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Cited by 340Physical Activity and HealthContext-Aware Activity Recognition SystemsHealth disparities and outcomes

Association of sedentary time with mortality independent of moderate to vigorous physical activity

Open access
Koster, Annemarie, Caserotti, Paolo, Patel, Kushang V., Matthews, Charles E., Berrigan, David, Van Domelen, Dane R., Brychta, Robert J., Chen, Kong Y. +1 more·2012·PLoS ONE
DOI 10.1371/journal.pone.0037696PMC PMC3374810
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Abstract

BACKGROUND: Sedentary behavior has emerged as a novel health risk factor independent of moderate to vigorous physical activity (MVPA). Previous studies have shown self-reported sedentary time to be associated with mortality; however, no studies have investigated the effect of objectively measured sedentary time on mortality independent of MVPA. The objective our study was to examine the association between objectively measured sedentary time and all-cause mortality. METHODS: 7-day accelerometry data of 1906 participants aged 50 and over from the U.S. nationally representative National Health and Nutrition Examination Survey (NHANES) 2003-2004 were analyzed. All-cause mortality was assessed from the date of examination through December 31, 2006. RESULTS: Over an average follow-up of 2.8 years, there were 145 deaths reported. In a model adjusted for sociodemographic factors, lifestyle factors, multiple morbidities, mobility limitation, and MVPA, participants in third quartile (hazard ratio (HR):4.05; 95%CI:1.55-10.60) and fourth quartile (HR:5.94; 95%CI: 2.49-14.15) of having higher percent sedentary time had a significantly increased risk of death compared to those in the lowest quartile. CONCLUSIONS: Our study suggests that sedentary behavior is a risk factor for mortality independent of MVPA. Further investigation, including studies with longer follow-up, is needed to address the health consequences of sedentary behavior.

AI snapshot

Written from the paper’s full text.

TL;DR

In a nationally representative sample of US adults aged 50 and older, objectively measured sedentary time was associated with higher all-cause mortality after adjustment that included moderate to vigorous physical activity (MVPA). The association persisted in sensitivity analyses, but follow-up was short.

Key findings

  • Over an average 2.8 years of follow-up, 145 deaths occurred among 1,906 participants. In the fully adjusted model, the highest quartile of sedentary hours had an HR of 3.26 (95% CI: 1.59–6.69) for mortality compared with the lowest quartile.
  • For percent sedentary time, fully adjusted mortality HRs were 4.05 (95% CI: 1.55–10.60) in the third quartile and 5.94 (95% CI: 2.49–14.15) in the fourth quartile compared with the lowest quartile.
  • MVPA was also associated with mortality: the lowest quartile of MVPA had an HR of 5.60 (95% CI: 2.25–13.96) compared with the highest quartile in a model adjusted for sociodemographic factors, lifestyle factors, morbidities, and mobility limitation.
  • Sensitivity analyses excluding participants with mobility limitation, diabetes/coronary heart disease/congestive heart failure/stroke, cancer, or the first year of follow-up showed that positive associations between sedentary time and mortality remained; results were similar when selecting participants with 4 or more valid accelerometry days.

Methods

  • The study analyzed 2003–2004 NHANES accelerometry data from 1,941 participants aged 50 and older with at least 1 valid day of accelerometry data (≥10 hours wear time); 35 participants with missing mortality or covariate data were excluded, leaving 1,906 for analysis.
  • Sedentary time was measured with a uniaxial ActiGraph AM-7164 accelerometer and defined as counts per minute below 100; percent sedentary time was total sedentary time divided by total wear time; MVPA was defined as counts per minute ≥2020. Mortality was assessed through December 31, 2006 via linkage to the National Death Index.
  • Cox proportional hazard models estimated hazard ratios by gender-specific quartiles of sedentary time, with progressive adjustment for sociodemographic factors, lifestyle factors, morbidities, mobility limitation, and MVPA; interactions with gender and age were not statistically significant (all p>0.10), and analyses accounted for the complex survey design and sample weights.

Limitations

  • The paper states that accelerometers are not sensitive to all activities, such as standing still, upper body movements, and biking; the MVPA cutpoint based primarily on younger adults may underestimate MVPA in older adults, potentially leading to residual confounding; and the sedentary cutpoint’s accuracy may vary by age, though small cutpoint variations were judged unlikely to affect quartile classification.
  • The paper states that the short follow-up may increase the risk of reverse causation, that unknown or unmeasured factors may account for some associations, and that longer follow-up and larger studies are needed.
  • Evident from the text: the observational design cannot establish causality, and the sample is restricted to US adults aged 50 and older with only 2.8 years average follow-up and 145 deaths, limiting precision and generalizability.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1371/journal.pone.0037696

Cites

20 of 20 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 9 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    After excluding the first year of follow-up, the positive association between sedentary time and mortality remained.

    “Further, after excluding the first year of follow-up to exclude deaths (n = 55) in the first year of the study the positive association between sedentary time and mortality remained (Table 3, Model 4).”
    Quote in the paperSubstantial claim
  • Findingown data

    Mortality risk increased significantly with greater sedentary time adjusted for sociodemographic factors.

    “Figure 1 shows that mortality risk increased significantly with greater sedentary time adjusted for sociodemographic factors.”
    Quote in the paperSubstantial claim
  • Findingown data

    In model 3, participants in the third quartile of percent sedentary time had a significantly increased risk of death compared to those in the lowest quartile (HR 4.05; 95% CI 1.55-10.60).

    “Participants in the third quartile (hazard ratio (HR):4.05; 95%CI:1.55–10.60) and fourth quartile (HR:5.94; 95%CI:2.49–14.15) of percent sedentary time had a significantly increased risk of death compared to those in the lowest quartile.”
    Quote in the paperSubstantial claim
  • Findingown data

    In model 3 adjusted for sociodemographic factors, lifestyle factors, multiple morbidities, mobility limitation, and MVPA, participants in the highest quartile of sedentary hours had a 3.3 times increased risk of mortality compared to those in the lowest quartile (95% CI 1.59-6.69).

    “In model 3 that included sociodemographic factors, lifestyle factors, multiple morbidities, mobility limitation, and MVPA, those in the highest quartile of sedentary hours had a 3.3 times increased risk of mortality compared to participants in lowest quartile (95% confidence interval (CI):1.59–6.69).”
    Quote in the paperSubstantial claim
  • Findingown data

    When selecting participants with 4 or more valid days of accelerometry data, results remained very similar.

    “When we selected participants with 4 or more valid days (n = 1701) of accelerometry data instead of the 1 or more valid day in the current analysis, results remained very similar (Table 4).”
    Quote in the paperNot a substantial claim
  • The quote only partly states this claim. 2
  • Classified as probably not a substantial claim. 11
  • May combine two claims. 6

  • The quote only partly states this claim.

    Findingown data

    In sensitivity analyses excluding participants with mobility limitation, diabetes, coronary heart disease, congestive heart failure, and stroke, and cancer, sedentary time remained positively associated with mortality.

    “In these groups of healthier individuals, sedentary time remained positively associated with mortality.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    In model 3, participants in the fourth quartile of percent sedentary time had a significantly increased risk of death compared to those in the lowest quartile (HR 5.94; 95% CI 2.49-14.15).

    “Participants in the highest quartile of percentage of time spent sedentary, which corresponds to more than 73.5% of time in men and more than 70.5% in women, had more than 5 times greater risk of death compared to those in the lowest quartile.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Over an average follow-up of 2.8 years, 145 deaths were reported.

    “Over an average follow-up of 2.8 years, 145 deaths were reported.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Figure 2 illustrates the shifted distribution of more time spent sedentary in those who died compared with those who survived.

    “Figure 2 clearly illustrates the shifted distribution of more time spent sedentary in those who died compared with those who survived.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Recent studies with objectively measured sedentary time data have shown that prolonged time in sedentary behaviors is a cardiometabolic risk factor independent of moderate to vigorous physical activity.

    “Recent studies with objectively measured sedentary time data have shown that prolonged time in sedentary behaviors is a cardiometabolic risk factor independent of moderate to vigorous physical activity [6], [7].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [6] A Bankoski, 2011, Sedentary Activity Associated With Metabolic Syndrome Independent of Physical Activity., Diabetes Care source

      Not checked in the free run.

    • cites [7] GN Healy, 2008, Objectively measured sedentary time, physical activity, and metabolic risk: the Australian Diabetes, Obesity and Lifestyle Study (AusDiab)., Diabetes Care source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The accuracy of the sedentary cutpoint may vary in different age groups.

    “Similarly, while the cutpoint we used to define sedentary time has been evaluated for validity [17], it is possible that the accuracy of this threshold varies in different age groups.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] CE Matthews, 2008, Amount of time spent in sedentary behaviors in the United States, 2003–2004., Am J Epidemiol source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductnone given

    The follow-up time of the study was short, which may increase the risk of reverse causation.

    “The follow-up time of our study was short which may increase the risk of reverse causation.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    The analyses were adjusted for a wide range of potential confounding variables, but other unknown or unmeasured factors may account for some of the reported associations.

    “We adjusted our analyses for a wide range of potential confounding variables, we can however not exclude that other unknown or unmeasured factors may account for some of the reported associations.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Accelerometers are not sensitive to detect all activities such as standing still, upper body movements and biking.

    “However, accelerometers are not sensitive to detect all activities such as standing still, upper body movements and biking.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Data were analyzed using SAS and SUDAAN to account for complex survey design and incorporate sample weights.

    “Data were analyzed using SAS Software 9.1 (SAS Institute Inc., Cary, NC) and SUDAAN 10.0 (RTI International, Research Triangle Park, NC) to account for the complex survey design and incorporate sample weights.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    The NHANES data were linked to death certificate data from the National Death Index.

    “The NHANES data were linked to death certificate data from the National Death Index”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [15] NHANES (1999–2004). Linked Mortality Files.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Study design and conductnone given

    Small variations in the cut-point selected (e.g., 50, 100, 150 counts per minute) would not be likely to affect the classification of individuals into quartiles of sedentary time, so results are unlikely to be affected by the cutpoint chosen.

    “However, small variations in the cut-point selected (e.g., 50, 100, 150 counts per minute) would not be likely to affect the classification of individuals into quartiles of sedentary time. Thus, our results are unlikely to be affected by the cutpoint chosen to define sedentary time.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The study used data from 2003-2004 NHANES, a nationally representative survey with a stratified, multistage design.

    “This study used data from the 2003–2004 NHANES survey, a nationally representative survey with a stratified, multistage design [14].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14] National Cancer Institute Risk factor monitoring and methods: SAS programs for analyzing NHANES 2003–2004 accelerometer data.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    Use of an accelerometer definition of MVPA based on studies of primarily younger adults may lead to an underestimate of MVPA for older adults due to the decline in exercise capacity with age, which may lead to residual confounding.

    “Use of an accelerometer definition of MVPA based on studies of primarily younger adults may lead to an underestimate of MVPA for older adults due to the decline in exercise capacity with age, which may lead to residual confounding.”
    Quote in the paperNot a substantial claim
14 of 14

  • The paper relies on this without support.

    No studies have investigated the effect of objectively measured sedentary behavior on mortality and whether this association is independent of MVPA.

    “however, no studies have investigated the effect of objectively measured sedentary time on mortality independent of MVPA.”
    “To our knowledge no studies have investigated the effect of objectively measured sedentary behavior on mortality and whether this association is independent of MVPA.”
1 of 1

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Five of the six studies also presented data for models without adjustment for physical activity, which allowed examination of associations between daily total sitting time and mortality risk with and without adjustment for physical activity.

    “Five of the six studies also presented data for models without adjustment for physical activity[10,11,30,32,33], which allowed us to examine associations between daily total sitting time and mortality risk, with and without adjustment for physical activity.”

    From Daily Sitting Time and All-Cause Mortality: A Meta-Analysis (2013) · cites this paper as [30]

  • Five studies assessed daily total sitting time by self-report, and one study used objective measurement of daily sedentary time.

    “Five studies assessed daily total sitting time by self-report[10,11,32-34]. One study used objective measurement of daily sedentary time[30].”

    From Daily Sitting Time and All-Cause Mortality: A Meta-Analysis (2013) · cites this paper as [30]

  • Across study samples, effect sizes for all-cause mortality were similar across doses of daily total sitting time, except the accelerometer study (Koster et al.) showed considerably larger hazards among respondents whose total daily sitting time exceeded the first quartile (7.6 h/day for men, 7.2 h/day for women).

    “We observed similar effect sizes for all study samples across dose of sitting, except in the accelerometer study[30], which showed considerably larger hazards of dying from all causes among respondents whose total daily sitting time exceeded the first quartile of the sample (7.6 h/day for men, 7.2 h/day for women).”

    From Daily Sitting Time and All-Cause Mortality: A Meta-Analysis (2013) · cites this paper as [30]

  • Individual study PAFs ranged from 1.9% (largest self-report study) to 58% (Koster et al. objective measure study).

    “Individual study PAFs ranged from 1.9% for the largest study with self-report data [11] to 58% for the smaller objective measure study by Koster and colleagues[30].”

    From Daily Sitting Time and All-Cause Mortality: A Meta-Analysis (2013) · cites this paper as [30]

  • Excluding the Koster et al. study, the overall weighted PAF for all-cause mortality attributable to total daily sitting time was 4.4% (range 1.9%-15.6%), after accounting for physical activity.

    “When the Koster et al study was excluded, the overall weighted PAF for all-cause mortality attributable to total daily sitting time was 4.4% (range: 1.9% - 15.6%), after accounting for physical activity.”

    From Daily Sitting Time and All-Cause Mortality: A Meta-Analysis (2013) · cites this paper as [30]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Conflicting sample sizes for the four-valid-day analysis

    Minor

    The Results give 1,701 participants, while Table 4 gives 1,711. The quartile counts in Table 4 also sum to 1,711.

1 of 1

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Authors
Koster, A., Caserotti, P., Patel, K. V., Matthews, C. E., Berrigan, D., Van Domelen, D. R., Brychta, R. J., Chen, K. Y., & Harris, T. B.
Affiliations
  • National Institutes of Health (US)
  • University of Southern Denmark (DK)
  • National Institute on Aging (US)
  • National Cancer Institute (US)
Corresponding author
Koster, Annemarie
ORCID
Venue
PLoS ONE
Publisher
Public Library of Science (PLoS)
Published
2012-06-13
Volume
7
Issue
6
Pages
e37696
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0037696
PMC
PMC3374810
OpenAlex
W1978604479
Semantic Scholar
572382a89975df5200d007cd85074febef10282f
Cited by
340
References
20
Citations by year
2026: 6 · 2025: 4 · 2024: 14 · 2023: 18 · 2022: 14 · 2021: 29 · 2020: 23 · 2019: 29 · 2018: 26 · 2017: 32 · 2016: 45 · 2015: 37 · 2014: 35 · 2013: 25 · 2012: 3
FWCI
21.45
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, public-domain)
  • PubMed Central (publishedVersion, public-domain)
  • PubMed (publishedVersion)
  • University of Southern Denmark Research Portal (University of Southern Denmark) (publishedVersion)
  • Research Publications (Maastricht University) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Research Publications (Maastricht University) (submittedVersion, other-oa)
Topics
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
  • Physical Sciences › Computer Science › Computer Vision and Pattern Recognition › Context-Aware Activity Recognition Systems
  • Social Sciences › Health › Health disparities and outcomes
Keywords
sedentary behavior, all-cause mortality, moderate-to-vigorous physical activity, accelerometry, older adults, mortality risk factors, physical inactivity
MeSH terms
Aged, Female, Humans, Male, Middle Aged, Mortality, Motor Activity, Sedentary Behavior

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