American College of Physicians: Internal Medicine — Doctors for Adults ®

Thursday, February 12, 2015

Are we sitting on a major health risk?

The big medical news is that sitting hours a day is taking years from our lives, whether we exercise or not. We have heard similar things before, so the now reiterated message is: Yes, we are sitting on a major health risk. Sitting IS the major health risk! The new study, a meta-analysis in the Annals of Internal Medicine, purportedly adds precision to the estimate of risk.

There are 2 rational responses to this, and neither of them involves panic or setting fire to all of your chairs.

First, it does make sense that the amount of time we spend in a chair each day might conspire against health itself.

Every hour spent sitting is not an hour spent standing, walking, or doing any of the most healthful options. Just as foods influence health directly, and indirectly because of the foods they replace, so does an hour spent in any given activity influence health directly and indirectly.

Sitting may adversely affect health directly, perhaps because the position puts pressure on body parts and adversely impacts circulation. But just as plausible is an indirect effect, mediated by what we aren't doing instead.

Either way, the answer would seem to be: sit less. This can be met with a derisive “easier said than done,” but doing it is not really that daunting. Many modern inventions allow for doing desk jobs standing, walking, or even allow for more active forms of sitting. Which of these is best for health is not yet established with good data, so choose whichever works best for your circumstance.

But of course, it's not necessary to go that far. Another option is simply to interrupt long bouts of sitting with some movement. If sitting is bad because it displaces motion, this fixes that. If it is bad because of vascular compression, this decompresses the vasculature. A 5-minute break for motion once an hour is apt to go a long way toward reverse engineering the harms of sitting, and is likely to work better than coffee for focus and productivity into the bargain. My lab developed and offers for free a program of brief, structured, video-guided activity bursts for just such use, and suitable for the office setting. Help yourself.

In general, I'm an advocate of the idea that motion is a good thing. We have a native animal vitality we neglect and all too often squander. Exercise of some kind at some time during the day is great, but there is no reason it should obviate a general proclivity to move as a matter of routine. Take the stairs, not the elevator. Collect your thoughts, or record a memo while walking rather than sipping coffee. Or drink the coffee while walking; I like coffee, too.

So, yes, getting up more could only be good.

But then there is the other reason not to panic and burn chairs: This research is only about an apparent association, not proof of cause and effect. The new study is a meta-analysis, and that's good, but you can only meta-analyze the data you have. To my knowledge, we have no data at all from trials that randomize people to sit for hours a day, or not, and then follow them for years to see differential outcomes. The authors acknowledged that their data set included no such trials, and was limited to observational studies of association.

Studies of association can be important but do not prove cause and effect. Perhaps people who sit more are more stressed, and maybe stress is the real health threat. To know for sure, we would need reliable data about differential levels of stress across differential amounts of sitting.

There are other plausible explanations as well. More total hours of sitting may mean more total hours of work, and less down time. Maybe workload is a factor here. Or perhaps sleep deprivation is a factor. More time sitting means less time outside. Maybe lack of daylight, and conceivably such effects as lower blood levels of vitamin D, are factors as well.

If those hours are spent watching television, perhaps that means spending time alone. Maybe long hours of sitting is a marker for isolation, or loneliness, or an impaired social network. Our social connections are on the short list of priorities for health.

In the end, then, the data are really rather murky but the takeaways are fairly clear just the same.

If you don't exercise, you really should. Certainly not because I advise it. The reason to do it is because your life will be better. Healthy people have more fun. Go ahead and count steps if so inclined, but we might just as well count our blessings when our body parts all work well enough to allow us to choose the activities we like best. Not everyone is so fortunate. If you are, as I am, I recommend taking full advantage of it.

As for sitting, less is certainly better. But it may be that sitting is truly something of a peril in its own right, or it may be that it is merely a marker of excess work, inadequate recreation, poor posture, lack of outdoor time, inadequate social connections, or stress overload. My advice is to consider all of these, and anything else that seems relevant to your circumstance. Then, whatever you decide your personal health threat is most likely to be, try to do something constructive about that. Just make sure you don't sit on it.

David L. Katz, MD, FACP, MPH, FACPM, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care. He is a board certified specialist in both Internal Medicine, and Preventive Medicine/Public Health, and Associate Professor (adjunct) in Public Health Practice at the Yale University School of Medicine. He is the Director and founder (1998) of Yale University's Prevention Research Center; Director and founder of the Integrative Medicine Center at Griffin Hospital (2000) in Derby, Conn.; founder and president of the non-profit Turn the Tide Foundation; and formerly the Director of Medical Studies in Public Health at the Yale School of Medicine for eight years. This post originally appeared on his blog at The Huffington Post.

Labels: , , , ,


Post a Comment

Subscribe to Post Comments [Atom]

<< Home

This is a printer-friendly version of this page

Print this page  |  Close the preview




Contact ACP Internist

Send comments to ACP Internist staff at

Blog log

Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:

Albert Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.

And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.

Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.

Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.

Controversies in Hospital Infection Prevention
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Iowa City, IA, with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).

db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.

Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.

Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.

Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.

Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.

Glass Hospital
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.

Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.

I'm dok
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.

Informatics Professor
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.

David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.

Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.

Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.

MD Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.

Medical Lessons
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.

Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.

More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).

David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

Reflections of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.

The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.

Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.

Peter A. Lipson, MD
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.

Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.

World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.

Other blogs of note:

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by an emergency room physician.

Powered by Blogger

RSS feed