Relationship Between Sedentary Behavior and Cardiovascular Risk

  • Robert V. Same
  • David I. Feldman
  • Nishant Shah
  • Seth S. Martin
  • Mahmoud Al Rifai
  • Michael J. Blaha
  • Garth Graham
  • Haitham M. AhmedEmail author
Lipid Abnormalities and Cardiovascular Prevention (G De Backer, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Lipid Abnormalities and Cardiovascular Prevention


The majority of adults do not meet current guideline recommendations for moderate to vigorous physical activity. Recent research has linked a high amount of sedentary behavior with an increased risk of obesity, diabetes, the metabolic syndrome, cardiovascular disease, and death. This correlation with sedentary behavior even extends to individuals who meet recommended physical activity goals during the remainder of their day, which implies that sedentary behavior may represent a distinct cardiovascular risk factor that is independent of the overall amount of physical activity. During the past several years, there has been significant interest in identifying and understanding the mechanisms through which sedentary behavior affects cardiovascular health. In this review, we critically evaluate the literature pertaining to sedentary behavior and cardiovascular risk with an emphasis on studies published over the past year, and we suggest possible interventions that may help reduce sedentary behavior time.


Sedentary behavior Cardiovascular risk Physical activity Lifestyle mHealth 


Compliance with Ethical Standards

Conflict of Interest

Robert V. Same, David I. Feldman, Nishant Shah, Mahmoud Al Rifai, and Haitham M. Ahmed declare that they have no conflicts of interest.

Michael J. Blaha is employed by the FDA (SGE for EDMAC), has received grant support from the FDA/NHLBI, the AHA, and the Aetna Foundation, and has received honoraria from Pfizer and Luitpold Pharmaceuticals.

Seth S. Martin received grant support from the Aetna Foundation for mHealth and Physical Activity.

Garth Graham is employed by the Aetna Foundation.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Sedentary Behaviour Research Network. Letter to the editor: standardized use of the terms “sedentary” and “sedentary behaviours. Appl Physiol Nutr Metab. 2012;37:540–2.PubMedCrossRefGoogle Scholar
  2. 2.
    Owen N, Sparling PB, Healy GN, Dunstan DW, Matthews CE. Sedentary behavior: emerging evidence for a new health risk. Mayo Clin Proc. 2010;85(12):1138–41.PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Pate RR, O’Neill JR, Lobelo F. The evolving definition of “sedentary”. Exerc Sport Sci Rev. 2008;36(4):173–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Tremblay MS, Colley RC, Saunders TJ, Healy GN, Owen N. Physiological and health implications of a sedentary lifestyle. Appl Physiol Nutr Metab. 2010;35(6):725–40.PubMedCrossRefGoogle Scholar
  5. 5.
    Church TS, Martin CK, Thompson AM, Earnest CP, Mikus CR, Blair SN. Changes in weight, waist circumference and compensatory responses with different doses of exercise among sedentary, overweight postmenopausal women. PLoS One. 2009;4(2):e4515.PubMedPubMedCentralCrossRefGoogle Scholar
  6. 6.
    Melanson EL, Gozansky WS, Barry DW, Maclean PS, Grunwald GK, Hill JO. When energy balance is maintained, exercise does not induce negative fat balance in lean sedentary, obese sedentary, or lean endurance-trained individuals. J Appl Physiol. 2009;107(6):1847–56.PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Mullen SP, Olson EA, Phillips SM, Szabo AN, Wójcicki TR, Mailey EL, et al. Measuring enjoyment of physical activity in older adults: invariance of the physical activity enjoyment scale (paces) across groups and time. Int J Behav Nutr Phys Act. 2011;8:103.PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Sims ST, Larson JC, Lamonte MJ, Michael YL, Martin LW, Johnson KC, et al. Physical activity and body mass: changes in younger versus older postmenopausal women. Med Sci Sports Exerc. 2012;44(1):89–97.PubMedCrossRefGoogle Scholar
  9. 9.
    Smith AE, Lockwood CM, Moon JR, Kendall KL, Fukuda DH, Tobkin SE, et al. Physiological effects of caffeine, epigallocatechin-3-gallate, and exercise in overweight and obese women. Appl Physiol Nutr Metab. 2010;35(5):607–16.PubMedCrossRefGoogle Scholar
  10. 10.
    Canadian Physical Activity, and Sedentary Behaviour Guidelines. Canadian Society for Exercise Physiology (n.d.): n. pag. Canadian Sedentary Behavior Guidelines. Canadian Society for Exercise Physiology, 2012. Web. 20 Nov. 2015<>.Google Scholar
  11. 11.
    “Australia’s Physical Activity and Sedentary Behaviour Guidelines” Australian Government 10 Department of Health. N.p., 10 July 2014. Web. 21 Nov. 2015.
  12. 12.••
    Biswas A, Oh PI, Faulkner GE, Bajaj RR, Silver MA, Mitchell MS, et al. Sedentary time and its association with risk for disease incidence, mortality, and hospitalization in adults: a systematic review and meta-analysis. Ann Intern Med. 2015;162(2):123–32. Meta-analysis highlights significant association of sedentary behavior and CVD events/mortality. Results were attenuated by higher levels of physical activity.PubMedCrossRefGoogle Scholar
  13. 13.
    Dunstan DW, Barr EL, Healy GN, Salmon J, Shaw JE, Balkau B, et al. Television viewing time and mortality: the Australian Diabetes, Obesity and Lifestyle Study (AusDiab). Circulation. 2010;121(3):384–91.PubMedCrossRefGoogle Scholar
  14. 14.
    Grøntved A, Hu FB. Television viewing and risk of type 2 diabetes, cardiovascular disease, and all-cause mortality: a meta-analysis. JAMA. 2011;305(23):2448–55.PubMedPubMedCentralCrossRefGoogle Scholar
  15. 15.
    Katzmarzyk PT, Church TS, Craig CL, Bouchard C. Sitting time and mortality from all causes, cardiovascular disease, and cancer. Med Sci Sports Exerc. 2009;41(5):998–1005.PubMedCrossRefGoogle Scholar
  16. 16.
    Thorp AA, Owen N, Neuhaus M, Dunstan DW. Sedentary behaviors and subsequent health outcomes in adults a systematic review of longitudinal studies, 1996–2011. Am J Prev Med. 2011;41(2):207–15.PubMedCrossRefGoogle Scholar
  17. 17.
    Wijndaele K, Brage S, Besson H, Khaw KT, Sharp SJ, Luben R, et al. Television viewing time independently predicts all-cause and cardiovascular mortality: the EPIC Norfolk study. Int J Epidemiol. 2011;40(1):150–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Healy GN, Matthews CE, Dunstan DW, Winkler EA, Owen N. Sedentary time and cardio-metabolic biomarkers in US adults: NHANES 2003–06. Eur Heart J. 2011;32(5):590–7.PubMedPubMedCentralCrossRefGoogle Scholar
  19. 19.
    Cohen SS, Matthews CE, Signorello LB, Schlundt DG, Blot WJ, et al. Sedentary and physically active behavior patterns among low-income African-American and White adults living in the southeastern United States. PLoS ONE. 2013;8(4):e59975. doi: 10.1371/journal.pone.0059975.PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Matthews CE, Chen KY, Freedson PS, Buchowski MS, Beech BM, Pate RR, et al. Amount of time spent in sedentary behaviors in the United States, 2003–2004. Am J Epidemiol. 2008;167(7):875–81. doi: 10.1093/aje/kwm390.PubMedPubMedCentralCrossRefGoogle Scholar
  21. 21.
    Stamatakis E, Hamer M, Dunstan DW. 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. 2011;57:292–9.PubMedCrossRefGoogle Scholar
  22. 22.••
    Chomistek AK, Manson JE, Stefanick ML, Lu B, Sands-Lincoln M, Going SB, et al. Relationship of sedentary behavior and physical activity to incident cardiovascular disease: results from the Women’s Health Initiative. J Am Coll Cardiol. 2013;61:2346–54. Prolonged sedentary time is associated with increased CVD risk among a large heterogeneous population.PubMedPubMedCentralCrossRefGoogle Scholar
  23. 23.
    Matthews CE, George SM, Moore SC, Bowles HR, Blair A, Park Y, et al. Amount of time spent in sedentary behaviors and cause-specific mortality in US adults. Am J Clin Nutr. 2012;95:437–45.PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    Kim Y, Wilkens LR, Park SY, Doodman MT, Monroe KR, Kolonel LN. Association between various sedentary behaviours and all-cause, cardiovascular disease and cancer mortality: the Multiethnic Cohort Study. Int J Epidemiol. 2013;42:1040–56.PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.••
    Seguin R, Buchner DM, Liu J, Allison M, Manini T, Wang CY, et al. Sedentary behavior and mortality in older women: the Women’s Health Initiative. Am J Prev Med. 2014;46(2):122–35. Analysis of older women from the Women’s Health Initiative found a linear relationship between sedentary time and mortality risk.PubMedPubMedCentralCrossRefGoogle Scholar
  26. 26.
    de Rezende LF, Rodriguez Lopes M, Rey-Lopez JP, Matsudo VK, Luiz OC. Sedentary behavior and health outcomes: an overview of systematic reviews. PLoS One. 2014;9(8):e105620.PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    van Uffelen JGZ, Wong J, Chau JY, van der Ploeg HP, Riphagen I, et al. Occupational sitting and health risks: a systematic review. Am J Prev Med. 2010;39:379–88.PubMedCrossRefGoogle Scholar
  28. 28.
    Ford ES, Caspersen CJ. Sedentary behaviour and cardiovascular disease: a review of prospective studies. Int J Epidemiol. 2012;41:1338–53.PubMedPubMedCentralCrossRefGoogle Scholar
  29. 29.••
    Wilmot EG, Edwardson CL, Achana FA, Davies MJ, Gorely T, Gray LJ, et al. Sedentary time in adults and the association with diabetes, cardiovascular disease and death: systematic review and meta-analysis. Diabetologia. 2012;55(11):2895–905. Meta-analysis including nearly 800,000 participants, which found associations between increased sedentary time and diabetes, cardiovascular disease, and all-cause mortality.PubMedCrossRefGoogle Scholar
  30. 30.
    Bey L, Hamilton MT. Suppression of skeletal muscle lipoprotein lipase activity during physical inactivity: a molecular reason to maintain daily low-intensity activity. J Physiol. 2003;551(Pt 2):673–82.PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.•
    Brocklebank LA, Falconer CL, Page AS, Perry R, Cooper AR. Accelerometer-measured sedentary time and cardiometabolic biomarkers: a systematic review. Prev Med. 2015;76:92–102. A large systematic review of accelerometer-measured sedentary time found significant associations of sedentary behavior with increased triglyceride levels and poor insulin sensitivity.PubMedCrossRefGoogle Scholar
  32. 32.
    Seider MJ, Nicholson WF, Booth FW. Insulin resistance for glucose metabolism in disused soleus muscle of mice. Am J Physiol. 1982;242(1):E12–8.PubMedGoogle Scholar
  33. 33.
    Hamburg NM, McMackin CJ, Huang AL, Shenouda SM, Widlansky ME, Schulz E, et al. Physical inactivity rapidly induces insulin resistance and microvascular dysfunction in healthy volunteers. Arterioscler Thromb Vasc Biol. 2007;27(12):2650–6.PubMedPubMedCentralCrossRefGoogle Scholar
  34. 34.
    Alibegovic AC, Sonne MP, Højbjerre L, Hansen T, Pedersen O, van Hall G, et al. The T-allele of TCF7L2 rs7903146 associates with a reduced compensation of insulin secretion for insulin resistance induced by 9 days of bed rest. Diabetes. 2010;59(4):836–43.PubMedPubMedCentralCrossRefGoogle Scholar
  35. 35.
    Gennuso KP, Gangnon RE, Thraen-Borowski KM, Colbert LH. Dose–response relationships between sedentary behaviour and the metabolic syndrome and its components. Diabetologia. 2015;58(3):485–92.PubMedCrossRefGoogle Scholar
  36. 36.
    Healy GN, Winkler EA, Owen N, Anuradha S, Dunstan DW. Replacing sitting time with standing or stepping: associations with cardio-metabolic risk biomarkers. Eur Heart J. 2015;36(39):2643–9. doi: 10.1093/eurheartj/ehv308.PubMedCrossRefGoogle Scholar
  37. 37.
    Hamer M, Stamatakis E, Steptoe A. Effects of substituting sedentary time with physical activity on metabolic risk. Med Sci Sports Exerc. 2014;46(10):1946–50.PubMedPubMedCentralCrossRefGoogle Scholar
  38. 38.•
    Buman MP, Winkler EA, Kurka JM, Hekler EB, Baldwin CM, Owen N, et al. Reallocating time to sleep, sedentary behaviors, or active behaviors: associations with cardiovascular disease risk biomarkers, NHANES 2005–2006. Am J Epidemiol. 2014;179(3):323–34. Beneficial effects of replacing sedentary time with sleep, light activity, or moderate-to-vigorous physical activity improve CVD risk profile.PubMedCrossRefGoogle Scholar
  39. 39.
    Patel AV, Bernstein L, Deka A, et al. Leisure time spent sitting in relation to total mortality in a prospective cohort of US adults. Am J Epidemiol. 2010;172:419–29.PubMedPubMedCentralCrossRefGoogle Scholar
  40. 40.
    Warren TY, Barry V, Hooker SP, et al. Sedentary behaviors increase risk of cardiovascular disease mortality in men. Med Sci Sports Exerc. 2010;42:879–85.PubMedPubMedCentralCrossRefGoogle Scholar
  41. 41.
    Healy GN, Dunstan DW, Salmon J, et al. Breaks in sedentary time: beneficial associations with metabolic risk. Diabetes Care. 2008;31:661–6.PubMedCrossRefGoogle Scholar
  42. 42.
    Bergouignan A, Rudwill F, Simon, et al. Physical inactivity as the culprit of metabolic inflexibility: evidence from bed-rest studies. J Appl Physiol. 2012;111(4):1201–10.CrossRefGoogle Scholar
  43. 43.
    Dunstan DW, Kingwell BA, Larsen R, et al. Breaking up prolonged sitting reduces postprandial glucose and insulin responses. Diabetes Care. 2012;35(5):976–83.PubMedPubMedCentralCrossRefGoogle Scholar
  44. 44.
    Hamilton MT, Hamilton DG, Zderic, et al. Role of low energy expenditure and sitting in obesity, metabolic syndrome, type 2 diabetes, and cardiovascular disease. Diabetes. 2007;56(11):2655–67.PubMedCrossRefGoogle Scholar
  45. 45.
    Saunders TJ, Larouche R, Colley RC, Tremblay MS. Acute sedentary behavior and markers of cardiometabolic risk: a systematic review of intervention studies. J Nutr Metab. 2012;2012:712435.PubMedPubMedCentralGoogle Scholar
  46. 46.
    Carson V, Wong SL, Winkler E, et al. Patterns of sedentary time and cardiometabolic risk among Canadian adults. Prev Med. 2014;65:23–7.PubMedCrossRefGoogle Scholar
  47. 47.
    Martin A, Fitzsimons C, Jepson R, Saunders DH, van der Ploeg HP, Teixeria PJ, et al. Interventions with potential to reduce sedentary time in adults: systematic review and meta-analysis. Br J Sports Med. 2014. doi: 10.1136/bjsports-2014-094524.Google Scholar
  48. 48.
    Knight E, Stuckey MI, Petrella RJ. Health promotion through primary care: enhancing self-management with activity prescription and mHealth. Phys Sportmed. 2014;42(3):90–9.CrossRefGoogle Scholar
  49. 49.
    Impact of the Built Environment on Health (2011) Retrieved 14 June 2015 from
  50. 50.•
    Neuhaus M, Eakin EG, Straker L, Owen N, Dunstan DW, Reid N, et al. Reducing occupational sedentary time: a systematic review and meta-analysis of evidence on activity-permissive workstations. Obes Rev. 2014;15(10):822–38. This study showed a proof of concept that changing factors in an individual’s workplace environment can help reduce sedentary time.PubMedCrossRefGoogle Scholar
  51. 51.
    Clark BK, Sugiyama T, Healy GN, et al. Validity and reliability of measures of television viewing time and other nonoccupational sedentary behaviour of adults: a review. Obes Rev. 2009;10:7–16.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Robert V. Same
    • 1
  • David I. Feldman
    • 1
  • Nishant Shah
    • 1
  • Seth S. Martin
    • 1
  • Mahmoud Al Rifai
    • 1
  • Michael J. Blaha
    • 1
  • Garth Graham
    • 2
    • 3
  • Haitham M. Ahmed
    • 1
    Email author
  1. 1.Johns Hopkins Ciccarone Center for the Prevention of Heart DiseaseBaltimoreUSA
  2. 2.Aetna FoundationHartfordUSA
  3. 3.University of Connecticut School of MedicineFarmingtonUSA

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