insights

Now more than ever, both children and adults are spending copious amounts of time in sedentary behavior—defined as any waking behavior characterized by a low energy expenditure while in a sitting or reclining posture.¹ Sedentary behavior, in and of itself, has emerged as a potential risk factor for cardiometabolic health, chronic disease, and mortality.^1,2

And yet, for many, a sedentary lifestyle has become the norm. Throw in a 30-minute workout a few times a week, and the average individual may even consider themselves to be physically active. The medical community says this is not enough. Current health policy guidelines recommend at least 150 minutes of physical activity per week coupled with reduced daily sedentary behavior by interrupting prolonged sitting with bouts of light activity every 30 minutes to promote health and quality of life.³ Anything less is considered physical inactivity, which is one of the most prevalent major health risk factors, with 8 in 10 US adults not meeting aerobic and muscle-strengthening guidelines.⁴ Over 80% of adolescents do not do enough aerobic physical activity to meet the guidelines for youth; many children spend more than seven and a half hours a day in front of a screen.⁵

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Physical inactivity accounts for more cardiovascular disease (CVD)–related deaths (37%) than smoking (19%) and hypertension (13%) combined, and 15-17% of all premature deaths are attributable to low fitness according to data from a 2018 study.³ The American Heart Association (AHA) promotes physical activity as part of its 2020 Impact Goals to improve cardiovascular health and reduce deaths caused by stroke and cardiovascular disease.⁴ In April 2018, the AHA issued a scientific statement recommending a “systems change” approach for ameliorating sedentary behavior by imploring healthcare providers to call on others in the community, like clinical and community care providers, fitness experts, health coaches, and other stakeholders, to help get people moving.⁴

How can clinicians help patients modify sedentary behaviors—many of which are involuntary—and incorporate physical activity into their daily lives? Functional Medicine educators teach clinicians how to craft sustainable, personalized exercise prescriptions to reduce cardiometabolic risk for patients who are struggling with sedentary behavior and physical inactivity. “IFM has a wonderful tool in the toolkit that helps [clinicians] walk patients through the process of writing an exercise prescription,” says IFM educator Cheryl Montgomery, who offers Functional Medicine health coaching at the office of Shilpa Saxena, MD. “I think this is fantastic because when you tell your patient to go exercise, they are much more likely to do it if you hand them a piece of paper—just like if you write them a prescription for medication or a nutraceutical—they are more likely to do it if they have something in their hand.”

In the following video, IFM educator Elizabeth Boham, MD, MS, RD, talks about ways to improve a
patient’s health through exercise.

Sedentary time, higher intensity physical activity, and cardiorespiratory fitness may all be targeted with metabolic syndrome and diabetes status.⁶ Sedentary behavior (sitting time) and low physical activity levels are strongly associated with increased cardiovascular disease risk and cardiovascular-related mortality in major studies.^1,7,8 Standing, as a way to interrupt prolonged sitting time, has been shown to be effective at improving many measures of health.³

Many workplaces now offer adjustable standing desks that allow employees to intermittently switch between standing and sitting throughout the day. Movement breaks can also be added into the day, alternating between five minutes of movement for every 30 minutes of sitting. Some working patients could also be encouraged to hold “walking meetings” throughout the day.⁹

In addition to reducing sedentary time, exercise is also an effective strategy for reducing total and cardiovascular mortality in patients with coronary artery disease.¹⁰ Which modality works best? A 2017 systematic review and meta-analysis suggests that high-intensity interval training (HIIT) (as opposed to moderate-intensity continuous training) may improve peak oxygen uptake and should be considered as a component of care for coronary artery disease patients.¹⁰ Another interesting study in 2019 suggests that HIIT results in significant reductions in total fat mass, abdominal fat percentage, and improved lipid profile in patients with myocardial infarction who underwent cardiac rehabilitation.¹¹

Conclusion

The Functional Medicine model emphasizes the importance of helping cardiovascular and other patients to identify what types of physical activity they enjoy the most to maintain a higher level of adherence to exercise prescriptions. To be truly effective, a Functional Medicine exercise prescription must not only help the patient develop an exercise routine but also help them replace a certain amount of sitting time each day with standing, stepping, or walking.
Learn more about tools and strategies to help patients achieve sustainable lifestyle change and improve their well-being through IFM’s new course Lifestyle: The Foundations of Functional Medicine.

To learn more about the benefits of exercise, consider reading the following IFM-authored articles:

Protecting the brain with exercise

Movement, exercise, and long-term health

Lifestyle journal helps patients track daily choices

References

1. Edwardson CL, Henson J, Bodicoat DH, et al. Associations of reallocating sitting time into standing or stepping with glucose, insulin and insulin sensitivity: a cross-sectional analysis of adults at risk of type 2 diabetes. BMJ Open. 2017;7(1):e014267. doi:10.1136/bmjopen-2016-014267
2. Thivel D, Tremblay A, Genin PM, Panahi S, Rivière D, Duclos M. Physical activity, inactivity, and sedentary behaviors: definitions and implications in occupational health. Front Public Health. 2018;6:288. doi:10.3389/fpubh.2018.00288
3. Solomon TPJ, Eves FF, Laye MJ. Targeting postprandial hyperglycemia with physical activity may reduce cardiovascular disease risk. But what should we do, and when is the right time to move? Front Cardiovasc Med. 2018;5:99. doi:10.3389/fcvm.2018.00099
4. Lobelo F, Rohm YD, Sallis R, et al. Routine assessment and promotion of physical activity in healthcare settings: a scientific statement from the American Heart Association. Circulation. 2018;137(18):e495-e522. doi:10.1161/CIR.0000000000000559
5. President’s Council on Sports, Fitness & Nutrition. Facts & statistics: physical activity. US Department of Health & Human Services. Updated January 26, 2017. Accessed August 17, 2020. https://www.hhs.gov/fitness/resource-center/facts-and-statistics/index.html
6. van der Velde JHPM, Schaper NC, Stehouwer CDA, et al. Which is more important for cardiometabolic health: sedentary time, higher intensity physical activity or cardiorespiratory fitness? The Maastricht Study. Diabetologia. 2018;61(12):2561-2569. doi:10.1007/s00125-018-4719-7
7. Patterson R, McNamara E, Tainio M, et al. Sedentary behavior and risk of all-cause, cardiovascular and cancer mortality, and incident type 2 diabetes: a systematic review and dose response meta-analysis. Eur J Epidemiol. 2018;33(9):811-829. doi:10.1007/s10654-018-0380-1
8. Colberg SR. Key points from the updated guidelines on exercise and diabetes. Front Endocrinol. 2017;8:33. doi:10.3389/fendo.2017.00033
9. Clayton R, Thomas C, Smothers J. How to do walking meetings right. Harv Bus Rev. Published August 5, 2015. Accessed October 8, 2018. https://hbr.org/2015/08/how-to-do-walking-meetings-right
10. Gomes-Neto M, Durães AR, Reis HFCD, Neves VR, Martinez BP, Carvalho VO. High-intensity interval training versus moderate-intensity continuous training on exercise capacity and quality of life in patients with coronary artery disease: a systematic review and meta-analysis. Eur J Prev Cardiol. 2017;24(16):1696-1707. doi:10.1177/2047487317728370
11. Dun Y, Thomas RJ, Medina Inojosa JR, et al. High-intensity interval training in cardiac rehabilitation: impact on fat mass in patients with myocardial infarction. Mayo Clin Proc. 2019;94(9):1718-1730. doi:10.1016/j.mayocp.2019.04.033