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Daily Sitting Time and All-Cause Mortality: A Meta-Analysis

Open access
Chau, Josephine Y., Grunseit, Anne C., Chey, Tien, Stamatakis, Emmanuel, Brown, Wendy J., Matthews, Charles E., Bauman, Adrian E., van der Ploeg, Hidde P.·2013·PLoS ONE
DOI 10.1371/journal.pone.0080000PMC PMC3827429
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Abstract

OBJECTIVE: To quantify the association between daily total sitting and all-cause mortality risk and to examine dose-response relationships with and without adjustment for moderate-to-vigorous physical activity. METHODS: Studies published from 1989 to January 2013 were identified via searches of multiple databases, reference lists of systematic reviews on sitting and health, and from authors' personal literature databases. We included prospective cohort studies that had total daily sitting time as a quantitative exposure variable, all-cause mortality as the outcome and reported estimates of relative risk, or odds ratios or hazard ratios with 95% confidence intervals. Two authors independently extracted the data and summary estimates of associations were computed using random effects models. RESULTS: Six studies were included, involving data from 595,086 adults and 29,162 deaths over 3,565,569 person-years of follow-up. Study participants were mainly female, middle-aged or older adults from high-income countries; mean study quality score was 12/15 points. Associations between daily total sitting time and all-cause mortality were not linear. With physical activity adjustment, the spline model of best fit had dose-response HRs of 1.00 (95% CI: 0.98-1.03), 1.02 (95% CI: 0.99-1.05) and 1.05 (95% CI: 1.02-1.08) for every 1-hour increase in sitting time in intervals between 0-3, >3-7 and >7 h/day total sitting, respectively. This model estimated a 34% higher mortality risk for adults sitting 10 h/day, after taking physical activity into account. The overall weighted population attributable fraction for all-cause mortality for total daily sitting time was 5.9%, after adjusting for physical activity. CONCLUSIONS: Higher amounts of daily total sitting time are associated with greater risk of all-cause mortality and moderate-to-vigorous physical activity appears to attenuate the hazardous association. These findings provide a starting point for identifying a threshold on which to base clinical and public health recommendations for overall sitting time, in addition to physical activity guidelines.

AI snapshot

Written from the paper’s full text.

TL;DR

This meta-analysis of six prospective cohort studies found that higher daily total sitting time is associated with greater all-cause mortality risk, with a non-linear dose-response and some attenuation after adjusting for moderate-to-vigorous physical activity. Risk increased significantly above 7 h/day with physical activity adjustment, and sitting 10 h/day was associated with 34% higher mortality after physical activity adjustment.

Key findings

  • Six studies included 595,086 adults, 29,162 deaths, and 3,565,569 person-years of follow-up; mean study quality score was reported as 12/15 points.
  • With physical activity adjustment, the pooled hazard ratio per 1-hour increase in sitting was 1.02 (95% CI: 1.01–1.03). The best-fitting spline had knots at >3 and >7 h/day, with HRs per 1-hour increment of 1.00 (95% CI: 0.98–1.03) for 0–3 h/day, 1.02 (95% CI: 0.99–1.05) for >3–7 h/day, and 1.05 (95% CI: 1.02–1.08) for >7 h/day. Sitting 10 h/day was associated with HR 1.34 (95% CI: 1.28–1.40), and the weighted population attributable fraction was 5.9%.
  • Without physical activity adjustment, the pooled HR per 1-hour increase was 1.04 (95% CI: 1.02–1.05). The best-fitting spline had knots at >4 and >8 h/day, with HRs per 1-hour increment of 1.02 (95% CI: 0.99–1.04) for 0–4 h/day, 1.02 (95% CI: 1.00–1.04) for >4–8 h/day, and 1.08 (95% CI: 1.05–1.11) for >8 h/day. Sitting 10 h/day was associated with HR 1.52 (95% CI: 1.46–1.58).
  • Heterogeneity was high: I²=82.7% with physical activity adjustment and I²=85.1% without. Excluding the accelerometer study did not change the pooled estimate with physical activity adjustment (HR=1.02; 95% CI: 1.01–1.03) or improve heterogeneity (I²=81.0%).

Methods

  • Systematic search of multiple databases, reference lists of systematic reviews, and authors’ personal literature databases for prospective cohort studies published from 1989 to January 2013; inclusion required healthy adults at baseline, total daily sitting time as a quantitative exposure, all-cause mortality as outcome, and reported RR/OR/HR with 95% CIs.
  • Two authors independently extracted data and appraised study quality using 15 criteria (score 0–15); summary estimates used random effects models, generalized least squares for trend, spline dose-response models, I² heterogeneity testing, and population attributable fraction calculations in STATA 11.
  • Five studies assessed daily total sitting by self-report and one used accelerometer-measured sedentary time; analyses were run with and without adjustment for moderate-to-vigorous physical activity.

Limitations

  • The paper states the main limitation is the small number of included studies; five of six used single-item self-report sitting measures, which could cause misclassification and attenuation of risk estimates; some studies had short follow-up, increasing reverse-causality risk; unmeasured confounding or reverse causality cannot be excluded; and publication bias could not be formally tested due to few studies and heterogeneity, though visual inspection suggested possible bias.
  • Evident from the text: the included populations were mainly female, middle-aged or older adults from high-income countries, limiting generalizability; sitting categories were inconsistent across studies; and statistical heterogeneity was high (I² >80%).

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Integrity signals

Registry

Crossref · 10.1371/journal.pone.0080000

Cites

44 of 44 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

0 of 60 cited sources checked · 0 supported · 0 flagged

  • Findingreasoning

    The spline model estimated a 34% higher mortality risk for adults sitting 10 h/day, after taking physical activity into account.

    “This model estimated a 34% higher mortality risk for adults sitting 10 h/day, after taking physical activity into account.”
    Quote in the paperSubstantial claim
  • Findingown data

    With physical activity adjustment, the spline model of best fit had dose-response HRs of 1.00 (95% CI: 0.98-1.03), 1.02 (95% CI: 0.99-1.05) and 1.05 (95% CI: 1.02-1.08) for every 1-hour increase in sitting time in intervals between 0-3, >3-7 and >7 h/day total sitting, respectively.

    “With physical activity adjustment, the spline model of best fit had dose-response HRs of 1.00 (95% CI: 0.98-1.03), 1.02 (95% CI: 0.99-1.05) and 1.05 (95% CI: 1.02-1.08) for every 1-hour increase in sitting time in intervals between 0-3, >3-7 and >7 h/day total sitting, respectively.”
    Quote in the paperSubstantial claim
  • Findingown data

    Higher amounts of daily total sitting time are associated with greater risk of all-cause mortality.

    “Higher amounts of daily total sitting time are associated with greater risk of all-cause mortality”
    Quote in the paperSubstantial claim
  • Findingown data

    The overall weighted population attributable fraction for all-cause mortality for total daily sitting time was 5.9%, after adjusting for physical activity.

    “The overall weighted population attributable fraction for all-cause mortality for total daily sitting time was 5.9%, after adjusting for physical activity.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Associations between daily total sitting time and all-cause mortality were not linear.

    “Associations between daily total sitting time and all-cause mortality were not linear.”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 20
  • May combine two claims. 30

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

    Findingcitation

    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].”
    Quote in the paperNot a substantial claim0 of 6 sources checked
    • cites [10] HP van der Ploeg, 2012, Sitting time and all-cause mortality risk in 222,497 Australian adults, Arch Intern Med source

      Not checked in the free run.

    • cites [11] CE Matthews, 2012, Amount of time spent in sedentary behaviors and cause-specific mortality in US adults, Am J Clin Nutr source

      Not checked in the free run.

    • cites [32] TG Pavey, 2012, Sitting-time and 9-year all-cause mortality in older women, Br J Sports Med

      Not checked in the free run.

    • cites [33] JY Chau, 2013, Sedentary behaviour and risk of mortality from all–causes and cardio-metabolic diseases in adults: evidence from the HUNT3 population cohort, Br J Sports Med

      Not checked in the free run.

    • cites [34] M Inoue, 2008, Daily total physical activity level and premature death in men and women: results from a large-scale population-based cohort study in Japan (JPHC study), Ann Epidemiol source

      Not checked in the free run.

    • cites [30] A Koster, 2012, Association of sedentary time with mortality independent of moderate to vigorous physical activity, PLOS ONE source

      Not checked in the free run.

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

    Findingown data

    The cut-points for the sitting categories were not consistent across the studies.

    “However, the cut-points for the categories were not consistent across the studies (see Table 1).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Six studies were included, involving data from 595,086 adults and 29,162 deaths over 3,565,569 person-years of follow-up.

    “Six studies were included, involving data from 595,086 adults and 29,162 deaths over 3,565,569 person-years of follow-up.”
    • Also stated in: § Study characteristics · plain
      “Data from 595,086 people were included in the meta-analysis. There were 29,162 deaths during 3,565,569 person-years of follow-up.”
    Quote in the paperSubstantial claim

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

    Findingown data

    Study participants were mainly female, middle-aged or older adults from high-income countries.

    “Study participants were mainly female, middle-aged or older adults from high-income countries”
    • Also stated in: § Study characteristics · plain
      “One study involved women only[32], and over 50% of participants in four of the five other studies were female[10,30,33,34].”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In initial linear random-effects models, the pooled HRs per 1-hour increase in daily total sitting time were 1.03 (95% CI 0.98-1.08) with physical activity adjustment and 1.05 (95% CI 0.98-1.13) without.

    “Initial linear random effects analyses suggested that the association between daily total sitting time and all-cause mortality was not linear in models with adjustment for physical activity (HR=1.03; 95% CI: 0.98-1.08) and without physical activity adjustment (HR=1.05; 95% CI:0.98-1.13).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Goodness-of-fit tests indicated linear dose-response models did not fit the data well, with physical activity adjustment (χ2(19)=71.02, p<0.001) and without (χ2(15)=91.37, p<0.001).

    “The goodness-of-fit test suggested that the linear dose-response models did not fit the data well with adjustment for physical activity (χ2 (19) = 71.02, p<0.001) and without physical activity adjustment (χ2 (15) = 91.37, p<0.001).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    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).”
    • Also stated in: § Discussion · boosted
      “The only study that used an objective measure of sedentary behavior showed a much stronger association with all-cause mortality[30].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [30] A Koster, 2012, Association of sedentary time with mortality independent of moderate to vigorous physical activity, PLOS ONE source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    There was high and statistically significant heterogeneity among studies in the physical activity-adjusted analysis (I2=82.7%, p<0.001).

    “Heterogeneity was high (I2=82.7%) and statistically significant (p<0.001).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Based on dose-response spline models, compared with sitting 1 h/day, an adult sitting 10 h/day had 34% higher all-cause mortality risk (HR 1.34, 95% CI 1.28-1.40) with physical activity adjustment and 52% higher (HR 1.52, 95% CI 1.46-1.58) without.

    “an adult sitting for 10 h/day would have 34% (HR=1.34, 95% CI: 1.28-1.40) and 52% (HR=1.52, 95% CI: 1.46-1.58) increased all-cause mortality risk with and without adjusting for physical activity, respectively.”
    • Also stated in: § Discussion · hedged
      “Our dose-response modeling estimated the risk of all-cause mortality for sitting 10 h/day to be 34% and 52% higher than sitting for 1 h/day when physical activity was and was not taken into account, respectively (Figures 2A and 3A).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In the unadjusted spline model, HRs per 1-hour increment in daily sitting were 1.02 (95% CI 0.99-1.04) for 0-4 h/day, 1.02 (1.00-1.04) for >4-8 h/day, and 1.08 (1.05-1.11) for >8 h/day.

    “For every 1-hour increment of sitting in intervals 0-4, >4-8 and >8h/day total sitting time, the HRs were 1.02 (95% CI: 0.99-1.04), 1.02 (95% CI: 1.00-1.04), and 1.08 (95% CI: 1.05-1.11), respectively.”
    • Also stated in: § Discussion · plain
      “When physical activity was not taken into account, total sitting >4-8 and >8 h/day were both associated with significantly higher risk of dying (2% and 8% per 1-hour increment in sitting time per day, respectively).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Visual inspection of forest and funnel plots suggested possible publication bias, with larger cohort studies reporting smaller effects.

    “However, visual inspection of the forest and funnel plots (Figure S1) suggest that there may be some publication bias present, with larger cohort studies reporting the smaller effects[36].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [36] M Egger, 1997, Bias in meta-analysis detected by a simple, graphical test, BMJ source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    In the physical activity-adjusted spline model, HRs per 1-hour increment in daily sitting were 1.00 (95% CI 0.98-1.03) for 0-3 h/day, 1.02 (0.99-1.05) for >3-7 h/day, and 1.05 (1.02-1.08) for >7 h/day.

    “For every 1-hour increment of sitting in intervals 0-3, >3-7 and >7 h/day total sitting time, the HRs were 1.00 (95% CI: 0.98-1.03), 1.02 (95% CI: 0.99-1.05) and 1.05 (95% CI: 1.02-1.08) respectively.”
    • Also stated in: § Discussion · plain
      “However, there was no evidence of higher mortality risk per 1-hour increment of sitting at daily total sitting times 0-3 and >3-7 h/day.”
    • Also stated in: § Discussion · hedged
      “The risk appears to increase significantly when adults sit for more than 7 h/day; by 5% for each 1-hour increment in daily sitting time, when the effects of physical activity are taken into account.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Without adjustment for physical activity, the pooled HR per 1-hour increase in daily total sitting time was 1.04 (95% CI 1.02-1.05), higher than the physical activity-adjusted estimate.

    “The pooled HR of 1.04 (95% CI: 1.02-1.05) was higher than that for the physical activity adjusted analyses”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Models were run with the Koster et al accelerometer study included and excluded to see if the results were changed with inclusion of this paper.

    “As accelerometers have been shown to measure sitting time in a different manner to questionnaires[31], we ran models with this study included and excluded, to see if the results were changed with inclusion of this paper.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [31] GN Healy, 2011, Measurement of adults&apos; sedentary time in population-based studies, Am J Prev Med source

      Not checked in the free run.

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

    Study design and conductnone given

    All studies provided information about their objectives, study design, participant sampling and recruitment, measures of total sitting and mortality, data sources and statistical methods.

    “All studies provided information about their objectives, study design, participant sampling and recruitment, measures of total sitting and mortality, data sources and statistical methods.”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    Mean study quality score was 12/15 points.

    “mean study quality score was 12/15 points”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    This is the first meta-analysis of dose-response relationships between total daily sitting time and mortality risk, with and without adjustment for physical activity.

    “To the best of our knowledge, this is the first meta-analysis of dose-response relationships between total daily sitting time and mortality risk, with and without adjustment for physical activity.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    Grøntved and Hu found a pooled hazard ratio of 1.13 per 2-hour increase in TV-viewing per day for all-cause mortality.

    “They found a pooled hazard ratio of 1.13 per 2-hour increase in TV-viewing per day for all-cause mortality.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13] A Grøntved, 2011, Television viewing and risk of type 2 diabetes, cardiovascular disease, and all-cause mortality, JAMA source

      Not checked in the free run.

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

    Study design and conductnone given

    All studies ascertained participants' mortality status through linkage with a regional or national death registry.

    “All studies ascertained participants’ mortality status through linkage with a regional or national death registry.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    Katzmarzyk and Lee reported an 18%-45% increase in risk of all-cause mortality for higher levels of sitting, relative to the lowest level.

    “In another study, Katzmarzyk and Lee [15] reported an 18%-45% increase in risk of all-cause mortality for higher levels of sitting, relative to the lowest level.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [15] PT Katzmarzyk, 2012, Sedentary behaviour and life expectancy in the USA: a cause-deleted life table analysis, BMJ Open source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Two authors independently appraised the methodological quality of all included studies using a quality rating list based on previous checklists.

    “Two authors independently appraised the methodological quality of all included studies using a quality rating list based on previous checklists[20-23].”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [20] L Tooth, 2005, Quality of reporting of observational longitudinal research, Am J Epidemiol source

      Not checked in the free run.

    • cites [21] E von Elm, 2008, The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies, J Clin Epidemiol source

      Not checked in the free run.

    • cites [22] AE Fung, 2009, Applying the CONSORT and STROBE statements to evaluate the reporting quality of neovascular age-related macular degeneration studies, Ophthalmology

      Not checked in the free run.

    • cites [23] JGZ van Uffelen, 2010, Occupational sitting and health risks: A systematic review, Am J Prev Med source

      Not checked in the free run.

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

    Study design and conductcitation

    This meta-analysis was conducted following the checklist of the Meta-Analyses of Observational Studies in Epidemiology.

    “This meta-analysis was conducted following the checklist of the Meta-Analyses of Observational Studies in Epidemiology[19].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] DF Stroup, 2000, Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group, JAMA source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductcitation

    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.”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [10] HP van der Ploeg, 2012, Sitting time and all-cause mortality risk in 222,497 Australian adults, Arch Intern Med source

      Not checked in the free run.

    • cites [11] CE Matthews, 2012, Amount of time spent in sedentary behaviors and cause-specific mortality in US adults, Am J Clin Nutr source

      Not checked in the free run.

    • cites [30] A Koster, 2012, Association of sedentary time with mortality independent of moderate to vigorous physical activity, PLOS ONE source

      Not checked in the free run.

    • cites [32] TG Pavey, 2012, Sitting-time and 9-year all-cause mortality in older women, Br J Sports Med

      Not checked in the free run.

    • cites [33] JY Chau, 2013, Sedentary behaviour and risk of mortality from all–causes and cardio-metabolic diseases in adults: evidence from the HUNT3 population cohort, Br J Sports Med

      Not checked in the free run.

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

    Study design and conductown data

    Study quality scores ranged from 10/15 to 12/15 with a mean percentage agreement of 85.6% on quality ratings between the reviewers.

    “Study quality scores ranged from 10/15 to 12/15 with a mean percentage agreement of 85.6% on quality ratings between the reviewers.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Wilmot and colleagues' meta-analysis of 16 prospective studies involved mixed exposures of sedentary behavior, such that TV-viewing, leisure-time sedentary behavior, and sitting, measured in heterogeneous units and categories, were combined in the same analyses.

    “However, this meta-analysis of 16 prospective studies involved mixed exposures of sedentary behavior, such that TV-viewing, leisure-time sedentary behavior, and sitting, measured in heterogeneous units and categories, were combined in the same analyses.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [18] EG Wilmot, 2012, Sedentary time in adults and the association with diabetes, cardiovascular disease and death: systematic review and meta-analysis, Diabetologia source

      Not checked in the free run.

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

    Study design and conductnone given

    Two authors independently extracted the data from each study and compared the data for consistency.

    “Two authors independently extracted the data from each study and compared the data for consistency.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    A growing body of literature suggests high sitting time is associated with higher risk of adverse health outcomes, including cardiovascular disease, type 2 diabetes, cancer and mortality, even after adjustment for moderate-to-vigorous physical activity.

    “A growing body of literature suggests high sitting time is associated with higher risk of adverse health outcomes, including cardiovascular disease, type 2 diabetes, cancer and mortality, even after adjustment for moderate-to-vigorous physical activity[8-13].”
    Quote in the paperSubstantial claim0 of 6 sources checked
    • cites [8] KI Proper, 2011, Sedentary behaviors and health outcomes among adults: A systematic review of prospective studies, Am J Prev Med source

      Not checked in the free run.

    • cites [9] AA Thorp, 2011, Sedentary behaviors and subsequent health outcomes in adults: A systematic review of longitudinal studies, 1996-2011, Am J Prev Med source

      Not checked in the free run.

    • cites [10] HP van der Ploeg, 2012, Sitting time and all-cause mortality risk in 222,497 Australian adults, Arch Intern Med source

      Not checked in the free run.

    • cites [11] CE Matthews, 2012, Amount of time spent in sedentary behaviors and cause-specific mortality in US adults, Am J Clin Nutr source

      Not checked in the free run.

    • cites [12] E Stamatakis, 2011, Screen-based entertainment time, all-cause mortality, and cardiovascular events: Population-based study with ongoing mortality and hospital events follow-up, J Am Coll Cardiol source

      Not checked in the free run.

    • cites [13] A Grøntved, 2011, Television viewing and risk of type 2 diabetes, cardiovascular disease, and all-cause mortality, JAMA source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    All-cause mortality risk increases progressively as daily sitting time increases, with physical activity having a partially protective effect, especially when sitting time is high.

    “Nonetheless, all-cause mortality risk appears to increase progressively as people sit more during the day, with physical activity having a partially protective effect, especially when sitting time is high.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductcitation

    All three studies with short follow-up conducted sensitivity analyses for reverse causality and reported similar associations.

    “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].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [10] HP van der Ploeg, 2012, Sitting time and all-cause mortality risk in 222,497 Australian adults, Arch Intern Med source

      Not checked in the free run.

    • cites [30] A Koster, 2012, Association of sedentary time with mortality independent of moderate to vigorous physical activity, PLOS ONE source

      Not checked in the free run.

    • cites [33] JY Chau, 2013, Sedentary behaviour and risk of mortality from all–causes and cardio-metabolic diseases in adults: evidence from the HUNT3 population cohort, Br J Sports Med

      Not checked in the free run.

  • May combine two claims.

    Study design and conductcitation

    The small number of studies and significant heterogeneity precluded formal testing for publication bias.

    “The small number of studies and presence of significant heterogeneity precluded formal testing for publication bias[35].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [35] JP Ioannidis, 2007, The appropriateness of asymmetry tests for publication bias in meta-analyses: a large survey, CMAJ source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductcitation

    The main limitation is the small number of studies included, though greater than some previous meta-analyses.

    “The main limitation of this meta-analysis is the small number of studies included, although this was greater than in some previous meta-analyses[13,15].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [13] A Grøntved, 2011, Television viewing and risk of type 2 diabetes, cardiovascular disease, and all-cause mortality, JAMA source

      Not checked in the free run.

    • cites [15] PT Katzmarzyk, 2012, Sedentary behaviour and life expectancy in the USA: a cause-deleted life table analysis, BMJ Open source

      Not checked in the free run.

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

    Premisecitation

    A meta-analysis of three studies on TV-viewing and mortality showed a pooled HR for all-cause mortality of 1.13 per two-hour increase in TV-viewing.

    “The findings of this meta-analysis are consistent with a meta-analysis of three studies on TV-viewing and mortality[13], which showed a pooled HR for all cause mortality of 1.13 per two hour increase of TV-viewing.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13] A Grøntved, 2011, Television viewing and risk of type 2 diabetes, cardiovascular disease, and all-cause mortality, JAMA source

      Not checked in the free run.

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

    Premisecitation

    A recent multinational study showed 25% of people in developed and developing countries sit for 8 or more hours per day.

    “A recent multinational study has shown that 25% of people in developed and developing countries sit for 8 or more hours per day[7].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [7] A Bauman, 2011, The descriptive epidemiology of sitting – a 20 country comparison using the International Physical Activity Questionnaire (IPAQ), Am J Prev Med

      Not checked in the free run.

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

    Study design and conductcitation

    Two studies excluded participants with poor self-rated health or pre-existing chronic illness.

    “Two studies also excluded participants with poor self-rated health at baseline or pre-existing chronic illness from their analyses[11,32].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [11] CE Matthews, 2012, Amount of time spent in sedentary behaviors and cause-specific mortality in US adults, Am J Clin Nutr source

      Not checked in the free run.

    • cites [32] TG Pavey, 2012, Sitting-time and 9-year all-cause mortality in older women, Br J Sports Med

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    Excluding the Koster et al. study in a sensitivity analysis did not change the pooled HR (1.02, 95% CI 1.01-1.03) or improve heterogeneity (I2=81.0%, p<0.001).

    “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).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [30] A Koster, 2012, Association of sedentary time with mortality independent of moderate to vigorous physical activity, PLOS ONE source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The range of adjustments and exclusions may partly account for the significant heterogeneity, though reverse causality cannot be excluded.

    “The range of adjustments and exclusions in the studies in this meta-analysis may partly account for the significant heterogeneity observed, although the potential for reverse causality cannot be excluded.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Prior meta-analyses combined different measures of sedentary behavior and did not examine dose-response relationships for daily total sitting time.

    “However, both studies combined different measures of sedentary behavior (TV-viewing mostly, and sitting time) in their analyses, and neither study examined dose-response relationships for daily total sitting time.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [15] PT Katzmarzyk, 2012, Sedentary behaviour and life expectancy in the USA: a cause-deleted life table analysis, BMJ Open source

      Not checked in the free run.

    • cites [18] EG Wilmot, 2012, Sedentary time in adults and the association with diabetes, cardiovascular disease and death: systematic review and meta-analysis, Diabetologia source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductcitation

    Five of six included studies assessed total sitting time via single-item self-report, and measurement error could have led to misclassification and attenuation of risk estimates.

    “Five of the six studies included in this meta-analysis assessed total sitting time through single-item self-report measures, and measurement error in reported sitting time could have led to misclassification and attenuation of the risk estimates observed in these studies[31,37].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [31] GN Healy, 2011, Measurement of adults&apos; sedentary time in population-based studies, Am J Prev Med source

      Not checked in the free run.

    • cites [37] CE Matthews, 2012, Improving self-reports of active and sedentary behaviors in large epidemiologic studies, Exerc Sport Sci Rev source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationown data

    The results provide a starting point for more specific recommendations about how much sitting is associated with adverse health outcomes and benefits of reducing sitting.

    “The results of this meta-analysis provide a starting point for making more specific recommendations about how much sitting is associated with adverse health outcomes and the potential health benefits of reducing daily total sitting time, in addition to those accrued through engaging in moderate-to-vigorous physical activity.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Current US and UK physical activity guidelines advise reducing sedentary time but do not indicate how much sitting is harmful.

    “Although current physical activity guidelines, such as those from the USA [41] and UK [42], include advice for adults to reduce the amount of time spent sedentary or sitting for prolonged periods, they do not indicate how much sitting is harmful for health.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [41] CE Garber, 2011, American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise, Med Sci Sports Exerc source

      Not checked in the free run.

    • cites [42] 2011, Physical Activity, Health Improvement and Protection

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    All included studies adjusted for age and physical activity; four of six adjusted for sex; five for education and/or smoking.

    “All studies in this meta-analysis adjusted their analyses for age and physical activity, while four out of six studies also adjusted for sex, and five studies for education and/or smoking (Table 1).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductreasoning

    The objective-measure study was the smallest (145 deaths) and had relatively short follow-up (2.8 years), increasing risk of reverse causality.

    “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.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [30] A Koster, 2012, Association of sedentary time with mortality independent of moderate to vigorous physical activity, PLOS ONE source

      Not checked in the free run.

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

    Premisecitation

    WHO reported PAFs for tobacco use (8.7%), physical inactivity (5.5%), and overweight/obesity (4.8%).

    “This estimate is similar to that reported by the World Health Organization for other major risk factors such as tobacco use (8.7%), physical inactivity (5.5%) and overweight and obesity (4.8%)[40]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [40] 2009, Global health risks: mortality and burden of disease attributable to selected major risks

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationown data

    The findings provide a starting point for identifying a threshold for sedentary behavior recommendations.

    “The findings from this study provide a starting point for identifying a threshold on which to base sedentary behavior recommendations for overall sitting time.”
    Quote in the paperNot a substantial claim
44 of 44

  • The paper relies on this without support.

    TV-viewing time is a poor proxy of total sitting time.

    “Such evidence has value for formulating quantitative clinical and public health recommendations for TV-viewing time, but not for overall sitting, because TV-viewing time is a poor proxy of total sitting time.”

  • The authors state this as an assumption.

    For open ended categories, the same magnitude of dose as for the neighboring category can be assumed.

    “For open ended categories we assumed the same magnitude of dose as for the neighboring category.”

  • The paper relies on this without support.

    No quantitative guidelines exist for sedentary behavior because it is not known how much sedentary behavior is harmful to health.

    “In contrast with physical activity, for which there have been clinical and public health guidelines in place for nearly two decades[14], no quantitative guidelines exist for sedentary behavior because it is not known how much sedentary behavior is harmful to health.”

  • The paper relies on this without support.

    The observed association between daily sitting time and all-cause mortality is causal, so that a population attributable fraction can be estimated.

    “The overall weighted PAF for all-cause mortality attributable to total daily sitting time, after taking physical activity into account, was estimated to be 5.9%.”
    “We estimated that 5.9% of deaths could be attributed to daily total sitting time, even with physical activity taken into account.”
4 of 4

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?

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Consistentχ²(19) = 71.02reported p < .001 · recomputed p < .001

    “χ2 (19) = 71.02, p < .001”

  • Consistentχ²(15) = 91.37reported p < .001 · recomputed p < .001

    “χ2 (15) = 91.37, p < .001”

  • Consistentχ²(17) = 22.67reported p = .16 · recomputed p = .160

    “χ2 (17) =22.67, p = .160”

  • Consistentχ²(13) = 17.85reported p = .163 · recomputed p = .163

    “χ2 (13)=17.85, p = .163”

  • Consistentχ²(13) = 24.27reported p = .029 · recomputed p = .029

    “χ2 (13) =24.27, p = .029”

5 of 5

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.

  • Activity-adjusted spline increments do not produce the stated 10-hour risk

    Major

    Relative to 1 h/day, the stated hourly HRs give two hours at 1.00, four at 1.02 and three at 1.05 through 10 h/day. Their product is about 1.25, not the reported HR of 1.34.

    Reported 1.34 · recomputed 1.253051

  • Unadjusted spline increments do not produce the stated 10-hour risk

    Major

    Relative to 1 h/day, the stated unadjusted hourly HRs give seven hours at 1.02 and two at 1.08 through 10 h/day. Their product is about 1.34, not the reported HR of 1.52.

    Reported 1.52 · recomputed 1.339827

  • The assigned dose for the 4-<8 h/day category is not its midpoint

    Minor

    The methods say doses were assigned using category midpoints, but the midpoint between 4 and 8 h/day is 6, not the reported 5 h/day.

    Reported 5 · recomputed 6

  • The stated quality-score range excludes a reported score

    Minor

    The text says scores ranged from 10/15 to 12/15, but Table 2 reports a score of 13 for Pavey 2012.

4 of 4

Cites

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Cited by

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Related

Authors
Chau, J. Y., Grunseit, A. C., Chey, T., Stamatakis, E., Brown, W. J., Matthews, C. E., Bauman, A. E., & van der Ploeg, H. P.
Affiliations
  • The University of Sydney (AU)
  • The University of Queensland (AU)
  • National Cancer Institute (US)
Corresponding author
Chau, Josephine Y.
ORCID
Venue
PLoS ONE
Publisher
Public Library of Science (PLoS)
Published
2013-11-13
Volume
8
Issue
11
Pages
e80000
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0080000
PMC
PMC3827429
OpenAlex
W2077503759
Semantic Scholar
2800eb0e9f17e4e68d505f5e61f06392f5e15f1a
Cited by
876
References
44
Citations by year
2026: 23 · 2025: 43 · 2024: 67 · 2023: 66 · 2022: 75 · 2021: 104 · 2020: 89 · 2019: 70 · 2018: 104 · 2017: 77 · 2016: 61 · 2015: 64 · 2014: 30
FWCI
5.69
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Pure Amsterdam UMC (publishedVersion)
  • Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
  • VU Research Portal (publishedVersion, other-oa)
  • RePEc: Research Papers in Economics (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • UCL Discovery (University College London) (submittedVersion)
  • Figshare (submittedVersion, cc-by)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
Funders
  • National Institute for Health and Care Research (CDF-2010-03-30)
  • Medical Research Council
  • National Health and Medical Research Council (569940)
Topics
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
  • Social Sciences › Psychology › Social Psychology › Ergonomics and Musculoskeletal Disorders
  • Health Sciences › Medicine › Pharmacology › Coffee research and impacts
Keywords
sitting time, sedentary behavior, all-cause mortality, moderate-to-vigorous physical activity, dose-response relationship, population attributable fraction, physical activity guidelines, adults
MeSH terms
Cause of Death, Female, Health Status, Humans, Male, Mortality, Prospective Studies, Exercise, Proportional Hazards Models, Publication Bias

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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