Device-Measured Physical Activity and Sedentary Behavior in Relation to Cardiovascular Diseases and All-Cause Mortality: Systematic Review and Meta-Analysis of Prospective Cohort Studies

Seaw Jia Liew; Nicholas A Petrunoff; Nithya Neelakantan; Rob M van Dam; Falk Müller-Riemenschneider

doi:10.1016/j.focus.2022.100054

Device-Measured Physical Activity and Sedentary Behavior in Relation to Cardiovascular Diseases and All-Cause Mortality: Systematic Review and Meta-Analysis of Prospective Cohort Studies

AJPM Focus. 2022 Dec 10;2(1):100054. doi: 10.1016/j.focus.2022.100054. eCollection 2023 Mar.

Authors

Seaw Jia Liew^{1

2}, Nicholas A Petrunoff¹, Nithya Neelakantan¹, Rob M van Dam^{1

2

3

4}, Falk Müller-Riemenschneider^{1

2

5}

Affiliations

¹ Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.
² Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore.
³ Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
⁴ Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, United States.
⁵ Berlin Institute of Health, Charité University Medical Centre, Berlin, Germany.

Abstract

Introduction: This review synthesized evidence from prospective cohort studies on the association of device-measured physical activity and sedentary behavior with cardiovascular disease and all-cause mortality among adults.

Methods: Five databases were searched from 2000 through April 29, 2020. Study quality was appraised using the NIH Quality Assessment Tool. Pooled hazard ratio and 95% CI were obtained from random-effects meta-analyses. Subgroup analyses by age and sex were conducted for studies on all-cause mortality.

Results: Of 29 articles included in the systematic review, 5 studies on cardiovascular disease mortality and 15 studies on all-cause mortality were included in meta-analyses. Comparing the highest with the lowest exposure categories, the pooled hazard ratios (95% CIs) for cardiovascular disease mortality were 0.29 (CI=0.18, 0.47) for total physical activity, 0.37 (CI=0.25, 0.55) for moderate-to-vigorous physical activity, 0.62 (0.41-0.93) for light physical activity, and 1.89 (CI=1.09, 3.29) for sedentary behavior. The pooled hazard ratios (95% CIs) for all-cause mortality were 0.42 (CI=0.34, 0.53) for total physical activity, 0.43 (CI=0.35, 0.53) for moderate-to-vigorous physical activity, 0.58 (CI=0.43, 0.80) for light physical activity, and 1.58 (CI=1.19, 2.09) for sedentary behavior. The pooled hazard ratio (95% CI) for all-cause mortality was 0.35 (CI=0.29, 0.42) for steps per day, but the studies available for analysis were conducted in older adults. The results of subgroup analyses were consistent with the main results.

Discussion: Rapidly accumulating evidence suggests that more physical activity and less sedentary behavior are associated with a lower risk of cardiovascular disease and all-cause mortality. Similar beneficial relationships were found for step counts and all-cause mortality among older adults. Future studies employing standardized research methodologies and up-to-date data processing approaches are warranted to recommend specific amounts of physical activity and limits to sedentary behavior.

Keywords: Physical activity; cohort study; meta-analysis; review; sedentary behavior; step count.

Publication types

Review