TAxonomy of Self-reported Sedentary behaviour Tools (TASST) framework for development, comparison and evaluation of self-report tools: content analysis and systematic review

Reliability and Validity of Self-Reported Questionnaires Assessing Physical Activity and Sedentary Behavior in Finland

Reliable and valid data on physical activity (PA) and sedentary behavior (SB) are needed for implementing evidence-based interventions and policies. Monitoring of these behaviors is based on PA questionnaires (PAQs) and device-based measurements, but their comparability is challenging. The present study aimed to investigate the test-retest reliability and concurrent validity of Finnish versions of the widely used PAQs (IPAQ-SF, EHIS-PAQ, GPAQ, Eurobarometer) and to compare their data with accelerometer data. This study is based on the Finnish data of the European Union Physical Activity and Sport Monitoring project (EUPASMOS). Participants (n = 62 adults, 62% women) answered the PAQs twice, one week apart, and wore an accelerometer for these seven consecutive days. Intraclass correlations, Spearman's rank correlations, t-tests, and Cohen's kappa with bootstrap confidence intervals were used to analyze the data. The PAQs had typically moderate-to-good test-retest reliability (ICC 0.22-0.78), GPAQ, EHIS-PAQ, and Eurobarometer showing the highest reliability. The PAQs correlated with each other when assessing sitting and vigorous PA (R = 0.70-0.97) and had a fair-to-substantial agreement when analyzing adherence to the PA recommendations (74-97%, Cohen's kappa 0.25-0.73). All the PAQs had a poor criterion validity against the accelerometry data. The Finnish versions of the PAQs are moderately reliable and valid for assessing PA, adherence to PA recommendations and sitting among adult participants. However, the poor criterion validity against accelerometer data indicates that PAQs assess different aspects of PA constructs compared to accelerometry.

Sedentary time at school and work in Canada

OBJECTIVES

High levels of sedentary time (ST) are associated with poor physical and mental health. Given that Canadians spend a large portion of their days at school and work, they may be important targets for reducing ST. Our objectives are to estimate the daily amount of school and work ST among Canadians, examine differences by subgroups, and determine associations with health.

METHODS

Using the 2020 Canadian Community Health Survey Healthy Living Rapid Response module (N = 5242), the amount of time spent sitting while at school and work was estimated among youth (12-17 years) and adults (18-34 and 35-64 years). Differences by sociodemographics and 24-Hour Movement Guideline adherence were assessed with independent t-tests. Associations between school and work ST and health indicators were assessed using adjusted logistic regression.

RESULTS

Canadian youth aged 12-17 years and adults aged 18-34 years reported an average of 4.5 and 5.2 h/day of school ST, respectively. Adults 18-34 years and 35-64 years reported an average of 3.9 and 4.0 h/day of work ST, respectively. School and work ST differed within several subgroups. Among adults 18-34 years, higher school ST was associated with a reduced odds of 'excellent/very good' mental health, whereas higher work ST was associated with a greater likelihood of reporting 'excellent/very good' general health.

CONCLUSION

Canadian youth and working-age adults report an average of 4-5 h/day sedentary at school or work. This is the first study estimating school and work ST in a representative sample of Canadians and will aid in increasing awareness of setting-specific behaviours to better inform targeted interventions including addressing inequalities in ST.

A Review of Sedentary Behavior Assessment in National Surveillance Systems

BACKGROUND

Temporal changes in sedentary behavior patterns reflect the evolving nature of our built and social environments, particularly the expanding availability of electronic media. It is important to understand what types of sedentary behavior are assessed in national surveillance to determine whether, and to what extent, they reflect contemporary patterns. The aims of this review were to describe the characteristics of questionnaires used for national surveillance of sedentary behavior and to identify the types of sedentary behaviors being measured.

METHOD

We reviewed questionnaires from national surveillance systems listed on the Global Observatory for Physical Activity (GoPA!) country cards to locate items on sedentary behavior. Questionnaire characteristics were categorized using the Taxonomy of Self-reported Sedentary Behavior Tools (TASST). The purpose and type of sedentary behaviors captured were classified using the Sedentary Behavior International Taxonomy (SIT).

RESULTS

Overall, 346 surveillance systems were screened for eligibility, of which 93 were included in this review. Most questionnaires used a single-item direct measure of sitting time (n = 78, 84%). Work and domestic were the most frequently captured purposes of sedentary behavior, while television viewing and computer use were the most frequently captured types of behaviors.

CONCLUSION

National surveillance systems should be periodically reviewed in response to evidence on contemporary behavior patterns in the population and the release of updated public health guidelines.

The Association of Contemporary Screen Behaviours with Physical Activity, Sedentary Behaviour and Sleep in Adolescents: a Cross-sectional Analysis of the Millennium Cohort Study

BACKGROUND

Screen behaviours are highly prevalent in adolescents and may be adversely associated with physical and mental health. Understanding how screen behaviours inter-relate with physical activity and sleep may help to clarify pathways through which they impact health and potential routes to behaviour change. This cross-sectional study examines the association of contemporary screen behaviours with physical activity, sedentary behaviour and sleep in adolescents.

METHOD

Data are from sweep 6 (2015/2016) of the Millennium Cohort Study, conducted when participants were aged 14 years. Outcome variables were accelerometer-assessed overall physical activity and moderate-to-vigorous physical activity (MVPA), self-reported sedentary behaviour and sleep duration. Screen behaviours were assessed using a 24-h time-use diary. Multivariable regression was used to examine the association between screen behaviours and each outcome variable separately for weekdays and weekend days.

RESULTS

The use of social network sites was associated with (beta coefficient, 95% confidence interval (CI); minutes/day) less time in MVPA (weekdays: - 5.2 (- 10.3, - 0.04); weekend: - 10.0 (- 15.5, - 4.5)), and sedentary behaviours (weekdays: - 19.8 (- 31.0, - 8.6); weekend: - 17.5 (- 30.9, - 4.1)). All screen behaviours were associated with shorter sleep duration on weekdays, whereas only the use of email/texts and social network sites was associated with shorter sleep duration on weekend days. The association of using social network sites with overall physical activity was stronger in girls than in boys; the association of internet browsing with sedentary behaviour was stronger in boys than in girls.

CONCLUSION

Intervention strategies to enhance MVPA and sleep duration by limiting screen-based activities may be warranted.

Questionnaires Measuring 24-Hour Movement Behaviors in Childhood and Adolescence: Content Description and Measurement Properties-A Systematic Review

BACKGROUND

We aim to systematically review the literature on measurement properties of self- and proxy-reported questionnaires measuring 24-hour movement behaviors in children and adolescents.

METHODS

PubMed, PsycINFO, SPORTDiscus, and EMBASE were searched until June 2021. Studies were included if the sample size for validity studies had 50 participants (minimum) and included, at least, both validity and test-retest reliability results of questionnaires. The review followed an adaptation of the Consensus-based Standards for the selection of health Measurement INstruments guidelines, to evaluate the quality of measurements properties of the questionnaires (content, convergent and criterion validity, reliability, measurement error, and responsiveness), as well as the risk of bias of each measurement property.

RESULTS

This review included 29 studies, describing 37 questionnaires. Sixty-eight percent showed "adequate" content validity. None of the questionnaires showed overall "adequate" criterion validity, and the risk of bias was "very low" for 92%. One questionnaire showed "adequate" convergent validity, and 73% of the studies were classified with a "high risk of bias." Seven questionnaires showed "adequate" reliability, and 27.3% of the studies were rated with a "very low risk of bias." None of the questionnaires showed "adequate" criterion validity and reliability, simultaneously.

CONCLUSIONS

Existing questionnaires have insufficient measurement properties, and none considered the 24-hour movement behavior paradigm. These results highlight the need for better questionnaires of movement behavior combinations, to improve the monitoring and surveillance systems of 24-hour movement behaviors in this population.

Profiles of sedentary behaviors in the oldest old: findings from the National Health and Aging Trends Study

BACKGROUND

Sedentary behavior is a significant health risk. Emerging research suggests that mentally active sedentary behaviors (e.g., computer use and reading) are associated with better health than mentally passive sedentary behaviors (e.g., watching TV). However, these relationships are not well established in the literature, and little is known about the oldest old (age ≥ 80).

AIMS

The aims of this study were to (1) identify distinct subgroups of oldest old adults based on six domains of sedentary behavior (watching TV, using a computer/tablet, talking to friends or family members, doing hobby or other activities, transportation, and resting/napping); and (2) compare health-related outcomes across identified subgroups, using the National Health and Aging Trends Study (NHATS) dataset.

METHODS

Latent profile analysis was used to identify distinct profiles of sedentary behavior. Design-based linear and logistic regressions were used to examine associations between different profiles and health outcomes, accounting for socio-demographic characteristics.

RESULTS

A total of 852 participants were included. We identified four profiles and named them based on total sedentary time (ST) and passive/active pattern: "Medium-passive", "High-passive", "Low", "High-mentally active". Compared to the "High-passive" group, "Low" group and "High-mentally active" group were associated with fewer difficulties with activities of daily living, fewer problems limiting activities and higher cognitive function.

CONCLUSION

This study, with a national representative sample of the oldest old population, suggests that both total ST and sedentary behavior pattern matter when evaluating health outcomes of being sedentary. Interventions should encourage oldest old adults to reduce ST and especially target mentally passive ST.

Questionnaires measuring movement behaviours in adults and older adults: Content description and measurement properties. A systematic review

Background

Sleep, sedentary behaviour and physical activity are constituent parts of a 24h period and there are several questionnaires to measure these movement behaviours, the objective was to systematically review the literature on content and measurement properties of self- and proxy-reported questionnaires measuring movement behaviours in adults and older adults.

Methods

The databases PubMed, CINAHL, PsycINFO and SPORTDiscus were systematically searched until April 2021. Articles were included if: the questionnaires were design for adults and older adults; the sample size for validity studies had at least 50 participants; at least, both validity and test-retest reliability results of questionnaire that were developed specifically to measure the amount of sleep, sedentary behaviour or physical activity, or their combination were reported; and articles had to be written in English, Spanish, French, Portuguese, German, Italian or Chinese.

Findings and conclusions

Data extraction, results, studies’ quality, and risk of bias were evaluated using the Consensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. Fifty-five articles were included in this review, describing 60 questionnaires. None of the questionnaires showed adequate criterion validity and adequate reliability, simultaneously; 68.3% showed adequate content validity. The risk of bias for criterion validity and reliability were very low in 72.2% and 23.6% of the studies, respectively. Existing questionnaires have insufficient measurement properties and frequent methodologic limitations, and none was developed considering the 24h movement behaviour paradigm. The lack of valid and reliable questionnaires assessing 24h movement behaviours in an integrated way, precludes accurate monitoring and surveillance systems of 24h movement behaviours.

Deducing the Impact of Physical Activity, Sedentary Behavior, and Physical Performance on Cognitive Function in Healthy Older Adults

Objectives: Participating in physical activity and maintaining physical performance as well as reducing sedentary behavior are discussed to be beneficially associated with cognitive function in older adults. The purpose of this cross-sectional analysis was to differentiate the relevance of objectively measured physical activity, physical performance, and sedentary behavior on cognitive function in healthy older adults (n = 56, age = 76 ± 7 yrs, gender = 30 female). Methods: Accelerometer based physical activity and sedentary behavior were analyzed as minutes per week spent sedentary and physically active with light or moderate to vigorous intensity. Participants' physical performance was assessed via cardiopulmonary exercise testing and analyzed as maximal workload and heart rate, heart rate reserve and peak oxygen uptake. The assessment of cognitive function included working memory, attention, executive function, and verbal memory. Data was analyzed with Spearman and partial correlations. Trial registration: NCT02343029. Results: Light physical activity was moderately associated with executive function (r = -0.339, p = 0.015). Attention was significantly associated with maximal workload (r = -0.286, p = 0.042) and peak oxygen uptake (r = -0.337, p = 0.015). Working memory was associated with maximal workload (r = 0.329, p = 0.017). Conclusion: Whereas a broad range of cognitive function were beneficially linked to physical performance, light intensity activities in particular showed an impact on executive function. Our research underlines the need to separate the impact of physical performance and physical activity on cognitive function and highlights the relevance of light physical activity.

Exploration of sedentary behaviour among general practitioners: A cross-sectional study

BACKGROUND

Sedentary behaviour, which may have increased among GPs due to increasing use of telemedicine, is associated with many illnesses and increased all-cause mortality.

AIM

To explore levels of sedentary behaviour among GPs and General Practice Specialty Trainees (GPSTs).

DESIGN & SETTING

Sequential, cross-sectional design (initial online sedentary behaviour questionnaire, subsequent thigh-worn accelerometer sub-study) of GPs and GPSTs in Northern Ireland.

METHOD

Self-reported questionnaire data were aggregated and compared with device-measured accelerometry data.

RESULTS

Data from 353 participants (17.7% of GPs and GPSTs in Northern Ireland) revealed doctors in general practice self-reported higher workday sedentary time (10.33 (SD =2.97) hours) than those in secondary care (7.9 (SD =3.43) hours) (MD 2.43 hours; P<0.001). An active workstation (eg, sit-stand desk), was used by 5.6% of participants in general practice, while 86.0% of those without one would consider using one in future. Active workstation users self-reported lower workday sedentary time (7.88 (SD =3.2) hours) than non-users (10.47 (SD =2.88) hours) (MD -2.58 hours, P=0.001). Accelerometer sub-study participants underestimated their workday sedentary time by 0.17 hours (95% CI -1.86, 2.20; P=0.865), and non-workday sedentary time by 2.67 hours (95% CI 0.99, 4.35; P=0.003). Most GPs (80.7%) reported increased workday sitting time compared to prior to the COVID-19 pandemic, while 87.0% would prefer less workday sitting time.

CONCLUSION

GPs have high levels of workday sedentary time, which may be detrimental to their health. It is imperative to develop methods to address sedentary behaviour among GPs on workdays, both for their own health and the health of their patients.

Alternatives for Measuring Sitting Accumulation in Workplace Surveys

OBJECTIVES

To develop and assess the measurement properties of self-report measures of accumulation of sitting time.

METHODS

Seven candidate measures were collected in 51 workers from three office environments (79% women) via online questionnaire administered immediately before and after 7-day monitoring periods (activPAL3 24-hour protocol with diary recorded work hours).

RESULTS

Three measures had some validity (P < 0.05 vs activPAL): % of sitting in long bouts more than or equal to 30 minutes, sitting strategy frequency (0 to 100), and interruption rate (n/h sitting). Agreement was limited. Some reliability (intraclass correlation or kappa P < 0.05) was seen for these measures, strategy variety (0 to 100), typical day (five categories), and making a conscious effort to sit less (yes/no).

CONCLUSIONS

Two brief and one longer option may suit workplace studies requiring self-report measures of sitting accumulation. Validity was weaker for sitting accumulation than sitting time.

Sedentary Lifestyle Matters as Past Sedentariness, Not Current Sedentariness, Predicts Cognitive Inhibition Performance among College Students: An Exploratory Study

Background: Currently, sedentariness is assessed over a short period of time, thus it is difficult to study its cognitive implications. To investigate the cognitive consequences of a sedentary lifestyle, the past level (i.e., the sedentary time accumulated over the years) and current level of sedentariness should be considered. This pilot study aimed to investigate the negative association between a sedentary lifestyle and cognition by considering both the current and past sedentariness. It was expected that the physical activity level moderates the potential negative association between sedentariness and cognition. Methods: 52 college students (M_age = 20.19, SD_age = 2; 36 women) participated in the study. Current sedentariness (ratio of sedentary time in the last year), past sedentariness (ratio of sedentary time accumulated in previous years), and physical activity (ratio of time spent in physical activity in years) were assessed using a questionnaire. Cognitive inhibition, cognitive flexibility, and working memory updating were measured through three specific tests. Results: Past sedentariness significantly explained the inhibition performance when controlled for physical activity, whereas current sedentariness did not. More precisely, past sedentariness only negatively predicted cognitive inhibition when the physical activity level was low (β = -3.15, z(48) = -2.62, p = 0.01). Conclusions: The impact of sedentariness on cognitive functioning might only be revealed when past sedentariness and physical activity are controlled.

Understanding Variations in the Health Consequences of Sedentary Behavior: A Taxonomy of Social Interaction, Novelty, Choice, and Cognition

The study of sedentary behaviors requires taxonomies (classification schemes) to standardize data collection, measurements, and outcomes. Three taxonomies of sedentary behaviors have been identified, but none address an important challenge in sedentary behavior research, which is to distinguish between beneficial and detrimental health effects of various sedentary behaviors. Some sedentary behaviors (e.g., reading) are associated with positive health outcomes, whereas other sedentary behaviors (e.g., television viewing) are associated with adverse health outcomes. To address directly this complexity and present a different conception and understanding of discrepant findings related to health outcomes, a new taxonomy is needed. The development of the new taxonomy is guided by analysis of literature and selection of a relevant and informative behavioral sciences theoretical framework (i.e., self-determination theory). Because older adults are an increasing percentage of the population and report a high prevalence of sedentary behaviors, the new taxonomy was designed for older adults with potential application to all age groups. Taylor's taxonomy of sedentary behaviors is parsimonious with four domains: social interaction (i.e., not solitary, companionship, interacting, and connecting with others); novelty (i.e., refreshingly new, unusual, or different); choice (i.e., volition, preferred option or alternative, the power, freedom, or decision to choose); and cognition (i.e., mentally stimulating and engaging).

Interventions for reducing sedentary behaviour in people with stroke

BACKGROUND

Stroke survivors are often physically inactive as well as sedentary,and may sit for long periods of time each day. This increases cardiometabolic risk and has impacts on physical and other functions. Interventions to reduce or interrupt periods of sedentary time, as well as to increase physical activity after stroke, could reduce the risk of secondary cardiovascular events and mortality during life after stroke.

OBJECTIVES

To determine whether interventions designed to reduce sedentary behaviour after stroke, or interventions with the potential to do so, can reduce the risk of death or secondary vascular events, modify cardiovascular risk, and reduce sedentary behaviour.

SEARCH METHODS

In December 2019, we searched the Cochrane Stroke Trials Register, CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, Conference Proceedings Citation Index, and PEDro. We also searched registers of ongoing trials, screened reference lists, and contacted experts in the field.

SELECTION CRITERIA

Randomised trials comparing interventions to reduce sedentary time with usual care, no intervention, or waiting-list control, attention control, sham intervention or adjunct intervention. We also included interventions intended to fragment or interrupt periods of sedentary behaviour.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected studies and performed 'Risk of bias' assessments. We analyzed data using random-effects meta-analyses and assessed the certainty of the evidence with the GRADE approach.

MAIN RESULTS

We included 10 studies with 753 people with stroke. Five studies used physical activity interventions, four studies used a multicomponent lifestyle intervention, and one study used an intervention to reduce and interrupt sedentary behaviour. In all studies, the risk of bias was high or unclear in two or more domains. Nine studies had high risk of bias in at least one domain. The interventions did not increase or reduce deaths (risk difference (RD) 0.00, 95% confidence interval (CI) -0.02 to 0.03; 10 studies, 753 participants; low-certainty evidence), the incidence of recurrent cardiovascular or cerebrovascular events (RD -0.01, 95% CI -0.04 to 0.01; 10 studies, 753 participants; low-certainty evidence), the incidence of falls (and injuries) (RD 0.00, 95% CI -0.02 to 0.02; 10 studies, 753 participants; low-certainty evidence), or incidence of other adverse events (moderate-certainty evidence). Interventions did not increase or reduce the amount of sedentary behaviour time (mean difference (MD) +0.13 hours/day, 95% CI -0.42 to 0.68; 7 studies, 300 participants; very low-certainty evidence). There were too few data to examine effects on patterns of sedentary behaviour. The effect of interventions on cardiometabolic risk factors allowed very limited meta-analysis.

AUTHORS' CONCLUSIONS

Sedentary behaviour research in stroke seems important, yet the evidence is currently incomplete, and we found no evidence for beneficial effects. Current World Health Organization (WHO) guidelines recommend reducing the amount of sedentary time in people with disabilities, in general. The evidence is currently not strong enough to guide practice on how best to reduce sedentariness specifically in people with stroke. More high-quality randomised trials are needed, particularly involving participants with mobility limitations. Trials should include longer-term interventions specifically targeted at reducing time spent sedentary, risk factor outcomes, objective measures of sedentary behaviour (and physical activity), and long-term follow-up.

Effect of Group Contingency Type on Walking: Comparisons of Effectiveness and Cost Efficiency

Group contingency (GC) is an effective and cost-efficient strategy that can be successfully applied to technology-based interventions. This study examined the relative effectiveness and cost efficiency of three types of technology-based group contingencies on walking among adults. Seventy two students were divided into teams of three. Each team was randomly assigned to one of three GC conditions (independent, interdependent, or dependent) and underwent 66 days of technology-based group contingency intervention. Sixty five participants completed the intervention and 61 completed the follow-up assessment 2 months later. Step counts and self-reported walking activity increased after the intervention under all three conditions. The proportion of participants that met the target step counts was significantly higher under the dependent group contingency condition. However, 2 months later, intervention effects were not maintained under any condition. For cost efficiency, the increase in step count per point was significantly higher under the interdependent group contingency condition. Group cohesion and social validity (point satisfaction and point utility) were significantly higher under the dependent group contingency condition. Finally, the clinical implications and limitations of this study are discussed.

Validity and Reliability of IPAQ-SF and GPAQ for Assessing Sedentary Behaviour in Adults in the European Union: A Systematic Review and Meta-Analysis

Current lifestyles are marked by sedentary behaviour; thus, it is of great importance for policymaking to have valid and reliable tools to measure sedentary behaviour in order to combat it. Therefore, the aim of this review and meta-analysis is to critically review, assess, and compile the reliability, criterion validity, and construct validity of the single-item sedentary behaviour questions within national language versions of most commonly used international physical activity questionnaires for adults in the European Union: The International Physical Activity Questionnaire-Short Form and the Global Physical Activity Questionnaire. A total of 1749 records were screened, 287 full-text papers were read, and 14 studies were included in the meta-analysis. The results and quality of studies were evaluated by the Quality Assessment of Physical Activity Questionnaires checklist. Meta-analysis indicated moderate to high reliability (rw = 0.59) and concurrent validity (rw = 0.55) of national language versions of single-item sedentary behaviour questions. Criterion validity was rather low (rw = 0.23) but in concordance with previous studies. The risk of bias analysis highlighted the poor reporting of methods and results, with a total bias score of 0.42. Thus, we recommend using multi-item SB questionnaires and smart trackers for providing information on SB rather than single-item sedentary behaviour questions in physical activity questionnaires.

The Maugeri daily activity profile: a tool to assess physical activity in patients with chronic obstructive pulmonary disease

Patients with chronic obstructive pulmonary disease (COPD) report reduced physical activity (PA). There are only few tools available to assess PA and sedentary behavior in these patients, and none of them aims to differentiate between sedentary and active patterns. The aim of the study was to evaluate an easy tool to profile daily activity time in a cohort of patients with COPD, compared to healthy subjects; the study was set at the Istituti Clinici Scientifici Maugeri (ICS), IRCCS of Tradate and Lumezzane, Italy, and at the Ente Ospedaliero Cantonale Novaggio, Switzerland (Italian Speaking). The populations were inpatients with COPD, healthy subjects. The items of the Maugeri Daily Activity (MaDA) profile were chosen based on literature, interviews with patients and health professionals. Time spent during sleep (ST), when awake (AT), active (ACT) or in sedentary behavior (SET) were recorded. Lung function tests, arterial blood gases, the modified Medical Research Council (mMRC), the six-minute walking distance test (6MWD), the COPD Assessment Test (CAT), and the body-mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index were also assessed in patients. Sixty patients with COPD and 60 healthy controls filled in the questionnaire. As compared to controls, patients showed longer AT and SET. Active time of patients was significantly correlated with mMRC, CAT, Bode Index and 6MWD, but not with demographics, anthropometrics or stages of disease. Using this tool, we found that patients with COPD spent longer time awake and in sedentary behavior. The MaDA may be useful to evaluate PA in patients with COPD.

Criterion validity of a single-item question for assessment of daily breaks in sedentary time in adults

BACKGROUND

As the implementation of sensor-based assessment for sedentary time (ST) and physical activity (PA) has practical limitations when applied on a large-scale, most studies rely on subjective data. We aimed to examine the criterion validity of a single-item question to assess daily breaks in ST and other PA-related outcomes for the first time using sensor-based data as the criterion.

METHODS

In a sample of 858 adults, breaks in ST and other PA-related parameters were assessed through sensor-based accelerometry and subjective data, which included a comprehensive questionnaire with a specific question ('During the day, do you usually sit for a long time in a row or interrupt frequently?') with a three-level closed answer. The Spearman's rank correlation coefficient was used to determine the agreement between the single-item question and sensor-based data.

RESULTS

Positive correlations were found for self-reported breaks in ST with sensor-based breaks in ST in both women (ρ=0.37; 95% CI=0.29-0.44) and men (ρ=0.15; 95% CI=0.04-0.26). Self-reported breaks in ST were inversely correlated with ST in women (ρ =-0.33; 95% CI=-0.40 to 0.25). For both sexes, self-reported breaks in ST showed a positive correlation with light-intensity PA (ρ=0.39; 95% CI=0.31-0.46 women; ρ=0.13; 95% CI=0.02-0.24 men), however, positive correlations between self-reported breaks in ST and moderate-to-vigorous PA (ρ=0.13; 95% CI=0.02-0.24) were found only in men.

CONCLUSIONS

Our single-item question can be used as an indication for ranking people's breaks in ST during the waking day, although acknowledging that some misclassification will occur, especially in men. There must be an effort to include this question in future national and international surveys to replicate these findings.

Sedentary behaviour among general practitioners: a systematic review

Background

Sedentary behaviour is when someone is awake, in a sitting, lying or reclining posture and is an independent risk factor for multiple causes of morbidity and mortality. A dose-response relationship has been demonstrated, whereby increasing sedentary time corresponds with increasing mortality rate. This study aimed to identify current levels of sedentary behaviour among General Practitioners (GPs), by examining and synthesising how sedentary behaviour has been measured in the primary care literature.

Methods

A systematic review was conducted to identify studies relating to levels of sedentary behaviour among GPs. Searches were performed using Medline®, Embase®, PscycINFO, Web of Science and the Cochrane Library, from inception of databases until January 2020, with a subsequent search of grey literature. Articles were assessed for quality and bias, with extraction of relevant data.

Results

The search criteria returned 1707 studies. Thirty four full texts were reviewed and 2 studies included in the final review. Both were cross-sectional surveys using self-reported estimation of sedentary time within the International Physical Activity Questionnaire (IPAQ). Keohane et al. examined GP trainees and GP trainers in Ireland. 60% reported spending in excess of 7 h sitting each day, 24% between 4 and 7 h, and 16% less than or equal to 4 h. Suija et al. examined female GPs in Estonia. The mean reported daily sitting time was 6 h and 36 min, with 56% sitting for over 6 h per day. Both studies were of satisfactory methodological quality but had a high risk of bias.

Conclusion

There is a paucity of research examining current levels of sedentary behaviour among GPs. Objective data is needed to determine GPs’ current levels of sedentary behaviour, particularly in light of the increase in remote consulting as a result of the COVID-19 pandemic.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-020-01359-8.

Worldwide surveillance of self-reported sitting time: a scoping review

BACKGROUND

Prolonged sitting time is a risk factor for chronic disease, yet recent global surveillance is not well described. The aims were to clarify: (i) the countries that have collected country-level data on self-reported sitting time; (ii) the single-item tools used to collect these data; and (iii) the duration of sitting time reported across low- to high-income countries.

METHODS

Country-level data collected within the last 10 years using single-item self-report were included. The six-stage methodology: (1) reviewing Global Observatory for Physical Activity! Country Cards; (2-4) country-specific searches of PubMed, the Demographic and Health Survey website and Google; (5) analysing the Eurobarometer 88.4; and (6) country-specific searches for World Health Organization STEPwise reports.

RESULTS

A total of 7641 records were identified and screened for eligibility. Sixty-two countries (29%) reported sitting time representing 47% of the global adult population. The majority of data were from high-income (61%) and middle income (29%) countries. The tools used were the International Physical Activity Questionnaire (IPAQ; n = 34), a modified IPAQ (n = 1) or the Global Physical Activity Questionnaire (GPAQ; n = 27). The median of mean daily sitting times was 4.7 (IQR: 3.5-5.1) hours across all countries. Higher-income countries recorded a longer duration of sitting time than lower-income countries (4.9 vs 2.7 h).

CONCLUSIONS

This study provides an updated collation of countries collecting self-reported sitting time data. The daily sitting time findings should be interpreted cautiously. Current surveillance of sitting time is limited by a lack of coverage. Measures of population sitting time that are valid, feasible and sensitive to change should be embedded within global surveillance systems, to help guide future policy, research and practice.

TRIAL REGISTRATION

Not applicable.

Validity and reliability of subjective methods to assess sedentary behaviour in adults: a systematic review and meta-analysis

BACKGROUND

Subjective measures of sedentary behaviour (SB) (i.e. questionnaires and diaries/logs) are widely implemented, and can be useful for capturing type and context of SBs. However, little is known about comparative validity and reliability. The aim of this systematic review and meta-analysis was to: 1) identify subjective methods to assess overall, domain- and behaviour-specific SB, and 2) examine the validity and reliability of these methods.

METHODS

The databases MEDLINE, EMBASE and SPORTDiscus were searched up to March 2020. Inclusion criteria were: 1) assessment of SB, 2) evaluation of subjective measurement tools, 3) being performed in healthy adults, 4) manuscript written in English, and 5) paper was peer-reviewed. Data of validity and/or reliability measurements was extracted from included studies and a meta-analysis using random effects was performed to assess the pooled correlation coefficients of the validity.

RESULTS

The systematic search resulted in 2423 hits. After excluding duplicates and screening on title and abstract, 82 studies were included with 75 self-reported measurement tools. There was wide variability in the measurement properties and quality of the studies. The criterion validity varied between poor-to-excellent (correlation coefficient [R] range - 0.01- 0.90) with logs/diaries (R = 0.63 [95%CI 0.48-0.78]) showing higher criterion validity compared to questionnaires (R = 0.35 [95%CI 0.32-0.39]). Furthermore, correlation coefficients of single- and multiple-item questionnaires were comparable (1-item R = 0.34; 2-to-9-items R = 0.35; ≥10-items R = 0.37). The reliability of SB measures was moderate-to-good, with the quality of these studies being mostly fair-to-good.

CONCLUSION

Logs and diaries are recommended to validly and reliably assess self-reported SB. However, due to time and resources constraints, 1-item questionnaires may be preferred to subjectively assess SB in large-scale observations when showing similar validity and reliability compared to longer questionnaires.

REGISTRATION NUMBER

CRD42018105994.

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

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

Cross-sectional and longitudinal comparisons of self-reported and device-assessed physical activity and sedentary behaviour

OBJECTIVES

To examine the longitudinal associations and differences between self-reported and device-assessed physical activity (PA) and sedentary behaviour (SB), using a multifaceted statistical approach.

DESIGN

Longitudinal measurement burst.

METHODS

In total, 52 university students (78% female) aged 18-38 years (mean=21.94±4.57 years) participated. The study consisted of three blocks of six days of measurement, during which participants wore an accelerometer on their wrist for the entire block, and self-reported their PA over the 6 days at the end of each block.

RESULTS

Meaningful latent differences between methods were observed for moderate PA and SB across all three assessment periods, such that participants underreported the time spent in each activity. Bland-Altman plots revealed a positive mean difference for vigorous PA, with over-reporting increasing as mean levels increased. Negative mean differences were observed for all other intensities. Underreporting of moderate PA increased as the mean level increased, whereas for light PA and SB, underreporting decreased at high levels. Repeated measures correlations revealed a meaningful association for vigorous PA only, suggesting that as self-reported minutes increase so too do device-measured minutes.

CONCLUSIONS

We found evidence of cross-sectional and longitudinal differences and weak associations between self-reported and device-assessed PA and SB. Future work is needed to enhance the quality of self-reported methods to assess PA and SB (e.g., face and content validity), and consider improvements to the processing of device-based data.

Sedentary behaviour surveillance in Canada: trends, challenges and lessons learned

Background

Historical changes in the nature of sedentary activities have been observed in other countries, but it is not clear if similar trends exist in Canada. It is also unclear how changes in the measurement of sedentary behaviour affects national estimates. Our objective is to document all sources and measures of sedentary behaviour from Canadian, nationally representative surveys, and report on selected estimates of time spent in sedentary activities. Lessons learned can benefit the wider international surveillance community.

Methods

We describe and document all data sources of sedentary behaviour at the national level in Canada, and report on selected prevalence data from repeated cross-sectional surveys. We summarize amounts of total device-assessed sedentary time and self-reported sedentary activities (e.g., passive travel, leisure television, computer, video games, screen, and reading) by age group over time.

Results

Nineteen national surveys were identified. Changes in questions and/or response categories precluded direct assessment of trends over time for some measures; however, certain trends were observed. Accelerometer-measured sedentary time, leisure reading (among those < 50 years) and television/video viewing in younger age groups have remained relatively stable (with a possible slight decline in television/video viewing). Time spent in passive travel and leisure computer and electronic device use appears to have increased. Television and video viewing appears to have increased in older adults while their leisure reading appears to have fallen.

Conclusions

Changes in measurement of sedentary behaviour can affect estimates and reduce comparability over time. Total leisure screen use appears to have increased over time, reflecting the ways in which Canadians spend their free time and technological advances. The main public health message is the need for continued efforts to reduce leisure screen use, especially among youth and older adults.

A comparison of self-reported and device measured sedentary behaviour in adults: a systematic review and meta-analysis

BACKGROUND

Sedentary behaviour (SB) is a risk factor for chronic disease and premature mortality. While many individual studies have examined the reliability and validity of various self-report measures for assessing SB, it is not clear, in general, how self-reported SB (e.g., questionnaires, logs, ecological momentary assessments (EMAs)) compares to device measures (e.g., accelerometers, inclinometers).

OBJECTIVE

The primary objective of this systematic review was to compare self-report versus device measures of SB in adults.

METHODS

Six bibliographic databases were searched to identify all studies which included a comparable self-report and device measure of SB in adults. Risk of bias within and across studies was assessed. Results were synthesized using meta-analyses.

RESULTS

The review included 185 unique studies. A total of 123 studies comprising 173 comparisons and data from 55,199 participants were used to examine general criterion validity. The average mean difference was -105.19 minutes/day (95% CI: -127.21, -83.17); self-report underestimated sedentary time by ~1.74 hours/day compared to device measures. Self-reported time spent sedentary at work was ~40 minutes higher than when assessed by devices. Single item measures performed more poorly than multi-item questionnaires, EMAs and logs/diaries. On average, when compared to inclinometers, multi-item questionnaires, EMAs and logs/diaries were not significantly different, but had substantial amount of variability (up to 6 hours/day within individual studies) with approximately half over-reporting and half under-reporting. A total of 54 studies provided an assessment of reliability of a self-report measure, on average the reliability was good (ICC = 0.66).

CONCLUSIONS

Evidence from this review suggests that single-item self-report measures generally underestimate sedentary time when compared to device measures. For accuracy, multi-item questionnaires, EMAs and logs/diaries with a shorter recall period should be encouraged above single item questions and longer recall periods if sedentary time is a primary outcome of study. Users should also be aware of the high degree of variability between and within tools. Studies should exert caution when comparing associations between different self-report and device measures with health outcomes.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42019118755.

Is urinary incontinence associated with sedentary behaviour in older women? Analysis of data from the National Health and Nutrition Examination Survey

BACKGROUND

Urinary incontinence (UI) is a common geriatric syndrome associated with physical and cognitive impairments. The association between type of UI and sedentary behaviour (SB) has not been explored.

AIM

To determine association between moderate-severe UI, or any stress UI (SUI) or any urgency UI (UUI) and SB in community-dwelling older women.

METHODS

Women aged 60 and over from the 2005-2006 cycle of the National Health and Nutrition Examination Survey (NHANES) with objectively measured (accelerometer) and self-reported SB and UI data were selected. Multivariate models exploring association between moderate-severe UI and SB, or SUI and SB, or UUI and SB were analysed using logistic regression adjusted for factors associated with UI.

RESULTS

In the overall sample of 459 older women, 23.5% reported moderate-severe UI, 50.5% reported any SUI and 41.4% reported any UUI. In bivariate analysis objectively measured proportion of time in SB was associated with moderate-severe UI and UUI (p = 0.014 and p = 0.047) but not SUI. Average duration of SB bouts in those with moderate-severe UI or any SUI was no longer than older women reporting no continence issues, but it was significantly (19%) longer in older women with any UUI (mean difference 3.2 minutes; p = 0.001). Self-reported SB variables were not associated with any type of UI. Multivariate analysis showed an association between UUI and a longer average duration of SB bouts (OR = 1.05, 95% CI = 1.01-1.09, p = 0.006) but no association with moderate-severe UI or SUI.

CONCLUSION

UUI was significantly associated with increased average duration of SB bouts in community-dwelling older women. The importance of objective measurement of SB is highlighted and suggests that decreasing time in prolonged sitting may be a target intervention to reduce UUI. Future studies are required to further explore the association between SB and incontinence.

Device-Measured Sedentary Behavior, Physical Activity and Aerobic Fitness Are Independent Correlates of Cognitive Performance in Healthy Middle-Aged Adults-Results from the SCAPIS Pilot Study

High aerobic fitness, more moderate to vigorous physical activity (MVPA) and less sedentary behavior (SED) have all been suggested to promote cognitive functions, but it is unclear whether they are independent predictors of specific cognitive domains. This study aimed to investigate to what extent aerobic fitness MVPA and SED are independently associated with cognitive performance among middle-aged Swedish adults. We acquired device-based measures of aerobic fitness, cognitive performance and percent daily time spent in MVPA and SED in Swedish adults (n = 216; 54–66 years old). Aerobic fitness was associated with better performance at one out of two tests of speed/attention and one out of four tests of executive attention, and with worse performance at one of seven tests of memory. Increasing %MVPA was associated with better performance at one out of seven tests of memory and two out of three tests of verbal ability, whereas increasing %SED was associated with better performance at all four tests of executive attention and four out of seven tests of memory. These findings suggest that aerobic fitness, %MVPA and %SED are partly independent correlates of cognitive performance. To fully understand the association between SED and performance at several tests of cognitive function, future investigations might attempt to investigate intellectually engaging SED (such as reading books) separately from mentally undemanding SED (such as watching TV).

Relationships between Physical Activity, Sedentary Behaviour and Cognitive Functions in Office Workers

Increasing evidence from animal experiments suggests that physical activity (PA) promotes neuroplasticity and learning. For humans, most research on the relationship between PA, sedentary behaviour (SB), and cognitive function has relied on self-reported measures of behaviour. Office work is characterised by high durations of SB combined with high work demands. While previous studies have shown that fitter office workers outperform their less fit colleagues in cognitive tests, the importance of PA and SB remains unknown. This study investigated associations between objectively measured PA and SB, using hip-worn accelerometers, and cognitive functions in 334 office workers. Time spent in moderate-to-vigorous PA (MVPA) was not associated with any cognitive outcome. However, time spent in SB tended to be positively associated with words recalled in free recall (β = 0.125). For the least fit participants, the average length of MVPA bouts was favourably related to Stroop performance (β = -0.211), while for the fitter individuals, a longer average length of MVPA bouts was related to worse recognition (β = -0.216). While our findings indicate that the length of MVPA bouts was associated with better Stroop performance in the least fit participants, our findings do not support the notion that more time spent in MVPA or less time in SB is associated with better cognitive function.

Is sitting invisible? Exploring how people mentally represent sitting

Background

Growing evidence suggests that prolonged uninterrupted sitting can be detrimental to health. Much sedentary behaviour research is reliant on self-reports of sitting time, and sitting-reduction interventions often focus on reducing motivation to sit. These approaches assume that people are consciously aware of their sitting time. Drawing on Action Identification Theory, this paper argues that people rarely identify the act of sitting as ‘sitting’ per se, and instead view it as an incidental component of more meaningful and purposeful typically-seated activities.

Methods

Studies 1 and 2 explored whether people mentioned sitting in written descriptions of actions. Studies 3–5 compared preferences for labelling a typically desk-based activity as ‘sitting’ versus alternative action identities. Studies 6 and 7 used card-sort tasks to indirectly assess the prioritisation of ‘sitting’ relative to other action descriptions when identifying similar actions.

Results

Participants rarely spontaneously mentioned sitting when describing actions (Studies 1–2), and when assigning action labels to a seated activity, tended to offer descriptions based on higher-order goals and consequences of action, rather than sitting or other procedural elements (Studies 3–5). Participants primarily identified similarities in actions based not on sitting, but on activities performed while seated (e.g. reading; Studies 6–7).

Conclusion

‘Sitting’ is a less accessible cognitive representation of seated activities than are representations based on the purpose and implications of seated action. Findings suggest that self-report measures should focus on time spent in seated activities, rather than attempting to measure sitting time via direct recall. From an intervention perspective, findings speak to the importance of targeting behaviours that entail sitting, and of raising awareness of sitting as a potential precursor to attempting to reduce sitting time.

How are we measuring physical activity and sedentary behaviour in the four home nations of the UK? A narrative review of current surveillance measures and future directions

Background/objectives

To explore and describe the comparability between the surveys of the UK home nations (England, Northern Ireland, Scotland, Wales) that monitor compliance with the Chief Medical Officers’ physical activity (PA) recommendations. We also suggest ways to improve the UK national PA and sedentary behaviour (SB) surveillance systems.

Methods

We identified national surveys that monitor PA and SB through searching UK-wide and devolved administration websites, the Global Observatory for Physical Activity Country Cards and the Active Healthy Kids Report Cards. Subsequently, we extracted information from survey documentation on the survey commissioners and contractors, method of administration, current questionnaire details relevant to the PA recommendations, questionnaire changes over the previous decade and the most recent prevalence figures.

Results

For adults and older adults, five surveys assess the moderate-to-vigorous PA (MVPA) recommendation, three assess muscle strengthening and three assess SB. For older adults only, three assess balance and co-ordination. For children, seven assess MVPA, none assess muscle strengthening and five assess SB. Only one survey reports on the under 5 PA recommendation. There is no part of the recommendations for which comparable estimates can be calculated across all four home nations. The greatest variation is among the SB questions and reporting. No survey has regularly used device-based measures.

Conclusion

UK surveillance of the PA recommendations is complex, undertaken separately in the home nations, using multiple surveys that cover adults and children separately. We recommend that the costs and benefits of harmonising the existing questionnaires are considered, along with the potential introduction of device-based measures.

Comparison of sedentary behaviour questionnaires in people with multiple sclerosis

Background: People with multiple sclerosis are at risk of developing co-morbidities associated with sedentary behaviour. Despite an increase in studies examining sedentary behaviour in multiple sclerosis, researchers have not yet examined the appropriateness of the content or format of questionnaires assessing sedentary behaviour in multiple sclerosis.Objective: Evaluate perceptions of sedentary behaviour questionnaires for people with multiple sclerosis.Methods: Fifteen people with multiple sclerosis completed six validated sedentary behaviour questionnaires: Longitudinal Ageing Study Amsterdam, Marshall Sitting Questionnaire, International Physical Activity Questionnaire, Measure of Older Adults Sedentary Time, Sedentary Behaviour Questionnaire and SIT-Q. Participants' perceptions regarding questionnaire content and format were explored by interviews.Results: Self-reported sedentary time ranged between a mean of 470 (standard deviation 260) (Measure of Older Adults Sedentary Time) and 782 (322) min (Longitudinal Ageing Study Amsterdam) per weekday. Analysis of variance revealed a significant effect of questionnaire on mean sitting time: Longitudinal Ageing Study Amsterdam and SIT-Q yielded higher mean estimates of weekday sitting time than other questionnaires. The questionnaires were viewed as being suitable for use in multiple sclerosis but failed to capture some sedentary activities. Variability of symptoms yielded difficulties in describing a "typical day".Conclusions: The questionnaires were considered suitable for multiple sclerosis but produced variation in estimated sedentary time. Future work might validate questionnaire data with device-based assessments of sedentary time.Implications for rehabilitationSelf-reported sitting time ranged from 7.8 to 13.0 h per day in people with multiple sclerosis.Sedentary behaviour questionnaires are suitable for multiple sclerosis but yield variable estimates of sitting time.Watching television was the most prevalent sedentary activity and may have implications for interventions that break up sedentary time.

Stand and Move at Work sedentary behavior questionnaire: validity and sensitivity to change

PURPOSE

We evaluated the validity and sensitivity to change of a workplace questionnaire to assess sedentary behavior (SB) during and outside work.

METHODS

Participants wore an activPAL and completed an SB questionnaire at two time points (baseline and 3-month follow-up). Ecological momentary assessments were used to assess workplace location (at desk vs. away from desk). Intraclass correlation coefficients, mean difference, root of mean square error, kappa agreement, and Bland-Altman plots assessed validity. Sensitivity to change after 3 months of intervention was assessed using the standardized effect size.

RESULTS

Data from 546 participants (age = 45.1 ± 16.4 years, 24.9% males, 72.7% white) were analyzed. Intraclass correlation coefficients ranged from 0.08 to 0.23. SB was overestimated d¯(95%CI)[] by 47.9 (39.2, 56.6) min during work hours but underestimated for both non-work hours and nonworkdays by -38.3 (-47.4, 29.1) and -106.7 (124.0, -89.5) min, respectively. Participants slightly underestimated SB by -3.4 (-12.6, 5.7)% when at their desk but overestimated SB by 2.8 (-2.4, 8.0)% when not at their desk. The questionnaire demonstrated similar standardized effect size (>0.6) to the activPAL for sedentary and standing time.

CONCLUSIONS

Agreement between the questionnaire and activPAL was on par with other self-report measures. The questionnaire yielded valid estimates of at/away from desk SB and was sensitive to change.

Positive and negative well-being and objectively measured sedentary behaviour in older adults: evidence from three cohorts

Background

Sedentary behaviour is related to poorer health independently of time spent in moderate to vigorous physical activity. The aim of this study was to investigate whether wellbeing or symptoms of anxiety or depression predict sedentary behaviour in older adults.

Method

Participants were drawn from the Lothian Birth Cohort 1936 (LBC1936) (n = 271), and the West of Scotland Twenty-07 1950s (n = 309) and 1930s (n = 118) cohorts. Sedentary outcomes, sedentary time, and number of sit-to-stand transitions, were measured with a three-dimensional accelerometer (activPAL activity monitor) worn for 7 days. In the Twenty-07 cohorts, symptoms of anxiety and depression were assessed in 2008 and sedentary outcomes were assessed ~ 8 years later in 2015 and 2016. In the LBC1936 cohort, wellbeing and symptoms of anxiety and depression were assessed concurrently with sedentary behaviour in 2015 and 2016. We tested for an association between wellbeing, anxiety or depression and the sedentary outcomes using multivariate regression analysis.

Results

We observed no association between wellbeing or symptoms of anxiety and the sedentary outcomes. Symptoms of depression were positively associated with sedentary time in the LBC1936 and Twenty-07 1950s cohort, and negatively associated with number of sit-to-stand transitions in the LBC1936. Meta-analytic estimates of the association between depressive symptoms and sedentary time or number of sit-to-stand transitions, adjusted for age, sex, BMI, long-standing illness, and education, were β = 0.11 (95% CI = 0.03, 0.18) and β = − 0.11 (95% CI = − 0.19, −0.03) respectively.

Conclusion

Our findings indicate that depressive symptoms are positively associated with sedentary behavior. Future studies should investigate the causal direction of this association.

Criterion validity and test-retest reliability of SED-GIH, a single item question for assessment of daily sitting time

Background

Sedentary behaviour has been closely linked to metabolic and cardiovascular health and is therefore of importance in disease prevention. A user-friendly tool for assessment of sitting time is thus needed. Previous studies concluded that the present tools used to assess a number of sedentary behaviours are more likely to overestimate sitting than single-item questions which often underestimate sitting time, and that categorical answering options are recommended. In line with this, the single-item question with categorical answering options, SED-GIH, was developed.

The aim of this study was to investigate the criterion validity of the SED-GIH question using activPAL3 micro as the criterion measure. The second aim was to evaluate the test-retest reliability of the SED-GIH questionnaire.

Method

In the validity section of this study, 284 middle-aged adults answered a web questionnaire, which included SED-GIH, wore activPAL and filled in a diary log for one week. Spearman’s rho assessed the relationship between the SED-GIH answers and the daily average sitting time as monitored by the activPAL (activPAL-SIT), a Weighted Kappa assessed the agreement, ANOVA assessed differences in activPAL-SIT between the SED-GIH answer categories, and a Chi² compared the proportions of hazardous sitters between the different SED-GIH answer categories. In the reliability section, 95 elderly participants answered the SED-GIH question twice, with a mean interval of 5.2 days. The reliability was assessed with ICC and a weighted Kappa.

Results

The SED-GIH question correlated moderately with activPAL-SIT (rho = 0.31), with a poor agreement (weighted Kappa 0.12). In total, 40.8% underestimated and 22.2% overestimated their sitting time. The ANOVA showed significant differences in activPAL-SIT between the different SED-GIH answer categories (p < 0.001). The Chi² showed a significant difference in proportion of individuals sitting more than 10 h per day within each SED-GIH answer category. ICC for the test-retest reliability of SED-GIH was excellent with ICC = 0.86, and the weighted Kappa showed an agreement of 0.77.

Conclusions

The unanchored single item SED-GIH question showed excellent reliability but poor validity in the investigated populations. Validity and reliability of SED-GIH is in line with other questionnaires that are commonly used when assessing sitting time.

The effectiveness of interventions targeting physical activity and/or sedentary behaviour in people with Multiple Sclerosis: a systematic review

Background: Remaining physically active is important to maintain functional ability and reduce the incidence of co-morbidities in people with Multiple Sclerosis. The aim of this review was to evaluate the effectiveness of interventions on physical activity or sedentary behaviour in people with Multiple Sclerosis.Methods: A systematic search was conducted in May 2018 of the following databases: Web of Science Core Collections, Embase and Medline. Included studies were randomised controlled trials involving people with Multiple Sclerosis who completed an intervention, compared to any comparator. Outcomes included subjective or objective measures of physical activity or sedentary behaviour. Quality assessment was performed using the Physiotherapy Evidence Database scale.Results: Twenty-five trials were included covering 1697 participants, the majority of which had mild-moderate disability (average Physiotherapy Evidence Database score 6.2 ± 1.5). Experimental interventions included exercise prescription (n = 5), behaviour change interventions (n = 10), combined exercise, and behaviour change techniques (n = 7) and education (n = 3). Generally, subjective but not objective physical activity improved in those with mild-moderate disability. Insufficient data existed on the effectiveness on sedentary behaviour.Conclusions: A discrepancy seems to exists between the effectiveness of physical activity interventions in people with Multiple Sclerosis depending on whether physical activity was assessed objectively or subjectively, with the latter indicating effects. Effects on sedentary behaviour remain to be elucidated.Implications for RehabilitationRemaining physically active is important to maintain functional ability, independence, quality of life, and to reduce the incidence of co-morbidity.Exercise prescription, behaviour change interventions, combined exercise and behaviour change interventions, and health promotion education appear to subjectively improve physical activity in people with Multiple Sclerosis with mild-moderate disability, yet this is often not the case when measured objectively.There is a lack of evidence to support the effectiveness of these interventions on sedentary behaviour.

Reliability, minimal detectable change and responsiveness to change: Indicators to select the best method to measure sedentary behaviour in older adults in different study designs

Introduction

Prolonged sedentary behaviour (SB) is associated with poor health. It is unclear which SB measure is most appropriate for interventions and population surveillance to measure and interpret change in behaviour in older adults. The aims of this study: to examine the relative and absolute reliability, Minimal Detectable Change (MDC) and responsiveness to change of subjective and objective methods of measuring SB in older adults and give recommendations of use for different study designs.

Methods

SB of 18 older adults (aged 71 (IQR 7) years) was assessed using a systematic set of six subjective tools, derived from the TAxonomy of Self report Sedentary behaviour Tools (TASST), and one objective tool (activPAL3c), over 14 days. Relative reliability (Intra Class Correlation coefficients-ICC), absolute reliability (SEM), MDC, and the relative responsiveness (Cohen’s d effect size (ES) and Guyatt’s Responsiveness coefficient (GR)) were calculated for each of the different tools and ranked for different study designs.

Results

ICC ranged from 0.414 to 0.946, SEM from 36.03 to 137.01 min, MDC from 1.66 to 8.42 hours, ES from 0.017 to 0.259 and GR from 0.024 to 0.485. Objective average day per week measurement ranked as most responsive in a clinical practice setting, whereas a one day measurement ranked highest in quasi-experimental, longitudinal and controlled trial study designs. TV viewing–Previous Week Recall (PWR) ranked as most responsive subjective measure in all study designs.

Conclusions

The reliability, Minimal Detectable Change and responsiveness to change of subjective and objective methods of measuring SB is context dependent. Although TV viewing-PWR is the more reliable and responsive subjective method in most situations, it may have limitations as a reliable measure of total SB. Results of this study can be used to guide choice of tools for detecting change in sedentary behaviour in older adults in the contexts of population surveillance, intervention evaluation and individual care.

Characteristics of a protocol to collect objective physical activity/sedentary behaviour data in a large study: Seniors USP (understanding sedentary patterns)

The Seniors USP study measured sedentary behaviour (activPAL3, 9 day wear) in older adults. The measurement protocol had three key characteristics: enabling 24-hour wear (monitor location, waterproofing); minimising data loss (reducing monitor failure, staff training, communication); and quality assurance (removal by researcher, confidence about wear). Two monitors were not returned; 91% (n=700) of returned monitors had 7 valid days of data. Sources of data loss included monitor failure (n=11), exclusion after quality assurance (n=5), early removal for skin irritation (n=8) or procedural errors (n=10). Objective measurement of physical activity and sedentary behaviour in large studies requires decisional trade-offs between data quantity (collecting representative data) and utility (derived outcomes that reflect actual behaviour).

Cognitive ability does not predict objectively measured sedentary behavior: Evidence from three older cohorts

Higher cognitive ability is associated with being more physically active. Much less is known about the associations between cognitive ability and sedentary behavior. Ours is the first study to examine whether historic and contemporaneous cognitive ability predicts objectively measured sedentary behavior in older age. Participants were drawn from 3 cohorts (Lothian Birth Cohort, 1936 [LBC1936] [n = 271]; and 2 West of Scotland Twenty-07 cohorts: 1950s [n = 310] and 1930s [n = 119]). Regression models were used to assess the associations between a range of cognitive tests measured at different points in the life course, with sedentary behavior in older age recorded over 7 days. Prior simple reaction time (RT) was significantly related to later sedentary time in the youngest, Twenty-07 1950s cohort (p = .04). The relationship was nonsignificant after controlling for long-standing illness or employment status, or after correcting for multiple comparisons in the initial model. None of the cognitive measures were related to sedentary behavior in either of the 2 older cohorts (LBC1936, Twenty-07 1930s). There was no association between any of the cognitive tests and the number of sit-to-stand transitions in any of the 3 cohorts. The meta-analytic estimates for the measures of simple and choice RT that were identical in all cohorts (n = 700) were also not significant. In conclusion, we found no evidence that objectively measured sedentary time in older adults is associated with measures of cognitive ability at different time points in life, including cognitive change from childhood to older age. (PsycINFO Database Record

Systematic comparative validation of self-report measures of sedentary time against an objective measure of postural sitting (activPAL)

BACKGROUND

Sedentary behaviour is a public health concern that requires surveillance and epidemiological research. For such large scale studies, self-report tools are a pragmatic measurement solution. A large number of self-report tools are currently in use, but few have been validated against an objective measure of sedentary time and there is no comparative information between tools to guide choice or to enable comparison between studies. The aim of this study was to provide a systematic comparison, generalisable to all tools, of the validity of self-report measures of sedentary time against a gold standard sedentary time objective monitor.

METHODS

Cross sectional data from three cohorts (N = 700) were used in this validation study. Eighteen self-report measures of sedentary time, based on the TAxonomy of Self-report SB Tools (TASST) framework, were compared against an objective measure of postural sitting (activPAL) to provide information, generalizable to all existing tools, on agreement and precision using Bland-Altman statistics, on criterion validity using Pearson correlation, and on data loss.

RESULTS

All self-report measures showed poor accuracy compared with the objective measure of sedentary time, with very wide limits of agreement and poor precision (random error > 2.5 h). Most tools under-reported total sedentary time and demonstrated low correlations with objective data. The type of assessment used by the tool, whether direct, proxy, or a composite measure, influenced the measurement characteristics. Proxy measures (TV time) and single item direct measures using a visual analogue scale to assess the proportion of the day spent sitting, showed the best combination of precision and data loss. The recall period (e.g. previous week) had little influence on measurement characteristics.

CONCLUSION

Self-report measures of sedentary time result in large bias, poor precision and low correlation with an objective measure of sedentary time. Choice of tool depends on the research context, design and question. Choice can be guided by this systematic comparative validation and, in the case of population surveillance, it recommends to use a visual analog scale and a 7 day recall period. Comparison between studies and improving population estimates of average sedentary time, is possible with the comparative correction factors provided.