Effects of breaking up prolonged sitting on vascular endothelial function in adults: a systematic review

Objective: Sedentary behavior contributes to vascular endothelial dysfunction and elevated cardiovascular disease risk. Because endothelial responses may differ by vascular bed, this review systematically evaluated the effects of breaking up prolonged sitting on adults' vascular endothelial function, focusing on flow-mediated dilation (FMD), blood flow, shear-rate outcomes, and the artery or measurement location reported in each study. Methods: Based on the PRISMA guidelines, literature searches was conducted in PubMed, Web of Science, CNKI, VIP, and Wanfang databases using English search terms "sedentary, sitting, sedentary behaviour, sitting position, standing, exercise, endothelial function, endothelial dysfunction, endothelium" and Chinese search terms "sedentary, sitting, sedentary behaviour, sitting position, standing, exercise, endothelial function, endothelial dysfunction, endothelium". The search period spanned from January 2000 to November 2025. The PEDro scale was used to assess the quality of the literature, and a review analysis was conducted on the 24 included articles. Results: Interrupting prolonged sitting generally improved peripheral hemodynamics, especially lower-limb blood flow and shear-rate responses, whereas FMD responses were heterogeneous and depended partly on the artery examined (e.g., brachial, superficial femoral/femoral, or popliteal artery), participant characteristics, and interruption dose. Across the included studies, frequent 2-3 min lower-limb dynamic or simple resistance breaks every 20-30 min appeared most consistently beneficial for hemodynamic outcomes. Conclusion: Short-term breaks from prolonged sitting may protect vascular function by improving blood flow and shear-rate profiles, particularly in lower-limb arteries. Because FMD findings are site-specific, brachial, femoral/superficial femoral, and popliteal artery results should be interpreted separately when applying these findings to practice. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261332434, PROSPERO CRD420261332434.