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Association between daily sitting time and sarcopenia in the US population: a cross-sectional study

Archives of Public Health volume 83, Article number: 5 (2025) Cite this article

Abstract

Background

Sarcopenia is an age-related syndrome marked by a gradual decline in skeletal muscle mass and function. While various factors influencing sarcopenia have been studied, the link between daily sedentary time and sarcopenia remains underexplored.

Method

This study analyzed the association between daily sitting time and sarcopenia using data from the National Health and Nutrition Examination Survey (NHANES 2011–2018). Daily sitting time was assessed through questionnaires, while sarcopenia was measured using body mass index (BMI) adjusted appendicular skeletal muscle mass (ASM). The relationship was analyzed using weighted logistic regression models and smoothing curves. Stratified analyses and interaction testing were employed to investigate population-specific characteristics of this association. Furthermore, chi-square test and grouped logistic regression were used to further analyze the impact of vigorous activity on the relationship between the two variables.

Result

This study included 9998 participants with complete information. The fully adjusted model showed a significant positive correlation between daily sitting time and the prevalence of sarcopenia (OR = 1.07, 95% CI: 1.03–1.10, P = 0.0026). The group with daily sitting time ≥ 9 h had a 90% higher risk of sarcopenia compared to the < 4 h group (OR = 1.90, 95% CI: 1.22–2.84, P = 0.0040). Smooth curve fitting analysis showed a linear correlation between this relationship. Stratified analysis shows that non-Hispanic white men with a lower BMI (BMI < 25) have a higher risk of sarcopenia. Compared to those who actively participate in vigorous activities, individuals who lack recreational activities have a higher prevalence and risk of sarcopenia.

Conclusion

Our research has found that increased sedentary time significantly increases the risk of sarcopenia, especially among non-Hispanic white men with lower BMI. Additionally, individuals who lack vigorous physical activity also have a higher prevalence and risk of sarcopenia. Therefore, reducing sedentary behavior and increasing moderate exercise may be effective prevention strategies.

Peer Review reports

Text box 1. Contributions to the literature

• Large-scale population studies indicate that over 60.05% of participants sit for more than 6 h each day, and prolonged sitting time is significantly positively correlated with sarcopenia.

• Non-Hispanic white men with low BMI and a lack of recreational activities face a higher risk of developing sarcopenia.

• There is an urgent need to promote public health policies to reduce sedentary behavior and increase physical activity to address sarcopenia.

Introduction

In recent years, sedentary behavior has become a major public health issue, distinct from physical inactivity. Sedentary lifestyles are widespread in modern society, referring to low-energy activities (≤ 1.5 metabolic equivalents) performed while sitting, reclining, or lying down during waking hours [1]. This behavior is associated with various health problems, including low back pain, cardiovascular diseases, diabetes, cancer, and mental health issues [2,3,4]. Large-scale epidemiological studies have shown that sedentary behavior not only increases the risk of cardiovascular events but is also closely linked to all-cause mortality [5]. The latest global guidelines on physical activity and sedentary behavior recommend limiting sedentary time and improving physical health by increasing physical activity [6].

Sarcopenia is a systemic, progressive skeletal muscle disease characterized by a gradual decline in muscle mass and function [7]. Studies show that it affects 10–16% of the elderly globally [8], and is closely linked to various adverse health outcomes such as falls, fractures, functional impairment, disability, and all-cause mortality [8,9,10]. Moreover, sarcopenia is associated with increased cardiovascular risk, including hyperglycemia, hypertension, insulin resistance, and cardiovascular disease [11,12,13]. Its presence not only impairs quality of life, but also significantly increases the risk of hospitalization and healthcare costs [14, 15]. As global aging intensifies, the number of affected individuals is expected to exceed 500 million by 2050 [16]. Although the exact causes of sarcopenia are not yet fully understood, it is generally believed to be related to factors such as age, malnutrition, lack of exercise, metabolic disorders, and oxidative stress [17,18,19,20]. Despite the growing awareness of sarcopenia, its prevalence remains high. Therefore, it is crucial to raise public awareness of sarcopenia and identify factors that can mitigate its impact.

Sarcopenia is closely related to unhealthy lifestyle habits. Daily sitting time is also a hot topic in lifestyle issues today. Based on existing research, we hypothesize that daily sitting time is correlated with sarcopenia. However, current research lacks large-scale population studies exploring this correlation and lacks robust theoretical support. This study uses data from the National Health and Nutrition Examination Survey (NHANES) survey from 2011 to 2018 to investigate the relationship between daily sitting time and sarcopenia, providing a scientific basis for identifying high-risk groups and developing preventive measures.

Method

Study population

This cross-sectional study used the publicly available NHANES dataset (http://www.cdc.gov/nchs/nhanes.htm), which is an ongoing national survey aimed at collecting health and nutrition information from the U.S. population. The survey was approved by the ethics review board of the National Center for Health Statistics (NCHS), so no additional ethical review was needed. In this study, we selected 39,156 individuals from four cycles between 2011 and 2018, and after applying strict inclusion criteria, we identified 9,998 participants, as detailed in Fig. 1. We excluded 14,505 participants due to missing daily sedentary time, 11,434 missing related sarcopenia data, and 3,219 missing covariate data.

Fig. 1
figure 1

Participant screening flowchart

Full size image

Sitting time

Sedentary time is a key part of sedentary behavior and is gathered through self-reported questionnaires. Sitting time is defined as the “time spent sitting or reclining on a typical day,” which includes time spent sitting or leaning while awake at work, home, or school. This encompasses time spent at a desk, socializing with friends (primarily referring to static social leisure activities such as those in cafes, cinemas, etc.), riding in cars, buses, or trains, reading, playing cards, watching TV, or using a computer. Based on previous research and population distribution, sitting time is categorized into four levels: less than 4 h (h) per day, 4 to ≤ 6 h per day, 6 to ≤ 9 h per day, and ≥ 9 h per day, with less than 4 h of sitting time per day considered the reference group [21].

Definition of Sarcopenia

The NHANES uses dual-energy X-ray absorptiometry (DXA) to quantify appendicular skeletal muscle mass (ASM). Due to the design principles of the NHANES database, individuals aged 60 and older are not eligible to participate in DXA. ASM is defined as the total lean soft tissue mass of the arms and legs. Sarcopenia is objectively defined using the sarcopenia index (ASM/BMI), with a cutoff of less than 0.789 for men and less than 0.512 for women [22, 23], and previous studies have validated the feasibility of this criterion [24].

Covariates

The current study collected potential confounding variables that may associate sedentary time with sarcopenia based on previous research [24,25,26]. These covariates include age, gender, race, education level, poverty income ratio (PIR), height, weight, body mass index (BMI), waist circumference, smoking status, drinking status, diabetes, hypertension, coronary heart disease, moderate and vigorous recreational activity status, albumin, creatinine, blood urea nitrogen (BUN), high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), energy intake, protein intake, carbohydrate intake, and dietary fiber intake.

Smoking was defined as smoking 100 cigarettes or more during the life cycle; drinking was ever having 4–5 or more drinks a day. Chronic disease was based on physician diagnosis or medication records. Moderate leisure activities were ≥ 10 min/week of moderate-intensity exercise (e.g., brisk walking, cycling, swimming, golf); vigorous activities were ≥ 10 min/week of high-intensity exercise (e.g., running, basketball). Nutritional intake is calculated as the average of the first and second days.

Statistical analysis

NHANES uses complex sampling and weighting methods to represent the national population. The sample weight for this study is WTINT2YR/4. We used weighted chi-square tests and weighted linear regression to compare baseline characteristics. Results are presented as mean ± standard error (SE; for continuous variables) or percentage (for categorical variables). Weighted logistic regression was used to analyze the relationship between sitting time and sarcopenia in different models, and trends were detected by grade (P values indicate trends (P for trends). Model 1 did not adjust for covariates, Model 2 adjusted for age, gender, race, education, and household income, while Model 3 made comprehensive adjustments for all covariates. In the fully adjusted model, we also employed generalized additive models (GAM) and smooth curve fitting to study their non-linear relationship. We conducted stratified analyses and interaction tests to assess the consistency and differences in outcomes among baseline variables. Furthermore, to further analyze the impact of vigorous activity on the relationship between the two, we employed chi-square tests and grouped logistic regression. All analyses were performed using R software version 4.1 and EmpowerStats version 4.1. P-values < 0.05 were considered statistically significant.

Results

The study ultimately included 9,998 participants with complete data (Fig. 1), which, when weighted, represent a total population of 104,887,159. The participants consisted of 5,166 females and 4,832 males, with over one-quarter spending 6 to ≤ 9 h sitting daily, and 60.05% of the total population sitting for more than 6 h (Table 1). There were significant differences in age, race, education level, PIR, activity status (vigorous and moderate activity), smoking status, drinking status, diabetes, coronary heart disease, and markers such as albumin, BUN, creatinine, TC, and LDL-C across different sedentary time groups. Sarcopenia prevalence rates were similar across the four groups, ranging from 6.93 to 7.81%.

Table 1 Participant characteristics by daily sitting time categories: NHANES 2011–2018, weighted
Full size table

We applied weighted univariate and multivariate logistic regression models to study the relationship between daily sitting time and sarcopenia, using individuals who sat < 4 h per day as the control group (Table 2). The unadjusted model (model 1) showed no significant association between sitting time and sarcopenia. However, after adjusting for demographic characteristics (model 2), groups with 6 to ≤ 9 h and ≥ 9 h per day of sitting time showed significant correlation with sarcopenia risk (6 to < 9 h, OR = 1.40, 95% CI: 1.07–1.83; ≥ 9 h, OR = 1.63, 95% CI: 1.18–2.24), with longer sitting duration associated with higher risk(OR = 1.07, 95% CI: 1.02–1.11, P = 0.0002). The same trend was observed in the fully adjusted model (model 3), particularly showing significantly increased sarcopenia risk among individuals who sat for more than 6 h daily. Figure 2A shows the sarcopenia risk trend for different daily sedentary time groups in the fully adjusted model. Moreover, trend analysis indicated that sedentary time was significantly associated with the risk of sarcopenia (p for trend < 0.05), and this finding was confirmed in both preliminary and fully adjusted models.

Table 2 Univariate and multivariate analyses by logistic regression model, weighted
Full size table
Fig. 2
figure 2

The correlation between daily sitting time and sarcopenia. A: Adjusted prevalence of sarcopenia and its 95% confidence interval (CI) for different sedentary time groups. B: The red line represents the smooth fitting curve between variables, and the blue band indicates the 95% CI of the fit. (Adjustments have been made for all relevant covariates)

Full size image

GAM and smooth curve fitting analyses indicated a linear relationship between sitting time and sarcopenia (Fig. 2B), with each unit increase in sitting time associated with a 7% increased risk of sarcopenia. Weighted stratification and interaction effect analyses identified potential factors influencing this relationship, with results showing that gender, race, and BMI may play a role (Table 3). Notably, males, non-Hispanic whites, and individuals with a BMI of less than 25 may face a higher risk of sarcopenia.

Table 3 Stratified analysis and interaction analysis, weighted. Each stratification adjusted for all factors except the stratification factor itself
Full size table

Further analysis of the relationship between vigorous recreational activities and sarcopenia showed that individuals who participated in vigorous recreational activities had lower rates of sarcopenia, regardless of their daily sitting time (Fig. 3). Significant differences in sarcopenia prevalence were observed between those who participated in vigorous activities and those who did not across all groups (Supplementary Table 1). According to the grouped logistic regression model (Model 3) fully adjusted for covariates, individuals lacking vigorous activity showed a statistically significantly higher risk of developing sarcopenia compared to those with vigorous activity (Supplementary Table 2). Non-linear analysis further confirmed that among people lacking vigorous activities, sitting time showed a linear relationship with sarcopenia, with longer sitting times associated with higher risk (Supplementary Fig. 1).

Fig. 3
figure 3

Effects of vigorous activity on sarcopenia prevalence. *, P < 0.05

Full size image

Discussion

This study aims to evaluate the relationship between daily sitting time and sarcopenia, and to examine the impact of vigorous recreational activities. In a cross-sectional analysis of 9,998 participants (weighted represent approximately 10.48 million individuals), it was found that over 60% of participants sat for > 6 h daily, particularly non-Hispanic whites with higher educational levels. Through weighted logistic regression analysis, we discovered a positive correlation between sedentary time and the risk of sarcopenia, especially after adjusting for covariates; individuals had a significantly increased risk of sarcopenia. GAM and smooth curve analyses further confirmed this linear relationship, showing that for each additional hour of sedentary time, the risk of sarcopenia increased by 7%. Notably, males, non-Hispanic whites, and individuals with a BMI of less than 25 may face a higher risk of sarcopenia. Our research found that for each additional hour of daily sitting time, the risk of sarcopenia increases by 7%. Although this single increment may seem small, its cumulative effect cannot be overlooked, especially for populations lacking physical activity. This study provides important scientific evidence for understanding the potential threats of modern lifestyles to muscle health.

With the development of society, modern lifestyles and work habits have undergone significant changes, and prolonged sitting has become an important part of daily life [27, 28]. Reports show that Australian adults spend 50–70% of their day in a sedentary state [29], while American adults have increased their total sitting time by nearly one hour over the past decade [30]. This sedentary and inactive lifestyle has increased various health risks, including obesity, cardiovascular diseases, diabetes, mental health issues, musculoskeletal disorders, and mortality rates [2, 3, 31,32,33]. Research indicates that increased sitting time is closely associated with all-cause mortality and cognitive decline in older adults [34, 35]. Furthermore, sedentary behavior significantly raises healthcare costs, with the medical expenses in Australia attributed to sedentary behavior reaching AUD 185 million [36], while in the UK, it is as high as GBP 800 million [37]. According to a recent report from The Lancet, nearly one-third of adults do not meet the World Health Organization (WHO) recommended levels of physical activity, with the age-standardized prevalence of physical inactivity reaching 31.3% [38]. In 2020, the WHO guidelines for the first time recommended reducing sedentary behavior, emphasizing the substantial health benefits of increasing physical activity [6].

In recent years, sarcopenia has become a major public health concern. Sarcopenia, a term coined by Irwin Rosenberg, describes age-related muscle atrophy [39]. It is now defined as a disease characterized by a reduction in skeletal muscle mass, strength, and function [21]. Approximately 10-16% of the elderly population worldwide are affected by this condition [8]. Sarcopenia leads to a decline in functional capacity and quality of life during the aging process, and increases the risk of adverse outcomes such as falls, disability, frailty, hospitalization, and all-cause mortality [10, 21, 40]. Sarcopenia primarily affects the elderly, but it is gradually spreading to younger individuals. With the global increase in the elderly population, the prevalence of sarcopenia is expected to rise, posing a significant burden on public health systems. As there is currently no cure, the prevention or slowing of sarcopenia progression is of utmost importance.

Prolonged sitting is often seen as a sign of physical inactivity, but research shows that even with regular exercise, prolonged sitting is still harmful to metabolic health [41]. This suggests that the impact of prolonged sitting on health is partly independent of exercise, and the detrimental association between sitting time and various diseases cannot be fully mitigated or eliminated through exercise alone [42]. Despite previous studies exploring the potential impact of sedentary behavior on sarcopenia [43], there is a lack of sufficient evidence and large-scale population research. Our research shows that prolonged sitting time is significantly associated with the risk of sarcopenia, and the longer the sitting time, the higher the risk of sarcopenia. Furthermore, the prevalence and risk of sarcopenia are higher in populations lacking vigorous recreational activities. Notably, in populations engaging in vigorous recreational activities, the impact of sedentary behavior on sarcopenia is not significant. Therefore, we strongly recommend that people who sit for long periods of time each day increase their physical activity to prevent sarcopenia.

Several biological mechanisms may explain our results. First, prolonged sedentary behavior may reduce muscle protein synthesis by lowering the sensitivity of muscle anabolic metabolism, leading to muscle loss and a decline in physical function [44]. Second, sedentary behavior may increase levels of chronic low-grade inflammation [45], stimulating protein catabolism and inhibiting muscle synthesis [46]. Additionally, factors such as malnutrition, insulin resistance, mitochondrial dysfunction, oxidative stress, declining motor neuron function, and aging are also considered potential causes [7, 47,48,49].

Previous research has suggested that hormonal changes during menopause in women lead to a higher morbidity rate compared to men [50, 51]. However, in our study, the average age of the subjects was 34–39 years, during which estrogen plays a protective role for women. The results indicated that the morbidity rate was higher in men, a finding that is supported by Patel HP et al. [52]. Although obesity has many negative effects on health, our research found that a lower body mass index is significantly associated with the risk of sarcopenia, consistent with previous studies [53]. Furthermore, sarcopenia also shows variability across different regions and ethnicities, with differences observed between Western and Asian populations, as well as between White and Black individuals [54].

This study has several advantages. First, it is a large-scale cross-sectional study, benefiting from the rigor of the NHANES data, making the results relatively reliable. Secondly, by adjusting for covariates using different data models, potential confounding factors were effectively controlled. However, the study also has its limitations. First, the cross-sectional design makes it difficult to establish causal relationships. Second, the exposure variables rely on self-reporting, which may introduce bias and affect the analysis results. Additionally, DXA can only assess populations under 60 years old, leading to a lack of research on elderly patients. Therefore, future research should be more comprehensive and in-depth to further validate these findings.

Conclusion

Our research shows that after adjusting for potential confounding factors, sedentary time is significantly associated with sarcopenia, and the risk of sarcopenia increases with longer daily sitting time. This association is more pronounced in non-Hispanic white men with a BMI less than 25. Furthermore, those without vigorous recreational activity have a higher prevalence and risk of sarcopenia compared to those with vigorous recreational activity. Therefore, reducing sedentary behavior and increasing moderate exercise may effectively prevent sarcopenia.

Data availability

No datasets were generated or analysed during the current study.

Abbreviations

NHANES:

National Health and Nutrition Examination Survey

BMI:

Body mass index

ASM:

Appendicular skeletal muscle mass

NCHS:

National Center for Health Statistics

DXA:

Dual-energy X-ray absorptiometry

PIR:

Poverty income ratio

BUN:

Blood urea nitrogen

HDL-C:

High-density lipoprotein cholesterol

TC:

Total cholesterol

TG:

Triglycerides

LDL-C:

Low-density lipoprotein cholesterol

SE:

Standard error

GAM:

Generalized additive models

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Acknowledgements

The author appreciates the valuable contributions of the NHANES study staff and participants.

Funding

This study was supported by grants from Department of Health of Zhejiang Province (2023KY494 to Dr. Haiyu Shao and 2022KY608 to Dr. Tingxiao Zhao).

Author information

Author notes

  1. Alei Zhang, Yanlei Li and Jinlei Zhou contributed equally to this study.

Authors and Affiliations

  1. Department of Second Orthopedics, First People’s Hospital of Jiashan County, Tiyu South Road 1218#, Jiashan County, Zhejiang, China

    Alei Zhang & Tao Tang

  2. Emergency and Critical Care Center, Department of Emergency, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Shangtang Road 158#, Hangzhou, Zhejiang, 310014, China

    Yanlei Li

  3. Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Shangtang Road 158#, Hangzhou, Zhejiang, China

    Jinlei Zhou, Shanggao Xie, Haiyu Shao & Tingxiao Zhao

  4. Department of Rheumatology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China

    Yuan Zhang

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  1. Alei Zhang
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Contributions

TT and ALZ contributed to the conception and design of the study; YLI, JLZ, YZ, SGX, HYS, and TXZ were responsible for data collection and processing; TT, ALZ, TXZ, and YLI performed the data analyses and constructive discussions. TT and ALZ drafted the manuscript, tables, and figures, and other authors critically revised the manuscript. All authors contributed to the article and approved the submitted version.

Corresponding authors

Correspondence to Tingxiao Zhao or Tao Tang.

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The NHANES data is publicly available. According to local laws and institutional requirements, this study did not require ethical review and approval.

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Zhang, A., Li, Y., Zhou, J. et al. Association between daily sitting time and sarcopenia in the US population: a cross-sectional study. Arch Public Health 83, 5 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s13690-025-01501-x

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Archives of Public Health

ISSN: 2049-3258