Okay, everyone needs to fess up! Most of you have been sitting around just waiting for COVID-19 to vanish into the clear blue sky. I say that because by the number of people calling my office for appointments, chances are that many of you are losing fitness by the day sitting too much. My hope is that this article will help motivate you to get off your duff.
We all know that physical activity and movement is good and that “motion is lotion” to our bodies. However, most of us are not aware that a sedentary lifestyle that involves sitting kills. It is now known with research that sitting too much all by itself can raise your risk of disease and premature death.
A large study in 2012 of 240,819 healthy, American adults showed that the more time spent sitting was linked to premature death due to heart disease or cancer. It found that even if people exercised more than seven hours a week, watching TV for more than seven hours a day was linked to a 50% greater risk of mortality and two fold greater risk of cardiovascular mortality.
To be blunt, “sitting kills.” If you desire a short, sickly life, just keep on sitting 13 hours a day like the average American. Whereas with other Wesetern societies, adults spend 55-70% of their day or 9-11 hours sitting. The bottom line is that Americans sit too much.
But, don’t feel you are doomed especially during this pandemic. Get this! Replacing just two minutes of sitting every hour with a bit of motion helps mitigate, not eliminate, the risks of sitting. Better yet, if you try not to sit for more than 30 minutes at a stretch, your odds improve. For those of you that are addicted to the internet, I know that will be a challenge.
What these studies reveal is that sedentary behavior is not just the absence of physical activity, but a human behavior with its own health risks. In fact, there is now a new field of research called “sedentary physiology.”
From this new field of research, sedentary behavior has been defined as any waking behavior characterized by an energy expenditure of less than or equal to 1.5 times the resting metabolic rate while in a sitting or reclining position. Researchers measure activity in METs or metabolic equivalents where one MET is the amount of energy it takes to sit still whereas moderate activity burns three to six MET’s and vigorous activity burns more than six.
Not to confuse you, but this is different from physical inactivity which has been defined as not reaching the recommended 150 minutes per week of moderate intensity exercise. Using this criteria, physical inactivity is now believed to be the biggest public health problem worldwide in the 21st century. It is now believed physical inactivity causes as many deaths globally as the habit of smoking. That is why public health professionals have been saying that too much sitting is the new smoking.
But unfortunately, most research studies fail to differentiate between sedentary behavior and physical inactivity. Let me emphasize, however, that a sedentary lifestyle not only raises the risk of getting many chronic diseases, but increases the severity of these diseases and the risk of dying from them.
Simply put, a sedentary lifestyle triggers a cascade of unhealthy metabolic events like tending to increase your visceral or belly fat. A sedentary lifestyle combined with our diets increase what is called “visceral fat.” Visceral fat is not just thought of anymore as a stagnant blob of tissue most of us carry around, but an active organ that pumps out chemicals leading to chronic systemic inflammation. This chronic systemic inflammation is the underlying cause of many of the chronic diseases seen today in our society. Especially leading to insulin resistant atherosclerosis which is a precursor to diabetes and neurological degeneration.
A sedentary lifestyle is also linked to what is called high cholesterol metabolic syndrome, gallstones, asthma, chronic obstructive pulmonary disease (COPD), some cancers, cognitive dysfunction, dementia, osteoarthritis, lower back pain, frailty, decreased function independence, constipation, muscle weakness, chronic inflammation, depression, less health levels of triglycerides, HDL (high density lipoprotein or good cholesterol), and a C reactive protein which is a marker for inflammation.
If what you have just learned is not enough to motivate you into motion, sitting too much raises the risk of heart disease and the more prolonged you are sitting raises the risks. Keep this in mind too that if you sit more than 10 hours a day, increased levels of a protein, troponin, will be evident in blood work ups. Troponin is a blood marker seen from the damage of cardiac cells as in a heart attack. On top of that, sitting too much raises the risk of blood clots.
Physical inactivity now accounts for an estimated 5.3 million deaths worldwide according to a study done in 2012. That number is actually 9% of premature deaths or death before a person’s statistical life expectancy. In addition, that number represents 6% of deaths by coronary heart disease, 7% of type II diabetes, 10% of breast cancer, and 10% of colon cancer. This following statement is mind boggling in that if inactivity were decreased by 10-25%, more than 1.3 million deaths could be averted worldwide.
Even just standing and not exercising and not sitting alone would reduce premature deaths from all causes. That is according to a study of 16,586 adults in Canada.
The one obvious consequence to our society today from a sedentary lifestyle, physical inactivity, and too much sitting is the rise of obesity. Obesity is defined as having a body mass index (BMI) of 30 or more. Currently in this country, 35% of adult men and 40.4% of adult women are obese. Unfortunately, our future is not bright unless we as a nation change our habits because children aged 2-19 years of age are 17.0% obese and 5.8% extremely obese.
Why is that? Sitting makes us fat because it lowers the amount of food that is converted to energy. The excess body fat increases the risk of heart disease, diabetes, arthritis, and some cancers. The hits just keep on coming!
But don’t give up hope. There are things you can do to reduce the risk of sitting. One way is by just improving your postural alignment while sitting. When you sit with good posture, your body efficiently resists gravity in the least stressful way affecting your neuromuscular, fascial, and structural systems. It also allows your internal organs to function more efficiently.
When one thinks of sitting posture, it is typically thought of as static, but the truth is that it is far from it. It is a dynamic process between your neuromuscular, fascial, and structural systems. With good, correct posture having the weight equally distributed between the right and left sides of the body allows one to be straight and aligned. This allows the weight to be carried by the sound structure involving your bones, ligaments, and tendons and not relying on muscle activity. Yes, you need some muscles to hold you up against gravity, but with good, correct posture the bulk of the ongoing support work is done by the skeletal structure like the steel girders of a skyscraper.
With poor, posture you experience increased muscle tension and stiffness because the neuromuscular system has to do the work that should be done by your skeleton. That is why most backaches occur with poor posture overworking the muscular system. Therefore, you have to take a closer look at how you sit.
By improving your sitting posture, the benefits are many like increasing your lung capacity allowing you to breathe easier and more deeply. It gives your body more power and energy while living more from a stable, balanced foundational core.
No matter what your mother may have told you about posture, sitting up straight requires a balanced position of the pelvis. On top of that, you have probably heard that good things are worth working for and that is true when talking about sitting posture. It is a habit that requires awareness and practice.
Posture is something that applies to everyone at every age. From birth to death, posture is one of the most important components to a healthy life that is often times overlooked.
But keep this in mind. Your posture is like a window into your spine and the function of your vital, internal organs. It is a measure of the balance of your spinal column making up part of the core for your entire body that ultimately affects the function of your internal organs.
Looking from a frontal view, your structure should be vertical in alignment with the chin, shoulder, and pelvic girdles parallel with the floor. Whereas from a side view, your spine should have three naturally flowing curves all helping to support the weight of your body and head.
In a balanced, symmetrical position, your head sits directly on top of your spine which houses and protects the spinal cord, the vital nerve tract that extends from your brain acting as the intelligence line of communication for your entire body. Proper spinal alignment allows for proper function of this cord which is paramount to excellent health, vigor, and performance.
Do you need more convincing on how important your sitting posture is? So, let’s begin changing your sitting posture. The following steps can help you improve your structural alignment when sitting:
•Sitting posture begins from the top down starting with the head. Alter the position of the head and the body will follow something I learned in the sport of ski jumping. When the head doesn’t sit balanced on the spine, it is commonly referred to as a “forward head posture.” A position that causes us to be constantly falling and catching ourselves at least as far as the neuromuscular system is concerned. Over time, this causes wear and tear on the entire body. By bringing your head back in alignment with the shoulders so your ears are in alignment with the shoulders, reduces the kyphosis of the thoracic spine. Kyphosis is a postural position of the spine in which the upper body and head are carried well in front of the rest of the body.
•Check your shoulders. Are they positioned too high up by your ears? If so, it causes tightness of the trapezius and levator scapulae muscles, both affecting the position of your neck and shoulder girdles. By slightly lowering your shoulder girdles down from the ears, it reduces the strain on your head and neck. Also, if your shoulders are positioned forward of your hips, focus first on moving your trunk back so the shoulders are aligned over the hips.
•Position your hip and knee joints to begin the quest for better sitting posture. Your knees should be at a ninety degree angle whereas the hips can be positioned a bit more open to about one-hundred twenty degrees. How open the hips are positioned, depends on the tilt of your pelvis while sitting. When looking at the tilt of the pelvis, focus on the lordosis or lack of lordosis with the lumbar spine. The tilt of the human pelvic girdle is a continuum that runs from anterior to posterior with most women having an anterior and most men having a posterior tilt, but that is not always true. I have evaluated women in my practice with a posterior tilt and men with an anterior tilt.
In an anterior tilt, the lordotic or concave curve of the lumbar spine is increased whereas with a posterior tilt it is more flat. Therefore with an anterior tilt, it is advised that the hips are positioned at about ninety degrees and with a posterior tilt positioned more open as just mentioned.
•Sit upright and vertical. During sitting, your body weight is transferred from your pelvic girdle onto the chair or support you are sitting. On the bottom of the human pelvic girdle are two knobby bones called appropriately SIT bones. The SIT bones are actually the ischial tuberosity on either side of the pelvic girdle. For ideal sitting posture and alignment, you should feel like you are right on top of these bones, not feeling in front nor in the back of them. To practice getting on top of the SIT bones or what is often referred to as a “neutral position”, gently rock your weight forward so you are in front of the SIT bones and then to the back. Finally, come to a position between the two extremes and you find that sweet spot, a “neutral position.”
•Preserve your spinal curves. Spinal curves of the cervical, thoracic, and lumbar spine help maintain an upright, vertical posture. The cervical and lumbar spine should have a concave curve that sweeps forward when you view the body from the side whereas the thoracic spine is more convex. For good sitting posture, you should be able to slip your hand in the space between your lower back and the back of the chair. Problems arise when there is no lumbar lordosis or an over arched back. If you find your back is over arched, adjust the tilt of your pelvis posterior to flatten the lumbar spine. Conversely if your back is flattened with minimal lordosis, adjust the tilt of your pelvis anterior to increase the lordosis. In this instance, you may even benefit from a lumbar cushion or roll that may support the natural lordotic curve of your lower back.
•Compare the weight distribution between the right and left SIT bones. It has been my experience that most, but not always, a right handed person will have more weight on their right SIT bone and a left handed person will have more weight on their left SIT bone. When this happens, a shift of the head, neck, and trunk will occur toward that side creating a compensated posture or false vertical position from a true vertical position.
To assess your weight distribution, position both hands under the right and left SIT bones feeling for a difference. Again, the ideal is to feel equal pressure through both hands. With the hands under your SIT bones, shift your head, neck, and shoulders to the right and then to the left before coming back toward a “neutral position” where you feel equal weight on both SIT bones. When doing the shift, your head, chin, and shoulder girdles should remain parallel with the floor.
•Keep your feet flat on the floor which can be a challenge for the “vertically challenged.” If your feet don’t reach the floor, try using a footrest or place a thick book under them. Avoid awkward positions of your feet.
•Take a deep breath and exhale. Remember, the primary breathing muscle is the diaphragm. Sitting in good alignment allows the diaphragm to move vertically in an optimum manner allowing your lungs to fully expand. If you sit with poor alignment, it limits the mobility of the diaphragm and rib cage and your breathing with each inhalation and exhalation. When breathing, focus on the movement of your abdomen more than the elevation and depression of your rib cage. This type of breathing is called diaphragmatic breathing and is more efficient than the rising and falling of your rib cage which utilizes your neck muscles.
•Practice good sitting posture often because that is the only way you can change your postural habits. Yes, your sitting posture is a habit and changing habits take awareness and time to change. Practice!
But even if you improve your sitting posture as just described, many of you still have five daily habits in regards to sitting that need to change:
•Daily Habit #1-Sitting too much which we have already discussed and the dangers to your health contributing to serious chronic illnesses. Keep in mind that prolonged sitting can also result in decreased body circulation, weak gluteal muscles, tight hip flexors and hamstrings resulting in stiff joints throughout the body. Tight hip flexors and hamstrings will also cause compensation in your standing posture and gait. In addition, it can cause compensation with your back and neck resulting in tightness and stiffness. Last but not least, prolonged sitting especially with poor posture weakens your core causing you to hunch forward even more. Bottom line: Don’t sit for more than one hour at a time. Then, get up and move. Sit with good, postural alignment.
•Daily Habit #2-Excessive texting can virtually lead to a “pain in your neck.” It can contribute to tightness and stiffness of your neck and back muscles creating muscle imbalances that can often lead to headache pain. Just tilting your head forward while texting at a 15 degree angle is equivalent to applying 27 pounds of force on your neck. Remember, the head is to be balanced on top of the spine and not in a forward head position. Bottom line: Become more aware of your head and neck position while texting and reduce the amount you text each day.
•Daily Habit #3-When using a computer which is similar to texting, again become more aware of your head position. I can’t stress enough how much stress is added to your neck when the head and neck are not balanced on top of the spine. The weight of the average human head is 10-11 pounds. Again, increasing its tilt forward by 15 degrees as in a forward head posture will increase the weight of the head on your neck to 27 pounds. Remember the shoulders too. Awkward arm and shoulder angles while working on your computer can trigger head, neck, shoulder, arm, wrist, and hand pain. Bottom line: Be aware of how you are sitting when working on your computer and do not sit for more than one hour at a time. Have your work station be ergonomically correct.
•Daily Habit #4-Driving, especially for long periods of time usually causes you to lose focus on your sitting posture. The compensatory position while driving often results in stiffness and pain in your back, neck, shoulders, and legs. Make sure your seat is adjusted correctly for you looking at the tilt of the pelvis, lordosis of the lumbar spine, and hip angle as discussed above. Bottom line: When going on road trips, stop periodically and get out of the car and move.
•Daily Habit #5-Don’t cross your legs. It can cause your pelvic girdle to rotate or tilt ultimately leading to poor alignment of your spine. Bottom line: If you feel you need to cross your legs, cross them at your ankles.
It can’t be stressed enough that physical activity and movement is the key to changing a sedentary and physically inactive lifestyle. There is no shortage of ways to get moving, but here are some suggestions:
•Walk more. Plenty of research has borne out the health benefits of just a daily 30 minute walk. During its 26 year follow up, Nurses’ Health Study found people who walked briskly or otherwise achieved moderate intensity for at least 30 minutes every day had a lower risk of sudden cardiac death. Also, a study published in 2015 found as little as three five minute walks throughout a work day can reverse the harm prolonged sitting causes to peripheral arteries in the legs. Whenever you have the opportunity to walk, “just do it!”
For those of you that feel running is better, you are correct only from the standpoint of burning calories. Consider these statistics for a person who weighs 155 pounds:
•Running 30 minutes at 5 mph burns 298 calories.
*Running 30 minutes at 6 mph burns 373 calories.
*Running 30 minutes at 7.5 mph burns 465 calories.
*Walking 30 minutes at 3.5 mph burns 149 calories.
*Walking 30 minutes at 4 mph burns 167 calories.
*Walking 30 minutes at 4.5 mph burns 186 calories.
•Take the stairs when you can. A study published in 2017 found stair climbing, which is considered a vigorous intensity physical activity, burns more calories than jogging. Taking stairs whenever possible can help you maintain a healthy weight as well as build and maintain a healthy status of your bones, joints, and muscles.
•Stand up. If your job requires you to sit longer periods, make it a point to stand up at least every hour and it is even better if you can do this every 30 minutes.
•Make pilates, yoga, tai chi, stretching or other movement or calisthenic routines part of your fitness routine. I have picked up tai chi chih which has helped me get moving with my arthritic knees.
So there you have it. It is time to get moving even during this pandemic. Get off your duff! Don’t forget to wear your mask when you are out, social distance, and wash your hands.
Just a reminder: My clinic will be closed at least until November 30th. I will let you know when I reopen once this spike of COVID 19 subsides. Be well and stay well.
Terry Kern, P.T.