Medicina, Vol. 58, Pages 1764: Public Health Concern on Sedentary Behavior and Cardiovascular Disease: A Bibliometric Analysis of Literature from 1990 to 2022

1. IntroductionCardiovascular disease (CVD), as a non-communicable disease, has been the leading cause of death and disability worldwide since 1990, posing a significant public health issue [1]. CVD is identified as a class of diseases that involve heart or blood vessels, while the common forms of CVD include coronary artery diseases, strokes and transient ischemic attacks, peripheral arterial disease, and aortic disease [2,3]. The World Health Organization (WHO) reported in 2019 that CVD was responsible for 32% of deaths worldwide [4], and was directly responsible for 18.6 million deaths worldwide in 2019 [1]. In terms of the geographical distribution of the burden of CVD, more than three quarters of deaths due to CVD occurred in developing countries [1,4]. Given the accelerating rate of ageing [5], and the difficulty in accessing CVD-related health services in these areas [6], effective and affordable public health actions and interventions against CVD are needed to mitigate the further widening of global health inequalities [7].Among the various risk factors for CVD, sedentary behavior (SB), which is a modifiable behavioral risk factor, has been of increasing interest to a growing number of stakeholders in recent decades [8]. This complicated human movement behavior is defined as ‘any waking behaviour characterised by an energy expenditure of ≤1.5 metabolic equivalents of task while in a sitting, reclining or lying posture’ [9]. However, in the sport science research area, the term “sedentary” is often applied to describe the incompliant with certain thresholds for moderate to vigorous physical activity (PA) [10]. Meanwhile, SB was also confused with the concept of physical inactivity until the definition of SB in the field of PA for health was standardized [11]. Therefore, in previous studies, the definition of SB varies depending on the time period in which the study took place, the different professions, and other factors.The sedentary lifestyle is considered a highly prevalent disease in the 21st century due to the serious risk to public health [12]. Prolonged SB is common among children [13], adolescents [14], adults [15], and the elderly [16]. According to the estimation of the WHO, excessive SB is responsible for approximately 3.2 million deaths each year [17]. Considerable evidence demonstrated that high levels of SB increase all-cause and CVD mortality [8,18]. Furthermore, by treating SB as a risk factor independent of PA, previous studies have still reported the association of prolonged SB with high CVD mortality and morbidity [19,20,21]. To address this growing public health issue, the WHO [22], the UK [23], the USA [24], Canada [25], Australia [26], China [27], and other countries have developed a series of evidence-based guidelines on PA and SB. Moreover, several public health intervention trials based on behavior change techniques and wearable devices to reduce SB have been demonstrated to be effective in reducing cardiometabolic risk factors and thus preventing CVD [28,29,30]. Furthermore, PA were often designed as an intervention to replace SB, and previous studies have found an individualized spectrum of PA that affects the body mass index and thus overall probability of metabolic syndrome [31,32].The majority of scientific research is presented in the form of publications, and bibliometric analysis is a mixed-method analysis of the literature in a given field using mathematical and statistical methods, to assess research trends and present the development frontiers in the given research fields [33]. The purpose of bibliometrics differs from that of systematic reviews and scoping reviews [34]. The primary purpose of a bibliometric analysis in a particular research area is to focus the attention of researchers and funding agencies on under-researched areas, and to help policy makers conduct rational public health policies and decisions [35]. In the public health area, bibliometric analysis has been performed to investigate publications on topics such as vaccine hesitancy [35], global migrant health [34], PA and air pollution [36]. Despite the increasing global burden of SB and CVD on public health systems, and the growing public concern around the world over the past 30 years, hitherto, there has been no bibliometric analysis of global publications on the sedentary behavior and cardiovascular diseases (SB-CVD) research area.

Therefore, this present research aims to provide bibliometric analysis and draw knowledge maps from the global published literature in the SB-CVD research area from 1990 to 2022. Specifically, this present research will identify: (1) the countries, institutions, authors, disciplines, journals and references that contribute significantly to global research on SB-CVD; (2) the current hotspots and primary topics of global research on SB-CVD; and (3) the frontiers in the SB-CVD research area.

5. Conclusions

This study illustrated the research progress, hotspots, and research frontiers of the SB-CVD research area from 1990 to 2022 through bibliometrics and visual knowledge mapping techniques. After three decades of development, SB-CVD research has reached a stable stage with a steady increase in the number of citations. Within the SB-CVD research area, institutions and researchers from western developed countries contributed the majority of publications. SB-CVD is a multidisciplinary research area and important disciplines, journals, funding agencies, and representative references within this area were identified. Investigations within the SB-CVD research area addressed the entire lifespan, the most popular type of research was the epidemiological study, and the accelerometer was the primary instrument used for measuring SB. In terms of the variables, PA and SB were the dominant lifestyle behaviors, while obesity and hypertension were the most common CVD-related health problems. Occupational PA and guidelines are at the frontiers of the SB-CVD research area and are currently in the burst stage. The above findings provided further research ideas for subsequent investigation on SB-CVD and provided a reference for international collaboration.

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