title: Replacing sitting time with standing or stepping: associations with cardio-metabolic risk biomarkers.
abstract: OBJECTIVE
  While excessive sitting time is related adversely to cardio-metabolic health, it is unknown whether standing is a suitable replacement activity or whether ambulatory movement is required. Using isotemporal substitution analyses, we modelled cross-sectional associations with cardio-metabolic risk biomarkers of reallocating time (2 h/day) from sitting to standing or to stepping.
  
  
  RESULTS
  A subsample of participants from the 2011/12 Australian Diabetes, Obesity, and Lifestyle Study wore the posture-based activPAL3 monitor [36-80 years (mean 57.9, SD 9.9 years); 57% women; n = 698 with data]. Associations of activPAL3-derived mean daily time sitting/lying (sitting), standing and stepping with body mass index (BMI), waist circumference, blood pressure, HbA1c, fasting glucose and lipids (high-density lipoprotein-, HDL, and low-density lipoprotein-cholesterol, total/HDL-cholesterol ratio, and triglycerides), and 2-h plasma glucose were examined. Adjusted for relevant confounders, sitting-to-standing reallocations were only significantly (P < 0.05) associated with approximately 2% lower fasting plasma glucose, 11% lower triglycerides, 6% lower total/HDL-cholesterol ratio, and 0.06 mmol/L higher HDL-cholesterol per 2 h/day. Sitting-to-stepping reallocations were only significantly associated with approximately 11% lower BMI, 7.5 cm lower waist circumference, 11% lower 2-h plasma glucose, 14% lower triglycerides, and 0.10 mmol/L higher HDL-cholesterol per 2 h/ day, while standing-to-stepping reallocations were only significantly associated with ∼10% lower BMI, 7 cm lower waist circumference, and 11% lower 2-h plasma glucose.
  
  
  CONCLUSIONS
  Findings suggested that sitting-reduction strategies targeting increased standing, stepping, or both, may benefit cardio-metabolic health. Standing is a simple alternative to sitting, and requires further examination in prospective and intervention studies.
authors.affiliation: School of Public Health, The University of Queensland, Herston Road, Herston, Brisbane, QLD 4006, Australia Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia School of Physiotherapy, Curtin University, Perth, WA, Australia g.healy@uq.edu.au.
authors.forename: Genevieve N
authors.initials: GN
authors.lastname: Healy
authors.affiliation: School of Public Health, The University of Queensland, Herston Road, Herston, Brisbane, QLD 4006, Australia.
authors.forename: Elisabeth A H
authors.initials: EA
authors.lastname: Winkler
authors.affiliation: School of Public Health, The University of Queensland, Herston Road, Herston, Brisbane, QLD 4006, Australia Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia Department of Medicine, Monash University, Malvern East, VIC, Australia Department of Epidemiology and Preventive Medicine, Monash University, Malvern East, VIC, Australia School of Population Health, The University of Melbourne, Melbourne, VIC, Australia.
authors.forename: Neville
authors.initials: N
authors.lastname: Owen
authors.affiliation: School of Public Health, The University of Queensland, Herston Road, Herston, Brisbane, QLD 4006, Australia.
authors.forename: Satyamurthy
authors.initials: S
authors.lastname: Anuradha
authors.affiliation: School of Public Health, The University of Queensland, Herston Road, Herston, Brisbane, QLD 4006, Australia Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia Department of Medicine, Monash University, Malvern East, VIC, Australia Department of Physiology, Monash University, Melbourne, VIC, Australia Department of Physiology, The University of Melbourne, Melbourne, VIC, Australia Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Burwood, VIC, Australia School of Sport Science, Exercise and Health, The University of Western Australia, Perth, WA, Australia Mary MacKillop Institute for Health Research, The Australian Catholic University, Melbourne, VIC, Australia.
authors.forename: David W
authors.initials: DW
authors.lastname: Dunstan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D005081:Exercise Therapy / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008659:Metabolic Diseases / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D008875:Middle Aged; D018670:Monitoring, Ambulatory; D011446:Prospective Studies; D057185:Sedentary Behavior; D055105:Waist Circumference
chemical_list: D015415:Biomarkers
keywords: Adult; Cardio-metabolic; Cross-sectional; Isotemporal; Sitting; Standing