Stand pat. Stand tall. Take a stand. Making up one’s mind and expressing it publicly means one has taken a stand. Could another meaning be attached to these words, one that connects office workers around the world with resources for improving their health and wellbeing? “The evidence has been growing since the 1950s about a difference in health outcomes depending on whether you are sitting all day long or up and moving around,” said Carrie Schmitz, Manager of Human Factors and Engineering Publications for Ergotron, Inc. Taking a stand while working—literally—is an action for reversing sitting’s ill effects.

“When we get to work, many of us park our bodies in chairs just as we parked our vehicles in the parking lot,” says Ms. Schmitz. She is referring to reconnecting the “disconnect” between mind and body. “We have to remember we have a body that needs to be dynamic.” This goes unnoticed during the workday, to the detriment of the body. “We need to integrate the mind and body” while at work because during working hours, the “body is suffering from neglect.”

Realizing what is at stake has converted Ms. Schmitz and her colleagues into trailblazers, ones self-tasked with staking paths to healthier workplaces, encouraging new thoughts on workplace wellbeing and serving others in creating their own interpretations of healthier work environments. What they have set out to do could be a model for those with similar interests. In creating the non-profit organization Just Stand, a movement and an active workplace resource has an online presence. The practical results being achieved support why they—and others—believe in what they are doing.

Just Stand, a non-profit clearinghouse for the active workplace, with tools, products and health resources serving a global membership.

About Sitting and Standing

There is no lesser evil among the health risks associated with sitting too much, especially when connected to a sedentary lifestyle. As cited in a 2009 study, the risks include heart disease, obesity, diabetes, certain cancers and early death, wrote New York Times writer Olivia Judson. She adds any of these are “possible independently of whether you exercise regularly.” As for obesity, Ms. Judson clarifies what many have surmised: the “slow creep” of weight gain. “Two pounds this year, three pounds next year. You can gain this much if, each day, you eat just 30 more calories than you burn.”

What needs to happen? Those advocating workplace activity have made sitting for too long a linchpin in their arguments: reversing historical trends requires attention sooner rather than later. Research published since 2007 has upended, or at least disputed, the popular thesis that changing diets and adding exercise alone could remedy obesity.

The new realization: office workers should find ways to burn more calories during the workday. Phrases such as passive energy expenditure and nonexercise activity soon entered this conversation. A possibility for doing that–what some might call a ridiculously simple solution–is to work standing up for a bit each day.

Standing does at least two good things: it increases heart rate and burns more calories than sitting. Because nobody is perfectly still while standing, all that shifting and fidgeting helps burn calories, too. Standing can reduce that “sluggish feeling after lunch…some people say that standing helps them be more productive,” according to a New York Times article. “It’s like an afternoon pick-me-up.”

(To work while walking on a treadmill or while cycling on a stationary bike are also possibilities, and will be covered in a separate article–SW.)

Conditions 150 Years in the Making

There has been an “unprecedented shift in the human demographic in the last 150 years,” writes Dr. James Levine, of the Mayo Clinic’s Department of Endocrinology. “In a mere 150 years, homo sapiens has become addicted to the chair,” says Dr. Levine. Most humans consume more calories than they expend and this, compounded by less physical activity because of technological advances, has led to nearly epidemic obesity and related health concerns. Dr. Levine further charges the computer with being an accomplice in the case. He writes, “Half of the world’s population now works behind a computer whereas twenty years ago this was less than one percent.”

Working behind a computer usually means sitting, and long periods of it. To counteract this, studies by Dr. Levine and others emphasize getting workers out of their chairs and onto their feet, if only a few hours each day. How can this help?

By “short-circuiting unhealthy molecular signals causing metabolic diseases,” writes Dr. Marc Hamilton in a 2007 study. This research team found inactivity triggered “unique cellular processes” quite different from those caused by exercise. In layman’s terms, their significant conclusion was that being physically active outside of work is fine, but sitting in a chair all day undoes the beneficial effects. Maintaining nonexercise activity throughout the day—such as standing while working—could have beneficial health effects.

Competing Scenarios

Dr. Levine offers two scenarios for increasing nonexercise activity within the work environment. The first, called “individualized scenarios”, seek to persuade individuals to stand when they once sat. In Dr. Levine’s “environmental re-engineering” scenario, he advances the thought that elements of the design and outfitting of the workplace encourage individuals to sit. Though he enumerates advantages for public health toward reversing the effects of years of sedentary living, he concedes that “such endeavors are costly and the standards that define success are ill-defined.”

What is this, and what has it to do with workplace health? Standing on this BOSU ball increases passive energy expenditure while working.

1950s Research to New Millennium Policy

As Ergotron’s Carrie Schmitz mentioned, warnings about ill effects from the kind of sitting being encountered by computer users were first published in the mid-1950s. “The study of drivers and conductors on London’s double-decker buses showed the sedentary drivers having more heart disease than the conductors, who were on their feet going up and down the stairs throughout their shifts,” she said. Computing was then at an embryonic stage: the earliest vacuum tube devices were educating themselves about playing chess and were often called “electronic brains” in the periodicals of the day.

Ms. Schmitz singled out Dr. Frank Booth for raising a flag over the issue of sedentary health risk ten years ago. In her paper, “Standing Up for Workplace Wellness”, she wrote that Dr. Booth “didn’t mince words” in using “Sedentary Death Syndrome” for referencing “the host of health disorders” attributed to inactivity. Abbreviated “SeDS”, this term was a creation of the nation’s 200 leading physiologists. Dr. Booth’s 2011 study concluded, “physical inactivity has a large impact in shortening average life expectancy” and “accelerates secondary aging.” This refers to reductions in “bone mineral density, maximal oxygen consumption and skeletal muscle strength and power.”

Ms. Schmitz credits Dr. Booth’s early efforts with turning the gears of public policy development; gears whose movements make the growth of trees seem abrupt by comparison. A Washington, D.C. speech by Dr. Booth in May 2001 launched SeDS into the national conversation. In April 2006, the American College of Sports Medicine and 40 national organizations produced a call to action for a “healthier America through increased physical activity and exercise.”

Two pivotal events followed. The first-ever Physical Activity Guidelines were released by the U.S. Centers for Disease Control and Prevention. Then, in May 2010, along came the U.S. National Physical Activity Plan (NPAP), which envisaged “one day, all Americans will be physically active and they will live, work, and play in environments that facilitate regular physical activity.”

The NPAP makes recommendations in eight sectors of society with a specific sector for Business and Industry. This sector’s rationale includes:

Technological advancements in the workplace have greatly improved efficiency, reduced redundancy of tasks, and maximized output. However, an unfortunate consequence is that many job tasks in the modern workplace have become increasingly sedentary…because of their close ties with employees, business and industry can encourage employees to positive physical activity…

Tactics for implementing the suggested strategies include developing and maintaining a clearinghouse for examples of best practice and identifying cross-sector partnerships for promoting physical activity. While the use of the word “encourage” in the rationale could sound ominous, the NPAP’s authors likely chose the word because employers can change work rules, approve purchases of mobility-enhancing furniture, and provide employees with information or incentives for adopting healthier work styles. But, where might the information be found to create settings that encourage such changes?

JustStand's message reaches office workers the world over, including those working and living near the Louvre.

A Go To Resource for Active Office Ideas

An excellent starting place is JustStand.org, a not-for-profit information clearinghouse about the active workplace for individuals, businesses, institutions and researchers. JustStand.org operates autonomously of its benefactor, Ergotron. The site includes studies and resources for working while standing, with connections to products and solutions (including those manufacturers competing with Ergotron). Michelle Judd, Ergotron’s Marketing Manager, Global Communications, says the site isn’t intended as the single authority, but as an accessible location for relevant, carefully vetted resources.

Anyone can join JustStand, proven by its multinational membership. From the lower 48 states, to the UAE, Australia and the European Union, global members have access to videos, calorie calculators and testimonials. Ms. Judd says the site has been translated into German and French, with a Spanish translation on the way. “We have intentions for Japanese, Chinese and Italian versions,” she added.

“While we are advocating for standing, we’re not saying it is the only solution,” continues Ms. Judd. “We’re just asking members and others to be aware of the dangers associated with sitting too much, while introducing them to ways of getting healthy movement into their workday–one way of doing that is to stand more.”

The big picture is just as clear to Carrie Schmitz, who says, “There are so many ways to approach this issue—metabolic process, aging, lifespan, arthritis, inflammation—where each one has ramifications with outcomes that could be positively affected.” The first JustStand Summit, held during July 2011, attracted researchers, scientists, ergonomists and other interested parties. The day’s content has since been posted to JustStand.org. Planning is underway for 2012’s summit.

Among the products shown on JustStand.org: Ergotron WorkFit D Sit-Stand Desk, shown with dual monitors and keyboard arm. Photo credit: Ergotron.

Ergotron’s Working Laboratory

Theirs is a company that is ergonomically-empowered. “Ask anyone here about their workstation,” says Ms. Schmitz, “They’ll be able to tell you about their set-up and why they did it.” This supports the case for the human body knowing what is best for it—if only the owners would listen and act on what the body is trying to communicate. At Ergotron’s U.S. headquarters, in St. Paul, visitors will find offices doubling as a practical environment for active workplace solutions.

Ms. Schmitz says that the catalytic event occurred when Ergotron’s management decided everyone would trade their bulky CRTs for two flat panel monitors. “Everything changed for us,” after that because “more motion was possible.” By using products from the Ergotron offering with the new monitors, far more adjustment was possible than with CRTs. “This new flexibility allowed everyone to experiment and adjust their offices for better workflow and much better ergonomics,” she said. “Suddenly a few people raised their desks so they could work standing, and they brought stools so they could split their time between standing and sitting.” Ms. Schmitz says this experimentation has informed product development.

“The great thing about the sit-to-stand workstations is that they take the activity right to place it will be used,” says Ms. Schmitz. This idea connects Dr. Levine’s thinking about persuading individuals to stand where they once sat, and that the ideal activity is convenient, easily accessed and easier to do than to not do. Then comes the idea of individual control within the work environment, to which Ms. Schmitz concludes, “Our products are designed for working in either sitting or standing positions, giving individuals total control over how they work.”

Serving a global community means offering multiple versions of JustStand's website. An Italian translation is among those planned. Shown: Bari, in Italy's Taranto province.

Effects of Standing on Productivity

Professor Leon Straker, at Curtin University of Technology’s School of Physiotherapy in Perth, set out to uncover what effects on task performance occurred when keyboarding or using a mouse while standing. A few of the many findings from this detailed study:

• Keyboarding performance: same for standing as sitting.
• Combined keyboard and mouse performance: same for standing as sitting.
• Actual exertion: Standing exertion was the same as a walking speed of 1.6 km/h
• Real world feasibility: 83% agreed with standing workstation feasibility
• User perceptions: A good break from sitting; the most feasible approach; good for posture; and good for musculoskeletal soreness associated with all-day sitting. The most desirable option would the ability to use one of the workstation variations for short periods of time to break up the day.

When asked about the productivity aspect of introducing active workstations into offices, Professor Straker responded:

“This is where we are looking to go next with our research… Using active workstations to provide variety to the traditional sitting office work may diminish physical and mental fatigue, and thus enhance productivity in the short term. In the long term, activity is related to better weight management and overall physical and mental health, so the current evidence suggests long-term productivity should be enhanced.”

Regarding the physical health aspect, this study points to specific benefits in musculoskeletal health. Less time spent in prolonged sitting may:

• Reduce exacerbation and perpetuation of low-back pain:
• Reduce leg swelling; and,
• Increased spinal motion may result, which “will enhance intervertebral disc nutrition and may reduce spinal shrinkage.”

Evidence has been accumulating since the 1950s to support a connection between sedentary lifestyles and health outcomes. The "chair addiction" was well developed long before some of these Chicago office buildings were on the drawing boards.

First-hand Results

Among the many questions that Ms. Schmitz gathers information about, one with particular significance, is this: “How much can we recover once the consequences of sitting too much take hold?” That she has her own health outcome to contribute is what makes this a special question. The fact is, Ms. Schmitz has been working while standing for sometime, and at various times has augmented her sit/stand workstation with a treadmill and with a BOSU Ball (a round platform with a squishy dome that looks like half of an exercise ball). Because she has arthritis of the lower back that makes sitting painful after a short while, she has a keen interest in the recovery possibilities. While the arthritis remains, she says that, “My bone density has increased, and I actually have gained a half-inch of height. I told this to a doctor visiting our offices, and how surprised I was about it. He said, ‘This is probably because the discs in your back are becoming more healthy and they have added some height’.”

Performs as Designed

How long will it take to adopt ideas for the active workplace like those promoted by JustStand.org? Ms. Schmitz describes a cycle of eventual acceptance of “any new idea that appears on the scene.” The cycle begins in frothy denials, moves to prosecution of the idea, then faint signs of tentative acceptance and concludes in full-blown embrace of the idea so as to “push out any other ideas occupying the same space to where a backlash develops.” This backlash, she explains, is inevitable and “is part of the progression of how people take on new ideas.” Aside from that, she adds that we should be willing to accept at face value that we are going to feel better if we use our bodies as they were meant to be used – our bodies were designed for movement, they need movement throughout the day. Does this make truth of the old saw, “Use it, or lose it?” If so, we have much to gain by taking a stand.

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My Experience

I would like to add a personal comment based on my own experience with standing while working. In the spring of 2011, I began standing while doing some of my writing, most of my telephone interviews, during research reviews and a number of other routine tasks. I also took the stairs to our third-floor office as much as possible, but this and standing while working for three-to-four hours most days comprised the extent of my workday re-engineering. I didn’t make any conscious changes to my diet. In October 2011, I went for my annual physical. The good cholesterol was a bit higher. The bad cholesterol (which had been creeping upward) was a bit lower. My weight was down a few pounds. Blood pressure was good, but it usually runs to low end of the scale. I was surprised that eight months of relatively limited, modest changes in my workday could produce these results. I am a believer, and will continue to spend part of my day on my feet. –SW.

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With appreciation for their generosity and participation in the writing of this article:

Carrie Schmitz, Manager of Human Factors and Engineering Publications, Ergotron. Via interview and emails.

Michelle Judd, Marketing Manager, Global Communications, Ergotron. Via interview and emails.

Professor Leon Straker, Director of Research and Higher Degree Programs at the School of Physiotherapy, Curtin University of Technology. Via email.

Schmitz, C. 2010. Standing up for workplace wellness: JustStand.org January.

Judson, O. 2010. Stand up while you read this: New York Times 23 February.

Perkins, A. 2010. Feeling at home in the office: New York Times 07 August.

Ashby, W.R. 1949. The electronic brain: Radio Electronics March. (Via VintageComputer.net)

Levine, J. 2007. Nonexercise activity thermogenesis – liberating the life-force: Journal of Internal Medicine 262: 273-287.

Hamilton, M., D. Hamilton, T. Zderic. 2007. Role of low energy expenditure and sitting in obesity, metabolic syndrome, type 2 diabetes, and cardiovascular disease: Diabetes 56:2655-2667.

Seiders, K., L. Barry. 2007. Should business care about obesity?: MIT Sloan Management Review January. (Via sloanreview.mit.edu)

Booth, F., M. Laye, M. Roberts. 2011. Lifetime sedentary living accelerates some aspects of secondary aging: Journal of Applied Physiology November.

American College of Sports Medicine. “The Policy Roundtable: Collaborative Action Bears Fruit”: ACSM website http://www.acsm.org/about-acsm/policy-center

Straker, L., J. Levine, A. Campbell. 2009. The effects of walking and cycling computer workstations on keyboard and mouse performance: Human Factors: The Journal of the Human Factors and Ergonomic Society December.

University of Missouri. 2001. Press release–Sedentary death syndrome is what researcher now call America’s second largest threat to public health: Missouri.edu May.

Beers, E., J. Roemmich, L. Epstein, P. Horvath. 2008. Increasing passive energy expenditure during clerical work. Journal of Applied Physiology June.

Photo credits: From the Internet under free documentation except as noted.