Medicine: Personal Health & Fitness:
The Time for Uprising is Here
by Ragnar Viir, MD, PhD
Our greatest glory is not in never falling, but in rising every time we fall
Editor’s Note: There is a worldwide epidemic of sedentarism; in countries throughout the world, particularly in the developed nations, we simply spend too much time sitting and not enough time on our feet.This paper, by BWW Member Dr. Ragnar Viir, was originally written for an Estonian readership; it is presented here translated into English. – JP.
For us, Estonians, the time has come to awake and rise up. Especially now that Estonia is chairing the Council of the European Union.
No joke, the matter is serious. We are sitting too much! If there was a European Union Member States Sitting Championship, Estonia would have eighth place, which means that in seven countries people are sitting more than us, but in twenty countries, less. (1)
Give yourself a present. Let´s start the action!
According to the latest 2017 Bloomberg Poll, and published WHO, UN and World Bank statistics, Estonians belong to the top 50 healthiest countries in the world, being in the 38th place. (2)
Reasons why we are not further ahead include being overweight or obese, and a lack of physical activity. Physical inactivity is generally sitting (in the office, car, on the couch in front of the television). (3) The force of gravity hurts. Fat cells react to the continuous mechanical pressure of sitting. They can increase in size by up to double, thus also the buttocks measurements increase, and the initially overweight person becomes obese. (4) Estonian women have the third highest rate of obesity in the EU and men have the eighth highest. (5)
Research has shown that continuous sitting causes many health problems and faster ageing, even without other bad lifestyle ‘accomplices’ such as smoking, alcohol consumption or poor eating habits. Chronic health problems from sitting arise whether it is a child, adolescent or adult, a man or woman, white or blue-collar worker, driver or passenger. However, middle-aged male office workers seem to be more "dangerously sedentary" than pensioners, according to new research from Scotland.(6) These problems can't even be cured by healthy exercising, which although necessary, on its own is not enough.(3,7)
So, what can we do?
Estonia is not a wealthy country. We don't have the chance to put a large amount of money into preventing health problems, including chronic diseases, also called as noncommunicable diseases.(8) We can, however, without spending a single euro, do something very important for our health. Continuous non-stop sitting is a treacherous enemy! Hundreds of studies have shown that sitting must simply be interrupted, and regularly. Recently it is shown that breaks from sitting in occupational condition reduce the risk of noncommunicable diseases.(9)
In order to encourage the sitting person to stand up from time to time, wealthier countries have acquired work desks that rise and lower. England is implementing - at great expense - these types of work desks for all doctors, nurses, secretaries, the entire medical staff that use computers in their work.(10) There are these types, perhaps oversold sit-stand desks(11) , also in Estonia in some wealthier companies. But a person can rise from the chair by himself, without such an expensive motivator, to get up and straighten his back. According to Dr. Vernikos, who was responsible for the health of NASA astronauts, gravity is a greater contributor to good health than anyone had previously thought: “Standing up [against the force of gravity!] often is what matters, not how long you remain standing. If you stand up 16 times a day for 2 minutes, the body will read that as 16 stimuli, whereas if you stood once and remained standing for 32 minutes, it would see as one stimulus”, and: “Easy, everyday, all-day movement will keep you healthy for life.” (7)
When giving presentations and training, the following has always bothered me: I am speaking and the listeners beside me are sitting. Until suddenly I realized that it doesn't have to be like this! Listeners don't have to sit the entire time. I bought a bell for three Euros and put it to use. Every ten minutes, I ring the bell, the audience ― surprise, surprise ― rises up fast, I give them permission to sit back down immediately, their mood improves greatly, they laugh, and I get very positive feedback from them.
And now, when I write this to you, I take my bell and use it on myself. I wish it would even reach your ears: one has to stand up for their health!
Private photo Ragnar Viir
I am a doctor who has, for over 40 years, dealt with patients who have had direct musculoskeletal diseases (rheumatoid arthritis, spine disease ankylosing spondylitis etc) and I have recommended to them to exercise, both on land and in water.First and foremost is simply walking, which is most natural for two legged bipedal creatures, but I also prescribe movements for bedridden patients on their backs in hospitals. Physical activity!(12) Not too much at once, but frequently throughout the day. Thus, my rheumatic patients formed their own group (which they started to call the Baby-Like Kicking Patients Association).
Even healthy people can benefit from, for example, lying down for a minute or two on a mat every hour and doing simple movements on it. This will relieve physical strains,(13) and has proven to relieve pains(14) while causing also the “Eureka moment.”(15) And standing up from yoga mat is an even greater gravity stimulus than getting up from a chair.(7)
Particularly concerning are reports of doctors and nurses experiencing burnout. Being a doctor, I know very well that medical personnel, doctors, nurses, nursing aides, lab workers ― they unfortunately do not realize that they must also look after their own health, especially during work.
We have a nice example to follow from Seneca, New York: nurses and architects together present what the resting room for medical personnel in a hospital should be like: 1) It should be separated from patients and their relatives; 2) it should not be far from the workplace (high responsibility work requires quick arrival); 3) It should contain some green, better yet something that grows and is alive; 4) it should have a window; and 5) a bonus would be a balcony. And then the nurses special request: “Put one´s feet up!”, an opportunity to lie back and raise the legs for couple minutes as a means of physical reprieve from long hours of standing and walking. Researchers are convinced that this raises job satisfaction among medical personnel, reduces work stress, and improves work quality.(16) Medice cura de ipsum. Dear colleagues, take care of yourselves in order to care for others. A third of life we recover for the next day – lying is not sedentary behavior.(17,18) Both prolonged sitting and standing postures can and should be avoided by changes to workplace organization and environments.(19)
Dear friends, each of us is in need of peer support to change the lifestyle, and fortunately we are not alone. In Australia, the movement Stand Up Victoria, Stand Up Australia has started. From the famous Mayo Clinic in USA, we hear, "Get Up!"(20) , and a call to redeem chairmen and chairwomen from their curse of lethal sitting!(21) Our neighbor's, Finland's social and health ministry has already from 2015 posted Finnish National advice: „Jokainen ylösnousu tekee hyvää!” (Every uprising is beneficial!)(22)
ISBN 978-952-00-3726-0 (PDF) http://urn.fi/URN:ISBN:978-952-00-3726-0
Estonia chairs the Council of the European Union, every physical action starts with rising up from chairs, example inspires others.
Bulgaria is next in line to assume the rotating Chair of the EU in 2018 and let us challenge the whole of Europe to stand up for health!
Third slide in pdf: Inactivity Physiology by Marc Hamilton. http://www.seriecientifica.org/sites/default/files/hamilton.pdf Dr Bauman is the Sesquicentenary Professor of Public Health and Director of the Prevention Research Collaboration at the University of Sydney, Australia, the WHO Collaborating Centre on Physical Activity, Nutrition and Obesity.
Revolutionary, not evolutionary!
Let the idea of uprising ring like a bell in our conscious!
Thank you for standing up for your health!
I wish to thank Mr. Brian Weir for his careful revision of the English in this paper, and Mrs. Victoria Traat without whom criticism and encouragement I could not have conceived this review article. My deep thanks to President & Director at The BWW Society for sharing concern of global sitting epidemic and supporting find out ways of it. RV.
Editor’s Note: A summary version of this article was published on June 22, 2017 in the Estonian language newspaper 'Maaleht' (On-Line Editor: Aive Mõttus) under the title: “Ülestõusmise aeg on käes” (“The Time for Uprising is Here”). http://maaleht.delfi.ee/news/maaleht/arvamus/ulestousmise-aeg-on-kaes?id=78573843
1. Loyen, A., van der Ploeg, H. P., Bauman, A., Brug, J., & Lakerveld, J. (2016). European Sitting Championship: Prevalence and Correlates of Self-Reported Sitting Time in the 28 European Union Member States. PLoS ONE, 11(3), e0149320. http://doi.org/10.1371/journal.pone.0149320
2. Lu, W., DelGiudice, V. (2017). Italy’s Struggling Economy Has World’s Healthiest People. https://www.bloomberg.com/news/articles/2017-03-20/italy-s-struggling-economy-has-world-s-healthiest-people
3. Hamilton, M. Inactivity Physiology. Pennington Biomedical Research Center Louisiana State University System. http://www.seriecientifica.org/sites/default/files/hamilton.pdf
4. American Friends of Tel Aviv University. (2014). Obesity: Not just what you eat. Science Daily. www.sciencedaily.com/releases/2014/03/140320111907.htm
5. Eurostat statistics explained. Overweight and obesity - BMI statistics. http://ec.europa.eu/eurostat/statistics-explained/index.php/Overweight_and_obesity_-_BMI_statistics
6. Strain, T., Kelly, P., Mutrie., Fitzsimons, C. (2017). Differences by age and sex in the sedentary time of adults in Scotland. J Sports Sci. Jun 16:1-10. doi: 10.1080/02640414.2017.1339904. [Epub ahead of print]
7. Vernikos J. (2011). Sitting Kills, Moving Heals How Simple Everyday Movement Will Prevent Pain, Illness, and Early Death — and Exercise Alone Won’t. Fresno, California. http://www.joanvernikos.com/pages/sitting-kills-moving-heals.php
8. WHO. Noncommunicable diseases. (accessed Sept 5, 2017). http://who.int/mediacentre/factsheets/fs355/en/
9. Jalayondeja, C., Jalayondeja, W., Mekhora, K., Bhuanantanondh, P., Dusadi-Isariyavong, A., & Upiriyasakul, R. (2017). Break in Sedentary Behavior Reduces the Risk of Noncommunicable Diseases and Cardiometabolic Risk Factors among Workers in a Petroleum Company. International Journal of Environmental Research and Public Health, 14(5), 501. http://doi.org/10.3390/ijerph14050501
10. O’Connell, S. E., Jackson, B. R., Edwardson, C. L., Yates, T., Biddle, S. J. H., Davies, M. J., … Munir, F. (2015). Providing NHS staff with height-adjustable workstations and behavior change strategies to reduce workplace sitting time: protocol for the Stand More AT (SMArT) Work cluster randomized controlled trial. BMC Public Health, 15, 1219. http://doi.org/10.1186/s12889-015-2532-5
11. Chau, J. Y., McGill, B., Freeman, B., Bonfiglioli, C., Bauman, A. (2017) Overselling Sit-Stand Desks: News Coverage of Workplace Sitting Guidelines. Health Commun. Aug 29:1-7. doi: 10.1080/10410236.2017.1359034. http://www.tandfonline.com/doi/full/10.1080/10410236.2017.1359034
12. Viir, R. 2011. Countering the Harm Done by Prolonged Sitting. Publications & Special Reports BWW Society Home Page © 2011 The Bibliotheque: World Wide Society, An Interdisciplinary International Forum, Dedicated to the Future & Committed to Positive Global Solutions http://www.bwwsociety.org/journal/archive/prolongedsitting.htm
13. Viir, R., Ranna, L., Rajaleid, K., Mikkelsson, M,, Laiho, K., Kaarela, K., Hakala, M. (2008). Lying back gives prompt tension decrease in upper trapezius muscle but not applied relaxation technique in fibromyalgia patients. Scand. J. Rheumatol. 37: 36
14. Fardo, F., Spironelli, C., & Angrilli, A. (2013). Horizontal Body Position Reduces Cortical Pain-Related Processing: Evidence from Late ERPs. PLoS ONE, 8(11), e81964. http://doi.org/10.1371/journal.pone.0081964
15. Lipnicki, D. M., Byrne, D. G. (2005) Thinking on your back: solving anagrams faster when supine than when standing. Brain Res Cogn Brain Res. Aug;24(3):719-22.
16. Nejati, A., Shepley, M., Rodiek, S., & Lee, C. (2016). Restorative Design Features for Hospital Staff Break Areas: A Multi-Method Study. Health Environments Research & Design Journal. 1.1, 2016. http://journals.sagepub.com/doi/abs/10.1177/1937586715592632
17. Viir, R., Veraksitš, A. (2012). Discussion of “Letter to the Editor: Standardized use of the terms sedentary and sedentary behaviours” — Sitting and reclining are different states. Applied Physiology Nutrition and Metabolism , 37 (6), http://www.nrcresearchpress.com/doi/abs/10.1139/h2012-123#.WXMIYLpuJ9A
18. Viir, R., Pääsuke, M., Rajaleid, K. (2008). Measuring Muscle Visco-Elasticity in Horizontal Bed Rest Model for Better Understanding of Sedentary Life Style. The 2008 ISU 12th Annual Symposium – ‘Space Solutions to Earth’s Global Challenges’ http://www.sedentarybehaviour.org/2013/05/17/measuring-muscle-visco-elasticity-in-horizontal-bed-rest-model-for-better-understanding-of-sedentary-life-style/
19. Messing, K., Stock, S., Côté, J, Tissot F. (2014). Is sitting worse than static standing? How a gender analysis can move us toward understanding determinants and effects of occupational standing and walking. J Occup Environ Hyg. 12(3):D11-7. doi: 10.1080/15459624.2014.987388. https://www.ncbi.nlm.nih.gov/pubmed/25493919
20. Levine, J. (2014). Get Up! Why Your Chair Is Killing You & What You Can Do About It. ISBN: 978-1-137-27899-9 Publisher: Palgrave Macmillan. 2014 ErgoExpo Webinar http://www.juststand.org/GetUpBook/tabid/958/Default.aspx
21. Levine, J. A. (2014). The Chairman's curse: Lethal sitting. Mayo Clinic Proceedings, 89 (8), pp. 1030-1032 http://www.mayoclinicproceedings.org/article/S0025-6196%2814%2900573-4/fulltext
22. Istu vähemmän – voi paremmin! Kansalliset suositukset istumisen vähentämiseen. ISBN 978-952-00-3725-3 (nid.) ISBN 978-952-00-3726-0 (PDF) http://urn.fi/URN:ISBN:978-952-00-3726-0
23. Bauman, A. http://sydney.edu.au/medicine/people/academics/profiles/adrian.bauman.php
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