Sitting is the new smoking

You’ve just got home after a big day at work. Maybe you have uni or a family to raise, or maybe you work a second job? Our lives are busy and hectic, and often there is more to do in a day than there is time to do it in. When faced with these, or any of life’s other endless obligations something must give, and often it is our physical health that falls through the cracks. 

When our body and mind begin to wane, we are often told by those around us to sit down and relax, take it easy or chill out. This is the school of thought that tells us the best way to recharge is by doing nothing. However, a report by the World Health Organisation found reduced physical activity has lead to poor health outcomes like anxiety, diabetes, cardiovascular disease, even death. The phenomenon has become so prevalent that a study by Dr James Levine, director of the Mayo Clinic at Arizona State University, found physical inactivity and the associated health impacts of sedentary living are now worse than smoking.

Smoking vs Sitting. According to the article by Chau et al. 2019 in British Journal of Sport Medicine. Graphic: Andrew Chounding

In 2002 the WHO chose sedentary living as the theme for World Health Day, after finding sedentary behaviour was responsible for two million deaths a year, and was likely one of the top ten non-communicable causes of death globally.

In 2020, the Australian Institute of Health and Welfare found sedentary living contributed to 2.5 per cent of all disease-related deaths and 20 per cent of deaths caused by diabetes, bowel cancer, uterine cancer, dementia, breast cancer, coronary heart disease and stroke each year.  Annually, deaths caused by sedentary living have increased by 37.5 per cent since World Health Day 2002. This rise follows a 2020 study by Park et al. in the Korean Journal of Family Medicine that found sedentary living contributes to 3.2 million deaths globally, per year. 

In 2002 the message from WHO was the same as it is today, prevention is the cure, and the cure is simple. Do 30 minutes of moderate physical activity a day to prevent negative physical and mental health issues arising from sedentary lifestyles.

The message to simply find 30 has long been the catch cry of Australian governments and policymakers all the way back to the be Active Australia campaign in 1997. Despite the consistent message, the Australian Institute of Health and Welfare found sedentary behaviour has stagnated for over a decade. A report by the National Institute of Health on the long-term outcome of government-funded health-based marketing campaigns found the message is retained, but the campaigns fail to produce meaningful change. Like other national health campaigns of years gone-by, Get Moving, Unplug and Play, Find Thirty and Life, Be In It, the message to be Active Australia only lasted about 30 minutes. So if the message is being received why then do sedentary behaviours persist?

Life be in it campaign video 1997. Video: rolandf1.

Professor Ken Kazunori Nosaka is the Director of Exercise and Sports Science at the Edith Cowan University School of Medical and Health Sciences. He says 80 per cent of Australians don’t meet the physical activity recommendation of 30 minutes a day because they are not motivated. He believes the time has come to rethink how we motivate people and says presenting people with achievable goals should be the starting point. “Instead of doing 150 to 50 minutes of exercise a week, we can say do five minutes every day. That sounds easier and then some people may try,” he says. “Once people see that they can do five minutes of easy exercise, they generally want to do more.”

“Once people see that they can do five minutes of easy exercise, they generally want to do more.”

Professor Ken Kazunori Nosaka

Getting people to do any level of moderate exercise is a priority if we want to reduce physical inactivity. But understanding how the human body works and finding exercises to suit the individual’s environment makes the process less daunting. Using a recent program developed for the Australian Defence Force to curb sedentary behaviour in submariners, Nosaka explains even under the most extreme conditions, moderate exercise is achievable.

“The recommended physical activity is 75 minutes of vigorous intensive aerobic exercise or 150 minutes of moderate-intensity or combination of the two, but this is not possible in a submarine,” he explains. “In a submarine, there are barriers to exercise, for example, the space is very limited. They cannot make any noise or vibration, also they cannot take a shower every day. But exercise is necessary to maintain health including mental health, physical and cognitive function.” “So, we just propose they do only four exercises, focusing on eccentric contraction, which is a chair squat, chair recline back, wall push-up and heel drop,” he says. 

Professor Ken Kazunori Nosaka explains the benefits of eccentric exercise. Video: Edith Cowan University.

An eccentric exercise is essentially resistance training using the body’s mass. Exercises focus on movements that contract muscles while they are being stretched. The activity is less metabolically demanding so easier to perform and creates less fatigue. Exercises that target one part of the body will have an impact on the whole body as maintaining muscle mass is the key factor in maintaining physical health.

The model is not ideal to meet the recommended physical activity standards, but Nosaka says, five minutes of eccentric muscle contractions are sufficient to meet the minimal physical and mental health standards required to maintain a healthy lifestyle. He believes incorporating the exercises into a daily routine could add 10 years to a sedentary person’s life. 

The simplicity of his method is intentional. By creating a minimalistic exercise routine, participation is not limited to the submariners for whom the program was designed. Nosaka’s program can be performed by anybody with a chair such as office workers and those with flexible working agreements.

Jessica Fuentes is one of the thousands of workers on a flexible working agreement whose job is classified as highly sedentary. She says she developed a vitamin D deficiency, back pain and low energy levels after spending over 12 hours a day sitting at a desk. “I work in a call centre, so I am connected to my computer via my headphones. I would spend my entire shift sedentary.” 

Health Direct Australia recently surveyed people whose jobs included high levels of sedentary behaviour. The report found one-third of respondents report a significant impact on their mental and physical health, while over 50 per cent struggled to find the motivation to exercise. The report also found 40 per cent experience shoulder, back and neck pain and 52 per cent experience pain related to muscle strain.  

Fuentes who uses a stand-up desk while working from the office says her partner got her a stand-up desk to use at home because he is concerned for her health. “He was worried about me spending all day seated, and I study online so some days I was spending over twelve hours at my desk. She says she noticed a change in her energy levels almost immediately when using the stand-up desk.

Stand-up desks are common in offices but experts warn they are not the solution.
Photo: Andrew Chounding .

Once touted as the solution to alleviating health impacts associated with sedentary behaviour, stand-up desks have become a staple in many workplaces and home offices. But David Beard an accredited exercise physiologist and chair of the West Australian chapter of Exercise & Sports Science Australia (ESSA), says stand-up desks are not the silver bullet they’ve been made out to be. 

“They’re good, they’re better than sitting all day because you’re getting some movement. But if you’re just standing in one spot all day, they’re not the answer. You can’t just buy a stand-up desk and do no exercise and expect your health to improve.”

Beard says the health issues associated with sedentary behaviour are well known and entirely preventable through physical activity. “We know that exercise positively impacts mood and mental state and brain functioning. So, if people become more sedentary and less active, like not walking to work or getting outside or finding any amount of activity their health is going to deteriorate,” he says. “Exercise basically improves every health marker that there is, whether that be for heart disease, diabetes, mental health, you name it.”

“Exercise basically improves every health marker that there is, whether that be for heart disease, diabetes, mental health, you name it.”

David Beard

He says our health system is overwhelmed because too many people are sick with conditions that are preventable through exercise and diet. “Now more than ever the government should be saying, okay, how do we prevent some people needing the health system?”

Act, Belong, Commit is a government-funded program run by Mentally Healthy WA which focuses on preventing poor mental health through physical activity.  

Meg Clarey is the campaign manager for “Act, Belong Commit.” She says, keeping any preventable health initiative at the forefront of public health funding is an uphill battle. “It’s a long road to get money allocated towards prevention because the government is often playing catch up and having to address day-to-day issues like smoking and obesity, so it’s always a battle to keep it on the agenda that prevention is better than a cure.”

She says policymakers have acknowledged the benefits of preventative health programs with the state government committing to additional funds in the coming years. “We had a commitment from our current state government, prior to the election, that funding for prevention in mental health was going to increase to 5 per cent in the overall budget by 2025. So that was a commitment that was made. And we’re looking forward to seeing that come to fruition by 2025.”

Act, belong, commit, campaign poster. Image: supplied.

Of the original measures recommended by the WHO in 2002 many have come to pass. Bike lanes are an increasingly a common site and public spaces are being developed to encourage walking and outdoor engagement. However, of all the recommendations put forward the Government’s action on banning smoking in public spaces is possibly the most significant. With the growing chorus of health experts and academics drawing parallels between the health implications of smoking and sedentary living perhaps it won’t be long before the same urgency is applied to sedentary behaviour.

It’s the ideal outcome for David Beard who chuckles at the irony of the situation. “We’ve got lots of drugs to treat things, they all come with the risk and potential side effects. Exercise pretty much improves, everything from heart disease to depression, there isn’t a health condition that exercise doesn’t have a positive impact on.

“With zero side effects.”