Association of Sitting Time With Mortality and Cardiovascular Events in High-Income, Middle-Income, and Low-Income Countries

Abstract

High amounts of sitting time are associated with increased risks of cardiovascular disease (CVD) and mortality in high-income countries, but it is unknown whether risks also increase in low-and middle-income countries.OBJECTIVE To investigate the association of sitting time with mortality and major CVD in countries at different economic levels using data from the Prospective Urban Rural Epidemiology study. DESIGN, SETTING, AND PARTICIPANTSThis population-based cohort study included participants aged 35 to 70 years recruited from January 1, 2003, and followed up until August 31, 2021, in 21 high-income, middle-income, and low-income countries with a median follow-up of 11.1 years.EXPOSURES Daily sitting time measured using the International Physical Activity Questionnaire. MAIN OUTCOMES AND MEASURESThe composite of all-cause mortality and major CVD (defined as cardiovascular death, myocardial infarction, stroke, or heart failure). RESULTSOf 105 677 participants, 61 925 (58.6%) were women, and the mean (SD) age was 50.4 (9.6) years. During a median follow-up of 11.1 (IQR, 8.6-12.2) years, 6233 deaths and 5696 major cardiovascular events (2349 myocardial infarctions, 2966 strokes, 671 heart failure, and 1792 cardiovascular deaths) were documented. Compared with the reference group (<4 hours per day of sitting), higher sitting time (Ն8 hours per day) was associated with an increased risk of the composite outcome (hazard ratio [HR], 1.19; 95% CI, 1.11-1.28; P for trend < .001), all-cause mortality (HR, 1.20; 95% CI, 1.10-1.31; P for trend < .001), and major CVD (HR, 1.21; 95% CI, 1.10-1.34; P for trend < .001). When stratified by country income levels, the association of sitting time with the composite outcome was stronger in low-income and lower-middle-income countries (Ն8 hours per day: HR, 1.29; 95% CI, 1.16-1.44) compared with high-income and upper-middle-income countries (HR, 1.08; 95% CI, 0.98-1.19; P for interaction = .02). Compared with those who reported sitting time less than 4 hours per day and high physical activity level, participants who sat for 8 or more hours per day experienced a 17% to 50% higher associated risk of the composite outcome across physical activity levels; and the risk was attenuated along with increased physical activity levels.CONCLUSIONS AND RELEVANCE High amounts of sitting time were associated with increased risk of all-cause mortality and CVD in economically diverse settings, especially in low-income and lower-middle-income countries. Reducing sedentary time along with increasing physical activity might be an important strategy for easing the global burden of premature deaths and CVD.

Effectiveness of an intervention to reduce sedentary behaviour as a personalised secondary prevention strategy for patients with coronary artery disease: main outcomes of the SIT LESS randomised clinical trial

“…The observed reductions in ST in both groups could be clinically relevant. Isotemporal substitution analyses show that reducing 30 min of ST is associated with 2% lower risk of mortality and major adverse cardiovascular events [ 37 ] and 2–4% improvement in cardiovascular risk factors [ 38 ]. The relation between ST and (cardiovascular) mortality risk appears to be curvilinear, as the risk increases exponentially as daily ST increases [ 4 ].…”

The Metaverse, the Built Environment, and Public Health: Opportunities and Uncertainties

“…Fourth, this adoption of a “metaverse lifestyle” could also have potential unintentional physical health consequences by increasing physical inactivity. For instance, spending several hours per day in a metaverse could accumulate too much sitting time, which has been found to have several adverse physical health effects [ 32 , 33 ]. To avoid too much sitting, interacting in the metaverse should require physical movement in the real world.…”

How can physical activity facilitate a sustainable future? Reducing obesity and chronic disease

“…The past decade has seen increased focus on the adverse health effects of sedentary behaviour specifically and independently of overall physical activity levels. A recent publication, for example, involving over 105 000 men and women followed for a median of 11•1 years, observed that sitting for ≥8 h/d compared with sitting for <4 h/d was associated with an increased risk of allcause mortality and CVD events and this association was stronger in low-income and lower-middle-income countries than in high-income and upper-middle income countries (103) . Such findings confirm earlier reports from the community based Kungsholmen Project in Stockholm, Sweden, that physical activity is an essential healthy lifestyle component associated with extended mortality where benefits are maintained even in those in their 70s and 80s (104) .…”