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Our modern world tends to dictate that we sit frequently, often adopt this posture in front of a screen, where our body is supported in a comfortable chair. It would appear that we become more sedentary and less active with age.
The positive effects of being physically active are well known, but an emerging area of research is now considering the novel effect of sedentary behaviour. Sedentary behaviour is a complex and ubiquitous behaviour that most of us do frequently throughout the day without a second thought.
Some sitting activities are of great value: the cognitive benefits of a puzzle, craft work or reading, the restorative effects of rest and relaxation, the comfort of conversation with friends, the sheer gratification of being able to sit down and immerse ourselves into something we enjoy.
Thus, demonising the act of sitting in itself would be wrong, however, research shows that frequent prolonged bouts of sitting or high level of daily sitting behaviour have been linked with negative physical and mental health consequences: obesity, diabetes, cardiovascular disease and frailty, to name but a few.
And sitting itself has become ‘easier’ because you can literally buy an office chair for less than $100 or less (here are some examples). In the UK, Physical Activity Guidelines for Health (PAGH) recommend that we are active daily, accumulating 150 minutes of moderate intensity exercise (for instance, brisk walk), carry out strength work on two days a week and minimise the amount of time we spend in a seated posture.
The ‘sit less’ aspect of the PAGH are so often neglected in favour of the more exhilarating ‘be active’ component. Indeed, being active is important and relevant. A study examining life expectancy found that increasing physical activity can attenuate risk from accumulated sitting time.
However, it is apparent that our frailer populations find being active most challenging, therefore find it difficult to gain these benefits, so perhaps have the most to gain from the ‘sit less’ message.
A study adopting a tailored programme to help frail older adults sit less found that the participants gained an increase in physical function, specifically their ability to rise from a chair and move, when they focused on goals set around their own personal sitting behaviour (recorded by an inclinometer). Along with providing the benefits of reducing sitting time, the improved function offers a gateway to meeting other aspects of the physical activity guidelines.
The older adults valued reviewing their own personal activity and sitting time charts. The programme itself was tailored with goals defined by participants in terms of their abilities and desired outcomes. This appears to be responsible for the changes made by the participants to their daily routines. This study examined the barriers to being unable to change sitting time for the individuals taking part in the study. Personal factors of pain, mobility, fatigue and mood were commonly cited, but there was also indication that these individuals felt apart from society, not of value and lonely.
Therefore, to make real impact on the life of frailer older adults we need to look at environmental, social, and cultural models to truly see change. Frailty is not inevitable with age and as a society we need to take steps to ensure that we curb deconditioning and isolation as we age.
When objectively measured older adults spend 85–95 per cent of their day sedentary when residing in rehabilitation wards, this is in comparison to community dwelling older adults who spend 60–80 per cent of the day sedentary. Unfortunately, deconditioning happens rapidly when activity is restricted, 10 days bed rest results in a 16 per cent reduction in in strength, reduced ability to do things for one’s self, a reduction in physical fitness and increases the likelihood of further complications. This is no revelation to those working in healthcare, but Professor Brian Dolan is leading the way in changing ward culture to prioritise reducing deconditioning with the #EndPJParalysis Campaign.
The improvement project has had global impact with the simple message ‘Get Up, Get Dressed and Get Moving’. At its core, the project is about patient choice and dignity and allowing the patients ownership of their activity during their hospital stay. It is hoped that the change in culture will reduce sedentary time in the hospital environment allowing people to return home without the functional decline of the past.
Call to action: Should we all at a personal level think about sitting less, moving more and getting active?
Dr Juliet Harvey is a Practice Development Physiotherapist and Researcher from Glasgow.
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