Death by Work: Evolution in workplace design to maximize health, vitality and productivity.
Productivity and health/wellness are inseparable. Without a sense of wellbeing, there is at best, basic output. Conversely, a feeling of vitality will logically be reflected in more consistently elevated performance and job satisfaction. It is the fuel that fires the engine.
The human race is now the sickest species on the planet and there is no emerging indication that this is in any way about to change. The facts are incontrovertible as evidenced by the alarming rise in debilitating disease over the past 25 years, including asthma, type2 diabetes, obesity/metabolic disorders, circulatory dysfunction, arthritis, chronic pain and mental illness. According to a 2014 study, one in five Canadians suffers with chronic pain. This of itself should provide serious pause for concern, but when combined with the reality that these diseases are emerging far earlier than previously witnessed, the full magnitude of the problem emerges. Perhaps even more important… statistically for all the money spent on health care, this trend is accelerating. The question as to why this is happening has been irrefutably evidenced in research demonstrating the negative impact of an inactive lifestyle in general and prolonged sitting in specific. In a 2012 article published online in the “Journal of Applied Physiology, Nutrition and Metabolism”, the author Ian Janssen reported the costs associated with a sedentary lifestyle amounted to more than $4.3 billion in Canada alone. I feel that the workplace may be the only environment with enough consistency to impact this dilemma with any level of certainty and the cure may be much simpler than one would imagine.
For the most part, we are all born healthy. In fact over literally thousands of years, the human body has evolved into the consummate “health machine”. All of our physical, chemical and intellectual component parts are designed to allow us to effectively adapt to an ever changing environment. Through the trial and error of genetics, over hundreds of generations, the human body has developed into a complete health factory, capable of growth, vitality, and self-repair.
From an evolutionary standpoint, man was designed to move. For most of our development we survived as nomads, either chasing food or running away from something that saw us as food. As such, efficient movement became the defining purpose for how the human body took shape. Even the role of our organs are essentially in support of the physical body by feeding and eliminating waste associated with bio-mechanical function or, via the brain and nervous system, directing activity. Over the past 50 years with the expanding use of computer based technology we have seen a massive shift to more sedentary work and lifestyle environments. It is here that we uncover the root cause of this downward trend in health as well as the seeds to future vitality and wellness. One thing is certain: If we do not immediately make changes, the potential health care costs and disability going forward will result in the collapse of our current health care system with catastrophic domino effects across life as we know it.
What do we know for sure!
Fact, we sit an average of 9.3 hours a day, more than we spend sleeping. Scientists believe that anyone sitting more than 6 hours a day is at a heightened risk of developing health problems and this much sitting may be as bad as smoking a pack of cigarettes every day.
Sitting 6 plus hours per day makes you up to 40% likelier to die within 15 years than someone who sits less than 3. Even if you exercise!
People with sitting jobs have twice the likelihood of developing cardiovascular disease as people with standing jobs.
Recent evidence predicts a distinct relationships between ‘too much sitting’ and biomarkers of metabolic disease, such as increased risk of type 2 diabetes, cardiovascular disease and other prevalent chronic health problems.
Dr. James Levine, co-director of the Mayo Clinic and the Arizona State University Obesity Initiative, and author of the book “Get Up! Why Your Chair Is Killing You and What You Can Do About It”, has dedicated a good part of his career to investigating the impact of prolonged sitting. His investigations show that when you've been sitting for a long period of time and then get up, a number of molecular- cascades occur. For example, within 90 seconds of standing up, the muscular and cellular systems that process blood sugar, triglycerides, and cholesterol—which are mediated by insulin—are activated.
All of these molecular effects are activated simply by carrying your own bodyweight. These cellular mechanisms are also responsible for pushing fuel into your cells and, if done regularly, will radically decrease your risk of diabetes and obesity.
In short, at the molecular level, your body was designed to be active and on the move all day long. When you stop moving for extended periods of time, it's like telling your body it's time to shut down and prepare for death.
“The Mind Unleashed” featured a particularly noteworthy description of what happens in various areas of your body after prolonged sitting:
Heart: When you sit, blood flows slower and muscles burn less fat, which makes it easier for fatty acids to clog your heart. Research published in the Journal of the American College of Cardiology, for instance, showed that women who sit for 10 or more hours a day may have a significantly greater risk of developing heart disease than those who sit for five hours or less.
Pancreas: Your body's ability to respond to insulin is affected by just one day of excess sitting, which leads your pancreas to produce increased amounts of insulin, and this may over time lead to increased risk of diabetes.
Research published in “Diabetologia” found that those who sat for the longest periods of time were twice as likely to have diabetes or heart disease, compared to those who sat the least. Sitting for more than eight hours a day has also been associated with a 90 percent increased risk of type 2 diabetes.
Colon Cancer: Excess sitting may increase your risk of colon, breast, and endometrial cancers. The mechanism isn't known for certain, but it could be due to excess insulin production, which encourages cell growth, or the fact that regular movement boosts antioxidants in your body that may eliminate potentially cancer-causing free radicals.
Findings presented at the 2015 Inaugural Active Working Summit also found that sitting increases, lung cancer by 54 percent, uterine cancer by 66 percent, and colon cancer by 30 percent.
Digestion: Sitting down after you've eaten causes your abdominal contents to compress, slowing down digestion. Sluggish digestion, in turn, can lead to cramping, bloating, heartburn, and constipation, as well as dysbiosis (Disruption of normal bacterial balance) in your gastrointestinal tract, a condition caused by microbial imbalances in your body.
According to Microbial Ecology in Health and Disease: "There is growing evidence that dysbiosis of the gut microbiota is associated with the pathogenesis of both intestinal and extra-intestinal disorders. Intestinal disorders include inflammatory bowel disease, irritable bowel syndrome (IBS), and celiac disease, while extra-intestinal disorders include allergy, asthma, metabolic syndrome, cardiovascular disease, and obesity."
Brain Damage: Your brain function slows when your body is sedentary for too long. Your brain will get less fresh blood and oxygen, which are needed to trigger the release of brain- and mood-enhancing chemicals.
The consequential outcome will be increased disease, increased disability, and unsustainable health care costs.
A byproduct of sitting or even standing at a workstation for extended periods is serious postural change, with forward head carriage emerging as an increasing concern across all segments of society. The problem is precipitated by the prolonged use of computer technology and mobile devices. It is multi-faceted from a cause/effect perspective, and is impacted by body type, predisposing weaknesses, stress, length of time under load, physical strength/weakness, rest, etc. The true downside from a health perspective is just starting to emerge. There is strong evidence to the effect that prolonged forward head carriage creates aberrant muscle function leading to a distortion of spinal and shoulder mechanics .This supports the suppositions that unattended, the condition will logically result in mechanical failure in shoulder/neck mechanics, chronic inflammatory upper back and shoulder strain. All of which will contribute to the early advancement of degenerative arthritis. This leads to logical predictions of altered bio-mechanical function, including increased headaches, vertigo, neurological manifestations such as brachial neuropathy, carpal tunnel and dramatic increase in “pain syndromes” such as fibromyalgia. Predictive collateral concerns include impact upon circulation and restricted flow of CSF (cerebral spinal fluid), reduced vital capacity, altered digestion. This combined with the aforementioned health concerns associated with a lifestyle marked by lack of activity exposes the true magnitude of this emerging health disaster.
A 2016 study published by Ding Ding, Lawson et.al. in “The Lancet” presented staggering evidence of the true costs associated with physical inactivity: “Conservatively estimated, physical inactivity cost health-care systems international $ (INT$) 53·8 billion worldwide in 2013, of which $31·2 billion was paid by the public sector, $12·9 billion by the private sector, and $9·7 billion by households. In addition, physical inactivity related deaths contribute to $13·7 billion in productivity losses, and physical inactivity was responsible for 13·4 million DALYs worldwide. High-income countries bear a larger proportion of economic burden (80·8% of health-care costs and 60·4% of indirect costs), whereas low-income and middle-income countries have a larger proportion of the disease burden (75·0% of DALYs). Sensitivity analyses based on less conservative assumptions led to much higher estimates.”
What must we do?
I believe that the health care system as we currently experience it is incapable of crafting or implementing a solution. It is already struggling to keep up with the demands being placed upon it by our aging population and in many ways philosophically at odds with most natural approaches to health. The answer will be found in understanding and applying the lessons of evolution and exploring the impact of the physical body on overall health. I believe that within health care, we (physiotherapists/chiropractors) are the best equipped to create an effective strategy to start movement towards “functional health maintenance” rather than fighting disease. The answer to fighting disease will never be found in a pill, but rather in creating more efficient human beings. This means changing our attitude towards health and the control of disease.
When evaluating potential strategies with likelihood for success, experience has taught us that there is no way we can change the way people behave. Behavior is a reflection of what we believe. People for the most part choose to ignore behavioral repercussions and it would be folly to expect them to. So, if you can’t change behavior, what can we do to deal with this emerging dilemma?
I believe that the only reasonable solution lies in altering the environment. In this case, it means making some changes in the workplace that will subtly improve posture, balance and function to maximize health potential. In dealing with employees in a controlled environment, there is actually real opportunity for change by structurally altering the workplace to maximize the potential for creating sound biomechanics. Dr. Joan Vernikos former director of NASA’s Life Science Division, in her book “Sitting Kills, Moving Heals” found that even regular exercise does not counteract the effects of prolonged sitting. Her research with astronauts has clarified why this occurs and, even more importantly, provides us with a simple regimen that could counteract the consequences of inactivity.
In order to determine why regular exercise does not appear to compensate for the negative effects of prolonged sitting, her research was focused on what type of movement is withdrawn by sitting. What she discovered was as revolutionary as it was counterintuitive. Not only did she discover that the act of standing up is more effective than walking for counteracting the ill effects of sitting, the key is how many times you stand up.
It’s actually the change in posture that is most powerful, in terms of having a beneficial impact on your health, not the act of standing in and of itself. Put another way, the core component to counteracting the ill effects of sitting is to repeatedly interrupt your sitting. The key is frequent intermittent interactions with gravity. The science shows that standing up 35 times at once will provide only a small percent of the benefit of standing up once every 20 minutes.
Interestingly, lipoprotein lipase is dramatically reduced during inactivity, and increases with activity, the most effective activity being, you guessed it, standing up from a seated position. Lipoprotein lipase is an enzyme that attaches to fat in your bloodstream and transports it into your muscles to be used as fuel. So essentially, simply by standing up, you are actively helping your body to burn fat for fuel. But what is it about the mechanism of standing up that would account for this?
“These are all movements, almost below-threshold kind of movements, that do not burn up a lot of calories, as we know them, but that are designed to work against gravity,” Dr. Vernikos explains. From an evolutionary perspective this mechanism makes sense as the body prepares for movement by stimulating the metabolic processes necessary to support muscular activity involved in locomotion.
Proposed Corrective Strategy
I see the workplace demands of the today and going forward to be unique. Over the past 25 years, with computer and communication technology being virtually embedded in all aspects of life there are challenges to productivity and health never before encountered. I believe these new and expanding challenges to employers will require equally unique strategies that may force the need to look “outside the box” for solutions. Employee performance, health and satisfaction may become even more a direct reflection of their workplace environment. I propose the following ideas for consideration as part of a series of pilot projects to improve health, productivity and overall employee satisfaction.
I have designed a desk that will move three times an hour to facilitate postural as well as biochemical changes. It has been crafted to foster ideal postural alignment as well as systematically transitioning from a seated to standing platform. This results in Dr. Vernikos ‘cascade of bio-chemical, enzymatic and muscular activity. New York Times Research Reporter Gretchen Reynolds expands Vernikos’ work, noting that standing up every 20 minutes, leads to increased biomechanical conditioning and initiates a flood of supportive chemical reactions in the body. The most notable of which, is the release of enzymes that break up fat in the blood stream. These enzymes that move bad fat from your arteries to your muscles, where it can be burned as fuel, slow down with prolonged sitting. Metabolism actually shrinks by about 90% after just 30 minutes of sitting. The muscles in your lower body turn off and after 2 hours your good cholesterol drops by approximately 20%. As such, the simple act of going from a seated to a standing position not only reaffirms proper postural alignment, but also helps to stimulate bio-chemical processes which could positively impact obesity/metabolic syndrome and physical de-conditioning.
To enhance the project further, I suggest that ½ of the corresponding chairs be equipped with a pressure activated pulsed vibration to further activate postural muscles traditionally de-conditioned during prolonged sitting. There is emerging research demonstrating some real therapeutic benefits of vibration stimulation as both a therapy and for it’s muscle stimulation benefits. An article published in “Plos One” in 2014 by Regerschot, Van Heuvelen et. el, showed some interesting data on the benefits of vibration therapy. This study demonstrated that passive WBV has positive effects on cognition in humans. Results showed that a short session of passive WBV with 30 Hz frequency and approximately 0.5 mm amplitude has a positive short-term effect on executive functions (attention and inhibition) in healthy young adults with a high level of cognitive functioning. Additional studies are in progress in young adults, (immobile) older adults and people with attention deficit hyperactivity disorder.
Development of software that pause computers forcing employees to take periodic breaks and stand. There are currently numerous “Apps” available such as “P.C. Work Break,” “Big Stretch Reminder,” and “Stand Up! The Work Break Timer.”
Use of technology to block cell phone transmission within the immediate work environment. This is not only inexpensive, but the logical benefits to productivity and attention to detail go without saying.
In closing, logic and history point to the continued expansion of technology as a foundational component of all work environments going forward. This will inevitably mean a more sedentary work environment blending into a more sedentary home and leisure environment. It is proven that as we do less, we get sicker. That means more direct health care costs, absenteeism, disability and reduced productivity, all of which drive up “bottom line.” I see the associated costs associated with a sedentary lifestyle as ever increasing with no potential for rectification evident. Due to the relatively controlled nature of a work environment this is the only reasonable avenue to implement meaningful change. The clock is ticking!