Excellence in Ergonomics & Injury Prevention

The Challenge of Containing the Risks and Costs of the Seated Worker

AGENDA• The Problem

• The Megatrends

• The Research

• The Solutions

• Functional Movement System (FMS)

• Q&A

The Challenge of

Containing the Risks and Costs

of the Seated Worker

The Problem

https://www.youtube.com/watch?v=uiKg6JfS658

Chair Tethered Society

ABC’s of Excessive Sitting

A – Arthritis

B – Back pain, Blood pressure

C – Cancer, Cholesterol problem

D – Diabetes, Dementia

E – Emphysema

F – Fat gain

G – Gestational diabetes

H – Heart Attack, Heart Disease

I – Immobility, Isolation, Infertility

J – Joint pain

K – Kidney problems, Kyphosis

L – Loneliness, Leg swelling

M – Moodiness, Muscle pain

N – Nutricide, Nerve entrapment

O – Obesity, Osteoporosis

P – Poor productivity

Q – Quality of life decrease

R – Relationship problems

S – Stigmatization, Swollen ankles,

Sexual dysfunction, Sleep apnea

T – Tendonitis, Trapped feeling

U – Underachiever, Unhappiness

V – Varicose veins

W – Wasted opportunities

Y – Yearning for something better

Z – Zestless living

Reference: Levine, J. A. (2014). Get Up, Why Your Chair is Killing You and What You Can Do About It. New York, NY. Palgrave Macmillan

The Megatrends – What are we seeing?

Employers and Employees

• Employees want standing solutions

• Employers are uncertain

Furniture Manufacturers

• Increasing options

• Ubiquitous marketing

• Stubborn price point

Reference: http://workriteergo.com/fundamentals-ex-electric/

The Research What do we actually know?

How This All Started

• 1953 London Bus Study – higher mortality in drivers than conductors.

• Health researchers have been making the correlations between

increased risk of adverse health outcomes & sedentary living for 20+

years. Historically, however, this has focused on the implications for

exercise, nutrition, etc.

• The research on Non-Exercise Activity Thermogenesis (NEAT) began to

‘heat’ up in the early 2000’s.

• Concurrently, epidemiological studies that looked at population wide

effects of sedentary life began to be published at an increasing rate.

• Correlations have been increasingly drawn in the media over the last

5-10 years.

Sedentary Time and its Association with Risk for Disease

Incidence, Mortality and Hospitalization in Adults, A

Systematic Review and Meta-analysis.

Annals of Internal Medicine. Jan 2015.

Prolonged uninterrupted sedentary behavior will, without

question, kill you over time.

Episodic exercise isn’t enough to counteract the effects,

but the associations may become less pronounced as

physical activity increases – more research is needed.

Prolonged, uninterrupted SEDENTARY POSTURES are

independently correlated with premature death, premature

aging, increased MSD prevalence, increased chronic disease

states (such as obesity, diabetes, heart disease, cancer)

decreased quality of life, etc.

The Latest and Greatest on Sitting

So standing must

be good right?

It’s all about the METs

Metabolic equivalent (MET) – measures the intensity of activity in terms

of energy expenditure.

MET Measures Per Activity:

• Laying Down / Reclining / Sleeping = .9 METs

• Quiet Sitting / TV Watching = 1 MET

• Quiet Standing = 1.2 METs

• Talking / Eating While Sitting = 1.5 METs

• Working at a Desk While Sitting = 1.5 METs

• Working at a Desk While Standing = <2.0 METs

• Walking 3.0 MPH = 3.0 METs

Activity 1.5 METs or less is typically

classed as SEDENTARY

It’s all about the METs

SUMMING IT UP

• Sitting at a workstation all day is a sedentary activity.

• Standing can barely be considered light activity.

• Sedentary activities are bad for you.

• Use caution with product benefit claims.

This is a society wide problem

Sedentary

behaviors

are

problems

for all of us.

You can blame

modern

conveniences,

lifestyle,

technology,

and certainly

your job.

As our jobs become more intellectual…

Church TS, Thomas DM, Tudor-Locke C, Katzmarzyk PT, et al. (2011) Trends over 5 Decades in U.S. Occupation-Related

Physical Activity and Their Associations with Obesity. PLoS ONE 6(5): e19657. doi:10.1371/journal.pone.0019657

http://www.plosone.org/article/info:doi/10.1371/journal.pone.0019657

Figure 1. Service, goods producing and agriculture jobs in US

They become more stationary…Figure 2. Trends in the prevalence of sedentary, light and moderate intensity

occupations

Church TS, Thomas DM, Tudor-Locke C, Katzmarzyk PT, et al. (2011) Trends over 5 Decades in U.S. Occupation-Related Physical

Activity and Their Associations with Obesity. PLoS ONE 6(5): e19657. doi:10.1371/journal.pone.0019657

http://www.plosone.org/article/info:doi/10.1371/journal.pone.0019657

And may be killing us…

BUT… so are our washing machines, dishwashers,

and cars…

To sum up sitting…

Our TV’s, jobs, cars, washing machines, and dishwashers are killing us. Awesome…

The trend is AUTOMATION vs. LOCOMOTION.

We’ve lost movement and need to get it back.

Reference: http://www.beschriftung.cc/media/images/bluetech-popup/evolution.jpg

Can more standing help us?

• Standing burns approximately 20% more calories than sitting. This works

out to be approximately 10 more calories an hour!

• Standing also boosts the production of the enzyme lipoprotein lipase

(which turns bad cholesterol into good) and reduces glucose resistance.

(Hamilton, et. al.)

• Standing has also been shown to be helpful in addressing abdominal fat

storage.

• Standing as an alternate posture to sitting reduces accumulated loads

and provides injury prevention benefit as postural variation does.

• BUT…

Prolonged Standing is BADStationary standing is correlated with extremely

high incidence of low back pain, even in

participants who had no prior history of low back

discomfort.

People working in a fixed standing posture are at a

significantly greater risk of cardiovascular disease,

blood clots, etc. than those working in a fixed sitting

posture.

Standing occupations have an increased risk of varicose

veins, leg cramps, leg swelling, birth defects and

pregnancy complications.

What do we know about sit-stand desks?

• The research is highly conflicted.

• The rate of adoption post implementation declines rapidly after 1 month.

• The research shows no meaningful improvement in the total number of

steps taken per day - sitting is usually replaced exclusively by standing.

• Self reported comfort measures and symptoms sometimes improve but

there is a lack of high quality analysis and statistically significant findings.

• The studies that have shown positive results have specifically identified

that the equipment must be provided along with specific training on use, a

supportive management climate, and a participatory organizational culture

–which have been shown to improve movement rates without height

adjustable equipment.

• Alternating sitting and standing was comparable to uninterrupted

sitting regarding plasma glucose. Sitting and light intensity activity

breaks lowered plasma glucose (Bailey and Locke, 2014).

How did we get to this point?

• We seek easy, automated solutions

• We seem to prefer pathology over

responsibility

• New knowledge is perceived as

‘better‘

• New technology is ‘cool’ &

‘seductive’

• AND equipment comes with a

marketing budget, motion doesn’t…

the results are frightening.

So what’s the answer?

There are really two goals or outcomes we can aim at…

1. How do we PREVENT further DECLINE in health &

TREAT chronic conditions (e.g. return to population

baseline)?

1. How do we IMPROVE the health and wellness of a

sedentary population?

The Solution

PREVENTION & TREATMENT

• Simply stand up once every 15 minutes.

• The simple activity of standing up 30 to 35 times a day

(which is akin to a squat) is enough to maintain your health

and prevent a decline from sedentary life. (NASA, Vernikos)

The Benefits

• It actually WORKS

• It’s FREE

• It’s PARTICIPATORY

• You can do it anywhere

• No approvals, permissions, or doctor’s notes needed.

• You will improve your glucose metabolism, lipase

protein production, joint health, focus, and studies

suggest be more productive at work.

Our bodies want to move.

Our brains want to move.

Join us in daily movement.

Together we can change the world.

1. Culture and Leadership

2. Systems & Procedures – Get Everyone’s Buy-In

3. Physical Infrastructure

4. Furnishings

5. Biotech Self Monitoring

6. Develop Personal Plans Using the 5 Weapons

7. Enhance the Group Dynamic

8. Science is Power

9. Test, Test Again and Retest

10. Oversight and Ethics

11. Mission

12. Sustain for 2 Years

Reference: Levine, J. A. (2014). Get Up, Why Your Chair is Killing You and What You Can Do About It. New York, NY. Palgrave Macmillan

Active Working – Where and How?

The Bottomline 1. Increased productivity

2. Improved health measures

and decreased healthcare

costs

3. Decreased employee stress

4. The ripple effect: Benefits

of programs delivered in the

workplace consistently

ripple into employee’s home

lives

5. Increased happiness

6. Positive atmosphere

7. Decreased staff turnover

8. Hiring advantage

Reference: Levine, J. A. (2014). Get Up, Why Your Chair is Killing You and What You Can Do About It. New York, NY. Palgrave Macmillan

"Change is the law of life and those who

look only to the past or present are certain

to miss the future.“ – John F. Kennedy

"Never doubt that a small group of

thoughtful, concerned citizens can

change the world. Indeed it is the only

thing that ever has.“ – Margaret Mead

Functional Movement System

Contact Information:

Matthew Marino, PT, MSPT, CPE, CWcHP, CSCS, CPT

503-863-6062

matthew.marino@briotix.com