Is sitting the new smoking? What the research actually says

No. Long hours of sitting are linked with higher risks of type 2 diabetes, heart disease and dying earlier, but those risks are much smaller than the risks of smoking, and unlike smoking, a good share of them appears to be offset by regular physical activity. "Sitting is the new smoking" is a catchy line, not a research finding.

That doesn't make sitting harmless. The research behind the worry is real, and for people who sit most of the day it points to a few changes that are much easier than the slogan suggests.

Where "sitting is the new smoking" came from

The phrase is usually credited to James Levine, an obesity researcher who spent many years at the Mayo Clinic. Levine studied how much energy people burn in everyday movement outside of exercise, the walking, fidgeting and standing that fill a day, and he became one of the best-known champions of treadmill desks. In interviews in the early 2010s, and in a book about the chair, he argued that sitting was as dangerous as smoking, or worse.

The line spread quickly through news stories and office wellness talks. It was memorable, and it carried a real message: the way modern work keeps people still for hours might matter for their health. What it lost along the way was any sense of how big the risk actually is.

What the research on long sitting says

The evidence comes in two broad kinds.

Large observational studies follow many thousands of people for years. People who report sitting for most of the day, and especially those who watch a lot of TV, have higher rates of type 2 diabetes, heart disease and death from any cause. These studies show an association, not proof. People who sit a lot may also differ in diet, sleep, income or health to begin with, and researchers can only adjust for what they measure.

Lab studies are much smaller and shorter. They compare a few hours of unbroken sitting with the same hours broken up by short spells of light walking or standing. Several have found that breaking up sitting lowers the rise in blood sugar and insulin after a meal. That makes the link in the big studies more believable, because it shows one way that sitting still could affect the body.

Some things the research doesn't settle. In some large studies, evening TV time shows a clearer link with poor health than sitting at work does. Nobody is fully sure why. One guess is that evening TV tends to come in long, unbroken stretches, often with snacks, after a day already spent sitting, while work sitting is broken up by meetings and trips to the kitchen. Either way, "sitting" is not one single thing. For what long sitting feels like over a single working day, see what sitting all day does.

How much does exercise make up for it?

This is the part the slogan leaves out. One large analysis, published in The Lancet in 2016, pooled data on more than a million adults. People who did about 60 to 75 minutes of moderate activity a day, such as brisk walking, appeared to have no extra risk of early death from sitting a lot. For people who did less, more sitting went with more risk. Long hours of TV were the exception: even high activity softened that link without removing it.

Most people don't get an hour a day. The World Health Organization's 2020 guidelines ask adults for 150 to 300 minutes of moderate activity a week, and say that adults who sit a lot should aim for more than the minimum and limit how long they sit. So the realistic picture is this: exercise helps a great deal, the amount that cancels out heavy sitting is more than most people do, and breaking up the sitting itself is a sensible second line.

Nothing like that is true of smoking. There is no amount of running that makes a pack a day safe.

Why the comparison goes too far

Researchers who set the two side by side in a 2018 review in the American Journal of Public Health concluded that the comparison is misleading, above all because the risks are of such different sizes. A few reasons are easy to see.

• The scale is very different. The World Health Organization says tobacco kills up to half of the people who use it and don't quit. The risks linked to long sitting are real, but nowhere near that.
• Sitting isn't optional in the same way. Nobody needs to smoke. Almost everyone sits for part of the day, and plenty of people can't stand or walk for long.
• Activity offsets much of it. Heavy sitting with plenty of movement looks very different from heavy sitting without it. Smoking has no such counterweight.
• It can make smoking sound safer. Putting the two side by side can shrink the real danger of tobacco in people's minds as much as it raises concern about chairs.

There is a quieter downside too. A slogan that makes the office chair sound deadly pushes people toward dramatic fixes that don't help much, like standing rigidly all day, and away from the dull ones that do.

Is standing better than sitting?

Not on its own. Standing burns a little more energy than sitting, but not enough to count as exercise, and standing still for hours brings its own problems. Sore feet, aching legs, lower back trouble and swollen ankles are common in jobs that keep people on their feet. At least one large study, from Ontario in Canada, found more heart disease over the following years among people whose jobs involved mostly standing than among those whose jobs involved mostly sitting. It was observational, and standing jobs differ from desk jobs in many ways, but it is a fair warning against swapping one fixed position for another.

What helps is change: sit for a while, stand for a while, and move in between. A standing desk is useful as a way to switch more often, not as a replacement for the chair, and these standing desk tips cover how to use one without overdoing it.

What actually helps at a desk

The practical message from all this is mild and very doable.

1. Break up long sits. Get up for a few minutes about once an hour. How often you should get up from your desk has a rhythm that fits real workdays.
2. Count light movement. A walk to the kitchen, a flight of stairs or pacing on a call all count. The WHO guidelines say that replacing sitting with activity of any intensity, light activity included, has benefits.
3. Keep the weekly exercise. Brisk walking, cycling, swimming, anything that gets you a little out of breath, toward those 150 to 300 minutes a week.
4. Watch the evening sit. After a desk day, a long evening on the sofa is the stretch most worth breaking up. Stand between episodes, or take a walk after dinner.
5. Don't panic about the chair. Sitting to work is normal. The aim is fewer very long, unbroken stretches, not zero sitting.

If you have a health condition, or moving more hurts, a doctor or a physiotherapist can tell you how much activity suits you, and what kind.

Noticing the long sit while it happens

The hard part isn't believing any of this. It is noticing the long sit while it is happening, because an absorbed hour feels like twenty minutes. Notchpals does that noticing from your Mac's notch. Coach Flex, one of its Movement characters, keeps count of your unbroken time at the keyboard and mouse, and when it gets close to an hour he comes down to sub you in. He shouts most of his lines, but not all of them:

Coach FlexUp you get! Shake out the legs, nice and easy. Coach believes in you!

Done means you are up. Later buys you twenty minutes, then one more ask. Time away from the keyboard and mouse doesn't count, so a meeting in another room never adds to the total, and a few minutes away from the desk starts it again from zero. Notchpals can't tell whether you stood, and it takes your word for it. It will also never tell you that your chair is as bad as a cigarette.