Nicola W. Burton

Occupational sitting and health risks: a systematic review

CONTEXT Emerging evidence suggests that sedentary behavior (i.e., time spent sitting) may be negatively associated with health. The aim of this study was to systematically review the evidence on associations between occupational sitting and health risks. EVIDENCE ACQUISITION Studies were identified in March-April 2009 by literature searches in PubMed, PsycINFO, CENTRAL, CINAHL, EMBASE, and PEDro, with subsequent related-article searches in PubMed and citation searches in Web of Science. Identified studies were categorized by health outcome. Two independent reviewers assessed methodologic quality using a 15-item quality rating list (score range 0-15 points, higher score indicating better quality). Data on study design, study population, measures of occupational sitting, health risks, analyses, and results were extracted. EVIDENCE SYNTHESIS 43 papers met the inclusion criteria (21% cross-sectional, 14% case-control, 65% prospective); they examined the associations between occupational sitting and BMI (n=12); cancer (n=17); cardiovascular disease (CVD, n=8); diabetes mellitus (DM, n=4); and mortality (n=6). The median study-quality score was 12 points. Half the cross-sectional studies showed a positive association between occupational sitting and BMI, but prospective studies failed to confirm a causal relationship. There was some case-control evidence for a positive association between occupational sitting and cancer; however, this was generally not supported by prospective studies. The majority of prospective studies found that occupational sitting was associated with a higher risk of DM and mortality. CONCLUSIONS Limited evidence was found to support a positive relationship between occupational sitting and health risks. The heterogeneity of study designs, measures, and findings makes it difficult to draw definitive conclusions at this time.

Measuring total and domain-specific sitting: a study of reliability and validity.

PURPOSE Although independent relationships between sitting behaviors (mainly television viewing) and health outcomes have been reported, few studies have examined the measurement properties of self-report sitting questions. This study assessed gender-specific test-retest reliability and validity of a questionnaire that assessed time spent sitting on weekdays and weekend days: 1) traveling to and from places, 2) at work, 3) watching television, 4) using a computer at home, and 5) for leisure, not including television. METHODS Test-retest reliability of domain-specific sitting time (min x d(-1)) on weekdays and weekend days was assessed using data collected on two occasions (median = 11 d apart). Validity of domain-specific self-reported sitting time on weekdays and weekend days was assessed against log data and sedentary accelerometer data. RESULTS Complete repeat questionnaire and log data were obtained from 157 women (aged 51-59 yr) and 96 men (aged 45-63 yr). Reliability coefficients were high for weekday sitting time at work, watching television, and using a computer at home (r = 0.84-0.78) but lower for weekend days across all domains (r = 0.23-0.74). Validity coefficients were highest for weekday sitting time at work and using a computer at home (r = 0.69-0.74). With the exception of computer use and watching television for women, validity of the weekend-day sitting time items was low. CONCLUSIONS This study confirms the importance of measuring domain- and day-specific sitting time. The measurement properties of questions that assess structured domain-specific and weekday sitting time were acceptable and may be used in future studies that aim to elucidate associations between domain-specific sitting and health outcomes.

Effects of interventions in health care settings on physical activity or cardiorespiratory fitness

INTRODUCTION This paper reviews studies of physical activity interventions in health care settings to determine effects on physical activity and/or fitness and characteristics of successful interventions. METHODS Studies testing interventions to promote physical activity in health care settings for primary prevention (patients without disease) and secondary prevention (patients with cardiovascular disease [CVD]) were identified by computerized search methods and reference lists of reviews and articles. Inclusion criteria included assignment to intervention and control groups, physical activity or cardiorespiratory fitness outcome measures, and, for the secondary prevention studies, measurement 12 or more months after randomization. The number of studies with statistically significant effects was determined overall as well as for studies testing interventions with various characteristics. RESULTS Twelve studies of primary prevention were identified, seven of which were randomized. Three of four randomized studies with short-term measurement (4 weeks to 3 months after randomization), and two of five randomized studies with long-term measurement (6 months after randomization) achieved significant effect on physical activity. Twenty-four randomized studies of CVD secondary prevention were identified; 13 achieved significant effects on activity and/or fitness at twelve or more months. Studies with measurement at two time points showed decaying effects over time, particularly if the intervention were discontinued. Successful interventions contained multiple contacts, behavioral approaches, supervised exercise, provision of equipment, and/or continuing intervention. Many studies had methodologic problems such as low follow-up rates. CONCLUSION Interventions in health care settings can increase physical activity for both primary and secondary prevention. Long-term effects are more likely with continuing intervention and multiple intervention components such as supervised exercise, provision of equipment, and behavioral approaches. Recommendations for additional research are given.

Feasibility and effectiveness of psychosocial resilience training: a pilot study of the READY program.

Despite many studies on the characteristics associated with resilience, there is little research on interventions to promote resilience in adults. The aims of this study were to gather preliminary information regarding the feasibility of implementing a group psychosocial resilience training program (REsilience and Activity for every DaY, READY) in a workplace setting, and to assess if program would potentially promote well-being. The program targets five protective factors identified from empirical evidence: Positive emotions, cognitive flexibility, social support, life meaning, and active coping. Resilience enhancement strategies reflect core acceptance and commitment therapy (ACT) processes and cognitive behavior therapy strategies. Sessions involve psychoeducation, discussions, experiential exercises, and home assignments. Sixteen participants completed 11 × two h group sessions over 13 weeks. Baseline and post-intervention assessment included self-administered questionnaires, pedometer step counts, and physical and hematological measures. Data were analyzed using standardized mean differences and paired t-tests. There was a significant improvement between baseline and post intervention scores on measures of mastery (p = 0.001), positive emotions (p = 0.002), personal growth (p = 0.004), mindfulness (p = 0.004), acceptance (p = 0.012), stress (p = 0.013), self acceptance (p = 0.016), valued living (p = 0.022), autonomy (p = 0.032) and total cholesterol (p = 0.025). Participants rated the program and materials very highly. These results indicate that the READY program is feasible to implement as a group training program in a workplace setting to promote psychosocial well-being.

Do walking strategies to increase physical activity reduce reported sitting in workplaces: a randomized control trial

BackgroundInterventions designed to increase workplace physical activity may not automatically reduce high volumes of sitting, a behaviour independently linked to chronic diseases such as obesity and type II diabetes. This study compared the impact two different walking strategies had on step counts and reported sitting times.MethodsParticipants were white-collar university employees (n = 179; age 41.3 ± 10.1 years; 141 women), who volunteered and undertook a standardised ten-week intervention at three sites. Pre-intervention step counts (Yamax SW-200) and self-reported sitting times were measured over five consecutive workdays. Using pre-intervention step counts, employees at each site were randomly allocated to a control group (n = 60; maintain normal behaviour), a route-based walking group (n = 60; at least 10 minutes sustained walking each workday) or an incidental walking group (n = 59; walking in workday tasks). Workday step counts and reported sitting times were re-assessed at the beginning, mid- and endpoint of intervention and group mean± SD steps/day and reported sitting times for pre-intervention and intervention measurement points compared using a mixed factorial ANOVA; paired sample-t-tests were used for follow-up, simple effect analyses.ResultsA significant interactive effect (F = 3.5; p < 0.003) was found between group and step counts. Daily steps for controls decreased over the intervention period (-391 steps/day) and increased for route (968 steps/day; t = 3.9, p < 0.000) and incidental (699 steps/day; t = 2.5, p < 0.014) groups. There were no significant changes for reported sitting times, but average values did decrease relative to the control (routes group = 7 minutes/day; incidental group = 15 minutes/day). Reductions were most evident for the incidental group in the first week of intervention, where reported sitting decreased by an average of 21 minutes/day (t = 1.9; p < 0.057).ConclusionCompared to controls, both route and incidental walking increased physical activity in white-collar employees. Our data suggests that workplace walking, particularly through incidental movement, also has the potential to decrease employee sitting times, but there is a need for on-going research using concurrent and objective measures of sitting, standing and walking.

Accuracy of body mass index estimated from self-reported height and weight in mid-aged Australian women

Objective: To assess the accuracy of body mass index (BMI) estimated from self‐reported height and weight from a mailed survey, in a population‐based sample of mid‐aged Australian women.

Neighborhood Disadvantage and Physical Activity: Baseline Results from the HABITAT Multilevel Longitudinal Study

PURPOSE To examine the association between neighborhood disadvantage and physical activity (PA). METHODS We use data from the HABITAT multilevel longitudinal study of PA among middle-aged (40-65 years) men and women (N = 11,037, 68.5% response rate) living in 200 neighborhoods in Brisbane, Australia. PA was measured using three questions from the Active Australia Survey (general walking, moderate, and vigorous activity), one indicator of total activity, and two questions about walking and cycling for transport. The PA measures were operationalized by using multiple categories based on time and estimated energy expenditure that were interpretable with reference to the latest PA recommendations. The association between neighborhood disadvantage and PA was examined with the use of multilevel multinomial logistic regression and Markov chain Monte Carlo simulation. The contribution of neighborhood disadvantage to between-neighborhood variation in PA was assessed using the 80% interval odds ratio. RESULTS After adjustment for sex, age, living arrangement, education, occupation, and household income, reported participation in all measures and levels of PA varied significantly across Brisbanes neighborhoods, and neighborhood disadvantage accounted for some of this variation. Residents of advantaged neighborhoods reported significantly higher levels of total activity, general walking, moderate, and vigorous activity; however, they were less likely to walk for transport. There was no statistically significant association between neighborhood disadvantage and cycling for transport. In terms of total PA, residents of advantaged neighborhoods were more likely to exceed PA recommendations. CONCLUSIONS Neighborhoods may exert a contextual effect on the likelihood of residents participating in PA. The greater propensity of residents in advantaged neighborhoods to do high levels of total PA may contribute to lower rates of cardiovascular disease and obesity in these areas.

Does Physical Activity Impact on Presenteeism and Other Indicators of Workplace Well-Being?

The term ‘presenteeism’ is a relatively new concept in workplace health, and has come to signify being at work despite poor health and performing below par. Presenteeism, which is potentially critical to employers, has been associated with a range of psychosocial outcome measures, such as poor mental health and employee well-being. Physical activity is a potential strategy for reducing presenteeism, and for improving the mental health of employees. This article reviews evidence on the relationships between physical activity and employee well-being and presenteeism in the workplace, and identifies directions for research in an emerging field.Electronic and manual literature searches were used to identify 20 articles that met the inclusion criteria. These included 13 intervention trials (8 randomized controlled trials, 5 comparison trials) and 7 observational studies (3 cohort, 4 cross-sectional). Outcome measures were grouped into workplace well-being, psychosocial well-being and physical well-being. Studies measured a wide variety of outcomes, with absenteeism being the most commonly assessed. Evidence indicated a positive association between physical activity and psychosocial health in employees, particularly for quality of life and emotional well-being. However, findings were inconclusive as to the role of physical activity in promoting workplace well-being. Only one study reported on presenteeism, with mixed evidence for outcomes.This article indicates that physical activity and employee psychosocial health are positively related, but there is limited evidence of a relationship between physical activity and presenteeism. A standardized definition of presenteeism and an appropriate evaluation tool are key research priorities if the complex relationships between physical activity and workplace well-being are to be better understood.

A prospective study of overweight, physical activity, and depressive symptoms in young women.

This study examined the prospective associations of BMI, physical activity (PA), changes in BMI, and changes in PA, with depressive symptoms. Self‐reported data on height, weight, PA, selected sociodemographic and health variables and depressive symptoms (CESD‐10) were provided in 2000 and 2003 by 6,677 young adult women (22–27 years in 2000) participating in the Australian Longitudinal Study on Womens Health (ALSWH). Results of logistic regression analyses showed that the odds of developing depressive symptoms at follow‐up (2003) were higher in women who were overweight or obese in 2000 than in healthy weight women, and lower in women who were active in 2000 than in sedentary women. Changes in BMI were significantly associated with increased odds of depressive symptoms at follow‐up. Sedentary women who increased their activity had lower odds of depressive symptoms at follow‐up than those who remained sedentary. Increases in activity among initially sedentary young women were protective against depressive symptoms even after adjusting for BMI changes. These findings indicate that overweight and obese young women are at risk of developing depressive symptoms. PA appears to be protective against the development of depressive symptoms, but does not attenuate the depressive symptoms associated with weight gain. However, among initially sedentary young women, even small increases in PA over time may reduce the odds of depressive symptoms, regardless of weight status.

A preliminary study of the effects of Tai Chi and Qigong medical exercise on indicators of metabolic syndrome, glycaemic control, health-related quality of life, and psychological health in adults with elevated blood glucose

Objectives To evaluate the feasibility, acceptability and effects of a Tai Chi and Qigong exercise programme in adults with elevated blood glucose. Design, Setting, and Participants A single group pre–post feasibility trial with 11 participants (3 male and 8 female; aged 42–65 years) with elevated blood glucose. Intervention Participants attended Tai Chi and Qigong exercise training for 1 to 1.5 h, 3 times per week for 12 weeks, and were encouraged to practise the exercises at home. Main Outcome Measures Indicators of metabolic syndrome (body mass index (BMI), waist circumference, blood pressure, fasting blood glucose, triglycerides, HDL-cholesterol); glucose control (HbA1c, fasting insulin and insulin resistance (HOMA)); health-related quality of life; stress and depressive symptoms. Results There was good adherence and high acceptability. There were significant improvements in four of the seven indicators of metabolic syndrome including BMI (mean difference −1.05, p<0.001), waist circumference (−2.80 cm, p<0.05), and systolic (−11.64 mm Hg, p<0.01) and diastolic blood pressure (−9.73 mm Hg, p<0.001), as well as in HbA1c (−0.32%, p<0.01), insulin resistance (−0.53, p<0.05), stress (−2.27, p<0.05), depressive symptoms (−3.60, p<0.05), and the SF-36 mental health summary score (5.13, p<0.05) and subscales for general health (19.00, p<0.01), mental health (10.55, p<0.01) and vitality (23.18, p<0.05). Conclusions The programme was feasible and acceptable and participants showed improvements in metabolic and psychological variables. A larger controlled trial is now needed to confirm these promising preliminary results.