Advise Patients About the Risks of a Sedentary Lifestyle

Regular physical activity is one of the most important things individuals can do to improve their health. Globally, however, up to 31% of individuals 16 years and older don’t meet the recommended levels of physical activity.^1,2 Importantly, a sedentary lifestyle is linked to an increased risk of adverse health outcomes worldwide and contributes to the deaths of 3.2 million individuals each year.^2,3

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The term sedentary refers to physical inactivity. In 2012, the Sedentary Behaviour Research Network proposed this now widely used definition: any waking behavior such as sitting or leaning with an energy expenditure of 1.5 metabolic equivalent tasks (METs) or less.⁴ An MET is defined as the ratio of work metabolic rate to the standard resting metabolic rate of 1 kcal/(kg/h). To put this in perspective, light physical activity has a MET of 1.6 to 2.9 and moderate physical activity has a MET between 3.0 and 5.9.

The dangers of inactivity are significant. A large review of studies published in the Annals of Internal Medicine in 2015 found that even after adjusting for physical activity, sitting for long periods was associated with worse health outcomes.⁵ This includes heart disease, type 2 diabetes, hypertension, obesity, cancer, and all-cause mortality.^6,7 Sedentary behavior also increases the risk of developing mood and mental health disorders such as anxiety and depression and can contribute to aches, pains, and injuries from poor muscle, joint, and bone health.^6,7

Inactivity is also associated with a higher risk of dementia. A 2023 study published in JAMA suggests that time spent in sedentary behaviors among older adults is significantly associated with a higher incidence of all-cause dementia.8 In this study, researchers found that participants’ chances of developing dementia increased if a total of 10 hours of their day was spent sedentary. The longer the total time spent in sedentary behaviors, the higher the risk for dementia.⁸

CONTRIBUTIONS TO A SEDENTARY LIFESTYLE

Multiple factors contribute to a sedentary lifestyle. Sitting for long periods—working at a computer, watching TV, playing video games, commuting in the car, or sitting at school or work—can impact overall health. Sedentary behaviors can also impact overall health relatively quickly. Research shows it can take just 2 weeks of inactivity in young, healthy individuals to negatively affect health, muscle mass, and metabolism.⁶

ACTIVITY RECOMMENDATIONS

The current Activity Guidelines for Americans from the US Department of Health and Human Services (HHS) and the American Heart Association recommend getting 150 minutes of activity per week.⁹ This can equate to roughly 30 minutes a day, 5 days a week of moderate-intensity aerobic activity. Examples of aerobic activities are walking, jogging, tennis, swimming, and cycling, although there are many other options. Activities can vary, with a combination of activities each week to reach the 150-minute goal. Ultimately, the best exercise is the one that can be enjoyed and done consistently. Even small activities such as a yoga class, gardening, or playing with one’s children can increase activity.

According to the HHS guidelines, adults should also incorporate muscle-strengthening exercises such as resistance training or weight training at least 2 days per week.

Moderate to vigorous physical activity also can help diminish the increased health risks associated with being sedentary, according to an observational study published in British Journal of Sports Medicine. Experts in the study examined data for 11,989 individuals 50 years or older, half of whom were women.¹⁰ They measured moderate activity such as very brisk walking (4 mph or faster), heavy cleaning such as washing windows or mopping, cycling at 10 to 12 mph, and badminton, as well as vigorous activities such as hiking, jogging at 6 mph or faster, shoveling, fast cycling, football, basketball, or tennis. The study found that participants who sat 12 or more hours a day had a 38% higher risk of death than those who sat 8 hours a day. However, the rate of increased risk fell as levels of moderate to vigorous exercise increased. Just 10 minutes of such activity per day reduced the risk of death by 35%.¹⁰

WAYS TO PRIORITIZE ACTIVITY

The best exercise will be the one that works for individualized needs and priorities, whether that is going for a walk with friends, taking a yoga class, or playing tennis. It’s also important to prioritize movement throughout the day. Although daily exercise certainly has benefits, its effects can be quickly counteracted by staying sedentary for the rest of the day.

Suggestions for staying active throughout the workday include walking away from the computer screen at regular intervals, walking over to a coworker instead of calling, stopping for breaks on long car rides, and exercising on a lunch break.

At home, our modern lifestyle makes many things convenient, but it also contributes to inactivity. For example, going to get groceries instead of having them delivered and physically changing the thermostat instead of using an app are easy ways to incorporate a little bit more movement. Even cooking a healthy meal from scratch is a great way to incorporate active time into the day.

There are many benefits to being active throughout the day. By decreasing the amount of sedentary time, patients can better control weight, reduce blood pressure, improve mental health, and decrease the risk of other negative health outcomes. Educating patients about the small ways they can incorporate more movement can have significant impacts on their overall health.

About the Author

Joanna Lewis, PharmD, MBA, is the 340B compliance coordinator at Baptist Health in Jacksonville, Florida.

References

1. Physical activity for different groups. CDC. July 29, 2021. Accessed November 15, 2023. https://www.cdc.gov/physicalactivity/basics/age-chart.html
2. Park JH, Moon JH, Kim HJ, Kong MH, Oh YH. Sedentary lifestyle: overview of updated evidence of potential health risks. Korean J Fam Med. 2020;41(6):365-373. doi:10.4082/kjfm.20.0165
3. Health promotion. World Health Organization. Accessed November 15, 2023. https://www.who.int/teams/healthpromotion/physical-activity
4. Tremblay MS, Aubert S, Barnes JD, et al. Sedentary Behavior Research Network (SBRN) – Terminology Consensus Project process and outcome. Int J Behav Nutr Phys Act. 2017;14(1):75.doi:10.1186/s12966-017-0525-8
5. Biswas A, Oh PI, Faulkner GE, et al. Sedentary time and its association with risk for disease incidence, mortality, and hospitalization in adults: a systematic review and metaanalysis. Ann Intern Med. 2015;162(2):123-132. doi:10.7326/M14-1651
6. 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. Eur J Epidemiol. 2018;33(9):811-829. doi:10.1007/s10654-018-0380-1
7. Katzmarzyk PT, Church TS, Craig CL, Bouchard C. Sitting time and mortality from all causes, cardiovascular disease, and cancer. Med Sci Sports Exerc. 2009;41(5):998-1005. doi:10.1249/MSS.0b013e3181930355
8. Raichlen DA, Aslan DH, Sayre MK, et al. Sedentary behavior and incident dementia among older adults. JAMA. 2023;30(10):934-940. doi:10.1001/jama.2023.15231
9. US Department of Health and Human Services. Physical activity guidelines for Americans, 2nd ed. 2018. Accessed November 15, 2023. https://health.gov/sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_edition.pdf
10. Sagelv EH, Hopstock LA, Morseth B, et al. Device-measured physical activity, sedentary time, and risk of all-cause mortality: an individual participant data analysis of four prospective cohort studies. Br J Sports Med. 2023;57(22):1457-1463. doi:10.1136/bjsports-2022-106568