on behalf of SBRN Terminology Consensus Project ParticipantspersName, Mark S. TremblaypersName, Salomé AubertpersName, Joel D. BarnespersName, Travis J. SaunderspersName, Valerie CarsonpersName, Amy E. Latimer‐CheungpersName, Sébastien ChastinpersName, Teatske M. AltenburgpersName, Mai J. M. ChinapawpersName (2017date). “Sedentary Behavior Research Network (SBRN) - Terminology Consensus Project process and outcome.” International Journal of Behavioral Nutrition and Physical Activitytitle·venue.
Object of study — A TERMINOLOGY, AND THE PROCEDURE FOR AGREEING ONE - ten sequential steps, 1,094 members invited, 87 responding, and a 75% bar set before the vote, to settle what 'sedentary behaviorterm·def', 'stationary behavior', 'sitting', 'reclining', 'lying', 'standing' and 'screen time' each mean
Research question — what the field's key terms should mean, when its own literature defines the central one at METterm·var ceilings from 1.5 to 2.0 and three papers give no number at all
Contribution — consensus definitions for ten terms plus the usage of 'bouts', 'breaks' and 'interruptions', with caveats and examples written for all age groups and functional abilities, and a conceptual model positioning the terms
phenomenon · claim-type · cross-domain-transfer · mechanism · claim-relation · replication-status · limitation — grounded in the full text| phenomenon | a fast-growing field whose central term had a widely-cited definition and a live dispute about its threshold at the same time — “The definition of sedentary behavior as “any waking behaviour characterized by an energy expenditure ≤1.5 METs while in a sitting or reclining posture,” proposed by SBRN [ 25 ] was widely adopted as evidenced by frequent citations (558 according to SCOPUS, March 20, 2017), though at least one article claimed that there is still not a real consensus on the definition” | |
| claim-type | method — “A series of sequential processes were employed in an effort to derive consensus definitions for key terms in sedentary behavior research (Fig. 1 ). These processes included i) a literature search, ii) establishment of a Steering Committee of SBRN members, iii) invitation to all SBRN members to participate in the consensus project, iv) selecting a list of key terms, v) developing a conceptual model, vi) drafting definitions for key terms, vii) collecting input and feedback on the conceptual model and draft definitions from participating SBRN members, viii) compiling input and finalizing (reaching consensus on) the conceptual model and definitions, ix) preparing the manuscript with sign-off by all participants, x) and finally disseminating project results through publication and presentation.” | |
| method — evidence | — “A series of sequential processes were employed in an effort to derive consensus definitions for key terms in sedentary behavior research (Fig. 1 ). These processes included i) a literature search, ii) establishment of a Steering Committee of SBRN members, iii) invitation to all SBRN members to participate in the consensus project, iv) selecting a list of key terms, v) developing a conceptual model, vi) drafting definitions for key terms, vii) collecting input and feedback on the conceptual model and draft definitions from participating SBRN members, viii) compiling input and finalizing (reaching consensus on) the conceptual model and definitions, ix) preparing the manuscript with sign-off by all participants, x) and finally disseminating project results through publication and presentation.” | |
| object of study — evidence | — “A series of sequential processes were employed in an effort to derive consensus definitions for key terms in sedentary behavior research (Fig. 1 ). These processes included i) a literature search, ii) establishment of a Steering Committee of SBRN members, iii) invitation to all SBRN members to participate in the consensus project, iv) selecting a list of key terms, v) developing a conceptual model, vi) drafting definitions for key terms, vii) collecting input and feedback on the conceptual model and draft definitions from participating SBRN members, viii) compiling input and finalizing (reaching consensus on) the conceptual model and definitions, ix) preparing the manuscript with sign-off by all participants, x) and finally disseminating project results through publication and presentation.” | |
| research question — evidence | — “As this field of research has grown, so too has confusion over the definition of sedentary behavior (see Table 1 for a sample of definitions) and other related terms (e.g., screen time, sedentary behavior patterns, bouts, breaks) [ 4 , 7 , 17 – 22 ]. For example, Altenburg and Chinapaw [ 17 ] recently recommended that to advance the field of sedentary behavior epidemiology, standardized procedures for accelerometer data collection and data reduction should be defined; standardized operational definitions of sedentary bouts and breaks are needed; sedentary bouts should be operationally defined as a minimum period of uninterrupted sedentary time; total time accumulated in sedentary bouts per day (or per week) should be calculated rather than using average bout duration; and the best mathematical adjustment that converts accelerometer data into sedentary patterns should be further explored.” | |
| contribution — evidence | — “The survey asked participants to assess the clarity of, and agreement with, the conceptual model and proposed definitions (using a five point scale from strongly agree to strongly disagree), while also providing an opportunity for general comments. Consensus was determined a priori to have been achieved if ≥75% of respondents strongly agreed or somewhat agreed with a particular question (see Additional file 1 : for complete survey). Note that the term “physical inactivity” was not included in the survey because there were no suggested changes to the existing SBRN” | |
| mechanism | A CONSENSUS DEFINITION AGREED BY 8% OF THE MEMBERSHIP IT WAS SENT TO: `Our initial invitation ... was sent to all 1094 SBRN members. Of these, 390 SBRN members opened the email (36%), 134 SBRN members (12% of total and 34% of those that opened the email) indicated interest, and 87 (8% of total and 22% of those that opened the email) completed the survey.` The funnel is printed in full, which is the only reason the 8% is visible - and 9 of the 87 were the Steering Committee that drafted the definitions — “Our initial invitation to participate in the process was sent to all 1094 SBRN members. Of these, 390 SBRN members opened the email (36%), 134 SBRN members (12% of total and 34% of those that opened the email) indicated interest, and 87 (8% of total and 22% of those that opened the email) completed the survey, including Steering Committee members ( n = 9). Respondents were from 20 countries and represented researchers, trainees, graduate students, practitioners and government employees” | mechanisms[0] |
| mechanism | AND THE BAR WAS SET BEFORE THE VOTE, WITH ONE TERM EXEMPTED FROM IT: `CONSENSUS WAS DETERMINED A PRIORI to have been achieved IF >=75% of respondents strongly agreed or somewhat agreed with a particular question ... Note that the term `PHYSICAL INACTIVITY` was not included in the survey because there were no suggested changes to the existing SBRN definition.` A fourth consensus threshold in this corpus - after ADQI's two-thirds, CONSORT-AI's 80% and GLIS's >80% - and a term that keeps its definition by not being asked about — “The survey asked participants to assess the clarity of, and agreement with, the conceptual model and proposed definitions (using a five point scale from strongly agree to strongly disagree), while also providing an opportunity for general comments. Consensus was determined a priori to have been achieved if ≥75% of respondents strongly agreed or somewhat agreed with a particular question (see Additional file 1 : for complete survey). Note that the term “physical inactivity” was not included in the survey because there were no suggested changes to the existing SBRN” | mechanisms[1] |
| mechanism | AND THE DEFINITION HAS TWO COMPONENTS AND NO INSTRUMENT MEASURES BOTH: `The SBRN definition has dual components, including both energy expenditure and posture. The postural aspect is easily operationalized ... but tends to ignore the energetic component. In contrast, the energetic aspect, often determined by indirect calorimetry or accelerometry, has received criticism in relation to its inability to discriminate between postures. However, it should be noted that accelerometers assess movement rather than energy expenditure, and therefore at best represent an indirect method.` Each instrument sees one half of the definition, and the commonest one sees neither directly — “The SBRN definition has dual components, including both energy expenditure and posture. The postural aspect is easily operationalized and widely used to identify sedentary behavior using questionnaires, direct observation or inclinometers, but tends to ignore the energetic component. In contrast, the energetic aspect, often determined by indirect calorimetry or accelerometry, has received criticism in relation to its inability to discriminate between postures. However, it should be noted that accelerometers assess movement rather than energy expenditure, and therefore at best represent an indirect method of assessing energy expenditure in any population.” | mechanisms[2] |
| mechanism | AND THE CANONICAL INSTANCE FAILS THE CRITERION: `the 1.5 metabolic equivalent (MET) intensity threshold used in the SBRN definition ... was generally appropriate for distinguishing between common sitting and standing activities in healthy weight and obese adults; however, some common sitting behaviors (e.g., typing) sometimes have a MET level above this threshold.` Typing is sitting and typing is not sedentary behaviour, by the definition's own number — “Mansoubi et al. [ 29 ] concluded that the 1.5 metabolic equivalent (MET) intensity threshold used in the SBRN definition of sedentary behavior was generally appropriate for distinguishing between common sitting and standing activities in healthy weight and obese adults; however, some common sitting behaviors (e.g., typing) sometimes have a MET level above this threshold.” | mechanisms[3] |
| mechanism | AND TWO STUDIES REACH OPPOSITE CONCLUSIONS ABOUT THE SAME THRESHOLD FOR THE SAME POPULATION: one reports `that adult MET thresholds may not be appropriate for children and that the upper limit of the MET threshold for sedentary behavior in children should be increased from 1.5 to 2.0 METs`; `IN CONTRAST, using whole-room calorimetry as the criterion measure, Reilly et al. and others concluded that the current MET threshold recommendation of <=1.5 METs seems appropriate for young children`. Same threshold, same population, opposite verdicts, different criterion measures — “In a recent study that compared MET-defined cut-points used to classify sedentary behaviors in children aged 7–13 years in simulated free-living conditions, it was reported that adult MET thresholds may not be appropriate for children and that the upper limit of the MET threshold for sedentary behavior in children should be increased from 1.5 to 2.0 METs [ 22 ]. These authors suggested that a more precise, age-specific definition of sedentary behavior in children may improve overall physical activity (mis)classification in the population and may be of value in quantifying the health burden of sedentary behaviors in youth. In contrast, using whole-room calorimetry as the criterion measure, Reilly et al. [ 21 ] and others [ 30 ] concluded that the current MET threshold recommendation of ≤1.5 METs seems appropriate for young children (mean age of 5.3 years).” | mechanisms[4] |
| mechanism | AND THE ACCELEROMETER CUT-POINT MAY MEAN A DIFFERENT THING IN A DIFFERENT BODY: `While the THRESHOLD OF <=100 cpm is the most commonly used cut-point, Ezeugwu and colleagues suggested that it may actually represent light intensity activity for some people with mobility impairment.` The number is the same and the category it names is not - the same shape as this corpus's `the definition names what the assay cannot see`, with the population as the hidden variable — “There is much debate concerning how to measure sedentary behavior with accelerometers in individuals with different mobility impairments. While the threshold of ≤100 cpm is the most commonly used cut-point [ 35 ], Ezeugwu and colleagues [ 33 ] suggested that it may actually represent light intensity activity for some people with mobility impairment and that there is still a need for further research to determine appropriate accelerometer cut-points among groups with different mobility impairments.” | mechanisms[5] |
| mechanism | AND A CONTROLLED VOCABULARY THAT HAS NOT CAUGHT UP: `the standardized use of key terms (e.g., sedentary behavior vs physical inactivity) has had variable uptake across disciplines (e.g., behavioral science vs exercise physiology) and medical subject headings (MESH) continue to use physical inactivity when sedentary behavior would be more appropriate.` The indexing vocabulary the whole literature is retrieved through is five years behind the distinction the field made — “There remains, however, a need for further refinement and consensus on a variety of related and emergent terms (e.g., screen time, standing, sitting, reclining), and it has become clear that some commonly used terms are ill-suited for specific populations, such as young children (e.g., before they can sit or stand), those with chronic disease (e.g., hyperthyroidism), or those with mobility impairment (e.g., where postural challenges with standing may represent light or moderate physical activity). Furthermore, the standardized use of key terms (e.g., sedentary behavior vs physical inactivity) has had variable uptake across disciplines (e.g., behavioral science vs exercise physiology) and medical subject headings (MESH) continue to use physical inactivity when sedentary behavior would be more appropriate. Collectively, these issues underscore the need for standardization of terminology, and for definitions that have utility across all ages and physical abilities.” | mechanisms[6] |
| mechanism | AND VARYING THE DEFINITION CHANGES WHAT THE VARIABLE PREDICTS: Altenburg and colleagues `examined the occurrence and duration of sedentary bouts, and explored the cross-sectional associations of various operational definitions of sedentary bouts with health indicators in children. Their study highlighted the potential influence of varying definitions of a sedentary bout or sedentary break on their association with health indicators, and provided support for the need for a consensus definition of these terms.` The definition is upstream of the finding — “Altenburg and colleagues [ 18 ] examined the occurrence and duration of sedentary bouts, and explored the cross-sectional associations of various operational definitions of sedentary bouts with health indicators in children. Their study highlighted the potential influence of varying definitions of a sedentary bout or sedentary break on their association with health indicators, and provided support for the need for a consensus definition of these terms.” | mechanisms[7] |
| mechanism | AND THE DEFINITION IS BOTH WIDELY ADOPTED AND STILL DISPUTED, IN ONE SENTENCE: `The definition ... proposed by SBRN WAS WIDELY ADOPTED AS EVIDENCED BY FREQUENT CITATIONS (558 ACCORDING TO SCOPUS, March 20, 2017), though at least one article claimed that there is still not A real consensus on the definition.` A citation count offered as evidence of consensus, with the counter-example in the same clause — “The definition of sedentary behavior as “any waking behaviour characterized by an energy expenditure ≤1.5 METs while in a sitting or reclining posture,” proposed by SBRN [ 25 ] was widely adopted as evidenced by frequent citations (558 according to SCOPUS, March 20, 2017), though at least one article claimed that there is still not a real consensus on the definition” | mechanisms[8] |
| mechanism | AND THE PREVIOUS DEFINITION TRAVELLED BY TRANSLATION: `In 2012, the Sedentary Behaviour Research Network published a letter proposing definitions aimed at clarifying differences between `SEDENTARY BEHAVIOUR` AND `PHYSICAL INACTIVITY`. This clarification, authored by 52 SBRN members, achieved wide acceptance and was published in English and was subsequently translated and published in French`, Portuguese and Spanish. A definition propagated by translation, with the author count as its warrant — “In 2012, the Sedentary Behaviour Research Network (SBRN; a network connecting sedentary behavior researchers and health professionals from around the world interested in sedentary behavior research [ 24 ]) published a letter proposing definitions aimed at clarifying differences between “sedentary behaviour” and “physical inactivity” [ 25 ]. This clarification, authored by 52 SBRN members, achieved wide acceptance and was published in English [ 25 , 26 ] and was subsequently translated and published in French” | mechanisms[9] |
| extends | the 2012 SBRN letter (Sedentary Behaviour Research Network, Appl Physiol Nutr Metab), authored by 52 members, which proposed the <=1.5 MET sitting-or-reclining definition this project carries forward and builds ten more terms around — “In 2012, the Sedentary Behaviour Research Network (SBRN; a network connecting sedentary behavior researchers and health professionals from around the world interested in sedentary behavior research [ 24 ]) published a letter proposing definitions aimed at clarifying differences between “sedentary behaviour” and “physical inactivity” [ 25 ]. This clarification, authored by 52 SBRN members, achieved wide acceptance and was published in English [ 25 , 26 ] and was subsequently translated and published in French” | claim_relations[0] |
| critiques | the use of 'physical inactivity' as a Medical Subject Heading where 'sedentary behavior' is meant, five years after the distinction was published — “There remains, however, a need for further refinement and consensus on a variety of related and emergent terms (e.g., screen time, standing, sitting, reclining), and it has become clear that some commonly used terms are ill-suited for specific populations, such as young children (e.g., before they can sit or stand), those with chronic disease (e.g., hyperthyroidism), or those with mobility impairment (e.g., where postural challenges with standing may represent light or moderate physical activity). Furthermore, the standardized use of key terms (e.g., sedentary behavior vs physical inactivity) has had variable uptake across disciplines (e.g., behavioral science vs exercise physiology) and medical subject headings (MESH) continue to use physical inactivity when sedentary behavior would be more appropriate. Collectively, these issues underscore the need for standardization of terminology, and for definitions that have utility across all ages and physical abilities.” | claim_relations[1] |
| sense | `sedentary behavior` (SBRN 2012, carried into 2017) - `any waking behaviour characterized by an energy expenditure <=1.5 METs WHILE IN A sitting or reclining posture` - 558 Scopus citations by March 2017 — “The definition of sedentary behavior as “any waking behaviour characterized by an energy expenditure ≤1.5 METs while in a sitting or reclining posture,” proposed by SBRN [ 25 ] was widely adopted as evidenced by frequent citations (558 according to SCOPUS, March 20, 2017), though at least one article claimed that there is still not a real consensus on the definition” | senses[0] |
| sense | `sedentary behavior` (as used in the literature) - a MET ceiling of <=1.5 in most papers, **<2.0 in one**, 1.0-1.8 in another, and no number at all in three (`non-upright activities`; `time spent sitting or lying`) — “As this field of research has grown, so too has confusion over the definition of sedentary behavior (see Table 1 for a sample of definitions) and other related terms (e.g., screen time, sedentary behavior patterns, bouts, breaks) [ 4 , 7 , 17 – 22 ]. For example, Altenburg and Chinapaw [ 17 ] recently recommended that to advance the field of sedentary behavior epidemiology, standardized procedures for accelerometer data collection and data reduction should be defined; standardized operational definitions of sedentary bouts and breaks are needed; sedentary bouts should be operationally defined as a minimum period of uninterrupted sedentary time; total time accumulated in sedentary bouts per day (or per week) should be calculated rather than using average bout duration; and the best mathematical adjustment that converts accelerometer data into sedentary patterns should be further explored.” | senses[1] |
| sense | `physical inactivity` - the term the 2012 letter existed to separate from `sedentary behaviour`, EXEMPTED from the 2017 vote because nobody proposed a change, and still the MeSH heading used in its place — “In 2012, the Sedentary Behaviour Research Network (SBRN; a network connecting sedentary behavior researchers and health professionals from around the world interested in sedentary behavior research [ 24 ]) published a letter proposing definitions aimed at clarifying differences between “sedentary behaviour” and “physical inactivity” [ 25 ]. This clarification, authored by 52 SBRN members, achieved wide acceptance and was published in English [ 25 , 26 ] and was subsequently translated and published in French” | senses[2] |
| sense | `sedentary bout` / `sedentary break` - terms whose OPERATIONAL definitions vary, and the variation changes their measured association with health indicators — “Altenburg and colleagues [ 18 ] examined the occurrence and duration of sedentary bouts, and explored the cross-sectional associations of various operational definitions of sedentary bouts with health indicators in children. Their study highlighted the potential influence of varying definitions of a sedentary bout or sedentary break on their association with health indicators, and provided support for the need for a consensus definition of these terms.” | senses[3] |
| control | setting the >=75% agreement bar A PRIORI, before the survey ran — held — “Our initial invitation to participate in the process was sent to all 1094 SBRN members. Of these, 390 SBRN members opened the email (36%), 134 SBRN members (12% of total and 34% of those that opened the email) indicated interest, and 87 (8% of total and 22% of those that opened the email) completed the survey, including Steering Committee members ( n = 9). Respondents were from 20 countries and represented researchers, trainees, graduate students, practitioners and government employees” — rules out a consensus threshold chosen once the answers were visible — “The survey asked participants to assess the clarity of, and agreement with, the conceptual model and proposed definitions (using a five point scale from strongly agree to strongly disagree), while also providing an opportunity for general comments. Consensus was determined a priori to have been achieved if ≥75% of respondents strongly agreed or somewhat agreed with a particular question (see Additional file 1 : for complete survey). Note that the term “physical inactivity” was not included in the survey because there were no suggested changes to the existing SBRN” | controls[0] |
| control | recruiting the Steering Committee from the authors of the papers the literature search identified — partial — “Our initial invitation to participate in the process was sent to all 1094 SBRN members. Of these, 390 SBRN members opened the email (36%), 134 SBRN members (12% of total and 34% of those that opened the email) indicated interest, and 87 (8% of total and 22% of those that opened the email) completed the survey, including Steering Committee members ( n = 9). Respondents were from 20 countries and represented researchers, trainees, graduate students, practitioners and government employees” — rules out a committee with no standing in the literature it is standardising - at the cost that 9 of the 87 respondents drafted what they were voting on — “A series of sequential processes were employed in an effort to derive consensus definitions for key terms in sedentary behavior research (Fig. 1 ). These processes included i) a literature search, ii) establishment of a Steering Committee of SBRN members, iii) invitation to all SBRN members to participate in the consensus project, iv) selecting a list of key terms, v) developing a conceptual model, vi) drafting definitions for key terms, vii) collecting input and feedback on the conceptual model and draft definitions from participating SBRN members, viii) compiling input and finalizing (reaching consensus on) the conceptual model and definitions, ix) preparing the manuscript with sign-off by all participants, x) and finally disseminating project results through publication and presentation.” | controls[1] |
| control | writing caveats and examples for all age groups and functional abilities into every definition — partial — “There is much debate concerning how to measure sedentary behavior with accelerometers in individuals with different mobility impairments. While the threshold of ≤100 cpm is the most commonly used cut-point [ 35 ], Ezeugwu and colleagues [ 33 ] suggested that it may actually represent light intensity activity for some people with mobility impairment and that there is still a need for further research to determine appropriate accelerometer cut-points among groups with different mobility impairments.” — rules out terms that are 'ILL-SUITED FOR SPECIFIC POPULATIONS ... young children before they can sit or stand ... those with mobility impairment' — “There remains, however, a need for further refinement and consensus on a variety of related and emergent terms (e.g., screen time, standing, sitting, reclining), and it has become clear that some commonly used terms are ill-suited for specific populations, such as young children (e.g., before they can sit or stand), those with chronic disease (e.g., hyperthyroidism), or those with mobility impairment (e.g., where postural challenges with standing may represent light or moderate physical activity). Furthermore, the standardized use of key terms (e.g., sedentary behavior vs physical inactivity) has had variable uptake across disciplines (e.g., behavioral science vs exercise physiology) and medical subject headings (MESH) continue to use physical inactivity when sedentary behavior would be more appropriate. Collectively, these issues underscore the need for standardization of terminology, and for definitions that have utility across all ages and physical abilities.” | controls[2] |
| weight | the 2012 SBRN letter (Sedentary Behaviour Research Network, Appl Physiol Nutr Metab), authored by 52 members, which proposed the <=1.5 MET sitting-or-reclining definition this project carries forward and builds ten more terms around — 0.95 — “In 2012, the Sedentary Behaviour Research Network (SBRN; a network connecting sedentary behavior researchers and health professionals from around the world interested in sedentary behavior research [ 24 ]) published a letter proposing definitions aimed at clarifying differences between “sedentary behaviour” and “physical inactivity” [ 25 ]. This clarification, authored by 52 SBRN members, achieved wide acceptance and was published in English [ 25 , 26 ] and was subsequently translated and published in French” | claim_relations[0] |
| weight | the use of 'physical inactivity' as a Medical Subject Heading where 'sedentary behavior' is meant, five years after the distinction was published — 0.85 — “There remains, however, a need for further refinement and consensus on a variety of related and emergent terms (e.g., screen time, standing, sitting, reclining), and it has become clear that some commonly used terms are ill-suited for specific populations, such as young children (e.g., before they can sit or stand), those with chronic disease (e.g., hyperthyroidism), or those with mobility impairment (e.g., where postural challenges with standing may represent light or moderate physical activity). Furthermore, the standardized use of key terms (e.g., sedentary behavior vs physical inactivity) has had variable uptake across disciplines (e.g., behavioral science vs exercise physiology) and medical subject headings (MESH) continue to use physical inactivity when sedentary behavior would be more appropriate. Collectively, these issues underscore the need for standardization of terminology, and for definitions that have utility across all ages and physical abilities.” | claim_relations[1] |
| note | sedentary behaviour —distinct-from→ physical inactivity — `In 2012, the Sedentary Behaviour Research Network published A letter proposing definitions aimed at clarifying differences between `SEDENTARY BEHAVIOUR` AND `PHYSICAL INACTIVITY`.` The distinction needed its own publication, 52 authors, and three translations - and five years later `medical subject headings (MESH) continue to use physical inactivity when sedentary behavior would be more appropriate` — “In 2012, the Sedentary Behaviour Research Network (SBRN; a network connecting sedentary behavior researchers and health professionals from around the world interested in sedentary behavior research [ 24 ]) published a letter proposing definitions aimed at clarifying differences between “sedentary behaviour” and “physical inactivity” [ 25 ]. This clarification, authored by 52 SBRN members, achieved wide acceptance and was published in English [ 25 , 26 ] and was subsequently translated and published in French” | concept_edges[0] |
| relation | sedentary behaviour —distinct-from→ physical inactivity — the two terms were separated by a dedicated 52-author letter in 2012; MeSH still uses the second where the first is meant — “In 2012, the Sedentary Behaviour Research Network (SBRN; a network connecting sedentary behavior researchers and health professionals from around the world interested in sedentary behavior research [ 24 ]) published a letter proposing definitions aimed at clarifying differences between “sedentary behaviour” and “physical inactivity” [ 25 ]. This clarification, authored by 52 SBRN members, achieved wide acceptance and was published in English [ 25 , 26 ] and was subsequently translated and published in French” — “published a letter proposing definitions aimed at clarifying differences between “sedentary behaviour” and “physical inactivity”” | concept_edges[0] |
| weight | sedentary behaviour —distinct-from→ physical inactivity — 0.95 — “In 2012, the Sedentary Behaviour Research Network (SBRN; a network connecting sedentary behavior researchers and health professionals from around the world interested in sedentary behavior research [ 24 ]) published a letter proposing definitions aimed at clarifying differences between “sedentary behaviour” and “physical inactivity” [ 25 ]. This clarification, authored by 52 SBRN members, achieved wide acceptance and was published in English [ 25 , 26 ] and was subsequently translated and published in French” | concept_edges[0] |
| note | postural aspect —distinct-from→ energetic aspect — 'The postural aspect is easily operationalized ... but tends to ignore the energetic component. In contrast, the energetic aspect ... has received criticism in relation to its inability to discriminate between postures.' A two-part definition with no single instrument that can apply it - which is why 'typing' can be sitting and not sedentary at the same time — “The SBRN definition has dual components, including both energy expenditure and posture. The postural aspect is easily operationalized and widely used to identify sedentary behavior using questionnaires, direct observation or inclinometers, but tends to ignore the energetic component. In contrast, the energetic aspect, often determined by indirect calorimetry or accelerometry, has received criticism in relation to its inability to discriminate between postures. However, it should be noted that accelerometers assess movement rather than energy expenditure, and therefore at best represent an indirect method of assessing energy expenditure in any population.” | concept_edges[1] |
| relation | postural aspect —distinct-from→ energetic aspect — the two components of the definition are measured by different instruments, and each instrument is blind to the other component — “The SBRN definition has dual components, including both energy expenditure and posture. The postural aspect is easily operationalized and widely used to identify sedentary behavior using questionnaires, direct observation or inclinometers, but tends to ignore the energetic component. In contrast, the energetic aspect, often determined by indirect calorimetry or accelerometry, has received criticism in relation to its inability to discriminate between postures. However, it should be noted that accelerometers assess movement rather than energy expenditure, and therefore at best represent an indirect method of assessing energy expenditure in any population.” — “The postural aspect is easily operationalized and widely used to identify sedentary behavior using questionnaires, direct observation or inclinometers, but tends to ignore the energetic component. In contrast, the energetic aspect, often determined by indirect calorimetry or accelerometry, has received criticism in relation to its inability to discriminate between postures.” | concept_edges[1] |
| weight | postural aspect —distinct-from→ energetic aspect — 0.95 — “The SBRN definition has dual components, including both energy expenditure and posture. The postural aspect is easily operationalized and widely used to identify sedentary behavior using questionnaires, direct observation or inclinometers, but tends to ignore the energetic component. In contrast, the energetic aspect, often determined by indirect calorimetry or accelerometry, has received criticism in relation to its inability to discriminate between postures. However, it should be noted that accelerometers assess movement rather than energy expenditure, and therefore at best represent an indirect method of assessing energy expenditure in any population.” | concept_edges[1] |
| note | accelerometers —distinct-from→ energy expenditure — 'it should be noted that accelerometers assess movement rather than energy expenditure, and therefore at best represent an indirect method of assessing energy expenditure in any population.' The threshold is in METs and the instrument is in counts per minute - the gap between them is where '<=100 cpm' starts meaning different things in different bodies — “The SBRN definition has dual components, including both energy expenditure and posture. The postural aspect is easily operationalized and widely used to identify sedentary behavior using questionnaires, direct observation or inclinometers, but tends to ignore the energetic component. In contrast, the energetic aspect, often determined by indirect calorimetry or accelerometry, has received criticism in relation to its inability to discriminate between postures. However, it should be noted that accelerometers assess movement rather than energy expenditure, and therefore at best represent an indirect method of assessing energy expenditure in any population.” | concept_edges[2] |
| relation | accelerometers —distinct-from→ energy expenditure — accelerometers measure MOVEMENT; the definition's threshold is on ENERGY EXPENDITURE, which they reach only indirectly — “The SBRN definition has dual components, including both energy expenditure and posture. The postural aspect is easily operationalized and widely used to identify sedentary behavior using questionnaires, direct observation or inclinometers, but tends to ignore the energetic component. In contrast, the energetic aspect, often determined by indirect calorimetry or accelerometry, has received criticism in relation to its inability to discriminate between postures. However, it should be noted that accelerometers assess movement rather than energy expenditure, and therefore at best represent an indirect method of assessing energy expenditure in any population.” — “accelerometers assess movement rather than energy expenditure, and therefore at best represent an indirect method of assessing energy expenditure” | concept_edges[2] |
| weight | accelerometers —distinct-from→ energy expenditure — 0.95 — “The SBRN definition has dual components, including both energy expenditure and posture. The postural aspect is easily operationalized and widely used to identify sedentary behavior using questionnaires, direct observation or inclinometers, but tends to ignore the energetic component. In contrast, the energetic aspect, often determined by indirect calorimetry or accelerometry, has received criticism in relation to its inability to discriminate between postures. However, it should be noted that accelerometers assess movement rather than energy expenditure, and therefore at best represent an indirect method of assessing energy expenditure in any population.” | concept_edges[2] |
| outcome | control — held — “The survey asked participants to assess the clarity of, and agreement with, the conceptual model and proposed definitions (using a five point scale from strongly agree to strongly disagree), while also providing an opportunity for general comments. Consensus was determined a priori to have been achieved if ≥75% of respondents strongly agreed or somewhat agreed with a particular question (see Additional file 1 : for complete survey). Note that the term “physical inactivity” was not included in the survey because there were no suggested changes to the existing SBRN” — “Our initial invitation to participate in the process was sent to all 1094 SBRN members. Of these, 390 SBRN members opened the email (36%), 134 SBRN members (12% of total and 34% of those that opened the email) indicated interest, and 87 (8% of total and 22% of those that opened the email) completed the survey, including Steering Committee members ( n = 9). Respondents were from 20 countries and represented researchers, trainees, graduate students, practitioners and government employees” | controls[0] |
| outcome | control — partial — “A series of sequential processes were employed in an effort to derive consensus definitions for key terms in sedentary behavior research (Fig. 1 ). These processes included i) a literature search, ii) establishment of a Steering Committee of SBRN members, iii) invitation to all SBRN members to participate in the consensus project, iv) selecting a list of key terms, v) developing a conceptual model, vi) drafting definitions for key terms, vii) collecting input and feedback on the conceptual model and draft definitions from participating SBRN members, viii) compiling input and finalizing (reaching consensus on) the conceptual model and definitions, ix) preparing the manuscript with sign-off by all participants, x) and finally disseminating project results through publication and presentation.” — “Our initial invitation to participate in the process was sent to all 1094 SBRN members. Of these, 390 SBRN members opened the email (36%), 134 SBRN members (12% of total and 34% of those that opened the email) indicated interest, and 87 (8% of total and 22% of those that opened the email) completed the survey, including Steering Committee members ( n = 9). Respondents were from 20 countries and represented researchers, trainees, graduate students, practitioners and government employees” | controls[1] |
| outcome | control — partial — “There remains, however, a need for further refinement and consensus on a variety of related and emergent terms (e.g., screen time, standing, sitting, reclining), and it has become clear that some commonly used terms are ill-suited for specific populations, such as young children (e.g., before they can sit or stand), those with chronic disease (e.g., hyperthyroidism), or those with mobility impairment (e.g., where postural challenges with standing may represent light or moderate physical activity). Furthermore, the standardized use of key terms (e.g., sedentary behavior vs physical inactivity) has had variable uptake across disciplines (e.g., behavioral science vs exercise physiology) and medical subject headings (MESH) continue to use physical inactivity when sedentary behavior would be more appropriate. Collectively, these issues underscore the need for standardization of terminology, and for definitions that have utility across all ages and physical abilities.” — “There is much debate concerning how to measure sedentary behavior with accelerometers in individuals with different mobility impairments. While the threshold of ≤100 cpm is the most commonly used cut-point [ 35 ], Ezeugwu and colleagues [ 33 ] suggested that it may actually represent light intensity activity for some people with mobility impairment and that there is still a need for further research to determine appropriate accelerometer cut-points among groups with different mobility impairments.” | controls[2] |
| limitation | THE FIELD HAS SEVERAL SIMULTANEOUS STANDARDISATION PROJECTS AND NO AGREED DEFINITIONS: `Several other large-scale projects are currently underway to produce A common taxonomy, harmonized measurement protocols, consistent data reduction and analytic procedures, and a framework for establishing research priorities. However, A collaborative global initiative to arrive at consensus definitions on key terms has remained elusive.` Five named initiatives - AlPHABET, ISMPB, ISPAH, the Sensor Methods Collaboratory, SIT, SOS - and the definitions were still open — “Several other large-scale projects are currently underway to produce a common taxonomy, harmonized measurement protocols, consistent data reduction and analytic procedures, and a framework for establishing research priorities (Table 2 ). However, a collaborative global initiative to arrive at consensus definitions on key terms has remained elusive.” | limitations[0] |
| limitation | AND THE TERMS ARE ILL-SUITED TO SOME OF THE PEOPLE THEY DESCRIBE: `it has become clear that some commonly used terms are ill-suited for specific populations, such as young children (e.g., before they can sit or stand), those with chronic disease (e.g., hyperthyroidism), or those with mobility impairment (e.g., where postural challenges with standing may represent light or moderate physical activity).` A definition built on posture excludes, by construction, everyone whose posture does not mean what it assumes — “There remains, however, a need for further refinement and consensus on a variety of related and emergent terms (e.g., screen time, standing, sitting, reclining), and it has become clear that some commonly used terms are ill-suited for specific populations, such as young children (e.g., before they can sit or stand), those with chronic disease (e.g., hyperthyroidism), or those with mobility impairment (e.g., where postural challenges with standing may represent light or moderate physical activity). Furthermore, the standardized use of key terms (e.g., sedentary behavior vs physical inactivity) has had variable uptake across disciplines (e.g., behavioral science vs exercise physiology) and medical subject headings (MESH) continue to use physical inactivity when sedentary behavior would be more appropriate. Collectively, these issues underscore the need for standardization of terminology, and for definitions that have utility across all ages and physical abilities.” | limitations[1] |
| limitation | and the evidence base narrowed sharply: `The literature search identified 997 articles, and after screening for inclusion criteria, 14 were used for the identification and definition of key terms.` Fourteen papers behind a terminology for a field publishing at the rate this one does — “The literature search identified 997 articles, and after screening for inclusion criteria, 14 were used for the identification and definition of key terms in sedentary behavior research.” | limitations[2] |
finding · quantity · variable · definition · key-term — grounded in the full text| finding | — “Our initial invitation to participate in the process was sent to all 1094 SBRN members. Of these, 390 SBRN members opened the email (36%), 134 SBRN members (12% of total and 34% of those that opened the email) indicated interest, and 87 (8% of total and 22% of those that opened the email) completed the survey, including Steering Committee members ( n = 9). Respondents were from 20 countries and represented researchers, trainees, graduate students, practitioners and government employees” | content_tags.findings[0] |
| finding | — “The SBRN definition has dual components, including both energy expenditure and posture. The postural aspect is easily operationalized and widely used to identify sedentary behavior using questionnaires, direct observation or inclinometers, but tends to ignore the energetic component. In contrast, the energetic aspect, often determined by indirect calorimetry or accelerometry, has received criticism in relation to its inability to discriminate between postures. However, it should be noted that accelerometers assess movement rather than energy expenditure, and therefore at best represent an indirect method of assessing energy expenditure in any population.” | content_tags.findings[1] |
| finding | — “Mansoubi et al. [ 29 ] concluded that the 1.5 metabolic equivalent (MET) intensity threshold used in the SBRN definition of sedentary behavior was generally appropriate for distinguishing between common sitting and standing activities in healthy weight and obese adults; however, some common sitting behaviors (e.g., typing) sometimes have a MET level above this threshold.” | content_tags.findings[2] |
| finding | — “In a recent study that compared MET-defined cut-points used to classify sedentary behaviors in children aged 7–13 years in simulated free-living conditions, it was reported that adult MET thresholds may not be appropriate for children and that the upper limit of the MET threshold for sedentary behavior in children should be increased from 1.5 to 2.0 METs [ 22 ]. These authors suggested that a more precise, age-specific definition of sedentary behavior in children may improve overall physical activity (mis)classification in the population and may be of value in quantifying the health burden of sedentary behaviors in youth. In contrast, using whole-room calorimetry as the criterion measure, Reilly et al. [ 21 ] and others [ 30 ] concluded that the current MET threshold recommendation of ≤1.5 METs seems appropriate for young children (mean age of 5.3 years).” | content_tags.findings[3] |
| finding | — “There remains, however, a need for further refinement and consensus on a variety of related and emergent terms (e.g., screen time, standing, sitting, reclining), and it has become clear that some commonly used terms are ill-suited for specific populations, such as young children (e.g., before they can sit or stand), those with chronic disease (e.g., hyperthyroidism), or those with mobility impairment (e.g., where postural challenges with standing may represent light or moderate physical activity). Furthermore, the standardized use of key terms (e.g., sedentary behavior vs physical inactivity) has had variable uptake across disciplines (e.g., behavioral science vs exercise physiology) and medical subject headings (MESH) continue to use physical inactivity when sedentary behavior would be more appropriate. Collectively, these issues underscore the need for standardization of terminology, and for definitions that have utility across all ages and physical abilities.” | content_tags.findings[4] |
| finding | — “Altenburg and colleagues [ 18 ] examined the occurrence and duration of sedentary bouts, and explored the cross-sectional associations of various operational definitions of sedentary bouts with health indicators in children. Their study highlighted the potential influence of varying definitions of a sedentary bout or sedentary break on their association with health indicators, and provided support for the need for a consensus definition of these terms.” | content_tags.findings[5] |
| quantity | 1,094 invited, 390 opened (36%), 134 interested (12%), 87 completed (8%) — — “Our initial invitation to participate in the process was sent to all 1094 SBRN members. Of these, 390 SBRN members opened the email (36%), 134 SBRN members (12% of total and 34% of those that opened the email) indicated interest, and 87 (8% of total and 22% of those that opened the email) completed the survey, including Steering Committee members ( n = 9). Respondents were from 20 countries and represented researchers, trainees, graduate students, practitioners and government employees” | content_tags.quantities[0] |
| quantity | >=75% strongly or somewhat agreeing, set a priori — — “The survey asked participants to assess the clarity of, and agreement with, the conceptual model and proposed definitions (using a five point scale from strongly agree to strongly disagree), while also providing an opportunity for general comments. Consensus was determined a priori to have been achieved if ≥75% of respondents strongly agreed or somewhat agreed with a particular question (see Additional file 1 : for complete survey). Note that the term “physical inactivity” was not included in the survey because there were no suggested changes to the existing SBRN” | content_tags.quantities[1] |
| quantity | <=1.5 in most, <2.0 in one, 1.0-1.8 in another, absent in three — — ““Sedentary behavior may be defined as having a MET value between one and 1.5 (for example, equivalent to sitting or lying down)”. [ 65 ] “Sedentary behaviors were defined as having MET <2.0 (e.g., equivalent to sitting or lying down)”. [ 66 ] “A distinct class of behaviors characterized by low energy expenditure”. [ 67 ] “Sedentary behavior involves activities with a very low energy expenditure (1.0–1.8 metabolic equivalents [MET]), performed mainly in a sitting or supine position”. [ 68 ] “Sedentary behavior refers to activities that do not increase energy expenditure substantially above the resting level and includes activities such as sleeping, sitting, lying down, and watching television, and other forms of screen-based entertainment. Operationally, sedentary behavior includes activities that involve energy expenditure at the level of 1.0–1.5 metabolic equivalent units (METs)”. [ 4 ] “Sedentary behaviors such TV viewing, computer use, or sitting in an automobile typically are in the energy-expenditure range of 1.0 to 1.5 METs (multiples of the basal metabolic rate). Thus, sedentary behaviors are those that involve sitting and low levels of energy expenditure”. [ 2 ] “Sitting, lying down, and expending very little energy (approximately 1.0–1.5 metabolic equivalents [METs])”. [ 56 ] “Non-upright” activities”. [ 69 ] “Sedentary behaviours are considered those requiring ≤1.5 METs.” [ 7 ] “Sedentary behaviour, defined as time spent sitting or lying”. [ 70 ] “The term sedentary behavior (from the Latin word sedere, “to sit”) describes a distinct class of activities that require low levels of energy expenditure in the range of 1.0–1.5 METs (multiples of the basal metabolic rate) and involve sitting during commuting, in the workplace and the domestic environment, and during leisure”. [ 6 ] “Any waking behavior characterized by energy expenditure ≤1.5 metabolic equivalents (METs) while in a sitting or reclining posture”. [ 25 ]” | content_tags.quantities[2] |
| quantity | 997 articles identified, 14 used — — “The literature search identified 997 articles, and after screening for inclusion criteria, 14 were used for the identification and definition of key terms in sedentary behavior research.” | content_tags.quantities[3] |
| variable | METs — “Mansoubi et al. [ 29 ] concluded that the 1.5 metabolic equivalent (MET) intensity threshold used in the SBRN definition of sedentary behavior was generally appropriate for distinguishing between common sitting and standing activities in healthy weight and obese adults; however, some common sitting behaviors (e.g., typing) sometimes have a MET level above this threshold.” | content_tags.variables[0] |
| definition | sedentary behavior — “The definition of sedentary behavior as “any waking behaviour characterized by an energy expenditure ≤1.5 METs while in a sitting or reclining posture,” proposed by SBRN [ 25 ] was widely adopted as evidenced by frequent citations (558 according to SCOPUS, March 20, 2017), though at least one article claimed that there is still not a real consensus on the definition” | content_tags.definitions[0] |
| concept | sedentary behaviour — not defined in this paper's own words; the term this project exists to define, at <=1.5 METs in a sitting or reclining posture — “In 2012, the Sedentary Behaviour Research Network (SBRN; a network connecting sedentary behavior researchers and health professionals from around the world interested in sedentary behavior research [ 24 ]) published a letter proposing definitions aimed at clarifying differences between “sedentary behaviour” and “physical inactivity” [ 25 ]. This clarification, authored by 52 SBRN members, achieved wide acceptance and was published in English [ 25 , 26 ] and was subsequently translated and published in French” | concepts[0] |
| concept | physical inactivity — not defined in this paper's own words; the term it must be separated from - and the one MeSH still uses in its place — “In 2012, the Sedentary Behaviour Research Network (SBRN; a network connecting sedentary behavior researchers and health professionals from around the world interested in sedentary behavior research [ 24 ]) published a letter proposing definitions aimed at clarifying differences between “sedentary behaviour” and “physical inactivity” [ 25 ]. This clarification, authored by 52 SBRN members, achieved wide acceptance and was published in English [ 25 , 26 ] and was subsequently translated and published in French” | concepts[1] |
| concept | postural aspect — not defined in this paper's own words; one half of the definition: easily operationalised, and blind to energy expenditure — “The SBRN definition has dual components, including both energy expenditure and posture. The postural aspect is easily operationalized and widely used to identify sedentary behavior using questionnaires, direct observation or inclinometers, but tends to ignore the energetic component. In contrast, the energetic aspect, often determined by indirect calorimetry or accelerometry, has received criticism in relation to its inability to discriminate between postures. However, it should be noted that accelerometers assess movement rather than energy expenditure, and therefore at best represent an indirect method of assessing energy expenditure in any population.” | concepts[2] |
| concept | energetic aspect — not defined in this paper's own words; the other half: measured by calorimetry or accelerometry, and unable to discriminate between postures — “The SBRN definition has dual components, including both energy expenditure and posture. The postural aspect is easily operationalized and widely used to identify sedentary behavior using questionnaires, direct observation or inclinometers, but tends to ignore the energetic component. In contrast, the energetic aspect, often determined by indirect calorimetry or accelerometry, has received criticism in relation to its inability to discriminate between postures. However, it should be noted that accelerometers assess movement rather than energy expenditure, and therefore at best represent an indirect method of assessing energy expenditure in any population.” | concepts[3] |
| concept | accelerometers — not defined in this paper's own words; the commonest instrument, which measures neither half directly — “The SBRN definition has dual components, including both energy expenditure and posture. The postural aspect is easily operationalized and widely used to identify sedentary behavior using questionnaires, direct observation or inclinometers, but tends to ignore the energetic component. In contrast, the energetic aspect, often determined by indirect calorimetry or accelerometry, has received criticism in relation to its inability to discriminate between postures. However, it should be noted that accelerometers assess movement rather than energy expenditure, and therefore at best represent an indirect method of assessing energy expenditure in any population.” | concepts[4] |
| concept | energy expenditure — not defined in this paper's own words; what the MET threshold is a threshold on, and what accelerometers do not measure — “The SBRN definition has dual components, including both energy expenditure and posture. The postural aspect is easily operationalized and widely used to identify sedentary behavior using questionnaires, direct observation or inclinometers, but tends to ignore the energetic component. In contrast, the energetic aspect, often determined by indirect calorimetry or accelerometry, has received criticism in relation to its inability to discriminate between postures. However, it should be noted that accelerometers assess movement rather than energy expenditure, and therefore at best represent an indirect method of assessing energy expenditure in any population.” | concepts[5] |
| percentage agreement | — “The survey asked participants to assess the clarity of, and agreement with, the conceptual model and proposed definitions (using a five point scale from strongly agree to strongly disagree), while also providing an opportunity for general comments. Consensus was determined a priori to have been achieved if ≥75% of respondents strongly agreed or somewhat agreed with a particular question (see Additional file 1 : for complete survey). Note that the term “physical inactivity” was not included in the survey because there were no suggested changes to the existing SBRN” | content_tags.statistics[0] |
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Int J Behav Nutr Phys Act Int J Behav Nutr Phys Act 243 ijbenutr The International Journal of Behavioral Nutrition and Physical Activity 1479-5868 BMC PMC5466781 PMC5466781.1 5466781 5466781 28599680 10.1186/s12966-017-0525-8 525 1 Research Sedentary Behaviorterm·def Research Network (SBRN) – Terminology Consensus Project process and outcome TremblaypersName Mark S. 613 737-7600 mtremblay@cheo.on.ca 1 AubertpersName Salomé saubert@cheo.on.ca 1 BarnespersName Joel D. jbarnes@cheo.on.ca 1 SaunderspersName Travis J. trsaunders@upei.ca 2 CarsonpersName Valerie vlcarson@ualberta.ca 3 Latimer-CheungpersName Amy E. amy.latimer@queensu.ca 4 ChastinpersName Sebastien F.M. Sebastien.ChastinpersName@gcu.ac.uk 5 6 AltenburgpersName Teatske M. t.altenburgpersName@vumc.nl 7 ChinapawpersName Mai J.M. m.chinapawpersName@vumc.nl 7 on behalf of SBRN Terminology Consensus Project ParticipantspersName AltenburgpersName Teatske M. Aminian Saeideh Arundell Lauren Atkin Andrew J. AubertpersName Salomé BarnespersName Joel Barone Gibbs Bethany Bassett-Gunter Rebecca Belanger Kevin Biddle Stuart Biswas Aviroop CarsonpersName Valerie Chaput Jean-Philippe ChastinpersName Sebastien Chau Josephine ChinAPawpersName Mai Colley Rachel Coppinger Tara Craven Catharine Cristi-Montero Carlos de Assis Teles Santos Douglas del Pozo Cruz Borja del Pozo-Cruz Jesus Dempsey Paddy do Carmo Santos Gonçalves Ricardo Filipe Ekelund Ulf Ellingson Laura Ezeugwu Victor Fitzsimons Claire Florez-Pregonero Alberto Friel Ciarán P. Fröberg Andreas Giangregorio Lora Godin Linda Gunnell Katie Halloway Shannon Hinkley Trina Hnatiuk Jill Husu Pauliina Kadir Mohammad Karagounis Leonidas G. Koster Annemarie Lakerveld Jeroen Lamb Martin Larouche Richard Latimer-CheungpersName Amy LeBlanc Allana G. Lee Eun-Young Lee Paul Lopes Luis Manns Trish Manyanga Taru Martin Ginis Kathleen McVeigh Joanne Meneguci Joilson Moreira Carla Murtagh Elaine Patterson Freda Rodrigues Pereira da Silva Danilo Pesola Arto J. Peterson Neil Pettitt Cherie Pilutti Lara Pinto Pereira Snehal Poitras Veronica Prince Stephanie Rathod Apoorva Rivière Fabien Rosenkranz Sara Routhier François Santos Rute SaunderspersName Travis Smith Brett Theou Olga Tomasone Jennifer TremblaypersName Mark Tucker Patricia Umstattd Meyer Renée van der Ploeg Hidde Villalobos Tania Viren Toni Wallmann-Sperlich Birgit Wijndaele Katrien Wondergem Roderick 1 0000 0000 9402 6172 grid.414148.c Healthy Active Living and Obesity Research Group, Children’s Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON K1H 8L1 Canada 2 0000 0001 2167 8433 grid.139596.1 Department of Applied Human Sciences, University of Prince Edward Island, Charlottetown, PEI C1A 4P3 Canada 3 grid.17089.37 Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB T6G 2H9 Canada 4 0000 0004 1936 8331 grid.410356.5 School of Kinesiology and Health Studies, Queen’s University, Kingston, ON K7L 3N6 Canada 5 0000 0001 0669 8188 grid.5214.2 Institute of Applied Health Research, Glasgow Caledonian University, Glasgow, Scotland 6 0000 0001 2069 7798 grid.5342.0 Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium 7 0000 0004 0435 165X grid.16872.3a VU University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, Netherlands 10 6 2017 2017 14 283368 75 7 4 2017 16 5 2017 10 06 2017 14 06 2017 31 05 2024 © The Author(s). 2017 https://creativecommons.org/licenses/by/4.0/ Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated. Background The prominence of sedentary behaviorterm·def research in health science has grown rapidly. With this growth there is increasing urgency for clear, common and accepted terminology and definitions. Such standardization is difficult to achieve, especially across multi-disciplinary researchers, practitioners, and industries. The Sedentary Behaviorterm·def Research Network (SBRN) undertook a Terminology Consensus Project to address this need.
Method First, a literature review was completed to identify key terms in sedentary behaviorterm·def research. These key terms were then reviewed and modified by a Steering Committee formed by SBRN. Next, SBRN members were invited to contribute to this project and interested participantspersName reviewed and provided feedback on the proposed list of terms and draft definitions through an online survey. Finally, a conceptual model and consensus definitions (including caveats and examples for all age groups and functional abilities) were finalized based on the feedback received from the 87 SBRN member participantspersName who responded to the original invitation and survey.
Results Consensus definitions for the terms physical inactivityterm, stationary behavior, sedentary behaviorterm·def, standing, screen time, non-screen-based sedentary time, sitting, reclining, lying, sedentary behaviorterm·def pattern, as well as how the terms bouts, breaks, and interruptions should be used in this context are provided.
Conclusion It is hoped that the definitions resulting from this comprehensive, transparent, and broad-based participatory process will result in standardized terminology that is widely supported and adopted, thereby advancing future research, interventions, policies, and practices related to sedentary behaviorsterm·def.
Electronic supplementary material The online version of this article (doi:10.1186/s12966-017-0525-8) contains supplementary material, which is available to authorized users.
Keywords Physical inactivityterm Sedentary behaviorterm·def Stationary behavior Standing Screen time Non-screen-based time Sitting Reclining Lying Bouts Interruptions Breaks pmc-status-qastatus 0 pmc-status-live yes pmc-status-embargo no pmc-status-released yes pmc-prop-open-access yes pmc-prop-olf no pmc-prop-manuscript no pmc-prop-legally-suppressed no pmc-prop-has-pdf yes pmc-prop-has-supplement no pmc-prop-pdf-only no pmc-prop-suppress-copyright no pmc-prop-is-real-version no pmc-prop-is-scanned-article no pmc-prop-preprint no pmc-prop-in-epmc yes pmc-license-ref CC BY issue-copyright-statement © The Author(s) 2017 Background There has been rapid and progressive growth in research studying sedentary time and sedentary behaviorsterm·def [ 1 – 8 ]. Increasing evidence of the link between excessive sedentary behaviorterm·def and adverse health indicators or outcomes has perpetuated this interest [ 3 , 5 – 7 , 9 – 15 ]. The American Heart Association recently issued a science advisory on sedentary behaviorterm·def and cardiovascular morbidity and mortality [ 16 ]. As this field of research has grown, so too has confusion over the definition of sedentary behaviorterm·def (see Table 1 for a sample of definitions) and other related terms (e.g., screen time, sedentary behaviorterm·def patterns, bouts, breaks) [ 4 , 7 , 17 – 22 ]. For example, AltenburgpersName and ChinapawpersName [ 17 ] recently recommended that to advance the field of sedentary behaviorterm·def epidemiology, standardized procedures for accelerometerterm data collection and data reduction should be defined; standardized operational definitions of sedentary bouts and breaks are needed; sedentary bouts should be operationally defined as a minimum period of uninterrupted sedentary time; total time accumulated in sedentary bouts per day (or per week) should be calculated rather than using average bout duration; and the best mathematical adjustment that converts accelerometerterm data into sedentary patterns should be further explored. The majority of sedentary behaviorterm·def self- and proxy-report questionnaires in the published literature have not undergone psychometric testing [ 10 ]. Of those that have undergone testing, a small number have acceptable levels of reliability, although the validity of most questionnaires is low [ 23 ]. Several other large-scale projects are currently underway to produce a common taxonomy, harmonized measurement protocols, consistent data reduction and analytic procedures, and a framework for establishing research priorities (Table 2 ). However, a collaborative global initiative to arrive at consensus definitions on key terms has remained elusive. Table 1 Sample of definitions of sedentary behaviorterm·def from the research literature Definition Reference “Sedentary behaviorterm·def may be defined as having a METterm·var value between one and 1.5 (for example, equivalent to sitting or lying down)”. [ 65 ] “Sedentary behaviorsterm·def were defined as having METterm·var <2.0 (e.g., equivalent to sitting or lying down)”. [ 66 ] “A distinct class of behaviors characterized by low energy expenditureterm”. [ 67 ] “Sedentary behaviorterm·def involves activities with a very low energy expenditureterm (1.0–1.8 metabolic equivalents [METterm·var]), performed mainly in a sitting or supine position”. [ 68 ] “Sedentary behaviorterm·def refers to activities that do not increase energy expenditureterm substantially above the resting level and includes activities such as sleeping, sitting, lying down, and watching television, and other forms of screen-based entertainment. Operationally, sedentary behaviorterm·def includes activities that involve energy expenditureterm at the level of 1.0–1.5 metabolic equivalent units (METsterm·var)”. [ 4 ] “Sedentary behaviorsterm·def such TV viewing, computer use, or sitting in an automobile typically are in the energy-expenditure range of 1.0 to 1.5 METsterm·var (multiples of the basal metabolic rate). Thus, sedentary behaviorsterm·def are those that involve sitting and low levels of energy expenditureterm”. [ 2 ] “Sitting, lying down, and expending very little energy (approximately 1.0–1.5 metabolic equivalents [METsterm·var])”. [ 56 ] “Non-upright” activities”. [ 69 ] “Sedentary behavioursterm are considered those requiring ≤1.5 METsterm·var.” [ 7 ] “Sedentary behaviourterm, defined as time spent sitting or lying”. [ 70 ] “The term sedentary behaviorterm·def (from the Latin word sedere, “to sit”) describes a distinct class of activities that require low levels of energy expenditureterm in the range of 1.0–1.5 METsterm·var (multiples of the basal metabolic rate) and involve sitting during commuting, in the workplace and the domestic environment, and during leisure”. [ 6 ] “Any waking behavior characterized by energy expenditureterm ≤1.5 metabolic equivalents (METsterm·var) while in a sitting or reclining posture”. [ 25 ] Table 2 Initiatives related to, or possibly beneficiaries of, the SBRN Terminology Consensus Project AlPHABET The AlPHABET project is an open science project set up to develop a common taxonomy (naming and cataloging system) for classification, harmonization and storage of objective tracking sensor data of human physical behavior in daily life [ 71 ]. Development will be through an international consensus process using the Delphi method. It aims to reach international consensus on an overarching definition for the study of how activities, physical actions and movements as part of human daily behavior impacts health and well-being; and on an integrated classification system, data model and nomenclature. A brief description is available online [ 71 ].
International Society for the Measurement of Physical Behavior The International Society for the Measurement of Physical Behavior is a non-profit scientific society which focuses on issues related to ambulatory monitoring, wearable monitors, movement sensors, physical activity, sedentary behaviorterm·def, movement behavior, body postures, sleep and constructs related to physical behaviors. It aims to promote and facilitate the study and applications of objective measurement and quantification of free-living physical behavior using wearable devices. More information about this society, its membership, actions or shared resources can be found on its website [ 72 ].
International Society for Physical Activity and Health The International Society for Physical Activity and Health (ISPAH) [ 73 ] has a mission to advance and promote physical activity as a global health priority through excellence in research, education, capacity building and advocacy. The ISPAH has recently launched a Sedentary Behaviorterm·def Council [ 74 ] to specifically focus on advancing science, advocacy, and practice related to sedentary behaviourterm.
Sensor Methods Collaboratory (National Institutes of Health) The Sensor Methods Collaboratory is an initiative created after a pre-conference workshop at the 3rd International Conference on Ambulatory Monitoring of Physical Activity and Movement (ICAMPAM) in June 2013 which was held to propose a collaborative approach to algorithm development to interpret ambulatory monitoring of movement behaviours [ 75 ]. Researchers would benefit if a commonly accepted approach to data reduction can ultimately be achieved. The collaboration aims to provide an opportunity for the research community to discuss needs, develop shared resources, propose standard protocols and metadata requirements, pilot new tools, and disseminate methodological research for further evaluation or implementation. At this time, smaller working groups are being formed to propose solutions to different issues (ethics and privacy; harmonizing calibration protocols and data elements; hardware, software and data management logistics; and evaluating evidence and comparison of analytic approaches) and efficient models for dissemination of the results of these deliberations will be explored [ 76 ].
Sedentary Behaviorterm·def International Taxonomy (SIT) SIT is an open science project setup to develop a common taxonomy of sedentary behaviorsterm·def through a formal consensus process taking into account the opinion of experts and of the general public. The first round of the Delphi method involved experts who were asked to make statements about the taxonomy; its purpose and use; the domains, categories or facets that should be considered and included; the structure/architecture to arrange and link these domains and facets has been reported [ 77 ]. The SIT taxonomy aims to facilitate systematic and standardised investigation and analysis, to enable systematic and standardised reporting, to facilitate comparison and meta-analysis and to facilitate development of measurement tools, sensors and outcome measures of sedentary behaviorsterm·def. Contributions from interested researchers remain welcomed; further information can be found online [ 78 ].
Sedentary Behaviourterm Research Network (SBRN) SBRN is a network of researchers and practitioners interested in the health-impact of sedentary behaviourterm. SBRN’s mission is to connect sedentary behaviourterm 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. Further information can be found online [ 24 ].
Systems of Sedentary Behaviorsterm·def (SOS) Framework The SOS-framework is an international transdisciplinary consensus framework developed for the study of determinants, research priorities and policy on sedentary behaviorterm·def across the life course [ 79 ]. A comprehensive concept mapping approach was used to develop this framework, involving an international expert scientist working group which was recruited directly based on publication records in the field of sedentary behaviorterm·def research, their respective field of expertise and focus on specific stage of the life course. The final framework consisted of six clusters of determinants: Physical Health and Wellbeing, Social and Cultural Context, Built and Natural Environment, Psychology and Behavior, Politics and Economics, and Institutional and Home Settings. The framework can be used as a tool to prioritize future research and to develop policies to reduce sedentary time.
In 2012, the Sedentary Behaviourterm Research Network (SBRN; a network connecting sedentary behaviorterm·def researchers and health professionals from around the world interested in sedentary behaviorterm·def research [ 24 ]) published a letter proposing definitions aimed at clarifying differences between “sedentary behaviourterm” and “physical inactivityterm” [ 25 ]. This clarification, authored by 52 SBRN members, achieved wide acceptance and was published in English [ 25 , 26 ] and was subsequently translated and published in French [ 27 ], Portuguese and Spanish [ 28 ]. There remains, however, a need for further refinement and consensus on a variety of related and emergent terms (e.g., screen time, standing, sitting, reclining), and it has become clear that some commonly used terms are ill-suited for specific populations, such as young children (e.g., before they can sit or stand), those with chronic disease (e.g., hyperthyroidism), or those with mobility impairment (e.g., where postural challenges with standing may represent light or moderate physical activity). Furthermore, the standardized use of key terms (e.g., sedentary behaviorterm·def vs physical inactivityterm) has had variable uptake across disciplines (e.g., behavioral science vs exercise physiology) and medical subject headings (MESH) continue to use physical inactivityterm when sedentary behaviorterm·def would be more appropriate. Collectively, these issues underscore the need for standardization of terminology, and for definitions that have utility across all ages and physical abilities.
Building on previous work, the SBRN orchestrated a comprehensive effort to further develop consensus definitions for terms related to sedentary behaviorterm·def research, for all age groups and for all physical abilities, through engagement of its membership. The purpose of this paper is to report on the process employed, conceptual model created, and consensus definitions developed for terms routinely used in research related to sedentary behaviorterm·def.
Methods A series of sequential processes were employed in an effort to derive consensus definitions for key terms in sedentary behaviorterm·def research (Fig. 1 ). These processes included i) a literature search, ii) establishment of a Steering Committee of SBRN members, iii) invitation to all SBRN members to participate in the consensus project, iv) selecting a list of key terms, v) developing a conceptual model, vi) drafting definitions for key terms, vii) collecting input and feedback on the conceptual model and draft definitions from participating SBRN members, viii) compiling input and finalizing (reaching consensus on) the conceptual model and definitions, ix) preparing the manuscript with sign-off by all participantspersName, x) and finally disseminating project results through publication and presentation. Fig. 1 Terminology Consensus Project timeline A literature search was performed in March 2016 to i) review the current use of the SBRN [ 25 ] definition, and potential deviations from this definition, and ii) examine current operational definitions of sedentary behaviorterm·def and related terms (e.g., screen time, sedentary behaviorterm·def patterns, bouts and breaks) and any evidence of inconsistencies, differences, conflicts, or concerns over variations in definitions employed. To identify current relevant articles a search with filters capturing papers published in the past 5 years (May 2011 to May 2016) was conducted in PubMed (see Table 3 for search terms). The articles were selected if there was mention of sedentary behaviorterm·def and/or related term definitions, cut-points, measurement challenges/recommendations or standard processing techniques for accelerometerterm data in the title or abstract, with no regard to the population (e.g., child or adult; healthy or unhealthy), type of study, intervention, or comparison being explored. After reviewing the included full-text articles, data were extracted from relevant articles including the aim of the study, defined/discussed terms, targeted population, and definitions/relevant information. Table 3 Literature search strategy ((definition*[Title/Abstract] OR consensus[Title/Abstract] OR standard*[Title/Abstract]) AND (sedentary[Title/Abstract] OR sitting[Title/Abstract] OR reclining[Title/Abstract] OR stationary[Title/Abstract])) AND (time[Title/Abstract] OR duration*[Title/Abstract] OR bout*[Title/Abstract] OR pattern*[Title/Abstract] OR interruption*[Title/Abstract] OR break*[Title/Abstract] OR type*[Title/Abstract] OR characteristic*[Title/Abstract] OR intermittence*[Title/Abstract]) In addition to gathering background information for the project, the literature search allowed for the identification of authors of key papers who were invited to form a Steering Committee for the SBRN Terminology Consensus Project (MST (Chair), TJS, VC, AEL, SFMC, TA, MJMC and project management support from SA and JDB from SBRN). Key terms from the literature search were collated and the Steering Committee members were asked to add or remove key terms from the list. A final draft list of terms was agreed upon by this Committee. An email was sent to the SBRN membership, consisting of researchers, scholars, practitioners, trainees and students interested in sedentary behaviorterm·def (1094 members worldwide in April, 2016), soliciting interest in participating in the project and asking for suggestions for key terms to be included in the survey.
The Steering Committee identified the most common key terms reported and deliberated through a short survey and email communication to arrive at draft definitions for each term, important caveats for certain age and ability groups, examples to assist with interpretation and, when available, references for the proposed definition. The final list of terms included stationary behavior, sedentary behaviorterm·def, standing, screen time, non-screen-based sedentary time, sitting, reclining, lying, and sedentary behaviorterm·def pattern. This process also led to the development of a conceptual model to help position the key terms in relation to one another. The draft definitions, caveats, examples, references, and conceptual model were included in a survey developed for distribution to participating SBRN members. The survey asked participantspersName to assess the clarity of, and agreement with, the conceptual model and proposed definitions (using a five point scale from strongly agree to strongly disagree), while also providing an opportunity for general comments. Consensus was determined a priori to have been achieved if ≥75% of respondents strongly agreed or somewhat agreed with a particular question (see Additional file 1 : for complete survey). Note that the term “physical inactivityterm” was not included in the survey because there were no suggested changes to the existing SBRN [ 25 ] definition.
Input from all participantspersName, including the Steering Committee, was consolidated (by MST, SA, JDB) and revisions to the conceptual model, definitions, caveats, examples, and references were made by the Steering Committee. The draft manuscript, including the revised conceptual model and definitions, was sent to all participantspersName for additional review and comments. After additional revisions, a revised draft of the manuscript was resent to all participantspersName for comments, group consensus, and assessment of likelihood of use. Finally, the further revised manuscript (third review) was recirculated to the project participantpersName group for final comments and sign-off for submission.
Results Literature review The literature search identified 997 articles, and after screening for inclusion criteria, 14 were used for the identification and definition of key terms in sedentary behaviorterm·def research. The definition of sedentary behaviorterm·def as “any waking behaviour characterized by an energy expenditureterm ≤1.5 METsterm·var while in a sitting or reclining posture,” proposed by SBRN [ 25 ] was widely adopted as evidenced by frequent citations (558 according to SCOPUS, March 20, 2017), though at least one article claimed that there is still not a real consensus on the definition [ 20 ]. Support for the SBRN definition was found for adults [ 29 ] and children [ 21 ].
The SBRN definition has dual components, including both energy expenditureterm and posture. The postural aspectterm is easily operationalized and widely used to identify sedentary behaviorterm·def using questionnaires, direct observation or inclinometers, but tends to ignore the energetic component. In contrast, the energetic aspectterm, often determined by indirect calorimetry or accelerometry, has received criticism in relation to its inability to discriminate between postures. However, it should be noted that accelerometersterm assess movement rather than energy expenditureterm, and therefore at best represent an indirect method of assessing energy expenditureterm in any population.
Mansoubi et al. [ 29 ] concluded that the 1.5 metabolic equivalent (METterm·var) intensity threshold used in the SBRN definition of sedentary behaviorterm·def was generally appropriate for distinguishing between common sitting and standing activities in healthy weight and obese adults; however, some common sitting behaviors (e.g., typing) sometimes have a METterm·var level above this threshold. In a recent study that compared MET-defined cut-points used to classify sedentary behaviorsterm·def in children aged 7–13 years in simulated free-living conditions, it was reported that adult METterm·var thresholds may not be appropriate for children and that the upper limit of the METterm·var threshold for sedentary behaviorterm·def in children should be increased from 1.5 to 2.0 METsterm·var [ 22 ]. These authors suggested that a more precise, age-specific definition of sedentary behaviorterm·def in children may improve overall physical activity (mis)classification in the population and may be of value in quantifying the health burden of sedentary behaviorsterm·def in youth. In contrast, using whole-room calorimetry as the criterion measure, Reilly et al. [ 21 ] and others [ 30 ] concluded that the current METterm·var threshold recommendation of ≤1.5 METsterm·var seems appropriate for young children (mean age of 5.3 years). Other research supports the inclusion of postural condition (“while in a sitting or reclining posture”) in the sedentary behaviorterm·def definition instead of just using a definition based on energy cost (≤1.5 METsterm·var) [ 31 , 32 ]. Despite a few inconsistencies, in general, there was broad support in the published literature for the SBRN [ 25 ] definition of sedentary behaviorterm·def, at least in individuals without mobility impairment.
The SBRN [ 25 ] definition has also been used for individuals with mobility impairment, for example in studies of people with multiple sclerosis [ 33 – 35 ] and community-dwelling older adults (≥60 years of age) who self-reported mobility impairments [ 36 ]. The cut-point of ≤1.5 METsterm·var was accepted and used for these populations to distinguish between sedentary behaviorterm·def and light physical activity. There is much debate concerning how to measure sedentary behaviorterm·def with accelerometersterm in individuals with different mobility impairments. While the threshold of ≤100 cpm is the most commonly used cut-point [ 35 ], Ezeugwu and colleagues [ 33 ] suggested that it may actually represent light intensity activity for some people with mobility impairment and that there is still a need for further research to determine appropriate accelerometerterm cut-points among groups with different mobility impairments.
AltenburgpersName and colleagues [ 18 ] examined the occurrence and duration of sedentary bouts, and explored the cross-sectional associations of various operational definitions of sedentary bouts with health indicators in children. Their study highlighted the potential influence of varying definitions of a sedentary bout or sedentary break on their association with health indicators, and provided support for the need for a consensus definition of these terms. AltenburgpersName and ChinapawpersName [ 17 ] discussed and proposed definitions of sedentary bouts and breaks in studies among children. They recommended that a sedentary bout should be defined as a minimum period of uninterrupted sedentary time, not allowing any “tolerance time” (e.g., time spent in non-sedentary behaviors). They further recommended calculating the total time spent in sedentary bouts (per day or per week) instead of average bout duration and they proposed that a sedentary break be defined as a non-sedentary period in between two sedentary bouts. Based on analyses of associations between accelerometer-derived sedentary bout length and cardiovascular disease risk factors using the U.S. National Health and Nutrition Examination Survey, Kim et al. [ 37 ] proposed that a threshold of 5 or 10 min be used to define a sedentary bout.
The literature search gathered evidence supporting, and related to, the standardization, harmonization and consensus initiatives summarized in Table 2 . For example, several articles highlighted the need for evidence-based and standardized accelerometerterm cut-points, data collection protocols and data reduction procedures for assessing sedentary time in children and adults [ 19 , 38 – 43 ]. These are important areas for future work but beyond the scope of this Terminology Consensus Project.
SBRN participantpersName survey findings The Terminology Consensus Project survey included an overarching conceptual model and draft definitions of key terms identified through the literature search and from project participantspersName. The complete survey (i.e., survey 3 in Fig. 1 ) sent to respondents is provided in Additional file 1 . The survey was organized to be consistent with the hierarchical structure of the conceptual model and the results are presented in the order asked in the survey. Our initial invitation to participate in the process was sent to all 1094 SBRN members. Of these, 390 SBRN members opened the email (36%), 134 SBRN members (12% of total and 34% of those that opened the email) indicated interest, and 87 (8% of total and 22% of those that opened the email) completed the survey, including Steering Committee members ( n = 9). Respondents were from 20 countries and represented researchers, trainees, graduate students, practitioners and government employees (see Terminology Consensus Project ParticipantpersName list below for specific affiliations). Survey results regarding clarity and agreement with the draft definitions, caveats and examples are provided in Table 4 . Levels of agreement with the proposed conceptual model and all definitions, caveats and examples were very high (i.e., average ≥ 92%, see Table 4 ), indicating strong support overall, even before modifications were made to address survey feedback. One survey respondent requested their name be removed as a project participantpersName because of disagreements with the paper content and two others because they felt they had not made a sufficient contribution to warrant coauthorship. In each of these cases the survey results were retained in analyses. In the end, survey results for 87 participantspersName are reported while the manuscript has 84 Terminology Consensus Project coauthors. Table 4 Survey results for clarity and agreement with the draft definitions, caveats and examples Item Item clearly stated Agreement with item Total n Strongly agree Somewhat agree Combined agreement Total n Strongly agree Somewhat agree Combined agreement Figure 85 45 (53%) 37 (44%) 82 (96%) 85 41 (48%) 33 (39%) 74 (87%) Stationary Behavior Definition 86 62 (72%) 17 (20%) 79 (92%) 84 56 (67%) 20 (24%) 65 (76%) Caveats 85 49 (58%) 25 (29%) 74 (87%) 86 51 (59%) 23 (27%) 74 (86%) Examples 83 52 (63%) 20 (24%) 72 (87%) 84 51 (61%) 29 (35%) 80 (95%) Sedentary Behaviorterm·def Definition 86 74 (86%) 12 (14%) 86 (100%) 86 74 (86%) 10 (12%) 84 (98%) Caveats 86 63 (73%) 21 (24%) 84 (98%) 86 68 (79%) 14 (16%) 82 (95%) Examples 86 72 (84%) 12 (14%) 84 (98%) 86 69 (80%) 15 (17%) 84 (98%) Standing Still Definition 85 64 (75%) 17 (20%) 81 (95%) 86 65 (76%) 19 (22%) 84 (98%) Caveats 86 69 (80%) 12 (14%) 81 (94%) 86 69 (80%) 12 (14%) 81 (94%) Examples 85 65 (76%) 18 (21%) 83 (98%) 86 66 (77%) 19 (22%) 85 (99%) Screen Time Definition 85 70 (82%) 12 (14%) 82 (96%) 84 71 (85%) 10 (12%) 81 (96%) Caveats 84 60 (71%) 17 (20%) 77 (92%) 82 60 (73%) 15 (18%) 75 (91%) Examples 84 65 (77%) 14 (20%) 79 (94%) 83 62 (75%) 15 (18%) 77 (93%) Non-Screen-Based Sedentary Time Definition 85 73 (86%) 9 (11%) 82 (96%) 85 71 (84%) 8 (9%) 79 (93%) Caveats 85 66 (78%) 11 (13%) 77 (91%) 86 64 (74%) 15 (17%) 79 (92%) Examples 85 66 (78%) 13 (15%) 79 (93%) 86 63 (73%) 14 (16%) 77 (90%) Sitting Definition 85 72 (85%) 9 (11%) 81 (95%) 86 70 (81%) 11 (13%) 81 (94%) Caveats 85 14 (16%) 11 (13%) 75 (88%) 84 59 (70%) 15 (18%) 74 (88%) Examples 85 61 (72%) 14 (16%) 75 (88%) 85 55 (65%) 21 (25%) 76 (89%) Reclining Definition 84 68 (81%) 10 (12%) 78 (93%) 83 68 (82%) 8 (10%) 76 (92%) Caveats 84 70 (83%) 8 (10%) 78 (93%) 83 69 (83%) 7 (8%) 76 (92%) Examples 84 70 (83%) 9 (11%) 79 (94%) 83 67 (81%) 10 (12%) 77 (93%) Lying Definition 85 75 (88%) 6 (7%) 81 (95%) 85 75 (88%) 6 (7%) 81 (95%) Caveats 84 76 (90%) 3 (4%) 79 (94%) 85 76 (89%) 4 (5%) 80 (94%) Examples 85 75 (88%) 6 (7%) 81 (95%) 85 75 (88%) 6 (7%) 81 (95%) Sedentary Behaviorterm·def Pattern Definition 86 78 (91%) 6 (7%) 84 (98%) 86 76 (88%) 9 (10%) 85 (99%) Caveats 86 72 (84%) 9 (10%) 81 (94%) 85 71 (84%) 9 (11%) 80 (94%) Examples 86 60 (70%) 19 (22%) 79 (92%) 85 58 (68%) 19 (22%) 77 (91%) Average Definition 71 (83%) 11 (13%) 82 (96%) 70 (82%) 11 (13%) 81 (95%) Caveats 65 (77%) 13 (15%) 78 (92%) 65 (77%) 13 (15%) 78 (92%) Examples 65 (77%) 14 (16%) 79 (93%) 63 (74%) 16 (19%) 79 (94%) Total sample size was 87 – not all respondents answered all survey questions so individual rows have varying “n”.
Other response categories had mostly empty cells as is evident from the very high prevalence of agreement. Complete data are available upon request In addition to the closed-ended question results presented in Table 4 , survey respondents were given the opportunity to provide written comments on all aspects of the consensus project. A total of 420 comments from the respondents were collected (see Fig. 2 for distribution of written responses). With respect to the conceptual model circulated in the survey (see Additional file 1 ), 17 respondents expressed concerns about the amount of space allocated to each type of activity (e.g., sleep, physical activity, stationary time); and the use of colors. Six respondents commented that it was unclear what time, bouts, interruptions and/or breaks meant in the figure, and five suggested to move or link standing still to the light physical activity section. Finally, four respondents had concerns about the title of the figure because it contained “24-h movement behaviors” but was including a lot of “non-movement behaviors”. Fig. 2 Distribution of respondents’ comments over each survey section (survey 3 from Fig. 1 ; full survey provided in Additional file 1 ) Concerning the definition and caveats for stationary behavior bouts and breaks, seven respondents asked to specify a minimum and a maximum amount of time for a bout and/or break. Four respondents suggested organizing the examples by presenting the most common types of actions first and two asked to put s tanding still in the light physical activity category. For the definitions related to sedentary behaviorterm·def , four respondents asked again to specify duration of bout and/or break and three suggested that we should use the interval of 1 to 1.5 METsterm·var, instead of ≤1.5 METsterm·var. The most recurrent feedback for the standing still section concerned the proposed METterm·var value (≤2.0 METsterm·var): six respondents thought that it was too high, too low, or not adapted to everyone, and two suggested adding the definition of 1 METterm·var in this section. Two respondents were against the use of the term “standing still” given that one may be moving weight from one leg to the other when standing, and again, two suggested to put this definition in the light physical activity section. Similar to the previous sections, two respondents asked for a specific length of time for a bout and/or break. Lastly, two criticized the inclusion of “using a standing desk” as an example of standing still .
With regard to the definitions related to screen time , there were a few comments about the examples used: six respondents asked for and suggested more examples, and three suggested specifically adding “video games” in the examples. For non-screen-based sedentary time , seven respondents also gave example suggestions, and four asked for more consistency in the examples (concerning the wording, the hierarchical organization and the use of the “non-recreational/occupational” language present in other sections).
Several relevant comments were made in the sections concerning the proposed definitions for sitting , reclining and lying . For the sitting definition, 15 respondents asked for or suggested further clarifications and examples for active sitting and five for its distinction with passive sitting. Seven respondents also expressed concerns over the evidence supporting the proposed MET-value, and five asked to add specific examples for persons with disabilities, and for infants and toddlers. Concerning the reclining definition, four respondents asked for or suggested more examples, three said that reclining does not have to be “relaxed” or passive, and two wanted to state that body weight is supported by some particular parts of the body (e.g., lower back, buttocks). Finally, for lying , seven respondents suggested clarifying being asleep or being awake in the caveats, three asked for or suggested examples (especially for children) and two suggested to specify the distinction between active and passive lying , as it was done for sitting . Finally, concerning the sedentary behaviorterm·def pattern definition and caveats, 21 respondents asked for the definition of specific values, cut-points or details for the definitions of breaker, prolonger, extended sitting bout, the distinction between long- and short-bouts, and frequent breaks.
After analysis of the qualitative and quantitative survey data, feedback from the participating SBRN members was taken into account and several major edits were made to the Figure and the definitions by the Steering Committee. First, the conceptual model colors were reorganized and an explanation was added stating that the proportion of space is not representative of the recommended time that should be spent in each behavior category. The definitions were modified to ensure all examples were organized in a consistent fashion, with the most common examples occurring first; the standing still term was changed to standing with clarifications of passive standing and active standing (both stationary behaviors); and examples of active screen time were added to the screen time definition. Changes to definitions were recirculated to all Terminology Consensus Project participantspersName with the draft manuscript and additional reviews and comments were received. These reviews led to several additional minor changes to definitions, caveats and examples. The standing definition was significantly modified with a clarification and examples of passive vs active standing added. The operational definition of “METterm·var” was also added as a footnote to the Table 5 list of definitions. Finally, the conceptual model was further refined based on comments received, removing the term “stationary behavior” and rearranging the illustration to explicitly present the dual components of energy expenditureterm (inner ring) and posture (outer ring). Table 5 Final definitions, caveats and examples of key terms from the Sedentary Behaviorterm·def Research Network (SBRN) Terminology Consensus Project Term 1. Physical Inactivityterm General definition An insufficient physical activity level to meet present physical activity recommendations [ 45 , 80 , 81 ].
Caveats General definition applies to all age and ability groups.
Examples • Toddlers and preschoolers (1–4 years): Not achieving 180 min of physical activity of any intensity per day [ 45 ]. • Children and youth (5–17 years): Not achieving 60 min of moderate- to vigorous-intensity physical activity per day [ 81 ]. • Adults (≥ 18 years): Not achieving 150 min of moderate-to-vigorous-intensity physical activity per week or 75 min of vigorous-intensity physical activity per week or an equivalent combination of moderate- and vigorous-intensity activity [ 81 ].
Term 2. Stationary Behavior General definition Stationary behavior refers to any waking behavior done while lying, reclining, sitting, or standing, with no ambulation, irrespective of energy expenditureterm.
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). General definition applies to all age and ability groups except for infants (<1 year to pre-walking) and people with a mobility impairment who are unable to stand.
Examples • Use of electronic devices (e.g., television, computer, tablet, phone) while sitting, reclining or lying; reading/writing/drawing/painting/talking while sitting; sitting at school/work; sitting in a bus, car or train. • Standing in a line; standing at church; standing for a hallway discussion; writing a text-message while standing; using a standing desk. • Being carried/held/cuddled by someone.
Term 3. Sedentary Behaviorterm·def General definition Sedentary behaviorterm·def is any waking behavior characterized by an energy expenditureterm ≤1.5 metabolic equivalents (METsterm·var), while in a sitting, reclining or lying posture [ 25 ].
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 behaviorsterm·def. • Sedentary bout: A period of uninterrupted sedentary time [ 17 , 37 ]. • Sedentary interruptions/breaks: A non-sedentary bout in between two sedentary bouts. • Infants (<1 year or pre-walking): Any waking behavior characterized by low energy expenditureterm 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. • Toddlers [ 51 ] and preschoolers (1–4 years), children and youth (5–17 years) [ 48 – 52 ] adults (≥ 18 years) and all ability groups [ 82 ]: Same as the general definition.
Examples • Infants (<1 year or pre-walking): Lying awake in the bed with minimal movement; sitting in a baby chair/high chair/stroller/car seat with minimal movement; being carried/held/cuddled by someone • Toddlers and preschoolers (1–4 years): Use of electronic devices (e.g., television, computer, tablet, phone) while sitting, reclining or lying; reading/drawing/painting while sitting; sitting in stroller; sitting in baby chair or couch while eating a meal; sitting in a bus, car or train. • Children and youth (5–17 years): Use of electronic devices (e.g., television, computer, tablet, phone) while sitting, reclining or lying; reading/writing/drawing/painting while sitting; homework while sitting; sitting at school; sitting in a bus, car or train. • Adults (≥ 18 years): Use of electronic devices (e.g., television, computer, tablet, phone) while sitting, reclining or lying; reading/writing/talking while sitting; sitting in a bus, car or train. • People who use a manual wheelchair or a power chair: Use of electronic devices (e.g., television, computer, tablet, phone) while sitting, reclining or lying; reading/writing/drawing/painting/talking while sitting; sitting in a bus, car or train; moving from place to place in a power chair; being pushed while passively sitting in a manual wheelchair.
Term 4. Standing General definition A position in which one has or is maintaining an upright position while supported by one’s feet [ 83 ].
Caveats • Active standing: Active standing refers to any waking activity in a standing posture characterized by an energy expenditureterm >2.0 METsterm·var, while standing without ambulation, whether supported or unsupported. • Passive standing: Passive standing refers to any waking activity in a standing posture characterized by an energy expenditureterm ≤2.0 METsterm·var, while standing without ambulation, whether supported or unsupported [ 84 ]. • 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. • Infants (<1 year or pre-walking), toddlers and preschoolers (1–4 years), children and youth (5–17 years), adults (≥ 18 years) and people who use a manual wheelchair or a power chair: Same as the general definition. • People who are unable to stand: Not applicable.
Examples • Active standing: Standing on a ladder; standing while painting; standing while washing dishes; working an assembly line while standing; standing while juggling; standing while lifting weights. • Passive standing: Standing in a line; standing for a hallway discussion; use of electronic devices (e.g., television, computer, tablet, phone) while standing; standing at church. • Supported standing: Standing while holding a couch, chair, or a parent’s hand; standing with the aid of crutches, a cane, standing frame or body weight support.
Term 5. Screen Time General definition Screen time refers to the time spent on screen-based behaviors [ 15 , 85 ]. These behaviors can be performed while being sedentary or physically active.
Caveats • Recreational screen time: Time spent in screen behaviors that are not related to school or work [ 44 ]. • 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). • General definition applies to all age and ability groups.
Examples • All age and ability groups: Watching TV, using a smartphone/tablet, using a computer. • Active screen time: Playing active video games, running on a treadmill while watching television.
Term 6. Non-Screen-Based Sedentary Time General definition Non-screen-based sedentary time refers to the time spent in sedentary behaviorsterm·def that do not involve the use of screens.
Caveats • Recreational non-screen time: Time spent in non-screen based sedentary behaviorsterm·def that are not related to school or work. • General definition applies to all age and ability groups.
Examples • Infants (<1 year or pre-walking): Lying supine on a mat while sedate; sitting in a stroller or car seat with little movement. • Toddlers and preschoolers (1–4 years): Sitting in a child seat, chair or car seat; sitting idle in the sandbox or on the floor; reading a non-electronic book or playing a board game while seated. • Children and youth (5–17 years): Sitting at school; sitting doing homework or art work; reading a non-electronic book; playing a board game; sitting in a car. • Adults (≥ 18 years): Reading a non-electronic book; playing a board game; sitting in a car. • People who use a manual wheelchair or a power chair: Reading a non-electronic book; playing a board game; sitting in a car; being pushed while passively sitting in a manual wheelchair.
Term 7. Sitting General definition 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 [ 83 ].
Caveats • Active sitting: Active sitting refers to any waking activity in a sitting posture characterized by an energy expenditureterm >1.5 METsterm·var. • Passive sitting: Passive sitting refers to any waking activity in a sitting posture characterized by an energy expenditureterm ≤1.5 METsterm·var. • General definition applies to all age and ability groups.
Examples • Active sitting: Working on a seated assembly line; playing guitar while seated; using devices that engage ones feet/legs while seated; doing arm ergometry while in a wheelchair. • Passive sitting: Refer to sedentary behaviorterm·def examples while sitting.
Term 8. Reclining General definition Reclining is a body position between sitting and lying.
Caveats General definition applies to all age and ability groups. Reclining behavior can be either passive (≤ 1.5 METsterm·var) or active (>1.5 METsterm·var).
Examples Passive reclining (all age and ability groups): Lounging/slouching on a chair or couch while sedentary. Active reclining (all age and ability groups): Recumbent cycling.
Term 8. Lying General definition Lying refers to being in a horizontal position on a supporting surface [ 83 ].
Caveats General definition applies to all age and ability groups. Lying behavior can be either passive (≤ 1.5 METsterm·var) or active (>1.5 METsterm·var).
Examples Passive lying (all age and ability groups): Lying on a couch, bed or floor while sedentary. Active lying (all age and ability groups): Isometric plank hold.
Term 9. Sedentary Behaviorterm·def Pattern General definition The manner in which sedentary behaviorterm·def is accumulated throughout the day or week while awake (e.g., the timing, duration and frequency of sedentary bouts and breaks) [ 19 , 69 ].
Caveats General definition applies to all age and ability groups.
Examples Prolonger: Someone who accumulates sedentary time in extended continuous bouts [ 1 ]. Breaker: Someone who accumulates sedentary time with frequent interruptions and in short bouts [ 1 ].
METterm·var = metabolic equivalent corresponding to resting metabolic rate of the population under study. A metabolic equivalent is deemed to be 3.5 ml O 2 /kg/min in adults without mobility impairment or chronic disease. A metabolic equivalent is generally higher in children and in those with conditions that elevate muscle activity or metabolism and is generally lower in those with paralysis, small muscle mass or wasting conditions. The interpretation of METterm·var values should be made with attention to the population under study, and the definitions and caveats above applied accordingly The further revised manuscript, table of definitions, and conceptual model was recirculated to all participantspersName for a final review and sign-off. In conjunction with this final review, participantspersName were also asked three questions: 1. Do you agree that your view has been listened to and taken account during this process? (yes/no) 2. Has your level of agreement/support for the consensus definitions changed since you completed the survey? (increased/decreased/no change) 3. Are you likely to use the consensus definitions? (yes/no). Of the 84 final coauthors 100% answered “yes” to questions one and three providing strong support for the participatory consensus process. For question two, 73% responded “increased” and 27% responded “no change”, no one responded decreased. With the already strong support reported in response to the initial survey it is reasonable to believe that the revisions made in response to feedback received resulted in final definitions and a conceptual model that has very strong support from participantspersName. Subjective comments received with participantpersName responses to the various reviews support this observation.
Final conceptual model and consensus definitions The final conceptual model, presented in Fig. 3 , illustrates how the various terms fit together structurally and provides support for the definitions included in this project. Final consensus definitions for key terms (physical inactivityterm, stationary behavior, sedentary behaviorterm·def, standing, screen time, non-screen-based sedentary time, sitting, reclining, lying, sedentary behaviorterm·def pattern), caveats related to age and/or ability differences, examples and related references are provided in Table 5 . For the purpose of these consensus definitions, the following age groups were used: Infants – ages 3 months to <1 year; Toddlers and preschoolers – ages 1 to 4 years; Children and youth – ages 5 to 17 years; Adults and Older Adults – age ≥ 18 years. The age ranges for 1- to 4-year-olds and for children and youth are consistent with those used in the Canadian Physical Activity Guidelines for the Early Years and the Canadian 24-Hour Movement Guidelines for Children and Youth respectively [ 44 , 45 ]. Adults and Older Adults were grouped given that definitions did not differ across the adult lifespan. The definitions were developed with attention to being inclusive in language and examples. Specifically, examples of interpretations of definitions for people with mobility impairment(s) are provided where appropriate. Fig. 3 Illustration of the final conceptual model of movement-based terminology arranged around a 24-h period. The figure organizes the movements that take place throughout the day into two components: The inner ring represents the main behavior categories using energy expenditureterm. The outer ring provides general categories using posture. Detailed definitions, caveats and examples related to sedentary behaviorterm·def are provided in Table 5 . The proportion of space occupied by each behavior in this figure is not prescriptive of the time that should be spent in these behaviors each day Discussion In this paper we describe the processes and outcomes of a comprehensive initiative to establish consensus definitions for terms relevant to sedentary behaviorterm·def research and to develop a conceptual model to illustrate the hierarchical structural connections among the various terms. This Terminology Consensus Project had several novel and progressive elements: it was informed by the best available evidence; it built on the previous SBRN definition project [ 25 ] and other related initiatives (Table 2 ); it leveraged the diverse membership base of SBRN using an open participatory process; it significantly expanded the scope of terminology covered compared to earlier efforts; it developed a conceptual model to illustrate the structural connections among the various terms; it was observant of nuances for all age groups; it added examples to help interpret the terms; and it was attentive to the interpretation and application of the terminology for people with varying physical abilities. SBRN now has 1273 members from 35 countries (as of March 20, 2017) representing all inhabited continents, of which 84 members from 20 countries and multiple employment sectors participated in all aspects of this project (see Terminology Consensus ParticipantspersName section below for details).
This project resulted in several notable advances in terminology standardization in the field of sedentary behaviorterm·def. For example, the addition of the term “lying” to the widely used definition of sedentary behaviorterm·def [ 25 ] fills an obvious gap in the earlier definition. The introduction of the term “stationary behavior” provides a behavioral classification home for “standing”. The consensus definition suggests “passive standing” is a stationary, non-sedentary behavior ≤2.0 METsterm·var and that “active standing” is a stationary physical activity >2.0 METsterm·var (see Table 5 definitions for more details). Also, for clarity, researchers can now use the term “stationary time” when reporting data collected from an accelerometerterm that does not measure posture. The consensus definitions add clarity on the distinction between sedentary “behaviors” (with context) and “time” at an established level of intensity (absent of context, which includes most accelerometerterm and inclinometer data) as well as a standardized approach for defining bouts and interruptions/breaks. Although there is currently no consensus on a minimum duration of a sedentary bout, the work of Kim et al. [ 37 ] provide support for 10 min as a conservative sedentary bout threshold. The applicability of these movement behaviors for individuals with mobility impairment was also a distinct improvement.
The conceptual model, with clear definitions of terminology related to sedentary behaviorterm·def, provides clarity for researchers interested in exploring the relationships between, and among, the various movement behaviors across the whole day (i.e., sleep, sedentary behaviorsterm·def and various intensities of physical activity) [ 44 , 46 ] and may facilitate future research exploring behavior substitutions aimed to improve health [ 47 ]. Consensus definitions, as presented here, were derived to assist with the standardization, or at least harmonization, of measurement procedures, data processing, and data analytics. Ultimately, common definitions form the foundation upon which related measurement decisions are based. It is hoped that these consensus definitions will help facilitate standardization efforts, reduce confusion, and advance initiatives and research related to sedentary behaviorterm·def.
There has been much debate around the appropriate METterm·var threshold to use when describing or characterizing sedentary behaviorterm·def and standing. While there will always be exceptions, the consensus definitions proposed in this paper (sedentary behaviorterm·def ≤1.5 METsterm·var, passive standing ≤2.0 METsterm·var; Table 5 ) have a broad base of support. Several recent studies have shown that a variety of sedentary behaviorsterm·def were ≤1.5 METsterm·var for children and youth [ 21 , 48 – 52 ], while others suggested that the threshold may be too low for many childhood behaviors that would be considered sedentary by observation [ 53 , 54 ]. There is general agreement that determining METsterm·var in children should use a VO 2 standard that is higher than 3.5 ml/kg/min [ 55 ], and when this is employed, there is broad support for the ≤1.5 METterm·var threshold for preschool-aged [ 21 , 51 ] and school-aged children and youth [ 48 – 50 , 52 ]. For adults, the sedentary behaviorterm·def threshold of ≤1.5 METsterm·var has been widely recommended and accepted [ 4 , 7 , 25 , 56 ].
The METterm·var threshold for passive standing (e.g., not working on an assembly line or painting) is also supported by the literature. For example, the compendium of energy expendituresterm for youth reports the following METterm·var values: sending text messages while standing, 1.8 METsterm·var; talking while standing, 1.8 METsterm·var; standing quietly, 1.5 METsterm·var; arts and crafts while standing, 1.9 METsterm·var; reading while standing, 1.8 METsterm·var; drinking while standing, 2.0 METsterm·var; and eating while standing, 2.0 METsterm·var [ 55 ]. The standing threshold of ≤2.0 METsterm·var for adults also has support in the literature [ 29 , 31 ]. Values from the highly cited physical activity compendium also support this threshold, for example: standing doing miscellaneous, 2.0 METsterm·var; standing doing arts and crafts (light effort), 1.8 METsterm·var; cooking or food preparation while standing, 2.0 METsterm·var; standing quietly in a line, 1.2 METsterm·var; standing while talking or talking on the phone, 1.8 METsterm·var; and standing while reading, 1.8 METsterm·var [ 57 ].
Strengths and limitations A strength of this project was the systematic approach taken to determine the list of key terms and arrive at consensus definitions for these terms. The use of a large, broad, diverse and global cohort of participantspersName to provide input to the consensus definitions is a clear strength and should help with the uptake and acceptance of these definitions. Yet, the participantspersName were limited to SBRN members and the overall participation rate by SBRN members was only 8%. However, for SBRN members that opened the email invitation to participate, the rate was 22%, slightly lower than the participation rate of 34% (52/155) for the first SBRN consensus definitions project [ 25 ]. It is possible that the participantspersName do not represent the larger population of sedentary behaviorterm·def researchers and practitioners. A limitation to work of this nature is that there will always be situations and/or circumstances where the proposed definitions are sub-optimal or not wholly satisfactory. Furthermore, there will likely be different conceptual models and other definitions that exist for good reasons or that will emerge as research evolves. The goal of this project was not to marginalize such opinions, but rather respond to calls for better standardization and harmonization of work in the field at this point in time.
Future directions and research needs There are many future research needs directly related to the definitions proposed in this manuscript. For example, the validity of the proposed terms needs to be tested and further work is necessary to study their content and face validity. In addition, refinements of MET-value thresholds for different ages (e.g., young adults vs older adults), different situations (e.g., while sitting and typing; in different environmental conditions; or in short vs extended durations) or as measured using alternate measurement methods (e.g., measuring muscle activity), and the consequent MET-value-related health implications, requires further exploration [ 29 , 32 ]. The importance of sedentary behaviorterm·def context (e.g., leisure time vs school vs work) and modality (e.g., television viewing vs reading vs talking on the phone) in relation to health indicators and outcomes is poorly understood and additional clarity may lead to refinement of the conceptual model and/or the consensus definitions. Additional research is required in populations with mobility impairments or disease conditions where different cut-points/thresholds may exist and there may be different relationships with health indicators than in the general population. Research into the health impact of standing is just beginning to emerge [ 58 – 63 ]. How standing interacts with sedentary behaviorsterm·def and/or sedentary time, sleep and physical activities of various intensities, and how these interactions relate to health outcomes and indicators, needs further research. Through the survey responses SBRN members asked for more research to arrive at specific MET-values and related accelerometerterm cut-points for categorizing sedentary time. Further research to understand and compare accelerometerterm data collected from different placement locations (e.g., hip vs wrist) when assessing sedentary time is also required. There were also requests from respondents for standard criteria for defining sedentary bouts and breaks to classify people as “Breakers” or “Prolongers” [ 1 ]. Similarly, further research exploring health indicators and outcomes associated with sitting bouts of different durations, distinguishing between long- and short-bouts, and operationalizing “frequent breaks” were all recommended. How the intensity of movement of a “break” affects resultant health-related indictors also requires further exploration. Although questionnaires are frequently used to assess sedentary behaviorterm·def, few have undergone psychometric testing [ 10 ]. Further research is needed to identify the most valid and reliable means of assessing total sedentary behaviourterm, specific forms of sedentary behaviourterm, and sedentary behaviourterm patterns via self- and proxy-report questionnaires. Finally, the physiological impact of ‘transitions’ (e.g., sleep-awake, sit-stand, stand-step) needs to be elucidated [ 64 ].
Conclusion The definitions arrived at through the SBRN Terminology Consensus Project are presented as standardized definitions that we encourage researchers to embrace, use and promote. With the assistance of international SBRN volunteers, efforts are underway to ensure these definitions are translated into several other languages, including French, Spanish, Portuguese, Dutch, Korean, German and others. Copies of all language versions of the consensus definitions are available on the SBRN website [ 24 ]. Periodic reviews of these consensus definitions should be done, and updates made when appropriate. It is hoped that the definitions resulting from this comprehensive, transparent and broad-based participatory process will result in widely supported and adopted standardization of terminology, and advance future research, interventions, policies and practices related to sedentary behaviorsterm·def.
Additional file Additional file 1: SBRN Terminology Consensus Project survey. (DOCX 435 kb) Electronic supplementary material The online version of this article (doi:10.1186/s12966-017-0525-8) contains supplementary material, which is available to authorized users.
Acknowledgements None.
Terminology Consensus Project ParticipantspersName (in alphabetical order) Teatske M. AltenburgpersName (t.altenburgpersName@vumc.nl), Department of Public and Occupational Health, Amsterdam Public Health research institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands; Saeideh Aminian (saeideh_612@yahoo.com), Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Unit 1607, 9939, 109 Street, Edmonton, AB Canada T5 K 1H6, Canada; Lauren Arundell (lauren.arundell@deakin.edu.au), Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, 221 Burwood Highway, Burwood, Victoria 3125, Australia; Andrew J. Atkin (A.Atkin@uea.ac.uk), School of Health Sciences, Faculty of Medicine and Heath Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ; Salomé AubertpersName (saubert@cheo.on.ca), HALO Research Group, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8 L1, Ontario, Canada; Joel BarnespersName (jbarnes@cheo.on.ca), HALO Research Group, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8 L1, Ontario, Canada; Bethany Barone Gibbs (bbarone@pitt.edu), University of Pittsburgh, Departments of Physical Activity and Health, and Clinical and Translational Science, Physical Activity and Weight Management Research Center, University of Pittsburgh, 32 Oak Hill Court Pittsburgh, PA 15216, USA; Rebecca Bassett-Gunter (rgunter@yorku.ca), School of Kinesiology and Health Science York University, 310 Stong College School of Kinesiology and Health Science York University, 4700 Keele Street Toronto, Ontario M3J1P3, Canada; Kevin Belanger (kbelanger@cheo.on.ca), HALO Research Group, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8 L1, Ontario, Canada; Stuart Biddle (stuart.biddle@usq.edu.au), Institute for Resilient Regions, University of Southern Queensland, Springfield Central, Queensland 4300, Australia and Victoria University, Melbourne, VIC 8001 Australia; Aviroop Biswas (avi.biswas@mail.utoronto.ca), Institute for Work and Health, 8th Floor, 481 University Avenue, Toronto, M5G2E9 Ontario, Canada; Valerie CarsonpersName (vlcarson@ualberta.ca), University of Alberta, 8840–114 Street, Van Vliet Complex, University of Alberta, Edmonton, AB T6G 2H9, Canada; Jean-Philippe Chaput (jpchaput@cheo.on.ca), HALO Research Group, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8 L1, Ontario, Canada; Sebastien ChastinpersName (Sebastien.ChastinpersName@gcu.ac.uk), Institute of Applied Health Research, Glasgow Caledonian University, Glasgow, Scotland and Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium; Josephine Chau (josephine.chau@sydney.edu.au), Prevention Research Collaboration, School of Public Health, University of Sydney, 6 N51 Level 6 The Hub D17 The Charles Perkins Centre University of Sydney NSW 2006 Australia; Mai ChinAPawpersName (m.chinapawpersName@vumc.nl), Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands; Rachel Colley (rachel.colley@canada.ca), Statistics Canada, 150 Tunney’s Pasture Driveway Ottawa, Ontario K1A 0 T6, Canada; Tara Coppinger (tara.coppinger@cit.ie), Department of Sport, Leisure & Childhood Studies, Cork Institute of Technology, Rossa Avenue Cork, Ireland; Catharine Craven (cathy.craven@uhn.ca), University of Toronto, Department of Medicine, Division of Physical Medicine and Rehabilitation Toronto Rehabilitation Institute - University Health Network, Toronto Rehab, Lyndhurst Centre 520 Sutherland Drive Rm 206-J Toronto, ON M4G 3 V9, Canada; Carlos Cristi-Montero (carlos.cristi.montero@gmail.com), IRyS Group, Physical Education School, Pontificia Universidad Católica de Valparaíso, Av. el bosque 1290, Viña del Mar, Chile; Douglas de Assis Teles Santos (datsantos@uneb.br), College of Physical Education, Department of Education, University of the State of Bahia, Avenue: Presidente Getúlio Vargas, n°7100, house 43, Teixeira de Freitas City, Bahia, Brazil; Borja del Pozo Cruz (b.delpozocruz@auckland.ac.nz), Department of Exercise Science, Faculty of Sciences, The University of Auckland, 261 Morrin Rd., St Johns, 1072 Auckland, New Zealand; Jesus del Pozo-Cruz (jpozo2@us.es), Department of Physical Education and Sports, University of Seville, Spain. Pirotecnia street s/n, 41,013, Seville, Spain; Paddy Dempsey (paddy.dempsey@baker.edu.au), Physical Activity, Metabolic & Vascular Physiology and Behavioural Epidemiology Laboratories, Baker Heart and Diabetes Institute Level 4, 99 Commercial Rd., Melbourne VIC 3004, Australia; Ricardo Filipe do Carmo Santos Gonçalves (ricardo.goncalves@ismat.pt), Instituto Superior Manuel Teixeira Gomes, Morada: Dr. Estêvão de Vasconcelos n° 33 A, 8500–656 Portimão, Portugal; Ulf Ekelund (ulf.ekelund@nih.no), Department of Sport Medicine, Norwegian School of Sport Sciences, PO Box 4014, Ulleval Stadion, 0806 Oslo, Norway; Laura Ellingson (ellingl@iastate.edu), Iowa State University, Department of Kinesiology, ISU 534 Wallace Rd. Ames, IA 50011, USA; Victor Ezeugwu (ezeugwu@ualberta.ca), University of Alberta, Faculty of Rehabilitation Medicine, 3–48 Corbett Hall, Edmonton Alberta T6G 2G4, Canada; Claire Fitzsimons (claire.fitzsimons@ed.ac.uk), University of Edinburgh, Physical Activity for Health Research Centre Institute Sport, Physical Education and Health Sciences, The University of Edinburgh, St Leonard’s Land, Edinburgh, United Kingdom EH8 8AQ; Alberto Florez-Pregonero (floreza@javeriana.edu.co), Pontificia Universidad Javeriana, Carrera 7 No. 40–62, Bogotá, Colombia; Ciarán P. Friel (cpf2111@tc.columbia.edu), Teachers College, Columbia University, 525 W 120th St, New York, NY 10027, USA; Andreas Fröberg (andreas.froberg@gu.se), Department of Food and Nutrition, and Sport Science, University of Gothenburg, Pedagogen, Hus C, Läroverksgatan 5, PO Box 300, SE-405 30, Gothenburg, Sweden; Lora Giangregorio (lora.giangregorio@uwaterloo.ca), Department of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo ON N2L3G1, Canada; Linda Godin (linda.godin@hamilton.ca), Healthy Living Division, City of Hamilton Public Health Services, 110 King Street West, 4th floor, Hamilton, Ontario L8P 4S6, Canada; Katie Gunnell (kgunnell@cheo.on.ca), HALO Research Group, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8 L1, Ontario, Canada; Shannon Halloway (shannon_halloway@rush.edu), Rush University College of Nursing, 600 S. Paulina , Suite 1080 Chicago, IL 60612, USA; Trina Hinkley (trina.hinkley@deakin.edu.au), Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, 221 Burwood Highway, Burwood, Victoria 3125, Australia; Jill Hnatiuk (jill.hnatiuk@deakin.edu.au), Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, 221 Burwood Highway, Burwood, Victoria 3125, Australia; Pauliina Husu (pauliina.husu@uta.fi), UKK Institute for Health Promotion Research, PO Box 30, FI-33501, Tampere, Finland; Mohammad Kadir (m.kadir@griffith.edu.au), Research Fellow, Social Marketing @ Griffith and Menzies Health Institute Queensland, Griffith University, 170 Kessels Road, Nathan, Brisbane, Queensland 4111 Australia; Leonidas G. Karagounis (leonidas.karagounis@rdls.nestle.com), Nestlé Research Center, Institute of Nutritional Science, Lausanne, Switzerland and The University of St. Mark & St. John, Experimental Myology and Integrative Biology Research Cluster, Faculty of Sport and Health Sciences, Plymouth, UK; Annemarie Koster (a.koster@maastrichtuniversity.nl), Maastricht University, CAPHRI School for Public Health and Primary Care, Department of Social medicine, P.O. Boxes 616, 6200 MD Maastricht, The Netherlands; Jeroen Lakerveld (j.lakerveld@vumc.nl), Department of Epidemiology and Biostatics, VU University Medical Center Amsterdam, De Boelelaan 1089a, 1081 HV, Amsterdam, The Netherlands; Martin Lamb (m.lamb@shu.ac.uk), Sheffield Hallam University, Health & Wellbeing Research Institute, Chestnut Court Collegiate Crescent, Sheffield, UK S10 2BP; Richard Larouche (rlarouche@cheo.on.ca), HALO Research Group, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8 L1, Ontario, Canada; Amy Latimer-CheungpersName (amy.latimer@queensu.ca), School of Kinesiology and Health Studies, Queen’s University,28 Division Street Kingston Ontario K7 L 3 N6 Canada; Allana G. LeBlanc (allanagwleblanc@gmail.com), University of Ottawa Heart Institute, Division of Prevention and Rehabilitation, 20 Ruskin St., Ottawa K1Y 4 W7, Ontario, Canada; Eun-Young Lee (elee2@ualberta.ca), Faculty of Physical Education & Recreation, University of Alberta, Edmonton, AB. Canada, 1–149 Van Vliet Complex, Edmonton, AB. Canada T6G2H9; Paul Lee (paul.h.lee@polyu.edu.hk), School of Nursing, Hong Kong Polytechnic University, GH527, School of Nursing, Hunghom, Hong Kong; Luis Lopes (luis.iec.um@hotmail.com), Research Centre for Physical Activity, Health and Leisure (CIAFEL), Faculty of Sports, University of Porto, Porto, Portugal, Rua Dr. Plácido Costa n°91, 4200–450 Porto, Portugal; Trish Manns (trish.manns@ualberta.ca), Department of Physical Therapy, University of Alberta, Edmonton, AB T6G2G4, Canada; Taru Manyanga (tmanyanga@cheo.on.ca), HALO Research Group, CHEO Research Institute,401 Smyth Road, Ottawa K1H 8 L1, Ontario, Canada; Kathleen Martin Ginis (kathleen_martin.ginis@ubc.ca), University of British Columbia, School of Health and Exercise Sciences, 1147 Research Road Kelowna BC V1 V 1 V7, Canada; Joanne McVeigh (joanne.mcVeigh@curtin.edu.au), School of Occupational Therapy and Social Work, Curtin University, Perth, Australia and Exercise Laboratory, School of Physiology, University of Witwatersrand, South Africa; Joilson Meneguci (joilsonmeneguci@yahoo.com.br), Federal University of Triangulo Mineiro, Av Tutunas, 490, Tutunas, Uberaba, MG, Brazil, CEP: 38,066–030; Carla Moreira (carla_m_moreira@sapo.pt), Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Portugal, Rua de Cela, n° 475, S. Miguel Couto 4780–254 Santo Tirso, Portugal; Elaine Murtagh (elaine.murtagh@mic.ul.ie), Mary Immaculate College, University of Limerick, South Circular Road, Limerick, Ireland; Freda Patterson (fredap@udel.edu), Center for Biomedical Research Excellence in Cardiovascular Health, College of Health Sciences, University of Delaware, 019 Carpenter Sports Building Newark, DE 19716; Danilo Rodrigues Pereira da Silva (danilorpsilva@gmail.com), State University of Londrina, Physical Education and Sport Centre, Celso Garcia Cid, Pr. 445, Km 380, 86,057,970, Londrina, PR, Brazil; Arto J. Pesola (arto.pesola@gmail.com), Neuromuscular Research Center, Unit of Biology of Physical Activity, University of Jyväskylä and South-Eastern Finland University of Applied Sciences, Patteristonkatu 3 D, 50,101 Mikkeli, Finland; Neil Peterson (neil-peterson@byu.edu), Brigham Young University College of Nursing, 500 Spencer W. Kimball Tower Provo, UT 84602, USA; Cherie Pettitt (cherie.pettitt@mnsu.edu), Minnesota State University Mankato, HC 1400 Mankato, MN 56001 USA; Lara Pilutti (lpilutti@uottawa.ca), University of Ottawa, E250G 200 Lees Avenue, Ottawa, ON, K1 N 6 N5, Canada; Snehal Pinto Pereira (snehal.pereira@ucl.ac.uk), UCL Great Ormond Street Institute of Child Health, 30 Guilford Street London WC1N 1EH, UK; Veronica Poitras (veronicap@cadth.ca), Canadian Agency for Drugs and Technologies in Health, 865 Carling Avenue, Suite 600, Ottawa K1S 5S8, Ontario, Canada; Stephanie Prince (sprinceware@ottawaheart.ca), University of Ottawa, Heart Institute, Division of Prevention and Rehabilitation, 40 Ruskin Street, H2353 Ottawa, Ontario K1Y 4 W7, Canada; Apoorva Rathod (apoorva.rathod@gu.se), Unit for Human Geography, University of Gothenburg, Viktoriagatan 13 40,530 Göteborg Sweden; Fabien Rivière (fbn.riviere@gmail.com), EA 4360 APEMAC, University of Lorraine, Paris-Descartes University, Nancy 54,505, France; Sara Rosenkranz (sararose@ksu.edu), Department of Food, Nutrition, Dietetics and Health, and Physical Activity and Nutrition Clinical Research Consortium, Rm 212 Justin Hall, 1324 Lovers Lane, Kansas State University, Manhattan, KS 66506, USA; François Routhier (francois.routhier@rea.ulaval.ca), Center for interdisciplinary research in rehabilitation and social integration and Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec G1 M 2S8, Canada; Rute Santos (rutes@uow.edu.au; rsantos.ciafel@fade.up.pt), Early Start Research Institute, Faculty of Social Sciences, University of Wollongong, Building 21, room 214 Northfields Avenue 2522 NSW, Australia and Research Centre in Physical Activity and Health, Faculty of Sport, University of Porto, Portugal; Travis SaunderspersName (trsaunders@upei.ca), Department of Applied Human Sciences, University of Prince Edward Island, 550 University Avenue Charlottetown, PE C1A 4P3, Canada; Brett Smith (smithbs@bham.ac.uk), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT UK; Olga Theou (olga.theou@dal.ca), Department of Medicine, Dalhousie University, 5955 Veterans’ Memorial Lane, Rm 1313 Halifax, NS, B3H2E1, Canada; Jennifer Tomasone (tomasone@queensu.ca), School of Kinesiology and Health Studies, Queen’s University, 28 Division Street, KHS 301F Kingston, ON K7L3N6, Canada; Mark TremblaypersName (mtremblay@cheo.on.ca), HALO Research Group, CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8 L1, Ontario, Canada and and Department of Pediatrics, University of Ottawa, Ottawa, Canada; Patricia Tucker (ttucker2@uwo.ca), University of Western Ontario, 1201 Western Road London, Ontario, Canada N6G 1H1; Renée Umstattd Meyer (renee_umstattd@baylor.edu), Baylor University, Public Health, Department of Health, Human Performance and Recreation Robbins College of Health and Human Sciences, One Bear Place, #97313 Waco, TX 76798; Hidde van der Ploeg (hp.vanderploeg@vumc.nl), Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center, Van der Boechorststraat, 7 1081BT Amsterdam, The Netherlands and Sydney School of Public Health, University of Sydney, Australia; Tania Villalobos (tania.villalobos@gmail.com), Departamento de Nutrición y Bromatología I, Facultad de Farmacia, Universidad Complutense de Madrid, General Guisan Strasse 14, Arlesheim BL 4144, Switzerland; Toni Viren (toni.viren@outlook.com), Metropolia University of Applied Sciences, Unit of Physiotherapy, Vanha Viertotie 23, 00350 Helsinki, Finland; Birgit Wallmann-Sperlich (birgit.sperlich@uni-wuerzburg.de; b.sperlich@dshs-koeln.de), Institute for Sports Science, Julius-Maximilians University Würzburg, Judenbühlweg 11, 97,082 Würzburg, Germany and Institute of Health Promotion and Clinical Movement Science, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50,933 Köln, Germany; Katrien Wijndaele (katrien.wijndaele@mrc-epid.cam.ac.uk), MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, United Kingdom; Roderick Wondergem (r.wondergem@fontys.nl), Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht and, Department of Rehabilitation, Physical Therapy Research and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht and Department of Health Innovations and Technology, Fontys University of Applied Sciences, Ds. Th. Fliednerstraat 2, P.O box 347, Eindhoven, The Netherlands.
Funding There was no funding for this project.
Availability of data and materials All data generated or analysed during this study are included in this published article and its supplementary information files.
Authors’ contributions The literature review was run by SA. The identified key terms were reviewed and modified by the Steering Committee formed by MST, SA, JDB, TJS, VC, AELC, SFMC, TMA and MJMC. Next, all Terminology Consensus Project ParticipantspersName reviewed and provided feedback on the proposed list of terms. JDB created the online Survey 1 for the final key term list modification/approval/shortening that was completed by the Steering Committee members (MST, SA, JDB, TJS, VC, AELC, SFMC, TMA and MJMC) and prepared a compilation of the collected data. MST, SA and JDB did the analysis of Survey 1 and finalized the key term list. Then JDB created the Survey 2 (asking for first proposition of definitions of each key term and caveats) that was completed by the Steering Committee members and JDB compiled the collected data. MST, SA and JDB analysed the collected data and created the first draft of definition of each key term and caveats, and created the conceptual model. JDB created the draft of the online Survey 3 (asking level of agreement and feedback on proposed model, key term definitions and caveats) that was reviewed by the Steering Committee members and then completed by all Terminology Consensus Project ParticipantspersName. JDB did the analysis of quantitative data and SA of qualitative data collected by Survey 3. Based on those analyses, modifications to model and key term definitions were made by MST, SA and JDB. MST wrote the manuscript with the help of SA and JDB, and then the manuscript (including the definitions and the conceptual model) was reviewed 2 times by the Steering Committee members and 3 times by all Terminology Consensus Project ParticipantspersName who all give their final sign-off for submission. All authors read and approved the final manuscript.
Competing interests BBG has received research support from Humanscale. SB has received funding since 2013 for consultancy work from Fitness First, Nuffield Health, and Unilever (none of these are currently active); funding was received in 2016 for consultancy work for Halpern PR Limited; in-kind support through the provision of a sit-to-stand desk was provided by Ergotron from 2012 to 2014; advice has been requested by and offered to Active Working, Get Britain Standing, and Bluearth, none with funding. LG has consulted on physical function in individuals with osteoporosis for ICON on behalf of Eli Lilly. TJS is supported by the Jeanne and J.-Louis Lévesque Research Professor in Nutrisciences and Health, and has received research and/or in-kind support from Stepscount, Ergotron, and Fitabase. No other authors declare any conflict of interest.
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