Health Hazards of Sedentariness

Health Hazards of Sedentariness
Associate Professor David Dunstan
Head – Physical Activity
VicHealth Public Health Research Fellow
Baker IDI Heart & Diabetes Institute
Melbourne, Australia
David.Dunstan@bakeridi.edu.au
id
@b k idi d
O tli
Outline
• State of knowledge (evidence base)
– Introduction to the sedentary behaviour paradigm
– Health impact, implications for workplaces
• Current & future research directions towards
building the evidence
evidence-base
base in relation to
sedentary behaviour in the workplace
Ackno ledgements
Acknowledgements
•
Particular thanks to the Baker IDI - UQ team: Neville Owen, Genevieve
Healy Paul Zimmet,
Healy,
Zimmet Jonathan Shaw,
Shaw Bronwyn Kingwell,
Kingwell Robyn Smith
Smith,
Katrien Wijndaele, Jo Salmon, Ester Cerin, Adrian Cameron, Dianna
Magliano; also Elizabeth Eakin, Adrian Bauman, Wendy Brown, Marc
Hamilton Chuck Matthews; and
Hamilton,
and, our other collaborators and their
funding bodies
•
Cancer Prevention Research Centre Research Infrastructure Grant
from Queensland Health to the University of Queensland
•
Program Grant # 301200, and #233200 from the National Health &
Medical Research Council of Australia
•
David Dunstan is supported by a Victorian Health Promotion
Foundation Public Health Research Fellowships
•
Genevieve Healy is supported by an NHMRC/Heart Foundation
Fellowship
How times have changed
Then
Now
Transport
Work
Domestic
‘Purposeful Exercise’
Active = ≥150mins moderateintensity activity / wk
I
Inactive
ti = 0-149
0 149 mins
i moderated t
intensity activity / wk
‘Non-exercise time’ behaviours
Aka: Prolonged
Sitting
Sedentary1
adj (from Latin sedere: to sit)
A: Of habits, occupations, etc.:
Requiring continuance in a sitting posture (1603)
p
B: Of persons:
Accustomed or addicted to sitting still; engaged in
sedentary pursuits; not in the habit of taking
physical exercise (1662)
Sedentariness1
The quality or condition of being sedentary
1Compact
Oxford English Dictionary
S d t
Sedentary
Behaviour
B h i
Activities of low energy expenditure, characterised by sitting
MET
Moderate
4
3.8: Brisk walking
Public Health
Physical
y
Activity
y
Guidelines: time
spent in moderatevigorous activity
3
Light
g
2.5: Slow walking
g
2
Sedentary
1
2.0: Standing
1.8: Sitting (desk work)
1 5: Sitting (talking)
1.5:
1.0: Sitting quietly (television viewing)
0.9: Sleeping
Ainsworth BE, et al. Med Sci Sport Exer. 2000;32:S498–S516
A Key Distinction
Physically Inactive Sedentary Lifestyle
Lifestyle’
‘Sedentary
Sedentary Behavior1,2
‘Sedentary
Sedentary Time
Time’
=
Too little moderate‐
intensity physical activity
(< 150 mins per week)
(< 150 mins per week)
1Owen
Sitting too much
et al. Ex Sports Sci Rev 2000, 2Pate et al. Ex Sports Sci Rev 2008
Th Proposition
The
P
iti
Sedentary behaviour (too much sitting)
may be a deeply-embedded
deeply embedded public health
problem, which is additional to lack of
physical
h i l activity
i i ((too little
li l exercise)
i )
Our modern ‘sitting orientated’ society
£
Awake
7 am
¤
¥
Breakfast
15 mins
Work on
computer
3.5 hrs
Transport to
work
45 mins
¡
Transport
From work
45 mins
£
Watch TV
4 hrs
Lunch
30 mins
Work on
computer
4 hrs
§
Sleep
11pm
g
Evening
meal
30 mins
Sitting Opportunities 15.5 hrs
W lk – 30 min
Walk
i
Sitti induces
Sitting
i d
muscular
l inactivity
i
ti it
4 STEPS
GETTING OUT
GETTING
OUT
OF A CHAIR
SITTING
STANDING
Source: Hamilton, M.T., Hamilton, D.G. and Zderic, T.W. (2007) Diabetes, 56, 2655-2667
Self-reported Sitting time
H l h outcomes
Health
Katzmarzyk et al. (2009)
Jans et al. (2007)
- Majority report detrimental associations with waist
- Thorp et al
al. detrimental associations with CVD risk markers
- Katzmarzyk et al. – increased risk of early death
IDF Atlas
2006
- None
report
beneficial association
Ball et al. (2002)
Brown et al.(2003)
Mummery et al. (2005)
Thorp et al.(Under review)
Accelerometers
• Small,, lightweight,
g
g , unobtrusive
• Record the time, duration, frequency, &
intensity of walking or running
movements
6000
Mod-to-Vigorous (≥1952)
5000
3000
2000
Light Intensity
1000
Sedentary (<100 cpm)
PM
11
:0
0
PM
M
:0
0
10
9:
00
P
P
M
M
00
8:
00
7:
00
P
M
P
M
6:
00
P
5:
00
4:
P
M
M
P
M
3:
00
00
P
M
TIME
2:
1:
00
P
PM
:0
0
AM
12
11
:0
0
:0
0
AM
M
10
00
A
9:
00
8:
A
M
M
A
M
7:
00
00
A
M
6:
5:
00
A
00
A
M
M
A
4:
3:
00
00
A
M
2:
00
A
AM
1:
:0
0
M
0
12
ACTIVITY
4000
How Australian adults’ overall daily behaviour
patterns are distributed between physicallyactive
act
e and
a d sedentary
sede ta y ttime
e
moderate to vigorous
activities: 0.7 hours/day (5%)
light-intensity
activities: 6.5
hours/day (35%)
sedentary time: 9.3
hours/day (60%)
Healy, G.N.,
Healy
G N Wijndaele,
Wijndaele K
K., Dunstan
Dunstan, D
D.W.,
W Shaw
Shaw, JJ.E.,
E Salmon
Salmon, JJ, Zimmet
Zimmet, P
P.Z.
Z and Owen
Owen, N.
N
(2008). Objectively-measured sedentary time, physical activity and metabolic risk: the AusDiab
study. Diabetes Care, 31, 369-71
You can be ‘active’,
active , but also highly sedentary!
The ‘Active’ Couch Potato
Activity
Intensity
Morning
Time (minutes)
T
Moderate/vigorous
Energy
Expenditure
Very High
Light
Night
g
Sedentary
Mean mod-to-vigorous time = 31 mins/day
% Waking hours spent in Sedentary = 71%
Very Low
G
Ground-Breaking
dB
ki Fi
Findings
di
• Sedentary time –associated
associated with risk factors for CVD
and type 2 diabetes (independent of physical activity
levels)2
Sedentary time
Light-intensity activity
Healy GN, Dunstan DW et al. Diabetes Care 2008; 31: 369-371
Variations in sedentary
y behaviour
patterns are also important
“Prolonger”
“Breaker”
Sedentary
CPM < 100
Not sedentary
CPM 100+
These participants have
exactly the same
sedentary time
Waist Circumference
p for trend = 0.022
95
*
90
85
29
Body mass inde
B
ex (kg.m -2)
Waist circumferrence (cm)
W
100
Body Mass Index
80
28
27
26
25
24
Q1
Q2
Q3
Q4
Q1
Quartiles of breaks in sedentary time
Breakers
Triglycerides (log)
0.50
p for trend = 0.019
0.25
0.00
-0.25
-0.50
Q1
Q2
Q3
Q4
Quartiles of breaks in sedentary time
Prolongers
Breakers
Q2
Q3
Q4
Quartiles of breaks in sedentary time
Prolongers
2-hr plasma glucose (mmo
ol.L -1)
Prolongers
g
Log triglyce
erides (mmol.L -1)
p for trend = 0.036
Breakers
2-hr plasma glucose
7
p for trend = 0.032
6
*
5
4
Q1
Q2
Q3
Q4
Quartiles of breaks in sedentary time
Prolongers
Healy GN et al. (2008) Diabetes Care
Breakers
The Workplace – A key target
£
Awake
7 am
¤
¥
Breakfast
15 mins
Work on
computer
3.5 hrs
Transport to
work
45 mins
¡
Transport
From work
45 mins
Lunch
30 mins
Work on
computer
4 hrs
£
Watch TV
4 hrs
§
Sleep
11pm
g
Evening
meal
30 mins
W k l
Workplace
sitting…….Economic
itti
E
i Impact
I
t
Prolonged
P
l
d sitting
itti
• Increased risk of chronic disease and premature
mortality
People with Chronic Disease
• 60% less likely to participate in the
workforce
• Days off work - doubled
• Annual loss due to CD: 537,000 person years
(FT); 47, 000 person-years (PT)
AIHW 2009. Chronic disease and participation in work. Cat. No. PHE 109. Canberra: AIHW
What is the Extent of the Sitting Problem in the
Workplace?
• Limited evidence
• Dutch Workers1 (n = 7,720)
• Australian workers2 (n = 243 )
• Australian workers3 (n = 1,579)
1 579)
7 hrs/day
4.2 hrs/day
3 3 hrs/day
3.3
ALL HAVE BEEN BASED ON SELF-REPORT
1Jans
J
ett al.
l Am
A JP
Prev M
Med
d 2007,
2007 2Brown
B
et al.
l Int
I t J Obes
Ob 2003,
2003 3Mummery
M
et al.
l Am
A JP
Prev M
Med
d 2005
Stand Up
p Australia
to Improve Health and
Productivity
Re-engineering the ‘sitting’
generation
Aim: To understand the extent to which reducing sitting time in the
workplace can improve the health and productivity of working
Australians
St d Up
Stand
U Australia
A t li – Research
R
h Phases
Ph
Phase 1 – Understanding the problem
Accurately characterise sitting/sedentary patterns in Australian workers
Phase 2 – Acting on the problem
Trial and evaluate innovative strategies to reduce sitting time in the workplace
Ph
Phase
1
1: U
Understanding
d t di th
the Problem
P bl
• First study to use objective measurement of
sedentary
d
and
d physical
h i l activity
i i time
i
iin workers
k
• First study to combine objective
measurements
t with
ith self-report
lf
t
Si ifi
Significance
• Ground
Ground-breaking
breaking evidence on the extent to
which sedentary time occupies the work day in
employees
l
• Key evidence necessary for the development
and
d evaluation
l ti off intervention
i t
ti strategies
t t i
targeting the reduction of sitting time and
breaking up of sitting time in the workday
Stand Up
p Australia
to Improve Health and
Productivity
‘Integrated’ approach - considerations
Workplace
W
k l
Arrangements/
Conditions
Social/cultural
Individuals
Reduction
in sitting time
in the workplace
Workplace
Design
g
Organisations
&
Policies
‘A ti it permissive’
‘Activity
i i ’ workplaces
k l
- individuals
i di id l
•
•
•
•
•
Stand whilst on the telephone
‘Standing’
Standing progress meetings
Walking progress meetings - incentives
Incorporate breaks into prolonged meetings
Support standing and movement during
meetings
• ‘Standing’ hot desks
• Removal of in
in-office
office rubbish bins
‘A ti it permissive’
‘Activity
i i ’ workplaces
k l
- design
d i
Energy Expenditure Estimates During
the Workday
• Based on: Ainsworth BE, Haskell WL, Whitt MC et al.
Compendium
p
of Physical
y
Activities: an update
p
of
activity codes and MET intensities. Medicine and
Science in Sports
p
and Exercise 32 ((9)) Suppl.,
pp S498S516, 2000
• a universally accepted tool that lists specific physical
activities by rate of energy expenditure (METs)
–
–
–
–
Sitting (Code: 11580) 1
1.5
5 METS
Standing (Code: 11600) 2.3 METS
Slow pace walking (Code: 17152) 2
2.5
5 METS
Brisk walk (Code: 17200) 3.8 METS
“Gains” in workday energy expenditure through increased
standing
Sitting
only
4,498
3,704
Equivalent
‘Gain’*
(Brisk Walk –
minutes)
* 85 kg
MALE
* 70 kg
FEMALE
½ day sitting
+ ½ day
standing
5,699
1,201
50 mins
987
4,691
Standing
only
6,896
2,398
1,974
5,678
1
2
3
4
5
6
Kilojoules per 8 hour work day (1000)
100 mins
7
“Gains” in workday energy expenditure through increased
light-intensity walking around the office
Sitting
only
4,498
Equivalent
‘Gain’*
(Brisk Walk –
minutes)
* 85 kg
MALE
3,704
* 70 kg
FEMALE
2 min walk
every 30 mins
500
4,998
20 mins
379
5 min
walk
every
y
hour
4,083
625
5,123
26 mins
515
4,219
1
2
3
4
5
6
Kilojoules per 8 hour work day (1000)
7