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Any public health guidelines should always be developed from a consistent, clear evidence base
  1. Emmanuel Stamatakis1,2,
  2. Ding Ding1,2,
  3. Mark Hamer3,4,
  4. Adrian E Bauman1,2,
  5. I-Min Lee5,6,
  6. Ulf Ekelund7,8
  1. 1Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
  2. 2Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
  3. 3Department of Epidemiology and Public Health, University College London, London, UK
  4. 4National Centre for Sport & Exercise Medicine, Loughborough University, Loughborough, UK
  5. 5Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
  6. 6Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  7. 7Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway
  8. 8Nasjonalt Folkehelseinstitutt, Oslo, Norway
  1. Correspondence to Professor Emmanuel Stamatakis, Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia; emmanuel.stamatakis{at}

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We thank Chaput and colleagues1 for their comments on our recent review2 that examined the timeliness of sitting guidelines and provided a critical overview of the sedentary behaviour evidence base. To recap for the reader: we argued that evidence of sitting and health is limited and we urged caution to prevent enthusiastic but premature guideline development. Chaput and colleagues argued that the sedentary behaviour evidence base is adequate and that a provisional screen time-based benchmark is better than no benchmark at all. We see four main areas for debate and discuss them in turn.

Dispute #1: ‘activity mixes’ and ‘reconceptualisation’ of physical activity in public health

Initially, our respected international colleagues1 proposed that the field needs to move towards ‘activity mixes’ that take into account the 24-hour compositional nature of the physical activity, sedentary behaviour and sleep data. Consider a weekend day when a person goes for a 3-hour bike ride. That reduces potential sitting time by 3 hours, so these physical activity elements, moderate to vigorous physical activity (MVPA) (bike ride), and sedentary …

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