2/5/2015 OVERVIEW. Peter T. Katzmarzyk, PhD, FACSM, FAHA Financial Disclosures

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1 Sitting, Physical Activity and Cardiovascular Disease Risk: Opposite Sides of the Same Coin? Peter T. Katzmarzyk, PhD, FACSM, FAHA Associate Executive Director for Population and Public Health Sciences Pennington Biomedical Research Center Baton Rouge, LA Peter T. Katzmarzyk, PhD, FACSM, FAHA Financial Disclosures I have received approximately $35 million in research funding as Principal Investigator or Co-Investigator in the past 10 years from grants awarded to my institution from the Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, International Development Research Centre of Canada, Louisiana Public Facilities Authority, Louisiana Department of Health and Hospitals, National Institutes of Health, United States Department of Agriculture, The Coca-Cola Company, Blue Cross and Blue Shield Foundation of Louisiana, Robert Wood Johnson Foundation, the Health Care Services Division of the Louisiana State University System, and the Patient-Centered Outcomes Research Institute. I have performed consulting services for the Ontario Ministry of Health Promotion, Health Canada, Aventis Pharma Inc., the Canadian Transportation Agency, University of South Carolina, and the Deepwater Horizon Claims Administrator. OVERVIEW Definition & Epidemiology of Sedentary Behavior Sedentary Behavior & Health Outcomes Prospective Associations between Sedentary Behavior & Mortality Is Sedentary Behavior Independent of Physical Activity? 1

2 Physical Activity, Fitness and Mortality Katzmarzyk. ACSM s Resource Manual for Guidelines for Exercise Testing and Prescription, 5th edition. pp , DEFINITION OF SEDENTARY BEHAVIOR Any waking behavior characterized by an energy expenditure 1.5 METs while in a sitting or reclining posture. Sedentary Behaviour Research Network, Appl Physiol Nutr Metab EPIDEMIOLOGY OF SEDENTARY BEHAVIOR Sitting in US Adults, NHANES Harrington et al. J Sci Med Sport

3 EPIDEMIOLOGY OF SEDENTARY BEHAVIOR Sitting Time among Adults from 20 Countries Median Minutes per Day Median 50 0 Bauman et al. Am J Prev Med SEDENTARY BEHAVIOR, OBESITY AND DIABETES 6 Years of Follow-up in Women y of Age (Nurses Health Study) Obesity Type 2 Diabetes P for Trend <0.001 P for Trend < Relative Risk > >40 TV Hours per Week Adjusted for age, smoking, alcohol use, hormone use, physical activity, total fat, cereal fiber, glycemic load, and total calories Hu et al. JAMA

4 Sitting and Cardiometabolic Risk Factors, NHANES Staiano et al. Br J Sports Med 2014;48: SEDENTARY BEHAVIOR & METABOLIC SYNDROME Screen Time and Metabolic Syndrome in NHANES, US Adults 3 Men Women 2.5 Odds Ratio Screen Time (Hours per Day) Adjusted for age, smoking, education, BMI, ethnicity, physical activity & percent fat in diet Sisson et al. Met Syn Relat Disord Sedentary Behavior and Mortality 4

5 Sedentary Behavior and All-Cause Mortality Wilmot et al, Diabetologia 2012;55: SITTING & MORTALITY 100 Cumulative Survival (%) Daily Sitting Almost None of the Time ¼ of the Time ½ of the Time ¾ of the Time Almost All of the Time Follow-up Years N = 17,013 Canadian Men and Women, Canada Fitness Survey 12-year Mortality Follow-up, Katzmarzyk et al. MSSE SITTING & MORTALITY P< P< NS P< Hazard Ratio for Mortality Daily Sitting Almost All of the Time ¾ of the Time ½ of the Time ¼ of the Time Almost None of the Time All-Cause CVD Cancer Other N = 17,013 Canadian Men and Women, Canada Fitness Survey 12-year Mortality Follow-up, Katzmarzyk et al. MSSE

6 P for Trend <0.001 P for Trend <0.001 P for Trend <0.001 Multivariable-Adjusted Hazard Ratios for Mortality Television Viewing < 1 h/d 1-2 h/d 3-4 h/d 5-6 h/d 7 h/d All-Cause CVD Cancer Hazard Ratio for Mortality * * Daily TV < 2 h/d 2-4 h/d 4+ h/d All-Cause CVD Cancer 6

7 Is Sedentary Behavior Independent of Physical Activity? Different strategies have been used by the prospective mortality studies: Controlling for Physical Activity Inoue et al., 2008 Katzmarzyk et al Patel et al Dunstan et al Wijndaele et al Stamatakis et al van der Ploeg et al Matthews et al Brown et al Leon-Munoz et al Stratification by Physical Activity Level Katzmarzyk et al Patel et al Wijndaele et al Stamatakis et al van der Ploeg et al Matthews et al Brown et al Leon-Munoz et al SEDENTARY BEHAVIOR, PHYSICAL ACTIVITY & MORTALITY Age-Adjusted All-Cause Death Rate per 10,000 Person-Years Daily Sitting Almost All of the Time ¾ of the Time ½ of the Time ¼ of the Time Almost None of the Time Inactive Active Active defined as 7.5 MET-hr/week N = 17,013 Canadian Men and Women, Canada Fitness Survey 12-year Mortality Follow-up, Katzmarzyk et al. MSSE

8 The Spectrum of Human Movement All-Cause Death Rates (per 10,000 person-y) Sitting Standing Leisure-time Physical Activity 0 None 1/4 1/2 3/4 All None 1/4 1/2 3/4 All Q1 Q2 Q3 Q4 Q5 of the of the of the of the Time Time Time Time 17,013 Canadian Men and Women, Canada Fitness Survey 12-year Mortality Follow-up, Katzmarzyk, Unpublished Results, SUMMARY Sedentary behavior is ubiquitous in modern society. Sedentary behavior is related to obesity, metabolic risk factors and mortality from all causes and CVD. The degree to which sedentary behavior is independent of physical activity per se requires more research. THANK YOU! 8