If Sitting is the Problem, is Standing the Solution? NO!

Photo by mokee81/iStock / Getty Images
Photo by mokee81/iStock / Getty Images

“Yes, I know sitting is “the new smoking”; that’s why I have a standing desk”. 

I’ve heard this a lot over the last few years.  And it seems to make perfect sense: after all, isn’t standing the opposite of sitting?

Well, not exactly.  Come to think on it, sitting and standing actually have a lot in common.  Yes, when most people sit they slouch forward or lean against the back rest and arm rests and their postural muscles turn off and go dark.  But, most folks at a standing desk lock their knees and slide a hip forward to adopt a locked out posture that pretty much turns off most of their postural muscles, just like their seated coworkers.  So, at the muscular level, sitting and standing aren’t that different.  And thus it isn’t surprising that there’s only a modest increase in the metabolic rate when moving from sitting to standing (16%).

But there is one big difference between sitting and standing.  It turns out that the risk of heart disease is twice as high for those who stand most of the day compared to those who sit.  This surprising result just published in the American Journal of Epidemiology is based upon observing 7,300 workers over 12 years.  It’s a well done study that adjusted for a variety of factors.

Why would this be so?  Lead author Dr. Peter Smith explains that biological mechanisms largely explain why standing in a fixed place for hours at a time is actually worse for your health in the long term than sitting down. “The blood tends to pool in your legs, there is an increase in venous tension and oxidative stress, all of which increase the risk for cardiovascular disease,” he noted. “Combinations of standing and sitting and walking are probably where we need to be for all types of occupations.”

Does Dr. Smith think it’s time to retire all those standing desks that HR just bought?  “There is a real absence of evidence that standing for short periods does anything to reduce your risk of cardiovascular disease.  The best thing to do is to be more active during the day rather than think that just standing a few extra hours will make any difference.”

So the real culprit seems not to be sitting or standing, but inactivity.  And it turns out that while sitting still is bad, standing still is even worse, about twice as bad in fact.

The real solution is to inject activity into your day wherever possible.  Active standing (AKA walking) is better than standing still, of course.  But because we spend so much time sitting, active sitting is much, much better than sitting still.   

Active sitting.  It’s a thing, because it has its own Wikipedia page.  But it’s a topic for another blog.

Comfortable Chairs and the Purpose of Sitting

No one wants to be uncomfortable, and especially not for long periods of time.  So it’s hardly surprising that when it comes to sitting, the activity that consumes most of our waking hours, the question of “comfort” comes up immediately and just won’t go away. 

                   But “comfort” when sitting is likely a more complicated concept than simply the absence of pain; indeed, comfort is probably more than just one thing. 

One idea of comfort seems to be the absence of any muscular effort, a concept that leads to a new sort of “chair”, one that resembles what most of us would recognize as a bed. 

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Such sitting options are now for sale, but, for most of us, this won’t be a helpful solution: too expensive, too intrusive, and, well, just a little too weird

While the “chair as bed” may be a non-starter, it can serve as a valuable thought experiment.  Is it really true that the purpose of a chair is to extinguish all muscular effort?  If so, well, chairs with foot rests, arm rests, back rests, head rests, etc. seem like the obvious solution: the more rests, the more restful. 

But is rest really what chairs are for?  Heck, isn’t that what beds are for?  Yes, there’s a crossover category, the recliner, which seems like just the thing when relaxing in front of the television or listening to music, but the recliner makes more interactive activities difficult or impossible, so it’s often not the best choice, and certainly not the best choice if there’s work to be done. 

As an alternative to “complete physical relaxation” as the definition of comfort, perhaps a better definition of comfort would be “sitting in the best posture for the task at hand”.  In this view the most important function of a chair is to help one find and sustain such a posture.  Note that this posture can change minute to minute or even moment to moment, which makes this a big ask of one’s chair. 

Unless one has an active chair, that is, a chair that adapts in real time to postural changes.

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Yes, active sitting necessarily involves some muscular activity, but this small investment can pay big dividends in terms of both comfort and productivity.  And it turns out that even a little muscular activity (AKA exercise) provides a range of important metabolic benefits, benefits that may actually extend one’s life span.

Productivity?  Metabolic benefits?  Longer lifespan?  Come on, really? 

Yes, but these are topics for other blogs.

 

Feldenkrais: a doctor's view

    I’ve been a student of the Feldenkrais method for about a decade now, so I’m really just a beginner.  But here’s what I think I’ve been learning…

   Our bodies are the most basic tool we possess.  As children we learn through play to use our bodies, but unfortunately, as we age and abandon play we may forget these early lessons.  Over time we may adopt ways of using our bodies that are not optimal, and indeed may cause pain and even disability.   It is at this stage that patients often seek help from the medical community, but, because the medical model begins with the assumption of a structural abnormality, the interaction may be frustrating for patient and doctor alike.  Doctors typically don’t study functional abnormalities; getting all the anatomical abnormalities memorized is about all there is time for in four years of medical school.

   The Feldenkrais method seeks to gently reeducate those who have may have forgotten how to move comfortably by subtly retraining the nervous system.  This approach is fundamentally different from medical care: In the Feldenkrais method the student collaborates with his teacher to relearn comfortable ways of moving, whereas in the medical approach the emphasis is on repairing a structural defect.  Additionally, patients initially drawn to the Feldenkrais method for relief of symptoms may find that improvement in the efficiency and comfort of their movements are worth pursuing for their own sake.

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   Not every complaint is amenable to the Feldenkrais method, of course, but because the method is inexpensive (it can be provided as group lessons) and very unlikely to cause complications the Feldenkrais method is a very attractive initial approach to functional disorders.  As a surgeon, I’ve come to understand that not every physical complaint has a surgical solution.  Further, the least invasive approach to a problem is almost always the best place to start looking for a cure, and on this count the Feldenkrais method is an excellent choice.

   So how does this Feldenkrais reeducation work in practice?  In group lessons the Feldenkrais teacher suggests movements to a group of students who are usually lying on mats.  These movements are done slowly, with attention to detail, in order to allow the body to break old habits and find new ways of moving.  The phrase “see if you can find a way to…” is used a lot.  Because students are lying on the ground they are free of the tyranny of gravity, and so free to move in ways not readily allowed when standing.

   And, come to think of it, this is sort of the way many people experience of active sitting.  When sitting in conventional chairs the support provided by the backrest, the foot rest, the arm rests, the lumbar support, etc. makes moving creatively difficult; indeed, the whole design seems dedicated to preventing movement.  Active chairs, by contrast, invite (and almost require) a sort of playful interaction with gravity to stay balanced and upright.  Freed of the constraints of standard office chairs, active sitters can rediscover ways to align their spine, hips, ankles and neck, alignments that they may have forgotten over the years.

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Moshe Feldenkrais works with Dr. J

   Moshi Feldenkrais, the founder of the Feldenkrais method, defined perfect posture as any position from which one was free to move in any direction without preparation, that is, without physical or mental adjustment.  Thus, if perfectly balanced, movement in any direction is equally possible.  Active sitting chairs help one find this position, and thus allow one to explore and internalize perfect posture.  In passing, martial artists find the ability to move in any direction helpful, and this may in part explain the affinity of some Aikido students for active chairs.

   One last connection: it was almost 3 years ago that one of my Feldenkrais teachers introduced me to active sitting.  I’ve spent hours every day sitting actively since that introduction, and I think I’m finally beginning to understand why active sitting has been such a revelation for me personally.  I’ve also become convinced that sitting actively may be of help to others. 

And this is why we began the QOR360.com project: to make active sitting options available (and affordable) for everyone.

 

   You can read more about the Feldenkrais method in a recent New York Times article, “Trying the Feldenkrais Method for Chronic Pain” by Jane Brody:

https://www.nytimes.com/2017/10/30/well/trying-the-feldenkrais-method-for-chronic-pain.html?_r=0

 

 

Why "Ergonomic" chairs are bad for your posture

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What they say . . .

     

     Posture is response of the body to gravity.  It is the moment to moment conversation our bodies have with gravity.  This conversation begins at birth, and continues as babies first lift their head, then creep, then crawl, then toddle and finally stand.  Throughout this awakening of the body the spine is adapting to gravity, developing the normal curves in the lower back, thorax and neck that allow for perfectly balanced, calorically efficient standing and sitting while at rest.  Simultaneously the body is also developing muscular reflexes that facilitate efficient posture, reflexes that adjust the spine moment to moment to assure balanced, stable posture.  Importantly, these reflexes also allow the spine to adjust on the fly to surprises that might cause a fall if not compensated for.

     Unfortunately, standard chairs distort the perfect posture that we develop throughout our childhood, by providing “support” that distorts our posture.  The back rest, arm rests, foot rests, head rests all require that the spine respond with new, unusual, conformations.  Unfortunately, these new, unusual, conformations can cause discomfort in the short run:  witness the frequent changes of sitting positions required when sitting for more than a few minutes.  Worse, over time real pain syndromes can develop: over 80% of Americans will visit an emergency room for low back pain at some point in their lives, something not seen in cultures that have not adopted chairs as the standard format for sitting (e.g. Japan). 

     Because our brains are embodied in our bodies, posture also affects the mind.  This is in part the basis of yoga and meditation: certain postures help the mind to find its groove.  Because active sitting profoundly affects posture, it is likely that it also improves mental states.  This is a hypothesis that seems not to have been explored; we hope by making active sitting available to as many people as possible that we’ll be able to examine this hypothesis.
   

     I've referred to "spinal reflexes" a few times, but I'm not sure this phrase actually is English; it might be a medical reference that doesn't have much resonance for most people.  But spinal reflexes are very real and very important.  For example, if you put your hand on a hot stove you will immediately and involuntarily jerk it away, before you actually feel the heat or pain.  What has happened is that the information "you're burning your hand" is conveyed up the nerves of the arm to the spinal cord.  At the spinal cord this information is sent on to two places: 1. to your brain where it registers in your consciousness as "you burned your hand", and 2. to the flexor muscles of your arm which immediately flex and thus jerk your hand away from the stove.  This direct connection of the pain sensors in your hand to the flexor muscles in your arm at the spinal level is called a spinal reflex.  The result is mysterious, almost magical: you move your arm before you feel the burning of your hand.  This reflex has obvious advantages, because the sooner you remove your hand from the stove the less injured you will be.
     If you want to experiment with spinal reflexes without injury, you might try this:  Lie on the floor and relax completely, eyes closed for two or three minutes.  Then, still with your eyes closed look strongly up (toward the wall "above" your head) and very slowly and deliberately, lift your head 1/2 inch off the ground, noting how much effort this maneuver requires.  Rest for one minute, thinking about how hard or easy this might have been for you.  Now, still with your eyes closed, look strongly down (toward your feet), and again, very slowly and deliberately, lift your head 1/2 inch off the ground, noting how much effort is required now.  Most people find that the subjective effort to raise their head is different, depending upon where the eyes are looking.  The explanation for this oddity is that the positioning of the eyes powerfully affects the availability of the muscles of the neck through spinal reflexes.  We are so accustomed to our spinal reflexes that we usually don't notice their effects, working silently in the background.  It is only through experiments that we can discover just how much of our life is actually reflexive.
     Spinal reflexes can also be triggered simply by the position of the spine.  These reflexes are responsible for the automatic readjustment of posture that allows us to restore our equilibrium if we should trip while walking.  These same reflexes are invoked by our QOR360 chairs: when the pelvis tips, spinal reflexes immediately and automatically restore one's balance by making a myriad of small adjustments to the spine.  And all this happens automatically, below the level of consciousness.  You’re free to listen in on this conversation between your spine and gravity, but most people just get on with their workday. 

     Because our chairs allow one to outsource picking a comfortable posture to your spinal reflexes, you’re free to think about other things, confident that when you stand up at the end of the day your spine will be as fresh as when you sat down at your desk.

-turner

 

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What you get . . . 

How QOR360 came to be.

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  I’m sometimes asked “How did you come up with the rocker for your chairs?”  I usually deflect this question with something like “Well, it wasn’t the first thing I thought of…” and hope that’s enough explanation, because it’s a sort of meandering tale that stumbles from silly failure to ridiculous failure.  It doesn’t show me in a good light, frankly.  But, here’s an abbreviated version of the story.

   Like most of America, I’d spent a great deal of time sitting.  Although my job as a trauma surgeon kept me on my feet a lot (on rounds, in the OR, in clinic, in the OR, in the ER, …), unavoidably I also sat at a desk, and I found I just couldn’t get comfortable sitting.  Worse, I was prey to occasional spells of intense back pain that could last a week or more.  I tried the yoga ball, the kneeling chair, and a host of other solutions, but nothing seemed to help.

    But, as a professor of surgery it’s an article of faith that if you understand a problem you can solve it.  So, I read up a bit on back pain, sitting, posture, bodywork, anthropology, and the epidemiology of back pain.  Eventually I came to understand that it was sitting, and particularly sitting in western chairs, that was the root cause of my back pain problems.  Moreover, it was likely that western chairs were the source of most other people’s back pain problems as well.  And then the penny dropped: Here was a problem worth solving.

    I thought “How hard could it be to create a different sort of a chair, one that avoided the problems of conventional chairs?”   As it turned out, pretty hard.

    I started by buying a standing “wobble board’ and attaching it to a sitting stool with a piece of bungee cord; this worked … terribly. But it worked well enough that I spent almost a year trying to get to a version that did work.  In retrospect, all my prototypes were pretty ridiculous and, unfortunately, I took some pictures along the way.  The root problem was that using a hemisphere as the source of instability unavoidably created a “flat spot” where the bungee cord emerged; no matter what I tried, there simply wasn’t a work-around. 

    And then in an “ah-ha” moment I tumbled to the idea of using two cylinders rather than a single hemisphere.  I made the first prototype from PVC drain pipe and although it looked silly, it worked surprisingly well.  I then cycled through wooden versions (to dangerous to make by hand), 3D printed versions (too expensive), before settling on an injection molded version.  Made from polycarbonate and manufactured accurate to 1 part in 10,000 these rockers are indestructible, attractive, affordable and geometrically perfect.

    It was about this time that I wandered into “The Generator”, a maker space here in Burlington, Vermont where I had the great good fortune to meet Erik Cooper and Matt Flego.  Together they are M//E Design, a team with skills (design, CAD programming, CNC routing, welding, robotics, …).  Erik and Matt were immediately sold on the idea of a chair that would actually be good for people, and loved the simplicity of the rocker.  And they especially loved the constraints I put on the project: our chairs had to not only move, but be so solid we could offer a lifetime guarantee, so attractive that people would want them, and so inexpensive that everyone could have one.  As an epidemiologist I knew that it wasn’t enough that our new chair solve the problems caused sitting; it had to also be affordable if it was to solve the public health catastrophe brought on by conventional chairs.

     Is it too much to say that conventional chairs are a public health emergency?  Yes, but that’s a topic for another blog.

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Yoga balls: not the solution for sitting at work (or anywhere else...)

 "It's like the yoga ball, isn't it?"
    I hear this often when people encounter our QOR360 chairs for the first time and are trying to figure out what sitting on one of our rockers might feel like.
    And, it's a good observation:  Both the yoga ball (exercise ball, Swiss ball, etc.) and our chairs are alternatives to the standard chairs that have caused so much mischief and unhappiness.  And both the yoga ball and our chairs allow sitting to involve moving: the term "active sitting" is an oxymoron that I like a lot.  But that where the similarities end.
    The yoga ball has been around since 1963 when an Italian plastics manufacture first figured out how to make a mold for a large, inflatable plastic balls.  They were initially used to treat premature infants, but soon caught on in Switzerland as a way to treat movement disorders in adults.  Yoga balls are now ubiquitous and are used to allow motion in athletic training routines, yoga, and Pilates.
    Because yoga balls are about the height of a chair and allow movement and because sitting still is bad for us it was natural to think that sitting on a yoga ball might be benefical.  Unfortunately, this hasn't turned out to be true.  As Wikipedia observes:  "There is no scientific evidence of those benefits occurring by just sitting on a yoga ball without additional exercises..., some warn against using a yoga ball as a chair because of ergonomic considerations or biomechanical reasons..."  So, while yoga balls seem like a cheap answer to the problems of sitting, they fail.
    And they fail for a couple of reasons.  First, because they are squishy, one can't feel ones sitting bones (ischial tuberosities) when sitting on a yoga ball.  Because the base is poorely defined, it's hard to align ones spine on top of a yoga ball.  Perhaps worse, when sitting on a yoga ball there's a tendency rock ones pelvis backward, leading to a hunched lower back and, after a short while, lower back discomfort.  Still another difficulty with yoga balls is that it's impossible to adjust their height.  Because the height of ones chair is critical to sitting with good posture, this makes yoga balls a nonstarter for most people.
    And yet we find yoga balls everywhere.  I think this is because yoga balls are very cheap to make, and very, very, cheap to ship.  But mostly, I think it's that people hate their chairs and are disparate for a better solution to the problem of sitting.
    We think our chairs are a much better solution to sitting.  Not only do our QOR360 chairs provide a firm seat that allows one to clearly feel their sitting bones, but our chairs also are adjustable (or come in different sizes), so that they accommodate folks comfortably of every size.  Yes, our chairs are more expensive than yoga balls, but almost everything of lasting value is more expensive.
    If you're like most Americans, you sit an average of 11 hours each day, so finding a solution to the problem of sitting is time well spent.  
    You're going to be sitting a lot.  Shouldn't you be getting a lot out of sitting?

-Turner Osler, Founder and Chief Innovation Officer at QOR360.  Sit better.


REFERENCES

 

Clapp, Jane (2006). Working on the Ball: A Simple Guide to Office Fitness. Andrews McMeel Publishing. ISBN 978-0-7407-5699-3.

Greenwood-Robinson, Maggie (2007). The Biggest Loser Fitness Program. Rodale. p. 65. ISBN 1-59486-695-3.

 Gregory DE, Dunk NM, Callaghan JP (2006). "Stability ball versus office chair: comparison of muscle activation and lumbar spine posture during prolonged sitting". Hum Factors. 48 (1): 142–53. PMID 16696264doi:10.1518/001872006776412243.

 McGill SM, Kavcic NS, Harvey E (May 2006). "Sitting on a chair or an exercise ball: various perspectives to guide decision making". Clin Biomech (Bristol, Avon). 21 (4): 353–60. PMID 16410033doi:10.1016/j.clinbiomech.2005.11.006.

  Gregory, Diane E. "The Use of Stability Balls in the Workplace in Place of the Standard Office Chair". Centre for Research Expertise for the Prevention of Muscloskeletal Disorders, University of Waterloo. Retrieved 1 January 2011.