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Association of Sedentary Time with Mortality Independent of Moderate to Vigorous Physical Activity
Open accessAbstract
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.
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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.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Association of Sedentary Time with Mortality Independent of Moderate to Vigorous Physical Activity > Results
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Figure 1 shows that mortality risk increased significantly with greater sedentary time adjusted for sociodemographic factors.”
§ Association of Sedentary Time with Mortality Independent of Moderate to Vigorous Physical Activity > Results
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Association of Sedentary Time with Mortality Independent of Moderate to Vigorous Physical Activity > Results
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Association of Sedentary Time with Mortality Independent of Moderate to Vigorous Physical Activity > Results
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Association of Sedentary Time with Mortality Independent of Moderate to Vigorous Physical Activity > Results
Strength:plain· not yet calibratedn = 1,701Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Interactions with gender and age were not statistically significant (all p>0.10); therefore all results are shown for men and women and all ages combined.”
§ Association of Sedentary Time with Mortality Independent of Moderate to Vigorous Physical Activity > Methods > Study Population
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Those in the lowest quartile of MVPA had 5.6 times greater mortality risk compared to those in the highest quartile of MVPA (95%CI: 2.25–13.96) in a model that was adjusted for sociodemographic factors, lifestyle factors, multiple morbidities, and mobility limitation.”
§ Association of Sedentary Time with Mortality Independent of Moderate to Vigorous Physical Activity > Results
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIn the paper
“These studies are limited by their use of self-reported data, which is known to be prone to reporting errors of physical activity duration and intensity [13].”
§ Association of Sedentary Time with Mortality Independent of Moderate to Vigorous Physical Activity > Introduction
What the sources say
- Not checked yetcites [13] JF Sallis, 2000, Assessment of physical activity by self-report: status, limitations, and future directions., Res Q Exerc Sport source
Load-bearingStrength:boosted· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesNone of the sources cited for this claim have been checked yet.
In the paper
“Previous studies have shown self-reported sedentary time to be associated with mortality”
- Also stated in: § Introduction · plain
“Additionally, self-reported sedentary time in several domains including sitting [8], [9], riding in a car [10], and TV watching [11], [12] is positively associated with mortality.”
§ Association of Sedentary Time with Mortality Independent of Moderate to Vigorous Physical Activity > Abstract > Background
What the sources say
- Not checked yetcites [8] PT Katzmarzyk, 2009, Sitting time and mortality from all causes, cardiovascular disease, and cancer., Med Sci Sports Exerc source
- Not checked yetcites [9] AV Patel, 2010, Leisure time spent sitting in relation to total mortality in a prospective cohort of US adults., Am J Epidemiol source
- Not checked yetcites [10] TY Warren, 2010, Sedentary behaviors increase risk of cardiovascular disease mortality in men., Med Sci Sports Exerc source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Also stated in: § Introduction · plain
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This study shows that time spent in sedentary behavior is positively associated with mortality in this representative sample of adults aged 50 and older.”
§ Association of Sedentary Time with Mortality Independent of Moderate to Vigorous Physical Activity > Discussion
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes
- The quote only partly states this claim. 2
- Probably not a substantial claim. 11
- It may state two separate claims as one. 6
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In these groups of healthier individuals, sedentary time remained positively associated with mortality.”
§ Association of Sedentary Time with Mortality Independent of Moderate to Vigorous Physical Activity > Results
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesThe quote only partly states this claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Association of Sedentary Time with Mortality Independent of Moderate to Vigorous Physical Activity > Discussion
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesThe quote only partly states this claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Over an average follow-up of 2.8 years, 145 deaths were reported.”
§ Association of Sedentary Time with Mortality Independent of Moderate to Vigorous Physical Activity > Results
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Figure 2 clearly illustrates the shifted distribution of more time spent sedentary in those who died compared with those who survived.”
§ Association of Sedentary Time with Mortality Independent of Moderate to Vigorous Physical Activity > Results
Strength:boosted· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“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].”
§ Association of Sedentary Time with Mortality Independent of Moderate to Vigorous Physical Activity > Introduction
What the sources say
- Not checked yetcites [6] A Bankoski, 2011, Sedentary Activity Associated With Metabolic Syndrome Independent of Physical Activity., Diabetes Care source
- Not checked yetcites [7] GN Healy, 2008, Objectively measured sedentary time, physical activity, and metabolic risk: the Australian Diabetes, Obesity and Lifestyle Study (AusDiab)., Diabetes Care source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
In the paper
“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.”
§ Association of Sedentary Time with Mortality Independent of Moderate to Vigorous Physical Activity > Discussion
What the sources say
- Not checked yetcites [17] CE Matthews, 2008, Amount of time spent in sedentary behaviors in the United States, 2003–2004., Am J Epidemiol source
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The follow-up time of our study was short which may increase the risk of reverse causation.”
§ Association of Sedentary Time with Mortality Independent of Moderate to Vigorous Physical Activity > Discussion
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Association of Sedentary Time with Mortality Independent of Moderate to Vigorous Physical Activity > Discussion
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“However, accelerometers are not sensitive to detect all activities such as standing still, upper body movements and biking.”
§ Association of Sedentary Time with Mortality Independent of Moderate to Vigorous Physical Activity > Discussion
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Association of Sedentary Time with Mortality Independent of Moderate to Vigorous Physical Activity > Methods > Study Population
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“The NHANES data were linked to death certificate data from the National Death Index”
§ Association of Sedentary Time with Mortality Independent of Moderate to Vigorous Physical Activity > Methods > Study Population
What the sources say
- Not checked yetcites [15] NHANES (1999–2004). Linked Mortality Files.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Association of Sedentary Time with Mortality Independent of Moderate to Vigorous Physical Activity > Discussion
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.
In the paper
“This study used data from the 2003–2004 NHANES survey, a nationally representative survey with a stratified, multistage design [14].”
§ Association of Sedentary Time with Mortality Independent of Moderate to Vigorous Physical Activity > Methods > Study Population
What the sources say
- Not checked yetcites [14] National Cancer Institute Risk factor monitoring and methods: SAS programs for analyzing NHANES 2003–2004 accelerometer data.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Association of Sedentary Time with Mortality Independent of Moderate to Vigorous Physical Activity > Discussion
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
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.”
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?
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“Another study conducted sensitivity analyses by excluding participants with mobility limitations, cardio-metabolic disease, and cancer and found that the associations between sedentary time and mortality were maintained[30].”
From Daily Sitting Time and All-Cause Mortality: A Meta-Analysis (2013) · cites this paper as [30]
In the citing paper
“Nonetheless, all three studies that had a short follow up period conducted sensitivity analyses in order to check for potential reverse causality (at least by excluding people who died in the first year), and all three reported similar associations between sitting time and all-cause mortality in their sensitivity analyses[10,30,33].”
From Daily Sitting Time and All-Cause Mortality: A Meta-Analysis (2013) · cites this paper as [30]
In the citing paper
“A sensitivity analysis excluding the results of the Koster et al [30] study did not change the pooled estimate (HR=1.02; 95% CI: 1.01-1.03), nor improve heterogeneity (I2=81.0%, p <0.001).”
From Daily Sitting Time and All-Cause Mortality: A Meta-Analysis (2013) · cites this paper as [30]
In the citing paper
“However, this was also the smallest study (145 deaths) and the average follow up was relatively short (2.8 years), which increases the risk of reverse causality.”
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
MinorThe Results give 1,701 participants, while Table 4 gives 1,711. The quartile counts in Table 4 also sum to 1,711.
“When we selected participants with 4 or more valid days (n = 1701) of accelerometry data”
“Table 4 Mortality rates and hazard ratios and 95% confidence intervals of mortality according to quartiles of sedentary time selecting participants with 4 or more valid days of accelerometry data (n = 1711).”
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Metadata
- 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)
- 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
- gold
- doi.org
- 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 › Public Health, Environmental and Occupational Health › 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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