Do the associations of sedentary behaviour with cardiovascular disease mortality and cancer mortality differ by physical activity level? A systematic review and harmonised meta-analysis of data from 850 060 participants

2018 ◽  
Vol 53 (14) ◽  
pp. 886-894 ◽  
Author(s):  
Ulf Ekelund ◽  
Wendy J Brown ◽  
Jostein Steene-Johannessen ◽  
Morten Wang Fagerland ◽  
Neville Owen ◽  
...  

ObjectiveTo examine whether the associations between sedentary behaviours (ie, daily sitting/TV-viewing time) and mortality from cardiovascular disease (CVD) and cancer differ by different levels of physical activity (PA).DesignHarmonised meta-analysis of prospective cohort studies. Data on exposure variables were harmonised according to a predefined protocol and categorised into four groups for sedentary behaviours and into quartiles of PA (MET-hour/week).Data sourcesPubMed, PsycINFO, Embase, Web of Science, Sport Discus and Scopus.Eligibility criteria for selecting studiesIndividual level data on both sedentary behaviours and PA and reported effect estimates for CVD or cancer mortality.ResultsNine studies (n=850 060; deaths=25 730) and eight studies (n=777 696; deaths=30 851) provided data on sitting time and CVD and cancer mortality, respectively. Five studies had data on TV-viewing time and CVD (n=458 127; deaths=13 230) and cancer (n=458 091; deaths=16 430) mortality. A dose–response association between sitting time (9%–32% higher risk; p for trend <0.001) and TV time (3%–59% higher risk; p for trend <0.001) with CVD mortality was observed in the ‘inactive’, lowest quartile of PA. Associations were less consistent in the second and third quartiles of PA, and there was no increased risk for CVD mortality with increasing sedentary behaviours in the most active quartile. Associations between sedentary behaviours and cancer mortality were generally weaker; 6%–21% higher risk with longer sitting time observed only in the lowest quartile of PA.ConclusionPA modifies the associations between sedentary behaviours and CVD and cancer mortality. These findings emphasise the importance of higher volumes of moderate and vigorous activity to reduce, or even eliminate these risks, especially for those who sit a lot in their daily lives.

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Heather A McGrane Minton ◽  
Kelly Thevenet-Morrison ◽  
I. Diana Fernandez

Background: Sedentary behaviors (SB) are activities associated with prolonged time periods of sitting, reclining, or laying down during waking hours. While the relation between SB and physical activity is complex, the common consensus is that SB is not the absence of physical activity and consists of its own determinants posing distinct health outcomes. These behaviors are of significant public health importance as the majority of Americans spend much of their days in SB and due to the increased risks of morbidity and mortality associated with SB. Adverse health outcomes associated with SB include cardiovascular disease, obesity, metabolic syndrome, hypertension and mortality. Television-viewing time and total sitting time have both been used widely to assess time spent in SB and therefore we hypothesize that TV-viewing time and total hours sitting will have high concordance and can be used interchangeably to represent sedentary behaviors. Methods: Using a sample (n = 2858) from the Images of a Healthy Worksite study, a group-randomized control trial involving nutrition and physical activity, the current study assessed how two different tools measured time spent in SB. Tertiles were created based upon the distribution of hours sitting and hours spent TV-vewing. Weighted Kappa statistics were used to measure concordance between hours of TV-viewing and total hours of time spent sitting for the entire sample and for subgroup analyses. Results: Weighted Kappa statistics for tertiles of hours sitting and tv hours were 0.0046, indicating little agreement on the television and the sitting items. Kappa w statistics for BMI categories also showed poor agreement (obese Kappa w = 0.02, overweight Kappa w = 0.002, and healthy subjects Kappa w = 0.006. The Kappa w statistics for males and females were -0.006 and 0.02, respectively. Kappa w statistics for the intervention group (Kappa w = 0.007) and for the control group (Kappa w = 0.0005) also showed little agreement. Conclusions: These results suggest that although commonly used, using television viewing time and total time spent sitting as interchangeable markers of SB, is not a valid assumption. We propose that total time spent sitting and hours spent television-viewing represent different domains within the construct of sedentary behavior. It is important for future researchers to use measures of sedentary behavior that capture the numerous domains involved in measuring SB to allow for the most sensitive measurement of this high-risk behavior.


2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Nie ◽  
Y Wang

Abstract Background Marital status has been identified as an important social factor associated with mortality. In current epidemiologic research, being unmarried was observed to be a suboptimal health status in the global population. The growing number of unmarried people has health implications, in light of evidence suggesting that it is associated with an increase in the incidence of various diseases and high mortality. Few attempts have been made to produce an overall estimate and sufficiently clarified of the sex difference between unmarried status and mortality risks, this is still a matter of debate. Purpose To ascertain whether sex differences exist in the relationship between marital status and cardiovascular disease (CVD), cancer, all-cause mortality in the general population and to explore the potential effect of age, location, the duration of follow-up and publication years on these outcomes. Methods A systematic search was performed in PubMed and EMBASE from inception through to April 2018 and review of references. We used the sex-specific RRs (relative risk) to derive the women-to-men ratio of RRs (RRR) and 95% CIs from each study. Subsequently, the RRR for each outcome was pooled with random effects meta-analysis weighted by the inverse of the variances of the log RRRs. Results Twenty-one studies with 7,881,040 individuals were included for meta-analysis. Compared with married individuals, being unmarried was significantly associated with all-cause mortality, cancer mortality, CVD mortality and coronary heart disease (CHD) mortality, especially for singles, for both sexes (Figure 1). However, the association with death from all-cause and CVD was significantly stronger in men. Compared with women who were divorced/separated, divorced/separated men had significantly higher risk of all-cause mortality, cancer mortality and CVD mortality. Moreover, never married men had 31% and 9% higher excess risk of stroke mortality and all-cause mortality, respectively, compared with never married women. No sex differences were observed concerning the impact of any unmarried status on CHD mortality. Conclusions Being unmarried (widowed, divorced/separated or never married) conferred higher excess risk of stroke mortality and all-cause mortality for men than women. Moreover, divorced/separated men had significantly higher risk of cancer mortality and CVD mortality. Further studies are warranted to clarify the biological, behavioral, and/or social mechanisms involved in sex differences driving these associations.


2020 ◽  
Author(s):  
Andrew Webster ◽  
G David Batty ◽  
Natalie Pearson ◽  
Emmanuel Stamatakis ◽  
Mark Hamer

AbstractAimsWhile physical activity appears to confer protection against depression, the relationship between sedentary behaviour and mental health is uncertain. Self-reported methods provide information about context although there may be error in the quantification of sedentary behaviour. Accordingly, we examined associations of both device-measured and self-reported sedentary behaviour with depression.MethodParticipants (n=4,704; 52.4% Female; aged 46-48) were drawn from the 1970 British Cohort Study. Sitting time and moderate-vigorous physical activity was measured using a thigh-worn accelerometer device (ActivPAL) over a seven day period. A range of self-reported sedentary behaviours was measured to provide context. Depression diagnosis was captured using a combination of self-reported consultation with a physician and use of anti-depressant medication. Malaise inventory was used to assess depressive symptoms.ResultsRelative to those who spent <8 hr/d sitting, those in the highest tertile of device measured sitting (>10 hr/d) had increased odds of depression diagnosis (odds ratio= 1.48 [95% confidence interval 1.05-2.08]). There was no association between self-reported TV viewing and depression diagnosis (1.07; 0.71-1.63). We observed protective associations between moderate-vigorous physical activity and depression diagnosis (highest tertile vs. the lowest tertile; 0.70;0.49-1.00). Associations of sitting time and physical activity with depression were mutually independent. Relative to <1 hours of internet usage, 2-3 and >3 hours of internet weekday usage were associated with increased odds of depressive symptoms (1.60;1.30-1.97 and 1.63;1.32-2.03, respectively).ConclusionDevice-measured sitting is associated depression diagnosis, although less consistent associations are observed with self-reported sedentary behaviours. Regular physical activity and reducing sedentary time may be beneficial for prevention of depression.


2020 ◽  
Author(s):  
Andrew Webster ◽  
G David Batty ◽  
Natalie Pearson ◽  
Emmanuel Stamatakis ◽  
Mark Hamer

Abstract Aims While physical activity appears to confer protection against depression, the relationship between sedentary behaviour and mental health is uncertain. Self-reported methods provide information about context although there may be error in the quantification of sedentary behaviour. Accordingly, we examined associations of both device-measured and self-reported sedentary behaviour with depression. Method Participants (n=4,704; 52.4% Female; aged 46-48) were drawn from the 1970 British Cohort Study. Sitting time and moderate-vigorous physical activity was measured using a thigh-worn accelerometer device (ActivPAL) over a seven day period. A range of self-reported sedentary behaviours was measured to provide context. Depression diagnosis was captured using a combination of self-reported consultation with a physician and use of anti-depressant medication. Malaise inventory was used to assess depressive symptoms. Results Relative to those who spent <8 hr/d sitting, those in the highest tertile of device measured sitting (>10 hr/d) had increased odds of depression diagnosis (odds ratio= 1.48 [95% confidence interval 1.05-2.08]). There was no association between self-reported TV viewing and depression diagnosis (1.07; 0.71-1.63). We observed protective associations between moderate-vigorous physical activity and depression diagnosis (highest tertile vs. the lowest tertile; 0.70;0.49-1.00). Associations of sitting time and physical activity with depression were mutually independent. Relative to <1 hours of internet usage, 2-3 and >3 hours of internet weekday usage were associated with increased odds of depressive symptoms (1.60;1.30-1.97 and 1.63;1.32-2.03, respectively). Conclusion Device-measured sitting is associated depression diagnosis, although less consistent associations are observed with self-reported sedentary behaviours. Regular physical activity and reducing sedentary time may be beneficial for prevention of depression.


2018 ◽  
Vol 52 (12) ◽  
pp. 761-768 ◽  
Author(s):  
Emmanuel Stamatakis ◽  
Paul Kelly ◽  
Tessa Strain ◽  
Elaine M Murtagh ◽  
Ding Ding ◽  
...  

Background/objectivesWalking pace is associated with risk of premature mortality. However, whether this relationship is independent of total volume of physical activity and highest physical activity intensity remains unclear. We examined the associations between walking pace and cause-specific mortality, investigating the potential modifying effect of factors such as total physical activity volume, highest physical activity intensity, age, sex and body mass index (BMI).MethodsProspective pooled analysis of 11 population-based baseline surveys in England and Scotland between 1994 and2008 that were linked with mortality records. Multivariate-adjusted Cox proportional hazards models examined associations between walking pace (slow, average, brisk/fast) and all-cause, cancer and cardiovascular disease (CVD) mortality.Results50 225 walkers were entered in the core analyses. Among participants who did not experience an event in the first 2 years of follow-up (n=49 731), walking at an average or brisk/fast pace was associated with a reduced risk of all-cause (20% (95% CI 12% to 28%) and 24% (95% CI 13% to 33%), respectively) and CVD mortality (24% (95% CI 9% to 36%) and 21% (95% CI 1% to 38%), respectively), compared with reporting walking at a slow pace. In stratified analyses, such associations were evident among those over 50 years, those not meeting the physical activity recommendations and those who did not undertake vigorous-intensity activity. There were no interactions by sex or BMI. No associations were seen between pace and cancer mortality.ConclusionWalking benefits health. Assuming causality, these analyses suggest that increasing walking pace could reduce risk for all-cause and CVD mortality. Walking pace could be emphasised in public health messages, especially in situations when increase in walking volume or frequency is less feasible.


2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
N Gonzalez ◽  
M Wilhelm ◽  
A Arango ◽  
V Gonzalez ◽  
C Mesa ◽  
...  

Abstract Background Current guidelines recommend that adults with chronic health conditions should engage in regular physical activity (PA), and avoid inactivity. Yet, the exact role of PA trajectories in the mortality risk of patients with coronary heart disease (CHD) remains unclear. Purpose We aimed to perform a systematic review and meta-analysis on the association of longitudinal trajectories of PA with all-cause and cardiovascular disease (CVD) mortality in patients with CHD. Methods We performed a systematic review and meta-analysis based on PRISMA statement. Six electronic databases were searched for cohort studies that analysed the association of PA trajectories (inactive over time, active over time, increased activity over time, and decreased activity over time) with the risk of all-cause and CVD mortality in patients with CHD. Study quality was evaluated by the Newcastle Ottawa scale. We used the inverse variance weighted method to combine summary measures using random-effects models to minimize the effect of between-study heterogeneity. The study is registered in PROSPERO. Results We meta-analyzed nine longitudinal cohorts involving 33,576 patients (25010 acute CHD, 8566 chronic CHD, mean age 62.5 years, 34% women, median follow-up duration 7.2 years), according to four PA trajectories. All studies assessed PA through validated questionnaires. The definitions of activity and inactivity at baseline and follow-ups were in agreement with current PA guidelines. Trajectories were calculated based on comparison of activity status at baseline and follow-up. All the studies defined increased activity over time as moving from the inactive to the active category, and decreased activity over time as moving from the active to the inactive category. Compared to patients remaining inactive over time, the lowest risk of all-cause and CVD mortality was observed in patients remaining active over time (HR [95% CI]: 0.50 [0.39–0.63] and 0.48 [0.35–0.68], respectively), followed by patients who increased their PA over time (HR [95% CI]:0.55 [0.44–0.7] and 0.63 [0.51–0.78], respectively), and patients who decreased activity over time (HR [95% CI]: 0.80 [0.64–0.99] and 0.91 [0.67–1.24], respectively). These results were consistent both in the acute and chronic CHD settings. The overall risk of bias was low, and no evidence of publication bias was observed. Multiple sensitivity analyses provided consistent results. Conclusions In patients with CHD, the risk of all-cause and CVD mortality is progressively reduced from being inactive over time, to decreased activity over time, to increased activity over time, to being active over time. These findings highlight the benefits of adopting a more physically active lifestyle in patients with chronic and acute CHD, independent of previous PA levels. Future studies should clarify the complex interactions between motivations and disease severity as potential drivers for PA trajectories FUNDunding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): University of Bern


2018 ◽  
Vol 23 ◽  
pp. 1-6
Author(s):  
Grégore Iven Mielke ◽  
Luiza Ricardo ◽  
Andrea Wendt ◽  
Diego Christofaro ◽  
Neville Owen

High volumes of daily television viewing time increase risk of cardiovascular disease and other health problems. We report the descriptive epidemiology of high (3+ hrs/day) and very high (5+ hrs/ day) television (TV) viewing time and their correlates among Brazilian adults. Data from 60,202 participants (18 more years of age) in the National Health Survey carried in 2013 were analysed. The proportions of adults spending more than 3 hours per day and more than 5 hours/day watching TV were calculated. Descriptive and adjusted analyses examined variations in the prevalence of high and very high (of TV viewing time by age, educational attainment and physical activity level, separately for men and women. Prevalence in a normal day of high TV viewing time was 28.9% and was 8.9% for very high TV time. Overall, women and those who were less educated reported more TV time than did men and the more educated. There was a slightly inverse association between physical activity practice and TV time for men but there was not a clear association between physical activity and time spent watching TV among women. Prevalence of very high TV time was 46% lower among high-educated women than their counterparts. The prevalence of high and very high TV time suggests the need to implement actions to address high levels of TV time as a prevalent leisure- time sedentary behaviour and to promote attractive active recreational options at the population level in Brazil.


2020 ◽  
Vol 11 (4) ◽  
pp. 790-814 ◽  
Author(s):  
Mei Chung ◽  
Naisi Zhao ◽  
Deena Wang ◽  
Marissa Shams-White ◽  
Micaela Karlsen ◽  
...  

ABSTRACT Tea flavonoids have been suggested to offer potential benefits to cardiovascular health. This review synthesized the evidence on the relation between tea consumption and risks of cardiovascular disease (CVD) and all-cause mortality among generally healthy adults. PubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, Food Science and Technology Abstracts, and Ovid CAB Abstract databases were searched to identify English-language publications through 1 November 2019, including randomized trials, prospective cohort studies, and nested case-control (or case-cohort) studies with data on tea consumption and risk of incident cardiovascular events (cardiac or peripheral vascular events), stroke events (including mortality), CVD-specific mortality, or all-cause mortality. Data from 39 prospective cohort publications were synthesized. Linear meta-regression showed that each cup (236.6 mL)  increase in daily tea consumption (estimated 280 mg  and 338 mg  total flavonoids/d for black and green tea, respectively) was associated with an average 4% lower risk of CVD mortality, a 2% lower risk of CVD events, a 4% lower risk of stroke, and a 1.5% lower risk of all-cause mortality. Subgroup meta-analysis results showed that the magnitude of association was larger in elderly individuals for both CVD mortality (n = 4; pooled adjusted RR: 0.89; 95% CI: 0.83, 0.96; P = 0.001), with large heterogeneity (I2 = 72.4%), and all-cause mortality (n = 3; pooled adjusted RR: 0.92; 95% CI: 0.90, 0.94; P &lt; 0.0001; I2 = 0.3%). Generally, studies with higher risk of bias appeared to show larger magnitudes of associations than studies with lower risk of bias. Strength of evidence was rated as low and moderate (depending on study population age group) for CVD-specific mortality outcome and was rated as low for CVD events, stroke, and all-cause mortality outcomes. Daily tea intake as part of a healthy habitual dietary pattern may be associated with lower risks of CVD and all-cause mortality among adults.


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