Substituting prolonged sedentary time and cardiovascular risk in children and youth: a meta-analysis within the International Children's Accelerometry database (ICAD).

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White, Thomas 
Andersen, Lars Bo 
Bugge, Anna 
Kolle, Elin 

BACKGROUND: Evidence on the association between sitting for extended periods (i.e. prolonged sedentary time (PST)) and cardio-metabolic health is inconsistent in children. We aimed to estimate the differences in cardio-metabolic health associated with substituting PST with non-prolonged sedentary time (non-PST), light (LIPA) or moderate-to-vigorous physical activity (MVPA) in children. METHODS: Cross-sectional data from 14 studies (7 countries) in the International Children's Accelerometry Database (ICAD, 1998-2009) was included. Accelerometry in 19,502 participants aged 3-18 years, together with covariate and outcome data, was pooled and harmonized. Iso-temporal substitution in linear regression models provided beta coefficients (95%CI) for substitution of 1 h/day PST (sedentary time accumulated in bouts > 15 min) with non-PST, LIPA or MVPA, for each study, which were meta-analysed. RESULTS: Modelling substitution of 1 h/day of PST with non-PST suggested reductions in standardized BMI, but estimates were > 7-fold greater for substitution with MVPA (- 0.44 (- 0.62; - 0.26) SD units). Only reallocation by MVPA was beneficial for waist circumference (- 3.07 (- 4.47; - 1.68) cm), systolic blood pressure (- 1.53 (- 2.42; - 0.65) mmHg) and clustered cardio-metabolic risk (- 0.18 (- 0.3; - 0.1) SD units). For HDL-cholesterol and diastolic blood pressure, substitution with LIPA was beneficial; however, substitution with MVPA showed 5-fold stronger effect estimates (HDL-cholesterol: 0.05 (0.01; 0.10) mmol/l); diastolic blood pressure: - 0.81 (- 1.38; - 0.24) mmHg). CONCLUSIONS: Replacement of PST with MVPA may be the preferred scenario for behaviour change, given beneficial associations with a wide range of cardio-metabolic risk factors (including adiposity, HDL-cholesterol, blood pressure and clustered cardio-metabolic risk). Effect estimates are clinically relevant (e.g. an estimated reduction in waist circumference of ≈1.5 cm for 30 min/day replacement). Replacement with LIPA could be beneficial for some of these risk factors, however with substantially lower effect estimates.

ALSPAC, Cardio-metabolic, ICAD, Iso-temporal, Physical activity, Prolonged sitting, Accelerometry, Adolescent, Blood Pressure, Cardiovascular Diseases, Child, Child, Preschool, Cholesterol, HDL, Cross-Sectional Studies, Exercise, Humans, Risk Factors, Sedentary Behavior, Waist Circumference
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Int J Behav Nutr Phys Act
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Springer Science and Business Media LLC
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Medical Research Council (MC_UU_12015/3)
Medical Research Council (MC_UU_12015/7)
Cambridge University Hospitals NHS Foundation Trust (CUH) (146281)
Medical Research Council (G0701877)
British Heart Foundation (None)
Medical Research Council (MR/K023187/1)
This work was supported by the National Prevention Research Initiative [grant number: G0701877] ( The funding partners relevant to this award are: British Heart Foundation; Cancer Research UK; Department of Health; Diabetes UK; Economic and Social Research Council; Medical Research Council; Research and Development Office for the Northern Ireland Health and Social Services; Chief Scientist Office; Scottish Executive Health Department; The Stroke Association; Welsh Assembly Government and World Cancer Research Fund. This work was additionally supported by the Medical Research Council [grant numbers MC_UU_12015/3, MC_UU_12015/7], The Research Council of Norway [grant number 249932/F20], Bristol University, Loughborough University and Norwegian School of Sport Sciences. We also gratefully acknowledge the contribution of Prof Chris Riddoch, Prof Ken Judge, Prof Ashley Cooper and Dr Pippa Griew to the development of ICAD. This work was further supported by a British Heart Foundation Intermediate Basic Science Research Fellowship [grant number FS/12/58/29709].