Relationship of Sedentary Behavior and Physical Activity to Incident Cardiovascular Disease
Open accessAbstract
Objectives The aim was to examine the independent and joint associations of sitting time and physical activity with risk of incident cardiovascular disease (CVD). Background Sedentary behavior is recognized as a distinct construct beyond lack of leisure-time physical activity, but limited data exists on the interrelationship between these two components of energy balance. Methods Participants in the prospective Women’s Health Initiative Observational Study (N = 71,018), aged 50–79 and free of CVD at baseline (1993–1998), provided information on sedentary behavior, defined as hours of sitting per day, and usual physical activity at baseline and during follow-up through September 2010. First CVD (coronary heart disease or stroke) events were centrally adjudicated. Results Sitting ≥ 10 hours/day compared to ≤ 5 hours/day was associated with increased CVD risk (HR=1.18, 95% CI 1.09, 1.29) in multivariable models including physical activity. Low physical activity was also associated with higher CVD risk (P, trend <0.001). When women were cross-classified by sitting time and physical activity (P, interaction = 0.94), CVD risk was highest in inactive women (≤1.7 MET-hrs/week) who also reported ≥10 hrs/day of sitting. Results were similar for CHD and stroke when examined separately. Associations between prolonged sitting and risk of CVD were stronger in overweight versus normal weight women and women aged 70 years and older compared to younger women. Conclusions Prolonged sitting time was associated with increased CVD risk, independent of leisure-time physical activity, in postmenopausal women without a history of CVD. A combination of low physical activity and prolonged sitting augments CVD risk.
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Five included studies specifically investigated occupational-related physical activity or commuting activity, either as the primary objective or in addition to leisure time activity.
“five studies specifically investigated occupational-related physical activity or commuting activity,32,35,48,50,60 either as the primary objective or in addition to investigating leisure time activity.”
From Sex Differences in Physical Activity and Incident Stroke: A Systematic Review (2022) · cites this paper as [35]
The Methods (Exposure Assessment; page unavailable) specify that the physical-activity measure was leisure-time activity. The Discussion (page unavailable) says the study could not examine transportation separately because its questionnaire measured only total sitting time. Thus, this paper did not specifically investigate occupational or commuting physical activity as the citing sentence claims. (LLM, conf=0.88)
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Experimental — accuracy not yet measuredEight studies (29%) reported a non-significant association between physical activity and incident total stroke in women.
“and eight (29%) reported a non-significant association between physical activity and incident total stroke.30,33,35,41,56,62,64,65”
From Sex Differences in Physical Activity and Incident Stroke: A Systematic Review (2022) · cites this paper as [35]
The Results section reports that decreased physical activity was associated with increased stroke risk in the women studied and says the associations remained statistically significant after further adjustment (Table 2). That contradicts describing this study as reporting a non-significant physical-activity–stroke association. The eight-study count and 29% are claims about the citing paper’s collection of studies, not findings this source can establish. (LLM, conf=0.87)
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Experimental — accuracy not yet measuredAmong those 17 papers, 3 (18%) showed a significant effect of physical activity on total stroke in men but not in women.
“3 (18%) of studies showed a significant effect in men but not in women”
From Sex Differences in Physical Activity and Incident Stroke: A Systematic Review (2022) · cites this paper as [35]
The Methods (Study Population; page unavailable) describe an analysis of 71,018 women, and the Discussion says its findings cannot necessarily be generalized to men. The Results report stroke outcomes in that cohort, but our copy provides no tally of 17 papers or finding that three showed a significant effect in men but not women (searched for the 3/17 figure and sex differences in stroke). (LLM, conf=0.77)
Experimental — accuracy not yet measuredTen or more hours of sitting per day increased cardiovascular disease risk by 18% (HR=1.18; 95% CI 1.09-1.29) compared to five or fewer hours.
“For example, ten or more hours of sitting per day increased cardiovascular diseases risk by 18 % (Hazard ratio = 1.18; 95% CI = 1.09–1.29) as compared to five or fewer hours [73]”
From Smoking, screen-based sedentary behavior, and diet associated with habitual sleep duration and chronotype: data from the UK Biobank (2016) · cites this paper as [73]
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BackgroundCardiovascular Disease and Alzheimer's Disease: The Heart–Brain Axis
Saeed, A., López, O., Cohen, A. D., & Reis, S. (2023) · Journal of the American Heart Association : Cardiovascular and Cerebrovascular Disease · doi:10.1161/jaha.123.030780 · Cited by 138 · see citing works
“59 The 2019 American College of Cardiology/American Heart Association CVD prevention guidelines 60 emphasize that a comprehensive lifestyle intervention encompasses regular self-monitoring of food intake, physical activity, and weight.”
BackgroundPhysical activity and cardiovascular aging: Physiological and molecular insights
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“29) as compared to five or fewer hours [73], while four or more hours (versus ≤1) of screen-based sedentary behavior per day (TV and recreational computer use) was associated with an adjusted twofold greater prevalence (Prevalence Ratio = 2.”
BackgroundCocoa Polyphenols and Inflammatory Markers of Cardiovascular Disease
Khan, N., Khymenets, O., Urpí-Sardà, M., Tulipani, S., Garcia‐Aloy, M., Monagas, M., Cubillos, L. X. M., Llorach, R., & Andrés‐Lacueva, C. (2014) · Nutrients · doi:10.3390/nu6020844 · Cited by 138 · see citing works
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“Specifically, physical activity improves postmenopausal women’s balance, body composition, muscle strength, and bone health; improves mood (45); reduces cardiovascular risk (46, 47); and, potentially, reduces falls contributing to osteoporotic fractures (47).”
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“S edentary behavior, when self-reported, has been consistently associated with risk of cardiovascular disease (CVD) in population cohort studies (6,8,21,27).”
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BackgroundSedentary Behavior and Mortality in Older Women
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Self-citationPrevalence of Physical Activity and Sedentary Behavior Among Stroke Survivors in the United States
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Self-citationRelationship Between Sedentary Behavior and Cardiovascular Risk
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“For example, in a recent report from the Women’s Health Initiative, women who reported more than 10 h/d of sitting had an 18% increased risk of cardiovascular disease than did women who sat less than 5 h/d, regardless of physical activity levels.(10) These data suggest that sedentary behavior is more than merely the l…”
Chinese Guideline on the Primary Prevention of Cardiovascular Diseases
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Prolonged sitting leg vasculopathy: contributing factors and clinical implications
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“Although our study did not directly examine potential mechanisms, moderate PA may protect against adverse biomarker changes by increasing cerebral blood flow; reducing insulin resistance; reducing the risk of cardiovascular disease (CVD) and cerebrovascular disease; or increasing production of growth factors, such as…”
BackgroundAndersson, C., Lyass, A., Larson, M. G., Spartano, N. L., Vita, J. A., Benjamin, E. J., Murabito, J. M., Esliger, D., Blease, S. J., Hamburg, N. M., et al. (2015) · Journal of the American Heart Association · doi:10.1161/jaha.114.001528 · Cited by 87 · see citing works
“Although we did not observe any statistically significant inverse associations between sedentary time and arterial stiffness measures, other studies have suggested that physical inactivity is a significant risk factor for CVD independent of physical activity levels.(53,54) Consequently, physical inactivity should be c…”
BackgroundSkeletal muscle as a regulator of the longevity protein, Klotho
Avin, K. G., Coen, P. M., Huang, W., Stolz, D. B., Sowa, G., Dubé, J. J., Goodpaster, B. H., O'Doherty, R. M., & Ambrosio, F. (2014) · Frontiers in Physiology · doi:10.3389/fphys.2014.00189 · Cited by 83 · see citing works
Association of Physical Activity and Fracture Risk Among Postmenopausal Women
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Self-citationCardiac Rehabilitation: United States
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Physical activity and emotional intelligence among undergraduate students: a correlational study
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Epigenetic associations in relation to cardiovascular prevention and therapeutics
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“According to epidemiological and clinical studies, lifestyle modifications to nutrition and exercise can be initial protective measures to reduce CVD risk [7, 8].”
BackgroundCastellanos, N. P., Díez, G. G., Almagro, C. A., Bailén, M., Bressa, C., González-Soltero, R., Pérez, M., & Larrosa, M. (2020) · Frontiers in Microbiology · doi:10.3389/fmicb.2019.03142 · Cited by 71 · see citing works
“…of physical inactivity has increased alarmingly, and sedentary lifestyle has emerged as a risk factor for obesity and several other disorders, such as cancer and cardiovascular disease (Packey and Ciorba, 2010; Winzer et al., 2011; Chomistek et al., 2013; Gonzalez-Gross and Melendez, 2013).”
BackgroundMattioli, A. V., Sciomer, S., Moscucci, F., Maiello, M. R., Cugusi, L., Gallina, S., Dei, A., Lombardi, C., Pengo, M. F., Parati, G., et al. (2019) · Journal of Cardiovascular Medicine · doi:10.2459/jcm.0000000000000831 · Cited by 67 · see citing works
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“In addition, we included hours of watching television as a proxy for sedentary behavior, which has been shown to be a modifiable risk behavior independent from overall physical activity (15).”
BackgroundMethodObesity and Black Women: Special Considerations Related to Genesis and Therapeutic Approaches
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Fe en Acción: Promoting Physical Activity Among Churchgoing Latinas
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Socio-demographic, clinical and health behavior correlates of sitting time in older adults
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“Studies have shown that prolonged sedentary behavior, independent of physical activity level, is associated with various negative health conditions such as cardiovascular disease [5], obesity [6], diabetes mellitus [7], cancer [8], metabolic syndrome [9], and psychological distress [10].”
BackgroundNutraceuticals and Bioactive Components from Fish for Dyslipidemia and Cardiovascular Risk Reduction
Chiesa, G., Busnelli, M., Manzini, S., & Parolini, C. (2016) · Marine Drugs · doi:10.3390/md14060113 · Cited by 59 · see citing works
“hypertension, obesity, insulin resistance and diabetes, susceptible to lifestyle modifications, which include diet and physical exercise [11,12].”
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Association of sedentary behavior and metabolic syndrome
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Protective Effect of Time Spent Walking on Risk of Stroke in Older Men
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Sedentary Time in Late Childhood and Cardiometabolic Risk in Adolescence
Stamatakis, E. A., Coombs, N. A., Tiling, K., Mattocks, C., Cooper, A. R., Hardy, L. L., & Lawlor, D. A. (2015) · PEDIATRICS · doi:10.1542/peds.2014-3750 · Cited by 55 · see citing works
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Long-Term and Acute Benefits of Reduced Sitting on Vascular Flow and Function
Hartman, Y., TILLMANS, L. C. M., BENSCHOP, D. L., Hermans, A. N. L., Nijssen, K. M. R., Eijsvogels, T. M. H., Willems, P. H. G. M., Tack, C. J., Hopman, M. T. E., Claassen, J. A. H. R., et al. (2020) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000002462 · Cited by 54 · see citing works
“High levels of sedentary time increase the risk for cardiovascular (4) and cerebrovascular (5) disorders (6,7).”
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Physical activity and incidence of heart failure in postmenopausal women
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“, from sedentary behavior-induced increases in inflammation and endothelial dysfunction [31,32], which is supported by recent research [33].”
ResultThe descriptive epidemiology of daily sitting time as a sedentary behavior in multiple sclerosis
Hubbard, E. A., Motl, R. W., & Manns, P. J. (2015) · Disability and health journal · doi:10.1016/j.dhjo.2015.06.003 · Cited by 49 · see citing works
Buddhist Activities related to Sedentary behavior and Hypertension in Tibetan monks
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Noz, M. P., Hartman, Y., Hopman, M. T. E., Willems, P. H. G. M., Tack, C. J., Joosten, L. A. B., Netea, M. G., Thijssen, D. H. J., & Riksen, N. P. (2019) · Journal of the American Heart Association · doi:10.1161/jaha.119.013764 · Cited by 47 · see citing works
Acceptability of smartphone technology to interrupt sedentary time in adults with diabetes
Pellegrini, C. A., Hoffman, S. A., Daly, E., Murillo, M., Iakovlev, G., & Spring, B. J. (2015) · Translational Behavioral Medicine · doi:10.1007/s13142-015-0314-3 · Cited by 43 · see citing works
“Prolonged sedentary time is also linked with numerous health conditions, including cardiovascular disease [3, 4], metabolic syndrome [5, 6], obesity [7], and breast cancer [8].”
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“Prior literature, including several WHI studies, has also suggested protective effects of physical activity on the incidence and survival of other cancer types and diseases, including breast cancer,(12,13) colorectal cancer,(14) and cardiovascular disease.(15,16) A study of 1.”
ResultSelf-citationTime Spent Sitting as an Independent Risk Factor for Cardiovascular Disease
Henschel, B., Gorczyca, A. M., & Chomistek, A. K. (2017) · American Journal of Lifestyle Medicine · doi:10.1177/1559827617728482 · Cited by 45 · see citing works
“CVD among women in the highest category of PA (>20 MET-h/wk).(78)”
BackgroundSelf-citation
- Authors
- Chomistek, A. K., Manson, J. E., Stefanick, M. L., Lu, B., Sands-Lincoln, M., Going, S. B., Garcia, L., Allison, M. A., Sims, S. T., LaMonte, M. J., Johnson, K. C., & Eaton, C. B.
- Affiliations
- Harvard University (US)
- Brigham and Women's Hospital (US)
- Stanford University (US)
- University of Arizona (US)
- University of California San Diego (US)
- University at Buffalo, State University of New York (US)
- University of Tennessee Health Science Center (US)
- Brown University (US)
- Corresponding author
- Chomistek, Andrea K.
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2013-06
- Volume
- 61
- Issue
- 23
- Pages
- 2346-2354
- ISSN
- 0735-1097 (ISSN-L)
- PMC
- PMC3676694
- OpenAlex
- W1495777861
- Semantic Scholar
- 5c485803781b186b6e6f011fd743b707d53f91ac
- Cited by
- 389
- References
- 26
- Citations by year
- 2026: 13 · 2025: 18 · 2024: 24 · 2023: 28 · 2022: 27 · 2021: 32 · 2020: 33 · 2019: 44 · 2018: 35 · 2017: 30 · 2016: 36 · 2015: 39 · 2014: 24 · 2013: 5
- FWCI
- 24.07
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (HL035464)
- National Institutes of Health, U.S. Department of Health and Human Services
- National Cancer Institute (CA152904)
- National Institute of Diabetes and Digestive and Kidney Diseases (DK007703-17)
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Health Sciences › Medicine › Pharmacology › Coffee research and impacts
- Keywords
- sedentary behavior, sitting time, physical activity, cardiovascular disease, coronary artery disease, stroke, postmenopausal women, energy balance, overweight, older women, Women's Health Initiative
- MeSH terms
- Age Factors, Aged, Cardiovascular Diseases, Female, Humans, Middle Aged, Motor Activity, Prognosis, Prospective Studies, Time Factors, United States, Cohort Studies, Body Mass Index, Incidence, Survival Rate, Multivariate Analysis, Proportional Hazards Models, Women's Health, Postmenopause, Risk Assessment, Overweight, Sedentary Behavior
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