Sitting for long periods has a bad reputation. A 2012 review concluded that the most inactive people were more than twice as likely to develop or develop diabetes than the least inactive people, and also faced a much greater risk of premature death. Another, in 2015, found that sitting for long periods was associated with “adverse health outcomes regardless of physical activity.” Three years later, an analysis of news articles in the British Journal of Sports Medicine found hundreds of articles making claims likening sitting to smoking.
This is exaggerated. In 2018, the American Journal of Public Health noted that it carries about a tenth of the risk. But this is still bad. Hence the appeal of standing desks, and more recently “active seating”: chairs and benches that tilt, sway, or vibrate to force constant adjustments to body posture. Is it actually healthier?
A 2018 analysis found that standing at a desk burns nine more calories per hour than sitting. The cardiovascular gains are also not impressive. A review in 2020 collected nine trials including 877 people. Participants stood for about 1.3 hours a day and were followed for about four months. Body fat and blood sugar control improved slightly, but blood pressure, insulin, cholesterol, and triglycerides did not improve. However, the study did not look at blood flow and postural muscle activation, both factors that may contribute to the benefits of standing over sitting.
However, standing can have downsides. A study in the International Journal of Epidemiology in 2024 analyzed data on 83,013 adults in Britain and was followed for an average of about seven years. Those who stood for more than two hours a day were more likely to develop varicose veins and venous ulcers, possibly due to blood pooling in the legs.
What matters much more is movement. A study of nearly 482,000 Taiwanese adults in 2024 found that just 15-30 minutes of additional daily exercise could erase most of the excess mortality risks associated with sitting at work. So desk-bound workers may wonder whether active sitting can make a difference. Some results are encouraging.
Consider trying out at Georgia Southern University. The researchers asked 20 adults to perform short reading and writing tasks on a regular chair, an exercise ball, and a bench mounted over an inflatable bladder. Energy expenditure on the ball was similar to normal sitting. But on the bladder, participants’ heart rate and calorie burn increased by 6-13% and 19-40%, respectively. Writing in Ergonomics in 2019, researchers attributed this to muscle contractions required to maintain balance.
A longer trial found another benefit. For six months, 133 office workers in Bangkok sat either on a foam seat cushion or on a slightly unstable inflatable pillow, designed to encourage frequent changes in body position. Those who used the latter were 81% and 84% less likely to develop neck and lower back pain, respectively. Writing in the Scandinavian journal Work, Environment and Health in 2024, the researchers described the pillow as a “light exercise device.” They believe it reduces fatiguing muscle spasms and improves blood flow to compressed tissues.
There are caveats. Many studies on dynamic sitting have been small or brief. Results varied with seat design, and some participants reported discomfort in the back seat. However, there seems to be a lesson here: the real difference is not between sitting and standing, but between staying still and moving.
After a free, evidence-based guide to health and wellness? Subscribe to our weekly Enlightened newsletter.
