Let’s begin with a pretest. I want to make it clear that a pretest is not to check whether you know the information, but that you have an open mind and are willing to learn.
1)Which may have the most detrimental impact on your health?
d. A and C
e. All have the same impact
2)People who exercise are considered active.
3)Inactivity may increase the risk of what? Select all that apply.
b. Heart disease
A snowy and icy winter is upon us, and our thoughts turn to hibernation and not falling. Who wants to be active when it’s cold and slippery outside? Let me delineate between exercise and inactivity; they are not complete opposites. When we consider exercise, studies tend to focus on moderate to intense activity. However, light activity and being sedentary, or inactive, tend to get clumped together. But there are differences between light activity and inactivity.
Light activity may involve cooking, writing, and strolling. (1). Inactivity involves sitting as in watching TV or in front of a computer screen. Inactivity utilizes between 1-1.5 metabolic equivalent units — better known as METS — a way of measuring energy, while light activity requires greater than 1.5 METS. Thus, in order to avoid inactivity, we don’t have to exercise in dreaded wintery conditions. We need to increase our movement.
What are the potential costs of inactivity? According to the World Health Organization over 3 million people die annually from inactivity. This ranks inactivity in the top five potential underlying causes of mortality (2). The consequences of inactivity are estimated at 1 to 2.6 percent of health-care dollars, which sounds small, but translates into actual dollars spent in the U.S. of between $38 billion and $100 billion (3).
How much time do we spend inactive? Good question. In a recent observational study of over 7,000 women with a mean age of 71 years old, 9.7 waking hours were spent inactive or sedentary. These women wore an accelerometer to measure movements. Interestingly, as BMI and age increased, the amount of time spent sedentary also increased (4).
Inactivity may increase the risk of mortality and plays a role in increasing risk for diseases such as heart disease, diabetes, and fibromyalgia. It can also increase the risk of disability in older adults. Surprisingly, inactivity may be worse than smoking and obesity. Even for those who exercise, inactivity can still occur. There can be a doubling of the risk for diabetes in those who sit for long periods of time, compared to those who sit the least (5).
By the way, the answers to the pretest are 1) e; 2) b; 3) a, b, c, d, e.
Let’s look at the evidence.
DOES EXERCISE TRUMP INACTIVITY?
We tend to think that exercise trumps all; if you exercise, you can eat what you want and, by definition, you’re not sedentary. Right? Not exactly. Diet is important, and you can still be sedentary even if you exercise. In a meta-analysis — a group of 47 studies — results show that there is an increased risk of all-cause mortality with inactivity, even in those who exercised (6). In other words, even if you exercise, you can’t sit for the rest of the day. The risk for all-cause mortality was 24 percent overall.
However, those who exercised saw a blunted effect with all-cause mortality, making it significantly lower than those who were inactive and did very little exercise: 16 percent versus 46 percent increased risk of all-cause mortality. So it isn’t that exercise is not important, it just may not be enough to reduce the risk of all-cause mortality if you are inactive for a significant part of the rest of the day.
In an earlier published study using the Women’s Health Initiative, results showed that those who were inactive most of the time had greater risk of cardiovascular disease (7). Even those who exercised moderately but sat most of the day were at increased risk of cardiovascular disease. Moderate exercise was defined as 150 minutes of exercise per week. Those at highest risk were women who did not exercise and sat at least 10 hours a day. This group had a 63 percent increased risk of cardiovascular disease (heart disease or stroke).
However, those who sat fewer than five hours a day had a significantly lower risk of cardiovascular events. And those who were in the highest group for regular exercise (walking seven hours/week or jogging/running four-to-five hours/week) did see more benefit in cardiovascular health, even if they were inactive the rest of the day. Sitting longer did not have negative impact on the individuals in the high exercise level group.
WORSE THAN OBESITY?
Obesity is a massive problem in this country; it has been declared a disease itself and also contributes to other chronic diseases. But would you believe that inactivity has more of an impact than even obesity? In a newly published observational study, using data from the EPIC trial, inactivity might be responsible for two times as many premature deaths as obesity (8). This was a study involving 330,000 men and women.
Interestingly, the researchers created an index that combined occupational activity with recreational activity. They found that the greatest reduction in premature deaths (in the range of 16 to 30 percent) was between two groups, the normal weight and moderately inactive group versus the normal weight and completely inactive group. The latter was defined as those having a desk job with no additional physical activity. To go from the completely inactive to moderately inactive, all it took, according to the study, was 20 minutes of brisk walking on a daily basis.
ALL IS NOT LOST!
In another recent study evaluating 56 participants, walking during lunch time at work immediately improved mood (9). This small study clearly shows that by being more active at lunch time, there was a change for the better, increasing enthusiasm and reducing stress compared to in the morning before they had walked. Participants had to walk at least 30 minutes three times a week for 10 weeks; pace was not important.
So what have we learned thus far about inactivity? It is all relative. If you are inactive, increasing your activity to be moderately inactive by briskly walking for 20 minutes a day may reduce your risk of premature death significantly. Even if you exercise the recommended 150 minutes a week, but are inactive the rest of the day, you may still be at risk for cardiovascular disease. You can potentially further reduce your risk of cardiovascular disease by increasing your activity with small additions throughout the day.
The underlying message is that we need to consciously move throughout the day, whether at work with a walk during lunch or at home with recreational activity. Those with desk jobs need to be most attuned to opportunities to increase activity. Simply setting a timer and standing or walking every 30-45 minutes may increase your activity levels and possibly reduce your risk. Just because the groundhog saw his shadow, don’t let it influence you to be inactive.
(1) Exerc Sport Sci Rev. 2008;36(4):173-178. (2) WHO report: http://bit.ly/1z7TBAF. (3) forbes.com. (4) JAMA. 2013;310(23):2562-2563. (5) Diabetologia 2012; 55:2895-2905. (6) Ann Intern Med. 2015;162:123-132, 146-147. (7) J Am Coll Cardiol. 2013;61(23):2346-54. (8) Am J Clin Nutr. online January 24, 2015. (9) Scand J Med Sci Sports. Online Jan. 6, 2015.
Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, go to the website www.medicalcompassmd.com and/or consult your personal physician.