Background: The prominence of sedentary behavior research in health science has grown rapidly. With this growth there is increasing urgency for clear, common and accepted terminology and definitions. Such standardization is difficult to achieve, especially across multi-disciplinary researchers, practitioners, and industries. The Sedentary Behavior Research Network (SBRN) undertook a Terminology Consensus Project to address this need. Method: First, a literature review was completed to identify key terms in sedentary behavior research. These key terms were then reviewed and modified by a Steering Committee formed by SBRN. Next, SBRN members were invited to contribute to this project and interested participants reviewed and provided feedback on the proposed list of terms and draft definitions through an online survey. Finally, a conceptual model and consensus definitions (including caveats and examples for all age groups and functional abilities) were finalized based on the feedback received from the 87 SBRN member participants who responded to the original invitation and survey. Results: Consensus definitions for the terms physical inactivity, stationary behavior, sedentary behavior, standing, screen time, non-screen-based sedentary time, sitting, reclining, lying, sedentary behavior pattern, as well as how the terms bouts, breaks, and interruptions should be used in this context are provided. Conclusion: It is hoped that the definitions resulting from this comprehensive, transparent, and broad-based participatory process will result in standardized terminology that is widely supported and adopted, thereby advancing future research, interventions, policies, and practices related to sedentary behaviors.

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Sedentary behavior research network (SBRN) - terminology consensus project process and outcome

Aims/hypothesis
Sedentary (sitting) behaviours are ubiquitous in modern society. We conducted a systematic review and meta-analysis to examine the association of sedentary time with diabetes, cardiovascular disease and cardiovascular and all-cause mortality.

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Sedentary time in adults and the association with diabetes, cardiovascular disease and death: systematic review and meta-analysis

Accumulating evidence suggests that, independent of physical activity levels, sedentary behaviours are associated with increased risk of cardio-metabolic disease, all-cause mortality, and a variety of physiological and psychological problems. Therefore, the purpose of this systematic review is to determine the relationship between sedentary behaviour and health indicators in school-aged children and youth aged 5-17 years. Online databases (MEDLINE, EMBASE and PsycINFO), personal libraries and government documents were searched for relevant studies examining time spent engaging in sedentary behaviours and six specific health indicators (body composition, fitness, metabolic syndrome and cardiovascular disease, self-esteem, pro-social behaviour and academic achievement). 232 studies including 983,840 participants met inclusion criteria and were included in the review. Television (TV) watching was the most common measure of sedentary behaviour and body composition was the most common outcome measure. Qualitative analysis of all studies revealed a dose-response relation between increased sedentary behaviour and unfavourable health outcomes. Watching TV for more than 2 hours per day was associated with unfavourable body composition, decreased fitness, lowered scores for self-esteem and pro-social behaviour and decreased academic achievement. Meta-analysis was completed for randomized controlled studies that aimed to reduce sedentary time and reported change in body mass index (BMI) as their primary outcome. In this regard, a metaanalysis revealed an overall significant effect of -0.81 (95% CI of -1.44 to -0.17, p = 0.01) indicating an overall decrease in mean BMI associated with the interventions. There is a large body of evidence from all study designs which suggests that decreasing any type of sedentary time is associated with lower health risk in youth aged 5-17 years. In particular, the evidence suggests that daily TV viewing in excess of 2 hours is associated with reduced physical and psychosocial health, and that lowering sedentary time leads to reductions in BMI.

http://activeworking.com/pdfs/research/71.pdf

Systematic review of sedentary behaviour and health indicators in school-aged children and youth: an update.

Objective To quantify the association between daily total sitting and all-cause mortality risk and to examine dose-response relationships with and without adjustment for moderate-to-vigorous physical activity. Methods Studies published from 1989 to January 2013 were identified via searches of multiple databases, reference lists of systematic reviews on sitting and health, and from authors' personal literature databases. We included prospective cohort studies that had total daily sitting time as a quantitative exposure variable, all-cause mortality as the outcome and reported estimates of relative risk, or odds ratios or hazard ratios with 95% confidence intervals. Two authors independently extracted the data and summary estimates of associations were computed using random effects models. Results Six studies were included, involving data from 595,086 adults and 29,162 deaths over 3,565,569 person-years of follow-up. Study participants were mainly female, middle-aged or older adults from high-income countries; mean study quality score was 12/15 points. Associations between daily total sitting time and all-cause mortality were not linear. With physical activity adjustment, the spline model of best fit had dose-response HRs of 1.00 (95% CI: 0.98-1.03), 1.02 (95% CI: 0.99-1.05) and 1.05 (95% CI: 1.02-1.08) for every 1-hour increase in sitting time in intervals between 0-3, >3-7 and >7 h/day total sitting, respectively. This model estimated a 34% higher mortality risk for adults sitting 10 h/day, after taking physical activity into account. The overall weighted population attributable fraction for all-cause mortality for total daily sitting time was 5.9%, after adjusting for physical activity. Conclusions Higher amounts of daily total sitting time are associated with greater risk of all-cause mortality and moderate-to-vigorous physical activity appears to attenuate the hazardous association. These findings provide a starting point for identifying a threshold on which to base clinical and public health recommendations for overall sitting time, in addition to physical activity guidelines.

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Daily sitting time and all-cause mortality: a meta-analysis.

Physical activity and sedentary behaviour in youth have been reported to vary by sex, age, weight status and country. However, supporting data are often self-reported and/or do not encompass a wide range of ages or geographical locations. This study aimed to describe objectively-measured physical activity and sedentary time patterns in youth. The International Children’s Accelerometry Database (ICAD) consists of ActiGraph accelerometer data from 20 studies in ten countries, processed using common data reduction procedures. Analyses were conducted on 27,637 participants (2.8–18.4 years) who provided at least three days of valid accelerometer data. Linear regression was used to examine associations between age, sex, weight status, country and physical activity outcomes. Boys were less sedentary and more active than girls at all ages. After 5 years of age there was an average cross-sectional decrease of 4.2 % in total physical activity with each additional year of age, due mainly to lower levels of light-intensity physical activity and greater time spent sedentary. Physical activity did not differ by weight status in the youngest children, but from age seven onwards, overweight/obese participants were less active than their normal weight counterparts. Physical activity varied between samples from different countries, with a 15–20 % difference between the highest and lowest countries at age 9–10 and a 26–28 % difference at age 12–13. Physical activity differed between samples from different countries, but the associations between demographic characteristics and physical activity were consistently observed. Further research is needed to explore environmental and sociocultural explanations for these differences.

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Objectively measured physical activity and sedentary time in youth: the International children's accelerometry database (ICAD).

There has recently been an increase in research related to the health impact of sedentary behaviour (e.g., sitting) (Tremblay et al. 2010). Numerous studies suggest that those who engage in high amounts of sedentary behaviour can be at increased risk of morbidity and mortality regardless of their level of moderateto vigorous-intensity physical activity (MVPA) (Dunstan et al. 2010; Grøntved and Hu 2011; Katzmarzyk et al. 2009; Thorp et al. 2011; Wijndaele et al. 2011). Further, it has been noted that there is often little association between sedentary behaviour and MVPA (Biddle et al. 2004; Ekelund et al. 2006) and that it is possible for an individual to accumulate large amounts of both MVPA and sedentary behaviour in the course of a day (Healy et al. 2008; Katzmarzyk et al. 2009; Owen et al. 2010; Tremblay et al. 2010; Wong and Leatherdale 2008). Taken together, these findings suggest that too much sitting and too little MVPA represent separate and distinct risk factors for chronic, noncommunicable diseases (e.g., cardiovascular disease, diabetes, cancer). While research into the biology and health impact of sedentary behaviour represents an exciting new field of study, current inconsistencies in terminology are confusing for students, researchers, policymakers, and the general public. In short, the term “sedentary” currently has two separate and contradictory operational definitions. In this emerging field of research, sedentary behaviours are typically defined by both low energy expenditure (e.g., resting metabolic rate, typically ≤1.5 metabolic equivalents (METs)) and a sitting or reclining posture (Owen et al. 2010; Pate et al. 2008; Tremblay et al. 2010). In this context, a person may be described as sedentary if they engage in a large amount of sedentary behaviour. In contrast, in the sport and exercise literature the term sedentary is frequently used to describe the absence of some threshold of MVPA (Church et al. 2009; Melanson et al. 2009; Mullen et al. 2011; Sims et al. 2012; Smith et al. 2010). Thus, it is common for researchers in this field to describe a participant as sedentary because they are not meeting physical activity guidelines. Hence, many exercise studies include a “sedentary control group” or refer to their participants as coming from a “sedentary population” because of their lack of physical activity without actually measuring or assessing their level of sedentary behaviour. It is not difficult to see how these conflicting definitions of the term sedentary can easily lead to confusion. When reading the title or abstract of an article, it is often difficult to ascertain which definition of sedentary the authors have employed. If an article focuses on the health impact of a “sedentary lifestyle”, are they concerned with excessive sitting–lying down, the lack of physical activity, or both? Further, it is surprisingly common for articles within a given academic journal to oscillate between one definition and the other. To prevent further confusion, we propose that journal editors adopt a consistent definition of the term sedentary and require that all manuscripts published within their journal adhere to this common terminology. We suggest that journals formally define sedentary behaviour as any waking behaviour characterized by an energy expenditure ≤1.5 METs while in a sitting or reclining posture. In contrast, we suggest that authors use the term “inactive” to describe those who are performing insufficient amounts of MVPA (i.e., not meeting specified physical activity guidelines). The formal adoption of the above definitions by journal editors and reviewers would greatly improve the clarity of research and discussion related to these important health behaviours and help researchers searching for studies specific to sedentary behaviour or physical inactivity. We hope the research community will support these definitions and we look forward to further improvements in our understanding of the health impacts of sedentary behaviour and physical activity.

Mark McCall

Papers

Letter to the Editor: Standardized use of the terms "sedentary" and "sedentary behaviours"