Managing Sedentary Behavior to Reduce the Risk of Diabetes and Cardiovascular Disease
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Modern human environments are vastly different from those of our forebears. Rapidly advancing technology in transportation, communications, workplaces, and home entertainment confer a wealth of benefits, but increasingly come with costs to human health. Sedentary behavior—too much sitting as distinct from too little physical activity—contributes adversely to cardiometabolic health outcomes and premature mortality. Findings from observational epidemiology have been synthesized in meta-analyses, and evidence is now shifting into the realm of experimental trials with the aim of identifying novel mechanisms and potential causal relationships. We discuss recent observational and experimental evidence that makes a compelling case for reducing and breaking up prolonged sitting time in both the primary prevention and disease management contexts. We also highlight future research needs, the opportunities for developing targeted interventions, and the potential of population-wide initiatives designed to address too much sitting as a health risk.
KeywordsSitting time Sedentary behavior Breaks in sedentary time TV viewing time Physical activity Physical inactivity Type 2 diabetes Cardiovascular disease Cardiometabolic risk Mortality
Neville Owen receives grant support from the National Health and Medical Research Council of Australia. David W. Dunstan receives competitive research grants from National Health and Medical Research Council, Australian Research Council, and Heart Foundation of Australia.
Compliance with Ethics Guidelines
Conflict of Interest
Paddy C. Dempsey declares that he has no conflict of interest. Neville Owen receives book royalties from Sage Publishers; and has received travel/accommodations expenses covered or reimbursed from the University of British Columbia; American Institute for Cancer Research. Stuart J. H. Biddle is a consultant to Weight Watchers on physical activity and sedentary behavior. David W. Dunstan receives royalties from Fitness Australia. He has received travel/accommodations expenses covered or reimbursed from Ergotron Pty Ltd.
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.Diabetes Atlas. 6th ed: International Diabetes Federation; 2013.Google Scholar
- 2.Global status report on noncommunicable diseases. Geneva: World Health Organization 2011; 2010.Google Scholar
- 4.•Lee IM, Shiroma EJ, Lobelo F, et al. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet. 2012;380:219–29. A recent summary of the epidemiologic evidence for physical inactivity and health using a burden of disease approach. An estimated 9% of premature mortality across the world was attributed to physical inactivity (not meeting MVPA physical activity recommendations). These estimates were similar to smoking, and larger than estimates attributed to obesity.PubMedCentralPubMedCrossRefGoogle Scholar
- 5.Sedentary Behaviour Research N. Letter to the editor: standardized use of the terms “sedentary” and “sedentary behaviors”. Appl Physiol Nutr Metab. 2012;37:540–2.Google Scholar
- 7.Katzmarzyk PT, Lee IM. Sedentary behaviour and life expectancy in the USA: a cause-deleted life table analysis. BMJ Open. 2012;2.Google Scholar
- 15.••Healy GN, Wijndaele K, Dunstan DW, et al. Objectively measured sedentary time, physical activity, and metabolic risk: the Australian Diabetes, Obesity and Lifestyle Study (AusDiab). Diabetes Care. 2008;31:369–71. Cross-sectional analysis of 169 adults from the AusDiab study, in which accelerometers were used to derive sedentary and physical activity time. Significant associations of sedentary time, light-intensity time, and mean activity intensity with waist circumference and clustered metabolic risk were shown, independent of MVPA.PubMedCrossRefGoogle Scholar
- 20.•Healy GN, Matthews CE, Dunstan DW, et al. Sedentary time and cardio-metabolic biomarkers in US adults: NHANES 2003-06. Eur Heart J. 2011;32:590–7. Cross-sectional analysis of 4757 adults from the 2003–2004 and 2005–2006 US NHANES, in which accelerometers were used to derive sedentary and physical activity time. Independent of potential confounders, including moderate-to-vigorous physical activity, detrimental associations of sedentary time with waist circumference, HDL cholesterol, C-reactive protein, triglycerides, insulin, Homeostasis Model Assessment (HOMA)-%B, and HOMA-%S were observed. Independent of potential confounders and sedentary time, breaks were beneficially associated with waist circumference and C-reactive protein.PubMedCentralPubMedCrossRefGoogle Scholar
- 34.••Chau JY, Grunseit AC, Chey T, et al. Daily sitting time and all-cause mortality: a meta-analysis. PLoS One. 2013;8:e80000. This is the first meta-analysis of dose-response relationships between total daily sitting time and mortality risk. The association between sitting and all-cause mortality were found to be nonlinear—such that people with high sitting time (>7 hours/day) have even higher risk of death (hazard ratio 5% vs 2%).PubMedCentralPubMedCrossRefGoogle Scholar
- 35.••Healy GN, Dunstan DW, Salmon J, et al. Breaks in sedentary time: beneficial associations with metabolic risk. Diabetes Care. 2008;31:661–6. This cross-sectional study showed that, independent of total sedentary time and moderate-to-vigorous-intensity activity time, increased breaks in sedentary time were beneficially associated with waist circumference, body mass index, triglycerides, and 2-hour plasma glucose.PubMedCrossRefGoogle Scholar
- 36.•Saunders TJ, Larouche R, Colley RC, et al. Acute sedentary behaviour and markers of cardiometabolic risk: a systematic review of intervention Studies. J Nutr Metab. 2012;2012:712435. This systematic review concluded that (acute) uninterrupted sedentary behavior results in rapid and deleterious changes in insulin sensitivity, glucose tolerance, and lipid levels in adults. While there was a paucity of studies looking at sitting per se, the authors identify important areas for future research.PubMedCentralPubMedGoogle Scholar
- 37.••Dunstan DW, Kingwell BA, Larsen R, et al. Breaking up prolonged sitting reduces postprandial glucose and insulin responses. Diabetes Care. 2012;35:976–83. This randomized crossover trial assessed the effect of breaking up 5 hours of prolonged unbroken sitting with intermittent bouts of light and moderate treadmill walking (2 minutes every 20 minutes) in overweight/obese inactive participants. The study showed similar reductions in postprandial glucose and insulin ‘area under the curve’ with both types of activity ‘break’ compared with prolonged sitting.PubMedCentralPubMedCrossRefGoogle Scholar
- 41.Duvivier BM, Schaper NC, Bremers MA, et al. Minimal intensity physical activity (standing and walking) of longer duration improves insulin action and plasma lipids more than shorter periods of moderate to vigorous exercise (cycling) in sedentary subjects when energy expenditure is comparable. PLoS One. 2013;8:e55542.PubMedCentralPubMedCrossRefGoogle Scholar
- 42.•Holmstrup M, Fairchild T, Keslacy S, et al. Multiple short bouts of exercise over 12-h period reduce glucose excursions more than an energy-matched single bout of exercise. Metabolism. 2014;63:510–9. This was a small but well-controlled randomized crossover study of 12 hours duration in obese participants, using high frequency blood sampling. Hourly 5-minute bouts of exercise were compared with an energy-matched single (1 hour) session of exercise. The 5-minute bouts were more effective in reducing postprandial glucose excursions and insulin concentrations compared with the longer duration (beyond daily physical activity recommendations) exercise bout.PubMedCrossRefGoogle Scholar
- 44.••Peddie MC, Bone JL, Rehrer NJ, et al. Breaking prolonged sitting reduces postprandial glycemia in healthy, normal-weight adults: a randomized crossover trial. Am J Clin Nutr. 2013;98:358–66. This large randomized crossover trial investigated the effect of breaking up 9 hours of prolonged unbroken sitting with intermittent bouts of treadmill walking (1:40 minute every 30 minutes) vs a single 30-minute bout of walking in 70 normal-weight adults. Interestingly, regular activity bouts were more effective at reducing postprandial glucose and insulin than was a single continuous bout of physical activity.PubMedCrossRefGoogle Scholar
- 45.Thorp AA, Kingwell BA, Sethi P, et al. Alternating bouts of sitting and standing attenuates postprandial glucose responses. Med Sci Sports Exerc. 2014; [In press].Google Scholar
- 63.•Bergouignan A, Rudwill F, Simon C, et al. Physical inactivity as the culprit of metabolic inflexibility: evidence from bed-rest studies. J Appl Physiol. 2011;111:1201–10. This review summarizes the data over the last 60 years on the metabolic adaptations to bed rest in healthy participants. The authors assert that physical inactivity may promote the concomitant development of insulin resistance, impairments in lipid trafficking, alterations in substrate utilization, and increased deposition of intracellular lipid. They also postulate that sedentary behaviors may promote metabolic inflexibility—a hypothesis of great relevance to metabolic disorders such as obesity and T2D.PubMedCrossRefGoogle Scholar
- 66.•Sonne MP, Alibegovic AC, Hojbjerre L, et al. Effect of 10 days of bedrest on metabolic and vascular insulin action: a study in individuals at risk for type 2 diabetes. J Appl Physiol. 2010;108:830–7. This study interestingly tested whether the offspring of T2D parents have different changes in metabolic and vascular insulin action following bed rest compared with controls.PubMedCrossRefGoogle Scholar
- 67.Brown WJ, Bauman AE, Bull FC, et al. Development of Evidence-based physical activity recommendations for adults (18-64 years). Report prepared for the Australian Government Department of Health. 2012.Google Scholar
- 68.The Sedentary Behaviour & Obesity Expert Working Group. Sedentary Behaviour and Obesity: Review of the Current Scientific Evidence. London: Department of Health; 2010.Google Scholar
- 77.Ebrahim S, Taylor F, Ward K, et al. Multiple risk factor interventions for primary prevention of coronary heart disease. Cochrane Database Syst Rev. 2011:CD001561.Google Scholar
- 87.Pronk NP, Katz AS, Lowry M, et al. Reducing occupational sitting time and improving worker health: the Take-a-Stand Project, 2011. Prev Chron Dis. 2012;9:E154.Google Scholar
- 89.Healy GN, Eakin EG, Lamontagne AD, et al. Reducing sitting time in office workers: short-term efficacy of a multicomponent intervention. Prev Med. 2013.Google Scholar