Isotemporal substitution of sedentary time with physical activity for cardiovascular health in older adults: a systematic review

TL;DR

This review finds that replacing sedentary time with physical activity, especially moderate-to-vigorous intensity, improves cardiovascular health in older adults.

Contribution

The study systematically evaluates how substituting sedentary behavior with physical activity of varying intensities affects cardiovascular health in older adults.

Findings

Replacing sedentary time with moderate-to-vigorous physical activity improves blood pressure, triglycerides, and insulin sensitivity in older adults.

A 30-minute daily substitution of sedentary time with physical activity is feasible and beneficial, with longer durations offering additional vascular benefits.

Light-intensity physical activity shows modest benefits, particularly for frail or mobility-limited older adults.

Abstract

Cardiovascular disease (CVD) is the leading cause of death among older adults, with sedentary behavior (SB) as a key modifiable risk factor. While physical activity (PA) is associated with cardiovascular health, evidence remains limited on the specific effects of replacing SB with PA of varying intensities.

To systematically review evidence on the cardiovascular effects of substituting SB with PA in adults aged 65 and older using isotemporal substitution modeling (ISM).

Following PRISMA guidelines, seven databases were searched up to April 2025. Risk of bias was assessed using the JBI tool, and a narrative synthesis was conducted.

Eighteen observational studies (15 cross-sectional, 3 cohorts) using ISM were included. Replacing 10–60 min of SB with moderate-to-vigorous PA (MVPA) was associated with more favorable in blood pressure, triglycerides, waist circumference, inflammatory markers (CRP, IL−6, GDF−15), and insulin sensitivity (HOMA-IS, Matsuda-ISI). Light-intensity PA (LPA) showed modest associations, particularly among frail or mobility-limited individuals. A daily substitution of 30 min was identified as a feasible reference window, with ≥60 min linked to additional vascular and autonomic benefits.

Replacing SB with PA, especially MVPA, was consistently associated with favorable cardiovascular profiles in older adults. Even brief substitutionsmay be beneficial, supporting intensity-stratified public health strategies and refinement of physical activity guidelines for aging populations.Because most included studies were cross-sectional, these findings should be interpreted as associations rather than definitive causal effects, and reverse causation remains a plausible concern.

https://www.crd.york.ac.uk/prospero/view/CRD420251021829/1/0, PROSPERO CRD420251021829.

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