Editor’s Note: We are pleased to present this guest post from Vik Khanna.
Sitting will kill you, won’t it? Everyone says so … from the pharma- and health plan-funded American Heart Association (AHA) to the Gatorade- and health plan-backed American College of Sports Medicine (ACSM). Business woman Nilofer Merchant’s rambling, platitudinous essay in the Harvard Business Review declared that sitting is the new smoking. But, is it really?
The control merchants, whether they are the government, its private ostensibly not-for-profit water carriers, or for-profit companies, need things they can grind against in order to validate their existence and that they can use to scold people. The imbroglio about sitting is so intense that I somehow feel foolish when I sit down, which, like most people, I do often because I work at a desk, and I really like Hulu.
Sitting is evil. Americans sit too much. Sitting causes death. Disability. Diabetes. Heart disease. Cancer. Depression. Dementia. Who knew sofas, benches and chairs were such evildoers? The solutions promoted to cure us of our evil posturing are “stand at work,” “walk on a treadmill while working,” or the most brilliant advice of all, “get 30 minutes of physical activity” most or all days of the week. Even better, get your daily 10,000 steps even though there is not a shred of evidence that volume lowers mortality. Like many things in modern fitness, it’s made up, as much a unicorn as “drink 8 glasses of water a day.”
The anti-sitters are all wrong, and their argument left the rails more than 200 years ago. Since the dawn of the Industrial Revolution (we’ll say, for the sake of argument, 1800) every generation of Americans has sat more than the previous one as mechanization and then automation gradually erased physical labor from daily life. Coca Cola funded-Steven Blair and colleagues have concluded that since 1950, modernization of life has removed about 1,300 kcal of activity per week from the lives of female American homemakers.
Yet, despite the impact of modernization, there has been a steady increase in lifespan and a steady decrease in the mortality rate. If sitting is so deadly, why didn’t mortality increase when farmers went from walking behind horse-drawn ploughs to sitting in tractors? When farmers became factory workers and when factory workers became managers, or when those managers began sitting in front of banks of monitors instead of walking shop floors, why didn’t mortality increase?
Why didn’t mortality increase when we went from being an agricultural economy to an industrial one to a service one, and now, finally, to an information-based economy? Because the conundrum of what empowers us to live longer and in better health every year is much more complex than the single act of sitting versus standing. During these periods when sitting increasingly became the cultural norm, we also created sanitation systems, antibiotics, cleaner air and water, safer workplaces and highways, and a duplicitous healthcare industry claiming that it can prevent or fix nearly everything, albeit with exorbitant harm, waste, and cost.
The inordinate focus on sitting as a public health problem reflects the make-work tendency of the bureaucracy and its inability to see the forest for the trees. Where they see people who sit too much, I see people who’ve been screwed over by school systems that do a horrendous job of teaching health and physical education; a mainstream media that unashamedly promotes the results of every new “study” no matter how poorly done or worthless; most importantly, I see a culture where the concept of being a physical person is derided instead of celebrated. Our problem is not that we sit. Our problem is we don’t understand what it means (and takes) to be fit or why that is important.
The AHA recently released a position statement on sitting, which you can find here. It’s mostly a rehash of the obvious: being sedentary is bad for you because it worsens risk factors that can promote serious chronic diseases and premature mortality. Geez, what a news flash.
The AHA’s enterprising writers laboriously justify the conclusion they wanted to reach. Their conceit is so obvious that it makes the paper painful to read, especially if you first review John P. A. Ioannidis’s essay on the biases that corrupt and render the peer-reviewed literature simply unbelievable. The AHA writing team extols the virtues of studies based on memory-based surveys and then praises the supposed objectivity of studies using accelerometers (a type of wearable device). Both those tools are terrible proxies for the elephant in the room that they assiduously ignore: fitness. Hence, their stirring conclusion that sitting (or, more correctly, sedentary behavior) will kill you is based on either subjective, memory-based data that are almost certainly flawed or quasi-objective data from wearables.
Premature mortality risk is about risk factors, and risk factor management is a complicated stew of genes (mostly not manageable), environment (somewhat manageable, at least at home for most people), and behavior (the most manageable, but also the most difficult to change). In the last decade, three different studies produced nearly the same result with regard to risk factors and mortality risk. The studies are here, here, and here. Data from three different populations produced strikingly similar results, which enhances believability.
The critical mortality-reduction behaviors are: not smoking, exercising regularly and eating a high-quality diet. These behaviors drive the normalization of essential risk factors: healthy body weight, blood pressure, blood lipids and blood sugar. The only thing I’d add to those metrics are to have as low a resting heart rate as possible. These eight elements of risk have a honeycomb relationship: you need to do the first three things in order to achieve the last five. If one of the three hallmark behaviors collapses, it’s likely the others will too, and thus risk factor dominos start to fall.
The same risk factor argument applies the current dogma about sitting and the apex risk factor, cardiorespiratory fitness. Nothing forestalls premature mortality as well as cardiorespiratory fitness. Even Coke grant recipient Peter Katzmarzyk, a co-author on the current AHA paper, and Steven Blair allude to this in their 2015 paper in the Mayo Clinic Proceedings. This makes you wonder, then, how Katzmarzyk and colleagues could have so blithely ignored two papers that both conclude that a high fitness level mitigates the effects of sitting. One paper, by Kerem Shuval and colleagues, is noted by Katzmarzyk’s team (footnote 102), but they buried the lede: fitness counteracts the effects of TV-viewing time, but not time in a car, which leads me to wonder whether the time seated in a car is more harmful because of the stresses of driving (and perhaps heading to a job you hate) and not just being seated, per se.
The second and more important study is completely ignored by Katzmarzyk and team. J. H. Van der Velde and colleagues actually put people on treadmills to measure fitness and found that fitness mitigates the effects of sedentary time and is associated with improved risk factors:
“sedentary time showed no independent associations with cardio-metabolic risk after correction for fitness and MVPA (moderate to vigorous physical activity)”
Why would you ignore something so intuitive that it’s very nearly obvious, but is also supported by objective measurement? Because it’s counter to the narrative. People such as Blair and Katzmarzyk who’ve taken oodles of money from the feds and companies such as Coca-Cola don’t want to have an intellectually honest conversation. They need to satisfy their funders first and foremost, because that’s what keeps the cash pipeline open. So they point the finger at insufficient physical activity, hoping to deflect blame from diets soaked in poor quality carbohydrates that promote weight gain and a worsening of all the biological markers.
Simultaneously, they perpetuate the myth that “physical activity” is the tool that will save your life. I’ve had conversations with ACSM hotshots who freely admit that the physical activity narrative holds sway because they’re afraid telling people the truth (fitness today, fitness tomorrow, fitness forever) will turn people off and even fewer Americans will exercise. Well, frankly, that strategy is a well-documented disaster. Their obtuse logic is almost as laughable as the evolution of the conventional fitness marketplace. Go into any spit-and-polish fitness palace in America (such as Life Time Fitness, which is virtually a citadel of sitting), and I am sure you will find a personal trainer who will very seriously lecture you about the evils of sitting all day and then guide you through a session of exercises done while you sit on a dozen or more machines. Are you kidding me?
There is zero evidence that a lot of little activities will improve cardiorespiratory fitness to the point where it will affect the mortality curve. Improving CRF is hard and requires exercise, which is quite different from physical activity, as everyone who’s done it knows. You might start on the path to better health by taking a few extra steps every day, but that’s a self-limited strategy. If you do no more, you’ll benefit only from the first increment and miss out on the dramatic impact on mortality that comes from higher levels of fitness, which require work. Not to mention that a rigorous exercise habit is also a vital hedge against stress, anxiety, dementia and depression, and a massive boost to mood and outlook.
And, don’t get hung up on what you do. The variety of choices from the exercise universe is nearly endless. Your body doesn’t care whether you corral your risk factors via kettlebells, CrossFit, rowing, cycling, circuit training, running or anything else that improves CRF. If the net effect of your choices is to normalize the risk factors we know how to measure (and probably many we don’t), then you will have done all you can to manage your mortality risk. And, we haven’t even gotten to the unique benefits of strength training that aerobic exercise simply cannot provide.
Giving advice to populations is hard, but it’s doubly so when the advisors lie, misstate and obfuscate because they don’t want to tell the truth. Will fitness save or improve every life? Of course not. But the strategic purpose of population-wide advice is to give people an idea of what may work most of the time for most people in most circumstances. Improving fitness, especially CRF, is the single biggest beneficial thing you can do for yourself. The second is to stop worrying about whether or not you sit too much.
Vik Khanna is a healthcare entrepreneur, writer and exercise coach in St. Louis, MO. He has an undergraduate degree in exercise science and physical education, is a physician assistant with experience in internal medicine and rehabilitation, and he holds a Master’s degree from The Johns Hopkins School of Public Health. A lifelong advocate for strength training, he hopes to soon test for his black belt at the Missouri Karate Association in Chesterfield, MO, where he is the conditioning coach and has created the dojo’s first ever kettlebell-centered conditioning program.