Standing Desks – More Harm Than Good?



“Sitting is the new smoking!” “Sitting is a silent killer!” “Are you sitting your way straight to the grave?” If you believe what the media is telling you, you’ll never want to sit again. But what does the science have to say about sitting vs standing desks? Let’s find out.

I’ve been using a standing desk for over 5 years now, and when I set out to create this post, I was expecting to find substantial research to back my decision. But after reading over two dozen research articles on the subject, I found myself surprised, as the data isn’t as clear cut as some would have you believe. So what does the data have to say about sitting, and are standing desks really the best option for your health and productivity?


The Evidence Against Sitting

First, it’s important to understand the arguments against sitting and traditional desks. So what’s so bad about sitting?

The fundamental principle is that a sedentary lifestyle and the physiologic changes that ensue are harmful to us. And there’s a lot of evidence that physical inactivity is linked to higher morbidity and mortality, but the question is how does this relate to sitting at our desks, and whether standing desks are a viable alternative.

Mandsager and colleagues demonstrated in 2018 that poor cardiorespiratory fitness, as assessed on an exercise treadmill test, was strongly correlated with mortality. In short, if you’re in better shape, you’re less likely to die. It is important to note, however, that this study, and many others, are retrospective studies and therefore by definition, they demonstrate correlation, not causation.

Additionally, it’s been noted that the negative effects of sitting aren’t reversed by exercise. Reason being, the metabolic changes and subsequent deleterious effects induced by sitting aren’t simply reversed by being active. Sitting also increases the pressure to your lower back in comparison to standing – ever notice that your back hurts more when you sit for prolonged periods of time?


The Evidence for Standing Desks

Now if sitting for prolonged periods is bad for us, it’s easy to see how standing desks would seem like a logical solution.

Buckley and colleagues in 2014 demonstrated that standing reduces postprandial glycemic variability, meaning your blood sugar varies less after eating a meal if you’re standing. This is good, as greater amplitudes of glycemic variability have been linked to circulatory oxidative stress. However, Bailey et al. in 2015 had conflicting data, suggesting that standing did not alter postprandial glycemic variation, but short bouts of light-intensity activity did.

Gibbs et al in 2017 postulated that decreased caloric expenditure could be a specific mechanism through which sedentary behavior increases health risks, such as by contributing to an energy imbalance leading to obesity. They also demonstrate that standing expends more energy than sitting – no surprise there.

As a whole, however, the literature regarding the benefits of standing desk isn’t clear cut. Katzmarzyk in 2013 suggested that increased standing time was correlated to reduced mortality rates, but Smith and colleagues in 2018 suggested the exact opposite; that occupations involving primarily standing were associated with a 2-fold increase in heart disease compared to occupations involving predominantly sitting.

Several other studies I came across in my research emphasized the increases in physical activity associated with standing desks, reduction of lower back pain, and improvement in cholesterol or blood pressure. However, others suggested that the increased physical activity at a standing desk was offset by a decrease in physical activity away from the desk. And while some studies pointed to improvements in psychological wellbeing, creativity, and no detrimental effects to focus or productivity, others concluded that standing desks were associated with deterioration in reaction time and mental state.

The data is best summarized by two systematic reviews. Neuhaus and colleagues in 2014 concluded that “the installation of activity-permissive workstations in office-based workplaces is likely to be a feasible and acceptable means to reduce sedentary time, with mostly neutral or positive impacts on adiposity and other health and work-related outcomes.” The systematic review by MacEwen and colleagues in 2015 concluded that there wasn’t enough evidence to evaluate the utility of each type of desk, however, treadmill desks demonstrated the most significant improvements in glucose, cholesterol, and fat loss. Standing desks had few physiologic changes, but improved psychological wellbeing. And ultimately, too much standing or sitting would result in discomfort.


So Where Does It Leave Us?

The key take away from my deep dive in the literature is that… the literature on standing versus sitting desks is far from conclusive. The overwhelming majority of the studies were retrospective and did not adequately control for possible confounding variables. For example, Smith and colleagues demonstrated people working occupations involving primarily standing were associated with a 2-fold increase in heart disease. But without controlling for the types of occupations, socioeconomic variables, and other demographic factors, that information is close to meaningless.

The data is quite strong that a sedentary lifestyle is not good for you, but I’m not convinced that a standing desk is necessarily the solution. This is a complex problem – people are no longer getting much exercise in their lives – and we are proposing an incredibly simple solution, hoping it’s an easy fix. Unfortunately, even with the scientific method we don’t get clear cut answers, and we must make decisions with imperfect information.

So should you sit or stand at your desk? I’d argue that isn’t the right question to ask.

Caldwell and colleagues in 2018 even demonstrated that prolonged standing resulted in measurable increases in arterial stiffness. It seems, then, that any form of inactivity, whether standing or seated, results in negative health implications. Instead of focusing on standing or sitting at our desks, it appears that the most important principle is to move regularly – some have suggested every 20 minutes as a good rule of thumb. Our bodies are designed to move – we aren’t designed to sit still. So even if you’re using a standing desk, you don’t want to stay immobile all day. You should be shifting, walking, moving, stretching, doing yoga poses, and switching between sitting and standing throughout the day.

Because this is Med School Insiders, I don’t want to leave you hanging. I want to give you actionable advice. Here are three points to act on:

1 | Stay Hydrated

One of my favorite methods to induce movement is to stay well hydrated. It has the benefit of, well, keeping me well hydrated, but also the side benefit of prompting me to move regularly, as I need to use the restroom frequently. If you need a friendly reminder to drink more water, the easiest thing you can do is buy a water bottle and keep it nearby. I personally opt for the BPA free Nalgene 1.5L. I bought it for approximately $10 over 5 years ago, and it’s still serving me well. Link in the description below.

2 | Adjust Your System to Facilitate Physical Activity

Remember that your systems produce results. After watching this video, if you feel motivated to move and exercise more, I guarantee it won’t last. If, instead, you take that motivation and use it to change your systems, you’ll be much more likely to see results. My favorite is a simple tweak – instead of driving to work, or to the grocery store, or to visit your friends, try riding your bike instead. If it’s too far, then use public transport in the middle, but still ride your bike to and from the station.

3 | Experiment For Yourself

In this day and age, we want quick answers. Sometimes, the answer is best found out through self-experimentation. From my own self-experimentation, I’ve figured out a system that works for me. I will continue to use my standing desk, because I see significant benefits in my posture as well as alleviation of any back pain, and I feel that I can offset any potential detrimental effects by moving frequently, either through regular hydration, as stated earlier, or through a simple timer on my watch.

If you’d like to see how I created this article and how I approached the research that led me to my conclusions, I have provided behind the scenes looks with exclusive access to my notes and research documents on my Patreon page. By becoming a patron, you’ll be supporting us to continue producing content like this, and you’ll get exclusive perks, including Patreon-exclusive Q&A sessions, video commentary where I provide additional gems that I couldn’t fit my videos, priority voting rights for upcoming videos, and even video chats with yours truly.

Where do you stand on the standing versus traditional desk debate? Did this video make the science more clear, or are you just more confused? I’d love to hear from you, so leave a comment down below.


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