Hoeveel zitten we en is dat erg?

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1 Hoeveel zitten we en is dat erg? Hidde van der Ploeg Department of Public & Occupational Health EMGO Institute for Health & Care Research VU University Medical Centre Amsterdam

2 London bus drivers & conductors Jeremy Morris - The Lancet 1953 Coronary heart disease lower in conductors

3 What was their explanation?

4 Physical activity recommendations WHO 2010

5 WHO recommendations - adults WHO 2010

6 More physical activity? vs

7 Everything we do when awake Sedentary ( 1.5 MET) Light (>1.5 and <3 MET) Moderate activities ( 3 and <6 MET) Vigorous activities ( 6 MET) What about the other 98%? }Health enhancing physical activity WHO recommends 150 min/wk of MVPA for adults =2% of the waking day

8 Sedentary behavior definition Any waking behaviour characterized by an energy expenditure 1.5 METs while in a sitting or reclining posture (Sedentary Behaviour Research Network 2012) = Sitting & lying down Inactivity

9 An Active Day? In the life of Homer Simpson 30 min 30 min 4 hours 8 hours 30 min YES

10 EuroBarometer 2005

11 Country % the Netherlands 45.6 Greece 42.0 Denmark 40.2 Czech Republic 39.9 Cyprus(Republic) 37.9 Finland 34.6 Poland 33.3 Sweden 33.2 Belgium 33.2 Estonia 30.9 Germany West 30.8 Cyprus(TCC) 30.6 Slovenia 30.3 Croatia 29.8 Luxembourg 28.0 Great Britain 27.7 Slovakia 27.2 Germany East 27.0 Austria 26.3 Latvia 25.4 Bulgaria 24.4 France 23.1 Northern Ireland 23.1 Turkey 22.6 Lithuania 21.8 Italy 21.1 Ireland 21.1 Spain 20.9 Hungary 19.2 Romania 16.1 Malta 16.0 Portugal 12.3 Bennie et al., IJBNPA 2013

12 Measurement of sedentary behaviour Chau et al. Br J Sport Med 2011

13 National Health Survey England 2008 hr/d 12,0 11,0 10,0 9,0 8,0 7,0 6,0 5,0 4,0 3,0 2,0 1,0 0,0 ~70% sedentary Age Men Women Health Survey for England 2008

14 Accelerometer summary Canada (07-09): 68% (Actical) England (08): 70% (<200 cnts/min) Sweden (01-02): 59% US (03-04): 55% ~8-9 hr/d of sedentary behaviour Average accelerometer wear time = 14 hr/d

15 Context? Trends?

16 Non occupational time (NL) 80 hr/wk ~60% sedentary MVPA Light Sedentary van der Ploeg et al. AJPM 2013

17 7,0 6,0 Household time (NL) 5,0 hr/d 4,0 3,0 MVPA Light Sedentary 2,0 ~30% sedentary 1,0 0, van der Ploeg et al. AJPM 2013

18 1,6 1,4 1,2 Transport time (NL) Australia: ~83% sedentary 1,0 hr/d 0,8 0,6 0,4 ~70% sedentary MVPA Light Sedentary 0,2 0, van der Ploeg et al. AJPM 2013

19 7 6 Leisure time (NL) 5 hr/d ~85% sedentary MVPA Light Sedentary van der Ploeg et al. AJPM 2013

20 6 Sedentary leisure time (NL) 5 hr/d Other Radio/music Transport Needle work Socializing Reading Computer TV van der Ploeg et al. AJPM 2013

21 Dutch Time Use Surveys (SCP) Occupational time (NL) hr/wk van der Ploeg et al. AJPM 2013

22 Danish Work Environment Cohort Study 40 proportion sitting 3/4 of work time year van der Ploeg et al. IJBNPA 2015

23 Prevalence conclusions Adults are sedentary 8-9 hr/d (Australia, Europe, North America) Sedentary work seems to be increasing Non occupational time: leisure time most sedentary

24

25 Overweight/ obesity CVD Cancer Type 2 diabetes Mortality

26 Possible working mechanisms Reduced metabolic and vascular health Disrupt metabolic function plasma triglyceride levels high-density lipoprotein cholesterol insulin sensitivity (Δ lipoprotein lipase activity)

27 TV viewing & health

28 TV viewing & all-cause mortality Matthews et al., Am J Clin Nutr 2012;95:437 45

29 TV viewing & CVD mortality Matthews et al., Am J Clin Nutr 2012;95:437 45

30 TV viewing & T2DM, CVD, mortality Grontved & Hu, JAMA 2011

31 Total sitting time & health

32 All participants n=222,497 Adjusted for: sex, age, education, urban/rural, BMI, smoking, self-rated health and disability van der Ploeg et al., Arch Intern Med 2012

33 Total sitting & mortality 1,8 Fitted 1,6 Inoue (M) Hazard ratios 1,4 1,2 1 Inoue(F) Van der Ploeg Mathews Chau Koster Pavey 95%L 95%U 0,8 0,0 1,0 1,5 2,0 2,5 3,0 3,5 4,0 4,5 5,0 5,5 6,0 6,5 7,0 7,5 8,0 8,5 9,0 9,5 10,0 10,5 11,0 11,5 12,0 Total sitting hr/day Chau et al. PLoS One 2013

34 Sitting volume & breaking up sitting

35 Breaking up sitting time Dunstan et al, Diabetes Care 2012

36 Breaking up sitting time Dunstan et al, Diabetes Care 2012

37 Breaking up sitting time Dunstan et al, Diabetes Care 2012

38 Sitting & health Break up sitting? Or reduce total volume of sitting?

39 Reducing sitting time scenario 3

40 Standing & mortality All cause mortality risk (HR) Standing hr/d van der Ploeg et al. Prev Med 2014

41 Risks of standing Prolonged standing can increase the risk of: Varicose veins Musculoskeletal problems (i.e. back, neck) Alternating sitting, standing and physical activity Do not demonize sitting!

42 Conclusions We sit a lot Too much sitting has a negative impact on health, regardless of whether or not we meet physical activity guidelines Meeting PA recommendations is important Too early for sitting public health recommendations Solution: find a better balance between sitting, standing and light intensity physical activity Also target sitting during leisure time

43 Hartelijk dank!

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