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Sedentary Lifestyle: Overview of Updated Evidence of Potential Health Risks



One-third of the global population aged 15 years and older engages in insufficient physical activities, which affects health. However, the health risks posed by sedentary behaviors are not well known. The mean daily duration of sedentary behavior is 8.3 hours among the Korean population and 7.7 hours among the American adult population. Sedentary lifestyles are spreading worldwide because of a lack of available spaces for exercise, increased occupational sedentary behaviors such as office work, and the increased penetration of television and video devices. Consequently, the associated health problems are on the rise. A sedentary lifestyle affects the human body through various mechanisms. Sedentary behaviors reduce lipoprotein lipase activity, muscle glucose, protein transporter activities, impair lipid metabolism, and diminish carbohydrate metabolism. Furthermore, it decreases cardiac output and systemic blood flow while activating the sympathetic nervous system, ultimately reducing insulin sensitivity and vascular function. It also alters the insulin-like growth factor axis and the circulation levels of sex hormones, which elevates the incidence of hormone-related cancers. Increased sedentary time impairs the gravitostat, the body's weight homeostat, and weight gain, adiposity, and elevated chronic inflammation caused by sedentary behavior are risk factors for cancer. Sedentary behaviors have wide-ranging adverse impacts on the human body including increased all-cause mortality, cardiovascular disease mortality, cancer risk, and risks of metabolic disorders such as diabetes mellitus, hypertension, and dyslipidemia; musculoskeletal disorders such as arthralgia and osteoporosis; depression; and, cognitive impairment. Therefore, reducing sedentary behaviors and increasing physical activity are both important to promote public health.
Sedentary Lifestyle: Overview of
Updated Evidence of Potential Health
Jung Ha Park1, Ji Hyun Moon1,2, Hyeon Ju Kim1,2, Mi Hee Kong1,2, Yun Hwan Oh1,2,*
1Department of Family Medicine, Jeju National University Hospital, Jeju, Korea
2Department of Family Medicine, Jeju National University School of Medicine, Jeju, Korea
One-third of the global population aged 15 years and older engages in insufficient physical activities, which affects
health. However, the health risks posed by sedentary behaviors are not well known. The mean daily duration of
sedentary behavior is 8.3 hours among the Korean population and 7.7 hours among the American adult popula-
tion. Sedentary lifestyles are spreading worldwide because of a lack of available spaces for exercise, increased occu-
pational sedentary behaviors such as office work, and the increased penetration of television and video devices.
Consequently, the associated health problems are on the rise. A sedentary lifestyle affects the human body through
various mechanisms. Sedentary behaviors reduce lipoprotein lipase activity, muscle glucose, protein transporter
activities, impair lipid metabolism, and diminish carbohydrate metabolism. Furthermore, it decreases cardiac out-
put and systemic blood flow while activating the sympathetic nervous system, ultimately reducing insulin sensitivi-
ty and vascular function. It also alters the insulin-like growth factor axis and the circulation levels of sex hormones,
which elevates the incidence of hormone-related cancers. Increased sedentary time impairs the gravitostat, the
body’s weight homeostat, and weight gain, adiposity, and elevated chronic inflammation caused by sedentary be-
havior are risk factors for cancer. Sedentary behaviors have wide-ranging adverse impacts on the human body in-
cluding increased all-cause mortality, cardiovascular disease mortality, cancer risk, and risks of metabolic disor-
ders such as diabetes mellitus, hypertension, and dyslipidemia; musculoskeletal disorders such as arthralgia and
osteoporosis; depression; and, cognitive impairment. Therefore, reducing sedentary behaviors and increasing
physical activity are both important to promote public health.
Keywords: Sedentary Behavior; All-Cause Mortality; Cancer; Metabolic Disease; Physical Activity; Exercise
Received: July 15, 2020, Accepted: August 4, 2020
*Corresponding Author: Yun Hwan Oh
Tel: +82-64-717-8650, Fax: +82-64-757-8276, E-mail: Korean J Fam Med 2020;41:365-373
Review Article
eISSN: 2092-6715
Copyright © 2020 The Korean Academy of Family Medicine
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Jung Ha Park, et al. • Sedentary Lifestyle: Overview of Updated Evidence of Potential Health Risks366
1. Epidemiology
Approximately 31% of the global population aged ≥15 years engages in
insufficient physical activity, and it is known to contribute to the death
of approximately 3.2 million people every year.1) In South Korea, the
physical activity rate is on the decline among adults aged ≥19 years, ir-
respective of the type of activity, including aerobic exercise, walking,
and muscle training. Therefore, in 2017, the rates of aerobic exercise,
walking, and muscle training in the Korean adult population were
48.5%, 39.0%, and 21.6%, respectively, with the majority of the Korean
population engaging in physical inactivity.2) In addition to physical in-
activity, sedentary behavior is also a serious problem, and a substantial
number of people engage in it for prolonged periods. For instance,
Americans spend 55% of their waking time (7.7 hours a day) engaged
in sedentary behaviors whereas Europeans spend 40% of their leisure
time (2.7 hours a day) watching television.3) Similar patterns have been
observed in Koreans, who have been reported to demonstrate long
sedentary times. According to Korea Health Statistics of 2018, adults in
Korea aged ≥19 years engage in 8.3 hours of sedentary time. Only 8.9%
of the adult population engaged in <4 hours of sedentary time whereas
20.6% of the adults were involved in >12 hours of sedentary time.4)
2. Causes of Physical Inactivity and Sedentary Lifestyles
A poor participation in physical activity is speculated to be influenced
by multiple factors. Some environmental factors include traffic con-
gestion, air pollution, shortage of parks or pedestrian walkways, and a
lack of sports or leisure facilities.1) Television viewing, video viewing,
and cell phone usage are positively correlated with an increasingly
sedentary lifestyle.5) Sedentary behaviors are projected to continue to
rise on the basis of this socio-cultural background.
Sedentary lifestyles have a major impact on the overall health of the
global population. Many people worldwide engage in sedentary life-
styles, and the prevalence of relevant non-communicable diseases is
on the rise. It is well known that insufficient physical activity, that is,
physical inactivity, has a detrimental effect on health. Physical inactivi-
ty is the fourth leading risk factor for global mortality, accounting for
6% of global mortality.6) Despite the fact that sedentary behavior poses
a comparable risk to health and contributes to the prevalence of vari-
ous diseases, most physical activity-related education in clinical prac-
tice is focused on improving the physical activity levels, with less em-
phasis on lowering the sedentary behavior. In addition to understand-
ing and informing patients about the health impact of a sedentary life-
style, healthcare providers of various fields, including clinicians,
should reflect upon its significance in policies. This study examined
the effects of a sedentary lifestyle on health and the lifestyle-related
improvements to be made to promote healthy living.
1. The Concept of a Sedentary Lifestyle
Sedentary behavior is defined as any waking behavior such as sitting
or leaning with an energy expenditure of 1.5 metabolic equivalent task
(MET) or less.7) This definition, proposed by the Sedentary Behavior
Research Network in 2012, is currently the most widely used definition
of sedentary behavior. Some examples of sedentary behavior include
television viewing, playing video games, using a computer, sitting at
school or work, and sitting while commuting (Figure 1).8) According to
the 2011 Compendium of Physical Activities, MET is defined as the ra-
tio of work metabolic rate to the standard resting metabolic rate (RMR)
Figure 1. Examples of sedentary behavior. (A)
Playing a video game. (B) Watching television.
(C) Using a computer. (D) Reading a book.
Jung Ha Park, et al. • Sedentary Lifestyle: Overview of Updated Evidence of Potential Health Risks 367
of 1 kcal/(kg/h). One MET is the RMR or energy cost for a person at
rest. When classified quantitatively based on their intensities, physical
activities can be classified into 1.0–1.5 METs (sedentary behavior), 1.6–
2.9 METs (light intensity), 3–5.9 (moderate intensity), and ≥6 METs
(vigorous intensity) (Figure 2).9)
A sedentary lifestyle increases all-cause mortality and the risks for
cardiovascular diseases (CVD), diabetes mellitus (DM), hypertension
(HTN), and cancers (breast, colon, colorectal, endometrial, and epi-
thelial ovarian cancer). This has been consistently documented in the
literature.3,10,11) There is no disagreement on the fact that prolonged to-
tal sedentary behavior times are associated with poor disease out-
comes. However, the patterns of sedentary time may differ even within
the same total amount of time, and not much is known about the par-
ticular patterns of prolonged sedentary time that pose more significant
health hazards (for example, continuous sedentary behavior without a
break or intermittent sedentary behavior).12) One study reported that
even if the total sedentary time was equal, having short sedentary
bouts and engaging in physical activities intermittently can have rela-
tive health benefits. The total sedentary time and moderate-to-vigor-
ous physical activity (MVPA) have been reported to be negatively cor-
related, where the waist circumference (standardized β, -0.16; 95%
confidence interval [CI], -0.31 to -0.02; P=0.026), body mass index (β,
-0.19; 95% CI, -0.35 to -0.02; P=0.026), triglyceride level (β, -0.18; 95%
CI, -0.34 to -0.02; P=0.029), and 2-hour postprandial plasma glucose
level (β, -0.18; 95% CI, -0.34 to -0.02; P=0.025) decreased with increas-
ing the number of breaks in the sedentary time.13) Furthermore, when
the sedentary time was interrupted with light- or moderate-intensity
physical activity, the systolic and diastolic blood pressures dropped by
2–3 mm Hg whereas interrupting the sedentary time with light-inten-
sity physical activity (LIPA) or simple muscle training in patients with
diabetes (88% of the population had HTN) decreased the systolic pres-
sure by 14–16 mm Hg and the diastolic pressure by 8–10 mm Hg.14)
2. Physiological Features
The exact mechanisms of the various adverse effects of sedentary be-
havior on the human body are currently unknown. However, several
hypotheses have been proposed for the overall understanding of the
impact of sedentary behavior on the human body, which are de-
scribed below.
Sedentary lifestyles are associated with metabolic dysfunctions,
such as elevated plasma triglycerides and high-density lipoprotein
(HDL) cholesterol and reduced insulin sensitivity.15,16) Lipoprotein li-
pase (LPL) is a protein that interacts at the cellular level, and a low LPL
concentration is known to decrease the plasma HDL cholesterol level,
while affecting the prevalence of severe HTN, diabetes-induced dys-
lipidemia, metabolic disorders caused by aging, metabolic syndrome,
and coronary artery diseases. Moreover, LPL activity is diminished by
physical inactivity. Additionally, physical inactivity inhibits LPL activity
in skeletal muscles and rapidly signals for impaired lipid metabolism.
In an experiment based on a rat model, the reduction of LPL activity in
rats that engaged in light walking was only about 10% of the LPL activi-
ty in rats that were only placed in their cages.17) The fact that muscle
LPL activity is highly sensitive to physical inactivity and low-intensity
muscular contractile activity can serve as evidence supporting the the-
ory that sedentary behavior is a risk factor for various metabolic disor-
Physical inactivity reduces bone mineral density.19) In a study on
healthy adult men and women, 12 weeks of bed rest decreased the
mineral density of the lumbar spine, femoral neck, and greater tro-
chanter by 1%–4%.19) The balance between bone resorption and bone
deposition mediates the relationship between sedentary behavior and
the reduction of bone mineral density. According to some studies, bed
rest elevates bone resorption markers and does not influence bone
formation markers.20-22)
Some studies have provided limited evidence that sedentary behav-
ior has a negative impact on vascular health. A study on healthy wom-
en reported that 56 days of head-down bed rest decreased the endo-
thelium-dependent vasodilation while increasing the endothelial cell
damage. Such alterations in vascular function were prevented through
aerobic exercise and muscle training.23)
1. Sedentary Lifestyles, Mortality, and Morbidity
(Cardiovascular Diseases and Other Causes)
A sedentary lifestyle is strongly associated with CVD, DM, cancer, and
premature mortality. The total daily sedentary time and television
viewing time were correlated with an increased all-cause mortality
risk.24) In a study analyzing the mortality rates of people with >10 hours
and <5 hours of sitting times a day, the sitting time was significantly
correlated with all-cause mortality (odds ratio [OR], 1.16; 95% CI, 1.04–
1.29; P<0.05).25) In a study that examined the correlation between the
television viewing time and all-cause mortality, the people who
watched television for ≥6 hours a day had a two-fold higher all-cause
mortality risk compared to the people who watched television for <2
hours a day (hazard ratio [HR], 1.98; 95% CI, 1.25–3.15)26) whereas the
people who watched television for ≥4 hours a day had a 1.5 times
higher all-cause mortality risk compared to the people who watched
TV for <2 hours a day (HR, 1.48; 95% CI, 1.19–1.83).27)
Figure 2. Examples of moderate to vigorous physical activity. (A) Riding a bicycle. (B)
Jung Ha Park, et al. • Sedentary Lifestyle: Overview of Updated Evidence of Potential Health Risks368
Sedentary time (sitting time, television or screen viewing time, lei-
sure time while sitting in a day) is independently associated with all-
cause mortality, CVD incidence or mortality, incidence or mortality of
certain cancers (breast, colon, colorectal, endometrial, and epithelial
ovarian cancer), and type 2 DM. In particular, the adverse effect of
sedentary time was more evident among people who engaged in little
physical activity compared to those who engaged in frequent physical
activity. The relative risk (RR) for all-cause mortality was 30% higher
with high physical activity (HR, 1.16; 95% CI, 0.84–1.59) compared to
that with low physical activity (HR, 1.46; 95% CI, 1.22–1.75).28)
2. Sedentary Lifestyles and Metabolic Diseases
1) Diabetes mellitus
The fact that the prevalence of type 2 DM increases with increasing
sedentary time has been consistently documented in various studies
(HR, 1.91; 95% CI, 1.64–2.22).28)
In an assessment of DM risk considering both sedentary time and
physical activity, the DM risk increased with the increasing daily sed-
entary time (HR, 1.13; 95% CI, 1.04–1.22; P<0.001), and the effect was
not offset by the level of physical activity (HR, 1.11; 95% CI, 1.01–1.19;
P<0.001). The risk for CVD also increased with the increasing daily
sedentary time (HR, 1.29; 95% CI, 1.27–1.30; P<0.001), and although
the physical activity level slightly offset this effect, sedentary time still
significantly increased the risk (HR, 1.11; 95% CI, 1.01–1.19; P<0.001).
This shows that the level of physical activity does not influence the im-
pact of prolonged sedentary time on the risk for CVD and DM.
A few biological mechanisms can explain the impact of the total
daily sedentary time on CVD and DM risk. Prolonged sitting is known
to affect the content and activity of muscle glucose transporter pro-
teins. An animal study observed that prolonged muscle inactivity re-
duces the LPL activity, which regulates blood lipid concentration and
carbohydrate metabolism through cellular pathways that differ from
the normal motor response; however, additional verification is re-
quired by human studies.29)
2) Hypertension
A sedentary lifestyle affects blood pressure through various mecha-
nisms, and subsequently changes the blood pressure by altering the
cardiac output and total peripheral vascular resistance. A prolonged
sedentary time reduces the metabolic demands and systemic blood
flow, and by stimulating the sympathetic nervous system, it decreases
insulin sensitivity and vascular function while increasing the oxidative
stress and promoting the low-grade inflammatory cascade.14) A study
reported a direct association between sedentary behavior and a high
risk of HTN (HR, 1.48; 95% CI, 1.01–2.18; P for trend=0.03). Among
sedentary behaviors, non-interactive sedentary behaviors (watching
television, sleeping) have been reported to further escalate the risk for
HTN compared to interactive sedentary behaviors (driving, using a
3) Dyslipidemia
Sedentary behaviors induce metabolic dysfunction characterized by
elevated blood triglyceride levels, reduced HDL-cholesterol levels, and
diminished insulin sensitivity.17) A study reported that sedentary be-
haviors increased the rate of newly diagnosed dyslipidemias in women
(OR, 1.17; 95% CI, 1.00–1.36) and increased the risk for dyslipidemia in
both men and women (men: OR, 1.21; 95% CI, 1.02–1.44) (women:
OR, 1.24; 95% CI, 1.04–1.48).31) In contrast, MVPA was negatively asso-
ciated with blood triglyceride levels (β, -0.18; 95% CI, -0.36 to -0.01;
4) Obesity
Sedentary time is known to have significant correlations with waist cir-
cumference and clustered metabolic risk scores independent of
MVPA. The waist circumference increased by 3.1 cm with a 10% in-
crease in the sedentary time.32) Obese patients tend to move less;
therefore, increasing the activity levels can be utilized as a strategy in
obesity treatment.33) While this is a widely known fact, the underlying
mechanism remains unknown. A study in 2020 reported that the rea-
son for weight gain is a prolonged sedentary time.34) According to a
Swedish study that compared an experimental group which wore a
heavy 11-kg vest for 8 hours a day and the control group which wore a
light 1-kg vest for 8 hours a day, the experimental group had a weight
loss of 1.6 kg whereas the control group lost 0.3 kg three weeks later. An
animal study shed light on an energy balance system known as the
“gravitostat” that maintains a consistent body weight.35) This regulation
occurs partially due to an influence on appetite where the system re-
quires a personal weighing machine for the proper functioning of this
regulation. This Swedish study found that humans also feature a simi-
lar built-in scale. An individual’s scale measures lower values with pro-
longed sitting, which explains why sitting is associated with obesity
and poor health. A heavy vest can increase the score on this, thereby
inducing weight loss.34)
3. Sedentary Lifestyles and Cancer Risk
Sedentary behavior is also closely related to the prevalence of cancer.
According to a study that investigated the correlation between seden-
tary behavior and cancer prevalence, the cancer risk was 13% higher in
the group with the longest sedentary time compared to that with the
shortest sedentary time,28) and another study reported that sedentary
time increased the overall cancer risk by 20%.36)
Prolonged sitting increases colorectal, endometrial, ovarian, and
prostate cancer risks, and it has been reported to increase cancer mor-
tality particularly in women.37) There was a significant correlation be-
tween cancer mortality and the incidences of breast, colorectal, endo-
metrial, and epithelial ovarian cancers.28) An increased total sitting
time was positively correlated with colon cancer (RR, 1.24; 95% CI,
1.03–1.50) and endometrial cancer (RR, 1.32; 95% CI, 1.08–1.61).36) Ad-
ditionally, television viewing time was also positively correlated with
colon cancer (RR, 1.54; 95% CI, 1.19–1.98) and endometrial cancer
(RR, 1.66; 95% CI, 1.21–2.28).36) Occupational sitting time was positive-
Jung Ha Park, et al. • Sedentary Lifestyle: Overview of Updated Evidence of Potential Health Risks 369
ly correlated with only colon cancer (RR, 1.24; 95% CI, 1.09–1.41).36)
Sedentary behavior leads to metabolic dysfunctions such as hyper-
glycemia, hyperinsulinemia, insulin resistance, perturbation of insu-
lin-like growth factor axis, and changes in the circulation levels of sex
hormones. Altered circulation levels of sex hormones can be linked to
hormone-related cancers such as breast and endometrial cancers.38)
Additionally, sedentary behavior induces low-grade chronic systemic
inflammation, and sedentary time is associated with inflammation-re-
lated markers such as C-reactive protein (β, 0.18±0.06; P=0.002), inter-
leukin 6 (β, 0.24±0.06; P<0.001), leptin (β, 0.15±0.04; P<0.001), and the
leptin: adiponectin ratio (β, 0.21±0.05; P<0.001).39) Chronic inflamma-
tion can trigger cancer growth.40) Adiposity can also mediate the rela-
tionship between sedentary behavior and cancer, and obesity is a risk
factor for several cancers.8)
4. Sedentary Lifestyles and Osteoporosis
Sedentary behavior is known to show a negative association with the
bone mineral density of the total femur and all hip sub-regions irre-
spective of MVPA, and the bone mineral density (g/cm2) of the total
femur had a marked negative correlation with the sedentary time (β,
-0.16; 95% CI, -0.24 to -0.08) in adult women.41) Bone mineral density
was correlated with the duration and not the frequency of sedentary
behavior. In men, sedentary behavior was not markedly correlated
with the bone mineral density of the hip and spine.41)
5. Sedentary Lifestyles and Musculoskeletal Diseases
A prolonged sedentary time was correlated with chronic knee pain. In
an analysis of the correlation between chronic knee pain and the total
daily sedentary time (<5, 5–7, 8–10, >10 hours), the results claimed that
the incidence of chronic knee pain was higher in individuals with lon-
ger sedentary times (P for trend=0.02).42) In particular, a sedentary time
>10 hours a day was markedly correlated with chronic knee pain (ad-
justed OR, 1.28; 95% CI, 1.02–1.61; P=0.03).42) People who engaged in
greater physical activity had less chronic knee pain (adjusted OR, 0.78;
95% CI, 0.67–0.91; P=0.00), but women with >10 hours of sedentary
time while engaging in greater physical activity were highly likely to
experience chronic knee pain (adjusted OR, 1.19; 95% CI, 1.02–1.39;
P=0.03). The study recommends individuals to shorten their sedentary
times to <10 hours a day.42)
6. Sedentary Lifestyles and Other Diseases
1) Depression
Mentally passive sedentary behaviors such as television viewing (RR,
1.18; 95% CI, 1.07–1.30), sitting, listening to music, and talking while
sitting were positively correlated with depression risks (RR, 1.17; 95%
CI, 1.08–1.27). In contrast, mentally active sedentary behaviors such as
reading books or newspapers, driving, attending a meeting, or knitting
or sewing were not markedly correlated with depression risk (RR, 0.98;
95% CI, 0.83–1.15).43) Using a computer, which is a mentally active sed-
entary behavior, was not correlated with depression risk in one study
(RR, 0.99; 95% CI, 0.79–1.23)43) but was positively correlated with de-
pression risk in another study (RR, 1.22; 95% CI, 1.10–1.34),44) and thus
its correlation with depression remains controversial. The mechanism
underlying the correlation between sedentary behavior and depres-
sion may involve the following: sedentary behaviors may increase the
risk for depression by blocking direct communication and lowering
social interactions, or by reducing the available time to engage in
physical activities that help to prevent and treat depression.43)
2) Cognitive function
The relationship between sedentary behavior and cognitive function
is uncertain. A systematic review found marked alterations of cogni-
tion (improved in two studies45,46) and impaired in two studies47,48)) in
some studies but no changes in cognitive function in some studies.49)
However, the only long-term study included in that systematic review
suggested that a less-sedentary lifestyle and less sedentary work have
benefits related to cognitive function.46) It is believed that replacing the
sedentary time with physical activity can help improve the cognitive
function. In a randomized clinical trial that analyzed the cognitive
changes after 30 minutes of sedentary behavior with other activities for
6 months in older adults with little physical activity, replacing the sed-
entary time with MVPA and sleep significantly improved cognitive
functions, and replacing it with LIPA did not lead to statistically signifi-
cant changes.46)
1. Discrepant Health Effects of Sedentary Lifestyle and
Physical Activity
Past studies have observed that a prolonged sedentary lifestyle leads to
poor health outcomes irrespective of physical activity. A sedentary life-
style was independently correlated with mortality and was not com-
pensated for by physical activity.10) The time spent in front of a screen
was positively correlated with the presence of metabolic syndrome, in-
dependent of the level of physical activity (OR, 3.30; 95% CI, 2.04–
2. The Attenuative Effect of Physical Activity on Sedentary
A few recent studies have reported that increasing physical activity can
offset the adverse impacts of sedentary behavior. In particular, the off-
set effect was more evident in people with little physical activity.
A meta-analysis reported that mortality was not elevated in the peo-
ple engaging in high levels of moderate-intensity physical activity (60–
75 minutes of moderate-intensity physical activity a day) even when
they had >8 hours of sedentary time a day. There was no difference in
mortality between the most active people (>35.5 MET-h/wk) with <4
hours of sedentary time a day and equally active people (>35.5 MET-
h/wk) with >8 hours of sedentary time a day (HR, 1.04; 95% CI, 0.99–
1.10). However, television viewing for >3 hours a day increased the
mortality regardless of physical activity, and the people who watched
Jung Ha Park, et al. • Sedentary Lifestyle: Overview of Updated Evidence of Potential Health Risks370
television for ≥5 hours a day showed markedly high mortalities (HR,
1.16; 95% CI, 1.05–1.28).51)
In one study, sitting time showed a dose-response with all-cause
mortality and CVD mortality risk in the least active group (<150 MVPA
min/wk).51) In contrast, the group with at least 8 hours of sedentary
time a day showed a higher mortality than the group with less than 4
hours of sedentary time a day (HR, 1.52; 95% CI, 1.13–2.03). However,
the group who met the essential MVPA criterion (150–299 MVPA min/
wk) or engaged in more physical activity did not show a consistent
trend in the relationship between increased sitting time and CVD and
all-cause mortalities.
Similarly, a study showed that a sedentary time of over 9 hours per
day in the low physical activity group (<600 METs-min/wk) had a sig-
nificant association with an increased CVD risk (OR, 1.29; 95% CI,
1.04–1.62). In the group with more physical activity, sedentary time
was not significantly associated with CVD risk.52)
In other words, while increased sedentary time increases the mor-
tality among people who engage in little physical activity, adequate
physical activity seems to offset the impact of increased sedentary time
on mortality.53)
A study analyzed the correlation between all-cause mortality and
net uncompensated sedentary behavior metabolic equivalent hours
(USMh=MET/h [sedentary time]–MET/h [MVPA time]), which was
computed by subtracting METs for MVPA from METs for sedentary
behavior throughout a day. USMh was independently associated with
all-cause mortality when it was greater than 7 MET/h, and for televi-
sion viewing, when it was greater than 3 MET/h. The mean increase in
mortality per USMh was 1% (RR, 1.01; 95% CI, 1.00–1.02; P=0.01), and
the mean increase in mortality per USMh for TV watching was 7% (RR,
1.07; 95% CI, 1.04–1.10; P<0.001). In other words, physical activity as
well as sedentary time should be assessed, and therefore, USMh was
revealed to be a more practical index for assessing sedentary behav-
In the people with the least daily activity (≤17 min/d MVPA), replac-
ing 30 minutes of the sitting time each day with light physical activity
reduced the mortality risk by 14% (HR, 0.86; 95% CI, 0.81–0.89), and
replacing it with MVPA reduced the mortality risk by 45% (HR, 0.55;
95% CI, 0.47–0.62). However, in the people with the highest daily activ-
ity (MVPA >38 min/d), replacing the sitting time with LIPA or MVPA
was not linked with a reduced mortality risk.55)
Replacing the sedentary behavior with physical activity also has an
impact on cancer-related mortality. A recently published study
showed that sedentary behavior was independently associated with
cancer mortality risk, where a higher sedentary time led to a greater
cancer mortality risk. In this study, the individuals in the top 1/3 of the
sedentary group showed a substantially higher cancer mortality risk
than those in the bottom 1/3 (adjusted HR, 1.52; 95% CI, 1.01–2.27).56)
However, replacing 30 minutes of sedentary time with LIPA reduced
the cancer mortality by 8% (HR, 0.92; 95% CI, 0.86–0.97) and replacing
it with MVPA reduced it by 31% (HR, 0.69; 95% CI, 0.48–0.97).56)
While the various countries have their own guidelines for physical ac-
tivity and sedentary behavior, overall, the recommendations are simi-
la r.
1. Recommendations in the United States
Although the 2018 Advisory Committee revealed that sedentary be-
havior is strongly correlated with all-cause and CVD mortalities in
adults, the evidence was insufficient to offer advice on the recom-
mended daily sedentary time and duration of physical activity. It could
not determine the recommended daily sedentary time and frequency
of physical activity for adults or adolescents because the risks associat-
ed with sedentary behavior are related to the amount of MVPA.
It is advisable for inactive people not engaging in moderate physical
activity (MPA) to lower their sedentary behavior and replace their sed-
entary behavior with LIPA. However, LIPA alone is insufficient to ob-
tain health benefits; they will be able to reduce their health risk by
gradually increasing their physical activities to MPA or beyond. Inac-
tive people who engage in insufficient physical activity that does not
meet the criterion of 150–300 minutes of MPA per week would be able
to obtain health benefits by increasing their MPA slightly and reap
even greater health benefits by reducing their sedentary behaviors. Ac-
tive people who engage in sufficient physical activity (150–300 minutes
of MPA per week) would gain more benefits by lowering their seden-
tary behaviors. Highly active people who engage in more than 300
minutes of MPA per week are recommended to maintain or improve
their levels of physical activity by participating in a variety of activi-
2. Recommendations in Australia
The Australian Government Department of Health presented age-spe-
cific recommendations for physical activity and sedentary behavior.
According to the Australian physical activity-sedentary behavior
guidelines, individuals are recommended to minimize their sitting
times, including sitting during work, commuting, and breaks, and to
avoid sitting for prolonged periods as much as possible.58) Infants and
children aged less than 5 years are advised to not be bound in a stroller,
car seat, or high chair for more than 1 hour at a time. While they en-
gage in sedentary behaviors, they are recommended to spend time
reading books, singing, solving puzzles, and talking with their caregiv-
ers as compared to watching television or a DVD (digital video disc),
playing on the computer, or playing other video games.59) For children
between the ages of 5 and 17, the sedentary recreational screen time
should be limited to 2 hours a day, and they are advised to engage in
positive social interactions and experiences. Older adults aged 65
years and more are advised to remain active as much as possible every
day.60) The recommended amount of physical activity for adults is 150–
300 minutes of MPA or 75–150 minutes of vigorous physical activity or
an equivalent MVPA per week.
Jung Ha Park, et al. • Sedentary Lifestyle: Overview of Updated Evidence of Potential Health Risks 371
3. Recommendations in Korea
The guidelines for physical activity for the Korean population pub-
lished by the Department of Health Promotion at the Ministry of
Health and Welfare in October 2013 recommend that people limit
their sedentary leisure time (e.g., computer, smartphone, and televi-
sion) to 2 hours a day and engage in a low level of physical activity.
Children and adolescents are recommended to develop an active life-
style overall, including sports, physical education, walking, and cycling
at home and school. If older adults and people with chronic diseases
are unable to engage in the recommended physical activities, these
groups of people are advised to engage in physical activities to the ex-
tents permitted by their situations.61)
Since the beginning of the coronavirus pandemic, social distancing
has become important, and engaging in physical activity in the post-
corona era is difficult. Therefore, a study of the problems of sedentary
lifestyle is considered more valuable at this point.
A sedentary lifestyle has an array of adverse health effects, including
elevated all-cause mortality, CVD mortality, cancer risk, risks for meta-
bolic diseases such as DM, HTN, dyslipidemia, and musculoskeletal
diseases such as knee pain and osteoporosis.
It is indisputable that the negative health impacts intensify with in-
creases in the total daily sedentary times. For this reason, it is impor-
tant to reduce the sedentary time as much as possible.
The findings of studies determining the worst type of sedentary be-
havior varied across studies. Studies observed better health outcomes
with a short sedentary bout with intermittent physical activity, with
light physical activity or simple muscle training, intermittent interrup-
tions of sedentary behavior during work, and rest with physical activity.
Health outcomes also vary depending on the type of sedentary be-
havior and watching television led to the worst outcomes. This may be
attributable to the fact that television watching is a passive sedentary
behavior and that people often consume snacks while watching televi-
sion. Therefore, among the various types of sedentary behaviors, indi-
viduals should refrain from watching television as much as possible,
and snacking should be minimized while watching television.
Even if the total daily sedentary time cannot be reduced for un-
avoidable reasons, it is advisable to engage in sufficient exercise equiv-
alent to or more than 150–300 minutes of MPA per week, as studies
found that physical activity could offset the adverse effects of sedentary
behavior. If sufficient exercise cannot be performed, individuals
should at least perform light physical activity, as opposed to not engag-
ing in physical activity at all as health benefits can be obtained even
with light physical activity, albeit insufficient; they should further try to
increase their physical activity levels as their situations permit.
No potential conflict of interest relevant to this article was reported.
Jung Ha Park: https ://
Ji Hyun Moon:
Hyeon Ju Kim:
Mi Hee Kong:
Yun Hwan Oh:
1. World Health Organization. Physical inactivity: a global public health
problem [Internet]. Geneva: World Health Organization; 2020 [cited
2020 Jun 15]. Available from:
2. Korea Centers for Disease Control and Prevention. Trends in percent-
age of physical activity, among Korean adults aged ≥19 years, 2007-
2017 [Internet]. Cheongju: Korea Centers for Disease Control and Pre-
vention; 2019 [cited 2020 Jun 15]. Available from: https://www.cdc.go.
3. Patterson R, McNamara E, Tainio M, de Sa TH, Smith AD, Sharp SJ, et
al. Sedentary behaviour and risk of all-cause, cardiovascular and can-
cer mortality, and incident type 2 diabetes: a systematic review and
dose response meta-analysis. Eur J Epidemiol 2018;33:811-29.
4. Statistics Korea. Korea health statistics 2018: Korea National Health
and Nutrition Examination Survey (KNHANES VII-3). Daejeon: Statis-
tics Korea; 2018.
5. Fennell C, Barkley JE, Lepp A. The relationship between cell phone
use, physical activity, and sedentary behavior in adults aged 18-80.
Comput Human Behav 2019;90:53-9.
6. World Health Organization. Global recommendations on physical ac-
tivity for health. Geneva: World Health Organization; 2010.
7. Sedentary Behaviour Research Network. SBRN Terminology Consen-
sus Project: 2017-2020 [Internet]. Ottawa: Sedentary Behaviour Re-
search Network; 2020 [cited 2020 Nov 6]. Available from: https://www.
8. Jochem C, Wallmann-Sperlich B, Leitzmann MF. The influence of sed-
entary behavior on cancer risk: epidemiologic evidence and potential
molecular mechanisms. Curr Nutr Rep 2019;8:167-74.
9. Ainsworth BE, Haskell WL, Herrmann SD, Meckes N, Bassett DR Jr,
Tudor-Locke C, et al. 2011 Compendium of physical activities: a sec-
ond update of codes and MET values. Med Sci Sports Exerc 2011;43:
10. Katzmarzyk PT, Church TS, Craig CL, Bouchard C. Sitting time and
mortality from all causes, cardiovascular disease, and cancer. Med Sci
Sports Exerc 2009;41:998-1005.
11. Dunstan DW, Barr EL, Healy GN, Salmon J, Shaw JE, Balkau B, et al.
Television viewing time and mortality: the Australian Diabetes, Obesi-
ty and Lifestyle Study (AusDiab). Circulation 2010;121:384-91.
12. Diaz KM, Duran AT, Colabianchi N, Judd SE, Howard VJ, Hooker SP.
Potential effects on mortality of replacing sedentary time with short
sedentary bouts or physical activity: a national cohort study. Am J Epi-
demiol 2019;188:537-44.
13. Healy GN, Dunstan DW, Salmon J, Cerin E, Shaw JE, Zimmet PZ, et al.
Breaks in sedentary time: beneficial associations with metabolic risk.
Jung Ha Park, et al. • Sedentary Lifestyle: Overview of Updated Evidence of Potential Health Risks372
Diabetes Care 2008;31:661-6.
14. Dempsey PC, Larsen RN, Dunstan DW, Owen N, Kingwell BA. Sitting
less and moving more: implications for hypertension. Hypertension
15. Yanagibori R, Kondo K, Suzuki Y, Kawakubo K, Iwamoto T, Itakura H,
et al. Effect of 20 days’ bed rest on the reverse cholesterol transport
system in healthy young subjects. J Intern Med 1998;243:307-12.
16. Hamburg NM, McMackin CJ, Huang AL, Shenouda SM, Widlansky
ME, Schulz E, et al. Physical inactivity rapidly induces insulin resis-
tance and microvascular dysfunction in healthy volunteers. Arterio-
scler Thromb Vasc Biol 2007;27:2650-6.
17. Hamilton MT, Hamilton DG, Zderic TW. Role of low energy expendi-
ture and sitting in obesity, metabolic syndrome, type 2 diabetes, and
cardiovascular disease. Diabetes 2007;56:2655-67.
18. Bey L , Hamilton MT. Suppression of skeletal muscle lipoprotein lipase
activity during physical inactivity: a molecular reason to maintain dai-
ly low-intensity activity. J Physiol 2003;551:673-82.
19. Zerwekh JE, Ruml LA, Gottschalk F, Pak CY. The effects of twelve
weeks of bed rest on bone histology, biochemical markers of bone
turnover, and calcium homeostasis in eleven normal subjects. J Bone
Miner Res 1998;13:1594-601.
20. Kim H, Iwasaki K, Miyake T, Shiozawa T, Nozaki S, Yajima K. Changes
in bone turnover markers during 14-day 6 degrees head-down bed
rest. J Bone Miner Metab 2003;21:311-5.
21. Smith SM, Davis-Street JE, Fesperman JV, Calkins DS, Bawa M, Macias
BR, et al. Evaluation of treadmill exercise in a lower body negative
pressure chamber as a countermeasure for weightlessness-induced
bone loss: a bed rest study with identical twins. J Bone Miner Res 2003;
22. Zwart SR, Hargens AR, Lee SM, Macias BR, Watenpaugh DE, Tse K, et
al. Lower body negative pressure treadmill exercise as a countermea-
sure for bed rest-induced bone loss in female identical twins. Bone
23. Demiot C, Dignat-George F, Fortrat JO, Sabatier F, Gharib C, Larina I,
et al. WISE 2005: chronic bed rest impairs microcirculatory endotheli-
um in women. Am J Physiol Heart Circ Physiol 2007;293:H3159-64.
24. Katzmarzyk PT, Powell KE, Jakicic JM, Troiano RP, Piercy K, Tennant B,
et al. Sedentary behavior and health: update from the 2018 Physical
Activity Guidelines Advisory Committee. Med Sci Sports Exerc
25. Rillamas-Sun E, LaMonte MJ, Evenson KR, Thomson CA, Beresford
SA, Coday MC, et al. The influence of physical activity and sedentary
behavior on living to age 85 years without disease and disability in
older women. J Gerontol A Biol Sci Med Sci 2018;73:1525-31.
26. Hamer M, Yates T, Demakakos P. Television viewing and risk of mor-
tality: exploring the biological plausibility. Atherosclerosis 2017;263:
27. Imran TF, Ommerborn M, Clark C, Correa A, Dubbert P, Gaziano JM,
et al. Television viewing time, physical activity, and mortality among
African Americans. Prev Chronic Dis 2018;15:E10.
28. 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;162:123-32.
29. Bailey DP, Hewson DJ, Champion RB, Sayegh SM. Sitting time and risk
of cardiovascular disease and diabetes: a systematic review and meta-
analysis. Am J Prev Med 2019;57:408-16.
30. Beunza JJ, Martinez-Gonzalez MA, Ebrahim S, Bes-Rastrollo M, Nunez
J, Martinez JA, et al. Sedentary behaviors and the risk of incident hy-
pertension: the SUN Cohort. Am J Hypertens 2007;20:1156-62.
31. Zhou J, Zhou Q, Wang DP, Zhang T, Wang HJ, Song Y, et al. Associa-
tions of sedentary behavior and physical activity with dyslipidemia.
Beijing Da Xue Xue Bao Yi Xue Ban 2017;49:418-23.
32. Healy GN, Wijndaele K, Dunstan DW, Shaw JE, Salmon J, Zimmet PZ,
et al. Objectively measured sedentary time, physical activity, and met-
abolic risk: the Australian Diabetes, Obesity and Lifestyle Study (Aus-
Diab). Diabetes Care 2008;31:369-71.
33. Levine JA, Lanningham-Foster LM, McCrady SK, Krizan AC, Olson
LR, Kane PH, et al. Interindividual variation in posture allocation: pos-
sible role in human obesity. Science 2005;307:584-6.
34. Ohlsson C, Gidestrand E, Bellman J, Larsson C, Palsdottir V, Hagg D, et
al. Increased weight loading reduces body weight and body fat in
obese subjects: a proof of concept randomized clinical trial. EClini-
calMedicine 2020;22:100338.
35. Lund J. Weighing the evidence for a body mass-regulating gravitostat.
Proc Natl Acad Sci U S A 2018;115:E1334.
36. Schmid D, Leitzmann MF. Television viewing and time spent seden-
tary in relation to cancer risk: a meta-analysis. J Natl Cancer Inst
37. Lynch BM. Sedentary behavior and cancer: a systematic review of the
literature and proposed biological mechanisms. Cancer Epidemiol
Biomarkers Prev 2010;19:2691-709.
38. Tworoger SS, Missmer SA, Eliassen AH, Barbieri RL, Dowsett M, Han-
kinson SE. Physical activity and inactivity in relation to sex hormone,
prolactin, and insulin-like growth factor concentrations in premeno-
pausal women: exercise and premenopausal hormones. Cancer
Causes Control 2007;18:743-52.
39. Henson J, Yates T, Edwardson CL, Khunti K, Talbot D, Gray LJ, et al.
Sedentary time and markers of chronic low-grade inflammation in a
high risk population. PLoS One 2013;8:e78350.
40. Murata M. Inflammation and cancer. Environ Health Prev Med 2018;
41. Chastin SF, Mandrichenko O, Helbostadt JL, Skelton DA. Associations
between objectively-measured sedentary behaviour and physical ac-
tivity with bone mineral density in adults and older adults, the
NHANES study. Bone 2014;64:254-62.
42. Lee SH, Son C, Yeo S, Ha IH. Cross-sectional analysis of self-reported
sedentary behaviors and chronic knee pain among South Korean
adults over 50 years of age in KNHANES 2013-2015. BMC Public
Health 2019;19:1375.
43. Huang Y, Li L, Gan Y, Wang C, Jiang H, Cao S, et al. Sedentary behav-
iors and risk of depression: a meta-analysis of prospective studies.
Transl Psychiatry 2020;10:26.
44. Zhai L, Zhang Y, Zhang D. Sedentary behaviour and the risk of depres-
sion: a meta-analysis. Br J Sports Med 2015;49:705-9.
45. Mullane SL, Buman MP, Zeigler ZS, Crespo NC, Gaesser GA. Acute ef-
fects on cognitive performance following bouts of standing and light-
intensity physical activity in a simulated workplace environment. J Sci
Med Sport 2017;20:489-93.
46. Fanning J, Porter G, Awick EA, Ehlers DK, Roberts SA, Cooke G, et al.
Jung Ha Park, et al. • Sedentary Lifestyle: Overview of Updated Evidence of Potential Health Risks 373
Replacing sedentary time with sleep, light, or moderate-to-vigorous
physical activity: effects on self-regulation and executive functioning. J
Behav Med 2017;40:332-42.
47. Ohlinger CM, Horn TS, Berg WP, Cox RH. The effect of active worksta-
tion use on measures of cognition, attention, and motor skill. J Phys
Act Health 2011;8:119-25.
48. John D, Bassett D, Thompson D, Fairbrother J, Baldwin D. Effect of us-
ing a treadmill workstation on performance of simulated office work
tasks. J Phys Act Health 2009;6:617-24.
49. Magnon V, Vallet GT, Auxiette C. Sedentary behavior at work and cog-
nitive functioning: a systematic review. Front Public Health 2018;6:
50. Bertrais S, Beyeme-Ondoua JP, Czernichow S, Galan P, Hercberg S,
Oppert JM. Sedentary behaviors, physical activity, and metabolic syn-
drome in middle-aged French subjects. Obes Res 2005;13:936-44.
51. Ekelund U, Steene-Johannessen J, Brown WJ, Fagerland MW, Owen N,
Powell KE, et al. Does physical activity attenuate, or even eliminate,
the detrimental association of sitting time with mortality?: a harmon-
ised meta-analysis of data from more than 1 million men and women.
Lancet 2016;388:1302-10.
52. Lee Y, Son JS, Eum YH, Kang OL. Association of sedentary time and
physical activity with the 10-year risk of cardiovascular disease: Korea
National Health and Nutrition Examination Survey 2014-2017. Korean
J Fam Med 2020 Feb 3 [Epub].
53. Stamatakis E, Gale J, Bauman A, Ekelund U, Hamer M, Ding D. Sitting
time, physical activity, and risk of mortality inadults. J Am Coll Cardiol
54. Xu C, Furuya-Kanamori L, Liu Y, Faerch K, Aadahl M, Seguin RA, et al.
Sedentary behavior, physical activity, and all-cause mortality: dose-re-
sponse and intensity weighted time-use meta-analysis. J Am Med Dir
Assoc 2019;20:1206-12.
55. Rees-Punia E, Evans EM, Schmidt MD, Gay JL, Matthews CE, Gapstur
SM, et al. Mortality risk reductions for replacing sedentary time with
physical activities. Am J Prev Med 2019;56:736-41.
56. Gilchrist SC, Howard VJ, Akinyemiju T, Judd SE, Cushman M, Hooker
SP, et al. Association of sedentary behavior with cancer mortality in
middle-aged and older US adults. JAMA Oncol 2020;6:1210-7.
57. U.S. Department of Health and Human Services. Physical activity
guidelines for Americans. 2nd ed. Washington (DC): U.S. Department
of Health and Human Services; 2018.
58. Brown WJ, Bauman AE, Bull FC, Burton NW. Development of evi-
dence-based physical activity recommendations for adults (18-64
years): report prepared for the Australian Government Department of
Health. Canberra: Commonwealth of Australia; 2012.
59. Department of Health, Australian Government. Australian 24-hour
movement guidelines for the early years (birth to 5 years): an integra-
tion of physical activity, sedentary behaviour, and sleep [Internet].
Canberra: Commonwealth of Australia; 2019 [cited 2020 Jun 15]. Avail-
able from:
60. Commonwealth of Australia; Repatriation Commission. Choose
health: be active: a physical activity guide for older Australians. Can-
berra: Commonwealth of Australia and the Repatriation Commission;
61. Ministry of Health and Welfare. The Physical Activity Guide for Kore-
ans. Sejong: Ministry of Health and Welfare; 2013.
... Participation in fitness and strength training activities is becoming increasingly popular and brings along various health benefits [1,2]. Nevertheless, sedentary lifestyles remain a serious health issue worldwide [3]. In times of growing sedentary behavior and related adverse health problems, fitness and strength training activities can play a major role in improving public health worldwide, because they are readily accessible [3]. ...
... Nevertheless, sedentary lifestyles remain a serious health issue worldwide [3]. In times of growing sedentary behavior and related adverse health problems, fitness and strength training activities can play a major role in improving public health worldwide, because they are readily accessible [3]. However, on the downside, there is a health risk related to fitness and strength training activities in the form of musculoskeletal injuries. ...
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... Consequently, health risks associated with a sedentary lifestyle are on the rise. Sedentary lifestyles and behaviors have several negative effects on the human body including, 'risks of metabolic disorders such as diabetes mellitus, hypertension, and dyslipidemia' 1 . ...
... It has been proposed that weight gain and its related comorbidities can be reversed through caloric restriction and increased physical activity 8 . In addition, it has been found that relative health benefits can emerge even in those cases in which there is no change in total sedentary time but intermittent physical activities are included 1 . In this respect, it has been observed that regular exercise is an effective measure against chronic diseases as it improves the inflammatory profile 9 . ...
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Occupational health and safety (OSH) concern all developed economies. Digital transformation and innovations cause as a side effect of working environment musculoskeletal disorders (MSDs). They have become a long-time work-related health problem and remain the most common occupational disease in the EU. Gender, age, and lifestyle influence differences in musculoskeletal disorders' prevalence and occupational consequences, lower productivity, sick leaves, and early retirement. The most prevalent symptoms of MSDs are in the lower back, neck, and shoulder regions, wrist pains, and eye syndrome. The paper aims at health and safety at work with an accent on MSDs and risk prevention. The methodology uses a combination of on-the-desk analysis of papers from the Web of Science and two narrative cases about the situation in the Czech Republic – one about OSH in micro and small enterprises and the second one about the digital well-being of higher education lecturers. Public administration encourages MSDs prevention on the national level through campaigns and education programs. Employers can develop MSD prevention that can include various provisions; the minimum consists of complying with the OSH legislation, monitoring risk factors at workplaces, using protective equipment, and offering stretch training exercises.
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Background Recently we provided evidence for a leptin-independent homeostatic regulation, the gravitostat, of body weight in rodents. The aim of the present translational proof of concept study was to test the gravitostat hypothesis in humans. Methods We conducted a randomized controlled single center trial ( number, NCT03672903), to evaluate the efficacy of artificially increased weight loading on body weight in subjects with mild obesity (BMI 30–35 kg/m²). Subjects were either treated with a heavy (=high load; 11% of body weight) or light (=low load; 1% of body weight) weight vest for eight hours per day for three weeks. The primary outcome was change in body weight. Secondary outcomes included change in body fat mass and fat-free mass as measured using bioelectrical impedance analysis. Findings In total 72 participants underwent randomization and 69 (36 high load and 33 low load) completed the study for the primary outcome. High load treatment resulted in a more pronounced relative body weight loss compared to low load treatment (mean difference -1.37%, 95% confidence interval (CI), -1.96 to -0.79; p = 1.5 × 10⁻⁵). High load treatment reduced fat mass (-4.04%, 95% CI, -6,53 to -1.55; p = 1.9 × 10⁻³) but not fat free mass (0.43%, 95% CI, -1.47 to 2.34; p = 0.65) compared to low load treatment. Interpretation Increased weight loading reduces body weight and fat mass in obese subjects in a similar way as previously shown in obese rodents. These findings demonstrate that there is weight loading dependent homeostatic regulation of body weight, the gravitostat, also in humans. Funding Funded by Jane and Dan Olsson (JADO) Foundation, the Torsten Söderberg Foundation, The Knut and Alice Wallenberg's Foundation and the Novo Nordisk Foundation.
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Epidemiological evidence on the association between sedentary behaviors and the risk of depression is inconsistent. We conducted a meta-analysis of prospective studies to identify the impact of sedentary behaviors on the risk of depression. We systematically searched in the PubMed and Embase databases to June 2019 for prospective cohort studies investigating sedentary behaviors in relation to the risk of depression. The pooled relative risks (RRs) and 95% confidence intervals (CIs) were calculated with random-effect meta-analysis. In addition, meta-regression analyses, subgroup analyses, and sensitivity analyses were performed to explore the potential sources of heterogeneity. Twelve prospective studies involving 128,553 participants were identified. A significantly positive association between sedentary behavior and the risk of depression was observed (RR = 1.10, 95% CI 1.03–1.19, I2 = 60.6%, P < 0.01). Subgroup analyses revealed that watching television was positively associated with the risk of depression (RR = 1.18, 95% CI 1.07–1.30), whereas using a computer was not (RR = 0.99, 95% CI 0.79–1.23). Mentally passive sedentary behaviors could increase the risk of depression (RR = 1.17, 95% CI 1.08–1.27), whereas the effect of mentally active sedentary behaviors were non-significant (RR = 0.98, 95% CI 0.83–1.15). Sedentary behaviors were positively related to depression defined by clinical diagnosis (RR = 1.08, 95% CI 1.03, 1.14), whereas the associations were statistically non-significant when depression was evaluated by the CES-D and the Prime-MD screening. The present study suggests that mentally passive sedentary behaviors, such as watching television, could increase the risk of depression. Interventions that reduce mentally passive sedentary behaviors may prevent depression.
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Background: Sedentary behavior is associated with increased cardiovascular disease (CVD) risk. We investigated this association of sedentary time and physical activity with increased 10-year CVD risk in Korean adults. Methods: This cross-sectional study used data from the Korea National Health and Nutrition Examination Survey (2014-2017). In total, 14,551 participants aged 30-74 years (6,323 men, 8,228 women) were analyzed. The usual length of sedentary time per day was categorized into three groups (<6, 6-<9, or ≥9 h/d), and physical activity (metabolic equivalents [METs]∙min/wk) was categorized into two groups (low, <600 METs∙min/wk; moderate/high, ≥600 METs∙min/wk). Logistic regression analysis was performed to assess the association between sedentary time and increased CVD risk (predicted 10-year risk ≥10%). Adjusted variables were age, sex, body mass index, marital status, employment, household income, alcohol use, family history of CVD, and comorbidity (hypertension, diabetes, and dyslipidemia). Results: The average sedentary time for the 14,551 participants was 7.49 h/d, with an average 10-year CVD risk of 9.58%. There was no significant association between sedentary time and increased 10-year CVD risk in the moderate/ high physical activity group. In the low physical activity group, sedentary time ≥9 h/d had a significant association with increased CVD risk (odds ratio [OR], 1.29; 95% confidence interval [CI], 1.04-1.62). However, when the sedentary time was <6 h/d, no significant associations were found (OR, 1.17; 95% CI, 0.92-1.49). Conclusion: In the low physical activity group, reduction of sedentary time might be important for preventing increased CVD risk.
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Background: An increasing amount of evidence supports an association between sedentary behaviors and chronic knee pain. However, the association between the total daily duration of sedentary behavior and chronic knee pain in the general population remains unclear. We aimed to analyze the association between sedentary behavior and chronic knee pain in a study population representative of the general Korean population aged > 50 years while also considering the physical activity or body mass index (BMI). Methods: This cross-sectional study used data from the 6th Korean National Health and Nutrition Examination Survey (KNHANES VI) of 2013-2015, which was completed by 22,948 Korean adult participants aged > 50 years. The participants were divided into two groups based on the status of the chronic knee pain. Data were analyzed using multivariable logistic regression after adjustment for age, sex, and individual factors. Results: Longer sedentary behavior was correlated with chronic knee pain (p for trend = 0.02). Sedentary behavior exceeding 10 h/day was significantly associated with chronic knee pain (adjusted odds ratio, 1.28; p = 0.03). Participants with high levels of physical activity were less likely to suffer from chronic knee pain (adjusted odds ratio, 0.78; p = 0.00), and women with over 10 daily hours of sedentary behavior with high levels of physical activity were more likely to have chronic knee pain. A significant association was noted between chronic knee pain and obesity (≥30.0 kg/m2) individuals (adjusted odds ratio, 3.48; p = 0.04). Conclusions: Longer duration of sedentary behaviors was correlated with chronic knee pain. Our study suggests the need to encourage reductions in overall sedentary behavior to < 10 h daily. A high physical activity level is recommended, particularly for women > 50 years and those with obesity.
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Context: Whether physical activity attenuates the association of total daily sitting time with cardiovascular disease and diabetes incidence is unclear. This systematic review and meta-analysis examined the association of total daily sitting time with cardiovascular disease and diabetes with and without adjustment for physical activity. Evidence acquisition: PubMed, Web of Science, BASE, MEDLINE, Academic Search Elite, and ScienceDirect were searched for prospective studies, published between January 1, 1989, and February 15, 2019, examining the association of total daily sitting time with cardiovascular disease or diabetes outcomes. Data extraction and study quality assessments were conducted by 2 independent reviewers. Pooled hazard ratios (HRs) were calculated using a fixed-effects model. The quality assessment and meta-analysis procedures were completed in 2018. Evidence synthesis: Nine studies with 448,285 participants were included. A higher total daily sitting time was associated with a significantly increased risk of cardiovascular disease (HR=1.29, 95% CI=1.27, 1.30, p<0.001) and diabetes (HR=1.13, 95% CI=1.04, 1.22, p<0.001) incidence when not adjusted for physical activity. The increased risk for diabetes was unaffected when adjusting for physical activity (HR=1.11, 95% CI=1.01, 1.19, p<0.001). For cardiovascular disease, the increased risk was attenuated but remained significant (HR=1.14, 95% CI=1.04, 1.23, p<0.001). Conclusions: Higher levels of total daily sitting time are associated with an increased risk of cardiovascular disease and diabetes, independent of physical activity. Reductions in total daily sitting may be recommended in public health guidelines.
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Abstract Objectives Previous studies have placed those with excessive sedentary behavior at increased risk of all-cause mortality. There is evidence of interdependency of sedentary behavior with physical activity, and its elucidation will have implications for guidelines and practice. This study investigated if sedentary behavior–related mortality risk can be offset by moderate- to vigorous-intensity physical activity (MVPA) considered in a time-use fashion. Design PubMed was searched (from its inception till May 2018) for studies or meta-analyses that used data harmonized for MVPA. Of the 17 data-custodians located, 7 provided data on sitting time or TV viewing time, or both. A dose-response meta-analysis modeling log relative risks of all-cause mortality against uncompensated sedentary behavior metabolic equivalent hours (USMh) was run using the robust error meta-regression method. (Registration: CRD42017062439) Setting Individual subject data held by data custodians on this topic. Participants General adults. Measurements Sedentary time, MVPA. Results Five harmonized cohorts of sitting time (258,688 participants) and 4 of TV viewing time (156,593 participants) demonstrated that sedentary behavior was significantly associated with mortality, but this risk was attenuated with increasing energy expenditure through MVPA modeled in a time-use fashion. The average increment in mortality per USMh spent on sitting was 1% [relative risk (RR) 1.01, 95% confidence interval (CI) 1.00, 1.02; P = .01] and that per USMh spent on TV viewing was 7% (RR 1.07, 95% CI 1.04, 1.10; P < .001). The thresholds for risk started at 7 USMh for sitting and 3 USMh for TV viewing. Conclusions/Implications Our findings suggest that overall daily sitting time energy expenditure of 7 MET-hours (or TV viewing of 3 MET-hours) in excess of that expended on MVPA is independently related to all-cause mortality. These findings support the view that sitting is strongly influenced by consideration of concurrent MVPA in its impact on adverse health consequences and that the USMh is a more practical metric of sedentary behavior.
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Background: It is unclear what level of moderate to vigorous intensity physical activity (MVPA) offsets the health risks of sitting. Objectives: The purpose of this study was to examine the joint and stratified associations of sitting and MVPA with all-cause and cardiovascular disease (CVD) mortality, and to estimate the theoretical effect of replacing sitting time with physical activity, standing, and sleep. Methods: A longitudinal analysis of the 45 and Up Study calculated the multivariable-adjusted hazard ratios (HRs) of sitting for each sitting-MVPA combination group and within MVPA strata. Isotemporal substitution modeling estimated the per-hour HR effects of replacing sitting. Results: A total of 8,689 deaths (1,644 due to CVD) occurred among 149,077 participants over an 8.9-year (median) follow-up. There was a statistically significant interaction between sitting and MVPA only for all-cause mortality. Sitting time was associated with both mortality outcomes in a nearly dose-response manner in the least active groups reporting <150 MVPA min/week. For example, among those reporting no MVPA, the all-cause mortality HR comparing the most sedentary (>8 h/day) to the least sedentary (<4 h/day) groups was 1.52 (95% confidence interval: 1.13 to 2.03). There was inconsistent and weak evidence for elevated CVD and all-cause mortality risks with more sitting among those meeting the lower (150 to 299 MVPA min/week) or upper (≥300 MVPA min/week) limits of the MVPA recommendation. Replacing sitting with walking and MVPA showed stronger associations among high sitters (>6 sitting h/day) where, for example, the per-hour CVD mortality HR for sitting replaced with vigorous activity was 0.36 (95% confidence interval: 0.17 to 0.74). Conclusions: Sitting is associated with all-cause and CVD mortality risk among the least physically active adults; moderate-to-vigorous physical activity doses equivalent to meeting the current recommendations attenuate or effectively eliminate such associations.
Importance Sedentary behavior is associated with several health outcomes, including diabetes, cardiovascular disease, and all-cause mortality. Less is known about the association between objectively measured sedentary behavior and cancer mortality, as well as the association with physical activity. Objective To examine the association between accelerometer-measured sedentary behavior (total volume and accrual in prolonged, uninterrupted bouts) and cancer mortality. Design, Setting, and Participants A prospective cohort study conducted in the contiguous US included 8002 black and white adults aged 45 years or older enrolled in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. The present analysis was performed from April 18, 2019, to April 21, 2020. Exposures Sedentary time, light-intensity physical activity (LIPA), and moderate- to vigorous-intensity physical activity (MVPA) were measured using a hip-mounted accelerometer worn for 7 consecutive days. Main Outcomes and Measures Cancer mortality. Results Of the 8002 study participants, 3668 were men (45.8%); mean (SD) age was 69.8 (8.5) years. Over a mean (SD) follow-up of 5.3 (1.5) years, 268 participants (3.3%) died of cancer. In multivariable-adjusted models, including MVPA, greater total sedentary time was associated with a greater risk of cancer mortality (tertile 2 vs tertile 1: hazard ratio [HR], 1.45; 95% CI, 1.00-2.11; tertile 3 vs tertile 1: HR, 1.52; 95% CI, 1.01-2.27). Longer sedentary bout duration was not significantly associated with greater cancer mortality risk: after adjustment for MVPA (tertile 2 vs tertile 1: HR, 1.26; 95% CI, 0.90-1.78; tertile 3 vs tertile 1: HR, 1.36; 95% CI, 0.96-1.93). Replacing 30 minutes of sedentary time with LIPA was significantly associated with an 8% (per 30 minutes: HR, 0.92; 95% CI, 0.86-0.97) lower risk of cancer mortality; MVPA was significantly associated with a 31% (per 30 minutes: HR, 0.69; 95% CI, 0.48-0.97) lower risk of cancer mortality. Conclusions and Relevance In this cohort study, greater sedentary time, as measured with accelerometry, appeared to be independently associated with cancer mortality risk. Replacing sedentary time with either LIPA or MVPA may be associated with a lower risk of cancer mortality. These findings suggest that the total volume of sedentary behavior is a potential cancer mortality risk factor and support the public health message that adults should sit less and move more to promote longevity.
Purpose: To provide an overview of relationships between sedentary behavior and mortality as well as incidence of several noncommunicable diseases and weight status reported in the 2018 Physical Activity Guidelines Advisory Committee Scientific Report (2018 PAGAC Scientific Report), and to update the evidence from recent studies. Methods: Evidence related to sedentary behavior in the 2018 PAGAC Scientific Report was summarized, and a systematic review was undertaken to identify original studies published between January 2017 and February 2018. Results: The 2018 PAGAC Scientific Report concluded there was strong evidence that high amounts of sedentary behavior increase the risk for all-cause and cardiovascular disease (CVD) mortality and incident CVD and type 2 diabetes. Moderate evidence indicated sedentary behavior is associated with incident endometrial, colon and lung cancer. Limited evidence suggested sedentary behavior is associated with cancer mortality and weight status. There was strong evidence that the hazardous effects of sedentary behavior are more pronounced in physically inactive people. Evidence was insufficient to determine if bout length or breaks in sedentary behavior are associated with health outcomes. The new literature search yielded seven new studies for all-cause mortality, two for CVD mortality, two for cancer mortality, four for type 2 diabetes, one for weight status, and four for cancer; no new studies were identified for CVD incidence. Results of the new studies supported the conclusions in the 2018 PAGAC Scientific Report. Conclusions: The results of the updated search add further evidence on the association between sedentary behavior and health. Further research is required on how sex, age, race/ethnicity, socioeconomic status, and weight status may modify associations between sedentary behavior and health outcomes.
Introduction: Excess sitting is a risk factor for early mortality. This may be resulting, at least in part, from the displacement of physical activity with sedentary behaviors. The purpose of this observational study was to examine the mortality risk reductions associated with replacing 30minutes/day sitting for an equivalent duration of light or moderate to vigorous physical activity (MVPA). Methods: Participants included 37,924 men and 54,617 women in the Cancer Prevention Study-II Nutrition Cohort, of which 14,415 men and 13,358 women died during follow-up (1999-2014). An isotemporal substitution approach to the Cox proportional hazards regression model was used to estimate adjusted hazard ratios and 95% CIs for mortality associated with the substitution of 30minutes/day self-reported sitting for light physical activity or MVPA. Analyses were conducted in 2018. Results: Among the least active participants (≤17minutes/day MVPA), the replacement of 30minutes/day sitting with light physical activity was associated with a 14% mortality risk reduction (hazard ratio=0.86, 95% CI=0.81, 0.89) and replacement with MVPA was associated with a 45% mortality risk reduction (hazard ratio=0.55, 95% CI=0.47, 0.62). Similar associations were seen among moderately active participants (light physical activity replacement, hazard ratio=0.94, 95% CI=0.91, 0.97; MVPA replacement, hazard ratio=0.83, 95% CI=0.76, 0.88). However, for the most active (MVPA >38 minutes/day), substitution of sitting time with light physical activity or MVPA was not associated with a reduction in mortality risk (hazard ratio=1.00, 95% CI=0.97, 1.03, and hazard ratio=0.99, 95% CI=0.95, 1.02, respectively). Conclusions: These findings suggest that the replacement of modest amounts of sitting time with even light physical activity may have the potential to reduce the risk of premature death among less active adults.