Sitting: A Modern SIB for BCBAs and Their Clients

By Nick Green M.S., BCBA

Guest Author

Ahh…the life of the modern-day Board Certified Behavior Analyst (BCBA): training RBTs, writing behavior plans, and cracking the (ever-changing) insurance code. BCBA certifications are at an all-time high, with more and more individuals receiving the services they need every day.

However, as you, the behavior analyst, go about your day-to-day activities, you are indirectly putting your own health at risk. While you reduce self-injurious behavior (SIB) for clients, you may also be engaging in your own form of self-injury without even knowing about it!

What am I talking about! Excessive sitting!

(A quick aside…self-injury or self-harm have varied definitions (Yates, 2004). Here, I use the term loosely to describe both direct and indirect consequences of prolonged sitting, or sedentary behavior)

First, A Quick Lesson About Evolution & Our Bodies

Our bodies evolved to move. Changes in our spine, hips, and musculature allow us to stand up and move forward efficiently (Lieberman, 2014). Anything we do (especially sitting) that goes against evolution, or what our bodies have been meticulously designed to do, creates havoc for us in the modern world (e.g., low back pain, chronic disease, metabolic issues – more on that below).

We live in a time of amazing technology, yet our bodies are not adapted for these changes (i.e., sitting in chairs all day). We spend the majority our days in the office, with over 80% of our time spent sedentary (Parry & Straker, 2013). Whether you are a BCBA writing reports or an administrator calling insurance companies, much of your day is spent sitting at a computer.

Let’s not forget about our children either! While physical activity levels may vary in human service settings (e.g., ABA clinics), typical school children spend 6-8 hours per day sitting in desks at school (Pate, Mitchell, Byun, & Dowda, 2011).

Sitting as Self-Injury

First, let’s visit SIB. When we typically assess and treat SIB, the goal is to reduce a behavior with a known, undesired consequence. Many consequences of SIB are immediate: swollen skin, bleeding, and a risk of broken bones (depending on topography). Some consequences are delayed such as a brain damage.

We can agree that reducing SIB is a good idea considering its potential health consequences. SIB compromises the future health and well-being of our clients.

What about other behaviors with known consequences? Enter sitting as SIB.

Sitting consequences are both immediate and delayed. Thus, behavior change related to sitting has the potential to impact our health in both ways.

Research regarding the immediate and delayed consequences of excessive sitting have accumulated over the past 10 years. This body of research has led to the popular phrase “sitting is the new smoking” which have allowed standing desk sales to skyrocket. (And yes, I have a standing desk at home…and at school).

So, what’s the big deal about sitting?

Indirect Consequences of Sitting: The Long-Term Problem

Up until this point, you may be thinking, “I exercise every day, isn’t that good enough”? Well, not so fast.

Sitting (or technically sedentary behavior) is an independent risk factor, outside of regular exercise, for various health problems such as cardiovascular disease, obesity, and increased risk of various cancers, and diabetes (van der Ploeg et al., 2012; Biswas et al., 2015). Put simply, the more you sit, the more you are at risk for these health problems, even if you maintain a regular workout regimen! In this sense, sitting is self-injurious as it increases the probability of known undesired health outcomes (just like repeated SIB, although the severity may be debatable).

Again, exercise does not protect against a day of working at our desks all day. Regular exercise is an important variable needed to maintain a healthy lifestyle, but not the only one!

Reading in between the lines, studies from sedentary behavior research present two alternatives. You can get healthier, by either:

• increasing total exercise time, or
• reducing total sitting time.

Of course, if you want the maximize your health outcomes in the long-term, you need to exercise AND reduce sitting time.

With low-adherence to exercise guidelines (about 20% of U.S. adults), reducing total sitting time may be the best prescription for inactive populations.

Direct Consequences of Sitting: Short-Term Problems

Outside of the long-term risks associated with too much sitting, here are a few short-term issues:

1. Reduced circulation – sitting in chairs puts extra pressure on your legs, making them feel “asleep”; poor blood flow is associated with increased risk of cardiovascular disease (Thosar, 2015); think negative reinforcement when you make your legs “wake up”
2. Impaired metabolism – sitting down is associated with poorer blood profiles such as with increased triglycerides (fats) and blood glucose (sugar) levels (Dunstan et al., 2012, Healy et al., 2008); regular movement can influence these important blood markers.
3. Postural issues – unless we have perfect ergonomic desks, we are likely put unnecessary pain on our low back and neck; standing and walking are common solutions to reduce back pain for desk workers (Sheahan, Diesbourg, & Fischer, 2016); negative reinforcement again, movement is often motivated by pain reduction.
4. Reduced oxygen to the brain – sitting down reduces the space that our diaphragm (our breathing muscle) can expand and contract. Reduced space means that we cannot breathe as well, delivering less oxygen to our bodies (Szczygieł, Zielonka, Mętel, & Golec, 2017). Loosely speaking, we are not as “sharp”…suggesting that we can literally think better on our feet.

What To Do About Sitting: Expert Recommendations

Fortunately, sedentary behavior experts have recommended that we combat too much sitting in one of two ways:

1. Reduce total sitting time by 2 hours, working up to 4 hours
2. Break the sitting pattern every 30 minutes

Tackling sitting with Antecedent Manipulations

Education – an important first step to increasing physical activity levels. Before we can act, we should be educated about an issue’s risks and benefits (e.g., this blog)

Environmental Manipulations – changing the built environment is essential to many health behaviors. Want more children to play on the playground? Install playground equipment. In the context of sitting, the simplest and most popular environmental change: standing desks. Standing and bar-height tables evoke…standing behavior! Remove chairs from a room and people will likely sit less.

Having a standing desk tackles recommendation 1; reducing total sitting time. There are plenty of do-it-yourself solutions out there or you can see other examples at The Standing Initiative.

Prompting – we often get busy and time flies, enter timers and reminders. If you have a Fitbit or Apple Watch, then you might already use the prompts that came with it. That’s great! Setting regular timers every 30 minutes may help you get into a regular movement routine. However, my early research indicated that (vibration) prompts alone were ineffective at reducing sedentary activity (Green, Sigurdsson, & Wilder, 2016).

Tackling sitting with Consequence Manipulations

Create Meaningful Work Opportunities – assuming you have a good relationship with your fellow coworkers, how about going to ask a question face-to-face instead of sending a text or an email? What tasks can be completed when paired with physical activity? Can certain meetings be walking meetings?

Monitoring Delayed Health Outcomes – the problem with healthy behavior change programs is that improvement in physical health are often delayed. It takes a long time to lose weight and get strong (when done right). When it comes to increasing movement throughout the day, health benefits related to sitting less may take longer to notice. Are there certain aches and pains that you can monitor over the next 3 months when you begin to move more?

Feedback and Goal Setting – my research (manuscripts in prep) following Green, Sigurdsson, & Wilder (2016) indicate that simple measurement and email feedback can be effective for some sedentary office workers. We all know the value of measurement, but what can you track as it relates to physical inactivity in the workplace? Total steps? Total sitting time? Number of trips down the hallway?

Application for the modern practitioner: BCBAs, Autism, and Sedentary Behavior

A recent meta-analysis analyzed certain risk factors associated between Autism Spectrum Disorder (ASD) and sedentary behavior. ASD individuals are more overweight and obese. They also participated less in physical activity compared to their peers (McCoy, Jakicic, & Gibbs, 2016). These data are concerning given the characteristics of many ABA treatment contexts: sedentary tasks (e.g., worksheets, sorting, discrete trials) and sedentary reinforcers (e.g., iPad, computer games, consuming edibles seated at a table).

These findings related to physical activity are somewhat intuitive. Engaging in exercise by yourself or with peers often require higher level social skills, rule-governed behavior, and the ability to perform complex motor patterns (e.g., hopscotch, shooting a basketball). Those individuals with fewer skills in their repertoires will likely have a difficult time contacting “natural” reinforcers (e.g., making a basket, social recognition).

How should a behavior analyst address sedentary behavior with their clients?

Try the following:

• Program regular movement in their schedule – avoid long sessions of seated table work.
• Program regular exercise – kids need 60 minutes of play every day!
• Replace sitting work with standing work – do you have to sort while seated? can someone read their homework while standing and walking?

Take Home Points on Sitting

Sitting is necessary because it gives our legs a break. However, the real harm occurs when sitting exceeds 45 minutes or more at a stretch, and these long bouts accumulate throughout the day. Standing more at work does seem odd, but the evidence I mentioned above paints a clear picture: we cannot afford to sit all day!

Decades of sitting behavior has been reinforced. Now, we must reinforce more standing and regular movement to create healthy environments for ourselves and our clients. Creating a movement-rich culture is a near imperative. Take small steps and evaluate how the environment can support healthy behavior changes.

Keep moving my friends.

How are you working to promote active lifestyles?  Let us know in the comments below, and be sure to subscribe to bSci21 via email to receive the latest articles directly to your inbox!

References

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 of sedentary time and disease incidence, mortality, and hospitalization. Annals of internal medicine, 162(2), 123-132.

Dunstan, D. W., Kingwell, B. A., Larsen, R., Healy, G. N., Cerin, E., Hamilton, M. T., … & Owen, N. (2012). Breaking up prolonged sitting reduces postprandial glucose and insulin responses. Diabetes care, 35(5), 976-983.

Green, N., Sigurdsson, S., & Wilder, D. A. (2016). Decreasing bouts of prolonged sitting among office workers. Journal of applied behavior analysis, 49(3), 717-722.

Healy, G. N., Dunstan, D. W., Salmon, J., Cerin, E., Shaw, J. E., Zimmet, P. Z., & Owen, N. (2008). Breaks in sedentary time. Diabetes care, 31(4), 661-666.

Lieberman, D. (2014). The story of the human body: evolution, health, and disease. Vintage Books.

McCoy, S. M., Jakicic, J. M., & Gibbs, B. B. (2016). Comparison of obesity, physical activity, and sedentary behaviors between adolescents with autism spectrum disorders and without. Journal of autism and developmental disorders, 46(7), 2317-2326.

Parry, S., & Straker, L. (2013). The contribution of office work to sedentary behaviour associated risk. BMC public health, 13(1), 296.

Pate, R. R., Mitchell, J. A., Byun, W., & Dowda, M. (2011). Sedentary behaviour in youth. British journal of sports medicine, 45(11), 906-913.

Sheahan, P. J., Diesbourg, T. L., & Fischer, S. L. (2016). The effect of rest break schedule on acute low back pain development in pain and non-pain developers during seated work. Applied ergonomics, 53, 64-70.

Szczygieł, E., Zielonka, K., Mętel, S., & Golec, J. (2017). Musculo-skeletal and pulmonary effects of sitting position–a systematic review. Annals of Agricultural and Environmental Medicine, 1(1), 0-0.

Thosar, S. S., Bielko, S. L., Mather, K. J., Johnston, J. D., & Wallace, J. P. (2015). Effect of prolonged sitting and breaks in sitting time on endothelial function.

Van der Ploeg, H. P., Chey, T., Korda, R. J., Banks, E., & Bauman, A. (2012). Sitting time and all-cause mortality risk in 222 497 Australian adults. Archives of internal medicine, 172(6), 494-500.

Yates, T. M. (2004). The developmental psychopathology of self-injurious behavior: Compensatory regulation in posttraumatic adaptation. Clinical Psychology Review, 24(1), 35-74.

 

Nick Green M.S., BCBA is the founder and CEO of BehaviorFit, an organization dedicated to improving the health and well-being of others through behavioral science. Visit BehaviorFit to learn more about workshops, consulting services or read other articles related to health and wellness. You can contact him at [email protected].

Nick is currently a Ph.D. student at the University of Florida and is interested in improving employee health with behavioral interventions. His research specifically aims to increase employee physical activity by evaluating variables such as education, prompting, goal-setting, and feedback.

Nick holds an M.S. in Organizational Behavior Management from Florida Institute of Technology. He previously worked in a clinical setting serving young adults diagnosed with Autism for 5 years under the guidance of Dr. Carl Sundberg.