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Sedentary Behavior: A Silent Killer?

Table of Contents

Key Takeaways:
  • The folks of planet earth are not nearly physically active enough, and its costing us a lot
  • Physical activity has a significant number of benefits, spanning from decreasing risk of death and cancer to increased bone strength and improved cognition
  • Primary care providers only educate 1/3 of their patients on the benefits of physical activity
  • Physical therapists are primed to talk about and implement physical activity in their plans of care and practice

Why Physical Activity?

I’m certain that everyone on the planet kinda knows that they need to exercise more and be more active, or at least has a sort of intuition about it. Just like they know they need to eat more fruits and vegetables, sleep more and not smoke.

A big part of the problem with people not being physically active enough is that most folks feel just fine with being inadequately active. Of course, this is the crux of behavior change issues. How do you convince someone that they need to change when they feel like they don’t. Usually they end up asking the question of, whats the big deal?

One aspect of the answer to this question is that a whopping $117B per year¹ is spent on conditions related to sedentary behavior, not to mention that physical inactivity caused 6%–10% of the cases of premature mortality, coronary heart disease, type 2 diabetes, breast cancer and colon cancer globally.²

In addition to that enormous amount of money that could be better spent elsewhere, being physically active enough can help prevent:

  • All-cause mortality Aka dying by any means, without specifics.
  • Diseases such as coronary heart disease, stroke, cancer at multiple sites, type 2 diabetes, obesity, hypertension, and osteoporosis.
  • Risk factors for disease, such as being overweight or having obesity, hypertension, and high blood cholesterol.
  • Conditions that affect cognition, such as depression and anxiety, and Alzheimer’s disease.
  • Falls or injuries from falls.
  • For pregnant women, reduced risk of excessive weight gain, gestational diabetes, and postpartum depression.

Being physically active enough can also help improve:

  • Physical fitness, such as aerobic capacity and muscle strength and endurance.
  • Functional capacity, or the ability to engage in activities needed for daily living.
  • Brain health benefits, including possible improved cognitive function, improved sleep and quality of life.³
The Physical Activity Guidelines

Now that you have a better idea as to the why of physical activity, lets chat about what guidelines you should be holding your patients and yourself accountable to. 

  • Adults and older adults should do muscle-strengthening activities of moderate or greater intensity and that involve all major muscle groups on 2 or more days a week.
  • Adults should do at least 150 minutes (2 hours and 30 minutes) to 300 minutes (5 hours) a week of moderate-intensity, or 75 minutes (1 hour and 15 minutes) to 150 minutes (2 hours and 30 minutes) a week of vigorous-intensity aerobic physical activity.³

What counts as moderate or vigorous you ask?

  • Moderate intensity aerobic activity include walking briskly,  playing doubles tennis, or raking the yard.
  • Vigorous intensity aerobic activity include jogging, running, or participating in a strenuous fitness class. 

Despite all of this information, only 1 in 4 adults and adolescents meet these guidelines, including both the aerobic and muscle strengthening categories. It seems that there is still work to be done. 

The fact that only ⅓ of patients going to their primary care provider received physical activity education doesn’t help either.⁶

Translation into physical therapy world?

The final and biggest question that needs to be answered here is what do you as a physical therapist do with this information?

There are a few key things to bring to the front of your brain

  1. If appropriate, you should include physical activity in each one of your sessions.
    • Splitting aerobic activity into shorter bouts of 10 minutes and accumulating multiple shorter sessions per day has been shown⁵ to be just as beneficial for the cardiovascular system as doing one big chunk of cardio. In a nutshell, if every minute counts, then you need to start counting the minutes, wherever you can get them in.
  2. You have the time that other care managers don’t
    • Primary care managers cite⁶ lack of time, lack of education and needing to address multiple complex medical issues in one session as a few barriers to not making physical activity recommendations
    • As a physical therapist, you are lucky in that you likely get 30-60 minutes with patients, multiple times per month
  3. You want to do no harm
    • Just like every physical therapist before and after you, you want the best for your patients.
    • If there was something that you could focus on that would significantly decrease the risk of them dying or having a decreased quality of life, why wouldn’t you?
    • Wouldn’t that something take precedent over more sedentary or passive treatments? Especially considering active and passive interventions seem to produce similar outcomes?⁷
  1. Singh R, Pattisapu A, Emery MS. US Physical Activity Guidelines: Current state, impact and future directions. Trends Cardiovasc Med. 2020 Oct;30(7):407-412. doi: 10.1016/j.tcm.2019.10.002. Epub 2019 Oct 17. PMID: 31677904.
  2. Katzmarzyk PT, Friedenreich C, Shiroma EJ, Lee IM. Physical inactivity and non-communicable disease burden in low-income, middle-income and high-income countries. Br J Sports Med. 2022 Jan;56(2):101-106. doi: 10.1136/bjsports-2020-103640. Epub 2021 Mar 29. PMID: 33782046; PMCID: PMC8478970.
  3. Physical Activity Guidelines for Americans 2nd edition
  4. Barnes PM, Schoenborn CA. Trends in adults receiving a recommendation for exercise or other physical activity from a physician or other health professional. NCHS data brief, no 86. Hyattsville, MD: National Center for Health Statistics. 2012.
  5. Murphy, M.H., Lahart, I., Carlin, A. et al. The Effects of Continuous Compared to Accumulated Exercise on Health: A Meta-Analytic Review. Sports Med 49, 1585–1607 (2019). https://doi.org/10.1007/s40279-019-01145-2
  6. Jones M, Bright P, Hansen L, Ihnatsenka O, Carek PJ. Promoting Physical Activity in a Primary Care Practice: Overcoming the Barriers. Am J Lifestyle Med. 2019 Aug 5;15(2):158-164. doi: 10.1177/1559827619867693. PMID: 33786031; PMCID: PMC7958222.
  7. Hopewell S, Keene DJ, Heine P, Marian IR, Dritsaki M, Cureton L, Dutton SJ, Dakin H, Carr A, Hamilton W, Hansen Z, Jaggi A, Littlewood C, Barker K, Gray A, Lamb SE. Progressive exercise compared with best-practice advice, with or without corticosteroid injection, for rotator cuff disorders: the GRASP factorial RCT. Health Technol Assess. 2021 Aug;25(48):1-158. doi: 10.3310/hta25480. Erratum in: Health Technol Assess. 2022 Aug;25(48):159-160. PMID: 34382931; PMCID: PMC9421560.