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Sedentary time in adults and the association with diabetes, cardiovascular disease and death: systematic review and meta-analysis
Abstract
Aims/hypothesis Sedentary (sitting) behaviours are ubiquitous in modern society. We conducted a systematic review and meta-analysis to examine the association of sedentary time with diabetes, cardiovascular disease and cardiovascular and all-cause mortality. Methods Medline, Embase and the Cochrane Library databases were searched for terms related to sedentary time and health outcomes. Cross-sectional and prospective studies were included. RR/HR and 95% CIs were extracted by two independent reviewers. Data were adjusted for baseline event rate and pooled using a random-effects model. Bayesian predictive effects and intervals were calculated to indicate the variance in outcomes that would be expected if new studies were conducted in the future. Results Eighteen studies (16 prospective, two cross-sectional) were included, with 794,577 participants. Fifteen of these studies were moderate to high quality. The greatest sedentary time compared with the lowest was associated with a 112% increase in the RR of diabetes (RR 2.12; 95% credible interval [CrI] 1.61, 2.78), a 147% increase in the RR of cardiovascular events (RR 2.47; 95% CI 1.44, 4.24), a 90% increase in the risk of cardiovascular mortality (HR 1.90; 95% CrI 1.36, 2.66) and a 49% increase in the risk of all-cause mortality (HR 1.49; 95% CrI 1.14, 2.03). The predictive effects and intervals were only significant for diabetes. Conclusions/interpretation Sedentary time is associated with an increased risk of diabetes, cardiovascular disease and cardiovascular and all-cause mortality; the strength of the association is most consistent for diabetes.
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“Sedentary behaviour (SB) and physical inactivity -promoted by increasingly sedentary jobs [6]-have a high prevalence in adults with T2D [7,8] and are two of the main modifiable risk factors for the prevention, development and management of glucose intolerance (IGT or prediabetes) and T2D [9].”
In the citing paper
“In adults with T2D, the prevalence of SB and physical inactivity is related to a higher rate of cardiovascular morbidity and mortality [9].”
In the citing paper
“More time spent in sedentary behaviors was associated with an increased risk of developing diabetes and poorer metabolic and inflammatory profiles in those with T2DM.”
From The Impact of Physical Activity in Patients With Type 2 Diabetes (2025) · cites this paper as [79]
In the citing paper
“However, both studies combined different measures of sedentary behavior (TV-viewing mostly, and sitting time) in their analyses, and neither study examined dose-response relationships for daily total sitting time.”
From Daily Sitting Time and All-Cause Mortality: A Meta-Analysis (2013) · cites this paper as [18]
In the citing paper
“Other meta-analyses have shown pooled HRs of 1.18-1.45 [15] and 1.49 [18] for the group with the highest level of sitting or sedentary time compared with the lowest group, respectively.”
From Daily Sitting Time and All-Cause Mortality: A Meta-Analysis (2013) · cites this paper as [18]
In the citing paper
“However, this meta-analysis of 16 prospective studies involved mixed exposures of sedentary behavior, such that TV-viewing, leisure-time sedentary behavior, and sitting, measured in heterogeneous units and categories, were combined in the same analyses.”
From Daily Sitting Time and All-Cause Mortality: A Meta-Analysis (2013) · cites this paper as [18]
In the citing paper
“Once again, the authors were unable to examine dose-response relationships between total sitting time and all-cause mortality.”
From Daily Sitting Time and All-Cause Mortality: A Meta-Analysis (2013) · cites this paper as [18]
In the citing paper
“A growing body of epidemiologic literature over the past 5-10 years has described associations between sedentary behaviour and increased risks of all-cause mortality and cardio-metabolic diseases,[11]”
From Using accelerometers to measure physical activity in large-scale epidemiological studies: issues and challenges (2014) · cites this paper as [11]
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Metadata
- Authors
- Wilmot, E. G., Edwardson, C. L., Achana, F. A., Davies, M. J., Gorely, T., Gray, L. J., Khunti, K., Yates, T., & Biddle, S. J. H.
- Affiliations
- University of Leicester (GB)
- Loughborough University (GB)
- Corresponding author
- Yates, T.
- ORCID
- Venue
- Diabetologia
- Published
- 2012-08-14
- Volume
- 55
- Issue
- 11
- Pages
- 2895-2905
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- OpenAlex
- W2141398296
- Semantic Scholar
- 844e192c1ec7573f36b0c3299ff56059c77ca737
- Cited by
- 1,789
- References
- 61
- Citations by year
- 2026: 55 · 2025: 82 · 2024: 75 · 2023: 112 · 2022: 146 · 2021: 153 · 2020: 165 · 2019: 169 · 2018: 165 · 2017: 186 · 2016: 155 · 2015: 163 · 2014: 96 · 2013: 63
- FWCI
- 11.23
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Diabetologia (publishedVersion)
- PubMed (publishedVersion)
- Stirling Online Research Repository (University of Stirling) (submittedVersion)
- Victoria University Research Repository (Victoria University) (submittedVersion)
- Leicester Research Archive (University of Leicester) (submittedVersion)
- Funders
- National Institute for Health and Care Research (RP-DG-1210-10183, RP-PG-0606-1272)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Physical Activity and Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Pharmacology (medical) › Coffee research and impacts
- Keywords
- sedentary behavior, sitting time, diabetes mellitus, cardiovascular disease, cardiovascular mortality, all-cause mortality, health risks
- MeSH terms
- Adult, Cardiovascular Diseases, Diabetes Mellitus, Humans, Risk Factors, Sedentary Behavior
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