J Health Behav Med Hist 2025-5.
Commentary (1) on: “Association between long-term sedentary behavior and depressive symptoms in U.S. adults” – Guo et al., (Nature) Sci Rep 2024.
Robert C. van de Graaf, MD, director
MEDTCC Institute for Health, Behaviour, Medicine and its History, The Netherlands.
The article published in Nature Scientific Reports on the association between long-term sedentary behavior and depressive symptoms in U.S. adults by Yuyang Guo and colleagues (2024) contributes valuable insight into the broader (mental) health impacts of sedentary behavior [Gou, 2024]. However, an important and often overlooked perspective may deepen our understanding: the viewpoint of addiction medicine.
In clinical practice as an addiction medicine specialist, I regularly work with individuals struggling with various forms of dependency. Among them, a growing number exhibit a pattern of compulsive chair use that resembles the diagnostic profile of substance use disorders. I refer to this emerging condition as Chair Use Disorder (CUD) [Van de Graaf, 2022].
CUD presents with striking parallels to substance use disorders as defined in the DSM-5. Patients often meet multiple of the following criteria:
- Using chairs more frequently or for longer periods than intended.
- Failing to cut down or stop using chairs despite wanting to.
- Spending significant time obtaining, using, or recovering from chair use.
- Experiencing cravings and urges to use chairs.
- Neglecting responsibilities at work, home, or school due to chair use.
- Continuing to use chairs despite relationship problems.
- Abandoning social, occupational, or recreational activities due to chair use.
- Using chairs even when it is dangerous.
- Persisting in chair use despite physical or psychological issues caused or worsened by it.
- Needing to use chairs more to achieve the same comfort (tolerance).
- Experiencing withdrawal symptoms, such as discomfort, irritability, and lower back pain, which can be relieved by using chairs again (chair use withdrawal syndrome).
As with other addictions, the core issue is not merely the amount of time spent in a sedentary state, but the persistence of harmful use despite clear physical, psychological, and social consequences—and the inability to stop despite a desire to change.
In my experience, individuals with Chair Use Disorder frequently grapple with deeply ingrained psychological patterns that closely resemble those seen in substance dependence. A pervasive loss of self-confidence, coupled with recurring depressive symptoms, is common—complicating recovery efforts and perpetuating the behavioral cycle driven by the lure of comfort.
Viewing sedentary behavior through the lens of addiction medicine offers a meaningful reframing. It not only allows us to better empathize with the lived experience of affected individuals but also expands the clinical and public health toolkit. Recognizing CUD as a legitimate behavioral addiction may open the door to leveraging effective interventions from the field of addiction care—such as motivational counseling, relapse prevention, environmental restructuring, and peer support.
This perspective deepens the discourse on sedentary behavior by revealing its compulsive nature and reframing it as more than just a conscious lifestyle choice. It invites a shift from mere risk-factor language toward a more comprehensive and humane understanding – one that acknowledges suffering, promotes agency, and encourages tailored, evidence-based responses at both individual and population levels.
References:
Guo (2024). Yuyang Guo, Kaixin Li, Yue Zhao, Changhong Wang, Hongfei Mo & Yan Li. Association between long-term sedentary behavior and depressive symptoms in U.S. adults. Sci Rep. 2024 Mar 4;14(1):5247. doi: 10.1038/s41598-024-55898-6. https://www.nature.com/articles/s41598-024-55898-6
Van de Graaf RC (2022). Van de Graaf RC, Hofstra L, Scherder EJA. Chair use disorder. We should treat excessive chair use as an addiction. J Phys Act Health 2022; 19(7):473. Doi: 10.1123/jpah.2022-0330. https://journals.humankinetics.com/view/journals/jpah/19/7/article-p473.xml