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.
Keywords
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References
- Sedentary Behavior Research Network (SBRN)—Terminology Consensus Project process and outcome.Int J Behav Nutr Phys Act. 2017; 14: 75
- Physical activity, sedentary behavior, and cause-specific mortality in black and white adults in the Southern Community Cohort Study.Am J Epidemiol. 2014; 180: 394-405
- Amount of time spent in sedentary behaviors in the United States, 2003-2004.Am J Epidemiol. 2008; 167: 875-881
- Sitting time and mortality from all causes, cardiovascular disease, and cancer.Med Sci Sports Exerc. 2009; 41: 998-1005
- Causes of death associated with prolonged TV viewing: NIH-AARP Diet and Health Study.Am J Prev Med. 2015; 49: 811-821
- Sedentary behaviors and health outcomes among adults: A systematic review of prospective studies.Am J Prev Med. 2011; 40: 174-182
- Occupational sitting and health risks: A systematic review.Am J Prev Med. 2010; 39: 379-388
- Sedentary behaviors and subsequent health outcomes in adults a systematic review of longitudinal studies, 1996-2011.Am J Prev Med. 2011; 41: 207-215
- Sedentary behavior and health outcomes among older adults: A systematic review.BMC Public Health. 2014; 14: 333
- Role of objectively measured sedentary behaviour in physical performance, frailty and mortality among older adults: A short systematic review.Eur J Sport Sci. 2017; 17: 940-953
- Daily sitting time and all-cause mortality: A meta-analysis.PLoS One. 2013; 8: e80000
- 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: 123-132
- Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women.Lancet. 2016; 388: 1302-1310
- Sedentary time in adults and the association with diabetes, cardiovascular disease and death: Systematic review and meta-analysis.Diabetologia. 2012; 55: 2895-2905
- Sedentary behaviour and risk of all-cause, cardiovascular and cancer mortality, and incident type 2 diabetes: A systematic review and dose response meta-analysis.Eur J Epidemiol. 2018; 33: 811-829
- A cut-off of daily sedentary time and all-cause mortality in adults: A meta-regression analysis involving more than 1 million participants.BMC Med. 2018; 16: 74
- Television viewing and risk of type 2 diabetes, cardiovascular disease, and all-cause mortality: A meta-analysis.JAMA. 2011; 305: 2448-2455
- Association between television viewing time and all-cause mortality: A meta-analysis of cohort studies.Am J Epidemiol. 2015; 182: 908-916
- A review of lifetime risk factors for mortality.Br Actuarial J. 2009; 15: 17-64
- Meta-analysis of observational studies in epidemiology: A proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group.JAMA. 2000; 283: 2008-2012
- Too much sitting: A novel and important predictor of chronic disease risk?.Br J Sports Med. 2009; 43: 81-83
- Integrating sleep, sedentary behaviour, and physical activity research in the emerging field of time-use epidemiology: Definitions, concepts, statistical methods, theoretical frameworks, and future directions.Kinesiology. 2017; 49: 1-18
- Isotemporal substitution paradigm for physical activity epidemiology and weight change.Am J Epidemiol. 2009; 170: 519-527
- 2011 compendium of physical activities: A second update of codes and MET values.Med Sci Sports Exerc. 2011; 43: 1575-1581
- The energy expenditure of sedentary behavior: A whole room calorimeter study.PLoS One. 2013; 8: e63171
- The robust-error meta-regression method for dose-response meta-analysis.Int J Evid Based Healthc. 2018; 16: 138-144
- Sleep duration and risk of all-cause mortality: A flexible, non-linear, meta-regression of 40 prospective cohort studies.Sleep Med Rev. 2017; 32: 28-36
- Association between various sedentary behaviours and all-cause, cardiovascular disease and cancer mortality: The Multiethnic Cohort Study.Int J Epidemiol. 2013; 42: 1040-1056
- A randomized non-pharmacological intervention study for prevention of ischaemic heart disease: Baseline results Inter99.Eur J Cardiovasc Prev Rehabil. 2003; 10: 377-386
- Television viewing time independently predicts all-cause and cardiovascular mortality: The EPIC Norfolk study.Int J Epidemiol. 2011; 40: 150-159
- Television viewing time and mortality: The Australian Diabetes, Obesity and Lifestyle Study (AusDiab).Circulation. 2010; 121: 384-391
- Sedentary behavior and mortality in older women: The Women's Health Initiative.Am J Prev Med. 2014; 46: 122-135
- Television viewing, computer use, time driving and all-cause mortality: The SUN cohort.J Am Heart Assoc. 2014; 3: e000864
- Environmental determinants of physical activity and sedentary behavior.Exerc Sport Sci Rev. 2000; 28: 153-158
- Measurement issues and poor adjustments for physical activity and sleep undermine sedentary behaviour research—The focus should shift to the balance between sleep, sedentary behaviour, standing and activity.Kinesiology. 2014; 46: 135-146
- Compositional data analysis for physical activity, sedentary time and sleep research.Stat Methods Med Res. 2018; 27: 3726-3738
- Is sedentary behaviour just physical inactivity by another name?.Int J Behav Nutr Phys Act. 2017; 14: 142
- Associations of change in television viewing time with biomarkers of postmenopausal breast cancer risk: The Australian Diabetes, Obesity and Lifestyle Study.Cancer Causes Control. 2014; 25: 1309-1319
- Prospective cohort study of C-reactive protein as a predictor of clinical events in adults with congenital heart disease: Results of the Boston Adult Congenital Heart Disease Biobank.Eur Heart J. 2018; 39: 3253-3261
- Association between inflammatory biomarker C-reactive protein and radiotherapy-induced early adverse skin reactions in a multiracial/ethnic breast cancer population.J Clin Oncol. 2018; 36: 2473-2482
- Systematic comparative validation of self-report measures of sedentary time against an objective measure of postural sitting (activPAL).Int J Behav Nutr Phys Act. 2018; 15: 21
- Measurement of adults' sedentary time in population-based studies.Am J Prev Med. 2011; 41: 216-227
- Sitting-time and 9-year all-cause mortality in older women.Br J Sports Med. 2015; 49: 95-99
- Daily total physical activity level and premature death in men and women: Results from a large-scale population-based cohort study in Japan (JPHC study).Ann Epidemiol. 2008; 18: 522-530
- Sitting time and mortality in older adults with disability: A national cohort study.J Am Med Dir Assoc. 2016; 17: 960.e15-960.e20
- Reallocating accelerometer-assessed sedentary time to light or moderate- to vigorous-intensity physical activity reduces frailty levels in older adults: An isotemporal substitution approach in the TSHA study.J Am Med Dir Assoc. 2018; 19: 185.e1-185.e6
- Sitting time and all-cause mortality risk in 222 497 Australian adults.Arch Intern Med. 2012; 172: 494-500
Reference
- A typology of reviews: An analysis of 14 review types and associated methodologies.Health Info Libr J. 2009; 26: 91-108
- (Version 5.1.0 [updated March 2011])Higgins J.P.T. Green S. Cochrane Handbook for Systematic Reviews of Interventions. The Cochrane Collaboration, 2011 (Available at:)
Article info
Publication history
Published online: July 01, 2019
Footnotes
This study received no funding. All data in the meta-analysis can be obtained from the relevant data custodians.
L.F.-K. is supported by National Health and Medical Research Council (NHMRC) of Australia Early Career Fellowship (no. 1158469). N.O. is supported by a NHMRC Senior Principal Research Fellowship (no. 1003960), an NHMRC Centre for Research Excellence Grant (no. 1057608) and by the Victorian Government’s Operational Infrastructure Support Program. D.D. is supported by an NHMRC Senior Research Fellowship (no. 1078360), an NHMRC Centre for Research Excellence Grant (no. 1057608), and by the Victorian Government’s Operational Infrastructure Support Program. The Women's Health Initiative (WHI) program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services, through contracts HHSN268201600018C, HHSN268201600001C, HHSN268201600002C, HHSN268201600003C, and HHSN268201600004C.
Identification
Copyright
© 2019 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
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