Sedentary behavior and medical multimorbidity

doi:10.1016/j.physbeh.2015.08.016

Physiology & Behavior

Volume 151, 1 November 2015, Pages 395-397

https://doi.org/10.1016/j.physbeh.2015.08.016 Get rights and content

Abstract

Emerging research demonstrates that sedentary behavior is associated with various individual chronic conditions, independent of physical activity. Despite multimorbidity (having at least 2 chronic diseases) being highly prevalent (≥ 23% of adults) and associating with premature mortality, limited research has examined the association between sedentary behavior and multimorbidity, which was the purpose of this research letter. Data from the 2005–2006 NHANES were used (analyzed in 2015). A multimorbidity index variable was created indicating the number of 14 morbidities each patient had; sedentary behavior and physical activity were assessed via accelerometry. For every 60 min/day increase in sedentary behavior, participants had a higher multimorbidity index (β_adjusted = 0.08; 95% CI: 0.04–0.11, p < 0.001) and had an 11% (OR_adjusted = 1.11; 95% CI: 1.01–1.21; p = 0.03) increased odds of being multimorbid (i.e., having ≥ 2 morbidities). Sedentary behavior is associated with multimorbidity (independent of light-intensity physical activity and adherence to moderate-to-vigorous physical activity guidelines), which underscores the importance of minimizing prolonged sedentary behavior (in addition to promoting physical activity) among adults.

Introduction

Considerable research demonstrates that physical activity (PA) is associated with improved health (e.g., reduced risk of cardiovascular disease) [1]. There is also emerging research demonstrating that sedentary behavior (SB) is associated with various individual health outcomes, independent of PA [2]. At this point, most outcome-based research examines individual health outcomes, as opposed to the concurrent presence of multiple chronic diseases (hereafter ‘multimorbidity’), despite at least 23.2% of adults having 2 or more chronic diseases [3]. Limited research has examined the relationship of SB and multimorbidity [4]. This is concerning as not only is multimorbidity prevalent, but multimorbidity is associated with premature mortality [5], reduced functional status [6], [7], [8], and increased utilization of inpatient and ambulatory health care [9], [10]. Therefore, the purpose of this short communication was to examine the association between SB (independent of PA) and multimorbidity in a national sample of U.S. adults.

Section snippets

Study design and participants

Data from the 2005–2006 National Health and Nutrition Examination Survey (NHANES) cycle was used; this is the only present NHANES cycle with available data on all the study variables (including sleep behavior). NHANES study procedures were approved by the NCHS ethics review board, with informed consent obtained from all participants. In the 2005–2006 NHANES, 2048 adult (≥ 20 yrs) participants provided data on the study variables.

Multimorbidity

A multimorbidity index [11] variable was calculated based on the

Results

Table 1 reports the weighted characteristics of the analyzed sample. In a multivariable logistic regression, and after adjustments, for every 60 min increase in SB, participants had an 11% (OR_adjusted = 1.11; 95% CI: 1.01, 1.21; P = .03) increased odds of being multimorbid (i.e., having ≥ 2 morbidities). In a multivariable linear regression, and after adjustments, for every 60 min/day increase in SB, participants had a higher multimorbidity index (β_adjusted = 0.08; 95% CI: 0.04, 0.11, P < .001). After

Discussion

These findings that demonstrate a relationship between SB (independent of adherence to light-intensity PA and adherence to MVPA guidelines) and multimorbidity are in support of the accumulating research demonstrating that SB is independently associated with various individual chronic diseases [2]. Given the inability to ascertain temporality with the NHANES cross-sectional design, it is equally plausible to suggest that in this sample, multimorbid patients engaged in more SB because of the

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Cited by (32)

Evolution of sedentarism prevalence in Spanish population between 1987 and 2020
2024, Medicina Clinica
El sedentarismo es un factor predictivo para numerosas enfermedades. El objetivo de este estudio fue valorar la evolución de la prevalencia de sedentarismo en la población española adulta entre los años 1987-2020.
Las fuentes de datos fueron las Encuestas Nacionales y Europeas de Salud. La prevalencia de sedentarismo se valoró en 3 escenarios (actividad principal, tiempo libre y todos los escenarios). Se estimaron prevalencias de sedentarismo global, por sexo y grupo de edad. En todos los escenarios la prevalencia también se estimó por comunidad autónoma. La tendencia de las prevalencias se analizó con los porcentajes de cambio anual (PCA) obtenidos a través de modelos joinpoint.
La prevalencia de sedentarismo en la actividad principal varió entre el 31,2% en 1987 y el 38,4% en 2020 (PCA: 0,7 [0,5 a 1,0]), siendo mayor en los varones que en las mujeres, y más elevada en los más jóvenes y en los más mayores. La prevalencia de sedentarismo en el tiempo libre varió entre el 55,1% en 1993 y el 36,4% en 2020 (PCA: −1,4 [−1,9 a −0,9]), siendo siempre superior en las mujeres, más alta en los mayores de 64 años y menor en los de 16-24 años. Cantabria y Canarias fueron las comunidades autónomas con la prevalencia de sedentarismo más baja en todos los escenarios.
La prevalencia de sedentarismo en la actividad principal está aumentando en España, mientras que durante el tiempo libre está descendiendo. Es importante aplicar medidas de prevención y promoción de la salud dirigidas a disminuir el sedentarismo en la población.
Sedentary behavior is a predictive factor for numerous diseases. The objective of this study was to assess the evolution of the prevalence of sedentary behavior in the Spanish adult population between 1987 and 2020.
The data sources were the National and European Health Surveys. The prevalence of sedentary behavior was assessed in three scenarios (main activity, leisure time and all scenarios). Prevalence of sedentary behavior was estimated overall, by sex and age group. In all scenarios, prevalence was also estimated by Autonomous Community. The prevalence trend was analyzed with the annual percent change (APC) obtained through joinpoint models.
The prevalence of sedentary in the main activity ranged from 31.2% in 1987 to 38.4% in 2020 [PCA: 0.7 (0.5-1.0)], being higher in men than in women and higher in younger and older people. The prevalence of sedentary in the leisure time varied between 55.1% in 1993 and 36.4% in 2020 [PCA: −1.4 (−1.9 to −0.9)], being always higher in women, higher in those over 64 years of age and lower in those aged 16–24 years. Cantabria and the Canary Islands were the Autonomous Communities with the lowest prevalence of sedentary behavior in all scenarios.
The prevalence of sedentary behavior in the main activity is increasing in Spain, whereas during leisure time it is decreasing. It is important to implement prevention and health promotion measures aimed at reducing sedentary behavior in the population.
Physical multimorbidity and cancer prevalence in the National Health and Nutrition Examination Survey
2021, Public Health
As the US population ages, both cancer and multimorbidity become more common and pose challenges to the healthcare system. Limited studies have examined the association between multimorbidity and cancer prevalence in the US adult population. To help address this gap, we evaluated the associations between individual chronic conditions and all-site cancer, multimorbidity and all-site cancer, and multimorbidity and site-specific cancers.
This is a cross-sectional study.
Data from 10,731 adults aged 20 years or older who participated in the 2013–2016 National Health and Nutrition Examination Survey were used in our study. Self-reported demographics, smoking status, sedentary behavior, body mass index, individual chronic conditions, multimorbidity status, cancer history, and cancer sites were assessed.
In our sample, the prevalence of having any type of cancer or multimorbidity was 9% (N = 861) and 38% (N = 4248), respectively. Respiratory conditions (multivariable-adjusted odds ratio [OR]: 1.3; 95% confidence interval [CI]: 1.1–1.6) and arthritis (multivariable-adjusted OR: 1.5; 95% CI: 1.2–1.8) were observed to be statistically significantly associated with having all-site cancer after adjusting for potential confounders. Having multimorbidity was also statistically significantly associated with having all-site cancer (multivariable-adjusted OR: 1.4; 95% CI: 1.2–1.7), cervical cancer (multivariable-adjusted OR: 2.6; 95% CI: 1.2–5.4), and bladder cancer (multivariable-adjusted OR: 2.8; 95% CI: 1.0–7.6).
Multimorbidity was associated with all-site cancer, cervical cancer, and bladder cancer. The present study provides new evidence of the potential relationships between multimorbidity and cancer. Future longitudinal studies are warranted to clarify the temporality and potential biological mechanisms of the associations between multimorbidity and cancer.
Physical multimorbidity and sedentary behavior in older adults: Findings from the Irish longitudinal study on ageing (TILDA)
2020, Maturitas
Citation Excerpt :
Non-communicable diseases are the leading cause of premature mortality worldwide, accounting for around 70 % of deaths [1]. Research and clinical care tend to focus on managing diseases individually, but between 13 % and 59 % of adults have two or more chronic physical health conditions, or multimorbidity, in community or care settings [2–8]. Multimorbidity is associated with a shorter life expectancy and elevated risk of premature mortality that is greater in older adults, increasing with the number of conditions [9–12].
Physical multimorbidity, defined as the presence of two or more chronic physical conditions, is widespread and reduces life expectancy and quality of life in older adults. Sedentary behavior (SB) is increasingly identified as a risk factor for a range of chronic physical conditions, independent of physical activity.
To investigate associations between physical multimorbidity and SB in older adults.
We used cross-sectional data from a population-based sample of 6903 adults aged ≥50 years who participated in the Irish Longitudinal Study on Ageing (TILDA) in 2009-2011. We conducted multivariable linear and logistic regression analyses to assess associations between multimorbidity and SB.
Self-reported minutes/day of SB and high SB (≥ 8 h/day).
We found that most of the 14 individual chronic physical conditions included here were associated with greater SB. Those with stroke (OR = 2.63, 95 % CI = 1.69, 4.10) and cirrhosis (OR = 2.53, 95 %CI = 1.19, 5.41) were the most likely to be classified with high SB. Time spent in SB and the prevalence of high SB increased linearly with number of chronic conditions. Multivariable regression models adjusting for sociodemographic and psychological factors, disability, social network, and physical activity showed that, compared with people with none, those with ≥4 chronic physical conditions had 1.45 times greater odds (OR = 1.45, 95 % CI = 1.09, 1.93) of high SB and higher mean minutes/day of SB (β = 21.37, 95 % CI = 5.53, 37.20).
Our results suggest that physical multimorbidity is associated with SB and highlight the need for prospective research to examine the directionality and mechanisms of these associations.
CKD and Sedentary Time: Results From the Canadian Health Measures Survey
2018, American Journal of Kidney Diseases
Sedentary behavior and low physical activity are associated with incident diabetes, cardiovascular disease, and early mortality. Previous studies have examined associations between chronic kidney disease (CKD) and physical activity, but little is known about the role of sedentary time.
Cross-sectional national survey.
A nationally representative sample of adults (n = 8,444) participating in the Canadian Health Measures Survey’s (CHMS) activity monitoring component (2007-2013).
Estimated glomerular filtration rate (eGFR).
Sedentary time (total sedentary minutes/total wear time) measured using triaxial accelerometry.
Multivariable ordinal logistic regression for quartiles of sedentary time and linear regression for sedentary time measured on a continuous scale were performed in the entire study population and in the subgroup with CKD.
Mean proportion of sedentary time ranged from 58% (least sedentary quartile: Q1) to 81% (most sedentary quartile: Q4). Lower eGFR, older age, lower serum albumin level, higher blood pressure, cardiovascular disease, diabetes, and higher body mass index were independently associated with a higher proportion of sedentary time. Patients with eGFRs < 45 mL/min/1.73 m² had more than 4-fold higher likelihood of being sedentary (OR, 4.2; 95% CI, 2.5-7.3). Within the CKD subgroup, greater sedentary time was associated with diabetes (OR, 2.68; 95% CI, 1.56-4.59) and arthritis (OR, 2.32; 95% CI, 1.43-3.77) in adjusted analysis.
Cross-sectional design precluded evaluation of longitudinal outcomes and establishment of the causal nature of observed associations. Small sample of individuals with advanced CKD.
In this cross-sectional survey, reduced eGFR was strongly and independently associated with greater sedentary time. This risk was further heightened by the presence of diabetes and arthritis. Studies to determine causes for sedentary behavior and assess the feasibility and value of interventions to reduce sedentary time in CKD are needed.
Correlates of sedentary behavior in 2,375 people with depression from 6 low- and middle-income countries
2018, Journal of Affective Disorders
Citation Excerpt :
SB is highly prevalent across the world (Ekelund et al., 2016b; Loyen et al., 2016). In addition to the deleterious physical health consequences of SB (Wirth et al., 2017) including an increased risk of multimorbidity (Loprinzi, 2015), there is also an increasing evidence base suggesting its association with depression. A recent meta-analysis, almost exclusively among high-income countries, found that among more than 110,000 individuals, higher levels of SB were associated with a higher risk for developing depression (relative risk 1.31 (95%CI 1.16 to 1.48)) (Zhai et al., 2015).
Sedentary behaviour (SB) is harmful for health and well-being and may be associated with depression. However, little is known about the correlates of SB in people with depression. Thus, we investigated SB correlates among community-dwelling adults with depression in six low- and middle-income countries.
Cross-sectional data from the World Health Organization’s Study on Global Ageing and Adult Health were analyzed. The analysis was restricted to those with DSM-IV Depression or receiving depression treatment in the last 12 months. Self-reported time spent sedentary per day was the outcome. High SB was defined as ≥8 hours of SB per day. The correlates (sociodemographic and health-related) of SB were estimated by multivariable linear and logistic regression analyses.
In 2375 individuals with depression (mean age=48.0 years; 60.7% female), the prevalence of high SB was 11.1% (95%CI=8.2%-14.9%), while the mean (±SD) time spent sedentary was 215 (±192) minutes per day. Socio-demographic factors significantly associated with high SB were older age and being unmarried, being male and being unemployed. In other domains, no alcohol consumption, current smoking, mild cognitive impairment, bodily pain, arthritis, stroke, disability, and lower levels of social cohesion, COPD, visual impairment, and poor self-rated health was associated with greater time spent sedentary.
Our data suggest that future interventions seeking to reduce SB among individuals with depression may target at risk groups based on identified sociodemographic correlates while the promotion of social cohesion may have the potential to increase the efficacy of future public health initiatives. From a clinical perspective, bodily pain and somatic co-morbidities need to be taken into account.
Associations between accelerometer-assessed sedentary behavior, physical activity and objectively-measured cardiorespiratory fitness with red blood cell distribution width
2016, International Journal of Cardiology
Citation Excerpt :
High sensitivity CRP concentration was quantified using latex-enhanced nephelometry, and reported in mg/dL to the nearest hundredth (0.01). A multimorbidity index variable was calculated as the sum of multiple chronic diseases which have previously been shown to associate with various health-enhancing behaviors [38–40], and all-cause mortality [41]. Additionally, chronic diseases spanning multiple physiological systems were included to adhere to the suggestion that multiple classes of chronic diseases should be evaluated [42].
Emerging work identifies red blood cell distribution width (RDW) as a unique biomarker independently associated with cardiovascular disease and mortality. Encouragingly, recent research demonstrates individual associations of sedentary behavior, physical activity and cardiorespiratory fitness with RDW. However, no study has evaluated their independent and combined associations on RDW, which was this study's purpose.
Data from the 2003–2004 National Health and Nutrition Examination Survey were used (N = 627 adults 20–49 yrs). Sedentary behavior and MVPA were objectively assessed (accelerometry) with cardiorespiratory fitness determined from a submaximal treadmill-based test. Participants were classified as above or below the median values for each of these three parameters, with a PACS (Physical Activity Cardiorespiratory Sedentary) score ranging from 0 to 3, indicating the participant number of these three positive characteristics. A blood sample was obtained from each participant to assess RDW.
Only above median MVPA (OR = 0.47; 95% CI: 0.32–0.68) was independently associated with a reduced odds of having an elevated RDW. With regard to the additive model, and after adjustment, the odds ratio (95% CI) for the PACS score of 1 (vs. 0), 2 (vs. 0), and 3 (vs. 0), respectively, were 0.81 (0.45–1.45; P = 0.46), 0.66 (0.44–0.99; P = 0.04) and 0.35 (0.18–0.68; P = 0.004).
When considering sedentary behavior, MVPA, and cardiorespiratory fitness, only MVPA was associated with reduced odds of elevated RDW, but those with all three characteristics had the lowest odds of elevated RDW.

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Sedentary behavior and medical multimorbidity

Abstract

Introduction

Section snippets

Study design and participants

Multimorbidity

Results

Discussion

Mayo Clin. Proc.

Mayo Clin. Proc.

Lancet

J. Clin. Epidemiol.

Mayo Clin. Proc.

Prev. Med.

Lifestyle factors and multimorbidity: a cross sectional study

BMC Public Health

Clinical multimorbidity and physical function in older adults: a record and health status linkage study in general practice

Fam. Pract.

Relationship between multimorbidity and health-related quality of life of patients in primary care

Qual. Life Res.

Multimorbidity and quality of life in primary care: a systematic review

Health Qual Life Outcomes.

Epidemiology and impact of multimorbidity in primary care: a retrospective cohort study

Br J Gen Pract

Prevalence, expenditures, and complications of multiple chronic conditions in the elderly

Arch. Intern. Med.

Sports Nutrition: an introduction to energy production and performance