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Cited by 2,648Physical Activity and HealthErgonomics and Musculoskeletal DisordersNutritional Studies and Diet

Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women

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Ekelund, Ulf, Steene-Johannessen, Jostein, Brown, Wendy J, Fagerland, Morten Wang, Owen, Neville, Powell, Kenneth E, Bauman, Adrian, Lee, I-Min·2016·The Lancet
DOI 10.1016/s0140-6736(16)30370-1
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Abstract

Background High amounts of sedentary behaviour have been associated with increased risks of several chronic conditions and mortality. However, it is unclear whether physical activity attenuates or even eliminates the detrimental effects of prolonged sitting. We examined the associations of sedentary behaviour and physical activity with all-cause mortality.Methods We did a systematic review, searching six databases (PubMed, PsycINFO, Embase, Web of Science, Sport Discus, and Scopus) from database inception until October, 2015, for prospective cohort studies that had individual level exposure and outcome data, provided data on both daily sitting or TV-viewing time and physical activity, and reported effect estimates for all-cause mortality, cardiovascular disease mortality, or breast, colon, and colorectal cancer mortality. We included data from 16 studies, of which 14 were identified through a systematic review and two were additional unpublished studies where pertinent data were available. All study data were analysed according to a harmonised protocol, which categorised reported daily sitting time and TV-viewing time into four standardised groups each, and physical activity into quartiles (in metabolic equivalent of task [MET]-hours per week). We then combined data across all studies to analyse the association of daily sitting time and physical activity with all-cause mortality, and estimated summary hazard ratios using Cox regression. We repeated these analyses using TV-viewing time instead of daily sitting time.Findings Of the 16 studies included in the meta-analysis, 13 studies provided data on sitting time and all-cause mortality. These studies included 1 005 791 individuals who were followed up for 2-18·1 years, during which 84 609 (8·4%) died. Compared with the referent group (ie, those sitting <4 h/day and in the most active quartile [>35·5 MET-h per week]), mortality rates during follow-up were 12-59% higher in the two lowest quartiles of physical activity (from HR=1·12, 95% CI 1·08-1·16, for the second lowest quartile of physical activity [<16 MET-h per week] and sitting <4 h/day; to HR=1·59, 1·52-1·66, for the lowest quartile of physical activity [<2·5 MET-h per week] and sitting >8 h/day). Daily sitting time was not associated with increased all-cause mortality in those in the most active quartile of physical activity. Compared with the referent (<4 h of sitting per day and highest quartile of physical activity [>35·5 MET-h per week]), there was no increased risk of mortality during follow-up in those who sat for more than 8 h/day but who also reported >35·5 MET-h per week of activity (HR=1·04; 95% CI 0·99-1·10). By contrast, those who sat the least (<4 h/day) and were in the lowest activity quartile (<2·5 MET-h per week) had a significantly increased risk of dying during follow-up (HR=1·27, 95% CI 1·22-1·31). Six studies had data on TV-viewing time (N=465 450; 43 740 deaths). Watching TV for 3 h or more per day was associated with increased mortality regardless of physical activity, except in the most active quartile, where mortality was significantly increased only in people who watched TV for 5 h/day or more (HR=1·16, 1·05-1·28).Interpretation High levels of moderate intensity physical activity (ie, about 60-75 min per day) seem to eliminate the increased risk of death associated with high sitting time. However, this high activity level attenuates, but does not eliminate the increased risk associated with high TV-viewing time. These results provide further evidence on the benefits of physical activity, particularly in societies where increasing numbers of people have to sit for long hours for work and may also inform future public health recommendations.Funding None.

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  • Physical activity attenuates cardiometabolic risk but does not eliminate the increased risk associated with high sedentary time.

    “Emerging evidence suggests that physical activity attenuates cardiometabolic risk but does not eliminate the increased risk associated with high sedentary time [1,6].”

    From Feasibility and Preliminary Efficacy of a “Sit Less” Program Leveraging Fitbit Tracking and Tailored Text Messages in Cardiometabolic Disease: Findings From 2 Parallel Randomized Controlled Trials in Coronary Artery Disease and Type 2 Diabetes (2026) · cites this paper as [6]

    The Findings and Interpretation passages (page not supplied) report that high physical activity seemed to eliminate the increased all-cause mortality risk associated with high sitting time—the opposite of the claim's unqualified statement. The paper distinguishes TV-viewing time, for which activity attenuated but did not eliminate increased mortality risk; it does not establish the stated cardiometabolic-risk outcome. (LLM, conf=0.88)

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  • Regular exercise extends life expectancy and reduces morbidity in aging.

    “longitudinal studies have shown that regular exercise extends life expectancy and reduces morbidity in aging89,90.”

    From Mechanisms of muscle atrophy and hypertrophy: implications in health and disease (2021) · cites this paper as [89]

  • For people who exercised a lot every day, increasing sitting time did not increase all-cause mortality.

    “for people who exercised a lot every day, increasing their sitting time did not increase their all-cause mortality.”

    From Effects of aerobic exercise on lipids and lipoproteins (2017) · cites this paper as [18]

  • Compared with an exercise group (>35.5 MET-h per week), the mortality rate during follow-up was 12-59% higher for people who sat for a long time daily.

    “Compared with the exercise group (i.e., > 35.5 MET-h per week), the mortality rate during follow-up was 12–59% higher for people who were sitting for a long time on a daily basis.”

    From Effects of aerobic exercise on lipids and lipoproteins (2017) · cites this paper as [18]

  • Prolonged sitting could increase all-cause mortality, but a certain amount of exercise per day seemed to counteract this effect to some extent.

    “prolonged sitting could indeed increase all-cause mortality, but a certain amount of exercise per day seemed to counteract this effect to some extent.”

    From Effects of aerobic exercise on lipids and lipoproteins (2017) · cites this paper as [18]

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Authors
Ekelund, U., Steene-Johannessen, J., Brown, W. J., Fagerland, M. W., Owen, N., Powell, K. E., Bauman, A., & Lee, I.-M.
Affiliations
  • University of Cambridge (GB)
  • The University of Queensland (AU)
  • Oslo University Hospital (NO)
  • Baker Heart and Diabetes Institute (AU)
  • The University of Sydney (AU)
  • Brigham and Women's Hospital (US)
Corresponding author
Ekelund, Ulf
ORCID
Venue
The Lancet
Publisher
Elsevier BV
Published
2016-09
Volume
388
Issue
10051
Pages
1302-1310
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
DOI
10.1016/s0140-6736(16)30370-1
OpenAlex
W2335965827
Cited by
2,648
References
11
Citations by year
2026: 177 · 2025: 216 · 2024: 277 · 2023: 223 · 2022: 280 · 2021: 326 · 2020: 326 · 2019: 289 · 2018: 281 · 2017: 222 · 2016: 27
FWCI
32.11
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet (publishedVersion)
  • PubMed (publishedVersion)
  • Pure Amsterdam UMC (publishedVersion, other-oa)
  • Apollo (University of Cambridge) (acceptedVersion)
  • QUT ePrints (Queensland University of Technology) (submittedVersion, cc-by-nc-nd)
  • Deakin Research Online (Deakin University) (submittedVersion)
  • Research Bank (Australian Catholic University) (submittedVersion)
  • BIBSYS Brage (BIBSYS (Norway)) (submittedVersion)
  • Figshare (submittedVersion, cc-by)
  • NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
  • Amsterdam UMC (VU Amsterdam) - Institutional Repository (submittedVersion)
  • Swinburne figshare (Swinburne University of Technology) (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
Funders
UK Medical Research Council programme (grant MC_UU_12015/3)
Topics
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
  • Social Sciences › Psychology › Social Psychology › Ergonomics and Musculoskeletal Disorders
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
Keywords
sedentary behavior, sitting time, physical activity, all-cause mortality, cardiovascular mortality, cancer mortality, television viewing, dose-response relationship, cardiovascular risk factors, prospective cohort, MET-hours per week, sex differences, age differences
MeSH terms
Cardiovascular Diseases, Female, Humans, Male, Mortality, Prospective Studies, Risk Factors, Television, Time Factors, Exercise, Proportional Hazards Models, Sedentary Behavior

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