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Too Much Sitting and Cardio-Metabolic Risk: An Update of Epidemiological Evidence

  • Physical Activity (D Warburton, Section Editor)
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Abstract

Sedentary behavior, as distinct from a lack of moderate-to-vigorous physical activity, is an emerging health risk behavior for the development of chronic diseases. Examples of sedentary behavior include sitting, watching television, using a computer, and driving a car. In this article, we define sedentary behavior; outline key concepts related to the physiology of sedentary behavior, review the recent evidence on the effects of prolonged sedentary behavior (or sitting) on the risk of cardio-metabolic disease and all cause mortality, and discuss the implications for current clinical practice. We found that most large scale studies on sedentary behavior were published in the last 5 years. There is moderately consistent evidence for an association between total sitting time and all-cause mortality, even when adjusted for or stratified by leisure time physical activity. Overall, we identified a compelling case for sitting reduction to be included in clinical preventive advice as a key component of ‘active living,’ where adults and children are encouraged to ‘move more and sit less’ across different settings and locations throughout the day.

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References

Papers of particular interest, published recently, have been highlighted as: •  Of importance

  1. • Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT. Effect of physical inactivity on major noncommunicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet. 2012;380:219–29. This paper was a recent summary of the epidemiological evidence for physical inactivity and health using a burden of disease approach. It is slightly outside the remit ofsitting and healthresearch, but is an important recent distillation of the health impact of not being physically active, with an estimated 9% of premature mortality across the world attributed to physical inactivity ( not meeting moderate intensity physical activity recommendations). This is around 5 million deaths per year that could be prevented if physical inactivity were abolished, and is a similar attributable number for tobacco smoking globally, and substantially larger to that attributed to obesity. For this reason, physical inactivity remains an important and under-recognized issue in preventive health.

    Article  PubMed  Google Scholar 

  2. WHO. Global recommendations on physical activity for health. Geneva: World Health Organization; 2010.

  3. • Proper KI, Singh AS, van Mechelen W, Chinapaw MJM. Sedentary behaviors and health outcomes among adults: a systematic review of prospective studies. Am J Prev Med. 2011;40:174–82. This systematic review explored the relationship between sedentary behaviors and health outcomes in adults, and identified 19 studies. The evidence was mixed for some outcomes, but a moderate evidence for sitting behavior and diabetes was evident, and a strong relationship between sitting behavior and all cause and cardiovascular disease mortality was noted. This type of summary is starting to synthesize the evidence that enables us to move towards public health recommendations.

    Article  PubMed  Google Scholar 

  4. Thorp AA, Owen N, Neuhaus M, Dunstan DW. Sedentary behaviors and subsequent health outcomes in adults: a systematic review of longitudinal studies, 1996–2011. Am J Prev Med. 2011;41:207–15.

    Article  PubMed  Google Scholar 

  5. Grøntved A, Hu FB. Television viewing and risk of type 2 diabetes, cardiovascular disease, and all-cause mortality. JAMA. 2011;305:2448–55.

    Article  PubMed  Google Scholar 

  6. • Katzmarzyk PT, Lee IM. Sedentary behavior and life expectancy in the USA: a cause-deleted life table analysis. BMJ Open. 2012;2:4. This meta-analysis reviewed studies of sitting and mortality, and estimated increased life expectancy amongst USA adults if sitting time was reduced. The authors estimated that life expectancy would increase by 2 years if sitting were reduced to less than 3 hours per day, and an increase of 1.38 years in life expectancy would accrue if television viewing was restricted to less than 2 hours per day. Whilst the former may be a difficult goal to achieve in sedentary workplaces, the latter is a population health goal that might be achievable if alternate ways of spending time in domestic setting, became culturally normative. This is a long term approach, but is an important idea in thinking about the beneficial effects of reducing sitting time.

    Article  Google Scholar 

  7. Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, et al. Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc. 2000;32(9 Suppl):S498–504.

    PubMed  CAS  Google Scholar 

  8. • Sedentary Behavior Research Network. Standardized use of the terms "sedentary" and "sedentary behaviors". Appl Physiol Nutr Metab. 2012;37:540–2. This methodological note describes the difference between not meeting physical activity recommendations (being inactive) and the specific sedentary behaviors, defined aswaking time behavior with an energy expenditure of less than 1.5 METS, whilst in a sitting or reclining position”. This definition is important because light physical activity might not meet recommendations, and includes standing or walking around, but is not classified assedentary behaviortime. This distinction is important physiologically, epidemiologically, and for characterizing peoples lifestyle behaviors.

    Article  Google Scholar 

  9. Matthews CE, Chen KY, Freedson PS, Buchowski MS, Beech BM, Pate RR, et al. Amount of time spent in sedentary behaviors in the United States, 2003–2004. Am J Epidemiol. 2008;167:875–81.

    Article  PubMed  Google Scholar 

  10. Colley RC, Garriguet D, Janssen I, Craig CL, Clarke J, Tremblay MS. Physical activity of Canadian adults: accelerometer results from the 2007 to 2009 Canadian Health Measures Survey. Health Reports, Statistics Canada, Catalogue no. 82-003-XPE. 2011;22.

  11. Hagströmer M, Troiano RP, Sjöström M, Berrigan D. Levels and patterns of objectively assessed physical activity - a comparison between Sweden and the United States. Am J Epidemiol. 2010;171:1055–64.

    Article  PubMed  Google Scholar 

  12. Aresu M, Bécares L, Brage S, Chaudhury M, Doyle-Francis M, Esliger D, et al. Health survey for England 2008 Volume 1. Physical activity and fitness. UK: the NHS Information Centre for health and social care, 2009.

  13. Bauman A, Ainsworth BE, Sallis JF, Hagströmer M, Craig CL, Bull FC, et al. The descriptive epidemiology of sitting–a 20-country comparison using the International Physical Activity Questionnaire (IPAQ). Am J Prev Med. 2011;41:228–35.

    Article  PubMed  Google Scholar 

  14. Chau JY, Merom D, Grunseit A, Rissel C, Bauman AE, van der Ploeg HP. Temporal trends in nonoccupational sedentary behaviors from Australian Time Use Surveys 1992, 1997, and 2006. IJBNPA. 2012;9:76.

    PubMed  Google Scholar 

  15. van der Ploeg HP, Venugopal K, Chau JY, van Poppel MNM, Breedveld K, Merom D, et al. Population changes in nonoccupational sedentary behaviors in The Netherlands between 1975 and 2005. Am J Prev Med. 2013;44:382–7.

    Article  PubMed  Google Scholar 

  16. Church TS, Thomas DM, Tudor-Locke C, Katzmarzyk PT, Earnest CP, Rodarte RQ, et al. Trends over 5 decades in U.S. occupation-related physical activity and their associations with obesity. PLoS One. 2011;6:e19657.

    Article  PubMed  CAS  Google Scholar 

  17. Bergouignan A, Rudwill F, Simon C, Blanc S. Physical inactivity as the culprit of metabolic inflexibility: evidence from bed-rest studies. J Appl Physiol. 2011;111:1201–10.

    Article  PubMed  CAS  Google Scholar 

  18. Hamilton MT, Hamilton DG, Zderic TW. Role of low energy expenditure and sitting in obesity, metabolic syndrome, type 2 diabetes, and cardiovascular disease. Diabetes. 2007;56:2655–67.

    Article  PubMed  CAS  Google Scholar 

  19. Tremblay MS, Colley RC, Saunders TJ, Healy GN, Owen N. Physiological and health implications of a sedentary lifestyle. Appl Physiol Nutr Metab. 2010;35:725–40.

    Article  PubMed  Google Scholar 

  20. Henriksen EJ, Bourey RE, Rodnick KJ, Koranyi L, Permutt MA, Holloszy JO. Glucose transporter protein content and glucose transport capacity in rat skeletal muscles. Am J Physiol. 1990;259(4 Pt 1):E593–8.

    PubMed  CAS  Google Scholar 

  21. Kawanaka K, Tabata I, Katsuta S, Higuchi M. Changes in insulin-stimulated glucose transport and GLUT-4 protein in rat skeletal muscle after training. J Appl Physiol. 1997;83:2043–7.

    PubMed  CAS  Google Scholar 

  22. Bey L, Hamilton MT. Suppression of skeletal muscle lipoprotein lipase activity during physical inactivity: a molecular reason to maintain daily low-intensity activity. J Physiol. 2003;551:673–82.

    Article  PubMed  CAS  Google Scholar 

  23. Hamilton MT, Etienne J, McClure WC, Pavey BS, Holloway AK. Role of local contractile activity and muscle fiber type on LPL regulation during exercise. Am J Physiol. 1998;275(6 Pt 1):E1016–22.

    PubMed  CAS  Google Scholar 

  24. Stephens BR, Granados K, Zderic TW, Hamilton MT, Braun B. Effects of 1 day of inactivity on insulin action in healthy men and women: interaction with energy intake. Metabolism. 2011;60:941–9.

    Article  PubMed  CAS  Google Scholar 

  25. • Dunstan DW, Kingwell BA, Larsen R, Healy GN, Cerin E, Hamilton MT, et al. Breaking up prolonged sitting reduces postprandial glucose and insulin responses. Diabetes Care. 2012;35:976–83. This experimental study examines physiological responses to sitting and compares a small number of mid aged adults in a randomized trial, with subjects allocated uninterrupted sitting, 2 minutes of light intensity every 20 minutes, and 2 minutes of moderate intensity every 20 minutes. This tests the question whether interrupting sitting with just standing or with moderate intensity activity improves physiological parameters. Objectively measured glucose uptake was examined, and the area under the curve was reduced in both the standing and moderate intensity categories compared with uninterrupted sitting. The insulinarea under the curvewas similarly reduced in both intervention groups, suggesting post prandial responses to sitting are ameliorated by interrupting sitting time. This has implications for normalizing sitting related physiological responses.

    Article  PubMed  Google Scholar 

  26. Wilmot EG, Edwardson CL, Achana FA, Davies MJ, Gorely T, Gray LJ, et al. Sedentary time in adults and the association with diabetes, cardiovascular disease and death: systematic review and meta-analysis. Diabetologia. 2012;55:2895–905.

    Article  PubMed  CAS  Google Scholar 

  27. George ES, Rosenkranz RR, Kolt GS. Chronic disease and sitting time in middle-aged Australian males: findings from the 45 and up Study. Int J Behav Nutr Phys Act. 2013;10:20.

    Article  PubMed  Google Scholar 

  28. Yates T, Khunti K, Wilmot EG, Brady E, Webb D, Srinivasan B, et al. Self-reported sitting time and markers of inflammation, insulin resistance, and adiposity. Am J Prev Med. 2012;42:1–7.

    Article  PubMed  Google Scholar 

  29. Cooper A, Sebire S, Montgomery A, Peters T, Sharp D, Jackson N, et al. Sedentary time, breaks in sedentary time and metabolic variables in people with newly diagnosed type 2 diabetes. Diabetologia. 2011;55:589–99.

    Article  PubMed  Google Scholar 

  30. Ford ES, Caspersen CJ. Sedentary behavior and cardiovascular disease: a review of prospective studies. Int J Epidemiol. 2012;41:1338–53.

    Article  PubMed  Google Scholar 

  31. Pinto Pereira SM, Ki M, Power C. Sedentary behavior and biomarkers for cardiovascular disease and diabetes in mid-life: the role of television-viewing and sitting at work. PLoS One. 2012;7:e31132. doi:10.1371/journal.pone.0031132.

    Article  PubMed  Google Scholar 

  32. Frydenlund G, Jorgensen T, Toft U, Pisinger C, Aadahl M. Sedentary leisure time behavior, snacking habits and cardiovascular biomarkers: the Inter99 Study. Eur J Prev Cardiol. 2012;19:1111–9.

    Article  PubMed  Google Scholar 

  33. Brown WJ, Williams L, Ford JH, Ball K, Dobson AJ. Identifying the energy gap: magnitude and determinants of 5-year weight gain in midage women. Obes Res. 2005;13:1431–41.

    Article  PubMed  Google Scholar 

  34. Ekelund U, Brage S, Besson H, Sharp S, Wareham NJ. Time spent being sedentary and weight gain in healthy adults: reverse or bidirectional causality? Am J Clin Nutr. 2008;88:612–7.

    PubMed  CAS  Google Scholar 

  35. Pulsford RM, Stamatakis E, Britton AR, Brunner EJ, Hillsdon MM. Sitting behavior and obesity evidence from the Whitehall II study. Am J Prev Med. 2013;44:132–8.

    Article  PubMed  Google Scholar 

  36. Shuval K, Leonard T, Murdoch J, Caughy MO, Kohl HW, Skinner CS. Sedentary behaviors and obesity in a low-income, ethnic-minority population. J Phys Act Health. 2013;10:132–6.

    PubMed  Google Scholar 

  37. Gomez-Cabello A, Pedrero-Chamizo R, Olivares PR, Hernandez-Perera R, Rodriguez-Marroyo JA, Mata E, et al. Sitting time increases the overweight and obesity risk independently of walking time in elderly people from Spain. Maturitas. 2012;73:337–43.

    Article  PubMed  Google Scholar 

  38. de Heer HD, Wilkinson AV, Strong LL, Bondy ML, Koehly LM. Sitting time and health outcomes among Mexican origin adults: obesity as a mediator. BMC Public Health. 2012;12.

  39. Chau JY, van der Ploeg HP, Merom D, Chey T, Bauman AE. Cross-sectional associations between occupational and leisure-time sitting, physical activity and obesity in working adults. Prev Med. 2012;54:195–200.

    Article  PubMed  Google Scholar 

  40. Banks E, Lim L, Seubsman SA, Bain C, Sleigh A. Relationship of obesity to physical activity, domestic activities, and sedentary behaviors: cross-sectional findings from a national cohort of over 70,000 Thai adults. BMC Public Health. 2011;11.

  41. Matthews CE, George SM, Moore SC, Bowles HR, Blair A, Park Y, et al. Amount of time spent in sedentary behaviors and cause-specific mortality in US adults. Am J Clin Nutr. 2012;95:437–45.

    Article  PubMed  CAS  Google Scholar 

  42. Pavey TG, Peeters GG, Brown WJ. Sitting-time and 9-year all-cause mortality in older women. Br J Sports Med. 2012;10. Accesible on: 1136/bjsports-2012-091676.

  43. Koster A, Caserotti P, Patel KV, Matthews CE, Berrigan D, Van Domelen DR, et al. Association of sedentary time with mortality independent of moderate to vigorous physical activity. PLoS One. 2012;7:e37696.

    Article  PubMed  CAS  Google Scholar 

  44. Campbell PT, Patel AV, Newton CC, Jacobs EJ, Gapstur SM. Associations of recreational physical activity and leisure time spent sitting with colorectal cancer survival. J Clin Oncol. 2013;31:876–85.

    Article  PubMed  Google Scholar 

  45. van der Ploeg HP, Chey T, Korda R, Banks E, Bauman AE. Sitting time and all-cause mortality risk in 222,497 Australian adults. Arch Intern Med. 2012;172:494–500.

    Article  PubMed  Google Scholar 

  46. Tremblay MS, Leblanc AG, Janssen I, Kho ME, Hicks A, Murumets K, et al. Canadian sedentary behavior guidelines for children and youth. Appl Physiol Nutr Metab. 2011;36(59–64):65–71.

    Article  Google Scholar 

  47. Department of Health, Physical Activity, Health Improvement and Protection. Start active, stay active: a report on physical activity for health from the four home countries’ Chief Medical Officers. UK: Department of Health, 2011.

  48. Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43:1334–59.

    Article  PubMed  Google Scholar 

  49. Bellew B, Bauman A, Martin B, Bull F, Matsudo V. Public policy actions needed to promote physical activity. Curr Cardiovasc Risk. 2011;5:340–9.

    Article  Google Scholar 

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Adrian E Bauman declares that she has no conflict of interest. Josephine Y Chau declares that she has no conflict of interest. Ding Ding declares that he has no conflict of interest. Jason Bennie declares that he has no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Correspondence to Adrian E. Bauman.

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Bauman, A.E., Chau, J.Y., Ding, D. et al. Too Much Sitting and Cardio-Metabolic Risk: An Update of Epidemiological Evidence. Curr Cardiovasc Risk Rep 7, 293–298 (2013). https://doi.org/10.1007/s12170-013-0316-y

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