Arocha-Rodulfo I (2026) Burden of Sedentarism. Ann Musc Disord 7(1): 1018.

It has been a relatively short period of time since the first humans left aside their nomadic way of life and settled down to establish themselves as farmers, starting the establishment of small conglomerates of these primitive humans that later growth to begin small village and town years later. At the same time, the trade-off of merchandise between neighborhoods starts thanks to the domestication of several animals [1]. This opinion letters are intended to highlight the dangers of a sedentary lifestyle in general population health for two main reasons. The first one lies in the little or no physical activity developed by children and adolescents together with the explosive increase in overweight and obesity in these age groups and the second reason is that most of these cases are attended and treated by non-specialist doctors in the cardiometabolic area, so they do not pay much attention to the sedentary habits and biochemical alterations because the these last one are marginal, so they would consider that weight gain is an attribute of development or that they can be treated later. In this sense, the time factor must not be underestimated, and the golden rule is that the sooner any metabolic alteration in a young person is controlled or eradicated, the better [2]. Evidence indicates that regular exercise is linked with numerous health benefits in general populations, such as healthier body composition, higher cardiorespiratory fitness, improved insulin sensitivity, and lower cardiometabolic disease risk factors. Despite these health benefits, a large percentage of the population do not follow the recommendation to practice vigorous physical activity several times a week or, at least, keep in active movement avoiding long periods of physical inactivity or be seated [3]. Sedentarism is a way of life adopted by many people around the world fostered by the progression of technology and these lifestyle habits are being transmitted to adolescent and infant people, who spend a lot of time in front of screens like telephones, video games or TV. It is accepted that the design of the human organism (encoded in its genes) is the result of millions of years of biological evolution and almost the entire human genome was formed during pre-agricultural evolution and is considered to be the optimal one, which allowed us to adapt to the changes in the environment that our ancestors faced at each stage of our evolution [1-4]. In ancient age, the human being active by nature, remained wandering in much of this evolutionary period and during this time, physical activity strengthened both muscle cells and the central nervous system as it is the organ that controls body movements in all time variables which led to the expansion evolution of the regions of the cerebral cortex [1-4]. Although the transformation of human beings into settlement occurred barely 10,000 years ago when they became farmers, it took less than a century for human to become into a comfortable being with so little physical activity and thanks to technology, giving rise to a series of cardiometabolic alterations with a significant impact and decisive on health from an early age. Undoubtedly, the most decisive physical functionality in a Homo sapiens was the ability to cover long distances to gather food and even to hunt animals by persistence with low energy cost, often in conditions of food or water scarcity, in high temperatures or through rough, irregular terrain [1-4]. So, being accomplish with the evolutionary paradigm is so important, and why being functional as a Homo sapiens still matters even in today’s environment—where the truly “functional” skill is being able to spend many hours sitting, focused, and attending to a screen in without notice that this time of inactivity is damaging their health. Sedentary behavior also shows a dose/response relationship, that is, more sedentary time translates into a greater risk of mortality and/or adverse outcomes. especially cardiometabolic [5]. Moreover, the longer the time living under sedentary behavior, aggregation of cardiometabolic risk factors (CMRF) is greater [6-9]. In this sense, all person related to health care must kept in mind that sedentary behavior is not simply less physical activity, but corresponds to a set of individual attitudes in which sitting and/or lying down becomes the predominant postural posture accompanied by other harmful habits such as increased caloric intake and/or smoking, alcohol, factors which increase the cardiometabolic risk. In recent decades, a sedentary lifestyle has become a serious problem that has grown by leaps and bounds with the arrival of new technological inventions in an effort to facilitate daily activities, without realizing that humanity is becoming increasingly immobile, as that to work, have fun, shop, or do housework, a greater degree of movement required less than half a century ago [3]. Today, many of these activities can be carried out from home or office through a computer, which has led to a reduction in muscle activity and keeping people increasingly sedentary, transforming active and dynamic persona into an inactive one with less waste of energy [2]. Of course, such behaviors were exacerbated by the confinement resulting from the COVID-19 pandemic. In recent years, the sedentary lifestyle has become a serious public health problem, especially in schoolchildren and adolescents, which has gradually increased in importance with the arrival of new technological inventions, with the aim of facilitating or distracting the life of people, without realizing that the consequences on cardiometabolic health. Given the dimension of the problem, the World Health Organization (WHO) classifies a sedentary lifestyle as a fourth risk factor in terms of global mortality (6% of deaths registered worldwide corresponding to 3.2 million people) [10], which means a death every 10 seconds, and responsible as a cause in [14]:

• 6 % of cases of coronary artery disease (CAD).

• 7 % of T2DM. 

• 10 % of breast cancer. • 10 % of colon cancer.

• 9 % of premature mortality, that is, more than 5.3 million deaths, caused in 2008.

• The risk of death from any cause is higher in adults whose physical activity is insufficient compared to those who practice at least 150 minutes of exercise per week or its equivalent.

Worldwide, in 2018 the study by Guthold et al. [11], belonging to the WHO Noncommunicable Diseases Division was published, where they analyzed the results on physical inactivity in 168 countries from 358 population surveys between 2001 and 2016 that included almost two million participants. Briefly, the results showed that the problem of insufficient physical activity reaches alarming dimensions and is on the rise, with 27.5% of adults aged 18 or over not being active enough. Women were less active than men (31.7% vs. 23.4%, respectively) and older people were less active than young people; the highest percentages occurred among women from Latin America and the Caribbean (43.7%), Southeast Asia (43.0%), and high-income Western countries (42.3%); while the lowest values corresponded to men from Oceania (12.3%), East and Southeast Asia (17.6%) and Sub-Saharan Africa (17.9%). The prevalence in 2016 was more than double in high income countries than in low-income countries (36.8% versus 16.2%, respectively), the former showing an increase compared to the 2001 figure of 31.6 %; worse still is that between 2001 and 2016, the figure for insufficient physical activity remained with very little variation. Regarding the regional approach, the data related to Latin America in this publication showed a high percentage of insufficient physical activity for the region of 39.1%, distributed in 43.7% for women and 34.3% for men, with a group of countries with the lowest prevalence (Chile and Uruguay) and the highest in Brazil, Colombia and Argentina (47.0%, 44.0 % and 41.6%, respectively), these figures being higher in women than in men. A recent study, published in 2024 [12], found that nearly one third (31%) of the world’s adult population, 1.8 billion adults, are physically inactive. That is, they do not meet the global recommendations of at least 150 minutes of moderate-intensity physical activity per week. This means an increase of 5 percentage points between 2010 and 2022. If this trend continues, the proportion of adults not meeting recommended levels of physical activity is projected to rise to 35% by 2030. Globally, there were a notable age and gender differences in levels of physical inactivity [13], as follow:

• Women are less active than men by an average of 5 percentage points. This has not changed since 2000.

• After 60 years of age physical inactivity levels increase in both men and women.

• 81% of adolescents (aged 11–17 years) were physically inactive [14].

• Adolescent girls were less active than adolescent boys, with 85% vs. 78%, not meeting WHO guidelines [14].

Many different factors can determine how active people are and the overall levels of physical activity in different population groups. These factors can be related to the individual or wider social, cultural, environmental and economic determinants that influence access and opportunities to be active in safe and enjoyable ways. The clinical consequences of a sedentary lifestyle on the various systems of the body are extensive and interconnected, summarized below (Figure 1) [5-15]:

Metabolic: Obesity decreased insulin sensitivity, T2DM, dyslipidemia, hyperuricemia. of An metabolic excessive syndrome, accumulation adipose tissue may result in release of proinflammatory cytokines (and oxidative stress and excess deposition) in several organs, lipotoxicity. Moreover acts promoting the development of Metabolic Dysfunction–Associated Steatotic Liver Disease (MASLD),

• Cardiovascular disease: atherosclerosis, coronary disease, unstable angina, myocardial infarction, heart failure, stroke, intermittent claudication, thrombosis, high blood pressure.

• Vascular function: Increased vascular tone due to hyperactivity of the systemic nervous system, endothelial dysfunction, increased arterial stiffness.

Pulmonary: Asthma, chronic obstructive pulmonary disease (COPD), reduced ventilatory capacity.

• Neurobiological aspects: Intellectual dysfunction, dementia, depression, mood and anxiety disorders, Alzheimer’s disease particularly in the elderly. By the contrary, physical activity prescription reduces the probability of suffering from poor mental health and this effect is mainly driven by females within the targeted population, so the prescription of physical activity not only contributes to the improvement of physical health but is also a useful tool to help preserve mental wellbeing, particularly in older people [16].

• Muscular disorders. If the stimulus of the exercise does not exist, the muscle fiber is lost, which causes impairment of muscle strength, resistance to fatigue, balance and falls with the consequent fracture. Considering current knowledge, muscle mass is a large endocrine organ that produces a series of hormones, has fundamental roles in glucose and lipid metabolism, and supports the immune system. Sarcopenia with its characteristic reduction in muscle mass and cross-sectional area of the fibers, infiltration of the muscle by fat and connective tissue, decreased size and number of type 1 and 2 muscle fibers, mitochondrial dysfunction, sarcoplasmic reticulum proliferation, and dysfunction of the progenitor cells.

• Greater physical frailty, especially in the elderly.

Figure 1 The burden of sedentarism affects the health in multiples systems and organs. The negative impact of sedentarism affects most of vital organs. Prolonged sedentary time is independently associated with deleterious health outcomes regardless of physical activity. Technological advancements in modern society have created environments that encourage engagement in sedentary behaviour, making this a public health concern. The dangers of this way of life is particularly relevant to older adults who exhibit the highest amounts of sedentary time and are vulnerable to the adverse health effects of aging.

• Quality of life: Decreased psychological well being, psychological frailty, ability to perform daily activities and social interactions, functional restriction, and sleep irregularities. • Constipation and unfavorable changes in the intestinal microbiota.

• Increased risk of cancer and cancer mortality.

• Excessive sedentary behavior was associated with an increased risk of chronic kidney disease (CKD), especially albuminuria, regardless of the level of physical activity, only in women [17]. Moreover, longer sitting time had been significantly associated with the risk of kidney function decline (aHR, 1.136; 95% CI, 1.036-1.247, P=0.007), comparing participants with baseline sitting time in the lowest quartile with those in the highest quartile) after adjustment for potential confounders [15].

• Shorter life expectancy with risk of premature death.

Additionally, the effect of sedentarism on brain and cognitive health is well known. In a cohort study recruited adults aged 37-73 years enrolled between 2006 and 2010, with follow-up until 2014 [18]. The total cohort comprised 33,402 participants (mean age: 54.53). After nearly 8-year follow-up, there was a close relationship between sedentary time with decreased grey matter volume in several brain regions, including bilateral primary somatosensory cortex (S1), secondary somatosensory cortex, putamen, primary motor cortex (M1), insula, hippocampus, amygdala, as well as right supplementary motor area, left medial frontal cortex, and right anterior cingulate cortex (FDR-corrected p-value < 0.05) [18]. As had been mentioned, higher amounts of sedentary behavior in adults are associated with a several poor health outcome, notably all-cause mortality, cardiovascular disease and cardiometabolic mortality and cancer incidence, and a growing incidence of cardiometabolic disease (including obesity and T2DM), cancer and lower back pain [19,20]. Confronted by this long list of health issues, the World Health Organization considered to categorize sedentarism as a risk factor for good health status in general and cardiometabolic disease in particular [21]. Job sedentary lifestyle: a silent risk to vascular health Nowadays, since most working adults spend a high proportion of their waking hours in increasingly sedentary tasks, there will be a particular focus on the field of occupational health [22]. Our societal changes, favoring the minimization of physical effort, are particularly problematic based on the assumption that individuals possess an innate tendency to conserve energy and avoid unnecessary physical exertion. This general trend to avoid energy expenditure may explain why people do not exercise regularly despite the known negative effects of physical inactivity on health [14-16]. Moreover, we are currently living in a paradoxical time where our society has become more “technophilic,” favoring strategies to avoid and/or minimize physical effort (and per se human motion) with more time devoted to sedentary behaviors; while on the other hand, there is a growing interest and concern for healthy lifestyles. Sitting for long periods does not only affect posture or generate low back pain, scientific evidence shows that it impairs the endothelial function of the lower extremities, an early marker of cardiovascular risk [23]. The sustained reduction of blood flow in the legs, common in extensive working hours, directly impacts vascular health, even in apparently healthy people. Pekas et al. [24], showed that uninterrupted prolonged sitting attenuates peripheral arterial hemodynamic, which can results in impairments in vasoactive, oxidative, and inflammatory molecules that may attenuate macro and microvascular function Interrupting prolonged sitting with bouts of muscular contraction may protect against these alterations by restoring peripheral hemodynamics, which can result in vasoactive substances homeostasis as well as antioxidative and anti-inflammatory effects that may ultimately preserve macro and micro-vascular function.

What should this mean for organizations and most of the public office?

• Redesign active pauses with physiological criteria

• Promote movement strategies during the working day • Integrate exercise as a real tool for occupational cardiovascular prevention

• Reduce the risk of chronic disease and absenteeism Modern occupational safety and health administration do not put enough attention in it and it must prevent them including some sessions of bouts of exercise during working time.

Putting into action

As it is easy to deduce, the future of the next generations is highly compromised to avoid cardiometabolic diseases,such as ACVD, obesity and T2DM with all the morbidity that accompany them, unless there is an eradication or drastic reduction in sedentary habits with increased physical activity and better nutrition [25]. Young people should be aware that to enjoy a good general state of health in the elderly, it is essential to routinely practice some demanding physical activity from an early age, and adapt to the possibilities of each person, regardless of gender. Of course, this practice will also have immediate effects on general good health, and as it lasts over time, the benefit will be greater, dose-response style: the more health care, the better functional capacity in the decades. of the golden years [25,26]. Physical inactivity is a ubiquitous global issue and is associated with the development of many common and costly chronic conditions [1,2]. There are many national and international guidelines around physical activity and exercise that consistently recommend that our entire population, from young children to older adults, needs to move more every day. Physical activity and exercise plans should include being less sedentary along with a mix of aerobic, resistance, and balance activities throughout the day and week [25,26]. Recommendations can be tailored by age and comorbidity. The evidence for adoption of regular physical activity is very compelling: reductions in the incidence and improved management of chronic diseases like T2DM, heart disease, certain cancers, mental health issues, and overall improved survival [3-26]. Without fear of being mistaken, it can be said that sedentary lifestyles are an existential problem brought on by technological advances, primarily in communications. In fact, a high percentage of people spend all or most of their time sitting in the office, and even worse with remote work from home. Accordingly, there is a need to address how sedentarism should be managed. To the best of our knowledge physical activity is the best and economic strategies to solve this problem, but it is not so easy as it sounds because people need to be convinced and constant for several years [3 26]. Emphasis on sedentary time loss through physical activity (at least moderate 150 minutes/week or vigorous 75 minutes/week or, at least, move more and sit less) can substantially lower cardiometabolic risk and improve muscular function [3-26].

1. Mattson MP. Evolutionary aspects of human exercise--born to run purposefully. Aging Res Rev. 2012; 11: 347-352.
2. Arocha Rodulfo JI. Sedentary lifestyle a disease from xxi century. Clin Investig Arterioscler. 2019; 31: 233-240. English, Spanish.
3. Global action plan on physical activity 2018-2030: more active people for a healthier world. Geneva: World Health Organization; 2018.
4. Spotorno AE. Evolution of the human species: odyssey or tragedy?. Electronic Journal of Innovation in Science Teaching 2017; 1: 79-99.
5. Wilmot EG, Edwardson CL, Achana FA, Davies MJ, Gorely T, Gray LJ, et al. Sedentary time in adults and the association with diabetes, cardiovascular disease and death: systematic review and meta- analysis. Diabetologia. 2012; 55: 2895-2905.
6. Zhao R, Bu W, Chen Y, Chen X. The Dose-Response Associations of Sedentary Time with Chronic Diseases and the Risk for All-Cause Mortality Affected by Different Health Status: A Systematic Review and Meta-Analysis. J Nutr Health Aging. 2020; 24: 63-70.
7. Barnett TA, Kelly AS, Young DR, Perry CK, Pratt CA, Edwards NM, et al. Approaches to the Prevention and Management of Childhood Obesity A Scientific Statement From the American Heart Association. 2012; 127.
8. Powell C, Herring MP, Dowd KP, Donnelly AE, Carson BP. The cross- sectional associations between objectively measured sedentary time and cardiometabolic health markers in adults - a systematic review with meta-analysis component. Obes Rev. 2018; 19: 381-395.
9. Katzmarzyk PT, Powell KE, Jakicic JM, Troiano RP, Piercy K, Tennant B; 2018 PHYSICAL ACTIVITY GUIDELINES ADVISORY COMMITTEE*.Sedentary Behavior and Health: Update from the 2018 Physical Activity Guidelines Advisory Committee. Med Sci Sports Exerc. 2019; 51: 1227-1241.
10. Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT; Lancet Physical Activity Series Working Group. Effect of physical inactivity on major non-communicable diseases worldwide: An analysis of burden of disease and life expectancy. Lancet. 2012; 380: 219-229.
11. Guthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1.9 million participants. Lancet Global Health. 2018; 6: e1077-e1086.
12. Strain T, Flaxman S, Guthold R, Semenova E, Cowan M, Riley LM, et al. Country Data Author Group. National, regional, and global trends in insufficient physical activity among adults from 2000 to 2022: a pooled analysis of 507 population-based surveys with 5·7 million participants. Lancet Glob Health. 2024; 12: e1232-e1243.
13. WHO. Physical activity. 2025.
14. Guthold R, Stevens GA, Riley LM, Bull FC. Global trends in insufficient physical activity among adolescents: a pooled analysis of 298 population-based surveys with 1 6 million participants. Lancet Child Adolescence Health. 2020; 4: 23-35.
15. Yu P, Zhao Z, Huang L, Zou H, Meng X, Kan R, et al. The Impact of Sedentary Behavior on Renal Function Decline in 132,123 Middle Aged and Older Adults: A Nationwide Cohort Study. Med Sci Monit. 2023; 29: e941111.
16. Hernández-Pizarro HM, Maynou L. The effects of physical activity prescription on mental health: Evidence from primary care. Econ Hum Biol. 2024; 55: 101432.
17. Jang YS, Park YS, Kim H, Hurh K, Park EC, Jang SY. Association between sedentary behavior and chronic kidney disease in Korean adults. BMC Public Health. 2023; 23: 306.
18. Jiang X, Tang L, Zhang Y, Bai Y, Luo H, Wang R, et al. Does sedentary time and physical activity predict chronic back pain and morphological brain changes? A UK biobank cohort study in 33,402 participants. BMC Public Health. 2024; 24: 2685.
19. Díaz-Martínez X, Garrido A, Martínez MA, Leiva AM, Álvarez C,

    Ramírez-Campillo R, et al. Factors associated with physical inactivity in Chile: results of the 2009-2010 National Health Survey. Rev Med Chil. 2017; 145: 1259-1267.

20. Gilchrist SC, Howard VJ, Akinyemiju T, Judd SE, Cushman M, Hooker SP, et al. Association of sedentary behavior with cancer mortality in middle-aged and older US adults. JAMA Oncol. 2020; 6: 1-9,
21. Arocha Rodulfo I. The Cardiometabolic Burden of Sedentarism and Its Implications on Health. Clin Med Res 2022; 11: 95-101.
22. Thivel D, Tremblay A, Genin PM, Panahi S, Rivière D, Duclos M. Physical Activity, Inactivity, and Sedentary Behaviors: Definitions and Implications in Occupational Health. Front Public Health. 2018; 6: 288.
23. Chau JY, Grunseit AC, Chey T, Stamatakis E, Brown WJ, Matthews CE,et al. Daily sitting time and all-cause mortality: a meta-analysis. PLoS ONE. 2013; 8: e80000.
24. Pekas EJ, Allen MF, Park SY. Prolonged sitting and peripheral vascular function: potential mechanisms and methodological considerations. J Appl Physiol (1985). 2023 Apr; 134: 810-822.
25. Young DR, Hivert MF, Alhassan S, Camhi SM, Ferguson JF, Katzmarzyk PT, et al. Sedentary Behavior and Cardiovascular Morbidity and Mortality: A Science Advisory From the American Heart Association.Physical Activity Committee, 2016; 134.
26. Arocha-Rodulfo JI, Aure-Fariñez G. Músculo activo, una maquinaria compleja y eficiente. Revisión narrativa. Med Interna (Caracas) 2023; 39: 171-183.