Karin I. Proper

Sedentary Behaviors and Health Outcomes Among Adults: A Systematic Review of Prospective Studies

CONTEXT Nowadays, people spend a substantial amount of time per day on sedentary behaviors and it is likely that the time spent sedentary will continue to rise. To date, there is no review of prospective studies that systematically examined the relationship between diverse sedentary behaviors and various health outcomes among adults. PURPOSE This review aimed to systematically review the literature as to the relationship between sedentary behaviors and health outcomes considering the methodologic quality of the studies. EVIDENCE ACQUISITION In February 2010, a search for prospective studies was performed in diverse electronic databases. After inclusion, in 2010, the methodologic quality of each study was assessed. A best-evidence synthesis was applied to draw conclusions. EVIDENCE SYNTHESIS 19 studies were included, of which 14 were of high methodologic quality. Based on inconsistency in findings among the studies and lack of high-quality prospective studies, insufficient evidence was concluded for body weight-related measures, CVD risk, and endometrial cancer. Further, moderate evidence for a positive relationship between the time spent sitting and the risk for type 2 diabetes was concluded. Based on three high-quality studies, there was no evidence for a relationship between sedentary behavior and mortality from cancer, but strong evidence for all-cause and CVD mortality. CONCLUSIONS Given the trend toward increased time in sedentary behaviors, additional prospective studies of high methodologic quality are recommended to clarify the causal relationships between sedentary behavior and health outcomes. Meanwhile, evidence to date suggests that interventions aimed at reducing sedentary behavior are needed.

Review and special articleSedentary Behaviors and Health Outcomes Among Adults: A Systematic Review of Prospective Studies

CONTEXT Nowadays, people spend a substantial amount of time per day on sedentary behaviors and it is likely that the time spent sedentary will continue to rise. To date, there is no review of prospective studies that systematically examined the relationship between diverse sedentary behaviors and various health outcomes among adults. PURPOSE This review aimed to systematically review the literature as to the relationship between sedentary behaviors and health outcomes considering the methodologic quality of the studies. EVIDENCE ACQUISITION In February 2010, a search for prospective studies was performed in diverse electronic databases. After inclusion, in 2010, the methodologic quality of each study was assessed. A best-evidence synthesis was applied to draw conclusions. EVIDENCE SYNTHESIS 19 studies were included, of which 14 were of high methodologic quality. Based on inconsistency in findings among the studies and lack of high-quality prospective studies, insufficient evidence was concluded for body weight-related measures, CVD risk, and endometrial cancer. Further, moderate evidence for a positive relationship between the time spent sitting and the risk for type 2 diabetes was concluded. Based on three high-quality studies, there was no evidence for a relationship between sedentary behavior and mortality from cancer, but strong evidence for all-cause and CVD mortality. CONCLUSIONS Given the trend toward increased time in sedentary behaviors, additional prospective studies of high methodologic quality are recommended to clarify the causal relationships between sedentary behavior and health outcomes. Meanwhile, evidence to date suggests that interventions aimed at reducing sedentary behavior are needed.

Relationship between young peoples' sedentary behaviour and biomedical health indicators: a systematic review of prospective studies

The aim of this systematic review was to describe the prospective relationship between childhood sedentary behaviour and health indicators. We identified prospective studies from searches in PubMed, EMBASE, PsycInfo and Cochrane, from January 1989 through April 2010. Two reviewers independently screened the titles and abstracts for eligibility, rated the methodological quality of the studies, and extracted data.

Design of a RCT evaluating the (cost-) effectiveness of a lifestyle intervention for male construction workers at risk for cardiovascular disease: The Health under Construction study

BackgroundOf all workers in Dutch construction industry, 20% has an elevated risk of cardiovascular disease (CVD). A major risk factor for CVD risk is an unhealthy lifestyle. The aim of our study is to design a lifestyle intervention for construction workers with an elevated CVD risk, and to evaluate its (cost-) effectiveness.Methods/DesignIn a RCT, 692 participants will be randomised to either the control or the intervention group. The control group will receive usual care. For the intervention group, a lifestyle intervention has been designed based on interviews and current literature. The intervention will last 6 months and will comprise 3 face-to-face and 4 telephone contacts, consisting of individual counselling aimed at increasing daily physical activity (PA) and improving dietary behaviour, and/or smoking cessation. Counselling will take place at the Occupational Health Service (OHS), and will be done according to motivational interviewing (MI). Additional written information about healthy lifestyle will also be provided to those in the intervention group. At baseline, after 6 and after 12 months, measurements will take place. Primary outcome variables will be the lifestyle behaviours of concern, i.e. daily PA, dietary intake, and smoking status. Secondary outcome variables will be body mass index (BMI), systolic and diastolic blood pressure, total and HDL blood cholesterol, Hba1c and cardio-respiratory fitness (CRF). Sickness absenteeism and cost-effectiveness will be assessed as well. Multilevel analysis will be performed to compare all outcome measures between the intervention group and the control group.DiscussionBy improving lifestyle, CVD risk may be lowered, yielding benefits for both employee and employer. If proven effective, this lifestyle intervention will be implemented on a larger scale within the Occupational Health Services in construction industry.Trial registrationCurrent Controlled Trials ISRCTN60545588

Effect of Individual Counseling on Physical activity fitness and health: A randomized controlled trial in a workplace setting

BACKGROUND Physical inactivity and obesity are major public health problems. Our objective was to investigate the effectiveness of an individual counseling intervention at the workplace on physical activity fitness and health. Counseling content derived from the Patient-centered Assessment and Counseling for Exercise and Nutrition (PACE) program. METHODS A total of 299 employees of three municipal services in the Dutch town of Enschede were randomly allocated into intervention (n =131) and control group (n =168). Over a 9-month period, intervention group subjects were offered seven counseling sessions. Counseling was based on the individuals stage of behavioral change using PACE physical activity and nutrition protocols. Subjects in both the intervention and control group received written information about several lifestyle factors. Primary outcome measures were physical activity (total energy expenditure, during sports activities, during physical activity leisure time other than sports, and meeting the moderate-intensity public health recommendations); cardiorespiratory fitness; and prevalence of musculoskeletal symptoms. Secondary outcome measures were body composition (body mass index [BMI], and percentage of body fat measured via skinfold thicknesses); blood pressure; and blood cholesterol. RESULTS There were significant positive effects on total energy expenditure, physical activity during sports, cardiorespiratory fitness, percentage of body fat, and blood cholesterol. No effects were found for the proportion of subjects meeting the public health recommendation of moderate-intensity physical activity, physical activity during leisure time other than sports, prevalence of musculoskeletal symptoms, body mass index, and blood pressure. CONCLUSIONS Individual face-to-face counseling at the workplace based on PACE protocols positively influenced physical activity levels and some components of physical fitness. The implementation of workplace counseling programs for individuals should therefore be promoted.

Sitting time and socio-economic differences in overweight and obesity

Objectives:To examine (1) the inter-relationships between socio-economic status (SES), physical activity, three different domains of sitting time (weekday, weekend day and leisure-time sitting), and being overweight or obese (body mass index⩾25 kg/m2); and (2) the potential mediation effects of sitting time in the relationship between socio-economic factors and being overweight or obese in working Australian adults.Design:Observational epidemiological study.Subjects:One thousand forty eight working adults. Using a multistage sampling design on neighbourhood SES, participants were from high and low SES neighbourhoods of an Australian capital city.Measurements:Neighbourhood SES was assessed using census data; individual SES was based on self-reported educational attainment and household income. There were three sitting time variables: sitting time on weekdays, weekend days and in leisure time. Overweight and obesity were determined using self-reported body weight and height.Results:Gender, age, neighbourhood SES, education, working hours and physical activity were independently associated with weekday, weekend day and leisure-related sitting time. With the exception of education and working hours, these variables were also independently associated with being overweight or obese. Leisure-time sitting was found to be a mediator in the relationships between gender, education and being overweight or obese.Conclusion:Strategies to promote less sitting in leisure time are required to combat overweight and obesity in Australian adults, especially among those from low SES neighbourhoods, and among those with high levels of education and income who work long hours.

The relationship between overweight and obesity, and sick leave: a systematic review

Objective:To investigate the relationship between overweight and obesity and sick leave.Design:Systematic, qualitative review.Literature search:A search in diverse databases was performed. Studies were considered as relevant if they were longitudinal in design and investigated the relationship between overweight and obesity and sick leave.Data extraction:The methodological quality of the studies was evaluated with a quality criteria list. To draw conclusions, a best-evidence synthesis was applied.Results:Thirteen studies were included. Four out of seven found overweight to be a predictor of long-term sick leave, whereas the remaining three showed a positive trend, but did not observe significance. Of the five studies investigating the relationship between overweight and short-term sick leave, inconsistent results were shown. Seven out of eight studies investigating the relationship with long-term sick leave found obesity as a significant predictor of long-term sick leave. In contrast, there were inconsistent results between the five studies examining the relationship between obesity and short spells of sick leave.Conclusions:Although this review found inconclusive evidence for a relationship between overweight and sick leave, a clear trend was discerned in that overweight was a predictor of especially long spells (>7 days) of sick leave. As regards obesity, there was strong evidence for a positive relationship with sick leave because of the consistent finding that obesity was a significant predictor of long-term sick leave.

Dose–response relation between physical activity and sick leave

Objective: To investigate the dose–response relation between moderate and vigorous physical activity and sick leave in a working population. Methods: Data were used from three large Dutch databases: two continuous, cross sectional surveys among a representative sample of the Dutch population and one prospective cohort study. A distinction was made between duration, frequency and intensity of physical activity. The outcome measure was the number of days of sick leave. Analyses of variance were used to compare sick leave (in days) for workers with different amounts of physical activity, in particular workers meeting the physical activity recommendations v those who did not. Linear and logistic regression analyses were used to obtain effect estimates in the prospective cohort study, with the generalised estimating equation (GEE) method. Results: No relation was found between moderate physical activity and sick leave. In two databases, workers meeting the recommendation of vigorous physical activity (active at a vigorous level for at least three times a week) had significantly less sick leave: more than one day over two months and more than four days over a year. The duration of vigorous physical activity was not associated with sick leave. Conclusion: Physical activity at a vigorous intensity level for at least three times a week, as in the CDC/ACSM recommendation, has a positive effect on sick leave.

Health effects of employment: a systematic review of prospective studies

Objectives The purpose of this review was to systematically summarise the literature on the health effects of employment. Methods A search for prospective studies investigating the effect of employment on health was executed in several electronic databases, and references of selected publications were checked. Subsequently, the methodological quality of each study was assessed by predefined criteria. To draw conclusions about the health effect of employment, a best evidence synthesis was used, and if possible, data were pooled. Results 33 prospective studies were included, of which 23 were of high quality. Strong evidence was found for a protective effect of employment on depression and general mental health. Pooled effect sizes showed favourable effects on depression (OR=0.52; 95% CI 0.33 to 0.83) and psychological distress (OR=0.79; 95% CI 0.72 to 0.86). Insufficient evidence was found for general health, physical health and mortality due to lack of studies or inconsistent findings. Conclusions This systematic review indicates that employment is beneficial for health, particularly for depression and general mental health. There is a need for more research on the effects of employment on specific physical health effects and mortality to fill the knowledge gaps.

Sustained body weight reduction by an individual-based lifestyle intervention for workers in the construction industry at risk for cardiovascular disease: results of a randomized controlled trial

OBJECTIVE To evaluate the effectiveness of a lifestyle intervention for male workers in the construction industry at risk of cardiovascular disease (CVD). METHODS In a randomized controlled trial performed in the Netherlands between 2007 and 2009, usual care was compared to 6 months of individual counseling using motivational interviewing techniques, delivered face to face and by telephone. Participants aimed at improving energy balance-related behavior or smoking cessation. Linear regression analyses were performed to determine the effects. RESULTS Body weight had significantly decreased at 6 (β=-1.9, 95% CI -2.6; -1.2) and 12 months (β=-1.8, 95%CI -2.8; -1.1). The intervention effects were also significant for diastolic blood pressure at 6 months (β=-1.7, 95% CI -3.3; -0.1). Among participants who had aimed at energy balance, the intervention had a significant favorable effect on body weight at 6 (β=-2.1, 95% CI -2.9; -1.3) and 12 months (β=-2.2, 95% CI -3.1; -1.3) and at HDL cholesterol (β=0.05, 95% CI 0.01; 0.10) and HbA1c (β=-0.06, 95%CI -0.12; -0.001) at 12 months, although there was no intervention effect on these variables over time. CONCLUSION Individual-based counseling resulted in significant beneficial long-term effects on body weight. This is an important finding for occupational health, considering the rising prevalence of obesity and CVD.