Too much sitting — Nurses’ role in educating patients to reduce health risks of prolonged sedentary time

August 31, 2018 – Sitting for too many hours per day, or sitting for long periods without a break, is now known to increase a wide range of health risks, even if one engages in recommended amounts of physical activity. The health risks of prolonged sedentary time – and nurses' role in reducing those risks – are discussed in an integrative literature review and update in the September issue of the American Journal of Nursing. The journal is published in the Lippincott portfolio by Wolters Kluwer.

But while the evidence on the adverse effects of prolonged sedentary time continues to grow, further studies are needed to determine "the most effective and practical interventions for reducing habitual sitting," according to the article by Linda Eanes, EdD, MSN, of the School of Nursing at the University of Texas Rio Grande Valley, Edinburg. She writes, "Nurses have a pivotal role to play in increasing public awareness about the potential adverse effects of high-volume and prolonged uninterrupted sitting."

Health Risks of Too Much Sitting – What's the Evidence?

In recent years, studies have shown a direct relationship between prolonged sitting and the risk of several chronic health conditions. Increased health risks have been reported both for high-volume sitting, such as sitting for seven or more hours per day, and for prolonged uninterrupted sitting, such as sitting for 30 minutes or longer without a break. The health risks of prolonged sitting are independent of whether the person participates in recommended physical activity.

In her review, Dr. Eanes summarizes pivotal studies showing the association between high-volume and prolonged uninterrupted sitting and health risks including cardiovascular disease, diabetes, and all-cause mortality. In conjunction with obesity, sedentary time is also linked to an increased risk of certain cancers, including ovarian, endometrial, and colon cancer.

How does too much sitting increase health risks? Immobility decreases stimulation of weight-bearing muscles, leading to decreased activity of an enzyme (lipoprotein lipase) that plays an essential role in lipid metabolism, including production of high-density lipoprotein cholesterol (the so-called "good" cholesterol) as well as uptake of glucose from the blood. In contrast, breaking up sedentary times with frequent bouts of standing or slow walking may reduce these metabolic risks–although the optimal levels of standing or walking remain unclear.

Nurses and other healthcare professionals now have a new priority: educating patients about the health risks of prolonged sedentary time and making suggestions to reduce and interrupt sitting times. Proposed interventions include using a standing desk or taking frequent walking or standing breaks, as well as the use of computer or smartphone reminders to take brief physical activity breaks during the day.

But questions remain about the most effective ways to address high-volume or uninterrupted sitting, including the "dose-response relationships" between sedentary behavior, taking breaks, and various health outcomes. In contrast to efforts to increase physical activity, merely providing people with information and education might be effective in promoting reduction of sedentary behavior. "Much more research is needed in the field of inactivity physiology," according to the author.

While it's still important to promote regular physical activity, nurses should pay more attention to evaluating total daily sitting time, and to understanding the individual, social, occupational, and community/environmental factors that contribute to it. "Nurses can also actively encourage all patients, regardless of demographics, to balance sedentary behavior and physical activity simply by taking more frequent standing or walking breaks," Dr. Eanes writes. She believes that nurses are well positioned to contribute to research on the health risks associated with prolonged sitting – and the most effective interventions for reducing those risks.

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Click here to read "CE: Too Much Sitting A Newly Recognized Health Risk"

DOI: 10.1097/01.NAJ.0000544948.27593.9b

### About American Journal of Nursing

American Journal of Nursing is the most honored broad-based nursing journal in the world. Peer reviewed and evidence-based, it is considered the profession's premier journal. AJN's mission is to promote excellence in nursing and health care through the dissemination of evidence-based, peer-reviewed clinical information and original research, discussion of relevant and controversial professional issues, adherence to the standards of journalistic integrity and excellence, and promotion of nursing perspectives to the health care community and the public.

About Wolters Kluwer

Wolters Kluwer is a global leader in professional information, software solutions, and services for the health, tax & accounting, finance, risk & compliance, and legal sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with specialized technology and services.

Wolters Kluwer, headquartered in the Netherlands, reported 2017 annual revenues of €4.4 billion. The company serves customers in over 180 countries, maintains operations in over 40 countries, and employs approximately 19,000 people worldwide.

Wolters Kluwer Health is a leading global provider of trusted clinical technology and evidence-based solutions that engage clinicians, patients, researchers and students with advanced clinical decision support, learning and research and clinical intelligence. For more information about our solutions, visit http://healthclarity.wolterskluwer.com and follow us on LinkedIn and Twitter @WKHealth.

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