Sedentary behavior among university students: a systematic review

Comportamento sedentário em universitários: uma revisão sistemática

Dayana Chaves Franco Natália Lujan Ferraz Thiago Ferreira de Sousa About the authors

Abstract

Estudos sobre o tema do comportamento sedentário (SB) em universitários têm sido publicados, diante disso o conhecimento sobre os métodos adotados torna-se importante para a ciência, e a caracterização das prevalências e fatores associados a esse atributo são essenciais no âmbito das políticas de saúde para esse grupo. Assim, o objetivo do presente estudo foi descrever as prevalências e os fatores associados, e as características metodológicas empregadas nas pesquisas sobre o SB em universitários. Uma busca nas bases de dados National Library of Medicine (PUBMED), Scientific Electronic Library Online (SciELO), Biblioteca Virtual em Saúde (BVS) e SCOPUS foi realizada. Este estudo adotou os itens e recomendações do Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA), e os artigos selecionados foram analisados conforme as características metodológicas, além das prevalências e os fatores associados ao SB. Dos 1.740 artigos encontrados nas bases de dados, 23 fizeram parte dessa revisão. Foram observadas prevalências para o tempo sentado de 34,0% a 90,2%. O uso de definições operacionais e pontos de corte foram diversificados, além do uso de variados instrumentos para estimar o SB. Foi observada a falta de padronização entre os pontos de corte para determinação do SB e das definições operacionais, como uso de instrumentos não validados. Dentre os fatores associados com maiores prevalências, destacaram-se o excesso de peso e os sintomas depressivos. Conclui-se que as prevalências de SB foram elevadas em domínios não relacionados ao tempo dedicado aos estudos e características biológicas e psicológicas representaram atributos mais associados ao SB.

Key words
Health behavior; Sedentary lifestyle; Students

Resumo

Estudos sobre o tema do comportamento sedentário (SB) em universitários têm sido publicados, diante disso o conhecimento sobre os métodos adotados torna-se importante para a ciência, e a caracterização das prevalências e fatores associados a esse atributo são essenciais no âmbito das políticas de saúde para esse grupo. Assim, o objetivo do presente estudo foi descrever as prevalências e os fatores associados, e as características metodológicas empregadas nas pesquisas sobre o SB em universitários. Uma busca nas bases de dados National Library of Medicine (PUBMED), Scientific Electronic Library Online (SciELO), Biblioteca Virtual em Saúde (BVS) e SCOPUS foi realizada. Este estudo adotou os itens e recomendações do Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA), e os artigos selecionados foram analisados conforme as características metodológicas, além das prevalências e os fatores associados ao SB. Dos 1.740 artigos encontrados nas bases de dados, 23 fizeram parte dessa revisão. Foram observadas prevalências para o tempo sentado de 34,0% a 90,2%. O uso de definições operacionais e pontos de corte foram diversificados, além do uso de variados instrumentos para estimar o SB. Foi observada a falta de padronização entre os pontos de corte para determinação do SB e das definições operacionais, como uso de instrumentos não validados. Dentre os fatores associados com maiores prevalências, destacaram-se o excesso de peso e os sintomas depressivos. Conclui-se que as prevalências de SB foram elevadas em domínios não relacionados ao tempo dedicado aos estudos e características biológicas e psicológicas representaram atributos mais associados ao SB.

Palavras-chave
Condutas de saúde; Estilo de vida sedentário; Estudantes

INTRODUCTION

High SB time is considered to be harmful to health11 Pate RR, O'Neill JR, Lobelo F. The evolving definition of "sedentary". Exerc Sport Sci Rev 2008;36(4):173-78., regardless of complying with recommended guidelines for moderate to vigorous physical activity22 Thosar SS, Johnson BD, Johnston JD, Wallace JP. Sitting and endothelial dysfunction: the role of shear stress. Med Sci Monit 2012;18(12):173-80.. In the last decade, studies have concluded that SB is a public health problem33 Hallal PC, Bauman AE, Heath GW, Kohl HW, Lee IM, Pratt M. Physical activity: more of the same is not enough. Lancet 2012;380(9838):190-1.. Furthermore, in a meta-analysis, which systematized information from 54 countries between 2002 and 2011, it was shown that 3.8% of all-cause deaths, about 433,000 deaths, were caused by the high time spent on sedentary activities44 Rezende LFM, Sá TH, Mielke GI, Viscondi JYK, Rey-López JP, Garcia LMT. All-Cause Mortality Attributable to Sitting Time: Analysis of 54 Countries Worldwide. Am J Prev Med 2016;51(2):253-63.. Another meta-analysis also observed association between time watching television and type 2 diabetes, cardiovascular disease, and all-cause mortality in adults55 Proper KI, Singh AS, van Mechelen W, Chinapaw MJM. Sedentary behaviors and health outcomes among adults: a systematic review of prospective studies. Am J Prev Med 2011;40(2):174-82..

In the university population, the prevalence of this behavior is not clear, since review studies on the subject were not found in databases. On the other hand, among studies on this population, Lourenço et al.66 Lourenço CLM, Sousa TF, Fonseca SA, Virtuoso Junior JS, Barbosa AR. Comportamento sedentário em estudantes Universitários. Rev Bras Ativ Fís Saúde 2016;21(1):67-77. showed prevalence of 83.7% for screen time in Brazilian university students and in the study by Feng et al.77 Feng QI, Zhang Q, Du Y, Ye Y, He Q. Associations of Physical Activity, Screen Time with Depression, Anxiety and Sleep Quality among Chinese College Freshmen. Plos One 2014;9(6):e100914. in Chinese university students, prevalence of 72.7% for screen time was found. Studies on this subject in university students presented greater exposure to screen time among women88 Musaiger AO, Al-Khalifa F, Al-Mannai M. Obesity, unhealthy dietary habits and sedentary behaviors among university students in Sudan: growing risks for chronic diseases in a poor country. Environ Health Prev Med 2016;21(4):224-30., and associated with sitting time99 Ballard M, Gray M, Reilly J, Noggle M. Correlates of video game screen time among males: Body mass, physical activity, and other media use. Eat Behav 2009;10(3):161-7. and high use of Internet1010 Kim JH, Lau CH, Cheuk K, Kan P, Hui HLC, Griffiths SM. Brief report: Predictors of heavy Internet use and associations with health-promoting and health risk behaviors among Hong Kong university students. J Adolesc 2010;33(1):215-20. among university students with higher body mass index (BMI), as well as those who presented inadequate nutrition1010 Kim JH, Lau CH, Cheuk K, Kan P, Hui HLC, Griffiths SM. Brief report: Predictors of heavy Internet use and associations with health-promoting and health risk behaviors among Hong Kong university students. J Adolesc 2010;33(1):215-20..

It is important to note that SB has become a relevant topic in research in recent years, and due to this broadening of focus, measurement instruments and health risk cutoff points have become diversified1111 Meneguci J, Santos DAT, Silva RB, Santos RG, Sasaki JE, Tribess S, et al. Comportamento sedentário: conceito, implicações fisiológicas e os procedimentos de avaliação. Motri 2015;11(1):160-74.. This variety of tests and criteria used to measure health risks is also observed in studies on physical activity in adolescents1212 Tassitano RM, Bezerra J,Tenório MCM, Colares V, Barros MVG, Hallal PC. Atividade física em adolescentes brasileiros: uma revisão sistemática. Rev Bras Cineantropom Desempenho Hum 2017;19(6):730-42. and university students1313 Sousa TF. Inatividade Física em universitários brasileiros: uma revisão sistemática. Rev Bras Ciên Saúde 2011;29(9):47-55.. Such diversity can be observed when analyzing the study by Lourenço et al.66 Lourenço CLM, Sousa TF, Fonseca SA, Virtuoso Junior JS, Barbosa AR. Comportamento sedentário em estudantes Universitários. Rev Bras Ativ Fís Saúde 2016;21(1):67-77., who used cutoff point of 2 hours or more as a health risk estimator, considering as SB the total screen time on one day of the week, in contrast, Peltzer and Apidechkul1414 Peltzer K, Pengpid S, Apidechkul T. Heavy Internet use and its associations with health risk and health-promoting behaviours among Thai university students. Int J Adolesc Med Health 2014;26(2):187-94. considered cutoff point equal to or greater than 6 hours of internet use per day, both of which were cross-sectional studies and that measured information through questionnaires.

Thus, it is necessary that the evidences on SB in university students be systematized in order to better observe how this topic has been designed and implemented in researches so that the characterization of the quality of such researches regarding the sampling forms, instruments and SB classification can contribute to the implementation of other researches with the same topic, since this group can undergo changes in relation to lifestyle, such as eating habits1515 Racette SB, Deusinger SS, Strube MJ, Highstein GR, Deusinger RH. Changes in weight and health behaviors from freshman through senior year of college. J Nutr Educ Behav 2008;40(1):39-42., reduced physical activity 1616 Jung ME, Bray SR, Ginis KAM. Behavior change and the freshman 15: tracking physical activity and dietary patterns in 1st-year university women. J Am Coll Health 2008;56(5):523-30. and increased time spent in sedentary activities1717 Pullman AW, Masters RC, Zalot LC, Carde LE, Saraiva MM, Dam YY, et al. Effect of the transition from high school to university on anthropometric and lifestyle variables in males. Appl Physiol Nutr Metab 2009;34(2):162-71., and the use of appropriate techniques to collect information becomes important. Thus, this study sought to systematically review articles on SB among university students, showing prevalence and associated factors, as well as the methodological characteristics used in these studies.

METHOD

For the present systematic review, the items and recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA)1616 Jung ME, Bray SR, Ginis KAM. Behavior change and the freshman 15: tracking physical activity and dietary patterns in 1st-year university women. J Am Coll Health 2008;56(5):523-30. were adopted. The work was registered in the International Prospective Register of Systematic Reviews (PROSPERO-CRD42018085891), titled “Sedentary behavior in university students: a systematic review”.

An advanced search was conducted in the English language, since the selected databases present the publication of articles or information of titles, abstracts and keywords in that language. The electronic databases chosen were: National Library of Medicine (PUBMED), Scientific Electronic Library Online (SciELO), Virtual Health Library (VHL) and Scopus. The descriptors used were: “sitting time”, “sedentary behavior”, “sedentary lifestyle” and “screen time”, along with “undergraduate”, “college students”, “academics” and “university student” (check supplement 1). The logical operators available in databases, AND and OR, were used for the combination of terms and the truncation symbols (“”, * and $) for searches of variations of terms.

The eligibility criteria for inclusion in the review were: a) original articles; b) published in English, Portuguese and Spanish; c) presentation of SB cutoff point (total sitting time, screen time, internet time, cell phone time, videogame time, television time, and others); d) university population without age restriction; d) cross-sectional or longitudinal observational studies; e) information on methodological procedures, operational definition of SB and instruments used for SB measurement. There was no restriction of the year of publication.

The selected databases were searched on December 6, 2017. Initially, the reading of the titles of articles found in databases was performed. From those identified, abstracts were read. Subsequently, articles chosen from abstracts were read in full and selected according to the established inclusion criteria. From these, a manual search was performed by reading the references and studies that met the criteria were included. All stages of the study selection process were performed in pairs and disagreements were resolved in a consensus meeting. The Zotero software was used for storing articles and deleting duplicates, and Excel software was used for tabulating extracted data.

The following information from the articles that met the inclusion criteria of this review were considered and extracted for analysis: a) author; b) year of publication; c) study design; d) sample size; e) sex of participants; f) age group of participants; g) country where the study was conducted; h) SB cutoff point; i) SB definition; j) instruments used to measure SB; k) SB prevalence; and l) factors associated with SB.

The evaluation of the quality of each article was performed based on the methods of Loney et al.1919 Loney PL, Chambers LW, Bennett KJ, Roberts JG, Stratford PW. Critical Appraisal of the Health Research Literature: Prevalence or Incidence of a Health Problem. Chronic Dis Can 1998;19(4):170-6 for cross-sectional and cohort studies, with consideration of eight items referring to methods, sample, measuring instruments, interpretation and applicability of results. For each item, score 1 was assigned if the article presented the necessary quality, and 0 otherwise.

RESULTS

A total of 1,740 articles were found from searches in the selected databases, of which 187 were excluded by duplicate, remaining 1,553 articles for more detailed analysis through titles, abstracts and reading in full. Thirty-one articles were excluded after reading in full (references listed in Supplementary material 2), and 22 articles were selected to compose the review, since they met the pre-established inclusion criteria, and one (n = 1) article was manually included based on references of selected articles, making a total of 23 articles that composed this systematic review (Figure 1).

Figure 1
Organization chart of the selection process of SB articles

Table 1 shows that among the 23 articles, the smallest number of publications that met the quality criteria referred to the sampling methods and measurement instruments. Only one (n = 1) had maximum evaluation score3131 Seo DC, Torabi MR, Jiang N, Fernandez-Rojas X, Park B. Cross-cultural Comparison of Lack of Regular Physical Activity among College Students: Universal Versus Transversal. Int J Behav Med 2009;16(4):355-359. and six presented score 766 Lourenço CLM, Sousa TF, Fonseca SA, Virtuoso Junior JS, Barbosa AR. Comportamento sedentário em estudantes Universitários. Rev Bras Ativ Fís Saúde 2016;21(1):67-77.,77 Feng QI, Zhang Q, Du Y, Ye Y, He Q. Associations of Physical Activity, Screen Time with Depression, Anxiety and Sleep Quality among Chinese College Freshmen. Plos One 2014;9(6):e100914.,1414 Peltzer K, Pengpid S, Apidechkul T. Heavy Internet use and its associations with health risk and health-promoting behaviours among Thai university students. Int J Adolesc Med Health 2014;26(2):187-94.,2020 Banks E, Lim L, Seubsman S, Bain C, Sleigh A. Relationship of obesity to physical activity, domestic activities, and sedentary behaviours:n crosssectional findings from a national cohort of over 70,000 Thai adults. BMC Public Health 2011;11(762):1-14.,3333 Wu X, Tao S, Zhang Y, Zhang S, Tao F. Low Physical Activity and High Screen Time Can Increase the Risks of Mental Health Problems and Poor Sleep Quality among Chinese College Students. Plos One 2015;10(3):1-10.

34 Wu X,Tao S, Zhang S, Zhang Y, Chen K,Yang Y, et al. Impact of screen time on mental health problems progression in youth: a 1-year follow-up study. BMJ Open 2016;9(6):e011533.
-3535 Xu X, Pu Y, Sharma M, Rao Y, Cai Y, Zhao Y. Predicting Physical Activity and Healthy Nutrition Behaviors Using Social Cognitive Theory: CrossSectional Survey among Undergraduate Students in Chongqing, China. Int J Environ Res Public Health 2017;14(11):1-13., and the lowest evaluation score (score = 3) occurred in one (n = 1) study2525 Kim S, Kim J, Jee Y. Relationship between smartphone addiction and physical activity in Chinese international students in Korea. J Behav Addic 2015;4(3):200-5..

Table 1
Guidelines used for the criticai evaluation of SB studies in university students and scores obtained by selected articles. Evaluation criteria proposed by Loney et al.1616 Jung ME, Bray SR, Ginis KAM. Behavior change and the freshman 15: tracking physical activity and dietary patterns in 1st-year university women. J Am Coll Health 2008;56(5):523-30..

Regarding the characteristics of selected studies, articles were published between 2009 and 2017, with 14 publications between 2014 and 201766 Lourenço CLM, Sousa TF, Fonseca SA, Virtuoso Junior JS, Barbosa AR. Comportamento sedentário em estudantes Universitários. Rev Bras Ativ Fís Saúde 2016;21(1):67-77.

7 Feng QI, Zhang Q, Du Y, Ye Y, He Q. Associations of Physical Activity, Screen Time with Depression, Anxiety and Sleep Quality among Chinese College Freshmen. Plos One 2014;9(6):e100914.
-88 Musaiger AO, Al-Khalifa F, Al-Mannai M. Obesity, unhealthy dietary habits and sedentary behaviors among university students in Sudan: growing risks for chronic diseases in a poor country. Environ Health Prev Med 2016;21(4):224-30.,1414 Peltzer K, Pengpid S, Apidechkul T. Heavy Internet use and its associations with health risk and health-promoting behaviours among Thai university students. Int J Adolesc Med Health 2014;26(2):187-94.,2121 Caballero LGR, Sánchez LZR, Delgado EMG. Sobrepeso y obesidad enestudiantes universitarios colombianos y su asociación con la actividad física. Nutr Hosp 2015;31(2):629-36.,2222 Claumann GS, Felden EPG, Pelegrini A. Comportamento sedentário em universitários: prevalência e fatores associados. Rev Baiana Saúde Pública 2016;40(3):574-88.,2424 Felez-Nobrega M, Hillman CH, Cirera E, Puig-Ribera A. The association of context-specific sitting time and physical activity intensity to working memory capacity and academic achievement in young adults. Eur J Public Health 2017;27(4):741-6.,2828 Pelletier JE, Lytle LA, Laska MN. Stress, Health risk behaviors, and weight status among community college students. Health Educ Behav 2016;43(2):139-44.,3333 Wu X, Tao S, Zhang Y, Zhang S, Tao F. Low Physical Activity and High Screen Time Can Increase the Risks of Mental Health Problems and Poor Sleep Quality among Chinese College Students. Plos One 2015;10(3):1-10.

34 Wu X,Tao S, Zhang S, Zhang Y, Chen K,Yang Y, et al. Impact of screen time on mental health problems progression in youth: a 1-year follow-up study. BMJ Open 2016;9(6):e011533.
-3535 Xu X, Pu Y, Sharma M, Rao Y, Cai Y, Zhao Y. Predicting Physical Activity and Healthy Nutrition Behaviors Using Social Cognitive Theory: CrossSectional Survey among Undergraduate Students in Chongqing, China. Int J Environ Res Public Health 2017;14(11):1-13.. Regarding the study design, predominance of cross-sectional studies was observed66 Lourenço CLM, Sousa TF, Fonseca SA, Virtuoso Junior JS, Barbosa AR. Comportamento sedentário em estudantes Universitários. Rev Bras Ativ Fís Saúde 2016;21(1):67-77.,77 Feng QI, Zhang Q, Du Y, Ye Y, He Q. Associations of Physical Activity, Screen Time with Depression, Anxiety and Sleep Quality among Chinese College Freshmen. Plos One 2014;9(6):e100914.,99 Ballard M, Gray M, Reilly J, Noggle M. Correlates of video game screen time among males: Body mass, physical activity, and other media use. Eat Behav 2009;10(3):161-7.,1414 Peltzer K, Pengpid S, Apidechkul T. Heavy Internet use and its associations with health risk and health-promoting behaviours among Thai university students. Int J Adolesc Med Health 2014;26(2):187-94.,2020 Banks E, Lim L, Seubsman S, Bain C, Sleigh A. Relationship of obesity to physical activity, domestic activities, and sedentary behaviours:n crosssectional findings from a national cohort of over 70,000 Thai adults. BMC Public Health 2011;11(762):1-14.

21 Caballero LGR, Sánchez LZR, Delgado EMG. Sobrepeso y obesidad enestudiantes universitarios colombianos y su asociación con la actividad física. Nutr Hosp 2015;31(2):629-36.

22 Claumann GS, Felden EPG, Pelegrini A. Comportamento sedentário em universitários: prevalência e fatores associados. Rev Baiana Saúde Pública 2016;40(3):574-88.

23 Farinola MG, Bazán NE. Conducta sedentaria y actividad física en estudiantes universitarios: un estudio piloto. Rev Argent Cardiol 2011;79(4):351-4.

24 Felez-Nobrega M, Hillman CH, Cirera E, Puig-Ribera A. The association of context-specific sitting time and physical activity intensity to working memory capacity and academic achievement in young adults. Eur J Public Health 2017;27(4):741-6.

25 Kim S, Kim J, Jee Y. Relationship between smartphone addiction and physical activity in Chinese international students in Korea. J Behav Addic 2015;4(3):200-5.

26 Mathur C, Stigler M, Lust K, Laska MA Latent Class Analysis of Weight-Related Health Behaviors Among 2-and 4-Year College Students and Associated Risk of Obesity. Health Educ Behav 2014;41(6):663-72.

27 Musaiger AO, Awadhalla MS, Al-Mannai M, AlSawad M, Asokan GV. Dietary habits and sedentary behaviors among health science university students in Bahrain. Int J Adolesc Med Health 2015;29(2):1-6.

28 Pelletier JE, Lytle LA, Laska MN. Stress, Health risk behaviors, and weight status among community college students. Health Educ Behav 2016;43(2):139-44.

29 Pires CGS, Mussi FC, Cerqueira BB, Pitanga FJG, Silva DO. Prática de atividade física entre estudantes de graduação em enfermagem. Acta Paul Enferm 2013;26(5):436-43.

30 Hidalgo-Rasmussen CA, Ramírez-López G, Martín AH. Actividad física, conductas sedentarias y calidad de vida en adolescentes universitarios de Ciudad Guzmán, Jalisco, México. Ciênc Saúde Colet 2013;18(7):1943-52.

31 Seo DC, Torabi MR, Jiang N, Fernandez-Rojas X, Park B. Cross-cultural Comparison of Lack of Regular Physical Activity among College Students: Universal Versus Transversal. Int J Behav Med 2009;16(4):355-359.

32 Tayem YI, Yaseen NA, Khader WT, Rajab LOA, Ramahi AB, Saleh MH. Prevalence and risk factors of obesity and hypertension among students at a central university in the West Bank. Libyan J Med 2012;7(1):1-5.

33 Wu X, Tao S, Zhang Y, Zhang S, Tao F. Low Physical Activity and High Screen Time Can Increase the Risks of Mental Health Problems and Poor Sleep Quality among Chinese College Students. Plos One 2015;10(3):1-10.
-3434 Wu X,Tao S, Zhang S, Zhang Y, Chen K,Yang Y, et al. Impact of screen time on mental health problems progression in youth: a 1-year follow-up study. BMJ Open 2016;9(6):e011533., with only two longitudinal studies1717 Pullman AW, Masters RC, Zalot LC, Carde LE, Saraiva MM, Dam YY, et al. Effect of the transition from high school to university on anthropometric and lifestyle variables in males. Appl Physiol Nutr Metab 2009;34(2):162-71.,3535 Xu X, Pu Y, Sharma M, Rao Y, Cai Y, Zhao Y. Predicting Physical Activity and Healthy Nutrition Behaviors Using Social Cognitive Theory: CrossSectional Survey among Undergraduate Students in Chongqing, China. Int J Environ Res Public Health 2017;14(11):1-13.. Sample size ranged from 108 1717 Pullman AW, Masters RC, Zalot LC, Carde LE, Saraiva MM, Dam YY, et al. Effect of the transition from high school to university on anthropometric and lifestyle variables in males. Appl Physiol Nutr Metab 2009;34(2):162-71. to 74,9812020 Banks E, Lim L, Seubsman S, Bain C, Sleigh A. Relationship of obesity to physical activity, domestic activities, and sedentary behaviours:n crosssectional findings from a national cohort of over 70,000 Thai adults. BMC Public Health 2011;11(762):1-14. participants. In two studies, there was a wide variation in age, from 15 to 87 years2020 Banks E, Lim L, Seubsman S, Bain C, Sleigh A. Relationship of obesity to physical activity, domestic activities, and sedentary behaviours:n crosssectional findings from a national cohort of over 70,000 Thai adults. BMC Public Health 2011;11(762):1-14. and from 17 to 66 years2323 Farinola MG, Bazán NE. Conducta sedentaria y actividad física en estudiantes universitarios: un estudio piloto. Rev Argent Cardiol 2011;79(4):351-4., with the others focusing on age groups between 18 and 35 years, and in only two studies, samples were exclusively composed of men99 Ballard M, Gray M, Reilly J, Noggle M. Correlates of video game screen time among males: Body mass, physical activity, and other media use. Eat Behav 2009;10(3):161-7.,1717 Pullman AW, Masters RC, Zalot LC, Carde LE, Saraiva MM, Dam YY, et al. Effect of the transition from high school to university on anthropometric and lifestyle variables in males. Appl Physiol Nutr Metab 2009;34(2):162-71.. Surveys were carried out in 13 different countries (United States99 Ballard M, Gray M, Reilly J, Noggle M. Correlates of video game screen time among males: Body mass, physical activity, and other media use. Eat Behav 2009;10(3):161-7.,2626 Mathur C, Stigler M, Lust K, Laska MA Latent Class Analysis of Weight-Related Health Behaviors Among 2-and 4-Year College Students and Associated Risk of Obesity. Health Educ Behav 2014;41(6):663-72.,2828 Pelletier JE, Lytle LA, Laska MN. Stress, Health risk behaviors, and weight status among community college students. Health Educ Behav 2016;43(2):139-44., Thailand1414 Peltzer K, Pengpid S, Apidechkul T. Heavy Internet use and its associations with health risk and health-promoting behaviours among Thai university students. Int J Adolesc Med Health 2014;26(2):187-94.,2020 Banks E, Lim L, Seubsman S, Bain C, Sleigh A. Relationship of obesity to physical activity, domestic activities, and sedentary behaviours:n crosssectional findings from a national cohort of over 70,000 Thai adults. BMC Public Health 2011;11(762):1-14., Colombia2121 Caballero LGR, Sánchez LZR, Delgado EMG. Sobrepeso y obesidad enestudiantes universitarios colombianos y su asociación con la actividad física. Nutr Hosp 2015;31(2):629-36., Brazil66 Lourenço CLM, Sousa TF, Fonseca SA, Virtuoso Junior JS, Barbosa AR. Comportamento sedentário em estudantes Universitários. Rev Bras Ativ Fís Saúde 2016;21(1):67-77.,2222 Claumann GS, Felden EPG, Pelegrini A. Comportamento sedentário em universitários: prevalência e fatores associados. Rev Baiana Saúde Pública 2016;40(3):574-88.,2929 Pires CGS, Mussi FC, Cerqueira BB, Pitanga FJG, Silva DO. Prática de atividade física entre estudantes de graduação em enfermagem. Acta Paul Enferm 2013;26(5):436-43., Spain2424 Felez-Nobrega M, Hillman CH, Cirera E, Puig-Ribera A. The association of context-specific sitting time and physical activity intensity to working memory capacity and academic achievement in young adults. Eur J Public Health 2017;27(4):741-6., China77 Feng QI, Zhang Q, Du Y, Ye Y, He Q. Associations of Physical Activity, Screen Time with Depression, Anxiety and Sleep Quality among Chinese College Freshmen. Plos One 2014;9(6):e100914.,1010 Kim JH, Lau CH, Cheuk K, Kan P, Hui HLC, Griffiths SM. Brief report: Predictors of heavy Internet use and associations with health-promoting and health risk behaviors among Hong Kong university students. J Adolesc 2010;33(1):215-20.,3333 Wu X, Tao S, Zhang Y, Zhang S, Tao F. Low Physical Activity and High Screen Time Can Increase the Risks of Mental Health Problems and Poor Sleep Quality among Chinese College Students. Plos One 2015;10(3):1-10.

34 Wu X,Tao S, Zhang S, Zhang Y, Chen K,Yang Y, et al. Impact of screen time on mental health problems progression in youth: a 1-year follow-up study. BMJ Open 2016;9(6):e011533.
-3535 Xu X, Pu Y, Sharma M, Rao Y, Cai Y, Zhao Y. Predicting Physical Activity and Healthy Nutrition Behaviors Using Social Cognitive Theory: CrossSectional Survey among Undergraduate Students in Chongqing, China. Int J Environ Res Public Health 2017;14(11):1-13., Argentina2323 Farinola MG, Bazán NE. Conducta sedentaria y actividad física en estudiantes universitarios: un estudio piloto. Rev Argent Cardiol 2011;79(4):351-4., South Korea2525 Kim S, Kim J, Jee Y. Relationship between smartphone addiction and physical activity in Chinese international students in Korea. J Behav Addic 2015;4(3):200-5., Bahrain - Persian Gulf2727 Musaiger AO, Awadhalla MS, Al-Mannai M, AlSawad M, Asokan GV. Dietary habits and sedentary behaviors among health science university students in Bahrain. Int J Adolesc Med Health 2015;29(2):1-6., Sudan88 Musaiger AO, Al-Khalifa F, Al-Mannai M. Obesity, unhealthy dietary habits and sedentary behaviors among university students in Sudan: growing risks for chronic diseases in a poor country. Environ Health Prev Med 2016;21(4):224-30., Canada1717 Pullman AW, Masters RC, Zalot LC, Carde LE, Saraiva MM, Dam YY, et al. Effect of the transition from high school to university on anthropometric and lifestyle variables in males. Appl Physiol Nutr Metab 2009;34(2):162-71., Mexico3030 Hidalgo-Rasmussen CA, Ramírez-López G, Martín AH. Actividad física, conductas sedentarias y calidad de vida en adolescentes universitarios de Ciudad Guzmán, Jalisco, México. Ciênc Saúde Colet 2013;18(7):1943-52. and West Bank3232 Tayem YI, Yaseen NA, Khader WT, Rajab LOA, Ramahi AB, Saleh MH. Prevalence and risk factors of obesity and hypertension among students at a central university in the West Bank. Libyan J Med 2012;7(1):1-5.), and one study (n = 1) was conducted with samples from the United States, Costa Rica, India and South Korea3131 Seo DC, Torabi MR, Jiang N, Fernandez-Rojas X, Park B. Cross-cultural Comparison of Lack of Regular Physical Activity among College Students: Universal Versus Transversal. Int J Behav Med 2009;16(4):355-359..

The methodological characteristics of studies are presented in Table 2. Regarding the operational definition of SB, several ways of considering risk in relation to different types of research contexts were observed, such as in relation to screen time (n = 16)66 Lourenço CLM, Sousa TF, Fonseca SA, Virtuoso Junior JS, Barbosa AR. Comportamento sedentário em estudantes Universitários. Rev Bras Ativ Fís Saúde 2016;21(1):67-77.

7 Feng QI, Zhang Q, Du Y, Ye Y, He Q. Associations of Physical Activity, Screen Time with Depression, Anxiety and Sleep Quality among Chinese College Freshmen. Plos One 2014;9(6):e100914.

8 Musaiger AO, Al-Khalifa F, Al-Mannai M. Obesity, unhealthy dietary habits and sedentary behaviors among university students in Sudan: growing risks for chronic diseases in a poor country. Environ Health Prev Med 2016;21(4):224-30.
-99 Ballard M, Gray M, Reilly J, Noggle M. Correlates of video game screen time among males: Body mass, physical activity, and other media use. Eat Behav 2009;10(3):161-7.,1717 Pullman AW, Masters RC, Zalot LC, Carde LE, Saraiva MM, Dam YY, et al. Effect of the transition from high school to university on anthropometric and lifestyle variables in males. Appl Physiol Nutr Metab 2009;34(2):162-71.,2020 Banks E, Lim L, Seubsman S, Bain C, Sleigh A. Relationship of obesity to physical activity, domestic activities, and sedentary behaviours:n crosssectional findings from a national cohort of over 70,000 Thai adults. BMC Public Health 2011;11(762):1-14.,2222 Claumann GS, Felden EPG, Pelegrini A. Comportamento sedentário em universitários: prevalência e fatores associados. Rev Baiana Saúde Pública 2016;40(3):574-88.,2525 Kim S, Kim J, Jee Y. Relationship between smartphone addiction and physical activity in Chinese international students in Korea. J Behav Addic 2015;4(3):200-5.

26 Mathur C, Stigler M, Lust K, Laska MA Latent Class Analysis of Weight-Related Health Behaviors Among 2-and 4-Year College Students and Associated Risk of Obesity. Health Educ Behav 2014;41(6):663-72.
-2727 Musaiger AO, Awadhalla MS, Al-Mannai M, AlSawad M, Asokan GV. Dietary habits and sedentary behaviors among health science university students in Bahrain. Int J Adolesc Med Health 2015;29(2):1-6.,3030 Hidalgo-Rasmussen CA, Ramírez-López G, Martín AH. Actividad física, conductas sedentarias y calidad de vida en adolescentes universitarios de Ciudad Guzmán, Jalisco, México. Ciênc Saúde Colet 2013;18(7):1943-52.

31 Seo DC, Torabi MR, Jiang N, Fernandez-Rojas X, Park B. Cross-cultural Comparison of Lack of Regular Physical Activity among College Students: Universal Versus Transversal. Int J Behav Med 2009;16(4):355-359.

32 Tayem YI, Yaseen NA, Khader WT, Rajab LOA, Ramahi AB, Saleh MH. Prevalence and risk factors of obesity and hypertension among students at a central university in the West Bank. Libyan J Med 2012;7(1):1-5.

33 Wu X, Tao S, Zhang Y, Zhang S, Tao F. Low Physical Activity and High Screen Time Can Increase the Risks of Mental Health Problems and Poor Sleep Quality among Chinese College Students. Plos One 2015;10(3):1-10.

34 Wu X,Tao S, Zhang S, Zhang Y, Chen K,Yang Y, et al. Impact of screen time on mental health problems progression in youth: a 1-year follow-up study. BMJ Open 2016;9(6):e011533.
-3535 Xu X, Pu Y, Sharma M, Rao Y, Cai Y, Zhao Y. Predicting Physical Activity and Healthy Nutrition Behaviors Using Social Cognitive Theory: CrossSectional Survey among Undergraduate Students in Chongqing, China. Int J Environ Res Public Health 2017;14(11):1-13., sitting time (n = 5)2020 Banks E, Lim L, Seubsman S, Bain C, Sleigh A. Relationship of obesity to physical activity, domestic activities, and sedentary behaviours:n crosssectional findings from a national cohort of over 70,000 Thai adults. BMC Public Health 2011;11(762):1-14.,2121 Caballero LGR, Sánchez LZR, Delgado EMG. Sobrepeso y obesidad enestudiantes universitarios colombianos y su asociación con la actividad física. Nutr Hosp 2015;31(2):629-36.,2323 Farinola MG, Bazán NE. Conducta sedentaria y actividad física en estudiantes universitarios: un estudio piloto. Rev Argent Cardiol 2011;79(4):351-4.,2828 Pelletier JE, Lytle LA, Laska MN. Stress, Health risk behaviors, and weight status among community college students. Health Educ Behav 2016;43(2):139-44.,2929 Pires CGS, Mussi FC, Cerqueira BB, Pitanga FJG, Silva DO. Prática de atividade física entre estudantes de graduação em enfermagem. Acta Paul Enferm 2013;26(5):436-43. and internet time (n = 2)1010 Kim JH, Lau CH, Cheuk K, Kan P, Hui HLC, Griffiths SM. Brief report: Predictors of heavy Internet use and associations with health-promoting and health risk behaviors among Hong Kong university students. J Adolesc 2010;33(1):215-20.,1414 Peltzer K, Pengpid S, Apidechkul T. Heavy Internet use and its associations with health risk and health-promoting behaviours among Thai university students. Int J Adolesc Med Health 2014;26(2):187-94.. The instruments used were questionnaires, some of them validated such as IPAQ2121 Caballero LGR, Sánchez LZR, Delgado EMG. Sobrepeso y obesidad enestudiantes universitarios colombianos y su asociación con la actividad física. Nutr Hosp 2015;31(2):629-36.,2929 Pires CGS, Mussi FC, Cerqueira BB, Pitanga FJG, Silva DO. Prática de atividade física entre estudantes de graduação em enfermagem. Acta Paul Enferm 2013;26(5):436-43., GPAQ2323 Farinola MG, Bazán NE. Conducta sedentaria y actividad física en estudiantes universitarios: un estudio piloto. Rev Argent Cardiol 2011;79(4):351-4., SIT-Q-7d2424 Felez-Nobrega M, Hillman CH, Cirera E, Puig-Ribera A. The association of context-specific sitting time and physical activity intensity to working memory capacity and academic achievement in young adults. Eur J Public Health 2017;27(4):741-6., ISAQ-A66 Lourenço CLM, Sousa TF, Fonseca SA, Virtuoso Junior JS, Barbosa AR. Comportamento sedentário em estudantes Universitários. Rev Bras Ativ Fís Saúde 2016;21(1):67-77. and YRBS3131 Seo DC, Torabi MR, Jiang N, Fernandez-Rojas X, Park B. Cross-cultural Comparison of Lack of Regular Physical Activity among College Students: Universal Versus Transversal. Int J Behav Med 2009;16(4):355-359., or by specific questions developed for the purpose of the study, being a characteristic associated to 14 studies77 Feng QI, Zhang Q, Du Y, Ye Y, He Q. Associations of Physical Activity, Screen Time with Depression, Anxiety and Sleep Quality among Chinese College Freshmen. Plos One 2014;9(6):e100914.,1010 Kim JH, Lau CH, Cheuk K, Kan P, Hui HLC, Griffiths SM. Brief report: Predictors of heavy Internet use and associations with health-promoting and health risk behaviors among Hong Kong university students. J Adolesc 2010;33(1):215-20.,1414 Peltzer K, Pengpid S, Apidechkul T. Heavy Internet use and its associations with health risk and health-promoting behaviours among Thai university students. Int J Adolesc Med Health 2014;26(2):187-94.,1717 Pullman AW, Masters RC, Zalot LC, Carde LE, Saraiva MM, Dam YY, et al. Effect of the transition from high school to university on anthropometric and lifestyle variables in males. Appl Physiol Nutr Metab 2009;34(2):162-71.,2222 Claumann GS, Felden EPG, Pelegrini A. Comportamento sedentário em universitários: prevalência e fatores associados. Rev Baiana Saúde Pública 2016;40(3):574-88.,2626 Mathur C, Stigler M, Lust K, Laska MA Latent Class Analysis of Weight-Related Health Behaviors Among 2-and 4-Year College Students and Associated Risk of Obesity. Health Educ Behav 2014;41(6):663-72.

27 Musaiger AO, Awadhalla MS, Al-Mannai M, AlSawad M, Asokan GV. Dietary habits and sedentary behaviors among health science university students in Bahrain. Int J Adolesc Med Health 2015;29(2):1-6.
-2828 Pelletier JE, Lytle LA, Laska MN. Stress, Health risk behaviors, and weight status among community college students. Health Educ Behav 2016;43(2):139-44.,3030 Hidalgo-Rasmussen CA, Ramírez-López G, Martín AH. Actividad física, conductas sedentarias y calidad de vida en adolescentes universitarios de Ciudad Guzmán, Jalisco, México. Ciênc Saúde Colet 2013;18(7):1943-52.,3232 Tayem YI, Yaseen NA, Khader WT, Rajab LOA, Ramahi AB, Saleh MH. Prevalence and risk factors of obesity and hypertension among students at a central university in the West Bank. Libyan J Med 2012;7(1):1-5.

33 Wu X, Tao S, Zhang Y, Zhang S, Tao F. Low Physical Activity and High Screen Time Can Increase the Risks of Mental Health Problems and Poor Sleep Quality among Chinese College Students. Plos One 2015;10(3):1-10.

34 Wu X,Tao S, Zhang S, Zhang Y, Chen K,Yang Y, et al. Impact of screen time on mental health problems progression in youth: a 1-year follow-up study. BMJ Open 2016;9(6):e011533.
-3535 Xu X, Pu Y, Sharma M, Rao Y, Cai Y, Zhao Y. Predicting Physical Activity and Healthy Nutrition Behaviors Using Social Cognitive Theory: CrossSectional Survey among Undergraduate Students in Chongqing, China. Int J Environ Res Public Health 2017;14(11):1-13.. The cutoff points used were also diverse, with nine studies using cutoff point of ≥2 hours66 Lourenço CLM, Sousa TF, Fonseca SA, Virtuoso Junior JS, Barbosa AR. Comportamento sedentário em estudantes Universitários. Rev Bras Ativ Fís Saúde 2016;21(1):67-77.,77 Feng QI, Zhang Q, Du Y, Ye Y, He Q. Associations of Physical Activity, Screen Time with Depression, Anxiety and Sleep Quality among Chinese College Freshmen. Plos One 2014;9(6):e100914.,1717 Pullman AW, Masters RC, Zalot LC, Carde LE, Saraiva MM, Dam YY, et al. Effect of the transition from high school to university on anthropometric and lifestyle variables in males. Appl Physiol Nutr Metab 2009;34(2):162-71.,2626 Mathur C, Stigler M, Lust K, Laska MA Latent Class Analysis of Weight-Related Health Behaviors Among 2-and 4-Year College Students and Associated Risk of Obesity. Health Educ Behav 2014;41(6):663-72.,2727 Musaiger AO, Awadhalla MS, Al-Mannai M, AlSawad M, Asokan GV. Dietary habits and sedentary behaviors among health science university students in Bahrain. Int J Adolesc Med Health 2015;29(2):1-6.,3030 Hidalgo-Rasmussen CA, Ramírez-López G, Martín AH. Actividad física, conductas sedentarias y calidad de vida en adolescentes universitarios de Ciudad Guzmán, Jalisco, México. Ciênc Saúde Colet 2013;18(7):1943-52.,3232 Tayem YI, Yaseen NA, Khader WT, Rajab LOA, Ramahi AB, Saleh MH. Prevalence and risk factors of obesity and hypertension among students at a central university in the West Bank. Libyan J Med 2012;7(1):1-5.,3333 Wu X, Tao S, Zhang Y, Zhang S, Tao F. Low Physical Activity and High Screen Time Can Increase the Risks of Mental Health Problems and Poor Sleep Quality among Chinese College Students. Plos One 2015;10(3):1-10.,3434 Wu X,Tao S, Zhang S, Zhang Y, Chen K,Yang Y, et al. Impact of screen time on mental health problems progression in youth: a 1-year follow-up study. BMJ Open 2016;9(6):e011533. per day and one study using ≥10 hours2323 Farinola MG, Bazán NE. Conducta sedentaria y actividad física en estudiantes universitarios: un estudio piloto. Rev Argent Cardiol 2011;79(4):351-4. ( ≥600 min) per day.

Table 2
Characteristics of studies on sedentary behavior in university students according to methodological criteria and prevalence.

In relation to SB prevalence (Table 2), values for sitting time of 34.0% (cutoff point: ≥10 h / day)2323 Farinola MG, Bazán NE. Conducta sedentaria y actividad física en estudiantes universitarios: un estudio piloto. Rev Argent Cardiol 2011;79(4):351-4., 48.4% (cutoff point: ≥5 h / day)2828 Pelletier JE, Lytle LA, Laska MN. Stress, Health risk behaviors, and weight status among community college students. Health Educ Behav 2016;43(2):139-44. and 82.5% (cutoff point: ≥3 h / day) 2929 Pires CGS, Mussi FC, Cerqueira BB, Pitanga FJG, Silva DO. Prática de atividade física entre estudantes de graduação em enfermagem. Acta Paul Enferm 2013;26(5):436-43. were found. Prevalence values observed for television and computer time were 16.5% (cutoff point: ≥4 h / day)3535 Xu X, Pu Y, Sharma M, Rao Y, Cai Y, Zhao Y. Predicting Physical Activity and Healthy Nutrition Behaviors Using Social Cognitive Theory: CrossSectional Survey among Undergraduate Students in Chongqing, China. Int J Environ Res Public Health 2017;14(11):1-13., 20.8% (cutoff point > 2 h / day)3333 Wu X, Tao S, Zhang Y, Zhang S, Tao F. Low Physical Activity and High Screen Time Can Increase the Risks of Mental Health Problems and Poor Sleep Quality among Chinese College Students. Plos One 2015;10(3):1-10., 48.2% (cutoff point > 2 h / day)3434 Wu X,Tao S, Zhang S, Zhang Y, Chen K,Yang Y, et al. Impact of screen time on mental health problems progression in youth: a 1-year follow-up study. BMJ Open 2016;9(6):e011533., and for screen time (computer, videogame and television) of 83.7% (cutoff point > 2 h / day).

In Table 3, attributes that were positively associated with SB such as screen time (videogame and internet) and sitting time in a great number of studies were excess body weight1010 Kim JH, Lau CH, Cheuk K, Kan P, Hui HLC, Griffiths SM. Brief report: Predictors of heavy Internet use and associations with health-promoting and health risk behaviors among Hong Kong university students. J Adolesc 2010;33(1):215-20.,2020 Banks E, Lim L, Seubsman S, Bain C, Sleigh A. Relationship of obesity to physical activity, domestic activities, and sedentary behaviours:n crosssectional findings from a national cohort of over 70,000 Thai adults. BMC Public Health 2011;11(762):1-14.,2121 Caballero LGR, Sánchez LZR, Delgado EMG. Sobrepeso y obesidad enestudiantes universitarios colombianos y su asociación con la actividad física. Nutr Hosp 2015;31(2):629-36. and depressive symptoms77 Feng QI, Zhang Q, Du Y, Ye Y, He Q. Associations of Physical Activity, Screen Time with Depression, Anxiety and Sleep Quality among Chinese College Freshmen. Plos One 2014;9(6):e100914.,1010 Kim JH, Lau CH, Cheuk K, Kan P, Hui HLC, Griffiths SM. Brief report: Predictors of heavy Internet use and associations with health-promoting and health risk behaviors among Hong Kong university students. J Adolesc 2010;33(1):215-20.,3333 Wu X, Tao S, Zhang Y, Zhang S, Tao F. Low Physical Activity and High Screen Time Can Increase the Risks of Mental Health Problems and Poor Sleep Quality among Chinese College Students. Plos One 2015;10(3):1-10.,3434 Wu X,Tao S, Zhang S, Zhang Y, Chen K,Yang Y, et al. Impact of screen time on mental health problems progression in youth: a 1-year follow-up study. BMJ Open 2016;9(6):e011533.. The practice of physical activity was the characteristic most inversely associated with SB (screen time: internet and video game)66 Lourenço CLM, Sousa TF, Fonseca SA, Virtuoso Junior JS, Barbosa AR. Comportamento sedentário em estudantes Universitários. Rev Bras Ativ Fís Saúde 2016;21(1):67-77.,99 Ballard M, Gray M, Reilly J, Noggle M. Correlates of video game screen time among males: Body mass, physical activity, and other media use. Eat Behav 2009;10(3):161-7.,1010 Kim JH, Lau CH, Cheuk K, Kan P, Hui HLC, Griffiths SM. Brief report: Predictors of heavy Internet use and associations with health-promoting and health risk behaviors among Hong Kong university students. J Adolesc 2010;33(1):215-20..

Table 3
Factors associated with sedentary behavior of university students among selected studies.

DISCUSSION

It was possible to observe that studies on the subject are recent, with the first articles selected having been published about nine years ago1717 Pullman AW, Masters RC, Zalot LC, Carde LE, Saraiva MM, Dam YY, et al. Effect of the transition from high school to university on anthropometric and lifestyle variables in males. Appl Physiol Nutr Metab 2009;34(2):162-71.,99 Ballard M, Gray M, Reilly J, Noggle M. Correlates of video game screen time among males: Body mass, physical activity, and other media use. Eat Behav 2009;10(3):161-7.,2424 Felez-Nobrega M, Hillman CH, Cirera E, Puig-Ribera A. The association of context-specific sitting time and physical activity intensity to working memory capacity and academic achievement in young adults. Eur J Public Health 2017;27(4):741-6.,3131 Seo DC, Torabi MR, Jiang N, Fernandez-Rojas X, Park B. Cross-cultural Comparison of Lack of Regular Physical Activity among College Students: Universal Versus Transversal. Int J Behav Med 2009;16(4):355-359.,3535 Xu X, Pu Y, Sharma M, Rao Y, Cai Y, Zhao Y. Predicting Physical Activity and Healthy Nutrition Behaviors Using Social Cognitive Theory: CrossSectional Survey among Undergraduate Students in Chongqing, China. Int J Environ Res Public Health 2017;14(11):1-13.. There was predominance of publications between 2014 and 201766 Lourenço CLM, Sousa TF, Fonseca SA, Virtuoso Junior JS, Barbosa AR. Comportamento sedentário em estudantes Universitários. Rev Bras Ativ Fís Saúde 2016;21(1):67-77.

7 Feng QI, Zhang Q, Du Y, Ye Y, He Q. Associations of Physical Activity, Screen Time with Depression, Anxiety and Sleep Quality among Chinese College Freshmen. Plos One 2014;9(6):e100914.
-88 Musaiger AO, Al-Khalifa F, Al-Mannai M. Obesity, unhealthy dietary habits and sedentary behaviors among university students in Sudan: growing risks for chronic diseases in a poor country. Environ Health Prev Med 2016;21(4):224-30.,1414 Peltzer K, Pengpid S, Apidechkul T. Heavy Internet use and its associations with health risk and health-promoting behaviours among Thai university students. Int J Adolesc Med Health 2014;26(2):187-94.,2121 Caballero LGR, Sánchez LZR, Delgado EMG. Sobrepeso y obesidad enestudiantes universitarios colombianos y su asociación con la actividad física. Nutr Hosp 2015;31(2):629-36.,2222 Claumann GS, Felden EPG, Pelegrini A. Comportamento sedentário em universitários: prevalência e fatores associados. Rev Baiana Saúde Pública 2016;40(3):574-88.,2424 Felez-Nobrega M, Hillman CH, Cirera E, Puig-Ribera A. The association of context-specific sitting time and physical activity intensity to working memory capacity and academic achievement in young adults. Eur J Public Health 2017;27(4):741-6.

25 Kim S, Kim J, Jee Y. Relationship between smartphone addiction and physical activity in Chinese international students in Korea. J Behav Addic 2015;4(3):200-5.
-2626 Mathur C, Stigler M, Lust K, Laska MA Latent Class Analysis of Weight-Related Health Behaviors Among 2-and 4-Year College Students and Associated Risk of Obesity. Health Educ Behav 2014;41(6):663-72.,2828 Pelletier JE, Lytle LA, Laska MN. Stress, Health risk behaviors, and weight status among community college students. Health Educ Behav 2016;43(2):139-44.,3333 Wu X, Tao S, Zhang Y, Zhang S, Tao F. Low Physical Activity and High Screen Time Can Increase the Risks of Mental Health Problems and Poor Sleep Quality among Chinese College Students. Plos One 2015;10(3):1-10.

34 Wu X,Tao S, Zhang S, Zhang Y, Chen K,Yang Y, et al. Impact of screen time on mental health problems progression in youth: a 1-year follow-up study. BMJ Open 2016;9(6):e011533.
-3535 Xu X, Pu Y, Sharma M, Rao Y, Cai Y, Zhao Y. Predicting Physical Activity and Healthy Nutrition Behaviors Using Social Cognitive Theory: CrossSectional Survey among Undergraduate Students in Chongqing, China. Int J Environ Res Public Health 2017;14(11):1-13. and predominance of studies performed in the Asian continent77 Feng QI, Zhang Q, Du Y, Ye Y, He Q. Associations of Physical Activity, Screen Time with Depression, Anxiety and Sleep Quality among Chinese College Freshmen. Plos One 2014;9(6):e100914.,1010 Kim JH, Lau CH, Cheuk K, Kan P, Hui HLC, Griffiths SM. Brief report: Predictors of heavy Internet use and associations with health-promoting and health risk behaviors among Hong Kong university students. J Adolesc 2010;33(1):215-20.,1414 Peltzer K, Pengpid S, Apidechkul T. Heavy Internet use and its associations with health risk and health-promoting behaviours among Thai university students. Int J Adolesc Med Health 2014;26(2):187-94.,2020 Banks E, Lim L, Seubsman S, Bain C, Sleigh A. Relationship of obesity to physical activity, domestic activities, and sedentary behaviours:n crosssectional findings from a national cohort of over 70,000 Thai adults. BMC Public Health 2011;11(762):1-14.,2525 Kim S, Kim J, Jee Y. Relationship between smartphone addiction and physical activity in Chinese international students in Korea. J Behav Addic 2015;4(3):200-5.,3131 Seo DC, Torabi MR, Jiang N, Fernandez-Rojas X, Park B. Cross-cultural Comparison of Lack of Regular Physical Activity among College Students: Universal Versus Transversal. Int J Behav Med 2009;16(4):355-359.,3333 Wu X, Tao S, Zhang Y, Zhang S, Tao F. Low Physical Activity and High Screen Time Can Increase the Risks of Mental Health Problems and Poor Sleep Quality among Chinese College Students. Plos One 2015;10(3):1-10.

34 Wu X,Tao S, Zhang S, Zhang Y, Chen K,Yang Y, et al. Impact of screen time on mental health problems progression in youth: a 1-year follow-up study. BMJ Open 2016;9(6):e011533.
-3535 Xu X, Pu Y, Sharma M, Rao Y, Cai Y, Zhao Y. Predicting Physical Activity and Healthy Nutrition Behaviors Using Social Cognitive Theory: CrossSectional Survey among Undergraduate Students in Chongqing, China. Int J Environ Res Public Health 2017;14(11):1-13.. Among selected articles, most had cross-sectional design, with the exception of two studies, with longitudinal design1717 Pullman AW, Masters RC, Zalot LC, Carde LE, Saraiva MM, Dam YY, et al. Effect of the transition from high school to university on anthropometric and lifestyle variables in males. Appl Physiol Nutr Metab 2009;34(2):162-71.,3535 Xu X, Pu Y, Sharma M, Rao Y, Cai Y, Zhao Y. Predicting Physical Activity and Healthy Nutrition Behaviors Using Social Cognitive Theory: CrossSectional Survey among Undergraduate Students in Chongqing, China. Int J Environ Res Public Health 2017;14(11):1-13.. The methodological discrepancy among studies in relation to the definition and the cutoff point used to determine SB was highlighted. The instruments used for SB measurement were also diverse; however, all studies used questionnaires for this purpose. Excess body weight, depressive and psychopathological symptoms, and anxiety were the characteristics of studies most associated with SB.

It was observed that of the 23 articles, there was poor quality of publications with only one study (n = 1) presenting higher evaluation score3131 Seo DC, Torabi MR, Jiang N, Fernandez-Rojas X, Park B. Cross-cultural Comparison of Lack of Regular Physical Activity among College Students: Universal Versus Transversal. Int J Behav Med 2009;16(4):355-359., followed by six publications with score 766 Lourenço CLM, Sousa TF, Fonseca SA, Virtuoso Junior JS, Barbosa AR. Comportamento sedentário em estudantes Universitários. Rev Bras Ativ Fís Saúde 2016;21(1):67-77.,77 Feng QI, Zhang Q, Du Y, Ye Y, He Q. Associations of Physical Activity, Screen Time with Depression, Anxiety and Sleep Quality among Chinese College Freshmen. Plos One 2014;9(6):e100914.,1414 Peltzer K, Pengpid S, Apidechkul T. Heavy Internet use and its associations with health risk and health-promoting behaviours among Thai university students. Int J Adolesc Med Health 2014;26(2):187-94.,2020 Banks E, Lim L, Seubsman S, Bain C, Sleigh A. Relationship of obesity to physical activity, domestic activities, and sedentary behaviours:n crosssectional findings from a national cohort of over 70,000 Thai adults. BMC Public Health 2011;11(762):1-14.,3333 Wu X, Tao S, Zhang Y, Zhang S, Tao F. Low Physical Activity and High Screen Time Can Increase the Risks of Mental Health Problems and Poor Sleep Quality among Chinese College Students. Plos One 2015;10(3):1-10.

34 Wu X,Tao S, Zhang S, Zhang Y, Chen K,Yang Y, et al. Impact of screen time on mental health problems progression in youth: a 1-year follow-up study. BMJ Open 2016;9(6):e011533.
-3535 Xu X, Pu Y, Sharma M, Rao Y, Cai Y, Zhao Y. Predicting Physical Activity and Healthy Nutrition Behaviors Using Social Cognitive Theory: CrossSectional Survey among Undergraduate Students in Chongqing, China. Int J Environ Res Public Health 2017;14(11):1-13.. In view of these characteristics, it is necessary to present the methodological information, so that it is possible to replicate studies and also to analyze the quality of studies regarding the procedures adopted. On the other hand, the lower quality of most publications also demonstrates lack of studies that meet satisfactory levels regarding sampling aspects, with many studies not presenting random selection process88 Musaiger AO, Al-Khalifa F, Al-Mannai M. Obesity, unhealthy dietary habits and sedentary behaviors among university students in Sudan: growing risks for chronic diseases in a poor country. Environ Health Prev Med 2016;21(4):224-30.

9 Ballard M, Gray M, Reilly J, Noggle M. Correlates of video game screen time among males: Body mass, physical activity, and other media use. Eat Behav 2009;10(3):161-7.
-1010 Kim JH, Lau CH, Cheuk K, Kan P, Hui HLC, Griffiths SM. Brief report: Predictors of heavy Internet use and associations with health-promoting and health risk behaviors among Hong Kong university students. J Adolesc 2010;33(1):215-20.,1717 Pullman AW, Masters RC, Zalot LC, Carde LE, Saraiva MM, Dam YY, et al. Effect of the transition from high school to university on anthropometric and lifestyle variables in males. Appl Physiol Nutr Metab 2009;34(2):162-71.,2222 Claumann GS, Felden EPG, Pelegrini A. Comportamento sedentário em universitários: prevalência e fatores associados. Rev Baiana Saúde Pública 2016;40(3):574-88.,2323 Farinola MG, Bazán NE. Conducta sedentaria y actividad física en estudiantes universitarios: un estudio piloto. Rev Argent Cardiol 2011;79(4):351-4.,2828 Pelletier JE, Lytle LA, Laska MN. Stress, Health risk behaviors, and weight status among community college students. Health Educ Behav 2016;43(2):139-44.

29 Pires CGS, Mussi FC, Cerqueira BB, Pitanga FJG, Silva DO. Prática de atividade física entre estudantes de graduação em enfermagem. Acta Paul Enferm 2013;26(5):436-43.
-3030 Hidalgo-Rasmussen CA, Ramírez-López G, Martín AH. Actividad física, conductas sedentarias y calidad de vida en adolescentes universitarios de Ciudad Guzmán, Jalisco, México. Ciênc Saúde Colet 2013;18(7):1943-52..3535 Xu X, Pu Y, Sharma M, Rao Y, Cai Y, Zhao Y. Predicting Physical Activity and Healthy Nutrition Behaviors Using Social Cognitive Theory: CrossSectional Survey among Undergraduate Students in Chongqing, China. Int J Environ Res Public Health 2017;14(11):1-13..

Variation of SB prevalence from 34.0%2323 Farinola MG, Bazán NE. Conducta sedentaria y actividad física en estudiantes universitarios: un estudio piloto. Rev Argent Cardiol 2011;79(4):351-4. to 90.2%2121 Caballero LGR, Sánchez LZR, Delgado EMG. Sobrepeso y obesidad enestudiantes universitarios colombianos y su asociación con la actividad física. Nutr Hosp 2015;31(2):629-36. for sitting time was observed in this review. Screen time (television, computer, internet, cell phone, videogame time), was the definition most used by studies, which corroborates the review of Guerra, Farias Junior and Florindo3636 Guerra PH, Farias Júnior JC, Florindo A.A. Comportamento sedentário em crianças e adolescentes brasileiros: revisão sistemática. Rev Saúde Pública 2016;50(9):1-15., with a focus on children and adolescents, a population with study regime and permanence in educational institutions that approach university students. Of studies included in this review, the one showing 90.2% for the total sitting time in Colombian men2121 Caballero LGR, Sánchez LZR, Delgado EMG. Sobrepeso y obesidad enestudiantes universitarios colombianos y su asociación con la actividad física. Nutr Hosp 2015;31(2):629-36. was highlighted in relation to the other studies, because although researchers used an expressive cutoff point, 8 hours or more of SB per day, the prevalence value was high, being one of the studies that presented quality assessment score 6, lacking in questions related to the adequate response rate (item A6) and the presentation of information that better allows replicating the study (item C8).

Among Brazilian studies included in this review, close prevalence values were found between studies of Lourenço et al.66 Lourenço CLM, Sousa TF, Fonseca SA, Virtuoso Junior JS, Barbosa AR. Comportamento sedentário em estudantes Universitários. Rev Bras Ativ Fís Saúde 2016;21(1):67-77., with 83.7% screen time and those of Pires et al.2929 Pires CGS, Mussi FC, Cerqueira BB, Pitanga FJG, Silva DO. Prática de atividade física entre estudantes de graduação em enfermagem. Acta Paul Enferm 2013;26(5):436-43., with 82.5% for the sitting time, while in the other study with Brazilian university students, lower prevalence values were found; however, screen time was divided between leisure (40.6%) and study / work (29.2%)2222 Claumann GS, Felden EPG, Pelegrini A. Comportamento sedentário em universitários: prevalência e fatores associados. Rev Baiana Saúde Pública 2016;40(3):574-88.. The diversity of prevalence values, both in Brazilian and international studies, derives from the differentiation of methods used and represent a recurrent characteristic in studies on SB, as also observed in other systematic descriptive reviews with children and adolescents3636 Guerra PH, Farias Júnior JC, Florindo A.A. Comportamento sedentário em crianças e adolescentes brasileiros: revisão sistemática. Rev Saúde Pública 2016;50(9):1-15. and in the elderly3737 Santos RG, Medeiros JC, Schmitt BD, Meneguci J, Santos DAT, Damião R, et al. Comportamento Sedentário em Idosos: Uma Revisão Sistemática. Motri 2015;11(3):171-86.. In the present review, as in reviews with populations other than university students3636 Guerra PH, Farias Júnior JC, Florindo A.A. Comportamento sedentário em crianças e adolescentes brasileiros: revisão sistemática. Rev Saúde Pública 2016;50(9):1-15.,3737 Santos RG, Medeiros JC, Schmitt BD, Meneguci J, Santos DAT, Damião R, et al. Comportamento Sedentário em Idosos: Uma Revisão Sistemática. Motri 2015;11(3):171-86., lack of standardization of the SB definition was observed, such as the use of total time spent sitting and lying down, screen time (watching television, playing videogames, internet, cell phone time), study and reading time, which in fact represents the variety of contexts to which SB can be investigated. However, establishing a set of information about the same events becomes difficult.

Regarding the cutoff point used to estimate SB as a promoter of potential health risks, lack of consensus among studies was observed. Cutoff points varying from ≥2 hours66 Lourenço CLM, Sousa TF, Fonseca SA, Virtuoso Junior JS, Barbosa AR. Comportamento sedentário em estudantes Universitários. Rev Bras Ativ Fís Saúde 2016;21(1):67-77.,77 Feng QI, Zhang Q, Du Y, Ye Y, He Q. Associations of Physical Activity, Screen Time with Depression, Anxiety and Sleep Quality among Chinese College Freshmen. Plos One 2014;9(6):e100914.,1717 Pullman AW, Masters RC, Zalot LC, Carde LE, Saraiva MM, Dam YY, et al. Effect of the transition from high school to university on anthropometric and lifestyle variables in males. Appl Physiol Nutr Metab 2009;34(2):162-71.,2626 Mathur C, Stigler M, Lust K, Laska MA Latent Class Analysis of Weight-Related Health Behaviors Among 2-and 4-Year College Students and Associated Risk of Obesity. Health Educ Behav 2014;41(6):663-72.,2727 Musaiger AO, Awadhalla MS, Al-Mannai M, AlSawad M, Asokan GV. Dietary habits and sedentary behaviors among health science university students in Bahrain. Int J Adolesc Med Health 2015;29(2):1-6.,3030 Hidalgo-Rasmussen CA, Ramírez-López G, Martín AH. Actividad física, conductas sedentarias y calidad de vida en adolescentes universitarios de Ciudad Guzmán, Jalisco, México. Ciênc Saúde Colet 2013;18(7):1943-52.,3232 Tayem YI, Yaseen NA, Khader WT, Rajab LOA, Ramahi AB, Saleh MH. Prevalence and risk factors of obesity and hypertension among students at a central university in the West Bank. Libyan J Med 2012;7(1):1-5.

33 Wu X, Tao S, Zhang Y, Zhang S, Tao F. Low Physical Activity and High Screen Time Can Increase the Risks of Mental Health Problems and Poor Sleep Quality among Chinese College Students. Plos One 2015;10(3):1-10.
-3434 Wu X,Tao S, Zhang S, Zhang Y, Chen K,Yang Y, et al. Impact of screen time on mental health problems progression in youth: a 1-year follow-up study. BMJ Open 2016;9(6):e011533. per day to ≥10 hours2323 Farinola MG, Bazán NE. Conducta sedentaria y actividad física en estudiantes universitarios: un estudio piloto. Rev Argent Cardiol 2011;79(4):351-4. (≥600 min) per day were observed, which was also observed in previous reviews with children and adolescents, and in the elderly, regarding the distinction of the adopted risk criteria3636 Guerra PH, Farias Júnior JC, Florindo A.A. Comportamento sedentário em crianças e adolescentes brasileiros: revisão sistemática. Rev Saúde Pública 2016;50(9):1-15.,3737 Santos RG, Medeiros JC, Schmitt BD, Meneguci J, Santos DAT, Damião R, et al. Comportamento Sedentário em Idosos: Uma Revisão Sistemática. Motri 2015;11(3):171-86.. These findings highlight the need for future studies to estimate the SB time that best predicts the deleterious health effects in university students.

Regarding SB measurement instruments, all studies analyzed used the self-report to measure these characteristics, which is an alternative used in health surveys3838 Gabriel KKP, Morrow JR, Woolsey ALT. Framework for physical activity as a complex and multidimensional behavior. J Phys Act Health 2012;9(1);1-18., and questionnaires are the most used instruments in epidemiological studies3939 Atkin AJ, Gorely T, Clemes SA, Yates T, Edwardson C, Brage S, et al. Methods of measurement in epidemiology: sedentary behaviour. Int J Epidemiol 2012;41(5):1460-71.. However, there was lack of standardization of these instruments, since different questionnaires, whether national, international, or questionnaires developed for the study were used, which were also found in other systematic review studies on SB3636 Guerra PH, Farias Júnior JC, Florindo A.A. Comportamento sedentário em crianças e adolescentes brasileiros: revisão sistemática. Rev Saúde Pública 2016;50(9):1-15.,3737 Santos RG, Medeiros JC, Schmitt BD, Meneguci J, Santos DAT, Damião R, et al. Comportamento Sedentário em Idosos: Uma Revisão Sistemática. Motri 2015;11(3):171-86.. This may contribute to results that are not comparable, as well as biased information that may induce inappropriate institutional policies. The lower quality of SB publications in this review was related to the use of unsuitable instruments, which was observed in 12 articles, with special characteristic for the use of instruments without previous presentation of the psychometric qualities of these measures.

In addition, lack of longitudinal studies on this subject in university students was also observed, since only two longitudinal studies were systematized 1717 Pullman AW, Masters RC, Zalot LC, Carde LE, Saraiva MM, Dam YY, et al. Effect of the transition from high school to university on anthropometric and lifestyle variables in males. Appl Physiol Nutr Metab 2009;34(2):162-71.,3434 Wu X,Tao S, Zhang S, Zhang Y, Chen K,Yang Y, et al. Impact of screen time on mental health problems progression in youth: a 1-year follow-up study. BMJ Open 2016;9(6):e011533.. Studies with prospective characteristic could contribute with the presentation of other information that would allow the establishment of causal relationships between different characteristics of link with the University and SB 4040 Bastos JLD, Duquia RP. Um dos delineamentos mais empregados em epidemiologia: estudo transversal. Sci Med 2007;17(4):229-32..

Among factors associated with SB, overweight was one of the main characteristics associated with different types of SB and with the highest amount of articles presenting this relation. The association of these attributes was also shown in a systematic review in children and adolescents3737 Santos RG, Medeiros JC, Schmitt BD, Meneguci J, Santos DAT, Damião R, et al. Comportamento Sedentário em Idosos: Uma Revisão Sistemática. Motri 2015;11(3):171-86.. The associated factor, inversely proportional to SB, with emphasis among studies, was the level of physical activity, with active individuals being less likely to present high time of use of videogame99 Ballard M, Gray M, Reilly J, Noggle M. Correlates of video game screen time among males: Body mass, physical activity, and other media use. Eat Behav 2009;10(3):161-7. and internet1010 Kim JH, Lau CH, Cheuk K, Kan P, Hui HLC, Griffiths SM. Brief report: Predictors of heavy Internet use and associations with health-promoting and health risk behaviors among Hong Kong university students. J Adolesc 2010;33(1):215-20.. It is necessary to emphasize that these different constructs coexist as behaviors that are part of the daily life of populations, so that it is possible to concomitantly present recommended levels of physical activity and high time of exposure to SB. Other studies with university students that can better demonstrate potential mediators of the relationship between these two behaviors represent an important path for future publications.

As limitations of this review, the impossibility of establishing comparisons among different studies due to the amplitude of SB types, as well as the variety of procedures of adopted methods stand out, with special differentiation between measurement instruments and cutoff points. On the other hand, the scope of studies of different countries and years of publication, which allows understanding the characteristics of these studies on SB of university students, as well as the use of an instrument for the evaluation of research quality in order to highlight the relevance of information on this theme, are strengths.

CONCLUSION

This review showed high prevalence of SB in university students from different countries. In addition, it was observed that overweight and depressive symptoms were the main factors associated with SB. Regarding methodological aspects, diversity of sampling procedures was observed. There was lack of standardization among cutoff points for health risk assessment as a result of SB, as well as the use of unvalidated instruments and low number of longitudinal studies.

Further SB-focused studies on university students should pay attention to the quality of methodological information (sampling procedure, instruments and cutoff points) in order to present information with satisfactory quality and thus help in establishing institutional policies for the health of university students. In a practical way, there is need for the health care of university students, with a view of transforming university spaces as a means of stimulating active and healthy lifestyle, focusing on the excess time exposed to SB in this group.

How to cite this article

COMPLIANCE WITH ETHICAL STANDARDS

  • Funding
    This research did not receive any specific grant from funding agencies in the public, commercial, or non-profit sectors.
  • Ethical approval
    Ethical approval was obtained from the local Human Research Ethics Committee – This research is in accordance with standards set by the Declaration of Helsinki.

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SUPPLEMENTARY FILE 1

Descriptors used in electronic databases in the search of articles on sedentary behavior in university students.

Boolean operator “AND” was used for combinations between descriptor groups. Boolean operator “OR” was used for the variation of descriptors of the same group. Truncation symbols (“”, * and $) specific to each database were used to find words in the singular or plural or composed words.

SUPPLEMENTARY FILE 2

Articles excluded after reading in full.

Publication Dates

  • Publication in this collection
    30 May 2019
  • Date of issue
    2019

History

  • Received
    23 Apr 2018
  • Accepted
    11 Dec 2018
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