Why the Canadian sedentary behaviour guidelines should reflect sex and gender.

Liwander, Anna ; Pederson, Ann ; Boyle, Ellexis 等

In the past decade, sedentary behaviour has emerged as a distinct health concern, (1) yet health promotion researchers, policy makers and practitioners have only begun to pay attention to it quite recently. Importantly, sedentary behaviour is distinct from both physical activity and physical inactivity. Whereas physical inactivity is a broad category that can be used to characterize groups of people whose level of activity falls below a given threshold, sedentary behaviours are specific practices characterized by little physical movement and low energy expenditure such as sitting and watching television, using a computer, reading, occupational sitting and using motorized transportation. (2) A review of promising interventions in sedentary behaviour conducted by the British Columbia Centre of Excellence for Women's Health in 2012/2013 suggests that there are currently few health promotion interventions targeting sedentary behaviour; in fact, the majority of interventions in the field focus on increasing physical activity, not reducing sedentary time or sedentary behaviours per se.

In 2011, the Canadian Society for Exercise Physiology (CSEP), in collaboration with ParticipACTION and with support from the Public Health Agency of Canada, undertook a literature review on sedentary behaviour that informed the world's first evidence-based sedentary behaviour guidelines. (3) Designed for children and youth aged 0-17 years, the guidelines suggest that children and youth should spend no more than 1-2 hours per day on recreational screen time (depending on age) and that time spent on sedentary transportation and extended sitting should be limited throughout the day. (3) Although guidelines on sedentary behaviour are encouraging, we note that the CSEP guidelines do not consider adults, despite data suggesting that the majority of adults spend a considerable amount of time being sedentary each day, nor sex and gender, despite compelling evidence for the integration of a sex- and gender-based approach to research and policy on sedentary behaviour. We argue that the current guidelines need to be expanded to consider the impact of sex and gender in sedentary behaviour and that guidelines for adults should be developed in order to increase the efficacy of research, policy and practice in reducing sedentary behaviours and their negative health outcomes. We also argue that there is a need to consider women's and men's diversity as well as to address their differential access to resources, opportunities and power as these factors may shape sedentary behaviour. "One-size-fits-all" approaches that do not understand and address unfair differences may not only lead to ineffective interventions but also to policies and practices that deepen health disparities and inequities.

Sex and gender considerations in sedentary behaviour

Accelerometer results from the Canadian Health Measures Survey (CHMS) 2007-2009 suggest that women and men are equally sedentary: men spend on average 9.6 hours per day sedentary and women spend 9.8 hours. (4) Girls and boys (aged 6-19 years) spend less time in sedentary pursuits but are also equally sedentary (8.5 hours for boys; 8.7 hours for girls). (5) Although these data provide a brief glimpse into girls', women's, boys' and men's sedentary time, they do not explain why these patterns exist nor what behaviours women and men engage in, how they may differ, and why. In the literature, however, we find that women and men in fact tend to engage in different sedentary behaviours. For example, more men than women report being frequent users of computers and television, while women are more likely to report sedentary time spent reading. (6) Females also tend to spend more time in communication-based sedentary behaviours such as talking on the telephone, texting and instant messaging, (7) but also while engaging in arts, crafts (8) and personal care. (9)

Factors such as how workplaces, schools, communities and transportation systems are organized are likely to influence sedentary behaviour. Developments in transportation, communication and the structure and organization of workplaces and schools have essentially created reduced demands for physical activity and thus encourage (or even mandate) sedentary behaviour. Family environment and neighbourhood environment are also important factors, which may affect, and encourage, females' and males' sedentary time differently. For example, poor neighbourhoods and those that are perceived as less safe tend to have higher rates of television viewing (10) and it is possible that girls and women may have less power and entitlement to move with safety in some neighbourhoods and may therefore spend more time sedentary.

Sex differences in health risks associated with sedentary behaviour

Sedentary behaviour has been linked to increased risk of a number of chronic conditions including type 2 diabetes mellitus, (11) some cancers, (2) and cardiovascular disease, (11,12) and has also shown to be adversely associated with mental well-being. (13) Although both women and men are at risk of developing these health outcomes, research suggests that there are sex-specific correlations between some health risks and sedentary behaviour. For women, sedentary time has been associated with increased risk of endometrial cancer (2) and ovarian cancer. (14) One study showed that women who were sitting more than 8 hours per day had a 52% increased odds of endometrial cancer when compared to those sitting fewer than 4 hours per day. (15) For men, sedentary behaviour has been associated with an increased risk of colon (2) and prostate cancers. (16) Studies of cardiovascular disease are also revealing of sex-specific health outcomes associated with sedentary behaviour. For example, high levels of television watching have been shown to predict fatal and non-fatal cardiovascular disease in both men and women. Yet, for women, there was a detrimental, dose-response association between television viewing time and 2-hour plasma glucose and fasting insulin. (12) There are also sex differences in mental well-being. One study focusing on selected non-occupational sedentary behaviours (TV watching, travel and computer use) found that that all types of sitting time were adversely associated with mental well-being in women, independent of potential confounders such as physical activity. For men, however, only computer use was found to be associated with adverse mental well-being. (13)

These findings suggest that sex-disaggregated and gender-informed analyses are important for understanding and addressing sedentary behaviour, and that research, guidelines and policy in the field might be more effective if a sex- and gender-informed approach were adopted. This includes producing sex- and gender sensitive sedentary behaviour guidelines that consider the differences, and similarities, between women and men, boys and girls, but also other determinants such as social, economic and gendered barriers that could influence their sedentary behaviour.

CONCLUSION

Results from Canadian population surveys such as the CHMS (2007-2009) suggest that women and men spend, on average, an equal amount of time sedentary per day, but the literature further suggests that they have different reasons for being sedentary, that they engage in different behaviours, and experience different health outcomes associated with sedentary behaviour, some of which are related to differences in the reproductive systems.

We argue that girls' and boys', women's and men's tendencies to engage in different behaviours should be recognized in policies and practices, including the Canadian Sedentary Behaviour Guidelines, and we encourage potential future guidelines to take these differences into consideration. Effective policies would have to be built on an understanding of girls' and boys', women's and men's daily lives and their opportunities for reducing sedentary time. This requires a solid research base on whether and how adults' behaviours differ from those of children and youth, from which to build policy directions and suggest interventions specific to the issue of sedentary behaviour. This includes the collection of quantitative evidence to better understand whether the guidelines should also be quantitatively different.

Additionally, we recognize the need for intense and targeted health communication campaigns to accompany these guidelines, possibly with messages tailored to girls and boys, women and men separately so that each group is able to see that the message applies to them. Current strategies and health communication campaigns that fail to engage with the ways that sex and gender may contribute to the health problem could be less effective in addressing sedentary behaviours in the population. For example, if sedentary behaviour is regularly associated with the concept of "screen time", as it is in some health communications directed at children and youth, and girls or women spend less time using computers than boys and men, it is conceivable that the health messages could be interpreted as irrelevant to girls and women. Sex and gendered aspects of sedentary behaviour can be further complicated by variables such as age, neighbourhood socio-economic status, income and total physical activity, suggesting that sedentary behaviours, like all health practices, are deeply influenced by social, physical and economic conditions. When developing programs and recommendations designed to limit sedentary behaviour, researchers and policy makers should therefore consider a range of determinants as well as recognize the various barriers that women and men may face in reducing their sedentary time. Failure to do so may result in ineffective interventions, and policies and practices that deepen health disparities and inequities rather than reducing them. Additionally, policies and health communication campaigns with messages about sedentary behaviour should be embedded in structural approaches to change the social and built environment, as the problem with sedentary behaviour is not merely avoiding a select set of behaviours but rather addressing an entire way of life. Changes in organizational practices and the built environment are therefore important to make Canadian society less supportive of sedentary living.

REFERENCES

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Received: June 25, 2013

Accepted: October 29, 2013

Anna Liwander, mph, [1] Ann Pederson, MSc, [1,2] Ellexis Boyle, PhD [1,3]

Author Affiliations

[1.] British Columbia Centre of Excellence for Women's Health, Vancouver, BC

[2.] Experimental Medicine, University of British Columbia, Vancouver, BC

[3.] Intersections of Mental Health Perspectives in Addictions Research Training (IMPART), Vancouver, BC

Correspondence: Ann Pederson, Director, BC Centre of Excellence for Women's Health, Room E311, 4500 Oak Street, Box 48, Vancouver, BC V6H 3N1, Tel: 604-875-3715, Fax: 604-875-3716, E-mail: apederson@cw.bc.ca Conflict of Interest: None to declare.