Prolonged Sitting Leads to Pain and Premature Death

Dr. Levine popularized the phrase “sitting is the new smoking” to reflect the devastating effects of prolonged sitting on our health. Research has reported prolonged sitting substantially increases our risk of developing cancer, cardiovascular disease (heart attack or stroke), metabolic syndrome, obesity, and dying (up to 40% increased risk of dying in a group of > 45-year-old adults in Australia). Earlier research reported the risks of prolonged sitting, such as that of full-time office workers, are not abated by regular exercise. To make matters worse for the ‘long-sitters’, prolonged sitting also makes it painful to live – research has demonstrated that prolonged sitting increases the risk of developing back, neck, and shoulder pain.

If your work looks something like this,

I’ve likely steeped you into a solid state of depression (the other kind of SSD). That would be cruel if there weren’t important updates to the research and solutions that abate the health risks of prolonged sitting; solutions that also boost work productivity, sense of well-being and vigour, sleep quality, mood and mental health, sex drive (not to be performed while sitting… or working, for that matter), and creativity.

The mechanisms that link cancer, cardiovascular disease, brain health and mental health to prolonged sitting relate to sitting being a sedentary behaviour. So, before you jump up to buy, or pat yourself on the back for using a stand-up desk, let us be clear - NOT MOVING for prolonged periods is the essential characteristic of sitting that puts us at risk. Prolonged periods of sitting, standing or laying are sedentary behaviours that have hormonal and metabolic consequences that lead to what Dr. Peter Attia describes as the four horsemen of mortality.

Prolonged sitting has been demonstrated to increase the blood markers of metabolic syndrome, i.e. elevated glucose, triglycerides, and body mass index. It also elevates Cortisol – a hormone that is detrimental to metabolism and a signal our system is under stress.  Living in a persistent state of stress has significant health outcomes that have been linked to cancer, cardiovascular disease, and pain; thus, a common thread - we are meant to move.

Patients often ask me, “How should I sit?” - The tongue-in-cheek answer is, “Not for long”.

No position is a good position if held for hours at a time. The remedy for the injuries, pain and discomfort that result from sedentary work is to move more often. Some sitting habits, however, can make matters worse.

We can group these habits into two categories: Overactive and Failure to Find Support.

Overactive posture is when people engage posture like it’s a military exercise: belly in! chest up! shoulders back! Don’t slouch!!!

Ideal posture is defined by minimal muscle activity for the required task. Sitting is a low-threshold task that requires very little muscle activity. Holding tension in your belly, back, chest and shoulders adds unnecessary stress, changes your breathing, and leads to a host of problems, including “tight” shoulders, back and hips, a stiff neck and headache.

So RELAX. Let your belly go; let your shoulders rest and relax into your body; relax your jaw, relax your back, and let your breath go.

Failure to Find Support is when people sustain and maintain a position of sitting whereby they find their support on their bums and not their sit bones. Sitting on your bum means rocking back in your pelvis so that your support comes from the muscles, fascia, ligaments and back-side of your sit bones. It looks something like this.

Consistent with the theme – no position is a good position if held for hours at a time – sitting in this “slouched” position is fine if for brief periods, intermittently spread through the day. However, sustaining and maintaining this position for prolonged periods can lead to increased tension in the neck and head and excessive strain on the lower back.

I have iterated this word – HELD – a couple of times, and it deserves attention. Unless we are gripping a ledge to avoid falling or holding something heavy in our hands, we shouldn’t be HOLDING our posture; we should be resting IN our posture – relaxed and flowing, both mind and body, even when we are focused and intent on a task. Many of our patients are unaware of the high-tension holding patterns they hold; their perception is that they are relaxed when indeed they are not. We must develop the ability to feel the contrast between complete relaxation and tension. This brings me to my final point on posture as it relates to pain, tension and discomfort.

Several lifestyle and psychological factors are predictive of the new onset of pain, and increase the risk of developing persistent (chronic) pain, including:

·      Smoking

·      High stress, anxiety and depression

·      Excessive worry and/or fear about pain

·      Overprotecting – fear of movement - (conscious or unconscious)

·      Poor sleep quality

·      Passive coping strategies

Humans have evolved to mix periods of activity with rest. Anthropological researchers suggest our ancient ancestors engaged in over 2 hours of moderate to vigorous physical activity daily and walked on average 8-16 km per day; they also engaged in a large variety of movements ranging from walking, running, pushing, pulling, lifting, reaching and climbing. Considerable research confirms our minds, muscles, joints, tendons, ligaments and bones REQUIRE regular movement to maintain good health. But there’s a problem; most of us live and work in a culture void of the natural and imposed need to move. As a result, the intentional development of our social, family, and work culture is required.

There is no one-size-fits-all model here; many roads do indeed lead to Rome. Below are a few recommendations to get you going. Take them with a grain of salt, and feel free to get creative to foster the environment you need to achieve the goal – to MOVE MORE.

Key Habits:

1.        Microdose movement and incorporate it into your day:

·      3 minutes of movement every 30 minutes, or if you’re in the groove, 6 minutes every hour. I have seen some articles and individuals recommending simple neck or shoulder “stretches” as part of these microbreaks –this will do little to help your neck and worse, it is wasting otherwise valuable time. Get up and drop into a Warrior 1 Stretch – which demands significant energy and work from your legs, and allows you to extend a long reach overhead and elongate your spine. If you prefer, repeat 10 lunges. Have stairs in your office? Go hike a flight or two. The main goal is to promote blood flow and stimulate metabolism; this means your muscles must be working (not just stretching). Check out the videos at the bottom of the article for some exercise ideas. You can do one at a time (about 1-2 min each) or all together (7 min).

·      Worried about productivity? Don’t. The research is clear that incorporating movement into your day improves focus, creativity, and energy. Your productivity will improve and you will feel better too.

·      Worried about judgment from colleagues? Don’t be - the ‘weird’ ones are those NOT moving.  Consider engaging in discussion with your colleagues about their health and the effects of prolonged sitting and sedentary behaviour at work; consider asking them to join you. I have been impressed by the offices who, after I presented a lunch and learn workshop for them, engaged in team-based exercise goals. One accountant’s office had some fun during tax season by competing for specific exercise goals each week.

2.        Engage dialogue with family and friends on the International and Canadian Recommended Guidelines for Physical Activity, which includes a minimum of 150 minutes of moderate to vigorous physical activity per week and TWO strength training sessions that train all the major muscle groups.

·      For some, this is a tall task and a hard habit to develop. Tips on getting there are perhaps a good topic for a future article, but for starters, please know that if you don’t enjoy it you won’t stick with it. Habit change is hard; so if you don’t succeed the first time around, try again. 

References:

1. Levine, J. A. (2014). Get Up! Why Your Chair is Killing You and What You Can Do About It. Palgrave Macmillan. 

2. https://peterattiamd.com/peter-on-the-four-horsemen-of-chronic-disease/
   

3. Dang, T. H. A., Romero Starke, K., Liebers, F., Burr, H., Seidler, A., & Hegewald, J. (2024). Impact of sitting at work on musculoskeletal complaints of German workers - results from the study on mental health at work (S-MGA). Journal of Occupational Medicine and Toxicology, 19(1), 9. https://doi.org/10.1186/s12995-024-00408-7
   

4. Stamatakis, E., Gale, J., Bauman, A., Ekelund, U., Hamer, M., & Ding, D. (2019). Sitting time, physical activity, and risk of mortality in adults. Journal of the American College of Cardiology, 73(16), 2062-2072. https://doi.org/10.1016/j.jacc.2019.02.031
   

5. Rezende, L. F. M., Sá, T. H., Mielke, G. I., Viscondi, J. Y. K., Rey-López, J. P., & Totaro Garcia, L. M. (2016). All-cause mortality attributable to sitting time: Analysis of 54 countries worldwide. American Journal of Preventive Medicine, 51(2), 253-263. https://doi.org/10.1016/j.amepre.2016.01.022

6. Stamatakis, E., Gale, J., Bauman, A., Ekelund, U., Hamer, M., & Ding, D. (2019). Sitting time, physical activity, and risk of mortality in adults. Journal of the American College of Cardiology, 73(16), 2062-2072. https://doi.org/10.1016/j.jacc.2019.02.031

7. Gao, W., Sanna, M., Chen, Y.-H., et al. (2024). Occupational sitting time, leisure physical activity, and all-cause and cardiovascular disease mortality. Public Health. https://doi.org/10.1016/j.puhe.2023.11.006

8. van der Ploeg, H. P., Chey, T., Korda, R. J., Banks, E., & Bauman, A. (2012). Sitting time and all-cause mortality risk in 222,497 Australian adults. Archives of Internal Medicine, 172(6), 494-500. https://doi.org/10.1001/archinternmed.2011.2174

9. Richard M Pulsford,1,* Emmanuel Stamatakis,2,3,4 Annie R Britton,4 Eric J Brunner,4 and Melvyn Hillsdon (2015). Associations of sitting behaviours with all-cause mortality over a 16-year follow-up: the Whitehall II study. Int J Epidemiol. 2015 Dec; 44(6): 1909–1916. Published online 2015 Oct 9. doi: 10.1093/ije/dyv191

10. Yoshihiro Aramaki,1,2 Fujiyasu Kakizaki,3,* Shinichi Kawata,1 Takuya Omotehara, Masahiro Itoh (2021) Effects of the posterior pelvic tilt sitting posture on thoracic morphology and respiratory function J Phys Ther Sci. 2021 Feb; 33(2): 118–124. Published online 2021 Feb 13. doi: 10.1589/jpts.33.118
    

11. Urszula Żywień, Katarzyna Barczyk-Pawelec, and Tomasz Sipko* (2022). Associated Risk Factors with Low Back Pain in White-Collar Workers—A Cross-Sectional Study. J Clin Med. 2022 Mar; 11(5): 1275. Published online 2022 Feb 25. doi: 10.3390/jcm11051275
    

12. Francis Q. S. Dzakpasu,1,2,3 Alison Carver,1 Christian J. Brakenridge,1,2,3 Flavia Cicuttini,4 Donna M. Urquhart,4 Neville Owen,3,5 and David W. Dunstan1,2 (2021). Musculoskeletal pain and sedentary behaviour in occupational and non-occupational settings: a systematic review with meta-analysis. Int J Behav Nutr Phys Act. 2021; 18: 159. Published online 2021 Dec 13. doi: 10.1186/s12966-021-01191-y