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New global guidelines on sedentary behaviour and health for adults: broadening the behavioural targets
Open accessAbstract
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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![Fig. 1 Joint associations of sedentary (sitting) time and MVPA with risk of all-cause mortality based on data by Ekelund et al. [4] – now also broadly applicable for risk of CVD and cancer mortality [3]. Orange and yellow shading represents transitional decreases in risk. For context, data analysis ranges for all-cause mortality [4] were based on four levels of self-reported sedentary time (< 4, 4–6, 6–8, > 8 h/day) and MVPA (∼5, 25–35, 50–65, 60–75 min/day), but specific scales are intentionally left blank and could vary considerably for either device-based measures (e.g. hip or thigh accelerometry), by different health outcomes (e.g. type 2 diabetes, adiposity), or by different sub-populations (e.g. frail/elderly adults, people living with some chronic conditions or disabilities). Heat map adapted from the PAGAC [9] report](/paper-figures/0d63ebdf19eb48c781e269dce67242df/new-global-guidelines-on-sedentary-behaviour-and-health-for-adults-broadening-figure-1.jpg)
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“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]
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Metadata
- 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)
- Amsterdam Public Health (NL)
- World Health Organization (CH)
- Corresponding author
- Dempsey, Paddy C.
- ORCID
- Venue
- International Journal of Behavioral Nutrition and Physical Activity
- Published
- 2020-11-26
- Volume
- 17
- Issue
- 1
- Pages
- 151-151
- ISSN
- 1479-5868 (ISSN-L)
- 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
- 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 › Public Health, Environmental and Occupational Health › Physical Activity and Health
- Social Sciences › Human Factors and Ergonomics › 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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