Stand Up for Health: The Dangers of Sitting

Environments that promote sedentary behavior have traditionally been seen as a sign of progress and economic power. For example, in low- and middle-income countries, using a bicycle instead of a car or not having a maid to perform household chores is a measure of low socioeconomic status.

The Health Risks

More than half of the average person’s waking hours are spent sitting.¹ Unfortunately, this kind of sedentary behavior can lead to significant health issues, including heart disease, diabetes, metabolic syndrome, and some types of cancer. Study results have shown an inverse relationship between time spent sitting and ideal cardiovascular health.² Additionally, spending a few hours a week engaged in moderate to vigorous activity does not offset these risks.³

Although the exact mechanism for this inverse relationship is under investigation, it is understood that prolonged sitting reduces metabolism, thereby affecting the body’s ability to regulate blood sugar and blood pressure and break down fat.⁴ Sedentary lifestyles have also been associated with high levels of lowdensity lipoproteins, triglycerides, and total cholesterol, as well as low levels of high-density lipoproteins. The Online Table lists health problems that can occur from too much sitting.

Table: Health Problems Associated with Too Much Sitting

Mental

Stress

Anxiety

Exhaustion

Depression

Sleep disorders

Cardiovascular

Hypertension

Cardiovascular disease

High levels of low-density lipoproteins, triglycerides, and total cholesterol

Low levels of high-density lipoproteins

Stroke

Angina

Myocardial infarction

Limbs

Loss of muscle mass

Loss of flexibility

Carpal tunnel syndrome

Hand/wrist tendonitis

Posture

Loss of flexibility

Rotator cuff disease

Pulmonary disease

Chronic pain in the neck, shoulder, back, or hand

Back

Thoracic outlet syndrome

Ruptured disks

Pulled or strained muscles/ligaments

Gut

Weight gain

Metabolic syndrome

Diabetes

Impaired libido

Coronary artery disease is the leading cause of death in the United States and the most common type of heart disease.⁵ Coronary artery calcification is an early marker for heart disease risk. This occurs when plaque accumulates in the arteries over time, causing them to narrow.⁵ One study analyzed heart scans and physical activity records of more than 2000 adults living in Dallas, Texas, and found a 14% average increase in coronary artery calcification for every hour of sedentary time per day.⁵ Additionally, meta-analysis results published in Diabetologia showed a sedentary lifestyle is associated with a 112% increase in the risk for diabetes, a 147% increase in the risk for cardiovascular events, a 90% increase in the risk for cardiovascular mortality, and a 49% increase in the risk for all-cause mortality.⁶

Although the term “sedentary lifestyle” used to mean not exercising regularly, the term has been modified to describe people who sit too much. The levels of activity for individuals are now sedentary (sitting too much), active without exercise (too little exercise), and active with exercise, with the last being the healthiest. Current guidelines for adults recommend 150 minutes per week of moderate to vigorous physical activity,⁷ as well as increasing the amount of time they exercise. Health care providers should counsel patients to limit sedentary time, particularly sitting.8

The Benefits of Moving

Standing instead of sitting burns 30% more calories,⁹ which can add up over the course of a day. The caloric outflow of nonexercise activity thermogenesis throughout a day can lead to a higher calorie expenditure than 30 to 60 minutes of moderate to vigorous exercise.¹⁰ Therefore, changes need to be made to decrease daily sitting times. This responsibility falls on individuals and the environments in which they spend their time.

Research suggests that, regardless of total sitting time, regular interruptions from sitting may help reduce the risk of developing heart disease and diabetes.¹¹ Although no set limit of sedentary time has been established, the general consensus is that everyone should get up and move around for 1 to 3 minutes every 30 minutes.

Whereas some situations, such as driving, cannot be modified to include standing or moving around, most situations can be modified. At home, stand up while folding laundry or clean while watching television. Limit time sitting with a computer. Play video games that require standing. Read while walking on a treadmill. At work, instead of sending an e-mail, leave your seat to communicate with a coworker. Request a sit-stand desk to allow standing while working. Take the stairs instead of the elevator. Take a walk at lunchtime. Have walking meetings instead of sitting in a conference room. Pace while on the phone. Set an alarm as a reminder to stand, stretch, and walk. Other suggestions include shopping at a mall instead of online, parking farther away from buildings to increase walking, walking into restaurants and pharmacies instead of using drive-throughs, and taking up active hobbies such as gardening or volunteering to walk dogs at an animal shelter.

End Note

Fortunately, a revolution against sitting is already under way. Many studies have quantified the health risks of sitting too much. The evidence of the cardiovascular risks is clear, although the health risks of different sedentary activities may vary. Driving requires more muscle movement than sitting at a computer, which requires more muscle movement than watching television.12 Companies around the world are recognizing the health risks of too much sitting and are providing employees with standing desks and making other changes that promote standing and stepping. Perhaps schools will start to provide standing desks, stretching times, and time for walking throughout the day to help children stay healthy and learn healthy habits.

Health care providers, corporations, teachers, and individuals need to take a stand for health, literally!

Dr. Kenny earned her doctoral degree from the University of Colorado Health Sciences Center. She has 20-plus years’ experience as a community pharmacist and works as a clinical medical writer based out of Colorado Springs, Colorado. Dr. Kenny is also the Colorado education director for the Rocky Mountain Chapter of the American Medical Writer’s Association.

References

• 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 meta-analysis. Ann Intern Med. 2015;162(2):123-132. doi: 10.7326/M14-1651.
• Crichton GE, Alkerwi A. Association of sedentary behavior time with ideal cardiovascular health: the ORISCAV-LUX study. PLoS ONE. 2014;9(6):e99829. doi: 10.1371/journal.pone.0099829.
• Levine JA. Adult health: what are the risks of sitting too much? Mayo Clinic website. www.mayoclinic.org/healthy-lifestyle/adult-health/expert-answers/sitting/faq-20058005. Published September 4, 2015. Accessed October 3, 2015.
• Why sitting too much is bad for your health. NHS Choices website. www.nhs.uk/livewell/fitness/pages/sitting-and-sedentary-behaviour-are-bad-for-your-health/. Accessed October 3, 2015.
• Study bolsters link between heart disease, excessive sitting. American College of Cardiology website. www.acc.org/about-acc/press-release/2015/03/05/16/19/study-bolsters-link-between-heart-disease-excessive-sitting/. Accessed October 3, 2015.
• Wilmot EG, Edwardson CL, Achana FA, et al. Sedentary time in adults and the association with diabetes, cardiovascular disease and death: systematic review and meta-analysis. Diabetologia. 2012;55(11):2895-2905. doi: 10.1007/s00125-012-2677-z.
• Crichton GE, Alkerwi A. Physical activity, sedentary behavior time and lipid levels in the Observation of Cardiovascular Risk Factors in Luxembourg study. Lipids Health Dis. 2015;14:87. doi: 10.1186/s12944-015-0085-3.
• 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.
• Corliss J. Too much sitting linked to heart disease, diabetes, premature death. Harvard Medical School website. www.health.harvard.edu/blog/much-sitting-linked-heart-disease-diabetes-premature-death-201501227618. Published January 22, 2015. Accessed October 3, 2015.
• Lopez-Jimenez F. Standing for healthier lives—literally. Eur Heart J. 2015;36:2650-2652. Published online July 30, 2015. Accessed October 14, 2015.
• The risk of sitting too much. SA Health website. www.sahealth.sa.gov.au/wps/wcm/connect/Public+Content/SA+Health+Internet/Healthy+living/Is+your+health+at+risk/The+risk+of+sitting+too+much. Accessed October 3, 2015.
• Basterra-Gortari FJ, Bes-Rastrollo M, Gea A, Núñez-Córdoba JM, Toledo E, Martínez-González MÁ. Television viewing, computer use, time driving and all-cause mortality: the SUN cohort. J Am Heart Assoc. 2014;3(3):e000864. doi: 10.1161/JAHA.114.000864.