Journal Logo

APPLIED SCIENCES

The Effectiveness of Standing on a Balance Board for Increasing Energy Expenditure

NELSON, MEGAN C.; CASANOVA, MADELINE P.; VELLA, CHANTAL A.

Author Information
Medicine & Science in Sports & Exercise: August 2018 - Volume 50 - Issue 8 - p 1710-1717
doi: 10.1249/MSS.0000000000001595

Abstract

On average, Americans spend 6–8 h·d−1 in sedentary behaviors while commuting, during leisure time, and in the workplace (1–3). Sedentary behavior can be defined as any waking sitting or reclining activity requiring very low amounts of energy expenditure (EE), specifically ≤1.5 METs (4). Excessive amount of time spent in sedentary behaviors has been shown to decrease daily EE, which can negatively influence health outcomes such as obesity and increase the risk for early mortality (5). Notably, the detrimental health outcomes associated with excessive sedentary behavior occur independently of the amount of moderate-to-vigorous physical activity (PA) an individual participates in (6).

Technological advances over the past 50 yr have largely replaced the need for manual labor, leading working adults to spend one-half to two-thirds of their work day sitting (2,7,8). Spontaneous PA that promotes nonexercise activity thermogenesis is relatively low in sedentary occupations, resulting in a low energy cost throughout the work day (9,10). In fact, it has been estimated that occupational EE has decreased by at least 100 kcal·d−1 over the past 50 yr (7). Equipment, such as standing and treadmill desks, has been developed specifically to encourage standing, light activity, and less sedentary time in the workplace. Although many studies have shown improvements in health outcomes when light activity is used to replace sitting in the workplace (11–14), the research on standing appears to be more conflicting (3,8,11,15). This is of interest because standing seems to be accepted by desk workers, and there is no evidence to suggest that increased standing time via the use of a sit–stand work station is compensated with more sedentary behavior at home (3,16,17). Standing is an easy alternative to sitting in the workplace because sit–stand and standing desks have gained popularity making them widely available and relatively affordable. In addition, common tasks performed by workers in sedentary jobs such as typing, reading, and writing can easily be performed in an upright posture. For example, measures of productivity between sitting and standing postures have shown to remain unchanged or have little difference (8,18). However, the EE associated with standing appears to be extremely variable in the research, with results indicating differences of 0 kcal·h−1 up to 20.4 kcal·h−1 between sitting and standing (15,17–22). A recent study also reported that interventions using sit–stand desks in the workplace have been shown to successfully reduce sitting time by an average of 65 min (23).

Analogous to too much sitting, too much standing that is static with little movement poses its own unique health risks (11,24). Prolonged standing can contribute to the development of varicose veins and swelling or edema to the ankles and feet (24). Because of these outcomes, it has been suggested that active workstations should not be static (3,20). Innovative technologies—such as standing balance boards—have since been developed to be used within an office setting, which could be a different yet feasible option for replacing sitting. A balance or wobble board is a device that assumes a standing position on an unstable surface and has traditionally been used in a rehabilitation setting for balance training (25). Standing on a balance board while performing work at a standing desk adds an additional element of postural control that static standing does not, and this may have the potential to increase occupational EE or positively affect health. Little research exists on the energy cost of standing on a balance board while performing work or if productivity is affected.

The purpose of this study was to investigate EE and productivity while performing an acute bout of sedentary-based work while seated, standing, and standing on a balance board in healthy adults employed in sedentary-based jobs. A secondary objective of this study was to examine self-reported pain and fatigue between these three positions. We hypothesized that compared with sitting and standing, work performed while standing on the balance board would increase EE without altering productivity or increasing overall feelings of self-reported fatigue or pain.

METHODS

Participants

A convenience sample of adults employed in sedentary-based jobs between the ages of 18 and 65 yr were recruited via the use of email announcements through the university’s online newsletter and flyers posted in the surrounding area to take part in the study. A sedentary-based job was defined as a job in which the daily work performed involves primarily sitting with occasional standing or walking and lifting no more than approximately 4.5 kg (26). Although not required, participants employed in sedentary-based jobs that regularly used a sit–stand or standing desk were not excluded from participating. Exclusion criteria included not being employed in a sedentary-based job, medical or orthopedic conditions that would impair balance or limit typing or standing for a prolonged duration, diagnosis of cardiometabolic disease, females who were currently pregnant or breastfeeding, and currently taking any medications that may influence metabolic rate. All participants completed a prescreening questionnaire and health history questionnaire administered by a trained researcher to determine eligibility to participate. Written informed consent was obtained from all participants before testing. This study was approved by the university’s institutional review board.

Sample size calculations for a within-subjects repeated-measures design to detect a difference in EE between the three conditions in this study were based on the effect size of 0.385 obtained for indirect calorimetry between standing and sitting from a previous study (20) and a within-subjects correlation of r = 0.5 (18). To reject the null hypothesis with a probability (power) of 0.8 and α = 0.05, the calculation indicated that 18 participants were required.

Study Design and Protocol

In this randomized crossover study, data were collected during one 3-h visit to the laboratory. Before testing, participants were instructed to avoid strenuous activity for at least 24 h and arrive after at least 8 h of fasting. Upon arrival, consent was obtained along with demographics and information related to employment and standing desk usage, if applicable. Participants were also asked to self-report sitting and PA levels. Anthropometric measurements including body composition were assessed before taking part in the experimental conditions.

Participants performed a total of 1.5 h of typing work in three 30-min bouts in the following positions: sitting (SIT), standing (STAND), and standing on a balance board (BOARD). The balance board (Level, FluidStance, Santa Barbara, CA) has a wooden top and aluminum base with dimensions of 67.31 cm in length, 30.99 cm in width, and 6.35 cm in height, which allows for motion in three dimensions. The shape of the board was designed to mimic the range of motion an individual usually experiences while walking. The order of positions was randomized and counterbalanced to reduce bias in the outcome variables due to potential order or carry over effects. After an explanation of the typing task, an electric height-adjustable desk (UPLIFT Desk, Austin, TX) and a chair were fitted to the participant. In the SIT position, the chair was adjusted so that the participant’s feet were flat on the floor and knees were bent at approximately 90°. The height of the desk was also adjusted to allow a bend in the elbows of approximately 90°. In both the STAND and the BOARD positions, the height of the desk was adjusted similarly in that the bend of the elbows was approximately 90°. In the BOARD position, participants were given instructions for standing on the board according to the manufacturer’s recommendations and were then given time to familiarize themselves to the board. For all positions, participants were instructed to work as comfortably and normally as possible. Fidgeting was not restricted, although participants may not have had full control of their normal range of motion because of the setup of the equipment (i.e., mask attached to a hose connected to a metabolic cart). A heart rate (HR) monitor and a gas exchange mask were individually fitted to each participant. After all equipment was set up and calibrated, participants began typing a document as specified by the researcher. The first 10 min of each position was used as a familiarization period, where participants were able to adjust to the typing program and reach a steady state. For metabolic variables and HR, the last 20 min of each position was used for data analysis. In addition, for each position, participants were asked to rate their overall level of fatigue and pain, if any, at 10, 20, and 30 min. After finishing 30 min of typing in the specified position, participants were allotted a 5-min break where they were allowed to sit between subsequent trials.

Assessments and Analysis

Demographics, anthropometry, and body composition

The background questionnaires included items related to health, employment, and standing desk use. PA and sitting over the past 7 d were assessed with the short form of the International Physical Activity Questionnaire. Total weekly PA in minutes per week was calculated by multiplying the amount of time spent in each activity by the amount of days the activity was performed throughout the last 7 d. To assess sitting time, one question asks about the amount of time spent sitting or lying while doing various activities or watching television on a typical weekday. Height was measured to the nearest 0.1 cm as the average of two measurements with a scale-mounted stadiometer (Seca 220, Hamburg, Germany). Body mass was measured with a calibrated electric scale to the nearest 0.1 kg (Seca 220). Body mass index (BMI) was computed as body mass divided by height squared. Body volume was measured via air displacement plethysmography with the BOD POD (COSMED USA Inc., Concord, CA). Participants were instructed to wear tight-fitting spandex or a swimsuit for the measurement. Before each measurement, the system was calibrated according to the manufacturer’s instructions. A minimum of two consecutive body volume measurements lasting approximately 50s were taken while participants were seated still and relaxed in the chamber. Thoracic gas volume was measured using a filter and breathing tube. Body density was calculated by using body mass and body volume measures while accounting for thoracic gas volume. The Siri (general population) equation was used to covert body density to percent body fat.

Indirect calorimetry and HR

Participants breathed through a silicon mask (7450 Series V2 Oro-Nasal Mask; Hans-Rudolph, Inc., Shawnee, KS), and expired gases were analyzed breath-by-breath via indirect calorimetry with a TrueOne 2400 Metabolic Measurement System (Parvo Medics, Inc., Salt Lake City, UT). The metabolic cart was calibrated before each measurement according to the manufacturer’s instructions and standardized for barometric pressure, temperature, and humidity. Oxygen consumption (V˙O2), carbon dioxide production (V˙CO2), ventilation (E), RER, and absolute MET values were collected over each 30-min position. The first 10 min of data were discarded to allow for familiarization of each position and ample time to reach a steady state. Steady state was defined as achieving a ≤10% coefficient of variation in the last 20 min of each position in the metabolic variables V˙O2, V˙CO2, and E (27). The last 20 min of data was used for analysis, and each metabolic variable was processed using a 15-breath-moving average (28). EE (kcal·min−1) was calculated using respiratory quotient values with corresponding caloric equivalent values (without protein) and oxygen consumption (29).

HR was continuously measured using a chest strap HR monitor and receiver integrated with the metabolic cart (Polar Electro, Inc., Woodbury, NY). Average HR for each position was computed by averaging the last 20 min of data.

Productivity

For each position, participants typed a passage for 30 min through the interface of an online typing program (www.typingtestonline.org). Three passages randomly generated by the typing program were selected by the researchers for all participants to transcribe while in the three different positions. The passages were chosen based on their similar reading level, minimal number of quotations, and bland topic. For the last 20 min of each position, words typed per minute, accuracy, and the number of mistakes were recorded by the typing program and used to quantify productivity while typing.

Self-reported fatigue and pain

Participants completed validated 10-cm visual analog scales by rating their overall degree of fatigue and pain at 10, 20, and 30 min for each position (30,31). The scales were anchored with “no fatigue, very severe fatigue” and “no pain, worse pain possible,” respectively, and included no numbers.

Statistical Analysis

Statistical analyses were conducted using IBM Statistical Package for the Social Sciences for Windows version 25.0 (SPSS Inc., Chicago, IL). Variables are reported as mean ± SD or n (%). Normality was assessed using visual inspection of normality and residual plots. Nonnormal variables were transformed by applying a square root transformation and rechecked for normality. Repeated-measures ANOVA was used to assess differences on the outcome variables related to EE and productivity across condition (SIT, STAND, and BOARD) controlling for sex and current standing desk use. There were no effects of sex among the conditions in the EE variables (P > 0.05); however, because of differences in body composition profiles, the absolute values were different (men had higher absolute values than women). Current standing desk use was used as a covariate to control for the effect familiarization with a standing or sit–stand desk had on the outcome variables. A doubly repeated-measures ANOVA was used to assess differences on the self-report variables across condition and time. A Bonferroni correction was applied in post hoc analyses following the identification of significant main effects of condition or time. An order effect on EE was tested and found to be nonsignificant (P = 0.39). A probability level of P < 0.05 was considered statistically significant.

RESULTS

Sample characteristics

Thirty participants, 18 females and 12 males, employed full time in sedentary-based jobs met inclusion criteria and participated in this study. The occupations of the participants varied, but in general consisted of university administrators and professors, secretaries/office workers, engineers, researchers, and research assistants. The age range of the participants was between 22 and 59 yr, with an average BMI classified as overweight (26.7 ± 5.0 kg·m−2). On average, participants self-reported their sitting time on a typical weekday as 8.2 h·d−1 and 76.7% self-reported participating in at least 150 min·wk−1 of moderate-to-vigorous PA. Thirteen participants reported currently using a standing or sit–stand desk for performing sedentary-based work. The characteristics of all participants are presented in Table 1. Three participants did not meet the steady-state criteria of a coefficient of variation ≤10% in all three metabolic variables (V˙O2, V˙CO2, and E); however, inclusion of these three participants did not change the results of the analysis and, therefore, were included in the final analysis.

T1
TABLE 1:
Characteristics of participants.

EE

The results of EE and HR between all three conditions can be found in Table 2. There was a main effect of condition on V˙O2, V˙CO2, E, RER, HR, and EE, regardless of current standing desk use. In comparison with SIT, the mean absolute EE was 10.6% higher in STAND (P < 0.001) and 14.2% higher in BOARD (P < 0.001). The mean absolute EE in BOARD was 4.1% higher than that in STAND (P = 0.01). HR was 11.8% higher than SIT for both STAND (P < 0.001) and BOARD (P < 0.001); however, HR was not different between STAND and BOARD (P = 1.00). The mean RER was lower in BOARD compared with SIT (P < 0.05); however, RER was not different between STAND and BOARD or SIT and STAND. When V˙O2 and EE were expressed relative to body mass (mL·kg−1·min−1 and kcal·kg−1·min−1, respectively) and fat-free mass (mL·kg FFM−1·min−1 and kcal·kg FFM·min−1, respectively), the main effect of condition remained significant, regardless of current standing desk use (P < 0.001 for all). Although current standing desk use had no effect on the variables, data are also presented stratified by standing desk use to illustrate that both groups showed similar responses (see Table, Supplemental Digital Content 1, Energy expenditure, productivity, and average self-reported fatigue and pain variables stratified based on standing desk usage, https://links.lww.com/MSS/B223).

Productivity

As displayed in Table 2, words typed per minute, typing accuracy, and number of mistakes were not different among conditions (P > 0.05 for all). However, when stratified by standing desk use, there was a significant interaction between condition and standing desk use for number of mistakes (P = 0.04). Nonstanding desk users made the most mistakes while in SIT, whereas current standing desk users made the most mistakes while in STAND. In addition, current standing desk users made less typing mistakes overall among the three conditions (see Table, Supplemental Digital Content 1, Energy expenditure, productivity, and average self-reported fatigue and pain variables stratified based on standing desk usage, https://links.lww.com/MSS/B223).

T2
TABLE 2:
Gas exchange, EE, HR, and productivity variables during all three conditions.

Self-reported fatigue and pain

Figure 1 shows the change in self-reported fatigue over the 30 min for each condition. There was a significant main effect for self-reported fatigue over time (P < 0.001). For all three conditions, fatigue significantly increased over time (P < 0.001 for all comparisons). On average, self-reported fatigue was not different (P = 0.23) between SIT (2.40 ± 2.32 cm), STAND (2.12 ± 1.66 cm), and BOARD (1.76 ± 1.38 cm). These results remained similar regardless of current standing desk use (see Table, Supplemental Digital Content 1, Energy expenditure, productivity, and average self-reported fatigue and pain variables stratified based on standing desk usage, https://links.lww.com/MSS/B223).

F1
FIGURE 1:
Self-reported fatigue (cm) measured at 10, 20, and 30 min by a 10-cm visual analog scale for SIT, STAND, and BOARD. Error bars represent 95% confidence intervals.

There was a significant main effect for self-reported pain over time (P < 0.001). Multiple comparisons revealed self-reported pain was significantly higher at minute 20 and minute 30 compared with minute 10 (P <0.001 for both); however, there was no difference between minute 20 and minute 30 (P = 0.30). In addition, there was a significant condition–time interaction for self-reported pain (P = 0.047). As presented in Figure 2, self-reported pain increased linearly throughout 30 min of STAND, however for SIT and BOARD, pain increased slightly from minute 10 to minute 20, then leveled off from minute 20 to minute 30. On average, self-reported pain was not different among (P = 0.36) SIT (1.05 ± 1.42 cm), STAND (1.30 ± 1.26 cm), and BOARD (1.10 ± 0.96 cm). These results remained similar regardless of current standing desk use (see Table, Supplemental Digital Content 1, Energy expenditure, productivity, and average self-reported fatigue and pain variables stratified based on standing desk usage, https://links.lww.com/MSS/B223).

F2
FIGURE 2:
Self-reported pain (cm) measured at 10, 20, and 30 min by a 10-cm visual analog scale for SIT, STAND, and BOARD. Error bars represent 95% confidence intervals.

DISCUSSION

The present study tested the differences in EE when performing sedentary-based work (typing) while standing on a balance board, standing, or sitting at a traditional desk in an adjustable office chair. Standing on the balance board resulted in the highest EE when compared with both standing and sitting. The increases in EE were similar whether the participant currently used a standing or sit–stand desk for performing sedentary-based work or not. In addition to a higher EE, self-reported pain remained relatively constant and the participants’ ability to type efficiently was not impaired when standing on the balance board.

In comparison with sitting, EE was 9.3 kcal·h−1 greater while performing sedentary-based work when standing and 12.4 kcal·h−1 greater when standing on the balance board. Although existing studies examining the EE of standing have reported variable results, our data are similar to several recent studies that found EE during an acute bout of desk work executed in a standing position was 9%–11% greater compared with sitting (15,18,20). To our knowledge, no studies examining EE while performing sedentary-based work in different positions have included participants already familiarized with a sit–stand or standing desk or have accounted for this variable. Almost half of the participants in this study regularly used a sit–stand or standing desk, yet EE was still higher while performing work in a standing position and while standing on the board. Little evidence exists on whether initial increases in EE resulting from performing work while standing are maintained as an individual continues to stand on a daily basis (17). Our study provides preliminary evidence that EE may remain elevated even with chronic sit–stand or standing desk use. A positive energy balance of as little as 15 to 50 kcal·d−1 may result in weight gain over time (10). There is evidence that PA has an important role in weight maintenance and prevention of weight gain (32). Although not enough to promote weight loss, our study suggests standing or standing on a balance board could be an effective strategy to help adults in sedentary occupations maintain weight.

Most of the variability in resting EE between individuals can be explained by differences in FFM (20,33–35). Previous research has demonstrated that FFM can explain up to 85% of differences in resting EE (33–35). Our study revealed that significant differences in EE among sitting, standing, and standing on the board were still present regardless of sex or standing desk use, even when expressing EE in terms of FFM. This is consistent with a recent study that investigated differences among sitting, standing, and sit-to-stand transitions (20), implying the EE responses among the three postural conditions examined in the present study were independent of body composition or sex. Furthermore, our data suggest performing work while in a standing posture is more metabolically taxing than sitting (15,20–22).

Although modest, the metabolic rate when standing on the balance board was significantly above that of standing alone (approximately 3.2 kcal·h−1). Unstable surfaces such as balance or wobble boards manufactured in a variety of different forms and materials have existed for years and have traditionally been used for rehabilitation and in resistance training (25). The present study is unique because the board used in this study was specifically designed to be used within the context of an office setting at a standing desk. The greater energy cost of this activity is likely due to the instability of the board increasing muscle activity in the lower extremity or core to maintain and upright posture. It has been shown that when individuals perform sedentary-based work while standing still, muscle activity in the lower leg (tibialis anterior, gastrocnemius, and soleus) and thigh (biceps femoris and vastus lateralis) is significantly greater compared with sitting (15). This increase in lower extremity muscle activity was shown to correlate well with EE, indicating it is an important determinant of EE during standing (15). Although muscle activity was not measured in the present study, standing on an unstable surface requires an additional demand of the body to maintain stability, which may engage more musculature or require greater muscular activity than that of standing on a stable surface. All participants were instructed on how to properly use the board according to the manufacturer’s user guide, but several remained relatively still while using the board. It is unknown whether individuals would increase their range of motion on the board as they become more comfortable with chronic exposure. This may influence EE and HR to a larger degree when compared with standing.

Productivity generally encompasses both the quality of output produced and the rate at which it is produced relative to an individual’s input (8). Our study evaluated typing productivity by assessing words typed per minute, accuracy, and number of mistakes and found that all variables remained similar across conditions. This result is consistent with a variety of studies examining acute typing performance between sitting and standing postures that found no difference in words or characters typed per minute (18,19,36). Interestingly, we did find a significant interaction between position and standing desk use for the number of typing mistakes made. However, this result was likely driven by the low number of mistakes the individuals in the current standing desk group made when in SIT and the small sample size categorized as current standing desk users in our study.

Participants had similar feelings of fatigue across conditions. For all three conditions, self-reported fatigue increased from minute 10 to minute 30. This is in contrast to a recent study that found no changes in self-reported fatigue as measured by visual analog scales over 60 min while performing sedentary-based work (typing and worksheets) in a seated, standing, and alternating sit–stand position (18). In addition, another study that used visual analog scales for measuring fatigue while typing at a traditional seated desk, seated on a therapy ball, or standing found fatigue was significantly higher in the nontraditional working positions (19). The present study asked participants to rate their overall level of fatigue and did not differentiate muscular fatigue from other types of fatigue such as mental fatigue. It is not specified in the existing studies that used visual analog scales for quantifying fatigue whether the researchers instructed their participants to rate a specific type of fatigue (18,19). Many participants in the present study expressed they did not typically perform typing for such an extended duration without any interruptions. This may have contributed to the linear increase in fatigue over time for all conditions. Although not statistically significant, the overall amount of self-reported fatigue was lowest while standing on the board.

Although participants self-reported similar levels of pain for the three conditions overall, pain while standing continued to increase throughout the 30 min where it only minimally changed while performing work when sitting or standing on the board. Our self-reported pain data are inconsistent with many studies that report individuals decreased pain using an alternative workstation (12,37). Several participants in our study found the face mask uncomfortable to wear, especially as time persisted. To create a controlled environment, all participants used the same basic keyboard and monitor setup, which also may have been uncomfortable. We suspect these factors may have contributed to how participants rated their overall pain, similar to another recent study that found no differences or changes in self-reported pain between a sitting, sit–stand, and standing workstation (18). Standing and sit–stand desks are currently being used for interventions targeting low back pain, considering it is one of the most common musculoskeletal issues in adults and has been associated with sitting for prolonged durations (38,39). However, a recent review addressing the associations of prolonged standing with musculoskeletal symptoms concluded there is evidence for a detrimental association of prolonged standing with low back pain and lower extremity symptoms (40). Interestingly, it has been suggested that the introduction of greater instability has application for reducing low back pain, increasing joint stability, and enhancing muscular activity (25). Being an unstable surface that mimics functional movement, standing on a balance board while performing work has theoretical potential for improving pain. If individuals could maintain a state of slight movement while standing on the board, this could help avoid static posture that is typically experienced while sitting and standing, making it an appropriate device for replacing occupational sitting (24). Further research is warranted on the chronic use of a balance board within an occupational setting.

Methodological considerations

In this laboratory study, a controlled environment was used to eliminate potential confounding variables. Different results may have been obtained if participants had the ability to use their own workstation setup. Throughout all three conditions, participants were encouraged to work as comfortably and normally as possible. Again, comfort and mobility due to the indirect calorimetry equipment may have altered the ability to work normally. All participants typed passages as a form of work because many sedentary-based jobs involve some sort of typing or computer work for a large portion of the day. However, typing a random passage is likely not something individuals do at their job. We chose to avoid letting participants perform their actual work to minimize changes in mood, stress level, and obtain an objective measure of productivity. Different passages with similar qualities (i.e., reading level, low number of quotations) were typed in the same order although the conditions were randomized; therefore, there is no way to determine whether order or carry-over truly influenced the typing variables. We chose to have participants complete all conditions on 1 d to minimize participant burden and control for variance that may have been introduced if participants had visited the laboratory on multiple occasions. Furthermore, this may have influenced feelings of fatigue and pain. Lastly, we did not ask participants how many hours per day or week they spent sitting at their job, as we did not want to limit or exclude sit–stand or standing desk users from participating in the study.

It is also important to reinforce the acute effects observed over the 30 min of continuous sitting, standing, and standing on the board may not be extrapolated to chronic exposures. Although almost half of the participants in this study regularly used a standing or sit–stand desk for performing sedentary-based work, a longitudinal study is necessary to understand if EE continues to remain elevated with chronic use of an alternative workstation. Future studies should aim to understand the chronic effects of standing on the balance board while performing sedentary-based work within a laboratory and occupational context, as well as with different populations. In addition, other aspects of health such as risk factors for cardiovascular disease should be analyzed to examine if this type of alternative workstation can influence health.

CONCLUSION

Standing on a balance board while performing sedentary-based work elevated EE, did not interfere with typing productivity, and did not increase self-reported pain compared with sitting and standing. More research is necessary to determine whether standing on a balance board could be a viable option as an alternative workstation for replacing sitting in the workplace and if long-term use may benefit health.

The authors would like to thank Katie Eason, Elizabeth Biancosino, Alexandra Dluzniewski, Eric Nelson, and Michael Salmon for their assistance throughout the study. In addition, we would like to thank the participants for their time and effort.

There was no financial support in relation to the current project. The results of the present study do not constitute endorsement by the American College of Sports Medicine. The authors declare that there are no conflicts of interest and that the results of the present study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation.

REFERENCES

1. Matthews CE, Chen KY, Freedson PS, et al. Amount of time spent in sedentary behaviors in the United States, 2003–2004. Am J Epidemiol. 2008;167(7):875–81.
2. Thorp AA, Healy GN, Winkler E, et al. Prolonged sedentary time and physical activity in workplace and non-work contexts: a cross-sectional study of office, customer service and call centre employees. Int J Behav Nutr Phys Act. 2012;9:128.
3. Chau JY, der Ploeg HP, van Uffelen JG, et al. Are workplace interventions to reduce sitting effective? A systematic review. Prev Med. 2010;51(5):352–6.
4. Sedentary Behaviour Research Network. Letter to the editor: standardized use of the terms “sedentary” and “sedentary behaviours.” Appl Physiol Nutr Metab. 2012;37(3):540–2.
5. Katzmarzyk PT, Church TS, Craig CL, Bouchard C. Sitting time and mortality from all causes, cardiovascular disease, and cancer. Med Sci Sports Exerc. 2009;41(5):998–1005.
6. Koster A, Caserotti P, Patel KV, et al. Association of sedentary time with mortality independent of moderate to vigorous physical activity. PLoS One. 2012;7(6):e37696.
7. Church TS, Thomas DM, Tudor-Locke C, et al. Trends over 5 decades in U.S. occupation-related physical activity and their associations with obesity. PLoS One. 2011;6(5):e19657.
8. Tudor-Locke C, Schuna JM Jr, Frensham LJ, Proenca M. Changing the way we work: elevating energy expenditure with workstation alternatives. Int J Obes (Lond). 2014;38(6):755–65.
9. Hamilton MT, Hamilton DG, Zderic TW. Role of low energy expenditure and sitting in obesity, metabolic syndrome, type 2 diabetes, and cardiovascular disease. Diabetes. 2007;56(11):2655–67.
10. Levine JA. Nonexercise activity thermogenesis—liberating the life-force. J Intern Med. 2007;262(3):273–87.
11. MacEwen BT, MacDonald DJ, Burr JF. A systematic review of standing and treadmill desks in the workplace. Prev Med. 2015;70:50–8.
12. Graves LEF, Murphy RC, Shepherd SO, Cabot J, Hopkins ND. Evaluation of sit–stand workstations in an office setting: a randomized controlled trial. BMC Public Health. 2015;15:1145.
13. Thorp AA, Kingwell BA, English C, et al. Alternating sitting and standing increases the workplace energy expenditure of overweight adults. J Phys Act Health. 2016;13(1):24–9.
14. Buckley JP, Mellor DD, Morris M, Joseph F. Standing-based office work shows encouraging signs of attenuating post-prandial glycaemic excursion. Occup Environ Med. 2014;71(2):109–11.
15. Gao Y, Silvennoinen M, Pesola AJ, Kainulainen H, Cronin NJ, Finni T. Acute metabolic response, energy expenditure, and EMG activity in sitting and standing. Med Sci Sports Exerc. 2017;49(9):1927–34.
16. Chau JY, Daley M, Srinivasan A, Dunn S, Bauman AE, van der Ploeg HP. Desk-based workers’ perspectives on using sit–stand workstation: a qualitative analysis of the [email protected] study. BMC Public Health. 2014;14:752.
17. Rommich JN. Height-adjustable desks: energy expenditure, liking, and preference of sitting and standing. J Phys Act Health. 2016;13(10):1094–9.
18. Gibbs BB, Kowalsky RJ, Perdomo SJ, Grier M, Jakicic JM. Energy expenditure of deskwork when sitting, standing or alternating positions. Occup Med (Lond). 2017;67(2):121–7.
19. Beers EA, Roemmich JN, Epstein LH, Horvath PJ. Increasing passive energy expenditure during clerical work. Eur J Appl Physiol. 2008;103(3):353–60.
20. Judice PB, Hamilton MT, Sardinha LB, Zderic TW, Silva AM. What is the metabolic and energy cost of sitting, standing, and sit/stand transitions? Eur J Appl Physiol. 2016;116(2):263–73.
21. Reiff C, Marlatt K, Dengel DR. Difference in caloric expenditure in sitting versus standing desks. J Phys Act Health. 2012;9(7):1009–11.
22. Speck RM, Schmitz KH. Energy expenditure comparison: a pilot study of standing instead of sitting at work for obesity prevention. Prev Med. 2011;52(3–4):283–4.
23. Chau JY, Daley M, Srinivasan A, Dunn S, Bauman AE, van der Ploeg HP. The effectiveness of sit–stand workstations for changing office workers’ sitting time: results from the [email protected] randomized controlled trial pilot. Int J Behav Nutr Phys Act. 2014;11:127.
24. Buckley JP, Hedge A, Yates T, et al. The sedentary office: an expert statement on the growing case for change towards better health and productivity. Br J Sports Med. 2015;49(21):1357–62.
25. Behm DG, Drinkwater EJ, Willardson JM, Cowley PM. The role of instability rehabilitative resistance training for the core musculature. Strength Cond J. 2011;33(3):72–81.
26. Social Security Code of Federal Regulations [Internet]. (USA): Social Security Administration; [cited 2017 Jan 6]. Available from: https://www.ssa.gov/OP_Home/cfr20/404/404-1567.htm.
27. Popp CJ, Tisch JJ, Sakarcan KE, Bridges WC, Jesch ED. Approximate time to steady-state resting energy expenditure using indirect calorimetry in young, healthy adults. Front Nutr. 2016;3:49.
28. Robergs RA, Dwyer D, Astorino T. Recommendations for improved data processing from expired gas analysis indirect calorimetry. Sports Med. 2010;40(2):95–111.
29. Carpenter TM. Tables, Factors, and Formulas for Computing Respiratory Exchange and Biological Transformations of Energy. Washington: Carnegie Institution of Washington; 1921. https://play.google.com/store/books/details?id=SzEbAAAAYAAJ&rdid=book-SzEbAAAAYAAJ&rdot=1. Accessed November 27, 2016.
30. Lee KA, Hicks G, Nino-Murcia G. Validity and reliability of a scale to assess fatigue. Psychiatry Res. 1991;36(3):291–8.
31. Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 2011;63(11 Suppl):S240–52.
32. Donnelly JE, Blair SN, Jakicic JM, Manore MM, Rankin JW, Smith BK. American College of Sports Medicine Position Stand: appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults. Med Sci Sports Exerc. 2009;41(2):459–71.
33. Sparti A, DeLany JP, de la Bretonne JA, Sander GE, Bray GA. Relationship between resting metabolic rate and the composition of the fat-free mass. Metabolism. 1997;46(10):1225–30.
34. Gallagher D, Belmonte D, Deurenberg P, et al. Organ-tissue mass measurement allows modeling of REE and metabolically active tissue mass. Am J Physiol. 1998;275(2 Pt 1):E249–58.
35. Illner K, Brinkmann G, Heller M, Bosy-Westphal A, Muller MJ. Metabolically active components of fat free mass and resting energy expenditure in nonobese adults. Am J Physiol Endocrinol Metab. 2000;278(2):E308–15.
36. Straker L, Levine J, Campbell A. The effects of walking and cycling computer workstations on keyboard and mouse performance. Hum Factors. 2009;51(6):831–44.
37. Ognibene GT, Torres W, von Eyben R, Horst KC. Impact of a sit–stand workstation on chronic low back pain: results of a randomized trial. J Occup Environ Med. 2016;58(3):287–93.
38. Dugan SA. The role of exercise in the prevention and management of acute low back pain. Clin Occup Environ Med. 2006;5(3):615–32.
39. Janwantanakul P, Pensri P, Jiamjarasrangsri V, Sinsongsook T. Prevalence of self-reported musculoskeletal symptoms among office workers. Occup Med (Lond). 2008;58(6):436–8.
40. Coenen P, Parry S, Willenberg L, et al. Associations of prolonged standing with musculoskeletal symptoms – a systematic review of laboratory studies. Gait Posture. 2017;58:310–8.
Keywords:

ALTERNATIVE WORKSTATION; METABOLIC COST; PRODUCTIVITY; SELF-REPORTED PAIN; SELF-REPORTED FATIGUE

Supplemental Digital Content

Copyright © 2018 by the American College of Sports Medicine