Sedentary Behaviour Interrupted: Acute, medium and long-term effects on biomarkers of healthy aging, physical function and mortality

摘要 老年人努力从事增进健康的体力活动(PA)，每天花费长达11小时 坐着。特别是老年妇女，患慢性病和残疾的风险增加，并使用高剂量的 医疗保健资源的比例。改善这两种行为有望改善几个显著的方面 衰老结果，但有证据表明如何最好地中断长时间久坐不动的行为 缺少(某人)。很少有基于实验室的试验包括70岁以上的成年人，重点是PA到 打断某人，并且没有测试过老年人可能接受的站立休息。最近的一篇评论 表明在现实世界中，传统的PA干预并不会对某人产生有意义的影响。相比之下， 以站立为重点的干预措施可以减少SB，每天最多2小时。流行病学研究表明 自我报告的SB与死亡风险和代谢结果的增加之间显示出关联，但非常 很少有前瞻性研究采用客观的方法来衡量某人。尽管加速度计测量可以 表示运动的强度或缺乏运动，传统的切入点不能准确地对这样的行为进行分类 如坐着、站着或走路。虽然飞行员干预研究使用了大腿佩戴的倾斜仪， 证明SB可以大大减少，在老年人中没有随机对照试验的健康结果。那里 在我们对SB和健康老龄化的理解上有很大的提高空间。国家老龄问题研究所 2013年举办了一系列夏季讲习班，以解决这一问题。因此，我们设计了一个程序 项目-久坐时间和衰老研究(STAR)-提供更严格和全面的 关于如何中断久坐时间及其对健康衰老的影响的证据。特别是，我们正在 建议从将能源消耗作为健康结果的主要机制转变为 研究一些行为，比如短暂的从坐到立的转变，这种转变消耗的能量很少，但会消耗肌肉， 改善体位血流，并可能影响老年人的身体功能。此外，我们将研究一项 比迄今调查的结果范围更广，包括具有针对性的新机制，对 健康的衰老。STAR计划将包括3个项目和2个核心项目，用于研究绝经后妇女 罹患慢性病的风险。STAR包括2个随机试验，在实验室(N=86)和在真实世界中 (n=592)，重点是优化新的计算技术，以适用于现有的预期 加速度计数据(n&gt；6000)。所有项目都将调查长时间坐着、站立、简短的后果 坐立转换和PA断裂在健康衰老机制上的作用，包括葡萄糖调节， 内皮功能和线粒体功能。我们还将调查身体功能、血液 压力和项目3中的5-7年死亡风险。所有项目都将比较不同年龄段的效果。星星 将提供全面的证据基础，可以为关于SB和老龄化的公共卫生指南提供信息。我们会 协调我们的努力与一个新的美国心脏协会中心关于某人和拉丁人。

Abstract Older adults struggle to engage in health enhancing physical activity (PA) and spend up to 11 hours a day sitting. Older women, in particular, are at increased risk of chronic disease and disability, and use a high proportion of healthcare resources. Improving both these behaviors has promise for improving several salient aging outcomes, but evidence to inform guidelines on how best to interrupt long periods of sedentary behavior (SB) are lacking. Few laboratory-based trials have included adults over 70 years old, have focused on PA to interrupt SB, and have not tested standing breaks that might be acceptable to older adults. A recent review showed that in the real world, traditional PA interventions do not meaningfully impact SB. In contrast, interventions that focus on standing can reduce SB, up to 2 hours per day. Epidemiological studies have shown associations between self-reported SB and increased risks of death and metabolic outcomes, but very few prospective studies have employed objective measures of SB. Although accelerometer measures can indicate the intensity of movement or lack of it, traditional cutpoints do not accurately classify behaviors such as sitting, standing or walking. While pilot intervention studies, using thigh worn inclinometers, have demonstrated that SB can be greatly reduced, there are no RCTs in older adults with health outcomes. There is much room for improvement in our understanding of SB and healthy aging. The National Institute on Aging conducted a summer workshop series to address this issue in 2013. We have therefore designed a Program project – Sedentary Time and Aging Research (STAR) – to provide more rigorous and comprehensive evidence on how to interrupt sitting time and the consequences for healthy aging. In particular, we are proposing a paradigm shift away from energy expenditure as the primary mechanism for health outcomes to investigating behaviors such as brief sit-to-stand transitions that expend little energy but engage muscles, improve postural blood flow, and may impact physical functioning in older adults. Further, we will study a broader range of outcomes than investigated to date, including targeted novel mechanisms important for healthy aging. The STAR program will include 3 Projects and 2 Cores for study of postmenopausal women at risk for chronic disease. STAR includes 2 randomized trials, in the laboratory (N=86) and in the real world (N=592), with focus on optimizing new computational techniques to apply to existing prospective accelerometer data (n>6000). All projects will investigate the consequences of extended sitting, standing, brief sit-to-stand transitions and PA breaks on mechanisms of healthy aging including glucose regulation, endothelial functioning, and mitochondrial functioning. We will also investigate physical functioning, blood pressure and in Project 3, 5-7 year mortality risk. All Projects will compare effects across age groups. STAR will provide a comprehensive evidence base that can inform public health guidelines on SB and aging. We will coordinate our efforts with a new American Heart Association Center on SB and Latinas.