This study reports on the feasibility of the SitLess with MS trial, an intervention targeting sedentary behavior in individuals with multiple sclerosis (MS).Single group, pre-post intervention design.Community.Participants (N=41) with mild to moderate disability from MS.The intervention was 15 weeks, with a 7-week follow-up, and included 2 stages: SitLess and MoveMore. During the SitLess stage, participants were encouraged to break up prolonged sitting bouts over a 7-week period, whereas the MoveMore stage promoted increased steps per day and interrupting sitting over a 7-week period. The intervention was delivered through weekly one-on-one coaching sessions via telerehabilitation and an accompanying newsletter based on social-cognitive theory. Activity was monitored throughout the program using a Fitbit.Process (eg, recruitment) and resource and management (eg, personnel requirements) metrics were assessed, along with efficacy outcomes (eg, effect). Progression criteria were set a priori and were related to safety, fatigue, satisfaction, and attrition. Sedentary behavior, measured using the ActivPal, was reported pre- and postintervention, as well as 7 weeks postintervention. Effect sizes (pre to post, pre to 7 weeks post) were calculated for the sedentary behavior outcomes (eg, time sitting, transitions from sitting to standing, number of long sitting bouts). Experiences with the intervention were explored through an online survey.Forty-one participants enrolled, 39 of whom completed the intervention. All participants but 1 were satisfied with the experience. Pre-post intervention effect sizes for change in total sedentary time, number of transitions from sit to stand, and number of long (>30 min) sedentary bouts were 0.34, 0.02, and 0.39 respectively. All a priori progression criteria were met.The SitLess with MS program, a novel intervention that emphasized and facilitated sitting less and moving more, was feasible and resulted in small changes in sedentary behavior in individuals with MS.
Changing children’s lifestyle habits from sedentary to physically active may be an important step to prevent, reverse and/or manage obesity. The increased use of technology has caused children to sit for long periods of time. This is of great concern as sitting may have detrimental health effects into adulthood independent of lack of physical activity. This thesis represents a series of studies designed to better understand sedentary behaviour in children. Firstly, it was important to establish the validity of a monitor that differentiated sitting from standing in children in both laboratory and school settings. In this thesis, the ActivPAL monitor was used which had not been validated in children previously. Secondly, a pilot observational study was conducted in a primary school to identify the period where children were most sedentary. Thirdly, it was important to determine the most appropriate and feasible strategies by interviewing teachers and principals, before intervening in a classroom environment. Fourthly, a “dynamic classroom” which encouraged less sitting, and more standing and movement in children was implemented in one primary school.
In Study 1 (Chapter 2), the validity of the ActivPAL monitor in measuring sedentary behaviour of primary school children in a laboratory setting was objectively examined against video observation and other known motion sensors. A strong correlation (r ≥ 0.99) was found between the video recordings and the ActivPAL data in time spent sitting/lying, standing, stepping, and sit to stand and stand-to-sit transitions, and step counts in slow and normal walking but not in fast walking and running.
In Study 2 (Chapter 3), the validity of the ActivPAL monitor in assessing free-living sitting/lying, standing, and stepping time, and transition and step counts in children was examined at school compared to direct observation. There was a strong correlation (r = 0.77-0.99) between the video and the ActivPAL in measuring sitting/lying, standing and stepping time, and step counts in both classtime and unstructured play. In counting classtime and playtime stand-to-sit transitions, correlation (r = 0.53-0.61) was moderate. The results of Studies 1 and 2 showed that the ActivPAL monitor was overall a valid device in measuring sedentary behaviour in children in both laboratory and primary school settings.
In Study 3 (Chapter 4), the time children spent sitting, standing and stepping, in a typical school day, was quantified by the ActivPAL monitor. Children spent 56% sitting, 25% standing, and 18% stepping during a school day, however, 49% of sitting occurred in classroom. These findings suggested that an intervention to reduce sitting time in the classroom was needed.
In Study 4 (Chapter 5), the most appropriate and feasible strategies to reduce children’s sitting time in the classroom were identified by interviewing primary school teachers and principals. It was found that height-adjustable standing desks/workstations and Swiss balls could be incorporated in the classroom.
The effectiveness of a “dynamic classroom” environment in reducing children’s sitting and increasing standing was tested in Study 5 (Chapter 6). Traditional desks and chairs from a classroom were completely removed and height-adjustable standing workstations, Swiss balls, bean-bags, and benches were incorporated in the classroom over two school terms (22 weeks). Children’s sitting and standing were objectively measured using the ActivPAL monitor at three time points (baseline, week 5, and week 9). Pain, inattention and hyperactivity were also assessed at baseline, midline, and the final time point. At week 22, an interview with the intervention class teacher and a focus group with children were conducted. During school, there was a large increase in standing (intervention: 2.06 (0.44), mean (SD); control: 1.60 (0.69) h/day) which persisted across the full day (3.71 (0.92); 2.77 (0.76) h/day). Children and school staff were supportive of the “dynamic classroom” intervention as it offered increased space, social interactions, happier children, and better, quicker and easier supervision. The “dynamic classroom” seemed to increase concentration specifically in children with Attention Deficit Hyperactivity Disorder (ADHD). Height adjustable standing workstations were successfully integrated into the classroom environment to increase standing and decrease sedentary time in children.
In conclusion, the school environment, where children spend most of their time, may be an effective setting to reduce sitting time in children. It seemed that incorporating height-adjustable standing workstations in the classroom to be a feasible and inexpensive strategy to encourage children to stand more and sit less. Future studies should investigate the impact of the “dynamic classroom” intervention on a larger sample for a longer period.
Multiple sclerosis is a chronic neurological disease with the highest prevalence in Canada. Replacing sedentary behavior with light activities may be a feasible approach to manage multiple sclerosis symptoms. This study explored the perspectives of adults with multiple sclerosis about sedentary behavior, physical activity and ways to change behavior.Fifteen adults with multiple sclerosis (age 43 ± 13 years; mean ± standard deviation), recruited through the multiple sclerosis Clinic at the University of Alberta, Edmonton, Canada, participated in semi-structured interviews. Interview audios were transcribed verbatim and coded. NVivo software was used to facilitate the inductive process of thematic analysis.Balancing competing priorities between sitting and moving was the primary theme. Participants were aware of the benefits of physical activity to their overall health, and in the management of fatigue and muscle stiffness. Due to fatigue, they often chose sitting to get their energy back. Further, some barriers included perceived fear of losing balance or embarrassment while walking. Activity monitoring, accountability, educational and individualized programs were suggested strategies to motivate more movement.Adults with multiple sclerosis were open to the idea of replacing sitting with light activities. Motivational and educational programs are required to help them to change sedentary behavior to moving more. IMPLICATIONS FOR REHABILITATION One of the most challenging and common difficulties of multiple sclerosis is walking impairment that worsens because of multiple sclerosis progression, and is a common goal in the rehabilitation of people with multiple sclerosis. The deterioration in walking abilities is related to lower levels of physical activity and more sedentary behavior, such that adults with multiple sclerosis spend 8 to 10.5 h per day sitting. Replacing prolonged sedentary behavior with light physical activities, and incorporating education, encouragement, and self-monitoring strategies are feasible approaches to manage the symptoms of multiple sclerosis.
Background: Our understanding of the amount of time children spend sitting, standing and stepping during a typical school day is limited. The ActivPAL monitor, which can differentiate between sitting and standing, was used in this study to objectively assess free-living activities in children. Aims: The main purpose was to objectively quantify the time children spend sitting, standing and stepping in atypical school day. A secondary purpose was to compare the ActivPAL monitor step counts with those obtained from Actical accelerometers. Study Design:Pilot observational study.
Introduction People with multiple sclerosis (MS) are less physically active, and more sedentary than their peers despite evidence that activity helps to manage MS-related symptoms. Traditional approaches to increasing physical activity, such as exercise programmes, can be challenging for people with MS, especially those with walking disability. Focusing on decreasing prolonged sitting, and increasing light-intensity activities may be more feasible and result in more sustainable behaviour change in persons with MS. This paper describes the rationale and development of a sedentary behaviour intervention targeting persons with MS. Methods and analysis The feasibility and preliminary efficacy of a sedentary behaviour intervention will be tested using a prepost intervention design in 40 adults with MS. The 22-week programme includes a 15-week intervention and a 7-week follow-up. The intervention itself is divided into two stages: Sit-Less and Move-More. The Sit-Less stage is designed to encourage participants to break up prolonged sitting bouts, while the Move-More stage promotes increasing steps per day, in addition to interrupting sitting. The intervention is delivered through individual coaching sessions between an interventionist and a participant, and an accompanying newsletter based on social cognitive theory. A Fitbit is used to monitor activity throughout the programme. Process, resource and management metrics will be recorded (eg, retention, time required for communication during the trial). Sedentary and physical activities and MS-related symptoms are measured before and after the intervention and again during follow-up. Experiences with the programme are explored through an online survey and one-on-one interviews. Ethics and dissemination The Health Research Ethics Board at the University of Alberta granted permission to conduct this study. Results will be disseminated in scientific journals and conferences, and the MS Society of Alberta. Physical therapists and kinesiologists are important stakeholders and will be targeted during dissemination. Trial registration number NCT03136744 .
A reduction in sedentary behaviour (e.g. the length of time spent sitting) may prevent or reverse childhood obesity. The effectiveness of a 'dynamic classroom' environment in increasing standing and reducing sitting time in children was determined. A controlled trial with 26 (n = 18 intervention) New Zealand children (aged 9.8 ± 0.4 years; mean ± SD) was conducted. The intervention class received height-appropriate workstations for 22 weeks while the control class retained traditional desks and chairs. Children's sitting and standing were measured at three time points (baseline, week 5, week 9). Pain, inattention and hyperactivity were also assessed. At week 22, qualitative data were collected via a focus group and an interview and analyzed using the thematic framework. Mean differences were interpreted using standardized magnitude thresholds. On weekdays (during waking hours) there was on average a large increase in overall standing, 55 minutes per day over nine weeks of intervention compared with the control classroom. Children's overall sitting time reduced, but the changes were small. There were no substantial differences between the control and intervention classrooms in pain and inattention-hyperactivity mean scores. Children enjoyed working at the height-appropriate standing workstations. Teachers were supportive of the dynamic classroom environment. Height-appropriate standing workstations can be successfully integrated into classrooms to increase overall standing and decrease sitting time.
Decreasing sedentary activities that involve prolonged sitting may be an important strategy to reduce obesity and other physical and psychosocial health problems in children. The first step to understanding the effect of sedentary activities on children's health is to objectively assess these activities with a valid measurement tool.To examine the validity of the ActivPAL monitor in measuring sitting/lying, standing, and walking time, transition counts and step counts in children in a laboratory setting.Twenty five healthy elementary school children (age 9.9 ± 0.3 years; BMI 18.2 ± 1.9; mean ± SD) were randomly recruited across the Auckland region, New Zealand. Children were fitted with ActivPAL monitors and observed during simulated free-living activities involving sitting/lying, standing and walking, followed by treadmill and over-ground activities at various speeds (slow, normal, fast) against video observation (criterion measure). The ActivPAL sit-to-stand and stand-to-sit transition counts and steps were also compared with video data. The accuracy of step counts measured by the ActivPAL was also compared against the New Lifestyles NL-2000 and the Yamax Digi-Walker SW-200 pedometers.We observed a perfect correlation between the ActivPAL monitor in time spent sitting/lying, standing, and walking in simulated free-living activities with direct observation. Correlations between the ActivPAL and video observation in total numbers of sit-to-stand and stand-to-sit transitions were high (r = 0.99 ± 0.01). Unlike pedometers, the ActivPAL did not misclassify fidgeting as steps taken. Strong correlations (r = 0.88-1.00) between ActivPAL step counts and video observation in both treadmill and over-ground slow and normal walking were also observed. During treadmill and over-ground fast walking and running, the correlations were low (r = 0.21-0.46).The ActivPAL monitor is a valid measurement tool for assessing time spent sitting/lying, standing, and walking, sit-to-stand and stand-to-sit transition counts and step counts in slow and normal walking. The device did not measure accurately steps taken during treadmill and over-ground fast walking and running in children.
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