Definition, measurement, and health risks associated with sedentary behavior. A systematic review of school-based interventions targeting physical activity and sedentary behaviour among older adolescents Intervening to Reduce Sedentary Behaviors and Childhood Obesity among School-Age Youth: A Systematic Review of Randomized Trials A cluster-randomized controlled trial to reduce sedentary behavior and promote physical activity and health of 8-9 year olds: The Transform-Us! Study Economic evaluation in short bowel syndrome (SBS): an algorithm to estimate utility scores for a patient-reported SBS-specific quality of life scale (SBS-QoL™) Correlates of preschool children’s objectively measured physical activity and sedentary behavior: a cross-sectional analysis of the SPLASHY study Comparison of Actical and activPAL measures of sedentary behaviour in preschool children. Motivational counselling and SMS-reminders for reduction of daily sitting time in patients with rheumatoid arthritis: a descriptive randomised controlled feasibility study A Pan-Canadian practice guideline: prevention, screening, assessment, and treatment of sleep disturbances in adults with cancer Randomised controlled feasibility study of a school-based multi-level intervention to increase physical activity and decrease sedentary behaviour among vocational school students The John Charnley Award. Practice surveillance: a practical method to assess outcome and to perform clinical research. What are the most effective behaviour change techniques to promote physical activity and/or reduce sedentary behaviour in inactive adults? A systematic review protocol
PURPOSE AND METHODS Although evidence is accumulating that sedentary behavior ( SB ) , independent of moderate-to-vigorous intensity physical activity ( MVPA ) , is associated with cardiometabolic and aging outcomes in adults , several gaps present opportunities for future research . This article reports on the " Research Evidence on Sedentary Behavior " session of the Sedentary Behavior : Identifying Research Priorities workshop , sponsored by the National Heart , Lung , and Blood Institute and the National Institute on Aging , which aim ed to identify priorities in SB research . RESULTS AND CONCLUSIONS A consensus definition of SB has not yet been established , although agreement exists that SB is not simply all behaviors other than MVPA . The two most common definitions are as follows : one based solely on intensity ( < 1.5 metabolic equivalents [ METs ] ) and another which combines low intensity ( ≤1.5 METs ) with a seated or reclining posture . Thus , for the definition of SB , evaluation of whether or not to include a postural component is a research priority . SB assessment method ologies include self-report and objective measurement , each offering distinct information . Therefore , evaluation , st and ardization , and comparison across self-report and objective assessment methods are needed . Specific priorities include the development and validation of novel devices capable of assessing posture and st and ardization of research practice s for SB assessment by accelerometry . The prospect i ve evidence that SB relates to health outcomes is limited in that SB is almost exclusively measured by self-report . The lack of longitudinal studies with objective ly measured SB was recognized as a major research gap , making examination of the association between objective ly measured SB and adverse health outcomes in longitudinal studies a research priority . Specifically , studies with repeated measures of SB , evaluating dose-response relationships , with inclusion of more diverse population s are needed ABSTRACT Lack of  physical activity  (  PA  ) and high levels of sedentary behaviour ( SB ) have been associated with health problems . This systematic review evaluates the effectiveness of school-based interventions to increase PA  and decrease SB  among 15–19-year-old adolescents , and examines whether intervention characteristics ( intervention length , delivery mode and intervention provider ) and intervention content ( i.e. behaviour change techniques , BCTs ) are related to intervention effectiveness . A systematic search of r and omised or cluster r and omised controlled trials with outcome measures of PA and /or SB rendered 10 results . Risk of bias was assessed using the Cochrane risk of bias tool . Intervention content was coded using Behaviour Change Technique Taxonomy v1 . Seven out of 10 studies reported significant increases in PA . Effects were generally small and short-term ( Cohen 's d ranged from 0.132 to 0.659 ) . Two out of four studies that measured SB reported significant reductions in SB . Interventions that increased PA  included a higher number of BCTs , specific BCTs ( e.g. , goal setting , action planning and self-monitoring ) , and were delivered by research staff . Intervention length and mode of delivery were unrelated to effectiveness . More studies are needed that evaluate long-term intervention effectiveness and target SBs among older adolescents Objective . To assess the effectiveness of interventions that focus on reducing  sedentary behavior ( SB ) among school-age youth and to identify elements associated with interventions ' potential for translation into practice setting s. Methods . A comprehensive literature search was conducted using 4 data bases for peer- review ed studies published between 1980 and April 2011 . R and omized trials , which lasted at least 12 weeks , aim ed at decreasing  SB among children aged 6 to 19 years were identified . Results . Twelve studies were included ; 3 focused only on SB , 1 focused on  physical activity ( PA )  , 6 were combined SB and PA interventions , and 2 studies targeted SB , PA , and diet .  The majority of the studies were conducted in a school setting , while others were conducted in such setting s as clinics , community centers , and libraries . Conclusions . Overall , interventions that focused on decreasing SB were associated with reduction in time spent on SB and /or improvements in anthropometric measurements related to childhood obesity . Several of the studies did consider elements related to the intervention 's potential for translation into practice setting Background Physical activity ( PA ) is associated with positive cardio-metabolic health and emerging evidence suggests sedentary behavior ( SB ) may be detrimental to children 's health independent of PA . The primary aim of the Transform-Us ! study is to determine whether an 18-month , behavioral and environmental intervention in the school and family setting s results in higher levels of PA and lower rates of SB among 8 - 9 year old children compared with usual practice ( post-intervention and 12-months follow-up ) . The secondary aims are to determine the independent and combined effects of PA and SB on  children 's cardio-metabolic health risk factors ; identify the factors that mediate the success of the intervention ; and determine whether the intervention is cost-effective . Methods / design A four-arm cluster-r and omized controlled trial ( RCT ) with a 2 × 2 factorial design , with schools as the unit of r and omization . Twenty schools will be allocated to one of four intervention groups , sedentary behavior ( SB-I ) , physical activity ( PA-I ) , combined SB and PA ( SB+PA-I ) or current practice control ( C ) , which will be evaluated among approximately 600 children aged 8 - 9 years in school year 3 living in Melbourne , Australia . All children in year 3 at intervention schools in 2010 ( 8 - 9 years ) will receive the intervention over an 18-month period with a maintenance ' booster ' delivered in 2012 and children at all schools will be invited to participate in the evaluation assessment s. To maximize the sample and to capture new students arriving at intervention and control schools , recruitment will be on-going up to the post-intervention time point . Primary outcomes are time spent sitting and in PA assessed via accelerometers and inclinometers and survey . Discussion To our knowledge , Transform-Us ! is the first RCT to examine the effectiveness of intervention strategies for reducing children 's overall sedentary time , promoting PA and optimizing health outcomes . The integration of consistent strategies and messages to children from teachers and parents in both school and family setting s is a critical component of this study , and if shown to be effective , may have a significant impact on educational policies as well as on pedagogical and parenting practice s . Trial registration ACTRN12609000715279 ; Current Controlled Trials IS RCT Purpose Condition-specific preference-based measures can offer utility data where they would not otherwise be available or where generic measures may lack sensitivity , although they lack comparability across conditions . This study aim ed to develop an algorithm for estimating utilities from the short bowel syndrome health-related quality of life scale ( SBS-QoL ™ ) . Methods SBS-QoL ™ items were selected based on factor and item performance analysis of a European SBS-QoL ™ data set and consultation with 3 SBS clinical experts . Six-dimension health states were developed using 8 SBS-QoL ™ items ( 2 dimensions combined 2 SBS-QoL ™ items ) . SBS health states were valued by a UK general population sample ( N = 250 ) using the lead-time time trade-off method . Preference weights or ‘ utility decrements ’ for each severity level of each dimension were estimated by regression models and used to develop the scoring algorithm . Results Mean utilities for the SBS health states ranged from −0.46 ( worst health state , very much affected on all dimensions ) to 0.92 ( best health state , not at all affected on all dimensions ) . The r and om effects model with maximum likelihood estimation regression had the best predictive ability and lowest root mean squared error and mean absolute error , and was used to develop the scoring algorithm . Conclusions The preference-weighted scoring algorithm for the SBS-QoL ™ developed is able to estimate a wide range of utility values from patient-level SBS-QoL ™ data . This allows estimation of SBS HRQL impact for the purpose of economic evaluation of SBS treatment benefits Background Identifying ways to promote physical activity and decrease sedentary time during childhood is a key public health issue . Research on the putative influences on preschool children ’s  physical activity ( PA ) and  sedentary behavior  ( SB ) is limited and has yielded inconsistent results . Our aim was to identify correlates of PA and SB in preschool children . Methods Cross-sectional data were drawn from the Swiss Preschoolers ’ Health Study ( SPLASHY ) , a Swiss population -based cohort study . Of 476 two to six year old children , 394 ( 54 % boys ) had valid PA data assessed by accelerometry .  Information on exposure data was directly measured or extracted from parental question naires . Multilevel linear regression modeling was used to separately assess associations between 35 potential correlates and  total PA ( TPA ) , moderate-to-vigorous PA ( MVPA ) and SB . Results In total , 12 correlates from different domains were identified . TPA and MVPA were greater in boys than girls , increased with age and were positively associated with gross motor skills . Children from single parent families had a higher level of TPA and spent less time sedentary than those living with two parents . Time spent outdoors was positively associated with TPA and negatively with SB . The child ’s activity temperament was related all three outcomes , whereas parental sports club membership , living area per person and neighborhood safety were associated with SB only . Fixed and r and om factors in the final models accounted for 28 % , 32 % and 22 % of the total variance in TPA , MVPA and SB , respectively . Variance decomposition revealed that age , sex and activity temperament were the most influential correlates of both , TPA and MVPA , whereas the child ’s activity temperament , time outdoors and neighborhood safety were identified as the most important correlates of SB . Conclusions A multidimensional set of correlates of young children ’s  activity behavior has been identified . Personal factors had the greatest influence on PA , whereas environmental-level factors had the greatest influence on SB . Moreover , we identified a number of previously unreported , potentially modifiable correlates of young children ’s PA and SB . These factors could serve to define target groups or become valuable targets for change in future interventions .Trial registration Current Controlled Trials IS RCT N41045021 ( date of registration : 21.03.14 ) OBJECTIVES The purpose of this study was to examine the convergent validity of the Actical and activPAL to measure  sedentary behaviour ( SB ) and non-SB in preschoolers in a free-living environment . DESIGN A convenience sample of 49 preschoolers ( 22 boys ; 4.0 ± 0.5 years ) from six early childhood centres in Auckl and , New Zeal and were included in data analysis . METHODS Participants wore a hip-mounted Actical and a thigh-mounted activPAL accelerometer simultaneously during centre attendance for one day and data were collected in 15s epochs . Bl and -Altman tests were used to assess differences in group mean minutes and percentage of time in (non-)SB between both monitors . Agreement between binary coded ( SB vs. non-SB ) 15s-by-15s Actical and activPAL data was evaluated by calculating percentage agreement and κ statistic . RESULTS The monitors were worn on average for 294.8 ± 46.3 min result ing in a total of 57,780 15s epochs . Bl and -Altman tests suggested a small group mean difference in (non-)SB ( 1.3 min ; 0.1 % ) and a wide prediction interval ( 121.3 min ; 39.2 % ) . No obvious systematic bias was observed in the Bl and -Altman plot . Percentage agreement between the 15s-by-15s Actical and activPAL data of all participants was 73.0 % ( inter-child range : 36.8 - 93.8 % ) . The κ statistic showed moderate agreement with a value of 0.46 ( 95 % CI : 0.45 - 0.47 ) . CONCLUSIONS Although the group mean estimate of (non-)SB was similar between the Actical and activPAL , the output of both monitors can not be considered convergent as meaningful r and om disagreement was found between both monitors Background Patients with rheumatoid arthritis ( RA ) spend a high proportion of their waking time in sedentary behaviour ( SB ) and have an increased risk of cardiovascular disease . Reduction of SB and increase in light intensity physical activity has been suggested as a means of improvement of health in patients with mobility problems . Short-term intervention studies have demonstrated that SB can be reduced by behavioural interventions in sedentary population s. To evaluate descriptively the feasibility of recruitment , r and omisation , outcome assessment s , retention and the acceptability of an individually tailored , theory-based behavioural intervention targeting reduction in daily sitting time in patients with RA . Methods A r and omised , controlled trial with two parallel groups . RA patients > 18 years of age and Health Assessment Question naire ( HAQ ) score < 2.5 were consecutively invited and screened for daily leisure time sitting > 4 h. The 16-week intervention included 1 ) three individual motivational counselling sessions and 2 ) individual text message reminders aim ed at reducing daily sitting time . The control group was encouraged to maintain their usual lifestyles . Outcomes were assessed at baseline and after the 16 week intervention . Daily sitting time was measured using  an ActivPAL3TM activity monitor .  The study was not powered to show superiority ; rather the objective was to focus on acceptability among patients and clinical health professionals . Results In total , 107 patients were invited and screened before 20 met eligibility criteria and consented ; reasons for declining study participation were mostly flares , lack of time and co-morbidities . One patient from the control group dropped out before end of intervention ( due to a RA flare ) . Intervention participants completed all counselling sessions . All procedures regarding implementation of the trial protocol were feasible . The daily sitting time was reduced on average by 0.30 h in the intervention group unlike the control group that tended to increase it by 0.15 h after 16 weeks . Conclusions This study shows that an individually tailored behavioural intervention targeting reduction of SB was feasible and acceptable to patients with RA.Trial registration The Danish Data Protection Agency ( ref.nb . 711 - 1 - 08 - 20 March 2011 ) , the Ethics Committee of the Capital Region of Denmark ( ref.nb . H-2 - 2012 - 112- 17 October 2012 ) , clinical trials.gov ( NCT01969604 - October 17 2013 , retrospectively registered ) Purpose This study aims to provide recommendations on the optimal strategies and interventions for the prevention , screening , assessment , and management of  cancer-related sleep disturbance ( insomnia and insomnia syndrome ) in adult cancer population s. Methods A systematic search of the published health literature was conducted to identify r and omized controlled trials , clinical practice guidelines , systematic review s , and other guidance documents . The Sleep Disturbance Expert Panel [ comprised of nurses , psychologists , primary care physicians , oncologists , physicians specialized in sleep disturbances , research ers , and guideline method ologists ] review ed , discussed , and approved the final version of the guideline . Health care professionals across Canada were asked to provide feedback through an external review process . Results Three clinical practice guidelines and 12 r and omized controlled trials were identified as the evidence base . Overall , despite the paucity of evidence , the evidence and expert consensus suggest that it is important to screen and assess adult cancer patients for sleep disturbances using st and ardized screening tools on a routine basis . While prevention of sleep disturbance is the desired objective , cognitive behavioral therapies are effective in improving sleep outcomes . As part of the external review with 16 health care providers , 81 % indicated that they agreed with the recommendations as written . Conclusions Sleep difficulty is a prevalent problem in cancer population s that needs greater recognition by health professionals . Prevention , screening , assessment , and treatment strategies supported by the best available evidence are critical . Recommendations and care path algorithms for practice are offered Background No school-based physical activity ( PA ) interventions among older adolescents have demonstrated long-term effectiveness , and few of them so far have addressed sedentary behaviour ( SB ) . Based on behavioural theories and evidence , we design ed a multi-level intervention to increase  PA  and decrease SB  among vocational school students . This study investigates feasibility and acceptability of two main intervention components and research procedures . We also examine uptake of behaviour change techniques ( BCTs ) by the participants . Methods Design was an outcome assessor blinded , cluster-r and omised controlled trial . Four classes of students ( matched pairs ) were r and omised into one intervention and one control arm . The intervention consisted of ( 1 ) a 6-h group-based intervention for students , ( 2 ) two 2-h training workshops to reduce their students ’ sitting in class for teachers , and ( 3 ) provision of light PA equipment in classrooms . At baseline ( T1 ) , mid-intervention ( T2 ) at 3 weeks , post-intervention ( T3 ) and 6 months after baseline ( T4 ) we measured hypothesised psychosocial mediators and self-reported PA and sitting . Objective assessment of PA and SB ( 7-day accelerometry ) was conducted at T1 , T3 and T4 . Body composition ( bioimpedance ) was measured at T1 and T4 . Students and teachers in the intervention arm filled in acceptability question naires at T3 . Results  Recruitment rate was 64 % ( students ) and 88.9 % ( teachers ) , and at T3 , all post-intervention measurements were completed by 33 students ( retention 76.7 % ) and 15 teachers ( retention 93.8 % ) .  Acceptability ratings of sessions were high ( students M = 6.29 , scale 1–7 ) , and data collection procedures were feasible . Intervention arm students reported increased use of BCTs , but uptake of some key BCTs was suboptimal . BCT use correlated highly with objective measures of PA . Based on both self-report and student evaluation , teachers in the intervention arm increased the use of sitting reduction strategies  at post-intervention and T4 follow-up ( p < .05 ) . Conclusions We detected willingness of the target groups to participate , good response rates to question naires , adequate retention , as well as acceptability of the trial protocol . Investigation of BCT use among students helped further enhance intervention procedures to promote BCT use . After making necessary modifications identified , intervention effectiveness can next be tested in a definitive trial . Trial registration IS RCT N34534846 . Registered 23 May 2014 . Retrospectively registered The senior author systematic ally began collecting preoperative and postoperative data on all the total hip arthroplasties he performed starting in July 1970 . The data collected represent a 26-year experience using practice surveillance ( preoperative and regular interval postoperative collection and analysis of outcomes ) as a method to document the outcome of the total hip arthroplasty procedure and as a method to evaluate the need for changes in the procedure . As the senior author made few selected changes in the operative procedure during the followup period , the primary author has been able to evaluate the change in outcome based on these changes . The six studies reported in the current study show the durability of the long-term results of cemented total hip arthroplasty , the improvement in radiographic reproducibility obtained on the femoral side of the construct with improved cementing techniques , the deleterious effects of using cable to reattach the greater trochanter , the deleterious effects of changing femoral component design that included a change in surface finish , the improvement in acetabular fixation using cementless fixation , and the optimization of bearing surface wear using smaller diameter femoral heads . All of these findings have been incorporated into the primary surgeon 's practice based on this practice surveillance . As shown , practice surveillance also has provided a tool for performing clinical research . Although practice surveillance of controlled cohorts never will supplant prospect i ve r and omized clinical trials in evidence based medicine , it should help each surgeon with his or her own practice and can be used as an important research tool to study the optimization of outcomes of a surgical procedure Introduction Large proportions of the population are not meeting recommended levels of physical activity and have increasingly sedentary lifestyles . Low levels of physical activity are predictive of poor health outcomes and time spent sedentary is related to a host of risk factors independently of physical activity levels . Building an evidence base of the best approaches to intervene in the lifestyles of inactive individuals is crucial in preventing long-term disease , disability and higher mortality rates . Methods and analysis Systematic search es will be conducted on all relevant data bases ( eg , PubMed , Scopus , CINAHL , PsycINFO ) . Studies will be included if they assess interventions aim ed at changing physical activity or sedentary behaviour levels in adults ( over 18 ) who are inactive and do not suffer from chronic conditions . Studies must also be r and omised controlled trials ( RCTs ) , have a primary outcome of physical activity or sedentary behaviour , and measure outcomes at least 6 months after intervention completion . Studies will be coded using the Behaviour Change Technique ( BCT ) taxonomy v1 and Template for Intervention Description and Replication ( TIDieR ) guidelines . 2 review ers will independently screen full-text articles and extract data on study characteristics , participants , BCTs , intervention features and outcome measures . Study quality will also be assessed independently by 2 review ers using the Cochrane risk of bias tool . A meta- analysis will be considered if there is sufficient homogeneity across outcomes . GRADE criteria will be used to assess quality of evidence . Dissemination This will be the first review to systematic ally appraise interventions aim ed at changing the physical activity or sedentary behaviour of inactive individuals using RCT design s with a 6-month follow-up post-intervention . This review will better inform intervention design ers targeting inactive population s and inform the design of a future complex intervention . Review registration number This protocol was registered with the International Prospect i ve Register of Systematic Review s ( PROSPERO ) on 17 October 2014 ( registration number : CRD42014014321 )
Assessing SB as a sum of behaviours and using a previous day recall were the most promising features of existing tools .
Accuracy was poor for all existing tools , with underestimation and overestimation of SB .
There was a lack of evidence about sensitivity to change .
OBJECTIVE Sedentary behaviour ( SB ) has distinct deleterious health outcomes , yet there is no consensus on best practice for measurement .
This study aim ed to identify the optimal self-report tool for population surveillance of SB , using a systematic framework .