Adult Sedentary Behavior

A Systematic Review
Ryan E. Rhodes, PhD, Rachel S. Mark, MA, Cara P. Temmel, BSc

Context: While the health benefıts of meeting moderate/vigorous-intensity physical activity

(MVPA) guidelines have been well established, the health risks of sedentary behavior, independent of
meeting MVPA guidelines, are becoming evident. Sedentary behavior may require different inter-
ventions, based on correlates that differ from MVPA. The current review aimed to collect and
appraise the current literature on correlates of sedentary behaviors among adults.
Evidence acquisition: Papers were considered eligible if they were published in English-language
peer-reviewed journals and examined correlates of sedentary behaviors. Literature searches were
conducted in August 2011 among ten search engines yielding 3691 potentially relevant records; of
these, 109 papers (82 independent samples) passed eligibility criteria.

Evidence synthesis: Articles included were published between 1982 and 2011, with sample sizes
ranging from 39 to 123,216. Eighty-three were cross-sectional, 24 followed a prospective design, one
was experimental baseline data, and one was cohort design. Sedentary behavior was primarily
measured as TV viewing or computer use, followed by analysis of a more omnibus assessment of time
spent sitting. Evidence was present for sedentary behavior and correlates of education, age, employ-
ment status, gender, BMI, income, smoking status, MVPA, attitudes, and depressive symptoms/
quality of life. Notable differences by specifıc sedentary behaviors were present that aided in the
explanation of fındings.

Conclusions: Results point to the high specifıcity of various sedentary behaviors (e.g., TV viewing
vs sitting and socializing), suggesting that the research domain is complex and cannot be considered
the simple absence of MVPA. Several sociodemographic and health factors appear reliably linked to
sedentary behavior, yet there is an obvious absence of research focused on cognitive, social, and
environmental factors that could be of use in anti–sedentary behavior interventions.
(Am J Prev Med 2012;42(3):e3– e28) © 2012 Published by Elsevier Inc. on behalf of American Journal of
Preventive Medicine

Context A more recent research literature,6 – 8 however, is be-

ginning to evaluate the deleterious health effects of sus-

T
he health benefıts of regular moderate to vigorous
intensity physical activity (MVPA) continue to
accumulate as the research in this domain
grows.1,2 Indeed, regular physical activity is associated
with the reduction of more than 25 chronic diseases,
including all-cause mortality, heart disease, hyperten-
sion, stroke, type II diabetes, and certain forms of cancer.3
With this overwhelming evidence, most nations have
formal position stands that recommend at least 150 min-
utes of regular MVPA per week.4,5
From the Behavioural Medicine Laboratory, University of Victoria, Victo-
ria, British Columbia, Canada
Address correspondence to: Ryan E. Rhodes, PhD, School of Exercise
Science, Physical and Health Education, Behavioural Medicine Laboratory,
Faculty of Education, University of Victoria, P.O. Box 3015 STN CSC,
Victoria BC, V8W 3P1, Canada. E-mail: rhodes@uvic.ca.
0749-3797/$36.00
doi: 10.1016/j.amepre.2011.10.020
tained sedentary behavior. While initially viewed simply
as the low end of the physical activity continuum, a spe-
cifıc study of sedentary behaviors (e.g., sitting, TV view-
ing, reading, computer use) has been recommended.9 –11
This research12,13 is focused on behaviors between the
absence of movement and light-intensity physical activity
(i.e., ⬍1.5 METs). Given the initial evidence for the health
risk of sedentary behavior, it stands to reason that posi-
tioning around recommendations for time allotted to
uninterrupted sitting would be warranted. Thus, some
government position stands now include recommenda-
tions for a maximum amount of sedentary behavior time
per day.14
With these guidelines and health evidence now a part
of the extant literature, it seems a worthy endeavor to
understand the correlates of sedentary behavior and tar-
get these in intervention efforts much like the approach

© 2012 Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine Am J Prev Med 2012;42(3):e3– e28 e3
e4 Rhodes et al / Am J Prev Med 2012;42(3):e3– e28
taken in MVPA promotion campaigns.5 In comparison
to physical activity, however, the study of sedentary be-
haviors has received little attention. Research on the cor-
relates of sedentary behaviors has been predominantly
focused on children15; less work has focused on adults
despite the evidence of considerable time spent in seden-
tary leisure pursuits.16
Therefore, the purpose of the current study was to
collect, theme, appraise, and review the existing liter-
ature that has focused on the correlates of sedentary
behavior among adults. Correlates were grouped into
several broad categories based on the social ecologic
model17 for the purpose of analysis: fıxed sociodemo-
graphic variables (e.g., age, gender, and ethnicity); cog-
nitive variables (e.g., goal orientation, intention);
behavioral variables (e.g., smoking, MVPA); social
variables (e.g., modeling, child/peer/spouse); and
physical environment variables (e.g., neighborhood).
Evidence Acquisition
Inclusion Criteria
Studies featuring a correlate or correlates of sedentary behavior
were included within this review. Papers had to be from peer-
reviewed, English-language journals.
Exclusion Criteria
Exclusion criteria for this review were pre-established by all three
authors. Studies were excluded if they (1) examined child, adolescent,
or clinical populations; (2) did not include an expression of at least one
variable and its relationship to a sedentary behavior; (3) did not in-
clude a measure of sedentary behavior that was independent from
physical activity; or (4) were tests of reliability and validity of sedentary
measurement tools/tool development.
Search Strategy
Database searches were performed in August 2011. Online da-
tabases used were ISI Web of Knowledge, as well as the following
EBSCO databases: CINAHL with Full Text, Show allHealth
Source - Consumer Edition, Health Source: Nursing/Academic
Edition, Health Technology Assessments, MEDLINE with Full Text,
PsycARTICLES, PsycCRITIQUES, PsycINFO, and SPORTDiscus.
All of the EBSCO database searches were performed simultaneously to
avoid the number of duplicate records obtained. The initial search was
performed by one author. A combination of keywords was used in-
cluding sedentary behavior, physical inactivity, leisure time behavior,
inactivity, occupation, driving, screen time, television, video games,
computer, sitting, and adult. The search was not restricted by publica-
tion date or study design. Manual cross-referencing of reference lists
was also completed to ensure the saturation of the literature search
(Appendix A).
Screening
All citations found from the fınal cumulative literature search were
screened by two reviewers using the predetermined inclusion criteria.
Studies were initially screened based on title and abstract. Relevant
abstracts were shortlisted and selected for a full read of the article.
Articles potentially meeting the inclusion criteria were examined by
three reviewers. It was then determined whether the study met the
inclusion criteria and could be included in the review. Consensus was
reached in 100% of the cases.
Study Quality Assessment
Risk of bias/study quality for all studies was assessed using a check-
list tool developed specifıcally for this review. The tool was based
on the Cochrane Collaboration’s instrument for assessing risk of
bias.18 The instrument included seven questions answered with a
yes (1) or a no (0) (e.g., Was an objective measure of sedentary
behavior used? Were the measures of sedentary behaviors reliable?).
Low risk of bias/high quality was considered with a score of 5 to 7,
moderate quality and bias was considered with scores of 2 to 4, and low
quality and high risk of bias was considered with scores of 0 to 1
(Appendix B).
Data Abstraction and Analysis
An eight-item data abstraction form that included authors, year of
publication, study design, participants, correlates measured, mea-
sure of sedentary behavior, general fındings, and quality of the
study was used. Following initial scans of the fındings, themes
and subthemes were developed. Findings present in more than
three independent studies were considered a theme (e.g., at least
three studies were needed to examine sedentary behavior and
education to create an education theme). Correlates were eval-
uated by signifıcance within the study and then by meeting the
minimum magnitude of a small effect size (e.g., d ⬎0.19).19
Themes were evaluated with the criteria used previously by Sallis
and colleagues.20 Specifıcally, positive or negative association was
conferred if ⬎59% of studies supported this fınding, respectively;
an indeterminate assessment was given if 34%–59% of studies
showed an association, and a null result was provided when ⬍34%
of studies showed any association. A meta-analysis of fındings was
considered early in the process, but this was deemed inappropriate
because of the extreme heterogeneity of the measures employed,
and the diverse cut-off criteria used in the sedentary behavior
measures. When outcome variables are this discrepant, the effect
sizes can be misleading in meta-analysis.21
Evidence Synthesis
The process for undergoing the literature search and
screening, including number of papers excluded and
the reasons for exclusion can be found in Figure 1.
Briefly, initial database searches and manual reference
checks yielded 3691 potentially relevant articles. Of
these, 3582 were excluded throughout the screening
process (Figure 1). Overall, 109 papers examining 82
samples passed the eligibility criteria to be included in
the review22–129 (Table 1).
Study Characteristics
Of the 109 samples included in this review, 25 were
considered high-quality/low risk of bias, and 84 were
considered to be of moderate quality. No studies in-
cluded were considered to be low-quality/high risk of
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 Rhodes et al / Am J Prev Med 2012;42(3):e3– e28
Figure 1. Flow diagram for the literature search
bias. Papers included in this review were published
between 1982 and 2011. Overall, the 82 independent
samples represented a total of 724,478 participants
with sample sizes ranging from 39 to 123,216. The ages
of participants ranged between 18 and 91 years. The
majority of samples were North American participants
(n⫽47), whereas the remainder originated from South
America (n⫽2); Europe (n⫽17); Australia/New Zea-
land (n⫽12); Asia (n⫽3); and multicontinental (n⫽1).
Of the 109 papers included, 83 were cross-sectional, 24
followed a prospective design, one was experimental
baseline data, and one was cohort design.
Demographics
Age. Thirty-one samples24,30,32,41,42,44,47,51,54,60,62,63,65,
66,70,76,77,81,88,95,97,98,103,104,112,115,116,120 –122,126 included
an age variable as a correlate of sedentary behavior. These
were a mix of cross-sectional (n⫽23) and prospective
(n⫽8) data sets representing Australia, Spain, France,
Canada, Taiwan, Belgium, Scotland, a collection of EU
countries, India, and the U.S. Overall, 17 of these 31
samples supported a relationship between higher values
of sedentary behavior and age. More specifıc relation-
ships, however, were present by the type of sedentary
behavior assessed. Specifıcally, 20 studies24,32,41,42,
44,47,51,54,63,66,70,77,81,88,97,98,104,116,120,121 assessed TV
viewing behavior. Of these, 1132,51,54,66,70,77,81,97,104,
116,121 found support for a relationship between higher
age and corresponding higher hours of TV viewing, and
two studies24,47 found support for this relationship only
for women.
Research focused on computer use, however, had sup-
porting evidence that young adults used computers more
than middle-aged or older adults in three32,60,121 of fıve
studies.44,47 Three studies62,75,112 evaluated age as a cor-
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relate of screen viewing (composite of both TV viewing
and computer or video game use). In this case, Oppert et
al.112 showed no relationship among women but a nega-
tive relationship among men. By contrast, Stamatkis and
colleagues75 showed a small positive relationship and
Banks showed a signifıcant result with a trivial effect
size.62
Three studies47,112,121 measured reading behavior and
age, and these results showed two null effects and one
positive relationship between reading and older age.121
Finally, ten studies assessed sedentary behavior with a
generalized sitting assessment via self-report30,46,47,65,
44,122,126
95,103,115 or accelerometry. Again, the results
were mixed, with fıve null effects, three negative correla-
tions, and two positive correlations with age. The results
could not be differentiated by the type of measures or
designs employed. Overall, the results suggest that age
may be positively related to TV viewing, negatively cor-
related with computer use, unrelated to reading, and ex-
tremely mixed for generalized screen viewing and sitting
(Table 2).
Education. Twenty-four data sets22,24,32,47,52,54,60,63,64,66,
70,75,77,88,97,98,103,104,109,115,116,120,121,126 reported an edu-
cation variable and its relationship with sedentary behav-
ior. Higher levels of TV viewing were associated with
lower values of formal education in 1424,47,54,63,64,66,70,
75,77,97,98,109,116,120,121 of 18 studies. However, the four
studies32,60,78,121 that examined computer use found it
was positively correlated with years of education. Gener-
alized sitting behavior was found to be unrelated to
education in four studies22,47,103,121 and positively re-
lated in two studies.115,126 No differences in these fınd-
ings were identifıed by design or measurement. Taken
together, the results suggest that higher hours of TV
viewing may have a negative association with educa-
tion whereas there may be a positive association be-
tween education and computer use and no association
with general sitting time.
Employment. Twenty-two studies24,30,32,36,40,47,53,62,63,
66,67,75,77,81,91,97,115,116,120,122,126,127 reported on the rela-
tionship between employment status and sedentary be-
havior. The measurement of employment status, how-
ever, differed across the studies. Twenty studies
compared employment status to unemployment status.
Of these, 1424,32,36,40,47,63,66,77,81,97,116,120,121,127 of 1550
studies on TV viewing supported a positive relationship
between unemployment/retirement and higher viewing.
Further, the most convincing evidence came from a
French prospective study77 that tracked the entry into
retirement over 3 years and the subsequent changes in TV
viewing behavior. The results showed that retirees were
twice as likely to be engaging in prolonged TV viewing
 e6
Table 1. Data extraction table for studies used in review

Significant findings,
Research Measure of sedentary associations, and effect Study
Study design Participants, n Correlates behavior sizes quality/7

AusDiab Cross-sectional 11,247 1. Age Questionnaire TV and increased age 4–5

Cameron (2003)21 (prospective 2. Education TV (women only); lower
Clark (2010)22 for Wijndaele 3. Employment education, being single
Dunstan (2010)24 et al.) 4. Income (men); unemployment;
Healy (2008)25 5. Gender smoking; and higher BMI
Lynch (2010)27 6. BMI
Wijndaele (2010)32 7. Leisure-time physical activity
8. Smoking status
9. Alcohol consumption
10. Eating behavior

Rhodes et al / Am J Prev Med 2012;42(3):e3– e28

11. Marital status
Australian Longitudinal Prospective 8,233 1. BMI Questionnaire None across time 4–5
Study on Women’s Sitting
Health
De Cocker (2010)23
Van Uffelen (2010)31
Canadian Community Cross-sectional 57,367 (TV) 1. Age Questionnaire TV and higher age, higher 4
Health Survey 57,617 2. Education TV BMI, unemployment, and
Shields (2008 a,b)29,30 (computer) 3. Employment Computer higher income
4. Gender Computer use and lower age,
5. Income higher education,
6. Marital status unemployment, being
7. Urban–rural single, gender (increased
8. BMI use and being male)
Colorectal Cancer and Prospective 1,867 1. BMI Questionnaire Small effect of TV viewing on 5
Quality of Life Study 2. Well-being TV increased BMI and lower
Lynch (2011)26 well-being over time
Wijindaele (2009)33
CPS II Nutrition Cohort Prospective 18,583 1. Age Questionnaire Sitting and unemployment, 4–5
Blanck (2007)20 women 2. Employment Non-occupational and decreased leisure-time
Patel (2010)28 53,440 men 3. Gender sitting physical activity
4. BMI
5. Ethnicity
6. Alcohol consumption
7. Leisure-time physical activity
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8. Eating behavior
9. Education
10. Smoking
11. Occupational physical activity
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Table 1. (continued)

Significant findings,
Research Measure of sedentary associations, and effect Study
Study design Participants, n Correlates behavior sizes quality/7

EPIC Norfolk Study Cross-sectional 14,189 1. Gender Questionnaire TV and increased BMI, 4–5
Jakes (2003)41 Prospective 2. BMI TV higher age, lower
Wijindaele, (2011)52 3. Age education, smoking, lower
4. Education physical activity; lower
5. Smoking alcohol consumption in
6. Alcohol consumption women
7. Eating behavior
8. Sleep
9. Total physical activity

Rhodes et al / Am J Prev Med 2012;42(3):e3– e28

Flemish Policy Research Centre Cross-sectional 1,440 1. Gender Questionnaire Screen viewing and being 4
Sport, Physical Activity and 2. BMI Screen viewing male, and high BMI
Health Study
Duvigneaud (2008)36
Wijindaele (2009)53
Health Examination Program by Cross-sectional 8,885 1. Age Questionnaire TV and increased age, 3–4
Health Advancement 2. Education TV higher BMI, and lower
Services 3. Employment physical activity
Tucker (1990)48 4. BMI
Tucker (1993)49 5. Smoking
Tucker (1991)50 6. Leisure-time physical activity
Tucker (1989)51 7. Gender
Health Professionals Follow-Up Prospective 19,478 1. Age Questionnaire TV and smoking, decreased 4–5
Study 2. BMI TV physical activity, and
Coakley (1998)35 3. Smoking increased caloric
Hu (2001)39 4. Alcohol consumption consumption
5. Leisure-time physical activity
6. Eating behavior
NHANES Cross-sectional 18,825 1. Age Questionnaire Total sedentary time and 3–4
Clark (2011)34 2. Ethnicity Sitting increased age, and being
Ford (2010)37 3. BMI TV unemployed
Matthews (2008)42 4. Gender Computer Mexicans were less
McDowell (2006)43 5. Employment Accelerometer sedentary than blacks or
6. Eating behavior Total sedentary time whites.
TV viewing had an
association with higher
BMI, and being
unemployed.
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Table 1. Data extraction table for studies used in review (continued)

Significant findings,
Research Measure of sedentary associations, and effect Study
Study design Participants, n Correlates behavior sizes quality/7

Nurses’ Health Study Prospective 68,497 (diabetes 1. Age Questionnaire Higher TV viewing and lower 4
Granner (2010)38 analysis) 2. BMI TV perceived health, being
Hu (2003)40 50,277 (obesity 3. Smoking unemployed, and higher
analysis) 4. Alcohol consumption depression and anxiety
5. Leisure-time physical
activity
6. Eating behavior
7. Self-reported health
8. Depressive symptoms

Rhodes et al / Am J Prev Med 2012;42(3):e3– e28

9. Anxiety symptoms
10. Employment status
11. Ethnicity
PLACE Study Cross-sectional 1,048 1. Age Questionnaire TV and increased age 4
Proper (2007)44 2. Education Computer (women only); lower
Sugiyama (2008)45 3. Employment Video games education; lower
Sugiyama (2008)46 4. Gender Reading employment; no children
Sugiyama (2007)47 5. BMI Sitting with friends or in the home; higher BMI;
Vandelanotte (2009)76 6. Income listening to music and lower physical
7. Total physical activity Talking on the phone activity (women only)
8. Environmental TV Sitting was associated with
walkability Driving/riding in a car decreased age, lower
9. Neighborhood SES hours of work
10. Marital status Computer use was
11. Children in the home associated with higher
education, lower
employment, being male,
and higher BMI
Scottish Health Study Cross-sectional 7,940 1. Age Questionnaire Screen time and increased 3–4
Hamer (2010)70 2. Education Screen time age, lower education,
Stamatakis (2009)73 3. Employment manual labor, higher BMI,
Stamatakis (2009)74 4. Gender being single, higher
Stamatakis (2011)72 5. BMI smoking status, not
6. Smoking owning a car, less work-
7. Alcohol consumption time physical activity,
8. Leisure-time MVPA psychological distress,
9. Ethnicity and lower physical activity
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10. Marital status

11. Psychological distress
12. Work physical activity
13. Car ownership
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Table 1. (continued)

Significant findings,
Research Measure of sedentary associations, and effect Study
Study design Participants, n Correlates behavior sizes quality/7

SUN Cohort Prospective 10,381 1. Gender Questionnaire Correlations between 4–5

Beunza (2007)63 2. Age Composite of many sedentary behavior and
Sanchez-Villegas (2008)71 3. BMI sedentary behaviors being male, being
4. Leisure-time physical activity younger, and higher
5. Alcohol consumption alcohol consumption

Rhodes et al / Am J Prev Med 2012;42(3):e3– e28

6. Smoking
7. Depression incidence
8. Anxiety incidence
SU.VI.MAX Cross-sectional 4,682 1. Gender Questionnaire TV and higher BMI (women 4
Charreire (2010)69 2. BMI TV only); unemployment; and
Touvier (2010)75 3. Employment lower physical activity
4. Leisure-time physical activity (women only)
Aadah (2007)54 Cross sectional 1,693 1. BMI Questionnaire Association of higher BMI 4
TV and higher TV viewing
Anand (2007)55 Cross-sectional 245 1. Academic achievement Questionnaire Association of high video 2
2. Gender Video games game play, being male,
and lower academic
achievement
Anderson (1996)56 Cross-sectional 491 1. Gender Questionnaire Higher TV viewing for women 5
2. Stress TV
Anuradha (2011)57 Cross-sectional 5,893 1. Ethnicity Questionnaire Association of TV viewing 4
TV and being black compared
to other ethnicities
Assael (2005)58 Cross-sectional 5,140 1. Age Questionnaire Computer use and 3
2. Education Internet decreased age, increased
3. Gender education, non-Mexican
4. Ethnicity ethnicity, higher
5. Income education, and increased
6. Cognitions attitudes about computers
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Table 1. Data extraction table for studies used in review (continued)

Significant findings,
Research Measure of sedentary associations, and effect Study
Study design Participants, n Correlates behavior sizes quality/7

Ballard (2009)59 Cross-sectional 116 1. BMI Questionnaire Video games and higher 4
2. Total physical activity Video games BMI and lower physical
activity
Banks (2010)60 Cross-sectional 91,266 1. Gender Questionnaire Association effect of 4
2. Urban–rural Screen time screen time and urban
3. Income resident, higher BMI,
4. Employment and lower physical
5. Smoking activity

Rhodes et al / Am J Prev Med 2012;42(3):e3– e28

6. Age
7. BMI
8. Alcohol consumption
9. Total MVPA
Bennett (2006)61 Cross-sectional 486 1. Age Questionnaire TV and lower education, 4
2. Education TV unemployment, being
3. Employment male, being black over
4. Gender other ethnicities, and
5. BMI less physical activity
6. Ethnicity
7. Total physical activity
Berry (2007)62 Cross-sectional Not provided 1. Education Questionnaire Association of TV viewing 3
TV and lower education
Bowman (2006)64 Cross-sectional 9,157 1. Age Questionnaire TV and increased age, 4
2. Education TV lower education,
3. Employment unemployment, higher
4. Gender BMI, being black
5. BMI compared to other
6. Ethnicity ethnicities, lower
7. Income income, and higher
8. Eating behavior caloric intake
9. Urban/rural
Brown (2003)65 Cross-sectional 714 1. Occupational status Questionnaire More sitting was reported 4
2. Gender Sitting among full-time workers
3. BMI compared to part-time
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or homemakers, and
men reported more
sitting than women.
(continued on next page)
March 2012

Table 1. (continued)

Significant findings,
Research Measure of sedentary associations, and effect Study
Study design Participants, n Correlates behavior sizes quality/7

Buckworth (2004)66 Cross-sectional 493 1. Gender Questionnaire TV and being male as well 3
2. Leisure-time physical activity TV as lower physical activity
Studying Computer use and being
Computer male
Burazeri (2008)67 Cross-sectional 1,088 1. Leisure-time physical activity Interviews Association of TV viewing 4
TV with lower physical activity
Chang (2008)68 Cross-sectional 2,353 1. Age Questionnaire Associations/effects of TV 4
2. Education TV viewing and higher age,

Rhodes et al / Am J Prev Med 2012;42(3):e3– e28

3. Marital status lower education, lower
4. Income income, smoking, and
5. Smoking higher BMI
6. Alcohol consumption
7. Leisure-time physical
activity
8. Occupational activity
9. Gender
10. BMI
Crawford (1999)69 Prospective 873 1. Body composition Questionnaire TV and lower income 6
2. Income TV
Depp (2010)79 Cross-sectional 3,982 1. Age Telephone Associations of TV viewing 3
2. Employment questionnaire with higher age,
3. Gender TV unemployment, being
4. Income male, lower income, being
5. Marital status single, and being less
6. Ethnicity happy
7. Happiness
De Wit (2011)78 Cross-sectional 2,353 1. Anxiety Questionnaire Association of TV viewing 4
2. Depression TV and higher depression
3. Total MVPA Computer
Dunton (2009)80 Cross-sectional 21,475 1. BMI Questionnaire Association of computer use 4
TV with increased BMI
Interview
TV
Computer use
Playing games
Reading
Transportation
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Table 1. Data extraction table for studies used in review (continued)

Significant findings,
Research Measure of sedentary associations, and effect Study
Study design Participants, n Correlates behavior sizes quality/7

Ekelund (2008)81 Prospective 393 1. BMI Heart rate monitor Prediction of sedentary 5
Sedentary time time via BMI
Ellison (1982)82 Cross-sectional 99 1. Loneliness Questionnaire None 3
TV
Fitzgerald (1997)83 Cross-sectional 2,452 1. Gender Questionnaire None 5
2. BMI TV
3. Total physical activity
Frey (2007)85 Cross-sectional 42,021 1. Life satisfaction Questionnaire Associations of higher TV 4

Rhodes et al / Am J Prev Med 2012;42(3):e3– e28

TV viewing and lower life
satisfaction
Fountaine (2011)84 Cross-sectional 736 1. Gender Questionnaire Associations of TV 4
2. Leisure-time physical activity TV viewing and screen
Screen time time with being male
Higher screen time was
associated with lower
physical activity.
Gao (2007)86 Cross-sectional 455 1. Age Questionnaire Associations of TV 3
2. Gender TV viewing and lower
3. BMI physical activity and
4. Education being married
5. Smoking
6. Alcohol consumption
7. Marital status
8. Total physical activity
9. Eating behavior
Gordon (2007)87 Cross-sectional 312 1. Gender Questionnaire Associations of Internet 2
2. Depression Internet use and being male
3. Loneliness
Jacoby (2003)88 Cross-sectional 1,176 families 1. Income Questionnaire None 4
2. BMI TV
Jans (2007)89 Cross-sectional 7,720 1. Employment Questionnaire None 4
Sitting
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Jeffrey (1998)90 Prospective 1,059 1. Gender Questionnaire Higher TV viewing 5

2. Eating behavior TV associated with higher
3. Leisure-time physical activity caloric intake, lower
4. BMI income, and BMI in
5. Income women
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Table 1. (continued)

Significant findings,
Research Measure of sedentary associations, and effect Study
Study design Participants, n Correlates behavior sizes quality/7

Jeffrey (1998)90 Cross-sectional 39 1. Location of TV Electronic recorder Higher TV viewing when the 4
TV TV is in the bedroom
Kaleta (2007)92 Cross-sectional 954 1. Leisure-time physical activity Questionnaire Association of TV viewing 4
TV and lower physical activity
Katzmarzyk (2009)93 Prospective 17,013 1. Age Questionnaire Association of sitting with 5
2. Leisure-time MVPA Sitting low MVPA
3. BMI

Rhodes et al / Am J Prev Med 2012;42(3):e3– e28

4. Smoking behavior
5. Alcohol consumption
Kayany (2000)94 Cross-sectional 185 1. Gender Questionnaire Associations for online use 3
Online computer use and being male
King (2010)95 Cross-sectional 5,556 1. Age Questionnaire TV and increased age, lower 4
2. Education TV education, unemployment,
3. Employment higher BMI, being black,
4. BMI having no children in the
4. Ethnicity home, being single, lower
5. Income income, and higher
6. Smoking depressive symptoms
7. Alcohol consumption
8. Leisure-time physical
activity
9. Depression
10. Gender
11. Marital status
12. Children in the home
13. Non-leisure-time physical
activity
King (2010)95 Prospective 14,449 1. Age Questionnaire Associations of TV viewing 5
2. BMI TV and lower education,
3. Eating behavior higher BMI, higher caloric
4. Education intake, smoking, lower
5. Income alcohol consumption, and
6. Marital status low physical activity
7. Smoking behavior
8. Alcohol consumption
9. Total MVPA
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 Table 1. Data extraction table for studies used in review (continued)

e14
Significant findings,
Research Measure of sedentary associations, and effect Study
Study design Participants, n Correlates behavior sizes quality/7

Kronenberg (2000)97 Cross-sectional 1,778 1. Gender Questionnaire TV and increased age, 4

2. BMI TV lower education,
3. Leisure-time physical activity unemployment, higher
BMI, being black, lower
income, and higher
depressive symptoms
Landhuis (2008)98 Prospective 1,037 1. BMI Questionnaire Association of TV viewing 5
TV and higher BMI
Lee (2003)99 Prospective 103 1. Gender Questionnaire None 5
Sitting activities

Rhodes et al / Am J Prev Med 2012;42(3):e3– e28

TV
Reading
Lindstrom (2005)100 Cohort 466 1. Gender Questionnaire None 5
TV
Martinez-Gonzalez (1999)101 Cross-sectional 15,239 1. Age Questionnaire None 5
2. Education Sitting time
3. BMI
4. Income
5. Smoking
6. Leisure-time physical activity
McCarthy (1993)102 Cross-sectional 531 1. Age Questionnaire Associations of TV viewing 3
2. Education TV and increasing age, and
3. Income lower income
4. Contentedness
McCormack (2004)103 Cross-sectional 1,803 1. Total physical activity Interviews Association of vigorous 4
TV physical activity only and
lower TV viewing hours
McCreary (1999)104 Prospective 341 1. Gender Questionnaire None 3
TV
Meier (2007)105 Experimental 185 1. Gender Logs None 5
2. Total physical activity Screen time
Nelson (2007)106 Cross-sectional 24,613 1. Gender Questionnaire Higher TV viewing among 4
2. Ethnicity TV African Americans
www.ajpmonline.org

3. BMI compared to other

ethnicities, and higher
BMI
Ogletree (2007)108 Cross-sectional 206 1. Gender Questionnaire Video game playing higher 3
Video games for men than women
(continued on next page)
March 2012

Table 1. (continued)

Significant findings,
Research Measure of sedentary associations, and effect Study
Study design Participants, n Correlates behavior sizes quality/7

O’Guinn (1997)107 Cross-sectional 785 1. Education Questionnaire Association of TV viewing 4

2. Income TV and lower education and
income
Oken (2006)109 Prospective 1,805 1. Total physical activity Questionnaire Association between TV 5
TV viewing and less vigorous
physical activity
Oppert (2006)110 Cross-sectional 405 1. Age Questionnaire Screen viewing and 3
2. Gender Screen viewing decreased age (men

Rhodes et al / Am J Prev Med 2012;42(3):e3– e28

3. Body composition Reading only); increased body fat
4. Leisure-time physical activity (women only); and
5. Occupational physical decreased physical
activity activity (women only)
Reading and higher leisure-
time physical activity
(women only); and lower
occupational physical
activity
Padilla-Walker (2010)111 Cross-sectional 813 1. Gender Questionnaire Association of higher video 4
2. Ethnicity Internet game playing and being
3. Alcohol consumption Video games male and higher alcohol
4. Self-esteem consumption
Internet use associated
with being African
American compared to
other ethnicities and
lower self-esteem
Polley (2005)112 Cross-sectional 84 1. Ethnicity Questionnaire None 3
TV
Rastogi (2004)113 Cross-sectional 960 1. Age Questionnaire Associations of sitting and 4
2. BMI Sitting increased age; higher
3. Alcohol consumption education; higher
4. Leisure-time physical activity occupational status
5. Gender (nonmanual labor); lower
6. Education work activity; and higher
7. Smoking status BMI
8. Occupational status
9. Occupational physical
activity
(continued on next page)

e15
 e16
Table 1. Data extraction table for studies used in review (continued)

Significant findings,
Research Measure of sedentary associations, and effect Study
Study design Participants, n Correlates behavior sizes quality/7

Raynor (2006)114 Prospective 1,422 1. Gender Questionnaire Relationship of high TV 5

2. Ethnicity TV viewing with being
3. Age older, of lower
4. Education education, being
5. Employment status unemployed, being
6. Marital status married, and lower
7. BMI MVPA
8. Total physical activity
9. Eating behavior
Rhodes (2009)—Sample 1115 Cross-sectional 206 1. Cognitions Questionnaire Intention and attitude 3

Rhodes et al / Am J Prev Med 2012;42(3):e3– e28

TV correlated with all
Computer sedentary behaviors
Reading/music Subjective norm
Sedentary socializing correlated with TV,
computer use, and
socializing
Rhodes (2009)—Sample 2115 Prospective 175 1. Cognitions Questionnaire Intention correlated with 4
TV all sedentary behaviors
Computer Attitude correlated with
Reading/music TV viewing and
Sedentary socializing computer use
Richmond (2010)116 Cross-sectional 6,049 1. BMI Questionnaire Associations of TV 5
2. Ethnicity TV viewing and being
black as well as higher
BMI among white
young adult women
Rouse (2010)117 Prospective 84 1. Gender Ecologic TV viewing and 3
2. Leisure-time physical activity Momentary decreased physical
assessment diaries activity (men only)
TV Computer games and
Computer games being male and
Sitting talking decreased physical
activity (men only)
Sitting and talking and
being female
Salmon (2000)118
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Cross-sectional 3,392 1. Age Questionnaire TV viewing and low 4

2. Education TV education,
3. Employment unemployment, higher
4. Gender BMI, and lower
5. BMI physical activity
6. Leisure-time physical activity
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March 2012

Table 1. (continued)

Significant findings,
Research Measure of sedentary associations, and effect Study
Study design Participants, n Correlates behavior sizes quality/7

Salmon (2003)119 Cross-sectional 1,332 1. Age Questionnaire TV viewing and increased 4

2. Education TV age, lower education,
3. Gender Sitting socializing being male, and
4. Cognitions Reading enjoyment
Computer use Socializing and decreased
Telephone age and enjoyment
Reading and increased
age, higher education,

Rhodes et al / Am J Prev Med 2012;42(3):e3– e28

and enjoyment
Computer use and
decreased age, and
higher education
Sanchez (2008)120 Cross-sectional 394 1. Age Accelerometer Sedentary behavior and 4
2. Employment Sedentary time unemployment, no
3. BMI children, physical
4. Ethnicity inactivity, and higher
5. Physical activity depressive symptoms
6. Eating behavior
7. Cognitions
8. Children in the household
Santos (2010)121 Cross-sectional 4,091 1. BMI Questionnaire Association between higher 4
Sitting time sitting time and higher
BMI
Sirgy (1998)122 Cross-sectional 1,226 1. Life satisfaction Questionnaire Small relationship between 3
TV TV viewing and life
dissatisfaction
Teychenne (2010)123 Cross-sectional 3,645 1. Depression Questionnaire Depressive symptoms 4
Computer higher for those who
TV watch more TV and sit
Sitting
Van Dyck (2010)124 Cross-sectional 1,200 1. Neighborhood walkability Accelerometer Association of sitting and 4
2. Gender Total sedentary time higher education, white-
3. Age Questionnaire collar professionals, and
4. Employment status Sitting no children
5. Education
6. Children in the home
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e17
e18 Rhodes et al / Am J Prev Med 2012;42(3):e3– e28

NHANES, National Health and Nutrition Examination Survey; PLACE, Physical Activity in Localities and Community Environments; SUN, Seguimiento University of Navarra; SU.VI.MAX,
AusDiab, Australian Diabetes, Obesity and Lifestyle Study; CPS, Cancer Prevention Study; EPIC, the European Prospective Investigation of Cancer; MVPA, moderate to vigorous physical activity;
compared to those still employed. Of the four studies to
quality/7 evaluate computer use, two32,47 showed a positive rela-
Study

5
tionship with use and unemployment whereas the other
two36,121 were null. Four studies30,36,47,122 examining
general sitting also found positive correlations with
TV viewing and unemployment,
associations, and effect sizes

TV viewing and higher age and

unemployment, but an additional study67 showed a
lower quality of life (men),

A negative relationship with

negative relationship and two others91,121 indicated no
being male, being black,

and a preference for TV

Significant findings,

relationship. Proper et al.46 evaluated the total hours of

physical activity work and leisure-time sitting and found that more

less education
hours of work equated to considerably less sitting dur-
ing leisure time.
Four studies examined the work sector and its potential
viewing

None
impact on sedentary behavior. Jans and colleagues91 found
relatively little difference across sectors in the Dutch work-
force, whereas Stamatakis et al.75 identifıed that manual
labor workers had higher screen viewing and sitting during
Measure of sedentary

leisure time than professionals. By contrast, Rogosti et al.115

and van Dyck126 found manual laborers reported less total
Screen viewing
behavior

Questionnaire

Questionnaire

Questionnaire

Questionnaire

sitting time than professionals. This discrepancy among

studies may be due to the difference between total sitting
Sitting

(i.e., leisure and work) and leisure-time sitting outcomes.

TV

TV

Finally, occupational physical activity was evaluated

as a correlate of sedentary behavior in six stud-
ies.30,70,74,97,112,115 TV and screen viewing showed null
Physical activity cognitions

results in three70,74,97 of four112 studies and general

1. Total physical activity

2. Total physical activity

Physical environment

sitting was negatively associated with high occupa-

tional physical activity in one study115 but not corre-
Correlates

Life satisfaction

Dissatisfaction

lated in the other.30 Overall, the evidence is supportive

Employment

for a positive relationship between unemployment and

Education
Ethnicity

Income

higher hours of TV viewing, but other sedentary be-

Gender
Table 1. Data extraction table for studies used in review (continued)

1. BMI

haviors are less clear. Other indicators of employment,

Age

such as job demands and occupational physical activ-

1.
2.
3.
4.
5.
6.

1.
2.
3.
4.

ity, need sustained research before any decisions can

be rendered though screen viewing may be unrelated
Participants, n

to job-related physical activity.

576

8,353

225

907

Gender. Forty-fıve samples30,32,35,36,43,47,50,55,57,58,60,62,

SUpplementation en VItamines et Mineraux AntioXydants

63, 65–68, 70, 71, 75,81,85,86,88,89,92,96,97,99,101,102,104,106–108,110,112,113,

compared men and women on measures
115,116, 119–121,126,127
of sedentary behavior. These evaluations included 35 cross-
Cross-sectional

Cross-sectional

Cross-sectional

Cross-sectional

sectional surveys, one momentary assessment design, one co-

Research

hort study, and eight prospective designs. The studies also had
design

strong geographic representation including England, Scotland,

Spain, Taiwan, Belgium, France, the U.S., India, Canada, and
Australia. For TV viewing, only eight58,63,68,81,86,104,121,127 of
29 studies showed evidence for gender differences. The
null effect was also supported by the more method-
Williams (1999)125

Yancey (2004)126

Zhang (2004)128

ologically advanced prospective and momentary assess-

Yang (2010)127

ment designs. Five32,47,68,89,96 of nine studies44,60,113,121 found

men reported more computer use than women. When video
games specifıcally were evaluated, men reported more use than
Study

women in all four studies.57,110,113,119 This effect was also sup-

ported by the momentary assessment design. The six studies to

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 Rhodes et al / Am J Prev Med 2012;42(3):e3– e28 e19
Table 2. Summary of the correlates of sedentary behavior evaluategeneralscreentime
showed four null ef-
Sedentary No. of fects62,75,107,112 and two
Correlate behavior studies Association
correlations55,86 in support
Age TV viewing 20 ⫹ of higher screen time
Screen viewing 3 ? among men.
Computer use 5 – Null effects were evident
for general sitting behavior
Reading 3 0
in seven studies,30,44,47,101,
General sitting 10 ? 115,121,126 but men were
Education TV viewing 18 – shown to sit more than
Computer use 4 ⫹ women in the other two
studies.65,67 Finally, all four
General sitting 6 0
studies47,101,112,121 to evalu-
Employment status ate reading behavior found
Unemployed/retired TV viewing 15 ⫹ no association with gender.
Computer use 4 ?
Overall, the results suggest
that gender may not affect
Sitting 7 ? sedentary behaviors with
Manual labor Sitting 4 ? the exception of video
Increased occupational TV/screen viewing 4 0 games, where more men
physical activity play than women.
Gender (male) TV viewing 29 0
BMI. The relationship
Computer use 9 ?
between BMI and seden-
Video games 4 ⫹ tary behavior has been
Screen viewing 6 0 evaluated in 44 stud-
Reading 4 0
ies30, 32–35, 38,41–43,45,48,51,56,
61–63, 65–67,70, 71, 75,82,83,85,88,
General sitting 9 0 90, 92, 95, 97–100, 103, 108 ,112, 115,
BMI TV viewing 28 ⫹ 116,118,120,122,123,129,130 that

Computer use 4 ? include representation

from the U.S., U.K., Tai-
Ethnicity TV viewing 13 ?
wan, India, France, Spain,
General sitting 3 0 Portugal, Peru, Australia,
Marital status TV viewing 9 ? many countries in the EU
Income TV viewing 14 ?
and Scotland. All studies re-
ported BMI to assess body
Computer use 3 0
composition. Of the 28
Children in home General sitting 4 – studies to include an assess-
Smoking TV viewing 9 ? ment of TV viewing,
1632,34,35,43,45,47,51, 56, 66, 70,
General sitting 5 0 97–100,108,120
demon-
Alcohol consumption TV viewing 8 0 strated an overall effect
General sitting 4 0 for higher BMI and higher
Leisure-time physical TV viewing 25 – TV hours, whereas
activity three71,92,118 showed sup-
Computer use 3 0
port for this effect with
Screen viewing 6 – women but not men. The
General sitting 9 0 most convincing evidence
(continued on next page)
for the effect of TV on body
composition was from a
prospective trial35 showing

March 2012
e20 Rhodes et al / Am J Prev Med 2012;42(3):e3– e28
Table 2. Summary of the correlates of sedentary behavior (continued) Income. Seventeen large-
sample surveys,24,32,48,60,
Sedentary No. of 62, 66, 70, 77, 81, 90, 92,97,98,103,
Correlate behavior studies Association
104,109,130 inclusive of the
Caloric intake TV viewing 10 0 U.S., Canada, Taiwan,
General sitting 3 0 Peru, selected countries
in the EU, and Australia
Sedentary attitude TV viewing 3 ⫹
have evaluated house-
Computer use 3 ⫹ hold income as a corre-
Depressive symptoms TV viewing 4 ⫹ late of sedentary behav-
Computer use 3 0
ior. For TV viewing,
eight66,70,79,81,92,97,104,109
Life satisfaction TV viewing 7 – of 14 studies24,32,47,77,
Note: At least three studies were required for a theme and an estimate of each sedentary behavior. 90,98 found an association
⫹, positive association (⬎59% of studies); ⫺, negative association (⬎59% of studies); ?, indeterminate between higher incomes
(34%–59% of studies showing an association); 0, no association (⬍34% of studies showing any
association) and less viewing hours.
Computer use was not
associated with income
32,47,60
that changes over 5 years in TV time were signifıcantly associ- in the three studies available. The results, therefore,
ated in commensurate changes in waist circumference. Still, suggest that TV viewing and its relationship with income
another 3-year prospective design130 found null results in BMI is inconclusive, although it appears that it is unrelated to
change. computer use.
Of the four computer use studies to evaluate BMI,
two48,82 found higher use linked to higher BMI and Social Factors
two31,45 found no association. General screen viewing Marital status. Ten studies32,35,47,70,74,81,88,97,98,116 re-
was linked to higher BMI in three studies38,62,75 and to ported on a relationship between sedentary behavior and
women but not men in a fourth study.112 Eight stud- marital status of the participants. Nine of these focused
ies30,33,45,48,65,67,95,103 on sitting and BMI did not fınd a on TV viewing and resulted in two samples88,116 support-
relationship. However, a 5-year longitudinal study found ing an association between higher TV viewing and being
that weight-related variables predicted future sedentary married/common-law, three35,81,97 supporting a rela-
behavior, but sedentary behavior did not predict future tionship between high TV viewing and being single, and
weight changes.83 Finally, three studies evaluated leisure- the other four32,47,70,98 showing no relationship between
47,82,112
time reading with null relationships on BMI. TV viewing and marital status. Clearly, more evidence is
Overall, the results provide some evidence for a relation- needed before any summary statement can be made
ship between TV and general screen viewing and BMI about sedentary behavior and marital status.
although the relationship between BMI and other seden-
Children in the home. Five studies47,67,97,122,126 re-
tary behaviors does not appear strong.
ported on the presence of children in the home and its
Ethnicity. Seventeen studies30,40,44,59,60,63,66,74,81,97,108, association with sedentary behavior. These included four
113,114,116,118,122,127 examined ethnicity and sedentary be- evaluations of general sitting behavior and found support
74,116 for a relationship between higher sitting and no children
havior relationships. All studies but two were large
samples in the U.S. The studies from Australia and Scot- in three studies67,122,126 and a null effect in the other.47
land had almost no variation in ethnicity (i.e., 95% Cau- The evidence base is scant at present, but it suggests that
casian) and may not be powered to detect ethnic differences. the presence of children is associated with less sedentary
Seven59,63,66,97,108,118,127 of the 13 studies40,44,81,113,114,116 to behavior.
examine ethnicity and TV viewing identifıed African Amer-
icans/blacks as watching more TV compared to other eth- Health Behaviors
nicities. No relationship between general sitting and ethnic- Smoking. Sixteen studies22,29,41,42,51,54,62,65,70,75,88,95,97,
ity was identifıed in the three studies available.30,44,122 Other 98,103,115 reported a relationship between smoking status
sedentary behaviors were too sparse to theme at present. and sedentary behavior. Nine of these studies focused on
Overall, the results are inconclusive for ethnicity as a corre- TV viewing. Of these, fıve29,41,54,70,98 showed associations
late of any sedentary behavior, yet it appears that a null between TV viewing and increased likelihood of being a
relationship is present for sitting. smoker. Five studies22,65,95,103,115 also evaluated general

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 Rhodes et al / Am J Prev Med 2012;42(3):e3– e28
sitting and its relationship with smoking with null asso-
ciations. The results suggest that smoking behavior and
TV viewing is mixed, but general sedentary activity does
not appear to be related to smoking.
Alcohol consumption. Consumption of alcohol and its
relationship with sedentary behavior was evaluated in 15
29,30,41,42,54,62,65,70,75,88,95,97,98,113,115
studies. These included large
samples from the U.S., U.K., Spain, Australia, Canada,
Taiwan, and India. Of the eight studies to evaluate TV
viewing, six29,41,42,70,88,97 found no relationship between
alcohol consumption and hours of TV viewing, and the
other two studies54,98 found an association of lower alco-
hol consumption and higher TV viewing for women.
Three studies30,95,115 found no relationship with sitting,
whereas another showed a positive relationship.65 Over-
all, the evidence does not support a relationship between
sedentary behavior and consumption of alcoholic
beverages.
Leisure-time physical activity. The relationship be-
tween physical activity and sedentary behavior has been
examined in 38 studies.24,30,41,42,47,51,54,61– 63,65,68 –71,75,80,
85,86,88,92,94,95,97–99,103,105,107,111,112,115,116,119,120,122,128,129
41,51,54,63,68,69,88,94,98,105,111,116,120
Thirteen of 25 studies
on TV viewing supported a negative relationship with
physical activity, and an additional three studies showed
the relationship for women47,71 or men exclusively.119
The three studies47,68,80 to evaluate computer use
showed no relationship with physical activity, whereas
four62,75,86,128 of the six studies assessing general screen
time supported a negative association of physical activity,
one112 showed this association for women only and the
other107 was null. Finally, of the nine studies to evaluate
sitting, three30,73,95 showed a negative relationship with
physical activity and 47,65,103,115,119,129six showed no rela-
tionship. These relationships did not appear to differ by
the way physical activity was defıned (i.e., total, moderate–
vigorous intensity) or by the design of the study. Overall,
there is some evidence for a negative association between
TV viewing and general screen viewing with physical
activity, but no relationship is apparent for computer use
or general sedentary behavior.
Eating behavior. A relationship between caloric intake
and sedentary behavior was estimated in 12 stud-
ies.26,30,41,42,45,54,66,88,92,98,116,122 For the ten studies to
evaluate TV viewing, six26,42,45,54,88,116 showed a null re-
lationship and four41,66,92,98 showed a relationship of
higher caloric intake with higher viewing hours. No rela-
tionships were identifıed for general sitting.30,45,122 Thus,
there is limited evidence for a relationship between ca-
loric intake and sedentary behaviors at present.
March 2012
e21
Cognitions
Attitudes. Five studies evaluated attitudes toward sed-
entary behavior and actual sedentary behavior. Two used
the theory of planned behavior117 (Study 1 and Study 2),
another121 used behavioral choice theory, one60 applied a
generalized attitude measure, and the other127 used a
social cognitive approach. All three that measured TV
viewing supported an association with an attitude con-
struct (preference, utility, enjoyment). Three of three
samples also found support for a relationship between
attitudes and computer use. In addition, Salmon et al.120
and Williams et al.127 showed that barriers to physical
activity (cost, weather) were correlates of TV viewing,
whereas Rhodes and Dean117 found that sedentary be-
haviors have a large correlation with intention but no
relationship with perceived behavioral control over a be-
havior. Overall, the literature is limited but sedentary
behaviors appear to be related to positive attitudes.
Depression. Depressive symptoms and their relation-
ship with sedentary behavior were measured in six data
sets.40,80,89,97,122,125 TV viewing time showed a positive
association with depressive symptoms in four of four
studies,42,80,97,125 but no effect was identifıed for com-
puter use in the three studies80,89,125 available. The stud-
ies are limited at present, but TV viewing appears linked
to depressive symptoms but not computer use.
Quality of life. Life satisfaction/well-being/happiness
was measured in seven studies74,77,81,87,104,124,127 that
comprised large samples from the U.S., Europe, Scotland,
and a multinational sample. All studies evaluated TV
viewing and four74,81,87,124 of these found an association
between lower satisfaction and higher viewing, one127
found the effect for men only, and the other two77,104
were null. The results are limited but generally suggest
that high TV viewing is related to lower psychological
well-being.
Conclusion
The purpose of the present study was to review the liter-
ature that has focused on the correlates of sedentary be-
havior among adults. All published literature that met
our search criteria was included and themed by broad
categories of demographic, behavioral, cognitive, social,
and physical environment variables. This review assessed
82 independent samples (109 peer-reviewed papers)
from all inhabited continents. TV viewing proved the
most prevalent sedentary behavior that was measured,
although some papers incorporated other behaviors such
as sitting time, computer time, and videogames. Most of
our evidence base at this time is from cross-sectional
designs (76% of studies reviewed). The results proved
e22 Rhodes et al / Am J Prev Med 2012;42(3):e3– e28
informative for the purposes of making some conclu-
sions, outlining gaps in our current understanding, and
drawing attention to methodologic limitations at present.
Overall, the separation of the fındings into select cate-
gories proved interesting. Considerable research has ac-
cumulated on the sociodemographic and behavioral cor-
relates of sedentary behaviors, but limited research has
been conducted on the cognitive, social, or environmen-
tal categories. This relative lack suggests that future ef-
forts need to focus on these types of correlates for an
understanding of sedentary behavior that covers socio-
ecologic17 breadth. For example, an initial study found
that placement of a TV in the bedroom increases viewing
time93 whereas another found that neighborhoods that
are not conducive to physical activity are associated with
high TV viewing among those with low incomes.97 More
studies on these factors are needed for replication. Fur-
ther, the cognitive, social, and environmental correlates
seem better suited for targeted intervention efforts to
reduce sedentary behavior. Thus, it is recommended that
future research employ socioecologic models, with an
emphasis on environmental and cognitive correlates, to
better understand sedentary behavior.
In terms of sociodemographics, the review demon-
strated that those who watch a lot of TV tend to be less
educated, older, unemployed or work less hours, and
have higher BMI than those who watch less TV. The effect
appears to be relatively independent of gender. By con-
trast, there was mixed evidence for TV viewing and its
association with marital status, income and ethnicity. For
computer use, high users are more likely to be younger
and more educated than low users and computer game
users are more likely to be male. General sitting behavior
was not associated with education, ethnicity, or gender
but negatively related to the presence of children in the
home. Other sociodemographic factors are inconclusive
at present. Finally, occupational variables such as em-
ployment type and physical activity on the job are rela-
tively under-researched at present. More evidence is
needed on these topics before any fırm conclusions can be
drawn.
In terms of behavioral correlates, evidence was present
to suggest alcohol consumption is not related to seden-
tary behavior with any practical import, but smoking is
less conclusive. Interestingly, total caloric intake and sed-
entary behavior had limited association. The fınding re-
quires further research, because caloric intake and seden-
tary behavior are associated in youth.131 An association
between higher TV viewing and lower leisure-time phys-
ical activity was present in most of the studies reviewed,
but this association was not found for general sitting or
computer use. The inverse association with TV viewing,
the most prevalent leisure-time activity,16 provides evi-
dence for time displacement (i.e., leisure time spent
watching TV takes away leisure time for MVPA)130
which is not an apparent concern with youth.10 The dif-
ferences in available leisure time are the most likely rea-
son for the discrepancy.131
This review also highlighted some cognitive correlates
of sedentary behavior, despite the limited number of
studies at present. The sedentary attitude construct, for
example, was a strong correlate of all sedentary behaviors.
More application of psychological and social models are
currently needed. Depressive symptoms and low satisfac-
tion with life were also noted as positive correlates of
sedentary behavior. These fındings require more sus-
tained research. It would be interesting to tease out
whether these symptoms are a behavioral antecedent or
outcome through longitudinal/experimental work.
One of the key fındings of the current review was that
differences in the correlates were present by the type of
sedentary behavior measured. For example, TV viewing
and computer use had similar correlates, but in the oppo-
site directions (e.g., education, age). This supports prior
notions that sedentary behavior is not a single construct.
Attempts to measure sedentary behavior as the absence of
MVPA or without any behavioral specifıcs (i.e., type) are
not recommended in the future. Indeed, generalized as-
sessments of “screen time” behaviors are not recom-
mended in the adult population based on the fındings of
the current review.
Some other fındings of the review may help guide
future research in sedentary behavior. First, there was an
obvious lack of any standardized metric when measuring
behavior. Although hours of use was the most common,
researchers categorized this in all kinds of values (e.g., ⬎1
hour; ⬎2 hours, tertiles; ⬎4 hours). This thwarted any
attempt at quantitative synthesis. Eventually it is hoped
that evidence-based guidelines can be used for sedentary
behavior as a criterion, but in the absence of these guide-
lines it is recommended that continuous data be used in
determining the sedentary behavior outcome. Interest-
ingly, this approach was used in a very limited number of
papers but it provides the least bias and best understand-
ing of sedentary behavior at present.
Second, a fair number of studies reported statistical
associations between a sedentary behavior and a pro-
posed correlate, but these associations were trivial in
magnitude when considering effect size.19 Researchers
are encouraged to report standardized effect sizes along
with the signifıcance criterion, so effects in this newly
emerging domain can be understood in terms of practical
importance. This will also help with future meta-analytic
reviews so the magnitude of sedentary correlates can be
assessed.
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 Rhodes et al / Am J Prev Med 2012;42(3):e3– e28
Finally, many studies employed self-reported esti-
mates of sedentary behavior and these have unknown
validity. Because of its high prevalence and passive na-
ture, sedentary behavior may be very diffıcult to recall
accurately. It seems prudent for future research to use
accelerometry, with a log book to record the type of
activity, and assessments of sedentary behavior in order
to provide greater veracity to our understanding of be-
havioral correlates.
It is also important to highlight the limitations of the
current review in order to provide a context for the re-
sults. First, the assessment is limited to published work
and may be subject to publication bias. Second, the work
contained in this review is limited to English-language
journals and thus the results cannot generalize to studies
conducted and published in other languages. Finally, the
review is limited to the search terms and databases con-
tained in our Methods section and the hand searching of
their references. Studies that have not been abstracted
with these key words will be missing from the review.
Overall, the results point to the high specifıcity of var-
ious sedentary behaviors (e.g., TV viewing versus com-
puter use) and this suggests that the research domain is
complex and cannot be considered the simple absence of
MVPA. Several sociodemographic and health behaviors,
however, appear reliably linked to sedentary behavior, yet
there is an obvious absence of research that has focused
on the cognitive, social, and environmental factors that
could be of use in anti–sedentary behavior interventions.
Future research should continue to focus on select seden-
tary behaviors of high prevalence and their association
with psychological, social, and environmental variables.
Improved methodologic characteristics (measurement,
design); standardization of the outcome measures; and
the reporting of effect sizes are also recommended. These
should prove most useful in impending intervention
initiatives.
RER is supported by a New Investigator Award from the Cana-
dian Institutes of Health Research, a Senior Scientist Award
with the Canadian Cancer Society, and with additional funds
from the Social Sciences and Humanities Research Council of
Canada, the Canadian Diabetes Association and the Canadian
Cancer Society.
No fınancial disclosures were reported by the authors of this
paper.
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Appendix A
Search Syntax, August 8 –22
CINAHL with Full Text, Show All Health Source - Consumer
Edition, Health Source: Nursing/Academic Edition, Health Tech-
nology Assessments, MEDLINE with Full Text, PsycARTICLES,
PsycCRITIQUES, PsycINFO, SPORTDiscus
1. Sedentary behavior and review
2. Physical inactivity and sedentary behavior and screen time
3. Physical inactivity and screen time
4. Sedentary behavior and screen time
5. Leisure-time behavior and screen time and television
6. Leisure-time behavior and screen time
7. Adult and video games
8. Sedentary behavior and video game and television and
computer
9. Sedentary Behavior and adult and Sitting
10. Sedentary behavior and screen time and adult
11. Inactivity and occupation and leisure
12. Inactivity and screen time
13. Sedentary behavior
14. Screen time and adult
15. Motivation and sedentary behavior
16. Television view and adult and sedentary
17. Television view and adult
18. Occupational and driving and inactivity
19. Driving and inactivity
Appendix B
Quality Ratings of Studies: Assessment Tool
Questions
1. Did the study include a theoretical framework?
2. Was an objective measure of sedentary behavior used?
3. Were the measures of sedentary behavior reliable (e.g.,
pre-tested)?
4. Was the study powered to detect a nontrivial correlation?
5. Was the design an RCT?
6. Was baseline sedentary behavior considered in analyses (analysis
longitudinal)?
7. Were statistically appropriate/acceptable methods of data anal-
yses used?
www.ajpmonline.org
 Rhodes et al / Am J Prev Med 2012;42(3):e3– e28 e27
Appendix B. (Continued) Appendix B. (Continued)

Study 1 2 3 4 5 6 7 Total Study 1 2 3 4 5 6 7 Total

AusDiab NHANES
21
Cameron (2003) x x x X 4 Clark (2011)34 X x x x 4
22 37
Clark (2010) x x x X 4 Ford (2010) X x x 3
24 42
Dunstan (2010) x x x X 4 Matthews (2008) X x x x 4
25 43
Healy (2008) x x x X 4 McDowell (2006) X x x x 4
27
Lynch (2010) x x x x X 5 Nurses’ Health Study
32
Wijndaele (2010) x x x x X 5 Granner (2010)38 X x x x 4
40
Australian Longitudinal Study Hu (2003) X x x x 4
on Women’s Health
PLACE Study
De Cocker (2010)23 x x x X 4
Proper (2007)44 X x x x 4
Van Uffelen (2010)31 x x x x X 5 45
Sugiyama (2008) X x x x 4
Canadian Community Health 46
Survey Sugiyama (2008) X x x x 4
47
Shields (2008 a,b)29,30 x x X 4 Sugiyama (2007) X x x x 4
76
Colorectal Cancer and Quality Vandelanotte (2009) X x x x 4
of Life Study
Scottish Health Study
Lynch (2011)26 x x x x X 5
Hamer (2010)70 X x x 3
33
Wijindaele (2009) x x x x X 5 73
Stamatakis (2009) X x x x 4
CPS II Nutrition Cohort 74
Stamatakis (2009) X x x x 4
Blanck (2007)20 x x x x X 5 72
Stamatakis (2011) X x x x 4
Patel (2010)28 x x x X 4
SUN Cohort
EPIC Norfolk Study
Beunza (2007)63 X x x x 4
41
Jakes (2003) x x x x X 5 71
Sanchez-Villegas (2008) X x x x x 5
Wijindaele, (2011)52 x x x X 4
SU.VI.MAX
Flemish Policy Research
Centre Sport, Physical Charreire (2010)69 X x x x 4
Activity and Health Study Touvier (2010) 75
X x x x 4
Duvigneaud (2008)36 x x x X 4 Aadah (2007) 54
X x x x 4
Wijindaele (2009)53 x x x X 4 Anand (2007) 55
X x 2
Health Examination Program Anderson (1996) 56
X x x x x 5
by Health Advancement
Services 57
Anuradha (2011) X x x x 4
48 58
Tucker (1990) x x x X 4 Assael (2005) X x x 3
49 59
Tucker (1993) x x X 3 Ballard (2009) X x x x 4
50 60
Tucker (1991) x x X 3 Banks (2010) X x x x 4
51 61
Tucker (1989) X x x 3 Bennett (2006) X x x x 4
Health Professionals Follow- 62
Berry (2007) X x x 3
Up Study
64
Bowman (2006) X x x x 4
Coakley (1998)35 X x x x x 5
65
Brown (2003) X x x x 4
Hu (2001)39 X x x x 4
66
Buckworth (2004) X x x 3
(continued)
67
Burazeri (2008) X x x x 4
(continued on next page)

March 2012
e28 Rhodes et al / Am J Prev Med 2012;42(3):e3– e28
Appendix B. (Continued) Appendix B. (Continued)

Study 1 2 3 4 5 6 7 Total Study 1 2 3 4 5 6 7 Total

68 113
Chang (2008) X x x x 4 Rastogi (2004) X x x x 4
69 114
Crawford (1999) X x x x x x x 7 Raynor (2006) X x x x x 5
79
Depp (2010) X x x 3 Rhodes (2009)— X x x 3
78
Sample #1115
De Wit (2011) X x x x 4
80
Rhodes (2009)— X x x x 4
Dunton (2009) X x x x 4 Sample #2115
Ekelund (2008)81 X x x x x 5 Richmond (2010)116 X x x x x 5
8
Ellison (1982) X x x 3 Rouse (2010) 117
X x x 3
Fitzgerald (1997)83 X x x x x 5 Salmon (2000) 118
X x x x 4
Frey (2007)85 X x x x 4 Salmon (2003) 119
X x x x 4
Fountaine (2011)84 X x x x 4 Sanchez (2008) 120
X x x x 4
Gao (2007)86 X x x 3 Santos (2010) 121
X x x x 4
Gordon (2007)87 x x 2 Sirgy (1998) 122
X x x 3
Jacoby (2003)88 X x x x 4 Teychenne (2010) 123
X x x x 4
Jans (2007)89 X x x x 4 Van Dyck (2010) 124
X x x x 4
Jeffrey (1998)90 X x x x x 5 Williams (1999) 125
X x x 3
Jones (2010)91 X x x 4 Yancey (2004) 126
X x x x 4
Kaleta (2007)92 X x x x 4 Yang (2010) 127
X x x 3
Katzmarzyk (2009)93 X x x x x 5 Zhang (2004) 128
X x x x x 5
Kayany (2000)94 X x x 3 AusDiab, Australian Diabetes, Obesity and Lifestyle Study; CPS,
King (2010)95 X x x x 4 Cancer Prevention Study; EPIC, the European Prospective Investiga-
tion of Cancer; NHANES, National Health and Nutrition Examination
Krishnan (2009)96 X x x x x 5 Survey; PLACE, Physical Activity in Localities and Community Envi-
ronments; SUN, Seguimiento University of Navarra; SU.VI.MAX,
97
Kronenberg (2000) X x x x 4 SUpplementation en VItamines et Mineraux AntioXydants
98
Landhuis (2008) X x x x x 5
99
Lee (2003) X x x x x 5
100
Lindstrom (2005) X x x x 5
Martinez-Gonzalez X x x x x 5
(1999)101
McCarthy (1993)102 X x x 3
McCormack (2004)103 X x x x 4
McCreary (1999)104 X x x 3
Meier (2007)105 X x x x x 5
Nelson (2007)106 X x x x 4
Ogletree (2007)108 X x x 3
O’Guinn (1997)107 X x x x 4
Oken (2006)109 X x x x x 5
Oppert (2006)110 X x x 3
Padilla-Walker X x x x 4
(2010)111
Polley (2005)112 X x x 3
(continued)

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