To sit or to stand . . . that is the question!

I have been a community pharmacist for 19 years. Growing up playing competitive soccer, I suffered many injuries. The amount of standing I did at work definitely contributed to the chronic back pain I experienced over the years. Over the past 10 months I have transitioned to a more sedentary role, which has brought both benefits and challenges. My new role as a consultant and coach found me sitting for long periods of time, which caused my hips and lower back to tighten. When people do too much of anything in life, you usually find that this does not work well for them. Many of us can remember reading the headline ‘Sitting is the new smoking'. When I read this I thought I was on the ‘good’ side of the spectrum because as a pharmacist, I spent the majority of my time standing at work. That was until I read articles about how standing for prolonged periods of time also had significant negative consequences. Below are some of the impacts of prolonged sitting and standing: Prolonged sitting Causes hip flexor muscles to shorten and tighten, causing stiffening of the joints, affecting gait and balance and making activities like walking harder—and perhaps even setting you up for a fall Relaxes your large muscles like your glutes and hamstrings. When muscles relax, they take up very little glucose from the blood, raising your risk of type 2 diabetes We don’t use our lower body muscles to hold us up leading to muscle atrophy Puts significant stress on spinal structures and other joints, such as the shoulders and hips, especially when sitting with poor posture Being sedentary for long periods of time raises the risks of deep-vein thrombosis, metabolic syndrome, and varicose veins When you sit, your body’s production of lipoprotein lipase (an enzyme essential for breaking down fat) drops by about 90%. When your body cannot break down fat, it is stored instead Eating at your desk while being distracted by your phone or the TV puts you at a higher risk of eating larger portions. Prolonged standing Causes exhaustion, fatigue, leg cramps, lower back pain, bunions, corns, plantar fasciitis, and excess pressure on the joints Increased the risk of heart disease, as people working in standing jobs were about twice as likely to develop heart disease as people working in sitting jobs When searching through the literature for studies comparing sitting vs. standing, I found a study done in our backyard here in Toronto. The researchers conducted a prospective cohort study examining the effects of each on heart disease incidence. Led by a team from the Institute for Work & Health, 7,320 people (half men, half women) were followed for an average of 12 years. Initial information about their job type and government health records helped determine who developed heart disease. The job types were divided by whether they predominantly involved sitting; standing; a combination of sitting, standing, and walking; or other body positions like crouching and bending. The combination of jobs and other body position-related jobs wasn't significantly different from sitting jobs; however, people working in standing jobs were about twice as likely to develop heart disease as people working in sitting jobs. This relationship held true even after adjusting for various confounding factors like body mass index, other physical activity, and the physical demands of the work. It is clear that too much sitting or standing is not ideal. Variety and movement in each position is the key. As our role as pharmacists continues to evolve, so does the amount of prolonged sitting and standing we do. If you are in a more clinical role involving more prolonged sitting, try these tips. Move around every 30 minutes and get 60-75 minutes per day of moderate-intensity activity One hour of exercise will counteract many of the negative impacts of 6-7 hours of prolonged sitting Use your iPhone or wearable device to track your steps. The evidence is that those accumulating 7,000 steps per day had a 50-70% lower risk of dying than those doing less than 7,000 steps. (The 10,000 steps per day number came from a Japanese marketing company and became popular.) Don’t think you need to go to the gym five days a week to see benefits. The truth is that a comfortable 15- or 20-minute walk accomplishes a lot when done regularly. Park a little further from work rather than taking up the spot beside the accessibility spot Between in-person appointments, close the door and do 10-15 jumping jacks. I have done this myself and found it to be effective for resetting my mind and body. If you are in a more traditional setting involving more prolonged standing try these tips: Every hour, do 10-15 calf raises to keep blood circulating through your legs Try wearing elasticized compression stockings [15 to 20 or even 20 to 30 mm Hg] to help alleviate the tired and achy feelings in your legs. The majority of us sell these in our stores so no excuses here! Do standing quadriceps stretches when standing at a computer terminal Be aware of your breathing. Before you move to the counselling station, take one deep belly breath so you can be fully present in front of the patient you are serving. This helps you with transitions and over time will make you more aware of what your body is feeling. Males generally have tight hips and hip flexors. Check out this YouTube channel for short and useful hip stretches to do before you call it a night. Check out more articles on combating burnout by subscribing to my free weekly newsletter here. References https://www.betterhealth.vic.gov.au/health/healthyliving/the-dangers-of-sitting https://www.healthline.com/health/workplace-health/things-that-happen-when-you-sit-down-all-day https://www.health.harvard.edu/pain/the-dangers-of-sitting

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To sit or to stand . . . that is the question!

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Manjit Hansra

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