Sedentary Behavior and Physical Activity: Independent, Co dependent or Irrelevant?

Transcription

1 Sedentary Behavior and Physical Activity: Independent, Co dependent or Irrelevant? Harold W. (Bill) Kohl, III, Ph.D., MSPH University of Texas Health Science Center Houston School of Public Health Michael and Susan Dell Center for Healthy Living The University of Texas at Austin Department of Kinesiology and Health Education #physicalactivity

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3 Acknowledgments Capt. Richard Troiano Ms. Heather Steele ILSI Energy Balance Committee

4 Overview Definition and framework Existing research Recommendations

5 Children s Games, Pieter Bruegel the Elder, 1560

6 Current situation

7 Children s Games, Pieter Bruegel the Elder, 1560

8 Current situation

9 180 Growth in Sedentary Science Enter Sedentary Behavior Publications Scopus.com Articles or reviews: sedentary AND time OR behavior in title

10 Enter Sedentary Behavior Measurement Measurement Measurement

11 Enter Sedentary Behavior Television time Sitting time Screen time Sleep Occupational Transportation

12 Definition of Sedentary Behavior Activities that do not increase energy expenditure substantially above the resting level. Such as sleeping, sitting, lying down, and watching television, and other forms of screen based entertainment. Operationally, sedentary behavior includes activities that involve energy expenditure at the level of metabolic equivalent units (METs). Light physical activity, is often grouped with sedentary behavior but is in fact a distinct activity construct Such as slow walking, sitting and writing, cooking food, and washing dishes. Involves energy expenditure at the level of METs. Pate et al 2009

13 Exercise Leisure Occupation Specific Activity Type e.g., soccer, lifting heavy boxes or children, walking Frequency Intensity Household Domestic Self Care Transport Intensity Category e.g., light, moderate, vigorous Duration Pattern Physical Activity Recall Cue Characteristic Gabriel et al 2011

14 Leisure Occupation Specific Behavior Type Sitting, laying, sleeping Frequency Volume Type Sleep Transport Context Duration Pattern Physical Inactivity Recall Cue Characteristic Kohl and Troiano unpublished

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16 Whitfield et al 2013

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18 Whitfield et al 2014

19 Competitive runners sit more than 10 hours/day! Whitfield et al 2014

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21 Jefferis et al 2014

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23 Inactivity All adults should avoid inactivity. Some physical activity is better than none, and adults who participate in any amount of physical activity gain some health benefits.

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25 Sitting Time Prospectively Associated with Early Mortality Katzmarzyk et al 2009

26 independent of physical activity Katzmarzyk et al 2009

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28 Standing Time Prospectively Associated with Early Mortality Katzmarzyk 2014

29 but not independent of physical activity Katzmarzyk 2014

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31 Biswas et al 2015

32 Sedentary behavior and noncommunicable disease outcome Hazard Ratio All cause mortality CVD mortality CVD incidence Cancer mortality Cancer incidence Diabetes incidence Adapted from Biswas et al 2015

33 Sedentary behavior, physical activity and all cause mortality Low Activity/ High Sedentary High Activity/ High Sedentary Hazard Ratio * * * * 0.0 Seguin et al 2014 Patel et al 2010 Pavey et al, 2012 Kim et al, 2013 van der Ploeg et al, 2012 Matthews et al, 2012 Adapted from Biswas et al 2015

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35 Association being driven by pre existing disease? Especially cardiometabolic disease? Van der Ploeg et al 2013

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37 Physical Activity and Health Conceptual Framework Health Outcomes Physical Activity Exposure Intensity Cardiovascular/ Respiratory Health (including CHD, PVD, Stroke) Metabolic Health (including Diabetes Mellitus and Obesity) Musculoskeletal Health (including Osteoporosis) Cancers Functional Health Mental Health All-Cause Mortality Frequency Examples Examples Examples Examples Examples Examples Examples Duration Pattern Type Dyslipidemias Blood Pressure Hemostatic/ Coagulation Factors Asthma Fitness Cardiac Function Lung Function Insulin Resistance Insulin Sensitivity Glucose uptake Metabolic Syndrome Overweight Constipation Fitness Hormonal influences Sleep quality Bone mineralization Flexibility Strength Balance Maturation/ Growth Fitness Motor skill development Muscle fiber Bowel transit time Hormonal factors Immune Function Linkages with other behaviors. Quality of life Functional independence Balance Pain Fall prevention Cognitive Function Anxiety Self-concept Sleep quality Strength Balance Fitness Previous Injury Family history Risk Factors Caloric Expenditure Adverse events and Risks of Physical Activity

38 Physical Inactivity, Sedentary Behaviors and Health Conceptual Framework Physical Inactivity Health Outcomes Volume of inactivity Frequency Duration Cardiovascular/ Respiratory Health (including CHD, PVD, Stroke) Metabolic Health (including Diabetes Mellitus and Obesity) Musculoskeletal Health (including Osteoporosis) Cancers Functional Health Mental Health All-Cause Mortality Volume of physical activity Pattern Timing Examples Dyslipidemias Blood Pressure Hemostatic/ Coagulation Factors Asthma Fitness Cardiac Function Lung Function Examples Insulin Resistance Insulin Sensitivity Glucose uptake Metabolic Syndrome Overweight Constipation Fitness Hormonal influences Sleep quality Examples Bone mineralization Flexibility Strength Balance Maturation/ Growth Fitness Motor skill development Muscle fiber Examples Bowel transit time Hormonal factors Immune Function Linkages with other behaviors. Examples Quality Pain of life Functional ADL independence FHQoL Balance Pain Fall prevention Cognitive Function Examples Anxiety Self-concept Sleep quality Type Sedentary Behavior Mechanisms Kohl and Troiano unpublished

39 Conclusions Sedentary behavior has been measured/used in a variety of ways. Can make up a large portion of a day, even for very active people. A consistent definition and framework for research must be applied. Data suggest some kind of independent association (or not) with health outcomes sitting, not standing. Unclear if it is real or an artifact of measurement. Early mechanistic studies suggest directions but none support independent associations.

40 Recommendations Although the full range of activity intensities (sedentary to vigorous) contribute to total energy expenditure, activity performed within a narrow intensity range (e.g., vigorous) may influence health in ways that are unique from other activity intensities. Conclusions of studies should be phrased carefully so as to be consistent with the activity variables that were actually measured in the study. Care should be taken to avoid discussing replacing reduction in sedentary behavior for meeting physical activity guidelines. Mechanistic studies are urgently needed. Physiologic principles of overload, specificity and adaptation still apply.

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42 Physical Inactivity, Sedentary Behaviors and Health Conceptual Framework Physical Inactivity Health Outcomes Volume of inactivity Frequency Duration Cardiovascular/ Respiratory Health (including CHD, PVD, Stroke) Metabolic Health (including Diabetes Mellitus and Obesity) Musculoskeletal Health (including Osteoporosis) Cancers Functional Health Mental Health All-Cause Mortality Volume of physical activity Pattern Timing Examples Dyslipidemias Blood Pressure Hemostatic/ Coagulation Factors Asthma Fitness Cardiac Function Lung Function Examples Insulin Resistance Insulin Sensitivity Glucose uptake Metabolic Syndrome Overweight Constipation Fitness Hormonal influences Sleep quality Examples Bone mineralization Flexibility Strength Balance Maturation/ Growth Fitness Motor skill development Muscle fiber Examples Bowel transit time Hormonal factors Immune Function Linkages with other behaviors. Examples Quality Pain of life Functional ADL independence FHQoL Balance Pain Fall prevention Cognitive Function Examples Anxiety Self-concept Sleep quality Mood Type Sedentary Behavior Mechanisms Kohl and Troiano unpublished

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44 Enter Sedentary Behavior Mechanisms Mechanisms Mechanisms

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47 Mechanisms? Aerobic capacity Skeletal muscle metabolism and function Telomeres/genetic stability Cognitive function Overload, Specificity, Adaptation

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49 Dunstan et al 2012 n=19 overweight/obese adults Age years Three treatment crossover trial: Uninterrupted sitting Sitting with 2 min bouts of light intensity physical activity every 20 mins Sitting with 2 min bouts of moderate intensity physical activity every 20 mins Glucose tolerance test area under curves for insulin and glucose

50 24 30% reduction in plasma glucose AUC after activity break conditions increased insulin sensitivity? 2 h post load glucose highest in Uninterrupted Sitting condition Dunstan et al 2012

51 23% reduction in insulin AUC after activity break conditions reduced insulin secretion? Dunstan et al 2012

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53 Thorp et al 2014 n=23 overweight/obese adults Age years Five day simulated office environment crossover: Seated work for 8 hours Interchanging seated and standing every 30 mins Glucose tolerance test area under curves for insulin and glucose; triglyceride response.

54 Differences in change in glucose AUC but not insulin increased insulin sensitivity? Thorp et al 2014

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56 Thosar et al, non obese men 24.2 years of age (mean) Two randomized 3 hour sitting trials Sitting 3 hours uninterrupted Sitting interrupted by 5 min treadmill breaks at 30 mins and at each hour (2 mph). Superficial femoral artery flow mediated dilation and shear rate

57 Thosar et al 2014 Decline in FMD attenuated with active breaks

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59 Sjögren et al, 2014 n=49 sedentary, overweight men and women 68 years of age (mean) 6 month clinical trial of individualized physical activity intervention. Treatment behavioral intervention Control Blood cell telomere length analyzed by changes in time spent in physical activity and by changes in time spent sitting. Sitting time measured using short IPAQ.

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