Abstract
There has been a recent trend in the integration of sit-stand option desks in the work place. Fear-based advertising insinuating that sitting is the health equivalent of smoking has pervaded many work environments. As workers want to remain healthy and pain free, and employers want and need a healthy workforce, it appears that there is a pervasive trend of avoiding sitting as often as possible. Because work tasks that call for an extensive amount of sitting are often times computer-based, this ‘standing is healthy’ fad is most notably presenting itself at computer-based work stations. The understandably perceived simple fix to the dilemma of sitting, has been the introduction of the sit-stand desk. However, before we all throw out our chairs, it is important to discuss the past and recent research that indicates that prolonged standing can also have detrimental effects on the human system. It is crucial that we expand our idea of a healthy work environment to one that facilitates movement and change in position and empowers the worker to understand their role in their own musculoskeletal and physiological health and wellness, beyond the use of equipment. If we can replace the phrase, ‘sitting is the new smoking’ with the phrase, ‘sedentary is the new smoking’, then we can elucidate the idea of what a healthy computer-based work environment and routine would be.
Keywords
Computer use and sitting
Although The National Institute for Occupational Safety and Health (NIOSH) provides no exact statistic on the number of workers in the United States (U.S.) whose work tasks require computer use, based on the existing number of jobs that are known to require computer use of some kind, they estimate approximately half U.S workers, which is 120 million people, are required to spend part of their work day at the computer [1, 2]. This statement comes from the most recent publication from National Institute of Occupational Safety and Health (NIOSH) regarding video display terminals, which is from 1999. In 2003, the Bureau of Labor Statistics (BLS) published data on computer and internet use at work estimating 77 million persons (55.5 percent of total employment) connected to the internet while on the job [3]. Although both of these figures are quite old, if we consider the exponential increase in available technology since that time, and the increase of individuals who are teleworking, self-employed and participating in computer work at home, or locations that have integrated computer use where hard copy documentation was once utilized, then we can surmise that this number is currently much higher. Occupational physical activity trend analysis over the last 50 years indicates that there has been an increasing presence of occupations that once required moderate intensity physical activity, evolving into occupations that requiring a majority of time spent in sitting [4, 5].
In a meta-analysis by Wilmot et al., (2014), it was reported that increased time spent by individuals performing sedentary behaviors is associated with an increased risk of mortality causing diseases, specifically diabetes and those related to the cardiovascular system. With diabetes being the most strongly correlated disease [6]. However, the term sedentary is utilized, not the word sitting. We can understand that sedentary activity can easily be achieved through maintaining the sitting position for long periods of time, however it is important that we differentiate between the term sedentary and sitting.
If we can integrate movement into our sitting positions by encouraging change in sitting position and breaking up periods of prolonged sitting, then we decrease the sedentary aspect of sitting. In a study published in the Journal of Hypertension by Dempsey et al., (2014), it was found that prolonged sitting resulted in the elevation of both diastolic and systolic blood pressure, and noradrenaline levels in individuals with Type 2 diabetes [7]. It was found in this study, that interrupting this prolonged sitting every 30 minutes with 3 minutes of light resistance exercises comprised of 20 seconds of half squats, 20 seconds of calf-raises, and 20 seconds of gluteal contractions and knee raises (all with bodyweight only), performed 3 times in row, resulted in a decrease in elevated diastolic and systolic blood pressure, as well as a decrease in elevated noradrenaline levels [7]. A similar outcome was found to a slightly lesser extent when light walking was performed for 3 minutes every 30 minutes to break-up prolonged sitting [7].
Effects of standing
After reading the research, it would be understandable that people may surmise that if sitting can be detrimental, then standing is the way to fix this. However, the preverbal ‘too much of anything is a bad thing’ may be very fitting in this instance. A study by Baker et al. (2018), titled; A detailed description of the short-term musculoskeletal and cognitive effects of prolonged standing for office computer work, discusses that epidemiological studies suggest that prolonged standing may be associated with health issues including venous insufficiency, atherosclerotic progression, as well as back and lower limb discomfort [8]. In this same study by Baker et al. (2018), it was reported that prolonged bouts of standing (up to two hours of uninterrupted standing) resulted in increased discomfort in multiple areas of the body and decreased cognition [8]. This study is important as many have advocated for the use of standing desks that are not a medical necessity, based on the idea that standing will facilitate increased efficiency and productivity.
When it comes to non-healthcare setting ergonomic evaluations the inability to access past medical history, inability to perform functional limitation evaluations, lack of real sit-stand desk training, and decreased occurrence of follow-up assessments to assure proper use of equipment, may actually increase the occurrence of musculoskeletal discomfort, and physiological stress on the body from prolonged sitting or standing.
Currently, there are no standardized recommendation for ratio times between sitting and standing, as every person has different needs and functional limitations. The lack of a ratio is one of the barriers for accurate recommendations by health care professionals such as occupational therapists and ergonomists. Which may leave the worker responsible for determining appropriate standing times based on personal trial and error. Suggestions have been made regarding what should be considered when providing insight to standing ratios. Body mass, sex, directional preference all seem to be contributing factors for sitting/standing tolerance but access to this information can be limited when ergonomic evaluations are taking place in non-healthcare settings [9]. These considerations may be unaddressed when ergonomic training occurs only in non-healthcare settings or when health professionals are left out of the discussion completely.
How do we improve the work place?
We first must reflect on the culture of the work-place. Does the environment provide sufficient options for movement and change in position? Can the basic recommended stretches be carried out at the immediate workstation? If not, is there a location that the worker has efficient access to in order to carry out this movement?
It is important that the worker is supported by administration to incorporate movement and mobility. This may come in the form of group training and encouragement to get up and move throughout the day, there is existing software that can be installed on computers to cue workers for movement and stretches. Group exercise and meditation classes can be offered at facilities to convey a culture of health and wellness. The importance of creating a culture of movement and health cannot be understated. Sometimes this can be something as simple as the supervisors stating that it is not only permitted, but encouraged, that the worker integrates movement and mobility into their work day. As many workers may feel demands for productivity trump the desire for movement, the encouragement on the administrative level is crucial in the successful integration of mobility in the workplace.
When and where should ergonomic evaluations take place?
The individualization of ergonomic evaluation and training may need to be reconsidered entirely. There is absolutely a place for ergonomic intervention and training in a non-healthcare setting. Preventative ergonomic intervention is crucial at keeping a young and an aging healthy workforce, healthy. Ergonomic programs that are companywide are crucial for creating a paradigm shift in the integration of healthy movement and lifestyle into the workplace. However, special consideration should be provided to employees that have existing health issues and musculoskeletal disease, as their needs may need to be individualized based on current functional limitations.
When a worker has a history of injury or chronic disease that may be impacted by specific exercises or prolonged activity, the most responsible location for intervention would be a healthcare setting. It is only here that a thorough review of the worker’s past medical history can take place, and an evaluation of existing functional limitations can be assessed. The individual’s response to activity can be monitored by observing blood pressure and heartrate, prolonged positional preference regarding spinal flexion verses extension can be determined, and other activities of daily living (ADL) that may be contributing to the overall experience of discomfort can be addressed.
People are typically awake for at least 16 hours a day. If only eight hours of that are spent at work, that leaves eight hours of activity that can contribute to a person’s experience of discomfort and perception of overall health and wellness. If physicians begin to refer their patients with chronic disease and injury to outpatient occupational therapy, or integrate occupational therapy into the primary care setting, then training in all ADL can take place. It is occupational therapy’s holistic perspective that makes it a preferred option for this intervention [10].
Final thoughts
Standing desks are not a negative thing; anything that will facilitate the presence of movement in the work environment should be considered. But we would be doing our workers a disservice if we fail at finding a balanced combination of the integration of ergonomic principles, providing ergonomic equipment, facilitation of frequent movements and stretches, and the personalization of intervention. It is all of these principles which may support the desired outcome of a healthy and pain free workforce.
When the culture and environment facilitate the stabilization of the physiological functions and reduced presence of musculoskeletal discomfort, we may see a decrease in worker absenteeism, decreased worker compensation costs, decreased prevalence of musculoskeletal discomfort, and other chronic diseases linked to a sedentary lifestyle.
Let us step back from standing for just a moment, consider pausing on the mass purchasing of standing desks, and be sure that first, the worker is educated in the principles of ergonomics and understands the importance of movement, the environment and culture supports the principle of movement, and proper training and individualized assessment for appropriateness has been carried out.
Conflict of interest
None to report.