Category: Public Health

New Paper: Prevalence and Correlates of Sitting in Europeans

| March 28, 2016 | 0 Comments

From the journal PLOS ONE:

Objective
Sedentary behaviour is increasingly recognized as an important health risk, but comparable data across Europe are scarce. The objective of this study was to explore the prevalence and correlates of self-reported sitting time in adults across and within the 28 European Union Member States.

Methods
This study reports data from the Special Eurobarometer 412. In 2013, 27,919 randomly selected Europeans (approximately 1000 per Member State) were interviewed face-to-face. Sitting time on a usual day was self-reported and dichotomised into sitting less- and more than 7.5 hours per day. Uni- and multivariate odds ratios of sitting more than 7.5 hours per day were assessed by country and socio-demographic variables using binary logistic regression analyses. The analyses were stratified by country to study the socio-demographic correlates of sitting time within the different countries.

Results
A total of 26,617 respondents were included in the analyses. Median sitting time was five hours per day. Across Europe, 18.5 percent of the respondents reported to sit more than 7.5 hours per day, with substantial variation between countries (ranging from 8.9 to 32.1 percent). In general, northern European countries reported more sitting than countries in the south of Europe. ‘Current occupation’ and ‘age when stopped education’ were found to be the strongest correlates of sitting time, both across Europe and within most Member States. Compared to manual workers, the odds ratio of sitting more than 7.5 hours per day was 5.00 for people with white collar occupations, 3.84 for students, and 3.65 for managers.

Conclusions
There is substantial variation in self-reported sitting time among European adults across countries as well as socio-demographic groups. While regular surveillance of (objectively measured) sedentary behaviour is needed, the results of this study provide entry points for developing targeted interventions aimed at highly sedentary populations, such as people with sedentary occupations.

The full article is available for free here.

Workplace interventions for reducing sitting at work

| March 18, 2016 | 0 Comments

An updated Cochrane Review has examined the impact of workplace interventions to reduce sitting.  From the plain language summary, available via the Cochrane Library.

Why is the amount of time spent sitting at work important?

Physical inactivity at work, particularly sitting has increased in recent years. Long periods of sitting increase the risk for obesity, heart disease, and overall mortality. It is unclear whether interventions that aim to reduce sitting at workplaces are effective at reducing the amount of time spent sitting.

The purpose of this review

We wanted to find out the effects of interventions aimed at reducing sitting time at work. We searched the literature in various databases up to 2 June 2015.

What trials did the review find?

We found twenty studies with a total of 2174 participants from high income nations. Nine studies evaluated physical changes in the workplace, four evaluated changes in workplace policy, seven studies evaluated information and counselling interventions and one study evaluated both physical workplace changes and information and counselling components.

Effect of sit-stand desks

Sit-stand desks alone decreased workplace sitting with about half an hour to two hours per day. When combined with information and counselling sit-stand desks reduced sitting at work in the same range. Sit-stand desks also reduced total sitting time (both at work and outside work) and the duration of sitting episodes that last 30 minutes or longer.

Effect of active workstations

Treadmill desks combined with counselling reduced sitting time at work compared to no intervention. Pedalling workstations combined with information did not reduce sitting at work compared to information alone.

Effect of walking during breaks

The introduction of walking during breaks in two studies with 443 participants did not change sitting time.

Effect of information and counselling

In two studies counselling decreased sitting time with 28 minutes and in another study mindfulness training did not have any effect on sitting at work. There was no considerable increase in work engagement with counselling.

Computer prompting software did not reduce sitting time in two studies. In another study computer prompts reduced sitting time with 55 minutes compared to no intervention. One study found that prompts to stand reduced sitting 14 minutes more than prompts to step. Computer prompts did not change the number of sitting episodes that last 30 minutes or longer.

Interventions from multiple categories

When multiple categories of interventions were combined to decrease sitting, there was reduction in workplace sitting time at 12 weeks’ and six months’ follow-up but there was no considerable difference between intervention and control group at 12 months’ follow-up.

Conclusions

The quality of evidence was very low to low for most interventions mainly because studies were very poorly designed and because they had very few participants. We conclude that at present there is very low quality evidence that sit-stand desks can reduce sitting at work at the short term. There is no evidence for other types of interventions. We need research to assess the effectiveness of different types of interventions for decreasing sitting at workplaces in the long term.

Seasons Greetings

| December 24, 2015 | 0 Comments

Wishing you a healthy, active holiday season and New Year.

Best wishes from SBRN!

Recipe for a healthy day: how compositional data analysis can help us optimise our daily routine to be healthy.

| December 21, 2015 | 1 Comment

The recipe

Today’s post comes from Dr Sebastien Chastin at Glasgow Caledonian University. 

What is the recipe for a healthy day?

This is the question we explore in our research article “Combined Effects of Time Spent in Physical Activity, Sedentary Behaviors and Sleep on Obesity and Cardio-Metabolic Health Markers: A Novel Compositional Data Analysis Approach” published by PLOS One. In this article, we argue that if we really want to know how much time we should spend; sleeping, sitting, standing, walking and exercising every day to be in good health, we have to adopt a compositional data paradigm. This is because, it is the only adequate mathematical representation of the pattern of time spent in different activities or behaviours throughout the day.  In other words, one that takes into account the fact that time spent in one type of activity cannot be spent in another type of activity.

While developing this novel approach, initially just to overcome some technical issues with collinearity, we realised that it was more than just a new statistical technique. It actually provided an interesting unifying conceptual framework to study the impact and determinants of daily pattern of time use in an integrated and multidisciplinary way.  In this blog piece, I would like to touch on some of these aspects.

It is helpful first to think about some analogous problems.

If I want to cook a tasty and healthy dish, nutritionists tell me that I have to combine in my recipe the right proportion of fat, carbohydrates, protein, vitamins, etc… and a good chef will tell me what ingredients to use and in what proportion.  In the same way, to formulate an effective pill, pharmacologists combine active and inert compounds in the right proportions, ensuring that all ingredients are compatible and that their interactions do not alter or blunt the desired effect. Both my dish and the medical pills are fundamentally compositions. A composition is an entity of multiple non-overlapping parts which sum to a whole. Figure 1, shows different compositional representation of my dish and a medical pill, in graphical and mathematical terms.  I apologise to nutritionists and pharmacologists if I did not get the number quite right to make these compositions actually healthy.

 

Figure 1: Schematic illustration of common composition and how the composition determines their effect.

Figure 1: Schematic illustration of common composition and how the composition determines their effect.

Similarly, our pattern of time use during the day is fundamentally a composition. For example we might describe the pattern of daily time use as

24 hour day = 8 hours (33.3%) sleep +  8 hours (33.3%) of work + 8 hours of leisure (33.3%)

OR

Waking day = 2% Moderate to vigorous activity + 38% Light activity + 60% Sedentary behaviour

Figure 2: Daily activity as a composition.

Figure 2: Daily activity as a composition.

 

 

I am sure that you have, at least once, represented the pattern of daily time use with a pie chart as in figure 2. You might not have realised it but this is already compositional data analysis, but let’s see how we can take it further.

An interesting property of compositions is that their effect is determined by the proportion of the various basic ingredients that constitute them and not solely by the amount of one of these.

Surely, not! Let’s see how we can change the effect of my dish or pill. To make my drug more potent I need to absorb more of the active ingredient. To do this I can either take more pills of the same composition, or I can include more active ingredients in my pill, changing its composition. Similarly, I can eat less fat if I include less fat in my dish, but then its composition changed or I can eat less of the dish but I am still swallowing the same composition. In either case, the dose response depends on both the composition and the size.

This property becomes more important in the context of time use because to be healthy we can only change the composition of the day – we can’t make it any longer or shorter! In our paper we have actually shown that the composition of the day in terms of time spent in sleep, sedentary behaviour, light and moderate to vigorous activity is associated with adiposity and cardiometabolic markers. To be more active, I have to change the composition of my day.  if I want to go to the gym and exercise I have to take time away from something else.

Conceptually, this is quite a departure from how we have usually considered time spent in physical activity, sleep or sedentary behaviour research. To date, we have conceptualised these as independent quantities of time and our reasoning and all the statistics we use to probe for evidence are based on this assumption. For example, we considered that health depends on the amount of time we spend exercising daily but did not address the fact that this time depends on the composition of the day. Our models and evidence rest on the underlying assumption that this time can be increased to infinity. Our current recipe for a healthy day is a minimum of daily 30 minutes of moderate to vigorous activity. This is roughly 2% of the time we have in a day. This recipe assumes that the remaining 98% of the day either has no impact on health or just the mirror opposite effect. This Manichaean concept would work if exercise was indeed the only ingredient of the day that impacts health.

However, we have more recently started to consider, that too much sitting might be bad for health, that sleep time is important for health, and that time spent in light activities might influence adiposity and glycaemic control. Since then, we have struggled to integrate and explain these within our current conceptual model of the day. This has led to some interesting controversies. A good example is contained in the article by Maher et al. 2014 published in PloS One and the comments it attracted [1]. Some scientists claim that sitting has effects on health regardless of the amount of moderate to vigorous activity, while others respond that sitting time is just inactive time and that the associations reported are only due to sitting displacing physical activity.  This will be familiar to you, and I have certainly heard the same arguments in numerous conferences. I found neither of these hypothesis satisfying. On one hand is it really reasonable to consider that the effect of sitting is independent when we know that time spent sitting and active are necessarily co-dependent and sitting necessarily displaces some active time? On the other, the dualist view activity/inactivity does not explain some of the lab results we have on sitting [2,3] and can’t account for the differences in effect we observed between sitting and light activity. Our field of research seems to be polarised in a dead lock as evidence seems to remain equivocal and flaunt by statistical difficulties such as collinearity[4].

This is why compositional data analysis is so attractive, it certainly enables us to overcome collinearity issues and to account in statistical models for time spent in all behaviours or categories of activity.  But more importantly it offers a unifying way forward.

From a compositional stand point, the hypotheses above are not antithetic but complementary. Spending time sitting can have both specific health effects and displace active time thus contributing to the effects of inactivity. Our results clearly show this. The compositional approach does not invalidate or contradict any of our evidence to date; actually our results are consistent with it all. Instead it provides a sound theoretical framework and the practical statistical tools to integrate them so that we can move forward.

Let’s face it most of us struggle to fit in 2% of our time in exercise, so finding out how to optimise the rest of the day is of interest to a lot of people. Besides that, we cannot exercise all day, so why not act on the whole distribution of time to improve health. Compositional analysis can help us get to the recipe for healthy day.

We are currently developing resources, training material and workshops about compositional data analysis and we would like to hear from people who might be interested in these or better in helping and collaborating toward developing a larger open science project using compositional data analysis to formulate the recipe for a healthy day.

References

  1. Maher C, Olds T, Mire E, Katzmarzyk PT. Reconsidering the Sedentary Behaviour Paradigm. Johannsen D, editor. PLoS One. Public Library of Science; 2014;9: e86403. doi:10.1371/journal.pone.0086403
  2. Dunstan DW, Kingwell BA, Larsen R, Healy GN, Cerin E, Hamilton MT, et al. Breaking Up Prolonged Sitting Reduces Postprandial Glucose and Insulin Responses. Diabetes Care. 2012; doi: 10.2337/dc11–1931.
  3. Chastin SFM, Egerton T, Leask C, Stamatakis E. Meta-analysis of the relationship between breaks in sedentary behavior and cardiometabolic health. Obesity (Silver Spring). 2015;23: 1800–10. doi:10.1002/oby.21180
  4. Zeljko Pedisic. Measurement issues and poor adjustments for physical activity and sleep undermine sedentary behaviour research. Kinesiology. 2014;46: 135–146.

This post was originally published on Obesity Panacea.

Online Research Study: How does sitting affect muscles?

| December 20, 2015 | 0 Comments

Dr Ragnar Viir is looking for participants to complete an online survey looking at the way that sitting impacts muscle function.

From the survey:

Muscular activity, movement, keep us healthy. Excessive sitting is a risk factor for poor health and shorter life expectancy. The process starts from sitting per se – but what happen to muscles when we are sitting?

Here we explore whether the digital 3PPIUTT test (Three Position Personally Informative Upper Trapezius muscle Test) can be used to distinguish qualitative differences between standing, sitting and lying positions. Test results can enhance our understanding of how to recover from upright positions´ related muscular stress.

Method: Respondents are asked to investigate their own Upper Trapezius (UT) muscles in two ways.

1) Gently squeezing the muscle to form an opinion of muscle stiffness in sitting, standing and supine,

2) Pulling muscle, fixed by thumb and fingers´ pincer-like grip in frontal (to nose) direction alternately with pulling muscle in dorsal direction, forms opinion of muscle tension; again in three sitting, standing and supine positions.

Respondents should use thumb and fingers in a pincer-like grip and test left side muscle with right hand and right side muscle with left hand. Next page videos show location of Upper Trapezius (UT) muscle and using the thumb and fingers´ pincer-like grip to test UT muscle.

Subjective assessments of muscle stiffness and tension please mark on a scale of 1-5 where: 1 = Most relaxed and 5 = Most stiff / Most tensed.
By completing and submitting this survey you are providing consent for your results to be used for research purposes.

Tallinn Medical Research Ethics Committee (TMREC) has given acceptance nr 307 (application nr 1054, TMREC protocol nr 174) to Ragnar Viir Limited Partnership, principal investigator Dr. Ragnar Viir PhD

The survey can be found here.

Why aren’t we capturing weather variation in active living research?

| December 17, 2015 | 0 Comments

Today’s post comes from Dr. Tarun Katapally. You can find more on Dr. Katapally at the bottom of this post.

We all seem to understand and experience the impact of weather on our movement patterns, yet most active living research is conducted without taking weather variation into account. In temperate climatic zones, and especially in Canada, we experience a wide variation in seasonal weather – not to mention adverse weather within seasons. Yet, in understanding the role of different contexts (i.e., urban design and neighbourhood built environment, school, home and recreational environment) in facilitating active living, weather seems to be ignored consistently.

It is true that we have no control over weather patterns. However, we do have the capacity to inform and influence policies that drive the environmental factors in our neighbourhoods, work places and schools. Individuals living in some neighbourhoods might have more access and amenities that may enable them to counter adverse weather and be active in all weather conditions. The same rationale applies to work places, schools or any other environmental context we are exposed to everyday. In informing policymakers, why aren’t we including weather variation in our analyses so that we can understand what physical and social environmental factors moderate the impact of adverse weather?

In Canada, time-stamped weather data are readily available through Environment Canada and this data could be easily linked with either accelerometry or self-report data. We appreciate that most accelerometry data are cross-sectional and hence, we have developed a methodology to link this cross-sectional data with weather data to study the influence urban design and built environment on children’s moderate to vigorous physical activity. This study has now been published in BMJ Open: bmjopen.bmj.com/content/5/11/e009045.full?keytype=ref&ijkey=3i5wwwyzlgy2cS2

Moreover, the article describing the methodology of the data linkage has itself been accepted for publication in the Canadian Journal of Public Health and will be available in early 2016. The methods used to capture weather variation and link weather data with accelerometry data could not only be replicated, but also modified or adapted. More importantly, researchers could easily adopt the overall approach of taking weather into account in active living research. We hope that weather variation, a perennial factor that interacts with all other environmental variables to influence active living, is not ignored in generating and translating knowledge to policymakers.

tarun-katapally Dr. Katapally is a medical doctor trained in India and a population health policy researcher. He is currently a faculty member at the Johnson-Shoyama Graduate School of Public Policy that is based at the Universities of Regina and Saskatchewan. He is also an adjunct faculty member in the Department of Community Health and Epidemiology at the University of Saskatchewan. Dr. Katapally’s expertise is in the employment of advanced mixed-methods and complex analytical techniques to understand the influence of policy and policy-driven social and physical contexts on the influence of children’s physical activity and sedentary behaviour.

SBRN Membership Hits 1,000 Mark

| December 14, 2015 | 0 Comments

The Sedentary Behaviour Research Network (SBRN) is celebrating signing up its 1,000th member.

Launched in 2011, SBRN is the only organization for researchers and health professionals which focuses specifically on the health impact of sedentary behaviour. The Network has grown steadily since 2011 and includes prominent researchers in the areas of physiology, epidemiology, psychology, and ergonomics. Further, the Network’s membership has also published a letter promoting a standardized and more robust definition of sedentary behaviour that can be applied consistently across research domains, which has been co-published in both French and English in 3 separate journals and translated into several other languages. The Network’s members have also organized in-person meetings at conferences in Europe, North America, and Australia.

Patterson_Freda-2015-10-10x67zn-199x300SBRN Membership reached the landmark figure when Dr. Freda Patterson, Assistant Professor of Health Promotion in the Department of Behavioral Health and Nutrition at the University of Delaware, joined several weeks ago.

Dr. Patterson’s work focuses on cardiovascular health and in particular, the promotion of heart health behaviors such as increased physical activity, decreased sedentary behavior and smoking cessation in at-risk populations. To this end, she has worked across the health promotion spectrum with both clinical and community based organizations to conceptualize, implement and evaluate novel programming around these behavioral targets.  She has over 60 peer-reviewed publications and has received funding from agencies including the American Heart Foundation, the Barra foundation and Robert Wood Johnson to continue her work.

Congratulations to Dr. Patterson – and to all SBRN members – for contributing to the Network’s past and ongoing success!

MSc opportunity at University of Regina (Canada)

| December 1, 2015 | 1 Comment
Dr Katya Herman currently has funding available for 2 MSc students with an interest in physical activity and sedentary behaviour epidemiology.  Students should have a minimum 80% GPA, with background in kinesiology, exercise science, health studies, epidemiology or related disciplines.  The positions can start anytime in 2016.  Students would become involved in a large multi-year project funded by the Saskatchewan Health Research Foundation, investigating seasonal and daily variations in physical activity and sedentary behaviour among adults, and associations with cardiometabolic outcomes.
Please feel free to post or forward on to students who might be interested, or to others who might know of interested students.
For more information, please contact me at katya.herman@uregina.ca
The University of Regina is a mid-sized comprehensive university enrolling 14,000 full-time and part-time undergraduate and graduate students in 10 faculties and 25 academic departments, with reputations for excellence and innovative programs (120 undergraduate + 78 graduate programs) leading to bachelor’s, master’s and doctoral degrees.

Of possible interest: Please complete this brief survey

| November 25, 2015 | 0 Comments

The below study may be of interest to SBRN members.  Please see details below.

As a practitioner or researcher whose work is in some way connected with physical activity, sedentary time and/or sleep, you are being invited to participate in a survey soliciting your opinion on a draft of Canada’s Integrated 24-Hour Movement Behaviour Guidelines for Children and Youth: an integration of physical activity, sedentary behavior and sleep (herein referred to as the Integrated Guidelines).

Traditionally, research examining the health implications of physical activity, sedentary behaviour, and sleep among children and youth has been conducted in movement behaviour silos, even though these behaviours do not occur in isolation of each other and have intuitive and empirical interactions. A body of research indicates that an integrated or holistic approach is more effective in changing behaviour resulting in a larger impact on health indicators, compared to an approach that only focuses on individual risk factors. Feedback from Canadian pediatricians, our knowledge user colleagues, and our expert international collaborators indicates that evidence-informed 24-hour guidelines that integrate physical activity, sedentary behaviour and sleep are needed and preferred over separate guides in order to enhance the promotion of healthy active lifestyles among children and youth across Canada.

With leadership from the Canadian Society for Exercise Physiology, a group of Canadian and International research and practice experts in physical activity, sedentary behaviour, sleep, and health promotion were convened to participate in the development of the Integrated Guidelines. After reviewing and consolidating the existing bodies of evidence in physical activity, sedentary behaviour and sleep, the experts have produced an initial version of the Integrated Guidelines.

One of the final stages in the development of the Integrated Guidelines is to gain feedback about the clarity of the guidelines, as well as level of agreement, perceived importance, and support for the guidelines from a large number of practitioners (e.g., pediatrics, education, public health, health promotion, physical activity, etc.). Acceptance and dissemination of the Integrated Guidelines is important for the alignment of strategic efforts in policy, practice, and research aimed at promoting health for Canadian children.

Participation in this survey is voluntary. By accessing and completing this survey you are giving your implied/passive consent to participate in the survey. A potential discomfort may include you feeling uncomfortable with some of the questions being asked if they are sensitive or evocative.  If you feel uncomfortable, you may choose not to answer a question. The survey does not collect information about your name or email address and responses will be presented in group format only. This survey will be distributed through our collaborating partner’s networks, memberships and email listservs; in the past, similar surveys have resulted in 2,000 respondents. If you have any questions about this study, please contact Dr. Mark Tremblay at 613-737-7600 ext. 4114 or mtremblay@cheo.on.ca. The Children’s Hospital of Eastern Ontario (CHEO) Research Ethics Board (REB) has reviewed this protocol. The REB considers ethical aspects of all research studies involving human participants at the CHEO and its Research Institute. If you have any questions about your rights as a study participant, you may contact the CHEO REB Chairperson at 613-737-7600 ext. 3624.

Note: Canada’s Integrated 24-Hour Movement Behaviour Guidelines for Children and Youth is in draft form and is not intended for general circulation.

Click on the link below for more information on the survey and instructions on how to get started.  Thanks for your time!

www.fluidsurveys.com/s/24-hour-guidelines

We encourage you to circulate the survey link to your colleagues and among your networks. This stakeholder survey will be open until 12 p.m. EST on December 18th, 2015. 

Exploring the context of sedentary behaviour in older adults (what, where, why, when and with whom)

| November 16, 2015 | 0 Comments

Today’s post comes from PhD student Calum Leask, describing his new paper, which is available here.  You can find more on Calum at the bottom of this post.

Spending too long sedentary is associated with a multitude of physical and mental health risks.  Of all sub-groups, older adults are the most sedentary and spend an average of 8.5 hours a day sitting down.  Everybody is living longer now than ever before and therefore, it is important to make sure that these additional years can be as healthy as possible.  One simple way this can be done is by reducing the amount of time spent sitting and interrupt prolonged (>60 mins) seated periods.  Depending on the context of older adults’ sitting (for example what, when, where and with whom are these periods occurring), some sedentary bouts may be easier / more difficult to break up.  Therefore, gaining this information may provide valuable guidance for future research.  This is one of the first studies to explore the context of sedentary behaviour in older adults using objective measures (an activity monitor and wearable camera) and this study formed the first stage of my PhD research.  The study was co-authored by Juliet Harvey, Professor Dawn Skelton and Dr Sebastien Chastin at the Institute of Applied Health Research in Glasgow Caledonian University.

For this study, 36 older adults (13 male and 23 female) were recruited and wore an activity monitor and timelapse camera for between 1 and 7 days.  Participants had a mean age of 73 years and were recruited from the Glasgow Caledonian University Older Adult Volunteer Research Database.  The activity monitor was attached to the individuals’ leg and detected both movement and posture in order to identify the periods in which participants were sedentary.  The timelapse camera was worn on a lanyard around the participants’ neck and automatically captured an image of the physical environment from a first person perspective when a change in light or temperature was detected.  The images taken during the sedentary periods identified by the activity monitor were then examined using an international classification system (SITONAUMY) to describe what, where, when, why and with whom the sedentary periods were occurring.  The concept of using the activity monitor and camera images in combination is visible below.

figure 1



In total, 52 days of data from 36 participants were available for analysis.   Participants spent the majority of their sedentary time (70.1% at home) and 22.9% of their non-screen sedentary behaviour reading.  Whilst the deleterious effects of sitting too much have already been discussed, activities like reading are cognitively stimulating and facilitate cognitive function, especially during aging.  Therefore, it should be questioned whether future interventions should target these periods, or solely focus on sedentary activities which are cognitively passive.

figure 2

A large portion of older adults’ sedentary time (56.9%) was spent alone.  Loneliness increases the risk of prolonging sedentary time in this population; therefore older adults living alone may be an important sub-group to specifically target in future interventions.  The social sedentary activities which this sample participated in were prolonged (18% of sedentary time) yet infrequent (6.9% of sedentary bouts).  Socialising, like reading, has a mental health benefit, therefore it may be suggested that sedentary activities in specific contexts should be targeted, as opposed to generically aiming to reduce sedentary behaviour.

figure 3

Whilst this study was conducted on a relatively small convenience sample, some of the results, including average daily sedentary time (14.2 hours) and television viewing time (4.3 hours), compare favourably to larger previously published works.  Although using objective measurement (as conducted here) has been shown as more accurate than subjective means, the assessment is quite costly and due to the vast amount of data collected, requires intensive data processing and coding.  However, the findings provide detailed insight into the context of older adults’ sedentary behaviour and provide specific guidelines for future interventions, although these results should be confirmed in a larger and representative population of older adults.

The full text may be found here: http://www.eurapa.net/content/12/1/4

 

calum

       Calum Leask

Calum Leask is a PhD Student in the School of Health and Life Sciences at Glasgow Caledonian University, Scotland.  His research focuses on reducing sedentary behaviour in older adults and more specifically, developing strategies to help older adults identify and reduce prolonged seated periods. For further information, please contact: calum.leask@gcu.ac.uk