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Park D, Kim Y. Joint Association of Change in Physical Activity and Sitting Time with Metabolic Syndrome Risk: A Prospective Cohort Study. Metab Syndr Relat Disord 2024. [PMID: 38949924 DOI: 10.1089/met.2024.0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2024] Open
Abstract
Background and Aims: The purpose of this study was to investigate the combined impact of variations in physical activity (PA) and sitting time (ST) on the risk of developing metabolic syndrome (MetS). Methods: This study was conducted on a cohort of adults from the general population, aged 40-69 years, who participated in the KOGES community-based cohort study over a span of 10 years. Changes in PA and ST were assessed using the results from PA questionnaires completed during baseline and follow-up surveys. The diagnosis of MetS was determined according to the criteria established by the International Diabetes Federation. To evaluate the combined effect of PA and ST changes on the incidence of MetS, we calculated hazard ratios and 95% confidence intervals using a Cox proportional hazards regression model. Result: The incidence of MetS was reduced by 39% (HR = 0.61, 95% CI = 0.46-0.82) for increased ST/increased PA and 26% (HR = 0.74, 95% CI = 0.58-0.94) for decreased ST/increased PA, compared with increased ST/decreased PA, respectively. In addition, this study confirmed that the combined impact of changes in PA and ST, based on the domain of PA, on the incidence of MetS varied. Conclusion: Changes in ST and PA are associated with the risk of developing MetS. These findings lay the groundwork for further research on the relationship between changes in PA, ST, and the occurrence of diseases.
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Affiliation(s)
- DooYong Park
- Department of Physical Education, College of Education, Seoul National University, Seoul, South Korea
| | - YeonSoo Kim
- Department of Physical Education, College of Education, Seoul National University, Seoul, South Korea
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Ahmadi MN, Blodgett JM, Atkin AJ, Chan HW, Del Pozo Cruz B, Suorsa K, Bakker EA, Pulsford RM, Mielke GI, Johansson PJ, Hettiarachchi P, Thijssen DHJ, Stenholm S, Mishra GD, Teixeira-Pinot A, Rangul V, Sherar LB, Ekelund U, Hughes AD, Lee IM, Holtermann A, Koster A, Hamer M, Stamatakis E. Relationship of device measured physical activity type and posture with cardiometabolic health markers: pooled dose-response associations from the Prospective Physical Activity, Sitting and Sleep Consortium. Diabetologia 2024; 67:1051-1065. [PMID: 38478050 PMCID: PMC11058050 DOI: 10.1007/s00125-024-06090-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 12/04/2023] [Indexed: 04/30/2024]
Abstract
AIMS/HYPOTHESIS The aim of this study was to examine the dose-response associations of device-measured physical activity types and postures (sitting and standing time) with cardiometabolic health. METHODS We conducted an individual participant harmonised meta-analysis of 12,095 adults (mean ± SD age 54.5±9.6 years; female participants 54.8%) from six cohorts with thigh-worn accelerometry data from the Prospective Physical Activity, Sitting and Sleep (ProPASS) Consortium. Associations of daily walking, stair climbing, running, standing and sitting time with a composite cardiometabolic health score (based on standardised z scores) and individual cardiometabolic markers (BMI, waist circumference, triglycerides, HDL-cholesterol, HbA1c and total cholesterol) were examined cross-sectionally using generalised linear modelling and cubic splines. RESULTS We observed more favourable composite cardiometabolic health (i.e. z score <0) with approximately 64 min/day walking (z score [95% CI] -0.14 [-0.25, -0.02]) and 5 min/day stair climbing (-0.14 [-0.24, -0.03]). We observed an equivalent magnitude of association at 2.6 h/day standing. Any amount of running was associated with better composite cardiometabolic health. We did not observe an upper limit to the magnitude of the dose-response associations for any activity type or standing. There was an inverse dose-response association between sitting time and composite cardiometabolic health that became markedly less favourable when daily durations exceeded 12.1 h/day. Associations for sitting time were no longer significant after excluding participants with prevalent CVD or medication use. The dose-response pattern was generally consistent between activity and posture types and individual cardiometabolic health markers. CONCLUSIONS/INTERPRETATION In this first activity type-specific analysis of device-based physical activity, ~64 min/day of walking and ~5.0 min/day of stair climbing were associated with a favourable cardiometabolic risk profile. The deleterious associations of sitting time were fully attenuated after exclusion of participants with prevalent CVD and medication use. Our findings on cardiometabolic health and durations of different activities of daily living and posture may guide future interventions involving lifestyle modification.
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Affiliation(s)
- Matthew N Ahmadi
- Mackenzie Wearables Research Hub, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia.
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
| | - Joanna M Blodgett
- Institute of Sport, Exercise and Health, Division of Surgery and Interventional Sciences, UCL, London, UK
| | - Andrew J Atkin
- School of Health Sciences and Norwich Epidemiology Centre, University of East Anglia, Norwich, UK
| | - Hsiu-Wen Chan
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Borja Del Pozo Cruz
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, University of Cádiz, Cádiz, Spain
- Faculty of Education, University of Cádiz, Cádiz, Spain
| | - Kristin Suorsa
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Esmee A Bakker
- Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
| | | | - Gregore I Mielke
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Peter J Johansson
- Occupational and Environmental Medicine, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Occupational and Environmental Medicine, Uppsala University Hospital, Uppsala, Sweden
| | - Pasan Hettiarachchi
- Occupational and Environmental Medicine, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Dick H J Thijssen
- Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Sari Stenholm
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Gita D Mishra
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Armando Teixeira-Pinot
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Vegar Rangul
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Lauren B Sherar
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Ulf Ekelund
- Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Department of Chronic Diseases, Norwegian Public Health Institute, Oslo, Norway
| | - Alun D Hughes
- MRC Unit for Lifelong Health and Ageing, UCL Institute of Cardiovascular Science, UCL, London, UK
- UCL BHF Research Accelerator, University College London, London, UK
- University College London Hospitals NIHR Biomedical Research Centre, London, UK
| | - I-Min Lee
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Andreas Holtermann
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Annemarie Koster
- Department of Social Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Mark Hamer
- Institute of Sport, Exercise and Health, Division of Surgery and Interventional Sciences, UCL, London, UK
| | - Emmanuel Stamatakis
- Mackenzie Wearables Research Hub, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Brierley ML, Chater AM, Edwardson CL, Castle EM, Hunt ER, Biddle SJ, Sisodia R, Bailey DP. The Regulate your Sitting Time (RESIT) intervention for reducing sitting time in individuals with type 2 diabetes: findings from a randomised-controlled feasibility trial. Diabetol Metab Syndr 2024; 16:87. [PMID: 38659052 PMCID: PMC11040907 DOI: 10.1186/s13098-024-01336-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/15/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Reducing and breaking up sitting is recommended for optimal management of Type 2 diabetes mellitus (T2DM). Yet, there is limited evidence of interventions targeting these outcomes in individuals with this condition. The primary aim of this study was to assess the feasibility and acceptability of delivering and evaluating a tailored online intervention to reduce and break up sitting in adults with T2DM. METHODS A mixed-methods two-arm randomised controlled feasibility trial was conducted in ambulatory adults with T2DM who were randomised 1:1 to the REgulate your SItting Time (RESIT) intervention or usual care control group. The intervention included online education, self-monitoring and prompt tools (wearable devices, smartphone apps, computer apps) and health coaching. Feasibility outcomes were recruitment, attrition, data completion rates and intervention acceptability. Measurements of device-assessed sitting (intended primary outcome for definitive trial), standing and stepping, and physical function, psychosocial health and wellbeing were taken at baseline, 3 months and 6 months. Individual semi-structured interviews were conducted at six-months (post intervention) to explore acceptability, feasibility and experiences of the trial and intervention using the Framework Method. RESULTS Seventy participants aged 55 ± 11 years were recruited. Recruitment rate (proportion of eligible participants enrolled into the study) was 67% and participant retention rate at 6 months was 93% (n = 5 withdrawals). Data completion rates for daily sitting were 100% at baseline and ranged from 83 to 91% at 3 months and 6 months. Descriptive analysis demonstrated potential for the intervention to reduce device-measured sitting, which was 30.9 ± 87.2 and 22.2 ± 82.5 min/day lower in the intervention group at 3 and 6 months, respectively, compared with baseline. In the control group, sitting was 4.4 ± 99.5 and 23.7 ± 85.2 min/day lower at 3 and 6 months, respectively. Qualitative analysis identified three themes: reasons for participating in the trial, acceptability of study procedures, and the delivery and experience of taking part in the RESIT intervention. Overall, the measurement visits and intervention were acceptable to participants. CONCLUSIONS This study demonstrated the feasibility and acceptability of the RESIT intervention and evaluation methods, supporting a future definitive trial. If RESIT is found to be clinically effective, this could lead to changes in diabetes healthcare with a focus on reducing sitting. TRIAL REGISTRATION The trial was registered with ISRCTN (number ISRCTN14832389).
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Affiliation(s)
- Marsha L Brierley
- Centre for Physical Activity in Health and Disease, College of Health, Medicine and Life Sciences, Brunel University London, Kingston Lane, UB8 3PH, Uxbridge, UK
- Division of Sport, Health and Exercise Sciences, Department of Life Sciences, Brunel University London, Kingston Lane, UB8 3PH, Uxbridge, UK
| | - Angel M Chater
- Institute for Sport and Physical Activity Research, Centre for Health, Wellbeing and Behaviour Change, University of Bedfordshire, Polhill Avenue, MK41 9EA, Bedford, UK
- Centre for Behaviour Change, University College London, 1-19 Torrington Place, WC1E 7HB, London, UK
| | - Charlotte L Edwardson
- Leicester Lifestyle and Health Research Group, Diabetes Research Centre, University of Leicester, Leicester General Hospital, LE5 4PW, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, LE5 4PW, Leicester, UK
| | - Ellen M Castle
- Centre for Physical Activity in Health and Disease, College of Health, Medicine and Life Sciences, Brunel University London, Kingston Lane, UB8 3PH, Uxbridge, UK
- Physiotherapy Division, Department of Health Sciences, College of Health, Medicine and Life Sciences, Brunel University London, Kingston Lane, UB8 4PH, Uxbridge, UK
- Curtin School of Allied Health, School of Health Sciences, Curtin University, Western Australia, 6845, Bentley, Australia
| | - Emily R Hunt
- Centre for Physical Activity in Health and Disease, College of Health, Medicine and Life Sciences, Brunel University London, Kingston Lane, UB8 3PH, Uxbridge, UK
- Division of Sport, Health and Exercise Sciences, Department of Life Sciences, Brunel University London, Kingston Lane, UB8 3PH, Uxbridge, UK
| | - Stuart Jh Biddle
- Centre for Health Research, University of Southern Queensland, Springfield Central, 4300, Springfield, QLD, Australia
- Faculty of Sport & Health Sciences, University of Jyväskylä, FI-40014, Jyväskylä, Finland
| | - Rupa Sisodia
- Centre for Physical Activity in Health and Disease, College of Health, Medicine and Life Sciences, Brunel University London, Kingston Lane, UB8 3PH, Uxbridge, UK
- Division of Sport, Health and Exercise Sciences, Department of Life Sciences, Brunel University London, Kingston Lane, UB8 3PH, Uxbridge, UK
| | - Daniel P Bailey
- Centre for Physical Activity in Health and Disease, College of Health, Medicine and Life Sciences, Brunel University London, Kingston Lane, UB8 3PH, Uxbridge, UK.
- Division of Sport, Health and Exercise Sciences, Department of Life Sciences, Brunel University London, Kingston Lane, UB8 3PH, Uxbridge, UK.
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Gibbs BB, Kozai AC, McAdoo SN, Davis KD, Savidge MB, Paley JL, Hauspurg A, Catov JM. The sedentary behavior reduction in pregnancy intervention (SPRING) pilot and feasibility randomized trial. BMC Pregnancy Childbirth 2024; 24:261. [PMID: 38605328 PMCID: PMC11007988 DOI: 10.1186/s12884-024-06474-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/31/2024] [Indexed: 04/13/2024] Open
Abstract
Pregnant individuals rarely achieve moderate-to-vigorous intensity physical activity recommendations.Purpose The sedentary behavior reduction in pregnancy intervention (SPRING) pilot and feasibility randomized trial aimed to demonstrate feasibility, acceptability, and initial efficacy of a lower intensity intervention targeting reduced sedentary behavior and increased standing and steps.Methods First trimester pregnant individuals at risk for high sedentary behavior and adverse pregnancy outcomes (APO) were randomized 2:1 to a multi-component sedentary behavior reduction intervention or no-contact control. Intervention components included biweekly remote health coaching, wearable activity monitor, height-adjustable workstation, and a private Facebook group. Evidence-based behavioral targets included sedentary time < 9 h/day, increasing standing by 2-3 h/day, and ≥ 7500 steps/day. Participants completed all-remote assessments (baseline, second trimester, third trimester) of sedentary behavior and activity (thigh-worn activPAL) along with exploratory pregnancy health outcomes abstracted from medical records. Intervention effects vs. control were evaluated using generalized mixed models and an intention-to-treat approach. Intervention participants also provided feedback on perceived benefits and acceptability.Results Participants (34 intervention; 17 control) had mean age 32 years, were 83% White, with mean pre-pregnancy BMI 28 kg/m2. Retention was high (90% and 83% at second and third trimester follow-up visits). Intervention participants decreased sedentary time (-0.84 h/day, p = 0.019) and increased standing (+0.77 h/day, p = 0.003), but did not increase steps/day (+710, p = 0.257) compared to controls. Intervention participants reported many perceived benefits and identified the wearable, height-adjustable workstation, and behavioral lessons as most useful.Conclusion For pregnant individuals at risk for high sedentary behavior and APOs, a sedentary behavior reduction intervention is feasible, acceptable, and may offer a viable alternative to more intense physical activity recommendations during pregnancy. Further testing in a fully powered clinical trial is warranted.Trial registration NCT05093842 on clinicaltrials.gov.
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Affiliation(s)
- Bethany Barone Gibbs
- Department of Epidemiology and Biostatistics, West Virginia University School of Public Health, PO Box 9190, 64 Medical Center Drive, Morgantown, WV, 26506, USA.
| | - Andrea C Kozai
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Health and Human Development, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shannon N McAdoo
- Department of Health and Human Development, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kelliann D Davis
- Department of Health and Human Development, University of Pittsburgh, Pittsburgh, PA, USA
| | - Meghan B Savidge
- Department of Exercise Science, University of South Carolina, Columbia, SC, USA
| | - Joshua L Paley
- Department of Health and Human Development, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alisse Hauspurg
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, and Magee Women's Research Institute, Pittsburgh, PA, USA
| | - Janet M Catov
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, and Magee Women's Research Institute, Pittsburgh, PA, USA
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Rosenberg DE, Zhu W, Greenwood-Hickman MA, Cook AJ, Florez Acevedo S, McClure JB, Arterburn DE, Cooper J, Owen N, Dunstan D, Perry SR, Yarborough L, Mettert KD, Green BB. Sitting Time Reduction and Blood Pressure in Older Adults: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e243234. [PMID: 38536177 PMCID: PMC10973891 DOI: 10.1001/jamanetworkopen.2024.3234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/28/2024] [Indexed: 04/28/2024] Open
Abstract
Importance Practical health promotion strategies for improving cardiometabolic health in older adults are needed. Objective To examine the efficacy of a sedentary behavior reduction intervention for reducing sitting time and improving blood pressure in older adults. Design, Setting, and Participants This parallel-group randomized clinical trial was conducted in adults aged 60 to 89 years with high sitting time and body mass index of 30 to 50 from January 1, 2019, to November 31, 2022, at a health care system in Washington State. Intervention Participants were randomized 1:1 to the sitting reduction intervention or a healthy living attention control condition for 6 months. Intervention participants received 10 health coaching contacts, sitting reduction goals, and a standing desk and fitness tracker to prompt sitting breaks. The attention control group received 10 health coaching contacts to set general healthy living goals, excluding physical activity or sedentary behavior. Main Outcomes and Measures The primary outcome, measured at baseline, 3 months, and 6 months, was sitting time assessed using accelerometers worn for 7 days at each time point. Coprimary outcomes were systolic and diastolic blood pressure measured at baseline and 6 months. Results A total of 283 participants (140 intervention and 143 control) were randomized (baseline mean [SD] age, 68.8 [6.2] years; 186 [65.7%] female; mean [SD] body mass index, 34.9 [4.7]). At baseline, 147 (51.9%) had a hypertension diagnosis and 97 (69.3%) took at least 1 antihypertensive medication. Sitting time was reduced, favoring the intervention arm, with a difference in the mean change of -31.44 min/d at 3 months (95% CI, -48.69 to -14.19 min/d; P < .001) and -31.85 min/d at 6 months (95% CI, -52.91 to -10.79 min/d; P = .003). Systolic blood pressure change was lower by 3.48 mm Hg, favoring the intervention arm at 6 months (95% CI, -6.68 to -0.28 mm Hg; P = .03). There were 6 serious adverse events in each arm and none were study related. Conclusions and Relevance In this study of a 6-month sitting reduction intervention, older adults in the intervention reduced sedentary time by more than 30 min/d and reduced systolic blood pressure. Sitting reduction could be a promising approach to improve health in older adults. Trial Registration ClinicalTrials.gov Identifier: NCT03739762.
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Affiliation(s)
- Dori E. Rosenberg
- Kaiser Permanente Washington Health Research Institute, Seattle
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - Weiwei Zhu
- Kaiser Permanente Washington Health Research Institute, Seattle
| | | | - Andrea J. Cook
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Stefani Florez Acevedo
- Department of Health Services, School of Public Health, University of Washington, Seattle
| | - Jennifer B. McClure
- Kaiser Permanente Washington Health Research Institute, Seattle
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | | | - Julie Cooper
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Neville Owen
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - David Dunstan
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria, Australia
| | | | | | | | - Beverly B. Green
- Kaiser Permanente Washington Health Research Institute, Seattle
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
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Pinto AJ, Bergouignan A, Dempsey PC, Roschel H, Owen N, Gualano B, Dunstan DW. Physiology of sedentary behavior. Physiol Rev 2023; 103:2561-2622. [PMID: 37326297 PMCID: PMC10625842 DOI: 10.1152/physrev.00022.2022] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 05/10/2023] [Accepted: 06/14/2023] [Indexed: 06/17/2023] Open
Abstract
Sedentary behaviors (SB) are characterized by low energy expenditure while in a sitting or reclining posture. Evidence relevant to understanding the physiology of SB can be derived from studies employing several experimental models: bed rest, immobilization, reduced step count, and reducing/interrupting prolonged SB. We examine the relevant physiological evidence relating to body weight and energy balance, intermediary metabolism, cardiovascular and respiratory systems, the musculoskeletal system, the central nervous system, and immunity and inflammatory responses. Excessive and prolonged SB can lead to insulin resistance, vascular dysfunction, shift in substrate use toward carbohydrate oxidation, shift in muscle fiber from oxidative to glycolytic type, reduced cardiorespiratory fitness, loss of muscle mass and strength and bone mass, and increased total body fat mass and visceral fat depot, blood lipid concentrations, and inflammation. Despite marked differences across individual studies, longer term interventions aimed at reducing/interrupting SB have resulted in small, albeit marginally clinically meaningful, benefits on body weight, waist circumference, percent body fat, fasting glucose, insulin, HbA1c and HDL concentrations, systolic blood pressure, and vascular function in adults and older adults. There is more limited evidence for other health-related outcomes and physiological systems and for children and adolescents. Future research should focus on the investigation of molecular and cellular mechanisms underpinning adaptations to increasing and reducing/interrupting SB and the necessary changes in SB and physical activity to impact physiological systems and overall health in diverse population groups.
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Affiliation(s)
- Ana J Pinto
- Division of Endocrinology, Metabolism, and Diabetes, Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Applied Physiology & Nutrition Research Group, Center of Lifestyle Medicine, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Audrey Bergouignan
- Division of Endocrinology, Metabolism, and Diabetes, Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Institut Pluridisciplinaire Hubert Curien, Centre National de la Recherche Scientifique, Université de Strasbourg, Strasbourg, France
| | - Paddy C Dempsey
- Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, United Kingdom
| | - Hamilton Roschel
- Applied Physiology & Nutrition Research Group, Center of Lifestyle Medicine, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Neville Owen
- Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
- Centre for Urban Transitions, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Bruno Gualano
- Applied Physiology & Nutrition Research Group, Center of Lifestyle Medicine, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
- Food Research Center, University of Sao Paulo, Sao Paulo, Brazil
| | - David W Dunstan
- Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
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Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH, Dixon DL, Fearon WF, Hess B, Johnson HM, Kazi DS, Kolte D, Kumbhani DJ, LoFaso J, Mahtta D, Mark DB, Minissian M, Navar AM, Patel AR, Piano MR, Rodriguez F, Talbot AW, Taqueti VR, Thomas RJ, van Diepen S, Wiggins B, Williams MS. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2023; 82:833-955. [PMID: 37480922 DOI: 10.1016/j.jacc.2023.04.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
AIM The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease." METHODS A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost-value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
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Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH, Dixon DL, Fearon WF, Hess B, Johnson HM, Kazi DS, Kolte D, Kumbhani DJ, LoFaso J, Mahtta D, Mark DB, Minissian M, Navar AM, Patel AR, Piano MR, Rodriguez F, Talbot AW, Taqueti VR, Thomas RJ, van Diepen S, Wiggins B, Williams MS. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 2023; 148:e9-e119. [PMID: 37471501 DOI: 10.1161/cir.0000000000001168] [Citation(s) in RCA: 126] [Impact Index Per Article: 126.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
AIM The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease." METHODS A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost-value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
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Affiliation(s)
| | | | | | | | | | | | - Dave L Dixon
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
| | - William F Fearon
- Society for Cardiovascular Angiography and Interventions representative
| | | | | | | | - Dhaval Kolte
- AHA/ACC Joint Committee on Clinical Data Standards
| | | | | | | | - Daniel B Mark
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
| | | | | | | | - Mariann R Piano
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
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Murayama H, Shimada S, Morito K, Maeda H, Takahashi Y. Evaluating the Effectiveness of Letter and Telephone Reminders in Promoting the Use of Specific Health Guidance in an At-Risk Population for Metabolic Syndrome in Japan: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3784. [PMID: 36900792 PMCID: PMC10001113 DOI: 10.3390/ijerph20053784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 06/18/2023]
Abstract
Japan has introduced a nationwide lifestyle intervention program (specific health guidance) for people aged 40-74 years. Medical insurers apply a reminder system to improve their utilization rates. This study examined the effectiveness of two methods of reminders (mailed letters and telephone calls) in a randomized controlled trial. Subscribers to National Health Insurance in Yokohama City, Kanagawa Prefecture, who were eligible for specific health guidance in 2021, were recruited. A total of 1377 people who met the criteria of having or being at risk of developing metabolic syndrome (male: 77.9%, mean age: 63.1 ± 10.0 years) were randomly assigned to one of three groups: a "no reminder" group, a "letter reminder" group, or a "telephone reminder" group. The utilization rates of specific health guidance were not significantly different between the three groups (10.5%, 15.3%, and 13.7%, respectively). However, in the case of the telephone reminder group, a subgroup analysis showed that the utilization rate was significantly higher among participants who received the reminder than those who did not answer the calls. Although the effectiveness of a telephone reminder might be underestimated, this study suggests that neither method impacted the utilization rates of specific health guidance among the population at risk of metabolic syndrome.
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Affiliation(s)
- Hiroshi Murayama
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan
| | | | | | - Haruna Maeda
- Health and Welfare Bureau, Yokohama 231-0005, Japan
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10
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van Bakel BMA, Kroesen SH, Bakker EA, van Miltenburg RV, Günal A, Scheepmaker A, Aengevaeren WRM, Willems FF, Wondergem R, Pisters MF, de Bruin M, Hopman MTE, Thijssen DHJ, Eijsvogels TMH. Effectiveness of an intervention to reduce sedentary behaviour as a personalised secondary prevention strategy for patients with coronary artery disease: main outcomes of the SIT LESS randomised clinical trial. Int J Behav Nutr Phys Act 2023; 20:17. [PMID: 36788615 PMCID: PMC9927064 DOI: 10.1186/s12966-023-01419-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/26/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND A high sedentary time is associated with increased mortality risk. Previous studies indicate that replacement of sedentary time with light- and moderate-to-vigorous physical activity attenuates the risk for adverse outcomes and improves cardiovascular risk factors. Patients with cardiovascular disease are more sedentary compared to the general population, while daily time spent sedentary remains high following contemporary cardiac rehabilitation programmes. This clinical trial investigated the effectiveness of a sedentary behaviour intervention as a personalised secondary prevention strategy (SIT LESS) on changes in sedentary time among patients with coronary artery disease participating in cardiac rehabilitation. METHODS Patients were randomised to usual care (n = 104) or SIT LESS (n = 108). Both groups received a comprehensive 12-week centre-based cardiac rehabilitation programme with face-to-face consultations and supervised exercise sessions, whereas SIT LESS participants additionally received a 12-week, nurse-delivered, hybrid behaviour change intervention in combination with a pocket-worn activity tracker connected to a smartphone application to continuously monitor sedentary time. Primary outcome was the change in device-based sedentary time between pre- to post-rehabilitation. Changes in sedentary time characteristics (prevalence of prolonged sedentary bouts and proportion of patients with sedentary time ≥ 9.5 h/day); time spent in light-intensity and moderate-to-vigorous physical activity; step count; quality of life; competencies for self-management; and cardiovascular risk score were assessed as secondary outcomes. RESULTS Patients (77% male) were 63 ± 10 years and primarily diagnosed with myocardial infarction (78%). Sedentary time decreased in SIT LESS (- 1.6 [- 2.1 to - 1.1] hours/day) and controls (- 1.2 [ ─1.7 to - 0.8]), but between group differences did not reach statistical significance (─0.4 [─1.0 to 0.3]) hours/day). The post-rehabilitation proportion of patients with a sedentary time above the upper limit of normal (≥ 9.5 h/day) was significantly lower in SIT LESS versus controls (48% versus 72%, baseline-adjusted odds-ratio 0.4 (0.2-0.8)). No differences were observed in the other predefined secondary outcomes. CONCLUSIONS Among patients with coronary artery disease participating in cardiac rehabilitation, SIT LESS did not induce significantly greater reductions in sedentary time compared to controls, but delivery was feasible and a reduced odds of a sedentary time ≥ 9.5 h/day was observed. TRIAL REGISTRATION Netherlands Trial Register: NL9263. Outcomes of the SIT LESS trial: changes in device-based sedentary time from pre-to post-cardiac rehabilitation (control group) and cardiac rehabilitation + SIT LESS (intervention group). SIT LESS reduced the odds of patients having a sedentary time >9.5 hours/day (upper limit of normal), although the absolute decrease in sedentary time did not significantly differ from controls. SIT LESS appears to be feasible, acceptable and potentially beneficial, but a larger cluster randomised trial is warranted to provide a more accurate estimate of its effects on sedentary time and clinical outcomes. CR: cardiac rehabilitation.
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Affiliation(s)
- B. M. A. van Bakel
- grid.10417.330000 0004 0444 9382Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - S. H. Kroesen
- grid.10417.330000 0004 0444 9382Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - E. A. Bakker
- grid.10417.330000 0004 0444 9382Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - R. V. van Miltenburg
- grid.10417.330000 0004 0444 9382Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - A. Günal
- grid.470077.30000 0004 0568 6582Department of Cardiology, Bernhoven Hospital, Uden, The Netherlands
| | - A. Scheepmaker
- grid.470077.30000 0004 0568 6582Department of Cardiology, Bernhoven Hospital, Uden, The Netherlands
| | - W. R. M. Aengevaeren
- grid.415930.aDepartment of Cardiology, Rijnstate Hospital, Arnhem, The Netherlands
| | - F. F. Willems
- grid.415930.aDepartment of Cardiology, Rijnstate Hospital, Arnhem, The Netherlands
| | - R. Wondergem
- grid.5477.10000000120346234Department of Rehabilitation, Physical Therapy Science and Sport, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands ,grid.448801.10000 0001 0669 4689Research Group Empowering Healthy Behaviour, Department of Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands ,Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, the Netherlands
| | - M. F. Pisters
- grid.5477.10000000120346234Department of Rehabilitation, Physical Therapy Science and Sport, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands ,grid.448801.10000 0001 0669 4689Research Group Empowering Healthy Behaviour, Department of Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands ,Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, the Netherlands
| | - M. de Bruin
- grid.10417.330000 0004 0444 9382Department of IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M. T. E. Hopman
- grid.10417.330000 0004 0444 9382Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - D. H. J. Thijssen
- grid.10417.330000 0004 0444 9382Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands ,grid.4425.70000 0004 0368 0654Research Institute for Sports and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - T. M. H. Eijsvogels
- grid.10417.330000 0004 0444 9382Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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Bourdier P, Simon C, Bessesen DH, Blanc S, Bergouignan A. The role of physical activity in the regulation of body weight: The overlooked contribution of light physical activity and sedentary behaviors. Obes Rev 2023; 24:e13528. [PMID: 36394185 PMCID: PMC10910694 DOI: 10.1111/obr.13528] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/31/2022] [Accepted: 10/23/2022] [Indexed: 11/18/2022]
Abstract
The role of physical activity (PA) in the regulation of body weight is still a major topic of debate. This may be because studies have essentially focused on the effects of moderate/vigorous PA (MVPA) on body weight while overlooking the other components of PA, namely, light-intensity PA (LPA, daily life activities) and sedentary behaviors (SB, too much sitting). In this review, we will (i) describe the history of changes in PA behaviors that occurred with modernization; (ii) review data from cross-sectional and longitudinal studies that examined the associations between PA, SB, and measures of obesity; (iii) review interventional studies that investigated the effects of changes in PA and SB on body weight and adiposity; and (iv) discuss experimental studies that addressed potential biological mechanisms underlying the effects of PA and SB on weight regulation. Overall recent findings support the importance of considering all components of PA to better understand the regulation of energy balance and suggest an important role for LPA and SB in addition to MVPA on body weight regulation. Longitudinal large-scale rigorous studies are needed to advance our knowledge of the role of PA/SB in combating the obesity epidemic.
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Affiliation(s)
- Pierre Bourdier
- CNRS IPHC UMR 7178 Université de Strasbourg, Strasbourg, France
| | - Chantal Simon
- CarMen Laboratory, INSERM 1060, INRAE 1397, University of Lyon, Oullins, France
- Human Nutrition Research Centre of Rhône-Alpes, Hospices Civils de Lyon, Lyon, France
| | - Daniel H. Bessesen
- Anschutz Health and Wellness Center, Division of Endocrinology, University of Colorado, Aurora, Colorado, USA
| | - Stéphane Blanc
- CNRS IPHC UMR 7178 Université de Strasbourg, Strasbourg, France
| | - Audrey Bergouignan
- CNRS IPHC UMR 7178 Université de Strasbourg, Strasbourg, France
- Anschutz Health and Wellness Center, Division of Endocrinology, University of Colorado, Aurora, Colorado, USA
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12
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Padilha CS, Antunes BM, Jiménez-Maldonado A, St-Pierre DH, Lira FS. Impact of Breaking up of Sitting Time on Anti-inflammatory Response Induced by Extracellular Vesicles. Curr Pharm Des 2023; 29:2524-2533. [PMID: 37921133 DOI: 10.2174/0113816128244442231018070639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/21/2023] [Accepted: 08/31/2023] [Indexed: 11/04/2023]
Abstract
Physical inactivity and sedentary behaviors (SB) have promoted a dramatic increase in the incidence of a host of chronic disorders over the last century. The breaking up of sitting time (i.e., sitting to standing up transition) has been proposed as a promising solution in several epidemiological and clinical studies. In parallel to the large interest it initially created, there is a growing body of evidence indicating that breaking up prolonged sedentary time (i.e., > 7 h in sitting time) could reduce overall mortality risks by normalizing the inflammatory profile and cardiometabolic functions. Recent advances suggest that the latter health benefits, may be mediated through the immunomodulatory properties of extracellular vesicles. Primarily composed of miRNA, lipids, mRNA and proteins, these vesicles would influence metabolism and immune system functions by promoting M1 to M2 macrophage polarization (i.e., from a pro-inflammatory to anti-inflammatory phenotype) and improving endothelial function. The outcomes of interrupting prolonged sitting time may be attributed to molecular mechanisms induced by circulating angiogenic cells. Functionally, circulating angiogenic cells contribute to repair and remodel the vasculature. This effect is proposed to be mediated through the secretion of paracrine factors. The present review article intends to clarify the beneficial contributions of breaking up sitting time on extracellular vesicles formation and macrophage polarization (M1 and M2 phenotypes). Hence, it will highlight key mechanistic information regarding how breaking up sitting time protocols improves endothelial health by promoting antioxidant and anti-inflammatory responses in human organs and tissues.
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Affiliation(s)
- Camila S Padilha
- Exercise and Immunometabolism Research Group, Post-graduation Program in Movement Sciences, Department of Physical Education, Universidade Estadual Paulista (UNESP), Presidente Prudente, São Paulo, Brazil
| | - Bárbara M Antunes
- Facultad de Deportes Campus Ensenada, Universidad Autónoma de Baja California, Ensenada, Mexico
| | | | - David H St-Pierre
- Department of Kinesiology, Université du Québec à Montréal (UQAM), Montreal QC, Canada
| | - Fabio S Lira
- Exercise and Immunometabolism Research Group, Post-graduation Program in Movement Sciences, Department of Physical Education, Universidade Estadual Paulista (UNESP), Presidente Prudente, São Paulo, Brazil
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13
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Belcher BR, Kang DW, Yunker AG, Dieli-Conwright CM. Interventions to Reduce Sedentary Behavior in Cancer Patients and Survivors: a Systematic Review. Curr Oncol Rep 2022; 24:1593-1605. [PMID: 35829982 DOI: 10.1007/s11912-022-01313-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW Sedentary behaviors (SB) after cancer diagnosis are associated with poor prognosis for certain cancers, and cancer patients and survivors report high levels of SB. Reducing SB may be a feasible and effective intervention strategy to improve outcomes. This systematic review aims to identify and evaluate the literature on interventions to reduce SB in cancer patients and survivors. RECENT FINDINGS Studies were identified via database searches in December 2020. Two authors evaluated study eligibility. Data were extracted and checked, and risk of bias was assessed by the study team. Of 1401 records identified, nine studies involving 394 cancer patients or survivors were included in this review. Six were randomized trials, three were non-randomized intervention studies, and almost all (n = 8) focused on feasibility with small sample sizes. All studies were conducted within the previous 5 years in Canada, Australia, USA, and South Korea. Cancer types studied were breast (n = 3), prostate (n = 2), colorectal or peritoneal (n = 1), and mixed types (n = 3). Intervention duration of 12 weeks was most common (n = 7). Five studies had multiple intervention components, and six studies included wearable devices to measure and/or prompt behavior change. There was an overall trend where intervention groups reduced SB vs. control groups, often coupled with an increase in moderate-to-vigorous physical activity. This review suggests that there is some promise for intervention strategies to reduce SB in cancer patients and survivors. There is a need for more high-quality randomized controlled trials to understand how to best decrease SB in cancer patients and survivors.
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Affiliation(s)
- Britni R Belcher
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Dong-Woo Kang
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 375 Longwood Avenue, MB, Boston, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Alexandra G Yunker
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 375 Longwood Avenue, MB, Boston, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Christina M Dieli-Conwright
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 375 Longwood Avenue, MB, Boston, USA.
- Department of Medicine, Harvard Medical School, Boston, MA, USA.
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Pan CY, Tsai CL, Hsu PJ, Chen FC, Jiang SY, Chu CH. Levels and patterns of physical activity and sedentary behavior in adults with and without visual impairment. Disabil Health J 2022; 15:101361. [PMID: 35843843 DOI: 10.1016/j.dhjo.2022.101361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 05/30/2022] [Accepted: 06/20/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Limited data are available on objectively measured physical activity (PA) and sedentary behavior (SB) among adults with and without visual impairment (VI). OBJECTIVE To compare PA and SB levels and patterns in adults with and without VI and to examine how these differ based on sex and day of the week. METHODS Thirty-two participants with VI and 32 participants without VI participated in this cross-sectional study. PA and SB were assessed using GT3X ActiGraph accelerometers during waking hours for 7 days, and variables were examined in terms of disability group, sex, and day of the week. Nonparametric Mann-Whitney U test and Wilcoxon signed-rank test were used, and significance was set at p < 0.05. RESULTS PA did not differ in terms of sex or day of the week in participants with VI. The PA of participants without VI was significantly higher for men than it was for women and was significantly higher during weekdays than on weekend days. Total sedentary time and the duration of SB breaks were significantly longer for female participants with VI than for those without VI. The number of sedentary bouts lasting ≥10 min during weekend days was significantly higher for participants with VI than for those without VI. CONCLUSIONS Most adults with and without VI did not meet the recommended levels of daily PA and spend a large portion of the day being sedentary. Interventions to enhance PA and reduce sedentary time in adults with and without VI are required.
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Affiliation(s)
- Chien-Yu Pan
- Department of Physical Education, National Kaohsiung Normal University, Kaohsiung 802, Taiwan
| | - Chia-Liang Tsai
- Institute of Physical Education, Health and Leisure Studies, National Cheng Kung University, Tainan 701, Taiwan
| | - Po-Jen Hsu
- Graduate Institute of Physical Education, National Taiwan Sport University, Taoyuan City 333, Taiwan
| | - Fu-Chen Chen
- Department of Physical Education, National Kaohsiung Normal University, Kaohsiung 802, Taiwan
| | - Shao-Yun Jiang
- Department of Physical Education, National Kaohsiung Normal University, Kaohsiung 802, Taiwan
| | - Chia-Hua Chu
- Department of Physical Education, National Kaohsiung Normal University, Kaohsiung 802, Taiwan.
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Effects of reduced sedentary time on cardiometabolic health in adults with metabolic syndrome: A three-month randomized controlled trial. J Sci Med Sport 2022; 25:579-585. [DOI: 10.1016/j.jsams.2022.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/31/2022] [Accepted: 04/03/2022] [Indexed: 12/18/2022]
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Baradaran Mahdavi S, Riahi R, Vahdatpour B, Kelishadi R. Association between sedentary behavior and low back pain; A systematic review and meta-analysis. Health Promot Perspect 2022; 11:393-410. [PMID: 35079583 PMCID: PMC8767074 DOI: 10.34172/hpp.2021.50] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 10/29/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Sedentariness is a substantial risk for many chronic diseases. We aimed to investigate the correlation of sedentary behavior and its indicators with low back pain (LBP) among adults and children. Methods: Original articles published up to April 28, 2020, using PubMed, Embase, Web of Science and Scopus were evaluated. Odds ratio (OR, 95% CI) was considered the overall effect size for desired associations. Results: We reviewed 49 English articles with analytical observational study design, of which, 27 studies with cross sectional/survey design were retained in the meta-analysis. Among adults, sedentary lifestyle was a considerable risk factor for LBP (OR=1.24, 1.02-1.5); prolonged sitting time (OR=1.42, 1.09-1.85) and driving time (OR=2.03, 1.22-3.36) were the significant risk factors. Sedentary behavior was associated with LBP in office workers (OR=1.23). Moreover, excess weight (OR=1.35, 1.14-1.59) and smoking (OR=1.28, 1.03-1.60) were associated with LBP. Among children, sedentary lifestyle was a remarkable risk factor for LBP (OR=1.41, 1.24- 1.60); prolonged TV watching (OR=1.23, 1.08-1.41) and computer/mobile using and console playing time (OR=1.63, 1.36-1.95) were significant risk factors for LBP. Consumption of coffee, however, has yield conflicting results to be considered as a risk factor. Moreover, the researches on the correlation between sedentariness and high-intensity LBP are scarce and inconclusive. Conclusion: Sedentary behavior, whether in work or leisure time, associates with a moderate increase in the risk of LBP in adults, children and adolescents.
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Affiliation(s)
- Sadegh Baradaran Mahdavi
- Department of Physical Medicine and Rehabilitation, School of Medicine, Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran.,Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Roya Riahi
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Babak Vahdatpour
- Department of Physical Medicine and Rehabilitation, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Roya Kelishadi
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
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Ellingson LD, Lansing JE, Perez ML, DeShaw KJ, Meyer JD, Welk GJ. Facilitated Health Coaching Improves Activity Level and Chronic Low back Pain Symptoms. TRANSLATIONAL JOURNAL OF THE AMERICAN COLLEGE OF SPORTS MEDICINE 2022. [DOI: 10.1249/tjx.0000000000000192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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18
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Ke J, Li K, Ke T, Zhong X, Zheng Q, Wang Y, Li L, Dai Y, Dong Q, Ji B, Xu F, Shi J, Peng Y, Zhang Y, Zhao D, Wang W. Association of sedentary time and carotid atherosclerotic plaques in patients with type 2 diabetes. J Diabetes 2022; 14:64-72. [PMID: 34989161 PMCID: PMC9060024 DOI: 10.1111/1753-0407.13242] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/03/2021] [Accepted: 11/18/2021] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Atherosclerosis is a common complication in patients with type 2 diabetes (T2DM). Multiple factors are involved in the development and progress of atherosclerosis. We evaluated the association of weekly sedentary time (WST) with carotid plaque formation. METHODS After data cleaning, a total of 26 664 participants with T2DM from 10 National Metabolic Management Centers (MMCs) from June 2017 to April 2021 were enrolled. Self-reported lifestyle data including WST, sleeping time, smoking and drinking information, carotid artery ultrasound, and biochemical parameters were obtained. The independent association of carotid plaue with sedentary and other lifestyle behaviors was evaluated using multivariable logistic regression models, and odds ratio (OR) with 95% confidence interval (CI) were reported. Moreover, stratified analysis was conducted to demonstrate the influence of confounding factors. RESULTS The mean (SD) age of the participants was 54.0 (11.6) years, and the median (interquartile range) WST was 35.0 (21.0, 42.0) h. Comparing with participants in the first tertile of WST, those in the second or third tertile of WST were younger and with a shorter duration of diabetes. There were positive associations between longer sedentary time and odds of artery plaque after adjustment, with corresponding ORs in the second and third tertile were 1.40 (95% CI: 1.31-1.50) and 1.67 (95% CI: 1.56-1.79), respectively. However, the effect of WST on plaque in patients aged 18-40 years old had no statistical significance; the p value in the third tertile was 0.163. CONCLUSIONS In summary, higher WST appears to be associated with higher prevalence of carotid plaque in patients with T2DM, especially in aged populations.
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Affiliation(s)
- Jing Ke
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe HospitalCapital Medical UniversityBeijingChina
| | - Kun Li
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe HospitalCapital Medical UniversityBeijingChina
| | - Tingyu Ke
- Department of EndocrinologyThe Second Affiliated Hospital of Kunming Medical UniversityKunmingChina
| | - Xu Zhong
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the P. R. China, Shanghai National Center for Translational Medicine, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Qidong Zheng
- Department of Internal MedicineThe Second People's Hospital of YuhuanYuhuanChina
| | - Yufan Wang
- Department of Endocrinology and Metabolism, Shanghai General HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Li Li
- Department of EndocrinologyNingbo First HospitalNingboChina
| | - Yuancheng Dai
- Department of Internal Medicine of Traditional Chinese MedicineSheyang Diabetes HospitalYanchengChina
| | - Qijuan Dong
- Department of Endocrinology and MetabolismPeople's Hospital of Zhengzhou Affiliated Henan University of Chinese MedicineZhengzhouChina
| | - Bangqun Ji
- Department of EndocrinologyXingyi People's HospitalXinyiChina
| | - Fengmei Xu
- Department of Endocrinology and MetabolismHebi Coal (group). LTD. General HospitalHebiChina
| | - Juan Shi
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the P. R. China, Shanghai National Center for Translational Medicine, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Ying Peng
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the P. R. China, Shanghai National Center for Translational Medicine, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yifei Zhang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the P. R. China, Shanghai National Center for Translational Medicine, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Dong Zhao
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe HospitalCapital Medical UniversityBeijingChina
| | - Weiqing Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the P. R. China, Shanghai National Center for Translational Medicine, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
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Cândido LM, Wagner KJP, Costa MED, Pavesi E, Avelar NCPD, Danielewicz AL. Comportamento sedentário e associação com multimorbidade e padrões de multimorbidade em idosos brasileiros: dados da Pesquisa Nacional de Saúde de 2019. CAD SAUDE PUBLICA 2022; 38:e00128221. [DOI: 10.1590/0102-311x00128221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/09/2021] [Indexed: 11/21/2022] Open
Abstract
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.
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Luciano M, Sampogna G, Amore M, Andriola I, Calcagno P, Carmassi C, Del Vecchio V, Dell'Osso L, Di Lorenzo G, Gelao B, Giallonardo V, Rossi A, Rossi R, Siracusano A, Fiorillo A. How to improve the physical health of people with severe mental illness? A multicentric randomized controlled trial on the efficacy of a lifestyle group intervention. Eur Psychiatry 2021; 64:e72. [PMID: 34812136 PMCID: PMC8715281 DOI: 10.1192/j.eurpsy.2021.2253] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background
People with severe mental illnesses (SMI) have a mortality rate two times higher compared to the general population, with a decade of years of life lost. In this randomized controlled trial (RCT), we assessed in a sample of people with bipolar disorder, major depressive disorder, and schizophrenia spectrum disorder, the efficacy of an innovative psychosocial group intervention compared to a brief psychoeducational group intervention on patients’ body mass index (BMI), body weight, waist circumference, Framingham and HOMA-IR indexes.
Methods
This is a multicentric RCT with blinded outcome assessments carried out in six Italian university centers. After recruitment patients were randomized to receive a 6-month psychosocial intervention to improve patients’ physical health or a brief psychoeducational intervention. All recruited patients were assessed with standardized assessment instruments at baseline and after 6 months. Anthropometric parameters and blood samples have also been collected.
Results
Four-hundred and two patients with a diagnosis of bipolar disorder (43.3%), schizophrenia or other psychotic disorder (29.9%), or major depression (26.9%) were randomly allocated to the experimental (N = 206) or the control group (N = 195). After 6 months, patients from the experimental group reported a significant reduction in BMI (odds ratio [OR]: 1.93, 95% confidence intervals [CI]: 1.31–2.84; p < 0.001), body weight (OR = 4.78, 95% CI: 0.80–28.27, p < 0.05), and waist circumference (OR = 5.43, 95% CI: 1.45–20.30, p < 0.05). Participants with impaired cognitive and psychosocial functioning had a worse response to the intervention.
Conclusions
The experimental group intervention was effective in improving the physical health in SMI patients. Further studies are needed to evaluate the feasibility of this intervention in real-world settings.
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Affiliation(s)
- Mario Luciano
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Gaia Sampogna
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Mario Amore
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy
| | - Ileana Andriola
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Pietro Calcagno
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy
| | - Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Valeria Del Vecchio
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giorgio Di Lorenzo
- Department of System Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Barbara Gelao
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | | | - Alessandro Rossi
- Section of Psychiatry, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Rodolfo Rossi
- Section of Psychiatry, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alberto Siracusano
- Department of System Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
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21
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Di Somma C, Scarano E, Barrea L, Solari D, Riccio E, Arianna R, Cavallo LM, Romano F, Di Benedetto E, Rodriguez A, de Alteriis G, Colao A. Craniopharyngioma, Chronotypes and Metabolic Risk Profile. Nutrients 2021; 13:nu13103444. [PMID: 34684445 PMCID: PMC8538918 DOI: 10.3390/nu13103444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/24/2021] [Accepted: 09/25/2021] [Indexed: 12/15/2022] Open
Abstract
Aim: To investigate the potential association among Craniopharyngioma (CP), chronotypes and metabolic risk profile. Subjects and Methods: The study population included 28 patients (46.4% males; 42.6 ± 15.8 years) and 28 controls, age, gender and BMI matched (46.4% males; 46.5 ± 12.9 years). In this study sample, we evaluated: anthropometric measurements (waist circumference, WC; BMI), plasma glucose, lipid profile, and systolic (SBP) and diastolic (DBP) blood pressure. Morningness-Eveningness was measured with the Horne-Ostberg Morningness-Eveningness Questionnaire (MEQ), which included 19 questions about preferred sleep time and daily performance. Results: in both patients and controls grade I obesity was detected in 15 subjects (53.6%), grade II obesity in 13 subjects (46.4%). In the patient group, the mean score of chronotype was 47.8 ± 12.6. In particular, 9 patients (32.1%) exhibited the morning chronotype, 6 (21.4%) the intermediate chronotype and 13 (46.4.%) the evening chronotype. No significant difference was found in gender and age among the chronotype categories. Patients with the evening chronotype had higher blood pressure values and worse metabolic parameters than those with the morning chronotype. In the control group, the mean score of the chronotype was 57.6 ± 9.5. In particular, 16 (57.1%) subjects exhibited the morning chronotype, 10 (35.7%) the intermediate chronotype and only 2 (7.1.%) the evening chronotype. The prevalence of intermediate and evening chronotypes was higher in females than males (p = 0.021), while males have a higher prevalence of the morning chronotype. Subjects with intermediate and evening chronotypes had worse metabolic parameters than those with the morning chronotype. In patients, the chronotype score was inversely correlated to WC, BMI, SBP, DBP, plasma glucose, total cholesterol, triglycerides, LDL cholesterol and positively correlated with HDL cholesterol. No correlation was found between age and chronotype. In controls, the chronotype score was inversely correlated to WC, BMI, plasma glucose, total cholesterol, LDL cholesterol. No correlation was found among chronotype and age, blood pressure, triglycerides, HDL cholesterol. Considering the whole population of the study (patients and controls), at logistic regression the chronotype score was significantly associated with the presence of CP. Conclusions: for the first time thus far, our study puts the light on the association of the CP with chronotypes and metabolic alterations in this disease, which are the main determinants of the reduced quality of life, higher morbidity and mortality in this setting of patients. This finding suggests that alterations of chronotype might represent an adjunctive risk for CP patients and a possible target for their integrate management.
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Affiliation(s)
- Carolina Di Somma
- Endocrinology Unit, Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy; (E.S.); (L.B.); (E.R.); (R.A.); (F.R.); (E.D.B.); (A.R.); (G.d.A.); (A.C.)
- Cattedra Unesco “Educazione Alla Salute e allo Sviluppo Sostenibile”, Federico II University, 80131 Naples, Italy
- Correspondence: ; Tel.: +39-081-746-3779
| | - Elisabetta Scarano
- Endocrinology Unit, Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy; (E.S.); (L.B.); (E.R.); (R.A.); (F.R.); (E.D.B.); (A.R.); (G.d.A.); (A.C.)
| | - Luigi Barrea
- Endocrinology Unit, Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy; (E.S.); (L.B.); (E.R.); (R.A.); (F.R.); (E.D.B.); (A.R.); (G.d.A.); (A.C.)
| | - Domenico Solari
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, 80125 Naples, Italy; (D.S.); (L.M.C.)
| | - Enrico Riccio
- Endocrinology Unit, Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy; (E.S.); (L.B.); (E.R.); (R.A.); (F.R.); (E.D.B.); (A.R.); (G.d.A.); (A.C.)
| | - Rossana Arianna
- Endocrinology Unit, Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy; (E.S.); (L.B.); (E.R.); (R.A.); (F.R.); (E.D.B.); (A.R.); (G.d.A.); (A.C.)
| | - Luigi Maria Cavallo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, 80125 Naples, Italy; (D.S.); (L.M.C.)
| | - Fiammetta Romano
- Endocrinology Unit, Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy; (E.S.); (L.B.); (E.R.); (R.A.); (F.R.); (E.D.B.); (A.R.); (G.d.A.); (A.C.)
| | - Elea Di Benedetto
- Endocrinology Unit, Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy; (E.S.); (L.B.); (E.R.); (R.A.); (F.R.); (E.D.B.); (A.R.); (G.d.A.); (A.C.)
| | - Alice Rodriguez
- Endocrinology Unit, Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy; (E.S.); (L.B.); (E.R.); (R.A.); (F.R.); (E.D.B.); (A.R.); (G.d.A.); (A.C.)
| | - Giulia de Alteriis
- Endocrinology Unit, Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy; (E.S.); (L.B.); (E.R.); (R.A.); (F.R.); (E.D.B.); (A.R.); (G.d.A.); (A.C.)
| | - Annamaria Colao
- Endocrinology Unit, Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy; (E.S.); (L.B.); (E.R.); (R.A.); (F.R.); (E.D.B.); (A.R.); (G.d.A.); (A.C.)
- Cattedra Unesco “Educazione Alla Salute e allo Sviluppo Sostenibile”, Federico II University, 80131 Naples, Italy
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