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Severe obesity

Sedentary behaviour associated with poor adult health

(Credit: Tony Alter)
Cardiometabolic health was assessed via physical measures, fasting blood samples and medication use

Sedentary behaviour is associated with poor cardiovascular health and diabetes in adults with severe obesity, independent of how much exercise they perform, a University of Pittsburgh Graduate School of Public Health-led study showed for the first time. The finding, ‘Objectively-measured sedentary time and cardiometabolic health in adults with severe obesity’, published online in the March 2016 issue of the journal Preventive Medicine, could be used to design and test programmes for adults with severe obesity that emphasise reducing time spent sitting, rather than immediately working toward increased moderate- to vigorous-intensity physical activity or exercise, such as brisk walking. In the US, 15 percent of adults have severe obesity, placing them at high risk of cardiovascular and metabolic disease, and premature mortality.

Wendy King (Credit: Pitt Public Health)

"Adults with severe obesity often have difficultly following national guidelines to participate in at least 30 minutes per day of moderate- to vigorous-intensity physical activity for health benefits," said lead author, Dr Wendy C King, associate professor in the Department of Epidemiology at Pitt Public Health. "Our findings suggest that replacing sedentary behaviour, like watching television or sitting at the computer, with low-intensity physical activities, such as light housework or going for a casual stroll, may improve cardiometabolic health in this population."

In addition, King and her colleagues determined that defining ‘sedentary time’ as ten minutes or more without walking yielded stronger associations between sedentary behaviour and cardiometabolic health compared to allowing sedentary time to be as short as one minute, which has been the norm in the field.

"This is important because accurate assessment of sedentary behaviour is crucial to being able to evaluate if and how this behaviour is related to health outcomes. If our estimate of sedentary behaviour is poor, we may not detect true associations," added King.

She and her colleagues followed 927 patients participating in the Longitudinal Assessment of Bariatric Surgery-2 (LABS-2), a prospective study of patients undergoing weight-loss surgery at one of ten different hospitals across the US. For a one-week period before surgery, the research team measured the participants' activity - or lack of activity - using monitors that tracked the number of steps taken each minute.

Cardiometabolic health was assessed via physical measures, fasting blood samples and medication use. Indices of sedentary time were derived from StepWatch activity monitor data with minimum bout durations of one min, ten min and 30 min.

Sedentary time was 9.3 h/d (8.1, 10.5) in ≥ one minute bouts, 6.5 h/d (5.2, 8.0) in ≥ ten minute bouts, or 3.2 h/d (2.1, 4.5) in ≥ 30 min bouts. Associations with ST were generally strongest with the ≥ ten minute bout duration.

For every hour per day participants spent in sedentary bouts of at least ten minutes, their odds of having diabetes increased by 15 percent, metabolic syndrome by 12 percent and elevated blood pressure by 14 percent, and their waist circumference was a half inch larger, after adjusting for their sex, age, household income, smoking status, alcohol use, depressive symptoms, body mass index (BMI) and time spent in moderate- to vigorous-intensity physical activity.

"These findings indicate the importance of investigating sedentary behaviour as a distinct health risk behaviour, not simply lack of moderate- to vigorous-intensity physical activity, among adults with severe obesity," said King. "This ultimately may inform physical activity guidelines for this special population."

Future research is needed to determine whether replacing sedentary behaviour with low-intensity physical activity is an effective approach to preventing and managing cardiovascular and metabolic diseases in adults with severe obesity, and evaluate strategies to help this population make such lifestyle changes. 

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