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The behavioural epidemiology of sedentary behaviour in inflammatory arthritis: where are we, and where do we need to go?
Fenton, SAM, O'Brien, CM, Kitas, GD, Duda, JL, Veldhuijzen van Zanten, JJCS, Metsios, GS
Rheumatology advances in practice. 2023;(1):rkac097
Abstract
In the last decade, studies into sedentary behaviour in inflammatory arthritis have raised important questions regarding its role in this condition. Specifically, evidence is needed on whether sedentary behaviour might exacerbate adverse inflammatory arthritis outcomes, and whether reducing sedentary behaviour might offer an effective avenue for self-management in this population. Research exploring these important research questions is still very much in its infancy and lacks the direction and scientific rigour required to inform effective intervention design, delivery and evaluation. Behavioural epidemiology refers to research that aims explicitly to understand and influence health behaviour patterns to prevent disease and improve health. To this end, the Behavioural Epidemiology Framework specifies a focused approach to health behaviour research, which leads to the development of evidence-based interventions directed at specific populations. In this review, we introduce the Behavioural Epidemiology Framework in the context of research into sedentary behaviour in inflammatory arthritis and ask: where are we, and where do we need to go?
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Different types of physical activity are positively associated with indicators of mental health and psychological wellbeing in rheumatoid arthritis during COVID-19.
Brady, SM, Fenton, SAM, Metsios, GS, Bosworth, A, Duda, JL, Kitas, GD, Veldhuijzen van Zanten, JJCS
Rheumatology international. 2021;(2):335-344
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Abstract
Nationwide lockdowns during SARS-CoV-2 (COVID-19) can compromise mental health and psychological wellbeing and limit opportunities for physical activity (PA), particularly in clinical populations, such as people with rheumatoid arthritis (RA), who are considered at risk for COVID-19 complications. This study aimed to investigate associations between PA and sedentary time (ST) with indicators of mental health and wellbeing in RA during COVID-19 lockdown, and examine the moderation effects of self-isolating. 345 RA patients completed an online questionnaire measuring PA (NIH-AARP Diet and Health Study Questionnaire), ST (International Physical Activity Questionnaire-Short Form), pain (McGill Pain Questionnaire and Visual Analogue Scale), fatigue (Multidimensional Fatigue Inventory), depressive and anxious symptoms (Hospital Anxiety and Depression Scale), and vitality (Subjective Vitality Scale) during the United Kingdom COVID-19 lockdown. Associations between PA and ST with mental health and wellbeing were examined using hierarchical multiple linear regressions. Light PA (LPA) was significantly negatively associated with mental fatigue (β = - .11), depressive symptoms (β = - .14), and positively with vitality (β = .13). Walking was negatively related to physical fatigue (β = - .11) and depressive symptoms (β = - .12) and positively with vitality (β = .15). Exercise was negatively associated with physical (β = - .19) and general (β = - .12) fatigue and depressive symptoms (β = - .09). ST was positively associated with physical fatigue (β = .19). Moderation analyses showed that LPA was related to lower mental fatigue and better vitality in people not self-isolating, and walking with lower physical fatigue in people self-isolating. These findings show the importance of encouraging PA for people with RA during a lockdown period for mental health and wellbeing.
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Effectiveness of a childhood obesity prevention programme delivered through schools, targeting 6 and 7 year olds: cluster randomised controlled trial (WAVES study).
Adab, P, Pallan, MJ, Lancashire, ER, Hemming, K, Frew, E, Barrett, T, Bhopal, R, Cade, JE, Canaway, A, Clarke, JL, et al
BMJ (Clinical research ed.). 2018;360:k211
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Plain language summary
Excess weight in childhood is a global problem affecting around 41 million children under the age of 5 years. In addition to physical and psychosocial health consequences in these early years, childhood excess weight is an important predictor of obesity in adulthood. The aim of the study is to assess the effectiveness of a school and family based healthy lifestyle programme (WAVES intervention) compared with usual practice, in preventing childhood obesity. The primary outcome for clinical effectiveness was the difference in BMI z scores between arms at 15 and 30 months. The study was a school based, cluster randomised, controlled trial where 200 schools were randomly selected from all state run primary schools within 35miles of the study centre (n=980). 144 eligible schools were approached to achieve the target recruitment of 54 schools. The intervention components were delivered over a period of 12 months and targeted the home and school environment. The results show that there was no overall evidence of improvement in the primary outcomes of reduction in body mass index (BMI) z scores at 15 and 30 months after a childhood obesity prevention programme was delivered through schools and targeting 6 and 7-year olds. The intervention did not have any effects on secondary anthropometric, behavioural, or clinical outcomes. A clinically significant difference in BMI z score in favour of the intervention was seen in the first cohort of schools recruited. However, post hoc analysis suggested that this outcome may have been a cohort effect as no effect was seen in group 2 schools at any time point. Authors conclude that the study intervention did not result in a statistically significant difference in BMI z score overall, and there was no evidence of effect on measured diet or physical activity levels in children. However, the lower cost components of the intervention could be considered by schools to fulfil their mandated responsibilities for education on health and wellbeing.
Abstract
OBJECTIVE To assess the effectiveness of a school and family based healthy lifestyle programme (WAVES intervention) compared with usual practice, in preventing childhood obesity. DESIGN Cluster randomised controlled trial. SETTING UK primary schools from the West Midlands. PARTICIPANTS 200 schools were randomly selected from all state run primary schools within 35 miles of the study centre (n=980), oversampling those with high minority ethnic populations. These schools were randomly ordered and sequentially invited to participate. 144 eligible schools were approached to achieve the target recruitment of 54 schools. After baseline measurements 1467 year 1 pupils aged 5 and 6 years (control: 28 schools, 778 pupils) were randomised, using a blocked balancing algorithm. 53 schools remained in the trial and data on 1287 (87.7%) and 1169 (79.7%) pupils were available at first follow-up (15 month) and second follow-up (30 month), respectively. INTERVENTIONS The 12 month intervention encouraged healthy eating and physical activity, including a daily additional 30 minute school time physical activity opportunity, a six week interactive skill based programme in conjunction with Aston Villa football club, signposting of local family physical activity opportunities through mail-outs every six months, and termly school led family workshops on healthy cooking skills. MAIN OUTCOME MEASURES The protocol defined primary outcomes, assessed blind to allocation, were between arm difference in body mass index (BMI) z score at 15 and 30 months. Secondary outcomes were further anthropometric, dietary, physical activity, and psychological measurements, and difference in BMI z score at 39 months in a subset. RESULTS Data for primary outcome analyses were: baseline, 54 schools: 1392 pupils (732 controls); first follow-up (15 months post-baseline), 53 schools: 1249 pupils (675 controls); second follow-up (30 months post-baseline), 53 schools: 1145 pupils (621 controls). The mean BMI z score was non-significantly lower in the intervention arm compared with the control arm at 15 months (mean difference -0.075 (95% confidence interval -0.183 to 0.033, P=0.18) in the baseline adjusted models. At 30 months the mean difference was -0.027 (-0.137 to 0.083, P=0.63). There was no statistically significant difference between groups for other anthropometric, dietary, physical activity, or psychological measurements (including assessment of harm). CONCLUSIONS The primary analyses suggest that this experiential focused intervention had no statistically significant effect on BMI z score or on preventing childhood obesity. Schools are unlikely to impact on the childhood obesity epidemic by incorporating such interventions without wider support across multiple sectors and environments. TRIAL REGISTRATION Current Controlled Trials ISRCTN97000586.
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Sedentary behaviour in rheumatoid arthritis: definition, measurement and implications for health.
Fenton, SAM, Veldhuijzen van Zanten, JJCS, Duda, JL, Metsios, GS, Kitas, GD
Rheumatology (Oxford, England). 2018;(2):213-226
Abstract
RA is a chronic autoimmune disease characterized by high grade-inflammation, and associated with elevated cardiovascular risk, rheumatoid-cachexia and functional impairment. Sedentary behaviour (SB) is linked to heightened inflammation, and is highly pervasive in RA, likely as a result of compromised physical function and persistent fatigue. This high sedentarity may exacerbate the inflammatory process in RA, and hold relevance for disease-related outcomes. The aim of this narrative review is to provide an overview of the definition, measurement and health relevance of SB in the context of RA. Contradictions are highlighted with regard to the manner in which SB is operationalized, and the significance of SB for disease outcomes in RA is outlined. The advantages and disadvantages of SB measurement approaches are also discussed. Against this background, we summarize studies that have reported SB and its health correlates in RA, and propose directions for future research.
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Sedentary behaviour is associated with increased long-term cardiovascular risk in patients with rheumatoid arthritis independently of moderate-to-vigorous physical activity.
Fenton, SAM, Veldhuijzen van Zanten, JJCS, Kitas, GD, Duda, JL, Rouse, PC, Yu, CA, Metsios, GS
BMC musculoskeletal disorders. 2017;(1):131
Abstract
BACKGROUND Rheumatoid Arthritis (RA) is associated with an increased risk of cardiovascular disease (CVD). The physical dysfunction symptomatic of RA means people living with this disease spend large periods of the day sedentary, which may further elevate their risk of CVD. The primary aim of this study was to investigate relationships between objectively assessed sedentary behaviour patterns and light physical activity (LPA) with 10-year risk of CVD. Secondary aims were to explore the role of sedentary behaviour patterns and LPA for individual CVD risk factors and functional disability in RA. The extent to which associations were independent of moderate-to-vigorous physical activity (MVPA) engagement was also examined. METHODS Baseline data from a subsample of participants recruited to the Physical Activity in Rheumatoid Arthritis (PARA) study were used to answer current research questions. Sixty-one patients with RA (mean age (± SD) = 54.92 ± 12.39 years) provided a fasted blood sample and underwent physical assessments to evaluate factors associated with their cardiovascular health. Sedentary behaviour patterns (sedentary time, sedentary bouts, sedentary breaks), LPA and MVPA were measured via 7-days of accelerometry. Ten-year CVD risk was computed (Q-risk-score2), and functional disability determined via questionnaire. RESULTS Regressions revealed significant positive associations between sedentary time and the number of sedentary bouts per day ≥20 min with 10-year CVD risk, with the reverse true for LPA participation. Associations were independent of MVPA engagement. CONCLUSIONS Promoting LPA participation and restricting sedentary bouts to <20 min may attenuate long-term CVD risk in RA, independent of MVPA engagement. TRIAL REGISTRATION ISRCTN04121489 (retrospectively registered 19/10/2012).
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Inter-participant variability in daily physical activity and sedentary time among male youth sport footballers: independent associations with indicators of adiposity and cardiorespiratory fitness.
Fenton, SA, Duda, JL, Barrett, T
Journal of sports sciences. 2016;(3):239-51
Abstract
Participation in youth sport is assumed to promote and contribute towards more physically active lifestyles among children and adolescents. The aim of this study was to examine inter-participant variability in objectively measured habitual physical activity (PA) behaviours and sedentary time among youth sport participants and their implications for health. One-hundred-and-eighteen male youth sport footballers (Mean ± s = 11.72 ± 1.60) wore a GT3X accelerometer for 7 days. Average daily PA [min · day(-1), in light (LPA), moderate (MPA), vigorous (VPA) and combined moderate-to-vigorous (MVPA)] and sedentary time were calculated. Participants' body mass index adjusted for age and sex (BMI-standard deviation score), per cent body fat (BF%), waist circumference and cardiorespiratory fitness were assessed. Results revealed that variability in daily PA behaviours and sedentary time (min · day(-1)) was associated with BMI-standard deviation score [VPA (-), MVPA (-)], BF% [sedentary time (+), VPA (-), MVPA (-)], waist circumference [sedentary time (+), LPA (-)] and cardiorespiratory fitness [sedentary time (-), MPA (+), VPA (+), MVPA (+)]. Whilst sedentary time and MVPA were not related to health outcomes independent of one another, associations with markers of adiposity and cardiorespiratory fitness were stronger for sedentary time. Sedentary time was also significantly positively related to waist circumference independent of VPA. Results demonstrate inter-participant variability in habitual PA and sedentary time among youth sport participants which holds implications for their health. Thus, promoting PA and, in particular, reducing sedentary time may contribute towards the prevention of adverse health consequences associated with a physically inactive lifestyle for children and adolescents active in the youth sport context.
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Sedentary behaviour in people with multiple sclerosis: Is it time to stand up against MS?
Veldhuijzen van Zanten, JJ, Pilutti, LA, Duda, JL, Motl, RW
Multiple sclerosis (Houndmills, Basingstoke, England). 2016;(10):1250-6
Abstract
Historically, people with multiple sclerosis (MS) have been considered sedentary, although the actual scientific study of sedentary behaviour in MS did not originate until 2011. Sedentary behaviour, which is conceptually distinct from physical inactivity, is defined as any waking activity characterised by an energy expenditure ⩽ 1.5 metabolic equivalents and in a sitting or reclining posture. In the general population, the volume of sitting time is associated with increased risks of morbidity and mortality, independent of physical activity, and has been suggested to carry a greater risk of mortality than smoking behaviour. There are many symptoms of MS (e.g. mobility disability and fatigue) that could increase the prevalence of sedentary behaviour, and sedentary behaviour may have considerable implications for the development of comorbid conditions prevalent in MS. This review provides a summary of the rates, correlates, consequences and interventions attempting to reduce sedentary behaviour in MS. We provide a research agenda that guides future research on sedentary behaviour in MS. This paper provides a clarion call that it is time to 'stand up against MS'.
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Changes in work affect in response to lunchtime walking in previously physically inactive employees: A randomized trial.
Thøgersen-Ntoumani, C, Loughren, EA, Kinnafick, FE, Taylor, IM, Duda, JL, Fox, KR
Scandinavian journal of medicine & science in sports. 2015;(6):778-87
Abstract
Physical activity may regulate affective experiences at work, but controlled studies are needed and there has been a reliance on retrospective accounts of experience. The purpose of the present study was to examine the effect of lunchtime walks on momentary work affect at the individual and group levels. Physically inactive employees (N = 56; M age = 47.68; 92.86% female) from a large university in the UK were randomized to immediate treatment or delayed treatment (DT). The DT participants completed both a control and intervention period. During the intervention period, participants partook in three weekly 30-min lunchtime group-led walks for 10 weeks. They completed twice daily affective reports at work (morning and afternoon) using mobile phones on two randomly chosen days per week. Multilevel modeling was used to analyze the data. Lunchtime walks improved enthusiasm, relaxation, and nervousness at work, although the pattern of results differed depending on whether between-group or within-person analyses were conducted. The intervention was effective in changing some affective states and may have broader implications for public health and workplace performance.
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Promoting physical activity: development and testing of self-determination theory-based interventions.
Fortier, MS, Duda, JL, Guerin, E, Teixeira, PJ
The international journal of behavioral nutrition and physical activity. 2012;:20
Abstract
A growing number of studies have pulled from Deci and Ryan's Self-Determination Theory to design interventions targeting health behavior change. More recently, researchers have begun using SDT to promote the adoption and maintenance of an active lifestyle. In this review, we aim to highlight how researchers and practitioners can draw from the SDT framework to develop, implement, and evaluate intervention efforts centered on increasing physical activity levels in different contexts and different populations. In the present paper, the rationale for using SDT to foster physical activity engagement is briefly reviewed before particular attention is given to three recent randomized controlled trials, the Canadian Physical Activity Counseling (PAC) Trial, the Empower trial from the UK, and the Portuguese PESO (Promotion of Health and Exercise in Obesity) trial, each of which focused on promoting physical activity behavior. The SDT-based intervention components, procedures, and participants are highlighted, and the key findings that have emanated from these three trials are presented. Lastly, we outline some of the limitations of the work conducted to date in this area and we acknowledge the challenges that arise when attempting to design, deliver, and test SDT-grounded interventions in the context of physical activity promotion.
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"Step by Step". A feasibility study of a lunchtime walking intervention designed to increase walking, improve mental well-being and work performance in sedentary employees: Rationale and study design.
Thøgersen-Ntoumani, C, Loughren, EA, Duda, JL, Fox, KR, Kinnafick, FE
BMC public health. 2010;:578
Abstract
BACKGROUND Following an extensive recruitment campaign, a 16-week lunchtime intervention to increase walking was implemented with insufficiently physically active University employees to examine programme feasibility and the effects of the programme in increasing walking behaviour, and in improving well-being and work performance. METHODS/DESIGN A feasibility study in which participants were randomised to an immediate treatment or a delayed treatment control (to start at 10 weeks) group. For the first ten weeks of the intervention, participants took part in three facilitator-led group walks per week each of thirty minutes duration and were challenged to accumulate another sixty minutes of walking during the weekends. In the second phase of the intervention, the organised group walks ceased to be offered and participants were encouraged to self-organise their walks. Motivational principles were employed using contemporary motivational theory. Outcome measures (including self-reported walking, step counts, cardiovascular fitness, general and work-related well-being and work performance) were assessed at baseline, at the end of the 16-week intervention and (for some) four months after the end of the intervention. Process and outcome assessments were also taken throughout, and following, the intervention. DISCUSSION The results of the intervention will determine the feasibility of implementing a lunchtime walking programme to increase walking behaviour, well-being and performance in sedentary employees. If successful, there is scope to implement definitive trials across a range of worksites with the aim of improving both employee and organisational health. TRIAL REGISTRATION Current Controlled Trials ISRCTN81504663.