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Sedentary behaviour and risk of all-cause, cardiovascular and cancer mortality, and incident type 2 diabetes: a systematic review and dose response meta-analysis

Open access
Patterson, Richard, McNamara, Eoin, Tainio, Marko, de Sá, Thiago Hérick, Smith, Andrea D., Sharp, Stephen J., Edwards, Phil, Woodcock, James, Brage, Søren, Wijndaele, Katrien·2018·European Journal of Epidemiology
DOI 10.1007/s10654-018-0380-1PMC PMC6133005
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Abstract

PURPOSE: To estimate the strength and shape of the dose-response relationship between sedentary behaviour and all-cause, cardiovascular disease (CVD) and cancer mortality, and incident type 2 diabetes (T2D), adjusted for physical activity (PA). Data Sources: Pubmed, Web of Knowledge, Medline, Embase, Cochrane Library and Google Scholar (through September-2016); reference lists. Study Selection: Prospective studies reporting associations between total daily sedentary time or TV viewing time, and ≥ one outcome of interest. Data Extraction: Two independent reviewers extracted data, study quality was assessed; corresponding authors were approached where needed. Data Synthesis: Thirty-four studies (1,331,468 unique participants; good study quality) covering 8 exposure-outcome combinations were included. For total sedentary behaviour, the PA-adjusted relationship was non-linear for all-cause mortality (RR per 1 h/day: were 1.01 (1.00-1.01) ≤ 8 h/day; 1.04 (1.03-1.05) > 8 h/day of exposure), and for CVD mortality (1.01 (0.99-1.02) ≤ 6 h/day; 1.04 (1.03-1.04) > 6 h/day). The association was linear (1.01 (1.00-1.01)) with T2D and non-significant with cancer mortality. Stronger PA-adjusted associations were found for TV viewing (h/day); non-linear for all-cause mortality (1.03 (1.01-1.04) ≤ 3.5 h/day; 1.06 (1.05-1.08) > 3.5 h/day) and for CVD mortality (1.02 (0.99-1.04) ≤ 4 h/day; 1.08 (1.05-1.12) > 4 h/day). Associations with cancer mortality (1.03 (1.02-1.04)) and T2D were linear (1.09 (1.07-1.12)). CONCLUSIONS: Independent of PA, total sitting and TV viewing time are associated with greater risk for several major chronic disease outcomes. For all-cause and CVD mortality, a threshold of 6-8 h/day of total sitting and 3-4 h/day of TV viewing was identified, above which the risk is increased.

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Fig. 1 Flow diagram for study inclusion
Fig. 1 Flow diagram for study inclusionCC BY · PubMed Central
Fig. 2 Non-linear associations between sedentary behaviour and health outcomes presented with and without PA adjustment
Fig. 2 Non-linear associations between sedentary behaviour and health outcomes presented with and without PA adjustmentCC BY · PubMed Central

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  1. Scholes S, Mindell J. Chapter 2—Physical activity in adults. In: Craig R, Mindell J, editors. Health survey for England 2012. Volume 1: Health, social care and lifestyles. Leeds: Health and Social Care Information Centre; 2013.

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Metadata

Authors
Patterson, R., McNamara, E., Tainio, M., de Sá, T. H., Smith, A. D., Sharp, S. J., Edwards, P., Woodcock, J., Brage, S., & Wijndaele, K.
Affiliations
  • Imperial College London (GB)
  • University of Cambridge (GB)
  • University College London (GB)
  • London School of Hygiene & Tropical Medicine (GB)
Corresponding author
Patterson, Richard
ORCID
Venue
European Journal of Epidemiology
Publisher
Springer Science and Business Media LLC
Published
2018-03-28
Volume
33
Issue
9
Pages
811-829
ISSN
  • 0393-2990 (ISSN-L)
  • 1573-7284
DOI
10.1007/s10654-018-0380-1
PMC
PMC6133005
OpenAlex
W2794463825
Cited by
1,423
References
99
Citations by year
2026: 118 · 2025: 188 · 2024: 247 · 2023: 202 · 2022: 206 · 2021: 169 · 2020: 184 · 2019: 88 · 2018: 21
FWCI
15.20
Type
journal article
Language
en
Open access
Licence
Locations
  • European Journal of Epidemiology (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, other-oa)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • UCL Discovery (University College London) (submittedVersion)
  • Spiral (Imperial College London) (submittedVersion, cc-by)
  • Apollo (University of Cambridge) (submittedVersion, cc-by)
  • Apollo (cc-by)
Funders
  • British Heart Foundation (FS/12/58/29709)
  • Medical Research Council (MC_UU_12015/3, MC_UU_12015/1)
  • Cancer Research UK
  • Economic and Social Research Council
  • National Institute for Health Research
  • Wellcome Trust
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, television viewing, all-cause mortality, cardiovascular mortality, cancer mortality, type 2 diabetes, dose-response relationship, physical activity, nonlinear relationship, threshold effects, chronic disease risk
MeSH terms
Cardiovascular Diseases, Diabetes Mellitus, Type 2, Female, Humans, Male, Neoplasms, Television, Time Factors, Exercise, Sedentary Behavior

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