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      New global guidelines on sedentary behaviour and health for adults: broadening the behavioural targets

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          In 2018, the World Health Organisation (WHO) commenced a program of work to update the 2010 Global Recommendations on Physical Activity for Health, for the first-time providing population-based guidelines on sedentary behaviour. This paper briefly summarizes and highlights the scientific evidence behind the new sedentary behaviour guidelines for all adults and discusses its strengths and limitations, including evidence gaps/research needs and potential implications for public health practice.


          An overview of the scope and methods used to update the evidence is provided, along with quality assessment and grading methods for the eligible new systematic reviews. The literature search update was conducted for WHO by an external team and reviewers used the AMSTAR 2 (Assessment of Multiple Systematic Reviews) tool for critical appraisal of the systematic reviews under consideration for inclusion. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) method was used to rate the certainty (i.e. very low to high) of the evidence.


          The updated systematic review identified 22 new reviews published from 2017 up to August 2019, 14 of which were incorporated into the final evidence profiles. Overall, there was moderate certainty evidence that higher amounts of sedentary behaviour increase the risk for all-cause, cardiovascular disease (CVD) and cancer mortality, as well as incidence of CVD, cancer, and type 2 diabetes. However, evidence was deemed insufficient at present to set quantified (time-based) recommendations for sedentary time. Moderate certainty evidence also showed that associations between sedentary behaviour and all-cause, CVD and cancer mortality vary by level of moderate-to-vigorous physical activity (MVPA), which underpinned additional guidance around MVPA in the context of high sedentary time. Finally, there was insufficient or low-certainty systematic review evidence on the type or domain of sedentary behaviour, or the frequency and/or duration of bouts or breaks in sedentary behaviour, to make specific recommendations for the health outcomes examined.


          The WHO 2020 guidelines are based on the latest evidence on sedentary behaviour and health, along with interactions between sedentary behaviour and MVPA, and support implementing public health programmes and policies aimed at increasing MVPA and limiting sedentary behaviour. Important evidence gaps and research opportunities are identified.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12966-020-01044-0.

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          Most cited references 54

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          GRADE: an emerging consensus on rating quality of evidence and strength of recommendations.

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            AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both

            The number of published systematic reviews of studies of healthcare interventions has increased rapidly and these are used extensively for clinical and policy decisions. Systematic reviews are subject to a range of biases and increasingly include non-randomised studies of interventions. It is important that users can distinguish high quality reviews. Many instruments have been designed to evaluate different aspects of reviews, but there are few comprehensive critical appraisal instruments. AMSTAR was developed to evaluate systematic reviews of randomised trials. In this paper, we report on the updating of AMSTAR and its adaptation to enable more detailed assessment of systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. With moves to base more decisions on real world observational evidence we believe that AMSTAR 2 will assist decision makers in the identification of high quality systematic reviews, including those based on non-randomised studies of healthcare interventions.
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              GRADE guidelines: 3. Rating the quality of evidence.

              This article introduces the approach of GRADE to rating quality of evidence. GRADE specifies four categories-high, moderate, low, and very low-that are applied to a body of evidence, not to individual studies. In the context of a systematic review, quality reflects our confidence that the estimates of the effect are correct. In the context of recommendations, quality reflects our confidence that the effect estimates are adequate to support a particular recommendation. Randomized trials begin as high-quality evidence, observational studies as low quality. "Quality" as used in GRADE means more than risk of bias and so may also be compromised by imprecision, inconsistency, indirectness of study results, and publication bias. In addition, several factors can increase our confidence in an estimate of effect. GRADE provides a systematic approach for considering and reporting each of these factors. GRADE separates the process of assessing quality of evidence from the process of making recommendations. Judgments about the strength of a recommendation depend on more than just the quality of evidence. Copyright © 2011 Elsevier Inc. All rights reserved.

                Author and article information

                Int J Behav Nutr Phys Act
                Int J Behav Nutr Phys Act
                The International Journal of Behavioral Nutrition and Physical Activity
                BioMed Central (London )
                26 November 2020
                26 November 2020
                : 17
                [1 ]GRID grid.5335.0, ISNI 0000000121885934, MRC Epidemiology Unit, Institute of Metabolic Science, , University of Cambridge, ; Cambridge Biomedical Campus, Cambridge, UK
                [2 ]GRID grid.1051.5, ISNI 0000 0000 9760 5620, Baker Heart and Diabetes Institute, ; Melbourne, Australia
                [3 ]Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
                [4 ]GRID grid.1048.d, ISNI 0000 0004 0473 0844, Centre for Health Research, , University of Southern Queensland, ; Springfield Central, Australia
                [5 ]GRID grid.215654.1, ISNI 0000 0001 2151 2636, College of Health Solutions, , Arizona State University, ; Phoenix, AZ USA
                [6 ]GRID grid.5342.0, ISNI 0000 0001 2069 7798, Department of Movement and Sports Sciences, , University of Ghent, ; Ghent, Belgium
                [7 ]GRID grid.5214.2, ISNI 0000 0001 0669 8188, School of Health and Life Sciences, Institute for Applied Health Research, , Glasgow Caledonian University, ; Glasgow, UK
                [8 ]GRID grid.412285.8, ISNI 0000 0000 8567 2092, Department of Sport Medicine, , Norwegian School of Sport Science, ; Oslo, Norway
                [9 ]GRID grid.418193.6, ISNI 0000 0001 1541 4204, Department of Chronic Diseases and Ageing, , Norwegian Institute of Public Health, ; Oslo, Norway
                [10 ]GRID grid.413574.0, ISNI 0000 0001 0693 8815, Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, , Alberta Health Services, ; Calgary, Canada
                [11 ]GRID grid.22072.35, ISNI 0000 0004 1936 7697, Departments of Oncology and Community Health Sciences, Cumming School of Medicine, , University of Calgary, ; Calgary, Canada
                [12 ]GRID grid.250514.7, ISNI 0000 0001 2159 6024, Pennington Biomedical Research Center, ; Baton Rouge, LA 70808 USA
                [13 ]GRID grid.7727.5, ISNI 0000 0001 2190 5763, Department of Epidemiology and Preventive Medicine, , University of Regensburg, ; Regensburg, Germany
                [14 ]GRID grid.1013.3, ISNI 0000 0004 1936 834X, Charles Perkins Centre, School of Health Sciences, Faculty of Medicine and Health, , University of Sydney, ; Sydney, Australia
                [15 ]GRID grid.12380.38, ISNI 0000 0004 1754 9227, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, , Vrije Universiteit Amsterdam, ; Amsterdam, The Netherlands
                [16 ]GRID grid.3575.4, ISNI 0000000121633745, Physical Activity Unit, Department of Health Promotion, , World Health Organization, ; Geneva, Switzerland
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                Funded by: National Health and Medical Research Council of Australia
                Award ID: 1110526 and 1194510
                Award ID: 1142685
                Award Recipient :
                Funded by: PAL Technologies
                Funded by: FundRef http://dx.doi.org/10.13039/100011094, Public Health Agency of Canada;
                Funded by: Government of Norway
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