Role of Low Energy Expenditure and Sitting in Obesity, Metabolic Syndrome, Type 2 Diabetes, and Cardiovascular Disease
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It is not uncommon for people to spend one-half of their waking day sitting, with relatively idle muscles. The other half of the day includes the often large volume of nonexercise physical activity. Given the increasing pace of technological change in domestic, community, and workplace environments, modern humans may still not have reached the historical pinnacle of physical inactivity, even in cohorts where people already do not perform exercise. Our purpose here is to examine the role of sedentary behaviors, especially sitting, on mortality, cardiovascular disease, type 2 diabetes, metabolic syndrome risk factors, and obesity. Recent observational epidemiological studies strongly suggest that daily sitting time or low nonexercise activity levels may have a significant direct relationship with each of these medical concerns. There is now a need for studies to differentiate between the potentially unique molecular, physiologic, and clinical effects of too much sitting (inactivity physiology) separate from the responses caused by structured exercise (exercise physiology). In theory, this may be in part because nonexercise activity thermogenesis is generally a much greater component of total energy expenditure than exercise or because any type of brief, yet frequent, muscular contraction throughout the day may be necessary to short-circuit unhealthy molecular signals causing metabolic diseases. One of the first series of controlled laboratory studies providing translational evidence for a molecular reason to maintain high levels of daily low-intensity and intermittent activity came from examinations of the cellular regulation of skeletal muscle lipoprotein lipase (LPL) (a protein important for controlling plasma triglyceride catabolism, HDL cholesterol, and other metabolic risk factors). Experimentally reducing normal spontaneous standing and ambulatory time had a much greater effect on LPL regulation than adding vigorous exercise training on top of the normal level of nonexercise activity. Those studies also found that inactivity initiated unique cellular processes that were qualitatively different from the exercise responses. In summary, there is an emergence of inactivity physiology studies. These are beginning to raise a new concern with potentially major clinical and public health significance: the average nonexercising person may become even more metabolically unfit in the coming years if they sit too much, thereby limiting the normally high volume of intermittent nonexercise physical activity in everyday life. Thus, if the inactivity physiology paradigm is proven to be true, the dire concern for the future may rest with growing numbers of people unaware of the potential insidious dangers of sitting too much and who are not taking advantage of the benefits of maintaining nonexercise activity throughout much of the day.
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In Western cultures, the most common acquired causes of insulin resistance are obesity, sedentary lifestyle, and aging, and these factors are interrelated.
“In Western cultures, the most common acquired factors causing insulin resistance are obe-sity, sedentary lifestyle, and aging, all of which are interrelated (2,3,8).”
From Insulin sensitivity: Modulation by nutrients and inflammation (2008) · cites this paper as [8]
The physiological effects of sedentary and non-exercise light activities that adults do most of the day are not well understood.
“the potential physiological effects of the types of activities that most adults engage in during the vast majority of their day, namely sedentary (sitting) and non-exercise light activities (standing, walking), are not well understood.(Hamilton, Hamilton, and Zderic 2007)”
From Successful aging: Advancing the science of physical independence in older adults (2015) · cites this paper as Hamilton, Hamilton, and Zderic 2007
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“12 20 For example, in a recent study of almost one-quarter million US older adults (50 – 71 years) free from cardiovascular disease and cancer, more time spent on TV viewing was associated with higher all-cause mortality rates, regardless of physical activity level.”
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- Authors
- Hamilton, M. T., Hamilton, D. G., & Zderic, T. W.
- Affiliations
- University of Missouri (US)
- ORCID
- Hamilton, Marc T.
- Venue
- Diabetes
- Publisher
- American Diabetes Association
- Published
- 2007-11-01
- Volume
- 56
- Issue
- 11
- Pages
- 2655-2667
- ISSN
- 0012-1797 (ISSN-L)
- 1939-327X
- OpenAlex
- W2162523749
- Cited by
- 1,655
- References
- 98
- Citations by year
- 2026: 34 · 2025: 52 · 2024: 58 · 2023: 49 · 2022: 58 · 2021: 76 · 2020: 83 · 2019: 82 · 2018: 121 · 2017: 103 · 2016: 111 · 2015: 133 · 2014: 153 · 2013: 127 · 2012: 121
- FWCI
- 6.16
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- National Heart, Lung, and Blood Institute (HL-70482, HL-52490, P01HL052490, F32HL070482)
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Epidemiology › Adipokines, Inflammation, and Metabolic Diseases
- Keywords
- sedentary behavior, sitting time, obesity, metabolic syndrome, type 2 diabetes, cardiovascular disease, mortality, lipoprotein lipase, skeletal muscle, exercise physiology, intermittent exercise
- MeSH terms
- Cardiovascular Diseases, Diabetes Mellitus, Type 2, Energy Metabolism, Female, Humans, Life Style, Male, Middle Aged, Motor Activity, Posture, Public Health, Exercise, Metabolic Syndrome
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.
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.
What counts as a claim ›How we measure confidence ›How we check this ›
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