White-collar problems: In defense of traditional sitting

Sitting is bad

I'm sure this is not the first time that you have heard about the danger under your bottom. Sitting Disease is a term coined by James Lavine, a medical doctor who has spent most of his career studying sitting at the Mayo Clinic in Rochester, Minnesota. Estimates on exactly how much we sit vary. But it's hard to deny that many white-collar workers are plagued with this diagnosis.

Consider the human behavior that we call sitting. Notice what's going on all around you. Sitting has been implicated in numerous orthopedic problems like headaches and disc herniations. You do not have to earn a PhD in biomechanics to confirm all the protruding heads, C-shaped spines, and extremities that have adapted to the chair position.

A recent study by the American Heart Association found that whether or not you exercise, long sedentary periods raise your risk of developing heart disease, diabetes, cancer, and obesity. In other words, a lunch time jog does not make up for a typical day of sitting at work or class, and in the car, and while eating and reading and watching TV.  In 2010, British experts linked prolonged periods of sitting to a greater likelihood of disease, and Australian researchers reported that each hour spent watching TV is associated with an 18% increase in the risk of dying from cardiovascular disease.

The chair's fault

In the United States, the science of ergonomics is generally considered to have originated during World War II. Since then, both the medical community and furniture companies have attempted to design safe chairs, desks, and anything else needed to perform repetitive sedentary work. 

Numerous ball-shaped chairs, kneeling chairs, and ultra adjustable chairs have been proposed. These are definite improvements with some degree of scientific and plenty of anecdotal evidence for effectiveness. Yet many ergonomic solutions spare one part of the body at the expense of another, don't fit properly at common table heights, or have an odd appearance that is unacceptable for a professional workplace. Other ergonomic chairs simply don't accomplished what most people still want: enabling us to sit still and comfortably accomplish work.

It is my opinion that we are asking far too much from our chairs. The research seems to indicate that a healthy chair is an oxymoron. We may as well be talking about designing a low-impact hammer or the best Oreo for weight loss.

At this point, the conversation on Sitting Disease warrants some perspective. 

Lesser of evils

I imagine ages past when people hoped for a time when less strenuous work would allow them or their children to lead happy and healthy lives. These days, we are far less optimistic about that idea. Only recently have we began to understand some of the risks of white-collar work.

Sitting is not the only thing that is taxing on the body. The far majority of humans throughout history have had to perform more or less repetitive physical labor, rarely by choice. In modern times, blue-collar workers of all ages are in worse health than white-collar workers, even after controlling for socioeconomic variables. Blue collar workers are more likely to suffer from arthritis and report 3.4 more musculoskeletal injuries per one hundred workers. At age 65, blue-collar men score a mortality rate 42 percent higher than white-collar men.

When the daily grind involves repetitive lifting, carrying, pushing, pulling, kneeling, and operating heavy machinery, a good sit is legitimately therapeutic.Who among us hasn't been there after even one Saturday afternoon of yard work?

"Ahhh. The chair."

Keep in mind that many of us have such things as gardens and yards to tend to outside of our employment. We all sprint through seasons of time-crunched mayhem, some of it self-induced. But overall, Americans have far more leisure time than ever. We have the time and freedom to choose whether or not we want to watch TV, exercise, or otherwise fight back against what ails us.

The problems

The problem isn't simply the chair or desk or sitting or being classified primarily as a blue- or white-collar worker. The real problem, of course, is that too much of anything is bad for us. Some of the studies listed above and many others like them have found that physical inactivity, and not necessarily just sitting, is the crime we commit against ourselves.

Sedentary living is undeniably linked with sitting, and white-collar work demands siting long and often. But the fact of the matter is that our bodies gradually break down and fail us. If not from sitting, we would likely suffer repercussions from months and years of farming, hanging drywall, sorting packages, standing on cement, or some other task.

Some occupational risks are less obvious than others. Despite a growing body of evidence, white-collar employees remain less aware of their risks. A national workplace survey sponsored by The Hartford Financial Services Group Inc. found that while the average blue-collar worker expects to suffer overuse and traumatic injuries on the job, far fewer of their white-collar peers recognize that possibility.

Some not-quite solutions

Be aware of the realities of sitting for the majority of the day. Do not take the threat of sitting down...sitting down. By all means get your work done. But fidget, stand, kneel, walk and move as if your life depended on it, because it does. Search some of the evidence on NEAT (Non-exercise activity thermogenesis). Fascinating evidence is emerging that every small movement does count.

If many of your waking hours involve sitting, for heaven's sake, don't sit during the time you allocate to exercise. For example, the seated leg extension machine, the bicep curl machine, and the recumbent bike are not your smartest choices at the gym. Don't let me catch you on these unless you have a specific disability or other good reason for using them. I'm an advocate of exercises like squat and lunge variations, step-ups, shoulder presses, and pretty much anything where you must practice good posture, balance, and control the movement of multiple body segments against gravity.

Yes, you should schedule breaks from sitting, stretch, and take the requisite time and effort to create an environment that enables you to work efficiently over the long haul. Remind employers that an ounce of prevention is indeed worth a pound of cure.

As a physical therapist it is my duty and obligation to lecture you about posture. If only you could see my hypocritical posture as I type this! Why is it so difficult not to slouch? Gravity, our ancient friend and foe, is relentless. Stretching, strength training, "adjustments" and ergonomic chairs all only provide the potential to sit and stand with good posture. In the end, the only way to actually achieve good posture is relentless attention to sitting and standing with good posture. 

Don't stay in any one positions for too long, and don't give up. Variety, the spice of life, is also good medicine!

Given this problem with no easy or complete solutions, one of the most powerful things we have is gratitude. If only we can choose to be thankful for the privileged time and place in which we live. We can at least envision a narrow road that lies between the broad paths of sedentary living and backbreaking manual labor. With the perspective and time we have been granted to learn and engage in activities that do not involve chairs, maybe we can even be thankful for our place to sit.

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Long duration of inactivity raises risk despite exercise habits: http://circ.ahajournals.org/content/107/1/e2.full

Long duration sitting linked to various disease: http://bjsm.bmj.com/content/43/2/81.extract

Television viewing time and mortality:  http://circ.ahajournals.org/content/121/3/384.long

There is no one correct posture, chair, or correct way to sit: http://www.knoll.com/media/477/936/wp_future_ergonomic_seating.pdf

Blue-collar workers of all ages are in worse health than white-collar:

Blue collar workers 3.4 more musculoskeletal injuries per one hundred workers:

Mortality of blue-collar and white-collar men at age 65: http://jech.bmj.com/content/57/5/373.full

Americans have more leisure time than previous generations: 

Sedentary lifestyle, but not siting, linked to health-related costs: 

Every small movement counts: http://www.ncbi.nlm.nih.gov/pubmed/16439708

Cost effectiveness of occupational health intervention: http://www.ncbi.nlm.nih.gov/pubmed/16299706


The Health & Fitness Trump Card

This is not the time to explain or debate the finer points of why something works for me and the clients under my care, or what may work best for you.  But here I make the claim that physical health and fitness can be reduced to this: building and maintaining muscle and strength. This is indeed THE critical component of staying healthy and functioning well as you grow and age.

When you regularly perform total body resistance training primarily with free-weights with good form and appropriate progression, you remain fit and "balanced." You don't have to diet or do a lot of "cardio." Everywhere you go, 24-hours per day you carry around functional, good-looking muscle that burns energy and allows you to eat a reasonable amount of relatively normal food. More likely than not, you will have good blood profiles, low body fat, and far more strength and endurance than you need on a daily basis.

Or you can believe the prevailing notions about the pathways and barriers to health and fitness. You can spend hours per week on the elliptical, "tone up" with high reps on the Nautilus machines, wave around the 2-pound pink dumbbells, take the lemon balm extract and whatever other supplements Oprah and Dr. Oz are hawking, buy the low sugar ice cream, the organic smoothies, and the whole grain cookies, rub on the pain relieving creams and gels, and throw out your nutrient depleting microwave oven. I could go on...

Don't get me wrong. To be healthy and achieve aesthetic or performance related goals, you do have to exercise and be mindful of what you eat. But it's truly not complex and time-demanding. We're not talking about knock-down-drag-out blood-sweat-tears marathons.

Today I was tired. Completed a few quick errands after work, disassembled a treadmill, installed a new belt, and put it back together. With little time and energy for training, I trained. The lack of music and training partner increased the demand by 27%. After a "clean the basement floor" warm-up, the days work included only 3 sets of intense single leg squats, one set of 20-rep squats, a few bicep curls, and a "core" finisher which including wailing on a tree stump with a heavy ax.

So to summarize. If you want better health, less pain, and to look good with minimal time investment, do resistance exercise. Compliment the Zumba, golf, yoga, skiing or whatever activity that you enjoy with time under the weights.

Consistent (2 to 4 days per week)

total body (controlling multiple body segments against gravity - in good form)

resistance exercise (strength training and conditioning activities safe for you)

is what I'm selling.

And there's the trump card. - bam -

Rest enough, minimize processed food, try to manage stress and have some fun.

See where that gets you!


advice to an aspiring medical professional

After a few questions about student loans and the state of health care, the aspiring medical professional puts it out there:

"So if you could go back and do it again, what would you choose differently?"

I gave him a few platitudes. Most of this young mans questions are good. At 22-years old, he's thinking through scenarios that were off my radar at that age. Even now, in our everyday discussion I can readily sense that in many ways he's more mature than I, and in others less.

I attempted to answer the question; couldn't think of another career path (physical therapy with personal training on the side) that would be better suited for my talents and inclinations. Teaching would be nice, maybe some day.

The young man comes from a supportive family with kind and intelligent parents. He has the grades and the standardized test scores and the work ethic and the personality and the various experiential learning to impress ANY admissions board. Success is practically guaranteed. I'm sure he doesn't understands how blessed (some would say lucky) and talented he is. These more meaningful words should have been communicated.

Ahhh success. Doesn't everyone define it differently? Here are just a few other thoughts that of course came 8-hours late:

-Commit to a community. Fall in love with a geographical area like it's a person. Choose to serve that community well for all the days you are given to dwell it. Some areas are surely better than others, but they all have their strengths and weaknesses. Being needed and needing others is more important than you think, for them and for you.

-Do what you can to not spend a quarter of your life sitting around getting to and from work. Sure, books on tape are good but focused or relaxed reading on the couch or in the back yard is far better.

-Follow your passion? I'm not so sure Lady Gaga. Sometimes you're not going to feel passionate about what you must do to honor your commitments and pay the bills. The work (pain in the ass) parts of work are good for you. 

-Accept uncertainty. Doing your homework and walking forward with caution and care is no substitute for the fact there will always be relevant developments that we don't know or understand. The cost of things will go up and the car will need repairs. Other than that, change is constant and little is truly predictable. 

-Live below your means. If you want to even have a chance at a low stress, semi-sane  existence where you can find joy and see the beauty that's in front of you, find a way to live below your means. There will never be enough money or time. The shiny finer things will always get old and sooner than that they will be old to you.  

Take these for what you will, the thoughts of a 38-year old who does terrible with accepting uncertainty, but is content with weight training in his basement and roasting marshmallows with the various kids who end up in his backyard. In the finances game he wins small and loses small. He drives a '98 Subaru, for Pete's sake, and takes great pride in using an old car but because of other life choices couldn't do much about it if he didn't.

 - - - - -

Remove far from me vanity and lies; give me neither poverty nor riches; feed me with the bread of my daily need.


an exercise in perspective

I was beating the clock on a timed weightlifting interval in my backyard. Such things make for brief yet effective training if you're willing to push yourself. An appointed rest interval ended. The time to get moving quickly came and went, slipped away like a car speeding down the highway. Instead of starting the task at hand I kneeled and pulled a weed from the lawn.
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1. Training: 

Training is select movement with a specific performance goal in mind. Variables like loading and reps, speed and rest are manipulated with intent. One session supports and builds upon the other, and the end goal is much too lofty and specialized for any single bout of effort. Training requires a chunk of time with structured progressions and regressions, recovery and peaking. This type of effort requires the greatest amount of discipline regarding what to do as well as what not to do.

Training culminates in astounding displays of nearly superhuman strength and speed and endurance. This is exercise.

2. Working out: 

Working out requires showing up, and it may require great effort and courage. This is what usually comes to mind when we talk about "getting in shape." You lunge or dance, kick or spin, or maybe follow what an instructor planned for the hour. You fit in a jog or brisk walk. You put in a DVD and repeat circuits of calisthenics. Working out may or may not have much structure. It's formal calorie burning, where you gasp and sweat and go on with your day.  

This too is exercise.

3. Corrective exercise and rehab:

This is highly specific and structured but less intense. You may sweat depending on your fitness base. The primary aim is to use movement as a means to gradually build tissue resiliency, improve joint stability or mobility, and ingrain more efficient movement patterns. You alter the mechanical forces on your bum knee by stretching the ankle in a specific way and building hip strength. This is physical therapy, gait and balance training, and I suppose some forms of yoga.

These count as exercise.

4. Work: 

Work involves a bazillion reps of moderate to low intensity. You lift and sort packages, mow the grass, pick green beans, build a shed, perform stretching and adjustments, wash windows, or pace hospital floors. Work is, well, work. It's the 40-plus hour per week grind that lasts for months and years. Work is also the weekend binge, like loading the barn with hay or painting the house.

A reminder of the obvious is warranted here. Work is awesome because at the end of the day you have achieved something beyond fitness. Your muscles tugged at your skeletal segments and your heart beat fast and it resulted in compensation or some other immediately tangible offering to the world.

Labor is definitely exercise. Every pile of split firewood warms you twice.

- - - - -

With this as a reminder, here are a few thoughts:

-The vast majority of human activity has always been in the realm of #4. Only in recent times have many of us needed #2 or had the time and means to take #1 very seriously. Most with a career that requires even moderate manual labor cannot comprehend why anyone would want to spend their limited leisure time and energy on #1 or #2. These days, the #1 and 2s just assume those folks are neglectful or lazy. Maybe they are. Or maybe they're just tired.

-On sports: Playing the game where winning is the primary intent is #1. Playing where the main goal is to have fun or exercise is #2. Pay heed to this and do not mix the two.

-The #1s often fail to realize that doing time with #3 will help them resist injury and achieve new levels of performance. It goes for #2 and 4 as well. In fact, excessive anything outside of #3, without attention to #3, will often result in taking you to #3. But as Ronnie Coleman would say, ain't no one wanna do no boring-ass corrective work.

-There is sometimes a fine line between #1 and #2, but often there is not. Currently there is a LOT of confusion between the two. Athletes who have a specific performance goal in mind are caught running around, giving their body too much variety, going through unnecessary random draining workouts, with all the effort serving to stifle their advancement in #1. On the other hand, those who aspire to simply be active and get in shape are isolating their muscles on resistance training machines or, even worse, performing relatively technical and heavy movements they don't need or want.

-The funny thing is when a person who is all about the workout and gym culture imagines their #2 is some kind of magical greatness when in fact almost any #4 would be a lot more demanding and beneficial for them. Pay someone to plow the snow so you can go to the gym and work bis and abs.

-Military personnel, police, and other public servants are the only true #1s. Or at least they should be. Where else in modern times may life and death truly depend on high level performance? Professional athletes are often impressive genetic freaks with sharp intellect and superhuman work ethic. But at the end of the day, win or lose, they go home and eat, sleep, and hang out with their friends and family.

-The point, I think, is to clarify exactly what you want out of your fitness program (and life). I will point you to the enjoyment of pursuing a purposeful #1 rather than merely suffering through workouts. Do not discount the myriad of psychological benefits that even a light #2 provides.

-Right now I waver between #1 and 4, and except for casual mountain biking, usually altogether avoid structured #2. There's no need for random energy burning with all the work, housework, children, semi-rec sport. I remain fascinated with the idea of being a serious athlete, the discipline and diligence, structure and progression of #1. But could this be fading? I did pull the dandelion when I could have set a PR.

Sucker didn't come easy.