Theme: The science of sedentary behavior
Adults' Sedentary Behavior: Determinants and Interventions

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Abstract

Research is now required on factors influencing adults' sedentary behaviors, and effective approaches to behavioral-change intervention must be identified. The strategies for influencing sedentary behavior will need to be informed by evidence on the most important modifiable behavioral determinants. However, much of the available evidence relevant to understanding the determinants of sedentary behaviors is from cross-sectional studies, which are limited in that they identify only behavioral “correlates.” As is the case for physical activity, a behavior- and context-specific approach is needed to understand the multiple determinants operating in the different settings within which these behaviors are most prevalent. To this end, an ecologic model of sedentary behaviors is described, highlighting the behavior settings construct. The behaviors and contexts of primary concern are TV viewing and other screen-focused behaviors in domestic environments, prolonged sitting in the workplace, and time spent sitting in automobiles. Research is needed to clarify the multiple levels of determinants of prolonged sitting time, which are likely to operate in distinct ways in these different contexts. Controlled trials on the feasibility and efficacy of interventions to reduce and break up sedentary behaviors among adults in domestic, workplace, and transportation environments are particularly required. It would be informative for the field to have evidence on the outcomes of “natural experiments,” such as the introduction of nonseated working options in occupational environments or new transportation infrastructure in communities.

Introduction

Epidemiologic and physiologic research on sedentary behavior has demonstrated novel health consequences of prolonged sitting time, which are independent of those attributable to lack of physical activity. However, behavioral research that could lead to effective interventions for influencing sedentary behaviors is less developed, especially so for adults. The purpose of this theme issue of the American Journal of Preventive Medicine is to propose a set of perspectives on “too much sitting” that can guide future research. As the theme papers demonstrate, recent epidemiologic evidence (supported by physiologic studies) is consistent in identifying sedentary behavior as a distinct health risk. However, to build evidence-based approaches for addressing sedentary behavior and health, there is the need for research to develop high-quality measures, to understand the personal, social, and environmental factors that influence sedentary behaviors, and to develop and test the relevant interventions.

As Salmon and colleagues explain in their contribution on children and youth,1 a comprehensive “behavioral epidemiology” research agenda2, 3 is required for the sedentary behavior field; this involves five research phases. For adults, the evidence germane to the first three phases: (1) relationships of sedentary behavior with health outcomes; (2) measuring sedentary behavior; and (3) characterizing prevalence and variations of sedentary behavior in populations, is addressed respectively in the Thorp et al.,4 Healy et al.,5 and Bauman et al.6 papers in this theme issue. However, the knowledge base for informing interventions, mass-reach programs, and the relevant environmental and policy initiatives requires further development.

Salmon et al.1 review the relevant phases of the behavioral epidemiology research strategy on sedentary behavior for children and youth and are able to highlight several strengths of the evidence relevant to interventions and public health initiatives. However, as demonstrated in the present paper, there is a less-developed research base on adults within the fourth and fifth behavioral epidemiology research phases: (4) identifying the determinants of sedentary behavior; (5) developing and testing interventions to influence sedentary behavior.7, 8

The present paper has several goals: The first is to outline a conceptual approach to understanding the determinants of prolonged sitting time, based on an ecologic model of sedentary behavior. Relevant evidence from the few available studies on the correlates of sedentary behavior is presented. Consideration is also given to the modest evidence base on sedentary behavior interventions in adults. Five research recommendations are proposed for understanding factors that influence adults' sedentary behavior and the development and evaluation of interventions.

Section snippets

What Is Sedentary Behavior?

Sedentary behavior is distinct from lack of physical activity; put simply, it is too much sitting, as distinct from too little exercise, as has been argued elsewhere,7, 9, 10 For example, an individual can be sufficiently active according to the physical activity guidelines but still can spend prolonged time sitting in front of TV. The generic term sedentary behavior identifies a class of behaviors characterized primarily by sitting, with associated low levels of metabolic energy expenditure.7,

Mapping the Multiple Domains of Sedentary Behavior Determinants: An Ecologic Model

An ecologic approach to understanding the influences on a behavior assumes there are multiple levels of influence, including individual, social, organizational/community, environmental, and policy.13 Of particular importance is to understand the behavior setting, which is the physical and social context where sitting occurs.14 Within the generic class of behavior that may be described as “sedentary,” there are particular sedentary behaviors that occur commonly in a variety of settings: TV

Correlates of Sedentary Behaviors: Emerging Evidence

Research on factors related to sedentary behaviors is at an early stage, with much of the available evidence being in relation to TV viewing time. For example, an early study by Salmon et al.24 reported on factors related to high levels of TV time (14 hours or more a week) in a large sample of Australian adults. The predictors of high TV time were enjoyment of TV, and perceived barriers to physical activity (cost, work commitments). A more recent descriptive epidemiology study showed that

Interventions to Influence Adults' Sedentary Behaviors

Decreasing adults' sedentary time is a new health behavior change target, and most studies on reducing sedentary time have been conducted with children and adolescents.1 Only two intervention trials conducted with adults were found. The first such trial (TView, conducted in the U.S.) focused on a particular sedentary behavior (TV viewing) and evaluated a 3-week program using an electronic TV lock-out system with 36 overweight and obese participants aged 22 to 61 years.35 A 61% reduction in TV

Sedentary Behavior Determinants and Interventions: Research Priorities

Sedentary behavior determinants and intervention studies will benefit from building explicitly on the elements of the behavioral epidemiology research agenda highlighted in this theme issue.1, 4, 5, 6 Scientific progress will require evidence-based behavioral targets identified by physiologic studies on the relationships of sedentary behaviors with biomarkers and health outcomes; understanding of the strengths and limitations of the measures required for determinants and intervention studies;

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