Joint associations of accelero-meter measured physical activity and sedentary time with all-cause mortality: a harmonised meta-analysis in more than 44 000 middle-aged and older individuals

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Abstract

Objectives

To examine the joint associations of accelerometer-measured physical activity and sedentary time with all-cause mortality.

Methods

We conducted a harmonised meta-analysis including nine prospective cohort studies from four countries. 44 370 men and women were followed for 4.0 to 14.5 years during which 3451 participants died (7.8% mortality rate). Associations between different combinations of moderate-to-vigorous intensity physical activity (MVPA) and sedentary time were analysed at study level using Cox proportional hazards regression analysis and summarised using random effects meta-analysis.

Results

Across cohorts, the average time spent sedentary ranged from 8.5 hours/day to 10.5 hours/day and 8 min/day to 35 min/day for MVPA. Compared with the referent group (highest physical activity/lowest sedentary time), the risk of death increased with lower levels of MVPA and greater amounts of sedentary time. Among those in the highest third of MVPA, the risk of death was not statistically different from the referent for those in the middle (16%; 95% CI 0.87% to 1.54%) and highest (40%; 95% CI 0.87% to 2.26%) thirds of sedentary time. Those in the lowest third of MVPA had a greater risk of death in all combinations with sedentary time; 65% (95% CI 1.25% to 2.19%), 65% (95% CI 1.24% to 2.21%) and 263% (95% CI 1.93% to 3.57%), respectively.

Conclusion

Higher sedentary time is associated with higher mortality in less active individuals when measured by accelerometry. About 30–40 min of MVPA per day attenuate the association between sedentary time and risk of death, which is lower than previous estimates from self-reported data.

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Most cited references 33

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The Physical Activity Guidelines for Americans

Katrina L Piercy, Richard Troiano, Rachel M Ballard … (2018)

Approximately 80% of US adults and adolescents are insufficiently active. Physical activity fosters normal growth and development and can make people feel, function, and sleep better and reduce risk of many chronic diseases.

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Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women.

Ulf Ekelund, Jostein Steene-Johannessen, Wendy Brown … (2016)

High amounts of sedentary behaviour have been associated with increased risks of several chronic conditions and mortality. However, it is unclear whether physical activity attenuates or even eliminates the detrimental effects of prolonged sitting. We examined the associations of sedentary behaviour and physical activity with all-cause mortality.

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Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: systematic review and harmonised meta-analysis

Ulf Ekelund, Jakob Tarp, Jostein Steene-Johannessen … (2019)

Abstract Objective To examine the dose-response associations between accelerometer assessed total physical activity, different intensities of physical activity, and sedentary time and all cause mortality. Design Systematic review and harmonised meta-analysis. Data sources PubMed, PsycINFO, Embase, Web of Science, Sport Discus from inception to 31 July 2018. Eligibility criteria Prospective cohort studies assessing physical activity and sedentary time by accelerometry and associations with all cause mortality and reported effect estimates as hazard ratios, odds ratios, or relative risks with 95% confidence intervals. Data extraction and analysis Guidelines for meta-analyses and systematic reviews for observational studies and PRISMA guidelines were followed. Two authors independently screened the titles and abstracts. One author performed a full text review and another extracted the data. Two authors independently assessed the risk of bias. Individual level participant data were harmonised and analysed at study level. Data on physical activity were categorised by quarters at study level, and study specific associations with all cause mortality were analysed using Cox proportional hazards regression analyses. Study specific results were summarised using random effects meta-analysis. Main outcome measure All cause mortality. Results 39 studies were retrieved for full text review; 10 were eligible for inclusion, three were excluded owing to harmonisation challenges (eg, wrist placement of the accelerometer), and one study did not participate. Two additional studies with unpublished mortality data were also included. Thus, individual level data from eight studies (n=36 383; mean age 62.6 years; 72.8% women), with median follow-up of 5.8 years (range 3.0-14.5 years) and 2149 (5.9%) deaths were analysed. Any physical activity, regardless of intensity, was associated with lower risk of mortality, with a non-linear dose-response. Hazards ratios for mortality were 1.00 (referent) in the first quarter (least active), 0.48 (95% confidence interval 0.43 to 0.54) in the second quarter, 0.34 (0.26 to 0.45) in the third quarter, and 0.27 (0.23 to 0.32) in the fourth quarter (most active). Corresponding hazards ratios for light physical activity were 1.00, 0.60 (0.54 to 0.68), 0.44 (0.38 to 0.51), and 0.38 (0.28 to 0.51), and for moderate-to-vigorous physical activity were 1.00, 0.64 (0.55 to 0.74), 0.55 (0.40 to 0.74), and 0.52 (0.43 to 0.61). For sedentary time, hazards ratios were 1.00 (referent; least sedentary), 1.28 (1.09 to 1.51), 1.71 (1.36 to 2.15), and 2.63 (1.94 to 3.56). Conclusion Higher levels of total physical activity, at any intensity, and less time spent sedentary, are associated with substantially reduced risk for premature mortality, with evidence of a non-linear dose-response pattern in middle aged and older adults. Systematic review registration PROSPERO CRD42018091808.

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Author and article information

Journal

Journal ID (nlm-ta): Br J Sports Med

Journal ID (iso-abbrev): Br J Sports Med

Journal ID (hwp): bjsports

Journal ID (publisher-id): bjsm

Title: British Journal of Sports Medicine

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Print): 0306-3674

ISSN (Electronic): 1473-0480

Publication date (Print): December 2020

Publication date (Electronic): 23 November 2020

Volume: 54

Issue: 24

Pages: 1499-1506

Affiliations

[1 ] departmentDepartment of Sport Medicine , Norwegian School of Sport Sciences , Oslo, Norway

[2 ] departmentDepartment of chronic diseases and ageing , Norwegian Institute of Public Health , Oslo, Norway

[3 ] departmentDepartment of Sport Science and Physical Education , University of Agder , Kristiansand, Vest-Agder, Norway

[4 ] departmentPrimary Care & Population Health, Institute of Epidemiology & Health care , University College London , London, UK

[5 ] departmentPopulation Health Research Institute , St George's, University of London , London, UK

[6 ] departmentCenter for Behavioral Cardiovascular Health , Columbia University Medical Center , New York, New York, USA

[7 ] departmentCollege of Health and Human Services , San Diego State University , San Diego, California, USA

[8 ] departmentDepartment of Epidemiology , School of Public Health, University of Alabama at Birmingham , Birmingham, Alabama, USA

[9 ] departmentDepartment of Biostatistics , Boston University School of Public Health , Boston, Massachusetts, USA

[10 ] departmentDepartment of Endocrinology, Diabetes, Nutrition and Weight Management , Boston University School of Medicine , Boston, Massachusetts, USA

[11 ] departmentDepartments of Medicine and Epidemiology , Boston University School of Medicine and Boston University School of Public Health , Boston, Massachusetts, USA

[12 ] departmentDepartment of Neurobiology, Care Sciences and Society, Division of Physiotherapy , Karolinska Institutet , Stockholm, Sweden

[13 ] departmentFunction area Occupational Therapy and Physiotherapy, Allied Health Professionals , Karolinska Institutet , Huddinge, Sweden

[14 ] departmentNIHR Leicester Biomedical Research Centre , University of Leicester and University Hospitals of Leicester NHS Trust , Leicester, UK

[15 ] departmentDiabetes Research Centre, College of Life Sciences , University of Leicester , Leicester, UK

[16 ] departmentLaboratory of Epidemiology and Population Sciences , National Institute on Aging , Bethesda, Maryland, USA

[17 ] departmentMedical Research Council Epidemiology Unit , University of Cambridge , Cambridge, Cambridgeshire, UK

[18 ] departmentPhysical Activity & Behavioural Epidemiology Laboratories , Baker Heart & Diabetes Institute , Melbourne, Victoria, Australia

[19 ] departmentDepartment of Medicine , Brigham and Women’s Hospital and Harvard Medical School , Boston, Massachusetts, USA

[20 ] departmentDepartment of Epidemiology , Harvard T.H. Chan School of Public Health , Boston, Massachusetts, USA

Author notes

[Correspondence to ] Professor Ulf Ekelund, Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo 0806, Norway; Ulf.Ekelund@ 123456nih.no

Author information

Ulf Ekelund http://orcid.org/0000-0003-2115-9267

Ing-Mari Dohrn http://orcid.org/0000-0003-2593-550X

I-Min Lee http://orcid.org/0000-0002-1083-6907

Article

Publisher ID: bjsports-2020-103270

DOI: 10.1136/bjsports-2020-103270

PMC ID: 7719907

PubMed ID: 33239356

SO-VID: d88d72ea-b99e-4ed1-bea3-fcbe2bc835ba

License:

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

History

Date accepted : 12 September 2020

Funding

Funded by: National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care East Midlands;

Funded by: National Health and Medical Research Council of Australia;

Award ID: #1142685

Funded by: Health and Human Services;

Award ID: N268201500001I

Award ID: R01-AG047645

Award ID: R01-HL131029

Funded by: NIHR Biomedical Research Centre in Cambridge;

Award ID: IS-BRC-1215-20014

Funded by: UK Medical Research Council;

Award ID: MC_UU_12015/3

Award ID: MR/N003284/1

Funded by: National Institute on Aging;

Funded by: National Institute of Neurological Disorders and Stroke of the National Institutes of Health;

Award ID: R01-NS061846

Award ID: U01-NS041588

Funded by: American Heart Association;

Award ID: 15GPSGC24800006

Funded by: Research Council of Norway;

Award ID: 249932/F20

Funded by: FundRef http://dx.doi.org/10.13039/501100004348, Stockholms Läns Landsting;

Funded by: National Institutes of Health;

Award ID: CA047988

Award ID: CA154647

Award ID: CA182913

Award ID: HL043851

Award ID: HL080467

Award ID: HL099355

Funded by: Norwegian Directorate for Public Health;

Funded by: FundRef http://dx.doi.org/10.13039/501100005350, Centrum for Idrottsforskning;

Funded by: Cancer Research UK;

Award ID: C864/A14136

Funded by: The Coca-Cola Company;

Funded by: National Institutes of Health, National Heart, Lung, and Blood Institute;

Award ID: N01-HC25195

Funded by: British Heart Foundation;

Award ID: PG/13/86/30546

Award ID: RG/13/16/30528

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ScienceOpen disciplines: Sports medicine

Keywords: accelerometer,sedentary,meta-analysis,death

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ScienceOpen disciplines: Sports medicine

Keywords: accelerometer, sedentary, meta-analysis, death

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Joint associations of accelero-meter measured physical activity and sedentary time with all-cause mortality: a harmonised meta-analysis in more than 44 000 middle-aged and older individuals

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Abstract

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Chinese Journal of School Health

Most cited references 33

The Physical Activity Guidelines for Americans

Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women.

Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: systematic review and harmonised meta-analysis

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Cited by 97

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