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Table 1 Summary of the findings from the studies assessing mortality outcomes

From: Health outcomes associated with reallocations of time between sleep, sedentary behaviour, and physical activity: a systematic scoping review of isotemporal substitution studies

Study Sample and study design Measures of sleep, SB, LPA, MVPA Outcome measures Data analysis method/reallocated time Adjustments for confounding Results
Chomistek et al. [50] Men (n = 44,551) from The Health Professionals Follow-up Study, USA; prospective cohort LPA, MPA, VPA – self report; sleep, SB – not assessed Sum of total CVD risk factors, total cancer, or other nontraumatic death. Mekary et al. [12]/10 MET h-wk− 1 Smoking, aspirin use, vitamin E supplement use, parental history of myocardial infarction or cancer, alcohol consumption, energy-adjusted intake of polyunsaturated fat, trans fatty acids, omega-3 fatty acids, fiber, diabetes, hypertension, and hypercholesterolemia. HR (95% CI)
MPA → VPA: 0.96 (0.93, 0.99)
Fishman et al. [54] Adults (n = 3029) from the 2003–2004 and 2005–2006 waves of the National Health and Nutrition Examination Survey, USA; prospective cohort SB, LPA, MVPA – waist-worn accelerometers; sleep – not assessed Mortality risk Mekary et al. [12]/10, 30 and 60 min Age, sex, race/ethnicity, education, and minutes of device wear time (model 1). Model 2 includes BMI, smoking, the presence of diabetes, coronary heart disease, congestive heart failure, stroke, cancer, and mobility limitation. In model 3 those with prevalent chronic illnesses (diabetes, coronary heart disease, congestive heart failure, stroke, and cancer) or mobility limitations at baseline were excluded. HR (95% CI)
10 min reallocation
Model 1
SB → LPA: 0.90 (0.88, 0.93)
SB → MVPA: 0.73 (0.57, 0.94)
MVPA → LPA: 1.23 (0.96, 1.58)
MVPA → SB: 1.36 (1.06, 1.75)
Model 2
SB → LPA: 0.92 (0.89, 0.94)
SB → MVPA: 0.79 (0.63, 0.99)
MVPA → LPA: 1.15 (0.92, 1.44)
MVPA → SB: 1.26 (1.01, 1.58)
Model 3
SB → LPA: 0.91 (0.86, 0.96)
SB → MVPA: 0.70 (0.57, 0.85)
MVPA → LPA: 1.30 (1.06, 1.59)
MVPA → SB: 1.43 (1.17, 1.74)
Reallocating 30 or 60 min from SB to LPA or MVPA was associated with a reduction in mortality risk after 5 years of follow-up.
Lee [62] Adults (n = 7006) from the National Health and Nutrition Examination Survey, USA; prospective cohort SB, LPA, MPA, VPA – waist-worn accelerometers; sleep – not assessed All-cause mortality Mekary et al. [12]/1 min and a dose-response analysis Age, sex, education level, income, BMI, binge drinking, smoking status, energy intake by 24-h dietary recall, self-reported general health condition, high blood pressure, high cholesterol, type 2 diabetes, history of heart attack, stroke, and cancer. Reallocating 1 min of SB to LPA or MPA demonstrated a J-shaped association with mortality, with the turning point at about
400 min and 15 min per day, respectively.
Reallocating time from SB to VPA decreased all-cause mortality in a linear manner.
Loprinzi et al. [65] Adults (n = 5377) from the 2003–2006 National Health and Nutrition Examination Survey, USA; prospective cohort SB, LPA, MVPA – waist-worn accelerometers; sleep – not assessed Mortality Mekary et al. [12]/30 min Age, sex, race–ethnicity, BMI, smoking status and education HR (95% CI)
SB → LPA: 0.87 (0.80, 0.95)
SB → MVPA: 0.19 (0.06, 0.60)
LPA → SB: 1.14 (1.04, 1.24)
LPA → MVPA: 0.22 (0.07, 0.69)
MVPA → SB: 5.03 (1.64, 15.40)
MVPA → LPA: 4.40 (1.42, 13.56)
Matthews et al. [66] Less active (n = 69,606) and more active (n = 85,008) individuals from the NIH-AARP Diet and Health Study, USA; prospective cohort Sleep, SB, exercise and non-exercise activities, LPA, MVPA – self report All-cause and cardiovascular mortality Mekary et al. [12]/60 min Age, education, smoking history, sleep duration, overall health, BMI, overall sitting, each type of physical activity, and the sum of overall sitting and physical activity time HR (95% CI)
All-cause mortality
Less active individuals
SB → exercise: 0.58 (0.54, 0.63)
SB → non-exercise: 0.70 (0.66, 0.74)
SB → household chores: 0.80 (0.74, 0.86)
SB → lawn and garden: 0.49 (0.43, 0.56)
SB → daily walking: 0.66 (0.57, 0.78)
SB → LPA: 0.81 (0.75, 0.88)
SB → MVPA: 0.58 (0.54, 0.62)
More active individuals
SB → exercise: 0.91 (0.88, 0.94)
SB → non-exercise: 1.00 (0.98, 1.02)
SB → household chores: 1.02 (0.99, 1.05)
SB → lawn and garden: 0.97 (0.93, 1.01)
SB → daily walking: 0.99 (0.94, 1.05)
SB → LPA: 1.04 (1.01, 1.08)
SB → MVPA: 0.96 (0.94, 0.98)
The time reallocations for cardiovascular mortality were weaker and non-significant among less active men for household chores, daily walking, and LPA compared to women. An increase in the risk was noted when reallocating SB with household and LPA in more active men. A significant inverse association for replacing SB with lawn and garden activities in more active men was noted (the same was not observed among women).
Matthews et al. [67] Adults (n = 4840) from the 2003–2006 National Health and Nutrition Examination Survey, USA; prospective cohort SB, LPA, MVPA – waist-worn accelerometers; sleep – not assessed Mortality risk Mekary et al. [12]/60 min Age, sex, race-ethnicity, alcohol consumption, smoking status, BMI, self-reported diabetes, coronary artery disease, stroke, cancer, and mobility limitation. HR (95% CI)
Overall
SB → LPA: 0.82 (0.73, 0.92)
SB → MVPA: 0.58 (0.44, 0.77)
Less active individuals
SB → LPA: 0.80 (0.69, 0.92)
SB → MVPA: 0.37 (0.26, 0.54)
More active individuals
SB → LPA: 1.29 (0.95, 1.74)
SB → MVPA: 0.92 (0.60, 1.43)
Schmid et al. [71] Adults (n = 3702) from the National Health and Nutrition Examination Survey 2003–2004 and 2005–2006 cycles, USA; prospective cohort SB, LPA, MVPA – accelerometers (location is not presented); sleep – not assessed All-cause mortality, CVD mortality, cancer mortality Mekary et al. [12]/30 min Age, sex, total accelerometer wear time (model 1). Model 2 is additionally adjusted for education, ethnicity, height, smoking, alcohol consumption, total dietary fat intake, total dietary fibre intake, mobility
limitations, history of diabetes, history of coronary heart disease, history of congestive heart failure, history of stroke, history of cancer. Model 3 is the same as model 2 plus waist circumference.
HR (95% CI)
All-Cause Mortality
Model 1
SB → LPA: 0.85 (0.81, 0.88)
SB → MVPA: 0.38 (0.22, 0.63)
SB → LPA and MVPA: 0.82 (0.79, 0.85)
LPA → MVPA: 0.45 (0.26, 0.75)
Model 2
SB → LPA: 0.86 (0.83, 0.90)
SB → MVPA: 0.50 (0.31, 0.80)
SB → LPA and MVPA: 0.85 (0.81, 0.88)
LPA → MVPA: 0.58 (0.36, 0.93)
Model 3
SB → LPA: 0.88 (0.84, 0.92)
SB → MVPA: 0.51 (0.32, 0.83)
SB → LPA and MVPA: 0.86 (0.82, 0.90)
LPA → MVPA: 0.58 (0.36, 0.95)
CVD Mortality
Model 1
SB → LPA: 0.84 (0.77, 0.90)
SB → MVPA: 0.25 (0.09, 0.71)
SB → LPA and MVPA: 0.80 (0.74, 0.86)
LPA → MVPA: 0.30 (0.11, 0.86)
Model 2
SB → LPA: 0.86 (0.79, 0.93)
SB → MVPA: 0.35 (0.14, 0.92)
SB → LPA and MVPA: 0.83 (0.77, 0.90)
LPA → MVPA: 0.41 (0.16, 1.08)
Model 3
SB → LPA: 0.88 (0.81, 0.95)
SB → MVPA: 0.36 (0.13, 0.95)
SB → LPA and MVPA: 0.85 (0.78, 0.92)
LPA → MVPA: 0.41 (0.15, 1.11)
Cancer mortality
Model 1
SB → LPA: 0.91 (0.85, 0.98)
SB → MVPA: 0.53 (0.22, 1.31)
SB → LPA and MVPA: 0.88 (0.82, 0.96)
LPA → MVPA: 0.58 (0.24, 1.44)
Model 2
SB → LPA: 0.92 (0.85, 0.99)
SB → MVPA: 0.69 (0.32, 1.50)
SB → LPA and MVPA: 0.90 (0.83, 0.98)
LPA → MVPA: 0.75 (0.34, 1.63)
Model 3
SB → LPA: 0.93 (0.86, 1.01)
SB → MVPA: 0.79 (0.39, 1.62)
SB → LPA and MVPA: 0.92 (0.85, 1.00)
LPA → MVPA: 0.85 (0.41, 1.73)
Stamatakis et al. [72] Adults (n = 201,129) from the 45 and Up study from New South Wales, Australia; prospective cohort Sleep, SB, LPA, MVPA – self report All-cause mortality Mekary et al. [12]/60 min Age, sex, educational level, marital status, residence, BMI, smoking status, self-rated health, receiving help with daily tasks for a long-term illness or disability, prevalent disease at baseline, psychological distress, mutually adjusted for all activity classes, and total time in all activity classes. HR (95% CI)
Sleeping (≤7 h) → screen-time: 1.01 (0.98, 1.05)
Sleeping (≤7 h) → sitting: 1.03 (0.99, 1.07)
Sleeping (≤7 h) → standing: 0.98 (0.94, 1.02)
Sleeping (≤7 h) → walking: 0.93 (0.84, 1.03)
Sleeping (≤7 h) → MVPA: 0.90 (0.85, 0.96)
Sleeping (≤7 h) → total activity: 1.01 (0.98, 1.04)
Sleeping (> 7 h) → screen-time: 0.95 (0.93, 0.97)
Sleeping (> 7 h) → sitting: 0.96 (0.94, 0.98)
Sleeping (> 7 h) → standing: 0.92 (0.9, 0.94)
Sleeping (> 7 h) → walking: 0.80 (0.75, 0.86)
Sleeping (> 7 h) → MVPA: 0.84 (0.81, 0.87)
Sleeping (> 7 h) → total activity: 1.06 (1.04, 1.07)
Screen-time → sleeping (≤7 h): 0.95 (0.91, 0.99)
Screen-time → sleeping (> 7 h): 1.06 (1.04, 1.09)
Screen-time → sitting: 1.01 (1.00, 1.03)
Screen-time → standing: 0.97 (0.95, 0.98)
Screen-time → walking: 0.87 (0.82, 0.92)
Screen-time → MVPA: 0.89 (0.86, 0.91)
Screen-time → total activity: 1.01 (1.00, 1.02)
Sitting → sleeping (≤7 h): 0.94 (0.90, 0.98)
Sitting → sleeping (> 7 h): 1.05 (1.03, 1.07)
Sitting → screen-time: 0.99 (0.97, 1.00)
Sitting → standing: 0.95 (0.94, 0.96)
Sitting → walking: 0.86 (0.81, 0.90)
Sitting → MVPA: 0.88 (0.85, 0.90)
Sitting → total activity: 1.02 (1.01, 1.03)
Standing → sleeping (≤7 h): 0.99 (0.95, 1.03)
Standing → sleeping (> 7 h): 1.10 (1.08, 1.13)
Standing → screen-time: 1.04 (1.02, 1.05)
Standing → sitting: 1.05 (1.04, 1.06)
Standing → walking: 0.90 (0.85, 0.95)
Standing → MVPA: 0.92 (0.89, 0.95)
Standing → total activity: 0.98 (0.97, 0.99)
Walking → sleeping (≤7 h): 1.10 (1.03, 1.18)
Walking → sleeping (> 7 h): 1.17 (1.12, 1.21)
Walking → screen-time: 1.15 (1.09, 1.22)
Walking → sitting: 1.17 (1.11, 1.23)
Walking → standing: 1.11 (1.05, 1.18)
Walking → MVPA: 1.02 (0.96, 1.09)
Walking → total activity: 0.88 (0.83, 0.93)
MVPA → sleeping (≤7 h): 1.07 (1.02, 1.13)
MVPA → sleeping (> 7 h): 1.18 (1.14, 1.22)
MVPA → screen-time: 1.13 (1.09, 1.16)
MVPA → sitting: 1.14 (1.11, 1.18)
MVPA → standing: 1.09 (1.06, 1.12)
MVPA → walking: 0.98 (0.92, 1.04)
MVPA → total activity: 0.90 (0.87, 0.92)
Wijndaele et al. [39] Middle-aged adults (n = 423,659) from the UK Biobank cohort study, UK; prospective cohort SB (leisure screen time, TV viewing, computer usage) and leisure/home activities (walking for pleasure, light and heavy do-it-yourself), structured exercise, sleep – self reported Mortality risk Mekary et al. [12]/30 min Townsend deprivation index, alcohol intake, smoking status, salt adding behaviour, oily fish consumption, fruit and vegetable intake, processed and sleep duration, chronic disease status, parental history of cardiovascular disease or diabetes HR (95% CI)
Screen time → leisure/home activities: 0.95 (0.94, 0.97)
Screen time → structured exercise: 0.87 (0.84, 0.90)
Screen time → walking for pleasure: 0.95 (0.92, 0.98)
Screen time → light do-it-yourself: 0.97 (0.94, 1.00)
Screen time → heavy do-it-yourself: 0.93 (0.90, 0.96)
Screen time → strenuous sports: 0.87 (0.79, 0.95)
Screen time → other exercises: 0.88 (084, 0.91)
TV viewing → leisure/home activities: 0.94 (0.93, 0.96)
TV viewing → structured exercise: 0.87 (0.84, 0.90)
TV viewing → walking for pleasure: 0.94 (0.92, 0.97)
TV viewing → light do-it-yourself: 0.96 (0.94, 0.99)
TV viewing → heavy do-it-yourself: 0.91 (0.89, 0.95)
TV viewing → strenuous sports: 0.86 (0.79, 0.95)
TV viewing → other exercises: 0.87 (0.83, 0.91)
Men
Computer usage → leisure/home activities: 0.98 (0.96, 1.00)
Computer usage → structured exercise: 0.89 (0.85, 0.93)
Computer usage → walking for pleasure: 0.98 (0.95, 1.01)
Computer usage → light do-it-yourself: 0.99 (0.96, 1.02)
Computer usage → heavy do-it-yourself: 0.97 (0.93, 1.00)
Computer usage → strenuous sports: 0.90 (0.81, 0.99)
Computer usage → other exercises: 0.88 (0.84, 0.93)
Women
Computer usage → leisure/home activities: 0.94 (0.91, 0.97)
Computer usage → structured exercise: 0.90 (0.84, 0.96)
Computer usage → walking for pleasure: 0.93 (0.89, 0.98)
Computer usage → light do-it-yourself: 0.99 (0.94, 1.04)
Computer usage → heavy do-it-yourself: 0.84 (0.76, 0.94)
Computer usage → strenuous sports: 0.88 (0.73, 1.06)
Computer usage → other exercises: 0.90 (0.84, 0.97)
  1. SB sedentary behaviour, LPA light intensity physical activity, MVPA moderate-to-vigorous intensity physical activity, MPA moderate intensity physical activity, VPA vigorous intensity physical activity, CVD cardiovascular disease, BMI body mass index, MET metabolic equivalent of task, HR hazard ratio, CI confidence interval