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

neville.owen@bakeridi.edu.au

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.

Released July 2011. New UK-wide Guidelines for PA

Released: November 2011

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

E-pub 28th Feb, 2012

Study Protocol

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

now for some good science!

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