Chronic disease and sitting time in middle-aged Australian males: findings from the 45 and Up Study

How shoulder immobilization after surgery influences daily activity - a prospective pedometer-based study

PURPOSE

Immobilization, especially of the lower extremity, after orthopaedic surgery has been associated with reduced physical activity. Previous interventions from our study group showed even in young, healthy people reduced activity levels after immobilization of the shoulder. Therefore, this study investigates the change in physical activity due to shoulder immobilization after a reconstructive surgery.

METHODS

This prospective study includes 40 patients undergoing surgery from May 2019 to December 2020. Daily activity was measured before surgery, after discharge and three weeks postoperatively each time for six days. Activity including step counts and active time were measured by Fitbit™ inspire. Range of motion before and after surgery as well as Pain (VAS) were documented.

RESULTS

Steps became significantly less immediately postoperatively with an immobilized shoulder joint than before surgery (9728.8 vs. 6022.6, p < 0.05). At follow-up, the number of steps increased again, but still showed a significantly lower number of steps (mean 8833.2) compared to preoperative. Patients preoperatively showed mostly an "active" activity pattern, whereas postoperatively a "low active" behaviour predominated. The proportion of sedentary behaviour ("basal activity" and "limited activity") was almost three times higher postoperatively (12.5% vs. 30%).

CONCLUSION

General physical activity is restricted during upper limb immobilization in adults. Therefore, activity-enhancing measures should be implemented in the early phase of rehabilitation after upper extremity surgery.

Device-measured sitting time and musculoskeletal pain in adults with normal glucose metabolism, prediabetes and type 2 diabetes-The Maastricht Study

BACKGROUND

Detrimental associations of sedentary behaviour (time spent sitting) with musculoskeletal pain (MSP) conditions have been observed. However, findings on those with, or at risk of, type 2 diabetes (T2D) have not been reported. We examined the linear and non-linear associations of device-measured daily sitting time with MSP outcomes according to glucose metabolism status (GMS).

METHODS

Cross-sectional data from 2827 participants aged 40-75 years in the Maastricht Study (1728 with normal glucose metabolism (NGM); 441 with prediabetes; 658 with T2D), for whom valid data were available on activPAL-derived daily sitting time, MSP [neck, shoulder, low back, and knee pain], and GMS. Associations were examined by logistic regression analyses, adjusted serially for relevant confounders, including moderate-to-vigorous intensity physical activity (MVPA) and body mass index (BMI). Restricted cubic splines were used to further examine non-linear relationships.

RESULTS

The fully adjusted model (including BMI, MVPA, and history of cardiovascular disease) showed daily sitting time to be significantly associated with knee pain in the overall sample (OR = 1.07, 95%CI: 1.01-1.12) and in those with T2D (OR = 1.11, 95%CI: 1.00-1.22); this was not statistically significant in those with prediabetes (OR = 1.04, 95%CI: 0.91-1.18) or NGM (OR = 1.05, 95%CI: 0.98-1.13). There were no statistically significant associations between daily sitting time and neck, shoulder, or low back pain in any of the models. Furthermore, the non-linear relationships were statistically non-significant.

CONCLUSION

Among middle-aged and older adults with T2D, daily sitting time was significantly associated with higher odds of knee pain, but not with neck, shoulder, or low back pain. No significant association was observed in those without T2D for neck, shoulder, low back, or knee pain. Future studies, preferably those utilising prospective designs, could examine additional attributes of daily sitting (e.g., sitting bouts and domain-specific sitting time) and the potential relationships of knee pain with mobility limitations.

Stable Gender Gap and Similar Gender Trend in Chronic Morbidities between 1997-2015 in Adult Canary Population

There is little information about the trend of the gender gap in chronic morbidities and whether the trend of expansion occurs equally in the age and gender groups. The objectives were to examine the consistency and stability of the gender gap in the main self-reported chronic morbidities in the general population, and, likewise, to analyze the trend of major chronic morbidities between 1997 and 2015 in men and women across age groups. The data were extracted from the Canary Health Survey, which uses a probabilistic sampling in the population >16 years of age, for the years 1997 (n = 2167), 2004 (n = 4304), 2009 (n = 4542), and 2015 (n = 4560). The data for the twelve most frequent chronic morbidities were analyzed using logistic regression, estimating the annual change ratio between 1997 and 2015, adjusting for age and educational level. The interaction of age with the period (1997−2015) was examined to analyze the rate of change for each morbidity in the age groups. Musculoskeletal diseases, headaches, anxiety and depression, and peripheral vascular diseases showed a stable gender gap across observed years. High cholesterol and high blood pressure tended to a gap reduction, while heart disease, diabetes, and respiratory disease did not show a significant gender gap along the period. The trend of the main chronic morbidities increased similarly in men and women in all age groups, but significantly in women older than 60 years and in men older than 45 years. Aging explained a substantial part of the trend of increasing prevalence of the main chronic morbidities, but not totally. Factors other than age and education are driving the increase in chronic morbidity in older age groups.

Physical activity and sitting time changes in response to the COVID-19 lockdown in England

To reduce the spread of the novel coronavirus disease 2019 (COVID-19), national governments implemented measures to limit contact between citizens. This study evaluated changes in physical activity and sitting in response to the first COVID-19 lockdown in England and factors associated with these changes. A cross-sectional online survey-based study collected data from 818 adults between 29 April and 13 May 2020. Participants self-reported demographic information, physical activity and sitting for a 'typical' week before and during lockdown. Participants were grouped into low, moderate and high physical activity, and low and high (≥8 hours/day) sitting. Paired samples t-tests compared physical activity (MET-min/week) before and during lockdown. Pearson's Chi-squared evaluated the proportion of participants in the physical activity and sitting categories. Logistic regression explored associations of demographic and behavioural factors with physical activity and sitting during lockdown. Walking and total physical activity significantly increased during lockdown by 241 (95% confidence interval [CI]: 176, 304) MET-min/week and 302 (CI: 155, 457) MET-min/week, respectively (P < 0.001). There was a 4% decrease in participants engaging in low physical activity and a 4% increase in those engaging in high physical activity from before to during lockdown (P < 0.001). The proportion engaging in high sitting increased from 29% to 41% during lockdown (P < 0.001). Lower education level (odds ratio [OR] = 1.65, P = 0.045) and higher BMI (OR = 1.05, P = 0.020) were associated with increased odds of low physical activity during lockdown, whereas non-White ethnicity (OR = 0.24, P = 0.001) was associated with reduced odds. Younger age was associated with increased odds of high sitting (OR = 2.28, P = 0.008). These findings suggest that physical activity and sitting both increased during lockdown. Demographic and behavioural factors associated with low physical activity and high sitting have been identified that could inform intervention strategies during situations of home confinement.

Impact of staying at home measures during COVID-19 pandemic on the lifestyle of Qatar's population: Perceived changes in diet, physical activity, and body weight

Countries worldwide imposed different swift protective measures such as movement restrictions and staying at home measures to mitigate the spread of COVID-19. Despite the benefits gained from such measures in containing the spread of the infection, adverse lifestyle consequences happened. In this study we aimed to assess the impact of staying at home measures imposed during COVID-19 pandemic on dietary behaviors, physical activity, and body weight in Qatar's population. A population based cross sectional survey was conducted between December 2020 and February 2021 targeting adults ≥18 years. A total of 1408 participants completed the survey in four languages. Concerning the overall diet perception, 27.8%, and 33.2% perceived that their overall diet has become less healthy, or healthier respectively, since the start of staying at home measures. Almost half of all participants reported weight gain. Participants reported increased sitting/reclining time (1.94 h/day mean increase), screen times (2.05 h/day mean increase) with p < 0.001, and decreased exercise time (0.11 h/day mean reduction) with p < 0.001. The ordinal logistic regression analysis showed that the numbers of unhealthy dietary behaviors adopted by participants, and adverse changes in exercise, setting/reclining and screen times were significantly associated with weight gain. The results of this study indicate that peoples in Qatar have experienced adverse lifestyle changes with regard to their diet, physical activity, and body weight. More emphasis should be put on encouraging people to maintain healthy lifestyle behaviors during home confinement measures that might be imposed during any public health crises or any potential future outbreaks.

Prevalence and patterns of physical activity, sedentary behaviour, and their association with health-related quality of life within a multi-ethnic Asian population

OBJECTIVE

The study aimed to examine the prevalence and sociodemographic correlates of physical activity and sedentary behaviour in the general population of the multi-ethnic nation of Singapore as part of the Knowledge, Practice and Attitudes towards Diabetes study, a cross-sectional and population-based survey. It also examined the relationship between physical activity, sedentary behaviour, and health-related quality of life (HRQoL).

METHODS

Physical activity and sedentary behaviour were assessed via the Global Physical Activity Questionnaire (GPAQ), while physical and mental HRQoL was assessed via the Short Form Health Survey (SF-12v2). Survey weights were employed to account for complex survey design. Multivariable logistic regression models were utilized to examine sociodemographic correlates of physical activity (insufficient vs. sufficient physical activity) and sedentary behaviour (< 7 h/day vs ≥7 h/day). Descriptive statistics were calculated to examine the percentage of time spent in different domains of physical activity. Multivariable linear regressions were conducted to examine the association between physical activity and sedentary behaviour with physical and mental HRQoL.

RESULTS

Two thousand eight hundred sixty seven participants recruited from February 2019 to March 2020 (prior to COVID-19 lockdown and related restrictions in Singapore) were included in the analyses. 83.3% of respondents had sufficient physical activity. Age (65 years and above) and income (SGD 2000 to 3999) were associated with a higher likelihood of insufficient physical activity. In contrast, those of Malay ethnicity and having one chronic physical condition were associated with a lower likelihood of insufficient physical activity. 47.7% reported that they had sedentary behaviour of ≥7 h/day. Older age and a primary school education were related to a lower likelihood of sedentary behaviour, while being single, having higher income, obesity, and multimorbidity were associated with higher sedentary behaviour. Insufficient physical activity was significantly associated with lower physical HRQoL but was not significantly associated with mental HRQoL. Sedentary behaviour was not significantly associated with mental or physical HRQoL.

CONCLUSION

About 17% of the population did not meet the minimum requirements for physical activity, while around half of the population spent a considerable time being sedentary. As insufficient physical activity was associated with poorer physical HRQoL, policymakers should promote moderate physical activity and encouraging the breaking up of prolonged sedentary periods within the middle- and high-income groups, especially at the workplace. Increased leisure-time exercise should be encouraged for those in the lower- income group.

Factors associated with musculoskeletal symptoms in professionals working in sitting position

OBJECTIVE

To estimate the prevalence of musculoskeletal symptoms and analyze their associated factors in professionals from administrative sectors working predominantly in sitting position.

METHODS

This is a cross-sectional study with data obtained from 451 workers from a federal public institution in Southern Brazil. The dependent variable was the number of musculoskeletal symptoms in the prior 12 months, measured using the Nordic Musculoskeletal Questionnaire. In the analyses, 19 independent variables were investigated, divided into four categories: sociodemographic, behavioral, occupational and health characteristics. Univariate analysis and multiple Poisson regression with robust variance were performed. The independent variables were inserted into blocks with stepwise backward criterion, considering the value for Wald statistics equal to 0.20. The effect measures were expressed in a relative increase (RI) in the mean value, and the data were analyzed for a 5% significance level.

RESULTS

The estimated prevalence of musculoskeletal symptoms in the prior 12 months was 90% (confidence interval – 95%CI 87–93). In the final model of regression analysis, the variables female gender (RI = 14.75%), low (RI = 100.02%) and moderate (RI = 64.06%) work ability index, use of medications (RI = 48.06%) and waist circumference at risk (RI = 15.59%) had a significant association with the increase in the mean number of symptoms; schooling with technical education acted as a protective factor, reducing the mean by 36.46%.

CONCLUSIONS

The high prevalence of musculoskeletal symptoms found and the associated factors indicate the need to propose specific actions and care for this population, such as immediate treatment of symptoms and changes in the organization and work environment, to achieve balance and harmony in the demands of prolonged sitting work and avoid its impact effect of this condition on public health.

A population-based study of health-promoting behaviors and their predictors in Iranian males, 2019

BACKGROUND

Health-promoting lifestyle (HPL) is any measure taken to maintain a person's health. The most important and influential factor in maintaining and enhancing health are health-promoting behaviors (HPB). This study aimed to determine HPB and their predictors among Iranian men.

METHODS

In this cross-sectional study, 783 Iranian men, living in Tehran, were selected, using multistage cluster sampling. The employed questionnaires, namely the sociodemographic questionnaire, Health-Promoting Lifestyle Profile II (HPLP-II), and the second part of the Personal Resource Questionnaire (PRQ 85-Part 2), were completed through interviews. The relationship between the dependent variables (HPLP-II and its subdomains) and independent variables (sociodemographic characteristics and social support) was investigated using the adjusted General Linear Model (GLM).

RESULTS

The mean ± standard deviation of the total HPLP-II score was 2.72 ± 0.44 in the range of 1-4. Among the six dimensions of the HPB, the participants achieved the highest score (3.00 ± 0.52) and lowest score (1.96 ± 0.56) in spiritual growth and physical activity, respectively. The Pearson test showed that the perceived social support was significantly correlated with HPLP-II (r = 0.23; p < 0.001) and all of its subdomains (r = 0.09-0.24; p < 0.001). Based on the adjusted general linear model, social support, age, job, and income adequacy were the predictors of HPL in men and could explain 30.9% of the variance of the HPL score.

CONCLUSIONS

The research findings confirmed the importance of social support and modifying variables (social and personal) in the incidence of HPB in men.

Sedentary time and blood pressure in Australian toddlers: The get-up study longitudinal results

Epidemiological data suggests that the genesis of cardiovascular disease occurs during childhood. Sedentary time (ST) is a main driver of high blood pressure (BP) in adolescents and adults. However, associations between ST and cardiovascular health in young children are uncertain. Prospective associations between ST and BP were assessed among 172 toddlers (88 boys), aged 19.5 ± 3.9 months at baseline, recruited from the GET-UP! Study, Australia and followed over a 12-month period. BP was measured with a digital monitor and z-scores were computed by age and sex for systolic and diastolic BP. Total ST was measured over 7 days using Actigraph accelerometers and expressed over a 24-h period. Multilevel linear regression models were used to assess regression coefficients and standard errors, predicting BP at follow-up from ST at baseline. Analyses controlled for socio-economic status, height, age, gender, group (intervention or control) and zWC at baseline. Adjusted analyses showed that total ST did not predict systolic or diastolic BP (β = 0.0009, p = 0.368 and β = 0.002, p = 0.05, respectively). Most likely, longer follow-up periods might be needed to confirm or rule out our results, as the effects of cumulative ST over time on BP values are prone to manifest later in life and track into adolescence and adulthood.

Agreement between the International Physical Activity Questionnaire and Accelerometry in Adults with Orthopaedic Injury

Orthopaedic injury can lead to decreased physical activity. Valid measures for assessing physical activity are therefore needed in this population. The aim of this study was to determine the agreement and concordance between the International Physical Activity Questionnaire-Short Form (IPAQ) and device-measured physical activity and sitting time in orthopaedic injury patients. Adults with isolated upper or lower limb fracture (n = 46; mean age of 40.5 years) wore two activity monitors (ActiGraph wGT3X-BT and activPAL) for 10 days, from 2 weeks post-discharge. The IPAQ was also completed for a concurrent 7-day period. Lin's concordance correlation coefficients and Bland-Altman plots were calculated to compare walking/stepping time, total METmins, and sitting time. The IPAQ overestimated device-derived walking time (mean difference = 2.34 ± 7.33 h/week) and total METmins (mean difference = 767 ± 1659 METmins/week) and underestimated sitting time (mean difference = -2.26 ± 3.87 h/day). There was fair concordance between IPAQ-reported and device-measured walking (ρ = 0.34) and sitting time (ρ = 0.38) and moderate concordance between IPAQ-reported and device-measured METmins (ρ = 0.43). In patients with orthopaedic injury, the IPAQ overestimates physical activity and underestimates sitting time. Higher agreement was observed in the forms of activity (walking, total PA and sitting) commonly performed by this patient group.

Designing and psychometric of reproductive health related behaviors assessment tool in Iranian males: an exploratory mixed method study protocol

BACKGROUND

Male reproductive health is a relatively new concept, and most men are neglected in reproductive health discussions. Therefore, it appears that there is insufficient information about the male reproductive health. This study aims to design a psychometric instrument for assessing the male reproductive health-related behavior.

METHODS/DESIGN

This is a sequential exploratory mixed-method study with a classical instrument development design. It will be conducted in two qualitative and quantitative phases on the studied units including the men living in Tehran. In the first phase, a qualitative study of a contractual content analysis approach will be conducted in order to perceive the concept of male reproductive health-related behavior, determine the dimensions of the questionnaire, and explore the items. In the second phase, a quantitative study will be carried out to evaluate the psychometric properties as well as (form, content, and construct) validity and reliability of the instrument designed in the first phase. Finally, the instrument will be scored and interpreted.

DISCUSSION

Discovering men's perception of concept of reproductive health-related behavior can help design a valid and reliable questionnaire which can be used in studies evaluating the male reproductive health-related behavior.

ETHICAL CODE

IR.TUMS.FNM.REC.1397.157.

The Home Office: Ergonomic Lessons From the “New Normal”

Millions of workers have been uprooted by COVID-19 (coronavirus disease 2019) and been thrown into a “new normal” of working from home offices. To further complicate things, many individuals were provided with only a laptop and little, if any, education on setting up an ergonomically correct workstation. As a result, many home office–based workers potentially face suboptimal working conditions. Based on 41 home office ergonomic evaluations, most ergonomic concerns related to laptop usage, nonadjustable chairs without armrests, low monitor heights, and hard desk surfaces. If home-based office work continues, people need to understand the ramifications of poor workstation.

Time Spent Sitting as an Independent Risk Factor for Cardiovascular Disease

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

Association of total sedentary behaviour and television viewing with risk of overweight/obesity, type 2 diabetes and hypertension: A dose-response meta-analysis

AIMS

To explore the quantitative dose-response association of total sedentary behaviour and television viewing with overweight/obesity, type 2 diabetes and hypertension in a meta-analysis.

MATERIALS AND METHODS

We searched three databases to identify English-language reports that assessed the association of total sedentary behaviour or television viewing with the aforementioned health outcomes. Restricted cubic splines were used to evaluate possible linear or non-linear associations of total sedentary behaviour and television viewing with these health outcomes.

RESULTS

We included 48 articles (58 studies) with a total of 1 071 967 participants in the meta-analysis; 21 (six cohort and 15 cross-sectional) studies examined the association of total sedentary behaviour with overweight/obesity, 23 (13 cohort and 10 cross-sectional) studies examined the association with type 2 diabetes and 14 (one cohort and 13 cross-sectional) studies examined the association with hypertension. We found linear associations between total sedentary behaviour and type 2 diabetes (P_{non-linearity} = 0.190) and hypertension (P_{non-linearity} = 0.225) and a non-linear association between total sedentary behaviour and overweight/obesity (P_{non-linearity} = 0.003). For each 1-h/d increase in total sedentary behaviour, the risk increased by 5% for type 2 diabetes and 4% for hypertension. We also found linear associations between television viewing and type 2 diabetes (P_{non-linearity} = 0.948) and hypertension (P_{non-linearity} = 0.679) and a non-linear association for overweight/obesity (P_{non-linearity} = 0.007). For each 1-h/d increase in television viewing, the risk increased by 8% for type 2 diabetes and 6% for hypertension.

CONCLUSIONS

High levels of total sedentary behaviour and television viewing were associated with overweight/obesity, type 2 diabetes and hypertension.

Helsinki by nature: The Nature Step to Respiratory Health

Background

The Nature Step to Respiratory Health was the overarching theme of the 12th General Meeting of the Global Alliance against Chronic Respiratory Diseases (GARD) in Helsinki, August 2018. New approaches are needed to improve respiratory health and reduce premature mortality of chronic diseases by 30% till 2030 (UN Sustainable Development Goals, SDGs). Planetary health is defined as the health of human civilization and the state of the natural systems on which it depends. Planetary health and human health are interconnected, and both need to be considered by individuals and governments while addressing several SDGs.

Results

The concept of the Nature Step has evolved from innovative research indicating, how changed lifestyle in urban surroundings reduces contact with biodiverse environments, impoverishes microbiota, affects immune regulation and increases risk of NCDs. The Nature Step calls for strengthening connections to nature. Physical activity in natural environments should be promoted, use of fresh vegetables, fruits and water increased, and consumption of sugary drinks, tobacco and alcohol restricted. Nature relatedness should be part of everyday life and especially emphasized in the care of children and the elderly. Taking “nature” to modern cities in a controlled way is possible but a challenge for urban planning, nature conservation, housing, traffic arrangements, energy production, and importantly for supplying and distributing food. Actions against the well-known respiratory risk factors, air pollution and smoking, should be taken simultaneously.

Conclusions

In Finland and elsewhere in Europe, successful programmes have been implemented to reduce the burden of respiratory disorders and other NCDs. Unhealthy behaviour can be changed by well-coordinated actions involving all stakeholders. The growing public health concern caused by NCDs in urban surroundings cannot be solved by health care alone; a multidisciplinary approach is mandatory.

Identifying characteristics of indicators of sedentary behavior using objective measurements

Objective

Recent attention has been focused on sedentary behavior (SB) affecting health outcomes, but the characteristics of indicators reflecting SB remain to be identified. This cross‐sectional study aims to identify the characteristics of indicators of SB, focusing on the examination of correlations, reliability, and validity of sedentary variables assessed by the smartphone app.

Method

Objectively measured data of SB of eligible 46 Japanese workers obtained from smartphones were used. We assessed the characteristics of current indicators being used with a 10‐minute or 30‐minute thresholds, in addition to the conventional indicators of total sedentary time, mean sedentary bout duration, and total number of sedentary bouts. They were evaluated from three perspectives: (a) association among the indicators, (b) reliability of the indicators, and (c) criterion validity.

Results

Total sedentary time under 10 minutes (U10) and U30 had negative associations with Total sedentary time (r = −.47 and −.21 respectively). The correlation between Mean sedentary bout duration and Total number of sedentary bouts was −.84, whereas between Mean sedentary bout duration 10, 30 and Total number of sedentary bouts were −.54 and −.21, respectively. The intraclass correlation coefficients of almost all indicators were around .80. Mean sedentary bout duration, Mean sedentary bout duration 10, Total number of sedentary bouts, Total sedentary time 30, U30 and U10 have significant differences between three BMI groups.

Conclusion

This study comprehensively revealed the rationale of advantage in the current indicator being used with a 10‐minute or 30‐minute threshold, rather than the conventional total amount of SB.

Sedentary behavior in the city of São Paulo, Brazil: ISA-Capital 2015

INTRODUCTION

The excessive sitting time involved in activities of low energy expenditure (sedentary behavior) can contribute to the development of chronic diseases. Assessing factors related to this behavior in a population is important to identify its most vulnerable segments.

OBJECTIVE

To describe sitting time distribution in the adult population of São Paulo City according to sociodemographic and environmental characteristics and health conditions.

METHODS

This is a cross-sectional study involving 2,512 individuals, aged 20 to 65 years, who participated in the Health Survey in the City of São Paulo (Inquérito de Saúde no Município de São Paulo - ISA-Capital) 2015. Data relating to sitting time were collected using the International Physical Activity Questionnaire (IPAQ), initially analyzed continuously, and, afterward, dichotomized by the median to analyze categorical variables.

RESULTS

The total sitting time median in the sample was 180 min/day. The variables that, after adjustments, remained related to sedentary behavior were: schooling (prevalence ratio - PR = 1.41; 95% confidence interval - 95%CI 1.35 - 1.48); marital status (PR = 1.05; 95%CI 1.02 - 1.08); neighborhood safety (PR = 0.96; 95%CI 0.93 - 0.99); age (PR = 0.91; 95%CI 0.87 - 0.95); income (PR = 1.07; 95%CI 1.00 - 1.15); self-rated health (PR = 1.03; 95%CI 1.01 - 1.07), and gender (PR = 0.96; 95%CI 0.94 - 0.99).

CONCLUSION

The most vulnerable groups to sedentary behavior in this population are: younger males, with higher schooling and income, who live in neighborhoods considered safe, unmarried, and with negative self-rated health.

Direct healthcare costs of sedentary behaviour in the UK

BACKGROUND

Growing evidence indicates that prolonged sedentary behaviour increases the risk of several chronic health conditions and all-cause mortality. Sedentary behaviour is prevalent among adults in the UK. Quantifying the costs associated with sedentary behaviour is an important step in the development of public health policy.

METHODS

National Health Service (NHS) costs associated with prolonged sedentary behaviour (≥6 hours/day) were estimated over a 1-year period in 2016-2017 costs. We calculated a population attributable fraction (PAF) for five health outcomes (type 2 diabetes, cardiovascular disease [CVD], colon cancer, endometrial cancer and lung cancer). Adjustments were made for potential double-counting due to comorbidities. We also calculated the avoidable deaths due to prolonged sedentary behaviour using the PAF for all-cause mortality.

RESULTS

The total NHS costs attributable to prolonged sedentary behaviour in the UK in 2016-2017 were £0.8 billion, which included expenditure on CVD (£424 million), type 2 diabetes (£281 million), colon cancer (£30 million), lung cancer (£19 million) and endometrial cancer (£7 million). After adjustment for potential double-counting, the estimated total was £0.7 billion. If prolonged sedentary behaviour was eliminated, 69 276 UK deaths might have been avoided in 2016.

CONCLUSIONS

In this conservative estimate of direct healthcare costs, prolonged sedentary behaviour causes a considerable burden to the NHS in the UK. This estimate may be used by decision makers when prioritising healthcare resources and investing in preventative public health programmes.

Impact of Sedentary Time on Chronic Kidney Disease and Disability Incidence in Community-Dwelling Japanese Older Adults: A 4-Year Prospective Cohort Study

This study examined the association between the estimated glomerular filtration rate (eGFR) and disability incidence according to sedentary time in community-dwelling Japanese older adults. This prospective cohort study sampled 5,104 community-dwelling older adults (≥65 years) enrolled in a health promotion study in a general population. The participants (n = 4,457; ≥65 years) were monitored for inclusion in the long-term care insurance system for 4 years. This study used blood samples to assess eGFR. Cox proportional regression analysis was used to determine predictors of disability. In total, 461 participants (10.3%) became newly certified as needing long-term care insurance services. Cox regression models were adjusted for multiple confounders: eGFR < 45 ml/min/1.73 m² (hazard ratio = 1.741, 95% confidence interval [1.193-2.539]) and eGFR < 45 ml/min/1.73 m² with high sedentary time (≥8 hr) (hazard ratio = 4.367, 95% confidence interval [2.021-9.438]) remained significantly associated with disability incidence. Our findings suggest that in the case of chronic kidney disease, the disability incidence rate may be affected by sedentary time.

Breaks in Sitting Time: Effects on Continuously Monitored Glucose and Blood Pressure

PURPOSE

We examined the effects of interrupting prolonged sitting with multiple 2-min walking breaks or one 30-min continuous walking session on glucose control and ambulatory blood pressure (ABP).

METHODS

Ten overweight/obese, physically inactive participants (five men; 32 ± 5 yr; BMI, 30.3 ± 4.6 kg·m) participated in this randomized four-trial crossover study, with each trial performed on a separate, simulated workday lasting 9 h: 1) 30 min of continuous moderate-intensity (30-min MOD) walking at 71% ± 4% HRmax; 2) 21 × 2 min bouts of moderate-intensity (2-min MOD) walking at 53% ± 5% HRmax, each performed every 20 min (42 min total); 3) 8 × 2 min bouts of vigorous-intensity (2-min VIG) walking at 79% ± 4% HRmax, each performed every hour (16 min total); 4) 9 h of prolonged sitting (SIT). Participants underwent continuous interstitial glucose monitoring and ABP monitoring during and after the simulated workday spent in the laboratory, with primary data analysis from 12:30 h to 07:00 h the next morning.

RESULTS

Compared with SIT (5.6 ± 1.1 mmol·L), mean 18.7-h glucose was lower during the 2-min MOD (5.2 ± 1.1 mmol·L) and 2-min VIG (5.4 ± 0.9 mmol·L) trials and mean 18.7-h glucose during the 30-min MOD trial (5.1 ± 0.8 mmol·L) was lower than all other trials (P < 0.001). Postprandial glucose was approximately 7% to 13% lower during all trials compared with SIT (P < 0.001), with 30-min MOD having the greatest effect. Only the 30-min MOD trial was effective in reducing systolic ABP from 12:30 to 07:00 h (119 ± 15 mm Hg) when compared with SIT (122 ± 16 mm Hg; P < 0.05).

CONCLUSIONS

Replacing sitting with 2-min MOD walking every 20 min or 2 min of vigorous-intensity walking every hour during a simulated workday reduced 18.7 h and postprandial glucose, but only 30-min MOD walking was effective for reducing both glucose and systolic ABP.

Evidence of increasing sedentarism in Mexico City during the last decade: Sitting time prevalence, trends, and associations with obesity and diabetes

INTRODUCTION

Sedentary behaviors such as sitting time are associated with obesity and diabetes independently of total reported physical activity. This study aimed to describe the current sitting time/day prevalence and trends and to examine the association of sitting time with sociodemographic and clinical variables in Mexico City.

METHODS

Two cross-sectional representative surveys in Mexico City were used for this analysis (2006: n = 1148 and 2015: n = 1329). Sedentary behavior questions from the International Physical Activity Questionnaire included time spent sitting on a weekday in the last week or on a Wednesday. Sitting time /day was divided into deciles, and participants in the highest decile (≥ 420 minutes/day) were classified within the high sitting category; others were classified in the low sitting time category. Multivariate logistic regression was used to evaluate the associations of sitting time with sociodemographic and clinical indicators, controlling for confounders and testing for potential interactions.

RESULTS

A total of 13.7% (2006) and 14.8% (2015) adults were classified in the highest sitting time category (≥ 420 minutes/day). There was a significant increase in the average sitting time/day between the surveys (216.0 minutes in 2006 vs. 233.3 minutes in 2015, p < 0.001). In 2015, men, those aged 20-49 years, those in low-intensity jobs, students, and those with a high socioeconomic level were more likely to be in the highest sitting time category. Participants with overweight/obesity (OR = 2.37, 95% CI: 1.11, 5.09) and those with high glucose levels (survey finding) (OR = 2.34, 95% CI: 1.04, 5.25) were more likely to report sitting time in the highest category.

DISCUSSION

Sitting time/day prevalence increased 8%, and average daily sitting minutes significantly increased by 8.2% (18 minutes) in the nine-year study period (2006-2015). Current public health policies should consider strategies not only for increasing physical activity levels, but also for reducing sitting time/day among the population as a measure to fight the growing epidemic of obesity and diabetes in Mexico.

A Health Behavior Score is Associated with Hypertension and Obesity Among Australian Adults

OBJECTIVE

To investigate associations between a health behavior score and prevalence of hypertension and overweight/obesity.

METHODS

Adults (n = 4,609; 19-85 years) were included from the cross-sectional Australian National Nutrition and Physical Activity Survey. A health behavior score was derived based on individuals meeting recommendations for diet quality, smoking, physical activity, sedentary time, and sleep. Poisson regression estimated the prevalence ratio (PR) of hypertension and overweight/obesity by health behavior score.

RESULTS

Individuals meeting three (PR: 0.67, 95% CI: 0.54-0.86; P = 0.001), four (PR: 0.76, 95% CI: 0.59-0.96; P = 0.024), or five (PR: 0.63, 95% CI: 0.43-0.94; P = 0.024) health behavior recommendations had a lower hypertension PR compared with those meeting zero or one recommendation. The PR of overweight/obesity was lower in individuals meeting three (PR: 0.98, 95% CI: 0.95-1.02; P = 0.019), four (PR: 0.95, 95% CI: 0.91-0.99; P = 0.019), or five (PR: 0.94, 95% CI: 0.90-0.99; P = 0.022) recommendations compared with those meeting zero or one.

CONCLUSIONS

Hypertension and overweight/obesity prevalence were lower in individuals who had above-average diet quality, never smoked, were physically active, spent less time sedentary, and got adequate sleep. These findings support a holistic approach to public health recommendations.

Reliability of smartphone-based gait measurements for quantification of physical activity/inactivity levels

Objectives:

Objective measurements using built-in smartphone sensors that can measure physical activity/inactivity in daily working life have the potential to provide a new approach to assessing workers' health effects. The aim of this study was to elucidate the characteristics and reliability of built-in step counting sensors on smartphones for development of an easy-to-use objective measurement tool that can be applied in ergonomics or epidemiological research.

Methods:

To evaluate the reliability of step counting sensors embedded in seven major smartphone models, the 6-minute walk test was conducted and the following analyses of sensor precision and accuracy were performed: 1) relationship between actual step count and step count detected by sensors, 2) reliability between smartphones of the same model, and 3) false detection rates when sitting during office work, while riding the subway, and driving.

Results:

On five of the seven models, the inter-class correlations coefficient (ICC _(3,1)) showed high reliability with a range of 0.956-0.993. The other two models, however, had ranges of 0.443-0.504 and the relative error ratios of the sensor-detected step count to the actual step count were ±48.7%-49.4%. The level of agreement between the same models was ICC _(3,1): 0.992-0.998. The false detection rates differed between the sitting conditions.

Conclusions:

These results suggest the need for appropriate regulation of step counts measured by sensors, through means such as correction or calibration with a predictive model formula, in order to obtain the highly reliable measurement results that are sought in scientific investigation.

Associations between quality of life and duration and frequency of physical activity and sedentary behaviour: Baseline findings from the WALK 2.0 randomised controlled trial

While physical and mental health benefits of regular physical activity are well known, increasing evidence suggests that limiting sedentary behaviour is also important for health. Evidence shows associations of physical activity and sedentary behaviour with health-related quality of life (HRQoL), however, these findings are based predominantly on duration measures of physical activity and sedentary behaviour (e.g., minutes/week), with less attention on frequency measures (e.g., number of bouts). We examined the association of HRQoL with physical activity and sedentary behaviour, using both continuous duration (average daily minutes) and frequency (average daily bouts≥10 min) measures. Baseline data from the WALK 2.0 trial were analysed. WALK 2.0 is a randomised controlled trial investigating the effects of Web 2.0 applications on engagement, retention, and subsequent physical activity change. Daily physical activity and sedentary behaviour (duration = average minutes, frequency = average number of bouts ≥10 minutes) were measured (ActiGraph GT3X) across one week, and HRQoL was assessed with the ‘general health’ subscale of the RAND 36-Item Health Survey. Structural equation modelling was used to evaluate associations. Participants (N = 504) were 50.8±13.1 (mean±SD) years old with a BMI of 29.3±6.0. The 465 participants with valid accelerometer data engaged in an average of 24.0±18.3 minutes and 0.64±0.74 bouts of moderate-vigorous physical activity per day, 535.2±83.8 minutes and 17.0±3.4 bouts of sedentary behaviour per day, and reported moderate-high general HRQoL (64.5±20.0). After adjusting for covariates, the duration measures of physical activity (path correlation = 0.294, p<0.05) and sedentary behaviour were related to general HRQoL (path coefficient = -0.217, p<0.05). The frequency measure of physical activity was also significant (path coefficient = -0.226, p<0.05) but the frequency of sedentary behaviour was not significantly associated with general HRQoL. Higher duration levels of physical activity in fewer bouts, and lower duration of sedentary behaviour are associated with better general HRQoL. Further prospective studies are required to investigate these associations in different population groups over time.

Evaluating the Consistency of Current Mainstream Wearable Devices in Health Monitoring: A Comparison Under Free-Living Conditions

Background

Wearable devices are gaining increasing market attention; however, the monitoring accuracy and consistency of the devices remains unknown.

Objective

The purpose of this study was to assess the consistency of the monitoring measurements of the latest wearable devices in the state of normal activities to provide advice to the industry and support to consumers in making purchasing choices.

Methods

Ten pieces of representative wearable devices (2 smart watches, 4 smart bracelets of Chinese brands or foreign brands, and 4 mobile phone apps) were selected, and 5 subjects were employed to simultaneously use all the devices and the apps. From these devices, intact health monitoring data were acquired for 5 consecutive days and analyzed on the degree of differences and the relationships of the monitoring measurements ​​by the different devices.

Results

The daily measurements by the different devices fluctuated greatly, and the coefficient of variation (CV) fluctuated in the range of 2-38% for the number of steps, 5-30% for distance, 19-112% for activity duration, .1-17% for total energy expenditure (EE), 22-100% for activity EE, 2-44% for sleep duration, and 35-117% for deep sleep duration. After integrating the measurement data of 25 days among the devices, the measurements of the number of steps (intraclass correlation coefficient, ICC=.89) and distance (ICC=.84) displayed excellent consistencies, followed by those of activity duration (ICC=.59) and the total EE (ICC=.59) and activity EE (ICC=.57). However, the measurements for sleep duration (ICC=.30) and deep sleep duration (ICC=.27) were poor. For most devices, there was a strong correlation between the number of steps and distance measurements (R²>.95), and for some devices, there was a strong correlation between activity duration measurements and EE measurements (R²>.7). A strong correlation was observed in the measurements of steps, distance and EE from smart watches and mobile phones of the same brand, Apple or Samsung (r>.88).

Conclusions

Although wearable devices are developing rapidly, the current mainstream devices are only reliable in measuring the number of steps and distance, which can be used as health assessment indicators. However, the measurement consistencies of activity duration, EE, sleep quality, and so on, are still inadequate, which require further investigation and improved algorithms.

Is More Area-Level Crime Associated With More Sitting and Less Physical Activity? Longitudinal Evidence From 37,162 Australians

Does a rise in crime result in increased sitting time and a reduction in physical activity? We used unobserved ("fixed")-effects models to examine associations between change in objectively measured crime (nondomestic violence, malicious damage, breaking and entering, and stealing, theft, and robbery) in Australia and measures of sitting time, walking, and moderate-to-vigorous physical activity (MVPA) in a residentially stable sample of 17,474 men and 19,688 women at baseline (2006-2008) and follow-up (2009-2010). Possible sources of time-varying confounding included age, income, economic status, relationship (couple) status, and physical functioning. In adjusted models, an increase in all crimes of 10 counts per 1,000 residents was associated with an increase in sitting time (hours/day) among men (β = 0.21, 95% confidence interval (CI): 0.17, 0.25) and women (β = 0.18, 95% CI: 0.15, 0.22). Counterintuitively, the same increase in crime was also associated with an increase in the weekly number of ≥10-minute walking sessions (men: rate ratio (RR) = 1.01 (95% CI: 1.01, 1.02); women: RR = 1.00 (95% CI: 0.99, 1.01)) and MVPA sessions (men: RR = 1.02 (95% CI: 1.02, 1.03); women: RR = 1.01 (95% CI: 1.00, 1.02)). Similar associations were found for the other area-level crime indicators. While area-level crime prevention may be considered a lever for promoting more active lifestyles, these results suggest that the association is not unequivocal.

Using Sit-to-Stand Workstations in Offices: Is There a Compensation Effect?

PURPOSE

Sit-to-stand workstations are becoming common in modern offices and are increasingly being implemented in sedentary behavior interventions. The purpose of this study was to examine whether the introduction of such a workstation among office workers leads to reductions in sitting during working hours, and whether office workers compensate for any reduction in sitting at work by increasing sedentary time and decreasing physical activity (PA) outside work.

METHODS

Office workers (n = 40; 55% female) were given a WorkFit-S, sit-to-stand workstation for 3 months. Participants completed assessments at baseline (before workstation installation), 1 wk and 6 wk after the introduction of the workstation, and again at 3 months (postintervention). Posture and PA were assessed using the activPAL inclinometer and ActiGraph GT3X+ accelerometer, which participants wore for 7 d during each measurement phase.

RESULTS

Compared with baseline, the proportion of time spent sitting significantly decreased (75% ± 13% vs 52% ± 16% to 56% ± 13%), and time spent standing and in light activity significantly increased (standing: 19% ± 12% vs 32% ± 12% to 37% ± 15%, light PA: 14% ± 4% vs 16% ± 5%) during working hours at all follow-up assessments. However, compared with baseline, the proportion of time spent sitting significantly increased (60% ± 11% vs 66% ± 12% to 68% ± 12%) and light activity significantly decreased (21% ± 5% vs 19% ± 5%) during nonworking hours across the follow-up measurements. No differences were seen in moderate-to-vigorous activity during nonworking hours throughout the study.

CONCLUSION

The findings suggest that introducing a sit-to-stand workstation can significantly reduce sedentary time and increase light activity levels during working hours. However, these changes were compensated for by reducing activity and increasing sitting outside of working hours. An intervention of a sit-to-stand workstation should be accompanied by an intervention outside of working hours to limit behavior compensation.

Correlates of sedentary time in different age groups: results from a large cross sectional Dutch survey

BACKGROUND

Evidence shows that prolonged sitting is associated with an increased risk of mortality, independent of physical activity (PA). The aim of the study was to identify correlates of sedentary time (ST) in different age groups and day types (i.e. school-/work day versus non-school-/non-work day).

METHODS

The study sample consisted of 1895 Dutch children (4-11 years), 1131 adolescents (12-17 years), 8003 adults (18-64 years) and 1569 elderly (65 years and older) who enrolled in the Dutch continuous national survey 'Injuries and Physical Activity in the Netherlands' between 2006 and 2011. Respondents estimated the number of sitting hours during a regular school-/workday and a regular non-school/non-work day. Multiple linear regression analyses on cross-sectional data were used to identify correlates of ST.

RESULTS

Significant positive associations with ST were observed for: higher age (4-to-17-year-olds and elderly), male gender (adults), overweight (children), higher education (adults ≥ 30 years), urban environment (adults), chronic disease (adults ≥ 30 years), sedentary work (adults), not meeting the moderate to vigorous PA (MVPA) guideline (children and adults ≥ 30 years) and not meeting the vigorous PA (VPA) guideline (4-to-17-year-olds). Correlates of ST that significantly differed between day types were working hours and meeting the VPA guideline. More working hours were associated with more ST on school-/work days. In children and adolescents, meeting the VPA guideline was associated with less ST on non-school/non-working days only.

CONCLUSIONS

This study provides new insights in the correlates of ST in different age groups and thus possibilities for interventions in these groups. Correlates of ST appear to differ between age groups and to a lesser degree between day types. This implies that interventions to reduce ST should be age specific. Longitudinal studies are needed to draw conclusions on causality of the relationship between identified correlates and ST.

Comparing the effects of two different break strategies on occupational sedentary behavior in a real world setting: A randomized trial

Developing interventions to reduce sedentary behavior in the workplace is an important public health priority. Furthermore, research is needed to determine whether different approaches to breaking up prolonged sitting during the workday are equally feasible and effective. Thus, the purpose of this study was to determine whether varying the frequency and duration of activity breaks during the workday would differentially impact sedentary behavior and health outcomes. Inactive females (N = 49) working full-time sedentary jobs were recruited for this parallel-group randomized trial. Participants were randomly assigned to take short, frequent breaks from sitting (1–2 min every half hour; SB) or longer, planned breaks from sitting (two 15-minute breaks per workday; LB) during each workday across an 8-week intervention. Sedentary time and health outcomes were assessed at baseline and post-intervention. The study ran from March 2014–June 2015. Results showed sedentary time during the workday decreased significantly in the SB group (− 35.6 min; d = − 0.75; p = 0.03), but did not change in the LB group (+ 4.5 min; d = 0.12). Participants in the SB group also demonstrated small-to-moderate declines in total cholesterol (d = − 0.33; p = 0.10), triglycerides (d = − 0.38; p = 0.06) and fasting blood glucose (d = − 0.29; p = 0.01) from pre to post-intervention. Health outcomes did not change in the LB group. This study demonstrated that taking short, frequent breaks from sitting during the workday is a feasible and effective approach for reducing sedentary time at work. These results have implications for the development of public health messages addressing sedentary behavior, and inform future interventions to reduce sedentary time in the workplace.

Trial registration

This study is registered at www.clinicaltrials.gov: NCT02609438.

•

Adherence rates were 69% (short breaks) and 61% (long breaks) across 8 weeks.

•

Sedentary time declined in participants who took short frequent breaks from sitting.

•

Fasting blood glucose improved post-intervention in the short break group only.

•

Taking short, frequent breaks from sitting may be a feasible and effective approach.

Balanced: a randomised trial examining the efficacy of two self-monitoring methods for an app-based multi-behaviour intervention to improve physical activity, sitting and sleep in adults

BACKGROUND

Many adults are insufficiently physically active, have prolonged sedentary behaviour and report poor sleep. These behaviours can be improved by interventions that include education, goal setting, self-monitoring, and feedback strategies. Few interventions have explicitly targeted these behaviours simultaneously or examined the relative efficacy of different self-monitoring methods.

METHODS/DESIGN

This study aims to compare the efficacy of two self-monitoring methods in an app-based multi-behaviour intervention to improve objectively measured physical activity, sedentary, and sleep behaviours, in a 9 week 2-arm randomised trial. Participants will be adults (n = 64) who report being physically inactive, sitting >8 h/day and frequent insufficient sleep (≥14 days out of last 30). The "Balanced" intervention is delivered via a smartphone 'app', and includes education materials (guidelines, strategies to promote change in behaviour), goal setting, self-monitoring and feedback support. Participants will be randomly allocated to either a device-entered or user-entered self-monitoring method. The device-entered group will be provided with a activity tracker to self-monitor behaviours. The user-entered group will recall and manually record behaviours. Assessments will be conducted at 0, 3, 6, and 9 weeks. Physical activity, sedentary behaviour and sleep-wake behaviours will be measured using the wrist worn Geneactiv accelerometer. Linear mixed models will be used to examine differences between groups and over time using an alpha of 0.01.

DISCUSSION

This study will evaluate an app-based multi-behavioural intervention to improve physical activity, sedentary behaviour and sleep; and the relative efficacy of two different approaches to self-monitoring these behaviours. Outcomes will provide information to inform future interventions and self-monitoring targeting these behaviours.

TRIAL REGISTRATION

ACTRN12615000182594 (Australian New Zealand Clinical Trials Registry. Registry URL: www.anzctr.org.au ; registered prospectively on 25 February 2015).

Too much sitting and all-cause mortality: is there a causal link?

Background

Sedentary behaviours (time spent sitting, with low energy expenditure) are associated with deleterious health outcomes, including all-cause mortality. Whether this association can be considered causal has yet to be established.

Using systematic reviews and primary studies from those reviews, we drew upon Bradford Hill’s criteria to consider the likelihood that sedentary behaviour in epidemiological studies is likely to be causally related to all-cause (premature) mortality.

Methods

Searches for systematic reviews on sedentary behaviours and all-cause mortality yielded 386 records which, when judged against eligibility criteria, left eight reviews (addressing 17 primary studies) for analysis. Exposure measures included self-reported total sitting time, TV viewing time, and screen time. Studies included comparisons of a low-sedentary reference group with several higher sedentary categories, or compared the highest versus lowest sedentary behaviour groups. We employed four Bradford Hill criteria: strength of association, consistency, temporality, and dose–response. Evidence supporting causality at the level of each systematic review and primary study was judged using a traffic light system depicting green for causal evidence, amber for mixed or inconclusive evidence, and red for no evidence for causality (either evidence of no effect or no evidence reported).

Results

The eight systematic reviews showed evidence for consistency (7 green) and temporality (6 green), and some evidence for strength of association (4 green). There was no evidence for a dose–response relationship (5 red). Five reviews were rated green overall. Twelve (67 %) of the primary studies were rated green, with evidence for strength and temporality.

Conclusions

There is reasonable evidence for a likely causal relationship between sedentary behaviour and all-cause mortality based on the epidemiological criteria of strength of association, consistency of effect, and temporality.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3307-3) contains supplementary material, which is available to authorized users.

Association between sedentary time and kidney function in community-dwelling elderly Japanese people

AIM

The aim of the present study was to evaluate the relationship between sedentary time and declines in kidney function among community-dwelling older adults.

METHODS

Participants comprised 10 242 community-dwelling older adults who were participating in the National Center for Geriatrics and Gerontology - Study of Geriatric Syndromes. Sedentary time was determined by asking participants to record the total amount of hours usually spent sitting each day, with values divided into quartiles of 0 to <4 h (reference), 4 to <6 h, 6 to <8 h and ≥8 h of sitting time per day. The estimated glomerular filtration rate was determined according to creatinine levels, and participants were classified into two categories: ≥60.0 or <60 mL/min/1.73 m² .

RESULTS

After multivariate adjustment, the highest quartiles of sedentary time showed a higher rate of kidney function decline than those in the lowest quartile (odds ratio 1.42, 95% CI 1.02-1.37). In addition, participants with a history of cancer (odds ratio 1.18, 95% CI 1.01-1.39) or hypertension (odds ratio 1.38; 95% CI 1.07-1.60) had significantly increased risks of kidney function decline in the highest sedentary time group, regardless of multivariate control. Furthermore, analyses showed an increased risk of kidney function decline for a history of both cancer and hypertension (odds ratio 2.02, 95% CI 1.08-3.80).

CONCLUSIONS

A higher level of sedentary time was associated with kidney function decline among community-dwelling older adults. Geriatr Gerontol Int 2017; 17: 730-736.

Recruitment, screening, and baseline participant characteristics in the WALK 2.0 study: A randomized controlled trial using web 2.0 applications to promote physical activity

OBJECTIVE

To describe in detail the recruitment methods and enrollment rates, the screening methods, and the baseline characteristics of a sample of adults participating in the Walk 2.0 Study, an 18 month, 3-arm randomized controlled trial of a Web 2.0 based physical activity intervention.

METHODS

A two-fold recruitment plan was developed and implemented, including a direct mail-out to an extract from the Australian Electoral Commission electoral roll, and other supplementary methods including email and telephone. Physical activity screening involved two steps: a validated single-item self-report instrument and the follow-up Active Australia Questionnaire. Readiness for physical activity participation was also based on a two-step process of administering the Physical Activity Readiness Questionnaire and, where needed, further clearance from a medical practitioner.

RESULTS

Across all recruitment methods, a total of 1244 participants expressed interest in participating, of which 656 were deemed eligible. Of these, 504 were later enrolled in the Walk 2.0 trial (77% enrollment rate) and randomized to the Walk 1.0 group (n = 165), the Walk 2.0 group (n = 168), or the Logbook group (n = 171). Mean age of the total sample was 50.8 years, with 65.2% female and 79.1% born in Australia.

CONCLUSION

The results of this recruitment process demonstrate the successful use of multiple strategies to obtain a diverse sample of adults eligible to take part in a web-based physical activity promotion intervention. The use of dual screening processes ensured safe participation in the intervention. This approach to recruitment and physical activity screening can be used as a model for further trials in this area.

The association between time spent in sedentary behaviors and blood pressure: a systematic review and meta-analysis

BACKGROUND AND OBJECTIVE

Sedentary behaviors, defined as waking behaviors with low energy expenditure while sitting, are positively associated with several adverse health outcomes. However, the association between sedentary behaviors and blood pressure (BP) is inconclusive. This study aimed to conduct a systematic review and meta-analysis on the association between time spent in sedentary behaviors and BP.

METHODS

We searched PubMed, MEDLINE, and Web of Science for papers published before August 2014 that assessed the association between time spent in sedentary behaviors and BP. Studies on both adults and children were included. Only good quality studies were included. The pooled estimates of systolic BP (SBP) and diastolic BP (DBP) increase per hour of time spent in sedentary behaviors a day were computed using a fixed-effects model and a random-effects model, respectively. Another pooled estimate of odds ratio per hour of time spent in sedentary behaviors a day on having high BP was computed using a fixed-effects model. A sub-group analysis was conducted for studies using self-reported and objectively assessed time spent in sedentary behaviors separately.

RESULTS

A total of 31 papers of good quality were included in the systematic review, 18 of which found no association between time spent in sedentary behaviors and BP (58.1%). A total of 28 papers were included in the meta-analysis. Pooled effects showed that an additional hour of time spent in sedentary behaviors per day was associated with an increase of 0.06 mmHg (108,228 participants, 95% CI 0.01-0.11, p = 0.01) of SBP and 0.20 mmHg (107,791 participants, 95% CI 0.10-0.29, p < 0.001) of DBP. Accelerometer-assessed time spent in sedentary behaviors was not associated with either SBP (p = 0.06) or DBP (p = 0.33). The odds ratio (OR) of having high BP with an additional hour of time spent in sedentary behaviors per day was 1.02 (98,798 participants, 95% CI 1.003-1.03, p = 0.02).

CONCLUSIONS

Self-reported but not accelerometer-assessed time spent in sedentary behaviors was associated with BP. Further studies are warranted to determine the preventive effect of reducing sedentary behaviors on high BP.

Sitting and Activity Time in People With Stroke

BACKGROUND

Excessive sitting time is linked to cardiovascular disease morbidity. To date, no studies have accurately measured sitting time patterns in people with stroke.

OBJECTIVE

The purpose of this study was to investigate the amount and pattern of accumulation of sitting time, physical activity, and use of time in people with stroke compared with age-matched healthy peers.

DESIGN

This study used an observational design.

METHODS

Sitting time (total and time accumulated in prolonged, unbroken bouts of ≥30 minutes) was measured with an activity monitor. Physical activity and daily energy expenditure were measured using an accelerometer and a multisensory array armband, respectively. All monitors had a 7-day wear protocol. Participants recalled 1 day of activity (during monitor wear time) using the Multimedia Activity Recall for Children and Adults.

RESULTS

Sixty-three adults (40 with stroke and 23 age-matched healthy controls) participated. The participants (35% female, 65% male) had a mean age of 68.4 years (SD=10.0). Participants with stroke spent significantly more time sitting (X̅=10.9 h/d, SD=2.0) compared with controls (X̅=8.2 h/d, SD=2.0), with much of this sitting time prolonged (stroke group: X̅=7.4 h/d, SD=2.8; control group: X̅=3.7 h/d, SD=1.7). Participants with stroke accumulated most of their sitting time while watching television and in general quiet time, whereas control participants spent more time reading and on the computer. Physical activity and daily energy expenditure were lower in the stroke group compared with the control group.

LIMITATIONS

A sample of convenience was used to select participants for the stroke and control groups, which may reduce the generalizability of results.

CONCLUSIONS

Participants with stroke spent more time sitting and less time in activity than their age-matched peers. Further work is needed to determine whether reducing sitting time is feasible and leads to clinically important reductions in cardiovascular risk in this population.

Association between sedentary and physical activity patterns and risk factors of metabolic syndrome in Saudi men: A cross-sectional study

Background

This study examined the association between objectively measured physical activity patterns and risk factors of metabolic syndrome (MetS) in Saudi men.

Methods

The study was cross-sectional, and 84 healthy men from the Saudi population (age 37.6 ± 8.8 years, body mass index [BMI] 28.4 ± 5.4 kg/m²) were recruited. Measurements of physical activity were made using triaxial accelerometers over 7 consecutive days of leisure time physical activity. Waist circumference and blood pressure were measured, and fasting blood samples taken to measure glucose, high density lipoprotein cholesterol (HDL), and triglycerides (TG).

Results

A total 21.4 % of participants had three or more risk factors for MetS, with low HDL levels the most frequent factor. Light physical activity (LPA) and BMI explained 13 % of the variation in TG. Moderate to vigorous physical activity (MVPA) with a minimum 10-min per session (10-min MVPA), LPA, and BMI explained 16 % of the variation in HDL. Sedentary behavior was not significantly associated with risk factors of MetS, although odds ratios indicated that decreased sedentarism does have a protective effect against MetS.

Conclusions

LPA and 10-min MVPA were associated with elevated HDL levels among Saudi men. Future studies should confirm whether time spent physically active independent of intensity is an important factor in improving HDL levels.

Association Between Television Viewing Time and All-Cause Mortality: A Meta-Analysis of Cohort Studies

Findings on the association between television (TV) viewing and all-cause mortality in epidemiologic studies have been inconsistent. Therefore, we conducted a meta-analysis of data from prospective cohort studies to quantify this association. Relevant articles were identified by searching MEDLINE (PubMed; National Library of Medicine, Bethesda, Maryland) and EMBASE (Elsevier B.V., Amsterdam, the Netherlands) from inception to March 1, 2015, and reviewing the reference lists of retrieved articles. Study-specific results were pooled using a random-effects model. Of 2,578 citations identified by the search strategy, 10 cohort studies (61,494 deaths among 647,475 individuals) met the inclusion criteria. The summary relative risk of all-cause mortality for the highest category of TV viewing time versus the lowest was 1.33 (95% confidence interval: 1.20, 1.47), with heterogeneity among studies (I(2) = 66.7%, P(heterogeneity) = 0.001). In dose-response meta-analysis, TV viewing time was statistically significantly associated with all-cause mortality risk in a J-shaped fashion (P(nonlinearity) = 0.001). These results indicate that prolonged TV viewing time might increase the risk of all-cause mortality. Given the high prevalence of excessive TV viewing, public health recommendations or interventions aimed at decreasing the amount of TV viewing time in modern societies are warranted.

Contribution of regional brain melanocortin receptor subtypes to elevated activity energy expenditure in lean, active rats

Physical activity and non-exercise activity thermogenesis (NEAT) are crucial factors accounting for individual differences in body weight, interacting with genetic predisposition. In the brain, a number of neuroendocrine intermediates regulate food intake and energy expenditure (EE); this includes the brain melanocortin (MC) system, consisting of MC peptides as well as their receptors (MCR). MC3R and MC4R have emerged as critical modulators of EE and food intake. To determine how variance in MC signaling may underlie individual differences in physical activity levels, we examined behavioral response to MC receptor agonists and antagonists in rats that show high and low levels of physical activity and NEAT, that is, high- and low-capacity runners (HCR, LCR), developed by artificial selection for differential intrinsic aerobic running capacity. Focusing on the hypothalamus, we identified brain region-specific elevations in expression of MCR 3, 4, and also MC5R, in the highly active, lean HCR relative to the less active and obesity-prone LCR. Further, the differences in activity and associated EE as a result of MCR activation or suppression using specific agonists and antagonists were similarly region-specific and directly corresponded to the differential MCR expression patterns. The agonists and antagonists investigated here did not significantly impact food intake at the doses used, suggesting that the differential pattern of receptor expression may by more meaningful to physical activity than to other aspects of energy balance regulation. Thus, MCR-mediated physical activity may be a key neural mechanism in distinguishing the lean phenotype and a target for enhancing physical activity and NEAT.

Factors associated with higher sitting time in general, chronic disease, and psychologically-distressed, adult populations: findings from the 45 & up study

This study examined factors associated with higher sitting time in general, chronic disease, and psychologically-distressed, adult populations (aged ≥45 years). A series of logistic regression models examined potential socio-demographic and health factors associated with higher sitting (≥6hrs/day) in adults from the 45 and Up Study (n = 227,187), including four separate subsamples for analysis comprising those who had ever had heart disease (n = 26,599), cancer (n = 36,381), diabetes (n = 19,550) or psychological distress (n = 48,334). Odds of higher sitting were significantly (p<.01) associated with a number of factors across these groups, with an effect size of ORs≥1.5 observed for the high-income ≥$70,000AUD, employed full-time and severe physical limitations demographics. Identification of key factors associated with higher sitting time in this population-based sample will assist development of broad-based, public health and targeted strategies to reduce sitting-time. In particular, those categorized as being high-income earners, full-time workers, as well as those with severe physical limitations need to be of priority, as higher sitting appears to be substantial across these groups.

Helsinki alert of biodiversity and health

Urban living in built environments, combined with the use of processed water and food, may not provide the microbial stimulation necessary for a balanced development of immune function. Many chronic inflammatory disorders, including allergic, autoimmune, metabolic, and even some behavioural disorders, are linked to alteration in the human commensal microbiota. Sedentary lifestyle is associated with reduced exposure to a broad spectrum of environmental micro-organisms and surplus energy balance, both risk factors of chronic inflammatory disorders. According to the Biodiversity Hypothesis, an environment with diverse macrobiota and microbiota modifies and enriches the human microbiota, which in turn is crucial in the development and maintenance of appropriate immune function. These issues were discussed in the symposium 'Chronic Inflammation, Lifestyle and Environment', held in Helsinki, 20-22 August 2014, under the sponsorship of the Yrjö Jahnsson Foundation. This paper briefly outlines the recent findings in the context of the environment, lifestyle, and health; discusses the forces that undermine immune tolerance in urban environments; and highlights the possibilities to restore broken immune tolerance among urban dwellers, summarizing the main messages in four statements and calling for actions to combat major public health threats.

Sedentary time and its association with risk for disease incidence, mortality, and hospitalization in adults: a systematic review and meta-analysis

BACKGROUND

The magnitude, consistency, and manner of association between sedentary time and outcomes independent of physical activity remain unclear.

PURPOSE

To quantify the association between sedentary time and hospitalizations, all-cause mortality, cardiovascular disease, diabetes, and cancer in adults independent of physical activity.

DATA SOURCES

English-language studies in MEDLINE, PubMed, EMBASE, CINAHL, Cochrane Library, Web of Knowledge, and Google Scholar databases were searched through August 2014 with hand-searching of in-text citations and no publication date limitations.

STUDY SELECTION

Studies assessing sedentary behavior in adults, adjusted for physical activity and correlated to at least 1 outcome.

DATA EXTRACTION

Two independent reviewers performed data abstraction and quality assessment, and a third reviewer resolved inconsistencies.

DATA SYNTHESIS

Forty-seven articles met our eligibility criteria. Meta-analyses were performed on outcomes for cardiovascular disease and diabetes (14 studies), cancer (14 studies), and all-cause mortality (13 studies). Prospective cohort designs were used in all but 3 studies; sedentary times were quantified using self-report in all but 1 study. Significant hazard ratio (HR) associations were found with all-cause mortality (HR, 1.240 [95% CI, 1.090 to 1.410]), cardiovascular disease mortality (HR, 1.179 [CI, 1.106 to 1.257]), cardiovascular disease incidence (HR, 1.143 [CI, 1.002 to 1.729]), cancer mortality (HR, 1.173 [CI, 1.108 to 1.242]), cancer incidence (HR, 1.130 [CI, 1.053 to 1.213]), and type 2 diabetes incidence (HR, 1.910 [CI, 1.642 to 2.222]). Hazard ratios associated with sedentary time and outcomes were generally more pronounced at lower levels of physical activity than at higher levels.

LIMITATION

There was marked heterogeneity in research designs and the assessment of sedentary time and physical activity.

CONCLUSION

Prolonged sedentary time was independently associated with deleterious health outcomes regardless of physical activity.

PRIMARY FUNDING SOURCE

None.

Lack of exercise of "moderate to vigorous" intensity in people with low levels of physical activity is a major discriminant for sociodemographic factors and morbidity

INTRODUCTION

The aim is to examine the differences between participation at low and zero moderate to vigorous physical activity (MVPA) in relation to their trends and associations with known socio-demographic and health factors. We hypothesised that the number of people at zero MVPA level could be rising despite a parallel increase in the population meeting the recommended MVPA level. We also hypothesised that graded associations of sociodemographic and health factors exist across MVPA levels.

METHODS

Two independent population-based samples (n = 4320 [2004] and n = 2176 [1997]), were recruited with a stratified and random sampling procedure and interviewed at home by professional interviewers. The MVPA was assessed by validated questionnaire. The participants were classified into three MVPA levels: zero, low and recommended MVPA. The trend of each MVPA level was analysed with the standardized prevalence ratios. Correlates of low and zero MVPA levels were examined using multinomial logistic regression.

RESULTS

The population at zero and recommended MVPA levels rose between 1997-2004 by 12% (95% CI, 5-20%) and 7% (95% CI,-4-19%) respectively, while the population at low MVPA level decreased. At zero MVPA level, associative patterns were observed with sociodemographic and health factors which were different when compared to the population at low MVPA level.

CONCLUSIONS

Despite the slight increase of population meeting the recommended MVPA level, a higher trend of increase was observed at zero MVPA level. Both recommended and low MPVA levels increased their participation by absorbing participants from the low MVPA level. The sociodemographic profile of those with low MVPA was more similar to the population at recommended MVPA than at zero MVPA level. Methodological implications about the combination of light and moderate-intensity PA could be derived. The prevention of decline in actual low MVPA could change the trend of increase in the population at zero MVPA level, particularly among young adults.

Sedentary behavior as a mediator of type 2 diabetes

Over the past 5 years, the fastest growing new area of physical activity research centered around the concept that the large amount of time people spend sitting inactive may have significant physiological consequences hazardous to human health, including risk for type 2 diabetes and poor metabolism of lipids and glucose. Meta-analysis (10 studies) suggests there is a 112% greater relative risk associated with a large duration of sedentary behavior for type 2 diabetes. Meta-analysis also indicates significantly greater odds for metabolic syndrome. We also summarize results for 7 studies using objective measures of total sedentary time and focusing on cardiometabolic risks in persons at high risk for type 2 diabetes or already diagnosed with type 2 diabetes. The underlying hypothesis introduced in 2004 by the inactivity physiology paradigm has been that frequent and abundant contractile activity by certain types of skeletal muscle can have a potent influence on key physiological processes, even when the intensity is below that achieved through exercise. We explain some of the mechanisms for why the metabolism in slow-twitch oxidative skeletal muscle is key for understanding the healthy responses to low-intensity physical activity (LIPA). Findings from objective measures from inclinometry indicated that the quartile range for weekly sedentary time is ∼29 h/week. The total daily time that people sit, stand, and accumulate nonexercise steps is independent of traditionally recommended moderate-vigorous physical activity. The large amount of sedentary time associated with risk for disease can only be reduced significantly with safe and nonfatiguing LIPA, especially in the most at-risk proportion of the population. Importantly, experimental studies are starting to indicate that it will be especially insightful to understand the acute dose-response effects of LIPA in order to understand why reducing sedentary time can improve lipid and glucose metabolism for the prevention and treatment of chronic disorders related to type 2 diabetes.

Which population groups are most unaware of CVD risks associated with sitting time?

OBJECTIVE

Prolonged sitting is an emerging risk factor for poor health yet few studies have examined awareness of the risks associated with sitting behaviours. This study identifies the population subgroups with the highest levels of unawareness regarding the cardiovascular disease (CVD) risks associated with sitting behaviours.

METHOD

Adults (n=1256) living in Queensland, Australia completed a telephone-based survey in 2011, analysis conducted in 2013. The survey assessed participant's socio-demographic characteristics, physical activity, sitting behaviours and awareness of CVD risks associated with three sitting behaviours: 1) sitting for prolonged periods, 2), sitting for prolonged periods whilst also engaging in regular physical activity, and 3) breaking up periods of prolonged sitting with short activity breaks. Population sub-groups with the highest levels of unawareness were identified based on socio-demographic and behavioural characteristics using signal detection analysis.

RESULTS

Unawareness ranged from 23.3% to 67.0%. Age was the most important variable in differentiating awareness levels; younger adults had higher levels of unawareness. Body mass index, physical activity, TV viewing, employment status and time spent at work also identified population sub-groups.

CONCLUSION

Unawareness of CVD risk for prolonged sitting was moderately high overall. Younger adults had high levels of unawareness on all of the outcomes examined.

Longitudinal changes in health behaviours and body weight among Swedish school children--associations with age, gender and parental education--the SCIP school cohort

Background

In order to develop health promotion initiatives it is important to identify at what age gender and socioeconomic inequalities in health-related behaviours emerge. The aim of this longitudinal study was to analyse how health-related behaviours and weight status differed by age-group, gender, family socio-economic status and over time in three cohorts of school children.

Methods

All children in grades 2, 4 and 7 in a Swedish semi-urban municipality were invited to participate (n = 1,359) of which 813 (60%) consented. At baseline and after 2 years a health questionnaire was answered by all children. Height and weight was measured. Fourteen outcomes were analysed. The main and interaction effects of time, gender and parental educational level on the health-related behaviours, weight status and body mass index standard deviation score (BMIsds) were analysed by the Weighted Least Squares method for categorical repeated measures and Analysis of Variance.

Results

Nine of 12 health behaviours deteriorated over the two years: consumption of breakfast and lunch, vegetables and fruit, intake of sweetened drinks, TV viewing, club membership, being outdoors, and school recess activity; two behaviours were unchanged: intake of sweets, and active transport. Only sports participation increased with time. Girls consumed more vegetables, less sweetened drinks, performed less sports, were less physically active during recess, and had lower BMIsds, compared to boys. Those with more highly educated parents had more favourable or similar behaviours compared to those with less educated parents in 10 out of 12 health behaviours, the only exception being intake of sweets and being outdoors, and had lower BMIsds.

Conclusions

This study adds to our knowledge regarding the temporal development of health behaviours and weight status in school children. Differences with regard to gender and socioeconomic status were seen already at a young age. These results contribute to our understanding of several important determinants of obesity and chronic diseases and may inform future interventions regarding how to decrease gender and social inequalities in health.

Correlates of resistance training in post-treatment breast cancer survivors

PURPOSE

To explore demographic, health, social-cognitive and behavioural correlates of resistance training among post-treatment breast cancer survivors.

METHODS

A sample of 330 post-treatment breast cancer survivors recruited from across Australia completed a mailed questionnaire. A multivariate logistical regression model was used to test associations between independent variables and meeting the resistance training guidelines.

RESULTS

Less than a quarter of the participants were meeting the resistance training guidelines of at least two sessions of resistance training per week. Higher task self-efficacy for resistance training (p < 0.01) and greater goal-setting behaviour (p < 0.05) were identified as significant predictors of meeting the resistance training guidelines, with a one unit increase in task self-efficacy and goal setting, increasing the odds of meeting the resistance training guidelines by a factor of approximately 1.2 (odds ratio (OR) task self-efficacy = 1.23, 95 % confidence interval (CI) = 1.05-1.43; goal-setting OR = 1.20, 95 % CI = 1.04-1.38). No other variables significantly predicted meeting the resistance training guidelines in the multivariate analysis.

CONCLUSIONS

Strategies targeting task self-efficacy and goal-setting behaviours are likely to be important intervention components in resistance training interventions for breast cancer survivors.

IMPLICATIONS FOR CANCER SURVIVORS

The findings of this study will be useful for informing the development of evidence-based interventions aiming to promote resistance training among this group.

Cross-sectional associations between multiple lifestyle behaviors and health-related quality of life in the 10,000 Steps cohort

Background

The independent and combined influence of smoking, alcohol consumption, physical activity, diet, sitting time, and sleep duration and quality on health status is not routinely examined. This study investigates the relationships between these lifestyle behaviors, independently and in combination, and health-related quality of life (HRQOL).

Methods

Adult members of the 10,000 Steps project (n = 159,699) were invited to participate in an online survey in November-December 2011. Participant socio-demographics, lifestyle behaviors, and HRQOL (poor self-rated health; frequent unhealthy days) were assessed by self-report. The combined influence of poor lifestyle behaviors were examined, independently and also as part of two lifestyle behavior indices, one excluding sleep quality (Index 1) and one including sleep quality (Index 2). Adjusted Cox proportional hazard models were used to examine relationships between lifestyle behaviors and HRQOL.

Results

A total of 10,478 participants provided complete data for the current study. For Index 1, the Prevalence Ratio (p value) of poor self-rated health was 1.54 (p = 0.001), 2.07 (p≤0.001), 3.00 (p≤0.001), 3.61 (p≤0.001) and 3.89 (p≤0.001) for people reporting two, three, four, five and six poor lifestyle behaviors, compared to people with 0–1 poor lifestyle behaviors. For Index 2, the Prevalence Ratio (p value) of poor self-rated health was 2.26 (p = 0.007), 3.29 (p≤0.001), 4.68 (p≤0.001), 6.48 (p≤0.001), 7.91 (p≤0.001) and 8.55 (p≤0.001) for people reporting two, three, four, five, six and seven poor lifestyle behaviors, compared to people with 0–1 poor lifestyle behaviors. Associations between the combined lifestyle behavior index and frequent unhealthy days were statistically significant and similar to those observed for poor self-rated health.

Conclusions

Engaging in a greater number of poor lifestyle behaviors was associated with a higher prevalence of poor HRQOL. This association was exacerbated when sleep quality was included in the index.