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The Sitting Disease: sitting linked to DEATH, even if you exercise

If you’re currently sitting, I suggest that you stand up to read this article.

Humans were born to move. The more we sit, the more we’re going against the natural tendencies of our body mechanics.

Most people are well aware of the benefits of exercise. We have been told repeatedly that movement is good for your health and that we should try to be more physically active each day. But what you may be unaware of is that sitting for prolonged periods has now been scientifically correlated with negative health repercussions, including: higher rates of hospitalizations, diabetes, heart disease, cancer and even early death! For me, the real kicker was that these findings were positive regardless of whether or nor you exercise regularly! Despite the astronomical benefits of exercise, even if you exercise 1 hour daily, sitting for prolonged periods is still detrimental to your health. It is important to be conscious of both exercising regularly AND moving around periodically throughout your day.

I am very excited to share research work that my university colleague and Ph.D. candidate, Avi Biswas undertakes as part of his doctoral thesis supervised by Dr. David Alter a cardiologist and scientist at Toronto Rehabilitation Institute. They recently published a paper in a very posh journal, Annals of Internal Medicine, about the consequences of sitting. When your research is featured in a Gable comic in the Globe and Mail, I think it’s a sure sign you’re onto some spectacular, novel research.

They examined 47 studies that looked at the single effect of sitting for long periods of time in a day (after already adjusting their estimates for the potentially linked effects of also exercising) and whether this was associated with negative health risks. By statistically analyzing the findings from these studies, they concluded that long periods of time spent sitting was correlated with a 90% higher risk of developing diabetes, an 18% higher chance of dying of heart disease or certain cancers ( … ) and a 25% greater chance of death by any cause! Another key finding of the study was that when also studying whether high levels of exercise reduced the risks from long bouts of sitting, they found that the risks were still present (though much lower than those who sit more frequently and exercise very little). This suggested to them that even exercising regularly does not completely remove your risk of chronic disease and death if you sit for long periods of time every day. They also promote the key message that people should ideally aim to both exercise regularly AND find moments to reduce sitting time with moments of standing/moving. Avi has graciously allowed me to interview him regarding the findings of his study.

What sparked your interest in this area of research?

"I stumbled into sedentary behavior research by accident. I actually wanted to pursue research in disease prevention more generally, and three experiences inspired me to look into this field. First, seeing a close relative suffer from a chronic disease condition and then successfully manage their condition by diligently making small changes to their lifestyle gave me a strong interest in wanting to eventually do research in disease prevention. The second moment was learning first-hand how many chronic disease sufferers often link their woes to common issues such as a lack of knowledge and the availability of healthy alternatives while working at a non-profit health promotion organization. Perhaps the moment that bound those experiences was being inspired by local internet sensation Dr. Mike Evans’ “23 ½ hours” YouTube clip, and taking home from that the message that health prevention is perhaps most effective if made most simple and accessible. Luckily enough, after giving my supervisor this “three moments in my life” spiel and his emerging interest in sedentary behaviour research, we both felt that investigating sedentary behaviour as a thesis topic was aligned with my own experiences and would allow for me to make a direct positive impact in the lives of many people as a result of my research."

How exactly is sitting related to heart disease, cancer risk and death? What kinds of biomarkers were used to assess sitting on increased chances of mortality?

"We’re not exactly sure of the biological reasons for why sitting is bad for us. There have been several ideas pushed around based on studies done in labs, and one that is quite popular is the following: When we stand, several muscles that are responsible for keeping us upright, are closely linked to the pathways in our body that do the housekeeping in our body with regards to potentially harmful metabolites like excess blood glucose, fats and so forth. These muscles, when active, also burn calories to keep up upright. When we sit for long periods of time, these muscles become inactive as well, we burn less calories, and our metabolism is less efficient in clearing up potentially harmful metabolites that are linked with type 2 diabetes, certain cancers, heart disease and so forth."

Why does exercise not mitigate the effects of sitting for the rest of the day?

"We’re not sure. Our study seems to suggest that the pathways I’ve described above are probably a bit different to the pathways linked to the positive effects of exercise. The positive health effects of exercise might be more to do with an improvement in cardiovascular fitness and the positive effects that come from that, while reduced sitting leads to positive effects on our overall metabolism. It’s also important to remember that exercising still reduces the negative health effects of long periods of sitting quite a lot compared to those who exercise very little/don’t exercise at all."

How much is your risk of dying increased by each year, if you sit for most hours of the day?

"Our review of all the available literature, and accounting for the effects of exercising, suggests that if you sit for a long period of time, daily, you increase your risk of dying by 24% compared to those who sit for short periods of time a day."

What is it about sitting that increases "all cause mortality"?

"While we’re not sure, it might be linked to an overall metabolic effect. All-cause mortality is basically dying from all causes, and this includes the risk from heart disease, cancer and other chronic diseases."

Does lying down fall into this category or is it just sitting?

"Yes, lying down is considered “sedentary behaviour”. In essence, body movements that cause you to spend very little metabolic energy such as sitting and lying when you’re otherwise awake are considered to be sedentary/sitting behaviours."

How much sitting should we limit in hour day? How many hours should be spent, sitting, standing or exercising?

"We found a lot of variation on how different studies report extremes of sitting and standing and we don’t have consensus yet. I would say a good ballpark figure to go by is to aim for 4 hours of daily sitting when you’re awake in the day, and try not to sit for more than 8 hours. For exercising, I would follow the recommended guidelines of trying to exercise so that you at least break a sweat for 30 minutes a day, 5 days a week (150 minutes a week). Altogether, try to fit your day with regular exercise and lots of daily movement."

How can we mitigate the effects of sitting for people who have desk jobs or long commutes? Have any useful tips?

"There isn’t an easy, one-size-fits-all answer to this question. While treadmill desks are gaining popularity, they might now work for everyone. For example, those who are not usually sitting by a desk (think of your bus driver or busy emergency nurse), unable to afford one or where an employer is resistant to invest in them. Instead I borrow from behavioral psychology theory to suggest the following:

  • Monitor the moments in your day that you typically sit. By monitoring our behaviour, we’re more likely to change it.

  • Evaluate these moments and think of ways you can replace sitting times with standing or moving times. For example, stand while having your breakfast cereal. Stand or walk around during TV commercials.

  • Set small achievable goals and work up as you begin to achieve them. This helps you build towards greater non-sitting targets over a longer period of time.

  • Set an alarm to remind you to get standing if you sit for long periods of time. "

Your research has had over 165 media hits to date! It has been featured in Time Magazine, the Rick Mercer Report, CBC, CNN, the National Post, the Jimmy Kimmel Live Show, and that's only gracing the tip of the iceburg. How do you feel about all the publicity?

"While I really appreciate the media attention, a lot of it has focused on the message that sitting is bad for you. Sitting is not bad for you, but like most things, don’t do it excessively. It’s also not very hard to reduce the risks from long periods of sitting and several controlled studies have shown that taking a standing/walking break every 20-40 minutes for just 1-2 minutes can be really good for you. While I’m bracing myself for the rest of my work not having the same level of fanfare, I won’t feel terrible. I think this study is more suited to mass media circulation. I’ll still be happy if the rest of my work has some impact/influence, even if it means laying the groundwork for further research."

For anyone who knows me, you are well aware of how much I hate inactivity (perhaps that’s why I took up running), but in today’s world sometimes it just cannot be avoided. Whether it is road trips, airplanes, eating, waiting rooms, studying, sitting in classrooms if you are a student or if you have an office job! Being a naturopathic medical student, here is the breakdown of (just class/lecture) time spent sitting down in a lecture theatre in second-year naturopathic medical classes:

Monday: 7 hours

Tuesday: 6.5 hours

Wednesday: 6 hours

Thursday: 9 hours

Friday: 1.5 hours

That is not even including all of the other activities in the day that we would spend sitting! Since heath risks are dramatic for people who sit for long periods of time, here are my tips to avoid the sitting slump:

-set a timer and take a standing break every ½ hour (fill your tea, water, etc.)

-always stand whenever you’re on the phone or texting

-stand every time you ride the subway or bus

-purchase a standing desk (I bought a StandStand - see the photo below of my bamboo StandStand)

- stand while you read the newspaper, magazine or articles

- if you have regular meetings, schedule a walking meeting (or even a meeting where you stand if your partners or clients do not mind)

-only watch TV if you are standing, stretching, or doing yoga

-my favourite tip: if you’re at home, try studying or doing work while in a yoga pose. I pretty much wrote my entire Masters thesis in a yoga pose; props help a lot! A few of my favourites were legs up the wall (Viparita Karani), wide angled seated forward bend (upavista konasana), staff pose (dadasana) and bound angle pose (baddhak konasana).

This StandStand standing desk is the perfect height for any table. Best part is that it's portable! You will be surprised at how compact this desk can become when you fold it up.

Can’t wait to see what the future of research holds!

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