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Diabetes Prevention
The Challenge and Complexities of health policy initiatives, environmental changes, well-designed public
Behavioral Change education campaigns and, most importantly, reinforcement and
A key next step in this research field is to assess the feasibility and endorsement in clinical settings, is crucial in order to modify the
sustainability of reducing sedentary behavior. Fortunately, valuable patterns of a behavior that are ubiquitous in the population and that
lessons can be taken from the established body of behavioral are persistent and highly resistant to change for individuals.
research on physical activity. Specifically, sedentary behavior may be
viewed in much the same manner as physical activity behavior, which Too Little Exercise, Too Much Sitting, and
is now widely acknowledged as involving many different behavioral Cardio-metabolic Health—Where to From Here?
choices in many different contexts.
31
Furthermore, research on the The research agenda on too much sitting includes developing a
determinants of physical activity has shown that several complex broader understanding of the health consequences of prolonged
factors may act singly or in combination to promote or constrain sitting time and examining what follows from changes in these
people’s ability to be physically active.
32,33
behaviors. This will require implementing and evaluating innovative
interventions to change sedentary behaviors in transport, domestic,
Briefly, such behavioral determinants, as they might be applied to community, and occupational settings. Such studies will include
prolonged sitting in a range of contexts, may include: controlled intervention trials to better understand the acute and
chronic cardio-metabolic consequences of sitting for prolonged
personal and demographic attributes (including gender, age, and periods. This evidence will greatly assist in understanding the causal
educational attainment, which may affect the likelihood of nature of how too much sitting affects health and will be necessary to
discretionary and non-discretionary prolonged sitting); inform potential new public health and clinical guidelines in relation
biological attributes (for example, overweight and obesity or other to sitting time.
inherent attributes that may affect physical comfort or discomfort
associated with prolonged sitting); Additionally, there is now consideration being given to environmental,
the particular characteristics of the relevant behaviors, which may policy, regulatory, and educational interventions to reduce prolonged
take different forms for different people in different settings (for periods of sitting time in workplaces. Policy and regulatory approaches
example, sitting in conjunction with eating meals in front of will require the relevant workplace consultation approaches, and
television sets, sitting rather than standing on public transport, educational interventions will most likely involve innovative uses of
habitual email use rather than walking and talking to communicate information technology, particularly email and websites, to inform and
with workplace colleagues); motivate individuals. Such initiatives will need to be carefully evaluated
the psychological, cognitive, and emotional attributes of to determine whether they have the expected benefits, or whether
individuals, which may provide a basis for enjoyment of sitting in there might be harm associated with them. Such interventions and
different contexts (for example screen-based entertainment or careful evaluations will be required to further build on the evidence base
recreational automobile use); now available on the cardio-metabolic correlates of sedentary behavior.
knowledge of health risks associated with prolonged sitting time;
the social and cultural factors that act to make some sedentary Public Health Policy Implications
choices easy and some more difficult for different individuals (for In public health, there is a long history of large-scale behavioral
example, the expectations of others, or social norms that make change initiatives that have had significant impacts on whole
walking to destinations or standing within the workplace an populations.
29
For example, since the publication of landmark
inappropriate or awkward choice; also the generally limited documents on smoking and health in the 1960s, there have been
opportunities that exist for eating and drinking or sport- remarkable reductions in smoking prevalence in developed countries.
spectatorship while standing); These have resulted from a plethora of inter-related social,
physical environment factors, particularly those aspects of the environmental, and policy changes, all fundamentally based on
built environment that may make active transport choices more knowledge about the health consequences of tobacco use.
difficult and driving a car an easier and more realistic option; and
policies, rules, and regulations in many settings that may mandate For public health initiatives aimed at increasing physical activity and
being seated and not moving around (for example fire-safety reducing sedentary behavior, there are many allies in sectors other
regulations preventing standing in many entertainment/conference than health. For example, transportation and urban planning experts
venues; workplace regulations that require fixed time at desks and are now proposing changes to transport systems and the physical and
other workstations). functional layout of urban areas, including higher street connectivity
(allowing multiple walking or bicycle routes to destinations), more
Over the past three decades, research on physical activity and other mixed land use (providing multiple local destinations such as retail,
health behaviors has highlighted the challenges of promoting food outlets, and other services), and population density (with more
persistence with changes in socially, environmentally, and personally people making local services and businesses more viable), as well as
ingrained patterns of behavior. As we have illustrated above, the related public policy initiatives that will act to promote higher rates of
determinants of these behaviors operate on multiple levels, and walking and bicycle use as alternatives to the use of private motor
single changes within any of these domains are unlikely to have a vehicles.
35
Potentially, the accumulation of additional evidence on the
sustainable impact in changing habitual behaviors.
34
Use of public health impacts of sedentary behaviors may help to persuade workplace
32 US ENDOCRINOLOGY
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