In modern society we spend a great deal of time sitting. If we consider the risks and effects that are associated with prolonged sitting there are many well documented problems but how can we mitigate the effects that prolonged sitting has? Sometimes it isn’t possible to create scenarios in which sitting can be avoided.

What does the research say and why does it matter?

According to Raichlen et al. 2020 human physiology is not well adapted to extended periods of sitting. The risk of prolonged sitting is that it can increase the likelihood of cardiovascular complications and overall mortality. The paper identified that we are more adapted to “active rest” which involves greater amounts of muscle activity. The authors suggest that interventions that involve greater muscle activity may help to reduce the health impact that sitting may cause.

Prolonged sitting has been shown time and time again to effect the muscle contractions, neuromuscular control and spinal movement. If we consider Janda’s (2,3) subsystem model deterioration of one those three subsystems can affect the others in a number of ways. The effect that a dysfunctional subsystem can have: 1. Acute compensation, 2. Long term adaptation of another sub-system to accommodate the dysfunction, and/or 3. An injury to one or more components of a subsystem. The human body is extremely adaptable especially in children. It is likely that they will adapt first however the best remedy for sub-system failure is prevention.

Changes to neuromuscular control of the spine especially in flexed position whilst seated was documented by Korakakis et al. 2017 (4). In their paper they identified that prolonged sitting can affect spinal position sense however they documented spinal movement can negate the effects of prolonged sitting. Is was also demonstrated by O’Sullivan et al. 2006 (5)

What happens with attention deficit hyperactivity disorder (ADHD) and developmental coordination disorder (DCD)? A study by Feng et al. 2007 (6) found that almost half of children with ADHD also had motor problems and in particular balance functioning. They put in their paper that coordination should be emphasised when planning care for these patients. To quote the paper “The maintenance and control of posture and balance, whether in static or dynamic conditions, are essential requirements for daily activity”.

It was also found that attention in ADHD individuals reduces when ‘passively resting’. A 2019 article by Rassovsky and Alfassi (7) found that ADHD individuals showed improved cognitive score testing when lightly exercising again indicating ‘active rest’ could provide better outcomes for individuals with ADHD. Abuin-Porras et al. 2018(8) who also found that balance skill may be a contributing factor in Attention-Deficit/hyperactivity disorder.

Dynamic/Active seating has the ability to improve lumbar proprioception in schoolchildren helping to off load the effect prolonged sitting has on neuromuscular control/feedback. Fettweis et al. 2018 (9) found that the children that had dynamic seating had better trunk repositioning than their peers that didn’t have dynamic seating. This paper is particularly interesting as there was random allocation of students not just students with neurodevelopmental disorders.

As balance and coordination are needed across many tasks that we do in everyday life why not start as soon as possible on something as simple as a wobble chair. Coordination appears to improve when vestibular control is more effective. The vestibular system is located in our inner ears and affects our orientation in space. When we develop better feedback from our vestibular system we can notice more subtle changes in our orientation and allow us to better stabilise ourselves (9,10,11).

Implications.

The conclusion from the research appear to indicate that although sitting is an inevitable factor in modern life, the effects of prolonged sitting can be negated by active sitting. Active sitting can improve the ability to sense postural changes in children and most interstingly appears to be low cost and efficient modality to improve cognitive performance and balance control in individuals with attention deficit hyperactivity disorder (ADHD) and developmental coordination disorders (DCD). Active sitting naturally channels excessive energy that children may have naturally have allowing them to offload physical energy whilst focusing on cognitive tasks. Active sitting is not just beneficial for children with ADHD and DCD it also helps to improve balance/coordination with any individual using the chair. This simple intervention has enormous crossover into other tasks we have in day to day life and long term in our development. Simply put could wobble chairs be the way forward for our children and adults alike?!

 By Dr. Michael Perkin

References

1. Raichlen D, Pontzer H, Zderic T, Harris J, Mabulla A, Hamilton M et Sitting, squatting, and the evolutionary biology of human inactivity. Proceedings of the National Academy of Sciences. 2020;117(13):7115-7121. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32152112

2. Panjabi The Stabilizing System of the Spine. Part I. Function, Dysfunction, Adaptation, and Enhancement. Journal of Spinal Disorders. 1992;5(4):383-389. Available from:https://www.ncbi.nlm.nih.gov/pubmed/1490034
3. Cholewicki J, Panjabi M, Khachatryan Stabilizing Function of Trunk Flexor-Extensor Muscles Around a Neutral Spine Posture. Spine. 1997;22(19):2207-2212. Available from:https://www.ncbi.nlm.nih.gov/pubmed/?term=10.1097%2F00007632-199710010-00003
4. Korakakis V, Giakas G, Sideris V, Whiteley R. Repeated end range spinal movement while seated abolishes the proprioceptive deficit induced by prolonged flexed sitting A study assessing the statistical and clinical significance of spinal position sense. Musculoskeletal Science and Practice. 2017;31:9-20. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28624723
5. O’Sullivan P, Dankaerts W, Burnett A, Straker L, Bargon G, Moloney N et al. Lumbopelvic Kinematics and Trunk Muscle Activity During Sitting on Stable and Unstable Journal of Orthopaedic and Sports Physical Therapy. 2006;36(1):19-25. Available from: https://www.ncbi.nlm.nih.gov/pubmed/16494070
6. Feng L, Cheng J, Wang [Motor coordination function of attention deficit hyperactivity disorder (review)]. Beijing Da Xue Xue Bao Yi Xue Ban [Internet]. 2007;39(3):333-336. Available from: https://www.ncbi.nlm.nih.gov/pubmed/17572795
7. Rassovsky Y, Alfassi Attention Improves During Physical Exercise in Individuals With ADHD. Frontiers in Psychology. 2019;9: 2747. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6333702/
8. Abuin-Porras V, Villafañe J, Jiménez-Antona C, Palacios A, Martínez-Pascual B, Rodríguez-Costa I. Relationship between attention and balance: a dual-task condition study in children. Journal of Exercise Rehabilitation. 2018;14(3):349-355. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30018917

9. Fettweis T, Onkelinx M, Schwartz C, Demoulin C, Croisier J, Vanderthommen Influence of a dynamic seating habit on lumbar motor control in schoolchildren. Journal of Back and Musculoskeletal Rehabilitation. 2018;31(2):347-353. Available from:https://www.ncbi.nlm.nih.gov/pubmed/29171979
10. Nakamura J, Shiozaki T, Tsujimoto N, Ikuno K, Okada Y, Shomoto Role of somatosensory and/or vestibular sensory information in subjective postural vertical in healthy adults. Neuroscience Letters. 2020;714:134598. Available from:https://www.ncbi.nlm.nih.gov/pubmed/31678433
11. Smith C, Reynolds Vestibular feedback maintains reaching accuracy during body movement. The Journal of Physiology. 2016;595(4):1339-1349. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27730646