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      Sedentary Behavior and Health Outcomes: An Overview of Systematic Reviews

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          Abstract

          Objective

          1) To synthesize the current observational evidence for the association between sedentary behavior and health outcomes using information from systematic reviews. 2) To assess the methodological quality of the systematic reviews found.

          Methodology/Principal Findings

          Medline; Excerpta Medica (Embase); PsycINFO; and Web of Science were searched for reviews published up to September 2013. Additional publications were provided by Sedentary Behaviour Research Network members. The methodological quality of the systematic reviews was evaluated using recommended standard criteria from AMSTAR. For each review, improper use of causal language in the description of their main results/conclusion was evaluated. Altogether, 1,044 review titles were identified, 144 were read in their entirety, and 27 were included. Based on the systematic reviews with the best methodological quality, we found in children and adolescents, strong evidence of a relationship between time spent in sedentary behavior and obesity. Moreover, moderate evidence was observed for blood pressure and total cholesterol, self-esteem, social behavior problems, physical fitness and academic achievement. In adults, we found strong evidence of a relationship between sedentary behavior and all-cause mortality, fatal and non-fatal cardiovascular disease, type 2 diabetes and metabolic syndrome. In addition, there is moderate evidence for incidence rates of ovarian, colon and endometrial cancers.

          Conclusions

          This overview based on the best available systematics reviews, shows that sedentary behavior may be an important determinant of health, independently of physical activity. However, the relationship is complex because it depends on the type of sedentary behavior and the age group studied. The relationship between sedentary behavior and many health outcomes remains uncertain; thus, further studies are warranted.

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          Most cited references28

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          Sedentary behaviors and subsequent health outcomes in adults a systematic review of longitudinal studies, 1996-2011.

          Alicia Thorp, Neville Owen, Maike Neuhaus … (2011)
          To systematically review and provide an informative synthesis of findings from longitudinal studies published since 1996 reporting on relationships between self-reported sedentary behavior and device-based measures of sedentary time with health-related outcomes in adults. Studies published between 1996 and January 2011 were identified by examining existing literature reviews and by systematic searches in Web of Science, MEDLINE, PubMed, and PsycINFO. English-written articles were selected according to study design, targeted behavior, and health outcome. Forty-eight articles met the inclusion criteria; of these, 46 incorporated self-reported measures including total sitting time; TV viewing time only; TV viewing time and other screen-time behaviors; and TV viewing time plus other sedentary behaviors. Findings indicate a consistent relationship of self-reported sedentary behavior with mortality and with weight gain from childhood to the adult years. However, findings were mixed for associations with disease incidence, weight gain during adulthood, and cardiometabolic risk. Of the three studies that used device-based measures of sedentary time, one showed that markers of obesity predicted sedentary time, whereas inconclusive findings have been observed for markers of insulin resistance. There is a growing body of evidence that sedentary behavior may be a distinct risk factor, independent of physical activity, for multiple adverse health outcomes in adults. Prospective studies using device-based measures are required to provide a clearer understanding of the impact of sedentary time on health outcomes. Copyright © 2011 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
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            Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women.

            Matthias B. Schulze (2004)
            Sugar-sweetened beverages like soft drinks and fruit punches contain large amounts of readily absorbable sugars and may contribute to weight gain and an increased risk of type 2 diabetes, but these relationships have been minimally addressed in adults. To examine the association between consumption of sugar-sweetened beverages and weight change and risk of type 2 diabetes in women. Prospective cohort analyses conducted from 1991 to 1999 among women in the Nurses' Health Study II. The diabetes analysis included 91,249 women free of diabetes and other major chronic diseases at baseline in 1991. The weight change analysis included 51,603 women for whom complete dietary information and body weight were ascertained in 1991, 1995, and 1999. We identified 741 incident cases of confirmed type 2 diabetes during 716,300 person-years of follow-up. Weight gain and incidence of type 2 diabetes. Those with stable consumption patterns had no difference in weight gain, but weight gain over a 4-year period was highest among women who increased their sugar-sweetened soft drink consumption from 1 or fewer drinks per week to 1 or more drinks per day (multivariate-adjusted means, 4.69 kg for 1991 to 1995 and 4.20 kg for 1995 to 1999) and was smallest among women who decreased their intake (1.34 and 0.15 kg for the 2 periods, respectively) after adjusting for lifestyle and dietary confounders. Increased consumption of fruit punch was also associated with greater weight gain compared with decreased consumption. After adjustment for potential confounders, women consuming 1 or more sugar-sweetened soft drinks per day had a relative risk [RR] of type 2 diabetes of 1.83 (95% confidence interval [CI], 1.42-2.36; P or =1 drink per day compared with <1 drink per month, 2.00; 95% CI, 1.33-3.03; P =.001). Higher consumption of sugar-sweetened beverages is associated with a greater magnitude of weight gain and an increased risk for development of type 2 diabetes in women, possibly by providing excessive calories and large amounts of rapidly absorbable sugars.
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              Sedentary behaviors and health outcomes among adults: a systematic review of prospective studies.

              Karin I. Proper, Amika S Singh, Willem van Mechelen … (2011)
              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. 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. 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. Copyright © 2011 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
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                Author and article information

                Contributors
                Alejandro Lucia: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, USA )
                ISSN (Electronic): 1932-6203
                Publication date Collection: 2014
                Publication date (Electronic): 21 August 2014
                Volume: 9
                Issue: 8
                Electronic Location Identifier: e105620
                Affiliations
                [1 ]Departamento de Medicina Preventiva, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
                [2 ]Centro de Estudos do Laboratório de Aptidão Fĩsica de São Caetano do Sul, São Caetano do Sul, Brasil
                Universidad Europea de Madrid, Spain
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: LFMR ML JPRL VKRM OCL. Performed the experiments: LFMR ML JPRL VKRM OCL. Analyzed the data: LFMR ML JPRL. Contributed reagents/materials/analysis tools: LFMR ML JPRL. Wrote the paper: LFMR ML JPRL VKRM OCL.

                Article
                Publisher ID: PONE-D-13-43708
                DOI: 10.1371/journal.pone.0105620
                PMC ID: 4140795
                PubMed ID: 25144686
                SO-VID: f31ca5fc-c939-4c4b-87da-1e8e68c85de4
                Copyright statement: Copyright @ 2014
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 23 October 2013
                Date accepted : 23 July 2014
                Page count
                Pages: 7
                Funding
                This study received financial support from the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP, São Paulo Research Foundation; Grant no. 2012/07314-8). JPRL received financial support from the FAPESP, São Paulo Research Foundation: Grant no. 2012/057238. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Subject: Research Article
                Subject: Biology and Life Sciences
                Subject: Psychology
                Subject: Behavior
                Subject: Medicine and Health Sciences
                Subject: Epidemiology
                Subject: Lifecourse Epidemiology
                Subject: Health Care
                Subject: Health Care Policy
                Subject: Health Risk Analysis
                Subject: Health Statistics
                Subject: Public and Occupational Health
                Subject: Behavioral and Social Aspects of Health
                Subject: Sports and Exercise Medicine
                Subject: Research and Analysis Methods
                Subject: Research Assessment
                Subject: Systematic Reviews
                Subject: Research Design
                Subject: Clinical Research Design
                Subject: Social Sciences

                ScienceOpen disciplines: Uncategorized
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                ScienceOpen disciplines: Uncategorized

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