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Is prolonged sitting really as bad as smoking?

Is sitting really as bad as smoking?

Key Points

  • Despite the media hype, prolonged sitting is not even close to being as bad as smoking
  • Prolonged sitting does increase your risk of all-cause mortality (the rate of any attributable death), cardiovascular disease, and all-cause cancers, but not to the same extent as smoking
  • However, prolonged sitting significantly increases your risk of developing Type 2 diabetes (and is slightly worse than heavy smoking in this regard)
  • Ideally, you should get up and walk for 5 minutes every 30 minutes as this has been shown to lower blood pressure and decrease blood glucose spikes after eating
  • Performing a Bruegger’s posture, either standing or seated, can help ease the neck and back pain often associated with prolonged sitting.

In a bit more detail.

We’ve all heard the media stories that sitting is the new smoking, but is this true?  And, if sitting is unavoidable in our job or lifestyle, what can we do to minimise the harm?

Is sitting as bad as smoking?

Generally speaking: No, not even close!

When you consider all-cause mortality (the rate of any attributable death), cardiovascular disease, all-cause cancers, and the rate of occurrence of lung cancer, smoking is not just a little bit worse than sitting, it’s a lot worse.  The only exception is that prolonged sitting does increase your chance of getting Type 2 diabetes slightly more than heavy smoking (Vallance et al., 2018).

So, if it’s not so bad, does that mean we shouldn’t do anything about it?

Well, prolonged sitting, while not as bad as smoking, is still bad. It significantly increases the risk of everything noted above, just not as much as smoking does, and, it almost doubles your likelihood of developing Type 2 diabetes (Vallance et al., 2018).  Also, as previously discussed in my blog on ergonomic workstation setup, it’s also not great for your posture (especially your neck and lower back).

Firstly, what is excessive sitting?

While studies are yet to exactly define this, 6-7 hours or more of sitting per day significantly increases your risk of everything mentioned above.  Further, more than 5 hours of watching TV per day and less than 1 hour of physical activity per week appears to double your risk of developing Type 2 diabetes (Biswas et al., 2015).

So, what can we do about it?

One study found that the largest improvements to blood pressure and blood glucose levels happened when you got up every 30 minutes and walked for 5 minutes, and this had a bigger impact than walking for an hour per day – although this was still better than not walking at all (Duran et al., 2023).  To put this into a practical context, a recent medical journal suggested that GPs should greet each person by walking to the waiting room as one way to break up prolonged sitting (Baddeley et al., 2016).

What about your posture?

Your ligaments and tendons are meant to shorten and stretch (in fact, it’s referred to as the stretch-shorten cycle).  However, they don’t like being on stretch for periods of 20 minutes or more as a phenomenon called ligamentous creep starts to occur (think of an overstretched rubber band), and this is thought to be part of the process in neck and back pain (Steilen et al., 2014).  In addition to getting up and moving, postural correction exercises such as the Bruegger’s posture has shown to be helpful to combat the effects of prolonged sitting (Gurudut et al., 2020).

Bruegger’s posture

Assume the anatomical position above, you can do a seated version of this – just try and ‘sit tall’.

  • Slightly tuck your chin but keep your neck ‘long’
  • Roll your shoulders down and back
  • Keep your arms straight and have your palms facing forward
  • Try and breathe into your belly

The purpose of this posture is to gently put your neck, back and shoulders into an ‘extension’ posture (to reverse the excessive flexion that we generally are in when we are sitting).


Baddeley, B., Sornalingam, S., & Cooper, M. (2016). Out of Hours Sitting is the new smoking: Where do we stand? British Journal of General Practice, 66(646), 258.

Biswas, A., Oh, P. I., Faulkner, G. E., Bajaj, R. R., Silver, M. A., Mitchell, M. S., & Alter, D. A. (2015). Sedentary time and its association with risk for disease incidence, mortality, and hospitalization in adults a systematic review and meta-analysis. Annals of Internal Medicine, 162(2), 123–132.

Duran, A. T., Friel, C. P., Serafini, M. A., Ensari, I., Cheung, Y. K., & Diaz, K. M. (2023). Breaking Up Prolonged Sitting to Improve Cardiometabolic Risk: Dose-Response Analysis of a Randomized Crossover Trial. Medicine and Science in Sports and Exercise, 55(5), 847–855.

Gurudut, P., Welling, A., & Chodankar, A. (2020). Effect of self- care exercises in forward head posture on craniovertebral angle and craniocervical flexion endurance: A pilot study. Indian Journal of Physical Therapy and Research, 2(1), 25.

Steilen, D., Hauser, R., Woldin, B., & Sawyer, S. (2014). Chronic Neck Pain: Making the Connection Between Capsular Ligament Laxity and Cervical Instability. The Open Orthopaedics Journal, 8(1), 326–345.

Vallance, J. K., Gardiner, P. A., Lynch, B. M., D’Silva, A., Boyle, T., Taylor, L. M., Johnson, S. T., Buman, M. P., & Owen, N. (2018). Evaluating the evidence on sitting, smoking, and health: Is sitting really the new smoking? American Journal of Public Health, 108(11), 1478–1482.