A new study shows that being sedentary increases the risk of the most common types of heart disease, even among those who get enough exercise.

Investigators at Mass General Brigham found sedentary behavior was associated with higher risks of all four types of heart disease, with a marked 40-60 percent greater risk of heart failure and cardiovascular death when sedentary behavior exceeded 10.6 hours a day. (Sedentary behavior is defined as waking activity with low energy expenditure while sitting, reclining, or lying down and does not include hours spent sleeping at night.)

Researchers also emphasized that meeting guideline levels of moderate-to-vigorous physical activity may be insufficient on its own to reduce cardiovascular risk if one is also sitting too much.

Their results are published in the Journal of the American College of Cardiology.

“Many of us spend the majority of our waking day sitting, and while there’s a lot of research supporting the importance of physical activity, we knew relatively little about the potential consequences of sitting too much beyond a vague awareness that it might be harmful,” said lead author Ezimamaka Ajufo, a cardiology fellow at Brigham and Women’s Hospital.

“Sedentary risk remained even in people who were physically active, which is important because many of us sit a lot and think that if we can get out at the end of the day and do some exercise we can counterbalance it,” Ajufo says. “However, we found it to be more complex than that.”

Ajufo’s team, which included researchers from across MGB, analyzed one week of activity-tracker data from 89,530 individuals from the U.K. Biobank prospective cohort.

They looked at associations between daily time spent sitting and the future risk of four common cardiovascular diseases: atrial fibrillation, heart attacks, heart failure, and death from cardiovascular causes. The team used a machine learning algorithm to classify sedentary behavior.

Many of the negative effects of sedentary behavior persisted even among those individuals who achieved the guideline-recommended more than 150 minutes of moderate-to-vigorous physical activity per week.

For example, although the study found that the risk of atrial fibrillation and heart attacks could be mostly eliminated by engaging in physical activity, the excess risk of heart failure and cardiovascular  death could only be partially offset by physical activity.

“Our data supports the idea that it is always better to sit less and move more to reduce heart disease risk, and that avoiding excessive sitting is especially important for lowering risk of heart failure and cardiovascular death,” said co-senior author Shaan Khurshid,  an electrophysiologist and faculty member in the Telemachus And Irene Demoulas Family Foundation Center for Cardiac Arrythmias at Massachusetts General Hospital.

The research team hopes these findings will help inform future guidelines and public health efforts. They would like future prospective studies to test the efficacy of public health interventions that help people reduce the number of hours they spend being sedentary and see how that affects cardiovascular health.

Next, they plan to extend this research to investigate the impacts of sedentary behavior on a range of other diseases and for longer spans of time.

“Exercise is critical, but avoiding excessive sitting appears separately important,” said co-senior author Patrick Ellinor,  a cardiologist and co-director of the Corrigan Minehan Heart Center at Massachusetts General Hospital. “Our hope is that this work can empower patients and providers by offering another way to leverage movement behaviors to improve cardiovascular health.”

Authorship: Additional Mass General Brigham authors include Timothy W. Churchill, J. Sawalla Guseh, and Krishna G. Aragam. Additional authors include Shinwan Kany and Joel T. Rämö.

Disclosures: Krishna G. Aragam receives sponsored research support from Sarepta Therapeutics and Bayer AG; he also reports a research collaboration with the Novartis Institutes for Biomedical Research. Patrick T. Ellinor receives sponsored research support from Bayer AG, IBM Research, Bristol Myers Squibb, Pfizer and Novo Nordisk; he has also served on advisory boards and/or consulted for Bayer AG.

Researchers were supported by the John S. LaDue Memorial Fellowship in Cardiovascular Medicine or Vascular Biology grant, the Walter Benjamin Fellowship from the Deutsche Forschungsgemeinschaft (521832260), a research fellowship from the Sigrid Jusélius Foundation, the National Institutes of Health (K23HL159262-01A1, 1K08HL153937, RO1HL092577, R01HL157635, and K23HL169839-01), the American Heart Association (19AMFDP34990046, 862032, 18SFRN34230127, 961045, and 2023CDA1050571), the President and Fellows of Harvard College (5KL2TR002542-04), and the European Union (MAESTRIA 965286).