Review and special article
Sedentary Behaviors and Health Outcomes Among Adults: A Systematic Review of Prospective Studies

https://doi.org/10.1016/j.amepre.2010.10.015Get rights and content

Context

Nowadays, people spend a substantial amount of time per day on sedentary behaviors and it is likely that the time spent sedentary will continue to rise. To date, there is no review of prospective studies that systematically examined the relationship between diverse sedentary behaviors and various health outcomes among adults.

Purpose

This review aimed to systematically review the literature as to the relationship between sedentary behaviors and health outcomes considering the methodologic quality of the studies.

Evidence acquisition

In February 2010, a search for prospective studies was performed in diverse electronic databases. After inclusion, in 2010, the methodologic quality of each study was assessed. A best-evidence synthesis was applied to draw conclusions.

Evidence synthesis

19 studies were included, of which 14 were of high methodologic quality. Based on inconsistency in findings among the studies and lack of high-quality prospective studies, insufficient evidence was concluded for body weight–related measures, CVD risk, and endometrial cancer. Further, moderate evidence for a positive relationship between the time spent sitting and the risk for type 2 diabetes was concluded. Based on three high-quality studies, there was no evidence for a relationship between sedentary behavior and mortality from cancer, but strong evidence for all-cause and CVD mortality.

Conclusions

Given the trend toward increased time in sedentary behaviors, additional prospective studies of high methodologic quality are recommended to clarify the causal relationships between sedentary behavior and health outcomes. Meanwhile, evidence to date suggests that interventions aimed at reducing sedentary behavior are needed.

Section snippets

Context

Sedentary behavior is a different construct than physical (in)activity, with both behaviors having different determinants.1 In an editorial2 of this journal, in 2007, Biddle made clear that the study of sedentary behavior was becoming popular and he encouraged to perform more research on sedentary behavior. In order to distinguish between light-intensity activities and sedentary behavior, in 2008, Pate and colleagues3 provided a definition of sedentary behavior. Following that definition,

Identification and Selection of the Literature

A literature search was conducted in several electronic bibliographic databases, namely, PubMed, Embase, PsycINFO, and the Cochrane Library. The keywords used referred to the exposure (sedentary behavior); outcome (health-related); and study design (longitudinal designs). English written publications published between 1989 and February 25, 2010, were applied as a limit. As a systematic review to the relationship between sedentary behaviors and health among children and adolescents was performed

Search and Selection

The search resulted in a total of 10,555 records (4994 from PubMed, 4564 from Embase, 457 from PsycINFO, and 540 from Cochrane Library). After removing the duplicate publications, a total of 8424 publications remained. After screening the titles and abstracts, 137 full papers were read. Of those, most were excluded because the study applied a cross-sectional design or the study applied a definition of sedentary behavior that did not meet the criterion. Finally, 19 prospective studies were

Discussion

The present review aimed to systematically summarize the literature with regard to the relationship between sedentary behavior and health outcomes, taking into account the methodologic quality of the studies. Despite the start date of the literature being 1989, the majority (12 of 19) of the studies included were published after 2005. This indicates that the topic of sedentary behavior as a probable independent predictor for certain health outcomes has recently gained increased attention in the

Conclusion

This review of prospective studies showed moderate evidence for an independent relationship between sedentary time and type 2 diabetes. In addition, strong evidence was found for sedentary behavior to be related to all-cause and CVD mortality, but not for mortality from cancer. Because of mixed results and the lack of prospective studies, there was insufficient evidence for a relationship between sedentary time and weight outcomes and CVD risk factors. Given the increasing modern technology

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