Int J Sports Med 2022; 43(02): 97-106
DOI: 10.1055/a-1502-6787

Effects of Breaking Up Prolonged Sitting on Cardiovascular Parameters: A systematic Review

1   Post-graduate Program in Rehabilitation Sciences, Universidade Nove de Julho, Sao Paulo, Brazil
Luiza Batista Santini
2   Instituto Israelita de Ensino e Pesquisa, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
Breno Quintella Farah
3   Departament of Physical Education, Universidade Federal Rural de Pernambuco, Recife, Brazil
4   Post-graduate Program in Physical Education, Universidade Federal de Pernambuco, Recife, Brazil
Antonio Henrique Germano-Soares
5   Associated Post-graduate Program in Physical Education Universidade de Pernambuco, Recife, Brazil
Mariliade Almeida Correia
6   Post-graduate Program in Medicine, Universidade Nove de Julho, Sao Paulo, Brazil
Raphael Mendes Ritti-Dias
1   Post-graduate Program in Rehabilitation Sciences, Universidade Nove de Julho, Sao Paulo, Brazil
› Author Affiliations
Funding This work was supported by: “Fundação de Amparo à Pesquisa do Estado de São Paulo – FAPESP” (processo#2019/05221-1), “Conselho Nacional de Desenvolvimento Científico e Tecnológico – CNPq” (processo#310508/2017-7, processo#409224/2018-9), e “Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – CAPES” (processo#88881.133008/2016-01).


The aim of this systematic review was to analyze the acute and chronic effects of sitting breaks on cardiovascular parameters. PubMed and Web of Science databases were searched by two independent researchers for relevant studies published until February 2020. Acute or chronic studies reporting the effects of sitting breaks or reduction in sitting time on cardiovascular parameters were examined. The eligibility criteria followed PICOS: Population - Humans ≥ 18 years old; Interventions – Sitting break strategies; Comparisons – Uninterrupted sitting; Outcomes – Cardiovascular parameters (blood pressure, heart rate, ambulatory blood pressure, vascular function, pulse-wave velocity, cerebral blood flow and biomarkers); Study design – Randomized controlled trials, non-randomized non-controlled trials and randomized crossover trials. Forty-five studies were included, where 35 investigated the acute and 10 the chronic effects of sitting breaks or reductions in sitting time. Walking was the main acute study strategy, used in different volumes (1 min 30 s to 30 min), intensities (light to vigorous) and frequencies (every 20 min to every 2 h). Acute studies found improvements on cardiovascular parameters, especially blood pressure, flow-mediated dilation, and biomarkers, whereas chronic studies found improvements mostly on blood pressure. Breaking up or reducing sitting time improves cardiovascular parameters, especially with walking.

Supplementary Material

Publication History

Received: 07 December 2020

Accepted: 28 April 2021

Article published online:
17 September 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

  • References

  • 1 Harvey JA, Chastin SF, Skelton DA. Prevalence of sedentary behavior in older adults: a systematic review. Int J Environ Res Public Health 2013; 10: 6645-6661
  • 2 Larsen RN, Kingwell BA, Sethi P. et al. Breaking up prolonged sitting reduces resting blood pressure in overweight/obese adults. Nutr Metab Cardiovasc Dis 2014; 24: 976-982
  • 3 Barone Gibbs B, Kowalsky RJ, Perdomo SJ. et al. Effect of alternating standing and sitting on blood pressure and pulse wave velocity during a simulated workday in adults with overweight/obesity. J Hypertens 2017; 35: 2411-2418
  • 4 Restaino RM, Holwerda SW, Credeur DP. et al. Impact of prolonged sitting on lower and upper limb micro- and macrovascular dilator function. Exp Physiol 2015; 100: 829-838
  • 5 Restaino RM, Walsh LK, Morishima T. et al. Endothelial dysfunction following prolonged sitting is mediated by a reduction in shear stress. Am J Physiol Heart Circ Physiol 2016; 310: H648-H653
  • 6 Hadgraft NT, Winkler E, Climie RE. et al. Effects of sedentary behaviour interventions on biomarkers of cardiometabolic risk in adults: systematic review with meta-analyses. Br J Sports Med 2021; 55: 144-154
  • 7 Katzmarzyk PT, Church TS, Craig CL. et al. Sitting time and mortality from all causes, cardiovascular disease, and cancer. Med Sci Sports Exerc 2009; 41: 998-1005
  • 8 Buckley JP, Hedge A, Yates T. et al. The sedentary office: an expert statement on the growing case for change towards better health and productivity. Br J Sports Med 2015; 49: 1357-1362
  • 9 Paterson C, Fryer S, Zieff G. et al. The effects of acute exposure to prolonged sitting, with and without interruption, on vascular function among adults: a meta-analysis. Sports Med 2020; 50: 1929-1942
  • 10 Moher D, Liberati A, Tetzlaff J. et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 2009; 339: b2535
  • 11 Liberati A, Altman DG, Tetzlaff J. et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 2009; 6: e1000100
  • 12 Harriss DJ, MacSween A, Atkinson G. Ethical standards in sport and exercise science research: 2020 Update. Int J Sports Med 2019; 40: 813-817
  • 13 Smart NA, Waldron M, Ismail H. et al. Validation of a new tool for the assessment of study quality and reporting in exercise training studies: TESTEX. Int J Evid Based Healthc 2015; 13: 9-18
  • 14 Altenburg TM, Rotteveel J, Serné EH. et al. Standing is not enough: A randomized crossover study on the acute cardiometabolic effects of variations in sitting in healthy young men. J Sci Med Sport 2019; 22: 790-796
  • 15 Bailey DP, Locke CD. Breaking up prolonged sitting with light-intensity walking improves postprandial glycemia, but breaking up sitting with standing does not. J Sci Med Sport 2015; 18: 294-298
  • 16 Carter SE, Jones M, Gladwell VF. Energy expenditure and heart rate response to breaking up sedentary time with three different physical activity interventions. Nutr Metab Cardiovasc Dis 2015; 25: 503-509
  • 17 Carter SE, Gladwell VF. Effect of breaking up sedentary time with callisthenics on endothelial function. J Sports Sci 2017; 35: 1508-1514
  • 18 Carter SE, Draijer R, Holder SM. et al. Regular walking breaks prevent the decline in cerebral blood flow associated with prolonged sitting. J Appl Physiol (1985) 2018; 125: 790-798
  • 19 Carter SE, Draijer R, Holder SM. et al. Effect of different walking break strategies on superficial femoral artery endothelial function. Physiol Rep 2019; 7: e14190
  • 20 Champion RB, Smith LR, Smith J. et al. Reducing prolonged sedentary time using a treadmill desk acutely improves cardiometabolic risk markers in male and female adults. J Sports Sci 2018; 36: 2484-2491
  • 21 Dogra S, Wolf M, Jeffrey MP. et al. Disrupting prolonged sitting reduces IL-8 and lower leg swell in active young adults. BMC Sports Sci Med Rehabil 2019; 11: 23
  • 22 Miyashita M, Burns SF, Stensel DJ. Accumulating short bouts of brisk walking reduces postprandial plasma triacylglycerol concentrations and resting blood pressure in healthy young men. Am J Clin Nutr 2008; 88: 1225-1231
  • 23 Peddie MC, Bone JL, Rehrer NJ. et al. Breaking prolonged sitting reduces postprandial glycemia in healthy, normal-weight adults: a randomized crossover trial. Am J Clin Nutr 2013; 98: 358-366
  • 24 Sperlich B, De Clerck I, Zinner C. et al. Prolonged sitting interrupted by 6-min of high-intensity exercise: circulatory, metabolic, hormonal, thermal, cognitive, and perceptual responses. Front Physiol 2018; 9: 1279
  • 25 Takahashi M, Miyashita M, Park JH. et al. Effects of breaking sitting by standing and acute exercise on postprandial oxidative stress. Asian J Sports Med 2015; 6: e24902
  • 26 Thosar SS, Bielko SL, Mather KJ. et al. Effect of prolonged sitting and breaks in sitting time on endothelial function. Med Sci Sports Exerc 2015; 47: 843-849
  • 27 Benatti FB, Larsen SA, Kofoed K. et al. Intermittent standing but not a moderate exercise bout reduces postprandial glycemia. Med Sci Sports Exerc 2017; 49: 2305-2314
  • 28 Bhammar DM, Sawyer BJ, Tucker WJ. et al. Breaks in sitting time: effects on continuously monitored glucose and blood pressure. Med Sci Sports Exerc 2017; 49: 2119-2130
  • 29 Climie RE, Wheeler MJ, Grace M. et al. Simple intermittent resistance activity mitigates the detrimental effect of prolonged unbroken sitting on arterial function in overweight and obese adults. J Appl Physiol (1985) 2018; 125: 1787-1794
  • 30 Howard BJ, Fraser SF, Sethi P. et al. Impact on hemostatic parameters of interrupting sitting with intermittent activity. Med Sci Sports Exerc 2013; 45: 1285-1291
  • 31 Kruse NT, Hughes WE, Benzo RM. et al. Workplace strategies to prevent sitting-induced endothelial dysfunction. Med Sci Sports Exerc 2018; 50: 801-808
  • 32 Wennberg P, Boraxbekk C-J, Wheeler M. et al. Acute effects of breaking up prolonged sitting on fatigue and cognition: A pilot study. BMJ Open 2016; 6: e009630
  • 33 Wheeler MJ, Dunstan DW, Smith B. et al. Morning exercise mitigates the impact of prolonged sitting on cerebral blood flow in older adults. J Appl Physiol (1985) 2019; 126: 1049-1055
  • 34 Wheeler MJ, Dunstan DW, Ellis KA. et al. Effect of morning exercise with or without breaks in prolonged sitting on blood pressure in older overweight/obese adults. Hypertension 2019; 73: 859-867
  • 35 Zeigler ZS, Mullane SL, Crespo NC. et al. Effects of standing and light-intensity activity on ambulatory blood pressure. Med Sci Sports Exerc 2016; 48: 175-181
  • 36 Freire YA, Macedo GAD, Browne RAV. et al. Effect of breaks in prolonged sitting or low-volume high-intensity interval exercise on markers of metabolic syndrome in adults with excess body fat: a crossover trial. J Phys Act Health 2019; 16: 727-735
  • 37 Miyashita M. Effects of continuous versus accumulated activity patterns on postprandial triacylglycerol concentrations in obese men. Int J Obes (Lond) 2008; 32: 1271-1278
  • 38 Miyashita M, Burns SF, Stensel DJ. Accumulating short bouts of running reduces resting blood pressure in young normotensive/pre-hypertensive men. J Sports Sci 2011; 29: 1473-1482
  • 39 Zeigler ZS, Swan PD, Bhammar DM. et al. Walking workstation use reduces ambulatory blood pressure in adults with prehypertension. J Phys Act Health 2015; 12: S119-S127
  • 40 Perdomo SJ, Gibbs BB, Kowalsky RJ. et al. Effects of alternating standing and sitting compared to prolonged sitting on cerebrovascular hemodynamics. Sport Sci Health 2019; 15: 375-383
  • 41 Dempsey PC, Sacre JW, Larsen RN. et al. Interrupting prolonged sitting with brief bouts of light walking or simple resistance activities reduces resting blood pressure and plasma noradrenaline in type 2 diabetes. J Hypertens 2016; 34: 2376-2382
  • 42 Kerr J, Crist K, Vital DG. et al. Acute glucoregulatory and vascular outcomes of three strategies for interrupting prolonged sitting time in postmenopausal women: A pilot, laboratory-based, randomized, controlled, 4-condition, 4-period crossover trial. PLoS One 2017; 12: e0188544
  • 43 Kashiwabara K, Kidokoro T, Yanaoka T. et al. Different patterns of walking and postprandial triglycerides in older women. Med Sci Sports Exerc 2018; 50: 79-87
  • 44 English C, Janssen H, Crowfoot G. et al. Frequent, short bouts of light-intensity exercises while standing decreases systolic blood pressure: Breaking Up Sitting Time after Stroke (BUST-Stroke) trial. Int J Stroke 2018; 13: 932-940
  • 45 Kowalsky RJ, Jakicic JP, Hergenroeder A. et al. Acute cardiometabolic effects of interrupting sitting with resistance exercise breaks. Appl Physiol Nutr Metab 2019; 44: 1025-1032
  • 46 Miyashita M, Burns S, Stensel D. Accumulating Short bouts of running exercise throughout the day reduces postprandial plasma triacylglycerol concentrations and resting blood pressure in healthy young men. J Phys Act Health 2006; 3: 112-123
  • 47 Dunning JR, McVeigh JA, Goble D. et al. The effect of interrupting sedentary behavior on the cardiometabolic health of adults with sedentary occupations: A pilot study. J Occup Environ Med 2018; 60: 760-767
  • 48 Healy GN, Winkler EAH, Eakin EG. et al. A cluster RCT to reduce workers' sitting time: impact on cardiometabolic biomarkers. Med Sci Sports Exerc 2017; 49: 2032-2039
  • 49 Koepp GA, Manohar CU, McCrady-Spitzer SK. et al. Treadmill desks: A 1-year prospective trial. Obesity (Silver Spring) 2013; 21: 705-711
  • 50 Puig-Ribera A, Bort-Roig J, Gonzalez-Suarez AM. et al. Patterns of impact resulting from a 'sit less, move more' web-based program in sedentary office employees. PLoS One 2015; 10: e0122474
  • 51 Winkler EAH, Chastin S, Eakin EG. et al. Cardiometabolic impact of changing sitting, standing, and stepping in the workplace. Med Sci Sports Exerc 2018; 50: 516-524
  • 52 Mainsbridge CP, Cooley PD, Fraser SP. et al. The effect of an e-health intervention designed to reduce prolonged occupational sitting on mean arterial pressure. J Occup Environ Med 2014; 56: 1189-1194
  • 53 John D, Thompson DL, Raynor H. et al. Treadmill workstations: a worksite physical activity intervention in overweight and obese office workers. J Phys Act Health 2011; 8: 1034-1043
  • 54 Kozey Keadle S, Lyden K, Staudenmayer J. et al. The independent and combined effects of exercise training and reducing sedentary behavior on cardiometabolic risk factors. Appl Physiol Nutr Metab 2014; 39: 770-780
  • 55 Thomsen T, Aadahl M, Beyer N. et al. The efficacy of motivational counselling and SMS reminders on daily sitting time in patients with rheumatoid arthritis: a randomised controlled trial. Ann Rheum Dis 2017; 76: 1603-1606
  • 56 Mainsbridge C, Ahuja K, Williams A. et al. Blood pressure response to interrupting workplace sitting time with non-exercise physical activity: results of a 12-month cohort study. J Occup Environ Med 2018; 60: 769-774
  • 57 Bruno RM, Ghiadoni L, Seravalle G. et al. Sympathetic regulation of vascular function in health and disease. Front Physiol 2012; 3: 284
  • 58 Latouche C, Jowett JB, Carey AL. et al. Effects of breaking up prolonged sitting on skeletal muscle gene expression. J Appl Physiol (1985) 2013; 114: 453-460
  • 59 Padilla J, Fadel PJ. Prolonged sitting leg vasculopathy: contributing factors and clinical implications. Am J Physiol Heart Circ Physiol Heart Circ Physiol 2017; 313: H722-H728