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What are the Effects of Chronic Conditions on Morbidity and Sedentary Behaviour?

A study assessed the association between chronic conditions, physical multi-morbidity, and sedentary behaviour among adults in six countries.

Sedentary behaviour is associated with a wide range of deleterious outcomes such as diabetes, stroke, and premature mortality, irrespective of a person’s physical activity levels.

There have been no studies that are nationally representative, multi-national, or population-based that investigate the relationship between sedentary behaviour, chronic conditions, and physical multimorbidity (having more than one medical condition). (1, 2)

Assessing the association between chronic conditions, physical multimorbidity, and sedentary behaviour

This cross-sectional study aimed to assess the association between chronic conditions, physical multimorbidity, and sedentary behaviour among community-dwelling adults in six low- and middle-income countries.

The Study on Global Ageing and Adult Health (SAGE) survey included 34,129 adults over 50 years old from China, South Africa, Ghana, India, Mexico, and Russia.

Sedentary behaviour was self-reported as either more than eight hours a day (high) or less than eight hours a day (low).

The scientists assessed for eleven physical chronic conditions including angina, arthritis, asthma, chronic back pain, chronic lung disease, diabetes, edentulism, hearing problems, hypertension, stroke, or visual impairment.

Results of the Study

The results were recently published in the International Journal of Behavioral Nutrition and Physical Activity in 2017.

The study showed that the prevalence of high sedentary behaviour increased in a linear fashion from 7.1% in people with no chronic conditions to 24.1% in those with more than four chronic conditions.

In the multivariable analysis, visual impairment, stroke, chronic back pain hearing problems, chronic lung disease, asthma, arthritis and multimorbidity were significantly associated with high sedentary behaviour.

Disability explained more than 50% of the association for all chronic conditions with particularly high percentages (over 80%) for arthritis, asthma, and multimorbidity. Mobility problems explained 88% and 85% of the association of sedentary behaviour with arthritis and physical multimorbidity, respectively.

The pain was highly influential, explaining more than 86% of the relationship between sedentary behaviour and arthritis.

Sleep/energy problems explained between 9.3% (stroke) to 49.1% (arthritis) of the association, and cognitive problems from 21.5% (stroke) to 33.4% (hearing problems).

Findings for anxiety and depression were mixed.

In low to middle-income countries, those with chronic conditions and physical multimorbidity are significantly more sedentary. Clinicians should consider not only pain, mobility problems, and disability as barriers to physical activity in those with chronic conditions, but also psychological factors such as poor sleep and cognition.

Future research in these countries should focus on the effectiveness of reducing sedentary behaviour in the management of chronic conditions.

Written by Dr. Swapna Aleti, Scientific Writer and Associate Professor


  1. Fortin M, Stewart M, Poitras M-E, Almirall J, Maddocks H. A systematic review of prevalence studies on multimorbidity: toward a more uniform methodology. The Ann Fam Med. 2012;10:142–51.
  2. Picco L, Achilla E, Abdin E, Chong SA, Vaingankar JA, McCrone P, Chua HC, Heng D, Magadi H, Ng LL. Economic burden of multimorbidity among older adults: impact on healthcare and societal costs. BMC Health Serv Res. 2016;16:173.
  3. Vancampfort DStubb B, Koyanagi A. Physical chronic conditions, multimorbidity and sedentary behaviors amongst middle-aged and older adults in six low- and middle-income countries. International Journal of Behavioral Nutrition and Physical Activity. 2017. 



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