Türümüz milyonlarca yıldır hareket etmek için tasarlanmış ve uyarlanmıştır. Ancak, içinde bulunduğumuz dijital çağ vücutlarımızın uzun dönem tasarımı ve uyarlanım durumu üzerinde dramatik değişikliklere neden olmaktadır. Çağımızın en önemli davranış değişikliklerinden bir tanesi uzun oturma süreleridir. Modern dünyanın yaşam ve iş koşulları ne yazık ki türümüzün daha önce hiç deneyimlemediği kadar uzun oturma süreleri ile karşı karşıya kalmamıza neden olmuştur. Sedanter yaşamın en önemli göstergesi, yapılan işlerin 1.5 MET düzeyinin altında olmasıdır (Tremblay ve ark., 2017). Oturmak, enerji harcaması bakımından 1.5 MET’ lik veya daha altında bir enerji harcamasına neden olmaktadır (Zheng ve ark., 2014). Bilimsel kanıtlar, enerji tüketiminin kardiyovasküler hastalıklar, kanser türleri, tip 2 diyabet gibi hastalıkların risk faktörü olduğunu göstermektedir. Artan günlük enerji tüketiminin bu hastalıkların görülme risk düzeyleri ile ters ilişkili olduğu iddia edilmektedir. Başka bir ifadeyle, artan enerji harcaması bu hastalıkların görülme risk düzeyini düşürmektedir (Parkin ve ark., 1992; Prentice ve ark., 2011; Tinker ve ark., 2011; Hamilton ve ark., 2007; Mansoubi ve ark., 2015; Saeidifard ve ark., 2018).
Oturma süresinin uzaması ile sigara içme nedeniyle görülen ölüm oranları kıyaslandığında belki de oturmanın neden yeni sigara içme salgını olduğu iddiasına ışık tutulabilir. Literatürde, kadın ve erkekler üzerinde yapılan epidemiyolojik çalışmalar kadınlarda %17 erkeklerde ise %21 oranında ölüm nedeni olarak sigara gösterilmektedir (Fenelon ve Preston, 2012). Oturma süresinin ölüm oranları üzerine etkisini araştıran bir çalışmada 600 bin kişi takip edilmiş ve oturma süresinin uzamasının ölümlerin %5.9’ undan sorumlu olduğu saptanmıştır (Chau ve ark., 2013). Başka bir çalışmada ise 54 ülkede eş zamanlı devam eden incelemelerde oturma süresinin uzamasının tüm ölüm vakalarının %3.8’ inden sorumlu olduğu rapor edilmiştir (Rezende ve ark., 2016; Vallance ve ark., 2018).
Bu soruna dikkat çekmek için 2010 yılında “Los Angeles Times ve Time” dergileri “yeni sigara içme salgını veya en az sigara içmek kadar kötü” gibi manşetler atmışlardır. Aynı zamanda, yazılı medya tarafından bu başlıklar belki de toplumların ve hükümetlerin dikkatini çekmek için egzajere edilmiştir. Dahası, 2012-2016 yılları arasında bu tür başlıklarda 12-16 katlık bir haberleştirme artışı olduğu bilinmektedir. Ayrıca, bilimsel toplum aynı başlıkları bilimsel kanıtlarla ifade etmeye çalışmıştır (Chau ve ark., 2019; Mayo Clinic Letter, 2014). Literatürde, 13 randomize kontrollü araştırmanın verilerini yeniden değerlendiren bir meta-analiz çalışmasında, günde 8 saatten fazla oturmanın tıpkı sigara içme ve Obezite gibi ölüm risk düzeyini arttırdığı ifade edilmiştir. Ancak, her ne kadar oturma süresi uzunluğu yaşam beklentisini azaltsa da sigara içme faktörü oturmaya göre oldukça büyük bir risk faktörüdür.
Bilimsel araştırmalar, oturma süresinin uzaması ile enerji harcamasında dramatik düşüşlerin olduğunu vurgulamaktadır. Enerji harcamasında meydana gelen bu dramatik düşüşler nedeniyle kan basıncı, kan şekeri, kan kolesterol seviyesi, vücut yağ oranı ve bel çevresi gibi parametreler negatif etkilenmektedir. Sedanter yaşam tarzının özelikle kan glikoz, lipid ve insülin düzeyini dramatik şekilde arttırdığı ifade edilmiştir. Belirtilen bu parametrelerin oturma süresinden etkilenmesi kümülatif olarak metabolik sendrom durumunu ortaya çıkartabilmektedir (Stephens ve ark., 2011; Lyden ve ark., 2015; Tremblay ve ark., 2010).
Buraya kadar oturma süresinin metabolik durum üzerine etkileri noktasında kanıtlar sunmaya çalıştım peki oturma süresinin metabolik sağlığı etkileme potansiyelinin mekanizmaları nelerdir? Bilimsel kanıtlarda, uzun oturma sürelerinin karbonhidrat metabolizmasını negatif etkileyerek kaslara glikoz taşıyıcı (Glut reseptörleri) proteinlerin morfolojik ve fonksiyonel yapılarını etkilediği vurgulanmıştır. Dahası, uzun süre kasların hareketsiz kalması lipoprotein lipaz aktivitesini (kan lipid seviyesi regülasyonu) değiştirerek hem lipid hem de glikoz metabolizması gen ifadelerini değiştirmektedir. Aynı zamanda, uzun oturma süreleri kan damarlarında kan akışı değişimine ve kan akış basınç stresine neden olarak vasküler disfonksiyon gelişimine böylece inflamasyon artışına ve ateroskleroz gelişiminin önünü açmaktadır (Tremblay ve ark., 2010; Bergouignan ve ark., 2016; Latouche ve ark., 2016; Hamilton ve ark., 2007; Carter ve ark., 2017; Bailey ve ark., 2019). Yukarıda bahsettiğim mekanizmalar uzun oturma sürelerinin kas hücrelerini, kan glikoz ve insülin regülasyonunu ve kalp damar sağlığını nasıl etkilediğini açıklamaya çalışmaktadır.
Bilimsel kanıtlara göre yüksek oturma sürelerinin (8+ saat) düşük oturma sürelerine göre (4 saat ve altı) tip 2 diyabet gelişim risk düzeyini arttırma potansiyeli 1.91 kattır. Aynı zamanda, tüm ölüm nedenleri üzerine uzun oturma sürelerinin tehlike artış oranı 1.22 kat iken, kanser ölüm nedenlerine 1.13 kat ve kalp damar hastalıklarından ölüm oranlarında 1.15 kat risk artışına neden olmaktadır (Biswas ve ark., 2015; Pandey ve ark., 2016).
Buraya kadar uzun oturma sürelerinin neden olduğu sağlık sorunları üzerine dikkat çekmeye çalıştım. Peki, oturma sürelerinin neden olduğu etkileri ortadan kaldırmak veya önleyebilmek için neler yapabiliriz. Literatürde bazı araştırmalarda, modern dünya günü döngüsü içinde uzun oturma sürelerinin negatif etkilerini önlemede en etkili stratejinin gün içinde en az 60 dakika fiziksel aktivite veya egzersiz yapmak olduğu vurgulanmıştır. Bir milyondan fazla kişinin incelendiğinde bir araştırmada gün boyu uzun oturma sürelerine sahip olan (8+ saat) ama aktif yaşam süren (günde 60 dk fiziksel aktivite) kişilerin daha az etkilendiği rapor edilmiştir. Dahası, fiziksel aktif olmanın oturmanın neden olabileceği mortalite risk düzeyinde düşüşler görülmüştür (Ekelund ve ark., 2016).
Uzun oturma sürelerini yönetmek ve muhtemel negatif etkilerini minimize etmek için yapılabilecek bazı stratejiler:
- Her 30 dk oturma süresi için kısa dinlenme aralıkları vermek (2-3 dk veya toplam oturma süresinin %10’u)
- Toplam oturma süresinin tek seferse 2 saati aşmamasına özen göstermek
- Telefon konuşmalarını ayakta yapmak
- TV programlarının bir bölümünü ayakta izlemek
- Bazı bireysel görüşmeleri yürüme seansları içinde yapmak
Oturma süresinin azaltılması veya oturma süresi oranına göre fiziksel aktivite veya egzersiz katılımının muhtemel sağlık etkileri:
- Kemik sağlığının gelişmesi (kemik mineral yoğunluğunda ve sağlamlığında artış)
- Beyin morfolojisinin ve fonksiyonlarının gelişmesi (oksijen ve besin taşınımı artışı)
- Enerji harcamasının artması (depo yağların kullanım oranında artış)
- Kanser riskinin minimize olması (uzun oturma süreleri kolon, meme ve rahim kanseri risk artışı)
- Kardiyovasküler hastalıkların gelişim riskinin azalması (kan dolaşımı süreçlerinin optimizasyonu ve ani kalp krizi risklerinin düşmesi)
- Diyabet gelişiminin minimize olması ve diyabet hastalığının efektif yönetimi (kan glukoz ve insülin seviyesinin regüle olması
- Erken ölüm oranlarında azalma (uzun oturma süreleri erken ölüm nedenleri arasında sayılmaktadır)
- Kas-iskelet sisteminin gelişmesi (kas kütlesi ve kuvvetinin artması, denge artışı, ağrıların azalması)
- Postürün korunması ve sürdürülmesi (omurga sağlığı ve fonksiyonunun restorasyonu)
Sonuç olarak, oturma modern dünyanın bugün için olmazsa olmazı haline gelmiştir. Yaşam ve iş koşulları gereği oturmayı hayatımızdan çıkartmamız son derece zor bir konudur. Ancak, uzun oturma sürelerini etkin stratejiler ile yönetmek son derece faydalı olacaktır. Günün sonunda elimizde olan en güçlü bilimsel kanıt, uzamış oturma sürelerinin organizma üzerine negatif etkilerini minimize etmenin en efektif yolu enerji harcamasını arttırmaktır.
“Haftanın Mottosu: Hareket etmezsen, zincirlerini fark edemezsin – Tolstoy”
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