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Wilmot EG, Edwardson CL, Achana FA, et al. 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: 6.67). 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.

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    • "It has been shown that sedentary time has specific metabolic consequences even among those meeting the moderate-to-vigorous physical activity guidelines. A gradient exists with higher morbidity and mortality rates among those who spend more of their time being sedentary , independent of whether or not they engage in regular physical activity [2, 3]. Typically, " sedentary " is defined as any waking activity that requires an energy expenditure ranging from 1.0 to 1.5 (basal metabolic rate) while in a sitting or reclining posture [4, 5]. "
    [Show abstract] [Hide abstract] ABSTRACT: Background Recent research shows that sedentary behaviour is associated with adverse cardio-metabolic consequences even among those considered sufficiently physically active. In order to successfully develop interventions to address this unhealthy behaviour, factors that influence sedentariness need to be identified and fully understood. The aim of this review is to identify individual, social, environmental, and policy-related determinants or correlates of sedentary behaviours among adults aged 18–65 years. Methods PubMed, Embase, CINAHL, PsycINFO and Web of Science were searched for articles published between January 2000 and September 2015. The search strategy was based on four key elements and their synonyms: (a) sedentary behaviour (b) correlates (c) types of sedentary behaviours (d) types of correlates. Articles were included if information relating to sedentary behaviour in adults (18–65 years) was reported. Studies on samples selected by disease were excluded. The full protocol is available from PROSPERO (PROSPERO 2014:CRD42014009823). Results 74 original studies were identified out of 4041: 71 observational, two qualitative and one experimental study. Sedentary behaviour was primarily measured as self-reported screen leisure time and total sitting time. In 15 studies, objectively measured total sedentary time was reported: accelerometry (n = 14) and heart rate (n = 1). Individual level factors such as age, physical activity levels, body mass index, socio-economic status and mood were all significantly correlated with sedentariness. A trend towards increased amounts of leisure screen time was identified in those married or cohabiting while having children resulted in less total sitting time. Several environmental correlates were identified including proximity of green space, neighbourhood walkability and safety and weather. Conclusions Results provide further evidence relating to several already recognised individual level factors and preliminary evidence relating to social and environmental factors that should be further investigated. Most studies relied upon cross-sectional design limiting causal inference and the heterogeneity of the sedentary measures prevented direct comparison of findings. Future research necessitates longitudinal study designs, exploration of policy-related factors, further exploration of environmental factors, analysis of inter-relationships between identified factors and better classification of sedentary behaviour domains.
    Full-text · Article · Dec 2016 · BMC Public Health
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    • "Opt to Stand intervention group participants showed a downward trajectory in sitting time and a commensurate increase in standing time across the measurement time points over 19 weeks. These changes are important in light of the evidence about the harms linked to prolonged sitting (Wilmot et al, 2012; Chau et al, 2013 ) and potential benefits of increasing standing as one way to reduce sitting time (van der Ploeg et al, 2014; Matthews et al, 2015). Our data strongly suggest that sit-stand desks are a feasible option for increasing standing in desk-based workers that can be translated to non-health-related workplaces, in this case, a call center environment. "
    [Show abstract] [Hide abstract] ABSTRACT: This study evaluated the effects of sit-stand desks on workers' objectively and subjectively assessed sitting, physical activity, and productivity. This quasi-experimental study involved one intervention group (n = 16) and one comparison group ( n = 15). Participants were call center employees from two job-matched teams at a large telecommunications company in Sydney, Australia (45% female, 33 ±. 11 years old). Intervention participants received a sit-stand desk, brief training, and daily e-mail reminders to stand up more frequently for the first 2. weeks post-installation. Control participants carried out their usual work duties at seated desks. Primary outcomes were workday sitting and physical activity assessed using ActivPAL or ActiGraph devices and self-report questionnaires. Productivity outcomes were company-specific objective metrics (e.g., hold time, talking time, absenteeism) and subjective measures. Measurements were taken at baseline, 1, 4, and 19. weeks post-installation. Intervention participants increased standing time after 1. week (+. 73. min/workday (95% CI: 22, 123)) and 4. weeks (+. 96. min/workday (95% CI: 41, 150)) post-intervention, while control group showed no changes. Between-group differences in standing time at one and 4. weeks were + 78 (95% CI: 9, 147) and + 95. min/workday (95% CI: 15, 174), respectively. Sitting time in the intervention group changed by -. 64 (95% CI: - 125, - 2), - 76 (95% CI: - 142, - 11), and - 100. min/workday (95% CI: - 172, -. 29) at 1, 4, and 19. weeks post-installation, respectively, while the control group showed no changes. No changes were observed in productivity outcomes from baseline to follow-up in either group. Sit-stand desks can increase standing time at work in call center workers without reducing productivity.
    Full-text · Article · Jun 2016
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    • "Although we found an increased mortality risk for those with long sedentary durations, no dose-response association was present and the effect diminished after full adjustment. Several authors reported persistent positive dose-response relationships between sedentary time and mortality [14,27,28]. Two studies used objective data on sedentariness measured with an Actigraph sensor [14,27]. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Physical activity is an important component of health. Recommendations based on sensor measurements are sparse in older people. The aim of this study was to analyse the effect of objectively measured walking and sedentary duration on four-year mortality in community-dwelling older people. Methods: Between March 2009 and April 2010, physical activity of 1271 participants (≥65 years, 56.4% men) from Southern Germany was measured over one week using a thigh-worn uni-axial accelerometer (activPAL; PAL Technologies, Glasgow, Scotland). Mortality was assessed during a four-year follow-up. Cox-proportional-hazards models were used to estimate the associations between walking (including low to high intensity) and sedentary duration with mortality. Models were adjusted for age and sex, additional epidemiological variables, and selected biomarkers. Results: An inverse relationship between walking duration and mortality with a minimum risk for the 3rd quartile (102.2 to128.4 minutes walking daily) was found even after multivariate adjustment with HRs for quartiles 2 to 4 compared to quartile 1 of 0.45 (95%-CI: 0.26; 0.76), 0.18 (95%-CI: 0.08; 0.41), 0.39 (95%-CI: 0.19; 0.78), respectively. For sedentary duration an age- and sex-adjusted increased mortality risk was observed for the 4th quartile (daily sedentary duration ≥1137.2 min.) (HR 2.05, 95%-CI: 1.13; 3.73), which diminished, however, after full adjustment (HR 1.63, 95%-CI: 0.88; 3.02). Furthermore, our results suggest effect modification between walking and sedentary duration, such that in people with low walking duration a high sedentary duration was noted as an independent factor for increased mortality. Conclusions: In summary, walking duration was clearly associated with four-year overall mortality in community-dwelling older people.
    Full-text · Article · Apr 2016 · PLoS ONE
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