The following is a draft of my issue brief about why Penn State should encourage students take breaks from prolonged sitting and stand more often:

Sitting is positively associated with markers for cardiovascular risk. Glucose and insulin peak higher for those who remain continuously seated after eating, relative to those who punctuate sitting with low-intensity movement, such as walking, every twenty minutes, among 19 obese but non-diabetic people, according to a 2012 study by Dunstan et al. According to the same study, lower levels of blood sugar and insulin following meals are associated with a lower risk for type 2 diabetes mellitus. Additionally, people burn fewer calories while sitting, whether they are of healthy weight or obese (Levine, Schleusner, & Jensen, 2000). Together, these findings explain the report of Hamilton et al. (2007) linking sitting time to increased risk for type 2 diabetes mellitus and obesity.

Lipoprotein lipase (LPL) decreases while sitting. LPL is an enzyme that appears to directly interact with cholesterol in the blood and promote its uptake, reducing LDL (bad) cholesterol levels and indirectly increasing HDL (good) cholesterol levels. LPL is produced by skeletal muscles, which produce higher amounts of LPL during exercise. However, continuous low levels of activity seem to be needed for continuous LPL production. Studies in rats show that after four hours of activity analogous to sitting, LPL levels decline for a period of about fourteen hours by 90 – 95%, at which level they remain; thus a single day spent sitting abrogates most LPL activity. Since LPL improves cholesterol levels, sitting indirectly raises triglycerides and LDL cholesterol and lowers HDL cholesterol (Hamilton, Hamilton, & Zderic, 2007; Hamilton, Healy, Dunstan, Zderic, & Owen, 2008). LDL cholesterol levels positively correlate with risk for fatal atherosclerosis and heart attacks, as do high triglyceride to HDL ratios (Assmann & Schulte, 1992). Together, these findings provide a mechanism to support the research by Katzmarzyk and Lee (2012) showing that sitting increases the risk of death by any cause and that, on average, people who sit for more than six hours per day die between 1.8 to 2.0 years sooner than those who sit for fewer than three hours per day.

How much Penn State students are sitting, & when.

College students are not invincible against the maladies of prolonged sitting—not even at Penn State University. Penn State professors David Conroy, Steriani Elavsky, and Shawna Doerksen and graduate students Jaclyn Maher and Amanda Hyde (2013) monitored the activity of 128 undergraduates and found that on average, they sat for 67% of their waking hours—over eleven hours per day. Conroy et al. also found, paradoxically, that students both sat and purposefully exercised the most on Tuesdays, Wednesdays, Thursdays, and Fridays, since, they reasoned, students have classes and sports practices on weekdays.

 

Curious about what factors besides the day of the week lead to intrapersonal differences in sedentary behavior, Conroy et al. found, unsurprisingly, that habitually sedentary students tended to sit more during the study, but that the stronger their daily wills to avoid sedentary behavior, the less time they spent sitting. This suggests that Penn State students, though predisposed towards sitting in class and while studying, can sit less if they choose. Therefore, if Penn State can convince students to avoid prolonged sitting, it is likely that students would begin to habitually sit less.

Indeed, some colleges are already piloting standing workstations. At the College of Saint Benedict and Saint John’s University, a pair of liberal arts colleges in Minnesota, exercise science professor Mary Stenson prompted her department to install standing desks in half of the classrooms in Murray Hall, a gym facility on campus. Although a controlled study to determine whether these standing workstations benefit students’ performance and well-being is still underway, Stenson reported that she feels more alert and productive at her standing desk (Dittberner, 2014). These desks were provided by JustStand, a national organization that markets Ergotron brand sit-stand workstations and other products, which it has donated to over 4,000 organizations (The Mission for JustStand.org, 2015).

Students at Penn State will likewise benefit from a well-designed program to encourage them to reduce the time they spend sitting. Admittedly, implementing a standing desk program at the College of Saint Benedict and Saint John’s University would be easier than implementing one at Penn State. The former pair of institutions enrolls only 3,744 undergraduates and charges over $40,000 in annual tuition (The College of Saint Benedict and Saint John’s University, 2015), while Penn State’s University Park campus has 40,541 undergraduates, who pay $17,502 (in state) or $30,452 (out of state) per year (The Pennsylvania State University, 2015). Penn State is therefore less flexible and receives fewer private funds; consequently, implementing a standing desk program would likely take more time and effort, although it could implement a small pilot program as an initial step towards determining how to design a larger program.

Recommendations for Penn State to improve

There are a number of mutually inclusive components of this program to reduce the amount of time that students spend sitting. However, Conroy et al. (2013) found that both students’ habits and intentions to avoid being sedentary strongly influence their sedentary behavior. Simply providing students with standing workstations without educating them as to why they should avoid sitting would likely change the engrained habits of few students, so the investment in standing desks would be wasted. In order to change students’ sedentary habits, Penn State must first make students intend to sit less, which could be accomplished by educating students first about the health impacts of sitting. After students want to sit less, they would be more likely to use equipment that Penn State would provide later on to change their habits.

The endeavor to encourage Penn State students to interrupt long sitting breaks would comprise three main goals: first, educate students about why they should sit less and for shorter periods of time; second, provide students with the equipment that they would need to accomplish this; third, develop ways to continuously motivate students to avoid protracted sitting. To develop these goals, it must be noted that Professor Conroy himself said, “It took a little while to get used to standing while working…. It’s best to ease your way into it” (LaJeunesse, 2013). That being said, students should not immediately try to stand up continuously as they work. Rather, they should first focus on interrupting habitual protracted sitting. As Professor Conroy again said, “Frequent interruptions to the amount of time spent sitting are likely to accumulate over time into valuable health benefits” (LaJeunesse, 2013). As students become accustomed to standing, they can stand for longer periods of time.

This overall goal begins with the first goal of educating students, which would be the responsibility of those who develop the classes and design the curricula of different majors, as well as of students to spread the message. Students already take interest in their fitness by frequenting the gym and taking some of the 65 fitness-based kinesiology classes that Penn State offers for credit, presumably because they have learned throughout their lives that exercise is important for health (The Pennsylvania State University, 2015). The aim of this goal is to create a culture in which students view prolonged sitting as being even more detrimental to their health than lack of vigorous exercise. Initially, this could be accomplished by incorporating lectures on the scientific risks of sitting into every physical fitness class. Additionally, a new 1.5-credit kinesiology class consisting of lectures on the risks of prolonged sitting could be created. This class would meet for less class time than most fitness classes, but most of the grade would be based on one assignment: wearing a device to measure the amount of time spent sitting and standing and being graded on the frequency of breaks while sitting.

Not every student takes physical education classes, however. Students are required to take at least 3 general health credits at Penn State, but these can come from sedentary biobehavioral health and nutrition classes as well (The Pennsylvania State University, 2015). Therefore, the general education requirements could be changed to mandate at least 1.5 to 3 physically active classes to ensure that all students would learn about the risks of prolonged sitting. To reach students who are not currently taking a physical education class, infographics about the adverse effects of prolonged sitting could be placed in popular locations around campus to encourage health-minded students to take notice. All together, these measures could educate Penn State students that sedentary behavior is as influential as physical activity in determining health. “The health message has been delivered really successfully that physical activity is good for you…. However, very few people think about the dangers of sitting all day,” (LaJeunesse, 2013), said Professor Conroy.

After Penn State students begin to realize the importance of avoiding prolonged sitting, Penn State can begin the second goal: provide students with the resources they need to avoid prolonged sitting. This goal would fall to the administrators who purchase classroom and commons building furniture. As purchasing new equipment may be expensive, these administrators have several options to mitigate the expenses. First, they can replace furniture as it wears out, as they would need to purchase new furniture anyway. This option has the upside of being relatively inexpensive but the downside of being slow, as it may be many years before all of the furniture wears out and is replaced. Second, they could sell the existing furniture to other schools that need to replace theirs; this option would recuperate some of the costs of buying standing-compatible desks but would involve effort to sell the furniture, and Penn State would not be able to sell some of it, such as large, built-in desks and lecture hall seats. Third, Penn State could raise tuition by the amount (small, compared to the overall tuition) needed to defray the cost of the standing equipment. Additionally, there are already products that use a harness to support a desk in front of one’s chest, on which one can place a laptop or notebook. Penn State could design such a product and sell it at the bookstore to help defray the costs of new furniture. Combined, these options would provide students with materials that they would need to stand up and minimize the cost to Penn State.

To continuously encourage students to interrupt sitting, with or without using these materials, is the third goal of this program. Professor Conroy is himself developing interventions to encourage this behavior, which I will interview him about. Penn State University has developed a wellness initiative, Take Care of Your Health, in which faculty who complete a WebMD wellness profile and get a preventative physical exam and biometric screening are rewarded $100 each year they complete it (Take Care of Your Health Initiative, 2015). Through an initiative, Walking Works, faculty of the Hershey Medical Center and the Penn State College of Medicine can compete to take the most steps (Walking Works returns to medical center campus next month, 2006). Combining Walking Works with Take Care of Your Health, Penn State could develop a program for all campuses in which teams of faculty, and even students, could compete to take the most steps and spend as little time seated as possible. Top teams could be given modest prizes. Deliberate programs such as these could encourage students and faculty to sit for shorter periods of time and be more active.

Meanwhile, Penn State could implement a number of other, informal strategies to reduce sedentary time. The campus is under constant renovation, and new buildings could be designed to better accommodate standing or sit-standing behavior. Food courts, especially, could be changed to eliminate buffets, since students can take too much food and spend a long uninterrupted time sitting to eat their meal. Even more simply, the buffets could do away with trays (just as there are no trays in the a la carte area of Redifer), so that students could carry only one or two dishes at once and would need to get up periodically for more food; this strategy could discourage both uninterrupted sitting and overeating. To encourage students to take breaks to move around while studying, Penn State could design a smartphone app that would remind them every half hour to get up for a few minutes and record, using the phone’s pedometer, whether the students did. This information could be used in the aforementioned wellness competition and physical education classes contingent on reducing sitting. During class, professors could have students stand up for two minutes every 25 minutes (once in a 50 minute class, twice in a 75 minute class). Research suggests that elementary school students lose focus when sitting for long periods of time and that in children, adolescents, and even the elderly, aerobic fitness positively correlates with working memory. Moreover, obesity, to which prolonged sitting can lead, is correlated to brain damage (Ratey & Sattelmair, 2012). These informal interventions to break up prolonged sitting may therefore improve students’ health and academic performance.

Concession of the drawbacks of these approaches

Before such initiatives go into effect, Penn State should consider the potential drawbacks. Cost and effort is the foremost tangible obstacle to providing students with the resources to stand in class and while studying. However, the strategies proposed, including selling current furniture, replacing furniture as it wears out, redesigning buildings to be renovated to accommodate standing, designing and selling wearable notebook or laptop harnesses, and raising tuition to cover the unmet costs would enable Penn State to provide standing or sit-stand workstations for students. Another drawback of implementing standing desks is the potential for students to begin standing too much, too soon. Indeed, Krause et al. (2000) show that prolonged standing, while already a risk factor for the development of varicose veins, may lead to atherosclerosis more so than prolonged sitting, at least in those with ischemic heart disease. Clearly, standing all day is not the solution; rather, the consensus among all studies seems to be that prolonged periods of being stationary, rather than specifically sitting or standing, impair health.

Conclusion, and why this matters

A large amount of research shows that prolonged inactivity, especially sitting, leads to a broad range of chronic diseases, including obesity and heart disease, and to a greater risk of death from any cause over time. Moreover, sedentary behavior impairs learning and focus. Schools are now taking notice and piloting programs to encourage students to move more. While elementary school is the ideal time to merge school and physical activity, college is not too late, and students who in college form healthy work habits may carry these habits into the workplace. While research has revealed risks of prolonged sitting, a smaller amount of research suggests that prolonged standing in one position may also be risky; therefore, the goal is not to encourage students to stand for long periods of time, but rather to avoid sitting for long periods of time. Penn State can encourage students by providing furniture—such as the high tables in Atherton and Simmons—at which students can either stand or sit, developing wellness initiatives, educating students on the risks of prolonged inactivity, and a myriad of other strategies. This endeavor will require time, effort, and money, but the short-term cost of investing in students’ health is outweighed by the long-term benefits for students: improved academic performance, health, and lower medical expenses later in life. By habitualizing students to avoid sedentary behavior now, Penn State can give its students longer, more productive, and healthier lives.

 

References

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