Monitoring and surveillance of physical activity Towards objective monitoring of physical activity, sedentary behaviour and fitness Research and development manager Jaana Suni, PhD, PT UKK Institute for Health Promotion Research (UKKI), Tampere, Finland jaana.h.suni@uta.fi 7.12.2017 1
Aim of the activity to enhance the objective population monitoring of physical activity spectrum and fitness in European countries by providing latest knowledge and experience on measurement methods supporting new projects in monitoring and surveillance and seeking possibilities for common grant money applications 7.12.2017 2
7.12.2017 3
Towards objective population monitoring in the Europe: PHYSICAL ACTIVITY, SEDENTARY BEHAVIOUR AND FITNESS June 7-8, 2017 Workshop at UKK Institute, Tampere, Finland http://www.ukkinstituutti.fi/en/populationmonitoring 7.12.2017 4
Accelerometry Simple, but challenging EDITORIAL Scand J Med Sci Sports. 2017;27:574 578. H E A R T R A T E SENSOR ORIENTATION SEDENTARY BEHAVIOR STANDING ACCELERATION PHYSICAL ACTIVITY INFORMATION: MEASUREMENT: BODY POSTURE SENSOR ORIENTATION ENERGY CONSUMPTION (MET) ACCELERATION HEART RATE 7.12.2017 5
Population-based studies on objectively measured PA, SB and Fitness: Van der Velde JHPM, Kostner A, Van der Berf JD et al. Sedentary Behavior, Physical Activity, and Fitness-The Maastricht Study. Med Sci Sports Exerc 2017;49:1583 91. van der Velde JHPM, Savelberg HHCM, van der Berg JD et al. Sedentary Behavior Is Only Marginally Associated with Physical Function in Adults Aged 40-75 Years-the Maastricht Study. Front Physiol 2017;25;8:242. (activpal3 PA monitor, thigh: posture + stepping time as HPA and LPA) Keevil VL, Cooper AJ, Wijndaele K, et al. Objective Sedentary Time, Moderate-to- Vigorous Physical Activity, and Physical Capability in a British Cohort. Med Sci Sports Exerc 2016;48:421-9. (ActiGraph, GT1M) Bann D, Hire D, Manini T, et al. Light Intensity physical activity and sedentary behavior in relation to body mass index and grip strength in older adults: cross-sectional findings from the Lifestyle Interventions and Independence for Elders (LIFE) study. PLoS One. 2015;10:e0116058. (Actigraph GT3X) 7.12.2017 6
Mitchell T, Borner K, Finch J, Kerr J, and Carlson JA. Using Activity Monitors to Measure Sit-to-Stand Transitions in overweight/obese Youth. Med Sci Sports Exerc 2017;491592 1598. Results: The hip and wrist accelerometer cut points and the hip inclinometer function overestimated the number of hourly sit-to-stand transitions by approximately triple as compared with direct observation. ICC values between the ActiGraph methods and the direct observation were all <0.12. Sit-to-stand transitions assessed from activpal were within 17% of direct observation; ICC was 0.26. Conclusion: Despite the common use of the 100-count hip-worn accelerometer cut point for assessing sedentary time, these processing decisions should be used with caution for assessing sit-to-stand transitions. Future research should investigate other processing methods for ActiGraph data, and studies investigating postural changes should consider including devices such as activpal. 7.12.2017 7
Validation studies by the UKK Institute based on raw data of tri-axial accelerometers Vähä-Ypyä H, Vasankari T, Husu P, et al. A universal, accurate intensity-based classification of different physical activities using raw data of accelerometer. Clin Physiol Funct Imaging 2015;35:64-70 Aittasalo M, Vähä-Ypyä H, Vasankari T, et al. Mean amplitude deviation calculated from raw acceleration data: a novel method for classifying the intensity of adolescents' physical activity irrespective of accelerometer brand. BMC Sports Sci Med Rehabil 2015;7:18 Vähä-Ypyä H, Vasankari T, Husu P, et al. Validation of Cut-Points for Evaluating the Intensity of Physical Activity with Accelerometry-Based Mean Amplitude Deviation (MAD). PLoS One 2015;10:e0134813 Vähä-Ypyä H, Husu P, Suni J, Vasankari T, Sievänen H. Reliable recognition of lying, sitting and standing with a hip-worn accelerometer. Scand J Med Sci Sports (in press) 7.12.2017 8
Validity of MAD (mean amplitude deviation) with reference to measured Oxygen uptake as a function of walking/running speed. PLoS One 2015;10:e0134813 7.12.2017 9
7.12.2017 10
7.12.2017 11
Graphics of different sedentary activities (lying, sitting), standing and walking based on the MAD and APE analysis 7.12.2017 12
Conclusion and perspectives Conventionally the hip-worn accelerometers have classified activities below a certain intensity threshold (e.g. count) as SB while it has not been possible to separate different body postures from each other until this study. Since standing may confer some health benefits compared to sitting and lying, SB should be defined as low intensity activity spent sitting or lying. Therefore it is highly important that the analysis of the accelerometer data can accurately identify different stationary postures. 7.12.2017 13
Conclusion and perspectives The present APE approach based on a single hip-worn tri-axial accelerometer showed good-to-excellent performance in identifying different body postures, also in free-living conditions, and can thus give valuable information about (1) total daily time spent lying, sitting and standing (2) durations/number of different bouts of SB and standing (3) breaks between sedentary periods. 7.12.2017 14
Comparison between thigh- and hip-worn tri-axial accelerometer (sitting) Sitting on a Swiss ball 7.12.2017 15
24/7 physical activity spectrum The above-described MAD-APE algorithms will shortly be complemented by a sleep analysis algorithm, which will be validated against polysomnography data. When used for the sleep analysis, the monitor is wristworn; otherwise the monitor is hip-worn. This two-site approach provides the optimal solution to measure accurately and analyze specifically the entire 24/7 individual behavior of PA, SB and sleep. 7.12.2017 16
Men Women Physical activity and sedentary behavior as a proportion of measurement time Health 2011 Study Agegroup 70-85 60-69 50-59 40-49 30-39 18-29 70-85 60-69 50-59 40-49 30-39 18-29 0 20 40 60 80 100 % Sedentary behavior Standing still Light PA Moderate PA Vigorous PA 7.12.2017 17 Husu et al. 2016 BMC Publ Health
PA and SB (%) from measured time 100 % 80 % 60 % 40 % 20 % 2,8 2,4 1,7 1,3 1,7 1,4 1,1 0,8 15 14 11 9 12 10 8 7 26 25 6 6 23 8 21 9 50 53 56 60 30 9 47 27 10 23 22 12 14 52 56 57 Rasittava liikkuminen Reipas liikkuminen Kevyt liikkuminen Seisominen Makuu ja istuminen 0 % 9-v. 11-v. 13-v. 15-v. 9-v. 11-v. 13-v. 15-v. pojat boys tytöt girls 7.12.2017 18
Associations of objectively measured PA and SB on health outcomes Health 2011 study, UKK PA/Fitness Sub-study Husu P, Suni J, Vähä-Ypyä H, et al. Objectively measured sedentary behavior and physical activity in a sample of Finnish adults: a cross-sectional study. BMC Public Health 2016;16:920. Vasankari V, Husu P, Vähä-Ypyä H, et al. Association of objectively measured sedentary behaviour and physical activity with cardiovascular disease risk. Eur J Prev Cardiol 2017;24:1311-1318. Husu P, Suni J, Tokola K, et al. Frequent breaks in sedentary time and several short standing periods are associated with smaller waist circumference. Submitted to Int J Obes 7.12.2017 19
Associations of objectively measured sedentary behavior and standing on waist circumference M1: adjusted for sex, age, age 2 M2 additionally for VO 2max M3 additionally for MVPA 7.12.2017 20
Conclusions Novel objectively measured accelerometer parameters of SB and standing were more strongly associated with waist circumference than conventionally used total times. When cardiorespiratory fitness and MVPA were taken into account, more breaks in SB and higher number of short standing bouts were associated with smaller waist circumference. Besides the total times, SB and standing should be separately assessed also in terms of breaks and different bout lengths in epidemiological and intervention studies. Husu et al. Submitted to Int J Obes 7.12.2017 21
The best model explaining the Framingham CVD risk score* *Age *Total cholesterol *HDL cholesterol *Systolic BP *Antihypertensive medication *Smoking *Diabetes Standardized beta Significance 7.12.2017 22
There is increasing evidence that combination of decreasing sedentary behaviour (SB) and increasing moderate-to-vigorous physical activity (MVPA), resulting in positive change in cardiorespiratory fitness (CRF), is likely to be the most beneficial for improving health. Among inactive individuals/patient groups reducing daily SB with light physical activity (LIPA) has shown to improve metabolic markers. Health-related time use pattern over 24 hours is more important for population health than traditionally accepted single health risks. 7.12.2017 23
Less Sitting, More Physical Activity, or Higher Fitness? Bouchard D, Blair SN, Katzmarzyk PT. Mayo Clinical Proc. 2015; 90: 1533 24. Global estimates related to levels of physical activity (PA) in terms of current PA guidelines don t take into account sedentary behaviour (SB) and cardiorespiratory fitness (CRF). Epidemiological studies have found that time spent in sedentary behaviours, levels of physical activity and CRF are all associated with mortality rates. They are also related to the risks of obesity, type 2 diabetes mellitus, hypertension, cardiovascular disease, aging associated frailty, and cancer. There is 25 years of accumulated evidence on health benefits of CRF, but no consensus recommendations. More research is needed on muscular strength as a risk factor for health outcomes. 7.12.2017 24
Bouchard D, Blair SN, Katzmarzyk PT. Mayo Clinical Proc. 2015; 90: 1533 24. 7.12.2017 25
6MWT: SEE of predicted VO 2max Men, VO 2max (ml/kg/min) 110.546 + 0.063 x (distance) 0.250 x (age) 0.486 x (BMI) 0.420 x (height) 0.109 x (HR) Women, VO 2max (ml/kg/min) 22.506 0.271 x (weight) + 0.051 x (distance) 0.065 x (age) Mänttäri et al. 2017, submitted 7.12.2017 26
Oral session: Conference ROOM Zagreb November 16 th at 15:15 FINFIT 2017: population-based study on objectively measured physical fitness, activity, sedentary behavior and sleep in Finland (KunnonKartta 2017) Pauliina Husu, Jaana Suni, Kari Tokola, Henri Vähä-Ypyä, Ari Mänttäri, Harri Sievänen, Tommi Vasankari The UKK Institute for Health Promotion Research HEPA Europe Conference, Zagreb, Croatia, November 16 th, 2017 7.12.2017 27
FINFIT2017 Participants PA and SB during waking hours are measured by a hip-worn triaxial accelerometer (UKK RM42, The UKK Institute, Finland) for seven consecutive days. For the sleep assessment the accelerometer is removed from hip to wrist. 7.12.2017 28
Research accelerometer used in population studies in Finland 7.12.2017 29
24/7 physical activity spectrum Postural orientation Sleep, Lying/Sitting, Standing Physical Activity Light Moderate Vigorous 1.0 MET 1.5 MET 3.0 MET 6.0 MET MET = metabolic equivalence 1 MET equals resting metabolic oxygen consumption of 3.5 ml/min/kg Moderate walking: oxygen consumption varies individually between 3 6 METs 7.12.2017 30