Smoking and being sedentary are two of the most harmful habits for your health. Don't think so? Just take a quick look back through the articles we've posted here over the years (see this, this, and this). Time and time again, Beijing United Family Hospital (BJU) doctors recommend quitting smoking and taking an adequate amount of exercise (among other measures) in order to prevent a wide range of diseases. Recently, however, new studies have been published and widely reported on that claim that "sitting is the new smoking" – in other words, that being sedentary has worse health outcomes than smoking does. Could this possibly be true? We put the question to four BJU experts to find out.
Heart disease is one of the top causes of death in the world. When doctors talk about risk factors for heart disease, they distinguish between modifiable and non-modifiable ones. Age, family history, and gender are unmodifiable, but there are plenty of risk factors that we do have control over. And which are at the top of the list? You guessed it: smoking and physical inactivity. Let's look at how these affect your heart.
"Smoking is one of the classical risk factors of cardiovascular disease," says Cardiologist and Assistant Chair of the Cardiovascular Center at BJU, Dr. Bai Shuling. Smoking (whether it's cigarettes, e-cigarettes, or cigars) hardens and narrows the walls of blood vessels, causing higher pressure within the blood vessels (this condition is known as hypertension or high blood pressure). This high pressure can, in turn, cause heart attacks, strokes, and other health complications by making blockages in the blood vessels more likely to occur.
So, smoking is bad for your heart and circulation – but Dr. Bai also warns that "Sitting around for long periods also brings adverse effects, such as deep-vein thrombosis; weight gain; and elevated blood pressure, blood sugar, and lipids" due to your metabolism slowing down. These factors also contribute to heart disease by increasing the chance of blockages in the blood vessels. When it comes to the heart, then, both smoking and being sedentary contribute to poor outcomes.
The women's health perspective
There are absolutely no surprises here. In the words of BJU OB-GYN Physician Dr. Sahba Farhad, "Smoking in pregnancy is associated with multiple high risks." But you probably already knew that. What's the big deal, though? Why is it so bad? "First of all," says Dr. Farhad, "you have an increased risk of infertility. Then, once you get pregnant, risk of miscarriage and high blood pressure. There is also a risk of small-for-gestational-age babies." Why does this happen? Dr. Farhad explains that smoking introduces toxins into all cells of the body. The presence of these toxins makes it harder for women to conceive and carry babies and, when they are able to, these toxins make their way to the placenta and affect the baby as it grows. The aforementioned restrictive effect that smoking has on the blood vessels also leads to development issues related to poor circulation, adds Dr. Farhad.
So, what about sitting then? Surely pregnant women should refrain from walking, carrying their shopping, opening their own doors, standing while on public transport, or doing anything remotely athletic, right? Not exactly. "You can ask my patients – I tell every single patient to walk from day one," says Dr. Farhad. Why? The answer is simple: "When you exercise during pregnancy, you have less nausea and vomiting, so the overall body circulation is better," she says. "It affects the mood and it affects the digestive system (because when you're moving around, your digestive system is moving too). Women who walk and exercise also have higher rates of normal vaginal deliveries and better labor outcomes." Dr. Farhad also cautions that being sedentary can contribute to increased weight gain during pregnancy and that this excessive weight gain can bring with it its own set of complications such as diabetes, general lack of energy, musculoskeletal issues, and stretch marks.
The musculoskeletal perspective
You might think that being sedentary would prevent you from hurting your bones and joints because you're removing yourself from the risk of injury from high-impact activities. You would be surprised, then, to hear BJU Physiotherapist Ying Swee Ong say that "As a physiotherapist, people often come in and tell me that they have pain from being in a static position for too long. Very few patients come in and say that they have pain from moving too much." So, if you thought that your couch potato habits were saving you from a host of injuries, think again! Getting moving throughout the day can help prevent chronic issues that come from being seated all day long. Here's how to get started.
What about smoking then? How can smoking affect your musculoskeletal system? Well, in addition to depositing toxins into your (and your baby's) cells, tobacco use can also cause your bones to become more brittle and susceptible to breaking, especially in old age. "From what I've seen from my patients," says Ying Swee, "both of these groups have slower recovery and healing rates and poor exercise tolerance." That means that quitting smoking and keeping your body in shape now can help you move and heal better in your old age.
The general health perspective
It's easy to see how smoking and sitting affect specifics parts of your body and life. Here to explain the bigger picture is Family Medicine Physician Dr. Joe Donroe. "Most of the risks attributable to sedentary lifestyle are in the domain of cardiovascular risk – so heart disease, for example," says Dr. Donroe. "But, if you look at smoking, it's not only a risk factor for cardiovascular stuff – it's also been directly linked to around 12 different cancers, pulmonary disease, dementia, and Alzheimer's disease. There are so many connections between smoking and bad outcomes later on in life that it's really not quite comparable to a sedentary lifestyle.” And it's not just that smoking is bad for you. As Dr. Donroe points out, "The other thing that separates smoking and sitting is that your sitting doesn't bother me at all but your smoking does – it affects me, it affects my kids, it affects everybody around you. The harms of second-hand smoke are also well-known and well-established."
There was one thing that all four BJU experts agreed on: Both smoking and leading a sedentary lifestyle are bad for you. But, when asked to compare them, not everyone agreed. OB-GYN Physician Dr. Farhad says, "They're different – they're both not good, but they're different. I wouldn't say one is better than the other." Cardiologist Dr. Bai also thinks they're similar: "To be honest, I don't notice the difference in general between the health of patients who smoke versus patients who live sedentary lifestyles. I would say both are unhealthy."
Physiotherapist Ying Swee and Family Medicine Physician Dr. Donroe, however, both agree that smoking is worse. "The damage that smoking does is not completely reversible. Someone with a sedentary lifestyle can still make the change by starting to move a little every day," says Ying Swee. Dr. Donroe sums it all up neatly: "This whole 'sitting is the new smoking', it's a catchphrase. It's for headlines. They're both not good for you. Smoking is much worse for a lot of different reasons."
If you are a dedicated smoker and/or couch potato and want to live your best life to become a heart-healthy, joint-pain-free old person, BJU offers support to help you change your ways. First of all, our smoking cessation program is a great resource for smokers who want a multifaceted approach to quitting smoking. Dr. Donroe is also an addiction specialist and can help you work through your addiction to smoking.
The recommended weekly amount of physical exercise is 150 minutes. That could be as painless as a 15-minute bike ride to and from work on weekdays. If you want to improve your physical activity levels and need some extra motivation getting started, you can see your Family Medicine Physician for guidance. "Being sedentary is associated with real adverse health outcomes," says Dr. Donroe. "So, if you had a bad health outcome, you'd go see your doctor. Doctors are a good starting point to get yourself organized around how to make that change. They can help you see how being sedentary might be connected with some of the problems that you already have like stress, high blood pressure, cardiovascular disease, being overweight, or diabetes."
If you're worried about your heart health before you get into a new physical exercise routine, you can talk to your cardiologist about getting a cardiac stress test so you know your limits. If you have an old injury or are worried about hurting yourself as you exercise more, your physiotherapist can also help design a workout plan that gets your body used to your new routine without getting injured.
If you're pregnant or planning to get pregnant and want to quit smoking or get moving, Dr. Farhad has some uplifting news, too. "I have many, many patients who, if they smoked before, quit as soon as they find out they're pregnant. And I would say the majority find it very easy – they just didn't have a craving for it and they're able to stop right away when they find out they're pregnant." As for being sedentary, she adds that "There are times during the pregnancy where the mother can't be active for some medical reason like cervical incompetence or multiple gestations or something like that – and that's fine. But, the majority of the time, light activity is recommended for all women." Walking is enough to get the benefits.
Dr. Shuling Bai is a Cardiologist and the Assistant Chair of the Cardiovascular Center at BJU.
She speaks English and Mandarin.
Dr. Sahba Farhad is an Obstetrician and Gynecologist at BJU.
She speaks English, Persian, French, Mandarin, and Spanish.
Ms. Ying Swee Ong is a New Zealand-trained Physiotherapist at BJU.
She speaks English, Malay, and Mandarin.
Dr. Joseph Donroe is a Pediatrician, Internist, and a specialist in Addiction Medicine at BJU.He speaks English and Spanish.
If you'd like to make an appointment with a doctor or a therapist at BJU, please call the BJU Service Center 4008-919191.