To sit or to stand? That is the question
Friday 27 February & 1 May 2015
There has been much recent publicity about the time office workers spend seated at their desks; should we stand instead? But is that the real issue? What if we go to the gym in the lunch hour? What if we have ergonomic chairs? What difference does standing make anyway? These issues and others will be considered in this session.
John is a consulting Ergonomist specialising in work and workplace design in relation to musculoskeletal disorders. He worked previously for the Robens Institute at the University of Surrey for over 20 years, qualified as an applied physiologist, and has since worked extensively in ergonomics research and consultancy, particularly in the areas of manual handling and office ergonomics.
He is a Fellow of the Institute of Ergonomics & Human Factors (IEHF), a Fellow of the Royal Society for Public Health and a Fellow of the Institution of Occupational Safety and Health. He is included on the UK Register of Expert Witnesses.
Due to popular demand, the February webinar was re-run 3 months later, in May.
Q: My consideration is that standing at a workstation will require a posture education programme similar to that given to a seated employee. Will this be a H&S requirement? Do you have any suitable instruction leaflets that could be provided to employees?
A: It may sound ridiculous to some, but I think you are right; standing incorrectly or for too long can be as bad, or worse, than not doing it in the first place; so yes, I think this will have to be incorporated into the normal DSE training sessions that are provided. I do not know of any specific reference to such 'requirements' at the moment other than it is implicit in the UK HSE guidance that people should be trained in the use of equipment provided for them. There is soon to be updated guidance published by the HSE in support of the UK DSE Regulations, but I do not know if this has been addressed therein. I understand that Posturite will be producing guidance sheets in relation to this topic, but they are not immediately available.
Q: Really enjoying the Webinar and found links to staff wellbeing interesting. Do you think there are other links between ergonomics and wellbeing?
A: Ergonomics is ‘all encompassing’ in my view – if you design a tool, workplace, activity or whatever without considering the overall health, safety and wellbeing of the users/workers then you haven’t fully applied the ergonomics process; but that is perhaps a little idealistic as we are rarely given the time and resources to address all of these issues.
Q: I don’t mean to be rude here but most of the [sit-stand] campaign’s and mail communications on the dangers of sitting are coming from the folks who sell ergonomic furniture.
A: In this age you are perhaps wise to be cautious; however, as far as I can tell the growing tide of concern in this area is based on considerable peer reviewed research from around the world, and although this was a presentation on the Posturite webinar programme, the material presented was based entirely on the research and good ergonomics practice.
Q: Do you think that medical back-up evidence should be obtained for the use of electric height adjustable desks?
A: At present, because of the significant cost of some of these adjustable desks, this is often understandably required (as also is ergonomics support), usually to establish a position that enables the employer to refuse requests from those who adopt the ‘they’ve got one, so I want one’ approach. However, when re-furbishing or opening new floors, I view is that all new desking should be height adjustable, since it is coming significantly down in price and in the long run will be cost effective as it should reduce reports of discomfort, it should avoid the expense of re-fitting to suit new staff and work performance will generally improve.
Q: Do you think sit-stand desks lend themselves better to the 'hot desk' environment?
A: Absolutely, but any significant benefit may depend on the length of time the individual remains at that desk during the day, since for short periods an adjustable chair and adjustable screen should provide a suitable range of adjustment for most people.
Q: I make recommendations for electric desks on occasion but the problem is that they are only recommendations and I can't enforce it - any advice on strategy when managers refuse?
A: If your recommendations are because of related health issues then get the individual to provide a supporting letter from their treating professional. Otherwise you will simply have to convince management to be brave and to take the ‘leap’ to this new work practice where, because workers are more in control and more comfortable, they will actually be more productive.
Q: If an employee were to embrace the recommended micro breaks required to remain in a good ergonomic seated position, would this not negate the need for expensive furniture upgrades?
A: Micro breaks are still important, but prolonged gross body static postures (whether seated or standing) should still be avoided; this is regardless of whether you have provided sit-stand desks, however expensive they may or may not have been.
Q: We advise all of our clients to have sit to stand desks, we start with a program of 20 mins in each sitting hour to begin with, increasing to 40 minutes at a session. The only negative feedback in the last three years that we've had has been clients adjusting to bifocal use in standing...have you had any similar negative observations?
A: I have not seen this specific problem, partly perhaps because I advise workers to adjust their screen height when working in these different postures, but also because I would always advise against using bifocal lenses if prescribed (as they usually are) for the reading distance and for distance viewing – neither of these are properly suitable for the VDU distance although individuals will find different levels of accommodation because of their prescription needs.
Q: What is your view on kneeling chairs?
A: I like them – provided they are used as originally intended; namely, for relatively short periods (as a second relief option) and by stretching out straight in front one or other leg alternately so as to regularly take the load off the supporting lower limb. If a person stays in this type of chair for a prolonged time then their back posture is likely to slump and the chair will become ineffective.
Q: In the late 90s a company I worked for installed adjustable desks throughout the Brussels HQ. This meant staff could chose to sit or stand at their desk (not many stood). Is this something you would advocate?
A: If the desks were electrically adjustable through the required sit to stand range then I would advocate moving to this provision; however, I have myself found that in the UK where these have been provided, it did take quite a long time in some companies for their proper use to become normal practice. This does require a cultural change of approach to office working, it’s not a massive one, but most office workers are fairly conservative in this regard. Comment from fellow webinar listener: "I have a riser desk and it's great".
Q: We're trialing Varidesk’s at the minute and staff are quite enthusiastic. I notice however that some of them need to readjust monitors etc when they change position. Is there access to information on standing posture other than an ISO (which companies have to pay for) as there's a wealth of free information on seating positions and I want to make sure I give people guidance on posture?
A: I think the simple answer is to adjust the monitor height independently when the new position is selected, and the height should be such that the top of the screen is roughly level with the horizontal eye line; but this should not be taken as prescriptive, since some people will find other arrangements more comfortable, but they should still adjust accordingly.
Q: Do (manual) adjustable desks and desktop units require annual testing like electrical equipment needs PAT testing?
A: Users should be trained in their use and that should include an awareness of the mechanisms such that any change in ease of operation is reported and action taken; but also these matters should be considered at the DSE assessment.
Q: Are there any examples of desk bikes?
A: There are, but it was not my intention to get involved in this discussion here; this needs a separate webinar as does the question of the treadmill desk – any of these devices can be helpful for some workers, but if deployed generally then, in my view, they are more likely to create problems and risks for workers.
Q: Would you recommend running a pilot to see how staff accept the concept?
A: A trial of this type of desk would let you see whether they presented your staff with any particular problems or benefits, but generally I have found that it takes quite a while for these desks to be used ‘normally and naturally’, and hence any pilot might not truly provide the answers you seek. The evidence would suggest that the benefits of this way of working will show through; it just needs the employer to have the courage to take that step.
Q: What was the research for '2 mins of stair climbing'?
A: I believe this was a summary slide which, as far as I recall, came from an Australian news item on the web; the research comes from (amongst others) a paper by Dunstan et al (Melbourne, Australia) entitled 'Breaking up prolonged sitting reduces postprandial glucose and insulin responses' from Diabetes Care, 35:976-983, 2012.
Q: What are your thoughts regarding walking treadmill desks?
A: As mentioned above, this is a subject for another discussion, but for the moment, suffice to say, I would advise caution. Apart from the obvious health and safety risks, the alleged work benefits depend on the type of work being attempted and the speed of the treadmill.
Q: Would we need to adapt our DSE assessments if we are to introduce adjustable desks?
A: Yes, I believe you would; since even though desks are already an issue that has to be considered, the particular characteristics of the adjustable desk and the way users might work with them would have to be considered, as would the training, since the appropriate use of sit-stand desks is not always obvious to all beneficiaries.
Q: What symptoms would people suffer from regarding to the metabolic lack of ability to break down organic compounds and fats?
A: This is a good question but I’m afraid that is outside my area of knowledge – all I am aware of is that the metabolic effects of inactivity results in inflammation in the tissues; how significantly and quickly this and any other symptoms might be recognised by a user is something I will have to investigate.
Q: Excellent presentation Vic & Mike Illumina.
A: Thank you.
Q: Thank you very much John. That was interesting.
A: Thank you.
Q: Does a quality chair that allows for movement when seated compensate a little for not standing?
A: My preferred answer would have to be ‘no’, but of course, a quality ergonomic chair would be better than the alternative; nevertheless, I’m not sure that I could accept that it would compensate for lack of standing and moving (i.e. replace the need) although this might depend on your definition of ‘compensate’. The purpose of a good ergonomics chair is to provide the user with a device that can be set up for their particular anthropometry and then to appropriately and comfortably support them in the task they are doing; but no matter how well this works, the user will still need to interrupt the sedentary posture as frequently as reasonably practicable in order to get muscular activity and the blood moving better through the body (to help offset fatigue etc). Now, a good chair will allow some movement (especially from the rocking facility) but this can only be used at certain times and during specific tasks (e.g. a meeting, or telephone conversation) and not everyone has these opportunities.
Q: I am currently trialing the Varidesk from your company and while I like the concept it is causing me more backache – any advice most welcome.
A: It is not possible on this evidence to offer specific advice on the problems you are experiencing; however, it is of concern that you should find using the device to cause more back pain. This could and should be examined further and I would suggest you immediately contact your DSE assessor and/or local back care advisor; if these people are unable to help then I would suggest seeking external ergonomics advice.
Q: I believe standing at your desk and working is better for you, I look forward to the webinar for the benefits of sit or stand.
A: Thank you.
Q: Are there studies relating productivity or maintaining energy through the working day with use of sit-stand desking? As there is some cost increase to providing the equipment, making the case is important.
A: Most of the studies that I have seen address the issue of reducing potential health problems by varying your posture throughout the day; this itself over the long term should have a significant impact on productivity since people will not be absent from work as often and more efficient while they are there. There are some studies looking at work output when working on a treadmill desk, but these tend to investigate efficiency against different treadmill speeds (you can find these papers very easily by Googling ‘treadmill desks’.
Q: What can be done to get office staff to speak up and highlight issues early before a serious injury at the workstation occurs?
A: A good question and one that is not easily answered, but the problem occurs in all spheres of our life – for instance, at what point do we decide we need a new stair carpet; do we change it when it looks a bit faded, or when it’s worn, or when it’s dangerous? Unfortunately, with health issues, making the decision late may not mean we can get back the body we had, so the timing of the decision is important; but I’m sure we are all aware of how difficult it is to navigate the waters between not wanting to cause a fuss and 'Why on earth didn’t you come to see me earlier?'. It does depend on the problem, but my advice would be that if your musculoskeletal problem resolves overnight then it may just be fatigue, but if it is still with you in the morning or starts as soon as you start your work then it's time to talk to your line manager and/or health and safety person. Having some sort of scale or measure like this does seem to help people make this reporting decision.
Q: There is an argument against moving from a static seating to a static standing position – does moving from one static position to another increase/decrease the likelihood of health issues (blood clots etc) or does the risk stay the same?
A: I certainly agree that simply changing from one static posture to another would not be enormously beneficial, but if carried out frequently this would at least introduce some movement into the static periods. However, I would also want to see that the leg movement (that I discussed as necessary in the webinar) of alternating foot placement on a footrest when standing formed an integral part of this whole process. There is some concern for an increased risk of DVT's for static seated postures in particular, but these are usually associated with constrained leg positions, and normally, provided workers have at least 600mm of knee space this shouldn't be a significant problem. As I discussed, I would also prefer to see people taking every reasonable opportunity to get away from the desk for brief periods of exercise, whether they have been standing or sitting.
Q: Height adjustable desking or Varidesk? What is the determining factor in choosing one or the other?
A: This partly depends on the resources of your organisation, partly on your strategic plans and partly on the specific needs of the user. The Varidesk can be very quickly introduced into the workplace to help someone perhaps with an acute back pain problem who cannot sit and work at the desk; if the back pain resolves then the Varidesk can be removed, and the individual return to their earlier way of working. The Varidesk can also be used as a trial to see whether people find the standing position to be something that they can incorporate into their particular type of working. However, the Varidesk has some limitations. A sit-stand desk has the ability to move the complete surface to any height that you want to use, giving you significant benefits. This, however, does involve some limited workplace upheaval in order to introduce these desks. Some people would also see the relative costs as being a determining factor, although certainly with multiple purchases of desks, this does not seem to be as large a factor as it was a little while ago.
Q: There is some research about standing on the job, but in industrial or medical environments. Is there research regarding max amount of time to stand (or sit) in the office environment at a height adjustable desk? How about spinal stenosis & standing?
A: This is an area that needs further research, and the current guidance that is offered by different people varies greatly. Some say an hour seated and half an hour standing; I generally recommend that people change their posture according to their own feelings of aches & pain (preferably before the onset of fatigue), but when asked, I would say one half hours sitting and one hour standing as a ‘rule of thumb’, but this is based on experience rather than research evidence. It is also important to consider the type of work being undertaken and whether it is itself interrupted, as this will also have a bearing on these matters.
Q: Please show the BS EN (?) standard reference again. Thanks.
A: BS EN ISO 9241-5:1999 – ergonomic requirements for office work with visual display terminals; part 5: workstation layout and postural requirements.
Q: How is this applied to pregnant office workers - any further risks to standing e.g. varicose veins etc?
A: The ability to change posture should greatly help the pregnant worker but it is again a question adopting a work regime that suits the particular needs of the individual, and certainly standing for long periods would not be advisable in this situation.
Q: What is a Swiss Ball?
A: These are the large air filled balls often used in gyms and exercise rooms, but more commonly being seen in the office environment as the seat at a computer desk. My own view is that unless specifically recommended by a medical practitioner they should not be used in the office. Simply from a postural point of view the chances of the balls not being of the correct size or correctly inflated can lead to inappropriate upper body postures; furthermore, rotating the ball backwards and forwards has the effect of raising and lowering the seated worker, again leading to poor postures at the keyboard.
Q: I have found it difficult for staff to speak up, have you known a successful way of overcoming barriers?
A: As mentioned in the webinar I agree that people find it difficult to overcome the barriers but if there is an office culture that supports the use of these equipments then after initial slow progress my experience is that people tend to become very comfortable with making the adjustments.
Q: Can I ask what your opinion is of the current trend towards the large Swiss Balls for sitting at desks? Particularly my pregnant ladies are being advised to use these at their desks and I'm not keen on them.
A: Please see my earlier answer; and I would add to that the general health and safety risk associated with the instability of these pieces of gym equipment.
Q: Pre-placement health questionnaire by Occupational health would help to see if there is a potential risk re DSE.
A: Pre-placement health questionnaires are clearly helpful, but often the problems people encounter arise out of the blue and would not have been picked up in this way; hence, regular DSE risk assessments are important so that new problems can be identified and quickly addressed, and the use of sit-stand desks, both initially and with time, should be monitored, as should the use of the new mobile technology.
Q: Keen to understand whether there are any average costs associated with the introduction of a height adjustable desk vs an employee taking 5 mins comfort break every 1-2 hours over a 12 month period.
A: The answer to this question requires clarification of so many unknowns; however, if we make a number of major assumptions, then you might like to consider your own situation in relation to the following figures: I am told that if an adjustable desk costs £600 and lasts for 10 years, then it can be calculated that this costs about 24p a day; if we aggregate your comfort breaks to an approximate 30 minutes a day, then on the basis of someone earning £20k/annum this may be calculated to cost the employer £6.60 a day. This purely financial comparison suggests the adjustable desk to be the clear winner; however, the comfort breaks are still important, and I would like to see those retained even in the presence and use of an adjustable desk. The musculoskeletal benefits alone of having the adjustable desk would in my view warrant the 24p a day cost, and there are also of course the additional health benefits that are more difficult to quantify.
Q: Many companies use web based DSE training, is this really suitable?
A: The HSE accept that this is a reasonably practicable way of providing such training, and indeed I believe they use it themselves. The most effective way, of course, is to provide one-to-one training followed by one-to-one assessment but company resources and the availability of suitably competent trainers and assessors mean that this is a less attractive or practicable process. Online systems should provide the necessary information and training and they should enable the identification of any significant problems, which should themselves then be addressed individually by a competent person.