Stephen Leeder: Can we stand for this?

SITTING is not good for us. We should be up and about.

In a recent Australian-based study, published in the Archives of Internal Medicine, hours spent sitting was shown to confer a small increase in the risk of death from all causes.

Is the chair the problem? Historically, “chair” suggested power and authority, not vulnerability and death.

Chair comes from the Greek cathedra and cathedrals were places with chairs on which men of power sat. The occupant of a chair would expect us to take notice, whether a bishop, king or a professor. But the privilege of being seated and treated as a power-person may come at a price.

In fact, doctors who sit 10 hours a day, advising their patients to exercise more, may be in strife themselves.

Sixty years ago a study showed that conductors aged less than 50 years who worked on London double-decker buses had sudden death rates one-third those of bus drivers. Presumably this contrast had something to do with sitting versus standing.

The authors of the paper back then found that the variations in sudden death rates could not be explained by the drivers wearing bigger trousers than the conductors — because they didn’t. “The difference between conductors and drivers in the sudden death rates cannot be explained by differences between the two occupations in physique as measured by uniform size”, they wrote.

The latest study by Australian researchers strengthens growing concern that sitting in and of itself may contribute to all-cause mortality.

So what would be an appropriate public health policy response to this observation?

First, it would be prudent to draw the finding to public attention so that when options present for choosing sitting or standing, people are encouraged to stand (and move).

This has salience when considering ergonomic arrangements in the workplace, where opportunities for working at a computer console might include adjustable desk heights that permit the user to stand rather than sit. Presumably, this would make the temptation to occasionally walk about stronger.

Second, we might encourage doctors and others to consult on our feet as managers who wish to keep meetings short do. Walking clubs organised by several private health insurance funds and the Heart Foundation could be publicised through doctors’ practices. These groups blend physical activity with socialising and chat.

Perhaps a Medicare Local could pilot the value and cost of a walking group for doctors and other health professionals, organised to fit easily into their schedules. This may also save money otherwise set aside for those excruciating team-building and networking retreats.

Third, the Australian National Preventive Health Agency, with the expectation that it will engage in heavy-duty evidence assessment on which prevention programs work best and in what context, may wish to review reportedly successful nationwide activity programs such as Agita São Paulo Program in Brazil.

“The verb ‘agita’ means to move the body, but the term also suggests changing the way of thinking and becoming a more active citizen”, write the program’s protagonists Sandra Matsudo and colleagues.

Launched in 1996 among the 37 million citizens of the state of São Paulo, Agita is now widely adopted by the rest of Brazil and endorsed by WHO. Its message is to encourage people to adopt an active lifestyle by accumulating at least 30 minutes of moderate physical activity per day, on most days of the week.

Following widespread community application, 7% of citizens exposed to the program remained sedentary compared with 14% of those who had not been exposed.

And finally, we should attend to the way we design, build or renovate our urban spaces. In the world’s great cities such as Manhattan, public commuter transport encourages regular incidental walking as well as relieving road traffic obesity and thrombosis.

Time for me to get up from this chair and go for a walk, I think!

Professor Stephen Leeder is the director of the Menzies Centre for Health Policy and professor of public health and community medicine at the University of Sydney.

Posted 16 April 2012