B2EVIDENCE ON SEDENTARY BEHAVIOUR FOR ADULTS (18 YEARS OF AGE AND OLDER)

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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

Table

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. Table B2.1 presents the reviews that were excluded and their reason for exclusion.

Table B2.1. Excluded Systematic Reviews, with Reasons for Exclusion.

Table B2.1

Excluded Systematic Reviews, with Reasons for Exclusion.

Table B2.2 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.

Table B2.3 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 B2.2. Credibility Ratings (based on AMSTAR 2 (23)).

Table B2.2

Credibility Ratings (based on AMSTAR 2 (23)).

Table B2.3. Systematic Reviews Assessed, by Author.

Table B2.3

Systematic Reviews Assessed, by Author.

B.2. Sedentary Behaviour

Table B.2.a. All-cause and cause-specific mortality: Association between sedentary behaviour and all-cause mortality among adults (in alphabetical order by author) (PDF, 204K)

See the Supplementary materials for description of evidence of US PAGAC (24) by outcome

Table B.2.b. CVD incidence: Association between sedentary behaviour and CVD incidence among adults (in alphabetical order by author) (PDF, 64K)

See the Supplementary materials for description of evidence of US PAGAC (24) by outcome

Table B.2.c. Cancer incidence: Association between sedentary behaviour and cancer incidence among adults (in alphabetical order by author) (PDF, 69K)

See the Supplementary materials for description of evidence of US PAGAC (24) by outcome

Table B.2.d. Type 2 diabetes incidence: Association between sedentary behaviour and Type 2 diabetes incidence among adults (in alphabetical order by author) (PDF, 67K)

See the Supplementary materials for description of evidence of US PAGAC (24) by outcome

Table B.2.e. Adiposity: Association between sedentary behaviour and measures of adiposity among adults (in alphabetical order by author) (PDF, 65K)

See the Supplementary materials for description of evidence of US PAGAC (24) by outcome

Appendix A. Data Extractions of Included Evidence (in alphabetical order by author)

Download PDF (103K)

References

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2.: Al Tunaiji H, Davis JC, Mansournia MA, Khan KM. Population attributable fraction of leading non-communicable cardiovascular diseases due to leisure-time physical inactivity: A systematic review. BMJ open sport & exercise medicine. 2019/06/14 ed2019. p. e000512. [PMC free article: PMC6539142] [PubMed: 31191969]

3.: Bailey DP, Hewson DJ, Champion RB, Sayegh SM. Sitting Time and Risk of Cardiovascular Disease and Diabetes: A Systematic Review and Meta-Analysis. American journal of preventive medicine. 2019;57(3):408–16. [PubMed: 31377090]

4.: Baumeister SE, Leitzmann MF, Linseisen J, Schlesinger S. Physical Activity and the Risk of Liver Cancer: A Systematic Review and Meta-Analysis of Prospective Studies and a Bias Analysis. Journal of the National Cancer Institute. 2019;111(11):1142–51. [PMC free article: PMC6855940] [PubMed: 31168582]

5.: Berger FF, Leitzmann MF, Hillreiner A, Sedlmeier AM, Prokopidi-Danisch ME, Burger M, et al. Sedentary Behavior and Prostate Cancer: A Systematic Review and Meta-Analysis of Prospective Cohort Studies. Cancer prevention research (Philadelphia, Pa). 2019;12(10):675–88. [PubMed: 31362941]

6.: Chan DSM, Abar L, Cariolou M, Nanu N, Greenwood DC, Bandera EV, et al. World Cancer Research Fund International: Continuous Update Project-systematic literature review and meta-analysis of observational cohort studies on physical activity, sedentary behavior, adiposity, and weight change and breast cancer risk. Cancer causes & control : CCC. 2019;30(11):1183–200. [PubMed: 31471762]

7.: Chastin SFM, De Craemer M, De Cocker K, Powell L, Van Cauwenberg J, Dall P, et al. How does light-intensity physical activity associate with adult cardiometabolic health and mortality? Systematic review with meta-analysis of experimental and observational studies. British journal of sports medicine. 2019;53(6):370–6. [PMC free article: PMC6579499] [PubMed: 29695511]

8.: del Pozo-Cruz J, Garcia-Hermoso A, Alfonso-Rosa RM, Alvarez-Barbosa F, Owen N, Chastin S, et al. Replacing sedentary time: Meta-analysis of objective-assessment studies. American journal of preventive medicine. 2018;55(3):395–402. [PubMed: 30122216]

9.: Ekelund U, Brown WJ, Steene-Johannessen J, Fagerland MW, Owen N, Powell KE, et al. Do the associations of sedentary behaviour with cardiovascular disease mortality and cancer mortality differ by physical activity level? A systematic review and harmonised meta-analysis of data from 850 060 participants. British journal of sports medicine. 2018;53(14):886–94. [PubMed: 29991570]

10.: Ekelund U, Tarp J, Steene-Johannessen J, Hansen BH, Jefferis B, Fagerland MW, et al. Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: Systematic review and harmonised meta-analysis. BMJ. 2019;366:l4570. [PMC free article: PMC6699591] [PubMed: 31434697]

11.: Friedenreich CM, Pader J, Barberio AM, Ruan Y, Poirier AE, Grevers X, et al. Estimates of the current and future burden of cancer attributable to sedentary behavior in Canada. Preventive medicine. 2019;122:73–80. [PubMed: 31078175]

12.: Fuzeki E, Engeroff T, Banzer W. Health benefits of light-intensity physical activity: A systematic review of accelerometer data of the National Health and Nutrition Examination Survey (NHANES). Sports medicine (Auckland, NZ). 2017;47(9):1769–93. [PubMed: 28393328]

13.: Ku PW, Steptoe A, Liao Y, Hsueh MC, Chen LJ. A cut-off of daily sedentary time and all-cause mortality in adults: a meta-regression analysis involving more than 1 million participants. BMC medicine. 2018;16(1):74. [PMC free article: PMC5998593] [PubMed: 29793552]

14.: Ku PW, Steptoe A, Liao Y, Hsueh MC, Chen LJ. A Threshold of Objectively-Assessed Daily Sedentary Time for All-Cause Mortality in Older Adults: A Meta-Regression of Prospective Cohort Studies. Journal of clinical medicine. 2019;8(4). [PMC free article: PMC6517908] [PubMed: 31027301]

15.: Lee J. Physical activity, sitting time, and the risk of ovarian cancer: A brief research report employing a meta-analysis of existing. Health care for women international. 2019;40(4):433–58. [PubMed: 30358498]

16.: Ma P, Yao Y, Sun W, Dai S, Zhou C. Daily sedentary time and its association with risk for colorectal cancer in adults: A dose-response meta-analysis of prospective cohort studies. Medicine. 2017;96(22):e7049. [PMC free article: PMC5459729] [PubMed: 28562564]

17.: Mahmood S, MacInnis RJ, English DR, Karahalios A, Lynch BM. Domain-specific physical activity and sedentary behaviour in relation to colon and rectal cancer risk: a systematic review and meta-analysis. International journal of epidemiology. 2017;46(6):1797–813. [PubMed: 29025130]

18.: Manas A, Del Pozo-Cruz B, Garcia-Garcia FJ, Guadalupe-Grau A, Ara I. Role of objectively measured sedentary behaviour in physical performance, frailty and mortality among older adults: A short systematic review. European journal of sport science. 2017;17(7):940–53. [PubMed: 28532299]

19.: Patterson R, McNamara E, Tainio M, de Sa TH, Smith AD, Sharp SJ, et al. Sedentary behaviour and risk of all-cause, cardiovascular and cancer mortality, and incident type 2 diabetes: a systematic review and dose response meta-analysis. European journal of epidemiology. 2018;33(9):811–29. [PMC free article: PMC6133005] [PubMed: 29589226]

20.: Shephard RJ. Physical activity in the prevention and management of bladder cancer. The Journal of sports medicine and physical fitness. 2017;57(10):1359–66. [PubMed: 28116879]

21.: Wang J, Huang L, Gao Y, Wang Y, Chen S, Huang J, et al. Physically active individuals have a 23% lower risk of any colorectal neoplasia and a 27% lower risk of advanced colorectal neoplasia than their non-active counterparts: systematic review and meta-analysis of observational studies. British journal of sports medicine. 2019. [PubMed: 31296585]

22.: Xu C, Furuya-Kanamori L, Liu Y, Faerch K, Aadahl M, R AS, et al. Sedentary Behavior, Physical Activity, and All-Cause Mortality: Dose-Response and Intensity Weighted Time-Use Meta-analysis. Journal of the American Medical Directors Association. 2019;20(10):1206–12.e3. [PubMed: 31272857]

23.: Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR 2: A critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017;358:j4008. [PMC free article: PMC5833365] [PubMed: 28935701]

24.: 2018 Physical Activity Guidelines Advisory Committee. 2018 Physical Activity Guidelines Advisory Committee Scientific Report. Washington, DC. 2018. p. 1–779.

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World Health Organization, Geneva

NLM Citation

WHO Guidelines on Physical Activity and Sedentary Behaviour. Geneva: World Health Organization; 2020. B2, EVIDENCE ON SEDENTARY BEHAVIOUR FOR ADULTS (18 YEARS OF AGE AND OLDER)

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

Table B2.1Excluded Systematic Reviews, with Reasons for Exclusion

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

Table B2.2Credibility Ratings (based on AMSTAR 2 (23))

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

	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 2018^a (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 2019^c (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