Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2016

Open Access 01-12-2016 | Research article

Too much sitting and all-cause mortality: is there a causal link?

Authors: Stuart J. H. Biddle, Jason A. Bennie, Adrian E. Bauman, Josephine Y. Chau, David Dunstan, Neville Owen, Emmanuel Stamatakis, Jannique G. Z. van Uffelen

Published in: BMC Public Health | Issue 1/2016

Login to get access

Abstract

Background

Sedentary behaviours (time spent sitting, with low energy expenditure) are associated with deleterious health outcomes, including all-cause mortality. Whether this association can be considered causal has yet to be established.
Using systematic reviews and primary studies from those reviews, we drew upon Bradford Hill’s criteria to consider the likelihood that sedentary behaviour in epidemiological studies is likely to be causally related to all-cause (premature) mortality.

Methods

Searches for systematic reviews on sedentary behaviours and all-cause mortality yielded 386 records which, when judged against eligibility criteria, left eight reviews (addressing 17 primary studies) for analysis. Exposure measures included self-reported total sitting time, TV viewing time, and screen time. Studies included comparisons of a low-sedentary reference group with several higher sedentary categories, or compared the highest versus lowest sedentary behaviour groups. We employed four Bradford Hill criteria: strength of association, consistency, temporality, and dose–response. Evidence supporting causality at the level of each systematic review and primary study was judged using a traffic light system depicting green for causal evidence, amber for mixed or inconclusive evidence, and red for no evidence for causality (either evidence of no effect or no evidence reported).

Results

The eight systematic reviews showed evidence for consistency (7 green) and temporality (6 green), and some evidence for strength of association (4 green). There was no evidence for a dose–response relationship (5 red). Five reviews were rated green overall. Twelve (67 %) of the primary studies were rated green, with evidence for strength and temporality.

Conclusions

There is reasonable evidence for a likely causal relationship between sedentary behaviour and all-cause mortality based on the epidemiological criteria of strength of association, consistency of effect, and temporality.
Appendix
Available only for authorised users
Literature
1.
Sedentary Behaviour Research Network. Letter to the Editor: Standardized use of the terms “sedentary” and “sedentary behaviours”. Applied Physiology, Nutrition & Metabolism. 2012;37:540–2.CrossRef
2.
Dempsey PC, Owen N, Biddle SJH, Dunstan DW. Managing sedentary behaviour to reduce the risk of diabetes and cardiovascular disease. Curr Diab Rep. 2014;14(9):522.CrossRefPubMed
3.
Healy GN, Dunstan DW, Salmon J, Shaw JE, Zimmet PZ, Owen N. Television time and continuous metabolic risk in physically active adults. Med Sci Sports Exerc. 2008;40(4):639–45.CrossRefPubMed
4.
Bouchard C, Blair SN, Katzmarzyk PT. Less sitting, more physical activity, or higher fitness? Mayo Clin Proc. 2015;90(11):1533–40.CrossRefPubMed
5.
Owen N, Healy GN, Matthews CE, Dunstan DW. Too much sitting: The population health science of sedentary behavior. Exerc Sport Sci Rev. 2010;38(3):105–13.CrossRefPubMedPubMedCentral
6.
Bauman AE, Chau JY, Ding D, Bennie J. Too much sitting and cardio-metabolic risk: an update of epidemiological evidence. Current Cardiovascular Risk Reports. 2013;7(4):293–8.CrossRef
7.
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.CrossRefPubMed
8.
Wilmot EG, Edwardson CL, Achana FA, Davies MJ, Gorely T, Gray LJ, Khunti K, Yates T, Biddle SJH. Sedentary time in adults and the association with diabetes, cardiovascular disease and death: systematic review and meta-analysis. Diabetologia. 2012;55(11):2895–905.CrossRefPubMed
9.
Edwardson CL, Gorely T, Davies MJ, Gray LJ, Khunti K, Wilmot EG, Yates T, Biddle SJH. Association of sedentary behaviour with metabolic syndrome: a meta-analysis. PLoS One. 2012;7(4):e34916.CrossRefPubMedPubMedCentral
10.
Rezende LFM, Rodrigues Lopes M, Rey-López JP, Matsudo VKR, Luiz OC. Sedentary behavior and health outcomes: an overview of systematic reviews. PLoS One. 2014;9(8):e105620.CrossRefPubMedPubMedCentral
11.
Suchert V, Hanewinkel R, Isensee B. Sedentary behavior and indicators of mental health in school-aged children and adolescents: A systematic review. Prev Med. 2015;76:48–57.CrossRefPubMed
12.
van Uffelen JGZ, Gellecum YRV, Burton NW, Peeters G, Heesch KC, Brown WJ. Sitting-time, physical activity, and depressive symptoms in mid-aged women. Am J Prev Med. 2013;45(3):276–81.CrossRefPubMed
13.
Löllgen H, Böckenhoff A, Knapp G. Physical activity and all-cause mortality: an updated meta-analysis and different intensity categories. Int J Sports Med. 2009;30:213–24.CrossRefPubMed
14.
15.
Weed DL, Gorelic LS. The practice of causal inference in cancer epidemiology. Cancer Epidemiol Biomarkers Prev. 1996;5:303–11.PubMed
16.
Urquhart DM, Zheng Y, Cheng AC, Rosenfeld JV, Chan P, Liew S, Hussain SM, Cicuttini FM. Could low grade bacterial infection contribute to low back pain? A systematic review. BMC Med. 2015;13:13.CrossRefPubMedPubMedCentral
17.
Phillips CV, Goodman KJ. The missed lessons of Sir Austin Bradford Hill. Epidemiologic Perspectives & Innovations. 2004;1:3.CrossRef
18.
Dishman RK, Heath GW, Lee I-M. Physical activity epidemiology (2nd Edn). Champaign: Human Kinetics; 2013.
19.
Howick J, Glasziou P, Aronson JK. The evolution of evidence hierarchies: what can Bradford Hill’s ‘guidelines for causation’ contribute? J R Soc Med. 2009;102:186–94.CrossRefPubMedPubMedCentral
20.
Karimkhani C, Boyers LN, Schilling LM, Dellavalle RP. The Surgeon General should say that indoor ultraviolet radiation tanning causes skin cancer. Am J Prev Med. 2015;49(3):437–40.CrossRefPubMed
21.
Ganesh A, Apel S, Metz L, Patten S. The case for vitamin D supplementation in multiple sclerosis. Multiple Sclerosis and Related Disorders. 2013;2(4):281–306.CrossRefPubMed
22.
Roffey DM, Wai EK, Bishop P, Kwon BK, Dagenais S. Causal assessment of occupational sitting and low back pain: results of a systematic review. Spine J. 2010;10(3):252–61.CrossRefPubMed
23.
Lucas RM, McMichael AJ. Associaton or causation: evaluting links between "environment and disease". Bull World Health Organ. 2005;83(10):792–5.PubMedPubMedCentral
24.
25.
George E, Rosenkranz R, Kolt G. Chronic disease and sitting time in middle-aged Australian males: findings from the 45 and Up Study. Int J Behav Nutr Phys Act. 2013;10(1):20.CrossRefPubMedPubMedCentral
26.
Graff-Iversen S, Selmer R, Sørensen M, Skurtveit S. Occupational physical activity, overweight, and mortality. Res Q Exerc Sport. 2007;78(3):151–61.PubMed
27.
Chau J, Grunseit A, Midthjell K, Holmen J, Holmen TL, Bauman AE, Van der Ploeg HP. Sedentary behaviour and risk of mortality from all causes and cardiometabolic diseases in adults: evidence from the HUNT3 population cohort. Br J Sports Med. 2015;49(11):737–42.CrossRefPubMed
28.
Dunstan DW, Barr ELM, Healy GN, Salmon J, Shaw JE, Balkau B, Magliano DJ, Cameron AJ, Zimmet PZ, Owen N. Television viewing time and mortality: The Australian Diabetes, Obesity and Lifestyle Study (AusDiab). Circulation. 2010;121:384–91.CrossRefPubMed
29.
Inoue M, Iso H, Yamamoto S, Kurahashi N, Sasazuki S, Tsugane S, for the Japan Public Health Center-Based Prospective Study Group. Daily total physical activity level and premature death in men and women: results from a large-scale population-based cohort study in Japan (JPHC Study). Ann Epidemiol. 2008;18:522–30.CrossRefPubMed
30.
Katzmarzyk PT, Church TS, Craig CL, Bouchard C. Sitting time and mortality from all causes, cardiovascular disease, and cancer. Medicine and Science in Sports & Exercise. 2009;41(5):998–1005.CrossRef
31.
Matthews CE, George SM, Moore SC, Bowles HR, Blair A, Park Y, Troiano RP, Hollenbeck A, Schatzkin A. Amount of time spent in sedentary behaviors and cause-specific mortality in US adults. Am J Clin Nutr. 2012;95:437–45.CrossRefPubMedPubMedCentral
32.
Patel AV, Bernstein L, Deka A, Feigelson HS, Campbell PT, Gapstur SM, Colditz GA, Thun MJ. Leisure time spent sitting in relation to total mortality in a prospective cohort of US adults. Am J Epidemiol. 2010;172:419–29.CrossRefPubMedPubMedCentral
33.
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(3):292–9.CrossRefPubMed
34.
Weller I, Corey P. The impact of excluding of non-leisure energy expenditire on the relation between physical activity and mortality in women. Epidemiology. 1998;9(6):632–5.CrossRefPubMed
35.
Wijndaele K, Brage S, Besson H, Khaw K-T, Sharp SJ, Luben R, Wareham NJ, Ekelund U. Television viewing time independently predicts all-cause and cardiovascular mortality: the EPIC Norfolk Study. Int J Epidemiol. 2010;40(1):150–9.CrossRefPubMed
36.
van der Ploeg HP, Chey T, Korda RJ, Banks E, Bauman A. Sitting time and all-cause mortality risk in 222,497 Australian adults. Arch Intern Med. 2012;172(6):494–500.CrossRefPubMed
37.
38.
Pavey TG, Peeters GMEE, Brown WJ. Sitting-time and 9-year all-cause mortality in older women. Br J Sports Med. 2015;49:95–9.CrossRefPubMed
39.
Seguin R, Buchner DM, Liu J, Allison M, Manini T, Wang C-Y, Manson JE, Messina CR, Patel MJ, Moreland L, et al. Sedentary behavior and mortality in older women. Am J Prev Med. 2014;46(2):122–35.CrossRefPubMedPubMedCentral
40.
Kim Y, Wilkens LR, Park S-Y, Goodman 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(4):1040–56.CrossRefPubMedPubMedCentral
41.
Leon-Munoz LM, Martinez-Gomez D, Balboa-Castillo T, Lopez-Garcia E, Guallar-Castillon P, Rodriguez-Artalejo F. Continued sedentariness, change in sitting time, and mortality in older adults. Medicine and Science in Sports & Exercise. 2013;45(8):1501–7.CrossRef
42.
Martinez-Gomez D, Guallar-Castillon P, Leon-Munoz L, Lopez-Garcia E, Rodriguez-Artalejo F. Combined impact of traditional and non-traditional health behaviors on mortality: a national prospective cohort study in Spanish older adults. BMC Med. 2013;11(1):47.CrossRefPubMedPubMedCentral
43.
Campbell PT, Patel AV, Newton CC, Jacobs EJ, Gapstur SM. Associations of recreational physical activity and leisure time spent sitting with colorectal cancer survival. J Clin Oncol. 2013;31(7):876–85.CrossRefPubMed
44.
Proper KI, Singh AS, van Mechelen W, Chinapaw MJM. Sedentary behaviors and health outcomes among adults: A systematic review of prospective studies. Am J Prev Med. 2011;40(2):174–82.CrossRefPubMed
45.
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.CrossRefPubMedPubMedCentral
46.
47.
Chau JY, Grunseit AC, Chey T, Stamatakis E, Brown WJ, Matthews CE, Bauman AE, Van der Ploeg HP. Daily sitting time and all-cause mortality: a meta-analysis. PLoS One. 2013;8(11):e80000.CrossRefPubMedPubMedCentral
48.
Rezende LFM, Rey-López JP, Matsudo VKR, Luiz OC. Sedentary behavior and health outcomes among older adults: a systematic review. BMC Public Health. 2014;14:333.CrossRefPubMedPubMedCentral
49.
Biswas A, Oh PI, Faulkner GE, Bajaj RR, Silver MA, Mitchell MS, Alter DA. 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;162:123–32.CrossRefPubMed
50.
Rosenthal JA. Qualitative descriptors of strength of association and effect size. J Soc Serv Res. 1996;21(4):37–59.CrossRef
51.
Khaw K, Wareham N, Bingham S, Welch A, Luben R, Day N. Combined impact of health behaviours and mortality in men and women: The EPIC-Norfolk Prospective Population Study. PLoS Med. 2007;5(1):e12.CrossRef
52.
Ding D, Rogers K, van der Ploeg H, Stamatakis E, Bauman AE. Traditional and emerging lifestyle risk behaviors and all-cause mortality in middle-aged and older adults: evidence from a large population-based Australian cohort. PLoS Med. 2015;12(12), e1001917.CrossRefPubMedPubMedCentral
53.
Stamatakis E, Chau JY, Pedisic Z, Bauman AE, Macniven R, Coombs N, Hamer M. Are sitting occupations associated with increased all-cause, cancer, and cardiovascular disease mortality risk? A pooled analysis of seven British population cohorts. PLoS One. 2013;8(9):e73753.CrossRefPubMedPubMedCentral
54.
Van der Ploeg HP, Chey T, Ding D, Chau JY, Stamatakis E, Bauman AE. Standing time and all-cause mortality in a large cohort of Australian adults. Prev Med. 2014;69:187–91.CrossRefPubMed
55.
Mansoubi M, Pearson N, Biddle SJH, Clemes S. The relationship between sedentary behaviour and physical activity in adults: A systematic review. Prev Med. 2014;69:28–35.CrossRefPubMed
56.
Bergouignan A, Rudwill F, Simon C, Blanc S. Physical inactivity as the culprit of metabolic inflexibility: evidence from bed-rest studies. J Appl Physiol. 2011;111(4):1201–10.CrossRefPubMed
57.
Bey L, Akunuri N, Zhao P, Hoffman EP, Hamilton DG, Hamilton MT. Patterns of global gene expression in rat skeletal muscle during unloading and low-intensity ambulatory activity. Physiol Genomics. 2003;13:157–67.CrossRefPubMed
58.
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;551:673–82.CrossRefPubMedPubMedCentral
59.
Vernikos J. Sitting kills, moving heals. Fresno: Quill Driver Books; 2011.
60.
Thyfault JP, Krogh-Madsen R. Metabolic disruptions induced by reduced ambulatory activity in free-living humans. J Appl Physiol. 2011;111(4):1218–24.CrossRefPubMed
61.
Hamilton MT, Healy GN, Dunstan DW, Zderic TW, Owen N. Too little exercise and too much sitting: Inactivity physiology and the need for new recommendations on sedentary behavior. Current Cardiovascular Risk Reports. 2008;2:292–8.CrossRefPubMedPubMedCentral
62.
Dunstan DW, Kingwell BA, Larsen R, Healy GN, Cerin E, Hamilton MT, Shaw JE, Bertovic DA, Zimmet PZ, Salmon J, et al. Breaking up prolonged sitting reduces postprandial glucose and insulin responses. Diabetes Care. 2012;35(5):976–83.CrossRefPubMedPubMedCentral
63.
Healy GN, Winkler EA, Owen N, Anuradha S, Dunstan D. Replacing sitting time standing or stepping: associations with cardio-metabolic risk biomarkers. Eur Heart J. 2015.
64.
Troiano RP, Berrigan D, Dodd KW, Masse LC, Tilert T, McDowell M. Physical activity in the United States measured by accelerometer. Medicine and Science in Sports & Exercise. 2008;40:181–8.CrossRef
65.
Bjork-Petersen C, Bauman A, Grønbæk M, Helge JW, Thygesen LC, Tolstrup JS. Total sitting time and risk of myocardial infarction, coronary heart disease and all-cause mortality in a prospective cohort of Danish adults. Int J Behav Nutr Phys Act. 2014;11:13.CrossRefPubMed
66.
Chomistek AK, Manson JE, Stefanick ML, Lu B, Sands-Lincoln M, Going SB, Garcia L, Allison MA, Sims ST, LaMonte MJ, 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(23):2346–54.CrossRefPubMedPubMedCentral
67.
Pulsford RM, Stamatakis E, Britton AR, Brunner EJ, Hillsdon M. Associations of sitting behaviours with all-cause mortality over a 16-year follow-up: the Whitehall II study. International Journal of Epidemiology. 2015. Epub ahead of print.
68.
Stamatakis E, Rogers K, Ding D, Berrigan D, Chau J, Hamer M, Bauman A. All-cause mortality effects of replacing sedentary time with physical activity and sleeping using an isotemporal substitution model: a prospective study of 201,129 mid-aged and older adults. Int J Behav Nutr Phys Act. 2015;12(1):121.CrossRefPubMedPubMedCentral
69.
Buman MP, Winkler EAH, Kurka JM, Hekler EB, Baldwin CM, Owen N, Ainsworth BE, Healy GN, Gardiner PA. 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.CrossRefPubMed
70.
Pedisic Z. Measurement issues and poor adjustments for physical activity and sleep undermine sedentary behaviour research — The focus should shift to the balance between sleep, sedentary behaviour, standing and activity. Kinesiology. 2014;46(1):135–46.
71.
Chastin SFM, Palarea-Albaladejo J, Dontje ML, Skelton DA. Combined effects of time spent in physical activity, sedentary behaviors and sleep on obesity and cardio-metabolic health markers: a novel compositional data analysis approach. PLoS One. 2015;10(10):e0139984.CrossRefPubMedPubMedCentral
72.
Healy GN, Clark BK, Winkler EAH, Gardiner PA, Brown WJ, Matthews CE. Measurement of adults' sedentary time in population-based studies. Am J Prev Med. 2011;41(2):216–27.CrossRefPubMedPubMedCentral
73.
Sugiyama T, Healy GN, Dunstan DW, Salmon J, Owen N. Is television viewing time a marker of a broader pattern of sedentary behavior? Ann Behav Med. 2008;35:245–50.CrossRefPubMed
Metadata
Title
Too much sitting and all-cause mortality: is there a causal link?
Authors
Stuart J. H. Biddle
Jason A. Bennie
Adrian E. Bauman
Josephine Y. Chau
David Dunstan
Neville Owen
Emmanuel Stamatakis
Jannique G. Z. van Uffelen
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2016
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-016-3307-3

Other articles of this Issue 1/2016

BMC Public Health 1/2016 Go to the issue

Study protocol

The GOOD life: Study protocol for a social norms intervention to reduce alcohol and other drug use among Danish adolescents

Research article

A systematic review of the health and well-being impacts of school gardening: synthesis of quantitative and qualitative evidence

Research article

Using short-message-service notification as a method to improve acute flaccid paralysis surveillance in Papua New Guinea

Research article

Community perceptions of health and rodent-borne diseases along the Inter-Oceanic Highway in Madre de Dios, Peru

Research article

Socio-economic development and emotion-health connection revisited: a multilevel modeling analysis using data from 162 counties in China

Research article

Public awareness of the link between alcohol and cancer in England in 2015: a population-based survey