Research Article
Motivational Counseling to Reduce Sitting Time: A Community-Based Randomized Controlled Trial in Adults

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Background

Sedentary behavior is regarded as a distinct risk factor for cardiometabolic morbidity and mortality, but knowledge of the efficacy of interventions targeting reductions in sedentary behavior is limited.

Purpose

To investigate the effect of an individualized face-to-face motivational counseling intervention aimed at reducing sitting time.

Design

A randomized, controlled, observer-blinded, community-based trial with two parallel groups using open-end randomization with 1:1 allocation.

Setting/participants

A total of 166 sedentary adults were consecutively recruited from the population-based Health2010 Study.

Intervention

Participants were randomized to a control (usual lifestyle) or intervention group with four individual theory-based counseling sessions.

Main outcome measures

Objectively measured overall sitting time (ActivPAL 3TM, 7 days); secondary measures were breaks in sitting time, anthropometric measures, and cardiometabolic biomarkers, assessed at baseline and after 6 months. Data were collected in 2010–2012 and analyzed in 2013–2014 using repeated measures multiple regression analyses.

Results

Ninety-three participants were randomized to the intervention group and 73 to the control group, and 149 completed the study. The intervention group had a mean sitting time decrease of –0.27 hours/day, corresponding to 2.9% of baseline sitting time (hours/day); the control group increased mean sitting time by 0.06 hours/day. The between-group difference in change, –0.32 hours/day (95% CI=–0.87, 0.24, p=0.26), was not statistically significant. Significant differences in change in fasting serum insulin of –5.9 pmol/L (95% CI=–11.4, –0.5, p=0.03); homeostasis model assessment–estimated insulin resistance of –0.28 (95% CI=–0.53, –0.03, p=0.03); and waist circumference of –1.42 cm (95% CI=–2.54, –0.29, p=0.01) were observed in favor of the intervention group.

Conclusions

Although the observed decrease in sitting time was not significant, a community-based, individually tailored, theory-based intervention program aimed at reducing sitting time may be effective for increasing standing and improving cardiometabolic health in sedentary adults.

Trial registration

This study is registered at Clinicaltrials.gov (NCT00289237).

Introduction

Recent evidence1, 2, 3, 4, 5, 6, 7, 8, 9 suggests that sedentary behavior may be a distinct risk factor for cardiovascular morbidity and mortality, independent of leisure-time moderate and vigorous physical activity (MVPA). The detrimental health effects of sedentary behaviors (e.g., during TV viewing)1, 3, 5, 10, 11 and overall sitting during the day2, 6, 7, 8, 12, 13 have been shown in observational studies. Additionally, the number of breaks in sitting time may be inversely associated with the cardiometabolic risk profile.14

It has been proposed that targeting increased participation in MVPA may not be sufficient to offset the health hazards associated with excessive sitting. In a group of healthy middle-aged and elderly women, participation in sustained 10-minute bouts of objectively measured MVPA was unrelated to objectively measured duration of daily sitting time.15 Recent experimental studies also suggest that neither recommended levels of MVPA16 nor restricted energy intake17 can fully compensate the negative cardiometabolic health effects of sitting.

Sedentary behavior is defined as “any waking behavior characterized by an energy expenditure ≤1.5 METs while in a sitting or reclining position.”18 Adults in Western societies spend 45%–60% of their waking hours in sedentary pursuits, a stark contrast to the small proportion of total time spent in MVPA (5%).19, 20, 21, 22 Reduction of sitting time therefore represents a potential target for promotion of health and prevention of chronic disease.

Recently, a number of studies23, 24, 25, 26, 27, 28, 29 have reported on the effects of interventions aimed at reducing and breaking up sedentary time in different settings and populations. Generally, studies have been small-scale feasibility studies with theory-based behavioral interventions,26, 27 short-term experimental studies,24, 28 or worksite intervention studies conducted in small convenience samples.23, 25, 29

These studies23, 25, 26, 27, 28, 29 have shown that reduction of sitting time is possible, with reductions ranging from 3%–4% of total daily sitting time26, 27 up to approximately 25% of working hours.23, 25, 29 Additionally, positive cardiometabolic effects have been observed in some studies.23, 24 However, there is a need for randomized trials conducted in population-based study samples to confirm that the possible beneficial effects of reducing sitting time are achievable in community settings and to obtain unbiased estimates of the effects on various health outcomes.

Therefore, the aim of the present study was to investigate the efficacy of an individually tailored, theory-based, motivational counseling intervention on objectively measured sitting time, number of breaks in sitting time, anthropometric measures, and cardiometabolic biomarkers, in a population-based sample of sedentary adult men and women. We hypothesized that daily sitting time could be reduced, the number of breaks in sitting time could be increased, and cardiometabolic biomarkers and anthropometric measures could be improved.

Section snippets

Setting and Participants

Participants for the present RCT, the Sedentary Intervention Trial (SIT), were consecutively recruited from The Health2010 study, a population-based epidemiologic study carried out at The Research Centre for Prevention and Health (RCPH). A random sample of 3,762 men and women aged between 18 and 69 years and living in ten municipalities in the Western part of the Capital Region of Denmark was initially drawn through the Danish Civil Registration Office.

The Health2010 participants (N=1,522,

Participant Flow and Baseline Characteristics

During the inclusion period, 689 Health2010 participants were assessed for eligibility. Among these, 299 (43% of participants assessed for eligibility) met eligibility criteria (Figure 1) and 171 (57% of eligible participants) initially consented to participate and started the 7-day baseline ActivPAL monitoring period. Five participants withdrew after initially accepting participation, but before randomization, one because of a skin reaction to the adhesive ActivPAL PAL stickie and four

Discussion

In this population-based study sample of community-dwelling adults, a 6-month, individually tailored, theory-based intervention program aimed at reducing daily sitting time was effective for improving cardiometabolic biomarkers. The overall sitting time was reduced by 2.9% in the intervention group, although this was not statistically different compared to the control group. However, standing time significantly increased in the intervention group and fasting serum insulin level, HOMA-IR, and

Acknowledgments

We sincerely thank all the participants who choose to be a part of the present study in addition to their participation in the Health2010 study. The work was supported by the Health Insurance Foundation (Helsefonden, Grant No. 2012B233) and the Lundbeck Foundation (Grant No. j.nr. 14/2010). D.W. Dunstan is supported by an Australian Research Council Future Fellowship.

The authors declare that there was no racial or gender bias in the selection of participants.

No financial disclosures were

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