HOW MANY STEPS/DAY FOR HEALTH? AND IS EXCESSIVE SITTING SETTING YOU UP FOR DISEASE & EARLY DEATH?

“Even if you’re ill, physical activity at a lower level will help you beat it.”

~Dr. Jim Loehr, Performance Psychologist


DAILY PHYSICAL ACTIVITY VS. INTENTIONAL EXERCISE

I should first note that I typically differentiate PHYSICAL ACTIVITY from EXERCISE in the following way: physical activity involves significant bodily movement where “getting exercise” isn’t the primary (or only) purpose for the physical movement. Some examples might include…


*Significant physical activity at work

*Walking or riding bike to work, school, the store, etc.

*Taking the stairs

*Shopping for groceries (online doesn’t count 😉)

*Doing yard work (riding lawnmowers doesn’t count 😉)

*Doing house work (cleaning, preparing food, doing laundry, etc.)

*Certain DIY projects (home improvement, working on car, etc.)

*Taking care of elderly parents

*Taking care of (or playing with) children or pets

*Showering and bathing

*Sexual activity



In a previous article we made note of an obvious trend in American life the past 50+ years- the noticeable decline in the amounts (and types) of physical activity in most American’s daily lives when compared to earlier parts of the 20th century. While we briefly examined some of the ideological, cultural and technological reasons for that change in that article, in this article I wanted to look at what the research says on physical activity, steps, sitting and health outcomes. What I found was somewhat alarming…


HOW MANY STEPS A DAY DO WE NEED

TO BE OUR HEALTHIEST?

The World Health Organization has deemed physical activity as the 4th leading risk factor for global mortality. Physical activity, including regular walking, reduces the risk of cardiovascular disease, colon and breast cancers, diabetes, depression and obesity. There’s even research showing that physical activity is positively correlated with a lower risk of dementia and cognitive decline. [1]


So how many steps a day is ideal to reap optimal health benefits? The most common and well-known answer is “10,000 steps a day”, which owes its popularity in large part to the work of Dr. Yoshiro Hatano, a Japanese researcher who developed one of the first commercially popular pedometers in the mid-1960s. Dr. Hatano’s research led him to believe that 10,000 steps a day would be cardioprotective and would decrease the risk of developing cardiovascular disease.


What does the rest of the scientific literature say? In essence, it’s in agreement. Several studies have found an inverse relationship between the number of daily steps taken and the risk for several common degenerative diseases, including heart disease, certain cancers, diabetes, obesity and metabolic syndrome. Health benefits start to kick in at around 4500-5000 steps a day and seem to increase even beyond 10,000 steps a day. [2-5]



So how is the world doing with physical activity and steps? It seems like most of the world is coming up short. A study from the scientific journal Nature in July 2017 looked a daily step data from at least 1000 participants in each of 46 participating countries. Hong Kong came out on top with an average of 6,900 steps a day. The United States came in 30th with an average of around 4800 steps a day. And Indonesian came in last with an average of only 3500 steps a day. The study also found that there was a relatively wide gap in activity levels between people in each country, which often depended on factors like occupation, age, gender and environment (ex. walk-conducive urban areas vs non walk-conducive urban areas). [6]


Other studies have found daily step averages to fall anywhere from around 4,000 all the way up to 18,000 (the latter number coming from a study of Amish men and women where the men averaged 18,000 steps a day and the women 14,000). A very small study of Australian workers in 2012 helped to highlight the differences in activity levels between professions. For example, waiters and nurses in this study averaged 16,000 to 23,000 steps a day, whereas call center and office workers only averaged 6,000 to 7,500 daily steps. [7-9]


The big takeaway here probably isn’t a shocker to anyone: in general, the greater amount of physical activity and daily steps the less risk of several degenerative diseases and mental health conditions. For many people a goal of 10,000 steps a day is challenging but not unfeasible and will solicit noticeable health benefits if consistently attained. In order to track daily steps I recommend using a fitness wearable of some type, usually either a FitBit or Apple Watch (the latter if you’re an iPhone user). Research has shown that those who actively track their daily steps average around 2500 more steps a day that their non-tracking counterparts, which is one more research to utilize a fitness wearable device. [5]



THE SITTING EPIDEMIC

Many industrialized countries are in the midst of an ever increasing “sitting epidemic”, the United States included. The average American adult spends 6-8 hours a day sitting at work and sits for a grand total of (drum roll please)… 9-10 hours a day! [10-12] Wow, right!? And what are the consequences of this kind of widespread inactivity? I think most of us are aware of the physical activity-obesity link, so I thought here I’d look at sitting’s effect on the top cause of adult death in the U.S. and the world- cardiovascular disease…



THE LINK BETWEEN EXCESSIVE SITTING & CARDIOVASCULAR DISEASE (CVD)

Those who sat for the longest periods of time were TWICE as likely to have heart disease, compared to those who sat the least. The risk of heart failure was MORE THAN DOUBLE for men who sat at least 5 hours a day outside of work and who didn’t exercise often, compared to men who sat for less than 2 hours a day (note that while only men were looked at in this study, we might expect similar findings when looking at women as well). [13]


Adults who spent more than 4 hours a day in front of screen-based entertainment had a 125% INCREASED RISK OF CARDIOVASCULAR EVENT (including chest pain and heart attack) compared to those who spent less than 2 hours a day doing the same activity. [14]


What are these findings saying? In short, that those who regularly sit for prolonged periods of time will essentially DOUBLE their risk of developing some form of cardiovascular disease.


NEWSFLASH: HUMANS CREATED TO REGULARLY MOVE

Healthy blood and lymph flow and even synovial fluid activity is dependent upon regular physical movement. Restrict movement and these essential fluids become “sluggish”, leading to a host of physical maladies, not to mention what happens to the musculoskeletal system due to repeatedly being in the seated position (think muscle imbalances, lumbar compression, negative changes in posture, rigid connective tissue, etc.).


God created Adam and Eve and originally placed them in a garden to work, walk and move naturally (Gen. 2:15, 18, 22-23). He didn’t put them in a cubicle to sit all day. The ancient King Solomon, full of wisdom and at the end of his life, observed that “much study wearies the body” (Ecc. 12:12 NIV). I don’t think it’s a stretch to say that part of the point he is making is that spending large amounts of time being physically inactive (whether at study, at work or at recreation) will ultimately have a negative effect on the body. The original design involved plenty of physical activity, and regularly bucking against that design (whether intentionally or unintentionally) WILL contribute to disease, as the above data shows.


DOES EXERCISE OFFSET DAMAGE

FROM PROLONGED SITTING?

I wondered if the negative consequences of this “sitting epidemic” might be offset by simply doing more exercise. The answer is, according to the research- not entirely. Some of the findings…


Over 10,000 studies have shown that prolonged sitting will reduce your lifespan by promoting dozens of chronic diseases, EVEN IF YOU EXERCISE REGULARLY. [11]


One large study (following >82,000 men for 10 years) found that a regular fitness routine DOES NOT COUNTERACT THE EFFECTS OF PROLONGED SITTING. That same study found that six hours of sitting negated the positive health benefits of exercising for an hour. [13]


These findings are not saying that exercise is pointless. What they are highlighting is the negative health consequences of chronic, excessive sitting, EVEN IF a person has a regular habit of exercise.


SO WHAT EXACTLY CONSTITUTES

‘PROLONGED SITTING’?

This was one of the questions I had in looking at this data. While there is some ambiguity between studies, it seems that the most common definition is that ‘prolonged sitting’ is regularly sitting for a total of 6 or more hours a day. To me, it seems there are two distinct dangers with this kind of prolonged sitting…


THE DANGER OF CUMULATIVE SITTING

This is the total number of hours a person normally sits each day. As we saw above, the average for Americans here is 9-10 hours.


THE DANGER OF CONTINUOUS SITTING

This would be the amount of time a person sits at one stretch without getting up.


Which of these is the more dangerous? I don’t know. I haven’t come across any studies specifically comparing “cumulative” vs “continuous” sitting and their effect on health (most studies only look at cumulative sitting). A study like this might be helpful to give answers to questions like “Which is the healthier habit- to sit for a total of 7 hours a day but get up and move for 5 minutes every hour OR to sit for a total of 5 hours a day but not get up and move during that time?”


SOLUTIONS TO COMBAT EXCESSIVE SITTING

When it comes to physical activity (as distinct from intentional exercise), how do we begin to effectively battle or reduce our risk of developing CVD (or a host of other chronic diseases)? Some relatively simple solutions…


FOR EVERY HOUR SITTING, TRY SPENDING 5-10 MINUTES MOVING

Spend 5-10 minutes of every hour doing some kind of physical activity. As James Levine, co-director of Obesity Solutions at the Mayo Clinic in Phoenix says, “If you’ve been sitting for an hour, you’ve been sitting too long.” If you currently spend large amounts of time sitting while at work or at home, try this- set a timer on your phone to go off every hour. When it goes off, get up and spend the next 5-10 minutes doing some kind of physical activity or light exercise. This could include deep breathing, self-massage (using a tennis ball, Tiger Tail, foam roller, Thera Cane, etc.), stretching or range of motion exercises, bodyweight strength movements (like lunges, planks, hip thrusts, etc.) or some kind of general physical activity (walking, cleaning, organizing, etc.). Indeed, one small study has already shown that much of the impaired cardiovascular functioning that results from prolonged sitting can be reversed by simply taking a 5-minute walk after every hour of sitting. [15]


MAKE SURE YOUR WORK STATION(S) ARE ERGONOMIC

The average American adult spends 50-70% of the day sitting at work. Yikes! If we’re going to sit that much (and we probably shouldn’t), we should at least make sure our workstation ergonomics are preventing musculoskeletal issues as much as possible. In 2000, OSHA estimated that $1 out of every $3 spent on workers’ compensation claims were from ergonomic issues at work! What are some of the basics of workstation ergonomics when we’re sitting? One- the hips should sit above the knees. Any lower and we’re really bunching and shortening the hip flexor muscles. Two- either have back support that helps maintain a neutral/stacked spine and torso or be body aware enough to maintain it yourself. Three- if you’re typing, make sure your forearms are at 90 degrees or more in relation to your upper arms. And four- make sure the middle of your screen is lined up with your line of vision when you’re sitting properly. [16-17]



INVEST IN AN “EXERCISE BALLCHAIR”

While this workstation intervention won’t increase your physical activity levels, using a properly sized exercise ball as your desk chair can help reduce hip, pelvis and lower back stiffness and pain.


INVEST IN AN ADJUSTABLE WORK STATION

An adjustable work station lets you alternate between standing and sitting. Or if you have the funds and really want to increase physical activity, you might even consider a bicycle or treadmill desk!


SOURCES

1 www.cbsnews.com/news/which-countries-most-walking-least-walking/

2 www.ncbi.nlm.nih.gov/pmc/articles/PMC3197470/ (2011 review on daily steps and health benefits)

3 www.ncbi.nlm.nih.gov/pmc/articles/PMC4344772/ (2015; study of >300 South Africans found that those who averaged <5,000 steps/day were more likely to be obese than those who averaged >5,000 steps/day)

4 www.ncbi.nlm.nih.gov/pmc/articles/PMC5015672/ (2016; 12 week study that found several mental health & body composition benefits for people who accumulated at least 10k steps/day)

5 www.ncbi.nlm.nih.gov/pmc/articles/PMC5488109/ (2017 review of data on daily steps & health outcomes found that those who wear trackers average 2500 more steps/day, men average more than women & young average more than old)

6 www.nature.com/articles/nature23018#ref4

7 www.verywell.com/whats-typical-for-average-daily-steps-3435736

8 www.livescience.com/43956-walking-10000-steps-healthy.html

9 www.healthline.com/health/average-steps-per-day#guidelines

10 worksitewellnesssummit.org/standingupforworkplacewellness/

11 fitness.mercola.com/sites/fitness/archive/2015/05/08/sitting-too-long.aspx

12 news.heart.org/sitting-too-much-may-raise-heart-disease-risk/

13 fitness.mercola.com/sites/fitness/archive/2014/04/11/intermittent-movement.aspx

14 www.mayoclinic.org/healthy-lifestyle/adult-health/expert-answers/sitting/faq-20058005

15 www.medicaldaily.com/quit-sitting-and-walk-hourly-5-minute-walks-found-undo-side-effects-prolonged-sitting-302602

16 https://link.springer.com/article/10.1007/s00125-012-2677-z (2012; average adult spends 50-70% of day sitting at work)

17 https://www.osha.gov/news/testimonies/04272000 (2000; $1 in $3 on workers comp spent on ergonomic related issues)