Sedentary time in adults and the association with diabetes, cardiovascular disease and death: Systematic review and meta-analysis

Department of Cardiovascular Sciences, University of Leicester, Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK.
Diabetologia (Impact Factor: 6.88). 08/2012; 55(11):2895-905. DOI: 10.1007/s00125-012-2677-z
Source: PubMed

ABSTRACT Sedentary (sitting) behaviours are ubiquitous in modern society. We conducted a systematic review and meta-analysis to examine the association of sedentary time with diabetes, cardiovascular disease and cardiovascular and all-cause mortality.
Medline, Embase and the Cochrane Library databases were searched for terms related to sedentary time and health outcomes. Cross-sectional and prospective studies were included. RR/HR and 95% CIs were extracted by two independent reviewers. Data were adjusted for baseline event rate and pooled using a random-effects model. Bayesian predictive effects and intervals were calculated to indicate the variance in outcomes that would be expected if new studies were conducted in the future.
Eighteen studies (16 prospective, two cross-sectional) were included, with 794,577 participants. Fifteen of these studies were moderate to high quality. The greatest sedentary time compared with the lowest was associated with a 112% increase in the RR of diabetes (RR 2.12; 95% credible interval [CrI] 1.61, 2.78), a 147% increase in the RR of cardiovascular events (RR 2.47; 95% CI 1.44, 4.24), a 90% increase in the risk of cardiovascular mortality (HR 1.90; 95% CrI 1.36, 2.66) and a 49% increase in the risk of all-cause mortality (HR 1.49; 95% CrI 1.14, 2.03). The predictive effects and intervals were only significant for diabetes.
Sedentary time is associated with an increased risk of diabetes, cardiovascular disease and cardiovascular and all-cause mortality; the strength of the association is most consistent for diabetes.

Download full-text


Available from: Stuart J.H. Biddle, Aug 30, 2015
1 Follower
    • "Sedentary behaviors are characterized by a sitting or lying posture and low energy expenditure (Sedentary Behaviour Research Network, 2012). In older adults, sedentary time is related to obesity, cardiovascular disease, diabetes, and mortality even after adjustment moderate-to-vigorous physical activity (Leon-Munoz et al., 2013; Proper, Singh, van Mechelen, & Chinapaw, 2011; Wilmot et al., 2012). Overweight and obese older adults have low levels of physical activity, high sedentary time, and often have multiple chronic conditions (Evenson, "
    [Show abstract] [Hide abstract]
    ABSTRACT: Overweight and obese older adults have high sedentary time. We tested the feasibility and preliminary effects of a sedentary time reduction intervention among adults over age 60 with a body mass index over 27 kg/m(2) using a nonrandomized one-arm design. Participants (N = 25, mean age = 71.4, mean body mass index = 34) completed an 8-week theory-based intervention targeting reduced total sitting time and increased sit-to-stand transitions. An inclinometer (activPAL™) measured the primary outcomes, change in total sitting time and sit-to-stand transitions. Secondary outcomes included physical activity (ActiGraph GT3X+ accelerometer), self-reported sedentary behaviors, physical function (Short Physical Performance Battery), depressive symptoms (8-item Patient Health Questionnaire), quality of life (PROMIS), and study satisfaction. Paired t tests examined pre-post test changes in sitting time, sit-to-stand transitions, and secondary outcomes. Inclinometer measured sitting time decreased by 27 min/day (p < .05) and sit-to-stand transitions increased by 2 per day (p > .05), while standing time increased by 25 min/day (p < .05). Accelerometer measured sedentary time, light-intensity, and moderate-to-vigorous physical activity improved (all p values ≤ .05). Self-reported sitting time, gait speed, and depressive symptoms also improved (all p values < .05). Effect sizes were small. Study satisfaction was high. Reducing sitting time is feasible, and the intervention shows preliminary evidence of effectiveness among older adults with overweight and obesity. Randomized trials of sedentary behavior reduction in overweight and obese older adults, most of whom have multiple chronic conditions, may be promising. © 2015 Society for Public Health Education.
    Health Education &amp Behavior 03/2015; DOI:10.1177/1090198115577378 · 1.54 Impact Factor
  • Source
    • "However, research to date has primarily used commercially available units and watches. Researchers and practitioners are always seeking ways to optimise population-based physical activity assessment as well as novel physical activity interventions to improve adherence and enhance health outcomes (Haskell et al., 2007; Nelson et al., 2007; Wilmot et al., 2012; Zinman, Ruderman, Campaigne, Devlin, & Schneider, 2004). As an objective measure of physical activity, GPS is more accurate than self-report (Badland, Duncan, Oliver, Duncan, & Mavoa, 2010; Duncan & Mummery, 2007; Stopher, Fitzgerald, & Xu, 2007), is less time consuming and impractical than direct observation (Maddison & Ni Mhurchu, 2009) and unlike pedometers and accelerometers provides contextual information of where activities occur (Krenn, Titze, Oja, Jones, & Ogilvie, 2011). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Abstract This study assessed the validity and reliability of an iPhone(TM) "app" and two sport-specific global positioning system (GPS) units to monitor distance, intensity and contextual physical activity. Forty (23 female, 17 male) 18-55-year-olds completed two trials of six laps around a 400-m athletics track wearing GPSports Pro(TM) and WiSpi(TM) units (5 and 1 Hz) and an iPhone(TM) with a Motion X GPS(TM) "app" that used the inbuilt iPhone(TM) location services application programming interface to obtain its sampling rate (which is likely to be ≤1 Hz). Overall, the statistical agreement, assessed using t-tests and Bland-Altman plots, indicated an underestimation of the known track distance (2.400 km) and average speed by the Motion X GPS(TM) "app" and GPSports Pro(TM) while the GPSports WiSpi(TM) device overestimated these outcomes. There was a ≤3% variation between trials for distance and average speed when measured by any of the GPS devices. Thus, the smartphone "app" trialled could be considered as an accessible alternative to provide high-quality contextualised data to enable ubiquitous monitoring and modification of programmes to ensure appropriate intensity and type of physical activity is prescribed and more importantly adhered to.
    Journal of Sports Sciences 01/2015; 33(14):1-8. DOI:10.1080/02640414.2014.994659 · 2.10 Impact Factor
  • Source
    • "The quality of the original studies was assessed in 16 (60%) reviews,[15], [16], [18], [20], [21], [26], [27], [28], [31], [32], [34], [36], [38]–[41], and 6 (22%) performed a meta-analysis. [19], [26], [28], [29], [34], [37]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective 1) To synthesize the current observational evidence for the association between sedentary behavior and health outcomes using information from systematic reviews. 2) To assess the methodological quality of the systematic reviews found. Methodology/Principal Findings Medline; Excerpta Medica (Embase); PsycINFO; and Web of Science were searched for reviews published up to September 2013. Additional publications were provided by Sedentary Behaviour Research Network members. The methodological quality of the systematic reviews was evaluated using recommended standard criteria from AMSTAR. For each review, improper use of causal language in the description of their main results/conclusion was evaluated. Altogether, 1,044 review titles were identified, 144 were read in their entirety, and 27 were included. Based on the systematic reviews with the best methodological quality, we found in children and adolescents, strong evidence of a relationship between time spent in sedentary behavior and obesity. Moreover, moderate evidence was observed for blood pressure and total cholesterol, self-esteem, social behavior problems, physical fitness and academic achievement. In adults, we found strong evidence of a relationship between sedentary behavior and all-cause mortality, fatal and non-fatal cardiovascular disease, type 2 diabetes and metabolic syndrome. In addition, there is moderate evidence for incidence rates of ovarian, colon and endometrial cancers. Conclusions This overview based on the best available systematics reviews, shows that sedentary behavior may be an important determinant of health, independently of physical activity. However, the relationship is complex because it depends on the type of sedentary behavior and the age group studied. The relationship between sedentary behavior and many health outcomes remains uncertain; thus, further studies are warranted.
    PLoS ONE 08/2014; 9(8):e105620. DOI:10.1371/journal.pone.0105620 · 3.23 Impact Factor
Show more