Adverse associations of car time with markers of cardio-metabolic risk

Neighborhood socioeconomic status and cardiometabolic risk: mediating roles of domain-specific physical activities and sedentary behaviors

PURPOSE

We examined the potential mediating roles of domain-specific physical activities and sedentary behaviors in the relationship between area-level socioeconomic status (SES) and cardiometabolic risk.

METHODS

Data were from the 2011/2012 Australian Diabetes, Obesity and Lifestyle study (n = 3431). The outcome was a clustered cardiometabolic risk (CCR) score, and the exposure was suburb-level SES. Potential mediators were domain-specific physical activities and sedentary behaviors. Multilevel linear regression models examined associations between SES and potential mediators (α) and between mediators and CCR (β). Mediation was assessed using the joint-significance test.

RESULTS

Higher SES was associated with a lower CCR score. Lower SES was associated with less frequent walking for transport, lower vigorous-intensity recreational physical activity, and higher TV time, which were associated with higher CCR scores. However, higher SES was associated with longer transport-related sitting time (all modes and in cars), which were associated with higher CCR scores.

CONCLUSIONS

The SES-cardiometabolic risk relationship may be partially explained by walking for transport, vigorous-intensity recreational physical activity, and TV viewing. These findings, which require corroboration from prospective evidence and clarification of the roles of transport-related sitting and occupational physical activity, can inform initiatives addressing socioeconomic inequalities in cardiometabolic health.

Area-level associations of travel behaviour metrics with waist circumference: findings from linkage of travel and health surveys

Individual-level analyses have consistently shown associations of travel behaviours with obesity-related measures. However, transport planning policies often target areas rather than individuals. To better inform transport-related policies and initiatives for obesity prevention, area-level relationships need to be investigated. This study linked data from two travel surveys with data from the Australian National Health Survey at the level of Population Health Areas (PHAs) and examined to what extent area-level travel behaviours metrics (prevalence of active travel, mixed travel and sedentary travel, diversity of travel modes) were associated with the rate of high waist circumference. Data from 51,987 travel survey participants were aggregated into 327 PHAs. Bayesian conditional autoregressive models were used to account for spatial autocorrelation. It was found that statistically replacing participants who relied on cars for travel (without walking/cycling) with those engaging in 30+ min/d of walking/cycling (without car use) was associated with a lower rate of high waist circumference. Areas with greater diversity of travel modes (mix of walking/cycling, car use, public transport use) also had lower prevalence of high waist circumference. This data-linkage study suggests that area-level transport planning strategies addressing car dependency, shifting car use to walking/cycling over 30 min/d, may help to reduce obesity.

Is city-level travel time by car associated with individual obesity or diabetes in Latin American cities? Evidence from 178 cities in the SALURBAL project

There is growing evidence that longer travel time by private car poses physical and mental risks. Individual-level obesity and diabetes, two of the main public health challenges in low- and middle-income contexts, could be associated to city-level travel times by car. We used individual obesity and diabetes data from national health surveys from individuals in 178 Latin American cities, compiled and harmonized by the SALURBAL project. We calculated city-level travel times by car using the Google Maps Distance Matrix API. We estimated associations between peak hour city-level travel time by car and obesity and diabetes using multilevel logistic regression models, while adjusting for individual characteristics and other city-level covariates. In our study we did not observe a relationship between city-level peak-hour travel time by car and individual obesity and diabetes, as reported in previous research for individual time spent in vehicles in high-income settings. Our results suggest that this relationship may be more complex in Latin America compared to other settings, especially considering that cities in the region are characterized by high degrees of population density and compactness and by a higher prevalence of walking and public transportation use.

Built Environments and Cardiovascular Health: REVIEW AND IMPLICATIONS

PURPOSE

This review presents a general overview of the state of evidence on the relationships between neighborhood built environments and cardiovascular health outcomes among adults. We also summarize relevant literature on the associations of built environments with active living behaviors (physical activity [PA] and sedentary behavior), as they are considered as key behavioral pathways.

REVIEW METHODS

We identified recently published systematic reviews assessing associations of built environment attributes with cardiovascular health outcomes or active living behaviors. We summarized findings of the key systematic reviews and presented findings of pertinent empirical studies, where appropriate.

SUMMARY

Increasing evidence suggests that living in a place supportive of engaging in PA for transportation (eg, walkability features) and recreation (eg, parks) can be protective against cardiovascular disease (CVD) risk. Places conducive to higher levels of sedentary travel (ie, prolonged sitting in cars) may have adverse effects on cardiovascular health. The built environment of where people live can affect how active they are and subsequently their cardiovascular health. Clinical professionals are encouraged to consider the built environment features of where their patients live in counseling, as this may assist them to understand potential opportunities or barriers to active living and to propose a suitable CVD prevention strategy.

City-Level Travel Time and Individual Dietary Consumption in Latin American Cities: Results from the SALURBAL Study

There is limited empirical evidence on how travel time affects dietary patterns, and even less in Latin American cities (LACs). Using data from 181 LACs, we investigated whether longer travel times at the city level are associated with lower consumption of vegetables and higher consumption of sugar-sweetened beverages and if this association differs by city size. Travel time was measured as the average city-level travel time during peak hours and city-level travel delay time was measured as the average increase in travel time due to congestion on the street network during peak hours. Vegetables and sugar-sweetened beverages consumption were classified according to the frequency of consumption in days/week (5-7: "frequent", 2-4: "medium", and ≤1: "rare"). We estimate multilevel ordinal logistic regression modeling for pooled samples and stratified by city size. Higher travel time (Odds Ratio (OR) = 0.65; 95% Confidence Interval (CI) 0.49-0.87) and delay time (OR = 0.57; CI 0.34-0.97) were associated with lower odds of frequent vegetable consumption. For a rare SSB consumption, we observed an inverse association with the delay time (OR = 0.65; CI 0.44-0.97). Analysis stratified by city size show that these associations were significant only in larger cities. Our results suggest that travel time and travel delay can be potential urban determinants of food consumption.

Domain-Specific Active and Sedentary Behaviors in Relation to Workers' Presenteeism and Absenteeism

OBJECTIVES

To examine the associations between domain-specific sedentary and active behaviors and workers' presenteeism and absenteeism in a sample of company employees.

METHODS

This study recruited participants (n = 2466) from a nationwide online survey database (Japan, 2019). Participants completed a questionnaire that captured data on relative and absolute presenteeism and absenteeism and domain-specific physical activity and sedentary behaviors.

RESULTS

Daily minutes of work-related physical activity were negatively associated with relative absenteeism. Daily minutes of leisure-related physical activity were positively associated with absolute presenteeism (ie, better productivity). Daily minutes of total physical activity were negatively and positively associated with relative absenteeism and absolute presenteeism (ie, better productivity). There was also a positive association between car sitting time and absolute absenteeism.

CONCLUSIONS

A change in work culture and practices that support active behaviors at work and outside of work may improve employee's productivity indices.

Posture and Muscle Activity during Waste Collection Work

The musculoskeletal load in waste collection has been examined through simulated assessment of pulling and pushing bins as well as lifting and throwing rubbish bags. With the onset of mechanization, many of these tasks do not exist and workers are faced with other loads not previously assessed. The purpose of this study was to quantify the postures and muscle activity during mechanized waste collection work. Three subtasks of mechanized waste collection were identified, namely driving, bin collection, and egress and access of the vehicle. Spinal, shoulder, and upper limb kinematics along with surface electromyography from three muscles were collected during these tasks in a typical work shift. During driving and bin collection, participants adopted a head-extended, torso forward-flexed posture with frequent rotations of the head and neck. Egress and access of the vehicle produced substantially larger ranges of movement compared with driving and bin collection. The forward-flex, sitting posture can increase the risk of low back pain if there are undulations in the terrain and if this posture is adopted for prolonged periods. The frequent head and neck rotations can increase the incidence and severity of neck pain. Prolonged driving has been linked with an increased cardiometabolic risk and egress and access has increased risk of trips and falls from a height. Managers of waste collection workers should consider implementing interventions to reduce the exposure of this important workforce to the deleterious demands of their work.

Built Environment, Physical Activity, and Obesity: Findings from the International Physical Activity and Environment Network (IPEN) Adult Study

Creating more physical activity-supportive built environments is recommended by the World Health Organization for controlling noncommunicable diseases. The IPEN (International Physical Activity and Environment Network) Adult Study was undertaken to provide international evidence on associations of built environments with physical activity and weight status in 12 countries on 5 continents (n > 14,000). This article presents reanalyzed data from eight primary papers to identify patterns of findings across studies. Neighborhood environment attributes, whether measured objectively or by self-report, were strongly related to all physical activity outcomes (accelerometer-assessed total physical activity, reported walking for transport and leisure) and meaningfully related to overweight/obesity. Multivariable indexes of built environment variables were more strongly related to most outcomes than were single-environment variables. Designing activity-supportive built environments should be a higher international health priority. Results provide evidence in support of global initiatives to increase physical activity and control noncommunicable diseases while achieving sustainable development goals.

Sedentary Behavior and Public Health: Integrating the Evidence and Identifying Potential Solutions

In developed and developing countries, social, economic, and environmental transitions have led to physical inactivity and large amounts of time spent sitting. Research is now unraveling the adverse public health consequences of too much sitting. We describe improvements in device-based measurement that are providing new insights into sedentary behavior and health. We consider the implications of research linking evidence from epidemiology and behavioral science with mechanistic insights into the underlying biology of sitting time. Such evidence has led to new sedentary behavior guidelines and initiatives. We highlight ways that this emerging knowledge base can inform public health strategy: First, we consider epidemiologic and experimental evidence on the health consequences of sedentary behavior; second, we describe solutions-focused research from initiatives in workplaces and schools. To inform a broad public health strategy, researchers need to pursue evidence-informed collaborations with occupational health, education, and other sectors.

Time Spent Sitting as an Independent Risk Factor for Cardiovascular Disease

Sedentary behavior is highly prevalent despite growing evidence of adverse effects on the cardiovascular and metabolic system that are independent of the level of recreational physical activity (PA). We present results for the association between sitting time and cardiovascular disease (CVD) from selected cohort and cross-sectional studies published in or after the year 2010 according to the domains where sitting time is accumulated during the day. These include TV viewing, occupational sitting, and sitting during transportation as well as overall sitting. The outcomes considered in this review are total CVD, coronary heart disease, and stroke as well as CVD risk factors-namely, hypertension, hypercholesterolemia, and type 2 diabetes and their associated biomarkers. Finally, several current issues with regard to studying the effects of sitting time on CVD are discussed, including how sedentary behavior is assessed, isotemporal substitution modeling, examination of joint associations for sitting and PA, and benefits of breaks in sitting time. Overall, the scientific evidence supports public health recommendations that encourage adults to limit their sedentary time in order to improve their cardiovascular health.

Cross-sectional and longitudinal associations between active commuting and patterns of movement behaviour during discretionary time: A compositional data analysis

Background

Active living approaches seek to promote physical activity and reduce sedentary time across different domains, including through active travel. However, there is little information on how movement behaviours in different domains relate to each other. We used compositional data analysis to explore associations between active commuting and patterns of movement behaviour during discretionary time.

Methods and findings

We analysed cross-sectional and longitudinal data from the UK Biobank study. At baseline (2006–2010) and follow up (2009–2013) participants reported their mode of travel to work, dichotomised as active (walking, cycling or public transport) or inactive (car). Participants also reported activities performed during discretionary time, categorised as (i) screen time; (ii) walking for pleasure; and (iii) sport and do-it-yourself (DIY) activities, summed to produce a total. We applied compositional data analysis to test for associations between active commuting and the composition and total amount of discretionary time, using linear regression models adjusted for covariates. Adverse events were not investigated in this observational analysis. The survey response rate was 5.5%. In the cross-sectional analysis (n = 182,406; mean age = 52 years; 51% female), active commuters engaged in relatively less screen time than those who used inactive modes (coefficient -0.12, 95% confidence interval [CI] -0.13 to -0.11), equating to approximately 60 minutes less screen time per week. Similarly, in the longitudinal analysis (n = 4,323; mean age = 51 years; 49% female) there were relative reductions in screen time in those who used active modes at both time points compared with those who used inactive modes at both time points (coefficient -0.15, 95% confidence interval [CI] -0.24 to -0.06), equating to a difference between these commute groups of approximately 30 minutes per week at follow up. However, as exposures and outcomes were measured concurrently, reverse causation is possible.

Conclusions

Active commuting was associated with a more favourable pattern of movement behaviour during discretionary time. Active commuters accumulated 30–60 minutes less screen time per week than those using inactive modes. Though modest, this could have a cumulative effect on health over time.

Urban Densification and 12-Year Changes in Cardiovascular Risk Markers

Background

Population densities of many cities are increasing rapidly, with the potential for impacts on cardiovascular health. This longitudinal study examined the potential impact of population‐density increases in urban areas (urban densification) on cardiovascular risk markers among Australian adults.

Methods and Results

Data were from the Australian Diabetes, Obesity and Lifestyle Study, in which adult participants’ cardiovascular risk markers were collected in 3 waves (in 1999–2000, 2004–2005, and 2011–2012). We included 2354 participants with a mean age of 51 years at baseline who did not change their residence during the study period. Outcomes were 12‐year changes in waist circumference, weight, systolic and diastolic blood pressure, fasting and 2‐hour postload plasma glucose, high‐density lipoprotein cholesterol, and triglycerides. The exposure was neighborhood population densification, defined as 12‐year change in population density within a 1‐km radius buffer around the participant’s home. Multilevel linear growth models, adjusting for potential confounders, were used to examine the relationships. Each 1% annual increase in population density was related with smaller increases in waist circumference (b=−0.043 cm/y; 95% CI, −0.065 to −0.021 [P<0.001]), weight (b=−0.019 kg/y; 95% CI, −0.039 to 0.001 [P=0.07]), and high‐density lipoprotein cholesterol (b=−0.035 mg/dL per year; 95% CI, −0.067 to −0.002 [P=0.04]), and greater increases in diastolic blood pressure (b=0.032 mm Hg/y; 95% CI, −0.004 to 0.069 [P=0.08]).

Conclusions

Our findings suggest that, at least in the context of Australia, urban densification may be protective against obesity risk but may have adverse effects on blood lipids and blood pressure. Further research is needed to understand the mechanisms through which urban densification influences cardiovascular health.

Horsepower of Doctors' Cars Correlates with Cardiovascular Risk and Sedentary Lifestyle but Not with Sexual Dysfunction or Sexual Satisfaction

Background: The horsepower not only of doctors' cars correlates with personal income and social status. However, no clear relationship has previously been described between the horsepower of doctors' cars and cardiovascular health or sexual dysfunction and/or satisfaction. Objective: Cross-sectional online survey to evaluate associations between self-reported horsepower of physicians' cars and health aspects. Methods: Of 1877 physicians from the two University-Hospitals in Austria that were asked to participate in the study, 363 (37.7 ± 8.0 years, 208 (57.3%) men) were included into the final analysis. Results: Physicians that own a car with a stronger engine were significantly older, were more often male, had more often a leading position, had a higher monthly income (all p < 0.001), had a higher scientific output (p = 0.030), and had hypercholesteremia more often (p = 0.009). They also tended to have a higher body mass index (p = 0.088), reported a higher maximum weight in previous years (p = 0.004) and less often reported regular healthy commuting to and from work (p = 0.010). No significant associations were found for self-reported physical fitness, smoking status, and arterial hypertension. In addition, sexual satisfaction and sexual dysfunction were also not related to horsepower in the whole population and the male subgroup. The findings essentially persisted after controlling for age. Conclusion: The horsepower of Austrian physicians' cars correlates with senior position and increased cardiovascular risk. However, our data shows no relationship between sexual dysfunction or lack of sexual satisfaction and the horsepower of doctors' cars.

Associations of local-area walkability with disparities in residents' walking and car use

Research has examined spatial distribution of physical activity, mostly focusing on between-area differences by examining associations of area-level walkability measures with physical activity. Within-area distribution is also relevant, since larger disparities in physical activity within an area can contribute to greater inequalities in health. However, associations of within-area disparity in walking and walkability have been examined only at a large geographical scale (city level). This cross-sectional study examined associations of local-area walkability measures with within-area disparities in residents' walking and car use, using data collected in the 2009 South-East Queensland Travel Survey in Australia. For each Statistical Area 2 (SA2), we calculated disparity indices of the duration of walking and car use among participants aged 18-84 years, using Gini coefficients. Linear regression examined associations of the disparity measures with population density, street connectivity, and Walk Score. Analyses were conducted for 196 SA2s, which contained 15,895 participants. Higher walkability was associated with lower levels of disparity in walking and higher levels of disparity in car use, regardless of the measures used. Each one-SD increment in Walk Score was associated with a 0.64 lower SD in walking disparity and a 0.50 higher SD in car-use disparity, after adjusting for covariates. The associations remained significant after further adjusting for car ownership. Higher walkability is known to be associated with more walking and less car use. This study extends previous knowledge by showing that higher local-area walkability can be associated with less inequality in residents' walking and higher diversity in their car use.

Walk Score® and Its Associations with Older Adults' Health Behaviors and Outcomes

This study aimed to investigate the associations between Walk Score^® and lifestyle behaviors and health outcomes in older Taiwanese adults. A nationwide survey was conducted through telephone-based interviews with older adults (65 years and older) in Taiwan. Data on Walk Score^®, lifestyle behaviors (physical activity, sedentary behavior, healthy eating behavior, alcohol use, and smoking status), health outcomes (overweight/obesity, hypertension, type 2 diabetes, and cardiovascular disease), and personal characteristics were obtained from 1052 respondents. A binary logistic regression adjusting for potential confounders was employed. None of the Walk Score^® categories were related to the recommended levels of total physical activity. The categories "very walkable" and "walker's paradise" were positively related to total sedentary time and TV viewing among older adults. No significant associations were found between Walk Score^® and other lifestyle health behaviors or health outcomes. While Walk Score^® was not associated with recommended levels of physical activity, it was positively related to prolonged sedentary time in the context of a non-Western country. The different associations between the walk score and health lifestyle behaviors and health outcomes in different contexts should be noted.

Built environment and cardio-metabolic health: systematic review and meta-analysis of longitudinal studies

Built environment attributes may be related to cardio-metabolic diseases (e.g. type 2 diabetes, heart disease and stroke) and their risk factors, potentially by influencing residents' physical activity. However, existing literature reviews on the built environment and health for the most part focus on obesity as the outcome and rely on cross-sectional studies. This systematic review synthesized current evidence on longitudinal relationships between built environment attributes and cardio-metabolic health outcomes among adults and on the potential mediating role of physical inactivity. By searching eight databases for peer-reviewed journal articles published in the English language between January 2000 and July 2016, the review identified 36 articles. A meta-analysis method, weighted Z-test, was used to quantify the strength of evidence by incorporating the methodological quality of the studies. We found strong evidence for longitudinal relationships of walkability with obesity, type 2 diabetes and hypertension outcomes in the expected direction. There was strong evidence for the impact of urban sprawl on obesity outcomes. The evidence on potential mediation by physical activity was inconclusive. Further longitudinal studies are warranted to examine which specific built environment attributes influence residents' cardio-metabolic health outcomes and how physical inactivity may be involved in these relationships.

Associations of context-specific sitting time with markers of cardiometabolic risk in Australian adults

Background

High volumes of sitting time are associated with an elevated risk of type 2 diabetes and cardiovascular disease, and with adverse cardiometabolic risk profiles. However, previous studies have predominately evaluated only total sitting or television (TV) viewing time, limiting inferences about the specific cardiometabolic health impacts of sitting accumulated in different contexts. We examined associations of sitting time in four contexts with cardiometabolic risk biomarkers in Australian adults.

Methods

Participants (n = 3429; mean ± SD age 58 ± 10 years) were adults without clinically diagnosed diabetes or cardiovascular disease from the 2011–2012 Australian Diabetes, Obesity and Lifestyle (AusDiab) study. Multiple linear regressions examined associations of self-reported context-specific sitting time (occupational, transportation, TV-viewing and leisure-time computer use) with a clustered cardiometabolic risk score (CMR) and with individual cardiometabolic risk biomarkers (waist circumference, BMI, resting blood pressure, triglycerides, HDL- and LDL-cholesterol, and fasting and 2-h post-load plasma glucose).

Results

Higher CMR was significantly associated with greater TV-viewing and computer sitting time (b [95%CI] = 0.07 [0.04, 0.09] and 0.06 [0.03, 0.09]), and tended to be associated with higher occupational and transport sitting time (0.01 [− 0.01, 0.03] and 0.03 [− 0.00, 0.06]), after adjustment for potential confounders. Furthermore, keeping total sitting time constant, accruing sitting via TV-viewing and computer use was associated with significantly higher CMR (0.05 [0.02, 0.08] and 0.04 [0.01, 0.06]), accruing sitting in an occupational context was associated with significantly lower CMR (− 0.03 [− 0.05, − 0.01]), while no significant association was seen for transport sitting (0.00 [− 0.03, 0.04]). Results varied somewhat between the respective biomarkers; however, higher sitting time in each domain tended to be associated detrimentally with individual biomarkers except for fasting glucose (non-significant associations) and systolic blood pressure (a beneficial association was observed). Overall, associations were stronger for TV-viewing and computer use, and weaker for occupational sitting.

Conclusions

Higher context-specific sitting times tended to be detrimentally associated, albeit modestly, with CMR and several cardiometabolic risk biomarkers. There was some evidence suggesting that the context in which people sit is relevant above and beyond total sitting time. Methodological issues notwithstanding, these findings may assist in identifying priorities for sitting-reduction initiatives, in order to achieve optimal cardiometabolic health benefits.

Electronic supplementary material

The online version of this article (10.1186/s12966-018-0748-3) contains supplementary material, which is available to authorized users.

Changes in workplace car parking and commute mode: a natural experimental study

Background

The use of private motor vehicles places a considerable burden on public health. Changes in workplace car parking policies may be effective in shifting behaviour. We use a natural experimental design to assess whether changes in policy were associated with differences in commute mode.

Methods

We used cohort data from participants working in Cambridge (2009–2012). Commuters reported their trips and travel modes to work over the last week, workplace car parking policy and socioeconomic, environmental and health characteristics. Changes in policy were defined between phases (1608 transition periods; 884 participants). Using generalised estimating equations, we estimated associations between changes in parking policy and the proportion of trips that (i) were exclusively by motor vehicle, (ii) involved walking or cycling and (iii) involved public transport at follow-up.

Results

25.1% of trips were made by motor vehicle, 54.6% involved walking or cycling and 11.7% involved public transport. The introduction of free or paid workplace parking was associated with higher proportions of motor vehicle trips (11.4%, 95% CI (6.4 to 16.3)) and lower proportions involving walking or cycling (−13.3%, 95% CI (−20.2 to –6.4)) and public transport (−5.8%, 95% CI (−10.6 to –0.9)) compared with those with no workplace parking. Restrictive changes in policy were associated with shifts in the expected direction but these were not statistically significant.

Conclusion

Relaxation of parking policy was associated with higher proportions of trips made by motor vehicle. Further longitudinal and intervention research is required to assess generalisability of these findings.

Driving in an urban environment, the stress response and effects of exercise

Driving may be detrimental to health, with one hypothesis suggesting that driving may elicit an acute stress response and, with repeated exposures, may become a chronic stressor. The present study examined the stress response to driving and the effectiveness of a prior exercise bout in dampening this response. Twenty healthy adults performed three tasks: control, driving and exercise plus driving. Heart rate (HR), heart rate variability (HRV), blood pressure (BP) and cortisol were measured to quantify the acute stress response to each condition. Data indicated a stress response to driving: HR was elevated and HRV was reduced during the driving task compared with control. HR was elevated and HRV was reduced comparing the exercise plus driving with the driving condition. BP and cortisol were not different among conditions. The potential of interventions, such as exercise, to counter daily stressors should be evaluated to safeguard long-term health. Practitioner Summary: this study confirms that driving induces a stress response, with the exercise intervention providing mixed results (an increase in cardiovascular measures and a decrease in cortisol measure trending significance). Given the known consequences of stress and evidence that exercise can mitigate acute stress, further evaluation of exercise interventions is recommended.

Drivers Are More Physically Active Than Non-Drivers in Older Adults

Car use has been identified as sedentary behavior, although it may enhance mobility, particularly in the older population. This cross-sectional study aimed to compare the time spent in objectively determined sedentary behavior (SB) and physical activity (PA) between older drivers and non-drivers. Four hundred and fifty Japanese older adults (74.3 ± 2.9 years) who had valid accelerometer data were included. They were asked to respond to a questionnaire and wear an accelerometer (HJA-350IT, Omron Healthcare) on their waist for 7 consecutive days in 2015. To compare activity time between drivers and non-drivers, we calculated estimated means using analysis of covariance, adjusting for sociodemographic, physical, and psychological factors and accelerometer wear time. Compared to non-drivers, drivers engaged in more light-intensity PA (LPA) (drivers: 325.0 vs. non-drivers: 289.0 min/day) and moderate-to-vigorous PA (drivers: 37.5 vs. non-drivers: 30.0 min/day) and less SB (drivers: 493.4 vs. non-drivers: 535.9 min/day) (all p < 0.05). After stratification by age, sex, and residential area, larger effect of driving on PA time was found in older-older adults, in men, and in rural residents. Older drivers were found to be more physically active than non-drivers, suggesting more access to outdoor activities or expanding social network.

Associations of neighbourhood walkability indices with weight gain

Background

Inconsistent associations of neighbourhood walkability with adults’ body weight have been reported. Most studies examining the relationships of walkability and adiposity are cross-sectional in design. We examined the longitudinal relationships of two walkability indices – conventional walkability and space syntax walkability, and their individual components, with weight change among adults over four years.

Methods

Data were from the Physical Activity in Localities and Community study in Adelaide, Australia. In 2003–2004, 2650 adults living in 154 Census Collection Districts (CCDs) returned baseline questionnaires; in 2007–2008, the follow-up survey was completed by 1098. Participants reported their weight at baseline and at follow-up. Neighbourhood walkability indices were calculated using geographic information systems and space syntax software. Linear marginal models using generalized estimating equations with robust standard errors were fitted to examine associations of the two walkability indices and their individual components with the weight at follow-up, adjusting for baseline weight, socio-demographic variables, and spatial clustering at the level of CCD.

Results

The overall mean weight gain over four years was 1.5 kg. The two walkability indices were closely correlated (r = 0.76, p < 0.01). No significant associations were found between the overall neighbourhood walkability indices and weight change. Among walkability components, there was a marginally significant negative association between space syntax measure of street integration and weight change: one standard deviation increment in street integration was associated with 0.31 kg less weight gain (p = 0.09).

Conclusions

Using a prospective study design and a novel space-syntax based measure of walkability, we were not able to identify relationships between neighbourhood walkability with weight gain. This is consistent with other inconclusive findings on the built environment and obesity. Research on the built environment and adults’ weight gain may need to consider not just local environments but also a larger scale environment within a city or workplace environment in order to capture multiple behaviours relevant to weight gain.

Patterns of health behaviour associated with active travel: a compositional data analysis

Background

Active travel (walking or cycling for transport) is associated with favourable health outcomes in adults. However, little is known about the concurrent patterns of health behaviour associated with active travel. We used compositional data analysis to explore differences in how people doing some active travel used their time compared to those doing no active travel, incorporating physical activity, sedentary behaviour and sleep.

Methods

We analysed cross-sectional data from the 2014/15 United Kingdom Harmonised European Time Use Survey. Participants recorded two diary days of activity, and we randomly selected one day from participants aged 16 years or over. Activities were categorised into six mutually exclusive sets, accounting for the entire 24 h: (1) sleep; (2) leisure moderate to vigorous physical activity (MVPA); (3) leisure sedentary screen time; (4) non-discretionary time (work, study, chores and caring duties); (5) travel and (6) other. This mixture of activities was defined as a time-use composition. A binary variable was created indicating whether participants reported any active travel on their selected diary day. We used compositional multivariate analysis of variance (MANOVA) to test whether mean time-use composition differed between individuals reporting some active travel and those reporting no active travel, adjusted for covariates. We then used adjusted linear regression models and bootstrap confidence intervals to identify which of the six activity sets differed between groups.

Results

6143 participants (mean age 48 years; 53% female) provided a valid diary day. There was a statistically significant difference in time-use composition between those reporting some active travel and those reporting no active travel. Those undertaking active travel reported a relatively greater amount of time in leisure MVPA and travel, and a relatively lower amount of time in leisure sedentary screen time and sleep.

Conclusions

Compared to those not undertaking active travel, those who did active travel reported 11 min more in leisure MVPA and 18 min less in screen time per day, and reported lower sleep. From a health perspective, higher MVPA and lower screen time is favourable, but the pattern of sleep is more complex. Overall, active travel was associated with a broadly health-promoting composition of time across multiple behavioural domains, which supports the public health case for active travel.

Electronic supplementary material

The online version of this article (10.1186/s12966-018-0662-8) contains supplementary material, which is available to authorized users.

A cross-sectional analysis of the associations between leisure-time sedentary behaviors and clustered cardiometabolic risk

Background

The aim of this study was to conduct a comprehensive investigation of the association between different types of leisure-time sedentary behavior (watching television, using a computer, reading and socializing) and clustered cardiometabolic risk in apparently healthy adults aged 40 to 65 years.

Methods

One hundred seventy-three participants from the general population (64% women; mean age = 54.4 years) consented to attend a cardiovascular examination program and to complete a questionnaire on leisure-time sedentary behaviors. Waist circumference, blood pressure, glucose, triglycerides, and high-density lipoprotein cholesterol of non-fasting blood samples were assessed, and a clustered cardiometabolic risk score [CMRS] was calculated. Data were collected between February and July 2015. Associations between leisure-time sedentary behaviors and CMRS were analyzed using linear and quantile regression, adjusted for socio-demographic variables and other types of leisure-time sedentary behavior (model 1) and additionally, adjusted for leisure-time physical activity and traveling in motor vehicles (model 2).

Results

Linear regression revealed that there was a positive association between watching television and CMRS (model 1: b = 0.27 [CI: 0.03; 0.52]; model 2: b = 0.30 [CI: 0.05; 0.56]). In addition, quantile regression analysis revealed that using a computer was negatively associated with the 50th (model 1: b = − 0.43 [CI: -0.79; − 0.07]) and the 75th percentiles (model 1: b = − 0.71 [CI: -1.27; − 0.14]) of CMRS. Reading and socializing were not associated with CMRS.

Conclusions

Watching television was positively associated with a clustered cardiometabolic risk score, while time spent using a computer revealed inconsistent findings. Our results give reason to consider different types of behaviors in which individuals are sedentary and the associations between these behaviors and cardiometabolic risk, supporting the need for behavior-specific assessments as well as public health recommendations to maintain or enhance adults’ health.

Trial registration

Clinical trial registration number: NCT02990039, Retrospectively registered (December 12, 2016).

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5213-3) contains supplementary material, which is available to authorized users.

Measurement of sedentary behaviour in population health surveys: a review and recommendations

Background

The purpose of this review was to determine the most valid and reliable questions for targeting key modes of sedentary behaviour (SB) in a broad range of national and international health surveillance surveys. This was done by reviewing the SB modules currently used in population health surveys, as well as examining SB questionnaires that have performed well in psychometric testing.

Methods

Health surveillance surveys were identified via scoping review and contact with experts in the field. Previous systematic reviews provided psychometric information on pediatric questionnaires. A comprehensive search of four bibliographic databases was used to identify studies reporting psychometric information for adult questionnaires. Only surveys/studies published/used in English or French were included.

Results

The review identified a total of 16 pediatric and 18 adult national/international surveys assessing SB, few of which have undergone psychometric testing. Fourteen pediatric and 35 adult questionnaires with psychometric information were included. While reliability was generally good to excellent for questions targeting key modes of SB, validity was poor to moderate, and reported much less frequently. The most valid and reliable questions targeting specific modes of SB were combined to create a single questionnaire targeting key modes of SB.

Discussion

Our results highlight the importance of including SB questions in survey modules that are adaptable, able to assess various modes of SB, and that exhibit adequate reliability and validity. Future research could investigate the psychometric properties of the module we have proposed in this paper, as well as other questionnaires currently used in national and international population health surveys.

The acute physiological stress response to driving: A systematic review

BACKGROUND

The experience of driving has been suggested to be detrimental to health. One hypothesis is that each exposure elicits an acute stress response, and that repeated exposures may act as a chronic stressor.

OBJECTIVE

The aim of this review is to evaluate and synthesise the evidence on whether driving elicits an acute physiological stress response.

METHODS

Electronic databases, including CINAHL, PsycINFO and Medline, were searched for original articles written in English from database inception until March 2016. The inclusion criteria of this review included a quantitative examination of an acute physiological stress response to driving, in either on-road or simulated settings, compared to a comparison or control condition. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting criteria.

RESULTS

A total of 27,295 abstracts were screened and 28 full-text manuscripts retrieved. Of these, seven articles met the inclusion criteria including four simulator studies and three on-road studies. All suggested a significant change in at least one physiological outcome, but the strongest evidence was for increases in urine catecholamine and cortisol after driving for long hours on-road; results on other outcomes are limited by the small number of studies or inconsistent findings.

CONCLUSIONS

Overall, these studies provided moderate evidence to suggest that driving for long hours elicits a stress response over an extended period of time. There is insufficient evidence that driving for a shorter period of time elicits an acute stress response, especially in real, on-road tasks. However, the limited number of studies, small sample sizes, heterogeneity in study objectives, methodologies and physiological outcomes limit conclusions. Future studies could be improved by recruiting a larger sample, utilizing modern stress markers such as heart rate variability, and primarily focusing on the acute physiological stress response to on-road driving.

Relations of Arterial Stiffness With Postural Change in Mean Arterial Pressure in Middle-Aged Adults: The Framingham Heart Study

Impaired regulation of blood pressure on standing can lead to adverse outcomes, including falls, syncope, and disorientation. Mean arterial pressure (MAP) typically increases on standing; however, an insufficient increase or a decline in MAP on standing may result in decreased cerebral perfusion. Orthostatic hypotension has been reported in older people with increased arterial stiffness, whereas the association between orthostatic change in MAP and arterial stiffness in young- to middle-aged individuals has not been examined. We analyzed orthostatic blood pressure response and comprehensive hemodynamic data in 3205 participants (1693 [53%] women) in the Framingham Heart Study Third Generation cohort. Participants were predominantly middle aged (mean age: 46±9 years). Arterial stiffness was assessed using carotid-femoral pulse wave velocity, forward pressure wave amplitude, and characteristic impedance of the aorta. Adjusting for standard cardiovascular disease risk factors, orthostatic change in MAP (6.9±7.7 mm Hg) was inversely associated with carotid-femoral pulse wave velocity (partial correlation, r_p=-0.084; P<0.0001), forward wave amplitude (r_p=-0.129; P<0.0001), and characteristic impedance (r_p=-0.094; P<0.0001). The negative relation between forward wave amplitude and change in MAP on standing was accentuated in women (P=0.002 for sex interaction). Thus, higher aortic stiffness was associated with a blunted orthostatic increase in MAP, even in middle age. The clinical implications of these findings warrant further study.

Sedentary Behavior and Health: Broadening the Knowledge Base and Strengthening the Science

We provide an overview of a recently published, edited book in a rapidly emerging field of research, policy, and practice for physical activity: Sedentary Behavior and Health. In this commentary, we highlight the broad perspectives provided in the 27 chapters of Sedentary Behavior and Health and suggest a research strategy to move the field forward-not only with scientific rigor, but also with breadth of scholarship. The book's chapters provide an overview of the background to and contexts for sedentary behavior and health. They then highlight the importance of understanding health consequences and underlying mechanisms; introduce key measurement technology and analytic strategies; consider sedentary behavior in subpopulations; describe conceptual models and theories to guide sedentary behavior interventions; and explain what is known about interventions in different settings. Considering the breadth of perspectives brought to bear on the field and the plethora of opportunities for research, policy, and practice, we suggest 3 elements of an interdisciplinary research strategy drawing upon the primary knowledge bases of physical activity and health: through the experimental methods of exercise science, through the observational tools of epidemiology, and through the conceptual approaches and methods of behavioral science. A better understanding of the health consequences of sedentary behavior and how they may be influenced can be encompassed by 3 key questions: What changes are needed to most effectively influence sedentary behaviors? What elements of sedentary behavior should be changed to improve health outcomes? What are the feasibility of and the benefits from changing sedentary behavior?

Association of Motorcycle Use with Risk of Overweight in Taiwanese Urban Adults

Sedentary transport is known to adversely affect health. Few studies have focused on motorcycle use. This study examines the association of motorcycle use with overweight in urban adults in Taiwan. Cross-sectional data from 1069 Taiwanese adults aged 20–64 years in three urban cities were collected in 2015. Data on self-reported body mass index, time spent in motorcycle use, lifestyle behavioral factors, and sociodemographic variables were obtained. Unadjusted and adjusted logistic regression models were applied. In Model 1, adults who spent more time using a motorcycle (third quartile, odds ratio (OR) = 1.17; fourth quartile, OR = 1.60) were more likely to be overweight compared with the first quartile. In Model 2, after adjusting for the covariates, only the fourth quartile of motorcycle use (OR = 1.50) was associated with a higher risk of overweight. Higher time spent in motorcycle use is related to higher risk of being overweight, even after adjustment for potential demographic and behavioral confounders. Intervention and behavioral change strategies targeting motorcycle use should be considered.

Health impacts of the M74 urban motorway extension: a mixed-method natural experimental study

Background

Making travel easier can improve people’s access to opportunities, but motor transport also incurs substantial undesirable health and social impacts.

Aims

To assess how a new urban motorway affected travel and activity patterns, road accidents and well-being in local communities, and how these impacts were experienced and brought about.

Design

The Traffic and Health in Glasgow study, a mixed-method controlled before-and-after study.

Setting

Glasgow, UK.

Participants

Repeat cross-sectional survey samples of 1345 and 1343 adults, recruited in 2005 and 2013, respectively. Of these, 365 formed a longitudinal cohort, 196 took part in a quantitative substudy using accelerometers and global positioning system receivers and 30, living within 400 m of the new motorway, took part in a qualitative substudy along with 12 other informants. Complementary analyses used police STATS19 road traffic accident data (1997–2014) and Scottish Household Survey travel diaries (2009–13).

Intervention

A new 5-mile, six-lane section of the M74 motorway, opened in 2011 and running through predominantly deprived neighbourhoods in south-east Glasgow, with associated changes to the urban landscape.

Main outcome measures

Differences in self-reported travel behaviour (1-day travel record), physical activity (short International Physical Activity Questionnaire) and well-being [Short Form 8 Health Survey (SF-8) and a short version of the Warwick–Edinburgh Mental Well-being Scale], and in the incidence of road traffic accidents.

Methods

A combination of multivariable cohort, cross-sectional, repeat cross-sectional and interrupted time series regression analyses comparing residents of the ‘M74 corridor’ intervention area and two matched control areas, complemented by novel qualitative spatial methods. Graded measures of the proximity of the motorway to each participant’s home served as a further basis for controlled comparisons.

Results

Both benefits and harms were identified. Cohort participants living closer to the new motorway experienced significantly reduced mental well-being (mental component summary of the SF-8 scale) over time compared with those living further away [linear regression coefficient –3.6, 95% confidence interval (CI) –6.6 to –0.7]. In the area surrounding an existing motorway, this association was concentrated among those with chronic conditions. In repeat cross-sectional analyses, participants living closer to a new motorway junction were more likely to report using a car at follow-up than those living further away (odds ratio 3.4, 95% CI 1.1 to 10.7). We found weaker quantitative evidence of a decline in physical activity participation and no quantitative evidence of an overall change in either active travel or accidents associated with motorway exposure. Qualitative evidence suggested that, although the new motorway improved connectivity for those with dispersed social networks and access to motor vehicles, the impacts were more complex for others, some of whom found the motorway to be a cause of severance. Changes in community composition and cohesion, and perceptions of personal safety, were widely perceived as more important to local people.

Limitations

A key limitation of natural experimental studies is that the risk of residual confounding cannot be eliminated.

Conclusions

Overall, these findings highlight the potential for urban infrastructural projects of this kind to add further burdens to already disadvantaged communities, exacerbating inequalities and contributing to poorer health outcomes. The health and social impacts of such initiatives should be more fully taken into account in planning and research.

Funding

The National Institute for Health Research Public Health Research programme.

Associations of street layout with walking and sedentary behaviors in an urban and a rural area of Japan

We examined whether street layout -a key urban design element- is associated with walking and sedentary behaviors in the context of a non-Western country; and, whether such associations differ between an urban and a rural area. In 2011, 1076 middle-to-older aged adults living in an urban and a rural area of Japan reported their walking and sedentary (sitting) behaviors. Two objective measures of street layout (intersection density and street integration) were calculated. Participants exposed to more-connected street layouts were more likely to walk for commuting and for errands, to meet physical activity recommendations through walking for commuting, and less likely to drive. These relationships differed between the urban and the rural area. This shows that previous findings from Western countries on associations of street connectivity with travel behaviors may also be applicable to Japan.

Built environmental factors and adults' travel behaviors: Role of street layout and local destinations

Street layout is consistently associated with adults' travel behaviors, however factors influencing this association are unclear. We examined associations of street layout with travel behaviors: walking for transport (WT) and car use; and, the extent to which these relationships may be accounted for by availability of local destinations. A 24-h travel diary was completed in 2009 by 16,345 adult participants of the South-East Queensland Household Travel Survey, Australia. Three travel-behavior outcomes were derived: any home-based WT; over 30min of home-based WT; and, over 60min of car use. For street layout, a space syntax measure of street integration was calculated for each Statistical Area 1 (SA1, the smallest geographic unit in Australia). An objective measure of availability of destinations - Walk Score - was also derived for each SA1. Logistic regression examined associations of street layout with travel behaviors. Mediation analyses examined to what extent availability of destinations explained the associations. Street integration was significantly associated with travel behaviors. Each one-decile increment in street integration was associated with an 18% (95%CI: 1.15, 1.21) higher odds of any home-based WT; a 10% (95%CI: 1.06, 1.15) higher odds of over 30min of home-based WT; and a 5% (95%CI: 0.94, 0.96) lower odds of using a car over 60min. Local destinations partially mediated the effects of street layout on travel behaviors. Well-connected street layout contributes to active travel partially through availability of more local destinations. Urban design strategies need to address street layout and destinations to promote active travel among residents.

Active transport and obesity prevention - A transportation sector obesity impact scoping review and assessment for Melbourne, Australia

Given the alarming prevalence of obesity worldwide and the need for interventions to halt the growing epidemic, more evidence on the role and impact of transport interventions for obesity prevention is required. This study conducts a scoping review of the current evidence of association between modes of transport (motor vehicle, walking, cycling and public transport) and obesity-related outcomes. Eleven reviews and thirty-three primary studies exploring associations between transport behaviours and obesity were identified. Cohort simulation Markov modelling was used to estimate the effects of body mass index (BMI) change on health outcomes and health care costs of diseases causally related to obesity in the Melbourne, Australia population. Results suggest that evidence for an obesity effect of transport behaviours is inconclusive (29% of published studies reported expected associations, 33% mixed associations), and any potential BMI effect is likely to be relatively small. Hypothetical scenario analyses suggest that active transport interventions may contribute small but significant obesity-related health benefits across populations (approximately 65 health adjusted life years gained per year). Therefore active transport interventions that are low cost and targeted to those most amenable to modal switch are the most likely to be effective and cost-effective from an obesity prevention perspective. The uncertain but potentially significant opportunity for health benefits warrants the collection of more and better quality evidence to fully understand the potential relationships between transport behaviours and obesity. Such evidence would contribute to the obesity prevention dialogue and inform policy across the transportation, health and environmental sectors.

Residential proximity to urban centres, local-area walkability and change in waist circumference among Australian adults

Consistent associations have been observed between macro-level urban sprawl and overweight/obesity, but whether residential proximity to urban centres predicts adiposity change over time has not been established. Further, studies of local-area walkability and overweight/obesity have generated mixed results. This study examined 4-year change in adults' waist circumference in relation to proximity to city centre, proximity to closest suburban centre, and local-area walkability. Data were from adult participants (n=2080) of a cohort study on chronic conditions and health risk factors in Adelaide, Australia. Baseline data were collected in 2000-03 with a follow-up in 2005-06. Multilevel regression models examined in 2015 the independent and joint associations of the three environmental measures with change in waist circumference, accounting for socio-demographic covariates. On average, waist circumference rose by 1.8cm over approximately 4years. Greater distance to city centre was associated with a greater increase in waist circumference. Participants living in distal areas (20km or further from city centre) had a greater increase in waist circumference (mean increase: 2.4cm) compared to those in proximal areas (9km or less, mean increase: 1.2cm). Counterintuitively, living in the vicinity of a suburban centre was associated with a greater increase in adiposity. Local-area walkability was not significantly associated with the outcome. Residential proximity to city centre appears to be protective against excessive increases in waist circumference. Controlled development and targeted interventions in the urban fringe may be needed to tackle obesity. Additional research needs to assess behaviours that mediate relationships between sprawl and obesity.

Effects of living near a new urban motorway on the travel behaviour of local residents in deprived areas: Evidence from a natural experimental study

We evaluated the effects of a new motorway built through deprived neighbourhoods on travel behaviour in residents. This natural experiment comprised a longitudinal cohort (n=365) and two cross-sectional samples (baseline n=980; follow-up n=978) recruited in 2005 and 2013. Adults from one of three study areas - surrounding the new motorway (South), an existing motorway (East), or no motorway (North) - completed a previous day travel record. Adjusted two-part regression models examined associations between exposure and outcome. Compared to the North, cohort participants in the South were more likely to undertake travel by any mode (OR 2.1, 95% CI 1.0–4.2) at follow-up. Within the South study area, cohort participants living closer to a motorway junction were more likely to travel by any mode at follow-up (OR 4.7, 95% CI 1.1–19.7), and cross-sectional participants living closer were more likely to use a car at follow-up (OR 3.4, 95% CI 1.1–10.7), compared to those living further away. Overall, the new motorway appeared to promote travel and car use in those living nearby, but did not influence active travel. This may propagate socioeconomic inequalities in non-car owners.

Where to Sit? Type of Sitting Matters for the Framingham Cardiovascular Risk Score

Background

Current evidence on associations of type-specific sedentary behavior with cardiovascular disease (CVD) is limited to mainly screen-time sedentary behavior (SB). We aimed to study the associations of type-specific and total time spent sitting with the Framingham 10-year cardiovascular disease risk score (Framingham score) in Finnish adults.

Methods

Data comprise the National FINRISK 2007 and 2012 health examination surveys with 10,185 participants aged 25–74 years, apparently free of CVD. Participants reported average daily time spent sitting in different locations: work-related sitting, at home in front of television (TV), at home in front of computer, in a vehicle, and elsewhere. Total SB time was calculated from these context-specific self-reports. Accelerometer-based sedentary time was assessed in 988 FINRISK 2012 participants. Framingham score was calculated using information on blood pressure and its medication, cholesterol levels, age, diabetes status, and smoking. Analyses were adjusted for age, study year, education, employment status, leisure time physical activity, and body mass index.

Results

Out of several type-specific sitting behaviors, only TV sitting showed systematic associations with the Framingham score in both genders. The lowest Framingham risk was found for TV sitting from 6 minutes to less than 1 hour daily. Of other types of sitting, computer sitting was inversely associated with the Framingham risk in men only. Total self-reported sitting time did not show significant associations with the Framingham score, but instead higher objectively assessed sedentary time showed higher Framingham risk in men.

Conclusions

TV sitting showed most systematic associations with CVD risk score. This suggests that of all types of SB, reducing TV sitting should be targeted for reducing CVD risk.

Walkability and cardiometabolic risk factors: Cross-sectional and longitudinal associations from the Multi-Ethnic Study of Atherosclerosis

We used data from 3227 older adults in the Multi-Ethnic Study of Atherosclerosis (2004-2012) to explore cross-sectional and longitudinal associations between walkability and cardiometabolic risk factors. In cross-sectional analyses, linear regression was used to estimate associations of Street Smart Walk Score® with glucose, triglycerides, HDL and LDL cholesterol, systolic and diastolic blood pressure, and waist circumference, while logistic regression was used to estimate associations with odds of metabolic syndrome. Econometric fixed effects models were used to estimate longitudinal associations of changes in walkability with changes in each risk factor among participants who moved residential locations between 2004 and 2012 (n=583). Most cross-sectional and longitudinal associations were small and statistically non-significant. We found limited evidence that higher walkability was cross-sectionally associated with lower blood pressure but that increases in walkability were associated with increases in triglycerides and blood pressure over time. Further research over longer time periods is needed to understand the potential for built environment interventions to improve cardiometabolic health.