Adults with low physical activity and high sedentary behavior had the highest risk of cardiovascular disease in a systematic review and meta-analysis published in European Journal of Preventive Cardiology. Increased cardiovascular risk was also observed among adults with either low physical activity and low sedentary behavior or high physical activity and high sedentary behavior.
The analysis pooled data from 17 cohort studies published between 2010 and 2025 that examined the joint association between physical activity, sedentary behavior, and fatal or nonfatal cardiovascular disease outcomes in adults. Study-level data identified through PubMed, EMBASE, and Cochrane databases were analyzed using meta-analytic methods.

Findings

• Lowest physical activity combined with highest sedentary behavior was associated with increased cardiovascular disease risk compared with the highest physical activity and lowest sedentary behavior group (HR 1.78; 95% CI 1.59-2.00).
• Increased cardiovascular risk was also observed in the lowest physical activity plus lowest sedentary behavior group (HR 1.25; 95% CI 1.12-1.40).
• Participants with high physical activity and high sedentary behavior also showed increased cardiovascular risk (HR 1.16; 95% CI 1.06-1.27).
• Subgroup analyses according to physical activity and sedentary behavior domains, cardiovascular outcomes, and exposure measurement methods showed similar patterns across studies.

The findings suggest that joint patterns of physical activity and sedentary behavior may provide additional information about cardiovascular risk beyond either behavior alone.