Physical activity might offset harms of spent sitting

Stamatakis, E.,  Gale, J.,  Bauman, A.,  Ekelund, U.,  Hamer, M., Ding, D. | 2019| 


A longitudinal study examined the joint associations of sitting and physical activity with all-cause and CVD (cardiovascular disease) mortality in a large population sample of middle-age and older Australian adults. An additional purpose of the study was to examine the associations between sitting and mortality separately in each physical activity stratum. A secondary aim was to estimate the theoretical effects of replacing sitting with standing, physical activity, and sleep on mortality risk.

The researchers report that sitting is associated with all-cause and CVD mortality risk among the least physically active adults (those participating in physical activity less than 150 minutes of moderate to vigorous intensity physical activity (MVPA) per week. 


The authors conclude that longer sitting times were associated with higher ACM and CVD mortality risk, but these associations were mostly restricted to people not meeting the physical activity recommendations. To redress this they suggest replacing sitting with walking and vigorous intensity physical activity is associated with the most consistent risk reductions. Reduction of sitting time is an important strategy, ancillary to increasing physical activity, for preventing cardiovascular disease and premature mortality in physically inactive populations (Source: Stamatakis et al, 2019) .

The research has now been published in Journal of the American College of Cardiology


Background It is unclear what level of moderate to vigorous intensity physical activity (MVPA) offsets the health risks of sitting.

Objectives The purpose of this study was to examine the joint and stratified associations of sitting and MVPA with all-cause and cardiovascular disease (CVD) mortality, and to estimate the theoretical effect of replacing sitting time with physical activity, standing, and sleep.

Methods A longitudinal analysis of the 45 and Up Study calculated the multivariable-adjusted hazard ratios (HRs) of sitting for each sitting-MVPA combination group and within MVPA strata. Isotemporal substitution modeling estimated the per-hour HR effects of replacing sitting.

Results A total of 8,689 deaths (1,644 due to CVD) occurred among 149,077 participants over an 8.9-year (median) follow-up. There was a statistically significant interaction between sitting and MVPA only for all-cause mortality. Sitting time was associated with both mortality outcomes in a nearly dose-response manner in the least active groups reporting less than 150 MVPA min/week. For example, among those reporting no MVPA, the all-cause mortality HR comparing the most sedentary (more than 8 h/day) to the least sedentary (less than 4 h/day) groups was 1.52 (95% confidence interval: 1.13 to 2.03). There was inconsistent and weak evidence for elevated CVD and all-cause mortality risks with more sitting among those meeting the lower (150 to 299 MVPA min/week) or upper ( more than or equal to 300 MVPA min/week) limits of the MVPA recommendation. Replacing sitting with walking and MVPA showed stronger associations among high sitters ( more than 6 sitting h/day) where, for example, the per-hour CVD mortality HR for sitting replaced with vigorous activity was 0.36 (95% confidence interval: 0.17 to 0.74).

Conclusions Sitting is associated with all-cause and CVD mortality risk among the least physically active adults; moderate-to-vigorous physical activity doses equivalent to meeting the current recommendations attenuate or effectively eliminate such associations.

The full article is available from the Journal of the American College of Cardiology

OnMedica  Physical activity might offset harms of time spent sitting

NIHR Signal: Switching to oral antibiotics early for bone and joint infections gave similar results to continuing intravenous therapy

NIHR | April 2019 | Switching to oral antibiotics early for bone and joint infections gave similar results to continuing intravenous therapy

Although current practice suggests antibiotics should be given intravenously (IV) for bone and joint infections, for at least six weeks, a large NIHR-funded UK trial challenges this assumption. In the trial participants were randomised to oral antibiotics seven days after initial surgical or IV antibiotic treatment. 222 participants (average age 36 years)  with hip pain and limited movement due to femoro-acetabular (hip) impingement but without a diagnosis of osteoarthritis.  Fifty per cent of the people who had surgery had significant benefit compared with a third of those having physiotherapy.

The randomised controlled trial had more than 1000 participants recruited from 26 centres. Patients were enrolled within seven days of either surgery or IV antibiotics to treat infection in the bone or joint. Causes ranged from a joint replacement infection to diabetes complications. Most had Staphylococcus aureus infections, and over 90% had initial surgical treatment.

Both the IV and the oral group received antibiotics for at least six weeks. In accordance with usual practice, the IV group could also be given oral antibiotics, such as rifampicin. Similarly, the oral group could have up to five consecutive days of IV antibiotics for unrelated infections; over 80% of the oral group started with IV antibiotics. The primary outcome was treatment failure within one year (Source: NIHR).

Read the Signal in full from NIHR 

Full reference: Palmer, A. J. et al |2019| Arthroscopic hip surgery compared with physiotherapy and activity modification for the treatment of symptomatic femoroacetabular impingement: multicentre randomised controlled trial| BMJ |364|l185.


BACKGROUND The management of complex orthopedic infections usually includes a prolonged course of intravenous antibiotic agents. We investigated whether oral antibiotic therapy is noninferior to intravenous antibiotic therapy for this indication. METHODS We enrolled adults who were being treated for bone or joint infection at 26 U.K. centers. Within 7 days after surgery (or, if the infection was being managed without surgery, within 7 days after the start of antibiotic treatment), participants were randomly assigned to receive either intravenous or oral antibiotics to complete the first 6 weeks of therapy. Follow-on oral antibiotics were permitted in both groups. The primary end point was definitive treatment failure within 1 year after randomization. In the analysis of the risk of the primary end point, the noninferiority margin was 7.5 percentage points. RESULTS Among the 1054 participants (527 in each group), end-point data were available for 1015 (96.3%). Treatment failure occurred in 74 of 506 participants (14.6%) in the intravenous group and 67 of 509 participants (13.2%) in the oral group. Missing end-point data (39 participants, 3.7%) were imputed. The intention-to-treat analysis showed a difference in the risk of definitive treatment failure (oral group vs. intravenous group) of −1.4 percentage points, indicating noninferiority. Complete-case, per-protocol, and sensitivity analyses supported this result. The between-group difference in the incidence of serious adverse events was not significant. Catheter complications, analyzed as a secondary end point, were more common in the intravenous group (9.3% vs. 1.0%). CONCLUSIONS Oral antibiotic therapy was noninferior to intravenous antibiotic therapy when used during the first 6 weeks for complex orthopedic infection, as assessed by treatment failure at 1 year. (Funded by the National Institute for Health Research; OVIVA Current Controlled Trials number, ISRCTN91566927.)



Full article available through Athens, Rotherham NHS staff can contact the Library for access

BMA: Supporting the mental health of doctors and medical students

BMA |April 2019 | Supporting the mental health of doctors and medical students

The BMA has now published its report: Supporting the mental health of doctors and medical students– which provides a summary of its findings from its survey (open to both BMA members and non-members) into doctors’ and medical students’ mental health, the survey received over 4300 responses. The report provides a summary of the BMA’s findings which include: 80 per cent of doctors are at high risk of burnout with junior doctors most at risk; nine-tenths of respondents said that current working, training or studying environment had contributed to their condition either to a significant or partial extent. Almost one-tenth (9%) of those completing the survey had also asked for but were not provided with support from their employer or medical school.
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Key points from the report’s findings:

  • Doctors can be vulnerable too
  • The working environment has an impact on doctors
  • Doctors should have access to support when they need it
  • The mental health of the workforce needs further support

Principles to improving mental health among doctors and medical students:

  • Building a supportive culture
  • Enhancing access to support
  • Encouraging self-care and peer support


An additional paper- ‘Personal stories of doctors in training with experience of mental illness’ – gives unique insights into what it is like to experience mental illness during a doctor’s trainee years by drawing on a review of the literature and  interviews with stakeholders and trainee doctors.

Key points

  • Doctors work when they know they are unwell and are reluctant to take sick leave
  • Doctors are concerned that their illness will be disclosed
  • Doctors can struggle to access support
  • Going back to work can be difficult

See also:  Personal stories of doctors in training with experience of mental illness

Further information about both publications is available from the BMA 

In the news:

OnMedica News Survey reveals ‘alarming’ mental health crisis among doctors


Staff praised as NHS productivity grows more than twice as fast as wider economy

NHS England | April 2019 | Staff praised as NHS productivity grows more than twice as fast as wider economy

Analysis of data by a team of  researchers at the University of York’s Centre for Health Economics, suggests that NHS staff provided 16.5% more care pound for pound in 2016/17 than they did in 2004/05, compared to productivity growth of only 6.7% in the economy as a whole. Their findings show that productivity in the NHS has increased at a rate faster than the the wider economy during the last 12 years, meaning more care and treatments for patients and better value for taxpayers.


Productivity of the English National Health Service: 2016/17 Update, revealed NHS outputs have increased since they began tracking productivity more than a decade ago.

According to NHS England this publication research reinforces figures published by the Office for National Statistics in January, which showed that NHS productivity in England in 2016/17 grew by 3% from the previous year, more than treble the 0.8% achieved by the whole economy (Source: NHS England).

Full details from NHS England

The publication Productivity of the English National Health Service: 2016/17 Update is available from the  University of York

In the news:

The Independent ‘Inefficient’ NHS has seen productivity grow twice as fast as the economy

Daily Mail Number of patients seen by hospitals rockets by five MILLION annually in 15 years as NHS demand reaches breaking point, study shows

NHS England: Thousands more set to get help as NHS rolls out mental health job coaches

NHS England | April 2019 | Thousands more set to get help as NHS rolls out mental health job coaches

A scheme that provides support to people with mental health conditions to gain employment is to be expanded, announces NHS England. The Individual Placement and Support (IPS) is to be extended to a further 28 areas meaning 80 per cent of England will have access to the programme; i
t is anticipated that by 2023/24, 50000 people will have befitted from the programme. As well as being referred to the IPS through their GP or a mental health professional, patients are also able to self- refer.


The scheme provides employment specialists offer coaching and advice, along with practical tips on finding a job and preparing for interviews. They can also search for jobs and engage with employers directly on patient’s behalf to identify well-suited roles – acting as a crucial link between patient, their employer and medical team.



Patients are able to call on the trained specialists who are embedded within health teams, at any time. They work alongside psychologists, mental health nurses and other health professionals and can speak to potential employers about how best to support people so that they can work effectively, while staying in good health (Source: NHS England).

Full details about the scheme are available from NHS England

NHS staff and parents to gain access to crucial child health information

NHS Digital | April 2019 | NHS staff and parents to gain access to crucial child health information

A new live service which enable access to important child health information at the point of care for health professionals has been launched by the NHS.

The service, the National Events Management Service, securely publishes information on key health interventions for children. Parents and health professionals can securely receive information digitally and use it to inform decisions on care and treatment, the service is the result of collaboration between NHS Digital and NHS England with IT suppliers.


The service shows which preventative interventions a child has received; improving the speed of diagnosis and treatment by giving health visitors and parents access to the same information sources at the same time.

The service has initially launched in North East London in partnership with North East London Foundation Trust (NELFT) and their health visiting and child health services. IT suppliers which already support the Trust have connected their products to the new service.

Full details from  NHS Digital