Elevated blood pressure (BP), including hypertension (HTN) and preHTN, affects 2 in 3 American adults and is a major contributor to cardiovascular disease (CVD) morbidity, mortality, and healthcare costs. Despite widespread use of pharmacotherapy, only about half of HTN is controlled, highlighting a need for innovative strategies to decrease the burden of elevated BP. Though regular exercise in the form of moderate-to-vigorous physical activity (MVPA) occurring in bouts of at least 10 minutes is recommended to decrease BP, we propose that reducing time spent sitting or `sedentary behavior' (SED) is a distinct, novel strategy that could lower BP in individuals with preHTN and HTN. Recent occupational and leisure changes (e.g., computers, video streaming) have resulted in more than half of the American day being spent in SED. At the same time, many observational studies have linked excessive SED with adverse outcomes, including HTN and CVD. Moreover, same day laboratory studies suggest that reducing or interrupting SED decreases BP acutely and our preliminary data suggest that systolic BP (SBP) is reduced by 4-6 mmHg after a 12-week SED intervention. Yet, there have been no robust, randomized trials of sufficient size and duration to demonstrate that reducing SED has sustained benefits on BP. Before clinical or public health SED recommendations can be made, such experimental evidence is imperative. Thus, the goal of this application is to demonstrate the efficacy of SED reduction to decrease BP in a 3-month randomized, clinical trial (intervention vs. control) in 300 adults (150 per group) with pre-to-Stage I HTN who have structured, prolonged SED as desk workers. We will use our proven approach that intervenes on multiple levels (individual, environmental modification with a sit-stand desk attachment) and utilizes behavioral strategies (individual counseling, self-monitoring, external prompting with a wrist-worn monitor light-intensity physical activity (LPA) (standing, light movement) and short spurts (<10 min) of activity (sporadic MVPA) as replacement behaviors. We will comprehensively study the effects of our intervention on vascular health by assessing resting BP, ambulatory BP, and carotid-femoral pulse wave velocity (cfPWV) (Aim 1) and key potential mechanisms (plasma renin activity, aldosterone) (Aim 2). We will use objective activity monitoring to evaluate dose-response relationships between amount of achieved SED reduction (and resulting increases in LPA and sporadic MVPA) with changes in outcomes (Aim 3). We will also study adiposity, fitness, and insulin sensitivity as exploratory outcomes that could change with our intervention, and if so, might relate to BP. Results from this study will determine whether decreasing SED can improve BP and vascular health and inform the necessary dose of SED reduction for clinically meaningful benefits. Also, evaluation of our novel intervention approach will inform future interventions for SED research and for designing translatable, population-level programs. If SED reduction improves BP, it could provide an important additional tool in the fight against elevated BP and CVD. and text messaging). These strategies will facilitate a targeted 2-4 hr/day SED reduction by increasing

Public Health Relevance

Though most American adults have elevated blood pressure, and time spent sitting or ?sedentary behavior? has been identified as a novel risk factor for high blood pressure and cardiovascular disease in observational studies, no large randomized trials have evaluated whether decreasing sedentary behavior will lower blood pressure. The proposed randomized, clinical trial will evaluate whether a 3-month sedentary behavior intervention (individual in-person and phone contacts, sit-stand desk attachment, wrist-worn activity prompter, and text messages) can decrease blood pressure and improve other vascular health measures in desk-based, working adults with pre-to-Stage 1 hypertension vs. a no-treatment, control condition. If we demonstrate that reducing sedentary behavior is efficacious for lowering blood pressure, these results could provide a new therapeutic strategy for blood pressure control in adults with prehypertension and hypertension.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Project (R01)
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Behavioral Medicine, Interventions and Outcomes Study Section (BMIO)
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Boyington, Josephine
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University of Pittsburgh
Schools of Arts and Sciences
United States
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Barone Gibbs, Bethany; Kline, Christopher E (2018) When does sedentary behavior become sleep? A proposed framework for classifying activity during sleep-wake transitions. Int J Behav Nutr Phys Act 15:81