JustStand Summit 2012 - Dr. David Dunstan

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Stand up, sit less, move more, more often: joining the scientific dots on sedentary behaviour and health

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JustStand Summit 2012 - Dr. David Dunstan

  1. 1. Stand Up, Sit Less, Move More, MoreOften: Joining the Scientific Dots on Sedentary Behaviour and Health Associate Professor David Dunstan Head – Physical Activity ARC Future Fellow Baker IDI Heart & Diabetes Institute Melbourne, Australia David.Dunstan@bakeridi.edu.au
  2. 2. Outline• State of knowledge (evidence base) – Sedentary behaviour (too much sitting) as a unique public health problem – paradigm shift – Evidence linking sedentary behaviour with mortality, even in people who are physically active• Current & future research directions towards building the evidence-base in relation to sitting – Controlled laboratory studies – Settings-based interventions
  3. 3. Acknowledgements• Prof Neville Owen, Dr Alicia Thorp, Prof Bronwyn Kingwell, Dr Robyn Larsen, Beth Howard: Baker IDI Heart and Diabetes Institute• Dr Genevieve Healy, Prof Elizabeth Eakin, Dr Elisabeth Winkler, Dr Paul Gardiner, Dr Bronwyn Clark: The University of Queensland• Australian Research Council• Victorian Health Promotion Foundation• Ergotron
  4. 4. The Aussie Brisbane, QueenslandSedentary BehaviourTeam Prof Elizabeth Dr Genevieve Eakin Healy Melbourne, Victoria Prof Neville Owen
  5. 5. Modern Society: Minimising Daily Muscular Activity! Then Now Transport Domestic Work
  6. 6. Our technologically advanced, ‘sitting orientated’ society     Work on Breakfast computer Transport Watch TV 15 mins 3.5 hrs From work 4 hrs 45 mins LunchAwake 30 mins Sleep Transport to 7 am 11pm work 45 mins Evening meal Work on 30 mins computer 4 hrs Exercise – 30 min Sitting Opportunities 15.5 hrs
  7. 7. Sedentary Behaviours • Sedere – “to sit” • Different activities that involve sitting and low levels of energy expenditure • Includes sitting during commuting, in the workplace, the domestic environment and during leisure time“Sitting time” = what these sedentary behaviours primarily involve
  8. 8. Sitting Induces Muscular Inactivity 4 STEPS GETTING OUT OF A CHAIR SITTING STANDINGSource: Hamilton, M.T., Hamilton, D.G. and Zderic, T.W. (2007) Diabetes, 56, 2655-2667
  9. 9. Thanks to Paul Gardiner – University of Queensland
  10. 10. Owen N, Healy GN, Matthews CE, Dunstan DW.Exerc Sports Sci Rev 2010 Volume 38: 105-113Commentary: Medical Hazards of Prolonged SittingPage: 101-102
  11. 11. rapidly-strengthening evidence base modest evidence base limited evidence base i) Identifying relationships of sitting time with health outcomes ii) measuring sitting time iii) characterising prevalence and variations of sitting time in populations iv) identifying the determinants of sitting time v) developing and testing interventions to influence sitting time vi) using the relevant evidence to inform public health guidelines and policy
  12. 12. AusDiab: TV time and all-cause mortality (hazard ratios) 3.0 Hazard ratios all-cause 2.5 mortality 2.0 46% ↑ risk 1.5 1.0 0.5 <2 >=2 to <4 >=4 TV time (hours/day)Adjusted for age, sex, smoking, education (≥12 years), total energy intake, diet quality index, leisure-time exercise, waist circumference, hypertension (blood pressure ≥140/90 mmHg or anti-hypertensive medication use), total plasma cholesterol, HDL-cholesterol (mmol/L), serum-triglycerides (mmol/L, log), lipid-lowering medication use, previously reported cardiovascular disease (angina, myocardial infarction or stroke), glucose tolerance status).
  13. 13. Sedentary Behaviour and Health Outcomes Associations reported from prospective studies: 1996-2011 Thorp et al. Am J Prev Med 2011 Time 1 Time 2 OUTCOME MEASURE EXPOSURE EXPOSURE MEASURE MEASURE (Baseline) (Follow-up)
  14. 14. Sedentary Behaviour and Health Outcomes Associations reported from prospective studies: 1996-2011 Thorp et al. Am J Prev Med 2011Obesity risk/incidence:Weight gain:Diabetes:Cancer:Cardiovascular disease:Mortality (all-cause & CVD): +ve association mediated by BMI / one gender no association
  15. 15. Sitting Time and All-Cause Mortality Risk in 222,497 Australian Adults Hidde P van Der Ploeg, Tien Chey, Rosemary J Korda, Emily Banks, Adrian Bauman Arch Intern Med. 2012; 172 (6) : 494-500Adjusted for:age, sex, education,marital status,urban/rural residence,physical activity,BMI, smoking
  16. 16. Deaths in Adults with CVD/Diabetes at Baseline H van der Ploeg et al. Arch Intern Med 172: 694-500 Hazard of Too Much Sitting Regardless of Exercise-like Leisure Time Physical Activity
  17. 17. Hot Off the Press Key Finding The analyses indicate that population life expectancy in the USA would be 2.00 years higher if adults reduced their sitting time to < 3 hours per day and 1.38 years if they reduced their television viewing to < 2 hrs/day
  18. 18. rapidly-strengthening evidence base modest evidence base limited evidence base1. Identifying relationships of sitting time with health outcomes2. measuring sitting time3. characterising prevalence and variations of sitting time in populations4. identifying the determinants of sitting time5. developing and testing interventions to influence sitting time6. using the relevant evidence to inform programs and policy
  19. 19. Device-Based Measurement of Movementand Posture InclinometerAccelerometer From whose output The ‘market dominator’ we can derive from whose output posture-based indices (counts of less than 100 of ‘sitting’ time pm) we infer ‘sedentary’ time
  20. 20. How Australian Adults’ Overall Daily BehaviourPatterns Are Distributed Between Physically-Active and Sedentary Time Moderate-vigorous activities 0.7 hrs/day (5%) Light-intensity Mix of working & Sedentary time 6.5 hrs/day (35%) non-working adults 9.3 hrs/day (60%) aged 30-87 years 95 Healy et al., 2008
  21. 21. Consistent Observations4% 3% 38% 58%40% 57% 5% 35% 60% Sedentary/Inactivity LIPA MVPA
  22. 22. You Can Be ‘Active’, But Mostly Sit The ‘Active’ Couch Potato Activity EnergyMorning Intensity Expenditure Moderate/vigorous Very High Time (minutes) LightNight Sedentary Very Low Mean mod-to-vigorous time = 31 mins/day % Waking hours spent in Sedentary = 71%
  23. 23. Accelerometer Measured Sedentary Patterns During Work Hours in Office Workers Work Hours WORKPLACE SITTING 2.4% = 33.5 hrs/week 20.6% = 1,608 hrs/year (67 full days) = 75,576 hrs/working life 75.8% 8.6 YEARS Sedentary Light Exercise 8.6 Thorp et al., Manuscript currently under review.
  24. 24. The ‘Breaks In Sedentary Time’ Hypothesis • ‘Breaking-up’ sedentary time (frequent transitions from sitting to standing) has beneficial associations with health outcomes (independent of sedentary time) “Prolonger” “Breaker” Sedentary CPM < 100 Not sedentary CPM 100+ Healy GN, Dunstan DW et al. Diabetes Care 2008; 31: 661-666
  25. 25. Sedentary Time & Breaks in Sedentary Time NHANES 03-06 Sedentary time: detrimental HDL-C, triglycerides, insulin, HOMA-%B, HOMA-%S Breaks: beneficial Waist circumference, HDL-C, C-reactive protein 4.3cm differenceAdjusted for age, sex, race/ethnicity, moderate-vigorous intensity activity + other potential confoundersBreaks in sedentary time additionally adjusted for total sedentary timeHealy G.N., Matthews, C.E., Dunstan, D.W., Winkler, E.A.H., Owen, N. (2011). Sedentary time and cardio-metabolic biomarkers in US adults: NHANES 2003-06. European Heart Journal, 32, 590-597
  26. 26. rapidly-strengthening evidence base modest evidence base limited evidence base1. Identifying relationships of sitting time with health outcomes2. measuring sitting time3. characterising prevalence and variations of sitting time in populations4. identifying the determinants of sitting time5. developing and testing interventions to influence sitting time6. using the relevant evidence to inform programs and policy
  27. 27. Thinking About Multiple Influences On HealthBehaviours Policy Context Physical Environment Interpersonal Intrapersonal biological psychological skills conventional ‘comfort zone’ for causationand explanation
  28. 28. rapidly-strengthening evidence base modest evidence base limited evidence base1. Identifying relationships of sitting time with health outcomes2. measuring sitting time3. characterising prevalence and variations of sitting time in populations4. identifying the determinants of sitting time5. developing and testing interventions to influence sitting time6. using the relevant evidence to inform programs and policy
  29. 29. AIM: To examine the acute effects of postprandialglucose and insulin levels of uninterruptedsitting compared with sitting interrupted by briefbouts of light- or moderate-intensity walking Dunstan et al. (2012) Diabetes Care 35: 976-983
  30. 30. The Hazards of Post-Prandial (dys)metabolism?(hyperglycemia, hyperlipidemia)• Independent risk factor for future cardiovascular events1• Exaggerated post-prandial spikes in glucose and lipids oxidative stress endothelial dysfunction atherosclerosis2,3• When repeated multiple times throughout the day: environment conducive for CVD risk factors and CHD1,3 1O’Keefe JH & Bell DSH 2008 Am J Cardiol 2Ceriello A 2000 Diabetes Metab Res Rev 3Heine RJ et al. 2004 Diab Med
  31. 31. CONDITION 1: A single bout of prolonged sitting Standardised mixed meal: ~75g CHO and ~50g Fat Blood sample: glucose, insulin, triglycerides, FFA’s Muscle and adipose tissue-2 -1 0 1 2 3 4 5 hrs biopsy (optional) EXPERIMENTAL SET UP ACTIVPAL PROFILE
  32. 32. CONDITIONS 2 & 3: Sitting + light/moderate-intensity activity bouts Light-intensity walking (2mins): Treadmill Speed = 3.2 km/hr Moderate-intensity walking (2mins): Treadmill Speed = 5.8-6.4 km/hr-2 -1 0 1 2 3 4 5 hrs EXPERIMENTAL SET UP ACTIVPAL PROFILE
  33. 33. Results: Glucose 20 > 24%  Dunstan et al. (2012) Diabetes Care 35: 976-983
  34. 34. “The workplace provides an ideal opportunity to engageindividuals in taking more control of their own health”.“The results suggest that simple interventions that can beimplemented in the workplace and domestically to decreasepassive sitting time and increase the number of breaks can alsolead to substantial health improvements.”
  35. 35. Workplace Health Promotion & Chronic Disease:Looking Through a Workplace Sitting Lens DUTY OF CARE “A person conducting a Organisational business or undertaking must ensure so far as is reasonably Policy & Culture practicable the provision and maintenance of a work environment without risks to health and safety” Workplace 23/06/2011 Safety Bill Model Work Health and Individuals Physical Environment
  36. 36. Stand Up Australia To Improve Health and ProductivityProgram of research investigating benefits from reducing sitting time in the workplace AUSTRALIA Stand Up  Sit Less  Move More
  37. 37. Population groups that are most at riskof prolonged sitting include thoseworking in offices, transportation, andhighly mechanised trades. Healy et al., VicHealth Report, 2012
  38. 38. Workplace Arrangements/ Conditions WorkplaceOrganisational Design & Policy Reducing prolonged sitting in the workplace Social / Individuals Cultural Health and Productivity
  39. 39. Stand Up Australia: Intervening on theproblemWhat happens when we intervene on the…• Environment• Individual environment• Individual behaviour• Organisation• Objective measures of sitting/standing time• Focus on measures of health and productivity
  40. 40. AUSTRALIA Initial Pilot Study – Melbourne, Victoria (Completed) Comcare
  41. 41. Stand Up Comcare• One month pilot study (to inform the main Stand Up Victoria trial currently ongoing)• One site (Comcare, Victoria), two floors• Participants (18 Ix, 18 C) randomised by floor WorkFit-S Kindly donated by Ergotron
  42. 42. Study Design Pre-Intervention 4 week Intervention (1-2 week prior) Unit Group Work- Individual Call 1 Call 2 Call 3 Assessment 2 BaselineIntervention: reps consult station consult (wk 2) (wk 3) (wk4) (end of Ix) consult install (Day 1-3) Baseline Assessment 2Comparison: OHS, management, general staff • role • brainstorm
  43. 43. Comcare Unit Representatives’ Input – “Laps” around office - defined circuit – Introduction of more standing into meetings (initiated by Chairperson from the outset) – Use printers further away – Ergonomically sound exercises at scheduled times – Wireless headsets for conference calls (to enable standing) – Breaks compliance software – Use the stairs (reduced access during intervention period) – “No bins” policy – no personal bins – Timed walking routes in vicinity of building
  44. 44. All Ix participants Face-to-Face • Information • Instruction Study Design • Refinement • Group feedback • Feedback • Goal setting • Tracking Pre-Intervention 4 week Intervention (1-2 week prior) Unit Group Work- Individual Call 1 Call 2 Call 3 Assessment 2 BaselineIntervention: reps consult station consult (wk 2) (wk 3) (wk4) (end of Ix) consult install (Day 1-3) Support bhr change Baseline Assessment 2Comparison: OHS, management, general staff • Role • Brainstorm
  45. 45. Example Feedback: Workplace Hours Average proportion of time at the workplace spent sitting (bouts ≥30min & <30mins), standing and moving Time Sitting ≥30mins Time Sitting < 30mins Time Standing Time Moving 9% Focus on reducing 24% prolonged, 11% unbroken sitting ≥30 minutes 56% Assessment Period: 12/03/2012 – 19/03/2012 Average work time: 8.3 hours per day Average number of sitting bouts 3 per day ≥30mins:
  46. 46. All days (from 6am to 10pm) Daily patterns of time spent sitting, standing and moving Assessment Period: 12/03/2012 – 19/03/2012 Time Sitting Time Standing Time Moving Day 1 2 3 4 5 6 7 8:00- 7:45- 9:30- 8:30- 8:30- Work hours NA NA 16:30 19:00 16:00 18:30 17:15
  47. 47. Goal setting: Key messagesWe recommend that you... Stand Up Sit Less Move More At least every 30 Use your Throughout the min! workstation! day!
  48. 48. Favorite Behaviour ChangeStrategies Stand Up  Set a timer (online, through outlook, etc)  Stand up when the phone rings or when someone enters the office  Stand up when someone else does Sit Less  Determine certain ‘standing times’, i.e. every morning and after lunch  Stand up when someone else does  Stand during meetings Move More  Use the stairs instead of the lift  Walking laps  More active lunch breaks (e.g. walking around the block)  Fill water bottle more often  Pick up printing more often  iMails
  49. 49. Results: At the Workplace (%) Baseline Follow-up Sitting 10.5 11.0 Standing SteppingComparison 24.4 21.9 (n=18) 65.1 67.1 ≥30m: 21.7% ≥30m: 26.3% 10.0 10.5Intervention 22.6 42.0 (n=18) 67.4 47.5 ≥30m: 24.3% ≥30m: 12.7% *Based on 8h workday
  50. 50. Changes in overall sitting time 600 Average sitting time (mins/16h day) Baseline 580 Follow-up 560 - 76 min 540 520 500 480 460 Comparison Control Intervention No between group differences in health and work-related outcomes
  51. 51. Comments on Workstations Positive  enjoying being able to work while standing  being less stiff  significant reductions in back/ neck/ shoulder discomfort  feeling less tired and lethargic  feeling better/ more energetic  improved concentration Negative  no flexibility to move WS back and forth on desk  no flexibility to move keyboard back and forth relative to monitor  sore feet/legs in beginning  keyboard/mouse shelf too small  workstation shelf too small  takes up too much room on desk 15/18 wanted to keep their workstations!
  52. 52. www.comcare.gov.au
  53. 53. Studies Currently Recruiting….
  54. 54. AUSTRALIA
  55. 55. Stand Up Victoria Stand Up  Sit Less  Move More CIs: David Dunstan, Genevieve Healy, Neville Owen, Elizabeth Eakin, Anthony LaMontagne, Marj Moodie • 3-year cluster-randomised controlled trial – 320 participants (160 per group) – 15+ worksites from one organisation • 3 months of intervention, 9 months of follow-up • Organisational, individual, environmental elements • Cost-effectiveness analysis
  56. 56. Stand Up Victoria – Partner Organisation
  57. 57. AUSTRALIA Maike Neuhaus (PhD Student)
  58. 58. Aims WorkFit-S Stand Up  Sit Less  Move More Kindly donated by Ergotron1) To evaluate the effectiveness of height-adjustable workstations in the workplace to reduce sitting time. 2) To evaluate whether the addition of an individual and organisational support component leads to greater reductions in sitting time than the workstations alone.  Non-randomised controlled trial (N=42) Group 1: Workstations (n=14) Group 2: Workstations + Individual Support + Organisational Support (n=14) Group 3: Control Group (n=14)
  59. 59. University of Queensland• HR/Payroll at UQ St Lucia Campus• Centre for Clinical Research (UQCCR) at UQ Herston Campus• Various departments from the UQ Gatton Campus.
  60. 60. Take Home Messages • Create opportunities within your waking hours to limit sitting time • Avoid prolonged sitting periods - break up sitting time on a regular basis (“Stand Up, Sit Less, Move More, More Often”) • Remember: 95 8.6 20
  61. 61. Thank You for Listening Contact Details A/Prof David Dunstan Head – Physical Activity Baker IDI Heart & Diabetes Institute Melbourne, Australia Email: David.Dunstan@bakeridi.edu.au Web: www.bakeridi.edu.au/research/physical_activity/
  62. 62. Other participant feedback• “I feel much more alert, especially after the lunch break.”• “We love it – do you mind if we post a photo of us standing at our workstations on yammer?• “My lower back pain is getting much better!”• “I feel more energetic!”• “I feel so much healthier, which means that I can eat more chocolate, right?”
  63. 63. What’s next...Baseline Intervention 3 months No Contact 12 months Jan – Mar 2013

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