by Peter Walker
Whether or not television is being unfairly maligned, it is accepted more generally that not all sitting behaviours are the same, and that some versions could be more harmful than others. In the most basic sense, that’s perhaps obvious. For example, it is little surprise that a movement-based computer game like a Nintendo Wii takes people above 1.5 METs when other computer games do not. Waving your arms about needs more exertion than just pushing buttons with your thumbs, whether or not you are sitting on a sofa at the time.
There are workplace equivalents. In Primate Change, Vybarr Cregan-Reid cites studies in Sardinia which showed that women living there who were tailors or seamstresses generally enjoyed good health despite their sedentary work. The reason appeared to be that they used pedal-operated manual sewing machines, with the leg action providing the women with sufficient levels of exertion, as well as, the researchers found, notably muscular calves.18
More widely, there are also suggestions that sitting in leisure time can be worse for your health than doing it at work. Danish research from 2016 found people who habitually used a chair in their job but sat less at home were more likely to have better fitness and smaller waist sizes than those whose sitting was mainly done out of the office.19 A series of studies by Swedish academics have made an actual distinction between ‘passive’ sedentary behaviour, for example watching television, or ‘active’ sitting, such as if you read or sit at a computer.20
There is perhaps a danger here of stigmatising one type of sitting, not least as numerous studies have shown that – as you might expect – lengthy sitting time in the workplace is more associated with middle-class jobs. In contrast, poorer people tend to watch more television.
Others, however, argue that the differences between types of sitting go well beyond this. James Levine, a British researcher who has spent most of his career in America, is one of the most regular public voices warning about the perils of prolonged sitting. He has written a book, Get Up!,21 an enjoyable half scientific autobiography, half diatribe against the modern curse that he calls ‘chairdom’. Levine clearly enjoys his role as something of an academic maverick, at one point in the book recounting how a failed experiment had started a fire, adding, nonchalantly: ‘Anyway, it wasn’t the first lab I had blown up.’22
Levine’s research breakthrough, first outlined in a paper just over twenty years ago, was something he calls ‘non-exercise activity thermogenesis’, or NEAT. This argues that even when immobile, different people expend significantly varying amounts of energy through activities they might not even realise they are doing, such as foot tapping, arm and leg swinging, and other fidgeting, or brushing back their hair, perhaps picking up a magazine to flick through it. In keeping with his individualistic approach, Levine tracked people’s movements using what he styled as ‘magic underpants’, high-tech devices fitted with sensors to detect what people were doing.
Levine’s initial paper calculated that even while sitting, someone who is fidgeting can expend over 50 per cent more energy than a person who is motionless in a chair. The amounts are fairly small – about 2.5 calories per minute – but they add up if extended over some hours.23 In a follow-up experiment a year later, Levine enlisted sixteen non-obese volunteers, himself among them, to eat an extra 1,000 calories above what was calculated as each person’s weight-maintenance food intake for a full eight weeks. While, as you might expect, everyone gained weight, the amounts involved varied from about a third of a kilo to over 4kg. The participants’ NEAT expenditure was measured again, thanks to the magic underwear, and was also found to vary hugely in response to the overfeeding, with high NEAT levels corresponding with low weight gains. Sadly for Levine, among the discoveries he made was that he was not among those people who can fidget their way to eating what they like.24 NEAT is, of course, not just about movement while sitting. The overfeeding trial showed that participants who gained the most weight sat on average for over two hours a day more than those who did not. But it demonstrates how not all sitting is equal in health terms.
To a layperson this can feel similar to the folk wisdom that slim people have a ‘higher metabolic rate’ than those who gain weight. But studies have shown this idea seems to be a myth. Basal metabolic rate, the amount of energy someone’s body consumes when immobile, varies between people for a variety of reasons, including gender and the proportion of muscle mass, but actually tends to be higher in overweight and obese people.25 Remaining slim is not some in-built biological given – it is all about different amounts of movement, even movements people don’t always notice in everyday life, like regularly standing up, or fidgeting.
Speaking from Paris, where he is now based, Levine told me that his ideas were first met with incredulity from the research community. Before the initial paper was published, Levine says, he presented its findings to a conference, at the end of which a very senior academic – whom he does not name – stood up and said: ‘This is a total load of rubbish!’
As it turned out, Levine’s paper was picked up by the prestigious US journal Science, and the sceptical academic ended up collaborating on a future piece of work. Levine says the consensus on the idea is now clear: ‘I think now, much more the greater question is the one of, how do we really implement this society-wide?’
Given the impracticality of persuading people to spend hours a day fidgeting, Levine’s solution is for activity to be built into other areas of life, including active travel. He argues that a combination of the inactivity crisis and the climate emergency should be used as an opportunity to completely reshape cities in favour of walking and cycling, and he would like to see his adopted home, Paris, make itself entirely car-free: ‘When big things happen in societies, it’s rarely one thing that precipitates big change, it’s normally the collision of several things.’26
Levine was being more prescient than he could have realised. We spoke just before the coronavirus emergency descended. At time of writing, to cope with the socially distanced transport aftermath, Paris’s mayor, Anne Hidalgo, has removed cars from a series of city centre roads and announced plans for hundreds of miles of extra cycle lanes. Levine’s dream could be about to happen.
Don’t just sit there
One of the biggest risks from excessive sitting down is known to be a greater propensity to diabetes, as well as the associated risk of increased waist size. Yet again, television viewing appears as a particularly significant factor, with one joint British–Australian project concluding that it contributed to twice the diabetes risk of sedentary time at work.27 One very long-term Swedish study found a clear link between the extent of television viewing among test subjects when they were sixteen and biological indicators showing their susceptibility to diabetes when they were forty-three.28
Professor David Dunstan, who heads the physical activity laboratory at the Baker Heart and Diabetes Institute in Melbourne, is one of the world’s leading experts on the dangers of too much sitting time, and has led several studies about the connection to diabetes. There is, he says, a ‘sound biological rationale’ for the link: ‘The absence of muscle contraction that occurs through long hours of sitting is not favourable for the whole glucose transport process. So, what we do know is that just muscle action itself can greatly help in terms of clearing glucose from the bloodstream. It’s pretty well documented in the epidemiological literature that regular physical activity in addition to other lifestyle factors like diet is an important modifier of risk for type 2 diabetes development.’29
Despite my many hours in the office chair I don’t, as far as I know, have any clinical signs linking me with diabetes. But both the amount of time I sit, and my unusually high, if bitterly contested, body fat reading would seemingly increase my risks of heading down that path. The two are also connected, with numerous studies linking sedentary lives with all sorts of obesity-related gauges, whether BMI, waist circumference or body fat percentage.
So what can I do about it? There is something fairly immediate, it seems – make sure tha
t even if I do sit down a lot, that time is at least interrupted fairly regularly. This is yet another way, as also highlighted in James Levine’s studies, in which not all sitting is the same. In terms of inactivity science, this is still relatively new, but the evidence is now very strong that one of the best ways to ameliorate the biological problems that come from prolonged sitting is to make sure that every now and then you jerk your bodily system into action, whether just by standing up, or ideally going for a wander, even just to get a cup of tea or to talk to a colleague.
One Australian study – a disproportionate amount of academic work on the health risks of sitting time seems to take place in Australia and the UK – fitted movement sensors to a group of middle-aged volunteers to assess how often they took a break from sitting, judged in this case as at least a minute of movement. Those who sat for the same overall time, but got up less often, were found to have more indicators of a propensity to diabetes, as well as bigger waists. In fact, when the group was split into quarters according to how often they broke their sitting, those in the 25 per cent who got up the least regularly had, on average, a 6cm bigger waist than those who did it the most.30 The risks seem to go further. One later US project tracking nearly 8,000 middle-aged US people found that both prolonged sitting time and long bouts of continuous sitting were linked to the risk of early death. Those who did the two faced the greatest dangers.31 One thing must be added: while simply standing up does use those vital leg and back muscles, it does not necessarily count as something sufficiently vigorous to break up sitting. A UK study which measured insulin and glucose levels in people who sat for long periods after a meal found that while these were improved in people who walked around for a few minutes every half an hour, there was no discernible effect on those who simply stood up.32
Professor Genevieve Healy is a researcher at the School of Public Health in Australia’s Queensland University, and led some of the pioneering studies showing the benefits of breaking up prolonged sitting. She says the initial findings confirmed what she had suspected as an ‘observational epidemiologist’. She tells me: ‘I used to be quite a sitter and happily sit and not fidget and just happily sit all day. And then my boss couldn’t sit still. But he had to sit in a lot of meetings. So I was like, “I wonder if there’s any difference between him and me in terms of outcomes? I wonder if we can capture that sort of thing in people that we actually put good monitors on and measured all their biomarkers.” And that’s when the results came back. There’s a bit of common sense as well, because if you get to the movies, or you get stuck in a car or plane for a long time, you can feel that difference between when you do that, versus when you’re getting up regularly. So I call it filling in the evidence for some common sense science.’33
There is an extent to which Healy’s boss is an example of James Levine’s high-NEAT fidgeters, people who in this case are so restless they don’t just tap a foot but intermittently get up and march around. Healy says she has now changed her own habits: ‘Probably the most I can sit is twenty minutes before I start to get quite fidgety, so I have a sit–stand desk at work, and that’s made a massive difference because I can just work in whatever posture I like. But in our workplace we’ve been doing this for over a decade – we’ve trained our building to be very aware of all the benefits of regular changes in posture, so nobody bats an eyelid if you get up, and most people get up and down during meetings, so it’s seen as natural. When we have speakers, people get up and down. It’s not seen as rude or anything.’
Healy is at the forefront of examining ways workplaces can reduce sitting time. She led a project at one office involving sit–stand workstations, which can be placed either at traditional desk height or propelled upwards so people can stand and work. This saw sitting time reduced by an average of three hours per eight-hour workday within three months, even if it did slip to a 45-minute reduction after a year. Reading the study, however, shows the amount of effort needed for such results – it was not just a matter of installing the new desks. The process began with meetings involving managers across the workplace (a federal government agency) and included individual training sessions for everyone given a new desk, plus regular phone consultations to make sure they were being used properly.34
Her university is behind an Australia-wide programme called BeUpstanding, which offers web-based support to workplaces wanting to reduce sitting times. This is not as comprehensive as the experiment at the government agency, but the results are still impressive. Since the scheme started in 2017, around 350 workplaces have signed up, with an average reduction in seated time of 9 per cent, or forty minutes a day.
‘It’s pretty good for predominantly just an education and culture change programme,’ Healy says. ‘There had been a lot of media in Australia about too much sitting for quite a long time because we’ve been doing a lot of the leading research and so a lot of workplaces invested in sit–stand workstations, but then there was no culture change behind that. They put this money in, got the workstations, and then people were like, “What are these for? Why should I use them?” So they just weren’t using them, despite this big investment.’
Another option is to reconfigure workspaces to ensure people get up fairly regularly and go for at least a brief walk. As we saw in the last chapter, some of this is about the design of the building, such as Google’s system of first-floor workspaces and ground-floor toilets. But it can be much more simple than that, as Healy explains: ‘One of our more popular strategies is having a rule of no lunch at the desk. That’s a free strategy that people can do. It also helps create a culture where you’re meeting, talking together, creating a stronger bond.’ This is a common observation – that encouraging people to get up more in an office doesn’t just make them healthier, it also improves communication around the office.
One of the key principles of the BeUpstanding project is that staff get to decide what methods work best for them. One of Healy’s favourite examples came in a call centre where she helped implement a programme to reduce sitting time. It was, she recalls, ‘a very high-stress environment’ where abusive calls were relatively regular. ‘One of the strategies that their team chose was that if someone got an abusive call, they would stand up and shake it off,’ Healy says. ‘And what that also meant, obviously, was that other people could see that experience, the abusive call, and check in on them. And so it actually had quite an impact on stress reduction as well as sitting time.’
As you might expect, James Levine has numerous ideas about how to discourage sitting at work, everything from switching around the location codes for printers, so a department’s printer is in a different part of the building, to entirely redesigning offices around open stairwells, providing an impetus for people to walk and chat to colleagues.
But often, he argues, the simplest and cheapest ideas can be the most effective. At the scientific think tank in Paris where he now works, meetings or phone calls can be colour-coded in green on the shared office calendar, meaning they are done on the move. Levine’s call with me was one of these, he says, and so he talked while walking up and down the office. Such designations are ‘not a reminder but an obligation’, he says, and different parts of the organisation compete against each other to see who can have the highest percentage of green meetings. There are even special ‘Walking meeting in progress’ lanyards to wear, so if you are talking to someone in person others don’t interrupt or eavesdrop. ‘All of these things we’ve just talked about cost nothing,’ Levine says. ‘On the other hand, building an entire building around a stairwell is a feat of engineering.’35
For those not working in so forward-thinking an environment, there are of course technological prompts people can use. For example, the heart rate–reading, step-counting exercise watch I borrowed for this book beeps and vibrates on my wrist to warn if I have been sitting down for an hour without a break. Most such devices have similar alerts built in. With mine, I do often find myself responding by jumping from a chair or the sofa
to walk around the room. Less expensively, there are a range of apps or programmes which will nudge you to get up at regular intervals via an alert, or a pop-up window on your computer. Some initial studies have indicated that such reminders can help people be more active. But it is by no means certain that this amounts to anything more than an extra tool to help people who have already decided to move around more anyway.
There are experts who worry that too much of the debate about sitting down ends up missing the point. Dr Justin Varney, the wellbeing expert we heard from in the last chapter, who now runs public health for the city of Birmingham, warns that the subject has ‘a complete over-focus’ on middle-class people in office jobs, who are often not the most sedentary overall.
‘The people we need most to be physically active are not sedentary because they’re sat in an office,’ he says. ‘They’re sedentary because they’re sat at home, they’re lonely and they’re isolated. They’re watching TV or on a computer. Ultimately it’s a bit like trying to ban coffee, or put alcohol back in the box. If someone says to me, “Well, you can’t binge-watch Picard, or whatever you’re into at the moment,” I’d be very indignant and I’d tell them to sod off. We need to be realistic about what we can change and what we can’t. I think this is a distraction. We should be focusing much more on getting everybody active every day, and I don’t care how you get moving.’36
In population-wide campaigning terms, Varney could well be correct. But if you are someone, like me, who does sit down a lot for work, that doesn’t mean you should ignore the issue. During my research, whenever I spoke on the phone to an academic or researcher connected to inactivity science, I would always ask them if they were speaking from a sit–stand desk. They invariably were.
One of my activity-based pledges to myself, when I finish this book – assuming the coronavirus lockdown ever eases enough for me to regularly return to my office in Westminster – is to ask my newspaper to get me a sit–stand desk. That I’ve not done this so far is partly down to sheer practicality. The Houses of Parliament can be a magical place to work, but some of the conditions, especially in the upper-floor corridor reserved for the media, can be quite basic. Our newspaper is crammed into a fairly poky room, and my worry is that a sit–stand desk will simply not fit into my corner, or would simply bash against one of the ancient bookcases when I tried to raise it. Elsewhere, however, these desks are becoming more common. Ever the individualist, James Levine has gone a stage further and invented the treadmill desk, a standing desk where you walk as you work on a conveyor belt, like that seen on indoor running machines. These are even better for your health outcomes and have a core of enthusiastic users, even if some reports note that it can make drinking coffee slightly perilous.