Exercise as it relates to Disease/The impact of reducing sitting time in university students on cardiometabolic health
This is a critique of the research article: Can reducing sitting time in the university setting improve the cardiometabolic health of college students? by Butler et al. 2018. 
What is the background to this research?
This study was aimed at combating the high prevalence of metabolic syndrome (MetS), which relates to the clustering of physiological abnormalities that are associated with pre-diabetes and increasing risk of cardiovascular disease (CVD) within society by reducing sedentary behaviour. The research was conducted within a university setting with a simple intervention aimed at reducing sedentary behaviour by utilising a standing desk during contact hours. The prevalence of MetS within the college setting is found to be 6.8%.  Given the elevated lifetime risk for cardiovascular disease and lower survival for those with risk factors in young adulthood, there appears to be a need for primary prevention programs within university and college settings.
The article has established a gap in existing literature by exploring sedentary behaviour in the university setting as opposed to the office environment which has been extensively studied. The only other relevant studies looked at incorporating a desk stepper into the university setting but this was seen to be an ineffective intervention as the 'desk stepper' had a negative impact on students learning. 
Where is the research from?
This research was published by the Dove Press Journal: Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy which is a reputable international peer-reviewed medical journal. The research was conducted at Western State Colorado University. With the research being conducted at such a wealthy institution concerns arise regarding the economic burden an intervention like this would have campus wide with standing desks costing much more for the university. Whilst universities are seen as very profitable, there are countless universities who would find this intervention outside of their budget to replace desks campus wide. Between all four authors they have been involved in 230 studies according to PubMed which enhances the reliability of the study. Research needed to provide information on general population and sedentary behaviour/cardiometabolic health and make the link between the importance of breaking the trend at university level before students have behaviour patterns for life.
What kind of research was this?
The study was a randomized control trial which are successful at reducing bias of results when evaluating the effectiveness of new treatments. This is achieved by randomly allocating participants to different groups, treating them differently and then comparing the data measured.  Numerous medical studies are conducted in the same manor.
What did the research involve?
A total of 21 students (13 male and 8 female) were selected based on the following criteria:
- 18 years or older
- College student at Western State Colorado University
- Minimum of 5 hours contact time
- Not Pregnant
- No injury/medical conditions
Students were to sign informed consent and complete two questionnaires; International Physical Activity Questionnaire and Sedentary Behaviour Questionnaire. Having such a small participant group greatly limited the validity of the study, to fully determine the interventions effectiveness, more participants should be recruited. Multiple cardiometabolic markers were measured weekly. The intervention involved half the students standing for a minimum of 5 hours per week for 3 weeks and then alternating after a washout week (all sitting) to sitting for 3 weeks. The study states participants stood for "minimum of 5 hours per day" referring to the weekly class time; which can be viewed as detrimental to data collected as 5 hours is such a small change in a 168 hour week, to achieve data that is more reliable indicating the advantages of standing. With not all participants standing for the same amount of time during the intervention data may skew towards utilising standing desks, possibly causing bias towards the effectiveness of the intervention. The data was collected for only 3 months which limits its validity as a longer study may have resulted in a greater contrast between standing and sitting. This methodology was appropriate for establishing the effectiveness of the intervention, multiple data sets were collected with strong correlation with cardiometabolic health providing a great indicator for the interventions efficacy. The study lacks validity due to the amount of time in which the actual intervention took place; over three months the participants partook in a minimum of 15 hours of standing time which does not provide a true reflection on the interventions effectiveness.
What were the basic results?
The mean measurements of cardiometabolic risk factors were established and the evidence points towards a successful intervention. The results have been tabulated below and illustrate a decrease in both SBP and DBP, blood glucose and a large reduction in triglycerides. HDL cholesterol saw a significant increase which is good as this is known as the 'healthy' cholesterol. Previous studies have stated the correlation between cardio-metabolic benefits (particularly glucose and lipid metabolism) achieved through reducing sitting time.
The results clearly show the advantage of standing, measurements recorded were optimal for this study as they reduce the risk for human error and misreported data with data being recorded by trained professionals. Collecting baseline readings contributed to the validity of the data recorded as weekly changes due to reduction in sedentary behaviour. Each data set is on an individual basis showing each individual change week to week due to the intervention. Due to the intervention participants may have consciously/subconsciously been less sedentary also skewing data and it is unclear whether this was taken into account during the study.
What conclusions can we take from this research?
It is clear to see through this study the effect that standing has on cardiometabolic health as the data illustrates the improvements made on all cardiometabolic factors. The study's validity is impacted negatively by both the data sample size and the duration of which the study took place. There is limited research in this area, although, numerous studies have been conducted based on the office setting and the research of this article is mirrored in other studies.  Further studies should be conducted on the effect that standing has on brain function and cognitive fatigue throughout the academic day before this intervention may be incorporated, as this intervention would be rendered ineffective if there is a negative impact on cognitive function as this is the top priority for universities.
- As shown in recent studies, even when adults meet the physical activity guidelines, sitting for long periods is detrimental to cardiometabolic health. This is why the breaking up of sedentary behaviour is crucial; it's impractical to advise individuals to stand up or be moving all day but a practical means by which to combat cardiometabolic health deterioration is to break up prolonged sedentary behaviour.
- Standing desks have been shown to be beneficial but there is a need for sitting within any setting as prolonged standing can negatively impact your cognitive function and tire the body which is why a 'sit stand' desk is more practical as it allows for students to decide their preference for each class; if they have 6 hours of classes in a day they may decide to sit for half the time ensuring they don't tire excessively. Having the option to sit also accommodates for injured, disabled or older students.
Allied Health Professionals:
- Butler KM, Ramos JS, Buchanan CA, Dalleck LC. Can reducing sitting time in the university setting improve the cardiometabolic health of college students?. Diabetes, metabolic syndrome and obesity: targets and therapy. 2018;11:603.
- Dalleck LC, Kjelland EM. The prevalence of metabolic syndrome and metabolic syndrome risk factors in college-aged students. American Journal of Health Promotion. 2012 Sep;27(1):37-42.
- Fountaine CJ, Johann J, Skalko C, Liguori GA. Metabolic and energy cost of sitting, standing, and a novel sitting/stepping protocol in recreationally active college students. International journal of exercise science. 2016;9(2):223.
- Chalmers TC, Smith Jr H, Blackburn B, Silverman B, Schroeder B, Reitman D, Ambroz A. A method for assessing the quality of a randomized control trial. Controlled clinical trials. 1981 May 1;2(1):31-49.
- Healy GN, Winkler EA, Owen N, Anuradha S, Dunstan DW. Replacing sitting time with standing or stepping: associations with cardio-metabolic risk biomarkers. European heart journal. 2015 Jul 30;36(39):2643-9.
- MacEwen BT, MacDonald DJ, Burr JF. A systematic review of standing and treadmill desks in the workplace. Preventive medicine. 2015 Jan 1;70:50-8.
- Buckley JP, Hedge A, Yates T, Copeland RJ, Loosemore M, Hamer M, Bradley G, Dunstan DW. The sedentary office: an expert statement on the growing case for change towards better health and productivity. Br J Sports Med. 2015 Nov 1;49(21):1357-62.
- Same RV, Feldman DI, Shah N, Martin SS, Al Rifai M, Blaha MJ, Graham G, Ahmed HM. Relationship between sedentary behavior and cardiovascular risk. Current cardiology reports. 2016 Jan 1;18(1):6.
- Owen N, Healy GN, Matthews CE, Dunstan DW. Too much sitting: the population-health science of sedentary behavior. Exercise and sport sciences reviews. 2010 Jul;38(3):105.