Get off your butt: Sitting may kill you.

Get off your butt: Sitting for prolonged periods throughout the day may kill you, even if you exercise regularly. If you sit for 6 hours a day or more, your risk of dying early jumps by 19%, compared with people who sit fewer than 3 hours a day. [5] These statistics come from a 2010 study, Patel's team collected data on nearly 128,000 men and women who were part of a cancer society prevention study. At the start of the study, all were free of major chronic diseases. During 21 years of follow-up, nearly 49,000 participants died.

"The simple message is that we should be moving more," said lead researcher Alpa Patel. "The less sitting you do, the better it is for you. Breaking up an hour of sitting with 2 minutes of standing or light activity can improve cholesterol, blood sugar and blood pressure."

To our detriment, we've become a society of sitters.  We spend most of our day sitting in the car, at a desk, on the couch, or in front of a screen.   Sitting for long periods can lead to weakening and wasting away of the large leg and gluteal muscles. Sitting causes your hip flexor muscles to shorten, which can lead to problems with your hip joints and lower back pain.  Sitting for long periods can also cause problems with your back, especially if you consistently sit with poor posture or don’t use an ergonomically designed chair or workstation. Poor posture may also cause poor spine health such as compression in the discs in your spine, leading to premature degeneration, which can be very painful.

Moving your muscles helps your body digest the fats and sugars you eat. If you spend a lot of time sitting, digestion is not as efficient, so you retain those fats and sugars as excess fat in your body.  Even if you exercise but spend a significant amount of time sitting, you are still risking health problems, such as metabolic syndrome.

We don’t yet understand the links between sitting and mental health as well as we do the relationships between sitting and physical health, but we do know that the risk of both anxiety and depression is higher in people that sit more.

A 2012 Australian study suggested that even when people are physically active for more than 300 minutes per week – double current recommendations – there is still an increased risk of dying associated with prolonged sitting. [6]

Prolonged sitting impairs our metabolic function (increased blood pressure, high blood sugar, excess body fat around the waist and abnormals, high cholesterol levels), and decreases an enzyme called lipoprotein lipase (LPL).   LPL is associated with:

  • Higher triglycerides (excess fat stored in the body)

  • Lower levels of HDL (the good cholesterol)

  • An increased risk of cardiovascular disease.

Prolonged periods of sitting reduces insulin sensitivity and decreases bone density.  Sitting has harmful effects on blood flow and increased damage to blood vessels. Sitting also increases the risk of death from all causes, even if you have a regular exercise routine.  Sitting has also been linked to and increase the risk of cardiovascular disease, and it may impair cognitive function as we age. 

Such messages are likely to produce a “what’s the point of trying?” response in many people and so could have a negative influence on physical activity behaviour.  If we’re going to improve our health and lower the risk of disease, we need to learn to change our behaviours positively.

What can we do?

The guidelines published by most government bodies tell us to “sit less and move more.” These guidelines are not very helpful as this is like telling someone to 'exercise' without telling them how?  A meta-analysis of 16 studies recently found that higher levels of physical activity – 60-75 minutes per day – can eliminate the increased risk of death associated with high sitting time. [7]. High volume and high-intensity exercise alone is not able to prevent the negative impacts of sedentary behaviour.  Being physically active throughout the day is more beneficial than sitting for most of the day and then performing 60minutes of physical exercise. Lean people tend to be physically active for more than 50% of the day. 

The message needs to be more transparent; we should be telling our clients to be more active throughout the day and break up long periods of sitting. 

The Australian Health Survey 2017–18 results show [8]:

  • Overall Australians aged 15 years and over-exercised 42 minutes per day on average, the most significant part of which consisted of walking for transport and walking for exercise (24.6 minutes).

  • However, only a minority met the physical activity guidelines with 1.9% of 15-17-year-olds, 15.0% of 18-64-year-olds and 17.2% of 65-year-olds and over meeting the 2014 Physical Activity Guidelines in 2017-18.

  • One in ten (10.3%) 15-17-year-olds engaged in 60 minutes of exercise (excluding workplace physical activity) every day and around one in six (15.8%) did strength or toning activities on three or more days in the last week.

  • More than half (55.4%) of 18-64 years olds undertook 150 minutes or more of exercise in the last week, excluding workplace physical activity and this increased to 65.5% when workplace physical activity was included.

  • One quarter (24.9%) of 18-64-year-olds undertook strength or toning activities on two or more days in the last week.

  • Just over a quarter (26.1%) of older adults (65 years and over) engaged in 30 minutes of exercise on five or more days in the last week.

  • Adults aged 18-64 years described their day at work as mostly sitting (43.7%), 22.8% described their day as mostly walking, 19.5% as mostly standing and 13.6% as mostly heavy labour or physically demanding work.

To change our behaviours and improve our health and life expectancy, many of our clients will need to make lifestyle changes. For every 30 consecutive minutes of sitting, stand up and move/walk for five minutes at a brisk pace to reduce the health risks from sitting. They could start by walking or cycling to and from work. When at work, they should have periodic occupational breaks – this could be as simple as standing and walking around. It’s also important to reclaim the lunch break – get outside, go for a walk to increase muscle activity.

When you sit, you use less energy than you do when you stand or move.  A 2018 study showed that standing expends 0.15 more calories per minute than sitting.  By substituting sitting with standing for 6 hours/day, a 65 kg person, with good lean muscle mass, expend an additional 54calories/day. [1]  The study showed that people with a higher lean muscle mass burned more calories per minute while standing than those with less muscle mass — another great reason why personal training and coaches should focus on strength training in the gym.

Standing or walking meetings can also be a great way to get more movement into your day. We can walk to a colleague’s desk to talk rather than sending an emailing. We could also use a height-adjustable workstation so we can stand at the desk and move around rather than sit down all day.

Then there are the simple things like taking the stairs more regularly and ignoring the lifts and escalators. If you’re short on time, perform floor-based exercises to break up television watching time, and there’s no reason why you can’t include children in exercise if separate time is challenging.

Decreasing your use of furniture to avoid a passive body position (where your body weight is fully supported by a chair), is also good.  Spending more time in a squatting position or seated on the floor.

The benefits of regular exercise include stress management, improved mood, increasing self-confidence, prevention of cognitive decline, increase in memory and brain function, increase in focus and productivity, increase in creativity, improved physical and mental performance.  Regular exercise has been shown to decrease the chances of chronic disease ranging from obesity to cardiovascular disease to type 2 diabetes, metabolic syndrome, cancer, osteoporosis, anxiety, depression, insomnia, dementia, Alzheimer’s, risk of falls, and early death, and that is just a partial list.

Moving more does not mean we need to be doing high-intensity training every day. In fact, it’s better for our health and longevity if we change the intensity of our training. High-intensity days should be followed by lower intensity days of training, if your goal is to improve fitness your performance will increase with a mix of aerobic (65-80% intensity) can anaerobic (80-100% intensity) energy system training.

Excess high-intensity training can lead to overtraining.  High-intensity-interval-training (HIIT) done correctly is a highly effective way of improving fitness [2] but should be followed by easier days to allow for musculoskeletal recovery and rebuilding.   HIIT sessions should be performed one-to-three times per week. HIIT involves intermittent bursts of moderate-to-high level intensity exercise with intervening periods of rest and recovery.  A 10-20min workout of the day (WOD) with no rest intervals is NOT HIIT, it's moderate-intensity continuous training (MICT).   "As little as 3 HIIT sessions per week, involving ≤10 min of intense exercise within a time commitment of ≤30 min per session, including warm-up, recovery between intervals and cool down, has been shown to improve aerobic capacity, skeletal muscle oxidative capacity, exercise tolerance and markers of disease risk after only a few weeks" [4].

A 2018 study found that performing HIIT training three times per week for eight weeks reduced total body and trunk fat percentage, total cholesterol and low-density lipoprotein-cholesterol and improved the mental component of quality of life [4].

Excessive exercise is a common problem in particular sports and fitness regimes. Nearly any type of exercise can be overdone, marathons, triathlons, cycling, HIIT, strength training, etc. Overtraining is associated with increased injury, oxidative damage, inflammation, and cognitive decline. It can also lead to decreased immune function, slower fat metabolism, and reduced cardiovascular health.

Don’t let your training regimen get in the way of your sleep. Overtraining can cut into valuable recovery time as most people try to fit exercise in before or after work.  Research has shown that endurance athletes who spend most of their day sitting, outside of their training time, have a higher risk of disease compared to athletes who didn’t sit as much.

Symptoms of overtraining include:

  • Decreased performance

  • Increased recovery time

  • Fatigue or lethargy

  • Insomnia

  • Difficulty concentrating

  • Memory loss

  • Muscle or joint pain

  • Low libido,

  • Amenorrhea in women

  • Anxiety and depression

Reducing and breaking up the time that we spend sitting must be seen as a possible public health priority.  As health and fitness professionals, we can help our clients lose weight, improve their fitness levels, and reduce the risk of disease and even death, but encouraging them to move frequently through the day.

REFERENCES:

  1. Differences of Energy Expenditure While Sitting Versus Standing: A Systematic Review and Meta-Analysis. Farzane.S, et al. 2018

  2. High-intensity Interval Training Versus Moderate-Intensity Continuous Training Within Cardiac Rehabilitation: A Systematic Review and Meta-Analysis. Amanda L Hannan, et al. 2018

  3. Is High-Intensity Interval Training a Time-Efficient Exercise Strategy to Improve Health and Fitness? Jenna B Gillen, et al. 2014

  4. High-intensity Interval Training Frequency: Cardiometabolic Effects and Quality of Life. Pinelopi S Stavrinou. Et al 2018

  5. Leisure Time Spent Sitting in Relation to Total Mortality in a Prospective Cohort of US Adults. Alpa V Patel, et al. 2010

  6. Sitting Time and All-Cause Mortality Risk in 222 497 Australian Adults. Hidde P Can Der Ploeg, et al. 2012

  7. Does Physical Activity Attenuate, or Even Eliminate, the Detrimental Association of Sitting Time With Mortality? A Harmonised Meta-Analysis of Data From More Than 1 Million Men and Women. Ulf Ekelund, et al. 2016

  8. Australian National Health Survey: First Results, 2017-2018