Tag Archives: back pain

Overprescribing: Do You Really Need to Take That Med?

Do you take 4 pills a day? If so, you’re like most Americans. Yet what are we taking all these pills for, and are they improving our lives?

The overuse of prescription drugs has become a serious problem in the US. We hear about this most in the context of opioids — narcotic painkillers whose widespread use and abuse has become a national crisis.

The overuse of antibiotics has also become the focus of an intensive campaign to steer doctors and patients to more judicious use.

The soaring use of prescription drugs has been driven by several factors: A plethora of new drugs coming to the market; a culture that has come to expect a “pill for every ill”; aggressive marketing to both doctors and consumers by the pharmaceutical industry; and treating some “pre-”diseases with pills rather than with lifestyle changes.

Between 1997 and 2016, the number of prescriptions filled in the US increased 85% — from 2.4 billion to 4.5 billion — even though the population increased by just 21%. Nearly half (49%) of adults take at least 1 prescription drug, 23% take 3 or more and about 12% take 5 or more, according to the latest data from the CDC (Centers for Disease Control and Prevention). One in 10 adults takes 10 or more drugs, and the average adult takes 4 prescription medications, according to a Consumer Reports survey of 1,947 adults conducted in April.

What can you do to make sure you’re not getting a drug you don’t need and to avoid harm?

Ten “secret shoppers” were sent to 45 drugstores across the US in a recent Consumer Reports investigative study. The shoppers were testing how well pharmacists identified potential problems with drugs.

Of course, it’s your doctor who should be your main consultant on the medicines you take. But bring a big measure of skepticism to your doctor visits: The evidence is now clear that they can be a part of the problem.

Based on the secret shoppers’ findings and more than a decade of Consumer Reports’ grant-funded Best Buy Drugs program, we have compiled a list of drugs that you should use special caution with when prescribed by your healthcare provider.

(For more detailed information, check out Consumer Reports’ September 2017 cover story and the physician-led Choosing Wisely program.

Abilify and Seroquel for Dementia or ADHD

These powerful antipsychotics have potent sedative effects and can be downright dangerous. Studies over the last decade show they have been overprescribed in general and particularly for elderly people with dementia.

The FDA and other healthcare and physician organizations now advise against their use entirely in elderly people. Multiple studies over many years have found an increased risk of death in elderly people prescribed these drugs.

Abilify (aripiprazole) and Seroquel (quetiapine) are also overprescribed to treat children and adults with attention-deficit/hyperactivity disorder (ADHD). The two drugs are not even approved for this condition. Their use to treat ADHD is not advisable unless a person is diagnosed with other psychiatric conditions, such as bipolar disorder. And even then, caution is warranted. Behavioral therapy is a better initial treatment for ADHD.

Advil, Aleve, Celebrex and Any Opioid for Back and/or Joint Pain

The non-steroidal anti-inflammatory drugs (NSAIDs) Advil (ibuprofen), Aleve (naproxen) and Celebrex (celecoxib) are commonly prescribed to treat back and joint pain (and headaches, of course). Short-term use — up to 10 days — is fine at the lowest dose that helps.

But long-term use — which is all too common — is ill-advised because all these drugs can cause bleeding in the intestines and stomach, and increase the risk of heart attack and stroke (especially at higher doses).

Opioids should simply never be a first-line treatment for either chronic back pain or garden-variety periodic back pain (“I threw my back out” kind of pain). The risks are too high. The side effects include drowsiness, sedation, nausea, vomiting, constipation, addiction and overdose. Instead, try yoga, swimming, gentle stretches, tai chi, massage, physical therapy, acupuncture or heat.

For intense pain flare-ups (pain in the range of 8 to 10 on a 10-point scale), an opioid can be useful, but it should be prescribed at the lowest dose that’s effective and for the shortest time possible, like a day or 2. And never more than a week to 10 days.

Celexa, Cymbalta, Lexapro and Prozac for Mild Depression

Antidepressants are overprescribed for people who have mild or so-called “situational” depression — that is, depression triggered by a life event such as a death in the family, job loss, divorce or breakup, accident, trauma or diagnosis with a serious health condition.

You don’t need a pill if these life events befall you. Social support, time and psychotherapy or counseling almost always help. Also, be sure to exercise and perhaps try meditation and/or yoga. For the vast majority of people who have situational depression, the symptoms lift within a few weeks to a couple months.

Nexium, Prevacid and Prilosec for Heartburn

These drugs, called proton-pump inhibitors (PPIs), reduce stomach acid. They were designed to treat a condition called gastroesophageal reflux disease (GERD). But they are greatly overprescribed for common, uncomplicated heartburn, which most of the time can be just as effectively treated with over-the-counter (OTC) products such as Maalox, Pepcid AC, Tums or Zantac 75.

The problem with taking PPIs is that they carry serious risks — a few of which were not fully appreciated until a few years ago. These include a reduction in the body’s ability to absorb certain nutrients and medications, along with an increased risk of gastrointestinal and other infections.

Instead, as a first-line treatment, eat smaller meals, don’t lie down soon after eating, lose excess weight, and avoid acidic or greasy meals that trigger heartburn.

If heartburn occurs twice weekly or more for 4 weeks or longer despite the above diet and lifestyle changes, then you might have damaged your esophagus. Check with your doctor, and if GERD is diagnosed, it would be appropriate to take a PPI for a few months while your esophagus heals.

Ambien, Belsomra and Lunesta for Insomnia

These strong sleeping pills are way overprescribed for people who have insomnia triggered by a life event, as well as for people who have chronic insomnia.

If you find yourself in the first group, try an OTC sleep aid containing an antihistamine, but not for longer than a few days. People with chronic insomnia are not helped in the long term by taking these medicines, recent evidence shows. Instead, try cognitive behavioral therapy (CBT), where a provider teaches you good sleep habits and suggests ways to change your behavior and nighttime habits.

Prescription medicines have significant side effects and risks, including dizziness, next-day drowsiness, impaired driving, dependence, and worsened sleeplessness when you try to stop.

AndroGel, Axiron, Androderm and Aveed for Low Testosterone

Low testosterone (“low T”) is a controversial diagnosis. If you get such a diagnosis and your doctor advises you to take any of these medicines, get a second opinion.

A small percentage of men (usually in their 50s, 60s and 70s) have “low T,” but the manufacturers of these products have sought to create a condition that is not firmly established in medical literature — one marked by low energy and low sex drive due to “low testosterone.”

Don’t buy into it. The drugs can cause blood clots in the legs, sleep apnea, an enlarged prostate and possibly an increased risk of heart attack or stroke.

Instead, talk to your doctor about treating common underlying conditions that can decrease testosterone level, such as diabetes, obesity and aging. Also discuss non-drug ways to boost energy and vitality by exercising, getting enough sleep and couples therapy with your partner.

Actonel, Boniva and Fosamax to Treat Osteopenia (Low Bone Density)

These drugs, called bisphosphonates, are widely prescribed to treat a condition dubbed “pre-osteoporosis.” But there’s scientific controversy about the prevalence and impact of mildly or marginally low bone density, and whether it warrants treatment with these strong medicines.

All have side effects and carry risks, which include diarrhea, nausea, vomiting, heartburn, esophageal irritation and bone, joint or muscle pain. Long-term use has also been linked to an increased risk of fractures of the femur (thigh bone).

Before considering one of these medicines, walk more, quit smoking and try eating more foods high in calcium and vitamin D. If bone density tests show you have full-blown osteoporosis, you should consider one of these medicines. But use caution with long-term use.

Detrol and Oxytrol for “Overactive Bladder”

The sudden or frequent need to pee is frustrating and inconvenient. These medicines, called anticholinergics, are often prescribed even to people who have mild symptoms.

The drugs can cause constipation, blurred vision, dizziness and confusion. So before trying one, cut back on caffeine, soft drinks and alcohol, and watch your liquid intake overall. Also, try bladder training (slowly increasing the time between bathroom visits) and Kegel exercises — repeatedly tightening and relaxing the muscles that stop urine flow. These techniques have been proven effective.

If several weeks or months of non-drug strategies don’t provide enough relief, consider an anticholinergic.

Actos and Glucophage for “Pre-diabetes”

Pre-diabetes is a widely accepted condition (unlike “low T”), but there’s no consensus on how aggressively to treat it, or if people with it should take drugs. People with pre-diabetes have blood glucose (sugar) levels at the high end of normal.

Because these diabetes medicines have side effects and carry risks — including dizziness, fatigue, muscle pain and, in rare cases, the dangerous buildup of lactic acid and a vitamin B12 deficiency — talk to your doctor about non-drug options first, such as exercise, a diet rich in unprocessed and non-starchy foods, and weight loss.

If you develop type 2 diabetes, however, you should consider a diabetes drug.

Drugs to treat Pre-hypertension

Like pre-diabetes, pre-hypertension is an accepted condition that warrants monitoring. It’s defined as blood pressure at the high end of normal. But, also like pre-diabetes, there’s no consensus on when to treat it with drugs.

Many classes of medicines are used. They include ACE inhibitors, angiotensin receptor blockers (ARBs), calcium channel blockers and diuretics. All are effective at lowering blood pressure but have side effects. Diuretics can cause frequent urination, low potassium levels and erectile dysfunction. ACE inhibitors and ARBs can cause high potassium levels and reduced kidney function. Calcium channel blockers can cause dizziness, an abnormal heartbeat, flushing, headache, swollen gums and, less often, breathing problems.

Unless a patient has other conditions that make the case for starting a drug, non-drug options are a better initial treatment to bring blood pressure into the normal range. Most important among them: Quit smoking, cut back on sodium and alcohol, lose excess weight, and exercise.

Belviq, Contrave, Qsymia and Xenical for Obesity

These weight loss drgs have mixed effectiveness. They work for some people and not at all for others. For patients who are significantly overweight or have diabetes or heart disease, and have been unable to lose weight through exercise and diet, one of these medicines may be worth trying.

But the drugs should not be a first-line treatment for anyone who is just 10 to 20 pounds overweight and hasn’t yet really tried lifestyle and diet changes. All have side effects that are common and can be quite discomforting. Constipation, diarrhea, nausea and vomiting are common.

The drugs also carry rare but dangerous risks, including leaky heart valves with Belviq and liver damage with Xenical.

Americans are all too often pushed — or rushed — into taking drugs too soon. Sure, lifestyle changes can be hard. But they don’t have side effects and the risks are well defined and easily avoidable. And the payoff from adopting a much healthier diet or sticking to an exercise regimen often goes well beyond addressing the medical condition at hand and improves your overall physical and mental health.

Quick Hits: FDA Approves New Antibiotic, ADHD Med, and Opioid Use in Depressed Patients

The FDA has approved Baxdela (delafloxacin), a fluoroquinolone antibiotic that is used to treat acute bacterial skin and skin structure infections (ABSSSI). The drug is available as a tablet or intravenous injection. Labeling for the drug includes a “black box” warning due to serious adverse and potentially irreversible reactions that have been associated with fluoroquinolones, such as tendinitis and tendon rupture, peripheral neuropathy and central nervous system effects. In trials, the most common adverse reactions in patients observed were nausea, diarrhea, headache, elevations of the enzyme transaminase, which can indicate liver damage, and vomiting. Posted June 19, 2017. Via Melinta Therapeutics.

A new once-daily treatment for attention deficit/hyperactivity disorder (ADHD) has won FDA approval. Mydayis, a stimulant for patients 13 years and older, contains the same active ingredients as Adderall (amphetamine/dextroamphetamine), but lasts for up to 16 hours compared to up to 6 for Adderall and 12 for Adderall XR. Adderall and Adderall XR are both available as a generic. Like other stimulant medications, such as methylphenidate (Ritalin, Concerta, Daytrana), Mydayis has a “black box” warning because it has a high chance for abuse and can cause physical and psychological dependence. Posted June 20, 2017. Via Shire.

Patients with low back pain who also suffer from depression are more likely to be given opioids that are prescribed at higher doses. This is problematic, since patients with depression are at a higher risk of misuse and overdose of opioids. Researchers examined data on opioid prescriptions from 2004-2009 and found that those with low back pain who also had depression were twice as likely to be prescribed an opioid than those without depression. And over a year, they typically got more than twice the usual dose, according to the study published in the journal Pain Reports. The authors noted more study is needed to determine the risks and benefits of prescribing such powerful painkillers to those who are depressed. Posted June 20, 2017. Via University of Rochester Medical Center.

Statins Linked to Higher Risk of Back Problems

Use of a common class of drugs used to lower cholesterol may increases one’s risk of developing back problems.

Researchers examined data on 14,000 adults more than 30 years old who were enrolled in TRICARE, the military’s health care program. Half had taken a statin drug an average of 3.7 years while the others had never taken one. Zocor (simvastatin) was the most commonly taken statin in the study.

Statin users had a higher likelihood of back disorders, such as spondylosis and intervertebral disc disorder, the researchers reported in JAMA Internal Medicine.

Researchers did caution that because the study subjects were TRICARE enrollees, they are not sure if the results would be applicable to those who lead a more sedentary lifestyle.

“Our results provide additional motivation to further investigate the overall influence of statin therapy on musculoskeletal health, specifically if prescribed for primary prevention in physically active individuals,” the researchers concluded.

Steroid Injections Provide No Long-Term Relief for Lower Back Pain

Getting steroid injections to alleviate lower back pain only offers short-term relief.

Researchers in France examined 145 patients that complained of lower back pain. On average, they suffered from back pain for 6 years. Some of the participants received a steroid injection, while others received no treatment. Patients were asked to rate the severity of their pain at the study start, and again 1, 3, 6 and 12 months later.

A month after treatment, 55% of those who got the injection experienced less lower back pain, compared with 33% who didn’t receive an injection. However, 12 months after the study began, there was no difference in pain outcomes between those who got the injection and those who didn’t, the researchers reported in the Annals of Internal Medicine.

In addition, at 12 months, the 2 groups had similar rates of disc inflammation, lower quality of life, more anxiety and depression, and use of pain medication.

Need to Know: Acetaminophen

Acetaminophen is a pain reliever used to treat conditions such as headaches, menstrual periods, toothaches, backaches, fevers, osteoarthritis, or cold/flu aches and pains. It is one of the most widely used pain medications in the world and is sold mainly over the counter. Although often used to treat mild to moderate pain, acetaminophen has been linked to severe side effects that are sometimes fatal.

Common Names

Tylenol, Panadol, Anacin, Paracetamol, APAP. Many over-the-counter drugs contain acetaminophen as well. These include Dimetapp, Excedrin, Mucinex, Nyquil, Robitussin, Sudafed, Triaminic and Tylenol PM.

Side Effects and What to Do About Them

Serious side effects are rare with acetaminophen. However, if used more than directed, acetaminophen can cause serious liver damage, which in some cases requires liver transplantation or causes death. You should not exceed more than 4,000 mg per day.

Other side effects reported are: red, peeling or blistering skin; rash; hives; itching; swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles or lower legs; hoarseness; difficulty breathing or swallowing.

If you experience any of those symptoms, stop the medication and contact your doctor immediately.

People who drink 3 or more alcoholic beverages while taking acetaminophen are even more susceptible to liver damage. Alcohol lowers your body’s tolerance of acetaminophen and can cause liver damage that may lead to acute liver failure and death.

One study published earlier this year in JAMA found that just acetaminophen at the recommended dose for 4 days in a row could elevate your risk of liver damage.

Women who take acetaminophen during pregnancy can experience unwanted side effects. Toxic levels of acetaminophen can pass through the placenta, mean the drug can pass through to the fetus. However, medical professionals consider acetaminophen the pain reliever of choice for pregnant women.

A study published this year also found that prenatal exposure to acetaminophen was associated with “a higher risk of having children who exhibit emotional or behavioral symptoms.” However, the FDA and many doctors have said there is no clear evidence linking acetaminophen to developmental issues.

Acetaminophen can be problematic because it is easy for adults to overdose unintentionally. Overdose usually occurs when adults decide to take more of the medication because they don’t feel relief from the recommended dosage.

Inadvertent overdosing also occurs when acetaminophen is combined with other drugs. Almost 200 brand-name and generic products contain acetaminophen; they range from headache and backache pills to cold and flu treatments and sore-throat remedies.

It is common for people to take several over-the-counter medications in order to alleviate pain. Taking prescription medications in conjunction with over-the-counter medications containing acetaminophen also increases the risk of overdosing. It is imperative that patients check product labels to avoid taking a double dose.

In 2014, the FDA issued a statement recommending that doctors stop prescribing combination drug products that contain more than 325mg of acetaminophen per tablet, capsule or other dosage unit. According to the FDA, “limiting the amount of acetaminophen per dosage unit will reduce the risk of severe liver injury from inadvertent acetaminophen overdose, which can lead to liver failure, liver transplant, and death.”

Drug Interactions

More than 600 prescription and over-the-counter drugs contain acetaminophen. Therefore, taking one medication with acetaminophen and another medication that also contains it could result in a potential overdose or lead to liver damage.

If these medications are prescribed together, ask your doctor if a dosage adjustment will be necessary. It is important to consult with your doctor and report all other medications that you are taking as well.

A complete list of drug interactions with acetaminophen is available here.

Effectiveness & Considerations

While acetaminophen is widely taken to treat aches, pains and fever, it is not a perfect pain reliever. Some reviews have found it to be ineffective in treating low back pain or disability.

A study published online in the BMJ tested the efficacy and safety of acetaminophen for spinal pain and osteoarthritis. Results found “high quality” evidence that acetaminophen is ineffective in the short term for reducing pain intensity and disability in people with low back pain. For hip or knee osteoarthritis, there was “high quality” evidence that acetaminophen in the short term provides a significant, although not clinically important, effect on pain and disability.

Alternatives to Acetaminophen

Although acetaminophen is widely used worldwide, there are other treatments available. A common alternative for acetaminophen are NSAIDs (non-steroidal anti-inflammatory drugs) such as Advil and Motrin (ibuprofen), as well as Aleve (naproxen). However, NSAIDs also have many side effects to contend with, so it is best to discuss with your doctor the optimal pain-relieving medication for you.

How They Work (Method of Action)

When taking acetaminophen, the drug is primarily processed in the liver. Acetaminophen belongs to a class of drugs called analgesics and antipyretic agents. An analgesic relieves pain while an antipyretic reduces fevers.

Acetaminophen works by elevating a body’s pain threshold. The effectiveness of the drug is believed to stem from the fact that it inhibits certain parts of the brain (neurotransmitter receptors) that register pain and blocks the enzyme that produces pain and inflammation.

What Worked for You?

Share your experience with acetaminophen in the Disqus Box below.

MedShadow Coverage on Acetaminophen

Further Reading

Why Opioids Are More Dangerous for Seniors

One of the most fascinating aspects of learning about side effects of drugs has been to discover that many side effects are predictable based on how the a drug works in the body — what is called “method of action.”

Opioids, for example, work by slowing pain receptors and increasing dopamine, a chemical that controls the brain’s reward and pleasure center, which is an effective way of inhibiting the body’s ability to feel pain and makes you feel great.

This colorful and informative video explains how opioids work (there’s no sound).

However, opioids not only go to the brain but also move throughout the entire body affecting (and most often, slowing) all body systems. The most obviously inhibited one, after pain, is the digestive system. Hence the well-known problem of “opioid-induced constipation.”

And Then There’s Aging

Aging bodies add another dimension. Medicines accumulate more easily in a body (especially in the kidneys) where all systems are naturally slowing down from age. If you’re a senior, ask your doctors to give you the lowest effective dose of the lowest level of pain med, which is good advice at any age. The choice of pain killer should be very different for a healthy 40-year-old who plays squash weekly than for an 80-year-old with high blood pressure who walks a few blocks a day and has a delicate stomach.

Elderly adults taking opioid painkillers have 4 times as many bone fractures, are 68% more likely to be hospitalized and are 87% more likely to die as those taking over-the-counter pain medication.

Side effects from most drugs, and especially opioid drugs, are more pronounced in seniors. Falls, dizziness, headaches, sedation, worse constipation and slow reaction times are much more common when using opioids. (Should you be driving while using even a mild opioid?)

Elderly adults taking opioid painkillers have 4 times as many bone fractures, are 68% more likely to be hospitalized and are 87% more likely to die as those taking over-the-counter pain medication, according to the National Safety Council.

When Options Become Limited

Why take any opioid if you’re a senior who isn’t in end-of-life care? Your options become limited as your stomach becomes more sensitive, your kidneys and liver process more slowly and you take other medicines that might interact badly with some meds. Some of the less extreme painkillers, like Aleve or Tylenol, aren’t tolerated well. For example, aspirin and NSAIDs can upset stomachs. Note that some studies indicate that opioid drugs are just as upsetting to stomachs.

Weaker opioids like codeine don’t work for many people. The next step up, morphine, is hard on the kidneys, an organ that is commonly compromised in old age. Hydromorphine is easier on the kidneys but much more potent, stronger than might be needed with stronger side effects. Opioid choices get stronger and affect the body more from there.

What to do if your doctor recommends an opioid-based drug? Consider refusing them. They are NOT RECOMMENDED for headaches or migraines, and the benefits of using them for fibromyalgia or chronic back pain probably don’t outweigh their very significant risks, the AAN (American Academy of Neurology) states.

Work with your doctor on a multifaceted approach to pain management, as recommended by the AAN. Cognitive-behavioral therapy and activity coaching have been very successful not only at lowering pain but increasing the ability to function.

Fix the source of the pain and take opioids for the shortest time period possible. Do your best to make sure a temporary severe pain doesn’t turn into a chronic one.

Watch for Drug Interactions

If you’re a senior and taking drugs for high blood pressure, cardio issues, diabetes, etc., prescribing is complicated and risky. Drug-to-drug interactions are not only possible, they are likely. Assume any new symptom is a side effect and call your doctor before it becomes life threatening or limiting. This is one of the many reasons that we at MedShadow encourage you to discuss thoroughly your options for alternatives to drugs wherever possible — this way, when you need drugs your doctors have more options.

Opioids are known for being highly addictive. And as discussed in our recent article, 3 Steps from Pain Management to Heroin, seniors are not immune to addiction.

Whether you are a senior, care for a senior or expect to become a senior one day, it’s always important to discuss with your health care provider why you are taking a drug, how long you can expect to take it and what the effect of it will be on your entire body, not just the problem area.

Pain in the Back

By Elizabeth Marglin
Most of the 56 million Americans who suffer from chronic low back pain are told to just take acetaminophen. The problem? It does little to relieve their discomfort. A recent study published in the British Medical Journal bears this out: Researchers concluded that Tylenol and other products containing acetaminophen were no more effective than a placebo for more than 1,600 people suffering from acute lower back pain. Prescription painkillers can provide relief in the short term, but because of their serious side effects, doctors are more and more reluctant to prescribe them. But the good news is that newer, drug-free treatments are gaining traction.

Back pain usually starts with muscle spasms — debilitating pain for short periods of time — typically triggered not by traumatic events but by mild tweaks.

“More than 70% of all adults experience disabling back pain at some point. It’s the most common cause of job-related disability and the reason behind most missed workdays,” says Rowland Hazard, MD, director of the Functional Restoration Program at Dartmouth-Hitchcock Medical Center in New Hampshire.

More than a quarter of adults — a figure Dr. Hazard puts at 30% — reported experiencing low back pain during the past 3 months.

Once back pain episodes become more frequent and intense, doctors might refer patients to spinal and orthopedic surgeons or order an MRI or other form of  imaging. They might learn that their particular brand of pain is the result of spondylitis (a type of arthritis that affects the spine), spinal stenosis (narrowing of the spaces between the bones of the spine, which can create pressure on the spinal cord and nerves), arthritis or degenerative disc disease.

Acute back pain tends to resolve itself after several weeks, but for people with chronic pain, it keeps recurring — and might, in fact, never go away.

Why Back Pain Diagnoses Are Evolving

Although it’s a remarkably common health issue, back pain is tricky to treat. Even with the sophisticated imaging tools at a doctor’s disposal, such as Magnetic Resonance Imaging (MRIs), often there’s no clear anatomical diagnosis.

‘We’re spending billions of dollars every year on treatment, MRIs, opioids and surgeries for people with back pain,’ Dr. Hazard says. ‘At the same time, there’s a disconnect. People are not feeling better.’

“A lot of images have false positives. Things will show up that are age-related but are not what’s causing the person’s trauma,” says Dr. Hazard. “Confusion and frustration arises from the difficulty of being able to make a specific diagnosis.”

And the rate of disability claims due to back pain are growing despite how much money we throw at the problem.
Back Pain and Disability
To improve treatment outcomes, doctors are beginning to shift their approaches to back pain. It’s no longer seen as a symptom, but a disease in and of itself. The spine is complex, and the pain can have a clear cause, such as a pinched nerve or herniated disc.

But it can also be a symptom of other medical conditions going on with the patient. Obesity and sedentary lifestyles, for example, also can set the stage for low back pain.

“In the last 5 years or so, a tidal wave of research demonstrates that sedentariness is substantially more impactful than previously thought,” says Stephen West, BS, RMT, a massage therapist based in Boulder, Colorado. “And the effects of sitting for 8 hours a day, on average, are not overcome merely by working out for 1 to 2 hours a day.”

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