Sedentary behavior and medical multimorbidity

[Evolution of sedentarism prevalence in Spanish population between 1987 and 2020]

BACKGROUND AND OBJECTIVE

Sedentary behavior is a predictive factor for numerous diseases. The objective of this study was to assess the evolution of the prevalence of sedentary behavior in the Spanish adult population between 1987 and 2020.

METHODS

The data sources were the National and European Health Surveys. The prevalence of sedentary behavior was assessed in three scenarios (main activity, leisure time and all scenarios). Prevalence of sedentary behavior was estimated overall, by sex and age group. In all scenarios, prevalence was also estimated by Autonomous Community. The prevalence trend was analyzed with the annual percent change (APC) obtained through joinpoint models.

RESULTS

The prevalence of sedentary in the main activity ranged from 31.2% in 1987 to 38.4% in 2020 [PCA: 0.7 (0.5-1.0)], being higher in men than in women and higher in younger and older people. The prevalence of sedentary in the leisure time varied between 55.1% in 1993 and 36.4% in 2020 [PCA: -1.4 (-1.9 to -0.9)], being always higher in women, higher in those over 64 years of age and lower in those aged 16-24 years. Cantabria and the Canary Islands were the Autonomous Communities with the lowest prevalence of sedentary behavior in all scenarios.

CONCLUSIONS

The prevalence of sedentary behavior in the main activity is increasing in Spain, whereas during leisure time it is decreasing. It is important to implement prevention and health promotion measures aimed at reducing sedentary behavior in the population.

Prevalence of and factors associated with multimorbidity among adults in Kuwait

BACKGROUND

This cross-sectional study aimed to assess the prevalence of morbidity i.e., one morbidity and multimorbidity (≥ 2 morbid conditions) among adults in Kuwait and to examine the sociodemographic and lifestyle factors associated with morbidity as a multinomial outcome in the study population.

METHODS

The data were collected from January 26, 2021, to February 3, 2021, using an electronic questionnaire, which was distributed on social media platforms. The consent form was attached with the questionnaire and the participants were requested to sign the consent form before completing the questionnaire. The prevalences (%) of each morbidity and multimorbidity were computed. Multivariable polychotomous logistic regression analysis was used to evaluate the association between the demographic and lifestyle factors with morbidity as a multinomial outcome.

RESULTS

Of 3572 respondents included, 89% were Kuwaiti, 78.3% females and 66% were 21- 40 years old. The prevalence of multimorbidity and one morbidity respectively was 27.4% and 29.7%. The prevalence of multimorbidity with two, three, four or five ill-health conditions were 14.3%, 7.4%, 3.5%, and 1.2%, respectively. A higher prevalence of multimorbidity was among respondents over 60 years of age (71%) and Kuwaiti nationals (28.9%). The final multivariable polychotomous logistic regression model revealed that age, sex, nativity, sedentary lifestyle, smoking, and alcohol drinking were significantly (p < 0.05) associated with multimorbidity. However, age and alcohol drinking were significant (p < 0.05) predictors of one morbidity.

CONCLUSION

This study provides evidence that multimorbidity is more prevalent among the elderly, females, and Kuwaiti nationals. Sedentary behaviour, smoking and alcohol consumption were significantly and independently associated with multimorbidity. These findings highlight the burden of multimorbidity and should be considered in the development of future prevention programs.

Correlates of physical activity and sedentary behavior in adults living with overweight and obesity: A systematic review

Overweight and obesity are consistently associated with lower physical activity (PA) levels and greater sedentary behavior (SB) in population studies. To date, no review has evaluated the factors associated with these behaviors in the specific population who have developed obesity/overweight. The aim of this systematic review was to identify the correlates/determinants of SB and PA in adults with overweight and obesity. Five databases were searched for studies, which reported factors or outcomes relating to PA or SB in adults living with overweight/obesity, published from 1980 to 2021. The factors were categorized using a socioecological model, strength, and direction of association. Of 34,058 articles retrieved, 45 studies were included, and 155 factors were identified. Self-efficacy, intrinsic motivation, exercise enjoyment, self-perceived good health, and social support were consistently associated with higher levels of PA. Consistent negative correlations were married females, increased BMI, obesity severity, pain, number of comorbidities, lack of time, energy, and willpower, and hilly terrain. Few studies (n = 12) examined SB, and no evidence for consistent associations were found. This review identified several correlates specific to PA in this population. Further studies are required to identify directionality and distal correlates for PA and all correlate levels of SB.

Sociodemographic, Behavioural, and Health Factors Associated with Sedentary Behaviour in Community-Dwelling Older Adults: A Nationwide Cross-Sectional Study

Few studies have focused on factors associated with sedentary behaviour among older Asian adults. This study aimed to identify factors independently associated with prolonged sedentary times in Korean older adults. We included 8273 community-dwelling older adults aged ≥65 years who participated in the Korean National Health and Nutrition Examination Survey. Self-reported sedentary times were assessed via the Global Physical Activity Questionnaire, and sedentary times of ≥420 min/day were considered 'long'. Complex-sample multivariable-adjusted logistic regression analyses were conducted to investigate the factors associated with long sedentary times. Among the participants, 4610 (55.72%) had long sedentary times that were associated with advanced age (odds ratio [OR], 2.49; 95% confidence interval [CI], 2.05-3.01), female sex (OR, 1.32; 95% CI, 1.11-1.57), unemployment (OR, 1.23; 95% CI, 1.09-1.38), living alone (OR, 1.24; 95% CI, 1.08-1.43), urban residence (OR, 1.35; 95% CI, 1.14-1.61), and insufficient aerobic exercise (OR, 1.80; 95% CI, 1.60-2.02). Among health factors, obesity (OR, 1.27; 95% CI, 1.12-1.45), diabetes (OR, 1.17; 95% CI, 1.04-1.32), cardiovascular diseases (OR, 1.30; 95% CI, 1.11-1.52), and arthritis (OR, 1.26; 95% CI, 1.11-1.43) had positive associations with long sedentary times. A tailored approach that considered various sociodemographic, behavioural, and health factors is needed to reduce sedentary behaviour in this population.

Effects of a peer health coaching program on college student lifestyle behaviors

Objective: Health coaching (HC) may promote healthy behaviors in incoming college students. Participants: 187 undergraduate students (76% female; age 18.6 ± 1.6) were recruited to participate in a peer HC program. Methods: Participants received four HC sessions in eight-weeks to work toward self-selected goals of physical activity (PA), diet, or stress management. PA was assessed using the International Physical Activity Questionnaire Short-Form, diet with the Eating Habits Confidence Survey, and stress with the Perceived Stress Scale. Results: Repeated measures ANOVAs investigated lifestyle behavior changes in 130 participants. Significant effects of time were reported, with a 39.6% gain in PA, 9.9% increase in dietary habit, and 16.3% decline in stress levels with moderate to large effect sizes (ηp2: 0.07-0.17; p< 0.01). Conclusion: The peer HC model promoted healthy lifestyles in college students. Additional research is needed to understand the effects of HC specifically for each goal, and student reactions to peer-led HC.

Multimorbidity is associated with TV-viewing, but not with other types of screen-based behaviors in Brazilian adults

Background

The presence of multimorbidity increases the risk of mortality, and identifying correlates of multimorbidity can direct interventions by targeting specific modifiable correlates. Here we aimed to investigate the association between two types of screen-based behaviors and multimorbidity.

Methods

We used data from 87,678 Brazilian adults from the National Health Survey (2019). Multimorbidity (presence of two or more chronic conditions among 12 possibilities), TV-viewing, and time on other types of screens (computer, tablet, or cell phone), were self-reported. Crude and adjusted binary and multinominal logistic regression models were performed stratified by sex, age group, and the number of chronic conditions.

Results

Considering adjusted values, 2 h/day as a reference, and reporting values in odds ratio (OR) and prevalence ratio (PR) with 95% confidence intervals (95%CI), multimorbidity presented associations with TV-viewing in general [from OR (95%CI) 1.10 (1.03–1.18) in 2 to < 3 h/d, to OR (95%CI) 1.57 (1.40–1.76) in ≥ 6 h/d], except in 2 to < 3 h/d time category for male and 35 to 49 years, and all time categories for 18 to 34 years. In addition, TV-viewing was associated with an increasing number of chronic conditions, all greater in ≥ 6 h/d [2 conditions - PR (95%CI) 1.24 (1.08–1.43); 3 conditions - PR (95%CI) 1.74 (1.45–2.08); 4 or more conditions - PR (95%CI) 2.29 (1.93–2.73)], except in 2 conditions on 2 to < 3 h/d. Other types of screen-based behaviors were only associated with multimorbidity among males [≥ 6 h/d: OR (95%CI) 1.22 (1.01–1.48)] and older individuals (65 years) in some time categories [3 to < 6 h/d: OR (95%CI) 1.98 (1.42–2.77) and ≥ 6 h/d: OR (95%CI) 1.73 (1.06–2.84)].

Conclusion

Intervention strategies for reducing screen time in Brazilian adults should focus mainly on TV-viewing, which seems to be associated with more harmful conditions than time on other types of screen-based behaviors.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14365-5.

Multimorbidity

Multimorbidity (two or more coexisting conditions in an individual) is a growing global challenge with substantial effects on individuals, carers and society. Multimorbidity occurs a decade earlier in socioeconomically deprived communities and is associated with premature death, poorer function and quality of life and increased health-care utilization. Mechanisms underlying the development of multimorbidity are complex, interrelated and multilevel, but are related to ageing and underlying biological mechanisms and broader determinants of health such as socioeconomic deprivation. Little is known about prevention of multimorbidity, but focusing on psychosocial and behavioural factors, particularly population level interventions and structural changes, is likely to be beneficial. Most clinical practice guidelines and health-care training and delivery focus on single diseases, leading to care that is sometimes inadequate and potentially harmful. Multimorbidity requires person-centred care, prioritizing what matters most to the individual and the individual's carers, ensuring care that is effectively coordinated and minimally disruptive, and aligns with the patient's values. Interventions are likely to be complex and multifaceted. Although an increasing number of studies have examined multimorbidity interventions, there is still limited evidence to support any approach. Greater investment in multimorbidity research and training along with reconfiguration of health care supporting the management of multimorbidity is urgently needed.

Comportamento sedentário e associação com multimorbidade e padrões de multimorbidade em idosos brasileiros: dados da Pesquisa Nacional de Saúde de 2019

Resumo: O comportamento sedentário emerge como um importante determinante da saúde da pessoa idosa, no entanto, sua relação com a multimorbidade e seus padrões de acometimento em estudos epidemiológicos têm sido pouco explorados na população brasileira. Tais associações poderão auxiliar na elaboração de políticas públicas visando à modificação desse comportamento. Assim, o objetivo deste estudo foi avaliar a associação entre comportamento sedentário com multimorbidade e seus padrões em idosos brasileiros. Estudo transversal, com 43.554 idosos da Pesquisa Nacional de Saúde de 2019. O comportamento sedentário autorreferido foi categorizado em < 3; 3-6; e > 6 horas por dia. A presença de multimorbidade e seus padrões foram analisados pelo autorrelato da coexistência de duas ou mais doenças crônicas, sendo que os três padrões estabelecidos consideraram as doenças com características clínicas similares: (1) cardiopulmonar; (2) vascular-metabólico; e (3) mental-musculoesquelético. As associações foram realizadas pela regressão logística binária. Os idosos que despendiam 3-6 horas/dia em comportamento sedentário tiveram maiores chances (OR = 1,39; IC95%: 1,29; 1,50) de apresentar multimorbidade, padrão vascular-metabólico (OR = 1,39; IC95%: 1,29; 1,50) e mental-musculoesquelético (OR = 1,11; IC95%: 1,00; 1,24). Quando o comportamento sedentário foi > 6 horas/dia, houve maiores chances de multimorbidade (OR = 1,58; IC95%: 1,43; 1,74) e dos padrões cardiopulmonar (OR = 1,73; IC95%: 1,33; 2,27), vascular-metabólico (OR = 1,49; IC95%: 1,35; 1,64) e mental-musculoesquelético (OR = 1,15; IC95%: 1,01; 1,31), quando comparados àqueles que ficavam até 3 horas/dia. Dessa forma, evidenciou-se que tempos elevados em comportamento sedentário são fatores de risco relevantes para a ocorrência de multimorbidade e seus padrões em idosos.

Prevalence and patterns of physical activity, sedentary behaviour, and their association with health-related quality of life within a multi-ethnic Asian population

OBJECTIVE

The study aimed to examine the prevalence and sociodemographic correlates of physical activity and sedentary behaviour in the general population of the multi-ethnic nation of Singapore as part of the Knowledge, Practice and Attitudes towards Diabetes study, a cross-sectional and population-based survey. It also examined the relationship between physical activity, sedentary behaviour, and health-related quality of life (HRQoL).

METHODS

Physical activity and sedentary behaviour were assessed via the Global Physical Activity Questionnaire (GPAQ), while physical and mental HRQoL was assessed via the Short Form Health Survey (SF-12v2). Survey weights were employed to account for complex survey design. Multivariable logistic regression models were utilized to examine sociodemographic correlates of physical activity (insufficient vs. sufficient physical activity) and sedentary behaviour (< 7 h/day vs ≥7 h/day). Descriptive statistics were calculated to examine the percentage of time spent in different domains of physical activity. Multivariable linear regressions were conducted to examine the association between physical activity and sedentary behaviour with physical and mental HRQoL.

RESULTS

Two thousand eight hundred sixty seven participants recruited from February 2019 to March 2020 (prior to COVID-19 lockdown and related restrictions in Singapore) were included in the analyses. 83.3% of respondents had sufficient physical activity. Age (65 years and above) and income (SGD 2000 to 3999) were associated with a higher likelihood of insufficient physical activity. In contrast, those of Malay ethnicity and having one chronic physical condition were associated with a lower likelihood of insufficient physical activity. 47.7% reported that they had sedentary behaviour of ≥7 h/day. Older age and a primary school education were related to a lower likelihood of sedentary behaviour, while being single, having higher income, obesity, and multimorbidity were associated with higher sedentary behaviour. Insufficient physical activity was significantly associated with lower physical HRQoL but was not significantly associated with mental HRQoL. Sedentary behaviour was not significantly associated with mental or physical HRQoL.

CONCLUSION

About 17% of the population did not meet the minimum requirements for physical activity, while around half of the population spent a considerable time being sedentary. As insufficient physical activity was associated with poorer physical HRQoL, policymakers should promote moderate physical activity and encouraging the breaking up of prolonged sedentary periods within the middle- and high-income groups, especially at the workplace. Increased leisure-time exercise should be encouraged for those in the lower- income group.

Association Between Self-Reported Sedentary Behavior and Health-Related Quality of Life Among Multimorbidity Patients in Singapore

BACKGROUND

The study examined the association between sedentary behavior and self-rated health-related quality of life (HRQoL) in a sample of patients with multimorbidity in Singapore recruited from a primary care clinic.

METHODS

Sedentary behavior and physical activity were assessed with the International Physical Activity Questionnaire short form (IPAQ-SF). HRQoL was assessed with EuroQol-5 Dimension (EQ-5D) utility index, visual analogue scale (EQ-VAS) and its 5 subscales (Mobility, Self-care, Usual Activities, Pain/Discomfort, and Anxiety/Depression). Depression was assessed via Patient Health Questionnaire (PHQ-9). Logistic and linear regression analyses adjusting for the effect of physical activity, depression, and sociodemographic variables (i.e., age, gender, ethnicity, education) were conducted.

RESULTS

932 patients participated in the study (mean age:64.5±8.5 years, range: 35-80) and 55% were men. Results indicated that women were less likely to have sedentary behavior (≥7 hrs/day) than men. Results indicated sedentary behavior was associated with lower EQ-5D index scores, but not EQ-VAS scores. Participants who were sedentary for ≥7 hrs/day were more likely to endorse having problems with mobility, self-care, and usual activities, but not with pain/discomfort, nor anxiety/depression.

CONCLUSION

Sedentary behavior was associated with poorer HRQoL. There is a need for interventions and health promotions to reduce sedentary behavior in patients with multimorbidity.

Physical multimorbidity and cancer prevalence in the National Health and Nutrition Examination Survey

OBJECTIVES

As the US population ages, both cancer and multimorbidity become more common and pose challenges to the healthcare system. Limited studies have examined the association between multimorbidity and cancer prevalence in the US adult population. To help address this gap, we evaluated the associations between individual chronic conditions and all-site cancer, multimorbidity and all-site cancer, and multimorbidity and site-specific cancers.

STUDY DESIGN

This is a cross-sectional study.

METHODS

Data from 10,731 adults aged 20 years or older who participated in the 2013-2016 National Health and Nutrition Examination Survey were used in our study. Self-reported demographics, smoking status, sedentary behavior, body mass index, individual chronic conditions, multimorbidity status, cancer history, and cancer sites were assessed.

RESULTS

In our sample, the prevalence of having any type of cancer or multimorbidity was 9% (N = 861) and 38% (N = 4248), respectively. Respiratory conditions (multivariable-adjusted odds ratio [OR]: 1.3; 95% confidence interval [CI]: 1.1-1.6) and arthritis (multivariable-adjusted OR: 1.5; 95% CI: 1.2-1.8) were observed to be statistically significantly associated with having all-site cancer after adjusting for potential confounders. Having multimorbidity was also statistically significantly associated with having all-site cancer (multivariable-adjusted OR: 1.4; 95% CI: 1.2-1.7), cervical cancer (multivariable-adjusted OR: 2.6; 95% CI: 1.2-5.4), and bladder cancer (multivariable-adjusted OR: 2.8; 95% CI: 1.0-7.6).

CONCLUSIONS

Multimorbidity was associated with all-site cancer, cervical cancer, and bladder cancer. The present study provides new evidence of the potential relationships between multimorbidity and cancer. Future longitudinal studies are warranted to clarify the temporality and potential biological mechanisms of the associations between multimorbidity and cancer.

Association between Participation Activities, Pain Severity, and Psychological Distress in Old Age: A Population-Based Study of Swedish Older Adults

Although chronic pain is common in old age, previous studies on participation activities in old age seldom consider pain aspects and its related consequences. This study analyses associations between participation activities, pain severity, and psychological distress in an aging population of Swedish older adults (N = 6611). We examined older adults' participation in five common leisure activities using the Multidimensional Pain Inventory (MPI), sociodemographic factors, pain severity, weight status, comorbidities, and pain-related psychological distress (anxiety, depression, insomnia severity, and pain catastrophising). We found that gender, body mass index (BMI) levels, and psychological distress factors significantly affected older adults' participation in leisure activities. Pain severity and multimorbidity were not significantly associated with older adults' participation in leisure activities nor with gender stratification in generalised linear regression models. The potentially modifiable factors, such as high levels of BMI and psychological distress, affected activity participation in men and women differently. Health professionals and social workers should consider gender and target potentially modifiable factors such as weight status and psychological distress to increase older adults' participation in leisure activities.

Agreement between the International Physical Activity Questionnaire and Accelerometry in Adults with Orthopaedic Injury

Orthopaedic injury can lead to decreased physical activity. Valid measures for assessing physical activity are therefore needed in this population. The aim of this study was to determine the agreement and concordance between the International Physical Activity Questionnaire-Short Form (IPAQ) and device-measured physical activity and sitting time in orthopaedic injury patients. Adults with isolated upper or lower limb fracture (n = 46; mean age of 40.5 years) wore two activity monitors (ActiGraph wGT3X-BT and activPAL) for 10 days, from 2 weeks post-discharge. The IPAQ was also completed for a concurrent 7-day period. Lin's concordance correlation coefficients and Bland-Altman plots were calculated to compare walking/stepping time, total METmins, and sitting time. The IPAQ overestimated device-derived walking time (mean difference = 2.34 ± 7.33 h/week) and total METmins (mean difference = 767 ± 1659 METmins/week) and underestimated sitting time (mean difference = -2.26 ± 3.87 h/day). There was fair concordance between IPAQ-reported and device-measured walking (ρ = 0.34) and sitting time (ρ = 0.38) and moderate concordance between IPAQ-reported and device-measured METmins (ρ = 0.43). In patients with orthopaedic injury, the IPAQ overestimates physical activity and underestimates sitting time. Higher agreement was observed in the forms of activity (walking, total PA and sitting) commonly performed by this patient group.

Sedentary Time Accumulated in Bouts is Positively Associated with Disease Severity in Fibromyalgia: The Al-Ándalus Project

To examine the associations of prolonged sedentary time (ST) with disease severity in women with fibromyalgia, and to analyse the combined association of total ST and prolonged ST with the disease severity in this population. Women (n = 451; 51.3 ± 7.6 years old) with fibromyalgia participated. Sedentary time and moderate-to-vigorous physical activity (MVPA) were measured using triaxial accelerometry and ST was processed into 30- and 60-min bouts. Dimensions of fibromyalgia (function, overall, symptoms) and the overall disease impact were assessed with the Revised Fibromyalgia Impact Questionnaire (FIQR). Body fat percentage was assessed using a bio-impedance analyser, and physical fitness was assessed with the Senior Fitness Tests Battery. Greater percentage of ST in 30-min bouts and 60-min bouts were associated with worse function, overall, symptoms and the overall impact of the disease (all, P < 0.05). Overall, these associations were statistically significant when additionally controlling for MVPA and overall physical fitness. Participants with low levels of total ST and prolonged ST (>60-min bouts) presented lower overall impact compared to participants with high levels of total ST and prolonged ST (mean difference = 6.56; 95% confidence interval (CI) = 1.83 to 11.29, P = 0.002). Greater percentage of ST accumulated in 30- and 60-min bouts and a combination of high levels of total and prolonged ST are related to worse disease severity. Although unable to conclude on causality, results suggest it might be advisable to motivate women with fibromyalgia to break prolonged ST and reduce their total daily ST.

Physical multimorbidity and sedentary behavior in older adults: Findings from the Irish longitudinal study on ageing (TILDA)

BACKGROUND

Physical multimorbidity, defined as the presence of two or more chronic physical conditions, is widespread and reduces life expectancy and quality of life in older adults. Sedentary behavior (SB) is increasingly identified as a risk factor for a range of chronic physical conditions, independent of physical activity.

OBJECTIVES

To investigate associations between physical multimorbidity and SB in older adults.

STUDY DESIGN

We used cross-sectional data from a population-based sample of 6903 adults aged ≥50 years who participated in the Irish Longitudinal Study on Ageing (TILDA) in 2009-2011. We conducted multivariable linear and logistic regression analyses to assess associations between multimorbidity and SB.

MAIN OUTCOME MEASURES

Self-reported minutes/day of SB and high SB (≥ 8 h/day).

RESULTS

We found that most of the 14 individual chronic physical conditions included here were associated with greater SB. Those with stroke (OR = 2.63, 95 % CI = 1.69, 4.10) and cirrhosis (OR = 2.53, 95 %CI = 1.19, 5.41) were the most likely to be classified with high SB. Time spent in SB and the prevalence of high SB increased linearly with number of chronic conditions. Multivariable regression models adjusting for sociodemographic and psychological factors, disability, social network, and physical activity showed that, compared with people with none, those with ≥4 chronic physical conditions had 1.45 times greater odds (OR = 1.45, 95 % CI = 1.09, 1.93) of high SB and higher mean minutes/day of SB (β = 21.37, 95 % CI = 5.53, 37.20).

CONCLUSIONS

Our results suggest that physical multimorbidity is associated with SB and highlight the need for prospective research to examine the directionality and mechanisms of these associations.

Device-Assessed Physical Activity and Sedentary Behaviors in Canadians with Chronic Disease(s): Findings from the Canadian Health Measures Survey

Physical activity and sedentary behaviors (SB) are major determinants of quality of life in adults with one or more chronic disease(s). The aim of this study is to compare objectively measured physical activity and SB in a representative sample of Canadian adults with and without chronic disease(s). The Canadian Health Measures Survey (CHMS) (2007-2013) was used in this study. Daily time spent in physical activities and sedentary behaviors were assessed by an accelerometer in Canadians aged 35-79 years. Data are characterized as daily mean time spent in moderate-to-vigorous physical activity (MVPA), light physical activity (LPA), steps accumulated per day and SB. Chronic diseases (chronic obstructive pulmonary disease, diabetes, heart diseases, cancer) were assessed via self-report diagnostic or laboratory data. Weighted multivariable analyses of covariance comparing physical activity and SB variables among adults without and with chronic disease(s) were conducted; 6270 participants were included. Analyses indicated that 23.9%, 4.9% and 0.5% had one, two, and three or more chronic diseases. Adults with two and more chronic diseases had significantly lower daily duration of MVPA and LPA, daily step counts, and higher daily duration of SB compared to adults without chronic diseases. Interventions targeting physical activity improvement and SB reduction might be beneficial for Canadian multimorbid adults.

Multimorbidity and lifestyle factors among adults with intellectual disabilities: a cross-sectional analysis of a UK cohort

BACKGROUND

Multimorbidity [two or more conditions in addition to intellectual disability (ID)] is known to be more common among people with ID. However, the relationship between multimorbidity and lifestyle factors is currently unknown. The aim of this study was to determine the prevalence of multimorbidity in a population of adults with ID. We also aimed to identify risk factors, including lifestyle factors, for multimorbidity in this population.

METHODS

This was a cross-sectional analysis using data from a diabetes screening study of 920 adults aged 18-74 years with ID living in Leicestershire, UK. We described comorbidities and the prevalence of multimorbidity in this population. We explored the relationship between multimorbidity and age, gender, ethnicity, severity of ID, socio-economic status, physical activity, sedentary behaviour, fruit and vegetable consumption and smoking status using multiple logistic regression.

RESULTS

The prevalence of multimorbidity was 61.2% (95% CI 57.7-64.7). Multimorbidity was independently associated with being female (P < 0.001) and severe/profound ID (P = 0.004). Increasing age was of borderline significance (P = 0.06). Individuals who were physically inactive or sedentary were more likely to be multimorbid, independent of ability to walk, age, gender, severity of ID, ethnicity and socio-economic status (adjusted OR = 1.91; 95% CI 1.23-2.97; P = 0.004 and OR = 1.98; 95% CI 1.42-2.77; P < 0.001). After excluding probable life-long conditions (autism spectrum conditions, attention deficit hyperactivity disorders, epilepsy, cerebral palsy and other paralytic syndromes) as contributing comorbidities, the effect of sedentary behaviour, but not physical activity, remained (P = 0.004). We did not observe a relationship between multimorbidity, fruit and vegetable consumption and smoking status.

CONCLUSIONS

Multimorbidity presents a significant burden to people with ID. Individuals who were physically inactive or sedentary were more likely to be multimorbid, but further work is recommended to explore the relationship between multimorbidity and lifestyle factors using standardised objective measures.

Prevalence of multimorbidity in community settings: A systematic review and meta-analysis of observational studies

BACKGROUND

With ageing world populations, multimorbidity (presence of two or more chronic diseases in the same individual) becomes a major concern in public health. Although multimorbidity is associated with age, its prevalence varies. This systematic review aimed to summarise and meta-analyse the prevalence of multimorbidity in high, low- and middle-income countries (HICs and LMICs).

METHODS

Studies were identified by searching electronic databases (Medline, Embase, PsycINFO, Global Health, Web of Science and Cochrane Library). The term 'multimorbidity' and its various spellings were used, alongside 'prevalence' or 'epidemiology'. Quality assessment employed the Newcastle-Ottawa scale. Overall and stratified analyses according to multimorbidity operational definitions, HICs/LMICs status, gender and age were performed. A random-effects model for meta-analysis was used.

RESULTS

Seventy community-based studies (conducted in 18 HICs and 31 LMICs) were included in the final sample. Sample sizes ranged from 264 to 162,464. The overall pooled prevalence of multimorbidity was 33.1% (95% confidence interval (CI): 30.0-36.3%). There was a considerable difference in the pooled estimates between HICs and LMICs, with prevalence being 37.9% (95% CI: 32.5-43.4%) and 29.7% (26.4-33.0%), respectively. Heterogeneity across studies was high for both overall and stratified analyses (I 2 > 99%). A sensitivity analysis showed that none of the reviewed studies skewed the overall pooled estimates.

CONCLUSION

A large proportion of the global population, especially those aged 65+, is affected by multimorbidity. To allow accurate estimations of disease burden, and effective disease management and resources distribution, a standardised operationalisation of multimorbidity is needed.

Childhood adversity: A gateway to multimorbidity in older age?

BACKGROUND

Multimorbidity, or co-occurrence of several chronic diseases, has major consequences in terms of function, quality of life and mortality. Recent advances suggest that the aetiology of multimorbidity includes a life-long process. The purpose of this study was to determine the association between childhood adversity and multimorbidity in community-dwelling older adults, and to investigate variation in participants born immediately before, during and at the end of the Second World War.

METHODS

Participants were 4731 community-dwelling older adults who enrolled in the Lausanne cohort 65+ study (Switzerland) at age 65-70 years in 2004/2009/2014. A baseline questionnaire provided several indicators of childhood adversity including premature birth, food restrictions, child labour, family economic environment, serious illness/accident, and stressful life events. Multimorbidity at age 67-72 years was defined as ≥2 active chronic diseases at the 2-year follow-up questionnaire.

RESULTS

All childhood adversity indicators except premature birth were significantly associated with multimorbidity. Odds ratio (OR) ranged from 1.23 (P = 0.034) for poor family economic environment to 1.74 (P < 0.001) for stressful life events. In a multivariable model adjusted for socioeconomic status, health behaviours and stressful life events in adulthood (>16 years), a history of serious illness/accident (OR = 1.45; P < 0.001) and stressful life events (OR = 1.42; P = 0.001) in childhood remained significantly associated with multimorbidity. Comparisons between cohorts indicated substantial variations in the prevalence of childhood adversity indicators but similar associations with multimorbidity.

CONCLUSION

There was an independent association between childhood adversity and multimorbidity after age 65. This study encourages a comprehensive life-course perspective to better understand and potentially prevent multimorbidity.

Correlates of sedentary behavior in 2,375 people with depression from 6 low- and middle-income countries

OBJECTIVE

Sedentary behaviour (SB) is harmful for health and well-being and may be associated with depression. However, little is known about the correlates of SB in people with depression. Thus, we investigated SB correlates among community-dwelling adults with depression in six low- and middle-income countries.

METHODS

Cross-sectional data from the World Health Organization's Study on Global Ageing and Adult Health were analyzed. The analysis was restricted to those with DSM-IV Depression or receiving depression treatment in the last 12 months. Self-reported time spent sedentary per day was the outcome. High SB was defined as ≥8 hours of SB per day. The correlates (sociodemographic and health-related) of SB were estimated by multivariable linear and logistic regression analyses.

RESULTS

In 2375 individuals with depression (mean age=48.0 years; 60.7% female), the prevalence of high SB was 11.1% (95%CI=8.2%-14.9%), while the mean (±SD) time spent sedentary was 215 (±192) minutes per day. Socio-demographic factors significantly associated with high SB were older age and being unmarried, being male and being unemployed. In other domains, no alcohol consumption, current smoking, mild cognitive impairment, bodily pain, arthritis, stroke, disability, and lower levels of social cohesion, COPD, visual impairment, and poor self-rated health was associated with greater time spent sedentary.

CONCLUSION

Our data suggest that future interventions seeking to reduce SB among individuals with depression may target at risk groups based on identified sociodemographic correlates while the promotion of social cohesion may have the potential to increase the efficacy of future public health initiatives. From a clinical perspective, bodily pain and somatic co-morbidities need to be taken into account.

Stand Up to Work: assessing the health impact of adjustable workstations

Purpose

Sedentary behavior is linked to health risks, and prolonged sitting is prevalent among office workers. Adjustable workstations (AWS) promote health by allowing transitions between sitting and standing. Stand Up to Work compares workers with AWS to traditional desks (TD). The paper aims to discuss these issues.

Design/methodology/approach

Employees were randomly selected from one office floor to receive AWS, two identical floors maintained TD. Participants received workplace wellness and ergonomic training, completed self-administered questionnaires, and responded to repeated micropolling at baseline (T0), 3 (T1), 6 (T2), and 12 (T3) months in Atlanta, 2015-2016. Groups were compared using two-sample t-tests and nonparametric Wilcoxon tests.

Findings

Compared to TD (n = 24), participants with AWS (n = 24) reported significantly less sedentary behavior at T1 and T2 after AWS installation (p<0.05), with a retention rate at T2 of 80 and 65 percent for the AWS and TD group, respectively. In all, 47 percent of participants with AWS reported decline in upper back, shoulder, and neck discomfort (p=0.04); 88 percent of AWS participants reported convenience to use, 65 percent reported increased productivity, and 65 percent reported positive impact outside the workplace. Individuals with normal or underweight body mass index (BMI) reported a significantly greater decline in percent of time sitting compared to participants with overweight or obese BMI at all three time points.

Originality/value

AWS are beneficial in reducing sedentary behavior in and outside the workplace. Behavioral changes were sustained over time and associated with less self-reported muscle pain, more self-reported energy, and awareness of standing. When considering total worker health, employers should include options for AWS to promote reducing sedentary behavior.

Effects of Sedentary Behavior, Physical Activity, Frequency of Protein Consumption, Lower Extremity Strength and Lean Mass on All-Cause Mortality

Background

No study has evaluated the potential independent and cumulative effects of physical activity, sedentary behavior, daily frequency of protein consumption, lean mass and muscular strength on mortality risk.

Methods

Data from the 1999–2002 NHANES were utilized (N = 1,079 adults 50–85 yr), with follow-up through 2011. Leg lean mass was estimated from DXA scans. Knee extensor strength was assessed using the Kin Com MP dynamometer. Physical activity and sedentary behavior were assessed via questionnaire, with the number of meals/day of ≥30 g of protein/meal assessed via a “multiple pass” 24-hour dietary interview. An index score was created (range = 0–5) indicating the number of these health characteristics each participant had.

Results

Only less sedentary behavior was independently associated with reduced mortality risk (HR_adjustment = 0.46; 0.32–0.66). After adjustments, and compared to those with an index score of 0, those with an index score of 1, 2 and 3+, respectively, had a 34%, 49%, and 57% reduced risk of all-cause mortality.

Conclusion

While considering physical activity, sedentary behavior, daily protein frequency consumption, lean mass and muscular strength, only sedentary behavior was independently associated with mortality risk among older adults.

Physical chronic conditions, multimorbidity and sedentary behavior amongst middle-aged and older adults in six low- and middle-income countries

Background

Sedentary behavior (SB) is, irrespective of a person’s physical activity levels, associated with a wide range of deleterious outcomes such as diabetes, stroke and associated premature mortality. There are no nationally representative, multi-national, population-based studies investigating the relationship between SB, chronic conditions, and physical multimorbidity (i.e., two or more chronic physical conditions). Thus, this cross-sectional study aimed to assess the association between chronic conditions, physical multimorbidity and SB among community-dwelling adults in six low- and middle-income countries (LMICs). We also explored the influential factors of these relationships.

Method

The Study on Global Ageing and Adult Health (SAGE) survey included 34,129 adults aged ≥50 years. SB was self-reported and expressed as a categorical variable [<8 or ≥8 h per day (high SB)]. Eleven chronic physical conditions (angina, arthritis, asthma, chronic back pain, chronic lung disease, diabetes, edentulism, hearing problems, hypertension, stroke, visual impairment) were assessed. Multivariable logistic regression and mediation analyses were conducted.

Results

The prevalence of physical multimorbidity and high SB (≥8 h/day) were 45.5% (43.7%–47.4%) and 10.8% (9.7%–12.1%), respectively. The prevalence of high SB increased in a linear fashion from 7.1% in people with no chronic condition to 24.1% in those with ≥4 chronic conditions. In the multivariable analysis, visual impairment (OR = 2.62), stroke (OR = 2.02), chronic back pain (OR = 1.70) hearing problems (OR = 1.58), chronic lung disease (OR = 1.48), asthma (OR = 1.39), arthritis (OR = 1.22) and multimorbidity (OR = 1.41) were significantly associated with high SB. Disability explained more than 50% of the association for all chronic conditions with particularly high percentages (>80%) for arthritis, asthma, and multimorbdity. Mobility problems explained 88.1% and 85.1% of the association of SB with arthritis and physical multimorbidiy, respectively. Pain was highly influential in the SB-arthritis relationship (85.6%). Sleep/energy problems explained between 9.3% (stroke) to 49.1% (arthritis) of the association, and cognitive problems from 21.5% (stroke) to 33.4% (hearing problems). Findings for anxiety and depression were mixed.

Conclusion

In LMICs, those with chronic conditions and physical multimorbidity are significantly more sedentary. Targeted messages to reduce time spent sedentary among individuals with chronic conditions may ameliorate associated disability, mobility difficulties and pain that are themselves the most important risk factors for SB.

Electronic supplementary material

The online version of this article (10.1186/s12966-017-0602-z) contains supplementary material, which is available to authorized users.

Effects of a Sedentary Intervention on Cognitive Function

PURPOSE

To examine the effects of a free-living, sedentary-inducing intervention on cognitive function.

DESIGN

Randomized controlled, parallel group intervention.

SETTING

University campus.

PARTICIPANTS

Thirty-three young adults (n = 23 intervention; n = 10 control).

MEASURES

The intervention group was asked to eliminate all exercise and minimize steps to ≤5000 steps/day for 1 week, whereas the control group was asked to continue normal physical activity (PA) levels for 1 week. Both groups completed a series of 8 cognitive function assessments (assessing multiple parameters of cognition) preintervention and immediately postintervention. The intervention group was asked to resume normal PA levels for 1 week postintervention and completed the cognitive assessments for a third time at 2 weeks postintervention.

ANALYSIS

Split-plot repeated-measures analysis of variance.

RESULTS

The results of our statistical analyses showed that the group × time interaction effect was not significant ( P > .05) for any of the evaluated cognitive parameters.

CONCLUSION

These findings demonstrate the need for future experimental investigations of sedentary behavior to better understand its effects on cognitive function. However, although previous work has demonstrated favorable effects of acute and chronic PA on cognitive function, our findings suggest that a 1-week period of reduced PA does not detrimentally affect cognitive function, which may have encouraging implications for individuals going through a temporary relapse in PA.

Source and Size of Social Support Network on Sedentary Behavior Among Older Adults

PURPOSE

To examine the association of source of social support and size of social support network on sedentary behavior among older adults.

DESIGN

Cross-sectional.

SETTING

National Health and Nutrition Examination Survey 2003 to 2006.

PARTICIPANTS

2519 older adults (60+ years).

MEASURES

Sedentary behavior was assessed via accelerometry over a 7-day period. Social support was assessed via self-report. Sources evaluated include spouse, son, daughter, sibling, neighbor, church member, and friend. Regarding size of social network, participants were asked, "In general, how many close friends do you have?"

ANALYSIS

Multivariable linear regression.

RESULTS

After adjustment, there was no evidence of an association between the size of social support network and sedentary behavior. With regard to specific sources of social support, spousal social support was associated with less sedentary behavior (β = -11.6; 95% confidence interval: -20.7 to -2.5), with evidence to suggest that this was only true for men. Further, an inverse association was observed between household size and sedentary behavior, with those having a greater number of individuals in the house having lower levels of sedentary behavior. These associations occurred independent of moderate-to-vigorous physical activity, age, gender, race-ethnicity, measured body mass index, total cholesterol, self-reported smoking status, and physician diagnosis of congestive heart failure, coronary artery disease, stroke, cancer, hypertension, or diabetes.

CONCLUSION

Spouse-specific emotion-related social support (particularly for men) and household size were associated with less sedentary behavior.

Systemic inflammation as a function of the individual and combined associations of sedentary behaviour, physical activity and cardiorespiratory fitness

BACKGROUND

Previous research demonstrates individual associations of sedentary behaviour, moderate-to-vigorous physical activity (MVPA) and cardiorespiratory fitness on systemic inflammation, often assessed via C-reactive protein (CRP) levels. Their potential additive association on CRP, however, has not been fully evaluated, which was the purpose of this study.

METHODS

Data from the 2003-2004 National Health and Nutrition Examination Survey were used (N = 627 adults 20-49 years). Sedentary behaviour and MVPA were objectively assessed (accelerometry) with cardiorespiratory fitness determined from a submaximal treadmill-based test. Participants were classified as above or below the median values for each of these three parameters, with a PACS (Physical Activity Cardiorespiratory Sedentary) score ranging from 0 to 3, indicating the participant number of these three positive characteristics. A blood sample was obtained from each participant to assess CRP via latex-enhanced nephelometry.

RESULTS

Above median sedentary behaviour (OR = 1·04; 95% CI: 0·65-1·66) was not associated with elevated (>0·3 mg dl^-1 ) CRP, but above median MVPA (OR = 0·62; 95% CI: 0·40-0·97) and above median VO_2max (OR = 0·61; 95% CI: 0·40-0·93) were associated with a reduced odds of having an elevated CRP. With regard to the additive model, and after adjustment, the odds ratios (95% CI) for the PACS score of 1 (versus 0), 2 (versus 0) and 3 (versus 0), respectively, were 0·59 (0·34-1·05; P = 0·07), 0·60 (0·31-1·15; P = 0·11) and 0·34 (0·12-0·97; P = 0·04).

CONCLUSION

Cardiorespiratory fitness and MVPA, but not sedentary behaviour, were independently associated with reduced odds of elevated CRP. Adults with all three characteristics, however, had the lowest odds of elevated CRP.

Executive function influences sedentary behavior: A longitudinal study

Background: No study has evaluated the effects of executive function on follow-up sedentary behavior, which was this study’s purpose.

Methods: A longitudinal design was employed among 18 young adult college students (M_age = 23.7 years; 88.9% female). Accelerometer-determined sedentary behavior and physical activity, along with executive function, were assessed at baseline. Approximately 8 weeks later, re-assessment of accelerometer-determined sedentary behavior and physical activity occurred. Executive function was assessed using the Parametric Go/No-Go (PGNG) computer task. From this, 2 primary executive function outcome parameters were evaluated, including the Simple Rule and Repeating Rule.

Results: After adjusting for baseline sedentary behavior, age, gender, body mass index and baseline moderate-to-vigorous physical activity (MVPA), for every 25% increase in the number of correctly identified targets for the Repeating rule at the baseline assessment, participants engaged in 91.8 fewer minutes of sedentary behavior at the follow-up assessment (β = -91.8; 95% CI: -173.5, -10.0; P = 0.03). Results were unchanged when also adjusting for total baseline or follow-up physical activity.

Conclusion: Greater executive function is associated with less follow-up sedentary behavior.

Accelerometer-determined physical activity and mortality in a national prospective cohort study: Considerations by visual acuity

BACKGROUND

Previous research demonstrates that visual impairment (VI) is associated with increased all-cause mortality risk and is also associated with reduced physical activity participation. Although physical activity is reduced among those with VI, no studies have examined the relationship between physical activity and all-cause mortality across different visual function statuses, which is noteworthy of investigation as physical activity is linked with greater survival.

METHODS

Data from the 2003-2006 NHANES were employed, with physical activity assessed via accelerometry and visual function assessed using the ARK-760 autorefractor.

RESULTS

For those with normal vision, and after adjustments, for every 60min increase in physical activity, normal-sighted adults had an 18% (HR=0.82; 95% CI: 0.72-0.93) reduced risk of all-cause mortality. Similarly, after adjustments and for every 60min increase in physical activity for those with uncorrected refractive error and VI, respectively, there was a 15% (HR=0.85; 95% CI: 0.72-1.00) and 35% (HR=0.65; 95% CI: 0.43-0.98) reduced risk of all-cause mortality. Among all three visual status groups, sedentary behavior was not associated with mortality status.

CONCLUSION

Among those with varying degrees of visual loss, sedentary behavior was not associated with mortality, but physical activity demonstrated survival benefits.

Multimorbidity, cognitive function, and physical activity

Previous research demonstrates that both physical activity and multimorbidity are associated with cognitive function. However, the extent to which physical activity may moderate the relationship between multimorbidity and cognitive function has not been thoroughly evaluated. Data from the 1999-2002 NHANES were used (60+ years; N = 2157). A multimorbidity index variable was created based on physician diagnosis of a multitude of chronic diseases. Physical activity was self-reported and cognitive function was evaluated from the digit symbol substitution test. Multimorbidity was inversely associated with cognitive function for the unadjusted and adjusted models. However, generally, multimorbidity was no longer associated with cognitive function for the majority of older adults who achieved the minimum recommended physical activity level (≥2000 MET-min-month), as issued by the United States Department of Health and Human Services. In this national sample of older adults, there was some evidence to suggest that physical activity moderates the relationship between multimorbidity and cognitive function.