Eminent NHS physician and health policy influencer Sir Muir Gray is on a crusade to get people to work standing up instead of sitting down to improve their health. He himself is in his 70s and works in his north Oxford home at a standing desk.
Professor Sir Muir Gray offers practical advice on how to fit walking and standing into our daily lives
By Olivia Gordon
Sir Muir Gray is doing this interview standing up. He has trained himself no longer to automatically search for a seat when entering a room. Instead the leading medical professor who has spent decades guiding the NHS in disease prevention works standing up in his north Oxford home and Summertown office, and talks to me in his office’s hallway where there are no chairs.
The man who believes ‘sitting is the new smoking’ looks at the world differently from most people. Most people think older people should be offered seats on trains. Gray thinks that the older you are, the more you should stand. From his perspective, not getting a seat on public transport is lucky, as is having to queue, or not finding a parking space near where you want to be – these situations force us to stand up and use our bodies. The worst thing a person can do for their health, he says, is to spend their life sitting down.
The humorous Glaswegian, once described by the former chief medical officer Liam Donaldson as ‘undoubtedly one of the most creative minds in British medicine’, has been instrumental in shaping NHS health strategies for ageing, cancer screening and smoking cessation, and helped create NHS Choices and the National Library for Health; he is the chief knowledge officer of the NHS. Now the honorary professor based at Oxford’s Nuffield department of Primary Care Health Sciences is on a crusade to warn people of the lethal dangers of sitting. He believes the NHS will in the future look back on early 21st century Western sedentary culture as a public health disaster.
‘We now live in a very dangerous environment, for three reasons: the car, the desk job, and the Internet,’ he says. ‘We’ve got a Neanderthal body in a post-Neanderthal world. In the last 50 years we’ve seen medical miracles but our environment is as harmful as it was in the 19th century. We’re waking up now to the public health danger of the environment we live in and the need to build more energy expenditure into daily life. The evidence is very clear.’Students hard at work at St Antony's College's library in north Oxford
The need to stand up rather then sit sounds obvious, but most people in Britain spend most of their waking lives sitting down. Sir Gray has long been among doctors advising the benefits of walking for health (his 2009 book, Dr. Gray’s Walking Cure, advises taking 3000 extra steps or 30 minutes’ extra walking daily). But the latest advice is not only to walk more, but to stand more. Over recent years, Sir Gray explains, research on the dangers of sitting has grown exponentially. One of his bibles, the 2014 book Get up! Why your chair is killing you and what you can do about it, by American obesity scientist James Levine, says that sitting is actually ‘worse than smoking’ for health.
Levine’s revolutionary book explains that what makes people fat and unhealthy in body and mind is not so much how many calories they eat or how often they do a gym workout (which doesn’t burn that many calories), but how much time they spend standing up and moving in the course of everyday life – that is how hundreds or even thousands of daily calories can be burned. After all, slimmer people in the past ate more calories than we do today, but they spent their lives on their feet. The difference between lean and obese people, Levine’s research found, is that obese people sit for two hours, 15 minutes a day longer than lean people. The benefits are obvious - standing doubles your calorie expenditure. We burn one calorie a minute sitting, two calories standing, four walking. Many of us these days spend hours a day at a desk, as pictured here at Oxford's Taylor Institute Library, but Gray recommends walking or standing as much as possible
As a result, Gray not only walks and cycles as much as possible but usually now stands for about a quarter of his working hours, or half an hour every two hours, which, he says, is the minimum to aim for. If he has sat at a desk for 30 minutes, he gets up and does Pilates-style stretches for a few minutes – though he says even just walking to the printer or to get a drink will do. The standing desk is becoming more mainstream as companies have picked up on medical advice, but Gray says a makeshift one will do – putting the computer on a couple of boxes so that hands are at right angles is what he does.
If he needs to talk on the phone, he does it while walking. In London he gets off the tube stops two stops early and in Oxford instead of driving to work he walks to the bus stop and gets the bus to build in more steps, or he cycles. He aims to do work meetings while walking and instead of seeking a seat on the train to London he finds the buffet car and stands there with his laptop resting on the bar. At 72, Sir Gray is lithe, with an enviable body mass index of 19.
‘The older you get the more you’ve got to do,’ he stresses. ‘Older workers should be up more than younger workers. Ageing by itself isn’t a big problem – look at the Queen or David Attenborough, still working at 90.’ In the early 1980s, Sir Gray posited the idea of the ‘fitness gap’ – the difference between the best possible rate of physical decline we all experience after middle age and the far worse decline most people experience because of lack of fitness. His 2015 book Sod 70! made clear that unfitness and ill health need not be inevitable in one’s seventies.
And sitting down, he notes, doesn’t just make you fat and miserable, but also causes disease. ‘Some disease is bad luck and there are genetic factors but the rest is environmental – heart disease, stroke, type 2 diabetes…it’s the way we live.’ He explains that our bodies’ inbuilt stress reactions are designed to help us in active situations (like fighting for berries or running from wild animals) but when we’re sitting in an office feeling stressed, the body responds with inflammation, and ‘inflammation is thought to be the cause of many diseases – type 2 diabetes, dementia, vascular disease – most common problems.’
Homeworking, says Sir Gray, is the most dangerous work lifestyle because it demands so little activity. ‘Then taking your car to work - you walk from door to car. Then public transport – people like me have to avoid the eyes of young people and say I don’t want a seat. You’re luckiest if you can walk or cycle to work but not many can do that.’
Increasingly we are seeing schools and businesses bring standing desks and exercise equipment into the classroom. And university life will change, too. Gray has asked the Bodleian to introduce more standing lecterns for reading – he thinks the academic lifestyle spent sitting hunched over a book or screen needs to return to the ways of the past, when scholars routinely read and wrote standing up.
‘Most academics,’ he wrote to the Bodleian, ‘suffer from…Hyper Sitting Syndrome, spending at least eight hours a day sitting, and often more. Standing may not seem a great form of exercise but if someone who sat eight hours a day even stood two hours a day, the net effect is equivalent to running six marathons a year. It may be that the construction industry is now safer than the academic industry because academics have to spend so much of their time in that dangerous activity of sitting…What is needed is to make lecterns available in the Bodleian and I would be pleased to lead a sponsored walk to raise funds for their purchase.’
Gray has just finished a new book on health for people in middle age, including the need to walk and stand, which will be published in December.
(This article was written standing up)
Images: Oxford University Images, Avalon, BBC