Striking the Right Balance: Evidence to Inform Combined Physical Activity and Sedentary Behavior Recommendations

Changes in physical activity, sedentary behaviour and sleep following pulmonary rehabilitation: a systematic review and network meta-analysis

BACKGROUND

The variety of innovations to traditional centre-based pulmonary rehabilitation (CBPR), including different modes of delivery and adjuncts, are likely to lead to differential responses in physical activity, sedentary behaviour and sleep.

OBJECTIVES

To examine the relative effectiveness of different pulmonary rehabilitation-based interventions on physical activity, sedentary behaviour and sleep.

METHODS

Randomised trials in chronic respiratory disease involving pulmonary rehabilitation-based interventions were systematically searched for. Network meta-analyses compared interventions for changes in physical activity, sedentary behaviour and sleep in COPD.

RESULTS

46 studies were included, and analyses were performed on most common outcomes: steps per day (k=24), time spent in moderate-to-vigorous physical activity (MVPA; k=12) and sedentary time (k=8). There were insufficient data on sleep outcomes (k=3). CBPR resulted in greater steps per day and MVPA and reduced sedentary time compared to usual care. CBPR+physical activity promotion resulted in greater increases in steps per day compared to both usual care and CBPR, with greater increases in MVPA and reductions in sedentary time compared to usual care, but not CBPR. Home-based pulmonary rehabilitation resulted in greater increases in steps per day and decreases in sedentary time compared to usual care. Compared to usual care, CBPR+physical activity promotion was the only intervention where the lower 95% confidence interval for steps per day surpassed the minimal important difference. No pulmonary rehabilitation-related intervention resulted in greater increases in MVPA or reductions in sedentary time compared to CBPR.

CONCLUSION

The addition of physical activity promotion to pulmonary rehabilitation improves volume of physical activity, but not intensity, compared to CBPR. High risk of bias and low certainty of evidence suggests that these results should be viewed with caution.

Deep learning of movement behavior profiles and their association with markers of cardiometabolic health

BACKGROUND

Traditionally, existing studies assessing the health associations of accelerometer-measured movement behaviors have been performed with few averaged values, mainly representing the duration of physical activities and sedentary behaviors. Such averaged values cannot naturally capture the complex interplay between the duration, timing, and patterns of accumulation of movement behaviors, that altogether may be codependently related to health outcomes in adults. In this study, we introduce a novel approach to visually represent recorded movement behaviors as images using original accelerometer outputs. Subsequently, we utilize these images for cluster analysis employing deep convolutional autoencoders.

METHODS

Our method involves converting minute-by-minute accelerometer outputs (activity counts) into a 2D image format, capturing the entire spectrum of movement behaviors performed by each participant. By utilizing convolutional autoencoders, we enable the learning of these image-based representations. Subsequently, we apply the K-means algorithm to cluster these learned representations. We used data from 1812 adult (20-65 years) participants in the National Health and Nutrition Examination Survey (NHANES, 2003-2006 cycles) study who worn a hip-worn accelerometer for 7 seven consecutive days and provided valid accelerometer data.

RESULTS

Deep convolutional autoencoders were able to learn the image representation, encompassing the entire spectrum of movement behaviors. The images were encoded into 32 latent variables, and cluster analysis based on these learned representations for the movement behavior images resulted in the identification of four distinct movement behavior profiles characterized by varying levels, timing, and patterns of accumulation of movement behaviors. After adjusting for potential covariates, the movement behavior profile characterized as "Early-morning movers" and the profile characterized as "Highest activity" both had lower levels of insulin (P < 0.01 for both), triglycerides (P < 0.05 and P < 0.01, respectively), HOMA-IR (P < 0.01 for both), and plasma glucose (P < 0.05 and P < 0.1, respectively) compared to the "Lowest activity" profile. No significant differences were observed for the "Least sedentary movers" profile compared to the "Lowest activity" profile.

CONCLUSIONS

Deep learning of movement behavior profiles revealed that, in addition to duration and patterns of movement behaviors, the timing of physical activity may also be crucial for gaining additional health benefits.

Device-measured physical activity and cardiometabolic health: the Prospective Physical Activity, Sitting, and Sleep (ProPASS) consortium

BACKGROUND AND AIMS

Physical inactivity, sedentary behaviour (SB), and inadequate sleep are key behavioural risk factors of cardiometabolic diseases. Each behaviour is mainly considered in isolation, despite clear behavioural and biological interdependencies. The aim of this study was to investigate associations of five-part movement compositions with adiposity and cardiometabolic biomarkers.

METHODS

Cross-sectional data from six studies (n = 15 253 participants; five countries) from the Prospective Physical Activity, Sitting and Sleep consortium were analysed. Device-measured time spent in sleep, SB, standing, light-intensity physical activity (LIPA), and moderate-vigorous physical activity (MVPA) made up the composition. Outcomes included body mass index (BMI), waist circumference, HDL cholesterol, total:HDL cholesterol ratio, triglycerides, and glycated haemoglobin (HbA1c). Compositional linear regression examined associations between compositions and outcomes, including modelling time reallocation between behaviours.

RESULTS

The average daily composition of the sample (age: 53.7 ± 9.7 years; 54.7% female) was 7.7 h sleeping, 10.4 h sedentary, 3.1 h standing, 1.5 h LIPA, and 1.3 h MVPA. A greater MVPA proportion and smaller SB proportion were associated with better outcomes. Reallocating time from SB, standing, LIPA, or sleep into MVPA resulted in better scores across all outcomes. For example, replacing 30 min of SB, sleep, standing, or LIPA with MVPA was associated with -0.63 (95% confidence interval -0.48, -0.79), -0.43 (-0.25, -0.59), -0.40 (-0.25, -0.56), and -0.15 (0.05, -0.34) kg/m2 lower BMI, respectively. Greater relative standing time was beneficial, whereas sleep had a detrimental association when replacing LIPA/MVPA and positive association when replacing SB. The minimal displacement of any behaviour into MVPA for improved cardiometabolic health ranged from 3.8 (HbA1c) to 12.7 (triglycerides) min/day.

CONCLUSIONS

Compositional data analyses revealed a distinct hierarchy of behaviours. Moderate-vigorous physical activity demonstrated the strongest, most time-efficient protective associations with cardiometabolic outcomes. Theoretical benefits from reallocating SB into sleep, standing, or LIPA required substantial changes in daily activity.

Physiology of sedentary behavior

Sedentary behaviors (SB) are characterized by low energy expenditure while in a sitting or reclining posture. Evidence relevant to understanding the physiology of SB can be derived from studies employing several experimental models: bed rest, immobilization, reduced step count, and reducing/interrupting prolonged SB. We examine the relevant physiological evidence relating to body weight and energy balance, intermediary metabolism, cardiovascular and respiratory systems, the musculoskeletal system, the central nervous system, and immunity and inflammatory responses. Excessive and prolonged SB can lead to insulin resistance, vascular dysfunction, shift in substrate use toward carbohydrate oxidation, shift in muscle fiber from oxidative to glycolytic type, reduced cardiorespiratory fitness, loss of muscle mass and strength and bone mass, and increased total body fat mass and visceral fat depot, blood lipid concentrations, and inflammation. Despite marked differences across individual studies, longer term interventions aimed at reducing/interrupting SB have resulted in small, albeit marginally clinically meaningful, benefits on body weight, waist circumference, percent body fat, fasting glucose, insulin, HbA1c and HDL concentrations, systolic blood pressure, and vascular function in adults and older adults. There is more limited evidence for other health-related outcomes and physiological systems and for children and adolescents. Future research should focus on the investigation of molecular and cellular mechanisms underpinning adaptations to increasing and reducing/interrupting SB and the necessary changes in SB and physical activity to impact physiological systems and overall health in diverse population groups.

Poor Sleep Quality and Working From Home Influence the Prevalence of Leisure Time Physical Inactivity During the COVID-19 Pandemic: COVID-Inconfidentes Study

OBJECTIVE

The aim of the study is to explore possible associations according to quality of sleep and work from home (WFH) with physical inactivity (PI) during the COVID-19 pandemic.

METHODS

This is a cross-sectional study in two Brazilian cities (>18 years), by probability sampling. Leisure-time physical activity was self-reported and classified according to guidelines. Sleep was by applying the Pittsburgh Sleep Quality Index. Work from home was classified as: total WFH or no WFH.

RESULTS

A total of 1750 adults were analyzed, 69.1% were physically inactive, 51.9% had poor sleep quality, and 79.8% were not in WFH. PI was associated with poor sleep quality and non-WFH. Compared with those who reported WFH and good sleep quality, those who reported non-WFH and poor sleep quality had 4 times the prevalence of PI.

CONCLUSIONS

Poor sleep quality, and not WFH, is associated with leisure PI. These factors combined increase the probability of PI.

The Effect of an Electronic Passive Prompt Intervention on Prolonged Occupational Sitting and Light-Intensity Physical Activity in Desk-Based Adults Working from Home during COVID-19 in Ireland

This study aimed to assess the effect of passive prompts on occupational physical behaviours (PBs) and bouts of prolonged sitting among desk-based workers in Ireland who were working from home during the COVID-19 pandemic. Electronic passive prompts were delivered every 45 min, asking participants to walk for five minutes, during working hours. Twenty-eight participants (aged 30-67 years) completed the six-week intervention between October 2020 and April 2021. PBs were measured using an activPAL3TM accelerometer, following a 24 h wear protocol, worn for the duration of the study. Participants were highly sedentary at both baseline (77.71% of work hours) and during the intervention (75.81% of work hours). However, the number of prolonged occupational sedentary bouts > 90 min was reduced compared to baseline (0.56 ± 0.08 vs. 0.77 ± 0.11, p = 0.009). Similar reductions were observed in the time spent in sustained sitting > 60 and >90 min when compared to baseline sedentary patterns (60 min: -31.27 ± 11.91 min, p = 0.014; 90 min: -27.97 ± 9.39 min, p = 0.006). Light-intensity physical activity (LIPA) significantly increased during the intervention (+14.29%, p = 0.001). This study demonstrates that passive prompts, delivered remotely, can both reduce the number and overall time spent in prolonged bouts of occupational sedentary behaviour and increase occupational LIPA.

Sedentary behavior is associated with poor sleep quality during the COVID-19 pandemic, and physical activity mitigates its adverse effects

BACKGROUND

We aimed to evaluate the association of sedentary behavior (SB) and moderate to vigorous leisure-time physical activity (MVPA) with sleep quality during the COVID-19 pandemic.

METHODS

Cross-sectional, population-based study in adults, conducted from October to December 2020 in the Iron Quadrangle region, Brazil. The outcome was sleep quality, evaluated with the Pittsburgh Sleep Quality Index. SB was assessed by self-report of total sitting time, before and during the pandemic. Individuals with ≥ 9 h of total sitting time were classified as SB. In addition, the ratio of time spent in MVPA to time in SB was analyzed. A contrasted directed acyclic graph (DAG) model was constructed to adjust logistic regression models.

RESULTS

A total of 1629 individuals were evaluated, the prevalence of SB before the pandemic was 11.3% (95%CI: 8.6-14.8), and during the pandemic 15.2% (95%CI: 12.1-18.9). In multivariate analysis, the chance of poor sleep quality was 77% higher in subjects with SB ≥ 9 h per day (OR: 1.77; 95% CI: 1.02-2.97). Furthermore, a one-hour increase in SB during the pandemic, increased the chance of poor sleep quality by 8% (OR: 1.08; 95%CI 1.01-1.15). In the analysis of the ratio of MVPA per SB in individuals with SB ≥ 9 h, practicing 1 min of MVPA per hour of SB reduces the chance of poor sleep quality by 19% (OR: 0.84; 95%CI: 0.73-0.98).

CONCLUSION

SB during the pandemic was a factor associated with poor sleep quality, and the practice of MVPA can reduce the effects of SB.

A Call for Action on Chronic Respiratory Diseases within Physical Activity Policies, Guidelines and Action Plans: Let's Move!

Global policy documents for the promotion of physical activity (PA) play an important role in the measurement, evaluation, and monitoring of population PA levels. The World Health Organisation (WHO) guidelines include, for the first time, recommendations for specific populations, including individuals living with a range of non-communicable diseases. Of note, is the absence of any chronic respiratory diseases (CRDs) within the recommendations. Globally, CRDs are highly prevalent, are attributable to significant individual and societal burdens, and are characterised by low PA. As a community, there is a need to come together to understand how to increase CRD representation within global PA policy documents, including where the evidence gaps are and how we can align with PA research in other contexts. In this commentary, the potential for synergy between evidence into the relationships between PA in CRDs globally and the relevance to current policies, guidelines and action plans on population levels of PA are discussed. Furthermore, actions and considerations for future research, including the need to harmonize and promote PA assessment (particularly in low- and middle-income countries) and encompass the synergistic influences of PA, sedentary behaviour and sleep on health outcomes in CRD populations are presented.

Joint Profiles of Sedentary Time and Physical Activity in Adults and Their Associations with Cardiometabolic Health

PURPOSE

This study aimed to identify and characterize joint profiles of sedentary time and physical activity among adults and to investigate how these profiles are associated with markers of cardiometabolic health.

METHODS

The participants included 3702 of the Northern Finland Birth Cohort 1966 at age 46 yr, who wore a hip-worn accelerometer during waking hours and provided seven consecutive days of valid data. Sedentary time, light-intensity physical activity, and moderate- to vigorous-intensity physical activity on each valid day were obtained, and a data-driven clustering approach ("KmL3D") was used to characterize distinct joint profiles of sedentary time and physical activity intensities. Participants self-reported their sleep duration and performed a submaximal step test with continuous heart rate measurement to estimate their cardiorespiratory fitness (peak heart rate). Linear regression was used to determine the association between joint profiles of sedentary time and physical activities with cardiometabolic health markers, including adiposity markers and blood lipid, glucose, and insulin levels.

RESULTS

Four distinct groups were identified: "active couch potatoes" ( n = 1173), "sedentary light movers" ( n = 1199), "sedentary exercisers" ( n = 694), and "movers" ( n = 636). Although sufficiently active, active couch potatoes had the highest daily sedentary time (>10 h) and lowest light-intensity physical activity. Compared with active couch potatoes, sedentary light movers, sedentary exercisers, and movers spent less time in sedentary by performing more physical activity at light-intensity upward and had favorable differences in their cardiometabolic health markers after accounting for potential confounders (1.1%-25.0% lower values depending on the health marker and profile).

CONCLUSIONS

After accounting for sleep duration and cardiorespiratory fitness, waking activity profiles characterized by performing more physical activity at light-intensity upward, resulting in less time spent in sedentary, were associated with better cardiometabolic health.

Costing the economic burden of prolonged sedentary behaviours in France

BACKGROUND

There is strong evidence showing that sedentary behaviour time increase the risk to develop several chronic diseases and to premature death. The economic consequences of this risk have never been evaluated in France. The aim of this study was to estimate the economic burden of prolonged sedentary behaviour in France.

METHODS

Based on individual sedentary behaviour time, relative risk to develop cardiovascular disease, colon cancer, breast cancer and all-causes of premature mortality were identified. From relative risk and prevalence of sedentary behaviour time, a population attributable fraction approach was used to estimate the yearly number of cases for each disease. Data from the National Health Insurance were used to calculate the annual average costs per case for each disease. Disease-specific and total healthcare costs attributable to prolonged sedentary behaviour time were calculated. Indirect costs from productivity loss due to morbidity and premature mortality were estimated using a friction cost approach.

RESULTS

In France, 51 193 premature deaths/year appear related to a prolonged daily sedentary behaviour time. Each year prolonged sedentary behaviour cost 494 million € for the national health insurance. Yearly productivity loss due to premature mortality attributable to prolonged sedentary behaviour cost 507 million € and yearly productivity loss due to morbidity cost between 43 and 147 million €.

CONCLUSION

Significant saving and many deaths could be avoided by reducing prolonged sedentary behaviour prevalence in France. To address this issue, strong responses should be implemented to tackle sedentary behaviour, complementary to physical activity promotion.

The Compositional Impacts of 2 Distinct 24-Hour Movement Behavior Change Patterns on Physical Fitness in Chinese Adolescents

BACKGROUND

The study aimed to examine predicted differences of 2 different behavior change patterns on physical fitness (PF).

METHODS

Participants were 241 students (51% girls) aged 11-14 years from China. Light physical activity, moderate to vigorous physical activity (MVPA), and sedentary behavior (SB) were objectively measured. Sleep was obtained by subtracting from awake time. According to Chinese National student PF standards, 5 components of PF, including body mass index, cardiorespiratory fitness, speed, muscular explosive power and strength endurance, and flexibility, were assessed. The effects of different time reallocations between 24-hour movement behaviors on PF were estimated based on adjusted compositional multiple linear regression models with isometric log ratios.

RESULTS

Compared with MVPA substituting for the remaining behaviors, MVPA replacing SB or light physical activity produced more favorable changes on the comprehensive PF score, cardiorespiratory fitness, explosive power, and speed. MVPA replacing 30 minutes of SB was associated with favorable changes in PF (+1.9 [0.53, 3.18] points), 50-m run (-0.17 [-0.31, -0.04] s), long-distance running (-5.54 s [for girls]/7.25 s [for boys]), and long jump (+0.05 [0.01, 0.09] m). When sleep replaced SB, PF improved.

CONCLUSIONS

MVPA substituting SB or light physical activity is a strategy with a greater improvement in PF.

A Manifesto for exercise science - a vision for improving the health of the public and planet

In this manifesto, we make the case that Exercise Science can and must do more to improve the health of the public and the planet. Post pandemic, our vision for Exercise Science is one of a maturing scientific discipline reaching outwards from a base of strong empirical evidence to have a profound and sustained positive global impact on health. In each of the three main areas of the discipline - research, teaching, and professional practice - a new and distinctive approach is needed. We propose 12 points of action, in no particular order, for a). quality, rigour, and professional standing, and b). reach, relevance, and public engagement and make numerous suggestions for action and change. We encourage the teachers, researchers and practitioners of Exercise Science to consider and act on these recommendations. We hope that this manifesto can help create a shared sense of purpose amongst the global Exercise Science community and further the principles of equality, diversity and inclusion. To act on these principles, we need to cultivate a discipline that encourages more women, people who experience racism and other forms of discrimination, and people with a disability to become involved in the discipline.

Accelerometer derived physical activity patterns in 27.890 middle-aged adults - the SCAPIS cohort study

The present study aims to describe accelerometer-assessed physical activity (PA) patterns and fulfilment of PA recommendations in a large sample of middle-aged men and women, and to study differences between sub-groups of socio-demographic, socio-economic and lifestyle-related variables. A total of 27,890 (92.5% of total participants, 52% women, aged 50-64 years) middle-aged men and women with at least four days of valid hip-worn accelerometer data (Actigraph GT3X+, wGT3X+ and wGT3X-BT) from the Swedish CArdioPulmonary bioImage Study, SCAPIS, were included. In total, 54.5% of daily wear time was spent sedentary, 39.1% in low, 5.4% in moderate, and only 0.1% in vigorous PA. Male sex, higher education, low financial strain, born in Sweden and sedentary/light working situation were related to higher sedentary time, but also higher levels of vigorous PA. High BMI and having multiple chronic diseases associated strongly with higher sedentary time and less time in all three PA intensities. All-year physically active commuters had an overall more active PA pattern. The proportion fulfilling current PA recommendations varied substantially (1.4% to 92.2%) depending on data handling procedures and definition used. Twenty-eight percent was defined as having an "at risk" behaviour, which included both high sedentary time and low vigorous PA. In this large population-based sample, a majority of time was spent sedentary and only a fraction in vigorous PA, with clinically important variations between subgroups. This study provides important reference material and emphasizes the importance of a comprehensive assessment of all aspects of the individual PA pattern in future research and clinical practice.

Association between Metabolic Syndrome Diagnosis and the Physical Activity-Sedentary Profile of Adolescents with Obesity: A Complementary Analysis of the Beta-JUDO Study

Metabolic syndrome (MetS) is highly prevalent in children and adolescents with obesity and places them at an increased risk of cardiovascular-related diseases. However, the associations between objectively measured movement-related behaviors and MetS diagnosis remain unexplored in youths with obesity. The aim was to compare profiles of sedentary (SED) time (more sedentary, SED+ vs. less sedentary, SED−), moderate to vigorous physical activity (MVPA) time (more active, MVPA+ vs. less active, MVPA−) and combinations of behaviors (SED−/MVPA+, SED−/MVPA−, SED+/MVPA+, SED+/MVPA−) regarding the MetS diagnosis. One hundred and thirty-four adolescents with obesity (13.4 ± 2.2 years) underwent 24 h/7 day accelerometry, waist circumference (WC), blood pressure (BP), high-density lipoprotein-cholesterol (HDL-c), triglycerides (TG) and insulin-resistance (IR) assessments. Cumulative cardiometabolic risk was assessed by using (i) MetS status (usual dichotomic definition) and (ii) cardiometabolic risk z-score (MetScore, mean of standardized WC, BP, IR, TG and inverted HDL-c). SED− vs. SED+ and MVPA+ vs. MVPA− had lower MetS (p < 0.01 and p < 0.001) and MetScore (p < 0.001). SED−/MVPA+ had the lowest risk. While SED and MVPA times were lower in SED−/MVPA− vs. SED+/MVPA+ (p < 0.001), MetScore was lower in SED−/MVPA− independently of body mass index (BMI) (p < 0.05). MVPA, but not SED, time was independently associated with MetS diagnosis (p < 0.05). Both MVPA (p < 0.01) and SED times (p < 0.05) were associated with MetScore independently of each other. A higher MVPA and lower SED time are associated with lower cumulative cardiometabolic risk.