Is sitting the new smoking?

Is sitting the new smoking? Not in the way the slogan suggests. Sitting for most of the day is linked to a higher risk of dying early, and that link deserves to be taken seriously. But the extra risk is a small fraction of what smoking does, and in the largest analysis it all but disappeared in people who were active enough. Here is where the phrase came from, what the studies actually found, and why the comparison does more harm than good.

Where did “sitting is the new smoking” come from?

The phrase is usually credited to James Levine, who led an obesity research initiative run by the Mayo Clinic and Arizona State University and is credited with inventing the treadmill desk. In a 2014 interview with the Los Angeles Times about his book Get Up!, he went further: “Sitting is more dangerous than smoking, kills more people than HIV and is more treacherous than parachuting. We are sitting ourselves to death” (Los Angeles Times, 2014).

It was a memorable line, and it spread. By 2018, a group of researchers who study sitting wrote a commentary in the American Journal of Public Health noting that sitting had frequently been equated with smoking, with some sources even suggesting that smoking was safer. Their verdict was that the two are not comparable (Vallance et al., 2018). In 2024, another group writing in the British Journal of Sports Medicine called the slogan inaccurate (Holtermann et al., 2024).

So the pushback comes from the very people who study sitting.

What the mortality data show

The link between sitting and early death has been measured many times. The findings are fairly consistent: more sitting goes with a higher risk, but the size of that risk is modest and depends heavily on how active people are otherwise.

• A review of 47 studies found that, after taking physical activity into account, people with the most sedentary behaviour had about a 24% higher risk of dying from any cause during follow-up. Almost every study relied on people reporting their own sitting time, and the designs varied a great deal (Biswas et al., 2015).
• A dose-response analysis of 34 studies with more than 1.3 million people found that the risk barely rose with each extra hour of sitting up to about eight hours a day, and then rose by about 4% per extra hour beyond that. The authors put the threshold for total sitting at six to eight hours a day. TV viewing showed stronger links than total sitting (Patterson et al., 2018).

What Ekelund 2016 found

The study most often quoted on this question is a pooled analysis in The Lancet of more than one million adults from 13 studies, followed for between 2 and 18 years (Ekelund et al., 2016). It grouped people both by how much they sat and by how active they were.

• People who sat for more than eight hours a day and were in the least active quarter had a 59% higher death rate than people who sat for under four hours and were the most active.
• In the most active quarter, roughly 60 to 75 minutes of moderate activity a day, sitting for more than eight hours was not linked to a higher death rate at all.
• People who sat for under four hours but were the least active still had a 27% higher death rate than the reference group.

That last finding is the one the slogan misses. A lack of movement, not the chair itself, carried much of the risk. TV was the exception: watching three hours or more a day was linked to higher mortality at every activity level except the most active, where the link appeared only at five hours or more.

These were observational studies based on questionnaires. They show associations, not proof that sitting causes early death.

What activity monitors add

Questionnaires are a rough way to measure sitting. A later analysis pooled data from 36,383 people who wore accelerometers, most of them middle-aged or older (average age 63). Over a median of about six years, the most sedentary quarter had 2.6 times the death rate of the least sedentary, and any activity, light activity included, was linked to a lower risk (Ekelund et al., 2019). Measured this way the link looks stronger, though it still cannot rule out that people who were already unwell simply moved less.

Not every study agrees. The Whitehall II study followed 5,132 British civil servants for about 16 years and found no link between any of five measures of sitting and the risk of dying. Its authors advised caution about treating sitting as a risk separate from physical activity (Pulsford et al., 2015).

Is sitting the new smoking? How the risks compare

This is where the slogan falls apart.

• In a US survey of more than 200,000 adults, current smokers had about three times the death rate of people who had never smoked, and lost more than ten years of life expectancy (Jha et al., 2013).
• In a study that followed 34,439 British doctors for 50 years, men who kept smoking cigarettes died on average about ten years younger than lifelong non-smokers (Doll et al., 2004).

Set a tripled death rate next to a rise of a fifth or a quarter for the most sitting. The AJPH commentary also put the gap in absolute terms. Among the heaviest smokers there are more than 2,000 extra deaths per 100,000 people a year compared with never-smokers. Comparing the people who sit most with those who sit least, the figure is about 190 (Vallance et al., 2018). That is a gap of more than tenfold.

Why the comparison misleads

The numbers are only part of the problem.

Smoking adds a harm; sitting mostly replaces movement. With cigarettes, what lowers the risk is stopping. In the British doctors study, quitting at 50 halved the hazard and quitting at 30 avoided almost all of it (Doll et al., 2004). With sitting, the Ekelund data suggest that enough activity elsewhere in the day can largely offset the risk, without giving up the chair.

You cannot quit sitting. Most desk jobs require it. A message that treats every hour in a chair like a cigarette sets a target people cannot meet and says little about what to do instead.

It points to the wrong fix. If sitting is the poison, standing looks like the cure. But among 83,013 UK Biobank participants who wore wrist accelerometers, time spent standing was not linked to a lower risk of heart disease or stroke. Standing for more than two hours a day was linked to a higher risk of circulation problems such as varicose veins (Ahmadi et al., 2024). We look at what that means for your desk in Are standing desks worth it?

Exaggeration erodes trust. The AJPH authors’ broader worry was that distorted messages about health risks lead to confusion and public doubt about health advice in general (Vallance et al., 2018).

So is sitting bad for you?

Yes, in a more ordinary way. The NHS notes that many adults spend more than seven hours a day sitting, and that you can hit your weekly activity target and still be at risk of ill health if you spend the rest of the time sitting or lying down (NHS). The WHO’s 2020 guidelines recommend that adults limit sedentary time, and say that replacing it with activity of any intensity, light activity included, has health benefits. The evidence was not strong enough to set a safe number of hours (Bull et al., 2020).

How the sitting is spread out may matter as well. In 168 Australian adults who wore sensors for a week, those who broke up their sitting more often had smaller waists and better blood sugar and blood fat readings, whatever their total sitting time (Healy et al., 2008). It was a snapshot study, and its authors called for public health advice on breaking up sitting, not only on cutting the total.

What it means for your neck and back

For people at a desk, the cost you notice first is usually not years of life but a stiff neck or an aching lower back. A review of 79 studies found that people who reported sitting a lot at work had higher odds of low back pain (about 1.5 times) and of neck and shoulder pain (about 1.7 times). Most were snapshot studies, so pain could drive sitting as much as the other way round. But in the experimental studies the review included, cutting down workplace sitting went together with less pain (Dzakpasu et al., 2021).

There is more on this in How much of your year do you spend sitting? and in our pages on lower back pain from sitting and neck pain from desk work.

What to do instead of worrying

None of this means giving up your job. The research points to a few ordinary habits.

• Move enough in total. The WHO recommends 150 to 300 minutes of moderate activity a week, and suggests that people who sit a lot aim for more than the minimum (Bull et al., 2020). In Ekelund’s 2016 data, the level that removed the link with sitting was around an hour a day, but in the monitor data any activity, even light, went with a lower risk. Walking counts, and Is walking good for back pain? looks at it from the back’s point of view.
• Break up long sits. Short, regular breaks are easier to fit into a workday than one long session. Our guide to microbreaks looks at how often to move, and the desk break timer can remind you. What are exercise snacks? covers very short bursts of activity.
• Watch the evenings. TV time had stronger links with mortality than total sitting in both Ekelund’s and Patterson’s analyses.
• Know your number. The sitting time calculator adds up how many hours a year you spend in a chair.
• Use breaks to change position. A few desk stretches are a simple way to get out of one posture without leaving your desk.

If you look after a team, our page for teams covers movement at work.

The bottom line

Sitting is not the new smoking. Smoking roughly triples the death rate and costs about a decade of life. Long hours of sitting are linked to a much smaller rise, and in the most active people the link largely disappears. What the slogan gets right is that hours of stillness are not good for you. What it gets wrong is the answer: not fear of chairs, but more movement, spread through the day.

Bavelu’s desk routines of two to four minutes are designed and filmed by physiotherapists for those gaps between tasks, with a longer daily session for days when you have more time.