Review
Too much sitting – A health hazard

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Abstract

In contemporary society, prolonged sitting has been engineered into our lives across many settings, including transportation, the workplace, and the home. There is new evidence that too much sitting (also known as sedentary behavior – which involves very low energy expenditure, such as television viewing and desk-bound work) is adversely associated with health outcomes, including cardio-metabolic risk biomarkers, type 2 diabetes and premature mortality. Importantly, these detrimental associations remain even after accounting for time spent in leisure time physical activity. We describe recent evidence from epidemiological and experimental studies that makes a persuasive case that too much sitting should now be considered an important stand-alone component of the physical activity and health equation, particularly in relation to diabetes and cardiovascular risk. We highlight directions for further research and consider some of the practical implications of focusing on too much sitting as a modifiable health risk.

Section snippets

Sedentary behavior and cardio-metabolic health – emergence of a new paradigm

Physical activity has been shown to be consistently associated with reduced risk of type 2 diabetes [1], cardiovascular disease [2] and premature mortality [3]. Public-health recommendations on participation in regular moderate-to-vigorous intensity physical activity (sometimes referred to as ‘health enhancing exercise’) have been widely promulgated, with the aim of reducing type 2 diabetes risk, cardiovascular disease and some cancers [4]. US Federal Guidelines [5] recommend at least 30 min of

The particular health hazards of too much sitting

The notion that prolonged sitting is hazardous to one's health is not new. Ramazzini [21], a distinguished occupational physician, noted as early as the 17th century that a relationship between sedentary behavior and deleterious health consequences were evident in workers whose occupations required them to sit for long hours. In the 1960s, Morris and colleagues [22] reported that workers in occupations requiring primarily sitting (London bus drivers and mail sorters) had a higher incidence of

Sedentary behavior and premature mortality

Over the past 3 years, nine separate studies have reported on the prospective relationships with premature mortality of self-reported sitting time [40], [41], [42]; on TV viewing time and other screen-time behaviors [43], [44], [45], [46]; and, on TV viewing time plus other sedentary behaviors [47], [48]. Consistently, these studies indicate that time spent in sedentary behavior may be independently associated with increased risk for all-cause and CVD-related mortality in both men and women.

Prolonged unbroken sitting is a contributor to poor health

As already noted, the development of device-based measures of physical activity has provided researchers with sophisticated tools to account accurately for the entire range of activity, from sedentary through to highly vigorous activities in free living participants over a number of days. The most commonly used device-based measure in population-based studies to date has been the accelerometer.

Initial findings from the 2004 to 2005 Australian Diabetes, Obesity and Lifestyle Study (AusDiab)

Experimental models addressing the metabolic consequences of prolonged, unbroken sedentary time

The highest priority for the new sedentary behavior and health research agenda is to gather additional evidence from prospective studies, and importantly, new evidence from human experimental work and intervention trials [10]. Understanding the biological mechanisms that underlie associations of prolonged sitting with adverse health outcomes is required in order to identify the specific causal nature of these relationships. To date, few examples exist of human experimental models that

Public health and clinical implications

On the strength of the evidence that we have reviewed – showing that prolonged sitting time appears to be an important determinant of major health outcomes – we posit that there is now sufficient evidence to assist practitioners and public health experts to expand their thinking beyond just ‘purposeful health enhancing exercise’. There are good reasons now to give serious consideration to advocating reductions in sedentary time. Already, some leading health agencies have taken a proactive

Conclusions

There is every reason to continue to emphasize the importance of regular moderate-to-vigorous physical activity in the prevention and treatment of chronic disease. However, new evidence linking prolonged sitting time with significant compromises to cardio-metabolic health, indicates that even in physically active adults, concurrent reductions in the amount of time spent sitting is likely to confer health benefits. At present, no definitive recommendations on how long people should sit for or

Conflict of interest

There are no conflicts of interest.

Acknowledgements

D.W. Dunstan is supported by an Australian Research Council Future Fellowship. N. Owen is supported by a National Health and Medical Research Council (NHMRC) Senior Principal Research Fellowship. G.N.Healy is supported by an NHMRC (no. 569861)/National Heart Foundation of Australia (PH 08B 3905) Postdoctoral Fellowship.

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