By Dr. Mercola
Is it possible to be incredibly fit yet still be at high risk of premature death and disability due to inactivity?
Startling as that may sound, mounting research says, yes, as does Dr. James Levine, author of the book Get Up!: Why Your Chair Is Killing You and What You Can Do About It.
Dr. Levine is co-director of the Obesity Initiative for Mayo Clinic/Arizona State University, and he’s also the inventor of the treadmill desk. His book is quite an interesting read. It reminds me of the similar paths I went through in my journey to help people understand new paradigms of health.
Like any novel concept, there’s resistance from the existing paradigm to change, accept, and embrace that which is new. And Dr. Levine has certainly suffered the slings and arrows of being on the cutting edge of a new paradigm.
But it’s a phenomenal story, and I for one am now absolutely convinced that sitting is in and of itself a root problem of many of our chronic health problems. As Dr. Levine says: “Because we’ve become so used to being seated... we’ve failed to realize that this is a major health concern.”
Now that I know the serious damage that sitting can do, I am really perplexed at how I missed such an important health principle for the first 60 years of my life. It seems a really foolish mistake and one that I hope you will not repeat.
Slings and Arrows...
In one of his early speeches, he presented compelling data showing that people prone to weight gain and obesity are those who stay seated for two and a quarter hours longer each day than those who go to the gym and happen to be lean.
The insinuation that sitting was independently harmful, and harmful enough to kill, was so unpopular that his peers sent letters to senior faculty at the Mayo Clinic suggesting he was psychiatrically ill, and he was required to be evaluated by a psychiatrist.
Since then, some 10,000 publications have shown that, indeed, sitting is harmful to your health, irrespective of other lifestyle habits, including an excellent exercise program.
“I will tell you... when your world is that of the intellect, of the mind, and of science, when your senior colleagues have you sent to a psychiatrist because they think you’re insane, that really does make you pause,” he says.
“That makes you wonder first of all, is this all worth it? Is this mandate of wanting to bring health to hundreds of thousands or millions of people, is it worth the personal toll?
Is it worth going to the point where you’re so questioned that you wonder whether you can actually exist in the circle of normal world at all? It pushed me back. It pushed me back a lot.
But then at the end of the day... you got to say, ‘What is right for the patient? What is right for the next generation? What is right for the kids of my kids?’ Once I actually woke up to that, the rest is history.”
The simple truth is that sitting is affecting the health of millions of Americans and millions of people in high- and middle-income countries around the world. This unlike other things, is something we can do something about.
And I wholeheartedly agree with Dr. Levine when he says that this is something we must act upon. Fortunately, the solution is simple: simply stand up! And avoid sitting down!
“My core cause is the patient who has been battling with obesity, who has been battling with type 2 diabetes, and who doesn’t go to the gym for various reasons: a) they may not be able to afford it; b) they may not actually have access; c) they may have three jobs and do not have the time.
And fourth... many people who have excess weight feel looked upon badly and have bad feelings about themselves when they enter the hallowed territory of the gymnasium. The 75 percent of Americans – more in fact – who do not exercise regularly are my core cause,” Dr. Levine says.
An Exercise Regimen May Not Be Enough to Counteract Ill Effects of Prolonged Sitting
While it appears counterintuitive, it also turns out that regular exercise does not protect you from the hazards of prolonged sitting. For Dr. Levine, this was a rather upsetting discovery, as it was for me when I first learned this a few years ago.
It can be quite disconcerting to realize that even if you dutifully go to the gym several times a week and are really fit, it is still not enough to counteract the many hours you sit during the rest of your day...
“There are a couple of important points,” he says. “First of all, if you go to the gym, that does do you good. In fact, that is a phenomenal dose-response relationship. The more you do, the more benefit you get.
That does not, however, relinquish you from the responsibility of being active throughout the day or of realizing the opportunities to be active throughout the day.
What is interesting is that the molecular mechanisms that come into play when somebody sits for hours on end, if you think about it, are actually not reversed by allowing all of that sedentariness to occur and then having a bout of activity in the evening or even in the morning.
It’s the hours of inactivity that are associated with the molecular mechanisms at the cellular level that are associated with causality for diabetes, hypertension, and even potentially cancer and other deleterious effects.”
Why Sitting Causes So Much Harm, and Why Standing Promotes Physical Health
According to Dr. Levine, there are at least 24 different chronic diseases and conditions associated with excess sitting. How do we reconcile and explain how something so simple can have such a massive expanse of ill health consequence?
According to Dr. Levine, when you have been sitting for a long period of time and then get up, at a molecular level, within 90 seconds of getting off your bottom, the muscular and cellular systems that process blood sugar, triglycerides, and cholesterol—which are mediated by insulin—are activated.
As soon as you stand up, a series of molecular mechanisms at the cell level set off a cascade of activities that impact the cellular functioning of your muscles. The way your body handles blood sugar is beneficially impacted, for example. Therefore, the disease prevention for diabetes comes into play. All of these molecular effects are activated simply by weight-bearing; by carrying your bodyweight upon your legs. Those cellular mechanisms are also responsible for pushing fuels into your cells.
“It makes perfect sense,” Dr. Levine says. “If you’ve been resting after a hard morning’s work and then you get back on your legs in order to go back into the fields, of course, your whole body system is to be pushing what you’ve just had for lunch into your muscle, into your body so that you can function well in agricultural practice, which, up until 200 years ago, was what the human body ultimately functioned to do.
The nature of the human body was to be active and moving all day. The body was never designed to be crammed into a chair where all of these cellular mechanisms get switched off. Obviously we’re supposed to rest from time to time. But that rest is supposed to break up the activity. It’s not supposed to be the way of life. [T]his very unnatural [sitting] posture is not only bad for your back, your wrists, your arms, and your metabolism, but it actually switches off the fundamental fueling systems that integrate what’s going on in the bloodstream with what goes on in the muscles and in the tissues.
As a consequence of that, blood sugar levels are inappropriately high in people who sit. The blood pressure is inappropriately high, the cholesterol handling is inappropriately high, and those toxins, those growth factors that will potentially lead to cancer, particularly breast cancer, are elevated in those people who sit too much. The solution? Get up!”
Studies looking at life in natural agriculture environments show that people in agrarian villages sit for about three hours a day. The average American office worker can sit for 13 to 15 hours a day. The difference between a “natural” amount of sitting and modern, inappropriate amounts of sitting is huge. So, when trying to determine what the “minimum dose of standing” might be, it’s important to realize that most people are not dealing with a minor tweak... Most people need to figure out how to get out of their chair for several hours each day. But as a general guideline, to give you a starting point, Dr. Levine notes:
“The bottom-line is that if you’ve been sitting for an hour, you’ve been sitting for too long. We should all be up at least 10 minutes out of every hour.”
I’ve previously recommended standing up and doing some exercises at your desk every 10-15 minutes to counteract the ill effects of sitting, but after discussing the issue with Dr. Levine and reading his book, I’m convinced this isn’t even enough. I really think the answer is to stand up as much as possible. Standing for 10 minutes for every hour of sitting is really the bare bones minimum; it’s still far from ideal. It would seem far wiser to strive to sit as little as possible, certainly less than three hours a day.
My New Appreciation of the Damage Sitting Does
I’ve been passionate about exercising for nearly 50 years now and have been very fit for most of my life. But I’m still constantly modifying my exercise program based on new information. Several years ago, Phil Campbell helped me understand the importance of high intensity exercise and its value in increasing growth hormone. Then Dr. McGuff helped me understand that using Super Slow weight training may even be a superior form of high intensity training than high intensity cardio.
Now I have an important new modification: to sit as little as possible. I personally strive to sit less than an hour a day. Earlier this month, I went on a coast to coast 6,000-mile tour, from Virginia, to Maryland, Washington DC, San Francisco, and Los Angeles. During that time, I decided to try an experiment—to avoid sitting as much as I could... In my hotel room, I put the mini fridge on the desk to get a modified standing desk. In one room, I merely used the waste paper basket on top of the desk to create a makeshift standing desk.
I was able to reduce my normal 12 to 14 hours of daily sitting to under one hour. And I noticed one amazing thing: the back pain I’ve struggled with for many years, simply disappeared. It would normally start after I’d walk or stand for more than 30 minutes, but since I reduced my sitting the pain disappeared.
I had previously tried four different chiropractors, posture exercises, Foundation Training, ab work, inversion tables, standing up every 15 minutes to stretch, and strength training. But nothing would touch it, other than to radically reduce my sitting. During my coast to coast trip, I would have to sit on a plane for five hours and I noticed when I did that, the pain returned for a day. Clearly, my body was speaking to my very strongly that I needed to radically reduce my sitting. I am still surprised I missed this important health principle for so long.
Another recent epiphany I had is that most of us need to walk much more than we do. Thankfully, there are now fitness trackers that allow us to objectively record how much we walk and there will be a literal explosion of the use of these devices in the next few years. The Apple Watch being launched next year is a good example. Most of us need about 10,000 steps a day, which is a bit more than five miles (8-9 km). The key realization I had though is that this walking is in addition to, not in place of, your normal exercise program. It’s even better if you can walk barefoot so you can get grounded, and better yet if you can walk on the beach by the ocean.
So, my new strategy is to walk at least 10,000 steps a day and for the last month I have been able to average about 13,000 steps a day, including travelling. In my case, this meant I had to walk up and down airport terminals, but you do what you have to do. I believe the combination of high intensity training, non-exercise activities like walking 10,000 steps a day, along with avoiding sitting whenever possible is the key to being really fit and enjoying a pain-free and joyful life.
If you don't have a fitness tracker that records your steps, I would encourage you to get one. Another advantage of some of the fitness trackers is that they can record how much you are really sleeping, and can help motivate you to get to bed earlier so you can get eight hours of sleep. I use the Jawbone UP24, which is one of the best ones out now, but far better ones will be available in the near future. For example, the MisFit1 is a new fitness tracker that tracks your steps and your sleep and starts at only $50.It looks like a watch but does not tell time.
Making It Work in the Work Place...
Not only do studies show that body weight improves when people stand up more during their work hours, productivity also goes up in companies that make such arrangements. As noted by Dr. Levine:
“Hardcore productivity – whether that’s the number of loads processed in one company, the financial services doubling in profit from another company – those numbers improved. The actual profits improved... The solution is simple, because actually the solution is to get people up. But the complexity – hence the book Get Up! – is: How do you actually build a working solution for a US corporation?
In order to do that... we developed 12 layers of deployment. A simple example: if you have a company, for example, much like my job that involves numerous meetings every single day, one of the recommendations for that company would be to have a system in place whereby walk-and-talk meetings become commonplace... If I can convert three of my meetings – and I may have eight in a day – into walk-and-talk meetings, that’s three hours of walking. Fantastic!
Again, unless you have the leadership agree, unless there’s a confidentiality code in that company, unless there is a protocol in place for doing this, unless there is clearance from the rest of the company, even as simple as it sounds in concept, it will not work.
...Whether it is in schools or whether it is in offices, what is critical to appreciate is that setting goals of getting up and getting down, getting up and getting down are simply impractical for 90 percent of American workers. What one has to do is understand the infrastructure and build solutions that enable people to be standing two to three hours extra per day than they are already.”
Automatic Benefits of Standing Desk Offices
As mentioned, Dr. Levine developed a treadmill desk, and there are already a number of standing desks on the market. These are excellent options. I, and many others, initially had doubts about whether a standing desk would do any good. I previously believed that standing still can be just as detrimental as sitting, but now I’m convinced otherwise and believe that standing desks are the way to go. According to Dr. Levine, such fears turn out to be mostly unfounded.
“When somebody gets a standing desk, they generally stand for several hours a day. But they don’t stand still,” Dr. Levine says. “A couple of things happen. The first thing that happens is, they generally move from leg to leg and generally change their body posture quite a lot. That weight-bearing and adjustment of weight-bearing has a whole series of physiological benefits to the musculature, the balance in musculature, the visual cortex, the testicular system, and so on.”
People with standing desks also tend to walk over to talk to their coworkers rather than sending an email or text. Two people working standing up who need to talk to each other also tend to naturally keep walking while talking.
“That is actually the trick of the standing-desk office,” Dr. Levine says. “Standing still isn’t actually terribly good for you, but the good news is you don’t naturally do it anyway. If people are often standing in an office space with many other workers, you inevitably create an atmosphere where people are up and moving. That is in fact the data. There’s a paper that’s just coming out actually exactly to this effect...
The ultimate dream of mine is that the default position in modern offices becomes the up and moving default as opposed to the current default, which is the sit and sedentary default... What I’m looking to do is switch the default. The way you switch the default is by a mass support based on giving people the best options, the best choice, and the best programs.”
Are You Ready to Give Up Your Chair?
The evidence is overwhelming at this point—10,000 studies and growing—that prolonged sitting is devastating to your health. It actively promotes dozens of chronic diseases, including overweight and type 2 diabetes. As a general guideline, if you’ve been sitting for an hour, you’ve sat too long. Dr. Levine recommends sitting no more than 50 minutes out of every hour. But that’s really a bare bones minimum recommendation. Ideally, you’d want to limit sitting altogether.
Again, people living in agricultural communities sit an average of just three hours a day, which would be an admirable goal. While it may sound “impossible,” it is doable—with a bit of ingenuity and mindfulness, I managed to limit my sitting to one hour per day while on my coast to coast tour. In addition to limiting your sitting as much as you possibly can, I also recommend challenging yourself to walk 10,000 steps per day. This is over and above your regular fitness program and standing up during work. Consider one of the new fitness trackers that can monitor your steps and your sleep.
Quite simply, most of us are still too sedentary on an hour-by-hour basis. The answer is simple, but it will require a change in thinking and being; a change in how we live, really. And we all have the power to do something—that’s the great part. So I encourage you to start thinking about how you can get more physical movement into your life, each and every hour of your waking day. To learn more, and for plenty of more tips and strategies, I highly recommend reading Dr. Levine’s book, Get Up!: Why Your Chair Is Killing You and What You Can Do About It.