Sedentary Time and Its Association With Risk for Disease Incidence, Mortality, and Hospitalization in Adults

A Systematic Review and Meta-analysis

Biswas, Aviroop BSc
Oh, Paul I. MD, MSc
Faulkner, Guy E. PhD
Bajaj, Ravi R. MD
Silver, Michael A. BSc
Mitchell, Marc S. MSc
Alter, David A. MD, PhD

From the Institute of Health Policy, Management and Evaluation, and the Faculty of Kinesiology and Physical Education, University of Toronto; University Health Network-Toronto Rehabilitation Institute, Cardiovascular Prevention and Rehabilitation Program; Sunnybrook Health Sciences Centre; York University; and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.

Financial Support: Dr. Alter is supported with a career investigator award from the Heart and Stroke Foundation of Canada. Dr Faulkner is supported with a Canadian Institutes of Health Research-Public Health Agency of Canada (CIHR-PHAC) Chair in Applied Public Health. Dr. Oh is supported with a Goodlife Fitness Chair in Cardiovascular Rehabilitation and Prevention, University Health Network-Toronto Rehabilitation Institute, University of Toronto.

Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-5133.

Requests for Single Reprints: David A. Alter, MD, PhD, Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, G1-06, Toronto, Ontario M4N 3M5, Canada; e-mail, [email protected].

Current author addresses and author contributions are available at www.annals.org.

For author affiliations, see end of text.

Current Author Addresses: Mr. Biswas: Institute of Health Policy, Management and Evaluation, University of Toronto, 4th Floor, 155 College Street, Toronto, Ontario M5T 3M6, Canada.

Dr. Oh: University Health Network-Toronto Rehabilitation Institute, 347 Rumsey Road, Toronto, Ontario M4G 1R7, Canada.

Dr. Faulkner and Mr. Mitchell: Faculty of Kinesiology and Physical Education, University of Toronto, 55 Harbord Street, Toronto, Ontario M5S 2W6, Canada.

Dr. Bajaj: Department of Cardiology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3A5, Canada.

Mr. Silver: Osgoode Hall Law School, York University, 4700 Keele Street, Toronto, Ontario M3J 1P3, Canada.

Dr. Alter: Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, G1-06, Toronto, Ontario M4N 3M5, Canada.

Author Contributions: Conception and design: A. Biswas, R.R. Bajaj, M.A. Silver, D.A. Alter.

Analysis and interpretation of the data: A. Biswas, P.I. Oh, G.E. Faulkner, M.A. Silver, M.S. Mitchell, D.A. Alter.

Drafting of the article: A. Biswas, P.I. Oh, G.E. Faulkner, M.S. Mitchell, D.A. Alter.

Critical revision of the article for important intellectual content: A. Biswas, G.E. Faulkner, R.R. Bajaj, M.A. Silver, M.S. Mitchell, D.A. Alter.

Final approval of the article: A. Biswas, P.I. Oh, G.E. Faulkner, R.R. Bajaj, M.S. Mitchell, D.A. Alter.

Provision of study materials or patients: D.A. Alter.

Statistical expertise: A. Biswas, M.S. Mitchell.

Administrative, technical, or logistic support: M.A. Silver, D.A. Alter.

Collection and assembly of data: A. Biswas, M.A. Silver.

Annals of Internal Medicine 162(2):p 123-132, January 20, 2015.

Background:

The magnitude, consistency, and manner of association between sedentary time and outcomes independent of physical activity remain unclear.

Purpose:

To quantify the association between sedentary time and hospitalizations, all-cause mortality, cardiovascular disease, diabetes, and cancer in adults independent of physical activity.

Data Sources:

English-language studies in MEDLINE, PubMed, EMBASE, CINAHL, Cochrane Library, Web of Knowledge, and Google Scholar databases were searched through August 2014 with hand-searching of in-text citations and no publication date limitations.

Study Selection:

Studies assessing sedentary behavior in adults, adjusted for physical activity and correlated to at least 1 outcome.

Data Extraction:

Two independent reviewers performed data abstraction and quality assessment, and a third reviewer resolved inconsistencies.

Data Synthesis:

Forty-seven articles met our eligibility criteria. Meta-analyses were performed on outcomes for cardiovascular disease and diabetes (14 studies), cancer (14 studies), and all-cause mortality (13 studies). Prospective cohort designs were used in all but 3 studies; sedentary times were quantified using self-report in all but 1 study. Significant hazard ratio (HR) associations were found with all-cause mortality (HR, 1.240 [95% CI, 1.090 to 1.410]), cardiovascular disease mortality (HR, 1.179 [CI, 1.106 to 1.257]), cardiovascular disease incidence (HR, 1.143 [CI, 1.002 to 1.729]), cancer mortality (HR, 1.173 [CI, 1.108 to 1.242]), cancer incidence (HR, 1.130 [CI, 1.053 to 1.213]), and type 2 diabetes incidence (HR, 1.910 [CI, 1.642 to 2.222]). Hazard ratios associated with sedentary time and outcomes were generally more pronounced at lower levels of physical activity than at higher levels.

Limitation:

There was marked heterogeneity in research designs and the assessment of sedentary time and physical activity.

Conclusion:

Prolonged sedentary time was independently associated with deleterious health outcomes regardless of physical activity.

Primary Funding Source:

None.