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.
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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Diabetes Atlas. 6th ed: International Diabetes Federation; 2013.
Global status report on noncommunicable diseases. Geneva: World Health Organization 2011; 2010.
Lanningham-Foster L, Nysse LJ, Levine JA. Labor saved, calories lost: the energetic impact of domestic labor-saving devices. Obes Res. 2003;11:1178–81.
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.
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.
Grontved A, Hu FB. Television viewing and risk of type 2 diabetes, cardiovascular disease, and all-cause mortality: a meta-analysis. JAMA. 2011;305:2448–55.
Katzmarzyk PT, Lee IM. Sedentary behaviour and life expectancy in the USA: a cause-deleted life table analysis. BMJ Open. 2012;2.
Proper KI, Singh AS, van Mechelen W, et al. Sedentary behaviors and health outcomes among adults: a systematic review of prospective studies. Am J Prev Med. 2011;40:174–82.
Thorp AA, Owen N, Neuhaus M, et al. Sedentary behaviors and subsequent health outcomes in adults a systematic review of longitudinal studies, 1996-2011. Am J Prev Med. 2011;41:207–15.
Church TS, Thomas DM, Tudor-Locke C, et al. Trends over 5 decades in U.S. occupation-related physical activity and their associations with obesity. PLoS One. 2011;6:e19657.
Chau JY, Merom D, Grunseit A, et al. Temporal trends in non-occupational sedentary behaviors from Australian Time Use Surveys 1992, 1997 and 2006. Int J Behav Nutr Phys Act. 2012;9:76.
van der Ploeg HP, Venugopal K, Chau JY, et al. Non-occupational sedentary behaviors: population changes in The Netherlands, 1975–2005. Am J Prev Med. 2013;44:382–7.
Colley RC, Garriguet D, Janssen I, et al. Physical activity of Canadian adults: accelerometer results from the 2007 to 2009 Canadian Health Measures Survey. Health Rep. 2011;22:7–14.
Hagstromer M, Troiano RP, Sjostrom M, et al. Levels and patterns of objectively assessed physical activity—a comparison between Sweden and the United States. Am J Epidemiol. 2010;171:1055–64.
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.
Matthews CE, Chen KY, Freedson PS, et al. Amount of time spent in sedentary behaviors in the United States, 2003-2004. Am J Epidemiol. 2008;167:875–81.
Bauman A, Ainsworth BE, Sallis JF, et al. The descriptive epidemiology of sitting. A 20-country comparison using the International Physical Activity Questionnaire (IPAQ). Am J Prev Med. 2011;41:228–35.
Heath GW, Parra-Perez D, Sarmiento-Duenas OL, et al. Evidence-based physical activity intervention: lessons from around the globe. Lancet. 2012;380:272–81.
Clark BK, Sugiyama T, Healy GN, et al. Validity and reliability of measures of television viewing time and other non-occupational sedentary behaviour of adults: a review. Obes Rev. 2009;10:7–16.
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.
Prince SA, Adamo KB, Hamel ME, et al. A comparison of direct vs self-report measures for assessing physical activity in adults: a systematic review. Int J Behav Nutr Phys Act. 2008;6:56.
Owen N. Ambulatory monitoring and sedentary behaviour: a population-health perspective. Physiol Meas. 2012;33:1801–10.
Owen N. Sedentary behavior: understanding and influencing adults’ prolonged sitting time. Prev Med. 2012;55:535–9.
Pate RR, O'Neill JR, Lobelo F. The evolving definition of “sedentary”. Exerc Sport Sci Rev. 2008;36:173–8.
Ekblom-Bak E, Ekblom B, Hellenius ML. Less sitting as important as increased physical activity. Lakartidningen. 2010;107:587–8.
Dunstan DW, Barr EL, Healy GN, et al. Television viewing time and mortality: the Australian Diabetes, Obesity and Lifestyle Study (AusDiab). Circulation. 2010;121:384–91.
Ford ES, Caspersen CJ. Sedentary behaviour and cardiovascular disease: a review of prospective studies. Int J Epidemiol. 2012;41:1338–53.
Gennuso KP, Gangnon RE, Matthews CE, et al. Sedentary behavior, physical activity, and markers of health in older adults. Med Sci Sports Exerc. 2013;45:1493–500.
Finni T, Haakana P, Pesola AJ, et al. Exercise for fitness does not decrease the muscular inactivity time during normal daily life. Scand J Med Sci Sports. 2014;24:211–9.
Healy GN, Dunstan DW, Salmon J, et al. Television time and continuous metabolic risk in physically active adults. Med Sci Sports Exerc. 2008;40:639–45.
van der Ploeg HP, Chey T, Korda RJ, et al. Sitting time and all-cause mortality risk in 222 497 Australian adults. Arch Intern Med. 2012;172:494–500.
Wilmot EG, Edwardson CL, Achana FA, et al. Sedentary time in adults and the association with diabetes, cardiovascular disease and death: systematic review and meta-analysis. Diabetologia. 2012;55:2895–905.
Craft LL, Zderic TW, Gapstur SM, et al. Evidence that women meeting physical activity guidelines do not sit less: an observational inclinometry study. Int J Behav Nutr Phys Act. 2012;9:122.
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%).
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.
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.
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.
Nygaard H, Tomten SE, Hostmark AT. Slow postmeal walking reduces postprandial glycemia in middle-aged women. Appl Physiol Nutr Metab. 2009;34:1087–92.
Stephens BR, Granados K, Zderic TW, et al. Effects of 1 day of inactivity on insulin action in healthy men and women: interaction with energy intake. Metabolism. 2011;60:941–9.
Buckley JP, Mellor DD, Morris M, et al. Standing-based office work shows encouraging signs of attenuating post-prandial glycemic excursion. Occup Environ Med. 2014;71:109–11.
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.
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.
Miyashita M, Park JH, Takahashi M, et al. Postprandial lipaemia: effects of sitting, standing and walking in healthy normolipidaemic humans. Int J Sports Med. 2013;34:21–7.
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.
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].
Blaak EE, Antoine JM, Benton D, et al. Impact of postprandial glycaemia on health and prevention of disease. Obes Rev. 2012;13:923–84.
O'Keefe JH, Abuannadi M, Lavie CJ, et al. Strategies for optimizing glycemic control and cardiovascular prognosis in patients with type 2 diabetes mellitus. Mayo Clin Proc. 2011;86:128–38.
Miyashita M. Effects of continuous vs accumulated activity patterns on postprandial triacylglycerol concentrations in obese men. Int J Obes (Lond). 2008;32:1271–8.
Miyashita M, Burns SF, Stensel DJ. Exercise and postprandial lipemia: effect of continuous compared with intermittent activity patterns. Am J Clin Nutr. 2006;83:24–9.
Miyashita M, Burns SF, Stensel DJ. Accumulating short bouts of brisk walking reduces postprandial plasma triacylglycerol concentrations and resting blood pressure in healthy young men. Am J Clin Nutr. 2008;88:1225–31.
Hamer M, Bostock S, Hackett R, et al. Objectively assessed sedentary time and type 2 diabetes mellitus: a case-control study. Diabetologia. 2013;56:2761–2.
Leenders M, Verdijk LB, van der Hoeven L, et al. Patients with type 2 diabetes show a greater decline in muscle mass, muscle strength, and functional capacity with aging. J Am Med Dir Assoc. 2013;14:585–92.
Henson J, Yates T, Biddle S, et al. Associations of objectively measured sedentary behaviour and physical activity with markers of cardiometabolic health. Diabetologia. 2013;56:1012–20.
Cooper AR, Sebire S, Montgomery AA, et al. Sedentary time, breaks in sedentary time and metabolic variables in people with newly diagnosed type 2 diabetes. Diabetologia. 2012;55:589–99.
Cooper AJM, Brage S, Ekelund U, et al. Association between objectively assessed sedentary time and physical activity with metabolic risk factors among people with recently diagnosed type 2 diabetes. Diabetologia. 2013;57:73–82.
van Dijk JW, Venema M, van Mechelen W, et al. Effect of moderate-intensity exercise vs activities of daily living on 24-hour blood glucose homeostasis in male patients with type 2 diabetes. Diabetes Care. 2013;36:3448–53.
Bey L, Hamilton MT. Suppression of skeletal muscle lipoprotein lipase activity during physical activity: a molecular reason to maintain daily low-intensity activity. J Physiol. 2003;551:673–82.
Hamilton MT, Healy GN, Dunstan DW, et al. Too little exercise and too much sitting: inactivity physiology and the need for new recommendations on sedentary behaviour. Curr Cardiovasc Risk Rep. 2008;2:292–8.
Zderic TW, Hamilton MT. Physical inactivity amplifies the sensitivity of skeletal muscle to the lipid-induced downregulation of lipoprotein lipase activity. J Appl Physiol. 2006;100:249–57.
Howard BJ, Fraser SF, Sethi P, et al. Impact on hemostatic parameters of interrupting sitting with intermittent activity. Med Sci Sports Exerc. 2013;45:1285–91.
Lammers G, Poelkens F, van Duijnhoven NT, et al. Expression of genes involved in fatty acid transport and insulin signaling is altered by physical inactivity and exercise training in human skeletal muscle. Am J Physiol Endocrinol Metab. 2012;303:E1245–51.
Latouche C, Jowett JB, Carey AL, et al. Effects of breaking up prolonged sitting on skeletal muscle gene expression. J Appl Physiol. 2013;114:453–60.
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.
Alibegovic AC, Hojbjerre L, Sonne MP, et al. Impact of 9 days of bed rest on hepatic and peripheral insulin action, insulin secretion, and whole-body lipolysis in healthy young male offspring of patients with type 2 diabetes. Diabetes. 2009;58:2749–56.
Hamburg NM, McMackin CJ, Huang AL, et al. Physical inactivity rapidly induces insulin resistance and microvascular dysfunction in healthy volunteers. Arterioscler Thromb Vasc Biol. 2007;27:2650–6.
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.
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.
The Sedentary Behaviour & Obesity Expert Working Group. Sedentary Behaviour and Obesity: Review of the Current Scientific Evidence. London: Department of Health; 2010.
Owen N, Healy GN, Matthews CE, et al. Too much sitting: the population health science of sedentary behavior. Exerc Sport Sci Rev. 2010;38:105–13.
Colberg SR, Albright AL, Blissmer BJ, et al. Exercise and type 2 diabetes: American College of Sports Medicine and the American Diabetes Association: joint position statement. Exercise and type 2 diabetes. Med Sci Sports Exerc. 2010;42:2282–303.
Haskell WL, Lee IM, Pate RR, et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation. 2007;116:1081–93.
Sattelmair J, Pertman J, Ding EL, et al. Dose response between physical activity and risk of coronary heart disease: a meta-analysis. Circulation. 2011;124:789–95.
Hallal PC, Andersen LB, Bull FC, et al. Global physical activity levels: surveillance progress, pitfalls, and prospects. Lancet. 2012;380:247–57.
Owen N, Sparling PB, Healy GN, et al. Sedentary behavior: emerging evidence for a new health risk. Mayo Clin Proc. 2010;85:1138–41.
Charlton BG. A critique of Geoffrey Rose’s ‘population strategy’ for preventive medicine. J R Soc Med. 1995;88:607–10.
Cooney MT, Dudina A, Whincup P, et al. Re-evaluating the Rose approach: comparative benefits of the population and high-risk preventive strategies. Eur J Cardiovasc Prev Rehabil. 2009;16:541–9.
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.
Jorgensen T, Capewell S, Prescott E, et al. Population-level changes to promote cardiovascular health. Eur J Prev Cardiol. 2013;20:409–21.
Rose G. Sick individuals and sick populations. 1985. Bull World Health Organ. 2001;79:990–6.
Carson V, Ridgers ND, Howard BJ, et al. Light-intensity physical activity and cardiometabolic biomarkers in US adolescents. PLoS One. 2013;8:e71417.
Loprinzi PD, Lee H, Cardinal BJ. Daily movement patterns and biological markers among adults in the United States. Prev Med. 2014;60:128–30.
Owen N, Salmon J, Koohsari MJ, et al. Sedentary behaviour and health: mapping environmental and social contexts to underpin chronic disease prevention. Br J Sports Med. 2014;48:174–7.
Biddle SJ, Marshall SJ, Gorely T, et al. Temporal and environmental patterns of sedentary and active behaviors during adolescents’ leisure time. Int J Behav Med. 2009;16:278–86.
Chau JY, der Ploeg HP, van Uffelen JG, et al. Are workplace interventions to reduce sitting effective? A systematic review. Prev Med. 2010;51:352–6.
Owen N, Sugiyama T, Eakin EE, et al. Adults' sedentary behavior determinants and interventions. Am J Prev Med. 2011;41:189–96.
Sallis JF, Floyd MF, Rodriguez DA, et al. Role of built environments in physical activity, obesity, and cardiovascular disease. Circulation. 2012;125:729–37.
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.
Owen N, Leslie E, Salmon J, et al. Environmental determinants of physical activity and sedentary behavior. Exerc Sport Sci Rev. 2000;28:153–8.
Healy GN, Eakin EG, Lamontagne AD, et al. Reducing sitting time in office workers: short-term efficacy of a multicomponent intervention. Prev Med. 2013.
Neuhaus M, Healy GN, Dunstan DW, et al. Workplace sitting and height-adjustable workstations: a randomized controlled trial. Am J Prev Med. 2014;46:30–40.
Carr LJ, Karvinen K, Peavler M, et al. Multicomponent intervention to reduce daily sedentary time: a randomized controlled trial. BMJ Open. 2013;3:e003261.
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.
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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.
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This article does not contain any studies with human or animal subjects performed by any of the authors.
This article is part of the Topical Collection on Lifestyle Management to Reduce Diabetes/Cardiovascular Risk
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Dempsey, P.C., Owen, N., Biddle, S.J.H. et al. Managing Sedentary Behavior to Reduce the Risk of Diabetes and Cardiovascular Disease. Curr Diab Rep 14, 522 (2014). https://doi.org/10.1007/s11892-014-0522-0
- Sitting time
- Sedentary behavior
- Breaks in sedentary time
- TV viewing time
- Physical activity
- Physical inactivity
- Type 2 diabetes
- Cardiovascular disease
- Cardiometabolic risk