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ABSTRACT
Background: There is a growing body of research linking sedentary behavior with increased risk of chronic disease and all-cause mortality. It is increasingly recommended that service providers address the multiple behavioral risk factors associated with these chronic diseases as part of routine substance abuse treatment. Objectives: The study objective was to investigate rates of physical activity and sedentary behavior in a residential substance abuse population. In addition, efficacy of a sedentary behavior intervention, “Sit Switch,” was examined for feasibility in this context. Methods: Participants (n = 54) were residents of The Salvation Army Recovery Service Centres located in Canberra and on the Gold Coast, Australia. Actigraph GT3X+ accelerometers were used to measure rates and patterns of sedentariness and physical activity. A nonrandomized controlled study of a single-session group intervention aimed at decreasing prolonged sitting (“Sit Switch”) was conducted. Education, motivational-interviewing, and goal setting components underpinned the “Sit Switch” intervention. Results: Individuals were highly sedentary, spending 73% of daily activity at sedentary intensity engaged in inadequate levels of moderate physical activity (6.6%/day). The single session educational program did not lead to any significant changes in sedentary behavior. Conclusion/Importance: High levels of sedentariness and low levels of physical activity engagement are evident in residents in substance abuse treatment programs. It is strongly recommended that sedentariness, a modifiable risk behavior with independent consequences for cardiovascular disease and cancer, be addressed within residential programs.
Glossary
Accelerometer: An instrument used for measuring the acceleration of a moving body.
Actigraph GT3X: Particular make and model of accelerometer used in study.
ANCOVA: Analysis of covariance
Cohen's d: Measure of effect size commonly used to indicate the standardized difference between two means.
Cut-point: Algorithm determined method for categorizing data into levels of sedentary and physical activity intensity as determined by count-intensity of each epoch.
Epoch: A user-defined time sampling interval used to filter continuous data collection and ensure more accurate classification of activity levels.
PRI: Perceived rate of intensity
Sit switch: Single-session, group based sedentary behavior intervention.
SPSS: IBM Statistical Package for Social Sciences.
Tri-axial: Measures acceleration and deceleration in three dimensions using a vertical vector, an anteroposterior vector, and a mediolateral vector.
Vector magnitude: Calculation based on the square root of the sum squared of activity counts in each vector.
Acknowledgments
Special thanks to Dylan Cliff, Bob O'Hare, Greg Driscoll, Gerard Byrne, Major David Pullen, and staff and participants of the Salvation Army Recovery Services in Canberra and on the Gold Coast.
Declaration of interest
The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.
Funding
This study was partially funded by the University of Wollongong. Dr. Peter J. Kelly was supported by a Cancer Institute NSW Early Career Research Fellowship.
Notes
1 Analysis of covariance approach (ANCOVA) was chosen in preference over other frequently used pre-post design statistical analyses methods (i.e., mean change score difference, post-treatment ANOVA, and percent change score difference) based on empirical evidence for ANCOVA as comparatively optimal approach where the primary outcome variable is continuous (Zhang et al., Citation2014). Main advantages of the use of ANCOVA are: 1) ANCOVA allows for adjustment of each participant's post-intervention scores in accordance with their baseline variance; and 2) in pre-post design, ANCOVA has been found to have greater statistical power (Vickers & Altman, Citation2001).
2 The Freedson Adult 1998 cut points option was chosen as the sedentary behavior cut points were set at 0.99 CPM (counts per minute), which is consistent with research in adults that has defined sedentary behavior on the basis of <100 CPM as optimal for data validation (e.g., Owen et al., Citation2011). CPM refers to the number of times a magnitude of acceleration exceeds a given threshold in one minute. Freedson Adult 1998 cut points are calculated on 60-sec epoch lengths and Actilife 6 automatically scaled up the 10-sec epoch files from this study to the 60-sec equivalent before performing the cut point categorization. Other cut points located in the Freedson Adult 1998 include: Light: 100–759 CPM; Lifestyle: 760–1951 CPM; Moderate: 1952–5724 CPM; Vigorous: 5725–9498 CPM; Very Vigorous: 9499–∞ CPM. These cut points were derived based on METs (metabolic equivalent of task) thresholds identified in reference research by Freedson and colleagues (1998).
3 At the time of data collection national guideline recommendation was for 30–60 minutes of moderate intensity physical activity on most days of the week, so derivation of 10% minimum was based on a calculation of 60 minutes per 12 hour day standard adjusted according to valid wear-time data calculated from 7am to 10pm. It is acknowledged that current 2014 national guidelines have changed. “Accumulate 150 to 300 minutes (2/1/2 to 5 hours) of moderate intensity physical activity or 75 to 150 minutes (1/1/4 to 2/1/2 hours) of vigorous intensity physical activity, or an equivalent combination of both moderate and vigorous activities, each week” (Brown, Bauman, Bull, & Burton, Citation2012).
Additional information
Notes on contributors
Carol A. Keane
Carol A. Keane was awarded an Honors degree in Psychology at the University of Wollongong in 2013. She is currently a PhD (Clinical Psychology) candidate at the University of Wollongong, Australia. Her PhD research involves examination of the nature and impact of Complex Trauma experiences for individuals experiencing extreme social disadvantage. Broader research areas of interest include exploration of the “healthy body/healthy mind” contention within applied clinical settings.
Peter J. Kelly
Peter J. Kelly is a Cancer Institute NSW Early Career Fellow, based at the University of Wollongong, Australia. He is a Member of the Australian College of Clinical Psychologists. Dr. Kelly obtained his Ph.D (Clinical Psychology) from the School of Psychology, UOW in 2007. Dr. Kelly's research is focused on the development, implementation and evaluation of evidence-based approaches within mental health and/or substance abuse settings. He has a particular interest in the development of behavioral interventions that reduce the risk of socially disadvantaged groups developing cardiovascular disease and cancer.
Christopher A. Magee
Christopher A. Magee, Associate Professor in the School of Psychology and Deputy Director, Centre for Health Initiatives at the University of Wollongong. Graduated with his PhD in Psychology at the University of Wollongong in 2008, and completed his Master of Business Administration in 2013. His primary area of research expertise is in health psychology.
Robin Callister
Robin Callister, Bachelor of Pharmacy from Sydney University, Australia 1975.PhD in exercise physiology from Ohio University, USA 1989. Current research focus is the role of exercise in prevention and management of disease, including those with mental health problems. Currently Professor and Head of Human Physiology in Faculty of Health and Medicine at the University of Newcastle, Australia.
Amanda Baker
Amanda Baker was awarded an Honors degree in psychology at the University of New South Wales in 1981, a Clinical Psychology Masters degree at the University of Sydney in 1984, topic “Cognitive-behavior therapy for depression: the effect of booster sessions on relapse,” and a Ph.D from University of New South Wales in 1996, topic “Motivational interviewing and relapse prevention interventions for HIV risk reduction among injecting drug users.” Amanda is a research academic employed at the School of Medicine and Public Health, University of Newcastle, Australia.
Frank P. Deane
Frank P. Deane, PhD, is a Professor of Psychology and Director of the Illawarra Institute for Mental Health at the University of Wollongong, Australia. He has research interests related to the effectiveness of treatments for mental illness and substance abuse problems in applied settings.