Sedentary Behavior: Emerging Evidence for a Fresh Health Risk
Compared with our parents or grandparents, we are spending enlargening amounts of time in environments that not only limit physical activity but require prolonged sitting—at work, at home, and in our cars and communities. One Work sites, schools, homes, and public spaces have been (and proceed to be) re-engineered in ways that minimize human movement and muscular activity. These switches have a dual effect on human behavior: people stir less and sit more. From an evolutionary perspective, humans were designed to stir—to locomote and engage in all manner of manual labor via the day. This was essential to our survival as a species. The latest shift from a physically requiring life to one with few physical challenges has been unexpected, occurring during a little fraction of human existence.
Societal indicators of reductions in human energy expenditure and increases in sedentary behavior during the past several decades are particularly striking. In 1970, two in ten working Americans were in jobs requiring only light activity (predominantly sitting at a desk), whereas three in ten were in jobs requiring high-energy output (eg, construction, manufacturing, farming). Two By 2000, more than four in ten adults were in light-activity jobs, whereas two in ten were in high-activity jobs. Two Moreover, during the past twenty years, total screen time (ie, using computers, watching television, playing movie games) has enlargened dramatically. In 2003, almost six in ten working adults used a computer on the job and more than nine in ten children used computers in school (kindergarten through grade 12). Three Inbetween one thousand nine hundred eighty nine and 2009, the number of households with a computer and Internet access enhanced from 15% to 69%. Three Other significant contributors to daily sitting time—watching television and driving individual vehicles—are at all-time highs, with estimates of almost four hours and one hour, respectively. Four,Five
Scientists studying the ill effects of this decrease in physical activity have exposed a complicated, multifaceted relationship among physical work, energy expenditure, and health. 6,7 Clinical and basic research has focused on the benefits of incorporating regular bouts of exercise into modern life to adjust to some extent for the loss of the physically active life led by our ancestors. Six Current public health recommendations propose engaging in at least one hundred fifty minutes per week of moderate-to-vigorous activity to help prevent and manage numerous chronic conditions, notably cardiovascular disease, type two diabetes, obesity, and some cancers. Seven The evidence base that supports this exercise recommendation is substantial. (Here, we use the terms exercise and moderate-to-vigorous activity interchangeably, recognizing that, by some definitions, exercise refers specifically to intentional activity carried out for health/fitness purposes. Seven )
Those who do not exercise have by convention been termed sedentary. However, this is no longer an adequate perspective. Latest epidemiologic evidence suggests that the metabolic and long-term health consequences of habitual sedentary behavior (too much sitting) are distinct from those associated with a lack of moderate-to-vigorous activity (too little exercise). 8,9 This shift in perspective is being clarified through innovations in technology used to characterize movement patterns in populations.
Fresh Technology Characterizes Sedentary and Physically Active Time in Populations
Nonexercise behaviors can be differentiated into two categories: sedentary behavior, which may be defined as sitting, lounging down, and expending very little energy (approximately 1.0-1.Five metabolic equivalents [METs]), and light-intensity activity, such as standing, self-care activities, and slow walking, which require low energy expenditure (approximately 1.6-2.9 METs). Ten Advances in microelectronic technologies, specifically the accelerometer, have enabled the time spent in sedentary, light-intensity, and exercise behaviors to be objectively derived. This has greatly improved the methodology for measuring activity patterns among free-living humans, which previously relied mainly on self-report of behavior. Eleven
Examining seven days of accelerometer data from a nationally representative sample of one thousand seven hundred fourteen white adults aged twenty to fifty nine years from the US National Health and Nutrition Examination Survey, twelve it is striking that the vast majority of daily nonsleeping time was spent in either sedentary behavior (58%) or light-intensity activity (39%), and only 3% in exercise time. Figure one shows the differences in time spent in light activity and exercise across quartiles of sedentary time. Most of the variance in sedentary time is due to the switch in the proportion of time spent in light-intensity activity. For example, sedentary time increases from 6.Three hours in quartile one to Ten.Two hours in quartile Four, a 62% increase with almost all of the sedentary time coming out of the block of light activity.
Sedentary time and light activity time were also very negatively correlated (r = −0.96) in a sample of Australian adults. Thirteen Albeit the precise magnitude of switches cannot be determined, the shift from time spent in light activities to time being sedentary undoubtedly has enhanced substantially in latest decades. This shift has likely contributed to the enlargening rates of obesity and type two diabetes.
Fresh Insights Into Sedentary Behavior and Cardiometabolic Risk
Latest studies have documented deleterious associations of adults’ reported television viewing time and overall sedentary time with central adiposity (larger waistline circumference) and with fasting triglyceride levels and markers of insulin resistance (ie, fasting insulin level, 2-hour glucose) that are independent of both central adiposity and exercise time. 13-17 With prolonged periods of sitting, fewer skeletal muscle contractions may result in diminished lipoprotein lipase activity and clearance of triglycerides, diminished clearance of an oral glucose flow, and less glucose-stimulated insulin secretion. 18-20 Moreover, time in sedentary behaviors is associated with enlargened cardiovascular and all-cause mortality; this has now been shown for television viewing time, eight overall daily sitting time, four and time spent sitting in cars. Twenty one
Another intriguing finding is that violates in sedentary time have beneficial associations with waistline circumference, assets mass index, triglyceride levels, and 2-hour glucose levels that are independent of total sedentary time and exercise time. Twenty two In Figure two , the variability in sedentary behavior and associated violates for three persons across one week is illustrated using cluster fever maps. Twenty three Case one reflects a healthy daily pattern that includes time spent in exercise and intermittent periods of light activity that break up periods of sedentary behavior, whereas case two illustrates a preponderance of sitting with the balance in light activity (and no exercise). The “exerciser” profile meets the accepted public health standard for sufficient exercise but is the exception and not the rule, whereas the “sedentary” profile is prevalent in the US population. In case Three, a variation of case Two, many bouts of light activity have substituted sedentary time across the day. This enhanced frequency of light activities may be by necessity (for example, being a mechanic, a physician with numerous examination rooms, or a mother with youthful children) or by choice. This “active” profile is not uncommon, but its potential salutary effect has been overlooked.
These three cases display the limited perspective provided when a person is identified as being physically active or not solely on the basis of the 3% or so of time spent in moderate or vigorous activity. Conventionally quoted population averages obscure the broad distribution of individual differences in allocation of time spent in behaviors that require very low, light, and moderate or high energy expenditure; they also fail to portray the frequency of beneficial cracks in very low energy output (sedentary) behaviors. Latest findings indicate that helping people shift from the “sedentary” profile toward the “active” profile would reap significant health benefits. 22,24
On the basis of our analysis, one in four white US adults spend about 70% of their waking hours sitting, 30% in light activities, and little or no time in exercise. Feasible steps to break up prolonged sitting with brief bouts of light activity include walking down the hall to speak with coworkers instead of emailing, extending walking distance during trips to the break room or bathroom, and standing or pacing when on the phone. Prolonged sitting is effortless to recognize and occurs in many settings, and interventions targeting it involve puny switches that may be readily accepted. Every minute of sedentary behavior substituted with light activity would expend one extra kilocalorie (calculated assuming 1.Five vs Two.Three METs for a person weighing seventy two kg). Greater energy expenditure is a plain benefit to cite. Yet, as the findings already summarized suggest, weight control is one of several significant potential benefits of spending less time sitting. Nineteen
Conclusion
In latest decades, affluent populations have become increasingly sedentary, with many adults spending 70% or more of their waking hours sitting. Parallel with this switch, evidence has emerged identifying habitual sedentary behavior (prolonged sitting) as a novel risk factor for cardiometabolic disease and all-cause mortality, independent of time spent in exercise. As this evidence is primarily observational in nature, further experimental research investigating potential mechanisms and dose-response relationships is necessary. For example, a daily quantity of neuromuscular stimulation (some combination of duration and frequency) that occurs during standing and light activities may be necessary to sustain components of musculoskeletal and metabolic health.
These fresh insights into the health risks of sedentary behavior broaden the accepted perspective on physical activity and health by identifying the need to reduce prolonged sitting and increase light-intensity activities (eg, standing and incidental walking), in addition to engaging in regular moderate-to-vigorous activity. The importance of exercise counseling in the primary care setting is well established. Twenty five Excellent resources providing practical advice for incorporating behavioral counseling in medical settings are available. 26,27
In light of latest findings, it has become clear that most patients face two obstacles: too little exercise and too much sitting. The American Academy of Pediatrics counsels parents to limit children’s screen time—television, DVDs, and movie games—to no more than two hours per day. Twenty eight Parents still tell their children to get off the sofa and go out and play. Latest evidence is compelling that adults too need similar advice from their physicians. Patients need to get out of their chairs more frequently, both at work and at home. Advising patients to reduce prolonged sitting can be readily combined with current recommendations on exercise and weight management.
Sedentary Behavior: Emerging Evidence for a Fresh Health Risk
Sedentary Behavior: Emerging Evidence for a Fresh Health Risk
Compared with our parents or grandparents, we are spending enlargening amounts of time in environments that not only limit physical activity but require prolonged sitting—at work, at home, and in our cars and communities. One Work sites, schools, homes, and public spaces have been (and proceed to be) re-engineered in ways that minimize human movement and muscular activity. These switches have a dual effect on human behavior: people budge less and sit more. From an evolutionary perspective, humans were designed to stir—to locomote and engage in all manner of manual labor across the day. This was essential to our survival as a species. The latest shift from a physically requiring life to one with few physical challenges has been unexpected, occurring during a little fraction of human existence.
Societal indicators of reductions in human energy expenditure and increases in sedentary behavior during the past several decades are particularly striking. In 1970, two in ten working Americans were in jobs requiring only light activity (predominantly sitting at a desk), whereas three in ten were in jobs requiring high-energy output (eg, construction, manufacturing, farming). Two By 2000, more than four in ten adults were in light-activity jobs, whereas two in ten were in high-activity jobs. Two Moreover, during the past twenty years, total screen time (ie, using computers, watching television, playing movie games) has enhanced dramatically. In 2003, almost six in ten working adults used a computer on the job and more than nine in ten children used computers in school (kindergarten through grade 12). Three Inbetween one thousand nine hundred eighty nine and 2009, the number of households with a computer and Internet access enhanced from 15% to 69%. Three Other significant contributors to daily sitting time—watching television and driving individual vehicles—are at all-time highs, with estimates of almost four hours and one hour, respectively. Four,Five
Scientists studying the ill effects of this decrease in physical activity have exposed a sophisticated, multifaceted relationship among physical work, energy expenditure, and health. 6,7 Clinical and basic research has focused on the benefits of incorporating regular bouts of exercise into modern life to adjust to some extent for the loss of the physically active life led by our ancestors. Six Current public health recommendations propose engaging in at least one hundred fifty minutes per week of moderate-to-vigorous activity to help prevent and manage numerous chronic conditions, notably cardiovascular disease, type two diabetes, obesity, and some cancers. Seven The evidence base that supports this exercise recommendation is substantial. (Here, we use the terms exercise and moderate-to-vigorous activity interchangeably, recognizing that, by some definitions, exercise refers specifically to intentional activity carried out for health/fitness purposes. Seven )
Those who do not exercise have by convention been termed sedentary. However, this is no longer an adequate perspective. Latest epidemiologic evidence suggests that the metabolic and long-term health consequences of habitual sedentary behavior (too much sitting) are distinct from those associated with a lack of moderate-to-vigorous activity (too little exercise). 8,9 This shift in perspective is being clarified through innovations in technology used to characterize movement patterns in populations.
Fresh Technology Characterizes Sedentary and Physically Active Time in Populations
Nonexercise behaviors can be differentiated into two categories: sedentary behavior, which may be defined as sitting, lounging down, and expending very little energy (approximately 1.0-1.Five metabolic equivalents [METs]), and light-intensity activity, such as standing, self-care activities, and slow walking, which require low energy expenditure (approximately 1.6-2.9 METs). Ten Advances in microelectronic technologies, specifically the accelerometer, have enabled the time spent in sedentary, light-intensity, and exercise behaviors to be objectively derived. This has greatly improved the methodology for measuring activity patterns among free-living humans, which previously relied mainly on self-report of behavior. Eleven
Examining seven days of accelerometer data from a nationally representative sample of one thousand seven hundred fourteen white adults aged twenty to fifty nine years from the US National Health and Nutrition Examination Survey, twelve it is striking that the vast majority of daily nonsleeping time was spent in either sedentary behavior (58%) or light-intensity activity (39%), and only 3% in exercise time. Figure one shows the differences in time spent in light activity and exercise across quartiles of sedentary time. Most of the variance in sedentary time is due to the switch in the proportion of time spent in light-intensity activity. For example, sedentary time increases from 6.Trio hours in quartile one to Ten.Two hours in quartile Four, a 62% increase with almost all of the sedentary time coming out of the block of light activity.
Sedentary time and light activity time were also very negatively correlated (r = −0.96) in a sample of Australian adults. Thirteen Albeit the precise magnitude of switches cannot be determined, the shift from time spent in light activities to time being sedentary undoubtedly has enlargened substantially in latest decades. This shift has likely contributed to the enlargening rates of obesity and type two diabetes.
Fresh Insights Into Sedentary Behavior and Cardiometabolic Risk
Latest studies have documented deleterious associations of adults’ reported television viewing time and overall sedentary time with central adiposity (larger mid-body circumference) and with fasting triglyceride levels and markers of insulin resistance (ie, fasting insulin level, 2-hour glucose) that are independent of both central adiposity and exercise time. 13-17 With prolonged periods of sitting, fewer skeletal muscle contractions may result in diminished lipoprotein lipase activity and clearance of triglycerides, diminished clearance of an oral glucose stream, and less glucose-stimulated insulin secretion. 18-20 Moreover, time in sedentary behaviors is associated with enlargened cardiovascular and all-cause mortality; this has now been shown for television viewing time, eight overall daily sitting time, four and time spent sitting in cars. Twenty one
Another intriguing finding is that violates in sedentary time have beneficial associations with waistline circumference, bod mass index, triglyceride levels, and 2-hour glucose levels that are independent of total sedentary time and exercise time. Twenty two In Figure two , the variability in sedentary behavior and associated cracks for three persons across one week is illustrated using cluster warmth maps. Twenty three Case one reflects a healthy daily pattern that includes time spent in exercise and intermittent periods of light activity that break up periods of sedentary behavior, whereas case two illustrates a preponderance of sitting with the balance in light activity (and no exercise). The “exerciser” profile meets the accepted public health standard for sufficient exercise but is the exception and not the rule, whereas the “sedentary” profile is prevalent in the US population. In case Three, a variation of case Two, many bouts of light activity have substituted sedentary time across the day. This enlargened frequency of light activities may be by necessity (for example, being a mechanic, a physician with numerous examination rooms, or a mother with youthful children) or by choice. This “active” profile is not uncommon, but its potential salutary effect has been overlooked.
These three cases showcase the limited perspective provided when a person is identified as being physically active or not solely on the basis of the 3% or so of time spent in moderate or vigorous activity. Conventionally quoted population averages obscure the broad distribution of individual differences in allocation of time spent in behaviors that require very low, light, and moderate or high energy expenditure; they also fail to portray the frequency of beneficial cracks in very low energy output (sedentary) behaviors. Latest findings indicate that helping people shift from the “sedentary” profile toward the “active” profile would reap significant health benefits. 22,24
On the basis of our analysis, one in four white US adults spend about 70% of their waking hours sitting, 30% in light activities, and little or no time in exercise. Feasible steps to break up prolonged sitting with brief bouts of light activity include walking down the hall to speak with coworkers instead of emailing, extending walking distance during trips to the break room or bathroom, and standing or pacing when on the phone. Prolonged sitting is effortless to recognize and occurs in many settings, and interventions targeting it involve petite switches that may be readily accepted. Every minute of sedentary behavior substituted with light activity would expend one extra kilocalorie (calculated assuming 1.Five vs Two.Trio METs for a person weighing seventy two kg). Greater energy expenditure is a plain benefit to cite. Yet, as the findings already summarized suggest, weight control is one of several significant potential benefits of spending less time sitting. Nineteen
Conclusion
In latest decades, affluent populations have become increasingly sedentary, with many adults spending 70% or more of their waking hours sitting. Parallel with this switch, evidence has emerged identifying habitual sedentary behavior (prolonged sitting) as a novel risk factor for cardiometabolic disease and all-cause mortality, independent of time spent in exercise. As this evidence is primarily observational in nature, further experimental research investigating potential mechanisms and dose-response relationships is necessary. For example, a daily quantity of neuromuscular stimulation (some combination of duration and frequency) that occurs during standing and light activities may be necessary to sustain components of musculoskeletal and metabolic health.
These fresh insights into the health risks of sedentary behavior broaden the accepted perspective on physical activity and health by identifying the need to reduce prolonged sitting and increase light-intensity activities (eg, standing and incidental walking), in addition to engaging in regular moderate-to-vigorous activity. The importance of exercise counseling in the primary care setting is well established. Twenty five Excellent resources providing practical advice for incorporating behavioral counseling in medical settings are available. 26,27
In light of latest findings, it has become clear that most patients face two obstacles: too little exercise and too much sitting. The American Academy of Pediatrics counsels parents to limit children’s screen time—television, DVDs, and movie games—to no more than two hours per day. Twenty eight Parents still tell their children to get off the sofa and go out and play. Latest evidence is compelling that adults too need similar advice from their physicians. Patients need to get out of their chairs more frequently, both at work and at home. Advising patients to reduce prolonged sitting can be readily combined with current recommendations on exercise and weight management.
Sedentary Behavior: Emerging Evidence for a Fresh Health Risk
Sedentary Behavior: Emerging Evidence for a Fresh Health Risk
Compared with our parents or grandparents, we are spending enlargening amounts of time in environments that not only limit physical activity but require prolonged sitting—at work, at home, and in our cars and communities. One Work sites, schools, homes, and public spaces have been (and proceed to be) re-engineered in ways that minimize human movement and muscular activity. These switches have a dual effect on human behavior: people budge less and sit more. From an evolutionary perspective, humans were designed to budge—to locomote and engage in all manner of manual labor via the day. This was essential to our survival as a species. The latest shift from a physically requiring life to one with few physical challenges has been unexpected, occurring during a little fraction of human existence.
Societal indicators of reductions in human energy expenditure and increases in sedentary behavior during the past several decades are particularly striking. In 1970, two in ten working Americans were in jobs requiring only light activity (predominantly sitting at a desk), whereas three in ten were in jobs requiring high-energy output (eg, construction, manufacturing, farming). Two By 2000, more than four in ten adults were in light-activity jobs, whereas two in ten were in high-activity jobs. Two Moreover, during the past twenty years, total screen time (ie, using computers, watching television, playing movie games) has enhanced dramatically. In 2003, almost six in ten working adults used a computer on the job and more than nine in ten children used computers in school (kindergarten through grade 12). Three Inbetween one thousand nine hundred eighty nine and 2009, the number of households with a computer and Internet access enhanced from 15% to 69%. Three Other significant contributors to daily sitting time—watching television and driving individual vehicles—are at all-time highs, with estimates of almost four hours and one hour, respectively. Four,Five
Scientists studying the ill effects of this decrease in physical activity have exposed a complicated, multifaceted relationship among physical work, energy expenditure, and health. 6,7 Clinical and basic research has focused on the benefits of incorporating regular bouts of exercise into modern life to adjust to some extent for the loss of the physically active life led by our ancestors. Six Current public health recommendations propose engaging in at least one hundred fifty minutes per week of moderate-to-vigorous activity to help prevent and manage numerous chronic conditions, notably cardiovascular disease, type two diabetes, obesity, and some cancers. Seven The evidence base that supports this exercise recommendation is substantial. (Here, we use the terms exercise and moderate-to-vigorous activity interchangeably, recognizing that, by some definitions, exercise refers specifically to intentional activity carried out for health/fitness purposes. Seven )
Those who do not exercise have by convention been termed sedentary. However, this is no longer an adequate perspective. Latest epidemiologic evidence suggests that the metabolic and long-term health consequences of habitual sedentary behavior (too much sitting) are distinct from those associated with a lack of moderate-to-vigorous activity (too little exercise). 8,9 This shift in perspective is being clarified through innovations in technology used to characterize movement patterns in populations.
Fresh Technology Characterizes Sedentary and Physically Active Time in Populations
Nonexercise behaviors can be differentiated into two categories: sedentary behavior, which may be defined as sitting, lounging down, and expending very little energy (approximately 1.0-1.Five metabolic equivalents [METs]), and light-intensity activity, such as standing, self-care activities, and slow walking, which require low energy expenditure (approximately 1.6-2.9 METs). Ten Advances in microelectronic technologies, specifically the accelerometer, have enabled the time spent in sedentary, light-intensity, and exercise behaviors to be objectively derived. This has greatly improved the methodology for measuring activity patterns among free-living humans, which previously relied mainly on self-report of behavior. Eleven
Examining seven days of accelerometer data from a nationally representative sample of one thousand seven hundred fourteen white adults aged twenty to fifty nine years from the US National Health and Nutrition Examination Survey, twelve it is striking that the vast majority of daily nonsleeping time was spent in either sedentary behavior (58%) or light-intensity activity (39%), and only 3% in exercise time. Figure one shows the differences in time spent in light activity and exercise across quartiles of sedentary time. Most of the variance in sedentary time is due to the switch in the proportion of time spent in light-intensity activity. For example, sedentary time increases from 6.Three hours in quartile one to Ten.Two hours in quartile Four, a 62% increase with almost all of the sedentary time coming out of the block of light activity.
Sedentary time and light activity time were also very negatively correlated (r = −0.96) in a sample of Australian adults. Thirteen Albeit the precise magnitude of switches cannot be determined, the shift from time spent in light activities to time being sedentary undoubtedly has enhanced substantially in latest decades. This shift has likely contributed to the enhancing rates of obesity and type two diabetes.
Fresh Insights Into Sedentary Behavior and Cardiometabolic Risk
Latest studies have documented deleterious associations of adults’ reported television viewing time and overall sedentary time with central adiposity (larger waistline circumference) and with fasting triglyceride levels and markers of insulin resistance (ie, fasting insulin level, 2-hour glucose) that are independent of both central adiposity and exercise time. 13-17 With prolonged periods of sitting, fewer skeletal muscle contractions may result in diminished lipoprotein lipase activity and clearance of triglycerides, diminished clearance of an oral glucose explosion, and less glucose-stimulated insulin secretion. 18-20 Moreover, time in sedentary behaviors is associated with enhanced cardiovascular and all-cause mortality; this has now been shown for television viewing time, eight overall daily sitting time, four and time spent sitting in cars. Twenty one
Another intriguing finding is that cracks in sedentary time have beneficial associations with mid-body circumference, figure mass index, triglyceride levels, and 2-hour glucose levels that are independent of total sedentary time and exercise time. Twenty two In Figure two , the variability in sedentary behavior and associated cracks for three persons across one week is illustrated using cluster warmth maps. Twenty three Case one reflects a healthy daily pattern that includes time spent in exercise and intermittent periods of light activity that break up periods of sedentary behavior, whereas case two illustrates a preponderance of sitting with the balance in light activity (and no exercise). The “exerciser” profile meets the accepted public health standard for sufficient exercise but is the exception and not the rule, whereas the “sedentary” profile is prevalent in the US population. In case Trio, a variation of case Two, many bouts of light activity have substituted sedentary time across the day. This enlargened frequency of light activities may be by necessity (for example, being a mechanic, a physician with numerous examination rooms, or a mother with youthfull children) or by choice. This “active” profile is not uncommon, but its potential salutary effect has been overlooked.
These three cases display the limited perspective provided when a person is identified as being physically active or not solely on the basis of the 3% or so of time spent in moderate or vigorous activity. Conventionally quoted population averages obscure the broad distribution of individual differences in allocation of time spent in behaviors that require very low, light, and moderate or high energy expenditure; they also fail to portray the frequency of beneficial violates in very low energy output (sedentary) behaviors. Latest findings indicate that helping people shift from the “sedentary” profile toward the “active” profile would reap significant health benefits. 22,24
On the basis of our analysis, one in four white US adults spend about 70% of their waking hours sitting, 30% in light activities, and little or no time in exercise. Feasible steps to break up prolonged sitting with brief bouts of light activity include walking down the hall to speak with coworkers instead of emailing, extending walking distance during trips to the break room or bathroom, and standing or pacing when on the phone. Prolonged sitting is effortless to recognize and occurs in many settings, and interventions targeting it involve petite switches that may be readily accepted. Every minute of sedentary behavior substituted with light activity would expend one extra kilocalorie (calculated assuming 1.Five vs Two.Trio METs for a person weighing seventy two kg). Greater energy expenditure is a plain benefit to cite. Yet, as the findings already summarized suggest, weight control is one of several significant potential benefits of spending less time sitting. Nineteen
Conclusion
In latest decades, affluent populations have become increasingly sedentary, with many adults spending 70% or more of their waking hours sitting. Parallel with this switch, evidence has emerged identifying habitual sedentary behavior (prolonged sitting) as a novel risk factor for cardiometabolic disease and all-cause mortality, independent of time spent in exercise. As this evidence is primarily observational in nature, further experimental research investigating potential mechanisms and dose-response relationships is necessary. For example, a daily quantity of neuromuscular stimulation (some combination of duration and frequency) that occurs during standing and light activities may be necessary to sustain components of musculoskeletal and metabolic health.
These fresh insights into the health risks of sedentary behavior broaden the accepted perspective on physical activity and health by identifying the need to reduce prolonged sitting and increase light-intensity activities (eg, standing and incidental walking), in addition to engaging in regular moderate-to-vigorous activity. The importance of exercise counseling in the primary care setting is well established. Twenty five Excellent resources providing practical advice for incorporating behavioral counseling in medical settings are available. 26,27
In light of latest findings, it has become clear that most patients face two obstacles: too little exercise and too much sitting. The American Academy of Pediatrics counsels parents to limit children’s screen time—television, DVDs, and movie games—to no more than two hours per day. Twenty eight Parents still tell their children to get off the sofa and go out and play. Latest evidence is compelling that adults too need similar advice from their physicians. Patients need to get out of their chairs more frequently, both at work and at home. Advising patients to reduce prolonged sitting can be readily combined with current recommendations on exercise and weight management.