Welcome! Interventions with

potential to reduce sedentary time in adults: What's the evidence?

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What’s the evidence? Martin A., Fitzsimons C., Jepson R., Saunders D., van der Ploeg H.P., Teixeira P.J., et al. (2015). Interventions with potential to reduce sedentary time in adults: Systematic review and meta-analysis. British Journal of Sports Medicine, 0, 1-10.http://www.healthevidence.org/view-article.aspx?a=28660

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A Model for Evidence-Informed Decision

Making

National Collaborating Centre for Methods and Tools. (revised 2012). A Model for Evidence-Informed Decision-Making in Public Health (Fact Sheet). [http://www.nccmt.ca/pubs/FactSheet_EIDM_EN_WEB.pdf]

Stages in the process of Evidence-Informed Public Health

National Collaborating Centre for Methods and Tools. Evidence-Informed Public Health. [http://www.nccmt.ca/eiph/index-eng.html]

Poll Question #3

Have you heard of PICO(S) before?

1.Yes2.No

Searchable Questions Think “PICOS”

1. Population (situation)

2. Intervention (exposure)

3. Comparison (other group)

4. Outcomes

5. Setting

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Poll Question #4

Interventions can reduce sedentary time in adultsA.Strongly agreeB.AgreeC.NeutralD.DisagreeE.Strongly disagree

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Poll Question #5

ReviewMartin A., Fitzsimons C., Jepson R., Saunders D., van der Ploeg H.P., Teixeira P.J., et al. (2015). Interventions with potential to reduce sedentary time in adults: Systematic review and meta-analysis. British Journal of Sports Medicine, 0, 1-10.

Rationale

Infographic on the Chief Medical Officers' guidelines

Source: https://www.gov.uk/government/uploads/system/uploads/attachment_d

ata/file/469457/Physical_activity_infographic.PDF

Sedentary behaviour refers to any waking activity characterized by an energy expenditure ≤ 1.5

metabolic equivalents and a sitting or reclining posture

Definition

What is sedentary behaviour?

– Any waking behaviour where sitting or lying is the dominant mode of posture

– Energy expenditure is very low

– Screen-time (TV viewing, computer use), motorised transport, sitting at work, sitting to read, talk, or listen to music

Sedentary behaviour and Health

• Significant hazard ratio (HR) associations were found with– all-cause mortality (HR, 1.220 [95% CI, 1.090 to

1.410])– cardiovascular disease mortality (HR, 1.150 [CI, 1.107

to 1.195])– cardiovascular disease incidence (HR, 1.143 [CI, 1.002

to 1.729])– cancer mortality (HR, 1.130 [CI, 1.053 to 1.213])– cancer incidence (HR, 1.130 [CI, 1.053 to 1.213])– type 2 diabetes incidence (HR, 1.910 [CI, 1.642 to

2.222]

• Largely independent of PA but HR bigger with lower PA

Biswas et al. Ann Intern Med. 2015;162:123-132.

Football Fans in Training: a gender sensitised weight loss, physical activity and healthy lifestyle programme for men

y

Hunt, K et al. (2014). Lancet. (13) 62420-4  

(Error bars represent 95% confidence intervals)

Adjusted between-group difference 12 weeks 5.18kg (CI 6.00, 4.35) p<.0001

Adjusted between-group difference 12 months 4.94kg (CI 3.95,5.94) p<.0001

PPrimary outcome: Weight loss (kg) at 12 months

Increase in self-reported PA

Adjusted ratio geometric means 12 weeks 2.38 (CI 1.90, 2.98) p<.0001

Adjusted ratio geometric means 12 months 1.49 (CI 1.11, 1.99) p=.008

(Error bars represent IQ range)12 months12 weeks

o

FFIT to EuroFIT

http://www.ffit.org.uk/page2/index.html

FP7-HEALTH.2013.3.3-1-Principal Investigator: Sally Wyke,

University of Glasgow http://eurofitfp7.eu/http://eurofitfp7.eu/http://www.eurofit.pthttp://www.eurofit.pt

WP1 - Nanette Mutrie and Anne Martin

1) Interventions to reduce sedentary time in adults: Systematic review and meta-analysis

2) BCTs used in sitting interventions

3) Design of SitFIT device

Review Focus• P - Adults (≥ 18 years)

• I - Any intervention which included an sedentary behaviour outcome measure in free-living adults

• C- no intervention, waiting list, attention control, usual care, alternative treatment conditions

• O - Objectively measured sedentary time obtained from accelerometers/ inclinometers

▸ Objectively or self-reported patterns of accumulation of sedentary behaviour▸ Self-reported total sitting time▸ Self-reported proxy measures of sitting time

Outline1. Overview of reviews2. Methods 3. Risk of Bias4. Review findings 5. Implication for practice6. Implication for research7. Overall summary

Overview of ReviewsPrince et al Obes Rev 2014;15:905–19•Modest reduction in sedentary behaviour in interventions with a specific goal of increasing PA levels and those which combined an increase in PA levels with a decrease in sedentary time

•Greatest reduction in interventions focusing on SB only

Shrestha N et al. Cochrane Database of Systematic Reviews 2016, Issue 3. Art. No.: CD010912•There is very low to low quality evidence that sit-stand desks may decrease workplace sitting between 30-120min/day

•There were no considerable or inconsistent effects of other interventions such as changing work organisation or information and counselling.

Literature Search and Selection

We searched:13 databases and trial registers for randomised controlled trials

Risk of Bias

34 studies combined:

Reduction by 22 min/day

Lifestyle interventions (20 studies):

Reduction by 24 min/day

Interventions targeting sedentary behaviour (2 studies):

Reduction by 42 min/day

Findings

Subgroup analysisHeterogeneity between studies partly explained by

•Intervention duration•Sex

Quality of evidenceAssessed using the GRADE scoring system

•Lifestyle intervention high-moderate quality•Targeted sedentary behaviour interventions low quality•Physical activity/sedentary behaviour interventions moderate quality•Targeted physical activity interventions moderate quality

Implications for research• Further research is needed to determine the

clinical significance of changing patterns of sedentary behaviour.

Aadahl et al., Am J Prev Med 2014;47:576–86.

• More interventions targeting sedentary behaviour need to be developed and tested.

• Further work is needed to identify the ‘active’ intervention components.

Update search findingsInterventions/studies

Participants Effect size (min/day)[95% Confidence interval]

All studies combined 72 20276 -21.54 [-28.20, -14.87]

Physical activity 28 11861 -13.72 [-23.49, -3.95]

Sedentary behaviour 4 264 -45.35 [-75.11, -15.60]

Physical activity & sedentary behaviour

14 1033 -46.60 [-76.14, -17.05]

Lifestyle interventions 26 7118 -16.74 [-28.16, -5.32]

Implications for practice• Findings of this review do not point to specific

recommendations on the degree of reduction in sitting time required to deliver significant health benefits.

• Findings should encourage clinicians and public health practitioners to provide advice about reducing the total volume of sitting time and breaking up long periods of sitting

• This advice should not diminish or replace advice on achieving recommended levels of physical activity.

• Interventions with a focus on physical activity should provide additional emphasis on the importance of and barriers to reducing sedentary behaviour.

OVERALL SUMMARY• It is possible to intervene to reduce sedentary behaviour in

adults by 22 min/day• Moderate to high-quality evidence on the efficacy of

lifestyle interventions suggests a promising approach • Targeted sedentary behaviour intervention resulted in the

greatest reduction in sedentary time (42 min/day);• Intervention durations up to 3 months can produce

significant reductions in sedentary behaviour• Intervention effects were evident up to 12 months follow-up• Research is needed to determine if sedentary behaviour

interventions are sufficient to produce clinically meaningful and sustainable reductions in sedentary time.

Interventions can reduce sedentary time in adultsA.Strongly agreeB.AgreeC.NeutralD.DisagreeE.Strongly disagree

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Poll Question #6

Poll Question #7Do you agree with the findings of this review?A.Strongly agreeB.AgreeC.NeutralD.DisagreeE.Strongly disagree

Questions?

A Model for Evidence-Informed Decision

Making

National Collaborating Centre for Methods and Tools. (revised 2012). A Model for Evidence-Informed Decision-Making in Public Health (Fact Sheet). [http://www.nccmt.ca/pubs/FactSheet_EIDM_EN_WEB.pdf]

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