Deaths potentially averted by small changes in physical activity and sedentary time: [meta-analysis], 2026, Ekelund+

[SNT Gatchaman]

Deaths potentially averted by small changes in physical activity and sedentary time: an individual participant data meta-analysis of prospective cohort studies

Spoiler: Authors

Ulf Ekelund; Jakob Tarp; Ding Ding; Miguel Adriano Sanchez-Lastra; Knut Eirik Dalene; Sigmund A Anderssen; Jostein Steene-Johannessen; Bjorge H Hansen; Bente Morseth; Laila A Hopstock; Edvard Sagelv; Peter Nordström; Anna Nordström; Maria Hagströmer; Ing-Mari Dohrn; Keith M Diaz; Steven Hooker; Virginia J Howard; I-Min Lee; Morten W Fagerland

BACKGROUND
The effects of small, realistic changes in physical activity and sedentary behaviour on population-level mortality are unclear. We aimed to estimate the proportion of deaths preventable by 5-min and 10-min incremental increases in moderate-to-vigorous intensity physical activity (MVPA) and 30-min and 60-min reductions in daily sedentary time.

METHODS
We did an individual participant data meta-analysis of prospective cohort studies. We included studies with device-measured physical activity and sedentary time. We estimated the proportion of deaths prevented (potential impact fractions; PIFs) by changes in (1) the approximately 20% least active participants (high-risk approach) and (2) all participants except the approximately 20% most active (population-based approach). We calculated PIFs from adjusted hazard ratios estimated for 5-min and 10-min increases in MVPA and 30-min and 60-min reductions in sedentary time from observed levels across the activity distribution.

FINDINGS
We included seven cohorts from Norway, Sweden, and the USA (n=40 327; 4895 deaths). Data from the UK Biobank (n=94 719; 3487 deaths) were analysed separately. A 5-min/day increase in MVPA in the least active participants might prevent 6·0% (95% CI 4·3–7·4) of all deaths. A similar increase in MVPA in all participants except the most active might prevent 10·0% (6·3–13·4) of all deaths. Reducing sedentary time by 30 min/day might prevent 3·0% (2·0–4·1) of all deaths in the high-risk approach and 7·3% (4·8–9·6) in the population-based approach. Results from the UK Biobank were of a smaller magnitude but still substantial—eg, reducing sedentary time by 30 min/day in all except the most active participants was associated with preventing 4·5% (2·8–6·1) of total deaths.

INTERPRETATION
Small and realistic increases in MVPA of 5 min/day might prevent up to 6% of all deaths in a high-risk approach and 10% of all deaths in population-based approach. Reducing sedentary time by 30 min/day might prevent a smaller, but still meaningful, proportion of deaths in the two risk scenarios.

FUNDING
None.

Web | DOI | PDF | The Lancet | Paywall

 

[bobbler]

That word averted feels contentious vs what even in the most dictatorial of circumstances could ever be possible to know / find out /messure?

Thing is everyone is sedentary until they then are in the ‘increased’ group but humans flip flop more than this surely? Certainly over spans long enough anyone could claim to make a difference on big groups.

And everyone is in the ‘I increased my steps or decreased sitting’ until a seriously bad health condition means they can’t or us it just because life got in the way or they stopped for other reasons. Well all of these things say you’d be mad to use words more definitive than association as having the job going to 16hrs a day stopping you nightly walk could be as much a factor as would bring in a situation where you had to say to that financially

It also feels like it’s stacking the cards towards an ideology without realising it by separating out ‘highest activity’ and things like that

We all know people who had jobs like gardener or heavy manual jobs in factory where even if it’s not stressful their body gets done in decades earlier and literally wears out

So that becomes the ‘we are taking about that end of things’ side of it. And yet there for everything human are individual differences and a spectrum for everything anyway

I don’t understand how people thought they could calculate this from the data they used.

It’s just surely saying those whose life went as planned vs those it didn’t had a small % death difference and then pretending there’s not this massive load of data everywhere else about how being poor living in crap accommodation on the bread line takes a decade off life expectancy.

And people who are from families where genetics means lots have eg cancer or me/cfs or other significant severe disabilities are passing down not just the bad luck but in countries where help to get on housing ladder or to access better schools relies on not having bad luck with your parents aren’t dying earlier because they couldn’t motivate themselves not to sit down. Life’s harder if you only have the choice of harder jobs due to your starting life with further commutes by bus returning home to a less wuiet relaxing home where you don’t stress how to keep the roof over your head and shout only affording cheap food and minimal heating.

How did they control for all these endless bigger explanatory correlations?

This is just a review multiplying bias and data issues on top of those in the initial papers potentially - determined as they are perhaps

 

[Utsikt]

A 5-min/day increase in MVPA in the least active participants might prevent 6·0% (95% CI 4·3–7·4) of all deaths. A similar increase in MVPA in all participants except the most active might prevent 10·0% (6·3–13·4) of all deaths.

most active might prevent 10·0% (6·3–13·4) of all deaths. Reducing sedentary time by 30 min/day might prevent 3·0% (2·0–4·1) of all deaths in the high-risk approach and 7·3% (4·8–9·6) in the population-based approach.

In both cases, the effect was larger for the 80 % most inactive than for the 20 % most inactive. How is that possible? Wouldn’t it be expected that the benefit of increased activity would be greater for those that are the least active, so you’d see a diminishing return?

One explanation might be that a larger proportion of the 20 % most inactive are inactive due to ill health, and that their health conditions don’t really improve from activity.

 

[rvallee]

Delayed would be more accurate than averted. All of this adds up to a few extra months of health-related quality of life, and only in some cases.

One explanation might be that a larger proportion of the 20 % most inactive are inactive due to ill health, and that their health conditions don’t really improve from activity.

Medicine's inability to actually think holistically is a serious impediment on its effectiveness. The weird obsession with ineffective exercise rehabilitation for illnesses where it's not a treatment likely takes away most of the benefits observed here, even if the best case scenario were followed.

And then there's other stuff like the dark side of fitness obsession, leading to so many people, men and women alike, taking substances to increase their performance, none of which is ever considered in this. Exercise is simply counted as beneficial without ever considering any of the negatives. How many people end up injuring themselves doing too much sport in their youth, end up being less active in later years, develop chronic pain that medicine is unable to treat? None of that is taken into account because it's impossible to track, has far too many variables.

This is actually comparable to how medicine's refusal to take chronic illness more than likely made all medically-assisted births either close to zero or a net negative. Apparently the estimated number of total assisted births is somewhere in the 15-20M range. The number of children who never got to be born because of neglected chronic illness is likely higher than that, a net negative as well.

That's why words matter. Absolutely not a damn thing out of psychosomatic/biopsychosocial is holistic in the sense of looking at the whole. Instead it explicitly is just a code word for pseudoscience. Looking holistically means counting all the ins and outs, not just focusing on a few ins while ignoring some outs and declaring it a net win, which is a common way to do 'creative accounting', aka financial fraud.

This is very common in all studies that only look at direct health care expenditures dealing with chronic illness like ours, then go on to declare that researching is too expensive, and there's "nothing to find anyway" so they pretend like throwing people out of health care amount to net savings. They never actually properly account for all the lost gains, and realistically can't because it didn't happen.

Humans are notoriously poor holistic thinkers. So much that the very word has become directly synonymous with pseudoscience and medical harm.

Just consider this:

and 30-min and 60-min reductions in daily sedentary time

The average working age adult has only a few hours of actual free time per day, barely any if they have children. Most of the rest of the day is typically spent working, in most professions much of this is sitting down, and a lot of the rest of the time is also typically spent sitting down, such as eating, transportation, and so on.

Since most people work sitting down, working fewer hours and more people working from home would likely do more to reduce time sitting down than any other measure. With more time and energy for people to do leisurely things, much of this would be more likely to be spent moving, instead of resting. But no one ever thinks of those things, no one ever seems to look at the big picture. Here sedentary time is all about the much smaller number of hours of free time that most people have, rather than the longer hours where it's not actually an option.