Adjustment for physical activity in studies of sedentary behaviour

Sedentary behaviour (too much sitting, as distinct from too little exercise) has emerged as a potentially significant public health issue. Analytically, researchers have reported 'independent' associations between sedentary behaviour (SB) and a number of health outcomes by adjusting for physical activity (PA) (and other confounders), and conclude that SB is associated with the outcome even in those who are physically active. However, the logical rationale for why adjustments for PA are required is often not delineated, and as a consequence, PA has been conceptualised as a confounder, an intermediary, and an effect measure modifier - sometimes simultaneously - in studies of SB and health outcomes. This paper discusses the analytical assumptions underlying adjustment for PA in studies of SB and a given outcome, and considers the implications for associations between SB and health.