This document discusses the negative health effects of sedentary behavior and inactivity. It defines sedentary behavior as activities that involve little physical movement and low energy expenditure (less than or equal to 1.5 METs), including sitting, watching TV, and driving. The document summarizes evidence that sedentary behavior and physical inactivity are associated with increased risk of chronic diseases like diabetes and cardiovascular disease, independent of exercise levels. It also discusses non-exercise activity thermogenesis (NEAT), which decreases with physical inactivity, as a major factor contributing to weight gain and metabolic issues when sedentary levels increase in modern society.

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. CC www.TheNounProject.com

3. In this presentation Definition of Sedentarism Distribution of Human Energy Expenditure Concept of NEAT (Non Exercise Activity Thermogenesis) Inactivity Physiology and Epidemiology 4 principles Solving the problem…or not?

4. What is to be sedentary? Is it the: Baseline exercise amount? Minutes/Steps Baseline energy used? Presence or lack of a particular behavior? Leisure/Work/House based?

5. What does the literature says?

8. Seems that we don’t agree. And these definitions concentrate in the presence/absence of exercise

9. A more “big picture” approach

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)

11. Not only the lack of exercise CC www.TheNounProject.com

12. For a real life example 34 years old male, no PMHx Fit him with one of these: Measures movement with three axis accelerometer.

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/

14. For a real life example (cont) Choose one very “active day” 11452 steps (5.4 miles) Exercised 30 minutes

15. This is the result of the “active day”

16. And over the long run?

17. Active Couch Potato Exerc. Sport Sci. Rev., Vol. 38, No. 3, pp. 105Y113, 2010 Appl. Physiol. Nutr. Metab. 35: 725–740 (2010 )

18. http://www.flickr.com/photos/ptooey/5018659279/ Does it make any difference?

19. Mayo Clin Proc. • December 2010;85(12):1138-1141

20. Understanding the Distribution of Energy Expenditure in Humans

21. European Journal of CliniCiI Nutrition (1996) 50, 72-92

22. European Journal of CliniCiI Nutrition (1996) 50, 72-92 Total exercise expenditure (TEE) , Mega Joules

23. Components 0 Kcal/day 2000 Kcal/day 1000 Kcal/day Basal Metabolic Rate (BMR) Activity Thermogenesis Thermal effect of food

24. European Journal of ClinicaI Nutrition (1996) 50, 72-92 Weight+Height+Gender  Predict 86% of BMR Basal Metabolic Rate (BMR), MegaJoules

25. Coeficient of Variation (CV) within individual for BMR 3-8% Thermal effect of food  10% of TEE CV 20% Curr Opin Clin Nutr Metab Care 7:599–605.

26. Weight+Height+Gender  Predict only 7% Physical Activity Level

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

28. More detailed! 0 Kcal/day 2000 Kcal/day 1000 Kcal/day Non Exercise Activity Thermogenesis (NEAT) Exercise

29. Which one is more affected by Sedentary behaviors? Some arguments in favor of NEAT

30. Circulation. 2007;116:1081-1093

31. Arterioscler Thromb Vasc Biol 2006;26;729-736

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

33. 20 females, BMI 32 8 weeks of low energy diet 500 kcal x 4w 850 kcal x 4 w 2 groups Exercise 3/w x 90 minutes No exercise Measured Average Daily and Sleeping Metabolic Rates Am J Clin Nutr 1995;62:722-9 .

34. Am J Clin Nutr 1995;62:722-9 .

35. What we thought would happen Non Exercise Activity Thermogenesis (NEAT) Exercise Non Exercise Activity Thermogenesis (NEAT) Exercise

36. What really happened Non Exercise Activity Thermogenesis (NEAT) Exercise Non Exercise Activity Thermogenesis (NEAT) Exercise

37. Revising concepts is NEAT! Stable “Exercise” levels Obesity levels increase We do “more” with “less”(movement) NEAT decreases with inactivity. NEAT decrease may be the main factor in energy overload

38. http://xkcd.com/552/

39. Science 307:584-586 164 min 152 min

41. 16 non obese people, asked not to exercise extra 8 weeks of overfeeding 1000 kcal Science 283: 212-214

42. Science 283: 212-214 Weight changed from 0.36 kg to 4.23 kg, mainly correlated to activity thermogenesis.

43. How does this affect our current paradigm of thinking about activity and weight/metabolic effects? To decrease NEAT, increase inactivity

44. 4 tenets of inactivity physiology 2 are logical consequences of the argument 2 are areas where research can prove/disprove the argument Diabetes 56:2655–2667, 2007

45. First

46. Second In cohorts of people who do not exercise Increased rates of DM CAD Obesity Cannot be caused by additional exercise deficiency!

47. Third Cellular and molecular processes of inactivity physiology vs exercise physiology are QUALITATIVELY different from each other http://xkcd.com/285/

48. CC www.TheNounProject.com

49. Evidence at all levels www.wikipedia.org

50. Image: Acta ortop. bras. vol.12 no.1 São Paulo Jan./Mar. 2004

51. What did they do? 60 rats. 12 hours of Hind limb unloading (remember picture?)then 4 hours of low intensity ambulatory activity. Measured gene expression in muscles. Only used genes that changed more than 1.5x expression to decrease false positives.

52. Three types of pattern Down and up to normal Up and staying up Up and down to normal

55. Showing 2 types of muscles, that react very differently to both Exercise Lack of movement (Sedentarism)

56. Oh, the Humanity!

57. Arterioscler Thromb Vasc Biol. 2007;27:2650-2656

58. Metabolism Clinical and Experimental

59. Image: Br J Sports Med 2006; 40 :779-784 doi:10.1136/bjsm.2006.027276

61. Australian Diabetes, Obesity and Lifestyle (AusDiab Study) 173 patient, underwent OGTT Accelerometer based Diabetes Care 30:1384–1389, 2007

62. Important: Effect even when adjusted for higher intensity activity

63. Same population Relationship of sedentarism and Waist circumference 3.1 cm difference Cluster of metabolic risk factors Diabetes Care 31:369–371, 2008

64. Evidence for the 3 rd tenet Changes in RNAm production Baseline is different than inactivity AND post inactivity Decrease in Lipoprotein lipase production Difference in between “exercise” muscles and “posture” muscles Metabolic changes Insulin and glucose levels, OGTT

65. CC www.TheNounProject.com

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

67. Cross sectional study of 1921 children, 9-10 yold and 15-16 yolds Accelerometer based activity Self reported TV viewing Metabolic risk score TV viewing was NOT correlated with PA (r=0.013, p=0.58) PLoS Med 3(12): e488. doi:10. 1371/journal.pmed.0030488

68. Obes Res. 2005;13:608–614

69. Epidemiology 1998; 9: 632-35 NEAT

70. NEAT

71. Med. Sci. Sports Exerc., Vol. 41, No. 5, pp. 998–1005, 2009

72. Exercisers Non Exercisers Even if you exercise, the effects are still there!

73. J Am Coll Cardiol 2011;57:292–9

74. And the beat goes on, and on, and on

77. Statistics of direct measurement CC www.TheNounProject.com No, it’s not Pac-man eating pie

78. European Heart Journal doi:10.1093/eurheartj/ehq451 http://www.bionetics.ca/exercise/mti%20actigraph.htm

79. JAMA. 2006;296:171-179 Absolute risk 12% 17.6% 24.7%

80. Evidence for the 4 th tenet Different effects of sedentary behavior compared to “exercise” Metabolic and Mortality effects seen Through age groups Through ethnic groups Newer objective data seems to support larger self reported data

81. http://www.flickr.com/photos/knitbunny/753713999 / What can we do about it?

82. Diabetes Care 31:661–666, 2008

83. But besides that study…

84. http://www.flickr.com/photos/cobalt/205542600

85. But do not despair!

86. IDLE Breaks Study Baker IDI Heart & Diabetes Institute Effects of acute bout of sitting time in post prandial Glc/Tg With and Without Breaks

88. Unpublished Data Glucose Insulin Breaking news: New data All are statistically significative!

90. Hot off the presses Treatment group burns 0.18 kcal/min more (17% more)  300 calories/week In obese/overweight group, increases to 0.38 kcal/min (32% more)  575 calories/week Am J Public Health. 2011 Mar 18. [Epub ahead of print ]

91. General Ending Points

92. We have changed as a species Int. J. Sports Med 19: 328-35, 1998 Estimated daily energy expenditure

93. We have changed as a species http://www.flickr.com/photos/xuxiaohui/15902318/

95. But not so much

96. We are failing http://www.flickr.com/photos/8185675@N07/3902633122/ exercise

97. But we may be missing something big Exercise NEAT inactivity

98. We want to avoid this http://www.flickr.com/photos/tedmurphy/3830352762/

99. And we need to accomplish this! http://www.flickr.com/photos/31364755@N08/2942780396/in/photostream

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