Now Reading: Prolonged sitting without exercise is not a good combo, vitals signs redefined to include exercise

Ploeg HP van der, Chey T, Korda RJ, Banks E, Bauman A. Sitting Time and All-Cause Mortality Risk in 222 497 Australian Adults. Arch Intern Med. 2012;172(6):494-500

Sallis R. Developing healthcare systems to support exercise: exercise as the fifth vital sign. British Journal of Sports Medicine. 2011;45(6):473-474.

The first paper is a study done (as its title says) in Australia, and covers the experience of 621,695 person years of observation around their sitting habits and likelihood of death. And their findings are that there is a greater likelihood with excessive sitting, with the tipping point occurring at 8 hours a day of sitting. The study did not measure whether the sitting was continuous or intermittent, just the total number of hours per day.

In looking at the people in the study ( 222,497 ), 25 percent said they sat 8 hours or more in a 24 hour period. Heavier people, people who smoked, and people with disabilities or in poor health sat longer, as did people who said they had 0 minutes of physical activity per week ( 5.4 percent of people ).

And…regardless of being healthy or unhealthy, overweight or not, people who reported more than 8 hours were more likely to die. The authors pegged the overall responsibility of sitting to 6.9% of deaths. Overall, and interestingly, sitting even in people with high amounts of physical activity also contributed to death in people with cardiovascular disease or diabetes. The right place to be, it appears, is at 150 minutes/week of physical activity and sitting less than 8 hours total per day.

What to do next? Make exercise a real vital sign -> Done!

The second paper is written by colleague Bob Sallis, MD, who has done something remarkable in the medical profession – added a new vital sign. First, what it is: two questions:

1. On average, how many days/ week do you engage in moderate or greater physical activity (like a brisk walk)?
2. On those days, how many minutes do you engage in activity at this level?

The two numbers are multiplied and the exercise vital sign is officially measured. The part about it officially being “added” is that it’s in the electronic health record, asked at every visit, and positioned with all the other vital signs it now joins, in all of Kaiser Permanente Southern California, more regions to come.

I have been known to say that patient access to their health information should be a vital sign, however, exercise as a vital sign trumps that. Why? Because the human body doesn’t care if its owner sees information, it cares if it is physically active. How much? A lot, and this is a vital sign whose numbers have a direct and linear correlation with longevity.

This addition to our vital sign repertoire also signals a change in what medicine sees as an “urgency” in the medical visit. The damage caused by not enough physical activity is immediate, prolonged, and cumulative. If you haven’t redefined the vital signs where you practice, now you have the recipe, the knowledge that many thousands of doctors are using it, and the future gratitude of your patients and their families.