Most of us have listened to the popular song Just Stand Up.
The song was performed by an all-star charity super-group of pop, rock and country artists during the telethon “Stand Up to Cancer” in 2008.
Now, it is high time for all of us to stand up for a different cause – getting people to move more in order to reduce the burden of non-communicable diseases.
There are 1,440 minutes a day. How many minutes do you spend on physical activity? How many minutes on sitting?
A host of epidemiologic evidence from large studies unequivocally supports an inverse, independent and graded association between volume of physical activity and obesity; while a growing body of evidence has highlighted the negative health consequences of excessive sedentary behaviour.
The physical, economic and social environments in which modern humans sit or move within the context of their daily lives have been changing rapidly, and particularly so since the middle of the last century.
Changes in transportation, communication, workplace and entertainment technologies have been associated with significantly reduced demands for physical activity.
However, these reductions in the environmental demands for being physically active are associated with another class of health-related behaviours.
Sedentary behaviours have emerged as a new focus for research on physical activity and health.
Any waking behaviour characterised by low energy expenditure in a sitting or reclining posture is considered as sedentary behaviour.
Sedentary behaviour is a distinct behaviour separate to that of merely being physically inactive. Public health focuses on promoting exercise, but neglects sitting, where people spend the majority of their time.
Research shows the amount of time people spend in sedentary behaviours has increased in recent years, and while this includes television time, a dramatic increase in other types of screen time, such as with computers and video games, appears to be driving the trend.
The new types of technological interaction appear to be more sedentary in nature and may have implications for obesity.
This behaviour has two distinct effects: time spent in sedentary behaviour reduces engagement in physical activity and specific deleterious effects of sedentary behaviour, such as mortality associated with television viewing.
These sedentary behaviours may in turn displace physical activity, decrease metabolic rate, and/or serve as a conditioned stimulus for eating.
Common examples of sedentary behaviours include:
• Sitting while at work or school
• Watching television
• Using a computer or playing video games – this excludes “active” gaming
• Sitting while socialising with friends or family
• Sitting in a car or other form of motorised transport – for a young child, this could include being carried in a car seat or pushed in a buggy.
There are health benefits to be gained from meeting the World Health Organization recommendations for moderate intensity physical activity levels.
However, research now suggests, even if an individual does achieve these exercise recommendations, they still face health risks from sitting for continuous periods of time.
Therefore, exploring ways of breaking up periods of inactivity (i.e. standing up every so often) are becoming more important.
A few studies reveal that it is more dangerous for a person to have a high cardio metabolic risk factor than one who is currently smoking.
The sitting generation
Those who do not exercise have by convention been termed sedentary. However, this is no longer an adequate perspective.
Although someone goes to the gym, exercises or walks for 30 to 45 minutes a day, if they sit during the remaining hours, they are also considered as having a sedentary lifestyle.
Sitting wrecks the body, and as soon as you sit, electric activity in the leg muscles shuts off; calorie burning drops to one per minute; and enzymes that help break down fat drop 90%.
People with sitting jobs have twice the rate of cardiovascular disease. In 1953, a study observed that bus conductors’ risk of heart attack was half that of bus drivers. The study averred the prominent difference between their lifestyles was that one of them spent their shift standing and the other seated.
We repeatedly see that office workers are becoming more sedentary.
When you think about the latest in technology and gadgets, almost all labour-saving devices have contributed to the average office worker sitting in excess of 12 hours a day (if you combine sitting at work and the habit of sitting at home).
Almost every modern invention has reduced the amount of movement we have each day.
Compared with our parents or grandparents, we are spending increasing amounts of time in environments that not only limit physical activity, but also require prolonged sitting – at work, at home, and in our cars and communities.
During adolescence, and in the transition to university (specifically during the duration of study at university), the disregard to a healthy lifestyle is prevalent and there is a reduction in moderate to vigorous physical activity.
There is evidence that a larger proportion of students transiting to university engage in low levels of physical activity, with about one-third of previously active students becoming inactive during the transition.
Children who tend to be more sedentary have a good chance of continuing to be sedentary as adolescents. This suggests sedentary habits developed early in life tend to be relatively unchanging over time.
Social cognitive factors
Research on physical activity participation has broadened beyond a focus on the effect of intra-personal factors alone, towards the application of the social cognitive model of health to physical activity.
This new focus has revealed that interpersonal, environmental and policy-related factors influence physical activity participation.
Self-efficacy is a key to regular exercise, while environmental factors, including social support and the environment, are important for exercise compliance.
Social support for exercise behaviour from friends and family is critical. Environmental factors like availability of facilities such as jogging tracks, bicycle lanes, swimming pools, gymnasiums, professional advice and coaching can also play a major role in your participation in physical activity.
Scientists studying the ill effects of this decrease in physical activity have revealed a complex, multifaceted relationship between physical work, energy expenditure and health.
With prolonged periods of sitting, fewer muscle contractions mean less glucose-stimulated insulin secretion.
Moreover, time spent in sedentary behaviours is associated with increased cardiovascular and all-cause mortality; this has now been shown for television viewing time, overall daily sitting time, and time spent sitting in cars.
Prolonged sitting increases your risk for diabetes, certain types of cancer, chronic kidney disease, hypertension, stroke, musculoskeletal symptoms, weight gain and the development of obesity.
One hour of sitting is as unhealthy as smoking two cigarettes. Therefore, sitting is often described as the new smoking.
Beyond the influence on health, sedentary behaviour may also influence overall successful ageing – a term used to represent the physical, psychological and social success with which adults age.
Evidence for the relationship of sitting to poor mental health outcomes is also emerging. Prolonged sitting can lead to psychological distress and low self-esteem.
Prevention is better than cure
We need to invest in our health and wellbeing now by encouraging new practices within our workforce:
• Walking meetings
• Treadmill desks
• Educating staff on sedentary lifestyles
• Taking mobile phone calls away from the desk
• Setting alarms to remind you to stretch and move
• Aiming for a good balance of sitting and standing
• Tweaking initial designs to encourage movement and flexible workspaces
• An ergonomic work space can help minimise the negative effects of too much sitting
• Discounts for health screenings and fitness tracking devices
We could also change the classroom environment to reduce sitting time:
• Incorporating sit-to-stand desks into classrooms appears to have effectively reduced classroom sitting in a diverse sample of children.
• Brochures with recommendations for physical activity.
• In-class lessons promoting physical activity and decreasing sedentary behaviour.
• Web-based, tailored physical activity advice to decrease sedentary behaviour.
• After-school dance classes.
• Free family swimming pass and health club memberships.
• Smart bike-sharing platforms.
Britain and Australia have started national campaigns to reduce sitting time. The Get Britain Standing campaign has been found to be promising in combatting prolonged sitting. It has been revealed that Australia’s Prime Minister Malcolm Turnbull uses the stand-up desk in his parliamentary office.
Let’s get active. Take breaks and stand up every 20 to 30 minutes. Incorporate stretching into your daily routine. Avoid after-hours electronics use.
Better still, go for walks. The key is to get started today!
Nizar Abdul Majeed Kutty is a senior lecturer at Universiti Tunku Abdul Rahman’s Faculty of Medicine & Health Sciences.