The Dangers of Sitting

Summary

The video, presented by ACSM, delves into the risks associated with prolonged sitting and sedentary lifestyles, exploring the link between inactivity and health issues such as obesity, diabetes, cardiovascular diseases, and even depression. The speaker emphasizes the significant impact of non-exercise activity thermogenesis (NEAT) on weight management and health. They explore historical data, physiological mechanisms, and societal factors contributing to these challenges, proposing innovative solutions across various areas - from personal lifestyle changes to corporate wellness programs, educational reforms, healthcare innovations, and urban design. The overarching message encourages embracing opportunities to increase daily movement and mitigate the negative health impacts of modern sedentary behaviors.

Highlights

• The video links prolonged sitting with serious health issues like obesity and diabetes. 💺🚨
• NEAT, or non-exercise activity thermogenesis, is crucial for maintaining health and varies between individuals. 🌟
• Jobs and activities in daily life significantly influence NEAT and overall health. 🏢🚴
• Wearable tech and apps are playing a vital role in encouraging more active lifestyles. 📲💡
• Schools and workplaces are creating environments that encourage movement, enhancing productivity and health. 🏢📈

Key Takeaways

• Sedentary lifestyles are linked to numerous health issues, including obesity and diabetes. 🚶🍰
• Non-exercise activity thermogenesis (NEAT) plays a significant role in energy expenditure and can vary greatly among individuals. 🔄🧘
• Innovative solutions across education, workplace, and urban design can help increase activity levels. 🌇🏢
• Technology, such as wearable devices, can assist in promoting and tracking physical activity. 📲🕹️
• Increasing movement doesn't always require structured exercise; simple daily activities can make a big difference. 🏃🌳

Overview

In this engaging video, ACSM highlights the perils of our increasingly sedentary lifestyles and how they contribute to significant health risks such as obesity, diabetes, and even mental health issues. By reviewing detailed research and data spanning over 150 years, the speaker draws attention to the mismatch between calorie intake and physical activity levels in modern societies.

The talk delves deep into NEAT (non-exercise activity thermogenesis) - the energy we burn through daily activities outside structured exercise. NEAT plays a critical role in how our bodies manage weight and energy balance. The speaker underscores how our jobs and daily routines drastically affect our NEAT, offering insights into personal and societal drivers of inactivity.

Offering a beacon of hope, the video highlights innovative strategies being implemented to combat sedentary behaviors. From integrating movement into workplaces with walking meetings and treadmill desks to revamping school environments for dynamic learning and urging city designs that promote walking and cycling, numerous fronts are advancing. There is emphasis on how technology, like apps and wearable devices, has become an essential ally in tracking and encouraging active habits.

Chapters

• 00:00 - 00:30: Introduction: Why Your Chair is Trying to Kill You The introduction, titled 'Why Your Chair is Trying to Kill You,' addresses the importance of physical movement and encourages listeners to move if they're feeling stiff. The speaker references a previous workout session and invites everyone to join the next one on Thursday. This sets the stage for a discussion about the dangers of prolonged sitting and the impact of modern sedentary lifestyles, hinting at the core topic of how chairs and prolonged sitting can be detrimental to health.
• 00:30 - 03:50: Energy Expenditure and Obesity This chapter explores the relationship between energy expenditure and obesity. It questions which part of the energy expenditure equation significantly impacts weight gain and obesity. The discussion is driven by data that highlights certain aspects of energy expenditure in relation to ill health, and the chapter takes a candid approach to addressing these issues.
• 03:50 - 10:00: Basal Metabolic Rate and Activity This chapter discusses the relationship between basal metabolic rate, activity, and obesity trends over the years. It highlights that contrary to common beliefs, the data does not strongly link increased energy intake to rising obesity levels. Specifically, since 1980, the UK's energy intake has decreased, although obesity rates have doubled during the same period. Australia is noted as an exception, with documented increased energy intake. The chapter emphasizes the significance of declining energy expenditure in contributing to obesity trends.
• 10:00 - 16:40: Non-Exercise Activity Thermogenesis (NEAT) The chapter discusses the impact of industrialization and urbanization over the past 150 years, particularly focusing on the development of office environments and screen-based lifestyles. It highlights the imbalance between energy intake and energy expenditure, emphasizing that modern lifestyles lead to consuming more calories than we burn. The chapter points out that this is not a conflict between physical activity and food intake but rather an issue of mismatched energy consumption and expenditure.
• 16:40 - 20:00: The Role of Environment in Energy Expenditure The chapter explores the concept of energy expenditure, particularly focusing on the role of environmental factors. It discusses different components contributing to energy expenditure, such as the basal metabolic rate, which accounts for 73% mainly influenced by lean body mass, and the thermic effect of food, accounting for about 11%. The text suggests that these factors generally have limited variability. The chapter implies remaining energy expenditure is related to physical activity. The speaker humorously anticipates a controversial discussion, indicating a potentially critical comment about American habits or culture.
• 20:00 - 33:20: NEAT and Obesity Research The chapter discusses the widespread issue of obesity, particularly in the United States, where 80% of individuals do not engage in regular exercise or attend the gym. This is contrasted with athletes who are accustomed to regular physical activity. The chapter highlights the time commitment required for going to the gym, noting that even for those who do manage to go three times a week, it involves additional time for commuting and changing clothes, apart from the workout itself.
• 33:20 - 40:00: The Impact of Sedentary Lifestyle on Health This chapter discusses the impact of a sedentary lifestyle on health, emphasizing the barriers to regular physical activity, such as time allocation for gym sessions and personal grooming. It highlights the disparity between time spent and actual activity, noting that for typical individuals, being active for a limited amount of time results in minimal energy expenditure, estimated at about 100 calories a day.
• 40:00 - 48:20: Technological Innovations to Combat Sedentariness The chapter discusses advancements in technology aimed at countering sedentariness among individuals, particularly in sedentary countries like Great Britain. It presents data showing wide variability in daily energy expenditure measured using Doubly Labeled Water. The chapter highlights the significant differences in caloric expenditure, with some individuals varying by 2,000 to 3,000 calories per day, underscoring the complexity and individual differences in energy expenditure in sedentary lifestyles.
• 48:20 - 60:00: Advancements in Measuring NEAT The chapter discusses the variations in daily energy expenditure among individuals of similar size, particularly focusing on Non-Exercise Activity Thermogenesis (NEAT). It highlights how two people with similar Basal Metabolic Rates (BMR) can still have a significant difference of up to 2,000 calories per day in their total energy expenditure due to factors like physical activity and possibly other lifestyle differences. This variance underlines the complexity of energy expenditure that extends beyond just metabolic rates or food intake.
• 60:00 - 70:00: Active Spaces in Schools The chapter discusses the concept of 'non-exercise activity thermogenesis' (NEAT) as a key factor in calorie expenditure and energy usage in schools. It emphasizes that unlike gym workouts, daily activities and smaller actions contribute significantly to calorie burning. The chapter contrasts regular gym routines, which may burn about 100 calories daily, with the more significant impact of NEAT on energy expenditure.
• 70:00 - 75:00: Health Programs and Wearable Technology The chapter explores the concept of non-exercise activity thermogenesis (NEAT) and its significance in caloric expenditure. It poses the question of how individuals of similar size can have vastly different calorie-burning rates without avid gym activity. The chapter highlights the influence of one's job on NEAT, noting a case observed in Swasiland where a student's NEAT was measured as zero.
• 75:00 - 76:40: Redesigning Cities for Health This chapter discusses the impact of redesigning cities to promote health through increased physical activity as part of daily routines. The chapter highlights the stark contrast between sedentary office workers, who expend approximately 300 calories a day through non-exercise activity thermogenesis (NEAT), and agricultural workers, who can expend up to 2,000 calories daily through their work activities. The chapter underscores the potential health benefits of reorganizing urban environments to encourage more movement throughout the day.
• 76:40 - 80:00: Conclusion: Reversing the Trends of Inactivity The chapter "Conclusion: Reversing the Trends of Inactivity" discusses the impact of modern conveniences such as online shopping and streaming services on inactivity. It emphasizes the importance of how we utilize our leisure time towards maintaining our NE (non-exercise activity thermogenesis). Despite our love for work, balancing our spare time with activities that prevent inactivity is crucial. The narrative humorously presents a typical evening scenario where one must choose between various relaxing yet sedentary options like watching Netflix or ordering pizza, highlighting the challenge in making healthier choices.

The Dangers of Sitting Transcription

• 00:00 - 00:30 [Music] whoa hey everyone all right um first of all permission anyone who wants to get up and move or just leave totally cool with me so please remember if you're feeling a bit STI if you didn't do the workout at the beginning amazing workout go to the next one on Thursday I think it is um please just get up and feel free to move uh why is your chair trying to kill you we got into this because um we were interested in the uh
• 00:30 - 01:00 energy people expend during everyday living and we couldn't understand why it is that of course there was tremendous issues regarding food but what parts of the energy expenditure equation are important in weight gain obesity and ultimately in ill health now the reason we were interested in this is because of the data shown here I feel as though I'm sort of caged off from you guys that's I'm going to I'm going to be like they're going to hate me for doing this but here we go how about this all right poised on the edge that's me that's what
• 01:00 - 01:30 they say right on the edge all right um over about 150 years the data on as obesity has emerged the data on um increasing energy intake and the emergence of obesity are actually not that strong in fact in the UK since 1980 energy intake has declined whilst obesity rates have doubled Australia is the only country that's actually documented increased energy intake but what's important is over that period of time energy expenditures progressively declined over
• 01:30 - 02:00 about 150 years since Industrial Revolution urbanization and then ultimately of course chair the development of the office a modern Factory and then ultimately the screen based lives we all uh live and what's important is this isn't a battle this isn't a them versus us uh activity versus food no not at all the issue is that we have inappropriately high energy intake for inappropriately low energy expenditure or we burn too few calories for the food we consume
• 02:00 - 02:30 when we think about energy expenditure all of you are familiar with this um the basil metabolic rate is of course something we can't really change 73% of the variance is affected by your lean body mass thermic effect of food is about 11% and doesn't vary that much it's the energy expenditure of converting intermediary metabolites converting food to intermediary metabolites and the remainder is activity now please don't throw things at me um I do not want any death threats at the end of this talk however yeah it would be totally brilliant if the of America and the
• 02:30 - 03:00 whole of the world where athletes totally get it yeah no problem but that ain't the case in my clinic in weight management clinic about 80% which is characteristic of the United States that people do not take regular exercise do not go to the gym and so even for those who of us who do go to the gym three times a week as you know it takes about half an hour to get there you got to change and then of course the class whether it's cardio I'm still sort of sweating from the one this morning it takes takes about half an
• 03:00 - 03:30 hour then actually the biggest barrier then the biggest barrier to the gym which which which which actually isn't my problem is actually redoing one's hair and then I'm not entirely sure why you're laughing um but then one has to get back to work and so for that hour and a half of time that you've allocated to your class you've only been active for about half an hour and that's done three times a week so when you average that out not for you like sports enthusiasts like total totally into it but regular human beings that's about 100 calories a day now when you look at energy expenditure
• 03:30 - 04:00 measured by W labeled water in a in a in another sedentary um country uh this is Great Britain um this is these are what the data look like youve got age on the x- axis total daily energy expenditure by W labeled water on the Y AIS now what's important to bear in mind is this is basically a sneeze plot there is massive variability and the 2 to 3,000 calorie per day difference between different people living in a highly
• 04:00 - 04:30 developed um sophisticated Society such as Great Britain um similarly to two people of similar size can vary their daily energy expenditure by 2,000 calories a day now if they're similar size their BMR are about the same the Bas metabolic rates about the same ther effective food is small so the only reason two people of similar size can vary their total daily energy expenditure by 2,000 calories a day has to be because of either you got a
• 04:30 - 05:00 massive sort of you know gym cohort but it doesn't happen so what else can it be it must be their non-exercise activity thermogenesis they're non- exercise activity thermogenesis and when you actually look at how the calories from energy expenditure associated with activity are actually differentiated yeah the gym goer may actually have 100 calories a day from exercise but for nearly everybody else the energy expenditure of activity
• 05:00 - 05:30 conversely inactivity is from neat non-exercise activity thermogenesis and that's how we got in the game so how can one person of similar size who doesn't go to the gym avidly burn 2,000 calories a day more than another individual of similar size how can neat vary so much well your job is a major driver of that the lowest neat we ever measured was actually in swasiland using W leveled water in a student obviously not at Arizona State University this person neat was zero and
• 05:30 - 06:00 the reason for that was she basically slept all day on The Other Extreme if we took a group of regular folk and move them into agricultural practice their neat their non-exercise activity thermogenesis associated with work would be potentially as high as 2,000 calories a day and I'll show you data to that effect many off sedentary American office workers have a work Associated neat of 300 calories a day basically sort of sitting on their bottoms getting backwards and forward to their motor transport getting home
• 06:00 - 06:30 pizza pizza pizza video game Amazon Prime click here it comes right now our leisure time is also important for our NE what we do in our spare time not all of us work 20 hours a day regrettably um and I know everyone here loves their job that's the trouble with ACSM right you guys we all love working anyway let's say you get home at sort of 5: in the evening you can choose between remote control Pizza Amazon Netflix
• 06:30 - 07:00 versus basically anything else whether that's you know hang out doing kickboxing with the not kickboxing with your kids but so you know participating in active Pursuits going for a walk with your children going to the art gallery U which by the way has some very good exhibitions in Phenix at the moment no conflict of interest uh but for those 5 hours you can either burn basically sort of zero calories in your evening or 3 4 500 calories in an evening if you want to go for a stroll in the mountains you want sort of paint your basement
• 07:00 - 07:30 whatever it may be and when you start looking at all of these different activities that we do throughout our day and we can measure all of these of course with you know very sort of quite quite good quality and direct calorimeters whilst doing different acts this this is a bit of an anachronism it's a sort of a man doing the washing up but what you can see is the sort of chair style um versus the neat way and and if you sort of just convert all of these things and it can just be things as simple as sort of you know on the phone on your sofa with your feet up as opposed to on the phone wandering around whatever it may be but you can see the differences one can create for one's
• 07:30 - 08:00 clients or for oneself using one's Leisure Time to promote activity so the calorie burn is enormous and so one person can burn 2,000 calories a day more than another because of either a very very inactive job plus very inactive leisure time or a highly active job plus active leisure time now if there's you thought I was going to go didn't you if there's so much variability
• 08:00 - 08:30 if there's so much variability in the calories you burn because of neat non-exercise activity thermogenesis could it be important could neat be important in the physiology of weight gain well our original experiments involve taking lean individuals and overfeeding them by a thousand calories a day above their weight maintenance needs all of this was done on a research setting so we established the that's me
• 08:30 - 09:00 we EST we established we established how many calories each individual required to keep their body weight absolutely steady and then overfed them by an extra thousand calories a day and we did that for eight weeks so that each individual received an excess of 56,000 extra calories and we were interested to know is well if you give somebody an extra calorie load on top of what they eat of 56,000 calories what happens to it well this is what's really interesting
• 09:00 - 09:30 first of all and this was already known is there's huge variability in fat gain meaning meaning you can eat an excess of 56,000 calories and you can be one of those people Everyone Else absolutely hates who doesn't gain a pound in body fat somehow you sort of go into overdrive and burn it off and the way you do that is you increase your neat your non exercis activity thermogenesis conversely you can you can be a normal human being who eats an excess whether it's on vacation stress at work whatever
• 09:30 - 10:00 it may be and that individual takes those extra calories and deposits them as body fat and those people who do not switch on their neat are those people prone to ready weight gain now we wanted to ask the question well if neat is so important in weight gain I guess I can walk all the way out the corridor is that acceptable is that acceptable okay all right totally cool I'm seeing this as you see it so we were
• 10:00 - 10:30 interested so if the change in neat is so important in fat gain could neat be important in obesity and in order to understand the calories that people burn in their everyday living we needed to sort of have a an Insight we need to have a look into how people live their lives and since most Americans were underwear we we figured that we could interlay sensors into underwear now these because
• 10:30 - 11:00 I come from Mayo Clinic and Arizona State University these underwear are shown as overwear and if you're not sure what the holes are for then then then then obviously I suppose you don't work in the biological sciences but into these underwear here you see into these underwear we interlace a whole series of sensors so that not only could we detect human movement but we could also detect human posture so we could know whether people were sitting standing moving we could
• 11:00 - 11:30 see what they were doing in bed rolling and and and and the other things that motans get up to at night opening the window is what one person told us I I've never seen anyone open the window and close the window and open the window and close the window so frequently but we were able to measure the posture and and the point is these sensors are so sensitive and specific as we get people to go through a sort of a test series of different movements you can see how sensitive and specific they are we measure 21 axes of movement in real time so we took all of this data we
• 11:30 - 12:00 cated it and we looked we asked the question again again taking Jim goes out of the equation regular Americans and what we wanted to know is we went into regular offices and we wanted to go to the cubicles cubeland and we said what is different about those people who are lean working in cubicles versus those people with obesity working in cubicles what differentiates them and this is what the data show showed the data showed that those
• 12:00 - 12:30 individuals with obesity sitting across the cube from somebody who's lean is a individual who's prone to be seed 2 and a/ qu hours a day more than people who are lean people who are lean and remain lean in modern society in a modern sedentary environment are those individuals who somehow found those find those opportunities to be up and moving 2 and a/4 hours a day more than people with obesity
• 12:30 - 13:00 we then said oh well what is this movement what's the trick to this movement how can it be that You' got that this this neat this non- exercise activity thermogenesis differentiates the people who are lean from people who obese is there enough calorie burn going on remember already we know that one person can burn 2,000 calories a day more than another person of similar weight so what we did is we took another group of people and we overfed them as well and this time they wore magic underwear and got overfed God these these studies are so much fun
• 13:00 - 13:30 and here's what the data showed it showed basically the same thing as we did before right which is sort of classic good science right keep repeating things until eventually you retire anyway so on the x-axis you see fat gain on the change on the y- AIS you see a change in neat but it's not neat specifically what we've done is we've pulled out all of the movement data and because remember we know when people are sitting sleeping and so on and so forth and what it is is change in Walking energy expenditure so what enabled an individual to overeat
• 13:30 - 14:00 56,000 extra calories and literally not gain a pound in body fat is because they spontaneously walk 800 calories a day more they don't go to the gym because we measure these people and track them and all this kind of thing those individuals who when they overfeed do not activate that neat are those individuals prone to weight gain it's kind of really interesting when you think about it or at
• 14:00 - 14:30 least because somebody who's overeating spontaneously moves more on a regression line compared to somebody else how does that occur how does that regulate it and and the obvious answer has to be is that this must be somehow computerized in the brain the brain knows when you're moving the brain know knows when you're sedentary and the Brain ultimately controls what you eat and so we started doing some experiments in in the brain this is a rat brain and what you see on on the top
• 14:30 - 15:00 left there is a rat and he's not wearing a religious head covering uh but what he actually has is a needle this is Mark 37 he has a needle penetrating the paraventricular nucleus of his hypothalmus Lana has Mark 37's head between her thumb and finger these animals tolerate this amazingly well actually medical students don't but rats do and she's got a canula and she's taking it and injecting putative chemicals right into the center Center of Mark's brain now the reason all the
• 15:00 - 15:30 rats were called Mark is it was the name of Lana's exboyfriend now unlike the real Mark who she couldn't contain she she would place the animal in the calorimeter chamber and we can measure all the movement the animal does and on top of that something else she couldn't do with real Mark is we videotape every single thing the animals do and as and with the animals permission obviously and so the there have now been four mediators of neat
• 15:30 - 16:00 identified in the central nervous system and this is orexin which is one of them orexin is really interesting because it's a sleepy wakey hormone when you wake up erex wakes you up in the morning so it so you can see why we were so interested in it and the more ereen you inject this is kak Koji kawaki's work the more ereen you inject the more neat the animal has now this is really really cool so if you take animals inbred fness shown here and inbred for obesity shown here 19
• 16:00 - 16:30 generations of inbreeding experiments that are difficult to do in humans you see that the animals inbred for obesity have lower neat than animals inbred for leanness rather like the H the human data but then as you inject more and more and more orexin into the brains of these animals inbred for obesity and inbred for leanness the animals inbred for obesity increase so
• 16:30 - 17:00 much the animals inbred for obesity increase this much twice as much that's really interesting so molecule for molecule for the animals inbred for lenus they move twice as much more than an animal inbred for obesity if you like the brain is far more sensitive in those innately bred to move more compared to those innately bred to have
• 17:00 - 17:30 obesity now this is true not only in rats this is a zebra fish we did amazing Ze we used to do tracking experiments in zebra fish is kind of really cool but but this goes right across the animal kingdom and in fact neat responses and this in this case to starvation are ubiquitous across nature whether it's actually horses elephants indeed wolves are humans when you calorically restrict when you take away food there's an initial a high in whoops excuse me a
• 17:30 - 18:00 high increase in neat and then ultimately with caloric restriction neat goes down but what the point I'm making is these chemical signals are not unique to the human or the rat brain but they go right across nature this is part of how we're built so there's a physiological relevance there a neurological drive but how about how about our how about our our environment now to me what's important about environment is it's not just cubicle
• 18:00 - 18:30 call it's not just teachers telling us to sit still if we were in Boston right now this amazingly there's still snow on the ground right it's less likely that you're going to sort of take a one or two hour walk this afternoon here you've got no excuse weather is important one of the key drivers of neat of non-exercise activity thermogenesis or the converse sedentariness is poverty so when I think about ecology there are
• 18:30 - 19:00 multiple factors at play now one of the key questions others and ourselves had is this idea that as as the human as humans have urbanized we used to live in these agricultural environments excuse me we used to have high neat now we all work behind desks has it really what are the data what are the data that substantiate that and they're shown here what we did is we went out to Jamaica I know I know it's it's all tough it's all part of a day's work so what we do and we went up to agricultural
• 19:00 - 19:30 communities particularly we with banana banana plantations and we kitted out people working there with those magic underwear we had one guy arrested actually was he was thought to be carrying an incendiary device but and his data were excluded for the one day he was in prison but were included for the rest I I'm being absolutely serious when you measure the neat in people living in agricultural communities they move ambulate specifically this
• 19:30 - 20:00 much now when you take people from Jamaican agricultural communities the agricultural sort of business scope is collapsing in Jamaica and they urbanized to Kingston they have their ambulation they Harve their ambulation and people working in factories and offices in Kingston actually have very similar neat to lean people weight match living in the United States and we've already discussed the impact of OB City so when you urbanize shown here is
• 20:00 - 20:30 sitting time when you urbanize from agricultural communities you double your sitting time and ultimately the differential between somebody with obesity live working in a cube in Cube Land in America they sit three times as much as people living in agricultural communities on one hand it's chilling because my goodness we've hared our amount of movement if not more but on the other hand it's really good news it's really good news
• 20:30 - 21:00 because what a therapeutic opportunity right humans have a capability of moving twice as much or three times as much more than they currently do living in modern societies Isn't that cool what an amazing yes so can you change it that's exactly exactly right can you change it we're going to talk about that next thank you all right you're hassling me no I like that I bring it on Bring it on I can take it but this is what we've
• 21:00 - 21:30 seen now just one one point just to your point how is all of this sort of environmental data relevant to the United States these are data from count the dots 3100 us counties and there zip code each dot there is a zip code what you see here is obesity rate and sedentariness these data were gathered with CDC and of course there's a there's a beautiful relationship between the ZIP codes with higher obesity rates and they have higher
• 21:30 - 22:00 sedentariness now what's really important about this is this is zip code it's not personal behavior is where you happen to find yourself living okay that to me is that really important because diabetes and sedentariness track with poverty in in in obviously a very sort of clean and discernable way so yeah of course we have personal choices but no one chooses to live in poverty no one chooses to live in a zip code with very high sedentariness and so
• 22:00 - 22:30 you get a sense of the power of these envir environmental drives so all of this is interesting and all of this hopefully is relevant but then what appeared to be the case as time went on Is Not only was sedent Terin associated with low calories obviously sort of sitting a lot but also the health consequences start to to become clear and it's quite obvious when you think about it if you take people who are moving moving all day long and scrunch them down into
• 22:30 - 23:00 chairs how crazy is that of course it's going to be unhealthy and indeed it is so the NIH consensus is shown on this reference here five FS paper published here and what it documents is that there are 34 chronic diseases and conditions associated with excess sitting and what's interesting to me is that they range from diabetes to hypertension to cardiovascular disease as you might expect breast cancer is dose dependently associated with sedentariness of course
• 23:00 - 23:30 back problems and most interestingly also is depression and psychiatric issues now why is that how can sedentariness be so closely linked with so many health issues so many Health complications now these experiments were sort of super simple and they go as follows regular healthy individuals were brought onto a research center and all of these individuals were given breakfast lunch and dinner and then they were told to do their
• 23:30 - 24:00 normal thing whether that's going to work at a computer or after dinner sitting at home watching television on the alternate day this was actually done nine times in a sort of a some ltis design it was all done very carefully on Alternate days individuals were given those same three me meals breakfast lunch and dinner and they were told instead to take a 15minute walk at 1 and 1/2 mil an hour which is the speed I'm walking at right now a 15minute walk at 1 and 1/2 mil hour
• 24:00 - 24:30 after each of those three meals and in all the volunteers we continuously monitored their glucose this is what happens the red line shows what happens if you don't if you sit down after all of your meals exactly exactly the Blue Line shows you what happens if you take a 15 minute stroll just as I'm doing now after each of those meals you have your post prandial glycemic Excursion
• 24:30 - 25:00 you have the change in blood glucose that occurs after all of these three meals half it I mean when I saw the data what do you think I do what's the biggest predictor of type two diabetes yeah exactly exactly the postp paral glycemic Excursion that's exactly right so of course just taking this example you immediately under one can immediately appreciate and now of course there's lots of mechanistic and Gene
• 25:00 - 25:30 data too to explain how sedentariness can so profoundly affect one's risk for diabetes and of course now you think about insulin and Insulin like growth factors that are also cleared by movement and therefore the link comes to potential malignancies and so on and so forth and so as soon as I saw this data you start to realize it sitting too much is sort of the channel the bridge to a whole series of the chronic diseases of modernity oh my goodness you add to that a couple
• 25:30 - 26:00 of hamburgers oi right and all of a sudden it starts to make sense but the it but the concern is greater so Ada is predicting what a third of Americans are going to have diabetes look at the curve here is the x-axis which is time and this is millions of people with diabetes in the United States and what's important about the curve is the shape there's no flattening off there's no leveling off in inner city programs we do here in um underserved 11y olds uh from from
• 26:00 - 26:30 our Latino communities one in three children one in three children already have elevated blood pressure right so when you start to realize that a third of Americans already have pre-diabetes this is what's going to happen but it's not just diabetes it's not just metabolic disease cancer back problems joint problems osteoporosis and so on there are also data that being inactive ass is associated with feeling blue depression but also things as
• 26:30 - 27:00 nefarious and as important as happiness dare I say what's that uh don't we all have the best jobs right I mean we we are like the chosen 1% in the whole world to get to do something we love to do and to help people get healthy but people who are stuck on their bottoms all day who are stuck in chairs all day have lower creativity dynamism mood and these are now published now the interest in sedent iness and ill health has has sort of is
• 27:00 - 27:30 is following the same curve we're watching we're documenting the ill effects of sedentariness and you can see how the PubMed citations are continuing to increase just like diabetes is so what do we going to do about it how are we going to take this challenge we know that people can move twice as much as they do how we actually going to start to create the society that enables people to be up and moving all day long well we despite my dream we
• 27:30 - 28:00 can't actually put the whole of the United States in magic underwear so we started building this is now 10 15 years ago a whole series of devices that took that same technology I haven't got time to tell you how the original Technologies were built built but I will tell you involved a lot of glue but we but the the key break theough is actually the there's a um the mems accelerometer the the micro micro El magnetic machine that goes inside these silicon chips that ultimately
• 28:00 - 28:30 Drive these devices anyway so we started working on miniaturizing these devices and making them scalable and then we Tech transferred out and again I'm sort of quite passionate about building stuff in labs and then sharing it with the world because otherwise what we do in our lab sort of stays ins outside the Ivory Tower anyway so we Tech transferred it out to a whole series of different groups we worked first with Apple computer day Tech transferred out the data to Nike and it became Nike Plus system we started building systems into earpieces because we realized they were
• 28:30 - 29:00 going to become ubiquitous that project failed horribly we worked with the US Army uh to build this device and the idea here was to drop 10,000 units into Rwanda who were actually seeing this amazing rebuild at the moment we wanted to chart what happens when you modernize and build new cities that project failed horribly after 5 years of work because 100 units were delivered to the NIH in Washington they gave them to 9 to 11 year old children who managed to destroy every single unit except for one we found children were remarkably creative regarding how they destroy
• 29:00 - 29:30 Technologies um everything between between actually putting these under the back wheels of their dad's car and watching their dad drive over them because they were told to test them we didn't mean kill them we test them anyway so so we learned a lot and ultimately these are the Standalone devices some of them we recognize and I have no conflicts of interest by the way um we also realize this is a trio cell phone none of you will recognize it I hope we also realized it' be kind of
• 29:30 - 30:00 interesting to start people Gathering their own data on movement and sharing it with others so it could actually become comp a competition and that's what we built here as a sort of a gaming system and that's obviously my avatar looking very much similar to Arnold Schwarzenegger um I suppose that isn't a good choice these days but it was at the time and um and and I could compete against people Elsewhere on the cellphone Network so all of these Technologies we started to brew we also found that the when you go from portrait to landscape the chip that measures
• 30:00 - 30:30 Earth's gravitational field is a triaxle accelerometer so we hacked into the iPhone 3 very early on and validated the fact that the chip inside of inside of all of our smartphones can measure human movement beautifully in fact these are actually some of the cleanest data we ever got they're really nice data and so we realized that you could start building apps to ultimately start to measure activity and we developed those algorithms and we also did we take transferred those out to multiple other people but this is what's very powerful so we
• 30:30 - 31:00 this was I can't remember what year it was five or six years ago so we literally with one student built this app we released it without any advertising dollars onto the web Business Week actually picked it up and voted it one of their top five apps and within 6 months we had 28,000 users and in 28,000 users we were gathering data at 15 Hertz 15 times a second and all of that data were being collected and actually what we see here is the data from 28,000 users gathered 15 times cing continuously for months and months on
• 31:00 - 31:30 end and here are the occurrences and actually what you see is human movement when you actually mush it all together is just is neat it's all a very high volume of these very low activity occurrences but that's not what's interesting if I have gone to my PhD supervisor decades ago and said to Mara Mara one day I'm not going to use surveys but I'm going to measure daily activity in 28,000 people in real time 15 times a second using a validated
• 31:30 - 32:00 technology she would have said I'm totally utterly crazy but all of a sudden the tools now exist whether those are fitbits that that have been sold to what 20 20 million people Nike Plus was sold to 28 30 million people and so on and so forth we now have the and cell phones we all carry them we now have the capability of measuring need in millions and millions and millions of people in real time but those aren't the only Technologies however that are important this is a simple lanyard that goes around the neck
• 32:00 - 32:30 we've deployed this in every corporation we've worked in Walking meeting in progress is what's on the thing there's a little protocol when somebody's having a walking meeting you don't interrupt them and what's important most is that walk and talk meetings are 11 minutes shorter on average than regular meetings which is a reason alone to deploy this immediately we've also built little stepping devices that go under the desk so that it when the phone goes you pull out your stepping device and you you talk away and we can actually measure when you're using the stepping device shown here and uh management groups can compete against
• 32:30 - 33:00 each other of course the infamous or now famous treadmill death no no conflicts of interest again I actually originally built this out of disuse hospital equipment as not a joke I didn't build it as a joke that's not true but but to show people what we're trying to get at this idea that you can move whilst you're at work and of course this has now sort of become a sort of a little bit of a flagship for for some of the programs we're involved in but as I said the trick with the technology is not to think that All Electronics all
• 33:00 - 33:30 Technologies involve machines this is a project I was involved in in Democratic Republic of Congo and all of these individuals none of whom are nurses none of who are Physicians are all carrying certificates so we build a certification program for community health workers who go out into their communities in obviously some of the poorest parts of the world and deliver very very specific health programs related to preventing diabetes and obesity but in other words part of the Technologies are not just devices but the systems in order to deploy their approaches and of course then of course
• 33:30 - 34:00 we work with armman and thanks to Matt Damon for coming down to Mayo Clinic and the idea here was to build a new type of of of clothing this is a type of business suit that is lighter than a track suit to sort of to create a new Vibe of dynamic working it's coming we also trademark neat and we started realizing that this model of develop validate protect scale is a fantastic way of getting valid
• 34:00 - 34:30 approaches out into the marketplace so we had all these tools and tricks how could he actually start deploying this as real programs in offices well what we started to do was we we started going around offices doing these sort of quite complex breakdowns as to how offices actually function only focused on movement and we do this with a whole series of sensors we we have real time recorders and so on we then talk to the office about what resources they're willing to deploy in order to
• 34:30 - 35:00 create an active workspace that can be shared desk that can be walk and talk what doesn't matter what it is it can be walking trails we then bring those in we work with the manufacturers and we work with the uh company representatives to bring in all this furniture we work with Architects as well we also work with it and lawyers we put we deploy all of these things and then at the end of the day we also have programs so that's derer who at the time ran her own company she's now employed by by us at Mayo Clint but what deri did is she we used the
• 35:00 - 35:30 Train the trainer modu model and we got 2 minutes per day for every employee and we would go out and develop ways of getting people up and moving in in corporations in various ways using all these various tools but importantly also using behavioral paradigms and in to prevent the question we also of course work with cafeterias to improve quality of nutrition in all of the corporations we work in we actually bring in and build a laboratory because because the whole ethos is you can't just keep doing stuff
• 35:30 - 36:00 without any data to validate what you're doing and the more we we built Laboratories in these different corporations the better we got at doing the science and we realized that some of the key variables we're interested in scientifically are not what companies are interested in and so we started measuring those as well we work it's it's now over just over 106 us corporations at this time was 71 work with and the point I'm trying to make here is we work some very large corporations but also very small ones and we use an alart approach what do you want to do here here of the data that show what's effective for whom and what
• 36:00 - 36:30 we do is we study we study we study and we publish and we and and the and that's the whole idea because there are lots of companies out there delivering Wellness programs but we're very interested in creating that scientific foundation and we're quite happy for others to take what we learn works and doesn't work and take it out for themselves let me just show you two two PE I'm actually just going to show you this one piece of data because I think it's really cool what we did here this was published relatively recently in plus one what we did here is measure three times a week people's
• 36:30 - 37:00 stress levels and we did that in employees and their managers and what you what we show is so is shown here this is sort of basically a sort of a score of Happiness of of wellbeing in the workplace when you deploy these kind of activity programs you can see multiple groups all show exactly the same thing I've lost the battery what happens I know it is what happens in the first few months of deploying an active program people people's happiness level they get more stress stressed out and of course they get more stressed out you're fundamentally changing how they work and
• 37:00 - 37:30 their working procedures and they're walking during the day they're not walking meetings they're not used to taking notes whilst walking whatever it may be and that happens for about two to three months then look what happens and we're going on now to 60 weeks we this we actually published two years people get it and once they start getting happy they get happier and happier and happier and happier and of course the corporations are seeing weight man decrease in weight decrease in diabetes and the healthc care cost savings but most importantly employees are becoming more productive 10 to 15% more
• 37:30 - 38:00 productive in fact and happier and healthier too we took all the programs and again Consolidated those and they they became a corporate manual and of course there there had to be a picture of me at work so all well and good and and as many of you know we we were sort of challenged by government to say oh you're doing all these things in corporations how about the kids how about the kids we took these same principles and we had now a lot of tools we had a lot of approaches and we had very good trainers and we went to a group of 10 to
• 38:00 - 38:30 15 year old children and we said could you guys design the School of the Future and they designed this space rather like a Socratic learning space where kids can move throughout the day and you can see what it is it's very open plan they move throughout the they move throughout this space this is the school in Minnesota and so of course they chose a hockey arena as their classroom and that's obviously not ice obviously and these whiteboards weigh just under two as they design them themselves and there's a design uh
• 38:30 - 39:00 patent which is different to a full patent on those these work tables were designed by the company we were working with at that time Ki no no conflicts of interest and you can see and there's a hockey net kids love to learn a net they did their own art their own art and everything lots of we learned a lot from doing this but what we also did is we measured the effectiveness of the strategy and what you can see is when you move kids into these very Dynamic spaces they double the amount of neat they double the amount of activity they do take yourself back to that data from
• 39:00 - 39:30 Jamaica doubling and as you urbanize you have people are meant to be moving twice as much Give Kids the chance they will double the amount of movement they do and most importantly educational scores of these kids improved by 11% compared to match children from similar schools well you can't go around building new schools everywhere great idea interestingly in Germany where we where we did quite a lot of work two out of 10 new schools are Health Schools because in other words every country is building schools all the time so now two
• 39:30 - 40:00 out of 10 it used to be 1 out of 10 two out of 10 are now allocated as health schools in Sweden we're doing one out of 10 new schools built will be Health Schools but you can't go around building all schools and it's more difficult in the United States for various reasons so what we did is we built this kit and the idea of a kit is you can take all the chairs and tables out of a classroom and put this kit in and this kit cost no conflict of interest cost $500 and this kit allows kids to learn and these are elementary kids kids to learn you know two * two is four while
• 40:00 - 40:30 they're sort of doing monkey bars and so on yeah it's really cool now again how do you validate this so what we did is we put our laboratory and we built it into a van and this is a dexa scanner we have Hipp approved medical record systems and so on and so forth and we drive the lab to the school now this proves to be very popular with children who view this as sort of experiential science and so that that proves to be a sort of a spin-off from all of this but here's what the data look like so if you give kids kids access to these active classrooms and
• 40:30 - 41:00 you measure their activity this time using actually a very Posh um measurement system again we co-developed with a Swiss company it's a research grade doesn't matter what it is but it's covered in Silicon is the important thing so when the kids sort of drop it in the bath let it fall in the toilet uh we can ask the kid to get it out for us anyway you can't anyway so um yeah enough toilet stories I'll tell you when you work with children you got a lot of toilet stories anyway um um here's what happens is you start
• 41:00 - 41:30 to deploy this is remember just a classroom you haven't rebuilt the school what we're doing is giving kids access to this classroom one lesson a day and as time goes on they become more and more and more active and what's really interesting in these data demonstrate how good these sensors are is you can see there that is their one lesson a day but what you also no is that throughout the day the kids become more active so if you give kids 30 minutes exposure one period actually it's two perod excuse me it's it's 48 minutes L it's an hour less
• 41:30 - 42:00 12 minutes these kids will increase their activity about 30% and that's just for one lesson so there are very powerful scalable systems other schools are started taking this on we work with this school originally we working with ADHD kids in this school but the program became so popular all the kids wanted to have these exercise bicycle things where they can cycle where they're learning this seems to work quite well and this is what's really interesting to me I'm got the price points in working in building School Furniture are very different to corporate suffice it to say the average cost of a chair and table in
• 42:00 - 42:30 a school is $717 and so it's a very difficult space to commercially work in but this company again no conflict of interest ergotron have have started to deploy in this space they're starting to sell in this space you can see here active kids furniture for schools the other thing I don't think I've got time to tell you about these kids um when you start working with children we do a lot of focus groups we meet with them find what they want I mean to give you a very quick example one kid explained to me in Iowa he gets
• 42:30 - 43:00 home from the day he's totally stressed out hates his new mother um parents remarried and what and how does he deal with his stress he goes into the basement kills 15 people and feels much better now we all know what he means right we all know what he means he he goes onto the video console and kills 15 people and feels much better I right this is the BBC report kids are spending more and more time on screens like we didn't know this but what I thought was really amusing is that this just over here is his eggut muffin and
• 43:00 - 43:30 the question the BBC are asking is why aren't Eggman muffins served all day and I don't know if you saw the press release yesterday from McDonald's now they are good news Okay so school here how about the health if if if neat is so important in 34 different chronic diseases and conditions how about the health care space we've started working with a whole series of different disease conditions everything from Stress Management cardiovascular disease and so on and so fourth we we work in 23 different Health um universities um on clinical trials
• 43:30 - 44:00 and such and this is we work in heart failure and so on and so forth but what I want to show you is is is what's coming next so you got fit you got these devices we the cam device is built specifically for this clinical space and we have programs but you can take all of that technology now and you can now condense it and put it in a chip this size okay that's a pencil head so now we can start to build these micr miniature Technologies and so in the wearable
• 44:00 - 44:30 space this young girl here is wearing a Band-Aid and there's the technology right there right and the important point from my con from my perspective is instead of it costs about7 $18 to make something that goes inside a Fitbit or something equivalent to that a Groove device that's $34 cam device I can't I don't know these are going to come out about 37 cents a unit so now if you say to me I want to do a diabetes prevention program in Mexico City I need aill ion units that's going to cost me about a million time a third of a cent right
• 44:30 - 45:00 $300,000 all of a sudden we can do not just we can do Mass measurements and not only can we measure activity we can actually measure continuous glucose using these kind of Technologies but also we can start to deliver therapies this woman is wearing a patch right here and through the sensing from the Band-Aid system we can actually now start to release medication straight into the bloodstream using that cell phone network yeah it's totally cool okay so we got the healthcare
• 45:00 - 45:30 industry 34 chronic diseases schools offices and but how about cities how about the places we live in now what's really interesting is now there are data coming out it's very difficult to do prospective studies redesigning studies but what we can do and these These are data from the UK is re-envision cities and actually do the mathematics using big data approaches algorithms to see what would happen to cities as you sort of take the cars out and start to start to ambulate them start to ambulate City centers and we
• 45:30 - 46:00 just came back from San Francisco and here's the pitch to San Francisco in San in San Francisco we know is that taking these kind of measures that actually cost the city nothing to do by ambulating the city commute time increases 18 minutes that's true it saves 2400 premature lives per year and saves the city of San Francisco with increased product in increased profits in shops increased walk by shops and healthc care cost savings $34 billion a year so there
• 46:00 - 46:30 are huge opportunities in cityscape redesign as well we've been working with the mayor of Phoenix this is Senator Venezuela build building programs in Phoenix so so please join the the Phoenix walks and so in conclusion ladies and gentlemen we we sort of walk together through what started off in a sort of a laboratory with animals inside sort of cylinders and now and now we get the opportunity to sort of realize that
• 46:30 - 47:00 inactivity is such a huge opportunity for health and we can impact that in so many different ways whether that's through the programs we deliver through our clients through the scalable opportunities in corporations in schools even in cities and we've seen this progression since Industrial Revolution and because it's only occurred over 200 years by definition it must be reversible we must be able to do something about it my our the team's approach to dealing to to building scalable solutions for those of you who are interested in in just get
• 47:00 - 47:30 out there and do stuff I mean and if you're a business person that's a lot of profit to be made in this space if you're a health person there are a lot of people who need your help who need your help and and our and our philosophy is invent validate and disseminate and and and here's and here's the Mantra here's the Mantra here's the Mantra this is Copeland's quote science proceeds from the assumption that misery is not fated that because all events are are caused all problems can eventually be
• 47:30 - 48:00 solved time to get up ladies and gentlemen thank you [Applause]