Association of Accelerometer‐Measured Sedentary Accumulation Patterns With Incident Cardiovascular Disease, Cancer, and All‐Cause Mortality

Abstract

Background Emerging evidence suggests accruing sedentary behavior (SB) in relatively more prolonged periods may convey additional cardiometabolic risks, but few studies have examined prospective outcomes. We examined the association of SB accumulation patterns with incident cardiovascular disease (CVD), cancer, and all‐cause mortality (ACM). Methods and Results Data were from 7671 EPIC‐Norfolk (European Prospective Investigation Into Cancer and Nutrition–Norfolk) cohort middle‐ to older‐aged adults who wore accelerometers on the right hip for 4 to 7 days. Cox proportional hazards regression modeled associations between 2 measures of SB accumulation and incident CVD, cancer, and ACM. These were usual SB bout duration (the midpoint of each individual’s SB accumulation curve, fitted using nonlinear regression) and alpha (hybrid measure of bout frequency and duration, with higher values indicating relatively shorter bouts and fewer long bouts). Models were adjusted for potential confounders, then further for 24‐hour time‐use compositions. During mean follow‐up time of 6.4 years, 339 ACM, 1106 CVD, and 516 cancer events occurred. Elevated rates of incident cancer and ACM were seen with more prolonged SB accumulation (lower alpha, higher usual SB bout duration) but not CVD. For usual SB bout duration and alpha, respectively, the confounder‐adjusted hazard ratios per SD of the exposure were 1.12 (95% CI, 1.02–1.23) and 0.88 (95% CI, 0.79–0.98) with incident cancer and 1.16 (95% CI, 1.07–1.26) and 0.80 (95% CI, 0.72–0.89) with ACM (all P <0.05). Further adjustment for 24‐hour time use weakened associations with ACM for usual bout duration (hazard ratio, 1.06; 95% CI, 0.97–1.16; P =0.209) and partially for alpha (hazard ratio, 0.87; 95% CI, 0.77–0.99; P =0.029). Conclusions Accruing SB in longer bout durations was associated with higher rates of incident cancer and ACM but not with incident CVD, with some evidence of direct SB accumulation effects independent of 24‐hour time use. Findings provide some support for considering SB accumulation as an adjunct target of messaging to “sit less and move more.”

Association of Accelerometer‐Measured Physical Activity and Sedentary Behavior With Incident Cardiovascular Disease, Myocardial Infarction, and Ischemic Stroke: The Women's Health Study

“…Three studies found no association between total time spent in SB or SB accumulation patterns with CVD risk after adjustment for covariates. 14 , 22 , 28 Null findings may be due to inadequate power 28 or the use of uniaxial accelerometers, which may not be as precise in measuring SB. 15 In contrast, 5 other studies reported that greater daily sedentary time was associated with increased risk of total CVD.…”

“… 14 , 15 , 16 , 17 , 18 , 19 , 23 , 24 , 25 , 26 Moreover, although there is strong evidence for an association between self‐reported SB and CVD incidence, 11 there is mixed evidence for whether accelerometer‐measured SB is associated with an increased risk of CVD or CVD mortality. 14 , 15 , 16 , 18 , 22 , 24 , 25 , 27 , 28 Public health interventions that increase time spent in higher‐intensity activities inherently require spending less time in a lower‐intensity activity, as time is fixed within a day. Few studies have assessed whether substituting time spent sedentary for either HLPA or MVPA, measured by accelerometry, is associated with lower risk of CVD.…”

Responsiveness of Electromyographically Assessed Skeletal Muscle Inactivity – methodological exploration and implications for health benefits

“…Analysis of accumulation pattern showed that EMG inactivity duration was accumulated through shorter EMG inactivity bouts, the lower the EMG inactivity threshold was (median 1 second to 97 seconds). Accelerometer-measured usual sedentary bout duration has been reported to be around 17-26 minutes in healthy participants, and several studies have reported that accruing total sedentary time in longer sedentary bouts is adversely associated with health [5][6][7][8][9]49 . However, in one study also short sedentary bouts were found to be detrimental 55 .…”

“…Observational evidence has further indicated that total overall volume of sedentary time is associated with incident of cardiovascular diseases and all-cause mortality 3,4 . In addition, accumulating sitting time or sedentary time in a prolonged unbroken manner consistent with long periods of muscle inactivity is associated with markers of cardiometabolic health, prevalent diabetes, incident cancer and all-cause mortality [5][6][7][8][9] . While high total sedentary time and a prolonged pattern of accumulation often co-exist, they may carry partly independent, and/or additive risk for health 5,6,10 .…”

The association between daily sedentary and active bout frequency with mortality risk in older men using accelerometry

“…12 Using accelerometers, bouts of activity and sedentary behavior can be calculated in many ways, such as activity fragmentation, active and sedentary bout length, or interruptions of a sedentary bout per hour. 8,[13][14][15][16][17] Activity fragmentation calculates the probability of transitioning from active to a sedentary state using minute-byminute data. 8 Active and sedentary bout length captures accumulation of these activities in specified bout lengths (e.g., accumulation of active bouts lasting 2-4 min, etc.).…”