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FEATURE FOCUS E nvironments that promote seden- tary behavior have traditionally been seen as a sign of progress and economic power. For example, in low- and middle-income countries, using a bicycle instead of a car or not having a maid to perform household chores is a measure of low socioeconomic status. The Health Risks More than half of the average per- son's waking hours are spent sitting. 1 Unfortunately, this kind of sedentary behavior can lead to significant health issues, including heart disease, diabetes, metabolic syndrome, and some types of cancer. Study results have shown an inverse relationship between time spent sitting and ideal cardiovascular health. 2 Additionally, spending a few hours a week engaged in moderate to vigorous activity does not offset these risks. 3 Although the exact mechanism for this inverse relationship is under investiga- tion, it is understood that prolonged sit- ting reduces metabolism, thereby affect- ing the body's ability to regulate blood sugar and blood pressure and break down fat. 4 Sedentary lifestyles have also been associated with high levels of low- density lipoproteins, triglycerides, and total cholesterol, as well as low levels of high-density lipoproteins. The Online Table lists health problems that can occur from too much sitting. Coronary artery disease is the leading cause of death in the United States and the most common type of heart disease. 5 Coronary artery calcification is an early marker for heart disease risk. This occurs when plaque accumulates in the arteries over time, causing them to narrow. 5 One study analyzed heart scans and physi- cal activity records of more than 2000 adults living in Dallas, Texas, and found a 14% average increase in coronary artery calcification for every hour of sedentary time per day. 5 Additionally, meta-analysis results published in Diabetologia showed a sedentary lifestyle is associated with a 112% increase in the risk for diabetes, a 147% increase in the risk for cardiovas- cular events, a 90% increase in the risk for cardiovascular mortality, and a 49% increase in the risk for all-cause mortality. 6 Although the term "sedentary life- style" used to mean not exercising regu- larly, the term has been modified to describe people who sit too much. The levels of activity for individuals are now sedentary (sitting too much), active without exercise (too little exercise), and active with exercise, with the last being the healthiest. Current guidelines for adults recommend 150 minutes per week of moderate to vigorous physical activ- ity, 7 as well as increasing the amount of time they exercise. Health care providers should counsel patients to limit seden- tary time, particularly sitting. 8 The Benefits of Moving Standing instead of sitting burns 30% Stand Up for Health Kathleen Kenny, PharmD, RPh p The Dangers of Sitting Dr. Kenny earned her doctoral degree from the University of Colorado Health Sciences Center. She has 20-plus years' experience as a community pharmacist and works as a clinical medical writer based out of Colorado Springs, Colorado. Dr. Kenny is also the Colorado education director for the Rocky Mountain Chapter of the American Medical Writer's Association. 50 PharmacyTimes.com December 2015