Is sitting the new smoking? Here’s why too much sitting can harm your health

We know that our increasingly sedentary lifestyles are bad for us, but is sitting really making you sick? Fiona Ralph asks the experts.

Are you slowly killing yourself while you sit at your desk or can you relax in your seat a little longer? The claim that sitting is the new smoking has been widely circulated since 2013, when Dr Anup Kanodia was quoted in a Los Angeles Times article.

However, while sitting too much is definitely bad for you, this exact statement has since been disproved. Even so, the claim continues to stick around – mostly because it’s alarmist and catchy – but also because there is some truth to the matter.

According to the World Health Organization (WHO), sedentary behaviour is associated with a higher risk of dying, including from cardiovascular disease and cancer. Too much sitting also contributes to the incidence of cardiovascular disease, cancer and type 2 diabetes, whereas physical activity has been shown to lower these health risks, as well as reduce symptoms of anxiety and depression, and delay the onset of dementia.

There isn’t always a direct correlation between sitting and an inactive lifestyle, though. For example, if you are a person who sits at a desk most of the day, but takes part in regular vigorous exercise outside of work, you may not be posing a great risk to your health. The study that inspired Anup’s claim did not separate the risks of inactivity from those of sitting, and focused on people sitting to watch TV rather than for work or other reasons.

Inactive vs sedentary

“Inactive and sedentary often cross over, but aren’t the same thing,” says Guardian journalist and author Peter Walker, whose book about the risks of a sedentary lifestyle, The Miracle Pill, is out in February (Simon & Schuster, $37.99). “While the former means not exerting your body enough, sedentary refers specifically to too much time spent sitting down.”

Peter says that while the claim that sitting is the new smoking is not strictly true, “it’s an interesting maxim in that, like smoking 40 years ago, a lot of people sit too long, and it does harm their health. This is separate to the risks from inactivity, even if many of the possible consequences are the same, such as a greater risk of type 2 diabetes, or cardiovascular disease.”

Peter first realised the benefits of physical activity when, as a “badly asthmatic, sedentary early 20-something” he gave up his desk job to become a cycle messenger for about three years. It transformed his life and health.

Unfortunately, as a journalist he now spends much of his time sitting at a desk. After publishing a book in 2017 about cycling, for which he researched the health benefits of regular exertion, he was inspired to write The Miracle Pill. During his research, Peter borrowed an activity tracker, and found that during work days he could easily sit for six or more hours, often for two hours at a time.

Inactivity linked to health risks

Mark Quinn, a physiotherapist and a director of Auckland Physiotherapy, refers to the correlation between sitting and inactivity when he says that though the claim that sitting is the new smoking is exaggerated, it’s not far from the truth, given that “inactivity is now globally recognised as the fourth leading risk factor for death.” (Tobacco is the second leading risk factor – with high blood pressure the first, and high blood glucose, which is most common in diabetics, the third.)

As well as these health risks, sitting for too long is bad for your spine, says Mark. “Static prolonged loads on the spine (especially when seated) are generally worse than changing loads in different directions, which is what we experience when we are walking around and in different positions … even when some lifting is involved.”

He sees a number of patients in his clinic who have been negatively impacted by their sedentary lifestyles. “The majority of our spinal patients are due to large amounts of sitting. We are made to move and our bodies have not evolved fast enough to adapt to this new way of living where we are often required to sit still in front of a computer for six or more hours a day.”

But is technology fully to blame? Peter thinks so. “One of the reasons that people a few generations ago were notably more active was that it was inescapable – if you wanted heat, or to cook, you chopped or brought in wood; transport involved walking or a bike; washing clothes was done by hand.” But he is clear that the solution does not involve returning to the past. “It’s about integrating activity into modern life,” he says. For example: taking short walking or standing breaks while working, and walking or cycling short distances rather than driving.

Unfortunately, as technology becomes even more ubiquitous, it’s even easier to stay home, which not only leads to decreased activity, but also isolation. “Technology does make it incredibly easy to sit in a chair all day if desired,” says Peter. “Even the most routine of movement, like going around shops, or walking to a café or cinema, are being supplanted by the internet, or app-summoned takeaways and streamed movies.”

Reduce the risk

Dr Rebecca Meiring, a lecturer in exercise sciences at The University of Auckland, has focused much of her research on the effects of physical activity and sedentary behaviour, and says that although both smoking and sedentary lifestyles have health risks, the two are not directly comparable. “The risk of cardiovascular disease and all-cause mortality is substantially higher in people who smoke compared to people who don’t. However, you can’t directly compare that risk to the risk associated with sitting too much – the health risks of smoking far outweigh the health risks of sedentary behaviour.”

The good news is that even if you are sitting a lot, small changes can make a difference. “Every bit helps,” says Rebecca. “Newer research is now showing us that doing something is better than doing nothing.” The Ministry of Health’s “sit less, move more” campaign offers ideas for adding movement into your day, including for those who have limited mobility or use a wheelchair.

“The first thing to try and do is be conscious of how much you are sitting, and when, and then try and interrupt it as much as is feasibly possible,” says Rebecca. This includes setting reminders to encourage you to stand up and take short walks throughout the working day, walking one extra bus stop, or parking your car further away, as well as taking part in regular exercise.

“One thing I learned is that even if you do sit a lot, you can reduce the health risks by getting up for a stretch or brief walk fairly regularly,” says Peter. “What is most dangerous is long, uninterrupted periods in a chair – say two hours.”

Peter believes governments could, and should, be doing more.

“Governments around the world have shown with coronavirus that they can take drastic action over public health risks. And yet inactivity is also a global disaster – it kills more than five million people a year, every year. The problem is that the impacts are long term and indirect, and governments can put the stress on individual responsibility. But it’s much more complex than that – people have not suddenly become more lazy; they just live in a world that conspires against active living.”

How much should we be moving?

WHO has just released new guidelines recommending an increase in activity across the population, including for children, adults, older adults, pregnant and post-partum women, and those with chronic medical conditions and disabilities. The guidelines, released in November 2020, advise that healthy adults aged 18 to 64 should get at least 150 to 300 minutes per week of moderate-intensity aerobic physical activity or at least 75 to 150 minutes per week of vigorous-intensity aerobic physical activity, which is up from the previous recommendation of 150 minutes per week and 75 minutes per week respectively.

“Up to five million deaths a year could be averted if the global population was more active,” says the organisation. “New WHO guidelines on physical activity and sedentary behaviour emphasise that everyone, of all ages and abilities, can be physically active and that every type of movement counts.”

New additions since the 2010 report include recommendations to reduce sedentary and screen time, and to counter high amounts of seated time with additional physical activity.

“Physical activity of any type and any duration can improve health and wellbeing, but more is always better,” said Dr Ruediger Krech, WHO’s director of health promotion. “And if you must spend a lot of time sitting still, whether at work or school, you should do more physical activity to counter the harmful effects of sedentary behaviour.”

Dr Rebecca Meiring is a lecturer in exercise sciences at The University of Auckland. She says that if you sit a lot, even small changes can make a difference.


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