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JustStand Summit 2012 - Dr. David Dunstan
The document discusses the health risks associated with sedentary behavior, highlighting evidence connecting prolonged sitting to increased mortality and various health conditions, even in physically active individuals. It outlines current research efforts focused on measuring sitting time, understanding its determinants, and developing interventions to reduce it, particularly in workplace settings. The findings suggest that reducing sedentary time could significantly improve health outcomes and longevity.
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JustStand Summit 2012 - Dr. David Dunstan
- 1. Stand Up, SitLess, Move More, More Often: 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. Outline • State ofknowledge (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. Acknowledgements • Prof NevilleOwen, 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. The Aussie Brisbane, Queensland Sedentary Behaviour Team Prof Elizabeth Dr Genevieve Eakin Healy Melbourne, Victoria Prof Neville Owen
- 5. Modern Society: MinimisingDaily Muscular Activity! Then Now Transport Domestic Work
- 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 Lunch Awake 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. 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. Sitting Induces MuscularInactivity 4 STEPS GETTING OUT OF A CHAIR SITTING STANDING Source: Hamilton, M.T., Hamilton, D.G. and Zderic, T.W. (2007) Diabetes, 56, 2655-2667
- 9. Thanks to PaulGardiner – University of Queensland
- 10. Owen N, HealyGN, Matthews CE, Dunstan DW. Exerc Sports Sci Rev 2010 Volume 38: 105-113 Commentary: Medical Hazards of Prolonged Sitting Page: 101-102
- 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. AusDiab: TV timeand 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. Sedentary Behaviour andHealth 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. Sedentary Behaviour andHealth Outcomes Associations reported from prospective studies: 1996-2011 Thorp et al. Am J Prev Med 2011 Obesity risk/incidence: Weight gain: Diabetes: Cancer: Cardiovascular disease: Mortality (all-cause & CVD): +ve association mediated by BMI / one gender no association
- 15. Sitting Time andAll-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) : 494-500 Adjusted for: age, sex, education, marital status, urban/rural residence, physical activity, BMI, smoking
- 16. Deaths in Adultswith 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. Hot Off thePress 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. rapidly-strengthening evidence base modest evidence base limited evidence base 1. Identifying relationships of sitting time with health outcomes 2. measuring sitting time 3. characterising prevalence and variations of sitting time in populations 4. identifying the determinants of sitting time 5. developing and testing interventions to influence sitting time 6. using the relevant evidence to inform programs and policy
- 19. Device-Based Measurement ofMovement and Posture Inclinometer Accelerometer 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. How Australian Adults’Overall Daily Behaviour Patterns 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. Consistent Observations4% 3% 38% 58% 40% 57% 5% 35% 60% Sedentary/Inactivity LIPA MVPA
- 22. You Can Be‘Active’, But Mostly Sit The ‘Active’ Couch Potato Activity Energy Morning Intensity Expenditure Moderate/vigorous Very High Time (minutes) Light Night Sedentary Very Low Mean mod-to-vigorous time = 31 mins/day % Waking hours spent in Sedentary = 71%
- 23. Accelerometer Measured SedentaryPatterns 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. The ‘Breaks InSedentary 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. 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 difference Adjusted for age, sex, race/ethnicity, moderate-vigorous intensity activity + other potential confounders Breaks in sedentary time additionally adjusted for total sedentary time Healy 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. rapidly-strengthening evidence base modest evidence base limited evidence base 1. Identifying relationships of sitting time with health outcomes 2. measuring sitting time 3. characterising prevalence and variations of sitting time in populations 4. identifying the determinants of sitting time 5. developing and testing interventions to influence sitting time 6. using the relevant evidence to inform programs and policy
- 27. Thinking About MultipleInfluences On Health Behaviours Policy Context Physical Environment Interpersonal Intrapersonal biological psychological skills conventional ‘comfort zone’ for causation and explanation
- 28. rapidly-strengthening evidence base modest evidence base limited evidence base 1. Identifying relationships of sitting time with health outcomes 2. measuring sitting time 3. characterising prevalence and variations of sitting time in populations 4. identifying the determinants of sitting time 5. developing and testing interventions to influence sitting time 6. using the relevant evidence to inform programs and policy
- 29. AIM: To examinethe acute effects of postprandial glucose and insulin levels of uninterrupted sitting compared with sitting interrupted by brief bouts of light- or moderate-intensity walking Dunstan et al. (2012) Diabetes Care 35: 976-983
- 30. The Hazards ofPost-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. CONDITION 1: Asingle 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. 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. Results: Glucose 20 > 24% Dunstan et al. (2012) Diabetes Care 35: 976-983
- 34. “The workplace providesan ideal opportunity to engage individuals in taking more control of their own health”. “The results suggest that simple interventions that can be implemented in the workplace and domestically to decrease passive sitting time and increase the number of breaks can also lead to substantial health improvements.”
- 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. Stand Up Australia To Improve Health and Productivity Program of research investigating benefits from reducing sitting time in the workplace AUSTRALIA Stand Up Sit Less Move More
- 37. Population groups thatare most at risk of prolonged sitting include those working in offices, transportation, and highly mechanised trades. Healy et al., VicHealth Report, 2012
- 38. Workplace Arrangements/ Conditions Workplace Organisational Design & Policy Reducing prolonged sitting in the workplace Social / Individuals Cultural Health and Productivity
- 39. Stand Up Australia:Intervening on the problem What 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. AUSTRALIA Initial Pilot Study – Melbourne, Victoria (Completed) Comcare
- 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. Study Design Pre-Intervention 4 week Intervention (1-2 week prior) Unit Group Work- Individual Call 1 Call 2 Call 3 Assessment 2 Baseline Intervention: reps consult station consult (wk 2) (wk 3) (wk4) (end of Ix) consult install (Day 1-3) Baseline Assessment 2 Comparison: OHS, management, general staff • role • brainstorm
- 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
- 45. 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 Baseline Intervention: reps consult station consult (wk 2) (wk 3) (wk4) (end of Ix) consult install (Day 1-3) Support bhr change Baseline Assessment 2 Comparison: OHS, management, general staff • Role • Brainstorm
- 46. Example Feedback: WorkplaceHours 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:
- 47. All days (from6am 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
- 48. Goal setting: Keymessages We recommend that you... Stand Up Sit Less Move More At least every 30 Use your Throughout the min! workstation! day!
- 49. Favorite Behaviour Change Strategies 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
- 50. Results: At theWorkplace (%) Baseline Follow-up Sitting 10.5 11.0 Standing Stepping Comparison 24.4 21.9 (n=18) 65.1 67.1 ≥30m: 21.7% ≥30m: 26.3% 10.0 10.5 Intervention 22.6 42.0 (n=18) 67.4 47.5 ≥30m: 24.3% ≥30m: 12.7% *Based on 8h workday
- 51. Changes in overallsitting 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
- 52. 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!
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- 57. 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
- 58. Stand Up Victoria– Partner Organisation
- 59. AUSTRALIA Maike Neuhaus (PhD Student)
- 60. Aims WorkFit-S Stand Up Sit Less Move More Kindly donated by Ergotron 1) 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)
- 61. 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.
- 62. 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
- 63. Thank You forListening 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/
- 64. 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?”
- 65. What’s next... Baseline Intervention 3 months No Contact 12 months Jan – Mar 2013