The study examined the association between sedentary behavior and self-rated health-related quality of life (HRQoL) in a sample of patients with multimorbidity in Singapore recruited from a primary care clinic.
Methods:
Sedentary behavior and physical activity were assessed with the International Physical Activity Questionnaire short form (IPAQ-SF). HRQoL was assessed with EuroQol-5 Dimension (EQ-5D) utility index, visual analogue scale (EQ-VAS) and its 5 subscales (Mobility, Self-care, Usual Activities, Pain/Discomfort, and Anxiety/Depression). Depression was assessed via Patient Health Questionnaire (PHQ-9). Logistic and linear regression analyses adjusting for the effect of physical activity, depression, and sociodemographic variables (i.e., age, gender, ethnicity, education) were conducted.
Results:
932 patients participated in the study (mean age:64.5±8.5 years, range: 35-80) and 55% were men. Results indicated that women were less likely to have sedentary behavior (≥7 hrs/day) than men. Results indicated sedentary behavior was associated with lower EQ-5D index scores, but not EQ-VAS scores. Participants who were sedentary for ≥7 hrs/day were more likely to endorse having problems with mobility, self-care, and usual activities, but not with pain/discomfort, nor anxiety/depression.
Conclusion:
Sedentary behavior was associated with poorer HRQoL. There is a need for interventions and health promotions to reduce sedentary behavior in patients with multimorbidity.
SmithSMSoubhiHFortinMHudonCO’DowdT. Managing patients with multimorbidity: systematic review of interventions in primary care and community settings. BMJ. 2012;345:e5205. doi:10.1136/bmj.e5205
2.
HarrisonCBrittHMillerGHendersonJ. Examining different measures of multimorbidity, using a large prospective cross-sectional study in Australian general practice. BMJ Open. 2014;4(7):e004694. doi:10.1136/bmjopen-2013-004694
3.
FortinMLapointeLHudonCVanasseANtetuALMaltaisD. Multimorbidity and quality of life in primary care: a systematic review. Health Qual Life Outcomes. 2004;2:51. doi:10.1186/1477-7525-2-51
4.
FortinMBravoGHudonCLapointeLDuboisM-FAlmirallJ. Psychological distress and multimorbidity in primary care. Ann Fam Med. 2006;4(5):417–422. doi:10.1370/afm.528
5.
StubbsBVancampfortDVeroneseN, et al.Multimorbidity and perceived stress: a population-based cross-sectional study among older adults across six low- and middle-income countries. Maturitas. 2018;107:84–91. doi:10.1016/j.maturitas.2017.10.007
6.
PiccoLAchillaEAbdinE, et al.Economic burden of multimorbidity among older adults: impact on healthcare and societal costs. BMC Health Serv Res. 2016;16:173. doi:10.1186/s12913-016-1421-7
7.
ViolanCFoguet-BoreuQFlores-MateoG, et al.Prevalence, determinants and patterns of multimorbidity in primary care: a systematic review of observational studies. PLoS One. 2014;9(7):e102149. doi:10.1371/journal.pone.0102149
8.
DivoMJMartinezCHManninoDM. Ageing and the epidemiology of multimorbidity. Eur Respir J. 2014;44(4):1055–1068. doi:10.1183/09031936.00059814
9.
MarengoniAAnglemanSMelisR, et al.Aging with multimorbidity: a systematic review of the literature. Ageing Res Rev. 2011;10(4):430–439. doi:10.1016/j.arr.2011.03.003
LehnertTHeiderDLeichtH, et al.Review: health care utilization and costs of elderly persons with multiple chronic conditions. Med Care Res Rev. 2011;68(4):387–420. doi:10.1177/1077558711399580
12.
McPhailSM. Multimorbidity in chronic disease: impact on health care resources and costs. Risk Manag Healthc Policy. 2016;9:143–156. doi:10.2147/RMHP.S97248
13.
BählerCHuberCABrünggerBReichO. Multimorbidity, health care utilization and costs in an elderly community-dwelling population: a claims data based observational study. BMC Health Serv Res. 2015;15:23. doi:10.1186/s12913-015-0698-2
14.
RogowskiJLillardLAKingtonR. The financial burden of prescription drug use among elderly persons. Gerontologist. 1997;37(4):475–482. doi:10.1093/geront/37.4.475
15.
WarburtonDERNicolCWBredinSSD. Health benefits of physical activity: the evidence. CMAJ. 2006;174(6):801–809. doi:10.1503/cmaj.051351
16.
AnokyeNKTruemanPGreenCPaveyTGTaylorRS. Physical activity and health related quality of life. BMC Public Health. 2012;12:624. doi:10.1186/1471-2458-12-624
17.
PedersenBKSaltinB. Exercise as medicine—evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports. 2015;25(Suppl 3):1–72. doi:10.1111/sms.12581
18.
RosenbergDCookAGellNLozanoPGrothausLArterburnD. Relationships between sitting time and health indicators, costs, and utilization in older adults. Pre Med Rep. 2015;2:247–249. doi:10.1016/j.pmedr.2015.03.011
19.
ThivelDTremblayAGeninPMPanahiSRivièreDDuclosM. Physical activity, inactivity, and sedentary behaviors: definitions and implications in occupational health. Front Public Health. 2018;6:288. doi:10.3389/fpubh.2018.00288
20.
LynchBM. Sedentary behavior and cancer: a systematic review of the literature and proposed biological mechanisms. Cancer Epidemiol Biomarkers Prev. 2010;19(11):2691–2709. doi:10.1158/1055-9965.EPI-10-0815
21.
KatzmarzykPT. Physical activity, sedentary behavior, and health: paradigm paralysis or paradigm shift?Diabetes. 2010;59(11):2717–2725. doi:10.2337/db10-0822
22.
HamiltonMTHamiltonDGZdericTW. Sedentary behavior as a mediator of type 2 diabetes. Med Sport Sci. 2014;60:11–26. doi:10.1159/000357332
23.
WarrenTYBarryVHookerSPSuiXChurchTSBlairSN. Sedentary behaviors increase risk of cardiovascular disease mortality in men. Med Sci Sports Exerc. 2010;42(5):879–885. doi:10.1249/MSS.0b013e3181c3aa7e
24.
WilmotEGEdwardsonCLAchanaFA, et al.Sedentary time in adults and the association with diabetes, cardiovascular disease and death: systematic review and meta-analysis. Diabetologia. 2012;55(11):2895–2905. doi:10.1007/s00125-012-2677-z
25.
PattersonRMcNamaraETainioM, et al.Sedentary behaviour and risk of all-cause, cardiovascular and cancer mortality, and incident type 2 diabetes: a systematic review and dose response meta-analysis. Eur J Epidemiol. 2018;33(9):811–829. doi:10.1007/s10654-018-0380-1
26.
BoberskaMSzczukaZKrukM, et al.Sedentary behaviours and health-related quality of life. a systematic review and meta-analysis. Health Psychol Rev. 2018;12(2):195–210. doi:10.1080/17437199.2017.1396191
27.
LoprinziPD. Sedentary behavior and medical multimorbidity. Physiol Behav. 2015;151:395–397. doi:10.1016/j.physbeh.2015.08.016
28.
Balboa-CastilloTLeón-MuñozLMGracianiARodríguez-ArtalejoFGuallar-CastillónP. Longitudinal association of physical activity and sedentary behavior during leisure time with health-related quality of life in community-dwelling older adults. Health Quality Life Outcomes. 2011;9(1):47. doi:10.1186/1477-7525-9-47
29.
SubramaniamMAbdinEPiccoLVaingankarJAChongSA. Multiple chronic medical conditions: prevalence and risk factors—results from the Singapore Mental Health Study. Gen Hosp Psychiatry. 2014;36(4):375–381. doi:10.1016/j.genhosppsych.2014.03.002
30.
RabinRde CharroF. EQ-5D: a measure of health status from the EuroQol Group. Ann Med. 2001;33(5):337–343.
31.
LuoNWangPThumbooJLimY-WVrijhoefHJM. Valuation of EQ-5D-3 L health states in Singapore: modeling of time trade-off values for 80 empirically observed health states. Pharmacoeconomics. 2014;32(5):495–507. doi:10.1007/s40273-014-0142-1
32.
AbdinESubramaniamMVaingankarJALuoNChongSA. Measuring health-related quality of life among adults in Singapore: population norms for the EQ-5D. Qual Life Res. 2013;22(10):2983–2991. doi:10.1007/s11136-013-0405-x
33.
CraigCLMarshallALSjöströmM, et al.International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;35(8):1381–1395. doi:10.1249/01.MSS.0000078924.61453.FB
34.
SubramaniamMZhangYLauJH, et al.Patterns of physical activity and health-related quality of life amongst patients with multimorbidity in a multi-ethnic Asian population. BMC Public Health. 2019;19(1):1612. doi:10.1186/s12889-019-7941-4
35.
KuP-WSteptoeALiaoYHsuehM-CChenL-J. A cut-off of daily sedentary time and all-cause mortality in adults: a meta-regression analysis involving more than 1 million participants. BMC Med. 2018;16(1):74. doi:10.1186/s12916-018-1062-2
36.
ChauJYGrunseitACCheyT, et al.Daily sitting time and all-cause mortality: a meta-analysis. PLOS One. 2013;8(11):e80000. doi:10.1371/journal.pone.0080000
37.
KroenkeKSpitzerRLWilliamsJB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–613. doi:10.1046/j.1525-1497.2001.016009606.x
38.
SungSCLowCCHFungDSSChanYH. Screening for major and minor depression in a multiethnic sample of Asian primary care patients: a comparison of the nine-item Patient Health Questionnaire (PHQ-9) and the 16-item Quick Inventory of Depressive Symptomatology–Self-Report (QIDS-SR16). Asia Pac Psychiatry. 2013;5(4):249–258. doi:10.1111/appy.12101
39.
HongCLCSungSCHengATKHuakCYShengDFS. Use of patient health questionnaires (PHQ-9, PHQ-2 & PHQ-1) for depression screening in Singapore primary care. Singapore Family Physi. 2018;44(2):68–73.
40.
O’DonoghueGPerchouxCMensahK, et al.A systematic review of correlates of sedentary behaviour in adults aged 18–65 years: a socio-ecological approach. BMC Public Health. 2016;16(1):163. doi:10.1186/s12889-016-2841-3
41.
RhodesREMarkRSTemmelCP. Adult sedentary behavior: a systematic review. Am J Prev Med. 2012;42(3):e3–e28. doi:10.1016/j.amepre.2011.10.020
42.
BellettiereJCarlsonJARosenbergD, et al.Gender and age differences in hourly and daily patterns of sedentary time in older adults living in retirement communities. PLOS One. 2015;10(8):e0136161. doi:10.1371/journal.pone.0136161
43.
OwenNHealyGNMatthewsCEDunstanDW. Too much sitting: the population-health science of sedentary behavior. Exerc Sport Sci Rev. 2010;38(3):105–113. doi:10.1097/JES.0b013e3181e373a2
44.
HarveyJAChastinSFMSkeltonDA. How sedentary are older people?A systematic review of the amount of sedentary behavior. J Aging Phys Act. 2015;23(3):471–487. doi:10.1123/japa.2014-0164
45.
AngelantonioEDKaptogeSWormserD, et al.Association of cardiometabolic multimorbidity with mortality. JAMA. 2015;314(1):52–60. doi:10.1001/jama.2015.7008
46.
VancampfortDKoyanagiAWardPB, et al.Chronic physical conditions, multimorbidity and physical activity across 46 low- and middle-income countries. Int J Behav Nutr Phys Act. 2017;14(1):6. doi:10.1186/s12966-017-0463-5
47.
SelvkumaranLWhiteRRostasMOsmotherlyP. Sedentary behaviour and chronic pain: building a profile of behaviours and clinical associations. Physiotherapy. 2015;101(1):e1368. doi:10.1016/j.physio.2015.03.1306
48.
StefansdottirRGudmundsdottirSL. Sedentary behavior and musculoskeletal pain: a five-year longitudinal Icelandic study. Public Health. 2017;149:71–73. doi:10.1016/j.puhe.2017.04.019
49.
AmorimABLevyGMPérez-RiquelmeF, et al.Does sedentary behavior increase the risk of low back pain? A population-based co-twin study of Spanish twins. Spine J. 2017;17(7):933–942. doi:10.1016/j.spinee.2017.02.004
50.
ChenS-MLiuM-FCookJBassSLoSK. Sedentary lifestyle as a risk factor for low back pain: a systematic review. Int Arch Occup Environ Health. 2009;82(7):797–806. doi:10.1007/s00420-009-0410-0
51.
SantosDASilvaAMBaptistaF, et al.Sedentary behavior and physical activity are independently related to functional fitness in older adults. Exp Gerontol. 2012;47(12):908–912. doi:10.1016/j.exger.2012.07.011
52.
DunlopDDSongJArnstonEK, et al.Sedentary time in US older adults associated with disability in activities of daily living independent of physical activity. J Phys Act Health. 2015;12(1):93–101. doi:10.1123/jpah.2013-0311
53.
SuPDingHZhangW, et al.The association of multimorbidity and disability in a community-based sample of elderly aged 80 or older in Shanghai, China. BMC Geriatr. 2016;16(1):178. doi:10.1186/s12877-016-0352-9
54.
ZhaiLZhangYZhangD. Sedentary behaviour and the risk of depression: a meta-analysis. Br J Sports Med. 2015;49(11):705–709. doi:10.1136/bjsports-2014-093613
55.
AllenMSWalterEESwannC. Sedentary behaviour and risk of anxiety: a systematic review and meta-analysis. J Affect Disord. 2019;242:5–13. doi:10.1016/j.jad.2018.08.081
56.
PengpidSPeltzerK. High sedentary behaviour and low physical activity are associated with anxiety and depression in Myanmar and Vietnam. Int J Environ Res Public Health. 2019;16(7):1251. doi:10.3390/ijerph16071251
57.
LiaoYShibataAIshiiKOkaK. Independent and combined associations of physical activity and sedentary behavior with depressive symptoms among Japanese adults. Int J Behav Med. 2016;23(4):402–409. doi:10.1007/s12529-015-9484-0
58.
AtkinAJGorelyTClemesSA, et al.Methods of measurement in epidemiology: sedentary behaviour. Int J Epidemiol. 2012;41(5):1460–1471. doi:10.1093/ije/dys118
59.
RyanDJWullemsJAStebbingsGKMorseCIStewartCEOnambele-PearsonGL. Reliability and validity of the international physical activity questionnaire compared to calibrated accelerometer cut-off points in the quantification of sedentary behaviour and physical activity in older adults. PLoS One. 2018;13(4):e0195712. doi:10.1371/journal.pone.0195712
60.
DiazKMHowardVJHuttoB, et al.Patterns of sedentary behavior and mortality in U.S. middle-aged and older adults: a national cohort study. Ann Intern Med. 2017;167(7):465–475. doi:10.7326/M17-0212
61.
HondaTChenSYonemotoK, et al.Sedentary bout durations and metabolic syndrome among working adults: a prospective cohort study. BMC Public Health. 2016;16(1):888. doi:10.1186/s12889-016-3570-3
62.
MakovskiTSchmitzSvan den AkkerMZeegersMStrangesS. Multimorbidity and quality of life—systematic literature review and meta-analysis. Revue d’Épidémiologie et de Santé Publique. 2018;66:S327. doi:10.1016/j.respe.2018.05.242
63.
MekaryRAWillettWCHuFBDingEL. Isotemporal substitution paradigm for physical activity epidemiology and weight change. Am J Epidemiol. 2009;170(4):519–527. doi:10.1093/aje/kwp163
64.
NagaiKTamakiKKusunokiH, et al.Isotemporal substitution of sedentary time with physical activity and its associations with frailty status. Clin Interv Aging. 2018;13:1831–1836. doi:10.2147/CIA.S175666
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