• Keith M Diaz, Virginia J Howard, Brent Hutto, Natalie Colabianchi, John E Vena, Monika M Safford, Steven N Blair, and Steven P Hooker.
• From Columbia University Medical Center and Weill Cornell Medical Center, New York, New York; University of Alabama at Birmingham, Birmingham, Alabama; University of South Carolina, Columbia, South Carolina; University of Michigan, Ann Arbor, Michigan; Medical University of South Carolina, Charleston, South Carolina; and Arizona State University, Phoenix, Arizona.
• Ann. Intern. Med. 2017 Oct 3; 167 (7): 465475465-475.

BackgroundExcessive 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.ObjectiveTo examine the association between objectively measured sedentary behavior (its total volume and accrual in prolonged, uninterrupted bouts) and all-cause mortality.DesignProspective cohort study.SettingContiguous United States.Participants7985 black and white adults aged 45 years or older.MeasurementsSedentary 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.ResultsOver 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.LimitationParticipants may not be representative of the general U.S. population.ConclusionBoth 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 SourceNational Institutes of Health.

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