Sitting Less, Living Better: Why Breaking Up Sedentary Time Matters as Much as Workouts for People with Osteoporosis

Table of Contents

1. Key Highlights:
2. Introduction
3. How the study was done and what it measured
4. Sedentary time versus exercise: untangling two separate risks
5. Where physical, emotional, and social health diverge
6. Biological mechanisms: how sitting accelerates bone and muscle loss
7. Health equity and access: private versus public care disparities
8. Practical strategies: interrupt sitting, build load, protect against falls
9. Designing daily routines: practical templates for different lifestyles
10. Group-based approaches and mental health benefits
11. Rehabilitation after fracture: restoring movement and confidence
12. Technology and low-cost tools to interrupt sitting
13. Clinical practice: how clinicians should adapt messages and prescriptions
14. Community and policy-level interventions
15. Addressing common concerns and safety questions
16. Patient-centered examples: small changes, measurable effects
17. Research gaps and next steps
18. How to begin—simple first steps for patients and caregivers
19. FAQ

Key Highlights:

• A University of Johannesburg study of 209 adults with osteoporosis found prolonged sitting independently worsens bone health and quality of life, even among those who meet weekly exercise targets.
• Emotional well-being and social connection scored far lower than physical functioning, highlighting that exercise alone does not address isolation, pain, and fear of falling.
• Practical actions—breaking up sitting every 30–60 minutes, prioritizing weight-bearing and resistance exercise, and using group or rehab programs—reduce fracture risk and improve physical and social outcomes.

Introduction

For people living with osteoporosis, conventional public health advice—hit 150 minutes of moderate exercise a week and you’re covered—misses a critical piece of the puzzle. New research from the University of Johannesburg shows that long uninterrupted periods of sitting carry their own, independent harm. Patients who faithfully complete their weekly workouts still reported lower quality-of-life scores when they spent the rest of their waking hours sedentary. That finding reframes bone health as a two-front battle: structured exercise and daily movement habits.

This investigation, conducted among adults aged 35 to 94 with an average age of 64, paired activity-pattern questionnaires with validated measures of physical, emotional, and social quality of life. The results expose a feedback loop that clinicians and caregivers see in practice: pain and fractures promote inactivity; inactivity accelerates bone and muscle loss; the resulting weakness breeds more falls and fractures. The chain of decline can be interrupted with relatively small, practical changes to the rhythm of every day—changes that address mobility, mood, and social connection at once.

The following sections explain the study’s design and findings, unpack the biological mechanisms linking sitting and bone loss, examine disparities in access to care, and provide detailed, actionable strategies individuals and systems can adopt to reduce sedentary harm while strengthening bone and muscle.

How the study was done and what it measured

Researchers enrolled 209 adults with diagnosed osteoporosis and gathered two primary data streams. One questionnaire captured physical activity across occupational, commuting, and leisure domains—how much time participants spent walking, standing, engaging in light movement, or doing vigorous activity. The second tool measured health-related quality of life across three domains: physical functioning, emotional well-being, and social connection.

Key characteristics:

• Age range: 35–94; mean age roughly 64.
• Activity patterns: Most participants logged walking or light movement but rarely vigorous exercise. Only 6% reported vigorous activity at work; 28% engaged in vigorous leisure activity.
• Quality-of-life scoring: Physical functioning averaged 76%; emotional well-being 58%; social connection 56%.

The cross-sectional design identifies associations, not causation. Still, the pattern is robust: high volumes of sedentary time correlated with lower overall quality-of-life scores, and the emotional and social effects appeared distinct from physical measures. Health insurance status aligned closely with outcomes: participants with private coverage reported a 73% quality-of-life score versus 50% for those relying on public healthcare systems.

These methods emphasize patient experience and daily behavior rather than focusing narrowly on bone mineral density. The approach aligns clinical priorities—fracture prevention, functional independence, and psychological health—with concrete, modifiable habits people can change without waiting for new pharmaceuticals or surgeries.

Sedentary time versus exercise: untangling two separate risks

The old framing treats exercise as the antidote to inactivity. This study shows the relationship is more complex: exercise and sedentary time are related yet distinct behaviors with independent effects.

Why both matter:

• Exercise sessions stimulate bone through mechanical loading: ground reaction forces, muscle contractions, and impact produce remodeling signals.
• Prolonged sitting removes habitual mechanical loading for hours at a time, reducing the frequency of stimuli that maintain bone and muscle.
• Metabolic effects of prolonged sitting—impaired insulin sensitivity, local blood flow changes, and inflammatory signaling—may undermine tissue maintenance and repair.

A simple illustration: two people each meet the weekly rule of 150 minutes of moderate activity. One spreads that activity across the day—walking in short bouts, standing breaks, household tasks—and sits less overall. The other compresses activity into three 50-minute sessions and spends the remaining hours seated. According to the study’s findings, the first person is likely to have better quality-of-life scores and lower functional decline over time because bone and muscle benefit from repeated intermittent loading and the metabolic effects of movement.

Clinical implications:

• Measuring physical activity in minutes per week is an incomplete metric for bone health.
• Counseling must expand beyond "get X minutes" to include the patterning of movement across the day.
• Prescriptions should incorporate interrupting sitting as an explicit target, with practical benchmarks (stand or move every 30–60 minutes).

Where physical, emotional, and social health diverge

The study’s quality-of-life findings are striking. Physical functioning scored highest at 76%, yet emotional well-being and social connection lagged in the high 50s. Those gaps reveal how the lived experience of osteoporosis extends well beyond bone density numbers.

The drivers of emotional and social decline:

• Pain and fear of falling foster anxiety, restricted activity, and reluctance to attend social functions.
• Loss of mobility limits participation in community life and hobbies, producing isolation.
• Chronic pain and sleep disruption undermine mood and cognitive resilience.

Real-world example: Consider a 68-year-old woman who completed a community exercise program twice a week. Her balance and strength improved, and she met weekly activity targets. Still, microfractures and chronic back discomfort made long family gatherings and shopping trips mentally exhausting. To avoid discomfort and perceived embarrassment, she began declining invitations. Her physical score remained reasonable, but loneliness and anxiety rose—reflected in low emotional and social scores.

Bridging these gaps requires dual-purpose interventions:

• Movement interventions designed for social engagement, such as group strength classes or walking clubs.
• Rehabilitation services that target pain, teach safe movement strategies, and restore confidence.
• Mental health supports integrated into osteoporotic care pathways, helping patients manage fear, depression, and isolation.

Biological mechanisms: how sitting accelerates bone and muscle loss

Bone and muscle respond to mechanical and metabolic cues. Prolonged inactivity alters those cues in ways that promote loss.

Bone remodeling basics:

• Osteoclasts resorb bone while osteoblasts lay down new bone. Healthy bone depends on a balance between these cells.
• Mechanical loading—impact, tension, and muscle pull—stimulates osteoblast activity and favors bone formation.
• Reduced loading shifts the balance toward resorption, decreasing bone mineral density over time.

How sitting interferes:

• Extended sitting minimizes axial and appendicular loading; bones receive fewer signals to lay down mineralized matrix.
• Reduced muscle use leads to atrophy and decreased strength. Muscles generate much of the mechanical stimulus bones require.
• Microvascular changes during prolonged sitting lower nutrient and oxygen delivery to musculoskeletal tissues, impairing repair.

Metabolic and inflammatory contributors:

• Sedentary behavior associates with insulin resistance and altered lipid profiles. Chronic metabolic disturbance increases systemic inflammation, which can accelerate osteoclastic activity.
• Sedentary time correlates with decreased myokine release (exercise-induced muscle signals like irisin) that normally support bone and metabolic health.
• Imbalances in vitamin D from reduced outdoor activity may follow more sitting indoors, worsening bone metabolism in some patients.

Neuromuscular and functional consequences:

• Prolonged sitting reduces proprioceptive input and balance practice, degrading coordination.
• Reaction times and postural control decline with disuse, raising fall risk.
• Muscle fiber-type shifts occur with inactivity—fast-twitch fibers atrophy more quickly, hampering quick corrective responses necessary to prevent a fall.

These mechanisms interact. A single low-energy fracture triggers pain-driven inactivity; inactivity heightens bone and muscle loss; the cycle repeats. Interventions must therefore restore mechanical stimuli, reverse metabolic detriments, and retrain neuromuscular systems.

Health equity and access: private versus public care disparities

A marked finding: participants with private health insurance reported quality-of-life scores averaging 73%, while public healthcare users averaged 50%. That disparity reflects more than patient demographics; it signals structural gaps in access to rehabilitation, osteoporosis-specific education, and multidisciplinary care.

Contributing factors:

• Rehabilitation services (physiotherapy, occupational therapy) are more accessible to privately insured patients, offering tailored exercise prescriptions and fall-prevention training.
• Private systems often provide faster diagnostics and specialist consultations, enabling earlier intervention after fractures or during early bone loss.
• Health education programs—group classes, individualized counseling on movement patterns, and behavior-change support—are more consistently available in private settings.

Consequences:

• Patients reliant solely on public care may receive pharmacologic therapy but lack practical, behaviorally-focused support to reduce sedentary time and rebuild function.
• Inequity intensifies the vicious cycle; without rehab and social supports, patients sit more, suffer more functional decline, and require higher-cost care later.

Policy implications:

• Public health systems should prioritize integration of physical-activity counseling, brief rehabilitation services, and community-based programs for people with osteoporosis.
• Investment in low-cost, scalable interventions—group classes at community centers, home exercise toolkits, and digital prompts to interrupt sitting—can reduce long-term costs associated with fractures and disability.
• Training primary care teams to deliver short, evidence-based advice about interrupting sedentary time would reach many patients who do not access specialty care.

Practical strategies: interrupt sitting, build load, protect against falls

The study offers actionable recommendations that work together. The essential prescription: interrupt seated time frequently and load bones with weight-bearing and resistance activities.

Specific targets and tactics:

• Interrupt sitting every 30–60 minutes. Even two minutes of standing, pacing, or light walking produces measurable benefits in blood flow and muscle activation.
• Favor short movement bouts scattered through the day over a single, lengthy exercise session. Ten minutes of brisk walking three times a day achieves both cardiovascular and bone-stimulating effects.
• Prioritize weight-bearing aerobic activities: walking, stair climbing, hiking, and dance. These deliver impact and loading signals to lower-limb and axial skeleton sites.
• Add progressive resistance training two to three times weekly. Use body weight, resistance bands, machines, or free weights to target major muscle groups that attach to bone. Progressive loading stimulates osteogenesis.
• Include balance and proprioception exercises: single-leg stands, tandem walking, tai chi, and stability drills reduce fall risk by improving coordination and reaction time.
• Use sit-stand workstations, scheduled stand breaks, and movement prompts on phones or watches. Simple cues—calendar reminders, hourly timers, or smart watch vibrations—reduce prolonged sitting.
• Break sedentary leisure patterns. Replace one television episode with a 10-minute walk. Use phone calls as walking prompts rather than sitting.
• Build social engagement into movement: walking groups, partner-based resistance routines, or community exercise classes reinforce adherence and address emotional and social deficits.

Safety considerations:

• Screen for fall risk and fracture history before prescribing higher-impact activities. Some patients require graded introduction to impact and load.
• Begin resistance training at low intensity with a focus on technique, progressing slowly under supervision where possible.
• For patients with vertebral fractures or severe kyphosis, certain flexion movements may be contraindicated. Tailor programs to individual medical context.

Real-world example: A community clinic implements a "30-minute move" protocol. Patients receive a wearable timer that vibrates every 45 minutes, prompting a two-minute walk or standing period. Participants who also join a twice-weekly community resistance class report improved strength, fewer long sitting bouts, and greater social engagement—mirroring the combined benefits the study suggests.

Designing daily routines: practical templates for different lifestyles

Interventions must match daily reality. Below are templates adapted to common life patterns—office worker, retiree, and caregiver—illustrating how to make movement habitual without overhauling life.

Office worker (typical 9–5 desk job)

• Set an hourly reminder to stand for two minutes and walk the length of the office or climb a flight of stairs.
• Schedule two 10-minute walking breaks—mid-morning and mid-afternoon.
• Use a sit-stand desk with a standing period of 20–30 minutes twice daily.
• Take conference calls standing or pacing.
• Prepare a 20–30 minute strength session before or after work, twice weekly, focusing on squats, calf raises, hip bridges, and light resistance exercises.

Retiree with flexible time

• Break the day into movement blocks: morning walk (20–30 minutes), mid-day household chores with standing intervals, late afternoon balance practice (10 minutes).
• Join a local walking group two or three times a week to combine social engagement with weight-bearing exercise.
• Incorporate resistance training using resistance bands or body-weight exercises three times weekly; local community centers often offer supervised classes.

Caregiver or parent with intermittent responsibilities

• Use short activity bursts between caregiving tasks: 3 minutes of marching in place, stair steps, or chair squats.
• Make chores bone-stimulating: carry groceries, use stairs instead of elevator where safe, garden with standing tasks.
• Recruit family members to join brief walks; social support doubles as emotional uplift.

Each template emphasizes regular interruption of sitting, intentional loading of the skeleton, and social connection.

Group-based approaches and mental health benefits

The research highlights a gap: emotional well-being and social connection are low even among physically active participants. Group-based activity addresses both movement and psychosocial needs.

Benefits of group programs:

• Accountability increases adherence to exercise prescriptions.
• Social interaction reduces isolation and builds emotional resilience.
• Structured classes can be tailored to osteoporotic patients—progressive balance and strength training led by trained instructors reduces fall risk.
• Group settings facilitate peer education and shared problem-solving around fear of falling, medication side effects, and lifestyle changes.

Examples of effective group formats:

• Community strength-and-balance classes led by physiotherapists.
• Walking clubs with graded routes to match participant abilities.
• Tai chi groups focusing on balance, controlled movement, and social presence.
• Home-visiting or telehealth group sessions for homebound patients, pairing guided movement with social check-ins.

Mental health integration:

• Screen for depression and anxiety routinely in patients with osteoporosis, particularly after fractures.
• Offer brief cognitive-behavioral strategies to address fear of movement (kinesiophobia) and catastrophic thinking that drives avoidance.
• Combine exercise with psychotherapy referrals when indicated; clinical evidence shows exercise plus talk therapy improves mood and physical outcomes across many chronic conditions.

Rehabilitation after fracture: restoring movement and confidence

Fractures dramatically change the activity profile of people with osteoporosis. Prompt, coordinated rehabilitation reduces the risk of subsequent fractures and accelerates return to function.

Components of effective post-fracture care:

• Early physiotherapy focusing on safe mobility, pain management, and progressive strength rebuilding.
• Occupational therapy to assess home hazards and recommend modifications to reduce fall risk (grab bars, lighting, removal of loose rugs).
• Fall-risk assessments and balance training tailored to the patient’s functional status.
• Education about pacing, graded activity resumption, and realistic goal-setting to rebuild confidence.

System gaps:

• Many health systems treat fracture as an orthopedic problem requiring acute repair but do not consistently provide follow-up rehabilitation that addresses osteoporosis management and behavior change.
• Fracture liaison services—a model that identifies patients after fragility fractures and connects them to bone health management and rehab—improve outcomes where implemented but remain unevenly available.

Real-world implementation: A hospital establishes a fracture liaison program that triggers a physiotherapy referral within one week of discharge. Patients receive a home-safety visit and enroll in a community-based balance program. Over a year, readmission and repeat fracture rates decline, demonstrating the value of coordinated, post-fracture care.

Technology and low-cost tools to interrupt sitting

Practical low-cost tools can help patients break up sitting without expensive infrastructure.

Wearables and prompts:

• Smartwatches and fitness trackers offer hourly reminders, stand goals, and step-count targets. Use them to cue movement breaks.
• Simple phone alarms or calendar appointments work for those not using wearables.

Environmental nudges:

• Place frequently used items (water, printer, recycling bin) across the room to encourage movement.
• Use standing meetings—if functionally appropriate—to reduce consecutive sitting spans at work or during social gatherings.
• Arrange living spaces so daily paths require brief walks—move the TV remote slightly farther, keep a basket of items that require periodic fetching.

Low-tech exercise aids:

• Resistance bands for home strength training are inexpensive, portable, and adaptable.
• Chairs with stable support facilitate safe sit-to-stand exercises, a functional movement that strengthens hips and legs.
• Ankle weights or light dumbbells increase loading safely when introduced gradually.

Digital programs:

• Telehealth physiotherapy extends access to instruction and monitoring in areas with limited local rehab resources.
• Online group classes provide social connection for housebound patients and may be offered on a sliding fee scale by community organizations.

Implementing these tools requires behavior change support—brief coaching on habit formation, cue-routine-reward frameworks, and small, measurable goals.

Clinical practice: how clinicians should adapt messages and prescriptions

Clinicians can shift osteoporosis management from a medication-dominant model to one that balances pharmaceuticals, lifestyle, and functional rehabilitation.

Practical clinician actions:

• Ask about sedentary patterns in routine assessments, not only exercise minutes per week.
• Give specific behavioral targets: stand or move every 30–60 minutes; aim for progressive resistance twice weekly; include balance exercises.
• Use "micro-prescriptions": brief, achievable actions (2-minute walks every hour) that patients can adopt immediately.
• Refer to physiotherapy and occupational therapy for personalized programs and home-safety evaluations.
• Coordinate care through fracture liaison services where available to ensure continuity after a fracture.
• Screen for mood disorders and social isolation and connect patients to community resources and group programs.
• Tailor exercise and movement plans to comorbidities (cardiovascular disease, arthritis, neuropathy) and functional limitations.

Documentation and follow-up:

• Record sedentary time and activity-pattern targets in the medical record to reinforce their importance.
• Review progress during follow-up visits, celebrating small wins like reduced average sitting time or improved single-leg balance time.

By converting vague advisories into concrete, trackable actions, clinicians make behavior change feasible and measurable.

Community and policy-level interventions

Individual behavior change benefits from supportive environments. Policy and community programs scale impact across populations.

Priority areas for systems:

• Expand access to low-cost community-based exercise programs targeted to older adults and people with osteoporosis.
• Fund fracture liaison services that close care gaps between acute fracture treatment and long-term management.
• Promote workplace policies that encourage breaks, sit-stand workstations, and active meetings.
• Support transportation and urban design that enable walking—safe sidewalks, benches to rest, and accessible crossings.
• Integrate brief activity counseling into primary care workflows, with training and incentives for clinicians.

Evidence-based program models:

• Community centers that host strength-and-balance classes for older adults consistently reduce fall rates and improve function.
• Subsidized physiotherapy sessions for vulnerable patients reduce long-term care needs and costs.
• Employer wellness programs that incorporate hourly stand reminders, walking meetings, and ergonomic workstations support workers returning after osteoporotic fractures.

Scaling requires targeted investment and measurement: track sitting patterns and fracture rates at the population level to evaluate intervention impact.

Addressing common concerns and safety questions

Patients and providers often raise similar questions about safe movement after diagnosis or fracture.

Is standing enough to protect bone?

• Brief standing breaks are valuable for breaking metabolic and circulatory consequences of sitting, but standing alone provides little bone-loading stimulus. Combine standing with walking, step-ups, or resistance exercises to load bone.

Are impact activities risky for people with osteoporosis?

• Impact provides beneficial loading, but risk depends on fracture history and individual anatomy. Low-to-moderate impact activities like brisk walking, stair climbing, and light jumping (for those cleared) are effective. High-impact sports require clinician clearance.

How fast should someone progress resistance training?

• Start with low resistance focusing on technique; increase resistance gradually (every 1–2 weeks) as tolerated. The goal is progressive overload—small increments that stimulate adaptation without causing injury.

What if fear of falling prevents movement?

• Begin with supervised balance and confidence-building exercises from a physiotherapist or trained instructor. Group classes with peers can reduce fear through social support.

Can technology replace supervised rehab?

• Technology complements but does not fully replace personalized rehab. Home programs guided by telehealth or apps extend reach and maintain progress when in-person services are limited.

Patient-centered examples: small changes, measurable effects

To illustrate practical application, here are anonymized, composite examples consistent with clinical experience.

Case 1: Office worker, age 62

• Baseline: Meets 150 minutes/week by attending an hour-long treadmill session three times weekly but sits 9–10 hours daily.
• Intervention: Hourly standing reminders; 15-minute walking break at lunch; two 20-minute resistance sessions per week focusing on squats and calf raises.
• Result after 6 months: Reduced sitting time by 2.5 hours/day, improved single-leg balance, and fewer reports of back pain. Emotional well-being improved after joining a walking group.

Case 2: Retiree with prior vertebral fracture, age 70

• Baseline: Avoids activity due to pain and fear of additional fractures.
• Intervention: Supervised physiotherapy including graded walking, core stability, and an osteoporosis-specific strength program. Home safety modifications reduced environmental hazards.
• Result after 9 months: Greater confidence in mobility, increased social outings, and maintenance of bone density on follow-up imaging.

Case 3: Low-resource setting, age 68

• Baseline: Limited access to rehab; receives pharmacotherapy through public system.
• Intervention: Community health worker delivers education on breaking sitting every 45 minutes and demonstrates chair-based resistance exercises and balance drills.
• Result after 6 months: Participants reported fewer prolonged sitting bouts, improved ability to perform daily tasks, and stronger sense of community support.

These vignettes show that modest, sustained changes in behavior, combined with social supports, produce meaningful improvements in function and quality of life.

Research gaps and next steps

The University of Johannesburg study highlights associations between sedentary behavior and quality-of-life deficits in osteoporosis but leaves open questions suitable for future research.

Key gaps:

• Longitudinal studies to quantify how reductions in sedentary time change fracture incidence and bone mineral density over years.
• Randomized trials testing specific interruption protocols (frequency, duration, intensity) and combinations of resistance training for optimal bone outcomes.
• Comparative effectiveness research on group-based versus individual interventions for emotional and social outcomes.
• Implementation science studies to determine how best to scale low-cost interventions in public healthcare systems.

Answering these questions will guide policymakers and clinicians toward the most cost-effective and scalable strategies to reduce the burden of osteoporosis.

How to begin—simple first steps for patients and caregivers

Starting does not require major investments. Use these immediate actions to shift daily patterns.

Begin today:

• Set an hourly alarm to stand and move for 2–3 minutes.
• Replace one sedentary leisure block with a 15–20 minute walk.
• Learn two resistance exercises (sit-to-stand, wall push-ups) and perform them twice daily.
• Join a local class or walking group for accountability and social support.
• Talk with your clinician about a referral to physiotherapy and a personalized fall-risk assessment.

Small, consistent changes accumulate. Interrupting sitting, coupling movement with social engagement, and rebuilding strength change the trajectory of bone health.

FAQ

Q: If I already exercise regularly, do I still need to worry about sitting? A: Yes. Meeting weekly exercise targets remains valuable but does not neutralize the harms of long, uninterrupted sitting. Aim to interrupt sitting every 30–60 minutes and distribute movement throughout the day.

Q: What counts as a valid "standing break"? A: A standing break that includes light movement—pacing, marching in place, or a brief walk—offers greater benefit than passive standing. Two minutes of light walking or stair climbing every hour is a useful benchmark.

Q: How much resistance training is needed for bone health? A: Evidence supports progressive resistance training two to three times per week, targeting major muscle groups with exercises that apply load to bone. Intensity should be increased gradually under instruction where possible.

Q: Are group classes better than home programs? A: Group classes add social and emotional benefits that often increase adherence and reduce isolation. When access to groups is limited, structured home programs with remote supervision can provide significant benefits.

Q: What precautions should I take after a recent fracture? A: Seek early physiotherapy and occupational therapy to restore safe movement patterns and make your home safer. Begin graded activity under professional guidance and prioritize balance and strength training as recommended.

Q: How can clinicians incorporate sitting-reduction counseling into busy clinics? A: Use brief behavioral prescriptions: ask about total sitting time, recommend hourly movement breaks, and provide 1–2 specific home exercises. Document goals and arrange follow-up or referral for patients with higher risk.

Q: Do wearable devices really help? A: Many people find wearables helpful because they provide consistent cues and feedback. For those who prefer low-tech options, calendar alarms or simple timers are effective alternatives.

Q: What role do medications still play? A: Pharmacologic therapies remain important for many individuals to slow bone resorption or increase formation. Medications and movement interventions are complementary; addressing both maximizes fracture prevention and quality of life.

Q: Are there particular exercises to avoid for people with osteoporosis? A: Avoid high-velocity spinal flexion or heavy loading that places the spine in flexion if you have vertebral fractures or severe kyphosis. Always consult a clinician or physiotherapist to tailor safe exercises to your condition.

Q: How do we address disparities in public systems? A: Policy interventions should expand access to community rehabilitation, train primary care teams in brief counseling, and invest in programs that scale low-cost, group-based activity and sit-reduction strategies.

The research from Johannesburg reframes osteoporosis care as an everyday practice: not merely a list of weekly exercise minutes but a pattern of movement woven through each day. Break sitting, build strength, and connect with others—those steps protect bone and preserve the ability to live fully.