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Consultations in primary care should be held standing up

BMJ 2014; 348 doi: (Published 18 February 2014) Cite this as: BMJ 2014;348:g1558
  1. Mohammed Ahmed Rashid, academic clinical fellow, Primary Care Unit, Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, Cambridge CB1 8RN, UK
  1. mar74{at}

Sitting for prolonged periods contributes to disease and premature death. Mohammed Ahmed Rashid suggests that doctors as well as patients may benefit from standing up in some general practice consultations

In the 1950s, epidemiologists discovered that heart disease was more common among bus drivers than bus conductors, and among clerical workers than postmen, leading to the hypothesis that “men in physically active jobs have a lower incidence of coronary heart disease in middle-age than men in physically inactive jobs.”1 In the following decades, the associations between occupational activity and cardiovascular disease were confirmed, as were its relations with physical activity generally.2

However, an additional nuance has recently emerged. Overall time spent sitting has been shown to be associated with several cardiovascular and metabolic diseases, as well as total mortality.3 This relation exists independently of exercise levels. In other words, regardless of time spent in formal exercise, spending prolonged periods sitting can contribute to premature morbidity and mortality.

Although researchers are attempting to further understand and define this relation, the evidence so far has been sufficiently persuasive to prompt policy makers to begin to explore avenues for intervention. One target is to reduce time spent sitting at work. Interventions developed have included personally tailored activity, counselling for employees, sending motivational email messages, encouraging use …

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