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Sitting for too many hours per day or sitting for long periods without a break is now known to increase a wide range of health risks - even if one engages in recommended amounts of physical activity. The health risks of prolonged sedentary time and nurses’ role in reducing those risks are discussed in a recent issue of the American Journal of Nursing.
While the evidence on the adverse effects of prolonged sedentary time continues to grow, further studies are needed to determine the most effective and practical interventions for reducing habitual sitting, says Linda Eanes, EdD, MSN, of the School of Nursing at the University of Texas Rio Grande Valley, Edinburg. "Nurses have a pivotal role to play in increasing public awareness about the potential adverse effects of high-volume and prolonged uninterrupted sitting," Eanes says.
Health Risks Of Too Much Sitting
In recent years, studies have shown a direct relationship between prolonged sitting and the risk of several chronic health conditions. Increased health risks have been reported both for high-volume sitting, such as sitting for seven or more hours per day, and for prolonged uninterrupted sitting, such as sitting for 30 minutes or longer without a break. The health risks of prolonged sitting are independent of whether the person participates in recommended physical activity. Dr. Eanes summarizes pivotal studies showing the association between high-volume and prolonged uninterrupted sitting and health risks including cardiovascular disease, diabetes, and all-cause mortality. In conjunction with obesity, sedentary time is also linked to an increased risk of certain cancers, including ovarian, endometrial, and colon cancer.
How does too much sitting increase health risks? Immobility decreases stimulation of weight-bearing muscles, leading to decreased activity of an enzyme - lipoprotein lipase - that plays an essential role in lipid metabolism, including production of high-density lipoprotein cholesterol - the so-called "good" cholesterol - as well as uptake of glucose from the blood. In contrast, breaking up sedentary times with frequent bouts of standing or slow walking may reduce these metabolic risks although the optimal levels of standing or walking remain unclear.
Nurses and other healthcare professionals now have a new priority: educating patients about the health risks of prolonged sedentary time and making suggestions to reduce and interrupt sitting times. Proposed interventions include using a standing desk or taking frequent walking or standing breaks, as well as the use of computer or Smartphone reminders to take brief physical activity breaks during the day.
But questions remain about the most effective ways to address high-volume or uninterrupted sitting, including the "dose-response relationships" between sedentary behavior, taking breaks, and various health outcomes. In contrast to efforts to increase physical activity, merely providing people with information and education might be effective in promoting reduction of sedentary behavior. Much more research is needed in the field of inactivity physiology.
While it's still important to promote regular physical activity, nurses should pay more attention to evaluating total daily sitting time, and to understanding the individual, social, occupational, and community/environmental factors that contribute to it. "Nurses can also actively encourage all patients, regardless of demographics, to balance sedentary behavior and physical activity simply by taking more frequent standing or walking breaks," Eanes says. She believes that nurses are well positioned to contribute to research on the health risks associated with prolonged sitting and the most effective interventions for reducing those risks.
Sedentary Lifestyle Drastically Increases Risk Of Dying From Cancer
Roswell Park Comprehensive Cancer Center researchers have once again identified a link between physical inactivity and an increased risk of mortality among cancer patients, emphasizing the health risks of a sedentary lifestyle and the importance of regular exercise as therapy for cancer patients both during and after treatment. Rikki Cannioto, Ph.D., EdD, MS, Assistant Professor of Oncology in the Department of Cancer Prevention and Control, is lead author of The Associations Of Habitual Physical (In)activity With Cancer Outcomes: Evidence From The Roswell Park Data Bank And BioRepository. While previous studies from Roswell Park have shown a strong link between lifetime inactivity and increased risk of particular cancers, the new findings are the first to demonstrate an association of pre- and post-diagnosis inactivity with survival across several different cancer types.
A growing body of evidence shows that a physically active lifestyle reduces the risk of many diseases, including cancer, but the effects of a sedentary lifestyle are less well studied. Given the prevalence of physical inactivity in the general population and among cancer patients - who often face unique exercise challenges due to their disease and its treatment - the research team examined the association between habitual physical inactivity and outcomes in 5,807 cancer patients enrolled in the Data Bank and BioRepository (DBBR) at Roswell Park between 2003 and 2016. The DBBR is a shared resource at Roswell Park directed by Christine Ambrosone, Ph.D., Senior Vice President of Population Sciences and Chair of Cancer Prevention & Control.
The investigators looked at patterns of physical activity over time, during a period spanning the decade before the cancer was diagnosed and continuing for up to one year after diagnosis. Cancer patients who engaged in regular, moderate-to-vigorous-intensity physical activity - such as walking, running, aerobics or other cardiovascular exercise - both before and after their diagnosis were considered habitually active, whereas those who did not exercise regularly were considered habitually inactive.
Link Between Inactivity And Cancer Mortality
Remarkably, the research team found that patients who were physically active both before and after treatment were 40 percent more likely to survive than those who were physically inactive. This was true for many different disease types, including breast, colon, prostate, ovarian, bladder, endometrial, esophageal and skin cancer. Moreover, the associations found between habitual inactivity and cancer mortality remained consistently strong regardless of the patient’s sex, tumor stage, smoking status or body-mass index (BMI).
“In other words, when it comes to exercise, something is better than nothing but regular, weekly exercise seems to really make a difference,” says Dr. Cannioto. “In fact, patients who were physically active three or four days a week experienced an even greater benefit than those who exercised daily, and patients who had only one or two days of regular activity per week did nearly as well. This is particularly encouraging, as cancer patients and survivors can be overwhelmed by current physical activity recommendations.”
One of the most striking observations was that previously inactive patients who began exercising after their diagnosis increased their odds of survival by nearly 30 percent. The researchers found that patients participating in as few as one to two sessions of regular, weekly exercise experienced similar survival advantages as those who exercised more frequently. “These findings have important implications for cancer patients, clinicians and researchers, because they suggest that a cancer diagnosis could serve as an impetus for healthy lifestyle changes that can result in a significant survival advantage for cancer patients and survivors,” says Dr. Ambrosone, who is senior author on the work.
Standing Up For Your Health
Sit up, stand up, repeat often. Sedentary people can put their prolonged chair-sitting days behind them with a few simple, strategic behavioral changes, says a recent study by researchers at Western University in London, Canada. "Even if we exercise regularly, most of us sit or recline for an average of 11 hours a day," said Wuyou (Yoah) Sui, a Ph.D. student in the Department of Kinesiology at Western. "Our bodies just aren't designed to function well with such low levels of activity. We all have to move more often than we do, or endure a variety of chronic health issues."
Prolonged sitting increases the risk of heart disease, obesity, Type 2 diabetes and some forms of cancer, several recent studies show. Creating new, healthier habits can be challenging for people who work long hours at their desks. In a study published in Applied Psychology: Health and Well-Being, Sui and co-author Kinesiology Professor Harry Prapavessis describe how students modified their sedentary behavior through a structured, six-week process that has also had success in smoking cessation and seatbelt compliance. For these Western students, the process had students choose their best strategies to take more frequent breaks, which for some of them included setting timers and phone reminders. They also had short check-in sessions three weeks into the study.
After six weeks, the students had turned these cues into habits: they took breaks, on average once an hour in comparison to their previous 90-minute sitting sessions. Even two weeks later, they continued to shave time from their sitting durations. By contrast, a control group showed no improvement in its sitting habits. "It's human nature to stumble when trying to add new activities to a busy day, which is why diets and exercise resolutions sometimes fall flat," said Sui. "This study shows we can combat 'occupational sitting' not by adding a new activity but by sliding a substitute regimen into the place of an existing one."
For students or office desk jockeys, those changes could include standing during phone calls, making a few short trips to the water fountain instead of one lingering visit, and replacing departmental email conversation with a walk-and-talk. "We can build into our day some simple strategies to bring us out of our chairs and off our couches," said Prapavessis, who is director of the Exercise and Health Psychology Lab at Westerns' School of Kinesiology. "It may or may not make us more productive - we suspect it does, but the jury is still out on that one - but we know the health impact of getting to our feet is a positive one."
19 Year Olds As Sedentary As 60 Year Olds
Physical activity among children and teens is lower than previously thought. In another surprise finding, young adults after the age of 20 show the only increases in activity over the lifespan, suggests a study conducted by researchers from the Johns Hopkins Bloomberg School of Public Health. The study found, starting at age 35, activity levels declined through midlife and older adulthood. The study also identified different times throughout the day when activity was highest and lowest, across age groups and between males and females. These patterns, the researchers say, could inform programs aimed at increasing physical activity by targeting not only age groups but times with the least activity, such as during the morning for children and adolescents.
The findings, which were published in the journal, Preventive Medicine, come amid heightened concern that exercise deficits are contributing to the growing obesity epidemic, particularly among children and teens. “Activity levels at the end of adolescence were alarmingly low, and by age 19, they were comparable to 60 year olds,” says the study’s senior author, Vadim Zipunnikov, assistant professor in the Bloomberg School’s Department of Biostatistics. “For school-age children, the primary window for activity was the afternoon between two and six p.m. So the big question is how do we modify daily schedules, in schools for example, to be more conducive to increasing physical activity?”
For their study, the researchers used data from the National Health and Nutrition Examination Survey from the 2003-2004 and 2005-2006 survey cycles. The 12,529 participants wore tracking devices for seven straight days, removing them for only bathing and at bedtime. The devices measured how much time participants were sedentary or engaged in light or moderate-to-vigorous physical activity. The researchers broke down findings into five age groups: children (ages six to 11); adolescents (ages 12 to 19); young adults (ages 20 to 29); adults at midlife (ages 31 to 59); and older adults (age 60 through age 84). Forty-nine percent were male, the rest female.
Meeting Recommended Guidelines
Activity among 20-somethings, the only age group that saw an increase in activity levels, was spread out throughout the day, with an increase in physical activity in the early morning, compared to younger adolescents. The increase may be related to starting full-time work and other life transitions. For all age groups, males generally had higher activity levels than females, particularly high-intensity activity, but after midlife, these levels dropped off sharply compared to females. Among adults 60 years and older, males were more sedentary and had lower light-intensity activity levels than females.
The study confirmed that recommended guidelines were not being met. For instance, the World Health Organization (WHO) recommends at least 60 minutes of moderate-to-vigorous physical activity a day for children ages five to 17 years. The study found that more than 25 percent of boys and 50 percent of girls ages six to 11 and more than 50 percent of male and 75 percent of female adolescents ages 12 to 19 had not met the WHO recommendation.
While WHO formulates its recommendations in terms of moderate-to-vigorous activity, the researchers say there is a growing consensus for the benefits of reducing sedentary behavior and increasing even low-intensity levels of physical activity. “The goal of campaigns aimed at increasing physical activity has focused on increasing higher-intensity exercise,” says Zipunnikov. “Our study suggests that these efforts should consider time of day and also focus on increasing lower-intensity physical activity and reducing inactivity.”
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