Sedentary behaviour and health: mapping environmental and social contexts to underpin chronic disease prevention

Daily Path Areas and Location Use During and After Cardiac Rehabilitation

PURPOSE

Little research has focused on the potential impact that the environment plays in shaping cardiac rehabilitation (CR) patient sedentary time (ST) and physical activity (PA). To address this, the current study generated daily path areas (DPAs) based on the locations they visited during and after they completed CR.

METHODS

Patients in CR (n = 66) completed a survey and wore an accelerometer and Global Positioning System receiver for 7 days early (first month), late (last 2 weeks of program), and 3 months after completing CR.

RESULTS

Individual DPAs were approximately 24 km 2 at baseline and remained stable over time. Location-based analyses showed that most patients' ST and PA time was spent at home, followed by other residential, commercial, work, and CR locations. However, the time spent in certain locations (eg, parks and recreation locations) fluctuated during and after CR by intensity.

CONCLUSIONS

CR patient DPA was stable over time. Within this space, they primarily engaged in ST and PA at home. However, when not home, the distribution of location use varied across a number of locations that extended well beyond their neighborhoods. Therefore, proximity to home may not be a barrier for CR patients in relation to their ST and PA.

Physical health effects of sedentary behaviour on adults with an intellectual disability: A scoping review

This literature review was designed to establish the effects of sedentary behaviour on the physical health of adults with an intellectual disability. Sedentary behaviour is defined as any waking behaviour characterized by an energy expenditure of ≤1.5 METs while in a sitting, lying or reclining posture. An extensive search was executed in six databases: EMBASE, Medline, CINAHL, PsycINFO, ASSIA and Web of Science. Following screening, 18 articles remained for inclusion in the review. A thematic analysis using the Braun and Clarke six step process resulted in the identification of seven broad health areas. Studies showed a prevalence of obesity, multimorbidity and metabolic syndrome as well as elevated levels of sedentary behaviour in adults with an intellectual disability. This literature review demonstrated that sedentary behaviour could be a contributor to the poor health which is common in adults with an intellectual disability. However to date the body of evidence does not confirm a cause-and-effect relationship.

Physical activity during summer and recognition of heatstroke prevention among patients with cardiovascular disease in an urban area of Japan: a descriptive study

OBJECTIVE

Patients with cardiovascular disease are considered a high-risk population for heat-related illnesses. This study aimed to describe the difference in physical activity between summer and fall among patients with cardiovascular disease and their recognition of heatstroke prevention in an urban area with high temperature conditions.

RESULTS

We enrolled 56 outpatients who participated in cardiac rehabilitation in the summer of 2022 (median age, 75 years [interquartile range, 68-80]). Physical activity level for each patient was assessed using the International Physical Activity Questionnaire at baseline in summer (August) and follow-up in fall (October). Changes in exercise habits and frequency of going outside during the study period and the patients' recognition of heatstroke prevention were assessed using questionnaires. The prevalence of low physical activity was higher in summer than in fall (57.1% vs. 37.5%, p = 0.013). Of the patients involved in self-exercise before summer, 33.9% answered that their exercise habits decreased in summer. Of them, 47.4% felt that their exercise habits remained decreased in fall. Regarding the frequency of going outside, 82.1% went outside less in summer. Most participants were highly interested in heatstroke prevention.

Associations of Cultural Characteristics with Sedentary Behaviour and Screen Time Among Indigenous Adults in Saskatchewan

BACKGROUND

Indigenous Peoples: First Nations, Métis and Inuit, have experienced significant disruptions of physical, mental, emotional and spiritual health and well-being through centuries of ongoing colonization and assimilation. Consequently, breakdown of cultural connections, increasingly sedentary lifestyles and high levels of screen time contribute to health inequity experiences.

PURPOSE

The purpose of this study is to examine associations of cultural connectedness with sedentary behaviour and the influence of relocation from home communities for Indigenous Peoples in Saskatchewan.

METHODS

Cultural connectedness, sedentary and screen time behaviour were evaluated through online questionnaires among 106 Indigenous adults. Within Indigenous identities, 2 × 2 factorial ANOVA compared cultural connectedness scores with sedentary behaviour and traditional activity participation by relocation from home communities.

RESULTS

Among First Nations and specifically Cree/Nehiyawak who relocated from home communities, positive associations of cultural connectedness scores with sedentary behaviour and screen time were identified, with no associations identified among those not relocating. Among Métis who did not relocate, greater ethnic identity, identity, spirituality and cultural connectedness (57.8 ± 5.36 vs. 81.25 ± 16.8; p = 0.02) scores were reported among those reporting 5 or more hours of continuous sitting.

CONCLUSIONS

Cultural connectedness associations with sedentary behaviour depend on relocation from home communities and differ between First Nations and Métis. Understanding associations of sedentary behaviour specific to First Nations and Métis populations may enable appropriate strategies to improve health outcomes.

Home office shift and sedentary behaviour in Germany during the COVID-19 pandemic: descriptives and related socioecological correlates

COVID-19 working restrictions resulted in a location shift of white-collar workers into their home office (HO). Little is known about how the proportion of HO affects sitting and physical activity (PA) behaviour during working hours, and potential correlates are not well understood. A cross-sectional sample of currently working adults in HO (n = 575) completed questionnaires regarding HO proportion before and during the pandemic, work-related sitting and PA, and socioecological factors regarding HO sitting time. The reported HO proportion increased by 46.7 ± 40.6% during COVID-19 working restrictions. Workday sitting proportion correlates positively with HO proportion. The regression model identified gender, education level, working hours, working environment to stand during work, and transport and leisure PA as correlates of the workday sitting proportion in HO. This study provides findings that high HO proportions are related to higher work-related sitting times and adds insights into possible correlates of sitting time in HO.Practitioner summary: Working in the home office (HO) is a common characteristic of flexible work in white-collar workers. This study found that the workday sitting proportion correlates positively with HO proportion and identified correlates of the workday sitting in HO. Practitioners should consider the potential impacts of HO on work-related sedentary behaviour in future workplace health promotion.

Relationship Between Physical Activity and Estimated Glomerular Filtration Rate in Renal Transplant Recipients: A Cross-sectional Study Analyzing Isotemporal Substitution Model

OBJECTIVES

Successful renal transplantation reduces mortality rates. However, the decline in the estimated glomerular filtration rate (eGFR) after transplantation is strongly associated with premature mortality in renal transplant recipients (RTRs). Physical activity (PA) is a modifiable lifestyle factor with the potential to maintain or improve eGFR. However, the effects of the type or intensity of PA and sedentary behavior (SB) on eGFR in RTRs remain unclear. The purpose of this study was to clarify the association between accelerometry-measured PA and SB and eGFR in RTRs using isotemporal substitution (IS) analysis.

METHODS

A total of 82 renal transplant outpatients participated in this cross-sectional study, of which 65 (average age, 56.9 years; average time post-transplant, 83.0 months) were finally analyzed. All RTRs wore a triaxial accelerometer to measure PA for 7 consecutive days. The measured PA was classified based on intensity into light PA, moderate-to-vigorous PA (MVPA), and SB. The association of each type of PA with eGFR was examined using multi-regression analyses of single-factor, partition, and IS models. The IS model was applied to examine the estimated effects of substituting 30 minutes of SB with an equal amount of time of light PA or MVPA on eGFR.

RESULTS

The partition model showed that MVPA was an independent explanatory variable for eGFR (β = 5.503; P < .05), and the IS model identified that the substitution of time spent in SB with MVPA led to improvements in eGFR (β = 5.902; P < .05).

CONCLUSIONS

The present study suggests that MVPA has an independent and positive association with eGFR, and replacing 30 minutes of SB with MVPA after renal transplantation might lead to the maintenance or improvement of eGFR in RTRs.

Providing office workers with height-adjustable workstation to reduce and interrupt workplace sitting time: protocol for the Stand Up for Healthy Aging (SUFHA) cluster randomized controlled trial

BACKGROUND

Sedentary behavior (SB) has been linked to several negative health outcomes. Therefore, reducing SB or breaking up prolonged periods of SB improves functional fitness, food consumption, job satisfaction, and productivity. Reducing SB can be achieved by introducing a health-enhancing contextual modification promoted by a sit-stand desk in the workplace. The primary goal will be to test the effectiveness of this intervention in reducing and breaking up SB, while improving health outcomes in office-based workers during a 6-month intervention.

METHODS

A two-arm (1:1), superiority parallel-group cluster RCT will be conducted to evaluate the effectiveness of this intervention in a sample of office-based workers from a university in Portugal. The intervention will consist of a psychoeducation session, motivational prompts, and contextual modification promoted by a sit-stand desk in the workplace for 6 months. The control group will work as usual in their workplace, with no contextual change or prompts during the 6-month intervention. Three assessment points will be conducted in both groups, pre-intervention (baseline), post-intervention, and a 3-month follow-up. The primary outcomes include sedentary and physical activity-related variables, which will be objectively assessed with 24 h monitoring using the ActivPAL for 7 days. The secondary outcomes include (a) biometric indices as body composition, body mass index, waist circumference, and postural inequalities; and (b) psychosocial variables such as overall and work-related fatigue, overall discomfort, life/work satisfaction, quality of life, and eating behavior. Both the primary and secondary outcomes will be assessed at each assessment point.

DISCUSSION

This study will lean on the use of a sit-stand workstation for 6 months, prompted by an initial psychoeducational session and ongoing motivational prompts. We will aim to contribute to this topic by providing robust data on alternating sitting and standing postures in the workplace.

TRIAL REGISTRATION

The trial was prospectively registered, and the details are at: https://doi.org/10.17605/OSF.IO/JHGPW ; Registered 15 November 2022. OSF Preregistration.

Device-measured sitting time and musculoskeletal pain in adults with normal glucose metabolism, prediabetes and type 2 diabetes-The Maastricht Study

BACKGROUND

Detrimental associations of sedentary behaviour (time spent sitting) with musculoskeletal pain (MSP) conditions have been observed. However, findings on those with, or at risk of, type 2 diabetes (T2D) have not been reported. We examined the linear and non-linear associations of device-measured daily sitting time with MSP outcomes according to glucose metabolism status (GMS).

METHODS

Cross-sectional data from 2827 participants aged 40-75 years in the Maastricht Study (1728 with normal glucose metabolism (NGM); 441 with prediabetes; 658 with T2D), for whom valid data were available on activPAL-derived daily sitting time, MSP [neck, shoulder, low back, and knee pain], and GMS. Associations were examined by logistic regression analyses, adjusted serially for relevant confounders, including moderate-to-vigorous intensity physical activity (MVPA) and body mass index (BMI). Restricted cubic splines were used to further examine non-linear relationships.

RESULTS

The fully adjusted model (including BMI, MVPA, and history of cardiovascular disease) showed daily sitting time to be significantly associated with knee pain in the overall sample (OR = 1.07, 95%CI: 1.01-1.12) and in those with T2D (OR = 1.11, 95%CI: 1.00-1.22); this was not statistically significant in those with prediabetes (OR = 1.04, 95%CI: 0.91-1.18) or NGM (OR = 1.05, 95%CI: 0.98-1.13). There were no statistically significant associations between daily sitting time and neck, shoulder, or low back pain in any of the models. Furthermore, the non-linear relationships were statistically non-significant.

CONCLUSION

Among middle-aged and older adults with T2D, daily sitting time was significantly associated with higher odds of knee pain, but not with neck, shoulder, or low back pain. No significant association was observed in those without T2D for neck, shoulder, low back, or knee pain. Future studies, preferably those utilising prospective designs, could examine additional attributes of daily sitting (e.g., sitting bouts and domain-specific sitting time) and the potential relationships of knee pain with mobility limitations.

Relationship between TV watching during childhood and adolescence and fitness in adulthood in the Raine Study cohort

To investigate: (1) whether TV watching habits throughout childhood and adolescence, a proxy of sedentary behaviour, impacted cardiorespiratory fitness (CRF) in adulthood, and (2) whether any potential impact of TV watching in childhood and adolescence on CRF in adulthood was changed by adult physical activity (PA) levels. A longitudinal study with questionnaire data available regarding TV watching collected at ages 5, 8, 10, 14, 17 and 20 yrs, allowed trajectories of TV watching to be developed. At age 28 yrs, participants completed a V̇O₂peak test and the International Physical Activity Questionnaire. General linear models tested for differences in CRF (time to exhaustion TTE and V̇O₂peak mL·kg^-1·min^-1) between TV watching trajectories. The secondary analysis tested the potential effect current PA levels has on the relationship between TV trajectory and fitness. In total, 449 participants [male n = 255 (56.8%), 28.3 ± 0.5 yrs; female n = 194 (43.2%), 28.2 ± 0.4 yrs] were included in the study. Three distinct trajectories of TV watching were identified: High TV, Increasing TV and Low TV. CRF was lowest in the High TV watching trajectory and increased progressively from High to Increasing TV and Increasing to Low TV (all P < .05). Within each of the TV trajectories, those engaging in high levels of current PA had greater CRF than those engaging in low and moderate PA. TV watching in childhood and adolescence negatively impacts upon adult fitness at the age of 28 years. However, this negative impact of historical TV watching on CRF can largely be attenuated by engaging in higher levels of PA in adulthood.

A Wrinkle in Measuring Time Use for Cognitive Health: How should We Measure Physical Activity, Sedentary Behaviour and Sleep?

One new case of dementia is detected every 4 seconds and no effective drug therapy exists. Effective behavioural strategies to promote healthy cognitive ageing are thus essential. Three behaviours related to cognitive health which we all engage in daily are physical activity, sedentary behaviour and sleep. These time-use activity behaviours are linked to cognitive health in a complex and dynamic relationship not yet fully elucidated. Understanding how each of these behaviours is related to each other and cognitive health will help determine the most practical and effective lifestyle strategies for promoting healthy cognitive ageing. In this review, we discuss methods and analytical approaches to best investigate how these time-use activity behaviours are related to cognitive health. We highlight four key recommendations for examining these relationships such that researchers should include measures which (1) are psychometrically appropriate; (2) can specifically answer the research question; (3) include objective and subjective estimates of the behaviour and (4) choose an analytical method for modelling the relationships of time-use activity behaviours with cognitive health which is appropriate for their research question.

Pediatric Overweight, Fatness and Risk for Dyslipidemia Are Related to Diet: A Cross-Sectional Study in 9-year-old Children

Pediatric overweight, dyslipidemia and insulin resistance can result from unhealthy lifestyle habits and increase morbidity and mortality in adulthood. Herein, we evaluated the relationship between diet and physical activity patterns with the metabolic health of 9-year-old school children. Measurements included anthropometry, adiposity, lipid, and glycemic profiles. Questionnaires evaluated diet and physical activity. Exploratory factor analysis (EFA) screened for diet patterns, and multilevel models evaluated diet and physical activity patterns against overweight, dyslipidemia, and insulin resistance markers across schools and children. EFA highlighted two diet patterns, Western and Traditional. Food rich in fat, salt, and sugar and fewer vegetables and fruits defined the Western pattern. The Traditional pattern, linked to healthier eating habits, had analogies to the Mediterranean diet. Overall, 39% of the children were overweight (including the obese), while 62% presented cardiovascular risk factors on their lipid profiles. Normal-weight children presented 60% high cholesterol incidence. Global insulin resistance incidence was 4.1%, but almost doubled among the overweight/obese. The Westernized diet consistently linked to worse cardiovascular risk markers, even independently of physical practice. Intensive or competitive physical activity was associated with decreased triglycerides (p = 0.003), regardless of diet. Future prospective studies are warranted to validate these results externally.

How many days of indoor positioning system data are required to characterise typical movement behaviours of office workers?

Indoor Positioning Systems (IPS) appear to offer great potential to study the movement and interaction of people and their working environment, including office workplaces. But little is known about appropriate durations for data collection. In this study, location observations collected from 24 office workers on a 1220 m² office floor over a 3-month period, were analysed to determine how many days are required to estimate their typical movement and spatial behaviours. The analysis showed that up to 8 days of data was sufficient to characterise participants' typical daily movement behaviours and 10 days were required to estimate their typical spatial mobility. However, the results also indicate that 5 weeks of data collection are required to gather the necessary 10 days of data from each participant. These findings will help researchers and workplace professionals to understand the capabilities and requirements of IPS when considering their use in indoor work environments.

Non-exercise activity thermogenesis in the workplace: The office is on fire

From the second half of the previous century, there has been a shift toward occupations largely composed of desk-based behaviors. This, inevitably, has led to a workload reduction and a consequent lower energy expenditure. On this point, small increments of the non-exercise activity thermogenesis (NEAT) could be the rationale to reach health benefits over a prolonged period. Different published researches suggest solutions to reverse sitting time and new alternative workstations have been thought to increase total physical activity. Therefore, the purpose of this narrative review is to summarize the current state of the research regarding the "NEAT approach" to weight-gain prevention in work environments. This review analyzes the main evidence regarding new alternative workstations such as standing, walking workstations, seated pedal, and gymnastic balls to replace a standard office chair.

A systematic review of interventions to increase physical activity and reduce sedentary behaviour following bariatric surgery

Background

Objectives

Eligibility

Study appraisal and synthesis methods

Results

Limitations

Conclusion and implications of key findings

Systematic review registration number

Data to Decisions: Methods to Create Neighbourhood Built Environment Indicators Relevant for Early Childhood Development

Healthy development in the early years lays the foundations for children’s ongoing physical, emotional, and social development. Children develop in multiple contexts, including their local neighbourhood. Neighbourhood-built environment characteristics, such as housing, walkability, traffic exposure, availability of services, facilities, and parks, are associated with a range of health and wellbeing outcomes across the life course, but evidence with early years’ outcomes is still emerging. Data linkage techniques were used to assemble a dataset of spatial (objectively-measured) neighbourhood-built environment (BE) measures linked to participant addresses in the 2015 Australian Early Development Census (AEDC) for children living in the 21 most populous urban and regional Australian cities (n = 235,655) to help address this gap. This paper describes the methods used to develop this dataset. This linked dataset (AEDC-BE) is the first of its kind worldwide, enabling opportunities for identifying which features of the built environment are associated with ECD across Australia at scale, allow comparisons between diverse contexts, and the identification of where best to intervene. National data coverage provides statistical power to model real-world complexities, such as differences by city, state/territory, and remoteness. The neighbourhood-built environment can be modified by policy and practice at scale, and has been identified as a way to help reduce inequitable early childhood development outcomes.

Stop motion: using high resolution spatiotemporal data to estimate and locate stationary and movement behaviour in an office workplace

Prolonged periods of stationary behaviour, a common occurrence in many office workplaces, are linked with a range of physical disorders. Investigating the physical context of this behaviour may be a key to developing effective interventions. This study aimed to estimate and locate the stationary and movement behaviours of office workers (n = 10) by segmenting spatiotemporal data collected over 5 days in an office work-based setting. The segmentation method achieved a balanced accuracy ≥85.5% for observation classification and ≥90% for bout classification when compared to reference data. The results show the workers spent the majority of their time stationary (Mean = 86.4%) and had on average, 28.4 stationary and 25.9 moving bouts per hour. While these findings accord with other studies, the segmented data was also visualised, revealing that the workers were stationary for periods ≥5 min at multiple locations and these locations changed across time. Practitioner Summary: This study applied a data segmentation method to classify stationary and moving behaviours from spatiotemporal data collected in an office workplace. The segmented data revealed not only what behaviours occurred but also their location, duration, and time. Segmenting spatiotemporal data may add valuable physical context to aid workplace research.

Neighbourhood, Built Environment and Children's Outdoor Play Spaces in Urban Ghana: Review of Policies and Challenges

Although a great deal of research work has been done by social scientists on walkability and playability, the focus to a large extent has been on the global north. Research work on the urban built environment and children's play has not engaged Africa in general and Ghana in particular. More importantly, there is limited evidence of policies in terms of community-based practices and governmental policies and programmes for the promotion of play. The limited effort in promoting physical activities have to a large extent focused on walkability, yet evidence to date indicates that walking only constitutes a small proportion of the physical activities of children. This is against the backdrop of growing urbanization and the increasing reported incidence of sedentary lifestyles, less physical activity and obesity among children and the youth. Our main objective in this paper is to contribute to the literature on Ghana, and by extension Sub-Saharan Africa, by examining the extent to which playability features in city and national policies and strategies in urban Ghana. We conclude that while there is dearth of public policies on children's play, with the situation in communities compounded by weak city government capacity to plan, implement and enforce development control to protect open spaces for children's play and recreational purposes. The paper recommends a change in policy and practice on creating spaces in urban built-environments for children's play in urban Ghana.

Musculoskeletal pain and sedentary behaviour in occupational and non-occupational settings: a systematic review with meta-analysis

BACKGROUND

Sedentary behaviour (SB; time spent sitting) is associated with musculoskeletal pain (MSP) conditions; however, no prior systematic review has examined these associations according to SB domains. We synthesised evidence on occupational and non-occupational SB and MSP conditions.

METHODS

Guided by a PRISMA protocol, eight databases (MEDLINE, CINAHL, PsycINFO, Web of Science, Scopus, Cochrane Library, SPORTDiscus, and AMED) and three grey literature sources (Google Scholar, WorldChat, and Trove) were searched (January 1, 2000, to March 17, 2021) for original quantitative studies of adults ≥ 18 years. Clinical-condition studies were excluded. Studies' risk of bias was assessed using the QualSyst checklist. For meta-analyses, random effect inverse-variance pooled effect size was estimated; otherwise, best-evidence synthesis was used for narrative review.

RESULTS

Of 178 potentially-eligible studies, 79 were included [24 general population; 55 occupational (incuding15 experimental/intervention)]; 56 studies were of high quality, with scores > 0.75. Data for 26 were meta-synthesised. For cross-sectional studies of non-occupational SB, meta-analysis showed full-day SB to be associated with low back pain [LBP - OR = 1.19(1.03 - 1.38)]. Narrative synthesis found full-day SB associations with knee pain, arthritis, and general MSP, but the evidence was insufficient on associations with neck/shoulder pain, hip pain, and upper extremities pain. Evidence of prospective associations of full-day SB with MSP conditions was insufficient. Also, there was insufficient evidence on both cross-sectional and prospective associations between leisure-time SB and MSP conditions. For occupational SB, cross-sectional studies meta-analysed indicated associations of self-reported workplace sitting with LBP [OR = 1.47(1.12 - 1.92)] and neck/shoulder pain [OR = 1.73(1.46 - 2.03)], but not with extremities pain [OR = 1.17(0.65 - 2.11)]. Best-evidence synthesis identified inconsistent findings on cross-sectional association and a probable negative prospective association of device-measured workplace sitting with LBP-intensity in tradespeople. There was cross-sectional evidence on the association of computer time with neck/shoulder pain, but insufficient evidence for LBP and general MSP. Experimental/intervention evidence indicated reduced LBP, neck/shoulder pain, and general MSP with reducing workplace sitting.

CONCLUSIONS

We found cross-sectional associations of occupational and non-occupational SB with MSP conditions, with occupational SB associations being occupation dependent, however, reverse causality bias cannot be ruled out. While prospective evidence was inconclusive, reducing workplace sitting was associated with reduced MSP conditions. Future studies should emphasise prospective analyses and examining potential interactions with chronic diseases.

PROTOCOL REGISTRATION

PROSPERO ID # CRD42020166412 (Amended to limit the scope).

No changes in adolescent's sedentary behaviour across Europe between 2002 and 2017

BACKGROUND

Public health organizations have been alerted to the high levels of sedentary behaviour (SB) among adolescents as well as to the health and social consequences of excess sedentary time. However, SB changes of the European Union (EU) adolescents over time have not been reported yet. This study aimed to identify SB of the EU adolescents (15-17 years) in four-time points (2002, 2005, 2013 and 2017) and to analyse the prevalence of SB according to the sex.

METHODS

SB of 2542 adolescents (1335 boys and 1207 girls) as a whole sample and country-by-country was analysed in 2002, 2005, 2013, and 2017 using the Sport and Physical Activity EU Special Eurobarometers' data. SB was measured using the sitting time question from the short version of the International Physical Activity Questionnaire (IPAQ), such that 4h30min of daily sitting time was the delineating point to determine excess SB behaviour (≥4h30min of sitting time) or not (≤4h30min of sitting time). A χ2 test was used to compare the prevalence of SB between survey years. Furthermore, SB prevalence between sexes was analysed using a Z-Score test for two population proportions.

RESULTS

The prevalence of SB among EU adolescents across each of the four survey years ranged from 74.2 and 76.8%, rates that are considered high. High levels of SB were also displayed by both sexes (girls: 76.8 to 81.2%; boys: 71.7 to 76.7%). No significant differences in the prevalence of SB among years (p > 0.05) were found for the whole sample, and for either girls or boys. Also, no significant differences in the prevalence of SB between girls and boys were found.

CONCLUSION

The SB prevalence in European adolescents is extremely high (76.8% in 2017) with no differences between girls and boys. No significant improvements have been seen between 2002 and 2017. Eurobarometer should increase the adolescents' sample to make possible benchmarking comparisons among the EU countries and extend the survey to the younger children population.

Movement at work: A comparison of real time location system, accelerometer and observational data from an office work environment

Office workers can spend significant periods of time being stationary whilst at work, with potentially serious health consequences. The development of effective health interventions could be aided by a greater understanding of the location and environmental context in which this stationary behaviour occurs. Real time location systems (RTLS) potentially offer the opportunity to gather this much needed information, but they have not been extensively trialled in office workplaces, nor rigorously compared against more familiar devices such as accelerometers. The aim of this paper was to determine whether an RTLS can measure and spatially locate the non-stationary and stationary behaviours of adults working in an office work environment. Data collected from a series of comparison studies undertaken in a commercial office building suggests that RTLS can measure the velocity at which people are moving and locate them, when stationary, with an accuracy of 0.668 m (SD 0.389). This opens up significant opportunities to further understand how people move within buildings, the indoor physical environmental influences on that movement, and the development of effective interventions to help people to move more whilst at work.

Associations between neighbourhood street pattern, neighbourhood socioeconomic status and sleep in adults

Sleep duration is a risk factor for poor health and all-cause mortality. Evidence suggests that neighbourhood characteristics such as built environment and socioeconomic status (SES) may affect sleep duration in adults. This study examined the relationship between neighbourhood built environment (i.e., measured via the street pattern) and SES with sleep duration in adults (n = 797) from 12 neighbourhoods in Calgary (Canada). Covariate adjusted linear and multinomial logistic regression models estimated the associations between street pattern (grid, warped-grid, curvilinear), SES and sleep duration. We also tested if the interaction between street pattern and SES was associated with sleep duration. Although neighbourhood street pattern and neighbourhood SES were not independently associated with sleep, the interaction between street pattern and neighbourhood SES, was associated with mean sleep duration. Individuals living in curvilinear low SES neighbourhoods had the shortest sleep duration (6.93 h per day; 95% CI 6.68, 7.18), while those living in curvilinear high SES neighbourhoods slept the longest (7.43 h per day; 95% CI 7.29, 7.57). Neighbourhood street pattern and SES, as well as their interaction, were not associated with the odds of sleeping shorter or longer than 7 to 8 h per day. Our findings suggest that the combined effect of the neighbourhood built environment and SES is potentially important for influencing sleep duration. More research is needed to understand the complex interrelationships between the built environment, SES, and sleep.

The Mediating role of perceived discrimination and stress in the associations between neighborhood social environment and TV Viewing among Jackson Heart Study participants

Objectives

The aim of this study was to test the mediating role of perceived discrimination and stress on associations between perceived neighborhood social environment (PNSE) and TV viewing.

Methods

Baseline data were used for 4716 participants (mean age = 55.1 y; 63.4% female) in the Jackson Heart Study (JHS), a large prospective cohort study of African Americans in Jackson, Mississippi. One binary TV viewing outcome was created: ≥4 h/day versus <4 h/day. PNSE variables included neighborhood violence, problems (higher value = more violence/problems), and social cohesion (higher value = more cohesion). Mediators included perceived lifetime discrimination, daily discrimination, and chronic stress (higher value = greater discrimination/stress). Multivariable regression was used with bootstrap-generated 95% bias-corrected confidence intervals (BC CIs) to test for mediation adjusting for demographics, health-related and psychosocial factors, and population density.

Results

Neighborhood violence, problems, and social cohesion were indirectly associated with TV viewing through lifetime discrimination (OR = 1.03, 95%BC CI = 1.00, 1.07; OR = 1.03, 95%BC CI = 0.99, 1.06 [marginal]; OR = 0.98, 95%BC CI = 0.94, 0.99, respectively) and chronic stress (OR = 0.95, 95%BC CI = 0.90, 0.99; OR = 0.96, 95%BC CI = 0.92, 0.99; OR = 1.05, 95%BC CI = 1.01, 1.10, respectively). Daily discrimination was neither directly nor indirectly associated with TV viewing.

Conclusions

Each PNSE variable was indirectly associated with TV viewing via lifetime discrimination and perceived stress, but not with daily discrimination among JHS participants. Unexpected directionality of mediating effects of lifetime discrimination and chronic stress should be replicated in future studies. Further research is also needed to pinpoint effective community efforts and physical environmental policies (e.g., installing bright street lights, community policing) to reduce adverse neighborhood conditions and psychosocial factors, and decrease TV viewing and subsequent cardiovascular disease risk.

Physical activity, sedentary time and sleep in cystic fibrosis youth: A bidirectional relationship?

PURPOSE

Physical activity (PA) and sleep are highly important for those with cystic fibrosis (CF), yet, despite this and suggestions of a bidirectional relationship between these factors in healthy children, their relationship is yet to be investigated.

METHODS

PA, sedentary time (SED), and sleep were objectively derived over seven days in 58 youth (11.9 ± 2.7 years; 29 CF). Generalized linear latent and mixed models with a random intercept and slope at child-level were adjusted for age, sex, wear-time, type of day, group and mean PA/SED and sleep.

RESULTS

Every additional 10 min sedentary was associated with 5.6 and 5.0 min less sleep and 10.6 and 12.0 min less wake after sleep onset (WASO) that night, in CF and healthy children, respectively. PA, regardless of intensity, was not associated with total sleep time but every additional 10 min of light PA (LPA) was associated with 3.0 min less WASO in healthy participants. Ten mins more sleep was associated with 3.1 and 1.7 min less SED in CF and healthy children, respectively. In CF, greater sleep time led to less LPA (3.6 min) the following day, whereas, in healthy children, poor sleep quality (greater WASO) was associated with more LPA (1.4 min) and moderate-to-vigorous PA (5.2 min) the following day.

CONCLUSION

A bidirectional relationship between SED and subsequent total sleep time was evident, irrespective of group, whereas the relationship between sleep and PA was group dependent. These findings have important implications regarding the reciprocal effects of promoting PA or sleep quantity or quality.

Association of active school commuting with physical activity and sedentary behaviour among adolescents: A global perspective from 80 countries

OBJECTIVES

To examine associations of active school commuting (ASC) with time spent in physical activity (PA) and sedentary behaviour (SB) among adolescents.

DESIGN

Cross-sectional study.

METHODS

Global School-based Student Health Survey data from 277,833 adolescents aged 11-17 years (48.9% girls), collected during 2007-2016, were analysed. Adolescents were asked how many days per week they walked or bicycled to and from school, were physically active, and how much time they spent sitting on a typical day. ASC was defined as ≥3 days/week, meeting PA recommendations as ≥60min/day, high SB as leisure-time sitting ≥3h/day. Multilevel logistic regression analysis was used to estimate the odds ratios (OR) and 95% confidence intervals (CI) of the association estimates.

RESULTS

Adolescents who used ASC≥3 days/week had over double the odds of meeting PA recommendations (OR: 2.06, 95% CI: 2.01-2.12), after adjusting for a set of covariates. Adolescents who reported ASC≥3 days/week had 17% lower odds of reporting high SB (0.83, 0.81-0.85). The estimated OR of ASC and PA was 2.57 (2.31-2.86) in low-income and 1.84 (1.75-1.94) in high-income countries. Adolescents with ASC≥3 days/week had 22% lower odds of reporting high SB in African and Eastern Mediterranean regions (0.78, 0.73-0.84 and 0.75-0.82, respectively). Country-wise estimates of the associations are presented.

CONCLUSIONS

ASC is strongly and positively associated with PA recommendations and moderately with lower SB in adolescents. These estimates vary across WHO regions and by country's income. Promoting ASC has the potential to promote active lifestyle among adolescents around the globe.

Could smart research ensure healthy people in disrupted cities?

BACKGROUND

Since the late 19th century, city planners have struggled to cope with new types of urban transport and mobility that threatened the existing system, or even rendered it obsolete.

PURPOSE

As city planners confront the range of disruptive urban mobilities currently on the horizon, this paper explores how we can draw on a vast body of evidence to anticipate and avoid unintended consequences to people's health and wellbeing.

METHODS

This commentary involved a rapid review of the literature on transport disruption.

RESULTS

We found that to avoid the unintended consequences of disruption, research, policy and practice must think beyond single issues (such as the risk of chronic disease, injury, or traffic management) and consider the broader consequences of interventions. For example, although autonomous vehicles will probably reduce road trauma, what will be the negative consequences for physical inactivity, sedentary behavior, chronic disease, land use, traffic congestion and commuting patterns? Research is needed that considers and informs how to mitigate the range of potential harms caused by disruptive mobilities.

CONCLUSION

In the face of new disruptive mobilities, we must: (a) draw on existing evidence to shape new regulations that address the 'who, when and where' rules of introducing new mobilities (such as electric assisted bicycles (e-bikes) and scooters (e-scooters)) of which the health repercussions can be easily anticipated; (b) monitor and evaluate the implementation of any interventions through natural experiment studies; and (c) use innovative research methods (such as agent-based simulation and health-impact-assessment modelling) to assess the likely effects of emerging disruptive mobilities (e.g., autonomous vehicles) on health and wellbeing and on the environment.

Promotion of Healthy Lifestyles to Teenagers with Mobile Devices: A Case Study in Portugal

Educating teenagers about nutrition and promoting active lifestyles is essential in reducing the long-term health risks and one idea to achieve this is by using mobile applications. Previous studies showed that the existing mobile applications have similar functionalities, such as intervention with questionnaires, and the use of gamification techniques to improve interactiveness. However, unlike our study, some studies are not validated and verified by healthcare professionals. Additionally, this study intends to promote the interaction between the teenagers and the medical communities. In this study, we analyze the benefits of the proposed mobile application, which features monitoring of physical activity, daily tips and curiosities, questionnaires, and gamification through earning points. Most of the teenagers were satisfied with the physical activity monitoring and found the tips, curiosities, and weekly questionnaires useful. The study started with 26 teenagers from two schools in the center of Portugal that would use the mobile application for five weeks. Still, at the end of the study, only 7 teenagers finalized the study. The decreasing number of teenagers in the study was affected by the lack of social interaction caused by the pandemic situation. During the period, the mobile application would engage the users with notifications on nutrition and physical activity, challenges concerning the number of steps and calories they would have to spend, and questionnaires related to the curiosities and suggestions from the previous week. We used Fisher’s test to investigate the relationship between the assessment obtained in the responses to the questionnaires, and the adoption of healthier eating and sports practices. In summary, participants were satisfied with the mobile application and experienced some improvements in diet and habits.

Interventions outside the workplace for reducing sedentary behaviour in adults under 60 years of age

BACKGROUND

Adults spend a majority of their time outside the workplace being sedentary. Large amounts of sedentary behaviour increase the risk of type 2 diabetes, cardiovascular disease, and both all-cause and cardiovascular disease mortality.

OBJECTIVES

Primary • To assess effects on sedentary time of non-occupational interventions for reducing sedentary behaviour in adults under 60 years of age Secondary • To describe other health effects and adverse events or unintended consequences of these interventions • To determine whether specific components of interventions are associated with changes in sedentary behaviour • To identify if there are any differential effects of interventions based on health inequalities (e.g. age, sex, income, employment) SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, Cochrane Database of Systematic Reviews, CINAHL, PsycINFO, SportDiscus, and ClinicalTrials.gov on 14 April 2020. We checked references of included studies, conducted forward citation searching, and contacted authors in the field to identify additional studies.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) and cluster RCTs of interventions outside the workplace for community-dwelling adults aged 18 to 59 years. We included studies only when the intervention had a specific aim or component to change sedentary behaviour.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened titles/abstracts and full-text articles for study eligibility. Two review authors independently extracted data and assessed risk of bias. We contacted trial authors for additional information or data when required. We examined the following primary outcomes: device-measured sedentary time, self-report sitting time, self-report TV viewing time, and breaks in sedentary time.

MAIN RESULTS

We included 13 trials involving 1770 participants, all undertaken in high-income countries. Ten were RCTs and three were cluster RCTs. The mean age of study participants ranged from 20 to 41 years. A majority of participants were female. All interventions were delivered at the individual level. Intervention components included personal monitoring devices, information or education, counselling, and prompts to reduce sedentary behaviour. We judged no study to be at low risk of bias across all domains. Seven studies were at high risk of bias for blinding of outcome assessment due to use of self-report outcomes measures. Primary outcomes Interventions outside the workplace probably show little or no difference in device-measured sedentary time in the short term (mean difference (MD) -8.36 min/d, 95% confidence interval (CI) -27.12 to 10.40; 4 studies; I² = 0%; moderate-certainty evidence). We are uncertain whether interventions reduce device-measured sedentary time in the medium term (MD -51.37 min/d, 95% CI -126.34 to 23.59; 3 studies; I² = 84%; very low-certainty evidence) We are uncertain whether interventions outside the workplace reduce self-report sitting time in the short term (MD -64.12 min/d, 95% CI -260.91 to 132.67; I² = 86%; very low-certainty evidence). Interventions outside the workplace may show little or no difference in self-report TV viewing time in the medium term (MD -12.45 min/d, 95% CI -50.40 to 25.49; 2 studies; I² = 86%; low-certainty evidence) or in the long term (MD 0.30 min/d, 95% CI -0.63 to 1.23; 2 studies; I² = 0%; low-certainty evidence). It was not possible to pool the five studies that reported breaks in sedentary time given the variation in definitions used. Secondary outcomes Interventions outside the workplace probably have little or no difference on body mass index in the medium term (MD -0.25 kg/m², 95% CI -0.48 to -0.01; 3 studies; I² = 0%; moderate-certainty evidence). Interventions may have little or no difference in waist circumference in the medium term (MD -2.04 cm, 95% CI -9.06 to 4.98; 2 studies; I² = 65%; low-certainty evidence). Interventions probably have little or no difference on glucose in the short term (MD -0.18 mmol/L, 95% CI -0.30 to -0.06; 2 studies; I² = 0%; moderate-certainty evidence) and medium term (MD -0.08 mmol/L, 95% CI -0.21 to 0.05; 2 studies, I² = 0%; moderate-certainty evidence) Interventions outside the workplace may have little or no difference in device-measured MVPA in the short term (MD 1.99 min/d, 95% CI -4.27 to 8.25; 4 studies; I² = 23%; low-certainty evidence). We are uncertain whether interventions improve device-measured MVPA in the medium term (MD 6.59 min/d, 95% CI -7.35 to 20.53; 3 studies; I² = 70%; very low-certainty evidence). We are uncertain whether interventions outside the workplace improve self-reported light-intensity PA in the short-term (MD 156.32 min/d, 95% CI 34.34 to 278.31; 2 studies; I² = 79%; very low-certainty evidence). Interventions may have little or no difference on step count in the short-term (MD 226.90 steps/day, 95% CI -519.78 to 973.59; 3 studies; I² = 0%; low-certainty evidence) No data on adverse events or symptoms were reported in the included studies.

AUTHORS' CONCLUSIONS

Interventions outside the workplace to reduce sedentary behaviour probably lead to little or no difference in device-measured sedentary time in the short term, and we are uncertain if they reduce device-measured sedentary time in the medium term. We are uncertain whether interventions outside the workplace reduce self-reported sitting time in the short term. Interventions outside the workplace may result in little or no difference in self-report TV viewing time in the medium or long term. The certainty of evidence is moderate to very low, mainly due to concerns about risk of bias, inconsistent findings, and imprecise results. Future studies should be of longer duration; should recruit participants from varying age, socioeconomic, or ethnic groups; and should gather quality of life, cost-effectiveness, and adverse event data. We strongly recommend that standard methods of data preparation and analysis are adopted to allow comparison of the effects of interventions to reduce sedentary behaviour.

Sedentary Behavior Research in the Chinese Population: A Systematic Scoping Review

Background: The negative effects of sedentary behavior (SB) on public health have been extensively documented. A large number of studies have demonstrated that high prevalence of SB is a critical factor of all-cause mortality. Globally, the frequency of SB research has continued to rise, but little is known about SB in the Chinese population. Therefore, this review was conducted to scope the research situation and to fill the gaps related to the effects of SB in the Chinese population. Methods: Using a scoping review based on York methodology, a comprehensive search of published journal articles and grey literature was carried out through 12 databases. The literature research was conducted by two authors in July 2019, and included journal articles that targeted on the Chinese population were published between 1999 and 2019. The two authors screened the records independently and included those research topics related to SB in the Chinese population. Results: The number of included studies increased from 1 to 29 per year during the analyzed period, during which, a remarkable climb happened from 8 in 2013 to 19 in July 2019. Out of the 1303 screened studies, a total of 162 studies (81 English and 81 Chinese journal articles) met the inclusion criteria in this review. Most of the included studies (66.0%) reported the overall estimated prevalence of SB, in which, 43.2% of studies reported the average time of SB, and 40.0% of studies reported the cutoff point of SB. Besides this, 54.9% and 23.5% of studies focused on the outcomes and correlates/determinants of SB, and the proportions of studies based on testing the validation of measurement tools and on interventions were 3.7% and 4.9%, respectively. Nearly all of the reviewed articles used data from cross-sectional studies (75.9%) and longitudinal studies (13.6%), while intervention trials are less developed. The majority of the studies (64.8%) used self-reported surveys, and only 3.7% studies used device-based measurement tools. Furthermore, 35.8% of the included studies were focused on children and adolescents, while only a few studies investigated infants/toddlers and older adults. Both female and male were examined in most studies, and non-clinical populations were investigated in the context of SB in a relatively large number of studies. Conclusions: The number of research articles on SB in the Chinese population published per year has increased year by year, indicating a growing interest in this research area. More studies using population subgroup samples are needed, particularly among infants/toddlers, older adults, and clinical populations. To provide stronger evidence of the determinants and outcomes of SB, longitudinal studies using device-based measures of SB are required.

Occupational, Transport, Leisure-Time, and Overall Sedentary Behaviors and Their Associations with the Risk of Cardiovascular Disease among High-Tech Company Employees

This study examined the associations of overall and domain-specific (i.e., occupational, transport, and leisure-time) sedentary behaviors with cardiovascular disease (CVD) risk factors among high-tech company employees in Taiwan. A total of 363 participants employed at high-tech companies (mean age ± standard deviation: 37.4 ± 7.2 years) completed a questionnaire administered by email regarding their overall, occupational, transport, and leisure-time sedentary behaviors. Self-reported data of height and weight, blood pressure, blood sugar, and total cholesterol levels were also collected in 2018. An adjusted binary logistic regression model was employed in the analysis. After adjusting for sociodemographic variables, high-tech company employees who used a computer (or Internet) for more than 2 h per day during their leisure time were more likely to have CVD risk factors (odds ratio: 1.80; 95% confidence interval: 1.08-3.00). No significant associations with CVD risk factors were detected for total sedentary time, occupational sitting, television viewing time, and transport-related sitting. Despite the nature of cross-sectional design in this study, our findings may have considerable implications for intervention designers and policymakers of Taiwan. Developing effective strategies for limiting leisure-time computer use should be considered for the prevention of CVD among high-tech company employees.

Supporting Workers to Sit Less and Move More Through the Web-Based BeUpstanding Program: Protocol for a Single-Arm, Repeated Measures Implementation Study

BACKGROUND

The web-based BeUpstanding Champion Toolkit was developed to support work teams in addressing the emergent work health and safety issue of excessive sitting. It provides a step-by-step guide and associated resources that equip a workplace representative-the champion-to adopt and deliver the 8-week intervention program (BeUpstanding) to their work team. The evidence-informed program is designed to raise awareness of the benefits of sitting less and moving more, build a supportive culture for change, and encourage staff to take action to achieve this change. Work teams collectively choose the strategies they want to implement and promote to stand up, sit less, and move more, with this bespoke and participative approach ensuring the strategies are aligned with the team's needs and existing culture. BeUpstanding has been iteratively developed and optimized through a multiphase process to ensure that it is fit for purpose for wide-scale implementation.

OBJECTIVE

The study aimed to describe the current version of BeUpstanding, and the methods and protocol for a national implementation trial.

METHODS

The trial will be conducted in collaboration with five Australian workplace health and safety policy and practice partners. Desk-based work teams from a variety of industries will be recruited from across Australia via partner-led referral pathways. Recruitment will target sectors (small business, rural or regional, call center, blue collar, and government) that are of priority to the policy and practice partners. A minimum of 50 work teams will be recruited per priority sector with a minimum of 10,000 employees exposed to the program. A single-arm, repeated-measures design will assess the short-term (end of program) and long-term (9 months postprogram) impacts. Data will be collected on the web via surveys and toolkit analytics and by the research team via telephone calls with champions. The Reach, Effectiveness, Adoption, Implementation, and Maintenance Framework will guide the evaluation, with assessment of the adoption/reach of the program (the number and characteristics of work teams and participating staff), program implementation (completion by the champion of core program components), effectiveness (on workplace sitting, standing, and moving), and maintenance (sustainability of changes). There will be an economic evaluation of the costs and outcomes of scaling up to national implementation, including intervention affordability and sustainability.

RESULTS

The study received funding in June 2018 and the original protocol was approved by institutional review board on January 9, 2017, with national implementation trial consent and protocol amendment approved March 12, 2019. The trial started on June 12, 2019, with 48 teams recruited as of December 2019.

CONCLUSIONS

The implementation and multimethod evaluation of BeUpstanding will provide the practice-based evidence needed for informing the potential broader dissemination of the program.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12617000682347; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372843&isReview=true.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/15756.

Moderators of Parents' Perceptions of the Neighborhood Environment and Children's Physical Activity, Time Outside, and Screen Time

BACKGROUND

Increased physical inactivity and sedentary behavior among children are a global health concern.

PURPOSE

Examine associations between parents' perceived neighborhood environment and children's physical activity, outside time, and screen time, and whether these associations were moderated by age and socioeconomic position (SEP).

METHODS

Parents (N = 1212) completed a survey during the Recording and EValuating Activity in a Modified Park study. The neighborhood perceptions (social and physical environment), children's age, physical activity, outside time, and screen time were parent-reported. The SEP was derived from the Index of Relative Socio-economic Advantage and Disadvantage. Multiple linear and logistic regressions were performed with age and SEP interactions.

RESULTS

Favorable perceptions of opportunities to be active and exercise were associated with a higher likelihood of meeting physical activity guidelines. Favorable perceptions of neighborhood ease for walking and a larger social network were also associated with more outdoor time. Moderation analyses revealed that favorable perceptions of several physical and social neighborhood environment features were associated with a higher likelihood of meeting physical activity guidelines in the high-SEP group and were negatively associated with preschoolers' weekday screen time.

CONCLUSION

Future neighborhood environment initiatives and interventions aiming to promote active living communities should consider differences in age and SEP.

Sedentary Behavior and Public Health: Integrating the Evidence and Identifying Potential Solutions

In developed and developing countries, social, economic, and environmental transitions have led to physical inactivity and large amounts of time spent sitting. Research is now unraveling the adverse public health consequences of too much sitting. We describe improvements in device-based measurement that are providing new insights into sedentary behavior and health. We consider the implications of research linking evidence from epidemiology and behavioral science with mechanistic insights into the underlying biology of sitting time. Such evidence has led to new sedentary behavior guidelines and initiatives. We highlight ways that this emerging knowledge base can inform public health strategy: First, we consider epidemiologic and experimental evidence on the health consequences of sedentary behavior; second, we describe solutions-focused research from initiatives in workplaces and schools. To inform a broad public health strategy, researchers need to pursue evidence-informed collaborations with occupational health, education, and other sectors.

Built environment changes and active transport to school among adolescents: BEATS Natural Experiment Study protocol

INTRODUCTION

Natural experiments are considered a priority for examining causal associations between the built environment (BE) and physical activity (PA) because the randomised controlled trial design is rarely feasible. Few natural experiments have examined the effects of walking and cycling infrastructure on PA and active transport in adults, and none have examined the effects of such changes on PA and active transport to school among adolescents. We conducted the Built Environment and Active Transport to School (BEATS) Study in Dunedin city, New Zealand, in 2014-2017. Since 2014, on-road and off-road cycling infrastructure construction has occurred in some Dunedin neighbourhoods, including the neighbourhoods of 6 out of 12 secondary schools. Pedestrian-related infrastructure changes began in 2018. As an extension of the BEATS Study, the BEATS Natural Experiment (BEATS-NE) (2019-2022) will examine the effects of BE changes on adolescents' active transport to school in Dunedin, New Zealand.

METHODS AND ANALYSIS

The BEATS-NE Study will employ contemporary ecological models for active transport that account for individual, social, environmental and policy factors. The published BEATS Study methodology (surveys, accelerometers, mapping, Geographic Information Science analysis and focus groups) and novel methods (environmental scan of school neighbourhoods and participatory mapping) will be used. A core component continues to be the community-based participatory approach with the sustained involvement of key stakeholders to generate locally relevant data, and facilitate knowledge translation into evidence-based policy and planning.

ETHICS AND DISSEMINATION

The BEATS-NE Study has been approved by the University of Otago Ethics Committee (reference: 17/188). The results will be disseminated through scientific publications and symposia, and reports and presentations to stakeholders.

TRIAL REGISTRATION NUMBER

ACTRN12619001335189.

Lifestyle factors and high-risk atherosclerosis: Pathways and mechanisms beyond traditional risk factors

Despite major efforts to reduce atherosclerotic cardiovascular disease (ASCVD) burden with conventional risk factor control, significant residual risk remains. Recent evidence on non-traditional determinants of cardiometabolic health has advanced our understanding of lifestyle-disease interactions. Chronic exposure to environmental stressors like poor diet quality, sedentarism, ambient air pollution and noise, sleep deprivation and psychosocial stress affect numerous traditional and non-traditional intermediary pathways related to ASCVD. These include body composition, cardiorespiratory fitness, muscle strength and functionality and the intestinal microbiome, which are increasingly recognized as major determinants of cardiovascular health. Evidence points to partially overlapping mechanisms, including effects on inflammatory and nutrient sensing pathways, endocrine signalling, autonomic function and autophagy. Of particular relevance is the potential of low-risk lifestyle factors to impact on plaque vulnerability through altered adipose tissue and skeletal muscle phenotype and secretome. Collectively, low-risk lifestyle factors cause a set of phenotypic adaptations shifting tissue cross-talk from a proinflammatory milieu conducive for high-risk atherosclerosis to an anti-atherogenic milieu. The ketone body ß-hydroxybutyrate, through inhibition of the NLRP-3 inflammasome, is likely to be an intermediary for many of these observed benefits. Adhering to low-risk lifestyle factors adds to the prognostic value of optimal risk factor management, and benefit occurs even when the impact on conventional risk markers is discouragingly minimal or not present. The aims of this review are (a) to discuss novel lifestyle risk factors and their underlying biochemical principles and (b) to provide new perspectives on potentially more feasible recommendations to improve long-term adherence to low-risk lifestyle factors.

The Social Context of Sedentary Behaviors and Their Relationships With Health in Later Life

This study examined sedentary behaviors among older adults and explored associations with social context and health measures using cross-sectional data from the National Health and Aging Trends Study (N = 1,687). Multivariate models were estimated to explore associations of time in six sedentary behaviors (i.e., television watching, sitting and talking, hobbies, computer use, driving, and resting) with sociodemographic characteristics and level of social engagement and with health status. Results indicated substantial variability in sedentary behaviors, with television watching being the most frequent and resting the least frequent activities. Sedentary behaviors varied by sociodemographic characteristics, including age, race/ethnicity, and education, as well as by level of social engagement. Television watching and resting, but not other behaviors, were associated with poorer health. These findings help to unpack the role of social context in sedentary behaviors and could inform public health interventions aimed at reducing time spent in behaviors that are adversely associated with health.

The associations between screen time-based sedentary behavior and depression: a systematic review and meta-analysis

Background

The use of computers/TV has become increasingly common worldwide after entering the twenty-first century and depression represents a growing public health burden. Understanding the association between screen time-based sedentary behavior (ST-SB) and the risk of depression is important to the development of prevention and intervention strategies.

Methods

We searched the electronic databases of Medline, Embase and the Cochrane Library. The odds ratio (OR) with corresponding 95% confidence intervals (CIs) was adopted as the pooled measurement. Subgroup analyses were investigated by stratified meta-analyses based on age, gender and reference group (reference category of screen time, e.g. 2 h/day, 4 h/day).

Results

There were 12 cross-sectional studies and 7 longitudinal studies met the inclusion criteria. Overall, the pooled OR was 1.28 with high heterogeneity (I² = 89%). Compared to those who reported less SB, persons reporting more SB had a significantly higher risk of depression. When the gender was stratified, the pooled OR was 1.18 in female groups while no significant association was observed in males. Among the 19 studies, 5 studies used a reference group with ST = 2 h/days (pooled OR = 1.46), 9 studies used ≥4 h as a reference group (pooled OR = 1.38), 2 studies used 1 h as a reference group (pooled OR = 1.07) and for the remaining 3 studies, hours of ST were calculated as a continuous variable (pooled OR = 1.04).

Conclusions

ST-SB is associated with depression risk and the effects vary in different populations. In addition, valid objective measures of SB should be developed in future studies.

Associations of sitting time with leisure-time physical inactivity, education, and body mass index change

We aimed to investigate the associations of long-term leisure-time physical inactivity, body mass index (BMI) change, and education with sitting time in a 35-year follow-up based on self-reports in surveys. Influences of working status in 2011 and familial confounding on the associations were tested. Data were based on the population-based Finnish Twin Cohort of 5232 twins (53-67-year-old, 41% men) with four surveys in 1975-2011. Statistical analyses were performed using linear regression with several covariates. The effect of familial confounding (genetics and shared environment) was analyzed using a co-twin control design which should be interpreted as if familial confounding plays a role, an association should be seen among all individuals but not in discordant twin pairs. Compared to those not at work, those at work had a longer total sitting time/d. For those at work, higher education was associated with more total sitting but with less non-work sitting. Long-term leisure-time physical inactivity was associated with more non-work sitting among those at work, whereas long-term weight gain with more total and non-work sitting regardless of working status. Familial confounding attenuated the associations, except for the association of increasing BMI with total and non-work sitting among women at work. To conclude, total sitting time was longer among those still at work, but it was also influenced by long-term leisure-time physical inactivity, higher education, and an increase of BMI over the years. Public health efforts should be targeted to reduce sedentary behavior by promoting life-long leisure-time physical activity and weight control.

Sitting time and associated factors among Portuguese older adults: results from Nutrition UP 65

Older adults are particularly susceptible to sedentary behaviours. Sitting time has been increasingly referred to as a potentially modifiable risk factor in the prevention of chronic diseases. Identifying factors associated with sitting time, particularly those that are modifiable, will allow for more effective public health strategies. This study aimed to describe sitting time among Portuguese older adults and to evaluate associated factors. A cross-sectional study including 1423 older adults ≥ 65 years old was conducted. Sitting time was assessed with the International Physical Activity Questionnaire. Socio-demographic, health, anthropometric and functional variables were collected. Bivariate and multivariate linear regression models were conducted to study the association between these variables and sitting time. The median of sitting time was 300 min/day (interquartile range = 240 min/day), which is equal to 5 h/day. The following factors were directly associated with longer sitting time: being male, age ≥ 80 years, living in Central or Southern Portugal, being retired from work, as well as presenting low physical activity, obesity or longer time to walk 4.6 metres. On the other hand, being married, having higher education and higher household income were inversely associated with longer sitting time. It can be concluded that Portuguese older adults spend a considerable amount of time sitting per day. Potentially modifiable risk factors associated with longer sitting time in this population were related to nutritional status and functional ability.

Effects of Full Body Exergaming in Virtual Reality on Cardiovascular and Muscular Parameters: Cross-Sectional Experiment

BACKGROUND

In recent years, many studies have associated sedentary behavior in front of screens with health problems in infants, children, and adolescents. Yet options for exergaming-playing video games that require rigorous physical exercise-seem to fall short of the physical activity levels recommended by the World Health Organization.

OBJECTIVE

The purpose of this study was to investigate the effect of a fully immersive virtual reality (VR)-based training system on cardiovascular and muscular parameters of young adults.

METHODS

A cross-sectional experiment design was used to analyze muscle activity (surface electromyography), heart rate, perceived exertion (RPE), cybersickness symptoms, perceived workload, and physical activity enjoyment (PACES) in 33 participants performing two 5-minute flights on a new training device.

RESULTS

Participants' performance of the planking position required to play the game resulted in moderate aerobic intensity (108 [SD 18.69] bpm). Due to the mainly isometric contraction of the dorsal muscle chain (with a mean activation between 20.6% [SD 10.57] and 26.7% [SD 17.39] maximum voluntary isometric contraction), participants described the exercise as a moderate to vigorous activity (RPE 14.6 [SD 1.82]). The majority reported that they enjoyed the exercise (PACES 3.74 [SD 0.16]). However, six participants had to drop out because of cybersickness symptoms and two because of muscle pain due to prior injuries.

CONCLUSIONS

Our findings suggest that fully immersive VR training systems can contribute to muscle-strengthening activities for healthy users. However, the dropout rate highlights the need for technological improvements in both software and hardware. In prevention and therapy, movement quality is a fundamental part of providing effective resistance training that benefits health. Exergaming on a regular basis has the potential to develop strong muscles and a healthy back. It is essential that future VR-based training systems take into account the recommendations of sport and exercise science.

Breaking barriers: using the behavior change wheel to develop a tailored intervention to overcome workplace inhibitors to breaking up sitting time

BACKGROUND

The workplace is a prominent domain for excessive sitting. The consequences of increased sitting time include adverse health outcomes such as cardiovascular disease and poor mental wellbeing. There is evidence that breaking up sitting could improve health, however, any such intervention in the workplace would need to be informed by a theoretical evidence-based framework. The aim of this study was to use the Behaviour Change Wheel (BCW) to develop a tailored intervention to break up and reduce workplace sitting in desk-based workers.

METHODS

The BCW guide was followed for this qualitative, pre-intervention development study. Semi-structured interviews were conducted with 25 office workers (26-59 years, mean age 40.9 [SD = 10.8] years; 68% female) who were purposively recruited from local council offices and a university in the East of England region. The interview questions were developed using the Theoretical Domains Framework (TDF). Transcripts were deductively analysed using the COM-B (Capability, Opportunity, Motivation - Behaviour) model of behaviour. The Behaviour Change Technique Taxonomy Version 1 (BCTv1) was thereafter used to identify possible strategies that could be used to facilitate change in sitting behaviour of office workers in a future intervention.

RESULTS

Qualitative analysis using COM-B identified that participants felt that they had the physical Capability to break up their sitting time, however, some lacked the psychological Capability in relation to the knowledge of both guidelines for sitting time and the consequences of excess sitting. Social and physical Opportunity was identified as important, such as a supportive organisational culture (social) and the need for environmental resources (physical). Motivation was highlighted as a core target for intervention, both reflective Motivation, such as beliefs about capability and intention and automatic in terms of overcoming habit through reinforcement. Seven intervention functions and three policy categories from the BCW were identified as relevant. Finally, 39 behaviour change techniques (BCTs) were identified as potential active components for an intervention to break up sitting time in the workplace.

CONCLUSIONS

The TDF, COM-B model and BCW can be successfully applied through a systematic process to understand the drivers of behaviour of office workers to develop a co-created intervention that can be used to break up and decrease sitting in the workplace. Intervention designers should consider the identified BCW factors and BCTs when developing interventions to reduce and break up workplace sitting.

Self-Concept and Physical Activity: Differences Between High School and University Students in Spain and Portugal

The period of adolescence stands out as a critical and decisive phase, first because it leaves its mark on personality development, which is affected by psychosocial factors, and second because the healthy lifestyle habits acquired during this stage form a foundation for adulthood. The objective of the present study was first to evaluate the levels of participation in physical activities (PA) and of self-concept in high school and university students, and second to find relationships between these psycho-physical variables. Four hundred and forty adolescents ranging in age from 16 to 20 years, from Spain and Portugal, participated in this study (cross-sectional design). The IPAQ and Self-Concept Form-5 questionnaires were used. The results demonstrated some differences; the Portuguese university students had lower scores in the academic, emotional and physical dimensions and vigorous PA but higher sitting time, walking and moderate PA compared to Portuguese high school students. In addition, Spanish university students had lower self-concept scores although higher practice of PA and lower sitting time than Spanish high school students (p < 0.05). On the other hand, a positive relationship was found between different dimensions of self-concept and levels of PA, while the relationship between these dimensions and the time the adolescent spent sitting was negative. In conclusion, the university students have lower scores of self-concept dimensions (in general), and the practice of PA is higher in Spanish university students, confirming the clear presence of differences between both educational stages. The relationship between the dimensions of self-concept in general and the level of PA was positive (following the contributions of Marsh).

An observational study of self-reported sedentary behaviour in people with chronic obstructive pulmonary disease and bronchiectasis

BACKGROUND

Few studies have examined sedentary behaviour in chronic respiratory disease. The limited evidence suggests that increased levels of sedentary behaviour are associated with increased mortality.

OBJECTIVES

This study aimed to compare the level of self-reported sedentary behaviour in people with chronic obstructive pulmonary disease (COPD) and bronchiectasis as well as to identify associations between sedentary time with functional performance measures and health-related quality of life in the chronic respiratory disease group.

METHODS

An observational study design was used. Participants completed the Sedentary Behaviour Questionnaire from which average sedentary time (hours/day) was determined. Functional performance was measured using the six-minute walk test, the four-metre gait speed test and the five sit-to-stand test. Health-related quality of life was measured using the St George's Respiratory Questionnaire. Sedentary time was compared between groups using an unpaired t-test. Univariate analysis explored relationships amongst variables.

RESULTS

The convenience sample consisted of 103 people with COPD [52% male; mean±SD age: 73±9 years, FEV₁% predicted: 56±23] and 33 people with bronchiectasis [52% male; 74±8 years, FEV₁% predicted: 69±25]. Average self-reported sedentary time in COPD was 7.6±2.7 hours/day and in bronchiectasis was 8.0±4.1 hours/day, with no between-group difference (-0.4, 95% CI -1.7, 0.8). No associations were found between sedentary time and any functional performance outcome or with health-related quality of life.

CONCLUSION

There was no difference in the high sedentary time between people with COPD and bronchiectasis. Sedentary behaviour was not associated with functional performance or disease-related health-related quality of life in people with chronic respiratory disease.

Using Oaxaca Decomposition to Study Socioeconomic Inequity of Physical Activity among Children Aged 10-12 Years: A Study in West of Iran

Background

Low physical activity (PA) is increasing public health problem. The present study aimed to determine socioeconomic inequality in PA among children aged 10-12 years old in Kurdistan, west of Iran in 2015.

Methods

The present cross-sectional study was conducted on 2506 children aged 10-12 in Sanandaj, Iran, in 2015. Data on the children's level of PA were collected using the Modifiable Activity Questionnaire. The concentration index was used to measure inequality and the Oaxaca decomposition to examine the different determinants of the inequality. The data were analyzed in Stata 13 and SPSS 20.

Results

Of the 2506 participants, 40.90% (38.97-42.82) had insufficient PA. Girls had a lower level of PA than boys (odds ratio [OR] = 0.34; 95% confidence intervals [CI]: 0.28-0.41) and it is directly related to maternal education (OR = 1.71; 95% CI: 1.18-2.47), the family's Socioeconomic status (SES) (OR = 2.18; 95% CI: 1.56-3.05), and the place of residence (OR = 1.68; 95% CI: 1.16-2.44). The concentration index for insufficient PA was -0.25 (95 CI: -0.30 to -0.21), revealing an insufficient PA in the group with a low SES. The prevalence of insufficient PA is 51.38% (95% CI: 48.45-54.31) in poor group and 28.40% (95% CI: 22.80-33.99) in the wealthier group. The Oaxaca decomposition showed maternal education and the place of residence was the most important determinants of inequality.

Conclusions

According to the findings, most of the children especially in the poor groups didn't have sufficient PA and socioeconomic factors could have the important role.

Validity and reliability of an instrument to measure factors associated with screen time in Brazilian students

This study analyzed the validity and reliability of an instrument with scales measuring factors associated with screen time in adolescents. Two cross-sectional studies included students for analyses of validity and internal consistency (n=1138, 51.5% boys) and test-retest reproducibility (n=194, 56.2% boys). Individual (attitude, self-efficacy and expectations), social (behaviors, rules, beliefs and family support and support of school members) and physical environmental (home and bedroom equipment) factors of screen time were evaluated. All the scales of the instrument met the statistical criteria of the validity of the exploratory factorial analysis (p<0.001). The exploratory factorial analysis indicated five one-dimensional and three two-factor scales (self-efficacy, expectations and familiar behavior), with factorial loads of 0.56 to 0.88. There were significant correlations between the scores of almost all the scales and the reported screen time (p<0.05). Eight of nine scales/subscales showed Cronbach's α value being higher than 0.70, and ICC ranged from 0.63 to 0.83. In conclusion, the instrument presented scales with acceptable validity and reliability and can be used to measure factors associated with screen time in Brazilian students.

A scoping review on the relations between urban form and health: a focus on Canadian quantitative evidence

INTRODUCTION

Despite the accumulating Canadian evidence regarding the relations between urban form and health behaviours, less is known about the associations between urban form and health conditions. Our study aim was to undertake a scoping review to synthesize evidence from quantitative studies that have investigated the relationship between built environment and chronic health conditions, self-reported health and quality of life, and injuries in the Canadian adult population.

METHODS

From January to March 2017, we searched 13 databases to identify peer-reviewed quantitative studies from all years that estimated associations between the objectively-measured built environment and health conditions in Canadian adults. Studies under-taken within urban settings only were included. Relevant studies were catalogued and synthesized in relation to their reported study and sample design, and health outcome and built environment features.

RESULTS

Fifty-five articles met the inclusion criteria, 52 of which were published after 2008. Most single province studies were undertaken in Ontario (n = 22), Quebec (n = 12), and Alberta (n = 7). Associations between the built environment features and 11 broad health outcomes emerged from the review, including injury (n = 19), weight status (n = 19), cardiovascular disease (n = 5), depression/anxiety (n = 5), diabetes (n = 5), mortality (n = 4), self-rated health (n = 2), chronic conditions (n = 2), metabolic condi-tions (n = 2), quality of life (n = 1), and cancer (n = 1). Consistent evidence for associations between aggregate built environment indicators (e.g., walkability) and diabetes and weight and between connectivity and route features (e.g., transportation route, trails, pathways, sidewalks, street pattern, intersections, route characteristics) and injury were found. Evidence for greenspace, parks and recreation features impacting multiple health outcomes was also found.

CONCLUSION

Within the Canadian context, the built environment is associated with a range of chronic health conditions and injury in adults, but the evidence to date has limitations. More research on the built environment and health incorporating rigorous study designs are needed to provide stronger causal evidence to inform policy and practice.

Motivational Counseling and Text Message Reminders: For Reduction of Daily Sitting Time and Promotion of Everyday Physical Activity in People with Rheumatoid Arthritis

Most patients with rheumatoid arthritis tend to be physically inactive and spend more time in sedentary behaviors compared with the general population. This inactive lifestyle can lead to serious health consequences, for example, increased risk of cardiovascular disease. For this reason, there is an interest in increasing participation in physical activity in patients with rheumatoid arthritis. The relatively new approach of reducing sedentary behavior and replacing it with light-intensity physical activity has been shown to be feasible and effective in promoting physical activity in patients with rheumatoid arthritis. However, methods to facilitate this behavior have not yet been fully explored.