The real truth about Sitting vs Standing

Here's what I've discovered in my 2 year-long, research-backed quest to find the answers behind the 'Sitting vs Standing at work' debate.

Like anything in life, there are always two sides to a story; the good vs the bad, the pros vs the cons, the optimists vs the critics. And so it's no surprise that this topic of sitting vs standing has its advocates and its detractors, particularly since standing desks started becoming mainstream about 5 years ago.

In this debate, occasionally there are misinformed opinion pieces and critics labeling standing desks a fad. To that point, a recently published study has prompted some publications to raise the alarm bells with prolonged standing and using standing desks in the workplace. But in actual fact, the study findings related to people whose jobs involve standing for long stretches of time without the option to sit, such as sales and service clerks, cooks, food and beverage servers and bank tellers.

So, are standing desks still a great idea? Yes! But, instead of opinions what I prefer to base my decisions on is fact, quality evidence and a lot of investigation. By that I mean, a LOT of research (scroll to the bottom for all the references). I've even designed my own standing desk and written a book about it. And now... I would like to take you in-depth into the real facts and explain exactly what this is all about.

A notice from the WHO (World Health Organisation)
Firstly, here’s why this is such an important topic. Back in 2013 I discovered a pretty shocking fact that changed the way I view my workday. Physical inactivity is the 4th leading risk factor of death globally, which means that 6% of deaths globally result from physical inactivity, or an estimated 3.2 million preventable deaths each year (read more). Fact: this is more than lung cancer + HIV combined. Physical inactivity is one of the largest health problems we are all facing in the modern world. Therefore, prolonged sitting is becoming our enemy. The reality is that our bodies have been designed to move, as all 20 of the health experts we interviewed agreed. But, many of us are underutilizing our bodies daily, often unintentionally. If we were designed to sit excessively, this stat would simply not exist.

Sitting or standing in moderation
I want to bring your attention to the word ‘prolonged’ for a moment. This word is just as important as when a doctor discusses the benefits of doing something ‘in moderation’. In the context of sitting vs standing, the word ‘prolonged’ before either of those two activities makes all the difference. There is nothing wrong with sitting, there's nothing wrong with standing, the issue is in the ‘prolonged’ part. And the real answer to this debate comes down to movement. How ever we can achieve more movement for our body is a good thing and that helps us to achieve better health. This is a medical fact. Using a standing desk gets us on our feet, which is a catalyst to movement. We will explore this later.

The proven benefits of standing
So exactly what is the difference between sitting and standing? Well, here are the facts. Outlined below are the changes that happen to our bodies when we're standing vs sitting. As you can see there are clear benefits we can use to motivate us to break old habits and be on our feet more. References can be found at the end of this post.

The astronomical Back Pain problem
Now let's draw your attention to back pain. Have a think about this - have you ever personally experienced back pain, or do you know of someone who has or is currently experiencing a back pain issue? Chances are, half of you reading this will say yes. I have personally experienced it, as well as having many close friends and family that have had serious problems with their back. It happens to a lot of us.

Lower back pain is an enormous problem for the modern world. In fact, In Australia, the direct cost of lower back pain was reported to be $9.2 billion annually, while in the United States it's estimated to be as high as a whopping $500 billion annually. Costs are a result of the loss of working hours, non-surgical therapies, surgical treatments, and rehabilitation. This is an enormous burden to healthcare budgets.

What causes this? We spoke to Dr. Dave Oehme Ph.D. to get an in-depth look into what causes this. And this is the brief summary of what I discovered.

1) When we are sitting we increase the amount of force on our lower number spine by 40% in comparison to standing.

2) When we are sitting and slouching forward, that amount of force is 90% more than when we are standing. To further verify this, I also met with several physiotherapists, osteopaths, and chiropractors that all point to excessive, prolonged sitting as a major cause of back pain, also due to impacts on our hip flexors which can shorten, as well as our glutes, abs and back muscles, which can deteriorate in strength when sitting for prolonged periods.

Postural problems from sitting
Health practitioners are confronting problematic postural issues every day in patients who have a lifestyle that's prone to long periods of sitting. This is what happens when we slip into a day full of prolonged sitting, day by day. Just like Dr Tickell says, for many of us, a regular day is like taking a "12-hour long haul flight", every day!

1) Strained Neck - Often when sitting at a desk, we have a habit of stretching our neck forward towards the keyboard and monitor, which can strain the vertebrae in your neck.

2) Sore Shoulders - Slumping forward overextends the shoulder muscles, and we often round the shoulders and chest inwards, leading to tense shoulders and upper back.

3) Inflexible Spine - When we don’t move, collagen around the tendons and ligaments in the spine hardens, restricting our range of motion, increasing our chance of an injury.

4) Weakened Abs - Your abdominal muscles have very little to no engagement when sitting, and as they weaken they can lead to the spine overarching, creating back issues.

5) Shortened Hips - The hip flexors are contracted when sitting, which over time become so shortened that range of motion, stride length, and balance are limited.

6) Weakened Glutes - Like abs, glutes are virtually unused when sitting. With less strength in your glutes, it’s difficult to maintain postural stability and movement agility.

What I experienced from sitting and standing
From my personal experience, when I started sitting and standing at work, I noticed these improvements in my day fairly quickly:
• Sustained energy throughout my day
• Maintaining my fitness level became easier
• No more afternoon slump, particularly after lunch
• Heightened productivity and alertness

To understand a new concept, why not give it a try for yourself and see if you like it. Associate Professor Kylie O’Brien started using a standing desk 2 years ago and noticed huge benefits. Check out her video to find out more.

The benefits of a healthier workday
Having delved into the research, I strongly believe that there is enough evidence to motivate companies to invest in professional training for health and wellness representatives, so they can have the right skills to build a long-term health culture that succeeds. Investing in the health of their people and team will have enormous returns. And here are two of the biggest reasons why:

#1 Improved Productivity - In Australia, a study by Medibank showed that the healthiest employees are almost 3 times more productive than their unhealthy colleagues. That’s up to 1,128 hours of extra productivity per employee per year!

As for standing desks, in May 2016, research from the Texas A&M Health Science Center School of Public Health indicated that standing desks could increase employee productivity by up to 53%!

#2 Reduced Sick Leave - In Australia, a study by Medibank Australia found that unhealthy employees take up to 9 times more sick days than their healthy colleagues. Unhealthy employees average 18 sick days annually while healthy employees average 2 sick days annually. As a result, this is costing Australian businesses $7 billion annually.

In America, a similar story can be seen where healthy employees take an average of 4 sick days annually. But employees of poor health or those who have a chronic health condition, such as obesity, high blood pressure, high cholesterol or diabetes, take an average of 12 sick days per year.

"A wellness program is paramount for great culture and employee health" - Bob Boyd

Transition to a standing desk
CAUTION - Incorrect use of a standing desk can cause harm. But surely everyone with a standing desk has been given some guidelines? Wrong. So here it is.

Everyone is different. It’s no different to going to the gym and using the weights incorrectly, e.g. loading up too much weight for your ability. Therefore, it’s not possible to have a standard number of standing hours per day everyone should achieve, there are only guidelines. This would be like saying there is only one gym workout program that suits everyone. This is not a one-size-fits-all approach. Depending on factors such as fitness, age, strength, physique, and injuries, your amount of daily standing time will be different from the next person's. Start slowly, and build up your standing hours gradually. If you’re standing and feel tired or sore, that’s an indication that it’s time to move, stretch or sit down and take a break. That's ok!

When Standing, DO

• Regularly change posture and move (every 30-40 minutes)
• Always consider the correct ergonomic setup and posture
• Distribute your weight evenly on both feet, hip-width apart, with flat shoes
• Listen to your body for any signs of strain or discomfort, if so change posture

When Standing, DO NOT

• Suddenly stand 8 hours a day when your desk arrives
• Push through to unrealistic standing time goals when you start
• Stand still and forget to change postures regularly or move on the spot
• Wear high heel footwear as this will compromise your posture and create issues

Getting the right standing desk setup
To help you avoid simple mistakes and get the best possible setup with your standing desk, here's a simple charge I've put together for you with the basic pointers. This was designed with input from Osteopathy Australia providing expertise on posture.

One last question... Is a standing desk 'the answer'?

Prolonged sitting is a huge problem for our modern world. There is no doubt about it. We also know that many of us need to do less sitting as it is the cause of many health problems, such as cancer, diabetes, heart disease and back pain. We can all agree on these two facts, and there's enough quality medical research to prove this.

But, standing on its own is not a single solution here. Standing is an excellent catalyst that encourages us to move more. The answer is in movement, and for many of us, like me, who work in an office on a laptop, that translates into sitting, standing and moving, moving our body, changing posture regularly and engaging our muscles often. Movement helps us to create a healthier, more productive workday.

"We spend so many hours at work. Just changing work habits leads to incredibly positive life outcomes" - Dr. Piers Bubbers

Coming back to that study from the top and our guidelines, prolonged standing can potentially cause issues, and I don't think anyone quite literally would want to spend the whole day standing for 10 hours, not moving, not sitting, not taking a break. Sounds painful. It's ok to keep your chair at bay. Anyone who is it who is an advocate for standing workstations, including many health professionals, would never recommend a prolonged standing approach to anyone. There is no 'moderation' in this approach.

It's recommended that we change our posture every 30 to 40 minutes. This encourages movement. Movement is what our body needs most. Being creatures of comfort and habit, the reason why sitting is problematic is that it can be a very comfortable position, and we have a tendency to become lazy. Therefore, behaviourally, sitting prevents us from getting up and moving regularly because we are locking into our posture (does a morning routine with a coffee at the desk sound familiar?).

Standing and working on our feet, however, gives us more freedom to move our bodies, change posture, stretch and walk over to colleagues quickly for a chat. It's a catalyst for movement. Don't be shy to incorporate other movement techniques into your day, such as standing or walking meetings, walking at lunchtime, standing up on the train, taking the stairs, stand up when taking a phone call, stretch at work.

The more movement in our day, the better it is for our health.

Thanks for reading,

Daniel Angelini

To see the standing desk I've designed, please check out: www.moviworkspace.com.

To learn more about the health research, please check out my 180-page eBook: 'The Sitting Epidemic'.


References

Here is a list of references used in relation to the facts cited in this post:

• Van der Ploeg HP, Chey T, Korda RJ, et al 2012, ‘Sitting Time and All-Cause Mortality Risk in 222 497 Australian Adults’, Archives of Internal Medicine, vol. 172, no. 6, pp. 494-500. <http://archinte.jamanetwork.com/article.aspx?articleid=1108810>

• Wilmot EG, Edwardson CL, Achana FA, et al 2012, ‘Sedentary time in adults and the association with diabetes, cardiovascular disease and death: systematic review and meta-analysis’, Diabetologia 2012 November, vol. 55, no. 11, pp. 2895-905 <http://www.ncbi.nlm.nih.gov/pubmed/22890825>

• World Health Organization, 2009, ‘Global health risks: mortality and burden of disease attributable to selected major risks’, WHO Library, pp. 6. <http://www.who.int/healthinfo/global_burden_disease/GlobalHealthRisks_report_full.pdf>

• Australian Institute of Health and Welfare, 2016, ‘AIHW 2016. Impacts of chronic back problems’, AIHW bulletin no. 137, cat. no. AUS 204. <http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129556199>

• Tissot F, Messing K, Stock S, 2009, ‘Studying the relationship between low back pain and working postures among those who stand and those who sit most of the working day’, Ergonomics, vol. 52, no. 11, pp. 1402-18. <http://www.ncbi.nlm.nih.gov/pubmed/19851907>

• Thomson CA, Thompson PA, ‘Healthy Lifestyle and Cancer Prevention’, 2008, ACSM’s Health & Fitness Journal, vol. 12, no. 3. <http://sites.millersville.edu/mdupain/kpe4/readings/rw9-10/cancer.pdf>

• Compston A, 2010, ‘Microscopical observations on the cerebral circulation of the blood in the cerebral cortex, by Howard Florey (BA and John Lucas Walker Student; From the Physiological Laboratory, Oxford and Pathological Laboratory, Cambridge)’, Oxford University Press Journal “Brain”, vol. 1925, no. 48, pp. 43–64. <http://brain.oxfordjournals.org/content/133/4/950>

• Olufsen MS, Ottesen JT, Tran HT, et al 2005, ‘Blood pressure and blood flow variation during postural change from sitting to standing: model development and validation’, Journal of Applied Physiology, vol. 99, no. 4, pp. 1523-1537. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2094039/>

• Pettersson H, Faager G, Westerdahl E, 2015, ‘Improved oxygenation during standing performance of deep breathing exercises with positive expiratory pressure after cardiac surgery: a randomized controlled trial’, Journal of Rehabilitation Medicine, vol. 47, pp. 748–752. <https://www.ncbi.nlm.nih.gov/pubmed/26134462>

• Eng JJ, Levins SM, Townson AF, et al 2001, ‘Use of Prolonged Standing for Individuals With Spinal Cord Injuries’, Journal of the American Physical Therapy Association, vol. 81, no. 8, pp. 1392-9. <https://www.ncbi.nlm.nih.gov/pubmed/11509069>

• Owen N, Sparling PB, Healy GN, et al 2010, ‘Sedentary Behavior: Emerging Evidence for a New Health Risk’, Mayo Clin Proceedings, vol. 85, no 12, pp. 1138–1141. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2996155/>

• University of Sydney and Heart Foundation, 2012, ‘The Stand @ Work Study: Do sit-stand workstations reduce employees’ sitting time?’, National Heart Foundation of Australia, pp. 1-2 <https://www.heartfoundation.org.au/images/uploads/main/Programs/nsw/HF-NSW_Stand@Work_CaseStudy.pdf>

• Reiff C, Marlatt K, Dengel DR, 2012, ‘Difference in caloric expenditure in sitting versus standing desks’, Journal of Physical Activity and Health, vol. 9, no. 7, pp. 1009-11. <http://www.ncbi.nlm.nih.gov/pubmed/22971879>

• Dunstan D, 2012, ‘Sitting is deadly’, ABC Catalyst with Baker IDI Heart and Diabetes Institute <http://www.abc.net.au/catalyst/stories/3568627.htm>

• Chau JY, Grunseit AC, Chey T, et al 2013, ‘ Daily Sitting Time and All-Cause Mortality: A Meta-Analysis’, PLoS ONE, vol. 8, no. 11, pp. 1-14 <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3827429/>

• Biswas A, Oh PI, Faulkner GE, et al, 2015, ‘Sedentary Time and Its Association With Risk for Disease Incidence, Mortality, and Hospitalization in Adults: A Systematic Review and Meta-analysis’, Annals of Internal Medicine, vol. 162, no. 2, pp. 123-132. <http://annals.org/article.aspx?articleid=2091327>

• Tikkanen O, Haakana P, Pesola AJ, et al 2013, ‘Muscle Activity and Inactivity Periods during Normal Daily Life’, PLoS One, vol. 8, no. 1. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3548884/>

• Pronk NP, Katz AS, Lowry M, et al 2011, ‘Reducing occupational sitting time and improving worker health: the Take-a-Stand Project, 2011’, Preventing Chronic Disease 2012, vol. 9, pp. 154. <http://www.ncbi.nlm.nih.gov/pubmed/23057991>

• Ten Research Studies You Can’t Afford to Ignore, Part IV, Worksite Health, 1995, vol. 3, pp. 23-27