 of people are here. So without further ado, I'd like to introduce our today's webinar. Again, it's Moving More to Breathe Better, Associations Between Physical Activity, Sitting Time and Lung Function in the CLSA. It's being presented by Dr. Shilpa Dogra. She's an associate professor in the Faculty of Health Sciences, Kinesiology, at the University of Ontario Institute of Technology. Her research expertise is in the area of exercise science, respiratory health, and active aging. In addition to working on large databases, Dr. Dogra has conducted several laboratory-based studies assessing the impact of different intensities of exercise among function in adults with asthma. She has also conducted several studies in the community, including recent work focused on active transportation in age-friendly communities. Dr. Dogra also recently led the development of an international consensus statement on sedentary behavior in older adults, and she's published extensively on the topic in Active Aging and has presented several national and international conference abstracts in this area. She was recently part of a panel on the future of aging and international society of behavioral nutrition and physical activity in Hong Kong, and so we're very pleased to have her presenting some of her work using the CLSA data, so without further ado, I will hand things over to Dr. Dogra. Awesome. Thank you for that, Lauren, and thank you everyone for attending this webinar. I'm really excited to be able to share with you some of the results from our work analyzing the CLSA. So let me see if I can get this moving here one second. Oh, there we go. Okay. So as Lauren mentioned, we're using the CLSA data to look at associations between lung function and a variety of different physical activity types of measures, and although it is the longitudinal study on aging, at this time we only have data cross-sectionally, so all of the results presented today are based on cross-sectional data. So one of the things that's really important to keep in mind is that although we use the term exercise in physical activity quite a bit, in today's talk I'll be talking about movement across the sort of physical activity or intensity spectrum. So if you look at this little figure on the slide here, you'll notice on the bottom on the X-axis we have metabolic equivalence, which is essentially exercise or physical activity intensity, and all along this arrow you'll see different types or different intensities of activity. And so for the work that we did, we looked at all of these different types of movement behaviors, starting with sedentary behavior, which is any activity that's below about one and a half metabolic equivalence, and something I suspect most of us are engaging in right now. So if you're sitting or you're in a reclined sort of position, or if you're lying down potentially to listen to this webinar, then you're probably engaging in sedentary behavior. If you start maybe to stand up and move around a little bit, you would fall into that light intensity physical activity in that sort of bin, and then if you move along and do higher intensities of activity, you would be considered moderate to vigorous intensity. So all of these movements are associated with health, and so we looked at all of these movements across the spectrum. It's also important to consider that all of these movements are sort of related to one another. So we have 24 hours in our day, and if we divide them up into sleep, sedentary behavior, and different intensities of physical activity, then basically if we increase one, then the other would have to decrease. So in a typical day, you would expect most people would spend about seven to nine hours sleeping, and eight to ten hours depending on your lifestyle would be spent in sedentary behaviors, and then depending on sort of how active your day-to-day life is, you might have a couple of hours of light intensity physical activity, and if you're engaging in exercise or higher intensities of activity, you might get somewhere between 30 to 90 minutes of moderate to vigorous intensity physical activity. So it's important to look at all of these different intensities of activity, but it's also important to look at the 24 hours of movement. So including sleep into that 24 hours is quite critical. So as a physical activity sort of expert or an exercise scientist, we often talk a lot about chronic disease prevention, and one of the cleanest models for chronic disease prevention and physical activity, I would say, is probably in the cardiometabolic disease world. So if you look at the pathophysiology of these types of conditions, we typically start with insulin resistance, and so insulin resistance will progress into hyperglycemia, and that typically progresses into diabetes or cardiovascular disease. And what's really nice for a physical activity person is that physical activity is quite critical or quite important and impactful in terms of preventing the progression from each step to the next. So if you're physically active when you're diagnosed with insulin resistance, then it can certainly prevent the progression to hyperglycemia, diabetes, and cardiovascular disease. So physical activity plays an important role in primary, secondary, and tertiary prevention in chronic cardiometabolic types of conditions. When you look at respiratory disease, though, it's not as clear of an association. So if you look at the progression of respiratory diseases or the pathophysiology, typically we see sort of this age-associated decline in lung function, and then exposure to things like smoking or air pollution or other noxious materials would increase sort of your risk of respiratory disease, and you might develop any one of many respiratory diseases. This might not be true for things like asthma and cystic fibrosis, which are more sort of genetically determined, but certainly for many respiratory diseases, this is sort of the pathway. And so the role for physical activity is a little bit less clear given what the sort of specific determinants are of respiratory disease or changes in lung function. So as I mentioned, there is a decline in lung function as we age, and there are other determinants that sort of predict whether you'll have a faster rate of decline or whether that rate of decline would be somewhat attenuated. So for example, in this study here, we see that the rate of decline is faster or greater if you're a smoker. So typically people would have anywhere between 30 to 50 milliliters per year in terms of loss of lung function, and the higher end of that is typically in smokers. And there's certainly some differences for across sexes and across different races as well. And things like exposure to different types of materials will certainly increase the rate of decline. There's even some evidence to suggest that things like poor diet would increase that rate of decline, and as I mentioned smoking status is actually quite important in terms of predicting that decline. So as an exercise scientist again, you come in and think, well, what are some other potential determinants and what role might physical activity play in attenuating or increasing this rate of decline? So there is some research to suggest that there might be an association between either physical activity or respiratory fitness and lung function. So this paper is from 2007, so a little over 10 years old now, but it was one of the first population level studies to show that there is an association between physical activity and lung function, particularly in people who were active smokers. So if you look at the graph, you'll see the beta coefficients are sort of plotted on this graph here. And people who engage in moderate intensity physical activity had an attenuated rate of decline in both FAB1 and FVC, and people who were engaging in high volumes of physical activity had an even greater attenuation in their decline. So really promising associations here to indicate that if you're active, even though you're a smoker, you might be able to attenuate the rate of decline of your lung function. So in this paper they also found that those who decreased their physical activity levels during follow-up had an increased lung function decline and COPD risk. The trend, which is interesting, was also significant when all smoker types were pooled together. So whether you were an active smoker or a non-smoker, this trend sort of stayed true in terms of physical activity being beneficial in attenuating that decline. For me, one of the potential reasons that there is this association between the different movement behaviors and lung function is the role that inflammation might play. So in particular, low-grade sort of chronic systemic inflammation is associated with a lot of these respiratory conditions. So if you look at this little graphic here on the slide, you'll see that in non-smokers, some of these inflammatory markers like CRP, TNF-alpha, ILH, IL6, and even Fibrinogen, they're not highly, they're not elevated in a lot of people among non-smokers. But if you go to the smokers part of the graph, you'll see that there's a larger number of people with elevated inflammatory markers. And then when you go over to the COPD group, you see an even larger representation of some of those inflammatory markers. So inflammation or this chronic low-grade systemic inflammation is certainly common among smokers and people with respiratory disease. And what's unfortunate is that these people who are persistently inflamed show worse health outcomes. So they have higher levels of all-cause mortality and certainly have higher exacerbations as well. When you look at population level data, there's evidence to suggest that people with COPD have higher levels of CRP or C-reactive protein. And even in those with asthma, things like IL8 and TNF-alpha are shown to be elevated when you look at systemic markers. So certainly there's a role for inflammation in these respiratory diseases, but how does physical activity play into that? So not surprisingly, there's evidence to suggest that movements across that movement behavior spectrum influence inflammation. So in particular, if we look at this study, this is a study that had people come into the lab on three occasions. And what they did was they had people come in and sit for five hours on one session. And then subsequent two sessions, they had people come in and sit for five hours. But during that time, they had people get up and walk for about three minutes per hour. So in the light intensity session, they walked for three minutes at a lighter intensity. And of course, in the moderate intensity session, they did a higher intensity walking break. And what we see quite nicely is that when you come in and sit for five hours, there's a significant increase in inflammatory markers, in this case plasma fibrinogen. But when you come in and you sit for five hours and break that up with a couple of different walks, whether it's moderate or light intensity, just that three minutes of movement every hour is enough to reduce inflammation significantly. So even something as low as sedentary time or sedentary behavior, breaking that up with just a little bit of movement can have a pretty significant impact on your systemic inflammation. And certainly again, from population level data, we see that sedentary time is associated with inflammatory markers such as CRP and IL-6. And that breaks in sedentary time are significantly associated with inflammatory markers as well. So you don't need to engage in high intensity exercise per se, but breaking up your sedentary time might be enough to reduce inflammation. So this is pretty exciting because it doesn't require high intensity sort of exercise. But if you look at physical activity or those higher intensities of activity, we do see similar associations. So in this graph, we have a study that looked at active and inactive people and looked at CRP levels. And you see a very nice association between physical activity and CRP, such that highly active people have lower systemic inflammation. This holds true in clinical populations as well. So in this particular study, they compared people with metabolic syndrome to those who didn't have metabolic syndrome comparing CRP levels pre and post cardiac rehab. And again, we see a really nice association between, or we see a nice sort of trend for a decrease in CRP levels with exercise in both groups. So you can engage in exercise regularly and reduce your sort of systemic inflammatory markers. And one of my favorite models of the association between physical activity and inflammation is this figure here. It's about 10 years old now, but I think it really nicely shows the impact that engaging in chronic physical activity can have on inflammation. So we see a really nice mechanistic pathway here where physical activity or movement can impact PGC1 alpha levels, which will then change or reduce your systemic inflammation and stop a person from becoming chronically inflamed. Whereas if you're inactive, or you have a sedentary lifestyle, that would lead to chronic systemic inflammation. So certainly inflammation seems like it could be one potential explanation for the association between physical activity and lung function. Another one of course would be the direct association with shortness of breath or dyspnea. So this is a model that's seen quite often in the respiratory world where dyspnea or shortness of breath leads to activity limitations. So you can imagine if you're short of breath, you might be less inclined to take the stairs or to walk to the grocery store, whatever the case might be. So it certainly causes limitations in activity. And people who have this sort of dyspnea end up in this vicious cycle where activity limitations leads to deconditioning, which then has an impact on things like airflow obstruction and hyperinflation, making it even more difficult to breathe or there's an increased sensation of shortness of breath. And so that dyspnea increases and then we have a further increase in activity limitations. So as an exercise scientist when I look at a figure like this I think well there's at least two areas in which I can intervene or where I can stop this cycle from progressing. The activity limitation and the deconditioning piece. So if I can get people moving and physically active and increase their fitness levels then I might be able to break this cycle. So with all that in mind it's quite clear from the research to date that movement or exercise affects inflammatory pathways and leads to some physiological adaptations associated with prevention and management of a number of chronic conditions. There's certainly quite a bit of evidence to suggest that moderate to vigorous intensity physical activity is good for shortness of breath and other clinically relevant outcomes in people with obstructive lung disease. What's not as well known is how the different intensities across that sort of spectrum influence chronic disease prevention and management. And in particular we know very little about the role of sedentary behavior in people with obstructive lung disease. So in terms of next steps you know we need to understand these associations at a population level to start to inform what needs to be done in experimental studies and in lab based mechanistic studies. We also need to provide some insight for prescription of movement behaviors. So currently the norm is pulmonary rehab types of programs where people are doing moderate to vigorous intensity physical activity and they might be doing some strength training. Because we have little evidence on the two extremes of the spectrum of movement behavior we're unable to really do much in terms of prescription there. But if we find strong associations we might be able to start recommending prescription at the other two ends of the spectrum. So we use the Canadian Longitudinal Study on aging to answer a couple of research questions pertaining specifically to lung function and all of these different movement behaviors. So the CLSA is a great database for this type of work. It has over 30,000 older adults, 45 and older. And it also has measured lung function in it. So participants from the CLSA went to little mobile units and were able to actually do some lung function tests. Specifically they used a handheld spirometer. And so the database contains information on forced expiratory volume in one second as well as forced vital capacity. It also contains information on physical activity levels. So unfortunately there was no device measured physical activity but they did use the physical activity scale for elderly which is a valid and reliable questionnaire for use of or for gathering information on sedentary time and physical activity. And the physical activity questions are related to different intensities of activity as well as strength training. So this is quite exciting because there's not a lot of research on strength training or on sedentary behavior. And so with this questionnaire we're actually able to assess some of these associations as well. In addition to the variables listed here we use sleep questions to determine how many hours sleep individuals were getting over a 24-hour period. We use self-reported smoking variables to determine the number of pack years of smoking. And there were quite a few demographic variables as well like age, sex and socio-economic status that were considered in our models. Okay so this is our first paper that we published out of this work. And this was specifically focused on healthy older adults. So we wanted to look specifically at the association between all of the different movement behaviors with lung function in healthy adults. And we wanted to look at this association across different smoker types. So people with different numbers of pack years in terms of their smoking history. So the sample for this study looks like this. All of them, the age groups were, or average age was sorry over about 60 considering that the youngest was 45 in the sample and the oldest was 79. So that our average ages were pretty consistent across the three groups. The main thing to point out here of course is lung function. So in the group that had 10 or more pack years we see lower lung function compared to those who had never smoked. So the main findings from this study which were quite exciting was that all of the different types of movement behaviors were significantly associated with lung function. So these results specifically are for FEV1. The paper contains results on all of the different smoker types and FEC as well. But if you look at this little figure here you can see quite nicely that sitting time was negatively associated with lung function. And walking, light intensity, moderate intensity, strenuous intensity, and strengthening activity were all positively associated with lung function. This was in the all smoker types group. So this was with all of the smoker types pooled together. But some of these associations remained significant when we looked at the different smoker types individually as well. So there is research needed to sort of assess what the cumulative effect would be. So some of these beta coefficients are quite small. And so to say that, for example, if we use the sitting time example at the top there, a change in lung function of 0.06% isn't that exciting. But it is with only one minute per week change in sitting time. So you can imagine if you start to look at that 24 hour model if you can actually optimize the 24 hours you might actually start to see clinically meaningful changes in lung functions. So over the course of a week if a person is actually to accumulate 150 minutes of moderate or vigorous intensity physical activity you could actually really see a pretty significant change in their lung function. Our second paper was looking specifically at individuals who had an existing obstructive lung condition. And we wanted to look specifically at clinically relevant outcomes. So we looked at lung function health care use and quality of life measures in people with COPD and with asthma. The COPD and asthma variables were reported. But again we did have lung function to confirm this. We also separately looked at a group of people who said they didn't have COPD or asthma but also had lower lung function. So as per the lower limit of normal based on their FEV1 we determined if their lung function was sort of suboptimal or not. And so the novelty of this study really is that for the first time we were able to look at this LLN group but also that we had movement from across the spectrum. So looking from sedentary behavior all the way up to that higher intensity of activity and strength training which is something we don't really have much of at the population level. So the sample for this study again older so average age was about 60 to 65. The COPD group was a bit older than the asthma group which is consistent with what you would see in the general population. And again if you look at the lung function percent predicted FEV1 was much lower in the COPD group to the asthma group and then of course in the LLN group it was much lower than that of the COPD group. The same could be said for FVC percent predicted and the same trend was observed in the FEV1 over FVC percent predicted as well. So some of the main findings from this study the first thing was we didn't see any significant associations with lung function. This isn't totally surprising considering that it was an unhealthy population with a progressive lung condition potentially. So some research in the past particularly with asthma groups show that exercise doesn't necessarily affect lung function but the exercise can affect the control or the management of the condition if it doesn't influence the severity of the condition. Which is why we looked at things like healthcare use and quality of life as well. So if you look at the healthcare use the first figure on the top there we have healthcare use in people with asthma. So in terms of overnight hospital stays for people who were engaging in light intensity physical activity they were less likely to have an overnight hospital stay than people who were engaging in no light intensity physical activity. So even with something as minimal as light intensity physical activity a significant impact on healthcare use. And then what's very novel here is that asthmatics who said they were strength training were less likely to report having an emergency department visit. So again exciting here to say that if individuals with asthma are strength training they might be able to reduce the risk of hospitalization or having to go to a hospital for emergency care. And the strength training thing is quite exciting because a lot of the times individuals have exercise induced asthma and those moderate to high intensities are more likely to induce that response. So if you can get people strength training as a starting point this might be a better entry level into exercise as it's less likely to induce that exercise induced asthma response. So it might be an opportunity to build functional capacity or exercise capacity before introducing aerobic physical activity. In the second graph on the bottom there we have the LLN group so the lower limit of normal impaired lung function. And we can see that sedentary behavior was significantly associated with hospital stays. So the comparison group here is people who were engaging in less than 14 hours per week of sedentary time. So if you were engaging in 14 to 18 hours of sedentary time then you were twice as likely to report having an overnight hospital stay. If you were engaging in 18 or more hours then you were almost three times as likely to have an overnight hospital stay. So this is pretty significant. These are not small odds ratios here. So simply measuring someone's sedentary time might be an indicator of their risk of hospitalization in people with impaired lung function. We did have some odd associations as well. I'd like to just brush over them but I won't. There were some associations that indicated that engaging in physical activity was worse or increased likelihood of an emergency department visit. So in this case it doesn't make sense obviously it's not intuitive. There's certainly other research to suggest that light intensity physical activity reduces the risk of hospitalization in people with COPD. So some of the potential reasons for this could be that our physical activity was a self-reported measure. And unfortunately when it's self-reported we don't know for sure if the people were engaging in that volume of physical activity or if the intensity is appropriately depicted. So it could be that some of these individuals were engaging in higher intensity. So for example some of the examples provided for light intensity physical activity were bowling. And for individuals who are deconditioned or have severe disease this might actually be a moderate intensity or vigorous intensity activity. So it's possible that this led to dyspnea and exacerbations which may have increased the risk of an emergency department visit. So certainly work is needed to follow up on that using better measures of physical activity. One of the other exciting findings like I said with this paper is that in people with obstructive lung conditions there were significant associations of quality of life. So the associations between all of the movement behaviors and measures of perceived health, perceived mental health and healthy aging were consistently significant in all of our adjusted models in all three groups. So people with asthma, COPD and the LLN group. So if you look at this graph here, this is just an example using the perceived health outcome with sedentary time. So we've got the asthma, COPD and LLN group and we've got the different levels of sedentary time there. Again the comparison group is people accumulating less than 14 hours per week of sedentary time. So in people with asthma you see about one and a half times higher odds of having poor perceived health if they were engaging in 14 to 18 hours of sedentary time or 18 to 24. In the COPD group we see two and a half to three times higher odds of reporting poor perceived health. And in the LLN group for the 14 to 18 hours of sedentary time group we saw significantly higher odds of self-reporting poor perceived health as well. So sedentary time again might be an indicator of poor quality of life in this population. And then again to me the exciting stuff is the strength training stuff because it's not been looked at very well before. So here we have our asthma COPD and LLN group and the odds ratios are presented and so you see that people who are engaging in strength training compared to those who are not are much less likely to report unhealthy aging. So people with COPD who are strength training even if it's just once a week are less likely to report unhealthy aging. So again strength training might be a good target for behaviour change. So the third study we conducted is it hasn't been published yet. It's in press with health reports and should be released in 2019. The purpose of this study was to look at replacement effects of different movement behaviours. And so this is done using a isotemporal substitution analysis. And what it allows us to do is assess for changes in lung function with by replacing one behaviour with another. So for example in our models we can look at improvements or changes in lung function when we're replacing 30 minutes of sitting time with 30 minutes of walking for example. So the model allows us to sort of predict whether changes in one behaviour or replacing one behaviour with the other would actually influence our lung function outcomes. So for those of you who are interested in the math behind it I'll quickly walk you through it. What we did first was we took all of our movement behaviours and converted them into units of 30 minutes per day. We then created a total time variable so that we had that 24 hour time variable. So this included sleep and all of the different intensities of movement behaviour. We then created single activity models. So these would be our adjusted linear aggressions where we had our outcome of lung function either FEV1 or FEC. And our main movement behaviour that we were looking at adjusted for all of the covariates. In the partition model we then added all of the other movement behaviours so we had the 24 hours represented in that model. And then in the isotemporal model what we do is we drop one of those behaviours and put in total activity time. And what that does is if you look at the equation at the bottom there, when you drop one of those behaviours but include total activity time the beta coefficient for the other behaviours indicates the replacement effects of that one behaviour dropped. So I'll go through this, I'll interpret the data for you from our results section. So in study 3 the sample we included both adults with obstructive lung disease as well as healthy adults. And again not surprisingly we see some significant differences between lung function measures in the two groups. So in our healthy adults the associations were actually quite consistent all movement behaviour variables were significantly associated with both FAV1% predicted and FVC% predicted. So I'll get you to take a look at the top part of the graph, the single activity models you'll see each of the different movement behaviours represented there. Any line that crosses that midline or any error bars that cross that midline means the association was not significant. So you can see that sitting time, walking time, light to moderate intensity activity and strenuous and strengthening activities were all significantly associated with lung function in the healthy adults. When we then added the other movement behaviours to the model the association between sitting time, light to moderate and strenuous to strengthening activity remained significant. So this is pretty exciting because what we're saying here is that even when you adjust for all of the other activities the person is doing over the 24 hours there are still significant associations between something like sitting time and FVV1 or FVC. We then look at the isotemporal substitution models or the replacement models which are the lower half of the graph. And so if we just focus on the first one which is replacing sitting time, you can see that when we replace sitting time with walking, light to moderate intensity activity or strenuous strengthening activity, or even with sleep we see a significant improvement in lung function. So taking 30 minutes of sitting and replacing that with 30 minutes of sleep for example would have a significant impact on your FVV1 predicted. And so we see some of those associations with replacement for light to moderate activity and replacement for strenuous and strengthening activity as well. So what does that mean? So if we actually interpret some of those beta coefficients what we're saying is that replacing sitting time with 30 minutes per day of strenuous or strengthening activity was associated with a .65% point higher FVV1 predicted. So basically if you had a lung function or FVV1 predicted of 80 it would mean you would go up to 80.65 if you replaced 30 minutes of sitting time with 30 minutes of strenuous or strengthening activity. The next one there replacing 30 minutes per day of sleep duration with strenuous or strengthening activity was associated with .49 percentage points of higher FVC percent predicted. So again we're seeing just replacing 30 minutes of sleep with physical activity would be beneficial. That was in healthy adults. If we look at the obstructive lung disease group we see some similar associations. So in this case if you look at our single activity models there is no association with sitting time but all of the physical activity variables were significantly associated with lung function. So light or moderate physical activity and strenuous or strengthening physical activity were positively associated with both FVV1 and FVC in our single activity and partition models. Walking unfortunately was not significant in those models but if you look at the replacement effects at the bottom of the graph you'll see that there were significant replacement effects for both the light to moderate group and the strenuous strengthening group. So replacing 30 minutes per day of sitting time or sleep duration with light to moderate or strenuous strengthening activity led to improvements in FVV1 and FVC percent predicted. So again I'll walk you through two beta coefficients here. So the first one replacing 30 minutes per day of sitting time with light or moderate activity was associated with .71 percentage points higher of FVV1 predicted. And replacing 30 minutes per day of sleep duration with strenuous or strengthening activity was associated with 1.13 percent points higher of FVV, FVC percent predicted. So individually these percent point changes aren't super significant in terms of their clinical impact but if you think about optimizing that 24 hours of the day and getting the optimal amount of moderate to vigorous physical activity, strengthening activity, reducing sedentary time and optimizing that sleep you might actually get to a point where you're having a clinically significant impact on a person's lung function. So in terms of overall conclusions from these three papers it's clear that activities of all of these different intensities as well as sleep might be impacting respiratory health in individuals who are healthy and even among individuals who have an existing obstructive lung condition. As I said the combined effect of an optimal 24 hours may provide greater benefit. So if we can get people to do all of the activities and reduce sedentary time we might actually have a clinically meaningful impact on their lung function. And physical activity may be a modifiable determinant of primary, secondary, and respiratory prevention for respiratory outcomes. So I think there is a role for physical activity at each stage of the game in terms of progression of decline of lung function or progression of disease pathology. So we might be able to impact lung function and clinically relevant outcomes among those individuals if we get them moving more. So in terms of the practical or clinical applications I'm using this little graph from a business model think about that whole physical activity spectrum starting from sedentary time to higher intensity activity. The low hanging fruit is that sedentary time piece so it might be difficult to convince your patients or people who are at high risk to do higher intensities or higher volumes of activity. But if you can get them to do the easy stuff like stand more or get them to do little things like lighter intensity physical activity which requires less skill to actually be able to get them to improve their lung function or other clinically relevant outcomes. So that would be a good starting place for a lot of people. And then once they build their capacity or increase their functional fitness and their exercise capacity you might be able to start introducing some of those higher intensity activities. Certainly the higher intensity activities would have more of an impact but we have to get them there gradually. Another key thing I would say is to not use strength training. From the evidence that we've presented here today there's clearly an association between strength training and the outcomes that we've looked at and so again considering the issues with dyspnea and exercise induced bronchial constriction strength training might be a great place to start as well. And the other key thing I would say in terms of practical or clinical applications is that we need to start counseling to the full 24 hours. So just recommending 150 minutes for this intensity physical activity isn't enough. We need to go beyond that and start telling people to sit less, move more, engage in some strength training and try and stay active throughout the day. In terms of future research I certainly think that we need experimental studies. There's evidence to suggest that simply breaking up your sedentary time is associated with better cardiorespiratory fitness. So in healthy older adults if we can just get people to break up their sedentary time we might be able to reduce the risk of declines in lung function or at least attenuate that decline. In people with existing chronic conditions the impact might be greater. There's also a growing body of evidence to suggest that light intensity physical activity is associated with significant health benefits and that really hasn't been explored as well in this population. We definitely need longitudinal data to start to understand the impact of physical activity on that age associated decline in lung function or evidence around that cardiorespiratory fitness as well. And then I believe that we need more research around the mechanisms or the pathways that are sort of linking physical activity to respiratory outcomes or pathophysiology there. And we're starting to do some of that work in our lab looking at salivary cytokines. So that's it for me. I'm happy to answer any questions at this time if there are any. Excellent presentation Dr. Doge. I'm kind of not sure if I'm happy or not. I do strength training but I also sit a lot so I think I have a week to go in terms of my own 20-hour clock. But I'd like to open up the session to questions now. Just a reminder that the muting will remain on but you can enter your questions into the chat window at the bottom right corner of the WebEx. And if you need to leave prior to the end of the webinar, please remember to complete the feedback survey in the polling options. So let me see if there are any questions here. I don't think there are any yet but I wondered myself if it was interesting that you were talking about for the example of bowling that it may actually be a different kind of level of activity depending on your health status. And I'm wondering did you look to see whether there were differences in terms of these associations across age group? Yeah so sorry the bowling example at the point that I was making there was that for people who have lower levels of fitness some of those examples might actually be higher intensity so we did adjust for age and sex in our models but we didn't look at the age, different age groups per se because you could have people who are younger that are still less fit and so the issue isn't necessarily age per se, it's more to do with fitness. And one of the things that you talked about in the presentation is you talked about kind of chronic exercise in that whole idea of the 24 hour clock which I find is very interesting. You look at, I know that you look at each thing individually but in terms of people who kind of these short bursts of exercise you know drive to the gym, do their cardio and then leave and go back to their sedentary behaviors it sounds like there's still an issue here. Like just kind of doing these short bursts is not quite enough, is that reasonable interpretation? No the short bursts are definitely good it sort of depends on what you mean by short bursts so some of the short bursts like the breaking up your sedentary time with a little bit of activity has definitely been shown to be beneficial. The key I think is that a lot of times people will do a little bit of physical activity at one point in the day so they might go to the gym for a half an hour and then sit for the rest of the day and that's certainly been shown to be problematic. So we want people to sort of move throughout the 24 hours so reducing the total amount of sedentary time but also breaking it up with different intensities of physical activity. Great. No I think it is quite interesting. Could you look at other diseases as well? I mean I know clearly CLTP and asthma because you're looking at lung function but when you think about the inflammation did you look at other things like arthritis that might again be associated with not being able to exercise as much or at least having more barriers to it? Yeah we didn't in our work we were looking specifically at the respiratory outcomes but there is evidence from like almost every other chronic disease population. So in particular I started with that cardiometabolic one and really physical activity has been shown to influence almost all of the chronic conditions out there. It's just for some of them the pathways are a little bit more clear or a little bit more direct. The respiratory one is a little bit less clear and there's certainly not as much research in this area compared to some of the other chronic conditions but there's definitely evidence for the benefits of exercise and reducing sedentary time for all of the different chronic conditions. Great and then just seeing if there's any questions make sure and put them in the chat window. Your talk was so completely complete that there aren't any questions so that is a shout out to you. Just in terms of maybe other people thinking about using CLSA data I'll take just waiting for some other questions about your talk. It looks like you've been very successful in getting free publications out of this in terms of the process. In terms of doing this as you're a fairly kind of junior person is the CLSA data really important in terms of kind of your area research and how does it kind of fit in with the other things that you're doing? In terms of accessing the data and analyzing the data it was fairly straightforward. I think it's a great resource if people are interested in looking at population level associations in older samples. For our work there's not a lot of databases that have measured lung functions so it's quite exciting to be able to use population level data with older adults and actually have that lung function variable. So if there's other researchers doing research in other areas there's lots of other measured variables in this data set which is great because it allows you to look at those associations at the population level using really clean measurements. Are you interested in your own work starting to look at some of the biological data and the biomarkers? Yeah, so we're starting to do some work around sitting time and cytokines in the saliva. So yeah, we're trying to look at that inflammatory pathway and see whether those little bursts in activity can actually impact systemic inflammation. It is kind of an interesting model because I think it's nice how you've been able to do kind of some of the lab work and look at very specific mechanisms and then able to look at it at the population level as well. I think that's kind of a really great way to use the CLSA data. Yeah, it can definitely support some of the things you're finding with smaller samples. Well, it looks like there's no other questions. So again, I'd like to thank you for a great presentation. We really appreciate your participation in the CLSA webinar. I'd like to remind everyone that the CLSA data access request applications are ongoing and the next deadline for applications is on February 25th, 2019. If you're interested in this, make sure to visit the CLSA website under data access and you can get all sorts of information about the application process. I'd also like to remind everyone to complete this survey located under the polling option before you leave the webinar. If you have any questions or concerns that we can help with, please write it in the chat box and we will definitely get back to you. As well, remember that CLSA promotes this webinar series using the hashtag CLSAWebinar and we invite you to follow us on Twitter. Finally, we'll have our next monthly webinar in December on clinical features of REM sleep behavior disorder in the population-based Canadian longitudinal study on aging cohort. Can we improve the screening tools? And this will be presented by Chun-Yao at a PhD candidate in neuroscience at Miguel University. So please go to our CLSA website to register for this webinar and the other webinars in the series and please join us for the 2018 and 2019 webinars. So thank you again for attending today's presentation and especially to Dr. Dogra. Thank you.