In the last decade, sedentary behavior has emerged as a new risk factor for health. The elderly spend most of their awake time in sedentary activities. Despite this high exposure, the impact of this ...sedentary behavior on the health of this population has not yet been reviewed. We systematically reviewed evidence for associations between sedentary behavior and multiple health outcomes in adults over 60 years of age.
We searched the Medline, Embase, Web of Science, SPORTDiscus, PsycINFO, CINAHL, LILLACS, and Sedentary Research Database for observational studies published up to May 2013. Additionally, we contacted members of the Sedentary Behaviour Research Network to identify articles that were potentially eligible. After inclusion, the methodological quality of the evidence was assessed in each study.
We included 24 eligible articles in our systematic review, of which only 2 (8%) provided high-quality evidence. Greater sedentary time was related to an increased risk of all-cause mortality in the older adults. Some studies with a moderate quality of evidence indicated a relationship between sedentary behavior and metabolic syndrome, waist circumference, and overweightness/obesity. The findings for other outcomes such as mental health, renal cancer cells, and falls remain insufficient to draw conclusions.
This systematic review supports the relationship between sedentary behavior and mortality in older adults. Additional studies with high methodological quality are still needed to develop informed guidelines for addressing sedentary behavior in older adults.
1) To synthesize the current observational evidence for the association between sedentary behavior and health outcomes using information from systematic reviews. 2) To assess the methodological ...quality of the systematic reviews found.
Medline; Excerpta Medica (Embase); PsycINFO; and Web of Science were searched for reviews published up to September 2013. Additional publications were provided by Sedentary Behaviour Research Network members. The methodological quality of the systematic reviews was evaluated using recommended standard criteria from AMSTAR. For each review, improper use of causal language in the description of their main results/conclusion was evaluated. Altogether, 1,044 review titles were identified, 144 were read in their entirety, and 27 were included. Based on the systematic reviews with the best methodological quality, we found in children and adolescents, strong evidence of a relationship between time spent in sedentary behavior and obesity. Moreover, moderate evidence was observed for blood pressure and total cholesterol, self-esteem, social behavior problems, physical fitness and academic achievement. In adults, we found strong evidence of a relationship between sedentary behavior and all-cause mortality, fatal and non-fatal cardiovascular disease, type 2 diabetes and metabolic syndrome. In addition, there is moderate evidence for incidence rates of ovarian, colon and endometrial cancers.
This overview based on the best available systematics reviews, shows that sedentary behavior may be an important determinant of health, independently of physical activity. However, the relationship is complex because it depends on the type of sedentary behavior and the age group studied. The relationship between sedentary behavior and many health outcomes remains uncertain; thus, further studies are warranted.
Strategic partnership is a logical approach to face some of the public health problems. However, its application is somewhat more complex. In this paper our experience with three networks (Agita São ...Paulo, Physical Activity Network of Americas, and Agita Mundo Network) was described. In the case of Agita São Paulo even the name was a consequence of a partnership with a marketing company, and is an idiomatic expression that means much more than just to move your body. It also means to move psychologically and socially, with the concept of “active citizenship”. Among the important features of that intervention, we highlighted: (a) national and international intellectual partnership; (b) strong institutional partnerships, including government in one hand, and non-governmental and private sector in the other hand, in a so called: “two-hats approach”; (c) minimal formalization/maximal flexibility; (d) a signed letter of agreement: an active symbol of institutional commitment; (e) use the “mobile management” adaptation of the ecological model, in which attention was given to intrapersonal, social, and physical environmental factors, in a dynamic way; (f) attention to inter-sectoral as well as to intra-sectoral partners, in which creates incentives for participation of more than one representative from each sector; (g) the inclusion principle, that was not restricted to the institution, but affected the program actions, materials, and particularly the messages; (h) a high level of legitimacy of the coordination institution in the leadership; (i) special attention to improve environment supports for physical activity, such as: strategic partnerships established with the Metro System, that serves over 1 million persons/day; the Truck Drivers Radio Station; the State Secretariat of Environment, that built a walking path around its main building; the city of São Caetano do Sul, with the healthy sidewalk program; the city of Santana do Parnaiba building a walking path around the outpatients clinic, as well as the establishment of a fitness room in the basic unit of health; and Sorocaba, a city of 600,000 inhabitants, that after 4 years of the program of building walk and bike pathways, and parks, found a decrease in hospitalization of 50% by stroke, and 57% of diabetes type 2. A recent paper has shown that sedendarism has declined relatively about 70% from 2002 to 2008 in the State of Sao Paulo, and World Bank has reported that Agita represents a saving of 310 million US dollars per year in the health sector of Sao Paulo. All this scenario strongly suggests that the social issue in the developing countries facilitates the success of strategic partnerships.
Objective To evaluate the relationship between children's lifestyles and health-related quality of life and to explore whether this relationship varies among children from different world regions. ...Study design This study used cross-sectional data from the International Study of Childhood Obesity, Lifestyle and the Environment. Children (9-11 years) were recruited from sites in 12 nations (n = 5759). Clustering input variables were 24-hour accelerometry and self-reported diet and screen time. Health-related quality of life was self-reported with KIDSCREEN-10. Cluster analyses (using compositional analysis techniques) were performed on a site-wise basis. Lifestyle behavior cluster characteristics were compared between sites. The relationship between cluster membership and health-related quality of life was assessed with the use of linear models. Results Lifestyle behavior clusters were similar across the 12 sites, with clusters commonly characterized by (1) high physical activity (actives); (2) high sedentary behavior (sitters); (3) high screen time/unhealthy eating pattern (junk-food screenies); and (4) low screen time/healthy eating pattern and moderate physical activity/sedentary behavior (all-rounders). Health-related quality of life was greatest in the all-rounders cluster. Conclusions Children from different world regions clustered into groups of similar lifestyle behaviors. Cluster membership was related to differing health-related quality of life, with children from the all-rounders cluster consistently reporting greatest health-related quality of life at sites around the world. Findings support the importance of a healthy combination of lifestyle behaviors in childhood: low screen time, healthy eating pattern, and balanced daily activity behaviors (physical activity and sedentary behavior). Trial registration ClinicalTrials.gov : NCT01722500.
Background Understanding environmental correlates of physical activity can inform policy changes. Surveys were conducted in 11 countries using the same self-report environmental variables and the ...International Physical Activity Questionnaire, allowing analyses with pooled data. Methods The participating countries were Belgium, Brazil, Canada, Colombia, China (Hong Kong), Japan, Lithuania, New Zealand, Norway, Sweden, and the U.S., with a combined sample of 11,541 adults living in cities. Samples were reasonably representative, and seasons of data collection were comparable. Participants indicated whether seven environmental attributes were present in their neighborhood. Outcomes were measures of whether health-related guidelines for physical activity were met. Data were collected in 2002–2003 and analyzed in 2007. Logistic regression analyses evaluated associations of physical activity with environmental attributes, adjusted for age, gender, and clustering within country. Results Five of seven environmental variables were significantly related to meeting physical activity guidelines, ranging from access to low-cost recreation facilities (OR=1.16) to sidewalks on most streets (OR=1.47). A graded association was observed, with the most activity–supportive neighborhoods having 100% higher rates of sufficient physical activity compared to those with no supportive attributes. Conclusions Results suggest neighborhoods built to support physical activity have a strong potential to contribute to increased physical activity. Designing neighborhoods to support physical activity can now be defined as an international public health issue.
To document time trends in physical activity in the state of São Paulo, Brazil (2002-2008). In addition, we discuss the role of Agita São Paulo at explaining such trends.
Cross-sectional surveys were ...carried out in 2002, 2003, 2006, and 2008 in the state of São Paulo, Brazil, using comparable sampling approaches and similar sample sizes. In all surveys, physical activity was measured using the short version of the International Physical Activity Questionnaire. Separate weekly scores of walking and moderate- and vigorous-intensity physical activities were generated; cutoff points of 0 and 150 min·wk were used. Also, we created a total physical activity score by summing these three types of activity. We used logistic regression models for adjusting time trends for the different sociodemographic compositions of the samples.
The prevalence of no physical activity decreased from 9.6% in 2002 to 2.7% in 2008, whereas the proportion of subjects below the 150-min threshold decreased from 43.7% in 2002 to 11.6% in 2008. These trends were mainly explained by increases in walking and moderate-intensity physical activity. Increases in physical activity were slightly greater among females than among males. Logistic regression models confirmed that these trends were not due to the different compositions of the samples.
Physical activity levels are increasing in the state of São Paulo, Brazil. Considering that the few data available in Brazil using the same instrument indicate exactly the opposite trend and that Agita São Paulo primarily incentives the involvement in moderate-intensity physical activity and walking, it seems that at least part of the trends described here are explained by the Agita São Paulo program.
PURPOSETo determine the relationships between moderate-to-vigorous physical activity (MVPA), vigorous physical activity (VPA), sedentary time, and obesity in children from 12 countries representing a ...wide range of human development.
METHODSThe sample included 6539 children age 9–11 yr. Times in MVPA, VPA, and sedentary behaviors were assessed by accelerometry. The body mass index (BMI; kg·m) was used to classify children as obese based on z-scores (> +2 SD) from World Health Organization reference data.
RESULTSThe mean (SD) times spent in MVPA, VPA, and sedentary behavior were 60 (25) min·d, 18 (11) min·d, and 513 (69) min·d, respectively. The overall proportion of the sample that was obese ranged from 5.2% to 24.6% across sites. The odds ratios for obesity were significant for MVPA (0.49; 95% CI, 0.44–0.55), VPA (0.41; 0.37–0.46), and sedentary time (1.19; 1.08–1.30) in the overall sample. The associations of MVPA and VPA with obesity were significant in all 12 sites, whereas the association between sedentary time and obesity was significant in five of the 12 sites. There was a significant difference in BMI z-scores across tertiles of MVPA (P < 0.001) but not across tertiles of sedentary time in a mutually adjusted model. The results of receiver operating characteristic curve analyses for obesity indicated that the optimal thresholds for MVPA (area under the curve AUC, 0.64), VPA (AUC, 0.67) and sedentary behavior (AUC, 0.57) were 55 (95% CI, 50–64) min·d, 14 (11–16) min·d, and 482 (455–535) min·d, respectively.
CONCLUSIONSGreater MVPA and VPA were both associated with lower odds of obesity independent of sedentary behavior. Sedentary time was positively associated with obesity, but not independent of MVPA. Attaining at least 55 min·d of MVPA is associated with lower obesity in this multinational sample of children, which supports current guidelines.
We examined the association between indicators of the school environment with sedentary behavior and different intensities of physical activity in children. The study that included 515 children (265 ...boys) aged 9-11 years old from public and private schools in the city of São Caetano do Sul. Sedentary behavior and different intensities of physical activity were evaluated with an accelerometer. Inside school environment (policies, supervision committee, extracurricular activities, breaks, and access to school facilities) was evaluated using a questionnaire. Policies and practice (β: 8.49; 95% CI: 3.62-13.36), supervision committee (5.42; 0.64-10.19), inter-school competitions (2.40, 2.25-2.55), breaks of 15-29 min/day (6.87; 2.20-10.75), and outdoor sports field (5.40; 0.37-10.44), were positively associated with moderate-to-vigorous-intensity physical activity. Furthermore, crossing guards (7.65; 3.00-12.30) were positively associated with moderate-to-vigorous-intensity physical activity. We concluded that an association was found between school environment indicators with higher levels of physical activity and greater odds of meeting physical activity guidelines.
The primary aim of the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) was to determine the relationships between lifestyle behaviours and obesity in a multi-national ...study of children, and to investigate the influence of higher-order characteristics such as behavioural settings, and the physical, social and policy environments, on the observed relationships within and between countries.
The targeted sample included 6000 10-year old children from 12 countries in five major geographic regions of the world (Europe, Africa, the Americas, South-East Asia, and the Western Pacific). The protocol included procedures to collect data at the individual level (lifestyle, diet and physical activity questionnaires, accelerometry), family and neighborhood level (parental questionnaires), and the school environment (school administrator questionnaire and school audit tool). A standard study protocol was developed for implementation in all regions of the world. A rigorous system of training and certification of study personnel was developed and implemented, including web-based training modules and regional in-person training meetings.
The results of this study will provide a robust examination of the correlates of adiposity and obesity in children, focusing on both sides of the energy balance equation. The results will also provide important new information that will inform the development of lifestyle, environmental, and policy interventions to address and prevent childhood obesity that may be culturally adapted for implementation around the world. ISCOLE represents a multi-national collaboration among all world regions, and represents a global effort to increase research understanding, capacity and infrastructure in childhood obesity.
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