Exercise as it relates to Disease/Occupation Sedentary Behaviour: Can Increased Standing Time Reduce Sedentary Associated Diabetes and Obesity?: Difference between revisions

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== Background ==
== Background ==


'''Low-Energy-Expenditure Activities''' Sedentary behavior is classified as conducting activities between 1.0-1.5 metabolic equivalent units (METs) such as sitting and driving (excluding sleeping). Moderate to Vigorous activity such as completing household chores to running utilizes appropriately 1.6-2.9 METs <ref>Pate, P., O'Neill, J., Lobelo, F., (2008), The Evolving Definition of "Sedentary", ''Exercise and Sport Sciences Reviews'', vol. 36, no. 4, pp. 173-178.</ref>. Occupational minimal motion standing incurs approximately 1.2 METs although low, it activates a larger number of muscles and has positive effect on blood pressure ultimately resulting in lower disease states and an overall decrease in mortality <ref>Katzmarzyk, P., (2014), "Standing and Mortality in a Prospective Cohort of Canadian Adults''",Medicine and Science in Sports and Exercise'', vol. 46, pp. 940-946. </ref>.
'''Low-Energy-Expenditure Activities''' Sedentary behavior is classified as conducting activities between 1.0-1.5 metabolic equivalent units (METs) such as sitting and driving (excluding sleeping). Moderate to Vigorous activity such as completing household chores to running utilizes appropriately 1.6-2.9 METs <ref>Pate, P., O'Neill, J., Lobelo, F., (2008), The Evolving Definition of "Sedentary", ''Exercise and Sport Sciences Reviews'', vol. 36, no. 4, pp. 173-178.</ref>. Occupational minimal motion standing incurs approximately 1.2 METs although low, it activates a larger number of muscles and has positive effect on energy utilisation and blood pressure ultimately resulting in lower disease states and an overall decrease in mortality <ref>Katzmarzyk, P., (2014), "Standing and Mortality in a Prospective Cohort of Canadian Adults''",Medicine and Science in Sports and Exercise'', vol. 46, pp. 940-946. </ref>.


'''Occupational sedentary behaviour''' is desk-based office work. We live in an age where most manual labour has been replaced by machinery, operated or regulated by people sitting for prolonged periods of time at computers. Theoretically it will only become more common. Awareness aimed at encouraging individuals with cardiovascular disease, obesity, diabetes and cancer to participate in more vigorous based exercise of a minimum of 150min has failed within approximately 40% globally and 70% in high income countries. <ref> Buckley, J., 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'', vol. 49, pp. 1357-62</ref> . Marketing for standing desks equipment is propelling at a faster rate than evidence supported research. However there is staggering results showing that breaking up prolonged sitting improves glucose and insulin levels <ref>Buckley, J., Mellor, D., Morris, M,. et al (2014), "Standing-based office work shows encouraging signs of attenuating post-prandial glycemic excursion" ''Occupational and Environmental Medicine'', vol. 71, no. 2, pp. 109-11</ref>. as well as reducing fat accumulation around vital organs <ref>Dempsey, P., Owen, N., Biddle, S., et al, (2014), "Managing Sedentary Behaviour to Reduce the Risk of Diabetes and Cardiovascular Disease", ''Current Diabetes Reports'', vol. 14, no. 9, pp. 522.</ref>
'''Occupational sedentary behaviour''' is desk-based office work. We live in an age where most manual labour has been replaced by machinery, operated or regulated by people sitting for prolonged periods of time at computers. Theoretically it will only become more common. Awareness aimed at encouraging individuals with cardiovascular disease, obesity, diabetes and cancer to participate in more vigorous based exercise of a minimum of 150min has failed within approximately 40% globally and 70% in individuals of high income countries. <ref> Buckley, J., 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'', vol. 49, pp. 1357-62</ref> . Marketing for standing desks equipment is propelling at a faster rate than evidence supported research. However there is staggering results showing that breaking up prolonged sitting improves glucose and insulin levels <ref>Buckley, J., Mellor, D., Morris, M,. et al (2014), "Standing-based office work shows encouraging signs of attenuating post-prandial glycemic excursion" ''Occupational and Environmental Medicine'', vol. 71, no. 2, pp. 109-11</ref>. as well as reducing fat accumulation around vital organs <ref>Dempsey, P., Owen, N., Biddle, S., et al, (2014), "Managing Sedentary Behaviour to Reduce the Risk of Diabetes and Cardiovascular Disease", ''Current Diabetes Reports'', vol. 14, no. 9, pp. 522.</ref>


'''Obesity''' is defined as a state of excess fat accumulation that may impede health <ref>World Heath Organisation 2016, Obesity and overweight, viewed 26th of October 2016, available at <http://www.who.int/mediacentre/factsheets/fs311/en/>.</ref>. Risk factors include sedentary behaviour and overconsumption of foods high in fat and sugar <ref>Swinburn, B., Caterson, I., Seidell, J., James, WPT., (2004), "Diet, nutrition and the prevention of excess weight gain and obesity", ''Public Health Nutrition'', vol. 7. no. 1A, pp. 123–146.</ref>. Some common obesity associated diseases are hypertension, cardiovascular disease, coronary heart disease, gallbladder disease and diabetes mellitus type 2 (must). The most common initial diagnosis method for obesity is Body Mass Index (BMI) determined by dividing the patients weight by their squared height however this method is not entirely accurate as many factors are not incorporated. Equations to determine body fat % (BF%) are available to assist in including factors such as age and sex and can minimise error estimates <ref>Paul Deurenberg, P., Weststrate, J., Seidell, J., (2007), "Body mass index as a measure of body fatness: age- and sex-specific prediction formulas", ''British Journal of Nutrition'', vol. 65, no. 2, pp. 105-114.</ref>.
'''Obesity''' is defined as a state of excess fat accumulation that may impede health <ref>World Heath Organisation 2016, Obesity and overweight, viewed 26th of October 2016, available at <http://www.who.int/mediacentre/factsheets/fs311/en/>.</ref>. Risk factors include sedentary behaviour and overconsumption of foods high in fat and sugar <ref>Swinburn, B., Caterson, I., Seidell, J., James, WPT., (2004), "Diet, nutrition and the prevention of excess weight gain and obesity", ''Public Health Nutrition'', vol. 7. no. 1A, pp. 123–146.</ref>. Some common obesity associated diseases are hypertension, cardiovascular disease, coronary heart disease, gallbladder disease and diabetes mellitus type 2 (must). The most common initial diagnosis method for obesity is Body Mass Index (BMI) determined by dividing the patients weight by their squared height however this method is not entirely accurate as many factors are not incorporated. Equations to determine body fat % (BF%) are available to assist in including factors such as age and sex and can minimise error estimates <ref>Paul Deurenberg, P., Weststrate, J., Seidell, J., (2007), "Body mass index as a measure of body fatness: age- and sex-specific prediction formulas", ''British Journal of Nutrition'', vol. 65, no. 2, pp. 105-114.</ref>.


'''Diabetes mellitus type 2''' (T2D) is caused by an insulin resistance. Insulin is the hormone responsible for uptake of glucose by cells for immediate energy use and/or the storage of glucose <ref>Guyton, A., Hall, J., (2016) Guyton And Hall Textbook Of Medical Physiology. Philadelphia, PA: Elsevier.</ref>. Insulin signaling pathways and a decrease in receptors are seen in obese individuals, the exact mechanisms for these occurrences is uncertain however studies suggest it is most likely caused by toxic effects of lipid accumulation <ref>"Diabetes Care, Classification and Diagnosis of Diabetes", ''American Diabetes Association'' last modified (2015 Jan) accessed 27th September 2016, available at http://dx.doi.org/10.2337/dc15-S005.</ref>.
'''Diabetes mellitus type 2''' (T2D) is caused by an insulin resistance. Insulin is the hormone responsible for uptake of glucose by cells for immediate energy use and/or the storage of glucose <ref>Guyton, A., Hall, J., (2016) Guyton And Hall Textbook Of Medical Physiology. Philadelphia, PA: Elsevier.</ref>. Insulin signaling pathways and a decrease in receptors are seen in obese individuals, the exact mechanisms for these occurrences is uncertain however studies suggest it is most likely caused by toxic effects of lipid accumulation <ref>"Diabetes Care, Classification and Diagnosis of Diabetes", ''American Diabetes Association'' last modified (2015 Jan) accessed 27th September 2016, available at http://dx.doi.org/10.2337/dc15-S005.</ref>.

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The research carried out for the Quebec Family Study was conducted at the Physical Activity Sciences Laboratory, Laval University <ref>Chaput, J-P., et al, (2015), "Workplace standing time and the incidence of obesity and type 2 diabetes: a longitudinal study in adults, ''BMC Public Health'', vol. 15, no. 1, pp. 1-7.</ref>. Funding was provided by the Canadian government through grants approved by the Canadian Institute of Health Research <ref>Canadian Institute of Health Research 2016, Funding Overview, viewed 26th of October 2016, <http://www.cihr-irsc.gc.ca/e/37788.html></ref>. Dr Jean-Philippe Chaput designed and conducted the analysis of the study, he is currently Assistant professor at the Faculty of Medicine Pediatrics, Children's Hospital of Eastern Ontario. Dr Chaput has also been involved in 149 research publications relating to pediatrics and obesity (<ref>https://www.researchgate.net/profile/Jean-Philippe_Chaput</ref>). All authors declared they had no competing interests.
The research carried out for the Quebec Family Study was conducted at the Physical Activity Sciences Laboratory, Laval University <ref>Chaput, J-P., et al, (2015), "Workplace standing time and the incidence of obesity and type 2 diabetes: a longitudinal study in adults, ''BMC Public Health'', vol. 15, no. 1, pp. 1-7.</ref>. Funding was provided by the Canadian government through grants approved by the Canadian Institute of Health Research <ref>Canadian Institute of Health Research 2016, Funding Overview, viewed 26th of October 2016, <http://www.cihr-irsc.gc.ca/e/37788.html></ref>. Dr Jean-Philippe Chaput designed and conducted the analysis of the study, he is currently Assistant professor at the Faculty of Medicine Pediatrics, Children's Hospital of Eastern Ontario. Dr Chaput has also been involved in 149 research publications relating to pediatrics and obesity (<ref>https://www.researchgate.net/profile/Jean-Philippe_Chaput</ref>). All authors declared they had no competing interests.





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'''Research''' was conducted via a longitudinal study of 293 participants over a period of six years. Initially the research began in 1979 to investigate the genetics of fitness, body composition and cardiovascular risk factors, involving 1650 participants across 375 families of French descent in Canada. The participants were included irrespective of body weight. Phase two and three of the study conducted from 1989-1997 incorporated 100 families from the initial study along with an additional 123 families totaling 293 participants. All participants had a BMI greater than 32 kg/m2 and were aged between 18-65.
'''Research''' was conducted via a longitudinal study of 293 participants over a period of six years. Initially the research began in 1979 to investigate the genetics of fitness, body composition and cardiovascular risk factors, involving 1650 participants across 375 families of French descent in Canada. The participants were included irrespective of body weight. Phase two and three of the study conducted from 1989-1997 incorporated 100 families from the initial study along with an additional 123 families totaling 293 participants. All participants had a BMI greater than 32 kg/m2 and were aged between 18-65.


'''Participants''' were assessed at baseline and year 6 measuring BMI and performing oral glucose tolerance tests along with questionnaires relating to occupational standing time. BMI was conducted measuring height with a stadiometer to the nearest 0.1 cm and weight with digital scales to the nearest 0.1 kg. Overweight and Obesity were determined via a BMI ≥25 kg/m2. A 12 hour fasted 75 g oral glucose tolerance test was performed in the mornings along with blood samples Samples were taken at -15, 0, 15, 30, 45, 60, 90, 120, 150 and 180 min. Blood samples were analysed in EDTA and Trasylol tubes for enzyme-linked immunosorbent assays (ELISA) (<ref>Kato, M,. (1996), "Optimal conditions for collection of blood samples for assay of alpha 2-macroglobulin-trypsin complex-like substance (MTLS)", ''PUBMED'', vol. 10, no. 5, pp. 239-42.</ref> and fasting glucose concentrations were calculated as the mean of -15 and 0 min. T2D and Impaired Glucose Tolerance (IGT) were determined via the diagnosis criteria of the American Diabetes Association <ref>"Diabetes Care, Classification and Diagnosis of Diabetes", ''American Diabetes Association'' last modified (2015 Jan) accessed 27th September 2016, available at http://dx.doi.org/10.2337/dc15-S005.</ref> and World HealtH organisation <ref>Alberti K., Zimmet P., (1998) "Definition, diagnosis and classification of diabetes mellitus and its complications, part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation", PUBMED, vol 15, pp.539–53.</ref>.
'''Participants''' were assessed at baseline and year 6 measuring BMI and performing oral glucose tolerance tests along with questionnaires relating to occupational standing time. BMI was conducted measuring height with a stadiometer to the nearest 0.1 cm and weight with digital scales to the nearest 0.1 kg. Overweight and Obesity were determined via a BMI ≥25 kg/m2. A 12 hour fasted 75 g oral glucose tolerance test was performed in the mornings along with blood samples Samples were taken at -15, 0, 15, 30, 45, 60, 90, 120, 150 and 180 min. Blood samples were analysed in EDTA and Trasylol tubes for enzyme-linked immunosorbent assays (ELISA) <ref>Kato, M,. (1996), "Optimal conditions for collection of blood samples for assay of alpha 2-macroglobulin-trypsin complex-like substance (MTLS)", ''PUBMED'', vol. 10, no. 5, pp. 239-42.</ref> and fasting glucose concentrations were calculated as the mean of -15 and 0 min. T2D and Impaired Glucose Tolerance (IGT) were determined via the diagnosis criteria of the American Diabetes Association <ref>"Diabetes Care, Classification and Diagnosis of Diabetes", ''American Diabetes Association'' last modified (2015 Jan) accessed 27th September 2016, available at http://dx.doi.org/10.2337/dc15-S005.</ref> and World HealtH organisation <ref>Alberti K., Zimmet P., (1998) "Definition, diagnosis and classification of diabetes mellitus and its complications, part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation", PUBMED, vol 15, pp.539–53.</ref>.


'''Accounting for variables''' was analysed and measured through questionnaires comprising of age, sex, annual family income and smoking habits. These variables along with race, abnormal cholesterol and triglyceride levels, high blood pressure, polysistic ovary syndrome and gestational diabetes pose high risk factors for developing T2D <ref>"Diseases and Conditions Diabetes, Risk Factors", MayoClinic, last updated July 1st 2014, accesses on the 27th of September available at: http://www.mayoclinic.org/diseases-conditions/diabetes/basics/risk-factors/con-20033091.</ref>. Three day food records to asses general daily energy intake along with cardiorespiratory fitness levels were also obtained. The food diaries recorded two week days and one weekend day which were shown to provide reliable data <ref>Tremblay A., Sévigny J., Leblanc C., Bouchard C., (1883), "The reproducibility of a three-day dietary record",''Nutr Res'', vol. 3, pp. 819–30.</ref>. Cardiorespiratory fitness levels were measured via a progressive exercise test conducted on a Monarck cycle ergometer at a heart rate of 150 beats per min.
'''Accounting for variables''' was analysed and measured through questionnaires comprising of age, sex, annual family income and smoking habits. These variables along with race, abnormal cholesterol and triglyceride levels, high blood pressure, polysistic ovary syndrome and gestational diabetes pose high risk factors for developing T2D <ref>"Diseases and Conditions Diabetes, Risk Factors", MayoClinic, last updated July 1st 2014, accesses on the 27th of September available at: http://www.mayoclinic.org/diseases-conditions/diabetes/basics/risk-factors/con-20033091.</ref>. Three day food records to assess general daily energy intake along with cardiorespiratory fitness levels were also obtained. The food diaries recorded two weekdays and one weekend day which were shown to provide reliable data <ref>Tremblay A., Sévigny J., Leblanc C., Bouchard C., (1883), "The reproducibility of a three-day dietary record",''Nutr Res'', vol. 3, pp. 819–30.</ref>. Cardiorespiratory fitness levels were measured via a progressive exercise test conducted on a Monark cycle ergometer at a heart rate of 150 beats per min. Moderate cardiorespiratory fitness in obese men have shown to have similar rates of mortality when compared with highly fit normal-weight groups <ref>Mcauley, P., et al (2010) "Obesity Paradox and Cardiorespiratory Fitness in 12,417 Male Veterans Aged 40 to 70 Years", ''Elsevier'', vol. 85, no. 2, pp. 115-121.</ref>


'''Sixty percent''' of Canadians are either overweight of obese which can narrow the scope of this study , <ref>Johnson, J., Somerville, R., Whitney, J., (2010), "DIABETES: CANADA AT THE TIPPING POINT Charting a New Path", ''Canadian Diabetes Association'', accessed 27th September 2016, available at: https://www.diabetes.ca/CDA/media/documents/publications-and-newsletters/advocacy-reports/canada-at-the-tipping-point-english.pdf</ref>. Questionnaires were also self reported which can encounter error. However the analysis of the study was found to have proficient predictive performance and was not subject to over-fitting.
too many parameters relative to the number of observations


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What kind of study was it? Observational, an RCT, a meta-analysis?
'''Comparative to similar studies''' the Quebec family study showed very similar method techniques and parameters. Several studies also mentioned the inaccuracy of self reported questionnaires <ref>Owen, N., Healy, G., Matthews, C., Dunstan, D., (2010), "Too Much Sitting: The Population-Health Science of Sedentary Behavior", ''Exerc Sport Sci PUBMED'', vol 38 no. 3, PP. 105–113.</ref>. A meta analysis of 59 articles conducted the Loughborough University identified that obesity/overweight individuals may not necessarily have excessive fat accumulation around vital organs which is a leading cause of diabetes and obesity related disease through MRI <ref> Buckley, J., 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'', vol. 49, pp. 1357-62</ref>.
Does the level of evidence from these, and other types of studies, differ?
What did the research involve?


Provide a lay summary of what the participants did in the study?
Was the methodology the best approach?
What limitations exist related to the important measures taken, or other aspects of the methodology (participant recruitment for instance)?


== Research Results==
== Research Results==

What were the important findings?
'''Findings''' At baseline there were 151 participants with a normal BMI and 33 with existing IGT/T2D. During the 6 year follow up 51 new cases of obesity/overweight were identified and 37 new cases of IGT/T2D. Occupational standing of the 293 participants were; 33% standing rarely or never, 23% half of the time and 19% most of the time. Significant association between decreased standing time and developing IGT/T2D and obesity/overweight was observed. However this association was no longer valid once the adjustment for other variables were included specifically family income and cardiorespiratory fitness.
How did the researchers interpret the results?

Do they over-emphasis the implications of their findings?

What conclusions can we take from this research?
The study results were slightly under emphasised due to the results. However the comparison to several other studies with validated data do suggest a correlation between the development of IGT/T2D and obesity/overweight with increased occupational sedentary time.



== Conclusion ==
== Conclusion ==
Provide your own insights on the conclusion (it may not quite be the same as the authors)


'''Can Increased Standing Time Reduce Sedentary Associated Diabetes and Obesity?''' Although the finding of this study do not provide further evidence to support that decreased occupational sedentary time reduces diabetes and obesity many other research resulted have shown a positive correlation <ref>Rahmouni, K., et al, (2005) "Obesity-Associated Hypertension New Insights Into Mechanisms", Hypertension, vol. 45, no. 1, pp 9-14.</ref> <ref>Must, A., et al, (1999) "The Disease Burden Associated with Overweight and Obesity", The Journal of the American Medical Association vol. 282, no. 16, pp. 1523-1529.</ref> <ref> Buckley, J., 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'', vol. 49, pp. 1357-62</ref> <ref>Buckley, J., Mellor, D., Morris, M,. et al (2014), "Standing-based office work shows encouraging signs of attenuating post-prandial glycemic excursion" ''Occupational and Environmental Medicine'', vol. 71, no. 2, pp. 109-11</ref>. Targeting the population during work time to decrease extended periods of sitting appears to be more achievable. However equipping offices with standing/seated workstations may initially seem far too costly the overall investment will lower absentee days and increase productivity as well as delay mortality <ref> Buckley, J., 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'', vol. 49, pp. 1357-62</ref>.

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== Further information of possible interest ==
'''Please follow the link to calculate your BMI''' https://heartfoundation.org.au/your-heart/know-your-risks/healthy-weight/bmi-calculator. Alternative locate your nearest centre for a DEXA scan or Anthropometric measurements which will give you more accurate overall measurements. Please keep in mind this not the most accurate method and if concerned you should seek medical advice.

Further readings for national Diabetes statistics 2014 can be located at; http://www.cdc.gov/diabetes/data/statistics/2014statisticsreport.html

This article explains 10 easy ways to be more active: http://www.lifehack.org/articles/communication/10-simple-ways-more-active.html.

Obesity prevention: https://www.hsph.harvard.edu/obesity-prevention-source/obesity-consequences/health-effects/


== Comparison of Findings ==
How do the findings align with other research in the area (in particular more recent publications that won't be mentioned in the paper)
Practical advice


What real-world implications does this research have?
Are there other considerations readers should know about before taking on this practical advice? Perhaps health/safety comments?
⚫
Further information/resources


* What further reading may interested readers benefit from?
* What website, or online organisations, offer further information/support to groups that are linked to your assignment?
References Add in the references using this code (if you have done the in-text referencing correctly, it will appear here - check the tips on Moodle for details, or of course the help options in wikimedia (or google it)


== Reference ==
== Reference ==
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<ref>Canadian Institute of Health Research 2016, Funding Overview, viewed 26th of October 2016, <http://www.cihr-irsc.gc.ca/e/37788.html></ref>
<ref>Canadian Institute of Health Research 2016, Funding Overview, viewed 26th of October 2016, <http://www.cihr-irsc.gc.ca/e/37788.html></ref>

<ref>Buckley, J., 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'', vol. 49, pp. 1357-62</ref>.


<ref>World Heath Organisation 2016, Obesity and overweight, viewed 26th of October 2016, available at <http://www.who.int/mediacentre/factsheets/fs311/en/>.</ref>
<ref>World Heath Organisation 2016, Obesity and overweight, viewed 26th of October 2016, available at <http://www.who.int/mediacentre/factsheets/fs311/en/>.</ref>


?????<ref>Rahmouni, K., et al, (2005) "Obesity-Associated Hypertension New Insights Into Mechanisms", Hypertension, vol. 45, no. 1, pp 9-14.</ref>
<ref>Rahmouni, K., et al, (2005) "Obesity-Associated Hypertension New Insights Into Mechanisms", Hypertension, vol. 45, no. 1, pp 9-14.</ref>
<ref>Must, A., et al, (1999) "The Disease Burden Associated with Overweight and Obesity", The Journal of the American Medical Association vol. 282, no. 16, pp. 1523-1529.</ref>
<ref>Must, A., et al, (1999) "The Disease Burden Associated with Overweight and Obesity", The Journal of the American Medical Association vol. 282, no. 16, pp. 1523-1529.</ref>


Line 78: Line 77:


<ref>Paul Deurenberg, P., Weststrate, J., Seidell, J., (2007), "Body mass index as a measure of body fatness: age- and sex-specific prediction formulas", ''British Journal of Nutrition'', vol. 65, no. 2, pp. 105-114.</ref>
<ref>Paul Deurenberg, P., Weststrate, J., Seidell, J., (2007), "Body mass index as a measure of body fatness: age- and sex-specific prediction formulas", ''British Journal of Nutrition'', vol. 65, no. 2, pp. 105-114.</ref>

<ref>Owen, N., Healy, G., Matthews, C., Dunstan, D., (2010), "Too Much Sitting: The Population-Health Science of Sedentary Behavior", ''Exerc Sport Sci PUBMED'', vol 38 no. 3, PP. 105–113.</ref>


<ref>Dempsey, P., Owen, N., Biddle, S., et al, (2014), "Managing Sedentary Behaviour to Reduce the Risk of Diabetes and Cardiovascular Disease", ''Current Diabetes Reports'', vol. 14, no. 9, pp. 522.</ref>
<ref>Dempsey, P., Owen, N., Biddle, S., et al, (2014), "Managing Sedentary Behaviour to Reduce the Risk of Diabetes and Cardiovascular Disease", ''Current Diabetes Reports'', vol. 14, no. 9, pp. 522.</ref>


<ref>Swinburn, B., Caterson, I., Seidell, J., James, WPT., (2004), "Diet, nutrition and the prevention of excess weight gain andobesity", ''Public Health Nutrition'', vol. 7. no. 1A, pp. 123–146.</ref>
<ref>Swinburn, B., Caterson, I., Seidell, J., James, WPT., (2004), "Diet, nutrition and the prevention of excess weight gain and obesity", ''Public Health Nutrition'', vol. 7. no. 1A, pp. 123–146.</ref>


<ref>Tremblay A., Sévigny J., Leblanc C., Bouchard C., (1883), "The reproducibility of a three-day dietary record",''Nutr Res'', vol. 3, pp. 819–30.</ref>
<ref>Tremblay A., Sévigny J., Leblanc C., Bouchard C., (1883), "The reproducibility of a three-day dietary record",''Nutr Res'', vol. 3, pp. 819–30.</ref>
Line 88: Line 89:
<ref>Guyton, A., Hall, J., (2016) Guyton And Hall Textbook Of Medical Physiology. Philadelphia, PA: Elsevier.</ref>
<ref>Guyton, A., Hall, J., (2016) Guyton And Hall Textbook Of Medical Physiology. Philadelphia, PA: Elsevier.</ref>

<ref>Mcauley, P., et al (2010) "Obesity Paradox and Cardiorespiratory Fitness in 12,417 Male Veterans Aged 40 to 70 Years", ''Elsevier'', vol. 85, no. 2, pp. 115-121.</ref>


<ref>"Diseases and Conditions Diabetes, Risk Factors", MayoClinic, last updated July 1st 2014, accesses on the 27th of September available at: http://www.mayoclinic.org/diseases-conditions/diabetes/basics/risk-factors/con-20033091.</ref>
<ref>"Diseases and Conditions Diabetes, Risk Factors", MayoClinic, last updated July 1st 2014, accesses on the 27th of September available at: http://www.mayoclinic.org/diseases-conditions/diabetes/basics/risk-factors/con-20033091.</ref>
Line 94: Line 97:


<ref>Chaput, J-P., et al, (2015), "Workplace standing time and the incidence of obesity and type 2 diabetes: a longitudinal study in adults, ''BMC Public Health'', vol. 15, no. 1, pp. 1-7.</ref>
<ref>Chaput, J-P., et al, (2015), "Workplace standing time and the incidence of obesity and type 2 diabetes: a longitudinal study in adults, ''BMC Public Health'', vol. 15, no. 1, pp. 1-7.</ref>

<ref>Johnson, J., Somerville, R., Whitney, J., (2010), "DIABETES: CANADA AT THE TIPPING POINT Charting a New Path", ''Canadian Diabetes Association'', accessed 27th September 2016, available at: https://www.diabetes.ca/CDA/media/documents/publications-and-newsletters/advocacy-reports/canada-at-the-tipping-point-english.pdf</ref>
<ref>Katzmarzyk, P., (2014), "Standing and Mortality in a Prospective Cohort of Canadian Adults''",Medicine and Science in Sports and Exercise'', vol. 46, pp. 940-946. </ref>
<ref>Katzmarzyk, P., (2014), "Standing and Mortality in a Prospective Cohort of Canadian Adults''",Medicine and Science in Sports and Exercise'', vol. 46, pp. 940-946. </ref>

Revision as of 06:26, 28 September 2016

Occupational Sedentary Behaviour: Can Increased Standing Time Reduce Sedentary Associated Diabetes and Obesity?

This wiki fact sheet analyses the research article "Workplace standing time and the incidence of obesity and type 2 diabetes" (http://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-015-1353-x). It will follow the outline of the article and briefly compare its findings to similar research articles. Statement: This has been created by [U3150604].

Background

Low-Energy-Expenditure Activities Sedentary behavior is classified as conducting activities between 1.0-1.5 metabolic equivalent units (METs) such as sitting and driving (excluding sleeping). Moderate to Vigorous activity such as completing household chores to running utilizes appropriately 1.6-2.9 METs [1]. Occupational minimal motion standing incurs approximately 1.2 METs although low, it activates a larger number of muscles and has positive effect on energy utilisation and blood pressure ultimately resulting in lower disease states and an overall decrease in mortality [2].

Occupational sedentary behaviour is desk-based office work. We live in an age where most manual labour has been replaced by machinery, operated or regulated by people sitting for prolonged periods of time at computers. Theoretically it will only become more common. Awareness aimed at encouraging individuals with cardiovascular disease, obesity, diabetes and cancer to participate in more vigorous based exercise of a minimum of 150min has failed within approximately 40% globally and 70% in individuals of high income countries. [3] . Marketing for standing desks equipment is propelling at a faster rate than evidence supported research. However there is staggering results showing that breaking up prolonged sitting improves glucose and insulin levels [4]. as well as reducing fat accumulation around vital organs [5]

Obesity is defined as a state of excess fat accumulation that may impede health [6]. Risk factors include sedentary behaviour and overconsumption of foods high in fat and sugar [7]. Some common obesity associated diseases are hypertension, cardiovascular disease, coronary heart disease, gallbladder disease and diabetes mellitus type 2 (must). The most common initial diagnosis method for obesity is Body Mass Index (BMI) determined by dividing the patients weight by their squared height however this method is not entirely accurate as many factors are not incorporated. Equations to determine body fat % (BF%) are available to assist in including factors such as age and sex and can minimise error estimates [8].

Diabetes mellitus type 2 (T2D) is caused by an insulin resistance. Insulin is the hormone responsible for uptake of glucose by cells for immediate energy use and/or the storage of glucose [9]. Insulin signaling pathways and a decrease in receptors are seen in obese individuals, the exact mechanisms for these occurrences is uncertain however studies suggest it is most likely caused by toxic effects of lipid accumulation [10].


Research Funding and authors

The research carried out for the Quebec Family Study was conducted at the Physical Activity Sciences Laboratory, Laval University [11]. Funding was provided by the Canadian government through grants approved by the Canadian Institute of Health Research [12]. Dr Jean-Philippe Chaput designed and conducted the analysis of the study, he is currently Assistant professor at the Faculty of Medicine Pediatrics, Children's Hospital of Eastern Ontario. Dr Chaput has also been involved in 149 research publications relating to pediatrics and obesity ([13]). All authors declared they had no competing interests.


Research Methods

Research was conducted via a longitudinal study of 293 participants over a period of six years. Initially the research began in 1979 to investigate the genetics of fitness, body composition and cardiovascular risk factors, involving 1650 participants across 375 families of French descent in Canada. The participants were included irrespective of body weight. Phase two and three of the study conducted from 1989-1997 incorporated 100 families from the initial study along with an additional 123 families totaling 293 participants. All participants had a BMI greater than 32 kg/m2 and were aged between 18-65.

Participants were assessed at baseline and year 6 measuring BMI and performing oral glucose tolerance tests along with questionnaires relating to occupational standing time. BMI was conducted measuring height with a stadiometer to the nearest 0.1 cm and weight with digital scales to the nearest 0.1 kg. Overweight and Obesity were determined via a BMI ≥25 kg/m2. A 12 hour fasted 75 g oral glucose tolerance test was performed in the mornings along with blood samples Samples were taken at -15, 0, 15, 30, 45, 60, 90, 120, 150 and 180 min. Blood samples were analysed in EDTA and Trasylol tubes for enzyme-linked immunosorbent assays (ELISA) [14] and fasting glucose concentrations were calculated as the mean of -15 and 0 min. T2D and Impaired Glucose Tolerance (IGT) were determined via the diagnosis criteria of the American Diabetes Association [15] and World HealtH organisation [16].

Accounting for variables was analysed and measured through questionnaires comprising of age, sex, annual family income and smoking habits. These variables along with race, abnormal cholesterol and triglyceride levels, high blood pressure, polysistic ovary syndrome and gestational diabetes pose high risk factors for developing T2D [17]. Three day food records to assess general daily energy intake along with cardiorespiratory fitness levels were also obtained. The food diaries recorded two weekdays and one weekend day which were shown to provide reliable data [18]. Cardiorespiratory fitness levels were measured via a progressive exercise test conducted on a Monark cycle ergometer at a heart rate of 150 beats per min. Moderate cardiorespiratory fitness in obese men have shown to have similar rates of mortality when compared with highly fit normal-weight groups [19]

Sixty percent of Canadians are either overweight of obese which can narrow the scope of this study , [20]. Questionnaires were also self reported which can encounter error. However the analysis of the study was found to have proficient predictive performance and was not subject to over-fitting.


Comparative to similar studies the Quebec family study showed very similar method techniques and parameters. Several studies also mentioned the inaccuracy of self reported questionnaires [21]. A meta analysis of 59 articles conducted the Loughborough University identified that obesity/overweight individuals may not necessarily have excessive fat accumulation around vital organs which is a leading cause of diabetes and obesity related disease through MRI [22].


Research Results

Findings At baseline there were 151 participants with a normal BMI and 33 with existing IGT/T2D. During the 6 year follow up 51 new cases of obesity/overweight were identified and 37 new cases of IGT/T2D. Occupational standing of the 293 participants were; 33% standing rarely or never, 23% half of the time and 19% most of the time. Significant association between decreased standing time and developing IGT/T2D and obesity/overweight was observed. However this association was no longer valid once the adjustment for other variables were included specifically family income and cardiorespiratory fitness.


The study results were slightly under emphasised due to the results. However the comparison to several other studies with validated data do suggest a correlation between the development of IGT/T2D and obesity/overweight with increased occupational sedentary time.


Conclusion

Can Increased Standing Time Reduce Sedentary Associated Diabetes and Obesity? Although the finding of this study do not provide further evidence to support that decreased occupational sedentary time reduces diabetes and obesity many other research resulted have shown a positive correlation [23] [24] [25] [26]. Targeting the population during work time to decrease extended periods of sitting appears to be more achievable. However equipping offices with standing/seated workstations may initially seem far too costly the overall investment will lower absentee days and increase productivity as well as delay mortality [27].



Further information of possible interest

Please follow the link to calculate your BMI https://heartfoundation.org.au/your-heart/know-your-risks/healthy-weight/bmi-calculator. Alternative locate your nearest centre for a DEXA scan or Anthropometric measurements which will give you more accurate overall measurements. Please keep in mind this not the most accurate method and if concerned you should seek medical advice.

Further readings for national Diabetes statistics 2014 can be located at; http://www.cdc.gov/diabetes/data/statistics/2014statisticsreport.html

This article explains 10 easy ways to be more active: http://www.lifehack.org/articles/communication/10-simple-ways-more-active.html.

Obesity prevention: https://www.hsph.harvard.edu/obesity-prevention-source/obesity-consequences/health-effects/



Reference

  1. ↑ Pate, P., O'Neill, J., Lobelo, F., (2008), The Evolving Definition of "Sedentary", Exercise and Sport Sciences Reviews, vol. 36, no. 4, pp. 173-178.
  2. ↑ Katzmarzyk, P., (2014), "Standing and Mortality in a Prospective Cohort of Canadian Adults",Medicine and Science in Sports and Exercise, vol. 46, pp. 940-946.
  3. ↑ Buckley, J., 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, vol. 49, pp. 1357-62
  4. ↑ Buckley, J., Mellor, D., Morris, M,. et al (2014), "Standing-based office work shows encouraging signs of attenuating post-prandial glycemic excursion" Occupational and Environmental Medicine, vol. 71, no. 2, pp. 109-11
  5. ↑ Dempsey, P., Owen, N., Biddle, S., et al, (2014), "Managing Sedentary Behaviour to Reduce the Risk of Diabetes and Cardiovascular Disease", Current Diabetes Reports, vol. 14, no. 9, pp. 522.
  6. ↑ World Heath Organisation 2016, Obesity and overweight, viewed 26th of October 2016, available at <http://www.who.int/mediacentre/factsheets/fs311/en/>.
  7. ↑ Swinburn, B., Caterson, I., Seidell, J., James, WPT., (2004), "Diet, nutrition and the prevention of excess weight gain and obesity", Public Health Nutrition, vol. 7. no. 1A, pp. 123–146.
  8. ↑ Paul Deurenberg, P., Weststrate, J., Seidell, J., (2007), "Body mass index as a measure of body fatness: age- and sex-specific prediction formulas", British Journal of Nutrition, vol. 65, no. 2, pp. 105-114.
  9. ↑ Guyton, A., Hall, J., (2016) Guyton And Hall Textbook Of Medical Physiology. Philadelphia, PA: Elsevier.
  10. ↑ "Diabetes Care, Classification and Diagnosis of Diabetes", American Diabetes Association last modified (2015 Jan) accessed 27th September 2016, available at http://dx.doi.org/10.2337/dc15-S005.
  11. ↑ Chaput, J-P., et al, (2015), "Workplace standing time and the incidence of obesity and type 2 diabetes: a longitudinal study in adults, BMC Public Health, vol. 15, no. 1, pp. 1-7.
  12. ↑ Canadian Institute of Health Research 2016, Funding Overview, viewed 26th of October 2016, <http://www.cihr-irsc.gc.ca/e/37788.html>
  13. ↑ https://www.researchgate.net/profile/Jean-Philippe_Chaput
  14. ↑ Kato, M,. (1996), "Optimal conditions for collection of blood samples for assay of alpha 2-macroglobulin-trypsin complex-like substance (MTLS)", PUBMED, vol. 10, no. 5, pp. 239-42.
  15. ↑ "Diabetes Care, Classification and Diagnosis of Diabetes", American Diabetes Association last modified (2015 Jan) accessed 27th September 2016, available at http://dx.doi.org/10.2337/dc15-S005.
  16. ↑ Alberti K., Zimmet P., (1998) "Definition, diagnosis and classification of diabetes mellitus and its complications, part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation", PUBMED, vol 15, pp.539–53.
  17. ↑ "Diseases and Conditions Diabetes, Risk Factors", MayoClinic, last updated July 1st 2014, accesses on the 27th of September available at: http://www.mayoclinic.org/diseases-conditions/diabetes/basics/risk-factors/con-20033091.
  18. ↑ Tremblay A., Sévigny J., Leblanc C., Bouchard C., (1883), "The reproducibility of a three-day dietary record",Nutr Res, vol. 3, pp. 819–30.
  19. ↑ Mcauley, P., et al (2010) "Obesity Paradox and Cardiorespiratory Fitness in 12,417 Male Veterans Aged 40 to 70 Years", Elsevier, vol. 85, no. 2, pp. 115-121.
  20. ↑ Johnson, J., Somerville, R., Whitney, J., (2010), "DIABETES: CANADA AT THE TIPPING POINT Charting a New Path", Canadian Diabetes Association, accessed 27th September 2016, available at: https://www.diabetes.ca/CDA/media/documents/publications-and-newsletters/advocacy-reports/canada-at-the-tipping-point-english.pdf
  21. ↑ Owen, N., Healy, G., Matthews, C., Dunstan, D., (2010), "Too Much Sitting: The Population-Health Science of Sedentary Behavior", Exerc Sport Sci PUBMED, vol 38 no. 3, PP. 105–113.
  22. ↑ Buckley, J., 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, vol. 49, pp. 1357-62
  23. ↑ Rahmouni, K., et al, (2005) "Obesity-Associated Hypertension New Insights Into Mechanisms", Hypertension, vol. 45, no. 1, pp 9-14.
  24. ↑ Must, A., et al, (1999) "The Disease Burden Associated with Overweight and Obesity", The Journal of the American Medical Association vol. 282, no. 16, pp. 1523-1529.
  25. ↑ Buckley, J., 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, vol. 49, pp. 1357-62
  26. ↑ Buckley, J., Mellor, D., Morris, M,. et al (2014), "Standing-based office work shows encouraging signs of attenuating post-prandial glycemic excursion" Occupational and Environmental Medicine, vol. 71, no. 2, pp. 109-11
  27. ↑ Buckley, J., 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, vol. 49, pp. 1357-62

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  1. ↑ Canadian Institute of Health Research 2016, Funding Overview, viewed 26th of October 2016, <http://www.cihr-irsc.gc.ca/e/37788.html>
  2. ↑ Buckley, J., 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, vol. 49, pp. 1357-62
  3. ↑ World Heath Organisation 2016, Obesity and overweight, viewed 26th of October 2016, available at <http://www.who.int/mediacentre/factsheets/fs311/en/>.
  4. ↑ Rahmouni, K., et al, (2005) "Obesity-Associated Hypertension New Insights Into Mechanisms", Hypertension, vol. 45, no. 1, pp 9-14.
  5. ↑ Must, A., et al, (1999) "The Disease Burden Associated with Overweight and Obesity", The Journal of the American Medical Association vol. 282, no. 16, pp. 1523-1529.
  6. ↑ Bucley, J., 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, vol. 49, pp. 1357-62
  7. ↑ Paul Deurenberg, P., Weststrate, J., Seidell, J., (2007), "Body mass index as a measure of body fatness: age- and sex-specific prediction formulas", British Journal of Nutrition, vol. 65, no. 2, pp. 105-114.
  8. ↑ Owen, N., Healy, G., Matthews, C., Dunstan, D., (2010), "Too Much Sitting: The Population-Health Science of Sedentary Behavior", Exerc Sport Sci PUBMED, vol 38 no. 3, PP. 105–113.
  9. ↑ Dempsey, P., Owen, N., Biddle, S., et al, (2014), "Managing Sedentary Behaviour to Reduce the Risk of Diabetes and Cardiovascular Disease", Current Diabetes Reports, vol. 14, no. 9, pp. 522.
  10. ↑ Swinburn, B., Caterson, I., Seidell, J., James, WPT., (2004), "Diet, nutrition and the prevention of excess weight gain and obesity", Public Health Nutrition, vol. 7. no. 1A, pp. 123–146.
  11. ↑ Tremblay A., Sévigny J., Leblanc C., Bouchard C., (1883), "The reproducibility of a three-day dietary record",Nutr Res, vol. 3, pp. 819–30.
  12. ↑ "Diabetes Care, Classification and Diagnosis of Diabetes", American Diabetes Association last modified (2015 Jan) accessed 27th September 2016, available at http://dx.doi.org/10.2337/dc15-S005.
  13. ↑ Guyton, A., Hall, J., (2016) Guyton And Hall Textbook Of Medical Physiology. Philadelphia, PA: Elsevier.
  14. ↑ Mcauley, P., et al (2010) "Obesity Paradox and Cardiorespiratory Fitness in 12,417 Male Veterans Aged 40 to 70 Years", Elsevier, vol. 85, no. 2, pp. 115-121.
  15. ↑ "Diseases and Conditions Diabetes, Risk Factors", MayoClinic, last updated July 1st 2014, accesses on the 27th of September available at: http://www.mayoclinic.org/diseases-conditions/diabetes/basics/risk-factors/con-20033091.
  16. ↑ Pate, P., O'Neill, J., Lobelo, F., (2008), The Evolving Definition of "Sedentary", Exercise and Sport Sciences Reviews, vol. 36, no. 4, pp. 173-178.
  17. ↑ Chaput, J-P., et al, (2015), "Workplace standing time and the incidence of obesity and type 2 diabetes: a longitudinal study in adults, BMC Public Health, vol. 15, no. 1, pp. 1-7.
  18. ↑ Johnson, J., Somerville, R., Whitney, J., (2010), "DIABETES: CANADA AT THE TIPPING POINT Charting a New Path", Canadian Diabetes Association, accessed 27th September 2016, available at: https://www.diabetes.ca/CDA/media/documents/publications-and-newsletters/advocacy-reports/canada-at-the-tipping-point-english.pdf
  19. ↑ Katzmarzyk, P., (2014), "Standing and Mortality in a Prospective Cohort of Canadian Adults",Medicine and Science in Sports and Exercise, vol. 46, pp. 940-946.
  20. ↑ Alberti K., Zimmet P., (1998) "Definition, diagnosis and classification of diabetes mellitus and its complications, part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation", PUBMED, vol 15, pp.539–53.
  21. ↑ https://www.researchgate.net/profile/Jean-Philippe_Chaput
  22. ↑ Kato, M,. (1996), "Optimal conditions for collection of blood samples for assay of alpha 2-macroglobulin-trypsin complex-like substance (MTLS)", PUBMED, vol. 10, no. 5, pp. 239-42.
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