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ICDAM8: Rome, May 2012 Session C-5: Assessment of Sedentary Behaviors
Chair: Neville Owen
Neville Owen: Sedentary Behaviors
Josephine Chau (Sydney): Measuring Workers' Sitting Time by Domain: The Workforce Sitting Questionnaire (paper to be presented by Adrian Bauman)
Ilona Csizmadi (Calgary): Comprehensive Tool to Assess Sedentariness and Activity Energy Expenditure
Alex Hamilton (Oxford): Measuring Episodes of Sedentary Behaviour Using SENSECAM: A Pilot Study
Anna Timperio (Melbourne): Agreement Between ACTIVPAL and ACTIGRAPH for Assessing Children’s Sedentary Time
Sedentary Behaviors
Neville Owen
NHMRC Senior Principal Research Fellow
Head – Behavioural Epidemiology, Baker IDI
ICDAM8
Rome: May, 2012
Sedentary Behaviours
• Sedere – “to sit”
• Different activities that
involve sitting and low
levels of energy
expenditure (1.0-1.5
METS)
• Includes sitting during
commuting, in the
workplace, the domestic
environment and during
leisure time
“Sitting time” = what these sedentary behaviours primarily involve
Sedentary Behaviours
METs
1
2
3
4
0.9: Sleeping
1.0: Sitting quietly (watching TV) 1.5: Sitting (talking) 1.8: Sitting (desk work)
2.5: Slow walking
3.8: Brisk walking
Sedentary
Light
Moderate
Ainsworth BE, et al. Med Sci Sport Exer. 2000;32:S498–S516
2.0: Standing
Physical Activity
Guidelines: time
spent in moderate-
vigorous activity
Sitting Induces Muscular Inactivity
SITTING
4 STEPS GETTING OUT OF A CHAIR
STANDING
Source: Hamilton, M.T., Hamilton, D.G. and Zderic, T.W. (2007) Diabetes, 56, 2655-2667. see also: Hamilton, M. and Owen, N. (in press). Sedentary behavior and inactivity physiology. In C. Bouchard,
S.N. Blair, W. L. Haskell (Eds.) Physical Activity and Health, 2nd edition, Champaign, Illinois: Human Kinetics.
High television viewing time (2 to 4+ hrs/day) is
detrimentally associated with biomarkers and health
outcomes, independent of leisure-time physical activity
• Cardiovascular disease risk1
• Overweight 2,3
• Diabetes3
• Metabolic Syndrome4,5
• Abnormal glucose metabolism6 and other
biomarkers of cardio-metabolic health 7
• Cancer 8,9
1Jakes et al., E J Clin Nu 2003; 2Ching et al., AJPH 1996; 3Hu et al., JAMA 2003 4Dunstan et al., Diabetologia
2005 ; 5Bertrais et al., Obesity Research 2005; 6Dunstan et al., Diabetes Care 2004; 7 Healy et al., MSSE
2008 ; 8 Patel et al., A J Epi 2006; 9Howard et al., Cancer Causes and Control 2008
Prolonged TV time and microcirculation
Anuradha, S., Dunstan, D.W., Healy, G.N., Shaw, J.E., Zimmet, P.Z., Wong, T.Y. and Owen, N. (2011). Physical activity, television viewing time and retinal vascular calibre. Medicine and Science in Sports and Exercise, 43, 280-286.
*adjusted for age, education, diet quality, smoking, waist circumference, systolic blood pressure, serum fasting glucose, serum 2h-post load glucose, serum fibrinogen levels, serum triglyceride levels, physical activity time
Computerised assessment of
Retinal Vascular Calibre
210.7
206
203
205
207
209
211
>2h/day <2h/day
Ve
no
us
Cal
ibre
in m
icro
ns
TV time
TV time and retinal venous calibre in men
p = 0.006*
1.0
1.3 1.5
1.9
2.4
1.1 1.3
1.6 1.8
2.1
1.4 1.5
1.8 1.9
2.4
1.4
2.0 2.0
2.4
3.0
2.0
2.4 2.6
3.5
4.2
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
7+ 4 to 7 1 to 3 <1 Never/rarely
<1 1 to 2 3 to 4 5 to 6 7+
TV Time and Cardiovascular Mortality: AARP Cohort Findings
Television Viewing (hours/day)
Reference
Moderate – vigorous physical activity (hours/week)
Ha
za
rd r
ati
o
Matthews, C.E., S.M. George, S.C. Moore, H.R. Bowles, A. Blair, Y. Park et al.: Amount of time spent in
sedentary behaviors and cause-specific mortality in US adults. Am J Clin Nutr, 2012. 95, 437-445.
Sitting time and mortality
Mortality outcome
≥ 18 17,013 (204,732)
CFS
(Katzmarzyk et al)
≥ 45 83,034 (725,071)
JPHC
(Inoue et al)
≥ 20 7,744 (21 years FU)
ACLS (men)
(Warren et al)
≥ 35 4,512
(19,364)
Scottish HS
(Stamatakis et al)
≥ 25 8,800
(58,087)
AusDiab
(Dunstan et al)
≥ 45 13,197
(124,902)
EPIC Norfolk
(Wijndaele et al)
Cancer CVD All cause
Age
(years)
N
(person-yrs FU) Study
CPS2
(Patel et al)
123,216 (1,610,728)
≥ 50 ♀
With thanks to Dr Katrien Winjdaele; Metabolic Sciences, Cambridge; see Thorp, A., Owen, N., Neuhaus, M. and Dunstan D.W. (2011). Sedentary behaviors and
subsequent health outcomes: A systematic review of longitudinal studies, 1996-2011. American Journal of Preventive Medicine, 41, 207-215.
rapidly-strengthening evidence base modest evidence base limited evidence base
vi) using the relevant evidence to inform public health guidelines and
policy
iii) characterising prevalence and variations of sitting time in populations
iv) identifying the determinants of sitting time
v) developing and testing interventions to influence sitting time
i) Identifying relationships of sitting time with health outcomes
ii) measuring sitting time
0
1000
2000
3000
4000
5000
6000
7000
8000
AC
TIV
ITY
\
Sedentary
Moderate-to-vigorous
Light Intensity
Accelerometer measurement of
sedentary time
You can be ‘active’, but mostly sit
The ‘Active’ Couch Potato
Mean mod-to-vigorous time = 31 mins/day
% Waking hours spent in Sedentary = 71%
Tim
e (
min
ute
s)
Morning
Night
Sedentary
Light
Moderate/vigorous
Activity
Intensity
Energy
Expenditure
Very Low
Very High
Sedentary time
Moderate-vigorous activities
Light-intensity
Well-Understood, Powerful
Biological Stimulus
BUT
Low Total Volume
Newly-Emerging, Unique
Biological Stimulus?
AND
Very Large Total Volume
Differentiating the Domain of NEAT (James Levine)
The ‘breaks in sedentary time’ hypothesis
Breaking-up sedentary time (with bfrequent transitions from sitting to
standing) has beneficial associations iomarkers (independent of total
sedentary time)
Healy, G.N., Dunstan, D.W., Salmon, J., Cerin, E., Shaw, J.E., Zimmet, P.Z., and Owen, N. (2008). Breaks in
sedentary time: Beneficial associations with metabolic risk. Diabetes Care, 31, 661-666.
“Prolonger” “Breaker”
Sedentary
CPM < 100
Not sedentary
CPM 100+
Sedentary time & breaks in sedentary time
NHANES 2003-2006
Adjusted for age, sex, race/ethnicity, moderate-vigorous intensity activity + other potential confounders Breaks in sedentary time additionally adjusted for total sedentary time
4.3cm difference
Sedentary time: detrimental
HDL-C, triglycerides, insulin,
HOMA-%B, HOMA-%S
Breaks: beneficial
Waist circumference, HDL-C,
C-reactive protein
Healy G.N., Matthews, C.E., Dunstan, D.W., Winkler, E.A.H., Owen, N. (2011). Sedentary time
and cardio-metabolic biomarkers in US adults: NHANES 2003-06. European Heart Journal, 32,
590-597
prolonged sitters breakers
IDLE Breaks: Initial Findings
Dunstan et al. (unpublished findings)
GLUCOSE
INSULIN
0
2
4
6
8
10
0
5
10
15
20
25
Pla
sm
a g
luco
se
(m
mo
l/L
)
Pla
sm
a g
lucose
AU
C (
mm
ol/L
/hr)
0 1 2 3 4 5 -2 -1
Hours
Uninterrupted
sitting
Sitting
+ light-intensity
breaks
Sitting
+ moderate-
intensity
breaks
Uninterrupted sitting
Sitting + light-intensity breaks
Sitting + moderate-intensity breaks
* *
* p<0.001, # p<0.01
0 1 2 3 4 5 -2 -1
Hours
Uninterrupted
sitting
Sitting
+ light-intensity
breaks
Sitting
+ moderate-
intensity
breaks
0
150
300
450
600
Se
rum
insu
lin (
pm
ol/L
)
Se
rum
insu
lin A
UC
(p
mo
l/L
/hr)
0
300
600
900
1200
# #
rapidly-strengthening evidence base modest evidence base limited evidence base
vi) using the relevant evidence to inform public health guidelines and
policy
iii) characterising prevalence and variations of sitting time in populations
iv) identifying the determinants of sitting time
v) developing and testing interventions to influence sitting time
i) Identifying relationships of sitting time with health outcomes
ii) measuring sitting time
Ecological Model of Four Domains of Sedentary Behavior
Behavior: Active Living Domains
Perceived Environment
Intrapersonal
07-20-05
Social Cultural Environment
Advocacy by individuals & organizations
Social climate, safety, crime, norms, culture
Interpersonal modeling,
social support, prompts to sit,
awkwardness of standing
Social norms Perceived crime
Leisure Time
Household
Transport
Occupation
Neighborhood - poor ped/bike facilities -aesthetics - traffic safety
Recreation Environment Seating in Parks Park design to promote sitting Screen-based entertain; movies, game arcades Sport spectatorship
Home Environment Electronic entertainment; passive/active Remote controls Labor-saving devices Furniture for sitting/reclining
Neighborhood - walkability - ped/bike facilities - parking -transit -traffic
Info promoting SB during transport - safety signage - radio ads & news - billboards (TV, movies, sports)
Workplace Environment Furniture designed for sitting Neighborhood walkability Parking Transit access Building design Stair design Ped/Bike Facilities
Healthcare: counseling, info Mass media - news, ads Sports spectating Informal discussions
Weather Topography Air quality
Transport policies Energy policies
Media regulations Health sector policies Business practices
Requirements for seated work
OHS codes Rules for breaks Zoning codes Building codes Parking regulations Transportation investments
Negative perceptions of “active” environments: unsafe, uncomfortable, unattractive, inconvenient
Information Environment
Natural Environment
School Environment Neighborhood walkability Ped/bike facilities Facilities PE program Walk to School program Requirements for sitting
PE & recess policies Facility & policy access policies Safe Routes to School funding
Demographics Biological
Psychological Family Situation
Price of electricity Incentives for energy conservation zoning codes
SB not assessed in health care Sidewalk requirements
Transport investments & Regulations
Public recreation Investments Park design policies
Sedentary Behavior Domains Domains
Perceived Environment
Intrapersonal
Behavior Settings:
Access & Characteristics
Policy Environment
Zoning codes Development
Regulations (sidewalk requirements)
Transport investments Traffic demand management Parking regulations Developer incentives
Cues for sitting, purpose of furniture/desk
Comfort, convenience of labor saving devices, attractiveness of sedentary entertainment
negative perceptions of active transport facilities; positive perception of motorized facilities
Owen, N., Sugiyama, T., Eakin, E.G., Gardiner, P.A., Tremblay, M.S. and Sallis JF. (2011). Adults’ sedentary behavior:
Determinants and interventions. American Journal of Preventive Medicine, 41, 189-196.
Sedentary behaviour measurement
How best to characterise sedentary time: total time; breaking-up, bouts of defined durations?
Making the best of both device-based and self-report measurement tools
Context-anchored measurement: identifying the volume and patterns of sitting time in key sedentary behaviour settings (workplace; domestic; transportation)
Capturing behavioural and contextual attributes concurrently
ICDAM8: Rome, May 2012 Session C-5: Assessment of Sedentary Behaviors
Josephine Chau (Sydney): Measuring Workers' Sitting Time by Domain: The Workforce Sitting Questionnaire (paper to be presented by Adrian Bauman)
Ilona Csizmadi (Calgary): Comprehensive Tool to Assess Sedentariness and Activity Energy Expenditure
Alex Hamilton (Oxford): Measuring Episodes of Sedentary Behaviour Using SENSECAM: A Pilot Study
Anna Timperio (Melbourne): Agreement Between ACTIVPAL and ACTIGRAPH for Assessing Children’s Sedentary Time