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
London bus drivers & conductors Jeremy Morris - The Lancet 1953 Coronary heart disease lower in conductors
What was their explanation?
Physical activity recommendations WHO 2010
WHO recommendations - adults WHO 2010
More physical activity? vs
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
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
An Active Day? In the life of Homer Simpson 30 min 30 min 4 hours 8 hours 30 min YES
EuroBarometer 2005
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
Measurement of sedentary behaviour Chau et al. Br J Sport Med 2011
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 16-34 35-44 45-54 55-64 65-74 75+ Age Men Women Health Survey for England 2008
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
Context? Trends?
120 100 Non occupational time (NL) 80 hr/wk 60 40 ~60% sedentary MVPA Light Sedentary 20 0 1975 1980 1985 1990 1995 2000 2005 van der Ploeg et al. AJPM 2013
7,0 6,0 Household time (NL) 5,0 hr/d 4,0 3,0 MVPA Light Sedentary 2,0 ~30% sedentary 1,0 0,0 1975 1980 1985 1990 1995 2000 2005 van der Ploeg et al. AJPM 2013
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 0,0 1975 1980 1985 1990 1995 2000 2005 van der Ploeg et al. AJPM 2013
7 6 Leisure time (NL) 5 hr/d 4 3 2 ~85% sedentary MVPA Light Sedentary 1 0 1975 1980 1985 1990 1995 2000 2005 van der Ploeg et al. AJPM 2013
6 Sedentary leisure time (NL) 5 hr/d 4 3 2 1 Other Radio/music Transport Needle work Socializing Reading Computer TV 0 1975 1980 1985 1990 1995 2000 2005 van der Ploeg et al. AJPM 2013
Dutch Time Use Surveys (SCP) 20 18 16 Occupational time (NL) 14 12 hr/wk 10 8 6 4 2 0 1975 1980 1985 1990 1995 2000 2005 van der Ploeg et al. AJPM 2013
Danish Work Environment Cohort Study 40 proportion sitting 3/4 of work time 30 20 10 0 1990 1995 2000 2005 2010 year van der Ploeg et al. IJBNPA 2015
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
Overweight/ obesity CVD Cancer Type 2 diabetes Mortality
Possible working mechanisms Reduced metabolic and vascular health Disrupt metabolic function plasma triglyceride levels high-density lipoprotein cholesterol insulin sensitivity (Δ lipoprotein lipase activity)
TV viewing & health
TV viewing & all-cause mortality Matthews et al., Am J Clin Nutr 2012;95:437 45
TV viewing & CVD mortality Matthews et al., Am J Clin Nutr 2012;95:437 45
TV viewing & T2DM, CVD, mortality Grontved & Hu, JAMA 2011
Total sitting time & health
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
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
Sitting volume & breaking up sitting
Breaking up sitting time Dunstan et al, Diabetes Care 2012
Breaking up sitting time Dunstan et al, Diabetes Care 2012
Breaking up sitting time Dunstan et al, Diabetes Care 2012
Sitting & health Break up sitting? Or reduce total volume of sitting?
Reducing sitting time scenario 3
Standing & mortality All cause mortality risk (HR) Standing hr/d van der Ploeg et al. Prev Med 2014
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!
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
Hartelijk dank!