMC4793648 DOI: 10.1186/s12966-016-0361-2] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 03/08/2016] [Indexed: 11/10/2022] Open
Abstract
Background Older adults have low physical activity(PA) and high sedentary behaviour(SB) levels. We investigate how total volume and specific patterns of moderate to vigorous PA(MVPA), light PA(LPA) and SB are related to adiposity and metabolic syndrome (MS). Then, with reference to physical activity guidelines which encourage MVPA in bouts > =10 min and avoiding “long” sedentary bouts, we investigate whether accumulating PA and SB in bouts of different defined durations are differently associated with these outcomes. Methods Cross-sectional study of men (71–91 years) recruited in UK primary care centres. Nurses made physical measures (weight, height, bio-impedance, blood pressure) and took fasting blood samples. 1528/3137 (49 %) surviving men had ≥3 valid days (≥600 min) accelerometer data. 450 men with pre-existing chronic disease were excluded. 1009/1078 (93.6 %) had complete covariate data. Results Men (n = 1009, mean age 78.5(SD 4.7) years) spent 612(SD 83), 202(SD 64) and 42(SD 33) minutes in SB, LIPA and MVPA respectively. Each additional 30 min/day of SB and MVPA were associated with 0.32 (95 % CI 0.23, 0.40)Kg/m2 higher Body Mass Index (BMI) and −0.72(−0.93, −0.51) lower BMI Kg/m2 respectively. Patterns for waist circumference (WC), fat mass index (FMI), fasting insulin and MS were similar. MVPA in bouts lasting <10 min or ≥10 min duration were not associated differently with outcomes. In models adjusted for total MVPA, each minute accumulated in SB bouts lasting 1–15 min was associated with lower BMI −0.012 kg/m2, WC −0.029 cm, and OR 0.989 for MS (all p < 0.05), and coefficients for LPA bouts 1–9 min were very similar in separate models adjusted for total MVPA. Minutes accumulated in SB bouts 1–15 min and LPA bouts 1–9 min were correlated, r = 0.62. Conclusions Objectively measured MVPA, LPA and SB were all associated with lower adiposity and metabolic risk. The beneficial associations of LPA are encouraging for older adults for whom initiating MVPA and maintaining bouts lasting ≥10 min may be particularly challenging. Findings that short bouts of LPA (1–9 min) and SB (1–15 min), but that all MVPA, not just MVPA accumulated in bouts ≥10 min were associated with lower adiposity and better metabolic health could help refine older adult PA guidelines.
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Affiliation(s)
- Barbara J Jefferis
- UCL Department of Primary Care & Population Health, UCL Medical School, Rowland Hill Street, London, NW3 2PF, UK. .,UCL Physical Activity Research Group, London, UK.
| | - Tessa J Parsons
- UCL Department of Primary Care & Population Health, UCL Medical School, Rowland Hill Street, London, NW3 2PF, UK.,UCL Physical Activity Research Group, London, UK
| | - Claudio Sartini
- UCL Department of Primary Care & Population Health, UCL Medical School, Rowland Hill Street, London, NW3 2PF, UK.,UCL Physical Activity Research Group, London, UK
| | - Sarah Ash
- UCL Department of Primary Care & Population Health, UCL Medical School, Rowland Hill Street, London, NW3 2PF, UK
| | - Lucy T Lennon
- UCL Department of Primary Care & Population Health, UCL Medical School, Rowland Hill Street, London, NW3 2PF, UK
| | - S Goya Wannamethee
- UCL Department of Primary Care & Population Health, UCL Medical School, Rowland Hill Street, London, NW3 2PF, UK
| | - I-Min Lee
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02215, USA
| | - Peter H Whincup
- Population Health Research Institute, St George's University of London, Cranmer Terrace, London, SW17 0RE, UK
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245
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An intensive longitudinal examination of daily physical activity and sleep in midlife women. Sleep Health 2016; 2:42-48. [DOI: 10.1016/j.sleh.2015.12.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 11/30/2015] [Accepted: 12/03/2015] [Indexed: 02/05/2023]
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246
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Behavioral Periodicity Detection from 24 h Wrist Accelerometry and Associations with Cardiometabolic Risk and Health-Related Quality of Life. BIOMED RESEARCH INTERNATIONAL 2016; 2016:4856506. [PMID: 26942195 PMCID: PMC4752978 DOI: 10.1155/2016/4856506] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 01/04/2016] [Indexed: 11/17/2022]
Abstract
Periodicities (repeating patterns) are observed in many human behaviors. Their strength may capture untapped patterns that incorporate sleep, sedentary, and active behaviors into a single metric indicative of better health. We present a framework to detect periodicities from longitudinal wrist-worn accelerometry data. GENEActiv accelerometer data were collected from 20 participants (17 men, 3 women, aged 35–65) continuously for 64.4 ± 26.2 (range: 13.9 to 102.0) consecutive days. Cardiometabolic risk biomarkers and health-related quality of life metrics were assessed at baseline. Periodograms were constructed to determine patterns emergent from the accelerometer data. Periodicity strength was calculated using circular autocorrelations for time-lagged windows. The most notable periodicity was at 24 h, indicating a circadian rest-activity cycle; however, its strength varied significantly across participants. Periodicity strength was most consistently associated with LDL-cholesterol (r's = 0.40–0.79, P's < 0.05) and triglycerides (r's = 0.68–0.86, P's < 0.05) but also associated with hs-CRP and health-related quality of life, even after adjusting for demographics and self-rated physical activity and insomnia symptoms. Our framework demonstrates a new method for characterizing behavior patterns longitudinally which captures relationships between 24 h accelerometry data and health outcomes.
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247
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Cellini N, McDevitt EA, Mednick SC, Buman MP. Free-living cross-comparison of two wearable monitors for sleep and physical activity in healthy young adults. Physiol Behav 2016; 157:79-86. [PMID: 26821185 DOI: 10.1016/j.physbeh.2016.01.034] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 12/31/2015] [Accepted: 01/24/2016] [Indexed: 12/26/2022]
Abstract
There is a growing need for free-living monitoring of the full 24 h spectrum of behaviors with a single or integrated set of sensors. The validity of field standard wearable monitors in sleep and physical activity have yet to be assessed for the complementary behavior in the context of 24 h continuous monitoring. We conducted a free-living comparison study of the Actigraph GT3X+ (GT3X+) to assess sleep parameters as compared with the Actiwatch-64 (AW-64) and concurrently, the AW-64 to assess sedentary and physical activity behaviors as compared with the GT3X+. Thirty young adults (15 female, 19.2±0.86 years) wore both monitors for 3 consecutive days and 2 consecutive nights. Agreement of sleep, sedentary, and physical activity metrics were evaluated using analyses of variance, intraclass correlation coefficients, Bland-Altman plots with associated confidence limits, mean absolute percentage of errors and equivalence tests. For sleep, the GT3X+ showed high agreement for total sleep time and sleep efficiency, but underestimated wakefulness after sleep onset and sleep onset latency relative to the AW-64. For sedentary behavior and physical activity, the AW-64 showed a moderate agreement for activity energy expenditure, but not for sedentary, light or moderate-vigorous physical activities relative to the GT3X+. Overall our results showed good agreement of the GT3X+ with AW-64 for assessing sleep but a lack of agreement between AW-64 and GT3X+ for physical activity and sedentary behaviors. These results are likely due to the monitor placement (wrist vs hip), as well as the algorithm employed to score the data. Future validation work of existing and emerging technologies that may hold promise for 24 h continuous monitoring is needed.
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Affiliation(s)
- Nicola Cellini
- Department of General Psychology, University of Padova, Via Venezia 8, 35131 Padova, Italy; Department of Psychology, University of California, Riverside, 900 University Ave., Riverside, CA 92521, USA.
| | - Elizabeth A McDevitt
- Department of Psychology, University of California, Riverside, 900 University Ave., Riverside, CA 92521, USA.
| | - Sara C Mednick
- Department of Psychology, University of California, Riverside, 900 University Ave., Riverside, CA 92521, USA.
| | - Matthew P Buman
- School of Nutrition & Health Promotion, Arizona State University, 550 N 3rd St, Phoenix, AZ 85004, USA.
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248
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Lakerveld J, Mackenbach JD, Horvath E, Rutters F, Compernolle S, Bárdos H, De Bourdeaudhuij I, Charreire H, Rutter H, Oppert JM, McKee M, Brug J. The relation between sleep duration and sedentary behaviours in European adults. Obes Rev 2016; 17 Suppl 1:62-7. [PMID: 26879114 DOI: 10.1111/obr.12381] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 12/15/2015] [Indexed: 11/27/2022]
Abstract
Too much sitting, and both short and long sleep duration are associated with obesity, but little is known on the nature of the relations between these behaviours. We therefore examined the associations between sleep duration and time spent sitting in adults across five urban regions in Europe. We used cross-sectional survey data from 6,037 adults (mean age 51.9 years (SD 16.4), 44.0% men) to assess the association between self-reported short (<6 h per night), normal (6-8 h per night) and long (>8 h per night) sleep duration with self-report total time spent sitting, time spent sitting at work, during transport, during leisure and while watching screens. The multivariable multilevel linear regression models were tested for moderation by urban region, age, gender, education and weight status. Because short sleepers have more awake time to be sedentary, we also used the percentage of awake time spent sedentary as an outcome. Short sleepers had 26.5 min day(-1) more sedentary screen time, compared with normal sleepers (CI 5.2; 47.8). No statistically significant associations were found with total or other domains of sedentary behaviour, and there was no evidence for effect modification. Long sleepers spent 3.2% higher proportion of their awake time sedentary compared with normal sleepers. Shorter sleep was associated with increased screen time in a sample of European adults, irrespective of urban region, gender, age, educational level and weight status. Experimental studies are needed to assess the prospective relation between sedentary (screen) time and sleep duration.
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Affiliation(s)
- J Lakerveld
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU Medical Center Amsterdam, Amsterdam, The Netherlands
| | - J D Mackenbach
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU Medical Center Amsterdam, Amsterdam, The Netherlands
| | - E Horvath
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU Medical Center Amsterdam, Amsterdam, The Netherlands
| | - F Rutters
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU Medical Center Amsterdam, Amsterdam, The Netherlands
| | - S Compernolle
- Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - H Bárdos
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - I De Bourdeaudhuij
- Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - H Charreire
- Lab-Urba, UPEC, Urban Institut of Paris, Paris Est University, Créteil, France.,Equipe de Recherche en Epidémiologie Nutritionnelle (EREN) Université Paris 13, Centre de Recherche en Epidémiologie et Statistiques Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, Bobigny, France
| | - H Rutter
- ECOHOST - The Centre for Health and Social Change, London School of Hygiene and Tropical Medicine, London, UK
| | - J-M Oppert
- Equipe de Recherche en Epidémiologie Nutritionnelle (EREN) Université Paris 13, Centre de Recherche en Epidémiologie et Statistiques Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, Bobigny, France.,Department of Nutrition Pitié-Salpêtrière Hospital (AP-HP), Institute of Cardiometabolism and Nutrition, Université Pierre et Marie Curie-Paris 6, Paris, France
| | - M McKee
- ECOHOST - The Centre for Health and Social Change, London School of Hygiene and Tropical Medicine, London, UK
| | - J Brug
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU Medical Center Amsterdam, Amsterdam, The Netherlands
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Ekblom-Bak E, Ekblom Ö, Bergström G, Börjesson M. Isotemporal substitution of sedentary time by physical activity of different intensities and bout lengths, and its associations with metabolic risk. Eur J Prev Cardiol 2015; 23:967-74. [PMID: 26635358 DOI: 10.1177/2047487315619734] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 11/08/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Time spent being sedentary, regardless of time in exercise, has been associated with metabolic risk using regression modelling. By using isotemporal substitution modelling, the effect of replacing sedentary time with an equal amount of time in physical activity (PA) of different intensities can be considered. The present study aims to investigate the effect of replacing sedentary time with time in light, moderate and vigorous PA to the prevalence of the metabolic syndrome (MetS). Also, replacement of sedentary time by PA of different bout lengths was studied. METHODS In total, 836 participants (52% women), aged 50-64 years, from the SCAPIS pilot study were included. Daily time spent sedentary and in PA of different intensities was assessed using hip-worn accelerometers. RESULTS In this cross-sectional study, replacing 10 minutes of sedentary time with the same amount of light PA was associated with significant lower MetS prevalence, odds ratio (OR) 0.96 (95% confidence interval 0.93-0.98). Replacement with moderate PA resulted in even lower OR, 0.89 (0.82-0.97), with the lowest OR for vigorous PA, 0.41 (0.26-0.66). Participants with high energy intake and high daily sedentary time benefitted more from the replacement of sedentary time with light PA. Significant associations were seen for all bout lengths of light, moderate and vigorous PA in a stepwise-like fashion from one minute to up to 120 minute bouts. CONCLUSION Theoretical substitutions of sedentary time with PA of any intensity and of as little as one minute were associated with significantly lower ORs for MetS. This may be an easily communicable message in clinical practice and for public health purposes.
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Affiliation(s)
- Elin Ekblom-Bak
- Åstrand Laboratory of Work Physiology, The Swedish School of Sport and Health Sciences, Sweden
| | - Örjan Ekblom
- Åstrand Laboratory of Work Physiology, The Swedish School of Sport and Health Sciences, Sweden
| | - Göran Bergström
- Department of Molecular and Clinical Medicine, University of Gothenburg, Sweden Sahlgrenska Centre for Cardiovascular and Metabolic Research, Sahlgrenska University Hospital, Sweden
| | - Mats Börjesson
- Åstrand Laboratory of Work Physiology, The Swedish School of Sport and Health Sciences, Sweden Department of Cardiology, Karolinska University Hospital, Sweden
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