standing and sitting while working: the impact on health by haris awang

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Standing and Sitting While Working: The Impact on

Health

A. HARIS AWANG

A. HARIS AWANG MBA2016-04-1001 MBA 6093 Operations Management

A Conceptual Paper

Submitted to:

Dr. Gunalan Nadarajah

27th August, 2016

ii

Standing and Sitting While Working: The Impact on Health. A. HARIS AWANG. Asia Metropolitan University. 2016

Table of Contents

Introduction ..................................................................................................................... 1

Literature Review ............................................................................................................ 1

2.1 Sitting is bad....................................................................................................... 1

2.2 Is standing really better? .................................................................................... 3

2.3 What about prolonged sitting & standing? .......................................................... 4

2.4 When is sitting or standing more suitable ........................................................... 5

Research Methodology ................................................................................................... 5

3.1 Method ............................................................................................................... 5

3.2 Limitations .......................................................................................................... 6

Conclusion/Recommendations ........................................................................................ 6

References ...................................................................................................................... 7

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Standing and Sitting While

Working: The Impact on Health A. HARIS AWANG

Recent studies have indicated a possible increase in the risks of coronary heart disease and kidney

disease from excessive sitting. Since the beginning of the industrial revolution, businesses and

manufacturers are known to implement standing operations at workplaces. From cashiers to

assembly line operators, customer service clerks to bank tellers, standing while working is

believed and perceived to be more efficient and more professional. On the workers’ side, it is

often communicated that there’s a long-term health benefits associated to it. On the contrary,

there’s also a case where an ex-employee filed a lawsuit against her former employer claiming

to be suffering from varicose veins where it was awarded in her favor along with others in a class-

action lawsuit. In conclusion, neither standing nor sitting can be good or bad. However,

prolonged standing or sitting can be detrimental to worker’s health.

Introduction

“The first wealth is health.” ~ Ralph Waldo Emerson

Back in early 90s, while working as senior industrial engineer at Sony, manufacturer of 3.5” micro

floppy disk drives, I was tasked to head a project to convert sitting to standing throughout the

entire manufacturing operations. The idea was to have higher productivity and better space

utilization while at the same time offering health benefits for workers. This conceptual paper

questions the advantage of standing while working in terms of health and at the same time looks

into why sitting can adversely impact worker’s health. It is also to find out what jobs or operations

suitable for sitting and standing.

The scope of this paper only covers the health aspects of the operations.

Literature Review

2.1 Sitting is bad

Does sitting while working adversely affect worker’s health?

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In a review of various problems of standing and sitting posture, Grandjean & Hunting (1977) point

out a study by Nachemson and Elfström (1970) in which it was found that the intradiscal pressure

IDP (the hydrostatic pressure measured in the nucleus pulpous of a non-degenerate intervertebral

disc), is higher in the sitting than in the standing posture (see Fig 1). The authors point out that a

great increase in intradiscal pressure must be considered as an unnecessary load and strain on the

discs, promoting pathological changes.

Grandjean & Hunting (1977) also state that more than 50% of the adults suffer back pain during

at least one period in their lives. The main reason for these back pain is a pathological degeneration

of the discs.

Fig. 1 Relative increase and decrease in intradiscal pressure in

different posture compared to the standing upright position

(=100%) (according to Nachemson and Elfström, 1970)

In a study by Seo et al, (1996) where leg swelling is measured by bioelectrical impedance method

on twelve subjects without restricting leg movement, it is shown sitting to have the highest

compared to standing.

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Lehman, Psihogios and Meulenbroek (2010), mention that sitting is reported to be less energy

consuming than standing and less stressful on the lower extremity joints. However, the literature

cites increased risk of low back pain in seated jobs and greater disc pressure for a seated than for

a standing posture.

Healy et al., (2012) in a review on reducing prolonged sitting in a workplace point out that

prolonged sitting at work may contribute indirectly to detrimental economic outcomes, through

increasing the risk of developing chronic diseases (such as type 2 diabetes, cardiovascular disease)

and other long-term health conditions (such as musculoskeletal disorders) amongst workers.

Dunstan et al., (2012) in their study concerning extensive sitting reveal a new evidence that too

much sitting (also known as sedentary behavior – which involves very low energy expenditure,

such as television viewing and desk-bound work) is adversely associated with health outcomes,

including cardio-metabolic risk biomarkers, type 2 diabetes and premature mortality.

Hartvigsen et al., (2000) on the other hand in their systematic, critical literature review of thirty-

five articles, 14 dealing with sitting-while-working and 21 with sedentary occupations between

1985-1997, find that all but one of the studies failed to find a positive association between sitting-

while-working and lower back pain (LBP). Only one low quality study associates sitting in a poor

posture with LBP. The authors conclude that the extensive epidemiological literature does not

support the popular opinion that sitting-while-at-work is associated with LBP.

2.2 Is standing really better?

While it is quite popular among employers to have employees stand while working for productivity

and efficiency reasons, not much has been studied about its impact on worker’s health.

The upper extremity postures in which the arms are outstretched either forward, backward or

sideways in the standing position lead to high levels of perceived shoulder discomfort ratings.

(Genaidy, A.M & Karwowski, W., 1993).

Los Angeles Times (2016) reports that the California Supreme Court ruled that workers whose

jobs can be done at least partly while sitting should not be forced to stand. This ruling came upon

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a class-action lawsuit by employees of various companies in California who were forced to stand

without being given the chance to sit while working.

“At the end of the day, I would be exhausted from standing in one place for hours and my legs

would ache,” Pamela Bowlin, a retired CVS cashier said in a sworn declaration. “I also suffered

from varicose veins which were painful, especially when standing.”

2.3 What about prolonged sitting & standing?

Limited rest break opportunity appears to be a major factor for several muscular problems. Neck

and shoulder problems were associated with posture factors such as 'only sitting or only standing'.

(Bergqvist et al., 1995).

However, prolonged static loads could still present a fatigue injury mechanism either due to low

but prolonged muscle contraction and/or prolonged fixed postures of the spine leading to

accumulated damage to the posterior component of the annulus. Standing appears to be a good rest

from sitting. Therefore, standing, used alternatively as a rest from sitting, could form a basis for

injury prevention when designing work. The constant loading with little dynamic movement

present in both standing and sitting would provide little rest or change for muscular activation

levels and the resultant low back loads. (Callaghan, J.P & McGill, S.M, 2001).

Messing et al (2005) in their research on why North American workers are not insisting on seats

despite known health benefits, mention that prolonged standing is associated with health problems.

Back pain associated with work is about twice as common among those who stand as among those

who usually work sitting. Standing at work has also been associated with pain in the lower limbs,

varicose veins, chronic venous insufficiency, a poorer prognosis after diagnosis of coronary artery

disease, and preterm births. Unfortunately, prolonged standing may have a lasting effect on

physical health, and the lack of respect associated with an insistence on standing may affect their

psychological health.

(Claus et al, 2008) conclude that since the initial studies of IDP, new tools and methods have

continued to advance understanding of pathomechanics and neuro-muscular control related to

spinal degeneration and low back pain. Current evidence shows similar IDP in standing and upright

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sitting postures. In vitro biomechanics show that the axial compression in sitting is unlikely to pose

a threat to non-degenerate discs. Epidemiology shows that sitting is no worse than standing for

incidence of disc degeneration or low back pain. If sitting is a greater threat for development of

low back pain than standing, the mechanism is unlikely to be raised IDP.

2.4 When is sitting or standing more suitable

Mital, A & Faard, H.F. (1990) point out that Isokinetic pull strength (dynamic strength exertions

at constant speed) of males is almost 37% greater in the standing posture than in the sitting posture.

Standing has a better leverage in handling heavy load compared to sitting.

In a study of sitting versus standing for cashiers doing item scanning, Lehman, Psihogios and

Meulenbroek (2010) state that standing posture provides a more stable condition for the low back.

Standing also facilitates dynamic use of the arms and trunk, which is better for handling loads, and

enables one to cover larger work areas. Standing requires significantly lower muscle activity for

shoulders and neck than sitting. Shoulder abduction is significantly lower for standing than seated

because cashiers could work below elbow height.

Research Methodology

3.1 Method

The conceptual paper is written based on several sources such as academic journals and

newspaper report. The method used in this research is described as follows:

a. At least fifteen sources e.g. journals, news were vetted through for keywords, methods and

results or conclusions.

b. Each source is categorized and separated into sitting and health, standing and health,

prolonged sitting and standing and jobs suitability.

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3.2 Limitations

The limitation faced during this research is time. The two weeks period to write and do research

is very short which makes it impossible for any real-time data collection, statistical or

mathematical analysis. So the research is somewhat limited to online searches, classroom

interactions and desk tasks.

Data measurements and detailed research is beyond the scope of this paper. The paper merely

touches the concept and needs deeper and further research as it will benefit workers and employers.

Conclusion/Recommendations

In conclusion, according to relevant studies presented under literature review, neither sitting nor

standing while working can be good or bad. However, prolonged sitting or standing can be

detrimental to worker’s health.

This paper recommends high quality studies to be conducted in workplaces involving real

operations such as factories, offices, supermarkets, restaurants, etc. instead of on selected subjects

on experimental basis.

Such studies should assess multiple health, economic and social outcomes and use validated

measurement methods and ideally the objective measurement techniques that are now available.

Further research especially in the Malaysian context is also recommended. More questions have

to be answered - What jobs are suitable for sitting and standing? What factors to be considered by

employers in work design? Do they need to provide chairs so workers can chose to sit when they

feel tired? Articles between 1977 to 2012 were reviewed and more recent studies need to be looked

into as there could be latest developments in ergonomic studies.

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References

Bergqvist et al.. (1995). Musculoskeletal disorders among visual display terminal workers:

individual, ergonomic, and work organizational factors. Ergonomics, 38(4), 763-776.

Callaghan, J.P & McGill, S.M. (2001). Low back joint loading and kinematics during standing

and unsupported sitting. Ergonomics, 44(3), 280-294.

Claus et al.. (2008). Sitting versus standing: Does the intradiscal pressure cause disc

degeneration or low back pain?. Journal of Electromyography and Kinesiology, 18, 550–

558.

Dunstan et al.. (2012). Too much sitting – A health hazard. Diabetes Research and Clinical

Practice, 97, 368-376.

Genaidy, A.M & Karwowski, W. (1993). The effects of neutral posture deviations on perceived

joint discomfort ratings in sitting and standing postures. Ergonomics, 36(7), 785-792.

Grandjean, E & Hunting, W. (1977). Ergonomics of posture Review of various problems of

standing and sitting posture. Applied Ergonomics, 8(3), 135-140.

Hartvigsen et al.. (2000). Is sitting-while-at-work associated with low back pain? A systematic,

critical literature review. Scand J Public Health, 28, 230-239.

Healy GN, Lawler SP, Thorp A, Neuhaus M, Robson EL, Owen N & Dunstan DW (2012).

Reducing prolonged sitting in the workplace (An evidence review: full report), Victorian

Health Promotion Foundation, Melbourne, Australia.

Lehman, K.R, Psihogios, J.P & Meulenbroek, R.G.J. (2010). Effects of sitting versus standing

and scanner type on cashiers. Ergonomics, 44(7), 719-738.

Los Angeles times. (2016). LA Times. Retrieved 25 August, 2016, from

http://www.latimes.com/local/lanow/la-me-ln-court-sitting-workers-20160404-story.html

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Messing et al.. (2005). Standing still: Why North American workers are not insisting on seats

despite known health benefits. International Journal of Health Services, 35(4), 745–763.

Mital, A & Faard, H.F. (1990). Effects of sitting and standing, reach distance, and arm

orientation on isokinetic pull strengths in the horizontal plane. International Journal of

Industrial Ergonomics, 6, 241-248.

Nachemson A & Elfström G. (1970). Intravital Dynamic Pressure Measurements in Lumbar

Discs: A Study of Common Movements, Maneuvers and Exercises. Scandinavian Journal

of Rehabilitation Medicine Supplement, 1, 1-40.

Rodacki et al.. (2001). Repeatability of measurement in determining stature in sitting and

standing postures. Ergonomics, 44(12), 1076-1085.

Seo et al.. (1996). Leg Swelling during Continuous Standing and Sitting Work without

Restricting Leg Movement. Journal of Occupational Health, 38, 186-189.

Tissot F, Messing K & Stock S. (2005) Standing, sitting and associated working conditions in

the Quebec population in 1998, Ergonomics, 48(3), 249-269.

standing and sitting while working: the impact on health by haris awang

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