Keith M. Diaz, PhD; Virginia J. Howard, PhD; Brent Hutto, MSPH; Natalie Colabianchi, PhD; John E. Vena, PhD; Monika M. Safford, MD; Steven N. Blair, PED; Steven P. Hooker, PhD
Acknowledgment: The authors thank the other investigators, staff, and participants of the REGARDS study for their valuable contributions. A full list of REGARDS investigators and institutions can be found at www.regardsstudy.org.
Financial Support: This research project is supported by a cooperative agreement U01-NS041588 and investigator-initiated grant R01-NS061846 from the National Institute of Neurological Disorders and Stroke of the National Institutes of Health. Additional funding was provided by an unrestricted research grant from The Coca-Cola Company.
Disclosures: Drs. Howard and Colabianchi report grants from the National Institutes of Health during the conduct of the study. Mr. Hutto and Dr. Blair report grants from the National Institutes of Health and The Coca-Cola Company during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-0212.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol: Available at www.regardsstudy.org. Statistical code: Available through written agreement with authors from Dr. Diaz (e-mail, firstname.lastname@example.org). Data set: Available through a data use agreement with University of Alabama at Birmingham (e-mail, email@example.com).
Requests for Single Reprints: Keith Diaz, PhD, Columbia University Medical Center, 622 West 168th Street, PH9-301, New York, NY 10032; email, firstname.lastname@example.org.
Current Author Addresses: Dr. Diaz: Columbia University Medical Center, 622 West 168th Street, PH9-301, New York, NY 10032.
Dr. Howard: Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294.
Mr. Hutto: Prevention Research Center, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, SC 29208.
Dr. Colabianchi: School of Kinesiology, University of Michigan, OBL 1145, 1402 Washington Heights, Ann Arbor, MI 48109.
Dr. Vena: Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Suite 303, MSC 835, Charleston, SC 29425.
Dr. Safford: Department of Medicine, Weill Cornell Medical Center, 1300 York Avenue, New York, NY 10021.
Dr. Blair: Department of Exercise Science, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, SC 29208.
Dr. Hooker: College of Health Solutions, Arizona State University, 550 North 3rd Street, Phoenix, AZ 85004.
Author Contributions: Conception and design: V.J. Howard, N. Colabianchi, J.E. Vena, M.M. Safford, S.P. Hooker.
Analysis and interpretation of the data: K.M. Diaz, V.J. Howard, B. Hutto, N. Colabianchi, M.M. Safford, S.P. Hooker.
Drafting of the article: K.M. Diaz, S.P. Hooker.
Critical revision of the article for important intellectual content: V.J. Howard, B. Hutto, N. Colabianchi, J.E. Vena, M.M. Safford, S.N. Blair, S.P. Hooker.
Final approval of the article: K.M. Diaz, V.J. Howard, B. Hutto, N. Colabianchi, J.E. Vena, M.M. Safford, S.N. Blair, S.P. Hooker.
Provision of study materials or patients: M.M. Safford, S.P. Hooker.
Statistical expertise: B. Hutto.
Obtaining of funding: V.J. Howard, M.M. Safford, S.N. Blair, S.P. Hooker.
Administrative, technical, or logistic support: V.J. Howard, M.M. Safford.
Collection and assembly of data: V.J. Howard, B. Hutto, M.M. Safford, S.P. Hooker.
Excessive sedentary time is ubiquitous in Western societies. Previous studies have relied on self-reporting to evaluate the total volume of sedentary time as a prognostic risk factor for mortality and have not examined whether the manner in which sedentary time is accrued (in short or long bouts) carries prognostic relevance.
To examine the association between objectively measured sedentary behavior (its total volume and accrual in prolonged, uninterrupted bouts) and all-cause mortality.
Prospective cohort study.
Contiguous United States.
7985 black and white adults aged 45 years or older.
Sedentary time was measured using a hip-mounted accelerometer. Prolonged, uninterrupted sedentariness was expressed as mean sedentary bout length. Hazard ratios (HRs) were calculated comparing quartiles 2 through 4 to quartile 1 for each exposure (quartile cut points: 689.7, 746.5, and 799.4 min/d for total sedentary time; 7.7, 9.6, and 12.4 min/bout for sedentary bout duration) in models that included moderate to vigorous physical activity.
Over a median follow-up of 4.0 years, 340 participants died. In multivariable-adjusted models, greater total sedentary time (HR, 1.22 [95% CI, 0.74 to 2.02]; HR, 1.61 [CI, 0.99 to 2.63]; and HR, 2.63 [CI, 1.60 to 4.30]; P for trend < 0.001) and longer sedentary bout duration (HR, 1.03 [CI, 0.67 to 1.60]; HR, 1.22 [CI, 0.80 to 1.85]; and HR, 1.96 [CI, 1.31 to 2.93]; P for trend < 0.001) were both associated with a higher risk for all-cause mortality. Evaluation of their joint association showed that participants classified as high for both sedentary characteristics (high sedentary time [≥12.5 h/d] and high bout duration [≥10 min/bout]) had the greatest risk for death.
Participants may not be representative of the general U.S. population.
Both the total volume of sedentary time and its accrual in prolonged, uninterrupted bouts are associated with all-cause mortality, suggesting that physical activity guidelines should target reducing and interrupting sedentary time to reduce risk for death.
National Institutes of Health.
Diaz KM, Howard VJ, Hutto B, et al. Patterns of Sedentary Behavior and Mortality in U.S. Middle-Aged and Older Adults: A National Cohort Study. Ann Intern Med. 2017;167:465–475. [Epub ahead of print 12 September 2017]. doi: https://doi.org/10.7326/M17-0212
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Published: Ann Intern Med. 2017;167(7):465-475.
Published at www.annals.org on 12 September 2017
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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