CE: Too Much Sitting: A Newly Recognized Health Risk

Eijnde B, Seghers J, Winkens B, Savelberg HHCM. The Association between Academic Schedule and Physical Activity Behaviors in University Students

BACKGROUND

University students sit too much, which is detrimental to their physical and mental health. Academic schedules, including scheduled education time and self-study time, may influence their physical activity behaviors.

OBJECTIVES

To investigate (1) the association between scheduled education time and students' physical activity levels during weekdays; (2) the association between self-study time and students' physical activity levels during the weekdays and weekends.

METHODS

126 (68 Maastricht University (UM); 58 KU Leuven (KUL)) first-year undergraduate students in biomedical sciences (mean ± SD age: 19.3 ± 1.0, BMI: 22.0 ± 3.0, 17% men, 83% women) completed a demographics questionnaire and reported their academic activities with a 7-day logbook. Furthermore, their physical activity behavior was measured with the activPAL monitor for 7 days. Linear mixed models were used to examine the associations between university (UM versus KUL), academic activities (scheduled education time and self-study time), and students' activity levels.

RESULTS

During weekdays, each hour of scheduled education time per day was significantly associated with a 1.3 min decrease of moderate to vigorous physical activity (MVPA) per day. Scheduled education time was not significantly associated with the sedentary time, light-intensity physical activity (LPA), and active sedentary behavior ratio. Each hour of self-study per day was significantly associated with 8 min more of sedentary time per day, 6 min less LPA per day, and 1.3 min less MVPA per day. Self-study time was not significantly associated with active sedentary behavior ratio. During the weekend, each hour of self-study time per day was associated with an additional 17.8 min of sedentary time per day and a reduction of 15.2 min of LPA per day. Self-study time was not significantly associated with the time spent doing MVPA and active sedentary behavior ratio.

CONCLUSIONS

It could be more effective to change students' physical activity behaviors during self-study than during scheduled education time. Therefore, offering a study environment that reduces sedentary behavior and promotes light-intensity physical activity, is crucial.

Eat, sleep, play: health behaviors and their association with psychological health among cancer survivors in a nationally representative sample

BACKGROUND

Cancer survivors are able to live much longer today than in the past due to advances in treatment. The promotion of health behaviors is important to address among cancer survivors. Not only can health behaviors reduce the risk of comorbidities, but they may also be key to improving psychological health among cancer survivors, such as psychological distress, perceptions of one's general health, and distress of cancer mortality (i.e., cancer fatalism). Our overall goal is to 1) determine which individual health behaviors (e.g., fruit consumption, physical activity, and sleep) are associated with psychological health among cancer survivors and 2) determine if the number of health behaviors engaged in is associated with better psychological health among cancer survivors.

METHODS

Using data from the HINTS 5 Cycle III survey (N = 856 cancer survivors), we compared whether participants who met guidelines for seven health behaviors (e.g., fruit and vegetable consumption, moderate physical activity, sleep duration) had improved psychological health. Multiple ordinal regression models controlling for sociodemographic variables were used to determine if meeting more recommendations was related to psychological health and then specifically which behaviors were of greatest importance to psychological health.

RESULTS

Meeting guidelines for sleep quality and moderate physical activity was associated with higher general health and meeting guidelines for vegetable intake and better sleep quality was associated with less psychological distress. Although the associations were not significant, cancer survivors who met more of the health behavior guidelines reported higher general health, lower psychological distress, and less distress about what could be done to lower one's chances to get cancer.

CONCLUSIONS

Meeting the guidelines for individual and multiple health behaviors is associated with favorable psychological health among cancer survivors. The findings can contribute to the development of health behavior interventions that focus on multiple health behaviors to improve psychological health and quality of life among cancer survivors.

Physical exercise training in the syllabus of Bachelor of Science in nursing degrees: An environmental scan

Background: Scientific evidence regarding the effectiveness of physical activity (PA) in the prevention and treatment of chronic diseases is increasing. Healthcare systems are trying to increase exercise prescription treatments. However, it is not clear if health professionals are sufficiently trained. Aim: to analyze the contents related to PA and exercise in the prevention and treatment of chronic diseases in the syllabus of the Bachelor of Science in Nursing at all Spanish universities. Methods: A systematic environmental scan that included a web page search of curricular guide programs of all Spanish universities offering the Bachelor of Science in Nursing was undertaken for the 2017-18 academic course. The assessment of the European Credit Transfer System (ECTS) about physical activity and/or exercise health-related benefits in the prevention or treatment of chronic diseases was performed by two experts in a peer-review process. ECTS of Practicum and Bachelor thesis were not included in the analysis. Results: In the mean, the Bachelor of Science in Nursing dedicated 5.82% (5.01% mandatory and 0.82% voluntary) of a total of 240 ECTS (ranging from 0 to 45 ECTS). The majority of contents were related to PA promotion; in contrast, contents related to exercise prescription are neglectable. Five Spanish universities do not offer any academic teaching to physical activity on prescription. Conclusions: A great disparity between universities was identified. In general, acquired knowledge seems scarce for PA promotion and exercise prescription in primary healthcare staff. Nurses would need additional physical activity on prescription training to improve PA promotion and exercise prescription knowledge as a coadjutant non-pharmacological treatment for non-communicable chronic diseases at Primary Healthcare settings.

A cluster analysis of physical activity profiles and resilience in intensive care nurses

Purpose

Limited evidence exists regarding a group of nurses' physical activity patterns and association with resilience. Less is known about the physical activity health paradox in nurses (the positive health effects of leisure time physical activity vs the negative health effects of occupational physical activity). This study aimed to explore the profiles of intensive care nurses' physical activity behaviours and associations with resilience, following a developed study-specific job demands–recovery framework.

Design/methodology/approach

A cross-sectional study was conducted with intensive care unit (ICU) nurses to explore their physical activity profiles and associations with resilience. The Connor-Davidson Resilience Scale 25 (CD-RISC 25) was used to assess resilience, and accelerometry was utilised to record participants' four-day activity (two workdays, two non-workdays). Hierarchical cluster analysis was employed to define groups of nurses by activity behaviours.

Findings

Participants (N = 93) were classified as low actives (n = 19), standers (n = 36), sitters (n = 31) and movers (n = 7). During two 12-h shifts, movers had the highest mean level of dynamic standing and the lowest mean level of sitting. During two non-workdays, movers had the highest mean level of walking as well as the lowest mean level of sitting and sleep time.

Originality/value

The uniqueness of this study was that it analysed ICU nurses' physical activity profiles and associations with resilience using identified clusters. However, the small number of participants limited this study's ability to determine significant relationships between resilience and the grouped physical activity profiles.

Economic Evaluation of a Reablement Training Program for Homecare Staff Targeting Sedentary Behavior in Community-Dwelling Older Adults Compared to Usual Care: A Cluster Randomized Controlled Trial

Purpose

Training and supporting homecare staff in reablement aims to change staff behavior from “doing for” to “doing with” older adults and is assumed to benefit the health and quality of life of older adults and reduce healthcare utilization and costs. This study evaluated the cost-effectiveness and cost-utility of the staff reablement training program “Stay Active at Home” (SAaH) from a societal perspective.

Participants and Methods

An economic evaluation was embedded in a 12-month cluster randomized controlled trial. Ten Dutch homecare nursing teams participated (n = 313 staff members), of which five teams were trained in reablement and the other five provided usual care. Cost and effect data were collected from 264 older adults at baseline, 6 and 12 months. Costs included “intervention,” “healthcare,” and “patient and family” costs (collectively, societal costs) and were assessed using questionnaires and client records or estimated by bottom-up micro-costing. Effects included sedentary behavior and quality-adjusted life years (QALYs). Multiple imputed bootstrapped data were used to generate cost-effectiveness planes and acceptability curves.

Results

No statistically significant differences were observed between the intervention and control group in terms of sedentary time (adjusted mean difference: \documentclass[12pt]{minimal} \usepackage{wasysym} \usepackage[substack]{amsmath} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage[mathscr]{eucal} \usepackage{mathrsfs} \DeclareFontFamily{T1}{linotext}{} \DeclareFontShape{T1}{linotext}{m}{n} {linotext }{} \DeclareSymbolFont{linotext}{T1}{linotext}{m}{n} \DeclareSymbolFontAlphabet{\mathLINOTEXT}{linotext} \begin{document} $$\beta $$ \end{document} 4.8 minutes [95% CI –26.4, 36.0]), QALYs (\documentclass[12pt]{minimal} \usepackage{wasysym} \usepackage[substack]{amsmath} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage[mathscr]{eucal} \usepackage{mathrsfs} \DeclareFontFamily{T1}{linotext}{} \DeclareFontShape{T1}{linotext}{m}{n} {linotext }{} \DeclareSymbolFont{linotext}{T1}{linotext}{m}{n} \DeclareSymbolFontAlphabet{\mathLINOTEXT}{linotext} \begin{document} $$\beta $$ \end{document} 0.01 [95% CI –0.03, 0.04]), and societal costs (\documentclass[12pt]{minimal} \usepackage{wasysym} \usepackage[substack]{amsmath} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage[mathscr]{eucal} \usepackage{mathrsfs} \DeclareFontFamily{T1}{linotext}{} \DeclareFontShape{T1}{linotext}{m}{n} {linotext }{} \DeclareSymbolFont{linotext}{T1}{linotext}{m}{n} \DeclareSymbolFontAlphabet{\mathLINOTEXT}{linotext} \begin{document} $$\beta $$ \end{document} €2216 [95% CI –459, 4895]), except lower costs for domestic help in the intervention group (\documentclass[12pt]{minimal} \usepackage{wasysym} \usepackage[substack]{amsmath} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage[mathscr]{eucal} \usepackage{mathrsfs} \DeclareFontFamily{T1}{linotext}{} \DeclareFontShape{T1}{linotext}{m}{n} {linotext }{} \DeclareSymbolFont{linotext}{T1}{linotext}{m}{n} \DeclareSymbolFontAlphabet{\mathLINOTEXT}{linotext} \begin{document} $$\beta $$ \end{document} €–173 [95% CI –299, –50]). The probability that SAaH was cost-effective compared to usual care ranged from 7.1% to 19.9%, depending on the willingness-to-pay (WTP) (€0‒€50,000)/minute of sedentary time averted and was 5.9% at a WTP of €20,000/QALY gained.

Conclusion

SAaH did not improve outcomes or reduce costs and was not cost-effective from a societal perspective compared to usual care in Dutch older adults receiving homecare. Consequently, there is insufficient evidence to justify widespread implementation of the training program in its current form.

Trial Registration

ClinicalTrials.gov: NCT03293303.

Too Much Sitting: A Serious 21st Century Health Risk

While weekly moderate-to-vigorous physical activity (MVPA) is considered a well-established key determinant for regulating weight and reducing risks of obesity and associated noncommunicable diseases, MVPA alone may not be enough to offset excessive sitting time. This integrative literature review aims to advance the discussion about sedentary behavior as a significant independent health risk for obesity and associated noncommunicable diseases, to increase awareness, to synthesize important evidence on sedentary behavior and a number of negative health outcomes, and to present the application of a whole-day approach to physical activity as a feasible strategy to promote health.

Objectively measured sedentary behaviour in overweight and obese prepubertal children: challenging the school

Sedentary lifestyle is associated with unfavourable health outcomes; however, few studies have analysed the daily fluctuations of sedentary behaviour in children. The aim was to characterise sedentary behaviour in low active, overweight/obese prepubertal children and to examine whether there were daily, age- or gender-based differences. In this observational study free-living movement was measured by accelerometry for one week. Eighty-eight low active, overweight/obese children (8- to 12-year-olds) were included. Analysis was conducted for weekends, weekdays, school time and non-school time on weekdays. Participants spent half of their waking hours engaged in sedentary behaviour (48.1%). Short sedentary bouts (1-4 min) accounted for 86% of sedentary time. Sedentary time was similar on weekends and non-school time, while it was highest during school time. Interventions for the management of childhood obesity should include strategies for shifting sedentary time to physical activity on weekends and non-school time and implementing more activity-permissive classroom lessons.

Can Replacing Sitting Time with Standing Time Improve Adolescents' Cardiometabolic Health?

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.