If you read Parts I, II, and III, this topic got into some heavy material which is important to be aware of but there is also some good news out there which was touched upon in each post. That good news can really be summarized in one word: MOVE. Something I find myself sharing with my clients is a very simple analogy I wish I could take credit for but Sir Isaac Newton beat me to it with his first law of motion: A body at rest stays at rest and a body in motion stays in motion. Granted he was talking about physical objects but it is amazing how much this relates to the dynamic organisms human beings are and their overall health, well being and mobility. And based on the current body of research, if you move more, you tend to live longer. That is pretty darn good news!
Avoiding sitting for prolonged periods of time and/or adding movement into your daily routine can be accomplished in any number of ways. You are truly only limited by your imagination. It could be simple things like taking 1-2 minute walking breaks each hour at work, taking the stairs instead of the elevator/escalator, parking farther from your destination, etc. Each of these ideas often seems trivial in isolation but it is amazing what happens cumulatively over weeks, months and years, and they can become normal routines you don't even have to actively think to do. (Your car will probably have less dings in it too from car doors and grocery carts...you're welcome.)
The more challenging change is actually engaging in more sustained activities instead of sitting because that involves time and we all know time is precious. However, if you take an honest look at your schedule you can probably find at least 30 minutes during the day to engage in some type of activity. You may have to tweak your schedule and routines a bit at first but again, sticking with good habits becomes a new routine. Instead of passively watching television, actively watch your favorite shows by incorporating some simple bodyweight exercises (pushups, squats, lunges, etc.), stretching or matwork style routines (Pilates), or if you really want to get your heart rate up, shadowboxing (one of my favorites). Or better yet, trade an hour of television altogether for an activity you like to do.
The easiest thing you can do and a great starting point is highlighted in this short video which addresses a few different things but relates very well to this topic.
The moral of this story is not to cause a panic or to suggest strict rules to live by because that would be unnecessarily extreme. Instead it is meant to be food for thought so that you can take advantage of this information and incorporate it into your life as you see fit. You know your schedule, you know your life and how you want to live it. Hopefully this information can help you optimize the ways in which you live your life so that you can be a happy, healthy and mobile person for a long time coming.
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In this latest installment, I will summarize a couple of studies that address sitting time and associated health risks. You can catch up on Parts I & II if you missed those the first time around here and here.
At this point there is a growing body of literature studying different outcomes, disease progressions and chronic conditions as they relate to sitting and they all have the same conclusions. Prolonged sitting essentially has a dose response outcome: the more sitting you do, the more likely you are to suffer from chronic health issues and a shortened life span. In many studies, these results are independent of other factors like diet and activity level which is even more concerning. Even if you get your 5 mile run in everyday but you sit for 8 hours, it turns out there is still an increased risk for chronic health issues. That being said, things like diet, exercise and sleep have profoundly positive effects in other ways so be sure to keep those good habits in your life.
Wilmot et al performed an analysis and summary of 18 moderate to high quality studies in 2012 all related to sedentary lifestyle and risk of diabetes, cardiovascular disease, and cardiovascular and all-cause mortality. (1) In order to avoid discrepancies in analysis because of differing methods in each study, they compared highest sedentary times to lowest. It is possible that this could skew their results by using the extremes but even taking that into consideration their results are striking:
112% increased risk of type II diabetes
147% increased risk of cardiovascular disease
90% increased risk of death by cardiovascular disease
49% increased risk of all-cause mortality
In 2010, Alpa et al looked at leisure time spent sitting and all-cause mortality rate. (2) They compared sitting more than 6 hours vs. sitting less than 3 hours during leisure time and did not include occupational sitting time over the course of 14 years for over 120,000 people participating in the study. Independent of physical activity women who sat for more than 6 hours had a 40% higher death rate than those who sat for less than 3 hours and men had an almost 20% higher death rate. When combining sitting time with low physical activity, those numbers jump to 94% and 48% respectively! Now you can imagine what happens if you add sitting time at work to these leisure numbers. Conversely, those that sat less than 3 hours for leisure and were physically active had lower death rates.
I could continue to highlight other studies like the amount of time watching television and cardiovascular disease or the risk of obesity and prolonged sitting but I think it is quite clear already what the overall conclusion is. Whether someone has to sit for work or chooses to sit for many hours during his/her leisure time (or both), that alone is a risk factor for his/her health and well being.
By pure coincidence, I came across an infographic basically addressing the same issues. It is a bit sensationalized but even so it sheds some light on this important issue. You can check it out here.
Wishing you many more healthy years before Mr. Reaper knocks on your door! Then again, you may have some knocking on your door with much more reasonable requests of tricks or treats in the near future!
1. E. G. Wilmot, C. L. Edwardson, F. A. Achana, M. J. Davies, T. Gorely, L. J. Gray, K. Khunti, T. Yates, S. J. H. Biddle. Sedentary time in adults and the association with diabetes, cardiovascular disease and death: systematic review and meta-analysis. Diabetologia. November 2012, Volume 55, Issue 11, pp 2895-2905.
2. Alpa V. Patel, Leslie Bernstein, Anusila Deka, Heather Spencer Feigelson, Peter T. Campbell, Susan M. Gapstur, Graham A. Colditz, Michael J. Thun. Leisure Time Spent Sitting in Relation to Total Mortality in a Prospective Cohort of US Adults. American Journal of Epidemiology. Volume 172, Issue 4, pp. 419-429.
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In the second installment of my sitting series, I will touch upon metabolic issues but if you missed Part I, you can catch up and read that here.
It is not rocket science to understand that your metabolism is directly related to your energy expenditure. The more active you are, the higher your metabolism is to meet your energy needs. Therefore the opposite is also true: the less active you are, the lower your metabolism is to meet your energy needs. In our modern society, we have traded active lives out of necessity for sedentary lives by way of convenience. Many of these conveniences involve sitting. You sit in your car to do your errands, you take in information and entertainment when you sit to watch television and so many of us sit at a desk with a computer now to work for 8-10 hours each day. That adds up to a lot of sitting every day of our lives which makes for a relatively sedentary lifestyle.
To illustrate this, I will briefly highlight a study performed in 2011 by Swartz et al (1) that looked at energy expenditure in four 30 minute situations. The first involved sitting for 30 minutes without a break as the baseline measurement. The second, third and fourth bouts of sitting were interrupted by periods of walking for 1, 2 and 5 minutes, respectively. It should come as no surprise that each person expended more energy when they interrupted their sitting time with a period of walking and as expected walking for 5 minutes expended the most. To put this into perspective you would burn an extra 24 calories on average over the course of an 8 hour work day if you walked for 1 minute every hour. Do it every half hour and that number would double. For a week that would be 120 calories (or 240). 660 calories would be burned per week if you walked for 5 minutes every hour but this may not be as realistic as 1 or 2 minute walking breaks. Extrapolate these numbers over a year and you get the picture.
The obvious implication of this small study is for weight maintenance, and for many people that means weight loss. Granted this particular regimen may not be possible on the hour, every hour, every day for every person but it does shine light on incredibly simple lifestyle and work style changes that can add up to very beneficial results. Now it should be noted that the exact numbers will be different for everyone but the idea remains the same. Simple changes in position and activity will lead to a positive change in your metabolism. Even alternating periods of sitting and standing at your desk will boost your metabolism rather than sitting the whole day. The ultimate would be those fancy treadmill desks but most offices aren't really equipped for that just yet.
Beyond the direct impact sitting has on metabolic rate and calories burned (or not burned), prolonged periods of sitting have been linked to a long list of chronic diseases and conditions associated with metabolic changes detrimental to a person's health. These include but are not limited to Type II Diabetes, Cardiovascular Disease, Metabolic Syndrome, Atherosclerosis, Obesity and Breast and Colon Cancers. At best, you may be inconvenienced by not fitting into a pair of jeans or having to go to your physician more often for tests to keep track of any signs or symptoms. At worst, your life becomes more challenging as you get sick more often, suffer major health setbacks like amputations and risk premature death from largely preventative health issues.
On that note, start a good habit by getting up wherever you're sitting to read this and walk around for a minute or two. Next time I will discuss some of the long term health risks in more detail.
1. Ann M Swartz, Leah Squires, Scott J Strath. Energy expenditure of interruptions to sedentary behavior. Int J Behav Nutr Phys Act. 2011; 8: 69.
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Dr. Greg Cecere
Your personal physical therapist, movement educator and knowledge dispenser.
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The contents of this blog is meant for educational purposes only. Momentum Physical Therapy of New Paltz and Dr. Greg Cecere are not responsible for any harm or injury that may occur due to any information on this blog as it is by no means a substitute for a thorough evaluation by a medical professional.