Prolonged Sitting Linked to Serious Health Risks, Death

Study Authors Offer Tips for Reducing Sedentary Time

January 27, 2015 04:18 pm Chris Crawford

A recent study suggested that sitting for prolonged periods increases risk for heart disease, diabetes, cancer and death, even among people who exercise regularly.

Cynthia Stapp in AAFP Public Relations works at a standing desk to reduce the time she spends sitting.

For the study article,( published in Annals of Internal Medicine on Jan. 20, researchers conducted a systematic review and meta-analysis of published research to quantitatively evaluate the association between adults' sedentary time and health outcomes independent of physical activity.

Evidence showed that prolonged sitting is independently associated with negative health outcomes and mortality. But the health effects of prolonged sitting were most pronounced in people who never exercise or do so only occasionally.

More than half of the average person's waking life involves sedentary activity, such as watching television, working at a computer or commuting, according to the study, so sitting should be a common health concern.

Jason Matuszak, M.D., of Buffalo, N.Y., a sports medicine specialist and member of the AAFP Commission on Health of the Public and Science, told AAFP News that the study shows everyone should reduce the time they spend sitting.

Story highlights
  • Researchers conducted a systematic review and meta-analysis of published research on the association between adults' sedentary time and health outcomes independent of physical activity; their work published Jan. 20 in Annals of Internal Medicine.
  • Evidence showed that prolonged sitting is independently associated with negative health outcomes and mortality.
  • Lead author David Alter, M.D., Ph.D., offered simple strategies physicians can pass along to patients to help them reduce sedentary time.

"People who don't exercise can be healthier even if all they do is reduce the amount of time they sit," he said. "People who do exercise can be healthier by decreasing the time they spend sitting, too. What we are really talking about is a change in the fundamental way that we do things in society by reducing sedentary time. We've known an active lifestyle is better for a long time."

Tips to Reduce Sedentary Time

The study's lead author, David Alter, M.D., Ph.D., senior scientist at Toronto Rehabilitation Institute-University Health Network and Institute for Clinical Evaluative Sciences, said exercising one hour a day does not counteract prolonged sitting.

He offered simple strategies physicians can pass along to their patients to help them reduce sedentary time, including:

  • taking a one- to three-minute break about every half hour during the day to stand (which burns twice as many calories as sitting) or move around and
  • standing or exercising while watching television.

Alter said he also tells patients to set achievable goals and scale up slowly. For example, a patient could start by reducing sitting by 15 to 20 minutes a day and then set weekly goals to improve from there. Eventually, Alter said, a patient should aim to cut two or three hours of sedentary time.

Family Physician Expert Weighs In

Matuszak said the study provides additional ammunition to get patients thinking about being more active.

He suggested a handful of icebreakers to start a patient discussion on the topic:

  • "Another study has shown that being sedentary is more lethal than obesity; do you have any thoughts about how we might get you to be more active?"
  • "Were there any times in your life when you were more active?"
  • "Everyone assumes cardiovascular exercise means running. Do you enjoy team sports or group exercise activities? Even activities like bowling can decrease your sedentary time."
  • "I'm very happy you are getting your 150 minutes of exercise a week, but what are you doing to decrease your screen time?"

Matuszak said the American College of Sports Medicine recommends 150 minutes a week of cardiovascular exercise in at least 10-minute periods.

"I like that Australia actually says 150 to 300 minutes," he said. "It should be noted that this is 'moderate intensity.' Many of my patients equate moderate intensity with going for a walk outside or they count the time walking from the car to the grocery store. I'll tell people moderate intensity is 'exercising with a purpose.' This should be breaking a sweat and breathing hard -- it should be work, not leisurely."

For patients with knee and hip arthritis, Matuszak said he starts by talking about yoga, tai chi, Pilates or even an aquatics arthritis program.

"I also start reinforcing the idea that having arthritis doesn't mean that you can't do weight-bearing exercise -- even running," he said. "There are almost no diagnoses that would entirely preclude exercise, with the exception of things like unstable angina or decompensated heart failure."

Matuszak said walking groups can help sedentary patients increase their physical activity. So can low-impact/low-exertion activities such as bowling, darts, Wii games, shuffleboard, leisurely swimming or shooting baskets, none of which require much more exertion than being seated but may mitigate some of the risk.

"The trick is to find something that sparks an interest with the particular individual, explore that interest and see if we might find a fit," he said.

Standing desks also can help patients who are stuck in a cubicle or office all day.

"I think desks that offer the user the option to transition easily from sit to stand are probably the best option, with the user being freely able to transition throughout the workday," Matuszak said.

One simple suggestion for family physicians is to practice what they preach. "In other words, if patients see physicians or their staff modeling the behavior, it makes a more powerfully convincing argument," he said. This includes leading walking groups ("Walk With the Doc" days) and keeping an updated list of community or local free physical activities, which many newspapers publish.

How do patients actually become less sedentary? "Repetition, repetition, repetition," Matuszak said. "While many people already lead busy lifestyles, remember the quote, 'What fits your busy schedule better: Exercising an hour a day or being dead 24 hours a day?'"

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