Sedentarismo, la enfermedad del siglo xxi

Abstract

Resumen
El sedentarismo y la inactividad física son altamente prevalentes globalmente y están asociados a un amplio rango de enfermedades crónicas y muerte prematura. El interés en la conducta sedentaria está justificado por la creciente evidencia que apunta hacia una relación entre esta conducta y el incremento en la prevalencia de obesidad, diabetes y enfermedad cardiovascular. A través de la historia es bien conocido que ser inactivo no es saludable, pero hoy día casi un tercio de la población del mundo es inactiva, lo que representa un serio problema de salud pública.

Full text

Clin
Investig
Arterioscler.
2019;31(5):233---240
www.elsevier.es/arterio
REVIEW
ARTICLE
Sedentarism,
a
disease
from
xxi
century
J.
Ildefonzo
Arocha
Rodulfo
Sociedad
Venezolana
de
Cardiología,
Caracas,
Venezuela
KEYWORDS
Sedentarism;
Sedentary;
Physical
inactivity;
Cardiovascular
disease;
Diabetes
Abstract
Sedentarism
and
physical
inactivity
is
highly
prevalent
globally,
and
are
associated
with
a
wide
range
of
chronic
diseases
and
premature
deaths.
The
interest
in
sedentary
behaviour
is
justified
by
a
growing
body
of
evidence
that
points
to
a
relationship
between
this
lifestyle
and
the
increase
in
the
prevalence
of
obesity,
diabetes
and
cardiovascular
disease.
It
has
been
known
throughout
history
that
being
inactive
is
unhealthy,
but
nowadays
almost
one-third
of
the
world’s
population
is
inactive,
thus
representing
a
major
public
health
problem.
©
2019
Published
by
Elsevier
Espa˜
na,
S.L.U.
on
behalf
of
Sociedad
Espa˜
nola
de
Arteriosclerosis.
PALABRAS
CLAVE
Sedentarismo;
Sedentario;
Inactividad
física;
Enfermedad
cardiovascular;
Diabetes
Sedentarismo,
la
enfermedad
del
siglo
xxi
Resumen
El
sedentarismo
y
la
inactividad
física
son
altamente
prevalentes
globalmente
y
están
asociados
a
un
amplio
rango
de
enfermedades
crónicas
y
muerte
prematura.
El
interés
en
la
conducta
sedentaria
está
justificado
por
la
creciente
evidencia
que
apunta
hacia
una
relación
entre
esta
conducta
y
el
incremento
en
la
prevalencia
de
obesidad,
diabetes
y
enfermedad
cardiovascular.
A
través
de
la
historia
es
bien
conocido
que
ser
inactivo
no
es
saludable,
pero
hoy
día
casi
un
tercio
de
la
población
del
mundo
es
inactiva,
lo
que
representa
un
serio
problema
de
salud
pública.
©
2019
Publicado
por
Elsevier
Espa˜
na,
S.L.U.
en
nombre
de
Sociedad
Espa˜
nola
de
Arterioscle-
rosis.
Introduction
Many
readers
will
be
aware
of
the
dose/response
relation-
ship
that
exists
between
exercise
and
health:
the
greater
the
physical
activity
(PA),
the
better
the
individual’s
overall
health.
However,
few
studies
have
focused
on
the
conse-
DOI
of
original
article:
https://doi.org/10.1016/j.arteri.2019.
04.004
E-mail
address:
jiarocha@gmail.com
quences
of
lack
of
PA,
and
this
will
be
the
main
subject
of
this
article.
It
is
easier
to
understand
the
significance
of
the
change
in
human
beings
from
a
nomadic
to
a
sedentary
lifestyle
by
looking
back
on
our
evolutionary
history.
About
3.7
million
years
ago,
one
of
the
first
hominids
to
walk
on
two
feet
appeared
in
Ethiopia:
Australopithecus
afarensis.
Bipedalism
allowed
these
hominids
to
use
their
hands
to
grasp
branches
and
stones
as
tools
or
weapons,
and
to
gather
food
(fruits,
seeds,
roots,
etc.),
while
their
long
legs
allowed
them
to
travel
farther
and
depend
less
on
trees.
2529-9123/©
2019
Published
by
Elsevier
Espa˜
na,
S.L.U.
on
behalf
of
Sociedad
Espa˜
nola
de
Arteriosclerosis.

234
J.I.
Arocha
Rodulfo
In
addition,
their
slightly
curved
hands,
shorter
fingers,
and
arched
feet
allowed
them
to
climb
trees,
while
the
medial
arch
of
the
foot
allowed
them
to
run
after
their
prey
or
flee
from
predators
or
enemy
tribes.1
The
design
of
the
human
organism
(encoded
in
its
genes)
is
known
to
be
the
result
of
millions
of
years
of
biolog-
ical
evolution.
Nearly
all
the
human
genome
was
formed
before
the
transition
from
hunting
and
gathering
to
farm-
ing,
and
this
is
believed
to
have
been
the
optimal
genome
-
the
one
that
enabled
us
to
adapt
to
the
changing
environ-
mental
conditions
faced
by
our
ancestors
at
each
stage
of
our
evolution.
In
nature,
obtaining
food
always
requires
high
muscle
energy
expenditure.
This
is
true
of
both
carnivores
(run-
ning
in
pursuit
of
prey)
or
herbivores
(looking
for
the
best
foliage
and,
in
smaller
animals,
watching
out
for
preda-
tors).
The
capacity
of
our
metabolism
to
adapt
to
cycles
of
abundance
and
food
shortage
(the
thrifty
genotype)
was
a
beneficial
factor
in
the
evolution
of
our
ancestors.2When
food
was
abundant,
our
thrifty
metabolism
took
over,
allow-
ing
us
to
accumulate
large
amounts
of
energy
in
the
form
of
fatty
deposits
and
muscle
glycogen.
Individuals
with
the
thrifty
phenotype
were
less
likely
to
die
out
during
peri-
ods
of
famine,
since
they
were
more
efficient
at
using
the
energy
stored
in
their
body.
Muscle
proteins
were
conserved,
and
muscle
contraction
was
more
efficient,
increasing
their
likelihood
of
finding
food
and
surviving
the
crisis.2
It
is
also
interesting
to
note
the
impact
on
the
central
nervous
system,
which
controls
all
bodily
movements
at
all
time
variables,
from
milliseconds
to
hours,
days,
months
and
years,
leading
to
the
evolutionary-induced
expansion
of
certain
regions
of
our
cerebral
cortex.1As
a
result,
PA
strengthened
both
muscle
and
brain
cells.
Homo
sapiens
(‘‘wise
man’’,
because
he
had
certain
skills
absent
in
his
predecessors)
appeared
in
Africa
300,000
years
ago
and
ranged
over
the
continent
for
200,000
years
before
spreading
to
the
rest
of
the
world,
even
as
far
as
Aus-
tralia.
It
was
this
expansion
that
sparked
a
major
cognitive
revolution
about
70,000
years
ago,
further
expanding
our
ecological
niches,
defined
as
the
way
in
which
we
interact
with
our
environment.
In
fact,
this
intellectual
‘‘big
bang’’
facilitated
the
development
of
amazing
cognitive
skills,
such
as
the
ability
to
learn,
understand
and
anticipate
complex
phenomena,
memorise
a
great
deal
of
detail,
and
establish
multiple
communications
with
the
environment,
particu-
larly
with
other
humans.3About
10,000
years
ago,
several
human
groups
discovered
ways
to
produce
certain
foods,
compelling
them
to
create
settlements
and
abandon
their
nomadic
lifestyle.3
This
summary
of
our
evolution
shows
that
human
beings
are
active
by
nature.
They
spent
most
of
their
evolution-
ary
history
wandering
over
the
land,
and
only
transitioned
to
sedentary
lifestyle
about
10,000
years
ago,
when
they
became
farmers.
Even
the
most
ancient
civilisations
knew
that
reducing
the
amount
of
physical
effort
made
in
our
daily
life
causes
the
organs
that
govern
bodily
movement
to
lower
their
output
and
adapt
their
operative
capacity
to
the
lower
demands
of
their
social
group.
However,
Hippocrates
(377
b.c.)
believed
in
the
benefits
of
PA,
and
warned
that4:
‘‘All
parts
of
the
body
which
have
a
function,
if
used
in
moderation
and
exercised
in
labors
in
which
each
is
accustomed,
become
thereby
healthy,
well
developed
and
age
more
slowly,
but
if
unused
they
become
liable
to
disease,
defective
in
growth
and
age
quickly’’.
However,
reliable
scientific
evidence
of
the
relationship
between
physical
inactivity
and
the
risk
of
chronic
disease
only
began
to
emerge
in
the
mid
1950s5,
sparking
interest
in
research
into
the
four
basic
aspects
of
the
problem6---10:
a.
The
increased
use
of
technology
to
accomplish
daily
tasks,
making
humans
more
sedentary.
b.
The
physiological
evidence
of
specific
effects
that
seden-
tary
behaviour
has
on
our
metabolism
and
health.
c.
Instruments,
such
as
accelerometers
and
questionnaires,
can
now
be
used
to
objectively
and
reliably
measure
the
time
spent
physically
inactive.
d.
The
difficulties
involved
in
motivating
individuals
to
become
more
active
and
engage
in
more
strenuous
PA
in
order
to
reduce
sitting
time.
This
is
the
most
pressing
area
of
study.
The
situation
is
further
complicated
by
the
fact
that
sedentary
behaviour
does
not
simply
mean
less
PA,
but
involves
a
set
of
individual
attitudes
in
which
sitting
or
lying
becomes
the
predominant
postural
form,
thus
greatly
redu-
cing
energy
expenditure.
Furthermore,
sedentary
behaviour
is
found
in
a
multitude
of
places
and
situations:
at
work,
at
school,
at
home,
in
our
means
of
transport
and
our
leisure
activities,
and
is
accompanied
by
other
harmful
habits,
such
as
increased
caloric
intake
or
smoking.
In
recent
decades,
sedentary
behaviour
has
become
a
serious
problem
that
has
been
aggravated
over
time
by
the
introduction
of
new
technological
inventions.
These
devices,
which
are
designed
to
make
our
lives
easier,
have
ultimately
increased
our
immobility,
since
working,
playing,
shopping
or
doing
housework
no
longer
requires
the
same
physical
effort
needed
50
years
ago.
Today,
everything
can
be
done
using
a
computer,
a
washing
machine,
a
dryer,
a
car
and
other
devices
developed
to
reduce
our
muscle
activity
and
increase
our
sedentary
behaviour.
Sedentary
behaviour
as
a
disease
The
morbidity
associated
with
sedentary
behaviour
came
increasingly
under
the
spotlight
in
the
1990s,
through
programmes
introduced
in
several
countries
to
encourage
PA
and
health.
These
programmes,
which
were
basically
devised
to
disseminate
PA
and
health
recommendations,
are
based
on
the
notion
that
the
general
population
is
unaware
of
the
importance
and
need
for
PA,
and,
therefore,
do
not
engage
in
such
activities.
Given
the
scale
of
the
problem,
the
World
Health
Orga-
nization
(WHO)
released
a
report
in
2004,11 subsequently
updated
in
2010,12 that
lists
sedentary
behaviour
as
the
fourth
greatest
risk
factor
for
mortality
(6%
of
deaths
recorded
worldwide).
A
more
recent
report
estimated
that
physical
inactivity
is
responsible
for:13
---
6%
of
the
burden
of
disease
from
coronary
heart
disease
(CHD).
---
7%
of
type
2
diabetes
mellitus
(DM2).

Sedentarism,
a
disease
from
xxi
century
235
Cardiovascular
CHD, unstable angina,
myocardial infarction, heart failure,
stroke, intermittent claudication,
atherosclerosis, thrombosis,
hypertension, increased
arterial stiffness
Metabolic
Obesity, DM2, metabolic
syndrome, dyslipidaemia,
nonalcoholic fatty liver,
hyperuricaemia, insulin resistance
Others
Constipation and changes
in the gut microbiota
Malignancies: cancer
of the breast, colon,
endometrium, prostate,
pancreas and melanomas
Shorter life expectancy
Musculoskeletal disorders
and quality of life
Osteoarthritis, rheumatoid arthritis,
osteoporosis and osteopenia,
sarcopenia
Physical and psychological
frailty,flexibility sleep irregularities,
cognitive impairment
Figure
1
Clinical
consequences
of
sedentary
behaviour.
The
pathophysiological
effects
of
sedentary
behaviour
encompass
a
wide
range
of
disorders,
particularly
cardiovascular
and
metabolic
alterations,
favouring
or
accelerating
progression
to
diabetes
or
atherosclerotic
cardiovascular
disease.
---
10%
of
breast
cancer.
---
10%
of
colon
cancer.
---
Inactivity
is
responsible
for
9%
of
premature
mortality
or
>5.3%
of
the
57
million
deaths
that
occurred
worldwide
in
2008.
If
inactivity
were
decreased
by
10%
or
25%,
>533,000
and
>1.3
million
deaths,
respectively,
may
be
averted
each
year.13 By
eliminating
physical
inactivity,
the
life
expectancy
of
the
world’s
population
is
estimated
to
increase
by
0.68
(0.41
to
0.95)
years.13
Physical
inactivity
also
carries
a
heavy
economic
burden.
A
report
published
in
2016
with
data
from
142
countries
(93.2%
of
the
world’s
population)
estimated
the
direct
health
costs
and
disability-adjusted
life-years
(DALYs)
for
various
diseases:14
---
Physical
inactivity
cost
health-care
systems
53.8
billion
international
dollars
(Int’l$)
in
2013.
---
Physical
inactivity-related
deaths
contribute
to
Int’l$
13.7
billion
in
productivity
losses.
--- Physical
inactivity
was
responsible
for
13.4
million
DALYs
worldwide.
---
High-income
countries
bear
a
larger
proportion
of
eco-
nomic
burden
(80.8%
of
health-care
costs
and
60.4%
of
indirect
costs),
whereas
low-income
and
middle-income
countries
have
a
larger
proportion
of
the
disease
burden
(75.0%
of
DALYs).
As
for
prevalence,
a
recent
study
estimates
that
more
than
one
in
four
adults
(28%
or
1.8
billion
people)
are
physi-
cally
inactive
(one
in
three
in
some
countries)15,
and
women
are
less
active
than
men,
with
more
than
8%
difference
between
the
sexes
(32%
in
men
vs.
24%
in
women).
High-
income
countries
have
the
highest
levels
of
inactivity
(32%)
compared
to
26%
and
16%,
respectively,
in
middle-
and
low-
income
countries.
These
results
highlight
the
urgent
need
to
prioritise
actions
aimed
at
creating
an
environment
con-
ducive
to
increasing
PA.
Sedentary
behaviour
as
a
risk
factor
The
extent
of
the
problem
and
the
role
of
PA
as
a
risk
factor
for
disease
is
outlined
in
the
WHO
report
published
in
2014.16
Briefly:
---
The
risk
of
death
from
any
cause
is
higher
among
adults
with
insufficient
PA
compared
with
those
who
practise
at
least
the
minimum
recommendation
of
150
minutes
of
moderate
physical
exercise
per
week
or
equivalent.
---
23%
of
adults
aged
18
years
or
older
did
not
do
enough
PA.
Women
were
less
active
than
men,
and
older
people
were
less
active
than
young
people.
---
Worldwide,
81%
of
adolescents
(aged
11
to
17)
did
not
do
enough
PA
in
2014,
with
girls
being
less
active
than
boys;
and
84%
and
78%,
respectively,
did
not
meet
the
WHO
global
recommendations
on
physical
activity
for
health.
The
clinical
consequences
of
sedentary
behaviour
on
various
bodily
systems
are
wide-ranging
and
inter-related
(Fig.
1).
They
can
be
summarised
as
functional
and/or
organic
alterations:8,10,17---28

236
J.I.
Arocha
Rodulfo
---
Metabolic:
obesity,
insulin
resistance,
DM2,
dyslipi-
daemia,
metabolic
syndrome,
hyperuricaemia.
---
Cardiovascular
diseases:
CHD,
unstable
angina,
myocar-
dial
infarction,
heart
failure,
stroke,
intermittent
claudication,
atherosclerosis,
thrombosis,
hypertension,
increased
arterial
stiffness.
---
Pulmonary
alterations:
asthma,
chronic
obstructive
pul-
monary
disease.
---
Neurological
diseases:
intellectual
dysfunction,
demen-
tia,
depression,
mood
disorder
and
anxiety,
Alzheimer’s
disease.
--- Musculoskeletal
disorders:
osteoarthritis,
rheumatoid
arthritis,
osteoporosis
and
osteopenia,
sarcopenia.
---
Greater
physical
frailty,
especially
in
the
elderly,
which,
in
turn,
increases
the
risk
of
morbidity
and
mortality.
---
Quality
of
life:
decreased
psychological
well-being,
psy-
chological
frailty,
inability
to
perform
activities
of
daily
living
and
social
interactions,
functional
restriction,
loss
of
balance,
flexibility
and
reaction
and
sleep
irregulari-
ties
(difficulty
falling
asleep,
frequent
waking
during
the
night,
or
waking
up
very
early
in
the
morning).
--- Constipation
and
changes
in
the
gut
microbiota.
--- Malignancies,
such
as
cancer
of
the
breast,
colon,
endometrium,
prostate,
pancreas
and
melanomas.
---
Shorter
life
expectancy.
Logically,
metabolic
and
cardiovascular
alterations
are
the
most
common
and
the
most
characteristic
of
the
bur-
den
of
disease,
because
once
established
they
gradually
progress,
despite
aggressive
treatment.
The
other
alter-
ations,
however,
can
be
reversed
or
improved
by
exercise
programmes
and
pharmacological
therapy,
if
necessary.
A
recently
identified
consequence
of
sedentary
behaviour
is
the
loss
of
metabolic
flexibility,8,29,30 that
is,
the
ability
to
adapt
substrate
oxidation
rates
in
response
to
changes
in
fuel
availability.
The
inability
to
switch
between
the
oxidation
of
lipids
and
carbohydrates
appears
to
be
an
important
feature
of
chronic
disorders
such
as
obesity
and
type
2
diabetes.
Evidence
has
shown
that
high
levels
of
physical
activity
predict
metabolic
flexibility,
while
phys-
ical
inactivity
and
sedentary
behaviours
trigger
a
state
of
metabolic
inflexibility,
even
in
subjects
who
meet
PA
recommendations.8,29,30
Definition
of
terms
In
their
Terminology
Consensus
Project,31 the
Sedentary
Behaviour
Research
Network
established
and
defined
the
following
terms:
---
PA:
any
body
movement
generated
by
the
contraction
of
skeletal
muscles
that
raises
energy
expenditure
above
resting
metabolic
rate.
It
is
characterised
by
its
modality,
frequency,
intensity,
duration,
and
context
of
practice.
--- Physical
inactivity:
the
non-achievement
of
physical
activity
guidelines.
--- Exercise:
a
subcategory
of
PA
that
is
planned,
structured,
repetitive,
and
that
favours
physical
fitness
maintenance
or
development.
---
Sport:
part
of
the
PA
spectrum
and
corresponds
to
any
institutionalised
and
organised
practice,
based
on
specific
rules.
---
Sedentary
behaviours:
any
waking
behaviours
charac-
terised
by
an
energy
expenditure
≤1.5
METs,
while
in
a
sitting,
reclining,
or
lying
posture.
Table
1
lists
some
activities
with
an
energy
expenditure
of
less
than
1.5
METs,
and,
therefore,
classed
as
sedentary.
These
activities
should
be
borne
in
mind
when
estimating
sedentary
behaviour,
as
patients
will
not
usually
consider
them
to
be
sedentary.
It
is
important
to
note
that
although
the
terms
sedentary
behaviour
and
physical
inactivity
are
used
indistinctly,
there
is
a
clear
distinction
between
them.
Sedentary
behaviour
involves
spending
a
great
deal
of
time
engaging
in
low-
energy-expenditure
activities
(<1.5
MET),
whereas
physical
inactivity
is
an
almost
total
absence
of
PA.16,17
It
is
interesting
to
note
that
an
increase
in
the
time
devoted
to
sedentary
behaviours
correlates
with
an
increase
in
cardiovascular
and
metabolic
risk
factors.
The
effect
of
sedentary
behaviours
on
these
markers
is
independent
of
sociodemographic
factors,
diet,
body
mass
index
and
PA.17
These
findings
are
important,
since
they
show
that
the
effect
of
sedentary
behaviours
on
these
variables
is
not
modulated
by
a
higher
caloric
intake,
but
by
a
reduction
in
energy
expenditure.17
Table
1
Sedentary
activities
with
energy
expenditure
<1.5
MET.
Home
Work/school
Transport
Distractions
Watching
TV,
sitting
or
reclining
Working
on
a
computer
Driving
or
travelling
in
a
motor
vehicle
Playing
a
musical
instrument
Talking
on
the
phone
Sitting
Arts
and
crafts
Listening
to
music
Writing
Knitting/sewing
Eating
Talking
on
the
phone
Meditating
Showering
Sitting
in
class
Playing
cards
or
board
games
Reading
Using
a
keyboard
Watching
sport
Reading
Going
to
a
religious
service
MET:
metabolic
equivalent;
TV:
television.
Taken
from
Young
et
al.17

Sedentarism,
a
disease
from
xxi
century
237
As
sedentarism
is
a
learned
behaviour
of
human
beings
that
has
increased
exponentially
during
the
21st
century,
the
risk
factors
or
conditions
that
favour
it
are
not
yet
known.
However,
various
lines
of
research
have
identi-
fied
the
following
general
factors,
particularly
in
younger
individuals:32---35
a.
Demographic:
demographic
factors
include
sex,
age
and
ethnicity.
Numerous
publications
show
that
women
are
less
active
than
men
and
older
children,
and
adolescents
are
less
active
than
younger
children.
Among
women,
those
of
African
descent
are
less
active
than
Caucasians.
b.
Personal:
certain
personal
factors,
such
as
underlying
dis-
eases
(cardiovascular
disease,
diabetes,
asthma,
chronic
orthopaedic
diseases)
or
disability,
predispose
to
seden-
tary
behaviours
due
to
the
child’s
tendency
to
remain
sedentary
or
to
their
preference
for
activities
that
demand
less
energy
expenditure.
Other
factors
include:
self-perceived
lack
of
time,
inappropriate
relationship
with
peers
and
an
activity
they
find
boring
or
unattrac-
tive.
Individual
factors
that
are
positively
associated
with
PA
are:
self-confidence
to
engage
in
exercise,
personal
ability,
positive
attitude
towards
PA,
interest
in
self-
improvement
and
ability
to
enjoy
PA.
Age
is
an
important
factor
in
this
category,
since
research
has
revealed
that
children
up
to
the
age
of
8
engage
in
moderate
to
vigor-
ous
PA,
but
start
to
become
less
active
from
the
age
of
1136,
making
this
a
crucial
period
for
PA
interventions.
c.
Family:
this
is
perhaps
the
most
important
factor,
since
the
preferences
and
habits
of
the
parents
will
affect
the
extent
to
which
the
child
is
encouraged
to
engage
in
PA
or
certain
motor
activities.
Watching
TV
is
more
influenced
by
the
parents’
attitude
towards
this
activity
than
by
the
number
of
TVs
in
the
home.
Other
situations,
such
as
both
parents’
growing
commitment
to
their
jobs,
and
single-
parent
families,
may
affect
the
possibility
of
engaging
in
extracurricular
PA.
d.
Social
and
environmental:
the
lack
of,
or
difficulty
in
accessing,
green
spaces
and
safe
sports
facilities
in
large
cities,
restrictions
on
supervision
by
qualified
personnel,
education
budget
limitations,
changes
in
curricular
prior-
ities,
impoverishment
and
civil
insecurity
are
some
of
the
many
factors
that
discourage
participation
in
and
limit
access
to
PA
both
during
and
out
of
school
hours.
The
‘‘chair
effect’’
and
its
repercussions
on
health
As
mentioned
above,
our
modern
lifestyle
reduces
the
time
we
spend
doing
PA.
In
fact,
over
the
last
decade,
several
studies
have
shown
that
excessive
sitting
time
can
increase
the
risk
of
death,
irrespective
of
whether
or
not
we
do
exer-
cise.
A
review
published
in
201237 used
data
from
2002
to
2011
to
estimate
the
proportion
of
deaths
attributable
to
the
‘‘chair
effect’’
in
the
population
of
54
countries,
with
the
following
results:
---
More
than
60%
of
people
worldwide
spend
more
than
three
hours
a
day
sitting
(the
average
in
adults
is
4.7
hours/day).
---
Sitting
time
is
responsible
for
3.8%
of
deaths
(approxi-
mately
433,000
deaths/year).
---
Among
the
territories
studied,
mortality
due
to
sitting
time
was
higher
in
countries
from
the
Western
Pacific
region,
followed
by
countries
in
Europe,
the
Eastern
Mediterranean,
America
and
Southeast
Asia.
The
authors
calculated
that
reducing
sitting
time
by
about
two
hours
(that
is,
50%)
would
result
in
a
2.3%
decrease
in
mortality
(3
times
less),
although
there
is
no
con-
clusive
proof
of
a
causal
relationship.
Even
a
more
modest
reduction
in
sitting
time,
of
10%
or
half
an
hour
a
day,
could
have
an
immediate
impact
on
all-cause
mortality
(0.6%)
in
the
countries
evaluated,
and
eliminating
sitting
time
would
increase
life
expectancy
by
0.20
years
in
the
countries
stud-
ied.
In
2017,
the
‘‘Termómetro
del
sedentarismo
en
Espa˜
na:
Informe
sobre
la
inactividad
física
y
el
sedentarismo
en
la
población
adulta
espa˜
nola’’
[Thermometer
of
sedentary
behaviour
in
Spain:
Report
on
physical
inactivity
and
seden-
tary
behaviour
in
Spanish
adults]
published
by
the
Fundación
Espa˜
na
Activa
[Active
Spain
Foundation]
and
the
Centro
de
Estudios
del
Deporte
[Sports
Studies
Centre]
of
the
Univer-
sidad
Rey
Juan
Carlos38 showed
an
alarming
upward
trend:
--- Physical
inactivity
is
responsible
for
13.4%
(over
52,000)
of
deaths
per
year
in
Spain.
This
means
that
6.6
people
die
every
hour
from
this
cause
compared
to
3.7
deaths
reported
in
the
meta-analysis
carried
out
by
Rezende
et
al.37
---
Nearly
half
of
all
Spanish
adults
do
not
practise
any
sport
and
do
not
do
any
exercise
or
any
other
physically
demanding
activity
in
their
spare
time.
---
The
least
qualified
social
classes
(lower
occupational
cat-
egory)
are
less
active
in
their
free
time,
while
those
with
higher
qualifications
are
less
active
during
their
working
hours.
In
other
words,
the
greater
the
economic
develop-
ment,
the
higher
the
level
of
sedentary
behaviour,
and,
therefore,
the
greater
the
associated
health
risks.
Population
impact
Although
sedentary
behaviour
affects
all
age
groups,
the
extreme
age
groups
are
the
most
affected
for
the
following
reasons:13,15,16,39---41
a.
Schoolchildren
and
adolescents:
logically,
due
to
the
impact
on
health
in
adulthood,
which
increases
the
risk
of
obesity,
DM2
and
hypertension.
Because
of
the
size
of
this
age
group,
more
effort
is
obviously
needed
to
ensure
adequate
levels
of
PA
in
all
social
classes.
b.
Women
are
the
most
affected,
since
inactivity
rate
among
women
is
8%
higher
than
in
men.
This
gender
gap
has
widened
steadily
over
the
21st
century,
perhaps
as
a
result
of
cultural
norms,
traditional
roles,
or
lack
of
social
and
community
support
from
an
early
age.
c.
The
elderly:
as
older
people
tend
to
be
more
physically
inactive,
the
economic
costs
of
inactivity
are
likely
to
increase
notably
and
place
a
heavy
burden
on
healthcare
budgets.
In
a
study
conducted
in
Germany,
the
poten-
tial
effects
of
interventions
aimed
at
promoting
PA
in

238
J.I.
Arocha
Rodulfo
the
over-65s
compensated
for
the
negative
effect
of
age-
ing
and
reduced
inactivity-related
healthcare
costs.41 In
other
words,
this
single
action
was
doubly
beneficial.
Cultural
differences
also
affect
levels
of
physical
activity.
An
example
of
this
is
Switzerland,
where
the
population
is
divided
into
three
distinct
language
groups:
French,
Italian
and
German.42 An
analysis
of
regional
differences
showed
that
the
per
capita
burden
of
physical
inactivity
is
nearly
double
in
French
and
Italian
speaking
regions
compared
to
the
German
speaking
population,
perhaps
due
to
a
higher
prevalence
of
physical
inactivity,
higher
per
capita
health-
care
spending,
and
higher
disease
prevalence.
Of
course,
the
foregoing
is
also
true
of
the
correlation
between
physical
inactivity
and
social
strata
or
the
stage
of
development
of
the
country.
The
higher
the
popula-
tion
density
and
the
human
development
index
(HDI),
the
greater
the
percentage
of
physical
inactivity
in
the
popula-
tion.
For
example,
estimates
have
shown
that
in
low-
and
middle-income
countries,
individuals
working
in
the
white-
collar
industry
compared
to
agriculture
were
84%
more
likely
to
be
physically
inactive,
and
greater
economic
devel-
opment
in
these
countries
brings
about
changes
in
their
occupational
structure,
resulting
in
increased
physical
inac-
tivity
levels.43,44 Moreover,
between
2001
and
2016,
the
percentage
of
inactivity
in
high-income
countries
(where
sedentary
behaviour
is
most
harmful)
increased
from
31.6
to
36.8%.
In
the
same
period,
inactivity
in
low-income
countries
remained
at
16%.15
Conclusion
and
recommendations
Sedentary
behaviour
is
increasing
rapidly
in
most
countries,
and
is
now
a
public
health
problem
that
will
worsen
over
the
coming
years.
An
analysis
of
the
time
spent
doing
PA
in
five
major
countries
(China,
the
USA,
the
United
Kingdom,
Brazil
and
India)
showed
a
significant
decrease
compared
to
previ-
ous
years,
and
this
downward
trend
is
expected
to
increase
in
the
future.45 In
the
USA,
for
example,
the
average
sitting
time
increased
from
26
hours
per
week
in
1965
to
38
hours
per
week
in
2009,
and
from
30
hours
per
week
in
1960
to
42
hours
per
week
in
2005
in
the
United
Kingdom.
Although
public
policies
and
research
into
PA
are
much
more
developed
today
than
they
were
decades
ago,
strate-
gies
to
change
sedentary
behaviour
are
timid
and
only
just
emerging,
and
little
progress
has
been
made
in
recent
years.
The
universal
recommendation
is
for
adults
to
engage
in
moderate-intensity
PA
for
30
minutes
per
day,
preferably
most
days
of
the
week46,
although
‘‘usual’’
PA
has
now
been
included
as
a
strategy
to
reduce
sedentary
behaviour3,9,16,46.
In
view
of
the
benefits
of
PA,
physicians
should
recom-
mend
a
minimum
level
of
daily
exercise.
Even
a
low
level
of
PA,
if
strenuous,
can
also
be
beneficial
in
reducing
car-
diovascular
risk,
especially
for
those
with
risk
factors
or
a
history
of
vascular
disease.
The
following
are
just
some
of
the
recommendations
published
by
working
groups
engaged
in
promoting
PA,
both
individually
and
at
the
community
level3,9,16,46:
a.
Organise
large-scale,
intensive
campaigns
in
prominent
locations
in
the
community.
b.
Encourage
people
to
use
the
stairs
instead
of
lifts
or
escalators.
c.
Promote
physical
education/sports
in
schools
and
univer-
sities.
d.
Organise
social
activities
(such
as
walking
groups).
e.
Introduce
individually-tailored
behavioural
change
pro-
grammes;
specifically,
limit
recreational
screen
time
in
children
and
adolescents.
f.
Facilitate
access
to
locations
suitable
for
PA.
g.
Motivate
people
to
reduce
sitting
time
to
two
hours
or
less,
with
active
pauses
every
hour
and
short
stretching
sessions
or
walks.
In
summary,
in
the
fight
against
sedentary
behaviour,
remember
that:
‘‘A
little
PA
is
better
than
none.
More
PA
is
better
than
less
PA’’,
and
that
doctors
are
under
the
obli-
gation
of
setting
an
example
in
their
community
by
living
a
more
active,
healthier
lifestyle,
and
‘‘walking
their
talk’’.
Funding
None.
Conflicts
of
interest
The
author
declares
that
this
review
has
received
no
commercial
or
financial
contributions
that
could
represent
a
potential
conflict
of
interest.
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