Move it or Lose it, Ignore the anti-exercise hype

Published 2.24.2016
I haven't written about the importance of not being sedentary for a bit, but this recent article in the Washington Post (WaPo) gives me a new opportunity to discuss the topic. It drives me batty when doctors state the exercise is not useful for weight loss (obesity specialist Yoni Freedhoff and cardiologist Aseem Malhotra, for two examples— both men working to ensure 100% employment for themselves and their colleagues, apparently). Exercise ABSOLUTELY helps with weight loss, particularly if you are sedentary to begin with. Basically, you either accept the reality of the energy balance, or you do not. And if you do not, then you should have no part in any treatment or recommendation regarding obesity.

But exercise does so much MORE than just affect the energy balance. Regular exercise (even without weight loss) lowers the risk of dying of all causes. And it doesn't take much movement to make a difference. Suggesting in any way that exercise is not necessary is a heinous dereliction of a doctor's oath to "first do no harm." Simply being less sedentary (standing more than you sit) can have a beneficial effect.

But it isn’t an all-or-nothing relationship. Instead, the more a person exercises, the more the risk of heart attack and premature death goes down. Only at extreme and prolonged exercise do worrisome effects appear, and even then there’s no evidence that such behavior shortens life.

This “dose-response” relationship is apparent as soon as you get off the couch and do almost anything. It’s like a signing bonus.

A study of 221,000 Australians age 45 and older found that those who simply stood more than two hours a day had a death rate 10 percent lower than people who stood for less than two hours when followed over the course of four years. People on their feet for eight hours a day had a 24 percent lower death rate.

Actual movement is best, but standing is better than nothing. My fitness journey began by standing up in front of my computer while I worked. If I hadn’t already owned a treadmill that I could turn into a home made desk, I’d still be standing (or pedaling) while working. I still maintain that the best thing that companies could do to lower healthcare costs would be to institute standing desk with stools rather than traditional desks with chairs. Stools so that those who must can sit when they want, but standing desks would send the message that the default position is to stand, rather than sit. And yes, I know that there would be significant opposition to this proposal. There is significant opposition to the suggestion within my own household! Again from the WaPo link:

So that’s the good news. The bad news is that exercise isn’t enough. You also have to stop sitting around when you’re not exercising. It turns out that sedentary behavior — defined as anything that takes less than 1.5 METs of effort — increases the risk of cardiovascular disease even if a person gets enough exercise.

Sitting for long times does more that decrease the odds of getting obese, it also lowers the odds of developing hemorrhoids.

Nip it in the bud?

Perhaps the best thing to do would be to put standing desks in schools. This has been done and studied. There was a large difference in the step counts of kids standing compared to those sitting in the first semester they had the desks, but the difference decreased significantly in the second. So much so that there was no statistical difference between the steps of those sitting and standing. There is no discussion of this result and no suggested reason for it. Could it be that the in the second semester the novelty had worn off and the kids sat on the stools more often? Or could it be that after standing all day in school, the kids sat more after school?

Of course the main result was that more study is needed.

This popular press article reports on the findings of this study, which measured the body's adaption to increased movement. Rather than reporting the nuances, the article makes the point that, sure exercise might be good, but only up to a point. What the actual research showed was that for very active people (athletes) a bit more exercise doesn't make a difference in calorie expenditure because they moved less when not exercising.

In other words, they increased the energy activation thermogenesis (EAT) and lowered their non-exercise activation thermogenesis (NEAT). These results suggest that the number of steps for the kids declined because thought they stood and moved at school, they began moving less at home.

I would note however, that the energy expenditure plateau is still higher than before exercise began. My answer is that NEAT needs to be considered changeable, not a function of genetics. Whether or not you stand while working or watching TV is a choice, not genetics.


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One Mom in the Middle…muses on the importance of not being sedentary

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