As a health and exercise professional, you likely started your career because you love being active, so sitting for long periods of time probably isn’t something you have to overcome on a regular basis. But what about the clients who come to you for exercise solutions? What do their daily activity habits look like? While we can design exercise programs that help our clients increase their activity levels when we are coaching them and if they continue to exercise in between sessions on their own, this accounts for only a few hours a week, at best. Is that enough, particularly for those who spend the majority of their time sitting at a desk, commuting to and from work or spending time in front of a screen?

A growing body of research suggests that it is not. While being physically active is essential and can certainly lower one’s risk of numerous health concerns, it cannot fully counteract the negative effects of prolonged periods of sedentary behaviors. So, what can you do to help your clients from becoming stuck in sedentary positions for hours at a time? What tools and tricks can you offer them that will support their efforts toward a healthier overall lifestyle, despite the restrictions of work or commuting? Drawing on the experience of a wide range of experts, this article answers these questions and also includes exercises and stretches you can offer your clients to help counteract the physiological effects of extended periods of sitting. 

Do People Really Sit Too Much?

To understand how time spent sitting can add up to have a negative effect on one’s health, consider the daily schedule of a working adult in North America who exercises two or three days per week:

• Wake up and get ready for work
• Commute to work, most likely in a seated position while driving or taking public transportation
• Work a minimum of eight hours per day, most likely in a desk-bound office job; if an individual works in an active job or in a standing position, he or she is often performing the same repetitive motions throughout a work shift
• Stop by a fitness facility for a workout two or three evenings per week. Even though an individual is exercising, which is great, he or she may be performing at least some of the exercises while in a seated position, which limits the opportunity to add more standing time to the day.
• Commute home, again probably in a seated position while operating or riding in a vehicle
• There is a high probability that many people will spend a few more hours in a seated position while watching a screen once they finally make it home for the evening.

While many clients are indeed more physically active during the day than the description given above, this is not an uncommon pattern of behavior in the daily lives of many Americans. In the United States, the 2015−2016 National Health and Nutrition Examination Survey (NHANES) of almost 6,000 adults found that 25% of respondents reported sitting for more than eight hours per day, with an additional 14% claiming they spend at least six to eight hours a day in a seated position; surprisingly, only less than 3% of adults reported sitting less than four hours a day (Ussery et al., 2018). 

Understanding Energy Expenditure 

Of course, the more people sit, the fewer calories they are likely to burn throughout the day, which can have a significant impact on weight control, even for those who exercise regularly.

Muscle cells use oxygen to help produce the energy to fuel contractions; the more oxygen consumed during (and after) exercise, the more calories burned. Sitting for too long is classified as sedentary behavior, the defining feature of which is a profound lack of physical activity and only a minimal amount of oxygen consumption. Sedentary behaviors are defined as any waking activities performed while sitting or lying that do not increase energy expenditure above 1.5 metabolic equivalents (METs). One MET is the volume of oxygen consumed during rest, which is classified as resting metabolic rate (RMR) and is approximately 3.5 milliliters of oxygen consumed per kilogram of bodyweight per minute (mL/kg/min) and represents the amount of oxygen used by the body while at rest. Understanding METs can help you identify the types of activities that use a high volume of oxygen to help your clients maximize overall energy expenditure. 

The Compendium on Physical Activity identifies MET values for a wide variety of physical activities. Researchers have assigned MET values for numerous activities, from many common types of exercise to relatively obscure ones. For example, walking at a moderate pace of 2.8 to 3.2 miles per hour (mph) on a level, firm surface is approximately 3.5 METs, while running at 7.0 mph, which allows you to cover one mile in approximately 8.5 minutes, has a MET value of 11.0. Sitting has a MET value of 1.3, while standing is 1.8 METs, above the 1.5 MET threshold for sedentary behavior. (Note: For the energy expenditure results of 10 different exercise machines, check out this ACE-sponsored research study.)

Understanding how to apply MET values can help identify the difference between, for example, working in a seated or standing position. Many organizations are starting to realize the health benefits of providing employees with standing desks. As stated above, standing is classified as 1.8 METs and sitting is only 1.3 METs (falling below the 1.5 MET threshold for sedentary behavior); while that 0.5 MET difference might not seem that significant, an individual can burn almost 30% more calories by standing instead of sitting for an hour.

The formula for converting METs to calories burned can provide a relatively accurate estimate for the amount of calories burned per minute while participating in a physical activity. All that is required to make the estimate is the MET value for the activity being performed and the individual’s body weight (to convert pounds to kg, divide by 2.2):

Formula: MET value x 3.5 x body weight (kg) / 200 = calories per minute

Standing at work for 60 minutes compared to sitting for 60 minutes for a 195-pound (88.6 kg) person is calculated as follows:

Standing:

• METs for standing: 1.8 
• 1.8 x 3.5 x 88.6 / 200 = 2.8 kcal/min x 60 = 168 kcal

Sitting:

• METs for sitting: 1.3
• 1.3 x 3.5 x 88.6 / 200 = 2 kcal/min x 60 = 120 kcal

This is a difference of 48 calories/hour. Considering that it takes approximately 100 calories to walk one mile, replacing just one hour of sitting with one hour of standing is the caloric equivalent of walking half a mile without leaving the workspace. 

Understanding Behavior Patterns

Using MET values is just one way to quantify the negative effects of too much time sitting. As the negative health consequences of sedentary behavior become more widely understood, more research is being conducted to understand behavior patterns; specifically, how much time people spend in a seated, sedentary position and the effects that time has on the human body. 

For example, in one study, researchers observed that up to 68% of adult participants' total waking time was spent in a sedentary position (Dunstan et al., 2012). Another study, which was published in the Annals of Internal Medicine, found that the length of time that an individual spends in a seated position can be linked to a greater risk of death from a number of chronic health conditions, including diabetes, cancer and heart disease. Additionally, the researchers concluded that sitting for lengthy periods of time can have negative consequences on overall health, and that these health consequences are greatly increased for individuals who participate in little-to-no physical activity. “The findings suggest that the health risk of sitting too much is less pronounced when physical activity is increased. We need further research to better understand how much physical activity is needed to offset the health risks associated with extended periods of sedentary time,” explains Avi Biswas, who led the study (Biswas et al., 2015). 

In addition to the physical cost, being sedentary comes with a high economic cost. A United Kingdom study of 2016 healthcare costs related to sedentary behavior found that the costs were almost 1 billion pounds (equivalent to almost $1.3 billion U.S. dollars) and resulted in an estimated 70,000 premature deaths (Heron et al., 2019). 

Many individuals who exercise think that their levels of physical activity mean that they don’t need to be concerned about accumulating sedentary time. An analysis of the research, however, reveals a surprising observation: “Those who reported participating in more than seven hours a week of moderate-to-vigorous physical activity during leisure time, but who also watched TV more than seven hours a day had a 50% greater risk of death from all causes and twice the risk of death from cardiovascular disease relative to those who undertook the same amount of physical activity but watched less than an hour of TV per day” (Dunstan et al., 2012).

While all of this information may seem overwhelming and, frankly, a little depressing, the good news is that the development of activity trackers has given scientists and public health researchers access to greater levels of data for understanding the negative health outcomes of sedentary behavior. With this data, they are beginning to identify solutions that can help move individuals toward improved health outcomes. 

The Mechanical and Physiological Effects of Sitting for Too Long 

The effects of sitting on the body can be organized into two general categories: 

1. Mechanical: Maintaining a consistent, static body position for an extended period of time can change the length-tension relationships of the muscles. When muscle length changes, joint motion is affected. 
2. Physiological: Prolonged periods of sitting creates specific changes in how the various systems of the body function to perform their normal duties. 

Every joint in the body is surrounded by muscles that produce and control movement. When muscles on one side of a joint become too tight from overuse, it can cause the muscles on the other side to become too weak from lack of use; this is called a muscle imbalance. Muscle imbalances are a potential cause of injury because they can affect the position of the joint at rest and change its path of motion during movement.

Remaining in a sedentary, seated position for an extended period of time can create muscle imbalances in the hips. While seated, the hips are flexed, which places the muscles that cause hip flexion in a shortened position. When the hip flexors are shortened, they will change the way the hip joints move. In addition, when the hip flexors are tightened, they reduce the neural activity to the gluteus maximus muscles responsible for extending the hips. If the glutes are not able to generate the force for hip extension, other muscles such as the hamstrings or lumbar erectors could be overworked, which might become a potential mechanism for low-back injury.

Anthony Carey, an ACE Certified Medical Exercise Specialist and creator of the Pain-free Movement Specialist education program, has considerable experience working with clients injured as the result of too much sitting. “In my experience, sitting for too long definitely can be a mechanism of injury,” says Carey. “Sitting for an extended period of time can be provocative for any pre-existing or underlying injuries in the lumbar spine. For example, when the hips remain in a flexed position for a long time, it can change tissue length. Certain muscles like the hip flexors adapt to the hips-flexed position by losing length and becoming tight, while other muscles like the hip extensors can experience a reduced neural drive, which limits contraction rates. When tissue length changes, it reduces kinesthetic awareness and proprioception, which could lead to other injuries.” 

Solutions to Counteract the Effects of Excessive Sitting 

A significant development in recent years that many believe has the potential to influence positive behavior change is the relatively widespread use of fitness trackers and smart watches. Trackers and watches not only help researchers collect data about the time spent sitting that is impacting our health, but the data are being used to help influence healthy behaviors in an effort to reduce lengthy periods of inactivity. Many of these devices feature trackers that monitor the amounts of physical activity performed and estimate the number of calories burned based on heart rate, body weight, age and other variables, as well as timers that remind users to move at regular intervals. 

Activity trackers and smart watches not only allow scientists and researchers to not only measure time spent being sedentary, but also to study and quantify behavior patterns and the amount of time spent being physically active. For instance, studies are using activity trackers to determine how calories are expended during specific types of exercise as well as non-exercise activities, such as walking to run errands or performing household chores. These data sources provide researchers with information to better understand how to develop interventions that can elevate levels of physical activity. For example, Dunstan and colleagues (2012) suggest that “new evidence linking prolonged sitting time with significant compromises to cardiometabolic health indicates that even in physically active adults, concurrent reductions in the amount of time spent sitting is likely to confer health benefits.” In this case, if the timers and alarms on activity trackers are used to remind individuals to stand and move on a regular basis (and wearers actually pay attention to the alarm and get up and move around), it could benefit overall health.

To overcome the effects of sedentary behaviors, the second edition of the Physical Activity Guidelines for Americans, released in 2018, recommends that adults accumulate between 150 and 300 minutes a week of moderate-intensity cardiorespiratory activity or 75 minutes a week of vigorous-intensity cardiorespiratory activity or a combination of the two. The Guidelines acknowledge that physical activity can provide many health benefits, including reducing the effects of sedentary behavior, yet they do not provide many specific strategies or solutions. As a result, this provides a tremendous opportunity for health and exercise professionals who can identify specific solutions to help clients improve their levels of physical activity, not only to improve general health but to directly counteract the physiological effects of time spent in a chair. This can be accomplished by designing specific exercise and stretching programs that can help clients undo the effects of sedentary behaviors. To help identify practical solutions that work, a number of health and exercise professionals contributed the solutions they use with their clients and group fitness classes. 

This is such an important issue that John Sinclair, a health coach based in Fort Lauderdale, Fla., started the website sevenmovements.com in an effort to educate individuals about the need to move throughout the day. “Reducing the effects of sedentary behavior does not require a lot of exercise but it does require a specific strategy and consistent activity,” says Sinclair. “There is no one exercise that can solve all of the issues from excessive sitting; however, it is important to educate clients on a variety of self-care and movement strategies that can be implemented throughout a day.” Sinclair goes on to explain that, after receiving numerous requests for movement solutions, “it made sense to simplify the information to seven movements and put it all on a website so that I could help not only my clients, but anyone who wants to add more activity to his or her life.” 

When it comes to spending a lot of time at a workstation, says Carey, variability—or moving around to constantly change position—is key. He also recommends thoracic spine and hip stretches to his clients so they can keep these important body parts mobile throughout the day to reduce overall tightness (see sidebar). “I recommend that to reduce the effects of sitting it is important to take activity breaks throughout the day in order to move the T-spine and hips in multiple planes of motion. Moving the joints in all directions is important for optimal joint health and I make sure that clients understand this,” said Carey. 

Dr. Rick Richey, a co-founder of ReCOVER, the first fitness studio in New York City to focus solely on recovery from exercise, tries to keep things simple for his clients with suggestions like standing to make phone calls and using alarms as reminders to get up and move. “Stretching is key. Low-back discomfort is all too common in our chair-bound society, [but] stretching the hip flexors and other leg muscles can help minimize overall stress on the lumbar spine and encourage movement,” he explains.

Sonja Friend-Uhl, an ACE Certified Health Coach based in Boca Raton, Fla., challenges her clients to break up their desk time at work with physical-activity challenges. “I try to help clients understand that making the time for little activity breaks such as 10 to 15 body-weight squats, standing knee hugs or side lunges can improve their energy while reducing overall muscle tightness,” says Friend-Uhl. 

Find a friend or coworker for activity breaks, urges Nicole Goldstein, a San Diego−based ACE Certified Personal Trainer. “I encourage clients to find someone else to do activity breaks with throughout the day, which can help hold them accountable and make it a little more enjoyable. Plus, it’s a great solution for meetings at work. A walking meeting is a great way to accomplish a task while increasing overall levels of physical activity making it a win-win,” says Goldstein. 

Adena Muncey, a personal trainer and yoga instructor in Hyderabad, India, uses education to help clients learn about the dangers of excessive sitting. “I find that educating clients on the negative effects of prolonged sitting helps them to understand the benefits of setting an alarm for a reminder to move. After these talks, many of my clients will relate how much they enjoy having their Apple Watch remind them to stand and move throughout the day,” she says. Ola Alghazzouli, a personal trainer at George Mason University in Northern Virginia, is a fan of walking meetings and urges clients to make the effort to go talk to coworkers in person as opposed to sending an e-mail or picking up the phone.

And finally, Cecily Guest, a San Francisco−based yoga instructor, sees the issue of too much time spent sitting as a time-management issue more than anything else. “The real problem, in my opinion, is that many people simply are not using their time efficiently. Each task at your desk should have a certain amount of time attached to it. Sitting there any longer than it takes to finish a task simply is not efficient,” argues Guest. “Complete one or two tasks and then get up to move as a sign of completing them and transitioning to a new task. If one task needs a lot of time, then it should be broken up into parts. People say that time is our most valuable commodity. Sitting, sitting and sitting is a sign that you’re not using your time efficiently.”     

Summary

Sitting is something that everyone has to do at some point throughout the day. Like a lot of things in life, a little bit of sitting is not bad for you, and for many people it is simply unavoidable. Unfortunately, as the research continues to show, excessive amounts of sitting could contribute to an early death. Educating clients about the negative effects of prolonged sitting while also providing them with specific strategies can help ensure that they have the knowledge and skills to move closer to their specific health and wellness goals.