Standing up for Diabetes (#DPC16)
This isn't a blog about advocating for diabetes, although that would be an excellent subject, I am being more literal; this is about standing more and sitting less if you are a Person With Diabetes (PWD) or someone concerned about your risk of Diabetes.
Recent research about the benefits that making small changes to our everyday behaviours can have on our blood glucose (BG) levels have implications for how we live our everyday lives and may change future Diabetes prevention and management programmes.
Diabetes UK Professional Conference
I was lucky enough to be at the Diabetes UK Professional Conference earlier this month, where Dr Thomas Yates (Reader in Physical Activity, Sedentary Behaviour and Health, University of Leicester) spoke about Type 2 Diabetes (T2D) and exercise. It will come as no surprise to anyone that his review of research data shows that high levels of time spent sitting are strongly associated with an increased risk of diabetes, cardiovascular disease and mortality.
This is very certainly not news, and as Dr. Yates points out, was raised as far back as far as 1713 in a book called “Sedentary Workers and Their Diseases” by Bernardino Ramazzini, the Italian physician who is often called the “Father of Occupational Medicine”.
That this continues to make newspaper headlines reflects that as a society we have largely ignored science and common sense that shows that so many of us are less active in our day to day lives than we should be. At an individual level, the hurdles to putting good intentions into practice are substantial; for several decades I led a lifestyle that was extremely inactive, and despite repeated warnings from healthcare professionals, I did nothing to improve things until my diagnosis with T2D in 2013. There are many overlapping reasons why people like me are reticent about changing their lifestyles; some of these are practical (other health and disability issues, pressure of work and family life for example) and some are more psychological (stigma surrounding lack of fitness and being overweight, not wishing to face up to the issues being just two), and in many cases it just boils down to putting things off until tomorrow.
Dr. Yates reviewed 2012 research showing that in the overweight, interrupting sitting time with short bouts of light or moderate intensity walking lowers BG after a meal, demonstrating that even 2 minute walking breaks every 20 minutes can have a positive and beneficial impact.
The results of a more recent study in 2016, albeit it one with a relatively small sample size of 34 post-menopausal women, went much further; showed that breaking up prolonged sitting with 5 minute bouts of standing had benefits for those at high risk of T2D.
This has important implications for how as a society we conduct large scale public health campaigns, as well as individual how we manage our day to day lives. Before discussing this in a bit more detail, there is one caveat; looking at this data with in light of a recent review of the Health Survey for England data (a series of annual surveys designed to measure health and health related behaviours in adults and children), suggests that these benefits might not apply to all. It demonstrates that those who are already physical active AND are not sedentary (categorised as "Busy Bees’) may not share in the benefits. For all of the rest of us, including the many of us who are regularly physically active but still spend considerable parts of the day off our feet ("Sedentary Exercisers") will still benefit.
Putting this into practice
It is sad to see that more of us are failing to make positive changes to our lifestyles than are succeeding in doing so. However, the encouraging news from this research is that whilst prolonged sitting is strongly associated with an increased risk of T2D and mortality, breaking our sitting with short walking breaks or short standing breaks could significantly improve our health. Whilst this work is not yet part of day to day clinical advice or health planning, the evidence (and common sense) suggest that we would all benefit from taking it to heart.
As someone who has, and continues to, struggle to improve my diet and levels of exercise, I have respect for all who are able to make big and positive changes to their everyday lives. I would like to think that if I can do it, so can many others, and I would never want to discourage anyone from embarking on (or persevering with) a more rigorous exercise plan. If you are thinking about doing this, or looking for a new challenge, I can strongly recommend a couch-to-5k and your local parkrun.
However, for those that cannot make big changes in every day life, or do not feel able to do so, and for anyone who spends significant periods of time sitting, our public health messages should now incorporate advice about taking short standing or walking breaks. These smaller adjustments will much easier for many people to accommodate into their every days lives, especially when the challenges of making bigger changes seem overwhelming, and seem likely to improve the risk factors and future lives of many people. Success in making smaller changes may also give encouragement to some people to go much further and embrace a more active lifestyle.
As someone who aspires to be a "Busy Bee’, but in reality is struggling to be a "Sedentary Exerciser", I have resolved to make some smaller changes to my working day. Already this week I have been taking the stairs between meetings to give myself a walking break and standing whilst on long phone calls. I am not, at least yet, ready for a standing desk...