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Sedentary Behavior and Inactivity Physiology Killing you softly and gently Yannis Guerra Endocrinology Department John H. Stroger Jr. Hospital of Cook County [email_address] @yannisguerra  on Twitter
CC  www.TheNounProject.com
In this presentation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What is to be sedentary? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What does the literature says?
 
 
Seems that we don’t agree. And these definitions concentrate in the presence/absence of exercise
A more “big picture” approach
A distinct class of behaviors (e.g., sitting, watching TV, driving) characterized by little physical movement and low energy expenditure  ( Less/equal to 1.5 METs) Appl. Physiol. Nutr. Metab.  35: 725–740 (2010)
Not only the lack of exercise CC  www.TheNounProject.com
For a real life example ,[object Object],[object Object],[object Object]
Accelerometers are all around us! CC  http://www.flickr.com/photos/oskay/1193147290/sizes/o/in/photostream/ http://www.flickr.com/photos/terrypaton/4613655114/ http://www.flickr.com/photos/zzathras777/2071956401/sizes/o/in/photostream/
For a real life example (cont) ,[object Object],[object Object],[object Object]
This is the result of the “active day”
And over the long run?
Active Couch Potato Exerc. Sport Sci. Rev., Vol. 38, No. 3, pp. 105Y113, 2010 Appl. Physiol. Nutr. Metab.  35: 725–740 (2010 )
http://www.flickr.com/photos/ptooey/5018659279/ Does it make any difference?
Mayo Clin Proc. ‱ December 2010;85(12):1138-1141
Understanding the  Distribution of Energy Expenditure in Humans
European Journal of CliniCiI Nutrition (1996) 50, 72-92
European Journal of CliniCiI Nutrition (1996) 50, 72-92 Total exercise expenditure (TEE) , Mega Joules
Components 0 Kcal/day 2000 Kcal/day 1000 Kcal/day Basal Metabolic Rate (BMR) Activity Thermogenesis Thermal effect of food
European Journal of ClinicaI Nutrition (1996) 50, 72-92 Weight+Height+Gender   Predict 86% of BMR Basal Metabolic Rate (BMR), MegaJoules
[object Object],[object Object],[object Object],Curr Opin Clin Nutr Metab Care 7:599–605.
Weight+Height+Gender   Predict only 7% Physical Activity Level
Returning to the Total Energy Expenditure 0 Kcal/day 2000 Kcal/day 1000 Kcal/day Basal Metabolic Rate Activity Thermogenesis Thermal effect of food
More detailed! 0 Kcal/day 2000 Kcal/day 1000 Kcal/day Non Exercise Activity Thermogenesis  (NEAT) Exercise
Which one is more affected by Sedentary behaviors? Some arguments in favor of NEAT
Circulation. 2007;116:1081-1093
Arterioscler Thromb Vasc Biol 2006;26;729-736
Easy solution, right? Just tell them to exercise more! I think you’ll find it’s a bit more complicated than that Ben Goldacre, www.Bad Science.net
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Am J Clin Nutr 1995;62:722-9 .
Am J Clin Nutr 1995;62:722-9 .
What we thought would happen Non Exercise Activity Thermogenesis  (NEAT) Exercise Non Exercise Activity Thermogenesis  (NEAT) Exercise
What really happened Non Exercise Activity Thermogenesis  (NEAT) Exercise Non Exercise Activity Thermogenesis  (NEAT) Exercise
Revising concepts is NEAT! ,[object Object],[object Object],[object Object],[object Object],[object Object]
http://xkcd.com/552/
Science 307:584-586 164 min 152 min
 
[object Object],[object Object],[object Object],Science 283: 212-214
Science 283: 212-214 Weight changed from 0.36 kg to 4.23 kg, mainly correlated to activity thermogenesis.
How does this affect our current paradigm of thinking about activity and weight/metabolic effects? To decrease NEAT, increase inactivity
[object Object],[object Object],[object Object],Diabetes 56:2655–2667, 2007
First
Second ,[object Object],[object Object],[object Object],[object Object],[object Object],Cannot be caused by  additional exercise deficiency!
Third ,[object Object],http://xkcd.com/285/
CC  www.TheNounProject.com
Evidence at all levels www.wikipedia.org
Image: Acta ortop. bras. vol.12 no.1 São Paulo Jan./Mar. 2004
What did they do? ,[object Object],[object Object],[object Object],[object Object]
Three types of pattern Down and up to normal Up and staying up Up and down to normal
 
 
Showing ,[object Object],[object Object],[object Object]
Oh, the Humanity!
Arterioscler Thromb Vasc Biol. 2007;27:2650-2656
Metabolism Clinical and Experimental
Image: Br J Sports Med  2006; 40 :779-784 doi:10.1136/bjsm.2006.027276
 
[object Object],[object Object],[object Object],Diabetes Care 30:1384–1389, 2007
Important:  Effect even when adjusted for higher intensity activity
[object Object],[object Object],[object Object],[object Object],[object Object],Diabetes Care 31:369–371, 2008
Evidence for the 3 rd  tenet ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CC  www.TheNounProject.com
What about the 4 th  tenet? Times that people spend sitting versus participating in exercise based leisure time physical activity are different classes of behavior with distinct determinants  AND INDEPENDENT RISKS FOR DISEASE Diabetes 56:2655–2667, 2007
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],PLoS Med 3(12): e488. doi:10. 1371/journal.pmed.0030488
Obes Res. 2005;13:608–614
Epidemiology 1998; 9: 632-35 NEAT
NEAT
Med. Sci. Sports Exerc., Vol. 41, No. 5, pp. 998–1005, 2009
Exercisers Non Exercisers Even if you exercise, the effects are still there!
J Am Coll Cardiol 2011;57:292–9
And the beat goes on, and on, and on
 
 
Statistics of direct measurement CC  www.TheNounProject.com No, it’s not Pac-man eating pie
European Heart Journal doi:10.1093/eurheartj/ehq451 http://www.bionetics.ca/exercise/mti%20actigraph.htm
JAMA. 2006;296:171-179 Absolute risk 12% 17.6% 24.7%
Evidence for the 4 th  tenet ,[object Object],[object Object],[object Object],[object Object],[object Object]
http://www.flickr.com/photos/knitbunny/753713999 / What can we do about it?
Diabetes Care 31:661–666, 2008
But besides that study

http://www.flickr.com/photos/cobalt/205542600
But do not despair!
IDLE Breaks Study ,[object Object],[object Object],[object Object]
 
Unpublished Data Glucose Insulin Breaking news:  New data All are statistically significative!
 
Hot off the presses ,[object Object],[object Object],Am J Public Health.  2011 Mar 18. [Epub ahead of print ]
General Ending Points
We have changed as a species Int. J. Sports Med 19: 328-35, 1998 Estimated daily energy expenditure
We have changed as a species http://www.flickr.com/photos/xuxiaohui/15902318/
 
But not so much
We are failing http://www.flickr.com/photos/8185675@N07/3902633122/ exercise
But we may be missing something big Exercise NEAT inactivity
We want to avoid this http://www.flickr.com/photos/tedmurphy/3830352762/
And we need to accomplish this! http://www.flickr.com/photos/31364755@N08/2942780396/in/photostream
Thanks to David Dunstan Associate Professor  Baker IDI  Heart & Diabetes Institute Travis Saunders Healthy Active Living and Obesity Research Group Obesity Panacea Blog Mark E. Benden Associate Professor Texas A&M Health Science Center School of Rural Public Health

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Sedentary behavior and inactivity physiology slideshare presentation

Hinweis der Redaktion

  1. Failures to affect our patient’s weight and clinical measurements with exercise therapy.
  2. 6 trials used energy expenditure (but different ways to get to it) 5 trials didn’t even defined sedentary
  3. Healthy Active Living and Obesity Research Group
  4. 1 MJ=238 kcal
  5. R for weight 0.48, for height 0.50, age -0.13 Total regression 86% SD 10%
  6. Department of Human Biology, University of Limburg, Netherlands
  7. Endocrine Research Unit Mayo.n 10 Lean BMI 23, n 10 Obese BMI 33. Movement monitored for 10 days, energy expenditure by doubly labeled water.
  8. Endocrine Research Unit, Mayo. N 16 non obese. Overfeed for 8 weeks 1000 kcal
  9. Endocrine Research Unit, Mayo. N 16 non obese. Overfeed for 8 weeks 1000 kcal
  10. Dr. Hamilton’s team, University of Missouri- Columbia. 60 rats. 12 hours of HU, then 4 hours of low intensity ambulatory activity. Only used genes that changed more than 1.5x expression to decrease false positives.
  11. Heparin releasable=HR
  12. Glycolytic= Used when exercising “extra”, Oxidative= Used for postural tone and day to day activity
  13. Herbert Morrison, the Hindenburg
  14. 20 healthy subjects, 5 days of bed rest
  15. 14 non obese young fit individuals, 3 conditions NOSIT(2900kcal), SIT(same), SITBAL(2200 kcal)
  16. Metabolic risk score: Skin folds, HDL, TG, fasting insulin, FPG
  17. NHANES data from 1999-2000. Metabolic syndrome definition ATPIII. Self reported leisure activity time for 43 activities. Self reported screen time
  18. Canadian Fitness Survey 1981. Females >30 yold, no CAD. 6620 women, f/u 7 years
  19. Canadian Fitness Survey Started with 17013 patients
  20. Active is 7.5 MET/h/wk
  21. 4757 participants in NHANES 2003-2006, accelerometer based
  22. Based on Health ABC study, 302 healthy elderly patients. Used accelerometer AND DLW
  23. AusDiab Data
  24. Mention ABLE study