Guiding Questions
- B2.
What is the association between sedentary behaviour and health-related outcomes?
Is there a dose response association (total volume, frequency, duration, and intensity of interruptions)?
Does the association vary by type and domain of sedentary behaviour?
Does physical activity modify the effect of sedentary behaviour on mortality?
Inclusion Criteria
Population: Adults 18 years of age and older
Exposure: Greater volume, decreased frequency, duration or intensity of interruption of sedentary behaviour
Comparison: Lesser volume, increased frequency, duration or intensity of interruption of sedentary behaviour
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| Outcomes | Importance |
|---|
| All-cause and cause-specific mortality | Critical |
| Incidence of cardiovascular disease | Critical |
| Incidence of cancer (site-specific) | Critical |
| Incidence of Type 2 Diabetes | Critical |
| Adiposity/Prevention of weight gain/Body composition | Critical |
| Mental health outcomes (e.g. depressive symptoms, anxiety symptoms) | Important |
| Cognitive outcomes (e.g. dementia, cognition) | Important |
| Physical function (e.g., physical strength, fitness) | Important |
| Musculoskeletal health (e.g., pain) | Important |
| Sleep duration and quality | Important |
| Health-related quality of life | Important |
Evidence identified
Twenty-two studies (published from 2017 to 2019) were initially identified that examined the association between sedentary behaviour and health-related outcomes among adults (1–22). Five review were subsequently excluded from further evaluation given the study design or exposures that were out-of-scope. presents the reviews that were excluded and their reason for exclusion.
Table B2.1Excluded Systematic Reviews, with Reasons for Exclusion
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| Author, Year | Reason for Exclusion | Rationale |
|---|
| Al Tunaiji 2019 (2) | Exposure | Examines relationship between lack of MVPA and CVD incidence |
| Baumeister 2019 (4) | Exposure | Examines relationship between PA and liver cancer |
| Chastin 2017 (7) | Exposure | Examines relationship between light-intensity PA and health outcomes |
| Friedenreich 2019 (11) | Design | Modelling study; underlying risk estimates not based on full systematic review methodology |
| Fuzeki 2017 (12) | Design | Analysis of NHANES data only |
presents the ratings for each remaining review according to all the AMSTAR 2 main domains. In general, the included reviews were of moderate credibility. One review was rated as having high credibility, 9 were rated as having moderate credibility, 3 were rated as having low credibility, and the remaining 4 were rated as having critically low credibility. Given concerns regarding the comprehensiveness and the validity of the results presented in reviews rated as having critically low credibility, they were not incorporated into the final Evidence Profiles. A total of 13 reviews were included in the Evidence Profiles below.
lists the 17 reviews that were assessed by outcome. A de novo search for important outcomes, that were not included in the PAGAC report was not conducted due to resource constraints. Evidence Profiles for these outcomes, therefore, are not included in this report. Extracted data for each included review is presented in Appendix A.
Table B2.2Credibility Ratings (based on AMSTAR 2 (23))
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| Author, Year | PICO1 | Apriori Methods2 | Study Design Selection3 | Lit Search Strategy4 | Study Selection5 | Data Extraction6 | Excluded Studies7 | Included Studies8 | RoB Assessment9 | Funding Sources10 | Statistical Methods11 | Impact of RoB12 | RoB Results13 | Heterogeneity14 | Publication Bias15 | COI16 | Overall Rating17 |
|---|
| Ahmad 2017 (1) | Y | PY | N | PY | Y | Y | Y | PY | PY | N | N/A | N/A | Y | Y | N/A | N | Moderate |
| Bailey 2019 (3) | Y | PY | N | PY | Y | Y | PY | PY | PY | N | Y | Y | Y | Y | Y | Y | Moderate |
| Berger 2019 (5) | Y | PY | N | PY | Y | Y | PY | Y | Y | N | Y | Y | Y | Y | Y | Y | Moderate |
| Chan 2019 (6) | Y | PY | N | PY | N | Y | Y | Y | Y | N | Y | Y | Y | Y | Y | Y | Moderate |
| del Pozo-Cruz 2018 (8) | Y | PY | N | PY | Y | N | PY | PY | Y | N | Y | Y | Y | Y | Y | Y | Moderate |
| Ekelund 2018 (9) | Y | Y | N | PY | N | Y | PY | Y | PY | N | Y | Y | Y | Y | Y | Y | Moderate |
| Ekelund 2019 (10) | Y | PY | N | PY | N | Y | PY | Y | Y | N | Y | N | N | N | Y | Y | Moderate |
| Ku 2018 (13) | Y | N | Y | PY | N | Y | Y | Y | Y | N | Y | Y | N | Y | Y | Y | Moderate |
| Ku 2019 (14) | Y | N | Y | PY | N | Y | Y | Y | Y | N | Y | Y | N | Y | Y | Y | Moderate |
| Lee 2019 (15) | N | N | N | PY | N | N | PY | Y | Y | N | N | N | N | Y | Y | Y | Critically Low |
| Ma 2018 (16) | N | N | N | PY | Y | Y | N | N | N | N | N | N | N | N | Y | N | Critically Low |
| Mahmood 2017 (17) | Y | PY | N | PY | Y | Y | PY | Y | N | N | Y | N | N | Y | Y | Y | Low |
| Mañas 2017 (18) | Y | N | N | PY | Y | N | PY | Y | N | N | N/A | N/A | N | N | N/A | Y | Critically Low |
| Patterson 2018 (19) | Y | N | N | PY | N | Y | PY | Y | PY | N | Y | Y | N | Y | Y | Y | Low |
| Shepard 2017 (20) | Y | N | N | N | N | N | N | Y | N | N | N/A | N/A | N | N | N/A | N | Critically Low |
| Wang 2018 (21) | Y | Y | Y | Y | Y | Y | PY | Y | Y | N | Y | Y | Y | Y | Y | Y | High |
| Xu 2019 (22) | Y | PY | N | N | N | N | N | Y | N | N | Y | N | N | Y | N | Y | Low |
Abbreviations: COI = conflict of interest; N = no; N/A = not applicable; PICO = population, intervention, comparator, outcome; PY = partial yes; RoB = risk of bias; Y = yes
- 1
Did the research questions and inclusion criteria for the review include the components of PICO?
- 2
Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justify any significant deviations from the protocol?
- 3
Did the review authors explain their selection of the study designs for inclusion in the review?
- 4
Did the review authors use a comprehensive literature search strategy?
- 5
Did the review authors perform study selection in duplicate?
- 6
Did the review authors perform data extraction in duplicate?
- 7
Did the review authors provide a list of excluded studies and justify the exclusions?
- 8
Did the review authors describe the included studies in adequate detail?
- 9
Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review?
- 10
Did the review authors report on the sources of funding for the studies included in the review?
- 11
If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results?
- 12
If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or other evidence synthesis?
- 13
Did the review authors account for RoB in individual studies when interpreting/ discussing the results of the review?
- 14
Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review?
- 15
If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss its likely impact on the results of the review?
- 16
Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review?
- 17
Shea et al. 2017. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both.
Table B2.3Systematic Reviews Assessed, by Author
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| Outcomes | | |
|---|
| Author, Year | ACM | Cause-specific mortality | CVD | Cancer | Diabetes | Adiposity | Mental health outcomes | Cognitive outcomes | Physical function | Musculoskeletal health | Sleep | HRQOL | Last Search Date | AMSTAR 2 |
|---|
| Ahmad 2017 (1) | | | ✕ | | ✕ | ✕ | | | | | | | Dec 2016 | Moderate |
|---|
| Bailey 2019 (3) | | | ✕ | | ✕ | | | | | | | | Feb 2019 | Moderate |
|---|
| Berger 2019 (5) | | Prostate | | Prostate | | | | | | | | | Jan 2019 | Moderate |
|---|
| Chan 2019 (6) | | | | Breast | | | | | | | | | Apr 2017 | Moderate |
|---|
| del Pozo-Cruz 2018 (8) | ✕ | | ✕ | | ✕ | ✕ | | | | | | | Dec 2016 | Moderate |
|---|
| Ekelund 2018a (9) | | CVD, Cancer | | | | | | | | | | | Oct 2015 | Moderate |
|---|
| Ekelund 2019 (10) | ✕ | | | | | | | | | | | | Jul 2018 | Moderate |
|---|
| Ku 2018 (13) | ✕ | | | | | | | | | | | | Jan 2018 | Moderate |
|---|
| Ku 2019 (14) | ✕ | | | | | | | | | | | | Mar 2019 | Moderate |
|---|
| Lee 2019 (15) | | | | Ovarian | | | | | | | | | Dec 2017 | Critically Low |
|---|
| Ma 2018 (16) | | | | Colorectal | | | | | | | | | Feb 2017 | Critically Low |
|---|
| Mahmood 2017 (17) | | | | Colorectal | | | | | | | | | Dec 2015 | Low |
|---|
| Mañas 2017 (18) | ✕b | | | | | | | | | | | | Oct 2016 | Critically Low |
|---|
| Patterson 2018 (19) | ✕ | CVD, Cancer | | | ✕ | | | | | | | | Sep 2016 | Low |
|---|
| Shepard 2017 (20) | | | | Bladder | | | | | | | | | Jun 2016 | Critically Low |
|---|
| Wang 2018 (21) | | | | Colorectal | | | | | | | | | Sep 2018 | High |
|---|
| Xu 2019c (22) | ✕ | | | | | | | | | | | | May 2018 | Low |
|---|
- a
Secondary data analysis of 2016 review
- b
Not included for this outcome given better quality reviews reporting this outcome
- c
Individual participant data meta-analysis
Appendix A. Data Extractions of Included Evidence (in alphabetical order by author)
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