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Impact of sedentary behavior on large artery structure and function in children and adolescents: a systematic review

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Abstract

Sedentary behavior contributes to increased atherosclerotic risk in adults. Whether or not this can be extended to pediatric populations is unclear. This systematic review assessed associations of sedentary behavior with large artery structure and function in pediatric populations. MEDLINE, EMBASE, CENTRAL, and Web of Science were searched from the earliest available date to 31st of December 2018. Analyses of associations of sedentary behavior with large artery structure or function in a pediatric (sub-)population were included, adhering to the PRISMA guidelines. The protocol was published in advance on PROSPERO (CRD42018112996). Study quality and quality of evidence were analyzed using NHLBI Study Quality assessment tools and GRADE. Six observational studies found no association of exposure and outcome variables, and one had contradicting results. One intervention found reduced flow-mediated dilation after 3 h of uninterrupted sitting. Exposure and outcome measures were highly heterogeneous. Study quality was low to moderate. Quality of evidence was very low or low in the observational studies and high in the intervention.

Conclusion: In pediatric populations, current evidence is limited and of low quality about how acute effects of sedentary behavior translate into early vascular aging and the long-term development of vascular dysfunction and atherosclerotic risk. Future studies should emphasize a careful choice of the adequate type and measurement site of a biomarker for large artery structure and function as well as conduct a detailed assessment of sedentary behavior patterns.

Trial registration: PROSPERO Registration Number: CRD42018112996

What is known:

• An independent association of sedentary behavior and biomarkers of large artery structure and function has been demonstrated in adults.

• In children, sedentary behavior is directly associated with classical cardiovascular risk factors like elevated blood glucose levels, insulin resistance, high blood pressure, obesity, and elevated blood lipids.

What is new:

• Currently, only few studies of low quality in children and adolescents provide limited evidence about how acute effects of sedentary behavior translate into early vascular aging and the long-term development of atherosclerosis.

• The type and measurement site of vascular biomarker need to be chosen carefully, and a detailed assessment of sedentary behavior patterns is important to minimize the methodological bias.

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Abbreviations

BMI:

Body mass index

baPWV:

Brachial-ankle pulse wave velocity

cIMT:

Carotid intima-media thickness

FMD:

Flow-mediated dilation

PWV:

Pulse wave velocity

References

  1. Ascenso A, Palmeira A, Pedro LM, Martins S, Fonseca H (2016) Physical activity and cardiorespiratory fitness, but not sedentary behavior, are associated with carotid intima-media thickness in obese adolescents. Eur J Pediatr 175:391–398. https://doi.org/10.1007/s00431-015-2654-x

    Article  PubMed  Google Scholar 

  2. Balshem H, Helfand M, Schunemann HJ, Oxman AD, Kunz R, Brozek J, Vist GE, Falck-Ytter Y, Meerpohl J, Norris S, Guyatt GH (2011) GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol 64:401–406. https://doi.org/10.1016/j.jclinepi.2010.07.015

    Article  PubMed  Google Scholar 

  3. Biswas A, Oh PI, Faulkner GE, Bajaj RR, Silver MA, Mitchell MS, Alter DA (2015) Sedentary time and its association with risk for disease incidence, mortality, and hospitalization in adults: a systematic review and meta-analysis. Ann Intern Med 162:123–132. https://doi.org/10.7326/M14-1651

    Article  PubMed  Google Scholar 

  4. Bleeker MW, De Groot PC, Rongen GA, Rittweger J, Felsenberg D, Smits P (1985) Hopman MT (2005) Vascular adaptation to deconditioning and the effect of an exercise countermeasure: results of the Berlin Bed Rest study. J Appl Physiol 99:1293–1300. https://doi.org/10.1152/japplphysiol.00118.2005

    Article  Google Scholar 

  5. Bleeker MW, De Groot PC, Poelkens F, Rongen GA, Smits P, Hopman MT (2005) Vascular adaptation to 4 wk of deconditioning by unilateral lower limb suspension. Am J Physiol Heart Circ Physiol 288:H1747–H1755. https://doi.org/10.1152/ajpheart.00966.2004

    Article  CAS  PubMed  Google Scholar 

  6. Boddy LM, Murphy MH, Cunningham C, Breslin G, Foweather L, Gobbi R, Graves LE, Hopkins ND, Auth MK, Stratton G (2014) Physical activity, cardiorespiratory fitness, and clustered cardiometabolic risk in 10- to 12-year-old school children: the REACH Y6 study. Am J Hum Biol 26:446–451. https://doi.org/10.1002/ajhb.22537

    Article  PubMed  Google Scholar 

  7. Bohn L, Ramoa A, Silva G, Silva N, Abreu SM, Ribeiro F, Boutouyrie P, Laurent S, Oliveira J (2017) Sedentary behavior and arterial stiffness in adults with and without metabolic syndrome. Int J Sports Med 38:396–401. https://doi.org/10.1055/s-0043-101676

    Article  PubMed  Google Scholar 

  8. Bonnin P, Ben Driss A, Benessiano J, Maillet A, Pavy le Traon A, Levy BI (2001) Enhanced flow-dependent vasodilatation after bed rest, a possible mechanism for orthostatic intolerance in humans. Eur J Appl Physiol 85:420–426. https://doi.org/10.1007/s004210100483

    Article  CAS  PubMed  Google Scholar 

  9. da Costa BGG, da Silva KS, Malheiros LEA, Minatto G, de Lima LRA, Petroski EL (2018) Are adolescents really being sedentary or inactive when at school? An analysis of sedentary behaviour and physical activity bouts. Eur J Pediatr 177:1705–1710. https://doi.org/10.1007/s00431-018-3233-8

    Article  PubMed  Google Scholar 

  10. de Groot PC, Poelkens F, Kooijman M, Hopman MT (2004) Preserved flow-mediated dilation in the inactive legs of spinal cord-injured individuals. Am J Physiol Heart Circ Physiol 287:H374–H380. https://doi.org/10.1152/ajpheart.00958.2003

    Article  PubMed  Google Scholar 

  11. de Groot P, Crozier J, Rakobowchuk M, Hopman M, MacDonald M (2005) Electrical stimulation alters FMD and arterial compliance in extremely inactive legs. Med Sci Sports Exerc 37:1356–1364

    Article  Google Scholar 

  12. Dratva J, Caviezel S, Schaffner E, Stolz D, Rothe T, Kuenzli N, Schmidt-Trucksass A, Zemp E, Probst-Hensch N (2018) Is there a gender-specific association between asthma and carotid intima media thickness in Swiss adolescents? Eur J Pediatr. https://doi.org/10.1007/s00431-018-3107-0

    Article  Google Scholar 

  13. Dunstan DW, Barr EL, Healy GN, Salmon J, Shaw JE, Balkau B, Magliano DJ, Cameron AJ, Zimmet PZ, Owen N (2010) Television viewing time and mortality: the Australian Diabetes, Obesity and Lifestyle Study (AusDiab). Circ 121:384–391. https://doi.org/10.1161/CIRCULATIONAHA.109.894824

    Article  CAS  Google Scholar 

  14. Ekelund U, Steene-Johannessen J, Brown WJ, Fagerland MW, Owen N, Powell KE, Bauman A, Lee IM, Lancet Physical Activity Series 2 Executive C, Lancet Sedentary Behaviour Working G (2016) Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women. Lancet 388:1302–1310. https://doi.org/10.1016/S0140-6736(16)30370-1

    Article  PubMed  Google Scholar 

  15. Ferreira I, Van De Laar RJ, Prins MH, Twisk JW, Stehouwer CD (2012) Carotid stiffness in young adults: a life-course analysis of its early determinants: The Amsterdam growth and health longitudinal study. Hypertension 59:54–61. https://doi.org/10.1161/HYPERTENSIONAHA.110.156109

    Article  CAS  PubMed  Google Scholar 

  16. Fujiwara H, Nakajima H, Inoue F, Kosaka K, Asano H, Yoshii K (2018) Arterial stiffness in junior high school students: longitudinal observations. Pediatr Int 60:127–135. https://doi.org/10.1111/ped.13475

    Article  PubMed  Google Scholar 

  17. Gimbrone MA Jr, Garcia-Cardena G (2013) Vascular endothelium, hemodynamics, and the pathobiology of atherosclerosis. Cardiovasc Pathol 22:9–15. https://doi.org/10.1016/j.carpath.2012.06.006

    Article  CAS  PubMed  Google Scholar 

  18. Haapala EA, Vaisto J, Veijalainen A, Lintu N, Wiklund P, Westgate K, Ekelund U, Lindi V, Brage S, Lakka TA (2017) Associations of objectively measured physical activity and sedentary time with arterial stiffness in pre-pubertal children. Pediatr Exerc Sci 29:326–335. https://doi.org/10.1123/pes.2016-0168

    Article  PubMed  PubMed Central  Google Scholar 

  19. Hartiala O, Magnussen CG, Kajander S, Knuuti J, Ukkonen H, Saraste A, Rinta-Kiikka I, Kainulainen S, Kahonen M, Hutri-Kahonen N, Laitinen T, Lehtimaki T, Viikari JS, Hartiala J, Juonala M, Raitakari OT (2012) Adolescence risk factors are predictive of coronary artery calcification at middle age: the cardiovascular risk in young Finns study. J Am Coll Cardiol 60:1364–1370. https://doi.org/10.1016/j.jacc.2012.05.045

    Article  PubMed  Google Scholar 

  20. Healy GN, Wijndaele K, Dunstan DW, Shaw JE, Salmon J, Zimmet PZ, Owen N (2008) Objectively measured sedentary time, physical activity, and metabolic risk: the Australian Diabetes, Obesity and Lifestyle Study (AusDiab). Diabetes Care 31:369–371. https://doi.org/10.2337/dc07-1795

    Article  PubMed  Google Scholar 

  21. Herrington W, Lacey B, Sherliker P, Armitage J, Lewington S (2016) Epidemiology of atherosclerosis and the potential to reduce the global burden of atherothrombotic disease. Circ Res 118:535–546. https://doi.org/10.1161/CIRCRESAHA.115.307611

    Article  CAS  PubMed  Google Scholar 

  22. Hopkins N, Stratton G, Ridgers ND, Graves LE, Cable NT, Green DJ (2012) Lack of relationship between sedentary behaviour and vascular function in children. Eur J Appl Physiol 112:617–622. https://doi.org/10.1007/s00421-011-2011-3

    Article  PubMed  Google Scholar 

  23. Huynh QL, Blizzard CL, Sharman JE, Magnussen CG, Dwyer T, Venn AJ (2014) The cross-sectional association of sitting time with carotid artery stiffness in young adults. BMJ Open 4:e004384. https://doi.org/10.1136/bmjopen-2013-004384

    Article  PubMed  PubMed Central  Google Scholar 

  24. Juhola J, Magnussen CG, Berenson GS, Venn A, Burns TL, Sabin MA, Srinivasan SR, Daniels SR, Davis PH, Chen W, Kahonen M, Taittonen L, Urbina E, Viikari JSA, Dwyer T, Raitakari OT, Juonala M (2013) Combined effects of child and adult elevated blood pressure on subclinical atherosclerosis: the International Childhood Cardiovascular Cohort Consortium. Circ 128:217–224. https://doi.org/10.1161/CIRCULATIONAHA.113.001614

    Article  Google Scholar 

  25. Juonala M, Magnussen CG, Venn A, Dwyer T, Burns TL, Davis PH, Chen W, Srinivasan SR, Daniels SR, Kahonen M, Laitinen T, Taittonen L, Berenson GS, Viikari JS, Raitakari OT (2010) Influence of age on associations between childhood risk factors and carotid intima-media thickness in adulthood: the Cardiovascular Risk in Young Finns Study, the Childhood Determinants of Adult Health Study, the Bogalusa Heart Study, and the Muscatine Study for the International Childhood Cardiovascular Cohort (i3C) Consortium. Circ 122:2514–2520. https://doi.org/10.1161/CIRCULATIONAHA.110.966465

    Article  Google Scholar 

  26. Juonala M, Viikari JS, Kahonen M, Taittonen L, Laitinen T, Hutri-Kahonen N, Lehtimaki T, Jula A, Pietikainen M, Jokinen E, Telama R, Rasanen L, Mikkila V, Helenius H, Kivimaki M, Raitakari OT (2010) Life-time risk factors and progression of carotid atherosclerosis in young adults: the Cardiovascular Risk in Young Finns study. Eur Heart J 31:1745–1751

    Article  CAS  Google Scholar 

  27. Katzmarzyk PT, Church TS, Craig CL, Bouchard C (2009) Sitting time and mortality from all causes, cardiovascular disease, and cancer. Med Sci Sports Exerc 41:998–1005. https://doi.org/10.1249/MSS.0b013e3181930355

    Article  PubMed  Google Scholar 

  28. Laughlin MH (1995) Endothelium-mediated control of coronary vascular tone after chronic exercise training. Med Sci Sports Exerc 27:1135–1144

    Article  CAS  Google Scholar 

  29. Magnussen CG, Smith KJ, Juonala M (2013) When to prevent cardiovascular disease? As early as possible: lessons from prospective cohorts beginning in childhood. Curr Opin Cardiol 28:561–568. https://doi.org/10.1097/HCO.0b013e32836428f4

    Article  PubMed  Google Scholar 

  30. McManus AM, Ainslie PN, Green DJ, Simair RG, Smith K, Lewis N (2015) Impact of prolonged sitting on vascular function in young girls. Exp Physiol 100:1379–1387. https://doi.org/10.1113/ep085355

    Article  PubMed  Google Scholar 

  31. Melo X, Santa-Clara H, Pimenta NM, Martins SS, Minderico CS, Fernhall B, Sardinha LB (2015) Intima-media thickness in 11- to 13-year-old children: variation attributed to sedentary behavior, physical activity, cardiorespiratory fitness, and waist circumference. J Phys Act Health 12:610–617. https://doi.org/10.1123/jpah.2013-0501

    Article  PubMed  Google Scholar 

  32. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement. BMJ 339:b2535. https://doi.org/10.1136/bmj.b2535

    Article  PubMed  PubMed Central  Google Scholar 

  33. Nettlefold L, McKay HA, Naylor PJ, Bredin SS, Warburton DE (2012) The relationship between objectively measured physical activity, sedentary time, and vascular health in children. Am J Hypertens 25:914–919. https://doi.org/10.1038/ajh.2012.68

    Article  PubMed  Google Scholar 

  34. Nilsson PM, Boutouyrie P, Laurent S (2009) Vascular aging: a tale of EVA and ADAM in cardiovascular risk assessment and prevention. Hypertension 54:3–10. https://doi.org/10.1161/HYPERTENSIONAHA.109.129114

    Article  CAS  PubMed  Google Scholar 

  35. Ried-Larsen M, Grontved A, Froberg K, Ekelund U, Andersen LB (2013) Physical activity intensity and subclinical atherosclerosis in Danish adolescents: the European Youth Heart Study. Scand J Med Sci Sports 23:e168–e177. https://doi.org/10.1111/sms.12046

    Article  CAS  PubMed  Google Scholar 

  36. Sardinha LB, Andersen LB, Anderssen SA, Quiterio AL, Ornelas R, Froberg K, Riddoch CJ, Ekelund U (2008) Objectively measured time spent sedentary is associated with insulin resistance independent of overall and central body fat in 9- to 10-year-old Portuguese children. Diabetes Care 31:569–575. https://doi.org/10.2337/dc07-1286

    Article  CAS  PubMed  Google Scholar 

  37. Sedentary Behaviour Research N (2012) Letter to the editor: standardized use of the terms “sedentary” and “sedentary behaviours. Appl Physiol Nutr Metab 37:540–542

  38. Stamatakis E, Hamer M, Dunstan DW (2011) 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 57:292–299. https://doi.org/10.1016/j.jacc.2010.05.065

    Article  PubMed  Google Scholar 

  39. Thijssen DH, Maiorana AJ, O'Driscoll G, Cable NT, Hopman MT, Green DJ (2010) Impact of inactivity and exercise on the vasculature in humans. Eur J Appl Physiol 108:845–875. https://doi.org/10.1007/s00421-009-1260-x

    Article  PubMed  Google Scholar 

  40. Thijssen DH, Green DJ, Hopman MT (2011) Blood vessel remodeling and physical inactivity in humans. J Appl Physiol (1985) 111:1836–1845. https://doi.org/10.1152/japplphysiol.00394.2011

    Article  Google Scholar 

  41. Thijssen DH, Black MA, Pyke KE, Padilla J, Atkinson G, Harris RA, Parker B, Widlansky ME, Tschakovsky ME, Green DJ (2011) Assessment of flow-mediated dilation in humans: a methodological and physiological guideline. Am J Physiol Heart Circ Physiol 300:H2–H12. https://doi.org/10.1152/ajpheart.00471.2010

    Article  CAS  PubMed  Google Scholar 

  42. Thosar SS, Bielko SL, Wiggins CC, Wallace JP (2014) Differences in brachial and femoral artery responses to prolonged sitting. Cardiovasc Ultrasound 12:50. https://doi.org/10.1186/1476-7120-12-50

    Article  PubMed  PubMed Central  Google Scholar 

  43. Tinken TM, Thijssen DH, Black MA, Cable NT, Green DJ (2008) Time course of change in vasodilator function and capacity in response to exercise training in humans. J Physiol 586:5003–5012. https://doi.org/10.1113/jphysiol.2008.158014

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Tinken TM, Thijssen DH, Hopkins N, Dawson EA, Cable NT, Green DJ (2010) Shear stress mediates endothelial adaptations to exercise training in humans. Hypertension 55:312–318. https://doi.org/10.1161/HYPERTENSIONAHA.109.146282

    Article  CAS  PubMed  Google Scholar 

  45. Vaisto J, Eloranta AM, Viitasalo A, Tompuri T, Lintu N, Karjalainen P, Lampinen EK, Agren J, Laaksonen DE, Lakka HM, Lindi V, Lakka TA (2014) Physical activity and sedentary behaviour in relation to cardiometabolic risk in children: cross-sectional findings from the Physical Activity and Nutrition in Children (PANIC) Study. Int J Behav Nutr Phys Act 11:55. https://doi.org/10.1186/1479-5868-11-55

    Article  PubMed  PubMed Central  Google Scholar 

  46. Veijalainen A, Tompuri T, Haapala EA, Viitasalo A, Lintu N, Vaisto J, Laitinen T, Lindi V, Lakka TA (2016) Associations of cardiorespiratory fitness, physical activity, and adiposity with arterial stiffness in children. Scand J Med Sci Sports 26:943–950. https://doi.org/10.1111/sms.12523

    Article  CAS  PubMed  Google Scholar 

  47. Vlachopoulos C, Xaplanteris P, Aboyans V, Brodmann M, Cifkova R, Cosentino F, De Carlo M, Gallino A, Landmesser U, Laurent S, Lekakis J, Mikhailidis DP, Naka KK, Protogerou AD, Rizzoni D, Schmidt-Trucksass A, Van Bortel L, Weber T, Yamashina A, Zimlichman R, Boutouyrie P, Cockcroft J, O'Rourke M, Park JB, Schillaci G, Sillesen H, Townsend RR (2015) The role of vascular biomarkers for primary and secondary prevention. A position paper from the European Society of Cardiology Working Group on peripheral circulation: Endorsed by the Association for Research into Arterial Structure and Physiology (ARTERY) Society. Atherosclerosis 241:507–532. https://doi.org/10.1016/j.atherosclerosis.2015.05.007

    Article  CAS  PubMed  Google Scholar 

  48. Wilkins JT, McDermott MM, Liu K, Chan C, Criqui MH, Lloyd-Jones DM (2012) Associations of noninvasive measures of arterial compliance and ankle-brachial index: the Multi-Ethnic Study of Atherosclerosis (MESA). Am J Hypertens 25:535–541. https://doi.org/10.1038/ajh.2012.13

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

We would like to thank Hannah Ewald from the University Library of the University of Basel, Switzerland, for peer-reviewing the search strings.

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Authors and Affiliations

  1. Department of Sport, Exercise and Health, Division Sports and Exercise Medicine, University of Basel, Birsstr. 320 B, 4052, Basel, Switzerland

    Karsten Königstein, Christopher Klenk, Timo Hinrichs & Arno Schmidt-Trucksäss

  2. University Medical Library, University of Basel, Basel, Switzerland

    Christian Appenzeller-Herzog

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Contributions

Karsten Königstein: Study conception and design; development of the search string and literature search; quality control of the included articles; manuscript draft; critical review of the drafts and final approval of the version to be published; accountable for all aspects of this work, especially regarding accuracy or integrity of any part of the work.

Christopher Klenk: Study conception and design; development of the search string and literature search; quality control of included articles; manuscript draft; critical review of the drafts; accountable for all aspects of this work, especially regarding accuracy or integrity of any part of the work.

Christian Appenzeller-Herzog: Study conception and design; development of the search string; critical review of the manuscript drafts, contributing special methodological expertise necessary for a structured and comprehensive conduction of systematic reviews; final approval of the version to be published; accountable for all aspects of this work, especially regarding accuracy or integrity of any part of the work.

Timo Hinrichs: Study conception and design; development of the search string; critical review of the manuscript drafts, contributing special expertise on sedentary behavior; final approval of the version to be published; accountable for all aspects of this work, especially regarding accuracy or integrity of any part of the work.

Arno Schmidt-Trucksäss: Study conception and design; development of the search string; critical review of the manuscript drafts, contributing special expertise on large artery structural and functional phenotyping; final approval of the version to be published; accountable for all aspects of this work, especially regarding accuracy or integrity of any part of the work.

Corresponding authors

Correspondence to Karsten Königstein or Arno Schmidt-Trucksäss.

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Königstein, K., Klenk, C., Appenzeller-Herzog, C. et al. Impact of sedentary behavior on large artery structure and function in children and adolescents: a systematic review. Eur J Pediatr 179, 17–27 (2020). https://doi.org/10.1007/s00431-019-03497-3

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