Physicians' Academy for Cardiovascular Education

Dose-response relationship between sedentary behavior and CVD in older women

Sedentary Behavior and Cardiovascular Disease in Older Women - The OPACH Study

Literature - Bellettiere J, LaMonte MJ, Evenson KR et al., - Circulation. 2019;139:1036–1046

Introduction and methods

The health benefits of moderate to vigorous physical activity (MVPA) are well-established. Conversely, evidence is now emerging that shows that high levels of sedentary behavior, independently of MVPA, is a modest risk factor for CVD [1]. Studies examining sedentary time have nearly all used self-reported data. This is biased and may lead to underestimated associations [2,3]. The American Heart Association, among others, therefore called for the use of objective measures of sedentary time when evaluating relations with cardiometabolic health [4].

Use of accelerometers to quantify sedentary behavior allows characterization of accumulation patterns of sedentary time: is total sedentary time highly interrupted, or highly prolonged, thus in long, continuous sedentary bouts? The latter have been shown to be associated with impaired glucose control and with other cardiometabolic risk factors, both in experimental [5,6] and in epidemiological studies [7,8]. No prospective studies have been conducted in later life, when sedentary time is higher.

This is a prospective study evaluating accelerometer-measured sedentary time and sedentary accumulation patterns in relation to CVD events in an ethnically diverse cohort of older women with no prior history of myocardial infarction (MI) or stroke. The OPACH Study (Objectively Measured Physical Activity and Cardiovascular Health) enrolled 7058 ambulatory women of 63 years or older between 2012 and 2014. Participants wore accelerometers over their right hip 24 hours a day for 7 consecutive days. Participants also self-reported in-bed and out-of-bed times on the days they wore the accelerometer, and these periods were removed from the accelerometer readings. 6133 Women met data processing criteria for estimating average daily sedentary time (≥10 waking wear hours on ≥4 days per week). The primary outcome for this study was CVD events: first occurrence of MI, revascularization, hospitalized angina, heart failure, stroke or death due to CVD in a women without that CVD.

Main results


This prospective ethnically diverse cohort study of older community-dwelling women, demonstrated a linear dose-response relationship of sedentary time with CVD events, by using accelerometer data. Both longer total sedentary time and prolonged bout duration affected CVD risk.


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