Heart disease is a sitting disease

by Carolyn Thomas    @HeartSisters

When Oregon cardiologist Dr. James Beckerman sent me a copy of his new book called Heart To Start and asked me to review it, I agreed – but I have to tell you that it took me a month to actually open it and read it. These days, I’m often invited to review heart-related books of varying quality, so I tend to be a wee bit wary when taking on another review. But I’d already been following Dr. B for some time on Twitter, and I’d quoted him in this 2013 article – so part of me really, really hoped I would like his new book.

But I was wrong. By the end of the first chapter, I realized that I didn’t like this book.  I loved it! 

Dr. Beckerman is not only a Harvard and Stanford-trained cardiologist at Portland’s Providence Heart and Vascular Institute, he’s also a jock, the team cardiologist of the Portland Timbers, founder and medical director of Play Smart Youth Heart Screenings, and a self-described “cardiactivist.”  

Dr. James Beckerman

His profound belief that “exercise is medicine” is especially applicable to heart patients. Far too many of us are afraid of physical activity while recuperating, and doctor referrals to cardiac rehabilitation programs are still appallingly low despite ample scientific evidence that such exercise-based programs result in significantly better outcomes for heart patients.

I believe we need more cardiactivist docs like Dr. B.  His Heart To Start exercise program (the inspiration for this book) means that every Wednesday for three winter months, he trades his white coat for a coach’s whistle for free group practice workouts in southwest Portland. His participants are training to enter the annual family-friendly Heart to Start Walk/Run event every February.  He shares important health information with his group of all ages and fitness levels. 

Dr. B and his ‘Heart To Start’ group in Portland

This kind of physician-led lifestyle program is comparable to Walk With A Doc, founded by fellow cardiactivist doc, Dr. David Sabgir of Ohio. This is another fantastic program (now embraced by motivated physician volunteers throughout the U.S. and Canada) that invites docs to stop just lecturing people about the benefits of exercise – and get right out there to lead regularly scheduled walks alongside them.

Why do these very busy doctors do this?

As Dr. Beckerman explained to KATU News:

    “One of the reasons I’m so passionate about cardiology is the amazing opportunity to try to prevent heart disease. About 80% of heart disease is preventable through what you do, what you eat, and if you exercise or quit smoking. 

“And it’s not about making big crazy changes that you can’t sustain – it’s about starting small and making it something you can fit into your lifestyle longterm.”

This might be particularly true for heart patients because, as Dr. Beckerman reminds us, having already had a cardiac event is one of the biggest risk factors in having another.  He warns:

“Regardless of your fitness level today, improving it is your greatest opportunity to reduce your risk moving forward as well as to treat heart problems if they do occur.”

But it turns out that there’s another important risk factor you need to know about. Dr. Beckerman has an entire section in his book called Heart Disease is a Sitting Disease.

Reading this should make you want to stand up. For example:

“I     We have known for years that regular exercise can prevent and treat heart disease – just 30 minutes a day is an ideal dose for many people. But that is just part of the story.

“Recent research has highlighted the fact that how you spend the other twenty-three-and-a-half hours of the day matters too. And it may matter even more. This comes as a disappointment to those of us who spend a half hour in the gym and then feel like we can justify spending the rest of the day sitting behind a desk or in our easy chair. But being active is a lifestyle, not just an appointment in your Outlook calendar.

“Take a minute and think about how many hours a day you spend in a chair.

“Add up the time you spend eating meals, sitting in your car during your two-way commute, and working behind your desk. And don’t forget about all those hours you might spend curled up in front of the television, behind your tablet or computer, or even reading a book. Be honest, and let’s see where you sit.

Hours  ___    ___  ___   ___   ___

“Are you spending half the day sitting down? Lots of people do.

“Researchers have found that if you spend more than 11 hours a day in a chair, you are 40 percent more likely to die in the next five years than someone who sits for just six or seven hours. Remember, that is even when you take into account your planned physical activity – even if you make a point of exercising thirty minutes a day.

“The takeaway is that in addition to scheduling exercise during our busy days, we also benefit greatly from incorporating activity into the rest of our lives. And it’s not always easy.

“But let’s find the silver lining. The good news is that you have a real opportunity to do something that will reduce your likelihood of dying in the next five years by up to 40 percent – just by getting up on your feet.

“Let’s put this into perspective.

“Most heart medications that cardiologists prescribe, like statins for lowering cholesterol or blood thinners to prevent blood clots, reduce the risk of death or heart attack by up to 30 percent – if you are lucky. Despite their effectiveness, medications can also be associated with side effects, not to mention money out of your pocket.

“Standing up is free, and side effects are pretty uncommon. It’s not a substitute for other treatments, but it sure is easy to hold down.

“The link between sedentary lifestyles and heart disease is so strong that some researchers have gone so far as to suggest that sitting is an independent risk factor for developing coronary artery disease, like smoking, high blood pressure, or Type 2 diabetes. Some people hear these statistics but understandably feel overwhelmed by recommendations to stand up an additional six hours a day. But thankfully, here is yet another example of how smaller lifestyle changes can have a real health impact.

“One study of nearly 125,000 American men and women over a fourteen-year period used some stricter cut-offs to demonstrate that small changes in standing really do matter. These researchers compared the impact of sitting more than six hours versus less than three hours a day, and found that women sitting more than six hours were 34 percent more likely to die, and that men sitting fewer than three hours were 17 percent more likely to survive. This was independent of body weight.

“Standing up is like any health intervention – there is a dose response. Some is good. More is better. And in this case, everything counts. And don’t worry – you can still keep your Barcalounger.

“This was demonstrated nicely in a study of 17,000 Canadians who were followed for 12 years. They kept it simple and reported their sitting qualitatively rather than quantitatively – they reported sitting:

  • almost none of the time
  • one-fourth of the time
  • half of the time
  • three-fourths of the time, or
  • almost all of the time.

“Regardless of smoking status, body weight, and other physical activity, more sitting was associated with earlier death from all causes, and from heart disease specifically. Full-time sitters were fifty-four percent more likely to die than the least sedentary.

“But can you exercise your way out of a sedentary lifestyle? Lots of us try to. But the data would suggest that while you would expect regular exercise to be beneficial in a more sedentary group, it actually takes a surprising amount of exercise to make up for the time you spend on your seat.

“Put another way, if you spend half your time in a chair and do not exercise regularly, you are at similar risk as a person who sits all day, except for when he goes to the gym. Being sedentary reduces the beneficial effects of exercise – and that’s true for any amount of time you spend in a chair. There is something about the very act (or the ‘inact’) of sitting that’s literally killing us.” *

© 2015 James Beckerman

So if you’re sitting down right now reading this excerpt from Heart To Start, stand up and just start moving!  My next post will include more evidence from this new book suggesting that we are, in fact, born to walk.

Meanwhile, follow Dr. Beckerman’s 10 simple tips from Heart To Start on how you too can get up – and stay up:

  1. Stand while speaking on the phone.
  2. Take a ten-minute walk after dinner every evening.
  3. Set a reminder every hour to get on your feet.
  4. Get off the couch during TV commercials.
  5. Encourage walking meetings at your workplace.
  6. Wear comfortable shoes.
  7. Use a pedometer, tracker, or app to set a daily activity goal.
  8. Invest in a standing desk.
  9. Meet in person rather than by phone or email.
  10. And stop looking for a good parking space!


* Excerpt published here with permission from Dr. James Beckerman, author of  Heart To Start: The Eight-Week Exercise Prescription To Live Longer, Beat Heart Disease, and Run Your Best Race; Head shot of Dr. Beckerman via KATU News; Heart To Start group photo via Dr. B himself.

Q: How will you include more moving and less sitting into everyday life this month?

NOTE FROM CAROLYN:   You’ll find much more about goal-setting for heart patients in my book, A Woman’s Guide to Living with Heart Disease (Johns Hopkins University Press). You can ask for it at your library or favourite bookshop (please support your local independent booksellers) or order it online (paperback, hardcover or e-book) at Amazon – or order it directly from Johns Hopkins University Press (and use their code HTWN to save 30% off the list price when you order).

See also:

Were you “born to walk”?

Six ways NOT to motivate patients to change

Why aren’t women heart attack survivors showing up for cardiac rehab?

The Sitting-Rising Test: what’s your score?

Physical exercise vs. the ‘plumber’s pipe’ theory of heart disease treatment

Failure to refer: why are doctors ignoring cardiac rehab?

Chest pain while running uphill

Let’s make our day harder – not easier!

Why your heart needs work – not rest! – after a heart attack


25 thoughts on “Heart disease is a sitting disease

  1. I like the idea of setting a timer to remind me to get up and walk around. I’m new to this country of heart disease (heart attack and stent placement less than a month ago, then back in hospital last week diagnosed with pericarditis). I’ve been told to rest, which is weird for me. As I follow those instructions I keep seeing the advice here and elsewhere to exercise and I get confused and anxious about which advice to follow.

    I start cardiac rehab in 1.5 weeks. It was supposed to be last week but cardiologist postponed it due to the pericarditis.

    I was told I had zero risk factors but after reading here and elsewhere I see that I was very stressed and inactive. I have a normal body weight and always thought I didn’t need to exercise as long as I didn’t gain weight.

    I now have this urge to “fix it now” by jumping into a fitness program, but I’ve got chest pain and very low energy. and have trouble with being patient with the pace of healing.

    I’m very grateful for this blog! Thanks so much for it ♥️

    Liked by 1 person

    1. Hello Martha – You are in relatively early days yet! No wonder you’re feeling a bit overwhelmed. I’m so glad you’ll be starting cardiac rehab soon. I think it will help you slow down and enjoy the (treadmill) moments… It’s also reassuring being in a supervised program where you’ll learn about the difference between safe exercising and overdoing it, especially at the beginning.

      As you have been learning, stress is a significant risk factor for heart disease – you now have an opportunity to learn all you can about patience! As I often say, I’ve had to learn about something called “pacing” which is something I never bothered to learn in my old life!

      Good luck, and try to learn how to enjoy taking it easy!


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  3. Once again, Carolyn, we seem to be on the same wavelength. I’ve been planning to write a post about exercise for those who can’t easily tolerate exercise. Hopefully, it will be my next post.

    You’re singing my song here, of course, because as a physical therapist in homecare, my entire job is about figuring out how to help my patients tolerate movement.

    There have been some interesting research studies recently published which confirm what I’ve been teaching my patients for years — which is that you don’t even have to do 30 consecutive minutes of exercise all at once, that several short periods of activity or exercise throughout the day count, too. In fact, I read a study which found that, say, 3 periods of ten minutes may in fact work better than one long bout of exercise for lowering blood pressure and promoting cardiac health.

    The bottom line seems to be to just get off one’s bottom regularly throughout the day, even if it’s only for a few minutes at a time. Many of my patients cannot tolerate standing in one place for long, due to spinal stenosis &other issues, but they can often tolerate a 5-minute walk or a few minutes of just standing up repeatedly.

    Got to get to work on that post…

    😉 Kathi

    Liked by 1 person

  4. Wow! I felt so guilty reading your article, feeling bad for spending so many hours in a day sitting at my desk preparing lessons and using my laptop.
    I love the little tips at the end, and I’m gonna right now stand up for a little walk or even vacuum downstairs…

    And from tomorrow I will remind myself to teach more standing up in front of my students than reading my notes or books from my desk!

    Liked by 1 person

  5. It was so much easier maintaining an active lifestyle when I lived in Colorado, a place where life revolved around terrain.

    It’s soooo hard to be truly active where I live now, because I do not consider trips to the gym active lifestyle. I soooo want to move back to my mountains.

    Liked by 1 person

  6. I’m a senior heart attack survivor fast approaching my 75th birthday. I also have significant osteoarthritis in my back, which makes standing longer than two hours at a stretch painful. I also live in Winnipeg, a community which experiences brutal winters that make walking outdoors not only unpleasant, but dangerous – slippery underfoot.

    So here’s my imperfect solutions to the problem of getting enough daily exercise: We walk in the mall every morning except Sunday for 35 minutes during the winter or outside around the neighbourhood in the summer, when it’s not raining; I garden (annuals) in the summertime; and in the winter I spend a couple of hours every day compiling the family photo albums – standing. I cook standing, but my husband shares this task, 2-3 times a week, and he’s taken over the laundry and major cleaning too, so it’s hard for me some days to get enough exercise. We live in a 1 1/2 story house, however, so if all else fails, I can always climb stairs!

    My main point – sometimes other health problems and/or the climate can interfere with the best intentions.

    Liked by 1 person

    1. Your “imperfect solution” sounds pretty darned perfect to me, Judy. I too engage in mall walking in the winter – it’s not only a safe and comfortable way to exercise, but includes socializing too. And I’m typing this at my standing desk (the breakfast bar in my kitchen!) Thanks so much for sharing your perspective here.


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