Could you skip your workout if you built more activity into your day?

Reprinted from The Washington Post April 30, 2019.

While writing this paragraph, I stood up and sat back down five times, swiveled a bunch in my chair, walked to the kitchen to make a pot of tea, brushed my dog, made my bed and performed at least six seated leg crisscrosses with my feet raised a good 12 inches off the floor. To the casual observer, this might look like a bad case of procrastination, but it all counts to boost my non-exercise activity thermogenesis, or NEAT, which is essentially the energy I burn when I’m not sleeping, eating, resting or deliberately exercising.

I became interested in non-exercise physical activity (which I sometimes refer to as the “exertion of daily living”) after realizing that most of my patients don’t meet the American Heart Association recommendation of 150 minutes of heart-pumping exercise plus two sessions of muscle-strengthening exercises per week. Some tell me that they don’t have the time, but others simply hate exercising, and sweating gives them no reward. I heard this so often that I began to wonder whether there are alternate ways to capture the health benefits typically associated with the AHA guidelines — benefits that include a lower risk of cancer, coronary heart disease, depression and physical disability.

It turns out there are.

With the advent of wearable devices that make it possible to accurately measure energy expenditure, rather than just counting steps, researchers are discovering that dozens of non-exercise activities can be slipped into our daily routine and, together, replace a stint at the gym or a morning jog.

“We are moving away from the word ‘exercise,’ ” said Barbara Brown, a researcher at the University of Utah who studies physical activity. “Exercise is that thing you do where you have to wear funny clothes, and you have to go to the gym and buy a membership, and you have to sweat for an hour. Some people love that, but many don’t.” Instead, Brown said, she and her colleagues talk about “active living.”

Endocrinologist James Levine coined the term NEAT when he was the director of the Obesity Solutions initiative at Mayo clinic.

“Anybody can have a NEAT life,” he said. “Our research showed that you can take two adults of the same weight and one can burn an extra 350 [calories per day] simply by getting rid of labor-saving devices and moving more throughout the day.”

(For reference, a 155-pound person who spent 30 minutes on a stair machine would burn 223 calories.)

Brown agrees. “There are little bitty activities you can accrue across the day, and you don’t have to change your clothes.”

So what are these little bitty things?

“First and foremost, avoid chairs at work, ” said I-Min Lee, a professor of epidemiology and physical activity researcher at Harvard. “We have 16 hours in the waking day. If you sit less in those 16 hours, then you must be doing more of something else.”

Indeed, working Americans spend, on average, more than40 percent of our waking hours in a chair, making this is an obvious place to amp up non-exercise energy expenditure.

The basic idea, according to Brown, Levine and Lee, is to act like that constantly moving kid in the second grade who drove the teacher crazy: Throw a ball, pace while on the phone, take stairs, wiggle on agility balls, do random under-the-desk movements such as stepping or swiveling, schedule walking meetings, and alternate between sitting and standing. (Despite enthusiasm for standing desks, it turns out that standing is not much better than sitting, but transitioning between the two can increase energy output.)

If you like numbers and want to get an idea of how many calories are burned per minute with your chosen NEAT activities, you can consult the Compendium of Physical Activities. This reference reports energy expenditure in METS — or metabolic equivalents — but can be converted to calories per minute by multiplying METS x 3.5 x body weight in kilograms then dividing by 200.

According to the compendium, if I amble around the office, I expend more than 3 calories per minute. Though this might sound trivial, I realized that if I walk whenever I’m on the phone, this adds up to a real workout. Climbing stairs burns up to 7 calories per minute.

Your commute to work is another way to get NEAT credits. Brown recently used accelerometers to study how the introduction of a light rail system affected people living in a mixed-income area in Salt Lake City. She discovered that people who lived closer to the rail were more likely to use it, and those who used the rail were more likely to lose weight and increase physical activity.

The fact that people in the study did not increase their activity on their non-work days suggests that simply changing a commute pattern can improve overall health.

Of course, none of this applies to you if you have a physically demanding job. The days I am in clinic, my Fitbit records an amazing four miles simply from my going from room to room and moving around the exam table. And some of my fittest patients are mail carriers, waitresses and preschool teachers, professions that require near-constant motion. (It should be said that technology has made things so convenient that even professions traditionally thought of as highly exertional, such as farming and longshore work, are now associated with prolonged sit-time behind the controls of a vehicle.)

For the unemployed, underemployed, retired and anyone with unspent energy after their work day, home maintenance can be an excellent form of NEAT. After all, if a workout feels like a chore, maybe it’s better to do a real chore and have something other than well-rounded glutes to show for it. Carrying groceries upstairs, handwashing clothes, picking fruit, shoveling, carpentry, rearranging the furniture and scrubbing floors stand out as stellar energy burners. I recently traded my electric coffee grinder for a hand grinder and, though I could not find this activity in the compendium, I am sure it would rival any five-minute weight workout.

“Making your bed is a surprising one. It uses as much energy as walking,” said Todd Manini, a researcher at the Institute on Aging at the University of Florida who runs the CHORES study, an effort to understand the metabolic requirements of various chores, especially for the elderly. “Make four to five beds in your day and you have 20 minutes” of exercise.

Manini has discovered that daily activities require more energy as we age. For example, a short walk might be trivial for a 20-year-old but could be metabolically demanding for a 90-year-old. He and his colleagues hope to add age-specific data to the Compendium of Physical Activities.

The compendium has a whole section dedicated to leisure activities such as playing with animals, weaving and laughing. One surprise was sex, which clocks in disappointingly low, somewhere between showering and playing a guitar. Of course, it’s easy to imagine that wearing a belted accelerometer might dampen the research subjects’ enthusiasm and energy output.

All the researchers I spoke with agree that the best way to nudge people toward non-exercise activity is to change the environment. After all, willpower only gets you so far. “I am interested in upstream things that can be done that subtly change our behaviors without having to think a lot about it,” Brown said. Examples of this include putting in public transit, making stairwells in buildings more accessible than elevators, installing sidewalks and creating new parks. Brown’s research shows that beautifying front yards and neighborhoods might be one of the most powerful upstream things a community can do to encourage non-exercise activity and improve public health.

But these are big changes that require support from politicians, urban planners and community members, as well as funding.

“Meanwhile, let’s all become NEAT ambassadors,” Levine said. Here are some ideas: Post friendly signs outside elevators reminding colleagues that there is, in fact, a stairwell (I honestly forget); move trash cans away from our chairs; do away with old-fashioned corded phones that tether us to our desks; schedule walking meetings; and have dance parties (rather than cake) for all those office birthdays and baby showers. Though this might sound like too much distraction and commotion, Levine and his team found the opposite to be true: Active work environments promote more productivity, less stress and less absenteeism.

Speaking of productivity, I’m off to hand wash last night’s pile of dishes. According to the compendium, all that scrubbing will easily burn 30 more calories than simply loading the dishwasher. 

Daphne Miller is a family physician and author of “Farmacology” and “The Jungle Effect.”  

A day in a neat life

Endocrinologist James Levine coined the term Non-Exercise Activity Thermogenesis (or NEAT) to refer to the energy burned while not engaged in traditional exercise. This chart, put together with his help, shows that if you work activity into your daily routine, you can burn an extra 529 calories a day. To burn the same number of calories through traditional exercise, a 155-pound person would have to do one hour of moderate stationary bicycling.

Daphne Miller is a family physician and author of “Farmacology” and “The Jungle Effect.”