Table 1 Characteristics of the general population studies

Study design – cross-sectional

 Non-occupational Sedentary Behaviour

Aweto et al. 2016 [58]

Nigeria

51 – 80 years

Sample size = 182

Average: age = 70.17(8.62), BMI = NR

%Female: 54.95%

Non-occupational – Sedentary behaviours (TV, reading, listening to music, sitting in a car, lying, talking on the phone)

Self-reported

LBP, UBP, Shoulder pain, Neck pain, Knee pain, Ankle pain, Elbow pain, Arm pain – Point and 12-month prevalence

%Prevalence: point prevalence = 51.6%; 12-months prevalence = 87.4%

Self-reported

Chi-square (χ2) test

Positive associations of sedentary behaviours with LBP; UBP; Knee pain; and Ankle pain. No association with Neck/shoulder and Elbow pain

LBP: χ2 = 15.7, p-value = 0.02; UBP: χ2 = 13.6, p-value = 0.03; Knee pain: χ2 = 16.8, p-value = 0.01; Ankle pain: χ2 = 14.2, p-value = 0.03; Shoulder pain: χ2 = 10.6, p-value = 0.56; Neck pain: χ2 = 7.8, p-value = 0.62; Elbow pain: χ2 = 5.6, p-value = 0.72

Kang et al. 2020 [59]

South Korea

 ≥ 50 years

Sample size = 3,761

Average: age = NR, BMI = NR

%Female: 48.3%

Non-occupational – Total SB(≥ 7.5 h/day)

Self-reported

Orthopaedic problems (OPPs): LBP, knee pain, and hip pain – 3-month prevalence

%Prevalence: men – 17.7% OPPs; women – 28.6% OPPs

Self-reported

Multiple logistic regression

Adjusted for age, education, income, occupation, marital status, smoking, BMI, physical activity at work, leisure physical activity, alcohol, sleep duration

Positive association of total SB (≥ 7.5 h/day) with OPPs in men [OR(95%CI) = 1.45(1.08 – 1.93)], and no association in women [OR(95%CI) = 1.04(0.80 – 1.35)]

Men had a positive association with knee pain [OR(95%CI) = 1.80(1.11 – 2.92)], whereas women had a positive association with hip pain [OR(95%CI) = 2.05(1.35 – 3.11)]

No associations of total SB (≥ 7.5 h/day) with LBP in both men and women, knee pain in women, and hip pain in men

Kim, 2019 [60]

South Korea

 ≥ 65 years

Sample size = 301

Average: age = 72.93(0.11), BMI = NR

%Female: 58.3%

Korea’s 6th National Health and Nutrition Examination Survey (KNHANES VI)

Non-occupational – Total SB (≥ 7.5 h/day)

Self-reported

LBP; Osteoarthritis; Knee pain; Hip pain – 3-month prevalence

%Prevalence: LBP = 30.5; Osteoarthritis = 92.7; Knee pain = 27.3; Hip pain = 12.8

Self-reported

Multiple logistic regression

Adjusted for sex, age, obesity, housing type, family income, education, and marital status

Positive associations of total SB (sitting) with LBP, knee pain, hip pain; and no association with osteoarthritis

LBP: OR(95%CI) = 1.44(1.19 – 1.74), p < 0.001; Knee pain: OR(95%CI) = 1.41(1.11 – 1.79), p < 0.05; Hip pain: OR(95%CI) = 1.54(1.1 – 2.03), p < 0.05; Osteoarthritis: OR(95%CI) = 1.72(0.86 – 3.43), p = 0.126

Kulaivelan et al. 2018 [61]

India

All adults

Sample size = 1503

Average: age = 48.23(13.12), BMI = 25.97(4.57)

%Female: 54.2%

Non-occupational – TV time, TB SB (sitting)

Self-reported

LBP – 12-month prevalence

%Prevalence: 9.0%

Self-reported – MNMQ

Binary logistic regression

Adjusted for smoking, income, sleeping hours, scheduled caste

No associations of TV time and total SB (sitting) with LBP

Sitting time (upper quartile): OR(95%CI) = 1.17(0.85 – 1.62); TV time(> 2 h/day): OR(95%CI) = 1.17(0.82 – 1.66)

Lee et al. 2019 [16]

South Korea

 ≥ 50 years

Sample size = 8008 (Without chronic pain = 6344, chronic pain = 1664)

Average: age – without chronic knee pain = 65.2(9.3), chronic knee pain = 61.3(8.7); BMI – without chronic knee pain = 24.0(3.1), chronic knee pain = 24.7(3.3)

%Female: without chronic knee pain = 72.6%, chronic knee pain = 27.4%

KNHANES VI

Non-occupational – Total SB (< 5, 5–7, 8–10, and > 10 h/day)

Self-reported – IPAQ

Chronic knee pain – 3-month prevalence

%Prevalence: 20.8%

Self-reported

Multivariable logistic regression

Adjusted for age and BMI, individual factors (lifestyle factors and health factors), such as smoking, alcohol consumption, occupation, education, household income, physical activity, depression, and sleep duration

Total SB (> 10 h/day) is significantly positively correlated with chronic knee pain, especially in women even with high levels of physical activity

Total SB > 10 h/day – Overall: OR(95% CI) = 1.28(1.02 – 1.61), p = 0.03; Women: OR(95% CI) = 1.33(1.02 – 1.74), p = 0.04; Men: OR(95% CI) = 1.17(0.78 – 1.75), p = 0.46

Loprinzi, 2014 [62]

USA

 ≥ 65 years

Sample size = 1753

Average: age – T2D = 73.4, without diabetes = 74.3; BMI – diabetes = 30.2, without diabetes = 27.3

%Female: diabetes = 55.1%, without diabetes = 74.3%, All = 57.4%

National Health and Nutrition Examination Survey (NHANES)

Non-occupational – Total SB

Device-measured – ActiGraph

Arthritis

%Prevalence – With diabetes = 43.4%; without diabetes = 33.5%

Self-reported

Wald tests and design-based likelihood ratio tests were used to examined statistical differences

Adjusted for gender, age, and accelerometer wear time

Positive association of total SB with arthritis in both T2D and non-diabetes

P-value: T2D = 0.001; without diabetes < .0001

Machado et al. 2018 [63]

Brazil

 ≥ 65 years

Sample size = 378

Average: age = 75.5(6.1), BMI = 27.3(4.9)

%Female: 70.9%

The PAINEL Study

Non-occupational – Total SB

Self-reported

LBP – 12-month prevalence

%Prevalence: 9.3%

Self-reported

Logistic regression

Adjusted for age, gender, BMI, income, multimorbidity, depressive symptoms, sleep hours, years of schooling, smoking, physical activity level

No association of total SB with LBP

Sitting time 4.2(2.5) h/day: OR(95%CI) = 1.03(0.81 – 1.31)

Mendonça et al. 2020 [64]

Brazil

All adults – Severely obese

Sample size = 150

Average: age = 39.6(0.7), BMI = 46.1(0.5)

%Female: 85.3%

‘DieTBra Trial’

Non-occupational – Total SB (Low SB < 1,182.15 min/day)

Device-measured – ActiGraph

MSP –Neck, shoulders, elbows, upper back, lower back, wrist/hands, hips/thighs, knees, and ankles/feet

%Prevalence:

89.3%(site with high prevalence – ankle/feet = 68.7%), LBP = 62.7%, knees = 53.3%, and UBP = 52.0%)

Self-reported

Poisson regression

Adjusted for sex, age, skin colour, years of schooling, economic class, and occupation

Low total SB (< 1,182.15 min/day) is associated with hip pain, but no association with shoulder pain and wrist/hands pain

Hip pain: PR(95%CI) = 1.84(1.05 – 3.21), p = 0.032. Shoulder pain: PR(95%CI) = 1.76(0.96 – 3.23), p = 0.066; Wrist/hands: PR(95%CI) = 0.59(0.33 – 1.06), p = 0.078

Mendonça et al. 2020a [65]

Brazil

All adults – Severely obese

Sample size = 150

Average: age = 39.57(0.72), BMI = 46.12(0.53)

%Female: 85.33%

‘DieTBra Trial’

Non-occupational – Total SB(Low SB < 1,182.15 min/day); Device-measured – ActiGraph

MSP-related pain intensity

%Prevalence: pain – 89.33%, severe pain – 69.33%, and pain in four or more sites – 53.33%

Self-reported

Poisson regression

Adjusted for demographic data (gender, education, and economic class), diet and exercise (fruit and vegetable consumption and MVPA [min/day]), and clinical characteristics (falls in the last 12 months, fracture, anxiety, depression, arthritis/arthrosis, use of analgesics, and muscle relaxant use)

A longer duration of total SB is associated with the experience of more pain

SB < Median (1182.15): Pain – PR(95%CI) = 0.95(0.86 – 1.06), p = 0.399; Severe pain – PR(95%CI) = 1.09(0.88 – 1.35), p = 0.432; Four or More Painful Sites – PR(95%CI) = 1.06(0.79 – 1.44), p = 0.680

Park et al. 2018 [66]

South Korea

 ≥ 50 years

Sample size = 5364

Average: age = without LBP = 63.4(8.7), LBP = 67.3(9.1); BMI = without LBP = 24.1(3.1), LBP = 24.4(3.4)

%Female: without LBP = 52.3%; LBP = 74.2%

KNHANES

Non-occupational – Total SB

Self-reported – IPAQ

LBP – 3-month prevalence

%Prevalence: 22.8%

Self-reported

Multiple logistic regression

Adjusted for age, sex, BMI, socioeconomic factors, education, household income, smoking, alcohol, and comorbidities

Positive association of total SB with LBP

Sitting time > 7 h/day: OR(95%CI) = 1.33 (95% CI, 1.10 – 1.61)

Ryan et al. 2017 [67]

UK

All adults

Sample size = 2313

Average: age = 52(18), BMI = 28(5)

%Female: 55%

Health Survey for England (HSE)

Non-occupational – Total SB

Device-measured – ActiGraph

Chronic MSP

%Prevalence: 17%

Self-reported

Isotemporal substitution

Adjusted for age, sex, socioeconomic status, diet, smoking history, alcohol intake, anxiety/depression, and presence of anon-musculoskeletal long-standing illness

Replacing 30 min SB with 30 min MVPA has a small but clinically relevant protective association with the chronic MSP prevalence ratio

Substituting 30 min SB with 30 min MVPA: PR(95%CI) = 0.71(0.55 – 0.88)

Sagat et al. 2020 [68]

Saudi Arabia

18 – 64 years

Sample size = 463

Average: age = NR, BMI = NR

%Female: 44.1%

Non-occupational – Total SB (Sitting always or most of the time)

Self-reported

LBP intensity

%Prevalence: Before quarantine = 38.8%, During quarantine = 43.8%

Self-reported

Spearman test for correlation

A significant positive correlation of LBP intensity with sitting during Covid-19 quarantine

Correlations of LBP intensity with sitting: Before quarantine – r = 0.054, p = 0.216; During quarantine – r = 0.124, p = 0.008

Smuck et al. 2014 [69]

USA

All adults

Sample size = 6796

Average: age = NR, BMI = NR

%Female: NR

NHANES

Non-occupational – Total SB, sedentary bout

Device-measured –ActiGraph

LBP – 3-month prevalence

%Prevalence: NR

Self-reported

Adjusted weighted logistic regression

Adjusted for BMI

Positive association of total SB and mean sedentary bout with LBP

Maximum SB bout [1239(903) min]: OR(95%CI) = 1.03(1.1 – 1.8); Average SB bout [50.0(46.9) min]: OR(95%CI) = 1.09(1.3 – 3.0)

Vancampfort et al. 2017 [70]

China, Ghana, India, Mexico, Russia, and South Africa

 ≥ 50 years

Sample size = 34,129 (China = 13,175; Ghana = 4305; India = 6560; Mexico = 2313; Russia = 3938; South Africa = 3838)

Average: age = median (IQR): 62(55 –70) years, BMI = NR

%Female: 52.1%

SAGE

Non-occupational – Total SB (≥ 8 h per day)

Self-reported

Chronic LBP – 1-month prevalence

%Prevalence: 8.6%,

Arthritis

%Prevalence: 29.5%

Self-reported

Multivariable logistic regression

Adjusted for sex, age, education, wealth, setting, unemployment, living arrangement, and country, comorbid chronic conditions

Positive association of total SB with arthritis and chronic LBP

Arthritis Overall: OR(95%CI) = 1.22(1.03 – 1.44); 50-64 years: OR(95%CI) = 1.17(0.92 – 1.49); ≥ 65 years: OR(95%CI) = 1.33(1.07 – 1.67);

Chronic LBP Overall: OR(95%CI) = 1.70(1.37 – 2.11), 50-64 years: OR(95%CI) = 1.38(0.98 – 1.95), ≥ 65 years: OR(95%CI) = 1.87(1.43 – 2.44)

 Occupational Sedentary Behaviour

Anita et al. 2019 [71]

Spain

Born between 1940 and 1966 (> 50 years)

Sample size = 1059

Average: age = 56.7(7.1), BMI – LBP = 27.1(5.4), No LBP = 27.1(4.2)

%Female: 55%

Occupational – Workplace sitting

Self-reported

LBP – 1-month prevalence

%prevalence = 14.2%

Self-reported

Multivariate regression

Adjusted for age, sex, depression/anxiety level

No association of workplace sitting with LBP

OR(95%CI) = 0.28(0.05 – 1.38), p = 0.12

 Occupational and Non-occupational Sedentary Behaviour

Bento et al. 2019 [72]

Brazil

All adults

Sample size = 600

Average: age = NR, BMI = NR

%Female: 50%

Occupational—Workplace sitting; and

Non-occupational—Sedentary behaviours (time spent on TV, on a computer, and/or video games)

Self-reported

LBP – Point prevalence

%Prevalence: 28.8%

Self-reported

Poisson regression

Adjusted for age, education, ethnicity, income, smoking, physical activity, depression, hypertension, diabetes, gastrointestinal, renal, and respiratory diseases

No associations od sedentary behaviours nor workplace sitting with LBP

TV time ≥ 3 h: Female PR = 0.96(95%CI = 0.31 – 1.71); Male PR(95%CI) = 1.06(0.68 – 1.65); Computer/video game ≥ 3 h: Female PR(95%CI) = 0.70(0.37 – 1.31); Male PR(95%CI) = 0.52(0.24 – 1.14). Sitting position at work (Always/usually): Female PR(95%CI) = 1.24(0.90 – 1.72); Male PR(95%CI) = 0.88(0.56 – 1.38)

Dos Santos et al. 2017 [73]

Brazil

All adults

Sample size = 600

Average: age = NR, BMI = NR

%Female: 50%

Occupational – Workplace sitting; and

Non-occupational – sedentary behaviours (time spent on TV, on a computer, and/or playing video games)

Self-reported

Neck pain – 12-month prevalence

%prevalence: 20.3%

Self-reported – NMQ

Poisson regression to calculate prevalence ratio with a confidence interval

Adjusted for gender

No associations of workplace sitting, TV time, and computer time with neck pain

Sitting position (Always/usually): PR = 1.09(95%CI = 0.78 – 1.52); TV time > 3 h: PR = 0.89(95%CI = 0.64 – 1.23); Computer time > 3 h: PR = 1.20(95%CI = 0.71 – 2.02)

Study design – case–control

 Occupational Sedentary Behaviour

Pope et al. 2003 [74]

UK

All adults

Sample size = 3385

Average: age = NR, BMI = NR,

%Female: Cases = 63.6; Control = 49.4

Occupational – Workplace sitting (≥ 2 h without a break)

Self-reported

Hip pain – 1-month prevalence

%Prevalence: 10.5%

Self-reported

Logistic regression

Adjusted for age, sex, and all physical activities

Positive association of prolonged sitting with hip pain

Sitting for prolonged periods – ≥ 2 h: (higher exposure vs not exposed): OR(95%CI) = 1.82(1.13 – 2.92)

Study design – prospective

 Non-occupational Sedentary Behaviour

Balling et al. 2019 [75]

Denmark

All adults

Duration: mean 7.4-years

Sample size = 46,826

Average: age = 47.6(15.8), BMI = 24.8(4.2)

%Female: 60.3%

Non-occupational – Total SB (sitting time)

Self-reported – IPAQ

LBP – Incidence

%Incidence: 3.8%

Medical records

Cox regression

Adjusted for age, sex, mental disorder, education, smoking status, BMI, leisure-time physical activity, and physical activity at work

No association of total SB (sitting) with an incidence of LBP

Sitting 6 to < 10 h: HR(95%CI) = 0.99(0.89 – 1.10); 10 + hrs: HR(95%CI) = 0.99(0.86 – 1.16)

Chang et al. 2020 [76]

USA

45 – 79-years at baseline

Duration: 8-year

Sample size = 1194

Average: age = 58.4(8.9), BMI = 26.8(4.5)

%Female: 58.4%

Osteoarthritis Initiative (OAI)

Non-occupational – Extensive sitting behaviour over 8 years

Self-reported

Knee pain – 12-month incidence

%Incidence: 13.0%

Clinical diagnosis – radiologic examination

Logistic regression

Adjusted for age, gender, BMI, depressive symptoms, comorbidities

No association of extensive sitting trajectory with incident knee osteoarthritis

Moderate frequency sitting trajectory: RR(95%CI) = 1.02(0.88 – 1.18); High frequency sitting trajectory: RR(95%CI) = 1.22(1.00 – 1.50)

da Silva et al. 2019 [77]

Australia

All adults

Duration: 3-, 6-, 9- and 12-month follow-ups

Sample size = 250

Average: age = 50(15), BMI: 26.5(5.3)

%Female: 50%

Non-occupational – Total SB

Self-reported

LBP – Incidence

%Incidence: 38% at 3-months; 56% at 6-months; and 69% at 12-months

Self-reported – 11-point numerical rating scale

Cox regression – completeness of follow-up was calculated using the completeness index

Adjusted for age BMI, smoking, and exposure to heavy load

Positive association of sitting time with LBP

Sitting > 5 h: HR(95%CI) = 1.50(1.08 – 2.09), p = 0.02

Hussain et al. 2016 [78]

Australia

All adults

Duration: 5-, 12-years

Sample size = 4974

Average: age = NR, BMI = NR

%Female: 55.8%

Australian Diabetes, Obesity, and Lifestyle (AusDiab) Study

Non-occupational – TV time

Self-reported

LBP intensity, LBP disability – 6-month prevalence

%Prevalence: 81.9%

Self-reported – Chronic Pain Grade Questionnaire (CPGQ)

Multinomial logistic regression

Adjusted for age, education, smoking status, dietary guideline index score, and BMI; SF-36 MCS score

High levels of TV time are positively associated with an increased risk of LBP disability in women but not in men. No association of TV time with LBP intensity

TV time ≥ 2 h: LBP intensity (Men) Low: OR(95%CI) = 1.15(0.91 – 1.46), p = 0.25; High: OR(95%CI) = 1.17(0.86 – 1.59), p = 0.31; (Women) Low: OR(95%CI) = 1.11(0.88 – 1.40), p = 0.37; High: OR(95%CI) = 1.17(0.88 – 1.56), p = 0.28; LBP Disability (Men) Low: OR(95%CI) = 1.10(0.84 – 1.43), p = 0.50; High: OR(95%CI) = 1.15(0.82 – 1.61), p = 0.42; (Women) Low: OR(95%CI) = 1.35(1.04 – 1.73), p = 0.02; High: OR(95%CI) = 1.29(1.01 – 1.72), p = 0.04

Stefansdottir & Gudmundsdottir, 2017 [17]

Iceland

All adults

Duration: 5-years

Sample size = 737

Average: age = 53(16), BMI = 27(5)

%Female: 39%

Health and Wellbeing of Icelanders survey

Non-occupational – Total SB

Self-reported

General musculoskeletal symptoms – 5-year prevalence

%Prevalence: 33.5%

Self-reported

Not reported

Positive association of total SB with general MSP

High SB: OR(95%CI) = 1.7(1.03 – 2.83)

 Occupational Sedentary Behaviour

Martin et al. 2013 [79]UK

36-year, 43-year, and 53-year old cohorts

Duration: Since birth in 1946

Sample size = 2957

Average BMI: 36-year = 24.1(3.7), 43-year = 25.4(4.2), 53-year = 27.4(4.8)

%Female: 36-year = 51.3%, 43-year = 51.3%; 53-year = 50.7%

Occupational – Workplace sitting (> 2 h)

Self-reported

Knee pain (Osteoarthritis) – 1-month prevalence

%Prevalence: 10.2%

Self-report and clinical examination

Logistic regression

Adjusted for gender, health risk factors, and socioeconomic position

Negative association of workplace with knee osteoarthritis in women, but no association in men

Sitting highly likely: (Men) 36 years OR(95%CI) = 1.13(0.61 – 2.06), p = 0.700; 43 years OR(95%CI) = 0.69 (0.39 – 1.24), p = 0.226; 53 years OR(95%CI) = 0.60 (0.34 – 1.07), p = 0.085; (Women) 36 years OR(95%CI) = 0.56 (0.33 – 0.94), p = 0.029; 43 years OR(95%CI) = 0.57 (0.36 – 0.89), P = 0.013; 53 years OR(95%CI) = 0.89 (0.56 – 1.43), p = 0.653