Nonworksite Interventions to Reduce Sedentary Behavior among Adults: A Systematic Review

Sedentary behavior has been identified as a major health risk. Although interventions to reduce time spent sedentary have become increasingly prevalent, the vast majority of this work in adults has been focused on workplace sedentary behavior and often pairs sedentary reduction interventions with increasing physical activity. As research designed to specifically decrease sedentary time that is not limited to the workplace becomes available, identifying strategies and approaches, along with feasibility and efficacy of these interventions, is warranted. Electronic databases were searched for sedentary interventions with eligibility criteria, including (a) interventions designed to explicitly reduce sedentary behavior that were not limited to the workplace, (b) outcomes specific to sedentary behavior, (c) adults at least 18 yr of age, and (d) written in English. A total of 767 full-text manuscripts were identified, with 13 studies meeting all eligibility criteria. Although intervention characteristics and methodological quality varied greatly among studies, 10 of the 13 studies observed a significant reduction in objectively measured sitting time postintervention. In those studies that collected participant feasibility/acceptability data, all reported that the intervention was viewed as “favorable to very favorable,” would use again, and that participant burden was quite low, suggesting that these interventions were feasible. Sedentary behavior interventions not limited to the workplace appear to be largely efficacious. Although results varied with respect to the magnitude of the decrease in time spent sedentary, they are encouraging. However, because of the small body of evidence and the variability of study designs, our ability to make overarching statements regarding “best practices” at this time is limited. Well-controlled trials of longer duration with larger samples, using theoretically based interventions with consistent prescriptions for limiting sedentary time, are needed

MOBILE AND WEARABLE DEVICE FEATURES THAT MATTER IN PROMOTING PHYSICAL ACTIVITY

Background: As wearable sensors/devices become increasingly popular to promote physical activity (PA), research is needed to examine how and which components of these devices people use to increase their PA levels. Aims: (1) To assess usability and level of engagement with the Fitbit One and daily SMS-based prompts in a 6-week PA intervention, and (2) to examine whether use/ level of engagement with specific intervention components were associated with PA change. Methods: Data were analyzed from a randomized controlled trial that compared (1) a wearable sensor/ device (Fitbit One) plus SMS-based PA prompts, and (2) Fitbit One only, among overweight/ obese adults (N067). We calculated average scores from Likert-type response items that assessed usability and level of engagement with device features (e.g., tracker, website, mobile app, and SMS-based prompts), and assessed whether such factors were associated with change in steps/day (using Actigraph GT3X'). Results: Participants reported the Fitbit One was easy to use and the tracker helped to be more active. Those who used the Fitbit mobile app (36%) vs. those who did not (64%) had an increase in steps at 6-week follow-up, even after adjusting for previous web/app use: '545 steps/ day (SE 0 265) vs. (28 steps/ day (SE 0242) (p 0.04). Conclusions: Level of engagement with the Fitbit One, particularly the mobile app, was associated with increased steps. Mobile apps can instantly display summaries of PA performance and could optimize self-regulation to activate change. More research is needed to determine whether such modalities might be cost-effective in future intervention research and practice

Physical activity, additional breast cancer events, and mortality among early-stage breast cancer survivors: findings from the WHEL Study

ObjectiveResearch suggests that physical activity is associated with improved breast cancer survival, yet no studies have examined the association between post-diagnosis changes in physical activity and breast cancer outcomes. The aim of this study was to determine whether baseline activity and 1-year change in activity are associated with breast cancer events or mortality.MethodsA total of 2,361 post-treatment breast cancer survivors (Stage I-III) enrolled in a randomized controlled trial of dietary change completed physical activity measures at baseline and one year. Physical activity variables (total, moderate-vigorous, and adherence to guidelines) were calculated for each time point. Median follow-up was 7.1 years. Outcomes were invasive breast cancer events and all-cause mortality.ResultsThose who were most active at baseline had a 53% lower mortality risk compared to the least active women (HR = 0.47; 95% CI: 0.26, 0.84; p = .01). Adherence to activity guidelines was associated with a 35% lower mortality risk (HR = 0.65, 95% CI: 0.47, 0.91; p < .01). Neither baseline nor 1-year change in activity was associated with additional breast cancer events.ConclusionsHigher baseline (post-treatment) physical activity was associated with improved survival. However, change in activity over the following year was not associated with outcomes. These data suggest that long-term physical activity levels are important for breast cancer prognosis

Randomized trial of a phone- and web-based weight loss program for women at elevated breast cancer risk: the HELP study

Excess weight and physical inactivity are modifiable risk factors for breast cancer. Behavioral intervention is particularly important among women with an elevated risk profile. This trial tested an intervention that trained women to use a self-monitoring website to increase activity and lose weight. Women with BMI≥27.5 kg/m(2) at elevated breast cancer risk were randomized to the intervention (N=71) or usual care (N=34). The intervention group received telephone-based coaching and used web-based self-monitoring tools. At 6 months, significant weight loss was observed in the intervention group (4.7% loss from starting weight; SD=4.7%) relative to usual care (0.4% gain; SD=3.0%) (p<.0001). By 12 months, the intervention group had lost 3.7% of weight (SD=5.4%), compared to 1.3% (SD=4.2) for usual care (p=.003). At 12 months, accelerometer-measured moderate-to-vigorous physical activity increased by 12 min/day (SD=24) compared to no change in usual care (p=.04. In summary, this web- and phone-based approach produced modest but significant improvements in weight and physical activity for women at elevated breast cancer risk

Accelerometer-derived physical activity and sedentary time by cancer type in the United States.

The 2003-2004 and 2005-2006 cycles of the National Health and Nutrition Examination Survey (NHANES) were among the first population-level studies to incorporate objectively measured physical activity and sedentary behavior, allowing for greater understanding of these behaviors. However, there has yet to be a comprehensive examination of these data in cancer survivors, including short- and long-term survivors of all cancer types. Therefore, the purpose of this analysis was to use these data to describe activity behaviors in short- and long-term cancer survivors of various types. A secondary aim was to compare activity patterns of cancer survivors to that of the general population. Cancer survivors (n = 508) and age-matched individuals not diagnosed with cancer (n = 1,016) were identified from a subsample of adults with activity measured by accelerometer. Physical activity and sedentary behavior were summarized across cancer type and demographics; multivariate regression was used to evaluate differences between survivors and those not diagnosed with cancer. On average, cancer survivors were 61.4 (95% CI: 59.6, 63.2) years of age; 57% were female. Physical activity and sedentary behavior patterns varied by cancer diagnosis, demographic variables, and time since diagnosis. Survivors performed 307 min/day of light-intensity physical activity (95% CI: 295, 319), 16 min/day of moderate-vigorous intensity activity (95% CI: 14, 17); only 8% met physical activity recommendations. These individuals also reported 519 (CI: 506, 532) minutes of sedentary time, with 86 (CI: 84, 88) breaks in sedentary behavior per day. Compared to non-cancer survivors, after adjustment for potential confounders, survivors performed less light-intensity activity (P = 0.01), were more sedentary (P = 0.01), and took fewer breaks in sedentary time (P = 0.04), though there were no differences in any other activity variables. These results suggest that cancer survivors are insufficiently active. Relative to adults of similar age not diagnosed with cancer, they engage in more sedentary time with fewer breaks. As such, sedentary behavior and light-intensity activity may be important intervention targets, particularly for those for whom moderate-to-vigorous activity is not well accepted

Nonworksite Interventions to Reduce Sedentary Behavior among Adults: A Systematic Review

Sedentary behavior has been identified as a major health risk. Although interventions to reduce time spent sedentary have become increasingly prevalent, the vast majority of this work in adults has been focused on workplace sedentary behavior and often pairs sedentary reduction interventions with increasing physical activity. As research designed to specifically decrease sedentary time that is not limited to the workplace becomes available, identifying strategies and approaches, along with feasibility and efficacy of these interventions, is warranted. Electronic databases were searched for sedentary interventions with eligibility criteria, including (a) interventions designed to explicitly reduce sedentary behavior that were not limited to the workplace, (b) outcomes specific to sedentary behavior, (c) adults at least 18 yr of age, and (d) written in English. A total of 767 full-text manuscripts were identified, with 13 studies meeting all eligibility criteria. Although intervention characteristics and methodological quality varied greatly among studies, 10 of the 13 studies observed a significant reduction in objectively measured sitting time postintervention. In those studies that collected participant feasibility/acceptability data, all reported that the intervention was viewed as “favorable to very favorable,” would use again, and that participant burden was quite low, suggesting that these interventions were feasible. Sedentary behavior interventions not limited to the workplace appear to be largely efficacious. Although results varied with respect to the magnitude of the decrease in time spent sedentary, they are encouraging. However, because of the small body of evidence and the variability of study designs, our ability to make overarching statements regarding “best practices” at this time is limited. Well-controlled trials of longer duration with larger samples, using theoretically based interventions with consistent prescriptions for limiting sedentary time, are needed.This accepted article is published as Thraen-Borowski K, Ellingson L, Meyer J, Cadmus-Bertram L (2017). Non-worksite interventions to reduce sedentary behavior: A systematic review. Translational Journal of the American College of Sports Medicine, 2(12); 68-78. doi: 10.1249/TJX.0000000000000036. Posted with permission.</p

Improving Hip-Worn Accelerometer Estimates of Sitting Using Machine Learning Methods.

PURPOSE:This study aimed to improve estimates of sitting time from hip-worn accelerometers used in large cohort studies by using machine learning methods developed on free-living activPAL data. METHODS:Thirty breast cancer survivors concurrently wore a hip-worn accelerometer and a thigh-worn activPAL for 7 d. A random forest classifier, trained on the activPAL data, was used to detect sitting, standing, and sit-stand transitions in 5-s windows in the hip-worn accelerometer. The classifier estimates were compared with the standard accelerometer cut point, and significant differences across different bout lengths were investigated using mixed-effect models. RESULTS:Overall, the algorithm predicted the postures with moderate accuracy (stepping, 77%; standing, 63%; sitting, 67%; sit-to-stand, 52%; and stand-to-sit, 51%). Daily level analyses indicated that errors in transition estimates were only occurring during sitting bouts of 2 min or less. The standard cut point was significantly different from the activPAL across all bout lengths, overestimating short bouts and underestimating long bouts. CONCLUSIONS:This is among the first algorithms for sitting and standing for hip-worn accelerometer data to be trained from entirely free-living activPAL data. The new algorithm detected prolonged sitting, which has been shown to be the most detrimental to health. Further validation and training in larger cohorts is warranted