SBRN– Terminology Consensus Project Summary Presentation

1. SBRN– Terminology Consensus Project Summary Presentation

2. Outline of the Presentation • Introduction • Background and Context • Methods and Survey Results • Definitions, Caveats and Examples • Conclusion

3. 1. Introduction • Objectives of the Presentation • The Sedentary Behaviour Research Network • First Consensus Sedentary Behaviour Definition

4. Objectives of the Presentation • To provide background evidence and support for the need for consensus definitions, and the potential confusion and/or harm in their absence. • To present the methods of the SBRN Terminology Consensus Project. • To release the consensus definitions, caveats and inclusive examples, for all ages, for the following terms: physical inactivity, stationary behaviour, sedentary behaviour, standing, screen time, non-screen-based sedentary time, sitting, reclining, lying and sedentary behaviour pattern.

5. The Sedentary Behaviour Research Network (SBRN) • The only organization for researchers and health professionals which focuses specifically on the health impact of sedentary behaviour.  • Mission: To connect sedentary behaviour researchers and health professionals working in all fields of study, and to disseminate this research to the academic community and to the public at large.  • Membership: • Membership in SBRN is free, and open to any researcher or health professional with an interest in sedentary behaviour. • More than 1,300 members from 20 countries.  • Website: http://www.sedentarybehaviour.org/

6. First SBRN Consensus Definition for Sedentary Behaviour • Aimed at defining and clarifying differences between “sedentary behaviour” and “physical inactivity” • Authored by >50 SBRN members, • Translated and published in French, Portuguese and Spanish • Had very good traction (cited >500 times, via SCOPUS) • Calls from SBRN membership to update and expand

7. First SBRN Consensus Definition for Sedentary Behaviour Sedentary behaviour : “Any waking behaviour characterized by an energy expenditure ≤1.5 METs while in a sitting or reclining posture”. Inactive: “Those who are performing insufficient amounts of MVPA (i.e., not meeting specified physical activity guidelines)”.

8. 2. Background and Context Confusion, Contradiction and Consternation: Importance and Implications of Harmonizing Definitions in Sedentary Behaviour Research

9. Growth in research related to Sedentary Behaviours Rapid and progressive growth in health research studying sedentary time/behaviours, and the link between excessive sedentary behaviour and health outcomes or indicators (van Ekris et al., 2017; Carson et al., 2016; Ekelund et al., 2006; Katzmarzyk et al., 2009; Chinapaw et al., 2011; Owen et al., 2011; Salmon et al., 2011; Stamatakis et al., 2011; Thorp et al., 2011; Tremblay et al., 2010)

10. Confusion in research related to Sedentary Behaviours As this field of research has grown, so too has confusion over the definition of key terms (e.g., sedentary behaviour, screen time, sedentary behaviour patterns, bouts, breaks) (Altenburg and Chinapaw, 2015; Altenburg et al., 2015; Chinapaw et al., 2014; Gibbs et al., 2015; Pate et al., 2008; Reilly et al., 2015; Saint-Maurice et al., 2016; Tremblay et al., 2010).

11. Aim of this new consensus project Need for further clarity and consensus on a variety of related terms Need for standardization of terminology, and for definitions that have utility across all ages and physical abilities, to further advance this field of study. Some commonly used terms are ill-suited for specific populations (e.g. young children, those with spinal cord injuries…) To develop consensus definitions for terms relevant to sedentary behaviour research, for all age groups and for all abilities, through engagement of the SBRN membership.

12. 3. Methods and Survey Results • Timeline • Background Literature Search • Steering Committee & SBRN Member Recruitment • Key Term List Creation • Survey 2: Definition Drafts • Compilation and Creation of Conceptual Model • Creation of Survey 3 • Intermediate Findings from Survey 3 • Writing and Review of the Manuscript

13. Terminology Consensus Project Timeline March 2016 Background literature search March 2016 Creation of the Steering Committee April 2016 Creation of the first key terms list April 2016 First email to SBRN members: Soliciting interest to participate and key term suggestions April 2016 Survey 1 to Steering Committee: Key term list modification/approval/shortening April 2016 Combination and analysis of Survey 1: List of key term finalization May 2016 Survey 2 to Steering Committee: Definitions of each key term and caveats May to July 2016 Compilation and synthesis of proposed definitions and creation of conceptual model July to August 2016 Definitions, model and Survey 3 draft approval by the Steering Committee September 2016 Survey 3 to SBRN members who expressed interest in participating: level of agreement and feedback on proposed model, key term definitions and caveats September 2016 to January 2017 Analysis of Survey 3 results, modifications to model and key term definitions January to February 2017 Draft manuscript prepared and circulated to Steering Committee for comments March 2017Draft manuscript prepared and circulated to all participating SBRN members for comments three times

14. Literature Search Goals • Review current use of the SBRN (2012) definition • Examine current operational definitions of sedentary behaviour and related terms (e.g., screen time, sedentary behavior pattern, bouts and breaks) • Examine evidence of inconsistencies, differences, conflicts or concerns over variations in definitions employed Method Literature search performed on PubMed with filters capturing papers published only in the past 5 years (May 2011 to May 2016) Data extracted from potentially relevant articles Aim of the study Defined/discussed terms Targeted population Definitions/relevant information

15. Steering Committee and SBRN Member Recruitment Steering Committee • Identification of authors of key papers through literature search • Final composition: • 7 international researchers • 2 project managers SBRN Members Email sent to the SBRN membership soliciting interest in participating in the project → 1,094 members worldwide in April, 2016 N=134 expressed interest in participating in the project

16. Key Term List Creation Literature Search Creation of key term list • First draft list of terms sent in the recruitment email to the SBRN membership • Asking for suggestions for additional key terms Online Survey 1: Key terms from the literature search and SBRN members were collated in a survey → Steering Committee members were asked to add or remove key terms from the list Final draft list of terms agreed upon by the Steering Committee

17. Survey 2: Definition Drafts Final draft list of terms “Physical inactivity” was not included → No suggested changes to the existing SBRN definition • Stationary Behaviour • Sedentary Behaviour • Standing • Screen Time • Non-Screen-Based Sedentary Time • Sitting • Reclining • Lying • Sedentary Behaviour Pattern Online Survey 2 • Addressed to Steering Committee Members • Asked to submit for each terms: • draft definitions, • caveats for age and ability groups, • examples for each categories, • References when available Age and ability groups • Infants (<1 year or pre-walking): • Toddlers and preschoolers (1-4 years) • Children and youth (5-17 years) • Adults (≥ 18 years) • People who use a manual wheelchair or a power chair

18. Creation of Survey 3 Survey 2 findings compilation First draft of Survey 3 Online Survey 3 First draft definitions with caveats and examples for each terms • Addressed to 134 participating SBRN members • Assessed for the conceptual model and each definition the clarity and level of agreement • Five point scale from “strongly agree” to “strongly disagree” • Provided opportunity for general comments Final version obtained after several reviews by email from Steering Committee members First version of the conceptual model of movement-based terminology Consensus = determined a priori to have been achieved if ≥75% of respondents “strongly” agreed or “somewhat” agreed with a particular question

19. Findings from Survey 3 Participants • N=87 completed the survey (including the 9 Steering Committee members) • Respondents were from 20 countries and represented researchers, trainees, graduate students, practitioners and government employees Average of clarity and level of agreement

20. Writing and review of the manuscript • Survey 3 findings → Revisions to conceptual model, definitions, caveats, examples, and references • Draft manuscript sent to all participating SBRN members for several rounds of review • Final version of the manuscript (after 3rd review) was recirculated to the 84 co-authors for final comments and sign-off for submission • 3 participants asked to be removed from author list: • 1 because of disagreements with the paper content • 2 because they felt they had not made a sufficient contribution

21. 4. Definitions, Caveats and Examples

22. Physical Inactivity “An insufficient physical activity level to meet present physical activity recommendations” < 3 hours/day of total PA < 60 min/day of MVPA < 150 min/week of MVPA

23. Sitting “A position in which one's weight is supported by one's buttocks rather than one's feet, and in which one's back is upright” Passive (≤ 1.5 METs) Active (> 1.5 METs)

24. Lying “Being in a horizontal position on a supporting surface” Passive (≤ 1.5 METs) Active (> 1.5 METs)

25. Sedentary Behaviour (General Population) “Any waking behavior characterized by an energy expenditure ≤1.5 metabolic equivalents (METs), while in a sitting, reclining or lying posture ”

26. Sedentary Behaviour (Infants) “Any waking behaviour characterized by low energy expenditure while restrained (e.g., stroller/pram, high chair, car seat/capsule), or when sedate (e.g., reclining/sitting in a chair with little movement but not restrained). Time spent in the prone position (“tummy time”) is not considered a sedentary exposure.”

27. Sedentary Behaviour Caveats • Sedentary time: The time spent for any duration (e.g., minutes per day) or in any context (e.g., at school or work) in sedentary behaviours. • Sedentary bout: A period of uninterrupted sedentary time. • Sedentary interruptions/breaks: A non-sedentary bout in between two sedentary bouts.

28. Sedentary Behaviour Caveats 7.00 Break in Sedentary Time 6.00 5.00 4.00 3.00 METs Sedentary Bout 2.00 1.00 Sedentary Time 0.00 8am 12pm 4pm 8pm 12am

29. Standing “A position in which one has or is maintaining an upright position while supported by one's feet ” Passive (≤ 2.0 METs) Active (> 2.0 METs)

30. Standing Caveats • Standing time: The time spent for any duration (e.g., minutes per day) or in any context (e.g., at school/work) while standing. • Standing bout: A period of uninterrupted time while standing. • Standing interruptions/breaks: A non-standing bout in between two standing bouts.

31. Stationary Behaviour “Any waking behaviour done while lying, reclining, sitting, or standing, with no ambulation, irrespective of energy expenditure.”

32. Stationary Behaviour Caveats • Stationary time: The time spent for any duration (e.g., per day, per week), in any context (e.g., at school/work), and at any intensity (e.g., standing in a line, working on an assembly line with no ambulation, working at a standing desk, sitting in a classroom) in stationary behaviors. • Stationary bout: A period of uninterrupted stationary time. • Stationary interruptions/breaks: A non-stationary bout in between two stationary bouts (applies to all age and ability groups except infants).

33. Screen Time “Screen time refers to the time spent on screen-based behaviours. These behaviours can be performed while being sedentary or physically active.”

34. Screen Time Caveats • Recreational screen time: Time spent in screen behaviours that are not related to school or work. • Stationary screen time: Time spent using a screen-based device (e.g., smartphone, tablet, computer, television) while being stationary in any context (e.g., school, work, recreational). • Sedentary screen time: Time spent using a screen-based device (e.g., smartphone, tablet, computer, television) while being sedentary in any context (e.g., school, work, recreational). • Active screen time: Time spent using a screen-based device (e.g., smartphone, tablet, computer, television) while not being stationary in any context (e.g., school, work, recreational).

35. Non-Screen-Based Sedentary Time “Time spent in sedentary behaviours that do not involve the use of screens.”

36. Sedentary Behaviour Pattern “The manner in which sedentary behaviour is accumulated throughout the day or week while awake (e.g., the timing, duration and frequency of sedentary bouts and breaks)” Dunstan et al, 2010 (Touch Briefings)

37. Not All Behaviours Are Mutually Exclusive Active Walking AND Screen Time

38. Not All Behaviours Are Mutually Exclusive Reclining AND Screen Time AND Non-Screen Sedentary Time

39. Not All Behaviours Are Mutually Exclusive Sedentary AND Active Sedentary & Inactive Sedentary & Active Sedentary Behaviour Inactive, Not Sedentary Active, Not Sedentary Physical Activity

40. 5. Conclusion

41. Article published in open access journal https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-017-0525-8

42. Conceptual Model

43. Promotion and Dissemination • Published manuscript in IJBNPA • Symposium at the ISBNPA Conference in Victoria • Press release from CHEO Research Institute (SBRN) and other author institutions • Promotional “postcard” • Complete update of the SBRN website (www.sedentarybehaviour.org) • Translated versions of the definitions, caveats and examples available on the SBRN website – translated into 10 different languages (Traditional Chinese, Dutch, French, German, Greek, Japanese, Korean, Portuguese (Brazil), Portuguese (Portugal), Spanish, so far)! Thanks to the translators! • ISBNPA posted a blog about the project in conjunction with the release – thanks to Dr. Travis Saunders for writing this! • Social media promotion associated with the release – please post/tweet/retweet/promote/blog etc. as you can and see fit

44. Acknowledgements • Joel Barnes, Travis Saunders, Mai Chin A Paw, Mark Tremblay, and Salomé Aubert for their contribution to the project and to this presentation • All the participating SBRN Members • The translators of the definitions and figure • Ergotron for the sponsorship of the ISBNPA symposium