April 2011 Issue

Break Free of Must-See TV — Help Clients Avoid Health Hazards of Too Much Screen Time
By Jenna A. Bell, PhD, RD, CSSD
Today’s Dietitian
Vol. 13 No. 4 P. 8

As RDs, we know that one important strategy to help our clients increase their activity level is to talk to them about spending less leisure time in front of the television or computer. A recent study published in the Journal of the American College of Cardiology shows that this strategy to increase physical activity may also be important for heart health and longevity.1 Stamatakis et al examined the independent relationship between television viewing or other screen-based entertainment and all-cause mortality and cardiovascular disease (CVD) events and revealed some disheartening findings about our screen time.

The researchers asked the 4,512 adult participants of the 2003 Scottish Health Survey to record the amount of leisure screen time (not including screen time at work or school) they clocked each day. Screen time included time spent watching TV and movies, playing video games, and using the computer. After four years of follow-up, there were 325 deaths from all causes and 215 CVD events. The researchers discovered that individuals who spent four or more hours per day sitting before a TV or a computer in their leisure time had a 48% increased risk of all-cause mortality.

The risk of CVD events increased with just two or more hours of screen time. Remarkably, individuals who spent two or more hours each day in front of the screen had a 125% increased risk of CVD events compared with those who spent fewer than two hours of leisure time before a screen. When the researchers fleshed out other potential contributing factors, such as BMI, hypertension, and smoking, hours of screen time were still correlated with CVD events. Disappointingly, the amount of physical activity performed by the subjects had little effect if they were still spending two or more hours per day in front of a screen; therefore, replacing screen time with activity is still a priority.  Overall, the authors concluded there was an independent, deleterious relationship between screen-based recreational sitting time and CVD events and all-cause mortality.

The results of this study are similar to those from the Australian Diabetes, Obesity and Lifestyle Study and the Canadian Fitness Survey; all found an association between sitting time and all-cause mortality and CVD independent of leisure time physical activity.2,3

So how can you help your clients—even those who are most resistant to physical activity—reduce their time spent in front of a screen and replace that time with more physical activity, as well as make screen time less sedentary? Experts offer some tips for encouraging clients to add some activity to daily living, both at work and at home.

Sedentary Living
By definition, sedentary behaviors include a range of endeavors that result in an energy expenditure of no more than 1.5 times resting energy expenditure (eg, sitting, reclining, resting during waking hours).4 According to the Bureau of Labor and Statistics, the majority of children and adults spend more than 50% of their waking hours being sedentary.4 Similarly, seven-day accelerometer data from the 2003-2004 National Health and Nutrition Examination Study (NHANES) showed that 78% of the U.S. population may be classified into patterns of physical activity that represent low levels of moderate-vigorous physical activity throughout the week.5 In addition, the same data found that less than 1% of the population engaged in vigorous physical activity for at least 20 minutes on three or more days per week.5

How Much Physical Activity Is Recommended?
Health and Human Services, in its 2008 Physical Activity Guidelines for Americans, recommends the following amount of physical activity for adults aged 18 to 64:

• Aim for greater than 150 minutes per week of moderate-intensity or 75 minutes per week of vigorous-intensity aerobic physical activity or an equivalent combination of moderate- and vigorous-intensity aerobic activity.

• People should perform aerobic activity in episodes of at least 10 minutes and spread it throughout the week.

• Adults should include muscle-strengthening activities that involve all major muscle groups on two or more days of the week.

• Adults looking for more extensive health benefits should aim for 300 minutes per week of moderate-intensity or 150 minutes per week of vigorous-intensity aerobic physical activity or an equivalent.

• Some physical activity is better than none. Adults who participate in any amount of physical activity gain some health benefits.

Action Steps
The study data described previously stressed the importance of decreasing screen time inactivity during leisure time; therefore, dietitians can help their clients move away from the screen throughout the day. Pamela Nisevich Bede, MS, RD, works with families and athletes as co-owner of Swim, Bike, Run, Eat! (with the author) and says, “I am frequently challenged to help families increase their leisure time activity, and my athletes are looking for ways to stay active at work as well.”

Along with another dietitian, Nisevich Bede shares some of her favorite tips that may help you in your practice:

Get Moving at Work
Make the most of downtime. For individuals whose job requires hours of sitting and staring at a screen, Nisevich Bede recommends sitting on a resistance ball behind the desk to add core strength. “I also encourage folks to use a resistance band while multitasking at the office to help tone tired muscles.”

Eat and run (or walk). Nisevich Bede understands the value of a “lunch break” and suggests her clients make the most of it. “I help clients find time to fit a lunch-to-go walk while they enjoy their midday meal.”

Take your gym shoes to work. “It’s a lot easier to be active at work when you have the tools [shoes and clothes] you need,” notes Nisevich Bede. She recommends that clients schedule frequent bouts of walking throughout the day.

Marin Gilbert, RD, LD, a clinical dietitian in Dayton, Ohio, reminds clients that exercise equals brain power and that a 30-minute walking break in the middle of the day can lead to a more productive afternoon.

Make an appointment to move. Send yourself a calendar invite or use an alarm on a sports watch to give you a friendly “ding” once per hour, signaling that it’s time to move. “Once per hour, get up and pace,” says Nisevich Bede. “Get out of the chair, remove yourself from the screen, and take a short walk to the water fountain or restroom in the office building.”

Be More Active at Home
Move around. Encourage clients who spend leisure hours sitting to engage in some activity as often as they can. Gilbert suggests doing sit-ups or (modified) push-ups during commercial breaks as well as putting a ban on the remote, thereby forcing a little more movement when it’s time to change the channel.

Recognize limits. Clients who simply have to have their TV, video game, and computer time should put a limit on the total time they spend engaging in sedentary behaviors.

Turn on the stereo, not the TV, when working around the house. Gilbert says music can be a great motivator, an effect that’s heightened when the music is delivered at a higher (yet reasonable) volume. While moving about, individuals can tackle chores they’ve been neglecting and simultaneously produce feelings of well-being with the added bonus of a calorie burn.

Motivating the Most Resistant Clients
Simplify goals. Instead of making recommendations as to how much and how often clients should be active, try a different approach. Encourage clients to simply sit less, stand more often, walk more and, in general, move around a bit more.

Start small. It’s good to encourage all individuals to meet the 2008 Physical Activity Guidelines, but for many, these guidelines may appear daunting and unachievable. “For individuals who can’t fathom breaking a sweat, let alone exercising most days of the week, start with simple, attainable goals such as walking for 10 minutes every three to four hours,” advises Nisevich Bede. “Once the client achieves this goal, build on it.”

— Jenna A. Bell, PhD, RD, CSSD, is a nutrition writer, blogger, and communications consultant living in Chicago.


1. Stamatakis E, Hamer M, Daunstan DW. Screen-based entertainment time, all-cause mortality, and cardiovascular events: Population-based study with ongoing mortality and hospital events follow-up. J Am Coll Cardiol. 2011;57(3):292-299.

2. Dunstan DW, Barr ELM, Healy GN, et al. Television viewing time and mortality: The Australian Diabetes, Obesity and Lifestyle Study (AusDiab). Circulation. 2010;121:384-391.

3. Katzmarzyk PT, Church TS, Craig CL, Bouchard C. Sitting time and mortality from all causes, cardiovascular disease, and cancer. Med Sci Sports Exerc. 2009;41(5):998-1005.

4. Matthews CE, Chen KY, Freedson PS, et al. Amount of time spent in sedentary behaviors in the United States, 2003–2004. Am J Epidemiol. 2008;167(7):875-881.

5. Metzger JS, Catellier DJ, Evenson KR, et al. Patterns of objectively measured physical activity in the United States. Med Sci Sports Exerc. 2008;40(4):630-638.