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Sedentary Behavior and Prevalent Diabetes in 6,166 Older Women: The Objective Physical Activity and Cardiovascular Health Study

DOI:10.1093/gerona/gly101
Authors:
John Bellettiere at University of California, San Diego
John Bellettiere
Genevieve N Healy at The University of Queensland
Genevieve N Healy
Michael J LaMonte
Michael J LaMonte
Michael J LaMonte
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Jacqueline Kerr
Jacqueline Kerr
Jacqueline Kerr
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Background We examined associations of sedentary time and sedentary accumulation patterns (i.e., how sedentary time is accumulated) with prevalent diabetes in an ethnically diverse cohort of older women. Methods Community-dwelling women aged 63-99 (n=6,116; median age=79) wore ActiGraph GT3X+ accelerometers 24 hours/day for up to seven days from which we derived average daily sedentary time and three measures of sedentary accumulation patterns: breaks in sedentary time, usual sedentary bout duration, and alpha. Odds ratios (ORs) and 95% confidence intervals (CIs) for prevalent diabetes were estimated using multivariable logistic regression. Results Twenty-one percent (n=1282) of participants had diabetes. Women in the highest quartile of sedentary time (≥10.3 hrs/day) had higher odds of diabetes (OR=2.18; 95% CI=1.77-2.70) than women in the lowest quartile (≤8.3 hrs/day). Prolonged accumulation patterns (i.e., accumulating sedentary time in longer sedentary bouts) was associated with higher odds of diabetes than regularly interrupted patterns [comparing quartiles with the most vs. least prolonged patterns: usual bout duration OR=1.57, 95% CI=1.28-1.92; alpha OR=1.61, 95% CI=1.32-1.97]; however, there was no significant association for breaks in sedentary time (OR=1.00, 95% CI=0.82-1.20). Conclusions High levels of sedentary time and accumulating it in prolonged patterns were associated with increased odds of diabetes among older women.
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... (Scheers et al., 2013;Jefferis et al., 2015) Any transition from a sedentary to a non-sedentary bout (with no tolerance), with no minimum duration of break required. (Bellettiere et al., 2019a) Sedentary breaks were exclusively continuous periods, with no interruptions or non-wear intervals allowed in the definition. (Diaz et al., 2017;Gilchrist et al., 2020) Average sedentary bout duration Calculated by dividing total sedentary time by the total number of sedentary bouts. ...
... It measures the bout duration above which half of all sedentary time is accumulated. (Bellettiere et al., 2019b;Bellettiere et al., 2019a;Dempsey et al., 2022) Prolonged sedentary time Prolonger is someone who accumulates sedentary time in extended continuous bouts. (Tremblay et al., 2017) The amounts of sedentary time spent in prolonged bouts (accumulated ≥30, 20, and 10 min/bout). ...
... (King et al., 2016) Sedentary time accumulating in continuous bouts ≥30 min/bout. (van der Berg et al., 2016;Bellettiere et al., 2019b;Yerramalla et al., 2022;Huang et al., 2021;Bellettiere et al., 2019a) The amounts of sedentary time spent in prolonged bouts (≥30 min with at least 80% of the minutes falling below the sedentary threshold, allowing for <5 consecutive minutes above the threshold). (Evenson et al., 2017) Time in sedentary bouts ranges from 1 to 29, 30 to 59, 60 to 89, and more than 90 min/bout. ...
Sedentary behavior patterns and the risk of non-communicable diseases and all-cause mortality: A systematic review and meta-analysis
Article
Background: The association between sedentary behavior and health-related outcomes has been well established, whereas it is inconclusive whether a sedentary behavior pattern is an additional risk factor for health-related outcomes independent of total sedentary time and physical activity. Objectives: To determine sedentary behavior patterns and their association with risks of noncommunicable diseases and all-cause mortality and to assess whether this association is independent of total sedentary time and physical activity. Design: This was a systematic review and meta-analysis. Methods: Studies were obtained by searching the Web of Science Core Collection, PubMed/Medline, the Cochrane Library, Embase, CINAHL, and SPORTDiscus up to April 2023. All observational studies published in English or Chinese were included if they explored sedentary behavior patterns and their association with risks of abdominal obesity, metabolic syndrome, diabetes, cardiovascular disease, cancer, and all-cause mortality among individuals who had never experienced the outcome event before the baseline assessment. Data extraction using a standardized form and quality appraisal using two authoritative tools were then performed. All these steps were completed by two independent reviewers from December 2022 to May 2023. If data were sufficiently homogenous, meta-analyses were performed; otherwise, narrative syntheses were employed. Harvest plots were also used to visually represent the distribution of evidence. Results: Eighteen studies comprising 11 prospective cohort studies and seven cross-sectional studies were included. The findings suggested that prolonged sedentary time and usual sedentary bout duration were two metrics that reflected the nonlinear dose-response effect of prolonged sedentary behavior patterns. Only extremely high levels of prolonged sedentary behavior patterns significantly increased the risk of adverse health outcomes, independent of physical activity. Whether prolonged sitting was an additional risk factor for adverse health outcomes, independent of total sedentary time, was inconclusive due to an insufficient number of primary studies that included total sedentary time as one of the potential covariates. There was some evidence that supported a sedentary bout that significantly increased the risk of adverse health outcomes was 30-60 min. The threshold of prolonged sedentary time differed with outcomes, and future studies are needed to make this threshold more precise. Conclusion: A prolonged sedentary behavior pattern was associated with increased risks of several major noncommunicable diseases and all-cause mortality. People, especially those who do not reach the recommended level of moderate-to-vigorous physical activity, are encouraged to interrupt sedentary bouts every 30 to 60 min and limit prolonged sedentary time per day as much as possible. Tweetable abstract: Breaking up consecutive sedentary bouts >30 to 60 min and substituting them with brief bouts of physical activity.
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... Observational evidence has further indicated that overall volume of sedentary time is associated with cardiovascular diseases and all-cause mortality 3,4 . Further, accumulating sitting time or sedentary time in a prolonged unbroken manner consistent with long periods of muscle inactivity is detrimentally associated with markers of cardiometabolic health, prevalent diabetes, incident cancer and all-cause mortality [5][6][7][8][9] . While high total sedentary time and a prolonged pattern of accumulation often co-exist, they may carry partly independent, and/or additive risk for health 5,6,9 . ...
... An analysis of the accumulation pattern showed that EMG inactivity duration was accumulated through shorter EMG inactivity bouts, the lower the EMG inactivity threshold was (median 1-97 s). Accelerometer-measured usual sedentary bout duration has been reported to be around 17-26 min in healthy participants, and several studies have reported that accruing total sedentary time in longer sedentary bouts is adversely associated with health [5][6][7][8][9]47 . However, in one study short sedentary bouts were found to be detrimental 53 . ...
Responsiveness of electromyographically assessed skeletal muscle inactivity: methodological exploration and implications for health benefits
Article
Full-text available
  • Dec 2022
Prolonged sedentary behaviour is detrimental to health due to low contractile activity in large lower extremity muscle groups. This muscle inactivity can be measured with electromyography (EMG), but it is unknown how methodological factors affect responsiveness longitudinally. This study ranks 16 different EMG inactivity thresholds based on their responsiveness (absolute and standardized effect size, responsiveness) using data from a randomized controlled trial targeted at reducing and breaking up sedentary time (InPact, ISRCTN28668090). EMG inactivity duration and usual EMG inactivity bout duration (weighted median of bout lengths) were measured from large lower extremity muscle groups (quadriceps, hamstring) with EMG-sensing shorts. The results showed that the EMG inactivity threshold above signal baseline (3 μV) provided overall the best responsiveness indices. At baseline, EMG inactivity duration of 66.8 ± 9.6% was accumulated through 73.9 ± 36.0 s usual EMG inactivity bout duration, both of which were reduced following the intervention (−4.8 percentage points, −34.3 s). The proposed methodology can reduce variability in longitudinal designs and the detailed results can be used for sample size calculations. Reducing EMG inactivity duration and accumulating EMG inactivity in shorter bouts has a potential influence on muscle physiology and health.
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... Em 2013, as idosas avaliadas no presente estudo, tiveram razões de chances seis vezes mais elevadas para a presença de obesidade associada à DCV quando permaneciam tempos ≥6 horas diárias. Esses resultados corroboram com estudos anteriores que avaliaram o comportamento sedentário e a presença DCV isolada ou associada com outros fatores de risco cardiovasculares 50,51 . Entretanto estudos com abrangência nacional que avaliaram as mesmas associações (obesidade + DCV) não foram encontrados, dificultando as comparações, e demonstrando a relevância dos nossos achados em âmbito nacional. ...
Tempo de televisão, obesidade e doenças cardiovasculares em idosos brasileiros: Pesquisas Nacionais de Saúde 2013 e 2019
Article
Full-text available
  • Nov 2023
Resumo Objetivou-se analisar a associação entre tempo assistindo televisão (TV) e a presença de obesidade isolada e associada às doenças cardiovasculares (DCV) de idosos brasileiros, conforme o sexo, comparando-se os dados das Pesquisas Nacionais de Saúde 2013 e 2019. Estudo transversal, com dados de 23.815 e 43.554 idosos das PNS 2013 e 2019, respectivamente. O autorrelato do tempo assistindo à TV foi categorizado em: <3, 3-6 e ≥6 horas diárias. A obesidade isolada foi avaliada pelo índice de massa corporal ≥27 kg/m² e a DCV pelo autorrelato de diagnóstico médico. Em 2013, as idosas que assistiam à TV ≥6 horas/dia apresentaram maiores chances de obesidade isolada (OR=1,87; IC95%=1,32;2,64) e associada à DCV (OR=6,30; IC95%=3,38;11,74). Em 2019, as idosas que assistiam à TV entre 3-6 horas/dia (OR=1,44; IC95%=1,25;1,65) e ≥6 horas/dia (OR=1,55; IC95%=1,28;1,88) tiveram maiores chances de obesidade isolada, já as chances de obesidade associada à DCV, foram maiores para ≥6 horas/dia (OR=2,13; IC95%=1,48;3,06). Em 2019, os homens tiveram maiores chances de obesidade associada às DCV assistindo à TV entre 3-6 horas/dia (OR=1,76; IC95%=1,20;2,56) e ≥6 horas/dia (OR=2,13; IC95%=1,27;3,57). Evidencia-se a importância em diminuir o tempo assistindo à TV dos idosos.
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... Gochman (20) defined health behavior as not only observable actions, behavioral patterns, and habits but also personal attributes related to health maintenance and wellness, restoration, and health improvement. Previous studies have reported that desirable health behavior among older adults can lower the risk of heart failure (21), prevent the development of diabetes (22), and lower the risk of cancer death (23). Thus, health behavior clearly has a positive impact on preventing NCDs during the aging process, and improving appropriate health behaviors is important for the prevention of these diseases in older adults. ...
Factors associated with health behaviors in preventing non-communicable diseases among older adults living alone in poverty in Japan
Article
Full-text available
  • Sep 2023
Introduction Older adults who live alone in poverty are highly susceptible to non-communicable diseases and other adverse conditions owing to health disparities resulting from social structures. However, the factors associated with health behavior to prevent non-communicable diseases in this population are rarely explored. The purpose of this study was to identify factors associated with health behavior to prevent non-communicable diseases among older adults living alone in poverty. Methods We conducted a self-administered mail survey covering 2,818 older adults living alone who were receiving public assistance, randomly selected from lists of individuals receiving national public assistance in all 1,250 local social welfare offices across Japan. A total of 1,608 individuals completed the questionnaire, a valid response rate of 57.1%. Respondents’ mean age was 74.5 years (standard deviation = 6.7), and 52.9% were women. The study variables included demographic characteristics, scores on a health behavior scale for older adults living alone and receiving public assistance (HBSO), and individual and community-related factors. Results Logistic regression analysis revealed that the individual factor of having a health check-up in the past 12 months [odds ratio (OR): 1.45, 95% confidence interval (CI): 1.10–1.91] and the community-related factors Lubben social network scale score (OR 1.15, 95% CI: 1.12–1.18) and Community Commitment Scale score (OR: 1.04, 95% CI: 1.00–1.08) were significantly associated with HBSO scores. Conclusion To improve health behavior among older adults living alone in poverty in Japan, social structures, such as lowering mental barriers to the detection, treatment, and management of non-communicable diseases and developing human resources, should be changed to provide social support, such that these individuals are not only dependent on family and friends.
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... Next to the association of overall ST with negative health outcomes, longer sedentary bouts and fewer breaks in SB seem to be negatively associated with physical function in older adults (Gennuso et al., 2016;Han et al., 2022). Similarly, older women with a higher mean sedentary bout duration have increased risk of falling (Rosenberg et al., 2021) and show higher odds of diabetes (Bellettiere et al., 2019). Another study suggests that for every additional hourly break in ST in older women, the odds for abdominal obesity decreased with 7% (Júdice et al., 2015). ...
Sedentary Patterns and Health Outcomes in the Oldest-Old: a Latent Profile Analysis
Preprint
Full-text available
  • Sep 2023
Background. Sedentary behavior is most prevalent among those aged 80 and above. Current literature emphasizes the significance of SB patterns, but further evidence is required to understand how these patterns relate to specific health outcomes and to identify at-risk profiles for tailored interventions in the oldest old. Therefore, the aim of this study was to identify profiles of older adults based on their sedentary patterns and health outcomes, and to examine associations between profiles and socio-demographics. Methods. A cross-sectional study was performed between February 2021 and December 2022 in Flanders, Belgium. Distinct profiles of device-based sedentary patterns and physical and cognitive functioning, mental health-related quality of life (QoL) and social isolation were identified using a latent profile analysis on data of 90 older adults (80+). Associations with socio-demographics were analyzed using one-way ANOVAs and chi²-tests. Results. Three distinct profiles were identified: (1) the ‘cognitively and physically frail’ profile, (2) the ‘healthy’ profile and (3) the ‘lower mental health-related QoL’ profile. Those in the ‘cognitively and physically frail’ profile exhibited the least favorable sedentary pattern, and had a higher likelihood of residing in a nursing home. No significant differences were found for the other socio-demographic variables, being age, sex, educational degree and family situation. Conclusions. Individuals with lower physical and cognitive functioning have the most unhealthy sedentary patterns, often involving prolonged bouts lasting at least one hour. Therefore, it is crucial to prioritize interventions that address and interrupt extended sedentary behavior in this subgroup.
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... Accumulating sedentary time in longer uninterrupted bouts is also associated with increased risk of all-cause mortality 8, 9 , type-2 diabetes 10 and cardiovascular disease 11 . The health risks of total sedentary behaviour appear only to be mitigated by high levels of cardiorespiratory fitness, or high levels of daily physical activity 12,13 which is difficult to achieve for the majority of the population. ...
Feasibility and Pilot Outcomes of the Move More @ Work Intervention Designed to Encourage Employees to be Physically Active for 2 Minutes After Every 30 Minutes of Sitting
Article
  • Jun 2023
Objective Evaluate the feasibility of a workplace intervention supporting employees to interrupt sitting time with short bouts of activity (termed an opportunity to move; OTM). Methods Using an interrupted time series design, 58 sedentary employees provided baseline assessments of physical activity, health and work-related outcomes and completed the 12-week intervention. Assessments were repeated immediately and 12-weeks post-intervention. Focus groups explored intervention acceptability. Results Accelerometer data showed no change in the number of OTMs taken pre- to post-intervention, while participants self-reported 62-69% intervention adherence. Physical activity at work, productivity and musculoskeletal health improved but cardiometabolic health and psychological wellbeing did not. Intervention components were viewed favourably (pending amendments), but taking an OTM every 30 min was not feasible. Conclusions The Move More @ Work intervention has potential, but adaptations are required to increase adherence.
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... This usually includes daily activities with prolonged periods of minimal physical exertion, such as sitting down to read, engagement in office work, and other activities including viewing screens such as television, mobile devices, computer monitors, etc. [59]. The average time of daily inactivity over the last four decades has roughly increased by about 50% in the United Kingdom and the United States [76], and is probably related to the higher in the incidence of CVD and diabetes [6]. ...
Exercise and vascular function in sedentary lifestyles in humans
Article
Full-text available
People with sedentary lifestyles engage in minimal or no physical activity. A sedentary lifestyle promotes dysregulation of cellular redox balance, diminishes mitochondrial function, and increases NADPH oxidase activity. These changes collectively increase cellular oxidative stress, which alters endothelial function by oxidizing LDL-C, reducing NO production, and causing eNOS uncoupling. Reduced levels of nitric oxide (NO) leads to vasoconstriction, vascular remodeling, and vascular inflammation. Exercise modulates reactive oxygen species (ROS) to modify NRF2-KEAP signaling, leading to the activation of NRF2 to alleviate oxidative stress. While regular moderate exercise activates NRF2 through ROS production, high-intensity intermittent exercise stimulates NRF2 activation to a greater degree by reducing KEAP levels, which can be more beneficial for sedentary individuals. We review the damaging effects of a sedentary lifestyle on the vascular system and the health benefits of regular and intermittent exercise.
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... As pointed out in a systematic review 9 and a meta-analysis 7 , studies regarding accelerometermeasured habitual PA and SB and resting BDNF in non-healthy adults (e.g., obesity, CVD, diabetes) are limited and pattern variables of PA and SB (e.g., sedentary bouts) were rarely reported in these studies. Only the study by Júdice and colleagues examined accelerometer-measured habitual PA and patterns of SB and resting BDNF in adults with type 2 diabetes mellitus (mean age: 58.3 years) 33 which represents also a vulnerable group because these individuals are less active and have lower levels of BDNF 41 . In line with their results, we could not find an association between habitual MVPA and resting BDNF. ...
Preliminary results of the cross-sectional associations of sedentary behavior and physical activity with serum brain-derived neurotrophic factor in adults with coronary heart disease
Article
Full-text available
  • Nov 2022
This is the first study to analyze the association of accelerometer-measured patterns of habitual physical activity (PA) and sedentary behavior (SB) with serum BDNF in individuals with coronary heart disease. A total of 30 individuals (M = 69.5 years; 80% men) participated in this pre-post study that aimed to test a multi-behavioral intervention. All participants underwent standardized measurement of anthropometric variables, blood collection, self-administered survey, and accelerometer-based measurement of PA and SB over seven days. Serum BDNF concentrations were measured using enzyme-linked immunosorbent assay kit. We applied separate multiple linear regression analysis to estimate the associations of baseline SB pattern measures, light and moderate-to-vigorous PA with serum BDNF (n = 29). Participants spent 508.7 ± 76.5 min/d in SB, 258.5 ± 71.2 min/d in light PA, and 21.2 ± 15.2 min/d in moderate-to-vigorous PA. Per day, individuals had 15.5 ± 3.2 numbers of 10-to-30 min bouts of SB (average length: 22.2 ± 2.1 min) and 3.4 ± 1.2 numbers of > 30 min bouts of SB (average length: 43.8 ± 2.4 min). Regression analysis revealed no significant associations between any of the accelerometer-based measures and serum BDNF. The findings of this study did not reveal an association of accelerometer-measured PA and SB pattern variables with serum BDNF in individuals with coronary heart disease. In addition, our data revealed a considerable variation of PA and SB which should be considered in future studies.
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Relationship between sedentary behavior and endothelial dysfunction in a cross-sectional study in China
Article
Full-text available
  • Aug 2023
Sedentary behavior is a risk factor for several diseases, and previous studies have mostly reported the effects of acute sedentary behavior on vascular endothelial function. Data on the relationship between sedentary lifestyle habits and vascular function in large sample populations are lacking. Therefore, the aim of this study was to assess the correlation between self-reported sedentary behavior and peripheral vascular function in a check-up population from real-world data. Methods We recruited 13,220 participants from two health management centers of general tertiary hospitals located in northern and southern China between 2017 and 2021. All participants had undergone both questionnaires and brachial artery flow-mediated dilation (FMD) measurements. Results In total, 3,205 participants with FMD ≤ 5.0% were identified to have endothelial dysfunction. In a multivariable regression model including lifestyle habits such as sedentary behavior and cardiovascular risk factors, taking leisure sedentary time <2 h/day as a reference, the risk of vascular endothelial dysfunction gradually increased with time: 2–4 h/day (OR = 1.182, 95% CI: 1.058–1.321, P = 0.003), 4–6 h/day (OR = 1.248, 95% CI: 1.100–1.414, P = 0.001) and >6 h/day (OR = 1.618, 95% CI: 1.403–1.866, P < 0.001). Conclusion Longer leisure sedentary time is associated with a higher prevalence of vascular endothelial dysfunction. These findings suggest that leisure sedentary behavior is a risk factor for the occurrence of vascular endothelial dysfunction in the Chinese check-up population.
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Patterns of Sedentary Behavior and Mortality in U.S. Middle-Aged and Older Adults: A National Cohort Study
Article
Full-text available
Background: Excessive sedentary time is ubiquitous in Western societies. Previous studies have relied on self-reporting to evaluate the total volume of sedentary time as a prognostic risk factor for mortality and have not examined whether the manner in which sedentary time is accrued (in short or long bouts) carries prognostic relevance. Objective: To examine the association between objectively measured sedentary behavior (its total volume and accrual in prolonged, uninterrupted bouts) and all-cause mortality. Design: Prospective cohort study. Setting: Contiguous United States. Participants: 7985 black and white adults aged 45 years or older. Measurements: Sedentary time was measured using a hip-mounted accelerometer. Prolonged, uninterrupted sedentariness was expressed as mean sedentary bout length. Hazard ratios (HRs) were calculated comparing quartiles 2 through 4 to quartile 1 for each exposure (quartile cut points: 689.7, 746.5, and 799.4 min/d for total sedentary time; 7.7, 9.6, and 12.4 min/bout for sedentary bout duration) in models that included moderate to vigorous physical activity. Results: Over a median follow-up of 4.0 years, 340 participants died. In multivariable-adjusted models, greater total sedentary time (HR, 1.22 [95% CI, 0.74 to 2.02]; HR, 1.61 [CI, 0.99 to 2.63]; and HR, 2.63 [CI, 1.60 to 4.30]; P for trend < 0.001) and longer sedentary bout duration (HR, 1.03 [CI, 0.67 to 1.60]; HR, 1.22 [CI, 0.80 to 1.85]; and HR, 1.96 [CI, 1.31 to 2.93]; P for trend < 0.001) were both associated with a higher risk for all-cause mortality. Evaluation of their joint association showed that participants classified as high for both sedentary characteristics (high sedentary time [≥12.5 h/d] and high bout duration [≥10 min/bout]) had the greatest risk for death. Limitation: Participants may not be representative of the general U.S. population. Conclusion: Both the total volume of sedentary time and its accrual in prolonged, uninterrupted bouts are associated with all-cause mortality, suggestive that physical activity guidelines should target reducing and interrupting sedentary time to reduce risk for death. Primary funding source: National Institutes of Health.
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Prolonged, Uninterrupted Sedentary Behavior and Glycemic Biomarkers Among US Hispanic/Latino Adults: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL)
Article
Full-text available
  • Aug 2017
Background: Excessive sedentary time is ubiquitous in developed nations and is associated with deleterious health outcomes. Few studies have examined whether the manner in which sedentary time is accrued (in short or long bouts) carries any clinical relevance. The purpose of this study was to examine the association of prolonged, uninterrupted sedentary behavior with glycemic biomarkers in a cohort of US Hispanic/Latino adults. Methods: We studied 12 083 participants from the HCHS/SOL (Hispanic Community Health Study/Study of Latinos), a population-based study of Hispanic/Latino adults 18 to 74 years of age. Homeostatic model assessment of insulin resistance and glycosylated hemoglobin were measured from a fasting blood sample, and 2-hour glucose was measured after an oral glucose tolerance test. Sedentary time was objectively measured with a hip-mounted accelerometer. Prolonged, uninterrupted sedentariness was expressed as mean sedentary bout length. Results: After adjustment for potential confounders and moderate to vigorous physical activity, longer sedentary bout duration was dose-dependently associated with increased homeostatic model assessment of insulin resistance (P for trend<0.001) and 2-hour glucose levels (P for trend=0.015). These associations were not independent of total sedentary time; however, a significant interaction between sedentary bout duration and total sedentary time was observed. Evaluation of the joint association of total sedentary time and sedentary bout duration showed that participants in the upper quartile for both sedentary characteristics (ie, high total sedentary time and high sedentary bout duration) had the highest levels of homeostatic model assessment of insulin resistance (P<0.001 versus low group for both sedentary characteristics) and 2-hour glucose (P=0.002 versus low group for both sedentary characteristics). High total sedentary time or high sedentary bout duration alone were not associated with differences in any glycemic biomarkers. Conclusions: Accruing sedentary time in prolonged, uninterrupted bouts may be deleteriously associated with biomarkers of glucose regulation.
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Associations of sitting accumulation patterns with cardio-metabolic risk biomarkers in Australian adults
Article
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Background: High amounts of time spent sitting can increase cardiovascular disease risk and are deleteriously associated cardio-metabolic risk biomarkers. Though evidence suggests that accruing sitting time in prolonged periods may convey additional risk, verification using high-quality measures is needed. We examined this issue in adults from the Australian Diabetes, Obesity and Lifestyle Study, using accurate measures of sitting accumulation. Methods: In 2011/12, 739 adults aged 36 to 89 years (mean±SD 58±10 years) wore activPAL3™ monitors (which provide accurate objective measures of sitting); 678 provided ≥4 valid days of monitor data and complete cardio-metabolic biomarker and confounder data. Multivariable linear regression models examined associations of sitting time, sitting time accrued in ≥30 minute bouts (prolonged sitting time), and three measures of sitting accumulation patterns with cardio-metabolic risk markers: body mass index (BMI), waist circumference, blood pressure, high- and low- density lipoprotein (HDL and LDL) cholesterol, triglycerides, glycated haemoglobin (HbA1c), fasting plasma glucose (FPG) and 2-hour post-load glucose (PLG). Interactions tests examined whether associations of sitting time with biomarkers varied by usual sitting bout duration. Results: Adjusted for potential confounders, greater amounts of sitting time and prolonged sitting time were significantly (p<0.05) deleteriously associated with BMI, waist circumference, HDL cholesterol, and triglycerides. Total sitting time was also significantly associated with higher PLG. Sitting accumulation patterns of frequently interrupted sitting (compared to patterns with relatively more prolonged sitting) were significantly beneficially associated with BMI, waist circumference, HDL cholesterol, triglycerides, PLG, and with FPG. Effect sizes were typically larger for accumulation patterns than for sitting time. Significant interactions (p<0.05) showed that associations of sitting time with HDL, triglycerides and PLG became more deleterious the longer at a time sitting was usually accumulated. Conclusions: Adding to previous evidence reliant on low-quality measures, our study showed that accumulating sitting in patterns where sitting was most frequently interrupted had significant beneficial associations with several cardio-metabolic biomarkers and that sitting for prolonged periods at a time may exacerbate some of the effects of sitting time. The findings support sedentary behavior guidelines that promote reducing and regularly interrupting sitting.
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The role of skeletal muscle contractile duration throughout the whole day: Reducing sedentary time and promoting universal physical activity in all people
Article
Full-text available
A shared goal of many researchers has been to discover how to improve health and prevent disease, through safely replacing a large amount of daily sedentary time with physical activity in everyone, regardless of age and current health status. This process involves contrasting how different muscle contractile activity patterns regulate the underlying molecular and physiological responses impacting health related processes. This process also requires an equal attention to behavioural feasibility studies in extremely unfit and sedentary people. A sound scientific principle is that the body is constantly sensing and responding to changes in skeletal muscle metabolism induced by contractile activity. Because of that, the rapid time course of health related responses to physical inactivity/activity patterns are caused in large part directly because of the variable amounts of muscle inactivity/activity throughout the day. However, traditional modes and doses of exercise fall far short of replacing most of the sedentary time in the modern lifestyle, because both the weekly frequency and duration of exercise time are an order of magnitude less than how much people sit inactive. This can explain why high amounts of sedentary time produce distinct metabolic and cardiovascular responses through inactivity physiology that are not sufficiently prevented by low doses of exercise. For these reasons, we hypothesize that maintaining a high metabolic rate over the majority of the day, through safe and sustainable types of muscular activity, will be the optimal way to create a healthy active lifestyle over the whole lifespan. This article is protected by copyright. All rights reserved.
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Accelerometer Data Collection and Processing Criteria to Assess Physical Activity and Other Outcomes: A Systematic Review and Practical Considerations
Article
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Background Accelerometers are widely used to measure sedentary time, physical activity, physical activity energy expenditure (PAEE), and sleep-related behaviors, with the ActiGraph being the most frequently used brand by researchers. However, data collection and processing criteria have evolved in a myriad of ways out of the need to answer unique research questions; as a result there is no consensus. Objectives The purpose of this review was to: (1) compile and classify existing studies assessing sedentary time, physical activity, energy expenditure, or sleep using the ActiGraph GT3X/+ through data collection and processing criteria to improve data comparability and (2) review data collection and processing criteria when using GT3X/+ and provide age-specific practical considerations based on the validation/calibration studies identified. Methods Two independent researchers conducted the search in PubMed and Web of Science. We included all original studies in which the GT3X/+ was used in laboratory, controlled, or free-living conditions published from 1 January 2010 to the 31 December 2015. ResultsThe present systematic review provides key information about the following data collection and processing criteria: placement, sampling frequency, filter, epoch length, non-wear-time, what constitutes a valid day and a valid week, cut-points for sedentary time and physical activity intensity classification, and algorithms to estimate PAEE and sleep-related behaviors. The information is organized by age group, since criteria are usually age-specific. Conclusion This review will help researchers and practitioners to make better decisions before (i.e., device placement and sampling frequency) and after (i.e., data processing criteria) data collection using the GT3X/+ accelerometer, in order to obtain more valid and comparable data. PROSPERO registration numberCRD42016039991.
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The Objective Physical Activity and Cardiovascular Disease Health in Older Women (OPACH) Study
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Background: Limited evidence exists to inform physical activity (PA) and sedentary behavior guidelines for older people, especially women. Rigorous evidence on the amounts, intensities, and movement patterns associated with better health in later life is needed. Methods/design: The Objective PA and Cardiovascular Health (OPACH) Study is an ancillary study to the Women's Health Initiative (WHI) Program that examines associations of accelerometer-assessed PA and sedentary behavior with cardiovascular and fall events. Between 2012 and 2014, 7048 women aged 63-99 were provided with an ActiGraph GT3X+ (Pensacola, Florida) triaxial accelerometer, a sleep log, and an OPACH PA Questionnaire; 6489 have accelerometer data. Most women were in their 70s (40%) or 80s (46%), while approximately 10% were in their 60s and 4% were age 90 years or older. Non-Hispanic Black or Hispanic/Latina women comprise half of the cohort. Follow-up includes 1-year of falls surveillance with monthly calendars and telephone interviews of fallers, and annual follow-up for outcomes with adjudication of incident cardiovascular disease (CVD) events through 2020. Over 63,600 months of calendar pages were returned by 5,776 women, who reported 5,980 falls. Telephone interviews were completed for 1,492 women to ascertain the circumstances, injuries and medical care associated with falling. The dataset contains extensive information on phenotypes related to healthy aging, including inflammatory and CVD biomarkers, breast and colon cancer, hip and other fractures, diabetes, and physical disability. Discussion: This paper describes the study design, methods, and baseline data for a diverse cohort of postmenopausal women who wore accelerometers under free-living conditions as part of the OPACH Study. By using accelerometers to collect more precise and complete data on PA and sedentary behavior in a large cohort of older women, this study will contribute crucial new evidence about how much, how vigorous, and what patterns of PA are necessary to maintain optimal cardiovascular health and to avoid falls in later life. Clinical trials registration: ClinicalTrials.gov identifier NCT00000611 . Registered 27 October 1999.
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Prolonged sitting may increase diabetes risk in physically inactive individuals: an 11 year follow-up of the HUNT Study, Norway
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Aims/hypothesis: We examined the association between sitting time and diabetes incidence, overall and by strata of leisure-time physical activity and BMI. Methods: We followed 28,051 adult participants of the Nord-Trøndelag Health Study (the HUNT Study), a population-based study, for diabetes incidence from 1995-1997 to 2006-2008 and estimated HRs of any diabetes by categories of self-reported total daily sitting time at baseline. Results: Of 28,051 participants, 1253 (4.5%) developed diabetes during 11 years of follow-up. Overall, sitting ≥8 h/day was associated with a 17% (95% CI 2, 34) higher risk of developing diabetes compared with sitting ≤4 h/day, adjusted for age, sex and education. However, the association was attenuated to a non-significant 9% (95% CI -5, 26) increase in risk after adjustment for leisure-time physical activity and BMI. The association between sitting time and diabetes risk differed by leisure-time physical activity (p Interaction = 0.01). Among participants with low leisure-time physical activity (≤2 h light activity per week and no vigorous activity), sitting 5-7 h/day and ≥8 h/day were associated with a 26% (95% CI 2, 57) and 30% (95% CI 5, 61) higher risk of diabetes, respectively, compared with sitting ≤4 h/day. There was no corresponding association among participants with high leisure-time physical activity (≥3 h light activity or >0 h vigorous activity per week). There was no statistical evidence that the association between sitting time and diabetes risk differed by obesity (p Interaction = 0.65). Conclusions/interpretation: Our findings suggest that total sitting time has little association with diabetes risk in the population as a whole, but prolonged sitting may contribute to an increased diabetes risk among physically inactive people.
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Improving Hip-Worn Accelerometer Estimates of Sitting Using Machine Learning Methods
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  • Feb 2018
Purpose: To improve estimates of sitting time from hip worn accelerometers used in large cohort studies by employing machine learning methods developed on free living activPAL data. Methods: Thirty breast cancer survivors concurrently wore a hip worn accelerometer and a thigh worn activPAL for 7 days. A random forest classifier, trained on the activPAL data, was employed to detect sitting, standing and sit-stand transitions in 5 second windows in the hip worn accelerometer. The classifier estimates were compared to the standard accelerometer cut point and significant differences across different bout lengths were investigated using mixed effect models. Results: Overall, the algorithm predicted the postures with moderate accuracy (stepping 77%, standing 63%, sitting 67%, sit to stand 52% and stand to sit 51%). Daily level analyses indicated that errors in transition estimates were only occurring during sitting bouts of 2 minutes or less. The standard cut point was significantly different from the activPAL across all bout lengths, overestimating short bouts and underestimating long bouts. Conclusions: This is among the first algorithms for sitting and standing for hip worn accelerometer data to be trained from entirely free living activPAL data. The new algorithm detected prolonged sitting which has been shown to be most detrimental to health. Further validation and training in larger cohorts is warranted.This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Total energy intake: implications for epidemiologic analyses
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Associations between intake of specific nutrients and disease cannot be considered primary effects of diet if they are simply the result of differences between cases and noncases in body size, physical activity, and metabolic efficiency. Epidemiologic studies of diet and disease should therefore be directed at the effect of nutrient intakes independent of total caloric intake in most instances. This is not accomplished with nutrient density measures of dietary intake but can be achieved by employing nutrient intakes adjusted for caloric intake by regression analysis. While pitfalls in the manipulation and interpretation of energy intake data in epidemiologic studies have been emphasized, these considerations also highlight the usefulness of obtaining a measurement of total caloric intake. For instance, if a questionnaire obtained information on only cholesterol intake in a study of coronary heart disease, it is possible that no association with disease would be found even if a real positive effect of a high cholesterol diet existed, since the caloric intake of cases is likely to be less than that of noncases. Such a finding could be appropriately interpreted if an estimate of total caloric intake were available. The relationships between dietary factors and disease are complex. Even with carefully collected measures of intake, consideration of the biologic implications of various analytic approaches is needed to avoid misleading conclusions.
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