ArticleJournal of sport and health science2026
Bidirectional reallocations of sitting time, physical activity, and sleep in relation to risk of all-cause mortality and cardiovascular disease: An analysis of the Prospective Urban Rural Epidemiology (PURE)-China cohort study.
Article in Journal of sport and health science, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundProlonged sedentary time is associated with adverse outcomes, but evidence in low-exposure ranges remains limited. The health effects of reallocating time between sitting, physical activity, and sleep have not been comprehensively examined.
methodsWe analyzed 41,733 adults (mean age = 50.6 years) from the Prospective Urban Rural Epidemiology (PURE)-China cohort, recruited between 2005 and 2009 and followed for a median of 11.9 years. Sitting, physical activity, and sleep were assessed using validated questionnaires. The primary outcome was a composite of all-cause mortality and major cardiovascular events. Cox frailty and isotemporal substitution models were applied.
resultsMedian sitting time was 3.0 h/day (interquartile range (IQR): 1.7-4.6). Sitting showed a J-shaped association with outcomes, with lowest risk around 4 h/day. Both low (<2 h/day) and high (≥6 h/day) sitting were associated with higher risk. Among participants sitting ≥4 h/day, replacing 30 min of sitting with physical activity was associated with a 3%-4% lower risk of the composite outcome, with stronger associations observed for all-cause mortality (6%-7%). In contrast, among those sitting <4 h/day, reallocating 30 min of physical activity or prolonged sleep to sitting was associated a 4%-6% lower risk of the composite outcome and a 4%-10% lower risk of all-cause mortality.
conclusionSitting time demonstrates context-dependent associations with health. The finding that moderate sitting was protective in highly active individuals reflects a potential "sitting paradox". Our study highlights the bidirectional effects of reallocating sitting, activity, and sleep, underscoring the need for more context-specific guidance.
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