Sedentary behaviour, physical activity, and fitness

156 Pages·2017·1.78 MB·English

Sedentary behaviour, physical activity, and fitness
Citation for published version (APA):
van der Velde, J. H. P. M. (2017). Sedentary behaviour, physical activity, and fitness: associations with
cardio-metabolic health. [Doctoral Thesis, Maastricht University]. Maastricht University.
https://doi.org/10.26481/dis.20171110jvdv
Document status and date:
Published: 01/01/2017
DOI:
10.26481/dis.20171110jvdv
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Download date: 27 Feb. 2023
Sedentary behaviour, physical activity, and
fitness: associations with cardio-metabolic health
Jeroen H.P.M. van der Velde
© Jeroen H.P.M. van der Velde, Maastricht, 2017
Production: Gildeprint – Enschede
ISBN: 978-94-6233748-0
Sedentary behaviour, physical activity, and
fitness: associations with cardio-metabolic health
PROEFSCHRIFT
Ter verkrijging van de graad van doctor aan de Universiteit Maastricht,
op gezag van de Rector Magnificus, prof. dr. Rianne M. Letschert,
volgens het besluit van het College van Decanen,
in het openbaar te verdedigen
op vrijdag 10 november 2017 om 14:00 uur
door
Jeroen Henricus Paulus Maria van der Velde
Promotores:
Prof. dr. N.C. Schaper
Prof. dr. H.H.C.M Savelberg
Copromotor:
Dr. ir. A. Koster
Beoordelingscommissie:
Prof. dr. ir. M.P. Weijenberg (voorzitter)
Dr. J.B.J. Bussmann (Erasmus universitair medisch centrum, Rotterdam)
Prof. dr. M.K.C. Hesselink
Prof. dr. J.P. Kooman
Prof. dr. ir. M. Visser (VU medisch centrum, Amsterdam)
Table of contents
1 7
Chapter General introduction
2 Associations of sedentary behaviour and physical activity with 19
Chapter
physical function – The Maastricht Study
3 Sedentary behaviour, physical activity and fitness – The 39
Chapter
Maastricht Study
Moderate activity and fitness, not sedentary time, are
4 61
Chapter independently associated with cardio-metabolic risk in U.S.
adults aged 18–49 – NHANES
Sedentary time and higher intensity physical activity versus
5 77
Chapter cardio respiratory fitness; what is more important for cardio-
metabolic health for adults aged 40-75? – The Maastricht Study
6 Replacement effects of sedentary time on metabolic outcomes 99
Chapter
– The Maastricht Study
7 119
Chapter Summary and general discussion
S
Appendices amenvatting (NL) 145
V
alorisation addendum 149
D
ankwoord (NL) 153
C V
urriculum itae 155

1
Chapter
General introduction
Chapter 1
Increase in non-communicable diseases globally
The prevalence of non-communicable diseases (NCDs), such as cardiovascular disease
and type 2 diabetes mellitus (T2DM) has increased significantly over the last decades.
NCDs are currently responsible for more deaths than all other causes combined: 38
million deaths per year, as reported by the WHO.1 In high income countries, 28% of
these NCD deaths occur before the age of 70, leading to loss of productivity. In
addition, the complications and comorbidities of NCDs impose a great burden on
patients, health care systems, and society. Therefore, the prevention of NCDs is critical.
In many persons NCDs could be prevented, as several risk factors, such as tobacco use
and dietary intake, are modifiable.2 Another key modifiable risk factor is lack of
physical activity, which is estimated to be the main cause of about one-third of T2DM
and coronary heart disease cases.3 Therefore, in the prevention of NCDs physical
activity is important.
Physical activity
Physical activity is defined as “any bodily movement produced by skeletal muscles that
requires energy expenditure”.4 The first study that established the importance of physical
activity in preventing disease was performed already more than sixty years ago by
Morris et al. in 1953.5 By comparing bus drivers (who sat all day and had low
occupational physical activity) with bus conductors (who walked around in the bus all
day and had high occupational physical activity), Morriset al. noticed that bus drivers
had higher rates of coronary heart diseases, arguably due to the lack of physical
activity. Since this land mark publication, decades of physical activity research have led
to a broad attention for lack of physical activity as a risk factor for diseases and
mortality.6-8 Nowadays, national physical activity guidelines have been established in
order to provide guidance in the prevention of NCDs. Although these guidelines differ
between countries, most guidelines state to engage at least 150 minutes per week in
moderate to vigorous physical activity (MVPA).4,9
MVPA is defined as activities ≥ 3.0 metabolic equivalents (METs) and includes
activities such as brisk walking, cycling, heavy housework, and most sports. A MET is
a physiological measure to express the energy expended during a certain activity as a
ratio to the energy expended when a person is seated and at rest (=1 MET).10,11
Biological mechanisms through which MVPA reduces the risk for NCDs have been
studied extensively. These mechanisms include improvements in body composition,
enhancements in lipid lipoprotein profiles (e.g. improvements in HDL-cholesterol),
reductions in blood pressure and systemic inflammation, and improved glucose
metabolism.12-14 In addition, regular MVPA promotes vascular, muscular, and
-8 -
General introduction
respiratory adaptations that lead to improved muscle quality, muscular strength and
cardiorespiratory fitness (CRF).15 In particular for older adults, engaging in muscle
1
strengthening activities is important for maintaining a sufficient level of physical
function, i.e. the ability to undertake the physical tasks of everyday living.12,16
Deterioration in physical function has been associated with loss of independence, a
reduced quality of life, disability, and mortality.17
Cardio-respiratory fitness (CRF)
CRF is defined as “the capacity of the cardiovascular and respiratory systems to supply fuel
and oxygen during sustained physical activity”.18 Thus, it’s a reflection of the efficiency of
the lungs, heart, vascular system and exercising muscles in the transport and use of
nutrients and oxygen. As CRF depends strongly on the amount of MVPA, CRF has
often been used as an objective measure for level of physical activity. However,
differences in frequency and intensity of engagement in physical activity only partly
explain differences in CRF between individuals. An estimated 10-50% of CRF is
explained by other factors than physical activity, including genetic differences,
behavioural (such as smoking and overweight), and external elements (such as medical
condition).19-21 Consequently, level of CRF may differ between individuals with similar
patterns of physical activity.
CRF is often determined from an exercise tolerance test performed on a treadmill or
cycle ergometer. Prospective studies have demonstrated that CRF is important in the
aetiology of the metabolic syndrome, cardiovascular disease, and premature
mortality.21,22 Although health benefits of MVPA are mediated by increased CRF,
MVPA also has acute health effects (without improving CRF), which include
improvements in blood pressure, blood lipids, and glucose metabolism.23
Consequently, despite being interrelated, MVPA and CRF appear to have distinct
health benefits.
Total daily activities
Even though the aforementioned study of Morris et al. from 1953 reported the
beneficial effect of light to moderate physical activities, until recently most research and
guidelines were focused on MVPA. However, MVPA only comprises a small part of all
daily activities in most individuals. To illustrate, US adults engaged on average 23
minutes per day in MVPA.24 European adults engaged slightly more in MVPA, but
similar to the Americans, the majority of European adults doesn’t meet the 150 minutes
per week physical activity guidelines.25
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