critical thinking list the sedentary activities you do regularly

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11 Activities That Promote Critical Thinking In The Class

52 Critical Thinking Flashcards for Problem Solving

Critical thinking activities encourage individuals to analyze, evaluate, and synthesize information to develop informed opinions and make reasoned decisions. Engaging in such exercises cultivates intellectual agility, fostering a deeper understanding of complex issues and honing problem-solving skills for navigating an increasingly intricate world. Through critical thinking, individuals empower themselves to challenge assumptions, uncover biases, and constructively contribute to discourse, thereby enriching both personal growth and societal progress.

Critical thinking serves as the cornerstone of effective problem-solving, enabling individuals to dissect challenges, explore diverse perspectives, and devise innovative solutions grounded in logic and evidence. For engaging problem solving activities, read our article problem solving activities that enhance student’s interest.

What is Critical Thinking?

Critical thinking is a 21st-century skill that enables a person to think rationally and logically in order to reach a plausible conclusion. A critical thinker assesses facts and figures and data objectively and determines what to believe and what not to believe. Critical thinking skills empower a person to decipher complex problems and make impartial and better decisions based on effective information.

Importance of Acquiring Critical Thinking Skills

Acquiring critical thinking skills was never as valuable as it is today because of the prevalence of the modern knowledge economy. Today, information and technology are the driving forces behind the global economy. To keep pace with ever-changing technology and new inventions, one has to be flexible enough to embrace changes swiftly.

Read our article: How to Foster Critical Thinking Skills in Students? Creative Strategies and Real-World Examples

Today critical thinking skills are one of the most sought-after skills by the companies. In fact, critical thinking skills are paramount not only for active learning and academic achievement but also for the professional career of the students. The lack of critical thinking skills catalyzes memorization of the topics without a deeper insight, egocentrism, closed-mindedness, reduced student interest in the classroom and not being able to make timely and better decisions.

Benefits of Critical Thinking Skills in Education

Certain strategies are more eloquent than others in teaching students how to think critically. Encouraging critical thinking in the class is indispensable for the learning and growth of the students. In this way, we can raise a generation of innovators and thinkers rather than followers. Some of the benefits offered by thinking critically in the classroom are given below:

It allows a student to decipher problems and think through the situations in a disciplined and systematic manner
Through a critical thinking ability, a student can comprehend the logical correlation between distinct ideas
The student is able to rethink and re-justify his beliefs and ideas based on facts and figures
Critical thinking skills make the students curious about things around them
A student who is a critical thinker is creative and always strives to come up with out of the box solutions to intricate problems
Critical thinking skills assist in the enhanced student learning experience in the classroom and prepares the students for lifelong learning and success
The critical thinking process is the foundation of new discoveries and inventions in the world of science and technology
The ability to think critically allows the students to think intellectually and enhances their presentation skills, hence they can convey their ideas and thoughts in a logical and convincing manner
Critical thinking skills make students a terrific communicator because they have logical reasons behind their ideas

Critical Thinking Lessons and Activities

11 Activities that Promote Critical Thinking in the Class

We have compiled a list of 11 activities that will facilitate you to promote critical thinking abilities in the students. We have also covered problem solving activities that enhance student’s interest in our another article. Click here to read it.

1. Worst Case Scenario

Divide students into teams and introduce each team with a hypothetical challenging scenario. Allocate minimum resources and time to each team and ask them to reach a viable conclusion using those resources. The scenarios can include situations like stranded on an island or stuck in a forest. Students will come up with creative solutions to come out from the imaginary problematic situation they are encountering. Besides encouraging students to think critically, this activity will enhance teamwork, communication and problem-solving skills of the students.

Read our article: 10 Innovative Strategies for Promoting Critical Thinking in the Classroom

2. If You Build It

It is a very flexible game that allows students to think creatively. To start this activity, divide students into groups. Give each group a limited amount of resources such as pipe cleaners, blocks, and marshmallows etc. Every group is supposed to use these resources and construct a certain item such as building, tower or a bridge in a limited time. You can use a variety of materials in the classroom to challenge the students. This activity is helpful in promoting teamwork and creative skills among the students.

It is also one of the classics which can be used in the classroom to encourage critical thinking. Print pictures of objects, animals or concepts and start by telling a unique story about the printed picture. The next student is supposed to continue the story and pass the picture to the other student and so on.

4. Keeping it Real

In this activity, you can ask students to identify a real-world problem in their schools, community or city. After the problem is recognized, students should work in teams to come up with the best possible outcome of that problem.

5. Save the Egg

Make groups of three or four in the class. Ask them to drop an egg from a certain height and think of creative ideas to save the egg from breaking. Students can come up with diverse ideas to conserve the egg like a soft-landing material or any other device. Remember that this activity can get chaotic, so select the area in the school that can be cleaned easily afterward and where there are no chances of damaging the school property.

6. Start a Debate

In this activity, the teacher can act as a facilitator and spark an interesting conversation in the class on any given topic. Give a small introductory speech on an open-ended topic. The topic can be related to current affairs, technological development or a new discovery in the field of science. Encourage students to participate in the debate by expressing their views and ideas on the topic. Conclude the debate with a viable solution or fresh ideas generated during the activity through brainstorming.

7. Create and Invent

This project-based learning activity is best for teaching in the engineering class. Divide students into groups. Present a problem to the students and ask them to build a model or simulate a product using computer animations or graphics that will solve the problem. After students are done with building models, each group is supposed to explain their proposed product to the rest of the class. The primary objective of this activity is to promote creative thinking and problem-solving skills among the students.

8. Select from Alternatives

This activity can be used in computer science, engineering or any of the STEM (Science, Technology, Engineering, Mathematics) classes. Introduce a variety of alternatives such as different formulas for solving the same problem, different computer codes, product designs or distinct explanations of the same topic.

Form groups in the class and ask them to select the best alternative. Each group will then explain its chosen alternative to the rest of the class with reasonable justification of its preference. During the process, the rest of the class can participate by asking questions from the group. This activity is very helpful in nurturing logical thinking and analytical skills among the students.

9. Reading and Critiquing

Present an article from a journal related to any topic that you are teaching. Ask the students to read the article critically and evaluate strengths and weaknesses in the article. Students can write about what they think about the article, any misleading statement or biases of the author and critique it by using their own judgments.

In this way, students can challenge the fallacies and rationality of judgments in the article. Hence, they can use their own thinking to come up with novel ideas pertaining to the topic.

10. Think Pair Share

In this activity, students will come up with their own questions. Make pairs or groups in the class and ask the students to discuss the questions together. The activity will be useful if the teacher gives students a topic on which the question should be based.

For example, if the teacher is teaching biology, the questions of the students can be based on reverse osmosis, human heart, respiratory system and so on. This activity drives student engagement and supports higher-order thinking skills among students.

11. Big Paper – Silent Conversation

Silence is a great way to slow down thinking and promote deep reflection on any subject. Present a driving question to the students and divide them into groups. The students will discuss the question with their teammates and brainstorm their ideas on a big paper. After reflection and discussion, students can write their findings in silence. This is a great learning activity for students who are introverts and love to ruminate silently rather than thinking aloud.

Read our next article: 10 Innovative Strategies for Promoting Critical Thinking in the Classroom

Become a better critical thinker with these 7 critical thinking exercises

Critical thinking is a skill you can use in any situation. Whether you're a student, entrepreneur, or business executive, critical thinking can help you make better decisions and solve problems.

But learning critical thinking skills isn't always an easy task. Many tools, techniques, and strategies are available, and choosing the right one can be challenging. Vague suggestions on the internet like "read more" aren't very helpful, and elaborate business examples don’t apply to many of us.

As average problem-solvers, we need actionable thinking exercises to improve our critical thinking skills and enhance our thinking processes. Regularly performing exercises that specifically stretch our decision-making and reasoning skills is the most effective method of improving our thinking abilities.

This article will explore several exercises that will help you develop critical thinking skills. Whether you are preparing for an exam, making an influential decision for your business, or going about your daily life, these fun activities can build your reasoning skills and creative problem-solving abilities.

Boost your logical thinking skills and start practicing a critical mindset with these 10 critical thinking exercises.

A Quick Look at Critical Thinking

As a thoughtful learner, you likely already understand the basics of critical thinking, but here's a quick refresher.

Critical thinking involves analyzing problems or issues objectively and rationally. Critical thinkers are able to understand their own biases and assumptions, as well as those of others. They’re also able to see the world from a different point of view and understand how their experiences impact their thinking.

Developing critical thinking skills is essential because it allows us to see things from multiple perspectives, identify biases and errors in reasoning, and be open to possible solutions. Making informed decisions is easier when we have a better understanding of the world around us.

Why We Need to Practice Critical Thinking

Critical thinking exercises: brain and four puzzle pieces

We aren't born with critical thinking skills, and they don’t naturally develop beyond survival-level thinking. To master critical thinking, we must practice it and develop it over time.

However, learning to think critically isn't as easy as learning to ride a bicycle. There aren't any step-by-step procedures to follow or supportive guides to fall back on, and it is not taught in public schools consistently or reliably. To ensure students' success, teachers must know higher-order thinking skills (HOTS) and how to teach them, research says.

Unfortunately, although teachers understand the importance of HOTS and attempt to teach it, studies show that their capacity to measure students' HOTS is low. Educator and author Dr. Kulvarn Atwal says, "It seems that we are becoming successful at producing students who are able to jump through hoops and pass tests."

As critical thinking skills become more important in higher grades, some students find it challenging to understand the concept of critical thinking. To develop necessary thinking skills, we must set aside our assumptions and beliefs. This allows us to explore and question topics from a "blank page" point of view and distinguish fact from opinion.

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7 Critical Thinking Exercises To Improve Your Critical Thinking Skills

Critical thinking exercises: steel model of the brain lifting dumbbells

The good news is that by assessing, analyzing, and evaluating our thought processes, we can improve our skills. Critical thinking exercises are key to this improvement. Our critical thinking builds and improves with regular practice, just like a muscle that gets stronger with use.

If you want to become a better critical thinker , here are some critical thinking exercises to try:

Exercise #1: The Ladder of Inference

You can exercise your critical thinking skills by using the Ladder of Inference model . This thinking model was developed by renowned organizational psychologist Chris Argyris. Each rung on the ladder of inference represents a step you take to arrive at your conclusions.

The decision-making process starts when we are faced with a problem or situation. As soon as we observe something problematic or important, we presume what is causing it, and then we use that assumption to draw conclusions. Based on those conclusions, we take action.

For example, say you're at a party and see a friend across the room. You catch their eye and wave, but they turn and walk away. Using the ladder, you might climb the rungs as follows:

Observe that your friend walked away.
Select a few details of the situation, including your wave and your assumption that they saw you.
Meaning is attached based on the environment, making you think your friend must have other people to talk to at the party.
Assumptions are made based on that meaning, assuming that means your friend doesn’t like you as much as them.
Conclusions are drawn from the assumption, and you determine that your friend must be mad at you or doesn't want you to be at the party.
Beliefs are formed, making you think you're not welcome.
Action is taken, and you leave the party.

In this example, you started with a situation (someone walking away at a crowded party) and made a series of inferences to arrive at a conclusion (that the person is mad at you and doesn't want you there).

The Ladder of Inference can be a helpful tool to frame your thinking because it encourages you to examine each step of your thought process and avoid jumping to conclusions. It's easy to make assumptions without realizing it, as in this scene. Perhaps your friend never even saw you wave from across the crowded room.

Exercise #2: The Five Whys

The "Five Whys" technique is an analytical skill that can help you uncover the source of a problem. The activity was created by Sakichi Toyoda, the founder of Toyota, and consists of repeatedly asking “why?” when a problem is encountered to determine its root cause.

This exercise can be difficult because knowing if you've discovered the source of your problem is challenging. The "five" in "Five Whys" is just a guideline — you may need to ask more. When you can't ask anything else, and your response is related to the original issue, you've probably arrived at the end.

Even if you need several rounds of questioning, just keep going. The important part that helps you practice critical thinking is the process of asking "why?" and uncovering the deeper issues affecting the situation.

For instance, say you're trying to figure out why your computer keeps crashing.

You ask " why ," and the answer is that there's a software problem.
Why? Because the computer keeps running out of memory.
Why? Because too many programs are running at the same time.
Why? Because too many browser tabs are open .
Why? Because multitasking is fragmenting your focus, you're doing too many things at once.

In this example, working through the "why's" revealed the underlying cause. As a result, you can find the best solution, which is concentrating on just one thing at a time.

Exercise #3: Inversion

Wooden blocks with seven black arrows and one red arrow

Inversion is another critical thinking exercise that you can use in any situation. Inversion is sort of like taking on the role of the devil's advocate. In this exercise, adopt the opposite view of whatever issue you're exploring and consider the potential arguments for that side. This will help broaden your critical thinking skills and enable you to see other perspectives on a situation or topic more clearly.

For example, let's say you're thinking about starting your own business. Using inversion, you would explore all of the potential arguments for why starting your own business is bad. This might include concerns like:

You could end up in debt.
The business might fail.
It's a lot of work.
You might not have time for anything else.

By exploring these potentially adverse outcomes, you can identify the potential risks involved in starting your own business and make a more sound decision. You might realize that now is not the right time for you to become an entrepreneur. And if you do start the company, you'll be better prepared to deal with the issues you identified when they occur.

Exercise #4: Argument Mapping

Argument mapping can be a beneficial exercise for enhancing critical thinking skills. Like mind mapping, argument mapping is a method of visually representing an argument's structure. It helps analyze and evaluate ideas as well as develop new ones.

In critical thinking textbooks, argument diagramming is often presented to introduce students to argument constructions. It can be an effective way to build mental templates or schema for argument structures, which researchers think may make critical evaluation easier .

Argument maps typically include the following:

Conclusion: What is being argued for or against
Premises: The reasons given to support the conclusion
Inferences: The connections made between the premises and conclusion

The argument map should be as clear and concise as possible, with a single word or phrase representing each element. This will help you make connections more easily. After the map is completed, you can use it to identify any weak points in the argument. If any areas aren't well-supported, additional premises can be added.

Argument mapping can be applied to any situation that requires critical thinking skills. The more time you take to map out an argument, the better you'll understand how the pieces fit together. Ultimately, this will help you think more creatively and critically, and make more informed decisions.

Exercise #5: Opinion vs. Fact

Critical thinking activities that focus on opinions and facts are particularly valuable and relevant new learning opportunities. Our constantly-connected world makes it easy to confuse opinions and facts , especially with sensationalist news articles and click-bait headlines.

How can you tell a fact from an opinion? Facts are generally objective and established, whereas opinions are subjective and unproven. For example, "the cloud is in the air" is a fact. "That dress looks good on you" is an opinion.

Practice your critical thinking skills by reading or listening to the news. See if you can identify when someone is stating an opinion rather than a fact. Ask yourself the following questions:

Who is saying what? What reasons might be behind their statements?
Does the claim make sense? Who would disagree with it and why?
How can you tell if the data is reliable? Can it be fact-checked? Has it been shared by other credible publishers?
How do you know whether or not the presenter is biased? What kind of language is being used?

This powerful exercise can train your mind to start asking questions whenever presented with a new claim. This will help you think critically about the information you're taking in and question what you're hearing before accepting it as truth.

Exercise #6: Autonomy of an Object

In her book " The Critical Thinking Tool Kit ," Dr. Marlene Caroselli describes a critical thinking exercise called "Living Problems, Lively Solutions." This exercise uses the autonomy of an object as a problem-solving tool to find a possible solution.

To do this, you'll personify your problem and place it in another context — a different time or place. This allows you to uncover unique solutions to the problem that might be tied to your mental associations with that setting.

For example, if your problem is poor time management , you might personify the issue as a thief of your time. The idea of a thief could make you think of jail, which might prompt thoughts of locking up specific distractions in your life. The idea of jail could also make you think of guards and lead you to the possible solution of checking in with an accountability buddy who can make sure you're sticking to your schedule.

The autonomy-of-object technique works because it stimulates thoughts you wouldn’t have considered without the particular context in which you place the problem.

Exercise #7: The Six Thinking Hats

Wooden blocks with different colored hats drawn on it

Designed by Edward de Bono, the Six Thinking Hats is a critical thinking exercise that was created as a tool for groups to use when exploring different perspectives on an issue. When people use other thinking processes, meetings can become challenging rather than beneficial.

To help teams work more productively and mindfully, de Bono suggests dividing up different styles of thinking into six categories, represented as hats:

The white hat is objective and focuses on facts and logic
The red hat is intuitive, focusing on emotion and instinct
The black hat is cautious and predicts negative outcomes
The yellow hat is optimistic and encourages positive outcomes
The green hat is creative, with numerous ideas and little criticism
The blue hat is the control hat used for management and organization

With each team member wearing a different hat, a group can examine an issue or problem from many different angles, preventing one viewpoint (or individual) from dominating the meeting or discussion. This means that decisions and solutions reached using the Six Thinking Hats approach will likely be more robust and effective, and everyone’s creative thinking skills will benefit.

Train Your Brain With Critical Thinking Exercises

Using critical thinking regularly in various situations can improve our ability to evaluate and analyze information. These seven critical thinking exercises train your brain for better critical thinking skills . With daily practice, they can become habits that will help you think more critically each day.

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Critical Thinking Exercises

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Critical thinking is a skill that students develop gradually as they progress in school. While the skill becomes more important in higher grades, some students find it difficult to understand the concept of critical thinking .

The reason critical thinking can be difficult to grasp is because it requires students to set aside assumptions and beliefs to learn to think without bias or judgment.

Critical thinking involves suspending your beliefs to explore and question topics from a "blank page" point of view. It also involves the ability to distinguish fact from opinion when exploring a topic.

These exercises are designed to help develop critical thinking skills.

Critical Thinking Exercise 1: Tour Guide for an Alien

This exercise provides an opportunity to think outside your normal way of thinking.

Pretend that you have been assigned the task of conducting a tour for aliens who are visiting the earth and observing human life. You're riding along in a blimp, viewing the landscape below, and you float over a professional baseball stadium. One of the aliens looks down and is very confused by what he sees. You explain that there is a game going on and he asks several important questions.

What is a game?
Why are there no female players?
Why do people get so excited about watching other people play games?
What is a team?
Why can't the people in the seats go down on the field and join in?

If you try to answer these questions fully, it will quickly become apparent that we carry around certain assumptions and values. We support a certain team, for instance, because it makes us feel like we're a part of a community. This sense of community is a value that matters to some people more than others.

Furthermore, when trying to explain team sports to an alien, you have to explain the value we place on winning and losing.

When you think like an alien tour guide, you are forced to take a deeper look at the things we do and things we value. Sometimes they don't sound logical from the outside looking in.

Critical Thinking Exercise 2: Fact or Opinion

Do you think you know the difference between fact and opinion? It's not always easy to discern. When you visit websites, do you believe everything you read? The abundance of available information makes it more important than ever for students to develop critical thinking skills. Additionally, it's an important reminder that you must use trustworthy sources in your school work.

If you don't learn the difference between fact and opinion, you may end up reading and watching things that continue to reinforce beliefs and assumptions you already own.

For this exercise, read each statement and try to determine whether it sounds like a fact or an opinion. This can be completed alone or with a study partner .

My mom is the best mom on earth.
My dad is taller than your dad.
My telephone number is difficult to memorize.
The deepest part of the ocean is 35,813 feet deep.
Dogs make better pets than turtles.
Smoking is bad for your health.
Eighty-five percent of all cases of lung cancer in the U.S. are caused by smoking.
If you flatten and stretch out a Slinky toy it will be 87 feet long.
Slinky toys are fun.
One out of every one hundred American citizens is color blind.
Two out of ten American citizens are boring.

You will probably find some of the statements easy to judge but other statements difficult. If you can effectively debate the truthfulness of a statement with your partner, then it's most likely an opinion.

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How to Fix a Sedentary Lifestyle

Sedentary Lifestyle Definition

How Harmful Is It?

Modern advances make our lives easier, but they've led many of us to adopt a more sedentary lifestyle. Moving less and sitting more is linked to several health conditions and is believed to be a significant cause of the obesity epidemic.

Sitting for longer than four hours per day significantly increases your risk for cardiovascular disease (perhaps even more than smoking), diabetes , and several other obesity-related conditions.

Mayur Kakade / Getty Images

Fixing a sedentary lifestyle takes some conscious effort at first, but the value of being more physically active is worth it for its myriad benefits.

Whether you're stuck at a desk all day or just struggling to get motivated and exercise, here are ideas to help you get moving.

What Counts as a Sedentary Lifestyle?

While there is no strict definition of what constitutes a sedentary lifestyle, researchers have a few different metrics to measure what a sedentary lifestyle is. One measure is the time an individual spends seated or reclining during waking hours. Spending four to six waking hours sitting or lying down is considered sedentary.

It would seem reasonable to assume that those meeting the requirements for physical activity would not be considered sedentary. However, research suggests that even those who do the amount of physical activity recommended by the World Health Organization (at least 150 minutes of moderate activity during the week or 75 minutes of intense activity per week) can still be considered sedentary if they spend four to six hours sitting or reclining per day.

In the short term, being inactive can increase depression or anxiety. It can also affect the way the body processes fats and sugars in the diet and lead to some weight gain if you aren't burning enough calories.

Over the long term, sedentary lifestyles increase the risk of mortality from cardiovascular disease, diabetes, and cancer. In addition to increasing the chances of dying of these causes, it also decreases the quality of life through increased knee pain, higher rates of depression, and decreased cognitive function.

Fixing a Sedentary Lifestyle

If you suspect you are living a sedentary lifestyle, the good news is there are myriad ways to add activity into your day and reverse your sedentary tendencies. Here are some suggestions.

Plenty of research has borne out the health benefits of a daily 30-minute walk.

Walking has a positive impact on mental health, a reduction in the incidence of cardiovascular disease and stroke, and a positive impact on blood pressure.

It's easy to start walking more, even at the office. Suggest walking meetings instead of sitting around a conference table. You can also try adding activities before or after work, such as walking your dog for longer stretches.

Look for other opportunities to take a walk. For example, if you live nearby, walk your kids to or from school, or at least as far as the bus stop. You can also walk after dinner and make it a family event.

Even if your family's schedule doesn't permit sharing dinner together, try taking a stroll through the neighborhood when everyone gets home. Not only will you all get moving, but you'll get to spend quality time together.

Take the Stairs

A study published in 2017 found stair climbing, considered a vigorous-intensity physical activity, burns more calories per minute than jogging.

Taking the stairs whenever possible can help you maintain a healthy weight as well as build and maintain strong bones, joints , and muscles.

Walk the Parking Lot

As long as you can do so safely, parking your car at the far end of the parking lot or down the street from your destination is an easy way to add extra steps to your day.

In the same vein as taking the stairs instead of the elevator if you're able, if you have the time and can walk a little farther, you'll get the benefits of additional activity.

Plus, walking across the parking lot or around the block from your office also gives you a moment outside to soak up the sun or enjoy the change of seasons, which can also be great for your mental health.

Ditch Your Car

The way we travel in the modern age is associated with rates of overweight and obesity. Compared to more passive ways of getting around, the active modes, such as walking or cycling, have many health benefits and greater potential to prevent obesity .

Even public transit appears associated with lower body mass index (BMI) compared to driving your own car to work. Standing on a subway platform or walking to a bus stop requires more steps than just going from your front door to your garage, in addition to more time standing and balancing.

BMI is a dated, flawed measure. It does not take into account factors such as body composition, ethnicity, sex, race, and age. Even though it is a biased measure, BMI is still widely used in the medical community because it’s an inexpensive and quick way to analyze a person’s potential health status and outcomes.

However, if you live in a city where you have to park in a city lot or several blocks away from where you live, you may be able to get in those added steps even if you do take your car.

Stand Up at Work

If your job requires you to sit for long periods, make it a point to stand up at least every 20 minutes. You may need to set a reminder using your calendar or phone, especially if you're used to getting involved with a project and losing track of time.

If you're worried about interrupting your workflow, you don't necessarily have to stop your task to take a quick standing or stretching break. You can easily take calls or review files standing up.

Try taking brief breaks away from your desk to get some water or confer with a colleague at their desk rather than sending an email.

Change Your Workstation

You might also consider getting a standing desk, a treadmill desk, or a fitness ball seat (which promotes "active sitting," where you engage your core).

If you have a workstation that can be adjusted to various heights, you can do some of your daily computer work standing up.

Standing workstations may even improve your posture, reduce back pain , and when arranged properly, can be a better ergonomic fit. Some companies employ workspace-ergonomics specialists who can evaluate your workstation and help you get set up.

Do Your Chores

Instead of moving from table to couch, clean your kitchen after dinner. Tasks like doing the dishes and wiping down countertops count as standing activities in your day.

Other chores like taking out the garbage, sweeping the floors, and vacuuming are even more physically active.

A bonus is that you'll get housework done during the week, which frees up your days off for more fun activities.

Be Active After Dinner

Planning activity after dinner not only boosts your fitness, it helps keep your blood sugar levels in the optimal range and reduces your risk of developing insulin resistance .

Even if you're eating out and won't have to do the cleaning up, you don't have to miss out on a chance to get moving. Suggest continuing the mealtime conversation with dinner companions by taking a short walk.

Use Commercial Breaks

Watching your favorite television show or having a movie night at home with your family doesn't have to be a prolonged sedentary activity.

You can use commercial breaks as a chance to move around. Need to refill the popcorn bowl? Pause the movie and give everyone a chance to stretch while you replenish snacks.

You can even make a game of it. See who can do the most pushups or situps during a commercial break. Or, if you still have chores to take care of, multitask. Folding laundry is one physical activity you can easily do while watching a movie.

Intentionally breaking up any screen time, whether television, computer, tablet, or phone, will help reduce the time you spend sedentary each day.

Develop a Fitness Routine

If the thought of going for a run intimidates you, you don’t have to run a marathon to enjoy the benefits of fitness.

There are many options for exercise . Experiment and find which you prefer. You might like running outdoors on trails or through your neighborhood best. Maybe the cardio machines at a gym or community center are a better fit. Swimming, high-intensity interval training, and cycling are all excellent options to break free of a sedentary lifestyle.

Exercising can also be a social event if you want it to be. If you don't prefer to exercise solo, you can join a fitness group.

Plant a Garden

Any gardener will tell you how much physical effort is involved in every gardening activity. Gardening is mentally and spiritually stimulating, but many people find it an enjoyable way to stay active.

The American Heart Association considers general gardening to be in the category of moderate-intensity physical activity.

You can get started with a garden in your own backyard if you have space, but if not, there are other ways to get your hands dirty.

If you don't have a yard of your own, volunteer to help out at a local community garden. Many cities, school districts, and nature centers rely on green-thumbed volunteers for planting and maintenance.

Try a Fitness Tracker

A pedometer is a great way to track your steps, which can help you gauge your activity throughout the day.

Knowing your activity can alert you to patterns or habits that lean toward an overly sedentary lifestyle. You can take action to combat the effects of sitting too much by finding opportunities to move more.

Sophisticated fitness trackers do more than tell you how many steps you're taking—you can use them to track calories in and calories out, your day-to-day activity level, and set goals. Some even track your heart rate and sleep.

Many smartphone apps provide similar functions even if a wearable fitness tracker isn't your preference or within your budget. Many options are free and may track your activity passively, so you won't have to remember to log your activity.

It is well-documented that a sedentary lifestyle leads to poor health outcomes. The great news is that even small changes to the amount of activity a person gets can lead to more significant changes in overall health. Simply walking more, parking farther away, or doing household chores positively impacts health. Adding a fitness routine to your lifestyle, whether cardio, swimming, or resistance training, can lead to significant health improvements.

Park JH, Moon JH, Kim HJ, Kong MH, Oh YH. Sedentary lifestyle: overview of updated evidence of potential health risks . Korean J Fam Med . 2020;41(6):365-373. doi:10.4082/kjfm.20.0165

Magnon V, Dutheil F, Auxiette C. Sedentariness: a need for a definition . Front Public Health . 2018;6:372. doi:10.3389/fpubh.2018.00372

MedlinePlus. Health risks of an inactive lifestyle .

An N, Chuo J. Walking and activeness: the first step toward the prevention of strokes and mental illness . Comput Intell Neurosci. 2022;2022:3440437. doi:10.1155/2022/3440437

Allison MK, Baglole JH, Martin BJ, Macinnis MJ, Gurd BJ, Gibala MJ. Brief Intense Stair Climbing Improves Cardiorespiratory Fitness . Med Sci Sports Exerc. 2017;49(2):298-307. doi:10.1249/MSS.0000000000001188

Parise I, Abbott P, Trankle S. Drivers to obesity—a study of the association between time spent commuting daily and obesity in the Nepean blue mountains area . Int J Environ Res Public Health . 2021;19(1):410. doi:10.3390/ijerph19010410

By Yasmine S. Ali, MD, MSCI Yasmine Ali, MD, is board-certified in cardiology. She is an assistant clinical professor of medicine at Vanderbilt University School of Medicine and an award-winning physician writer.

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Sedentary Activities: Can You Outwork Sitting?

By: Nick Soleyn, JD, PBC, BLOC Staff Coach, and Editor in Chief

Refrigerators are marvelous devices. The Second Law of Thermodynamics states that entropy always increases with time, a constant change that is observed in the transfer of heat: heat will not transfer naturally from a cold object to a hot one. Yet, within most modern households, there is a little box of defiance within which a constant cycle of liquid expansion and contraction reduces entropy, dumping heat into the surrounding area so that we can enjoy leftovers as the universe marches inexorably toward its ultimate heat death.

Physical decline as we age is as certain as entropy increasing, but like the refrigerator, we can find ways to impose our will and slow the spoil of our youth. We can make ourselves healthier, stronger, and more durable, but that takes work.

And we are working against our species’ version of entropy: human apathy for physical work increases with time and technology. Many of us exercise to undo the forced sedentariness of a job, to adjust to the work-from-home migration, or to set an example for kids whose lives are more automated every day. Sedentary behaviors take up more of our days now than any other time in history, and the days aren’t getting any longer.

But can you really undo the effects of a sedentary life? Sitting is not benign. It causes immediate changes in our oxygen levels, circulation, and muscle activity, and in high doses, it causes whole-body changes that read like the opposite of what we try to accomplish under the bar or when we exercise for health.

Sedentary Activities

Active people tend to ignore discussions of sedentariness. That’s not our fault. The most common definition of sedentary comes from the exercise science literature, which has not distinguished between sedentary activities and a general lack of exercise. Sedentary control groups are usually people who do not meet some minimum threshold for moderate or vigorous exercise, making it impossible for a person to be both sedentary and active in the same 24-hour period. People who lift weights and exercise cannot also be sedentary because they lift weights and exercise—at least in this common view.

Yet many dedicated lifters may spend six or more hours a day sitting—at a desk, on a commute, or in front of a television. According to a lot of exercise literature, that’s okay, as long as they meet the minimum threshold for being not sedentary. That common belief has been challenged in the last decade by a connection between sedentary activities and poor health outcomes that appear to be independent of how much a person exercises. Paying attention only to our healthful activities may be like eating a healthy, balanced meal every day but spending most of our time snacking on whatever is at hand.

A better approach is to look at our days as a tableau of physical activities: (1) moderate- to high-intensity exercise, (2) sleep, (3) non-exercise or light-exercise, and (4) sedentary activities. While not all training, sleep, or physical activities are equally valuable, health outcomes tend to reflect the balance of these activities rather than the quality of a single one. (In comparison, performance outcomes depend more heavily on the quality of your training, recovery, and nutrition.)

We are learning more about this balance from changes in how researchers monitor and quantify daily activities. Traditionally, studies have relied on self-reported surveys. People who reported more exercise tended to be in better health, giving us “[r]obust evidence on the health benefits of optimal patterns of sleep and moderate-to-vigorous physical activity” and “specific, time-based public health guidelines for both of these activities in adults.” [1] Unfortunately, survey data is limited in its usefulness. It depends on the questions asked, and participant’s responses come filtered through memory and self-perception. As a result, “much of the data published… deals with the relationship of specific health outcomes to time spent in only one activity during a daily 24-h cycle,” as opposed to the complete picture of physical activities that might make up a person’s day. [2]

Relatively new measurement devices, such as accelerometers, measure behaviors continuously and can be worn for days or weeks. With more comprehensive data, we can better study whether time spent in one kind of physical activity affects health outcomes related to other activities. In this tableau, sedentary behaviors are the negative space in our day, highlighting the positive things we do for health, but given too much of our time, sedentary activities threaten to wash out our best efforts in the gym or in other healthful pursuits.

Defining Sedentary

Most often, sedentary behavior is measured in MET units, which stands for the metabolic equivalent of task . METs are numerical representations of how much energy you use when doing different tasks, not in actual caloric expenditures but in comparison to a baseline activity, 1.0 METs. One MET is roughly equal to the energy spent while sitting quietly (about one kilocalorie per kilogram of body weight per hour). MET units are useful because, while the actual energy expenditure between two people for different activities will vary, the difference between those activities—say sitting (1.0 MET) and walking (2.0 MET)—will be about the same for everyone.

In an attempt to standardize sedentary as a technical term, a group of professors and professionals have proposed the following definition:

We suggest that journals formally define sedentary behavior as any waking behavior characterized by an energy expenditure ≤1.5 METs while in a sitting or reclining posture. In contrast, we suggest that authors use the term “inactive” to describe those who are performing insufficient amounts of MVPA (i.e., not meeting specified physical activity guidelines). [3]

One attempt to quantify the connection between MET measurements and cardiovascular disease and diabetes suggested that an at-risk person could improve their chances by increasing their physical activity by 11.25 MET-hours per week. To get that, a person would need to add about five and a half hours of walking during the week.

The problem is that not all energy expenditure is equal, and recommendations from the research differ depending on the particular focus of the study. Studies looking at the benefits of exercise tend to view sedentary behaviors as the absence of a daily threshold of energy expenditure: people are sedentary when they do not meet the minimum activity requirements. The letter quoted above suggests that a better term for people who do not meet exercise guidelines is “inactive.” The sedentary literature treats activities as sedentary, causing physical changes that are independent of the person’s other activities. The difference is that sedentary studies view sitting for prolonged periods as having a net negative effect. So, a person’s 2.0 METs from walking for one hour are much more healthful than 2.0 MET-hours’ worth of sitting. In the world of sedentary studies, everything we do either moves us closer to health or to disease—there is no middle ground.

That’s a bit extreme, but it highlights the point that a person can be both active and sedentary in the same 24-hour period. [4] The idea that sedentary activities may cause their own negative health effects has led the American Heart Association and others to take up the idea that, as James Hamblin writes, “you can’t undo sitting.”

Is Sitting Really that Bad?

We sit—a lot. The numbers vary depending on the study methods, but one study’s participants, who wore activity monitors 24 hours a day, spent nearly 55% of their monitored time sedentary, averaging to about 7.7 hours per day. [5] The text Sedentary Behavior Epidemiology , which breaks up our awake time into three types of physical activities (sedentary behavior, light-intensity, and moderate- to vigorous-intensity), says that “on average, sedentary and light-intensity activities comprise a much larger proportion of total waking time (~95%) compared to moderate-to-vigorous intensity physical activity (~5%).” [6] That makes sense since, by definition, you cannot engage in high-intensity exercise for several hours every day of the week.

Plenty of people have deep indents in their couches and still manage to live active, healthy lifestyles. Plenty of people train hard, exercise well, and eat right but have serious health problems that may be related to sitting. The latter is more concerning because we tend to excuse sedentary activities by dedicated exercise. The weekend warrior who works a desk job cannot outwork six to eight hours a day behind a computer during the weekend.

The obvious problem is that when you sit, you aren’t burning very many calories, but too much sitting is distinct from too little exercise. “[W]hile contractile activity of skeletal muscles is important for common activities involved in being upright (i.e., standing and ambulation), this muscle activity largely ‘flatlines” during sitting postures—as demonstrates by an unloading of the major locomotor muscle groups in studies measuring muscle electromyographic (EMG) activity.” [7] Most people sit in a slouched or awkward posture, compressing their chest cavity and decreasing their overall oxidation. [8] Many workstations are poorly set up for ergonomics, exacerbating muscle weakness and back pain. Longer-term, prolonged habitual sitting may increase risks of cardiovascular disease and insulin resistance, contribute to chronic low-grade inflammation, and increase incidences of all-cause mortality. “[T]hese associations appear to be largely additional to the risks associated with lack of moderate- to vigorous-intensity physical activity during leisure time.” [9] Sitting and poor circulation also increases the risk for deep vein thrombosis, a potentially life-threatening condition. Psychologically, when people exercise more, they tend to engage in less hedonic or self-rewarding behaviors (like sweet treats), an inhibition that is not present in people who are relatively sedentary throughout the day.

Can You Undo Sitting?

Yes and no. The AHA and other policy-driven bodies are notorious for aiming low: the easiest answers will be adopted by the most people and, therefore, create the biggest change. So one of the mantras that has come from sedentary studies is to “sit less, move more.” Writer James Hamblin of The Atlantic notes that this advice is only mildly aspirational: “by ‘move,’ they mean almost anything that is not sitting or reclining—anything that increases your metabolism to 1.5 times that of being absolutely still. Which is a very low bar. ‘Leisurely walking’ is close to 2.5, while gardening or throwing a baseball with a kid gets you closer to four.” [10]

You cannot undo sitting, especially when accumulated in long, unbroken bouts. The negative effects seem to run independently of everything else you might do in your day. However, sitting also isn’t poison. Its effects on the body are intertwined with your other (read: healthier) activities. Notice that most negative effects from sitting are the opposite of the positive effects of exercise and strength training: increased risks of cardiovascular disease and diabetes, muscular atrophy, sarcopenia, back pain, and a net-positive energy balance.

Sitting is potent, but so is exercise. While sitting less is a good thing, you may be able to outwork prolonged sedentary behaviors if you have no other choice. [11]

But you cannot excuse sitting by your other activities. If you have to sit for six to eight hours a day, it behooves you to consider that time as a negative stressor on your body and something that is working against your health goals. The best interventions for copious sedentary behaviors are quantity- over quality-based. While you should already be including high-quality strength and conditioning training into your week, high-quantity, low-impact activities can help mitigate negative health effects from prolonged sitting. Interrupt your sitting frequently (every 30 to 45 minutes) with at least moderate-intensity movement—just standing up doesn’t seem to do much. And include longer bouts of lighter-intensity exercise in your day—walking and low-impact cardio is vastly underrated for this purpose.

While you cannot undo the effects of prolonged sitting, and you certainly cannot excuse sitting with punctuated workouts—you may be able to outwork sitting (if you have to).

For mobility, strength, and generally counteracting the effects of sitting, there are few things we like as much as the big barbell lifts. To get started with them visit the Barbell Logic Beginning Barbells Page for in-depth, cues, and troubleshooting tips.

[1] Mary E. Rosenberger, Janet E. Fulton, Matthew P. Buman, Richard P. Troiano, Michael A. Grandner, David M. Buchner, William L. Haskell, “The 24-Hour Activity Cycle: A New Paradigm for Physical Activity,” Medicine & Science in Sports & Exercise . Vol. 51:3 (March 2019): 454-64, https://doi.org/10.1249/MSS.0000000000001811.

[3] Sedentary Behaviour Research Network. Letter to the editor: standardized use of the terms“sedentary” and “sedentary behaviours.” Appl Physiol Nutr Metab. 37(3) (2012): 540–2.

[5] Charles E. Matthews, Kong Y. Chen, Patty S. Freedson, Maciej S. Buchowski, Bettina M. Beech, Russell R. Pate, and Richard P. Troiano, “Amount of time spent in sedentary behaviors in the United States,” Am J Epidemiol . 167:875-81 (2008): 877–78, DOI: 10.1093/aje/kwm390.

[6] Paddy C. Dempsey and John P. Thyfault, “Physiological Responses to Sedentary Behaviour,” Sedentary Behaviour Epidemiology . Ch. 5 (2018): Fig. 5.1, Page 110.

[7] Id. At 116.

[8] Fang Lin, Sriranjani Parthasarathy, Susan J. Taylor, Deborah Pucci, Ronald W. Hendrix, Mohsen Makhsous, “Effect of Different Sitting Postures on Lung Capacity, Expiratory Flow, and Lumbar Lordosis,” Archives of Physical Medicine and Rehabilitation . Vol. 87, Isssue 4 (April 2006): 504–09 https://doi.org/10.1016/j.apmr.2005.11.031.

[9] Epidemiology , supra, p. 120

[10] James Hamblin, “The Futility of the Workout-Sit Cycle,” The Atlantic . (August 12, 2016): available at https://www.theatlantic.com/health/archive/2016/08/the-new-exercise-mantra/495908/.

[11] Ulf Ekelund, Jostein Steene-Johannessen, Wendy J Brown, Morten Wang Fagerland, Neville Owen, Kenneth E Powell, Adrian Bauman, I-Min Lee, “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 womenm” Lancet . 388 (July 2016): 1302–10, http://dx.doi.org/10.1016/S0140-6736(16)30370-1 . (“High levels of moderate intensity physical activity (ie, about 60–75 min per day) seem to eliminate the increased risk of death associated with high sitting time. However, this high activity level attenuates, but does not eliminate the increased risk associated with high TV-viewing time. These results provide further evidence on the benefits of physical activity, particularly in societies where increasing numbers of people have to sit for long hours for work and may also inform future public health recommendations.”)

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5 Critical Thinking Activities That Get Students Up and Moving

More movement means better learning.

Students engaged in critical thinking activities

It’s easy to resort to having kids be seated during most of the school day. But learning can (and should) be an active process. Incorporating movement into your instruction has incredible benefits—from deepening student understanding to improving concentration to enhancing performance. Check out these critical thinking activities, adapted from Critical Thinking in the Classroom , a book with over 100 practical tools and strategies for teaching critical thinking in K-12 classrooms.

Four Corners

In this activity, students move to a corner of the classroom based on their responses to a question with four answer choices. Once they’ve moved, they can break into smaller groups to explain their choices. Call on students to share to the entire group. If students are persuaded to a different answer, they can switch corners and further discuss.

Question ideas:

Which president was most influential: George Washington, Thomas Jefferson, John Adams, or Abraham Lincoln?
Is Holden Caulfield a hero: Strongly Agree, Agree, Disagree, or Strongly Disagree?

Gallery Walk

This strategy encourages students to move around the classroom in groups to respond to questions, documents, images, or situations posted on chart paper. Each group gets a different colored marker to record their responses and a set amount of time at each station. When groups move, they can add their own ideas and/or respond to what prior groups have written.

Gallery ideas:

Political cartoons

Stations are a great way to chunk instruction and present information to the class without a “sit and get.” Group desks around the room or create centers, each with a different concept and task. There should be enough stations for three to five students to work for a set time before rotating.

Station ideas:

Types of rocks
Story elements
Literary genres

Silent Sticky-Note Storm

In this brainstorming activity, students gather in groups of three to five. Each group has a piece of chart paper with a question at the top and a stack of sticky notes. Working in silence, students record as many ideas or answers as possible, one answer per sticky note. When time is up, they post the sticky notes on the paper and then silently categorize them.

How can you exercise your First Amendment rights?
What are all the ways you can divide a square into eighths?

Mingle, Pair, Share

Take your Think, Pair, Share to the next level. Instead of having students turn and talk, invite them to stand and interact. Play music while they’re moving around the classroom. When the music stops, each student finds a partner. Pose a question and invite students to silently think about their answer. Then, partners take turns sharing their thoughts.

How do organisms modify their environments?
What is the theme of Romeo and Juliet ?

Looking for more critical thinking activities and ideas?

Critical Thinking in the Classroom is a practitioner’s guide that shares the why and the how for building critical thinking skills in K-12 classrooms. It includes over 100 practical tools and strategies that you can try in your classroom tomorrow!

Get Your Copy of Critical Thinking in the Classroom

5 Critical Thinking Activities That Get Students Up and Moving

5 Activities To Help Students Improve Their Working Memory

Bell ringers that focus on what your students need most. Continue Reading

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Home > Books > Sedentary Behaviour - A Contemporary View

How to Reduce Sedentary Behavior at All Life Domains

Submitted: 04 September 2020 Reviewed: 05 March 2021 Published: 09 April 2021

DOI: 10.5772/intechopen.97040

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Sedentary Behaviour - A Contemporary View

Edited by Adilson Marques and Élvio Rúbio Gouveia

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Lifestyle has changed in the last century increasingly promoting sedentary behaviors. Prolonged sitting time is related to increased all-cause mortality risk. Therefore, scientific research aimed at understanding the effects of sitting on health has increased to find effective interventions that can be carried out in life domains (study, work, transport, and free time). The interaction between physical activity and sitting time plays a key role in the development of strategies to promote physical activity practice and reduce sedentary behavior. Accepting that the modern societies incite to spend long periods seated, the aim seems to find a balance between all the areas during the 24 h of the day. Maintaining sleep time, reducing screen leisure time to 3 h/day, and breaking prolonged sedentary time for 2–3 min every 30 min-1 h of sitting, as well as reaching the physical activity recommendation may help counteract the potential negative effect of too much sitting time. Governments must provide active free time options to promote active leisure time and help reduce screen time. At workplaces, managers and companies should encourage sitting breaks and work standing options, and for the special population such as children or older adults, new strategies must be considered to reduce sitting time.

sitting time
older adults
leisure time
sedentary breaks

Author Information

Olga lópez torres *.

ImFINE Research Group, Health and Human Performance Department, Faculty of Physical Activity and Port Science-INEF, Universidad Politécnica de Madrid, Spain
Laboratorio de Estudios en Actividad Física, Universidad de Flores, Argentina

Valeria Baigún

Gabriela f. de roia.

*Address all correspondence to: [email protected]

1. Introduction

Lifestyle has changed over the world in the past decades. The industrialization process and technological advances have simplified the physical work of human beings and changed the lifestyle of the last generations. Not that long ago, most of the jobs required physical activity and some energy expenditure. Nowadays the percentage of work sectors demanding high levels of physical activity has reduced drastically. This new reality derives in many people forced to spend at more than 8 h/day sitting and having difficulties to reach the physical activity recommendations [ 1 ]. Sedentary lifestyles have become a significant public health issue spreading worldwide, although there is evidence of being linked to a range of chronic health conditions [ 2 ]. Extended periods of inactivity can produce metabolic dysfunction and impair blood sugar regulation [ 3 ], elevate blood pressure [ 4 ], and make it difficult to use fat as a metabolic substrate, as well as increase the risk of early death regardless of physical activity levels [ 5 ]. Therefore, it seems crucial to find strategies that can be applied in all life domains to be able to reduce sedentary behavior, as well as to increase physical activity. Including regular and well-structured sedentary breaks during long sitting periods could help reduce the negative effects of a sedentary lifestyle.

This chapter aimed, firstly, to provide scientific evidence of the need to reduce sedentary behaviors as well as to include regularly sedentary breaks. Secondly, to show some possibilities and examples of how to break sedentarism in daily life. We believe that introducing these practices in workspaces, schools, leisure time, and in the daily activities of older adults might help control the negative effects derived from sedentary lifestyles.

2. Sedentary behavior

2.1 evolution of lifestyle and the concept of sedentary behavior.

Historically, exercise physiologists have studied sedentary lifestyle as the opposite of physical activity. The terms that have been used for research in this area have been confusing, which makes it difficult to compare clinical trials. Already in the 1950s, Morris et al. [ 6 ] concluded that sedentary work increased cardiovascular risk compared to those who worked more physically active. That study, among others, resulted in a strong area of research focused, for over 60 years, on quantifying the level of physical activity necessary to reduce morbidity and mortality [ 6 ]. These investigations provided recommendations on physical activity and the implementation of public policies to promote physical activity practice.

Despite the efforts, a high percentage of the population (mostly from countries that suffered rapid urbanization and industrialization) do no reach the physical activity recommendations and the tendency is that this number increases [ 1 ] Office works, school, screen games, technology, passive transportation and sedentary leisure time have had a strong impact on reducing the opportunities to perform physical activity at the same time that promote opportunities for sedentary behavior in all the life domains.

For the past two decades, the number of studies focused on sedentary behavior has grown exponentially, and physical activity and sedentary behavior can be considered as an independent research field. The term sedentary behavior comes from Latin “sedere” which means “to sit”. But not only the “position” determines what is currently conceived as sedentary behavior. Sedentary behavior is defined as any waking behavior characterized by the expenditure of 1.5 metabolic equivalents of task (MET)s or less of energy while in a sitting, reclining, or lying posture [ 7 ]. Sedentary behavior, like physical activity, can be found in all life domains (work, study, transport, and free time). Although research in this field has increased notably in the last decade, there is still confusion in the terminology and the scientific community has not reached a consensus in some terms and concepts yet. Many definitions of sedentary behavior can be found in the literature but some common concepts are repeated, such as low energy expenditure, mostly under 1.5 METs, activities performed in sitting, lying or reclining position and while the person is awake [ 7 ]. Besides, some other concepts associated with sedentary behavior have aroused the interest of the scientific community. Sedentary bouts, breaks of sitting, sedentarism, sedentary lifestyle vs. inactivity, among others, are related terms that could help deeply understand this problem.

Sedentary Behavior Concept has suffer an evolution over the years. Although the distinction between sedentarism and physical inactivity (not meeting worldwide recommendations for physical activity) has already been settled [ 7 ], it is still common to find some confusion in terms such as sedentary time, sitting time, screen time and stationary time; which, although in some cases are overlapping concepts, refer to different behaviors [ 7 ]. Because they refer to different aspects of behavior (position, movement, effort and the use of digital implements), these traits can be blended in different ways, so that some criteria are met but others are not. For example, one can be seated but doing physical activity (cycloergometer), so it’s not a sedentary behavior; one could be stationary, but not sitting (e.g., waiting in line); one may be in sedentary behavior, but not sitting (instead lying down watching TV), which in turn is independent of screen usage (reading a book); among other examples.

2.2 Using bed rest models

Studies on bed rest [ 8 , 9 , 10 , 11 , 12 , 13 ] provided useful information on the consequences of inactivity and low energy expenditure for long periods. Thanks to these studies, a lot is known about the effects of prolonged inactivity in metabolism and organ systems. Different studies focused on the effects of bed rest on metabolic function, found peripheral insulin resistance in skeletal muscle and adipose tissue, hepatic insulin resistance and a dyslipidemia [ 10 ], as well as a decline in function, muscle mass, and muscle strength [ 12 ] and a reduction in cardiorespiratory capacity after one-week bed rest [ 13 ]. In regards to the musculoskeletal structure, inactivity produces loss of strength and endurance, contractures, changes in soft tissues, disuse osteoporosis, sarcopenia, and degenerative joint disease [ 8 ]. At the cardiovascular level, the consequences can be postural hypotension, cardiac dysfunction, and thrombotic events [ 13 ]. Additionally, bed rest can lead to impaired respiratory, renal, gastrointestinal, and nervous system levels [ 9 ]. Outside hospitalization or illness, free-living healthy adults rarely spend these amounts of bed rest. Nevertheless, technological and social factors have made prolonged sitting time a common practice in all life domains (work, domestic life, and leisure time).

2.3 Quantifying sedentary behavior

Measuring physical activity and sitting time is complex. Research has been aimed at improving the quality of the data through the objective measurement of sedentary behavior using accelerometry, observing that the self-report measurement underestimates the daily time of sedentary behavior concerning the objective measurement.

Researchers have focused on developing devices to be able to objectively quantify physical activity. In the past decades, many studies using accelerometers have been carried out. A multi-country study (USA, Brazil, UK, Denmark, the Czech Republic, and Hong Kong) using accelerometry found that the average sedentary time per day was 513 min/day, or 8.55 h/day [ 14 ]. Sedentary time was estimated to be responsible for 3.8% of all-cause mortality in adults according to a meta-analysis pooling data across 54 countries [ 15 ]. The United States Physical Activity Guidelines Advisory Committee (PAGAC) [ 16 ] recently comprehensively reviewed the scientific evidence, linking sedentary behavior with specific physical health indicators in adults and older adults, including mortality, cardiovascular disease, type 2 diabetes, cancer, and obesity. Moreover, high levels of sedentary behavior are also negative associated with cognitive function, depression, function and disability, physical activity levels, and health-related quality of life [ 17 ]. In contrast, little evidence has demonstrated the relationship between sedentary behavior and musculoskeletal pain, accidents or injuries, fatigue, sleep, or work productivity [ 18 ]. Ku et al. [ 19 ] published in 2018 a meta-regression analysis involving more than 1 million participants in which the cut-off points of daily sedentary time that were related to all-cause mortality in adults were established for data measured objectively and self-reported [ 19 ]. According to the results of the study, the method of measuring sitting time significantly moderated the association between daily sitting time and mortality risk. The cut-off of daily sitting time in studies with self-report data was 7 h/day in comparison with 9 h/day for those with data measured by devices.

2.4 Sedentary behavior VS physical activity

It is accepted that exercise is an effective strategy for reducing key cardiovascular risks [ 20 ]. Nevertheless, it is unclear if the benefits can be modified by a sedentary lifestyle. Therefore, it is important to clearly define different concepts such as physical activity/inactivity or sedentary behavior, as their physiological consequences on health are different. While physical activity/inactivity is referred to whether or not a person reaches the physical activity recommendations, a person is considered as sedentary if he/she spends long periods of the day in sedentary behavior. While for the first one (cut-off points for being physically active) there is enough evidence to determine the recommendations (150 minutes of moderate physical activity or 75 minutes of vigorous physical activity or an equivalent metabolic combination between both, plus 2–3 days/week of resistance training) [ 21 ], for the second one (cut-off points for being sedentary) there are still no recommendations, since studies have found inconclusive results.

That means that a person can meet the physical activity guidelines and still be considered sedentary. Sedentary behavior might produce harmful effects on health independently of physical activity level, but when both are combined, the results seem to change (combined joint association). In other words, high levels of sedentary behavior combined with low levels of physical activity increase the risk of death by 46% [ 18 ]. On the contrary, some studies have shown that high levels of physical activity can counteract or reduce the risk of death caused by prolonged sedentary behavior [ 22 ]. Similar results were obtained in cancer patients, where in the most active patients no relationship was observed between sedentary behavior and cancer mortality, while for those less active the risk of death increased [ 23 ].

The sedentary inactive: Those who do not meet the physical activity recommendations and also spend long periods of the day sitting.

The non-sedentary inactive: Those who do not meet the physical activity recommendations but do not spend long periods of the day sitting.

The sedentary active: Those who reach the physical activity recommendation but spend long periods of the day sitting.

The non-sedentary active: Those who reach the physical activity recommendations and also do not spend long periods of the day sitting.

Figure 1 represents graphically these possibilities.

Person’s classification according to sedentary behavior and physical activity practice. (A) Sedentary inactive, (B) non-sedentay inactive, (C) sedentary active, (D) non-sedentary active.

The health implication for possibilities A and D are clear. Classification A has a negative influence on health and is negatively associated with all-cause mortality and D is positively associated with better health markers. What is not fully clear yet, are the implications of classifications B and C. Can one the variables counteract the negative effect of too much of the other one? Or, are the positive effects of one variable suppressed by the other one?

As mentioned before, some studies found that high levels of physical activity might attenuate the increased risk of some illness or death associated with high sitting times [ 22 ]. Notwithstanding, there is still some uncertainty in the characteristics of the specific dose–response curves, which makes it difficult to determine specific quantitative public health recommendations [ 24 ]. As sedentary lifestyle in western societies does not tend to reduce, new strategies might be the solution. Some degree of sedentary lifestyle might be beneficial for health so that it helps to rest and recover. On the contrary, excessive sitting time may become a risk factor. Scientific evidence has not found an increase in the risk of death from any cause in people with a total sitting time between 4–8 hours/day when compared to those who remain seated for less than 4 hours. Nevertheless, the risk increases by 15% when sitting time rises to 8–11 hours/day, and by 40% with sitting times higher than 11 hours/day [ 25 ]. Contrary, some other studies found a dose–response relationship for every 1-hour increase in sitting time in intervals between 0–3, >3–7, and > 7 h/day total sitting and all-cause mortality. This model estimated a 34% higher mortality risk for adults sitting 10 h/day, after taking physical activity into account, although the risk increased staggered [ 26 ], similar to other studies that observed statistically significantly higher risk of death with sedentary times of 9.5 h/day or more [ 23 ].

This situation has put the focus on the double challenge of increasing levels of physical activity and reducing sedentary behavior. Many countries have developed strategies to promote changes in the population. As an example, the Canadian government created the Canadian 24-Hour Movement Guidelines for Adults ( https://csepguidelines.ca/ ). It recommends that adults between 18–64 years must limit sedentary time to 8 hours/day or less, including no more than 3 hours/day of recreation screen time and breaking long periods of sitting as often as possible.

2.5 Sedentary breaks: effectivity of the different types according to scientific evidence

As it has been mentioned before, modern lifestyles predispose a high percentage of the population to spend long periods in sedentary behaviors. As too much sitting time is related to different chronic diseases such as type 2 diabetes, obesity, hypertension, and cardiovascular diseases, or some types of cancer, it seems crucial to clearly understand the mechanism and strategies to reduce the negative effects of a sedentary lifestyle. Generalizing, we get up, use the elevator to go to the car, drive to work, take the escalator to go work, spend 8 hours at least working with minimum movement, drive back home, eat, have some hours of recreational time, watch TV and go to bed. Fortunately, different lifestyles and personal situations (occupational situation and leisure-time preferences) as well as inherent individual differences, result in different accumulations of sedentary time. Due to the strong available evidence on the deleterious effects of a sedentary lifestyle on health, it is necessary to better understand the metabolic mechanisms and how it is accumulated. Researchers have observed that reducing or breaking up sedentary time may result in beneficial changes in body composition and acute improvements in markers of cardiometabolic risk.

Type of activity performed seated: intellectual or occupational sitting seems to be less harmful than TV time or less intellectual activities.

Level of PA: adequate levels of physical activity may attenuate the negative effect of prolonged sitting.

Age: as an accumulative factor, so that, normally, if a person has a sedentary lifestyle, it has been adopted for more years when the person is older and the deleterious effects have been applying longer.

Interruptions in sedentary bouts : interrupting sitting time regularly may attenuate its negative effects when comparing to the same average uninterrupted sitting time.

It has been proposed that breaks in sedentary time could help counteract the negative effect of prolonged periods of whole-body inactivity. A break in sedentary time can be defined as a period of non-sedentary activity, such as standing or walking in between two sedentary bouts [ 7 ]. Experimental studies have demonstrated that interrupting sedentary time with short frequent breaks reduces daily glucose, postprandial glucose, and insulin resistance [ 3 , 26 , 27 ]. In a study carried out by Healy et al. [ 28 ] in 2008, the authors found, that interruptions of sedentary behavior were negatively associated with obesity and cardiometabolic health. These results highlighted, already at that time, the fact that not only total sitting matters but also how it is distributed in a period of time. The characteristic of the sedentary breaks in the study from Healy et al. showed that the breaks reported by the participants were shorter than 5 min on average, and they were performed at a light intensity. Results from this study also found lower waist circumference, BMI, triglycerides, and 2-h plasma glucose in the participants with higher sedentary break bouts, independent of total sedentary time or moderate-to-vigorous intensity activity time. Since this pioneering study was published, the scientific community have had an increased interest in analyzing the effects of sedentary breaks, to be able to deeply understand the effects of prolonged sitting on metabolism, as well as to establish clear and specific guidelines of intervention. Different types of sedentary breaks have been studied trying to analyze if shorter bouts of sitting time, are less metabolic disrupting even when the total amount of daily or weekly sitting times are similar.

Brief bouts of light-intensity-activity sedentary breaks could reduce the negative effects of long periods sitting on lower limb vascular function in healthy and overweight/obese adults [ 29 ]. Experimental studies [ 30 , 31 , 32 ] have seen that combining exercise with breaks in sitting resulted in additional reductions in postprandial insulin-glucose dynamics and triglycerides when comparing exercise and uninterrupted sitting. This effect, although useful in any case, seems to be more effective in those with high basal insulin resistance.

As many studies focused on analyzing the effects of sedentary breaks to counteract the metabolic problems associated with prolonged sitting time have found positive interactions, the question that remains unanswered is not if we should break sitting regularly, what already has a positive answer. The unanswered question is, which is the best structure for a sedentary break?

As it has been mentioned before, the lack of enough specific interventional studies complicates for experts to concrete the most optimal structure for sedentary breaks. A recent study by Wheeler et al. [ 30 ] investigated the effects of 3 different sitting strategies in overweight and obese: i) uninterrupted sitting for 8 h, ii) sitting for 1 h, moderate-intensity walking for 30-min and uninterrupted sitting for 6.5 h and iii) sitting for 1 h, moderate-intensity walking for 30 min and sitting for 6.5 h interrupting sitting every 30 min with 3 min of light-intensity walking. They found reductions in postprandial insulin-glucose dynamics and triglycerides by combining exercise with breaks in sitting. This study not only proposes a way to help reach the physical activity recommendation by breaking sedentary time for 30 min/day but also demonstrates that regular sedentary breaks help control the metabolic deleterious effect of prolonged sitting.

A well-controlled meta-analysis conducted by Loh et al. in 2020 [ 33 ] found that the use of sitting breaks moderately attenuated post-prandial glucose, insulin, and triacylglycerol. The authors also found that the glycemic attenuation was greater in people with a higher body mass index. An interesting result was that for attenuating glucose levels, a statistically significant small advantage for sitting breaks was found over continuous exercise when exercise matched energy. That could mean that for glucose regulation, it might be more interesting short regular breaks along the day, than one continuous bout of exercise.

The skeletal muscle might also play a key role in glycaemia control, which is even more important in overweight. Bergouignan et al. [ 34 ] performed an analysis from randomized clinical trials comparing one or three days uninterrupted sitting with sitting interrupted with light-intensity or moderate-intensity walking every 20-min in the modulation of contraction- and insulin-stimulated glucose uptake pathways in muscle. They found that both sitting break interventions reduced postprandial glucose concentration as well as a transition to modulation of the insulin-signaling pathway and increased capacity for glucose transport. The moderate-intensity intervention resulted in a greater capacity for glycogen synthesis and ATP production. These results might through some light in preventive strategy for metabolic diseases.

Published literature [ 35 ] might tend to propose that the best option to reduce the negative effects of sedentary behavior on metabolic functions could be to combine regular activity breaks of several minutes every 30 min of sitting with 30 min of continuous walking whether at the beginning or the end of the long sitting period.

Therefore, breaking sedentary time should be a good way to reduce the negative effects of long periods of sitting, for both metabolic and muscle function. These breaks are even more interesting for patients with initial high blood sugar, insulin resistance, or overweight-obesity. The general recommendation would be to make an active 2–3 min-break every 30 min of sitting time. If the activity made during these breaks is of moderate-high intensity, such as climbing stairs, the metabolic benefits might be greater.

2.6 Sedentary behavior in the workplace. Strategies

The workplace is considered an important environment for the promotion and protection of health [ 36 ]. According to a report from the World Health Organization (WHO) together with the World Economic Forum, 65% of the world’s adult population is part of the workforce [ 37 ]. In 2007, about 3.1 billion people were part of the economically active population and it was estimated that by 2021 this number would exceed 3.6 billion [ 38 ]. Taking into account that this working adult population spends around a third of the day at work, workers´ health must be seen as a priority action.

Encouraging the reduction of sedentary behavior and promoting the practice of physical activity in the workplace is a strategy that helps maintain the health of the working population and affects their close environment. In 2018, the WHO presented the Global Action Plan for Physical Activity [ 39 ], with two mean challenges: reducing sedentary behavior by 2030 as well as the percentage of inactive population by 15% to the reported values of 2016. This plan encourages the population to take advantage of the many opportunities that arise in daily living to integrate physical activity, including the workplace (as a fundamental environment to practice physical activity programs as well as its promotion).

The activities where sedentary behavior predominates have increased lately and the workplace is a clear example. The machines have replaced human physical work at the same time that there has been a notable increase in office jobs, where the employee spends most of the working day in front of a computer. Although the negative consequences for cardiometabolic and musculoskeletal health of sedentary behavior have been widely demonstrated and office work represents for many workers a third of their day sitting, few have been made to improve this situation and reduce sitting time at workplaces, with the associated health risk.

The Healthy Work Environment model, proposed by the WHO [ 38 ] proposes intervention programs to reduce and break sedentary behavior in the workplace as a health promotion model and protection strategy. This model proposes four scenarios of action or “avenues of influence”, which are not isolated, but rather overlap each other:

The physical environment of the work, which refers to the structure, air, machinery, furniture.

The psychosocial work environment, which includes the organization of work and institutional culture, attitudes, values, beliefs that can affect the mental and physical well-being of workers.

Personal health resources in the workplace, that consist in an environment that promotes health, health services, information, resources, opportunities, and the flexibility that the companies offer to workers to support the efforts to improve or maintain healthy lifestyles, as well as to monitor and support your physical and mental health.

The physical participation of the institution in the community, which includes the activities that the company carries out to improve the safety, well-being, and quality of life of workers and their families.

Raising awareness among managers and chiefs of the importance of these interventions, facilitating employees to carry them out. Companies’ leaders must understand that these strategies are not only not time wasted but will also result in increased productivity.

A previous evaluation of the workplace and the type of tasks that are developed, that help design an optimal plan.

Execution of the plan with the support of all interested parts (managers, middle managers, bosses, CEO, etc.) and commitment by workers.

Re-evaluation and adaptation of the proposal.

With different adaptations, similar models can be recommended with more or less the same stages.

Experts have suggested different strategies to reduce or interrupt sedentary behavior in the workplace, which could be grouped into the following categories [ 40 ].

Physical/environmental changes in workplace design

Desks with adjustable height that allow lifting them to work standing up.

Raised desks with a treadmill.

Rooms with high tables for standing meetings.

Modify the layout of the workplace, for example, by placing printers, trashcans, or water dispensers away from desks, which will force employees to stand up and walk a few steps when they need to use these items.

Provide bicycle racks, lockers, and services to wash up to encourage active transportation to work.

Eliminate architectural barriers to allow employees to move around the workplace, creating unobstructed corridors and spaces that invite walking.

Changes in workplace policy to incentivize and encourage reduction and disruption of sitting time

Promote the holding of standing or walking meetings.

Propose active breaks during working hours (short breaks in which you can do joint mobility exercises, put on a musical theme and dance, or any activity that allows interrupting the sedentary behavior through light physical activity)

Offer group physical activity practice.

Encourage the use of breaks for short walks.

Encourage employees to communicate with their colleagues by approaching their desks rather than by phone or messages.

Propose to take advantage of telephone communications to do them standing or walking (obviously, spaces that do not interfere with the work of others should be considered).

Encourage the use of the stairs instead of the elevator or escalator.

Information and advice to raise employee awareness and commitment by offering

Workshops, training courses and outreach programs on the importance of reducing sedentary behavior. Reporting on the health risks of sedentary behavior and the benefits of practicing physical activity could allow people to evaluate their behavioral choices.

Campaigns through various means, such as posters, signage, emails, WhatsApp messages, telephone calls or internal messages to motivate a change in behavior or.

Install reminder software every 30 minutes on employees’ mobile phones or personal computers, for example, to interrupt the sedentary behavior by standing up, dancing or doing some movements.

2.7 Sedentary behavior in the leisure time. Strategies

As mentioned so far, human bodies are adapted to maintain a physically active lifestyle. Proof of this is the health consequences of an insufficient level of physical activity. However, it is also true that neurobiologically we are adapted to “optimize” our energy expenditure, avoiding additional efforts when possible; In other words, sedentary behaviors are attractive for human beings, and willing power is required to counteract this attraction and opt for a behavior with higher associated energy expenditure [ 41 ]. It has been studied how the energy cost associated with a task affects, not only our decision to choose another more “economic” one, but directly to our perception of the initial task [ 42 ] and, therefore, to our future intention to undertake it.

A process as complex as human behavior cannot be reduced to just one component. Emotional/affective factors, as well as built habits, are also related to sedentary behavior and physical activity [ 43 ]. However, it is an interesting starting point if we seek an alternative approach to the one traditionally used. The assumption that human behaviors are decided by rational evaluations of the available information are underlying concepts in many current intervention strategies and, therefore, knowing the benefits of regular physical activity and the damages of prolonged sedentary behavior should be enough to solve the problem [ 44 ]. Nevertheless, in light of the sustained global pandemic of physical inactivity, it may be necessary to complement and enrich this approach with other perspectives.

Sedentary behaviors in free time are usually classified as screen-time (watching television, videos via streaming platform or physical medium, browsing the internet and social networks by both on a computer, tablet or cell phone and the use of video games) or not screen-time (sitting down to eat, participating in social gatherings, playing board games, recreational, attending cultural events such as cinema, theater, show music, sports competition, religious ceremony, doing artistic activities like writing or drawing or hobbies. The extensive list is testimony to the enormous offer of sedentary activities in free time. Recommendations on physical activity and sedentary behavior limit the amount of time in sedentary behaviors, but particularly those carried out in front of the screen [ 21 ].

Sedentary activities in front of the screen in free time, in addition to adverse effects on physical health, are related to adverse effects on mental health, mainly in minors [ 45 ]. Screen time during childhood is negatively correlated with brain connectivity, compared to time spent reading books, as well as being related to loss of imagery ability [ 46 ] or social–emotional functionality [ 47 ]. Interestingly, and in contrast to these studies, in the specific case of video games, there is evidence that indicates various cognitive benefits according to the type of game (action, strategy), and even positive socio-emotional impacts [ 48 ].

Of the large number of sedentary activities carried out in free time, although the impact on physical health is equivalent, it would be differential over other dimensions of the subject’s health. This leads to one of the perspectives mentioned in the literature as a strategy to address sedentary behavior: “harm reduction”. Assuming that certain socio-cultural (technological) changes are already part of daily life, priority is given to modifying those behaviors that present a greater health risk: replacing sedentary behaviors in front of the screen with sedentary behaviors without a screen, or by non-sedentary screen activities (for example, walking while using portable devices or replacing sedentary video games with active ones) [ 49 ].

Different classifications have been proposed for reducing sedentary behavior in the free time [ 50 ]: 1) environmental interventions such as devices that limit the time of television use), and 2) behavioral interventions like education campaigns about the harms of prolonged sedentary behavior; 3) multi-component interventions which include both types mentioned above.

Although studies on this fact do not have homogeneous methodologies, some findings can be pointed out. Studies that focus on the sedentary behavior of children in the home context have found a relationship between the existence of screen devices in the bedroom and greater sedentary behavior (with less reading time). Likewise, both the interventions that use devices that limit the use of television and those on family rules for screen use have been successful in reducing sedentary behavior. Furthermore, it was observed that in those cases in which the parents had more television time, or participated with their children in sedentary activities, the children presented higher levels of sedentary behavior. In some studies, the existence of adequate space or equipment for practicing physical activity at home is related to less sedentary behavior (although it does not present higher levels of physical activity at moderate or vigorous intensities) [ 51 ].

In the case of adults and the elderly, studies on free time are scarce and methodological imprecise. The absence of control in the domains makes it difficult to control the changes since the decrease of sedentary time in a domain does not imply its replacement by physical activity since it could simply shift to sedentary behavior in another domain. Those interventions aimed exclusively at reducing sedentary behavior have better results than those that also focused on increasing physical activity [ 50 ].

For children and adolescents, as well as for adults and the elderly, there is another alternative intervention strategy, which constitutes itself in an emerging field of research: exergaming, also known as active gaming or effort video game. These video games, unlike the traditional ones, are controlled with body movements (either full body or only certain segments); Thus, instead of being a sedentary activity, at least light-intensity physical activity is achieved (with the potential to become moderate intensity and even vigorous). In the US, it is estimated that 90% of children and adolescents play video games recreationally. In an increasing technophile society, and in which electronic entertainment is already part of our lives, exergaming stands as a strategy to address those to whom other physical activity proposals are not convincing. In addition, the commitment, immersion, and experience of “flow” that they can generate, make them a great resource for health-related purposes. Sustainability over the years of this type of activity has been investigated, finding greater adherence in women, and similar to that of team sports [ 52 ].

Results for studies analyzing experiences in exergaming as part of both school physical education and at-home context show a decrease in sedentary behavior with potential, according to the intensity at which the game is played, increase of moderate-to-vigorous physical activity and good adherence to intervention programs. One of the challenges of exergaming is the “replay value” (once the game becomes monotonous and therefore the motivation to continue playing decreases), which maintain adherence. Multiplayer games (both face-to-face and remotely) show greater adherence. The eventual increase in the number of published games would compensate for this situation, allowing simply to change to a new one [ 53 ].

Particularly interesting is the research with older people, which improvements for both institutionalized and community-dwelling subjects, and not only in the physical dimensions but also in the cognitive one [ 54 ].

In all these cases, we refer mainly to consoles-home exergaming, but everyday mobile devices with augmented reality technology (Pokémon Go with geo-location system integrated into cell phones) are great opportunities to promote exergaming. Pokémon Go requires active movement of the player around their surroundings to play. This game mechanic has achieved a statistically significant change in the number of steps per day (thus decreasing sedentary behavior), although there is still not enough evidence on long-term adherence.

In the latter case, as in some home exergaming video games, there is no explicit intention in its design to promote health effects or to prescribe a systematic physical activity program. However, they have the potential to have a positive impact on the health and well-being of those who opt for this type of digital entertainment. Sedentary behavior in free time poses a great global challenge that requires, particularly for new generations, imagination and innovative approaches, in tune with contemporary technologies and paradigms.

2.8 Sedentary behavior in special populations: children and adolescents and older people. Strategies

2.8.1 children and adolescents.

It is well accepted that physical activity is beneficial to maintain and improve health and well-being across life [ 55 ]. In infants, toddlers, and preschoolers, high levels of physical activity have been seen to be related to better social and motor development improved metabolic health, and decreased adiposity, while a sedentary lifestyle is related to higher adiposity and poorer psychosocial health and cognitive development [ 54 ].

Children (preschoolers and scholars) spend more than 2 h/day of screen time, which is the maximal time recommended for this age group [ 56 ], plus eating time, school, passive transportation, homework, etc., which results in more than 8 h/day of sitting at this age. Moreover, studies found that screen time was associated with an increased risk of overweight/obese independent of physical activity [ 54 ]. Sex differences were also found. Boys are generally more involved in physical activity than girls, which normally spent more time on domestic tasks and homework. Children living in rural areas tend to use more active transportation than those who live in urban areas. Older children also tend to use more active transportation than the younger ones [ 57 ]. Taking into account that sedentary behavior in children is directly associated with classical cardiovascular risk factors like elevated blood glucose levels, insulin resistance, high blood pressure, obesity, and elevated blood lipids [ 58 ], strategies that help reduce total daily sitting time in children are crucial.

Nevertheless, although childhood should be a life stage where children should freely play, run and jump as part of their natural development, social rules, obligations, parent’s overprotection, new technologies, and urban environments, hinder the practice of physical activity for children with dramatic consequences. A qualitative study performed by Hidding et al. [ 59 ] aimed in determining the reasons for children to be sitting from the children or parents perspective, found that children most repeated reason was that they sit because is the norm and they have to and because they can play better that way. Other common answers were: I sit because seated activities are fun, I sit because I’m tired, I want to relax, I want to rest, I sit because of my health, I sit because there is nobody to play with, I sit because there is nothing to do, I sit because I’m not in the mood to do anything, I sit because of the weather. In regards to the answer “I sit because there is nobody to play with”, in families with more than one child, seems to be easy for children to perform physical activity [ 59 ].

SWEAT: Moderate to Vigorous Physical Activity: An accumulation of at least 60 min/day.

STEP: Light physical activity: Several hours of a variety of structured and unstructured light physical activities (playing, walking)

SLEEP: Uninterrupted 9 to 11 h/night for those aged 5–13 years and 8 to 10 h/night for those aged 14–17 years, with consistent bed and wake-up times.

SIT: Sedentary behavior: No more than 2 h/day of recreational screen time and limited sitting for extended periods.

Figure 2 ilustrates de cited guidelines.

Canadian 24-hour movement guidelines for children and youth (5-17 years): an integration of physical activity, sedentary behavior, and sleep. Taken from CSEP website ( https://csepguidelines.ca/ ).

In addition, parents might consider changing indoor activities for outdoor ones, when possible, and including moderate to vigorous physical activity in exchange for light physical activity at some point of the day.

Findings from a recent meta-analysis [ 60 ] on the physical activity a sedentary behavior suggest that physical activity interventions can improve adolescents’ mental health.

2.8.2 Older adults

Worldwide, the population is aging, which results in higher economic and social costs, as well as increased numbers of people living with more health problems, as aging increases the risk of suffering from chronic diseases. Therefore, the concept of successful aging has become a priority to guarantee, not only that life expectancy is high, but also that the years lived are of the best quality possible, free or with minimum chronic diseases. Physical activity has been proven to help increase or maintain health throughout life. Due to physical activity tends to reduce with age, older adults must become a risk population. Disability, frailty, dysfunction, or sarcopenia are some of the problems that can affect older adults, which can compromise the independence level [ 61 ]. As physical activity decreases in this group, sedentary behavior increases, with fatal consequences. Maintaining physical activity levels and reducing sedentary time, should be a priority for the administrations. In this regard, there is evidence about the negative associations of sedentary behavior with frailty and how this relationship can differ by sitting bout length. Some studies [ 62 ] have found that prolonged sedentary bouts and total sedentary time were associated with higher mortality risk in frail individuals but not in robust. These results, including moderate-to-vigorous physical activity, reducing sedentary time in those frail older adults, as well as including sedentary breaks seem like a suitable strategy to prevent dependency and maintain health. As the total hours of a day are always 24, that means that when a person increases the time spent in moderate-to-vigorous physical activity, this person is reducing the time spent in another activity, that could be sitting or light physical activity. If sleeping time remains stable and a person substitutes 30 min/day of light physical activity for moderate-to-vigorous physical activity that includes resistance training, and at the same time changes 1 hour of sitting for light physical activity such as walking, the frailty status could be significantly reduced. Moreover, if this person would include a short sedentary break every 30 min - 1 hour of the total time this person is seated, the benefits would be even higher with only small changes.

Due to older adults are mostly retired, which releases them of office sitting time and have a lot of leisure time, political strategies must center on providing older adults with a safe environment where they can perform light physical activity, such as walking [ 63 ]. Pavements and sidewalks in good conditions, green areas, and safe cross-roads might help improve that older adults go more often outside to take a walk. At the same time, organized affordable exercise activities, specifically designed by experts for this population, could make that older adult reach the recommendation for moderate-to-vigorous physical activity and resistance training. Moreover, these activities also promote social interaction, which improve wellbeing and might help reduce depression and anxiety, improving health-related quality of life, as well. These two actions would help to achieve physical activity recommendations at the same time that sedentary time would be reduced. To completely promote health in this group, clinicians, governments, and media should establish campaigns to make older adults understand the importance of breaking sedentary time. Things such as get up in the commercials when they watch TV, walking or standing while they are phoning, or get up to drink some water once each hour might be enough to break sitting time.

3. Conclusions

Lifestyle has dramatically changed in the last century. Industrialization and technology have reduced the physical requirements of many jobs, urbanization has changed population habits, force them to use passive transport instead of active ones, children play with digital devices since they are very young and older adult do not have to go outside because cities, family and environment easily provide all their needs. However, this sedentary lifestyle has disastrous consequences for health. Physical activity is necessary to maintain an optimal physiological function and prolonged sitting time interferes with the proper metabolic regulation. The combination of both, low physical activity levels and prolonged sitting time, maybe even more deleterious. That suggests a double challenge for developed countries; reducing and stopping prolonged sedentary behavior as well as increasing levels of physical activity. Although each of them separately has concrete effects on health, their interaction must be also taken into account. Sedentary behavior appears to be negative for health “per se”, as well as low physical activity levels, but how both are combined is what can make the difference. Scientific evidence says that high physical activity levels might help counteract the negative effects of sitting time and that this effect is progressive. That means, that the higher the physical activity intensity, the less negative effects of sitting time. At the same time, it seems that long continuous sitting bouts are more harmful than the same total sitting time but with breaks in between. Eight hours seated without any break might be a lot worse for metabolic regulation than the same 8 h of sitting but with breaks of 2–3 min every 30 min-1 h. With all these ideas in mind, the strategy to reduce sedentary behavior seems clear: practice enough physical activity, reduce free-time sitting and screen time, promote active transportation, and include sedentary breaks at sedentary jobs. The reason why these strategies are not working is complex and implies a compromise at different levels. First, governments must provide opportunities for affordable exercise practice and physical activity-friendly environments. Secondly, at workplaces, managers, CEOs, and bosses must be aware of the importance of promoting working places where employees have the opportunity of breaking sedentary time, and that it is seen as normal. Third, citizens should make efforts to include active activities in the free time as well as substitute classic videogames for exergaming, where at least, sitting time is exchanged for light physical activity. Last but not least, special populations (children and older adults) should not be forgotten. Parents and schools should reconsider the rules and norms and adapt them, when possible, to others more active versions, not forcing children to spend long periods seated promoting at the same time at least one hour of physical activity per day. Controlling screen time and giving good examples must be another priority for parents. In regards to older adults, societies should allow them to perform easy tasks that increase physical activity, encouraging them to used active transportations to carry them out, at the same time that exercise programs, specifical design for this population, are easily available in every neighborhood.

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13. Bringard A, Pogliaghi S, Adami A, De Roia G, Lador F, Lucini D, et al. Cardiovascular determinants of maximal oxygen consumption in upright and supine posture at the end of prolonged bed rest in humans. Respir Physiol Neurobiol. 2010;172(1-2):53-62
14. Van Dyck D, Cerin E, De Bourdeaudhuij I, Hinckson E, Reis RS, Davey R, et al. International study of objectively measured physical activity and sedentary time with body mass index and obesity: IPEN adult study. Int J Obes. 2015;39(2):199-207
15. Owen N, Sugiyama T, Eakin EE, Gardiner PA, Tremblay MS, Sallis JF. Adults’ sedentary behavior: Determinants and interventions. Am J Prev Med [Internet]. 2011;41(2):189-96. Available from: http://dx.doi.org/10.1016/j.amepre.2011.05.013
16. King AC, Powell KE, Kraus WE. The US Physical Activity Guidelines Advisory Committee Report - Introduction. Med Sci Sports Exerc. 2019;51(6):1203-5
17. Olanrewaju O, Stockwell S, Stubbs B, Smith L. Sedentary behaviours, cognitive function, and possible mechanisms in older adults: a systematic review. Aging Clin Exp Res [Internet]. 2020;32(6):969-84. Available from: https://doi.org/10.1007/s40520-019-01457-3
18. Biswas A, Oh PI, Faulkner GE, Bajaj RR, Silver MA, Mitchell MS, et al. Sedentary time and its association with risk for disease incidence, mortality, and hospitalization in adults a systematic review and meta-analysis. Ann Intern Med. 2015;162(2):123-32
19. Ku PW, Steptoe A, Liao Y, Hsueh MC, Chen LJ. A cut-off of daily sedentary time and all-cause mortality in adults: A meta-regression analysis involving more than 1 million participants. BMC Med. 2018;16(1):1-9
20. Hansen D, Niebauer J, Cornelissen V, Barna O, Neunhäuserer D, Stettler C, et al. Exercise Prescription in Patients with Different Combinations of Cardiovascular Disease Risk Factors: A Consensus Statement from the EXPERT Working Group. Sport Med. 2018;48(8):1781-97
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22. Ekelund U, Steene-johannessen J, Brown WJ, Fagerland MW. Ekelund , U ., Steene-Johannessen , J ., Brown , W . J ., Fagerland , M . W ., Owen , N ., Powell , K . E ., Bauman , A ., Lee , I . ( 2016 ). Does physical activity attenuate, or even eliminate , the detrimental association of sitting time with mortalit. Lancet. 2016;6736:972-7
23. Ekelund U, Brown WJ, Steene-Johannessen J, Fagerland MW, Owen N, Powell KE, et al. Do the associations of sedentary behaviour with cardiovascular disease mortality and cancer mortality differ by physical activity level? A systematic review and harmonised meta-analysis of data from 850 060 participants. Br J Sports Med. 2019;53(14):886-94
24. Dempsey PC, Biddle SJH, Buman MP, Chastin S, Ekelund U, Friedenreich CM, et al. New global guidelines on sedentary behaviour and health for adults: broadening the behavioural targets. Int J Behav Nutr Phys Act. 2020;17(1):1-12
25. Chau JY, Grunseit A, Midthjell K, Holmen J, Holmen TL, Bauman AE, et al. Sedentary behaviour and risk of mortality from all-causes and cardiometabolic diseases in adults: Evidence from the HUNT3 population cohort. Br J Sports Med. 2015;49(11):737-42
26. Dempsey PC, Larsen RN, Sethi P, Sacre JW, Straznicky NE, Cohen ND, et al. Benefits for Type 2 Diabetes of Interrupting Prolonged Sitting With Brief Bouts of Light Walking or Simple Resistance Activities. Diabetes Care. 2016;39(6):964-72
27. Duvivier BMFM, Schaper NC, Hesselink MKC, van Kan L, Stienen N, Winkens B, et al. Breaking sitting with light activities vs structured exercise: a randomised crossover study demonstrating benefits for glycaemic control and insulin sensitivity in type 2 diabetes. Diabetologia. 2017;60(3):490-8
28. Healy GN, Dunstan DW, Salmon J, Cerin E, Shaw J, Zimmet P, et al. Beneficial associations with metabolic risk. Diabetes Care. 2008;31(4):661-6
29. Thosar SS, Bielko SL, Mather KJ, Johnston JD, Wallace JP. Effect of prolonged sitting and breaks in sitting time on endothelial function. Med Sci Sports Exerc. 2015;47(4):843-9
30. Wheeler MJ, Green DJ, Cerin E, Ellis KA, Heinonen I, Lewis J, et al. Combined effects of continuous exercise and intermittent active interruptions to prolonged sitting on postprandial glucose, insulin, and triglycerides in adults with obesity: a randomized crossover trial. Int J Behav Nutr Phys Act. 2020;17(1):1-11
31. Climie RE, Wheeler MJ, Grace M, Lambert EA, Cohen N, Owen N, et al. Simple intermittent resistance activity mitigates the detrimental effect of prolonged unbroken sitting on arterial function in overweight and obese adults. J Appl Physiol. 2018;125(6):1787-94
32. Saunders TJ, Atkinson HF, Burr J, MacEwen B, Skeaff CM, Peddie MC. The Acute Metabolic and Vascular Impact of Interrupting Prolonged Sitting: A Systematic Review and Meta-Analysis. Sport Med [Internet]. 2018;48(10):2347-66. Available from: https://doi.org/10.1007/s40279-018-0963-8
33. Loh R, Stamatakis E, Folkerts D, Allgrove JE, Moir HJ. Effects of Interrupting Prolonged Sitting with Physical Activity Breaks on Blood Glucose, Insulin and Triacylglycerol Measures: A Systematic Review and Meta-analysis [Internet]. Vol. 50, Sports Medicine. Springer International Publishing; 2020. 295-330 p. Available from: https://doi.org/10.1007/s40279-019-01183-w
34. Bergouignan A, Latouche C, Heywood S, Grace MS, Reddy-Luthmoodoo M, Natoli AK, et al. Frequent interruptions of sedentary time modulates contraction- and insulin-stimulated glucose uptake pathways in muscle: Ancillary analysis from randomized clinical trials. Sci Rep [Internet]. 2016;6(July):1-13. Available from: http://dx.doi.org/10.1038/srep32044
35. Homer AR, Fenemor SP, Perry TL, Rehrer NJ, Cameron CM, Skeaff CM, et al. Regular activity breaks combined with physical activity improve postprandial plasma triglyceride, nonesterified fatty acid, and insulin responses in healthy, normal weight adults: A randomized crossover trial [Internet]. Vol. 11, Journal of Clinical Lipidology. National Lipid Association; 2017. 1268-1279.e1 p. Available from: http://dx.doi.org/10.1016/j.jacl.2017.06.007
36. World Health Organization (WHO). No Title. Ottawa Chart Heal Promot [Internet]. 1986; Available from: http://www.who.int/healthpromotion/conferences/previous/ottawa/en/
37. (WHO) WHO. Preventing noncommunicable diseases in the workplace through diet and physical activity : WHO/World Economic Forum report of a joint. World Heal Organ / World Econ Forum 2008 [Internet]. 2008;Global Str. Available from: https://www.who.int/dietphysicalactivity/workplace/en/
38. World Health Organization & Burton J. World Health Organization. WHO Heal Work Framew Model Backgr Support Lit Pract [Internet]. 2010; Available from: https://apps.who.int/iris/handle/10665/113144
39. WHO. More Active People for a Healthier World. J Policy Model. 2018;28(6):615-27
40. Shrestha N, Kukkonen-Harjula KT, Verbeek JH, Ijaz S, Hermans V, Pedisic Z. Workplace interventions for reducing sitting at work. Cochrane Database Syst Rev. 2018;2018(6)
41. Cheval B, Tipura E, Burra N, Frossard J, Chanal J, Orsholits D, et al. Avoiding sedentary behaviors requires more cortical resources than avoiding physical activity: An EEG study. Neuropsychologia [Internet]. 2018;119(May):68-80. Available from: https://doi.org/10.1016/j.neuropsychologia.2018.07.029
42. Hagura N, Haggard P, Diedrichsen J. Perceptual decisions are biased by the cost to act. Elife. 2017;6:1-20
43. Brand R, Cheval B. Theories to explain exercise motivation and physical inactivity: Ways of expanding our current theoretical perspective. Front Psychol. 2019;10(MAY):1-4
44. Hagger MS, Weed M. DEBATE: Do interventions based on behavioral theory work in the real world? Int J Behav Nutr Phys Act. 2019;16(1):1-10
45. Zink J, Belcher BR, Imm K, Leventhal AM. The relationship between screen-based sedentary behaviors and symptoms of depression and anxiety in youth: A systematic review of moderating variables. BMC Public Health. 2020;20(1)
46. Suggate SP, Martzog P. Screen-time influences children’s mental imagery performance. Dev Sci. 2020;23(6):1-13
47. Wan MW, Fitch-Bunce C, Heron K, Lester E. Infant screen media usage and social-emotional functioning. Infant Behav Dev [Internet]. 2021;62(November 2020):101509. Available from: https://doi.org/10.1016/j.infbeh.2020.101509
48. Granic I, Lobel A, Engels RCME. The benefits of playing video games. Am Psychol. 2014;69(1):66-78
49. Leigh M. Vanderloo PSCPMAMsKTCPJMMCSBMMs. Vanderloo2020. J Dev Behav Pediatr. 2020;41(5):19-20
50. Nguyen P, Le LKD, Nguyen D, Gao L, Dunstan DW, Moodie M. The effectiveness of sedentary behaviour interventions on sitting time and screen time in children and adults: An umbrella review of systematic reviews. Int J Behav Nutr Phys Act. 2020;17(1):1-11
51. Biddle SJH, Petrolini I, Pearson N. Interventions designed to reduce sedentary behaviours in young people: A review of reviews. Br J Sports Med. 2014;48(3):182-6
52. Emara AK, Ng MK, Cruickshank JA, Kampert MW, Piuzzi NS, Schaffer JL, et al. Gamer’s Health Guide: Optimizing Performance, Recognizing Hazards, and Promoting Wellness in Esports. Curr Sports Med Rep. 2020;19(12):537-45
53. Stojan R, Voelcker-Rehage C. A Systematic Review on the Cognitive Benefits and Neurophysiological Correlates of Exergaming in Healthy Older Adults. J Clin Med. 2019;8(5):734
54. Claus GM, Redkva PE, Brisola GMP, Malta ES, de Poli R de AB, Miyagi WE, et al. atric Exercise Science. The article appears here in its accepted, peer-re-viewed form, as it was provided by the submitting author. It has not been copyedited, proofread, or formatted by the publisher. 2017
55. Warburton DER, Bredin SSD. Health benefits of physical activity: A systematic review of current systematic reviews. Curr Opin Cardiol. 2017;32(5):541-56
56. Tremblay MS, Carson V, Chaput JP, Connor Gorber S, Dinh T, Duggan M, et al. Canadian 24-hour movement guidelines for children and youth: An integration of physical activity, sedentary behaviour, and sleep. Appl Physiol Nutr Metab. 2016;41(6):S311-27
57. Song C, Gong W, Ding C, Yuan F, Zhang Y, Feng G, et al. Physical activity and sedentary behavior among Chinese children aged 6-17 years: A cross-sectional analysis of 2010-2012 China National Nutrition and health survey. BMC Public Health. 2019;19(1):1-8
58. Königstein K, Klenk C, Appenzeller-Herzog C, Hinrichs T, Schmidt-Trucksäss A. Impact of sedentary behavior on large artery structure and function in children and adolescents: a systematic review. Eur J Pediatr. 2020;179(1):17-27
59. Hidding LM, Altenburg TM, van Ekris E, Chinapaw MJM. Why do children engage in sedentary behavior? Child- and parent-perceived determinants. Int J Environ Res Public Health. 2017;14(7)
60. Rodriguez-Ayllon M, Cadenas-Sánchez C, Estévez-López F, Muñoz NE, Mora-Gonzalez J, Migueles JH, et al. Role of Physical Activity and Sedentary Behavior in the Mental Health of Preschoolers, Children and Adolescents: A Systematic Review and Meta-Analysis. Sport Med [Internet]. 2019;49(9):1383-410. Available from: https://doi.org/10.1007/s40279-019-01099-5
61. Kehler DS, Theou O. The impact of physical activity and sedentary behaviors on frailty levels. Mech Ageing Dev [Internet]. 2019;180(November 2018):29-41. Available from: https://doi.org/10.1016/j.mad.2019.03.004
62. Kikuchi H, Inoue S, Amagasa S, Fukushima N, Machida M, Murayama H, et al. Associations of older adults’ physical activity and bout-specific sedentary time with frailty status: Compositional analyses from the NEIGE study [Internet]. Vol. 143, Experimental Gerontology. 2021. 111149 p. Available from: https://doi.org/10.1016/j.exger.2020.111149
63. Brookfield K, Thompson CW, Scott I. The uncommon impact of common environmental details on walking in older adults. Int J Environ Res Public Health. 2017;14(2)

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Home / Healthy Aging / Cognitive decline prevention: Brain stimulation and lifestyle choices

Cognitive decline prevention: Brain stimulation and lifestyle choices

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To protect your cognitive health, you don’t need to shop for expensive superfoods for the brain. Nor do you need to buy brain teaser apps or specific brain exercise products.

In fact, the list of lifestyle changes that benefit the brain isn’t very surprising. A healthcare professional — probably more than one — has likely already suggested everything on it.

“What’s good for your overall health is good for your brain too,” says Bryan K. Woodruff, M.D., a Mayo Clinic cognitive neurologist.

In other words, the same lifestyle choices that reduce your risk of heart disease, diabetes and cancer also can reduce your risk of cognitive decline. To understand why, it helps to know a little about the physiology of the brain.

The brain-body connection

You might have heard that Alzheimer’s disease — a brain disorder that leads to dementia — is caused, in part, by the buildup of beta-amyloid plaques and twisted tau proteins in the brain. While technically true, other brain changes also are likely involved, says Dr. Woodruff.

“When scientists look at the brains of people with Alzheimer’s disease after they’ve died, they find more than just plaques and tangles,” he says.

They often find a buildup of fats, cholesterol and other substances in the vessels that supply blood to the brain.

They also discover evidence of microscopic strokes — also called microinfarctions. Unlike major strokes that bring on noticeable symptoms like facial drooping, microscopic strokes are silent. People are unaware of them. However, as people experience more and more of them, they can starve brain tissue of oxygen and nutrition. If enough microvascular changes occur, there may be symptoms like slowed thinking and trouble concentrating.

“Your brain, as with every other organ in your body, depends on your cardiovascular system,” says Dr. Woodruff.

This is why it’s so important to care for your heart and blood vessels, he says.

Can lifestyle choices prevent cognitive decline?

Thanks to this connection between vascular health and brain health, what benefits your heart also protects your brain. To get these benefits:

Manage heart disease risk factors.

Treat elevated blood sugar, high blood pressure and undesirable cholesterol levels. Don’t use tobacco products. Keep your weight in the healthy range. “Treat all of those general medical conditions. The earlier you address them, the better the benefit is for your brain,” says Dr. Woodruff.

Follow a heart-healthy diet.

The Mediterranean diet is the most extensively studied nutritional approach for brain and overall health. Its emphasis on minimally processed whole foods and fruits and vegetables may improve brain health by helping to keep body fat and chronic inflammation in check. The Mayo Clinic diet takes a similar approach to establishing a healthy-eating lifestyle.

Read more: What is the Mediterranean diet?

Get enough sleep.

People who get less than six hours of sleep during their 50s and 60s are 30% more likely to be diagnosed with dementia decades later, according to a study of nearly 8,000 people. During sleep, the brain flushes away toxins, including the beta amyloid and tau proteins mentioned earlier, another study found . When you don’t sleep enough, you cut this process short. And poor sleep can also increase your risk of other diseases that can impact cognition, such as high blood pressure and diabetes.

Read more: How can quality sleep impact lifespan ?

Maintain social connections.

Social connections are thought to benefit the brain in many ways. Research suggests that social engagement triggers the release of chemicals such as serotonin and dopamine, which improve mood and outlook. And social connections may help to spur the growth of new connections between nerve cells.

Treat hearing and vision loss.

If you can’t see and hear what’s going on around you, you’ll find it more difficult to communicate and remain social. “Those sensory functions are integral to how we think and interact with the world,” says Dr. Woodruff. “If you don’t see or hear it, then you can’t encode and remember it.” This is part of the reason why preserving your hearing and eyesight is so important. So talk with your healthcare professional about whether hearing aids, corrective lenses or other strategies may be helpful.

Avoid chronic use of sedating medications.

Some of the medicines used to treat pain, insomnia and other conditions can dull thinking, slow reaction time and make you feel sleepy. If you’re not sure of the side effects of the medications you take regularly, talk with your healthcare professional, says Dr. Woodruff. “A health professional can look at what’s on your medication list and suggest alternatives,” he says.

Does exercise help the brain?

In people who exercise regularly, the lining of blood vessels remains smooth and slippery, making it harder for clots to form, finds research .

Exercise also stimulates the release of a protective molecule called brain-derived neurotrophic growth factor (BDNF). This substance works like fertilizer to protect existing brain cells and help create new ones.

Finally, regular exercise promotes other brain-healthy habits, like improved sleep and reduced stress.

That’s likely why a study of 128,925 adults determined that rates of cognitive decline were twice as common in sedentary people who didn’t exercise much, if at all.

The best type, intensity and duration of exercise for your brain is yet to be sorted out, says Dr. Woodruff. For overall physical health, the Centers for Disease Control and Prevention recommends 150 minutes of moderate cardiovascular activity weekly and two weekly strength training sessions. However, if you can’t do that much, know that any exercise is better than none, says Dr. Woodruff.

Can I exercise my brain?

Yes, you can exercise your brain, but not necessarily in the ways you might assume.

When you have difficulty learning something new, your brain builds new connections between nerve cells. If you continually learn new skills and information over time, experts believe that these networks of nerve cell connections create what’s called a cognitive reserve. The concept of cognitive reserve is a lot like a bank account. The greater your reserve (savings), the more you can stand to lose without ending up in the red.

“Cognitive reserve doesn’t mean you’re immune,” says Dr. Woodruff. “But it buys you some cushion against a neurodegenerative problem.”

Over the years, people have made “brain exercise” synonymous with doing crossword puzzles and brain games. While cognitively stimulating, those activities do not necessarily translate to daily life. You might, for example, get really good at coming up with eight-letter words that start with Z. However, that skill won’t necessarily help you remember your appointments, pay attention to a conversation or know not to click on a scam e-mail link telling you to claim a prize for a contest you didn’t enter.

To be clear, brain teasers and games aren’t bad for you. If you love them, keep doing them, says Dr. Woodruff.

“Keep your mind active, but find something that you like doing and find enjoyable. Otherwise, you’ll just go through the motions,” he says.

How to stimulate your brain

The best brain stimulation recipe varies from one person to another. As long as you choose activities that take you slightly outside of your comfort zone, you’re giving your brain a workout. Consider these brain-stimulating possibilities:

Play cards or board games, especially if they’re unfamiliar to you.
Learn a new language, musical instrument or skill.
Knit a complicated pattern.
Try a new recipe.
Take up a new art or craft.
Visit a new vacation spot.
Plan a dinner party.
Sign up for a lifelong learning class about astronomy or another new-to-you topic.

You might notice that the word “new” appears in most of the above examples. That’s key because novel experiences help stimulate the growth of new brain connections. Ideally, challenge your brain in many ways and continually change it up, says Dr. Woodruff.

When is it too late to protect brain health?

As long as you’re still alive, it’s not too late to slow cognitive decline, says Dr. Woodruff.

Some people with severe cognitive impairment may need support, he says. But that doesn’t mean they shouldn’t try. “I tell all my patients, regardless of the severity of their cognitive decline, to take care of their overall health. They are still living in that body, so it’s still good to take care of it.”

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Critical thinking definition

Critical thinking, as described by Oxford Languages, is the objective analysis and evaluation of an issue in order to form a judgement.

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A life less sedentary

We know that being physically active is good for us. It works our muscles, heart, and lungs, helps us feel better, and reduces the risk of disease. These benefits not only arise from regular exercise, but also from keeping your body moving throughout the day.

The importance of avoiding excessive sedentary time

The World Health Organization (WHO) estimates that physical inactivity is associated with 3.2 million deaths worldwide each year. 1 Recommendations encourage adults to do 150 minutes per week of moderate-intensity aerobic activity (e.g. running, brisk walking, swimming; any movement that makes you feel warm and slightly out of breath). Children should spend at least 60 minutes being physically active each day. This activity reduces the risk of non-communicable diseases, including breast and colon cancers, diabetes and cardiovascular disease (CVD). 1 However, recent findings raise concerns that there remain unique health risks associated with extended periods of sedentary time, even in people who exercise regularly. 2

Sedentary activities

“Sedentary” derives from the Latin word ‘sedere’, which means ‘to sit’. This includes any activity that has a low-level energy expenditure. 2 At rest, the organs of the body require an essential amount of energy for vital functioning which is known as the basal metabolic rate (BMR). Each motion, action, and gesture entails an additional energy cost. The more active we are the more energy we expend. The energy cost of an activity can be expressed as multiples of metabolic rate (to account for differences in body size) as a metabolic energy equivalent (MET) or physical activity ratio (PAR). One MET is the equivalent of burning approximately 1 kilocalorie per kg body weight per hour. 3 For example, based on the figures in Table 1, a person with a body weight of 70 kg who swims for 1 hour roughly burns 490 kilocalories (70 kg x 7 MET). Sedentary activities are defined as having ≤1.5 METs, as they do not raise energy expenditure much above resting metabolic rate (around 1 MET). They include any activity in which there is little physical movement. 4

Table 1. Energy costs of selected activities 3,5

Daily energy expenditure can be estimated using a physical activity level (PAL) value. PAL values can be equated to very general lifestyle categories (sedentary, low and moderate activity). PAL values range between 1.38 for the least active and 2.5 for the most active. Replacing time usually spent being inactive with being active can increase PAL by 0.12 per hour of walking (4.8 km/h or 3 mph), by 0.46 per hour of jogging (9.7 km/h or 6 mph) and up to 0.6 per hour of intense aerobic exercise. Meeting the WHO recommendations of participation in 150 minutes of moderate-intensity activity per week would increase PAL by 0.15. If a person who is generally inactive with a PAL of 1.5 increases their activity levels to meet these recommendations their average PAL is predicted to increase to 1.65. 3

However, total energy expenditure varies greatly between individuals largely because of repetitive body movements that occur throughout daily living such as fidgeting, posture change and maintenance of muscle tone, known as ‘spontaneous physical activity’ (SPA). Individuals with higher levels of SPA move more throughout the day and therefore have higher average PAL values. The difference in the level of spontaneous body movement accounts for ±15% variation in energy expenditure between individuals. In daily life some individuals are naturally inclined to choose activities of low-energy expenditure such as standing still on escalators rather than walking up or taking the elevator rather than walking up stairs. 3 At work, at home, and while travelling, there are increasing opportunities to be sedentary. 4

Historically a sedentary lifestyle has been explained as a lack of moderate to vigorous physical activity. There are health benefits to be gained from meeting the WHO recommendations for moderate-intensity physical activity levels. However, research now suggests, even if an individual does achieve these exercise recommendations, they still face health risks from sitting for continuous periods of time. Therefore, exploring ways of breaking up periods of inactivity (i.e. standing up every so often) are becoming more important. 4,6

Health risks of sitting too long

Extensive periods of inactivity are linked to obesity, but this relationship is complex. Many studies have found that young people who watch more TV have higher dietary energy intakes, through consuming energy-dense foods and drinks whilst watching TV, or this might possibly be due to advertising or psychosocial effects. 6,7 Unbroken sitting time is thought to switch off important processes in the body, for example those involved in the utilisation of fats and carbohydrates, possibly because of the absence of muscle contraction. 8 These adverse health effects may be why sedentary behaviour is associated with an increased risk of metabolic syndrome, CVD, type 2 diabetes, certain cancers and all-cause mortality in adults, and CVD markers in adolescents. 2,6,9 Inactivity is also known to disturb bone mineralisation, reduce bone density (which increases the risk of osteoporosis), and possibly cause deep vein thrombosis and muscular discomfort, such as back pain. 4,6,8

Stand up, move more, more often

The risks mentioned above can be reduced by taking short breaks from sedentary activities. Even small actions expend more energy than remaining still. Simply standing up and walking at a normal pace for 2–5 minutes each hour (e.g. to get a drink or talk to a colleague), during an 8-hour desk job is estimated to burn approximately 60–130 kilocalories. 10

Furthermore, research in Australia found that adults who frequently interrupted their sedentary time had a better metabolic profile (healthier weight, blood fat and blood glucose levels) than adults who stayed still. 8 Again this finding was independent of recorded levels of moderate to vigorous physical activity.

The minimum intensity and duration of beneficial interruption of inactivity, and the underlying mechanism, are not yet known. But even changing from a seated to a standing posture is thought to switch on important beneficial processes such as those involved in fat metabolism. 11

Reducing screen-time

Media platforms are growing; television, games consoles, computer games, internet surfing, and social media are highly attractive pastimes, and can contribute to a sedentary lifestyle. An analysis across 10 European cities by the EU-funded HELENA study (Healthy Lifestyle in Europe by Nutrition in Adolescence) found that European adolescents spend 9 hours per day in a sedentary state. This is equivalent to 70% of their waking hours (slightly higher than reported in the USA). 12 This proportion of time is believed to increase into adulthood. 13 The HELENA study found that 60% of European adolescents watched TV for more than two hours per day at the weekend. Extended TV viewing was more likely amongst adolescents with televisions in their bedroom (over half), and those who were less engaged with academic tasks. 13

The American Academy of Pediatrics has recommended a restriction on screen-based media use for children and adolescents of 1–2 hours per day, and to remove media from their bedrooms. 14 Such viewing may displace other interactive activities crucial for natural development, and is therefore ill-advised for children under two years. 6,15

Children could be motivated by using behavioural interventions such as TV turn-off challenges, and rewarding screen-reduction with physical activities such play and games. 6,15

Moving more

Given our evolving environment, sedentary pursuits are predicted to increase. 2,4 While participating in moderate-intensity physical activity is important, it is just as critical to reduce and interrupt sitting time with light-intensity activities. Limited research has explored strategies to break up sedentary activity. In future, we may start to see office spaces adapted for more movement, active workstations (standing, treadmill), or active lessons at school. Maybe new technology can play a positive role by encouraging people to move more, more often. 6,15

Further information

EU project HELENA

World Health Organization (2011). New physical activity guidance can help reduce risk of breast, colon cancers.
Hamilton M et al. (2007). Role of low energy expenditure and sitting in obesity, metabolic syndrome, type 2 diabetes, and cardiovascular disease. Diabetes 56(11):2655–2667.
Scientific Advisory Committee on Nutrition (SACN) (2011). Dietary Reference Values for Energy. London, UK.
Tremblay MS et al. (2010). Physiological and health implications of a sedentary lifestyle. Appl Physiol Nutr Metab 35(6):725–740.
Ainsworth BE et al. (2011). The Compendium of Physical Activities Tracking Guide. Arizona State University, USA.
Marshall S & Ramirez E. (2011). Reducing sedentary behavior: A new paradigm in physical activity promotion. Am J Lifestyle Med 5(6):518–530.
Rey-López JP et al. (2011). Food and drink intake during television viewing in adolescents: the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study. Public Health Nutr 14:1563–1569.
Healy GN et al. (2008). Breaks in sedentary time. Diabetes Care 31(4):661–666.
Martínez-Gómez D et al. (2010). Sedentary behavior, adiposity, and cardiovascular risk factors in adolescents. The AFINOS study. Revista Espanola de Cardiologia 63(3):277–285.
Swartz A et al. (2011). Energy expenditure of interruptions to sedentary behavior. Int J Behav Nutr Phys Act 8(69).
Bey L & Hamilton MT. (2003). Suppression of skeletal muscle lipoprotein lipase activity during physical inactivity: a molecular reason to maintain daily low-intensity activity. J Physiol 551(2):673–682.
Ruiz JR et al. (2011). Objectively measured physical activity and sedentary time in European adolescents. Am J Epidemiol 174(2):173–184.
Rey-López JP et al. (2010). Sedentary patterns and media availability in European adolescents: The HELENA study. Prev Med 51(1):50–55.
American Academy of Pediatrics (2011). Children, adolescents, and television. Pediatrics 107(2):423–426.
Salmon J. (2010). Novel strategies to promote children's physical activities and reduce sedentary behaviour. J Phys Act Health 7(Suppl 3):S299–S306.

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Sedentary Behavior | Don't Just Sit, and Sit, and Sit!

Sedentary behaviors are those that occur during waking hours and have a very low level of activity, such as sitting or lying down. Being sedentary can result in more sitting and less time spent being physically active which can lead to obesity and greater risk for having diabetes and other chronic health problems as an adult (1).

Being Sedentary Vs. Not Doing Physical Activity

Saying that “a person sits a lot” isn’t the same thing as saying “a person doesn’t exercise very much.” They are like two separate bank accounts. In one account, you keep track of how much time you spend being physically active and the other account tracks how much time you spend sitting. Just like different accounts can have different amounts, a child can play outside for one hour and put an hour of physical activity into their account; but, if they sit in front of a TV the rest of the day, they still put several hours of sitting into the other account.

As adults, we may know that exercise is important for us too, but we should also include short bouts of physical activity throughout our day (e.g. 5 minutes every hour) beyond just a visit to the gym after work. A gym workout doesn't eliminate the health effects of sitting all day. In one study of healthy adults who met the daily physical activity requirements, sitting and watching TV was still positively associated with a number of health risks (2).

Studies show in the past few years, children and youth are sitting a lot more than they used to and specific populations are at risk such as lower income families, African American and Latino populations (1).

Many states have standards requiring children to receive moderate-vigorous physical activity periods as well as limit sedentary time other than meals, snacks, and naps.

Aren’t Children Naturally Active?

Many preschoolers spend considerable time at organized out-of-home care, such as pre-schools, child care centers, and family child care homes. While these settings provide excellent opportunities to promote physical activity and limit time spent being sedentary (4), studies show that children spend up to 87% of their time in early care and education (excluding naps) being sedentary (5). It is important for parents and teachers to work closely together and ensure children have sufficient activity levels in both home and school settings.

Factors that influence sedentary behavior in the classroom or on the playground include not enough space (indoors or outdoors); bad weather (snow, rain, heat); limited equipment (e.g. must share with other classes) or unsafe or broken playground equipment, lack of teacher involvement (motivation, skill, personality, teaching style); and children who might be uninterested, overweight and or lack motor skills (6).

Preschoolers should not be sedentary for more than 60 mins at a time except when sleeping (3).

What Activities Are Considered Sedentary?

Sedentary behavior is not a lack of a positive health behavior but rather it is itself a negative health behavior

Sedentary activities most often understood are screen time activities such as watching TV, playing video games or sitting at a computer or smart phone. But it can also include other activities like reading, playing cards, driving in a car or bus or sitting at a desk during school or work time. Sedentary activities are those that “do not significantly use arms or legs or provide significant exercise, including, without limitation, sitting, standing, reading, playing a board game, riding in a wagon or drawing.” So while it is important for a child to do a puzzle, sit and build blocks or read a book, these are still sedentary activities and should be broken up with a physical activity at least every 60 minutes.

Excess screen time has a unique set of conditions all of its own beyond obesity, such as decreased creativity, eye problems, anxiety, depression and negative associations with learning and other cognitive processes.

What You Can Do

Children become more sedentary as they get older, so early intervention is crucial to establish and maintain a healthy lifestyle in the early years (4)

Requires involvement from both parents and teachers!

If weather permits, provide daily periods of outdoor play
Provide parent or teacher-led physical activity sessions at home or in preschools- not just free play
Teach children movement skills, don’t just expect them to “figure it out”
Provide enough materials and working equipment to avoid excessive competition and long waiting periods for sharing
Find fun games and activities suitable for all children regardless of weight status, ability, or skill level
Avoid elimination games and ensure children are active and inclusive
Create opportunities for physical activity during lesson plans or times of transition or waiting
Look for indoor activities such as dancing or doing a treasure hunt
Allow children who cannot sleep to play quietly during nap time
Lou, D. Sedentary Behaviors and Youth: Current Trends and the Impact on Health . San Diego, CA: Active Living Research; 2014.
Healy, G. N., Dunstan, D. W., Salmon, J., Shaw, J. E., Zimmet, P. Z., & Owen, N. (2008). Television Time and Continuous Metabolic Risk in Physically Active Adults. Medicine & Science in Sports & Exercise, 40(4), 639-645.
Physical Activity . (2015, June 16). Retrieved February 07, 2018.
Van Cauwenberghe, E., et al. Journal of Science and Medicine in Sport 16 (2013) 422–426
Pate, R. R., K. McIver, M. Dowda, W. H. Brown, A. Cheryl. 2008. Directly observed physical activity levels in preschool children. J. School Health 78:438-44
De Decker et al. Influencing factors of sedentary behavior in European preschool settings: an exploration through focus groups with teachers. Journal of School Health (2013); 83: 654-661.

Learn more about the author(s)

Also of Interest:

Associated programs.

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Healthy Kids Resource Center

A one-stop shop for evidence-based research, resources, curricula, activities and materials that focus on obesity prevention for teachers and parents of young children. It is designed to educate parents and teachers as well as provide the tools needed to teach young children how to live a healthy lifestyle.

Lou, D. Sedentary Behaviors and Youth: Current Trends and the Impact on Health. San Diego, CA: Active Living Research; 2014.
Physical Activity. (2015, June 16). Retrieved February 07, 2018.

CogniFit Blog: Brain Health News

Brain Training, Mental Health, and Wellness

5 Simple Exercises to Finally Break Free From Your Sedentary Lifestyle Before It’s too Late

Introduction: Does Sitting Really Take Years off Your Life?

Regarding a sedentary lifestyle, you probably heard headlines in recent months saying sitting is the new smoking. This expression comes from the Department of Health and Human services which found that most people sit for more than eight hours per day. This is especially true of older adults. Researchers have found higher sitting times are linked to a higher mortality risk. The study also linked sedentary behavior and increased mortality to the prevalence of Type 2 Diabetes.

Living a sedentary life can lead to increased risk of various health problems, including obesity, heart disease, and even cancer. Unfortunately, most of us spend the majority of our day sitting – either at work or while relaxing at home. The human body was designed to move, and when we don’t give it the physical activity it needs, we are setting ourselves up for lower back pain, cardiovascular disease, and withered core muscles.

But there is good news. Starting healthy habits does not have to be difficult. By incorporating regular movement into your routine, you can improve your health and well-being. Even small changes in your routine can make an impact. Fitness and health might feel like there’s a long road stretching out in front of you. Light, however, is on the horizon.

In this blog post, we’ll explore the benefits of physical activity, share simple exercises to incorporate into your routine, and provide tips for starting slow and gradually picking it up. By the end of this post, you’ll be equipped with the knowledge you need to break your sedentary life before it’s too late.

II. Understanding Sedentary Lifestyle

A sedentary lifestyle is defined as one that involves little or no physical activity. This typically includes prolonged periods of sitting, such as working at a desk job or watching TV for hours on end. Unfortunately, this has become the norm for many people in today’s society.

The negative impact of a sedentary lifestyle can be far-reaching. Prolonged sitting has been linked to increased body fat, decreased muscle strength, and a higher risk of obesity, type 2 diabetes, and heart disease.

According to the American Heart Association and the American College of Sports Medicine , adults should aim for at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic activity per week to stay healthy.

The good news is that breaking a habitual sedentary existence is possible. By making small adjustments to your routine and incorporating active movement into your day, you can improve your health, lose weight, and reduce your risk of chronic disease. In the next section, we will explore the benefits of physical activity and how it can help break the cycle of a the sedentary way of being. You will have reason to celebrate.

III. Benefits of Physical Activity over the sedentary lifestyle

Physical activity is crucial for maintaining good health and combating the effects of a being sedentary. Here are some of the most significant health benefits you can enjoy by incorporating exercise into your routine:

1. Helps Prevent Cardiovascular Disease:

Exercising strengthens your heart and improves circulation, reducing your risk of heart disease and stroke. It can also help manage high blood pressure and cholesterol levels. Good cardiovascular health is highly favorable to brain function.

2. Disease Control:

Exercise can help prevent or manage a wide range of serious health risks and problems, including diabetes, arthritis, and certain types of cancer.

3. Can Help you Lose Weight:

Combined with a balanced diet, regular physical activity helps control weight gain by burning excess calories that would otherwise be stored as fat.

4. Mental Health Benefits:

Physical activity can also improve mental health by reducing symptoms of anxiety and depression. It can also improve sleep, which is often disrupted by chronic diseases, stress, anxiety, and depression.

Exercise can affect the connection between brain and muscles. As we age, we need to maintain this connection by conscious exercise. If your sitting time is elevated, perhaps because your job requires you to sit hunched over a computer all day, you had better make sure you compensate with exercise.

Most people are aware that body composition is important and we use exercise to keep ourselves relatively trim. We are aware that our cardiovascular health is to be cared for, but the knowledge of the mind/body connection is rather more scarce.

Even a slow walk can do wonders for your brain as you can gain stronger connection to your legs and avoid problems such as falling; one of the many things we may have to deal with (with exercise if possible) as we age. Movement is important as a workout for brains as well. When you move your legs consciously as you walk, your brain is able to focus on control and balance, on muscle control.

You find yourself easily able to modulate the speed and stride of your walk. Slow walking is good, but you exercise well enough to be able to pick up the pace whenever you want.

5. Improved Strength in Major Muscle Groups and Flexibility:

Regular exercise can help increase strength, flexibility, and endurance of leg muscles. This can be particularly beneficial for reducing the risk of falls in older adults and improving functional capacity in daily activities.

Incorporating exercises that target major muscle groups and core muscles into your routine, such as push-ups for upper body strength and planks for core stability, can provide these benefits. In the next section, we’ll introduce some simple exercises that you can easily incorporate into your daily life to break your sedentary lifestyle.

IV. Simple Exercises to Incorporate into Routine

Breaking the cycle of a sedentary lifestyle can begin with small, simple steps. Here are some exercises that you can incorporate into your daily routine:

1. Walking: Walking is one of the easiest and most effective exercises you can do. Try taking a brisk walk during your lunch break, or consider walking to work if it’s feasible. Aim for at least 30 minutes of walking per day, but remember, any amount of walking is better than none.

A great idea is to reserve one day per week for a special walk in which you accept a more challenging route or a longer route, for example. This long walk should not replace your daily outings and the idea is not to challenge yourselves to any levels of intensity you are not comfortable with.

Simply allow your once-per-week walk challenge. Every time you walk, take advantage and turn it into exercise.

Exercise at any age as an old man jogs on a beach.

2. Desk Exercises: If you have a desk job, there are many exercises you can do right from your chair. Try leg extensions: while sitting, extend one leg out straight and hold for a few seconds, then lower it without letting your foot touch the ground. Repeat with the other leg.

You can also do chair squats: stand in front of your chair, lower your body down until you’re almost sitting, then stand back up. Look for opportunities in your week to dedicate as little as fifteen minutes to your health.

3. Stretching: Regular stretching can help your muscles improve flexibility and reduce the risk of injury. Try to incorporate a few minutes of stretching into your day, especially after periods of prolonged sitting.

4. Resistance Training: Resistance training can help build strength and muscle mass, which can boost your metabolism and help counteract the effects of a constant sitting around. This can be done with resistance bands, weights, or even bodyweight exercises like push-ups and squats.

5. Slow Coordinated Muscle Movement: These might include Yoga, qigong and tai chi. All of these are excellent because they allow the practitioner to start from absolute zero. These practices will teach you how to stand correctly, to improve your gait, to breath healthily. There is also a tremendous stimulation of the brain due to the balance and coordination factor.

Incorporating these exercises into your daily routine can go a long way in helping you stay active. In the next section, we will discuss how to start slow and move towards a more physically active way of facing the world.

V. Starting Slow and Moving away from the sedentary lifestyle

Embarking on a fitness journey, to break free from a sedentary lifestyle can be challenging, especially if you’ve been inactive for a long time. Here are some tips to help you start slow and make steady progress:

1. Begin with Low-Intensity Exercises: It’s essential to start with exercises that are comfortable and manageable. Low-intensity activities like walking or light stretching can be a great starting point. As your fitness level improves, gradually increase the intensity and duration of your workouts.

2. Set Realistic Goals: Setting achievable goals can provide motivation and a clear direction. Start with small goals like standing up and moving around for a few minutes every hour or during commercial breaks, then gradually increase this as your fitness improves.

3. Use Fitness Trackers: A fitness tracker can be an excellent tool for keeping you motivated and tracking your progress. Fitness trackers can monitor your steps, heart rate, and other aspects of your physical activity. They can provide valuable feedback and help you stay on track with your goals.

4. Listen to Your Body: Pay attention to how your body responds to increased activity. If you feel pain or discomfort, it may be a sign that you’re pushing yourself too hard. Remember, it’s okay to take a rest day and let your body recover. Make sure you get enough sleep.

5. Stay Consistent: Consistency is key when it comes to breaking a sedentary lifestyle. Make regular physical activity a part of your daily routine, and stick to it. Over time, these small changes can lead to big improvements in your overall health.

In our final section, we’ll wrap up and remind you of the importance of breaking your sedentary lifestyle before it’s too late.

VI. Conclusion – No More Sedentary Lifestyle

Breaking the cycle of a sedentary lifestyle is not just about adding years to your life, but life to your years. The benefits of regular physical activity extend beyond physical health, positively impacting your mental well-being and quality of life.

Remember, the goal is not to transform into an overnight athlete but to make small, sustainable changes that can significantly improve your health. Start with simple exercises, gradually increase your activity level, and stay consistent. You’ll be surprised how these little changes can make a big difference.

If you’re unsure where to start or need a personalized plan, consider consulting with a certified personal trainer. They can provide guidance, motivation, and a tailored exercise plan that suits your current fitness level and goals.

In the end, remember that it’s never too late to break your sedentary lifestyle. Every step you take towards a more active life is a step towards better health. So why wait? Start today, and pave the way for a healthier, happier future. Get moving! You might chose the graceful CogniFit Movements, learning to dance tango, slow walking or calisthenics. Do it safely! Get help from a professional and you are off! A new healthy life awaits you.

Brendan Carl Clarke

Category: Wellness
Tag: brain health , health

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Cochrane Database Syst Rev

Interventions for reducing sedentary behaviour in community‐dwelling older adults

Older adults are the most sedentary segment of society, often spending in excess of 8.5 hours a day sitting. Large amounts of time spent sedentary, defined as time spend sitting or in a reclining posture without spending energy, has been linked to an increased risk of chronic diseases, frailty, loss of function, disablement, social isolation, and premature death.

To evaluate the effectiveness of interventions aimed at reducing sedentary behaviour amongst older adults living independently in the community compared to control conditions involving either no intervention or interventions that do not target sedentary behaviour.

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, PsycINFO, PEDro, EPPI‐Centre databases (Trials Register of Promoting Health Interventions (TRoPHI) and the Obesity and Sedentary behaviour Database), WHO ICTRP, and ClinicalTrials.gov up to 18 January 2021. We also screened the reference lists of included articles and contacted authors to identify additional studies.

Selection criteria

We included randomised controlled trials (RCTs) and cluster‐RCTs. We included interventions purposefully designed to reduce sedentary time in older adults (aged 60 or over) living independently in the community. We included studies if some of the participants had multiple comorbidities, but excluded interventions that recruited clinical populations specifically (e.g. stroke survivors).

Data collection and analysis

Two review authors independently screened titles and abstracts and full‐text articles to determine study eligibility. Two review authors independently extracted data and assessed risk of bias. We contacted authors for additional data where required. Any disagreements in study screening or data extraction were settled by a third review author.

Main results

We included seven studies in the review, six RCTs and one cluster‐RCT, with a total of 397 participants. The majority of participants were female (n = 284), white, and highly educated. All trials were conducted in high‐income countries. All studies evaluated individually based behaviour change interventions using a combination of behaviour change techniques such as goal setting, education, and behaviour monitoring or feedback. Four of the seven studies also measured secondary outcomes. The main sources of bias were related to selection bias (N = 2), performance bias (N = 6), blinding of outcome assessment (N = 2), and incomplete outcome data (N = 2) and selective reporting (N=1). The overall risk of bias was judged as unclear.

Primary outcomes

The evidence suggests that interventions to change sedentary behaviour in community‐dwelling older adults may reduce sedentary time (mean difference (MD) −44.91 min/day, 95% confidence interval (CI) −93.13 to 3.32; 397 participants; 7 studies; I 2 = 73%; low‐certainty evidence). We could not pool evidence on the effect of interventions on breaks in sedentary behaviour or time spent in specific domains such as TV time, as data from only one study were available for these outcomes.

Secondary outcomes

We are uncertain whether interventions to reduce sedentary behaviour have any impact on the physical or mental health outcomes of community‐dwelling older adults. We were able to pool change data for the following outcomes.

• Physical function (MD 0.14 Short Physical Performance Battery (SPPB) score, 95% CI −0.38 to 0.66; higher score is favourable; 98 participants; 2 studies; I 2 = 26%; low‐certainty evidence).

• Waist circumference (MD 1.14 cm, 95% CI −1.64 to 3.93; 100 participants; 2 studies; I 2 = 0%; low‐certainty evidence).

• Fitness (MD ‐5.16 m in the 6‐minute walk test, 95% CI −36.49 to 26.17; higher score is favourable; 80 participants; 2 studies; I 2 = 29%; low‐certainty evidence).

• Blood pressure: systolic (MD −3.91 mmHg, 95% CI ‐10.95 to 3.13; 138 participants; 3 studies; I 2 = 73%; very low‐certainty evidence) and diastolic (MD −0.06 mmHg, 95% CI −5.72 to 5.60; 138 participants; 3 studies; I 2 = 97%; very low‐certainty evidence).

• Glucose blood levels (MD 2.20 mg/dL, 95% CI −6.46 to 10.86; 100 participants; 2 studies; I 2 = 0%; low‐certainty evidence).

No data were available on cognitive function, cost‐effectiveness or adverse effects.

Authors' conclusions

It is not clear whether interventions to reduce sedentary behaviour are effective at reducing sedentary time in community‐dwelling older adults. We are uncertain if these interventions have any impact on the physical or mental health of community‐dwelling older adults. There were few studies, and the certainty of the evidence is very low to low, mainly due to inconsistency in findings and imprecision. Future studies should consider interventions aimed at modifying the environment, policy, and social and cultural norms. Future studies should also use device‐based measures of sedentary time, recruit larger samples, and gather information about quality of life, cost‐effectiveness, and adverse event data.

Plain language summary

What works for reducing sedentary behaviour in older adults living in the community?

Key messages

There is not enough evidence to allow for any clear conclusions about whether programmes or policies are effective in reducing sedentary time in older adults. It is also uncertain whether these programmes or policies improve the physical or mental health of older adults.

Why did we do this review?

Older adults spend about 80% of their time being sedentary. Sedentary time is the amount of time spent sitting or lying down whilst awake. For example, sitting down watching TV is considered a sedentary behaviour. Long periods of sedentary time have been linked with an increased risk of several long‐term diseases, becoming frailer, developing disabilities, needing help with everyday activities, and early death. We wanted to know if programmes or policies intended to help older adults reduce their sedentary time are effective. We also wanted to know if these programmes or policies also provide physical or mental health benefits.

What did we do?

We searched electronic databases and relevant journals to find studies. We included any randomised study (in which people have the same chance of being given the intervention or not) that looked at policies or programmes that were designed to reduce sedentary time in older adults (aged 60 or over) living independently in the community. We compared and summarised the results of the studies and rated our confidence in the evidence, based on factors such as study methods and sizes.

What did we find out?

We found seven studies including a total of 397 older adults. All of the studies looked at ways to help individual older adults to change their sedentary behaviour. The support included a range of strategies like counselling, goal setting, and information sessions. Some of the studies used technology that records behaviour, such as activity monitors. We did not find any studies that looked at changes to the natural environment, the built environment, a person's social environment, or home environment where older adults live. We did not find any studies that looked at the effect of changing policies and laws that affect the sedentary behaviour of older adults. We did not find any studies that looked at whether the benefits and use of the programme were at least worth what was paid for them. None of the studies reported on unwanted effects.

What are the limitations of the evidence?

We have only low confidence in these findings, due to low sample sizes and because some studies were conducted in ways that may have introduced errors into their results. The findings also combined results from studies using self‐reported measures of sedentary time together with device‐based measures.

How up‐to‐date is the evidence?

The evidence is current to January 2021.

Summary of findings

Description of the condition.

Older adults (age ≥ 60 years) are one of the most sedentary groups in society, spending on average 80% of their time in a seated posture and with 67% being sedentary for more than 8.5 hours per day ( Harvey 2013 ). Sedentary behaviour has been defined as an activity where the predominant posture is sitting or lying and energy expenditure is low ( Chastin 2013 ; SBRN 2012 ). Sedentary behaviour is distinctly different from inactivity. Inactivity is often regarded as not meeting physical activity guidelines for health, or too little exercise, whilst sedentary behaviour is too much sitting ( Owen 2010 ). Standing for long periods would therefore be considered inactivity, and sitting or lying down (except sleep) for long periods would be sedentary behaviour. Going for a slow walk would not be considered being sedentary (as the person is not sitting), and if the person never or rarely sweat or was out of breath (moderate activity), they would be categorised as being inactive. Older people can reduce their sedentary behaviour if they get up on their feet (if able) as often as possible during their waking hours. Although it may be desirable, it is not necessary that older people should spend this time on their feet engaged in an activity for which the level of intensity is moderate or vigorous.

There is increasing evidence to suggest that sedentary behaviour, especially when accumulated in prolonged and continuous bouts, is detrimental to physical health ( de Rezende 2014 ; Dunstan 2012 ; Henson 2013 ), mental health ( Lauder 2006 ), quality of life ( Laforge 1999 ), and bone health ( Chastin 2014 ), in addition to being associated with all‐cause mortality, disease incidence, and hospitalisation ( Biswas 2015 ). Prolonged screen‐based sedentary activities, such as watching television, have been shown to be associated with depressive symptoms ( Teychenne 2010 ), whilst metabolic syndrome has a significant correlation with lengthy sedentary periods ( Bankoski 2011 ). Sedentary behaviour is also associated with lower odds of successful ageing ( Dogra 2012 ). These deleterious health effects of sedentary behaviour are different to those of physical inactivity, and are partially independent of an individual’s physical activity levels ( Bankoski 2011 ). Indeed, even individuals who meet the recommended daily moderate to vigorous physical activity guidelines might experience the adverse effect of sedentary behaviour ( Katzmarzyk 2009 ). In fact, a meta‐analysis reveals that over one hour of daily moderate‐intensity activity is required to attenuate the association between sedentary time and mortality ( Ekelund 2016 ).

The World Health Organization, the UK, the USA, and other countries have now issued recommendations to reduce sedentary time as part of their older adult physical activity guidelines ( Bull 2020 ; DoH 2019 ; Piercy 2018 ). These guidelines recommend reducing sedentary time in addition to increasing time spent in both light‐ and moderate‐intensity physical activity. This pragmatic stance reflects the findings that solely promoting physical activity does not necessarily reduce sitting time, as one may achieve the recommended physical activity guidelines, yet still sit for large periods of the day ( Dogra 2012 ; Katzmarzyk 2010 ). Indeed, reviews indicate that interventions aimed at promoting physical activity are ineffective at reducing sedentary time ( Martin 2015 ; Prince 2014 ). Experimental work indicates that time spent in moderate‐intensity activity tends to displace time that individuals usually spend in light activity and activities incidental to daily living, but not sitting time ( Gomersall 2015 ). Interventions devised specifically to reduce sedentary behaviour are needed ( Owen 2011 ).

The aim of this review was to synthesise and compare the current evidence on the effectiveness of interventions to reduce sedentary time amongst community‐dwelling older adults.

Description of the intervention

This review assessed the effectiveness of interventions aimed specifically at reducing sedentary behaviour in community‐dwelling older adults. Sedentary behaviour is ubiquitous and occurs throughout the day during leisure time activities, eating, and transport. In order to reduce sedentary time, interventions must specifically encourage people to spend more time on their feet throughout the day. Interventions can specifically focus on sedentary behaviour or be part of physical activity programmes which include a component specifically addressing sedentary behaviour ( Martin 2015 ; Prince 2014 ).

Reviews of the effects of sedentary behaviour reduction interventions in adults have found that interventions that target sedentary behaviour specifically were more successful in reducing sedentary time, and those using only physical activity intervention were ineffective ( Martin 2015 ; Prince 2014 ).

Interventions may be delivered at the individual, environmental, or policy levels. Interventions at individuals level might be delivered on a one‐to‐one basis, or they may look at a wider reach through communities. These interventions provide education and behaviour change counselling sessions designed to help people implement a behaviour change plan using different behaviour change techniques ( de Greef 2010 ). These behaviour change techniques might include setting goals and self‐monitoring, encouraging participants to track their sedentary time to raise awareness. With advances in body‐worn sensors and self‐tracking technology, the use body‐worn devices and activity monitors in interventions is starting to appear in the literature. Some of these interventions have been delivered via online media, for example using email messages ( Adams 2013 ), whilst face‐to‐face consultations have also been shown to provide fruitful outcomes in decreasing sedentary periods ( Gardiner 2011 ). At the environmental level, interventions might include change in the physical layout of the domestic environment, but also changes to the built environment. Finally, there might be policy developed to encourage standing and promote the reduction in sedentary behaviour.

There are some potential limitations in interventions attempting to reduce overall sedentary time in older adults. Primarily, some sedentary activities in which older adults participate, such as reading and socialising ( Leask 2015 ), provide a mental health benefit ( Alpass 2003 ), and facilitate cognitive function in ageing ( Hertzog 2008 ). Although prolonged sedentary time may have a detrimental effect on physical health, some instances of sedentary time therefore provide a positive mental health benefit and should not be decreased. Further activities, for example eating and resting, are essential for daily living and should not be altered. Older adults value some sedentary activities to such an extent that they would be unwilling to alter them, and there might be notable cultural differences in this ( Leask 2016 ; Palmer 2019 ).

The majority of interventions have focused on the individual, but others are attempting to modify more distal determinants of sedentary behaviour, or even target a different level of determinants ( Owen 2011 ). For example, environmental restructuring interventions modifying home and workplace layout, standing desks, or implementing outdoor spaces and facilities have all been acknowledged as potentially potent ways of reducing sedentary time ( Gardner 2016 ; Shrestha 2019 ; Tandon 2012 ). A systematic review identified that interventions based on environmental restructuring, persuasion, or education were more successful in reducing sitting time and that self‐monitoring, problem solving, and restructuring the social or physical environment were particularly useful behaviour change techniques ( Gardner 2016 ).

To date, there are no widely accepted guidelines quantifying a daily limit for sedentary time. The Canadian 24‐hour movement guidelines recommend older adults limit sedentary time to a maximum of 8 hours per day ( Ross 2020 ). One study suggests that substantial cardiovascular health benefits can be gained if adults reduce their sedentary time by two hours per day ( Healy 2011 ). However, these guidelines remain too controversial to be used as behavioural targets that interventions could set ( Stamatakis 2019 ).

How the intervention might work

There are different frameworks for understanding the determinants of sedentary behaviour and that inform interventions. The ecological model, proposed by Owen and colleagues ( Owen 2011 ), places individuals' behaviour within different contexts: leisure time, transport, household, and occupation. The System of Sedentary (SOS) behaviour framework takes a systems approach to understand sedentary behaviour, as the interaction between groups of factors: physical health, social and cultural context, built and natural environment, psychology and behaviour, politics and economy, and institutional and home settings ( Chastin 2016 ). Interventions to reduce sedentary time in adults have been either interventions with a specific goal of increasing physical activity levels alongside reducing sedentary time, or interventions aimed at reducing sedentary time only ( Martin 2015 ; Prince 2014 ). Those interventions focused on reducing sedentary behaviour have resulted in a greater reduction of sedentary time ( Martin 2015 ; Prince 2014 ). Indeed, the determinants of sedentary behaviour are distinct from those of physical activity ( Chastin 2015b ), and the intervention must specifically address these determinants.

There are a number of different ways that sedentary behaviour interventions could decrease total sedentary time or break up prolonged sitting time (bouts) in older adults. Based on the SOS framework, these could be as follows.

Changing the psychology and behaviour

Providing information: interventions could be used to educate individuals on the benefits of decreasing their overall sedentary time and breaking up prolonged sedentary periods, by using consultations/interviews, reviewing their own behaviour (self‐monitoring by diary), or employing a feedback system. An example of such a feedback system would be the use of objective monitors to detect sedentary behaviour and print out or provide digital feedback to identify times when prolonged sitting could be reduced (i.e. by avoiding valued seated activities such as social events, reading, and knitting).
Prompting: real‐time behaviour prompts using wearable sensor and mobile technology that detect prolonged sedentary periods and prompt the individual to rise and move. Less frequent reminders by email and phone messages may act as a less regular prompt system.

Altering the home settings and built environment

Environmental restructuring: interventions may alter indoor or outdoor spaces to attempt to decrease individuals’ sedentary time. More specifically, home or care setting layout changes might be considered in order to encourage individuals to sit less. Standing desks and perching stools rather than comfortable seats are some other potential examples of this.

Changing the social and cultural context

Challenge to cultural and social norms: it is culturally and socially acceptable in many places to expect older adults to sit. It is considered important to offer seats to older adults, such as on public transport. Friends and family often start doing household chores and tasks for older people rather than them being encouraged to be active and continue doing these activities. There is also a tendency for a risk‐averse culture around older adults, with a perception that sitting is safe and that standing might lead to a fall. Some interventions might challenge these cultural norms by education of older adults, family members, or carers or changing the perception of the place of older adults and active ageing in society.

Policy changes

Policy change: organisations which provide services and care for older adults might change working practices to encourage individuals to sit less.

Why it is important to do this review

There are well‐established benefits of older adults being physically active ( Kerr 2012 ; King 2001 ). Evidence describing the effectiveness of different intervention types to increase physical activity has been summarised in several review articles ( Sansano 2019 ; Stockwell 2019 ; Zubala 2017 ). Despite these findings, older adults spend large periods of the day sedentary, regardless of whether they are physically active at some time points ( Harvey 2013 ; Harvey 2015 ). Increased sedentary time is associated with poorer health outcomes in older adults ( Copeland 2017 ; de Rezende 2014 ), including physical function ( Rosenberg 2015 ), onset of frailty ( Song 2015 ), and less successful ageing ( Dogra 2012 ). There is now robust epidemiological evidence showing that the effect on health of prolonged sedentary time cannot be compensated for by adherence to physical activity or any exercise protocol ( Biswas 2015 ). Consequently, interventions that specifically target sedentary behaviour have been advocated in this population in addition to promoting physical activity ( Manns 2012 ; Sparling 2015 ). Older adults are potentially the population that might benefit the most from a reduction of sedentary time, because they are the most sedentary group and have the highest chronic disease burden ( Harvey 2013 ; Harvey 2015 ). In addition, qualitative research reveals that overweight or obese older adults consider interventions to reduce sedentary behaviour more acceptable and desirable for them to adhere to than exercise programmes ( Greenwood‐Hickman 2016 ). Early feasibility studies have shown that changing sedentary behaviour amongst older adults is feasible ( Gardiner 2011 ; Harvey 2015 ; Rosenberg 2015 ). Little is known about what older people feel are important outcome measures to report on within these interventions ( Dogra 2012 ).

To date, there is a single narrative review available ( Aunger 2019 ), but no systematic review and meta‐analysis that has summarised study findings which aim to reduce or change sedentary patterns in older adults. Three reviews summarised the evidence in adults, including older adults ( Elavsky 2019 ; Martin 2015 ; Prince 2014 ), and two looked at digital interventions ( Stockwell 2019 ; Yerrakalva 2019 ). They included studies with a control or comparison group and identified four studies in older adults, but none with a sole focus on sedentary time. An international consensus highlighted the need to understand the effectiveness of intervention to change sedentary behaviour in older adults as a main research priority ( Dogra 2017 ). Compiling this information may help inform future interventions regarding the most successful and efficient methods to decrease sedentary time in older adults.

To assess the effect on total sedentary time and the pattern of accumulation of sedentary time of interventions aimed at modifying sedentary behaviour in older adults who are 60 years and over compared to control conditions involving either no intervention or interventions that do not target sedentary behaviour.
To summarise the effects of interventions to reduce sedentary behaviour on quality of life, depression, and health status in older adults.
To summarise any evidence on the cost‐effectiveness and unintended consequences of interventions that reduce sedentary behaviour in older adults.

Criteria for considering studies for this review

Types of studies.

We wanted our conclusions to be based on the best available evidence, so we chose to include only randomised controlled trials (RCTs) and cluster‐RCTs in the review.

Types of participants

Studies had to report data on participants with the following characteristics.

Inclusion of a sample of adults of mean age of 60 years and over with no participants younger than 55 years old.
Older adults living independently in the community, either at home or in sheltered housing or a residential complex that does not provide daily nursing or social care. We excluded older adults living in care home or nursing homes.
Participants not recruited for belonging to specific clinical populations (e.g. stroke survivors) or having a specific condition or pathology. Participants may have comorbidities, but may not be recruited as a result of these.

Types of interventions

Studies had to report population‐, community‐, or individual‐based interventions specifically designed to reduce sedentary time, shorten lengths of prolonged sitting, and/or reduce particular sedentary behaviours, for example sitting time or watching television.

Interventions targeting the raising of awareness and provision of information. This might include interventions which use technology (e.g. digital, mHealth) and social networks in addition to peer support networks.
Interventions which use prompting on multiple occasions (vibration monitors, phones, emails) to raise awareness and provide feedback on sedentary behaviour.
Interventions which attempt to alter the environment, e.g. modifying the layout of indoor and outdoor spaces and furniture.
Interventions that aim to change culture, policy, and practice in people's work with older people, e.g. motivating staff to encourage older people to move more frequently.

We excluded studies reporting interventions aimed solely at increasing physical activity, but included interventions targeting both an increase in physical activity and a reduction in sedentary behaviour. The intervention could be delivered in community settings and within primary care. The interventions described above were compared with no intervention or with standard care or with interventions without sedentary behaviour change components.

Types of outcome measures

We included studies that reported sedentary behaviour as a primary or secondary outcome.

The primary outcome is sedentary behaviour, assessed at baseline and postintervention.

Time spent sedentary (measured by self‐reported measures or objective measures).
Time spent in specific sedentary behaviours (e.g. time spent watching TV) as defined by the Sedentary Behaviours International Taxonomy (SIT) ( Chastin 2013 ).
Pattern of accumulation of sedentary time (e.g. number of breaks in sedentary time) ( Chastin 2015a ; Healy 2008 ), distribution of bouts of sedentary time ( Chastin 2010 ).

Little is currently known about patient‐valued outcomes. We considered the following outcomes to be of interest.

Health status (improvement in physical function, cardiovascular and metabolic outcomes, and cognition).
Quality of life.
Depression.
Cost‐effectiveness.
Adverse events.

Search methods for identification of studies

Electronic searches.

We created a comprehensive search strategy derived from terms related to sedentary behaviour, study design type, and population of study participants. The search criteria were informed by previous reviews (e.g. Martin 2015 ; Prince 2014 ). We searched the following electronic databases up to 18 January 2021.

Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library. ( Appendix 1 )
MEDLINE (PubMed). ( Appendix 2 )
Embase (Embase.com). ( Appendix 3 )
CINAHL EBSCO (Cumulative Index to Nursing and Allied Health Literature). ( Appendix 4 )
PsycINFO (ProQuest). ( Appendix 5 )
PEDro (Physiotherapy Evidence Database; www.pedro.org.au). ( Appendix 6 )
EPPI‐Centre databases (eppi.ioe.ac.uk/cms/Default.aspx?tabid=185): Trials Register of Promoting Health Interventions (TRoPHI) and The database on obesity and sedentary behaviour studies. ( Appendix 7 )
World Health Organisation (WHO) International Clinical Trials Registry Platform (ICTRP) (apps.who.int/trialsearch). ( Appendix 8 )
US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov (clinicaltrials.gov). ( Appendix 9 )

We also screened the reference lists of included articles and contacted authors to identify additional studies.

Searching other resources

We screened the reference lists of included articles and identified systematic reviews for additional studies. We also contacted experts in the field through the International Physical and Environment Network (www.ipenproject.org/index.html), International Society for Physical Activity and Health (www.ispah.org), Sedentary Behaviour Research Network (www.sedentarybehaviour.org), and other leading international research networks to identify any additional work which is unpublished.

Selection of studies

We downloaded the references retrieved by the electronic and handsearches into Covidence ( Covidence ). Two review authors (out of a pool of nine) independently screened studies identified by the searches through two stages: 1) title and abstract screening and 2) full‐text screening using Covidence. Review authors coded the studies at each stage of the review process as 'included' or 'excluded'. The two review authors resolved any discrepancies regarding inclusion or exclusion by discussion or by consulting a third review author who acted as arbitrator. Review authors were not allowed to screen any studies on which they were co‐author. Duplicates of identified studies were excluded. We recorded the study selection process in a PRISMA flow diagram ( Moher 2009 ). We did not find any potentially relevant papers in a language other than English, so we did not require translation services.

Data extraction and management

We extracted the following data from the included studies using Covidence extraction templates.

Methodological information: study design, randomisation, intervention duration, follow‐up duration, study date, context.
Participant information: inclusion and exclusion criteria, sample size, age range, pre‐intervention and postintervention sitting time, health status, socioeconomic status.
Sedentary behaviour monitoring method.
Intervention information: intervention description, length, and comparison condition. We categorised interventions using the SOS framework as individual psychology and behaviour, socio‐cultural settings, environmental, home settings, policy change intervention ( Chastin 2016 ).
Outcome information: reporting both primary and secondary outcomes.
Additional information: missing data; conflicts of interest; intervention fidelity (whether the intervention was delivered as planned); information on the nature and extent of any additional actions given as part of the intervention (co‐interventions); intervention costs; source of study funding; adverse events.

Two review authors (from a pool of nine) independently extracted data from each study. Any disagreements regarding data extraction were resolved by discussion or by consulting a third review author if necessary. Review authors were not allowed to extract data from studies on which they were a co‐author.

Assessment of risk of bias in included studies

Two review authors (from a pool of nine) independently assessed risk of bias of the included studies using the Cochrane risk of bias tool ( Higgins 2021 ). Any disagreements in risk of bias assessment were resolved by discussion or through consensus with a third review author. Review authors were not allowed to assess the risk of bias of any studies on which they were a co‐author. The risk of bias tool assesses the following five domains:

selection bias (sequence generation and allocation concealment);
performance and detection bias (blinding);
attrition bias (incomplete outcome data, withdrawals, dropouts, protocol deviations);
reporting bias;
and an open 'other bias' category (e.g. baseline comparability for age, gender, and occupation).

We graded each domain as being at 'low', 'high', or 'unclear' risk of bias and provided a justification for our judgement in the risk of bias tables. We considered blinding of outcome assessment differently when sedentary time was assessed objectively or by self‐report, as participants cannot be blinded to self‐reported measures ( Shrestha 2014 ). For cluster‐RCTs, we considered:

recruitment bias;
baseline imbalance;
loss of clusters;
incorrect analysis; and
comparability with individually randomised trials.

We summarised risk of bias for each outcome as being as 'low' if none of studies contributing to the outcome had any domains assessed as at high risk of bias; unclear if fewer than the majority studies contributing to the outcome had more than three domains at high risk of bias, or 'high' ( CPHG 2011 ).

Measures of treatment effect

To calculate treatment effects, we entered outcome data from all included studies into Review Manager 5 ( Review Manager 2020 ). For studies with continuous outcome measures, we reported mean scores and standard deviations. We used the mean difference (MD) between intervention and control groups postintervention for each continuous outcome to analyse the size of the effects of interventions. We used the adjusted MD between groups for cluster‐RCTs.

Unit of analysis issues

We did not identify any studies with multiple intervention arms. For cluster‐RCTs, we assessed whether the reported results were properly adjusted to account for clustering effects.

We adjusted outcomes for cluster‐RCTs for clustering effect using the effective sample sizes method ( Higgins 2021 ). We used an intraclass correlation coefficient of 0.07 based on previous research in activity behaviour research ( Kerr 2018 ).

Dealing with missing data

We noted missing data on the data extraction form and reported this in the risk of bias table. Where we encountered missing numerical outcome data, we contacted study authors to obtain this information. Where outcome data such as standard deviations were missing and were not obtainable from the study authors, we derived them from other available statistics following the methods described in the Cochrane Handbook for Systematic Reviews of Interventions ( Higgins 2021 ).

Assessment of heterogeneity

We visually inspected the forest plots to assess statistical heterogeneity. In addition, we analysed heterogeneity using the I 2 and Chi 2 statistics and corresponding P value. We reported heterogeneity as follows:

low degree of heterogeneity (25% to 50%);
moderate degree of heterogeneity (50% to 75%);
high degree of heterogeneity (75% or higher).

We considered heterogeneity in design, intervention, participants, and outcomes, as recorded in the Characteristics of included studies table.

Assessment of reporting biases

As fewer than 10 studies were included per outcome, funnel plots could not be formally used to assess reporting bias, as the power of these tests would be too low to distinguish chance from real asymmetry ( Sterne 2011 ).

Data synthesis

The findings of the studies were systematically examined and integrated across studies. The included studies were tabulated and grouped by study design, population, outcomes, and setting, to explore relationships within and between included studies in a narrative summary. We conducted meta‐analyses using Review Manager 5 ( Review Manager 2020 ) employing a random‐effects model, which allows for a greater level of natural heterogeneity between studies ( Deeks 2011 ). We included data from cluster‐RCTs in meta‐analyses, as clustering was already taken into account in the analysis reported in included studies. We compared the effect of interventions aimed at reducing sedentary behaviour against control. When the control condition was a physical activity condition, we treated it the same as usual care or any intervention not aimed at changing sedentary behaviour that was used as control. Our rationale for this was that evidence shows that physical activity interventions do not change sedentary behaviour in older adults ( Gomersall 2015 ; Martin 2015 ). For some outcomes (primary outcome of breaks in sedentary time, secondary outcomes of depression, health status, and quality of life), it was not possible to conduct a meta‐analysis because insufficient data were available. We reported results for these outcomes narratively grouped by outcome.

Subgroup analysis and investigation of heterogeneity

We conducted a subgroup analysis based on the method of measurement of sedentary time as either objectively measured using body‐worn devices or measured using self‐report tools. We also conducted subgroup analysis according to the intervention duration, classified as interventions delivered during a single point of contact or interventions delivered longitudinally. This classification differs from that in our protocol, as the classification in our protocol did not fit the type of interventions we found. We planned further subgroup analysis based on sex, geographical location, intervention setting or 'deliverer', socioeconomic status, and health status, but due to the small number of included studies this was not possible.

Sensitivity analysis

We planned to conduct a sensitivity analysis to understand the impact of risk of bias on the findings by excluding from the analysis studies rated as at high risk of bias. However, overall risk of bias was uniform across studies, and we did not rank any studies as at high risk of bias.

Summary of findings and assessment of the certainty of the evidence

We summarised our findings according to the guidelines in Chapter 14 of the Cochrane Handbook for Systematic Reviews of Interventions ( Schünemann 2021 ). Two review authors (from a pool of nine) independently assessed the certainty of evidence for each of the primary outcome measures using the GRADE methodology ( Guyatt 2011 ). Results were tabulated using a template adapted from GRADEpro GDT ( GRADEpro GDT ). The certainty of a body of evidence as assessed by GRADE is the extent to which one can be confident in the estimate of effect. We assessed the certainty of the evidence for each outcome as high, moderate, low, or very low. In the GRADE approach, RCTs are assessed as high certainty at the start. Five criteria are considered for possible downgrading of the certainty of evidence: study quality (risk of bias); consistency (consistency between studies); directness (the same study participants, intervention, and outcome measures in included studies is for the people, measures, and outcomes we wanted to study); precision of results; and reporting biases. Three criteria are considered for possible upgrading of results: strong or very strong associations between intervention and outcome; large or very large dose‐response effects; and where all plausible confounders would have reduced the effect. We reported the certainty of evidence in Table 1 alongside the synthesis of outcomes.

Summary of findings 1

1 Downgraded one level for inconsistency due to wide variance of point estimates across studies (high heterogeneity). 2 Downgraded one level for imprecision due to wide confidence intervals. 3 Downgraded two levels for imprecision due to very small sample sizes.

Description of studies

See Characteristics of included studies , Characteristics of excluded studies , Characteristics of studies awaiting classification, Characteristics of ongoing studies .

Results of the search

Our search identified 7642 unique articles. After title and abstract screening, 81 articles were assessed for inclusion as full text, of which 7 met the inclusion criteria for the review. The flow of information and the breakdown of included and excluded studies is shown in Figure 1 .

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The full search strategies and the number of hits for the electronic databases and the clinical trials registries can be found in the Appendices . We contacted authors for Barone 2017 and Rosenberg 2020 to obtain detailed results, and received responses from both.

Included studies

We included six RCTs, Barone 2017 ; Lyons 2017 ; Owari 2019 ; Roberts 2019 ; Rosenberg 2020 ; White 2017 , and one cluster‐RCT ( Maher 2017 ). Comparison conditions were not uniform across all studies, and included waiting list or usual care ( Lyons 2017 ; Rosenberg 2020 ), physical activity intervention ( Barone 2017 ; Roberts 2019 ), intervention to reduce social isolation ( Maher 2017 ), and a simple information leaflet about physical activity ( Owari 2019 ; White 2017 ).

Settings for all studies were in the community and used research facilities ( Barone 2017 ; Lyons 2017 ; Roberts 2019 ; Rosenberg 2020 ), senior centres ( Maher 2017 ), health clubs ( Owari 2019 ), or primary care facilities ( White 2017 ). Four studies were undertaken in the USA ( Barone 2017 ; Lyons 2017 ; Maher 2017 ; Roberts 2019 ; Rosenberg 2020 ), one in the UK ( White 2017 ), and one in Japan ( Owari 2019 ).

Participants

The included studies involved a total of 397 participants (n = 284 females). Sample size varied from 38 participants, Barone 2017 , to 96, White 2017 . Participants were recruited through senior centres and older adults community groups ( Maher 2017 ; Owari 2019 ; Roberts 2019 ), database of volunteers affiliated with universities ( Barone 2017 ; Lyons 2017 ), advertisements in media ( Lyons 2017 ; Roberts 2019 ), and primary care ( Rosenberg 2020 ; White 2017 ). Participants were majority female, ranging from 58%, Rosenberg 2020 , to 85%, Lyons 2017 . In all of the included studies but Owari 2019 , participants were predominantly from a white ethnic background, ranging from 65%, Lyons 2017 , to 86%, Rosenberg 2020 . Education level ranged across the study groups, with those having reached degree/bachelor level between 35%, Rosenberg 2020 , and 81%, Barone 2017 . Body mass index (BMI) ranged from 28 kg/m 2 , Owari 2019 , to 35.5 kg/m 2 , Rosenberg 2020 . Overall, the study groups consisted of relatively young older adults, with mean age between 61 years, Lyons 2017 , and 72 years, Roberts 2019 . One study had a slightly older participant population, with an average age of 77 years old ( Maher 2017 ).

Intervention content, duration, and delivery

Interventions in the included studies were behavioural interventions targeting individual behaviour. We found no studies attempting to alter or restructure the environment of participants, challenge social or cultural norms, or change policy. All but two studies, Barone 2017 ; Owari 2019 , were reported to be designed based on behaviour change theories including social cognitive theory ( Bandura 1986 ), transtheoretical model ( Prochaska 1992 ), or habit formation ( Schwarzer 2007 ). All of the included studies employed a range of behaviour change techniques such as goal setting, education, and behaviour monitoring or feedback. Self‐monitoring was used in all studies except Owari 2019 and Maher 2017 , but varied considerably in the methods of self‐monitoring. Most studies provided participants with feedback on their behaviour, using activity monitors ( Barone 2017 ; Lyons 2017 ; Roberts 2019 ; Rosenberg 2020 ). White 2017 provided only paper‐based means of self‐recording behaviour. Additionally, two studies provided haptic prompts triggered when participants were inactive for longer than a self‐selected period of time ( Lyons 2017 ; Rosenberg 2020 ). Five studies provided individualised interventions with some element of continuous tailoring through regular revision of goal settings and one‐to‐one interaction with the intervention provider ( Barone 2017 ; Lyons 2017 ; Maher 2017 ; Roberts 2019 ; Rosenberg 2020 ), whilst two studies provided one‐size‐fits‐all messages through a leaflet ( Owari 2019 ; White 2017 ).

Intervention duration ranged from 12 weeks, Barone 2017 ; Lyons 2017 ; Rosenberg 2020 , to 20 weeks, Roberts 2019 . However, in some studies the intervention was via a single point of contact ( Owari 2019 ; White 2017 ), or a couple of group workshops over two weeks ( Maher 2017 ). Follow‐up measures postintervention ranged from one week, Maher 2017 , to one year, Owari 2019 .

Measurement of sedentary behaviour

The majority of studies used objective measures of sedentary behaviour. However, there was some heterogeneity regarding how these devices defined and classified sedentary behaviour. This included the use of accelerometers such as ActiGraph worn on the hip ( Roberts 2019 ), with a cut point of 100 count per minutes to identify sedentary time; SenseWear worn as an arm band ( Barone 2017 ); and Active Style Pro ( Owari 2019 ), with sedentary time obtained from periods of time with energy expenditure ≤ 1.5 metabolic equivalents (METs). Other studies used inclinometer instruments such as activPAL, which are worn on the thigh to identify periods of sitting ( Lyons 2017 ; Rosenberg 2020 ). The remaining studies used self‐report methods with single‐item instruments such as the International Physical Activity Questionnaire (IPAQ) and Measure of Older Adults' Sedentary Time (MOST) questionnaire ( White 2017 ), or multiple items assessing time in specific sedentary behaviours such as reading or watching TV ( Maher 2017 ). Only one study reported on breaks in sedentary behaviour ( Rosenberg 2020 ).

Four studies also measured secondary outcomes. Two studies measured change in physical function and balance using clinically validated methods such as the Short Physical Performance Battery (SPPB), repeated chair stand tests, and gait speed ( Barone 2017 ; Rosenberg 2020 ). Two studies considered measures of physical fitness using the 6‐minute walk test ( Lyons 2017 ; Roberts 2019 ). Three studies measured change in obesity markers: fat mass ( Lyons 2017 ), waist circumference ( Roberts 2019 ; Rosenberg 2020 ), and BMI ( Rosenberg 2020 ). Three studies reported on blood pressure ( Barone 2017 ; Roberts 2019 ; Rosenberg 2020 ). Finally, two studies also reported on blood markers of cardio‐metabolic health including levels of blood cholesterol, high‐density lipoprotein (HDL), low‐density lipoprotein (LDL), triglycerides, glucose, and glycated haemoglobin ( Roberts 2019 ; Rosenberg 2020 ). Only one study investigated changes in quality of life and depression ( Barone 2017 ). We found no studies investigating cost‐effectiveness or adverse events.

Excluded studies

We excluded 74 articles at the full‐text stage ( Characteristics of excluded studies ). The main reasons for exclusion were that the intervention delivered did not target sedentary behaviour (n = 29); the study sample did not meet our inclusion criteria (n = 24); study design was not RCT or cluster‐RCT (n = 15); sedentary time was not measured (n = 4); and finally one study compared two sedentary behaviour change interventions ( Harvey 2018 ).

Risk of bias in included studies

Risk of bias varied across studies ( Figure 2 ). No study was assessed as at low risk of bias for all domains ( Figure 3 ), but three studies were assessed as at low risk of bias for six of the seven domains considered ( Lyons 2017 ; Roberts 2019 ; Rosenberg 2020 ).

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Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

All of the included studies but Barone 2017 described using computer‐generated random sequences, therefore we assessed these studies as having a low risk of bias for this domain. Four studies described an adequate method of concealing the allocation to control or intervention group ( Lyons 2017 ; Maher 2017 ; Rosenberg 2020 ; White 2017 ); the allocation in these studies was performed by an independent research administrator or researcher. The allocation procedure was unclear for Roberts 2019 , and was performed by an unblinded researcher in Owari 2019 . Barone 2017 did not describe randomisation and allocation procedures and was therefore judged as at high risk of bias for both sequence generation and allocation concealment domains.

Performance bias was the most common source of bias across the included studies. Only one study blinded participants to allocation to the control of the sedentary behaviour intervention group ( White 2017 ).

There were issues with blinding of outcome assessors. Three studies reported procedures to make the researcher responsible for data entry and analysis blind to group allocation ( Owari 2019 ; Roberts 2019 ; Rosenberg 2020 ). In two studies the blinding of the assessor was not clearly described ( Barone 2017 ; Maher 2017 ). Finally, two studies clearly stated that no blinding of the assessor was performed ( Lyons 2017 ; White 2017 ).

Regarding outcome assessment (detection bias), five studies used an objective measurement of sedentary time and were therefore judged as at low risk of detection bias ( Barone 2017 ; Lyons 2017 ; Owari 2019 ; Roberts 2019 ; Rosenberg 2020 ). We assessed both Maher 2017 and White 2017 as at high risk of detection bias because both studies used self‐reported methods of assessing sedentary time, with well know large bias issues ( Chastin 2018 ).

Incomplete outcome data

Attrition rates were generally very low in all studies and were well documented and reported. All of the included studies but Rosenberg 2020 employed intention‐to‐treat analysis with adequate methods for handling missing data. Owari 2019 declared having analysed only data from participants with high adherence to the programme. We therefore judged all of the included studies as at low risk of attrition bias except Rosenberg 2020 and Owari 2019 , which we classified as at high risk.

Selective reporting

Four studies fully reported on all the outcomes described in their protocols and methods and were therefore judged as at low risk of reporting bias ( Maher 2017 ; Owari 2019 ; Roberts 2019 ; Rosenberg 2020 ). We judged White 2017 as high risk for this domain as outcomes declared in the methods section of the paper were not reported on in the results section. We judged Barone 2017 and Lyons 2017 as at unclear risk of reporting bias, as in the former some of the prespecified outcomes were only partially reported, and in the latter there was no protocol to compare original outcome measure choice.

Other potential sources of bias

We identified no other sources of bias in the seven included studies, which were therefore all judged as low risk for this domain.

Additional risk of bias domain for cluster‐RCTs

We assessed the single cluster‐RCT by Maher 2017 as low risk of bias for all domains except the baseline imbalance domain, which was judged as unclear because no information about baseline characteristics per clusters or condition was reported.

Effects of interventions

See: Table 1

The main comparison is reported in Table 1 . Below we present results per outcome only for outcomes for which data were available. As explained in the Included studies section, we did not find data for all secondary outcomes we intended to review.

Sedentary time

We pooled results from all seven included studies for the effect of intervention versus control on sedentary time. Overall the evidence suggests that interventions to change sedentary behaviour may reduce sedentary time (mean difference (MD) −44.91 min/day, 95% confidence interval (CI) −93.13 to 3.32; 397 participants; 7 studies; I 2 = 73%; Analysis 1.1 ; Figure 4 ). Subgroup analysis showed no significant difference in outcome between studies that measured sedentary time subjectively or objectively. However, precision was higher for studies that used objective measures of sedentary time with narrower confidence intervals but lower mean difference estimates. The subgroup analysis according to intervention duration showed no significant difference between interventions delivered as a single point of contact (MD ‐79.34 min/day, 95% CI ‐179.31 to 20.62) and those involving longitudinal contact with participants up to 20 weeks (MD −20.34 min/day, 95% CI −67.25 to 26.56).

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Forest plot of comparison between intervention to reduce sedentary behaviour and control. Plot also shows subgroup analysis per measurement method for sedentary time.

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Comparison 1: Intervention for reducing sedentary behaviour versus control: main outcomes, Outcome 1: Sedentary time [min/day]

Overall the certainty of evidence was low due to inconsistencies and heterogeneity in results and imprecision with wide confidence intervals and small sample sizes ( Table 1 ). It is likely that further research, particularly studies using objective measures of sedentary time, might change both effect estimates and our confidence in the evidence.

Time spent in specific sedentary behaviour

Only one study reported the effect of the intervention on time spent in specific sedentary behaviours such as TV time ( Maher 2017 ). The difference between the intervention and control group for sedentary time in these domains is presented in Figure 5 .

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Forest plot of comparison between intervention to reduce sedentary behaviour and control for time spent in specific sedentary behaviour [min/day].

Pattern of sedentary behaviour

Only one study reported the effect of intervention on breaks in sedentary behaviour ( Rosenberg 2020 ). No statistically difference between groups in number of breaks in sedentary behaviour was observed in this study (MD −8.00 number of breaks (nbr)/day, 95% CI −16.8 to 0.8). No study investigated the distribution of sedentary bouts.

The effects of sedentary behaviour interventions on secondary outcomes are summarised in Analysis 2.1 ; Analysis 2.2 ; Analysis 2.3 ; Analysis 3.1 ; Analysis 3.2 ; Analysis 3.3 ; Analysis 4.1 ; Analysis 5.1 ; Analysis 5.2 ; Analysis 6.1 ; Analysis 6.2 ; Analysis 6.3 ; Analysis 6.4 ; Analysis 6.5 ; Analysis 6.6 ; Analysis 7.1 ; Analysis 7.2 ; Analysis 7.3 ; Analysis 7.4 ; Analysis 7.5 ; Analysis 8.1 .

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Comparison 2: Intervention for reducing sedentary behaviour versus control: physical function outcomes, Outcome 1: SPPB

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Comparison 2: Intervention for reducing sedentary behaviour versus control: physical function outcomes, Outcome 2: Gait speed

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Comparison 2: Intervention for reducing sedentary behaviour versus control: physical function outcomes, Outcome 3: Chair stands (seconds)

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Comparison 3: Intervention for reducing sedentary behaviour versus control: obesity outcomes, Outcome 1: BMI

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Comparison 3: Intervention for reducing sedentary behaviour versus control: obesity outcomes, Outcome 2: Waist circumference (cm)

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Comparison 3: Intervention for reducing sedentary behaviour versus control: obesity outcomes, Outcome 3: Body fat (%)

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Comparison 4: Intervention for reducing sedentary behaviour versus control: fitness outcomes, Outcome 1: 6‐minute walk (metres)

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Comparison 5: Intervention for reducing sedentary behaviour versus control: blood pressure outcomes, Outcome 1: Systolic [mmHg]

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Comparison 5: Intervention for reducing sedentary behaviour versus control: blood pressure outcomes, Outcome 2: Diastolic [mmHg]

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Comparison 6: Intervention for reducing sedentary behaviour versus control: cardiometabolic markers outcomes, Outcome 1: Cholesterol [mg/dL]

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Comparison 6: Intervention for reducing sedentary behaviour versus control: cardiometabolic markers outcomes, Outcome 2: HDL [mg/dL]

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Comparison 6: Intervention for reducing sedentary behaviour versus control: cardiometabolic markers outcomes, Outcome 3: LDL [mg/dL]

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Comparison 6: Intervention for reducing sedentary behaviour versus control: cardiometabolic markers outcomes, Outcome 4: Triglycerides [mg/dL]

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Comparison 6: Intervention for reducing sedentary behaviour versus control: cardiometabolic markers outcomes, Outcome 5: Glucose [mg/dL]

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Comparison 6: Intervention for reducing sedentary behaviour versus control: cardiometabolic markers outcomes, Outcome 6: Glycated haemoglobin

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Comparison 7: Intervention for reducing sedentary behaviour versus control: quality of life, Outcome 1: SF‐36 Physical function

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Comparison 7: Intervention for reducing sedentary behaviour versus control: quality of life, Outcome 2: SF‐36 Energy

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Comparison 7: Intervention for reducing sedentary behaviour versus control: quality of life, Outcome 3: SF‐36 Emotional well‐being

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Comparison 7: Intervention for reducing sedentary behaviour versus control: quality of life, Outcome 4: SF‐36 Pain

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Comparison 7: Intervention for reducing sedentary behaviour versus control: quality of life, Outcome 5: SF‐36 General health

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Comparison 8: Intervention for reducing sedentary behaviour versus control: depression, Outcome 1: Depression (Center for Epidemiological Studies‐Depression (CES‐D))

Physical function

We pooled two studies that reported on physical function using the Short Physical Performance Battery (SPPB) (MD 0.14, 95% CI −0.38 to 0.66; 98 participants; 2 studies; I 2 = 26%) ( Barone 2017 ; Rosenberg 2020 ). We also pooled two studies that reported gait speed at follow‐up, which is an important marker of physical function (MD 0.02 m/s, 95% CI −0.04 to 0.09; 98 participants; 2 studies; I 2 = 0%) ( Barone 2017 ; Rosenberg 2020 ). It is uncertain if interventions to reduce sedentary time impact physical function of older adults, as the certainty of evidence was low due to very small sample sizes.

Physical fitness

We pooled the results of the two studies that measured fitness using the 6‐minute walk test at follow‐up (MD −5.16 m, 95% CI −36.49 to 26.17; 80 participants; 2 studies; I 2 = 29%) ( Lyons 2017 ; Roberts 2019 ). It is uncertain if interventions to reduce sedentary time impact the physical fitness of older adults, as the certainty of evidence was low due to very small sample sizes.

Body composition

We pooled the results of the two studies that measured waist circumference at follow‐up (MD 1.14 cm, 95% CI −1.64 to 3.93; 100 participants; 2 studies; I 2 = 0%) ( Barone 2017 ; Rosenberg 2020 ). It is uncertain if interventions to reduce sedentary time impact the body composition of older adults, as the certainty of evidence was low due to very small sample sizes.

Blood pressure

We pooled the results of the three studies that measured blood pressure at follow‐up ( Barone 2017 ; Roberts 2019 ; Rosenberg 2020 ). Pooled estimates were as follows: systolic blood pressure (MD −3.91 mmHg, 95% CI −10.95 to 3.13; 138 participants; 3 studies; I 2 = 73%) and diastolic blood pressure (MD −0.06 mmHg, 95% CI −5.72 to 5.60; 138 participants; 3 studies; I 2 = 97%). The certainty of evidence for this outcome was very low due inconsistency and imprecision, therefore it is uncertain if interventions to reduce sedentary time impact the blood pressure of older adults.

Blood markers of cardiometabolic health

We pooled the results of the two studies (100 participants) that examined blood markers of cardiometabolic health at follow‐up ( Roberts 2019 ; Rosenberg 2020 ). There was no difference between groups in total cholesterol (MD 3.25 mg/dL, 95% CI −9.52 to 16.03), HDL cholesterol (MD −2.47 mg/dL, 95% CI −7.40 to 2.45), LDL cholesterol (MD 4.17 mg/dL, 95% CI −6.89 to 15.22), triglycerides (MD 2.13 mg/dL, 95% CI −18.95 to 23.21), and glucose (MD 2.20 mg/dL, 95% CI −6.46 to 10.86). We rated the certainty of evidence for all these outcomes as low due to very small sample sizes.

Quality of life

Barone 2017 reported no difference between groups in quality of life at follow‐up as measured by any of the domains of the 36‐item Short Form Health Survey (SF‐36) (Physical function, Energy/Fatigue, Pain, Emotional well‐being, General health).

Cognitive function

No data were reported for this outcome.

Barone 2017 reported no difference between groups in depressive symptoms at follow‐up.

Cost‐effectiveness

Adverse events, summary of main results.

We included seven studies in this review. A summary of findings for the primary outcome of sedentary time is provided in Table 1 . It is not clear whether interventions targeting sedentary behaviour in community‐dwelling older adults reduce sedentary time, as the certainty of evidence is low. We only found one study reporting on breaks in sedentary behaviour and one reporting on sedentary time in different domains such as TV time.

It is also unclear if interventions to reduce sedentary time in community‐dwelling older adults impact their physical function, body composition, fitness, blood pressure, and blood markers of lipidaemia and glycaemia. We only found one study reporting on quality of life and depression. We found no data on cost‐effectiveness or adverse effects.

All of the interventions evaluated were delivered at the individual level, and none considered changing the environment, policies, or social and cultural norms surrounding older adults. The majority of interventions used a combination of behaviour change techniques and included information, education, counselling, goal setting, feedback (including from wearable technology and apps), prompts including just‐in‐time haptic prompts, workshops, short message service (SMS) texts, and phone calls. These were delivered in the community setting. Data on adherence, fidelity, intensity, and frequency of the intervention were not available.

Overall completeness and applicability of evidence

The majority of recruited participants were female, white, overweight, and highly educated, and were overall relatively younger older adults. In addition, all studies were conducted in high‐income countries. It is therefore unclear if these types of interventions could be effective in other groups of community‐dwelling older adults. The currently available literature is insufficient to address all of our objectives for this review. We could not investigate two of the primary outcomes: breaks in sedentary behaviour and sedentary time in specific domains, as these were reported in only one study. There were very few data for our secondary outcomes. Functional capacity, blood markers of cardiometabolic health, and fitness were reported in only two studies, and only three studies reported on blood pressure. We could not meta‐analyse and investigate depression and quality of life, as these were reported in only one study, and no data were reported for cost‐effectiveness or adverse events.

Quality of the evidence

The currently available body of evidence does not permit a robust answer to the research questions of this review. We assessed the certainty of evidence for sedentary time as low according to GRADE considering all seven studies and 397 participants included. This result combined evidence from studies using self‐reported measures of sedentary time as well as those using device‐based measures. None of the studies was considered to be at overall low risk of bias, and sample sizes were small and confidence intervals large for sedentary time.

Potential biases in the review process

The main limitation of this review is the potential for publication bias. We were not able to assess the risk of publication bias using funnel plots or other methods due to there being an insufficient number of studies. Studies with negative results may not have been published. It is therefore possible that the current evidence base identified might overrepresent studies with positive results. We attempted to minimise this by contacting experts in the field and by searching trial registries to identify potential studies that might not have been published. Together with handsearching reference lists, this increased the likelihood of identifying all relevant studies.

There is also the potential for bias in review processes such as assessing risk of bias and certainty of evidence using GRADE. These include the potential for subjectivity, as they involve personal judgements. We tried to keep this to a minimum by having two review authors conduct these assessments independently and by putting in place a system to mitigate disagreement. We furthermore excluded review authors from taking part in this process for any included studies on which they were an author, and we have declared this openly below.

Agreements and disagreements with other studies or reviews

This is the first review and meta‐analysis of interventions specifically targeting sedentary behaviour in community‐dwelling older adults. This review is important, as older adults are the most sedentary segment of the population, spending around 80% of their waking day sedentary.

There is only one narrative review focusing on community‐dwelling older adults to date ( Aunger 2019 ). This review included six studies consisting of a single RCT and five feasibility studies. It concluded that changing sedentary behaviour in older adults up to one hour per day appeared to be feasible in the very short term (less than eight weeks), but that the evidence base was very limited and lacked experimental evidence on clinical outcomes, such as physical function and cardiometabolic health. Conducting RCTs to reduce sedentary behaviour in older adults is feasible but does not substantiate claims about potential effect size. The experimental evidence is still too uncertain to provide robust conclusions about the impact of reduction in sedentary time on clinical outcomes.

Implications for practice

It is currently unclear whether interventions are effective in changing sedentary behaviour in community‐dwelling older adults. The evidence suggests that these interventions may reduce sedentary time. We were not able to draw any conclusions about the effectiveness of specific components of these interventions, or about the balance of benefits or harms and cost‐effectiveness. It is also unclear whether interventions to reduce sedentary time have an impact on the physical and mental health of community‐dwelling older adults. In summary, there is currently insufficient evidence to support decisions by policymakers and practitioners to recommend or implement interventions to reduce sedentary behaviour in community‐dwelling older adults.

Implications for research

There is a clear need for higher‐quality randomised controlled trials assessing the impact of intervention to reduce sedentary behaviour in community‐dwelling older adults to improve the evidence base. To improve the certainty of the evidence, several factors need to be considered. Future studies should use device‐based measures, particularly devices that recognise posture ( Chastin 2010 ), as they improve precision but also allow for outcome assessment blinding. In addition, future studies should measure and assess the change in patterns of sedentary behaviour, including breaks in prolonged sedentary behaviour, as well as total volume ( Chastin 2015c ). Larger trials are also required to improve upon precision.

In order to broaden the applicability of the evidence, future studies should recruit more varied samples in terms of age, gender, ethnicity, and socioeconomic background. More importantly, future research should examine the impact of modifying the environment, policy, and cultural social norms. None of the interventions included in this review attempted to modify these more distal determinants of sedentary behaviour. Future research should investigate the effect of intervention modifying factors included in the six clusters of the Determinants of Diet and Physical Activity (DEDIPAC) systems of sedentary behaviour ( Chastin 2016 ). Research on the potential effects of modifying the built environment and home settings should be prioritised, as recent research suggests that this might be the most promising avenue for lasting change in sedentary behaviour amongst older adults ( Buck 2019 ).

Whilst feasibility studies have shown that it is feasible to change sedentary behaviour in older adults, this review suggests that there is little to no effect compared to control. It is therefore possible that better implementation is needed. It has recently been suggested that co‐creation and participatory design might lead to more effective interventions ( Leask 2017 ), therefore future research should investigate co‐created intervention to reduce sedentary behaviour in older adults. Patient‐valued outcomes are important, and more research is needed to understand what outcomes are important to older people ( Dogra 2012 ).

In addition, studies should record key information such as quality of life, cost‐effectiveness, and adverse event data to permit a benefit‐to‐harm analysis. Finally, there should be a more systematic recording of intervention component frequency and intensity, using systematic methodology such as Perera 2007 .

Protocol first published: Issue 9, 2017

Acknowledgements

The authors wish to acknowledge the editorial team of the Cochrane Public Health Group, in particular Jodie Doyle for her help and patience, and the librarians at Glasgow Caledonian University and University of Queensland; Lars Eriksson and Julie Hansen who will create and execute the search strategies for the electronic databases. No funding was used to prepare this protocol and review. We also would like to thank members of the original team who have left since the development of the protocol.

Appendix 1. Cochrane Central Register of Controlled Trials (CENTRAL) search strategy

The following search was conducted in the Cochrane Central Register of Controlled Trials on 8 April 2019.

1. (Elderly OR Senior OR seniors OR "older adult" OR "older adults" OR geriatric OR geriatrics OR “old people” OR older‐age OR “old age” OR adult OR adults OR “older people”):ti

2. (Elderly OR Senior OR seniors OR "older adult" OR "older adults" OR geriatric OR geriatrics OR “old people” OR older‐age OR “old age” OR adult OR adults OR “older people”):ab

3. #1 OR #2

4. MeSH descriptor: [Aged] explode all trees

5. MeSH descriptor: [Aged, 80 and over]

6. #3 OR #4 OR #5

7. MeSH descriptor: [Automobile Driving] explode all trees

8. MeSH descriptor: [Television] explode all trees

9. MeSH descriptor: [Sedentary Behavior] explode all trees

10. MeSH descriptor: [Computers] explode all trees

11. MeSH descriptor: [Video Games] explode all trees

12. (“screen behavior” OR “screen behaviour” OR “screen entertainment” OR “screen time” OR “screen watching” OR “screen‐based entertainment” OR “sedentary behavior*” OR “sedentary behaviour*” OR “sedentary lifestyle*” OR “sitting time” OR “television time” OR “television viewing” OR “television watching” OR “TV time” OR “TV viewing” OR “TV watching” OR “video game time” OR “video game” OR “video gaming” OR “view television” OR “watch television” OR “watch TV”):ti

13. (“screen behavior” OR “screen behaviour” OR “screen entertainment” OR “screen time” OR “screen watching” OR “screen‐based entertainment” OR “sedentary behavior*” OR “sedentary behaviour*” OR “sedentary lifestyle*” OR “sitting time” OR “television time” OR “television viewing” OR “television watching” OR “TV time” OR “TV viewing” OR “TV watching” OR “video game time” OR “video game” OR “video gaming” OR “view television” OR “watch television” OR “watch TV”):ab

14. #7 OR #8 OR #9 OR #10 OR #11 OR #12 OR #13

15. #6 AND #14

The above search was repeated in the Cochrane Central Register of Controlled Trials on 18 January 2021 with limits on Publication Year from 2019 to 2021, with Cochrane Library publication date Between Apr 2019 and Jan 2021, in Trials

Appendix 2. MEDLINE search strategy

The following search was conducted in MEDLINE through PubMed on 8 April 2019.

((randomized controlled trial[pt] OR controlled clinical trial[pt] OR randomized[tiab] OR placebo[tiab] OR clinical trials as topic[mesh:noexp] OR randomly[tiab] OR trial[ti] OR "program evaluation"[Mesh] OR intervention*[ti] OR evaluation[ti] OR controlled trial[tiab] OR quasi‐experiment[tiab] OR feasibility[ti] OR health promotion[tiab] OR Health education[tiab] OR environmental design[tiab] OR environmental restructuring[tiab] OR evaluation studies[pt] OR "evaluation studies as topic"[mesh:noexp] OR (pre‐test[tiab] AND post‐test[tiab]) OR (pretest[tiab] AND posttest[tiab]) OR (program evaluation[tiab] OR effectiveness[ti])) AND (Elderly[tiab] OR Senior[tiab] OR seniors[tiab] OR older adult[tiab] OR older adults[tiab] OR elderly[tiab] OR geriatric[tiab] OR geriatrics[tiab] OR old people[tiab] OR older‐age[tiab] OR "aged"[Mesh] OR "aged, 80 and over"[Mesh] OR old age[tiab] OR adult[tiab] OR adults[tiab] OR older people[tiab]) AND ("Automobile Driving"[Mesh:noexp] OR "Television"[Mesh] OR video gaming[tiab] OR video game[tiab] OR computer gaming[tiab] OR video game time[tiab] OR computer game[tiab] OR "computers"[Mesh] OR "Video Games"[Mesh] OR screen time[tiab] OR screen entertainment[tiab] OR screen behaviour[tiab] OR screen behavior[tiab] OR screen‐based entertainment[tiab] OR television viewing[tiab] OR television watching[tiab] OR television time[tiab] OR TV viewing[tiab] OR TV watching[tiab] OR TV time[tiab] OR watch television[tiab] OR view television[tiab] OR watch TV[tiab] OR screen watching[tiab] OR screen time[tiab] OR screen entertainment[tiab] OR screen behaviour[tiab] OR screen behavior[tiab] OR screen‐based entertainment[tiab] OR sedentary behavior[tiab] OR sedentary behaviour[tiab] OR sedentary lifestyle[tiab] OR prolonged sitting[tiab] OR sitting time[tiab] OR lying time[tiab] OR "sedentary lifestyle"[MeSH]))

This search was re‐run on 18 January 2021 to include "Sedentary Behavior"[Mesh] with the publication date range of "1946/01/01"[Date ‐ Publication]: "2019/04/01"[Date ‐ Publication]"

The following search was conducted in MEDLINE through PubMed on 18 January 2021.

(((("randomized controlled trials as topic "[MeSH Terms] OR "Random Allocation"[MeSH Terms] OR "clinical trial, phase i"[Publication Type] AND "clinical trial, phase ii"[Publication Type] OR "clinical trial, phase iii"[Publication Type] OR "clinical trial, phase iv"[Publication Type] OR "controlled clinical trial"[Publication Type] OR "randomized controlled trial"[Publication Type] OR "multicenter study"[Publication Type] OR "clinical trial"[Publication Type] OR "Clinical Trials as topic"[MeSH Terms] OR randomized[tiab] OR randomised[tiab] OR placebo[tiab] OR randomly[tiab] OR trial[ti])) AND (Elderly[tiab] OR Senior[tiab] OR seniors[tiab] OR older adult[tiab] OR older adults[tiab] OR geriatric[tiab] OR geriatrics[tiab] OR old people[tiab] OR older‐age[tiab] OR "aged"[Mesh] OR "aged, 80 and over"[Mesh] OR old age[tiab] OR adult[tiab] OR adults[tiab] OR older people[tiab])) AND ("Automobile Driving"[Mesh:noexp] OR "computers"[Mesh] OR "Sedentary Behavior"[Mesh] OR "Television"[Mesh] OR "Video Games"[Mesh] OR “computer game*”[tiab] OR “computer gaming”[tiab] OR “lying time”[tiab] OR “prolonged sitting”[tiab] OR “physical inactivity”[tiab] OR “physically inactive”[tiab] OR Inactive[ti] OR “screen behavior”[tiab] OR “screen behaviour”[tiab] OR “screen entertainment”[tiab] OR “screen time”[tiab] OR “screen watching”[tiab] OR “screen‐based entertainment”[tiab] OR sedentary[ti] OR “sedentary behavior*”[tiab] OR “sedentary behaviour*”[tiab] OR “sedentary lifestyle*”[tiab] OR “sitting time”[tiab] OR “television time”[tiab] OR “television viewing”[tiab] OR “television watching”[tiab] OR “TV time”[tiab] OR “TV viewing”[tiab] OR “TV watching”[tiab] OR “video game time”[tiab] OR “video game”[tiab] OR “video gaming”[tiab] OR “view television”[tiab] OR “watch television”[tiab] OR “watch TV”[tiab])) AND (("2019/04/01"[Date ‐ Publication]: "2021/01/18"[Date ‐ Publication]))

PubMed was searched from 01/01/1946 ‐ 18/01/2021

Appendix 3. CINAHL search strategy

The following search was conducted in CINAHL via Ebscohost on 8 April 2019.

1. “randomized controlled trial” OR “controlled clinical trial” OR randomized OR placebo OR MH "Clinical Trials+" OR randomly OR TI trial OR MH "Program Evaluation" OR TI intervention* OR TI evaluation OR controlled trial OR quasi‐experiment* OR TI feasibility OR “health promotion” OR “Health education” OR “environmental design” OR “environmental restructuring” OR “evaluation studies” OR (TI “pre‐test” AND TI “post‐test”) OR (TI pretest AND TI posttest) OR (AB “pre‐test” AND AB “post‐test”) OR (AB pretest AND AB posttest) OR “program evaluation” OR TI effectiveness OR MH "Evaluation Research"

2. Elderly OR TI Senior OR seniors OR “older adult” OR “older adults” OR elderly OR geriatric OR geriatrics OR “old people” OR “older‐age” OR MH "Aged+" OR MH "Aged, 80 and Over" OR MH "Aging+" OR “old age” OR TI adult OR TI adults OR AB adult OR AB adults OR “older people”

3. MH "Automobile Driving" OR MH "Television" OR “video gaming” OR “video game” OR “computer gaming” OR “video game time” OR “computer game” OR MH "Computers and Computerization Utilization" OR MH "Video Games" OR “screen time” OR “screen entertainment” OR “screen behavior” OR “screen behavior” OR “screen‐based entertainment” OR “television viewing” OR “television watching” OR “television time” OR “TV viewing” OR “TV watching” OR “TV time” OR “watch television” OR “view television” OR “watch TV” OR “screen watching” OR “screen time” OR “screen entertainment” OR “screen behavior” OR “screen behavior” OR “screen‐based entertainment” OR “sedentary behavior” OR “sedentary behavior” OR “sedentary lifestyle” OR “prolonged sitting” OR “sitting time” OR “lying time” OR MH "Life Style, Sedentary+"

4. #1 AND #2 AND #3

The following search was conducted in CINAHL via Ebscohost on 4 June 2020.

1. MH "Random Assignment” OR MH "Clinical Trials+" OR "randomized controlled trials as topic "[MeSH Terms] OR MH "Multicenter Studies" OR “randomized controlled trial” OR “controlled clinical trial” OR randomized OR placebo OR MH "Clinical Trials+" OR randomly OR TI trial

2. Elderly OR TI Senior OR seniors OR “older adult” OR “older adults” geriatric OR geriatrics OR “old people” OR “older‐age” OR MH "Aged+" OR MH "Aged, 80 and Over" OR MH "Aging+" OR “old age” OR TI adult OR TI adults OR AB adult OR AB adults OR “older people”

3. “computer game” OR “computer gaming” OR “lying time” OR “physical inactivity” OR “physically inactive” OR “prolonged sitting” OR “screen behavior” OR “screen behaviour” OR “screen entertainment” OR “screen time” OR “screen watching” OR “screen‐based entertainment” OR “sedentary behavior*” OR “sedentary behaviour*” OR “sedentary lifestyle*” OR “sitting time” OR “television time” OR “television viewing” OR “television watching” OR “TV time” OR “TV viewing” OR “TV watching” OR “video game time” OR “video game” OR “video gaming” OR “view television” OR “watch television” OR “watch TV” OR MH "Automobile Driving" OR MH "Computers and Computerization Utilization" OR MH "Life Style, Sedentary+" OR MH "Television" OR MH "Video Games" OR TI Inactive OR TI sedentary

4. #1 AND #2 AND #3 Limiters ‐ Published Date: 20190401‐20200631; Language: English Database ‐ CINAHL

The following search was conducted in CINAHL via Ebscohost on 3 August 2020.

4. #1 AND #2 AND #3 Limiters ‐ Published Date: 19660101‐20190431; Language: English

Searches 2 and 3 were re‐run on January 18 2021 without the English limit.

CINAHL was searched from 01/01/1966 ‐ 18/01/2021.

Appendix 4. Embase search strategy

The following search was conducted in EMBASE on 8 April 2019.

1. 'randomized controlled trial'/exp OR 'randomized controlled trial (topic)'/exp OR 'randomization'/exp OR 'phase 1 clinical trial'/exp OR 'phase 2 clinical trial'/exp OR 'phase 3 clinical trial'/exp OR 'phase 4 clinical trial'/exp OR 'controlled clinical trial'/exp OR 'multicenter study'/exp OR 'clinical trial'/exp OR randomized;ti,ab OR randomised;ti,ab OR placebo;ti,ab OR randomly;ti,ab OR trial:ti

2. elderly:ti,ab OR senior:ti,ab OR seniors:ti,ab OR 'older adult':ti,ab OR 'older adults':ti,ab OR geriatric:ti,ab OR geriatrics:ti,ab OR 'old people':ti,ab OR 'older‐age':ti,ab OR 'aged'/exp OR 'very elderly'/exp OR 'old age':ti,ab OR adult:ti,ab OR adults:ti,ab OR 'older people':ti,ab

3. 'computer game':ti,ab OR 'computer gaming':ti,ab OR 'lying time':ti,ab OR 'physical inactivity':ti,ab OR 'physically inactive':ti,ab OR inactive:ti,ab OR 'prolonged sitting':ti,ab OR 'screen behavior':ti,ab OR 'screen behaviour':ti,ab OR 'screen entertainment':ti,ab OR 'screen time':ti,ab OR 'screen watching':ti,ab OR 'screen‐based entertainment':ti,ab OR 'sedentary behavior':ti,ab OR 'sedentary behaviour':ti,ab OR 'sedentary lifestyle':ti,ab OR 'sitting time':ti,ab OR 'television time':ti,ab OR 'television viewing':ti,ab OR 'television watching':ti,ab OR 'tv time':ti,ab OR 'tv viewing':ti,ab OR 'tv watching':ti,ab OR 'video game time':ti,ab OR 'video game':ti,ab OR 'video gaming':ti,ab OR 'view television':ti,ab OR 'watch television':ti,ab OR 'watch tv':ti,ab OR 'car driving'/exp OR 'computer'/exp OR 'sedentary lifestyle'/exp OR 'television'/exp OR 'video game'/exp

The following search was conducted in EMBASE on 4 June 2020.

4. #1 AND #2 AND #3 AND [english]/lim AND [embase]/lim AND [1‐4‐2019]/sd NOT [5‐6‐2020]/sd AND ([article]/lim OR [article in press]/lim OR [review]/lim)

The second search was re‐run on 18 January 2021 without the English language limit.

EMBASE was searched from 01/01/1980 ‐ 18/01/2021

Appendix 5. PsycINFO search strategy

The following search was conducted in PsycINFO on 8 April 2019.

(((((title: ("randomized controlled trial"))) OR ((title: ("controlled clinical trial"))) OR ((title: (randomized))) OR ((title: (placebo))) OR ((title: (randomly))) OR ((title: (trial))) OR ((title: (intervention*))) OR ((title: (evaluation))) OR ((title: (controlled trial))) OR ((title: (quasi‐experiment*))) OR ((title: (feasibility))) OR ((title: ("health promotion"))) OR ((title: ("Health education"))) OR ((title: ("environmental design"))) OR ((title: ("environmental restructuring"))) OR ((title: ("evaluation studies"))) OR (((title: ("pre‐test"))) AND ((title: ("post‐test")))) OR (((title: (pretest))) AND ((title: (posttest)))) OR (((title: ("pre‐test"))) AND ((title: ("post‐test")))) OR (((title: (pretest))) AND ((title: (posttest)))) OR ((title: ("program evaluation"))) OR ((title: (effectiveness)))) OR ((((abstract: ("randomized controlled trial"))) OR ((abstract: ("controlled clinical trial"))) OR ((abstract: (randomized))) OR ((abstract: (placebo))) OR ((abstract: (randomly))) OR ((title: (trial))) OR ((title: (intervention*))) OR ((title: (evaluation))) OR ((abstract: (controlled trial))) OR ((abstract: (quasi‐experiment*))) OR ((title: (feasibility))) OR ((abstract: ("health promotion"))) OR ((abstract: ("Health education"))) OR ((abstract: ("environmental design"))) OR ((abstract: ("environmental restructuring"))) OR ((abstract: ("evaluation studies"))) OR (((abstract: ("pre‐test"))) AND ((abstract: ("post‐test")))) OR (((abstract: (pretest))) AND ((abstract: (posttest)))) OR (((abstract: ("pre‐test"))) AND ((abstract: ("post‐test")))) OR (((abstract: (pretest))) AND ((abstract: (posttest)))) OR ((abstract: ("program evaluation"))) OR ((title: (effectiveness)))) OR ((((IndexTermsFilt: ("Clinical Trials"))))) OR ((((IndexTermsFilt: ("Program Evaluation"))))))) AND ((((title: (Elderly)) OR (title: (Senior)) OR (title: (seniors)) OR (title: (older adult)) OR (title: (older adults)) OR (title: (elderly)) OR (title: (geriatric)) OR (title: (geriatrics)) OR (title: ("old people")) OR (title: (older‐age)) OR (title: ("old age")) OR (title: (adult)) OR (title: (adults)) OR (title: ("older people")))) OR (((abstract: (Elderly)) OR (abstract: (Senior)) OR (abstract: (seniors)) OR (abstract: (older adult)) OR (abstract: (older adults)) OR (abstract: (elderly)) OR (abstract: (geriatric)) OR (abstract: (geriatrics)) OR (abstract: ("old people")) OR (abstract: (older‐age)) OR (abstract: ("old age")) OR (abstract: (adult)) OR (abstract: (adults)) OR (abstract: ("older people"))))) AND ((((((IndexTermsFilt: ("Computer Games"))))) OR ((((IndexTermsFilt: ("Computers"))))) OR ((((IndexTermsFilt: ("Drivers"))))) OR ((((IndexTermsFilt: ("Sedentary Behavior"))))) OR ((((IndexTermsFilt: ("Television Viewing"))))) OR ((((title: ("video gaming"))) OR ((title: ("video game"))) OR ((title: ("computer gaming"))) OR ((title: ("video game time"))) OR ((title: ("computer game"))) OR ((title: ("screen time"))) OR ((title: ("screen entertainment"))) OR ((title: ("screen behavior"))) OR ((title: ("screen behavior"))) OR ((title: ("screen‐based entertainment"))) OR ((title: ("television viewing"))) OR ((title: ("television watching"))) OR ((title: ("television time"))) OR ((title: ("TV viewing"))) OR ((title: ("TV watching"))) OR ((title: ("TV time"))) OR ((title: ("watch television"))) OR ((title: ("view television"))) OR ((title: ("watch TV"))) OR ((title: ("screen watching"))) OR ((title: ("screen time"))) OR ((title: ("screen entertainment"))) OR ((title: ("screen behavior"))) OR ((title: ("screen behavior"))) OR ((title: ("screen‐based entertainment"))) OR ((title: ("sedentary behavior"))) OR ((title: ("sedentary behavior"))) OR ((title: ("sedentary lifestyle"))) OR ((title: ("prolonged sitting"))) OR ((title: ("sitting time"))) OR ((title: ("lying time")))))) OR ((((abstract: ("video gaming"))) OR ((abstract: ("video game"))) OR ((abstract: ("computer gaming"))) OR ((abstract: ("video game time"))) OR ((abstract: ("computer game"))) OR ((abstract: ("screen time"))) OR ((abstract: ("screen entertainment"))) OR ((abstract: ("screen behavior"))) OR ((abstract: ("screen behavior"))) OR ((abstract: ("screen‐based entertainment"))) OR ((abstract: ("television viewing"))) OR ((abstract: ("television watching"))) OR ((abstract: ("television time"))) OR ((abstract: ("TV viewing"))) OR ((abstract: ("TV watching"))) OR ((abstract: ("TV time"))) OR ((abstract: ("watch television"))) OR ((abstract: ("view television"))) OR ((abstract: ("watch TV"))) OR ((abstract: ("screen watching"))) OR ((abstract: ("screen time"))) OR ((abstract: ("screen entertainment"))) OR ((abstract: ("screen behavior"))) OR ((abstract: ("screen behavior"))) OR ((abstract: ("screen‐based entertainment"))) OR ((abstract: ("sedentary behavior"))) OR ((abstract: ("sedentary behavior"))) OR ((abstract: ("sedentary lifestyle"))) OR ((abstract: ("prolonged sitting"))) OR ((abstract: ("sitting time"))) OR ((abstract: ("lying time")))))))

The following search was conducted in PsycINFO on 5 June 2020. The search was limited to publication year 2019 to 2020.

((Index Terms: ("video gaming") OR Index Terms: ("Computer Games") OR Index Terms: ("Computers") OR Index Terms: ("drivers") OR Index Terms: ("Sedentary Behavior") OR Index Terms: ("Television Viewing")) OR (title: ("video game") OR title: ("computer gaming") OR title: ("video game time") OR title: ("computer game") OR title: ("screen time") OR title: ("screen entertainment") OR title: ("screen behavior") OR title: ("screen behavior") OR title: ("screen‐based entertainment") OR title: ("television viewing") OR title: ("television watching") OR title: ("television time") OR title: ("TV viewing") OR title: ("TV watching") OR title: ("TV time") OR title: ("watch television") OR title: ("view television") OR title: ("watch TV") OR title: ("screen watching") OR title: ("screen time") OR title: ("screen entertainment") OR title: ("screen behavior") OR title: ("screen behaviour") OR title: ("screen‐based entertainment") OR title: ("sedentary behavior*") OR title: ("sedentary behaviour*") OR title: ("sedentary lifestyle*") OR title: ("prolonged sitting") OR title: ("sitting time") OR title: ("lying time") OR title: ("physical inactivity") OR title: ("physically inactive")) OR (abstract: ("video game") OR abstract: ("computer gaming") OR abstract: ("video game time") OR abstract: ("computer game") OR abstract: ("screen time") OR abstract: ("screen entertainment") OR abstract: ("screen behavior") OR abstract: ("screen behavior") OR abstract: ("screen‐based entertainment") OR abstract: ("television viewing") OR abstract: ("television watching") OR abstract: ("television time") OR abstract: ("TV viewing") OR abstract: ("TV watching") OR abstract: ("TV time") OR abstract: ("watch television") OR abstract: ("view television") OR abstract: ("watch TV") OR abstract: ("screen watching") OR abstract: ("screen time") OR abstract: ("screen entertainment") OR abstract: ("screen behavior") OR abstract: ("screen behaviour") OR abstract: ("screen‐based entertainment") OR abstract: ("sedentary behavior*") OR abstract: ("sedentary behaviour*") OR abstract: ("sedentary lifestyle*") OR abstract: ("prolonged sitting") OR abstract: ("sitting time") OR abstract: ("lying time") OR abstract: ("physical inactivity") OR abstract: ("physically inactive"))) AND ((title: (Elderly) OR title: (Senior) OR title: (seniors) OR title: (older adult) OR title: (older adults) OR title: (elderly) OR title: (geriatric) OR title: (geriatrics) OR title: ("old people") OR title: ("older‐age") OR title: ("old age") OR title: ("older people") OR title: (adult) OR title: (adults)) OR (abstract: (Elderly) OR abstract: (Senior) OR abstract: (seniors) OR abstract: (older adult) OR abstract: (older adults) OR abstract: (elderly) OR abstract: (geriatric) OR abstract: (geriatrics) OR abstract: ("old people") OR abstract: ("older‐age") OR abstract: ("old age") OR abstract: ("older people") OR abstract: (adult) OR abstract: (adults))) AND ((Index Terms: ("Clinical Trials")) OR (title: ("randomized controlled trial") OR title: ("controlled clinical trial") OR title: (randomized) OR title: (placebo) OR title: (randomly) OR title: (trial) OR title: (intervention*) OR title: ("randomized controlled trial") OR title: ("controlled clinical trial") OR title: (randomized) OR title: (placebo) OR title: (randomly) OR title: (trial)) OR (abstract: ("randomized controlled trial") OR abstract: ("controlled clinical trial") OR abstract: (randomized) OR abstract: (placebo) OR abstract: (randomly) OR abstract: (trial) OR abstract: (intervention*) OR abstract: ("randomized controlled trial") OR abstract: ("controlled clinical trial") OR abstract: (randomized) OR abstract: (placebo) OR abstract: (randomly) OR abstract: (trial))) AND Year: 2019 To 2020

The following search was conducted in PsycINFO on 18 January 2021.

for ((IndexTermsFilt: ("video gaming") OR IndexTermsFilt: ("Computer Games") OR IndexTermsFilt: ("Computers") OR IndexTermsFilt: ("drivers") OR IndexTermsFilt: ("Sedentary Behavior") OR IndexTermsFilt: ("Television Viewing")) OR (title: ("video game") OR title: ("computer gaming") OR title: ("video game time") OR title: ("computer game") OR title: ("screen time") OR title: ("screen entertainment") OR title: ("screen behavior") OR title: ("screen behavior") OR title: ("screen‐based entertainment") OR title: ("television viewing") OR title: ("television watching") OR title: ("television time") OR title: ("TV viewing") OR title: ("TV watching") OR title: ("TV time") OR title: ("watch television") OR title: ("view television") OR title: ("watch TV") OR title: ("screen watching") OR title: ("screen time") OR title: ("screen entertainment") OR title: ("screen behavior") OR title: ("screen behaviour") OR title: ("screen‐based entertainment") OR title: ("sedentary behavior*") OR title: ("sedentary behaviour*") OR title: ("sedentary lifestyle*") OR title: ("prolonged sitting") OR title: ("sitting time") OR title: ("lying time") OR title: ("physical inactivity") OR title: ("physically inactive")) OR (abstract: ("video game") OR abstract: ("computer gaming") OR abstract: ("video game time") OR abstract: ("computer game") OR abstract: ("screen time") OR abstract: ("screen entertainment") OR abstract: ("screen behavior") OR abstract: ("screen behavior") OR abstract: ("screen‐based entertainment") OR abstract: ("television viewing") OR abstract: ("television watching") OR abstract: ("television time") OR abstract: ("TV viewing") OR abstract: ("TV watching") OR abstract: ("TV time") OR abstract: ("watch television") OR abstract: ("view television") OR abstract: ("watch TV") OR abstract: ("screen watching") OR abstract: ("screen time") OR abstract: ("screen entertainment") OR abstract: ("screen behavior") OR abstract: ("screen behaviour") OR abstract: ("screen‐based entertainment") OR abstract: ("sedentary behavior*") OR abstract: ("sedentary behaviour*") OR abstract: ("sedentary lifestyle*") OR abstract: ("prolonged sitting") OR abstract: ("sitting time") OR abstract: ("lying time") OR abstract: ("physical inactivity") OR abstract: ("physically inactive"))) AND ((IndexTermsFilt: ("Older Adulthood")) OR (title: (Elderly) OR title: (Senior) OR title: (seniors) OR title: (older adult) OR title: (older adults) OR title: (elderly) OR title: (geriatric) OR title: (geriatrics) OR title: ("old people") OR title: ("older‐age") OR title: ("old age") OR title: ("older people") OR title: (adult) OR title: (adults)) OR (abstract: (Elderly) OR abstract: (Senior) OR abstract: (seniors) OR abstract: (older adult) OR abstract: (older adults) OR abstract: (elderly) OR abstract: (geriatric) OR abstract: (geriatrics) OR abstract: ("old people") OR abstract: ("older‐age") OR abstract: ("old age") OR abstract: ("older people") OR abstract: (adult) OR abstract: (adults))) AND ((IndexTermsFilt: ("Clinical Trials")) OR (title: ("randomized controlled trial") OR title: ("controlled clinical trial") OR title: (randomized) OR title: (placebo) OR title: (randomly) OR title: (trial) OR title: (intervention*) OR title: ("randomized controlled trial") OR title: ("controlled clinical trial") OR title: (randomized) OR title: (placebo) OR title: (randomly) OR title: (trial)) OR (abstract: ("randomized controlled trial") OR abstract: ("controlled clinical trial") OR abstract: (randomized) OR abstract: (placebo) OR abstract: (randomly) OR abstract: (trial) OR abstract: (intervention*) OR abstract: ("randomized controlled trial") OR abstract: ("controlled clinical trial") OR abstract: (randomized) OR abstract: (placebo) OR abstract: (randomly) OR abstract: (trial))) AND Year: 1966 To 2021

PsycINFO was searched from 01/01/1860 ‐ 18/01/2021

Appendix 6. PEDro search strategy

The following search was conducted in PEDro on 18 January 2021.

Abstract & Title: Sedentary

Therapy: Behaviour Modification

Subdiscipline: Gerontology

Appendix 7. EPPI‐Centre search strategy

The following search was conducted on EPPI‐Centre on 18 January 2021.

1. What type of study does this report describe?: RCT

2. Focus of the report: physical activity OR Freetext (All but Authors): sedentary

3. Characteristics of the study population: older people (+55 yrs) OR adults (22‐54 yrs)

Appendix 8. WHO ICTRP search strategy

A search was conducted in the WHO ICTRP on 18 January 2021 using the search term sedentary.

Appendix 9. ClinicalTrials.gov search strategy

The following search was conducted on clinicaltrials.gov on 18 June 2021.

Elderly OR Senior OR seniors OR older adult OR older adults OR elderly OR geriatric OR geriatrics OR old people OR older‐age OR old age OR adult OR adults OR older people | Completed Studies | Interventional Studies | Sedentary Behavior | Older Adult

Data and analyses

Comparison 1.

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Comparison 1: Intervention for reducing sedentary behaviour versus control: main outcomes, Outcome 2: Sedentary time [min/day] per intervention duration

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Comparison 1: Intervention for reducing sedentary behaviour versus control: main outcomes, Outcome 12: Sedentary time in specific domains [min/day]

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Object name is tCD012784-CMP-001.13.jpg

Comparison 1: Intervention for reducing sedentary behaviour versus control: main outcomes, Outcome 13: Breaks in sedentary behaviour

Comparison 2

Comparison 3, comparison 4, comparison 5, comparison 6, comparison 7, comparison 8, characteristics of studies, characteristics of included studies [ordered by study id].

BMI: body mass index

HDL: high‐density lipoprotein

IPAQ: International Physical Activity Questionnaire

LDL: low‐density lipoprotein

METs: metabolic equivalents

MOST: Measure of Older Adults Sedentary Time

MVPA: moderate‐ to vigorous‐intensity physical activity

RCT: randomised controlled trial

Characteristics of excluded studies [ordered by study ID]

Characteristics of ongoing studies [ordered by study id].

MVPA: moderate to vigorous physical activity PA: physical activity SB: sedentary behaviour ST: sedentary time WHO: World Health Organization

Differences between protocol and review

There are some differences between our published protocol, Chastin 2017 , and this review.

We restricted the review to randomised controlled trials (RCTs) and cluster‐RCTs because of the growing amount of research since the publication of the protocol and our desire to focus solely on the best available evidence.
We did not limit our search strategy to articles written English only.
We did not search the AMED (Allied and Complementary Medicine) database.
We had planned to conduct a sensitivity analysis to determine the impact of risk of bias on the findings by excluding from the analysis studies rated as at high risk of bias. However, the small number of included studies precluded this analysis.
Planned subgroup analysis was not possible (see Subgroup analysis and investigation of heterogeneity ).
We widened the age inclusion for study participants to studies with a sample with mean age of 60 years and over, and no participants below 55 years of age.
We categorised the type of interventions using the System of Sedentary (SOS) framework as individual behaviour, socio‐cultural settings, environmental, home settings, and policy change intervention ( Chastin 2016 ).
We modified the classification for the length of intervention, as the classification in our protocol did not fit the type of interventions identified.
We searched for data on adverse events.
We did not consider performance bias in our protocol ( Chastin 2017 ), as we believed it to be difficult to blind participants to allocation in this type of research. In our protocol, we considered outcome assessment and outcome assessors separately for the blinding risk of bias domain. We were advised to change this, and in the review we considered outcome assessors as part of performance bias, and also assessed risk of bias due to the lack of blinding of participants.

Contributions of authors

Chastin, Skelton, Ashe, Helbostad, Gardiner, and Leask conceived and developed the protocol. Harvey commented on drafts of the protocol and the search strategies. Gardiner performed the searches with the help of a librarian. Chastin, Skelton, Harvey, Jerez‐Roig, Rosenberg, Gardiner, and Leask reviewed studies for eligibility, extracted data, and assessed risk of bias of the included studies. Chastin wrote the first draft of the review and performed the statistical analysis. Skelton, Ashe, Helbostad, Harvey, Leask, Gardiner, Jerez‐Roig, and Rosenberg commented on drafts and the final version of the review.

Sources of support

Internal sources.

This review was not supported by any sources of support.

External sources

This review was not supported by any external sources of support.

Declarations of interest

Authors of this review were not allowed to screen, extract data from, or assess the risk of bias of studies on which they were a co‐author. Authors of this review were also authors of one of the studies included in this review ( Rosenberg 2020 ).

Sebastien Chastin: no other conflicts of interest

Paul A Gardiner: no other conflicts of interest

Juliet A Harvey: no other conflicts of interest

Calum F Leask: no other conflicts of interest

Javier Jerez‐Roig: no other conflicts of interest

Dori Rosenberg: no other conflicts of interest

Maureen C Ashe: no other conflicts of interest

Jorunn L Helbostad is a professor at the Norwegian University of Science and Technology, Trondheim, Norway. She is a board member for the Norwegian Research Council. She has no competing interest related to this project.

Dawn A Skelton: no other conflicts of interest

All authors have worked on this review during the course of their employment and were therefore supported by their employing institutions as per their affiliation.

References to studies included in this review

Barone 2017 {published data only}.

Barone Gibbs B, Brach JS, Byard T, Creasy S, Davis KK, McCoy S, et al. Reducing sedentary behavior versus increasing moderate-to-vigorous intensity physical activity in older adults . Journal of Aging and Health 2017; 29 ( 2 ):247-67. [DOI: 10.1177/0898264316635564] [ PubMed ] [ CrossRef ] [ Google Scholar ]

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Lyons EJ, Swartz MC, Lewis ZH, Martinez E, Jennings K. Feasibility and acceptability of a wearable technology physical activity intervention with telephone counselling for mid-aged and older adults: a randomized controlled pilot trial . Journal of Medical Internet Research 2017; 5 ( 3 ):e28. [DOI: 10.2196/mhealth.6967] [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]

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Maher JP, Sliwinski MJ, Conroy DE. Feasibility and preliminary efficacy of an intervention to reduce older adults' sedentary behavior . Translational Behavioral Medicine 2017; 7 ( 1 ):52-61. [DOI: 10.1007/s13142-016-0394-8] [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]

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Annesi JJ, Westcott WW, Gann S. Preliminary evaluation of a 10-wk. resistance and cardiovascular exercise protocol on physiological and psychological measures for a sample of older women . Perceptual and Motor Skills 2004; 98 ( 1 ):163-70. [DOI: 10.2466/pms.98.1.163-170] [ PubMed ] [ CrossRef ] [ Google Scholar ]

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Burton LC, Paglia MJ, German PS, Shapiro S, Damiano AM. The effect among older persons of a general preventive visit on three health behaviors: smoking, excessive alcohol drinking, and sedentary lifestyle. The Medicare Preventive Services Research Team . Preventive Medicine 1995; 24 ( 5 ):492-7. [DOI: 10.1006/pmed.1995.1078] [ PubMed ] [ CrossRef ] [ Google Scholar ]

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Lifelong Weight Loss Success

Sedentary to Active: Increasing Your Activity Level in Three Weeks

If you want to lose weight, increase your strength and muscle mass, and improve your health overall, you have to start moving. For many, it is difficult to go from being sedentary to active, for a variety of reasons, but most of those reasons can be overcome. Here are three easy steps to help you become more active.

Week 1: Increase your self-awareness. This doesn’t mean everything should be all about you, or that you should become egotistical. It means you need to become more aware of the things you do each day, how you do those things, and how much time you spend doing them. Write down what you do throughout the day. List the activity, such as going through your email, watching television or making the bed. List how much time you spent on the activity and note whether the activity was active or sedentary. Checking email or watching television, of course, is sedentary while making the bed is active.

At the end of each day, go over your notes. Where you see sedentary activities, write down what active activities you could have done instead at that time, or how you could have turned the sedentary activity into a more active activity. At the end of this first week, you will be more aware of how you are spending your time, and how active or inactive you actually are. Looking over the notes from the week, you will most likely find you were more active at the end of the week than you were at the beginning. This happens because you are more aware of how sedentary your life was, and you are subconsciously making lifelong changes.

Week 2: Listen to your body. Continue documenting your days and start listening to your body. When you do physical activities, are you experiencing any pain? Are you getting out of breath too easily? When you get out of breath, is it taking too long to recover? Are there things you cannot easily do, or cannot do at all, such as squatting or bending at the waist?

You may want to see your doctor for a checkup. Let him or her know that you are trying to be more active, and the problems you are encountering in your endeavors. Your doctor can determine if something is wrong, or not, and refer you for tests if they are unsure. Work with your doctor to find ways you can be more active if there are health problems, without putting your health at greater risk. For example, your doctor may determine that walking is better than running for you, or miniature golf is better than regular golf. He may feel you need even more strength training, or that strength training isn’t right for you, based on your health.

If you are not experiencing any problems, you still need to listen to your body and add information to the notes you are keeping. For example, when you note that you walked for an hour, write down how you felt during that walk, both physically and mentally, as well as how you felt at the end of your walk. You may even find it helpful to note how you were feeling before your walk. Maybe you felt stressed, and you weren’t looking forward to any physical exercise. You got up and went for that walk anyway, and as you were walking, you noticed you weren’t feeling quite as stressed. At the end of the walk, you were happy you did it; the stress was gone, and you may have even thought up a solution to the problem or issue that was causing you stress during your walk.

Week 3: Note the changes. By this time, you will start noticing both physical and mental changes. Mentally, you should feel happier. You should be experiencing less stress. You should notice that your thinking is clearer than it was before. Physically, you are probably noticing that you have become a bit stronger, you may have lost some weight, and you may have noticed that you do not get winded as easily as you did before.

Hopefully, when you look over your notes for the previous two weeks, you discover that you spend more of your waking hours being active than you do being sedentary. If this is the case, you have succeeded in ditching your sedentary life for a more active lifestyle. You should continue to keep notes or a journal documenting your activities and physical and mental feelings in relation to those activities, including the sedentary ones.

By continuing to document your activities, you will find that you are being more accountable to yourself, and you will be more likely to continue being active. When you find that you took a day off from being active and chose to be a couch potato for the day, don’t be too hard on yourself. We all need some downtime here and there. But the next day, make sure you get up off the couch and start doing physical activities once again.

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