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The Consequences of Sedentary Behaviors

Keeping Interpretations Anchored in Evidence

Tremblay, Mark S.

Exercise and Sport Sciences Reviews: January 2018 - Volume 46 - Issue 1 - p 4
doi: 10.1249/JES.0000000000000128
Commentary to Accompany

Healthy Active Living and Obesity (HALO) Research Group, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada

Authors for this section are recruited by Commentary Editor: Russell R. Pate, Ph.D., FACSM, Department of Exercise Science, University of South Carolina, Columbia, SC 29208 (E-mail:

Research on the health consequences of certain sedentary behaviors and excessive sedentary time has increased in recent years and is commanding increased attention in public health and exercise science-related research (1,2). The Sedentary Behavior Research Network recently published an article reporting the findings from a global terminology consensus project where standardized definitions of key terms used in sedentary behavior research were presented, with the hope of further advancing research in this new field (3). There is clear evidence of enthusiasm in this area of research, and the sensibility of both a temporal trend toward increased sedentary time in contemporary lifestyles and the presumed negative health consequence of such a trend are intuitive and seemingly opportunistic. But are these sensibilities supported by robust scientific evidence? Or has the field of study gotten ahead of itself? Are we overinterpreting the existing evidence base? Are the relations more complex than previously conceptualized?

In this issue of Exercise and Sport Sciences Reviews (ESSR), Professor Stuart Biddle and colleagues provide a brief review critically examining the evidence that sedentary behavior is causally related to adiposity in young people (4). They argue that despite some consistency of the evidence supporting the observation that increased sedentary behavior/screen/TV time is associated with undesirable adiposity measures in young people, the magnitude of the relations is usually small, based predominantly on associational research, and inconsistent between reported and direct measure methods and often fails to control or account for important factors (e.g., physical activity, diet, sleep) that could mediate or moderate the relations observed. The authors conclude that the current evidence does not support a causal association between sedentary behaviors and adiposity in young people, and they propose a conceptual model illustrating the complexity of this relation. Although the authors restrict their discussion to childhood obesity and adiposity, they remind us of the need to ensure that our research rhetoric does not supersede the underlying evidence.

Sedentary behavior research is in its infancy, or at best childhood, and although seems to be a plausible, prominent, and pervasive public health threat, there is some concern that related guidelines, recommendations, and messages may be ahead of the evidence supporting them. In addition to the caution conveyed by Biddle et al. (4), a recent American Heart Association Advisory (1) concluded that “further evidence is required to better inform public health interventions and future quantitative guidelines on sedentary behavior and cardiovascular health outcomes.” A comprehensive review by Prince et al. (5) “identifies the need for longitudinal studies, as well as further research on factors in the physical, social, and policy environments” and “recognizes the need to standardize methodology for collecting, defining, and reporting sedentary behavior and correlates.” Ekelund et al. (6) concluded that 60–75 min·d−1 of moderate-intensity physical activity may eliminate the increased risk of death associated with excessive sitting in adults but does not eliminate the elevated risk associated with high TV-viewing time specifically. The collective evidence is structurally weak if not equivocal.

Balancing the demand for public health guidance in relation to sedentary behaviors with the current state of the evidence is a challenge, and much more experimental research, with measures of the fidelity of interventions, is required. Nevertheless, as Biddle et al. (4) agree, the current approach of discouraging excessive sedentary behaviors, especially TV time, is sensible and the likelihood of benefit exceeds the risk of harm.

Mark S. Tremblay

Healthy Active Living and Obesity (HALO) Research Group

Children’s Hospital of Eastern Ontario Research Institute

Ottawa, ON, Canada

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1. Young DR, Hivert M-F, Alhassan S, et al. Sedentary behavior and cardiovascular morbidity and mortality: a science advisory from the American Heart Association. Circulation. 2016; 134:e262–79.
2. Tremblay MS, Colley R, Saunders TJ, Healy GN, Owen N. Physiological and health implications of a sedentary lifestyle. Appl. Physiol. Nutr. Metab. 2010; 35:725–40.
3. Tremblay MS, Aubert S, Barnes JD, et al. Sedentary Behavior Research Network (SBRN) — Terminology Consensus Project process and outcome. Int. J. Behav. Nutr. Phys. Act. 2017; 14:75.
4. Biddle SJH, Pearson N, Salmon J. Sedentary behaviors and adiposity in young people: causality and conceptual model. Exerc. Sport Sci. Rev. 2018; 46(1):18–25.
5. Prince SA, Reed JL, McFetridge C, Tremblay MS, Reid RD. Correlates of sedentary behaviour in adults: a systematic review. Obes. Rev. 2017; 18(8):915–35.
6. Ekelund U, Steene-Johannessen J, Brown WJ, et al. Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women. Lancet. 2016; 388(10051):1302–10.
© 2018 American College of Sports Medicine