Sedentary lifestyles are killing us – we need to build activity into our everyday lives, not just leave it for the gym. By Vybarr Cregan-Reid
The long read from the Guardian Thu 3 Jan 2019 01.00 EST Last modified on Thu 3 Jan 2019 06.54 EST
theguardian.com/news/2019/j...
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This is the time of year when trainers are mined from under beds and gym kits are disinterred from the bottom drawer. Google searches relating to physical fitness peak in January. Many people even trawl the web to find out about “desk exercises” and “workouts on the go” in case they are too busy to use their new gym memberships.
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Our relationship with exercise is complicated. Reports from the UK and the US show it is something we persistently struggle with. As the new year rolls around, we anticipate having the drive to behave differently and become regular exercisers, even in the knowledge that we will probably fail to do so. Why do we want to exercise? What do we expect it to do for us? We all know we are supposed to be exercising, but hundreds of millions of us can’t face actually doing it. It is just possible the problem lies at the heart of the idea of exercise itself.
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Exercise is movement of the muscles and limbs for a specific outcome, usually to enhance physical fitness. As such, for most of us, it is an optional addition to the working day – yet another item on a long list of responsibilities alongside the fulfilment of parental duties or earning money to put food on the table. But because the principal beneficiary of exercise is ourselves, it is one of the easiest chores to shirk. At the end of the working day, millions of us prefer to indulge in sedentary leisure activities instead of what we all think is good for us: a workout.
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Fitness crazes are like diets: if any of them worked, there wouldn’t be so many. CrossFit, the intensely physical, communal workout incorporating free weights, squats, pull-ups and so forth, is still less than 20 years old. Spin classes – vigorous group workouts on stationary bikes – have only been around for about 30. Aerobics was a craze about a decade before that, although many of its high-energy routines had already been around for a while. (The pastel horror of 1970s Jazzercise is probably best forgotten.) Before that, there was the jogging revolution, which began in the US in the early 1960s. The Joggers Manual, published in 1963 by the Oregon Heart Foundation, was a leaflet of about 200 words that sought to address the postwar panic about sedentary lifestyles by encouraging an accessible form of physical activity, explaining that “jogging is a bit more than a walk”. The jogging boom took a few years to get traction, hitting its stride in the mid- to late-80s, but it remains one of the most popular forms of exercise, now also in groups.
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The exercise craze that dominated the 1950s was, oddly, not even an exercise. The vibrating exercise belt promised users could achieve effortless weight loss by having their midriffs violently jiggled. It didn’t work, but you can still find similar machines available for purchase today.
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These fads even came with their own particular fashions – legwarmers, leotards, Lycra. So is our obsession with fitness doomed to be the stuff of embarrassing passing “phases”? Is exercise itself a fad?
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It is not news that we are becoming more sedentary as a species. The problem has been creeping up on us for generations. As industry and technology solved the physical demands of manual labour, they created new challenges for the human body.
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Evidence about bone strength and density gleaned from fossils of early humans suggests that, for hundreds of thousands of years, normal levels of movement were much higher than ours today. And the range of work required of the human body to subsist was sizeable: everything from foraging for food and finding water to hunting, constructing basic shelters, manufacturing tools and evading predators. The fossil record tells us that many prehistoric humans were stronger and fitter than today’s Olympians.
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A hundred years ago, while life was easier than it had been for our hunter-gatherer forebears, it was still required that shopping was fetched, floors scrubbed, wood chopped and washing done by hand. Modern urban environments do not invite anything like the same kinds of work from the body. It is not easy to clock up those miles when cities are built to prioritise cars and treat pedestrians as secondary. We are not assisted by our environments to move like we used to, for reasons tied up with motivation, safety and accessibility.
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Technological innovations have led to countless minor reductions of movement. To clean a rug in the 1940s, most people took it into their yard and whacked the bejeezus out of it for 20 minutes. Fast-forward a few decades and we can set robot vacuum cleaners to wander about our living rooms as we order up some shopping to be delivered, put on the dishwasher, cram a load into the washer-dryer, admire the self-cleaning oven, stack some machine-cut logs in the grate, pour a glass of milk from the frost-free fridge or thumb a capsule into the coffee maker. Each of these devices and behaviours is making it a bit more difficult for us to keep moving regularly throughout our day.
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As we step through various innovations, we tend to think of the work that is no longer required as “saved”. Cleaning a rug once burned about 200 calories, while activating a robo-vac uses about 0.2 – an activity drop of a thousandfold, with nothing to replace it. Nobody, when they buy a labour-saving device, thinks: “How am I going to replace that movement I have saved?”
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A great deal of energy is also saved in the kinds of work that we now do. Towards the end of the 19th century, the labour market began to change radically. Office clerks were the fastest-growing occupational group in the latter half of the period. The UK census of 1841 suggests that 0.1% of working people performed administrative or office work at that time. By 1891, the number had increased twentyfold, and only kept increasing. One recent US survey estimated that 86% of today’s workforce is in sedentary employment.
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As a result of our leisurely lifestyles, our bones are thinner and our muscles weaker, and while these are not problems in themselves, they are part of the larger, fleshier story whereby the diminution of movement is shackling humans to the very biggest global killers. Heart disease and strokes are responsible for about 17 million deaths a year, according to the World Health Organization.
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All-day activity trackers like the Apple Watch and the Fitbit (which is only a decade old this year) have attempted to make an intervention into this sandpit of sedentariness. Widespread use of wearables may be helping people to move more, but technology created this problem of sedentary work and leisure, and cannot solve it alone.
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A 2015 report by the Academy of Medical Royal Colleges called Exercise – the Miracle Cure said that regular exercise can assist in the prevention of strokes, some cancers, depression, heart disease and dementia, reducing risk by at least 30%. With regular exercise, the risk of bowel cancer drops by 45%, and of osteoarthritis, high blood pressure and type 2 diabetes by a whopping 50%.
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Exercise, in these terms, is not a fad, or an option, or an add-on to our busy lifestyles: it is keeping us alive. But before it can work for us, our whole approach needs to change.
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As a result of the Miracle Cure report, doctors were urged to promote regular exercise among their patients. Humans obviously need regular activity, but the modern world strives to take exertion out of our lives. Modernity is characterised by imperatives to simplify, improve and maximise efficiency. In much the same way, medical bodies trying to motivate the population to exercise promise big results with the absolute minimum of disruption to our busy, seated lives.
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Anyone researching exercise strategies this new year will find that the government recommends “at least 150 minutes of moderate aerobic activity such as cycling or brisk walking every week and strength exercises on 2 or more days a week that work all the major muscles (legs, hips, back, abdomen, chest, shoulders and arms)”.
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If 150 minutes – or half an hour five times a week – is too much for you, and the data suggests that for most of us it is, another public health strategy promotes the efficacy of being active for just 10 minutes a day. Public Health England launched its Active10 campaign on the grounds that just 10 minutes’ brisk walking each day “counts as exercise” and “can reduce your risk of serious illnesses like heart disease, type 2 diabetes, dementia and some cancers”.
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Even less time is required for high-intensity interval training (HIIT), which can involve bouts of just 20 seconds of intense effort a few times a week. It seems there is good evidence for the efficacy of very short bursts of strenuous anaerobic exercise, such as sprinting or cycling hard, followed by a brief recovery period. Interval training may improve insulin sensitivity and oxygen circulation, and increase muscle mass. But one of the early researchers into HIIT, kinesiologist Dr Martin Gibala, worried that despite its benefits, it required “an extremely high level of subject motivation”, because all-out exertion is unpleasant and can lead to dizziness, vomiting or injury. “Given the extreme nature of the exercise,” he wrote, “it is doubtful that the general population could safely or practically adopt the model.”
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While all of these three modes of exercise are effective in different ways, and each has its proponents and committed followers, none is an all-round solution for a “fit” human body. But the problem is not really with the exercises themselves; it is what we tend to do in between those bursts of activity.
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The health effects of being sedentary are as common and recognisable as they are serious. Anxiety, depression, heart disease, breast and colon cancer, type 2 diabetes, high blood pressure, obesity, osteoporosis, osteoarthritis and the leading cause of global disability, back pain, are all driven by sedentary behaviours.
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For our bodies to function properly, they operate on the assumption that we will be burning calories throughout the day, and not in short bursts. It is clear that periods of sedentariness are bad for the human body, and some exercise is always going to be better than none; the issue is not really to do with the types of exercise, but with our approach to them and what we expect them to achieve. We know from the data that the human relationship with exercise is predominantly characterised as both optional and additional to an otherwise sedentary life, which itself causes a ton of problems. As long as physical activity is divorced from the real work of our lives, we will find reasons for not doing it.
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No matter how low the institutional expectations for physical activity drop, more of us fail to meet them each year. A Public Health England survey last year found that people in England are becoming so inactive that 40% of those aged between 40 and 60 walk briskly for less than 10 minutes a month. The reasons are numerous, but they seem to be connected to our notion of exercise, and the difference between short bursts of running or cycling and low-level, sustained physical activity. If we go back to the beginnings of exercise, we can see why it is still so problematic for us today.
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The rise of exercise is synonymous with the rise of leisure. We associate this with the start of the Industrial Revolution, but in fact it dates from much earlier. Once humans settled and began to build, several thousand years ago, hierarchies began to form, particularly in cities, as did the gap between master and servant. To be one of the elite meant others were doing the physical work for you. For the masters, there was time to fill, and into this space grew the idea of leisure. Exercise also emerges here, in the imbalance created in the spread of labour performed across a population. Ever since, we have seen a powerful link between exercise and inequality.
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The wealthy men of ancient Greece, deprived of work by their slaves and with little else to do, invented a new place called the gymnasium, an open space in the city where they could strip off and gambol about naked, competing in made-up challenges to keep each other fit for war.
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Later, the Romans also celebrated the value of exercise. Cicero, the Roman politician and lawyer, said: “It is exercise alone that supports the spirits and keeps the mind in vigour.” Pliny the Younger, a writer and also a lawyer, said: “It is remarkable how one’s wits are sharpened by physical exercise.” Like their Greek gym buddies, these men were privileged and wealthy. They understood that even though the slave class did their work for them, exercise and physical activity were essential for a long and sane life.
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After the Greeks and Romans, exercise all but disappeared from western culture. It didn’t resurface properly until the 18th century, when inactivity became a problem for a certain class of gentleman. In 1797, the Monthly Magazine announced a new patent for Francis Lowndes’ Gymnasticon, the earliest of the static exercise machines – a frame in which the user sat, turning a spindle with his arms and operating a treadle with his feet. The article noted that “when peculiar or sedentary occupations enforce confinement to the house, it promises to be equally useful to the healthy as to the sick. The merchant, without withdrawing his attention from his accounts, and the student, while occupied in writing or reading, may have his lower limbs kept in constant motion by the slightest exertion, or, the assistance of a child.” The handle on the contraption’s lower spindle was arranged so that, if desired, a child could be employed to turn the wheel, to save the user valuable energy.
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In the early 20th century, calisthenics became popular among people with limited means of expending physical energy. In the opening pages of EM Forster’s Howards End, from 1910, we are introduced to the Wilcox family as they come and go in their country-house garden. They are “new money”; they see the world instrumentally, and are mostly allergic to it, too. A visitor reports the scene in a letter: “Then Evie comes out, and does some calisthenic exercises on a machine that is tacked on to a greengage tree – they put everything to use – and then she says ‘a-tissue,’ and in she goes.” Like inactivity, hay fever only seemed to afflict those higher up the social scale.
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In 1831 the Journal of Health defined calisthenics as “a reasonable, methodical, and regular employment of the exercises best calculated to develop the physical powers of young girls, without detriment to the perfecting of the moral faculties”. Its adoption was necessary because “young girls have not the same freedom as boys in their outdoor exercise, and their customary amusements and occupations, when not at school, are of a more sedentary nature”.
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Since our modern way of life denies many of us the physical exertion that kept our ancestors healthy, one way to gain social capital is to add it back in.
Any kind of communal exercise gives us a sense of belonging, of shared values and endeavours, aside even from its more general physical and mental benefits. When people gather together in a gym or in an exercise class, at least one aspect of what they are doing is joining together in a civic activity that ensures their collective survival, just like the ancient Greeks before them.
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If being fit promotes long life, you might expect being an elite athlete to help you reach a ripe old age. It doesn’t. Olympians buy themselves an extra 2.8 years on average, according to a 2012 study. Devoting your life to sport and exercise will buy you more time, but once you factor in the Olympians’ lifelong sustained attention to diet and healthy living, as well as tens of thousands of hours spent training, 2.8 years might not really seem sufficient recompense.
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Instead, the fittest and healthiest people on the planet have never been to a gym. These people, who report high levels of wellbeing and live extraordinarily long lives, inhabit what have been called “blue zones” – areas where lifestyles lead to peculiar longevity. The term was coined by two demographers, Gianni Pes and Michel Poulain, who, while collecting data on clusters of centenarians on the island of Sardinia, identified places of especially high longevity on their map with a blue felt-tip pen. Because clusters of long-lived people are often found in geographically remote places (also including parts of Okinawa, Costa Rica and Greece), jackpot genes seem like a strong candidate to explain their longevity. But a famous study of Danish twins has concluded that a long life seems to be only “moderately heritable”. Over the years, many studies have looked at the lifestyles of people in “blue zones” and found that a number of their customs and habits contribute to a long life (everything from a sense of belonging and purpose to not smoking, or eating a predominantly plant-based diet). In the list of contributory factors, there is a noticeable absence of exercise.
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I travelled to Sardinia to meet Pes and find out more about his work. He has a vested interest in longevity. His great uncle was a supercentenarian (living beyond 110). The years that Pes is interested in finding out more about are the good ones, not those spent with 24-hour care in a nursing home (there are also none of these in Sardinia’s blue zones). A trial by a group of gerontologists based at Boston University reported that 10% of supercentenarians made it to the final three months of their lives without being troubled by major age-related diseases.
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In my conversation with Pes, he repeatedly stressed that while diet and environment are important components of longevity, being sedentary is the enemy, and sustained, low-level activity is the key that research by him and others has uncovered: not the intense kinds of activity we tend to associate with exercise, but energy expended throughout the day. The supercentenarians he has worked with all walked several miles each day throughout their working lives. They never spent much time, if any, seated at desks.
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Pes has recently been studying workers in one of the island’s regions of longevity, Seulo (population around 1,000). He discovered one group of women who had spent their working lives seated, but nonetheless reached a great age. They had been working treadles (pedal-powered sewing machines), which meant they had regularly burned sufficient calories to derive the longevity benefits of remaining active. (Lowndes’ Gymnasticon, which works like a treadle, is starting to look a little less ridiculous as a solution for sedentary workers.)
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For all the trillions invested in healthcare year on year, there are regions in high-income nations (such as the UK and the US) where life expectancy is still as low as it was in the mid-60s. In Tower Hamlets, one of the poorer parts of London, men can only expect an average of 61 years of good health – and women just 56.
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So far, researchers agree that sustained periods of low-level activity seem to work well. Aiming for 10,000 steps a day is a good idea, but 15,000 better resembles the distances likely covered by our prehistoric ancestors, and indeed by those Sardinian centenarians.
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For those of us who can’t move to Sardinia and become a shepherd, a review published in the Lancet in 2016 found that “high levels of moderate-intensity physical activity (ie, about 60-75 min per day) seem to eliminate the increased risk of death associated with high sitting time”.
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So even if we go to the gym on a Saturday morning, our absolute inactivity at other times can still be damaging to the body. Low and moderate activity for longer or sustained periods seems to produce the best results. It looks like excessive high-intensity activity (the kind we see in elite athletes) drives metabolism and cell turnover, and may even, when all factors are taken into account, accelerate the ageing process.
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As those all-day activity trackers continue to mature into their second decade, they will no doubt find better ways of encouraging us out of our chairs. At the moment, though, they can only count the things we have done, not the opportunities for movement we have missed. They make us more likely to be attentive to our activity than our inactivity.
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After two centuries of trying, we should accept that exercise is not working as a global fitness strategy while it remains an addition to the working day. In the long view, it is starting to look a lot like a fad. Government guidelines in the UK and other countries that encourage sport and exercise are failing. These strategies struggle because we are trying to get people to give up what little leisure time they have to pursue activities that require substantial additional effort.
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Perhaps instead we should encourage people to make the kinds of daily decisions that result in a healthier life. What is needed are the kinds of strategies that would make exercise unnecessary. Urban planning that better addresses the outdoor experience and encourages movement would be a key part of this change. But on an individual level, we can think about returning a little of the friction that technology has so subtly smoothed out for us, and make it easy to get things done. Exercise becomes physical activity when it is part of your daily life.
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A year ago, my car lease came up for renewal. I had been a driver for nearly 30 years, but after all the alarming research I had read about the impact of modern lifestyles, I could not possibly keep it. I now walk miles more than I used to. Without a car, getting to the gym involved a 70-minute round trip. By the time I had walked there and back, the workouts seemed less necessary, so I cancelled my membership.
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I tried other things, too. I experimented with a standing desk, but I knew from Pes’s research in Sardinia that it is not sitting itself that is bad, but the inactivity associated with it. Standing in one place for hours is only marginally better than sitting there. The Gymnasticon is also making a comeback. Its new incarnation is the treadmill desk, which seeks to keep office workers permanently on the move. From a health perspective it seems superb, but it is hardly practical. Getting a less comfortable office chair would probably be as effective a strategy, making it less easy to settle into for long periods of immobility.
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You don’t have to join a gym this year. The numbers tell us that exercise is not the solution to the problems associated with physical inactivity, for the simple reason that these two things are not opposites. The antidote is activity: to find and recover some of the movement that modern life has been taking from us for centuries.
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Len
Exercise for aging people: where to begin, and how to minimize risk while maximizing potential, by Peter Attia M.D. 
Fatigue and O2 SAT?
