This roadmap aims to support health officials to consider changes to sedentary behaviour that may have occurred during the Covid-19 pandemic and to use psychologically informed behaviour change approaches to optimise health improvement and mitigate an increase in time spent sitting or lying down. This guidance should be used alongside the Achieving Behaviour Change (ABC) guide {1} for local government and partners, and the Improving People’s Health behavioural and social science strategy {2} {1}https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/875385/PHEBI_Achieving_Behaviour_Change_Local_Government.pdf {2}https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/744672/Improving_Peoples_Health_Behavioural_Strategy.pdfFinal Published versio

Abdin, Shanara

Arden , Madelynne

Armitage, Christopher

Byrne-Davis, Lucie

Chadwick, Paul

Chater, Angel

Drury, John

Epton, Tracy

Hart, Jo

Howlett, Neil

Kamal, Atiya

Lewis, Lesley

McBride, Emily

O'Connor, Daryl

Shorter, Gillian

Swanson, Vivien

Thompson, Sam

Whittaker, Eleanor

English

Behavioural science recommendationsLimiting and breaking up sedentary behaviour throughout the waking day can benefit both physical and psychological health. Levels of sedentary behaviour can be influenced by what we know and what we can do (capability); the people around us and our physical environment (opportunity); and our beliefs, what we want, how we see ourselves, how we regulate our emotions, and our habits (motivation). To limit and break up sedentary behaviour that may have increased since COVID-19:● Increase awareness and educate about what is sedentary behaviour, and how to reduce it. ● Consider whether any disruption to daily routines, physical environments (e.g. working from home/school closures), and/or social support may have influenced sedentary behaviour. ● Where needed, develop strategies to mitigate influences on sedentary behaviour (e.g. changing the physical and social environment to enable more regular movement, setting prompts as a reminder to break up sitting time).● Facilitate planning of how to break up and limit levels of sedentary behaviour, especially during home schooling/working and/or in the event of unpredictable circumstances (e.g. needing to self-isolate/quarantine).● Promote standing for tasks or activities that may otherwise be performed while sedentary and regular movement to break up sitting time throughout the day, for the benefit of physical health and psychological wellbeing. We recommend following the British Psychological Society’s Behavioural Science and Disease Prevention: Psychological guidance3 to shape any policy and/or communications strategy

Armitage, Chris

Arden, Madelynne A

Whittaker, Ellie

Queen's University Belfast Research Portal

COVID-19 Public Health Road Map: Sedentary behaviour

This roadmap aims to support health officials to consider changes to sedentary behaviour that may have occurred during the Covid-19 pandemic and to use psychologically informed behaviour change approaches to optimise health improvement and mitigate an increase in time spent sitting or lying down. This guidance should be used alongside the Achieving Behaviour Change (ABC) guide {1} for local government and partners, and the Improving People’s Health behavioural and social science strategy {2} {1}https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/875385/PHEBI_Achieving_Behaviour_Change_Local_Government.pdf {2}https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/744672/Improving_Peoples_Health_Behavioural_Strategy.pd

University of Hertfordshire Research Archive

GUIDANCE Covid-19 public health road map: Sedentary behaviourA I M  O F  T H I S  D O C U M E N TThis roadmap aims to support health officials to consider changes to sedentary behaviour that may have occurred during the Covid-19 pandemic and to use psychologically-informed behaviour change approaches to optimise health improvement and mitigate an increase in time spent sitting or lying down. This guidance should be used alongside the Achieving Behaviour Change (ABC) guide1 for local government and partners, and the Improving People’s Health behavioural and social science strategy2.B E H AV I O U R A L  S C I E N C E  R E C O M M E N D A T I O N SLimiting and breaking up sedentary behaviour throughout the waking day can benefit both physical and psychological health. Levels of sedentary behaviour can be influenced by what we know and what we can do (capability); the people around us and our physical environment (opportunity); and our beliefs, what we want, how we see ourselves, how we regulate our emotions, and our habits (motivation). To limit and break up sedentary behaviour that may have increased since Covid-19:Increase awareness and educate about what is sedentary behaviour, and how to reduce it.  Consider whether any disruption to daily routines, physical environments  (e.g. working from home/school closures), and/or social support may have influenced sedentary behaviour. Where needed, develop strategies to mitigate influences on sedentary behaviour  (e.g. changing the physical and social environment to enable more regular movement, setting prompts as a reminder to break up sitting time).Facilitate planning of how to break up and limit levels of sedentary behaviour, especially during home schooling/working and/or in the event of unpredictable circumstances (e.g. needing to self-isolate/quarantine).Promote standing for tasks or activities that may otherwise be performed while sedentary and regular movement to break up sitting time throughout the day, for the benefit of physical health and psychological wellbeing.  GUIDANCECovid-19 public health road map: Sedentary behaviour | BRE33zb | 16.10.20202GUIDANCE We recommend following the British Psychological Society’s Behavioural Science and Disease Prevention Psychological guidance3 to shape any policy and/or communications strategy.T A R G E T  B E H AV I O U R :  L I M I T I N G  A N D  B R E A K I N G  U P S E D E N T A R Y  B E H AV I O U R Sedentary behaviour is defined as any waking behaviour characterised by a low energy expenditure, <1.5 metabolic equivalents (METs), whilst in a sitting, laying or reclined posture4. When considering/measuring sedentary behaviour it is important to consider both: 1) the total amount of time spent sedentary in the waking day, and 2) the number of times that sedentary behaviour is broken with standing and light movement. Sedentary behaviour should not be confused with physical inactivity. Physical inactivity is defined by Sport England5 and the World Health Organisation6 as not reaching 30 minutes of moderate to vigorous physical activity (MVPA) per week for adults, or per day for children and young people. An individual can meet the recommended guidelines for physical activity and still be considered as engaging in high levels of sedentary behaviour, therefore, we have created separate guidance on physical activity/inactivity.W H Y  I S  R E D U C I N G  S E D E N T A R Y  B E H AV I O U R  I M P O R T A N T ?Sedentary behaviour has now emerged as an independent risk factor for poor cardiometabolic health that should be considered in addition to physical inactivity7. Daily sitting time increases the risk of type 2 diabetes, cardiovascular disease and mortality8,9 independent of physical activity levels. Sitting for long periods of time can slow metabolism, affecting the ability to regulate blood sugar, blood pressure and break down fat10. Engaging in prolonged bouts of sedentary behaviour is adversely associated with cardiovascular health11 and there is good evidence that breaking up sitting can benefit cardiometabolic health12,13 and also improve mood and psychological wellbeing13. For example, breaking up sitting with two to five minutes of light or moderate-intensity walking every 20 to 30 minutes can attenuate postprandial glucose responses9,14.  Consequently, limiting sedentary behaviour throughout the day, breaking up sitting time each hour, and engaging in light activity instead of prolonged sitting can have important physical and psychological health benefits.P O S S I B L E  C H A N G E S  T O  S E D E N T A R Y  B E H AV I O U R  S I N C E  C O V I D -19Covid-19 has had a significant impact on daily routines that may have impacted the amount of time spent sedentary each day. Prior to Covid-19, active commuting and walking in workplace and educational settings provided opportunities to break up sitting time. It is likely that changes in routines since Covid-19 have reduced these natural interruptions to sedentary behaviour and new plans and habits need to be developed to fit this new context.Additionally, it is likely that measures taken to contain Covid-19 may have resulted in increased sedentary behaviour, particularly for those in vulnerable or clinically at-risk groups asked to shield. Self-isolation and quarantine may also lead to greater time spent sedentary due to the requirement to stay at home. The short and long-term negative health effects of prolonged daily sedentary behaviour may exacerbate existing health issues and inequalities. For example, older adults, those living with long-term conditions15 and those in recovery from Covid-19 may experience deconditioning (e.g. decline in muscle strength and bulk) due to increased sedentary behaviour. Covid-19 public health road map: Sedentary behaviour | BRE33zb | 16.10.20203GUIDANCEW I D E - S C A L E  P U B L I C  H E A LT H  I N T E R V E N T I O NHealth officials have the opportunity to support national behaviour change through a number of policy levers. Table 1 highlights existing approaches and suggestions for future development. Using this document, alongside the ABC guide1 and support from experts in behaviour change, such as health psychologists, can help to optimise reach and impact of public health efforts.Policy categories Definition Examples and suggestionsCommunication/ marketingUsing print, electronic, telephonic or broadcast media.Use clear messaging about the benefits of  reducing prolonged periods of sedentary  behaviour and breaking up sitting each hour. Re-think marketing that is directed at a wanted  positive behaviour, such as staying at home,  but may have negative consequences on another  unwanted behaviour, such as excessive sitting  (e.g. the ‘Britain! We Need Your  Buttocks’ campaign)GuidelinesCreating documents that recommend or mandate practice. This includes all changes to service provision.Promote existing guidance for workplace sitting, and provide more clarity and guidance in relation to leisure-time sedentary behaviour18This includes accumulating two to four hours per day of standing and light activity during working hours and regularly breaking up sitting time.Fiscal measuresUsing the tax system to increase or reduce the financial cost.Reduce cost for things that will support a  reduction in sedentary behaviour (e.g. active workstations).  RegulationEstablishing rules or principles of behavioural practice.Regulate the amount of time sitting in highly sedentary environments (e.g. making codes of  practice to ensure that active workstations and  standing meetings/lessons are available in all  workplace/educational settings).  Legislation Making or changing laws.Make it a legal requirement for workplaces and  educational settings to provide opportunities to limit sedentary behaviour and access to  workstations that allow tasks while standing  (including when working from home).Table 1: Policy categories from the Behaviour Change Wheel1, 13,14 that could support limiting  and breaking up sedentary behaviour during the Covid-19 pandemic and beyond.GUIDANCECovid-19 public health road map: Sedentary behaviour | BRE33zb | 16.10.20204U N D E R S T A N D I N G  I N F L U E N C E S  O N  B E H AV I O U R  U S I N G  A C O M - B  D I A G N O S I STo assist in understanding behaviour and behaviour change, the COM-B model16–17, 19–20, suggests that there must be considerations made for the target population in relation to their:Capability to enact the Behaviour, that relies on both psychological (e.g. knowledge and skill) and physical (e.g. ability and strength) capability factors;Opportunity to enable the Behaviour, that considers both social (e.g. norms, support) and physical (e.g. resources, environment) opportunity facilitators; andMotivation to perform the Behaviour, that involves both reflective (e.g. attitudes, confidence, intentions, identity) and automatic (e.g. emotion, habit) motivational processes.The likely influences to consider when developing policies, campaigns or messaging to support physical activity based on a COM-B behavioural diagnosis are presented in Table 2.D I F F E R E N T  A U D I E N C E S  T O  C O N S I D E RW H O  N E E D S  T H I S  I N F O R M A T I O NWorld Health Organisation, International partners and public health teams, Public Health England, Public Health Scotland, Public Health Wales, Public Health Agency Northern Ireland, Local Authorities, commissioners, Clinical Commissioning Groups, primary care, schools, Sport England, Sport Scotland, Sport Wales, Sport Northern Ireland, Active Partnerships, Football Community and Education trusts, relevant charities (e.g. British Heart Foundation, Versus Arthritis, Macmillan Cancer Support, Diabetes UK), mental health services, all agencies and organisations with a remit of physical activity and sedentary behaviour. W H O  W I L L  B E  I N F L U E N C E D  M O S T  B Y  C O V I D - 1 9There is a need for researchers and policy makers to address how these barriers and facilitators differ based on occupation, role and employment status, gender/sex, socio-economic group, ethnic group, experience of physical and/or learning disabilities, age group, differing levels of risk for Covid-19 and those in Covid-19 recovery.Environmental/ social PlanningDesigning and/or controlling the physical or social environment.Provide access to active workstations in workplace  and educational settings and remove a quota of  chairs to facilitate tasks while standing, including  standing meetings/lessons. Encourage a social  norm to limit and break up sedentary behaviour. Service Provision Delivering a service.Provide personalised assessment and support  services (such as apps13) specifically to help  people to change their behaviour to break up  long periods of sitting. Service provision should include behaviour  change techniques known to be effective in  changing sedentary behaviour, such as those  found here12.GUIDANCECovid-19 public health road map: Sedentary behaviour | BRE33zb | 16.10.20205U S I N G  A  B E H AV I O U R A L  S C I E N C E  A P P R O A C HThis document provides considerations for the initial stages of intervention development using the Behaviour Change Wheel13,14 approach described in the ABC guide1 to support behaviour change. For further support on the full development and evaluation of interventions and the translation of this into practice using the whole system approach, you can contact the BPS Division of Health Psychology (with the subject title Covid-19). We would also encourage you to contact your local university or one with expertise in behaviour change, and/or find a psychologist via the Society’s website. Table 2: COM-B behavioural diagnosis of the likely influences on sedentary behaviour.Capability psychological/physicalOpportunity social/physicalMotivation reflective/automaticKnowledge of what sedentary behaviour is and why it is important to limit and break up sedentary time. (Psychological)Social support from family, friends or workplace to limit and break up sedentary behaviour. (Social)Belief that limiting and breaking up sedentary behaviour would be beneficial to health and/or a good thing to do. (Reflective)Having the cognitive and interpersonal skills (e.g. able to negotiate standing during a meeting) to limit and break up sedentary behaviour. (Psychological)Other people influencing the amount of time spent sedentary. (Social)Perceived risk of injury from moving to a standing position to break up  sedentary behaviour. (Reflective)Remembering to limit and break up sedentary behaviour when routines have changed. (Psychological)Family commitments influencing ability to limit and break up sedentary behaviour (e.g. home schooling). (Social)Having the confidence to limit and break up sedentary behaviour despite challenges since Covid-19. (Reflective)Knowing how to limit and break up sedentary behaviour. (Psychological)Social and cultural norms to limit and break up sedentary behaviour. (Social)Having strong intentions and goals to limit and break up sedentary behaviour. (Reflective)Ability to plan to limit and break up sedentary behaviour. (Psychological)Having appropriate resources (e.g. workstations) to limit and break up sedentary behaviour. (Physical)Holding an identity of someone who is not sedentary. (Reflective)Having the skill to limit and break up sedentary behaviour while doing other tasks. (Physical)Having access to the physical space to limit and break up sedentary behaviour (e.g. due to physical-distancing). (Physical)Overcoming emotion that may influence limiting and breaking up sedentary behaviour, such as anxiety (e.g. worried about infection), sadness, boredom. (Automatic)Strength and stamina to stand or move about in order to limit and break up sedentary behaviour. (Physical)Financial restrictions to limit and break up sedentary behaviour (e.g. if reduction in productivity). (Physical)Overcoming the habit to be sedentary. (Automatic)GUIDANCECovid-19 public health road map: Sedentary behaviour | BRE33zb | 16.10.20206R E S O U R C E S• NHS• British Heart Foundation• Sedentary behaviour research network • Measurements• Sport England: Covid-19 briefing: Exploring attitudes and behavioursin England during the Covid-19 pandemicC O N T R I B U T O R SProduced by Angel Chater, Shanara Abdin, Gillian Shorter, Lesley Lewis, Jo Hart, Christopher Armitage, Tracy Epton, Lucie Byrne-Davis, Madelynne Arden, Paul Chadwick, Atiya Kamal, John Drury, Emily McBride, Daryl O’Connor, Vivien Swanson, Sam Thompson, Eleanor Whittaker & Neil Howlett.On behalf of the BPS Covid-19 Behavioural Science and Disease Prevention Taskforce.GUIDANCECovid-19 public health road map: Sedentary behaviour | BRE33zb | 16.10.20207R E F E R E N C E S1 West, R., Michie, S., Atkins, L. et al. (2019). Achieving Behaviour Change: A guide for local government and partners.  London: Public Health England.  2 Public Health England. (2018). Improving People’s Health: Applying Behavioural and Social Sciences to Improve Population Health and Wellbeing in England. London: Public Health England. 3 Chater, A., Arden, M., Armitage, C. et al. (2020). Behavioural science and disease prevention: Psychological guidance. London: British Psychological Society.4 Tremblay, M.S., Aubert, S., Barnes, J.D. et al. (2017). Sedentary behaviour research network (SBRN)–terminology consensus project process and outcome. International Journal of Behavioral Nutrition and Physical Activity, 14(1), 75.5 Sport England. (2020). Inactive people. London: Author6 World Health Organisation. (2020). Global strategy on diet, physical activity and health. Geneva: Author.7 Dempsey, P.C., Owen, N., Yates, T.E. et al. (2016). Sitting less and moving more: Improved glycaemic control for type 2 diabetes prevention and management. Current Diabetes Reports, 16(11), 114.8 Katzmarzyk, P.T., Church, T.S., Craig, C.L. & Bouchard, C. (2009). Sitting time and mortality from all causes, cardiovascular disease, and cancer. Medicine & Science in Sports & Exercise, 41(5), 998–1005.9 Bailey, D.P., Hewson, D.J., Champion, R.B. & Sayegh, S.M. (2019). Sitting time and risk of cardiovascular disease and diabetes: A systematic review and meta-analysis. American Journal of Preventive Medicine, 57(3), 408–416.10 NHS. (2019). Why we should sit less. 11 Bellettiere, J., Winkler, E.A., Chastin, S.F. et al. (2017). Associations of sitting accumulation patterns with cardio-metabolic risk biomarkers in Australian adults. PloS One, 12(6), e0180119.12 Brierley, M.L., Chater, A.M., Smith, L.R. & Bailey, D.P. (2019). The effectiveness of sedentary behaviour reduction workplace interventions on cardiometabolic risk markers: A systematic review. Sports Medicine, 1–29. doi:10.1007/s40279-019-01168-9 13 Bailey, D., Mugridge, L., Dong, F. et al. (2020). Randomised controlled feasibility study of the MyHealthAvatar-Diabetes smartphone app for reducing prolonged sitting time in Type 2 diabetes mellitus. International Journal of Environmental Research and Public Health, 17(12), 4414. doi:10.3390/ijerph1712441414 Bailey, D.P. & Locke, C.D. (2015). Breaking up prolonged sitting with light-intensity walking improves postprandial glycaemia, but breaking up sitting with standing does not. Journal of Science and Medicine in Sport, 18(3), 294–298.15 Gray, M. & Bird, W. (2020). Covid-19 will be followed by a deconditioning pandemic. BMJ Opinion.16 Michie, S., van Stralen, M.M. & West, R. (2011). The Behaviour Change Wheel: A new method for characterising and designing behaviour change interventions. Implementation Science, 6(42). doi:10.1186/1748-5908-6-42.17 Michie, S., Atkins, L. & West, R. (2014). The Behaviour Change Wheel: A guide to designing interventions.  London: Silverback Publishing.18 Buckley, J.P., Hedge, A., Yates, T. et al. (2015). The sedentary office: An expert statement on the growing case for change towards better health and productivity. British Journal of Sports Medicine, 49(21), 1357–1362.  doi:10.1136/bjsports-2015-09461819 Howlett, N., Schulz, J., Trivedi, D. et al. (2020). Determinants of weekly sitting time: Construct validation of an initial COM-B model and comparison of its predictive validity with the theory of planned behaviour. Psychology & Health, 1–19.  doi:10.1080/08870446.2020.1763994  20 Ojo, S.O., Bailey, D.P., Hewson, D.J. & Chater, A.M. (2019). Perceived barriers and facilitators to breaking up sitting time among desk-based office workers: A qualitative investigation using the TDF and COM-B. International Journal of Environmental Research and Public Health, 16(16), 2903.St Andrews House,  48 Princess Road East,  Leicester LE1 7DR, UK 0116 254 9568  www.bps.org.uk  info@bps.org.uk© British Psychological Society | Incorporated by Royal Charter Registered Charity No 229642 | BRE33zb/16.10.2020

Covid-19 public health road map: Sedentary behaviour

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Covid-19 public health road map: Sedentary behaviour

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