Associations of sedentary time and physical activity with adverse health conditions: Outcome-wide analyses using isotemporal substitution model

Abstract

Background: As one of the most common lifestyles today, sedentary behaviour is a risk factor for many health conditions. To inform potential behavioural guideline development, we aimed to estimate the theoretical effects of replacing sedentary behaviour with different intensity of physical activity on risks of 45 common non-communicable diseases (NCDs).

Methods: A total of 360,047 participants (aged 37-73 years) in the UK Biobank free of the 45 common non-communicable diseases (NCDs) were included. Information on sedentary time (sum of television watching, computer using and driving behaviour) and physical activity (measured by International Physical Activity Questionnaire questionnaire) were collected by self-reported at baseline. Participants were followed up for 45 NCDs diagnosis according to the ICD-10 code using linkage to national health records until 2020. Isotemporal substitution models were used to investigate substituting sedentary time with light physical activity (LPA), moderate physical activity (MPA) and vigorous physical activity (VPA) after adjusting for potential confounders.

Finding: Participants who reported > 6 h/day compared with ≤ 2 h/day sedentary time had higher risks of 12 (26.7%) of 45 NCDs, including ischemic heart disease, diabetes, chronic obstructive pulmonary disease, asthma, chronic kidney disease, chronic liver disease, thyroid disorder, depression, migraine, gout, rheumatoid arthritis and diverticular disease. Theoretically, replacing sedentary time with equivalent LPA, MPA and VPA was associated with risk reductions in 4, 6 and 10 types of NCDs, respectively. Among long sedentary time (> 6 h/day), replacing 1 h/day sedentary time with equivalent VPA showed stronger associations with 5 NCDs (diabetes, depression, chronic liver disease, diverticular disease and sleep disorder), with a larger risk reduction of 11%-31%.

Interpretation: Sedentary time is associated with multiple adverse health conditions, replacing sedentary time with any equivalent amounts of VPA than LPA and MPA could be associated with risk reductions of more types of NCDs.

Funding: National Natural Science Foundation of China.

Keywords: Chronic non-communicable diseases; Isotemporal substitution model; Physical activity; Sedentary behaviour.

Figure 1

The hazard ratios of NCDs for sedentary time higher than 6 h/day compared with less than 2 h/day. Each box of forest plot indicates the hazard ratios and confidence interval for individual NCD. The models were adjusted for age (timescale), sex, ethnicity, Townsend Deprivation Index, employment status, educational attainment, smoking status, alcohol intake and BMI. Multivariate models for specific disorders for female (breast, cervix, endometrium and ovary cancer) were additionally adjusted for menopause status and hormone replacement therapy. All P values were corrected for multiple testing by using the Bonferroni's method (P < 0.0011).

Figure 2

Multivariable-adjusted population attributable fraction (PAF) for NCDs by over 6 h/day sedentary time. Each box of forest plot indicates the population attributable fraction (PAF) and confidence interval for individual NCD, which can be interpreted as the proportional reduction in population incidence that would have occurred during follow-up if all participants had adopted a sedentary time with < 6 h/day. The models were adjusted for age (timescale), sex, ethnicity, Townsend Deprivation Index, employment status, educational attainment, smoking status, alcohol intake and BMI.