Is standing healthier than sitting? What does research tell us?

The introduction of height-adjustable desks in many offices clearly shows that there is a growing awareness of health promotion in the workplace. According to a survey conducted by the Society for Human Resource Management in 2017, height-adjustable sitting/standing desks are enjoying rapidly growing popularity. Whereas in 2013 13% of companies opted for bar tables for new purchases, by 2017 this figure had risen to 44%.

The daily long sitting with various health problems, such as obesity, disturbances of the blood sugar metabolism, high blood pressure and the associated complications such as heart disease is now quite well known and scientifically substantiated. In view of the increasing number of standing desk users, the question arises as to whether a standing working posture can prevent the development of such diseases.

However, the studies on the health effects of standing at work reveal some highly controversial aspects, which are dealt with in more detail in this overview.

The lack of exercise persists

Inactivity and lack of exercise promote the development of metabolic diseases such as diabetes. Even though standing desks are widely marketed and associated as a healthier alternative, the scientific evidence for this is lacking.
 A standing person is still largely stationary and thus inactive. In the balance it consumes only infinitesimally more calories than a sitting person.

This is not known to many people who use a standing desk to lose body weight, even for motivational reasons. Studies comparing the energy expenditure of sitting and standing activities clearly prove this.
 A study published in 2016 in the renowned cardiology journal Circulation showed that the average difference in energy consumption between sitting and standing is only 0.15 kcal per minute. In practical terms, this means that the user of a standing desk that stands for six hours a day without interruption only metabolizes about 50 additional calories during this period (Saeidifard et al., 2016). If you eat an apple for comparison, you already consume about 100 calories. This illustrates that the efforts to lose weight by using a standing desk or to have a lasting positive influence on health are often in vain.

In this context, there could also be a danger that users of standing desks may feel a false sense of security and that other health-promoting activities may consequently be compensated for or reduced.

Musculoskeletal problems associated with standing

For most people, standing for a longer period of time is not pleasant, because after a longer period of time it is often accompanied by heaviness in the legs, fatigue and back pain.

Maintaining a correct posture while standing in order to avoid the above-mentioned discomfort is also a challenge for many people. There’s a simple reason for that. The human anatomy and physiology is not historically designed to maintain a standing stationary posture for long periods of time.

After years of sitting for many years, the soft tissues and muscles of the trunk and buttock muscles of many people are often chronically weakened, leading to a lack of stabilization of the pelvis. Shortened hip flexor muscles due to frequent sitting also contribute to an unfavourable posture for the back when standing. Similar to sitting, many people tend to lean on their side and thus lean on soft tissue structures instead of on bony structures. The body is easily out of balance when standing, which often leads to a preference for one side.

When working at a standing desk, people tend to form an exaggerated hollow back more quickly, which in turn leads to an unphysiological strain on the muscles close to the spine and compression of the intervertebral discs. Pain in the lower back is therefore a common complaint of people with a standing posture. This also does not lack a certain irony, since it is often back pain that causes many to apply for a standing desk or to be subsidized by the health insurance companies.

What about the rest of the body? The posture in the middle and upper parts of the back does not change significantly compared to sitting. A forward bent head and neck posture in combination with rounded shoulders often contributes to pain in this area and degeneration problems of the spine often occur over time. The ergonomic and cognitive effects of standing work at the computer were investigated in a study in which adult participants performed standing computer work. After two hours, most subjects complained of muscle fatigue,

Swelling of the lower extremities and a significant deterioration of cognitive performance in the form of reduced attention and reaction time was observed (Baker et al., 2018).

Half of all height-adjustable desks are used as normal desks

The associated inconvenience of height-adjustable desks often means that they are not used as intended. A large study in Germany has examined this question in more detail. Almost 700 participants were asked about their use of a sitting/standing desk. Of the study population, 16% had access to such a desk. Surprisingly, only half of these people used the desk’s standing function permanently, while the other half used the standing desk almost exclusively at a height that allowed it to be used with a conventional chair (Wallmann-Sperlich et al., 2017).

Standing desk users sit no less in the total

A large comparative analysis comparing the results of 21 individual studies and recorded in the Cochrane Study Register showed that access to a standing desk does not significantly reduce total sitting time. This seems to be due to the fact that users of standing desks are more inactive in their leisure time and sit more and do less sport as a compensatory measure. (Shrestha et al., 2016).

Standing work increases the risk of heart disease

Standing desks are often seen as measures to promote fitness and health at the workplace. The fact that the purchase of standing desks is encouraged by some health insurance companies also suggests that this assumption is scientifically based. In fact, however, the research points in a completely different direction.

Standing for longer periods of time could actually do more harm than good to your health. A study from Canada compared the predominant work posture of over 7000 employees over 12 years of age and correlated this data with the occurrence of cardiovascular disease. At the beginning of the study period, all subjects included in the study were free of heart disease. The study found that those who

who were primarily at work, had twice the risk of developing heart disease than those who spent most of their time sitting. Possible falsifying factors such as other health, socio-demographic, educational and work-related variables were excluded.

The reasons for this, although not yet fully understood, probably lie in the increased pressure in the venous blood vessels of the lower extremities and an associated increase in oxidative stress in the entire vascular system. Over a longer period of time, this permanent strain on the vascular walls could explain the paradoxically increased risk of heart disease in people who stand more. (Smith et al., 2017). Moreover, the heart does not seem to be the only organ that suffers from prolonged standing. Other studies have shown that frequent standing in women is associated with pregnancy complications, such as premature births and spontaneous abortions.

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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.