Episode 5
The 10-Hour Sit-Down: Uncovering the Real Killer in Your Workday
Get ready to rethink your chair time! In this episode of Movement Prescription, Dr. Richard Mayne dives into the hidden dangers of prolonged sitting—and why your body is crying out for motion. From the science linking sedentary behavior to heart disease, diabetes, and even early mortality, to Dr. Mayne’s top tips for breaking up long stretches of inactivity, you’ll learn simple strategies to stand up for your health. Tune in and discover how a few small shifts in your daily routine can add years—and vitality—to your life.
Produced with support from the British Society of Lifestyle Medicine.
Find us at https://themovementprescription.co.uk/ and join the conversation!
Transcript
Hussain: Hello and welcome to another episode of the Movement Prescription Podcast and
Speaker:Hussain: I've got a great one coming up and it's in fact with an old colleague of mine, Dr.
Speaker:Hussain: Richard Main, who actually specializes in sedentary behavior and he's done research
Speaker:Hussain: specifically looking at this in primary care and you may find it surprising
Speaker:Hussain: some of the insights that they found.
Speaker:Hussain: And you may want to reconsider sedentary time.
Speaker:Hussain: Is it the opposite of physical activity or does it bring distinct risks.
Speaker:Hussain: We'll look at that now and share with Richard, a previous colleague of mine,
Speaker:Hussain: what his insights have been.
Speaker:Hussain: Richard, lovely to have you on the show today. Really grateful for you to give up some of your time.
Speaker:Richard: Yeah, great to be here. Good to be connecting with you again,
Speaker:Richard: Hussain. It's been a while, but good to be catching up with you.
Speaker:Hussain: Yeah, for sure. How long has it been?
Speaker:Richard: It's nearly 10 years, yeah, since I was working in Warwick as a fairly green
Speaker:Richard: FY2 doctor whenever you were the very knowledgeable, experienced GP trainee
Speaker:Richard: running the show in Warwick Hospital ED.
Speaker:Hussain: Oh, I'm not sure. I'm not sure I was experienced and knowledgeable,
Speaker:Hussain: but I was trying my best. I was trying my best. God, 10 years ago,
Speaker:Hussain: it doesn't feel that long.
Speaker:Hussain: Now, Richard, it's been really a
Speaker:Hussain: pleasure to see kind of your career develop and
Speaker:Hussain: your interest to align in in my own
Speaker:Hussain: i know definitely at the time when we were at warwick i'm not sure we ever discussed
Speaker:Hussain: physical activity in a and e not that it's a common topic that would come up
Speaker:Hussain: in the emergency department but it was just it's just amazing to find out that
Speaker:Hussain: you were also really infused in the topic and you'd gone into kind of the academic side of things.
Speaker:Richard: Yeah so uh i suppose
Speaker:Richard: after uh i finished working in warwick i
Speaker:Richard: moved back to north island which people can probably tell from my
Speaker:Richard: accent is where I grew up and I started GP training in North Ireland and during
Speaker:Richard: GP training I had the opportunity to do a research program where you extended
Speaker:Richard: the GP training program by an extra year to fit in a research project which
Speaker:Richard: I undertook at Queen's University in Belfast,
Speaker:Richard: and I was looking specifically at sedentary behavior and physical activity among
Speaker:Richard: GPs because that was an area that was particularly interesting to me and actually
Speaker:Richard: ended up hopefully providing some interesting discussion for other people working
Speaker:Richard: in healthcare, particularly in primary care.
Speaker:Hussain: And what first drew you to study sedentary behaviour and physical activity?
Speaker:Hussain: Was there a past passion or was it more, it kind of perfectly aligned with where
Speaker:Hussain: you wanted to go at that point?
Speaker:Richard: Uh, so whenever I was during the first two years of GP training,
Speaker:Richard: I completed a master's in sport and exercise medicine.
Speaker:Richard: Um, so I'd always loved sport and I'd always been aware of the benefits from
Speaker:Richard: physical activity. Um, you know, the benefits of physical activity for health.
Speaker:Richard: Um, but, uh, it was during that master's in sport and exercise medicine,
Speaker:Richard: uh, at Ulster University that I started to learn about the harms of sedentary
Speaker:Richard: behavior, um, which is an independent risk factor for all-cause mortality and
Speaker:Richard: a range of different health problems.
Speaker:Richard: So during that time, I remember actually being in a lecture where we were learning
Speaker:Richard: about the harms of sedentary behavior.
Speaker:Richard: And then I was going back then to work in my day job as a GP ST1 or GP ST2, where I was in a GP job.
Speaker:Richard: I was commuting an hour and 10 minutes each way, sitting down.
Speaker:Richard: And then I was revising for the exams
Speaker:Richard: during my lunch break and yeah so
Speaker:Richard: i was i must have been sedentary for over 13 hours a
Speaker:Richard: day and i was thinking uh this is when i was learning
Speaker:Richard: about all these harms of the excessive sedentary behavior um
Speaker:Richard: and the the worst risk in terms of health is whenever you're sedentary
Speaker:Richard: for over eight hours a day and i was well in excess of that and
Speaker:Richard: i was starting to notice that how it was affecting my own
Speaker:Richard: health and well-being um and so that's what
Speaker:Richard: got me thinking uh this maybe isn't particularly good for me and it's not exactly
Speaker:Richard: setting a good example to patients to be somebody who's advising them on trying
Speaker:Richard: to live a healthier lifestyle while just stuck in their chair all day and that's
Speaker:Richard: what got me thinking is how much time do gps spend sitting down every day and
Speaker:Richard: what can we potentially do about that.
Speaker:Hussain: You know, you mentioned how it's an independent risk factors or sedentary or physical inactivity.
Speaker:Hussain: And how do we differentiate between the two, between being inactive and sedentary
Speaker:Hussain: behavior? Because a lot of people sometimes get confused.
Speaker:Hussain: Like in the active practice charter, we had elements, well, we have elements
Speaker:Hussain: for both the sedentary behavior and physical activity because they are two separate things.
Speaker:Hussain: But for someone listening going, well, surely they're just two sides of the
Speaker:Hussain: same coin. How would you respond to that?
Speaker:Richard: It's kind of this comes down to the isotemporal substitution domain,
Speaker:Richard: which is you have to be doing something with your body.
Speaker:Richard: OK, so you're either sleeping, which is potentially good for your health if
Speaker:Richard: you're getting the right amount of sleep.
Speaker:Richard: And then if you're awake, then you have to be in a movement posture,
Speaker:Richard: be that sitting, standing, moving or lying down.
Speaker:Richard: Um so being physically inactive being sedentary
Speaker:Richard: is when you're in a sitting lying or reclining posture in a
Speaker:Richard: state of low energy expenditure um so uh
Speaker:Richard: ideally you want to be replacing that with something else you know with either
Speaker:Richard: light or or more vigorous physical activity but you have to be doing something
Speaker:Richard: with your body so being sedentary is whenever you're sitting and not really
Speaker:Richard: doing anything else um so you can't argue that uh some people would probably
Speaker:Richard: like to argue that cycling or rowing are sedentary,
Speaker:Richard: but they're not strictly defined as being sedentary behavior,
Speaker:Richard: which is in a state of low energy expenditure.
Speaker:Richard: So not doing something like cycling and rowing, which are certainly quite demanding.
Speaker:Hussain: Yes, yes, I can confirm that to be the case. And is any sedentary time important?
Speaker:Hussain: Because you know, obviously, we mentioned sleep. Yes, okay, let's move sleep to one side.
Speaker:Hussain: Good quality sleep says yes, important. But is there a certain amount of time
Speaker:Hussain: which we should be including some sedentary recovery or relaxation time?
Speaker:Hussain: And is it quite complex, that answer?
Speaker:Hussain: Or should we be trying to minimize it as much as possible?
Speaker:Richard: Well, yeah, as I was mentioning with the isotemporal substitution,
Speaker:Richard: you have to be doing something with your body, and it's not possible to avoid sitting constantly.
Speaker:Richard: There was an interesting newspaper article from an American journalist in about
Speaker:Richard: 2014, and I think he did four weeks where he tried to minimize sitting.
Speaker:Richard: And it was really very awkward for him. You think socially in terms of at meals,
Speaker:Richard: he was the only person standing.
Speaker:Richard: And if there was a lecture or whatever, he was the only person standing up.
Speaker:Richard: Wherever everybody else is sitting down and going to the cinema um
Speaker:Richard: so i think it's to be expected that it is natural to
Speaker:Richard: have a certain amount of sitting time um but uh
Speaker:Richard: the problem is it's uh a sort of pro-inflammatory state
Speaker:Richard: when you're sitting um which is detrimental for health
Speaker:Richard: um and uh yeah so
Speaker:Richard: you kind of need to be thinking about what you're doing over a 24-hour period
Speaker:Richard: and ideally uh not be spending too much time sitting down but it's impossible
Speaker:Richard: to be physically active all the time either so it's just kind of having an awareness
Speaker:Richard: of what your movement behavior is um i'm thinking about how you can potentially
Speaker:Richard: improve that you know on a day-to-day basis as well well.
Speaker:Hussain: Before we go into kind of the details of the research that you did exploring
Speaker:Hussain: sedentary behavior in general practitioners what are the potential kind of harms
Speaker:Hussain: of sedentary behavior You know, you mentioned,
Speaker:Hussain: you touched on it a little bit, but like beyond merely the reduced fitness that
Speaker:Hussain: you'd experience by not being active, what are the potential harms?
Speaker:Richard: The main one would be the cardiometabolic outcomes, which are your cardiovascular
Speaker:Richard: disease and type 2 diabetes and metabolic syndrome because of the energy balance
Speaker:Richard: connotations associated with a lack of physical activity.
Speaker:Richard: Um so being physically inactive being sedentary will
Speaker:Richard: increase your risk of all of those things um but actually
Speaker:Richard: the there is furthermore uh evidence to
Speaker:Richard: to support that being having excessive sedentary time
Speaker:Richard: will also increase your risk of mental health issues um things like dementia
Speaker:Richard: and depression um and also um other physical health problems like um certain
Speaker:Richard: types of cancer as well so there are range uh and even bone mineral density
Speaker:Richard: is reduced if you're excessively sedentary as well.
Speaker:Richard: So there's a whole range of things that are associated with excessive sedentary time.
Speaker:Richard: And it's really just the inverse of the benefits of being physically active.
Speaker:Richard: So physical activity reduces your risk of all of those things,
Speaker:Richard: and being sedentary then increases your risk of all of those things.
Speaker:Hussain: When it comes to kind of understanding where this sort of behavior comes from,
Speaker:Hussain: have you seen or read about why do we tend to,
Speaker:Hussain: at least it feels like, gravitate towards sedentary time?
Speaker:Hussain: And we invent tools and equipment and technology to promote it,
Speaker:Hussain: whether it be apps to deliver your food or the chair or the remote control all
Speaker:Hussain: these things to help reduce that tiny bits of movement here or there like is
Speaker:Hussain: that something that you've read into do you understand why we're so obsessed with sedentary time.
Speaker:Richard: Yeah yeah it's something i've been looking at
Speaker:Richard: more recently um and it is fascinating but really
Speaker:Richard: when it comes down to it it's an evolutionary trait as
Speaker:Richard: a human species um because if you
Speaker:Richard: think of how our bodies were evolved to to survive um
Speaker:Richard: for you know the vast majority of human
Speaker:Richard: existence probably 99 or over 99 percent
Speaker:Richard: of human history we've had a struggle to achieve a
Speaker:Richard: positive energy balance to be able to survive and reproduce so a way of trying
Speaker:Richard: to mitigate that is by reducing any unnecessary uh physical activity so um to
Speaker:Richard: survive in centuries and millennia gone in the past,
Speaker:Richard: the way of doing that was only by being physically active whenever you really needed to.
Speaker:Richard: Which would be for hunting or gathering food and for moving from place to place
Speaker:Richard: and avoiding becoming food for another animal as well.
Speaker:Richard: And also then for social purposes as well, you know, to go and meet other people.
Speaker:Richard: But there was a necessity of being physically active to survive.
Speaker:Richard: Um and to uh
Speaker:Richard: yeah so so now we've evolved these bodies that are adapted
Speaker:Richard: to physically they're adapted to be uh to be
Speaker:Richard: active and to move efficiently but our brains
Speaker:Richard: are not changed uh from the
Speaker:Richard: time when they were always wanting to conserve energy
Speaker:Richard: as much as possible by minimizing movement and sitting down
Speaker:Richard: where possible it's just in the past you know our ancestors didn't have the
Speaker:Richard: luxury of doing that whereas now we do and that's where the problem arises this
Speaker:Richard: mismatch between the environment that our bodies are our bodies and brains are
Speaker:Richard: adapted to and the environment that we've um adapted for ourselves our.
Speaker:Hussain: Genetics takes tens of thousands of years to adapt but
Speaker:Hussain: our environment of late has been adapting over even
Speaker:Hussain: decades let alone centuries into the play okay that's really interesting all
Speaker:Hussain: right so let's let's explore some of the research that that you briefly mentioned
Speaker:Hussain: there looking at sedentary behavior in general practitioners i'm i'm not expecting
Speaker:Hussain: great results but richard let us know what did you find.
Speaker:Richard: Yeah, so, well, the original idea I had for the research study was to just go
Speaker:Richard: ahead with a sort of intervention trial where we brought in standing desks into
Speaker:Richard: GP surgeries and asked people to use them and see how they got on with it.
Speaker:Richard: But actually, when I suggested doing that, my supervisor said,
Speaker:Richard: well, let's kind of take it back a couple of steps, because how much time are
Speaker:Richard: GP spending sitting down at the moment anyway?
Speaker:Richard: So if you're going to do an intervention, you kind of need to know that it's
Speaker:Richard: a problem in the first place.
Speaker:Richard: So the aim of the initial study was to kind of get the baseline data as to how
Speaker:Richard: much the average GP is sitting down on a typical working day and also on a day off work.
Speaker:Richard: So we recruited GPs across North Ireland, which is part of the NHS,
Speaker:Richard: and working conditions in general practice in North Ireland are much the same as the rest of the UK.
Speaker:Richard: And yeah, we recruited quite a few participants.
Speaker:Richard: There were over 300 answered a questionnaire about their physical
Speaker:Richard: activity and sedentary behavior and then um we
Speaker:Richard: recruited a subset of 20 of them to wear an
Speaker:Richard: accelerometer on their thigh which is the sort of
Speaker:Richard: gold standard in sedentary behavior research because it doesn't lie so
Speaker:Richard: you can lie to the questionnaire you can't lie
Speaker:Richard: to the accelerometer if you're wearing the accelerometer if it's
Speaker:Richard: on your thigh it can detect whether you're sitting standing or moving um so
Speaker:Richard: um we got people to wear uh that for a week um and then basically from the overall
Speaker:Richard: results that we obtained we worked out that the average gp uh during a working
Speaker:Richard: day was sedentary for about 10 and a half hours 10.
Speaker:Hussain: And a half hours and that's not just including work time that's just the whole
Speaker:Hussain: day so some of that will be work time.
Speaker:Richard: Some of it will be that's from waking up to going to sleep um so that's really
Speaker:Richard: just quite similar to other people working in office settings so people working
Speaker:Richard: in call centers or maybe in an accountancy office or something like that,
Speaker:Richard: it is similar to- And this is excluding sleep, of course.
Speaker:Richard: Yes yeah.
Speaker:Hussain: So you're saying that 10 and a half hours on average of the person's day once
Speaker:Hussain: you remove sleep is spent sitting down or at least lying or doing something stationary.
Speaker:Richard: Yeah yeah while they're awake yeah so um
Speaker:Richard: so that was but that was the gps okay so there was
Speaker:Richard: um we also recruited some gp trainees who
Speaker:Richard: were working in hospital settings um and you
Speaker:Richard: know which we would have done in the past you whenever you're working in ed and
Speaker:Richard: i've worked in you know multiple hospital jaws before and
Speaker:Richard: uh what's interesting about that is they averaged about
Speaker:Richard: eight hours of sedentary time each day um so
Speaker:Richard: they were um that's and that's pretty good that's really
Speaker:Richard: what you'd be aiming for is is about sitting for
Speaker:Richard: about eight hours is actually fairly good so canada canada
Speaker:Richard: have um what they call 24-hour movement guidelines where
Speaker:Richard: they recommend people aim to achieve eight hours of sleep and also
Speaker:Richard: aim to be sedentary for less than eight hours a day so the
Speaker:Richard: doctors the junior doctors that were working in you know
Speaker:Richard: gp gp registrars that were working in hospital settings um they they were actually
Speaker:Richard: getting about eight hours of sedentary time each day because as you think you
Speaker:Richard: know in terms of your you're walking around the ward doing ward rounds you know
Speaker:Richard: going to different places in the hospital you are much more active than if you're
Speaker:Richard: stuck in your room in general practice my.
Speaker:Hussain: Memory of junior doctor days included much less time sitting on a chair if i'm
Speaker:Hussain: being honest maybe maybe i need one of those phi accelerometers to to get the
Speaker:Hussain: truth because i think in my mind i think i was sitting down for like one minute a day from how it.
Speaker:Richard: Felt i was constantly rushing around well i was gonna say i think um i used
Speaker:Richard: to relish the chance to sit down so whenever i was working in ed i remember
Speaker:Richard: that one stage they i don't know if i think it might have been at work you could
Speaker:Richard: never find a chair so you used to have like colleagues sitting in bins and stuff yeah yeah no.
Speaker:Hussain: For sure yes it was impossible to sit down anyway,
Speaker:Hussain: now i was going to ask you and you answered it
Speaker:Hussain: as to what does good look like because the thing is i
Speaker:Hussain: i talk a lot about let's say the physical activity
Speaker:Hussain: guidelines and the amount of minutes that we want to be doing or you know moderate
Speaker:Hussain: vigorous strength training etc but normally when i talk about send your baby
Speaker:Hussain: it's just about reducing it but i i don't know what good average and bad looks
Speaker:Hussain: like now you mentioned less than eight hours was was mentioned by the canadian guidelines um there and,
Speaker:Hussain: do they also define kind of what is bad do we have an idea of what bad average
Speaker:Hussain: and good or what to aim for is.
Speaker:Richard: Yeah, so I think Canada are probably the most progressive in terms of giving
Speaker:Richard: an actual 24-hour movement recommendations.
Speaker:Richard: There's other countries I think are going to be following suit moving forwards,
Speaker:Richard: but it is also kind of controversial.
Speaker:Richard: But yeah, so in the UK, they just recommend to try and limit sedentary time
Speaker:Richard: where possible, which is a bit more vague.
Speaker:Richard: And the World Health Organization guidelines are much the same. um
Speaker:Richard: but uh yeah so i would think um good
Speaker:Richard: you know a green light if you're sedentary for less than eight hours a
Speaker:Richard: day i think you're doing well um and then
Speaker:Richard: uh probably and this is just my personal
Speaker:Richard: opinion there's there there probably is uh some evidence
Speaker:Richard: to kind of correlate with this but uh it's above
Speaker:Richard: eight hours then is when the health risks from sedentary time start
Speaker:Richard: to go up um and so probably uh yeah beyond eight hours is when it becomes becomes
Speaker:Richard: more of a problem um so uh and it goes up quite steeply uh you know at that
Speaker:Richard: point in terms of the risks uh for every additional hour spent sitting um so yeah and.
Speaker:Hussain: For most of these risks is it it's association right because
Speaker:Hussain: like it's very hard to prove causation um between
Speaker:Hussain: the two but they're association i assume and does
Speaker:Hussain: it have a linear response like do we know that the the more you can limit sedentary
Speaker:Hussain: behavior the more you reduce those risks or does it plateau uh where you know
Speaker:Hussain: let's say much below seven or six hours whatever we're talking about you don't
Speaker:Hussain: tend to get any more benefits.
Speaker:Richard: Uh yeah it's a lot of diminishing returns it's the same with physical activity
Speaker:Richard: so it is very much like i think the story of sedentary behavior is kind of just
Speaker:Richard: the inverse of physical activity So the most benefit from becoming more physically
Speaker:Richard: active is in the people who do nothing to doing a small amount.
Speaker:Richard: So the most benefit from reducing sedentary time is the people who sit an awful
Speaker:Richard: lot and sit slightly less.
Speaker:Richard: So yeah, it does kind of drop off, and certainly that's where going less than
Speaker:Richard: eight hours probably doesn't make a huge difference.
Speaker:Richard: But you also need to be thinking about what you're replacing that sedentary time with.
Speaker:Richard: So ideally, you want to replace it with physical activity, but also you have
Speaker:Richard: to consider how you're actually living your life.
Speaker:Richard: So, you know, for us working in general practice, we are desk-based workers.
Speaker:Richard: So typically, and what we found in the research is the GPs that we recruited
Speaker:Richard: that had standing desks, they were sedentary, again, for about eight hours a day.
Speaker:Richard: So they were sedentary for about two and a half hours less than their colleagues
Speaker:Richard: that didn't have standing desks. But that time was very much replaced with static
Speaker:Richard: standing time, which isn't hugely more beneficial for health.
Speaker:Richard: It's less bad, but it's not as good as being physically active.
Speaker:Richard: However, you'd be fairly cutting edge, pioneering early adopter if you were
Speaker:Richard: bringing your treadmill desk into your consultations with you,
Speaker:Richard: which would certainly be an interesting research study.
Speaker:Hussain: That was going to be my question. Let's just focus on this group, the GPs that you had.
Speaker:Hussain: My first part before we go into it is from my understanding,
Speaker:Hussain: given that you did a questionnaire exploring sedentary time,
Speaker:Hussain: and then you did for 20 of the individuals, the close assessment with the accelerometer,
Speaker:Hussain: did people's perception of sedentary time match up to the reality?
Speaker:Hussain: Did most people estimate that they were doing about 10, 11 hours of sedentary
Speaker:Hussain: time and the accelerometer confirmed that? Or was it skewed one way or another?
Speaker:Richard: No, so GPs, something to be praised for is they're actually very good at estimating
Speaker:Richard: their sedentary time and their physical activity on a workday,
Speaker:Richard: but not so good on the days off.
Speaker:Richard: So on the days off, their estimates were all over the place,
Speaker:Richard: but I think it's probably down to having, on a workday, you're in a routine,
Speaker:Richard: so you probably have a similar length of commute and then you have a similar sort of day,
Speaker:Richard: so it's much easier to kind of record what your normal workday is and then estimate
Speaker:Richard: off that versus a day off work, which you could be doing something completely
Speaker:Richard: different from one day to the next.
Speaker:Richard: And something else to mention is that GPs on their days off were very active.
Speaker:Richard: It was very encouraging. There were quite a few of them getting over 10,000
Speaker:Richard: steps and having quite low levels of sedentary time.
Speaker:Richard: So really the main area in terms of if you're writing a report for improvement
Speaker:Richard: is to try and reduce their workday, sedentary time.
Speaker:Hussain: And we're going to come on to some tips because I'm sure lots of the people
Speaker:Hussain: listening are GPs and are feeling, yes, I'm probably doing 10 and a half hours.
Speaker:Hussain: How do I reduce it? We're going to come on to that at the end and take homes.
Speaker:Hussain: But I wonder, in terms of the group that you had identified,
Speaker:Hussain: that 20, were they randomly selected or was there any bias that you identified,
Speaker:Hussain: potentially from coming about?
Speaker:Hussain: Did people self-register for this trial? Like, do they have to express interest to do it?
Speaker:Hussain: Anything that you could identify as to the group?
Speaker:Richard: Well, yeah, I would imagine that, if anything, the people who participated,
Speaker:Richard: that responded to the initial questionnaire,
Speaker:Richard: were probably more interested in physical activity and this sort of thing,
Speaker:Richard: positive health behaviors,
Speaker:Richard: than the ones that didn't answer it.
Speaker:Richard: So that is an assumption that you could make as a potential limitation so if anything,
Speaker:Richard: the 10.5 hours that we came up with is potentially a conservative estimate because
Speaker:Richard: maybe the ones that didn't reply were sitting for 13-14 hours a day but just
Speaker:Richard: weren't interested and just maybe didn't want to know how bad it was.
Speaker:Richard: So in terms of the accelerometer study, they reflected the overall people that
Speaker:Richard: had signed up to the initial questionnaire uh so yeah they just were kind of reflective of that and.
Speaker:Hussain: You mentioned one of the gold standard ways of assessing sedentary time is the
Speaker:Hussain: phi accelerometer but for people listening that want to assess it themselves
Speaker:Hussain: and we have what smart watches smartphones etc do they do the apps like like
Speaker:Hussain: the health apps that are inbuilt to them etc are they good at assessing sedentary time are they accurate.
Speaker:Richard: Wrist-worn devices at
Speaker:Richard: the moment don't work uh so um you
Speaker:Richard: could be standing in a standing desk for an hour and then your
Speaker:Richard: apple watch might or you know one of your um or
Speaker:Richard: any other device i'm not biased but uh
Speaker:Richard: your activity tracking watch will then buzz even
Speaker:Richard: though you've been standing so you're not sedentary it'll say uh
Speaker:Richard: you know you've been you've been sitting you need to move um
Speaker:Richard: which can be a bit frustrating so uh no
Speaker:Richard: thigh worn accelerometers are the gold standard and
Speaker:Richard: unfortunately there's not really been any other good way
Speaker:Richard: of capturing it and i suppose um it was
Speaker:Richard: after finishing up the research study and and thinking
Speaker:Richard: about how we can try and help to intervene to help people to be more aware of
Speaker:Richard: the sedentary time uh that i then went on to co-found a business um called sonamove
Speaker:Richard: uh where we have been trying to help people with standing desks to optimize
Speaker:Richard: their use of their standing desks through the workday.
Speaker:Richard: Because from my experience of seeing people with standing desks and my own personal
Speaker:Richard: experience of using a standing desk is that it's not always a perfect solution either.
Speaker:Richard: Because too much time standing still isn't good for you either.
Speaker:Richard: And it is associated with health problems. So really, you need to be alternating
Speaker:Richard: between sitting and standing quite regularly.
Speaker:Hussain: Yeah that was gonna be one of my questions was is
Speaker:Hussain: the standing desk the answer um now you've touched on it already but can you
Speaker:Hussain: just go explain a bit more as to why like whether you feel that well first the
Speaker:Hussain: benefits that you think it brings but also maybe it's limitations and how you
Speaker:Hussain: would consider um trying to mitigate those limitations yeah.
Speaker:Richard: Yeah, so after the work that myself and my colleagues did in terms of getting
Speaker:Richard: the baseline levels of sensory behavior among GPs, there was actually a team in Loughborough,
Speaker:Richard: a team of researchers, mainly led by Amanda Daly and Greg Biddle,
Speaker:Richard: who looked at an intervention study where they did bring standing desks into general practice.
Speaker:Richard: And they looked at how patients perceived their appointments with GPs that were using a standing desk.
Speaker:Richard: And this was GPs recruited throughout the West Midlands in England.
Speaker:Richard: And actually the patients really perceived it quite positively and where I would
Speaker:Richard: have thought that a GP with a standing desk, anytime I was bringing in patients
Speaker:Richard: for a face-to-face assessment,
Speaker:Richard: typically I would have been lowering the standing desk to just being at a sitting
Speaker:Richard: height to hopefully improve the rapport and be on the same level as the patient
Speaker:Richard: who comes in and sits down.
Speaker:Richard: But they actually found that patients didn't seem to mind if the doctor was
Speaker:Richard: standing and they were sitting.
Speaker:Richard: Oh, really? Okay. For some health
Speaker:Richard: problems like sciatica and things like abscesses in unfortunate places.
Speaker:Hussain: Yes, in certain places.
Speaker:Richard: Where it's quite painful to sit, having the option of doing a standing consultation
Speaker:Richard: is helpful, but it's not that often.
Speaker:Richard: So I've been using a standing desk in general practice for a long time,
Speaker:Richard: and I work in lots of different practices.
Speaker:Richard: Uh and so i will if i'm in a practice for a few weeks i'll i'll come with my
Speaker:Richard: desk into the practice and get it set up um because it just converts a normal
Speaker:Richard: desk into a sitting standing oh.
Speaker:Hussain: Okay so you've got like the add-on one now.
Speaker:Richard: That's that's one that.
Speaker:Hussain: I've got as well yeah.
Speaker:Richard: Yeah so i i can pop it in the back of my car and bring
Speaker:Richard: it in you know in the morning and get set up and and get going um
Speaker:Richard: but uh yeah originally i found i was
Speaker:Richard: actually spending too much time standing up um and too much time
Speaker:Richard: standing is detrimental for your health as well because it can lead to
Speaker:Richard: things like barricades veins and you also get a sore back and sore legs
Speaker:Richard: as well so you kind of need to remember to to
Speaker:Richard: you know go between the two um uh so
Speaker:Richard: yeah typically uh and that's kind of where the the idea then for the business
Speaker:Richard: came up in terms of uh solar move which is uh spelled s-o-n-a-m-o-v-e we we
Speaker:Richard: just have a it's a software program that you can as a standing desk user log
Speaker:Richard: into that And then at the start of your day,
Speaker:Richard: you can say whether you're sitting or standing, and then you can identify,
Speaker:Richard: you can select how much time you want to be sitting and standing each hour.
Speaker:Richard: So for me, I aim to sit for about 20 minutes and stand for about 40 minutes each hour.
Speaker:Richard: But I don't think somebody who's just new to using a standing desk would be
Speaker:Richard: maybe as comfortable doing that. So you can kind of build that up more gradually over time.
Speaker:Hussain: And are there any guidelines to sort of give people that idea as to what they
Speaker:Hussain: should aim for in terms of the ratio of sitting to standing?
Speaker:Hussain: I'm assuming there isn't, but are there? How do you know what is the perfect balance?
Speaker:Richard: Yeah, again, there's not a simple answer for that.
Speaker:Richard: I think it probably does come down to the, partly to the individual in terms
Speaker:Richard: of how comfortable you are, because if you've just,
Speaker:Richard: if you've never used the standing desk before and you've always been sitting
Speaker:Richard: at a desk, you'll probably find it quite uncomfortable to be sitting for,
Speaker:Richard: you know, or to be standing, sorry, for half an hour, 40 minutes.
Speaker:Richard: So, yeah, in terms of the evidence seems to be ideally aiming for a fairly even
Speaker:Richard: split between sitting and standing.
Speaker:Richard: You probably don't want to be in a static position for much more than 30 minutes,
Speaker:Richard: you know, probably aiming to be somewhere around 50-50 while you're at your
Speaker:Richard: desk is probably be best um because even uh transitioning from a sit to a stand
Speaker:Richard: you know actually activates your you know fairly large muscles in your legs.
Speaker:Hussain: Um yeah which.
Speaker:Richard: You know does have a health benefit um so um transitioning between the two is
Speaker:Richard: uh is is better than just you know staying staying standing for too long either.
Speaker:Hussain: What else can someone do to
Speaker:Hussain: kind of go up to the next level let's say they've got
Speaker:Hussain: a standing desk they're doing a bit of the combination between
Speaker:Hussain: sitting and standing are for
Speaker:Hussain: example getting those under table treadmills or
Speaker:Hussain: pedal machines does that
Speaker:Hussain: add something to it and I don't suppose that's
Speaker:Hussain: something that Loughborough explored because I assume you would never want to
Speaker:Hussain: be on a treadmill while talking to a patient I mean that would be a very bizarre
Speaker:Hussain: experience but is there something that's been looked at in the research do we
Speaker:Hussain: compare standing desks to standing desks plus some form of lower limb movement.
Speaker:Richard: Well, it depends how you look at it.
Speaker:Richard: In terms of for your own personal physical health and potentially mental health,
Speaker:Richard: then if you can adopt a treadmill desk or like an under desk cycle,
Speaker:Richard: that's better again because you're just replacing your static standing time
Speaker:Richard: with physical activity, which will give you health benefits.
Speaker:Richard: However, you do have to think of the practicalities of the environment that
Speaker:Richard: you're working in and whether or not it's something that is going to be appropriate.
Speaker:Richard: So if, yeah, and also how able you are to carry out your work role while walking or pedaling.
Speaker:Richard: So it probably depends on the individual and it probably would take something
Speaker:Richard: that you could adapt to and get used to.
Speaker:Richard: But potentially it depends how much work you're doing remotely,
Speaker:Richard: but certainly for remote telephone consultations um
Speaker:Richard: as long as you weren't making too much noise you know and getting
Speaker:Richard: out of breath yeah you could you could potentially do it you know in general
Speaker:Richard: practice um i just haven't tried it myself and i'm not aware of any colleagues
Speaker:Richard: that have that have done it um i do have you know i have some fairly uh you
Speaker:Richard: know healthy fit and active gp colleagues but i'm not aware of anybody who's gone that far yeah.
Speaker:Hussain: Well i've one of um one of the partners at the practice,
Speaker:Hussain: he has a cycle machine and he only uses it during when he's doing admin and
Speaker:Hussain: reviewing kind of the, you know, doing those bits and bobs.
Speaker:Hussain: He doesn't do it whenever there's any kind of patient pacing kind of stuff.
Speaker:Hussain: And I'm not sure how often he actually uses it though.
Speaker:Hussain: That may be something I need to interrogate Tom on if it actually does get used
Speaker:Hussain: much, but definitely the thought is there. Now,
Speaker:Hussain: Are standing desks and that kind of element, are they just scratching the surface?
Speaker:Hussain: Are they not fixing the underlying structural, occupational,
Speaker:Hussain: sedentary behavior that gets built in because of our work environments,
Speaker:Hussain: because they are based on a desk and they are such?
Speaker:Hussain: Are they just scratching the surface? Is there anything else that we can do
Speaker:Hussain: feasibly to try to combat sedentary tunnel?
Speaker:Richard: Uh i mean it again that comes back to your
Speaker:Richard: eyes of temporal substitution in that you have
Speaker:Richard: to so yes standing desk so standing even static
Speaker:Richard: standing still so static standing is better than sitting um
Speaker:Richard: so it's kind of the lesser of two evils um but
Speaker:Richard: because you know if we were wanting to just prioritize our own health and not
Speaker:Richard: think about anything else then i suppose you maybe wouldn't work you would see
Speaker:Richard: lots of light uh light to moderate physical activity and live like a hunter
Speaker:Richard: gatherer in uh tanzania um but um for.
Speaker:Hussain: Some that may be alluring but but but for those uh
Speaker:Hussain: that of us that don't feel like that's the the way
Speaker:Hussain: forward um is the kick it has do you know of anywhere that's that's tried to
Speaker:Hussain: sort of change the kind of work environment the sort of whether it be like reducing
Speaker:Hussain: the amount of seats in the staff room or um you know adapting the space to try
Speaker:Hussain: to encourage sedentary to try to discourage sedentary time.
Speaker:Richard: No i think it's it's gonna come down to um you know individual uh action and
Speaker:Richard: preference uh so for me from a personal perspective uh fairly consciously on
Speaker:Richard: a daily basis i do think of where i'm gonna get my movement in for the day,
Speaker:Richard: and also through the course of the week.
Speaker:Richard: You know, I kind of have a sort of mental tick box of the physical activity
Speaker:Richard: that I'm aiming to achieve through the week.
Speaker:Richard: And I get a bit frustrated if I don't manage to fit that all in.
Speaker:Richard: But I think you kind of need to just think of from when you wake up to when
Speaker:Richard: you go to sleep and all of the potential opportunities to be physically active
Speaker:Richard: within that day and whether you're availing of them or not.
Speaker:Richard: Um and if you're not you know what you what you
Speaker:Richard: could potentially replace uh where you know that
Speaker:Richard: you are being sedentary and you could potentially replace that with being physically
Speaker:Richard: active um you know within your day uh
Speaker:Richard: that you're going to be happy with that you can sustain in the
Speaker:Richard: long term um so for me even so
Speaker:Richard: so so for me uh if it's um
Speaker:Richard: you know i'm bringing a patient to the consulting room i'll walk
Speaker:Richard: uh and i think some of the practice managers deliberately put my room the furthest
Speaker:Richard: from the waiting room just to kind of wind me up and it's fine for most patients
Speaker:Richard: but sometimes you'll get somebody who's maybe quite slow on a rollator you know
Speaker:Richard: maybe frail an elderly that's half the appointment gone,
Speaker:Richard: yeah that's the difficulty but at least you get the um social interaction the
Speaker:Richard: connection with them and you talk about the weather uh you know between uh the
Speaker:Richard: the waiting room and the consulting room and.
Speaker:Hussain: The examination begins in a way just just assessing that that gate into your
Speaker:Hussain: room is an opportunity isn't it to to assess the neurology and and the.
Speaker:Richard: Musculature and then you see so so at lunchtime i'll also
Speaker:Richard: uh where possible you know get out for a walk as
Speaker:Richard: well um because and try and talk some colleagues into coming with me as well
Speaker:Richard: um and if you see patients out and about you know some some people would be
Speaker:Richard: concerned that they're thinking they've got too much time you know i can't get
Speaker:Richard: an appointment with this practice and yet they're right at lunchtime you know
Speaker:Richard: walking around but yeah how dare they at.
Speaker:Hussain: Lunchtime be walking around.
Speaker:Richard: Yeah and this is the difficulty but uh you kind of have to think also that you're
Speaker:Richard: setting a positive example in that yes we're very busy but i'm also taking time
Speaker:Richard: to prioritize my own health um you know through the working day and a funny
Speaker:Richard: act was last week I'd walked down to the consulting room or to the waiting room to walk,
Speaker:Richard: you know, bring a patient into the room and I said,
Speaker:Richard: whenever we were in the room, yeah, you know, I'm Dr. May and he was like,
Speaker:Richard: oh, you're the doctor then?
Speaker:Richard: He obviously thought I was some sort of escort, you know, to bring him from the waiting room.
Speaker:Richard: And unfortunately, there's not many practices really have that sort of level
Speaker:Richard: of service, maybe in the private sector more, but certainly in general practice.
Speaker:Hussain: Oh, brilliant, brilliant. Okay, so some tips for people to take away.
Speaker:Hussain: Let's say they listen to this, the healthcare professionals,
Speaker:Hussain: they feel like they probably are spending quite a bit of time sedentary.
Speaker:Hussain: You mentioned a few there. So maybe at lunchtime, you can include a bit of a
Speaker:Hussain: walk, either as you eat or afterwards.
Speaker:Hussain: And often it doesn't take that long, even like 5, 10 minutes.
Speaker:Hussain: That can be helpful if we're converting 10 minutes of sedentary time to 10 minutes of movement.
Speaker:Hussain: I guess, you know, not using the cold buzzer, if you do have one,
Speaker:Hussain: to actually switch that off and just go out and bring the patient in yourself.
Speaker:Hussain: Because yes, that has the movement.
Speaker:Hussain: It's also getting up, going down. It does involve breaking it up quite easily.
Speaker:Hussain: What else? You also mentioned that potentially having a kind of a nice split
Speaker:Hussain: of time between standing and sitting if you are utilizing a standing desk.
Speaker:Hussain: And interesting to hear there that you mentioned that University of Loughborough
Speaker:Hussain: research had identified that patients actually seem to tolerate it and be quite
Speaker:Hussain: accepting of it if that was a concern for you.
Speaker:Hussain: Anything else, any other tips that you think a healthcare professional could
Speaker:Hussain: consider or any other professional listening to this that has a desk-based job,
Speaker:Hussain: any other tips to help them reduce that?
Speaker:Richard: Well, I mean, yeah, there's things like active commuting if you live close enough to practice.
Speaker:Richard: So most of the practices I work in are in day-to-day GP. I have to drive there.
Speaker:Richard: But I am fortunate in one role that I have is doing a musculoskeletal clinic
Speaker:Richard: as a sort of specialist interest clinic. And it's about a half hour cycle from my house.
Speaker:Richard: And within that role, I know I don't have any home visits either.
Speaker:Richard: So I'll cycle in to work on those days.
Speaker:Richard: And even just if you are actively if you're cycling or walking particularly
Speaker:Richard: even walking at lunchtime in the vicinity of the practice you get such a better idea,
Speaker:Richard: especially if you're working in lots of different practices like I am you get
Speaker:Richard: such a better idea of the environment,
Speaker:Richard: the built and natural environment that the patients are living in,
Speaker:Richard: because one inner city practice there may be a great local park that people
Speaker:Richard: could avail of or there may be nothing So whenever you're then trying to encourage
Speaker:Richard: them to be more physically active, then you're aware of what is available locally,
Speaker:Richard: maybe where the leisure centers are and what the environment is like and what
Speaker:Richard: type of restaurants and shops and things are available because are they even
Speaker:Richard: going to be able to access somewhere that they can buy healthy food or have a healthy meal?
Speaker:Richard: If you get out and walk at lunchtime or on the way to and from work,
Speaker:Richard: then you really get to take all that in, which you certainly miss if you're
Speaker:Richard: getting there in the car.
Speaker:Hussain: Absolutely. And now that you mentioned it for those of us that do locum and
Speaker:Hussain: let's say do move from practice to practice building that awareness actually
Speaker:Hussain: has a lot more impact than you think because for many we tend to locum at the
Speaker:Hussain: same kind of set of different practices that sort of go around and so you may not be aware of that.
Speaker:Hussain: Local environment and the potential impact that that may have and how to either
Speaker:Hussain: utilize it or understand the challenges that it poses.
Speaker:Hussain: That's a really interesting one. Okay. Yeah, I think active commuting is probably
Speaker:Hussain: a really good way. And it doesn't have to always be like replacing it whole.
Speaker:Hussain: So let's say if you can't cycle for one reason or another, then even just driving
Speaker:Hussain: and parking five, 10 minutes away from your destination.
Speaker:Hussain: I quite often do that for lots of reasons because um you
Speaker:Hussain: know levington it can be you can spend ages trying to buy in a parking space
Speaker:Hussain: close to where you need it to be if you just
Speaker:Hussain: park five ten minutes further away you find an easy space normally free
Speaker:Hussain: and the time that you spent trying to find
Speaker:Hussain: a tiny space you've spent just walking in um so yeah yeah it's just these little
Speaker:Hussain: bits that we can do and and it's interesting that you said right at the beginning
Speaker:Hussain: if we just reaffirm it in that we don't need to make wholesale changes you We
Speaker:Hussain: don't need to become hunter-gatherers again constantly on the move, but any small change,
Speaker:Hussain: whether it be half an hour reduction, et cetera,
Speaker:Hussain: over the whole day, that can have a meaningful impact on our long-term health.
Speaker:Hussain: Okay, so the final question I want to ask you before we close up is,
Speaker:Hussain: I heard the term like an active couch potato.
Speaker:Hussain: So I don't know if you've sort of seen kind of the slide or kind of the storyboard of this.
Speaker:Hussain: And this is where someone, let's say they're doing the 10K run in the evenings.
Speaker:Hussain: But they spend a lot of the rest of the day being very sedentary.
Speaker:Hussain: Let's say they spend 11 hours sedentary.
Speaker:Hussain: Is that activity able to negate the detriment of the sedentary time?
Speaker:Hussain: Or are these things need to be seen as two separate things?
Speaker:Richard: It's an interesting question. If they're going out and doing a 10-kilometer
Speaker:Richard: run, then that's fantastic, and they'll get a huge amount of health benefit from that.
Speaker:Richard: But as an individual, if they were wanting to, if they're really wanting to
Speaker:Richard: have, you know, the healthiest lifestyle and, you know, feel physically well
Speaker:Richard: through the day and, you know, have a healthy,
Speaker:Richard: you know, a good health span in terms of, you know, living a long and healthy life,
Speaker:Richard: then to me, they should probably be aiming to reduce their sedentary time as
Speaker:Richard: well as continuing the, you know, the 10 kilometer run.
Speaker:Richard: Because if they're somebody who is already engaged in terms of doing quite a
Speaker:Richard: lot of exercise because that's something that they're setting aside time and energy for,
Speaker:Richard: then they're likely to be the same type of person will be hopefully having the
Speaker:Richard: motivation to look at incorporating more physical activity into their day the
Speaker:Richard: rest of the time because there's no point in just,
Speaker:Richard: yeah just doing the one thing and thing that's the be all and end all you do
Speaker:Richard: need to kind of think of things over a 24-hour period over a week-long period
Speaker:Richard: in terms of how you can maximize your health and so reducing your sedentary
Speaker:Richard: time throughout the day is certainly one of them.
Speaker:Hussain: Yeah and like there's no right or wrong and I'll be interested to hear your
Speaker:Hussain: opinion on this but often when I sort of speak to patients you know if we are
Speaker:Hussain: speaking to someone that let's say is quite inactive and let's say less than
Speaker:Hussain: 30 minutes per week of physical activity.
Speaker:Hussain: And we're thinking about how we can incorporate,
Speaker:Hussain: movement and physical activity to help their health. I often explain that the
Speaker:Hussain: time that we spend being physically active as a percentage is quite low across
Speaker:Hussain: the week compared to all the things that we need to do.
Speaker:Hussain: And sometimes it can be more impactful to make lots of little changes in terms
Speaker:Hussain: of a change and shift in behavior and how you kind of move.
Speaker:Hussain: That can have even more impact than a lot of vigorous work happening for a very short space of time.
Speaker:Hussain: And sometimes that can be easier for the patient to understand and to be motivated
Speaker:Hussain: to do, you know, rather than having to take on like an hour of movement one evening every so often.
Speaker:Hussain: Instead, it's about just trying to incorporate little bits, you know,
Speaker:Hussain: breaking up the sedentary time, just bringing little exercise snacks through
Speaker:Hussain: the day, just making the day just that little bit more physically challenging.
Speaker:Hussain: That can be a good first step for a lot of people.
Speaker:Hussain: What do you think? Do you think that's, is that is that an approach that you
Speaker:Hussain: do do you talk about breaking up sedentary time with patients or is it something
Speaker:Hussain: that you you've got a different approach for.
Speaker:Richard: Uh no i generally just encourage them
Speaker:Richard: to be physically active uh i don't try and uh
Speaker:Richard: frame it all within exercise because i think
Speaker:Richard: think exercise can sometimes put people off but just talking about um being
Speaker:Richard: physically active like walking and even low level activity uh is is is better
Speaker:Richard: i find uh from from personal perspective and as you say it's got to be about
Speaker:Richard: something that they can sustain there's no point in them,
Speaker:Richard: going out and going for an hour run for
Speaker:Richard: four weeks and then never doing it again like they are much better doing less
Speaker:Richard: than that over the long term and maybe gradually building it up into eventually
Speaker:Richard: maybe doing that level in a year's time but it's got to be something that they
Speaker:Richard: can maintain in the long term.
Speaker:Hussain: What would your final message to listeners be that you want them to take away from this episode?
Speaker:Richard: Yeah, think about your movement from when you wake up to when you go to sleep.
Speaker:Richard: When you're sitting down, especially when you're sitting down for a long time,
Speaker:Richard: and think about how you can potentially bring more movement into your day.
Speaker:Richard: Even if it's just walking to the waiting room to greet patients or just getting
Speaker:Richard: out of the building at lunchtime,
Speaker:Richard: you will feel much better for it physically and mentally, more refreshed and more switched on.
Speaker:Richard: And you should hopefully then be able to live longer and healthier as a result.
Speaker:Richard: So definitely just try and build it in.
Speaker:Hussain: Thank you so much, Richard, for your time. Really appreciate it.
Speaker:Richard: You're welcome, Hussain. Yeah, great to catch up with you again.
Speaker:Hussain: So that was a fantastic conversation with Richard there talking about the importance
Speaker:Hussain: of considering sedentary time.
Speaker:Hussain: And he explained a bit around its sort of definition, how it differs from just
Speaker:Hussain: being the inverse of physical activity and also explained some of the research
Speaker:Hussain: that he had done exploring this in general practitioners.
Speaker:Hussain: It was interesting to see the results. I was actually quite surprised and blown
Speaker:Hussain: away by the 10 and a half hour figure that we saw in terms of sedentary time
Speaker:Hussain: during working day for general practitioners.
Speaker:Hussain: And it was interesting to see that although there isn't a whole heap of guidance
Speaker:Hussain: on the specifics around sedentary time, that there is, from the Canadian guidelines,
Speaker:Hussain: a suggestion that we should be aiming for less than eight hours.
Speaker:Hussain: Now, something that I'm definitely going to do is explore my own time as best I can.
Speaker:Hussain: You know, how much time am I spending in a chair and in a stationary position and what I can do.
Speaker:Hussain: Now, we also talked about standing desks and the potential benefits of them,
Speaker:Hussain: but also the limitations and challenges of use.
Speaker:Hussain: And Richard shared with us his work launching the company SonaMove,
Speaker:Hussain: supporting people utilising standing desks and considering how they can balance
Speaker:Hussain: up the time spent standing versus sitting.
Speaker:Hussain: And it was interesting to see that in research done at Loughborough University,
Speaker:Hussain: they highlighted that patients were quite accepting of clinicians using a standing desk.
Speaker:Hussain: So something that definitely I had been thinking
Speaker:Hussain: about in my own use of the standing desk and it
Speaker:Hussain: may change my behavior and use of them going forward
Speaker:Hussain: but I think what I really liked about what Richard highlighted was some easy
Speaker:Hussain: tips that we can do to try to bring down those 10 and a half hours whether that
Speaker:Hussain: be a walk with colleagues during lunchtime or using our time wisely when we're commuting.
Speaker:Hussain: Involving a little bit of activity, whether that be taking the bicycle or a
Speaker:Hussain: walk or even just parking a little bit further from the surgery.
Speaker:Hussain: And consider how we can bring our patients into our room, even that simple act.
Speaker:Hussain: If we're seeing 30, 40 patients a day, that's the potential of breaking up that
Speaker:Hussain: sedentary time 30, 40 times.
Speaker:Hussain: So I think these little things can be quite impactful and I'm really grateful
Speaker:Hussain: for Richard sharing his time and his insights. And let us know, what do you think?
Speaker:Hussain: Are you surprised by the 10 and a half hours?
Speaker:Hussain: What tips and ideas have you used to break up sedentary activity?
Speaker:Hussain: And what's your experience of a standing desk been? Have you had any negative
Speaker:Hussain: experiences with patients as well as positive ones?
Speaker:Hussain: Thank you. And we look forward to seeing you again at the Movement Prescription Podcast.
