1. 久坐行为的健康风险与现代生活方式困境
1.1 久坐行为的流行病学特征与全球负担
久坐行为已成为21世纪全球普遍存在的公共卫生问题，其流行程度堪比一场“流行病”1。随着科技进步和生活方式的改变，现代人每天长时间保持坐姿，无论是工作、通勤还是休闲娱乐，都显著增加了久坐时间23。例如，办公室工作者、司机、以及长时间使用电脑和观看屏幕的人群，其日均久坐时长远超过去。全球范围内，体力活动不足是导致死亡的第四大原因，而久坐行为，作为一种独立的健康风险因素，即使在达到推荐体力活动量的人群中，仍可能损害代谢健康24。
数据显示，全球约有三分之一的人口处于不活跃状态，这使得久坐成为一个重大的公共卫生挑战1。一项Meta分析显示，在肥胖成年人中，久坐行为的综合患病率高达31%（95% CI: 23-41%）5。在许多社会中，超过40%的成年人口以及越来越多的儿童，其体力活动不足以维持健康，这导致心血管疾病、肥胖等不良健康结局的发生率不断上升6。久坐行为的普遍性及其对健康的负面影响，使其被视为心血管疾病和全因死亡率的主要可改变风险因素之一7。研究表明，长时间久坐与多种慢性疾病的风险增加密切相关，包括结肠癌、子宫内膜癌和肺癌等28，以及糖尿病、心血管疾病和肥胖等139。此外，久坐行为还会增加牙周疾病的发生几率10，并与睡眠障碍之间存在关联，炎症生物标志物在此关联中发挥中介作用11。对于癌症幸存者而言，长时间久坐（≥6小时/天）与维生素D缺乏症并存时，全因死亡率和癌症特异性死亡率的风险显著升高12。这些证据共同强调了久坐行为作为现代社会一个严峻健康挑战的地位。
1.2 久坐对代谢与体成分的负面影响机制
久坐行为对人体代谢和体成分的负面影响是多方面的，其核心机制涉及肌肉活动减少、胰岛素抵抗以及脂肪代谢紊乱，最终导致血糖波动、内脏脂肪堆积和心血管疾病风险的升高。长时间的坐姿使下肢和核心肌群长期处于非活动状态 13。骨骼肌是体内葡萄糖的主要消耗者，其收缩活动对维持血糖稳态至关重要。当肌肉长时间不活动时，骨骼肌中的脂蛋白脂肪酶（LPL）活性会降低，这种酶负责水解血液中的甘油三酯，供肌肉吸收利用。LPL活性的降低导致血脂清除率下降，促进甘油三酯在肝脏和肌肉中的堆积，从而影响胰岛素信号传导。
更重要的是，肌肉活动减少直接影响葡萄糖转运蛋白4（GLUT4）的功能。GLUT4是一种位于肌肉和脂肪细胞膜上的葡萄糖转运蛋白，负责在胰岛素作用下将血糖从血液中转运到细胞内进行利用 14。在静息状态下，GLUT4主要存在于细胞内的储存囊泡中，当肌肉收缩或受到胰岛素刺激时，GLUT4会迅速转移到细胞膜表面，从而促进葡萄糖的摄取。然而，久坐行为导致肌肉缺乏收缩刺激，进而可能影响GLUT4转位到细胞膜的效率，即使胰岛素水平正常，细胞对葡萄糖的摄取能力也可能下降，从而引发胰岛素抵抗 13。胰岛素抵抗是2型糖尿病（T2D）和代谢综合征的核心特征之一，它会导致餐后血糖升高，并迫使胰腺分泌更多胰岛素以维持血糖平衡，长此以往将加重胰腺β细胞的负担，加速其功能衰竭 1516。
久坐还会导致脂肪代谢紊乱和内脏脂肪堆积。长时间的静止状态降低了整体能量消耗，使得多余的能量更容易以脂肪的形式储存起来，尤其是内脏脂肪 13。内脏脂肪被认为是代谢功能障碍的“活跃”组织，它能分泌多种促炎细胞因子和脂肪因子，进一步加剧全身炎症反应和胰岛素抵抗，形成恶性循环 17。此外，久坐行为还会影响下肢血液循环，可能导致血管内皮功能受损，增加心血管疾病的风险 1318。衰老过程中，肌肉质量的减少（肌少症）本身就会伴随脂肪浸润和纤维化，使得肌肉的代谢功能进一步受损 19202122。这些机制共同构成了久坐行为损害代谢健康和体成分的复杂网络，使得“久坐不动”成为现代生活方式中的一个隐形杀手 23。
1.3 传统运动干预的局限性与"低门槛"需求
尽管传统中高强度运动被广泛认为是改善健康和预防慢性疾病的有效手段，但其在久坐人群中的依从性和普及性面临诸多挑战。高强度运动往往要求个体投入较长时间、具备一定的体能基础，并可能伴随运动损伤的风险，这些因素共同构成了行为改变的障碍。对于许多久坐人群而言，缺乏时间、缺乏运动器械、环境限制以及缺乏动力是普遍存在的障碍 2425。例如，有研究指出，疼痛、疲劳和疾病的严重程度是纤维肌痛患者减少或中断久坐行为的主要障碍 26。此外，生活节奏快、工作压力大、以及时间碎片化等现代生活特征，使得很多人难以抽出完整的时间进行规律的传统运动。
在这种背景下，“碎片化短时活动”（或称“运动零食”，exercise snacks）作为一种低门槛、易于实施的替代策略应运而生。它旨在通过将短时、高效的身体活动融入日常生活中，以应对传统运动干预的依从性挑战 24。对于老年人而言，即使是短时间的阻力训练也能带来显著的健康益处，例如减少全因死亡率，这表明即使是“最小剂量”的运动也具有预防衰老的作用 27。这种方法尤其适合久坐人群，因为他们通常运动意愿较低，对长时间、高强度的运动存在心理抗拒。碎片化活动能够减少久坐时间，增加总体体力活动量，并有助于养成良好的运动习惯，而无需改变固有的生活或工作模式 24。
智能可穿戴设备和健康促进策略（如单向短信提醒）在提高运动依从性方面发挥了积极作用 2829。这些技术可以提醒用户进行短时活动，提供即时反馈，从而降低了运动的“门槛”。研究表明，这种低强度的碎片化干预在健康成年人、超重/肥胖者以及糖尿病患者中均显示出积极效果，有助于降低血糖并改善心肺功能 24。例如，在老年患者中，为每个个体量身定制运动方案，并考虑到其偏好和局限性，不仅能有效控制血糖，还能提高独立性、自尊心和生活质量 30。因此，碎片化短时活动提供了一个更具可行性和可持续性的路径，以应对久坐行为带来的健康挑战，并改善那些难以坚持传统运动模式人群的代谢健康和体成分。
2. 短时站立干预的核心模式与生理响应
2.1 "每坐20分钟站2分钟"的科学依据与剂量效应
“每坐20分钟站2分钟”作为一种推荐的短时站立干预模式，并非随意设定，而是基于对人体生理学，尤其是代谢响应和肌肉活动特征的深入理解。其科学依据主要体现在对血糖波动周期的有效中断、对肌肉失活阈值的靶向干预以及对能量消耗的累积贡献。
现有研究探索了多种站立频率和时长组合对代谢指标的影响。例如，一项针对绝经后超重或肥胖女性的试点研究比较了三种中断久坐策略的急性效果：a) 每20分钟站立2分钟；b) 每小时步行2分钟；c) 每小时站立10分钟。结果显示，尽管所有干预都具有一定的血糖调节和血管益处，但“每20分钟站立2分钟”和“每小时步行2分钟”这两种模式与第二餐（午餐）后的较低血糖响应显著相关，表明更频繁的中断可能对餐后血糖控制更为有效 31。另一项研究则发现，每小时进行15-30秒的爬楼梯等“运动零食”可以显著降低胰岛素抵抗人群的胰岛素曲线下面积（AUC），达到16.5%的降幅，这提示即使是极短时间的活动也能产生积极的代谢效应。
“每坐20分钟站2分钟”模式的优化依据主要有以下几点：
首先，血糖波动周期：餐后血糖通常在30-60分钟内达到峰值，并在2-3小时内逐渐恢复基线。长时间久坐会导致餐后血糖持续升高，增加胰岛素抵抗的风险。通过每20分钟站立2分钟，可以在血糖开始升高之前或早期进行干预，有效打断血糖持续升高的趋势，降低血糖峰值，并减少整体血糖波动幅度。频繁的短时活动有助于维持血糖稳定，避免剧烈波动，这对于糖尿病前期和2型糖尿病患者尤为重要，因为短期的血糖波动与认知功能障碍的风险增加相关 32。
其次，肌肉失活阈值：研究表明，长时间静坐会导致下肢肌肉（特别是腓肠肌、股四头肌）的电生理活动显著降低，进而影响其对葡萄糖的摄取和利用能力。例如卧床休息等严重的非活动状态会导致肌肉质量和功能的快速丧失，而肌肉蛋白合成率在长时间不活动后会下降 33。每20分钟进行2分钟的站立，足以重新激活这些肌肉群，即使是低强度的肌肉收缩，也能刺激葡萄糖转运蛋白（如GLUT4）的活性，促进血糖进入肌肉细胞，从而改善胰岛素敏感性。这种模式能够有效避免肌肉长时间处于完全失活状态，维持其基础代谢功能。
最后，行为依从性与可持续性：2分钟的站立时间较短，对工作或学习的干扰小，易于融入日常工作流中，降低了实施的心理和时间门槛。相比于要求更长时间或更高强度的活动，这种“小剂量”的干预更容易被久坐人群接受并长期坚持。频繁但短暂的站立间隔，也符合人们在长时间专注工作后短暂休息的习惯，使其更具可行性。
综合来看，“每坐20分钟站2分钟”的干预模式通过精准靶向血糖波动周期和肌肉失活阈值，以低门槛、高依从性的方式，对久坐人群的代谢健康产生了积极的急性干预效果，为改善长期健康状况奠定了基础。
2.2 短时站立对肌肉微活动的激活作用
短时站立干预之所以能有效改善久坐人群的代谢健康，一个关键机制在于其对下肢肌肉微活动的激活作用。虽然站立不像行走或跑步那样涉及剧烈的肌肉收缩，但它要求下肢和躯干肌肉持续进行低强度活动，以维持身体姿态和平衡 343536。这些看似微不足道的肌肉活动，却对局部血流、脂肪酸氧化以及胰岛素敏感性产生显著的积极影响。
当人体从坐姿转为站立时，下肢肌肉，特别是小腿的腓肠肌和比目鱼肌，以及大腿的股四头肌，会立刻被激活以对抗重力，维持身体直立 343637。肌电信号（EMG）研究清晰地揭示了这种肌肉活动模式的变化。例如，与静坐相比，站立时，腓肠肌和胫骨前肌等维持姿态的肌肉的EMG活动度会显著升高 3437。这种持续的、低强度的肌肉收缩对于改善代谢健康至关重要：
首先，促进局部血流：肌肉收缩能够挤压血管，促进血液循环，增加局部血流量。血流的增加意味着氧气和营养物质（包括葡萄糖和脂肪酸）输送效率的提高，同时也有助于代谢废物的清除。对于久坐人群而言，站立能有效对抗下肢血流停滞，减少水肿和深静脉血栓的风险。
其次，增强脂肪酸氧化：骨骼肌是脂肪酸氧化的主要场所。即使是低强度的肌肉活动，也能刺激脂肪酸转运蛋白（如CD36）的表达和活性，促进脂肪酸进入线粒体进行氧化 38。研究表明，规律的肌肉活动可以提高肌肉的脂肪氧化能力，减少脂肪在肌肉和肝脏中的堆积 38。短时站立虽然能量消耗有限，但其累积效应能促进脂肪酸作为能量底物的利用，有助于改善血脂状况和减少异位脂肪沉积。
第三，提升胰岛素敏感性：肌肉收缩是独立于胰岛素之外，刺激葡萄糖转运蛋白GLUT4转位至细胞膜表面的重要途径 39。这意味着，即使在胰岛素抵抗的个体中，肌肉活动也能直接促进葡萄糖的摄取和利用。短时站立引起的下肢肌肉反复收缩，能够持续激活这一机制，从而提高肌肉对胰岛素的反应性，降低餐后血糖水平 3940。有研究发现，通过激活腰多裂肌等躯干核心肌肉，也可以改善身体姿态稳定性，尽管这些主要与核心稳定性相关，但间接提示全身肌肉微活动的协同作用对健康的重要性 4142。此外，当进行站立骑行等活动时，大腿肌肉（如股二头肌和臀大肌）的活动会增加，进一步说明下肢肌肉在站立活动中的重要性 43。
这些由短时站立诱导的肌肉微活动，共同构成了其改善代谢健康的生理学基础。它们不仅即时地影响血糖和血脂，长期坚持还能促进肌肉适应性改变，从而持续提升机体的代谢健康水平。
2.3 站立与静坐的代谢率差异及能量消耗
短时站立与静坐相比，能带来额外的能量消耗，尽管单次差异看似微小，但长期累积效应不容忽视，对于改善体成分，特别是腰围，具有潜在的积极影响。多项研究量化了站立相比于静坐所增加的能量消耗（Energy Expenditure, EE）。
一项系统回顾和荟萃分析综合了46项研究，涉及1184名参与者，结果显示，站立比静坐平均每分钟多消耗0.15 kcal能量（95% CI: 0.12-0.17）44。具体而言，女性每分钟多消耗0.1 kcal，男性则多消耗0.19 kcal44。这意味着，如果一个体重65公斤的人每天用站立取代静坐6小时，将额外消耗约54 kcal/天44。假设能量摄入不变，一年下来，这相当于减少了约2.5公斤的体脂量44。
另一项针对办公环境的研究发现，与持续静坐相比，持续站立每小时可额外消耗约8.2 kcal（增加11.5%），而坐站交替（30分钟站立，30分钟静坐）则每小时额外消耗5.5 kcal（增加7.8%）45。如果按照推荐的每天站立4小时计算，一个体重88.9公斤的男性每天可额外消耗56.9 kcal，一个体重75.5公斤的女性每天可额外消耗48.3 kcal45。
近期研究也进一步证实了餐后站立对能量消耗的影响。一项针对健康男性的研究表明，餐后站立2小时比静坐状态下每分钟平均多消耗0.16 ± 0.08 kcal的能量，即在2小时内额外消耗约10.7 ± 4.6%的能量，且不会影响血糖代谢46。
值得注意的是，不同个体间站立的能量消耗存在差异，部分研究发现，约69%的个体在站立时的能量消耗与静坐相比无显著增加（低于5%），被称为“能量节约者”（energy savers），且这种现象在不同族裔的男性队列中均观察到47。这提示了个体差异的存在，可能与肌肉活动模式、身体构成等因素有关。然而，对于大多数人而言，站立仍然能够提供额外的能量消耗。
与散步等传统活动相比，短时站立的能量消耗效率较低。例如，中等强度的散步每分钟可能消耗3-5 kcal甚至更高，远超站立的0.15 kcal/min。然而，短时站立的优势在于其极低的门槛和高度的可持续性。它不要求特定的场地、装备或大幅度的身体移动，可以在办公室、家庭等日常环境中轻松实施，对工作或生活的干扰极小。这种“积少成多”的策略，使得难以进行传统运动的久坐人群也能通过这种“懒人运动法”累积可观的能量消耗，从而长期有助于控制体重，减少内脏脂肪堆积，进而“腰细了”成为可能。
此外，站立时的心率也会相应增加。例如，从静坐到站立，心率平均会增加约13次/分钟48，这进一步反映了站立对循环系统和代谢的轻微刺激作用。尽管这种刺激远低于中等强度运动，但其持续性和低门槛特性，使其成为对抗久坐行为、促进整体健康的重要补充手段。
3. 短时站立对血糖稳态的调控作用
3.1 对餐后血糖与胰岛素反应的急性改善
短时站立干预已被证实能有效改善久坐人群的餐后血糖和胰岛素反应，即刻缓解由长时间静坐引起的代谢负荷。多项随机对照试验（Randomized Controlled Trials, RCTs）均指出，通过频繁的站立或低强度活动来打断长时间久坐，能够显著缩短血糖峰值持续时间，降低餐后血糖水平，并减少胰岛素需求。
一项针对超重/肥胖成年人的研究发现，每小时进行8次、每次15-30秒的爬楼梯等“运动零食”可以显著降低餐后胰岛素水平。与持续久坐9小时相比，这种短时活动干预使总胰岛素曲线下面积（Insulin Area Under the Curve, AUC）降低了16.5%（P = 0.036），同时非酯化脂肪酸（NEFA）AUC也降低了21%（P = 0.016）49。这表明，即使是极短时间的高强度间歇性活动，也能对胰岛素敏感性和脂肪代谢产生即时积极影响。
另一项系统评价和荟萃分析综合了7项急性、单日随机交叉试验，主要针对超重或肥胖的成年人。结果显示，与长时间持续静坐相比，短时站立干预显著降低了餐后血糖（∆ = -0.31, 95% CI -0.60, -0.03; z = -2.15, p < 0.04），但对胰岛素或收缩压无显著影响。然而，轻度步行干预则对餐后血糖（∆ = -0.72）和胰岛素（∆ = -0.83）均有显著的降低作用，且优于单纯站立50。尽管轻度步行效果更佳，但短时站立作为一种更低门槛的干预手段，其对血糖的急性改善作用仍具有重要的临床意义。
有研究比较了长时间静坐、长时间站立以及每30分钟进行2分钟步行（时速5公里，10%坡度）中断静坐对血管功能和餐后葡萄糖及胰岛素反应的影响。结果显示，与持续静坐相比，规律的活动中断（2分钟步行）使胰岛素增量曲线下面积（iAUC）显著降低28%（P = 0.001），甚至比持续站立组降低19%（P = 0.015）51。这进一步证实了频繁短时活动对餐后胰岛素反应的积极影响。
值得注意的是，不同的研究模式和受试人群对短时站立的反应可能存在差异。例如，一项针对超重/肥胖办公室工作人员的研究发现，每30分钟进行坐站交替可使餐后葡萄糖增量曲线下面积降低11.1%（P = 0.007），但对胰岛素和甘油三酯无显著影响52。而一项针对年轻健康大学生的研究则发现，每30分钟进行坐站交替并未显著改善餐后血糖或胰岛素反应53。这提示了短时站立干预效果可能与个体健康状况（如是否存在胰岛素抵抗、超重/肥胖）以及具体的活动模式（站立、轻度步行、短时爬楼梯等）有关。
总体而言，短时站立，尤其是结合轻度活动的短时中断，通过激活肌肉、促进葡萄糖摄取，能够有效减缓餐后血糖升高速度，降低血糖峰值，并减少对胰岛素的需求，从而在急性层面上改善久坐人群的血糖稳态。
3.2 对胰岛素抵抗的长期干预效果
除了急性的餐后血糖改善，规律性的短时站立干预也被证明对胰岛素抵抗具有长期的积极影响，尤其是在代谢综合征患者等高风险人群中。多项持续6个月以上的追踪研究为这一结论提供了支持，主要通过评估稳态模型评估的胰岛素抵抗指数（HOMA-IR）、糖化血红蛋白（HbA1c）以及代谢综合征发生率等指标。
一项针对代谢综合征患者进行的长期随机对照试验（RCT）表明，持续减少久坐时间，即使不包含正式的运动，也能在一定程度上改善心血管代谢风险因素。在这项研究中，干预组通过增加站立和非运动性体力活动，成功地将每日久坐时间减少了约41分钟。尽管3个月时，干预组和对照组在空腹胰岛素、胰岛素抵抗指数（HOMA-IR）以及糖化血红蛋白（HbA1c）等指标上未显示出显著差异，但成功减少久坐时间的个体（每日至少减少30分钟）在胰岛素刺激的代谢灵活性和低强度运动脂肪氧化方面有所改善，且这些改善与站立时间增加和胰岛素敏感性增强相关 54。当观察到6个月时，减少久坐行为能够降低空腹胰岛素水平，而成功减少久坐和体脂则对全身胰岛素敏感性产生有益影响 55。这意味着，虽然单纯的短时站立可能效果有限，但当与体脂减少等因素相结合时，其长期效益更为显著。
另一项为期3个月的随机对照试验也强调了减少久坐行为对代谢指标的积极作用。该研究将代谢综合征的久坐中年成年人随机分为干预组和对照组，干预组的目标是每日减少1小时久坐时间，通过增加站立和轻度体力活动来实现。结果显示，干预组平均每日减少了50分钟的久坐时间，并通过增加轻度（19分钟/天）和中度至剧烈（24分钟/天）体力活动实现。尽管站立时间增加不显著，但在空腹胰岛素、HOMA-IR指数和HbA1c方面，干预组均优于对照组。具体而言，干预组的空腹胰岛素（83.4 pmol/l vs. 102.0 pmol/l）、HOMA-IR（3.2 vs. 4.0）和HbA1c（37 mmol/mol vs. 38 mmol/mol）均显著低于对照组 56。这表明，将短时站立与轻度至中度体力活动相结合，能够产生更明确和持久的代谢改善效果。
此外，一项在代谢综合征成年人中的横断面研究发现，站立时间与胰岛素敏感性标志物存在关联。即使在调整了体脂百分比、体力活动和体能等因素后，站立与HOMA-IR和胰岛素水平之间的负相关仍然显著 57。这进一步支持了站立对改善胰岛素抵抗的独立作用。
值得注意的是，糖化血红蛋白（HbA1c）是衡量长期血糖控制情况的重要指标，通常反映过去2-3个月的平均血糖水平 58。上述研究中观察到HbA1c的下降，意味着规律性的短时站立或与轻度活动相结合的干预，能够稳定地改善整体血糖控制。对于糖尿病前期或代谢综合征患者而言，这种长期效果尤其重要，因为它有助于延缓或预防2型糖尿病的发生，并降低其他心血管代谢疾病的风险。
尽管目前的长期研究多集中于减少久坐总时长而非单一的“每坐20分钟站2分钟”模式，但这些证据强烈暗示，将短时站立作为减少久坐总时长策略的一部分，对改善胰岛素抵抗和降低代谢综合征发生率具有累积的、长期的益处。未来的研究可以进一步细化，直接评估特定短时站立模式的长期效果。
3.3 不同人群的效果异质性
短时站立干预对血糖稳态的调控作用在不同人群中表现出异质性，其效果显著性与个体基线健康状况，特别是胰岛素敏感性密切相关。研究表明，对于健康人群，尤其是健康的年轻个体，短时站立可能不会带来显著的血糖改善，因为他们原本就具有较好的胰岛素敏感性和葡萄糖稳态调节能力。例如，一项针对年轻健康大学生（平均年龄21.4岁，BMI 22.8 kg/m²）的研究发现，每30分钟坐站交替并未显著改善餐后血糖或胰岛素反应。这可能归因于这些个体已经拥有高效的胰岛素介导的葡萄糖摄取能力，额外的低强度活动对其血糖代谢的边际效应较小。
然而，对于超重/肥胖者、糖尿病前期人群以及已存在胰岛素抵抗的个体（如腰围超标者），短时站立干预的效果则更为显著。这些人群通常伴有不同程度的胰岛素敏感性下降，骨骼肌对胰岛素的反应性较差，餐后血糖波动幅度较大。研究发现，在超重或肥胖成年人中，间歇性地中断久坐行为能够显著降低餐后血糖反应 50。一项汇总分析更是指出，长时间不间断久坐引起的餐后高血糖反应程度，与个体基线的胰岛素抵抗程度呈正相关。这意味着，那些空腹血糖、胰岛素水平较高或胰岛素抵抗指数（HOMA-IR）较差的个体，从规律性中断久坐中获得的代谢益处更大 59。
这种效果异质性的生理学机制主要在于：
- 基线胰岛素敏感性差异：在胰岛素敏感性受损的个体中，骨骼肌细胞内的葡萄糖转运蛋白GLUT4对胰岛素的反应不敏感，导致餐后血糖升高。短时站立诱导的肌肉收缩，能够以非胰岛素依赖的方式促进GLUT4从细胞内膜泡向细胞膜的转位，从而增加肌肉对葡萄糖的摄取。对于胰岛素抵抗个体，这种非胰岛素依赖的葡萄糖摄取途径的激活显得尤为重要，能够有效弥补胰岛素作用的不足，降低餐后血糖峰值和整体血糖负荷。
- 血糖波动幅度与风险：胰岛素抵抗个体在餐后往往经历更剧烈的血糖波动，这不仅增加了胰腺β细胞的负担，也与血管内皮损伤、氧化应激和炎症反应加剧有关。短时站立通过频繁地“削峰填谷”，平缓了餐后血糖曲线，降低了血糖毒性对机体的损害。
- 内脏脂肪与代谢风险：腰围超标往往是内脏脂肪堆积的直接体现，而内脏脂肪与全身性胰岛素抵抗和代谢综合征高度相关。这些个体从短时站立中获得的益处可能更为明显，因为站立本身也能促进下肢肌肉的微循环和脂肪酸氧化，长期有助于改善体成分和内脏脂肪分布，进而间接提升胰岛素敏感性。
例如，一项针对老年南亚裔和白人欧洲裔的急性研究发现，用短时轻度步行（而非单纯站立）打断长时间久坐，能显著改善老年人的餐后胰岛素、葡萄糖和血压，其中南亚裔在餐后胰岛素的降低方面更为显著 60。这提示即使是站立的“升级版”——轻度步行，其效果也受到种族和年龄等因素的影响。另一项对糖尿病前期成年人的研究也明确指出，频繁的短时站立干预（高频低时站立），相比于低频高时站立，能更有效地降低餐后血糖水平，这再次强调了对高危人群的精细化干预策略 61。
因此，在推广短时站立干预时，应重点关注超重/肥胖、糖尿病前期及已有胰岛素抵抗的个体，他们是该干预措施的最大受益者。
4. 短时站立对体成分与腰围的调节机制
4.1 内脏脂肪与皮下脂肪的选择性减少
短时站立干预对于体成分的积极调节，尤其体现在内脏脂肪和皮下脂肪的选择性减少上，这对于改善整体代谢健康和降低心血管疾病风险至关重要。内脏脂肪（Visceral Adipose Tissue, VAT）深藏于腹腔内，围绕着重要器官，被认为是代谢功能障碍的“活跃”组织，其堆积与胰岛素抵抗、2型糖尿病、高血压和血脂异常密切相关。皮下脂肪（Subcutaneous Adipose Tissue, SAT）则位于皮肤下方，相对而言对代谢健康的负面影响较小，但过量的堆积仍会影响美观和健康。
影像学研究，如计算机断层扫描（CT）和磁共振成像（MRI），是精确测量体内脂肪分布的金标准。通过这些技术，研究者们能够观察到短时站立干预对不同脂肪组织量的影响。尽管关于短时站立直接通过影像学手段证明选择性减少内脏脂肪的研究仍在积累中，但间接证据和相关机制研究已经提供了强有力的支持。
短时站立促进内脏脂肪减少的可能机制包括：
- 脂解酶活性提升：脂蛋白脂酶（Lipoprotein Lipase, LPL）是一种关键酶，负责水解血液中的甘油三酯，使其被组织吸收。肌肉活动，即使是低强度的站立，也能刺激LPL的活性，特别是骨骼肌LPL。当LPL活性提高时，脂肪酸在肌肉中被更有效地利用，减少了其在脂肪组织中的储存。有研究指出，持续的肌肉活动能够增加LPL活性，这有助于减少脂肪堆积。尽管这些研究多集中于中等强度运动，但低强度、频繁的肌肉收缩（如站立）同样能对LPL活性产生累积效应。
- 改善脂肪组织血流：脂肪组织，特别是内脏脂肪，其血流状况对脂肪代谢至关重要。良好的血流供应能够促进脂肪酸的动员和氧化，并有助于清除代谢废物。短时站立通过增加下肢肌肉的微活动，间接促进全身血液循环，也可能改善内脏脂肪和皮下脂肪的血流灌注。有研究显示，在不同体位下，如站立，皮下脂肪组织的血流会发生变化 62。这种血流的改善可能有助于脂肪细胞释放脂肪酸，并运送到肌肉等组织进行氧化消耗，从而减少脂肪堆积。
- 慢性炎症反应的缓解：内脏脂肪过度堆积与慢性低度炎症密切相关，炎症因子会进一步加剧胰岛素抵抗和脂代谢紊乱。规律的短时站立，通过改善代谢健康，可能有助于缓解全身性炎症反应，从而间接促进内脏脂肪的减少。
- 能量消耗的累积效应：如前所述，短时站立虽然单次能量消耗较小，但长期累积可产生可观的额外能量消耗。当总能量摄入不变时，这种额外的能量消耗会促使身体动用储存的脂肪，尤其是内脏脂肪，作为能量来源。
关于皮下脂肪的减少，虽然短时站立对其影响可能不如对内脏脂肪那样显著和优先，但长期的能量负平衡和全身代谢改善，也会逐步影响皮下脂肪的储存。一些抗肥胖药物，如胰高血糖素样肽1受体激动剂（GLP-1RA），在促进体重减轻的同时，也能显著减少皮下脂肪 6364。虽然短时站立的机制不同于药物，但其通过提高代谢效率、增加能量消耗，间接对皮下脂肪产生影响。
综合来看，短时站立干预通过多方面机制，包括提升脂解酶活性、改善脂肪组织血流、缓解炎症以及累积能量消耗等，有望选择性地减少内脏脂肪，同时对皮下脂肪产生积极影响。这不仅有助于“腰细了”的体型改善，更重要的是从根本上提升代谢健康水平。
4.2 腰围变化与肌肉-脂肪交互作用
短时站立干预之所以能带来“腰细了”的直观改变，不仅与内脏脂肪的选择性减少有关，更与下肢肌肉活动对腰腹核心肌群的间接刺激以及腰围与内脏脂肪之间紧密的交互作用机制密不可分。腰围是衡量腹部脂肪堆积，特别是内脏脂肪量的重要指标，其增加被公认为心血管疾病、代谢综合征和多种慢性疾病的独立风险因素 656667。
当人体从坐姿转换为站立姿态时，为了维持身体的平衡和直立，躯干的核心肌群，包括腹肌、背肌以及骨盆周围的深层肌肉，会自然而然地被激活。虽然这种激活强度低于有意识的核心力量训练，但它是一种持续性的低强度等长收缩，旨在稳定脊柱和骨盆，抵抗重力对身体姿态的影响。核心肌群在平衡和姿态控制中扮演着重要角色，其训练被证实能够改善平衡能力和下肢功能 6869。这种核心肌群的“微活动”在长时间内累积，能够起到锻炼腰腹部肌肉的效果，有助于增强核心力量和稳定性。例如，研究表明，核心稳定性训练能够改善平衡能力和下肢功能 70，并与动态膝外翻等下肢生物力学特征相关 7172，这间接说明了核心肌群在维持身体姿态中的重要性。
腰围与内脏脂肪之间存在显著的强相关性。内脏脂肪的堆积直接导致腰围的增加，因为它们都位于腹腔内部。多项研究证实，腰围是预测内脏脂肪含量和评估代谢风险的有效指标 656667。因此，任何能有效减少内脏脂肪的干预措施，都将直接体现在腰围的缩小上。短时站立通过前述的能量消耗累积、脂解酶活性提升和脂肪代谢改善等机制，促进了内脏脂肪的减少，这自然会导致腰围的同步缩小。
此外，肌肉与脂肪的交互作用也在此过程中发挥着关键作用。增强的核心肌群可以更好地支撑腹腔，改善腹壁的张力，从而在视觉上和测量上都显得腰部更紧致。同时，肌肉组织的增加（即使是低强度的激活），有助于提高基础代谢率，进一步促进脂肪的消耗。尽管短时站立的肌肉激活程度不足以显著增加肌肉体积，但肌肉功能和体成分的优化是多种干预措施共同作用的结果 7374，其对肌肉功能的维持和改善，特别是对“低负荷持续活动”适应性的提高，对于优化肌肉-脂肪比例具有长期益处。
综上所述，“腰细了”是短时站立干预多重生理机制共同作用的结果：它通过促进内脏脂肪的减少来直接缩小腰围，同时通过持续刺激腰腹核心肌群来改善腹部形态和支撑力，最终实现体成分的优化。
4.3 长期干预对体质量指数（BMI）的影响
短时站立干预对体质量指数（BMI）的影响，尤其是在长期（12周以上）干预中，是评估其对体成分整体效益的重要维度。BMI作为衡量体重状况的常用指标，其变化反映了身体脂肪和肌肉质量的综合改变。研究显示，短时站立单独或联合其他生活方式干预，能够对BMI产生积极影响，但其效果强度和作用机制与单纯减少久坐或增加中等强度运动存在差异。
多项12周及以上的干预研究表明，持续减少久坐行为，即使是低强度的短时站立，也能在一定程度上影响BMI。例如，一项为期12个月的集群随机对照试验，旨在评估一项名为“SMART Work and Life (SWAL)”的干预措施对办公室工作人员的影响，该干预措施包括行为改变策略，部分组别还配备了可调节高度的办公桌（SWAL plus desk）。结果显示，与对照组相比，SWAL加办公桌组在12个月时日常久坐时间显著减少了63.7分钟/天（95% CI -80.1至-47.4分钟/天，P<0.001）。尽管该研究主要关注坐立时间变化，但其报告了对身体成分和健康结局的有利影响，提示了久坐时间减少对BMI可能产生的间接益处75。另一项为期8个月的对儿童的干预研究也发现，使用可调节高度的书桌和教学策略以减少和打断课堂坐姿，能积极改变儿童的课堂坐姿模式，尽管对身体测量指标（如BMI和腰围）没有显著影响，但这可能是因为儿童的生长发育特性以及样本量和干预时间的限制76。
然而，单纯依靠短时站立来显著降低BMI，尤其是对于已经超重或肥胖的个体，可能不如结合了饮食控制或中等强度运动的干预效果明显。短时站立的能量消耗相对较低（如前所述，每小时额外消耗5-10大卡），这意味着其对BMI的直接影响更多体现在长期累积的能量负平衡上，而非短期内的快速减重。例如，一项研究指出，为了达到与每日30分钟中等强度运动（如快走）相似的能量消耗，可能需要更长时间的站立或更频繁地进行站立活动。中等强度运动能够显著提高心率和能量代谢，从而更有效地消耗卡路里和脂肪。
当短时站立与饮食控制相结合时，其对BMI的改善效果会显著增强。饮食是能量摄入的主要来源，通过控制总热量摄入、优化膳食结构，结合短时站立带来的额外能量消耗，能够更容易实现能量负平衡，从而促进体重的减轻和BMI的降低。这种多模式干预能够协同作用，达到更好的减重效果。
对比单纯减少久坐与增加中等强度运动的效果：
- 减少久坐（含短时站立）：主要通过增加基础能量消耗、改善胰岛素敏感性、减少内脏脂肪堆积来发挥作用。其优势在于依从性高，易于融入日常生活，对工作和学习干扰小，尤其适合难以进行高强度运动的人群。但其对BMI的直接影响可能较为温和，需要长期坚持才能看到显著效果。
- 增加中等强度运动：能够显著提高能量消耗、增强心肺功能、增加肌肉量。其对BMI的降低效果通常更为迅速和显著。然而，传统中等强度运动存在依从性挑战，需要更多的时间投入和较高的运动意愿。
值得注意的是，短时站立对于BMI的影响也可能受到个体差异、基线健康状况（如是否存在代谢综合征）、以及干预方案具体设计（如频率、时长、是否结合其他活动）的影响。对于久坐的办公人群，研究发现增加站立时间，但没有增加步数，可能会在短期内增加肌肉骨骼疼痛，但长期来看疼痛并未增加77。这提示我们在鼓励站立的同时，也应注意结合轻度活动，以实现最佳的健康效益。
总的来说，短时站立作为一种低门槛的干预策略，能够通过累积能量消耗和改善代谢健康来影响BMI。虽然其单独效果可能不如中等强度运动显著，但作为减少久坐行为的重要组成部分，尤其在与饮食控制相结合时，能够为改善体成分和降低BMI提供一个可持续且有效的途径。
5. 短时站立与传统运动的效果对比及优势
5.1 对代谢指标的等效性或互补性
短时站立干预与每日中等强度散步等传统运动在改善代谢指标方面，并非简单的替代关系，而是呈现出等效性或互补性的特征。尽管两者在活动强度和能量消耗效率上存在差异，但大量研究表明，低强度的短时活动累积起来，同样能为健康带来可观的价值，尤其是在久坐行为普遍的现代社会中。
血糖控制方面的对比与互补性：
研究普遍认为，中等强度的散步（如每日30分钟快走）能够显著改善餐后血糖和胰岛素敏感性，降低HbA1c水平，对预防和管理2型糖尿病具有明确的益处 7879。其机制在于大肌肉群的持续收缩能够高效地促进葡萄糖摄取和利用。然而，“每坐20分钟站2分钟”的短时站立模式，虽然强度较低，但其频繁中断久坐的特性，使得它能在餐后血糖即将升高时及时干预，有效“削峰填谷”。一些研究发现，频繁的短时站立（或轻度活动中断）能显著降低餐后血糖和胰岛素反应，其效果在某些情境下甚至可以媲美或接近持续中等强度运动。这表明，低强度活动中断久坐对血糖的急性改善作用非常明显，尤其对于那些因各种原因无法进行中等强度运动的个体，提供了一个有效的替代策略。
血脂与腰围改善方面的等效性或差异：
传统的中等强度运动（如散步），通过增加能量消耗、改善脂代谢和减少体脂，能够有效降低甘油三酯、提升高密度脂蛋白胆固醇（HDL-C），并减少腰围 80。长期坚持规律散步，已被证实能显著减少体重和腰围的反弹。短时站立虽然能量消耗不如散步，但其长期累积效应以及对内脏脂肪的选择性减少机制，同样有助于改善腰围。一项为期12个月的干预研究发现，通过使用可调节高度的办公桌并结合行为改变策略减少久坐时间，能够对身体成分和健康结局产生有利影响，这间接支持了短时站立对腰围改善的长期潜力。然而，要达到与每日30分钟中等强度散步等同的血脂改善效果，单纯的短时站立可能需要更长时间或更高的频率，或者与其他干预措施结合。
PASTBI指数（体力活动-久坐平衡指数）的研究视角：
体力活动-久坐平衡指数（Physical Activity-Sedentary Behavior Balance Index, PASTBI）的概念强调了体力活动与久坐行为之间的动态平衡对健康的重要性，而不仅仅是关注单一维度。PASTBI研究表明，低强度的体力活动，即使不能完全取代中等强度运动，也能通过改变整体行为模式，减少久坐时长，从而带来累积的健康益处。短时站立正是这种低强度活动中断久坐的典型代表。它将健康价值从传统的“大剂量”运动扩展到日常生活的“微剂量”活动中，使得任何增加活动、减少久坐的行为都具有积极意义。这种观点提示我们，对于久坐人群而言，短时站立并非要取代散步，而是作为一种互补策略，共同构建更健康的体力活动模式。特别是那些因身体原因（如老年人、慢性病患者）或时间限制无法进行剧烈运动的人，短时站立提供了一个“力所能及”的健康起点。
综上所述，“每坐20分钟站2分钟”的短时站立干预，在血糖控制方面表现出与中等强度散步一定的等效性或作为其有效补充，尤其在餐后血糖管理上作用显著。在血脂和腰围改善上，虽然其能量消耗效率较低，但凭借其高依从性和累积效应，同样能产生积极影响。PASTBI指数的提出进一步印证了这种低强度、碎片化活动在改善整体健康中的重要价值。
5.2 行为依从性与可持续性优势
短时站立干预相较于传统的运动方式，其最显著的优势之一在于卓越的行为依从性和可持续性。这种“每坐20分钟站2分钟”的模式之所以能更好地被大众采纳并长期坚持，主要得益于其在时间碎片化、环境适应性以及心理负担方面的独特优势，这些因素共同降低了干预的实施门槛。
首先是时间碎片化的优势。现代生活节奏快，工作和个人时间往往被切割成小块，难以安排连续的30分钟或更长时间进行中等强度运动。短时站立每次仅需2分钟，可以轻松嵌入到工作间隙、会议休息、广告时间、或者等待泡茶、打印文件等日常活动中，几乎不占用额外的时间成本。这种“化整为零”的策略，有效解决了许多人普遍面临的“没时间运动”的困境。有研究指出，人们通常会根据其更高层次的目标来决定坐下或站立，例如完成工作任务或观看电视81。短时站立正是利用了这种行为模式，将其与日常目标无缝结合，减少了行为改变的阻力。
其次，环境适应性极强。无论是办公室、居家环境、学校、甚至是公共场所，只要有站立的空间，就可以随时进行短时站立。它不需要特殊的场地（如健身房、跑道）、昂贵的器械或专门的服装。在办公室，员工可以在工位旁简单站立，或利用站立式办公桌。在家中，可以在看电视、阅读或做家务时随时站立。这种广泛的适用性极大地拓宽了干预的实施场景，使得久坐人群无论身处何地，都能轻松地执行干预。例如，坐站交替工作站的使用，已被证实能有效减少久坐时间，并通过听觉和触觉提示促进频繁的坐站转换，而无需调整工作台面，从而不影响工作效率82。
再者，心理负担极低，几乎没有“运动压力”。许多人对传统运动存在心理障碍，例如担心运动强度过大、导致疲劳或肌肉酸痛、形象不佳、或感到运动是一种额外的“任务”。短时站立由于其低强度和短时性，几乎不会带来这些心理负担。它更像是一种“姿势切换”而非“运动”，让人感觉轻松、无压力。这种无压力的特性，对于那些运动意愿低、或因身体原因（如关节疼痛、慢性疾病）不适合剧烈运动的人群尤为重要。例如，对于中风患者，涉及承重或站立姿势的活动，通过远程医疗监督也能安全可行，显示了低强度站立活动的广泛适应性83。此外，有研究发现，步行对心理健康有益84，而短时站立作为一种更简化的步行前置或替代形式，同样能带来心理层面的放松。
这些优势最终体现在干预试验中较低的脱落率上。虽然具体的数据因研究设计而异，但与那些需要更高强度、更长时间运动的干预项目相比，短时站立干预通常能实现更高的参与度和更低的退出率。例如，一项针对办公人群的干预研究通过鼓励频繁的坐站转换，有效减少了久坐时间，并指出这种微小的改变能够更容易融入日常工作流程，降低了依从性障碍。这种高依从性保证了干预效果的长期累积，使得看似微不足道的生理效益最终能转化为显著的健康改善。
综上所述，短时站立干预以其时间灵活性、环境普适性和心理低压性，克服了传统运动在依从性和可持续性上的诸多挑战，为久坐人群提供了一种更易于接受和长期坚持的健康行为模式。
5.3 与其他久坐干预方式（如坐站交替桌）的协同作用
短时站立干预与坐站交替办公桌等其他久坐干预方式并非互相排斥，而是能够形成有效的协同作用，共同优化久坐人群的行为模式，实现对久坐时长和站立频率的双重改善，从而带来更全面的健康效益。坐站交替办公桌（sit-stand desk）通过提供随时切换坐姿和站姿的便利性，已成为办公环境中减少久坐、促进身体活动的重要工具 85。
坐站交替办公桌的核心优势在于其便捷性，它允许使用者在不中断工作流的情况下，根据自身需求在坐姿和站姿之间平滑切换。这种灵活性促使个体更频繁地改变姿势，从而打断长时间的静坐。当这种设备与“每坐20分钟站2分钟”的短时站立干预策略结合时，其协同作用体现在以下几个方面：
- 最大化久坐时间减少：短时站立策略提供了一种明确的站立频率和时长指导，而坐站交替桌则提供了实现这一策略的物理环境。没有坐站交替桌，即使有站立的意愿，也可能因工作环境限制而难以实施。而有了坐站交替桌，用户可以轻松遵循“每20分钟站2分钟”的建议，甚至可以更频繁地进行坐站切换，从而显著减少每日的总体久坐时长。
- 提升站立频率和持续时间：坐站交替桌的使用者倾向于增加站立的频率和累积时长。一项研究评估了办公室工作人员在站立或坐站交替工作站上的身体运动，发现与传统坐姿工作站相比，坐站交替工作站的使用者在工作日中将更多的坐姿时间替换为站立时间 86。这种频繁的姿势转换，即使每次站立时间不长，累积起来也能有效增加整体的身体活动量，激活下肢肌肉，促进血液循环。
- 改善腰围与血糖的综合效益：坐站交替桌干预的研究显示，其对体成分（特别是腰围）和代谢指标（如血糖）均有积极影响。例如，一项研究发现，使用坐站交替桌并结合行为改变策略，能够对身体成分和健康结局产生有利影响 85。尽管该研究没有直接给出“腰围”的具体数据，但减少久坐和增加站立时间通常与腰围的减小趋势相关，因为这有助于减少内脏脂肪堆积。在血糖方面，通过坐站交替打断久坐已被证实能对餐后血糖和胰岛素反应产生影响。然而，针对年轻、正常体重大学生的研究发现，间歇性站立并未显著改善餐后代谢反应 53。
- 减轻肌肉骨骼不适：长时间的静坐不仅影响代谢健康，也容易导致肌肉骨骼不适，尤其是腰背部和肩颈部疼痛。坐站交替桌通过促进姿势多样性，有助于减轻这些不适。研究表明，使用坐站交替工作站能够有效减少肩部、上背部和下背部的肌肉骨骼不适感 86。然而，目前有限的证据并未明确显示增加站立或行走的干预措施能减少静坐工人的肌肉骨骼症状 87。这种改善舒适度的效果，反过来也能增强用户继续使用坐站交替桌并采纳短时站立策略的依从性。
尽管有研究指出，在年轻健康的大学生中，间歇性站立间隔可能无法急性改善餐后代谢反应 53，但这并不否认坐站交替桌在更广泛人群，特别是久坐且存在代谢风险的办公室人群中的协同价值。将“每坐20分钟站2分钟”的明确指导与坐站交替桌的物理支持结合，能够形成一个强大而可持续的久坐干预方案，为改善久坐人群的整体健康水平提供更优化的途径。
6. 实践推广的挑战与优化建议
6.1 干预方案的个性化调整
尽管“每坐20分钟站2分钟”的短时站立干预模式具有普适性，但在实际推广中，考虑到个体差异性，干预方案的个性化调整至关重要。不同职业、年龄和健康状态的人群，其生理特征、生活模式以及潜在的健康风险各异，需要量身定制的站立频率、时长和强度，以最大化干预效果并确保安全性。
1. 针对不同职业人群：
- 程序员/数据分析师等长时间伏案工作者： 这类人群久坐时间长，工作专注度高，往往难以主动中断。建议采用智能设备提醒（如坐姿监测器、计时软件）结合坐站交替办公桌。初期可严格执行“每20分钟站2分钟”，待习惯养成后，可根据工作节奏调整为“每30-45分钟站立3-5分钟”并进行轻微伸展活动，以缓解肌肉疲劳。站立期间可进行简单的颈部、肩部放松练习。
- 教师/客服等需长时间站立或讲话者： 这类职业虽然站立时间相对较长，但也可能长时间保持某一姿势，导致下肢疲劳或静脉曲张。干预重点应放在“动态站立”和“短暂休息”上。建议在讲课或通话间隙，进行原地踏步、小腿提踵等活动，或利用短暂休息时间坐下，避免长时间僵硬站立。由于长时间站立也被发现与腰背疼痛等职业健康问题相关 88，应提倡坐立结合，而非单纯增加站立时间。
- 司机/操作员等移动受限者： 对于这类无法随意站立的职业，应强调在停车、换班等一切可能的短暂间隙进行站立和下肢活动。例如，在红灯等待时，可尝试进行臀部肌肉收缩放松练习；在休息时间，务必离开座位进行至少5-10分钟的步行或站立活动。
2. 针对不同年龄人群：
- 青少年/儿童： 学习压力和电子产品使用导致青少年久坐时间增加。对于儿童，干预应融入游戏化和教育元素，如“站立小课堂”、“站立游戏时间”。对于青少年，可鼓励在课间休息时离开座位走动，或在完成作业时每隔一段时间起身喝水、伸展。学校和家庭环境应提供更多站立学习或活动的设施。
- 健康成年人： 大多数健康成年人可直接采纳“每20分钟站2分钟”模式。关键在于培养习惯，可借助手机应用或智能穿戴设备进行提醒。在会议中可尝试站立发言，或在接打电话时站立走动。
- 老年人群： 老年人平衡能力可能下降 89，长时间站立或快速起立时需注意跌倒风险。因此，老年人的站立干预应以延长单次站立时间但降低频率为宜，例如“每1-1.5小时站立5-10分钟”。站立时应确保有稳固支撑物可抓扶，并进行慢速、有控制的起立和坐下。站立期间可结合简单的平衡练习（如扶墙单腿站立）、太极、Pilates或阻力训练，这些都能有效改善老年人的平衡能力和肌肉力量 909192。有研究显示，运动干预能有效降低老年人跌倒风险23% 93。此外，对于有骨质疏松或关节问题的老年人，站立时间不宜过长，以免加重关节负担，应听从医嘱或康复师建议。
3. 针对不同健康状态人群：
- 糖尿病前期/2型糖尿病患者： 这类人群对血糖波动的管理尤为关键。建议严格执行“每20分钟站2分钟”，甚至更频繁地进行短时站立或轻度步行，尤其是在餐后。目标是最大化餐后血糖的“削峰填谷”效果，以改善胰岛素敏感性。
- 超重/肥胖人群： 除了短时站立，建议结合其他低强度活动，如站立办公时原地踏步，或利用休息时间快走，以增加总能量消耗，促进体脂减少。同时，强调饮食控制的重要性，以实现能量负平衡。
- 关节问题或慢性疼痛患者： 这类人群在站立时可能会感到不适。干预方案应在医生或物理治疗师指导下进行。可能需要调整站立时长，确保站立姿势正确，避免对关节造成额外压力。例如，可以采用带有支撑的站立姿势，或使用带有软垫的站立垫，减少足部和关节压力。
个性化调整并非一蹴而就，需要个体在实践中不断摸索，结合自身感受和健康反馈进行优化。同时，医疗专业人员、健身教练等应提供专业指导，确保干预方案的有效性和安全性。
6.2 技术辅助与行为干预的结合
为了有效提升短时站立干预的依从性，仅仅提供建议是远远不够的。现代技术辅助手段与行为经济学原理的巧妙结合，可以极大地增强干预措施的吸引力和持久性。智能穿戴设备、移动应用以及环境改造等提供了便利的工具，而行为经济学则为这些工具如何更有效地引导和激励个体行为提供了理论框架 94。
1. 智能穿戴设备与移动应用：
智能穿戴设备（如智能手表、手环）及其配套的移动应用在提升健康行为方面展现出巨大潜力 9596。
- 久坐提醒功能： 大多数智能穿戴设备都具备久坐提醒功能，通过震动、声音或屏幕提示，在用户长时间保持静坐状态时发出警示。这种即时反馈机制对于打断久坐、促使个体进行短时站立至关重要。研究表明，可穿戴设备结合在线干预（如在线指导和社交媒体支持）在减少久坐时间方面效果显著，优于单纯使用可穿戴设备进行自我监测 95。
- 进度追踪与目标设定： 智能穿戴设备能够记录用户的活动数据（如站立时长、步数），并在应用中以可视化方式呈现。这使得用户可以自我监测行为 97，清晰地看到自己减少久坐、增加站立的努力和进步。同时，应用可以设置个性化的小目标（例如，今日已站立X分钟，距离目标还有Y分钟），并通过完成目标给予奖励或徽章，利用游戏化元素（Gamification）激发用户的内在动力 9899100。例如，有研究表明，游戏化干预有助于提高儿童对24小时运动行为建议的依从性 98，其原理在成人健康行为改变中也有潜在应用。
- 社交支持与竞赛： 许多健康应用允许用户与朋友分享进度、互相鼓励甚至进行排行榜竞赛。这种社会影响和社会支持机制可以显著提升依从性 97。当个体看到他人的努力和成就时，会产生榜样效应，并通过健康的竞争来激励自己。
2. 环境改造：
物理环境的改变可以直接影响行为模式。
- 设立站立休息区： 在办公室、学校或公共场所设置专门的站立休息区、高脚桌或共享的站立工作台，为短时站立提供便利且具有暗示性的空间。这些区域可以配备茶水、咖啡或简报屏幕，鼓励人们在等待或休息时选择站立而非坐下。
- 推广坐站交替办公桌： 虽然成本较高，但坐站交替办公桌是办公环境中减少久坐最直接有效的手段之一。结合智能提醒，可以促使员工规律地在坐姿和站姿之间切换，实现久坐时间的最小化。
3. 行为经济学原理的运用：
行为经济学通过理解人类决策的非理性偏差，设计出更有效的激励和干预策略 94101102。
- 即时反馈与奖励 (Instant Feedback & Rewards)： 人类对即时奖励的反应远大于延迟奖励。智能设备的实时提醒和即时虚拟奖励（如勋章、积分）能够立即强化短时站立行为，形成正向循环 103。例如，研究发现，立即的经济奖励比延迟奖励更能有效提高体力活动水平 103。
- 承诺机制 (Commitment Devices)： 鼓励个体公开承诺他们的短时站立目标，或者与同事/家人建立“健康契约”。当人们公开承诺后，为了避免失去信誉，更有可能坚持下去。
- 损失厌恶 (Loss Aversion)： 人们对损失的规避心理强于对收益的追求。可以将奖励预先分配给用户，但如果未能达到设定的站立目标，奖励就会被“没收”。这种“失去”的风险可以作为强大的行为驱动力。然而，目前健康应用中很少有将行为经济学原理应用于奖励设计的研究 104。
- 默认设置 (Defaults)： 在数字平台或智能设备中，将短时站立提醒设置为默认开启，需要用户主动关闭，而非主动开启。改变默认选项可以显著影响行为，因为人们倾向于接受预设选项。
- 社会规范 (Social Norms)： 强调周围人群都在积极进行短时站立，营造一种“健康行动”的社会氛围，利用“从众心理”鼓励更多人参与。例如，定期发布办公室或团队的站立时长排名，可以激发成员的参与热情。
通过将这些技术辅助和行为经济学策略整合到短时站立干预方案中，可以更有效地克服行为障碍，将“每坐20分钟站2分钟”从一个健康建议转化为一种普遍且可持续的日常习惯。
6.3 长期效果的追踪与机制深化
尽管目前关于短时站立干预的研究已经展示了其在改善代谢健康和体成分方面的积极急性效应和初步的短期（通常在6个月以内）效果，但要将其作为一项成熟的公共健康策略进行推广，仍需关注其长期效果的追踪与机制的进一步深化。
当前研究的局限性在于，大多数试验时长较短，主要集中于评估餐后血糖、胰岛素反应等急性生理指标，或在数周到数月的周期内观察腰围、BMI等体成分变化 105。例如，许多短时站立干预研究的随访期通常不足6个月，难以揭示其对糖尿病、心血管疾病等慢性终点事件的长期影响。这些终点事件的发展是一个漫长的过程，需要年尺度的观察才能得出有力的结论。因此，未来的研究应设计更长时间（例如1年以上，甚至数年）的随机对照试验，以评估规律性短时站立对2型糖尿病发病率、心血管疾病事件（如心肌梗死、中风）、高血压、血脂异常等疾病发生率以及全因死亡率的影响 106107。此外，还需要对参与者的生活质量、医疗费用等经济社会效益进行评估。
除了长期效果的追踪，深入探究短时站立干预背后的分子生物学机制也至关重要。目前的研究已经初步揭示了肌肉活动、GLUT4转位、LPL活性等方面的作用，但仍有许多潜在的中介机制值得探索：
肌肉因子（Exerkines）的作用：运动可以诱导肌肉释放一系列细胞因子、肽和代谢产物，统称为“肌肉因子”（exerkines）。这些肌肉因子通过内分泌、旁分泌或自分泌的方式，影响全身多个器官的代谢功能，包括脂肪组织、肝脏、胰腺和大脑等 108。其中，鸢尾素（Irisin）是一种被广泛研究的肌肉因子，在运动过程中由骨骼肌分泌，可以促进白色脂肪组织褐变，增加能量消耗，改善胰岛素敏感性，并对认知功能有益 108109。短时站立，即使是低强度活动，也可能通过累积效应刺激鸢尾素等肌肉因子的释放，从而介导其对代谢健康和体成分的益处。未来的研究可以监测干预前后血液中鸢尾素及其他新兴肌肉因子（如FGF21、BDNF等）的水平变化，并探讨其与血糖、体成分改善之间的关联。
肠道菌群的调控：肠道菌群被认为是影响宿主代谢健康的重要因素，通过产生短链脂肪酸（SCFAs）、调节宿主免疫和炎症反应等途径发挥作用 109110。体力活动（包括低强度活动）已被证实可以影响肠道菌群的组成和功能，改善肠道屏障完整性 109。短时站立是否也能通过类似机制，调节肠道菌群，进而影响宿主的代谢健康和体成分，是一个有前景的研究方向。例如，研究可以分析干预前后粪便样本中的微生物组学数据，并结合代谢组学技术，探索短时站立对肠道菌群-代谢轴的影响。
脂肪细胞因子的影响：脂肪组织不仅仅是能量储存的场所，还能分泌多种脂肪细胞因子（adipokines），如瘦素、脂联素、抵抗素等，这些因子在能量代谢、炎症和胰岛素敏感性中发挥关键作用。内脏脂肪的减少通常伴随着脂肪细胞因子分泌模式的改善。未来的研究可以评估短时站立干预对这些脂肪细胞因子水平的影响，从而更全面地理解其对体成分和代谢健康的调节机制。
表观遗传学机制：生活方式干预，包括饮食和运动，可以影响基因表达的表观遗传学调控，如DNA甲基化。表观遗传时钟（epigenetic clock）已被用于评估生物学年龄和健康衰老。有研究显示，素食饮食等生活方式干预可以在短期内降低整体表观遗传年龄加速 111。短时站立干预是否也能通过影响DNA甲基化或其他表观遗传修饰，从而介导其对长期健康和衰老过程的影响，也是一个值得深入探讨的领域。
通过长期的随访研究和深入的机制探索，将有助于全面揭示短时站立干预对健康产生的深远影响，为其在临床实践和公共健康政策中的应用提供更坚实的科学依据，最终促进“久坐文化”向“活跃文化”的转变。
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Harold W Kohl, Cora Lynn Craig, Estelle Victoria Lambert, et al.
Lancet. 2012 Jul 21;380(9838):294-305. doi: 10.1016/S0140-6736(12)60898-8.
Physical inactivity is the fourth leading cause of death worldwide. We summarise present global efforts to counteract this problem and point the way forward to address the pandemic of physical inactivity. Although evidence for the benefits of physical activity for health has been available since the 1950s, promotion to improve the health of populations has lagged in relation to the available evidence and has only recently developed an identifiable infrastructure, including efforts in planning, policy, leadership and advocacy, workforce training and development, and monitoring and surveillance. The reasons for this late start are myriad, multifactorial, and complex. This infrastructure should continue to be formed, intersectoral approaches are essential to advance, and advocacy remains a key pillar. Although there is a need to build global capacity based on the present foundations, a systems approach that focuses on populations and the complex interactions among the correlates of physical inactivity, rather than solely a behavioural science approach focusing on individuals, is the way forward to increase physical activity worldwide.
5Sedentary behavior, physical inactivity, abdominal obesity and obesity in adults and older adults: A systematic review and meta-analysis.PubMed
Erika Aparecida Silveira, Carolina Rodrigues Mendonça, Felipe Mendes Delpino, et al.
Clin Nutr ESPEN. 2022 Aug;50:63-73. doi: 10.1016/j.clnesp.2022.06.001. Epub 2022 Jun 14.
BACKGROUND: Sedentary behavior and physical inactivity may increase the risk of obesity. This systematic review and meta-analysis aimed to investigate: i) the prevalence/incidence of sedentary behavior and physical inactivity, ii) the association of sedentary behavior and physical inactivity with obesity, and iii) the objective and subjective measures, diagnostic criteria, and cut-off points to estimate sedentary behavior and physical inactivity in adults and older adults with obesity. METHODS: We conducted a systematic review and meta-analysis in PubMed, Scielo, Lilacs, and Cochrane Library databases. A meta-analysis of a random-effects model was performed to estimate the combined prevalence of sedentary behavior and physical inactivity and their association with obesity. RESULTS: Twenty-three studies involving 638,000 adults and older adults were included in the systematic review. A meta-analysis was conducted with 111,851 individuals with obesity. The combined prevalence of sedentary behavior was 31% (95% CI, 23-41%), and physical inactivity was 43% (95% CI, 31-55%). Significant associations between obesity and sedentary behavior (OR 1.45, 95% CI, 1.21-1.75) and physical inactivity (OR 1.52, 95% CI, 1.23-1.87) were found. Nine studies have used objective measures to assess physical activity levels, such as accelerometers and pedometers, whereas fourteen applied subjective methods and self-reported questionnaires. CONCLUSIONS: As expected, we found elevated rates of sedentary behavior and physical inactivity in individuals with obesity and a positive risk association. The wide range of objective and subjective measures, methods and cut-offs resulted in great variations of physical inactivity and sedentary behavior estimates. TRIAL REGISTRATION: PROSPERO (CRD42016037747).
6Sedentary Behavior and Physical Inactivity in the Asia-Pacific Region: Current Challenges and Emerging Concerns.PubMed
Michael Annear
Int J Environ Res Public Health. 2022 Jul 30;19(15):9351. doi: 10.3390/ijerph19159351.
This editorial sets the scene for our Special Issue on the growing problem of sedentary behavior and physical inactivity in the Asia-Pacific region. In many societies, more than 40% of the adult population and growing numbers of children are insufficiently physically active to safeguard their health. This is contributing to high rates of cardiovascular disease, obesity, and other deleterious health outcomes across the region. The Asia-Pacific is heterogeneous and complex, with diverse social, cultural, and environmental barriers that affect intentions and opportunities for regular physical activity. Recently, the problem has been compounded by the acceleration of population aging, the worsening effects of anthropogenic climate change, and the ongoing COVID-19 pandemic. Without strong leadership, enduring funding support, and innovative interventions that cut across policy and society, we may yet be facing a century of unmitigated expansion of morbidity across the Asia-Pacific.
7Sedentary Behavior, Exercise, and Cardiovascular Health.PubMed
Carl J Lavie, Cemal Ozemek, Salvatore Carbone, et al.
Circ Res. 2019 Mar;124(5):799-815. doi: 10.1161/CIRCRESAHA.118.312669.
Sedentary behavior and physical inactivity are among the leading modifiable risk factors worldwide for cardiovascular disease and all-cause mortality. The promotion of physical activity and exercise training (ET) leading to improved levels of cardiorespiratory fitness is needed in all age groups, race, and ethnicities and both sexes to prevent many chronic diseases, especially cardiovascular disease. In this state-of-the-art review, we discuss the negative impact of sedentary behavior and physical inactivity, as well as the beneficial effects of physical activity /ET and cardiorespiratory fitness for the prevention of chronic noncommunicable diseases, including cardiovascular disease. We review the prognostic utility of cardiorespiratory fitness compared with obesity and the metabolic syndrome, as well as the increase of physical activity /ET for patients with heart failure as a therapeutic strategy, and ET dosing. Greater efforts at preventing sedentary behavior and physical inactivity while promoting physical activity, ET, and cardiorespiratory fitness are needed throughout the healthcare system worldwide and particularly in the United States in which the burden of cardiometabolic diseases remains extremely high.
8Physical activity, obesity and sedentary behavior in cancer etiology: epidemiologic evidence and biologic mechanisms.PubMed
Christine M Friedenreich, Charlotte Ryder-Burbidge, Jessica McNeil
Mol Oncol. 2021 Mar;15(3):790-800. doi: 10.1002/1878-0261.12772. Epub 2020 Aug 18.
An estimated 30-40% of cancers can be prevented through changes in modifiable lifestyle and environmental risk factors known to be associated with cancer incidence. Despite this knowledge, there remains limited awareness that these associations exist. The purpose of this review article was to summarize the epidemiologic evidence concerning the contribution of physical activity, sedentary behavior, and obesity to cancer etiology and to provide an overview of the biologic mechanisms that may be operative between these factors and cancer incidence. Strong and consistent evidence exists that higher levels of physical activity reduce the risk of six different cancer sites (bladder, breast, colon, endometrial, esophageal adenocarcinoma, gastric cardia), whereas moderate evidence inversely associates physical activity with lung, ovarian, pancreatic and renal cancer, and limited evidence inversely correlates physical activity with prostate cancer. Sedentary behavior, independent of physical activity, has been shown to increase the risk of colon, endometrial, and lung cancers. Obesity is an established risk factor for 13 different cancer sites (endometrial, postmenopausal breast, colorectal, esophageal, renal/kidneys, meningioma, pancreatic, gastric cardia, liver, multiple myeloma, ovarian, gallbladder, and thyroid). The main biologic mechanisms whereby physical activity, sedentary behavior, and obesity are related to cancer incidence include an effect on endogenous sex steroids and metabolic hormones, insulin sensitivity, and chronic inflammation. Several emerging pathways related to oxidative stress, DNA methylation, telomere length, immune function, and gut microbiome are presented. Key recommendations for future research in both the epidemiology and biology of the associations between physical activity, sedentary behavior, obesity, and cancer risk are also provided.
9Obesity, risk of diabetes and role of physical activity, exercise training and cardiorespiratory fitness.PubMed
Salvatore Carbone, Marco Giuseppe Del Buono, Cemal Ozemek, et al.
Prog Cardiovasc Dis. 2019 Jul-Aug;62(4):327-333. doi: 10.1016/j.pcad.2019.08.004. Epub 2019 Aug 20.
The epidemic of obesity contributes to the burden of type 2 diabetes mellitus (T2DM) in the United States and worldwide. Importantly, obesity is not only preventable but can be treated, particularly with lifestyle modifications to forestall T2DM in those with excess adiposity. The mechanisms linking obesity to T2DM are numerous and involve adipose tissue remodeling as a result of unhealthy behaviors, including unhealthy diet, reduced physical activity (PA) and exercise training (ET), and increased sedentary behaviors. Taken together, these factors markedly reduce cardiorespiratory fitness (CRF), one of the strongest predictors for cardiovascular outcomes and all-cause mortality in the general population, but also in those with T2DM. In this review we describe the mechanisms leading to adipose tissue remodeling resulting in obesity, as well as the mechanisms linking excess adiposity to insulin resistance and, in turn, T2DM. We then present the therapeutic strategies that can be implemented in obesity to prevent T2DM, with a brief discussion on weight loss, and greater emphasis on PA and ET. We finally present the evidence to support the beneficial effects of such strategies in patients with established T2DM and discuss the importance of achieving improvements in CRF in this population to potentially improve clinical outcomes.
10The association of sedentary behaviour and physical activity with periodontal disease in NHANES 2011-2012.PubMed
Maha Almohamad, Elizabeth Krall Kaye, Dania Mofleh, et al.
J Clin Periodontol. 2022 Aug;49(8):758-767. doi: 10.1111/jcpe.13669. Epub 2022 Jun 10.
AIM: Periodontal disease is one of the most prevalent oral pathologies and a major chronic disease worldwide. Lifestyle habits such as poor nutrition and smoking have been established to contribute to the development of periodontal disease, but limited research has investigated whether physical activity and sedentary lifestyle play a role. The purpose of this study is to evaluate the association between physical activity, sedentary behaviour, and periodontal disease. MATERIALS AND METHODS: We used a nationally representative data set from the National Health and Nutrition Examination Survey (NHANES) 2011-2012. We examined the association between physical activity and sedentary behaviour and periodontal disease using multivariable logistic regression models and reported odds ratios (ORs). RESULTS: Individuals with higher total physical activity, higher leisure time physical activity, and lower amount of total sedentary behaviour had lower periodontal disease prevalence. Adjusted multivariable regression models showed that higher sedentary behaviour (more than 7.5 h/day) was associated with higher odds of periodontal disease (OR = 1.17; 95% confidence interval = 1.00-1.36; p = .045). CONCLUSIONS: The findings showed that higher sedentary behaviour is associated with higher odds of periodontal disease. Future prospective longitudinal studies and strategies are needed to investigate implications further and define the magnitude of the association between physical activity and periodontal disease.
11The association between sedentary behavior, exercise, and sleep disturbance: A mediation analysis of inflammatory biomarkers.PubMed
Yanwei You, Yuquan Chen, Wen Fang, et al.
Front Immunol. 2023 Jan 13;13:1080782. doi: 10.3389/fimmu.2022.1080782. eCollection 2022.
BACKGROUND: Two related lifestyle behaviors associated with sleep disturbance are sedentary behavior and physical exercise participation. We aimed to use a population-based study to disentangle the relationships between sedentary behavior, exercise, and sleep disturbance based on blood-cell-based inflammatory biomarkers. METHODS: A total of 22,599 participants from the National Health and Nutrition Examination Survey (NHANES) were included in the analyses. Sleep disturbance was assessed according to the NHANES questionnaire. Exercise participation ansd sedentary behavior were evaluated by the global physical activity questionnaire. The inflammatory biomarkers in the examination were white blood cell (WBC) count, neutrophil count (NEU), neutrophil-to-lymphocyte ratio (NLR), and systemic immune inflammation index (SII). A complex multistage sampling design and weighted multivariable logistic regression were applied for further analysis. Mediation models were constructed to figure out the mediating role of inflammatory biomarkers. RESULTS: The weighted prevalence of sleep disturbance was 24.17%. Sedentary behavior and exercise were associated with sleep disturbance after full adjustment [for sedentary behavior, OR (95% CI): 1.261 (1.154, 1.377); for exercise, OR (95% CI): 0.849 (0.757, 0.953)]. In severe sedentary behavior groups, the mitigation effect of exercise on sleep disturbance was observed [OR (95% CI): 0.687 (0.551, 0.857)]. For the mechanism, strong associations were detected between inflammatory biomarkers and sleep disturbance. Mediation analysis showed that WBC, NEU, NLR, and SII mediated the statistical association between sedentary behavior and sleep disturbance with proportions (%) of 2.09, 2.27, 1.76, and 0.82, respectively. CONCLUSIONS: Our data suggested that sedentary behavior was a risk factor for sleep disturbance. Blood-cell-based inflammatory biomarkers were an easily accessible and cost-effective strategy for identifying sleep disturbance and also significantly mediated the association between sedentary behavior and sleep disturbance. Exercise was proved to be effective in severe sedentary behavior groups to improve sleep disturbance symptoms, while the internal mechanism needed further exploration.
12Joint association of sedentary behavior and vitamin D status with mortality among cancer survivors.PubMed
Yu Yu, Sijing Cheng, Hao Huang, et al.
BMC Med. 2023 Oct 31;21(1):411. doi: 10.1186/s12916-023-03118-9.
BACKGROUND: Sedentary behavior and vitamin D deficiency are independent risk factors for mortality in cancer survivors, but their joint association with mortality has not been investigated. METHODS: We analyzed data from 2914 cancer survivors who participated in the National Health and Nutrition Examination Survey (2007-2018) and followed up with them until December 31, 2019. Sedentary behavior was assessed by self-reported daily hours of sitting, and vitamin D status was measured by serum total 25-hydroxyvitamin D (25(OH)D) levels. RESULTS: Among 2914 cancer survivors, vitamin D deficiency was more prevalent in those with prolonged daily sitting time. During up to 13.2 years (median, 5.6 years) of follow-up, there were 676 deaths (cancer, 226; cardiovascular disease, 142; other causes, 308). The prolonged sitting time was associated with a higher risk of all-cause and noncancer mortality, and vitamin D deficiency was associated with a higher risk of all-cause and cancer mortality. Furthermore, cancer survivors with both prolonged sitting time (≥ 6 h/day) and vitamin D deficiency had a significantly higher risk of all-cause (HR, 2.05; 95% CI: 1.54-2.72), cancer (HR, 2.33; 95% CI, 1.47-3.70), and noncancer mortality (HR, 1.91; 95% CI, 1.33-2.74) than those with neither risk factor after adjustment for potential confounders. CONCLUSIONS: In a nationally representative sample of U.S. cancer survivors, the joint presence of sedentary behavior and vitamin D deficiency was significantly associated with an increased risk of all-cause and cancer-specific mortality.
13Sedentary Lifestyle: Overview of Updated Evidence of Potential Health Risks.PubMed
Jung Ha Park, Ji Hyun Moon, Hyeon Ju Kim, et al.
Korean J Fam Med. 2020 Nov;41(6):365-373. doi: 10.4082/kjfm.20.0165. Epub 2020 Nov 19.
One-third of the global population aged 15 years and older engages in insufficient physical activities, which affects health. However, the health risks posed by sedentary behaviors are not well known. The mean daily duration of sedentary behavior is 8.3 hours among the Korean population and 7.7 hours among the American adult population. Sedentary lifestyles are spreading worldwide because of a lack of available spaces for exercise, increased occupational sedentary behaviors such as office work, and the increased penetration of television and video devices. Consequently, the associated health problems are on the rise. A sedentary lifestyle affects the human body through various mechanisms. Sedentary behaviors reduce lipoprotein lipase activity, muscle glucose, protein transporter activities, impair lipid metabolism, and diminish carbohydrate metabolism. Furthermore, it decreases cardiac output and systemic blood flow while activating the sympathetic nervous system, ultimately reducing insulin sensitivity and vascular function. It also alters the insulin-like growth factor axis and the circulation levels of sex hormones, which elevates the incidence of hormone-related cancers. Increased sedentary time impairs the gravitostat, the body's weight homeostat, and weight gain, adiposity, and elevated chronic inflammation caused by sedentary behavior are risk factors for cancer. Sedentary behaviors have wide-ranging adverse impacts on the human body including increased all-cause mortality, cardiovascular disease mortality, cancer risk, and risks of metabolic disorders such as diabetes mellitus, hypertension, and dyslipidemia; musculoskeletal disorders such as arthralgia and osteoporosis; depression; and, cognitive impairment. Therefore, reducing sedentary behaviors and increasing physical activity are both important to promote public health.
14Endocytosis, recycling, and regulated exocytosis of glucose transporter 4.PubMed
Kevin Foley, Shlomit Boguslavsky, Amira Klip
Biochemistry. 2011 Apr 19;50(15):3048-61. doi: 10.1021/bi2000356. Epub 2011 Mar 25.
Glucose transporter 4 (GLUT4) is responsible for the uptake of glucose into muscle and adipose tissues. Under resting conditions, GLUT4 is dynamically retained through idle cycling among selective intracellular compartments, from whence it undergoes slow recycling to the plasma membrane (PM). This dynamic retention can be released by command from intracellular signals elicited by insulin and other stimuli, which result in 2-10-fold increases in the surface level of GLUT4. Insulin-derived signals promote translocation of GLUT4 to the PM from a specialized compartment termed GLUT4 storage vesicles (GSV). Much effort has been devoted to the characterization of the intracellular compartments and dynamics of GLUT4 cycling and to the signals by which GLUT4 is sorted into, and recruited from, GSV. This review summarizes our understanding of intracellular GLUT4 traffic during its internalization from the membrane, its slow, constitutive recycling, and its regulated exocytosis in response to insulin. In spite of specific differences in GLUT4 dynamic behavior in adipose and muscle cells, the generalities of its endocytic and exocytic itineraries are consistent and an array of regulatory proteins that regulate each vesicular traffic event emerges from these cell systems.
15Metabolic Syndrome Pathophysiology and Predisposing Factors.PubMed
António Bovolini, Juliana Garcia, Maria Amparo Andrade, et al.
Int J Sports Med. 2021 Mar;42(3):199-214. doi: 10.1055/a-1263-0898. Epub 2020 Oct 19.
Metabolic syndrome (MetS) is a cluster of cardiometabolic risk factors with high prevalence among adult populations and elevated costs for public health systems worldwide. Despite the lack of consensus regarding the syndrome definition and diagnosis criteria, it is characterized by the coexistence of risk factors such as abdominal obesity, atherogenic dyslipidemia, elevated blood pressure, a prothrombotic and pro-inflammatory state, insulin resistance (IR), and higher glucose levels, factors indubitably linked to an increased risk of developing chronic conditions, such as type 2 diabetes (T2D) and cardiovascular disease (CVD). The syndrome has a complex and multifaceted origin not fully understood; however, it has been strongly suggested that sedentarism and unbalanced dietary patterns might play a fundamental role in its development. The purpose of this review is to provide an overview from the syndrome epidemiology, costs, and main etiological traits from its relationship with unhealthy diet patterns and sedentary lifestyles.
16Diagnosis and Treatment of Type 2 Diabetes in Adults: A Review.PubMed
Rita R Kalyani, Joshua J Neumiller, Nisa M Maruthur, et al.
JAMA. 2025 Sep 16;334(11):984-1002. doi: 10.1001/jama.2025.5956.
IMPORTANCE: Type 2 diabetes involves progressive loss of insulin secretion from pancreatic β cells in the setting of insulin resistance and manifests clinically as hyperglycemia. Type 2 diabetes accounts for 90% to 95% of all cases of diabetes globally, with estimates ranging from 589 million to 828 million people worldwide. In the US, type 2 diabetes affects approximately 1 in 6 adults. OBSERVATIONS: Risk factors for type 2 diabetes include older age, family history, overweight or obesity, physical inactivity, gestational diabetes, Hispanic ethnicity, and American Indian or Alaska Native, Asian, or Black race. Diabetes is diagnosed if fasting plasma glucose is greater than or equal to 126 mg/dL, hemoglobin A1C is greater than or equal to 6.5%, or 2-hour glucose during 75-g oral glucose tolerance testing is greater than or equal to 200 mg/dL. Approximately one-third of adults with type 2 diabetes have cardiovascular disease and 10.1% have severe vision difficulty or blindness. The prevalence of type 2 diabetes is 39.2% among patients with kidney failure. Although weight management is an important component of treatment for type 2 diabetes, no specific diet has been proven to be most effective for improving health outcomes. Physical activity can reduce hemoglobin A1C by 0.4% to 1.0% and improve cardiovascular risk factors (ie, hypertension and dyslipidemia). Randomized clinical trials have reported absolute reductions in microvascular disease (3.5%), such as retinopathy and nephropathy, myocardial infarction (3.3%-6.2%), and mortality (2.7%-4.9%), with intensive glucose-lowering strategies (hemoglobin A1C <7%) vs conventional treatment 2 decades after trial completion. First-line medications for type 2 diabetes include metformin and, in patients with cardiovascular or kidney comorbidities or at high cardiovascular risk, glucagon-like peptide-1 receptor agonists (GLP-1RAs) or sodium-glucose cotransporter 2 inhibitors (SGLT2is). Common add-on medications include dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1RAs, dipeptidyl peptidase-4 inhibitors, sulfonylureas, and thiazolidinediones. Approximately one-third of patients with type 2 diabetes require treatment with insulin during their lifetime. Several randomized clinical trials have demonstrated benefits of specific SGLT2i and GLP-1RA medications compared with placebo for atherosclerotic cardiovascular disease (12%-26% risk reduction), heart failure (18%-25% risk reduction), and kidney disease (24%-39% risk reduction) over 2 to 5 years. Most trial participants with type 2 diabetes were taking metformin. High-potency GLP-1RA and dual GIP/GLP-1RA medications result in weight loss of greater than 5% in most individuals with type 2 diabetes, and weight loss may exceed 10%. CONCLUSIONS: Type 2 diabetes affects up to 14% of the global population and is associated with preventable long-term complications, such as cardiovascular disease, kidney failure, vision loss, and increased mortality. In addition to lifestyle modifications including diet, exercise, and weight management, metformin is generally first-line therapy for attainment of hemoglobin A1C targets. For individuals with type 2 diabetes and cardiovascular or kidney disease or at high cardiovascular risk, guidelines recommend early treatment with SGLT2i and/or GLP-1RA medications.
17Decreased autophagosome biogenesis, reduced NRF2, and enhanced ferroptotic cell death are underlying molecular mechanisms of non-alcoholic fatty liver disease.PubMed
Pengfei Liu, Annadurai Anandhan, Jinjing Chen, et al.
Redox Biol. 2023 Feb;59:102570. doi: 10.1016/j.redox.2022.102570. Epub 2022 Dec 5.
BACKGROUND AND AIMS: Caloric excess and sedentary lifestyles have led to an epidemic of obesity, metabolic syndrome, and non-alcoholic fatty liver disease (NAFLD). The objective of this study was to investigate the mechanisms underlying high fat diet (HFD)-induced NAFLD, and to explore NRF2 activation as a strategy to alleviate NAFLD. APPROACH AND RESULTS: Herein, we demonstrated that high fat diet (HFD) induced lipid peroxidation and ferroptosis, both of which could be alleviated by NRF2 upregulation. Mechanistically, HFD suppressed autophagosome biogenesis through AMPK- and AKT-mediated mTOR activation and decreased ATG7, resulting in KEAP1 stabilization and decreased NRF2 levels in mouse liver. Furthermore, ATG7 is required for HFD-induced NRF2 downregulation, as ATG7 deletion in Cre-inducible ATG7 knockout mice decreased NRF2 levels and enhanced ferroptosis, which was not further exacerbated by HFD. This finding was recapitulated in mouse hepatocytes, which showed a similar phenotype upon treatment with saturated fatty acids (SFAs) but not monounsaturated fatty acids (MUFAs). Finally, NRF2 activation blocked fatty acid (FA)-mediated NRF2 downregulation, lipid peroxidation, and ferroptosis. Importantly, the HFD-induced alterations were also observed in human fatty liver tissue samples. CONCLUSIONS: HFD-mediated autophagy inhibition, NRF2 suppression, and ferroptosis promotion are important molecular mechanisms of obesity-driven metabolic diseases. NRF2 activation counteracts HFD-mediated NRF2 suppression and ferroptotic cell death. In addition, SFA vs. MUFA regulation of NRF2 may underlie their harmful vs. beneficial effects. Our study reveals NRF2 as a key player in the development and progression of fatty liver disease and that NRF2 activation could serve as a potential therapeutic strategy.
18Sit less and move more for cardiovascular health: emerging insights and opportunities.PubMed
David W Dunstan, Shilpa Dogra, Sophie E Carter, et al.
Nat Rev Cardiol. 2021 Sep;18(9):637-648. doi: 10.1038/s41569-021-00547-y. Epub 2021 May 20.
Sedentary behaviour - put simply, too much sitting, as a distinct concept from too little exercise - is a novel determinant of cardiovascular risk. This definition provides a perspective that is complementary to the well-understood detrimental effects of physical inactivity. Sitting occupies the majority of the daily waking hours in most adults and has become even more pervasive owing to the COVID-19 pandemic. The potential for a broad cardiovascular health benefit exists through an integrated approach that involves 'sitting less and moving more'. In this Review, we first consider observational and experimental evidence on the adverse effects of prolonged, uninterrupted sitting and the evidence identifying the possible mechanisms underlying the associated risk. We summarize the results of randomized controlled trials demonstrating the feasibility of changing sedentary behaviour. We also highlight evidence on the deleterious synergies between sedentary behaviour and physical inactivity as the underpinnings of our case for addressing them jointly in mitigating cardiovascular risk. This integrated approach should not only reduce the specific risks of too much sitting but also have a positive effect on the total amount of physical activity, with the potential to more broadly benefit the health of individuals living with or at risk of developing cardiovascular disease.
19Age-related changes in the structure and function of skeletal muscles.PubMed
John A Faulkner, Lisa M Larkin, Dennis R Claflin, et al.
Clin Exp Pharmacol Physiol. 2007 Nov;34(11):1091-6. doi: 10.1111/j.1440-1681.2007.04752.x.
1. For animals of all ages, during activation of skeletal muscles and the subsequent contraction, the balance between the force developed by the muscle and the external load determines whether the muscle shortens, remains at fixed length (isometric) or is lengthened. With maximum activation, the force developed is least during shortening, intermediate when muscle length is fixed and greatest during lengthening contractions. During lengthening contractions, when force is high, muscles may be injured by the contractions. 2. 'Frailty' and 'failure to thrive' are most frequently observed in elderly, physically inactive people. A 'frail' person is defined as one of small stature, with muscles that are atrophied, weak and easily fatigued. The condition of 'failure to thrive' is typified by a lack of response to well-designed programmes of nutrition and physical activity. 3. With ageing, skeletal muscle atrophy in humans appears to be inevitable. A gradual loss of muscle fibres begins at approximately 50 years of age and continues such that by 80 years of age, approximately 50% of the fibres are lost from the limb muscles that have been studied. For both humans and rats, the observation that the timing and magnitude of the loss of motor units is similar to that for muscle fibres suggests that the mechanism responsible for the loss of fibres and the loss of whole motor units is the same. The degree of atrophy of the fibres that remain is largely dependent on the habitual level of physical activity of the individual. 4. 'Master athletes' maintain a high level of fitness throughout their lifespan. Even among master athletes, performance of marathon runners and weight lifters declines after approximately 40 years of age, with peak levels of performance decreased by approximately 50% by 80 years of age. The success of the master athletes and of previously sedentary elderly who undertake well-designed, carefully administered training programmes provide dramatic evidence that age-associated atrophy, weakness and fatigability can be slowed, but not halted.
20Bidirectional roles of skeletal muscle fibro-adipogenic progenitors in homeostasis and disease.PubMed
Wentao Chen, Wenjing You, Teresa G Valencak, et al.
Ageing Res Rev. 2022 Sep;80:101682. doi: 10.1016/j.arr.2022.101682. Epub 2022 Jul 6.
Sarcopenia and myopathies cause progressive muscle weakness and degeneration, which are closely associated with fat infiltration and fibrosis in muscle. Recently, experimental research has shed light on fibro-adipogenic progenitors (FAPs), also known as muscle-resident mesenchymal progenitors with multiple differentiation potential for adipogenesis, fibrosis, osteogenesis and chondrogenesis. They are considered key regulators of muscle homeostasis and integrity. They play supportive roles in muscle development and repair by orchestrating the regulatory interplay between muscle stem cells (MuSCs) and immune cells. Interestingly, FAPs also contribute to intramuscular fat infiltration, fibrosis and other pathologies when the functional integrity of the network is compromised. In this review, we summarize recent insights into the roles of FAPs in maintenance of skeletal muscle homeostasis, and discuss the underlying mechanisms regulating FAPs behavior and fate, highlighting their roles in participating in efficient muscle repair and fat infiltrated muscle degeneration as well as during muscle atrophy. We suggest that controlling and predicting FAPs differentiation may become a promising strategy to improve muscle function and prevent irreparable muscle damage.
21Muscle atrophy and weakness with aging: contraction-induced injury as an underlying mechanism.PubMed
J A Faulkner, S V Brooks, E Zerba
J Gerontol A Biol Sci Med Sci. 1995 Nov;50 Spec No:124-9. doi: 10.1093/gerona/50a.special_issue.124.
In old compared with young animals, muscle mass is decreased by 30% to 40%, and maximum force and power are decreased to an even greater extent. The age-related declines in muscle mass and muscle function are similar to those that occur with decreased physical activity. Despite the similarities, we conclude that the losses in muscle mass, force, and power are not due solely to old animals being less active, but rather accrue from intrinsic age-related changes in muscles and in muscle fibers that appear to be immutable and irreversible. The intrinsic changes are associated with denervation of fast fatigable fibers and motor units and motor unit remodeling, which may be initiated by contraction-induced injury. The mechanisms remain unresolved for the weakness, the fatigability, the high susceptibility to contraction-induced injury, and the impaired recovery from injury demonstrated by the skeletal muscles of old animals.
22Sarcopenia and Neuroscience: Learning to Communicate.PubMed
Brian C Clark, Richard G Carson
J Gerontol A Biol Sci Med Sci. 2021 Sep 13;76(10):1882-1890. doi: 10.1093/gerona/glab098.
In the 1990s and early 2000s, the common definition for sarcopenia was age-related loss of skeletal muscle, and low levels of muscle mass were central to sarcopenia diagnosis. In more recent consensus definitions, however, low muscle strength displaces low muscle mass as a defining feature of sarcopenia. The change stems from growing evidence that muscle weakness is a better predictor of adverse health outcomes (eg, mobility limitations) than muscle mass. This evidence accompanies an emerging recognition that central neural mechanisms are critical determinants of age-related changes in strength and mobility that can occur independently of variations in muscle mass. However, strikingly little practical attention is typically given to the potential role of the central nervous system in the etiology or remediation of sarcopenia (ie, low muscle function). In this article, we provide an overview of some mechanisms that mediate neural regulation of muscle contraction and control, and highlight the specific contributions of neural hypoexcitability, dopaminergic dysfunction, and degradation of functional and structural brain connectivity in relation to sarcopenia. We aim to enhance the lines of communication between the domains of sarcopenia and neuroscience. We believe that appreciation of the neural regulation of muscle contraction and control is fundamental to understanding sarcopenia and to developing targeted therapeutic strategies for its treatment.
23Physiological and health implications of a sedentary lifestyle.PubMed
Mark Stephen Tremblay, Rachel Christine Colley, Travis John Saunders, et al.
Appl Physiol Nutr Metab. 2010 Dec;35(6):725-40. doi: 10.1139/H10-079.
Sedentary behaviour is associated with deleterious health outcomes, which differ from those that can be attributed to a lack of moderate to vigorous physical activity. This has led to the field of "sedentary physiology", which may be considered as separate and distinct from exercise physiology. This paper gives an overview of this emerging area of research and highlights the ways that it differs from traditional exercise physiology. Definitions of key terms associated with the field of sedentary physiology and a review of the self-report and objective methods for assessing sedentary behaviour are provided. Proposed mechanisms of sedentary physiology are examined, and how they differ from those linking physical activity and health are highlighted. Evidence relating to associations of sedentary behaviours with major health outcomes and the population prevalence and correlates of sedentary behaviours are reviewed. Recommendations for future research are proposed.
24[Applying an Exercise Snack-Based Health Promotion Strategy].PubMed
Chen-Hui Huang, Miaofen Yen
Hu Li Za Zhi. 2023 Apr;70(2):78-83. doi: 10.6224/JN.202304_70(2).10.
Lack of time, lack of access to equipment, and environmental constraints are generally perceived as barriers to regular physical activity. Moreover, insufficient activity is known to promote sedentary behavior, which is a factor in many chronic diseases, negatively affects mental health, and reduces quality of life. Exercise snacks, defined as short and efficient bursts of exercise, are convenient and easy to implement, reduce sedentary time, increase physical activity, and promote the development of good exercise habits. Previous studies have found exercise snacks to be safe and feasible for the elderly, promoting physical function and reducing the incidence of falls and metabolic diseases. Exercise snacks have also been found to be effective in healthy adults as well as in patients with obesity and diabetes, helping decrease blood sugar and promoting cardiorespiratory fitness. Depending on the participant's age and tolerance, exercise snack patterns may be extended and distinguished into two forms: 10-minute bouts of gentle intermittent exercise twice a day and 60-second bouts of vigorous exercise 3 to 8 times a day. The main considerations for exercise snacks include: multi-joint exercise is better than single-joint exercise, lower body exercise is better than upper body exercise, and dynamic and rapid movement that pushes away from the ground promotes osteogenesis and helps prevent osteoporosis and fractures. Exercise snacks may be applied in healthcare practice and related research to promote health and improve quality of life for all.
25Correlates of physical activity and sedentary behavior in adults living with overweight and obesity: A systematic review.PubMed
Fiona Curran, Mary E Davis, Kaitlyn Murphy, et al.
Obes Rev. 2023 Nov;24(11):e13615. doi: 10.1111/obr.13615. Epub 2023 Aug 7.
Overweight and obesity are consistently associated with lower physical activity (PA) levels and greater sedentary behavior (SB) in population studies. To date, no review has evaluated the factors associated with these behaviors in the specific population who have developed obesity/overweight. The aim of this systematic review was to identify the correlates/determinants of SB and PA in adults with overweight and obesity. Five databases were searched for studies, which reported factors or outcomes relating to PA or SB in adults living with overweight/obesity, published from 1980 to 2021. The factors were categorized using a socioecological model, strength, and direction of association. Of 34,058 articles retrieved, 45 studies were included, and 155 factors were identified. Self-efficacy, intrinsic motivation, exercise enjoyment, self-perceived good health, and social support were consistently associated with higher levels of PA. Consistent negative correlations were married females, increased BMI, obesity severity, pain, number of comorbidities, lack of time, energy, and willpower, and hilly terrain. Few studies (n = 12) examined SB, and no evidence for consistent associations were found. This review identified several correlates specific to PA in this population. Further studies are required to identify directionality and distal correlates for PA and all correlate levels of SB.
26Correlates of sedentary behavior in people with fibromyalgia: A systematic review.PubMed
Davy Vancampfort, Emanuel Brunner, Ryan L McGrath, et al.
Int J Rheum Dis. 2023 May;26(5):841-849. doi: 10.1111/1756-185X.14678. Epub 2023 Mar 27.
INTRODUCTION: Understanding the correlates of sedentary behavior (SB) is important in the development of interventions which reduce and interrupt SB in people with fibromyalgia (PwF). This systematic review aimed to investigate the correlates of SB in PwF using the socio-ecological model. METHODS: Three databases (Embase, CINAHL and PubMed) were search from inception until July 21, 2022 using "sedentary" or different types of SB and "fibromyalgia" or "fibrositis" as keywords. The data collected was then analyzed using summary coding. RESULTS: Out of 23 SB correlates retrieved from 7 reports (n = 1698), no correlates were consistently reported (ie, reported in 4 or more studies). Higher pain intensity was the most commonly reported barrier for reducing/interrupting SB (reported in 3 reports). Other reported barriers to reducing/interrupting SB were experiencing physical and mental fatigue, a more severe disease impact, and a lack of motivation to be physically active (all reported in 1 study). A better experienced social and physical functioning and more vitality were facilitators for reducing/interrupting SB (all reported in 1 study). To date, in PwF no correlates of SB at the interpersonal, environmental and policy levels have been explored. CONCLUSION: Research on correlates of SB in PwF is still in its infancy. The current preliminary evidence suggests that clinicians should consider physical and mental barriers when aiming to reduce or interrupt SB in PwF. Further research on modifiable correlates at all levels of the socio-ecological model is required to inform future trials aiming to modify SB in this vulnerable population.
27A minimal dose approach to resistance training for the older adult; the prophylactic for aging.PubMed
James P Fisher, James Steele, Paulo Gentil, et al.
Exp Gerontol. 2017 Dec 1;99:80-86. doi: 10.1016/j.exger.2017.09.012. Epub 2017 Sep 28.
A plethora of research has supported the numerous health benefits of resistance training as we age, including positive relationships between muscular strength, muscle mass and reduced all-cause mortality. As such, resistance training has been referred to as medicine. However, participation and adherence remains low, with time constraints and perceived difficulty often cited as barriers to resistance training. With this in mind, we aimed to summarise the benefits which might be obtained as a product of a minimal dose approach. In this sense, participation in resistance training might serve as a prophylactic to delay or prevent the onset of biological aging. A short review of studies reporting considerable health benefits resulting from low volume resistance training participation is presented, specifically considering the training time, frequency, intensity of effort, and exercises performed. Research supports the considerable physiological and psychological health benefits from resistance training and suggests that these can be obtained using a minimal dose approach (e.g. ≤60min, 2d-wk), using uncomplicated equipment/methods (e.g. weight stack machines). Our hope is that discussion of these specific recommendations, and provision of an example minimal dose workout, will promote resistance training participation by persons who might otherwise have not engaged. We also encourage medical professionals to use this information to prescribe resistance exercise like a drug whilst having an awareness of the health benefits and uncomplicated methods.
28mHealth Interventions for Lifestyle and Risk Factor Modification in Coronary Heart Disease: Randomized Controlled Trial.PubMed
Jang-Whan Bae, Seoung-Il Woo, Joongyub Lee, et al.
JMIR Mhealth Uhealth. 2021 Sep 24;9(9):e29928. doi: 10.2196/29928.
BACKGROUND: Self-management of lifestyle and cardiovascular disease risk factors is challenging in older patients with coronary heart disease (CHD). SMS text messaging could be a potential support tool for self-management and the most affordable and accessible method through a mobile phone. High-quality evidence had been lacking, and previous studies evaluated the effects of SMS text messaging on the subjective measures of short-term outcomes. Recently, a large-sized randomized controlled trial in Australia reported promising findings on the objective measures upon 6-month follow-up. However, an examination of the effectiveness of such interventions in an Asian population with unique demographic characteristics would be worthwhile. OBJECTIVE: This study examined the effectiveness of a 1-way SMS text messaging program to modify the lifestyle and cardiovascular disease risk factors of patients who underwent the first percutaneous coronary intervention (PCI). METHODS: A parallel, single-blinded, 1:1 random allocation clinical trial was conducted with 879 patients treated through PCI. They were recruited during hospital admission from April 2017 to May 2020 at 2 university hospitals in the Republic of Korea. In addition to standard care, the intervention group received access to a supporting website and 4 SMS text messages per week for 6 months regarding a healthy diet, physical activity, smoking cessation, and cardiovascular health. Random allocation upon study enrollment and SMS text messaging after hospital discharge were performed automatically using a computer program. The coprimary outcomes were low-density-lipoprotein cholesterol (LDL-C), systolic blood pressure (SBP), and BMI. The secondary outcomes were change in lifestyle and adherence to the recommended health behaviors. RESULTS: Of the eligible population, 440 and 439 patients who underwent PCI were assigned to the intervention and control groups, respectively. The 1-way SMS text messaging program significantly enhanced physical activity (P=.02), healthy diet (P<.01), and medication adherence (P<.04) among patients with CHD. Hence, more people were likely to control their cardiovascular disease risk factors per the recommendations. The intervention group was more likely to control all 5 risk factors by 62% (relative risk 1.62, 95% CI 1.05-2.50) per the recommendations. On the other hand, physiological measures of the primary outcomes, including LDL-C levels, SBP, and BMI, were not significant. Most participants found the SMS text messaging program useful and helpful in motivating lifestyle changes. CONCLUSIONS: Lifestyle-focused SMS text messages were effective in the self-management of a healthy diet, exercise, and medication adherence, but their influence on the physiological measures was not significant. One-way SMS text messages can be used as an affordable adjuvant method for lifestyle modification to help prevent the recurrence of cardiovascular disease. TRIAL REGISTRATION: Clinical Research Information Service (CRiS) KCT0005087; https://cris.nih.go.kr/cris/search/detailSearch.do/19282.
29Advantages to Using Social-Behavioral Models of Medication Adherence in Research and Practice.PubMed
K Rivet Amico, M Mugavero, Marie A Krousel-Wood, et al.
J Gen Intern Med. 2018 Feb;33(2):207-215. doi: 10.1007/s11606-017-4197-5.
Achieving and sustaining high levels of adherence to medication regimens is essential to improving health outcomes, but continues to be a challenge for a sizable proportion of patients. Decades of research suggests that medication adherence is determined by a complex constellation of factors. Social-behavioral science research has focused on creating frameworks that identify which contextual, personal, social, or drug-related factors appear to most influence adherence. Comprehensive models of adherence propose specific structural relationships between these factors that can be used to plan for, implement, and monitor programs that seek to optimize adherence. The use of social-behavioral models offers multiple advantages in both practice and research environments; however, the breadth and depth of these models can deter many from engaging in this important exercise. To promote the use of social-behavioral frameworks and models of adherence, we provide a brief overview of the advantages in using a social-behavioral lens in adherence work, a sampling of models used in HIV medication adherence research that have high generalizability to other conditions, and practical guidance for grounding adherence promotion strategies in evidence informed by social-behavioral science research.
30Diabetes and exercise in the elderly.PubMed
Eduardo Ferriolli, Fernanda Pinheiro Amador S Pessanha, Juliana Cristina Lemos S Marchesi
Med Sport Sci. 2014;60:122-9. doi: 10.1159/000357342. Epub 2014 Sep 9.
Type 2 diabetes mellitus is highly prevalent among the elderly. Age-associated changes in body composition, obesity and sedentary behavior are some of the main factors responsible for the increased prevalence of diabetes in this population. Elderly patients experience important and specific issues, including the association of comorbidities and geriatric syndromes, use of many medications, the presence of dependencies and frailty. Physical activity has been shown to be as effective for the treatment of diabetes in the elderly as in younger patients, so that its practice must be strongly encouraged. Resistive activities are preferable for the frail and vulnerable diabetic elderly. Aerobic activities should be prescribed whenever possible, and the association of both modalities is the best choice. Moderate- to high-intensity exercises are more effective for glycemic control and, unlike previously thought, are generally safe for the elderly population. The frequency of exercising should be at least 3 days/week for aerobic and 2 days/week for resistance activities. Balance exercises may be beneficial in special situations. In the elderly patient, special care must be taken for: the presence of contraindications for the practice of each exercise modality; the interactions and limitations imposed by medications, chronic comorbidities and geriatric syndromes; the higher possibility of developing hypoglycemia, especially if insulin is used for treatment, and the prevention of orthostatic hypotension that may be worsened by dehydration. The prescription of exercises tailored for each patient's preferences and limitations is highly effective not only for glycemic control, but also for improving independence, self-esteem and quality of life.
31Acute glucoregulatory and vascular outcomes of three strategies for interrupting prolonged sitting time in postmenopausal women: A pilot, laboratory-based, randomized, controlled, 4-condition, 4-period crossover trial.PubMed
Jacqueline Kerr, Katie Crist, Daniela G Vital, et al.
PLoS One. 2017 Nov 30;12(11):e0188544. doi: 10.1371/journal.pone.0188544. eCollection 2017.
BACKGROUND: Prolonged sitting is associated with cardiometabolic and vascular disease. Despite emerging evidence regarding the acute health benefits of interrupting prolonged sitting time, the effectiveness of different modalities in older adults (who sit the most) is unclear. METHODS: In preparation for a future randomized controlled trial, we enrolled 10 sedentary, overweight or obese, postmenopausal women (mean age 66 years ±9; mean body mass index 30.6 kg/m2 ±4.2) in a 4-condition, 4-period crossover feasibility pilot study in San Diego to test 3 different sitting interruption modalities designed to improve glucoregulatory and vascular outcomes compared to a prolonged sitting control condition. The interruption modalities included: a) 2 minutes standing every 20 minutes; b) 2 minutes walking every hour; and c) 10 minutes standing every hour. During each 5-hr condition, participants consumed two identical, standardized meals. Blood samples, blood pressure, and heart rate were collected every 30 minutes. Endothelial function of the superficial femoral artery was measured at baseline and end of each 5-hr condition using flow-mediated dilation (FMD). Participants completed each condition on separate days, in randomized order. This feasibility pilot study was not powered to detect statistically significant differences in the various outcomes, however, analytic methods (mixed models) were used to test statistical significance within the small sample size. RESULTS: Nine participants completed all 4 study visits, one participant completed 3 study visits and then was lost to follow up. Net incremental area under the curve (iAUC) values for postprandial plasma glucose and insulin during the 5-hr sitting interruption conditions were not significantly different compared to the control condition. Exploratory analyses revealed that the 2-minute standing every 20 minutes and the 2-minute walking every hour conditions were associated with a significantly lower glycemic response to the second meal compared to the first meal (i.e., condition-matched 2-hour post-lunch glucose iAUC was lower than 2-hour post-breakfast glucose iAUC) that withstood Bonferroni correction (p = 0.0024 and p = 0.0084, respectively). Using allometrically scaled data, the 10-minute standing every hour condition resulted in an improved FMD response, which was significantly greater than the control condition after Bonferroni correction (p = 0.0033). CONCLUSION: This study suggests that brief interruptions in prolonged sitting time have modality-specific glucoregulatory and vascular benefits and are feasible in an older adult population. Larger laboratory and real-world intervention studies of pragmatic and effective methods to change sitting habits are needed. TRIAL REGISTRATION: ClinicalTrials.gov NCT02743286.
32Association between short-term glucose fluctuations and cognition in patients with acute ischemic stroke complicated by type 2 diabetes mellitus.PubMed
Ruolin Zhou, Chunxiao Wei, Meng Zhao, et al.
J Nutr Health Aging. 2024 Jul;28(7):100252. doi: 10.1016/j.jnha.2024.100252. Epub 2024 Apr 30.
OBJECTIVES: Glucose fluctuations are more harmful than persistent hyperglycemia for chronic complications of diabetes. However, the relationship between cognition and glucose fluctuations in patients with acute ischemic stroke (AIS) complicated by type 2 diabetes mellitus (T2DM) remains unclear. We aimed to evaluate the association between short-term glucose fluctuations and cognition in patients with AIS complicated by T2DM. DESIGN: A cohort study with a 2-year follow-up. SETTING AND PARTICIPANTS: We included 554 patients with mild AIS (mean age: 62 years; 170 females and 384 males). MEASUREMENTS: Glucose variability (GV) was evaluated using glycated hemoglobin (HbA1c), stress hyperglycemia (SHR), standard deviation of blood glucose (SDBG), mean postprandial blood glucose (MPBG), mean amplitude of glycemic excursion (MAGE), and time in range (TIR). We evaluated the relationship between GV, fasting blood glucose (FBG) and cognition during the acute phase using linear regression analysis. We evaluated the relationship between GV, FBG and the occurrence of post-stroke cognitive impairment (PSCI) using a logistic regression model. Mediation analyses were fitted to explore whether the relationships of HbA1c with cognition were mediated by cerebral small vessel disease (CSVD). RESULTS: A clear pattern of age-related GV was observed. Higher SHR in middle-aged participants; higher HbA1c, and lower TIR in older participants; and higher MAGE, MPBG, and SDBG across a broad age range (50-80 years) were associated with cognitive impairment in the acute phase of AIS. Higher SHR and SDBG together with lower TIR in middle-aged participants, higher HbA1c in older participants, and higher FBG, MPBG, and MAGE across a broad age range (50-80 years) were associated with the occurrence of PSCI. The association between HbA1c and cognition was partially mediated (proportion: 7-16%) by CSVD. CONCLUSIONS: Short-term glucose fluctuations are associated with cognition and a higher risk of PSCI in patients with AIS complicated by T2DM. CSVD might play an important role in the relationship between short-term glucose fluctuations and cognition.
33Important Concepts in Protein Nutrition, Aging, and Skeletal Muscle: Honoring Dr Douglas Paddon-Jones (1969-2021) by Highlighting His Research Contributions.PubMed
Emily J Arentson-Lantz, Donald K Layman, Heather J Leidy, et al.
J Nutr. 2023 Mar;153(3):615-621. doi: 10.1016/j.tjnut.2023.01.011. Epub 2023 Jan 11.
This review is a tribute to honor Dr Douglas Paddon-Jones by highlighting his career research contributions. Dr Paddon-Jones was a leader in recognizing the importance of muscle health and the interactions of physical activity and dietary protein for optimizing the health span. Aging is characterized by loss of muscle mass and strength associated with reduced rates of muscle protein synthesis (MPS) and the ability to repair and replace muscle proteins. Research from the team at the University of Texas Medical Branch in Galveston discovered that the age-related decline in MPS could be overcome by increasing the quantity or quality of dietary protein at each meal. Dr Paddon-Jones was instrumental in proposing and testing a "protein threshold" of ∼30 g protein/meal to optimize MPS in older adults. Dr Paddon-Jones demonstrated that physical inactivity greatly accelerates the loss of muscle mass and function in older adults. His work in physical activity led him to propose the "Catabolic Crisis Model" of muscle size and function losses, suggesting that age-related muscle loss is not a linear process, but the result of acute periods of disuse associated with injuries, illnesses, and bed rest. This model creates the opportunity to provide targeted interventions via protein supplementation and/or increased dietary protein through consuming high-quality animal-source foods. He illustrated that nutritional support, particularly enhanced protein quantity, quality, and meal distribution, can help preserve muscle health during periods of inactivity and promote health across the life course.
34Short-duration galvanic vestibular stimulation evokes prolonged balance responses.PubMed
Gregory Martin Lee Son, Jean-Sébastien Blouin, John Timothy Inglis
J Appl Physiol (1985). 2008 Oct;105(4):1210-7. doi: 10.1152/japplphysiol.01398.2006. Epub 2008 Jul 31.
The application of galvanic vestibular stimulation (GVS) evokes distinct responses in lower limb muscles involved in the control of balance. The purpose of this study was to investigate the balance and lower limb muscle responses to short-duration GVS and to determine whether these responses are modulated by small changes in center of gravity (CoG) and baseline muscle activity occurring during quiet standing. Twelve subjects stood quietly on a force plate with their feet together and were instructed to look straight ahead. One thousand twenty-four GVS stimuli (4 mA, 20-ms pulses) were delivered bilaterally to the mastoid processes in a bipolar, binaural configuration. Bilateral surface electromyography (EMG) from soleus (Sol) and tibialis anterior (TA) and ground reaction forces were recorded. EMG and force responses were trigger averaged at the onset of the GVS pulse. Short-duration GVS applied during quiet standing with the head facing forward evoked characteristic balance responses and biphasic modulation of all muscles with the same polarity for ipsilateral Sol and TA. The amplitude of the GVS-evoked muscle responses was modulated by both the estimated position of the subject's CoG and the background activation of the recorded muscle. Muscle-dependent modulations of the GVS-evoked muscle responses were observed: the Sol responses decreased, while the TA responses increased when the CoG position shifted toward the heels. The well-defined balance responses evoked by short-duration GVS are important to acknowledge when studying the vestibulo-motor responses in healthy subjects and patient populations.
35Vestibulospinal influences on lower limb motoneurons.PubMed
Paul M Kennedy, Andrew G Cresswell, Romeo Chua, et al.
Can J Physiol Pharmacol. 2004 Aug-Sep;82(8-9):675-81. doi: 10.1139/y04-080.
Galvanic vestibular stimulation (GVS) is a research tool used to activate the vestibular system in human subjects. When a low-intensity stimulus (1-4 mA) is delivered percutaneously to the vestibular nerve, a transient electromyographic response is observed a short time later in lower limb muscles. Typically, galvanically evoked responses are present when the test muscle is actively engaged in controlling standing balance. However, there is evidence to suggest that GVS may be able to modulate the activity of lower limb muscles when subjects are not in a free-standing situation. The purpose of this review is to examine 2 studies from our laboratory that examined the effects of GVS on the lower limb motoneuron pool. For instance, a monopolar monaural galvanic stimulus modified the amplitude of the ipsilateral soleus H-reflex. Furthermore, bipolar binaural GVS significantly altered the onset of activation and the initial firing frequency of gastrocnemius motor units. The following paper examines the effects of GVS on muscles that are not being used to maintain balance. We propose that GVS is modulating motor output by influencing the activity of presynaptic inhibitory mechanisms that act on the motoneuron pool.
36The effects of muscle activation on postural stability in diabetes mellitus patients with cutaneous sensory deficit in the foot.PubMed
R W Simmons, C Richardson
Diabetes Res Clin Pract. 2001 Jul;53(1):25-32. doi: 10.1016/s0168-8227(01)00231-5.
Activity of the lower leg muscles in response to an unexpected disturbance to upright standing was studied in diabetic patients and non-diabetic matched controls. The diabetic individuals were classified into two groups: diabetic patients with normal cutaneous sensitivity in the foot (n=27) and patients with cutaneous sensory deficit (n=23). All participants completed twenty trials standing on a force platform that rotated upward 8 deg at 50 deg/s. This movement produced short-latency and medium-latency responses in the gastrocnemius muscle and a single long-latency response in the anterior tibialis. All muscle activity was assessed using electromyography techniques. Results indicated that the average delay of the short-, medium- and long-latency responses produced by the diabetic groups was comparable to control group values. However, the within subject variability associated with activating the anterior tibialis was found to be statistically greater for the cutaneous deficit diabetic group. Additionally, fifty percent of the CD group failed to produce an observable stretch reflex response. The results suggest that the inability to generate a neuromuscular response with consistent temporal patterning is a contributing factor to greater postural sway observed in diabetic patients with cutaneous sensory deficit in the foot.
37Energy expenditure and muscle activity during lying, sitting, standing, and walking in people with motor-incomplete spinal cord injury.PubMed
Bart Dekker, Olaf Verschuren, Astrid C J Balemans, et al.
Spinal Cord. 2018 Oct;56(10):1008-1016. doi: 10.1038/s41393-018-0167-y. Epub 2018 Jun 28.
STUDY DESIGN: Cross-sectional exploratory study. OBJECTIVES: To determine oxygen uptake (VO), energy expenditure (EE), and muscle activity (MA) during lying (rest), sitting, standing, and walking among ambulatory individuals with spinal cord Injury (SCI) and to compare VO, EE, and MA between individuals with different levels of ambulation. SETTING: Rehabilitation institution with a spinal cord injury unit. METHODS: A total of 22 adults with motor-incomplete SCI, ten in a low-ambulation group (non-functional or household walker) and 12 in a high-ambulation group (community or normal walker). VO was measured using indirect calorimetry. EE was expressed in metabolic equivalent of task (MET). MA was measured using a wireless surface electromyography device. RESULTS: Mean VO was 3.19 ml/kg/min. During lying and sitting, EE was below 1.5 METs for all participants. During standing, three participants of the low-ambulation group and none in the high-ambulation group showed MET values of >1.5. In the walking condition, all participants showed MET values above 1.5. MA during stance was higher compared to the sitting condition and significantly higher in the low-ambulation group compared to the high-ambulation group. CONCLUSION: Lying, supported- and unsupported sitting, without moving, appear to be sedentary behaviors for ambulatory individuals with a motor-incomplete SCI (MET values of <1.5 and a lack of MA). Walking, but not standing, is a moderate physical activity (>1.5 METs), which can be used by all individuals with motor-incomplete SCI to interrupt sedentary behavior.
38In vivo, fatty acid translocase (CD36) critically regulates skeletal muscle fuel selection, exercise performance, and training-induced adaptation of fatty acid oxidation.PubMed
Jay T McFarlan, Yuko Yoshida, Swati S Jain, et al.
J Biol Chem. 2012 Jul 6;287(28):23502-16. doi: 10.1074/jbc.M111.315358. Epub 2012 May 14.
For ~40 years it has been widely accepted that (i) the exercise-induced increase in muscle fatty acid oxidation (FAO) is dependent on the increased delivery of circulating fatty acids, and (ii) exercise training-induced FAO up-regulation is largely attributable to muscle mitochondrial biogenesis. These long standing concepts were developed prior to the recent recognition that fatty acid entry into muscle occurs via a regulatable sarcolemmal CD36-mediated mechanism. We examined the role of CD36 in muscle fuel selection under basal conditions, during a metabolic challenge (exercise), and after exercise training. We also investigated whether CD36 overexpression, independent of mitochondrial changes, mimicked exercise training-induced FAO up-regulation. Under basal conditions CD36-KO versus WT mice displayed reduced fatty acid transport (-21%) and oxidation (-25%), intramuscular lipids (less than or equal to -31%), and hepatic glycogen (-20%); but muscle glycogen, VO(2max), and mitochondrial content and enzymes did not differ. In acutely exercised (78% VO(2max)) CD36-KO mice, fatty acid transport (-41%), oxidation (-37%), and exercise duration (-44%) were reduced, whereas muscle and hepatic glycogen depletions were accelerated by 27-55%, revealing 2-fold greater carbohydrate use. Exercise training increased mtDNA and β-hydroxyacyl-CoA dehydrogenase similarly in WT and CD36-KO muscles, but FAO was increased only in WT muscle (+90%). Comparable CD36 increases, induced by exercise training (+44%) or by CD36 overexpression (+41%), increased FAO similarly (84-90%), either when mitochondrial biogenesis and FAO enzymes were up-regulated (exercise training) or when these were unaltered (CD36 overexpression). Thus, sarcolemmal CD36 has a key role in muscle fuel selection, exercise performance, and training-induced muscle FAO adaptation, challenging long held views of mechanisms involved in acute and adaptive regulation of muscle FAO.
39Superior Effects of Eccentric to Concentric Knee Extensor Resistance Training on Physical Fitness, Insulin Sensitivity and Lipid Profiles of Elderly Men.PubMed
Trevor Chung-Ching Chen, Wei-Chin Tseng, Guan-Ling Huang, et al.
Front Physiol. 2017 Apr 10;8:209. doi: 10.3389/fphys.2017.00209. eCollection 2017.
It has been reported that eccentric training of knee extensors is effective for improving blood insulin sensitivity and lipid profiles to a greater extent than concentric training in young women. However, it is not known whether this is also the case for elderly individuals. Thus, the present study tested the hypothesis that eccentric training of the knee extensors would improve physical function and health parameters (e.g., blood lipid profiles) of older adults better than concentric training. Healthy elderly men (60-76 years) were assigned to either eccentric training or concentric training group ( = 13/group), and performed 30-60 eccentric or concentric contractions of knee extensors once a week. The intensity was progressively increased over 12 weeks from 10 to 100% of maximal concentric strength for eccentric training and from 50 to 100% for concentric training. Outcome measures were taken before and 4 days after the training period. The results showed that no sings of muscle damage were observed after any sessions. Functional physical fitness (e.g., 30-s chair stand) and maximal concentric contraction strength of the knee extensors increased greater ( ≤ 0.05) after eccentric training than concentric training. Homeostasis model assessment, oral glucose tolerance test and whole blood glycosylated hemoglobin showed improvement of insulin sensitivity only after eccentric training ( ≤ 0.05). Greater ( ≤ 0.05) decreases in fasting triacylglycerols, total, and low-density lipoprotein cholesterols were evident after eccentric training than concentric training, and high-density lipoprotein cholesterols increased only after eccentric training. These results support the hypothesis and suggest that it is better to focus on eccentric contractions in exercise medicine.
40Changes in plasma C1q, apelin and adropin concentrations in older adults after descending and ascending stair walking intervention.PubMed
Trevor C Chen, Tsang-Hai Huang, Wei-Chin Tseng, et al.
Sci Rep. 2021 Sep 3;11(1):17644. doi: 10.1038/s41598-021-96631-x.
This study compared changes in plasma complement component 1q (C1q), apelin and adropin concentrations in older obese women after descending (DSW) and ascending stair walking (ASW) training (n = 15/group) performed twice a week for 12 weeks, with gradual increases in exercise time from 5 to 60 min. Fasting blood samples were collected 3 days before the first and 4 days after the last training session. The improvements in the maximal voluntary isometric contraction (MVIC) strength of the knee extensors, functional physical fitness [e.g., 30-s chair stand (CS) performance], resting systolic blood pressure (SBP), insulin sensitivity [e.g., oral glucose tolerance test (OGTT)] and blood lipid profiles [e.g., total cholesterol (TC)] were greater (p < 0.05) in the DSW than ASW group. Plasma C1q decreased (- 51 ± 30%), and apelin (23 ± 15%) and adropin (127 ± 106%) increased (p ≤ .0.05) only after DSW. Significant (p ≤ 0.01) partial correlations were found between the pre- to post-DSW changes in C1q, apelin or adropin and changes in outcome measures [e.g., C1q and MVIC (r = - 0.837), apelin and SBP (r = - 0.854), and andropin and OGTT (r = - 0.729)]. These results showed that greater decreases in plasma C1q and greater increases in apelin and adropin concentrations were associated with greater improvements in outcome measures after DSW than after ASW.
41Effects of arm and leg positions on lumbar multifidus muscle activity while on hands and knees or while standing.PubMed
Yasuhiro Mitani, Masaru Hanafusa, Junichi Hashimoto, et al.
J Physiol Anthropol. 2022 Mar 7;41(1):6. doi: 10.1186/s40101-022-00279-z.
BACKGROUND: The lumbar multifidus (LMF) muscle, which is involved in the mechanical stability of the lumbar spine, reportedly undergoes atrophy in patients with low back pain. Preventing or mitigating low back pain requires strengthening the LMF muscle; however, methods for triggering selective and significant contraction of this muscle have not been fully studied. This study aims to clarify how, in the hands-and-knees or standing position, the position of the arm and leg on one side affects the activity of the lumbar erector spinae (LES) and LMF muscles. METHODS: We recruited nine adult men with no prior history of low back pain. Measurements were taken in four different postures under varying conditions (that is, one arm and one leg were lifted in either the hands-and-knees or standing position,) as follows: (1) shoulder joint flexion and hip joint extension in the hands-and-knees position; (2) 90° shoulder joint abduction and hip joint abduction in the hands-and-knees position; (3) shoulder joint flexion and hip joint extension in the standing position; and (4) 90° shoulder joint abduction and hip joint abduction in the standing position. The 90° shoulder joint abduction involved simultaneous horizontal abduction, while the hip joint abduction involved simultaneous extension. Muscle activity of the LES and LMF in each posture was measured using a surface electromyograph. RESULTS: Muscle activity of the LMF was significantly higher in 90° shoulder joint abduction and hip joint abduction than in shoulder joint flexion and hip joint extension in both the hands-and-knees and standing positions. The LES muscle showed no significant differences in activity between each posture. CONCLUSIONS: The results suggest that unilateral 90° shoulder joint abduction and contralateral hip joint abduction in the hands-and-knees and standing positions may produce selective and significant contraction of the LMF muscle.
42How do different standing positions affect trunk muscle activation in LBP-developers during prolonged standing?PubMed
Saeedeh Abbasi, Hooman Minoonejad, Hamed Abbasi, et al.
BMC Musculoskelet Disord. 2025 Mar 26;26(1):299. doi: 10.1186/s12891-025-08525-y.
BACKGROUND: Low back pain developers (PDs) are individuals at a high risk of developing low back pain (LBP), especially during prolonged standing. Understanding their characteristics is essential for devising effective preventive strategies. Prolonged standing has been associated with increased co-contraction of trunk muscles and elevated activity of the trunk extensor muscles. This study aims to examine the effects of using a normalized footrest height and altering arm positions on muscle activity in PDs. METHODS: Twenty-four female PDs, identified by a > 10 mm increase on the visual analog scale (VAS) during prolonged standing, were recruited. They were randomly divided into two groups: Group A used a footrest intermittently, while Group B used a footrest combined with changes in arm positions (shoulder flexion and hands crossed on the clavicles). Muscle activity was monitored using electromyography (EMG) over a one-hour standing protocol. RESULTS: Both interventions significantly reduced lumbar erector spinae (LES) muscle activity, as well as co-contraction of the trunk flexor and extensor muscles (p < 0.05). The group that adjusted their arm positions (Group B) experienced a greater reduction in muscle activity (p = 0.05). Additionally, transversus abdominis (TrA) muscle activity slightly increased in both groups, with a more notable increase in Group B (p > 0.05). Although lumbar spine muscle activity decreased, thoracic spine extensor (TES) activity increased in Group B. This increase is attributed to the engagement of the thoracic spine during upper limb movement, compensating for the reduced lumbar muscle activity, which may help alleviate back pain. CONCLUSIONS: Using footrests cyclically and adjusting arm positions can help prevent back pain during prolonged standing by promoting muscle relaxation, reducing fatigue, and improving posture. These findings offer practical strategies for enhancing workplace ergonomics, particularly for occupations involving prolonged standing. TRIAL REGISTRATION: This study is registered in the Clinical Trial Registry ( http://www.irct.ir/ ) with Trial ID 71,648 and IRCT ID IRCT20230628058610N1, dated January 20, 2024.
43Effect of crank length on biomechanical parameters and muscle activity during standing cycling.PubMed
Sumin Park, Jongryun Roh, Joonho Hyeong, et al.
J Sports Sci. 2022 Jan;40(2):185-194. doi: 10.1080/02640414.2021.1982516. Epub 2021 Sep 28.
This study investigated the effect of crank length on biomechanical parameters and muscle activity during standing cycling. Ten participants performed submaximal cycling trials on a stand-up bicycle using four crank lengths. Joint angles, moments, powers, and works of the lower limbs were calculated from motion data and pedal reaction forces. Electromyographic (EMG) data were recorded from gluteus maximus (GM), vastus medialis, rectus femoris, biceps femoris (BF), gastrocnemius medialis, soleus, and tibialis anterior, and used to obtain the integrated EMG. Statistical parametric mapping was employed to analyse the biomechanical parameters throughout the pedalling cycle. Knee and hip flexion angles and hip power increased at the initiation (0-20%) of pedalling with increasing crank length, while the BF and GM muscle activities increased during propulsion (20-40%). Additionally, increasing the crank length resulted in increased knee power absorption during upstroke phase (70-100%). Peak knee extension moment increased with decreasing crank length during propulsion, but the moment at a short crank length during propulsion was comparable to fast walking. Consequently, longer crank lengths require increased propulsion power by the lower limb muscles during standing cycling compared to shorter crank lengths. Therefore, shorter crank lengths are recommended for stand-up bicycles to avoid fatigue.
44Differences of energy expenditure while sitting versus standing: A systematic review and meta-analysis.PubMed
Farzane Saeidifard, Jose R Medina-Inojosa, Marta Supervia, et al.
Eur J Prev Cardiol. 2018 Mar;25(5):522-538. doi: 10.1177/2047487317752186. Epub 2018 Jan 31.
Background Replacing sitting with standing is one of several recommendations to decrease sedentary time and increase the daily energy expenditure, but the difference in energy expenditure between standing versus sitting has been controversial. This systematic review and meta-analysis aimed to determine this difference. Designs and methods We searched Ovid MEDLINE, Ovid Embase Scopus, Web of Science and Google Scholar for observational and experimental studies that compared the energy expenditure of standing versus sitting. We calculated mean differences and 95% confidence intervals using a random effects model. We conducted different predefined subgroup analyses based on characteristics of participants and study design. Results We identified 658 studies and included 46 studies with 1184 participants for the final analysis. The mean difference in energy expenditure between sitting and standing was 0.15 kcal/min (95% confidence interval (CI) 0.12-0.17). The difference among women was 0.1 kcal/min (95% CI 0.0-0.21), and was 0.19 kcal/min (95% CI 0.05-0.33) in men. Observational studies had a lower difference in energy expenditure (0.11 kcal/min, 95% CI 0.08-0.14) compared to randomised trials (0.2 kcal/min, 95% CI 0.12-0.28). By substituting sitting with standing for 6 hours/day, a 65 kg person will expend an additional 54 kcal/day. Assuming no increase in energy intake, this difference in energy expenditure would be translated into the energy content of about 2.5 kg of body fat mass in 1 year. Conclusions The substitution of sitting with standing could be a potential solution for a sedentary lifestyle to prevent weight gain in the long term. Future studies should aim to assess the effectiveness and feasibility of this strategy.
45Energy expenditure of deskwork when sitting, standing or alternating positions.PubMed
B Barone Gibbs, R J Kowalsky, S J Perdomo, et al.
Occup Med (Lond). 2017 Mar 1;67(2):121-127. doi: 10.1093/occmed/kqw115.
BACKGROUND: Recent guidelines recommend accruing 2-4h of standing or light activity during the working day. Use of sit-stand desks could achieve this goal, but whether standing can meaningfully increase energy expenditure (EE) is unclear. AIMS: To study EE, heart rate, feelings and productivity during deskwork while sitting, standing or alternating positions. METHODS: We measured EE by indirect calorimetry in working adults over three randomly ordered 60-min conditions while performing deskwork: continuous sitting (SIT), 30min of each standing and sitting (STAND-SIT) and continuous standing (STAND). We also assessed heart rate, productivity and self-reported energy, fatigue and pain. Linear mixed models compared minute-by-minute EE and heart rate across conditions. Non-parametric tests compared remaining outcomes across conditions. RESULTS: The study group comprised 18 working adults. Compared with SIT, STAND-SIT engendered an additional 5.5±12.4 kcal/h (7.8% increase) and STAND engendered an additional 8.2±15.9 kcal/h (11.5% increase) (both P < 0.001). Alternating positions to achieve the recommended 4h/day of standing could result in an additional 56.9 kcal/day for an 88.9kg man and 48.3 kcal/day for a 75.5kg woman. STAND-SIT and STAND also increased heart rate over SIT by 7.5±6.8 and 13.7±8.8 bpm, respectively (both P < 0.001). We observed no meaningful differences in feelings or productivity. CONCLUSIONS: Desk-based workers could increase EE without added discomfort by using a sit-stand desk. These findings inform future research on sit-stand desks as a part of workplace interventions to increase EE and potentially improve health.
46Effects of Standing after a Meal on Glucose Metabolism and Energy Expenditure.PubMed
Hiroya Kono, Kento Furuta, Takumi Sakamoto, et al.
Int J Environ Res Public Health. 2023 Oct 17;20(20):6934. doi: 10.3390/ijerph20206934.
In the past decade, university students have become more sedentary. A sedentary lifestyle is associated with an increased risk of obesity and cardiovascular disease. Methods that decrease sedentary lifestyles, such as the use of standing desks to increase physical activity, have been extensively examined. However, the effects of postprandial standing and sitting on energy metabolism have not yet been compared. Therefore, the present study investigated the effects of standing after a meal on energy expenditure and glucose metabolism. Ten males participated in the present study. The experiment was initiated with 300 g of rice ingested as a carbohydrate load. The subjects maintained a standing or sitting position for 120 min after the meal. Energy expenditure was calculated from VO and VCO using the indirect calorimetry method. Glucose metabolism was assessed by measuring blood glucose levels and the exogenous glucose metabolic rate. Energy expenditure through standing after eating was approximately 0.16 ± 0.08 kcal/min higher than that through sitting. Blood glucose dynamics did not significantly differ between the standing and sitting positions. Furthermore, no significant differences were observed in the dynamics of the exogenous glucose metabolic rate between the standing and sitting positions. Standing for 2 h after a meal increased energy expenditure by 10.7 ± 4.6% without affecting glucose metabolism.
47Energy Cost of Standing in a Multi-Ethnic Cohort: Are Energy-Savers a Minority or the Majority?PubMed
Cathríona R Monnard, Jennifer L Miles-Chan
PLoS One. 2017 Jan 5;12(1):e0169478. doi: 10.1371/journal.pone.0169478. eCollection 2017.
BACKGROUND: The disease risks associated with sedentary behavior are now firmly established, and consequently there is much interest in methods of increasing low-intensity physical activity. In this context, it is a widely held belief that altering posture allocation can modify energy expenditure (EE) to impact upon body weight regulation and health. However, we recently showed the existence of two distinct phenotypes pertaining to the energy cost of standing-with the majority of a Caucasian cohort showing no sustained increase in EE during standing relative to sitting. Here we investigated whether this phenomenon is also observed across a multi-ethnic male cohort. OBJECTIVE: To determine the magnitude and time-course of changes in EE and respiratory quotient (RQ) during steady-state standing versus sitting, and to explore inter-individual variability in these responses across 4 ethnic groups (European, Indian, Chinese, African). DESIGN: Min-by-min monitoring using posture-adapted ventilated-hood indirect calorimetry was conducted in 35 healthy, men (20-43 years) during 10 min of steady-state standing versus sitting comfortably. RESULTS: 69% of subjects showed little or no increase (<5%) in EE during standing compared to sitting (energy savers). Furthermore, the proportion of energy savers did not significantly differ between ethnic groups, despite ethnic differences in anthropometry; with body weight as the primary predictor of the energy cost of standing maintenance (r2 = 0.30, p = 0.001). CONCLUSION: Our results indicate that the majority of individuals in a multi-ethnic cohort display a postural energy-saver phenotype. The mechanisms by which the large majority of individuals appear to maintain sitting and standing postures at the same energetic cost remains to be elucidated but is of considerable importance to our understanding of the spontaneous physical activity compartment of EE and its potential as a target for weight regulation.
48What is the metabolic and energy cost of sitting, standing and sit/stand transitions?PubMed
Pedro B Júdice, Marc T Hamilton, Luís B Sardinha, et al.
Eur J Appl Physiol. 2016 Feb;116(2):263-73. doi: 10.1007/s00421-015-3279-5.
PURPOSE: Modern lifestyles require people to spend prolonged periods of sitting, and public health messages recommend replacing sitting with as much standing as is feasible. The metabolic/energy cost (MEC) of sitting and standing is poorly understood, and MEC associated with a transition from sitting to standing has not been reported. Thus, we carefully quantified the MEC for sitting, standing and sit/stand transitions, adjusting for age and fat-free mass (FFM) in a sample of adults with no known disease. METHODS: Participants (N = 50; 25 women), 20–64 years, randomly performed three conditions for 10 min each (sitting, standing, 1 sit/stand transition min(−1) and then sitting back down). MEC was measured by indirect calorimetry and FFM by dual-energy X-ray absorptiometry. RESULTS: V̇O2 (ml kg(−1) min(−1)) for sitting (2.93 ± 0.61; 2.87 ± 0.37 in men and women respectively), standing (3.16 ± 0.63; 3.03 ± 0.40), and steady-state cost of repeated sit/stand transitions (1 min(−1)) (3.86 ± 0.75; 3.79 ± 0.57) were significantly different regardless of sex and weight (p < 0.001). EE (kcal min(−1)) also differed from sitting (1.14 ± 0.18; 0.88 ± 0.11), to standing (1.23 ± 0.19; 0.92 ± 0.13), and sit/stand transitions (1 min(−1)) (1.49 ± 0.25; 1.16 ± 0.16). Heart-rate increased from sitting to standing (~13 bpm; p < 0.001). Neither sex nor FFM influenced the results (p ≥ 0.05). CONCLUSIONS: This study found in a sample of adults with no known disease that continuous standing raised MEC 0.07 kcal min(−1) above normal sitting. The transition from sitting to standing (and return to sitting) had a metabolic cost of 0.32 kcal min(−1) above sitting. Therefore, public health messages recommending to interrupt sitting frequently should be informed of the modest energetic costs regardless of sex and body composition.
49Metabolic Effect of Breaking Up Prolonged Sitting with Stair Climbing Exercise Snacks.PubMed
Hossein Rafiei, Kosar Omidian, Étienne Myette-Côté, et al.
Med Sci Sports Exerc. 2021 Jan;53(1):150-158. doi: 10.1249/MSS.0000000000002431.
PURPOSE: Prolonged sitting is associated with cardiometabolic complications. The study purpose was to investigate whether breaking up prolonged sitting with brief stair climbing exercise "snacks" could lower postprandial insulin, glucose, and free fatty acids responses. METHODS: In two separate randomized crossover studies, 12 young healthy-weight men (study 1) and 11 adults with overweight/obesity (OW; study 2) completed two experimental conditions: i) sedentary (SED; 9-h sitting) and ii) stair climbing snacks (SS; 8 × 15-30 s once per hour). The same high-glycemic index meals were consumed at 0, 3, and 6 h at each condition. The primary outcome was total insulin area under the curve (AUC) across 9 h. RESULTS: In healthy-weight men, there were no significant differences between SS and SED for total (9-h) insulin AUC (P = 0.24, d = 0.4), total glucose AUC (P = 0.17, d = 0.48), total nonesterified fatty acid (NEFA) AUC (P = 0.22, d = 0.4), or total triglyceride AUC (P = 0.72). In adults with OW, total insulin AUC (-16.5%, P = 0.036, d = 0.94) and total NEFA AUC (-21%, P = 0.016, d = 1.2) were significantly lower in SS versus SED. No differences were found for total glucose and triglyceride AUC (all, P > 0.31) in participants with OW. CONCLUSIONS: Breaking up 9 h of prolonged sitting with hourly brief stair climbing exercise snacks lowered postprandial insulin and NEFA levels in adults with overweight/obesity.
50The Acute Effects of Interrupting Prolonged Sitting Time in Adults with Standing and Light-Intensity Walking on Biomarkers of Cardiometabolic Health in Adults: A Systematic Review and Meta-analysis.PubMed
Aidan J Buffey, Matthew P Herring, Christina K Langley, et al.
Sports Med. 2022 Aug;52(8):1765-1787. doi: 10.1007/s40279-022-01649-4. Epub 2022 Feb 11.
BACKGROUND: Increasing evidence highlights that accumulating sitting time in prolonged bouts is detrimental to cardiometabolic health. OBJECTIVES: This systematic review aimed to compare the effects of fractionating prolonged sitting with frequent short bouts of standing and light-intensity walking on cardiometabolic health markers and conduct a meta-analysis for differences in systolic blood pressure (SBP), postprandial glucose and insulin. METHODS: Experimental randomised crossover trials with at least three intervention arms that assessed interrupting sitting with frequent short bouts of standing and light-intensity walking over a single day compared to a prolonged sitting condition were retrieved. These studies measured at minimum one marker of cardiometabolic health in adults > 18 years. An electronic search was completed on the 2nd of August 2021, searching PubMed and Web of Science Core Collection, Scopus, Embase, Cochrane Library and APA PsycINFO. Risk of bias was assessed using a modified Downs and Black checklist. A meta-analysis was conducted using calculated Cohen's d quantifying the magnitude of difference between experimental conditions. RESULTS: Seven studies met the inclusion criteria for the systematic review. All seven studies were included within the meta-analysis for postprandial glucose, four studies were pooled for postprandial insulin and three for SBP. Biomarkers of cardiometabolic health were discussed qualitatively if fewer than three studies measured and reported the variable. A meta-analysis of seven acute, 1-day randomised crossover trials that sampled mixed-sex adults (aged > 18 years) who were predominately overweight or participants with obesity found that standing as an interruption to prolonged sitting significantly reduced postprandial glucose (∆ = - 0.31, 95% CI - 0.60, - 0.03; z = - 2.15, p < 0.04) but had no significant effect on insulin or SBP. Light-intensity walking was shown to significantly attenuate postprandial glucose (∆ = - 0.72, 95% CI - 1.03, - 0.41; z = - 4.57, p < 0.001) and insulin (∆ = - 0.83, 95% CI - 1.18, - 0.48; z = - 4.66, p < 0.001) compared to continued sitting. When comparing light-intensity walking breaks compared to standing breaks a significant reduction in glucose (∆ = - 0.30, 95% CI - 0.52, - 0.08; z = -2.64, p < 0.009) and insulin (∆ = - 0.54, 95% CI - 0.75, - 0.33; z = -4.98, p < 0.001) was observed. Both standing and light-intensity walking showed no effect on SBP. CONCLUSIONS: Frequent short interruptions of standing significantly attenuated postprandial glucose compared to prolonged sitting; however, light-intensity walking was found to represent a superior physical activity break. The feasibility and longitudinal implications of breaking sedentary behaviour with light-intensity walking should be investigated in a free-living setting. REGISTRATION: Not available.
51The effects of prolonged sitting, prolonged standing, and activity breaks on vascular function, and postprandial glucose and insulin responses: A randomised crossover trial.PubMed
Meredith C Peddie, Chris Kessell, Tom Bergen, et al.
PLoS One. 2021 Jan 4;16(1):e0244841. doi: 10.1371/journal.pone.0244841. eCollection 2021.
The objective of this study was to compare acute effects of prolonged sitting, prolonged standing and sitting interrupted with regular activity breaks on vascular function and postprandial glucose metabolism. In a randomized cross-over trial, 18 adults completed: 1. Prolonged Sitting; 2. Prolonged Standing and 3. Sitting with 2-min walking (5 km/h, 10% incline) every 30 min (Regular Activity Breaks). Flow mediated dilation (FMD) was measured in the popliteal artery at baseline and 6 h. Popliteal artery hemodynamics, and postprandial plasma glucose and insulin were measured over 6 h. Neither raw nor allometrically-scaled FMD showed an intervention effect (p = 0.285 and 0.159 respectively). Compared to Prolonged Sitting, Regular Activity Breaks increased blood flow (overall effect of intervention p<0.001; difference = 80%; 95% CI 34 to 125%; p = 0.001) and net shear rate (overall effect of intervention p<0.001; difference = 72%; 95% CI 30 to 114%; p = 0.001) at 60 min. These differences were then maintained for the entire 6 h. Prolonged Standing increased blood flow at 60 min only (overall effect of intervention p<0.001; difference = 62%; 95% CI 28 to 97%; p = 0.001). Regular Activity Breaks decreased insulin incremental area under the curve (iAUC) when compared to both Prolonged Sitting (overall effect of intervention P = 0.001; difference = 28%; 95% CI 14 to 38%; p<0.01) and Prolonged Standing (difference = 19%; 95% CI 4 to 32%, p = 0.015). There was no intervention effect on glucose iAUC or total AUC (p = 0.254 and 0.450, respectively). In normal-weight participants, Regular Activity Breaks induce increases in blood flow, shear stress and improvements in postprandial metabolism that are associated with beneficial adaptations. Physical activity and sedentary behaviour messages should perhaps focus more on the importance of frequent movement rather than simply replacing sitting with standing.
52Alternating bouts of sitting and standing attenuate postprandial glucose responses.PubMed
Alicia Ann Thorp, Bronwyn A Kingwell, Parneet Sethi, et al.
Med Sci Sports Exerc. 2014 Nov;46(11):2053-61. doi: 10.1249/MSS.0000000000000337.
PURPOSE: This study aimed to examine whether reductions in sitting time through alternating 30-min bouts of sitting and standing can reduce postprandial glucose, insulin, and triglyceride responses. METHODS: Twenty-three overweight/obese sedentary office workers (17 males and six females; mean ± SD: age, 48.2 ± 7.9 yr; body mass index, 29.6 ± 4.0 kg · m(-2)) undertook two short-term (5 d) experimental conditions in an equal, randomized (1:1) order. In a simulated office environment, participants performed typical occupational tasks for 8 h · d(-1) while in a 1) seated work posture (control condition) or 2) interchanging between a seated and standing work posture every 30 min using an electric, height-adjustable workstation (intervention condition). Fasting and postprandial blood samples after a mixed test drink were collected hourly for 4 h on days 1 and 5 of each condition to assess serum insulin, plasma glucose, and triglycerides. Dietary intake (kJ · d(-1)) and physical activity were standardized during each condition. The trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12611000632998). RESULTS: After adjustment for time (days 1 and 5), incremental area under the analyte time curve differed significantly between conditions for plasma glucose (P = 0.007) but not for serum insulin or plasma triglycerides. Adjusted mean glucose incremental area under the analyte time curve was lowered by 11.1% after the intervention condition (6.38 mM · h(-1) (confidence interval, 5.04-7.71)) relative to the control condition (7.18 mM · h(-1) (confidence interval, 5.85-8.52)). No temporal changes (days 1 vs 5) between conditions were observed. CONCLUSIONS: Alternating standing and sitting in 30-min bouts results in modest beneficial effects on postprandial glucose responses in overweight/obese office workers.
53Intermittent standing does not acutely improve postprandial metabolism in university students.PubMed
Alfie G Price, Eleanor L Procter, Ruth Boat, et al.
J Sports Sci. 2024 Dec;42(24):2517-2526. doi: 10.1080/02640414.2024.2447664. Epub 2025 Jan 13.
Height-adjustable workstations offer a practical strategy to reduce sedentary behaviour in student populations, but the effect of standing intervals on young adults' metabolic health remains uncertain. This study investigated the acute impact of breaking up sitting time with intermittent standing on postprandial metabolic responses in university students. Using a randomised, cross-over design, 23 participants (13 females, 10 males; age, 24 ± 5 years; BMI, 23.2 ± 3.1 kg/m) completed two trials: 2 hours of uninterrupted sitting (SIT); and 2 hours alternating between sitting and standing every 30 minutes (STAND). During this period, participants underwent an oral glucose tolerance test, with [glucose] and [insulin] measured. food intake post intervention was also measured. No significant effects between trials nor trial × time interaction was found for [glucose] or [insulin] (all > 0.05). The postprandial iAUC did not differ for [glucose] ( = 0.824; SIT: 222 ± 83 mmol/L; STAND: 225 ± 90 mmol/L) or [insulin] ( = 0.269; SIT: 17507 ± 9738 pmol/L; STAND: 15649 ± 10181 pmol/L). There were no differences in energy or macronutrient intake between trials. These findings indicate that interrupting sitting with 30-minute standing intervals does not improve postprandial metabolic responses in young, normal-weight adults.
54Successfully Reducing Sitting Time Can Improve Metabolic Flexibility.PubMed
Taru Garthwaite, Tanja Sjöros, Saara Laine, et al.
Scand J Med Sci Sports. 2025 Aug;35(8):e70113. doi: 10.1111/sms.70113.
Impaired metabolic flexibility (MetFlex; the ability to regulate substrate oxidation) and sedentary behavior are both linked to cardiometabolic diseases, but the relationship between the two is not fully elucidated. This study investigated the effects of reduced sedentary time on MetFlex. Sixty-four sedentary adults with metabolic syndrome were randomized into intervention (INT, n = 33) and control (CON, n = 31) groups. INT aimed to reduce sedentary time by 1 h/day by increasing standing and non-exercise physical activity (PA) for 6 months, with continuous accelerometry. Substrate oxidation and MetFlex [ΔRER (respiratory exchange ratio)] from fasting to hyperinsulinemic-euglycemic clamp and low- to maximal-intensity exercise were assessed with indirect calorimetry. Intervention effects between INT and CON were analyzed with mixed models, and secondary analyses examined the effects based on accelerometer-derived behavior changes. INT reduced sedentary time by 41 min/day. Neither insulin- nor exercise-stimulated MetFlex changed in INT or CON, but carbohydrate oxidation during maximal exercise changed differently, favoring INT [INT +2.6 (95% CI: -6.1, 0.8), CON -1.4 (-2.1, 4.9) mg/kg/min; group * time p = 0.03]. In secondary analyses, those who successfully reduced sedentary time by at least 30 min/day (n = 34) improved insulin-stimulated MetFlex and low-intensity exercise fat oxidation compared to the continuously sedentary (n = 30) [ΔRER +0.03 (-0.01, 0.07) vs. -0.02 (-0.06, 0.03); and FATox +0.2 (-0.3, 0.7) vs. -0.4 (-1.0, 1.0) mg/kg/min, group * time p < 0.05]. Changes in insulin-stimulated MetFlex correlated with changes in standing and insulin sensitivity. Thus, successfully reducing daily sitting by at least half an hour can improve MetFlex, with parallel insulin sensitivity enhancements, and aid in cardiometabolic disease prevention in risk populations. Trial Registration: https://www.clinicaltrials.gov/study/NCT03101228.
55Clinical and physiological advances in sedentary behavior research.PubMed
Ilkka Heinonen
Front Physiol. 2024 Mar 14;15:1348122. doi: 10.3389/fphys.2024.1348122. eCollection 2024.
Sedentary behavior, defined as sitting with low energy expenditure, has emerged as a modifiable risk factor that affects our physiology and health. Evidence for the detrimental effects of sedentary behavior/physical inactivity on health, however, stems largely from epidemiological studies, which cannot address causalities. Acute and short-term sedentary behavior reduction interventions have been performed; however, in these studies, sitting has often been replaced by formal physical activity options, such as exercise, and long-term studies in subjects with cardiometabolic risk factors are still relatively few. We have recently conducted a long-term randomized controlled trial (RCT) to reduce daily sitting, without formal exercise, in metabolic syndrome patients, and this mini-review presents these studies with physiological aspects. The findings indicate that sedentary behavior reduction can prevent the increase in levels of many cardiometabolic risk factors after 3 months, but more intense physical activity rather than only reducing daily sitting time may be needed to further reduce the risk factor levels. At 6-month time point reduced sitting reduced fasting insulin, while successfully reducing sitting and body fat had beneficial effects also on whole-body insulin sensitivity, but other effects were relatively minor. Reduced sitting did not improve maximal aerobic fitness after 6 months, but an increase in daily steps was positively associated with an increase in fitness. However, the more the participants replaced sitting with standing, the more their maximal aerobic fitness was reduced. Overall, although the analysis of the collected data is still ongoing, our RCT findings suggest that the physiological and health effects of reduced sitting are relatively minor and that physical activities such as taking more daily walking steps are needed, which would be more beneficial and time-efficient for improving human health.
56Effects of reduced sedentary time on cardiometabolic health in adults with metabolic syndrome: A three-month randomized controlled trial.PubMed
Taru Garthwaite, Tanja Sjöros, Saara Laine, et al.
J Sci Med Sport. 2022 Jul;25(7):579-585. doi: 10.1016/j.jsams.2022.04.002. Epub 2022 Apr 7.
OBJECTIVES: To investigate if reducing sedentary behavior improves cardiometabolic biomarkers in adults with metabolic syndrome. DESIGN: Randomized controlled trial. METHODS: Sixty-four sedentary middle-aged adults with metabolic syndrome were randomized into intervention (INT; n = 33) and control (CON; n = 31) groups. INT was guided to limit sedentary behavior by 1 h/day through increased standing and light-intensity physical activity. CON was instructed to maintain usual habits. Sedentary behavior, breaks in sedentary behavior, standing, and physical activity were measured with hip-worn accelerometers for three months. Fasting blood sampling and measurements of anthropometrics, body composition, and blood pressure were performed at baseline and at three months. Linear mixed models were used for statistical analyses. RESULTS: INT reduced sedentary behavior by 50 (95% CI: 24, 73) min/day by increasing light-intensity and moderate-to-vigorous physical activity (19 [8, 30] and 24 [14, 34] min/day, respectively). Standing increased also, but non-significantly (6 [-11, 23] min/day). CON maintained baseline activity levels. Significant intervention effects favoring INT occurred in fasting insulin (INT: 83.4 [68.7, 101.2] vs. CON: 102.0 [83.3, 125.0] pmol/l at three months), insulin resistance (HOMA-IR; 3.2 [2.6, 3.9] vs. 4.0 [3.2, 4.9]), HbA (37 [36, 38] vs. 38 [37, 39] mmol/mol), and liver enzyme alanine aminotransferase (28 [24, 33] vs. 33 [28, 38] U/l). CONCLUSIONS: Reducing sedentary behavior by 50 min/day and increasing light-intensity and moderate-to-vigorous activity showed benefits in several cardiometabolic biomarkers in adults with metabolic syndrome. Replacing some of the daily sedentary behavior with light-intensity and moderate-to-vigorous physical activity may help in cardiometabolic disease prevention in risk populations.
57Standing is associated with insulin sensitivity in adults with metabolic syndrome.PubMed
Taru Garthwaite, Tanja Sjöros, Mikko Koivumäki, et al.
J Sci Med Sport. 2021 Dec;24(12):1255-1260. doi: 10.1016/j.jsams.2021.08.009. Epub 2021 Aug 14.
OBJECTIVES: To determine how components of accelerometer-measured sedentary behavior (SB) and physical activity (PA), and fitness are associated with insulin sensitivity in adults with metabolic syndrome. DESIGN: Cross-sectional. METHODS: Target population was middle-aged (40-65 years) sedentary adults with metabolic syndrome. SB, breaks in SB, standing, and PA were measured for four weeks with hip-worn accelerometers. VOmax (ml/min/kg) was measured with maximal cycle ergometry. Insulin sensitivity was determined by hyperinsulinaemic-euglycaemic clamp (M-value) and fasting blood sampling (HOMA-IR, insulin). Multivariable regression was used for analyses. RESULTS: Sixty-four participants (37 women; 58.3 [SD 6.8] years) were included. Participants spent 10.0 (1.0) h sedentary, 1.8 (0.6) h standing, and 2.7 (0.6) h in PA and took 5149 (1825) steps and 29 (8) breaks daily. In sex-, age- and accelerometer wear time-adjusted model SB, standing, steps and VOmax were associated with M-value (β = -0.384; β = 0.400; β = 0.350; β = 0.609, respectively), HOMA-IR (β = 0.420; β = -0.548; β = -0.252; β = -0.449), and insulin (β = 0.433; β = -0.541; β = -0.252; β = -0.453); all p-values < 0.05. Breaks associated only with M-value (β = 0.277). When further adjusted for body fat %, only standing remained significantly associated with HOMA-IR (β = -0.381) and insulin (β = -0.366); significance was maintained even when further adjusted for SB, PA and fitness. Light and moderate-to-vigorous PA were not associated with insulin sensitivity. CONCLUSIONS: Standing is associated with insulin sensitivity markers. The association with HOMA-IR and insulin is independent of adiposity, PA, SB and fitness. Further studies are warranted, but these findings encourage replacing sitting with standing for potential improvements in insulin sensitivity in adults at increased type 2 diabetes risk.
58The Relationship of Hemoglobin A1C to Time-in-Range in Patients with Diabetes.PubMed
Robert A Vigersky, Chantal McMahon
Diabetes Technol Ther. 2019 Feb;21(2):81-85. doi: 10.1089/dia.2018.0310. Epub 2018 Dec 21.
BACKGROUND: There has been recent recognition of the limitations of hemoglobin A1C (HbA1C) in describing both short- and long-term glycemic control. Continuous glucose monitoring (CGM) provides robust data about short-term glycemic control and provides metrics such as percent time-in-range (%TIR) that are now routinely reported to describe the change in glycemic control after an intervention in a clinical study or a change in therapy in a patient's care. Recent studies have shown that %TIR may have similar associations with diabetes microvascular complications as does HbA1C. The relationship of %TIR to the long-standing metric of overall glycemic control has not been clearly defined to date. METHODS: Articles that report paired HbA1C and %TIR metrics (n = 1137) or HbA1C and frequent self-monitoring of blood glucose (SMBG) (n = 1440) across a wide range of HbA1Cs, technologies, and subject demographics were reviewed to determine the correlation of these metrics. RESULTS: Selected paired HbA1C and %TIR data from 18 articles were evaluated by linear regression analysis and Pearson's correlation coefficient. There was an excellent correlation between the two (R = -0.84; R = 0.71). This relationship did not change after excluding one study that used SMBG or six studies with ≤7 days of CGM. For every absolute 10% change in %TIR, there was a 0.8% (9 mmol/mol) change in HbA1C. CONCLUSIONS: There is a good correlation between HbA1C and %TIR that may permit the transition to %TIR as the preferred metric for determining the outcome of clinical studies, predicting of the risk of diabetes complications, and assessing of an individual patient's glycemic control.
59Prolonged uninterrupted sitting elevates postprandial hyperglycaemia proportional to degree of insulin resistance.PubMed
Paddy C Dempsey, Robyn N Larsen, Elisabeth A H Winkler, et al.
Diabetes Obes Metab. 2018 Jun;20(6):1526-1530. doi: 10.1111/dom.13254. Epub 2018 Mar 6.
Prolonged uninterrupted sitting is related adversely to cardiometabolic risk markers and postprandial hyperglycaemia, relative to sitting interrupted by regular brief activity breaks. However, whether the magnitude of hyperglycaemic responses to prolonged sitting is dependent upon the underlying degree of insulin resistance remains unclear. Data were pooled from 3 randomized cross-over laboratory-based trials (n = 62) that examined the postprandial blood glucose- and insulin-lowering effects of prolonged sitting vs sitting interrupted by regular brief activity breaks in overweight/obese adults who had normal or impaired glucose metabolism (2 trials) or type 2 diabetes not treated by insulin (1 trial). Corrected for study effects, the magnitude of differences in postprandial glucose and insulin responses between the 2 conditions was significantly exacerbated with poorer baseline levels of fasting glucose, insulin and/or surrogate markers of β-cell function and insulin resistance. This suggests that those with higher underlying levels of insulin resistance may derive greater metabolic benefits from regularly interrupting prolonged sitting than their healthier counterparts. If these findings can be replicated, they may have implications for future targeting and optimization of physical activity/sedentary behaviour interventions in the prevention and management of type 2 diabetes.
60Metabolic Effects of Breaking Prolonged Sitting With Standing or Light Walking in Older South Asians and White Europeans: A Randomized Acute Study.PubMed
Thomas Yates, Charlotte L Edwardson, Carlos Celis-Morales, et al.
J Gerontol A Biol Sci Med Sci. 2020 Jan 1;75(1):139-146. doi: 10.1093/gerona/gly252.
BACKGROUND: Prolonged sitting is common in older adults and is associated with insulin resistance and poor cardiometabolic health. We investigate whether breaking prolonged sitting with regular short bouts of standing or light walking improves postprandial metabolism in older white European and South Asian adults and whether effects are modified by ethnic group. METHODS: Thirty South Asian (15 women) and 30 white European (14 women) older adults (aged 65-79 years) undertook three experimental conditions in random order. (a) Prolonged sitting: continuous sitting during an observation period if 7.5 hours consuming two standardized mixed meals. (b) Standing breaks: sitting interrupted with 5 minutes of standing every 30 minutes (accumulating 60 minutes of standing over the observation period). (c) Walking breaks: sitting interrupted with 5 minutes of self-paced light walking every 30 minutes (accumulating 60 minutes of walking). Blood samples (glucose, insulin, triglycerides) and blood pressure were sampled regularly throughout each condition. RESULTS: Compared with prolonged sitting, walking breaks lowered postprandial insulin by 16.3 mU/L, (95% CI: 19.7, 22.0) with greater reductions (p = .029) seen in South Asians (22.4 mU/L; 12.4, 32.4) than white Europeans (10.3 mU/L; 5.9, 14.7). Glucose (0.3 mmol/L; 0.1, 0.5) and blood pressure (4 mm Hg; 2, 6), but not triglycerides, were lower with walking breaks, with no ethnic differences. Standing breaks did not improve any outcome. CONCLUSIONS: Breaking prolonged sitting with short bouts of light walking, but not standing, resulted in clinically meaningful improvements in markers of metabolic health in older adults, with South Asians gaining a greater reduction in postprandial insulin. TRIAL REGISTRATION: NCT02453204.
61Does frequency or duration of standing breaks drive changes in glycemic response? A randomized crossover trial.PubMed
Meynard John L Toledo, Barbara E Ainsworth, Glenn A Gaesser, et al.
Scand J Med Sci Sports. 2023 Jul;33(7):1135-1145. doi: 10.1111/sms.14344. Epub 2023 Mar 7.
Intervention strategies to break up sitting have mostly focused on the modality (i.e., comparing different intensities and/or type of activities) and less on how frequency and duration of breaks affect health outcomes. This study compared the efficacy of different strategies to break up sitting time [i.e., high frequency, low duration standing breaks (HFLD) and low frequency, high duration standing breaks (LFHD)] in reducing postprandial glucose. Eleven sedentary and prediabetic adults (mean ± SD age = 46.8 ± 10.6 years; 73% female) participated in a cross-over trial. There were six blocks that represented all potential combinations (ordering) of the study conditions and participants were randomly assigned to a block. Each participant underwent three 7.5-h laboratory visits (1 week apart) where they engaged in either continuous sitting, HFLD, or LFHD condition while performing their usual office-related tasks. Standardized breakfast and lunch meals were provided. Postprandial mean glucose, area under the curve (AUC), and incremental area under the curve (iAUC) were evaluated using mixed models. Compared with LFHD condition, the HFLD standing breaks condition significantly lowered mean glucose by -9.94 (-14.13, -5.74) mg/dL·h after lunch, and by -6.23 (-9.93, -2.52) mg/dL·h, for the total lab visit time. Overall, the results favor frequently interrupting sitting with standing breaks to improve glycemic control in individuals with prediabetes. Further studies are needed with larger sample sizes to confirm the results.
62Subcutaneous adipose tissue blood flow in the forefoot during 24 hours. Labeling pattern and reproducibility.PubMed
R Jelnes, J Bülow, K H Tønnesen
Scand J Clin Lab Invest. 1987 May;47(3):223-7.
Wash-out of 133xenon from a local depot in the subcutaneous adipose tissue in the forefoot was measured continuously during 24 hours on subsequent recordings in 51 feet (normal circulation: 10, intermittent claudication: 22 and ischaemic nocturnal rest pain: 19) with a mean time interval of 26 days (range: 3-90 days). The patients were studied under two different conditions. Firstly, during the day in the erect position, awake (sitting, standing and quiet walking) and secondly, during night hours in the supine position, asleep. The coefficient of variation of nocturnal adipose tissue blood flow was calculated to 10%, and for the ratio of blood flow from day to night to 5%. The method is thus considered apt as a monitor in the treatment of peripheral vascular disease, for example, surgery and medical therapy. As predominant source of error is the formation of oedema.
63Mechanisms of Action of Liraglutide in Patients With Type 2 Diabetes Treated With High-Dose Insulin.PubMed
Anna Vanderheiden, Lindsay B Harrison, Jeremy T Warshauer, et al.
J Clin Endocrinol Metab. 2016 Apr;101(4):1798-806. doi: 10.1210/jc.2015-3906. Epub 2016 Feb 24.
CONTEXT: The mechanisms of action of incretin mimetics in patients with long-standing type 2 diabetes (T2D) and high insulin requirements have not been studied. OBJECTIVE: To evaluate changes in β-cell function, glucagon secretion, and fat distribution after addition of liraglutide to high-dose insulin. DESIGN: A single-center, randomized, double-blind, placebo-controlled trial. SETTING: University of Texas Southwestern and Parkland Memorial Hospital clinics. PATIENTS: Seventy-one patients with long-standing (median, 17 years) T2D requiring high-dose insulin treatment (>1.5 U/kg/d; average, 2.2 ± 0.9 U/kg/d). INTERVENTION: Patients were randomized to liraglutide 1.8 mg/d or matching placebo for 6 months. MAIN OUTCOME MEASURES: We measured changes in insulin and glucagon secretion using a 4-hour mixed-meal challenge test. Magnetic resonance-based techniques were used to estimate sc and visceral fat in the abdomen and ectopic fat in the liver and pancreas. RESULTS: Glycosylated hemoglobin improved significantly with liraglutide treatment, with an end-of-trial estimated treatment difference between groups of −0.9% (95% confidence interval, −1.5, −0.4%) (P = .002). Insulin secretion improved in the liraglutide group vs placebo, as measured by the area under the curve of C-peptide (P = .002) and the area under the curves ratio of C-peptide to glucose (P = .003). Insulin sensitivity (Matsuda index) and glucagon secretion did not change significantly between groups. Liver fat and sc fat decreased in the liraglutide group vs placebo (P = .0006 and P = .01, respectively), whereas neither visceral nor pancreatic fat changed significantly. CONCLUSIONS: Treatment with liraglutide significantly improved insulin secretion, even in patients with long-standing T2D requiring high-dose insulin treatment. Liraglutide also decreased liver and sc fat, but it did not alter glucagon secretion.
64Incretin-Based Weight Loss Pharmacotherapy: Can Resistance Exercise Optimize Changes in Body Composition?PubMed
João Carlos Locatelli, Juliene Gonçalves Costa, Andrew Haynes, et al.
Diabetes Care. 2024 Oct 1;47(10):1718-1730. doi: 10.2337/dci23-0100.
This narrative review highlights the degree to which new antiobesity medications based on gut-derived nutrient-stimulated hormones (incretins) cause loss of lean mass, and the importance of resistance exercise to preserve muscle. Glucagon-like peptide 1 receptor agonists (GLP-1RA) induce substantial weight loss in randomized trials, effects that may be enhanced in combination with glucose-dependent insulinotropic polypeptide (GIP) receptor agonists. Liraglutide and semaglutide (GLP-1RA), tirzepatide (GLP-1 and GIP receptor dual agonist), and retatrutide (GLP-1, GIP, and glucagon receptor triple agonist) are peptides with incretin agonist activity that induce ∼15-24% weight loss in adults with overweight and obesity, alongside beneficial impacts on blood pressure, cholesterol, blood glucose, and insulin. However, these agents also cause rapid and significant loss of lean mass (∼10% or ∼6 kg), comparable to a decade or more of aging. Maintaining muscle mass and function as humans age is crucial to avoiding sarcopenia and frailty, which are strongly linked to morbidity and mortality. Studies indicate that supervised resistance exercise training interventions with a duration >10 weeks can elicit large increases in lean mass (∼3 kg) and strength (∼25%) in men and women. After a low-calorie diet, combining aerobic exercise with liraglutide improved weight loss maintenance compared with either alone. Retaining lean mass during incretin therapy could blunt body weight (and fat) regain on cessation of weight loss pharmacotherapy. We propose that tailored resistance exercise training be recommended as an adjunct to incretin therapy to optimize changes in body composition by preserving lean mass while achieving fat loss.
65Obesity, body fat distribution and eye diseases.PubMed
Francesca Bosello, Angiola Vanzo, Chiara Zaffalon, et al.
Eat Weight Disord. 2024 May 6;29(1):33. doi: 10.1007/s40519-024-01662-8.
BACKGROUND: The prevalence of obesity, a chronic disease, is increasing, and obesity is now considered a global epidemic. Eye diseases are also increasing worldwide and have serious repercussions on quality of life as well as increasingly high costs for the community. The relationships between obesity and ocular pathologies are not yet well clarified and are not pathologically homogeneous: they seem to be somehow linked to excess body fat, especially to the distribution of adipose tissue and its ectopic deposits. PURPOSE: Our objective was to examine the associations between obesity and anthropometric indices, including body mass index (BMI), waist circumference (WC), and the waist/hip ratio (WHR), and the risk of most widespread eye diseases, with particular attention given to the most significant metabolic mechanisms. METHODS: This article provides a narrative overview of the effect of obesity and anthropometric measurements of body fat on prevalent eye diseases. We used the MEDLINE/PubMed, CINAHL, EMBASE, and Cochrane Library databases from 1984 to 2024. In addition, we hand-searched references from the retrieved articles and explored a number of related websites. A total of 153 publications were considered. RESULTS: There is significant evidence that obesity is associated with several eye diseases. Waist circumference (WC) and the waist/hip ratio (WHR) have been observed to have stronger positive associations with eye diseases than BMI. CONCLUSIONS: Obesity must be considered a significant risk factor for eye diseases; hence, a multidisciplinary and multidimensional approach to treating obesity, which also affects ocular health, is important. In the prevention and treatment of eye diseases related to obesity, lifestyle factors, especially diet and physical activity, as well as weight changes, both weight loss and weight gain, should not be overlooked. LEVEL OF EVIDENCE: Level V narrative review.
66Sex Differences in Protein Biomarkers and Measures of Fat Distribution.PubMed
Mariana F Ramirez, Abigail S Pan, Juhi K Parekh, et al.
J Am Heart Assoc. 2024 Nov 19;13(22):e000223. doi: 10.1161/JAHA.124.000223. Epub 2024 Nov 11.
BACKGROUND: Sex differences in obesity and fat distribution may in part explain differences in cardiovascular risk in men versus women. We sought to examine sex differences in the associations of obesity and adiposity measures with cardiovascular disease-related protein biomarkers. METHODS AND RESULTS: In a cross-sectional observational cohort study, we examined whether the association of obesity (body mass index [BMI] and waist circumference) and adiposity measures (visceral adipose tissue) with biomarkers demonstrates effect modification by sex using multiplicative interaction terms in multivariable linear regression models. Among 3143 participants (mean age, 50 years; 49% women), sex modified the association of BMI, waist circumference, and visceral adipose tissue with cardiovascular disease-related protein biomarkers (7 for BMI, 3 for waist circumference, and 23 for visceral adipose tissue, false discovery rate [FDR]-q<0.05 for all). For example, higher BMI was associated with lower α-microglobulin levels in men but not in women (ß, -0.113; SE, 0.028; <0.001 in men versus ß, -0.007; SE, 0.024; =0.78 in women). By contrast, higher BMI was associated with higher adipsin levels in men and women, but the association was more pronounced in women (ß, 0.287; SE, 0.023; <0.001 in women versus ß, 0.189; SE, 0.026; <0.001 in men). The associations of higher visceral adipose tissue with biomarkers representing adiposity, inflammation, and fibrosis were more pronounced in women versus men. CONCLUSIONS: We found that sex modified the associations of obesity and adipose traits with cardiovascular risk ascertained by cardiovascular disease-related biomarkers including markers of adiposity, inflammation, and fibrosis. These findings highlight potential biological pathways that may underlie some of the observed differences in obesity-related cardiovascular disease between women and men.
67Association between body mass index, waist circumference, and relative fat mass with the risk of first unprovoked venous thromboembolism.PubMed
Lucia M Caiano, Simona Costanzo, Teresa Panzera, et al.
Nutr Metab Cardiovasc Dis. 2021 Oct 28;31(11):3122-3130. doi: 10.1016/j.numecd.2021.07.018. Epub 2021 Jul 30.
BACKGROUND AND AIMS: Obesity defined by body mass index (BMI) is independently associated with venous thromboembolism (VTE). Abdominal obesity, defined by waist circumference, is a predictor of cardiovascular events. Recently, relative fat mass (RFM) was proposed as a marker of cardiovascular risk. We assessed the role of three different measures of obesity to predict unprovoked VTE in a longitudinal study. METHODS AND RESULTS: Moli-sani is a prospective cohort study carried out in the general population of the Molise region, Italy. A total of 23,538 individuals (48% men, age 55.4 years) enrolled between 2005 and 2010 were eligible. Patients on anticoagulant treatment were excluded. BMI ≥30 kg/m defined obesity, waist circumference >102 cm for men or 88 cm for women defined abdominal obesity, tertiles of RFM were compared. The long-term incidence of first unprovoked VTE during follow-up was assessed. Overall, 29.6% individuals were obese and 44.2% had abdominal obesity. A total of 66 first unprovoked VTE events were diagnosed during a median follow-up of 8.2 years. After multivariable Cox regression analysis, the risk of unprovoked VTE was significantly higher in obese participants (HR 1.89, 95% CI 1.16-3.07) than in participants with BMI <30; in subjects with abdominal obesity than with normal waist circumference (HR 2.19, 1.26-3.81); and in subjects with third vs first RFM tertile index (HR 2.46, 1.15-5.28). The areas under the curves for the models including the three obesity indexes were comparable. CONCLUSIONS: Three indexes of obesity based on BMI, waist circumference or RFM similarly predict first occurrence of unprovoked VTE.
68Trunk training following stroke.PubMed
Liselot Thijs, Eline Voets, Stijn Denissen, et al.
Cochrane Database Syst Rev. 2023 Mar 2;3(3):CD013712. doi: 10.1002/14651858.CD013712.pub2.
BACKGROUND: Previous systematic reviews and randomised controlled trials have investigated the effect of post-stroke trunk training. Findings suggest that trunk training improves trunk function and activity or the execution of a task or action by an individual. But it is unclear what effect trunk training has on daily life activities, quality of life, and other outcomes. OBJECTIVES: To assess the effectiveness of trunk training after stroke on activities of daily living (ADL), trunk function, arm-hand function or activity, standing balance, leg function, walking ability, and quality of life when comparing with both dose-matched as non-dose-matched control groups. SEARCH METHODS: We searched the Cochrane Stroke Group Trials Register, CENTRAL, MEDLINE, Embase, and five other databases to 25 October 2021. We searched trial registries to identify additional relevant published, unpublished, and ongoing trials. We hand searched the bibliographies of included studies. SELECTION CRITERIA: We selected randomised controlled trials comparing trunk training versus non-dose-matched or dose-matched control therapy including adults (18 years or older) with either ischaemic or haemorrhagic stroke. Outcome measures of trials included ADL, trunk function, arm-hand function or activity, standing balance, leg function, walking ability, and quality of life. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. Two main analyses were carried out. The first analysis included trials where the therapy duration of control intervention was non-dose-matched with the therapy duration of the experimental group and the second analysis where there was comparison with a dose-matched control intervention (equal therapy duration in both the control as in the experimental group). MAIN RESULTS: We included 68 trials with a total of 2585 participants. In the analysis of the non-dose-matched groups (pooling of all trials with different training duration in the experimental as in the control intervention), we could see that trunk training had a positive effect on ADL (standardised mean difference (SMD) 0.96; 95% confidence interval (CI) 0.69 to 1.24; P < 0.001; 5 trials; 283 participants; very low-certainty evidence), trunk function (SMD 1.49, 95% CI 1.26 to 1.71; P < 0.001; 14 trials, 466 participants; very low-certainty evidence), arm-hand function (SMD 0.67, 95% CI 0.19 to 1.15; P = 0.006; 2 trials, 74 participants; low-certainty evidence), arm-hand activity (SMD 0.84, 95% CI 0.009 to 1.59; P = 0.03; 1 trial, 30 participants; very low-certainty evidence), standing balance (SMD 0.57, 95% CI 0.35 to 0.79; P < 0.001; 11 trials, 410 participants; very low-certainty evidence), leg function (SMD 1.10, 95% CI 0.57 to 1.63; P < 0.001; 1 trial, 64 participants; very low-certainty evidence), walking ability (SMD 0.73, 95% CI 0.52 to 0.94; P < 0.001; 11 trials, 383 participants; low-certainty evidence) and quality of life (SMD 0.50, 95% CI 0.11 to 0.89; P = 0.01; 2 trials, 108 participants; low-certainty evidence). Non-dose-matched trunk training led to no difference for the outcome serious adverse events (odds ratio: 7.94, 95% CI 0.16 to 400.89; 6 trials, 201 participants; very low-certainty evidence). In the analysis of the dose-matched groups (pooling of all trials with equal training duration in the experimental as in the control intervention), we saw that trunk training had a positive effect on trunk function (SMD 1.03, 95% CI 0.91 to 1.16; P < 0.001; 36 trials, 1217 participants; very low-certainty evidence), standing balance (SMD 1.00, 95% CI 0.86 to 1.15; P < 0.001; 22 trials, 917 participants; very low-certainty evidence), leg function (SMD 1.57, 95% CI 1.28 to 1.87; P < 0.001; 4 trials, 254 participants; very low-certainty evidence), walking ability (SMD 0.69, 95% CI 0.51 to 0.87; P < 0.001; 19 trials, 535 participants; low-certainty evidence) and quality of life (SMD 0.70, 95% CI 0.29 to 1.11; P < 0.001; 2 trials, 111 participants; low-certainty evidence), but not for ADL (SMD 0.10; 95% confidence interval (CI) -0.17 to 0.37; P = 0.48; 9 trials; 229 participants; very low-certainty evidence), arm-hand function (SMD 0.76, 95% CI -0.18 to 1.70; P = 0.11; 1 trial, 19 participants; low-certainty evidence), arm-hand activity (SMD 0.17, 95% CI -0.21 to 0.56; P = 0.38; 3 trials, 112 participants; very low-certainty evidence). Trunk training also led to no difference for the outcome serious adverse events (odds ratio (OR): 7.39, 95% CI 0.15 to 372.38; 10 trials, 381 participants; very low-certainty evidence). Time post stroke led to a significant subgroup difference for standing balance (P < 0.001) in non-dose-matched therapy. In non-dose-matched therapy, different trunk therapy approaches had a significant effect on ADL (< 0.001), trunk function (P < 0.001) and standing balance (< 0.001). When participants received dose-matched therapy, analysis of subgroup differences showed that the trunk therapy approach had a significant effect on ADL (P = 0.001), trunk function (P < 0.001), arm-hand activity (P < 0.001), standing balance (P = 0.002), and leg function (P = 0.002). Also for dose-matched therapy, subgroup analysis for time post stroke resulted in a significant difference for the outcomes standing balance (P < 0.001), walking ability (P = 0.003) and leg function (P < 0.001), time post stroke significantly modified the effect of intervention. Core-stability trunk (15 trials), selective-trunk (14 trials) and unstable-trunk (16 trials) training approaches were mostly applied in the included trials. AUTHORS' CONCLUSIONS: There is evidence to suggest that trunk training as part of rehabilitation improves ADL, trunk function, standing balance, walking ability, upper and lower limb function, and quality of life in people after stroke. Core-stability, selective-, and unstable-trunk training were the trunk training approaches mostly applied in the included trials. When considering only trials with a low risk of bias, results were mostly confirmed, with very low to moderate certainty, depending on the outcome.
69The Effectiveness of Additional Core Stability Exercises in Improving Dynamic Sitting Balance, Gait and Functional Rehabilitation for Subacute Stroke Patients (CORE-Trial): Study Protocol for a Randomized Controlled Trial.PubMed
Rosa Cabanas-Valdés, Lídia Boix-Sala, Montserrat Grau-Pellicer, et al.
Int J Environ Res Public Health. 2021 Jun 19;18(12):6615. doi: 10.3390/ijerph18126615.
Trunk impairment produces disorders of motor control, balance and gait. Core stability exercises (CSE) are a good strategy to improve local strength of trunk, balance and gait. Methods and analysis: This is a single-blind multicenter randomized controlled trial. Two parallel groups are compared, and both perform the same type of therapy. A control group (CG) ( = 110) performs conventional physiotherapy (CP) (1 h per session) focused on improving balance. An experimental group (EG) ( = 110) performs CSE (30 min) in addition to CP (30 min) (1 h/session in total). EG is divided in two subgroups, in which only half of patients ( = 55) perform CSE plus transcutaneous electrical nerve stimulation (TENS). Primary outcome measures are dynamic sitting, assessed by a Spanish version of Trunk Impairment Scale and stepping, assessed by Brunel Balance Assessment. Secondary outcomes are postural control, assessed by Postural Assessment Scale for Stroke patients; standing balance and risk of fall assessed by Berg Balance Scale; gait speed by BTS G-Walk (accelerometer); rate of falls, lower-limb spasticity by Modified Ashworth Scale; activities of daily living by Barthel Index; and quality of life by EQ-5D-5L. These are evaluated at baseline (T0), at three weeks (T1), at five weeks (end of the intervention) (T2), at 17 weeks (T3) and at 29 weeks (T4). Study duration per patient is 29 weeks (a five-week intervention, followed by a 24-week post-intervention).
70Training for improved neuro-muscular control of balance in middle aged females.PubMed
Gregory S Anderson, Fabio Deluigi, Guido Belli, et al.
J Bodyw Mov Ther. 2016 Jan;20(1):10-18. doi: 10.1016/j.jbmt.2015.01.007. Epub 2015 Jan 31.
This study examined improvements in static balance and muscle electromyographic (EMG) activity following a four week progressive training program in 16 middle aged females (mean age = 46.9 ± 8.7 yrs; height 161.1 ± 6.0 cm; weight 65.4 ± 11.2 kg). Participants trained 3 times per week for 4 weeks, for 50 min per session, progressing base of support, stability, vision, resistance and torque in each of six basic exercises. Pre and post training measures of balance included feet together standing, a tandem stance and a one-leg stand (unsupported leg in the saggital plane) performed with the eyes closed, and a Stork Stand (unsupported leg in the frontal plane) with both eyes open and closed. In each position postural deviations were tallied for each individual while muscle recruitment was determined using root mean squared (RMS) EMG activity for the soleus, biceps femoris, erector spinae, rectus abdominis and internal oblique muscles of the dominant foot side. Balance scores were significantly improved post training in both the Balance Error Score System (p < 0.05) and stork stand positions (p < 0.01). Muscle activity was reduced post-training in all muscles in each condition except the soleus in the tandem position, although not all significantly. Reduced biceps femoris activity suggest that improved core stability allowed participants to move from a hip to an ankle postural control strategy through improved coordination of muscles involved in balance and reduced body sway. The core muscles were able to control body position with less activity post training suggesting improved muscle coordination and efficiency. These results suggest that short term progressive floor to BOSU™ balance training can improve standing balance in middle aged women.
71Can lower extremity anatomical measures and core stability predict dynamic knee valgus in young men?PubMed
Esmaeil Mozafaripour, Foad Seidi, Hooman Minoonejad, et al.
J Bodyw Mov Ther. 2021 Jul;27:358-363. doi: 10.1016/j.jbmt.2021.02.004. Epub 2021 Mar 3.
INTRODUCTION: Dynamic knee valgus (DKV) is a risk factor for lower extremity injuries such as anterior cruciate ligament and patellofemoral pain syndrome. Purpose of the current study was to investigate the relationship between lower extremity anatomical measures (LEAM) and core stability with DKV during the single-leg squat. METHODS: Thirty healthy men aged between 18 and 28 years participated in this cross-sectional biomechanical study.DKV was assessed using a 6-camera motion analysis system during a single-leg squat task. Anteversion of hip, hip internal and external rotation, Q-angle, knee hyperextension, tibial torsion, tibia vara, plantar arch index, and core stability were measured using standard clinical procedures. To predict DKV, a multiple linear regression model was used. RESULT: The stability index negatively and plantar arch index positively predicted greater DKV during the single-leg squat task (P = 0.001 and P = 0.09, respectively). Research variables together predicted 82% of the variance in DKV (F(4,26) = 28.09, p < 0.001). However, relationships between other variables and DKV were not found. CONCLUSION: The core stability index and plantar arch index were associated with observed DKV during the single-leg squat. These results suggested that proximal and distal variables to the knee should be considered when evaluating individuals who present DKV during the single-leg squat.
72Lower limb squat biomechanics and select clinical measures in chronic ankle instability.PubMed
David Werner, Lauren Casey, Ethan Myers, et al.
Clin Biomech (Bristol). 2024 Mar;113:106211. doi: 10.1016/j.clinbiomech.2024.106211. Epub 2024 Feb 27.
BACKGROUND: Individuals with chronic ankle instability often present with clinical and biomechanical abnormalities, however squat biomechanics have not been investigated. The purpose of this study was to compare select clinical assessments and squat biomechanics between individuals with and without chronic ankle instability. METHODS: Fifteen individuals with chronic ankle instability and a matched control group were studied. A weight-bearing dorsiflexion lunge test, foot posture, and an in-line half-kneeling motor control test for core stability were assessed. Lower limb 3D bilateral and unilateral squat biomechanics were captured. Groups, limbs and squat tasks were compared using an alpha of 0.05. FINDINGS: Individuals with chronic ankle instability had less static weight-bearing dorsiflexion and failed the core stability test more frequently, but did not differ in foot morphology compared to the controls. When squatting, those with chronic ankle instability demonstrated reduced peak ankle dorsiflexion angles and moments in the involved limb (p < 0.04) during single limb squats and had interlimb differences in ankle dorsiflexion angle as well as hip and knee kinetics (p < 0.04) during double limb squats. In those with chronic ankle instability, there was less overall motion, but higher kinetic demands in single limb versus double leg squatting (p < 0.03). INTERPRETATION: Individuals with chronic ankle instability had impaired weight-bearing dorsiflexion and showed impaired core stability more often, which accompanied altered squatting mechanics in both variations. Within the limbs with chronic ankle instability, single limb squats showed lesser kinematic demands but higher kinetic demands than double limb squatting.
73Improving multidisciplinary management of patients living with obesity: The evaluation of seated bioimpedance measures and relationship to functional performance following targeted intervention.PubMed
Elizabeth Ryan, Helen MacLaughlin, Robin Hay, et al.
Clin Obes. 2024 Aug;14(4):e12655. doi: 10.1111/cob.12655. Epub 2024 Mar 15.
Management of obesity requires a multidisciplinary approach including physical activity interventions, which have significant impacts on overall health outcomes. Greater levels of lean muscle mass are significantly associated with improved health and reduced risk of comorbidities and should be preserved where possible when undertaking rapid weight loss. This article reports on the physical and functional outcomes achieved during a 12-week intensive multidisciplinary intervention targeting obesity and evaluates correlations between body composition and functional outcomes. We additionally aimed to investigate the test-retest reliability and levels of agreement in body composition measurements using bioimpedance spectroscopy between seated and standing positions. Of the 35 participants included in analysis, significant differences were observed between baseline and post-intervention measures. These included weight loss of 12.6 kg, waist circumference reduction of 10.5 cm, fat mass reduction by 2.9%, muscle mass increase by 1.6%, 54.5 m improvement in the 6-minute walk test and 3.8 rep improvement in the 30-second sit-to-stand test. No significant correlations were observed between physical and functional outcome measures. Excellent test re-test reliability was observed in bioimpedance spectroscopy seated measurements (ICC >.9). Significant differences were observed between seated and standing bioimpedance spectroscopy measurements, however they are regarded as small differences in a clinical setting.
74Exercise intervention for unilateral amputees with low back pain: study protocol for a randomised, controlled trial.PubMed
Joseph G Wasser, Daniel C Herman, MaryBeth Horodyski, et al.
Trials. 2017 Dec 29;18(1):630. doi: 10.1186/s13063-017-2362-0.
BACKGROUND: Atraumatic lower limb amputation is a life-changing event for approximately 185,000 persons in the United States each year. A unilateral amputation is associated with rapid changes to the musculoskeletal system including leg and back muscle atrophy, strength loss, gait asymmetries, differential mechanical joint loading and leg length discrepancies. Even with high-quality medical care and prostheses, amputees still develop secondary musculoskeletal conditions such as chronic low back pain (LBP). Resistance training interventions that focus on core stabilization, lumbar strength and dynamic stability during loading have strong potential to reduce LBP and address amputation-related changes to the musculoskeletal system. Home-based resistance exercise programs may be attractive to patients to minimize travel and financial burdens. METHODS/DESIGN: This study will be a single-assessor-blinded, pre-post-test randomised controlled trial involving 40 men and women aged 18-60 years with traumatic, unilateral transtibial amputation. Participants will be randomised to a home-based, resistance exercise group (HBRX) or a wait-list control group (CON). The HBRX will consist of 12 weeks of elastic resistance band and bodyweight training to improve core and lumbopelvic strength. Participants will be monitored via Skype or Facetime on a weekly basis. The primary outcome will be pain severity (11-point Numerical Pain Rating Scale; NRS). Secondary outcomes will include pain impact on quality of life (Medical Outcomes Short Form 36, Oswestry Disability Index and Roland Morris Disability Questionnaire), kinematics and kinetics of walking gait on an instrumented treadmill, muscle morphology (muscle thickness of multifidus, transversus abdominis, internal oblique), maximal muscle strength of key lumbar and core muscles, and daily step count. DISCUSSION: The study findings will determine whether a HBRX program can decrease pain severity and positively impact several physiological and mechanical factors that contribute to back pain in unilateral transtibial amputees with chronic LBP. We will determine the relative contribution of the exercise-induced changes in these factors on pain responsiveness in this population. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT03300375 . Registered on 2 October 2017.
75Effectiveness of an intervention for reducing sitting time and improving health in office workers: three arm cluster randomised controlled trial.PubMed
Charlotte L Edwardson, Stuart J H Biddle, Stacy A Clemes, et al.
BMJ. 2022 Aug 17;378:e069288. doi: 10.1136/bmj-2021-069288.
OBJECTIVES: To evaluate the effectiveness of an intervention, with and without a height adjustable desk, on daily sitting time, and to investigate the relative effectiveness of the two interventions, and the effectiveness of both interventions on physical behaviours and physical, biochemical, psychological, and work related health and performance outcomes. DESIGN: Cluster three arm randomised controlled trial with follow-up at three and 12 months. SETTING: Local government councils in Leicester, Liverpool, and Greater Manchester, UK. PARTICIPANTS: 78 clusters including 756 desk based employees in defined offices, departments, or teams from two councils in Leicester, three in Greater Manchester, and one in Liverpool. INTERVENTIONS: Clusters were randomised to one of three conditions: the SMART Work and Life (SWAL) intervention, the SWAL intervention with a height adjustable desk (SWAL plus desk), or control (usual practice). MAIN OUTCOMES MEASURES: The primary outcome measure was daily sitting time, assessed by accelerometry, at 12 month follow-up. Secondary outcomes were accelerometer assessed sitting, prolonged sitting, standing and stepping time, and physical activity calculated over any valid day, work hours, workdays, and non-workdays, self-reported lifestyle behaviours, musculoskeletal problems, cardiometabolic health markers, work related health and performance, fatigue, and psychological measures. RESULTS: Mean age of participants was 44.7 years, 72.4% (n=547) were women, and 74.9% (n=566) were white. Daily sitting time at 12 months was significantly lower in the intervention groups (SWAL -22.2 min/day, 95% confidence interval -38.8 to -5.7 min/day, P=0.003; SWAL plus desk -63.7 min/day, -80.1 to -47.4 min/day, P<0.001) compared with the control group. The SWAL plus desk intervention was found to be more effective than SWAL at changing sitting time (-41.7 min/day, -56.3 to -27.0 min/day, P<0.001). Favourable differences in sitting and prolonged sitting time at three and 12 month follow-ups for both intervention groups and for standing time for the SWAL plus desk group were observed during work hours and on workdays. Both intervention groups were associated with small improvements in stress, wellbeing, and vigour, and the SWAL plus desk group was associated with improvements in pain in the lower extremity, social norms for sitting and standing at work, and support. CONCLUSIONS: Both SWAL and SWAL plus desk were associated with a reduction in sitting time, although the addition of a height adjustable desk was found to be threefold more effective. TRIAL REGISTRATION: ISRCTN Registry ISRCTN11618007.
76Impact of an 8-Month Trial Using Height-Adjustable Desks on Children's Classroom Sitting Patterns and Markers of Cardio-Metabolic and Musculoskeletal Health.PubMed
Ana María Contardo Ayala, Jo Salmon, Anna Timperio, et al.
Int J Environ Res Public Health. 2016 Dec 10;13(12):1227. doi: 10.3390/ijerph13121227.
During school hours, children can sit for prolonged and unbroken periods of time. This study investigated the impact of an 8-month classroom-based intervention focusing on reducing and breaking-up sitting time on children's cardio-metabolic risk factors (i.e., body mass index, waist circumference, blood pressure) and perceptions of musculoskeletal discomfort. Two Year-6 classes (24 students per class) in one primary school were assigned to either an intervention or control classroom. The intervention classroom was equipped with height-adjustable desks and the teacher was instructed in the delivery of pedagogical strategies to reduce and break-up sitting in class. The control classroom followed standard practice using traditional furniture. At baseline, and after 8-months, time spent sitting, standing, stepping, and sitting-bouts (occasions of continuous sitting) as well as the frequency of sit-to-stand transitions were obtained from activPAL inclinometers and the time spent in light-intensity physical activity was obtained from ActiGraph accelerometers. Demographics and musculoskeletal characteristics were obtained from a self-report survey. Hierarchical linear mixed models found that during class-time, children's overall time spent sitting in long bouts (>10 min) were lower and the number of sit-to-stand transitions were higher in the intervention group compared to the control group, while no changes were observed for musculoskeletal pain/discomfort. No significant intervention effects were found for the anthropometrics measures and blood pressure. Height-adjustable desks and pedagogical strategies to reduce/break-up sitting can positively modify classroom sitting patterns in children. Longer interventions, larger and varied sample size may be needed to show health impacts; however, these desks did not increase musculoskeletal pain/discomfort.
77Changes in Desk-Based Workers' Sitting, Standing, and Stepping Time: Short- and Longer-Term Effects on Musculoskeletal Pain.PubMed
Francis Q S Dzakpasu, Neville Owen, Alison Carver, et al.
Med Sci Sports Exerc. 2023 Dec 1;55(12):2241-2252. doi: 10.1249/MSS.0000000000003248. Epub 2023 Sep 19.
PURPOSE: Sitting at work can be associated with musculoskeletal pain, but the effect of reductions in sitting is not well understood. We examined relationships with musculoskeletal pain of changes in sitting, standing, stepping, and short and long bouts of these behaviors. METHODS: Analyses pooled data from 224 desk workers (68.4% women; mean ± SD age = 45.5 ± 9.4 yr; body mass index = 28.1 ± 6.1 kg⋅m -2 ) in intervention trial. Device-assessed (activPAL3) sitting, standing, and stepping time and multisite musculoskeletal pain (Nordic Questionnaire; 12 body areas) were assessed at baseline, 3 months, and 12 months. Compositional data analyses in linear mixed-effects regressions examined relationships within 16 waking hours of the behaviors and their short and long bouts, with changes from baseline in acute and chronic multisite musculoskeletal pain at 3 and 12 months. Analyses were adjusted for initial group randomization and relevant covariates. RESULTS: At 3 months, increased standing relative to changes in other compositions was significantly associated with increased multisite musculoskeletal pain (acute: β = 1.54, 95% confidence interval [CI] = 0.10 to 2.98; chronic: β = 1.49, 95% CI = 0.12 to 2.83). By contrast, increased stepping relative to changes in other compositions was significantly associated with reduced multisite musculoskeletal pain (acute: β = -1.49, 95% CI = -2.97 to -0.02; chronic: β = -1.87, 95% CI = -3.75 to -0.01). Neither sitting reduction relative to changes in other compositions nor changes in short bouts relative to long bouts of the behaviors were significantly associated with multisite musculoskeletal pain changes. At 12 months, there were no significant associations for any of the compositional changes. CONCLUSIONS: In the short term, while increasing standing with reduced sitting time can be unfavorable, concurrently increasing stepping could potentially reduce musculoskeletal pain. In the longer term, musculoskeletal pain may not be increased by moderate reductions in sitting time through spending more time standing or stepping.
78Exercise and cardiovascular health: A state-of-the-art review.PubMed
Ameesh Isath, Klaudia J Koziol, Matthew W Martinez, et al.
Prog Cardiovasc Dis. 2023 Jul-Aug;79:44-52. doi: 10.1016/j.pcad.2023.04.008. Epub 2023 Apr 28.
Cardiovascular (CV) disease (CVD) is the leading cause of global morbidity and mortality, and low levels of physical activity (PA) is a leading independent predictor of poor CV health and associated with an increased prevalence of risk factors that predispose to CVD development. In this review, we evaluate the benefits of exercise on CV health. We discuss the CV adaptations to exercise, focusing on the physiological changes in the heart and vasculature. We review the impact and benefits of exercise on specific CV prevention, including type II diabetes, hypertension, hyperlipidemia, coronary artery disease, and heart failure, in addition to CVD-related and all-cause mortality. Lastly, we evaluate the current PA guidelines and various modes of exercise, assessing the current literature for the effective regimens of PA that improve CVD outcomes.
79Health Benefits of Exercise.PubMed
Gregory N Ruegsegger, Frank W Booth
Cold Spring Harb Perspect Med. 2018 Jul 2;8(7):a029694. doi: 10.1101/cshperspect.a029694.
Overwhelming evidence exists that lifelong exercise is associated with a longer health span, delaying the onset of 40 chronic conditions/diseases. What is beginning to be learned is the molecular mechanisms by which exercise sustains and improves quality of life. The current review begins with two short considerations. The first short presentation concerns the effects of endurance exercise training on cardiovascular fitness, and how it relates to improved health outcomes. The second short section contemplates emerging molecular connections from endurance training to mental health. Finally, approximately half of the remaining review concentrates on the relationships between type 2 diabetes, mitochondria, and endurance training. It is now clear that physical training is complex biology, invoking polygenic interactions within cells, tissues/organs, systems, with remarkable cross talk occurring among the former list.
80Effects of walking training on weight maintenance after a very-low-energy diet in premenopausal obese women: a randomized controlled trial.PubMed
M Fogelholm, K Kukkonen-Harjula, A Nenonen, et al.
Arch Intern Med. 2000 Jul 24;160(14):2177-84. doi: 10.1001/archinte.160.14.2177.
BACKGROUND: Maintenance of weight loss is a core problem in the treatment of obesity. Physical activity may improve maintenance and metabolic risk factors associated with obesity. HYPOTHESES: (1) A walking training program of moderate intensity, started after weight reduction by a very-low-energy diet, improves maintenance of weight loss and obesity-related metabolic disorders; and (2) the effect of the training program is related to the prescribed amount of physical activity, ie, a higher amount (energy expenditure) leads to more favorable results. METHODS: The participants were premenopausal women with a mean body mass index of 34.0 kg/m(2). Eighty-two participants were randomized to this study; 74 participated in the follow-up assessment. A 12-week weight reduction by mostly a very-low-energy diet was followed by a 40-week maintenance program randomized in 3 groups: a control group with no increase in habitual exercise and with counseling on diet and relapse prevention; a walk-1 group, with a walking program targeted to expend 4.2 MJ/wk and diet counseling; and a walk-2 group, with a walking program of 8. 4 MJ/wk and diet counseling. Random permuted blocks within strata were used, with weight loss (in 3 classes) as the stratifying factor. After the intervention, the subjects were followed up for 2 years. MAIN OUTCOME MEASURES: Primary outcomes were body weight, fat mass, and waist circumference at the 2-year follow-up. Secondary outcomes were the levels of serum lipoproteins and lipids, plasma glucose, insulin, and blood pressure. RESULTS: The mean weight loss after weight reduction was 13.1 kg. The main outcome variables remained stable during the maintenance program, but increased during the follow-up period. Compared with the end of weight reduction, weight regain at the 2-year follow-up was 3.5 kg less (95% confidence interval, 0.2-6.8) and waist circumference regain 3.8 cm less (95% confidence interval, 0.3-7.3) in the walk-1 group vs controls. The secondary outcomes showed a partial relapse during the maintenance program, and a further regain during the follow-up period. CONCLUSIONS: Inclusion of a walking program of moderate training regimen into a weight maintenance program improved maintenance of losses in weight and waist circumference.
81Why do people sit? A framework for targeted behavior change.PubMed
Pam Ten Broeke, Benjamin Gardner, Debby G J Beckers, et al.
Health Psychol Rev. 2023 Dec;17(4):641-654. doi: 10.1080/17437199.2022.2143851. Epub 2022 Nov 11.
To improve health and wellbeing, it is crucial that people regularly interrupt their sitting. In this paper, we propose a framework for examining and changing sitting behavior that addresses two key steps in the process towards developing effective interventions. First, we suggest that research should move away from its current focus on sitting time, which is an outcome of behavior. Rather, researchers should focus on stand-to-sit and sit-to-stand transitions, which are discrete units of behavior. Second, drawing on goal hierarchy models, we suggest that people rarely engage in stand-to-sit and sit-to-stand transitions for the purpose of being in a sitting or standing position; rather, we suggest that these transitions are means to higher-order goals (e.g., to complete work tasks, to watch television, to eat dinner). To improve adherence to and effectiveness of sitting behavior interventions, intervention designers should aim to increase the frequency of sit-to-stand (and stand-to-sit) transitions. To achieve this aim, intervention designers should capitalize on the higher-order goals that are typically served by these transitions. We suggest four concrete intervention strategies to increase sit-to-stand transitions in congruence with people's everyday goals. We also describe the implications of our framework for theory and methods in sitting behavior research.
82Increasing movement during office work at sit-stand workstations: A novel seating device to facilitate transitions.PubMed
Mamiko Noguchi, Jackie D Zehr, Liana M Tennant, et al.
Appl Ergon. 2023 Sep;111:104044. doi: 10.1016/j.apergo.2023.104044. Epub 2023 May 13.
A novel active office chair (Movably Pro) was designed to facilitate frequent sit-stand movement 1) through auditory and tactile prompts and 2) with minimal-to-no work surface adjustment when transitioning. The purpose of this study was to compare lumbopelvic kinematics, discomfort, and task performance between the novel chair and traditional sitting/standing. Sixteen participants completed three separate 2-h sedentary exposures. Although participants transitioned every 3 min between sitting and standing with the novel chair, productivity was not affected. When standing in the novel chair, the lumbopelvic angles fell in between traditional sitting and standing (p < 0.01). Movement and/or postural changes that occurred with the novel chair reduced low back and leg discomfort for pain developers (PDs) (p < 0.01). All participants classified as PDs in traditional standing were non-PDs with the novel chair. This intervention was effective in reducing sedentary time without the time loss associated with desk movement.
83Look Before You Leap: Interventions Supervised via Telehealth Involving Activities in Weight-Bearing or Standing Positions for People After Stroke-A Scoping Review.PubMed
Emily R Ramage, Natalie Fini, Elizabeth A Lynch, et al.
Phys Ther. 2021 Jun 1;101(6). doi: 10.1093/ptj/pzab073.
OBJECTIVE: The COVID-19 pandemic has seen a rapid shift to telehealth-delivered physical therapy services. Common impairments after stroke create unique challenges when providing rehabilitation via telehealth, particularly when it involves activities undertaken in weight-bearing or standing positions, including walking training. Our scoping review maps the evidence regarding safety, efficacy, and feasibility of remotely supervised telehealth interventions involving activities undertaken in weight-bearing or standing positions for people after stroke. METHODS: Searches of relevant databases for primary research studies were conducted using keywords relating to exercise and telehealth. Studies of stroke survivors undertaking interventions involving activities in weight-bearing or standing positions, supervised in real-time via telehealth were included. Two reviewers independently appraised all studies. Data were charted by one reviewer, checked by another, and results synthesized narratively. RESULTS: Seven studies (2 randomized trials, 1 mixed-methods, and 4 pre-post studies) were included, involving 179 participants. Some studies included stroke survivors with cognitive impairment, and 2 (29%) studies included only participants who walked independently. Adherence (reported in 3 studies) and satisfaction (reported in 4 studies) were good, and no serious adverse events (data from 4 studies) related to interventions were reported. Strategies to overcome technological barriers were used to optimize intervention safety and feasibility, along with physiological monitoring, caregiver assistance, and in-person exercise prescription. However, there is limited high-quality evidence of efficacy. CONCLUSIONS: We identified strategies used in research to date that can support current practice. However, urgent research is needed to ensure that stroke survivors are receiving evidence-based, effective services. IMPACT: The COVID-19 pandemic has necessitated a rapid shift to telerehabilitation services for people with stroke, but there is little evidence to guide best practice. Our review provides practical guidance and strategies to overcome barriers and optimize safety and adherence for telehealth interventions involving activities in weight-bearing or standing positions.
84Walking on sunshine: scoping review of the evidence for walking and mental health.PubMed
Paul Kelly, Chloë Williamson, Ailsa G Niven, et al.
Br J Sports Med. 2018 Jun;52(12):800-806. doi: 10.1136/bjsports-2017-098827.
BACKGROUND/OBJECTIVES: Walking has well-established positive relationships with, and effects on, physical health. In contrast, while poor mental health contributes substantially to global health burden, an overview of the benefits from walking has not previously been published. We aimed to scope the literature and present what is known, and highlight what is not known, about walking and mental health. METHODS: Design: Scoping review. DATA SOURCES: Ovid (Medline), ProQuest, Web of Science.Screening and reporting: 13 014 records were identified and screened by a team of researchers. Included full texts were analysed and reported according to mental health outcome. RESULTS: For the 8 mental health outcomes (identified a priori), there were a total of 5 systematic reviews and 50 individual papers included. Depression had the most evidence and existing systematic reviews were reported. Evidence for anxiety, psychological stress, psychological well-being, subjective well-being and social isolation and loneliness varied in volume and effectiveness, but no harmful effects were identified. There were no studies for walking and resilience. The setting and context of walking seems to be important variables. CONCLUSION: The evidence base that suggests walking benefits mental health is growing, but remains fragmented and incomplete for some important outcomes. Policy and national guidelines should promote the known mental health benefits of increased walking and future research should directly address the gaps we have identified.
85The sedentary office: an expert statement on the growing case for change towards better health and productivity.PubMed
John P Buckley, Alan Hedge, Thomas Yates, et al.
Br J Sports Med. 2015 Nov;49(21):1357-62. doi: 10.1136/bjsports-2015-094618. Epub 2015 Jun 1.
An international group of experts convened to provide guidance for employers to promote the avoidance of prolonged periods of sedentary work. The set of recommendations was developed from the totality of the current evidence, including long-term epidemiological studies and interventional studies of getting workers to stand and/or move more frequently. The evidence was ranked in quality using the four levels of the American College of Sports Medicine. The derived guidance is as follows: for those occupations which are predominantly desk based, workers should aim to initially progress towards accumulating 2 h/day of standing and light activity (light walking) during working hours, eventually progressing to a total accumulation of 4 h/day (prorated to part-time hours). To achieve this, seated-based work should be regularly broken up with standing-based work, the use of sit-stand desks, or the taking of short active standing breaks. Along with other health promotion goals (improved nutrition, reducing alcohol, smoking and stress), companies should also promote among their staff that prolonged sitting, aggregated from work and in leisure time, may significantly and independently increase the risk of cardiometabolic diseases and premature mortality. It is appreciated that these recommendations should be interpreted in relation to the evidence from which they were derived, largely observational and retrospective studies, or short-term interventional studies showing acute cardiometabolic changes. While longer term intervention studies are required, the level of consistent evidence accumulated to date, and the public health context of rising chronic diseases, suggest initial guidelines are justified. We hope these guidelines stimulate future research, and that greater precision will be possible within future iterations.
86Postural variability: an effective way to reduce musculoskeletal discomfort in office work.PubMed
Kermit G Davis, Susan E Kotowski
Hum Factors. 2014 Nov;56(7):1249-61. doi: 10.1177/0018720814528003.
OBJECTIVE: This article investigates whether different interventions aimed at promoting postural change could increase body movement throughout the shift and reduce musculoskeletal discomfort. BACKGROUND: Many researchers have reported high levels of discomfort for workers that have relatively low-level demands but whose jobs are sedentary in nature. To date, few interventions have been found to be effective in reducing worker discomfort. METHODS: Thirty-seven call center operators were evaluated in four different workstation conditions: conventional workstation, sit-stand workstation, conventional workstation with reminder software, and sit-stand workstation with break reminder software-prompt to remind workers to take break The primary outcome variables consisted of productivity, measured by custom software; posture changes, measured by continuous video recording; and discomfort, measured by simple survey. Each condition was evaluated over a 2-week period. RESULTS: Significant reductions in short-term discomfort were reported in the shoulders, upper back, and lower back when utilizing reminder software, independent of workstation type. Although not significant, many productivity indices were found to increase by about 10%. CONCLUSIONS: Posture-altering workstation interventions, specifically sit-stand tables or reminder software with traditional tables, were effective in introducing posture variability. Further, postural variability appears to be linked to decreased short-term discomfort at the end of the day without a negative impact on productivity. APPLICATIONS: An intervention that can simply induce the worker to move throughout the day, such as a sit-stand table or simple software reminder about making a large posture change, can be effective in reducing discomfort in the worker, while not adversely impacting productivity.
87Workplace interventions for increasing standing or walking for decreasing musculoskeletal symptoms in sedentary workers.PubMed
Sharon P Parry, Pieter Coenen, Nipun Shrestha, et al.
Cochrane Database Syst Rev. 2019 Nov 17;2019(11):CD012487. doi: 10.1002/14651858.CD012487.pub2.
BACKGROUND: The prevalence of musculoskeletal symptoms among sedentary workers is high. Interventions that promote occupational standing or walking have been found to reduce occupational sedentary time, but it is unclear whether these interventions ameliorate musculoskeletal symptoms in sedentary workers. OBJECTIVES: To investigate the effectiveness of workplace interventions to increase standing or walking for decreasing musculoskeletal symptoms in sedentary workers. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, OSH UPDATE, PEDro, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal up to January 2019. We also screened reference lists of primary studies and contacted experts to identify additional studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs), cluster-randomised controlled trials (cluster-RCTs), quasi RCTs, and controlled before-and-after (CBA) studies of interventions to reduce or break up workplace sitting by encouraging standing or walking in the workplace among workers with musculoskeletal symptoms. The primary outcome was self-reported intensity or presence of musculoskeletal symptoms by body region and the impact of musculoskeletal symptoms such as pain-related disability. We considered work performance and productivity, sickness absenteeism, and adverse events such as venous disorders or perinatal complications as secondary outcomes. DATA COLLECTION AND ANALYSIS: Two review authors independently screened titles, abstracts, and full-text articles for study eligibility. These review authors independently extracted data and assessed risk of bias. We contacted study authors to request additional data when required. We used GRADE considerations to assess the quality of evidence provided by studies that contributed to the meta-analyses. MAIN RESULTS: We found ten studies including three RCTs, five cluster RCTs, and two CBA studies with a total of 955 participants, all from high-income countries. Interventions targeted changes to the physical work environment such as provision of sit-stand or treadmill workstations (four studies), an activity tracker (two studies) for use in individual approaches, and multi-component interventions (five studies). We did not find any studies that specifically targeted only the organisational level components. Two studies assessed pain-related disability. Physical work environment There was no significant difference in the intensity of low back symptoms (standardised mean difference (SMD) -0.35, 95% confidence interval (CI) -0.80 to 0.10; 2 RCTs; low-quality evidence) nor in the intensity of upper back symptoms (SMD -0.48, 95% CI -.096 to 0.00; 2 RCTs; low-quality evidence) in the short term (less than six months) for interventions using sit-stand workstations compared to no intervention. No studies examined discomfort outcomes at medium (six to less than 12 months) or long term (12 months and more). No significant reduction in pain-related disability was noted when a sit-stand workstation was used compared to when no intervention was provided in the medium term (mean difference (MD) -0.4, 95% CI -2.70 to 1.90; 1 RCT; low-quality evidence). Individual approach There was no significant difference in the intensity or presence of low back symptoms (SMD -0.05, 95% CI -0.87 to 0.77; 2 RCTs; low-quality evidence), upper back symptoms (SMD -0.04, 95% CI -0.92 to 0.84; 2 RCTs; low-quality evidence), neck symptoms (SMD -0.05, 95% CI -0.68 to 0.78; 2 RCTs; low-quality evidence), shoulder symptoms (SMD -0.14, 95% CI -0.63 to 0.90; 2 RCTs; low-quality evidence), or elbow/wrist and hand symptoms (SMD -0.30, 95% CI -0.63 to 0.90; 2 RCTs; low-quality evidence) for interventions involving an activity tracker compared to an alternative intervention or no intervention in the short term. No studies provided outcomes at medium term, and only one study examined outcomes at long term. Organisational level No studies evaluated the effects of interventions solely targeted at the organisational level. Multi-component approach There was no significant difference in the proportion of participants reporting low back symptoms (risk ratio (RR) 0.93, 95% CI 0.69 to 1.27; 3 RCTs; low-quality evidence), neck symptoms (RR 1.00, 95% CI 0.76 to 1.32; 3 RCTs; low-quality evidence), shoulder symptoms (RR 0.83, 95% CI 0.12 to 5.80; 2 RCTs; very low-quality evidence), and upper back symptoms (RR 0.88, 95% CI 0.76 to 1.32; 3 RCTs; low-quality evidence) for interventions using a multi-component approach compared to no intervention in the short term. Only one RCT examined outcomes at medium term and found no significant difference in low back symptoms (MD -0.40, 95% CI -1.95 to 1.15; 1 RCT; low-quality evidence), upper back symptoms (MD -0.70, 95% CI -2.12 to 0.72; low-quality evidence), and leg symptoms (MD -0.80, 95% CI -2.49 to 0.89; low-quality evidence). There was no significant difference in the proportion of participants reporting low back symptoms (RR 0.89, 95% CI 0.57 to 1.40; 2 RCTs; low-quality evidence), neck symptoms (RR 0.67, 95% CI 0.41 to 1.08; two RCTs; low-quality evidence), and upper back symptoms (RR 0.52, 95% CI 0.08 to 3.29; 2 RCTs; low-quality evidence) for interventions using a multi-component approach compared to no intervention in the long term. There was a statistically significant reduction in pain-related disability following a multi-component intervention compared to no intervention in the medium term (MD -8.80, 95% CI -17.46 to -0.14; 1 RCT; low-quality evidence). AUTHORS' CONCLUSIONS: Currently available limited evidence does not show that interventions to increase standing or walking in the workplace reduced musculoskeletal symptoms among sedentary workers at short-, medium-, or long-term follow up. The quality of evidence is low or very low, largely due to study design and small sample sizes. Although the results of this review are not statistically significant, some interventions targeting the physical work environment are suggestive of an intervention effect. Therefore, in the future, larger cluster-RCTs recruiting participants with baseline musculoskeletal symptoms and long-term outcomes are needed to determine whether interventions to increase standing or walking can reduce musculoskeletal symptoms among sedentary workers and can be sustained over time.
88Occupational health problems and injuries among Quebec's physical educators.PubMed
Jean Lemoyne, Louis Laurencelle, Michel Lirette, et al.
Appl Ergon. 2007 Sep;38(5):625-34. doi: 10.1016/j.apergo.2006.06.004. Epub 2006 Sep 20.
The purpose of this study was to describe the traumatology of teaching physical education (PE) and to document the causes and mechanisms of injuries in this occupation. Our sample was composed of 314 physical educators (PEs) teaching at three school levels (primary school, secondary school and college) who responded to a questionnaire survey. The results showed a 0.55 rate of recent lesion per teacher per year (0.65 for women and 0.51 for men). A total of 37.6% of subjects were affected by a lesion during the last year at work. Subjects with a higher weekly frequency of leisure physical activities or endurance activities (five times and more) were less affected by chronic lesions as well as those who frequently practiced aerobic physical activities. Prevalence of chronic injuries was higher in older teachers. Our results confirm that the rate of lesions in this group of workers is high, and that school level and respondent age may influence the rate of lesion and the characteristics of risk factors. In particular, the effect of ageing and teaching specialization on the incidence of occupational problems in PEs warrants further research. Given the relatively high rate of injuries among PE teachers, we suggest that it is necessary to further explore preventive strategies to reduce occupational risk in these workers. In particular, prophylactic physical activity outside of work may represent such a strategy since PEs more active outside their work have lower chronic injury prevalence. PEs gave long periods of standing the highest rating for movements or positions most likely to cause them occupational injuries. It can thus be suggested to find ways to reduce standing position sustained for long periods.
89Postural control in the older adult.PubMed
B E Maki, W E McIlroy
Clin Geriatr Med. 1996 Nov;12(4):635-58.
Age-related changes in the neural, sensory, and musculoskeletal systems can lead to balance impairments that have a tremendous impact on the ability to move about safely. The many complex substrates of the posture control system subserve a common functional goal: regulation of the relationship between the center of mass and the base of support. Traditional approaches, which have focused on the control of the center-of-mass displacement, have documented age-related changes in "feet-in-place" responses: during quiet standing, during volitional movement, or in response to applied perturbation. Recently, increasing attention has been directed toward the control of the base of support, that is, compensatory leg and arm movement, as an important element of the postural repertoire, and early results suggest profound age-related impairment in the control of compensatory stepping movements. For both feet-in-place and stepping responses, control of lateral stability appears to be a major problem associated with increased risk of falling. In view of age-related differences in ability to adapt postural responses under predictable task conditions, future work will likely benefit by mimicking, as much as possible, the varied and unpredictable nature of the events that often precipitate falls in daily life, in order to draw connections between the laboratory or clinic and "real-life" stability.
90Effects of a resistance and balance exercise programme on physical fitness, health-related quality of life and fear of falling in older women with osteoporosis and vertebral fracture: a randomized controlled trial.PubMed
B Stanghelle, H Bentzen, L Giangregorio, et al.
Osteoporos Int. 2020 Jun;31(6):1069-1078. doi: 10.1007/s00198-019-05256-4. Epub 2020 Jan 10.
UNLABELLED: Exercise is recommended for people with osteoporosis, but the effect for people who have suffered vertebral fracture is uncertain. This study shows that a multicomponent exercise-program based on recommendations for people with osteoporosis improved muscle strength, balance, and fear of falling in older women with osteoporosis and vertebral fracture. INTRODUCTION: Guidelines for exercise strongly recommend that older adults with osteoporosis or osteoporotic vertebral fracture should engage in a multicomponent exercise programme that includes resistance training in combination with balance training. Prior research is scarce and shows inconsistent findings. This study examines whether current exercise guidelines for osteoporosis, when applied to individuals with vertebral fractures, can improve health outcomes. METHODS: This single blinded randomized controlled trial included 149 older women diagnosed with osteoporosis and vertebral fracture, 65+ years. The intervention group performed a 12-week multicomponent exercise programme, the control group received usual care. Primary outcome was habitual walking speed, secondary outcomes were physical fitness (Senior Fitness Test, Functional Reach and Four Square Step Test), health-related quality of life and fear of falling. Descriptive data was reported as mean (standard deviation) and count (percent). Data were analyzed following intention to treat principle and per protocol. Between-group differences were assessed using linear regression models (ANCOVA analysis). RESULTS: No statistically significant difference between the groups were found on the primary outcome, walking speed (mean difference 0.04 m/s, 95% CI - 0.01-0.09, p = 0.132). Statistically significant between-group differences in favour of intervention were found on FSST (dynamic balance) (mean difference - 0.80 s, 95% CI - 1.57 to - 0.02, p = 0.044), arm curl (mean difference 1.55, 95% CI 0.49-2.61, p = 0.005) and 30-s STS (mean difference 1.85, 95% CI 1.04-2.67, p < 0.001), as well as fear of falling (mean difference - 1.45, 95% CI - 2.64 to - 0.26, p = 0.018). No statistically significant differences between the groups were found on health-related quality of life. CONCLUSION: Twelve weeks of a supervised multicomponent resistance and balance exercise programme improves muscle strength and balance and reduces fear of falling, in women with osteoporosis and a history of vertebral fractures. TRIAL REGISTRATION: ClincialTrials.gov Identifier: NCT02781974. Registered 25.05.16. Retrospectively registered.
91Physical exercise and prevention of falls. Effects of a Pilates training method compared with a general physical activity program: A randomized controlled trial.PubMed
Antonino Patti, Daniele Zangla, Fatma Nese Sahin, et al.
Medicine (Baltimore). 2021 Apr 2;100(13):e25289. doi: 10.1097/MD.0000000000025289.
INTRODUCTION: Falls are the leading cause of injury-related mortality and morbidity in the elderly. Physical activity plays a key role in the prevention of falls and stimulates postural control. The aim of this study was to compare a general physical activity program for the elderly with a Pilates program to evaluate the effects on balance and on reducing the risk of falling. MATERIALS AND METHODS: Forty-six subjects were enrolled in this study, but only 41 were included in the study. The subjects were divided into 2 groups: Pilates group (P-G) and a group following a nonspecific program of physical activity (Pa-G). Each subject underwent the hand grip test, Berg balance scale test, and posturographic analysis. RESULTS: Spearman correlation coefficient showed correlations between the following parameters: BBS versus hand grip test (r = 0.68); BBS versus ellipse surface area (r = -0.75). There were significant differences between groups after the exercise program: both groups showed an improvement in performance but the P-G recorded significantly better results than the Pa-G. DISCUSSION AND CONCLUSIONS: This study confirmed that physical activity improves both balance and strength. However, our data show that Pilates has a greater effect on these physical abilities than a general physical activity program.
92Effect of Pilates exercises on balance and gross motor coordination in children with Down syndrome.PubMed
Alaa Al-Nemr, Shimaa Reffat
Acta Neurol Belg. 2024 Oct;124(5):1499-1505. doi: 10.1007/s13760-024-02517-w. Epub 2024 Apr 1.
OBJECTIVE: To investigate the effect of Pilates exercises on balance and gross motor coordination in children with Down syndrome (DS). METHODS: Forty children with DS, aged 8 up to 10 years, were randomly divided into two groups; experimental and control groups. A designed physical therapy program was applied for both groups, while the experimental group received an additional Pilates exercise program. Balance and gross motor coordination as primary outcomes and quality of life (QoL) as secondary outcome were assessed using Biodex balance system (BBS), Bruininks Oseretsky of Motor Proficiency (BOT-2), and Pediatric quality of life inventory (PedsQL™) sequentially. RESULTS: Both experimental (Pilates) and control groups demonstrated significant improvements in dynamic balance, gross motor coordination, and QoL after interventions. However, comparison between groups showed significant improvement in favor of the Pilates group in all measured outcomes (P < 0.0001). CONCLUSION: Adding Pilates exercises to the designed physical therapy program could provide more significant improvements in balance, gross motor coordination, and QoL in children with DS. TRIAL REGISTRATION: Clinical Trial gov number Identifier: NCT05928949.
93Exercise for preventing falls in older people living in the community.PubMed
Catherine Sherrington, Nicola J Fairhall, Geraldine K Wallbank, et al.
Cochrane Database Syst Rev. 2019 Jan 31;1(1):CD012424. doi: 10.1002/14651858.CD012424.pub2.
BACKGROUND: At least one-third of community-dwelling people over 65 years of age fall each year. Exercises that target balance, gait and muscle strength have been found to prevent falls in these people. An up-to-date synthesis of the evidence is important given the major long-term consequences associated with falls and fall-related injuries OBJECTIVES: To assess the effects (benefits and harms) of exercise interventions for preventing falls in older people living in the community. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, three other databases and two trial registers up to 2 May 2018, together with reference checking and contact with study authors to identify additional studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) evaluating the effects of any form of exercise as a single intervention on falls in people aged 60+ years living in the community. We excluded trials focused on particular conditions, such as stroke. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. Our primary outcome was rate of falls. MAIN RESULTS: We included 108 RCTs with 23,407 participants living in the community in 25 countries. There were nine cluster-RCTs. On average, participants were 76 years old and 77% were women. Most trials had unclear or high risk of bias for one or more items. Results from four trials focusing on people who had been recently discharged from hospital and from comparisons of different exercises are not described here.Exercise (all types) versus control Eighty-one trials (19,684 participants) compared exercise (all types) with control intervention (one not thought to reduce falls). Exercise reduces the rate of falls by 23% (rate ratio (RaR) 0.77, 95% confidence interval (CI) 0.71 to 0.83; 12,981 participants, 59 studies; high-certainty evidence). Based on an illustrative risk of 850 falls in 1000 people followed over one year (data based on control group risk data from the 59 studies), this equates to 195 (95% CI 144 to 246) fewer falls in the exercise group. Exercise also reduces the number of people experiencing one or more falls by 15% (risk ratio (RR) 0.85, 95% CI 0.81 to 0.89; 13,518 participants, 63 studies; high-certainty evidence). Based on an illustrative risk of 480 fallers in 1000 people followed over one year (data based on control group risk data from the 63 studies), this equates to 72 (95% CI 52 to 91) fewer fallers in the exercise group. Subgroup analyses showed no evidence of a difference in effect on both falls outcomes according to whether trials selected participants at increased risk of falling or not.The findings for other outcomes are less certain, reflecting in part the relatively low number of studies and participants. Exercise may reduce the number of people experiencing one or more fall-related fractures (RR 0.73, 95% CI 0.56 to 0.95; 4047 participants, 10 studies; low-certainty evidence) and the number of people experiencing one or more falls requiring medical attention (RR 0.61, 95% CI 0.47 to 0.79; 1019 participants, 5 studies; low-certainty evidence). The effect of exercise on the number of people who experience one or more falls requiring hospital admission is unclear (RR 0.78, 95% CI 0.51 to 1.18; 1705 participants, 2 studies, very low-certainty evidence). Exercise may make little important difference to health-related quality of life: conversion of the pooled result (standardised mean difference (SMD) -0.03, 95% CI -0.10 to 0.04; 3172 participants, 15 studies; low-certainty evidence) to the EQ-5D and SF-36 scores showed the respective 95% CIs were much smaller than minimally important differences for both scales.Adverse events were reported to some degree in 27 trials (6019 participants) but were monitored closely in both exercise and control groups in only one trial. Fourteen trials reported no adverse events. Aside from two serious adverse events (one pelvic stress fracture and one inguinal hernia surgery) reported in one trial, the remainder were non-serious adverse events, primarily of a musculoskeletal nature. There was a median of three events (range 1 to 26) in the exercise groups.Different exercise types versus controlDifferent forms of exercise had different impacts on falls (test for subgroup differences, rate of falls: P = 0.004, I² = 71%). Compared with control, balance and functional exercises reduce the rate of falls by 24% (RaR 0.76, 95% CI 0.70 to 0.81; 7920 participants, 39 studies; high-certainty evidence) and the number of people experiencing one or more falls by 13% (RR 0.87, 95% CI 0.82 to 0.91; 8288 participants, 37 studies; high-certainty evidence). Multiple types of exercise (most commonly balance and functional exercises plus resistance exercises) probably reduce the rate of falls by 34% (RaR 0.66, 95% CI 0.50 to 0.88; 1374 participants, 11 studies; moderate-certainty evidence) and the number of people experiencing one or more falls by 22% (RR 0.78, 95% CI 0.64 to 0.96; 1623 participants, 17 studies; moderate-certainty evidence). Tai Chi may reduce the rate of falls by 19% (RaR 0.81, 95% CI 0.67 to 0.99; 2655 participants, 7 studies; low-certainty evidence) as well as reducing the number of people who experience falls by 20% (RR 0.80, 95% CI 0.70 to 0.91; 2677 participants, 8 studies; high-certainty evidence). We are uncertain of the effects of programmes that are primarily resistance training, or dance or walking programmes on the rate of falls and the number of people who experience falls. No trials compared flexibility or endurance exercise versus control. AUTHORS' CONCLUSIONS: Exercise programmes reduce the rate of falls and the number of people experiencing falls in older people living in the community (high-certainty evidence). The effects of such exercise programmes are uncertain for other non-falls outcomes. Where reported, adverse events were predominantly non-serious.Exercise programmes that reduce falls primarily involve balance and functional exercises, while programmes that probably reduce falls include multiple exercise categories (typically balance and functional exercises plus resistance exercises). Tai Chi may also prevent falls but we are uncertain of the effect of resistance exercise (without balance and functional exercises), dance, or walking on the rate of falls.
94Leveraging context-specific behavioral economic principles to enable patients to change their physical activity patterns.PubMed
Brittany V Barber, Michael Vallis, George Kephart, et al.
J Health Psychol. 2025 Nov;30(13):3907-3926. doi: 10.1177/13591053251317320. Epub 2025 Feb 19.
This study explores how context-specific behavioral economic principles could be employed to tailor interventions to support patients' efforts to modify day-to-day routines. Using adapted geo-ethnography techniques, interviews collected in-depth descriptions about facilitators and barriers to physical activity (PA), and contexts influencing decisions about day-to-day activities. Data were analyzed using the Capability, Opportunity, and Motivation - Behaviour (COM-B) model for behavior change and MINDSPACE behavioral economic principles as coding frameworks. Twenty-nine patients (19 men, 10 women) aged 50-79 participated. Findings indicate patients were motivated and capable of increasing PA but were challenged to identify opportunities to adapt day-to-day routines for increasing PA. Patients described disrupting default routines, increasing commitments, changing the messenger, and introducing incentives as potentially useful behavioral economic principles to improve day-to-day decisions about increasing PA. Patients had insight into potential behavioral economic principles, although they were not previously educated, and were valuable partners in developing research and clinic-based behavioral economic intervention strategies.
95Effects of using wearable devices on reducing sedentary time and prolonged sitting in healthy adults: a network meta-analysis.PubMed
Zihao He, Guanggao Zhao, Chao Li, et al.
BMJ Open. 2024 Nov 17;14(11):e080186. doi: 10.1136/bmjopen-2023-080186.
OBJECTIVES: This study aimed to compare the effectiveness of different wearable intervention strategies in reducing sedentary time (ST) and prolonged sitting (PS) on healthy adults. DESIGN: A network meta-analysis (NMA). DATA SOURCES: PubMed, Web of Science, SPORTDiscus, ProQuest, Opengrey, Medline and Cochrane Central Register of Controlled Trials were searched up to 1 June 2024. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised controlled trials (RCTs) that examined the effect of wearable device interventions on ST and PS among healthy adults were included. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers used standardised methods to search, screen and code included studies. Bias risks were assessed using Cochrane tools (Risk of Bias 2.0). Data were analysed using a frequentist framework NMA to directly and indirectly compare the effects of the five different intervention strategies (comparators). The results were reported as standardised mean differences (SMDs) with 95% CI and surface under cumulative ranking curve (SUCRA) was used to rank the best interventions. The five comparators were as follows: (1) wearable-only intervention (only using wearable devices for self-monitoring); (2) wearable combined with online intervention (ie, online coaching and social media support); (3) wearable combined with offline intervention (ie, face-to-face seminars and courses); (4) comparison group (ie, traditional, non-wearable interventions); (5) control group (ie, maintaining daily routine, waitlist). RESULTS: 12 RCTs with a total of 2957 participants were included. Results of NMA showed that the 'wearable+online' has significantly better effects in reducing ST compared with control group, comparison group and 'wearable only', with moderate to large effect sizes (SMD=0.96, 95% CI 0.65 to 1.27; SMD=0.87, 95% CI 0.21 to 1.53; SMD=0.78, 95% CI 0.14 to 1.42, respectively). However, no significant differences were identified between the groups in reducing PS. The SUCRA values were ranked as wearable+online (98.1%), wearable+offline (64.4%,), 'wearable only' (40.5%), comparison group (25.9%) and control group (21.1%) for ST reduction. Similar rankings were observed for PS reduction, with probabilities of 69.9%, 61.1%, 59.7%, 37.1% and 22.1%, respectively. CONCLUSIONS: Wearable+online is the best intervention strategy for reducing ST in healthy adults. Additionally, none of the wearable-based interventions effectively reduced PS in healthy adults, but as there is little research on PS, it should receive more attention in the future. CRD42021290017.
96Effectiveness of physical activity monitors in adults: systematic review and meta-analysis.PubMed
Rasmus Tolstrup Larsen, Vibeke Wagner, Christoffer Bruun Korfitsen, et al.
BMJ. 2022 Jan 26;376:e068047. doi: 10.1136/bmj-2021-068047.
OBJECTIVE: To estimate the effectiveness of physical activity monitor (PAM) based interventions among adults and explore reasons for the heterogeneity. DESIGN: Systematic review and meta-analysis. STUDY SELECTION: The electronic databases MEDLINE, Embase, SPORTDiscus, CINAHL, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched on 4 June 2021. Eligible randomised controlled trials compared interventions in which adults received feedback from PAMs with control interventions in which no feedback was provided. No restrictions on type of outcome measurement, publication date, or language were applied. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently extracted data and assessed risk of bias. Random effects meta-analyses were used to synthesise the results. The certainty of evidence was rated by the Grading of Recommendations Assessment and Evaluation (GRADE) approach. MAIN OUTCOME MEASURES: The three primary outcomes of interest were physical activity, moderate to vigorous physical activity, and sedentary time. RESULTS: 121 randomised controlled trials with 141 study comparisons, including 16 743 participants, were included. The PAM based interventions showed a moderate effect (standardised mean difference 0.42, 95% confidence interval 0.28 to 0.55) on physical activity, equivalent to 1235 daily steps; a small effect (0.23, 0.16 to 0.30) on moderate to vigorous physical activity, equivalent to 48.5 weekly minutes; and a small insignificant effect (-0.12, -0.25 to 0.01) on sedentary time, equal to 9.9 daily minutes. All outcomes favoured the PAM interventions. CONCLUSIONS: The certainty of evidence was low for the effect of PAM based interventions on physical activity and moderate for moderate to vigorous physical activity and sedentary time. PAM based interventions are safe and effectively increase physical activity and moderate to vigorous physical activity. The effect on physical activity and moderate to vigorous physical activity is well established but might be overestimated owing to publication bias. STUDY REGISTRATION: PROSPERO CRD42018102719.
97Using computer, mobile and wearable technology enhanced interventions to reduce sedentary behaviour: a systematic review and meta-analysis.PubMed
Aoife Stephenson, Suzanne M McDonough, Marie H Murphy, et al.
Int J Behav Nutr Phys Act. 2017 Aug 11;14(1):105. doi: 10.1186/s12966-017-0561-4.
BACKGROUND: High levels of sedentary behaviour (SB) are associated with negative health consequences. Technology enhanced solutions such as mobile applications, activity monitors, prompting software, texts, emails and websites are being harnessed to reduce SB. The aim of this paper is to evaluate the effectiveness of such technology enhanced interventions aimed at reducing SB in healthy adults and to examine the behaviour change techniques (BCTs) used. METHODS: Five electronic databases were searched to identify randomised-controlled trials (RCTs), published up to June 2016. Interventions using computer, mobile or wearable technologies to facilitate a reduction in SB, using a measure of sedentary time as an outcome, were eligible for inclusion. Risk of bias was assessed using the Cochrane Collaboration's tool and interventions were coded using the BCT Taxonomy (v1). RESULTS: Meta-analysis of 15/17 RCTs suggested that computer, mobile and wearable technology tools resulted in a mean reduction of -41.28 min per day (min/day) of sitting time (95% CI -60.99, -21.58, I2 = 77%, n = 1402), in favour of the intervention group at end point follow-up. The pooled effects showed mean reductions at short (≤ 3 months), medium (>3 to 6 months), and long-term follow-up (>6 months) of -42.42 min/day, -37.23 min/day and -1.65 min/day, respectively. Overall, 16/17 studies were deemed as having a high or unclear risk of bias, and 1/17 was judged to be at a low risk of bias. A total of 46 BCTs (14 unique) were coded for the computer, mobile and wearable components of the interventions. The most frequently coded were "prompts and cues", "self-monitoring of behaviour", "social support (unspecified)" and "goal setting (behaviour)". CONCLUSION: Interventions using computer, mobile and wearable technologies can be effective in reducing SB. Effectiveness appeared most prominent in the short-term and lessened over time. A range of BCTs have been implemented in these interventions. Future studies need to improve reporting of BCTs within interventions and address the methodological flaws identified within the review through the use of more rigorously controlled study designs with longer-term follow-ups, objective measures of SB and the incorporation of strategies to reduce attrition. TRIAL REGISTRATION: The review protocol was registered with PROSPERO: CRD42016038187.
98Effect of a Gamified Family-Based Exercise Intervention on Adherence to 24-Hour Movement Behavior Recommendations in Preschool Children: Single-Center Pragmatic Trial.PubMed
Gaizka Legarra-Gorgoñon, Yesenia García-Alonso, Robinson Ramírez-Vélez, et al.
JMIR Serious Games. 2025 Mar 4;13:e60185. doi: 10.2196/60185.
BACKGROUND: Adherence to 24-hour movement behavior recommendations, including physical activity (PA), sedentary time, and sleep, is essential for the healthy development of preschool children. Gamified family-based interventions have shown the potential to improve adherence to these guidelines, but evidence of their effectiveness among children is limited. OBJECTIVE: This study aimed to evaluate the effectiveness of a gamified family-based exercise intervention in promoting adherence to 24-hour movement behavior recommendations among preschool-aged children. METHODS: This 12-week study is a single-center, pragmatic randomized controlled trial that included 80 preschool children (56% boys) and their families, who were randomly assigned to either the gamification group (n=40) or the control group (n=40). The "3, 2, 1 Move on Study" incorporates family-oriented physical activities and gamification techniques to increase PA domains, reduce sedentary behavior, and improve sleep patterns. The primary outcome was to increase moderate to vigorous PA (MVPA) by 5 minutes/day, as measured by accelerometer at follow-up. Accelerometer-determined daily time spent (PA domains, sedentary behavior, and sleep), physical fitness (cardiorespiratory, speed-agility, muscular, physical fitness z-score), basic motor competencies (self-movement and object movement), and executive function (memory, cognitive flexibility, and inhibitory control) were also included as secondary outcomes. RESULTS: The 71 participants included in the per-protocol analyses (32 girls, 45%; 39 boys, 55%) had a mean (SD) age of 5.0 (0.5) years. Change in MVPA per day after the intervention (12 weeks) increased in both groups by +25.3 (SD 24.6) minutes/day in the gamification group and +10.0 (SD 31.4) minutes/day in the routine care group, but no significant between-group differences were observed (8.62, 95% CI -5.72 to 22.95 minutes/day, ηp2=.025; P=.23). The analysis of secondary outcomes showed significant between-group mean differences in the change in physical behaviors derived from the accelerometers from baseline to follow-up of 26.44 (95% CI 8.93 to 43.94) minutes/day in favor of light PA (ηp2=.138; P=.01) and 30.88 (95% CI 4.36 to 57.41) minutes/day in favor of total PA, which corresponds to a large effect size (ηp2=.087; P=.02). Likewise, the gamification group substantially increased their score in standing long jump and physical fitness z-score from baseline (P<.05). CONCLUSIONS: In the "3, 2, 1 Move on Study," a gamified intervention showed a modest but relevant increase in MVPA and other domains of 24-hour movement behavior among preschool-aged children. Therefore, gamified family-based interventions may provide a viable alternative to improve adherence to 24-hour movement behavior recommendations.
99Stepping into survivorship pilot study: Harnessing mobile health and principles of behavioral economics to increase physical activity in ovarian cancer survivors.PubMed
Elizabeth Schrier, Niya Xiong, Embree Thompson, et al.
Gynecol Oncol. 2021 May;161(2):581-586. doi: 10.1016/j.ygyno.2021.02.023. Epub 2021 Feb 23.
OBJECTIVE: Physical activity improves physical function, quality of life, and mental health, yet fewer than 80% of ovarian cancer survivors meet activity guidelines. This pilot intervention study aimed to increase physical activity in ovarian cancer survivors by leveraging principles of behavioral economics, gamification, and social support. METHODS: This 24-week study (12-week intervention; 12-week follow-up) enrolled women with ovarian cancer after completion of first-line treatment with a self-selected "teammate." Participants used Fitbits to measure daily steps, select an increased step goal, and enroll in a collaborative game, including points and levels for achieving step goals. Primary outcomes were feasibility (defined a priori as ≥60% approach-to-consent ratio and ≥ 70% adherence to Fitbit), acceptability (≤20% of participants reporting burden or regret for participation) and preliminary efficacy (≥70% reporting increased motivation); exploratory outcomes included change in steps. RESULTS: We recruited 24 participants (mean age = 63 years, range = 37-79 years) with a 94% approach-to-consent ratio. All participants completed the intervention with 94% tracker adherence. At 24-week follow-up, 1/24 (≤5%) of participants reported burden; 0/24 (0%) reported regret for study participation; and 22/24 (>90%) agreed/strongly agreed that "the study motivated me to increase activity levels." Participants' mean daily steps were 6210.7 (±3328.1) at baseline and increased to 7643 (± 3610.9) steps (p < 0.001) during the 12-week intervention. CONCLUSIONS: This pilot study demonstrated feasibility, acceptability, and preliminary efficacy, justifying a larger randomized clinical trial to test efficacy at increasing activity levels. Future studies should examine strategies for maintaining increased activity levels in survivors over time.
100The Acceptability, Feasibility, and Effectiveness of Wearable Activity Trackers for Increasing Physical Activity in Children and Adolescents: A Systematic Review.PubMed
Amy V Creaser, Stacy A Clemes, Silvia Costa, et al.
Int J Environ Res Public Health. 2021 Jun 8;18(12):6211. doi: 10.3390/ijerph18126211.
Wearable activity trackers (wearables) embed numerous behaviour change techniques (BCTs) that have previously been shown to increase adult physical activity (PA). With few children and adolescents achieving PA guidelines, it is crucial to explore ways to increase their PA. This systematic review examined the acceptability, feasibility, and effectiveness of wearables and their potential mechanisms of action for increasing PA in 5 to 19-year-olds. A systematic search of six databases was conducted, including data from the start date of each database to December 2019 (PROSPERO registration: CRD42020164506). Thirty-three studies were included. Most studies (70%) included only adolescents (10 to 19 years). There was some-but largely mixed-evidence that wearables increase steps and moderate-to-vigorous-intensity PA and reduce sedentary behaviour. There were no apparent differences in effectiveness based on the number of BCTs used and between studies using a wearable alone or as part of a multi-component intervention. Qualitative findings suggested wearables increased motivation to be physically active via self-monitoring, goal setting, feedback, and competition. However, children and adolescents reported technical difficulties and a novelty effect when using wearables, which may impact wearables' long-term use. More rigorous and long-term studies investigating the acceptability, feasibility, and effectiveness of wearables in 5 to 19-year-olds are warranted.
101Physical activity counseling in primary care: Insights from public health and behavioral economics.PubMed
Kerem Shuval, Tammy Leonard, Jeffrey Drope, et al.
CA Cancer J Clin. 2017 May 6;67(3):233-244. doi: 10.3322/caac.21394. Epub 2017 Feb 15.
Physical inactivity has reached epidemic proportions in modern society. Abundant evidence points to a causal link between physical inactivity and increased risk for numerous noncommunicable diseases, such as some types of cancer and heart disease, as well as premature mortality. Yet, despite this overwhelming evidence, many individuals do not meet the recommended amount of physical activity required to achieve maximum health benefits. Because primary care physicians' advice is highly regarded, clinicians have the unique opportunity to play an important role in enabling patients to modify their behavior at the point of care with the goal of guiding patients to adopt and maintain an active lifestyle. In the current study, the authors evaluate pertinent literature from the fields of medicine/public health and economics/psychology to suggest a comprehensive approach to physical activity counseling at the primary care level. They first examine the public health approach to physical activity counseling, and then proceed to offer insights from behavioral economics, an emerging field that combines principles from psychology and economics. The application of key behavioral economics tools (eg, precommitment contracts, framing) to physical activity counseling in primary care is elaborated. CA Cancer J Clin 2017;67:233-244. © 2017 American Cancer Society.
102Changing health behaviours in rheumatology: an introduction to behavioural economics.PubMed
Alexis Ogdie, David A Asch
Nat Rev Rheumatol. 2020 Jan;16(1):53-60. doi: 10.1038/s41584-019-0336-1. Epub 2019 Dec 4.
Although the management of patients with rheumatic diseases has evolved substantially over the past 20 to 30 years, lifestyle changes (such as weight reduction, physical activity and medication adherence) remain an important and unmet challenge in improving patient outcomes. The field of behavioural economics considers the many ways that individuals behave irrationally and uses the predictability of these patterns to create opportunities to anticipate and avoid or harness these behaviours to improve patient outcomes. Existing among other motivational approaches, the concepts in behavioural economics have only been applied to health care in the past 10 to 15 years. Although few published examples have applied behavioural economic concepts in the management of patients with rheumatic diseases specifically, these concepts have been applied in other chronic diseases, and such interventions could also be applicable in rheumatology. In this Perspectives article, we introduce six principles in behavioural economics (loss aversion, framing effect, present bias, status quo bias, time inconsistency and social normalization), discuss how these concepts have been addressed in other fields and examine their potential application in rheumatology. Using physical activity as an example, we describe how these concepts could be applied to promote healthy behaviour in patients with inflammatory arthritis.
103Adaptive Goals and Reinforcement Timing to Increase Physical Activity in Adults: A Factorial Randomized Trial.PubMed
Marc A Adams, Michael Todd, Siddhartha S Angadi, et al.
Am J Prev Med. 2022 Feb;62(2):e57-e68. doi: 10.1016/j.amepre.2021.09.014. Epub 2021 Dec 8.
INTRODUCTION: Potent lifestyle interventions to increase moderate-to-vigorous physical activity are urgently needed for population-level chronic disease prevention. This trial tested the independent and joint effects of a mobile health system automating adaptive goal setting and immediate financial reinforcement for increasing daily walking among insufficiently active adults. STUDY DESIGN: Participants were randomized into a 2 (adaptive versus static goal setting) X 2 (immediate versus delayed financial incentive timing) condition factorial trial to increase walking. SETTINGS/PARTICIPANTS: Participants (N=512 adults) were recruited between 2016 and 2018 and were 64.5% female, aged 18-60 years, 18.8% Hispanic, 6.1% African American, and 83% White. INTERVENTION: Principles of reinforcement and behavioral economics directed intervention design. MAIN OUTCOME MEASURES: Participants wore accelerometers daily (133,876 day-level observations) that remotely measured moderate-to-vigorous physical activity bout minutes of ≥3 minutes/day for 1 year. Primary outcomes were between-condition differences in (1) engaging ≥1 bout of moderate-to-vigorous physical activity on each day and (2) on days with ≥1 bout, daily total moderate-to-vigorous physical activity minutes. RESULTS: Mixed-effects hurdle models tested treatment group X phase (time) interactions using an intent-to-treat approach in 2021. Engaging in any ambulatory moderate-to-vigorous physical activity was greater for Adaptive than for Static Goal groups (OR=2.34, 95% CI=2.10, 2.60 vs OR=1.66, 95% CI=1.50, 1.84; p<0.001) and for Immediate than for Static Reinforcement groups (OR=2.16 95% CI=1.94, 2.40 vs OR=1.77, 95% CI=1.59, 1.97; p<0.01). The Immediate Reinforcement group increased by 16.54 moderate-to-vigorous physical activity minutes/day, whereas the Delayed Reinforcement group increased by 9.91 minutes/day (p<0.001). The combined Adaptive Goals + Immediate Reinforcement group increased by 16.52 moderate-to-vigorous physical activity minutes/day, significantly more than that of either Delayed Reinforcement group. CONCLUSIONS: This study offers automated and scalable-behavior change strategies for increasing walking among adults most at-risk for chronic diseases attributed to sedentary lifestyles. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.gov (ClinicalTrials.gov Identifier: NCT02717663).
104Gamification Use and Design in Popular Health and Fitness Mobile Applications.PubMed
Victor Cotton, Mitesh S Patel
Am J Health Promot. 2019 Mar;33(3):448-451. doi: 10.1177/0890117118790394. Epub 2018 Jul 26.
PURPOSE: To evaluate the presence of gamification in popular mobile applications and whether principles from behavioral economics were incorporated in the design. DESIGN: The top 50 ranked free health and fitness applications were downloaded. Gamification elements were predetermined through literature review, and applications were evaluated for their presence. SETTING: App Store by Apple Inc. MEASURES: Presence of gamification, type of game element, and use of behavioral economic principles. ANALYSIS: We classified the types and frequencies of targeted behaviors and features of gamification. Use of behavioral economic principles focused on designing rewards or points using loss aversion (allocated upfront and could be lost), variable reinforcement (not allocated constantly), and probability inflation (using drawings or lottery designs). RESULTS: Gamification was used by 64% of mobile applications. Most applications that included gamification (97%) targeted behaviors related to physical activity and weight loss. Applications focused on other areas such as reproductive health, meditation, and sleep used gamification less often (11%). Game elements used most commonly included goal setting (78%), social influences (78%), and challenges (63%), while less common elements included points (6%) and levels (3%). No applications incorporated behavioral economics principles specified in the study. CONCLUSIONS: Gamification was commonly used by popular health and fitness mobile applications, but none used the specified behavioral economic principles to design rewards or points. Mobile applications could potentially improve their use if their design better leveraged principles from behavioral economics.
105Short bouts of accumulated exercise: Review and consensus statement on definition, efficacy, feasibility, practical applications, and future directions.PubMed
Mingyue Yin, Yongming Li, Abdul Rashid Aziz, et al.
J Sport Health Sci. 2025 Sep 18:101088. doi: 10.1016/j.jshs.2025.101088.
BACKGROUND: Insufficient physical activity and prolonged sedentary behavior have emerged as major global public health challenges. Short bouts (≤10 min) of accumulated exercise (SBAE) throughout the day may be a promising strategy to mitigate the adverse effects of prolonged sitting and promote physical activity, ultimately promoting overall health. However, previous ambiguity in defining this concept has resulted in a fragmented and inconsistent evidence base, impeding practical applications, the development of guidelines, and policymaking. The purpose of this study is to establish an operational definition of SBAE by synthesizing systematic reviews and research trials alongside an expert consensus. Additionally, it seeks to evaluate acute and long-term efficacy and feasibility, providing evidence-based recommendations for practice and future research directions. METHODS: A literature search was performed across PubMed and Web of Science, followed by systematic screening and summarization of eligible studies based on predefined inclusion criteria. Inclusion criteria encompassed various modes/types of SBAE (bouts lasting ≤10 min, performed multiple times daily with ≥30 min intervals); both aerobic and resistance exercise were considered. Relevant systematic reviews and research trials were included. Methodological quality, risk of bias, and evidence certainty were assessed. Expert consensus was obtained through a survey to evaluate recommendations and agreement levels on findings. RESULTS: After analyzing 27 systematic reviews, 135 research studies, and an expert consensus involving 48 researchers from 11 countries, SBAE is defined as any exercise mode of activity, regardless of intensity, that is accumulated in either continuous or intermittent bouts lasting ≤10 min per session (including multiple intermittent sets) that are performed multiple times (≥2 sessions/day) per day, with intervals of ≥30 min between bouts or otherwise sufficient time for recovery. When used to interrupt prolonged periods of sedentary time, SBAE mitigates the acute adverse effects of sedentary behavior on more than 10 clinical biomarkers of endocrine, cardiovascular, and brain health/function among adults of diverse ages and conditions. Moreover, SBAE was superior for improving acute glycemic control compared to a single continuous exercise session. As a long-term intervention (average of 11 weeks), SBAE can improve over 20 health outcomes, including peak oxygen uptake, resting blood pressure, and metabolic health. Additionally, SBAE might be more effective than continuous exercise for improving longer-term glycemic control and body composition. Long-term completion rates for SBAE interventions are generally high (95%), with low dropout rates (12%) and high adherence rates even without supervision (85%), and its safety has been preliminarily validated. CONCLUSION: An operational definition of SBAE is provided along with its classification and acute and long-term efficacy. Practical exercise prescription recommendations and evidence-based strategies for various populations and contexts are provided. Future research should focus on generating high-quality evidence for SBAE in five key areas: quantification and monitoring, population-specific responses, optimization of exercise prescriptions, intervention efficacy, and practical implementation. Additionally, addressing policy, environmental, and promotional barriers is crucial for transitioning from expert consensus to public consensus, and for facilitating the application of this strategy in real-world environments.
106Burden of 375 diseases and injuries, risk-attributable burden of 88 risk factors, and healthy life expectancy in 204 countries and territories, including 660 subnational locations, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023.PubMed
Lancet. 2025 Oct 18;406(10513):1873-1922. doi: 10.1016/S0140-6736(25)01637-X. Epub 2025 Oct 12.
BACKGROUND: For more than three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has provided a framework to quantify health loss due to diseases, injuries, and associated risk factors. This paper presents GBD 2023 findings on disease and injury burden and risk-attributable health loss, offering a global audit of the state of world health to inform public health priorities. This work captures the evolving landscape of health metrics across age groups, sexes, and locations, while reflecting on the remaining post-COVID-19 challenges to achieving our collective global health ambitions. METHODS: The GBD 2023 combined analysis estimated years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 375 diseases and injuries, and risk-attributable burden associated with 88 modifiable risk factors. Of the more than 310 000 total data sources used for all GBD 2023 (about 30% of which were new to this estimation round), more than 120 000 sources were used for estimation of disease and injury burden and 59 000 for risk factor estimation, and included vital registration systems, surveys, disease registries, and published scientific literature. Data were analysed using previously established modelling approaches, such as disease modelling meta-regression version 2.1 (DisMod-MR 2.1) and comparative risk assessment methods. Diseases and injuries were categorised into four levels on the basis of the established GBD cause hierarchy, as were risk factors using the GBD risk hierarchy. Estimates stratified by age, sex, location, and year from 1990 to 2023 were focused on disease-specific time trends over the 2010-23 period and presented as counts (to three significant figures) and age-standardised rates per 100 000 person-years (to one decimal place). For each measure, 95% uncertainty intervals [UIs] were calculated with the 2·5th and 97·5th percentile ordered values from a 250-draw distribution. FINDINGS: Total numbers of global DALYs grew 6·1% (95% UI 4·0-8·1), from 2·64 billion (2·46-2·86) in 2010 to 2·80 billion (2·57-3·08) in 2023, but age-standardised DALY rates, which account for population growth and ageing, decreased by 12·6% (11·0-14·1), revealing large long-term health improvements. Non-communicable diseases (NCDs) contributed 1·45 billion (1·31-1·61) global DALYs in 2010, increasing to 1·80 billion (1·63-2·03) in 2023, alongside a concurrent 4·1% (1·9-6·3) reduction in age-standardised rates. Based on DALY counts, the leading level 3 NCDs in 2023 were ischaemic heart disease (193 million [176-209] DALYs), stroke (157 million [141-172]), and diabetes (90·2 million [75·2-107]), with the largest increases in age-standardised rates since 2010 occurring for anxiety disorders (62·8% [34·0-107·5]), depressive disorders (26·3% [11·6-42·9]), and diabetes (14·9% [7·5-25·6]). Remarkable health gains were made for communicable, maternal, neonatal, and nutritional (CMNN) diseases, with DALYs falling from 874 million (837-917) in 2010 to 681 million (642-736) in 2023, and a 25·8% (22·6-28·7) reduction in age-standardised DALY rates. During the COVID-19 pandemic, DALYs due to CMNN diseases rose but returned to pre-pandemic levels by 2023. From 2010 to 2023, decreases in age-standardised rates for CMNN diseases were led by rate decreases of 49·1% (32·7-61·0) for diarrhoeal diseases, 42·9% (38·0-48·0) for HIV/AIDS, and 42·2% (23·6-56·6) for tuberculosis. Neonatal disorders and lower respiratory infections remained the leading level 3 CMNN causes globally in 2023, although both showed notable rate decreases from 2010, declining by 16·5% (10·6-22·0) and 24·8% (7·4-36·7), respectively. Injury-related age-standardised DALY rates decreased by 15·6% (10·7-19·8) over the same period. Differences in burden due to NCDs, CMNN diseases, and injuries persisted across age, sex, time, and location. Based on our risk analysis, nearly 50% (1·27 billion [1·18-1·38]) of the roughly 2·80 billion total global DALYs in 2023 were attributable to the 88 risk factors analysed in GBD. Globally, the five level 3 risk factors contributing the highest proportion of risk-attributable DALYs were high systolic blood pressure (SBP), particulate matter pollution, high fasting plasma glucose (FPG), smoking, and low birthweight and short gestation-with high SBP accounting for 8·4% (6·9-10·0) of total DALYs. Of the three overarching level 1 GBD risk factor categories-behavioural, metabolic, and environmental and occupational-risk-attributable DALYs rose between 2010 and 2023 only for metabolic risks, increasing by 30·7% (24·8-37·3); however, age-standardised DALY rates attributable to metabolic risks decreased by 6·7% (2·0-11·0) over the same period. For all but three of the 25 leading level 3 risk factors, age-standardised rates dropped between 2010 and 2023-eg, declining by 54·4% (38·7-65·3) for unsafe sanitation, 50·5% (33·3-63·1) for unsafe water source, and 45·2% (25·6-72·0) for no access to handwashing facility, and by 44·9% (37·3-53·5) for child growth failure. The three leading level 3 risk factors for which age-standardised attributable DALY rates rose were high BMI (10·5% [0·1 to 20·9]), drug use (8·4% [2·6 to 15·3]), and high FPG (6·2% [-2·7 to 15·6]; non-significant). INTERPRETATION: Our findings underscore the complex and dynamic nature of global health challenges. Since 2010, there have been large decreases in burden due to CMNN diseases and many environmental and behavioural risk factors, juxtaposed with sizeable increases in DALYs attributable to metabolic risk factors and NCDs in growing and ageing populations. This long-observed consequence of the global epidemiological transition was only temporarily interrupted by the COVID-19 pandemic. The substantially decreasing CMNN disease burden, despite the 2008 global financial crisis and pandemic-related disruptions, is one of the greatest collective public health successes known. However, these achievements are at risk of being reversed due to major cuts to development assistance for health globally, the effects of which will hit low-income countries with high burden the hardest. Without sustained investment in evidence-based interventions and policies, progress could stall or reverse, leading to widespread human costs and geopolitical instability. Moreover, the rising NCD burden necessitates intensified efforts to mitigate exposure to leading risk factors-eg, air pollution, smoking, and metabolic risks, such as high SBP, BMI, and FPG-including policies that promote food security, healthier diets, physical activity, and equitable and expanded access to potential treatments, such as GLP-1 receptor agonists. Decisive, coordinated action is needed to address long-standing yet growing health challenges, including depressive and anxiety disorders. Yet this can be only part of the solution. Our response to the NCD syndemic-the complex interaction of multiple health risks, social determinants, and systemic challenges-will define the future landscape of global health. To ensure human wellbeing, economic stability, and social equity, global action to sustain and advance health gains must prioritise reducing disparities by addressing socioeconomic and demographic determinants, ensuring equitable health-care access, tackling malnutrition, strengthening health systems, and improving vaccination coverage. We live in times of great opportunity. FUNDING: Gates Foundation and Bloomberg Philanthropies.
107Mortality Implications of Prediabetes and Diabetes in Older Adults.PubMed
Olive Tang, Kunihiro Matsushita, Josef Coresh, et al.
Diabetes Care. 2020 Feb;43(2):382-388. doi: 10.2337/dc19-1221. Epub 2019 Nov 27.
OBJECTIVE: Diabetes in older age is heterogeneous, and the treatment approach varies by patient characteristics. We characterized the short-term all-cause and cardiovascular mortality risk associated with hyperglycemia in older age. RESEARCH DESIGN AND METHODS: We included 5,791 older adults in the Atherosclerosis Risk in Communities Study who attended visit 5 (2011-2013; ages 66-90 years). We compared prediabetes (HbA 5.7% to <6.5%), newly diagnosed diabetes (HbA ≥6.5%, prior diagnosis <1 year, or taking antihyperglycemic medications <1 year), short-duration diabetes (duration ≥1 year but <10 years [median]), and long-standing diabetes (duration ≥10 years). Outcomes were all-cause and cardiovascular mortality (median follow-up of 5.6 years). RESULTS: Participants were 58% female, and 24% had prevalent cardiovascular disease. All-cause mortality rates, per 1,000 person-years, were 21.2 (95% CI 18.7, 24.1) among those without diabetes, 23.7 (95% CI 20.8, 27.1) for those with prediabetes, 33.8 (95% CI 25.2, 45.5) among those with recently diagnosed diabetes, 29.6 (95% CI 25.0, 35.1) for those with diabetes of short duration, and 48.6 (95% CI 42.4, 55.7) for those with long-standing diabetes. Cardiovascular mortality rates, per 1,000 person-years, were 5.8 (95% CI 4.6, 7.4) among those without diabetes, 6.6 (95% CI 5.2, 8.5) for those with prediabetes, 11.5 (95% CI 7.0, 19.1) among those with recently diagnosed diabetes, 8.2 (95% CI 5.9, 11.3) for those with diabetes of short duration, and 17.3 (95% CI 13.8, 21.7) for those with long-standing diabetes. After adjustment for other cardiovascular risk factors, prediabetes and newly diagnosed diabetes were not significantly associated with a higher risk of all-cause mortality (hazard ratio [HR] 1.03 [95% CI 0.85, 1.23] and HR 1.31 [95% CI 0.94, 1.82], respectively) or cardiovascular mortality (HR 1.00 [95% CI 0.70, 1.43] and HR 1.35 [95% CI 0.74, 2.49], respectively). Excess mortality risk was primarily concentrated among those with long-standing diabetes (all-cause: HR 1.71 [95% CI 1.40, 2.10]; cardiovascular: HR 1.72 [95% CI 1.18, 2.51]). CONCLUSIONS: In older adults, long-standing diabetes has a substantial and independent effect on short-term mortality. Older individuals with prediabetes remained at low mortality risk over a median 5.6 years of follow-up.
108Exerkine irisin mitigates cognitive impairment by suppressing gut-brain axis-mediated inflammation.PubMed
Hu Zhang, Jiling Liang, Jielun Huang, et al.
J Adv Res. 2025 Sep;75:843-862. doi: 10.1016/j.jare.2024.10.031. Epub 2024 Oct 29.
INTRODUCTION: Exercise has been recognized to improve cognitive performance by optimizing gut flora and up-regulating exerkine irisin. OBJECTIVE: Although exercise-induced irisin is beneficial to cognitive improvement, whether this benefit is achieved by optimizing gut microbiota and metabolites is not fully explored. METHODS: After aerobic exercise and exogenous irisin interventions for 12 weeks, the 16S rRNA and metabolites in feces of 21-month-old mice were analyzed. Meanwhile, the differential miRNAs and mRNAs in hippocampal tissues were screened by high-throughput sequencing. Relevant mRNAs and proteins were evaluated by RT-PCR, Western blot, and immunofluorescence. RESULTS: Compared with the young control mice, irisin levels and cognitive capacity of aged mice revealed a significant reduction, while aerobic exercise and intraperitoneal injection of exogenous irisin reversed aging-induced cognitive impairment. Similarly, 147 up-regulated and 173 down-regulated metabolites were detected in aged mice, while 64 and 45 up-regulated and 225 and 187 down-regulated metabolites were detected in aged mice with exercise and irisin interventions, respectively. Moreover, during hippocampal miRNA and mRNA sequencing analysis, 9 differential gut flora and 35 differential genes were identified to be correlated with the inflammatory signaling mediated by the TLR4/MyD88 signal pathway. CONCLUSION: Aging-induced cognitive impairment is due to insulin resistance induced by TLR4/MyD88 signaling activation in hippocampal tissues mediated by gut microbiota and metabolite changes. Myokine irisin may be an important mediator in optimizing gut microbiota and metabolism for an improved understanding of mitigated aging process upon exercise interventions.
109Effect of BFS1243 on a female frailty model induced by fecal microbiota transplantation in germ-free mice.PubMed
Sashuang Dong, Qi Zeng, Weimin He, et al.
Food Funct. 2024 Apr 22;15(8):3993-4009. doi: 10.1039/d3fo05282f.
Frailty, a complex geriatric syndrome, significantly impedes the goal of achieving 'healthy aging'. Increasing evidence suggests a connection between gut microbiota, systemic inflammation, and disease. However, it remains to be determined whether interventions targeting the intestinal flora can effectively ameliorate frailty. Our research involved fecal microbiota transplantation (FMT) experiments on germ-free (GF) mice, dividing these mice into three groups: a group receiving transplants from healthy elderly individuals (HF group), a group of frailty patients (FF group), and the FF group supplemented with BFS1243 (FFL group). Our findings indicated a significant shift in the gut microbiota of the FF group, in contrast to the HF group, characterized by decreased and increased , , and . Concurrently, there was a reduction in amino acids and SCFAs, with BFS1243 partially mitigating these changes. The FF group exhibited an upregulation of inflammatory markers, including PGE2, CRP, and TNF-α, and a downregulation of irisin, all of which were moderated by BFS1243 treatment. Furthermore, BFS1243 improved intestinal barrier integrity and physical endurance in the FF mice. Correlation analysis revealed a negative association between SCFA-producing species and metabolites like lysine and butyric acid with pro-inflammatory factors. In conclusion, our study conclusively demonstrated that alterations in the gut microbiota of elderly individuals can lead to physical frailty, likely due to detrimental effects on the intestinal barrier and a pro-inflammatory state. These findings underscore the potential of gut microbiome modulation as a clinical strategy for treating frailty.
110The Effects of Intermittent Fasting on Brain and Cognitive Function.PubMed
Jip Gudden, Alejandro Arias Vasquez, Mirjam Bloemendaal
Nutrients. 2021 Sep 10;13(9):3166. doi: 10.3390/nu13093166.
The importance of diet and the gut-brain axis for brain health and cognitive function is increasingly acknowledged. Dietary interventions are tested for their potential to prevent and/or treat brain disorders. Intermittent fasting (IF), the abstinence or strong limitation of calories for 12 to 48 h, alternated with periods of regular food intake, has shown promising results on neurobiological health in animal models. In this review article, we discuss the potential benefits of IF on cognitive function and the possible effects on the prevention and progress of brain-related disorders in animals and humans. We do so by summarizing the effects of IF which through metabolic, cellular, and circadian mechanisms lead to anatomical and functional changes in the brain. Our review shows that there is no clear evidence of a positive short-term effect of IF on cognition in healthy subjects. Clinical studies show benefits of IF for epilepsy, Alzheimer's disease, and multiple sclerosis on disease symptoms and progress. Findings from animal studies show mechanisms by which Parkinson's disease, ischemic stroke, autism spectrum disorder, and mood and anxiety disorders could benefit from IF. Future research should disentangle whether positive effects of IF hold true regardless of age or the presence of obesity. Moreover, variations in fasting patterns, total caloric intake, and intake of specific nutrients may be relevant components of IF success. Longitudinal studies and randomized clinical trials (RCTs) will provide a window into the long-term effects of IF on the development and progress of brain-related diseases.
111Unveiling the epigenetic impact of vegan vs. omnivorous diets on aging: insights from the Twins Nutrition Study (TwiNS).PubMed
Varun B Dwaraka, Lucia Aronica, Natalia Carreras-Gallo, et al.
BMC Med. 2024 Jul 29;22(1):301. doi: 10.1186/s12916-024-03513-w.
BACKGROUND: Geroscience focuses on interventions to mitigate molecular changes associated with aging. Lifestyle modifications, medications, and social factors influence the aging process, yet the complex molecular mechanisms require an in-depth exploration of the epigenetic landscape. The specific epigenetic clock and predictor effects of a vegan diet, compared to an omnivorous diet, remain underexplored despite potential impacts on aging-related outcomes. METHODS: This study examined the impact of an entirely plant-based or healthy omnivorous diet over 8 weeks on blood DNA methylation in paired twins. Various measures of epigenetic age acceleration (PC GrimAge, PC PhenoAge, DunedinPACE) were assessed, along with system-specific effects (Inflammation, Heart, Hormone, Liver, and Metabolic). Methylation surrogates of clinical, metabolite, and protein markers were analyzed to observe diet-specific shifts. RESULTS: Distinct responses were observed, with the vegan cohort exhibiting significant decreases in overall epigenetic age acceleration, aligning with anti-aging effects of plant-based diets. Diet-specific shifts were noted in the analysis of methylation surrogates, demonstrating the influence of diet on complex trait prediction through DNA methylation markers. An epigenome-wide analysis revealed differentially methylated loci specific to each diet, providing insights into the affected pathways. CONCLUSIONS: This study suggests that a short-term vegan diet is associated with epigenetic age benefits and reduced calorie intake. The use of epigenetic biomarker proxies (EBPs) highlights their potential for assessing dietary impacts and facilitating personalized nutrition strategies for healthy aging. Future research should explore the long-term effects of vegan diets on epigenetic health and overall well-being, considering the importance of proper nutrient supplementation. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT05297825.