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

Nat Rev Cardiol. 2021 Sep;18(9):637-648. doi: 10.1038/s41569-021-00547-y. Epub 2021 May 20.


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.

Publication types

  • Review

MeSH terms

  • COVID-19
  • Cardiovascular Diseases / diagnosis
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / prevention & control*
  • Evidence-Based Medicine
  • Exercise*
  • Heart Disease Risk Factors
  • Humans
  • Randomized Controlled Trials as Topic
  • Risk Assessment
  • Risk Reduction Behavior*
  • Sedentary Behavior*
  • Sitting Position*
  • Time Factors