Sedentary Lifestyle 'Costing NHS Millions Each Year'

Theresa Bebbington

March 26, 2019

New research noted growing evidence that adults in the UK have become increasingly sedentary and that prolonged sedentary behaviour is linked to an increased risk of several chronic health conditions.

Strong evidence of high levels of sitting time leading to increased risk of cardiovascular disease (CVD), type 2 diabetes, and mortality from all causes, has already been established.

There is also moderate evidence linking a sedentary lifestyle to an increased risk of colon, endometrial, and lung cancers.

There are currently estimates for the financial impact of other lifestyle factors such as obesity and smoking, but not for prolonged sedentary behaviour.

Researchers have now looked at the financial impact that prolonged sedentary behaviour can have on the NHS, which they consider is an important step in the development of public health policy.

The study has been published in the Journal of Epidemiology & Community Health .

Definition of Sedentary Behaviour

Sedentary behaviour is not the same thing as physical inactivity, according to the research team, led by Leonie Heron from the Centre of Public Health at Queen's University Belfast.

They report that sedentary behaviour "refers to sitting or lying while expending low amounts of energy" (≤1.5 metabolic equivalents). This concurs with a definition given by the National Centre for Sport & Exercise Medicine, in an evidence briefing on sedentary behaviour.

One recent meta-analysis reported that being sedentary for 6 to 8 hours each day can increase the risk of cardiovascular and all-cause mortality.

For their own study, the researchers defined sedentary behaviour as spending at least 6 hours of waking time sedentary.

According to the Health Survey for England 2012, 30% of adults in England were sedentary for at least 6 hours a day on weekdays, with that number increasing to 37% during weekends.

Calculating the Numbers

Financial costs were calculated from the NHS’s perspective using a prevalence-based and population attributable fraction (PAF) approach.

The researchers used healthcare budgets for specific disease groupings for NHS England, Wales, and Scotland, and standardised them to 2017.

Because 30% of Europeans with type 2 diabetes were also affected by CVD, for example, they adjusted the figures for double-counting caused by comorbidity.

Based on their calculations the researchers reported the financial costs to the NHS attributable to sedentary behaviour for 2016–17 as follows:

  • Type 2 diabetes – £281.34 million

  • Cardiovascular disease – £424.38 million

  • Lung cancer – £19.16 million

  • Colon cancer – £29.64 million

  • Endometrial cancer – £7.29 million

  • Total cost – £761.8 million

The researchers noted in their report that the approach used for their analysis typically produced lower estimates than alternative econometric approaches, and other conditions such as musculoskeletal disorders were not considered, so the "total costs present are likely to be a conservative estimate of the true burden of sedentary behaviour".

Reducing the Human Cost

The researchers also used PAFs to estimate the reduction in disease that would occur if prolonged sedentary behaviour was reduced or eliminated.

Their results have suggested that 11.6% of all deaths were linked to sedentary behaviour, and if such behaviour was completely eliminated, 69,276 deaths could have been avoided in 2016.

Even reducing the levels of sedentary behaviour by 10% could result in preventing several thousand deaths, they said.

Ms Heron commented: "Many individuals in the UK spend their leisure time in sedentary behaviour, and the workplace represents a significant proportion of unavoidable daily sitting time for many people."

Dr Mike Brannan, national lead for physical activity at Public Health England (PHE), told Medscape News UK: "Even if you are physically active, sitting for long periods of time damages your health and greatly increases your risks of a broad range of health conditions.

"People should sit less and move more. But there are many situations in life – such as workplaces and care settings – where sitting is inevitable, so it is important to take regular breaks by standing or moving around."

Public Health England noted that the Health and Safety Executive (HSE) advises regular 5 to 10 minute breaks away from a screen every 50–60 minutes.

Lack of Clear National Guidelines

The researchers concluded that measures should be taken to reduce sedentary behaviour to both improve population health and reduce the financial burden to the health service.

However, as noted in the report's introduction, there are no national guidelines stating how many hours a day of sitting might be harmful – there is only a recommendation to minimise the time spent sedentary. According to the Chief Medical Officer's guidelines on physical activity, adults should "sit less" and "break up sitting time", as well as doing 150 minutes of moderate intensity exercise per week, to reduce the chance of developing type 2 diabetes by 40%, and cardiovascular disease by 35%.

The Sedentary Behaviour Briefing by the National Centre for Sport and Exercise Medicine has highlighted an evidence gap on what works to help people reduce sedentary time. It states: "The health outcomes associated with sedentary behaviour in children, young people and adults remains a relative new field of study… Most studies have focused solely upon the health outcomes associated with TV viewing while the health outcomes of other forms of sedentary behaviour, for example, occupational sitting or 'total' sedentary time, are less clear.

"For these reasons, it is currently not possible to provide an evidence-based quantitative recommendation, eg, <2 hours/day of sitting, for reducing the health risks of sedentary behaviour."

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