Background

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.

Objective

We conducted an umbrella review of systematic reviews and meta-analyses synthesizing the effects of sedentary time/behaviors on blood pressure or CVD.

Methods

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.

Results

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 a positive 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.

Conclusions

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.

中文翻译：

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久坐行为对血压和心血管疾病的影响：系统评价和荟萃分析的总体回顾

 背景

心血管疾病（CVD）是西方世界导致死亡的主要原因之一，而高血压是CVD的最大危险因素之一。鉴于一个人醒着的大部分时间都花在久坐行为上，因此了解久坐生活方式对心血管的影响势在必行。尽管公共卫生信息中鼓励限制久坐时间，但分析其对血压和心血管疾病等临床相关心血管结果影响的个别评论显示出相互矛盾的结果。

 客观的

我们对系统评价和荟萃分析进行了全面综述，综合了久坐时间/行为对血压或心血管疾病的影响。

 方法

要纳入其中，研究必须是系统评价和/或荟萃分析，研究久坐时间或久坐姿势对血压或心血管疾病发病率/死亡率的影响。该综述已在 PROSPERO (CRD4202342568) 中预注册，并于 2023 年 5 月进行。乔安娜·布里格斯研究所 (Joanna Briggs Institute) 和系统评价中的偏差风险工具评估了研究质量。随后进行了 PRISMA 报告。

 结果

我们的总体审查筛选了 2215 条引用，其中 40 项审查研究符合我们的纳入标准（ n = 22 荟萃分析），其中包括 3,769,755 名独特参与者的 234 项独特的个人研究。平均研究质量很高（11 项中的 9.2 ± 1.7）。少数研究 ( n = 7/20) 支持较少的久坐时间与较低的血压相关，介入研究的回顾通常没有观察到一致的效果 ( n = 9/12)，而横断面研究的回顾观察到积极影响（ n = 5/7）。当高血压发生率作为结果时，大多数（ n = 3/4）研究观察到久坐时间的有害影响。对于 CVD 发病率/死亡率，较少的久坐时间或屏幕时间与较低的 CVD 发病率/死亡率一致相关（ n = 17/23），研究显示零效应通常包括样本量较小和研究质量较低。总久坐时间和特定行为（即看电视和屏幕时间）也表现出类似的结果。

 结论

基于高质量的证据和大样本量，现有的系统评价和荟萃分析证明了久坐行为对心血管疾病发病率/死亡率的负面影响，并且根据研究设计的不同，血压报告相互矛盾。