Table 1 Summary of all studies included in this systematic review
Author Year | Study design | Participants | Accelerometer (definition of LPA) | Exposure(s) | Outcome measurements (direction)a | Confounders | Study quality |
|---|---|---|---|---|---|---|---|
Adults | |||||||
 Loprinzi PD. 2016 [26] | Cross- sectional (NHANES 2005–2006) | 2048 adults in the U.S. (≥ 20 years) | ActiGraph 7164 (100 to 2019 CPM) | Every 60-min increase/day in LPA | Multimorbidity (+): OR 0.87 (0.79, 0.96) | Age, sex, race-ethnicity, poverty-to-income ratio, MVPA, eating a healthy diet, smoking, and meeting sleep guidelines | Moderate |
 Robson J., et al. 2015 [27] | Cross-sectional (NHANES 2003–2004 and 2005–2006) | 1974 adults in the U.S. (≥ 20 years) | Actigraph AM-7164 (100 to 2019 CPM) | Every 30-min increase/day in bouted LPA and sporadic LPA | Bouted LPA metabolic syndrome (+): OR 0.96 (0.93, 0.99), WC (+): OR 0.96 (0.93, 0.98), triglycerides (+):OR 0.93 (0.90, 0.96), HDL(0): OR 0.98 (0.94, 1.01), BP (0): OR 0.98 (0.94, 1.02), and glucose (0): OR 0.97 (0.94, 1.01) Sporadic LPA metabolic syndrome (0): OR 0.91 (0.81, 1.03), WC (0): OR 0.88 (0.77, 1.00), triglycerides (0):OR 0.94 (0.83, 1.06), HDL(0): OR 0.99 (0.88, 1.11), BP (0): OR 0.96 (0.80, 1.12), and glucose (0): OR 0.99 (0.86, 1.14) | Bouted LPA age, sex, ethnicity, poverty–income ratio, alcohol, smoking, and the other physical activity variables with the exception of embedded MVPA Sporadic LPA age, sex, ethnicity, poverty–income ratio, alcohol, smoking, and the other physical activity variables with the exception of bouted MVPA | High |
 Healy GN., et al. 2007 [15] | Cross-sectional (AusDiab study 2004–2005) | 173 Australian adults (mean 53.3 years) | Actigraph (100 to 1951 CPM) | LPA (hours/day) | 2-h plasma glucose (+): β −0.22 (− 0.42, − 0.03), adjusted R2 0.17 | Age, sex, height, WC, time accelerometer worn, accelerometer unit, family history of diabetes, alcohol intake, education, income, smoking status, and MVPA | Moderate |
 Hawkins MS., et al. 2013 [20] | Cross-sectional (NHANES 2003–2004) | 463 adults in the U.S. with normal ankle–brachial index (56.0 ± 0.5 years) | ActiGraph AML-7164 (100 to 1951 CPM) | LPA (min/day) | Framingham risk score (0): β 0.0016 | Age, sex, race, lipid-lowering medication, BMI, diabetes status, smoking status, CRP, lipids, SB and MVPA | Moderate |
 Riou MÈ., et al. 2014 [44] | Cohort (part of the MONET study) | 65 Canadian women (47–54 years) | Actical | Tertile of LPA (min/week) | Body weight (0), BMI (0),WC (0), fat mass (+), fat-free mass (0), percent body fat (+), peripheral fat mass (0), and central fat mass (+) | MVPA and total energy intake | Moderate |
 Green AN., et al. 2014 [31] | Cross-sectional | 50 young women in the U.S. (24.0 ± 4.8 years) | ActiGraph GT3X+ (150 to 2689 CPM) | LPA (min/day) | Triglycerides (+), lipid accumulation product (+), and HOMA R (0) | MVPA, VO2peak, and body mass | Moderate |
 Scheers T., et al. 2013 [42] | Cross-sectional | 370 Flemish adults (41.7 ± 9.8 years) | SenseWear Pro 3 Armband | LPA (hours/day) | Metabolic syndrome (0): OR 0.88 (0.62, 1.26), abdominal obesity (0): OR 0.89 (0.67, 1.18), hypertriglyceridemia (0): OR 0.85 (0.64, 1.13), HDL-C (0): OR 1.12 (0.82, 1.51), hypertension (0): OR 0.93 (0.75, 1.15), and hyperglycemia (0): OR 1.15 (0.78, 1.70) | Sex, age, education, smoking status, alcohol consumption, and MVPA | Moderate |
 Salonen MK., et al. 2015 [43] | Cross-sectional (AYLS) | 737 Finnish young adults (24.4 ± 0.6 years) | SenseWear Armband | LPA | Metabolic syndrome (0): OR 1.26 (0.96, 1.66) | Age, sex, smoking, MVPA, and education | Moderate |
 Loprinzi PD., et al. 2013 [28] | Cross-sectional (NHANES 2003–2004, 2005–2006) | 1672 men in the U.S. (mean 55.6 years) | ActiGraph 7164 (100 to 2019 CPM) | Every 60-min increase/day in ≥1-min of LPA and ≥ 10-min of LPA | ≥1-min of LPA Serum prostate-specific antigen concentrations (+): OR 0.82 (0.68, 1.00) ≥10-min of LPA Serum prostate-specific antigen concentrations (0): OR 0.86 (0.73, 1.02) | Age, BMI, race, education, marital status, and dietary, biological, immunological variables, and MVPA | High |
 Alkahtani S., et al. 2015 [21] | Cross-sectional | 84 Saudi men (37.6 ± 8.8 years) | ActiGraph wGT3X-BT (100 to 1951 CPM) | LPA | HDL-C (+): β −4.7 | 10-min MVPA | Moderate |
 Matthews CE., et al. 2016 [36] | Cohort (NHANES 2003–2006) | 4840 adults in the U.S. (56.8 ± 0.4 years) | Actigraph 7164 (100 to 759 CPM) | Replace 1 h of SB with LPA LPA (3, 4, 5, ≥6 h/day) (ref. 3 h/day) | Mortality (+): HR 0.82 (0.73, 0.92) Mortality (+): HR 0.79 (0.7, 0.9) in 4 h/day, HR 0.77 (0.6, 1.0) in 5 h/day, HR 0.89 (0.6, 1.3) in ≥6 h/day | Age, race, education, sex, smoking, alcohol, diabetes, coronary artery disease, cancer, stroke, mobility limitations, BMI, and MVPA | High |
 Camhi SM., et al. 2011 [32] | Cross-sectional (NHANES 2005–2006) | 1371 adults in the U.S. (47.1 ± 0.9 years) | ActiGraph AM-7164 (760 to 2019 CPM) | Every 30 min/day increase in LPA | Triglycerides (+): β 0.89 (0.83, 0.97), HDL-C (+): β 0.87 (0.83, 0.92), SBP (0): β 0.95 (0.85, 1.06), glucose (0): β 0.93 (0.85, 1.03), WC (+): β 0.88 (0.83, 0.94), metabolic syndrome (+): β 0.87 (0.80, 0.96), hypertension (0): β 0.90 (0.77, 1.04), and diabetes (+): β 0.67 (0.55, 0.82) | Age, ethnicity, sex and MVPA recommendations (< 30 and ≥ 30 MVPA min/day) | Moderate |
 Loprinzi PD., et al. 2014 [29] | Cross-sectional (NHANES 2003–2006) | 1703 adults in the U.S. (mean 60.6 years) | Actigraph 7164 (100 to 2019 CPM) | LPA | BMI (+): β-0.01 (− 0.01, − 0.004), WC (+): β − 0.01 (− 0.02, − 0.009), CRP (0): β 0.00003 (− 0.001, 0.001), white blood cell (0): β − 0.0005 (− 0.002, 0.001), triglycerides (0): β − 0.07 (− 0.18, 0.03), HDL-C (0): β 0.001 (− 0.01, 0.01), glucose (0): β − 0.02 (− 0.05, 0.01), homocysteine (0): β − 0.004 (− 0.008, − 0.00001), and HbA1C (0): β − 0.0002 (− 0.0007, 0.0001) | Age, race-ethnicity, sex, BMI, cotinine, comorbidity index, poverty-to-income ratio, MVPA, and accelerometer wear time | Moderate |
 Chastin SFM., et al. 2015 [24] | Cross-sectional (NHANES 2005–2006) | 1937 adults in the U.S. (21–64 years) | Actigraph 7164 (100 to 1951 CPM) | LPA | BMI (−): γ 0.98, WC (0): γ 0.96, triglycerides (+): γ − 0.21, insulin (+): γ − 0.13, HOMA R (+): γ − 0.15, SBP (0): γ 1.30, DBP (0): γ 0.70, HDL-C (0): γ − 0.01, LDL-C (0): γ − 0.10, CRP (0): γ-0.06, and glucose (0): γ − 0.01 | Age, sex, ethnicity/race, self-reported health, diagnosis of health conditions, educational level, socio economic status, smoking status, alcohol consumption, total daily average dietary calorie intake, fat intake, caffeine intake, usage of medications for high blood pressure or diabetes, and time spent in other behaviors | Moderate |
 Nelson RK., et al. 2013 [39] | Cross-sectional (NHANES 2003–2004) | 402 adults in the U.S. (32.6 ± 0.6 years) | ActiGraph AM-7164 (260 to 1952 CPM) | LPA | HOMA R (0): β − 0.0154 | Adiposity, sex, age, and MVPA | Moderate |
 Ekblom-Bak E., et al. 2016 [40] | Cross-sectional (Swedish CArdioPulmonary bioImage study) | 836 Swedish adults (50–64 years) | Actigraph GT3X+ (200 to 2689 CPM) | Replace 10-min of SB with LPA | Metabolic syndrome (+): β 0.96 (0.93, 0.98), WC (+): β 0.97 (0.95, 0.98), triglyceride (+): β 0.97 (0.94, 0.99), HDL-C (+): β 0.95, 0.92, 0.98), BP (0): β 1.00 (0.97, 1.02), and glucose (0): β 0.99 (0.97, 1.01) | Sex, age, educational level, smoking habits, perceived psychological stress, energy intake, wear time, MPA, and VPA | Moderate |
 Kim J., et al. 2013 [45] | Cross-sectional | 483 Japanese adults (30–64 years) | Active Style Pro (1.6–2.9 METs) | LPA (hours/day) or tertile of LPA (< 11.1, 11.2–14.5, ≥ 14.6 METs-h day)(ref. < 11.1 METs-h day) | Metabolic syndrome (+): β − 0.249 (− 0.448, − 0.051), WC (+): β − 0.827 (− 1.518, − 0.137), SBP (0): β − 3.035 (− 6.695, 0.625), DBP (0): β − 0.215 (− 0.956, 0.525), glucose (0): β − 0.790 (− 1.993, 0.413), triglyceride (0): β − 3.582 (− 8.424, 1.259), HDL-C (+): β 1.118 (0.188, 2.049), dyslipidemia (+): OR 0.68 (0.39, 1.17), 0.39 (0.20, 0.74), hypertension (0) OR 0.98 (0.61, 1.58), 0.97 (0.59, 1.60) and abdominal obesity (+): OR 0.46 (0.28, 0.76), 0.50 (0.30, 0.84). | Age, sex, smoking status, calorie intake, accelerometer wear time and MVPA | Moderate |
Older adults | |||||||
 Johnson LG., et al. 2016 [33] | Cross-sectional (Tasmanian Older Adult Cohort Study) | 188 community-dwelling older adults in Australia (64.0 ± 7.3 years) | ActiGraph GT1M (251 to 1951 CPM) | LPA (min/day) | Cognitive performance (+): β − 0.114 (− 0.198, − 0.030) | Age, sex, smoking history, alcohol intake, educational achievement, MVPA, and neuropsychological functioning | Moderate |
 Ku PW., et al. 2016 [22] | Cohort | 307 community-dwelling older adults in Taiwan (≥ 65 years) | Actigraph GT3X+ (100 to 1951 CPM) | LPA | Dimensions of well-being: psychological (+), learning and growth (+), and social (+), general (0), physical (0), independence (0), material (0), and environmental (0) | Age, sex, education, living status, BMI, number of chronic disease, general or specific dimension of well-being, MVPA, and accelerometer wear time | Moderate |
 Jefferis BJ., et al. 2016 [35] | Cross-sectional (British Regional Heart Study) | 1009 older men in the U.K. (78.5 ± 4.7 years) | Actigraph GT3X (100 to 1040 CPM) | LPA (min/day) bouts in 1–9 min and ≥ 10 min | 1–9 min bouts BMI (+): β − 0.012 (− 0.019, − 0.006), WC (+): β − 0.025 (− 0.044, − 0.006), fat mass index (+): β − 0.007 (− 0.013, − 0.002), insulin (+): β − 0.017 (− 0.028, − 0.006), and metabolic syndrome (0): β 0.998 (0.993, 1.003) ≥10 min bouts BMI (0): β 0.007 (− 0.008, 0.021), WC (0): β − 0.010 (− 0.052, 0.033), fat mass index (0): β − 0.003 (− 0.015, 0.009), insulin (−): β 0.028 (0.004, 0.052), and metabolic syndrome (0): β 1.002 (0.990, 1.013) | Age, social class, living alone, smoking, alcohol use, region of residence, season of accelerometer wear, MVPA, and accelerometer wear time | High |
 Foong et al. 2014 [34] | Cross-sectional (Tasmanian Older Adult Cohort Study) | 636 Australian older adults (66.3 ± 7.1 years) | ActiGraph GT1M (251 to 1951 CPM) | Every 10-min increase in LPA | Body fat (+): β − 169 (− 277, − 61), trunk fat (+): β − 104 (− 169, − 39), and BMI (0): β − 0.04 (− 0.10, 0.02) | Age, sex, SB, MPA, and VPA. | Moderate |
Adults and older adults | |||||||
 Hamer M., et al. 2014 [37] | Cross-sectional (Whitehall II epidemiological cohort) | 445 adults in the U.K. (66 ± 6 years) | ActiGraph GT3X (200 to 1998 CPM) | Replace 10-min of SB with LPA | Glycated hemoglobin (0): β 0.001 (0.006, − 0.009), BMI (0): β − 0.002 (− 0.059, 0.056), HDL-C (0): β 0.005 (− 0.001, 0.010), and triglyceride (0): β − 0.004 (− 0.014, 0.006) | Age, sex, smoking, employment grade, MVPA, total wear time, and current statin use | Moderate |
 Fishman EI., et al. 2016 [30] | Cohort (NHANES 2003–2006& National Death Index) | 3029 U.S adults (50–79 years) | ActiGraph AM-7164 (100 to 2019 CPM) | Replace 10-min of SB with LPA Replace 30-min of SB with LPA | Mortality (+) HR: 0.92 (0.89, 0.94) Mortality (+) HR: 0.80 (0.75, 0.85) | Total minutes of device wear time, minutes of MVPA, baseline age, sex, race/ethnicity, education, smoking, BMI, mobility limitations, and prevalent chronic disease | Moderate |
 Lynch BM., et al. 2011 [23] | Cross-sectional (NHANES 2003–2006) | 1024 women in the U.S. (63.0 ± 9.4 years) | Actigraph 7164 (100 to 1951 CPM) | LPA (hours/day: < 4.48, 4.48 to 5.49, 5.49 to < 6.48, ≥6.48) | BMI (+), WC (+), CRP (0), glucose (0), insulin (0), and HOMA R (0) | Age, MVPA, and BMI: ethnicity, alcohol intake, age at first birth, age at menarche; WC: ethnicity, educational attainment, marital status, annual family income, alcohol intake, age at first birth; CRP: ethnicity, educational attainment, marital status, annual family income, age at last period, years of hormone replacement therapy use; Glucose: marital status, annual family income, alcohol intake, age at last period, years of hormone replacement therapy use, age at first birth; Insulin: ethnicity, marital status, annual family income, smoking status, alcohol intake, years of hormone replacement therapy use, age at first birth; HOMA-IR: ethnicity, marital status, annual family income, smoking status, alcohol intake, age at first birth | High |
Borgundvaag E., et al. 2017 [13] | Cohort (NHANES 2003–2004, 2005–2006) | 5562 adults in the U.S. (48.4 ± 30 years) | ActiGraph 7164 (100 to 2019 CPM) | Quintile of LPA (ref. quintile 1) | Mortality (+): quintile 2; HR 0.72 (0.51, 1.03), quintile 3; HR 0.64 (0.42, 0.98), quintile 4; HR 0.75 (0.51, 1.11), quintile 5; HR 0.90 (0.62, 1.29) | Other physical activity intensity, age, sex, race/ethnicity, poverty-to-income ratio, education, smoking, alcohol, dietary fat, dietary saturated fat, dietary sodium, and accelerometer wear time | High |
 Howard B., et al. 2015 [14] | Cross-sectional (NHANES 2003–2004, 2005–2006) | 4614 adults in the U.S. (46.8 ± 17 years) (2003 fasting sample, 851 OGTT sample) | ActiGraph 7164 (LLPA: 100 to 759 CPM, H LPA: 760 to 1951 CPM) | Every 1 SD increase in LLPA and HLPA | LLPA BMI (0): β − 0.31 (− 0.56, − 0.06), WC (+): β − 1.06 (− 1.65, − 0.47), SBP (0): RR 1.00 (1.00, 1.01), DBP (0): β 0.41 (− 0.42, 1.25), CRP (+): RR 0.91 (0.87, 0.95), HDL-C (0): RR 1.01 (1.00, 1.03), triglycerides (+) RR 0.96 (0.94, 0.98), LDL-C (0): β 0.01 (− 0.05, 0.07), plasma glucose (0): β 1.00 (1.00, 1.01), insulin (+):RR 0.92 (0.88, 0.96), HOMA β (+): RR 0.94 (0.92, 0.97), HOMA S (+): RR 1.08 (1.04, 1.12) and 2-h plasma glucose (0): RR 0.98 (0.95, 1.01) HLPA BMI (0): β 0.10 (− 0.14, 0.34), WC (0): β − 0.17 (− 0.73, 0.38, SBP (0): RR 1.00 (0.99, 1.00), DBP (0): β 0.39 (− 0.35, 1.14), CRP (+): RR 0.91 (0.86, 0.96), HDL-C (0): RR 1.01 (0.99, 1.02), triglycerides (+) RR 0.95 (0.92, 0.99), LDL-C (0): β 0.04 (− 0.03, 0.10), plasma glucose (0): β 1.00 (0.99, 1.00), insulin (+):RR 0.92 (0.87, 0.97), HOMA β (+): RR 0.98 (0.95, 1.00), HOMA S (+): RR 1.03 (1.00, 1.07) and 2-h plasma glucose (0): RR 0.97 (0.94, 1.00) | Age, sex, ethnicity, education, marital status, family poverty income ratio, smoking, alcohol intake, energy intake, saturated fat, medical characteristics, and WC, MET minutes of MVPA | Moderate |
 Schmid D., et al. 2016 [46] | Cohort (NHANES 2003–2004, 2005–2006) | 3702 adults in the U.S. (50–80 years) | ActiGraph 7164 (100 to 2019 CPM) | Replacing 30 min of SB with an equal amount of LPA | All-cause mortality (+): HR 0.88 (0.84, 0.92), cardiovascular disease mortality (+): HR 0.88 (0.81, 0.95), cancer mortality (0): HR 0.93 (0.86, 1.01) | Age, sex, education, ethnicity, height, smoking, alcohol consumption, total dietary fat intake, total dietary fiber intake, mobility limitations, history of diabetes, history of coronary heart disease, history of congestive heart failure, history of stroke, history of cancer (where appropriate), total accelerometer wear time, and all activities except the one it was replaced for | Moderate |
 Hamer M., et al. 2014 [38] | Cross-sectional (Health Survey for England) | 1947 adults in the U.K. (16–95 years) | ActiGraph GT1M (200 to 2019 CPM) | Tertiles of LPA (ref. the lowest tertile of LPA) | Psychological distress (+): OR 0.56 (0.37, 0.84) for the middle tertile, 0.73 (0.48, 1.12) for the highest tertile. | Age, sex, accelerometry wear time, smoking, alcohol, education, BMI, social occupational group employment long-term illness, and tertiles of MVPA | Moderate |
 Buman MP., et al. 2013 [25] | Cross-sectional (NHANES 2005–2006) | 4130 adults in the U.S. (46.6 ± 18.5 years) (923 fasting samples) | ActiGraph 7164 (100 to 1951 CPM) | Replacing 30 min of SB with LPA | WC (0): RR 0.999 (0.996, 1.001), triglycerides (+): RR 0.981 (0.972, 0.991), insulin (+): RR 0.976, (0.962, 0.991), HDL-C (0): RR 1.003 (0.998, 1.008), HOMA β (+), HOMA S (+), SBP (−), BP (−), glucose (0), CRP (0), and LDL-C (0) | Age, sex, race/ethnicity, marital status, education, work status, poverty, smoking, depressive symptoms, energy intake, saturated fat, caffeine, alcohol use, general health rating, disease, sleep duration, and MVPA | Moderate |
 Fanning J., et al. 2016 [41] | Cross-sectional | 247 adults in the U.S. (65.4 ± 4.6 years) | ActiGraph GT1M/ GT3X (51 to 1040 CPM) | Replacing 30 min of SB with LPA | Self-regulation (0), spatial working memory (0), and task switching (0) | Age, sex, race, total time, and other behavior. | Moderate |