Abstract
Living a sedentary life and dealing with obesity are well-known factors that increase the risk of heart problems in women, especially when these factors come together. This study incorporates insights from 15 reputable studies. These studies cover a variety of research types, from trials to long-term investigations, all aiming to understand the complex mix between physical activity, sitting too much, and heart health in women. To get to these findings, the study took a deep dive into various databases, scouring through Medline, SportsDicus, PubMed, Google Scholar, and Science Direct. Besides cross-sectional and longitudinal studies, the common study design encountered in this literature was the randomized controlled trials (RCTs), which are vital in testing ways to change behaviour.
The complex tapestry of the study extends to testing and treatment protocols, encompassing lifestyle changes and exercise programs aimed at mitigating the negative consequences of sedentary habits, as measured by accelerometers, surveys, and clinical examinations. The studies used advanced statistical approaches such as regression analysis and correlation studies to uncover complicated patterns related to sedentary behaviours. The unfolding literature emphasizes significant linkages between sedentary behaviour and increased CVD risks, with long-term physical exercise emerging as a preventive factor, positively altering lipid profiles.
Multiple studies’ synthesis offers a consistent picture, stressing the negative impact of sedentary lifestyles on all-cause mortality, CVD incidence and mortality, particular malignancies, and type 2 diabetes. It concludes with a request for focused actions, acknowledging the consequences for women’s health.
Despite limitations such as varying RCT quality and potential confounding factors, the study’s findings are applicable across domains, informing physical education teachers, policymakers, physicians, and caregivers. Notably, it is consistent with American Heart Association recommendations, emphasizing the importance of long-term physical activity as a primary strategy in combating CVD risk factors. It provides invaluable insights for educators and practitioners involved in public health programs and clinical practices.
Introduction
It is common knowledge that sedentary lifestyles and obesity are linked to cardiovascular disease (CVD) in females. According to data from the Centers for Disease Control (CDC), the percentage of individuals who report no leisure-time physical activity is higher than 30% in areas of the United States where obesity rates are higher than 30% (Barnes, 2012). Similarly, the likelihood of CVD death is predicted by the frequency of obesity and physical inactivity. According to Barnes (2012), sedentary lifestyles in the modern world are linked to obesity, cardiovascular disease, and other health problems. Women’s physiological characteristics require careful consideration while analyzing and mitigating these effects. Therefore, it is necessary to investigate correlations that show a positive correlation between sedentary behaviour and cardiovascular disease in women to inform healthcare. The complex link between inactive lifestyles and increased health risks—especially for women—is examined in this paper. This has therapeutic significance since it allows healthcare interventions to be tailored to women’s vulnerabilities. On the educational front, it requires creating focused programs that break the cycle of sedentary behaviour. This paper summarises peer-reviewed research to advance understanding and guide public health actions. By doing this, the literature review hopes to improve our knowledge of the difficulties that women’s sedentary lifestyles present and lay the groundwork for focused treatments that will improve their health and well-being.
Methodology
Search Strategy
A thorough literature search was conducted using several electronic databases, including Medline, SportsDicus, PubMed, Google Scholar, and Science Direct. The literature search made use of search terms such as “sedentary lifestyle,” “physical activity,” “exercise,” “lifestyle behaviour change,” “cardiovascular diseases,” “high blood pressure,” “obesity,” “BMI,” “women,” “sedentary lifestyles and health risks,” “clinical trials,” “cross-sectional studies,” “longitudinal studies,” and “randomized controlled trials.” After carefully analyzing the search results, 15 peer-reviewed publications were chosen for inclusion.
Research Design
The primary research design prevalent in much of the literature gathered for this study was randomized controlled trials (RCTs), which prove particularly advantageous for assessing the efficacy of interventions targeting behaviour modification. In the context of investigating sedentary lifestyles, an RCT could entail the random allocation of participants to either an intervention group, receiving a program aimed at reducing sedentary behaviour, or a control group, receiving a placebo or standard care (Folta et al., 2009; Popp et al., 2018; Silva et al., 2021). This random assignment is crucial in ensuring that any discernible outcome differences can be attributed specifically to the intervention rather than external factors.
Several studies, including Furukawa et al. (2009) and Ghosh et al. (2023), utilized longitudinal designs to monitor the long-term impact of prolonged inactivity, facilitating the identification of patterns and trends over time. Cross-sectional studies, as illustrated by Walia et al. (2014), Spehar et al. (2020), and Tremblay et al. (2011), provided a momentary perspective on the associations between sedentary behaviours and health risks in women. Additionally, intervention studies played a pivotal role in assessing the effectiveness of programs designed to mitigate the negative effects of sedentary lifestyles, yielding valuable insights into potential preventive measures.
Testing and Treatment Protocols
Researchers employed a variety of ways to determine how long durations of inactivity affect health. In a study to examine the association between sedentary behaviour, physical activity, and cardiovascular diseases, Liang et al. (2022) pooled data using fixed or random effects models, and the Cochrane Risk of Bias Instrument and the Newcastle Ottawa Scale assessed the quality of individual studies. Sedentary behaviour was measured using accelerometers, surveys, and observations. For example, Folta et al. (2009) observed that participants’ weight, waist circumference, diet, physical activity, and self-efficacy were measured before and after the intervention. They used clinical examinations, biomarkers, and self-reported data to determine the influence on health (Spehar et al.,2020; Harvey et al., 2015; Kim et al., 2013; Peter-Marske et al., 2023; Pines, 2015; Popp et al., 2018; Prokopets et al., 2021; Silva et al., 2021; Ghosh et al., 2023; Chomistek et al., 2013; Furukawa et al., 2009; Tremblay et al., 2011; and Walia et al., 2014). All 15 peer-reviewed articles applied a range of treatment protocols, from lifestyle changes to fitness programs to behavioural therapy, all to reduce inactive behaviour and enhance health.
Statistical Designs and Analyses
The studies also used strong statistical methods. They did not just describe data; they used advanced techniques like regression analyses and correlation studies to find meaningful patterns (Tremblay et al., 2011; Furukawa et al., 2011; Ghosh et al., 2023; Silva et al., 2021; Liang et al., 2022). Folta et al. (2009) used regression analysis in research that tested a community-based intervention designed to reduce CVDs in sedentary midlife and older women who were overweight or obese. Kim et al. (2013) used Cox proportional hazard models separately for women and men, with age as the time metric. The researchers performed trend tests by including a continuous variable in the model that was assigned the median value for the appropriate sitting category (Kim et al., 2013). Because smoking is a significant risk factor for premature death, we used a complicated time-dependent model previously developed for a study of tobacco use and lung cancer incidence (Kim et al., 2013; Prokopets et al., 2013; Chomistek et al., 2013). By looking at different groups and combining results from multiple studies (meta-analyses), researchers got a big-picture view of how sitting affects women’s health. These findings provide useful information for developing methods to keep women healthy in our modern, often sedentary lifestyle. Walia et al. (2014) performed a multivariate logistic regression analysis with age, BMI, and waist circumference to determine the significance of the association of different cardiovascular risk factors to determine the prevalence of cardiovascular risk factors among urban adults in a north Indian city. All statistical tests were two-sided with a significance level of =0.05 (Walia et al., 2014).
Results
Several significant findings emerged from the comprehensive analysis of peer-reviewed research articles evaluating the association between sedentary lifestyles and health risks in women. The combination of 36 longitudinal studies and 148 RCTs by Liang et al. (2022) encompassing 70,000 individuals demonstrated a significant relationship between sedentary behaviour and an elevated risk of cardiovascular disease. Long-term physical exercise, on the other hand, had a protective impact, lowering the CVD hazard ratio. Long-term physical exercise also improved lipid profiles, with higher HDL levels and lower triglycerides and total cholesterol (Liang et al., 2022). Spehar et al. (2020) discovered that women who spent more time sitting had lower levels of physical activity, a greater BMI, and a higher risk of having high blood pressure. According to Spehar et al. (2020), these correlations were also influenced by sociodemographic characteristics such as income and education.
In a randomized controlled trial conducted by Folta et al. (2009) aimed at reducing cardiovascular disease risk in sedentary midlife and older women who were overweight or obese, participants in the intervention group experienced significant improvements. Specifically, there was a notable decrease in body weight (-2.1 kg; 95% confidence interval [CI] = -3.2, -1.0), a reduction in waist circumference (-2.3 in; 95% CI = -4.2, -0.5), and a lowered energy intake (-390 kcal/day; 95% CI = -598, -183). Moreover, the intervention increased physical activity (+1637 steps/day; 95% CI = 712, 2562) and enhanced self-efficacy for dietary and physical activity behaviours. Similarly, Walia et al. (2014), Harvey et al. (2015), Peter-Marske et al. (2023), Prokopets et al. (2021), Chomistek et al. (2013), and Furukawa et al. (2009) studies showed that there is a strong association between sedentary lifestyle and the risk of cardiovascular diseases, which Chomistek et al. (2013) reported to be stronger in overweight compared to normal weight women and women 70 years of age and older compared with younger women.
As per Tremblay et al.’s (2011) comprehensive analysis of 232 studies, engaging in sedentary behaviour, primarily measured through prolonged TV viewing for more than 2 hours daily, was linked to adverse outcomes in body composition, reduced fitness levels, lower self-esteem, diminished pro-social behaviour scores, and lower academic achievement in school-aged children and youth (5-17 years). The collective findings from all studies investigating risk factors for metabolic syndrome (MS) and cardiovascular disease (CVD) indicated an increased health risk with heightened sedentary time. However, it is important to note that the studies covered a wide array of risk factors, leading to insufficient evidence to make conclusive statements regarding the relationship with metabolic risk as a whole (Walia et al., 2014; Harvey et al., 2015; Folta et al., 2009).
Furthermore, Kim et al. (2013) discovered that sitting while viewing television was connected with an elevated risk of cardiovascular death but not cancer mortality. Time spent sitting in a car/bus or at work, on the other hand, was unrelated to mortality. In three prior cohorts, a link between total daily sitting and all-cause death was investigated in this large cohort study. In two investigations, the odds of all-cause mortality were increased by 19% and 45% in healthy men and women aged 50 to 71 years or older than 45 years, 27 respectively. Another study, which included men and women between the ages of 18 and 90 who had cancer or heart disease, found an increased risk of 1.54, which could have been inflated by past disease. Similarly, Pine (2015) revealed that prolonged sitting is related to a shorter life expectancy, which must be discussed with our patients regularly.
However, the results of Silva et al. (2021) and Popp et al. (2018) data did not show any significant interaction effects for vascular function between experimental conditions and the effects of physical activity. The authors also found no significant interaction effects for systolic or diastolic blood pressure between conditions. The heart rate variability characteristics showed no significant interaction effects between conditions. In conclusion, isometric exercise to break up sitting does not substantially affect sedentary individuals’ cardiovascular health.
According to Popp et al. (2018), individual, period, and order terms indicated no significant differences in the ANOVA study. Energy expenditure was equivalent when lying and sitting (P = 0.56) (Popp et al., 2018), but standing energy expenditure was 9.0% greater than lying (P = 0.003) and 7.1% higher than sitting (P = 0.02) I(Popp et al., 2018). Despite statistical significance, the practical advantage of standing versus sitting was minor. In short, short-term standing does not provide a significant energy advantage over sitting (Popp et al., 2018).
Discussion and Conclusions
A sedentary lifestyle is strongly linked to cardiovascular disease (CVD), obesity, diabetes, cancer, and premature mortality. Both total daily sedentary time and television viewing time have been associated with an elevated risk of all-cause mortality. Analyzing mortality rates, individuals with over 10 hours and less than 5 hours of daily sitting exhibited a significant correlation with all-cause mortality (Kim et al., 2013). Another study found that individuals watching television for six or more hours daily had a twofold higher all-cause mortality risk than those watching less than two hours daily (Pine, 2015; Popp et al., 2018; Silva et al., 2021). Similarly, those watching television for four or more hours daily had a 1.5 times higher all-cause mortality risk (Kim et al., 2013).
Sedentary time, encompassing sitting time, television or screen viewing time, and leisure time spent sitting, is independently associated with all-cause mortality, CVD incidence or mortality, incidence or mortality of specific cancers (breast, colon, colorectal, endometrial, and epithelial ovarian cancer), and type 2 diabetes. This adverse impact of sedentary time is more pronounced in individuals with minimal physical activity than those engaging in frequent physical activity. The relative risk for all-cause mortality is 30% higher with high physical activity (Ghosh et al., 2023) compared to low physical activity (Tremblay et al., 2011; Furukawa et al., 2011; Ghosh et al., 2023; Silva et al., 2021; and Liang et al., 2022).
Moreover, numerous studies have consistently shown sedentary behaviour as a risk factor for cardiovascular disease (CVD). A study of the literature confirmed this link, indicating a 34% increase in the incidence of CVD, including non-fatal congenital heart defects (CHD), heart failure (HF), and fatal myocardial infarction events, among people who are frequently sedentary compared to those who are not (Park et al., 2020; Furukawa et al., 2009). Several studies have found strong and consistent findings showing the link between sedentary behaviour and all causes of CVD mortality.
A prospective cohort study found that increasing sitting time, particularly while watching television, was related to an increased risk of death from CVD (Kim et al., 2013). This discovery was consistent across different weights, genders, and races, correlating with comparable findings in the referred study (Popp et al., 2018; Prokopets et al., 2021; Silva et al., 2021; Ghosh et al., 2023; Chomistek et al., 2013; Furukawa et al., 2009; Tremblay et al., 2011; and Walia et al., 2014). Reduced turnover of endogenous energy stores, myogenic glycogen, and intracellular lipids arises from sedentary behaviour and a lack of physical activity. These modifications contribute to insulin resistance in skeletal muscle. Hyperinsulinism that follows increases adipogenesis, resulting in the synthesis of extremely low-density lipoproteins and decreased high-density lipoprotein levels in the liver, ultimately contributing to metabolic syndrome and, as a result, CVD (Park et al., 2020). Park et al. (2020) also argue that sedentary steatosis may also contribute to hyperglycemia, thus raising the risk of both diabetes and CVD.
Strengths and Limitations
This research is part of a broader body of studies that amalgamated randomized controlled trials (RCTs), cohort studies, cross-sectional studies, and longitudinal investigations to explore the correlation between physical activity (PA), sedentary behaviour (SB), and cardiovascular disease (CVD) in adults, with a particular focus on women. This study stands out by incorporating recent medical data into the existing literature. It differentiated the population under scrutiny and considered factors such as economic position, publication year, and participant numbers, making it a comprehensive investigation. Larger databases were utilized to gather articles due to the limited literature in prior meta-analyses, resulting in a more extensive sample size meeting the inclusion criteria. The outcomes of this study could offer policymakers, physicians, and caregivers additional treatment options, potentially guiding decision-making and prompting further in-depth research in the future.
The present study has several limitations. Firstly, the inconsistent quality of the randomized controlled trial (RCT) literature impacted the overall quality of the research, and the high risk of blinding for outcome assessment introduced some heterogeneity and imprecision in the study results. Additionally, including longitudinal studies and randomized controlled trials could have led to conflicting outcomes. Moreover, the study did not assess key confounding factors such as diet, smoking, and obesity due to variations in implementation criteria, dose requirements, and rubrics, potentially contributing to limitations in the findings. Given these limitations, it is advisable to interpret the study’s results cautiously.
The results from this extensive, ethnically diverse population of postmenopausal women indicate that extended periods of sitting elevate the risk of cardiovascular disease (CVD), obesity, and other health risks in women, irrespective of engagement in leisure-time physical activity. Considering the anticipated demographic increase of women aged 65 and older in the United States, coupled with a relatively high prevalence of physical inactivity, these findings hold significant public health implications. Mitigating sitting time, particularly among older women with lower physical activity levels, could potentially reduce the incidence of coronary heart disease (CHD) and stroke—major sources of morbidity in this demographic. Moreover, for individuals who may be unable or unwilling to exercise, adjusting the duration of sitting time might be a more feasible target than increasing physical activity levels.
Contributions to Practice
As an educator, this study relates to my physical education practice because the combined research studies provide insights into the relationship between sedentary lifestyles and cardiovascular disease, obesity, and other health risks in women. This knowledge directly informs physical education practices, enabling educators to design interventions that address the specific health concerns associated with sedentary behaviours. Given the focus on a multiethnic population of postmenopausal women, the findings offer practical guidance for reducing the risk of cardiovascular disease, particularly in older women. This is particularly relevant as an educator considering the anticipated demographic rise of women 65 and older, providing actionable insights for physical education teachers working with this demographic.
Moreover, the research underscores the public health implications of reducing sitting time among less active older women. As a physical education teacher, incorporating these findings into educational practices can contribute to broader public health initiatives by addressing the main causes of morbidity, such as coronary heart disease and stroke, in older populations.
Furthermore, the research findings hold significant implications for clinical practice, offering valuable guidance for practitioners. The results align with the recommendations of the American Heart Association (AHA), emphasizing long-term physical activity as a primary intervention for addressing dyslipidemia and reducing the risk of cardiovascular disease (CVD). Specifically, adhering to AHA guidelines, engaging in 40 minutes of moderate to vigorous aerobic activity three to four times per week is indicated to lower LDL and enhance HDL levels (Liang et al., 2022). The study also reveals a positive impact of physical activity on blood pressure levels. By AHA guidelines, incorporating aerobic activity into a routine three to four times per week for an average duration of 40 minutes per session over at least 12 weeks is recommended to improve blood pressure in adults. These findings provide practitioners with concrete evidence supporting incorporating regular physical activity into clinical interventions to manage dyslipidemia and hypertension, key factors in cardiovascular health.
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