Is “Sitting” Really “The New Smoking”?

CC BY-SA2.0 photo credit Frederico Feroldi

“Sitting is the new smoking”. You have probably read this featured catchphrase in newspapers, magazines or news websites.

Since 2010, media publicities comparing excessive sitting with smoking have increasingly been gaining public interest. An analysis looking at news articles found almost 300 publications reported on the topic.  But behind the increasing media attention, conflicting news headlines on sitting being the “new smoking” or “worse than smoking” has led to misperceptions and uncertainties with respect to public health recommendations. In actuality, it really is still too early to tell.  Studies  show it is still unjustifiable to conclude that “sitting” equates to the ranks of “smoking”.  According to a recent  meta-analysis by Vallance et al. published in the American Journal of Public Health in November 2018, equating sitting with smoking is “still unwarranted, misleading for the public, and may serve to distort and trivialize the ongoing and serious risks of smoking”.

According to the US Surgeon General’s report, the epidemic of smoking-related disease was ranked among the greatest public health catastrophes in the twentieth century in the nation. American Cancer Society reveals smoking as causing the highest proportion of cancer cases and deaths. The burden caused by smoking, as far as the annual cost of smoking-related diseases and disease risk estimates, still outweigh the numbers for sitting.  However, some people believe this may not hold true much longer.

While the century-long epidemic of cigarette smoking has been slowly declining over the past 50 years, most recent research studies show a growing prevalence of high sitting time and physical inactivity among US adults. A study analyzed data from 5,900 adults who participated in the National Health and Nutrition Examination Survey (NHANES),  and found about 1 in every 4 Americans report sitting for more than 8 hours a day, 4 in every 10 are physically inactive (i.e. no/limited moderate-to-vigoursous physical activity), and 1 in every 10 report both. Somehow, we consider this phenomenon to be attributed to an activity shift,  from a nation of manual labor, to a workforce of computer users whose jobs may entail sitting for hours on end.  After work, we continue sitting as we drive home in our cars. Once at home, we remain sedentary as we sit on our couch. Studies show that on average, adults in Western countries spend between 55% and 70% of their day sedentary. This is almost equivalent to approximately 9-11 hours/day of sitting time.

The increase in sitting time is becoming a national epidemic which needs to be addressed.  Sure, we have long been aware of the fact that we need to exercise to overcome the bad health effects of sedentary lifestyle. So why bring the public attention back to this hype on too much sitting?  Interestingly, new research found there is a significant difference between exercising too little and sitting too much. While exercise is essential for health, exercising alone can’t make up for the ills of excessive sitting.  And even when existing research shows high sitting time is not as bad as smoking, statistics show excessive sitting time does not fall too far behind, as far as causing negative health effects and this should not be discounted.

High volume of sitting (e.g. > 8 hours/day)  has been found to be associated with adverse health outcomes like type 2 diabetes, cancer, cardiovascular diseases, risk of depression and all-cause mortality.  Remarkably, recent studies reveal that a person with both, high sitting time and a lack of moderate-to-vigorous physical activity may even have a higher risk of premature mortality.

Research evidence still holds true the value of physical activity to combat too much sitting. As an effort to move this message across, the US Department of Health and Human Services created the 2018 edition of the Physical Activity Guidelines for Americans to provide the most current evidence-based guidance for policy makers and health professionals to use and implement programs and practices for increasing physical activity and improving health. In the implementation of these guidelines’  “Move Your Way” campaign, Americans are encouraged to move more and sit less throughout the day. Choose your move. Walk, run, dance, play.  According to the new guideline, any amount of physical activity can have health benefits.   For adults who are inactive, working on more achievable goals by “starting with small amounts of activity and working up to at least 150 minutes of moderate-to-vigorous aerobic activity each week plus two days per week of muscle strengthening activities over time” prove to be beneficial. For substantial health benefits, however, adults should do at least 150 to 300 minutes of moderate-intensity aerobic activity each week plus muscle strengthening activities on 2 days each week. ”Move More, Sit Less” is now the new mantra and key guideline for adults.

The Physical Activity Guidelines emphasize the many health benefits of any level of physical activity.  A single episode of physical activity can reduce anxiety and blood pressure and improve quality of sleep and insulin sensitivity. Increasing physical activity can improve cognition for those with dementia, multiple sclerosis, ADHD, and Parkinson’s disease, decrease pain for those with osteoarthritis, reduce symptoms of anxiety and depression, and reduce disease progression for hypertension and type 2 diabetes.  Long-term benefits include improved brain health, reduced risk for fall-related injuries in older adults, reduced risk of excessive weight gain and reduced risk of 8 types of cancer (including bladder, breast, colon, endometrium, esophagus, kidney, lung and stomach).  Physical activity can also prevent conditions such as heart disease, type 2 diabetes, and both breast and colon cancer. An analysis analysis found in the June 2016 JAMA discovered that women with either mild or intense physical activity before or after has shown to reduce breast cancer risk. 

Arguments proving sitting being the new smoking is still a work in progress.  In the meantime, we should not dismiss the public health impact still being caused by the century-long epidemic of cigarette smoking.  And although sitting may still not equate to smoking, we should also not underestimate the potential threat of it reaching the ranks to becoming the new smoking. Like smoking, too much sitting can be avoided and there are substantial evidence on the health benefits of following the currently-recommended medical intervention.  And like any bad habit, a resolution can be successfully achieved if it is not constantly overturned by procrastination.

“Move more, sit less” is a slogan designed to remind people of the existence of an evidence-based program intervention to counter sedentary lifestyle and prolonged sitting behavior. The Maurer Foundation breast health programs educates people on the value of increased physical activity, not only to reduce the chances of developing breast cancer, but also to improve over-all health. Like any great motto, it will do nothing without an intended action.  So, let’s not just sit on it!  Let’s walk the talk…move more and sit less.