Executive Summary

The Association Between Sedentary Behavior During School-time

and Changes in Body Mass Index
Fitri Rahmaniani
General Medicine Study Program, Faculty of Medicine, University of Riau
NIM. 1508121772

Background : Sedentary behavior refers to a distinct class of behaviors with

characteristics performed while sitting or reclining and low energy expenditure.
During adolescene, physical activity declines and sedentary time increase,
however little is known about whether the magnitude of these changes differs
within or between school-time, after-school time, or at weekends. The amount of
time children and adolescent spend daily in sedentary activities, and the
percentage of youths engaging in excessive sedentary time, have both increased in
recent years. The studying population spend nearly a half of their waking hours in
the school making occupational settings an ideal environment to sedentary
behavior. A great amount of sedentary time during weekdays occurs during
school-time as they participate in sedentary behaviors, such as sitting during long
class periods with few or no activity breaks. Perceived health, sedentary time, and
body mass index are important indices of health. BMI is an adequate proxy
measure for monitoring the underlying increase in health risk due to excess weight
at a population level. Negative self-rated health at worksite is associated with low
physical activity, overweight, obesity and comorbid health conditions. A review of
literature indicated that among the adult population poor perceptions of health was
significantly associated with BMI not within normal range. From 1980 to 2012
the percentage of youth who were overweight or changed to obesity increased
from 5% to nearly 21% in adolescents (12-19 years). Given that students spend
the majority of their waking hours at the school-place, schools are ideal locations
to implement health and wellness interventions.

Objective : The aim of this review is (a) to provide a through overview of

previous research with summarize and critically assess literature in sedentary
behavior during school-time in changes of body mass index; (b) to evaluate the
effect of sedentary behavior among students; and (c) to associate sedentary
behavior during school-time and changes in body mass index.

Method : A systemic literature review was conducted to identify BMI and

sedentary behavior in students. PubMed, DH, unsoed.ac.id, Alberta, BioMed
Central, ScopeMed, Active Living Research, ClinMed, and Oxford Journals were
searches for articles published between 2000 and March 2017. The search strategy
was based on four key elements : (a) sedentary behavior and its synonyms; (b)
types of sedentary behavior; (c) sedentary behavior during school-time and (d)
body mass index. Articles were included in the review if specific information
about sedentary behavior during school-time or changes in body mass index in
students were reported.

Result : The literature review identified 30 articles pertaining to sedentary

behavior, espescially during shool-time and changes in BMI. 9 of these studies
found statistically significant, positive associations between sedentary behavior
during school-time and changes in BMI. Sedentary behavior was associated with
overweight and obesity. The review of the literature on sedentary behavior and
biological pathway supported the hypothesized role of adiposity and metabolic
dysfunction as mechanism operant in the association between sedentary behavior
and overweight or obesity.

Conclusion : Available literature suggests that sedentary behavior is likely to be a

common behavior hazard in schools. It is linked to significant negative health and
BMI outcomes, and is increasingly being recognised in the community and by
international authorities as an important issue that needs attention.

There appear to be a number of initiatives that have demonstrated some success in

reducing sedentary behavior during school-time in some schools. There is a need
for consideration of the development of appropriate mechanism to support the
assessment and control the risks associated with changes in body mass index into
overweight or obes.

Recommendations : Sedentary behavior is ubiquitous in contemporary society,

its role in relation to body mass index should be a research priority. Improving
conceptualization and measurement of sedentary behavior is necessary to enhance
validity of future work.

The research literature explores a variety of other school interventions to

encourage students to engage in healthy behaviors. Such interventions include
walking challenges, hourly computer prompts reminding students to stand up and
move, motivational signs or posters to encourage stair climbing instead of elevator
riding and establishing school physical activity policies that encourage active
group lunch breaks, such as organized sports or neighbourhood walks.