Technology: Cause and Possible Solution of Sedentary Behaviors

All evidence points to technology being a major cause of sedentary behavior, particularly watching TV, computers and gaming. Inactivity contributes to obesity, which in turn contributes to heart disease and cancer. Early emphasis has been on moderate to vigorous physical activity (MVPA), with the recommendation of 150 minutes/week for adults. Unfortunately, only 5% of adults in the US only achieve this.

In the past several years we have learned that sedentary activity (1-3 METS) is an independent risk factor for cardiovascular disease and cancer, even if someone exercises. At age 65-70 adults spend about 75% of their waking hours in the sedentary mode.

So what is the solution?? Many countries are recommending walking programs to provide light intensity exercise to counteract the effects of sedentary activity. Pedometers are a good way to measure simple movements such as walking, but fail to measure exercise intensity. In the past decade accelerometers have become the gold standard for activity. They can measure steps, activity counts, body position, light levels, kilo-calories burned during the day and sleep at night and they do measure intensity. Currently I am wearing both a pedometer and accelerometer Actigo so I can understand these technologies better. As a spin-off benefit, sleep quantity/quality is also measured with the device worn on the wrist. There are also a variety of programs to monitor fitness these days, such as RunKeeper a smartphone program that tracks your times and distance by GPS and hosts that information on their server. Another interesting technology is Up by Jawbone; a wrist worn device that also tracks your activity but can vibrate to either remind you to get up from sedentary activity or to wake you up.

While I have great hope for technology, I'm a realist. It takes motivation and incentives to change people's habits. Just because the technology is "cool" and performs well doesn't mean people will spend more time walking and less time sitting. What is the solution?.....Bob

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Tags: actigraphy, inactivity, motion, sedentary, sensors

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Comment by Bob Hoyt on April 11, 2012 at 9:50am

Thanks for sharing the  UK approach to LTCs. It reminded me of a 16 March 2012 paper in the  BMJ entitled "Association between low functional health literacy and mortality in older adults: longitudinal cohort study". One third of older adults in England could not understand basic health information. I suspect the percentage is higher in the US and impacts our ability to decrease unhealthy behaviors

Comment by David Sandbach on April 11, 2012 at 9:41am

I am working on self care ideas and thought you may be interested in this paper from the Royal College og General Practitioners.

http://www.rcgp.org.uk/PDF/CIRC_Care_Planning.pdf

 

 

Comment by Bob Hoyt on April 11, 2012 at 9:10am

Interesting points. I do know one of the largest healthcare networks in the US (Kaiser-Permanente) is handing out free pedometers to their staff, in the hope that they will become more active. I don't know how successful that has been. You can "game the system" and just shake the device and record movement. The device I am currently wearing (ActiGo) allows you to accumulate points towards an award of their equipment or gift cards. Will probably take months to be able to buy anything but I wonder how strong an incentive this might be. 

I guess the bottom line is that we need a randomized controlled trial of very similar subjects who use the device with the same training but one group with incentives and one group without. It would be interesting to see if the group with the incentives outperformed those without. Perhaps there should be several different levels of incentives to see what works.....Bob

Comment by David Sandbach on April 11, 2012 at 8:48am

Dear Dr Hoyt,

 

I was wondering if insurance companies (the Government in the UK) would give an insurance discount for people who exercised and used one of these gizmos to record the fact and then down load the data to their online health record.

At the beginning of a wellness programme the GP / practice nurse could agree a series of targets e.g. reduction in hypertension index, reduced blood sugar levels etc. based on measurements taken at the surgery, these could be checked off at the end of the year against up dated biological measurements plus data from the fitness equipment and a cash bonus / insurance premium discount awarded?  Check points say quarterly using the online fitness data only could be agreed thus enabling the care professional to give some verbal coaching.

I would be interested in your views on this as a potential technique to motivate people using technology and financial incentives.

Yours Sincerely,

David Sandbach.

Comment by Bob Hoyt on March 15, 2012 at 3:09am

It is clear that we all have beautiful parks to walk in and great software to quantitatively measure our exercise. What is missing is the motivation and/or incentives to diet and exercise. I had a chuckle learning about the National Obesity Observatory. All I could envision was a hill where scientists looked down and counted fat people :-).....Bob

Comment by David Sandbach on March 14, 2012 at 8:43pm

Dear Dr. Hoyt,

Did a Google search for walking apps and came across this:

 

http://everybodywalk.org/app.html

 

Best wishes,

 

David Sandbach. 

Comment by David Sandbach on March 14, 2012 at 8:28pm

Dear Dr. Hoyt,

I saw these sites and thought you may be interested in seeing them since they are Public Healt orientated.

http://www.noo.org.uk/

 

http://www.wfh.naturalengland.org.uk/woodland-walks

 

I think that it would be easy enough to put an appt together with a woodland walks on, our historic town buildings walk or a "walks in the area" whith graded walks for different groups of patients depending on morbidity stage. Perhaps even a walk with me diary to help motivation?

 

Cost funded via local advertising or State Public Health sponsorship?

Best wishes,

 

David Sandbach

 

 

 

 

 

 

 

Comment by David Sandbach on March 14, 2012 at 2:45am

Dear Dr. Hoyt,

 

Look on the bright side todays young fatties are your patients of tomorrow!

Comment by Bob Hoyt on March 14, 2012 at 2:28am

Very interesting posts. Clearly people walk more in Europe than in the United States for the reasons mentioned and price of gasoline. My concern is that there is no app for motivation. As a physician, it is frustrating to discuss diet/exercise, drinking in moderation and smoking cessation with people who are in the late stages of disease and should have known better. It would be much better to prevent these public health issues early in the lives of patients but I am not optimistic about the younger generations taking up the battle cry for better health through diet and exercise. It will probably take some form of "shock therapy" to cause major changes. Sorry for the cynicism.....Bob

Comment by David Sandbach on March 13, 2012 at 8:13pm

Dear Dr. Hoyt,

Please see this link

http://departmentofhealth.ideascale.com/a/dtd/The-Obesity-App-using...

 

Not a fittness app per se but combined with one maybe some positive synergy to be had?

 

Best wishes,

 

David Sandbach. 

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