A Criticism of Standing Desks

Introduction

Over the past two decades, there has been an immense accumulation of evidence stating that a sedentary lifestyle significantly increases the risk of adverse health outcomes such as obesity, type II diabetes, and cardiovascular disease [1-5]. In response to this evidence, standing desks have grown in popularity, especially in the corporate office setting. Since sitting is by far the most popular sedentary position in the United States, the popularization of standing desks appears to be an appropriate response for improving health. However, when critically analyzed, there are many faulty premises associated with the alleged health-improving benefits of the standing desk. This article explains what the standing desk can (and cannot) be expected to do in terms of improving health outcomes.

Confusing the Definitions of “Sitting” and “Sedentary”

The use of standing desks has been claimed to elicit many health benefits, and the most common claims allege a reduction in rates of obesity, chronic disease, cancer, and postural problems. Media and commercial sources promoting standing desks will often use the phrase “sitting will kill you”. Phrases like this are inaccurate. Sitting does not kill you. Chronic inactivity is just one of many factors that decreases life expectancy, other factors being chronic stress [6], poor nutrition [7], and low socioeconomic status [8].

To say that “sitting will kill you” is to make a gross oversimplification. It is more accurate to say, “A sedentary lifestyle, which can occur in the form of chronic prolonged sitting, will increase the risk of adverse health outcomes and resultantly reduce life expectancy”. No one simply dies from sitting, just as no one simply dies from stress, even though both are significant public health concerns that adversely impact the health of millions [1-6].

It’s important to understand what sedentary means. The practical definition of “sedentary” is:

  • Physical inactivity that results in low levels of energy expenditure above basal metabolism* [9]

*Basal metabolism = “the minimal amount of energy necessary to maintain respiration, circulation, and other vital body functions while fasting and at total rest.” [10]

The key is to understand that “sedentary” and “sitting” are not exactly the same thing. Sitting is just one way to be sedentary. Within the definition of “sedentary”, standing must be included as well because it is a static position that does not appreciably increase one’s energy expenditure [11]. Media sources and corporations may praise the standing desk as the new hallmark of a healthy office, but standing simply does not challenge the musculoskeletal or cardiovascular systems to a significant degree. This fact brings to light a severe fault in the premise that standing desks can improve one’s health.

Technically, when compared to sitting, standing does cause the body to burn more calories because postural muscles have to work harder to maintain balance. Also, the cardiovascular system has to increase its work-output in a standing position because blood must be pumped against gravity to a greater degree. However, neither the musculoskeletal or cardiovascular systems are significantly challenged by replacing sitting with standing. Using a standing desk to increase energy expenditure is like trying to reduce caloric intake by forgoing a cherry on the top of your triple scoop ice cream sundae. Yes, there is a difference, but it is negligible, and the overall premise is flawed.

Faulty Premises behind the Alleged Benefits of Standing Desks

Now that we have a clear understanding of what “sedentary” means, we can begin to uncover the faulty premises behind the alleged benefits of standing desks.

In a recent comprehensive research review that assessed the effects of using standing desks, the authors stated that there is currently a lack of evidence to support the idea that standing desks can improve health [12]. This contextual fact must be kept in mind when examining the alleged benefits of standing desks. If there is no evidence to support the health benefits of standing desks, what are such alleged benefits based on?

Alleged Benefit #1: Standing Desks Help Prevent Obesity

As previously stated, it has been found that the standing position may not cause an appreciable increase in energy expenditure compared to sitting [11]. In contradiction, another study found that standing desks significantly increased energy expenditure [13]. However, the study had some notable limitations that were self-admitted (i.e. small sample size and short testing period). Even if the data reported in the study were compelling enough to be generalizable, individuals would have to replace sitting with standing for roughly 6 hours per day to burn an extra 114 calories. The notion that individuals will comply with 6 hours of standing instead of sitting is highly unrealistic. Even if individuals stand 50% of the time in replacement of sitting, which is more plausible but still questionable, the extra daily energy expenditure drops to 57 calories. Standing 25% of the time is far more realistic, which reduces extra daily energy expenditure to roughly 25 calories, a value that is essentially negligible.

Now let’s consider the claim that standing desks can prevent obesity. First we must understand the primary factors involved in weight loss, which are:

  1. Limiting total caloric intake to create an energy deficit
  2. Increasing physical activity to increase energy expenditure

Out of these two factors, limiting total caloric intake is by far the most important to control. It is very difficult to lose weight by exercising alone without reducing total caloric intake, and it is obvious standing desks do not affect caloric intake. As we already know, standing desks also do not appreciably increase energy expenditure. Therefore, there is no way that standing at a desk, instead of sitting, would stimulate weight loss and reduce/prevent the occurrence of obesity.

Alleged Benefit #2: Standing Desks Help Prevent Chronic Diseases

The primary factors involved in the prevention/management of chronic diseases (e.g. cardiovascular disease, type II diabetes, and cancer) include:

A standing desk does not affect nutritional habits or stress management, and as previously stated, they also do not significantly impact energy expenditure. Therefore, there is a lack of logic behind the notion that standing desks can contribute to the prevention of chronic diseases.

Alleged Benefit #3: Standing Desks Help Prevent Cancer

There is evidence suggesting that increasing levels of physical activity can reduce the risk of cancer [18,20,21]. I am beating a dead horse, but the relevance of the point remains – standing does not significantly impact physical activity levels compared to sitting. Therefore, standing desks should not be expected to prevent cancer. Interestingly, in a 2009 study, it was actually found that chronic prolonged sitting did not increase the risk of cancer [22].

Alleged Benefit #4: Standing Desks may Increase Life Expectancy

Increased life expectancy from using a standing desk is claimed because of alleged benefits #1 through #3, which are all based on faulty premises. Therefore, an increased life expectancy from replacing sitting with standing is predicated on a lack of evidence and weak logic.

Alleged Benefit #5: Standing Desks Improve Posture

Improving posture by using a standing desk may actually pass muster, at least in some respects. When the body is seated, certain joints and muscles are held in a shortened position while others are held in a lengthened position.

Chronic prolonged sitting encourages tightness in shortened muscles, and contributes to weakness, discomfort, and local ischemia (i.e. impaired blood flow) in lengthened muscles [23]. By standing, you can help normalize tissue length and restore balance to joint positions. The ability to move back and forth between sitting and standing may help some individuals feel more comfortable and less stiff throughout the work day.

However, it must be noted that one can still have poor posture while standing. By standing for long periods of time, the plantar tissue in your feet will become ischemic due to chronic compression, and the load bearing joints of the standing position (i.e. ankles, knees, and lower back) can become achy and stiff. Some researchers assert that using standing desks could cause orthopedic problems [12]. The primary key for facilitating healthy posture and overall orthopedic health is frequent and varied movement in all joints of the body.  

Alleged Benefit #6: Standing Desks Increase Spontaneous Physical Activity

It has been claimed that standing desks increase spontaneous physical activity because a standing individual is in a more mobile position than a sitting individual, and is therefore more likely to move around throughout the day. Examples of spontaneous physical activity include: walking to get a drink, going to talk to a peer, or taking a stretch break. This is not a direct benefit, but rather a potential associative effect of having a standing desk.

In a 2016 research review that analyzed the effect of classroom standing desks on the sedentary behavior of students, there were mixed results on whether standing desks increase spontaneous physical activity [24]. If standing desks can promote physical activity, they could indeed contribute to the positive health outcomes associated with alleged benefits #1-#5. Time (and further research) will tell. However, this alleged benefit is based on increasing physical activity, not just replacing sitting with standing.

Conclusion

Standing desks do provide some benefits, but they are mild at best.

The two primary benefits of standing desks are:

  • Increases desk-time comfort by providing 2 positions to switch between throughout the workday (direct benefit).
  • Potentially promotes spontaneous physical activity throughout the workday because standing is a more mobilized position than sitting (associative benefit).

The degree of these benefits is variable between individuals. Some may find notable improvements by using a standing desk, and others may find the standing position undesirable.  

Many media and commercial sources have claimed that standing desks provide health benefits (e.g. they help prevent obesity, chronic disease, and postural problems). However, there is simply no current evidence to base such claims on. At best, there is inconclusive and mixed evidence suggesting that standing desks may mildly contribute to positive health outcomes [12]. There have been no well-designed longitudinal studies that examine the long-term health outcomes of replacing a sitting desk with a standing desk.

A health innovation does not necessarily require robust supportive research as long as it is grounded in logic. However, the belief that a standing desk will improve health is based in neither evidence nor logic. A fundamental understanding of human physiology tells us that replacing sitting with standing will likely not provide any health benefits, as standing does not significantly challenge the musculoskeletal or cardiovascular systems. Standing falls within the working definition of sedentary, as it is a static position that does not appreciably increase energy expenditure.

Attempting to improve health by partially or totally replacing one prolonged static position with another is like trying to make a cricket feel at home by dropping a few blades of grass in the jar it’s kept in. Either work model (i.e. prolonged sitting and/or prolonged standing) is grossly unnatural for the human body. At the end of the day, millions of individuals are still working ad nauseam in front of screens in prolonged static positions. If the health of America’s desk-using workforce is to be improved, we must consider a deeper premise – is the current work model of spending 8+ hours a day in front of a screen while in a static position (or combination of static positions) inherently unhealthy? Will attempting to work within this current model only provide mild health benefits at best?

To decrease the adverse health outcomes associated with a sedentary lifestyle, one must engage in frequent bouts of movement on a daily basis. There are many forms of health-promoting physical activity, such as: walking, running, swimming, climbing, biking, sports, lifting weights, yard work, gardening, yoga, tai chi, etc. The form of physical activity does not necessarily matter as long as the musculoskeletal and cardiovascular systems are challenged. Physical activity does not have to be complicated. Muscle fatigue and/or an increased heart rate are the biggest indicators that you are not being sedentary.

Standing desks may be a step in the right direction, but they cannot be expected to make a significant impact on the health of the office workforce. A step up from the standing desk is the treadmill desk, which has been shown to significantly increase energy expenditure [12,25]. However, treadmill desks are quite expensive at approximately $1,600 per unit (plus continual maintenance costs) [25], and there is no guarantee that they will actually be utilized by employees. Also, the treadmill desk seems like an absurdly out of touch attempt at a “fix” on sedentariness; it’s reminiscent of a hamster on a wheel.  

To improve the health of the office workforce within the current model, the best course of action is to create incentivized wellness programs that promote daily physical activity, rather than spending exorbitant amounts of money on an office full of treadmill desks. Such wellness programs would need to be fashioned on a case-by-case basis to match the desires and expectations of the specific employee population, as enjoyment is a key factor in adherence to any exercise program.

Standing desks may provide benefits to some individuals, but they should not be relied upon for improving health; they must function secondarily to the priority of increasing physical activity. Think of standing desks like a dietary supplement. A dietary supplement only provides a mild nutritional benefit when overall nutrition is in good standing. Similarly, standing desks will only provide a mild health benefit when physical activity occurs on a regular basis.

Summary

  • A sedentary lifestyle contributes to a host of adverse health outcomes [1-5].

  • Sitting is the most popular sedentary position in the US.

  • Over the past 2 decades, standing desks have grown in popularity because they allegedly reduce the adverse health outcomes associated with chronic prolonged sitting.

  • However, sedentariness is not limited to sitting. Any static position that does not appreciably increase energy expenditure qualifies as sedentary [9]. Therefore, standing is also sedentary [11], and it should not be expected to improve health outcomes.

  • The alleged health benefits of replacing sitting desks with standing desks are supported by a meager amount of evidence that is inconclusive and mixed [12].

  • Treadmill desks are a better option for increasing energy expenditure [12,25], but they are expensive [25].

  • To promote increases in energy expenditure, resources would be better spent on creating incentivized wellness programs that promote daily physical activity. Such programs should be tailored specifically to the desires and expectations of the specific group they are intended for.

  • Ultimately, any attempt to improve health outcomes in the office workforce must primarily include daily physical activity that appreciably challenges the musculoskeletal and cardiovascular systems.

I will close on this sobering note that exemplifies the current epidemic of sedentariness:

The average American spends significantly more time being inactive when awake than when sleeping (8-9 hours/day compared to 6.8 hours/day, respectively) [26,27].  


References

1.) Tremblay, M. S., Colley, R. C., Saunders, T. J., Healy, G. N., & Owen, N. (2010). Physiological and health implications of a sedentary lifestyle. Applied Physiology, Nutrition, and Metabolism, 35(6), 725-740.

2.) Manson, J. E., Skerrett, P. J., Greenland, P., & VanItallie, T. B. (2004). The escalating pandemics of obesity and sedentary lifestyle: a call to action for clinicians. Archives of Internal Medicine, 164(3), 249-258.

3.) Chakravarthy, M. V., Joyner, M. J., & Booth, F. W. (2002). An obligation for primary care physicians to prescribe physical activity to sedentary patients to reduce the risk of chronic health conditions. Mayo Clinic Proceedings, 77(2), 165-173.

4.) Wilmot, E. G., Edwardson, C. L., Achana, F. A., Davies, M. J., Gorely, T., Gray, L. J., ... & Biddle, S. J. (2012). Sedentary time in adults and the association with diabetes, cardiovascular disease and death: systematic review and meta-analysis. Diabetologia, 55(11), 2895-2905.

5.) Biswas, A., Oh, P. I., Faulkner, G. E., Bajaj, R. R., Silver, M. A., Mitchell, M. S., & Alter, D. A. (2015). Sedentary time and its association with risk for disease incidence, mortality, and hospitalization in adults: a systematic review and meta-analysis. Annals of Internal Medicine, 162(2), 123-132.

6.) Sapolsky, R. M. (2004). Why zebras don't get ulcers: The acclaimed guide to stress, stress-related diseases, and coping-now revised and updated. Holt Paperbacks.

7.) Dwyer, J. (2006). Starting down the right path: nutrition connections with chronic diseases of later life. The American Journal of Clinical Nutrition, 83(2), 415S-420S.

8.) Stringhini, S., Carmeli, C., Jokela, M., Avendaño, M., Muennig, P., Guida, F., ... & Chadeau-Hyam, M. (2017). Socioeconomic status and the 25× 25 risk factors as determinants of premature mortality: a multicohort study and meta-analysis of 1· 7 million men and women. The Lancet, 389(10075), 1229-1237.

9.) Pate, R. R., O'neill, J. R., & Lobelo, F. (2008). The evolving definition of" sedentary". Exercise and Sport Sciences Reviews, 36(4), 173-178.

10.) Definition of basal metabolism. Dictionary.com. Retrieved from http://www.dictionary.com/browse/basal-metabolism

11.) Creasy, S. A., Rogers, R. J., Byard, T. D., Kowalsky, R. J., & Jakicic, J. M. (2016). Energy expenditure during acute periods of sitting, standing, and walking. Journal of Physical Activity and Health, 13(6), 573-578.

12.) MacEwen, B. T., MacDonald, D. J., & Burr, J. F. (2015). A systematic review of standing and treadmill desks in the workplace. Preventive Medicine, 70, 50-58.

13.) Reiff, C., Marlatt, K., & Dengel, D. R. (2012). Difference in caloric expenditure in sitting versus standing desks. Journal of Physical Activity and Health, 9(7), 1009-1011.

14.) Pan, X. R., Li, G. W., Hu, Y. H., Wang, J. X., Yang, W. Y., An, Z. X., ... & Jiang, X. G. (1997). Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance: the Da Qing IGT and Diabetes Study. Diabetes Care, 20(4), 537-544.

15.) Anderson, J. W., Kendall, C. W., & Jenkins, D. J. (2003). Importance of weight management in type 2 diabetes: review with meta-analysis of clinical studies. Journal of the American College of Nutrition, 22(5), 331-339.

16.) Lefevre, M., Redman, L. M., Heilbronn, L. K., Smith, J. V., Martin, C. K., Rood, J. C., ... & Ravussin, E. (2009). Caloric restriction alone and with exercise improves CVD risk in healthy non-obese individuals. Atherosclerosis, 203(1), 206-213.

17.) Wing, R. R., Lang, W., Wadden, T. A., Safford, M., Knowler, W. C., Bertoni, A. G., ... & Look AHEAD Research Group. (2011). Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes. Diabetes Care, 34(7), 1481-1486.

18.) Kushi, L. H., Doyle, C., McCullough, M., Rock, C. L., Demark‐Wahnefried, W., Bandera, E. V., ... & Gansler, T. (2012). American Cancer Society guidelines on nutrition and physical activity for cancer prevention. CA: A Cancer Journal for Clinicians, 62(1), 30-67.

19.) Thompson, P. D., Buchner, D., Piña, I. L., Balady, G. J., Williams, M. A., Marcus, B. H., ... & Fletcher, G. F. (2003). Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease. Circulation, 107(24), 3109-3116.

20.) Friedenreich, C. M., & Orenstein, M. R. (2002). Physical activity and cancer prevention: etiologic evidence and biological mechanisms. The Journal of Nutrition, 132(11), 3456S-3464S.

21.) Lee, I. M. (2003). Physical activity and cancer prevention--data from epidemiologic studies. Medicine and Science in Sports and Exercise, 35(11), 1823-1827.

22.) Katzmarzyk, P. T., Church, T. S., Craig, C. L., & Bouchard, C. (2009). Sitting time and mortality from all causes, cardiovascular disease, and cancer. Medicine & Science in Sports & Exercise, 41(5), 998-1005.

23.) Chaitow, L., & DeLany, J. (2008). Clinical application of neuromuscular techniques: the upper body (Vol. 1). Elsevier Health Sciences.

24.) Minges, K. E., Chao, A. M., Irwin, M. L., Owen, N., Park, C., Whittemore, R., & Salmon, J. (2016). Classroom standing desks and sedentary behavior: a systematic review. Pediatrics, 137(2): e20153087. doi: 10.1542/peds.2015-3087

25.) Levine, J. A., & Miller, J. M. (2007). The energy expenditure of using a “walk-and-work” desk for office workers with obesity. British Journal of Sports Medicine, 41(9), 558-561.

26.) Matthews, C. E., Chen, K. Y., Freedson, P. S., Pate, R. R., Schlundt, D. G., Buchowski, M. S., & Troiano, R. P. (2006). Time spent in sedentary behaviors: United States, 2003-2004. Frontiers in Cancer Prevention Research, 15(12).

27.) Jones, J. (2013, December 19th). In U.S., 40% Get Less Than Recommended Amount of Sleep. Retrieved from: http://news.gallup.com/poll/166553/less-recommended-amount-sleep.aspx