“Walking is mans best medicine”
Still holds true today!
Ramazzini (1633 – 1714AD)
Ramazzini on Sitting Occupations
“…those who sit at their work and are therefore called ‘chair workers,’ such as cobblers and tailors, suffer from their own particular diseases … [These workers] … suffer from general ill-health and an excessive accumulation of unwholesome humors….”
Sedentary workers … “suffer from the itch, are a bad colour, and in poor condition ….. for when the body is not kept moving the blood becomes tainted, its waste matter lodges in the skin, and the condition of the whole body deteriorates”.
The AICR have a lovely diagram showing how we can achieve breaks in sedentary behaviour.
Can We Change the Behaviour With What We Already Know?
Some catchy wee phrases
Neville Owen suggested we need to:
Reduce Automobile Time, Reduce Screen Time, Reduce Chair Time.
Stand Up, Sit Less, Move More, Move Often
John Buckley reminds us that by just standing we double our energy expenditure, and by standing we stimulate biological and autonomic mechanisms within the body.
Interventions Presented at the WCAA
Paul Gardiner and Benedicte Deforche presented interventions to reduce SB in older adults. Both Paul and Benedicte showed the importance of motivation, goal setting, planning and feedback for successful outcomes. Paul showed a 3.2% reduction in SB in older adults by about 30 mins with simple advice, than can be easily implemented in day to day life. He used a workbook, action plan and personal feedback profile in his study. He felt the patient’s engaged well and they reported a high level of satisfaction with the intervention.
Benedicte was interested the diabetic population and used face-to-face and telephone behavioural change methods. The findings were mixed. There were behavioural changes, such as reduction in sedentary time by accelerometer and self-report, along with an increase in physical activity. However, this change was not echoed in the biological markers of HbA1c. This could be as the study was only over a relativity short period, further work required. This underlines the fact that we need to ensure the behavioural change will actually influence the body’s mechanism.
With thanks to Neville Owen, Sebastien Chastin, Charles Matthews, Emmanuel Stamatakis, Margaret Grant, Benedicte Deforche, Paul Gardiner, John Buckley, Yu Ling Chen, Shilpa Dogra, Iuliana Hartescu, Sally Barber, Sandra Agyapong-Badu, Susan Pivavet, Ceilia Edwen, Sandra Van Oostrom, Ruth Melo, Carla Nascimento, Karen Francis, Jitka Jancova, Jaime Cuenca who made this wee blether possible!
Older Adult Sedentary Behaviour
It is well established from epidemiological evidence that as have more birthdays we tend to become more sedentary. Paul Gardiner noted that there has been little focus on sedentary behaviour in older adults with < 10% of papers on sedentary behaviour including the older population, so we will need to change that!
Shilpa Dodra, presented evidence that there is an independent relationship between sedentary behaviour and physical activity when considering the success of ageing using multiple outcomes. In females this relationship was clear, the male population did not show such a clear relationship.
Chuck Matthews and Emmanuel Stamatakis presented the findings of surveys on with older adults and showed that even high levels of physical activity do not mitigate the effect of high levels of sedentary behaviour in older adults. Emmanuel, noted that TV viewing is consistently associated with cardiometabolic risk factors where are accelerometry data is less convincing.
Yu Ling Chen presented her findings on prevalence of SB in adults over the age of 50. She found that those over 50 spend at least 2hrs watching TV and the majority watch between 1-4hrs a day. SHe highlighted the problem in collation of the information were measurement and analysis are varied from one study to the next. I have experienced similar difficulties when conducting my own systematic review on prevalence and amount of SB in the over 60’s.
In smaller scale studies sedentary behaviour in the care setting have been considered by Sally Barber and Margaret Grant. Margaret Grant showed when older adult are admitted to a hospital they have high levels of sedentary behaviour, even when they are medically stable, assessed to be independent on admission and in a rehab ward. The reason for this may be that they don’t have the same stimulus that they would at home, such as activities of daily living (cooking etc). When participants are followed up at home in the days after discharge their SB decreases.
There seems to be little work on SB in the clinical environment, so we really need to do more work in there to make sure the patients don’t increase sedentariness as this has potentially could hamper their recovery.
Neville Owen gave an excellent 1st Keynote on Friday’s programme at WCAA 2012. He presented “New Insights into Sedentary Behaviour and Older Adults” and I also caught great presentations from the following: Charles Matthews, Emmanuel Stamatakis, Margaret Grant, Benedicte Deforche, Paul Gardiner, John Buckley, Yu Ling Chen, Shilpa Dogra, Iuliana Hartescu, Sally Barber, Sandra Agyapong-Badu, Susan Pivavet, Ceilia Edwen, Sandra Van Oostrom, Ruth Melo, Carla Nascimento, Karen Francis, Jitka Jancova, Jaime Cuenca and many others report the importance of sedentary behaviour within their presentations. So here’s a wee summary of the lay of the land in sedentary behaviour (SB) territories over a 3 part series.
“Sedentary behaviour is any waking activity characterised by energy expenditure of ≤ 1.5MET’s and a sitting or reclined posture” (SBRN, 2012)
With the emergence of the digital revolution we have the opportunity to sit in most environments, domestic, work, travel and leisure. The problem with large amounts of sitting, is that we tend not to use very much energy (usually less than 1.5METs), obviously there are a quite a few exceptions propelling a wheelchair, cycling, horse riding, rowing, seated manual work, and so on. The notion of sitting being detrimental to health is not a new one and research goes back to Morris, et al., work in 1953 where he observed the incidence coronary heart disease to be higher in bus drivers and telephonist, than in conductors and postal workers (respectively). From there, the message was to increase physical activity and we now have national guidelines on physical activity for all age groups. So now we are beginning to shine the spotlight on sedentary behaviour.
Neville Owen presented the keynote with information from a population level right down to a cellular level; demonstrating that there is a detrimental health association with being sedentary, relating to morbidity (cardio-vascular risk, cancer, metabolic syndrome, diabetes, obesity) and mortality. The strongest associations of which seems to be with TV viewing, we consider TV viewing to be a proxy for sedentariness. Total sitting time and total sedentary time can also be measured by objective and subjective means. The patterns and bouts of which seem to be important factor and it may be that even short breaks in SB could perhaps lessen some of the detrimental effects of sedentariness.
Iuliana Hartescu brought to our attention that amount of sleep can also be related to CVD and suggest that maybe sleep should be considered as part of SB, or at the very least consider it alongside SB to observe it bearing.
Some feel that sedentariness is an inevitable part of ageing and indeed with older adults sitting is not always bad, as with all ages, we do need a certain amount of rest and recovery! There are many social and cultural experiences that shape our behaviour. As we get older, I guess there has been more time for these behaviours to be cemented in everyday life and perhaps a harder habit to break. Neville Owen suggest that on average, older adults seem to spend about 60% of their day in SB and the most popular behaviour TV watching, but what we really need to sus out is why this is: is it boredom? Rest? An Information Source? Entertainment? Jaime Cuenca showed us that older adults actually give very little value to TV watching and give much more value to activities for activities such as hobbies and interaction with the family.
SB Ref – SBRN (2012) Standardised use of the term “sedentary” and “sedentary behaviour”, Applied Physiology, Nutrition and Metabolism, 37:540-542.
A brief lowdown for those who have not heard of Sense Cam…..
The key instigators of the Sense Cam aka Vicon Revue (SC) rise to fame have been Steve Hodge, Alan Smeaton, Emma Berry, Charlie Foster, Aiden Docherty, Cathal Gurrin and Paul Kelly. They have been involved in many projects using the SC. The SC was largely initially used as a retrospective memory aid in those adults with cognitive decline and conditions, such as dementia.
In recent years, its has been used for a diverse number of purposes, from dieticians following diet habits, to market researchers following the buying behaviour. In addition, a lot of researchers are using the SC to validate other pieces of equipment. With the emergence and boom of social networking and life-logging to chart daily activities in picture is becoming a real hit with people. Cathal Gurrin has made a real commitment to this since 2006 by collecting over 8 million images of his day to day life!
My area of research is concerned with reducing sedentary behaviour in older adults. In my area of interest Jacqueline Kerr has been working with using SC to define sedentary behaviour. Using a coding protocol she and her team initially used the SC images to define the accuracy of Actigraph accelerometers in the definition of sedentary behaviour and physical activity. She used a small convenience sample for this and is now working on a larger scale project in older adult will this using only the camera. She is looking towards automatic recognition of behaviour, so that analysis is less laborious. Gemma Wilson has been using the SC to discover how pain relates to function in older adults and used the SC in association with the Life Shirt (which defines activity).
To sum up, there is massive potential for the use of SC in the research and clinical environment, as well as for personal use by individuals.
How we actually define, measure and analyse sedentary behaviour (SB) was the topic for discussion meeting on “Classification of Sedentary Behaviour: Towards a Taxonomy”. Dr Sebastien Chastin facilitated the discussion. Patient and expert alike were invited to the meeting, but unfortunately the public representation was low at this particular meeting.
A starting point:
“Sedentary behaviour is not simply a lack of physical activity but is a cluster of individual behaviours where sitting or lying is the dominant mode of posture and energy expenditure is very low.” (DoH, 2011 cited in SIT, other definitions are also considered).
The meeting spurred discussion from physiologist, epidemiologists, computer engineers, health care professionals, psychologist, students and others. We considered if we could gain expert consensus in the form of perhaps a hierarchical or faceted/networked method of defining older people’s behaviour. The majority of people seem to feel that location/environment seems to be an appropriate starting point and location is a reasonably easy aspect. It is black and white – we are either indoors or outdoors or travelling, expanding on this we could be in a domestic, work, maybe leisure environment. Interaction with others is another important aspect for us to understand if there is a social relationship to sedentary behaviour. Thus, when people are sedentary are they on their own, or with other and, if they are with others, are they engaging with them or perhaps not and just in a public place. Should it be task driven? For example we have essential (eating, activities of daily living) and non-essential tasks (reading, tv watching, hobbies) in the day or should we be merely be describing the actual activity or asking the participant to state the activity and categorise it – TV watching, using a computer, (or combine with “screen use”), eating, driving, reading. Should sleep be included as SB? How important is posture? Relationship to energy expenditure?
If we really want to know about how we can begin to change behaviour, we need understand the context and motives for the behaviour, so we really need the participant to be telling us this. So, why are people sitting? resting, following a day of activity; boredom; education; social interaction; when are they doing it? for how long? the list goes on!
Defining the purpose of the measurement is crucial, so it a difficult task to consider how we can meet the needs of everyone in the measurement of SB. Some feel there is not much point in consensus to such an extent, I suppose the looser the structure the more amenable it is for consensus across specialities. Can well put all this together in one assessment or is this unreasonable? Do we have to know everything or are some measurements more important. Objective? subjective? a bit of both? do we know enough at present to know what is important to measure? One thing is for sure, the meeting raised more questions than it answered! And the discussion continues at: http://sedentarybehaviourclassification.net/
Who contributed to the discussion? Neville Owen, Charles Matthews, Sebastien Chastin, Paul Gardiner, Emmanuel Stamatakis, Mark Hamer, Jannique Van Uffelen, Phillipa Dall, Yu Ling Chen, Shilpa Dogra, Iuliana Hartescu, Barbara Jefferis, me and many others, I just didn’t catch everyone’s name, sorry if you are one of them (let me know).
MEASUREMENT OF CONTEXT OF SEDENTARY BEHAVIOUR: FEASIBILITY STUDY IN USING COUPLED ACTIVITY MONITOR AND BODY WORN CAMERA
Presently, cross sectional evidence exist regarding time spend in Sedentary Behaviour (SB) by older adults (OA), but little is known about the actual context of this behaviour. Knowing the context of the behaviour is crucial if we are to develop appropriate and successful outcomes. Time lapse body worn cameras offer the opportunity to define context of the behaviour.
I presented the findings of my small scale feasibility study on the use of ActivPAL activity monitors and Vicon Revue camera to define the context of SB on Thur 16th August at the WCAA 2012. The aim of the study was to determine the feasibility of older adults wearing a camera and activity monitor to allow us to define the context of SB. I wanted to know how both the researchers and the participant would get on with using the equipment, the idea being this would inform the design of a larger scale project.
We recruited 6 volunteers from the Glasgow Caledonian University Older Adult Database to take part in the study. The study took place over 7 days. I kept a diary and completed a post study interview with each of the participants. I followed this up with thematic analysis.
The use of body worn cameras and activity monitoring should allow us to have a better understanding of the context of SB in OA. OA’s generally found the equipment to be acceptable to wear and did not interfere with privacy, safety or change behaviour. However, they did have some problems with the actual functioning of the camera and there are reliability issues with the Vicon Revue camera. I hope to publish my findings soon……