Sedentary behavior and inactivity physiology slideshare presentation

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Lecture about the effect of sedentary behavior in our health.

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  • Failures to affect our patient’s weight and clinical measurements with exercise therapy.
  • 6 trials used energy expenditure (but different ways to get to it) 5 trials didn’t even defined sedentary
  • Healthy Active Living and Obesity Research Group
  • 1 MJ=238 kcal
  • R for weight 0.48, for height 0.50, age -0.13 Total regression 86% SD 10%
  • Department of Human Biology, University of Limburg, Netherlands
  • Endocrine Research Unit Mayo.n 10 Lean BMI 23, n 10 Obese BMI 33. Movement monitored for 10 days, energy expenditure by doubly labeled water.
  • Endocrine Research Unit, Mayo. N 16 non obese. Overfeed for 8 weeks 1000 kcal
  • Endocrine Research Unit, Mayo. N 16 non obese. Overfeed for 8 weeks 1000 kcal
  • Dr. Hamilton’s team, University of Missouri- Columbia. 60 rats. 12 hours of HU, then 4 hours of low intensity ambulatory activity. Only used genes that changed more than 1.5x expression to decrease false positives.
  • Heparin releasable=HR
  • Glycolytic= Used when exercising “extra”, Oxidative= Used for postural tone and day to day activity
  • Herbert Morrison, the Hindenburg
  • 20 healthy subjects, 5 days of bed rest
  • 14 non obese young fit individuals, 3 conditions NOSIT(2900kcal), SIT(same), SITBAL(2200 kcal)
  • Metabolic risk score: Skin folds, HDL, TG, fasting insulin, FPG
  • NHANES data from 1999-2000. Metabolic syndrome definition ATPIII. Self reported leisure activity time for 43 activities. Self reported screen time
  • Canadian Fitness Survey 1981. Females >30 yold, no CAD. 6620 women, f/u 7 years
  • Canadian Fitness Survey Started with 17013 patients
  • Active is 7.5 MET/h/wk
  • 4757 participants in NHANES 2003-2006, accelerometer based
  • Based on Health ABC study, 302 healthy elderly patients. Used accelerometer AND DLW
  • AusDiab Data
  • Mention ABLE study
  • Sedentary behavior and inactivity physiology slideshare presentation

    1. 1. Sedentary Behavior and Inactivity Physiology Killing you softly and gently Yannis Guerra Endocrinology Department John H. Stroger Jr. Hospital of Cook County [email_address] @yannisguerra on Twitter
    2. 2. CC www.TheNounProject.com
    3. 3. In this presentation <ul><li>Definition of Sedentarism </li></ul><ul><li>Distribution of Human Energy Expenditure </li></ul><ul><ul><li>Concept of NEAT (Non Exercise Activity Thermogenesis) </li></ul></ul><ul><li>Inactivity Physiology and Epidemiology </li></ul><ul><ul><li>4 principles </li></ul></ul><ul><li>Solving the problem…or not? </li></ul>
    4. 4. What is to be sedentary? <ul><li>Is it the: </li></ul><ul><li>Baseline exercise amount? </li></ul><ul><ul><li>Minutes/Steps </li></ul></ul><ul><li>Baseline energy used? </li></ul><ul><li>Presence or lack of a particular behavior? </li></ul><ul><li>Leisure/Work/House based? </li></ul>
    5. 5. What does the literature says?
    6. 8. Seems that we don’t agree. And these definitions concentrate in the presence/absence of exercise
    7. 9. A more “big picture” approach
    8. 10. A distinct class of behaviors (e.g., sitting, watching TV, driving) characterized by little physical movement and low energy expenditure ( Less/equal to 1.5 METs) Appl. Physiol. Nutr. Metab. 35: 725–740 (2010)
    9. 11. Not only the lack of exercise CC www.TheNounProject.com
    10. 12. For a real life example <ul><li>34 years old male, no PMHx </li></ul><ul><li>Fit him with one of these: </li></ul><ul><ul><li>Measures movement with three axis accelerometer. </li></ul></ul>
    11. 13. Accelerometers are all around us! CC http://www.flickr.com/photos/oskay/1193147290/sizes/o/in/photostream/ http://www.flickr.com/photos/terrypaton/4613655114/ http://www.flickr.com/photos/zzathras777/2071956401/sizes/o/in/photostream/
    12. 14. For a real life example (cont) <ul><li>Choose one very “active day” </li></ul><ul><ul><li>11452 steps (5.4 miles) </li></ul></ul><ul><ul><li>Exercised 30 minutes </li></ul></ul>
    13. 15. This is the result of the “active day”
    14. 16. And over the long run?
    15. 17. Active Couch Potato Exerc. Sport Sci. Rev., Vol. 38, No. 3, pp. 105Y113, 2010 Appl. Physiol. Nutr. Metab. 35: 725–740 (2010 )
    16. 18. http://www.flickr.com/photos/ptooey/5018659279/ Does it make any difference?
    17. 19. Mayo Clin Proc. • December 2010;85(12):1138-1141
    18. 20. Understanding the Distribution of Energy Expenditure in Humans
    19. 21. European Journal of CliniCiI Nutrition (1996) 50, 72-92
    20. 22. European Journal of CliniCiI Nutrition (1996) 50, 72-92 Total exercise expenditure (TEE) , Mega Joules
    21. 23. Components 0 Kcal/day 2000 Kcal/day 1000 Kcal/day Basal Metabolic Rate (BMR) Activity Thermogenesis Thermal effect of food
    22. 24. European Journal of ClinicaI Nutrition (1996) 50, 72-92 Weight+Height+Gender  Predict 86% of BMR Basal Metabolic Rate (BMR), MegaJoules
    23. 25. <ul><li>Coeficient of Variation (CV) within individual for BMR 3-8% </li></ul><ul><li>Thermal effect of food  10% of TEE </li></ul><ul><ul><li>CV 20% </li></ul></ul>Curr Opin Clin Nutr Metab Care 7:599–605.
    24. 26. Weight+Height+Gender  Predict only 7% Physical Activity Level
    25. 27. Returning to the Total Energy Expenditure 0 Kcal/day 2000 Kcal/day 1000 Kcal/day Basal Metabolic Rate Activity Thermogenesis Thermal effect of food
    26. 28. More detailed! 0 Kcal/day 2000 Kcal/day 1000 Kcal/day Non Exercise Activity Thermogenesis (NEAT) Exercise
    27. 29. Which one is more affected by Sedentary behaviors? Some arguments in favor of NEAT
    28. 30. Circulation. 2007;116:1081-1093
    29. 31. Arterioscler Thromb Vasc Biol 2006;26;729-736
    30. 32. Easy solution, right? Just tell them to exercise more! I think you’ll find it’s a bit more complicated than that Ben Goldacre, www.Bad Science.net
    31. 33. <ul><li>20 females, BMI 32 </li></ul><ul><li>8 weeks of low energy diet </li></ul><ul><ul><li>500 kcal x 4w </li></ul></ul><ul><ul><li>850 kcal x 4 w </li></ul></ul><ul><li>2 groups </li></ul><ul><ul><li>Exercise 3/w x 90 minutes </li></ul></ul><ul><ul><li>No exercise </li></ul></ul><ul><li>Measured Average Daily and Sleeping Metabolic Rates </li></ul>Am J Clin Nutr 1995;62:722-9 .
    32. 34. Am J Clin Nutr 1995;62:722-9 .
    33. 35. What we thought would happen Non Exercise Activity Thermogenesis (NEAT) Exercise Non Exercise Activity Thermogenesis (NEAT) Exercise
    34. 36. What really happened Non Exercise Activity Thermogenesis (NEAT) Exercise Non Exercise Activity Thermogenesis (NEAT) Exercise
    35. 37. Revising concepts is NEAT! <ul><li>Stable “Exercise” levels </li></ul><ul><li>Obesity levels increase </li></ul><ul><li>We do “more” with “less”(movement) </li></ul><ul><li>NEAT decreases with inactivity. </li></ul><ul><li>NEAT decrease may be the main factor in energy overload </li></ul>
    36. 38. http://xkcd.com/552/
    37. 39. Science 307:584-586 164 min 152 min
    38. 41. <ul><li>16 non obese people, asked not to exercise extra </li></ul><ul><li>8 weeks of overfeeding </li></ul><ul><ul><li>1000 kcal </li></ul></ul>Science 283: 212-214
    39. 42. Science 283: 212-214 Weight changed from 0.36 kg to 4.23 kg, mainly correlated to activity thermogenesis.
    40. 43. How does this affect our current paradigm of thinking about activity and weight/metabolic effects? To decrease NEAT, increase inactivity
    41. 44. <ul><li>4 tenets of inactivity physiology </li></ul><ul><ul><li>2 are logical consequences of the argument </li></ul></ul><ul><ul><li>2 are areas where research can prove/disprove the argument </li></ul></ul>Diabetes 56:2655–2667, 2007
    42. 45. First
    43. 46. Second <ul><li>In cohorts of people who do not exercise </li></ul><ul><ul><li>Increased rates of </li></ul></ul><ul><ul><ul><li>DM </li></ul></ul></ul><ul><ul><ul><li>CAD </li></ul></ul></ul><ul><ul><ul><li>Obesity </li></ul></ul></ul>Cannot be caused by additional exercise deficiency!
    44. 47. Third <ul><li>Cellular and molecular processes of inactivity physiology vs exercise physiology are QUALITATIVELY different from each other </li></ul>http://xkcd.com/285/
    45. 48. CC www.TheNounProject.com
    46. 49. Evidence at all levels www.wikipedia.org
    47. 50. Image: Acta ortop. bras. vol.12 no.1 São Paulo Jan./Mar. 2004
    48. 51. What did they do? <ul><li>60 rats. </li></ul><ul><li>12 hours of Hind limb unloading (remember picture?)then 4 hours of low intensity ambulatory activity. </li></ul><ul><li>Measured gene expression in muscles. </li></ul><ul><li>Only used genes that changed more than 1.5x expression to decrease false positives. </li></ul>
    49. 52. Three types of pattern Down and up to normal Up and staying up Up and down to normal
    50. 55. Showing <ul><li>2 types of muscles, that react very differently to both </li></ul><ul><ul><li>Exercise </li></ul></ul><ul><ul><li>Lack of movement (Sedentarism) </li></ul></ul>
    51. 56. Oh, the Humanity!
    52. 57. Arterioscler Thromb Vasc Biol. 2007;27:2650-2656
    53. 58. Metabolism Clinical and Experimental
    54. 59. Image: Br J Sports Med  2006; 40 :779-784 doi:10.1136/bjsm.2006.027276
    55. 61. <ul><li>Australian Diabetes, Obesity and Lifestyle (AusDiab Study) </li></ul><ul><li>173 patient, underwent OGTT </li></ul><ul><li>Accelerometer based </li></ul>Diabetes Care 30:1384–1389, 2007
    56. 62. Important: Effect even when adjusted for higher intensity activity
    57. 63. <ul><li>Same population </li></ul><ul><li>Relationship of sedentarism and </li></ul><ul><ul><li>Waist circumference </li></ul></ul><ul><ul><ul><li>3.1 cm difference </li></ul></ul></ul><ul><ul><li>Cluster of metabolic risk factors </li></ul></ul>Diabetes Care 31:369–371, 2008
    58. 64. Evidence for the 3 rd tenet <ul><li>Changes in RNAm production </li></ul><ul><ul><li>Baseline is different than inactivity AND post inactivity </li></ul></ul><ul><li>Decrease in Lipoprotein lipase production </li></ul><ul><ul><li>Difference in between “exercise” muscles and “posture” muscles </li></ul></ul><ul><li>Metabolic changes </li></ul><ul><ul><li>Insulin and glucose levels, OGTT </li></ul></ul>
    59. 65. CC www.TheNounProject.com
    60. 66. What about the 4 th tenet? Times that people spend sitting versus participating in exercise based leisure time physical activity are different classes of behavior with distinct determinants AND INDEPENDENT RISKS FOR DISEASE Diabetes 56:2655–2667, 2007
    61. 67. <ul><li>Cross sectional study of 1921 children, </li></ul><ul><ul><li>9-10 yold and 15-16 yolds </li></ul></ul><ul><li>Accelerometer based activity </li></ul><ul><li>Self reported TV viewing </li></ul><ul><li>Metabolic risk score </li></ul><ul><li>TV viewing was NOT correlated with PA (r=0.013, p=0.58) </li></ul>PLoS Med 3(12): e488. doi:10. 1371/journal.pmed.0030488
    62. 68. Obes Res. 2005;13:608–614
    63. 69. Epidemiology 1998; 9: 632-35 NEAT
    64. 70. NEAT
    65. 71. Med. Sci. Sports Exerc., Vol. 41, No. 5, pp. 998–1005, 2009
    66. 72. Exercisers Non Exercisers Even if you exercise, the effects are still there!
    67. 73. J Am Coll Cardiol 2011;57:292–9
    68. 74. And the beat goes on, and on, and on
    69. 77. Statistics of direct measurement CC www.TheNounProject.com No, it’s not Pac-man eating pie
    70. 78. European Heart Journal doi:10.1093/eurheartj/ehq451 http://www.bionetics.ca/exercise/mti%20actigraph.htm
    71. 79. JAMA. 2006;296:171-179 Absolute risk 12% 17.6% 24.7%
    72. 80. Evidence for the 4 th tenet <ul><li>Different effects of sedentary behavior compared to “exercise” </li></ul><ul><li>Metabolic and Mortality effects seen </li></ul><ul><ul><li>Through age groups </li></ul></ul><ul><ul><li>Through ethnic groups </li></ul></ul><ul><li>Newer objective data seems to support larger self reported data </li></ul>
    73. 81. http://www.flickr.com/photos/knitbunny/753713999 / What can we do about it?
    74. 82. Diabetes Care 31:661–666, 2008
    75. 83. But besides that study…
    76. 84. http://www.flickr.com/photos/cobalt/205542600
    77. 85. But do not despair!
    78. 86. IDLE Breaks Study <ul><li>Baker IDI Heart & Diabetes Institute </li></ul><ul><li>Effects of acute bout of sitting time in post prandial Glc/Tg </li></ul><ul><ul><li>With and Without Breaks </li></ul></ul>
    79. 88. Unpublished Data Glucose Insulin Breaking news: New data All are statistically significative!
    80. 90. Hot off the presses <ul><li>Treatment group burns 0.18 kcal/min more (17% more)  300 calories/week </li></ul><ul><li>In obese/overweight group, increases to 0.38 kcal/min (32% more)  575 calories/week </li></ul>Am J Public Health.  2011 Mar 18. [Epub ahead of print ]
    81. 91. General Ending Points
    82. 92. We have changed as a species Int. J. Sports Med 19: 328-35, 1998 Estimated daily energy expenditure
    83. 93. We have changed as a species http://www.flickr.com/photos/xuxiaohui/15902318/
    84. 95. But not so much
    85. 96. We are failing http://www.flickr.com/photos/8185675@N07/3902633122/ exercise
    86. 97. But we may be missing something big Exercise NEAT inactivity
    87. 98. We want to avoid this http://www.flickr.com/photos/tedmurphy/3830352762/
    88. 99. And we need to accomplish this! http://www.flickr.com/photos/31364755@N08/2942780396/in/photostream
    89. 100. Thanks to David Dunstan Associate Professor Baker IDI Heart & Diabetes Institute Travis Saunders Healthy Active Living and Obesity Research Group Obesity Panacea Blog Mark E. Benden Associate Professor Texas A&M Health Science Center School of Rural Public Health

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