{"id":7665,"date":"2018-03-06T00:54:25","date_gmt":"2018-03-05T23:54:25","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bjsm\/?p=7665"},"modified":"2018-03-06T01:30:26","modified_gmt":"2018-03-06T00:30:26","slug":"risks-associated-sitting-physical-inactivity-not-comparable-smoking-letter-editor","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bjsm\/2018\/03\/06\/risks-associated-sitting-physical-inactivity-not-comparable-smoking-letter-editor\/","title":{"rendered":"Risks associated with sitting and physical inactivity are not comparable to those of smoking (Letter to the Editor)"},"content":{"rendered":"

By Brigid M. Lynch, Paul A. Gardiner, Jeff K. Vallance, Terry Boyle, Neville Owen and Ron Borland<\/strong><\/em><\/p>\n

Letter in Response to Online First Article (8 January 2018) \u201cInfographic: Physical activity, sitting time and mortality.<\/a>\u201d <\/strong><\/p>\n

Ekelund\u2019s Infographics piece1<\/sup><\/a> provides an overview of the Ekelund et al<\/em>.2<\/sup><\/a> harmonised meta-analysis of the joint effects of self-reported sitting and physical activity on all-cause mortality. \u00a0This meta-analysis found a clear dose-response association with mortality, such that combined high sitting (>8-h\/day) and low physical activity (<2.5 MET-h\/day) was associated with the greatest risk (HR=1.59; 95% CI: 1.52, 1.66), compared to combined low sitting (<4-h\/day) and high physical activity (>35.5 MET-h\/wk). \u00a0Ekelund et al<\/em>.\u2019s meta-analysis demonstrated that high physical activity completely attenuated the effects of sitting, suggesting that physical activity is an effective counter measure to address increasing volumes of sedentary behaviour.2<\/sup><\/a><\/p>\n

The infographic clearly communicates the risks of sitting and the benefits of physical activity, and will likely be a helpful resource for public health practitioners.\u00a0 However, we suggest a revision to remove the comparison of sitting with smoking<\/em><\/strong>.\u00a0 Ekelund states that the 59% increased risk of mortality for high sitting\/low physical activity \u201cis similar to that of smoking\u201d1<\/sup><\/a> and cites Schumacher et al<\/em>.\u2019s results derived from replicating the meta-analysis performed for the landmark 1964 U.S. Surgeon General\u2019s report on smoking and health, using contemporary meta-analytic methods.3<\/sup><\/a><\/p>\n

Schumacher et al<\/em>.\u2019s letter is not an appropriate reference in this context, primarily because it presents risks derived from cohort studies established in the 1950s.3<\/sup><\/a>\u00a0 The health risks associated with smoking have become stronger over time,4<\/sup><\/a> driven by a generational shift toward starting smoking in adolescence, and changes to cigarette design that promote deeper inhalation of smoke.5<\/sup><\/a>\u00a0 Further, Schumacher et al<\/em>. present risks derived from current vs. never smokers, rather than highest vs. lowest categories of smoking. \u00a0Grouping smokers together (regardless of consumption) does not account for the dose-response nature of the smoking-mortality association, meaning results cannot be fairly compared to the effects presented by Ekelund et al<\/em>.2<\/sup><\/a><\/p>\n

Findings from contemporary cohort studies give more reasonable risk estimates for smoking-related all-cause mortality.\u00a0 The relative risk for smoking 20-39 cigarettes per day vs. none is 3.33 (95% CI: 3.19, 3.48) for men, and 3.48 for women (95% CI: 3.30, 3.67).4<\/sup><\/a>\u00a0 These risks are four times<\/em><\/strong> the all-cause mortality risk associated with combined high sitting\/low physical activity.\u00a0 Risks associated with > 40 cigarettes per day are even higher.4<\/sup><\/p>\n

Distorted information regarding the health risks of personal behaviours can lead to distrust of public health messages.6<\/sup><\/a>\u00a0 Equating sitting with smoking is misleading, may reduce the perceived risk of smoking, and could erode hard-won tobacco control gains.<\/p>\n

Corresponding author:<\/strong> A\/Prof Brigid M. Lynch, brigid.lynch@cancervic.org.au, 615 St Kilda Rd, Melbourne VIC 3004, Australia.<\/p>\n

\u00a0<\/strong>Disclosures<\/strong><\/p>\n

Lynch is supported by a fellowship from the National Breast Cancer Foundation (ECF-15-<\/p>\n

012). \u00a0Gardiner is supported by a National Health and Medical Research Council (NHMRC) -Australian Research Council Dementia Research Development Fellowship. \u00a0Vallance is supported by the Canada Research Chairs program and a Population Health Investigator Award from Alberta Innovates-Health Solutions. \u00a0Boyle is supported by a National Health and Medical Research Council Early Career Fellowship (Australia). Owen is supported by a NHMRC Senior Principal Research Fellowship and NHMRC Centre for Research Excellence grant.<\/p>\n

References<\/strong><\/p>\n

    \n
  1. Ekelund U. Infographic: Physical activity, sitting time and mortality. BritishJournal of Sports Medicine. In press.<\/li>\n
  2. Ekelund U, Steene-Johannessen J, Brown WJ, et al. Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women. Lancet. 2016;388:1302-10.<\/li>\n
  3. Schumacher M, Rucker G, Schwarzer G. Meta-analysis and the Surgeon General’s report on smoking and health. The New England Journal of Medicine 2014;370:186-8.<\/li>\n
  4. Thun MJ, Carter BD, Feskanich D, et al. 50-year trends in smoking-related mortality in the United States. The New England Journal of Medicine 2013;368:351-64.<\/li>\n
  5. Thun MJ, Lopez AD, Hartge P. Smoking-related mortality in the United States. The New England Journal of Medicine 2013;368:1753.<\/li>\n
  6. Nagler RH. Adverse outcomes associated with media exposure to contradictory nutrition messages. Journal of Health Communication 2014;19:24-40.<\/li>\n<\/ol>\n

    <\/p>\n","protected":false},"excerpt":{"rendered":"

    By Brigid M. Lynch, Paul A. Gardiner, Jeff K. Vallance, Terry Boyle, Neville Owen and Ron Borland Letter in Response to Online First Article (8 January 2018) \u201cInfographic: Physical activity, sitting time and mortality.\u201d Ekelund\u2019s Infographics piece1 provides an overview of the Ekelund et al.2 harmonised meta-analysis of the joint effects of self-reported sitting and […]<\/p>\n

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