Sit less and move more for cardiovascular health: emerging insights and opportunities

Sedentary behaviour — put simply, too much sitting, as a distinct concept from too little exercise — is a novel determinant of cardiovascular risk. This definition provides a perspective that is complementary to the well-understood detrimental effects of physical inactivity. Sitting occupies the majority of the daily waking hours in most adults and has become even more pervasive owing to the COVID-19 pandemic. The potential for a broad cardiovascular health benefit exists through an integrated approach that involves ‘sitting less and moving more’. In this Review, we first consider observational and experimental evidence on the adverse effects of prolonged, uninterrupted sitting and the evidence identifying the possible mechanisms underlying the associated risk. We summarize the results of randomized controlled trials demonstrating the feasibility of changing sedentary behaviour. We also highlight evidence on the deleterious synergies between sedentary behaviour and physical inactivity as the underpinnings of our case for addressing them jointly in mitigating cardiovascular risk. This integrated approach should not only reduce the specific risks of too much sitting but also have a positive effect on the total amount of physical activity, with the potential to more broadly benefit the health of individuals living with or at risk of developing cardiovascular disease. In this Review, Dunstan and colleagues make a case for an approach to preventing and managing cardiovascular disease that involves sitting less and moving more, which will build on the well-established role of exercise in cardiovascular disease prevention and rehabilitation. Key points Sedentary behaviour — that is, too much sitting, as a distinct concept from too little exercise — has been shown through observational and experimental findings to adversely affect cardiovascular health. Observational evidence shows that sitting occupies the majority of adults’ waking hours and excessive sitting contributes to cardiovascular risk, particularly among individuals who do not meet the current physical activity recommendations. Prolonged, uninterrupted sitting detrimentally affects several biological processes related to cardiovascular risk; high levels of sitting displace total physically active time, negating the cardiovascular benefits of skeletal muscle activity. New evidence suggests the potential for broad cardiovascular health benefits through reducing and interrupting sitting time through practi