Sleep and Breathing

, Volume 17, Issue 4, pp 1257–1266 | Cite as

Physical activity and sedentary time in persons with obstructive sleep apnea and overweight enrolled in a randomized controlled trial for enhanced physical activity and healthy eating

  • Helena Igelström
  • Margareta Emtner
  • Eva Lindberg
  • Pernilla Åsenlöf
Original Article

Abstract

Background

The aim of the study was to describe the amount of physical activity and sedentary time in patients with obstructive sleep apnea syndrome (OSAS) and overweight and to explore potential disease-related and psychological correlates.

Methods

A descriptive and correlational study was performed. Prospective data of physical activity and sedentary time were collected through accelerometry, and body mass index (BMI), daytime sleepiness, exercise self-efficacy, fear of movement, and depressive symptoms were measured at one point. Seventy-three participants with overweight (mean BMI, 35 kg/m2 (5 SD)) and moderate/severe OSAS (apnea–hypopnea index ≥15) were consecutively recruited. Multivariate associations were determined through multiple linear regression analysis.

Results

The participants took a daily average of 7,734 (3,528 SD) steps, spent an average of 77 min (54 SD) in moderate-to-vigorous physical activity (MVPA), and spent 11 h and 45 min (2 h and 8 min SD) sedentary. BMI, daytime sleepiness, exercise self-efficacy, fear of movement, and depressive symptoms did not explain variance in MVPA or steps but explained 22.9 % of variance in sedentary time. In backward selection analysis, BMI contributed to the explanatory degree of MVPA with 9 % whereas, fear of movement explained 6.3 % of the variance in steps and 14.3 % of the variance in sedentary time.

Conclusions

An important implication for future physical activity interventions is that both physical activity and sedentary behaviors should be targeted, and fear of movement may be an important determinant for change in patients with OSAS and overweight.

Keywords

Sleep apnea Overweight Physical activity Sedentary time Accelerometer 

References

  1. 1.
    Pescatello LS, Franklin BA, Fagard R, Farquhar WB, Kelley GA, Ray CA (2004) American College of Sports Medicine position stand. Exercise and hypertension. Med Sci Sports Exerc 36(3):533–553PubMedCrossRefGoogle Scholar
  2. 2.
    Jorge ML, de Oliveira VN, Resende NM, Paraiso LF, Calixto A, Diniz AL, Resende ES, Ropelle ER, Carvalheira JB, Espindola FS, Jorge PT, Geloneze B (2011) The effects of aerobic, resistance, and combined exercise on metabolic control, inflammatory markers, adipocytokines, and muscle insulin signaling in patients with type 2 diabetes mellitus. Metabolism 60(9):1244–1252PubMedCrossRefGoogle Scholar
  3. 3.
    Healy GN, Dunstan DW, Salmon J, Cerin E, Shaw JE, Zimmet PZ, Owen N (2008) Breaks in sedentary time. Beneficial associations with metabolic risk. Diabetes Care 31:661–666PubMedCrossRefGoogle Scholar
  4. 4.
    Millman RP, Redline S, Carlisle CC, Assaf AR, Levinson PD (1991) Daytime hypertension in obstructive sleep apnea. Prevalence and contributing risk factors. Chest 99:861–866PubMedCrossRefGoogle Scholar
  5. 5.
    Ekkekakis P, Lind E (2006) Exercise does not feel the same when you are overweight: the impact of self-selected and imposed intensity on affect and exertion. Int J Obes 30(4):652–660CrossRefGoogle Scholar
  6. 6.
    Vincent HK, Lamb KM, Day TI, Tillman SM, Vincent KR, George SZ (2010) Morbid obesity is associated with fear of movement and lower quality of life in patients with knee pain-related diagnoses. PM&R 2(8):713–722CrossRefGoogle Scholar
  7. 7.
    Dominici M, Gomes Mda M (2009) Obstructive sleep apnea (OSA) and depressive symptoms. Arq Neuropsiquiatr 67(1):35–39PubMedCrossRefGoogle Scholar
  8. 8.
    de Wit L, van Straten A, Lamers F, Cuijpers P, Penninx B (2011) Are sedentary television watching and computer use behaviors associated with anxiety and depressive disorders? Psychiatry Res 186:239–243PubMedCrossRefGoogle Scholar
  9. 9.
    Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, Macera CA, Heath GW, Thompson PD, Bauman A (2007) Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation 116(9):1081–1093PubMedCrossRefGoogle Scholar
  10. 10.
    Tudor-Locke C, Craig CL, Brown WJ, Clemes SA, de Cocker K, Giles-Corti B, Hatano Y, Inoue S, Matsudo SM, Mutrie N, Oppert J-M, Rowe DA, Schmidt MD, Schofield GM, Spence JC, Teixeira PJ, Tully MA, Blair SN (2011) How many steps/day are enough? For adults. Int J Behav Nutr Phys Act 8 (79). doi:10.1186/1479-5868-8-79
  11. 11.
    O’Donovan G, Blazevich AJ, Boreham C, Cooper AR, Crank H, Ekelund U, Fox KR, Gately P, Giles-Corti B, Gill JMR, Hamer M, Mc Dermott I, Murphy M, Mutrie N, Reilly JJ, Saxton JM, Stamatakis E (2010) The ABC of physical activity for health: a consensus statement from the British Association of Sports and Exercise Sciences. J Sports Sci 28(6):573–591PubMedCrossRefGoogle Scholar
  12. 12.
    Netzer N, Lormes W, Giebelhaus V, Halle M, Keul J, Matthys H, Lehmann M (1997) Physical training of patients with sleep apnea. Pneumologie 51(Suppl 3):779–782PubMedGoogle Scholar
  13. 13.
    Giebelhaus V, Strohl KP, Lormes W, Lehmann M, Netzer N (2000) Physical Exercise as an Adjunct Therapy in Sleep Apnea-An Open Trial. Sleep Breath 4(4):173–176PubMedGoogle Scholar
  14. 14.
    Sengul YS, Ozalevli S, Oztura I, Itil O, Baklan B (2011) The effect of exercise on obstructive sleep apnea: a randomized and controlled trial. Sleep Breath 15(1):49–56PubMedCrossRefGoogle Scholar
  15. 15.
    Ackel-D'Elia C, da Silva AC, Silva RS, Truksinas E, Sousa BS, Tufik S, de Mello MT, Bittencourt LR (2012) Effects of exercise training associated with continuous positive airway pressure treatment in patients with obstructive sleep apnea syndrome. Sleep Breath 16(3):723–735PubMedCrossRefGoogle Scholar
  16. 16.
    da Silva Alves ED, Ackel-D'Elia C, Luz GP, Cunha TC, Carneiro G, Tufik S, Bittencourt LR, de Mello MT (2012) Does physical exercise reduce excessive daytime sleepiness by improving inflammatory profiles in obstructive sleep apnea patients? Sleep Breath. doi:10.1007/s11325-012-0729-8 Google Scholar
  17. 17.
    Theorell-Haglow J, Berne C, Janson C, Lindberg E (2011) The role of obstructive sleep apnea in metabolic syndrome: a populations-based study in women. Sleep Med 12:329–334PubMedCrossRefGoogle Scholar
  18. 18.
    Basta M, Lin H-M, Pejovic S, Sarrigiannidis A, Bixler EO, Vgontzas AN (2008) Lack of regular exercise, depression, and degree of apnea are predictors of excessive daytime sleepiness in patients with sleep apnea: sex differences. J Clin Sleep Med 4(1):19–25PubMedGoogle Scholar
  19. 19.
    West SD, Kohler M, Nicoll DJ, Stradling JR (2009) The effect of continuous positive airway pressure treatment on physical activity in patients with obstructive sleep apnoea: a randomised controlled trial. Sleep Med 10:1056–1058PubMedCrossRefGoogle Scholar
  20. 20.
    Chasens ER, Sereika SM, Houze MP, Strollo PJ (2011) Subjective and Objective Appraisal of Activity in Adults with Obstructive Sleep Apnea. J Aging Res Jan 3; 2011:751819. doi:10.4061/2011/751819
  21. 21.
    Verwimp J, Ameye L, Bruyneel M (2013) Correlation between sleep parameters, physical activity and quality of life in somnolent moderate to severe obstructive sleep apnea adult patients. Sleep Breath. doi:10.1007/s11325-012-0796-x PubMedGoogle Scholar
  22. 22.
    Diamanti C, Manali E, Ginieri-Coccossis M, Vougas K, Cholidou K, Markozannes E, Bakakos P, Liappas I, Alchanatis M (2013) Depression, physical activity, energy consumption, and quality of life in OSA patients before and after CPAP treatment. Sleep Breath. doi:10.1007/s11325-013-0815-6 PubMedGoogle Scholar
  23. 23.
    Igelström H, Emtner M, Lindberg E, Åsenlöf P (2013) Level of agreement between methods for measuring moderate to vigorous physical activity and sedentary time in people with obstructive sleep apnea and obesity. Phys Ther 93:50–59PubMedCrossRefGoogle Scholar
  24. 24.
    Katzmarzyk PT, Church TS, Craig CL, Bouchard C (2009) Sitting time and mortality from all causes, cardiovascular disease, and cancer. Med Sci Sports Exerc 41(5):998–1005PubMedCrossRefGoogle Scholar
  25. 25.
    Inoue M, Iso H, Yamamoto S, Kurahashi N, Iwasaki M, Sasazuki S, Tsugane S (2008) Daily total physical activity level and premature death in men and women: results from a large-scale population-based cohort study in Japan (JPHC Study). Ann Epidemiol 18:522–530PubMedCrossRefGoogle Scholar
  26. 26.
    Dunstan DW, Barr ELM, Salmon J, Shaw JE, Balkau B, Magliano DJ, Cameron AJ, Zimmet PZ, Owen N (2010) Television viewing time and mortality. The Australian diabetes, obesity and lifestyle study (AusDiab). Circulation 121:384–391PubMedCrossRefGoogle Scholar
  27. 27.
    Hamilton MT, Hamilton DG, Zderic TW (2004) Exercise physiology versus inactivity physiology: an essential concept for understanding lipoprotein lipase regulation. Exerc Sport Sci Rev 32(4):161–166PubMedCrossRefGoogle Scholar
  28. 28.
    Chasens ER, Umlauf MG, Weaver TE (2009) Sleepiness, physical activity, and functional outcomes in veterans with type 2 diabetes. Appl Nurs Res 22(3):176–182PubMedCrossRefGoogle Scholar
  29. 29.
    Orsini N, Belloco R, Bottai M, Hagströmer M, Sjöström M, Pagano M, Wolk A (2008) Profile of physical activity behaviours among Swedish women aged 56–75 years. Scand J Med Sci Sports 18:95–101PubMedCrossRefGoogle Scholar
  30. 30.
    Tudor-Locke C, Brashear MM, Johnson WD, Katzmarzyk PT (2010) Accelerometer profiles of physical activity and inactivity in normal weight, overweight, and obese U.S men and women. Int J Behav Nutr Phys Act 7(60)Google Scholar
  31. 31.
    Wouters EJ, Larsen JK, Zijlstra H, van Ramhorst B, Geenen R (2011) Physical activity after surgery for severe obesity: the role of exercise cognitions. Obes Surg 21:1894–1899PubMedCrossRefGoogle Scholar
  32. 32.
    Smith SS, Doyle G, Pascoe T, Douglas JA, Jorgensen G (2007) Intention to exercise in patients with obstructive sleep apnea. J Clin Sleep Med 3(7):689–694PubMedGoogle Scholar
  33. 33.
    Iber C, Ancoli-Israel S, Chesson A, Quan SF (2007) The ASSM manual for the scoring of sleep and associated events: rules, terminology, and technical specifications, 1st edn. American Academy of Sleep Medicine, WestchesterGoogle Scholar
  34. 34.
    Hagell P, Broman JE (2007) Measurement properties and hierarchical item structure of the Epworth Sleepiness Scale in Parkinson's disease. J Sleep Res 16(1):102–109PubMedCrossRefGoogle Scholar
  35. 35.
    Johns M (1991) A new method for measuring daytime sleepiness. The Epworth Sleepiness Scale. Sleep 14(6):540–545PubMedGoogle Scholar
  36. 36.
    Tsigos C, Hainer V, Basdevant A, Finer N, Fried M, Mathus-Vliegen E, Micic D, Maislos M, Roman G, Schutz Y, Toplak H, Zahorska-Markiewicz B (2008) Management of obesity in adults: European clinical practice guidelines. Obesity Facts 1:106–116PubMedCrossRefGoogle Scholar
  37. 37.
    Bandura A (2006) Guide for constructing self-efficacy scales. In: Pajares F, Urdan T (eds) Self-efficacy beliefs of adolescents. Information Age Publishing, Greenwich, pp 307–337Google Scholar
  38. 38.
    Shin YH, Hur HK, Pender NJ, Jang HJ, Kim M-S (2006) Exercise self-efficacy, exercise benefits and barriers, and commitment to a plan for exercise among Korean women with osteoporosis and osteoarthritis. Int J Nurs Stud 43:3–10PubMedCrossRefGoogle Scholar
  39. 39.
    Everett B, Salamonson Y, Davidson PM (2009) Bandura's exercise self-efficacy scale: validation in an Australian cardiac rehabilitation setting. Int J Nurs Stud 46:824–829PubMedCrossRefGoogle Scholar
  40. 40.
    Denison E, Åsenlöf P, Lindberg P (2004) Self-efficacy, fear avoidance, and pain intensity as predictors of disability in subacute and chronic musculoskeletal pain patients in primary health care. Pain 111(3):245–252PubMedCrossRefGoogle Scholar
  41. 41.
    Montgomery SA, Åsberg M (1979) A new depression scale designed to be sensitive to change. Br J Psychiatry April 134:382–389CrossRefGoogle Scholar
  42. 42.
    Snaith RP, Harrop FM, Newby DA, Teale C (1986) Grade scores of the Montgomery–Asberg Depression and the Clinical Anxiety Scales. Br J Psychiatry 148:599–601PubMedCrossRefGoogle Scholar
  43. 43.
    Cohen J (1992) A power primer. Psychol Bull 112(1):155–159PubMedCrossRefGoogle Scholar
  44. 44.
    Ainsworth BE, Haskell WL, Herrmann SD, Meckes N, Bassett DR Jr, Tudor-Locke C, Greer JL, Vezina J, Whitt-Glover MC, Leon AS (2011) 2011 Compendium of physical activities: a second update of codes and MET values. Med Sci Sports Exerc 43(8):1575–1581PubMedCrossRefGoogle Scholar
  45. 45.
    Bauman A, Ainsworth BE, Sallis JF, Hagströmer M, Craig CL, Bull FC, Pratt M, Venugopal K, Chau J, Sjöström M (2011) The descriptive epidemiology of sitting. A 20-country comparison using the International Physical Activity Questionnaire (IPAQ). Am J Prev Med 41(2):228–235PubMedCrossRefGoogle Scholar
  46. 46.
    Hagströmer M, Oja P, Sjöström M (2007) Physical activity and inactivity in an adult population assessed by accelerometry. Med Sci Sports Exerc 39(9):1502–1508PubMedCrossRefGoogle Scholar
  47. 47.
    Hemmingsson E, Ekelund U (2007) Is the association between physical activity and body mass index obesity dependent? Int J Obes 31(4):663–668Google Scholar
  48. 48.
    Papazoglou D, Augello G, Tagliaferri M, Savia G, Marzullo P, Maltezos E, Liuzzi A (2006) Evaluation of a multisensor armband in estimating energy expenditure in obese individuals. Obesity 14(12):2217–2223PubMedCrossRefGoogle Scholar
  49. 49.
    Roelofs J, Goubert L, Peters ML, Vlaeyen JWS, Crombez G (2004) The Tampa Scale for Kinesiophobia: a further examination of psychometric properties in patients with chronic low back pain and fibromyalgia. Eur J Pain 8:495–502PubMedCrossRefGoogle Scholar
  50. 50.
    Wouters EJ, van Numen AM, Vingerhoets AJ, Geenen R (2009) Setting overweight adults in motion: the role of health beliefs. Obes Facts 2:362–369PubMedCrossRefGoogle Scholar
  51. 51.
    Igelström H, Martin C, Emtner M, Lindberg E, Åsenlöf P (2012) Physical activity in sleep apnea and obesity—personal incentives, challenges, and facilitators for success. Behav Sleep Med 10(2):122–137PubMedCrossRefGoogle Scholar
  52. 52.
    Shahar E, Whitney CW, Redline S, Lee ET, Newman AB, Javier Nieto F, O'Connor GT, Boland LL, Schwartz JE, Samet JM (2001) Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med 163(1):19–25PubMedCrossRefGoogle Scholar
  53. 53.
    Baldwin JD, Baldwin JI (2001) Behavior principles in everyday life, 4th edn. Prentice-Hall, Upper Saddle RiverGoogle Scholar
  54. 54.
    Skinner B (1969) Contingencies of reinforcement: a theoretical analysis. Appleton-Century-Crofts, New YorkGoogle Scholar
  55. 55.
    Vlaeyen JW, Linton SJ (2000) Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain 85(3):317–332PubMedCrossRefGoogle Scholar
  56. 56.
    Elbelt U, Schuetz T, Hoffmann I, Pirlich M, Strasburger CJ, Lochs H (2010) Differences of energy expenditure and physical activity patterns in subjects with various degrees of obesity. Clin Nutr 29(6):766–772PubMedCrossRefGoogle Scholar
  57. 57.
    Vlaeyen JW, de Jong J, Geilen M, Heuts PH, van Breukelen G (2001) Graded exposure in vivo in the treatment of pain-related fear: a replicated single-case experimental design in four patients with chronic low back pain. Behav Res Ther 39(2):151–166PubMedCrossRefGoogle Scholar
  58. 58.
    Åsenlof P, Denison E, Lindberg P (2005) Individually tailored treatment targeting activity, motor behavior, and cognition reduces pain-related disability: a randomized controlled trial in patients with musculoskeletal pain. J Pain 6(9):588–603PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Helena Igelström
    • 1
  • Margareta Emtner
    • 1
    • 2
  • Eva Lindberg
    • 2
  • Pernilla Åsenlöf
    • 1
  1. 1.Department of Neuroscience; PhysiotherapyUppsala UniversityUppsalaSweden
  2. 2.Department of Medical Sciences; Respiratory Medicine and AllergologyUppsala UniversityUppsalaSweden

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