Author + information
- Received November 6, 2018
- Revision received January 31, 2019
- Accepted February 2, 2019
- Published online April 22, 2019.
- Emmanuel Stamatakis, PhDa,∗ (, )@M_Stamatakis,
- Joanne Gale, PhDa,
- Adrian Bauman, PhDa,
- Ulf Ekelund, PhDb,
- Mark Hamer, PhDc and
- Ding Ding, PhDa
- aCharles Perkins Centre and Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- bDepartment of Sport Medicine, Norwegian School of Sport Sciences, and Norwegian Institute of Public Health, Oslo, Norway
- cNational Centre for Sport & Exercise Medicine–East Midlands, Loughborough University, East Midlands, United Kingdom
- ↵∗Address for correspondence:
Dr. Emmanuel Stamatakis, D17, The Hub, Level 6, Charles Perkins Centre, The University of Sydney, 2006, NSW, Australia.
Background It is unclear what level of moderate to vigorous intensity physical activity (MVPA) offsets the health risks of sitting.
Objectives The purpose of this study was to examine the joint and stratified associations of sitting and MVPA with all-cause and cardiovascular disease (CVD) mortality, and to estimate the theoretical effect of replacing sitting time with physical activity, standing, and sleep.
Methods A longitudinal analysis of the 45 and Up Study calculated the multivariable-adjusted hazard ratios (HRs) of sitting for each sitting-MVPA combination group and within MVPA strata. Isotemporal substitution modeling estimated the per-hour HR effects of replacing sitting.
Results A total of 8,689 deaths (1,644 due to CVD) occurred among 149,077 participants over an 8.9-year (median) follow-up. There was a statistically significant interaction between sitting and MVPA only for all-cause mortality. Sitting time was associated with both mortality outcomes in a nearly dose-response manner in the least active groups reporting <150 MVPA min/week. For example, among those reporting no MVPA, the all-cause mortality HR comparing the most sedentary (>8 h/day) to the least sedentary (<4 h/day) groups was 1.52 (95% confidence interval: 1.13 to 2.03). There was inconsistent and weak evidence for elevated CVD and all-cause mortality risks with more sitting among those meeting the lower (150 to 299 MVPA min/week) or upper (≥300 MVPA min/week) limits of the MVPA recommendation. Replacing sitting with walking and MVPA showed stronger associations among high sitters (>6 sitting h/day) where, for example, the per-hour CVD mortality HR for sitting replaced with vigorous activity was 0.36 (95% confidence interval: 0.17 to 0.74).
Conclusions Sitting is associated with all-cause and CVD mortality risk among the least physically active adults; moderate-to-vigorous physical activity doses equivalent to meeting the current recommendations attenuate or effectively eliminate such associations.
Dr. Stamatakis is funded by a Senior Research Fellowship offered by the National Health and Medical Research Council; and has received support from PAL Technologies Ltd., which manufactures wearable monitors that quantify sitting/reclining, standing, and walking, in the form of an unrestricted grant. Dr. Ding is funded by a Future Leader Fellowship provided by the Heart Foundation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received November 6, 2018.
- Revision received January 31, 2019.
- Accepted February 2, 2019.
- 2019 The Authors