Taking A Stand Against Stand-Up Workstations

In case you have not noticed, stand-up desks are becoming more popular in both the home setting and the workplace.¹ The primary driving force of this trend has been the publication of rather alarming research demonstrating the risks of sitting all day.

A study of over 222,000 individuals over the age of 45 revealed that people sitting eight to 11 hours per day were 15 percent more likely to die from any cause than those who sat four hours or less per day.² Even more alarming, people who sat for more than 11 hours per day were 40 percent more likely to die from any cause. 

Many other studies have linked sitting and inactivity with type 2 diabetes, colon cancer and heart disease.^3-5 This prompted the American Medical Association (AMA) to issue a policy in 2013 that encouraged employers to offer employees alternatives to sitting all day.⁶ Such alternatives include standing workstations, isometric exercise balls or even treadmill work desks.⁷

This new healthy trend is not without its own problems.⁸ In my own practice, I have seen increasing numbers of patients presenting with foot conditions that started when they switched to a stand up work desk. This is not surprising. 

Standing upright on two feet is an activity that only human beings can accomplish and they do not do it very well. In upright quiet stance, the intrinsic muscles of the feet are inactive and the dynamic mechanisms that stabilize the arch (the tibialis posterior and peroneus longus as well as the windlass effect of the plantar fascia) do not engage. Therefore, the arch of the foot is stabilized only by static mechanisms, primarily the plantar fascia and the plantar ligaments. Strain in these structures is inevitable during prolonged quiet standing.

Early in clinical practice, I became aware that patients who were required to stand all day had many more foot problems than those who sat and treating foot problems in standing patients was far more challenging and prolonged. Retail clerks, grocery checkers, hairdressers and cooks are far more likely to present with heel pain and forefoot pain than any other patient who has the chance to sit in the workplace. I have also noticed that standing employees are far more likely to develop varicosities in the lower legs and often suffer the symptoms of venous stasis.

So my question to any patient presenting with heel pain and has recently purchased a stand up desk is: “Why in the world would you want to stand all day?”

When doing a quick literature review, I found plenty of studies that evaluated the benefits of standing workstations.^9-13 However, there were no reports of negative effects in the lower extremities, at least when I reviewed the abstracts of these papers.

In response to the need to avoid sitting all day, I would suggest that our profession get involved, just as the AMA did a few years ago. The American Podiatric Medical Association (APMA) should issue a policy statement with suggestions for avoiding prolonged sitting in the workplace while minimizing some of the negative effects of prolonged standing, particularly in regard to the lower extremities.

Seven Keys To Reduce The Risks Of Sitting Or Standing All Day

Here are just a few suggestions and guidelines that I share with my own patients who want to avoid sitting all day in the workplace.

1. Instead of switching to a pure “standing desk,” consider options that would not require upright standing all day in the workplace. For example, there are “sit-stand” workstations, which are adjustable to allow the worker to alternate between periods of sitting and standing. There are other “active workstations” that offer healthy alternatives to prolonged sitting in the workplace. One can position the desk over a treadmill or stationary bicycle, which can provide alternatives to sitting without the negative effects of prolonged standing in one place. Simply getting up from a sitting desk every hour and taking a five-minute walk is a good alternative to sitting all day.

2. If people wish to switch from a sitting desk to a standing desk, they must make the change gradually while their bodies adapt, just as they should when starting a new form of exercise.

3. The surface upon which an individual stands is critical for minimizing potential negative effects of prolonged standing on the feet and legs. Anti-fatigue work mats are popular in beauty salons as hairdressers have long ago learned that these mats can make all the difference in reducing pain in the feet and legs during prolonged standing.

4. As with all foot conditions, footwear is critical in both the cause and prevention of pathology. Many people work in a setting where they must wear fashionable footwear that is unsuited for prolonged standing. They must recognize that a change to casual, healthy shoes is critical to avoid problems in their new standing lifestyle. 

5. Even with casual shoes, there are potential problems with prolonged standing. Younger and even middle-aged people today prefer wearing very flat, flimsy casual shoes that lack any form of intrinsic stability. One must direct these patients to wearing structured shoes, which support the foot and minimize strain on the plantar fascia and calf musculature.

6. People with early signs of venous insufficiency including edema and varicosities in the lower legs should wear over the calf compression hosiery when standing in the workplace.

7. Although this remains unproven, patients can perform stretching and strengthening exercises for the feet and legs during the day to minimize the negative effects of prolonged standing. At the very least, taking breaks by walking or sitting will help people avoid prolonged strain on the lower extremities when standing in one place.

References

1. Radcliffe S. Quit sitting and live longer. Men’s Fitness. Available at https://www.mensfitness.com/life/outdoor/quit-sitting-and-live-longer .

2. Van der Ploeg HP, Chey T, Korda RJ, et al. Sitting time and all-cause mortality risk in 222,497 Australian adults. Arch Intern Med. 2012; 172(6):494-500.

3. Katzmarzyk PT, Church TS, Craig CL, Bouchard C. Sitting time and mortality from all causes, cardiovascular disease, and cancer. Med Sci Sports Exerc. 2009; 41(5):998-1005

4. World Health Organization. Physical activity. Available at https://www.who.int/dietphysicalactivity/pa/en/ .

5. Just Stand. The science of sitting and standing. Available at https://www.juststand.org/tabid/636/language/en-US/Default.aspx .

6. American Medical Association. AMA adopts new policies on second day of voting at annual meeting. Available at https://www.ama-assn.org/ama/pub/news/news/2013/2013-06-18-new-ama-policies-annual-meeting.page . Published June 18, 2013.

7. Brown E. AMA to offices: don’t make workers sit all day! Los Angeles Times. Available at https://www.latimes.com/science/sciencenow/la-sci-sn-ama-policy-sitting-20130619-story.html . Published June 18, 2013.

8. Bahe M. Seven reasons why you don’t want a standing workstation. Available at https://www.fitdeskjockey.com/7-reasons-why-you-dont-want-a-standing-workstation .

9. Shrestha N, Kukkonen-Harjula KT, Verbeek JH, et al. Workplace interventions for reducing sitting at work. Cochrane Database Syst Rev. 2016; epub March 17.

10. Chau JY, Sukala W, Fedel K, et al. More standing and just as productive: Effects of a sit-stand desk intervention on call center workers' sitting, standing, and productivity at work in the Opt to Stand pilot study. Prev Med Rep. 2015; 3:68-74.

11. Grunseit AC, Chau JY, van der Ploeg HP, Bauman A. Thinking on your feet: a qualitative evaluation of sit-stand desks in an Australian workplace. BMC Public Health. 2013; 13:365.

12. MacEwen BT, MacDonald DJ, Burr JF. A systematic review of standing and treadmill desks in the workplace. Prev Med. 2015; 70:50-58.

13. Torbeyns T, Bailey S, Bos I, Meeusen R. Active workstations to fight sedentary behavior. Sports Med. 2014; 44(9):1261-73.