Heart Health: Why your workout alone may not be enough if you sit for long periods

A morning workout can leave you feeling like you have done your bit for your health. Then come long hours at your desk and a long commute in traffic. By the time you get home the last thing you want to do is move. So you settle into the sofa for some television or your phone or simply a little downtime.

In your mind, you have still had an active day. After all, you did exercise that morning

But a study published earlier this month is putting the rest of the day under spotlight, how much time we spend being sedentary.

Published in Frontiers in Nutrition, the study followed nearly 476,000 people from the UK for more than 13 years and examined leisure-related sedentary time alongside physical activity and heart attack incidence. It found that people reporting more than four hours a day of leisure related sedentary time had a higher incidence of myocardial infarction, or heart attack, than those with two hours or less.

The researchers looked at sedentary time during leisure, including watching television, using a computer and driving.

The findings do not prove that prolonged sedentary behaviour directly causes heart attacks. But they raise a question that is easy to overlook. How much of the rest of the day do we spend sitting?

“When we remain inactive for long periods, the body is simply not getting the regular movement it needs to support healthy circulation and metabolism,” Dr Jan Strickling a consultant cardiologist at Medcare Hospital Al Safa, told Gulf News.

Over time, he said, prolonged inactivity can contribute to weight gain and affect blood sugar, blood pressure and cholesterol levels, all of which are important factors in cardiovascular health.

Strickling cautioned that the four-hour figure should not be treated as a strict threshold. “I would not look at four hours as a precise cut-off where risk suddenly changes,” he said. “Rather, it is a useful reminder that spending a large part of the day sitting, particularly when it becomes a daily habit, is something we should try to minimise.”

“One of the biggest misconceptions is that going to the gym or completing a workout automatically means you have had an active day,” Strickling said. “Exercise is extremely beneficial, but it does not necessarily compensate for spending most of the remaining day sitting.”

Regular exercise and reducing sedentary time are complementary rather than interchangeable parts of an active lifestyle.

“Cardiovascular health is also shaped by what we do during the rest of the day,” Dr Mangesh Dande a specialist in cardiology at Aster Clinic, Al Warqa, told Gulf News. “Sitting less, moving more frequently and incorporating regular moderate intensity activity should all be part of a heart healthy lifestyle.”

The study also found that higher moderate to vigorous physical activity was associated with a lower incidence of heart attack.

However, Dande emphasised, “Meeting the recommended weekly exercise target should not be viewed as a licence to remain seated for the rest of the day.”

For people with desk-based jobs or long daily commutes, spending less time sitting altogether may not always be realistic. The focus then can be on what can be done better around those unavoidable stretches.

“Prolonged sitting means the large muscles in the legs are doing very little work for long periods,” said Dr Deepak Mullasery, a senior physiotherapist at Medcare Physio & Rehab Centre.

Mullasery recommends looking for small opportunities to activate the muscles and interrupt long periods of sitting. At work, that could mean getting up between meetings, walking while taking a phone call, using the stairs when appropriate or doing a few sit-to-stands, ankle movements and calf raise.

Dande also suggests walking to a colleague whenever practical, parking slightly farther away if circumstances permit and considering walking meetings for suitable discussions.

In a city such as Dubai, where some daily commutes can be lengthy, Dande recommends looking for opportunities to add movement around those periods of sitting. This could include walking before or after a drive or taking a short walk after reaching the office or home.

At home, a short walk after a meal, getting up during a television break or moving around while waiting for something to finish can help break up longer periods of sitting.

Mullasery noted that these may seem like small changes, but that is precisely what makes them easier to sustain. They do not require gym clothes, equipment or another appointment in an already busy day, he added.

While these small changes can help reduce sedentary time, regular exercise remains an important part of cardiovascular health.

For most adults, Dande recommends around 150 to 300 minutes of moderate-intensity activity a week or around 75 to 150 minutes of vigorous activity. This should be combined with muscle strengthening exercises on at least two days a week.

For someone who has been largely inactive, Mullasery recommends starting below their maximum and gradually increasing the duration or frequency of movement as it becomes manageable.

He also recommends individual assessment for people experiencing significant breathlessness, chest symptoms, significant pain or problems with balance or mobility, rather than following a generic exercise plan.

The findings show a link between sedentary behaviour and heart attack incidence, but they do not establish a direct cause and effect relationship. Heart attack risk is influenced by many factors including age, family history, blood pressure, diabetes, cholesterol, smoking, diet and physical activity.

The focus is not on a precise number of sitting hours, but on combining regular exercise with more movement throughout the day.

A workout still counts. But for heart health, the rest of the day counts too.