Moderate-to vigorous-intensity physical activity has an established preventive role in cardiovascular disease, type 2 diabetes, obesity, and some cancers. However, recent epidemiologic evidence suggests that sitting time has deleterious cardiovascular and metabolic effects that are independent of whether adults meet physical activity guidelines. Evidence from “inactivity physiology” laboratory studies has identified unique mechanisms that are distinct from the biologic bases of exercising. Opportunities for sedentary behaviors are ubiquitous and are likely to increase with further innovations in technologies. We present a compelling selection of emerging evidence on the deleterious effects of sedentary behavior, as it is underpinned by the unique physiology of inactivity. It is time to consider excessive sitting a serious health hazard, with the potential for ultimately giving consideration to the inclusion of too much sitting (or too few breaks from sitting) in physical activity and health guidelines.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
References and Recommended Reading
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, 116:1081–1093.
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. Med Sci Sports Exerc 2007, 39:1423–1434.
Pate RR, Pratt M, Blair SN, et al.: Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA 1995, 273:402–407.
Hamilton MT, Hamilton DG, Zderic TW: The role of low energy expenditure and sitting on obesity, metabolic syndrome, type 2 diabetes, and cardiovascular disease. Diabetes 2007, 56:2655–2667.
Tremblay MS, Esliger DW, Tremblay A, et al.: Incidental movement, lifestyle-embedded activity and sleep: new frontiers in physical activity assessment. Can J Public Health 2007, 98(Suppl 2): S208–S217.
Hagstromer M, Oja P, Sjostrom M: Physical activity and inactivity in an adult population assessed by accelerometry. Med Sci Sports Exerc 2007, 39:1502–1508.
Troiano RP, Berrigan D, Dodd KW, et al.: Physical activity in the United States measured by accelerometer. Med Sci Sports Exerc 2008, 40:181–188.
Owen N, Leslie E, Salmon J, Fotheringham MJ: Environmental determinants of physical activity and sedentary behavior. Exerc Sport Sci Rev 2000, 28:153–158.
Morris JN, Heady JA, Raffle PA, et al.: Coronary heartdisease and physical activity of work. Lancet 1953, 265(6795):1053–1057; contd.
Morris JN, Heady JA, Raffle PA, et al.: Coronary heartdisease and physical activity of work. Lancet 1953, 265(6796):1111–1120; concl.
Taylor HL, Klepetar E, Keys A, et al.: Death rates among physically active and sedentary employees of the railroad industry. Am J Public Health Nations Health 1962, 52:1697–1707.
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, 167:875–881.
Dunstan DW, Salmon J, Owen N, et al.: Physical activity and television viewing in relation to risk of undiagnosed abnormal glucose metabolism in adults. Diabetes Care 2004, 27:2603–2609.
Dunstan DW, Salmon J, Owen N, et al.: Associations of TV viewing and physical activity with the metabolic syndrome in Australian adults. Diabetologia 2005, 48:2254–2261.
Dunstan DW, Salmon J, Healy GN, et al.: Association of television viewing with fasting and 2-h postchallenge plasma glucose levels in adults without diagnosed diabetes. Diabetes Care 2007, 30:516–522.
Healy GN, Dunstan DW, Salmon J, et al.: Television time and continuous metabolic risk in physically active adults. Med Sci Sports Exerc 2008, 40:639–645.
Healy GN, Dunstan DW, Salmon J, et al.: Objectively measured light-intensity physical activity is independently associated with 2-h plasma glucose. Diabetes Care 2007, 30:1384–1389.
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, 31:369–371.
Healy GN, Dunstan DW, Salmon J, et al.: Breaks in sedentary time: beneficial associations with metabolic risk. Diabetes Care 2008, 31:661–666.
Hamilton MT, Hamilton DG, Zderic TW: Exercise physiology versus inactivity physiology: an essential concept for understanding lipoprotein lipase regulation. Exerc Sport Sci Rev 2004, 32:161–166.
Bloom WL, Eidex MF: Inactivity as a major factor in adult obesity. Metabolism 1967, 16:679–684.
Levine JA, Lanningham-Foster LM, McCrady SK, et al.: Interindividual variation in posture allocation: possible role in human obesity. Science 2005, 307:584–586.
Raynor DA, Phelan S, Hill JO, Wing RR: Television viewing and long-term weight maintenance: results from the National Weight Control Registry. Obesity (Silver Spring) 2006, 14:1816–1824.
Bergouignan A, Blanc S: The energetics of obesity [in French]. J Soc Biol 2006, 200:29–35.
Cai G, Cole SA, Butte N, et al.: A quantitative trait locus on chromosome 18q for physical activity and dietary intake in Hispanic children. Obesity (Silver Spring) 2006, 14:1596–1604.
Simonen RL, Rankinen T, Perusse L, et al.: Genome-wide linkage scan for physical activity levels in the Quebec Family study. Med Sci Sports Exerc 2003, 35:1355–1359.
Dietz WH: The role of lifestyle in health: the epidemiology and consequences of inactivity. Proc Nutr Soc 1996, 55:829–840.
Bey L, Akunuri N, Zhao P, et al.: Patterns of global gene expression in rat skeletal muscle during unloading and low-intensity ambulatory activity. Physiol Genomics 2003, 13:157–167.
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):673–682.
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, 100:249–257.
Hamilton MT, Areiqat E, Hamilton DG, et al.: Plasma triglyceride metabolism in humans and rats during aging and physical inactivity. Int J Sport Nutr Exerc Metab 2001, 11(Suppl):S97–S104.
Hamilton MT, Etienne J, McClure WC, et al.: Role of local contractile activity and muscle fiber type on LPL regulation during exercise. Am J Physiol 1998, 275(6 Pt 1):E1016–E1022.
Hennig R, Lomo T: Firing patterns of motor units in normal rats. Nature 1985, 314:164–166.
Bauman A, Armstrong T, Davies J, et al.: Trends in physical activity participation and the impact of integrated campaigns among Australian adults, 1997–99. Aust N Z J Public Health 2003, 27:76–79.
Salmon J, Owen N, Crawford D, et al.: Physical activity and sedentary behavior: a population-based study of barriers, enjoyment, and preference. Health Psychol 2003, 22:178–188.
Sugiyama T, Salmon J, Dunstan DW, et al.: Neighborhood walkability and TV viewing time among Australian adults. Am J Prev Med 2007, 33:444–449.
Epstein LH, Roemmich JN: Reduced sedentary behavior: role in modifying physical activity. Exerc Sport Sci Rev 2001, 29:102–108.
About this article
Cite this article
Hamilton, M.T., Healy, G.N., Dunstan, D.W. et al. Too little exercise and too much sitting: Inactivity physiology and the need for new recommendations on sedentary behavior. Curr Cardio Risk Rep 2, 292 (2008). https://doi.org/10.1007/s12170-008-0054-8
- Physical Activity
- Sedentary Behavior
- Physical Inactivity
- Sedentary Time
- Physical Activity Guideline