Sedentary behaviour and health: association or causation? Prof Jason Gill Institute of Cardiovascular and Medical Sciences University of Glasgow

Transcription

1 Sedentary behaviour and health: association or causation? Prof Jason Gill Institute of Cardiovascular and Medical Sciences University of Glasgow

2 Global burden of physical inactivity Wen and Wu (2012) The Lancet

3 Physical activity and mortality risk: metaanalysis Vigorous exercise & sports Moderate activities of daily living Walking Transport physical activity Samitz et al. (2011) Int J Epidemiol; 40:

4 Aerobic vs resistance activity Aerobic Resistance

5 Aerobic and resistance activity and risk of diabetes in Nurses Health and Nurses Health II studies Grontved et al (2014). PLOS Med 11:e

6 UK physical activity guidelines minutes of moderate or 75 minutes of vigorous physical activity per week in bouts of at least 10 minutes Muscle strengthening activities 2 x per week Minimise the amount of time spent sedentary (sitting)

7 UK physical activity guidelines minutes of moderate or 75 minutes of vigorous physical activity per week in bouts of at least 10 minutes Muscle strengthening activities 2 x per week Minimise the amount of time spent sedentary (sitting)

8 What is sedentary behaviour? any waking behaviour characterized by an energy expenditure 1.5 METs while in a sitting, reclining or lying posture Tremblay et al (2017) Int J Behav Nutr Phys Act 14:75

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10 Is sedentary behaviour the same as lack of physical activity?

11 The 24-hour day for someone meeting current physical activity guidelines Rest of the day 65% Sleep 33% MVPA 2% MVPA = moderate-to-vigorous physical activity

12 Is sedentary behaviour associated with adverse health outcomes?

13 Is sedentary behaviour associated with adverse health outcomes? Does this persist after adjustment for MVPA?

14 Sitting and cardiovascular disease mortality Katzmarzyk et al (2009) Med Sci Sports Exerc; 41:

15 Sitting and cardiovascular disease mortality Katzmarzyk et al (2009) Med Sci Sports Exerc; 41:

16 Meta-analysis of effects of sedentary time on CVD and all-cause mortality Wilmot et al, 2012, Diabetologia, 55:

17 Meta-analysis of effects of sedentary time on diabetes and CVD Wilmot et al, 2012, Diabetologia, 55:

18 How much sitting is needed for increased risk of adverse health outcomes?

19 Sedentary time and risk of cardiovascular disease: a meta-analysis Increased risk of CVD with more than 10 hours per day of selfreported sedentary time Panday et al (2016) JAMA Cardiol; 1:

20 Self-reported sedentary behaviour is under-reported Study Population Self-reported sitting time (h/day) Clark et al (2015) Celis- Morales et al (2012) 700 healthy adults 317 healthy adults Objectivelymeasured sedentary time (h/day) Difference (h/day) 6.85 ± ± ± ± ± ± 1.35 Self-reported sitting time is under-reported by ~15 to 30% Clark et al (2015) IJBNPA; 12:148 Celis-Morales et al (201) PLOS ONE; 5:e36345

21 Sedentary time and risk of cardiovascular disease: a meta-analysis Increased risk of CVD with more than 10 hours per day of selfreported sedentary time Panday et al (2016) JAMA Cardiol; 1:

22 Sedentary time and risk of cardiovascular disease: a meta-analysis Increased risk of CVD with more than hours per day of objectively measured sedentary time Panday et al (2016) JAMA Cardiol; 1:

23 Absolute amounts of sitting which are associated with adverse health outcomes are quite high

24 Can high levels of physical activity attenuate the association between sitting and adverse health outcomes?

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26 Sitting time, physical activity and all-cause mortality Ekelund et al (2016) The Lancet; 388(10051):

27 Sitting time, physical activity and all-cause mortality >65 min/day MVPA <5 min/day MVPA Ekelund et al (2016) The Lancet; 388(10051):

28 TV viewing, physical activity and all-cause mortality Ekelund et al (2016) The Lancet; 388(10051):

29 TV viewing, physical activity and all-cause mortality >5 h/day of TV viewing associated with higher mortality risk Ekelund et al (2016) The Lancet; 388(10051):

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31 Sitting time, physical activity, CVD and cancer mortality CVD mortality Cancer mortality <5 min/day MVPA >65 min/day MVPA Ekelund et al (2018) BJSM; doi: /bjsports

32 TV viewing, physical activity, CVD and cancer mortality CVD mortality Cancer mortality <5 min/day MVPA >65 min/day MVPA Ekelund et al (2018) BJSM; doi: /bjsports

33 Can being fit and strong attenuate the adverse association between sedentary behaviour and health outcomes?

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35 Screen-time, physical activity, fitness, strength and risk of mortality in UK Biobank High activity Low activity Celis-Morales et al (2018) BMC Medicine 16:77

36 Screen-time, physical activity, fitness, strength and risk of mortality in UK Biobank High activity Low activity High fitness Low fitness Celis-Morales et al (2018) BMC Medicine 16:77

37 Screen-time, physical activity, fitness, strength and risk of mortality in UK Biobank High activity Low activity High fitness Low fitness High strength Celis-Morales et al (2018) BMC Medicine 16:77 Low strength

38 Grip-strength, physical activity and risk of mortality in UK Biobank (n = 495,786) Celis-Morales et al (2016) European Heart Journal

39 Fitness, physical activity and risk of mortality in UK Biobank (n = 76,702) Celis-Morales et al (2016) European Heart Journal

40 Who could potentially benefit from sitting less (if association is causal)?

41 Who probably doesn t need to sit less? Those doing more than about an hour of MVPA per day Those in the top third of the population for cardiorespiratory fitness or strength

42 Who might benefit from sitting less? Those doing less than 5 mins of MVPA per day Those sitting for more than ~8-10 hours per day who do less than an hour of MVPA per day Those who sit a lot and are not in the top third of the population for cardiorespiratory fitness or strength

43 But is the association between sitting and adverse health outcomes causal?

44 Limitations of available observational data: reverse causality Sitting Disease

45 Limitations of available observational data: reverse causality Sitting Disease

46 Reverse causality? Mortality risk is of high sedentary time is most evident in those also have low physical activity, low fitness and low strength. Do they have undiagnosed pre-existing disease? Ekelund et al (2016) Lancet 388(10051): Celis-Morales et al (2018) BMC Medicine 16:77

47 Is intervening to break up sitting time beneficial?

48 Short-term lab studies

49 10 x 3 mins vs 1 x 30 mins of brisk walking and postprandial lipaemia Miyashita et al (2008), Am J Clin Nutr, 88:

50 Effects of prolonged sitting on glucose and insulin responses Dunstan et al (2012) Diabetes Care, 35:

51 Effects of prolonged sitting on glucose and insulin responses Glucose Insulin Dunstan et al (2012) Diabetes Care, 35:

52 Effects of breaking up sitting with standing N=10 estate agents (8 women, 2 men) BMI <30 kg/m 2 ; age years Buckley JP et al (2014) Occup Environ Med 71:

53 Henson et al (2016) Diabetes Care 39:130-8

54 Effects of breaking up sitting with standing and walking Sitting for 7.5 hours with no breaks Sitting for 7.5 hours with 5 mins walking per 30 mins Sitting for 7.5 hours with 5 mins standing per 30 mins Henson et al (2016) Diabetes Care 39:130-8

55 Effects of breaking up sitting with standing and walking DAY 1 Glucose Insulin Henson et al (2016) Diabetes Care 39:130-8

56 Sedentary behaviour in older adults: investigating a new therapeutic paradigm

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58 Frequency of breaks in sedentary time and postprandial metabolic responses B Breakfast L Lunch Blood Sample Expired Air h B L 30 min SIT 15 min 7.5 min 7.5 min PRO-Stand 5 min 10 x (1.5 min stand min sit) 5 min INT-Stand Hawari et al (2016) Med Sci Sport Exerc 48:

59 Frequency of breaks in sedentary time and postprandial metabolic responses Energy expenditure Hawari et al (2016) Med Sci Sport Exerc 48:

60 Frequency of breaks in sedentary time and postprandial metabolic responses Glucose Insulin Hawari et al (2016) Med Sci Sport Exerc 48:

61 Effects of breaking up sedentary time with chair squats Hawari et al (2018) J Sports Sci (in press)

62 Longer-term sedentary behaviour reduction interventions

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64 Effectiveness of interventions to reduce non-occupational sedentary behaviour: systematic review & meta-analysis Short term 3months; Medium term 3-6 months Shrestha et al (2018), BJSM, doi: /bjsports

65 Is a 30 min/day reduction in sedentary time or an 11 min/day reduction in TV viewing enough to influence health outcomes?

66 Are there any other approaches we could try?

67 Who might benefit from sitting less? Those doing less than 5 mins of MVPA per day Those sitting for more than ~8-10 hours per day who do less than an hour of MVPA per day Those who sit a lot and are not in the top third of the population for cardiorespiratory fitness or strength

68 How might we intervene to reduce their risk? a) Develop and implement interventions to reduce their sitting time?

69 How might we intervene to reduce their risk? a) Develop and implement interventions to reduce their sitting time? b) Develop and implement interventions to increase their physical activity, strength and fitness?

70 Stamatakis & Gill (2018) BJSM; doi: /bjsports

71 Mortality risk: meta-analyses of sitting and MVPA compared MVPA Sedentary Arem et al (2015) JAMA Intern Med 175: mins/week MVPA associated with 31% lower mortality risk Patterson et al (2017) Eur J Epidemiol; doi: /s/ % higher mortality risk per h/day sitting beyond 8 h/day

72 Conclusions High levels of sedentary behaviour (>8-10 h/day) are associated with increased risk of a range of adverse health outcomes This risk is most evident in those who undertake low levels of physical activity, or who have low fitness or strength The extent to which reverse causality contributes is currently unclear Interventions to reduce sedentary behaviour at present are only modestly effective An alternative approach may be to focus on increasing physical activity, fitness and strength in those with high levels of sedentary behaviour

73 Acknowledgments