Making the most of sit-stand working

Sit-stand desks offer real health benefits, but to maximise their benefits they need careful introduction to workplaces. This article looks at how to make the most of sit-stand working, with reference to recent research, and we offer advice on making a switch to sit-stand working.

Health issues linked with prolonged sitting or standing

Probably the most important message we need to focus on, is that movement and switching between sitting and standing is what brings the comfort and health benefits, not just standing on it’s own. Research has found that prolonged sitting or standing can actually lead to similar pressures on the discs in the lower spine, and that there is  no real difference in outcome (in terms of disc degeneration and low back pain occurrence) (Karakolis, 2016).

The health effects of prolonged sitting go beyond the musculoskeletal system but so do the effects of prolonged standing. Some of the commonly cited health effects of sitting and standing are set out below:

Sitting:

  • back pain due to increased pressure in spine and poor spine posture,
  • cardiovascular problems, damage to blood vessels,
  • reduced metabolic rate (low energy expenditure),
  • risks to pregnancy,
  • higher blood sugar spikes / diabetes,
  • increased risk of colon cancer (Lee et al, 2012).

Standing:

  • blood pooling and varicose veins in legs and feet,
  • strain on hips knees and ankles, lower back pain,
  • muscle fatigue,
  • dizziness,
  • risks to pregnancy,
  • cardiovascular strain,
  • Constrained standing (i.e. having no option but to stand) is in particular associated with lower back pain.

Clearly there are disadvantages to either sitting or standing for long periods. Humans are built for movement, and moving between sitting and standing using a sit-stand desk helps reduce musculoskeletal issues to some extent – if it is done effectively; each posture gives us benefits and offsets potential problems caused by the other.

Benefits of sitting or standing alternately / in moderation

Sitting:

  • sitting normally eliminates lordosis in the lower back, which can become excessive and lead to pain during prolonged standing as the pelvis tilts forward,
  • sitting  allows for recovery of the circulatory system in the legs and feet, fluid pooling is reduced in the lower limbs,
  • sitting allows us to relax and recover from physical fatigue in the legs, hip and back.

Standing:

  • standing desk work has been found to result in more neutral postures and lower trapezius muscle activity.
  • standing promotes general light muscle activity time, and research indicates it doesn’t come at the expense of any significant spinal shrinkage or task performance.

The main point to bear in mind is that by sitting and standing in moderation we can maximise the benefits of both, and offset their potential negatives.

Variation in posture is key

Research indicates that the real comfort / musculoskeletal benefit of using sit-stand comes mostly just at the point of making a switch, whether it is from sitting to standing, or visa versa (Karakolis, 2016). At that point our discomfort levels are in effect ‘re-set’.

The ‘science-ey’ bit

When we sit down our lower backs tend to relax into kyphosis / flexion (our lower back bends out), whereas when we stand, our lower back tends to move into lordosis / extension (our lower back bends inwards). And if we’re not used to standing for sustained periods, the muscles which for simplicity’s sake we’ll call our ‘core’, allow our back to slump into excessive lordosis. Kyphosis, and excessive lordosis both put uneven pressure on the discs in our spine, and our back muscles have to work hard to try and stabilise the spine, which leads to fatigue and eventually discomfort.

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Moving from sitting to standing  switches which part (front or back) of the discs in the lower back are being squeezed – giving the front and back a chance to recover alternately. It also relieves the different sets of back muscles which work hard (but ultimately in vain) to keep some sort of peace and stability when we are in a fixed posture either sitting or standing.

The other benefit of keeping switching between sitting and standing is that over time, and with the help of some simple exercises and postural awareness, our core strength adapts and increases, so we can stand for longer periods without excessive lordosis which means going for longer without lower back fatigue or discomfort.

How much should we sit or stand?

Cconsensus guidance on sitting and standing was produced by Public Health England and Active Working C.I.C in January 2015, and it is as follows:

“…for those occupations which are predominantly desk based, workers should aim to initially progress towards accumulating 2 h/day of standing and light activity (light walking) during working hours, eventually progressing to a total accumulation of 4 h/day (prorated to part-time hours). To achieve this, seated-based work should be regularly broken up with standing-based work, the use of sit–stand desks, or the taking of short active standing breaks. …companies should also promote among their staff that prolonged sitting, aggregated from work and in leisure time, may significantly and independently increase the risk of cardiometabolic diseases and premature mortality”. (Buckley, 2015).

How often should we switch between sitting and standing?

The cumulative daily targets are one thing, but how should we achieve them – how often should we switch to standing and for how long each time? When we look at this the picture becomes a bit more complex.

For example, recent research showed that males generally develop higher discomfort when standing, compared to females. In the study, males developed noticeable discomfort at 10 mins when standing, but the same threshold was crossed at 20 mins in females. Females on the other hand developed higher levels of discomfort when sitting (Karakolis et al, 2016). The data suggests that an optimal ratio may be at least gender specific, but more likely individual specific.

The generally held view is that we should aim for a 3:1 sit:stand ratio (as an initial target until you get used to standing for longer). However, there is also research that suggests a ratio between 1:1 and 1:3 sit:stand – which reverses the more widely held ratio, and effectively meaning 45 minutes of standing per hour.

A 1:3 target is not for the faint hearted – literally! Although it might suit some people, we recommend a gradual build up if you are looking to achieve those kinds of levels of standing. It’s also useful to note that the same group of researchers found that for people who develop lower back pain when standing in a 1:3 sit:stand ratio over an hour, the 15 minute sit-down did not fully re-set discomfort back to the original baseline (Gallagher, 2014). In view of this, although up to 1:1 might well be achievable for some and beneficial, in lieu of further research, I would not recommend a 1:3 sit:stand ratio.

There is also the advice from Cornell, which recommends that for every 20 mins sitting, you should stand for 8 mins and move about for 2.

OK – Let’s get real!

Science is all well and good, but we don’t work in laboratories (unless we are laboratory technicians). We have all kinds of demands on us at work. It’s inevitable that for a lot of us, stopping every 20 minutes or so to switch posture and raise/lower our desk is at best inconvenient, and at worst downright disruptive.

For example, using a 20 minute marker for switching, and the Cornell ratios, over an 8 hour period this would mean an extraordinary 32 (approx.) desk height changes. It seems pretty inconceivable that anyone would switch that often without it becoming a nuisance.

Looking at this another way, research suggests that we shouldn’t sit for much longer than 30 minutes at a time. If we stand for 20 minutes after 30 minutes sitting, this works out to be a 1.5:1 sit:stand rato, which will result in nearly 20 height adjustments over 8 hours of work. Is that still too many? Very possibly for some.

What does seem clear is that to begin with at least, we shouldn’t stand for longer than approximately 20 minutes at a time. If we stick with a 3:1 sit:stand ratio as an initial target, with a 20 minute stand period this means would mean 20 minutes standing for every hour spent sitting (minus a few minutes from the hour of sitting, for moving about!).

This would mean about 11 height adjustments per day. This is more reasonable, it means you are getting up each hour, which is in line with more general health guidance, it means less disruption to your work and you will still benefit from a varied posture. However, because studies have shown pain differentiation at just 10 minutes when standing (Karakolis, 2016), our recommendation is that you actually start off with just a 10 minute standing period each time.

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Picture above: 3 to 1 ratio –  a recommended target once you are through your initial 10 minute stands. Remember to also spend  some time each hour moving about – it only needs to be a couple of minutes.

Our tip: Unless you are really keen and don’t mind switching heights – a lot! – don’t get too caught up in aiming for the 3:1 ratio with your initial 10 minute standing periods. One of the things that might be putting a lot of people off actually using sit-stand desks is the high expected frequency of switching. And rather than adjust the frequencies, there is a danger that people might just give up on the whole idea.

Summary of recommendations

The summary recommendations below are based on a practical overview of the research to-date. In our view upwards of 20 height adjustments per day will soon wear thin and for many won’t ever be achieved unless you have an automatic raising / lowering mechanism (although that can still be switched off – and again, there’s a risk it could irritate after a while). And although the research suggests we shouldn’t sit for more than 30 mins at a time – let’s be honest, unless we are real sit-stand evangelists (nothing wrong with that, but most of us aren’t!), if we can aim to at least do some standing work, it will be better than none at all (and definitely better than just giving up!) In view of all this our recommendations are:

Don’t go all out to start with; we recommend you aim initially for no more than 10 mins per hour. You need to get your body used to standing still. Normally when we stand we move about but when we stand still we put static strain on bodies which we are not used to. Over repeated exposure our bodies adapt to it to some extent.

Rest well; we are (very) used to sitting so one of the main things is that you make sure you sit for long enough in between standing to feel fully recovered.

Based on a combination of science and practicality, we recommend initially aiming for about 1 hours cumulative standing work per day (this means approximately one 10 minute stand per hour – although go for more if you feel like it). Then after a week increase it to 20 minutes standing per hour of sitting, which will get you broadly in line with the 2hr/day consensus recommendations.

If you like standing (and not everyone does!) after a month or two, you could aim to double this to about 4 hours cumulative standing per work day – i.e. standing between 20 and 40 minutes each time with shorter seated breaks.

Move about! Although the 20min:8min:2min advice might for some stretch the limits of practicality, the idea of moving about more is a very important one. Humans are built for movement, a switch between sitting and standing relieves the forces on the spine temporarily, but really it is movement which offers the main health benefits (as opposed to just the musculoskeletal ones). Aim to walk about and stretch at least once per hour for a couple of minutes. Take opportunities like walking to discuss something with a colleague instead of emailing them when they are just sat (or standing) a few feet away!

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Are you a sitter or a stander?!?

Some people can stand for longer than others and others are much more comfortable than others sitting for longer periods. This becomes especially true for people who have past-injuries or medical conditions.

People need to be able to exercise their personal preference and should never feel pressured to stand or sit, but they should be informed properly of the risks of not varying their posture – when either sitting OR standing, and how to manage the risks using the equipment provided.

It sounds simple but – if you get a sore back from sustained sitting then some standing will benefit you, and visa versa. Some of us are better ‘sitters’ and others are better ‘standers’. But over time, sitting a lot reduces our ability to stand comfortably for sustained periods, and that is something worth working to stop happening, especially in view of the wide range of health issues associated with long periods of sitting.

Stick with it

Recent research has identified significant productivity gains when people are given the opportunity to work when standing and are able to alternate throughout the day (Garrett et al, 2016). Although other research has not identified productivity gains (Russell, 2016), there is no evidence of productivity / performance drops when standing. Most likely performance gains will be multifactorial. So as well as healthier more positive staff, with fewer days off sick, you may even see a productivity boost.

It is a significant change for a lot of people, and it is important people don’t feel pressured to stand any more than they want to, but in the long term, it is definitely an idea worth sticking with.

A few other things to consider

Postural awareness

Research indicates that although standing does generally lead to better, more neutral postures, it is still easily possible to get into bad postural habits – leaning forward, slumping, leaning on one leg etc. and not adjusting desk or monitor heights correctly. Postural awareness training and a level of friendly supervision, or even a buddy system, can offer real additional benefits.

Sit-stand reminders / alarms

Just providing sit-stand equipment isn’t enough. In one study only 20% of staff with sit-stand desks actually used them to switch postures at least once per day (Wilks, 2006). This is a pretty low up-take but understandably when we think about how long we have been used to sitting, and how, when we are busy and concentrating, we tend to forget about looking after ourselves – particularly our posture.

There are plenty of apps which offer sit-stand reminders, they are better than just using a phone alarm / timer because they don’t need resetting each time they go off. There are even desks which automatically change height throughout the day so you don’t even have to think about it!

My personal experience is that I tend to forget to sit rather than forget to stand, and when I do I notice my knees stiffening up.

Anti-fatigue mats

These should be used for prolonged standing tasks, but providing you have sensible footwear and vary frequently enough between sitting and standing, in our view they are unlikely to be essential for sit-stand desk work. However, they can extend how long you can stand comfortably for. Some people may have a personal preference to use one and we recommend allowing staff to use one on a trial basis.

 Standing foot rests – a much overlooked piece of kit!

A place to rest one of your feet up (and alternate between them) when standing, can help to reduce standing fatigue and significantly improve perceptions of comfort.

Standing footrests reduce intervertebral disc pressure by preventing excessive lordosis. Research has shown that if footrests are provided they are used significantly more often than not (up to 80% of the time), and actively (users switching feet every 90 seconds or so)!.

The drawback of footrests is that they tend to place more than half bodyweight on the non-resting leg and hip. This can quickly lead to fatigue and strain on the non-resting leg and may over time increase wear and tear on the knee joints (which is probably why the frequency of switching legs tends to be so high). However, people don’t need to use them all the time, and they can be provided as an option. Sometimes people may want them, other times they won’t but it may help people who develop lower back discomfort earlier when standing. As with anti-fatigue mats, we recommend allowing staff to use one on a trial basis.

If you have any comments or questions about sit-stand working please get in touch.

Choosing a sit-stand desk

Buying a sit-stand desk can seem a challenge when you see all the options. Reviews.com have compared a range of sit-stand desks (note: this is a US-based review and as far as we know, not all of the desks are available through UK dealers currently). The review is detailed and points out a lot of useful considerations and issues to think about when looking to buy a sit-stand desk – things that you might not necessarily consider in the bright lights of a dealer’s displays! Click here to go to the review.

References

Babski-Reeves, K & Calhoun, A (2016) Muscle Activity and Posture Differences in the Sit and Stand Phases of Sit-to-Stand Workstation Use: A Comparison of Computer Configurations. IIE Transactions On Occupational Ergonomics And Human Factors. Published Online: 15 Sep 2016 Pages 1-11.

Buckley, J. P. et al (2015) Consensus statement The sedentary office: an expert statement on the growing case for change towards better health and productivity. British Journal of Sports Medicine, 49:1357-1362.

Garrett G et al (2016) Call Center Productivity Over 6 Months Following a Standing Desk Intervention. IIE Transactions on Occupational Ergonomics and Human Factors. 4:2-3, 188-195.

Karakolis, T., Barrett, J., & Callaghan, J.P. (2016): A comparison of trunk biomechanics, musculoskeletal discomfort and productivity during simulated sit-stand office work. Ergonomics. Taylor & Francis online.

Lee I. M. et al (2012) Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet Physical Activity Series Working Group. Lancet. 21;380(9838):219-29.

Russell, B. A. et al (2016) A randomised control trial of the cognitive effects of working in a seated as opposed to a standing position in office workers. Ergonomics. 59, 6, 737–744.

Wilks, S., Mortimer, M., Nylén, P (2006) The Introduction of Sit–Stand Worktables; Aspects of Attitudes, Compliance and Satisfaction. Applied Ergonomics. 37: 359–365.