Reviews20 January 2015
A Systematic Review and Meta-analysis
    Author, Article and Disclosure Information

    This article has been corrected. The original version (PDF) is appended to this article as a Supplement.

    Background:

    The magnitude, consistency, and manner of association between sedentary time and outcomes independent of physical activity remain unclear.

    Purpose:

    To quantify the association between sedentary time and hospitalizations, all-cause mortality, cardiovascular disease, diabetes, and cancer in adults independent of physical activity.

    Data Sources:

    English-language studies in MEDLINE, PubMed, EMBASE, CINAHL, Cochrane Library, Web of Knowledge, and Google Scholar databases were searched through August 2014 with hand-searching of in-text citations and no publication date limitations.

    Study Selection:

    Studies assessing sedentary behavior in adults, adjusted for physical activity and correlated to at least 1 outcome.

    Data Extraction:

    Two independent reviewers performed data abstraction and quality assessment, and a third reviewer resolved inconsistencies.

    Data Synthesis:

    Forty-seven articles met our eligibility criteria. Meta-analyses were performed on outcomes for cardiovascular disease and diabetes (14 studies), cancer (14 studies), and all-cause mortality (13 studies). Prospective cohort designs were used in all but 3 studies; sedentary times were quantified using self-report in all but 1 study. Significant hazard ratio (HR) associations were found with all-cause mortality (HR, 1.220 [95% CI, 1.090 to 1.410]), cardiovascular disease mortality (HR, 1.150 [CI, 1.107 to 1.195]), cardiovascular disease incidence (HR, 1.143 [CI, 1.002 to 1.729]), cancer mortality (HR, 1.130 [CI, 1.053 to 1.213]), cancer incidence (HR, 1.130 [CI, 1.053 to 1.213]), and type 2 diabetes incidence (HR, 1.910 [CI, 1.642 to 2.222]). Hazard ratios associated with sedentary time and outcomes were generally more pronounced at lower levels of physical activity than at higher levels.

    Limitation:

    There was marked heterogeneity in research designs and the assessment of sedentary time and physical activity.

    Conclusion:

    Prolonged sedentary time was independently associated with deleterious health outcomes regardless of physical activity.

    Primary Funding Source:

    None.

    References

    • 1. Canadian Society for Exercise Physiology. Canadian Physical Activity Guidelines and Canadian Sedentary Behaviour Guidelines. 2013. Accessed at www.csep.ca/guidelines on 28 August 2014. Google Scholar
    • 2. Warburton DERKatzmarzyk PTRhodes REShephard RJEvidence-informed physical activity guidelines for Canadian adults. Appl Physiol Nutr Metab2007;32:S16-S68. CrossrefGoogle Scholar
    • 3. Lee IMSesso HDOguma YPaffenbarger RSRelative intensity of physical activity and risk of coronary heart disease. Circulation2003;107:1110-6. [PMID: 12615787] CrossrefMedlineGoogle Scholar
    • 4. Matthews CEChen KYFreedson PSBuchowski MSBeech BMPate RRet alAmount of time spent in sedentary behaviors in the United States, 2003–2004. Am J Epidemiol2008;167:875-81. [PMID: 18303006] doi:10.1093/aje/kwm390 CrossrefMedlineGoogle Scholar
    • 5. Dunstan DWSalmon JOwen NArmstrong TZimmet PZWelborn TAet alAusDiab Steering CommitteeAssociations of TV viewing and physical activity with the metabolic syndrome in Australian adults. Diabetologia2005;48:2254-61. [PMID: 16211373] CrossrefMedlineGoogle Scholar
    • 6. Hu FBLeitzmann MFStampfer MJColditz GAWillett WCRimm EBPhysical activity and television watching in relation to risk for type 2 diabetes mellitus in men. Arch Intern Med2001;161:1542-8. [PMID: 11427103] CrossrefMedlineGoogle Scholar
    • 7. Hamilton MTHamilton DGZderic TWRole of low energy expenditure and sitting in obesity, metabolic syndrome, type 2 diabetes, and cardiovascular disease. Diabetes2007;56:2655-67. [PMID: 17827399] CrossrefMedlineGoogle Scholar
    • 8. Craft LLZderic TWGapstur SMVaniterson EHThomas DMSiddique Jet alEvidence that women meeting physical activity guidelines do not sit less: an observational inclinometry study. Int J Behav Nutr Phys Act2012;9:122. [PMID: 23034100] doi:10.1186/1479-5868-9-122 CrossrefMedlineGoogle Scholar
    • 9. Moher DLiberati ATetzlaff JAltman DGPRISMA GroupPreferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med2009;151:264-9, W64. [PMID: 19622511] LinkGoogle Scholar
    • 10. Salmon JBauman ACrawford DTimperio AOwen NThe association between television viewing and overweight among Australian adults participating in varying levels of leisure-time physical activity. Int J Obes Relat Metab Disord2000;24:600-6. [PMID: 10849582] CrossrefMedlineGoogle Scholar
    • 11. Tremblay MSColley RCSaunders TJHealy GNOwen NPhysiological and health implications of a sedentary lifestyle. Appl Physiol Nutr Metab2010;35:725-40. [PMID: 21164543] doi:10.1139/H10-079 CrossrefMedlineGoogle Scholar
    • 12. Proper KISingh ASvanMechelen WChinapaw MJSedentary behaviors and health outcomes among adults: a systematic review of prospective studies. Am J Prev Med2011;40:174-82. [PMID: 21238866] doi:10.1016/j.amepre.2010.10.015 CrossrefMedlineGoogle Scholar
    • 13. Hoogendoorn WEvanPoppel MNBongers PMKoes BWBouter LMSystematic review of psychosocial factors at work and private life as risk factors for back pain. Spine (Phila Pa 1976)2000;25:2114-25. [PMID: 10954644] CrossrefMedlineGoogle Scholar
    • 14. Singh ASMulder CTwisk JWvan Mechelen WChinapaw MJTracking of childhood overweight into adulthood: a systematic review of the literature. Obes Rev2008;9:474-88. [PMID: 18331423] doi:10.1111/j.1467-789X.2008.00475.x CrossrefMedlineGoogle Scholar
    • 15. Hayden JACôté PBombardier CEvaluation of the quality of prognosis studies in systematic reviews. Ann Intern Med2006;144:427-37. [PMID: 16549855] LinkGoogle Scholar
    • 16. Koeneman MAVerheijden MWChinapaw MJHopman-Rock MDeterminants of physical activity and exercise in healthy older adults: a systematic review. Int J Behav Nutr Phys Act2011;8:142. [PMID: 22204444] doi:10.1186/1479-5868-8-142 CrossrefMedlineGoogle Scholar
    • 17. Borenstein MHedges LHiggins JRothstein HComprehensive Meta Analysis. 2nd ed. Englewood, NJ: Biostat; 2005. Google Scholar
    • 18. Viechtbauer WConducting meta-analyses in R with the metafor package. J Stat Softw2010;36:1-48. CrossrefGoogle Scholar
    • 19. Zhang JYu KFWhat's the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. JAMA1998;280:1690-1. [PMID: 9832001] CrossrefMedlineGoogle Scholar
    • 20. Wilmot EGEdwardson CLAchana FADavies MJGorely TGray LJet alSedentary time in adults and the association with diabetes, cardiovascular disease and death: systematic review and meta-analysis. Diabetologia2012;55:2895-905. [PMID: 22890825] doi:10.1007/s00125-012-2677-z CrossrefMedlineGoogle Scholar
    • 21. Higgins JPThompson SGQuantifying heterogeneity in a meta-analysis. Stat Med2002;21:1539-58. [PMID: 12111919] CrossrefMedlineGoogle Scholar
    • 22. Knapp GHartung JImproved tests for a random effects meta-regression with a single covariate. Stat Med2003;22:2693-710. [PMID: 12939780] CrossrefMedlineGoogle Scholar
    • 23. Egger MDavey Smith GSchneider MMinder CBias in meta-analysis detected by a simple, graphical test. BMJ1997;315:629-34. [PMID: 9310563] CrossrefMedlineGoogle Scholar
    • 24. Dunstan DWBarr ELHealy GNSalmon JShaw JEBalkau Bet alTelevision viewing time and mortality: the Australian Diabetes, Obesity and Lifestyle Study (AusDiab). Circulation2010;121:384-91. [PMID: 20065160] doi:10.1161/CIRCULATIONAHA.109.894824 CrossrefMedlineGoogle Scholar
    • 25. George ESRosenkranz RRKolt GSChronic disease and sitting time in middle-aged Australian males: findings from the 45 and Up Study. Int J Behav Nutr Phys Act2013;10:20. [PMID: 23394382] doi:10.1186/1479-5868-10-20 CrossrefMedlineGoogle Scholar
    • 26. Inoue MIso HYamamoto SKurahashi NIwasaki MSasazuki Set alJapan Public Health Center-Based Prospective Study GroupDaily 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 Epidemiol2008;18:522-30. [PMID: 18504139] doi:10.1016/j.annepidem.2008.03.008 CrossrefMedlineGoogle Scholar
    • 27. Katzmarzyk PTChurch TSCraig CLBouchard CSitting time and mortality from all causes, cardiovascular disease, and cancer. Med Sci Sports Exerc2009;41:998-1005. [PMID: 19346988] doi:10.1249/MSS.0b013e3181930355 CrossrefMedlineGoogle Scholar
    • 28. Koster ACaserotti PPatel KVMatthews CEBerrigan DVanDomelen DRet alAssociation of sedentary time with mortality independent of moderate to vigorous physical activity. PLoS One2012;7:e37696. [PMID: 22719846] doi:10.1371/journal.pone.0037696 CrossrefMedlineGoogle Scholar
    • 29. Matthews CEGeorge SMMoore SCBowles HRBlair APark Yet alAmount of time spent in sedentary behaviors and cause-specific mortality in US adults. Am J Clin Nutr2012;95:437-45. [PMID: 22218159] doi:10.3945/ajcn.111.019620 CrossrefMedlineGoogle Scholar
    • 30. Patel AVBernstein LDeka AFeigelson HSCampbell PTGapstur SMet alLeisure time spent sitting in relation to total mortality in a prospective cohort of US adults. Am J Epidemiol2010;172:419-29. [PMID: 20650954] doi:10.1093/aje/kwq155 CrossrefMedlineGoogle Scholar
    • 31. Pavey TGPeeters GGBrown WJSitting-time and 9-year all-cause mortality in older women. Br J Sports Med2012. [PMID: 23243009] MedlineGoogle Scholar
    • 32. Seguin RBuchner DMLiu JAllison MManini TWang CYet alSedentary behavior and mortality in older women: the Women's Health Initiative. Am J Prev Med2014;46:122-35. [PMID: 24439345] doi:10.1016/j.amepre.2013.10.021 CrossrefMedlineGoogle Scholar
    • 33. Stamatakis EHamer MDunstan DWScreen-based entertainment time, all-cause mortality, and cardiovascular events: population-based study with ongoing mortality and hospital events follow-up. J Am Coll Cardiol2011;57:292-9. [PMID: 21232666] doi:10.1016/j.jacc.2010.05.065 CrossrefMedlineGoogle Scholar
    • 34. van der Ploeg HPChey TKorda RJBanks EBauman ASitting time and all-cause mortality risk in 222 497 Australian adults. Arch Intern Med2012;172:494-500. [PMID: 22450936] doi:10.1001/archinternmed.2011.2174 CrossrefMedlineGoogle Scholar
    • 35. León-Muñoz LMMartiacute;nez-Gómez DBalboa-Castillo TLópez-García EGuallar-Castillón PRodríguez-Artalejo FContinued sedentariness, change in sitting time, and mortality in older adults. Med Sci Sports Exerc2013;45:1501-7. [PMID: 23439420] doi:10.1249/MSS.0b013e3182897e87 CrossrefMedlineGoogle Scholar
    • 36. Kim YWilkens LRPark SYGoodman MTMonroe KRKolonel LNAssociation between various sedentary behaviours and all-cause, cardiovascular disease and cancer mortality: the Multiethnic Cohort Study. Int J Epidemiol2013;42:1040-56. [PMID: 24062293] doi:10.1093/ije/dyt108 CrossrefMedlineGoogle Scholar
    • 37. Wijndaele KBrage SBesson HKhaw KTSharp SJLuben Ret alTelevision viewing time independently predicts all-cause and cardiovascular mortality: the EPIC Norfolk study. Int J Epidemiol2011;40:150-9. [PMID: 20576628] doi:10.1093/ije/dyq105 CrossrefMedlineGoogle Scholar
    • 38. Chomistek AKManson JEStefanick MLLu BSands-Lincoln MGoing SBet alRelationship of sedentary behavior and physical activity to incident cardiovascular disease: results from the Women's Health Initiative. J Am Coll Cardiol2013;61:2346-54. [PMID: 23583242] doi:10.1016/j.jacc.2013.03.031 CrossrefMedlineGoogle Scholar
    • 39. Stamatakis EHamer MDunstan DWScreen-based entertainment time, all-cause mortality, and cardiovascular events: population-based study with ongoing mortality and hospital events follow-up. J Am Coll Cardiol2011;57:292-9. [PMID: 21232666] doi:10.1016/j.jacc.2010.05.065 CrossrefMedlineGoogle Scholar
    • 40. Wijndaele KBrage SBesson HKhaw KTSharp SJLuben Ret alTelevision viewing and incident cardiovascular disease: prospective associations and mediation analysis in the EPIC Norfolk Study. PLoS One2011;6:e20058. [PMID: 21647437] doi:10.1371/journal.pone.0020058 CrossrefMedlineGoogle Scholar
    • 41. Campbell PTPatel AVNewton CCJacobs EJGapstur SMAssociations of recreational physical activity and leisure time spent sitting with colorectal cancer survival. J Clin Oncol2013;31:876-85. [PMID: 23341510] doi:10.1200/JCO.2012.45.9735 CrossrefMedlineGoogle Scholar
    • 42. Friberg EMantzoros CSWolk APhysical activity and risk of endometrial cancer: a population-based prospective cohort study. Cancer Epidemiol Biomarkers Prev2006;15:2136-40. [PMID: 17057024] CrossrefMedlineGoogle Scholar
    • 43. Howard RAFreedman DMPark YHollenbeck ASchatzkin ALeitzmann MFPhysical activity, sedentary behavior, and the risk of colon and rectal cancer in the NIH-AARP Diet and Health Study. Cancer Causes Control2008;19:939-53. [PMID: 18437512] doi:10.1007/s10552-008-9159-0 CrossrefMedlineGoogle Scholar
    • 44. Zhang MXie XLee AHBinns CWSedentary behaviours and epithelial ovarian cancer risk. Cancer Causes Control2004;15:83-9. [PMID: 14970738] CrossrefMedlineGoogle Scholar
    • 45. George SMIrwin MLMatthews CEMayne STGail MHMoore SCet alBeyond recreational physical activity: examining occupational and household activity, transportation activity, and sedentary behavior in relation to postmenopausal breast cancer risk. Am J Public Health2010;100:2288-95. [PMID: 20864719] doi:10.2105/AJPH.2009.180828 CrossrefMedlineGoogle Scholar
    • 46. Hildebrand JSGapstur SMCampbell PTGaudet MMPatel AVRecreational physical activity and leisure-time sitting in relation to postmenopausal breast cancer risk. Cancer Epidemiol Biomarkers Prev2013;22:1906-12. [PMID: 24097200] doi:10.1158/1055-9965.EPI-13-0407 CrossrefMedlineGoogle Scholar
    • 47. Teras LRGapstur SMDiver WRBirmann BMPatel AVRecreational physical activity, leisure sitting time and risk of non-Hodgkin lymphoid neoplasms in the American Cancer Society Cancer Prevention Study II Cohort. Int J Cancer2012;131:1912-20. [PMID: 22275172] doi:10.1002/ijc.27445 CrossrefMedlineGoogle Scholar
    • 48. Peplonska BLissowska JHartman TJSzeszenia-Dabrowska NBlair AZatonski Wet alAdulthood lifetime physical activity and breast cancer. Epidemiology2008;19:226-36. [PMID: 18277160] doi:10.1097/EDE.0b013e3181633bfb CrossrefMedlineGoogle Scholar
    • 49. Hu FBLi TYColditz GAWillett WCManson JETelevision watching and other sedentary behaviors in relation to risk of obesity and type 2 diabetes mellitus in women. JAMA2003;289:1785-91. [PMID: 12684356] CrossrefMedlineGoogle Scholar
    • 50. Krishnan SRosenberg LPalmer JRPhysical activity and television watching in relation to risk of type 2 diabetes: the Black Women's Health Study. Am J Epidemiol2009;169:428-34. [PMID: 19056835] doi:10.1093/aje/kwn344 CrossrefMedlineGoogle Scholar
    • 51. Ford ESSchulze MBKröger JPischon TBergmann MMBoeing HTelevision watching and incident diabetes: Findings from the European Prospective Investigation into Cancer and Nutrition-Potsdam Study. J Diabetes2010;2:23-7. [PMID: 20923471] doi:10.1111/j.1753-0407.2009.00047.x CrossrefMedlineGoogle Scholar
    • 52. Tran BFalster MODouglas KBlyth FJorm LRHealth behaviours and potentially preventable hospitalisation: a prospective study of older Australian adults. PLoS One2014;9:e93111. [PMID: 24691471] doi:10.1371/journal.pone.0093111 CrossrefMedlineGoogle Scholar
    • 53. Higgins JPThompson SGDeeks JJAltman DGMeasuring inconsistency in meta-analyses. BMJ2003;327:557-60. [PMID: 12958120] CrossrefMedlineGoogle Scholar
    • 54. Schmid DLeitzmann MFTelevision viewing and time spent sedentary in relation to cancer risk: a meta-analysis. J Natl Cancer Inst2014;106. [PMID: 24935969] doi:10.1093/jnci/dju098 CrossrefMedlineGoogle Scholar
    • 55. Colley RCGarriguet DJanssen ICraig CLClarke JTremblay MSPhysical activity of Canadian adults: accelerometer results from the 2007 to 2009 Canadian Health Measures Survey. Health Rep2011;22:7-14. [PMID: 21510585] MedlineGoogle Scholar
    • 56. Atkin AJGorely TClemes SAYates TEdwardson CBrage Set alMethods of Measurement in epidemiology: sedentary Behaviour. Int J Epidemiol2012;41:1460-71. [PMID: 23045206] doi:10.1093/ije/dys118 CrossrefMedlineGoogle Scholar
    • 57. Taylor RSBrown AEbrahim SJolliffe JNoorani HRees Ket alExercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med2004;116:682-92. [PMID: 15121495] CrossrefMedlineGoogle Scholar
    • 58. Whaley MHBrubaker PHOtto RMArmstrong LEAmerican College of Sports MedicineACSM's Guidelines for Exercise Testing and Prescription. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2006. Google Scholar
    • 59. Wisse WBoer Rookhuizen Mde Kruif MDvan Rossum JJordans Iten Cate Het alPrescription of physical activity is not sufficient to change sedentary behavior and improve glycemic control in type 2 diabetes patients. Diabetes Res Clin Pract2010;88:e10-3. [PMID: 20138384] doi:10.1016/j.diabres.2010.01.015 CrossrefMedlineGoogle Scholar
    • 60. Sørensen JBSkovgaard TPuggaard LExercise on prescription in general practice: a systematic review. Scand J Prim Health Care2006;24:69-74. [PMID: 16690553] CrossrefMedlineGoogle Scholar
    • 61. Owen NSugiyama TEakin EEGardiner PATremblay MSSallis JFAdults' sedentary behavior determinants and interventions. Am J Prev Med2011;41:189-96. [PMID: 21767727] doi:10.1016/j.amepre.2011.05.013 CrossrefMedlineGoogle Scholar
    • 62. Ainsworth BEMacera CAPhysical Activity and Public Health Practice. Philadelphia: Taylor & Francis; 2012. Google Scholar
    • 63. Dunstan DWKingwell BALarsen RHealy GNCerin EHamilton MTet alBreaking up prolonged sitting reduces postprandial glucose and insulin responses. Diabetes Care2012;35:976-83. [PMID: 22374636] doi:10.2337/dc11-1931 CrossrefMedlineGoogle Scholar