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

Low levels of exercise are beneficial for adults

Even low levels of leisure-time physical activities are beneficial for adults, whilst doing more vigorous exercise has additional health benefits in terms of reducing mortality.  Authors call for the promotion of any amount and intensity of physical activity, to reduce mortality risk in the general population | British Journal of Sports Medicine


Background:  Evidence on the role of very low or very high volumes of leisure time physical activity (PA) on the risk of all-cause and cause-specific mortality is limited. We aimed to examine the associations of different levels of leisure time PA with the risk of all-cause, cardiovascular disease (CVD) and cancer-specific mortality.

Methods:  Data were from 12 waves of the National Health Interview Surveys (1997–2008) linked to the National Death Index records through 31 December 2011. A total of 88 140 eligible participants aged 40–85 years were included.

Results:  Compared with inactive individuals, those performing 10–59 min/week of PA had 18% lower risk of all-cause mortality. Those who reported 1–2 times (150–299 min/week) the recommended level of leisure time PA had 31% reduced risk of all-cause mortality. Importantly, the continued benefits were observed among those performing leisure time PA 10 or more times the recommended minimum level. In addition, there was a larger reduction in all-cause and cause-specific mortality for vigorous vs. moderate intensity PA.

Conclusions: We found that beneficial association between leisure time PA and mortality starts from a low dose. Doing more vigorous exercise could lead to additional health benefits.

Full abstract at British Journal of Sports Medicine

Full reference: Zhao M, Veeranki SP, Li S, et al | Beneficial associations of low and large doses of leisure time physical activity with all-cause, cardiovascular disease and cancer mortality: a national cohort study of 88,140 US adults | British Journal of Sports Medicine | Published Online First: 19 March 2019

See also: Even low amounts of exercise are beneficial | OnMedica

Staying fit and mentally active linked with reduced dementia risk

Researchers in Sweden have found that women who exercise and stay cognitively active during midlife have a reduced risk of dementia in older age | Neurology | via Alzheimer’s Research UK

In 1968, Swedish researchers began studying a group of 800 women in midlife, between the ages of 38 and 54, and measured the amount of time they spent doing cognitively stimulating activities, including reading books and writing. The team also recorded how much physical activity the women did including walking, and intense training like swimming.

The team followed the volunteers until 2012 to see if they went onto develop dementia. They found that those who were more engaged in physical activity and spent more time doing cognitive tasks had a lower risk of developing the condition.


Objective:  To investigate whether cognitive and physical activities in midlife are associated with reduced risk of dementia and dementia subtypes in women followed for 44 years.

Methods:  A population-based sample of 800 women aged 38–54 years (mean age 47 years) was followed from 1968 to 2012. Cognitive (artistic, intellectual, manual, religious, and club) and physical activity were assessed at baseline. During follow-up, dementia, Alzheimer disease, vascular dementia, mixed dementia, and dementia with cerebrovascular disease were diagnosed according to established criteria based on information from neuropsychiatric examinations, informant interviews, hospital records, and registry data. Cox regression models were used with adjustment for age, education, socioeconomic status, hypertension, body mass index, cigarette smoking, diabetes mellitus, angina pectoris, stress, and major depression.

Results:  We found that cognitive activity in midlife was associated with a reduced risk of total dementia and Alzheimer disease during follow-up. Physical activity in midlife was associated with a reduced risk of mixed dementia and dementia with cerebrovascular disease. The results were similar after excluding those who developed dementia before 1990, except that physical activity was then also associated with reduced risk of total dementia.

Conclusion: Our findings suggests that midlife cognitive and physical activities are independently associated with reduced risk of dementia and dementia subtypes. The results indicate that these midlife activities may have a role in preserving cognitive health in old age.

Full story at Alzheimer’s Research UK

Full reference: Najar, J. et al. | Cognitive and physical activity and dementia. A 44-year longitudinal population study of women | Neurology | First published February 20, 2019


Standing desks with a support package reduce time sitting at work

NIHR | January 2019 | Standing desks with a support package reduce time sitting at work

National Institute for Health Research reports how an office-based intervention involving a height-adjustable workstation and instruction package reduced the amount of time spent sitting for 146 NHS workers. Using a height- adjustable work station reduced time sat by between 60 to 90 minutes less per day at six and 12 months compared with the control group.


Sitting for long periods is a risk factor for ill health even in people meeting recommended levels of physical activity. Reducing time sitting at work could have health and economic benefits, but the evidence is limited. This trial was fairly small, involving 146 NHS workers. No firm conclusions can be drawn as to whether reduced sitting time may translate into effects on musculoskeletal health, work performance or sickness absence. However, the results are promising and will be important if shown to be effective and cost-effective for individuals and their employers when implemented more widely.

A larger NIHR-funded study involving council workers is underway which may provide further evidence and cost data.

Read the full Signal here 

Full reference:

Edwardson, C. | 2018|Effectiveness of the Stand More AT (SMArT) Work intervention: cluster randomised controlled trial|BMJ|10.3310/signal-000717


To evaluate the impact of a multicomponent intervention (Stand More AT (SMArT) Work) designed to reduce sitting time on short (three months), medium (six months), and longer term (12 months) changes in occupational, daily, and prolonged sitting, standing, and physical activity, and physical, psychological, and work related health.

Cluster two arm randomised controlled trial. Setting National Health Service trust, England.


37 office clusters (146 participants) of desk based workers: 19 clusters (77 participants) were randomised to the intervention and 18 (69 participants) to control.


The intervention group received a height adjustable workstation, a brief seminar with supporting leaflet, workstation instructions with sitting and standing targets, feedback on sitting and physical activity at three time points, posters, action planning and goal setting booklet, self monitoring and prompt tool, and coaching sessions (month 1 and every three months thereafter). The control group continued with usual practice.
Main outcome measures

The primary outcome was occupational sitting time (thigh worn accelerometer). Secondary outcomes were objectively measured daily sitting, prolonged sitting (≥30 minutes), and standing time, physical activity, musculoskeletal problems, self reported work related health (job performance, job satisfaction, work engagement, occupational fatigue, sickness presenteeism, and sickness absenteeism), cognitive function, and self reported psychological measures (mood and affective states, quality of life) assessed at 3, 6, and 12 months. Data were analysed using generalised estimating equation models, accounting for clustering.


A significant difference between groups (in favour of the intervention group) was found in occupational sitting time at 12 months. Differences between groups (in favour of the intervention group compared with control) were observed for occupational sitting time at three months and six months and daily sitting time at six months  and 12 months. Group differences (in favour of the intervention group compared with control) were found for prolonged sitting time, standing time, job performance, work engagement, occupational fatigue, sickness presenteeism, daily anxiety, and quality of life. No differences were seen for sickness absenteeism.

The full paper has been published in the BMJ

Funding for 13 councils to develop local solutions to childhood obesity

Department of Health and Social Care| January 2019 | Funding for councils to develop local solutions to childhood obesity

The Department of Health and Social Care has announced that 13 local authorities will receive funding and support to develop innovative plans to reduce childhood obesity that can be shared across the country. 


The work is part of the government’s Trailblazer programme, in partnership with the Local Government Association (LGA) supported by Public Health England. The programme will focus on inequalities and work closely with local authorities to:

  • test the limits of existing powers through innovative and determined action to tackle childhood obesity
  • share learning and best practice to encourage wider local action
  • develop solutions to local obstacles
  • consider further actions that government can take to support local action and achieve large-scale changes

The 3-year programme forms part of the second chapter of the government’s childhood obesity plan, launched in the summer.

This included the aim to halve childhood obesity and significantly reduce the gap in obesity between children from the most and least deprived areas by 2030. One in 3 children leaves primary school overweight or obese and children from the most deprived areas are more than twice as likely to be obese (Source: Department of Health and Social Care).

Full story from Department of Health and Social Care 

Want to stick to your News Year’s exercise regime? New research may help you to do so

University of Manchester | December 2018 | Want to stick to your New Year’s exercise regime? This research can help

Collbaorative research between experts at University of Manchester, Leeds Trinity University and the National University of Galway Ireland have analysed the results of 180 randomised trials in order to further research into the most effective techniques for changing adults’ physical activity using a concept known as self-efficacy.


This is basically the perception of our own ability and its influence on our ability to succeed or accomplish a specific goal. While earlier research has indicated that  higher levels of self-efficacy are associated with higher levels of physical activity, what is less certain is which techniques have the most impact on our self-efficacy.

A key finding from the study is that the greater the number of techniques used, the more effective they may be at maintaining our self-efficacy in the longer-term. They also found that simply providing people with information on the associated health benefits of exercise did not increase self-efficacy

Lead author Dr Mei Yee Tang at The University of Manchester said: “One of the biggest influences of our behaviour is our own beliefs. If we believe we are capable of doing something, then we are more likely to devote effort to it and feel we can do it even if it may be a difficult task.”

Dr Tang added: “We were unable to find clear patterns of techniques which should be used together, or which might not work as well together, in increasing self-efficacy.

“Previous similar reviews which have looked at specific adult populations have found self-regulatory techniques such as setting physical activity goals and monitoring physical activity behaviour to be effective at increasing self-efficacy in obese adults and adults without a clinical condition.

“Yet, these techniques were associated with lower self-efficacy in older adults. In older adults, techniques such as setting graded tasks – such as slowly increasing walking distance each time – ,were found to be more effective for this population.

“Therefore, it’s important to stress that there isn’t a single ‘magic bullet’ that can increase self-efficacy for physical activity across all adults.

“On January first we should think about factors such as age and any illness or conditions if we are to support ourselves and our loved ones in achieving their physical activity related-New Year’s resolution.”

Read the press release from the University of Manchester

Full reference: Tang, M.Y.,  Smith, D.M.,  Mc Sharry, J., Hann, M.,  French, D.P., | 2018| Behavior Change Techniques Associated With Changes in Postintervention and Maintained Changes in Self-Efficacy For Physical Activity: A Systematic Review With Meta-analysis| Annals of Behavioral Medicine| kay090|



Self-efficacy is an important determinant of physical activity but it is unclear how best to increase self-efficacy for physical activity and to maintain these changes.


This systematic review aimed to identify which specific behavior change techniques (BCTs), BCT clusters, and number of BCTs were associated with changes in postintervention and maintained changes in self-efficacy for physical activity across all adult populations.


A systematic search yielded 180 randomized trials (204 comparisons) which reported changes in self-efficacy. BCTs were coded using the BCT Taxonomy v1. Hierarchical cluster analysis explored the clustering of BCTs. Meta-analyses and moderator analyses examined whether the presence and absence of individual BCTs in interventions were associated with effect-size changes for self-efficacy.


Small intervention effects were found for postintervention self-efficacy for physical activity. “Information about social, environmental, and emotional consequences” was associated with higher effect sizes, whereas “social support (practical)” was associated with lower effect sizes. Small and nonsignificant effects were found for maintained changes in self-efficacy for physical activity . Lack of meaningful clustering of BCTs was found. A significant positive relationship was found between number of BCTs and effect sizes for maintained changes in self-efficacy for physical activity.


There does not appear to be a single effective approach to change self-efficacy for physical activity in all adults: different approaches are required for different populations. Interventions with more BCTs seem more effective at maintaining changes in self-efficacy for physical activity.


Rotherham NHS staff  can request the article here

Cycling and walking for individual and population health benefits

Public Health England | November 2018 | Cycling and walking for individual and population health benefits: A rapid evidence review for health and care system decision-makers

Public Health England (PHE)  has published Cycling and walking for individual and population health benefits, the publication is based on an evidence review to answer the question: What is the impact of walking and/or cycling on different health outcomes?


  • This review found that walking and cycling benefit health in a number of ways:
    people who walk or cycle have improved metabolic health and a reduced risk of
    premature mortality
  • walking and cycling reduce the risk factors for a number of diseases, including
    cardiovascular disease, respiratory disease, some cancers, and Type II diabetes
  • walking and cycling also have positive effects on mental health and general wellbeing. The mental health and neurological benefits include reduced risk of
    dementia, improved sleep quality, and a greater sense of wellbeing
  • in environmental terms, health benefits accrue for the general population from a
    reduction in pollution due to car use and a decrease in road congestion
  •  the evidence is that the health benefits of walking and cycling outweigh any
    potential health risks and harms – for example from injury or pollution (Source: PHE)

Read the evidence review in full from PHE