Impact of Sedentary Behaviors on Blood Pressure and Cardiovascular Disease: An Umbrella Review of Systematic Reviews and Meta-Analyses.

Abstract

Cardiovascular diseases (CVD) are among the leading causes of mortality in the western world, and high blood pressure is among the greatest risk factors for CVD. Given that most of a person's waking hours are spent in sedentary behaviors, understanding the cardiovascular impact of a sedentary lifestyle is imperative. Although limiting sedentary time is encouraged in public health messaging, individual reviews analyzing its impact on clinically relevant cardiovascular outcomes such as blood pressure and CVD exhibit conflicting results. We conducted an umbrella review of systematic reviews and meta-analyses synthesizing the effects of sedentary time/behaviors on blood pressure or CVD. To be included, studies had to be a systematic review and/or meta-analysis that studied the impact of sedentary time or a sedentary posture on blood pressure or CVD incidence/mortality. The review was preregistered in PROSPERO (CRD4202342568) and conducted in May 2023. The Joanna Briggs Institute and Risk of Bias in Systematic Reviews tools assessed study quality. PRISMA reporting was followed. Our umbrella review screened 2215 citations with 40 review studies meeting our inclusion criteria (n = 22 meta-analyses) that included 234 unique individual studies of 3,769,755 unique participants. The average study quality was high (9.2 ± 1.7 out of 11). A minority of studies (n = 7/20) supported that less sedentary time was associated with lower blood pressure, with reviews of interventional studies typically not observing a consistent effect (n = 9/12), whereas reviews of cross-sectional studies observed apositive effect (n = 5/7). When hypertension rates were used as the outcome, most (n = 3/4) studies observed a deleterious impact of sedentary time. For CVD incidence/mortality, less sedentary time or screen time was consistently associated with a lower CVD incidence/mortality (n = 17/23), with studies exhibiting a null effect generally including small sample sizes and being of a lower study quality. Total sedentary time and specific behaviors (i.e., television and screen time) exhibited similar findings. Based on a high quality of evidence and large sample size, existing systematic reviews and meta-analyses demonstrate the negative impact of sedentary behaviors on CVD incidence/mortality, with conflicting reports for blood pressure that vary based on the study design.