Interventions to reduce sedentary behavior

Self-determined motivational health coaching ('SAMI') during outpatient treatment to promote physical activity of people with serious mental illness: a pilot controlled trial

BACKGROUND

Brief motivational coaching, integrated into health care; seems promising to address physical inactivity of people with serious mental illness (SMI).

AIMS

To test the impact of a self-determined health coaching approach (the "SAMI" intervention) during outpatient mental health treatment on moderate-to-vigorous physical activity (MVPA) of people with SMI.

METHODS

Adults (mean age = 41.9, SD = 10.9) with an ICD-10 diagnosis of mental illness were semi-randomized to the SAMI-intervention group (IG) or control group (CG). The IG received 30 minutes of health coaching based on the self-determination theory (SDT). MVPA and sedentary time (ST) were measured with the International Physical Activity Questionnaire - short form (IPAQ-SF) and symptoms of mental illness with the Brief Symptom Inventory (BSI-18), each at baseline and follow-up (3-4 months). Differences in primary (MVPA) and secondary (ST, BSI-18) outcomes were evaluated using negative binomial regressions and general linear models.

RESULTS

In the IG (n = 30), MVPA increased from 278 (interquartile range [IQR] = 175-551) to 435 (IQR = 161-675) min/week compared to a decrease from 250 (IQR = 180-518) to 155 (IQR = 0-383) min/week in the CG (n = 26; adjusted relative difference at follow-up: Incidence Rate Ratio [IRR] = 2.14, 95% CI: 1.17-3.93, p = 0.014). There were no statistically significant differences in ST and BSI-18.

CONCLUSIONS

Brief self-determined health coaching during outpatient treatment could increase post-treatment MVPA in people with SMI, potentially up to a clinically relevant level. However, great uncertainty (for all outcomes) weakens the assessment of clinical relevance.

Activity-Induced Pain as a Predictor of Sedentary Behavior Among Midlife Adults

Purpose: Midlife adults have been estimated to spend over half of their waking time engaging in sedentary behavior, and greater sedentary behavior has been associated with a reduced likelihood of successful aging. Moreover, more than one-quarter of midlife adults report chronic pain, and there is reason to believe that pain may contribute to sedentary behavior among this population. The goal of these analyses was to test associations between self-reported increases in pain during activity and subsequent sedentary behavior among a sample of midlife adults with chronic pain. Methods: Participants included 200 midlife adults (age 50-64) who reported chronic pain and completed an online prospective survey. Activity-induced pain was assessed at baseline and total time spent engaging in sedentary behavior was assessed at baseline, 1-week, and 4-week follow-up assessments. Results: Activity-induced pain predicted greater sedentary behavior at 1-week (p < .05) and 4-week (p < .01) follow-up assessments, even after controlling for chronic pain intensity and baseline sedentary behavior. Conclusions: Activity-induced pain may represent an important mechanism underlying sedentary behavior among midlife adults with chronic pain, and programs designed to reduce sedentary behavior among this population may benefit from tailoring to account for the antithetical influence of activity-induced pain. Indeed, the current findings suggest that mitigating the extent to which pain increases during activity may be more important than reducing overall pain intensity when attempting to decrease sedentary behavior among this population. This and future work have the potential to inform the refinement of tailored interventions.

Lessons and Untapped Potential of Smartphone-Based Physical Activity Interventions for Mental Health: Narrative Review

BACKGROUND

Physical activity has well-known and broad health benefits, including antidepressive and anxiolytic effects. However, only approximately half of Americans meet even the minimum exercise recommendations. Individuals with anxiety, depression, or related conditions are even less likely to do so. With the advent of mobile sensors and phones, experts have quickly noted the utility of technology for the enhanced measurement of and intervention for physical activity. In addition to being more accessible than in-person approaches, technology-driven interventions may uniquely engage key mechanisms of behavior change such as self-awareness.

OBJECTIVE

This study aims to provide a narrative overview and specific recommendations for future research on smartphone-based physical activity interventions for psychological disorders or concerns.

METHODS

In this paper, we summarized early efforts to adapt and test smartphone-based or smartphone-supported physical activity interventions for mental health. The included articles described or reported smartphone-delivered or smartphone-supported interventions intended to increase physical activity or reduce sedentary behavior and included an emotional disorder, concern, or symptom as an outcome measure. We attempted to extract details regarding the intervention designs, trial designs, study populations, outcome measures, and inclusion of adaptations specifically for mental health. In taking a narrative lens, we drew attention to the type of work that has been done and used these exemplars to discuss key directions to build on.

RESULTS

To date, most studies have examined mental health outcomes as secondary or exploratory variables largely in the context of managing medical concerns (eg, cancer and diabetes). Few trials have recruited psychiatric populations or explicitly aimed to target psychiatric concerns. Consequently, although there are encouraging signals that smartphone-based physical activity interventions could be feasible, acceptable, and efficacious for individuals with mental illnesses, this remains an underexplored area.

CONCLUSIONS

Promising avenues for tailoring validated smartphone-based interventions include adding psychoeducation (eg, the relationship between depression, physical activity, and inactivity), offering psychosocial treatment in parallel (eg, cognitive restructuring), and adding personalized coaching. To conclude, we offer specific recommendations for future research, treatment development, and implementation in this area, which remains open and promising for flexible, highly scalable support.

Prevalence of dyslipidemia and associated factors in sedentary occupational population from Shanghai: a cross-sectional study

BACKGROUND

Dyslipidemia is a major risk factor for cardiovascular diseases, but its prevalence and determinants among sedentary occupational population are poorly understood. This study aimed to investigate the prevalence and associated factors for dyslipidemia among a sedentary occupational population in Shanghai, China.

METHODS

We collected data from 35,950 sedentary occupational workers on their demographics, social, medical, and family history, lifestyle, anthropometry, and biochemistry. We used the 2016 Chinese guideline for the management of dyslipidemia in adults to define dyslipidemia and its subtypes. We performed multivariate logistic regression to examine the factors associated with dyslipidemia.

RESULTS

The prevalence of dyslipidemia was 29.10%, with 15.86% for high triglycerides (TG), 6.43% for high total cholesterol (TC), 5.37% for high low-density lipoprotein cholesterol (LDL-C), and 14.68% for low high-density lipoprotein cholesterol (HDL-C). Men had a significantly higher prevalence of dyslipidemia than women (39.64% vs. 12.43%, P < 0.01). Factors associated with dyslipidemia included older age, being married, longer sedentary time while resting, frequent intake of animal viscera, current smoking, hypertension, diabetes, and obesity. Current drinking was associated with a 1.24 times higher prevalence of high TG (P < 0.01). Current smokers were less likely to have low HDL-C than non-smokers.

CONCLUSIONS

Our present study, in a population of 35,950 sedentary occupational workers from Shanghai, demonstrated a prevalence of dyslipidemia, but lower than in other previous studies without the limitation of occupational characteristics. Prevention and control measures for dyslipidemia should take into account the characteristics and related factors for this population group.

Device-measured physical activity and cardiometabolic health: the Prospective Physical Activity, Sitting, and Sleep (ProPASS) consortium

BACKGROUND AND AIMS

Physical inactivity, sedentary behaviour (SB), and inadequate sleep are key behavioural risk factors of cardiometabolic diseases. Each behaviour is mainly considered in isolation, despite clear behavioural and biological interdependencies. The aim of this study was to investigate associations of five-part movement compositions with adiposity and cardiometabolic biomarkers.

METHODS

Cross-sectional data from six studies (n = 15 253 participants; five countries) from the Prospective Physical Activity, Sitting and Sleep consortium were analysed. Device-measured time spent in sleep, SB, standing, light-intensity physical activity (LIPA), and moderate-vigorous physical activity (MVPA) made up the composition. Outcomes included body mass index (BMI), waist circumference, HDL cholesterol, total:HDL cholesterol ratio, triglycerides, and glycated haemoglobin (HbA1c). Compositional linear regression examined associations between compositions and outcomes, including modelling time reallocation between behaviours.

RESULTS

The average daily composition of the sample (age: 53.7 ± 9.7 years; 54.7% female) was 7.7 h sleeping, 10.4 h sedentary, 3.1 h standing, 1.5 h LIPA, and 1.3 h MVPA. A greater MVPA proportion and smaller SB proportion were associated with better outcomes. Reallocating time from SB, standing, LIPA, or sleep into MVPA resulted in better scores across all outcomes. For example, replacing 30 min of SB, sleep, standing, or LIPA with MVPA was associated with -0.63 (95% confidence interval -0.48, -0.79), -0.43 (-0.25, -0.59), -0.40 (-0.25, -0.56), and -0.15 (0.05, -0.34) kg/m2 lower BMI, respectively. Greater relative standing time was beneficial, whereas sleep had a detrimental association when replacing LIPA/MVPA and positive association when replacing SB. The minimal displacement of any behaviour into MVPA for improved cardiometabolic health ranged from 3.8 (HbA1c) to 12.7 (triglycerides) min/day.

CONCLUSIONS

Compositional data analyses revealed a distinct hierarchy of behaviours. Moderate-vigorous physical activity demonstrated the strongest, most time-efficient protective associations with cardiometabolic outcomes. Theoretical benefits from reallocating SB into sleep, standing, or LIPA required substantial changes in daily activity.

Social media consumption and depressive symptoms during the COVID-19 lockdown: the mediating effect of physical activity

Introduction

Social media platforms played a critical role during the COVID-19 pandemic. This study aimed to explore: (1) the changes in social media consumption patterns, physical activity levels/sedentary behavior, and depressive symptoms, and (2) how the changes in social media consumption patterns predict the changes in depressive symptoms while investigating the mediating role of changes in physical activity levels/sedentary behavior between before, and after the COVID-19 lockdown among U.S. adults with different age clusters.

Methods

A total of 695 U.S. participants completed an online questionnaire via MTurk, and participants were asked to recall their social media consumption patterns, physical activity/sedentary behavior, depressive symptoms in January and May of 2020 while covariates included non-physical activity health behavior including diet quality, alcohol consumption, smoking, and sleep quality.

Results

The results of Bayesian significance testing of changes showed that the older participants tended to spend more time with content-focused social media platforms during the lockdown. While significantly increased sitting time was reported by all age clusters, no significant changes were found in activity levels. Additionally, the middle-aged and older participants reported significantly higher depressive symptoms. The findings of a multigroup structural analysis showed the significant mediating effect of moderate-to-vigorous physical activity on the relationship between changes in social media consumption and depressive symptoms.

Discussion

This study highlights the need for targeting specific social media platforms for older adults and the importance of moderate-to-vigorous physical activity to alleviate the mental health issues resulting from social media consumption. The result of this study also highlights the need for sport-based intervention programs in the future and the need for more social media campaigns at the institution/organization levels established by public health stakeholders and policy makers to promote physical activity and maximize population perception and reach during the pandemic.

The impact of the covid-19 pandemic on lifestyle behaviors in U.S. college students

OBJECTIVE

To investigate COVID-19's impact on college student health behaviors.

PARTICIPANTS

189 college students.

METHODS

Participants completed an online survey on behaviors relating to sleep, sedentary activities, and physical activity before and during the COVID-19 pandemic. Comparisons utilized Students' dependent t-test or Wilcoxon signed-rank tests.

RESULTS

There was an increase in time to fall asleep (before: 23.4 ± 18.0 vs. during: 42.8 ± 44.3 min·day^-1, p < 0.001), time spent in bed (before: 7.8 ± 1.5 vs. during: 8.5 ± 1.5 hr·day^-1, p < 0.001), as well as shifts in later bed and awake time (p < 0.001). Total sedentary time increased during the pandemic (before: 9.0 ± 3.8 vs. during: 9.9 ± 4.1 hr·day^-1, p = 0.016); and time spent using a TV, computer, or phone (before: 3.1 ± 1.9 vs. during: 4.2 ± 2.3 hr·day^-1, p < 0.001). There was a significant decrease in moderate-vigorous activity (before: 123.8 ± 96.0 vs. during: 108.9 ± 75.5 min·week^-1, p = 0.028) and resistance training days (before: 2.4 ± 2.1 vs. during: 1.7 ± 2.1 days·week^-1, p < 0.001).

CONCLUSIONS

COVID-19 negatively influenced health behaviors in college students.

Health and Sedentary Behaviors within Polish Nurses: A Cross-Sectional Study

Health behaviors play a pivotal role in improving and strengthening health. Nurses, who constitute the vast majority of employees in the health sector, play a crucial role not only in treating disease but also in promoting and maintaining optimal health for themselves and society. The purpose of the study was to assess the level of health and sedentary behavior and the factors influencing them among nurses. A survey, cross-sectional study was conducted among 587 nurses. Standardized questionnaires evaluating health and sedentary behavior were used. The study utilized both single-factor and multifactor analyses, employing the linear regression method and Spearman correlation coefficient. The results showed that the health behaviors of the survey nurses were at an average level. Sedentary time (in hours) was an average of 5.62 h (SD = 1.77) and correlates significantly (p < 0.05) and negatively (r < 0) with health behaviors in terms of the positive mental attitude subscale; the longer the sitting time, the lower the intensity of this type of health behaviors. The efficient functioning of the healthcare system is greatly dependent on nursing staff. To improve health behaviors among nurses, systemic solutions such as workplace wellness programs, incentives for healthy behaviors, and education on the benefits of a healthy lifestyle are needed.

Sedentary Behavior Counseling Received from Healthcare Professionals: An Exploratory Analysis in Adults at Primary Health Care in Brazil

Counseling by health professionals has promising results in behavior change and is recommended as part of integrated community interventions. However, the knowledge about sedentary behavior (SB) counseling is incipient. The study aimed to identify the prevalence and explore the associated factors with SB counseling received from healthcare professionals by adults in primary health care (PHC) in Brazil. A cross-sectional study was conducted in 2019 that included a representative sample of 779 users in all 15 basic health units (BHU) in São José dos Pinhais, Paraná. We identified those who reported having received SB counseling during a consultation. The association between the sociodemographic factors, chronic diseases, access to health services, physical activity, SB, and counseling were analyzed using Poisson regression in a hierarchical model. The prevalence of counseling was 12.2% (95% CI: 10.1-14.7%); it was higher in women (PR: 1.77; 95% CI: 1.10-2.83), those aged ≥60 yrs (PR: 1.84; 95% CI: 1.14-2.98), BMI ≥ 30 kg/m² (PR: 2.60; 95% CI: 1.31-5.17), who consume ≥3 medications (PR: 2.21; 95% CI: 1.06-4.59), and those who spend a prolonged period of the day engaged in SB (4th quartile PR: 3.44; 95% CI: 1.88-6.31). The results highlight that SB counseling is underutilized and incipient in PHC. Understanding these results can help managers and healthcare professionals in BHU teams to implement and direct specific actions to reduce SB in adults through counseling.

Nudges used to promote physical activity and to reduce sedentary behaviour in the workplace: Results of a scoping review

Physical inactivity is one of the most important risk factors for non-communicable diseases. Workplace health promotion is therefore of growing interest to support an active day using nudges. The scoping review aims to (a) analyse how frequently nudges are applied in workplace health promotion to increase physical activity and/or reduce sedentary behaviour, and (b) characterise the nudges used. A systematic database search was conducted for the period 2009 to June 2020. According to predefined inclusion and exclusion criteria, studies promoting physical activity and/or reducing sedentary behaviour using nudges were included. Nudges were classified according to MINDSPACE and TIPPME. A study protocol was previously published. Of the 256 studies identified, 26 used nudges. Most studies were conducted in Europe (n = 12) and the USA (n = 8). N = 18 studies targeted physical activity and n = 8 studies targeted sedentary behaviour. In most studies promoting physical activity, prompts were given to climb stairs (n = 11). Interventions targeting sedentary behaviour were more diverse, using digital interventions or mixed approaches (n = 8). Although nudges can help increase physical activity and reduce sedentary behaviour, there are still gaps in terms of their effective and efficient use. There is a lack of long-term studies that analyse habituation and behavioural changes beyond the intervention period. In addition, the potential of digital and mixed approaches is not yet fully exploited. Further studies from low- and middle-income countries with different climates and working conditions are needed to investigate the feasibility of approaches and advance the fight against physical inactivity.

Mobile health apps to reduce sedentary behavior: a scoping review

Given the continued increase in mobile health applications (apps) aimed at healthcare and the recognition of sedentary behavior (SB) as a public health problem, the goal of this scoping review study was to summarize the effects of interventions based on mobile health apps designed to reduce SB in adults, with a specific focus on SB. The electronic databases PubMed, PsycINFO, SportDISCUS, Web of Science, and manual searches in reference lists were conducted on papers published up to September 2020. Nine out of the 897 studies researched were included and composed the descriptive synthesis. The investigations found in the present study showed a decrease in time spent on television viewing and in total time spent sitting, as well as an increase in the number of SB breaks after interventions based on mobile health apps. In conclusion, despite the growing interest in intervention programs in SB, only nine studies have used smartphone apps as a strategy to reduce SB in adults. Mobile health apps were proved to be effective in SB reduction, as assessed by different parameters, and should be encouraged. However, further studies are needed to verify the long-term effects of the utilization of such applications.

A multidimensional program including standing exercises, health education, and telephone support to reduce sedentary behavior in frail older adults: Randomized clinical trial

OBJECTIVES

The primary aim of this study was to evaluate the effect of a multidimensional program including home-based standing exercises, health education, and telephone support for the reduction of sedentary behavior in community-dwelling frail older adults. The secondary aim of this study was to evaluate the safety and adherence of the program.

STUDY DESIGN

A single-blind, randomized controlled trial.

METHODS

A total of 43 frail older adults were randomly assigned to the intervention and control groups. The intervention consisted of combined strategies including home-based standing exercises, health education, and telephone support for 16 weeks for frail older adults. The control group received orientation regarding the harmful effects of a sedentary lifestyle. Sedentary behavior was evaluated by total sedentary time, accumulated sedentary time in bouts of at least 10 min, and by the break in sedentary time, measured by an accelerometer used for at least 600 min/day for 4 days. Safety was assessed by self-reporting of possible adverse events. Adherence was assessed based on the number of days in which standing exercises were performed by the participants. Repeated measures ANOVA and Tukeys post hoc test were used to analyze the collected data.

RESULTS

The intervention group reduced the sedentary time by 30 min/day (p= 0.048), but without significant maintenance after 30 days of the program. Of the total number of participants, 82% (n = 14) of the intervention group participants showed more than 70% adherence to the program. The main adverse effects faced by the intervention group participants were tiredness (53%; n = 9) and lower limb pain (47%; n = 8).

CONCLUSIONS

The multidimensional program reduced sedentary behavior, was safe, and showed satisfactory adherence in frail older adults.

Effect of Reducing Sedentary Behavior on Blood Pressure (RESET BP): Rationale, design, and methods

Sedentary behavior (SB) has recently been recognized as a strong risk factor for cardiovascular disease, with new guidelines encouraging adults to 'sit less, move more.' Yet, there are few randomized trials demonstrating that reducing SB improves cardiovascular health. The Effect of Reducing Sedentary Behavior on Blood Pressure (RESET BP) randomized clinical trial addresses this gap by testing the effect of a 3-month SB reduction intervention on resting systolic BP. Secondary outcomes include other BP measures, pulse wave velocity, plasma renin activity and aldosterone, and objectively-measured SB (via thigh-mounted activPAL) and physical activity (via waist-worn GT3X accelerometer). RESET BP has a targeted recruitment of 300 adults with desk jobs, along with elevated, non-medicated BP (systolic BP 120-159 mmHg or diastolic BP 80-99 mmHg) and physical inactivity (self-reported aerobic physical activity below recommended levels). The multi-component intervention promotes 2-4 fewer hours of SB per day by replacing sitting with standing and light-intensity movement breaks. Participants assigned to the intervention condition receive a sit-stand desk attachment, a wrist-worn activity prompter, behavioral counseling every two weeks (alternating in-person and phone), and twice-weekly automated text messages. Herein, we review the study rationale, describe and evaluate recruitment strategies based on enrollment to date, and detail the intervention and assessment protocols. We also document our mid-trial adaptations to participant recruitment, intervention deployment, and outcome assessments due to the intervening COVID-19 pandemic. Our research methods, experiences to date, and COVID-specific accommodations could inform other research studying BP and hypertension or targeting working populations, including those seeking remote methods.

Innovations in Geroscience to enhance mobility in older adults

Aging is the primary risk factor for functional decline; thus, understanding and preventing disability among older adults has emerged as an important public health challenge of the 21st century. The science of gerontology - or geroscience - has the practical purpose of "adding life to the years." The overall goal of geroscience is to increase healthspan, which refers to extending the portion of the lifespan in which the individual experiences enjoyment, satisfaction, and wellness. An important facet of this goal is preserving mobility, defined as the ability to move independently. Despite this clear purpose, this has proven to be a challenging endeavor as mobility and function in later life are influenced by a complex interaction of factors across multiple domains. Moreover, findings over the past decade have highlighted the complexity of walking and how targeting multiple systems, including the brain and sensory organs, as well as the environment in which a person lives, can have a dramatic effect on an older person's mobility and function. For these reasons, behavioral interventions that incorporate complex walking tasks and other activities of daily living appear to be especially helpful for improving mobility function. Other pharmaceutical interventions, such as oxytocin, and complementary and alternative interventions, such as massage therapy, may enhance physical function both through direct effects on biological mechanisms related to mobility, as well as indirectly through modulation of cognitive and socioemotional processes. Thus, the purpose of the present review is to describe evolving interventional approaches to enhance mobility and maintain healthspan in the growing population of older adults in the United States and countries throughout the world. Such interventions are likely to be greatly assisted by technological advances and the widespread adoption of virtual communications during and after the COVID-19 era.

Standing up against office sitting: A study protocol

Background

Sedentary behaviour is associated with cardiometabolic diseases amongst office-bound workers, mostly through extended sitting and engaging in low-energy-demanding activities during work hours. The aim of this study is to assess the effectiveness of standing desks and healthy messages on cardiovascular parameters in a cohort of office-based workers and to explore the perceptions of these workers about the suitability of this intervention to lower occupation-related sedentariness.

Methods/design

The protocol will use a mixed-methods study design. Phase 1 of this study is a 12-month, single blinded, randomised controlled trial, which will include baseline, 3-month, 6-month and 12-month post-intervention assessments of plausible cardiometabolic risk biomarkers in office-bound workers at a South African credit and information management company. These biomarkers include anthropometry, sedentary behaviour and physical activity, sleep duration, blood pressure, glucose, glycated haemoglobin (HbA1c), lipid profile and cardiorespiratory fitness. Participants will be randomised into an intervention or control group. The intervention group will be provided with an adjustable sit-stand desk and receive weekly health-promoting messages for the intervention period. Phase 2 will use focus group discussions conducted post-intervention to explore the study participants' perceptions of the effectiveness of the intervention. Cardiometabolic risk biomarkers and changes in these variables will be compared between the intervention group and the control group at the four time points using descriptive and inferential statistics.

Discussion

Regression analysis will be undertaken to determine the association of cardiometabolic risk biomarkers with cardiometabolic diseases. A thematic content analysis approach will be used to explore emerging themes from focus group discussions.

Protocol identification

Pan African Clinical Trial Registry, PACTR201911656014962.

Continuous Compared to Accumulated Walking-Training on Physical Function and Health-Related Quality of Life in Sedentary Older Persons

The present study aimed to analyze the impact of overground walking interval training (WIT) in a group of sedentary older adults, comparing two different dose-distributions. In this quasi-experimental and longitudinal study, we recruited twenty-three sedentary older adults (71.00 ± 4.10 years) who were assigned to two groups of WIT. The continuous group (CWIT) trained for 60 min/session in the morning, while the accumulated group (AWIT) performed the same duration and intensity of exercise, but it was distributed twice a day (30 min in the morning and 30 more in the afternoon). After 15 weeks of an equal external-load training (3 days/week), Bonferroni post-hoc comparisons revealed significant (p < 0.050) and similar large improvements in both groups in cardiorespiratory fitness and lower limb strength; even larger gains in preferred walking speed and instrumental daily life activity, which was slightly superior for CWIT; and improvements in agility, which were moderate for CWIT and large for AWIT. However, none of the training protocols had an impact on the executive function in the individuals, and only the AWIT group improved health-related quality of life. Although both training protocols induced a general significant improvement in physical function in older adults, our results showed that the accumulative strategy should be recommended when health-related quality of life is the main target, and the continuous strategy should be recommended when weakness may be a threat in the short or medium term.

Environmental Quality Perceptions and Health: A Cross-Sectional Study of Citizens of Kaunas, Lithuania

The perception of urban environmental quality is an important contributor when identifying local problems in sustainable development and environmental planning policy. This study examined the associations between environmental and social residential characteristics, physical activity, obesity, and hypertension in Kaunas city, Lithuania. This cross-sectional study analyzed 580 citizens’ demographic-, socioeconomic-, health-, and lifestyle-related factors, environmental health concerns, and environmental quality perceptions. Using Geographic Information Systems and the multivariate logistic regression, we found that the less physically active group more often presented lower than mean ratings of the quality of pathways and cycling routes (32.9% and 45.6%, p = 0.042) and only irregularly visited the natural environment. Obese participants presented poorer ratings of air pollution, the quality of pathways and cycling routes, their possibility to reach green spaces by walking, and the available relaxing areas. The environmental issues associated with hypertension were poor possibilities to reach green spaces by walking (OR 1.94, 95% CI 1.14–3.32) and the availability of relaxation areas (OR 2.30, 95% 1.34–3.95). The quality of the neighborhood and individual-level characteristics were the factors that influenced a higher prevalence of health problems at the district level. Our findings suggest that a public health policy to improve the physical and social environment of the neighborhood would have a potential to increase citizens’ physical activity and health.

The effectiveness and complexity of interventions targeting sedentary behaviour across the lifespan: a systematic review and meta-analysis

BACKGROUND

Evidence suggests that sedentary behaviour (SB) is associated with poor health outcomes. SB at any age may have significant consequences for health and well-being and interventions targeting SB are accumulating. Therefore, the need to review the effects of multicomponent, complex interventions that incorporate effective strategies to reduce SB are essential.

METHODS

A systematic review and meta-analysis were conducted investigating the impact of interventions targeting SB across the lifespan. Six databases were searched and two review authors independently screened studies for eligibility, completed data extraction and assessed the risk of bias and complexity of each of the included studies.

RESULTS

A total of 77 adult studies (n=62, RCTs) and 84 studies (n=62, RCTs) in children were included. The findings demonstrated that interventions in adults when compared to active controls resulted in non-significant reductions in SB, although when compared to inactive controls significant reductions were found in both the short (MD -56.86; 95%CI -74.10, -39.63; n=4632; I2 83%) and medium-to-long term (MD -20.14; 95%CI -34.13, -6.16; n=4537; I2 65%). The findings demonstrated that interventions in children when compared to active controls may lead to relevant reductions in daily sedentary time in the short-term (MD -59.90; 95%CI -102.16, -17.65; n=267; I2 86%), while interventions in children when compared to inactive controls may lead to relevant reductions in the short-term (MD -25.86; 95%CI -40.77, -10.96; n=9480; I2 98%) and medium-to-long term (MD -14.02; 95%CI -19.49, -8.55; n=41,138; I2 98%). The assessment of complexity suggested that interventions may need to be suitably complex to address the challenges of a complex behaviour such as SB, but demonstrated that a higher complexity score is not necessarily associated with better outcomes in terms of sustained long-term changes.

CONCLUSIONS

Interventions targeting reductions in SB have been shown to be successful, especially environmental interventions in both children and adults. More needs to be known about how best to optimise intervention effects. Future intervention studies should apply more rigorous methods to improve research quality, considering larger sample sizes, randomised controlled designs and valid and reliable measures of SB.

Clustering of Physical Activity and Sedentary Behavior Associated to Risk for Metabolic Syndrome in Older Adults

This study aimed to investigate the clustering patterns of physical activity, sedentary time (ST), and breaks in ST, and the association between the identified clusters at risk for metabolic syndrome associated with obesity in older adults. Participants included 212 users of community health centers in Brazil. A questionnaire about sociodemographic characteristics was used to describe the sample, and physical activity, ST, and breaks in ST were evaluated using accelerometers. Waist circumference was measured as an indicator of the risk for metabolic syndrome. A two-step cluster analysis and logistic regression analysis were conducted. The following four clusters were identified: sitters (37.7%), inactive (28.3%), active (25.5%), and all-day sitters/lightly active (8.5%). Participants in the active cluster were 60% less likely to be at risk for metabolic syndrome. This study may contribute to a comprehensive understanding of which older adult groups need more attention in the context of community health centers.

Breaking barriers: using the behavior change wheel to develop a tailored intervention to overcome workplace inhibitors to breaking up sitting time

BACKGROUND

The workplace is a prominent domain for excessive sitting. The consequences of increased sitting time include adverse health outcomes such as cardiovascular disease and poor mental wellbeing. There is evidence that breaking up sitting could improve health, however, any such intervention in the workplace would need to be informed by a theoretical evidence-based framework. The aim of this study was to use the Behaviour Change Wheel (BCW) to develop a tailored intervention to break up and reduce workplace sitting in desk-based workers.

METHODS

The BCW guide was followed for this qualitative, pre-intervention development study. Semi-structured interviews were conducted with 25 office workers (26-59 years, mean age 40.9 [SD = 10.8] years; 68% female) who were purposively recruited from local council offices and a university in the East of England region. The interview questions were developed using the Theoretical Domains Framework (TDF). Transcripts were deductively analysed using the COM-B (Capability, Opportunity, Motivation - Behaviour) model of behaviour. The Behaviour Change Technique Taxonomy Version 1 (BCTv1) was thereafter used to identify possible strategies that could be used to facilitate change in sitting behaviour of office workers in a future intervention.

RESULTS

Qualitative analysis using COM-B identified that participants felt that they had the physical Capability to break up their sitting time, however, some lacked the psychological Capability in relation to the knowledge of both guidelines for sitting time and the consequences of excess sitting. Social and physical Opportunity was identified as important, such as a supportive organisational culture (social) and the need for environmental resources (physical). Motivation was highlighted as a core target for intervention, both reflective Motivation, such as beliefs about capability and intention and automatic in terms of overcoming habit through reinforcement. Seven intervention functions and three policy categories from the BCW were identified as relevant. Finally, 39 behaviour change techniques (BCTs) were identified as potential active components for an intervention to break up sitting time in the workplace.

CONCLUSIONS

The TDF, COM-B model and BCW can be successfully applied through a systematic process to understand the drivers of behaviour of office workers to develop a co-created intervention that can be used to break up and decrease sitting in the workplace. Intervention designers should consider the identified BCW factors and BCTs when developing interventions to reduce and break up workplace sitting.

Development and feasibility of a brief Zero-time Exercise intervention to reduce sedentary behaviour and enhance physical activity: A pilot trial

A brief intervention using Zero-time Exercise (ZTEx), a foot-in-the-door approach, was developed to reduce sedentary behaviour and increase physical activity. ZTEx refers to the integration of simple strength- and stamina-enhancing physical activity into daily life, which can be done anytime, anywhere and by anyone. This paper presents the development, feasibility, and preliminary evidence for the effectiveness of this intervention under the Hong Kong Jockey Club FAMILY Project. Needs assessments were conducted with social workers from the Christian Family Services Center(CFSC) and the Social Welfare Department (SWD). This single group prospective ZTEx intervention trial, guided by the Health Action Process Approach, included a 3-hr core session at baseline and a 1-hr booster session at 1-month follow-up. Fifty-six participants (social and service-related workers) from CFSC (n = 28) and SWD (n = 28) received the intervention and completed the self-administered questionnaires at baseline. Forty-nine and 43 participants completed the 1-month and 3-month self-administered questionnaires, respectively. Fifteen participants attended the focus group interviews to share their feedback on ZTEx intervention after implementing their community-based ZTEx activities. Intention-to-treat analysis was conducted with missing data replaced by baseline values. Participants reported significant decreases in sitting time by 27 (2, 52) minutes (mean [95% confidence interval]) and 36 (0.2, 71) minutes on a weekday, increases in physical activity while seated by 0.7 (0.2, 1.4) days and 1.1 (0.6, 1.7) days in a week, and improvements in perceived knowledge, outcome expectancies and plan on doing ZTEx at the 1-month and 3-month follow-up, respectively. Balance and muscle strength significantly improved at the 1-month follow-up. The effect ranged from small to large (Cohen's d: 0.27-1.05, all p < 0.05). The qualitative feedbacks support the quantitative findings. Our findings show early evidence that ZTEx effectively reduced sedentary behaviour and enhanced physical activity and fitness. Further trials on this simple and low-cost intervention as the first step to promote higher intensity exercise are warranted.

Feasibility of a Lifestyle Physical Activity Intervention to Prevent Memory Loss in Older Women With Cardiovascular Disease: A Mixed-Methods Approach

BACKGROUND

Memory loss in older age affects women more than men and cardiovascular disease is a leading risk factor. Physical activity can improve memory in healthy older adults; however, few physical activity interventions have targeted women with cardiovascular disease, and none utilized lifestyle approaches.

PURPOSE

The purpose of this study was to examine feasibility, acceptability, and preliminary effects of a 24-week lifestyle physical activity intervention (physical activity prescription, five group meetings, and nine motivational interviewing calls).

METHODS

A sequential mixed-methods approach was used. Participants were 18 sedentary women ≥65 years with cardiovascular disease and without cognitive impairment recruited in August 2017. Feasibility, acceptability, self-reported health, accelerometer-assessed physical activity, and neurocognitive memory tests were measured using a pre-post test design. Two post-intervention focus groups (n = 8) were conducted in June 2018. Concept analysis was used to identify barriers/motivators of intervention participation.

RESULTS

Meeting attendance was >72% and retention was 94%. Participants rated the program with high satisfaction. There were significant improvements at 24 weeks in self-rated physical health, objective daily steps, and estimated cardiorespiratory fitness (d = .30-.64). Focus group themes generated recommendations for modifying the intervention.

CONCLUSION

Findings support adapting the intervention further for women with cardiovascular disease and testing it in an efficacy trial.

Benefits of 8-wk Mindfulness-based Stress Reduction or Aerobic Training on Seasonal Declines in Physical Activity

Mindfulness-based stress reduction (MBSR) and aerobic exercise training (AET) programs improve health and well-being. Exercise participation has been related to mindfulness and may be altered by MBSR training.

Global physical activity levels - Need for intervention

Substantial evidence shows that physical inactivity (PI) and sedentary behavior (SB) increases the risk of many chronic diseases and shortens life expectancy. We describe evidence that certain domains of physical activity (PA) in the United States (US) population have declined substantially over 5 decades. The prevalence of PI is very high worldwide, which has contributed to 6%-10% of the burden of many chronic diseases and premature mortality. Reduction or elimination of PI would likely produce substantial increases in life expectancy of the world's population. Great efforts are needed to reduce PI and SB and increase levels of PA in the US and worldwide.

Workplace interventions for reducing sitting at work

BACKGROUND

A large number of people are employed in sedentary occupations. Physical inactivity and excessive sitting at workplaces have been linked to increased risk of cardiovascular disease, obesity, and all-cause mortality.

OBJECTIVES

To evaluate the effectiveness of workplace interventions to reduce sitting at work compared to no intervention or alternative interventions.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, OSH UPDATE, PsycINFO, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal up to 9 August 2017. We also screened reference lists of articles and contacted authors to find more studies.

SELECTION CRITERIA

We included randomised controlled trials (RCTs), cross-over RCTs, cluster-randomised controlled trials (cluster-RCTs), and quasi-RCTs of interventions to reduce sitting at work. For changes of workplace arrangements, we also included controlled before-and-after studies. The primary outcome was time spent sitting at work per day, either self-reported or measured using devices such as an accelerometer-inclinometer and duration and number of sitting bouts lasting 30 minutes or more. We considered energy expenditure, total time spent sitting (including sitting at and outside work), time spent standing at work, work productivity and adverse events as secondary outcomes.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened titles, abstracts and full-text articles for study eligibility. Two review authors independently extracted data and assessed risk of bias. We contacted authors for additional data where required.

MAIN RESULTS

We found 34 studies - including two cross-over RCTs, 17 RCTs, seven cluster-RCTs, and eight controlled before-and-after studies - with a total of 3,397 participants, all from high-income countries. The studies evaluated physical workplace changes (16 studies), workplace policy changes (four studies), information and counselling (11 studies), and multi-component interventions (four studies). One study included both physical workplace changes and information and counselling components. We did not find any studies that specifically investigated the effects of standing meetings or walking meetings on sitting time.Physical workplace changesInterventions using sit-stand desks, either alone or in combination with information and counselling, reduced sitting time at work on average by 100 minutes per workday at short-term follow-up (up to three months) compared to sit-desks (95% confidence interval (CI) -116 to -84, 10 studies, low-quality evidence). The pooled effect of two studies showed sit-stand desks reduced sitting time at medium-term follow-up (3 to 12 months) by an average of 57 minutes per day (95% CI -99 to -15) compared to sit-desks. Total sitting time (including sitting at and outside work) also decreased with sit-stand desks compared to sit-desks (mean difference (MD) -82 minutes/day, 95% CI -124 to -39, two studies) as did the duration of sitting bouts lasting 30 minutes or more (MD -53 minutes/day, 95% CI -79 to -26, two studies, very low-quality evidence).We found no significant difference between the effects of standing desks and sit-stand desks on reducing sitting at work. Active workstations, such as treadmill desks or cycling desks, had unclear or inconsistent effects on sitting time.Workplace policy changesWe found no significant effects for implementing walking strategies on workplace sitting time at short-term (MD -15 minutes per day, 95% CI -50 to 19, low-quality evidence, one study) and medium-term (MD -17 minutes/day, 95% CI -61 to 28, one study) follow-up. Short breaks (one to two minutes every half hour) reduced time spent sitting at work on average by 40 minutes per day (95% CI -66 to -15, one study, low-quality evidence) compared to long breaks (two 15-minute breaks per workday) at short-term follow-up.Information and counsellingProviding information, feedback, counselling, or all of these resulted in no significant change in time spent sitting at work at short-term follow-up (MD -19 minutes per day, 95% CI -57 to 19, two studies, low-quality evidence). However, the reduction was significant at medium-term follow-up (MD -28 minutes per day, 95% CI -51 to -5, two studies, low-quality evidence).Computer prompts combined with information resulted in no significant change in sitting time at work at short-term follow-up (MD -14 minutes per day, 95% CI -39 to 10, three studies, low-quality evidence), but at medium-term follow-up they produced a significant reduction (MD -55 minutes per day, 95% CI -96 to -14, one study). Furthermore, computer prompting resulted in a significant decrease in the average number (MD -1.1, 95% CI -1.9 to -0.3, one study) and duration (MD -74 minutes per day, 95% CI -124 to -24, one study) of sitting bouts lasting 30 minutes or more.Computer prompts with instruction to stand reduced sitting at work on average by 14 minutes per day (95% CI 10 to 19, one study) more than computer prompts with instruction to walk at least 100 steps at short-term follow-up.We found no significant reduction in workplace sitting time at medium-term follow-up following mindfulness training (MD -23 minutes per day, 95% CI -63 to 17, one study, low-quality evidence). Similarly a single study reported no change in sitting time at work following provision of highly personalised or contextualised information and less personalised or contextualised information. One study found no significant effects of activity trackers on sitting time at work.Multi-component interventions Combining multiple interventions had significant but heterogeneous effects on sitting time at work (573 participants, three studies, very low-quality evidence) and on time spent in prolonged sitting bouts (two studies, very low-quality evidence) at short-term follow-up.

AUTHORS' CONCLUSIONS

At present there is low-quality evidence that the use of sit-stand desks reduce workplace sitting at short-term and medium-term follow-ups. However, there is no evidence on their effects on sitting over longer follow-up periods. Effects of other types of interventions, including workplace policy changes, provision of information and counselling, and multi-component interventions, are mostly inconsistent. The quality of evidence is low to very low for most interventions, mainly because of limitations in study protocols and small sample sizes. There is a need for larger cluster-RCTs with longer-term follow-ups to determine the effectiveness of different types of interventions to reduce sitting time at work.

Wrist accelerometer shape feature derivation methods for assessing activities of daily living

Background

There has been an increasing interest in understanding the usefulness of wrist-based accelerometer data for physical activity (PA) assessment due to the ease of use and higher user compliance than other body placements. PA assessment studies have relied on machine learning methods which take accelerometer data in forms of variables, or feature vectors.

Methods

In this work, we introduce automated shape feature derivation methods to transform epochs of accelerometer data into feature vectors. As the first step, recurring patterns in the collected data are identified and placed in a codebook. Similarities between epochs of accelerometer data and codebook’s patterns are the basis of feature calculations. In this paper, we demonstrate supervised and unsupervised approaches to learn codebooks. We evaluated these methods and compared them with the standard statistical measures for PA assessment. The experiments were performed on 146 participants who wore an ActiGraph GT3X+ accelerometer on the right wrist and performed 33 activities of daily living.

Results

Our evaluations show that the shape feature derivation methods were able to perform comparably with the standard wrist model (F1-score: 0.89) for identifying sedentary PAs (F1-scores of 0.86 and 0.85 for supervised and unsupervised methods, respectively). This was also observed for identifying locomotion activities (F1-scores: 0.87, 0.83, and 0.81 for the standard wrist, supervised, unsupervised models, respectively). All the wrist models were able to estimate energy expenditure required for PAs with low error (rMSE: 0.90, 0.93, and 0.90 for the standard wrist, supervised, and unsupervised models, respectively).

Conclusion

The automated shape feature derivation methods offer insights into the performed activities by providing a summary of repeating patterns in the accelerometer data. Furthermore, they could be used as efficient alternatives (or additions) for manually engineered features, especially important for cases where the latter fail to provide sufficient information to machine learning methods for PA assessment.

Prevention Is the Best Treatment: The Case for Understanding the Transition from Monoclonal Gammopathy of Undetermined Significance to Myeloma

Multiple myeloma is an invariably fatal cancer of plasma cells. Despite tremendous advances in treatment, this malignancy remains incurable in most individuals. We postulate that strategies aimed at prevention have the potential to be more effective in preventing myeloma-related death than additional pharmaceutical strategies aimed at treating advanced disease. Here, we present a rationale for the development of prevention therapy and highlight potential target areas of study.

Dyadic interventions to promote physical activity and reduce sedentary behaviour: systematic review and meta-analysis

Several interventions have targeted dyads to promote physical activity (PA) or reduce sedentary behaviour (SB), but the evidence has not been synthesised. Sixty-nine studies were identified from MEDLINE, PsycINFO, and Web of Science, and 59 were included in the main meta-analyses (providing 72 independent tests). Intervention details, type of dyadic goal, participant characteristics, and methodological quality were extracted and their impact on the overall effect size was examined. Sensitivity analyses tested effect robustness to (a) the effects of other statistically significant moderators; (b) outliers; (c) data included for participants who were not the main target of the intervention. Dyadic interventions had a small positive, highly heterogeneous, effect on PA g = .203, 95% CI [0.123-0.282], compared to comparison conditions including equivalent interventions targeting individuals. Shared target-oriented goals (where both dyad members hold the same PA goal for the main target of the intervention) and peer/friend dyads were associated with larger effect sizes across most analyses. Dyadic interventions produced a small homogeneous reduction in SB. Given dyadic interventions promote PA over-and-above equivalent interventions targeting individuals, these interventions should be more widespread. However, moderating factors such as the types of PA goal and dyad need to be considered to maximise effects.

Diet and Activity Assessments and Interventions Using Technology in Older Adults

This paper reports on the findings and recommendations specific to older adults from the "Tech Summit: Innovative Tools for Assessing Diet and Physical Activity for Health Promotion" forum organized by the North American branch of the International Life Sciences Institute. The summit aimed to investigate current and emerging challenges related to improving energy balance behavior assessment and intervention via technology. The current manuscript focuses on how novel technologies are applied in older adult populations and enumerated the barriers and facilitators to using technology within this population. Given the multiple applications for technology in this population, including the ability to monitor health events and behaviors in real time, technology presents an innovative method to aid with the changes associated with aging. Although older adults are often perceived as lacking interest in and ability to adopt technologies, recent studies show they are comfortable adopting technology and user uptake is high with proper training and guided facilitation. Finally, the conclusions suggest recommendations for future research, including the need for larger trials with clinical outcomes and more research using end-user design that includes older adults as technology partners who are part of the design process.

THEME INFORMATION

This article is part of a theme issue entitled Innovative Tools for Assessing Diet and Physical Activity for Health Promotion, which is sponsored by the North American branch of the International Life Sciences Institute.

Clinical Approaches of Whole-Body Vibration Exercises in Individuals with Stroke: A Narrative Revision

Stroke is associated with long-term disability and patients experience numerous physical impairments including muscle weakness, particularly in the paretic limbs, balance, and functional mobility. During acute stroke rehabilitation, when individuals are less likely to be functionally independent and rely on rehabilitative care, the efficacy of low skill interventions that can reduce sedentary behaviour should be established. As such, this narrative revision focused on the use of empirical studies of whole-body vibration exercise (WBVE) on different health outcomes in stroke patients. The effects of WBVE on neuromuscular performance (muscular strength and power), mobility, spasticity, and cardiovascular responses have been highlighted. Although some positive results were reported we can conclude that there is no solid evidence confirming the beneficial effects of WBVE among people with stroke compared with either other types of physical activities or sham WBVE. Therefore, further research should be performed in this area, testing the feasibility and efficacy of using WBVE in a more homogeneous sample of stroke patients or comparing different WBVE parameters.

Physical Activity and Psychological Well-Being in Older University Office Workers: Survey Findings

Prolonged sitting time has been reported among university workers which can have adverse health effects. The aim of this study was to examine the sitting time, physical activity, and psychological well-being reported by older university office workers. An online self-reported survey was distributed to all office workers 55 years and older at one university in Australia. Sixty-six office workers were recruited. They reported an average sitting time of 7.5 hours per day on weekdays. In all, 72.7% of the sample reported both moderate and high physical activity levels. A high percentage of the office workers reported depression (25.8%) and anxiety (12.1%). Lower education levels were significantly related to higher perceived stress and more depressive symptomatology ( p = .03 and .02, respectively). Significant associations were found between stress, depression, and anxiety ( p < .001) among this group of workers.

Time Spent in Sedentary Behaviour as Discriminant Criterion for Frailty in Older Adults

This paper aims to analyse whether time spent in sedentary behaviour was a discriminant criterion for frailty in older adults. This was a cross-sectional study conducted in a sample of 457 elderly individuals aged ≥60 years. Frailty was defined as the presence of three or more of the following criteria: Unintentional weight loss, low walking speed at a 4.57 m course, reduced manual grip strength, exhaustion and insufficient physical activity level. Participants were classified into two groups: Non-frail or frail. Exposure to sedentary behaviour was assessed by the time spent sitting during a typical week, according to the adapted version of the International Physical Activity Questionnaire. Descriptive (mean, frequency) and inferential statistics (Poisson regression, Pearson’s Chi-square, Receiver Operating Characteristic Curve) were used to analyse the data, comparing them to the time-related areas exposed to sedentary behaviour by gender and the presence of fragility. The prevalence of frailty was 22.1% (n = 101). The most accurate cut-off points of sitting time for predicting frailty were >495 min/day (men) or >536 min/day (women). Time spent in sedentary behaviour can be used to indicate fragility in the elderly of both sexes.

Workplace interventions for reducing sitting at work

BACKGROUND

A large number of people are employed in sedentary occupations. Physical inactivity and excessive sitting at workplaces have been linked to increased risk of cardiovascular disease, obesity, and all-cause mortality.

OBJECTIVES

To evaluate the effectiveness of workplace interventions to reduce sitting at work compared to no intervention or alternative interventions.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, OSH UPDATE, PsycINFO, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal up to 9 August 2017. We also screened reference lists of articles and contacted authors to find more studies.

SELECTION CRITERIA

We included randomised controlled trials (RCTs), cross-over RCTs, cluster-randomised controlled trials (cluster-RCTs), and quasi-RCTs of interventions to reduce sitting at work. For changes of workplace arrangements, we also included controlled before-and-after studies. The primary outcome was time spent sitting at work per day, either self-reported or measured using devices such as an accelerometer-inclinometer and duration and number of sitting bouts lasting 30 minutes or more. We considered energy expenditure, total time spent sitting (including sitting at and outside work), time spent standing at work, work productivity and adverse events as secondary outcomes.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened titles, abstracts and full-text articles for study eligibility. Two review authors independently extracted data and assessed risk of bias. We contacted authors for additional data where required.

MAIN RESULTS

We found 34 studies - including two cross-over RCTs, 17 RCTs, seven cluster-RCTs, and eight controlled before-and-after studies - with a total of 3,397 participants, all from high-income countries. The studies evaluated physical workplace changes (16 studies), workplace policy changes (four studies), information and counselling (11 studies), and multi-component interventions (four studies). One study included both physical workplace changes and information and counselling components. We did not find any studies that specifically investigated the effects of standing meetings or walking meetings on sitting time.Physical workplace changesInterventions using sit-stand desks, either alone or in combination with information and counselling, reduced sitting time at work on average by 100 minutes per workday at short-term follow-up (up to three months) compared to sit-desks (95% confidence interval (CI) -116 to -84, 10 studies, low-quality evidence). The pooled effect of two studies showed sit-stand desks reduced sitting time at medium-term follow-up (3 to 12 months) by an average of 57 minutes per day (95% CI -99 to -15) compared to sit-desks. Total sitting time (including sitting at and outside work) also decreased with sit-stand desks compared to sit-desks (mean difference (MD) -82 minutes/day, 95% CI -124 to -39, two studies) as did the duration of sitting bouts lasting 30 minutes or more (MD -53 minutes/day, 95% CI -79 to -26, two studies, very low-quality evidence).We found no significant difference between the effects of standing desks and sit-stand desks on reducing sitting at work. Active workstations, such as treadmill desks or cycling desks, had unclear or inconsistent effects on sitting time.Workplace policy changesWe found no significant effects for implementing walking strategies on workplace sitting time at short-term (MD -15 minutes per day, 95% CI -50 to 19, low-quality evidence, one study) and medium-term (MD -17 minutes/day, 95% CI -61 to 28, one study) follow-up. Short breaks (one to two minutes every half hour) reduced time spent sitting at work on average by 40 minutes per day (95% CI -66 to -15, one study, low-quality evidence) compared to long breaks (two 15-minute breaks per workday) at short-term follow-up.Information and counsellingProviding information, feedback, counselling, or all of these resulted in no significant change in time spent sitting at work at short-term follow-up (MD -19 minutes per day, 95% CI -57 to 19, two studies, low-quality evidence). However, the reduction was significant at medium-term follow-up (MD -28 minutes per day, 95% CI -51 to -5, two studies, low-quality evidence).Computer prompts combined with information resulted in no significant change in sitting time at work at short-term follow-up (MD -10 minutes per day, 95% CI -45 to 24, two studies, low-quality evidence), but at medium-term follow-up they produced a significant reduction (MD -55 minutes per day, 95% CI -96 to -14, one study). Furthermore, computer prompting resulted in a significant decrease in the average number (MD -1.1, 95% CI -1.9 to -0.3, one study) and duration (MD -74 minutes per day, 95% CI -124 to -24, one study) of sitting bouts lasting 30 minutes or more.Computer prompts with instruction to stand reduced sitting at work on average by 14 minutes per day (95% CI 10 to 19, one study) more than computer prompts with instruction to walk at least 100 steps at short-term follow-up.We found no significant reduction in workplace sitting time at medium-term follow-up following mindfulness training (MD -23 minutes per day, 95% CI -63 to 17, one study, low-quality evidence). Similarly a single study reported no change in sitting time at work following provision of highly personalised or contextualised information and less personalised or contextualised information. One study found no significant effects of activity trackers on sitting time at work.Multi-component interventions Combining multiple interventions had significant but heterogeneous effects on sitting time at work (573 participants, three studies, very low-quality evidence) and on time spent in prolonged sitting bouts (two studies, very low-quality evidence) at short-term follow-up.

AUTHORS' CONCLUSIONS

At present there is low-quality evidence that the use of sit-stand desks reduce workplace sitting at short-term and medium-term follow-ups. However, there is no evidence on their effects on sitting over longer follow-up periods. Effects of other types of interventions, including workplace policy changes, provision of information and counselling, and multi-component interventions, are mostly inconsistent. The quality of evidence is low to very low for most interventions, mainly because of limitations in study protocols and small sample sizes. There is a need for larger cluster-RCTs with longer-term follow-ups to determine the effectiveness of different types of interventions to reduce sitting time at work.

Changes in Sitting Time and Sitting Fragmentation after a Workplace Sedentary Behaviour Intervention

Prolonged sedentary behaviour (SB) has shown to be detrimental to health. Nevertheless, population levels of SB are high and interventions to decrease SB are needed. This study aimed to explore the effect of a personalized intervention aimed at reducing SB and increasing breaks in SB among college employees. A pre-experimental study design was used. Participants (n = 36) were recruited at a college in Massachusetts, USA. SB was measured over 7 consecutive days using an activPAL3 accelerometer. Following baseline measures, all participants received a personalized SB consultation which focused on limiting bouts of SB >30 min, participants also received weekly follow-up e-mails. Post-intervention measures were taken after 16 weeks. Primary outcome variables were sedentary minutes/day and SB bouts >30 min. Differences between baseline and follow-up were analyzed using paired t-tests. The intervention did not change daily sedentary time (-0.48%; p > 0.05). The number of sedentary bouts >30 min decreased significantly by 0.52 bouts/day (p = 0.010). In this study, a personalized SB intervention was successful in reducing number of bouts >30 min of SB. However, daily sedentary time did not reduce significantly. These results indicate that personalized, consultation-based interventions may be effective if focused on a specific component of SB.

Context Mining of Sedentary Behaviour for Promoting Self-Awareness Using a Smartphone

Sedentary behaviour is increasing due to societal changes and is related to prolonged periods of sitting. There is sufficient evidence proving that sedentary behaviour has a negative impact on people’s health and wellness. This paper presents our research findings on how to mine the temporal contexts of sedentary behaviour by utilizing the on-board sensors of a smartphone. We use the accelerometer sensor of the smartphone to recognize user situations (i.e., still or active). If our model confirms that the user context is still, then there is a high probability of being sedentary. Then, we process the environmental sound to recognize the micro-context, such as working on a computer or watching television during leisure time. Our goal is to reduce sedentary behaviour by suggesting preventive interventions to take short breaks during prolonged sitting to be more active. We achieve this goal by providing the visualization to the user, who wants to monitor his/her sedentary behaviour to reduce unhealthy routines for self-management purposes. The main contribution of this paper is two-fold: (i) an initial implementation of the proposed framework supporting real-time context identification; (ii) testing and evaluation of the framework, which suggest that our application is capable of substantially reducing sedentary behaviour and assisting users to be active.

Breaking sedentary behaviour has the potential to increase/ maintain function in frail older adults

Objectives:

This pilot study aimed to evaluate the effect of a sedentary behaviour (SB) reduction intervention (Stomp Out (Prolonged) Sitting (SOS)) in frail older adults.

Methods:

Participants (>65years) were recruited from sheltered housing complexes and randomized into 2 groups. On weeks 2, 6 and 10 both groups had face-to-face 40min motivational sessions, including feedback on physical function and SB. One group had the addition of real-time tactile feedback on sitting. Total sedentary time and patterns of SB were recorded by activPAL, along with validated measures of function: Timed Up and Go (TUG), Sit-to-Stand (STS) and balance tests. Outcomes were analyzed by intention-to-treat mixed model analysis.

Results:

Twenty-three participants started the SOS intervention. Health issues led to high attrition in this frail population. TUG (4 seconds faster) and STS (>2 rises more in 30 seconds) scores improved significantly in both groups. There were no significant changes in SB parameters.

Conclusion:

Motivational interviewing alongside functional test feedback, visual and real-time feedback on SB improved physical function over the study. This pilot study suggests that sit-to-stand transitions to break prolonged sitting time may help reduce frailty and functional decline in people who are often unable to engage in more intense exercise interventions.

The Impact of Active Workstations on Workplace Productivity and Performance: A Systematic Review

Active workstations have been recommended for reducing sedentary behavior in the workplace. It is important to understand if the use of these workstations has an impact on worker productivity. The aim of this systematic review was to examine the effect of active workstations on workplace productivity and performance. A total of 3303 articles were initially identified by a systematic search and seven articles met eligibility criteria for inclusion. A quality appraisal was conducted to assess risk of bias, confounding, internal and external validity, and reporting. Most of the studies reported cognitive performance as opposed to productivity. Five studies assessed cognitive performance during use of an active workstation, usually in a single session. Sit-stand desks had no detrimental effect on performance, however, some studies with treadmill and cycling workstations identified potential decreases in performance. Many of the studies lacked the power required to achieve statistical significance. Three studies assessed workplace productivity after prolonged use of an active workstation for between 12 and 52 weeks. These studies reported no significant effect on productivity. Active workstations do not appear to decrease workplace performance.

Sedentary behavior and physical activity of young adult university students

Movement and non-movement behaviors include sleep, sedentary behavior (SB) and physical activity (PA). While young adults are generally perceived as healthy, the level and relationship of SB and PA in college-age students has not been greatly explored. The purpose of this study was to objectively measure the levels of SB and PA in 18-20 year-old university students, record their self-reported extracurricular activities, and explore the relationship of all these with body mass index (BMI) and waist circumference (WC). Male (n = 48) and female (n = 46) students participated in this cross-sectional study. Hierarchical multiple regression analyses were used to examine time spent in SB, moderate to vigorous physical activity (MVPA), number of self-reported sedentary extracurricular activities, and their relation to the dependent variables of BMI and WC. In correlation analyses, SB (p < .001) and MVPA (p = .017) both were negatively associated with BMI, and "other" race or ethnicity (African American, Hispanic, mixed; p = .013) and number of self-reported sedentary extracurricular activities (p = .006) were positively associated with BMI. In the WC regression model, SB (p = .018) was negatively associated and number of self-reported sedentary extracurricular activities (p = .006) was positively associated with WC. University students may be both highly active and highly sedentary. Future researchers should consider targeting interventions to reduce SB in addition to improving PA.

Using the Intervention Mapping and Behavioral Intervention Technology Frameworks: Development of an mHealth Intervention for Physical Activity and Sedentary Behavior Change

Few interventions to promote physical activity (PA) adapt dynamically to changes in individuals' behavior. Interventions targeting determinants of behavior are linked with increased effectiveness and should reflect changes in behavior over time. This article describes the application of two frameworks to assist the development of an adaptive evidence-based smartphone-delivered intervention aimed at influencing PA and sedentary behaviors (SB). Intervention mapping was used to identify the determinants influencing uptake of PA and optimal behavior change techniques (BCTs). Behavioral intervention technology was used to translate and operationalize the BCTs and its modes of delivery. The intervention was based on the integrated behavior change model, focused on nine determinants, consisted of 33 BCTs, and included three main components: (1) automated capture of daily PA and SB via an existing smartphone application, (2) classification of the individual into an activity profile according to their PA and SB, and (3) behavior change content delivery in a dynamic fashion via a proof-of-concept application. This article illustrates how two complementary frameworks can be used to guide the development of a mobile health behavior change program. This approach can guide the development of future mHealth programs.

Introducing sit-stand desks increases classroom standing time among university students

Excessive sedentary behavior has been associated with many negative health outcomes. While an understudied health topic, there is evidence that university students are excessively sedentary. Sit-stand desks have been shown to reduce sedentary time among pre-university students (ages 5-18 years) and sedentary workers but have not been tested in university classrooms. This study tested the effects of introducing sit-stand desks into a university classroom on student's classroom sitting and standing behaviors. Using a cross-over design, students received access to both traditional seated desks and sit-stand desks for six weeks. Data were collected between September and December, 2016. We recruited 304 healthy undergraduate university students enrolled in one of two small (25 seats) classrooms at a large Midwestern university during the fall of 2016. Average minutes of standing/hour/student, average percent class time spent standing, and the number of sit-stand transitions/student/hour were directly observed with video camera surveillance. Participants stood significantly more (p < 0.001) when provided access to sit-stand desks (7.2 min/h/student; 9.3% of class time spent standing) compared to when they had access to seated desks (0.7 min/h/student; 1.6% of class time spent standing) but no differences were observed for the number of sit-stand transitions (p = 0.47). Students reported high favorability for the sit-stand desks and improvements in several student engagement and affective outcomes while using the sit-stand desks. These findings support introducing sit-stand desks in university classrooms as an approach to reduce sedentary behaviors of university students.

Physical Inactivity, Sedentary Behavior and Chronic Diseases

New research into physical activity suggests that it is no longer sufficient just to meet minimum levels recommended by health guidelines in order to reduce cardiovascular risk. Both physical inactivity and sedentary behavior have their own health hazards and need to be addressed separately, in order to explore their different deleterious mechanisms. The aim of this review was to define and to characterize both concepts, and their relationship with major non-communicable chronic diseases. A PubMed database search was undertaken, using the following key words: physical activity, physical inactivity, sedentarism, sedentary behavior, and non-communicable chronic disease. This literature review provides an updated view on physical inactivity and sedentary behavior, and reevaluates their prevalence and association with major non-communicable chronic disease.

Moving to business - changes in physical activity and sedentary behavior after multilevel intervention in small and medium-size workplaces

BACKGROUND

Regular physical activity (PA) promotes and excessive sedentary behavior (SB) deteriorates health. Yet the Finnish working-aged population spends most of the day sitting. A 1-year Moving To Business (MTB) -intervention supported small and medium-size workplaces to combat sedentariness. This paper reports the changes in employees' PA and SB from before MTB (baseline) to 1 year after baseline (follow-up).

METHODS

Twelve workplaces with a total of 396 employees participated. Each workplace nominated a team to promote PA and reduce SB at organizational, working unit and employee level. The teams were mentored regionally through meetings, workshop and tools. Changes in PA and SB were assessed with a questionnaire and an accelerometer. Wald Confidence Interval (Cl) for a difference of proportions with matched pairs was used in the questionnaire data (%-points with 95% CI) and linear mixed model in the accelerometer data (minutes and % of wear-time with 95% CI).

RESULTS

The mean age of the respondents to the questionnaire (N = 296; 75%) was 42.6 (SD 10.9), 64% were women, 95% had some education after high school, 74% worked in the day shift, 71% did sedentary work and 51% were overweight. The mean number of actions implemented in the workplaces was 6.8 and the multilevel approach was fully applied in 6 workplaces. Based on the questionnaire the time spent in SB decreased from baseline to follow-up 16% (95% CI -29 to -3) in total and 22% (-41 to -3) at work. The accelerometer showed daily increases of 33.7 min (15.3 to 52.1) and 6.8% (3.1 to 10.4) in total PA, 30.9 min (15.3 to 46.5) and 6.1% (2.9 to 9.2) in light PA and 673 (209 to 1139) more steps at work. Daily SB at work decreased 44.9 min (-68.0 to -21.8) and 7.6% (-11.9 to -3.2). Daily leisure PA declined 11.0 min (-24.9 to 2.9) and 3.2% (-6.2 to -0.2). Number of levels or actions had no effect on changes.

CONCLUSIONS

Employees' PA increased and SB reduced at work during the intervention. At the same time leisure PA decreased slightly. Workplaces can achieve meaningful changes in employees' PA and SB if assisted systematically. Controlled studies are needed to confirm the present findings.

TRIAL REGISTRATION

NCT01999205 , registration date 11/01/2013.

Replacing sedentary time with sleep, light, or moderate-to-vigorous physical activity: effects on self-regulation and executive functioning

Recent attention has highlighted the importance of reducing sedentary time for maintaining health and quality of life. However, it is unclear how changing sedentary behavior may influence executive functions and self-regulatory strategy use, which are vital for the long-term maintenance of a health behavior regimen. The purpose of this cross-sectional study is to examine the estimated self-regulatory and executive functioning effects of substituting 30 min of sedentary behavior with 30 min of light activity, moderate-to-vigorous physical activity (MVPA), or sleep in a sample of older adults. This study reports baseline data collected from low-active healthy older adults (N = 247, mean age 65.4 ± 4.6 years) recruited to participate in a 6 month randomized controlled exercise trial examining the effects of various modes of exercise on brain health and function. Each participant completed assessments of physical activity self-regulatory strategy use (i.e., self-monitoring, goal-setting, social support, reinforcement, time management, and relapse prevention) and executive functioning. Physical activity and sedentary behaviors were measured using accelerometers during waking hours for seven consecutive days at each time point. Isotemporal substitution analyses were conducted to examine the effect on self-regulation and executive functioning should an individual substitute sedentary time with light activity, MVPA, or sleep. The substitution of sedentary time with both sleep and MVPA influenced both self-regulatory strategy use and executive functioning. Sleep was associated with greater self-monitoring (B = .23, p = .02), goal-setting (B = .32, p < .01), and social support (B = .18, p = .01) behaviors. Substitution of sedentary time with MVPA was associated with higher accuracy on 2-item (B = .03, p = .01) and 3-item (B = .02, p = .04) spatial working memory tasks, and with faster reaction times on single (B = -23.12, p = .03) and mixed-repeated task-switching blocks (B = -27.06, p = .04). Substitution of sedentary time with sleep was associated with marginally faster reaction time on mixed-repeated task-switching blocks (B = -12.20, p = .07) and faster reaction time on mixed-switch blocks (B = 17.21, p = .05), as well as reduced global reaction time switch cost (B = -16.86, p = .01). Substitution for light intensity physical activity did not produce significant effects. By replacing sedentary time with sleep and MVPA, individuals may bolster several important domains of self-regulatory behavior and executive functioning. This has important implications for the design of long-lasting health behavior interventions. Trial Registration clinicaltrials.gov identifier NCT00438347.

Future directions in physical activity intervention research: expanding our focus to sedentary behaviors, technology, and dissemination

Despite the increased health risks of a sedentary lifestyle, only 49 % of American adults participate in physical activity (PA) at the recommended levels. In an effort to move the PA field forward, we briefly review three emerging areas of PA intervention research. First, new intervention research has focused on not only increasing PA but also on decreasing sedentary behavior. Researchers should utilize randomized controlled trials, common terminology, investigate which behaviors should replace sedentary behaviors, evaluate long-term outcomes, and focus across the lifespan. Second, technology has contributed to an increase in sedentary behavior but has also led to innovative PA interventions. PA technology research should focus on large randomized trials with evidence-based components, explore social networking and innovative apps, improve PA monitoring, consider the lifespan, and be grounded in theory. Finally, in an effort to maximize public health impact, dissemination efforts should address the RE-AIM model, health disparities, and intervention costs.