Sedentary Behavior in Adults with Visual Impairments AER Conference on: Vision Loss in Older Adults and Veterans, November, 2015 Dr. Lauren J. Lieberman The College at Brockport Kinesiology, Sport Studies, and Physical Education

Outline What are the current physical activity and sedentary behavior habits in adults with visual impairments (VI)? How did we become so sedentary? How can sedentary behavior impact me? Ways to sit less and move more

Physical Activity what is it, and how much our we currently doing?

Physical Activity Can Manage Our Health Prevention, improvement, or maintenance of the following: Cardiovascular disease Stroke Type II Diabetes Hypertension Osteoporosis Obesity Breast & Prostate Cancer Mental Health – well being, self esteem, self-efficacy, less depression Maintenance of physical functioning Falling and injury

e.g. walking, cleaning, dancing, playing with your children Physical Activity = any bodily movement that results in a substantial increase in energy expenditure (i.e. burns calories)!!! e.g. walking, cleaning, dancing, playing with your children so this means that physical activity includes, walking your dog, taking the stairs, walking to the coffee shop, and the list goes on. You can see that this is a little different to exercise…

Type of Physical Activity Leisure Time PA Physical Activity Household Transportation Exercise I like to think of physical activity as this big umbrella term, with other components of physical activity being under it. For instance, exercise is something that you purposively do… jog, ride a bike, go to the gym etc. You may have a part time occupation such as being a greater at walmart… the activity you get while doing that would relate to your occupational physical activity… you do things around the house such as laundry, ironing, making the bed, vacuuming etc – this is household physical activity… so all of these things represent different types of physical activity, be it, household, occupational, exercise, etc… but they are all physical activity… bottom line… everything counts!! Occupational

How Much Should We Be Doing? 30 minutes of moderate physical activity on 5 or more days per week This can be broken down into segments  10 mins in the morning, afternoon, and evening (to total 30 mins) So exactly how much should we be doing them… Well we actually have national recommendations on how much we should be doing to try and be healthy, or how much we should be doing to try and avoid or reduce getting chronic diseases such as heart disease…. And then state that we should be doing… Moderate intensity refers to activities that increase your heart rate and breathing substantially however you could still hold a conversation with the person next to you!

How Much Are We Doing? Still being investigated Low in children – trend through adulthood Smaller proportion of individuals with disabilities are physically active compared to able-bodied Those with VI spend less than 7% of their total active time participating in moderate to vigorous physical activity (MVPA) the intensity needed to prevent, improve, and maintain our health Not much research has examined PA participation in adults with VI; PA decreases with aging, so if low in children, will be even lower in adults; What has been done, shows less VI involved in sports/PA compared to sighted peers; VI do not engage in as much MVPA potentially missing out of health benefits associated with exercise specifically; While many Americans do not accumulate recommended amounts of PA, even fewer with VI – potentially a result of increased barriers to PA

Self-Reported Physical Activity Levels of Adults with Visual Impairments One hundred and fifteen individuals (36.1±13.9yrs, 28±6.9kg/m2) with varying degrees of VI (B1, n=30; B2, n=25; B3, n=34; B4, n=26) completed the study, from 35 affiliation sites across 21 different states in the United States. Participants completed the International Physical Activity Questionnaire-Short Form (IPAQ-S), which assesses PA from the previous week based on self-reported duration and frequency of participation in walking, moderate PA (MPA), vigorous PA (VPA), and sitting time. There were no differences in physical activity or sedentary behavior across VI Participants spent 7.1% of their day walking, 4.9% in MPA, 4.9% in VPA, 9.8% in moderate to vigorous PA (MVPA), and 44.6% of the weekday sitting.

Barrier to Participation in Physical Activity in Individuals with VI & Sighted Peers Accessibility Income Knowledge Experience Confidence Motivation Awareness of needs Previous Injury Environment Social Support – friends, family, co-workers

If we are not being physically active what are we doing with our time?

What is Sedentary Behavior Latin word, “sedere” means “to sit” Activities that involve sitting/reclining or laying down while awake Low energy expending tasks Humans are made to move however we sit for long periods of time, day after day Technology Jobs Changes in our built environment Access to be active

Sedentary Behavior in Sighted Individuals Increase in sedentary behavior from age 6-18 then an increase in sedentary behavior from 50-85. This also results in a decrease in physical activity.

Sedentary Behavior in Individuals with Disabilities More likely to engage in sedentary lifestyle compared to able bodied Rimmer et al. (1999): African American women with disabilities 86% spent more than 10 hours inside home during the week Women reported sitting, laying down and/or sleeping - 18 hours/day = 75% of waking time Rimmer – can assume it was sedentary behavior inside home

Sedentary Behavior in Individuals with VI Majority of sedentary time watching TV, transportation, computer/paperwork Hours spent with sedentary behavior: Differences between acuity level: B1 more time reading vs. B4 B4 more time watching TV on weekends vs. B1 Weekdays Weekends Men 48.8 hrs/wk 16.2 hrs/wk Women 51.2 hrs/wk 18.0 hrs/wk USABA study – adults w/ VI; This is a physically active group! Reading on weekdays - (B1=1.41±1.81 vs. B4=0.42±0.60 hours/day) and weekend days (B1=1.55±1.75 vs. B4=0.48±0.67 hours/day), as well as for watching TV on the weekends (B4=2.69±1.61 vs. B1=1.39±1.52 hours/day). - Starkoff et al (in submission)

How Does this Behavior Impact Me? So to review, we have a poor health status as a population – suffering from mainly preventable chronic disease and we engage in a lot of sedentary behaviors and a little physical activity to promote health ….

Lack of Physical Activity in Individuals with Visual Impairment Insufficient PA exposes individuals with VI to more health risks compared to sighted peers: stroke osteoporosis depression hypertension heart disease diabetes falls obesity Ray 2007

Think before you sit Once you take a seat 2 hours later 24 hours later Your muscles are no longer engaged Your body does not expend many calories, almost nothing! The ability to utilize stored energy (triglycerides or fat) diminishes therefore increasing the likelihood of storing fat in the body 2 hours later A 20% reduction in the function of High-Density Cholesterol (Good Cholesterol) Increasing likelihood of cholesterol build-up in the arteries 24 hours later Risk of type II diabetes increases – insulin is 24% less effective

Too Much of A Good Thing Blood pressure Triglycerides Blood sugar (glucose) Waist size Body fat Clustering of these health markers Risk for developing cardiovascular disease and/or metabolic syndrome

TV Time and Obesity Obesity 1 in 3 adults are obese Obese individuals sit 2.5 times more than healthy weight individuals Positive relationship between watching TV and obesity in adults with VI Those watching 2 or more hours during the week – 2.89x more likely to be obese Greater TV time in higher acuity levels Lenz et al 2015 (JBIR) obesity – or an excess in body fat – this can occur through an imbalance of energy intake and energy expenditure through diet and PA!!! If we eat food all day long and do not do any activity all those calories are stored in our body as fat – but if we balance our diet with PA then the energy from food is used to allow us to be active and less of it will become excess weight!!! SO you can begin to see the relationship between SB and health. It is a vicious cycle! Lenz et al 2015 (JBIR) – this is specifically TV time

What does all of this mean? 2X Greater Risk of Type II Diabetes Greater Risk of Cardiovascular Disease Greater Risk of All-Cause Mortality 90% In sighted – so imagine what this means for VI! Large research studies following thousands of men and women physical activity and sedentary behavior habits have observed the following: People who sit more are at a …. 49%

Walking and Health Benefits So lets consider examining what are the health benefits of walking… could we find that walking, the most commonly reported physical activity, is related to being healthier for those who walk more per day?? It would be nice if this were in fact true!!

The Spectrum Health Promoting Physical Activity Lowest Energy Sedentary Behavior Light Physical Activity Moderate Physical Activity Vigorous Physical Activity So Based on that study walking should save the day and help us prevent all disease…True but is it enough? Research as early as the 1950s found relationships between health and too much sitting. Data suggested that men with less active jobs had more coronary artery disease than men who had more active jobs. More recently research found that even participating in health promoting physical activity does not protect us from the ill effects of too much sitting. A large study in Canada 7000 men and 9000 women ages 18-90 yrs found a relationship between sitting to long and all health causes of mortality even in those who exercise. So we need to sit less move more in addition to our regular exercise routine Lowest Energy Expenditure Highest Energy Expenditure

Say “NO” to Watching TV Shows Back to Back Each 1 hour increment in TV time 11% increased risk of all-cause mortality 18% increased risk of cardiovascular disease mortality When those watching 4+ hours of TV/d compared to those watching <2hrs/d TV 46% increased risk of all-cause mortality 80% increased risk of cardiovascular disease mortality Independent of smoking, blood pressure, cholesterol and diet, waist circumference, as well as leisure-time physical activity**

Sit Less Move More

Sit Less Move More: Transportation Household Wash dishes by hand instead of using the dishwasher Fold laundry while standing instead of sitting Volunteer to do the more “active” chores: mowing the lawn, washing windows, vacuuming/mopping the floor, raking leaves Use the stairs as an exercise platform – walk briskly up the stairs rather than slowly; take each item up the stairs one at a time instead of an armful Cook your meals instead of ordering out Walk/bike with your children/grandchildren to school or the park instead of drive Get off a stop or two earlier than your final destination if taking public transportation Bike/walk to church, dinner, Wegman’s If you go out for dinner walk into the restaurant instead of using the drive through

Sit Less Move More: Screen Time Games Do not use a remote stand up and change the channel Activity breaks during commercials Stand up, do a lap around the house, march in place, resistance train Multi task & perform a household chore while the television is on Iron, do dishes, clean Set a time limit for screen time 60 mins. max Stand around the table instead of sit Take sitting breaks during the game Choose more active games like charades rather than sedentary games Choose active video games over sedentary ones Wii Fit Games/Xbox Kinect - not just for the children/grandchildren

Sit Less Move More: Socializing Invite your friends over for a walk and catch up while enjoying the outdoors Walk around the house while chatting on the telephone “Active” volunteering Dog walking at a local shelter Babysit Start a neighborhood garden

Don’t Be A Couch Potato – Break it Up! Remember how I mentioned earlier that research suggests that this sedentary behavior is causing more harm than good and over powering the benefits of physical activity….So don’t be an “active”…

The Good News Break it UP! The more breaks you take from sitting the better health outcomes you will have Improved Blood sugar (glucose) Waist circumference Triglycerides Blood pressure

Resources and Useful Tools to Stay Active

Where can I go to be active? Indoor Outdoor

Tools to help me Move More Sit Less Fitness Tracking bands Fitbit, Jump bands, Nike Fuelbands, Pedometers Websites/Smartphone Apps www.mapmyfitness.com www.myfitnesspal.com Paper & Pencil Log your physical activity & sedentary behaviors

Review Sit less move more to prevent onset of chronic disease Participate in regular physical activity in addition to breaking up your sedentary behaviors Use your resources and tools to help you become the most active you can be

References American College of Sports Medicine. Reducing sedentary behaviors: sitting less and moving more. Campbell, V., & Crews, J. (2001). Health conditions, activity limitations, and participation restrictions among older people with visual impairments. Journal of Visual Impairment & Blindness (JVIB), 95(08).  Jaarsma, E., Dijkstra, P., Geertzen, J., & Dekker, R. (2014). Barriers to and facilitators of sports participation for people with physical disabilities: A systematic review. Scandinavian Journal of Medicine and Science in Sports. Holbrook, E. A., Caputo, J. L., Perry, T. L., Fuller, D. K., & Morgan, D. W. (2009). Physical activity, body composition, and perceived quality of life of adults with visual impairments. Journal of Visual Impairment & Blindness, 103(1), 17-29. N. Owen, GN Healy, CE Matthews, DW Dunstan. Too much sitting: The population health- science of sedentary behavior. ESSR 2010. 38(3). 105-113. BE Starkoff, EK Lenz. Break it up: Improving health by breaking up continuous bouts of sedentary behavior. ACSM Health & Fitness Journal (In Press 2015). EK Lenz Do sedentary behaviors impact the health of older adults. IJKSS (2014).