Associations between accelerometer-assessed occupational and leisure-time sitting and self-reported cognitive dysfunction in Swedish middle-aged adults: a cross-sectional analysis from the SCAPIS study
Frida Bergman, C. Boraxbekk, et al. • BMC Public Health • 2026
Domain-specific sitting time was associated with the occurrence, but not the severity, of self-reported cognitive dysfunction in middle-aged adults, with occupational sitting associated with lower odds and leisure-time sitting associated with higher odds of reporting cognitive dysfunction.
Key Findings
Results
Each additional hour of occupational sitting was associated with 8% lower odds of reporting any cognitive dysfunction in fully adjusted models.
Odds ratio (OR) 0.92, 95% confidence interval (CI) 0.87–0.98
Analysis used the logistic regression component of a Hurdle model
Fully adjusted model controlled for sex, age, educational level, moderate- to vigorous physical activity, sleep duration, risky alcohol intake, and emotional health limitations
Total sample included 1559 participants aged 50–64 years from the Umeå site of SCAPIS
Results
Each additional hour of leisure-time sitting was associated with 12% higher odds of reporting any cognitive dysfunction in fully adjusted models.
Odds ratio (OR) 1.12, 95% confidence interval (CI) 1.03–1.21
This contrasting direction compared to occupational sitting suggests context of sedentary behavior matters
Analysis used the logistic regression component of a Hurdle model
Leisure-time sitting was measured using a thigh-worn accelerometer over seven days
Results
Neither occupational nor leisure-time sitting was significantly associated with the severity of cognitive dysfunction among individuals who reported any dysfunction.
Severity analysis used the beta-binomial regression component of the Hurdle model
The Hurdle model was used to separately assess occurrence (logistic regression) and severity (beta-binomial regression) of cognitive dysfunction
Cognitive dysfunction was measured using the Cognitive Dysfunction Questionnaire
This finding indicates that sitting time relates to whether cognitive dysfunction is reported, but not how severe it is among those affected
Methods
The study used a Hurdle model to separately analyze the probability of any cognitive dysfunction and the severity of dysfunction among those reporting it.
Occupational and leisure-time sitting were measured using a thigh-worn accelerometer over seven days
Work hours were reported in a diary to distinguish occupational from leisure-time sitting
Cognitive dysfunction was self-reported using the Cognitive Dysfunction Questionnaire
Participants were 1559 Swedish adults aged 50–64 years enrolled in the cross-sectional SCAPIS study at the Umeå site
Discussion
The contrasting associations between occupational and leisure-time sitting suggest that the context of sedentary behavior may be relevant for cognitive health.
Occupational sitting was associated with lower odds of cognitive dysfunction while leisure-time sitting was associated with higher odds
Authors propose that cognitively active versus cognitively passive sedentary behaviors may explain the differential associations
Authors call for future longitudinal studies using device-based measurements to clarify causality and explore the role of cognitively active and passive sedentary behaviors
The cross-sectional design precludes causal inference
What This Means
This research suggests that not all sitting is equal when it comes to cognitive health. In a study of over 1,500 Swedish adults aged 50 to 64, researchers found that spending more time sitting at work was actually linked to a slightly lower likelihood of reporting cognitive difficulties, while spending more time sitting during leisure hours was linked to a higher likelihood of reporting such difficulties. Both findings held up after accounting for factors like physical activity levels, sleep, alcohol use, and emotional well-being.
Importantly, among people who did report cognitive difficulties, neither type of sitting was linked to how severe those difficulties were — only to whether difficulties were reported at all. The researchers suggest this difference between work and leisure sitting may be because sitting at work often involves mentally engaging tasks, while leisure sitting (such as watching television) may be more mentally passive. This distinction between 'cognitively active' and 'cognitively passive' sedentary behaviors could be key to understanding why context matters.
This research is cross-sectional, meaning it captured a single snapshot in time, so it cannot prove that sitting causes or prevents cognitive problems. Future studies following people over time will be needed to understand the direction of these relationships. The findings do suggest, however, that public health guidance on sedentary behavior and brain health may need to consider not just how much people sit, but where and how they sit.
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Frida Bergman, C. Boraxbekk, P. Hettiarachchi, M. Svartengren, Patrik Wennberg, M. F. Fortuin-de Smidt. (2026). Associations between accelerometer-assessed occupational and leisure-time sitting and self-reported cognitive dysfunction in Swedish middle-aged adults: a cross-sectional analysis from the SCAPIS study. BMC Public Health. https://doi.org/10.1186/s12889-026-29397-4