Sedentary WorkSedentary Work

Are Chairs Killing us?Are Chairs Killing us?

Not According to R. GunNot According to R. Gun“The Human Cost of Work” 2“The Human Cost of Work” 2ndnd Ed Ed

Industrial Injury ratesIndustrial Injury rates Occupational cancer rateOccupational cancer rate Overall Cancer rateOverall Cancer rate Musculoskeletal InjuriesMusculoskeletal Injuries Physical Exposure to Risk FactorsPhysical Exposure to Risk Factors Occupational Respiratory DiseaseOccupational Respiratory Disease Occupational Skin DiseaseOccupational Skin Disease Infections and Parasitic DiseasesInfections and Parasitic Diseases Psychological DisordersPsychological Disorders Heart DiseaseHeart Disease Outcomes from chemical exposuresOutcomes from chemical exposures

In all of these Situations, sedentary occupations are In all of these Situations, sedentary occupations are protective protective compared to other occupationscompared to other occupations There is an increased rate of There is an increased rate of compensation claimscompensation claims in the public sector for stress disorders but in the public sector for stress disorders but

NOT an actual increase in psychological disorder (ie employment culture with increased NOT an actual increase in psychological disorder (ie employment culture with increased reporting)reporting)

In addition Canberian’s have the longest longevity of all the statesIn addition Canberian’s have the longest longevity of all the states

So What’s the FussSo What’s the Fuss

Is there anything to worry about at all?Is there anything to worry about at all? Does the public sector just attract just a Does the public sector just attract just a

bunch of wingers ?bunch of wingers ? When things go wrong the first explanation When things go wrong the first explanation

becomes “Its my chair doc”, followed by becomes “Its my chair doc”, followed by OHS review and a new chairOHS review and a new chair

Failure to recover, is followed by a compo Failure to recover, is followed by a compo claimclaim

But Wait A MinuteBut Wait A Minute

Don’t we all get an achy neck or lower Don’t we all get an achy neck or lower back while sitting at our desk ?back while sitting at our desk ?

Who doesn’t remember the RSI epidemic Who doesn’t remember the RSI epidemic What if everyone sits too much? This What if everyone sits too much? This

would obscure differentiation. Isn’t there would obscure differentiation. Isn’t there more mechanisation than ever before? Are more mechanisation than ever before? Are we immersed in a medium of sitting?we immersed in a medium of sitting?

What’s the TruthWhat’s the Truth

When all else fails checkWhen all else fails check

the the

scientific data basescientific data base

Search ProfilesSearch Profiles Inactivity PhysiologyInactivity Physiology Disuse ParadigmDisuse Paradigm Prolonged WeightlessnessProlonged Weightlessness Muscle Activation and DisuseMuscle Activation and Disuse Physical activity and cancerPhysical activity and cancer Physical activity and diseasePhysical activity and disease Physical activity and healthPhysical activity and health SedentarySedentary Chairs and painChairs and pain Office ErgonomicsOffice Ergonomics Bed RestBed Rest Disc DiseaseDisc Disease Awkward PosturesAwkward Postures PosturesPostures

Evidence BaseEvidence Base

Weightlessness/microgravityWeightlessness/microgravity Paraplegia/chronic bed riddenParaplegia/chronic bed ridden GeriatricsGeriatrics Animal modelsAnimal models Population studiesPopulation studies Conceptual ModelsConceptual Models

Lessons Lessons

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Outer SpaceOuter Space

Low Gravity AdjustmentsLow Gravity AdjustmentsReferences 1,2,3,5References 1,2,3,5

During SpaceflightDuring Spaceflight A drop in Blood Pressure and Respiratory FrequencyA drop in Blood Pressure and Respiratory Frequency Stable Heart Rate and Heart Rate VariabilityStable Heart Rate and Heart Rate Variability

On Return to EarthOn Return to Earth Large changes in all variables before returning to earth valuesLarge changes in all variables before returning to earth values

Author ConclusionsAuthor Conclusions Functional adaptation in space physiological impairment on return to earthFunctional adaptation in space physiological impairment on return to earth Impairments include orthostatic intolerance, bone demineralisation, muscular atrophy, Impairments include orthostatic intolerance, bone demineralisation, muscular atrophy,

neurovestibular symptoms, increased urinary supersaturation of renal chemicals, neurovestibular symptoms, increased urinary supersaturation of renal chemicals, decreased urinary outputdecreased urinary output

Longer duration flights result in more severe and more prolonged disabilityLonger duration flights result in more severe and more prolonged disability The concept of safe duration of exposure in hostile microgravity environmentThe concept of safe duration of exposure in hostile microgravity environment Changes correlate with relatively immobile terrestrial patients eg spinal cord, geriatric Changes correlate with relatively immobile terrestrial patients eg spinal cord, geriatric

or prolonged best rest patientsor prolonged best rest patients

LessonsLessons

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thethe

LaboratoryLaboratory

Poor old RatsPoor old RatsRef 3,6,9,10Ref 3,6,9,10

Tails up heads downTails up heads down Disrupted cerebrovascular autoregulation, negative calcium balance with bone lossDisrupted cerebrovascular autoregulation, negative calcium balance with bone loss

Lower Limb Suspension (4 weeks)Lower Limb Suspension (4 weeks) Changes to muscle bulk and excitability which is muscle group and type dependantChanges to muscle bulk and excitability which is muscle group and type dependant

ImmobilisationImmobilisation Marked increase in the number of neutrophils, monocytes, eosinophils. No change in Marked increase in the number of neutrophils, monocytes, eosinophils. No change in

Lymphocytes. Ie Natural immunity cells increaseLymphocytes. Ie Natural immunity cells increase

LessonsLessons

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thethe

BedsideBedside

Prolonged Bed RestProlonged Bed RestRef 7,8Ref 7,8

Healthy Women Study (2 month bed rest)Healthy Women Study (2 month bed rest) Reduced microcirculation endothelium-dependant function and endothelium damageReduced microcirculation endothelium-dependant function and endothelium damage

Sixty days bed rest with head tilt downSixty days bed rest with head tilt down Significant reductions in Left and right Ventricular volumes ie cardiac atrophySignificant reductions in Left and right Ventricular volumes ie cardiac atrophy

Limb Immobilisation (1)Limb Immobilisation (1)Ref 13,14,15,18,19,20,21Ref 13,14,15,18,19,20,21

Neuromuscular Components of LossNeuromuscular Components of Loss Neurological component to strength loss/gain generally greater than muscle Neurological component to strength loss/gain generally greater than muscle

component. (48% neurological, 39% muscle) (56% and 36% Ref20)component. (48% neurological, 39% muscle) (56% and 36% Ref20) Changes in neurological components distributed widely. Loss of firing rate in motor Changes in neurological components distributed widely. Loss of firing rate in motor

neuron. Changes to muscle receptors with functional loss proprioception.neuron. Changes to muscle receptors with functional loss proprioception. Unloading produces severe muscle atrophy and slow to fast muscle type transitionsUnloading produces severe muscle atrophy and slow to fast muscle type transitions Loss of phosphokinase levels and muscle excitability. Altered ion channels.Loss of phosphokinase levels and muscle excitability. Altered ion channels. Reduced postural control through loss of slow twitch postural muscle typeReduced postural control through loss of slow twitch postural muscle type Muscle shortening through loss of loss of sarcomeres in series (ends of muscle Muscle shortening through loss of loss of sarcomeres in series (ends of muscle

necrosis) Altered length-tension functional relationship. Single joint muscles the most necrosis) Altered length-tension functional relationship. Single joint muscles the most because of type1 dominance. EMG activity changes.because of type1 dominance. EMG activity changes.

Increase in connective tissue relative to contractile mass. Functional increase in Increase in connective tissue relative to contractile mass. Functional increase in muscle stiffness. Decreased joint range.muscle stiffness. Decreased joint range.

Decreased synthesis, increased catabolism.Decreased synthesis, increased catabolism. Changes in the musculotendinous junction. Decreased contact area.Changes in the musculotendinous junction. Decreased contact area.

Limb Immobilisation (2)Limb Immobilisation (2)

Inflammatory mediatorsInflammatory mediators Acute and chronic disorders can be associated with free radical mediated Acute and chronic disorders can be associated with free radical mediated

inflammatory alterations to muscle strength and mass. Ie concomitant risk for bed inflammatory alterations to muscle strength and mass. Ie concomitant risk for bed ridden in addition to disuse. Acute intense exercise induces inflammation.ridden in addition to disuse. Acute intense exercise induces inflammation.

Age Related DifferencesAge Related Differences Muscle volume loss greater in older but similar loss in strengthMuscle volume loss greater in older but similar loss in strength

Long Term DisuseLong Term Disuse Speed and power more affected than strength. A future risk factor for falls.Speed and power more affected than strength. A future risk factor for falls.

LessonsLessons

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PopulationPopulation

Endemic DisordersEndemic DisordersRef 22Ref 22

Cardiovascular Disease, type2 diabetes, metabolic syndrome Cardiovascular Disease, type2 diabetes, metabolic syndrome and obesity, Musculoskeletal achesand obesity, Musculoskeletal aches

Daily Sitting or low nonexercise activity levels (NEAT) may have a direct connection The effects (negative ) of prolonged sitting may be distinct from the effects (positive )

of structured exercise NEAT is greater component of energy expenditure than exercise Brief but frequent muscular contraction throughout the day may be necessary to

oppose unhealthy molecular signals causing metabolic disease LPL activity more influenced by daily low intensity activity than adding vigorous

exercise. Inactivity produced chemical changes qualitatively different than exercise. Concept of Volume of intermittent nonexercise physical activity in everyday life.

(inactivity physiology paradigm) and (non exercise activity )

Cardiovascular RiskCardiovascular RiskRef 23,27,28,29,30,31,35,37Ref 23,27,28,29,30,31,35,37

Physical inactivity profound effects on lipoprotein metabolism. Modest exercise Physical inactivity profound effects on lipoprotein metabolism. Modest exercise prevented these changes creating sustained VLDL-TG lowering. Intense exercise did prevented these changes creating sustained VLDL-TG lowering. Intense exercise did not but increased HDL.not but increased HDL.

Physical inactivity reduces LPL activity in muscles and TG clearancePhysical inactivity reduces LPL activity in muscles and TG clearance Brisk walking and vigorous exercise have substantial and similar reduction in the Brisk walking and vigorous exercise have substantial and similar reduction in the

incidence of coronary events among women (regardless of BMI, race etc )incidence of coronary events among women (regardless of BMI, race etc ) Prolonged sitting predicts cardiovascular riskProlonged sitting predicts cardiovascular risk Moderate intensity exercise such as walking is associated with a substantial risk Moderate intensity exercise such as walking is associated with a substantial risk

reduction for total and ischemic stroke in a dose-response manner in womenreduction for total and ischemic stroke in a dose-response manner in women Average weekly exercise intensity in men was associated with reduced CHD Average weekly exercise intensity in men was associated with reduced CHD

(coronary heart disease) independent of MET hours in physical activity(coronary heart disease) independent of MET hours in physical activity At least 1 hour/week of walking in women lowered CHD risk. Time spent walking but At least 1 hour/week of walking in women lowered CHD risk. Time spent walking but

not pace predicted lower risk.not pace predicted lower risk. High intensity exercise produces the greatest change in lipid profileHigh intensity exercise produces the greatest change in lipid profile May be safer to exercise in afternoons (HR and V(o2) max reactivity )May be safer to exercise in afternoons (HR and V(o2) max reactivity )

ObesityObesityRef 24,32,33,34,36,42Ref 24,32,33,34,36,42

NEAT non exercise activity thermogenesis is highly individual and controlled by the NEAT non exercise activity thermogenesis is highly individual and controlled by the environment (employment). Up to 2000kcal/day rangeenvironment (employment). Up to 2000kcal/day range

NEAT is critical to fat depositionNEAT is critical to fat deposition Obese individuals exhibit an innate tendency to be seated 2.5 hours more than Obese individuals exhibit an innate tendency to be seated 2.5 hours more than

sedentary lean counterpartssedentary lean counterparts The equivalent of 11 miles walking/week at low or moderate intensity prevented The equivalent of 11 miles walking/week at low or moderate intensity prevented

accumulation of visceral fataccumulation of visceral fat A modest increase over above level resulted in significant decreases in visceral fatA modest increase over above level resulted in significant decreases in visceral fat Walking 19km/week at 40-55% peak V(o2) sufficient to increase aerobic fitness. Walking 19km/week at 40-55% peak V(o2) sufficient to increase aerobic fitness.

Higher levels increased fitness further.Higher levels increased fitness further. Metabolic cardiovascular syndrome is strongly associated with reduced habitual Metabolic cardiovascular syndrome is strongly associated with reduced habitual

energy expenditureenergy expenditure Sitting 7.4 hours /day strongly associated with obesitySitting 7.4 hours /day strongly associated with obesity Working women only ½ as likely to be obeseWorking women only ½ as likely to be obese

Type 2 DiabetesType 2 DiabetesRef 25,26Ref 25,26

A similar and significant risk reduction for type2 diabetes with equivalent energy A similar and significant risk reduction for type2 diabetes with equivalent energy expenditure by either walking or vigorous activityexpenditure by either walking or vigorous activity

Independent of energy levels, sedentary behaviour especially TV watching was Independent of energy levels, sedentary behaviour especially TV watching was associated with significant elevation of risk of type2 and obesityassociated with significant elevation of risk of type2 and obesity

Risk of type2 prevented by <10h/wk of TV and>or=30min/d of brisk walkingRisk of type2 prevented by <10h/wk of TV and>or=30min/d of brisk walking

All Praise to ModerationAll Praise to Moderation

Regular energy expenditure by whatever Regular energy expenditure by whatever form is beneficial and protective from the form is beneficial and protective from the development of type2,obesity and development of type2,obesity and cardiovascular disease.cardiovascular disease.

Musculoskeletal AchesMusculoskeletal AchesRef 38, 39, 40,41,42Ref 38, 39, 40,41,42

Ergonomic Intervention Programs report very modest reduction in moderate to severe Ergonomic Intervention Programs report very modest reduction in moderate to severe pain levels (20% to 16% prevalence)pain levels (20% to 16% prevalence)

Computer workstations have high prevalence of aches (shoulder pains 45%,back Computer workstations have high prevalence of aches (shoulder pains 45%,back pains 43%, wrist pains 30%, neck pain 30% typical levels )pains 43%, wrist pains 30%, neck pain 30% typical levels )

Only a 10% take up rate of advice regarding computer workstations. (poor Only a 10% take up rate of advice regarding computer workstations. (poor compliance)compliance)

Prognostic factors for aches were, time at the keyboard, and speed of workPrognostic factors for aches were, time at the keyboard, and speed of work

Disc Pain (1)Disc Pain (1)Ref 43-61Ref 43-61

Degeneration with degraded collagen can occur as early as 2Degeneration with degraded collagen can occur as early as 2ndnd decade decade Static Compressive loads can initiate a number of harmful responses in Static Compressive loads can initiate a number of harmful responses in

dose/response manner (rat experiments )dose/response manner (rat experiments ) Endplate calcification (mechanical stress) limits solute diffusion into the discEndplate calcification (mechanical stress) limits solute diffusion into the disc Disc degeneration can be induced by axial loading (rabbit)Disc degeneration can be induced by axial loading (rabbit) Endplate degeneration correlates with disc degeneration (52,55)Endplate degeneration correlates with disc degeneration (52,55) Chondrocyte apoptosis induced by static mechanical loadChondrocyte apoptosis induced by static mechanical load Endplate cartilage damage increases with age and reduces diffusionEndplate cartilage damage increases with age and reduces diffusion Aging and degeneration two separate processes (49)Aging and degeneration two separate processes (49) Axial Distraction can induce disc regeneration (rabbit) (54)Axial Distraction can induce disc regeneration (rabbit) (54) Density of openings in osseous end plate correlate with disc degenerationDensity of openings in osseous end plate correlate with disc degeneration XR’s more accurate than MRI in determining stage of disc degeneration(56)XR’s more accurate than MRI in determining stage of disc degeneration(56) Damage to endplate correlates with disc degeneration (pigs) (57)Damage to endplate correlates with disc degeneration (pigs) (57) End Plate is the main route of solute entry into the disc (60)End Plate is the main route of solute entry into the disc (60)

Disc Pain (2)Disc Pain (2)

Any mechanism that damages the Any mechanism that damages the Vertebral End Plate with loss of Perfusion Vertebral End Plate with loss of Perfusion can lead to nuclear, followed by annular can lead to nuclear, followed by annular damage (degeneration)damage (degeneration)

It is not clear about the contribution, It is not clear about the contribution, overall and in particular of cyclic and static overall and in particular of cyclic and static loading versus acute traumaloading versus acute trauma

LessonsLessons

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Conceptual ModellingConceptual Modelling

BonesBonesRef 11,12Ref 11,12

Osteocyte SignalsOsteocyte Signals Reduced loading leads to reduced osteoblast activity and increased osteoclast Reduced loading leads to reduced osteoblast activity and increased osteoclast

activity.activity. Most force environments sufficient to maintain osteoblast activity Most force environments sufficient to maintain osteoblast activity

Remodelling ThresholdRemodelling Threshold Restoration of normal architecture by remodelling is a high threshold event. Restoration of normal architecture by remodelling is a high threshold event.

Increasing bone mass by physical exercise is difficult in adults. Remodelling is part of Increasing bone mass by physical exercise is difficult in adults. Remodelling is part of youth. Exercise may stop further bone loss however.youth. Exercise may stop further bone loss however.

Disc ModelsDisc Models Focus on finite modelling with an emphasis on diffusion gradients and osmosis Focus on finite modelling with an emphasis on diffusion gradients and osmosis

affected by various force environmentsaffected by various force environments

Skeleton SummarySkeleton Summary

Musculoskeletal inactivity has the potential Musculoskeletal inactivity has the potential to develop muscular contractures, to develop muscular contractures, weakness, tissue type changes, disruption weakness, tissue type changes, disruption to disc architecture, loss of neural to disc architecture, loss of neural connectedness, biomechanical inefficiencyconnectedness, biomechanical inefficiency

The Story Thus FarThe Story Thus Far

Prolonged sitting has the potential to disturb Prolonged sitting has the potential to disturb chemistry and cellular signalling, shorten and chemistry and cellular signalling, shorten and stiffen muscles, weaken bones, change stiffen muscles, weaken bones, change neurological connectedness, upset energy neurological connectedness, upset energy regulation and be an input for the development regulation and be an input for the development of type2 diabetes, metabolic syndrome, obesity, of type2 diabetes, metabolic syndrome, obesity, musculoskeletal aches, osteoporosis and musculoskeletal aches, osteoporosis and cardiovascular disease. There is also an cardiovascular disease. There is also an increased risk of injury and falls.increased risk of injury and falls.

PausePause

AA TimeTime for for ReflectionReflection

What is the dose response relationship What is the dose response relationship between activity or its inverse variable between activity or its inverse variable inactivity and the risk of developing inactivity and the risk of developing physiological disturbance.physiological disturbance.

Cause=Exposure to Risk FactorsCause=Exposure to Risk Factors

Risk Factors ConsiderationsRisk Factors Considerations

Exposure DosageExposure Dosage Good or BadGood or Bad Extrinsic and IntrinsicExtrinsic and Intrinsic Sequential or ConcomitantSequential or Concomitant Intermittent or ContinuousIntermittent or Continuous Counterbalancing Positive Factors Counterbalancing Positive Factors Inadequate Recovery & Re-exposureInadequate Recovery & Re-exposure Age at time of exposureAge at time of exposure Circadian and other periodicitiesCircadian and other periodicities Intensity and VolumeIntensity and Volume Rate of ChangeRate of Change

A Timely ReminderA Timely Reminder

““All factors can be either Toxic or All factors can be either Toxic or Beneficial depending on the dose”Beneficial depending on the dose”

Too Much “Toxic”Too Much “Toxic” Generally blue collar occupations have more exposure to physical and chemical Generally blue collar occupations have more exposure to physical and chemical

hazardshazards There are exceptions such as hairdressing and sections of cosmetic industry with There are exceptions such as hairdressing and sections of cosmetic industry with

unusual toxic exposure.unusual toxic exposure. Sedentary usually implies less exposure to “Toxic” and is protectiveSedentary usually implies less exposure to “Toxic” and is protective

Too Little “Beneficial”Too Little “Beneficial” Insufficient outdoors reduces exposure to fresh air or vitamin D producing UVInsufficient outdoors reduces exposure to fresh air or vitamin D producing UV Insufficient sitting (Prolonged standing) can produce foot pathologyInsufficient sitting (Prolonged standing) can produce foot pathology Insufficient Vitamins lead to malnutritionInsufficient Vitamins lead to malnutrition Insufficient Energy expenditure may lead to physiological disturbance and diseaseInsufficient Energy expenditure may lead to physiological disturbance and disease Insufficient Movement may lead to faulty movement patterns and altered perfusion Insufficient Movement may lead to faulty movement patterns and altered perfusion

dynamicsdynamics

Concomitant DilemmaConcomitant Dilemma ““Toxic” and “Beneficial” inputs can occur togetherToxic” and “Beneficial” inputs can occur together Prolonged sitting means less exposure to beneficial movement inputs (B) while Prolonged sitting means less exposure to beneficial movement inputs (B) while

reducing exposure to hazardous inputs. (T)reducing exposure to hazardous inputs. (T) Is the reduction in “T” greater than the loss of “B” ?Is the reduction in “T” greater than the loss of “B” ?

““Climbing a mountain is both rewarding Climbing a mountain is both rewarding and dangerous”and dangerous”

““Not Climbing a mountain is both safe and Not Climbing a mountain is both safe and unrewarding”unrewarding”

Irreversible PathwaysIrreversible Pathways Exercise is not an antidote for non activity (LPL example)Exercise is not an antidote for non activity (LPL example) Gravity is not an antidote for prolonged weightlessnessGravity is not an antidote for prolonged weightlessness Surgery is not an antidote for joint destructionSurgery is not an antidote for joint destruction Stretch is not an antidote for shorteningStretch is not an antidote for shortening

““climbing a cliff face may not return one to climbing a cliff face may not return one to the top after rolling down a slope”the top after rolling down a slope”

Mechanisms of DiseaseMechanisms of Disease

““inputs mis- match physiological needs”inputs mis- match physiological needs”

A Common ErrorA Common Error

A returning Astronaut might be forgiven for A returning Astronaut might be forgiven for believing earth was a hostile environmentbelieving earth was a hostile environment

(the current environment may not be the cause)(the current environment may not be the cause)

Solutions to ComplexitySolutions to Complexity R.Gun suggests that we stop trying to codify risk and institute an information based R.Gun suggests that we stop trying to codify risk and institute an information based

system based on “situations”. He advocates this for toxicology and manual handling. system based on “situations”. He advocates this for toxicology and manual handling. This is similar to “near miss reporting” system utilised by the airline industry.This is similar to “near miss reporting” system utilised by the airline industry.

For exposures which are more pervasive like a creeping temperature rise or For exposures which are more pervasive like a creeping temperature rise or sedentary life perhaps a new approach is needed. How about a thermometer? Detect sedentary life perhaps a new approach is needed. How about a thermometer? Detect early and change the pertinent exposures to correct the temperature.early and change the pertinent exposures to correct the temperature.

Detect signs and symptoms of Sedentary life or Detect signs and symptoms of Sedentary life or excessive sitting early and reduce exposure. Apply excessive sitting early and reduce exposure. Apply antidotes if available. ie Early secondary interventionantidotes if available. ie Early secondary intervention

Early DetectorsEarly Detectors

Symptoms of fatigue, stiffness, achesSymptoms of fatigue, stiffness, aches Signs of low aerobic capacity, loss of Signs of low aerobic capacity, loss of

flexibility, muscle tenderness, central flexibility, muscle tenderness, central obesity, rising BP, fasting glucose, innate obesity, rising BP, fasting glucose, innate inflammatory markers, resting HR inflammatory markers, resting HR

ConclusionsConclusions Sedentary occupations are generally protective from other toxic inputsSedentary occupations are generally protective from other toxic inputs There appears to be a non risk exposure dosage for sittingThere appears to be a non risk exposure dosage for sitting Excess sitting may be negative and comparable to impairment produced by outer Excess sitting may be negative and comparable to impairment produced by outer

space exposure. This is due to loss of usual antigravity inputs and disruption to space exposure. This is due to loss of usual antigravity inputs and disruption to energy regulation.energy regulation.

Chronic excess sitting may insidiously create metabolic and structural harm which is Chronic excess sitting may insidiously create metabolic and structural harm which is difficult to reversedifficult to reverse

Some of the negative effects of excess can be obviated by moderate exerciseSome of the negative effects of excess can be obviated by moderate exercise Regular standing and walking are antidotes for some harm developmentRegular standing and walking are antidotes for some harm development A higher NEAT produced by above is protectiveA higher NEAT produced by above is protective

RemediesRemedies Reconstruct Work/Recreation Role (recommended)Reconstruct Work/Recreation Role (recommended) Office GymOffice Gym Pause GymnasticsPause Gymnastics Regular exercise classesRegular exercise classes Weekly sportWeekly sport Walk or cycle to workWalk or cycle to work Use the stairsUse the stairs Don’t watch TVDon’t watch TV

Final WordFinal Word

We are no more designed to sit for We are no more designed to sit for prolonged periods than we are to live on prolonged periods than we are to live on

the moonthe moon

Extra Last WordExtra Last Word

What is the ideal lifestyle/Job ?What is the ideal lifestyle/Job ?

Questions Questions and and DiscussionDiscussion