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Associations of sitting accumulation patterns with cardio-metabolic risk biomarkers in Australian adults
Open accessAbstract
BACKGROUND: High amounts of time spent sitting can increase cardiovascular disease risk and are deleteriously associated cardio-metabolic risk biomarkers. Though evidence suggests that accruing sitting time in prolonged periods may convey additional risk, verification using high-quality measures is needed. We examined this issue in adults from the Australian Diabetes, Obesity and Lifestyle Study, using accurate measures of sitting accumulation. METHODS: In 2011/12, 739 adults aged 36 to 89 years (mean±SD 58±10 years) wore activPAL3™ monitors (which provide accurate objective measures of sitting); 678 provided ≥4 valid days of monitor data and complete cardio-metabolic biomarker and confounder data. Multivariable linear regression models examined associations of sitting time, sitting time accrued in ≥30 minute bouts (prolonged sitting time), and three measures of sitting accumulation patterns with cardio-metabolic risk markers: body mass index (BMI), waist circumference, blood pressure, high- and low- density lipoprotein (HDL and LDL) cholesterol, triglycerides, glycated haemoglobin (HbA1c), fasting plasma glucose (FPG) and 2-hour post-load glucose (PLG). Interactions tests examined whether associations of sitting time with biomarkers varied by usual sitting bout duration. RESULTS: Adjusted for potential confounders, greater amounts of sitting time and prolonged sitting time were significantly (p<0.05) deleteriously associated with BMI, waist circumference, HDL cholesterol, and triglycerides. Total sitting time was also significantly associated with higher PLG. Sitting accumulation patterns of frequently interrupted sitting (compared to patterns with relatively more prolonged sitting) were significantly beneficially associated with BMI, waist circumference, HDL cholesterol, triglycerides, PLG, and with FPG. Effect sizes were typically larger for accumulation patterns than for sitting time. Significant interactions (p<0.05) showed that associations of sitting time with HDL, triglycerides and PLG became more deleterious the longer at a time sitting was usually accumulated. CONCLUSIONS: Adding to previous evidence reliant on low-quality measures, our study showed that accumulating sitting in patterns where sitting was most frequently interrupted had significant beneficial associations with several cardio-metabolic biomarkers and that sitting for prolonged periods at a time may exacerbate some of the effects of sitting time. The findings support sedentary behavior guidelines that promote reducing and regularly interrupting sitting.
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“Prolonged, uninterrupted sitting is more strongly associated with adverse cardiometabolic outcomes than interrupted sitting [40,41].”
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Cordova‐Rivera, L., Gardiner, P. A., Gibson, P. G., WINKLER, E. A. H., Guerrero, P. D. U., & McDonald, V. M. (2021) · Respiratory Medicine · doi:10.1016/j.rmed.2021.106367 · Cited by 19
Self-citationHomer, A. R., Taylor, F., Dempsey, P. C., Wheeler, M. J., Sethi, P., Grace, M. S., GREEN, D. J., Cohen, N. D., Larsen, R. N., Kingwell, B. A., et al. (2021) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2021.07.001 · Cited by 22
Self-citationWhipple, M. O., Schorr, E. N., Talley, K. M. C., Wolfson, J., Lindquist, R., Bronas, U. G., & Treat-Jacobson, D. (2020) · Annals of Vascular Surgery · doi:10.1016/j.avsg.2020.03.040 · Cited by 18
Patterns and correlates of sedentary behavior among university students
Vella, C. A., & Nelson, M. C. (2023) · Journal of American College Health · doi:10.1080/07448481.2023.2198020 · Cited by 17
Whipple, M. O., Masters, K. S., Huebschmann, A. G., Scalzo, R. L., Reusch, J. E. B., Bergouignan, A., & Regensteiner, J. G. (2021) · Vascular Medicine · doi:10.1177/1358863x211009307 · Cited by 18
“13,19,20 23 These benefits are more pronounced in individuals with impaired glycemia or T2D, 24,25 however, the beneficial effects of SB breaks do not appear to be limited to a specific population; similar effects have been observed regardless of age, sex, or BMI.”
BackgroundCE: Too Much Sitting: A Newly Recognized Health Risk
Eanes, L. S. (2018) · AJN American Journal of Nursing · doi:10.1097/01.naj.0000544948.27593.9b · Cited by 18
Fortune, J., Norris, M., Stennett, A., Kilbride, C., Lavelle, G., Hendrie, W., Victor, C. R., & Ryan, J. M. (2021) · Scientific Reports · doi:10.1038/s41598-021-99631-z · Cited by 17
Debache, I., Bergouignan, A., Chaix, B., Sneekes, E. M., Thomas, F., & Sueur, C. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16050741 · Cited by 17
“Even among the studies that explicitly distinguished between standing and sitting time, for example with regard to glucose or lipid profile [15,16], only a few investigated the associations between postural behavior and metabolic outcomes in natural, free-living conditions [17,18].”
BackgroundResultImpact of dopamine-related genetic variants on physical activity in old age – a cohort study
Dohrn, I., Papenberg, G., WINKLER, E. A. H., & Welmer, A. (2020) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-020-00971-2 · Cited by 15
Self-citationBellettiere, J., Nakandala, S., Tuz‐Zahra, F., WINKLER, E. A. H., Hibbing, P. R., Healy, G. N., Dunstan, D. W., Owen, N. G., Greenwood-Hickman, M. A., Rosenberg, D. E., et al. (2022) · Journal for the Measurement of Physical Behaviour · doi:10.1123/jmpb.2021-0062 · Cited by 15
“…versus more interrupted manner (henceforth referred to as sitting patterns; Tremblay et al., 2017) is also important to public health inquiry (Bellettiere et al., 2017; Diaz et al., 2016; Dunstan et al., 2012; Hartman et al., 2018; Healy et al., 2011; Owen et al., 2020; Saunders et al.,…”
Self-citationToledo, M. J. L., Ainsworth, B. E., Gaesser, G. A., Hooker, S. P., Pereira, M. A., & Buman, M. P. (2023) · Scandinavian Journal of Medicine and Science in Sports · doi:10.1111/sms.14344 · Cited by 18
Detecting prolonged sitting bouts with the ActiGraph GT3X
Kuster, R. P., Grooten, W. J. A., Baumgartner, D., Blom, V., Hagströmer, M., & Ekblom, Ö. B. (2019) · Scandinavian Journal of Medicine and Science in Sports · doi:10.1111/sms.13601 · Cited by 16
“The optimization searched for the best ensemble learner method (Bag, AdaBoost M2, RUS Boost), split criterion (gdi, twoing, deviance), number of trees (10-500), minimum leave size (1 to n/2, n = number of minutes), maximum number of splits (1 to n-1), and learning rate (0-1).”
MethodDu, L., Li, G., Ren, P., He, Q., Pan, Y., Chen, S., & Zhang, X. (2022) · European Journal of Cardiovascular Nursing · doi:10.1093/eurjcn/zvac079 · Cited by 14
Modelling of substrate access and substrate binding to cephalosporin acylases
Ferrario, V., Fischer, M., Zhu, Y., & Pleiss, J. (2019) · Scientific Reports · doi:10.1038/s41598-019-48849-z · Cited by 14
Andersen, E., van der Ploeg, H. P., van Mechelen, W., Gray, C. M., Mutrie, N., van Nassau, F., Jelsma, J. G. M., Anderson, A. S., Silva, M. N., Pereira, H. V., et al. (2021) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-021-01237-1 · Cited by 16
Laine, S., Sjöros, T., Vähä‐Ypyä, H., Garthwaite, T., Löyttyniemi, E., Sievänen, H. T., Vasankari, T. J., Knuuti, J. M., & HEINONEN, I. H. A. (2021) · Frontiers in Endocrinology · doi:10.3389/fendo.2021.655756 · Cited by 13
“ALT, U/l 37 (20) ** 28 (14)** AST, U/l 29 (10) 27 (7)”
Husu, P., Suni, J. H., Tokola, K., Vähä‐Ypyä, H., Valkeinen, H., Mäki-Opas, T. E., Sievänen, H. T., & Vasankari, T. J. (2019) · Journal of Sports Sciences · doi:10.1080/02640414.2019.1598251 · Cited by 12
“…Koziel, & Gluszek, 2018) have been associated with higher body weight and greater waist circumference, whereas frequent interruption of sitting (Bellettiere et al., 2017; Chastin, Egerton, Leask, & Stamatakis, 2015) has been associated with lower body mass index and smaller waist circumference.”
BackgroundResultInfluentialElectromyography of Sedentary Behavior: Identifying Potential for Cardiometabolic Risk Reduction
Lamberg, S., Brakenridge, C. J., Dunstan, D. W., Finni, T. J., Healy, G. N., Owen, N. G., & Pesola, A. J. (2024) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000003544 · Cited by 11
“Previous accelerometer studies show that the accumulation pattern of activity may be important beyond the total activity (50).”
Self-citationAngassa, D., Solomon, S., & Seid, A. (2022) · BMC Cardiovascular Disorders · doi:10.1186/s12872-022-02465-4 · Cited by 11
“This could be explained by longer sitting duration means fewer calories are being burned, which might lead to storage of calories in the form of lipids [33].”
BackgroundOginni, J., Otinwa, G., & Gao, Z. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13030694 · Cited by 10
“White-collar professionals, particularly corporate workers, often engage in light-intensity physical activity and sedentary behaviors, leading to increased BMI and blood pressure [8,21,22].”
BackgroundHoffmann, S. W., Schierbauer, J., Zimmermann, P., Voit, T., Grothoff, A., Wachsmuth, N. B., Rössler, A., Lackner, H. K., & Moser, O. (2024) · Diabetes Obesity and Metabolism · doi:10.1111/dom.15732 · Cited by 13
Jia, H., Liu, Y., & Liu, D. (2023) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1221228 · Cited by 14
Parr, E. B., Devlin, B. L., Pinto, S. K., Dunstan, D. W., & Hawley, J. A. (2018) · Nutrients · doi:10.3390/nu10060733 · Cited by 10
“Both observational and experimental studies demonstrate that prolonged sitting is detrimental to postprandial glucose levels [7], where the greatest exaggeration in hyperglycaemia with prolonged sitting occurs in the period after the first meal [8,9].”
BackgroundSelf-citationGuirado, T., Metz, L., Pereira, B., Brun, C., Birat, A., Boscaro, A., Bergouignan, A., Thivel, D., & Duclos, M. (2022) · Journal of Occupational and Environmental Medicine · doi:10.1097/jom.0000000000002583 · Cited by 10
Television Viewing Time and Stroke Risk: Australian Diabetes Obesity and Lifestyle Study (1999-2012)
Cumming, T. B., Holliday, E. G., Dunstan, D. W., & English, C. (2019) · Journal of Stroke and Cerebrovascular Diseases · doi:10.1016/j.jstrokecerebrovasdis.2018.12.020 · Cited by 9
Self-citationEkegren, C. L., Climie, R. E., Simpson, P. M., Owen, N. G., Dunstan, D. W., Veitch, W. G., & Gabbe, B. J. (2019) · Physical Therapy · doi:10.1093/ptj/pzz151 · Cited by 11
Self-citationBailey, D. P., Stringer, C. A., Maylor, B. D., & Zakrzewski-Fruer, J. K. (2022) · Nutrients · doi:10.3390/nu14030605 · Cited by 9
“An increased frequency of interruptions to sitting is also associated with improved fasting glucose and glucose tolerance [11].”
BackgroundRelationship between liver fat content and lifestyle factors in adults with metabolic syndrome
Laine, S., Sjöros, T., Garthwaite, T., Saarenhovi, M., Kallio, P., Löyttyniemi, E., Vähä‐Ypyä, H., Sievänen, H. T., Vasankari, T. J., Laitinen, K., et al. (2022) · Scientific Reports · doi:10.1038/s41598-022-22361-3 · Cited by 9
“Sedentary time, % of daily wear time 72 (7) 68 (5)*”
BackgroundUsing Point-of-Choice Prompts to Reduce Sedentary Behavior in Sit-Stand Workstation Users
Larouche, M. L., Mullane, S. L., Toledo, M. J. L., Pereira, M. A., Huberty, J., Ainsworth, B. E., & Buman, M. P. (2018) · Frontiers in Public Health · doi:10.3389/fpubh.2018.00323 · Cited by 9
“However, avoiding prolonged bouts of sitting (18) and sustaining frequent sitstand workstation use over time continues to be a challenge due to the habitual nature of sitting in the workplace (19).”
BackgroundWagnild, J. M., & Pollard, T. M. (2020) · Journal of Physical Activity and Health · doi:10.1123/jpah.2019-0315 · Cited by 9
Natali, A. J., Marin, K. A., Hermsdorff, H. H. M., Rezende, F. A. C., & Pelúzio, M. D. C. G. (2020) · Nutrición Hospitalaria · doi:10.20960/nh.02740 · Cited by 9
“These results are similar to those previously reported in different populations (49,50) and, more importantly, are consistent with the association of longer time spent in SB with obesity as observed in the present review.”
ResultPinto, A. J., Rezende, D. A. N., Sieczkowska, S. M., Meireles, K., Bonfiglioli, K. R., Ribeiro, A. C. D. M., Bonfá, E., Owen, N. G., Dunstan, D. W., Roschel, H., et al. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20053944 · Cited by 10
“Sedentary behavior can add to the adverse impacts of physical inactivity in impairing cardiovascular health [46].”
BackgroundSelf-citationMues, J. P., Flohr, S., & Kurpiers, N. (2025) · Sports · doi:10.3390/sports13060186 · Cited by 8
Fenton, S. A. M., O’Brien, C. M., Kitas, G. D., Duda, J. L., Zanten, J. V., & Metsios, G. S. (2022) · Rheumatology Advances in Practice · doi:10.1093/rap/rkac097 · Cited by 6
“with standing or light physical activity every 30 minutes) is associated with better outcomes [7, 9, 10].”
BackgroundHamilton, M. T., Hamilton, D. G., & Zderic, T. W. (2018) · Progress in molecular biology and translational science · doi:10.1016/bs.pmbts.2017.12.014 · Cited by 8
Chater, A., Smith, L. R., Ferrandino, L., Wyld, K., & Bailey, D. P. (2020) · Practical Diabetes · doi:10.1002/pdi.2311 · Cited by 9
Gaelen, P. V., Springael, D., & Smets, I. Y. M. (2021) · Water Practice & Technology · doi:10.2166/wpt.2021.022 · Cited by 8
Lin, C., Koohsari, M. J., Liao, Y., Ishii, K., Shibata, A., Nakaya, T., McCormack, G. R., Hadgraft, N. T., Sugiyama, T., Owen, N. G., et al. (2022) · Scientific Reports · doi:10.1038/s41598-021-03071-8 · Cited by 8
Self-citationMorton, S., Hall, J., Fitzsimons, C. F., Hall, J. F., English, C., Förster, A., Lawton, R., Patel, A. K., Mead, G. E., & Clarke, D. J. (2021) · Disability and Rehabilitation · doi:10.1080/09638288.2021.1955307 · Cited by 9
Metadata
- Authors
- Bellettiere, J., Winkler, E. A. H., Chastin, S. F. M., Kerr, J., Owen, N., Dunstan, D. W., & Healy, G. N.
- Affiliations
- San Diego State University (US)
- The University of Queensland (AU)
- Glasgow Caledonian University (GB)
- University of California San Diego (US)
- Baker Heart and Diabetes Institute (AU)
- Corresponding author
- Bellettiere, John
- Winkler, Elisabeth A. H.
- Chastin, Sebastien F. M.
- Kerr, Jacqueline
- Owen, Neville
- Dunstan, David W.
- Healy, Genevieve N.
- ORCID
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2017-06-29
- Volume
- 12
- Issue
- 6
- Pages
- e0180119
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC5491133
- OpenAlex
- W2729779756
- Cited by
- 169
- References
- 45
- Citations by year
- 2026: 2 · 2025: 11 · 2024: 14 · 2023: 13 · 2022: 19 · 2021: 38 · 2020: 22 · 2019: 29 · 2018: 18 · 2017: 3
- FWCI
- 14.57
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UniSA Research Outputs Repository (University of South Australia) (acceptedVersion, other-oa)
- ResearchOnline (Glasgow Caledonian University) (acceptedVersion, cc-by)
- Ghent University Academic Bibliography (Ghent University) (submittedVersion, other-oa)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by)
- Research Bank (Australian Catholic University) (submittedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Own your potential (DEAKIN) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Swinburne figshare (Swinburne University of Technology) (submittedVersion, cc-by)
- Swinburne figshare (Swinburne University of Technology) (cc-by)
- Funders
- National Health and Medical Research Council (566940, 1000986, 1003960, 1078360, 108029, 233200)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Physical Activity and Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Social Sciences › Human Factors and Ergonomics › Ergonomics and Musculoskeletal Disorders
- Keywords
- sedentary behavior, prolonged sitting, body mass index, waist circumference, HDL cholesterol, triglycerides, HbA1c, post-load glucose, blood pressure, Australian adults
- MeSH terms
- Adult, Aged, Aged, 80 and over, Australia, Cardiovascular Diseases, Female, Humans, Male, Middle Aged, Posture, Biomarkers, Young Adult, Sedentary Behavior
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