Natasha Reid

Reducing occupational sedentary time: a systematic review and meta-analysis of evidence on activity-permissive workstations

Excessive sedentary time is detrimentally linked to obesity, type 2 diabetes, cardiovascular disease and premature mortality. Studies have been investigating the use of activity‐permissive workstations to reduce sedentary time in office workers, a highly sedentary target group. This review systematically summarizes the evidence for activity‐permissive workstations on sedentary time, health‐risk biomarkers, work performance and feasibility indicators in office workplaces. In July 2013, a literature search identified 38 relevant peer‐reviewed publications. Key findings were independently extracted by two researchers. The average intervention effect on sedentary time was calculated via meta‐analysis. In total, 984 participants across 19 field‐based trials and 19 laboratory investigations were included, with sample sizes ranging from n = 2 to 66 per study. Sedentary time, health‐risk biomarkers and work performance indicators were reported in 13, 23 and 23 studies, respectively. The pooled effect size from the meta‐analysis was −77 min of sedentary time/8‐h workday (95% confidence interval = −120, −35 min). Non‐significant changes were reported for most health‐ and work‐related outcomes. Studies with acceptability measures reported predominantly positive feedback. Findings suggest that activity‐permissive workstations can be effective to reduce occupational sedentary time, without compromising work performance. Larger and longer‐term randomized‐controlled trials are needed to understand the sustainability of the sedentary time reductions and their longer‐term impacts on health‐ and work‐related outcomes.

Objectively measured activity patterns among adults in residential aged care.

Objectives: To determine the feasibility of using the activPAL3TM activity monitor, and, to describe the activity patterns of residential aged care residents. Design: Cross-sectional. Setting: Randomly selected aged care facilities within 100 km of the Gold Coast, Queensland, Australia. Participants: Ambulatory, older (≥60 years) residential aged care adults without cognitive impairment. Measurements: Feasibility was assessed by consent rate, sleep/wear diary completion, and through interviews with staff/participants. Activity patterns (sitting/lying, standing, and stepping) were measured via activPAL3TM monitors worn continuously for seven days. Times spent in each activity were described and then compared across days of the week and hours of the day using linear mixed models. Results: Consent rate was 48% (n = 41). Activity patterns are described for the 31 participants (mean age 84.2 years) who provided at least one day of valid monitor data. In total, 14 (45%) completed the sleep/wear diary. Participants spent a median (interquartile range) of 12.4 (1.7) h sitting/lying (with 73% of this accumulated in unbroken bouts of ≥30 min), 1.9 (1.3) h standing, and 21.4 (36.7) min stepping during their monitored waking hours per day. Activity did not vary significantly by day of the week (p ≥ 0.05); stepping showed significant hourly variation (p = 0.018). Conclusions: Older adults in residential aged care were consistently highly sedentary. Feasibility considerations for objective activity monitoring identified for this population include poor diary completion and lost monitors.

Associations of monitor-assessed activity with performance-based physical function

The purpose of this study was to investigate the cross-sectional associations of monitor-derived measures of sedentary time and physical activity with performance-based physical function in healthy Australian adults. Data from 602 participants (mean age 58.1±10.0 years; 58% female) from the 2011/12 wave of the Australian Diabetes, Obesity and Lifestyle (AusDiab3) study were analyzed. The thigh-worn activPAL3™ monitor (7-days continuous wear) was used to derive time during waking hours spent: sitting/reclining; standing; and, stepping (overall, and separately as light [<3 METs] and moderate-to-vigorous physical activity [MVPA; ≥3 METs]), and number of sit-stand transitions. Associations of these (in hours/day, or 15 transitions/day) with physical function measures (8ft Timed Up and Go [TUG-8; log-transformed seconds] and Knee Extensor Strength [KES; kg]) were tested via linear regression, adjusting for confounders. Interactions by sex and age-category (<45; 45–54; 55–64; ≥65 years) were tested. In all participants, KES was significantly (p<0.05) associated with stepping and MVPA stepping only; none of the activity measures were associated with TUG-8. However, subgroup analysis revealed that in older adults (≥65 years), TUG-8 was associated with stepping and MVPA stepping (both p<0.05). All associations with sitting time, standing, sit-stand transition and sex interactions were not statistically significant. In summary, sitting time was not significantly associated with impaired muscle strength or gait/mobility in Australian adults aged 36–80 years, but light- to moderate activity (stepping) was positively associated with muscle strength, and gait/mobility in older adults aged ≥65 years. The direction of causation is not known and remains important to investigate considering the high prevalence of both poor function and limited activity in older age.

The Association of Sitting Time With Sarcopenia Status and Physical Performance at Baseline and 18-Month Follow-Up in the Residential Aged Care Setting

This study investigated the association of sitting time with sarcopenia and physical performance in residential aged care residents at baseline and 18-month follow-up. Measures included the International Physical Activity Questionnaire (sitting time), European Working Group definition of sarcopenia, and the short physical performance battery (physical performance). Logistic regression and linear regression analyses were used to investigate associations. For each hour of sitting, the unadjusted odds ratio of sarcopenia was 1.16 (95% confidence interval [0.98, 1.37]). Linear regression showed that each hour of sitting was significantly associated with a 0.2-unit lower score for performance. Associations of baseline sitting with follow-up sarcopenia status and performance were nonsignificant. Cross-sectionally, increased sitting time in residential aged care may be detrimentally associated with sarcopenia and physical performance. Based on current reablement models of care, future studies should investigate if reducing sedentary time improves performance among adults in end of life care.

Sitting Time and Physical Function in Australian Retirees: An Analysis of Bidirectional Relationships

Background There is limited evidence on the directionality of the associations of sitting time with physical function. This study examined the longitudinal associations of sitting time with changes in physical function, and physical function with changes in sitting time. Methos Data from 10,027 retirees in the Social, Economic, and Environmental Factor (SEEF) population-based cohort were collected in 2006-20008 and in 2010-2011. Daily sitting time was assessed by a single-item question. Physical function was measured with the Medical Outcomes Study Physical Functioning Scale (range 0-100) with participants categorized as: no; minor; moderate; or severe limitation. General linear regression models, adjusted for covariates, were used to assess associations of sitting time with physical function for all participants and in subgroups according to sex, and categories of body mass index, physical activity, and physical function limitations. Results Each hour of baseline sitting was associated with declines in physical function for women (0.20 units [95% confidence interval {CI} 0.04-0.37]) and those with severe functional limitations (0.65 units [95% CI 0.20-1.12]). Each unit of baseline physical function was associated with declines in sitting time for all participants (0.009 hours/day [95% CI 0.005-0.013]) and for all subgroups. Conclusions There was limited evidence of a bidirectional association of sitting time with physical function except in women and people with severe functional limitations. Health promotion efforts are needed to address the impact of poor physical function on increases in sitting time which result in further functional declines for these subgroups of the population.

Responding to fetal alcohol spectrum disorder in Australia: Fetal alcohol spectrum disorder

Fetal alcohol spectrum disorder (FASD) is a significant public health issue in Australia that is poorly diagnosed, chronic and costly. FASD is a diffuse acquired brain injury secondary to prenatal alcohol exposure. The prevalence rate of FASD among the general population in Australia is currently unknown; however, an Australian study in a selected high‐risk population reported some of the highest rates of FASD in the world. A common misconception among clinicians is that a child must have ‘the face’ of FASD to have the disorder. This is incorrect. The three sentinel facial features only occur in the minority of individuals with FASD. FASD should be considered as a ‘whole body’ disorder as increased susceptibility to chronic health problems suggests suboptimal in utero environments places the individual at risk of later disease. Clinicians are reluctant to consider FASD as a possible diagnosis because of the concern of inducing stigma; however, this concern is neither supported by the evidence nor patient stories. The Australian Guide to the Diagnosis of FASD is now available to assist health professionals in providing timely and accurate diagnoses, which can lead to improved outcomes via evidence‐based intervention and is an important first step in future prevention.