Is Sitting Really the New Smoking? An In-Depth Discussion with the Experts

Written by Teena Maddox

Sitting can be as bad for your health as smoking. Spending hours sitting at a desk each day can lead to cancer, heart disease, and type 2 diabetes, and, much like smoking, the effects are not reversible through exercise or other healthy habits.

A new American Heart Association advisory warns that sitting too much is dangerous to your health. The advisory, published in the American Heart Association journal in September, showed that prolonged sedentary time is bad for your heart and blood vessels even if you are physically active and exercise regularly.

Tech jobs in particular involve plenty of sitting, and businesses are trying to find a way to incorporate more standing into the workday to help employees stay healthy. One study from the American Journal of Epidemiology published in 2010 found that men who sit six or more hours a day are 50% more likely to die from chronic disease, compared with those who sit three hours or fewer.

"Sitting can be detrimental to your health, so reducing your exposure to it-by no matter how little-can help," said Jonathan Dugas, Ph.D., director of health and research at the Vitality Institute, developer of an incentive-based wellness program. 

Standing up also increases productivity, as well as tones muscles, burns more calories, improves posture, and ramps up metabolism. Employees are opting for adjustable stand-up desks, leaning desks, and treadmill desks as ways to be less sedentary at their job.

The Steelcase Global Report found that many workers are desk-bound, and that 80% of offices have desktop computers vs. 39% with laptops.

In order to prevent some of the health issues, researchers recommend a range of 2 to 4 hours of varied movement-standing, walking, and other activities-in a typical 8-hour day. Allan Hedge, director of Cornell University's Human Factors and Ergonomics programs, suggests this mix: In each half hour sit for 20 minutes, stand for 8 minutes, and move around and stretch for two minutes. And when you are seated, choose seating that encourages a range of healthy postures (vs. a static seated posture). 

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To find out more, TechRepublic talked to medical professionals and workplace design experts to get their opinions on standing vs. sitting and what it all means.

Those participating in our roundtable included David Neuman, M.D., an orthopedic surgeon in New York, NY; Lior Cohen, director of Metro Physical Therapy and Sports Rehabilitation in New York, NY; Darren Pollack, a chiropractor based in New York, NY; Jonathan Webb, an executive with Green Bay, WI-based furniture manufacturer KI; Jonathan Dugas, Ph.D., director of health and research at the Vitality Institute in Chicago; and Ken Tameling, general manager, Seating and Surface Materials at Steelcase, in Grand Rapids, Mich.

TechRepublic: Is it more beneficial to sit or stand at work?

Neuman: This is dependent on the type of work someone does. There are some new studies out that note the benefits of standing while at work. Sedentary job positions lead to deconditioning and can lead to weight gain and loss of function. It can also lead to blood pooling in the lower extremities and can lead to vein insufficiency. Standing burns more calories than sitting, and is therefore better to do during work (as long as production at work does not fall).

Webb: It's actually important to have a balance of many postures throughout the day. The workplace has become this incubator for sedentary behavior, so it's important to promote movement amongst employees in any way possible. A sit/stand desk provides ongoing options to toggle back and forth throughout the day.

Pollack: Both. If someone either only sits or stands throughout the day, they may develop an issue which can affect the body's metabolic system. The main health concern with sitting too long is the muscles-specifically, the hip flexor muscle. While sitting the hip flexor becomes locked up and restricted. Especially crossing your legs because during that time, other muscles will start to compensate and in turn back pain will develop. Your hip flexor is a pseudo low back muscle-it's responsible for low back pain 90% of the time.

Dugas: It's important to avoid the extremes, so it's not that one or the other is what we should be doing all day. However most will understand that sitting has its downfalls, namely that it places undue stress on the lower back, and that can contribute to a more chronic presentation of low-back pain. Standing removes most of that stress on the lower back, so it is beneficial to break up your sitting time, and standing is one way to do that.

TechRepublic: Are standing desks a good alternative to traditional sit-down desks?

Neuman: I believe that they are, and standing helps keep the postural muscles active and engaged, thus increasing their stamina.

Cohen: They are at the moment the best alternative for sit-down desks. Standing desks have become very popular in the past few years and are gaining more and more popularity. You find these especially in big firms whose employees sit for many hours of the day, developing all sorts of medical issues.

Webb: We hear a lot about standing height desks (accompanied with stools) in the workplace. When programmed with stools, the user can still sit and stand throughout the day, which is great. However, not all workspaces can aesthetically accommodate such an environment. Sight lines, privacy concerns, and light glare can also be problematic depending on the building.

Pollack: Yes, because it helps to break the mold of sitting all day. Sitting desks are usually cookie-cutter in sense of size so they're not suitable for each individual. Standing desks allow you to adjust the height based on the person's position, which can really alleviate pain and improve posture while increasing the blood flow.

Dugas: Workstations that are convertible, and can go from a seated to a standing position, are the best alternative. These permit employees to take advantage of standing while still allowing them to do so in a way that is suitable for their work style and health.

Tameling: Height-adjustable desks are great options for dedicated or shared workspaces, and allow users to move quickly and frequently between sitting and standing, offering positive health outcomes, according to the Human Factors and Ergonomics Society. Different tasks require different workspaces, and it's critical that employees have access to a variety of spaces each designed to support different types of work. People at work need to focus, collaborate, rejuvenate, socialize, and learn throughout their day. No single space can support these diverse needs.

TechRepublic: Is there a limit to how much you should sit each day?

Neuman: Sitting has been shown to decondition people. In addition, this can lead to the pooling of blood in the lower extremities. The less the better, as long as work can be done adequately while standing. And, of course, the desks must be capable of being ergonomic for a standing worker.

Cohen: I am not sure there is a number-of-hours limit because everyone is different, but anything above 6-7 hours at a desk daily, for many years will start affecting the body. I tell all my patients who are at their desk (certainly those who are with any spine issues) to get up every 30 mins if they can. Best if they can walk around for 30 seconds but I encourage them to just stand and reverse that flexion position of the spine.

Webb: We already sit too much. Between work, transport, and evening sedentary lifestyles, most people spend upwards of 60% of their day in a seated/lounged position. This causes slower metabolism, decreases in heart rate, and even higher blood pressure.

Pollack: You could sit for as long as you have to or like to as long as every hour you set a timer and stand up. Whether you walk to the water cooler, the bathroom, or even just around the office, make it priority to get up every single hour.

Dugas: Like physical activity, sitting and standing exist on a continuum. It's not beneficial to be sedentary 100% of your waking hours, but nor is it possible or beneficial to be active during that entire time even if sedentary time is something we want to reduce. The best way to approach the sitting/standing debate is to encourage individuals to reduce their sitting time via standing or being active, but understanding that "reduce" is a relative term-some people can reduce their sitting time by hours each day, while others might be able to do it for only 30 minutes. Both people are winning because they are sitting less.

Tameling: Researchers recommend a range of 2 to 4 hours of varied movement-standing, walking, and other activities-in a typical 8-hour day. When the workplace provides a range of spaces-like traditional and lounge seating and seated, standing, or treadmill desks-workers can easily add activity and movement into their day.

TechRepublic: Are there chronic conditions that would make sitting difficult for some people? Or that would make standing difficult?

Neuman: Yes-certain neck and/or low-back problems (inflammation, disc herniation, stenosis or narrowing of the spinal cord canal, degeneration of the small joints of the lumbar spine) can feel worse with standing, while others feel worse with sitting. It really depends on what part of the spine is not functioning well. The optimal position for work is alternating between sitting and standing.

Pollack: Pretty much everybody has to sit and stand at some point during the day. If you sit or stand for too long, that's when most issues will tend to develop. Even if you have a standing desk it's important to change positions-sit down for a minute or two. If someone has a leg condition, I would not recommend that person stands all day. As far as the back goes, there aren't any conditions that would prevent you from sitting or standing.

TechRepublic: Who is best suited for a standing desk?

Neuman: Most people would benefit from standing more at work as compared to sitting. Mixing it up from standing to sitting (and having a proper work environment-ergonomic desks suited for the standing and the sitting worker) throughout the day is best.

Cohen: Anyone who is at their desk for longer than 6-7 hours daily. Anyone regardless of their age, but most certainly the older crowd should be aiming to change the workstation if possible. Anyone with with other medical conditions such as heart issues, obesity, circulatory issues (varicose veins), degenerative changes in their spine, posture alignment, etc.

Webb: Well, I'd have to say everyone, if I'm being honest. However, I think a practical way for a company to approach it is to look at those employees that, in order to be productive, have to spend a majority of time at their desk. Knowledge workers often need a computer to work, and unless you have a laptop and good Wi-Fi, mobility can be limited. So start with the people that need to be in front of a computer to be productive and go from there.

Pollack: Anybody who works full-time or who will be sitting for at least four consecutive hours per day should consider a standing desk to break the mold of sitting all day.

Dugas: Really almost anyone is best suited for a standing desk, the exceptions being when an orthopedic or other injury or conditions makes standing for prolonged periods impossible. The physical activity guidelines are a good analogy here. They state that in older aged individuals, if they cannot meet the recommended 150 minutes per week, they should do as much as their conditions or symptoms permit. In the same thread, some individuals might not be able to stand for prolonged periods, but short periods of standing are possible, and should be encouraged as a way to break up sedentary time.

TechRepublic: Does your age matter as to whether you should sit or stand at your desk?

Neuman: No. But those going from a more sitting to a more standing position while at work should do it in a step-wise manner (more and more standing as the weeks progress; not just jumping into the "let's stand all day today at work"). You must condition the body to increase the stamina of standing throughout the day.

Cohen: The older you are the more prone you are to developing issues from being at the desk.

Webb: I don't think so. With such an emphasis on health and wellness in the workplace, the application of sit/stand is really for anyone.

Pollack: No. As long as a person is aware of their health and listens to their body, age does not matter.

TechRepublic: Do people think better when they're on their feet?

Neuman: Not if they are fatigued or have aching feet or low back (due to deconditioning, uncomfortable or non-supportive shoes, or a low back condition that is exacerbated by standing) problems. I think this varies between people. Some are more comfortable and feel more alive and active when standing as compared to sitting. While others feel more relaxed and at ease (so [they] can think better) while sitting.

Webb: I think they do. I also think they work more. Research performed by Miami University in Ohio demonstrated that intermittent standing increased productivity through a reduction in the parameters of employee work breaks. In essence, the employees who intermittently changed their postures took fewer and shorter breaks throughout the day. Individuals who did not alter their position (non-standers) took an average of 47% more breaks throughout the day. In addition, the average duration of non-standers' work breaks was 56% longer.

Pollack: The key is to not get locked in either position for too long by sitting or standing and taking standing/sitting breaks and walks to clear your mind and refresh.

Tameling: Movement helps us stay fresh and productive. Using just one posture-static sitting or static standing-puts strain on the body and can drain a person's energy. In addition to physical health problems, this can lead to cognitive issues like poorer cognition and disengagement. According to findings in the Steelcase Global Report, workers are more highly engaged when they can choose from a range of spaces that best support the work they are doing.

TechRepublic: Do you burn more calories when you're standing vs. sitting?

Neuman: Standing-this is due to the engaging of the low back and upper back postural muscles, and the lower extremities are working more to keep one standing vs. sitting.

Webb: Standing a little more each day tones muscles, improves posture, increases blood flow, ramps up metabolism, and burns extra calories. Americans also burn 140 fewer calories a day than they did 50 years ago, mostly due to changes in work styles and job functions. A 200-pound man can burn nearly 30% more calories by standing rather than sitting during the normal workday.

Pollack: It depends on your heart rate. If your heart rate is the same while sitting or standing, then you will probably burn the same amount of calories in either position. Everybody is different, but some people may be able to burn up to 50 calories an hour just by standing.

Tameling: The research is mixed on this topic. Recent research by Catrine Tudor-Locke, Ph.D., a kinesiologist at the University of Massachusetts Amherst, found that workers expended about the same amount of energy seated as standing. No matter the posture, it is important to focus on incorporating activity and movement into each workday to create a more stimulating, healthier workplace.

TechRepublic: Do you think sitting is the new smoking as far as health risks are concerned?

Neuman: There are many reasons why this caveat is true: the more you sit the more deconditioned you get, the more weight you can put on due to being sedentary, the more likely you are to get venous insufficiency and blood clots, and the more likely you are to get low back pain. However, sitting does not affect every organ system like smoking does, and does not increase the rate of cancer in the body, like smoking does. Sitting should be looked at with "moderation" glasses on. Doing activities and "vice-like" things in moderation (alcohol intake, caffeine intake, gluttony, sweets, running, and team sports) are better tolerated by the body than doing things in excess.

Cohen: In a way I think it's as bad and could possibly be worse than smoking in some cases. When looking at the list of conditions/diseases that are related to sitting for long, it is incredible to discover how connected they are.

Webb: Maybe. There are enough studies to support this. One firm took a sample of 6,200 employees and divided them into groups with non-adjustable furniture and those that had user-adjustable furniture. They evaluated the number of work-related MSD (musculoskeletal disorders) expenses over a three-year period. The results were staggering. The firm's direct injury MSD expenses were 20 times greater for employees who did NOT have user-adjustable furniture over that three-year period. The three-year MSD costs alone could justify user-adjustable features. However, the total cost of ownership is even higher when considering the additional cost of providing ergonomic accommodations for fixed-height workstations.

The top three takeaways for TechRepublic readers

1. Sitting at your desk for too many hours can lead to heart and other cardiovascular issues, according to a new advisory from the American Heart Association.
2. Opting for a standing desk and doing a combination of standing and sitting is the ideal work environment for many people.
3. It doesn't matter what age you are, sitting instead of standing can lead to health issues.

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