Chair today gone tomorrow: why you need to move from your seat to your feet.

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We're a nation that sits. We sit when we eat, when we drive, when we watch TV, when we use the computer, and when we go to movies, ball games, concerts, you name it.

Except for the short intervals when we're waiting in line, shopping, or on our way, say, from the seat in our car to the seat at our desk, we're rarely on our feet. Add those hours of sitting to the hours we're lying down, and that leaves precious little time when we're in motion.

Even those conscientious people who take a brisk 30-minute walk each day are off their feet for most of the remaining 23 1/2 hours. And that's not good for our waistlines, our hearts, or our blood sugar levels.

"The idea is to get out of your chair," says James Levine, a professor of medicine at the Mayo Clinic.

He would know. His office has none.

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Maybe you're planning to go to the gym tonight. Or to take a brisk walk. Or to play some tennis or golf.

But what about the hours until then? While you're sitting at your desk, in your car, or in front of your computer, your body may be busy building and filling fat cells you don't want.

Exercise--physical activity that's designed to keep you fit--is unquestionably good for you. But for many of us, it's not enough.

Q: What has your research found about obesity?

A: We asked the question: How can it be that some people in this obesity-prone society remain thin?

So we took lean and obese people who were self-professed couch potatoes, none of whom went to the gym. And we overfed all of them by 1,000 calories a day above their weight maintenance needs. If you needed 2,300 calories a day to keep your weight stable, you'd get 3,300 calories.

That was done for eight weeks. And we meticulously examined where that excess fuel went on the bodies of these people.

Q: How?

A: We fitted out people in these magical underwear, which monitored every movement and every posture of the body. So if someone was sitting down or rolling around in bed, we got it.

And we found that those people who can somehow switch on their NEAT don't gain fat when they're overfed. Those people who don't turn on their NEAT literally gain 10 times more fat than the others. So it became self-evident that NEAT was crucially important in human weight gain.

Q: What is NEAT?

A: It stands for non-exercise activity thermogenesis. The dictionary defines exercise as bodily exertion for the sake of developing and maintaining physical fitness. NEAT is any other movement--everything from walking, talking, and toe-tapping to playing guitar, dancing, and shopping.

Q: So some people moved less?

A: Yes. We found that people with obesity are profoundly more sedentary than people who are lean. They move 2 1/2 hours less per day than lean people. That means they burn roughly 350 fewer calories a day.

People with obesity respond more to the chair-based environment. People who are lean have a greater propensity for finding those opportunities to move around, as their bodies are designed to do.

Q: What kind of movement did they do?

A: Predominantly ambulation. I use that word as opposed to walking not just to sound like a scientist. When you use the word walking, people inevitably think of putting on one's white sneakers and throwing one's arms backwards and forwards and walking around in some terribly fast, purposeful pace.

So I use the word ambulation to exemplify the idea of ambling around or getting up to speak to somebody. That sort of day-long walking appears to be the crucial discriminator between the lean and the obese.

Q: Did most of these people have office jobs?

A: That is correct. We actually matched the lean and obese people for the nature of their jobs. It was a small study, but they were remarkably representative of normal people.

Most people really do work in offices and drive to work and drive home and watch TV in the evening, and those are the type of people we studied. If you watch TV, you burn only 5 calories an hour above your resting metabolic rate. After four hours, you've burned only 20 extra calories.

Q: Anything is better than sitting?

A: Right. We're talking about getting up in the evening and making dinner. And then, instead of spending the entire evening watching TV, you might say "My favorite program is on at 7, so before then, I'm going to put on my iPod or MP3 player and go for a walk or paint my bedroom or take care of the weeds growing in the yard."

Q: And we also need to move at work?

A: Absolutely right. We need to integrate walking into our work and daily living. I'm talking to you now from a treadmill and I'm not being remarkably less coherent than I would be if I were sitting down.

Q: Do you answer many calls while on the treadmill?

A: I answer them all on the treadmill. I actually don't have any chairs in my office at all. I can just as easily respond to e-mails or use my computer walking on the treadmill as sitting down.

Q: Is there anything you can't do on the treadmill?

A: You can't sleep, which was a typical thing to do at this time in the afternoon in my prior life.

Q: So you limit the time that you're sedentary?

A: Yes. It's the notion of motion. And not necessarily on a treadmill. I'll switch off the treadmill now and talk to you from a $50 stepping device.

There's no reason why people can't hold one-on-one meetings while walking. There's no reason why you can't cook with your kids--standing around the kitchen table chopping things--rather than buying packets of stuff and shoving them in the microwave. There's no reason you can't choose activities for yourself or your family on the weekends as opposed to watching TV.

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Q: So it's not enough to fidget or just move in your chair?

A: I'm not a big fan of encouraging people to twiddle their hair or flick rubber bands while they're in their chairs. I say get out of your chairs and simply pace while on the telephone. Just fidgeting is a lost opportunity. It's a waste.

Q: You want people to walk down the hall to talk rather than send an e-mail and stand up every time the phone rings?

A: Yes. I train them to respond to a phone call by getting up. I literally get people to mark it off on a little pad. If you do it for 21 days, you'll get trained.

Q: Does sitting all day lead to more than obesity?

A: If you're going to sit around all day, your blood glucose and triglycerides are going to be riding high, you gain visceral fat, and you get insulin insensitivity. The link isn't proven, but it's reasonably good.

Q: Are you saying that people shouldn't exercise?

A: Absolutely not. When people say they're going to the gym, I say that's fantastic. I love it when people go to the gym. The trouble is that most people don't like going to the gym and don't go even if they do like it.

Q: What percent of a person's daily energy expenditure comes from nonexercise moving around?

A: If you look at an average sedentary person, 60 percent of total daily energy expenditure is basal metabolic rate, 30 percent is NEAT, and 10 percent is the thermal effect of food--the calories you burn to digest, absorb, and store the food you eat.

You can push NEAT to 40 percent if you're moderately active, and 50 percent if you're an agriculturalist, like a farmer from 150 years ago. But NEAT is 30 percent of the calories expended by most people. And you get down to 10 or 20 percent if you literally spend the day in bed.

Q: So NEAT is one of the few things you can change?

A: Yes. You can't change your basal metabolic rate. That's the calories you burn at rest to keep your heart, lungs, brain, liver, and other organs going.

It's very much like your mortgage, though perhaps one shouldn't say this in the subprime mortgage era. We all have some fixed large monthly payments that we can't change much. That's your basal metabolic rate. Then we have the expenses associated with the day-to-day running of our lives. That's getting our meals together or putting on the wash--the basics. They don't use many calories because we don't put that much time into them. They're pretty fixed, but they're pretty small.

Q: So NEAT and exercise are disposable income?

A: Yes. It's the rest--the money that's ours to spend. If you fortuitously get a pay raise, what do you do with that extra? Some people spend it and some save it.

So if you don't spend any extra calories as NEAT or exercise, they have to go into savings, right? And the savings are body fat. Lean people store at least two to three months of their calorie needs in fat, while obese people can carry around a year's worth of calories.

Q: So savings are good for money but not for fat?

A: Yes. I say to my patients, "I recommend that you save excess cash but dissipate excess calories."

Q: Does NEAT burn more calories than exercise?

A: Not for athletes. Cyclists in the Tour de France expend 5,000 calories a day. But for nearly everybody else, yes.

Think about somebody who goes to the gym three times a week. It takes 15 minutes to get there, 10 minutes to change, and 30 minutes sweating on the bike to burn 100 calories. Then you've got to shower, do your hair, and get back in the car to return to whence you came.

So let's say you've burned 120 calories for all of that and you do it three times a week. That's 360 calories a week divided by seven, or about 50 calories a day.

Q: Do you burn more than that at work?

A: Yes. If I switch back on the treadmill here in my office and spend an hour walking, I've expended an extra 100 calories. I'm walking at 1 mile an hour--that's a slow walking pace. There's a chap outside my office now reading a manuscript walking around the corridor at 1 mile an hour, so he's expending an extra 100 calories an hour.

And we haven't broken a sweat or left the office. You can get fit and active and healthy and never leave the office, so everyone wins.

Q: But doesn't the gym offer other benefits? To the heart, for example?

A: Correct. However, I sent a patient to sports medicine for rehabilitation and she came back a bit despondent. She was battling with weight issues and she said, "I'm doing this pulse-checking thing and I don't even get halfway there because my knees are hurting too much."

Q: So some people just give up?

A: Yes. Many of my patients with diabetes get exhausted walking. They have very low lactate thresholds. So when they're walking at about 2 1/2 miles an hour or less, they're experiencing that same feeling of utter exhaustion that a sprinter experiences after 100 meters. They are literally panting. So having them check their pulse is discouraging.

What I tell patients is how long to walk. I don't care how fast you walk. Listen to music, take a buddy, even your spouse, though it's become unfashionable to talk to one's spouse these days without the presence of a psychotherapist. Share a headphone with your spouse. You get the idea.

Q: Are some people naturally more active?

A: Yes. I call it the "NEAT beat." Some people have that slow-pulsing NEAT beat, where their natural tendency is to have a slow, gentle movement. Other people have a frenetic rock beat to them, where they're always moving around.

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Q: You've speculated that early in human evolution, both beats could have been a response to famine.

A: Yes. One response was for humans to search for food beyond their boundaries, which increases NEAT. An alternate response might have been to stop moving to conserve fuel and body fat stores, which decreases NEAT.

Of course, no one's got the data on NEAT over multiple centuries, so it's all hypothetical. But there is quite good fossil evidence from famine-based areas that people did start to roam. And there is evidence that people built sophisticated shelters when they walked across the land bridge from Asia to the Americas.

Q: And now our environment is drastically different?

A: Yes. The human body evolved over a million years, but the car-computer-chair-elevator-television-based world has evolved in less than a century. So you're imposing a massive environmental smush on a very old biology. No wonder it all goes haywire.

Q: And it's gotten worse in the last 20 years?

A: Yes, and so have obesity figures. People don't realize that 150 years ago--which is a speck of time--90 percent of the world's population were agriculturists. Now half the people in developed countries work behind a computer.

We don't realize the magnitude of the shift--of this tectonic plate shift--in human existence because it exceeds a generation. Most of us can't remember anyone who's an agriculturist. We haven't seen this sort of massive change that occurred very quickly because it's not within our time frame.

Q: And what you call sedentary cues encourage us to sit?

A: Yes, we're sedentary everywhere. We use cars, remote controls, lawn mowers and snow blowers that you ride on, the drive-thru, elevators, Game Boys, dishwashers. The other week in the airport in Toronto, I saw a little toy model car for kids who were waiting for an airplane. And you go inside the car and there's a computer showing cartoons. So you've got this kid who would otherwise be tearing around the waiting area before he or she sits on a plane, now sitting and watching cartoons while waiting. That's what we've become.

Q: And we're not aware of the cues?

A: Right. One of the great examples is the comfort of chairs. I remember as a young kid sitting on those orange plastic chairs. And you're sort of shuffling around on your bottom. They were implicitly uncomfortable. But I went to a seminar at the Mayo Clinic in a fantastic auditorium with seats that you can sink into and never get out of. Movie theatre chairs are even more comfortable now.

The cues are there--the cubicle, the car, that people live in suburbs and drive into the city as opposed to living in walkable cities like Manhattan. It's so overwhelming that of course we don't notice it. Our natural form has been crushed into the chair.

Q: Can people change?

A: Yes. It's within our power to use all this technology to move more. But we need to look at it differently. That's why I come to work every day. It's very exciting. This isn't an anti-technology, Luddite mission here. This is the new technology. Let's use it to become healthy.

Q: Chewing gum bums about 10 extra calories per hour. Should dieters chew gum?

A: We found that chewing wads of gum uses calories, but we never said that people should chew gum to lose weight. The point was that any movement--even chewing--burns calories.

But those calories are nothing corn pared with getting up on your legs and walking. As soon as you're up and walking at that 1 mile an hour, you're doubling your metabolic rate.

Q: What is your current research?

A: First of all, we're intensively examining the underlying biology--that underlying pulse of activity that seems to drive people in a subtle way. At the other end of the spectrum, we're asking: if this sedentariness is so ubiquitous, what can be done to reverse it?

So we've spent a lot of time working on hardcore practical solutions to get people up and walking around during the day. Not necessarily going to the gym, which is great, but finding new styles of offices, new types of schools, and working with the furniture industry to design the furnishings necessary to pull this off.

Q: To help people beyond the Mayo Clinic?

A: Yes. Mayo wants us to package what we're doing so it can go into real offices, real schools, across America and beyond.

We want hardcore solutions to render people more active. We want to reach out to 50 million people--that isn't a frivolous number--and in so doing, shift the population body weight bell-shaped curve to the left. If you do that, you dramatically reduce the number of people vulnerable to diabetes, hypertension, high cholesterol, and so on.

Q: You'll get businesses to make these programs available to employees?

A: Yes. The key notion is to not only demonstrate that these interventions don't hurt productivity, but that they're cost effective. Whether you're self-insured or insured by a company like Blue Cross Blue Shield, people are experiencing increases in insurance rates in the double digits. Companies are not even looking at reductions in health care costs. They're just trying to stop the rate of increase.

Q: Do you want corporations to get rid of their chairs?

A: You're talking about my fantasy. Offices will become these exciting, dynamic, moving environments within the next 10 to 20 years. I'm absolutely sure of it. But let's move back into reality.

The intermediary stage is to provide people the opportunity and the support to burn more calories, become healthier, brighter, lose weight, have less back pain, and so on.

Q: How?

A: In the most expansive project we're doing, we'll move in 20 to 40 walking workstations and scatter them over the office space. So when you want to do a few hours of NEAT, it's there.

We lay down walk-and-meet tracks using carpet tape so when you want to have a meeting, the normal way is walk and talk. We encourage people to do walk-and-talk meetings by scheduling them in their computer calendars using color coding.

We also provide nutritional advice and guidelines based on calorie needs if they want to lose weight, and do composition analysis so people can measure their body fat.

Q: How will you know if people are moving more?

A: We use electronic monitoring with a physical activity detector we call The Groove. These devices enable people to see how they're doing. And we bring in movologists who train people to increase their physical activity during the day, and to take it home with them.

The basic concept is to take the laboratory and place it in the office. And it's fascinating because it actually can be done. Best Buy, Wal-Mart, and Trane, an air conditioning company, have or are about to sign on.

In a way, it's a technological revolution, but it's using technology for health. And I think we can do it.

Not Just NEAT

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NEAT--walking, shopping, or other movement not meant as exercise--matters more than most people realize. But it's not the whole ball game. When restaurants are serving 500-calorie coffees, 500-calorie muffins, and 600-calorie tuna sandwiches, and when almost every Chinese, Italian, Mexican, or other entree has at least 1,000 calories, you can't forget about the food side of the equation.

And you can't forget about the benefits of moving more than 1 mile an hour. Studies show that people who walk briskly (about 3 miles an hour) for at least 30 minutes a day have a lower risk of heart disease, diabetes, stroke, and colon cancer.

Exercise also boosts the immune system and may help prevent dementia and depression. And strength training can prevent bone and muscle loss. That's not too shabby.

James Levine is an endocrinologist and professor of medicine in the Division of Endocrinology, Diabetes, Metabolism, and Nutrition at the Mayo Clinic in Rochester, Minnesota, where he heads the NEAT lab. He spoke with Nutrition Action's Bonnie Liebman from Rochester.