Despite what we currently see around us, the REAL pandemic of industrialised worlds is sedentary behaviour. According to the World Health Organisation (WHO), physical inactivity is the fourth most prominent risk factor for global mortality responsible for approximately 6% of all premature deaths. It is not just the sitting per se. It is a fact that while sitting, we tend to eat more, drink more alcohol, consume more visual entertainment, more news (mostly a source of great stress these days) and prefer activities that require very little effort—for example, ordering junk instead of cooking.
What exactly happens when we sit too long?
Human skeletal muscles (the ones we can control voluntarily) are highly metabolically active tissue. They help us regulate our blood sugar, and they keep our metabolism running at the optimal level. When we sit for too long, it may have a momentarily negative impact on our momentary blood circulation and blood sugar balance.
Sitting also means burning fewer calories than moving or standing and prolonged sitting can indeed contribute to weight gain. It is well known that unhealthy (non-lean mass) weight gain contributes to a variety of problems such as increased heart rate, blood pressure and poorer blood sugar control.
The problem with acquiring more fat tissue is that this is NOT an idle tissue. It doesn’t just sit there. Fat is very highly metabolically active. All fat cells produce a variety of inflammatory molecules and hormones of their own that interact with our hormones. This is why being obese is so dangerous. It is not just the sheer mass per se but the fact that the body of an obese person is locked in a chronic state of high-grade inflammation that slowly destroys the body from the inside.
And finally, prolonged sitting may negatively impact our brain health and our cognitive performance. Lack of physical activity reduces the production of Brain-Derived Neurotrophic Factor (BDNF). BDNF is an essential architect of our brain plasticity, helping us improve memory and brainpower. Here is the sole blog dedicated to this topic.
Wellbeing & Overall Quality of L:ife
A large national study in Spain looked at the quality of health of 21,200 students. Students self-recorded their activity levels as well as their self-perceived quality of life and health. What researchers found was an exponential increase in good health and well-being parallel with their activity level. Some interesting findings of this study:
· Exercising just twice a week reduced the risk of having any health complaints nearly by double
· Exercising 1-2 a week doubled self-perceived overall satisfaction with life
· Being active 5-6 times a week produced 460% increase in self-perceived health quality compared to students who were mostly inactive.
· All these effects were more profound in men but very significant in women as well.
Cardiometabolic health
Cardiometabolic health indicates the risk of developing diabetes or cardiovascular disease. It includes metabolic markers such as blood sugar, cholesterol, triglycerides (fats), BMI, bodyweight, obesity risk, heart rate and blood pressure.
In a 2018 meta-analysis, including over 1,331,468 participants, prolonged sitting was associated with 4% increased risk of cardiovascular mortality (especially over 6 hours a day) and 4% increased risk of all-cause mortality (over 8 hours a day).
We have to mention that much of the evidence on this particular topic is of cross-sectional nature. This is generally considered lower-validity evidence and higher-tier studies are needed to confirm. Otherwise, it is hard to separate the problematic factors from the ones which just happen to be in the way. One such example is that sedentary men are more likely to have high cholesterol but that could simply mean that men who sit longer are also more likely to eat more calories, consume more saturated fat & sugar and have other poorer lifestyle habits that are just all masking the real causative factor. Maybe men of them come back, sit on a couch, pop a few beers and watch several more hours of TV rather than going for a run. These factors are very hard to distinguish in epidemiology, especially in cross-sectional evidence.
Mental Health
According to 2017 study, people suffering from the major depressive disorder are more likely to be sedentary and engage in less physical exercise.
Prolonged sitting creates a vicious cycle for people suffering from mental health problems such as depression. This is because at their lowest, depressed people are less likely to move and more likely to seek escape and comfort inside their homes. It has been found that depressed people spend more time sitting, watching tv and browsing the internet, which further exacerbates their depression. This may lead to poor health choices such as ordering many takeaways, getting hooked on television shows, and becoming tired and sleepy. This then leads to damaged sleep, and when sleep becomes broken for a prolonged period, mental health, as well as metabolic health, suffer greatly. Prolonged sitting and watching television often leads to increased levels of stress hormones which cause psychological distress. TV becomes an escape from this unpleasant, stressful experience, only to be multiplied once the entertainment has ended.
Cognitive Health
Cognitive performance indicates the efficiency of learning, thinking, reasoning, remembering, problem-solving, decision-making, and attention. Measuring cognitive performance can tell whether the person (especially the elderly) is slowly developing a form of cognitive impairment such as dementia. However, cognitive decline is also typical in young, and it appears that lifestyle & diet play a significant role in this.
Excessive sedentary behaviour was associated with decreased verbal memory and reduced executive function. In the elderly, this problem becomes even more significant because they spend much more time sitting. One study stated: “There is now enough evidence to consider sedentary behaviour a risk factor for cognitive decline and dementia.” However, it would be a long stretch to say that sitting causes dementia. Either way, older & younger people will, in general, benefit from more mobility.
I have recently written an entire article on cognitive ageing and dietary and lifestyle strategies to minimise the risk of early onset cognitive decline, which you may read here.
Prostate Health
In men, prolonged sitting (over 7 hours/day) increases the chance of experiencing prostate problems (such as prostate growth) later in life. A marker of prostate growth called Prostate Specific Antigen (PSA) has been shown to be elevated by 16% for every one hour of sitting, however, we do not know if this was a temporary state (e.g. PSA goes back once they become active again, kind of like what happens with blood sugar) or the effect is cumulative.
Non-cancerous enlargement of the prostate (BPH – benign prostatic hyperplasia) is a multifactorial condition, which also largely depends on a person’s diet, lifestyle, habits, stress and much more. BPH is not prostate cancer but having BPH increases the risk of prostate cancer in later life.
For prostate cancer itself, there is so far only a non-significant statistical association with prolonged sitting so for now we don't know enough.
SLEEP QUALITY
A sedentary lifestyle (> 60hrs a week) may lead to insomnia in some people. Markers of sleep quality are worse in people who spend the most time sitting. There are a few reasons for this:
Sedentary behaviour often leads to eating unhealthy food. This can cause nutritional deficiencies, which can lead to sleep disturbances.
Being sedentary and spending much time looking at screens exposes the person to the monitor's blue light, which has been found to block the production of melatonin, the hormone of sleep.
As previously discussed, spending more time looking at screens generally increases self-perceived levels of stress, which interferes with sleep.
It is however, likely, that sitting while reading a book or journaling may improve quality of sleep. Likewise, sitting to meditate will definitely improve sleep quality.
What can we do about it?
Unfortunately, many of us make a living through screens and keyboards; in many cases, sitting is not optional. We have to clock a certain amount of hours per day in offices or cubicles. But there are still ways to be a little bit more mobile when possible. Short-term periods of sitting are not harmful as long as they are followed by a quick session of stretching, a short walk around the house or just some sort of active motion.
10:50 Strategy
Out of every hour working, spend 50 minutes sitting and 10 minutes performing a light physical activity. This may be light yoga or just a dynamic stretching, going for a walk, moving into the kitchen and making a fruit bowl or a coffee/tea (while the tea boils, stretch your legs, neck, arms and torso if nobody is watching 😉).
Standing Desk
Many employers and facility managers are now recognising the problems of prolonged sitting for the risk of lower back pain, weight gain and even diabetes in employees so getting a standing desk from your company might be easier than 5 years ago. Even if it meant a small deduction form your salary, it would be an investment worth making.
90 Minutes out and ABout
This is a strategy that forces you to spend 90 minutes per day outside of your home. Every time you go outside, you will track your time. You may split it into 3 short walks or a quick run in the morning and a walk in the evening or you may decide to do it all in one go. The aim is to be mobile. Sitting down for coffee does not count although walking with coffee does 😊. Biking, running or any form of other external activity counts.
STEP COUNTER
Basic and self-explanatory. Aim to perform 5,000-8,000 steps per day. A sports watch that count your step and remind you when you sit too much can be helpful as well.
Take your meetings outside
Regardless of the environment, you can probably take at least 1/3 of your meetings outside. Very often, you may be a silent participant, and other times maybe, you just can’t be bothered to pay attention. If you have a company phone or your own phone with unlimited data, most platforms like Zoom, GoogleMeet or Teams allow you to join via phone number. If you have a lot of data, use those to join.
Yes, I know, sometimes you just HAVE TO be there in front of PC. But there will be times when you don’t, so make the most of those occurrences. Or at least stand while being on the meeting. If you don’t have to be on camera, you can at least pace around in your room. Sometimes I like to do pushups or lunges while listening to meetings where I’m not required to speak. Of course, you can only do these if you are home worker, fully or partially.
Find a hobby that does not bind you to a chair
Photography, stargazing, video-blogging, shadow boxing, birdwatching, “reading” audiobooks while walking, collecting herbs, drawing in nature, roller-skating, table tennis, and many other creative forms of hobbies often force you to leave your home or at least to keep active and moving. Finding one that does not require a lot of sitting can definitely help.
In the end, it does not really matter what sort of strategy or technique you prefer. You don’t have to measure or track anything. Just try to find an opportunity to get up and be mobile a bit. Get the blood and the lymph flowing. Even when it rains, there is always something that can be done. Make the most of every day and don’t forget to have fun 😊 Moving should always have an element of enjoyment. If you hate running, dance. If you suck at dancing, get a used bike. If you are not a sports person, invest in an adjustable standing desk or start listening to a podcast on your daily walks.
Don’t forget to be kind to yourself. When you feel like you are not achieving your goals, always look back at the journey you have already walked to get here. Take a moment to appreciate it.
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SOURCES
De Rezende, L.F.M. Rey-Lopez, J.P. Matsudo, V.K.R. et al. (2014). ‘Sedentary behaviour and health outcomes among older adults: a systematic behaviour’, BMC Public Health, 14, pp.333.
Falck, R.S. David, J.C. Liu-Ambrose, T. (2016). ‘What is the association between sedentary behaviour and cognitive function? A systematic review’, British Journal of Sports Medicine, 51 (10), pp.800-811.
Galan, I. Boix, R. Medrano, M.J. et al. (2013). ‘Physical activity and self-reported health status among adolescents: a cross-sectional population-based study’, BMJ Open, 3 (5).
Hoare, E. Milton, K. Foster, C. et al. (2016). ‘The associations between sedentary behaviour and mental health among adolescents: a systematic review’, International Journal of Behavioural Nutrition and Physical Activity, 13 (1), pp.108.
Lewthwaite, H. Effing, T.W. Olds, T. et al. (2017). ‘Physical activity, sedentary behaviour and sleep in COPD guidelines: A systematic review’, Chronic Respiratory Disease, 14 (3), pp.231-244.
Patterson, R. McNamara, E. Tainio, M. et al. ‘Sedentary behaviour and risk of all-cause, cardiovascular and cancer mortality, and incident type 2 diabetes: a systematic review and dose response meta-analysis’, European Journal of Epidemiology, 33, pp.811-829.
Wu, X.Y. Han, L.H. Zhang, J.H. et al. (2017). ‘The influence of physical activity, sedentary behavior on health-related quality of life among the general population of children and adolescents: A systematic review’
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