The Ill Effects of Prolonged Sitting

by Ram

Paul Writing by Camille Pissarro

We live in a hyper-competitive world, where most of us work at stressful, sedentary jobs. In fact, nearly 86 percent of American workers sit all day at their jobs. Furthermore, accumulating evidence suggests that we spend a majority of our time sitting and indulging in sedentary activities. Sedentary activities includes the time spent sitting in an automotive on a long commute, sitting at a desk at work, sitting on the couch after work, watching television, reading, and playing games or surfing the internet. Recent research indicates that on an average, an American adult spends 10-12 hours each day sitting. Notice that sitting is now the norm and physical exercise is considered an intervention program advised by your personal physician to nullify the negative impacts on your health.

Prolonged sitting time considered as one of the major instance of sedentary behavior has emerged as a strong risk factor for various negative health outcomes. Study results have demonstrated associations of prolonged sitting time with premature mortality, chronic diseases such as cardiovascular disease, diabetes, and cancer, metabolic syndrome, and obesity. Those who spend a lot of time sitting have an almost eight-fold increased risk of dying prematurely compared to those who exercise often and are hardly sedentary. Medical experts agree that one of the reasons for a high rate of obesity, high blood pressure, diabetes, cancer, depression and other health issues seen predominantly in younger age individuals is due to prolonged sitting and physical inactivity. For people who engage in prolonged sitting activities, their risk of heart attack is about the same as smoking. The negative consequences are so alarming that medical experts have started referring to the poor health outcome from prolonged sitting as “sitting disease”. 

The ill effects from prolonged sitting are not restricted to the US population alone. In a recent study All-Cause Mortality Attributable to Sitting Time: Analysis of 54 Countries Worldwide in the American Journal of Preventive Medicine, researchers used survey data from 54 countries, analyzing the time spent sitting more than three hours a day along with data on population size, actuarial tables, and overall deaths. More than 60 percent of people worldwide spend more than three hours a day sitting down, and the researchers calculated that sitting time contributed to some 433,000 deaths a year (nearly 3.8% of all-cause mortality) among those 54 countries. 

The above findings agree with another survey of some 220,000 Australian adults Sitting time and all-cause mortality risk in 222 497 Australian adults that was published in the Archives of Internal Medicine. Those who sat for more than eight hours a day had a 15 percent greater risk of dying within three years than those who sat for fewer than four hours a day. The results were more alarming for those who sat for 11 hours or more a day; they had a 40 percent greater risk of early death compared to those who sat for under four hours. This risk sustained even for those who spent some time exercising. Experts now are of the unanimous opinion that even 30 minutes of physical activity is insufficient to neutralize the detrimental effects of 8 hours or more of sitting.

You may wonder why prolonged sitting contributes to negative health outcomes. There are evolutionary and biochemical reasons for this. As humans, our body was simply not designed to sit for prolonged hours. We were evolutionarily designed to "work out,” as evident from our ancestral hunter-gatherers. Hence our body reacts negatively to prolonged sitting. At the cellular level, numerous changes happen all of which trigger the detrimental effects. Prolonged sitting:

• decreases the activity and levels of an enzyme that helps burn fat
• reduces bone mineral density and blocks new bone formation
• reduces the diameter of arteries putting the individual at risk for heart disease
• makes the body insensitive to insulin thus resulting in type-2 diabetes

Additionally, prolonged sitting affects the architecture of the spine, hips and neck as well putting the individual at risk for skeletal fractures. Furthermore, a recent study Television Viewing and Time Spent Sedentary in Relation to Cancer Risk: A Meta-Analysis found that prolonged sitting whether at work or home increases the risk of three cancers namely colon, endometrial and lung. The study also found that high participation in sedentary activities and low participation in physical activities was linked with a 41 percent higher risk of recurrence of colorectal adenomas.

For many of us sitting for eight hours a day at our job is inevitable. This compounded with the extra sitting outside of work is what makes it harmful. Besides, too much sitting is harmful even if you're getting enough exercise. This means you could be meeting the recommended guidelines for a daily exercise but you will still be at higher risk of disease if you sit for long periods each day. So how can one avoid the dreaded effects that come from prolonged sitting? The best solution is to drastically change your lifestyle. While standing for long hours by no means is the answer, most experts recommend a 50:50 sit-stand allowance for optimal health. If your occupation involves sitting for long periods, work at a standing desk. The potential benefits from a standing desk are manifold including: higher productivity, reduced absenteeism, and lower health care costs among many (see A Neutral Posture White Paper). Experts also agree that it is beneficial to interrupt sitting time as often as possible. One way to do this is to move or stretch for at least 10 minutes for every hour of sitting time. 

For those of us who have an active yoga practice, you can either bring in a mini office yoga series (Featured Sequence: Mini Office Yoga Practice) or supplemental yoga with you (Yoga, Your Companion Through the Day). If you need to stretch your back and do not have too much time at hand, you could think of the mini series for the back (Featured Sequence: Low Back Care). Since prolonged sitting is not only having an impact on public health but also has effects on the health span of the individual, it is never too late to make simple changes and maintain a reasonable amount of activity particularly across the middle and later years to avoid early death and serious illness. 

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Learning to Sit On the Floor, Part 1

by Shari

We recently received a question about learning to sit on the floor without support. Because we often write about the benefits of sitting on the floor (see To Sit or Not To Sit (on the floor)?), we thought having a little guidance for people who are currently unable to sit comfortably on the floor would be useful for a large number of people. So we decided to dedicate an entire post to the topic of how you can learn to sit comfortably on the floor. But let’s begin with the question:

Q: I’m a stiff Western guy who was brought up sitting on chairs and finds it really uncomfortable to sit crossed-legged on the floor even for a few minutes. Now I find that for my wedding, which will be a Hindu ceremony, I will be expected to sit on the floor for several hours. What can I do to get in shape for this? (My normal exercise routine includes running and weight lifting—I don’t do yoga yet at this point.)

First off, may I say congratulations on your upcoming wedding. How exciting for you, and you are to be complimented in your thoughtfulness for your desire to fully participate in your wedding's rituals. I don’t know anything about Hindu wedding ceremonies except what I have read about or seen in various movies but I do know that though you will be on the floor you won’t be totally motionless. What I don’t know is exactly what type of sitting posture you will be required to do for certain lengths of time. I would encourage you to discuss this with your fiancé but let us propose that you may be in kneeling or cross-legged positions all without external back support.

For you, and everyone else who wants to work on sitting without support, it might be helpful to break down the components of unsupported sitting. Which areas need to be both flexible and strong that you can work on during the upcoming months? We also need to discuss the role of breathing in enabling you to sit unsupported.

The vertebral spine and the diaphragm are major supporting internal structures of the human body. The spine consists of four curves that when properly stacked upon each other can withstand a significant amount of gravitational force to maintain the solidity of the curves. The curves allow the spine to move as well as to maintain stillness. Nestled deep within the pelvis—which connects the vertebral spine to the lower limbs/legs—is a very important bone called the sacrum. The sacrum and the two pelvic bones (ilia) are literally the bridge that forms the base of support that we need to sit. The femurs (thigh bones) connect into the ilia at the hip joint to widen the base of support. To sit unsupported in a cross-legged fashion, we need to provide good contact of the outer heads of our femurs (thighbones) with the ground.

There is a lot of discussion among health care professionals and yogis on what ideal sitting posture is and how to obtain it. But for our discussion we need to find you a doable position. The key is that when we sit unsupported we need to position our knees lower than our hips. This is easy to see when you sit in a chair without using the backrest. To obtain this position we typically need to raise our seat height up to widen the angle between our torso and our thighs. Typical chairs for standard height individuals have us sitting with our knees level to our hips and our torso perpendicular to the chair and this is termed 90/90 sitting position. But if we widen the angle of thigh to torso ratio to 135 degrees it is easier for us to lift up and lengthen our spines.

This is where I suggest you start. Place a pillow or folded blanket on the chair seat to raise your pelvis—this will allow your knees to be lower than your hips so your pelvis can roll over the head or your femurs (thigh bones) to re-establish your lumbar curve (your lower spine). Then you can lengthen or elongate your spine. This will help you learn to sit with your spine in a lengthened position and to support this posture from the “inside out.”

To learn how to stabilize the spine from the inside out we need to learn about our diaphragm, transversus abdominus, and pelvic floor musculature, and how they all assist in spinal stabilization, especially in a seated position.

The diaphragm is the dome-shaped sheet of muscle and tendon that serves as the main muscle of respiration and plays a vital role in the breathing process as well as internal stabilization. The origins (attachments) of the diaphragm are found along the lumbar vertebrae of the spine and the inferior border of the ribs and sternum. When we inhale, the diaphragm contracts and is drawn inferiorly into the abdominal cavity until it is flat. At the same time, the external intercostal muscles between the ribs elevate the anterior rib cage like the handle of a bucket. The thoracic cavity becomes deeper and larger, drawing in air from the atmosphere. During exhalation, the rib cage drops to its resting position while the diaphragm relaxes and elevates to its dome-shaped position in the thorax. Air within the lungs is forced out of the body as the size of the thoracic cavity decreases.

Diaphragm

Structurally, the diaphragm consists of two parts: the peripheral muscle and central tendon. The peripheral muscle is made up of many radial muscle fibers—originating on the ribs, sternum, and spine—that converge on the central tendon. The central tendon, which is a flat aponeurosis made of dense collagen fibers, acts as the tough insertion point of the muscles. When air is drawn into the lungs, the muscles in the diaphragm contract and pull the central tendon inferiorly into the abdominal cavity. This enlarges the thorax and allows air to inflate the lungs.

Due to its structural orientation, the diaphragm can be used to assist in torso stabilization for erect sitting along with contraction of the transversus abdominus muscle. The transverse abdominis muscle attaches to the thoracolumbar fascia and the deep erector back muscles between the pelvic bone and rib cage posteriorly and from the lower six rib cartilages, linea alba and the inguinal ligament anteriorly.  It extends the entire length of the anterior trunk.  Since it is the only abdominal muscle to attach to the posterior spine, it is considered the “human corset” of the trunk.

It is also helpful to work with your pelvic floor. The pelvic floor muscles create a hammock that spans the base of the pelvis from the front to the sides and to the back. Women often learn about these muscles after childbirth and are taught Kegel exercises to “strengthen” this area. You learn to engage the urogenital triangle without using the buttocks or tucking your tail to engage. In yoga mula bandha (root lock) is the “Kegel” and is taught to create strength and preserve energy of the body.

To learn how to feel the diaphragm and transversus abdominus, you can lie on the floor with your head slightly elevated and your chest opened. You can do this by folding three yoga blankets in an overlapping stepped or tiered position so the different layers of blankets support the curve of your lumbar spine, your thoraco lumbar junction and lastly your head (see Yoga Couch on gingergarner.com):

If this setup is too complex, you can try a Supported Savasana with your torso on a bolster (or folded blankets) and your head on a support. See Savasana Variations for info.

To sense the muscular actions of breathing, place your hands on the outer edges of your waist on your floating ribs. Gently firm and draw in the area just below your umbilicus and keep that area gently firm as you take a full breath in. As you inhale, notice if you can feel your lower rib angles moving out into your hands. As you exhale, continue to keep your lower belly engage as you feel your ribs return to their resting position.  Once you can do this breathing  in the reclined position, you can transition to doing it in hands and knees position and then to sitting in a chair to learn to create internal support in an upright position.

To learn where your pelvic floor is, sit on a soft but firm chair with your knees lower than your hips and gently bear down as in defecation. You should feel a slight bulging of your perineum. Then, try to lift your perineal area by tightening the muscles between your pubis and anus. You might also notice that you are drawing in your lower belly to do this, and that is okay because we often engage both our transversus abdominus and our pelvic floor muscles. Just make sure you aren’t tightening your buttocks to do this. Continue to practice this regularly while sitting in a chair until you have built up your tolerance and stamina.

Now let’s look at the more visually obvious muscles you need to work with. To sit erect for long periods of time—whether on a chair or floor—you need to have strong back muscles. These include deepest paraspinal msucles that run the entire length of your spine from head to tail, the deep spinal muscles that are longer and broader, and the more superficial larger back muscles, such as the latissimus dorsi, trapezius. A good way to begin to strengthen these muscles is by practicing simple backbends like Locust pose (Salabasana) with various arm positions and leg lifts (see Locust (Dynamic Version) for a few ideas) and Bow pose (Dhanurasana). 

You might also want to work on your back in Bridge pose variations (Setu Bandha Sarvangasana), especially working with the deep spinal stabilizers, which you can do with One-Legged Bridge or Marching-in-Place Bridge. You might want to have someone watch you when you do these positions to make sure that you can keep your spine neutral and not sag or twist. Also an all-fours position (see Hunting Dog Pose) with opposite arm and leg lifts will work the deep spinal stabilizers. Using a stick that is placed from your head to tail along your spine gives you nice feedback that you are maintaining a neutral spine. Please remember when you start doing these active training positions to use your deep abdominal/diaphragmatic /pelvic floor stabilizing breathing that was described earlier.

Next let’s look at flexibility of your spine. Begin with passive backbends that are nice and easy, such as lying over a bolster to arch your spine into a reverse “C” curve. Keep it gentle—don’t be too aggressive in increasing your arch. More is definitely NOT better. Work with nice deep belly breaths here, not your stabilizing breathing pattern. Cobra pose (Bhujangasana) is also a good way to build spinal flexibility as well as a gentle Cat/Cow pose.

Now it’s time to turn to the lower body and learn to stretch our hips, buttocks, and legs. Thread the Needle/Figure Four pose (Sucirandhrasana) will help you begin to stretch your tight outer hip muscles. Happy Baby Pose (Ananda Balasana) will also help begin to stretch your gluteal muscles and tight lower back fascia. You can practice version one of Reclined Leg Stretch (Supta Padangusthana), but you may find that a sustained single leg stretch through a doorway with one leg up the doorway and the other leg straight on the floor through the doorway is a nice way to hold a hamstring stretch for a longer time period without your hands getting tired gripping a strap. Different poses to stretch your hip rotators such as seated Cow-Face pose (Gomukasana) or Pigeon pose (Kaptosana) preparation are also helpful. To stretch your rhomboids (mid-back muscles), consider adding upper back stretches, such as Garudasana (Eagle pose) arms, to your seated poses.

Finally, we need to move to standing. Begin at the beginning with Mountain pose (Tadasana). You need to learn to stand erect first before you can sit erect.

From here, learning to do Half Downward-Facing Dog pose at the Wall begins to teach you how to integrate your arms, legs and torso.

Then we do have to move onto standing poses! I think by this time you may realize that it would be helpful for you to join a beginner yoga class and to learn to do a home practice. When you find a class that you like, I would recommend privately talking with the teacher and perhaps meeting with him or her to help you devise a doable home practice to target all the areas that you need to stretch and strengthen. With patience, perseverance and a sense of humor you will accomplish your goal! 

For more on learning to sit on the floor (including photos of props you can use), see Learning to Sit on the Floor, Part 2.

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The Ill Effects of Prolonged Sitting

by Ram

Van Gough's Chair by Vincent van Gough

A quick question: are you sitting while reading my blog post? If you are, then maybe you should stand up to read it! According to a new study, sitting for long periods puts you at a risk of early death. (This sentence definitely made you stand, correct?) Most people in present day society spend the majority of their time sitting. A typical U.S. adult sits for an average of ten hours per day. Too much sitting is associated with numerous problems, including obesity, high blood pressure, osteoporosis, cardiovascular disease, colorectal cancer among others. Prolonged sitting does the following:

• decreases the activity of an enzyme which helps burn fat
• reduces bone mineral density and blocks new bone formation, raising the risk of fracture
• increases cholesterol levels and reduces the diameter of arteries putting the individual at risk for heart disease
• decreases insulin sensitivity and triggers type-2 diabetes

For many of us sitting for eight hours a day at our job is inevitable. Compounded with extra sitting outside of work is what makes it hazardous. Most importantly, the ill effects of prolonged sitting occur regardless of the individual’s physical activity. Those who exercise daily may assume that their vigorous training regimen protects them from the harmful effects of prolonged sitting. Unfortunately, it doesn't. Several independent research studies show that even an intense activity will not undo the deleterious effects that come from sitting for 8-10 hours in a day. Thus, too much sitting is harmful even if you're getting enough exercise. This means you could be meeting the recommended guidelines for a daily exercise but you will still be at higher risk of disease if you sit for long periods each day.

Recall that in my earlier posts The Power of Mental Exercise, Part 1 and Part 2, I emphasized incorporating mental exercises as a daily regimen to keep physically and mentally fit.  Now it appears that simply sitting or remaining sedentary changes certain brain cells such that it affects not just the brain but the heart as well, putting the individual at risk of heart disease. Findings from a recent study showed that individuals who sat for more than 11 hours daily were 40 percent more likely to die within the next three years than those who sat for four hours or less daily—even when their physical activity at other times of the day was accounted for. Prolonged sitting has become the norm rather than an exception. In today’s society it is very easy to end up sitting 12-15 hours a day. If you have a commute of 1-2 hours round trip, work in an office that requires you to sit for an average of 8 hours and follow it up by watching TV for a couple of hours of each night, you end up spending the vast majority of hours sitting.

This is against the evolutionary norms for humans as the human body simply is not built to sit for prolonged hours. Go back to history and notice that the cave man was always active—often quite strenuously—to get food, find shelter and simply survive. They naturally spent a lot of time outdoors, walking, hunting, gathering, and performing various other physically oriented tasks. To them this was not a physical exercise or "working out." It was just normal life.  In today’s world, activity/exercise is primarily an intervention; it is something we do to guard against the negative impacts of a sedentary lifestyle.

The question is: how can you avoid the dreaded effects that come from prolonged sitting? The only available option is to drastically change your lifestyle. Standing for long hours by no means is the answer or a panacea. Prolonged standing comes with its own baggage of ill health, especially to the legs, knees and lower back. For optimal health we need to reduce sitting time and increase "non-exercise" physical activity. Most experts recommend a 50:50 sit-stand allowance. Experts also agree that it is beneficial to interrupt sitting time as often as possible. One way to do this is to move or stretch for at least 10 minutes for each hour of sitting time.

Here are a few strategies to lessen the sitting hours and help incorporate more physical activity throughout the day:

1. Do not sit for more than two hours continuously. Take a break to do yoga or walk. Try poses from our office yoga series (see Mini Office Yoga Sequence and Office Yoga Sequence. And remember to bring supplemental yoga with you. Stand up for at least two minutes for each hour of sitting. Short breaks can make a big difference. If you have trouble remembering to take a break from sitting, use an alarm to draw your attention.

2. If your occupation involves sitting for long periods, you can work at a standing desk. The potential benefits from a standing desk are manifold, including, higher productivity, reduced absenteeism and lower health care costs among many. And if you are attending meetings that require long hours of sitting, try standing midway through the meeting. If you're worried about any impending stares from your colleagues or manager, just hand over this article to them.

3. Take every opportunity you can to walk. Use the stairs instead of the elevators to get to your location. Use the bathroom on the ground floor or the basement and take the stairs to go down. In the parking lot, try parking farthest away from the building’s entrance door. If you are in the shopping mall or grocery store, try parking farthest away, not only from the store entrance but also from the parking cart corrals. A yoga trick you can try while you are walking—as long as you’re not carrying anything—is to cross your arms behind your back and hold your elbows or forearms. This will open your chest and stretch the fronts of your shoulders, which become tight from typing, driving, and so on.

4. Walk or bicycle to work. If you live too far away to walk or ride, consider driving part of the way and walking or using the bicycle for the remainder. For people who cycle regularly, you can use your yoga practice to balance your body (see Yoga and Cycling).

5. Instead of sitting on a couch while you are watching TV, reading, listening to music and/or socializing, try sitting on the floor in different seated positions, including Seated Crossed Legs, Cobbler’s pose, Hero pose, Thunderbolt pose, Wide Angle pose (Nina likes to fold laundry in that pose), and so on. Try to change positions every 10 minutes or so. And add activity to your TV time by doing supplemental yoga during commercial breaks.

Notice that all the household furniture from lunch tables to computer desks is designed with sitting in mind. So an upright, activity-centered lifestyle will require modifications to the furniture setting.

There is no doubt that excessive time spent in sedentary behavior is not only having an impact on public health but also has effects on the life span of the individual. Those who maintain a reasonable amount of activity, particularly across the middle and later years, are twice as likely to avoid early death and serious illness. However, it appears that it is never too late to make some changes and experience these positive outcomes. The antidote for these obstacles and their consequences are awareness, focus and determination. So take my advice, get off the couch/chair and seek some enjoyable activity that involves some movement.

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