If sitting is “the new smoking”, what are the evidence-based strategies to kick the habit?

Epidemiological studies of the association between the hours per day spent sitting and mortality have observed correlations especially with cardiovascular disease, but also with obesity, Type 2 diabetes, depression and musculoskeletal problems. But what does the research tell us about how to combat this sitting epidemic?

In a study of over 123,000 men and women published in 2010 in the American Journal of Epidemiology researchers from the American Cancer Society found that even after controlling for smoking, body mass index and other factors, sitting for more than 6 hours per day was associated with death from cardiovascular and other chronic disease.

A recent systematic review and meta-analysis in The Annals of Internal Medicine considered 47 published articles that assessed correlations between sedentary behavior and disease incidence, hospitalization and mortality. (Abstract here.) While the evidence is weakened by reliance on self-report by participants, there appeared to be a clear relationship between a sedentary lifestyle and increased incidence of bad outcomes. What is more, poor outcomes were more pronounced among the most sedentary individuals.

A free infographic from Juststand.org summarizes much of what is known about the “Sitting Disease.”

A number of strategies have been promoted to address physical inactivity. MoveIt Monday “is a campaign from the Monday Campaigns, a non-profit public health initiative associated with Johns Hopkins, Columbia, and Syracuse universities that dedicates the first day of the week to health.” JustStand.org promotes a variety of products such as “sit-stand” work surfaces. While these interventions sound reasonable, the research that supports them is pretty thin.

A Cochrane Collaboration review of “Workplace interventions for reducing sitting time at work” concluded that, “…at present there is very low quality evidence that sit-stand desks can reduce sitting at work. However, the evidence for policy measures (such as walking breaks), or information and counselling is inconsistent. There is a need for high quality research to assess the effectiveness of different types of interventions. There are many trials being conducted at present and their results may change the conclusions of this research in the near future.

Puig-Ribera and colleagues published “Patterns of Impact Resulting from a ‘Sit Less, Move More’ Web-Based Program in Sedentary Office Employees” among office workers in Spain. The Walk@WorkSpain program was found to be “a feasible and effective evidence-based intervention that can be successfully deployed with sedentary employees to elicit sustained changes on “sitting less and moving more”. A similar workplace “sit less, walk more” intervention launched in Queensland, Australia, is here.

The University of Pittsburgh has recently received a $3 million NIH grant to “investigate whether they can improve the health of sedentary, overweight people with a program initially focusing on decreasing the amount of time they spend sitting… The new grant will put the concept of sitting less right up front as the primary movement goal.”

The first step is the recognition that there is a problem. Fortunately, steps are being taken to produce evidence clarifying association, correlation, or causality. Additionally, initiatives are being developed and deployed to the general public. Vehicles like social media, social networks, and mainstream media are being used to good effect. We believe it is at the provider level where the greatest impact can be delivered. Be a part of the solution by inquiring about your patients sitting habits and recommending movement strategies.