Abstract
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.
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Author, Article, and Disclosure Information
Aviroop Biswas,
From the Institute of Health Policy, Management and Evaluation, and the Faculty of Kinesiology and Physical Education, University of Toronto; University Health Network–Toronto Rehabilitation Institute, Cardiovascular Prevention and Rehabilitation Program; Sunnybrook Health Sciences Centre; York University; and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Financial Support: Dr. Alter is supported with a career investigator award from the Heart and Stroke Foundation of Canada. Dr Faulkner is supported with a Canadian Institutes of Health Research-Public Health Agency of Canada (CIHR-PHAC) Chair in Applied Public Health. Dr. Oh is supported with a Goodlife Fitness Chair in Cardiovascular Rehabilitation and Prevention, University Health Network-Toronto Rehabilitation Institute, University of Toronto.
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-1651.
Corresponding Author: David A. Alter, MD, PhD, Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, G1-06, Toronto, Ontario M4N 3M5, Canada; e-mail, dalter@ices.
Current Author Addresses: Mr. Biswas: Institute of Health Policy, Management and Evaluation, University of Toronto, 4th Floor, 155 College Street, Toronto, Ontario M5T 3M6, Canada.
Dr. Oh: University Health Network–Toronto Rehabilitation Institute, 347 Rumsey Road, Toronto, Ontario M4G 1R7, Canada.
Dr. Faulkner and Mr. Mitchell: Faculty of Kinesiology and Physical Education, University of Toronto, 55 Harbord Street, Toronto, Ontario M5S 2W6, Canada.
Dr. Bajaj: Department of Cardiology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3A5, Canada.
Mr. Silver: Osgoode Hall Law School, York University, 4700 Keele Street, Toronto, Ontario M3J 1P3, Canada.
Dr. Alter: Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, G1-06, Toronto, Ontario M4N 3M5, Canada.
Author Contributions: Conception and design: A. Biswas, R.R. Bajaj, M.A. Silver, D.A. Alter.
Analysis and interpretation of the data: A. Biswas, P.I. Oh, G.E. Faulkner, M.A. Silver, M.S. Mitchell, D.A. Alter.
Drafting of the article: A. Biswas, P.I. Oh, G.E. Faulkner, M.S. Mitchell, D.A. Alter.
Critical revision of the article for important intellectual content: A. Biswas, G.E. Faulkner, R.R. Bajaj, M.A. Silver, M.S. Mitchell, D.A. Alter.
Final approval of the article: A. Biswas, P.I. Oh, G.E. Faulkner, R.R. Bajaj, M.S. Mitchell, D.A. Alter.
Provision of study materials or patients: D.A. Alter.
Statistical expertise: A. Biswas, M.S. Mitchell.
Administrative, technical, or logistic support: M.A. Silver, D.A. Alter.
Collection and assembly of data: A. Biswas, M.A. Silver.
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