New global guidelines on sedentary behaviour and health for adults: broadening the behavioural targets

Dempsey, Paddy C.; Biddle, Stuart J. H.; Buman, Matthew P.; Chastin, Sebastien; Ekelund, Ulf; Friedenreich, Christine M.; Katzmarzyk, Peter T.; Leitzmann, Michael F.; Stamatakis, Emmanuel; van der Ploeg, Hidde P.; Willumsen, Juana; Bull, Fiona

doi:10.1186/s12966-020-01044-0

Cited by 275Physical Activity and HealthErgonomics and Musculoskeletal DisordersContext-Aware Activity Recognition Systems

New global guidelines on sedentary behaviour and health for adults: broadening the behavioural targets

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Dempsey, Paddy C., Biddle, Stuart J. H., Buman, Matthew P., Chastin, Sebastien, Ekelund, Ulf, Friedenreich, Christine M., Katzmarzyk, Peter T., Leitzmann, Michael F. +4 more·2020·International Journal of Behavioral Nutrition and Physical Activity

DOI 10.1186/s12966-020-01044-0PMC PMC7691115

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Abstract

Background: In 2018, the World Health Organisation (WHO) commenced a program of work to update the 2010 Global Recommendations on Physical Activity for Health, for the first-time providing population-based guidelines on sedentary behaviour. This paper briefly summarizes and highlights the scientific evidence behind the new sedentary behaviour guidelines for all adults and discusses its strengths and limitations, including evidence gaps/research needs and potential implications for public health practice. Methods: An overview of the scope and methods used to update the evidence is provided, along with quality assessment and grading methods for the eligible new systematic reviews. The literature search update was conducted for WHO by an external team and reviewers used the AMSTAR 2 (Assessment of Multiple Systematic Reviews) tool for critical appraisal of the systematic reviews under consideration for inclusion. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) method was used to rate the certainty (i.e. very low to high) of the evidence. Results: The updated systematic review identified 22 new reviews published from 2017 up to August 2019, 14 of which were incorporated into the final evidence profiles. Overall, there was moderate certainty evidence that higher amounts of sedentary behaviour increase the risk for all-cause, cardiovascular disease (CVD) and cancer mortality, as well as incidence of CVD, cancer, and type 2 diabetes. However, evidence was deemed insufficient at present to set quantified (time-based) recommendations for sedentary time. Moderate certainty evidence also showed that associations between sedentary behaviour and all-cause, CVD and cancer mortality vary by level of moderate-to-vigorous physical activity (MVPA), which underpinned additional guidance around MVPA in the context of high sedentary time. Finally, there was insufficient or low-certainty systematic review evidence on the type or domain of sedentary behaviour, or the frequency and/or duration of bouts or breaks in sedentary behaviour, to make specific recommendations for the health outcomes examined. Conclusions: The WHO 2020 guidelines are based on the latest evidence on sedentary behaviour and health, along with interactions between sedentary behaviour and MVPA, and support implementing public health programmes and policies aimed at increasing MVPA and limiting sedentary behaviour. Important evidence gaps and research opportunities are identified.

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Sedentary behavior is associated with adverse health outcomes, including increased risk of chronic non-communicable diseases, all-cause mortality, diminished positive affect, and increased susceptibility to depression and anxiety.
“Sedentary behavior, characterized by wakefulness with low energy expenditure (≤ 1.5 METs), is closely associated with various adverse health outcomes [1]. It increases the risk of chronic non-communicable diseases and all-cause mortality, diminishes positive affect, and increases susceptibility to depression and anxiety [2, 3].”
From Effect of classroom physical activity breaks on learning behaviors and academic achievements in university students: a systematic review (2026) · cites this paper as [2]
The Results (Overall conclusions; page not provided) report associations between higher sedentary time and all-cause mortality, cardiovascular disease, cancer, and type 2 diabetes. They do not address diminished positive affect or increased susceptibility to depression and anxiety; searches for those outcomes found no supporting passage in our copy. (LLM, conf=0.88)
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Background
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Effectiveness of an intervention for reducing sitting time and improving health in office workers: three arm cluster randomised controlled trial
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Device-measured physical activity, sedentary time, and risk of all-cause mortality: an individual participant data analysis of four prospective cohort studies
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Invest in physical activity to protect and promote health: the 2020 WHO guidelines on physical activity and sedentary behaviour
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Validity of the ActivPAL monitor to distinguish postures: A systematic review
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Physical Activity During Lockdowns Associated with the COVID-19 Pandemic: A Systematic Review and Multilevel Meta-analysis of 173 Studies with 320,636 Participants
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A Primer on Repeated Sitting Exposure and the Cardiovascular System: Considerations for Study Design, Analysis, Interpretation, and Translation
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Striking the Right Balance: Evidence to Inform Combined Physical Activity and Sedentary Behavior Recommendations
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The association between sedentary behaviour, physical activity and type 2 diabetes markers: A systematic review of mixed analytic approaches
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Classroom Movement Breaks and Physically Active Learning Are Feasible, Reduce Sedentary Behaviour and Fatigue, and May Increase Focus in University Students: A Systematic Review and Meta-Analysis
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Physical Activity Behavior and Mental Health Among University Students During COVID-19 Lockdown
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Association of Accelerometer‐Measured Sedentary Accumulation Patterns With Incident Cardiovascular Disease, Cancer, and All‐Cause Mortality
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Optimal Frequency of Interrupting Prolonged Sitting for Cardiometabolic Health: A Systematic Review and Meta‐Analysis of Randomized Crossover Trials
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Impact assessment of e-trainings in occupational safety and health: a literature review
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Can incidental physical activity offset the deleterious associations of sedentary behaviour with major adverse cardiovascular events?
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Physical activity: associations with health and summary of guidelines
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Differences in Accelerometer-Measured Physical Activity and Sedentary Behavior Between Middle-Aged Men and Women in Japan: A Compositional Data Analysis
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What works to reduce sedentary behavior in the office, and could these intervention components transfer to the home working environment?: A rapid review and transferability appraisal
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“Are We Working (Too) Comfortably?”: Understanding the Nature of and Factors Associated with Sedentary Behaviour When Working in the Home Environment
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New principles, the benefits, and practices for fostering a physically active lifestyle
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Does Modern Lifestyle Favor Neuroimmunometabolic Changes? A Path to Obesity
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Lifestyle Interventions for Treatment and Remission of Type 2 Diabetes and Prediabetes in Adults: A Clinical Practice Guideline From the American College of Lifestyle Medicine
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Summary and application of the WHO 2020 physical activity guidelines for patients with essential hypertension in primary care
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A Call to Clarify the Intensity and Classification of Standing Behavior
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Profile of leisure-time physical activity and sedentary behavior in adults in Brazil: a nationwide survey, 2019
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Improved Sleep Quality and Depressive Symptoms With Exercise Training in Obese Women From a Low Socioeconomic Community: A Randomized Controlled Trial
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A public health milestone: China publishes new Physical Activity and Sedentary Behaviour Guidelines
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Leisure-time physical activity improves happiness, health, and mood profile better than work-related physical activity
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Perceptions of physical activity and sedentary behaviour guidelines among end-users and stakeholders: a systematic review
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Responsiveness of electromyographically assessed skeletal muscle inactivity: methodological exploration and implications for health benefits
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Macrovascular and microvascular responses to prolonged sitting with and without bodyweight exercise interruptions: A randomized cross-over trial
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Levels and Correlates of Objectively Measured Sedentary Behavior in Young Children: SUNRISE Study Results from 19 Countries
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Physical activity intensity profiles associated with cardiometabolic risk in middle-aged to older men and women
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Evaluating a multi-component intervention to reduce and break up office workers’ sitting with sit-stand desks using the APEASE criteria
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Patterns and correlates of sedentary behavior among university students
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Prospective Associations of Accelerometer‐Measured Machine‐Learned Sedentary Behavior With Death Among Older Women: The OPACH Study
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Snacktivity™ to Promote Physical Activity in Primary Care, Community Health and Public Health Settings: A Feasibility Randomised Controlled Trial
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Modifiable determinants of older adults’ physical activity and sedentary behavior in community and healthcare settings: a DE-PASS systematic review and meta-analysis
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The “Worktivity” mHealth intervention to reduce sedentary behaviour in the workplace: a feasibility cluster randomised controlled pilot study
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Economic burden of excessive sedentary behaviour in Canada
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The 24-h activity cycle and cardiovascular outcomes: establishing biological plausibility using arterial stiffness as an intermediate outcome
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Sitting vs. standing: an urgent need to rebalance our world
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Perceived influences on reducing prolonged sitting in police staff: a qualitative investigation using the Theoretical Domains Framework and COM-B model
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CHAP-Adult: A Reliable and Valid Algorithm to Classify Sitting and Measure Sitting Patterns Using Data From Hip-Worn Accelerometers in Adults Aged 35+
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Can individual, dyadic, or collaborative planning reduce sedentary behavior? A randomized controlled trial
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Global Trends in Risk Factors for Low Back Pain: An Analysis of the Global Burden of Disease Study Data From 1990 to 2021
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Targeted Non-Pharmacological Interventions for People Living with Frailty and Chronic Kidney Disease
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Physical Activity Epidemiology
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Differential benefits of 12-week morning vs. evening aerobic exercise on sleep and cardiometabolic health: a randomized controlled trial
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A Standardised Core Outcome Set for Measurement and Reporting Sedentary Behaviour Interventional Research: The CROSBI Consensus Study
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Accelerometry Measured Movement Behaviors in Middle-Aged and Older Adults: Cross-Sectional Analysis of the ELSA-Brasil Study
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The Annual Rhythms in Sleep, Sedentary Behavior, and Physical Activity of Australian Adults: A Prospective Cohort Study
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Desk based prompts to replace workplace sitting with stair climbing; a pilot study of acceptability, effects on behaviour and disease risk factors
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Association of Standing with Cardiovascular Disease and Mortality in Adults
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Perspectives of people with myasthenia gravis on physical activity and experience of physical activity advice from health professionals in the Australian context: a qualitative study
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mHealth interventions targeting movement behaviors in Asia: A scoping review
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Correlates of screen-based behaviors among adults from the 2019 Brazilian National Health Survey
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Physical activity on executive function in sedentary individuals: Systematic review and meta-analysis of randomized controlled trials
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Social Jetlag on Obesity-Related Outcomes in Spanish Adolescents: Cross-Sectional Evidence from the EHDLA Study
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Use of electronic devices in leisure time modifies the prevalence and factors associated with sedentary behavior derived exclusively from excessive television viewing among Brazilian adults
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Additional file 1 of New global guidelines on sedentary behaviour and health for adults: broadening the behavioural targets
Dempsey, P. C., Biddle, S., Buman, M. P., Chastin, S., Ekelund, U., Friedenreich, C. M., Katzmarzyk, P. T., Leitzmann, M. F., Stamatakis, E. A., Ploeg, H. P. V. D., et al. (2020) · Figshare · doi:10.6084/m9.figshare.13290965
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2020 WHO guidelines on physical activity and sedentary behaviour for children and adolescents aged 5–17 years: summary of the evidence
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COMPARISON OF SEDENTARY BEHAVIOR GUIDELINES FOR OLDER ADULTS: A REVIEW OF LITERATURE AND QUALITY APPRAISAL
Huang, A.-L., Wang, E., Sanger, S., Παπαϊωάννου, Α., & Rodrigues, I. B. (2023) · Innovation in Aging · doi:10.1093/geroni/igad104.2843

Authors: Dempsey, P. C., Biddle, S. J. H., Buman, M. P., Chastin, S., Ekelund, U., Friedenreich, C. M., Katzmarzyk, P. T., Leitzmann, M. F., Stamatakis, E., van der Ploeg, H. P., Willumsen, J., & Bull, F.
Affiliations: Baker Heart and Diabetes Institute (AU)
University of Southern Queensland (AU)
Arizona State University (US)
Glasgow Caledonian University (GB)
Norwegian Institute of Public Health (NO)
Alberta Health Services (CA)
Pennington Biomedical Research Center (US)
University of Regensburg (DE)
The University of Sydney (AU)
World Health Organization (CH)
Corresponding author: Dempsey, Paddy C.
ORCID: Dempsey, Paddy C.
Biddle, Stuart J. H.
Buman, Matthew P.
Chastin, Sebastien
Ekelund, Ulf
Friedenreich, Christine M.
Katzmarzyk, Peter T.
Leitzmann, Michael F.
Stamatakis, Emmanuel
Willumsen, Juana
Bull, Fiona
Venue: International Journal of Behavioral Nutrition and Physical Activity
Publisher: Springer Science and Business Media LLC
Published: 2020-11-26
Volume: 17
Issue: 1
Pages: 151-151
ISSN: 1479-5868 (ISSN-L)
DOI: 10.1186/s12966-020-01044-0
PMC: PMC7691115
OpenAlex: W3107337658
Cited by: 275
References: 54
Citations by year: 2026: 37 · 2025: 48 · 2024: 56 · 2023: 44 · 2022: 46 · 2021: 41 · 2020: 3
FWCI: 20.15
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0/ (tdm)
creativecommons.org/licenses/by/4.0/ (vor)
Locations: International Journal of Behavioral Nutrition and Physical Activity (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
University of Southern Queensland ePrints (University of Southern Queensland) (acceptedVersion)
UniSA Research Outputs Repository (University of South Australia) (acceptedVersion, cc-by)
ResearchOnline (Glasgow Caledonian University) (acceptedVersion, cc-by)
Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion, cc-by)
Ghent University Academic Bibliography (Ghent University) (submittedVersion, cc-by)
Civil War Book Review (submittedVersion)
University of Regensburg Publication Server (University of Regensburg) (submittedVersion)
NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
Figshare (submittedVersion, cc-by)
Libraries and Cultural Resources (University of Calgary) (submittedVersion)
Pure Amsterdam UMC (submittedVersion, other-oa)
Apollo (University of Cambridge) (submittedVersion, cc-by)
Data Archiving and Networked Services (DANS) (submittedVersion)
Apollo (cc-by)
Funders: National Health and Medical Research Council of Australia (1110526 and 1194510, 1142685)
PAL Technologies
Public Health Agency of Canada
Government of Norway
Topics: Health Sciences › Medicine › Physiology › Physical Activity and Health
Social Sciences › Psychology › Social Psychology › Ergonomics and Musculoskeletal Disorders
Physical Sciences › Computer Science › Computer Vision and Pattern Recognition › Context-Aware Activity Recognition Systems
Keywords: sedentary behavior, physical activity guidelines, moderate-to-vigorous physical activity, cardiovascular mortality, cancer mortality, all-cause mortality, type 2 diabetes, evidence gaps, public health policy, AMSTAR 2, GRADE certainty of evidence
MeSH terms: Systematic Reviews as Topic, Adult, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Humans, Neoplasms, Public Health, Risk Factors, World Health Organization, Exercise, Guidelines as Topic, Sedentary Behavior, Policy

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New global guidelines on sedentary behaviour and health for adults: broadening the behavioural targets

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