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20 January 2015

Sedentary Time and Its Association With Risk for Disease Incidence, Mortality, and Hospitalization in Adults: A Systematic Review and Meta-analysis

This article has been corrected.
VIEW CORRECTION
Publication: Annals of Internal Medicine
Volume 162, Number 2

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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Supplemental Material

Supplement. Search Strategy

Supplement. Original Version (PDF)

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.
2.
Warburton DERKatzmarzyk PTRhodes REShephard RJ. Evidence-informed physical activity guidelines for Canadian adults. Appl Physiol Nutr Metab. 2007;32:S16-S68.
3.
Lee IMSesso HDOguma YPaffenbarger RS Jr. Relative intensity of physical activity and risk of coronary heart disease. Circulation. 2003;107:1110-6. [PMID: 12615787]
4.
Matthews CEChen KYFreedson PSBuchowski MSBeech BMPate RRet al. Amount of time spent in sedentary behaviors in the United States, 2003–2004. Am J Epidemiol. 2008;167:875-81. [PMID: 18303006]  doi: 10.1093/aje/kwm390
5.
Dunstan DWSalmon JOwen NArmstrong TZimmet PZWelborn TAet alAusDiab Steering Committee. Associations of TV viewing and physical activity with the metabolic syndrome in Australian adults. Diabetologia. 2005;48:2254-61. [PMID: 16211373]
6.
Hu FBLeitzmann MFStampfer MJColditz GAWillett WCRimm EB. Physical activity and television watching in relation to risk for type 2 diabetes mellitus in men. Arch Intern Med. 2001;161:1542-8. [PMID: 11427103]
7.
Hamilton MTHamilton DGZderic TW. Role of low energy expenditure and sitting in obesity, metabolic syndrome, type 2 diabetes, and cardiovascular disease. Diabetes. 2007;56:2655-67. [PMID: 17827399]
8.
Craft LLZderic TWGapstur SMVaniterson EHThomas DMSiddique Jet al. Evidence that women meeting physical activity guidelines do not sit less: an observational inclinometry study. Int J Behav Nutr Phys Act. 2012;9:122. [PMID: 23034100]  doi: 10.1186/1479-5868-9-122
9.
Moher DLiberati ATetzlaff JAltman DGPRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151:264-9, W64. [PMID: 19622511]
10.
Salmon JBauman ACrawford DTimperio AOwen N. The association between television viewing and overweight among Australian adults participating in varying levels of leisure-time physical activity. Int J Obes Relat Metab Disord. 2000;24:600-6. [PMID: 10849582]
11.
Tremblay MSColley RCSaunders TJHealy GNOwen N. Physiological and health implications of a sedentary lifestyle. Appl Physiol Nutr Metab. 2010;35:725-40. [PMID: 21164543]  doi: 10.1139/H10-079
12.
Proper KISingh ASvanMechelen WChinapaw MJ. Sedentary behaviors and health outcomes among adults: a systematic review of prospective studies. Am J Prev Med. 2011;40:174-82. [PMID: 21238866]  doi: 10.1016/j.amepre.2010.10.015
13.
Hoogendoorn WEvanPoppel MNBongers PMKoes BWBouter LM. Systematic 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]
14.
Singh ASMulder CTwisk JWvan Mechelen WChinapaw MJ. Tracking of childhood overweight into adulthood: a systematic review of the literature. Obes Rev. 2008;9:474-88. [PMID: 18331423]  doi: 10.1111/j.1467-789X.2008.00475.x
15.
Hayden JACôté PBombardier C. Evaluation of the quality of prognosis studies in systematic reviews. Ann Intern Med. 2006;144:427-37. [PMID: 16549855]
16.
Koeneman MAVerheijden MWChinapaw MJHopman-Rock M. Determinants of physical activity and exercise in healthy older adults: a systematic review. Int J Behav Nutr Phys Act. 2011;8:142. [PMID: 22204444]  doi: 10.1186/1479-5868-8-142
17.
Borenstein MHedges LHiggins JRothstein H. Comprehensive Meta Analysis. 2nd ed. Englewood, NJ: Biostat; 2005.
18.
Viechtbauer W. Conducting meta-analyses in R with the metafor package. J Stat Softw. 2010;36:1-48.
19.
Zhang JYu KF. What's the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. JAMA. 1998;280:1690-1. [PMID: 9832001]
20.
Wilmot EGEdwardson CLAchana FADavies MJGorely TGray LJet al. Sedentary time in adults and the association with diabetes, cardiovascular disease and death: systematic review and meta-analysis. Diabetologia. 2012;55:2895-905. [PMID: 22890825]  doi: 10.1007/s00125-012-2677-z
21.
Higgins JPThompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21:1539-58. [PMID: 12111919]
22.
Knapp GHartung J. Improved tests for a random effects meta-regression with a single covariate. Stat Med. 2003;22:2693-710. [PMID: 12939780]
23.
Egger MDavey Smith GSchneider MMinder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629-34. [PMID: 9310563]
24.
Dunstan DWBarr ELHealy GNSalmon JShaw JEBalkau Bet al. Television viewing time and mortality: the Australian Diabetes, Obesity and Lifestyle Study (AusDiab). Circulation. 2010;121:384-91. [PMID: 20065160]  doi: 10.1161/CIRCULATIONAHA.109.894824
25.
George ESRosenkranz RRKolt GS. Chronic disease and sitting time in middle-aged Australian males: findings from the 45 and Up Study. Int J Behav Nutr Phys Act. 2013;10:20. [PMID: 23394382]  doi: 10.1186/1479-5868-10-20
26.
Inoue MIso HYamamoto SKurahashi NIwasaki MSasazuki Set alJapan Public Health Center-Based Prospective Study Group. Daily 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 Epidemiol. 2008;18:522-30. [PMID: 18504139]  doi: 10.1016/j.annepidem.2008.03.008
27.
Katzmarzyk PTChurch TSCraig CLBouchard C. Sitting time and mortality from all causes, cardiovascular disease, and cancer. Med Sci Sports Exerc. 2009;41:998-1005. [PMID: 19346988]  doi: 10.1249/MSS.0b013e3181930355
28.
Koster ACaserotti PPatel KVMatthews CEBerrigan DVanDomelen DRet al. Association of sedentary time with mortality independent of moderate to vigorous physical activity. PLoS One. 2012;7:e37696. [PMID: 22719846]  doi: 10.1371/journal.pone.0037696
29.
Matthews CEGeorge SMMoore SCBowles HRBlair APark Yet al. Amount of time spent in sedentary behaviors and cause-specific mortality in US adults. Am J Clin Nutr. 2012;95:437-45. [PMID: 22218159]  doi: 10.3945/ajcn.111.019620
30.
Patel AVBernstein LDeka AFeigelson HSCampbell PTGapstur SMet al. Leisure time spent sitting in relation to total mortality in a prospective cohort of US adults. Am J Epidemiol. 2010;172:419-29. [PMID: 20650954]  doi: 10.1093/aje/kwq155
31.
Pavey TGPeeters GGBrown WJ. Sitting-time and 9-year all-cause mortality in older women. Br J Sports Med. 2012. [PMID: 23243009]
32.
Seguin RBuchner DMLiu JAllison MManini TWang CYet al. Sedentary behavior and mortality in older women: the Women's Health Initiative. Am J Prev Med. 2014;46:122-35. [PMID: 24439345]  doi: 10.1016/j.amepre.2013.10.021
33.
Stamatakis EHamer MDunstan DW. Screen-based entertainment time, all-cause mortality, and cardiovascular events: population-based study with ongoing mortality and hospital events follow-up. J Am Coll Cardiol. 2011;57:292-9. [PMID: 21232666]  doi: 10.1016/j.jacc.2010.05.065
34.
van der Ploeg HPChey TKorda RJBanks EBauman A. Sitting time and all-cause mortality risk in 222 497 Australian adults. Arch Intern Med. 2012;172:494-500. [PMID: 22450936]  doi: 10.1001/archinternmed.2011.2174
35.
León-Muñoz LMMartiacute;nez-Gómez DBalboa-Castillo TLópez-García EGuallar-Castillón PRodríguez-Artalejo F. Continued sedentariness, change in sitting time, and mortality in older adults. Med Sci Sports Exerc. 2013;45:1501-7. [PMID: 23439420]  doi: 10.1249/MSS.0b013e3182897e87
36.
Kim YWilkens LRPark SYGoodman MTMonroe KRKolonel LN. Association between various sedentary behaviours and all-cause, cardiovascular disease and cancer mortality: the Multiethnic Cohort Study. Int J Epidemiol. 2013;42:1040-56. [PMID: 24062293]  doi: 10.1093/ije/dyt108
37.
Wijndaele KBrage SBesson HKhaw KTSharp SJLuben Ret al. Television viewing time independently predicts all-cause and cardiovascular mortality: the EPIC Norfolk study. Int J Epidemiol. 2011;40:150-9. [PMID: 20576628]  doi: 10.1093/ije/dyq105
38.
Chomistek AKManson JEStefanick MLLu BSands-Lincoln MGoing SBet al. Relationship of sedentary behavior and physical activity to incident cardiovascular disease: results from the Women's Health Initiative. J Am Coll Cardiol. 2013;61:2346-54. [PMID: 23583242]  doi: 10.1016/j.jacc.2013.03.031
39.
Stamatakis EHamer MDunstan DW. Screen-based entertainment time, all-cause mortality, and cardiovascular events: population-based study with ongoing mortality and hospital events follow-up. J Am Coll Cardiol. 2011;57:292-9. [PMID: 21232666]  doi: 10.1016/j.jacc.2010.05.065
40.
Wijndaele KBrage SBesson HKhaw KTSharp SJLuben Ret al. Television viewing and incident cardiovascular disease: prospective associations and mediation analysis in the EPIC Norfolk Study. PLoS One. 2011;6:e20058. [PMID: 21647437]  doi: 10.1371/journal.pone.0020058
41.
Campbell PTPatel AVNewton CCJacobs EJGapstur SM. Associations of recreational physical activity and leisure time spent sitting with colorectal cancer survival. J Clin Oncol. 2013;31:876-85. [PMID: 23341510]  doi: 10.1200/JCO.2012.45.9735
42.
Friberg EMantzoros CSWolk A. Physical activity and risk of endometrial cancer: a population-based prospective cohort study. Cancer Epidemiol Biomarkers Prev. 2006;15:2136-40. [PMID: 17057024]
43.
Howard RAFreedman DMPark YHollenbeck ASchatzkin ALeitzmann MF. Physical activity, sedentary behavior, and the risk of colon and rectal cancer in the NIH-AARP Diet and Health Study. Cancer Causes Control. 2008;19:939-53. [PMID: 18437512]  doi: 10.1007/s10552-008-9159-0
44.
Zhang MXie XLee AHBinns CW. Sedentary behaviours and epithelial ovarian cancer risk. Cancer Causes Control. 2004;15:83-9. [PMID: 14970738]
45.
George SMIrwin MLMatthews CEMayne STGail MHMoore SCet al. Beyond recreational physical activity: examining occupational and household activity, transportation activity, and sedentary behavior in relation to postmenopausal breast cancer risk. Am J Public Health. 2010;100:2288-95. [PMID: 20864719]  doi: 10.2105/AJPH.2009.180828
46.
Hildebrand JSGapstur SMCampbell PTGaudet MMPatel AV. Recreational physical activity and leisure-time sitting in relation to postmenopausal breast cancer risk. Cancer Epidemiol Biomarkers Prev. 2013;22:1906-12. [PMID: 24097200]  doi: 10.1158/1055-9965.EPI-13-0407
47.
Teras LRGapstur SMDiver WRBirmann BMPatel AV. Recreational physical activity, leisure sitting time and risk of non-Hodgkin lymphoid neoplasms in the American Cancer Society Cancer Prevention Study II Cohort. Int J Cancer. 2012;131:1912-20. [PMID: 22275172]  doi: 10.1002/ijc.27445
48.
Peplonska BLissowska JHartman TJSzeszenia-Dabrowska NBlair AZatonski Wet al. Adulthood lifetime physical activity and breast cancer. Epidemiology. 2008;19:226-36. [PMID: 18277160]  doi: 10.1097/EDE.0b013e3181633bfb
49.
Hu FBLi TYColditz GAWillett WCManson JE. Television watching and other sedentary behaviors in relation to risk of obesity and type 2 diabetes mellitus in women. JAMA. 2003;289:1785-91. [PMID: 12684356]
50.
Krishnan SRosenberg LPalmer JR. Physical activity and television watching in relation to risk of type 2 diabetes: the Black Women's Health Study. Am J Epidemiol. 2009;169:428-34. [PMID: 19056835]  doi: 10.1093/aje/kwn344
51.
Ford ESSchulze MBKröger JPischon TBergmann MMBoeing H. Television watching and incident diabetes: Findings from the European Prospective Investigation into Cancer and Nutrition-Potsdam Study. J Diabetes. 2010;2:23-7. [PMID: 20923471]  doi: 10.1111/j.1753-0407.2009.00047.x
52.
Tran BFalster MODouglas KBlyth FJorm LR. Health behaviours and potentially preventable hospitalisation: a prospective study of older Australian adults. PLoS One. 2014;9:e93111. [PMID: 24691471]  doi: 10.1371/journal.pone.0093111
53.
Higgins JPThompson SGDeeks JJAltman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557-60. [PMID: 12958120]
54.
Schmid DLeitzmann MF. Television viewing and time spent sedentary in relation to cancer risk: a meta-analysis. J Natl Cancer Inst. 2014;106. [PMID: 24935969]  doi: 10.1093/jnci/dju098
55.
Colley RCGarriguet DJanssen ICraig CLClarke JTremblay MS. Physical activity of Canadian adults: accelerometer results from the 2007 to 2009 Canadian Health Measures Survey. Health Rep. 2011;22:7-14. [PMID: 21510585]
56.
Atkin AJGorely TClemes SAYates TEdwardson CBrage Set al. Methods of Measurement in epidemiology: sedentary Behaviour. Int J Epidemiol. 2012;41:1460-71. [PMID: 23045206]  doi: 10.1093/ije/dys118
57.
Taylor RSBrown AEbrahim SJolliffe JNoorani HRees Ket al. Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med. 2004;116:682-92. [PMID: 15121495]
58.
Whaley MHBrubaker PHOtto RMArmstrong LEAmerican College of Sports Medicine. ACSM's Guidelines for Exercise Testing and Prescription. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2006.
59.
Wisse WBoer Rookhuizen Mde Kruif MDvan Rossum JJordans Iten Cate Het al. Prescription of physical activity is not sufficient to change sedentary behavior and improve glycemic control in type 2 diabetes patients. Diabetes Res Clin Pract. 2010;88:e10-3. [PMID: 20138384]  doi: 10.1016/j.diabres.2010.01.015
60.
Sørensen JBSkovgaard TPuggaard L. Exercise on prescription in general practice: a systematic review. Scand J Prim Health Care. 2006;24:69-74. [PMID: 16690553]
61.
Owen NSugiyama TEakin EEGardiner PATremblay MSSallis JF. Adults' sedentary behavior determinants and interventions. Am J Prev Med. 2011;41:189-96. [PMID: 21767727]  doi: 10.1016/j.amepre.2011.05.013
62.
Ainsworth BEMacera CA. Physical Activity and Public Health Practice. Philadelphia: Taylor & Francis; 2012.
63.
Dunstan DWKingwell BALarsen RHealy GNCerin EHamilton MTet al. Breaking up prolonged sitting reduces postprandial glucose and insulin responses. Diabetes Care. 2012;35:976-83. [PMID: 22374636]  doi: 10.2337/dc11-1931

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Seigo Urushidani, MD, Akira Kuriyama, MD, MPH 17 February 2015
Sedentary time and risk of mortality

Biswas and colleagues conducted a meta-analysis of observational studies to examine the association between sedentary time and various health outcomes (1). That analysis suggested that sedentary time was associated with an increased risk of all-cause mortality, but suffered from substantial heterogeneity (I2 = 94.96%). We wonder whether further sensitivity analyses were needed to elucidate the cause of this heterogeneity.
First, sample sizes varied across studies, ranging from 217 to 240 819. A forest plot suggested that five of the seven studies with <10 000 participants presented more exaggerated point estimates of hazard ratios when compared with the remaining eight studies. In clinical trials in medicine, large treatment effects are known to be derived from small-sized trials (2). Likewise, smaller observational studies could be hypothesized to present larger hazard ratios compared with larger studies. An analysis examining the association between sample size and all-cause mortality might therefore be intriguing.
Second, many of the studies included in the analysis of all-cause mortality were susceptible to attrition bias. Among the 13 studies, the completeness of one was unclear, whereas that of six in the long term was less than 80%. A sensitivity analysis excluding studies at risk of attrition bias should be considered.
Third, the selection criteria of participants included in the meta-analysis were somewhat unclear. For example, participants included from one study had a sitting time of ≥11 h/day (3), while those from another study sat ≥9 h/day (4). Biswas et al. admitted that operational definitions and cutoffs were applied during the categorization of sedentary time. If so, analysis using different cutoffs of calculated energy expenditures or sedentary time might identify populations at higher risk of mortality.
Finally, how the authors extracted the information from certain populations is unclear. All participants from a study seemed to be included in the analysis, while Biswas et al. quoted the number of deaths from the subgroup of sedentary time ≥11 h/day from the same study (5). Clarification of this inconsistency is needed.
The studies included in this systematic review were heterogeneous in terms of age. Every life stage has its own societal role and lifestyle. Future research should define target generations or life stages to clarify who could benefit in the long run from not being sedentary.


References
1. Biswas A, Oh PI, Faulkner GE, Bajaj RR, Silver MA, Mitchell MS, et al. Sedentary Time and Its Association With Risk for Disease Incidence, Mortality, and Hospitalization in Adults: A Systematic Review and Meta-analysis. Ann Intern Med. 2015;162(2):123-32.
2. Pereira TV, Horwitz RI, Ioannidis JP. Empirical evaluation of very large treatment effects of medical interventions. JAMA. 2012;308(16):1676-84.
3. Seguin R, Buchner DM, Liu J, Allison M, Manini T, Wang CY, et al. Sedentary behavior and mortality in older women: the Women's Health Initiative. Am J Prev Med. 2014;46(2):122-35.
4. Matthews CE, George SM, Moore SC, Bowles HR, Blair A, Park Y, et al. Amount of time spent in sedentary behaviors and cause-specific mortality in US adults. Am J Clin Nutr. 2012;95(2):437-45.
5. van der Ploeg HP, Chey T, Korda RJ, Banks E, Bauman A. Sitting time and all-cause mortality risk in 222 497 Australian adults. Arch Intern Med. 2012;172(6):494-500.
Morton A. Kapusta, MD 19 March 2015
Comment
The cited review of Dr. Morris’ population studies, which were done more than fifty years ago, (1) supports his conclusions, which, in turn, supports the current Meta-analysis.
(1) Paffenbarger RS, Blair SN, Lee I-M. A history of physical activity, cardiovascular health and longevity: The contribution of Jeremy N Morris, D Sc, DPH, FRCP. Int.J. Epidemiol.2001 30 (5): 1184-1192.doi:10.1093/ise/30.5.1184
Aviroop Biswas BSc. and David A. Alter, MD PhD 26 March 2015
Response to Urushidani and Kuriyama
We acknowledge the concerns of Urushidani and Kuriyama regarding our study’s heterogeneity. Indeed, we focused much of our discussion section to factors that may have contributed to heterogeneity.
First, we agree that smaller sample sizes of two studies (1, 2) may exaggerate point estimates. Nonetheless, the majority of studies based on large cohorts (all but 2 based on >500 participants) show a consistent positive association, and then the precision of effect size should not change sufficiently to merit further examination.
Second, with regard to attrition bias, excluding studies at risk of attrition bias may be helpful, but conclusions may be misleading due to variability of follow-up times. This may unfairly penalize studies with lower completeness but longer follow-up duration over studies with high completeness but shorter follow-up.
Third, we agree for a more standardized approach to quantifying sedentary times. We ensured our findings were comparable by prioritizing the longest reported sitting time, and if this was not reported directly, the most comparable measure was selected (e.g. longest screen time). We resisted standardizing sedentary cut offs as the variability may lead to misleading conclusions. For example, a question asking the “time spent sitting while doing things, such as visiting friends etc.” (2) may elicit a different response to asking “about how many hours in each 24-hour day do you usually spend sitting?” (3).
Finally on the last point of inconsistencies extracting information from a study (3), although we reported deaths from all-cause mortality for sedentary time ≥11 h/day, this was based on the combined total (both) for men and women i.e. 649 deaths/222,497 participants. Information was extracted from the total population of men and women across all studies, and we combined results when presented separately for men and women.
Heterogeneity remains one of many important limitations. Additional analyses while intriguing, will likely not address the many unanswered questions that remain. Instead, we hope that our meta-analysis serves as an impetus for future research.

1. George ES, Rosenkranz RR, Kolt GS. Chronic disease and sitting time in middle-aged Australian males: findings from the 45 and Up Study. Int J Behav Nutr Phys Act. 2013;10(1):20.
2. Pavey TG, Peeters GG, Brown WJ. Sitting-time and 9-year all-cause mortality in older women. Br J Sports Med. 2012.
3. van der Ploeg HP, Chey T, Korda RJ, Banks E, Bauman A. Sitting time and all-cause mortality risk in 222 497 Australian adults. Arch Intern Med. 2012;172(6):494.

Information & Authors

Information

Published In

cover image Annals of Internal Medicine
Annals of Internal Medicine
Volume 162Number 220 January 2015
Pages: 123 - 132

History

Published online: 20 January 2015
Published in issue: 20 January 2015

Keywords

Authors

Affiliations

Aviroop Biswas, BSc
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.
Paul I. Oh, MD, MSc
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.
Guy E. Faulkner, PhD
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.
Ravi R. Bajaj, MD
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.
Michael A. Silver, BSc
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.
Marc S. Mitchell, MSc
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.
David A. Alter, MD, PhD
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, [email protected].
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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Aviroop Biswas, Paul I. Oh, Guy E. Faulkner, et al. Sedentary Time and Its Association With Risk for Disease Incidence, Mortality, and Hospitalization in Adults: A Systematic Review and Meta-analysis. Ann Intern Med.2015;162:123-132. [Epub 20 January 2015]. doi:10.7326/M14-1651

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