Context
Whether physical activity attenuates the association of total daily sitting time with
cardiovascular disease and diabetes incidence is unclear. This systematic review and
meta-analysis examined the association of total daily sitting time with cardiovascular
disease and diabetes with and without adjustment for physical activity.
Evidence acquisition
PubMed, Web of Science, BASE, MEDLINE, Academic Search Elite, and ScienceDirect were
searched for prospective studies, published between January 1, 1989, and February
15, 2019, examining the association of total daily sitting time with cardiovascular
disease or diabetes outcomes. Data extraction and study quality assessments were conducted
by 2 independent reviewers. Pooled hazard ratios (HRs) were calculated using a fixed-effects
model. The quality assessment and meta-analysis procedures were completed in 2018.
Evidence synthesis
Nine studies with 448,285 participants were included. A higher total daily sitting
time was associated with a significantly increased risk of cardiovascular disease
(HR=1.29, 95% CI=1.27, 1.30, p<0.001) and diabetes (HR=1.13, 95% CI=1.04, 1.22, p<0.001) incidence when not adjusted for physical activity. The increased risk for
diabetes was unaffected when adjusting for physical activity (HR=1.11, 95% CI=1.01,
1.19, p<0.001). For cardiovascular disease, the increased risk was attenuated but remained
significant (HR=1.14, 95% CI=1.04, 1.23, p<0.001).
Conclusions
Higher levels of total daily sitting time are associated with an increased risk of
cardiovascular disease and diabetes, independent of physical activity. Reductions
in total daily sitting may be recommended in public health guidelines.
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Article info
Publication history
Published online: August 01, 2019
Identification
Copyright
© 2019 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
