Every move counts: Non-exercise physical activity for cardiovascular health and longevity

Introduction

With the advancement of new technologies, people have found new ways to make their daily activities less intense and more efficient, and as a result, more sedentary. Indeed, these advances have also resulted in higher life expectancy owing to health and medical technology development. Moreover, the stay-at-home during the pandemic has aggravated the outcomes of sedentary behavior. Nowadays, people live longer but not healthier due to higher obesity rates and poorer physical health. Thus, it is important to understand how embedding non-exercise physical activity (NEPA) in daily life is essential for better cardiovascular health and longevity.

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Highlights 

• Every movement matters; any amount of physical activity is better than no movement, and the more, the better
• Studies suggest that physical activities are associated with a decreased risk of cardiovascular diseases and enhanced longevity 
• It is important to integrate Non-Exercise-Physical-Activity (NEPA) into daily life
• Policymakers should find new ways to integrate smart technology into daily life to support physical activity 

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Inactivity — the new activity 

During the second half of the twentieth century, when the electronics and telecommunications revolution started, widespread use of home appliances emerged to increase communication and decrease labor. These home appliances include telephones, washing machines, and vacuum cleaners. Therefore, physical activities like active transport and cleaning, normally conducted as part of a working day or as part of domestic duties, have been diminished due to the integration of these machines and technologies in daily life (1). This shift has decreased NEPA among older and low-income populations, who tend to be physically inactive. In addition to internet development, the change in work environment and communication have virtually immobilized office workers by encouraging them to work remotely after the Covid-19 pandemic severely increased sedentary behavior (2). For example, in Italy, remote workers grew from 8% to 69% amid the Covid-19 pandemic (3). In the USA, data showed an increase in the full workdays supplied from home from 5% before COVID-19 to 20% after (4). This digital transformation also affected the motivation for daily physical activity (5). As people spend more time in front of screens, they are less likely to engage in non-technology-related activities. There is an established correlation between reduced physical activity, including NEPA, and the most serious physical and mental diseases. This issue should be considered by public health advocates, physicians, and wellness coaches as a severe health issue that should be addressed on several fronts. 

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Non-exercise physical activity

NEPA is a term used to describe people's activities that do not involve exercise. It includes things like:

• Standing and walking around at work
• Gardening 
• Walking the pet 
• Doing the dishes 
• Shoveling snow
• Playing with your kids 

These trivial activities that might seem trivial to some people increase non-exercise activity thermogenesis (NEAT), which is the energy expenditure of all physical activities, and everything a person does other than sleeping, eating, or sports-like exercises. Many factors affect NEAT: occupation, the concrete/urban environment, genetic background, age, gender, body composition, etc. (6). In a study by Creasy et al., they measured the calories burned by 74 participants while they sat, stood, or walked. They showed that while standing, the number of calories burned was slightly higher than while sitting by eight calories/hour, which makes 24 calories if a standing desk was used for 3 hours, about the same number of calories as in a cup of cucumber (7). 

The following criteria are important for NEPA: 

• Activities should be done in a standing position. 
• Position relative to gravity should be changed every 30-60 minutes throughout the day.
• The number of changes in position is more important than the duration of the position.

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Importance of NEPA for cardiovascular health and longevity  

Cardiovascular diseases (CVD), including coronary heart disease, congestive heart failure, heart attack, and angina pectoris, are considered to have chronic high mortality rates worldwide. The prevalence of heart disease is on a continuous rise, especially in developing countries (8). Previous studies have proved multiple health and well-being benefits of physical activity and exercise, especially in older adults, by promoting healthy aging, reducing cardiovascular diseases, and shortening life expectancy (9, 10).

In the Honolulu Heart Program, Hakim et al. found a decreased relative risk of developing coronary diseases for those who walk 1.5 miles a day than those who walk <0.25 miles among older men aged 71-93 years and followed through 4 years (11). A cohort study that included 4232 women and men above 60 years in Stockholm city showed a significant decrease in the risk of the first CVD in individuals with higher NEPA levels. It is important to note that there is an evident association between NEPA, cardiovascular health, and longevity (12). This means that if an individual is active, there is a good chance that their lifestyle includes other healthy habits. As a result, this will improve their cardiovascular health and longevity (12). 

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Use of technology to encourage NEPA 

The use of technology in daily life has increased sedentary lifestyles and decreased physical activity. However, many companies have developed innovative solutions incorporating technology into our daily routines to support physical activity. Interactive technology initiatives have a broad range of implications (13). Nowadays, more than 6 billion people use smartphones, where thousands of health and fitness apps can be downloaded and used. It requires proper guidance by referring to guidelines and recommendations through which people can promote positive uses of technology. The use of wearables might be a practical solution to improve NEPA. Wearables are non-invasive gadgets approved by the US Food and Drug Administration. They are equipped with smart sensors that facilitate real-time monitoring that can be used for health management, fitness tracking, rehabilitation,  and diagnosis, which can help in preventing diseases, and promoting healthy, active lifestyles. A few months ago, a study was published assessing the interest in wearable fitness trackers of 1007 adult patients at six Federally Qualified Health Centers wearable fitness trackers between October-December of the year 2020. Despite the barriers of having a wearable device (cost, lack of information, investment), the majority of participants showed interest in having fitness trackers (14). Wearable activity trackers, such as fitness trackers, activity-tracking smartwatches, and pedometers, are affordable and user-friendly (15). For example, these trackers encourage the users to set a daily goal of steps and some start a competition with their friends and family who recorded the highest number of steps in a day. This promotes behavior-change techniques and decreases the pressure of more structured physical activity (16). The use of these devices not only enhance physiological outcomes, such as reduced body mass index, reduced blood pressure, and increased aerobic activity, but also the psychosocial, such as depression and anxiety (17,18). 

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Tips for Decision Makers 

In clinical practice, physicians and wellness coaches must recommend NEPA beyond encouraging regular exercise. Although exercise is a key component of many healthy lifestyles, it should be noted that not all older adults need to exercise vigorously. Some people may need to be more active than others. For example, someone with a severe mobility impairment may not engage in high-intensity exercise. Others may choose not to engage in any activity because they do not want to be perceived as ‘weak’ or ‘unable’. The good news is that there are many ways for people of any age to be physically active without moving around too much. Here are some examples: 

• Walking to work or college  
• Using the stair instead of elevators 
• Going for grocery shopping instead of ordering online 

Government and employers can also take the initiative in encouraging NEPA by creating workplaces that offer suitable opportunities for people to walk around and stretch during working hours. This requires setting interventional action plans and policies. Apple and the government of Singapore have teamed up to create the health initiative LumiHealth, which is a personalized program to encourage healthy and active moving using Apple watch as part of Singapore's Smart Nation Initiative. LumiHealth aims to encourage Singaporeans to manage and increase their activity levels through personalized reminders, programs, and coaching. It even reminds its users to go for their health screening and to improve their sleep habits (19). 

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Conclusion 

Studies have shown that prolonged sedentary time is associated with an increased risk of all-cause mortality, cardiovascular diseases, cancer, and type 2 diabetes regardless of physical activity. Fortunately, increasing movements and reducing sedentary time leads to significant reductions in the occurrence of many diseases. It is important to encourage people to increase their NEPA, for it requires less intensity and has many health and longevity benefits. Hierarchies of evidence prove the effectiveness of technology interventions such as wearables in increasing physical activity and NEPA, and enhancing the mental and physical health of their users. 

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References 

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