Epidemiological evidence is accumulating that indicates greater time spent in sedentary behavior is associated with all-cause and cardiovascular morbidity and mortality in adults such that some countries have disseminated broad guidelines that recommend minimizing sedentary behaviors. Research examining the possible deleterious consequences of excess sedentary behavior is rapidly evolving, with the epidemiologybased literature ahead of potential biological mechanisms that might explain the observed associations. This American Heart Association science advisory reviews the current evidence on sedentary behavior in terms of assessment methods, population prevalence, determinants, associations with cardiovascular disease incidence and mortality, potential underlying mechanisms, and interventions. Recommendations for future research on this emerging cardiovascular health topic are included. Further evidence is required to better inform public health interventions and future quantitative guidelines on sedentary behavior and cardiovascular health outcomes. E vidence is accumulating that sedentary behavior might be associated with increased cardiovascular-specific and overall mortality. Insufficient physical activity predicts premature cardiovascular disease (CVD) mortality and disease burden, such that the United States and other developed countries have issued physical activity guidelines, but these guidelines are specific to physical activity and do not include sedentary behavior.1 Sedentary behavior guidelines to reduce the risk of chronic diseases for adults have been developed in some countries, but they are broadly stated and nonquantitative. For example, Australia and the United Kingdom have public health guidelines stating that adults should minimize the amount of time spent being sedentary (sitting) for extended periods.2,3 Such broad public health guidelines for adults are likely appropriate, because evidence is still accumulating regarding the strength of the association, the evidence for causation (including understanding mechanisms), and the support for dose-response relationships that demonstrate sedentary behavior to be an independent risk factor for adverse health outcomes. Although at one time, excess sedentary behavior was considered to be at one end of the continuum of physical activity such that a person with no moderateto-vigorous physical activity (MVPA) was considered "sedentary," consensus is building that sedentary behavior is distinct from lack of MVPA. Even the word "sedentary," derived from the Latin "sedentarius" and defined as "sitting, remaining in one place," connotes a different set of behaviors than non-MVPA. 4 Thus, researchers studying MVPA, physical inactivity, and sedentary behavior are now viewing these behaviors as separate entities with their own unique determinants and health consequences.
CLiniCAL STATEMEnTS And GUidELinESThis American Heart Association science advisory summarizes the existing evidence about sedentary behavior as a potential risk factor for CVD and...