Objective To estimate the dose–response associations between non-occupational physical activity and several chronic disease and mortality outcomes in the general adult population. Design Systematic review and cohort-level dose-response meta-analysis. Data sources PubMed, Scopus, Web of Science and reference lists of published studies. Eligibility criteria Prospective cohort studies with (1) general population samples >10 000 adults, (2) ≥3 physical activity categories, and (3) risk measures and CIs for all-cause mortality or incident total cardiovascular disease, coronary heart disease, stroke, heart failure, total cancer and site-specific cancers (head and neck, myeloid leukaemia, myeloma, gastric cardia, lung, liver, endometrium, colon, breast, bladder, rectum, oesophagus, prostate, kidney). Results 196 articles were included, covering 94 cohorts with >30 million participants. The evidence base was largest for all-cause mortality (50 separate results; 163 415 543 person-years, 811 616 events), and incidence of cardiovascular disease (37 results; 28 884 209 person-years, 74 757 events) and cancer (31 results; 35 500 867 person-years, 185 870 events). In general, higher activity levels were associated with lower risk of all outcomes. Differences in risk were greater between 0 and 8.75 marginal metabolic equivalent of task-hours per week (mMET-hours/week) (equivalent to the recommended 150 min/week of moderate-to-vigorous aerobic physical activity), with smaller marginal differences in risk above this level to 17.5 mMET-hours/week, beyond which additional differences were small and uncertain. Associations were stronger for all-cause (relative risk (RR) at 8.75 mMET-hours/week: 0.69, 95% CI 0.65 to 0.73) and cardiovascular disease (RR at 8.75 mMET-hours/week: 0.71, 95% CI 0.66 to 0.77) mortality than for cancer mortality (RR at 8.75 mMET-hours/week: 0.85, 95% CI 0.81 to 0.89). If all insufficiently active individuals had achieved 8.75 mMET-hours/week, 15.7% (95% CI 13.1 to 18.2) of all premature deaths would have been averted. Conclusions Inverse non-linear dose–response associations suggest substantial protection against a range of chronic disease outcomes from small increases in non-occupational physical activity in inactive adults. PROSPERO registration number CRD42018095481.
Understanding barriers and facilitators for limiting occupational sitting and what impact it has on health on those with type 2 diabetes is essential for future trials and intervention development in primary healthcare settings. This study aimed to explore the feasibility and acceptability of an intervention using mobile health (mHealth) technology, together with counselling by a diabetes specialist nurse, to reduce occupational sitting in adults with type 2 diabetes.Individual semi-structured interviews were conducted in 15 participants with type 2 diabetes who completed a 3-month intervention including mHealth; activity tracker (Garmin Vivofit3) and SMS reminders, one initial face-to-face patient-centred counselling session and three telephone follow-up calls by a diabetes specialist nurse within the primary healthcare system in Sweden. The interviews were recorded, transcribed verbatim and analysed using qualitative content analysis.Two themes were identified: (1) 'From baby steps to milestones' reflecting three categories; 'Small changes make it easier to reduce sitting', 'Encouraged by trustworthy coaching', 'Physical and mental rewards matter' and (2) 'Tailoring strategies that fit me and my workplace' reflecting four categories; 'It's up to me', 'Taking advantage of the support', 'Using creativity to find practical solutions for interrupting sitting' and 'Living up to expectations'.The intervention was perceived as feasible and acceptable in different office workplaces, and led to increased awareness of sedentary behaviour in adults with type 2 diabetes. Stepwise goal setting together with personalization of the mHealth intervention should be emphasized in individual type 2 diabetes programmes aiming to reduce workplace sitting.
Abstract Since 1980, many studies have evaluated whether stair-use prompts increased physical activity by quantifying changes in stair use. To more completely evaluate changes in physical activity, this study addressed the often-overlooked assessment of climbing up escalators by evaluating the degree to which stair-use sign prompts increased active ascent—defined as stair use or escalator climbing. Over 5 months, at an airport stairs/escalator point of choice, we video-recorded passersby (N = 13,544) who ascended either stairs or escalators, on 10 days with signs and 10 days without signs. Ascenders using the stairs, standing on the escalator, and climbing the escalator were compared on days with versus without signs using multivariable logistic regression. The percentage of ascenders on days with versus without signs were as follows: stair use, 6.9 versus 3.6 percent; escalator standing, 75.2 versus 76.0 percent; and escalator climbing, 18.5 versus 20.4 percent. Signs more than doubled the odds of stair use (vs. escalator use; OR = 2.25; 95% CI = 1.90–2.68; p < .001). Signs decreased the odds of escalator climbing (vs. escalator standing or stair use); OR = 0.90; 95% CI = 0.82−0.99; p = .028). Signs increased the odds of active ascent versus escalator standing by 15 percent (OR = 1.15; 95% CI = 1.05–1.25; p = .002). Although stair-use prompts increased stair use more than twofold (125%), they increased active ascent by only 15 percent, partly because escalator climbing—a behavior not targeted by the intervention—decreased. Although our results corroborated the established consensus that point-of-choice prompts increase stair use, future studies should test interventions designed to increase active ascent.
<b>Purpose:</b> To determine whether interrupting sitting with brief bouts of simple resistance activities (SRAs) at different frequencies improves postprandial glucose, insulin and triglycerides in adults with medication-controlled type 2 diabetes (T2D). <p><b>Methods:</b> Participants [n=23, 10 females, Age: 62±8 y (mean±SD), BMI: 32.7 ± 3.5 kg<sup>.</sup>m<sup>-2</sup>] completed a three-armed randomized crossover trial (6-14 day washout): sitting uninterrupted for 7 h (SIT); sitting with 3-minute SRAs (half-squats, calf raises, gluteal contractions, and knee raises) every 30 minutes (SRA3); and, sitting with 6-minute SRAs every 60 minutes (SRA6). Net incremental areas under the curve (iAUC<sub>net</sub>) for glucose, insulin, and triglycerides were compared between conditions.</p> <p><b>Results:</b> <a>Glucose and insulin 7 h iAUC<sub>net </sub>were attenuated significantly during SRA6 (glucose 17.0 mmol<sup>.</sup>h<sup>.</sup>L<sup>-1</sup>, 95% CI 12.5, 21.4; insulin 1229 pmol<sup>.</sup>h<sup>.</sup>L<sup>-1</sup>, 95% CI 982, 1538) when compared to SIT (glucose 21.4 mmol<sup>.</sup>h<sup>.</sup>L<sup>-1</sup>, 95% CI 16.9, 25.8; insulin 1411 pmol<sup>.</sup>h<sup>.</sup>L<sup>-1</sup>, 95% CI 1128, 1767; <i>P</i> < 0.05), and compared to SRA3 ( for glucose only; 22.1 mmol<sup>.</sup>h<sup>.</sup>L<sup>-1</sup>, 95% CI 17.7, 26.6; <i>P </i>= 0.01) No significant differences in glucose or insulin iAUC<sub>net</sub> were observed comparing SRA3 and SIT. There was no statistically significant effect of condition on triglyceride iAUC<sub>net</sub>. </a></p> <p><b>Conclusion:</b> In adults with medication-controlled T2D, interrupting prolonged sitting with 6-minute SRAs every 60 minutes reduced postprandial glucose and insulin responses. Other frequencies of interruptions and potential longer-term benefits require examination to clarify clinical relevance. </p>
While regular exercise is effective in managing patients with type 2 diabetes (T2D), meeting prescribed exercise guidelines can be challenging. Observational and experimental evidence shows that breaking up prolonged sitting with light-activity bouts is beneficial for glycemic control and insulin sensitivity; however, this has not been experimentally tested in T2D patients. PURPOSE: To examine the acute effects on postprandial glucose, insulin and C-peptide levels of uninterrupted sitting compared to sitting interrupted by brief bouts of light-intensity walking (LW) or by simple resistance activities (SRA). METHODS: Inactive overweight/obese adults (n = 20; 45-75 y) with T2D were recruited for a randomized three-period, three-treatment acute crossover trial: 1) uninterrupted sitting (control); 2) sitting with 3 min bouts of light-intensity walking at 3.2 km/h every 30 min; and, 3) sitting with 3 min bouts of simple resistance activities (alternating half-squats, calf raises, brief gluteal contractions and single leg knee raises) every 30 min. Net 7-h incremental areas under the curve (iAUC; trapezoidal method) for glucose, insulin and C-peptide following standardized breakfast and lunch meals were calculated for the respective treatments. RESULTS: Glucose, insulin and C-peptide iAUC after both activity-break conditions were attenuated significantly compared with uninterrupted sitting (see Figure). All differences between LW and SRA were non-significant (p > 0.7). CONCLUSION: Interrupting sitting with brief light-intensity walking bouts or simple resistance activities attenuates postprandial glucose, insulin and C-peptide levels in adults with T2D. With sedentary behaviors being so ubiquitous, interrupting sitting has the potential to be beneficial and practical for patients with T2D. Supported by NHMRC Program Grant 569940
The number of people living with multiple long-term conditions (MLTCs) is predicted to rise. Within this population, those also living with frailty are particularly vulnerable to poor outcomes, including decreased function. Increased physical activity, including exercise, has the potential to improve function in those living with both MLTCs and frailty but, to date, the focus has remained on older people and may not reflect outcomes for the growing number of younger people living with MLTCs and frailty. For those with higher burdens of frailty and MLTCs, physical activity may be challenging. Tailoring physical activity in response to symptoms and periods of ill-health, involving family and reducing sedentary behaviour may be important in this population. How the tailoring of interventions has been approached within existing studies is currently unclear. This scoping review aims to map the available evidence regarding these interventions in people living with both frailty and MLTCs.We will use a six-stage process: (1) identifying the research questions; (2) identifying relevant studies (via database searches); (3) selecting studies; (4) charting the data; (5) collating and summarising and (6) stakeholder consultation. Studies will be critically appraised using the Mixed Methods Appraisal Tool.All data in this project will be gathered through database searches. Stakeholder consultation will be undertaken with an established patient and public involvement group. We will disseminate our findings via social media, publication and engagement meetings.
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