Direct healthcare costs of sedentary behaviour in the UK

Sedentary lifestyle and physical inactivity: A mutual interplay with early and overt frailty

AIMS

In recent years medical science and research are increasingly directed towards a holistic approach that considers health as global well-being rather than solely as the absence of disease. In this framework, lifestyle interventions and, in particular, physical exercise, are of crucial importance in prevention and treatment. Therefore, the purpose of this study is to describe this mutual interplay between physical behaviours, sarcopenia, and frailty, as well as to illustrate the role of structured exercise training in aging and disease.

DATA SYNTHESIS

Physical activity and exercise training are determinants of lifelong global wellness and healthy aging. On the contrary, sedentary behaviour and physical inactivity are strictly linked to frailty and pre-frailty, both in adults and the elderly, with or without chronic diseases. On the other hand, the presence of pathological conditions is associated with a more inactive and sedentary behaviour. The co-presence of these factors is characterized by a mutual causal exchange in which they are imbricated in a continuous mechanistic interplay that involves inflammation, sarcopenia, osteopenia, functional impairment and many other pathophysiological aspects that rapidly can lead to a status of frailty.

CONCLUSION

A sedentary lifestyle and physical inactivity critically affect alterations in body composition and loss in functional capacity, typically linked to aging and accelerated by chronic diseases. However, physical activity and exercise can counteract the onset of pre-frailty and frailty by conferring beneficial effects on the individual's overall well-being.

Participation in a Nationwide Workplace Step Count Competition Is Associated With Improved Physical Fitness and Mental Well-Being: A Longitudinal, Repeated-Measures Analysis

BACKGROUND

The widely recognized health benefits of physical activity have led to the development of programs designed to increase activity levels within workplaces, where inactivity is often prevalent. We aimed to evaluate how participation in a Scotland-wide workplace walking program (Step Count Challenge [SCC]) influenced participants' physical fitness and mental well-being.

METHODS

A 3-part multistudy design was employed, each using the 2-minute step test and Short Warwick-Edinburgh Mental Well-Being Scale to measure physical fitness and mental well-being, respectively. Study 1 (Spring, 8 wk, N = 475) and study 2 (Autumn, 4 wk, N = 336) were repeated-measures online-based nationwide cohort studies in 2021, and study 3 (N = 38) was an in-person experimental design with a control group in 2023.

RESULTS

Studies 1 and 2 found significant improvement in physical fitness (Spring: P < .001, η2 = .19; Autumn: P = .014, η2 = .13) and mental well-being (Spring: P < .001, η2 = .13; Autumn: P = .007, η2 = .05). Study 3 found a significant group × time interaction for physical fitness (P = .018, η2 = .172) such that the SCC group significantly improved over time (P = .042, η2 = .131) and found no significant differences for mental well-being.

CONCLUSIONS

The findings of studies 1 and 2 demonstrate that participation in SCC is associated with a positive effect on physical fitness and mental well-being regardless of seasonal and duration differences. Study 3 also showed improvement in physical fitness, with a significantly greater increase for those who participated in SCC. This supports the promotion of future workplace walking programs.

Screen-based sedentary behavior, physical activity, and the risk of chronic spinal pain: a cross-sectional and cohort study

BACKGROUND

Sedentary behavior (SB) is associated with chronic musculoskeletal pain, but limited evidence exists about its impact on chronic spinal pain (CSP).

AIM

This study aims to explore the relationship between SB, physical activity, and the risk of CSP.

DESIGN

Cross-sectional and cohort study design.

SETTING

United Kingdom (UK).

POPULATION

We included 481872 data collected between 2006 and 2010 for cross-sectional analysis and 45,096 data with the longest follow-up up to 2019 for longitudinal analysis of data from the UK.

METHODS

Screen-based SB was defined as self-reported television (TV) viewing time, computer usage time, and total screen time. CSP was characterized as self-reported neck/shoulder or back pain for more than 3 months.

RESULTS

Cross-sectional analyses suggested that screen-based SB is associated with a high risk of chronic neck/shoulder (OR [95%CI]=1.43 [1.31 to 1.57]) and back pain (OR [95%CI]=1.39 [1.28 to 1.52]). The longitudinal analysis showed that an increase of 1 h in daily screen-based SB was correlated with chronic back pain risk (RR [95% CI]=1.05 [1.03 to 1.07]). Replacing an equivalent amount of TV viewing time with 1 h of walking per day exhibited a connection with a lower potential for chronic neck/shoulder pain (4.82% reduction) and chronic back pain (5.26% reduction). Even replacing 10 min of TV viewing time with 10 min of physical activity demonstrated a similar trend.

CONCLUSIONS

Daily screen-based SB is associated with CSP, but a causal relationship cannot be established. Replacing sedentary TV time with 10 minutes of physical activity per day shows potential benefits for CSP.

CLINICAL REHABILITATION IMPACT

The public should be encouraged to reduce screen-based sedentary behavior and increase physical activity to mitigate the risk of chronic spinal pain.

Economic cost of not meeting the 24-h movement guidelines in china: Research gaps and recommendations

It is well-known that not meeting the 24-hours (h) movement guidelines, including insufficient physical activity (PA), excessive sedentary behavior (SB), inadequate sleep duration, and their combinations, are independent risk factors for noncommunicable diseases (NCDs). The prevalence of not meeting the guidelines is high across the world, especially in China where has one of the largest population. Some studies have estimated the economic cost of insufficient PA in China, which is useful to guide policymakers to develop and implement effective health actions. However, several research gaps should be discussed and addressed for better evidence base and decision making. This commentary aims to provide a research insight into gaps and recommendations related to the analysis of economic cost of not meeting the 24-h movement guidelines. Some major research gaps can be indicated, including less research attention on excessive SB and inadequate sleep, limited evidence regarding NCDs associated with not meeting all 24-h movement guidelines considered in economic cost analysis, absence of evidence on estimated cost of not meeting the guidelines, and the adherence to methodological guide. Future research is required to address the gaps to guide effective health policy development in China. We hope that this commentary can play an important role in updating research evidence and advancing policy practice.

Comparative risk assessment modeling of cardiovascular and all-cause burden attributable to sitting time and physical inactivity: evidence from Argentina

BACKGROUND

Although there is evidence that sitting time (ST) and insufficient physical activity (PA) are associated with premature mortality, the burden of cardiovascular disease (CVD) and all-cause mortality (ACM) attributable to the combined effects of ST and PA in counterfactual scenarios is limited.

METHODS

Potential impact fractions (PIFs) were used to calculate premature deaths (PDs) and disability-adjusted life years (DALYs). Cause-eliminated life tables were utilized to estimate health-adjusted life expectancy (HALE) gains. Monte Carlo simulations were performed for uncertainty analysis.

RESULTS

The theoretical minimum risk exposure level (ST < 4 $\mathrm{h} \cdot{\mathrm{d}}^{-1}$, PA > 65 $\mathrm{min} \cdot{\mathrm{d}}^{-1}$) could prevent 16.7% of CVD deaths and 12.3% of all-cause deaths annually. This would save 669 to 2,630 DALYs per 100,000 and increase healthy life years by 0.57 to 2.94. Increasing PA to > 65 $\mathrm{min} \cdot{\mathrm{d}}^{-1}$ while maintaining ST could yield gains in HALE from 0.49 (CVD) to 2.60 (ACM) years. Reducing ST to < 4 $\mathrm{h}\cdot{\mathrm{d}}^{-1}$ while keeping PA constant could lead to gains in HALE from 0.07 (CVD) to 0.34 (ACM) years. A 50% reduction in suboptimal ST (≥ 4 $\mathrm{h}\cdot{\mathrm{d}}^{-1}$) doubled HALE gains, ranging from 0.11 to 0.63 years.

CONCLUSIONS

Public health decision-makers should prioritize vulnerable populations, including older adults and individuals with inadequate PA levels.

Burden of NASH related liver cancer from 1990 to 2021 at the global, regional, and national levels

Background

The global burden of non-alcoholic steatohepatitis (NASH)-related liver cancer (NRLC) is increasing, making NASH the fastest-growing cause of liver cancer worldwide. This study presents a comprehensive analysis of NRLC burden at the global, regional, and national levels, further categorized by age, sex, and sociodemographic index (SDI).

Method

Data on NRLC from the Global Burden of Disease, Injuries, and Risk Factors (GBD) study 2021 were downloaded at global, regional, and national levels. The numbers and age-standardized rates (ASRs) of incidence, mortality, and disability-adjusted life years (DALYs) were analyzed to quantify the global burden of NRLC. Additionally, percentage changes in ASRs were used to identify trends in NRLC from 1990 to 2021.

Results

Globally, both the number of cases and ASRs for NRLC increased between 1990 and 2021. In 2021, there were 42,291 new cases, 40,925 deaths, and 995,475 DALYs attributed to NRLC. East Asia, South Asia, and Southeast Asia reported the highest absolute case numbers, while Western, Southern, and Eastern Sub-Saharan Africa exhibited the highest ASRs. From 1990 to 2021, Australasia, Southern Latin America, and High-income North America showed the most significant increases in NRLC incidence. Nationally, Mongolia, Gambia, and Mozambique exhibited the highest ASR in 2021.The greatest percentage increases in ASIR occurred in Australia, the United Kingdom, and New Zealand between 1990 and 2021. NRLC incidence rates were higher in men and increased with age, peaking at 80-89 years. Similar patterns were observed for NRLC-related deaths and DALYs. Regionally, ASRs initially declined but then increased as SDI rose. At the national level, ASRs consistently decreased with higher SDI.

Conclusion

This study highlights the substantial burden of NRLC at global, regional, and national levels. Males and older individuals bear a higher disease burden, and considerable variation exists across different regions and countries. These findings provide critical insights for formulating effective strategies to prevent and manage NRLC.

Burden of cancer attributable to sedentary behaviour in Germany: an epidemiological analysis of survey data

OBJECTIVES

Sedentary behaviour (SB) is associated with increased risks of breast, colorectal, endometrial, ovarian and rectal cancers. However, the number of cancer cases attributable to SB in Germany and the associated costs are unknown.

SETTING

Numbers and proportions (population-attributable fractions, PAF) of new cancer cases attributable to SB with published risk estimates for Germany for the years 2024, 2030 and 2040.

PARTICIPANTS

Sex-specific and age-specific population projections, national cancer incidence and exposure data.

PRIMARY AND SECONDARY OUTCOME MEASURES

new cancer cases attributable to SB and healthcare costs associated with cancer cases attributable to SB in Germany for the year 2024.

RESULTS

Estimated numbers of cancers attributable to SB are projected to be up to 7612 cases (6% of total cancer cases) in 2024, up to 7899 cases (6%) in 2030 and up to 8245 cases (6%) in 2040. The PAF attributable to SB in women is 3% for breast cancer, 8% for colon cancer, 9% for both endometrial and ovarian cancers and 2% for rectal cancer. In men, the PAF is 9% for colon cancer and 3% for rectal cancer. In 2024, the estimated costs of SB-attributable cancers are €270 million for colon cancer, €51 million for rectal cancer, €234 million for breast cancer and €242 million for female genital cancers.

CONCLUSIONS

A considerable number of cancer cases can be attributed to SB, which also imposes a large health economic burden. Implementing effective prevention measures, such as workplace, school or commuting interventions, is needed to reduce the incidence of cancer attributable to this modifiable risk factor.

Association between daily sitting time and sarcopenia in the US population: a cross-sectional study

BACKGROUND

Sarcopenia is an age-related syndrome marked by a gradual decline in skeletal muscle mass and function. While various factors influencing sarcopenia have been studied, the link between daily sedentary time and sarcopenia remains underexplored.

METHOD

This study analyzed the association between daily sitting time and sarcopenia using data from the National Health and Nutrition Examination Survey (NHANES 2011-2018). Daily sitting time was assessed through questionnaires, while sarcopenia was measured using body mass index (BMI) adjusted appendicular skeletal muscle mass (ASM). The relationship was analyzed using weighted logistic regression models and smoothing curves. Stratified analyses and interaction testing were employed to investigate population-specific characteristics of this association. Furthermore, chi-square test and grouped logistic regression were used to further analyze the impact of vigorous activity on the relationship between the two variables.

RESULT

This study included 9998 participants with complete information. The fully adjusted model showed a significant positive correlation between daily sitting time and the prevalence of sarcopenia (OR = 1.07, 95% CI: 1.03-1.10, P = 0.0026). The group with daily sitting time ≥ 9 h had a 90% higher risk of sarcopenia compared to the < 4 h group (OR = 1.90, 95% CI: 1.22-2.84, P = 0.0040). Smooth curve fitting analysis showed a linear correlation between this relationship. Stratified analysis shows that non-Hispanic white men with a lower BMI (BMI < 25) have a higher risk of sarcopenia. Compared to those who actively participate in vigorous activities, individuals who lack recreational activities have a higher prevalence and risk of sarcopenia.

CONCLUSION

Our research has found that increased sedentary time significantly increases the risk of sarcopenia, especially among non-Hispanic white men with lower BMI. Additionally, individuals who lack vigorous physical activity also have a higher prevalence and risk of sarcopenia. Therefore, reducing sedentary behavior and increasing moderate exercise may be effective prevention strategies.

Optimising an immersive virtual reality behaviour change intervention to support retired and non-working adults to reduce their sedentary behaviour: a mini-focus group interview study

OBJECTIVE

Prolonged sedentary behaviour is associated with numerous negative health outcomes. Immersive virtual reality (IVR) offers opportunities for retired and non-working adults to take part in meaningful non-sedentary activities that may not be available to them in their natural environment. Using the behaviour change wheel and theoretical domains framework, an IVR intervention prototype was developed. This study aimed to explore and optimise the prototype with retired and non-working adults. A secondary aim was to explore participants' perceptions of IVR more generally.

METHODS AND MEASURES

Five semi-structured mini-focus group interviews were conducted with 12 retired and non-working adults. Each group explored the intervention prototype together and discussed their experiences afterwards. A rapid analysis and reflexive thematic analysis (TA) were conducted on the data.

RESULTS

Several feasible intervention design changes were generated through the rapid analysis. The reflexive TA generated three themes relating to participants' past experiences reducing their time spent sedentary, how they experienced the intervention prototype as a means to reduce their time spent sedentary, and their perspectives on using such an intervention in the future.

CONCLUSION

The results indicate that retired and non-working adults may enjoy using IVR to reduce sedentary time but generally favour natural experiences when possible.

Characterising the activity, lifestyle behaviours and health outcomes of UK university students: an observational cohort study with a focus on gender and ethnicity

BACKGROUND

Health-related outcomes and behaviours in university students are known to be poor relative to the general population. The substantial contextual shifts related to the COVID-19 pandemic, combined with increased numbers of students from minoritised ethnicity backgrounds and presenting as trans and gender diverse (TGD), means that up-to-date information is unavailable. The primary aim of this study was therefore to characterise the current movement, dietary and lifestyle behaviours, mental health, and Body Mass Index (BMI) of UK university students and assess differences between genders and ethnic groups.

METHODS

An online, self-report survey was administered across three years (2021-2023). Three independent cohorts of university students' (n = 6,327) completed the survey on four key topic areas. One-way ANOVAs were used to assess differences between genders (men, women, TGD), and independent samples t-tests were used to assess differences between ethnic groups (White, Minoritised Ethnicity).

RESULTS

30% of students were not meeting physical activity guidelines, 54% were sedentary for ≥ 6 h·d- 1, 83% had poor diet quality, 51% were in high or increased risk groups for alcohol consumption, 18% experienced terrible or poor sleep quality, and 32% were overweight or obese. Gender differences were present for all variables other than walking physical activity (WPA) (P < 0.05), with men having better mental health and engaging in healthier movement and sleeping behaviours, whereas women had more healthful dietary and drinking behaviours, and TGD students had poorer outcomes compared to cis-gender students in most domains. Differences between White and minoritised ethnicity students were present for all variables other than sedentary behaviour, diet quality, WPA and BMI (P < 0.05); students of minoritised ethnicity engaged in better movement, drinking and sleep behaviours in addition to having more positive mental health than White students.

CONCLUSION

The findings of the current study provide an update on the landscape of UK university students' health and health-related behaviours. Overall, health-related outcomes and behaviours are poor in this population and these data suggest that gender and ethnicity play a role in determining students' health and health-related behaviours. Therefore, these factors should be considered when developing strategies to promote healthy living in the context of higher education.

Park proximity and all-day and time-specific physical activity and sedentary behaviour in older adults

BACKGROUND

Proximity to parks has been suggested as a factor influencing physical activity in older adults. However, it remains unclear the optimal distance between residences and parks for promoting physical activity and reducing sedentary time and whether these associations vary by the time of day. We examined whether the proximity to neighbourhood parks at varying distances is associated with all-day and time-specific physical activity and sedentary behaviour in older adults.

METHODS

Data were collected from 214 older adults receiving hospital services in Taipei, Taiwan. The number of parks within 400m, 800m, and 1,600m of participants' residences. Physical activity and sedentary behaviour, stratified by time of day (morning, afternoon, and evening), were measured using accelerometers. Adjusted linear regression models were used to estimate associations of park proximity with activity and sedentary outcomes.

RESULTS

Parks located within 400m and 800m of participants' residences were more markedly associated with longer time in physical activity and less sedentary time compared to parks located 1,600m away. A greater number of parks within 400m and 800m was positively associated with walking steps and light-intensity physical activity while both distances were negatively associated with sedentary time. The associations between park proximity and behavioural outcomes were mainly attributable to that during the afternoon and evening.

CONCLUSIONS

Our findings suggest that favourable access to parks within 800m of older adults' residences is associated with more physical activity and less sedentary time, particularly during the afternoon and evening. Future longitudinal studies are required to corroborate these associations.

A multi-method feasibility trial of a multi-component behaviour change intervention to reduce sedentary behaviour and increase physical activity among ethnically diverse older adults

INTRODUCTION

Evidence suggests that sedentary behaviour (SB) and physical activity (PA) are important indicators of well-being and quality of life in older adults (OAs). However, OAs are the least active and highly sedentary of all the age groups. The present study intends to examine the feasibility of a wearable gadget to remind users to break sitting time (by standing up and moving more), coupled with a brief health coaching session, pamphlet and reminder messages to decrease SB and improve PA.

METHODS AND ANALYSIS

This study will employ a multi-methods approach that generates quantitative data from questionnaires and qualitative data from semi-structured interviews following OAs' involvement in the study. This intervention will be informed by the socio-ecological model (SEM) and the habit formation model. The quantitative and qualitative data will be analysed separately and then integrated for interpretation and reporting, which will assist our knowledge of the feasibility of the programme.

ETHICS AND DISSEMINATION

Ethical approval for this study has been obtained from Swansea University (NM_ 2023 6667 6123). Informed consent will be obtained from participants. The findings of the study will be disseminated to the scientific community through conference presentations and scientific publications. The findings of the current study will determine the suitability of a future effectiveness trial.

TRIAL REGISTRATION NUMBER

NCT06407557.

Does sedentary time and physical activity predict chronic back pain and morphological brain changes? A UK biobank cohort study in 33,402 participants

BACKGROUND

The relationship between sedentary time, physical activity, and chronic back pain remains unclear. The study aims to investigate whether sedentary time and physical activity predict chronic back pain and morphological brain changes.

METHODS

This cohort study recruited adults aged 37-73 years enrolled between 2006 and 2010, with follow-up until 2014. The total cohort comprised 33,402 participants (mean age: 54.53). Data were collected on daily sedentary time, physical activity, lifestyle factors, and health outcomes.

RESULTS

After nearly 8-year follow-up, 3,006 individuals (9.00%) reported chronic back pain in total. Individuals with daily sedentary time exceeding 6 h had a 33% higher risk of chronic back pain compared to those with sedentary time of 2 h or less (RR, 1.33, 95%CI, 1.17-1.52). Sedentary time was also associated with decreased grey matter volume in several brain regions, including bilateral primary somatosensory cortex (S1), secondary somatosensory cortex, putamen, primary motor cortex (M1), insula, hippocampus, amygdala, as well as right supplementary motor area, left medial frontal cortex, and right anterior cingulate cortex (FDR-corrected p-value < 0.05). Compared to individuals who sat for more than 6 h with light physical activity, those engaging in moderate physical activity with sedentary time of 2 h or less (RR, 0.71, 95%CI, 0.52-0.99) exhibited a significant decrease in chronic back pain risk. In addition, replacing sedentary time with equivalent amount of physical activity also demonstrated a reduction in the risk of chronic back pain (RR, 0.87, 95%CI, 0.77-0.99) and increased the reginal grey matter volumes including the amygdala, insula, M1, putamen and S1.

CONCLUSIONS

Prolonged sedentary time is associated with heightened risks of chronic back pain and deterioration in brain health.

Large-scale greenway exposure reduces sedentary behavior: A natural experiment in China

As a global public health problem, sedentary behavior has attracted more and more attention. Although numerous studies have demonstrated many benefits of green spaces to health, causal evidence on how green spaces affect people's sedentary behavior is scarce. This study used a natural experiment to evaluate the impact of greenway intervention on sedentary behavior. Two waves of data were collected in 2016 and 2019 (before and after the intervention) at East Lake Greenway (102-km-long) in Wuhan, China, with 1020 participants in 52 neighborhoods. We adopted three major methods to evaluate the impact of greenway intervention on sedentary behavior, including Propensity Score Matching and difference-in-difference (PSM-DID) method (with both individual and neighborhood variables to match samples), continuous treatment DID method (with distance to the greenway as the continuous treatment), and mediation analysis (with moderate to vigorous physical activity or MVPA, and walking time as the mediator). The results revealed that the greenway intervention significantly reduced participants' sedentary time and the intervention has a distance decay effect. The closer to the greenway, the greater decrease in sedentary time after the greenway opening. Furthermore, we found that MVPA and walking time mediate the impact of the greenway intervention on the change in sedentary behavior. The effect of greenway intervention was more beneficial for those under the age of 60, those who were employed, or those who were married. Our findings provided robust evidence that exposure to urban greenways affects sedentary behavior and such green infrastructures help protect public health in high-density urban areas.

The effects of prolonged sitting behavior on resting-state brain functional connectivity in college students post-COVID-19 rehabilitation: A study based on fNIRS technology

Functional near-infrared spectroscopy (fNIRS) was used to explore the effects of sedentary behavior on the brain functional connectivity characteristics of college students in the resting state after recovering from Corona Virus Disease 2019 (COVID-19). Twenty-two college students with sedentary behavior and 22 college students with sedentary behavior and maintenance of exercise habits were included in the analysis; moreover, 8 ​min fNIRS resting-state data were collected. Based on the concentrations of oxyhemoglobin (HbO2) and deoxyhemoglobin (HbR) in the time series, the resting-state functional connection strength of the two groups of subjects, including the prefrontal cortex (PFC) and the lower limb supplementary motor area (LS), as well as the functional activity and functional connections of the primary motor cortex (M1) were calculated. The following findings were demonstrated. (1) Functional connection analysis based on HbO2 demonstrated that in the comparison of the mean functional connection strength of homologous regions of interest (ROIs) between the sedentary group and the exercise group, there was no significant difference in the mean functional strength of the ROIs between the two groups ( p > 0.05 ). In the comparison of the mean functional connection strengths of the two groups of heterologous ROIs, the functional connection strengths of the right PFC and the right LS ( p = 0.009 7 ), the left LS ( p = 0.012 7 ), and the right M1 ( p = 0.030 5 ) in the sedentary group were significantly greater. The functional connection strength between the left PFC and the right LS ( p = 0.031 2 ) and the left LS ( p = 0.037 0 ) was significantly greater. Additionally, the functional connection strength between the right LS and the right M1 ( p = 0.037 0 ) and the left LS ( p = 0.043 8 ) was significantly greater. (2) Functional connection analysis based on HbR demonstrated that there was no significant difference in functional connection strength between the sedentary group and the exercise group ( p > 0.05 ) or between the sedentary group and the exercise group ( p > 0.05 ). Similarly, there was no significant difference in the mean functional connection strength of the homologous and heterologous ROIs of the two groups. Additionally, there was no significant difference in the mean ROIs functional strength between the two groups ( p > 0.05 ). Experimental results and graphical analysis based on functional connectivity indicate that in this experiment, college student participants who exhibited sedentary behaviors showed an increase in fNIRS signals. Increase in fNIRS signals among college students exhibiting sedentary behaviors may be linked to their status post-SARS-CoV-2 infection and the sedentary context, potentially contributing to the strengthened functional connectivity in the resting-state cortical brain network. Conversely, the fNIRS signals decreased for the participants with exercise behaviors, who maintained reasonable exercise routines under the same conditions as their sedentary counterparts. The results may suggest that exercise behaviors have the potential to mitigate and reduce the impacts of sedentary behavior on the resting-state cortical brain network.

Determining factors of physical activity and sedentary behaviour in university students during the COVID-19 pandemic: A longitudinal study

INTRODUCTION

Historically, university students demonstrate poor movement behaviours that could negatively impact current and future health. Recent literature has focused on identifying determinants of physical activity (PA) and sedentary behaviour (SB) in this population to inform the development of intervention strategies. However, the COVID-19 pandemic substantially restricted movement behaviours in this population, meaning findings of previous research may no longer be applicable within the current societal context. The present study explored the longitudinal relationships between pre-pandemic psychological, behavioural and anthropometric factors, and the movement behaviours of UK university students nine months following the outbreak of COVID-19.

METHODS

Mental wellbeing (MWB), perceived stress (PS), body mass index (BMI), SB, and PA were assessed using an online self-report survey in 255 students prior to (October 2019) and nine months following (October 2020) the first confirmed case of COVID-19 in the UK. Path analysis was utilised to test relationships between pre-COVID mental wellbeing, perceived stress and BMI, and movement behaviours during the pandemic.

RESULTS

The fit of the path analysis model was good (χ2 = 0.01; CMIN = 0.10, CFI = 1.00, RMSEA = 0.00). Pre-covid MWB and PS positively influenced PA (β = 0.29; β = 0.24; P < 0.01) but not SB (β = -0.10; β = 0.00; P = 0.79) during the pandemic. Additionally, pre-pandemic SB and PA positively influenced SB and PA during the pandemic respectively (SB: β = 0.26; P < 0.01) (PA: β = 0.55; P < 0.01). Pre-pandemic BMI did not influence any measured variable during the pandemic (PA: β = 0.03 and P = 0.29; SB: β = 0.06 and P = 0.56), and there was no mediating effect of PA on SB during the pandemic (β = -0.26; P = 0.14).

CONCLUSION

These findings indicate that pre-covid mental health and movement behaviours had a direct positive influence on PA during the pandemic, but not SB. This longitudinal study demonstrates the influence that prior psychological and behavioural factors have in determining university students' response to periods of elevated stress and uncertainty, furthering our understanding of determinants of health-related behaviours in students.

Association of Sedentary Lifestyle with All-Cause and Cause-Specific Mortality in Adults with Reduced Kidney Function

Key Points

Nearly half of individuals with reduced kidney function had sedentary lifestyle, defined as more than 6 hours of sitting a day. Non-Hispanic White individuals and individuals with younger age, obesity, and with diabetes were more likely to have sedentary lifestyles. Spending more than 6 hours a day sedentary increases the future risk of death from all causes and cardiovascular diseases in individuals with reduced kidney function.

Background

Individuals with CKD tend to have sedentary behavior and decreased physical activity; both are independent predictors of mortality in general population. While physical inactivity correlates to adverse health outcomes in patients with reduced kidney function, it is unclear whether this relationship remains significant for sedentary behavior. Our study purpose was to evaluate the association of sedentary lifestyle with mortality risk in individuals with renal insufficiency.

Methods

The study population were adult participants of 2007–2016 National Health and Nutrition Examination Survey with eGFR <60 ml/min per 1.73 m2 or self-reporting receiving dialysis (N =1419). Sedentary lifestyle was defined as sedentary time >6 hours per day. Outcome of interest was all-cause and cardiovascular disease (CVD)–related or cancer-related mortality.

Results

We observed that non-Hispanic White individuals and individuals with younger age and higher educational level were more likely to have sedentary lifestyle. During a median follow-up of 99 (interquartile range, 70–128) months, a total of 458 participants died (3.98 deaths per 1000 person-months); 120 died from CVD and 92 from cancer, respectively. The crude analysis showed that individuals with sedentary lifestyle have higher risk of all-cause and CVD-related but not cancer-related mortality compared with the nonsedentary population. After adjusting for potential confounders, we showed that all-cause mortality and CVD-related mortality were 1.64-fold (95% confidence interval, 1.26 to 2.12) and 1.66-fold (95% confidence interval, 1.03 to 2.67) higher, respectively, in the sedentary population compared with the nonsedentary population. Similar results were observed in the sensitive analyses, in which we excluded individuals with dialysis, eGFR <15 ml/min per 1.73 m2, or mobility disability.

Conclusions

Our findings suggest that sedentary lifestyle correlated to greater risk of all-cause and CVD-related mortality among individuals with reduced kidney function. Interventions targeting the individuals with risky behaviors may have practical importance for public health.

Factors influencing the likelihood of dental service checkup: results from a survey in Saudi Arabia

Background

The funding and delivery of healthcare including dental care in the Kingdom of Saudi Arabia (KSA, or Saudi Arabia) is undergoing a process of reform. To inform this process, it is important that policymakers are aware of the relationships between service use, specific types of use, and the factors that influence this. Currently, there is a paucity of research in this area in KSA that examines dental service use for checkups at a national level and none that examines differences in this use across regions or that examines explicitly the role of income.

Aims

This study uses the most recent version of the Saudi Health Interview Survey (SHIS) to examine the relationships between the use of dental services for a checkup and socio-demographic characteristics of respondents. Particular focus is given to the differences between regions in service use and the role of socio-demographics within regions.

Methods

Data were taken from SHIS 2013. Descriptive statistics (means and standard errors) were used to characterize the sample. Logistic regression analyses were used to examine the relationship between checkups in the past 12 months and a range of covariates including income and region. The analysis was repeated for sub-samples based on specific regions. No attempt was made to impute missing values.

Results

A sample of 7603 respondents provided complete data for analysis. Fifty-one per cent of the respondents were male, 29% were educated at least to degree level, 25% reported that they floss at least once per day, 69% reported that they brushed their teeth at least once per day, and 11% reported that they had visited the dentist for a checkup in the preceding 12 months. Logistic regression analyses revealed income, region, and oral hygiene habits to be among the significant determinants of the likelihood of dental checkup in the preceding 12 months. In logistic regression analyses at the regional level, different relationships were evident between checkups and socio-demographic characteristics across regions.

Conclusion

Region and income are significant determinants of dental service use for checkups. Differences exist between regions in the relationship between socio-demographic characteristics and the likelihood of getting checkups. Policy changes should reflect the potential differences they might have across regions for which the role of socio-demographic characteristics varies.

Sedentary behavior, abdominal obesity and healthcare costs in Brazilian adults with cardiovascular diseases: a cross-sectional study

BACKGROUND

Research on the economic burden of sedentary behavior and abdominal obesity on health expenses associated with cardiovascular diseases is scarce.

OBJECTIVE

The objective of this study was to verify whether sedentary behavior, isolated and combined with abdominal obesity, influences the medication expenditure among adults with cardiovascular diseases.

DESIGN AND SETTING

This cross-sectional study was conducted in the city of President Prudente, State of São Paulo, Brazil in 2018.

METHODS

The study included adults with cardiovascular diseases, aged 30-65 years, who were treated by the Brazilian National Health Services. Sedentary behavior was assessed using a questionnaire. Abdominal obesity was defined by waist circumference. Medication expenditures were verified using the medical records of each patient.

RESULTS

The study included a total of 307 adults. Individuals classified in the group with risk factor obesity combined (median [IQ] USD$ 29.39 [45.77]) or isolated (median [IQ] USD$ 27.17 [59.76]) to sedentary behavior had higher medication expenditures than those belonging to the non-obese with low sedentary behavior group (median [IQ] USD$ 13.51 [31.42]) (P = 0.01). The group with combined obesity and sedentary behavior was 2.4 (95%CI = 1.00; 5.79) times more likely to be hypertensive.

CONCLUSION

Abdominal obesity was a determining factor for medication expenses, regardless of sedentary behavior, among adults with cardiovascular diseases.

The key values and factors identified by older adults to promote physical activity and reduce sedentary behaviour using co-production approaches: a scoping review

BACKGROUND

Inactivity and sedentary behaviour in older adults adversely impacts physical function, reduces social networks, and could contribute to population healthcare costs. To encourage and support the planning and uptake of physical activity by older adults, it is important to understand what physical activity means to older adults. Therefore, the aim of this scoping review was to collate what older adults have self-identified as the key factors for sustaining and increasing their physical activities.

METHODS

Arksey and O'Malley's Scoping Review framework was used to guide the review process. SCOPUS, ASSIA, PsychINFO and MEDLINE databases were searched. Studies were eligible for inclusion if they were peer-reviewed, the target population were older adults (aged 55 and above), co-production related research approaches were explicitly stated in the methods and there was a focus on design of physical activity interventions or products to support or enhance physical activity. Assets and values important for physical activity were first extracted from included studies and were subsequently thematically analysed. Themes are presented to provide an overview of the literature synthesis.

RESULTS

Sixteen papers were included in the analysis. Data from these papers were gathered via designing interventions or services (n = 8), products (n = 2), 'exergames' (n = 2) or mobile applications (n = 4). Outcomes were varied but common themes emerged across papers. Overarching themes identified by older adults were associated with a desire to increase activity when it was accessible, motivational, and safe. In addition, older adults want to enjoy their activities, want independence and representation, want to stay connected with families and friends, be outdoors, familiarity, activities to be tailored and resulting in measurable/observed progress.

CONCLUSIONS

Population demographics, personal attributes, and life experiences all affect preferences for physical activity. However, the key factors identified by older adults for increasing physical activity were common-even in separate co-production contexts. To promote physical activities in older adults, activities must fundamentally feel safe, provide a sense of social connectedness, be enjoyable and be accessible in terms of cost and ability.

Inpatient care utilisation and expenditure associated with objective physical activity: econometric analysis of the UK Biobank

BACKGROUND

Physical inactivity increases the risk of chronic disease and mortality. The high prevalence of physical inactivity in the UK is likely to increase financial pressure on the National Health Service. The UK Biobank Study offered an opportunity to assess the impact of physical inactivity on healthcare use and spending using individual-level data and objective measures of physical activity. The objective of this study was to assess the associations between objectively measured physical activity levels and future inpatient days and costs in adults in the UK Biobank study.

METHODS

We conducted an econometric analysis of the UK Biobank study, a large prospective cohort study. The participants (n = 86,066) were UK adults aged 43-79 who had provided sufficient valid accelerometer data. Hospital inpatient days and costs were discounted and standardised to mean monthly values per person to adjust for the variation in follow-up times. Econometric models adjusted for BMI, long-standing illness, and other sociodemographic factors.

RESULTS

Mean follow-up time for the sample was 28.11 (SD 7.65) months. Adults in the most active group experienced 0.037 fewer days per month (0.059-0.016) and 14.1% lower inpatient costs ( - £3.81 [ - £6.71 to  - £0.91] monthly inpatient costs) compared to adults in the least active group. The relationship between physical activity and inpatient costs was stronger in women compared to men and amongst those in the lowest income group compared to others. The findings remained significant across various sensitivity analyses.

CONCLUSIONS

Increasing physical activity levels in the UK may reduce inpatient hospitalisations and costs, especially in women and lower-income groups.

Economic burden of excessive sedentary behaviour in Canada

OBJECTIVE

To estimate health care and health-related productivity costs associated with excessive sedentary behaviour (> 8 h/day and > 9 h/day) in Canadian adults.

METHODS

Three pieces of information were used to estimate costs: (1) the pooled relative risk estimates of adverse health outcomes consistently shown to be associated with excessive sedentary behaviour, gathered from meta-analyses of prospective cohort studies; (2) the prevalence of excessive sedentary behaviour in Canadian men and women, obtained using waist-worn accelerometry in a nationally representative sample of adults (Canadian Health Measures Survey 2018-2019); and (3) the direct (health care) and indirect (lost productivity due to premature mortality) costs of the adverse health outcomes, selected using the Economic Burden of Illness in Canada 2010 data. The 2010 costs were then adjusted to 2021 costs to account for inflation, population growth, and higher average earnings. A Monte Carlo simulation was conducted to account for uncertainty in the model.

RESULTS

The total costs of excessive sedentary behaviour in Canada were $2.2 billion (8 h/day cut-point) and $1.8 billion (9 h/day cut-point) in 2021, representing 1.6% and 1.3% of the overall burden of illness costs, respectively. The two most expensive chronic diseases attributable to excessive sedentary behaviour were cardiovascular disease and type 2 diabetes. A 10% decrease in excessive sedentary behaviour (from 87.7% to 77.7%) would save an estimated $219 million per year in costs.

CONCLUSION

Excessive sedentary behaviour significantly contributes to the economic burden of illness in Canada. There is a need for evidence-based and cost-effective strategies that reduce excessive sedentary behaviour in the population.

Causal association of leisure sedentary behavior with arthritis: A Mendelian randomization analysis

OBJECTIVES

This study aimed at exploring the potential causal effects of leisure sedentary behavior (LSB) on common types of arthritis.

METHOD

Two-sample Mendelian randomization (MR), including both univariable MR (UVMR) and multivariable MR (MVMR) analysis, was performed to explore the effects of LSB on the risk of several common types of arthritis, including osteoarthritis, rheumatoid arthritis (RA), and psoriatic arthritis (PsA). Genetic variants from genome-wide association studies (GWAS) of LSBs for time spent on television watching, computer use, and driving were obtained from the UK Biobank. Summarized GWAS data of OA [overall, OA of the hip (HOA), and OA of the knee (KOA)], RA [overall, seronegative RA (nRA) and seropositive RA], and PsA was also acquired from the FinnGen Biobank Analysis. Causal Analysis Using Summary Effect Estimates (CAUSE) were further applied to verify the causality.

RESULTS

UVMR results provided evidence for the causal relationship of time spent on watching TV with overall OA [odds ratio (OR) = 1.80, 95% confidence interval (CI) = 1.45-2.23], KOA (OR = 1.86, 95% CI = 1.45-2.39) and HOA (IVW-fixed: OR = 1.65, 95% CI =1.20-2.26). Similar associations were observed in the TV-overall RA and TV-pRA, and TV-PsA, but the CAUSE method results only supported the causal association of time spent TV watching with OA and KOA. Moreover, MVMR results showed indicated an independent causal effect of TV watching on OA (overall, KOA, and HOA).

CONCLUSION

This study demonstrated the genetic causal association of prolonged TV watching time with overall OA and KOA risks.

Valuing preventable deaths from major non-communicable diseases and all causes associated with sedentary behavior in Argentina

OBJECTIVE

This study estimated the population attributable fractions, preventable deaths, and indirect economic costs from major non-communicable diseases (NCDs) and all causes associated with excessive sitting time in Argentina in 2019.

METHODS

Population attributable fractions were used to calculate preventable deaths from NCDs and all causes associated with prolonged sitting time (≥6 h/d). Then, the human capital approach was used to quantify the present value of lifetime earnings, which was subsequently used to calculate indirect costs due to lost productivity. A Monte Carlo simulation was performed in three counterfactual scenarios to evaluate the sensitivity of the results.

RESULTS

In Argentinian men and women, respectively, approximately 11.3% (381) [10% (290)] of deaths from colon cancer, 4.4% (250) from breast cancer (women only), 4.6% (588) [4.4% (402)] from coronary heart disease, 30.5% (1390) [27% (1047)] from diabetes, and 14.9% (24,686) [13.7% (21,418)] from all causes could have been avoided annually by eliminating excessive sitting time. The indirect economic costs of excessive sitting time reached 0.025% (0.019%-0.032%) and 0.37% (0.25-0.58%) of gross domestic product (GDP) for major NCDs and all causes, respectively. High levels of heterogeneity were found at the regional level.

CONCLUSION

Prolonged sitting time generates substantial societal costs. Public policies aimed at reducing excessive sedentary behavior in the overall population, especially in the most affected regions, would represent considerable savings for society as a whole. Such initiatives should address the complex and multifactorial causes of sedentary behavior, the clear gender and age differences in this behavior, and the factors underlying these differences.

The Cost-Effectiveness of the SMART Work & Life Intervention for Reducing Sitting Time

Sedentary behaviours continue to increase and are associated with heightened risks of morbidity and mortality. We assessed the cost-effectiveness of SMART Work & Life (SWAL), an intervention designed to reduce sitting time inside and outside of work, both with (SWAL-desk) and without (SWAL-only) a height-adjustable workstation compared to usual practice (control) for UK office workers. Health outcomes were assessed in quality-adjusted life-years (QALY) and costs in pound sterling (2019-2020). Discounted costs and QALYs were estimated using regression methods with multiply imputed data from the SMART Work & Life trial. Absenteeism, productivity and wellbeing measures were also evaluated. The average cost of SWAL-desk was £228.31 and SWAL-only £80.59 per office worker. Within the trial, SWAL-only was more effective and costly compared to control (incremental cost-effectiveness ratio (ICER): £12,091 per QALY) while SWAL-desk was dominated (least effective and most costly). However, over a lifetime horizon, both SWAL-only and SWAL-desk were more effective and more costly than control. Comparing SWAL-only to control generated an ICER of £4985 per QALY. SWAL-desk was more effective and costly than SWAL-only, generating an ICER of £13,378 per QALY. Findings were sensitive to various worker, intervention, and extrapolation-related factors. Based on a lifetime horizon, SWAL interventions appear cost-effective for office-workers conditional on worker characteristics, intervention cost and longer-term maintenance in sitting time reductions.

Impact of having a child on physical activity in the UK: a scoping review protocol

INTRODUCTION

Throughout the life course, there are major life transitions that are associated with reduced physical activity, which may have further implications for health and well-being. Having a child is one such transition that has been identified as a critical transformative experience and window for intervention. We will conduct a scoping review of available evidence exploring the impact of having a child on physical activity in the UK.

METHODS AND ANALYSIS

We will use best-practice methodological frameworks to map key concepts and available evidence, summarise and disseminate findings to stakeholders, and identify knowledge gaps. A three-step search strategy will identify primary research studies, including reviews, from published and grey literature, exploring the impact of having a child on physical activity in the UK, from the preconception period, throughout pregnancy, the postpartum period, and into parenthood. An initial limited search will identify relevant reviews, from which keywords and index terms will be extracted. We will conduct searches of CINAHL, Embase, Medline, PsycINFO and Web of Science to identify relevant articles written in English from inception to February 2022. Two reviewers will independently screen titles and abstracts of identified studies for inclusion and chart data, with a third reviewer resolving any conflicts. Backwards citation tracking will identify any additional studies. We will conduct numerical and thematic analysis to map data in tabular and diagrammatic format and provide a description of findings by theme.

ETHICS AND DISSEMINATION

Ethical approval is not required for this scoping review. We will disseminate findings to stakeholders through publications, conferences, social media platforms and in-person communications. Consultations with key stakeholders, with their unique expertise and perspectives, will provide greater insight. We will establish the main priorities for future research to inform the research questions of subsequent studies.

SCOPING REVIEW REGISTRATION

Open Science Framework (https://osf.io/gtqa4/) DOI 10.17605/OSF.IO/GTQA4.

The Effectiveness of Interventions to Reduce Sedentary Time in Different Target Groups and Settings in Germany: Systematic Review, Meta-Analysis and Recommendations on Interventions

BACKGROUND

Sedentary behavior is an important risk factor for several chronic diseases and is associated with an increased risk of mortality. We assessed the effectiveness of interventions to reduce sedentary time in Germany and provide recommendations on interventions to reduce sedentary time in children and adults.

METHODS

We comprehensively searched PubMed, Web of Science and the German Clinical Trials Register up to April 2022 for intervention studies targeting sedentary behavior in Germany. We performed a systematic review and qualitative synthesis of the interventions and a meta-analysis in children.

RESULTS

We included 15 studies comprising data from 4588 participants. The results of included primary studies in adults and children showed inconsistent evidence regarding change in sedentary time, with a majority of studies reporting non-significant intervention effects. The meta-analysis in children showed an increase in sedentary time for children in the control and intervention groups.

CONCLUSION

We found inconsistent evidence regarding the effectiveness of interventions to reduce time spent sedentary and our meta-analysis showed an increase in sedentary time in children. For children, we recommend physical and social environment interventions with an active involvement of families. For adults, we recommend physical environment interventions, such as height-adjustable desks at work.

Economic evaluation of an incentive-based program to increase physical activity and reduce sedentary behaviour in middle-aged adults

BACKGROUND

Incentive-based programs represent a promising approach for health insurers to encourage health-promoting behaviours. However, little is known about the value for money of such programs. This study aimed to determine the cost-effectiveness of the ACHIEVE (Active CHoices IncEntiVE) program designed to incentivise increased physical activity and reduced sedentary behaviour in middle-aged adults.

METHODS

 A within-trial cost-efficacy analysis was conducted. Benefits were assessed by evaluating paired t-tests from participants' pre- and post- trial Body Mass Index (BMI) (kg/m2), sitting time (minutes/day) and metabolic equivalents (METS) minutes. A health sector perspective was adopted for the assessment of costs. Pathway analysis was used to determine the resource use associated with the intervention, with costs expressed in Australian dollars (A$) for the 2015 reference year. A long-term cost-effectiveness analysis was undertaken which extended the analysis time horizon and the trial population to the relevant eligible Australian population. Within this analysis, the 16-week intervention was modelled for roll-out across Australia over a 1-year time horizon targeting people with private health insurance who are insufficiently active and highly sedentary. Improved health related quality of life quantified in Health-Adjusted Life Years (HALYs) (based on the health impacts of increased metabolic equivalent (MET) minutes and reduced body mass index (BMI) and cost-offsets (resulting from reductions in obesity and physical inactivity-related diseases) were tracked until the cohort reached age 100 years or death. A 3% discount rate was used and all outcomes were expressed in 2010 values. Simulation modelling techniques were used to present 95% uncertainty intervals around all outputs.

RESULTS

 The within-trial cost-efficacy analysis indicated that the ACHIEVE intervention cost approximately A$77,432. The cost per participant recruited was A$944. The incremental cost-effectiveness ratio (ICER) for MET increase per person per week was A$0.61; minute of sedentary time reduced per participant per day was A$5.15 and BMI unit loss per participant was A$763. The long-term cost effectiveness analysis indicated that if the intervention was scaled-up to all eligible Australians, approximately 265,095 participants would be recruited to the program at an intervention cost of A$107.4 million. Health care cost savings were A$33.4 million. Total HALYs gained were 2,709. The mean ICER was estimated at A$27,297 per HALY gained which is considered cost-effective in the Australian setting.

CONCLUSION

 The study findings suggest that financial incentives to promote physical activity and reduce sedentary behaviour are likely to be cost-effective.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry: ACTRN12616000158460 (10/02/2016).

Effectiveness of a healthcare-based mobile intervention on sedentary patterns, physical activity, mental well-being and clinical and productivity outcomes in office employees with type 2 diabetes: study protocol for a randomized controlled trial

BACKGROUND

Prolonged sedentary time is associated with an increased incidence of chronic disease including type 2 diabetes mellitus (DM2). Given that occupational sedentary time contributes significantly to the total amount of daily sedentariness, incorporating programmes to reduce occupational sedentary time in patients with chronic disease would allow for physical, mental and productivity benefits. The aim of this study is to evaluate the short-, medium- and long-term effectiveness of a mHealth programme for sitting less and moving more at work on habitual and occupational sedentary behaviour and physical activity in office staff with DM2. Secondary aims. To evaluate the effectiveness on glycaemic control and lipid profile at 6- and 12-month follow-up; anthropometric profile, blood pressure, mental well-being and work-related post-intervention outcomes at 3, 6 and 12 months.

METHODS

Multicentre randomized controlled trial. A sample size of 220 patients will be randomly allocated into a control (n = 110) or intervention group (n = 110), with post-intervention follow-ups at 6 and 12 months. Health professionals from Spanish Primary Health Care units will randomly invite patients (18-65 years of age) diagnosed with DM2, who have sedentary office desk-based jobs. The control group will receive usual healthcare and information on the health benefits of sitting less and moving more. The intervention group will receive, through a smartphone app and website, strategies and real-time feedback for 13 weeks to change occupational sedentary behaviour.

VARIABLES

(1) Subjective and objective habitual and occupational sedentary behaviour and physical activity (Workforce Sitting Questionnaire, Brief Physical Activity Assessment Tool, activPAL3TM); 2) Glucose, HbA1c; 3) Weight, height, waist circumference; 4) Total, HDL and LDL cholesterol, triglycerides; (5) Systolic, diastolic blood pressure; (6) Mental well-being (Warwick-Edinburgh Mental Well-being); (7) Presenteeism (Work Limitations Questionnaire); (8) Impact of work on employees´ health, sickness absence (6th European Working Conditions Survey); (9) Job-related mental strain (Job Content Questionnaire). Differences between groups pre- and post- intervention on the average value of the variables will be analysed.

DISCUSSION

If the mHealth intervention is effective in reducing sedentary time and increasing physical activity in office employees with DM2, health professionals would have a low-cost tool for the control of patients with chronic disease.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04092738. Registered September 17, 2019.

Associations of sedentary time and physical activity with adverse health conditions: Outcome-wide analyses using isotemporal substitution model

Background

As one of the most common lifestyles today, sedentary behaviour is a risk factor for many health conditions. To inform potential behavioural guideline development, we aimed to estimate the theoretical effects of replacing sedentary behaviour with different intensity of physical activity on risks of 45 common non-communicable diseases (NCDs).

Methods

A total of 360,047 participants (aged 37-73 years) in the UK Biobank free of the 45 common non-communicable diseases (NCDs) were included. Information on sedentary time (sum of television watching, computer using and driving behaviour) and physical activity (measured by International Physical Activity Questionnaire questionnaire) were collected by self-reported at baseline. Participants were followed up for 45 NCDs diagnosis according to the ICD-10 code using linkage to national health records until 2020. Isotemporal substitution models were used to investigate substituting sedentary time with light physical activity (LPA), moderate physical activity (MPA) and vigorous physical activity (VPA) after adjusting for potential confounders.

Finding

Participants who reported > 6 h/day compared with ≤ 2 h/day sedentary time had higher risks of 12 (26.7%) of 45 NCDs, including ischemic heart disease, diabetes, chronic obstructive pulmonary disease, asthma, chronic kidney disease, chronic liver disease, thyroid disorder, depression, migraine, gout, rheumatoid arthritis and diverticular disease. Theoretically, replacing sedentary time with equivalent LPA, MPA and VPA was associated with risk reductions in 4, 6 and 10 types of NCDs, respectively. Among long sedentary time (> 6 h/day), replacing 1 h/day sedentary time with equivalent VPA showed stronger associations with 5 NCDs (diabetes, depression, chronic liver disease, diverticular disease and sleep disorder), with a larger risk reduction of 11%-31%.

Interpretation

Sedentary time is associated with multiple adverse health conditions, replacing sedentary time with any equivalent amounts of VPA than LPA and MPA could be associated with risk reductions of more types of NCDs.

Funding

National Natural Science Foundation of China.

Cost-effectiveness of a programme to address sedentary behaviour in older adults: results from the SITLESS RCT

BACKGROUND

This study details the within-trial economic evaluation and long-term economic model of SITLESS, a multi-country, three-armed randomized controlled trial comparing a combined intervention of exercise referral schemes (ERS) enhanced by self-management strategies (SMS) against ERS alone and usual care (UC).

METHODS

A cost-utility analysis, conducted from the base-case perspective of the National Health Service and personal and social services, estimated the incremental cost per incremental quality-adjusted life year (QALY) and years in full capability (YFC). A secondary analysis combined the costs with a broad set of outcomes within a cost-consequence framework, from a societal perspective. A Markov-type decision-analytic model was developed to project short-term changes in physical activity to long-term outcomes and costs, over a 5- and 15-year time horizon.

RESULTS

The results of the within-trial analysis show that SMS+ERS is highly likely to be cost-effective compared to ERS alone (ICER €4270/QALY), but not compared to UC. Participants allocated to the SMS+ERS group also showed an improvement in YFC compared to ERS alone and UC. The long-term analysis revealed that SMS+ERS is likely to be a cost-effective option compared to ERS and UC over a 5-year, but not with a 15-year horizon, being then dominated by ERS alone.

CONCLUSION

This research provides new evidence that SMS is a cost-effective add-on to ERS strategies. This economic evaluation informs the case for further, cost-effective, refinement of lifestyle change programmes targeted to older adults, with the aim of ultimately reducing the impact of non-communicable diseases in this population.

Economic burden of low physical activity and high sedentary behaviour in Finland

BACKGROUND

Low physical activity and high sedentary behaviour are unquestionably relevant for public health while also increasing direct and indirect costs.

METHODS

The authors examined the direct and indirect costs attributable to low physical activity and high sedentary behaviour in Finland in 2017. Costs related to major non-communicable diseases drawn from Finnish registries covered direct costs (outpatient visits, days of inpatient care, medication and institutional eldercare) and indirect costs (sickness-related absences, disability pensions, unemployment benefits, all-cause mortality and losses of income tax revenue). Prevalences of low physical activity and high sedentary behaviour (≥8 hours per 16 waking hours) were based on self-reports among adolescents or accelerometer data among adults and the elderly from three Finnish population studies: FINFIT 2017, Health 2011 and the Cardiovascular Risk in Young Finns Study. Cost calculations used adjusted population attributable fractions (PAF) and regression models. Total annual costs were obtained by multiplying PAF by the total costs of the given disease.

RESULTS

The total costs of low physical activity in Finland in 2017 came to approximately €3.2 billion, of which direct costs accounted for €683 million and indirect ones for €2.5 billion. Costs attributable to high sedentary behaviour totalled roughly €1.5 billion.

CONCLUSION

The findings suggest that low physical activity and high sedentary behaviour levels create substantial societal costs. Therefore, actions intended to increase physical activity and reduce excessive sedentary behaviour throughout life may yield not only better health but also considerable savings to society.

Modelling the potential health and economic benefits of reducing population sitting time in Australia

BACKGROUND

Strong evidence indicates that excessive time spent sitting (sedentary behaviour) is detrimentally associated with multiple chronic diseases. Sedentary behaviour is prevalent among adults in Australia and has increased during the COVID-19 pandemic. Estimating the potential health benefits and healthcare cost saving associated with reductions in population sitting time could be useful for the development of public health initiatives.

METHODS

A sedentary behaviour model was developed and incorporated into an existing proportional, multi-state, life table Markov model (ACE-Obesity Policy model). This model simulates the 2019 Australian population (age 18 years and above) and estimates the incidence, prevalence and mortality of five diseases associated with sedentary behaviour (type 2 diabetes, stroke, endometrial, breast and colorectal cancer). Key model inputs included population sitting time estimates from the Australian National Health Survey 2014-2015, healthcare cost data from the Australian Institute of Health and Welfare (2015) and relative risk estimates assessed by conducting literature reviews and meta-analyses. Scenario analyses estimated the potential change in disease incidence as a result of changes in population sitting time. This, in turn, resulted in estimated improvements in long term health outcomes (Health-adjusted life years (HALYs)) and healthcare cost-savings.

RESULTS

According to the model, if all Australian adults sat no more than 4 h per day, the total HALYs gained would be approximately 17,211 with health care cost savings of approximately A$185 million over one year. Under a more feasible scenario, where sitting time was reduced in adults who sit 4 or more hours per day by approximately 36 min per person per day (based on the results of the Stand Up Victoria randomised controlled trial), potential HALYs gained were estimated to be 3,670 and healthcare cost saving could reach A$39 million over one year.

CONCLUSIONS

Excessive sedentary time results in considerable population health burden in Australia. This paper describes the development of the first Australian sedentary behaviour model that can be used to predict the long term consequences of interventions targeted at reducing sedentary behaviour through reductions in sitting time. These estimates may be used by decision makers when prioritising healthcare resources and investing in preventative public health initiatives.

Economics of sedentary behaviour: A systematic review of cost of illness, cost-effectiveness, and return on investment studies

AIMS

METHODS: RESULTS: We identified nine articles (conducted in Australia (n = 5), Europe (n = 3) and China (n = 1)); three reported healthcare costs associated with excessive sedentary time, whilst six were economic evaluations of interventions targeting sedentary behaviour. Healthcare costs associated with excessive sedentary time as reported in cost of illness studies were substantial; however, none explored non-health sector costs. In contrast, all full economics evaluations adopted a societal perspective; however, costs included differed depending on the intervention context. One sedentary behaviour intervention in children was cost-saving. The five interventions targeting occupational sitting time of adults in office workplaces were cost-effective. Physical environmental changes such as sit-stand desks, active workstations etc., were the key cost driver.

CONCLUSIONS

Sedentary behaviour is likely associated with excess healthcare costs, although future research should also explore costs across other sectors. Cost-effectiveness evidence of sedentary behaviour reduction interventions in workplaces is limited but consistent. Key gaps relate to the economic credentials of interventions targeting children, and modelling of long-term health benefits of interventions.

Measurement of physical activity and sedentary behavior in national health surveys, South America

Objectives.

To characterize how physical activity and sedentary behavior have been measured in national health surveys in South American countries.

Methods.

An extensive search was made for national health surveys from all 12 South American countries through health websites, national statistical offices, and contact with researchers and policy-makers. The following eligibility criteria were used to select surveys: conducted in a South American country; used a nationally representative sample ≥ 18 years; coordinated by the public, private or mixed private–public sector; and assessed physical activity and/or sedentary behavior. Data were extracted on general information about the surveys, specific details about the physical activity and sedentary behavior assessment, and additional questions related to activity behavior.

Results.

In total, 36 surveys were included, two of which were multicountry surveys; all surveys assessed physical activity and 27 assessed sedentary behavior. Most surveys (23/36; 64%) were based on previously validated international questionnaires, but 13 (57%) of these deviated from the reference tools, introducing changes and adaptations. Sedentary behavior was assessed mostly through questions on screen time and/or daily sitting time in the same physical activity questionnaires. No survey used device-based measures to generate data on these behaviors.

Conclusions.

Differences between instruments used and modifications limit the comparability of data across countries. This highlights the importance of standardizing assessment within South America for physical activity and sedentary behavior sections in national surveys, with the broader aim of contributing to establishing a standardized strategy for the surveillance of physical activity and sedentary behavior in South America.

Economic Evaluation of a Reablement Training Program for Homecare Staff Targeting Sedentary Behavior in Community-Dwelling Older Adults Compared to Usual Care: A Cluster Randomized Controlled Trial

Purpose

Training and supporting homecare staff in reablement aims to change staff behavior from “doing for” to “doing with” older adults and is assumed to benefit the health and quality of life of older adults and reduce healthcare utilization and costs. This study evaluated the cost-effectiveness and cost-utility of the staff reablement training program “Stay Active at Home” (SAaH) from a societal perspective.

Participants and Methods

An economic evaluation was embedded in a 12-month cluster randomized controlled trial. Ten Dutch homecare nursing teams participated (n = 313 staff members), of which five teams were trained in reablement and the other five provided usual care. Cost and effect data were collected from 264 older adults at baseline, 6 and 12 months. Costs included “intervention,” “healthcare,” and “patient and family” costs (collectively, societal costs) and were assessed using questionnaires and client records or estimated by bottom-up micro-costing. Effects included sedentary behavior and quality-adjusted life years (QALYs). Multiple imputed bootstrapped data were used to generate cost-effectiveness planes and acceptability curves.

Results

No statistically significant differences were observed between the intervention and control group in terms of sedentary time (adjusted mean difference: \documentclass[12pt]{minimal} \usepackage{wasysym} \usepackage[substack]{amsmath} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage[mathscr]{eucal} \usepackage{mathrsfs} \DeclareFontFamily{T1}{linotext}{} \DeclareFontShape{T1}{linotext}{m}{n} {linotext }{} \DeclareSymbolFont{linotext}{T1}{linotext}{m}{n} \DeclareSymbolFontAlphabet{\mathLINOTEXT}{linotext} \begin{document} $$\beta $$ \end{document} 4.8 minutes [95% CI –26.4, 36.0]), QALYs (\documentclass[12pt]{minimal} \usepackage{wasysym} \usepackage[substack]{amsmath} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage[mathscr]{eucal} \usepackage{mathrsfs} \DeclareFontFamily{T1}{linotext}{} \DeclareFontShape{T1}{linotext}{m}{n} {linotext }{} \DeclareSymbolFont{linotext}{T1}{linotext}{m}{n} \DeclareSymbolFontAlphabet{\mathLINOTEXT}{linotext} \begin{document} $$\beta $$ \end{document} 0.01 [95% CI –0.03, 0.04]), and societal costs (\documentclass[12pt]{minimal} \usepackage{wasysym} \usepackage[substack]{amsmath} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage[mathscr]{eucal} \usepackage{mathrsfs} \DeclareFontFamily{T1}{linotext}{} \DeclareFontShape{T1}{linotext}{m}{n} {linotext }{} \DeclareSymbolFont{linotext}{T1}{linotext}{m}{n} \DeclareSymbolFontAlphabet{\mathLINOTEXT}{linotext} \begin{document} $$\beta $$ \end{document} €2216 [95% CI –459, 4895]), except lower costs for domestic help in the intervention group (\documentclass[12pt]{minimal} \usepackage{wasysym} \usepackage[substack]{amsmath} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage[mathscr]{eucal} \usepackage{mathrsfs} \DeclareFontFamily{T1}{linotext}{} \DeclareFontShape{T1}{linotext}{m}{n} {linotext }{} \DeclareSymbolFont{linotext}{T1}{linotext}{m}{n} \DeclareSymbolFontAlphabet{\mathLINOTEXT}{linotext} \begin{document} $$\beta $$ \end{document} €–173 [95% CI –299, –50]). The probability that SAaH was cost-effective compared to usual care ranged from 7.1% to 19.9%, depending on the willingness-to-pay (WTP) (€0‒€50,000)/minute of sedentary time averted and was 5.9% at a WTP of €20,000/QALY gained.

Conclusion

SAaH did not improve outcomes or reduce costs and was not cost-effective from a societal perspective compared to usual care in Dutch older adults receiving homecare. Consequently, there is insufficient evidence to justify widespread implementation of the training program in its current form.

Trial Registration

ClinicalTrials.gov: NCT03293303.

Physical activity and sedentary behaviour in current and former recreational and elite cricketers: a cross-sectional study

OBJECTIVE

Former sports participants do not necessarily maintain high levels of physical activity (PA) across their lifespan. Considering physical inactivity in former athletes is associated with an increased susceptibility to inactivity-related chronic diseases, research into PA behaviours in cricketers of all playing-standards is needed. The objective was to (1) describe PA and sedentary behaviour in current and former cricketers, and (2) determine the odds of current, former, recreational and elite cricketers meeting PA guidelines and health-enhancing PA (HEPA) compared with the general population.

STUDY DESIGN

Cross-sectional survey.

SETTING

Questionnaire response, UK.

PARTICIPANTS

2267 current and former cricketers (age: 52±15 years, male: 97%, current: 59%, recreational: 45%) participated. Cricketers were recruited through the Cricket Health and Wellbeing Study and met eligibility requirements (aged ≥18 years; played ≥1 year of cricket).

PRIMARY AND SECONDARY OUTCOMES

Age-matched and sex-matched data from Health Survey for England 2015 (n=3201) was used as the general population-based sample. The International Physical Activity Questionnaire Short-Form assessed PA. Logistic regression, adjusted for age, sex, body mass index, alcohol consumption, smoking, education and ethnicity were used to meet the second aim.

RESULTS

90% of current and 82% of former cricketers met UK PA guidelines. Current (OR 1.26, 95% CI 1.06 to 1.49)) and elite (OR 1.35, 95% CI 1.01 to 1.78) cricketers had greater odds of meeting UK PA guidelines, and elite cricketers had greater odds of HEPA (OR 1.19, 95% CI 1.02 to 1.42), compared with the general population. Former cricketers had reduced odds (OR 0.78, 95% CI 0.62 to 0.99) of meeting the UK PA guidelines compared with the general population.

CONCLUSIONS

Elite cricketers had a greater odds of meeting the PA guidelines and HEPA, compared with the general population. Former cricketers demonstrated reduced odds of meeting the PA guidelines compared with the general population. Strategies are needed to transition cricketers to an active lifestyle after retirement, since former cricketers demonstrated reduced odds of meeting the PA guidelines compared with the general population.

Individual Characteristics Associated with Active Travel in Low and High Income Groups in the UK

Active travel (AT) has gained increasing attention as a way of addressing low levels of physical activity. However, little is known regarding the relationship between income and AT. The aim of this study was to investigate characteristics associated with undertaking AT in an adult population and by low- and high-income groups. Data collected from the Physical Activity and the Rejuvenation of Connswater (PARC) study in 2017 were used. Participants were categorised into socio-economic groups according to their weekly household income, and were categorised as participating in ‘no’ AT or ‘some’ AT and ‘sufficient’ AT. Multivariable logistic regression explored characteristics associated with AT in the full cohort, and the low- and high-income groups separately. Variables associated with AT in the low-income group were body mass index (BMI), physical activity self-efficacy, marital status, long term illness, difficulty walking and housing tenure. For the high-income group, BMI, marital status, housing tenure and education were associated with AT. For both income groups, there were consistent positive associations with the action/maintenance phase of the stage of change model across all AT categories. The findings suggest that population sub-groups may benefit from targeted initiatives to support engagement in AT and prevent further widening of inequalities.

Changes in Sitting Time, Screen Exposure and Physical Activity during COVID-19 Lockdown in South American Adults: A Cross-Sectional Study

The worldwide prevalence of insufficient physical activity (PA) and prolonged sedentary behavior (SB) were high before the coronavirus (COVID-19) pandemic. Measures that were taken by governments (such as home confinement) to control the spread of COVID-19 may have affected levels of PA and SB. This cross-sectional study among South American adults during the first months of COVID-19 aims to (i) compare sitting time (ST), screen exposure, moderate PA (MPA), vigorous PA (VPA), and moderate-to-vigorous PA (MVPA) before and during lockdown to sociodemographic correlates and (ii) to assess the impact of lockdown on combinations of groups reporting meeting/not-meeting PA recommendations and engaging/not-engaging excessive ST (≥7 h/day). Bivariate associations, effect sizes, and multivariable linear regressions were used. Adults from Argentina (n = 575) and Chile (n = 730) completed an online survey with questions regarding demographics, lifestyle factors, and chronic diseases. Mean reductions of 42.7 and 22.0 min./day were shown in MPA and VPA, respectively; while increases of 212.4 and 164.3 min./day were observed in screen and ST, respectively. Those who met PA recommendations and spent <7 h/day of ST experienced greatest changes, reporting greater than 3 h/day higher ST and more than 1.5 h/day lower MVPA. Findings from the present study suggest that efforts to promote PA to South American adults during and after COVID-19 restrictions are needed.

Accelerometer-Measured Sedentary and Physical Activity Time and Their Correlates in European Older Adults: The SITLESS Study

Background

Sedentary behavior (SB) and physical activity (PA) are important determinants of health in older adults. This study aimed to describe the composition of accelerometer-measured SB and PA in older adults, to explore self-reported context-specific SB, and to assess sociodemographic and functional correlates of engaging in higher levels of SB in participants of a multicenter study including four European countries.

Method

One thousand three hundred and sixty community-dwelling older adults from the SITLESS study (61.8% women; 75.3 ± 6.3 years) completed a self-reported SB questionnaire and wore an ActiGraph accelerometer for 7 days. Accelerometer-determined compositional descriptive statistics were calculated. A fixed-effects regression analysis was conducted to assess the sociodemographic (country, age, sex, civil status, education, and medications) and functional (body mass index and gait speed) correlates.

Results

Older adults spent 78.8% of waking time in SB, 18.6% in light-intensity PA, and 2.6% in moderate-to-vigorous PA. Accelerometry showed that women engaged in more light-intensity PA and walking and men engaged in higher amounts of moderate-to-vigorous PA. Watching television and reading accounted for 47.2% of waking time. Older age, being a man, single, taking more medications, being obese and overweight, and having a slower gait speed were statistically significant correlates of more sedentary time.

Conclusions

The high amount of SB of our participants justifies the need to develop and evaluate interventions to reduce sitting time. A clinically relevant change in gait speed can decrease almost 0.45 percentage points of sedentary time. The distribution of context-specific sedentary activities by country and sex showed minor differences, albeit worth noting.

Sedentary behaviour among general practitioners: a systematic review

Background

Sedentary behaviour is when someone is awake, in a sitting, lying or reclining posture and is an independent risk factor for multiple causes of morbidity and mortality. A dose-response relationship has been demonstrated, whereby increasing sedentary time corresponds with increasing mortality rate. This study aimed to identify current levels of sedentary behaviour among General Practitioners (GPs), by examining and synthesising how sedentary behaviour has been measured in the primary care literature.

Methods

A systematic review was conducted to identify studies relating to levels of sedentary behaviour among GPs. Searches were performed using Medline®, Embase®, PscycINFO, Web of Science and the Cochrane Library, from inception of databases until January 2020, with a subsequent search of grey literature. Articles were assessed for quality and bias, with extraction of relevant data.

Results

The search criteria returned 1707 studies. Thirty four full texts were reviewed and 2 studies included in the final review. Both were cross-sectional surveys using self-reported estimation of sedentary time within the International Physical Activity Questionnaire (IPAQ). Keohane et al. examined GP trainees and GP trainers in Ireland. 60% reported spending in excess of 7 h sitting each day, 24% between 4 and 7 h, and 16% less than or equal to 4 h. Suija et al. examined female GPs in Estonia. The mean reported daily sitting time was 6 h and 36 min, with 56% sitting for over 6 h per day. Both studies were of satisfactory methodological quality but had a high risk of bias.

Conclusion

There is a paucity of research examining current levels of sedentary behaviour among GPs. Objective data is needed to determine GPs’ current levels of sedentary behaviour, particularly in light of the increase in remote consulting as a result of the COVID-19 pandemic.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-020-01359-8.

The association between recreational screen time and cancer risk: findings from the UK Biobank, a large prospective cohort study

BACKGROUND

Evidence is suggestive of sedentary behaviour being associated with an increased risk of endometrial cancer, but the evidence base is too limited to draw any conclusions for other cancers. The aim of the study was to investigate the association between recreational screen time and site-specific cancer risk.

METHODS

We analysed data from the prospective UK Biobank cohort study. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between daily recreational screen time (including television (TV) viewing time, computer use time and total screen time) and site-specific cancer risk. Partition models and isotemporal substitution models investigated the impact of substituting recreational screen time with physical activity.

RESULTS

During a mean follow-up of 7.6 years, 28,992 incident cancers were identified among 470,578 adults. A 1-h increase in daily TV viewing time was associated with higher risks of oropharyngeal, oesophago-gastric and colon cancer in fully adjusted models. Participants who reported ≤1, compared with 1- ≤ 3, hours/day of TV viewing time had lower risks of lung, breast, and oesophago-gastric cancer. Findings were inconsistent for daily recreational computer use and daily total recreational screen time. The majority of observed associations were small, and were attenuated after excluding cancers diagnosed within the first two years of follow-up, except for oesophago-gastric and colon cancers (HR 1.05, 95% CI: 1.01, 1.10; and HR 1.04, 95% CI: 1.01, 1.07 per 1-h increase in daily TV viewing time, respectively). However, isotemporal substitution models showed reduced risk of some site-specific (oropharyngeal, lung, breast and colorectal) cancers when replacing 1-h/day of TV viewing with 1-h of moderate-intensity physical activity or walking.

CONCLUSIONS

Our findings show that daily recreational screen time, particularly TV viewing, was associated with small increased risks of oesophago-gastric and colon cancer. Replacing 1-h/day of TV viewing with 1-h of moderate-intensity physical activity or walking was associated with lower risk of oropharyngeal, lung, breast and colorectal cancers. Further research from other large prospective cohort studies is required, while mechanistic research is warranted to enhance the biological plausibility of these findings.

Engagement with and delivery of the 'parkrun practice initiative' in general practice: a mixed methods study

BACKGROUND

The parkrun practice initiative, a joint collaboration between parkrun and the Royal College of General Practitioners, was launched to encourage general practices to improve the health and wellbeing of patients and staff through participating in local 5 km parkrun events. Why and how practices engage with the initiative is unknown.

AIM

To investigate engagement with and delivery of the parkrun practice initiative in general practice.

DESIGN AND SETTING

Mixed methods study conducted from April-July 2019 comprising an online survey of all registered parkrun practices, and interviews and a focus group with practice staff in the West Midlands.

METHOD

The designated contacts at 780 registered parkrun practices were invited to complete an online survey. A purposive sample of parkrun practice staff and non-registered practice staff took part either in semi-structured interviews or a focus group, with transcripts analysed thematically.

RESULTS

Of the total number of parkrun practices, 306 (39.2%) completed the survey. Sixteen practice staff (from nine parkrun practices and four non-registered practices) took part in either semi-structured interviews (n = 12) or a focus group (n = 4). Key motivators for becoming a parkrun practice were: to improve patient and staff health and wellbeing, and to become more engaged with the community and enhance practice image. Practices most commonly encouraged patients, carers, and staff to take part in parkrun and displayed parkrun flyers and posters. Challenges in implementing activities included lack of time (both personal and during consultations) and getting staff involved. Where staff did engage there were positive effects on morale and participation. Non-registered practices were receptive to the initiative, but had apprehensions about the commitment involved.

CONCLUSION

Practices were keen to improve patient and staff health. Addressing time constraints and staff support needs to be considered when implementing the initiative.

Impact of unhealthy lifestyle on cardiorespiratory fitness and heart rate recovery of medical science students

Background

Medical science students represent valuable labour resources for better future medicine and medical technology. However, little attention was given to the health and well-being of these early career medical science professionals. The aim of this study is to investigate the impact of lifestyle components on cardiorespiratory fitness and heart rate recovery measured after moderate exercise in this population.

Methods

Volunteers without documented medical condition were recruited randomly and continuously from the first-year medical science students during 2011–2014 at the University of Surrey, UK. Demographics and lifestyle components (the levels of smoking, alcohol intake, exercise, weekend outdoor activity and screen-time, daily sleep period, and self-assessment of fitness) were gathered through pre-exercise questionnaire. Cardiorespiratory fitness (VO₂max) and heart rate recovery were determined using Åstrand–Rhyming submaximal cycle ergometry test. Data were analysed using SPSS version 25.

Results

Among 614 volunteers, 124 had completed both lifestyle questionnaire and the fitness test and were included for this study. Within 124 participants (20.6 ± 4 years), 46.8% were male and 53.2% were female, 11.3% were overweight and 8.9% were underweight, 8.9% were current smokers and 33.1% consumed alcohol beyond the UK recommendation. There were 34.7% of participants admitted to have < 3 h/week of moderate physical activity assessed according to UK Government National Physical Activity Guidelines and physically not fit (feeling tiredness). Fitness test showed that VO₂max distribution was inversely associated with heart rate recovery at 3 min and both values were significantly correlated with the levels of exercise, self-assessed fitness and BMI. Participants who had < 3 h/week exercise, or felt not fit or were overweight had significantly lower VO₂max and heart rate recovery than their peers.

Conclusion

One in three new medical science students were physically inactive along with compromised cardiorespiratory fitness and heart rate recovery, which put them at risk of cardiometabolic diseases. Promoting healthy lifestyle at the beginning of career is crucial in keeping medical science professionals healthy.

Cost-Effectiveness and Return-on-Investment of the Dynamic Work Intervention Compared With Usual Practice to Reduce Sedentary Behavior

OBJECTIVE

To assess the cost-effectiveness and return-on-investment (ROI) of the Dynamic Work (DW) Intervention, a worksite intervention aimed at reducing sitting time among office workers.

METHODS

In total, 244 workers were randomized to the intervention or control group. Overall sitting time, standing time, step counts, quality-adjusted life years (QALYs), and costs were measured over 12 months. The cost-effectiveness analysis was performed from the societal perspective and the ROI analysis from the employers' perspective.

RESULTS

No significant differences in effects and societal costs were observed between groups. Presenteeism costs were significantly lower in the intervention group. The probability of the intervention being cost-effective was 0.90 at a willingness-to-pay of 20,000&OV0556;/QALY. The probability of financial savings was 0.86.

CONCLUSION

The intervention may be considered cost-effective from the societal perspective depending on the willingness-to-pay. From the employer perspective, the intervention seems cost-beneficial.

The effectiveness and complexity of interventions targeting sedentary behaviour across the lifespan: a systematic review and meta-analysis

BACKGROUND

Evidence suggests that sedentary behaviour (SB) is associated with poor health outcomes. SB at any age may have significant consequences for health and well-being and interventions targeting SB are accumulating. Therefore, the need to review the effects of multicomponent, complex interventions that incorporate effective strategies to reduce SB are essential.

METHODS

A systematic review and meta-analysis were conducted investigating the impact of interventions targeting SB across the lifespan. Six databases were searched and two review authors independently screened studies for eligibility, completed data extraction and assessed the risk of bias and complexity of each of the included studies.

RESULTS

A total of 77 adult studies (n=62, RCTs) and 84 studies (n=62, RCTs) in children were included. The findings demonstrated that interventions in adults when compared to active controls resulted in non-significant reductions in SB, although when compared to inactive controls significant reductions were found in both the short (MD -56.86; 95%CI -74.10, -39.63; n=4632; I2 83%) and medium-to-long term (MD -20.14; 95%CI -34.13, -6.16; n=4537; I2 65%). The findings demonstrated that interventions in children when compared to active controls may lead to relevant reductions in daily sedentary time in the short-term (MD -59.90; 95%CI -102.16, -17.65; n=267; I2 86%), while interventions in children when compared to inactive controls may lead to relevant reductions in the short-term (MD -25.86; 95%CI -40.77, -10.96; n=9480; I2 98%) and medium-to-long term (MD -14.02; 95%CI -19.49, -8.55; n=41,138; I2 98%). The assessment of complexity suggested that interventions may need to be suitably complex to address the challenges of a complex behaviour such as SB, but demonstrated that a higher complexity score is not necessarily associated with better outcomes in terms of sustained long-term changes.

CONCLUSIONS

Interventions targeting reductions in SB have been shown to be successful, especially environmental interventions in both children and adults. More needs to be known about how best to optimise intervention effects. Future intervention studies should apply more rigorous methods to improve research quality, considering larger sample sizes, randomised controlled designs and valid and reliable measures of SB.

Genome-wide association studies and Mendelian randomization analyses for leisure sedentary behaviours

Leisure sedentary behaviours are associated with increased risk of cardiovascular disease, but whether this relationship is causal is unknown. The aim of this study is to identify genetic determinants associated with leisure sedentary behaviours and to estimate the potential causal effect on coronary artery disease (CAD). Genome wide association analyses of leisure television watching, leisure computer use and driving behaviour in the UK Biobank identify 145, 36 and 4 genetic loci (P < 1×10-8), respectively. High genetic correlations are observed between sedentary behaviours and neurological traits, including education and body mass index (BMI). Two-sample Mendelian randomization (MR) analysis estimates a causal effect between 1.5 hour increase in television watching and CAD (OR 1.44, 95%CI 1.25-1.66, P = 5.63 × 10-07), that is partially independent of education and BMI in multivariable MR analyses. This study finds independent observational and genetic support for the hypothesis that increased sedentary behaviour by leisure television watching is a risk factor for CAD.

Should We Scale-Up? A Mixed Methods Process Evaluation of an Intervention Targeting Sedentary Office Workers Using the RE-AIM QuEST Framework

Background: Interventions targeting a reduction in sedentary behaviour in office workers need to be scaled-up to have impact. In this study, the RE-AIM QuEST framework was used to evaluate the potential for further implementation and scale-up of a consultation based workplace intervention which targeted both the reduction, and breaking up of sitting time. Methods: To evaluate the Springfield College sedentary behaviour intervention across multiple RE-AIM QuEST indicators; intervention participant, non-participant (employees who did not participate) and key informant (consultation delivery team; members of the research team and stakeholders in workplace health promotion) data were collected using interviews, focus groups and questionnaires. Questionnaires were summarized using descriptive statistics and interviews and focus groups were transcribed verbatim, and thematically analysed. Results: Barriers to scale-up were: participant burden of activity monitoring; lack of management support; influence of policy; flexibility (scheduling/locations); time and cost. Facilitators to scale up were: visible leadership; social and cultural changes in the workplace; high acceptability; existing health and wellbeing programmes; culture and philosophy of the participating college. Conclusions: There is potential for scale-up, however adaptations will need to be made to address the barriers to scale-up. Future interventions in office workers should evaluate for scalability during the pilot phases of research.