By Ephrem Murindabigwi
Research by the Harvard Medical School and related institutions indicates that too much sitting constitutes a significant factor of chronic diseases for, even, people who exercise. Excessive sitting is called “new smoking”, because of the intensity of its health consequences. Excessive sedentary behavior is defined as sitting for 10 or more hours per day, and strongly associated with an increased risk of heart disease, stroke, type 2 diabetes and premature mortality.
Prolonged sedentary behavior stands disastrous for health because it prevents the body from working to its best; which accumulates unnecessary and dangerous substances in human bodies. In other words, it impairs the body’s normal metabolic activity. Metabolic activity means chemical processes in the body that convert food into energy, new growth and waste products. Too much sitting reduces how the body should normally function, and this carries the potential to lead to the buildup of unhealthy substances like fats and sugars in blood. Physical inactivity, also described as excessive sedentary behavior, claims lives of millions across the world.
Additional details about excessive sedentary behavior
Mayo Clinic-owning campuses in Arizona, Florida and Minnesota in the United States of America- stands as the world’s best hospital, according to Newsweek. This healthcare institution, in its dateless story entitled “What are the risks of sitting too much?”, points out “When you sit, you use less energy than you do when you stand or move. Many people sit for long periods of time, such as at a desk, behind a wheel or in front of a screen. Extended sitting has been linked to obesity. It also has been linked to a cluster of conditions that make up metabolic syndrome. These conditions include increased blood pressure, high blood sugar, excess body fat around the waist and unhealthy cholesterol levels.
Too much sitting overall also seems to raise the risk of death from heart disease and cancer. Researchers analyzed 13 studies of sitting time and activity levels among more than 1 million people. They found that people who sat for more than eight hours a day with no physical activity had a risk of dying similar to the risk posed by obesity and smoking. But 60 to 75 minutes of moderate aerobic physical activity a day offset the effects of too much sitting.”
According to the World Health Organization (WHO), physical inactivity stands as the fourth leading risk factor for noncommunicable diseases worldwide and is estimated to beget between 3.2 and 5 million deaths globally per year. “Globally, physical inactivity is estimated to cause around 27% of diabetes, 30% of ischaemic heart disease and 21%–25% of breast and colon cancer. Physical activity is also fundamental in achieving energy balance and weight control.”
The WHO, in its 26 June 2024 story titled “Nearly 1.8 billion adults at risk of disease from not doing enough physical activity”, reports “New data show that nearly one third (31%) of adults worldwide, approximately 1.8 billion people, did not meet the recommended levels of physical activity in 2022. The findings point to a worrying trend of physical inactivity among adults, which has increased by about 5 percentage points between 2010 and 2022.”
However, “At the World Health Assembly in May 2013, Member States endorsed the need to implement actions to reach the target of a 10% reduction in physical inactivity by 2025,” highlights the WHO. “If the trend continues, levels of inactivity are projected to further rise to 35% by 2030, and the world is currently off track from meeting the global target to reduce physical inactivity by 2030.
The World Health Organization (WHO) recommends that adults have 150 minutes of moderate-intensity, or 75 minutes of vigorous-intensity physical activity, or equivalent, per week. Physical inactivity puts adults at greater risk of cardiovascular diseases such as heart attacks and strokes, type 2 diabetes, dementia and cancers such as breast and colon.”
The Harvard Gazette- the Harvard University’s official news publication, in its 18 November 2024 story titled “Too much sitting hurts the heart” nonetheless discloses alarming information challenging what people generally think. “Even with exercise, sedentary behavior can increase risk of heart failure by up to 60%, according to study. A new study shows that being sedentary increases the risk of the most common types of heart disease, even among those who get enough exercise.
Investigators at Mass General Brigham found sedentary behavior was associated with higher risks of all four types of heart disease, with a marked 40-60 percent greater risk of heart failure and cardiovascular death when sedentary behavior exceeded 10.6 hours a day. (Sedentary behavior is defined as waking activity with low energy expenditure while sitting, reclining, or lying down and does not include hours spent sleeping at night.)”
The publication further alerts “Researchers also emphasized that meeting guideline levels of moderate-to-vigorous physical activity may be insufficient on its own to reduce cardiovascular risk if one is also sitting too much.” The guideline levels of moderate-to-vigorous physical activity is the recommended amount of exercise that is moderately hard to very hard, according to health authorities. For example, as aforesaid, the WHO recommends at least 150 minutes of moderate exercise per week or 75 minutes of vigorous exercise for adults.
“Many of us spend the majority of our waking day sitting, and while there’s a lot of research supporting the importance of physical activity, we knew relatively little about the potential consequences of sitting too much beyond a vague awareness that it might be harmful,” said the lead author of the study, Ezimamaka Ajufo, a cardiology fellow at Brigham and Women’s Hospital. “Sedentary risk remained even in people who were physically active, which is important because many of us sit a lot and think that if we can get out at the end of the day and do some exercise we can counterbalance it. However, we found it to be more complex than that.”
The Harvard Gazette says that Ajufo’s team, which engaged researchers from across MGB [Mass General Brigham- a large academic health system based in Boston, affiliated with Harvard University], examined one week of activity-tracker data from 89,530 individuals in the U.K. Biobank prospective cohort. “They looked at associations between daily time spent sitting and the future risk of four common cardiovascular diseases: atrial fibrillation, heart attacks, heart failure, and death from cardiovascular causes. The team used a machine learning algorithm to classify sedentary behavior. Many of the negative effects of sedentary behavior persisted even among those individuals who achieved the guideline-recommended more than 150 minutes of moderate-to-vigorous physical activity per week.
For example, although the study found that the risk of atrial fibrillation and heart attacks could be mostly eliminated by engaging in physical activity, the excess risk of heart failure and cardiovascular death could only be partially offset by physical activity.”
Prevalence of physical inactivity, its causes and economic impact
The WHO states “The highest rates of physical inactivity were observed in the high-income Asia Pacific region (48%) and South Asia (45%), with levels of inactivity in other regions ranging from 28% in high-income Western countries to 14% in Oceania.
Of concern, disparities remain between gender and age. Physical inactivity is still more common among women globally compared with men, with inactivity rates of 34% compared to 29%. In some countries, this difference is as much as 20 percentage points. Additionally, people over 60 are less active than other adults, underscoring the importance of promoting physical activity for older adults.”
Physical inactivity forms a significant and growing public health issue in Africa too where this inactivity is often termed a hidden pandemic or wicked problem. It results in the rise of non-communicable diseases [NDCs] like diabetes, heart disease and cancer on this continent. Sedentary behavior in this part of the world affects roughly 22% of adults, its rates climbing alongside development, and in some regions, up to more than 85% among in school-adolescents. Though lower than some in different areas of the globe, this figure is projected to increase, with substantial regional variations, on the continent.
“In the African Region, the prevalence of physical inactivity among adults is estimated at 22.1% and is alarmingly high at 85.4% among in-school adolescents. Physical inactivity is associated with over 200 000 deaths every year in the African Region,” specifies the WHO/Regional Office for Africa in its 6 October 2020 document entitled “FRAMEWORK FOR THE IMPLEMENTATION OF THE GLOBAL ACTION PLAN ON PHYSICAL ACTIVITY 2018–2030 IN THE WHO AFRICAN REGION”. These data of 2020 appear too old to be valid in 2026. Yet, based on some data in the preceding section, we can confidently affirm that the data are still valid especially since the situation might have worsened instead of improving.
Major causes of physical inactivity include technological and occupational advancements, urbanization, socio-economic factors, health status and age, among others. NCD Alliance, with its undated piece of writing titled “Physical inactivity”, explains “How did physical inactivity become a problem? In the past decades, countries around the world have seen technological advancements that have changed the way we move, work and play. While some of this change has had positive effects, it’s also led to higher rates of physical inactivity.
More people spend longer amounts of leisure sitting – watching television, playing video games, and using the computer – and physical activity associated with work, tasks at home, and transportation has also declined. What has gone up are rates of overweight and obesity, hypertension and NCDs [non-communicable diseases] like diabetes, cardiovascular disease, cancer and mental health conditions.”
It adds “Groups including women and girls, people living with disabilities or chronic conditions, and people living in low-resource urban settings face more barriers to physical activity. Physical activity levels tend drop significantly after the age of 60, which is cause for concern with an ageing global population. By 2030, one in six people in the world will be aged 60 or over.”
On one hand, as a person’s income increases, they tend to increase physical inactivity too, because of access to means facilitating physical inactivity. Yet on the other hand, a person with lower income also disregards it.
Physiopedia explains “Among low-and middle-income countries, raised Human Development Index values were linked with decreased levels of physical inactivity. The increased automatism of work and life in higher-income countries creates fewer opportunities for sufficient physical activity, whereas in low-and middle-income countries there is more work and transport related physical activity necessary for both men and women.”
MDPI- a publisher of open-access scientific journals, on 7 July 2024, published research entitled “Reduced Income and Its Associations with Physical Inactivity, Unhealthy Habits, and Cardiac Complications in the Hypertensive Population”. Its abstract reads “It was confirmed that having a family income under the poverty threshold is associated with perceiving one’s own health as bad, having a series of negative habits in terms of physical activity, diet, and alcohol consumption, and with suffering from congestive heart failure, heart attack, or stroke.
Increased odds ratios for these unhealthy habits and these conditions, plus coronary heart disease and angina pectoris, were found for hypertension sufferers under the poverty threshold. The sample comprised 6120 adults with hypertension (3188 males and 2932 females).”
Meanwhile, there exist sources that contend that higher income is consistently linked with higher levels of leisure-time physical activity and greater likelihood of executing the recommended exercise guidelines.
According to NCD Alliance, physical inactivity doesn’t happen without economic toll. “The global cost of physical inactivity is estimated at US$ 54 billion per year in direct health care, with an additional US$ 14 billion in lost productivity. This excludes mental health and musculoskeletal disorders, so the true economic toll is far higher than available estimates.”
Solution to prolonged sitting?
Founded on the above observation, the co-senior author of the study- Shaan Khurshid, an electrophysiologist and faculty member in the Telemachus And Irene Demoulas Family Foundation Center for Cardiac Arrythmias at Massachusetts General Hospital, highlights “Our data supports the idea that it is always better to sit less and move more to reduce heart disease risk, and that avoiding excessive sitting is especially important for lowering risk of heart failure and cardiovascular death.”
“Exercise is critical, but avoiding excessive sitting appears separately important,” according to the co-senior author Patrick Ellinor, a cardiologist and co-director of the Corrigan Minehan Heart Center at Massachusetts General Hospital. “Our hope is that this work can empower patients and providers by offering another way to leverage movement behaviors to improve cardiovascular health.”
Harvard T.H. Chan School of Public Health forms the public health school of Harvard University. It released a story headlined “Make sitting less and moving more a daily habit for good health” on 8 January 2025. In the story, I-Min Lee shares her thoughts about the dangers of sedentary behavior and how much exercise is needed to preclude its harms. Lee serves as a professor in the Department of Epidemiology at Harvard T.H. Chan School of Public Health.
She says “Studies have shown that physical activity may be insufficient to completely offset the increased risks of being sedentary. A study of ours using self-reported physical activity in one million persons found that more sitting is bad, as is less physical activity, and combining both makes health outcomes worse. Exercising at guideline levels did not completely ameliorate the harms of sitting for mortality. However, we found that for the most active group—who were getting 60-75 minutes of exercise a day—there was little increased risk from high levels of sitting.”
Here is what she suggests to people performing jobs obliging them to sit all day. “It is important to try to be physically active when you can. Try to take breaks from prolonged sitting. Nowadays, many wearables allow people to prompt a time to get up and move. There is no consensus on how long to sit before a break. We often say every 30 minutes, but that is based on convention rather than data.
Try to find other ‘automatic’ ways to incorporate movement into your life, such as parking farther away and taking the stairs instead of the elevator. Rather than being still, do some activity. Some is better than none, and more is better than some. If you’re moving, you can’t be sitting.”
About standing desks and her own tactics for sitting less and moving more during a busy workday, she explains “Standing desks may not be that great because long periods of standing without taking breaks to move can lead to lower back pain and swelling of legs. It may be better to use a treadmill desk, but the good, sturdy ones are expensive, and some people may not like the motion while reading the screen or find it difficult to type.
I’m naturally a fidgety person, so I don’t need to set a timer for myself. I tend to get restless and feel the need to stretch or stand up periodically.”
The WHO says that collective efforts and increased investments will be required to reach the least active people and to reduce inequalities in access to measures encouraging and improving physical activity. This UN organ responsible for health on the planet specifies that the efforts have to be founded on partnerships between government and nongovernmental stakeholders and that the investments are to create innovative approaches.
“Promoting physical activity goes beyond promoting individual lifestyle choice – it will require a whole-of-society approach and creating environments that make it easier and safer for everyone to be more active in ways they enjoy to reap the many health benefits of regular physical activity,” says Dr. Fiona Bull, Head of the WHO Unit for Physical Activity.
NCD Alliance echoes “If populations are to become more physically active, all sectors of society need to get involved in creating systems and communities that help people to get moving.”
In the meanwhile, Mayo Clinic says “Overall, less sitting and more moving can aid in better health. You might start by simply taking a short break from sitting to standing every 30 minutes. Or find ways to walk while you work. Here are other suggestions: Stand while talking on the phone or watching television. If you work at a desk, try using a standing desk some of the time. You can improvise by standing at a high table or counter. It is not clear, however, whether standing, on its own, is effective for lowering the risk of too much sitting.
Have a walking meeting with coworkers rather than sitting in a conference room. Place your work surface above a treadmill so that you can be in motion when you need to use the computer. You can do this by placing your computer screen and keyboard on a stand. Or get a specialized treadmill-ready vertical desk.”
It underscores “Movement of all types can have a great impact on your health. Even leisurely movement can help improve health. For starters, you’ll burn more calories. This might lead to weight loss and improved energy. Also, physical activity helps build muscle tone and support your mental well-being. This is especially important as you age.”
According to some sources, the short break to take every 30 minutes of sitting work corresponds to at least 5 minutes.