We're sitting ourselves to death

TOM FITZSIMONS
Last updated 12:48 19/07/2011
Catherine Adam
MAARTEN HOLL/The Dominion Post

SITTING PRETTY: Graphic designer Catherine Adam works standing at a desk because she finds it more comfortable than sitting. She alternates every half-hour of standing with five minutes on a tall stool.

Ceedee Doyle
PHIL REID/The Dominion Post
BACK UP: Ceedee Doyle, 38, had life-threatening clots in 2006.

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Spare a thought for the call centre workers. If they're not losing their jobs to Bangalore, they're dealing with abuse from someone they've never met before. Now research proves there's another, more covert danger to their work. In their first eight months on the job, according to one study, the average call centre worker packs on about 6 kilograms.

It doesn't matter if there's a gym on site, if they're male or female, if they're black or white  big weight gains are part of the deal.

It makes sense if you think about it, says Grant Schofield, director of Auckland University of Technology's centre for physical activity and nutrition. Call centre workers are glued to their seats. "It's a high-stress job with low control and lots of sitting."

Before you spend all your pity on them though, hold on. Because they're hardly alone. If you're a New Zealand worker, chances are that you too spend most of your day on your chuff.

"You go back 100 years in New Zealand," says Schofield, "50 per cent of the workforce was involved in primary agricultural production, and it was not mechanised. Now it's 2 per cent of our workforce and it's all mechanised. The reality is that most of us sit all day. I call it the new normal."

Throw in how we get around  in cars  and what we do with our leisure time  above all else, watch TV  and it's easy to see why experts say some people spend 16 hours a day sitting down.

Weight gain is just one problem that's been associated with excessive sitting. The list of others is long: heart problems, diabetes, metabolic syndrome, dangerous blood clots and some musculo-skeletal conditions.

To put it bluntly, as David Dunstan does, "people who are high sitters have increased risk of premature death". Dunstan is head of the physical activity laboratory at Melbourne's Baker IDI Heart and Diabetes Institute. He compares the sitting epidemic to awareness about the dangers of sun damage 20 years ago. One American expert goes further, calling sitting "the new smoking".

Dunstan says: "We're starting to understand that this is a potentially large public health problem. It's such an insidious behaviour that it's sort of flown under the radar."

Everyone knows that exercise is good for you, after years of campaigns pumping that message. And that's still true, but the evidence suggests that it doesn't matter  not when it comes to mitigating the risks of sitting down for too long.

"These are two distinct public health hazards  too much sitting and too little exercise," Dunstan says. "And I guess this is going to be a bit sobering for people who do go out and do their 30 minutes of brisk walking  but then ignore the potential harmful effects of sitting for another 15 1/2 hours."

You can actually die in your seat if you're very unlucky.

Ceedee Doyle has some sense of what that might be like. The 38-year-old project manager started to feel sick over a period of about 10 days in 2006.

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What started as one brief episode of faintness and a fast heartbeat became recurring moments of inexplicable breathlessness after climbing a few steps.

She went to the doctor, who ordered an X-ray that showed up nothing. The next day, she felt nauseous at work. In the bathroom, she looked at her face drained of colour.

"I walked back to my desk, which was like 10 paces, and I lay down on the floor, because I knew I was going to faint. And that's when I went unconscious."

At Hutt Hospital's emergency department, doctors found she had "massive" pulmonary emboli  blood clots in the lungs. Her condition was life-threatening.

Richard Beasley, director of the Medical Research Institute of New Zealand, has led two studies into the effect of long periods of sitting on blood clots. He's found that if you sit at a computer for more than 10 hours a day, including two-hour stints without standing, then your risk of a blood clot trebles. The problem is at least as worrying as the better-known danger from long-haul flights.

"For most people, the absolute risk is incredibly small," Beasley says. "But when you look at the number of people at risk, then it starts to come through as more of a major public health issue."

With the help of super clot-busting drugs, Doyle survived. She actually blames stress more than sitting for her episode. But she admits her case did back up Beasley's theory  as her job called for long periods of sitting.

Since her ordeal, she's had no more symptoms. She now takes every Wednesday off to break up her working week. She also has email reminders to stand up more often in the office.

If a blood clot is the scariest risk of sitting down too much, it's hardly the only  or most likely  one.

When we sit, in some senses our bodies go to sleep. Even compared with standing still, it's striking how little we're doing when we're in our seats, Dunstan says. "There's virtually nothing going on in the muscles. Why is that so important? Well, muscle is a major metabolically active part of the body."

If we don't contract our muscles by moving, we struggle to clear glucose and fat out of the bloodstream  both major risk markers for heart disease. It's this lack of muscle activity that also increases the risk of clotting.

The bodily changes can be even more essential than that, Schofield says. Sitting aids the production of an enzyme called lipoprotein lipase that makes it much easier to store fat. Even our DNA can be altered  a single long bout of sitting can turn on genes associated with diabetes.

Schofield says research is starting to show that "neural plasticity, that ability to change your brain and think of new things, is fundamentally supported by physical movement".

"That's the bloody irony of it. When you sit, your brain shuts down."

Chris Gregg, physiotherapist and general manager of injury rehabilitation company TBI Health, says sitting has marked effects on some of our muscles and bones, especially the neck. "Your neck position changes dramatically from when you stand to when you sit. Laptops are a nightmare because you have to crane your neck forward, and the loading on your neck increases dramatically."

And then there's that link between sitting and obesity. Out of 51 studies analysed by Schofield and his colleagues last year, 38 showed a significant connection. It seems clear: when we sit down too much, we expand.

One 2009 study of nearly 20,000 Canadians over 14 years found increasing sitting time was associated with "higher all-cause death".

A study released this year in The Journal of the American College of Cardiology that followed nearly 5000 Scottish men concluded that spending two or more leisure hours in front of a screen doubles the risk of a heart attack. Once again, exercising several hours a week made no difference.

Dunstan says it's only the start. The next five years will see mountains of new data assessing possible links between sitting and a bigger range of maladies.

How did we get here? Why are we doing this?

Clearly, the computer has a lot to do with it. It's created whole industries, felled others, transformed most of the rest. Where we used to bang fence posts in, now we tap keys. Even office jobs before the digital age used to be more active, from physically filing stuff to getting up and talking to people.

Dunstan says most people feel they don't have a choice when it comes to their workplace. "Their options throughout the day are to sit  or to sit."

But computers aren't the only agents of this revolution. The car has played its part and so has television, which now kicks things off alarmingly early in life.

Bob Hancox, an associate professor at Otago University, helps run the Dunedin multi-disciplinary health and development study, which has followed more than 1000 people born in Dunedin between April 1972 and March 1973. Among its findings is that kids who spend a lot of time in front of the TV feel the effects for decades. "Even at the age of 32, the impact of having watched a lot of telly during your school years was showing up in terms of obesity and poor fitness," Hancox says. "The interesting thing we found was that what you did as a child had more impact on your adult levels of fitness and obesity than what you're actually doing as an adult."

So maybe we're learning how to be sedentary from a very young age, hours of after-school screens paving the way for careers hunched in front of computers. Everyone agrees that we didn't go through millions of years of evolution for all this sitting.

"Humans are designed for an unstable outdoor environment in which we're in more or less constant motion," says Schofield. "We just created a world where you're scrunched up in a chair the whole day. I mean, it's just bizarre."

The body wants to be moving, says Gregg, the physiotherapist  "that's how muscles remain strong and ligaments stay nice and supportive."

"Fifteen years ago, we used to get up and talk to our colleagues," says Dunstan. "Now we email them. It's just taking a step back and saying: what have we come to here?"

The sitting phenomenon is part of that set of perverse modern problems that spring from our wealth and abundance, our excess of comfort. We want to sit for the same reasons we want to eat potato chips  we're built to think of them as treats.

Are we aware there's something wrong with what we're doing?

In some ways, surely. We've invented gyms, for one thing, as Schofield points out. "Pre-World War II, I'd maintain exercise wasn't really something anyone did or thought of. For the most part, we needed a rest because we were too active. It's just an invention to get over the fact that we actually sit around the whole day."

Catherine Adam had her own sense that something was wrong with the conventional office pose. It wasn't so much that she had a health concern, but more that she couldn't handle eight hours of sitting. "I'd end up trying all sorts of positions  cross-legged, legs-on-the-seat. But in the end, I just knew I had to stand."

About a decade ago, soon after she landed her first job as a graphic designer, Adam, now 36, tried a new approach. She fashioned a "stand-up desk" out of a stack of boxes and books. At first she stood all day; now she finds that too tiring, so she alternates every half-hour of standing with five minutes on a tall stool.

Whenever she starts a new job, she tells her bosses she has to stand. She's stood at an Ikea desk while working in France, a stack of wood in New York, and a plinth built by her father at home.

"I don't even know if it's recommended, but it's just so comfortable for me."

So should we all just stand up?

Most experts agree we should stand more. Standing triples the energy you use compared with sitting down.

If you sit while you work, the main piece of advice is to get up out of your desk at least every hour and move around. "You can just do a coffee or a water intervention," says Schofield. "Just drink heaps of either and you're going to be forced to get up. That's not a bad strategy."

More radical options such as dedicated standing desks and even "treadmill desks" that let you walk while you work also have plenty of backers. American researcher James Levine, of the Mayo Clinic, has led the charge for the latter, as well as advocating for chairless schools to help fight the obesity epidemic.

Standing desks are available in New Zealand from office supply stores for between $750 and $1500  about double the cost of ordinary desks. Most are height-adjustable.

Not everyone's sold on standing. Cornell University ergonomics scholar Alan Hedge told the Washington Post it was "one of the stupidest things one would ever want to do".

"Standing increases torso muscle activity and spinal disc pressure, increases the risk of varicose veins, increases the risk of carotid artery disease and increases the load on the heart."

He advises sitting in a slightly reclined posture.

Council of Trade Unions economist Peter Conway points out that many workers, such as bank tellers, restaurant staff, healthcare workers and shop assistants, have problems with too much standing. "Discomfort and fatigue are both clearly associated with prolonged sitting and prolonged standing."

The "exercise ball" arrangement also has its fans. The Mayo Clinic's Levine, for instance, says it helps with balance and engages more muscles than an ordinary chair does, although he mainly advises using it at home.

The real trick is movement  recognising the value of frequent, low-intensity activity. There's also a broad consensus that variation in posture is wise. We're probably going to hear more about the value of some standing at work, at least.

But if we are to change our position substantially, who's responsible for this?

Clearly, people can take it upon themselves to move, but some of the reasons they sit are out of their direct control.

So far, there's been little Government interest in sitting per se. The Health Ministry has no policy on workplace sitting; neither does sport and recreation agency Sparc. They've focused their energies on exercise.

The Labour Department and ACC have a couple of joint papers with advice about sitting posture and use of computers. They warn against the dangers of "tasks that involve holding the same posture(s) for long periods" and observe that "many people find standing a comfortable way to work", but they don't endorse it.

Meanwhile, if the state of the average office is anything to go by, it doesn't seem like employers are taking the lead in giving people options to stand.

Beasley says there's a long history of industries taking an unreasonable length of time to respond to scientific evidence, most shockingly after the risks of asbestos were proven.

"For many adults, you're spending over half of your waking life at work  and yet the risks at work have perhaps historically not been appreciated as well as they should have been."

Schofield suspects big change won't come until there's more research on how sitting slows us down when we're working. "If we can get more evidence on productivity, then it's a no-brainer."

But the need is clear, he says. The health budget has blown out from the costs of treating chronic disease. We're getting ever fatter. And yet, somehow, most of us have become accustomed to a very long and unhealthy rest whenever we go to work.

He has a good question. "What are we resting from?"

- The Dominion Post

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