Sedentary Time and Metabolic Risk in Extremely Active Older Adults

A systematic review of research reporting practices in observational studies examining associations between 24-h movement behaviors and indicators of health using compositional data analysis

Background

Compositional data analysis (CoDA) techniques are well suited for examining associations between 24-h movement behaviors (i.e., sleep, sedentary behavior, physical activity) and indicators of health given they recognize these behaviors are co-dependent, representing relative parts that make up a whole day. Accordingly, CoDA techniques have seen increased adoption in the past decade, however, heterogeneity in research reporting practices may hinder efforts to synthesize and quantify these relationships via meta-analysis. This systematic review described reporting practices in studies that used CoDA techniques to investigate associations between 24-h movement behaviors and indicators of health.

Methods

A systematic search of eight databases was conducted, in addition to supplementary searches (e.g., forward/backward citations, expert consultation). Observational studies that used CoDA techniques involving log-ratio transformation of behavioral data to examine associations between time-based estimates of 24-h movement behaviors and indicators of health were included. Reporting practices were extracted and classified into seven areas: (1) methodological justification, (2) behavioral measurement and data handling strategies, (3) composition construction, (4) analytic plan, (5) composition-specific descriptive statistics, (6) model results, and (7) auxiliary information. Study quality and risk of bias were assessed by the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-sectional Studies.

Results

102 studies met our inclusion criteria. Reporting practices varied considerably across areas, with most achieving high standards in methodological justification, but inconsistent reporting across all other domains. Some items were reported in all studies (e.g., how many parts the daily composition was partitioned into), whereas others seldom reported (e.g., definition of a day: midnight-to-midnight versus wake-to-wake). Study quality and risk of bias was fair in most studies (85%).

Conclusions

Current studies generally demonstrate inconsistent reporting practices. Consistent, clear and detailed reporting practices are evidently needed moving forward as the field of time-use epidemiology aims to accurately capture and analyze movement behavior data in relation to health outcomes, facilitate comparisons across studies, and inform public health interventions and policy decisions. Achieving consensus regarding reporting recommendations is a key next step.

Supplementary Information

The online version contains supplementary material available at 10.1186/s44167-024-00062-8.

Reallocating just 10 min to moderate-to-vigorous physical activity from other components of 24-hour movement behaviors improves cardiovascular health in adults

BACKGROUND

As components of a 24-hour day, sedentary behavior (SB), physical activity (PA), and sleep are all independently linked to cardiovascular health (CVH). However, insufficient understanding of components' mutual exclusion limits the exploration of the associations between all movement behaviors and health outcomes. The aim of this study was to employ compositional data analysis (CoDA) approach to investigate the associations between 24-hour movement behaviors and overall CVH.

METHODS

Data from 581 participants, including 230 women, were collected from the 2005-2006 wave of the US National Health and Nutrition Examination Survey (NHANES). This dataset included information on the duration of SB and PA, derived from ActiGraph accelerometers, as well as self-reported sleep duration. The assessment of CVH was conducted in accordance with the criteria outlined in Life's Simple 7, encompassing the evaluation of both health behaviors and health factors. Compositional linear regression was utilized to examine the cross-sectional associations of 24-hour movement behaviors and each component with CVH score. Furthermore, the study predicted the potential differences in CVH score that would occur by reallocating 10 to 60 min among different movement behaviors.

RESULTS

A significant association was observed between 24-hour movement behaviors and overall CVH (p < 0.001) after adjusting for potential confounders. Substituting moderate-to-vigorous physical activity (MVPA) for other components was strongly associated with favorable differences in CVH score (p < 0.05), whether in one-for-one reallocations or one-for-remaining reallocations. Allocating time away from MVPA consistently resulted in larger negative differences in CVH score (p < 0.05). For instance, replacing 10 min of light physical activity (LPA) with MVPA was related to an increase of 0.21 in CVH score (95% confidence interval (95% CI) 0.11 to 0.31). Conversely, when the same duration of MVPA was replaced with LPA, CVH score decreased by 0.67 (95% CI -0.99 to -0.35). No such significance was discovered for all duration reallocations involving only LPA, SB, and sleep (p > 0.05).

CONCLUSIONS

MVPA seems to be as a pivotal determinant for enhancing CVH among general adult population, relative to other movement behaviors. Consequently, optimization of MVPA duration is an essential element in promoting overall health and well-being.

Associations of 24 h time-use compositions of sitting, standing, physical activity and sleeping with optimal cardiometabolic risk and glycaemic control: The Maastricht Study

AIMS/HYPOTHESIS

The associations of sitting, standing, physical activity and sleep with cardiometabolic health and glycaemic control markers are interrelated. We aimed to identify 24 h time-use compositions associated with optimal metabolic and glycaemic control and determine whether these varied by diabetes status.

METHODS

Thigh-worn activPAL data from 2388 participants aged 40-75 years (48.7% female; mean age 60.1 [SD = 8.1] years; n=684 with type 2 diabetes) in The Maastricht Study were examined. Compositional isometric log ratios were generated from mean 24 h time use (sitting, standing, light-intensity physical activity [LPA], moderate-to-vigorous physical activity [MVPA] and sleeping) and regressed with outcomes of waist circumference, fasting plasma glucose (FPG), 2 h plasma glucose, HbA1c, the Matsuda index expressed as z scores, and with a clustered cardiometabolic risk score. Overall analyses were adjusted for demographics, smoking, dietary intake and diabetes status, and interaction by diabetes status was examined separately. The estimated difference when substituting 30 min of one behaviour with another was determined with isotemporal substitution. To identify optimal time use, all combinations of 24 h compositions possible within the study footprint (1st-99th percentile of each behaviour) were investigated to determine those cross-sectionally associated with the most-optimal outcome (top 5%) for each outcome measure.

RESULTS

Compositions lower in sitting time and with greater standing time, physical activity and sleeping had the most beneficial associations with outcomes. Associations were stronger in participants with type 2 diabetes (p<0.05 for interactions), with larger estimated benefits for waist circumference, FPG and HbA1c when sitting was replaced by LPA or MVPA in those with type 2 diabetes vs the overall sample. The mean (range) optimal compositions of 24 h time use, considering all outcomes, were 6 h (range 5 h 40 min-7 h 10 min) for sitting, 5 h 10 min (4 h 10 min-6 h 10 min) for standing, 2 h 10 min (2 h-2 h 20 min) for LPA, 2 h 10 min (1 h 40 min-2 h 20 min) for MVPA and 8 h 20 min (7 h 30 min-9 h) for sleeping.

CONCLUSIONS/INTERPRETATION

Shorter sitting time and more time spent standing, undergoing physical activity and sleeping are associated with preferable cardiometabolic health. The substitutions of behavioural time use were significantly stronger in their associations with glycaemic control in those with type 2 diabetes compared with those with normoglycaemic metabolism, especially when sitting time was balanced with greater physical activity.

Association between metabolic syndrome severity score and cardiovascular disease: results from a longitudinal cohort study on Chinese adults

Objective

This study aimed to quantify the severity of metabolic syndrome(MetS) and investigate its association with cardiovascular disease(CVD) risk on Chinese adults.

Methods

13,500 participants from the Zhejiang Adult Chronic Disease Study were followed up between 2010 and 2021. A continuous MetS severity score derived from the five components of MetS was used to quantify MetS severity, and the association between MetS severity and the risk of incident CVD was assessed using Cox proportional hazard and restricted cubic spline regression.

Results

Both the presence and severity of MetS were strongly associated with CVD risk. MetS was related to an increased risk of CVD (hazard ratio(HR):1.700, 95% confidence interval(CI): 1.380-2.094). Compared with the hazard ratio for CVD in the lowest quartile of the MetS severity score, that in the second, third, and highest quartiles were 1.812 (1.329-2.470), 1.746 (1.265-2.410), and 2.817 (2.015-3.938), respectively. A linear and positive dose-response relationship was observed between the MetS severity and CVD risk (P for non-linearity = 0.437). Similar results were found in various sensitivity analyses.

Conclusion

The MetS severity score was significantly associated with CVD risk. Assessing MetS severity and further ensuring intervention measures according to the different severities of MetS may be more useful in preventing CVD.

Sedentary behavior and risk of cardiovascular disease and all-cause mortality in United States adults with hypertension

BACKGROUND

Growing evidence has implicated sedentary behavior is associated with cardiovascular and all-cause mortality, independent of moderate to vigorous physical activity (MVPA). Contrary to national physical activity guidelines, reductions in sedentary behavior are not promoted as a lifestyle modification in hypertensive adults. This may be in part because of a paucity of evidence demonstrating that sedentary behavior confers morbidity and mortality risk in hypertensive adults.

PURPOSE

To examine the association between device-measured sedentary behavior and risk of cardiovascular and all-cause mortality and in hypertensive adults.

METHODS

Data for this analysis come from the 2003 to 2006 National Health and Nutrition Examination Survey, a nationally representative survey of US adults. Sedentary behavior and MVPA were assessed with an ActiGraph 7164 accelerometer. Hypertension was classified as blood pressure at least 140/≥90 mmHg or antihypertensive medication use.

RESULTS

Median follow-up was 14.5 years. After adjusting for covariates and MVPA, greater time spent in sedentary behavior was associated with an increased risk of cardiovascular mortality [quartile 1: REF, quartile 2: hazard ratio = 1.41 [95% confidence interval (95% CI) 0.83-2.38], quartile 3: hazard ratio = 1.25 (95% CI 0.81-1.94), quartile 4: hazard ratio = 2.14 (95% CI 1.41-3.24); P trend <0.001]. Greater sedentary behavior was also associated with an increased risk of all-cause mortality [quartile 1: REF: quartile 2: hazard ratio = 1.13 (95% CI 0.83-1.52), quartile 3: hazard ratio = 1.33 (95% CI 1.00-1.78), quartile 4: hazard ratio = 2.06 (95% CI 1.60, 2.64); P trend <0.001].

CONCLUSION

Greater sedentary behavior is associated with increased risk of cardiovascular mortality and all-cause mortality among US adults with hypertension. These findings suggest reductions in sedentary behavior should be considered to reduce mortality risk in hypertensive adults.

Type 2 Diabetes Mellitus and Sarcopenia as Comorbid Chronic Diseases in Older Adults: Established and Emerging Treatments and Therapies

Type 2 diabetes mellitus (T2DM) and sarcopenia (low skeletal muscle mass and function) share a bidirectional relationship. The prevalence of these diseases increases with age and they share common risk factors. Skeletal muscle fat infiltration, commonly referred to as myosteatosis, may be a major contributor to both T2DM and sarcopenia in older adults via independent effects on insulin resistance and muscle health. Many strategies to manage T2DM result in energy restriction and subsequent weight loss, and this can lead to significant declines in muscle mass in the absence of resistance exercise, which is also a first-line treatment for sarcopenia. In this review, we highlight recent evidence on established treatments and emerging therapies targeting weight loss and muscle mass and function improvements in older adults with, or at risk of, T2DM and/or sarcopenia. This includes dietary, physical activity and exercise interventions, new generation incretin-based agonists and myostatin-based antagonists, and endoscopic bariatric therapies. We also highlight how digital health technologies and health literacy interventions can increase uptake of, and adherence to, established and emerging treatments and therapies in older adults with T2DM and/or sarcopenia.

The joint association of physical activity and sedentary behavior with metabolic syndrome among urban men aged 60+ years in regional China

Objectives

Metabolic syndrome (MetS) is a major public health issue worldwide, which is preventable through physical activity (PA) promotion and sedentary behavior (SB) reduction. However, the joint association of PA and SB with MetS was not well-investigated, particularly in elderly people. This study aimed to examine separate and joint associations of PA and SB with MetS among elderly urban men in China.

Methods

In this cross-sectional study conducted in mid-2018, participants were urban men aged 60+ years randomly selected from in Nanjing of China. Exposure variables were PA and SB. The outcome variable was MetS. A participant was categorized as "having MetS" or "not having MetS" in the analysis. Independent variables were PA and SB, which were categorized as "sufficient PA or insufficient PA" and "shortened SB or prolonged SB", respectively. Mixed-effects logistics regression models were applied to calculate odds ratios (ORs) and 95% confidence intervals (CIs) to assess the association of PA and SB with MetS.

Results

Totally, 5,520 from 5,792 eligible participants were randomly recruited and their mean age was 68.9 (standard deviation: 16.9) years. The prevalence of MetS was 30.8% (95%CI = 29.6%, 32.0%) among urban men aged 60+ years in the study. After adjustment for potential confounders, subjects with sufficient PA were less likely (OR = 0.77, 95%CI = 0.67, 0.88) to experience MetS, independently of SB, relative to their counterparts with insufficient PA, while a lower odds (OR = 0.74; 95%CI = 0.61, 0.89) of experiencing MetS was examined for participants with shortened SB, also independently of PA, compared to those with prolonged SB in the study. Furthermore, compared to participants with insufficient PA and prolonged SB, those either within categories of insufficient PA and shortened SB (OR = 0.81; 95%CI = 0.65, 0.99), sufficient PA and prolonged SB (OR = 0.80; 95%CI = 0.70, 0.92), or sufficient PA and shortened SB (OR = 0.41; 95%CI = 0.26, 0.63) were at significantly lower risk to experience MetS, respectively.

Conclusions

PA was negatively associated with MetS, and SB was positively linked to MetS, which were independent of each other. Moreover, sufficient PA and shortened SB might exert additively joint influence on MetS. This study has important implications that concurrent PA promotion and SB reduction shall be encouraged for people to optimize the effectiveness of MetS prevention.

Continuous metabolic syndrome severity score and the risk of CVD and all-cause mortality

BACKGROUND

The dualistic diagnostic criteria for metabolic syndrome overlooked the severity of metabolic syndrome, and the relationships between the severity of metabolic syndrome and adverse health conditions are poorly characterized. We therefore aimed to investigate the associations of metabolic syndrome severity with incident cardiovascular disease (CVD)/all-cause mortality.

METHODS

A total of 116,772 participants from the Kailuan study were followed up biennially between 2006 and 2018. The severity of metabolic syndrome was evaluated using a continuous metabolic syndrome severity score (MetS score). Cox proportional hazards model was used to examine the association between MetS score and the risk of CVD and all-cause mortality. Restricted cubic spline analyses were performed to explore the dose-response associations.

RESULTS

We found that the risk of CVD and all-cause mortality increased consistently with the MetS score. In the multivariable-adjusted model, the hazard ratios of CVD and all-cause mortality were 2.05 (95% CI 1.86-2.25) and 1.45 (95% CI 1.35-1.56), respectively, in those subjects>75th percentile compared with those <25th percentile. Additionally, a J-shaped dose-response relationship was found between MetS score and the risk of all-cause mortality (p_nonlinearity  <.001), while a linear relationship between MetS score and the risk of CVD was observed in this study (p_nonlinearity  = .737).

CONCLUSIONS

This study suggests significant dose-response relationships between MetS score and the risk of CVD/mortality. Subjects without metabolic syndrome but with a relatively high MetS score should raise their awareness and pay more attention to the possible increased risk of CVD events.

Impact of BMI, Physical Activity, and Sitting Time Levels on Health-Related Outcomes in a Group of Overweight and Obese Adults with and without Type 2 Diabetes

Physical activity level and sedentary behaviors affect health status in people with obesity and type 2 diabetes (DM2); their assessment is mandatory to properly prescribe exercise programs. From January 2011 to February 2014, 293 overweight/obese adults (165 women and 128 men, mean age of 51.9 ± 9.5 years and 54.6 ± 8.3 years, respectively), with and without DM2, participated in a three-month intensive exercise program. Before starting, participants were allocated into three subgroups (overweight, body mass index or BMI = 25-29.9; class 1 of obesity, BMI = 30-34.4; or class 2 (or superior) of obesity, BMI > 35). The international physical activity questionnaire (IPAQ-it) was used to evaluate participants' baseline sitting time (SIT) and physical activity level (PAL). Stratified multiple analyses were performed using four subgroups of SIT level according to Ekelund et al., 2016 (low, 8 h/day of SIT) and three subgroups for PAL (high, moderate, and low). Health-related measures such as anthropometric variables, body composition, hematic parameters, blood pressure values, and functional capacities were studied at the beginning and at the end of the training period. An overall improvement of PAL was observed in the entire sample following the three-month intensive exercise program together with a general improvement in several health-related measures. The BMI group factor influenced the VO₂ max variations, leg press values, triglycerides, and anthropometric variables, while the SIT group factor impacted the sitting time, VO₂ max, glycemic profile, and fat mass. In this study, baseline PAL and SIT did not seem to influence the effects of an exercise intervention. The characteristics of our educational program, which also included a physical exercise protocol, allowed us to obtain positive results.

Metabolic syndrome severity score and the progression of CKD

BACKGROUND

Metabolic syndrome severity, expressed by the continuous metabolic syndrome risk score (MetS score), has been demonstrated to be able to predict future health conditions. However, little is known about the association between MetS score and renal function.

METHODS

A total of 22,719 participants with normal renal function abstracted from the Kailuan Study were followed from 2006 to 2016. The new onset of chronic kidney disease (CKD) was defined as eGFR <60 ml/min per 1.73 m² and/or proteinuria >300 mg/dl. Progressive decline in renal function was defined as an annual change rate of eGFR below the 10th percentile of the whole population.

RESULTS

In the multivariate-adjusted model, we found that the risk of progressive decline in renal function increased consistently with the MetS score, with an odds ratio of 1.49 (95% CI, 1.28, 1.73) for those subjects>75th percentile compared with those <25th percentile. Additionally, a high MetS score was found to be associated with an increased risk of CKD, with a hazard ratio of 1.53 (95% CI, 1.33, 1.78) for subjects >75th percentile compared with those <25th percentile.

CONCLUSIONS

Our findings suggested that the MetS score was associated with an increased risk of a progressive decline in renal function and was also a strong and independent risk factor for the development of CKD. These findings provide evidence of the potential clinical utility of the MetS score for assessing metabolic syndrome severity to detect the risk of decreased renal function and CKD.

Psychometric Properties of the Korean Version of the Perceived Therapeutic Efficacy Scale for Physical Activity in Adults With Type 2 Diabetes

PURPOSE

The purpose of this study is to translate the Perceived Therapeutic Efficacy Scale (PTES) into Korean and investigate its validity and reliability.

METHODS

The authors conducted a cross-sectional survey using baseline data from a randomized controlled study to psychometrically validate the PTES-Korean (PTES-K) among 108 adults with type 2 diabetes from an outpatient clinic at a university-affiliated hospital in Korea. The original PTES was forward-translated and back-translated to ensure translation equivalence of the PTES-K. Structured questionnaires were used for psychometric evaluation; exploratory and confirmatory factor analysis assessed validity, and Cronbach's alpha coefficient and intraclass correlation coefficient (ICC) were used for reliability.

RESULTS

The interitem correlation analyses revealed that 5 items were redundant; thus, the scale was reduced to 5 items. A 1-factor model explained 76.85% of the variance; confirmatory factor analysis showed that this model adequately fit the data. The ICC for test-retest reliability was .78; Cronbach's alpha was .92. The PTES-K showed significant associations with the scores of diabetes self-care activities for physical activity, quality of life, and depressive symptoms. Participants with good glycemic control and regular physical activity tended to have a higher score on the PTES-K than their counterparts, demonstrating known-groups validity.

CONCLUSIONS

The cross-cultural applicability, reliability, and validity of the PTES-K were confirmed. The PTES-K may be used in clinical settings to examine the potential role of perceived therapeutic efficacy for physical activity in enhanced glycemic control among patients with diabetes.

Associations of Mutually Exclusive Categories of Physical Activity and Sedentary Time With Metabolic Syndrome in Older Adults: An Isotemporal Substitution Approach

The aim of this study was to examine, theoretically, how reallocating time between the intensity of mutually exclusive categories of physical activity and sedentary behavior time is associated with metabolic syndrome. Four hundred and six older adults (61.6% women) from the second wave of the EpiFloripa Aging Cohort Study were included in the study (mean age 71.7 ± 5.9 years). Isotemporal substitution analysis showed a decrease of 35% (odds ratio: 0.65; 95% confidence interval [0.45, 0.96]) in the risk for metabolic syndrome when replacing 30 min/day of sedentary behavior with an equivalent amount of moderate to vigorous physical activity. Furthermore, it has been observed that older adults classified as low sedentary behavior and physically active were 57% less likely to have metabolic syndrome than participants classified as high sedentary and physically inactive (odds ratio: 0.43; 95% confidence interval [0.19, 0.97]). This study highlights the importance of behavioral categories that may emerge concerning the interrelationships of physical activity and health in older adults, having important implications for future health intervention programs.