Behavioral Aspects of Physical Inactivity and Sedentary Behavior Vs Physical Activity

Transcription

1 Behavioral Aspects of Physical Inactivity and Sedentary Behavior Vs Physical Activity Professor David Dunstan Head Physical Activity NHMRC Senior Research Fellow Baker IDI Heart & Diabetes Institute Mary MacKillop Institute for Health Research Australian Catholic University

2 Outline Guiding principles Clarifying the distinct behavioral entities Diminishing total PA levels and increasing sedentary time Key Features of the Sedentary Behavior Paradigm What to do? Too much sitting AND too little exercise where to next?

3 Disclosures None to report

4 Particular Thanks To Dr Genevieve Healy Prof Neville Owen Dr Chuck Matthews Paddy Dempsey

5 Why A Focus on Behavior? Strongly Environmentally Driven Behaviors Physiological Consequences

6 The Physical Activity Spectrum TOTAL PHYSICAL ACTIVITY Non- Exercise Activity Exercise (Baseline Activity) Sleep Sedentary Behaviour Light Intensity Activity (LIPA) Moderate-Vigorous Intensity Physical Activity (MVPA) Intense Exercise KEY POINT: SB = the reciprocal of total PA Adapted from: Tremblay MS et al. Appl. Physiol. Nutr. Metab. 2010; 35:

7 Mortality Risk Meeting PA Guidelines = Major Health Benefits Arem, H et al. Leisure Time PA and Mortality. A Detailed Pooled Analysis of the Dose-Response JAMA Intern Med E-pub Apr MET h/w 1-2x 2-3x 3-5x 5-10x 10 X Multiples of minimum recommended LTPA level

8 Dose-Response Gains Depend on Initial Activity Level A B C Pate, R et al. JAMA (1995)

9 Time Use Data and Projections - USA Source: Ng & Popkin (2012) Obesity Rev: 13:

10 The Sedentary Behavior Paradigm Features VOLUME UBIQUITOUS DISPLACEMENT Sedentary Behavior DETERMINANTS MECHANISMS

11 The Sedentary Behavior Paradigm Features Volume: the predominant behavior during non-sleeping hours 3% 4% 38% 40% 57% 58% 5% 35% 60% Sedentary LIPA MVPA

12 The Sedentary Behavior Paradigm Features Volume: the predominant behavior during non-sleeping hours Ubiquitous: and provides multiple opportunities for other concurrent unhealthy behaviours

13 The modern post-meal state an everyday life onslaught to our bodies Postprandial Postabsorptive Fasting 8 AM 11 AM 2 PM 5 PM Midnight 4 AM Breakfast Adapted from Monnier L. Eur J Clin Invest. 2000

14 The consequences of post-meal (PM) dysmetabolism PM dyslipidaemia PM hyperglycaemia PM hyperinsulinaemia Sympathetic hyperactivity Hypercoagulation (platelet activation) Inflammation Oxidative stress Endothelial dysfunction & vascular damage Diabetic complications; Atherosclerosis; Risk of CVD events O Keefe JH & Bell DSH 2008 Am J Cardiol ; Ceriello A 2000 Diabetes Metab Res Rev ; Heine RJ et al Diab Med

15 The Sedentary Behavior Paradigm Features Volume: the predominant behavior during non-sleeping hours Ubiquitous: and provides multiple opportunities for other concurrent unhealthy behaviours Displacement: SB reduces TOTAL PA, leading to increased disease risk Total PA = LIPA + MVPA Healy GN et al. Under Review

16 Mortality Risk Associated with Replacement of 1 hr/d Sitting with 1 hr/d of Specific Types of PA Matthews, CE et al. MSSE E-pub Jan NIH AARP Diet and Health Study In those less active (< 2 hrs/day) N = 69,606 In those more active ( 2 hrs/day) N = 85,008

17 Displacement: Missed Opportunities for Additional Benefit Missed Opportunities Pate, R et al. JAMA (1995)

18 The Sedentary Behavior Paradigm Features Volume: the predominant behavior during non-sleeping hours Ubiquitous: and provides multiple opportunities for other concurrent unhealthy behaviours Displacement: SB reduces TOTAL PA, leading to increased disease risk Determinants: personal and environmental factors that induce us to exercise are distinct from those which induce us to be sedentary

19 Leonard H Epstein Although sedentary behavior may arguably be conceptualized as no more than the other side of the physical activity (exercise) coin, we see it as a class of behaviours that can coexist with and also compete with physical activity (exercise) Thus it may be helpful to explore sedentary behavior as a unique attribute it its own right and to examine what is known about some of its outcomes Owen et al. Exerc Sport Sci Rev 28:

20 Unique Correlates/Determinants Ecological Model of Four Domains of Sedentary Behavior & Regulations Public recreation Investments Park design policies SB not assessed in health care Sidewalk requirements Transport investments Recreation Environment Seating in Parks Park design to promote sitting Screen-based entertain; movies, game arcades Sport spectatorship Neighborhood - poor ped/bike facilities -aesthetics - traffic safety Leisure Time Home Environment Household Electronic entertainment; passive/active Remote controls Labor-saving devices Price of electricity Furniture for sitting/reclining Incentives for energy conservation zoning codes Negative perceptions of active environments: unsafe, uncomfortable, unattractive, inconvenient Comfort, convenience of labor saving devices, attractiveness of sedentary entertainment Healthcare: counseling, info Mass media - news, ads Sports spectating Informal discussions Policy Environment Behavior Settings: Access & Characteristics Behavior: Sedentary Active Behavior Living Domains Domains Perceived Environment Perceived Environment Intrapersonal Demographics Biological Psychological Family Situation Social norms Perceived crime Interpersonal modeling, social support, prompts to sit, awkwardness of standing Social climate, safety, crime, norms, culture Neighborhood - walkability - ped/bike facilities - parking -transit -traffic negative Transport perceptions of active transport facilities; positive perception of motorized facilities Cues for sitting, purpose of furniture/desk Weather Topography Air quality Zoning codes Development Regulations (sidewalk requirements) Transport investments Occupation Info promoting SB during transport - safety signage - radio ads & news - billboards (TV, movies, sports) Workplace Environment Furniture designed for sitting Neighborhood walkability Parking Transit access Building design Stair design Ped/Bike Facilities School Environment Neighborhood walkability Ped/bike facilities Facilities PE program Traffic demand management Parking regulations Developer incentives Requirements for seated work OHS codes Rules for breaks Zoning codes Building codes Parking regulations Transportation investments Walk to School program Requirements for sitting PE & recess policies Facility & policy access policies Safe Routes to School funding Media regulations Health sector policies Business practices Advocacy by individuals & organizations Transport policies Energy policies Information Environment Social Cultural Environment Natural Environment Owen, N., Sugiyama, T., Eakin, E.G., Gardiner, P.A., Tremblay, M.S. and Sallis JF. (2011). Adults sedentary behavior: Determinants and interventions. American Journal of Preventive Medicine, 41,

21 Interventions Targeting SB Reduce Sedentary Time NOT Interventions Targeting PA Systematic review and meta-analysis - interventions Prince et al. 2014: 65 studies (31 meta-analysis) A comparison of the effectiveness of physical activity and sedentary behavior interventions in reducing sedentary time in adults: a systematic review and metaanalysis of controlled trials. Prince SA et al. Obesity Reviews (2014) 15:

22 Sedentary Behavior Interventions Consistent evidence that large and clinically meaningful reductions in sedentary time can be expected from interventions with a focus on reducing sedentary behaviors Prince SA et al. Obesity Reviews (2014) 15:

23 Physical Activity Interventions Interventions with a either a focus on PA or those including both a PA and SB component were of lower quality, produced less consistent findings and generally resulted in smaller and more modest reductions in sedentary time Prince SA et al. Obesity Reviews (2014) 15:

24 The Sedentary Behavior Paradigm Features Volume: the predominant behavior during non-sleeping hours Ubiquitous: and provides multiple opportunities for other concurrent unhealthy behaviours Displacement: SB reduces TOTAL PA, leading to increased disease risk Determinants: personal and environmental factors that induce us to exercise are distinct from those which induce us to be sedentary Mechanisms: some of the biological consequences of SB may be distinct from those arising from too little exercise

25 What Really Matters for Public Health Right Now? VOLUME UBIQUITOUS DISPLACEMENT Sedentary Behavior DETERMINANTS MECHANISMS

26 What To Do?

27 Observational Study Evidence Sedentary Not sedentary CPM < 100 CPM 100+ Prolonger Breaker These two people have exactly the same sedentary time More breaks from sitting time associated with lower average waist circumference, BMI, triglycerides, and 2-hr plasma glucose Healy, G.N., Dunstan, D.W., Salmon, J., Cerin, E., Shaw, J.E., Zimmet, P.Z. and Owen, N. (2008). Breaks in sedentary time: Beneficial associations with metabolic risk. Diabetes Care, 31,

28 Experimental Evidence Uninterrupted Sitting Interrupted Sitting Hrs

29 pmol/l mmol/l Experimental Evidence Glucose 24% Insulin Hrs Uninterrupted Sitting Interrupted Sitting 23% Uninterrupted Sitting Sitting + Light-intensity Activity Breaks Sitting + Moderate-intensity Activity Breaks Uninterrupted sitting Sitting + Lightintensity Activity Breaks Dunstan et al, 2012, Diabetes Care. Sitting + Moderate intensity Activity Breaks

30 Breaking Up Sitting Time in Type 2 diabetes Light Walking: 3 3.2km/hr every 30 min Paddy Dempsey: Abstract No. 2480, Poster Board #227 Fri May 29 9:30-11:00AM

31 Breaking Up Sitting Time in Type 2 diabetes Paddy Dempsey: Abstract No. 2480, Poster Board #227 Fri May 29 9:30-11:00AM

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33 Too Much Sitting and Too Little Exercise: Where to Next? 1. Is it feasible and beneficial for people of different ages to reduce, break up or otherwise change sitting time? 2. Experimental evidence is crucial: What is most relevant to change? Total time? Sit-to-stand transitions? Up time? LIPA time? Prolonged sitting bouts? Dose-response? 3. What are the mechanisms in which biological systems lead to too much sitting being a major health risk? With findings on 1, 2 and 3 from laboratory and field-based experimental studies, we can address 4, 5, 6 and 7 with greater precision and confidence...

34 Too Much Sitting and Too Little Exercise: Where to Next? 4. How to further integrate a focus on sitting into physical activity guidelines and policy? 5. How best to communicate and engage different groups in different contexts in relation to prolonged sitting and health? 6. What are the points of traction for reducing prolonged sitting that are most effective and that will do no harm? 7. Identify how the settings in which children, adolescents, adults and older people do a great deal of sitting home environment; transport; residential care; community exert their influences

35 Thank You for Listening Sit Less AND Move More Physical Activity Laboratory Baker IDI Heart & Diabetes Institute