Office workers of England - stand up for your health!

Workers have been warned to "stand up for at least two hours a day in [the] office," according to The Daily Telegraph. It says these are the first official health guidelines on the issue.

The guidance comes from a panel of experts, commissioned by Public Health England, which provides recommendations aimed at helping employers know what to aim for when trying to make workplaces less sedentary and more active. They say that this could potentially improve productivity and profitability, for example by reducing sickness.

This guidance has been prompted by a growing body of evidence that sedentary behaviour can increase the risk of a range of chronic diseases such as obesity, type 2 diabetes and high blood pressure. Some experts have gone as far as saying that "sitting is the new smoking".

Dr Ann Hoskins, Deputy Director for Health and Wellbeing, Healthy People, Public Health England said: "This research supports the Chief Medical Officer’s recommendations to minimise how much we sit still. Being active is good for your physical and mental health. Simple behaviour changes to break up long periods of sitting can make a huge difference."

Read more about why sitting too much is bad for your health

Who has asked workers to stand up?

The recommendations have come from an international group of experts. They were invited to provide these recommendations by Public Health England (PHE) and a UK community interest company (Active Working CIC). The guidance is published in the British Journal of Sports Medicine and has been made available on an open-access basis so it is free to read online or download as a PDF.

Why was the guidance needed?

The aim was to provide employers and staff working in office environments initial guidance on how to combat the potential risks of long periods of seated office work. The authors of the article report that recently more evidence has been published about the links between sedentary behaviour, including at work, and cardiovascular disease, diabetes and some cancers. These conditions are leading causes of ill health and death. As a result, they say that the guidance hopes to support those employers and staff who want to make their working environments less sedentary and more active.

How was the guidance developed?

The experts based their guidance on the available evidence. This included long-term epidemiological studies looking at the effects of sedentary behaviour, and studies of getting workers to stand or move more often.

They ranked the quality of the studies using the American College of Sports Medicine system – this ranks studies from the highest quality grading of A (overwhelming data from randomised controlled trials (RCTs) to D (a consensus judgement from the panel). They based their recommendations on the best available evidence.

They say that the key evidence used in developing their guidance was:

• data from a longer term retrospective national health and fitness survey which found that standing (or having some movement) for more than two hours a day at work was associated with lowering of risks, and those standing for at least four hours had the lowest risks. This was independent of a person’s physical activity
• data from a number of observational or short term interventional studies where there were changes in "cardiometabolic" and ergonomic risk factors (such as energy expenditure, blood glucose, insulin, muscle function and joint sensations), when the total accumulated time spent standing or having some movement was more than two hours a day

In preparing their recommendations they used other experts as a "sounding board". The guidance was also externally peer reviewed when it was submitted for publication.

What were the recommendations?

The recommendations for workers who are in mainly desk based occupations, were broadly that:

• The initial aim should be to work towards getting at least two hours a day of standing and light walking during working hours, and eventually work up to a total of four hours per day.
• Seated work should be regularly broken up with standing work and vice versa. Sit–stand adjustable desk stations were highly recommended.
• Similar to avoiding remaining in a static seated position for a long time, remaining in a static standing posture should also be avoided.
• Movement does need to be checked and corrected on a regular basis, especially if a person experiences musculoskeletal sensations. Occupational standing and walking have not been shown to cause low back and neck pain, and can provide relief.
• People new to adopting more standing-based work may have some musculoskeletal sensations and fatigue as part of the process of adapting to this. If these cannot be relieved either by changing posture or walking for a few minutes, then the worker should rest, including sitting, in a posture that relieves the sensations. If discomfort persists, then medical advice should be sought.
• Employers should promote the message to their staff that prolonged sitting, across work and leisure time, may significantly increase one’s risk of cardiometabolic diseases and premature death.

The evidence behind the recommendations was ranked between B (limited data from RCTs and high quality observational data) and D (expert opinion). The experts acknowledge that more evidence is required to add greater certainty to their recommendations. They call for longer term, prospective and large-scale RCTs to assess standing and light activity interventions in real office environments and their effect on long-term health outcomes. They note that future refinements to their recommendations will be needed as more evidence is published.