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A Look at the Unhealthiness of Sitting, and a Call for More Research on Its Effects

Mary K. Caffrey
The meta-analysis in Annals of Internal Medicine found that small doses of exercise were not enough to offset the effects of long periods of sitting on all-cause mortality and chronic disease, including diabetes.
Sitting for long periods is associated with chronic disease and even early death. Yet researchers have little understanding of why this is true, even though the world is increasingly designed for sitting, according to a meta-analysis published January 20, 2015, in the Annals of Internal Medicine.1
Both the study and an accompanying editorial read like a call to arms for researchers in basic science and in the healthcare industry, as the data clearly show the cost implications of caring for an aging population who bear the lifetime effects of sitting at desks and watching TV. The meta-analysis received widespread attention, with headlines warning that a small dose of exercise was not enough to offset the effects of sitting all day.2
The authors, led by Aviroop Biswas, BSc, and Paul I Oh, MD, MSc, examined studies involving all-cause mortality, cardiovascular disease, diabetes, and cancer in adults by searching scientic databases for all studies published through August 2014.1 Forty-seven studies met the criteria, and meta-analyses were performed on 41. Data pooled from the studies found that after adjusting for levels of physical activity, prolonged periods of sitting were positively correlated with:
• All-cause mortality (hazard ratio [HR] ,1.240; 95% CI, 1.09-1.41)
• Cardiovascular disease mortality (HR, 1.179; 95% CI, 1.106-1.257)
• Cardiovascular disease incidence (HR, 1.143; 95% CI, 1.002-1.729)
• Cancer mortality (HR, 1.173; 95% CI, 1.108-1.242)
• Cancer incidence (HR, 1.130; 95% CI, 1.053-1.213)
• Type 2 diabetes mellitus (T2DM) (HR 1.910; 95% CI, 1.642-2.222)
An accompanying editorial by Brigid M. Lynch, PhD, and Neville Owen, PhD, of the Baker IDI Heart and Diabetes Institute of Melbourne, Australia, found the implications of the study “far-reaching.” “Sedentary behavior is ubiquitous,” they wrote. “Society is engineered, physically and socially, to be sitting-centric.”3
Connections among sedentary behavior, chronic disease, and their fallout in managed care have been researched previously. In 2012, The American Journal of Managed Care reported results from Quinn et al, which found overweight and obese men were less likely to undergo screenings for colorectal and prostate cancer, even though the men presented risk factors, such as sedentary lifestyles and diets that were low in fruits and vegetables.4
In their Annals editorial, Lynch and Owen draw connections between the meta-analysis ndings and what they mean for governments that fund all or most of a nation’s healthcare coverage, given how little is known about the science behind how sitting affects cardiovascular activity. (They note, for example, that the Australian government recommends at least 5 hours of moderate physical activity each week.)3
To address the lack of research in the eld, they draw attention to the following areas of work:
• Isotemporal substitution modeling. This examines the effects of different associations when time spent doing 1 activity is altered by another activity while time is constant.
• Objective activity monitoring. At present, most activity is self-reported. Lynch and Owen recommend using devices to track activity more precisely, such as whether the person was walking up an incline or suddenly accelerating, to reduce errors and to provide a more complete picture of activity.• Studies of population subgroups. Authors of the editorial note that limited information about subgroups is available, even though it is unlikely that risk levels are the same across the population.3
The adverse effects of too much sitting have gained attention in recent years. Manufacturers have promoted different models of “standing desks,” which give office workers the ability to stay in an
upright position, with potential health benets. Now, the effects of the desks are being measured, and an early review of studies appeared in January 2015 in Preventive Medicine.5
MacEwen et al compared the effects of different models. Treadmill desks produced the greatest physiological outcomes, including improved postprandial glucose, high-density lipoprotein cholesterol, and anthropometrics, while standing desks were associated with few physiological changes. Both styles showed mixed results for improving psychological well-being and had little impact on work performance, the authors found.5
1. 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.
2. Doyle K. Gym time won’t cancel out too much sitting. Reuters website. Published January 20, 2015. Accessed February 4, 2015.
3. Lynch BM, Owen N. Too much sitting and chronic disease risk: steps to move the science forward. Ann Intern Med. 2015;162(2):146-147.
4. Quinn VP, Jacobsen SJ, Slezak JM, et al. Preventive care and health behaviors among over-weight/obese men in HMOs. Am J Manag Care. 2012;18(1):25-32.
5. MacEwen BT, MacDonald DJ, Burr JF. A system-atic review of standing and treadmill desks in the workplace. Prev Med. 2015;70C:50-58.
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