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Sit happens: A stock trader who sits and stares at her screen all day may fall prey to sedentary diseases. (Reuters)

Get up, stand up, stand up for your cardiovascular might

Amy Green, Phyllis Mbanje
Going to gym twice a week isn’t enough to counter the effect of sitting on your backside all week.

For over a decade James Levine, a researcher at the United States medical organisation Mayo Clinic, has been telling the world about the dangers of sitting and more recently headlines in popular media have proclaimed sitting "the new smoking" with researchers linking the practice to heart disease, stroke and diabetes.

With these lifestyle diseases on the rise in the country, health academics and activists are urging South Africans to eat and act in healthier ways. But what constitutes "sitting for too long" and what are the real risks to one’s health?

"Sedentary behaviour is any activity that expends very low levels of energy, typically between one and 1.5 times the energy that is expended at rest. But there is a postural component to the definition as well, meaning that it usually involves sitting or lying down," said Rebecca Meiring from the school of physiology at the University of the Witwatersrand.

Risky behaviour
Although "sitting" may appear harmless, said Meiring, prolonged periods of it or an increased time spent in sedentary behaviour was significantly associated with many health complications including coronary heart disease.

"Very few muscles are working or engaged during sedentary behaviour, which is the proposed reason as to how it can be so detrimental to cardiovascular and metabolic health," she said.

Metabolic health relates to risk factors for heart disease, diabetes and stroke such as obesity, high blood pressure and high blood sugar, according to the US’s National Heart, Lung and Blood Institute.

A 1953 landmark study published in the Lancet journal showed that conductors, who stood and walked up and down bus stations in London, had better health outcomes compared with the drivers of the buses.

"More recent studies from the Australian Diabetes, Obesity and Lifestyle study have also observed significant harmful associations between time spent being sedentary and cardiometabolic risk," said Meiring.

Couch potato
A follow-up of these Australian studies showed an 80% increased risk of cardiovascular disease for people who watch four or more hours of television, a common daily sedentary behaviour, compared with those who watched less than two hours, according to a 2010 article published in the journal Exercise and Sport Science Reviews.

Furthermore, said the researchers, regular moderate to vigorous physical activity, such as going to the gym twice a week, was not enough to counter daily prolonged periods of sitting, prompting the coining of the term "the active couch potato phenomenon". They note that there are negative "health consequences of prolonged sitting time, which may be independent of the protective effect of regular moderate-intensity physical activity".

Modern lifestyles have been seen as the major contributors to sedentary behaviour, according to Julia Goedecke, who is a senior specialist scientist at the Non-Communicable Diseases Research Unit of the South African Medical Research Council.

Increased urbanisation
"Everything has become mechanised, especially in South Africa – with increasing urbanisation people aren’t as physically active as they used to be. They now prefer taking cars, buses and trains [to walking] for transportation," she said.

"People are watching a lot of TV, they sit at their desks in front of the laptop all day long and, because of safety concerns, kids do not play outside anymore and are spending a lot of time sitting in front of the TV for more than two hours gaming, and all these increase the chances of obesity."

Another 2008 study published in the Journal of the Royal Society of Medicine showed that one in three people attending a New Zealand hospital who suffered from deep vein thrombosis, a blood clot that form in a deep-vein, sat for eight or more hours preceding the onset of the condition.

"It’s definitely associated with a lot of health complications like increasing insulin resistance, which is a precursor to diabetes," said Goedecke.

But, she said, there are simple interventions that people who sit for long stretches at a time can implement into their daily lives. "At a workplace, I would suggest that if there’s a meeting, conduct it while standing. It makes the meeting shorter. Every half hour, get up from your desk and stretch a bit. Instead of emailing your colleague, go over and discuss while standing."

Interventions
In a 2013 article published in the South African Medical Journal Tracy Kolbe-Alexander of the University of Cape Town’s department of exercise science and sports medicine said there were interventions such as non-exercise activity thermogenesis which included fidgeting, stair-climbing, walking at various speeds and even chewing gum to mitigate the negative health effects of sitting.

Kolbe said breaking up sitting time resulted in improved waist circumference and reduced cholesterol levels.

"So try to take a standing break every 20 or even 45 minutes. Prolonged sitting has been related to poor glucose control and increase [in] your waistline. The aim is to move, even slowly," she said.

Office design can also help to reduce time spent sitting, according to Lucy le Roux of the interior design company Paragon Interiors.

"Offices should be designed with separate areas for meeting, relaxing and making private phone calls to encourage movement throughout the day," she said.

Standing room
"Make sure you have at least one meeting room with a high table and no chairs for standing meetings. Not only will these meetings be shorter and more focused, but you will also be more energised."

Meiring said specific interventions should be designed for people whose jobs require prolonged sitting. "More research is required on this topic in South Africa and should be targeted at potentially affected populations like office workers and till operators, who sit for long periods."

James Levine, an American researcher, in a 2010 article published in the journal Diabetes, said there are many solutions to "chair-associated ill health that range from population-wide gym attendance, pharmacological administration, or genetic manipulation. Alternatively, people could get up".


M&G staff members take a stand

Three staff members at the Mail & Guardian have recently taken to standing while working at the office. We asked them to tell us about their experiences: 

Tanya Pampalone Executive editor
I was annoyed when a colleague of mine, who used to bounce around on one of those  orthopaedic balls, decided to make the newsroom look like a rubbish dump. There he was, taping pieces of cardboard boxes together, in some lame contraption that he proclaimed would be his "stand-up" desk. Whatever. 

I was still waiting for my treadmill desk to arrive. Or at the very least, a slick stand-up/sit-down desk like the one I once saw at the National Public Radio headquarters in Washington DC last year, which apparently arrived not long before a round of layoffs.

Anyway, then the piece in Time magazine arrived in my inbox. "Sitting is killing you", the headline screamed as I sat there. Then, the first line of the piece: "You’ve already heard sitting is the new smoking." No, actually, I hadn’t. 

But after reading through the litany of issues I was now facing because of a lifetime on my ass, I messaged my obnoxious colleague to tell him I finally understood his stupid rubbish dump desk idea. Then I went to him and politely asked if he would help me to build one. He threw a lopsided box at me and I slunk away, put it on my desk and watched it collapse under the weight of my laptop. 

Finally, I spied the box of A4 paper next to the printer. The librarian stared at me sideways as I heaved the whole thing away, then reappeared for four more packs of the 500-sheet variety as the box wasn’t high enough. Perfect! And far more attractive than my colleague’s unsightly set-up. 

I’ve been a stand-up girl ever since. Well, for about half the day. For the other half I sit and put my feet up. In my old age I’ve found my legs swell when I stand for too long, especially in the summer heat. But I swear I’ll never go back to sitting all day long – my body aches less at the end of the day and my lazy butt loves me for it. 

Phillip de Wet Associate editor
It’s not the initial physical adaptation, although the knees creak for a few days and a few previously undiscovered leg muscles soon make their presence rather forcefully known. It’s not the sudden inability to do boring reading, although standards of what is worthwhile sure do change. 

It’s the questions. There were many, many questions from colleagues when I initially started standing while working. So many that the productivity improvements from better concentration were swallowed up, and any health benefits were outweighed by the interruptions. 

But the questions die down, the pain in the feet dwindles, the legs adapt, and suddenly it is hard to imagine the alternative. You mean people actually work while sitting down? Gosh, the things kids get up to these days. I still read the studies that, one after the other, extol the many and varied virtues of more standing. But what keeps me standing is the thing that got me out of my chair in the first place: an aching lower back; or, more recently, the lack of pain. 

You can keep your kneeling chairs and exercise balls; my indolent slouch has overcome them all. Standing and typing, though, brooks no argument, and a straight back makes for a happier life – whether or not it turns out to be longer and healthier. 

Sarah Wild Science editor
In recent months, a number of studies have flitted across my desk about the dangers of sitting for long periods of time: it’s bad for your back, pushes up your blood pressure, makes you fat. But it seemed like a lot of effort, and my chair is very comfortable. 

Then a colleague started doing it, and it didn’t look as ridiculous as I thought it would. So I stacked magazines and an empty paper box and made a makeshift standing desk, to give it a test run and see whether I could stick to it before I made or bought a desk scaffold. 

The first two days were hard: my feet were sore, I felt as though my ankles had been hobbled (even though I took breaks – nonstop standing isn’t that good for you either), and my back muscles were stiff. I made playlists to listen to while working to distract me from the discomfort. 

I was very glad to get home to the couch at the end of the day. I’ve been work-standing for two weeks, and now it’s uncomfortable if I sit at my desk for long stretches of time without taking a walk. I would like to be able to say that I did it for my health, but in truth, the main reason is vanity: I want to see if standing more than I sit will tone my body and give me legs that extend up to my ears.


As bad as an arrow to the knee

Dressed in medieval attire, he steps into the wilderness in search of his first quest. He can hear the roar of dragons in the distance. The sun moves down in the sky as he walks closer to the mountain ledge. Alone, the young man shouts the dragon’s language as he gazes at the wide expanse before him.

This is what William Walters, an education student at Rhodes University and avid PC gamer, had been waiting for for a year: the release of the much anticipated video game Skyrim. "When Skyrim first came out at the end of 2011 I spent pretty much 10 hours a day playing," said Walters. "Since then I’ve clocked 140 hours on the game." 

With a huge body of research coming out about the dangers of sitting for prolonged periods of time, video gamers have been targeted as a high risk group because of the long hours many players spend in front of the computer or television. In a 2010 article published in the journal Diabetes, researcher James Levine of the Mayo Clinic said that the evidence suggests "that chair-living is lethal". 

Gavin Mannion, who runs the gaming news website Lazygamers.net, estimated last year’s attendance at Rage, South Africa’s biggest gaming expo, has been on the rise: "Last year they had over 30?000 people." 

"A lot of the more popular online games are very social, which means that people can end up sitting and chatting to their friends while playing for easily 12 hours in a day," he said. There have been a number of reports of gamers dying after hours-long gaming sessions. "There are horror stories like that kid in Taiwan who media reports said died after 40 hours of non-stop playing of the game Diablo III," said Mannion. 

According to media reports, the 18-year-old gamer forgot to eat, sleep or go to the toilet, and developed a blood clot which lead to his death. But Walters said these reports shouldn’t be taken too seriously. "There is this perception about us that exists that we don’t know how to stop, but that is one individual’s behaviour. The media focuses on this and then the public thinks these guys are all crazy, but we’re really not." 

Walters has a break to stretch his legs at least every three hours, but there are other ways to mitigate the negative effects of sitting for too long. 

"The Nintendo Wii has an automatic function built in that reminds gamers to take a break, and the Xbox 360 has a feature where you can limit the amount of time someone can use the console per day," said Mannion. "A simple way to keep yourself from sitting there all night is to set an alarm on your phone that will go off every two hours, and then you just need the self-control to leave the game and get into bed."

Walters said gamers shouldn’t be exclusively targeted as high risk as "you have people who watch TV or sit at a desk all day". "There are games like Skyrim that are very immersive and when your concentration is there it’s hard to move away but "most of us have enough self-control" to take breaks and do other activities. 

Would Walters ever forget to eat and sleep if he’s playing a particularly immersive game? "Of course not. While we do game a lot, we know when to stop." 

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heart diseaseInternational Diabetes FoundationMedical Research Council of South AfricaMedical Research Councilgaming