Physical Activity and Abnormal Blood Glucose Among Healthy Weight Adults

MedicalResearch.com Interview with:

Arch G. Mainous III, PhD  HSRMP Department Chair Florida Blue Endowed Professor of Health Administration University of Florida Health

Dr. Arch G. Mainous III

Arch G. Mainous III, PhD
HSRMP Department Chair
Florida Blue Endowed Professor of Health Administration
University of Florida Health

MedicalResearch.com: What is the background for this study?

Response: As our post-industrial society becomes more and more sedentary, there is a concern that a lack of activity is associated with poor health outcomes like diabetes. At the same time, the medical community has a strong focus on determining whether patients are overweight or obese as a way to classify them as  being at higher risk for poor health outcomes. However, individuals at a “healthy weight” in general, are considered to be at low risk. Some recent studies have shown that many individuals at “healthy weight” are not metabolically healthy. How then might we predict who at “healthy weight” would be unhealthy? We hypothesized that individuals at “healthy weight” who had a sedentary lifestyle would be more likely to have prediabetes or undiagnosed diabetes.

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Light-Intensity Activities Can Improve Glycemic Control in Diabetics

MedicalResearch.com Interview with:

Bernard M Duvivier  Department of Human Biology and Movement Science NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre Maastricht, the Netherlands

Dr. Bernard M Duvivier

Bernard M Duvivier 
Department of Human Biology and Movement Science
NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre
Maastricht, the Netherlands

MedicalResearch.com: What is the background for this study?  What are the main findings?

Response: The health benefits of exercise have been well established but sitting is a risk factor for health, independent of exercise.

As many people with type 2 diabetes don’t like to exercise we investigated whether replacing sitting time with light-intensity activities (standing and light walking) is equally effective to exercise when energy expenditure is comparable. Our results suggest that for people with type 2 diabetes, light-intensity activities (light walking and standing) can be an alternative to exercise to improve glucose regulation.

In addition we showed that too much sitting has negative effects on insulin sensitivity which could not be fully compensated by 1 hour of exercise per day.

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The Health ABC Study: Simple Exercise Test Predicts Heart Failure

MedicalResearch.com Interview with:

Vasiliki Georgiopoulou MD MPH PhD Assistant Professor of Medicine (Cardiology) Emory University School of Medicine

Dr. Vasiliki Georgiopoulou

Vasiliki Georgiopoulou MD MPH PhD
Assistant Professor of Medicine (Cardiology)
Emory University School of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Although existing evidence suggests that more exercise capacity is associated with lower risk of CV disease and death, we don’t know whether more exercise capacity would lead to lower risk for heart failure also. This would be especially important for older adults, who are the group with the highest risk to develop heart failure. We used the data of a cohort study to test this association.

The exercise capacity was evaluated by a walking test that is easy to perform – the long-distance corridor walk test. We observed that older adults who were able to complete the test had the lowest risk to develop heart failure and the lowest mortality rates, when compared with those who were not able to complete the test and those who could not do the test for medical reasons. We also observed that changes in exercise capacity 4 years later did not predict subsequent heart failure or mortality – perhaps because less fit older patients had already developed heart failure or had died.

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High Fitness Level Can Reduce Cardiovascular Risk of Prolonged Daily Sitting

MedicalResearch.com Interview with:

Ulrik Wisløff, PhD Professor, Head of K.G. Jebsen Center for Exercise in Medicine Department of Circulation and Medical Imaging Norwegian University of Science and Technology Norway

Dr. Ulrik Wisløff

Ulrik Wisløff, PhD
Professor, Head of K.G. Jebsen Center for Exercise in Medicine
Department of Circulation and Medical Imaging
Norwegian University of Science and Technology
Norway

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Prolonged time spent sedentary on a daily basis is detrimental for general health and is associated with increased risk of developing and dying from lifestyle related diseases such as cardiovascular disease – even in those following todays advice for physical activity given by health authorities worldwide. Number of hours spent inactive tend to increase with increased age. A person’s fitness level is regarded the best predictor of future health. We tested, in older adults (aged 70-77 years old) whether meeting physical activity recommendations and/or having high age-specific fitness level attenuated the adverse effect of prolonged sedentary time on cardiovascular risk factor clustering.

Main finding was that high age-specific fitness level fully attenuated the adverse effect of prolonged sedentary time on clustering of cardiovascular risk factors, independent of meeting the physical activity recommendation in older adults.

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Sedentary Lifestyle Linked To Increased Risk of Diabetic Retinopathy

MedicalResearch.com Interview with:

Paul Dinneen Loprinzi, PhD Health, Exercise Science and Recreation Management University of Mississippi

Dr. Paul Loprinzi

Paul Dinneen Loprinzi, PhD
Health, Exercise Science and Recreation Management
University of Mississippi

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Previous research demonstrates that adults who have higher daily sedentary behavior tend to have worse cardiometabolic health profiles. The extent to which sedentary behavior is associated with diabetic retinopathy has yet to be evaluated in the literature before our study. Our findings provided some suggestive evidence that more sedentary behavior was associated with a higher odds of having diabetic retinopathy.

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Relatively Brief Physical Activity Can Offset Adverse Effects of Prolonged Sitting

MedicalResearch.com Interview with:

Ulf Ekelund, PhD FACSM Professor Department of Sports Medicine Norwegian School of Sport Sciences

Prof. Ulf Ekelund

Ulf Ekelund, PhD FACSM
Professor
Department of Sports Medicine
Norwegian School of Sport Sciences 

MedicalResearch.com: What is the background for this study? What are the main findings?
Response: It is known that long sitting hours may be detrimental to health and previous studies have suggested associations between sitting time and all-cause mortality.However, it is not known whether physical activity can eliminate the increased risk of death associated with long sitting time.

We found that at least one hour of physical activity every day appear to offset the increased risk associated with more than eight hours of sitting. We also found that those who were physically inactive and sat for less than 4 hours every day were at greater risk compared with those who were physically active and sat for more than 8 hours providing further evidence on the benefits of physical activity.

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Pandemic of Global Physical Inactivity Costs Lives and Money

MedicalResearch.com Interview with:

Ding Ding (Melody), Ph.D., MPH NHMRC Early Career Senior Research Fellow/Sydney University Postdoctoral Research Fellow Prevention Research Collaboration Sydney School of Public Health The University of Sydney

Dr. Melody Ding

Ding Ding (Melody), Ph.D., MPH
NHMRC Early Career Senior Research Fellow
Sydney University Postdoctoral Research Fellow
Prevention Research Collaboration
Sydney School of Public Health
The University of Sydney

MedicalResearch.com: What is the background for this study?

Response: Understanding the true burden of a pandemic is indispensable for informed decision making. After decades of research, we now have established knowledge about how physical inactivity contributes to pre-mature deaths and chronic diseases, but the economic burden of physical inactivity remains unquantified at the global level. Through estimating the economic burden of physical inactivity for the first time, we hope to create a business case for investing in cost-effective actions to promote physical activity at the global levels.

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Type 2 Diabetes: “Stand Up, Sit Less, Move More, More Often” For Better Glucose Control

MedicalResearch.com Interview with:

Paddy Dempsey MPhEd, PhD in Medicine (expected June 2016) Physical Physical Activity and Behavioural Epidemiology Laboratory Baker IDI Heart and Diabetes Institute Melbourne VIC

Paddy Dempsey

Paddy Dempsey
MPhEd, PhD in Medicine (expected June 2016)
Physical Physical Activity and Behavioural Epidemiology Laboratory
Baker IDI Heart and Diabetes Institute
Melbourne VIC

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In addition to too little physical activity (PA), sedentary behavior – defined as any waking sitting or reclining behavior with low energy expenditure – has emerged as a ubiquitous and significant population-wide influence on cardiometabolic health outcomes, with potentially distinct and modifiable environmental and social determinants. There is now a consistent base of epidemiologic evidence reporting deleterious associations of excessive sedentary behaviors (e.g. TV viewing, car use, and desk work) with mortality and cardiometabolic morbidity, independent of moderate-vigorous PA.

To date, efforts to influence participation in moderate-to-vigorous exercise (i.e. 30 min a day of ‘exercise’ on most days a week for health) at the population level, such as through large-scale campaigns to promote walking, and other initiatives to encourage people to exercise during their leisure time have achieved only modest success. There may, however, be untapped preventive-health and clinical management potential through shifting the high volume of time spent sedentary to light-intensity physical activity interspersed throughout the day. As such, sedentary behavior represents a potentially feasible and therapeutic target, particularly in the promotion of metabolic health.

We posited that people with type 2 diabetes (T2D) were likely to derive the greatest benefits from interrupting their sitting time. However, until now the contributions of prolonged sitting and/or interrupting prolonged sitting with very-brief bouts of light-intensity PA had never been experimentally tested in patients with T2D. Moreover, this study for the first time moved beyond interrupting sitting with standing or ambulatory bouts (although walking bouts were also examined), which may have differing levels of metabolic stimulus (i.e. not physiologically taxing the body enough), practicality, or health efficacy, to examine a potential addition/alternative: simple resistance activities (SRA). A key premise behind these SRA bouts (half-squats, calf raises, gluteal contractions, and knee raises) were that they required no specialized equipment, only small amounts of space, and could be easily performed in a fixed position behind a work desk or at home with minimal disruption to work tasks or leisure pursuits. In addition, they also markedly increase muscle activity, and may also have other longer-term benefits (for example physical function, muscle strength, bone density), however we can only speculate on these aspects at present.

In this study in men and women with type 2 diabetes, plasma glucose, insulin and C-peptide (marker of insulin secretion and pancreatic beta cell function) levels following standardized breakfast and lunch meals were all markedly attenuated when prolonged sitting was regularly interrupted with light walking or resistance activities (3 min every 30 min) over an 8 hour day. Plasma triglyceride levels were also reduced for both types of activity bout; however, the reduction was only significant for the SRAs. Interestingly, the magnitude of glucose reduction for the walking bouts was greater in women for glucose levels.

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Cochrane Study Reviews Workplace Interventions For Reducing Sitting at Work

MedicalResearch.com Interview with:

Dr Nipun Shrestha MBBS, MPH Health Research and Social Development Forum Thapathali, Kathmandu, Nepal

Dr. Nipun Shrestha

Dr Nipun Shrestha MBBS, MPH
Health Research and Social Development Forum
Thapathali, Kathmandu, Nepal

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: These days our work in the offices isn’t the same as it used to be. Almost everybody is working with a computer nowadays and that makes you sit still all day. We do not need to move from our chair to do most of the things. This is not just the case in developed countries but for developing countries as well.

One would argue though we are sitting in the office hours but we are regularly doing lots of exercises. However researchers have found that sedentary behavior is an independent risk factor for many chronic diseases like diabetes, cardiovascular diseases and cancer. So breaking up time that we spend sitting is important.

There are many commercial innovations available in the market which are being advertised heavily by the manufacturers. The evidence on effectiveness of such innovation is however not available.

We found that there is limited evidence on effectiveness of interventions that aim to reduce sitting at work. There is some evidence that sit-stand desk may reduce sitting at work between 30 minutes to 2 hours without any adverse effects.

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Increased Time Watching TV Linked To Greater Mortality Risk

Sarah K. Keadle, PhD, MPH Cancer Prevention Fellow Nutritional Epidemiology Branch Division of Cancer Epidemiology and Genetics National Cancer Institute

Dr. Keadle

MedicalResearch.com Interview with:
Sarah K. Keadle, PhD, MPH
Cancer Prevention Fellow
Nutritional Epidemiology Branch
Division of Cancer Epidemiology and Genetics
National Cancer Institute

 

Medical Research: What is the background for this study? What are the main findings?

Dr. Keadle: Television viewing is extremely prevalent in the U.S. Ninety-two percent of Americans have a television at home and watching TV consumes more than half of their available leisure time, potentially displacing more physical activities. Previous studies have reported a relationship between TV viewing and increased risk of death from the two most common causes of death in the U.S., cancer and heart disease.

In our study, we followed more than 221,000 healthy Americans aged 50-71 years old for 14 years to look at this relationship. We confirmed the association with increased risk of death from cancer and heart disease. In addition, we found that TV viewing was associated with an increased risk of six other causes of death, including diabetes, influenza/pneumonia, Parkinson’s disease, and liver disease.

Also, compared to individuals who watched less than one hour per day, those who watched 3-4 hours of TV per day were 15% more likely to die from any cause, and individuals who watched seven or more hours of TV per day were 47% more likely to die over the study period.

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Don’t Just Sit There…Fidget!

Dr Gareth Hagger-Johnson PhD Senior Research associate Epidemiology & Public Health, Div of Population Health University College, LondonMedicalResearch.com Interview with:
Dr Gareth Hagger-Johnson PhD
Senior Research associate
Epidemiology & Public Health, Div of Population Health
University College, London

 

Medical Research: What is the background for this study? What are the main findings?

Response: Even among adults who meet recommended physical activity levels and who sleep for eight hours per night, it is possible to spend the vast majority of the day (up to 15 hours) sitting down. We were concerned about possible harm resulting from sitting for long periods combined with not moving.

Breaks in sitting time have previously been shown to improve markers of good health, such as body mass index and your body’s glucose and insulin responses. But until now, no study has ever examined whether fidgeting might modify an association between sitting time and mortality.

We noticed that The UK Women’s Cohort Study collected data (from 1999 to 2002) on health behavious, chronic disease, physical activity levels, sitting time – and fidgeting (a self-report scale ranging from 0 to 10, where 10 means ‘constantly’). More than 12,000 responses were received. We looked at the data to see who had died over the next 12 years.

Among women with low levels of fidgeting who also sat for 7 or more hours per day (compared to less than 5 hours), there was around a 30% increase in the risk of mortality over 12 years follow-up. Among women with medium or high levels of fidgeting, we did not see this harmful effect of sitting time, even after adjusting for other lifestyle factors including physical activity level.

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Increased Leisure Time Sitting Raises Cancer Risk

Alpa Patel, PHD Strategic Director, CPS-3 American Cancer Society, Inc. Atlanta, GA 30303MedicalResearch.com Interview with:
Alpa Patel, PHD
Strategic Director, CPS-3
American Cancer Society, Inc.
Atlanta, GA 30303

Medical Research: What is the background for this study? What are the main findings?

Dr. Patel: Using information from more than 146,000 men and women (69,260 men and 77,462 women) who were cancer-free and enrolled in the American Cancer Society Cancer Prevention Study II Nutrition Cohort, we examined the association between leisure time spent sitting and cancer risk. Study participants were followed from 1992 through 2009, during which time 18,555 men and 12,236 women were diagnosed with cancer. We found longer leisure-time spent sitting was associated with a 10 percent higher risk of cancer in women after adjustment for physical activity, BMI, and other factors.  The association in women was primarily due to invasive breast cancer, ovarian cancer, and multiple myeloma. No association was apparent in men.

Medical Research: What should clinicians and patients take away from your report?

Dr. Patel: These findings add to the growing body of scientific evidence that prolonged sitting is harmful to your overall health. Given the high rate of sedentary time in the U.S. any efforts to decrease sitting time can have broad public health benefit.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Patel: American Cancer Society guidelines for cancer prevention currently recommend reducing sitting time when possible. We need to conduct additional research to better understand the differences in associations between men and women as well as to quantify how much (or little) individuals should sit to prevent these negative health effects.

Citation:

 Leisure-time spent sitting and site-specific cancer incidence in a large US cohort
Alpa V. Patel, Janet S. Hildebrand, Peter T. Campbell, Lauren R. Teras, Lynette L Craft, Marjorie L. McCullough, and Susan M. Gapstur

Cancer Epidemiol Biomarkers Prev cebp.0237.2015; Published OnlineFirst June 30, 2015; doi:10.1158/1055-9965.EPI-15-0237

Alpa Patel, PHD (2015). Increased Leisure Time Sitting Raises Cancer Risk 

Average New Yorker Spends More Than Seven Hours Per Day Sitting

MedicalResearch.com Interview with:
Stella Yi, PhD, MPH

New York University Langone School of Medicine,
Department of Population Health
New York, NY 10016

MedicalResearch: What is the background for this study? What are the main findings?

Dr. Yi: Sedentary behaviors, such as sitting time, are an emerging risk factor in the field of physical activity epidemiology. Recent studies have demonstrated the negative health consequences associated with extended sitting time, including metabolic disturbances and decreased life expectancy independent of the effects of regular exercise.

We also assessed mean values of self-reported sitting time to characterize these behaviors in a diverse, urban sample of adults. The average New York City resident sits more than seven hours a day—greatly exceeding the three hours or more per day that is associated with decreased life expectancy.

Among the findings:

  • At the lower economic end, individuals spent 6.3 hours per day sitting, while those with higher incomes spent 8.2 hours per day sitting
  • College graduates spent 8.2 hours per day sitting, compared with 5.5 hours per day for those with less than a high school education
  • Whites spent on average 7.8 hours per day sitting, African Americans spent 7.4 hours sitting, Hispanics spent 5.4 hours sitting, and Asian Americans spent 7.9 hours per day sitting
  • Sitting time was highest in Manhattan, compared to other boroughs.

In the current analysis, we also assessed the validity of a two-question survey method of sitting time during waking hours using accelerometers to measure sedentary time in a subsample of our study participants. The correlation between sitting time reported in the survey and accelerometer-measured sedentary time was modest (r=0.32, p<0.01) with wide limits of agreement. We interpreted this to mean that while self-reported sitting might be useful at the population-level to provide rankings and subgroups, it may be limited in assessing an individual’s actual behavior.

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Sitting, Watching TV Increases Diabetes Risk In Predisposed Individuals

MedicalResearch.com Interview with:
Bonny Rockette-Wagner, Ph.D.

Director of physical activity assessment,
University of Pittsburgh Graduate School of Public Health and
Andrea Kriska, Ph.D.
Professor of epidemiology, University of Pittsburgh
Graduate School of Public Health

Researchers’ Note:

Drs. Kriska and Rockette-Wagner: It should be noted that this study looked at adults at high risk for diabetes. Not everyone in the general population would be at high risk. We would hypothesis that the risk increase from TV watching may be lower in those not at high risk for diabetes, but obviously could not test that in our study population.

MedicalResearch: What is the background for this study?

Response: In this research effort focused on participants in the Diabetes Prevention Program (DPP) study (published in 2002 and funded by the National Institute of Digestive and Diabetes and Kidney Diseases [NIDDK] section of the US National Institutes of Health [NIH]). That study enrolled 3,234 overweight US adults (1996–1999) of at least 25 years of age with the goal of delaying or preventing type 2 diabetes in high risk individuals with either a metformin drug or lifestyle intervention. The DPP demonstrated that the lifestyle intervention was successful at reducing the incidence of diabetes and achieving its goals of 150 minutes per week of moderate intensity activity (such as brisk walking) and a 7% weight loss (New England Journal of Medicine, 2002). There was no goal to reduce sitting in the Diabetes Prevention Program.

Results from other studies suggest that it is unclear if interventions focusing on increasing physical activity also reduce time spent sitting. This current investigation examined whether the Diabetes Prevention Program lifestyle intervention, which was shown to be effective at increasing physical activity, also decreased self-reported sitting time. The effect of sedentary behavior on diabetes development was also examined.

MedicalResearch: What are the main findings?

Response: For the lifestyle participants, a reduction in reported TV watching alone and the combination of TV watching and work sitting was observed. This reduction was significantly greater than any changes seen in the other two randomized groups, who did not receive the intervention. Because these reductions were accomplished without an explicit program goal to reduce sitting we feel optimistic that with better awareness of sitting behaviors and goal setting to reduce sitting it may be possible to have an even greater impact than what was achieved in this cohort.

Additionally, our results showed that for every hour spent watching TV there was a 3.4% increased risk of developing diabetes during the 3 year follow-up period in individuals at high risk for diabetes. This finding means that reductions in sitting can translate into a positive health effect separate from improvements in moderate-vigorous activity.

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Too Much Time Spent Sitting, TV Viewing May Increase Sleep Problems

Matthew Buman PhD Asst Professor SNHP Exercise & Wellness Arizona State UniversityMedicalResearch.com Interview with:
Matthew Buman PhD Asst Professor
SNHP Exercise & Wellness
Arizona State University

 

Medical Research: What is the background for this study? What are the main findings?

Dr. Buman: A lack of physical activity is a known risk factor for insomnia, poor sleep, and obstructive sleep apnea. In addition to physical activity, sedentary behavior has emerged as an important behavior. Sedentary behavior is not just the lack of physical activity, but actually refers to the time someone spend sitting. This behavior has been shown to, independent of physical activity, be related to many poor health outcomes including cardiovascular disease, diabetes, and even premature death. This is the first study to examine whether there is a relationship between excess sitting and insomnia, poor sleep, and risk for obstructive sleep apnea.

We found, after adjusting for physical activity and body weight (among other confounding factors), that total daily sitting was associated with poor sleep quality but not other sleep metrics or OSA risk. However, we also examined sitting while watching television and found a significant relationship between this type of sitting and a host of sleep quality metrics as well as risk for OSA. In a subsequent analysis we found that despite the independent relationship between sitting while watching television with OSA risk, those that were physically active were protected from this negative impact.

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Sitting Time Linked To Increased Heart Disease and Cancer Mortality

David Alter, MD, PhD FRCPC Senior Scientist Toronto Rehabilitation Institute-University Health Network and Institute for Clinical Evaluative Sciences Research Director, Cardiac Rehabilitation and Secondary Prevention Program Toronto Rehabilitation InstituteMedicalResearch.com Interview with:
David Alter, MD, PhD FRCPC Senior Scientist

Toronto Rehabilitation Institute-University Health Network and Institute for Clinical Evaluative Sciences
Research Director, Cardiac Rehabilitation and Secondary Prevention Program Toronto Rehabilitation Institute

 

Medical Research: What is the background for this study? What are the main findings?

Dr. Alter: We knew going into the study that exercise was an important lifestyle factor that improved health. We also knew from studies that sedentary time was associated with deleterious health-effects. What we didn’t know was whether the health-outcome effects of sedentary time and exercise were really one and the same (i.e., albeit opposite ends of the same spectrum) or alternatively, whether the health effects of each were independent of one another.  We explored over 9000 published studies to quantify the health-outcome effects associated with sedentary behaviour and extracted only those which took into account both sedentary time and exercise. We found a consistent association between sedentary time and a host of health outcomes independent of exercise. Specifically, after controlling for an individual’s exercising behaviour, sitting-time was associated with a 15-20% higher risk of death, heart-disease, death from heart disease, cancer-incidence, and death from cancer. Sitting time was also independently  associated with a marked (i.e., 90% increase) in the risk for diabetes after controlling for exercise. In short, sedentary times and exercise are each independently associated with health outcomes. We hypothesize that the two may have different mechanism, and may require different therapeutic strategies. But, the health-outcome implications of both are each important in their own right.

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Take a Short Walk: Don’t Sit For Long Periods of Time

Saurabh S. Thosar, Ph.D., Postdoctoral Researcher Oregon Institute for Occupational Health Sciences, Oregon Health & Science UniversiMedicalResearch.com Interview with:
Saurabh S. Thosar, Ph.D.,
Postdoctoral Researcher
Oregon Institute for Occupational Health Sciences,
Oregon Health & Science University


Medical Research: What are the main findings of the study?

Dr. Thosar: We discovered that 3 hours of sitting leads to an impairment in shear rate and an impairment in femoral artery endothelial function. When systematic breaks are added in the sitting time the shear rate and the endothelial function are preserved.
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Sitting Time Linked to Increased Disability

MedicalResearch.com Interview with:
Dorothy D Dunlop, PhD Professor, Medicine-Rheumatology Center for Healthcare Studies - Institute for Public Health and Medicine and Preventive Medicine Northwestern University Feinberg School of MedicineDorothy D Dunlop, PhD
Professor, Medicine-Rheumatology
Center for Healthcare Studies – Institute for Public Health and Medicine and Preventive Medicine
Northwestern University Feinberg School of Medicine

MedicalResearch.com: What are the main findings of the study?

Dr. Dunlop: We know being active, especially doing moderate activity like taking a brisk walk, is good for health. We know a sedentary lifestyle leads to health problems. What we do not know is whether or not those are two ways of looking at the same question. Does being sedentary like sitting just reflect insufficient activity OR is sedentary time is a separate and distinct risk factor for health problems. Our physical activity research group looked at national US data from the National Health and Nutrition Examination Survey.  This is an important study because they monitored physical activity using an accelerometer.  We found sedentary behavior such as sitting was its own separate risk factor for disability.
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