IS STANDING THE NEW SITTING ?
by Dr. Eric Söhngen
The introduction of height-adjustable desks in offices all over the world clearly reflects that there is a strong desire for health conscious work spaces. According to a 2017 survey by the Society for Human Resource Management, standing desks are the fastest growing benefits trend; 13% of employers provided or subsidised them in 2013 versus 44% in 2017.
So now the question becomes, can we cure this ‘sitting disease’ by elevating our desks? It would have been a shame if the solution had been this easy, and we had missed the corresponding health benefits over all these years. However, research has been done on the effects of the standing desk on our physiology, and the results have pointed towards some highly controversial issues.
Standing desk users are still largely inactive
One problem is that standing desks do not alleviate the detrimental effects on the metabolism, which are associated with inactivity. While not sitting, a standing person is still largely inactive. Many have altered their personal work environments in the effort to make a positive impact on their health, however, what they have gotten is an outright false sense of security that has not been backed by science.
The main issue with standing desks is connected to the very body position they force the user into. Standing for periods of time is unpleasant. Out of our own experience, we know that standing while waiting in a queue or behind a sales counter comes along with sensations of heaviness in the legs, back pain and generally leads to fatigue and even affects our mood.
Musculoskeletal issues related to standing
Maintaining proper posture while standing in order to avoid the pain sensations described above proves to be challenging for many. There is a simple reason for this. Our human anatomy and physiology is not optimised to facilitate such a posture for any extended period of time. After years of sitting, the body’s soft tissue and muscles have likely sustained considerable damage, resulting in relative weakness in the core and glute muscles, with consecutive lack of stabilisation and a forward tilted pelvis. Tight hip flexor muscles, which are often considerably shortened due to sitting, also contribute to a bad posture while standing. Same as in sitting, many people who stand tend to slouch and lean to one side, still relying rather loosely on soft tissue structures. The body easily comes off balance when standing, resulting in favouring one side or constant shifting forward and backward.
The posture typically seen in office workers using standing desks, is one where the arch in the lower back is exaggerated, resulting in compression of intervertebral disk spaces and often resulting in muscular pain. Lower back pain, therefore, is one of the most complaints that I have heard from patients using standing desks, which is somewhat ironic as many have sought to use standing desks to alleviate these same ailments.
What about the rest of the body? Our posture in the middle and upper portions of the back are not considerably changed when comparing standing to sitting. A forward bended head and neck posture in conjunction with rounded shoulders often contribute to pain in that area and spinal degeneration issues over time.
Scientific studies have looked into the question of standing desk ergonomics. In a 2018 study, adult participants performed standing computer work to investigate possible changes in discomfort as well as cognitive function. After just two hours, most users complained of muscle fatigue, lower limb swelling and mental state deterioration, coupled with decreases in attention and reaction time (Baker et al., 2018).
Half of all height-adjustable desks are used as normal desks
The associated discomfort of height-adjustable desks often results in them not being used in the intended way. A large study performed in Germany looked at this question in more detail. Almost 700 participants were interviewed regarding their usage of a sit-to-stand desk. Out of the study population, 16% had access to such a desk, similar to the range of other countries. Surprisingly, only half of these individuals utilised the standing functionality of the desk, the remaining half had stopped standing and instead lowered it back to a height that allows usage with a conventional chair (Wallmann-Sperlich et al., 2017).
Having access to a standing desk also appears to fail in substantially decreasing overall sitting time, likely due to a compensation with more time spent inactive during leisure time. A systematic review that compared the results from 21 different trials, published in the Cochrane Registry in 2016, concluded that the availability of standing desks only leads to a reduction of overall sitting time of around 30 minutes to two hours (Shrestha et al., 2016).
Standing doesn’t burn more calories than sitting
This finding has greater implications when considering that a motivation for many users when starting to use a standing desk is the desire to lose body weight. To evaluate the potential a standing desk can contribute to such weight loss goals, it is interesting to look at an analysis of energy expenditure in sitting versus standing. This question has been addressed in numerous studies in the past. A large review published in Circulation in 2016 compared findings of 44 studies with more than 1,000 participants. What they found is that the mean difference in energy expenditure between sitting and standing was only 0.15kcal/min. This means, that if a user of a standing desk would theoretically use the desk exclusively for six hours per day nonstop, it would equate to around 50 additional burned calories (Saeidifard et al., 2016). An apple has around 100 calories, which means that an attempt to lose weight by using a standing desk is little more than wishful thinking.
Standing at work for prolonged hours increases the risk for heart disease
The question remains whether standing desks are actually good for our cardiac health or not. The predominant association is that standing workstations are measures to promote health in work environments. The existence of subsidised programs by health insurance companies also indicates their overall positive health benefits. However, looking into this further, we find that the latest research actually points in the opposite direction.
Standing for extended periods of time might actually cause more harm than good. A study from Canada compared standing and sitting at work across 7,000 workers; researchers reviewed the employees’ healthcare records and looked for associations of occupational standing, sitting and cases of heart disease over the past 12 years. At the beginning of the study period, all of the people were free of heart disease. The study found that those who had to stand at their workplace had twice the risk of heart disease, compared to those who spent their time predominantly seated at work. Possible falsifying factors such as other health, sociodemographic, educational and work variables were excluded.
While not entirely understood, the underlying reasons are likely the result of a combination of too much blood pooling in the legs with an associated increase of pressure in the veins and an increase of oxidative stress in blood vessels. Over an extended period of time, this permanent stress on the vessel walls could explain the paradoxically increased risk for heart disease in those who stand more (Smith et al., 2017). And the heart doesn’t appear to be the only organ that suffers from prolonged standing at work. Early studies have indicated that serious pregnancy related risks, such as preterm births and spontaneous abortions could also be a result (McCulloch et al., 2002, Waters et al, 2015).
About The Author
Eric Soehngen, MD, PhD is a board-certified senior Physician and the Founder and CEO of
Also By The Author
Death by Sitting explains in a comprehensible and accessible format, with scientific accuracy exactly how sitting has become “the new smoking”. Read why we need a movement revolution.
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Baker, Richelle, et al. “A detailed description of the short-term musculoskeletal and cognitive effects of prolonged standing for office computer work.” Ergonomics 61.7 (2018): 877-890.
McCulloch, John. “Health risks associated with prolonged standing.” Work 19.2 (2002): 201-205.
Saeidifard, Farzane, et al. “Difference of Energy Expenditure While Standing versus Sitting: A Systematic Review and Meta-Analysis.” (2017): A20539-A20539.
Smith, Peter, et al. “The relationship between occupational standing and sitting and incident heart disease over a 12-year period in Ontario, Canada.” American journal of epidemiology 187.1 (2017): 27-33.
Wallmann-Sperlich, Birgit, et al. “Who uses height-adjustable desks?-Sociodemographic, health-related, and psycho-social variables of regular users.” International Journal of Behavioral Nutrition and Physical Activity 14.1 (2017): 26.
Waters, Thomas R., and Robert B. Dick. “Evidence of health risks associated with prolonged standing at work and intervention effectiveness.” Rehabilitation Nursing 40.3 (2015): 148-165.