Sitting Disease, Is It Possible to Overcome?

Sitting Disease, Is It Possible to Overcome?

Our society is being plagued with the preventable, sitting disease. According to the World Health Organization, approximately 3.2 million deaths each year are attributable to insufficient physical activity. The lack of physical activity is on the rise due to the fact that we are sitting more than we ever have.

By now, you have most likely heard the phrase, “sitting is the new smoking”. As the number of sedentary jobs have increased 83% since 1950, not only are we sitting more at work, but we are also sitting on our commutes, when we eat meals, and during our leisure or relaxing activities. A typical office worker can sit around a total of 15 hours a day!

While the phrase, “sitting is the new smoking” has grown in popularity in the past few years, it is not entirely accurate. If you look at our society as a whole, sitting is actually worse than smoking.¹ Dr. James Levine, the director of the Mayo Clinic at Arizona State University Obesity Solutions Initiative explains that “sitting is more dangerous than smoking, kills more people than HIV, and is more treacherous than parachuting.”²

It only takes two continuous hours of sitting to see an increase in the risk of suffering from an avoidable, lifestyle disease.¹ ³

“We are sitting ourselves to death” – Dr. James Levine²

Not only are we witnessing the harmful effects of sitting on our bodily functions, but also myriad of musculoskeletal pains and injuries.

Effects of this sitting disease on our bodies

We can look at how this disease affects us, both from a physiological and musculoskeletal standpoint.

Physiologically- our bodily functions

The most obvious symptom of the sitting disease is obesity. The more we sit, the less energy we expend, and the more fat we store.

But this disease goes beyond obesity. It is known to create actual changes in the cellular makeup of our muscles while also causing or increasing the risk of¹ ⁴:

● Diabetes
● Heart disease
○ High blood pressure
○ High cholesterol
● Cancer
● Premature death
● Depression

Fundamental changes in biology occur if you sit too long”¹

At the cellular level, the cells that make up our muscles are constantly responding to their environment. If we sit all day and barely contract our muscles, they will adapt to this. Even if you work out for an hour each day, that does not stop the negative effects that come from sitting for 8-10 hours at work. Your muscles are spending the most time in a non-contracted, non-working state.

Let’s continue down the cellular path. The changes that our cells go through while sitting too much actually inhibit different genes (located inside of our cells) that break down triglycerides and modulate glucose metabolism. As we sit, our own cells change and genes stop performing the tasks they are supposed to do!

When it comes to a decrease in breaking down of triglycerides and a slowing of glucose metabolism, our risk of high cholesterol, heart disease, and diabetes rises.⁵

As we sit, not only do our cells stop doing what they are supposed to be doing, but our body’s normal processes are stalled or stopped completely. Our cells and therefore our muscles stop moving and using fats and sugars and we inevitably store this as excess fat and we see our blood sugar levels and cholesterol numbers start to rise.

It does not take much time for these changes to happen. Even after just one day of sitting, someone with overall healthy cholesterol levels can experience a spike high enough to be well within the levels of someone that has heart disease. If one continues with this day after day, without changing their sitting habits, the risk of heart disease and having a heart attack increases.¹ ⁴

Metabolic, lifestyle diseases are not the only thing to be concerned about. Cancer may seem like a shocking symptom of the sitting disease. However, according to the American Cancer Association and the Journal of the American Medical Association (JAMA), greater amount of sitting time is linked with higher rates of cancer. Specifically in the study published in JAMA, the participants that had spent the most hours sitting were 82% more likely die from cancer than those in the group that sat the least.⁶

Honestly, no matter how you look at it, whether this sitting disease is affecting your heart, raising your blood sugar and cholesterol, or causing an increase in the risk of cancer, the risk of premature death rises significantly with sitting. People who sit for more than 11 hours each day have a 40% increase in chance of premature death than people that sit for 4 hours or less.¹

Musculoskeletal- the aches and pains of this sitting disease

Besides the fact that this disease can wreak havoc on our physiological processes, it can also hinder our musculoskeletal system, especially the low back.

Low back pain is one of the most common injuries that results from prolonged sitting.

Because of the very minimal dynamic movement and activation of the low back muscles while sitting, the load and stress is transferred to other parts of the spine, like our spinal discs and ligaments.⁷ These structures are not meant to bear constant load for prolonged periods of time like our muscles, especially our postural muscles, are. Ultimately, sitting disease leads to disuse and weakening of our musculoskeletal system. ⁷ ⁸ And, this continues the pain cycle.

How to overcome the sitting disease

Is it possible to overcome this man-made sitting disease? Well, exercise may seem like the no brainer answer. If you have to sit 8 hours a day at work, not including the time you sit for other normal daily activities, but you work out for 30-60 minutes each day, then you must be okay!


Research upon research proves that exercising regularly does not combat the negative effects of the sitting disease.

The basic premise is that sitting too much is not the same as lack of exercise and, as such, has its own unique metabolic consequences. ⁴

The same cellular and genetic research mentioned above, also demonstrated that exercise is not enough to combat the effects of sitting and that a balance of muscle inactivity and high duration, low intensity physical activities is more beneficial when compared to sitting all day with 30-60 minutes of high intensity exercise.⁵

In more simple words, a combination of sitting and frequent, long bouts of low intensity exercise, movement, or physical activity is more beneficial in helping to overcome the negative effects of the sitting disease when compared to sitting all day and then exercising really hard for an hour or so.⁴ ⁵

To truly overcome this sitting disease, we need to sit less. Sitting less is easier said than done. We can’t help the fact that we have a commute to work, that it is socially acceptable to sit and eat at the dinner table, and that most of us are desk bound at work. But we can help the fact by incorporating active sitting in addition to regularly scheduled work breaks.

Active sitting allows you to continuously use your postural muscles to stay balanced and comfortable in your chair. Using a chair, like the Symbiotic Chair, that has a balancing mechanism allows you to use your core while the chair moves with and follows you. This a simple, yet effective way to add long duration, low-intensity physical activity to your work day.

Clearly, our bodies are adaptable and respond to our environment. Set yourself up for success and for your best chance at living a long and healthy life but incorporating active sitting and overall, more low intensity physical activity throughout your work day.

Don’t let this sitting disease bring you down.

Author: Adria Biasi

Author is US based Doctor of Physical Therapy and Board Certified Orthopedic Specialist


1) James A. Levine. Get Up! Why Your Chair Is Killing You and What You Can Do About It (New York: St. Martin’s Press, 2014): 70-71.

How Can Active Sitting Improve your NEAT?

How Can Active Sitting Improve your NEAT?

Our society promotes a very sedentary lifestyle. We sit at work, on our commutes, while at school, during meals, and to relax. In the US, we can even sit while we wait for our groceries to be brought to our car and in the drive through bank or pharmacy. Not only are we sitting more and more, but we are also decreasing our non-exercise activity thermogenesis, also referred to as our NEAT.

Despite our sedentary environment, we have many ways to help decrease our overall lack of movement. Active sitting is one of these solutions.

What is NEAT?

Non-exercise activity refers to the activities you complete outside of your exercise routine. This can include walking around the grocery store, using the stairs, gardening, and even fidgeting. Thermogenesis refers to burning calories, or using energy.

Together, non-exercise activity thermogenesis refers to the amount of calories you burn, or the amount of energy you use to complete activities outside of your exercise routine.

There are 3 components that make up NEAT. This includes body posture, ambulation, and all other movements, the most impactful being fidgeting.¹ How you hold yourself, how much you walk, and how much you fidget play a significant role in your NEAT.

Why does NEAT matter?

NEAT matters most when you live a very sedentary lifestyle. This includes being desk bound at work. A sitting body does not expend very much energy. Therefore, excess calories, or energy, becomes stored in our body as excess weight.

These excess calories, resulting in increasing bodyweight, overtime can lead to obesity. And obesity is associated with the leading causes of preventable deaths, including diabetes, heart disease, stroke, and some cancers.

By simply increasing your NEAT, you can be saving your life.

According to Dr. James Levine, the director of the Mayo Clinic at Arizona State University Obesity Solutions Initiative, obesity was rare a century ago. The only thing that has really changed is an increase in sedentary jobs and the overall chair-enticing environment.

To test this, researchers gave volunteers an extra 1,000 calories a day for 56 days. Some of the participants did not gain weight while others did. The difference between the volunteers? Their amount of NEAT. Some had the ability to switch on their NEAT while others continued to stay seated as they overeat. The end result? The extra calories turned into body fat.²

For example, someone who is desk bound for a typical work day of 8 hours will burn around 300 calories from NEAT. Someone who has a more active job such as a waitress will burn around 1,300 calories from NEAT in an 8 hour work day. That is a difference of 1,000 calories a day. Overtime this adds up to either the employee becoming obese or staying within an appropriate, healthy weight.³

It is really your NEAT that makes up a good bulk of your energy expenditure each day. It can range from 15% of our total energy expenditure, up to as much as 50% in the fidgety, active people.² Even just standing or lightly walking can increase your NEAT by 350 kcal per day.¹ Adding slightly more movement to your everyday activities can improve your life exponentially.

Dr. Levine states:
“NEAT is the energy expended for everything we do that is not sleeping, eating or sports-like exercise. It ranges from the energy expended walking to work, typing, performing yard work, undertaking agricultural tasks and fidgeting. Even trivial physical activities increase metabolic rate substantially and it is the cumulative impact of a multitude of exothermic actions that culminate in an individual’s daily NEAT.”

How does active sitting help?

Many office workers spend up to 90% of their work day seated!⁵ Active sitting, which is exactly what it sounds like, offers a way of letting employees move and use their muscles while also staying productive at their desks.

Opposite of sitting still, active sitting will increase the use of your musculoskeletal and balance systems. While working more and more muscles to help maintain good posture and balance, you will also be increasing your NEAT.

Some chairs used for active sitting, like the Symbiotic Chair, include a balancing mechanism, meaning that you get to use your own muscles to help stay balanced and in control of the chair. As you reach forwards, turn around, or during any other movement, you will work your core muscles to help you move in the chair while the chair follows you to help keep you supported.

You could even consider active sitting as a way of fidgeting in your seat. And we all know how well fidgeting works to increase your NEAT, keeping you healthy and free from gaining extra weight.

Active sitting simply encourages better posture and more movement when compared to a traditional office chair. Your core, hips, and even your shoulder muscles work harder during active sitting, not only increasing your NEAT, but maybe even your strength.

Although you may not burn as many calories as you would during an hour at the gym, the increase in movement while sitting on a dynamic chair will promote an increase in your NEAT. Research has found that active, or dynamic sitting, in a chair that has a tilting, balance mechanism, allows users to perform the equivalent of light physical activity while sitting.⁶

NEAT is a very simple and natural human phenomenon that is sometimes forgotten about in our sedentary world. Use NEAT to your advantage, helping you to stay within a healthy body weight while avoiding so many other lifestyle diseases. If you find yourself having trouble with adding movement throughout your day, try an active sitting chair while you sit at your desk. You may be surprised by the full body benefits.

Author: Adria Biasi

Author is US based Doctor of Physical Therapy and Board Certified Orthopedic Specialist


3) Kelly Starrett, Deskbound, Standing Up to a Sitting World (Victoria Belt Publishing Inc., 2016): 18-19


Active Sitting as a Solution for Sitting Induced Low Back Pain

Active Sitting as a Solution for Sitting Induced Low Back Pain

Our bodies were not designed for sitting. If you travel back in time, you will find that our ancestors were too busy hunting and gathering to have any time to sit. And, if you think back to your childhood, you will remember that you spent so much more time running, jumping, playing, and much less time sitting.

How did we transform from such an active past to such as inactive present?

Unfortunately, it is today’s modern workforce that is mostly to blame. To make matters worse, our society is faced with the terrible COVID-19 pandemic. People who previously went into the office are now working from home with badly improvised work stations. From sitting on the couch with a laptop to slouching at the kitchen table, we will undoubtedly observe an even greater increase in the amount of sitting and the negative consequences that come with it, including low back pain.

Epidemic proportions of sitting induced low back pain

Low back pain has become an epidemic in our modern society and is now the leading cause of work absence and activity limitations throughout the world.¹ Even if you recover from your first episode of low back pain, chances are, you are going to experience another episode at some point in your life.

Why is this happening? Sitting. As our society continues to sit more and more, the prevalence of low back pain directly increases.

Humans are constantly sitting. We sit to eat, drive, and work. We sit to relax and during other leisure activities. In fact, working age adults in England sit for an average of 9.5 hours per day.

As you go into the office on Monday morning and have a seat at your desk, you may start with relatively good posture. Throughout the day, your posture may worsen, and over the course of a few days, weeks, months, your body adapts to this posture. Areas of the body get tight, other areas become weak, bad habits develop, and pain arises.

Why can’t we simply keep that good posture all day long?

Our bodies intuitively look for ways to decrease energy usage. So, instead of relying on muscles to help maintain a strong posture, we begin to rely on other passive structures such as ligaments, joints, and intervertebral discs. These parts of our bodies were not made for prolonged load-bearing. Therefore, the more we rely on these structures, the more pain we experience, the weaker our back muscles become, and the cycle continues.²

What makes back pain even worse is static sitting. Static sitting refers to maintaining the same posture or position throughout an activity or task. A continuous load is placed through muscles, tendons, joints, discs, and other body parts. This static sitting behavior has been found to be associated with chronic low back pain and pain related disability.³

So much research has been done on sitting induced low back pain. There is no denying the direct relationship that sitting time, whether for work or leisure, has on low back pain intensity.³

While avoiding sitting may be helpful in decreasing pain, some people cannot avoid sitting at least for some portion of their work day. So, if you have to sit, you may as well sit in the best posture with the most optimal muscle activation patterns you can.

How active sitting helps to prevent and reduce sitting induced low back pain

The opposite of static sitting, discussed earlier, is active sitting. Active sitting refers to engaging muscles, especially of your core, while in a sitting position. One could achieve the effects of active sitting by constantly getting up and moving around, but this is not very efficient for the workplace. Instead, someone could work on actively sitting by using the Symbiotic chair, which is an ergonomically and environmentally friendly chair.

This active sitting chair does not allow you to just passively sit while at work. Preferably, it stimulates your postural and trunk muscles that help keep your body upright and stable. Chairs that allow active sitting are built to still provide support to your sitting bones and low back, while also challenging the user’s muscles by having a flexible seat, mounted on a balancing mechanism. Whether reaching forwards to grab something, turning to answer the phone, and everything in between, this mechanism allows the person to use their own muscles to move around and stay balanced in their chair while still receiving adequate support.

Chairs without this balancing mechanism do not engage the user’s core muscles. Without using these muscles, the body relies on non-contractile tissues for support. And as we learned earlier, this is what can create the vicious cycle of pain.

However, with the use of the balance mechanism, there is an increase in trunk motion, higher muscle activity, constant changes in pressure to the joints, discs, and other structures of the spine, and overall less low back pain.⁴ This postural variation aspect of active sitting is a key component in combating sitting induced low back pain epidemic.

Postural variation

Postural variation is really the outcome of active sitting.

To better understand this concept, think of riding a horse. If you have ever ridden a horse, you may have noticed that it doesn’t take a significant amount of effort to stay upright and balanced. The horse is walking and moving around, while you stay balanced on top. This balanced poise while sitting for long horseback rides is the same thing that happens with active sitting. Your body is constantly shifting and moving to stay balanced, utilizing postural muscles, but without significant fatigue or realization that you are even doing this.

Now imagine sitting on the couch and watching a movie without any breaks. How do you feel when you stand up once the movie is over? Your back is probably stiff and it may take a few minutes to feel back to normal. This is because your couch or other chair does not have the ability to allow you to have postural variation.

Research has even found that in one hour of sitting, people that develop pain actually move much less than people that do not develop pain. This particular study found that it had nothing to do with the posture, but with the amount of movement. You can think of this as fidgeting for the spine.⁵

While it is unfortunate that so many people have to sit at work, we are lucky enough to have the resources available to create better sitting environments. The path to reducing low back pain, and avoiding it altogether starts with active sitting.

With active sitting, you will be able to have constant postural variation with the ability to use your own muscles to find balance, ending the sitting induced low back pain cycle.

Author: Adria Biasi

Author is US based Doctor of Physical Therapy and Board Certified Orthopedic Specialist