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Why Sports and Exercise are Barely Relevant and What Really Counts is Occupational and Household Activity

There is no doubt that reducing sedentariness and increasing physical activity can have enormous health benefits.

This is why public health policies and health promotion bombard us with messages on how to get more active – unfortunately, much of the advise focusses on increasing engagement in recreational and volitional sports and exercise.

A paper by Chuck Ratzlaff from Harvard University, published in the British Journal of Sports Medicine now suggests why attempts to encourage recreational physical activity are largely doomed to fail.

This is simply not where most people’s physical activity happens – not is likely to happen.

As I pointed out in yesterday’s post – most people simply do not like being physically active enough to want to do it – when given the choice, they’d much rather sit or lie down (which makes perfect evolutionary sense).

It is therefore but natural, that about 80% of total daily physical activity in most people is associated with occupational and non-leisure (household chores).

In his analysis, Ratzlaff of his recent population-based research measuring lifetime physical activity – sporting activity formed a small fraction of overall physical activity compared with occupational and household activity (even more so in women).


“Using a rigorously developed and validated computer-guided lifetime physical activity questionnaire in a sample of 4269 Canadian adults aged 45–90 years, we found that women spent about 10 times more energy in household activity (70.5 vs 7.3 metabolic equivalent – hours/week) and 5.5 times more in occupational activity (40.5 vs 7.3 metabolic equivalent – hours/week) than in sport/recreational activity. Men spent four times more energy on occupational activity (64.9 vs 16.9 metabolic equivalent – hours/week) and 1.5 times more on household activity (28.4 vs 16.9 metabolic equivalent – hours/week) than on sport/recreation.”

If anything women have gotten even more physically active than before:

“Over the past several decades, women have increased occupational and sport/recreational activity, while largely maintaining high levels of household activity.”

As Ratzlaff discusses,

“Most studies on the relationship between physical activity and health outcomes have focused on sport/recreation and have not investigated the combined effect of sport, occupation and household activity and have not completely classified physical activity.”

“A clear example is the evidence regarding physical activity in women. While women often spend 40+ hours a week at a full-time job and anywhere from 20 to 45 h a week working in the home, surveys used in many existing studies often fail to measure the frequency, duration and intensity of physical activities actually performed by women.”

This not only means that most of us (even those, who do not seek out or participate in ‘recreational’ physical activity) are probably more active than generally assumed. It also means that perhaps the focus of public health measures to promote a more active ‘lifestyle’ may need to focus more on restoring physical activity in occupational and household settings.

“Contemporary researchers argue for the need to develop strategies to promote standing and ambulating time and re-engineer our computer-driven work, school and home environments to render active living the option of choice. In doing so, obese individuals could potentially expend an additional 350 kcal per day, or up to 30 pounds per year, without formally participating in sport or exercise.”

While it is not clear that those extra 350 kcal per day will not simply be replaced by increased intake and of course the simplistic 350 kcal per day = 30 pounds calculation is entirely off the mark (see previous posts on this), regarding the many better established benefits of being more active, such efforts could well pay big rewards.

Obviously, re-introducing physical labor into the workplace and household may prove far more challenging than simply appealing to people to go for a walk or run (to nowhere).

That workplaces, buildings and whole communities can be re-engineered to promote physical activity (whether you like it or not) is, for example, exemplified in the new Edmonton Clinic Health Academy at the University of Alberta, which incidentally, also houses our School of Public Health.

Anyone entering this building is immediately faced with a wide open staircase (not stairwell!) – the elevators are rather hidden in a corner (and for some reason appear not to be accessible half the time). At any time there are people crowding the stairs.

Most people will climb stairs when they have to – like it or not. (Simply putting up a sign pointing to the hidden stairwell on the other hand has little effect.)

The point is that we need to be more creative in designing and transforming our work and home environments and even our whole communities into spaces where physical activity is not just the easy but perhaps even the only choice.

Perhaps, when it comes to building codes, it is time to establish codes for ‘active’ buildings in the same manner in which we now have building codes for environmental friendliness.

Despite all efforts (including tax breaks), we will probably not get the majority of the population to really ‘like and want’ to be physically active – most people would rather watch sports than do them (especially after a long day at work).

This is why increasing occupational and household physical activity by 10% may have a huge population impact while increasing volitional sports and exercise by even 100% may do little (the multiple of zero is still zero!).

Station touristique Duchesnay, QC Ratzlaff CR (2012). Good news, bad news: sports matter but occupational and household activity really matter – sport and recreation unlikely to be a panacea for public health. British journal of sports medicine PMID: 22411766



  1. “Over the past several decades, women have increased occupational and sport/recreational activity, while largely maintaining high levels of household activity.”

    On a related note:

    In the US, in 1972 one in 27 girls was participating in sports in school. Then Title IX of the education act passed and now one in 2.5 girls participates in a sport. The US Women’s Sports Foundation says sports participation among girls has increased by 900% because of Title IX. Hoookay. So, if Eat-Less-Move-More, and specifically sports activity, really had an impact on obesity (especially in children and youth), wouldn’t we have seen a more pronounced rise in obesity among boys than girls (since girls have now attained soccer equality and boys levels of sports participation remain stable)? Sadly, what we are seeing, I think, and correct me if I’m wrong, is that girls have succumbed to the “obesity epidemic” in at least equal numbers to boys, and we also see more early-onset puberty in girls.

    To me this indicates that the “obesity epidemic” is not a failure of individuals to ELMM, but the symptom of a fundamental “brokenness” in our bodies that now causes most of us to retain more calories than we need for survival. As I understand it, the curve that represents “average weight” of humans was a perfect bell until roughly 1970, then it began to morph and flatten on the right side. The center (mean weight) of what would have been the bell has moved up by 10 to 24 pounds, depending on the study you’re looking at, and we now have many more extremely fat people — who are stigmatized and told (through Biggest Loser programs, women’s magazines and other purveyors of cultural mythology) that if they just got off their fat asses they’d be trim in no time. And they’d stay that way, since we ignore maintenance, deny the gross prevalence of regain, and assume people live trimly ever after. Lah-dee-dah. The end.

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  2. I like the concept of “active buildings”. There is currently an absence of furniture that promotes standing and moving in the workplace. This should be a priority as well. Pairing designers and builders to create office stations that increase our activity. How has Edmonton Clinic Health Academy tackled this problem?

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  3. More exercise and lifestyle activity is likely a good idea for everybody, but the reality is that people eat too damn much, and no amount of taking the stairs will remedy that. I’ve really had to tone down my eating in order to maintain weight loss, and meals that are now a celebratory occasion (once every week or two), used to be every day, and I used to think that normal.

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  4. Okay. Building Codes. That’s a bit of any area of expertise for me. The original and most important purpose of building codes is to promote public safety through setting fire and structural standards for buildings. Other government priorities are also being reflected in the building codes. The two most important of those are sustainability and accessibility.

    When I say “accessibility,” I mean access for people with disabilities. When I say “people with disabilities,” I am not just talking about people in wheelchairs. That also means people with bad joints and other issues that may not be readily apparent to an observer. And this is where I need to point out that it’s not healthy or pain-free for a lot of people to climb stairs.

    Now, I’m all for putting the stairs front and centre and making them the obvious choice for people who are without physical problems. ‘Active Buildings” sound like a great idea. HOWEVER, the idea of eliminating elevators or in any way trying to force people to take stairs or to do other things that some may find uncomfortable and others are simply unable to do? Absolutely nuts and completely in opposition to the codes’ purposes, which are to make buildings safe, efficient and accessible.

    If you’re serious about this active buildings idea, then the thing to do is to create a design standard. Design standards can be referenced in building codes, and can be included in specifications and tenders for public and private building projects. However, if the standard violates the accessibility requirements of the National Building Code (Canada) or the International Building Code (US) then nobody will be able to use it.

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  5. Why is it that we are even discussing exercise for weight loss given the ample evidence to support exercise as a weight manager (stable body weight) not a weight loser?
    Isn’t exercise better suited to a debate of disease management in addition to its psychological and social benefits?

    Why don’t we ask the question “why is it that so many people don’t like to exercise”?

    Dr. Sharma I don’t understand your evolutionary point that you made; I actually most evolutionary reference styles quite arbitrary and subjective.
    In my view we have just simply overcomplicated weight loss to the point that people feel helpless, desperate and lost. In this circumstance of course someone will go to a “quick fix” – it’s simple. In terms of obesity, and referencing recent history, what we have is a normal response to an abnormal environment.

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  6. This not only means that most of us (even those, who do not seek out or participate in ‘recreational’ physical activity) are probably more active than generally assumed. It also means that perhaps the focus of public health measures to promote a more active ‘lifestyle’ may need to focus more on restoring physical activity in occupational and household settings

    Objectively measured physical activity from nationally representative samples like NHANES and CHMS still suggest that we’re not very active at home/work either. I agree that this approach is the way to go, but even lifestyle embedded PA is pretty low right now.

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  7. It would be great if there were more opportunities to be active at work and home and the concept of “active buldings” is intriguing. I have long been frustrated as a failure at weight loss, because so many sources tell us to find some activity that we “enjoy” and get active–problem is, I have yet to find an activity that I really enjoy. I would far rather curl up with a good book and a glass of wine, and I absolutely hate to feel hot, sweaty and breathless. It’s good to know I’m not the only one experiencing this problem!
    Part of the problem with active workplaces I think, is the workplace culture–quicker to take an elevator/escalator than climb the stairs, not enough time to take a more roundabout route to where you are going, jobs that have us so mentally/emotionally fatigued that we prefer to take the easy way out physically whenever we can. And there are other issues– stair climbing is a non-option for a lot of us with joint issues (for me, my knee arthritis pain is worsened more by going up or down stairs than by any other activity), and long periods of standing are difficult for people with joint issues or back pain.
    How much increased physical activity would have to be performed in the home and workplace to create a difference in weight management or weight loss? It seems that the gain in calorie expenditure would be quite minimal, and people will still have to tackle the whole issue of calories, portion sizes, etc. in a serious way.

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  8. I understand the evolutionary comment. We humans were designed to conserve energy at all costs. Not knowing when we’d get to eat again. We do live in an opposite evolutionary environment now. We are naturally designed to be lazy, over-eaters, not to be taken offensively, but seriously, viewed from the point of evolution, if food is present we eat it(in abundance), not knowing when we’d eat again. Then we’d rest to conserve energy. The problem now is, we live in a sociaty where we don’t need to hunt, forage, use large amounts of energy to obtain food, it’s simply a drive to the grocery store, a brief 15 minute walk, slow pace, back in the car, cook eat, sleep. We need to cut to the chase and realize that we are not designed to eat the amount and more pointedly the highly processed high carbohydrate unhealthy types of food we eat as they are likely polor opposite to what we ate 10000 plus years ago. Tough problem….. this obesity epidemic is, but I do agree that if we are forced to work 40 hours sitting down it’s a great concept to incorporate government manditated activity breaks, stand up work stations, stairs etc. But I believe we should make things simple and face the fact the living today means we consume enough processed carb to keep our tanks constantly full, and like Dr Sharma’s post eludes to in a 24 hour period we simply don’t move around enough to deplete the fuel tanks.

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  9. The original message is really demotivating ..:(

    Isn’t physical activity in our leisure time besides occupational and household activities, a lot more than just an energy equation ?? I explain to my patients : “every succesfull manager (professor ?) finds time for his personal physical activity in his busy agenda, and it’s fundamental for the lenght of his career ” …

    Should we abandon messages like the next one ? (Prof. Evans)

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  10. Talk about “polar oppisites” you want active buildings and those of us unfortunate ones with mobility issues are fighting for better accessabilility.
    I have recently had to resorted to having a foot brace to keep the foot bones from rubbing together and causing enough pain that I wake up in the morning with it–until now. I am glad that I don’t need to increase my pain medication, however, many with joint issues can’t get pain free. If the government decided to mandate activity breaks this would only be benefitial for those who do not have major mobility issues. The wheelchair bound employee CAN NOT get up and do maore physical activity and yet your all inclusive demeanor seems to point in that direction. The goverment issued laws the could help the disabled gain meaningful employment–something isn’t quite right with your thinking.

    Regarding the walking or running to “nowhere” is a real issue for me as I am very pragmatic something needs to have a purpose for me to ingage in it–recently the Clubhouse for mental health consumers had a walk-a-thon. I enjoyed the fundraising far more than the walking even though the fundraising required some walking.

    The real problem with physical activity is that as it is decreaded or stopped the amount of food needed to maintain the body is not decreased that is why many early middle age adults gain weight. They stop doing the acitivity and don’t stop quicker when eating–is it there fault–or is it that evolution thing.

    Thanks for the thought provoking articals the round out my need for information.

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  11. What I tell my patients is “You are not a firefighter, so you don’t have to climb stairs. But in case of an emergency, you should be able to walk down many flights of stairs.” According to Amanda Ripley’s book ‘The Unthinkable: Who survives when disaster strikes – and why’, people attempting to escape the World Trade Centres were not able to walk down the many flights of stairs. They collapsed in the stairwells and blocked the way for others.

    My advice to patients is to always use the stairs to exit a building. Take the elevator up, but always take the stairs down. The more, the better. The activity helps to strengthen the balancing and stabilizing muscles which support the knee cap and goes a long way to eliminating knee pain.

    Several squats per day will strengthen the other muscles. No one needs to perform 20 squats in sequence. Just do them over the course of a day, everyday. We need to maintain our joint health in order to carry out our daily tasks. We do not need to be Olympic athletes.


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  12. I recently got a pedometer for my birthday. I was shocked to discover that during my 8 hour work days I barely accomplish 5,000 steps! Compare this to the days when I’m home taking care of my children. On these days I am easily over 10,000 steps. I encourage you to try this experiment yourself so that you’re aware of the difference in your day to day count. Adults should be aiming for 10,000 steps per day. If the majority of this count could be accomplished at the workplace, we would be on the right track to a healthy lifestyle!

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  13. Kim

    There are many very overweight mailmen who walk up to 8 mies a day. It likely won’t make that much difference for weight.

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  14. Those mailmen are no doubt healthier for all the walking, though. Weight ≠ health, and health is more important than weight, unless you’re a actor or model and your livelihood depends on being thin.

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  15. In my view we have just simply overcomplicated weight loss to the point that people feel helpless, desperate and lost.

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  16. I came to this post late. But it’s not just about “active buildings”, it’s the design of cities that matters most, imo. A spatial culture that encourages people to drive to a store 5 minutes away (the result of decades of car-loving) can only hurt people living in it.

    I lost 30 pounds with no change in diet whatsoever, simply by moving to a walkable city with good design – actual neighbourhoods, transport links (even walking to one or more bus stops helps), and parks.

    There are obviously limitations on the ability to ‘retrofit’ the bedroom suburbs typical of North American cities, but I know city design makes all the difference.

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