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.


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


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.


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


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

Primary Funding Source:



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