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Blodgett JM, Ahmadi MN, Atkin AJ, Chastin S, Chan HW, Suorsa K, Bakker EA, Hettiarcachchi P, Johansson PJ, Sherar LB, Rangul V, Pulsford RM, Mishra G, Eijsvogels TMH, Stenholm S, Hughes AD, Teixeira-Pinto AM, Ekelund U, Lee IM, Holtermann A, Koster A, Stamatakis E, Hamer M. Device-measured physical activity and cardiometabolic health: the Prospective Physical Activity, Sitting, and Sleep (ProPASS) consortium. Eur Heart J 2024; 45:458-471. [PMID: 37950859 PMCID: PMC10849343 DOI: 10.1093/eurheartj/ehad717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/06/2023] [Accepted: 10/10/2023] [Indexed: 11/13/2023] Open
Abstract
BACKGROUND AND AIMS Physical inactivity, sedentary behaviour (SB), and inadequate sleep are key behavioural risk factors of cardiometabolic diseases. Each behaviour is mainly considered in isolation, despite clear behavioural and biological interdependencies. The aim of this study was to investigate associations of five-part movement compositions with adiposity and cardiometabolic biomarkers. METHODS Cross-sectional data from six studies (n = 15 253 participants; five countries) from the Prospective Physical Activity, Sitting and Sleep consortium were analysed. Device-measured time spent in sleep, SB, standing, light-intensity physical activity (LIPA), and moderate-vigorous physical activity (MVPA) made up the composition. Outcomes included body mass index (BMI), waist circumference, HDL cholesterol, total:HDL cholesterol ratio, triglycerides, and glycated haemoglobin (HbA1c). Compositional linear regression examined associations between compositions and outcomes, including modelling time reallocation between behaviours. RESULTS The average daily composition of the sample (age: 53.7 ± 9.7 years; 54.7% female) was 7.7 h sleeping, 10.4 h sedentary, 3.1 h standing, 1.5 h LIPA, and 1.3 h MVPA. A greater MVPA proportion and smaller SB proportion were associated with better outcomes. Reallocating time from SB, standing, LIPA, or sleep into MVPA resulted in better scores across all outcomes. For example, replacing 30 min of SB, sleep, standing, or LIPA with MVPA was associated with -0.63 (95% confidence interval -0.48, -0.79), -0.43 (-0.25, -0.59), -0.40 (-0.25, -0.56), and -0.15 (0.05, -0.34) kg/m2 lower BMI, respectively. Greater relative standing time was beneficial, whereas sleep had a detrimental association when replacing LIPA/MVPA and positive association when replacing SB. The minimal displacement of any behaviour into MVPA for improved cardiometabolic health ranged from 3.8 (HbA1c) to 12.7 (triglycerides) min/day. CONCLUSIONS Compositional data analyses revealed a distinct hierarchy of behaviours. Moderate-vigorous physical activity demonstrated the strongest, most time-efficient protective associations with cardiometabolic outcomes. Theoretical benefits from reallocating SB into sleep, standing, or LIPA required substantial changes in daily activity.
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Affiliation(s)
- Joanna M Blodgett
- Institute of Sport Exercise and Health, Division of Surgery and Interventional Sciences, University College London, London , UK
| | - Matthew N Ahmadi
- Mackenzie Wearables Research Hub, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Andrew J Atkin
- School of Health Sciences and Norwich Epidemiology Centre, University of East Anglia, Norwich, UK
| | - Sebastien Chastin
- School of Health and Life Science Glasgow Caledonian University, Glasgow, UK
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - Hsiu-Wen Chan
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - 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 Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
- Department of Medical BioSciences, Exercise Physiology ResearchGroup, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Pasan Hettiarcachchi
- Occupational and Environmental Medicine, Department of Medical Sciences, Uppsala University, Sweden
| | - Peter J Johansson
- Occupational and Environmental Medicine, Department of Medical Sciences, Uppsala University, Sweden
- Occupational and Environmental Medicine, Uppsala University Hospital, Uppsala, Sweden
| | - Lauren B Sherar
- School of Sport, Exercise and Health Sciences, Loughborough University, UK
| | - Vegar Rangul
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Norway
| | | | - Gita Mishra
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Thijs M H Eijsvogels
- Department of Medical BioSciences, Exercise Physiology ResearchGroup, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sari Stenholm
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
- Research Services, Turku University Hospital and University of Turku, Finland
| | - Alun D Hughes
- MRC Unit for Lifelong Health and Ageing, UCL Institute of Cardiovascular Science, UCL, UK
- UCL BHF Research Accelerator, University College London, London, UK
- University College London Hospitals NIHR Biomedical Research Centre, London, UK
| | | | - Ulf Ekelund
- Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Departmentof Chronic Diseases, Norwegian Public Health Institute, Oslo, Norway
| | - I-Min Lee
- Division of Preventive Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard TH 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
| | - Emmanuel Stamatakis
- Mackenzie Wearables Research Hub, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Mark Hamer
- Institute of Sport Exercise and Health, Division of Surgery and Interventional Sciences, University College London, London , UK
- University College London Hospitals NIHR Biomedical Research Centre, London, UK
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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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Sahabudhee A, Rao CR, Chandrasekaran B, Pedersen SJ. Dose-response effects of periodic physical activity breaks on the chronic inflammatory risk associated with sedentary behavior in high- and upper-middle income countries: A systematic review and meta-analysis. Diabetes Metab Syndr 2023; 17:102730. [PMID: 36863092 DOI: 10.1016/j.dsx.2023.102730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 02/16/2023] [Accepted: 02/19/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND AND AIMS Though moderate-vigorous physical activity (MVPA) is speculated to mitigate the inflammatory risk associated with sedentary behavior, only a fraction of the global population meets the recommended weekly dose of MVPA. More individuals indulge in bouted and sporadic light-intensity physical activity (LIPA) that occurs throughout the typical day. However, the anti-inflammatory effects of LIPA or MVPA breaks during prolonged sitting remains unclear. METHODS A systematic search was done on six peer-reviewed databases through January 27th, 2023. Two authors independently screened the citations for eligibility, and risk of bias and performed a meta-analysis. RESULTS The included studies originated from high and upper - middle income countries. Observational studies of SB interruptions with LIPA showed favourable effects on inflammatory mediators such as higher levels of adiponectin (odds ratio, OR = +0.14; p = 0.02). However, these findings are not supported by the experimental studies. Experimental studies reported non-significant increase in cytokines including IL-1β (standardised mean difference, SMD = 0.11 pg/ml; p = 0.29) and IL-6 (SMD = 0.19 pg/ml; p = 0.46) after interrupting sitting with LIPA breaks. But these LIPA breaks were found to reduce C-reactive protein (SMD = - 0.50 mg/dl; p = 0.85) and IL-8 levels (SMD = -0.08 pg/ml; p = 0.34) but did not reach statistical significance. CONCLUSION Interrupting prolonged sitting time with LIPA breaks shows promise for preventing the inflammatory effects associated with prolonged bouts of daily sitting, though the evidence remains in infancy and limited to high- and upper-middle income countries.
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Affiliation(s)
- Azarudheen Sahabudhee
- Department of Exercise and Sports Sciences, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Chythra R Rao
- Department of Community Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka - 576104, India.
| | - Baskaran Chandrasekaran
- Department of Exercise and Sports Sciences, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India; Center for Sports Science, Medicine and Research, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Scott J Pedersen
- Active Work Laboratory, School of Education, University of Tasmania, Tasmania, Australia.
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Booker R, Holmes ME, Newton RL, Norris KC, Thorpe RJ, Carnethon MR. Compositional analysis of movement behaviors' association on high-sensitivity c-reactive protein: the Jackson heart study. Ann Epidemiol 2022; 76:7-12. [PMID: 36210008 PMCID: PMC9879574 DOI: 10.1016/j.annepidem.2022.09.009] [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: 06/28/2022] [Revised: 09/22/2022] [Accepted: 09/29/2022] [Indexed: 01/28/2023]
Abstract
PURPOSE Movement behaviors (i.e. physical activity [PA], sedentary behavior [SB], and sleep) are intrinsically codependent, an issue resolved using compositional data analysis (CoDA). High-sensitivity C-reactive protein (hs-CRP) is a nonspecific inflammatory marker positively associated with cardiovascular diseases and affected by movement behaviors. Examine the relation between movement behaviors using CoDA and how time reallocation between two movement behaviors was associated with hs-CRP concentration. METHODS The Jackson Heart Study was designed to investigate cardiovascular disease risk factors among African American participants in the Jackson, MS area. PA and sleep were self-reported with SB calculated as the remaining time in the day. RESULTS The median untransformed hs-CRP concentration was 0.28 mg·dL-1 (interquartile range; 0.11, 0.61). Reallocating 15 minutes of PA with SB, the hypothetical change in log hs-CRP concentration was 0.08 mg·dL-1 (95% CIs; 0.04, 0.11) greater than the average log hs-CRP concentration. Substituting 15 minutes of SB or sleep with PA was associated with a hypothetical change in log hs-CRP concentration difference of -0.05 mg·dL-1 (-0.08, -0.03) and -0.06 mg·dL-1 (-0.08, -0.03), respectively. Reallocations between SB and sleep were not associated with the hypothetical difference in log hs-CRP concentration. CONCLUSIONS Modeling estimates suggest replacing 15 minutes of SB with PA is associated with lower inflammation.
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Affiliation(s)
- Robert Booker
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | - Megan E Holmes
- Department of Kinesiology, Mississippi State University, Mississippi State, MS
| | | | - Keith C Norris
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Roland J Thorpe
- Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, John Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
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5
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Daniele A, Lucas SJE, Rendeiro C. Detrimental effects of physical inactivity on peripheral and brain vasculature in humans: Insights into mechanisms, long-term health consequences and protective strategies. Front Physiol 2022; 13:998380. [PMID: 36237532 PMCID: PMC9553009 DOI: 10.3389/fphys.2022.998380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
Abstract
The growing prevalence of physical inactivity in the population highlights the urgent need for a more comprehensive understanding of how sedentary behaviour affects health, the mechanisms involved and what strategies are effective in counteracting its negative effects. Physical inactivity is an independent risk factor for different pathologies including atherosclerosis, hypertension and cardiovascular disease. It is known to progressively lead to reduced life expectancy and quality of life, and it is the fourth leading risk factor for mortality worldwide. Recent evidence indicates that uninterrupted prolonged sitting and short-term inactivity periods impair endothelial function (measured by flow-mediated dilation) and induce arterial structural alterations, predominantly in the lower body vasculature. Similar effects may occur in the cerebral vasculature, with recent evidence showing impairments in cerebral blood flow following prolonged sitting. The precise molecular and physiological mechanisms underlying inactivity-induced vascular dysfunction in humans are yet to be fully established, although evidence to date indicates that it may involve modulation of shear stress, inflammatory and vascular biomarkers. Despite the steady increase in sedentarism in our societies, only a few intervention strategies have been investigated for their efficacy in counteracting the associated vascular impairments. The current review provides a comprehensive overview of the evidence linking acute and short-term physical inactivity to detrimental effects on peripheral, central and cerebral vascular health in humans. We further examine the underlying molecular and physiological mechanisms and attempt to link these to long-term consequences for cardiovascular health. Finally, we summarize and discuss the efficacy of lifestyle interventions in offsetting the negative consequences of physical inactivity.
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Affiliation(s)
- Alessio Daniele
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Samuel J. E. Lucas
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom
| | - Catarina Rendeiro
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom
- *Correspondence: Catarina Rendeiro,
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6
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Vandercappellen EJ, Koster A, Savelberg HHCM, Eussen SJPM, Dagnelie PC, Schaper NC, Schram MT, van der Kallen CJH, van Greevenbroek MMJ, Wesselius A, Schalkwijk CG, Kroon AA, Henry RMA, Stehouwer CDA. Sedentary behaviour and physical activity are associated with biomarkers of endothelial dysfunction and low-grade inflammation-relevance for (pre)diabetes: The Maastricht Study. Diabetologia 2022; 65:777-789. [PMID: 35119485 PMCID: PMC8960649 DOI: 10.1007/s00125-022-05651-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 10/28/2021] [Indexed: 12/18/2022]
Abstract
AIMS/HYPOTHESIS Biomarkers of endothelial dysfunction and low-grade inflammation are important in the pathogenesis of CVD and can potentially be modified by physical activity and sedentary behaviour. Effects of physical activity on biomarkers of endothelial dysfunction may be especially prominent in type 2 diabetes. METHODS In the population-based Maastricht Study (n = 2363, 51.5% male, 28.3% type 2 diabetes, 15.1% prediabetes [defined as impaired glucose tolerance and impaired fasting glucose]), we determined biomarkers of endothelial dysfunction and low-grade inflammation, and combined z scores were calculated. Physical activity and sedentary behaviour were measured by activPAL. Linear regression analyses were used with adjustment for demographic, lifestyle and cardiovascular risk factors. RESULTS The association between total, light, moderate-to-vigorous and vigorous intensity physical activity and sedentary time on the one hand and biomarkers of endothelial dysfunction on the other were generally significant and were consistently stronger in prediabetes and type 2 diabetes as compared with normal glucose metabolism status (p for interaction <0.05). Associations between physical activity and sedentary behaviour on the one hand and low-grade inflammation on the other were also significant and were similar in individuals with and without (pre)diabetes (p for interaction >0.05). CONCLUSIONS/INTERPRETATION Physical activity and sedentary behaviour are associated with biomarkers of endothelial dysfunction and low-grade inflammation. For biomarkers of endothelial dysfunction, associations between physical activity and sedentary behaviour were consistently stronger in (pre)diabetes than in normal glucose metabolism. Whether increasing physical activity or decreasing sedentary time can positively influence biomarkers of endothelial dysfunction in individuals with prediabetes and type 2 diabetes requires further study.
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Affiliation(s)
- Evelien J Vandercappellen
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Annemarie Koster
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Department of Social Medicine, Maastricht University, Maastricht, the Netherlands
| | - Hans H C M Savelberg
- Department of Nutrition and Movement Science, Maastricht University, Maastricht, the Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Simone J P M Eussen
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
- Department of Epidemiology, Maastricht University, Maastricht, the Netherlands
| | - Pieter C Dagnelie
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Nicolaas C Schaper
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Miranda T Schram
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
- MHeNS School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
- Heart and Vascular Center, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Carla J H van der Kallen
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Marleen M J van Greevenbroek
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Anke Wesselius
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
- Department of Complex Genetics and Epidemiology, Maastricht University, Maastricht, the Netherlands
| | - Casper G Schalkwijk
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Abraham A Kroon
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
- Heart and Vascular Center, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Ronald M A Henry
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
- Heart and Vascular Center, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Coen D A Stehouwer
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands.
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands.
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Christofaro DGD, Tebar WR, Vanderlei LCM, Fernandes RA, Mota J, Mielke GI, Ritti-Dias RM. Association of cardiac autonomic modulation with different intensities of physical activity in a small Brazilian inner city: a gender analysis. Eur J Sport Sci 2022; 23:649-655. [PMID: 35184676 DOI: 10.1080/17461391.2022.2044913] [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: 11/03/2022]
Abstract
AbstractPhysical activity has been linked to higher cardiac autonomic modulation. However, it is not clear in the literature which type of intensity of physical activity (sedentary, light, moderate, or vigorous) could be related to better cardiac autonomic modulation and whether this relationship is similar in men and women. The aim of this study was to analyze the relationship between cardiac autonomic modulation and the different intensities of physical activity in men and women. The sample included 100 men and 131 women. Cardiac autonomic modulation was obtained by heart rate variability (SDNN, RMSSD, LF un, HF un, SD1, and SD2). Time spent in different intensities (sedentary, light, moderate, and vigorous intensity physical activity) was measured using a waist-worn accelerometer for seven days. Linear regression was used to verify the relationship between physical activity and cardiac autonomic modulation, considering the adjustment for age, ethnicity, and socioeconomic level. Among men, a significant relationship of moderate intensity was observed with SDNN (β=2.442; p = 0.021) and SD2 (β=2.936, p = 0.028), and of vigorous intensity with SDNN (β=12.826, p = 0.028), RMSSD (β=16.370, p = 0.018), and SD1 (β=12.344, p = 0.025) indices. Among women, light-intensity physical activity was significantly related with LFnu (β= .655, p = 0.005) and HFnu (β= -.590, p = 0.010). Moderate and vigorous physical activity was associated with better cardiac autonomic modulation in men. Light physical activity was associated with lower sympathetic modulation in women.
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Affiliation(s)
- Diego G D Christofaro
- São Paulo State University (Unesp), School of Technology and Sciences, Presidente Prudente, Brazil
| | - William R Tebar
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo (USP), Sao Paulo, Brazil
| | - Luiz Carlos M Vanderlei
- São Paulo State University (Unesp), School of Technology and Sciences, Presidente Prudente, Brazil
| | - Rômulo A Fernandes
- São Paulo State University (Unesp), School of Technology and Sciences, Presidente Prudente, Brazil
| | - Jorge Mota
- Research Center on Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
| | - Gregore I Mielke
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
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8
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Sit less and move more for cardiovascular health: emerging insights and opportunities. Nat Rev Cardiol 2021; 18:637-648. [PMID: 34017139 DOI: 10.1038/s41569-021-00547-y] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 02/01/2023]
Abstract
Sedentary behaviour - put simply, too much sitting, as a distinct concept from too little exercise - is a novel determinant of cardiovascular risk. This definition provides a perspective that is complementary to the well-understood detrimental effects of physical inactivity. Sitting occupies the majority of the daily waking hours in most adults and has become even more pervasive owing to the COVID-19 pandemic. The potential for a broad cardiovascular health benefit exists through an integrated approach that involves 'sitting less and moving more'. In this Review, we first consider observational and experimental evidence on the adverse effects of prolonged, uninterrupted sitting and the evidence identifying the possible mechanisms underlying the associated risk. We summarize the results of randomized controlled trials demonstrating the feasibility of changing sedentary behaviour. We also highlight evidence on the deleterious synergies between sedentary behaviour and physical inactivity as the underpinnings of our case for addressing them jointly in mitigating cardiovascular risk. This integrated approach should not only reduce the specific risks of too much sitting but also have a positive effect on the total amount of physical activity, with the potential to more broadly benefit the health of individuals living with or at risk of developing cardiovascular disease.
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9
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Llavero-Valero M, Escalada-San Martín J, Martínez-González MA, Basterra-Gortari FJ, Gea A, Bes-Rastrollo M. Physical Activity Intensity and Type 2 Diabetes: Isotemporal Substitution Models in the "Seguimiento Universidad de Navarra" (SUN) Cohort. J Clin Med 2021; 10:jcm10132744. [PMID: 34206360 PMCID: PMC8267904 DOI: 10.3390/jcm10132744] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/07/2021] [Accepted: 06/17/2021] [Indexed: 11/24/2022] Open
Abstract
Which intensity of physical activity (PA) is associated with type 2 diabetes (T2D) prevention remains unclear. Isotemporal substitution models assess the relationship of replacing the amount of time spent in one activity for another. We aimed to assess T2D incidence associated with light-to-moderate physical activity (LMPA) and vigorous physical activity (VPA) using isotemporal substitution models of one hour (1 h) sitting by 1 h of LMPA or VPA. Furthermore, we evaluated the effect on T2D of an isotemporal substitution of 1 h sitting by 1 h of slow (light physical activity) or brisk–very brisk walking (moderate physical activity). In total, 20,060 participants (both sexes) of the SUN cohort (Spain) initially free of T2D followed-up during a median of 12 years were included. Cox regression models were fitted to assess the association between the substitution of 1 h LMPA, VPA, slow and brisk–very brisk pace by 1 h sitting and T2D. The replacement of 1 h sitting time by 1 h of VPA was associated with an adjusted HR of 0.52 (95% CI: 0.34–0.80), not observed for the substitution by 1 h of LMPA (HR 0.93; 95% CI: 0.73–1.20). An apparent inverse association was observed for the replacement of 1 h sitting time by 1 h of brisk/very brisk walking (HR: 0.69; 95% CI: 0.46–1.04), not observed by 1 h of slow pace. From equal conditions of duration and frequency of PA, the higher the intensity of PA, the greater the T2D prevention.
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Affiliation(s)
- María Llavero-Valero
- Department of Preventive Medicine and Public Health, University of Navarra, 31008 Pamplona, Spain; (M.L.-V.); (M.A.M.-G.); (F.J.B.-G.); (A.G.)
- Department of Endocrinology and Nutrition, University of Navarra, 31008 Pamplona, Spain;
| | - Javier Escalada-San Martín
- Department of Endocrinology and Nutrition, University of Navarra, 31008 Pamplona, Spain;
- Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- IDISNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
| | - Miguel A. Martínez-González
- Department of Preventive Medicine and Public Health, University of Navarra, 31008 Pamplona, Spain; (M.L.-V.); (M.A.M.-G.); (F.J.B.-G.); (A.G.)
- Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- IDISNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Francisco Javier Basterra-Gortari
- Department of Preventive Medicine and Public Health, University of Navarra, 31008 Pamplona, Spain; (M.L.-V.); (M.A.M.-G.); (F.J.B.-G.); (A.G.)
- IDISNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
- Department of Endocrinology and Nutrition, Complejo Hospitalario de Navarra, 31008 Pamplona, Spain
| | - Alfredo Gea
- Department of Preventive Medicine and Public Health, University of Navarra, 31008 Pamplona, Spain; (M.L.-V.); (M.A.M.-G.); (F.J.B.-G.); (A.G.)
- Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
| | - Maira Bes-Rastrollo
- Department of Preventive Medicine and Public Health, University of Navarra, 31008 Pamplona, Spain; (M.L.-V.); (M.A.M.-G.); (F.J.B.-G.); (A.G.)
- Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- IDISNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
- Correspondence: ; Tel.: +34-948-425-600
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10
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Modelling the Reallocation of Time Spent Sitting into Physical Activity: Isotemporal Substitution vs. Compositional Isotemporal Substitution. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126210. [PMID: 34201369 PMCID: PMC8229040 DOI: 10.3390/ijerph18126210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 12/18/2022]
Abstract
Isotemporal substitution modelling (ISM) and compositional isotemporal modelling (CISM) are statistical approaches used in epidemiology to model the associations of replacing time in one physical behaviour with time in another. This study’s aim was to use both ISM and CISM to examine and compare associations of reallocating 60 min of sitting into standing or stepping with markers of cardiometabolic health. Cross-sectional data collected during three randomised control trials (RCTs) were utilised. All participants (n = 1554) were identified as being at high risk of developing type 2 diabetes. Reallocating 60 min from sitting to standing and to stepping was associated with a lower BMI, waist circumference, and triglycerides and higher high-density lipoprotein cholesterol using both ISM and CISM (p < 0.05). The direction and magnitude of significant associations were consistent across methods. No associations were observed for hemoglobin A1c, total cholesterol, or low-density lipoprotein cholesterol for either method. Results of both ISM and CISM were broadly similar, allowing for the interpretation of previous research, and should enable future research in order to make informed methodological, data-driven decisions.
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Owen N, Healy GN, Dempsey PC, Salmon J, Timperio A, Clark BK, Goode AD, Koorts H, Ridgers ND, Hadgraft NT, Lambert G, Eakin EG, Kingwell BA, Dunstan DW. Sedentary Behavior and Public Health: Integrating the Evidence and Identifying Potential Solutions. Annu Rev Public Health 2020; 41:265-287. [DOI: 10.1146/annurev-publhealth-040119-094201] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
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.
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Affiliation(s)
- Neville Owen
- Centre for Urban Transitions, Swinburne University of Technology, Hawthorn, Victoria 3122, Australia;,
- Behavioural Epidemiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria 3004, Australia
| | - Genevieve N. Healy
- School of Public Health, University of Queensland, Herston, Queensland 4006, Australia;, , ,
| | - Paddy C. Dempsey
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
- Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria 3004, Australia;,
| | - Jo Salmon
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria 3125, Australia;, , ,
| | - Anna Timperio
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria 3125, Australia;, , ,
| | - Bronwyn K. Clark
- School of Public Health, University of Queensland, Herston, Queensland 4006, Australia;, , ,
| | - Ana D. Goode
- School of Public Health, University of Queensland, Herston, Queensland 4006, Australia;, , ,
| | - Harriet Koorts
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria 3125, Australia;, , ,
| | - Nicola D. Ridgers
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria 3125, Australia;, , ,
| | - Nyssa T. Hadgraft
- Centre for Urban Transitions, Swinburne University of Technology, Hawthorn, Victoria 3122, Australia;,
| | - Gavin Lambert
- Iverson Health Innovation Institute, Swinburne University of Technology, Hawthorn, Victoria 3122, Australia
- Human Neurotransmitters Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria 3004, Australia
| | - Elizabeth G. Eakin
- School of Public Health, University of Queensland, Herston, Queensland 4006, Australia;, , ,
| | - Bronwyn A. Kingwell
- CSL Limited, Bio21 Institute, Melbourne, Victoria 3010, Australia
- Metabolic and Vascular Physiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria 3004, Australia
| | - David W. Dunstan
- Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria 3004, Australia;,
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria 3000, Australia
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12
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Controversies in the Science of Sedentary Behaviour and Health: Insights, Perspectives and Future directions from the 2018 Queensland Sedentary Behaviour Think Tank. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16234762. [PMID: 31783708 PMCID: PMC6926563 DOI: 10.3390/ijerph16234762] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 11/20/2019] [Accepted: 11/20/2019] [Indexed: 12/22/2022]
Abstract
The development in research concerning sedentary behaviour has been rapid over the past two decades. This has led to the development of evidence and views that have become more advanced, diverse and, possibly, contentious. These include the effects of standing, the breaking up of prolonged sitting and the role of moderate-to-vigorous physical activity (MVPA) in the association between sedentary behaviour and health outcomes. The present aim is to report the views of experts (n = 21) brought together (one-day face-to-face meeting in 2018) to consider these issues and provide conclusions and recommendations for future work. Each topic was reviewed and presented by one expert followed by full group discussion, which was recorded, transcribed and analysed. The experts concluded that (a). standing may bring benefits that accrue from postural shifts. Prolonged (mainly static) standing and prolonged sitting are both bad for health; (b). ‘the best posture is the next posture’. Regularly breaking up of sitting with postural shifts and movement is vital; (c). health effects of prolonged sitting are evident even after controlling for MVPA, but high levels of MVPA can attenuate the deleterious effects of prolonged sitting depending on the health outcome of interest. Expert discussion addressed measurement, messaging and future directions.
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13
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Moura BP, Rufino RL, Faria RC, Sasaki JE, Amorim PRS. Can Replacing Sitting Time with Standing Time Improve Adolescents' Cardiometabolic Health? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16173115. [PMID: 31461890 PMCID: PMC6747710 DOI: 10.3390/ijerph16173115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 08/12/2019] [Accepted: 08/23/2019] [Indexed: 11/16/2022]
Abstract
This study aimed to assess the effects of isotemporal replacement of sitting time (SIT) with standing (STA) on cardiometabolic biomarkers. In this cross-sectional study, male adolescents wore the GT3X+ activity monitor for 7 days to measure the SIT and STA. Moderate-to-vigorous physical activity (MVPA) was estimated by a youth-specific cut-off point. An isotemporal substitution approach was used to examine the effects of replacing different periods of SIT (15, 30, 60, and 120 min) with STA on cardiometabolic biomarkers [total cholesterol (TC), high-density lipoprotein cholesterol (HDL-c), non-HDL-c, low-density lipoprotein cholesterol (LDL-c), triglycerides (TG), glucose, insulin, HOMA2-β, HOMA2-S, and HOMA2-IR]. Analysis of covariance (ANCOVA) with a post-hoc Bonferroni test was used to compare the adjusted means between the four subgroups that were clustered according to SIT and STA amount. Adolescents (n = 84; age, 16.7 ± 0.9 years) wore GT3X+ for 15.2 ± 2.3 h, for 6.7 ± 0.6 days. Isotemporal substitution of SIT with STA was associated with TC, non-HDL-c, LDL-c, and TG. ANCOVA results showed a statistically significant difference for TC, non-HDL-c, and LDL-c. These findings showed that for male adolescents, sitting less and standing more may be an effective alternative to reduce cardiometabolic biomarker levels related to lipid metabolism, regardless of MVPA.
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Affiliation(s)
- Bruno P Moura
- Medical Science Graduate Program, Medical Sciences Faculty, Rio de Janeiro State University, Rio de Janeiro 20550-170, Rio de Janeiro, Brazil
| | - Rogério L Rufino
- Medical Science Graduate Program, Medical Sciences Faculty, Rio de Janeiro State University, Rio de Janeiro 20550-170, Rio de Janeiro, Brazil
| | - Ricardo C Faria
- Department of Physical Education, Viçosa Federal University, Viçosa 36570-900, Minas Gerais, Brazil
| | - Jeffer E Sasaki
- Graduate Program in Physical Education, Federal University of Triângulo Mineiro, Uberaba 38025-180, Minas Gerais, Brazil
| | - Paulo Roberto S Amorim
- Department of Physical Education, Viçosa Federal University, Viçosa 36570-900, Minas Gerais, Brazil.
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14
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Arouca AB, Santaliestra-Pasías AM, Moreno LA, Marcos A, Widhalm K, Molnár D, Manios Y, Gottrand F, Kafatos A, Kersting M, Sjöström M, Sáinz ÁG, Ferrari M, Huybrechts I, González-Gross M, Forsner M, De Henauw S, Michels N. Diet as a moderator in the association of sedentary behaviors with inflammatory biomarkers among adolescents in the HELENA study. Eur J Nutr 2019; 58:2051-2065. [PMID: 29974229 DOI: 10.1007/s00394-018-1764-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 06/26/2018] [Indexed: 12/20/2022]
Abstract
AIM To assess if a healthy diet might attenuate the positive sedentary-inflammation relation, whereas an unhealthy diet may increase the effect of sedentary behaviors on inflammatory biomarkers. METHODS In 618 adolescents (13-17 years) of the European HELENA study, data were available on body composition, a set of inflammation markers, and food intake assessed by a self-administered computerized 24 h dietary recall for 2 days. A 9-point Mediterranean diet score and an antioxidant-rich diet z-score were used as dietary indices and tested as moderators. A set of low-grade inflammatory characteristics was used as outcome: several cytokines in an inflammatory ratio (IL-6, IL-10, TNF-α, TGFβ-1), C-reactive protein, three cell-adhesion molecules (sVCAM-1, sICAM-1, sE-selectin), three cardiovascular risk markers (GGT, ALT, homocysteine) and three immune cell types (white blood cells, lymphocytes, CD3). Sedentary behaviors were self-reported and analyzed as total screen time. Multiple linear regression analyses tested moderation by diet in the sedentary behaviors-inflammation association adjusted for age, sex, country, adiposity (sum of six skinfolds), parental education, and socio-economic status. RESULTS Both diet scores, Mediterranean and antioxidant-rich diet, were significant protective moderators in the effect of sedentary behaviors on alanine-transaminase enzyme (P = 0.014; P = 0.027), and on the pro/anti-inflammatory cytokine ratio (P = 0.001; P = 0.004), but not on other inflammatory parameters. CONCLUSION A higher adherence to the Mediterranean diet or an antioxidant-rich diet may attenuate the onset of oxidative stress signs associated by sedentary behaviors, whereas a poor diet seems to increase inflammation.
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Affiliation(s)
- Aline B Arouca
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, Block K3-4th floor, 9000, Ghent, Belgium.
| | - Alba M Santaliestra-Pasías
- GENUD: "Growth, Exercise, Nutrition and Development" Research Group, Facultad de Ciencias de la Salud, University of Zaragoza, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
| | - Luis A Moreno
- GENUD: "Growth, Exercise, Nutrition and Development" Research Group, Facultad de Ciencias de la Salud, University of Zaragoza, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Madrid, Spain
| | - Ascensión Marcos
- Department of Metabolism and Nutrition, Institute of Food Science and Technology and Nutrition, Madrid, Spain
| | - Kurt Widhalm
- Department of Pediatrics, Div. Nutrition and Metabolism, Medical University of Vienna, Vienna, Austria
| | - Dénes Molnár
- Department of Pediatrics, Medical Faculty, University of Pécs, Pécs, Hungary
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | | | | | - Mathilde Kersting
- Research Department of Child Nutrition, Pediatric University Clinic, Ruhr-University Bochum, Bochum, Germany
| | - Michael Sjöström
- Department of Biosciences, Unit for Preventive Nutrition, Karolinska Institutet, Huddinge, Sweden
| | | | - Marika Ferrari
- Council for Agricultural Research and Economics, Research Center for Food and Nutrition, Rome, Italy
| | - Inge Huybrechts
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, Block K3-4th floor, 9000, Ghent, Belgium
- International Agency for Research on Cancer, Lyon, France
| | - Marcela González-Gross
- ImFINE Research Group. Department of Health and Human Performance, Facultad de Ciencias de la Actividad Física y del Deporte-INEF, Universidad Politécnica de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Madrid, Spain
| | - Maria Forsner
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Stefaan De Henauw
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, Block K3-4th floor, 9000, Ghent, Belgium
| | - Nathalie Michels
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, Block K3-4th floor, 9000, Ghent, Belgium
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Associations of Physical Behaviours and Behavioural Reallocations with Markers of Metabolic Health: A Compositional Data Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15102280. [PMID: 30336601 PMCID: PMC6210541 DOI: 10.3390/ijerph15102280] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/28/2018] [Accepted: 10/05/2018] [Indexed: 12/31/2022]
Abstract
Standard statistical modelling has shown that the reallocation of sitting time to either standing or stepping may be beneficial for metabolic health. However, this overlooks the inherent dependency of time spent in all behaviours. The aim is to examine the associations between physical behaviours and markers of metabolic health (fasting glucose, fasting insulin, 2-h glucose, 2-h insulin, Homeostasis Model Assessment of Insulin Sensitivity (HOMA-IS), Matsuda Insulin Sensitivity Index (Matsuda-ISI) while quantifying the associations of reallocating time from one physical behaviour to another using compositional analysis. Objectively measured physical behaviour data were analysed (n = 435) using compositional analysis and compositional isotemporal substitutions to estimate the association of reallocating time from one behaviour to another in a population at high risk of type 2 diabetes mellitus (T2DM). Stepping time was associated with all markers of metabolic health relative to all other behaviours. Reallocating 30 min from sleep, sitting, or standing to stepping was associated with 5⁻6 fold lower 2-h glucose, 15⁻17 fold lower 2-h insulin, and higher insulin sensitivity (10⁻11 fold via HOMA-IS, 12⁻15 fold via Matsuda-ISI). Associations of reallocating time from any behaviour to stepping were maintained for 2-h glucose, 2-h insulin, and Matsuda-ISI after further adjusting for body mass index (BMI). Relocating time from stepping into sleep, sitting, or standing was associated with lower insulin sensitivity. Stepping time may be the most important behavioural composition when promoting improved metabolic health in adults at risk of T2DM.
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Edwardson CL, Biddle SJH, Clarke-Cornwell A, Clemes S, Davies MJ, Dunstan DW, Eborall H, Granat MH, Gray LJ, Healy GN, Richardson G, Yates T, Munir F. A three arm cluster randomised controlled trial to test the effectiveness and cost-effectiveness of the SMART Work & Life intervention for reducing daily sitting time in office workers: study protocol. BMC Public Health 2018; 18:1120. [PMID: 30217233 PMCID: PMC6137871 DOI: 10.1186/s12889-018-6017-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 09/04/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Office-based workers typically spend 70-85% of working hours, and a large proportion of leisure time, sitting. High levels of sitting have been linked to poor health. There is a need for fully powered randomised controlled trials (RCTs) with long-term follow-up to test the effectiveness of interventions to reduce sitting. This paper describes the methodology of a three-arm cluster RCT designed to determine the effectiveness and cost-effectiveness of the SMART Work & Life intervention, delivered with and without a height-adjustable desk, for reducing daily sitting. METHODS/DESIGN A three-arm cluster RCT of 33 clusters (660 council workers) will be conducted in three areas in England (Leicester; Manchester; Liverpool). Office groups (clusters) will be randomised to the SMART Work & Life intervention delivered with (group 1) or without (group 2) a height-adjustable desk or a control group (group 3). SMART Work & Life includes organisational (e.g., management buy-in, provision/support for standing meetings), environmental (e.g., relocating waste bins, printers), and group/individual (education, action planning, goal setting, addressing barriers, coaching, self-monitoring, social support) level behaviour change strategies, with strategies driven by workplace champions. Baseline, 3, 12 and 24 month measures will be taken. PRIMARY OUTCOME Objectively measured daily sitting time (activPAL3). SECONDARY OUTCOMES objectively measured sitting, standing, stepping, prolonged sitting and moderate-to-vigorous physical activity time and number of steps at work and daily; objectively measured sleep (wrist accelerometry). Adiposity, blood pressure, fasting glucose, glycated haemoglobin, cholesterol (total, HDL, LDL) and triglycerides will be assessed from capillary blood samples. Questionnaires will examine dietary intake, fatigue, musculoskeletal issues, job performance and satisfaction, work engagement, occupational and general fatigue, stress, presenteeism, anxiety and depression and sickness absence (organisational records). Quality of life and resources used (e.g. GP visits, outpatient attendances) will also be assessed. We will conduct a full process evaluation and cost-effectiveness analysis. DISCUSSION The results of this RCT will 1) help to understand how effective an important simple, yet relatively expensive environmental change is for reducing sitting, 2) provide evidence on changing behaviour across all waking hours, and 3) provide evidence for policy guidelines around population and workplace health and well-being. TRIAL REGISTRATION ISRCTN11618007 . Registered on 21 January 2018.
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Affiliation(s)
- Charlotte L. Edwardson
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Stuart J. H. Biddle
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, QLD Australia
| | | | - Stacy Clemes
- NIHR Leicester Biomedical Research Centre, Leicester, UK
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, UK
| | - Melanie J. Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester, UK
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK
| | - David W. Dunstan
- Baker Heart and Diabetes Institute, Melbourne, VIC Australia
- School of Public Health, The University of Queensland, Brisbane, QLD Australia
- Department of Medicine, Monash University, Melbourne, VIC Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC Australia
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC Australia
- School of Sport Science, Exercise and Health, The University of Western Australia, Perth, WA Australia
- Mary MacKillop Institute for Health Research, The Australian Catholic University, Melbourne, VIC Australia
| | - Helen Eborall
- Department of Health Sciences, University of Leicester, Leicester, UK
| | | | - Laura J. Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Genevieve N. Healy
- Baker Heart and Diabetes Institute, Melbourne, VIC Australia
- School of Public Health, The University of Queensland, Brisbane, QLD Australia
- Faculty of Health Sciences, School of Physiotherapy, Curtin University, Perth, WA Australia
| | | | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Fehmidah Munir
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, UK
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