Sedentary Behavior Research Network (SBRN) - Terminology Consensus Project process and outcome

Background: The prominence of sedentary behavior research in health science has grown rapidly. With this growth there is increasing urgency for clear, common and accepted terminology and definitions. Such standardization is difficult to achieve, especially across multi-disciplinary researchers, practitioners, and industries. The Sedentary Behavior Research Network (SBRN) undertook a Terminology Consensus Project to address this need. Method: First, a literature review was completed to identify key terms in sedentary behavior research. These key terms were then reviewed and modified by a Steering Committee formed by SBRN. Next, SBRN members were invited to contribute to this project and interested participants reviewed and provided feedback on the proposed list of terms and draft definitions through an online survey. Finally, a conceptual model and consensus definitions (including caveats and examples for all age groups and functional abilities) were finalized based on the feedback received from the 87 SBRN member participants who responded to the original invitation and survey. Results: Consensus definitions for the terms physical inactivity, stationary behavior, sedentary behavior, standing, screen time, non-screen-based sedentary time, sitting, reclining, lying, sedentary behavior pattern, as well as how the terms bouts, breaks, and interruptions should be used in this context are provided. Conclusion: It is hoped that the definitions resulting from this comprehensive, transparent, and broad-based participatory process will result in standardized terminology that is widely supported and adopted, thereby advancing future research, interventions, policies, and practices related to sedentary behaviors

Examining the relationship between exercise and sedentary behaviour among cardiac rehabilitation patients to inform intervention strategies

Prolonged time in sedentary behaviours is associated with cardio-metabolic disease risk and mortality in adult populations. Yet, the association between sedentary behaviour and exercise participation on health outcomes is unclear. Six inter-related studies were conducted in the pursuit of the following objectives: to understand the risks and determinants of sedentary behaviour among patients participating in exercise-based cardiac rehabilitation (CR), and inform the development of sedentary behaviour interventions among these individuals. Prolonged sedentary time was found to be associated with cardio-metabolic disorders and mortality independent of physical activity, with greater mortality risks for those with low physical activity levels compared to those with greater levels. Among CR patients, exercise participation did not influence their sedentary time and were found to be highly sedentary (>8 hours per day) at the initiation of, and throughout CR, irrespective of whether physical activity guidelines were met. Patients and staff placed a lower priority in reducing sedentary behaviour than improving physical activity and other health behaviours. Intrapersonal factors (biological, psychological), and environmental factors (behaviour settings, the information environment, social-cultural factors, natural environment) were perceived to be facilitators of sedentary behaviour, and barriers to reducing sedentary behaviour. It was also determined that the exercise focus of CR might be beneficial to individuals who are unable to reallocate sedentary time to exercise and light physical activity. Alternatively, a focus on light-intensity physical activity alone may be suitable for those patients who are unable to participate in exercise. Lastly, it was found that CR programs do not benefit all patients equally, and an intervention strategy must be individually targeted. Taken together, these findings contribute towards a better understanding of whether prolonged sedentary time is a distinct health risk factor, and inform the development and pilot testing of future sedentary behaviour interventions for CR patients.Ph.D

Naturally occurring workplace facilities to increase the leisure time physical activity of workers: A propensity-score weighted population study

The benefit of providing access to physical activity facilities at or near work to support the leisure time physical activity (LTPA) of workers is uncertain. We examined the association between access to physical activity facilities at or near work and the LTPA of workers after adjusting for a range of individual and occupational characteristics. Data was obtained from 60,650 respondents to the 2007–2008 Canadian Community Health Survey. Participants were employed adults ≥18 years of age who had no long-term health condition which reduced their participation in physical activity. Latent class analysis determined naturally occurring combinations of physical activity facilities at or near work. Each combination was balanced by 19 individual and occupational covariate characteristics using inverse probability of treatment weights derived from propensity scores. The association between combinations of physical activity facilities at or near work on LTPA level was estimated by multinomial logistic regression. Five different combinations of physical activity facilities were available to respondents at or near work. Data were analyzed in 2017. All possible physical facilities increased the likelihood for LTPA (OR, 2.08, 95% CI, 1.03–4.20) and other combinations were also positively associated. Respondents with no physical activity facilities were characterized as having a low education, low income, high physically demanding work, poor health and mental health, non-white racial background, and being an immigrant. Access to supportive workplace environments can help workers be physically active. Future research should assess a range of personal, social and environmental factors that may be driving this relationship. Keywords: Physical activity, Workplace, Built environment, Health promotion, Exercis

The effect of leisure time physical activity and sedentary time on health outcomes across occupational physical demand groups: a systematic review protocol

This is a protocol for a systematic review is to determine whether leisure-time physical activity (LTPA), and specifically meeting physical activity guidelines exclusively during leisure time, confers the same health benefits across occupations grouped by physical demands (i.e., primarily sitting vs. stationary standing vs. intermittent movement vs. hard labour). Secondary objectives of this systematic review are to examine the association between time spent sedentary during leisure time and health outcomes across the same occupational physical demand groups; and determine if time spent sitting during leisure time modulates/attenuates the associations between occupational physical demands and health outcomes

A systematic review of physician retirement planning

Abstract Background Physician retirement planning and timing have important implications for patients, hospitals, and healthcare systems. Unplanned early or late physician retirement can have dire consequences in terms of both patient safety and human resource allocations. This systematic review examined existing evidence on the timing and process of retirement of physicians. Four questions were addressed: (1) When do physicians retire? (2) Why do some physicians retire early? (3) Why do some physicians delay their retirement? (4) What strategies facilitate physician retention and/or retirement planning? Methods English-language studies were searched in electronic databases MEDLINE, Web of Science, Scopus, CINAHL, AgeLine, Embase, HealthSTAR, ASSA, and PsycINFO, from inception up to and including March 2016. Included studies were peer-reviewed primary journal articles with quantitative and/or qualitative analyses of physicians’ plans for, and opinions about, retirement. Three reviewers independently assessed each study for methodological quality using the Newcastle-Ottawa Scale for quantitative studies and Critical Appraisal Tool for qualitative studies, and a fourth reviewer resolved inconsistencies. Results In all, 65 studies were included and analyzed, of which the majority were cross-sectional in design. Qualitative studies were found to be methodologically strong, with credible results deemed relevant to practice. The majority of quantitative studies had adequate sample representativeness, had justified and satisfactory sample size, used appropriate statistical tests, and collected primary data by self-reported survey methods. Physicians commonly reported retiring between 60 and 69 years of age. Excessive workload and burnout were frequently cited reasons for early retirement. Ongoing financial obligations delayed retirement, while strategies to mitigate career dissatisfaction, workplace frustration, and workload pressure supported continuing practice. Conclusions Knowledge of when physicians plan to retire and how they can transition out of practice has been shown to aid succession planning. Healthcare organizations might consider promoting retirement mentorship programs, resource toolkits, education sessions, and guidance around financial planning for physicians throughout their careers, as well as creating post-retirement opportunities that maintain institutional ties through teaching, mentoring, and peer support

Workers’ Activity Profiles Associated With Predicted 10‐Year Cardiovascular Disease Risk

Background There is a need to explore common activity patterns undertaken by workers and the association between these activity profiles and cardiovascular disease (CVD). This study explored the number and type of distinct profiles of activity patterns among workers and the association between these profiles and predicted 10‐year risk for a first atherosclerotic CVD event. Methods and Results Distinct activity patterns from a cross‐section of workers’ accelerometer data were sampled from Canadian Health Measures Survey participants (5 cycles, 2007–2017) and identified using hierarchical cluster analysis techniques. Covariates included accelerometer wear time, work factors, sociodemographic factors, clinical markers, and lifestyle variables. Associations between activity profiles and high atherosclerotic CVD risk >10% were estimated using robust Poisson regression models. Six distinct activity profiles were identified from 8909 workers. Compared with the “lowest activity” profile, individuals in the “highest activity” and “moderate evening activity” profiles were at 42% lower risk (relative risk [RR], 0.58; 95% CI, 0.47, 0.70) and 33% lower risk (RR, 0.67; 95% CI, 0.44, 0.87) of predicted 10‐year atherosclerotic CVD risk of >10%, respectively. “Moderate activity” and “fluctuations of moderate activity” profiles were also associated with lower risk estimates, whereas the “high daytime activity” profile was not statistically different to the reference profile. Conclusions Workers accumulating physical activity throughout the day and during recreational hours were found to have optimal CVD risk profiles. Workers accumulating physical activity only during daytime work hours were not associated with reduced CVD risk. Findings can inform alternative strategies to conferring the cardiovascular benefits of physical activity among workers. Large prospective studies are needed to confirm these findings

Patient and practitioner perspectives on reducing sedentary behavior at an exercise-based cardiac rehabilitation program

<p><b>Purpose:</b> To understand the awareness of sedentary behavior, as well as the perceived facilitators and barriers to reducing sedentary behaviors from the perspectives of patients undertaking an exercise-based cardiac rehabilitation program, and from staff involved in supporting patient self-management.</p> <p><b>Materials and methods:</b> A qualitative study was conducted at a large cardiac rehabilitation program in a metropolitan city in Canada. Guided by an ecological framework, semi-structured interviews were conducted individually with 15 patients, and in two focus groups with six staff. Transcribed interviews were analyzed by thematic analysis.</p> <p><b>Results:</b> Patients placed little importance on reducing sedentary behavior as they were unconvinced of the health benefits, did not perceive themselves to be sedentary, or associated such behaviors with enjoyment and relaxation. While staff were aware of the risks, they saw them as less critical than other health behaviors. Intrapersonal factors (physical and psychosocial health) and environment factors (the information environment, socio-cultural factors) within leisure time, the home, and work, influenced sedentary behavior.</p> <p><b>Conclusions:</b> While these findings require further testing, future interventions may be effective if aimed at increasing awareness of the health benefits of reducing sedentary behavior, utilizing existing behavior change strategies, and using a participatory approach to tailor strategies to patients.Implications for rehabilitation</p><p>Cardiac rehabilitation programs effectively use exercise promotion to improve the health of people with established cardiovascular disease.</p><p>As sedentary lifestyles become more prevalent, recommendations to reduce the health risks of prolonged sedentary behavior that are specific to the characteristics and prognostic profiles of cardiac rehabilitation patients are needed.</p><p>Cardiac rehabilitation programs must consider extending existing behavior change strategies utilized for exercise promotion towards addressing sedentary behaviors in order to be effective at reducing the sedentary time of patients.</p><p>A participatory approach involving both patients and health professionals can support patients in reducing their sedentary behavior by providing a supportive environment for behavior change, increasing awareness and understanding of risks, discussing the feasibility of potential strategies, and setting achievable and actionable goals.</p><p></p> <p>Cardiac rehabilitation programs effectively use exercise promotion to improve the health of people with established cardiovascular disease.</p> <p>As sedentary lifestyles become more prevalent, recommendations to reduce the health risks of prolonged sedentary behavior that are specific to the characteristics and prognostic profiles of cardiac rehabilitation patients are needed.</p> <p>Cardiac rehabilitation programs must consider extending existing behavior change strategies utilized for exercise promotion towards addressing sedentary behaviors in order to be effective at reducing the sedentary time of patients.</p> <p>A participatory approach involving both patients and health professionals can support patients in reducing their sedentary behavior by providing a supportive environment for behavior change, increasing awareness and understanding of risks, discussing the feasibility of potential strategies, and setting achievable and actionable goals.</p

The effect of leisure time physical activity and sedentary behaviour on the health of workers with different occupational physical activity demands: a systematic review

Background: Although it is generally accepted that physical activity reduces the risk for chronic non-communicable disease and mortality, accumulating evidence suggests that occupational physical activity (OPA) may not confer the same health benefits as leisure time physical activity (LTPA). It is also unclear if workers in high OPA jobs benefit from LTPA the same way as those in sedentary jobs. Our objective was to determine whether LTPA and leisure time sedentary behaviour (LTSB) confer the same health effects across occupations with different levels of OPA. Methods: Searches were run in Medline, Embase, PsycINFO, ProQuest Public Health and Scopus from inception to June 9, 2020. Prospective or experimental studies which examined the effects of LTPA or LTSB on all-cause and cardiovascular mortality and cardiovascular disease, musculoskeletal pain, diabetes, metabolic syndrome, arrhythmias and depression among adult workers grouped by OPA (low OPA/sitters, standers, moderate OPA/intermittent movers, high OPA/heavy labourers) were eligible. Results were synthesized using narrative syntheses and harvest plots, and certainty of evidence assessed with GRADE. Results: The review includes 38 papers. Across all outcomes, except cardiovascular mortality, metabolic syndrome and atrial fibrillation, greater LTPA was consistently protective among low OPA, but conferred less protection among moderate and high OPA. For cardiovascular mortality and metabolic syndrome, higher levels of LTPA were generally associated with similar risk reductions among all OPA groups. Few studies examined effects in standers and none examined effects of LTSB across OPA groups. Conclusions: Evidence suggests that LTPA is beneficial for all workers, but with larger risk reductions among those with low compared to high OPA jobs. This suggests that, in our attempts to improve the health of workers through LTPA, tailored interventions for different occupational groups may be required. More high-quality studies are needed to establish recommended levels of LTPA/LTSB for different OPA groups. Protocol registration: PROSPERO #CRD42020191708

Identifying the sociodemographic and work-related factors related to workers’ daily physical activity using a decision tree approach

Abstract Background The social and behavioural factors related to physical activity among adults are well known. Despite the overlapping nature of these factors, few studies have examined how multiple predictors of physical activity interact. This study aimed to identify the relative importance of multiple interacting sociodemographic and work-related factors associated with the daily physical activity patterns of a population-based sample of workers. Methods Sociodemographic, work, screen time, and health variables were obtained from five, repeated cross-sectional cohorts of workers from the Canadian Health Measures Survey (2007 to 2017). Classification and Regression Tree (CART) modelling was used to identify the discriminators associated with six daily physical activity patterns. The performance of the CART approach was compared to a stepwise multinomial logistic regression model. Results Among the 8,909 workers analysed, the most important CART discriminators of daily physical activity patterns were age, job skill, and physical strength requirements of the job. Other important factors included participants’ sex, educational attainment, fruit/vegetable intake, industry, work hours, marital status, having a child living at home, computer time, and household income. The CART tree had moderate classification accuracy and performed marginally better than the stepwise multinomial logistic regression model. Conclusion Age and work-related factors–particularly job skill, and physical strength requirements at work–appeared as the most important factors related to physical activity attainment, and differed based on sex, work hours, and industry. Delineating the hierarchy of factors associated with daily physical activity may assist in targeting preventive strategies aimed at promoting physical activity in workers

Larger workplaces, people-oriented culture, and specific industry sectors are associated with co-occurring health protection and wellness activities

Employers are increasingly interested in offering workplace wellness programs in addition to occupational health and safety (OHS) activities to promote worker health, wellbeing, and productivity. Yet, there is a dearth of research on workplace factors that enable the implementation of OHS and wellness to inform the future integration of these activities in Canadian workplaces. This study explored workplace demographic factors associated with the co-implementation of OHS and wellness activities in a heterogenous sample of Canadian workplaces. Using a cross-sectional survey of 1285 workplaces from 2011 to 2014, latent profiles of co-occurrent OHS and wellness activities were identified, and multinomial logistic regression was used to assess associations between workplace demographic factors and the profiles. Most workplaces (84%) demonstrated little co-occurrence of OHS and wellness activities. Highest co-occurrence was associated with large workplaces (odds ratio (OR) = 3.22, 95% confidence interval (CI) = 1.15&#8315;5.89), in the electrical and utilities sector (OR = 5.57, 95% CI = 2.24&#8315;8.35), and a high people-oriented culture (OR = 4.70, 95% CI = 1.59&#8315;5.26). Promoting integrated OHS and wellness approaches in medium to large workplaces, in select industries, and emphasizing a people-oriented culture were found to be important factors for implementing OHS and wellness in Canadian organizations. Informed by these findings, future studies should understand the mechanisms to facilitate the integration of OHS and wellness in workplaces