Patterns of Sedentary Behavior and Mortality in U.S. Middle-Aged and Older Adults

BACKGROUND: 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. OBJECTIVE: To examine the association between objectively measured sedentary behavior (its total volume and accrual in prolonged, uninterrupted bouts) and all-cause mortality. DESIGN: Prospective cohort study. SETTING: Contiguous United States. PARTICIPANTS: 7985 black and white adults aged 45 years or older. MEASUREMENTS: 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. RESULTS: 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. LIMITATION: Participants may not be representative of the general U.S. population. CONCLUSION: 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. PRIMARY FUNDING SOURCE: National Institutes of Health.