Movement, Exercise, and Long-Term Health

Current evidence suggests we need an update on exercise prescriptions for cardiovascular disease (CVD) reduction or prevention. Our emphasis up until now has primarily centered on motivating patients to initiate and maintain regular exercise, specifically 30-60 minutes of moderate to vigorous daily physical activity. However, in narrowing our focus to this recommendation, we might have neglected a concurrent cultural shift in our daily behaviors. In 1960, about 15% of all U.S. jobs were sedentary; by 2008, more than 20% of U.S. jobs were sedentary, and average amount of time spent sedentary has increased from 26 hours to 38 hours per week in 2009.¹

Moreover, U.S. adults spend an average of 6-8 hours in sedentary behaviors and less than 30 minutes on average per day in moderate-to-vigorous physical activity.¹ High amounts of sedentary time and low physical activity are each independently strong predictors of early death.²

Not only are we more sedentary as a people, but we have also created a new exercise archetype: the exercising couch potato. This humorous, although apt, phrase describes the individual who exercises most every day yet spends a majority of his/her day sitting, whether for work or for leisure. The dangerous assumption made by this individual, and perhaps the managing healthcare provider, has been that the daily exercise offsets the risks of the daily sedentary behavior. Unfortunately, this has not been supported by recent data. Increasing research supports that sedentary behavior should be viewed as a separate and additional risk factor for chronic disease development, specifically the development of coronary artery disease and type 2 diabetes.¹ So even though daily exercise should be commended, we must inquire further to ensure the risks of the office chair do not unknowingly fuel vascular and metabolic risks long term.

REFERENCES

1. Young DR, Hivert MF, Alhassan S, et al. Sedentary behavior and cardiovascular morbidity and mortality: a science advisory from the American Heart Association. Circulation. 2016;134(13):e262-79. doi: 10.1161/CIR.0000000000000440.
2. Schmid D, Ricci C, Leitzmann MF. Associations of objectively assessed physical activity and sedentary time with all-cause mortality in US adults: the NHANES study. PLoS One. 2015;10(3):e0119591. doi: 10.1371/journal.pone.0119591.
3. Dempsey PC, Larsen RN, Sethi P, et al. Benefits for type 2 diabetes of interrupting prolonged sitting with brief bouts of light walking or simple resistance activities. Diabetes Care. 2016;39(6):964-72. doi: 10.2337/dc15-2336.