Conflicts of Interest

Dr. James Levine has received no money

from any of the below entities but has the
potential to earn royalties in future
governed by Mayo Clinic policies:
Apple Computer, Microscoft, Armani, Kersh
Health Risk Management, SP Health, Gentag
Inc, Google Inc

In 2009 Dr. Levine received a single

payment from Steelcase for design
consultancy.
In 2015 Dr. Levine received consulting

Get Up!
Is sitting the new smoking?
You were rightI do feel more
productive
standing up

New Yorker 2015

NEAT
NEAT
Non-exercise Activity
Non-exercise
Activity
Thermogenesis
Thermogenesis

.. varies 2000 kcal/day

in people of same size

Non-Exercise Activity
Thermogenesis
Kcal/day

Exercise

3000
Activity
thermogenesis

2000
1000
0

Thermic effect of food

Basal metabolic rate

Non-exercise
Activity
Thermogenesis
(NEAT)

Black, Eur J Clin Nutr 50:72

The Chairmans Rise to Power

200 years

NEAT
NEAT
Non-exercise
Activity
Non-exercise
Activity
Thermogenesis
Thermogenesis

.. varies 2000 kcal/day

because of WORK & PLAY

Occupationtype

NE
A
T
(kc
al
/
d
a
y
)
Chair-bound 300
Seated work: no 700
option of
moving
Data assuming BMR = 1600 kcal/day
Seated work: 100
discretion &
0

Black, Eur J Clin Nutr 50:72

220

200
150
70

Kcal/hour

Stair
Climbing

Gum
Chewing

Standing

Sitting

15 20
1 mph

2 mph 3 mph

Walking

Non-Exercise Activity Thermogenesis

Chair style

The NEAT way

NEAT
NEAT
Non-exercise
Activity
Non-exercise
Activity
Thermogenesis
Thermogenesis

NEAT important in body

fat

Non-Exercise Activity
Thermogenesis

Levine. Science 283;212

Change in walking energy

expenditure (kcal\day)
100
0

R=0.71;
P<0.001

80
0
60
0
40
0
20
0
0
1

Fat gain

5
Levine Diabetes, 57:548-54.

NEAT
NEAT
Non-exercise
Activity
Non-exercise
Activity
Thermogenesis
Thermogenesis

NEAT important in
obesity

Body
postures

Movements
e.g. walking

Levine et al Science, 28:584-6.

NEAT
NEAT
Non-exercise
Activity
Non-exercise
Activity
Thermogenesis
Thermogenesis

Neurological drive

Non-Exercise Activity
Thermogenesis

Orexin

NEAT

Obese
Lean

Orexin increases
NEAT more in:
lean rats
than obese

Kiwaki AJP 2004, Novak AJP 2006

Orexin A (nmol)

NEAT
NEAT
Non-exercise
Activity
Non-exercise
Activity
Thermogenesis
Thermogenesis

Ecology versus biology

Frances Mabel
Staples

OCTOBER 2013 | VOLUME 15 |

When were you born?

I was born on June 30, 1928 at a
summer campsite in the woods. I
had two sisters, Elsie and barb
My family did logging there and
picked rutabagas when it was
rutabaga season. They picked those
by the bushel.

What was life like when you were

little?
It was beautiful. We had to work all the
time, help our parents outside in the
heat and sun.
We used to wash socks on one of those
washboards. That was tough duty,
those
socks. They sure get dirty.

What foods do you remember?

Same as what we eat now. Oatmeal.
Bacon. Fry bread. Pancakes.
We had a big garden. We used to go
up and take radishes. And wed go out
in the woods. We had deer meat, our
dads hunted and fished. We picked
berries.

How did you keep food cold?

Get ice from the lake. That would
keep it cold.
Do you eat candy?
Throw candy away! Dont eat that
candy.

Call me
Auntie.

NEAT =
700 kcal/day
200 years

NEAT =
2000 kcal/day

Jamaica; the impact of urbanization

Urban

Urban

Rural
Forrester et al 2010 Urban Stud

Levine 2015 J Hepatol

Low NEAT and

obesity

Levine, Diabetes

Obesity rate and zip code in the United States

Data from 3,319 counties

NEAT
Lethal Sitting
Non-exercise Activity
Thermogenesis

34 Chronic diseases

The chairmans curse

34 chronic disease and
conditions
Significant hazard ratio (HR) associations:
all-cause mortality (HR, 1.240)
cardiovascular disease mortality (HR, 1.179),
cardiovascular disease incidence (HR, 1.143),
cancer mortality (HR, 1.173),
cancer incidence (HR, 1.130)
type 2 diabetes incidence (HR, 1.910).
Biswas. 2015;162(2):123-132.

Metabolic
Diabetes
Cardiovascular
Hypertension
Mechanical
Arthritis
Back pain
Malignancy
Breast
Mental
Depression
Creativity

20

The Diabetes Epidemic in the United States

1980-2009

ab
et
e

15

Di

Millions
diagnosed
with
diabetes
10

1980

1990

2000

2010

International
Most people with
diabetes do not
know they have it

 glucose
mMol/l
8

Meals + walk

Meals (no walk)

6
4
2
0

Time from meal ingestion (hours)

Manohar Diabetes Care. 35:2493

Sedentary Behavior

Pubmed citations
(2012, estimated)

NEAT
Get
Up!
Lethal Sitting

Non-exercise Activity
Thermogenesis

Assessment

NEAT -technologies

J Phys Act Health. 2009;6:781

Networked solutions

Non-Exercise Activity
Thermogenesis
N=7,433
The app:

Walk n play:
4 months 7,543 users
6 months 28,000 users

NEAT
Get
Up!
Lethal
Sitting
Non-exercise Activity
Thermogenesis

Office

Get Up! Desks

Get Up! Desks

Get Up! Meetings

Get Up! Solution support

Get Up! Office science

Get Up! Office science

Get Up! Office science

Performance

Time (weeks)

Ben-Ner et al 2014 Plos One

Get Up! Office Solutions

NEAT
Get
Up!
Lethal
Sitting
Non-exercise Activity
Thermogenesis

Kids

Get Up! School science

Get Up! School science

Get Up! School science

Get Up! School science

Lanningham-Foster Obesity 2008

Get Up! School science

Scalable active classroom (with
SMART)

McCrady J Phys Act Health. 2014

Get Up! School

Get Up! School

Why schools are adding standing desks to

the classroom
http://www.today.com/parents/why-schools-are-adding-standing-desks-classroom-t51856

NEAT
Get
Up!
Lethal
Sitting
Non-exercise Activity
Thermogenesis

Medical

Modern

Clinical Space

Traditional

Stress
management

Diabetes

Depression

Cognitive
decline

Womens health
Ob, menopause

Cardiovascular
CHF, HTN

Mens health

Diabetes

November 8, 2015

Therapy

NEAT
Get
Up!
Lethal
Sitting
Non-exercise Activity
Thermogenesis

City

 San Francisco in 2013, the average persons travel time by

foot was 4 minutes/day.
In a leg-based travel active scenario, average commutes
would increase by 18 minutes.
2,404 avoided premature deaths per year.
healthcare cost savings in San Francisco would
approximate $34 billion/year.

Science proceeds from the

assumption that misery
is not fated ..
. that because all events
are caused, all problems
can eventually be solved.

Copeland

https://www.youtube.com/watch?v=UfJt2W695WE

Get Up!

Your chair is killing you .andyou can do

something about it

http://time.com/4
019563/exercisework-desk/