Adult total wellness: group differences based on sitting time and physical activity level

Engaging in sufficient levels of moderate-to-vigorous intensity physical activities for at least 30 minutes on five or more days of the week has been shown to provide health benefits [1]. In the 21^st century, however, many children and adults around the world fail to engage in sufficient levels of activity required to derive such health benefits, and the research evidence suggests that PA levels worldwide may be still on the decline [2]. One possible contributor to this may be the increase in sedentary lifestyles at home, in the office and during leisure time [3]. This is largely related to the increasing popularity of computer usage, video gaming and television viewing. Increased levels of sedentary behaviors have been associated with decreased levels of PA [4].

Sedentary behavior (e.g., sitting, TV viewing, driving a car) refers to low energy expenditure behavior [1.0 to 1.5 metabolic equivalent units (METs), with 1 MET being energy expenditure at rest] and is distinct from physical inactivity, often conceptualized as a lack of moderate-to-vigorous PA [5]. Sitting time has been used as a specific marker of sedentary behaviors during waking hours [6, 7]. Researchers [3] found that the average United States adult during the 2003-2004 period spent approximately 7.7 hours/day of their waking time engaged in sedentary behavior. Australian adults, on average, spent 9.3 hours/day of their waking time in sedentary activities [6].

An increasing body of evidence suggests that sedentary behaviors are associated with poor health outcomes such as obesity [8, 9], Type 2 diabetes [10], high blood pressure [11], cardiovascular disease [12] and metabolic syndrome [13]. Despite the popularity of estimating sedentary behaviors and moderate and vigorous-intensity physical activities to determine the prevalence of, or relationships with, various aspects of health, there is little research to date that has explored the impact of sedentary behavior and of moderate- and vigorous-intensity physical activity on total wellness. The term “wellness” was first coined by Dunn, [14] and is defined as “an integrated method of functioning which is oriented toward maximizing the potential of which the individual is capable” (p.4). It is multi-faceted, involving six dimensions (i.e., physical, occupational, social, spiritual, intellectual, and emotional) that are enmeshed, related and, when balanced properly, provide the individual with optimal health or “high-level wellness” [15, 16]. An individual can achieve optimal wellness through attending to each of the interconnected and dependent relationships among the dimensions of wellness [17, 18] and changes in one dimension of wellness may affect other dimensions – in both positive and negative directions [19]. Thus, total wellness is a concept which encompasses much more than health-related perceptions [20].

The benefits of moderate and vigorous-intensity PA are numerous and affect all age groups, often in multiple dimensions of wellness [21‐23]. In order to further explore this relationship, the purpose of this study was to examine differences in adult total wellness based on being in a group with high/low levels of sitting time combined with insufficient/sufficient PA. It was hypothesized that participants in the low level of sitting time group who engaged in sufficient PA would self-report levels of total wellness higher than those in the high level of sitting time with insufficient PA group.

Participant characteristics are shown in Table 1. Frequency values indicate that there were more males (n = 116 26.1 ± 6), than females (n = 110 29.0 ± 7). The age range was from 19 to 43 years. Sixty-nine percent of participants were students, whereas 31% were employed. The frequency of IPAQ-determined physical activity/sitting time classifications is presented in Figure 1-A. The majority (60%) of the participants were categorized in the high total sitting time and sufficient PA group followed by 29% in the high total sitting time and insufficient PA group. No participants were found in the low total sitting time and insufficient PA category.

Figure 1-B displays the frequency of WEL scores. The majority (77.4%) of the participants were categorized in the wellness development needed group followed by 22.6% in the moderate wellness group. No participants were found in a high level of wellness category.

The analysis of covariance (ANCOVA) was used in order to determine whether significant differences in total wellness existed among IPAQ-determined physical activity/sitting time classifications. Results of the analyses indicate that, after adjustment for age, sex and work status (student or employed), there was a significant differences in total wellness scores among IPAQ-determined physical activity/sitting time groups [F (2,220) = 32.5 (p <0.001)]. Post-hoc tests showed these significant differences for total wellness to be between the high total sitting time/insufficient PA group (67%) and high total sitting time/sufficient PA group (74%) (p < .001) and between a high total sitting time/insufficient PA group (66.5%) and low total sitting time/sufficient PA group (80%) (p < .001). Moreover, a significant difference for total wellness was found between the low total sitting time/sufficient PA group (80%) and high total sitting time/sufficient PA group (74%) (p < .001) (Figure 2).

Large effect sizes were observed for differences in total wellness between the high total sitting time/insufficient PA and high total sitting time/sufficient PA groups (d = 1.04) and between the high total sitting time/insufficient PA and low total sitting time/sufficient PA groups (d = 2.21). A moderate effect size was observed (d = 0.72) for differences between the high total sitting time/sufficient PA and low total sitting time/sufficient PA groups (Figure 2).

Cross-tabulation of the two wellness groups (wellness development needed group and moderate wellness group) by the three IPAQ-determined physical activity/sitting time classifications is shown in Table 2. A Chi-square test revealed a significant difference in the distribution of IPAQ groups within the two wellness groups [χ² (N = 226) = 54.4, p < .001]. One-hundred percent (100%) of participants who were in the IPAQ-determined high total sitting time/insufficient PA group were found in the wellness development needed group. By comparison, 72% of those in the IPAQ-determined low total sitting time/sufficient PA group, were located in the moderate wellness group, while the remainder of the participants were located in the wellness development needed group (28%). Of participants who were classified in the high total sitting time/sufficient PA group, 75% were in the wellness development needed group.

This study examined differences in total wellness among adults who self-reported high/low levels of sitting time and insufficient/sufficient PA. Results showed that more than half (60%) of participants were categorized in the high total sitting time/sufficient PA group. This finding provides support for the hypothesis that an individual can meet the public health recommendations for physical activity levels (30 min of moderate-intensity activity each day) yet still spend unhealthy amounts of time engaged in sedentary behaviors. These individuals are sometimes referred to as “active couch-potatoes” [34]. As hypothesised, those who spent less time in sitting and were sufficiently physically active were found in the moderate wellness group. Several studies have shown that participants from healthy populations who engage in higher physical activity levels may have higher levels of quality of life [35]. These higher levels are associated with improved physical and mental health, cognitive functioning, and social connectedness [36, 37]. In contrast, participants who spent more time in sitting and were not sufficiently physically active were most likely to be found in the wellness development needed group. One recent study examined the influence of screen time (high or low) on health related quality of life across different levels of physical activity (none, insufficient or sufficient PA) among a large sample of Australian adults. Results indicated that adults who reported no PA (zero physical activity) in combination with high screen time were more likely to report lower health related quality of life [38]. Additional research found that individuals who were engaged in a sedentary lifestyle were significantly more likely to report poor health-related quality of life than other adults who engaged in moderate or vigorous physical activity [39]. As both high total sitting time and insufficient PA have been shown to have negative health effects [40, 41], interventions should target a decrease of sedentary behavior as well as an increase of PA.

The findings of the current study are consistent with a Myers et al. [42] study of wellness that found no participants were in a high level of wellness category and the researchers suggested that high level wellness is not “the norm” in the United States. While this study employed a different wellness instrument, our findings are comparable to earlier studies, namely the association of total wellness with higher levels of physical activity. For example, Benzer and colleagues [43] conducted a study to explore the relationship between physical activity and perceived wellness, using the Perceived Wellness Survey (PWS) as the dependent variable. Greater levels of physical activity and leisure time activity were associated with higher perceived physical and psychological wellness scores. Those participants with a greater quantity of regular physical activity had greater overall perceived wellness scores. Those findings support the concept that an active lifestyle will be associated with greater overall wellness [43].

Wellness is a term that encompasses an individual’s outlook on life, including their perceptions of personal fitness, happiness, learning, society, work and spirituality [18]. According to the literature, wellness has many dimensions. Each dimension may be identified as having specific subscales and each is an integral part of the whole. Sedentary behavior and physical activity are subsumed within the physical dimension. The WEL model is based on the Adlerian theory that holism, an evaluation of the whole rather than the parts, was central to understanding human behavior. There is recognition that it is the interaction of the parts and the context in which a person lives that influences the whole [44]. Consistent with this philosophy, Myers and Sweeney [42] emphasized that all wellness dimensions are interrelated; a change in one area causes or contributes to changes to other areas, and this influences total wellness scores. The present study provides support for this notion, as participants who were engaged in low levels of sitting time/sufficient PA had significantly higher total wellness scores.

This research adds to the knowledge base by showing that sedentary behaviors (such as high sitting time and low physical activity) are not only associated with poor health outcomes [40, 41] but also with the lowest wellness scores, which include more than health-related perceptions. In this sense, reducing sitting time and engaging in moderate or vigorous-intensity PA may be a valuable approach to improving total wellness. This information supports the endorsement of public health recommendations concerning PA for adults (i.e. all adults should accumulate 30 minutes of moderate intensity PA on most, preferably all, days during the week) y.

This study has several limitations. The IPAQ, which was used to measure sitting time and insufficient/sufficient PA in the current study, has some limitations, one of which is that only one question was used to measure time spent sitting. The IPAQ is not designed to provide a detailed assessment of sitting across daily life domains: (work, transportation, home and leisure time). Future studies would benefit by use of an instrument which targets sedentary behaviors, including sitting time, within these specific daily life domains. The role of sitting time may vary by home and leisure time domains, therefore, the key scientific questions of public health importance also relate to the quantity of a behavior as much as the context within which the behavior occurs. All responses in this study were self-reported, which may have resulted in biased conclusions. The current study was conducted through the Internet, thus, people could only respond to the IPAQ/WEL if they could access the Internet and were university students or alumni. Overall, this selection bias limits the generalizability of the results. Future studies should include larger sample sizes, more representative age ranges and more diverse education levels. Objective measures (e.g., accelerometer) of PA level and total wellness would also be beneficial.

The results from this study provide meaningful information to enhance our understanding of the effects on total wellness of the combination of sitting time and insufficient/sufficient PA. One-hundred percent (100%) of participants in the high total sitting time/insufficient PA group were found in the wellness development needed group. Such knowledge is useful in arguing the importance of the development of public health initiatives that aim to increase PA and reduce sedentary behaviors such as sitting time. In addition, this research supports public health recommendations that target the “active couch potato” to identify that significant health benefits (and total wellness) may be achieved by adults who spend less time sitting as well as being sufficiently physically active.