Is Prolonged Sitting The New Smoking?

Ever since Dr. James Levine of the Mayo Clinic coined the phrase “Sitting is the new smoking”, there have been debates if this is truly so. Some health gurus made this phrase their mantra and inspired other people worldwide to work on their desk standing. On the other hand, some people think that the phrase sounds like a curse.

Studies showed that prolonged sitting is linked to diseases such as cancer, diabetes, and cardiovascular diseases --- the same health problems linked to smoking. This comparison became the reason why the phrase came to be.

And if we are going to look at the chart below, it seems that Americans are sedentary more than half of the day.

Is it really true?

Let the Numbers Speak For Themselves

People tend to become less active as they age. Obviously, elderly people aged 75 and above have the lowest level of activity achieving around 20 minutes of physical activity daily. Only one in four elderlies are considered sufficiently active.

According to the Centers for Disease Control and Prevention (CDC), 8.3% of deaths of non-disabled adults ages 25 and older were attributed to physical inactivity. Any extended sitting --- such as at a desk, or behind a wheel, or in a car, on long plane flights, or in front of a computer --- can be harmful. An analysis of 13 studies of sitting time and activity levels found that those who sat for more than eight hours a day with no physical activity had a risk of dying similar to the risks of dying posed by obesity and smoking.

One study said the men who think they sat almost 100% of the time were more likely to be obese than men who think they sat almost none of the time. Watching TV for 3 hours or more per day was associated with increased mortality regardless of physical activity.

What Happens When You’re Sitting For Too Long?

Humans are built to stand upright. Your heart and cardiovascular system work more effectively that way. Your bowel also functions more efficiently when you are upright. Even mobile phones were designed to be used standing but it turns out that people use them more while sitting. So what happens when you’re sitting for too long?

Stiff Neck and Shoulders

Working on your desk and in front of your computer for a long time can lead to pain and stiffness in your neck and shoulders.

Hips and Back

Prolonged sitting shortens your hip flexor muscles which can lead to problems with your hip joints. Poor posture causes compression in the discs in your spine, leading to premature degeneration, which can be very painful.

Legs and Gluteal Muscles

Prolonged sitting weakens your large leg and gluteal muscles. These large muscles are important for walking and for stabilizing you. If these muscles are weak you are more likely to injure yourself from falls, and from strains when you do exercise.

Weight

Physical activity helps your body digest the fats and sugars you eat. If you spend a lot of time sitting, digestion is not as efficient, so you retain those fats and sugars as fat in your body which leads to weight gain. Even if you exercise but spend a large amount of time sitting, you are still at risk of having metabolic syndrome. Research suggests you need 60 to 75 minutes of moderate-intensity activity per day to combat the dangers of excessive sitting.

Anxiety and depression

We know that the risk of both anxiety and depression is higher in people who sit more because they miss out on the positive effects of physical activity and fitness.

Cancer

Studies suggest the dangers of sitting include increasing your chances of developing lung, uterine, and colon cancers although the reason behind this is not yet known.

Heart disease

Sitting for a long time cannot remove the fat from your blood after eating a meal, and that puts you at 147% higher risk of cardiovascular disease, heart disease, and stroke. A study found out that men who watch more than 23 hours of television a week have a 64% higher risk of dying from cardiovascular disease than men who only watch 11 hours of television a week.

Diabetes

If you spend long periods sitting, then you cannot dispose of the glucose in the food that you’re eating. Glucose accumulates in your blood and increases the risk of diabetes. Studies have shown that five days lying in bed can lead to increased insulin resistance in your body which causes your blood sugar to rise. Another research suggests that people who spend more time sitting have a 112% higher risk of diabetes.

Varicose Veins

Prolonged sitting causes blood to pool in your legs which can lead to varicose veins or spider veins (a smaller version of varicose veins). Varicose veins are not usually dangerous.

Deep Vein Thrombosis

In rare cases, prolonged sitting can lead to blood clots which can cause serious problems. Deep vein thrombosis is a blood clot that forms in the veins of your leg. DVT is a serious problem because if part of a blood clot in the leg vein breaks off and travels, it can cut off the blood flow to other parts of the body, including your lungs, which can cause a pulmonary embolism. This is a medical emergency that can lead to major complications or even death.

What To Do?

It is important to reduce sitting time AND do regular exercise to combat the negative effects of physical inactivity. Being active is not as difficult as you think. One study found out that even a two-minute light activity every 30 minutes will keep your blood glucose at a normal level. Another study said five minutes of walking the dog, folding laundry, or taking out the trash for every hour of sitting is sufficient to reduce the negative effects of prolonged sitting. Thus, it is better to build more activity into your day.

Conclusion

The phrase “sitting is the new smoking” should not be taken at its face value. It would be better to say sitting is associated with the same health risks as smoking but both could not be compared.

The damage caused by smoking cannot be offset, but moderate physical activity can offset high levels of inactivity. However, this does not mean that having your regular daily 1-hour exercise allows you to slouch on the couch the rest of the day and still reap the health benefits. No. Meeting the recommended hours of physical activity is helpful but what you will be doing for the next 23 hours is another thing.

To combat the effects of obesity and other chronic diseases, reducing the time you spend sitting is the key. And since you decide what you do in a day, you have that key!

Sources:

Barlow, Carolyn E. 2016. “Association between Sitting Time and Cardiometabolic Risk Factors after Adjustment for Cardiorespiratory Fitness, Cooper Center Longitudinal Study, 2010–2013.” Preventing Chronic Disease 13.

Becker, Lara. 2020. “Sitting Isn’t the New Smoking, Apparently.” Medical Daily. October 21, 2020.

Better Health Channel. n.d. “The Dangers of Sitting: Why Sitting Is the New Smoking” www.betterhealth.vic.gov.au. Accessed December 18, 2021.

Chandler, Meredith. 2018. “Sitting Disease: The Terrifying Facts of Prolonged Sitting.” Ergonomics Health Association. April 19, 2018.

Ekelund, Ulf, Jostein Steene-Johannessen, Wendy J Brown, Morten Wang Fagerland, Neville Owen, Kenneth E Powell, Adrian Bauman, and I-Min Lee. 2016. “Does Physical Activity Attenuate, or Even Eliminate, the Detrimental Association of Sitting Time with Mortality? A Harmonised Meta-Analysis of Data from More than 1 Million Men and Women.” The Lancet 388 (10051): 1302–10.

Graff-Radford, Michelle. 2020. “Sitting Is the New Smoking.” https://Connect.mayoclinic.org/. February 11, 2020.

Khan, Coco. 2021. “Is Sitting the New Smoking? We Ask the Expert.” The Guardian. November 5, 2021.

Laskowski, Edward. 2018. “Sitting Risks: How Harmful Is Too Much Sitting?” Mayo Clinic. 2018.

Loh, Roland, Emmanuel Stamatakis, Dirk Folkerts, Judith E. Allgrove, and Hannah J. Moir. 2019. “Effects of Interrupting Prolonged Sitting with Physical Activity Breaks on Blood Glucose, Insulin, and Triacylglycerol Measures: A Systematic Review and Meta-Analysis.” Sports Medicine 50 (2): 295–330.

The Heart Foundation. 2019. “Is Sitting the New Smoking?” The Heart Foundation. August 10, 2019.

Understanding Social and Emotional Support in Lifestyle Medicine

We are now into the last area of focus in Lifestyle Medicine: support. As mentioned before, humans are social animals that have a desire to be close with other people or be a part of something bigger. Therefore, it is natural for you to feel needed and be part of a unit, big or small. Having a healthy relationship with others can provide you a sense of well-being and purpose which could add years to your life.

In this article, we will not only explore the links between human relationships and health but also how Lifestyle Medicine incorporates this knowledge into its practice.

The Early Years

In 1905, tuberculosis became endemic in Boston and only the rich could afford the treatment. So Dr. Joseph Pratt, an Internal Medicine physician, asked Elwood Worcester of the Emmanuel Church to support his project of improving the care of tuberculosis patients. While Emmanuel Church provided the meeting place and the funding, Dr. Pratt would gather the eight patients together to educate them about hygiene, encourage rest, nutrition, fresh air, and home visits. Although the group meetings became health education sessions, Pratt realized that the patients found a common bond in a common disease which contributed to the overall success of their treatment.

Definition of Support and Other Terms

We define support as providing assistance to other people in times of crisis to give them focus, encouragement, or positive self-image. Having your own support system enhances the quality of your life and provides you a buffer against adverse stress.

There are other terms that you also need to understand in the context of our topic.

Social isolation refers to the being alone with no relative amount of social relationships.

Social integration refers to your overall level of involvement with social relationships, whether within informal (family) or formal (religious group) groups.

Social network refers to the web of social relationships around you, including the type and strength of each relationship.

Quality of relationship refers to the positive and strained aspects of relationships. Emotional support from significant others is an example of a positive quality. Conflict is an example of a strained quality. Each of these aspects of social relationships affects your physical and mental health.

The Link Between Support and Health

Dr. Pratt’s project became one of the earliest studies on the physical and psychological health benefits of social support. Since then, scientists have studied social and emotional support’s influences on health. Although the long-term effects of such support remain to be determined, these effects show promise in influencing the quality of life in many chronic disease patients. The effects of all the social relationships emerged in childhood and cascaded throughout life providing you the cumulative advantage or disadvantage in your health.

If you will gather all the research studies, their findings would show any of the following conclusions:

• Social relationships significantly affect your health;

• Social relationships affect health behaviorally, psychosocially, and physiologically;

• Social relationships entail costs as it provide health benefits;

• Social relationships shape health outcomes throughout life and have a cumulative impact on your health over time;

• Social relationships’ costs and benefits are not distributed equally across the population.

Types of Support

There are many ways that you can support one another. So far, much research has been done on the effects of these distinct types of support:

Emotional Support

Emotional support often involves physical comfort such as hugs, holding hands, or pats on the back, as well as listening and empathizing. And speaking of empathy, you need to understand its difference from sympathy.

Sympathy vs. Empathy

Both words have the same root, “pathos” meaning emotions. The Greek “sym” means “together” thus, sympathy is used when you share the feelings of another. For example, when a person experiences grief after losing a loved one, you sympathize. You share the same feeling of grief.

On the other hand, empathy carries an emotional distance or a notion of projection. Thus, empathy is used when you understand or can imagine how someone feels without necessarily feeling it yourself. For example, when a person experiences overwhelm after encountering a stressful situation, you empathize. You understand how he or she feels but you don’t have to experience the same feeling of overwhelm.

In short, sympathy shares; empathy understands.

Esteem Support

Esteem support often involves encouragement or expressions of confidence. When you offer esteem support, you might point out the strengths they might have forgotten, or just let them know that you believe in them. Most life coaches and therapists offer this kind of support which often leads others to believe in themselves more.

Informational Support

Informational support often involves giving advice or sharing information that can help you know what your next steps are. Help desks are just examples of informational support.

Tangible Support

Tangible support involves taking on responsibilities for someone else so they can deal with a problem. They may come in different forms. Bringing food to someone sick is an example of tangible support. There are other ways that you could help others deal with their own issues.

How Do Relationships Benefit Health?

There are three ways how social relationships work to influence health: behavioral, psychosocial, and physiological.

Behavioral Explanations

Regular exercise, eating a nutritionally balanced diet, and adhering to your medical regimen are just examples of behaviors that promote health and prevent illness. Smoking, heavy drinking, and drug abuse do the opposite. Many research studies have provided evidence that these behaviors affect your health.

Social relationships influence health behaviors, in part, because these relationships can provide information, instill a sense of concern for others, and create norms that influence health habits.

Psychosocial Explanations

Psychosocial mechanisms such as support, control, symbolism, norms, and mental health may explain how social relationships promote health.

For example, social support may have indirect effects on health by reducing the impact of stress, or by fostering a sense of purpose in life. Eventually, it results in reduced blood pressure and heart rate which are beneficial to health.

Believing that you have a control over your mind and body influences health outcomes through your actions.

Symbolic meanings of social relationships are linked to health habits. For example, marriage is attached to the responsibility of staying healthy within the family. Another example is when teens point out that their relationship with their peers influence their alcohol, tobacco, and drug use. Thus, health behaviors within the context of social relationships vary.

Social norms and traditions influence health behaviors particularly when your tribe, community, religion, or race practices a specific health behavior that is unique from the rest. For example, there is a religious sect that prohibits its members from eating pork. Another religious sect does not believe in blood transfusion. Therefore, health professionals should be aware of these practices in order to provide proper care.

Mental health, on the other hand, is a pivotal mechanism that works together with each of the other mechanisms to shape physical health. For example, the emotional support provided by social relationships enhances your mental well-being, which, in turn, may reduce your risk of poor health.

Physiological Explanations

Supportive human interactions with others benefit your immune, endocrine, and cardiovascular functions which reflects the body’s wear and tear brought about by your overworked body in response to stresses.

The Dark Side Of Social Relationships

While social relationships are the center of emotional support for most people, social relationships can be extremely stressful. Research shows that marital strain affects health, too, and that its negative effect on health becomes greater with age. The propensity to engage in risky health behaviors in response to stress varies over your lifetime. Admit it, toxic relationships exist, too.

Compounding the problem is the fact that not everyone is in touch with their feelings. Many individuals find it difficult to express their desire for emotional support or fail to recognize how they can benefit from it. Some research suggests that patients may feel ashamed to ask for emotional support, they may believe that they have all the support that they need, or they may not realize how they can benefit from emotional support.

For example, a person trapped in an abusive relationship may not recognize the red flags or hesitant to ask for help because of fear. Be aware that there are support groups or help desks that could help you get away or heal from this relationship.

That is why it would be better for me, as a physician, to ask, “Do you know what you really want?” or “Can you describe what you’re feeling?” rather than ask, “What do you want?” or “What do you feel?”. Because some people might just be blinded by fear and need to know the difference.

Conclusion

Social networks, whether formal or informal, provide a sense of belonging and security. Support, whether from a valued group or individual, has been shown to influence health and there are behavioral, psychosocial, and physiological explanations for this. Scientific studies show that social relationships affect a wide range of health outcomes on mental and physical health, health habits, and mortality risk.

When being in a group, make sure you feel comfortable with the group's beliefs, practices, and expectations. But do not expect that you will never experience any disagreements. That would be unrealistic. Just remember that spending time with them should make you feel accepted, energized, peaceful, and not coerced, pressured, or anxious.

Surround yourself with trustworthy people who can support you through your journey. Identify your support system and maintain these relationships well to reach their full benefits. Remember that support, just like communication, is a two-way street. Communicate openly with them with trust and respect but without judgment. Be open to their feedback even if they tell you tough truths. It is the only way for you to see other options and perspectives.

If you're the type of person who prefers being alone, that is fine. You are probably an introvert who can still maintain a small set of family members and friends to have healthy close relationships.

If you are having questions regarding support, feel free to schedule a consultation. I will help and work with you and suggest changes that would help you. Who knows? Our Group Starter program might suit your needs. Or if you want to hear from me talk about Lifestyle Medicine, feel free to listen to our podcast or contact me using the contact form below.

Sources:

Cunningham, Jean, Donald Strassberg, and Howard Roback. 1978. “Group Psychotherapy for Medical Patients.” Comprehensive Psychiatry 19 (2): 135–40.

Kowitt, Sarah. 2013. “What Do We Mean by ‘Emotional Support’?” peersforprogress.org. University of North Carolina at Chapel Hill. October 24, 2013.

Lee, Aaron A., John D. Piette, Michele Heisler, Mary R. Janevic, and Ann-Marie Rosland. 2019. “Diabetes Self-Management and Glycemic Control: The Role of Autonomy Support from Informal Health Supporters.” Health Psychology 38 (2): 122–32.

Marksberry, Kellie. n.d. “Emotional and Social Support.” The American Institute of Stress.

Merriam-Webster. 2019. “What’s the Difference between Sympathy and Empathy?” Merriam-Webster.com. 2019.

Reblin, Maija, and Bert N Uchino. 2008. “Social and Emotional Support and Its Implication for Health.” Current Opinion in Psychiatry 21 (2): 201–5.

Umberson, Debra, and Jennifer Karas Montez. 2010. “Social Relationships and Health: A Flashpoint for Health Policy.” Journal of Health and Social Behavior 51 (1_suppl): S54–66.

How Exercise Can Propel You to Start Changing Your Lifestyle

Ever since I’ve re-launched this website, I started discussing Lifestyle Medicine and its six areas of focus. However, changing for the sake of living healthier seems daunting. Even the term “lifestyle change” tends to become a complicated message. There is this tendency to feel that you have to go extremes just to see and feel the difference or effects of the lifestyle change.

But that should not be the case.

As an Internal Medicine physician and an advocate of Lifestyle Medicine, I have been in this scenario. My husband and I felt that we had to do a radical change immediately as if it was a matter of life and death. But as we go along, we learned something and realized that the pace of lifestyle change is personal, therefore, subjective. Lifestyle change is not a one-size-fits-all method.

Also, as an Internal Medicine physician, I may be less equipped to advise you on your exercise regimen although I have a few professionals who specialize in exercise and fitness to help me. This is one of the reasons why Lifestyle Medicine is more collaborative rather than structured.

In this article, we will be discussing exercise not just a focus of Lifestyle Medicine but also a way to propel you to start changing to healthier living.

But before you embark on your exercise journey, be sure to consult your physician especially if you have risk factors such as cardiovascular diseases, smoking, high blood pressure, high cholesterol, diabetes, etc.

What is Exercise?

Exercise is defined as any activity that enhances or maintains physical fitness and overall health and wellness for various reasons. However, most people tend to focus on one type of exercise thinking that they are doing enough. Research has shown that a complete, safe, and effective exercise program should include endurance, strength, and flexibility. The reasons for this are each one has its own benefits, each can improve your ability to do the others, and variety helps reduce boredom and risk of injury.

Endurance (or Aerobic) Exercise

An aerobic exercise is any physical activity that uses large muscle groups in a continuous, rhythmic method over sustained periods of time during which causes the body to use more oxygen for increased cardiovascular endurance. That is why it is also called endurance exercise because this type of exercise helps you improve your staying power in keeping up with your activities of daily living. Examples of this kind of exercise include running, cycling, swimming, brisk walking, skipping rope, rowing, hiking, dancing, playing tennis, continuous training, long distance running, and other low-impact, weight-bearing exercises.

Strength Exercise

Strength exercise is any physical activity which often uses any form of resistance to induce muscular contraction. This in turn would build strength, anaerobic endurance, and size of skeletal muscles. Also called anaerobic exercise, this type of exercise can firm, tone, increase muscle mass, improve bone density, posture, balance, and coordination. Most weight management programs involve strength exercises. Examples are calisthenics, push-ups, pull-ups, lunges, squats, bench press, and weight-bearing exercises or training.

Flexibility Exercise

Flexibility exercise is any physical activity that uses a range of motion or the ability to move joints effectively through a complete range of motion. It includes mild stretching for 15 to 30 seconds while you breathe normally and should involve stretching for all of the major muscle groups like the arms, chest, back, stomach, hips, and legs to lengthen the muscles. Examples are swimming, cycling, yoga, Pilates, and other non-weight-bearing exercises.

Benefits

The health benefits of exercise depend on your goal, the type of exercise, and your age. People exercise for various reasons: improve health, prevent aging, develop muscles, hone athletic skills, for weight loss, and for enjoyment. Even doing a small amount of physical activity is better than doing nothing.

Exercise lifts your mood

Regular physical activity can relieve stress, anxiety, and depression. It provides a feel good sensation right after doing something.

Exercise keeps you physically fit

Exercise increases muscle strength which in turn increases your ability to function. Your body loses its strength and the ability to function properly without constant physical activity. An old saying goes, “You don’t stop moving from growing old, you grow old from stopping moving.”

Exercise helps keep the doctor away

Sitting for too long and other sedentary activities increase your risk of having a heart disease and stroke. According to a study, adults who watch more than four hours of television a day have 80% higher risk of dying from cardiovascular disease.

It just shows that being more active can help you lower your blood pressure, improve your blood circulation, keep your weight under control, helps you quit smoking or stay tobacco-free, prevent osteoporosis, helps you fall asleep faster and sleep soundly, etc. Imagine if you can add up all of these and equate them with your medical expenses in the future.

Exercise helps you live longer

Studies show that people who are physically active and with a healthy weight can live seven years more than those who are not active and obese. Staying physically active helps prevent diseases associated with aging or delay chronic diseases from coming. You could just imagine how exercise could maintain your quality of life as you age.

How Often or How Long Should You Exercise?

The American Heart Association and other fitness experts recommend at least 150 minutes a week of moderately intense physical activity. That could be equivalent to at least 30 minutes (or three 10-minute exercise sessions) a day for five days in a week for general health maintenance. If you are trying to lose weight, gradually work up to 45 minutes or longer at low to moderate intensities in a low- or non-impact activity for five to six days a week making sure that you take a day of rest at least once a week.

High-intensity exercise is fine only if you build up slowly and with proper supervision. Setting your exercise goals is a good way to start. Do not attempt to ramp up your exercise routine just for the sake of a challenge. Sometimes, it is better to take 15 to 20 minutes of intense weight-bearing exercise with hours of gap in between than taking one long session. Also varying the activities would take away boredom from the routine.

How to Get Started

Anyone of any age can do some type of physical activity. Deciding to become physically active is one of the best decisions you can do for your health. Exercise is not only for those who are healthy, though. People with chronic health conditions like heart disease, arthritis, chronic pain, high blood pressure, or diabetes can still still exercise. The National Institute on Aging recommends a few exercises for people with chronic conditions.

If you decide to begin exercising, here are a few tips:

• If you are over 45 years old, or have specific health conditions, consult your doctor and discuss your exercise plan.

• Start with low-intensity exercises slowly and keep your own pace. Increase gradually but do not rush with your exercise.

• Do not forget to warm up before exercising. Also, do not forget to cool down afterwards. Forgetting these two may cause your body to be sore.

• Wear appropriate, comfortable fitness clothes and shoes.

• Always rehydrate yourself by drinking water before, during, and after exercise even if you are not thirsty.

• Always go to the side of safety especially when exercising outdoors. Pay attention to your surroundings or equipment.

• Enjoy what you are doing.

Conclusion

Any physical activity that enhances fitness, health, and wellness is called an exercise. Even gardening is an exercise. Therefore, it would be best for you to move around rather than sit for hours doing nothing. You don’t have to make big life changes just to see the benefits of exercising. Start slowly and gradually build up your activity one step at a time.

If you are interested in starting an exercise program that would propel you to that lifestyle change, feel free to schedule a consultation. I will help and work with you to make changes at whatever pace you are comfortable with. There is a health program that might suit your needs. If you want to hear from me discuss more about Lifestyle Medicine, feel free to listen to my podcast. If you want to be updated with news and features from this website, subscribe to my newsletter or reach out using the contact forms below.

Sources:

American Council on Exercise. 2009. “Three Things Every Exercise Program Should Have.” www.acefitness.org. American Council on Exercise. January 28, 2009.

American Heart Association editorial staff. 2017. “Why Is Physical Activity so Important for Health and Wellbeing?” www.heart.org. American Heart Association. January 14, 2017.

Berkeley Wellness. 2011. “What Is Weight-Bearing Exercise?” Berkeley Wellness. Remedy Health Media LLC. January 1, 2011.

Kylasov, A., and S. Gavrov. 2011. Diversity of Sport: Non-Destructive Evaluation. Paris: UNESCO: Encyclopedia of Life Support Systems.

National Institute on Aging. 2020. “Four Types of Exercise Can Improve Your Health and Physical Ability.” National Institute on Aging. National Institutes of Health. April 2, 2020.

———. n.d. “How Older Adults Can Get Started with Exercise.” National Institute on Aging. National Institutes of Health. Accessed May 18, 2021.