‘Stand up’ for your health — Sage Perspectives Blog

By Jacquelyn Kulinski

For several years now, I have explored the role of sedentary behavior in disease, particularly as it relates to diabetes and cardiovascular disease risk. We now spend more time sitting that in all other activities combined. With rapid expansion of a ‘work from home’ culture, most recently driven by the COVID-19 pandemic, this has potential implications for health. Intriguingly, sitting increases risk for these diseases independent of physical activity and body mass index. Admittedly, an overwhelming amount of my prior research (and that of others) on this topic is derived from cross-sectional or longitudinal population cohort studies. While advantageous because of the large sample sizes, these studies are limited by the ‘association only’ nature of study conclusions, potential for missing confounders, and lack of specific interventions. Therefore, skepticism remains. Is replacing sitting - with standing - sufficient to affect any meaningful and measurable health benefits? While many intervention studies focus on increasing moderate and vigorous physical activity to combat “sitting disease”, little attention has been given to reducing sedentary time. Leveraging the sedentary workplace (or ‘work from home’) environment, where we spend most of our waking (and sitting) hours, may be an essential opportunity for intervention and risk reduction.

In our prospective pilot study of 15 overweight or obese subjects with sedentary office jobs, providing a low-cost, non-electric, height-adjustable, sit-stand desk to employees in the workplace led to improvements in cardiometabolic and vascular health after just 3 to 6 months. The majority of the cohort were middle-aged women with about 6.5 hours of sedentary work time at baseline. The post-intervention mean daily sedentary time at work decreased by 90 minutes at both 3 and 6 months. Vascular endothelial function of the superficial femoral artery, as measured by flow-mediated dilation, increased from 4.9 ± 1.7% to 6.4 ± 2.3% at 3 months and further to 8.1 ± 3.2% (p=0.009) at 6 months. There were no changes in brachial artery flow-mediated dilation. Subjects were obviously encouraged to use the desk but were not provided any prompting after the initial installation and training. This intervention did not translate to less sedentary time outside of work hours nor did subjects increase moderate or vigorous physical activity or step counts, during this period. There were no changes in weight or waist circumference. Improvements in fasting insulin and triglyceride levels were also seen.

The surrogate endpoints, namely vascular function, insulin resistance, and triglycerides are important ones. First, improvements of 1% in brachial artery flow-mediated dilation translate into an 8-13% lower risk of cardiovascular diseases. While there were no changes here in brachial artery FMD (which we would not necessarily expect given the nature of the intervention), we did see improvements in superficial femoral artery flow-mediated dilation. If we extrapolate what we know about brachial artery flow-mediated dilation, endothelial dysfunction in the lower limb arterial bed would be a precursor to the development of peripheral arterial disease; interventions that improve vascular function in the lower limbs might be expected to prevent or slow progression of peripheral vascular disease or improve circulation. However, this remains to be determined, as no study has tested whether improving lower limb flow-mediated dilation has lasting benefits for peripheral vascular health.

According to the Centers for Disease Control and Prevention (CDC), lack of time or having a busy schedule is the most common reason that adults do not engage in physical activity. Use of a sit-stand desk at work requires no additional time commitment from the employees and works on the “built environment” conceptual framework to affect behavioral changes in physical activity (or inactivity). Our study underscores benefit to vascular health outside of exercise activities by simply replacing sitting with standing, and our study will help inform future prospective studies on a broader scale. Furthermore, acceptability of sit-stand desks at home, evidence for increased employee productivity, combined with the potential health benefits, should more than offset the initial exposure of purchasing the desk (without a doctor’s prescription!) for employees, whether working from home or in the office. With more people working remotely from home because of the COVID-19 pandemic, reducing sedentary behavior may be more important now than ever. Let us all stand up for our health!

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Article details

The impact of standing desks on cardiometabolic and vascular health
Ariel Bodker,Alexis Visotcky,David Gutterman, Michael E Widlansky, Jacquelyn Kulinski
First published April 5, 2021
DOI: 10.1177/1358863X211001934
Vascular Medicine

About the author

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Dr. Jacquelyn Kulinski is Director of the Preventive Cardiology Program and Associate Professor of Medicine at the Medical College of Wisconsin with a secondary appointment as Associate Professor in the Graduate School of Biomedical Sciences. She is a board-certified cardiologist with a strong interest in preventive cardiology and provides individualized and comprehensive cardiovascular risk assessment to patients.

Dr. Kulinski earned her medical degree from the Medical College of Wisconsin. She completed a residency in internal medicine at the University of Washington in Seattle, and then completed a fellowship in cardiovascular medicine at the University of Texas Southwestern Medical Center in Dallas.