title: Independent and joint effects of sedentary time and cardiorespiratory fitness on all-cause mortality: the Cooper Center Longitudinal Study.
abstract: OBJECTIVE
  To examine the independent and joint effects of sedentary time and cardiorespiratory fitness (fitness) on all-cause mortality.
  
  
  METHODS
  A prospective study of 3141 Cooper Center Longitudinal Study participants. Participants provided information on television (TV) viewing and car time in 1982 and completed a maximal exercise test during a 1-year time frame; they were then followed until mortality or through 2010. TV viewing, car time, total sedentary time and fitness were the primary exposures and all-cause mortality was the outcome. The relationship between the exposures and outcome was examined utilising Cox proportional hazard models.
  
  
  RESULTS
  A total of 581 deaths occurred over a median follow-up period of 28.7 years (SD=4.4). At baseline, participants' mean age was 45.0 years (SD=9.6), 86.5% were men and their mean body mass index was 24.6 (SD=3.0). Multivariable analyses revealed a significant linear relationship between increased fitness and lower mortality risk, even while adjusting for total sedentary time and covariates (p=0.02). The effects of total sedentary time on increased mortality risk did not quite reach statistical significance once fitness and covariates were adjusted for (p=0.05). When examining this relationship categorically, in comparison to the reference category (≤10 h/week), being sedentary for ≥23 h weekly increased mortality risk by 29% without controlling for fitness (HR=1.29, 95% CI 1.03 to 1.63); however, once fitness and covariates were taken into account this relationship did not reach statistical significance (HR=1.20, 95% CI 0.95 to 1.51). Moreover, spending >10 h in the car weekly significantly increased mortality risk by 27% in the fully adjusted model. The association between TV viewing and mortality was not significant.
  
  
  CONCLUSIONS
  The relationship between total sedentary time and higher mortality risk is less pronounced when fitness is taken into account. Increased car time, but not TV viewing, is significantly related to higher mortality risk, even when taking fitness into account, in this cohort.
authors.affiliation: Intramural Research Department, American Cancer Society, Atlanta, Georgia, USA.
authors.forename: Kerem
authors.initials: K
authors.lastname: Shuval
authors.affiliation: The Cooper Institute, Dallas, Texas, USA.
authors.forename: Carrie E
authors.initials: CE
authors.lastname: Finley
authors.affiliation: The Cooper Institute, Dallas, Texas, USA.
authors.forename: Carolyn E
authors.initials: CE
authors.lastname: Barlow
authors.affiliation: Intramural Research Department, American Cancer Society, Atlanta, Georgia, USA.
authors.forename: Binh T
authors.initials: BT
authors.lastname: Nguyen
authors.affiliation: Yale University Prevention Research Center, Griffin Hospital, Derby, Connecticut, USA.
authors.forename: Valentine Y
authors.initials: VY
authors.lastname: Njike
authors.affiliation: Division of Epidemiology, Human Genetics and Environmental Sciences, University of Texas, School of Public Health, Austin, Texas, USA.
authors.forename: Kelley
authors.initials: K
authors.lastname: Pettee Gabriel
mesh_terms: D000328:Adult; D001334:Automobile Driving; D015992:Body Mass Index; D002319:Cardiovascular System; D015444:Exercise; D005080:Exercise Test; D005260:Female; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009026:Mortality; D010809:Physical Fitness; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D057185:Sedentary Behavior; D013690:Television
keywords: EPIDEMIOLOGY; PREVENTIVE MEDICINE; PUBLIC HEALTH