Sedentary Behaviors and Health Outcomes Among Adults

A Systematic Review of Prospective Studies
  • Karin I. Proper
    Address correspondence to: Karin I. Proper, PhD, VU University Medical Center, Department of Public and Occupational Health, EMGO Institute for Health and Care Research, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
    Department of Public and Occupational Health and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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  • Amika S. Singh
    Department of Public and Occupational Health and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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  • Willem van Mechelen
    Department of Public and Occupational Health and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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  • Mai J.M. Chinapaw
    Department of Public and Occupational Health and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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      Nowadays, people spend a substantial amount of time per day on sedentary behaviors and it is likely that the time spent sedentary will continue to rise. To date, there is no review of prospective studies that systematically examined the relationship between diverse sedentary behaviors and various health outcomes among adults.


      This review aimed to systematically review the literature as to the relationship between sedentary behaviors and health outcomes considering the methodologic quality of the studies.

      Evidence acquisition

      In February 2010, a search for prospective studies was performed in diverse electronic databases. After inclusion, in 2010, the methodologic quality of each study was assessed. A best-evidence synthesis was applied to draw conclusions.

      Evidence synthesis

      19 studies were included, of which 14 were of high methodologic quality. Based on inconsistency in findings among the studies and lack of high-quality prospective studies, insufficient evidence was concluded for body weight–related measures, CVD risk, and endometrial cancer. Further, moderate evidence for a positive relationship between the time spent sitting and the risk for type 2 diabetes was concluded. Based on three high-quality studies, there was no evidence for a relationship between sedentary behavior and mortality from cancer, but strong evidence for all-cause and CVD mortality.


      Given the trend toward increased time in sedentary behaviors, additional prospective studies of high methodologic quality are recommended to clarify the causal relationships between sedentary behavior and health outcomes. Meanwhile, evidence to date suggests that interventions aimed at reducing sedentary behavior are needed.
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      Linked Article

      • Sedentary Behavior: What's in a Definition?
        American Journal of Preventive MedicineVol. 40Issue 6
        • Preview
          Over the past decade, we have witnessed an increasing number of observational research studies investigating the impact of sedentary behavior on health; these studies were recently summarized in a systematic review.1 Although we recognize the need and importance of this review and support the authors' conclusions, we feel that the review succumbed to a common pitfall when trying to disentangle the effect of sedentary behavior from that of physical activity.
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      • Author Response
        American Journal of Preventive MedicineVol. 40Issue 6
        • Preview
          In our review,1 we examined the longitudinal relationship between sedentary behavior and health outcomes in adults. The main reason for this review was the increasing awareness and literature on the adverse health effect of sedentary time, independent of physical activity. We followed a systematic approach, including predefined criteria for the literature search, selection of studies, and subsequently their methodologic appraisal. To be included in the review, the study had to examine the prospective relationship between sedentary behavior and a health indicator.
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