Deconditioning – Are you headed for trouble?

Move More, Eat Less: Addressing Deconditioning and Obesity

Most of the clients that attend our clinic are suffering from a general physical deconditioning, which has ultimately resulted in some premature degeneration and pain.

This is an ever-more sedentary world we live in and this decline in physical activity together with the accompanying weight gain is causing an increase in obesity, physical deconditioning, structural degenerative changes, cardiovascular disease, diabetes and more.

This double-edged sword of deconditioning and excessive caloric intake is now of epidemic proportions. As a chiropractor, it is clear that this not only affects the general population, but it also affects our patients’ ability to respond as well as possible to their spinal adjustments and their ability to perform the exercises we prescribe.

Our Obesogenic Society

You know that the world is changing when we have to invent new words to describe things. Well, ‘Obesogenic’ is a recent medical term for factors that lead to obesity. The Health Promotion Board of Singapore recently revealed that obesity in Singapore has increased to 10.8 per cent, up from 6.9% in 2004, an increase of 56 per cent in only 8 years. The proportion of the population merely overweight is clearly much, much greater. This worrying trend continues and such figures do not surprise doctors because of Singaporeans’ love for eating. In America the situation is much worse and by 2015 it is estimated that 75 percent of adults will be overweight, and 41 percent will actually be obese.

A major reason for this rapid growth in obesity is the increase in caloric intake in our diets and a shift away from traditional home prepared natural food towards processed food ‘products’ and the Standard American Diet (SAD). We are eating more and we are eating more bad stuff. To reverse the obesity epidemic, we need to stop going for the universally available cheap calories found in soft drinks, fast foods, snack foods, fried foods, etc.

The Epidemic of Type 2 Diabetes

Since 2004, diabetes in Singapore has increased from 8% to 12 % of the population being affected. To put this into perspective, this is similar to the USA which of course has a truly appalling record when it comes to health. That’s one person in nine across the board. By 2050 half of the 70 year olds will have this terrible disease. Yes, that means half of the young adults and children alive today will eventually succumb to diabetes!!!

Physical Activity and the Deconditioning Syndrome

As our world continues to change, children and young adults spend more and more time watching TV, playing computer games, surfing the internet and interacting on social media. Studies clearly reveal declining physical activity with age. Less than half of our children obtain the recommended 60 minutes per day of physical activity, whereas less than one in ten percent of adolescents do. The amount of adults who receive the recommended 30 minutes day of physical activity is less than one in 20! All this results in many unhealthy changes to our bodies and this is commonly referred to as ‘deconditioning syndrome’. Major changes included in this syndrome are:

1) Decreased joint movement

2) Muscle wastage – decreased muscular strength and endurance

3) Decreasing core strength

4) Reduced cardiovascular fitness

5) Stiffness of ligaments and joints

6) Reduced metabolic activity

7) Increased susceptibility to sprains, strains and muscle spasms

8) Poor bone quality

9) Poorer balance and greater susceptibility to falls and accidents.

10) Move towards Metabolic Syndrome (Diabetes and Heart Disease)

These degenerative effects lead to pain which in turn causes greater avoidance of activity. This is the vicious circle many find themselves trapped in.

Pain and avoidance of activity ? deconditioning ? more pain

It’s true that most back pain sufferers get dragged into this spiral and we must do everything we can to break out of it and get back ‘on track.’

The Dangers of Inactivity

Deconditioning happens when we do little or no exercise for period of time, for example with bed rest, prolonged sitting or in living a very sedentary lifestyle. It is associated with a host of unhealthy changes and an important recent study revealed that long periods of sitting time are strongly associated with chronic diseases including: obesity, abnormal glucose metabolism, diabetes, metabolic syndrome, cardiovascular disease risk and cancer, independent of whether adults meet physical activity guidelines. (Ref 1 below)

This really is bad news for Singapore as this study clearly shows that the unhealthy metabolic changes brought on by prolonged inactivity cannot be fully reversed or compensated for by one hour of vigorous physical activity. Each one-hour increase in sitting time (watching television) increased the prevalence of the metabolic syndrome in women by 26 percent, independent of the amount of moderate to vigorous physical exercise performed. This is approximately the same decreased risk (28 percent) of the metabolic syndrome caused by 30 minutes of extra physical exercise.

Even activities as minimal as standing, rather than sitting, were shown to result in substantial increases in energy use and resistance to fat gain.

Bottom line – sitting all day is a killer!

In people who do not exercise, it is important to reduce their sitting time and try to do as much low-intensity activity (such as standing, walking and walking stairs) to reduce their metabolic risk.

Metabolic Syndrome

The metabolic syndrome or insulin resistance syndrome is characterized by at least three of the five following metabolic derangements:

1) High levels of ‘bad’ fats

2) Low levels of ‘good’ fats

3) High Blood Pressure

4) Elevated blood glucose

5) Increased waist circumference (>102 cm for men and >88 cm for women).

Increased waist circumference, which is a measure of visceral fat (fat in and around the organs), causes increased systemic inflammation, which promotes diabetes and cardio-vascular disease. Mortality (susceptibility of death) is increased 2.26-fold in men and 2.78-fold in women with metabolic syndrome, independent of age, body mass index, cholesterol levels and smoking status.

Move More, Eat Less

So, the take-home message can be concisely expressed as, “Move more, eat less.” This is clearly the basic formula for a healthy, long and functional life. It is important for everyone to understand that it is not enough to be passive and compliant, but we must learn to accept responsibility for our health and function. We need to understand that many of our symptoms and much of our dysfunction is within our control, not the doctor’s.

Dr Tim’s Recommendation

Find a decent chiropractor, buy a fit-ball and keep moving! Get Proactive!


1) 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):998e1005.

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