The Other 23 1/2 Hours in the Day –Beyond Physical Activity

Striking a Balance... Weigh in with Knowledge, Research, Practice Symposium, Canadian Diabetes Association

Ottawa, September 30th, 2013.

Robert RossPhD, FACSM, FAHA

School of Kinesiology and Health Studies

Medicine, Division of Endocrinology and Metabolism

Queen’s University

Kingston, Ontario, Canada

No Conflicts of Interest to Declare

Sedentary living is real…

….but is it a Unique Public Health Problem?

The Issue for today’s session

Slide courtesy David Dunstan

Slide courtesy David Dunstan

Physical Activity Sedentary

A Typical Canadian Day?

Slide courtesy David Dunstan

Accelerometer

‘Actigraph’

Physical Activity of Canadian Adults: Accelerometer Results from the 2007-2009 Canadian Health Measures Survey

Colley et al Health Reports 22 (1) March 2011

Time of Day

Accelerometer Data for a Single Day

Light-intensity Activity

Moderate/vigorous-intensity Activity

Sedentary

Time of Day

Accelerometer Data for a Single Day

Light-intensity Activity

Moderate/vigorous-intensity Activity

Sedentary

95% of waking hours

Is Sedentary time associated with health outcomes?

The Other 23 1/2 Hours in the Day –Beyond Physical Activity

Is Sedentary time associated with health outcomes independent of physical activity?

Two Questions:

A 2-week reduction of ambulatory activity (walking) is associated witha 17% reduction in Insulin sensitivity in 10 healthy young men.

Krogh-Madsen et al J Appl Physiol 108: 1034-1040, 2010.

Explored whether a decrease in daily steps from ~10,000 to 1,300 was

associated with a decrease in insulin sensitivity in young men.

17%

Key PointSedentary time (A) by accelerometers was detrimentally associated with 2-hr glucose independent of moderate-to-vigorous-intensity activity.

Healy et al. Diabetes Care

Sedentary

LPA

MVPA

2-h

r g

luco

se (

mm

ol/

l)

Sitting time and Mortality from All Causes, CardiovascularDisease, and Cancer in 17,013 Canadians (18-90 yr) followed

for an average of 12 yrs

Katzmarzyck P., et al. Med Sci Sport Exerc 41:998,2009.

Ag

e-a

dju

ste

d A

ll-c

au

se M

ort

ali

ty

Hu F. et al. JAMA 289:1785-1791, 2003.

Television Watching in Relation to Risk of Obesity and Type 2 Diabetes in Women

Independent of exercise watching TV was associated with significantly elevated risk of obesity and type 2 diabetes, whereas light to moderate activity

was associated with substantially lower risk.

Association between TV watching, Obesity and Type 2 Diabetes in Women

Associations between TV time and Sitting time

With Metabolic Syndrome in 1,958 Older Adults

Gardiner PA., et al. JAGS 59:788-796, 2011.

1.14 h/d

2.00 h/d

3.00 h/d

3.43 h/d

4.99 h/d

6.65 h/d

Take home Message?

1. Decrease sitting time

2. Increase physical activity time

Duvivier et al. PLoS One 8(2): e55542, 2013.

Does Minimal Intensity Exercise Improve Insulin Sensitivity in 18 Young (21 yr) Sedentary Subjects?

14 hrs 13.5 hrs 30 min8 hrs

6 hrs

Duration of each condition = 4 days

Duvivier et al. PLoS One 8(2): e55542, 2013.

Does minimal intensity exercise intensity lower Insulin Sensitivity in Sedentary Subjects?

Appl Physiol Nutr Metab 38: 477-483, 2013.

High levels of MVPA are Associated with reduced Cardiometabolic in

Children Regardless of Sedentary Time.

Type of Sedentary time (eg screen time) mayBe more important that overall Sedentary Time.

Excess TV viewing: a special component of sedentary time?

Moderate to Vigorous Physical Activity and Sedentary Timeand Cardiometabolic Risk factors in Children and Adolescents

Ekelund U. et al. JAMA 307(7):704-712,2012

14 studies ; 20,871 ; 4-18 yrHigher MVPA time in children and adolescents is

Associated with lower Cardiometabolic Risk Factors Regardless of Sedentary Time

SUMMARY

Adapted from Wen CP, Wu X The Lancet 2012;380:192-3

Sedentary Lifestyle: the Smoking of the 21st Century?

26%

35%1,57

1,28

8,7% 9,0 %

5,1 million

5,3 million

Smoking Inactivity Smoking Inactivity Smoking Inactivity Smoking Inactivity

Prevalence Hazard ratio*Population

Attributable RiskGlobal Deaths per Year

Comparison of global burden between smoking and physical inactivity (*from meta-analyses).

150 minutes per week of moderate (brisk walking) in bouts of 10 minutes or more.

Increase physical activity = Increase in cardiorespiratory fitness

~5 times - 30 min/day150 minutes /week

Card

iore

sp

irato

ry F

itn

ess

Before After

~4 Weeks

~20%

Effect of Fatness (BMI) and Fitness on Cardiovascular Disease (CVD) Mortality

Wei M et al. JAMA 1999; 282:1547-53

0

1.5

3

4.5

Normal Weight

RR

of

CV

D M

ort

ality

FitUnfit

Overweight Obese

“Fit” – top 80 percent – 30 minutes per day of physical activity

Association of CRF and PA with Risk of Developing Hypertension (HTN) in Men

WJR = walker/jogger/runner

Sport = other activities (such as cycling, swimming, racquet and ball sports)

Chase et al. Am J Hypertension 2009; 22(4): 417

Se

de

nta

ry

WJ

R

Sp

ort

Lo

w

Mid

dle

Hig

h

PA CRF

HR

Effect of Acute Exercise on Insulin Sensitivity in Men and Women

Perseghin et al. N Eng J Med. 335: 1996.

Insu

lin

Sen

sit

ivit

y(m

g/k

g, F

FM

)

Baseline Acute ( 1 Day )

Acute > Baseline**

0

2

6

10

14

18

20%

A Typical Canadian Day?

Slide courtesy David Dunstan

Excess TV viewing: a special component of sedentary time?

www.csep.ca

How much Daily Recreational Screen Time?

2 Hours….or less!

Sedentarism is real…

….but is it a Unique Public Health Problem?

The Issue of today’s lecture

Increasing physical activity behavior in today’s environment poses a challenge…

Importance of Self-Monitoring – Role for Pedometers

Accumulate 15-30 minutes per day

2000 extra steps / day

Goal: 10,000 steps / day

Exercise is a subset of physical activity

Exercise = ‘structured’ or leisure time activity

Is Exercise the same as Physical Activity?

Physical activity = ‘unstructured’ leisure and non-leisure activity

Relative Risk

Total Walking Time Walking Pace

Walking, Walking Pace and Risk of CHD in WomenLee et al. JAMA 285(11): 1447, 2001.

Easy< 3.2 km / hr

Normal3.2 – 4.8 km / hr

Brisk> 4.8 km / hr

Do Not Walk

Do Not Walk

1 to 59 min / wk

1.0 to 1.5 hr / wk

> 2 hr / wk

50% Reduction

FREE GYM!

Thank You

Merci

rossr@queensu.ca