What is sedentary behaviour? Any waking activity characterized by an energy expenditure 1.5 METs, and a sitting or reclining posture.

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2 What is sedentary behaviour? Any waking activity characterized by an energy expenditure 1.5 METs, and a sitting or reclining posture.

3 The Movement Continuum Sedentary Physiology Exercise Physiology sleep sedentary behaviour LPA moderate physical activity intense exercise METS - + NOT Well researched Well researched

4 Why focus on Sedentary Behaviour? Physical inactivity is the fourth leading cause of death worldwide 2011 CMO guidelines for physical activity and older people to improve public health recommend breaking up prolonged periods of sitting All Older adults should minimise the amount of time spent being sedentary (sitting) for extended periods CMO, Start Active Stay Active, 2011

5 An Active Day? 30 min 1 hour 4 hours 30 min 6 hours 30 min 30 min YES! But 12 hours sitting!

6 What does this mean? Sedentary Behaviour has been linked to frailty, mortality and chronic health problems. Also, likely to effect: Function Quality of Life Social Inclusion and Engagement Older adults are the most sedentary sector of the population.

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9 Katzmarzyk et al., MSSE SB as an independent risk factor Risk of Death % 36% 54% % 50% 75% 100% % Time Spent Sitting

10 Sedentary Behaviour & Chronic Disease Wilmot et al., 2012 (Diabetologia)

11 Bone Health & Sedentary behaviour Longer time spent sitting (objectively measured) is associated with lower femoral bone mineral density (BMD) in postmenopausal women. longer duration of sitting bouts, as opposed to sitting bout frequency. This effect is distinct from lack of engagement in physical activity and independent of total level of moderate and vigorous physical activity (MVPA) in women. Men, however, can reduce the effect of sitting by spending more time in MVPA. Chastin, Mandrichenko, Skelton, Bone, 2014, in press

12 Sedentary Behaviour Active bone and strength loss No standing activity leads to active loss of bone and muscle 1 wk bed rest leg strength by ~ 20% 1 wk bed rest spine BMD by ~1% Avoid bed rest! Nursing home residents spend 80-90% of their time seated or lying down Krolner 1983; Tinetti 1988; Skelton 2001; Beyer 2002

13 Are we doing harm to older patients? Older people on wards Community Dwelling older people Grant PM et al. J Aging Phys Act 2010

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15 How long do older people sit for? Hours Per Day No significant difference Significant difference between subjective report of sitting and objective report by accelerometry. Male Female 2 0 Self Report: Sitting Self Report: TV Self Report: Screen Accelerometry Harvey, Chastin, Skelton, In press 2014

16 Sedentary Behaviour and Increasing Age 14 Hours Daily TV Sitting Accelerometry > 95 Age Group Harvey, Chastin, Skelton, In press 2014

17 Prevalence of Sitting in Older Adults % Population N = 661,125 0 > 3 >4 >5 >6 >7 >8 >9 >11 Hours Harvey, Chastin, Skelton, IJERPH, 2013

18 TV viewing by Time Sections TV Watching by OA Over/Under 2hrs TV Watching Over 2hrs TV Watching Under 2hrs TV Watched by OA Over/Under 4hrs compared to < 2hrs, > 4hrs TV viewing = 46% risk of all cause mortality and 80% increased risk with CVD mortality. TV Watching Over 4 Hrs TV Watching Under 4 Hrs 45% This is independent to traditional risk factors (Dunstan, et al., 2010). 21% N = 350,419 55% 79% N = 257, 321 Harvey, Chastin, Skelton, In press 2014

19 Cost of Sedentary Behaviour High levels of sedentary behaviour are associated with poor health, regardless of how physically active a person is at other points in the day. In the UK, the estimated direct cost of physical inactivity to the NHS is 10 billion. CMO, Start Active Stay Active, 2011 The draft Scottish Charter for Physical Activity reports an economic benefit of 85.2 million if the number of inactive Scots was reduced by 1% each year for the next five years.

20 Seniors USP: Seniors - Understanding Sedentary Patterns PI: Dawn Skelton 817, May months MRC Reference: MR/K025023/1

21 Multidisciplinary Co-Investigators Who Where What Dr Sebastien Chastin Dr Philippa Dall Prof Ian Deary Prof Nanette Mutrie Dr Catharine Gale Dr Claire Fitzsimons Dr Gillian Mead Prof John Starr Dr Geoff Der Prof Sally Wyke Dr Jason Gill Prof Naveed Sattar Dr Cindy Gray Glasgow Caledonian University University of Edinburgh MRC Social and Public Health Sciences University of Glasgow Statistician/Physiotherapist Bioengineer Psychiatrist Exercise Science / Psychologist Epidemiologist Physiologist Geriatrician / Stoke Geriatrician / Dementia & LD Statistician Dr Carolyn Greig University of Birmingham Physiologist Prof Malcolm Granat University of Salford Bioengineer Health Care Researcher / GP Sports Sciences Endocrinologist / Biochemist Psychologist

22 Aim (s) of Seniors USP To better understand the determinants and effects of activity behaviour, especially sedentary behaviour, in older people in order to inform future interventions Which questions are best to measure sedentary behaviour in older people? How do past individual, social and environmental factors affect sedentary behaviour now? What do older people think about sedentary behaviour and how might we intervene?

23 Objectives: WP1 to provide recommendations for the development and tailoring of guidelines and interventions to reduce sedentary behaviour and increase physical activity in older people to disseminate information on the determinants and effects of sedentary behaviour to older people, professionals and organisations working with older people and policy makers to increase research capacity and interdisciplinary working in the field of sedentary behaviour You will hear from WP2, WP3 and WP4 separately

24 The Cohorts Lothian Birth Cohort 1936 (LBC1936) From age 11, now 77 years From 2004, regular monitoring Subjective Physical Activity Brain Scans IQ Cognition... West of Scotland Twenty- 07 study (Twenty-07) In their 60s and 80s From 1987, regular monitoring Subjective Physical Activity Medical Examinations Blood Tests Deprivation... Recruit 750 cohort members

25 Impact Tailoring interventions and who to target those interventions at: Recommendations Manuals Workshops Leaflets For professionals and organisations For policy makers For National Health Surveys and Research Dissemination Advisory Group with user engagement at the hub Internet (Website, Networks, Social Media, You Tube, Webinars) Publications (Peer review and professional) Conferences (with strong older people engagement and attendance) Academic Curriculum

26 Older People Researchers Education (HEIs and NHS) Service providers: Hospitals, Residential Settings, Community Care Beneficiaries Public Health Surveys Fitness and Physical Activity Professionals NGO s/ Charities Health & Social Care Professionals Policy Makers

27 260 researchers 35 institutions 12 countries 35 million Euros Set EU research and policy Surveillance/Monitoring Determinants Intervention Diet Physical activity Sedentary behaviour Diet Physical activity Sedentary behaviour Best Practice Policy Development

28 Working towards achieving the guidelines Increased benefits Moving More Often Moving regularly and frequently Meeting the guidelines Moving Sedentary Increased physical activity