Active sitting: Why ergonomic chairs and standing desks fail [PODCAST]

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The office chairs most of us sit in all day have little science behind them, and the popular fixes may not be much better. Turner Osler is a trauma surgeon and epidemiologist. This episode is based on his article “How the benefits of active sitting change desk work,” published on KevinMD. You will hear why life table analyses suggest the people who sit the most lose about two years of life, where the 90-90-90 posture came from, and why lumbar support has largely failed. You will hear what goes wrong with kneeling chairs and yoga balls, and why he says standing desks are even worse, citing a 2018 Ontario study of 6,300 people followed for 12 years in which heart disease was doubled in the group that stood. You will also learn how active sitting builds movement into the workday by changing the environment rather than relying on willpower, and what a moving surface could do for people who use a standing desk. Press play for why you do not have to accept the chair you are sitting in.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome Turner Osler. He’s a trauma surgeon and epidemiologist. Today’s KevinMD article is “How the benefits of active sitting change desk work.” Turner, welcome to the show.

Turner Osler: Hi, Kevin. Happy to be here. Thanks for having me on.

Kevin Pho: All right, let’s start by briefly sharing your story. Then we’ll jump right into why you decided to write this article on KevinMD.

Turner Osler: Well, it’s a burr I’ve had under my saddle for a while, and I’m just looking for a platform, any platform, to bring forth the idea that the chairs we’ve been sitting on for the last almost one hundred years really don’t have much design or ergonomics behind them. They’re designed by ergonomists, but when you start to look under the hood, there’s not any science behind it.

And it turns out that the chairs we’re sitting on are just pretty bad for us. We know this because people who sit a lot lose as much as two life years, according to life table analysis in peer-reviewed journals. So the business of sitting slumped in front of your computer all day turns out to be kind of a public health emergency. It’s not quite up there with smoking, but you may have heard, “Sitting is the new smoking.”

Kevin Pho: So tell us, are there any studies or data that have shown the harmful effects of our traditional chairs?

Turner Osler: Right. No, a life table analysis out of the epidemiology literature. I have a master’s in biostats, so I review this kind of literature for journals. And the life table analysis is pretty compelling: big studies out of Great Britain and also Canada. And it turns out the quartile that sits the most, if you look carefully at the data, loses on average two life years. You know, it’s really kind of an eye-opener, and you think, “How is that possible?”

The physiology is less well worked out, but it’s pretty clear that when people sit all day, their glucose curve becomes rather pathological. And the public health people say, “Well, you know, get up and go for a walk every thirty minutes.” There’s good data to show that helps, but there’s behavioral economics data to show it’s hard to get people to do something that’s good for them, especially if it involves doing something every thirty minutes.

Kevin Pho: So in your article, you mentioned that traditional chairs lock the body into a fixed 90-90-90 posture. Can you explain what that means?

Turner Osler: So the ergonomics literature has basically forever preached the idea of having the ankles at 90 degrees, the knees at 90 degrees, and the hips at 90 degrees. And if you try to track down where that came from, it’s like so many things: It’s very hard to see where it first emerges. In the late 1800s, there was the idea that humans were better than other animals, and we could show that because of our posture. You know, those great apes were all slumped, but we humans, we’re better. And so we kind of adopted it almost for moralistic reasons.

But if you look carefully at the 90-90-90 posture, it’s almost impossible to sit with your hips at 90 degrees and not lose your lumbar lordosis. And the chair industry is aware of that, so to restore the low back lumbar lordosis, they put in the lumbar support, which has been a cataclysmic failure. If you watch people sit on one of these chairs, they don’t use the lumbar support. They do everything they can to get away from it. They wiggle, they squirm, they sit on the front of the desk, or they slump away from it. But basically no one uses lumbar support, which was pitched as the solution to the problem.

Kevin Pho: So let’s talk about some of the approaches to fix the risks of sitting historically, right? Yoga balls, kneeling chairs, standing desks. What do you think about those attempts historically?

Turner Osler: Well, I think they really tell my story for me because the fact that so many different solutions have been tried kind of underscores just exactly what a failure the ergonomic office chair has been. And I need to say, there have been $100 billion worth of ergonomic office chairs sold, so it’s an immense business. The companies making these chairs have a vested interest in not changing a thing.

Nevertheless, the market has kind of bubbled up other solutions. The Balans kneeling chair from this guy Opsvik, a Danish designer, is very cool because it got people to shift some of their weight to their tibial tuberosity and got them to sit with an open hip angle, so they got their lumbar lordosis back. By having the knees lower than the hips, it guaranteed people couldn’t sit in a 90-90-90 posture in Opsvik’s chair. The problem was you got kind of wedged into that chair, and you couldn’t move.

So it was pitched as the first computer chair because people were spending hours at a time for the first time just staring at a screen, basically motionless. When people were typing and writing with a ballpoint pen or a quill, they were moving, but once you sat down at a computer, people pretty much stopped moving. So the Opsvik chair, the kneeling chair, tried to fix that by dropping the knees and wedging people in. It wasn’t a big solution. I sat on one for years, and it just didn’t work for me.

The yoga ball seems like a better solution because you see them in gyms and in yoga studios, so they’re there to invite motion. But if you’ve ever sat on one at a computer, and I have sat on one of those for years, you find that because your ischial tuberosities can’t find a surface to get organized, you pretty quickly just fall into a slump.

There are other problems with a yoga ball. You can’t adjust the height, and the height where you’re sitting is crucial if you want to get your knees lower than your hips so you can sit with an open hip angle and get your lumbar lordosis back.

Another problem is one I learned from an HR person, the head of HR at the University of Michigan. They banned yoga balls because they had five instances where a yoga ball suddenly failed, popped, and people fell on the ground, and one guy had a head injury and needed burr holes. So her advice to me, to share with anyone who’s listening, was if you have yoga balls in your system, throw them all away on January 1 and buy all new, because they get brittle over time, but if a yoga ball is less than a year old, it’s much less likely to fail.

But they fail in the basic sense that they don’t really give people better posture, and they don’t really invite people to move. So they’re kind of a double-barreled failure.

Even worse is the standing desk rage. Billions of dollars’ worth of standing desks have been sold because people got the idea that sitting was bad for them, and standing is the opposite of sitting, so it must be good, right? And the answer is, simply put, standing is not the opposite of sitting. Standing is just a locked-in posture that’s even less healthy than sitting, and there’s data for that.

A paper from Smith et al., 2018, out of Ontario followed 6,300 people for 12 years, an immense public health study. Basically, half of the people were sitting and half of them were standing, and heart disease was doubled in the group that stood. If you read Smith’s paper, I think it’s an important paper. I don’t think it’s been discussed enough. It’s been cited over 300 times, but you can tell reading the discussion section that they weren’t expecting that result when they broke the data code.

And so, as happens in medicine, when you have data that is clear but you don’t understand the physiology, you make up some physiology. And their idea was that because you’re standing, you have a column of blood from your right atrium down to your feet, and it’s just kind of pooled, and the valves and the veins get stretched. And because the blood isn’t moving much, it becomes basically subclinically hypercoagulable. It’s a made-up explanation. I don’t think we really know. But the data is quite clear, you know: p = 0.02.

Kevin Pho: So in your article, you introduce the concept of active sitting. For those who didn’t get a chance to read your article, just tell us what that concept is about.

Turner Osler: Right. You may notice that I’m staggering like a drunk here because I’m sitting on a geometric shape that, if you put it under the seat pad of a chair, tips in all directions. And because you’re constantly trying to rebalance yourself on top of this thing, you’re constantly moving. So the idea is to build movement into one’s day by changing the built environment.

My mentor in public health was Professor Susan Baker at the Hopkins School of Public Health, and she just beat into all of us that you can’t beg or control or trick people into healthier behavior. You must make it impossible for them to behave badly. Think of the airbag or the seatbelt or the divided highway or the child-locking cap on medicines. You can make the environment safer, and that way people can’t defeat it by being lazy or distracted.

So you can tell people to get up every thirty minutes and go for a two-minute walk, and you can be pretty sure that most people won’t do it. But if you put a chair under them that requires them to constantly be engaging their core muscles to balance, you can be pretty sure they’re going to stay engaged because otherwise they’ll wind up on the floor. You know, it’s kind of a tough-love concept.

Kevin Pho: So tell me about the solution. I know that you are the founder of a company that makes a device like this. It looks like you are constantly moving, so tell us the mechanics behind this chair. Is it generally unstable, and you just have to use core strength to keep you stable? It forces you to do that? Is it comfortable? Let me just simply ask you that.

Turner Osler: No, no. And I’ll say right at the top, there are other companies that make chairs that have this principle: Core Chair out of Canada, the Michu company in Germany, Swopper in Germany. There are several other companies that have different designs for making a seat slightly unstable so people are required to stay muscularly, and I’ll add metabolically, involved.

There’s a whole literature about how humans are designed to be hunter-gatherers. Daniel Lieberman, an evolutionary biologist at Harvard, went out to study the Hadza in Tanzania. He finds that these hunter-gatherers don’t sit in chairs because they’re hunter-gatherers. They don’t have any furniture. But they’re not always hunting and gathering, and so when they’re just sitting around telling stories and roasting tubers, they squat. And Lieberman describes it as an active resting posture. When you squat, your muscles are engaged, but it’s a way to sort of rest a little bit. And he says this is the posture that he recommends for people living in Manhattan.

It’s not going to happen because most people lose the ability to squat by the time they’re in first or second grade because they’ve been sitting in chairs at 90-90-90, and their ability to squat has been basically stolen from them. So squatting isn’t really something we’re going to get back to, but active sitting is something everybody can do.

And we found that people have to kind of ease into it. It is some work. Some people say, “Oh, you know, the next day my core was sore.” We tell people, “Take it twenty or thirty minutes the first time. See how you are as time goes by.” And basically everybody can be sitting actively all day long within weeks or months.

Kevin Pho: So how do you get everyone to change behavior? Because it looks like you’re asking them, in your ideal world, to switch from something that is perceived to be more comfortable to something that appears to be less comfortable, right? So what are your next steps in terms of convincing people of this approach?

Turner Osler: Right. You kind of think when you come across a problem that you think can be solved, you get excited. I spent a year working on different prototypes, and finally you come up with something that works, and you think, “OK, I got it.” But I’m part of a makerspace community here in Burlington called The Generator, and they said, “No, no, no, no, that’s just the down payment, having the idea. Now you have to figure out a way to manufacture it at scale and so on.”

OK, fine, so we figured that out. But it turns out that’s not the hard part. The hard part is explaining it to people and getting buy-in. And I am uniquely unqualified to do that. So what you do is you find some twenty-somethings or thirty-somethings who are interested in web-based communication and say, “Get these chairs out into the world.” So that’s our strategy: to tell the story to as many people as we can, like telling it to you, Kevin.

And I’ll say, NPR did a piece on us, and our website went from one hit a minute to one hit a second. It crashed the website. It was great.

Kevin Pho: Now, where do you see the next steps in terms of the target markets that are best positioned to utilize your approach of active sitting?

Turner Osler: Well, I would say anybody who’s sitting at a desk, which is basically everybody.

Kevin Pho: So tell us, what’s the next step in terms of the technology of sitting? What do we have to look forward to?

Turner Osler: Well, we mentioned standing desks, and it’s very hard to talk people out of their standing desks. So we thought, “Would there be a way to get more movement into people at a standing desk?” You may have seen that some people are trying to put treadmills under their standing desk. That turns out not to be a viable idea because you can’t mouse when you’re on a treadmill, and your cognitive ability to follow an argument kind of bottoms out.

So we had the idea that perhaps we could make a surface for people to stand on that would more closely approximate what the savanna was like. So we came up with the idea of having a bunch of tiles that would be independently mounted and would move around. By standing on such a surface, all the muscles in your feet and also your calves are engaged. So our idea is to get more muscular engagement and more movement into any office situation. And if people have a standing desk, we’ll meet them where they are and try to change the surface under their feet.

So we’ve got a prototype, and we’re kind of working with people here in Burlington, actually, to start making them and see how they pan out in the world. The reflexologists love them, and the barefoot shoe crowd loves them.

Kevin Pho: We’re talking to Turner Osler. He’s a trauma surgeon and epidemiologist. Today’s KevinMD article is “How the benefits of active sitting change desk work.” Turner, as always, let’s end with your take-home messages to the KevinMD audience.

Turner Osler: You don’t have to accept the chairs that Big Chair has foisted on all of us. I misunderstood that. I thought if I just bought the most expensive chair, it would solve the problem, and it’s just a more expensive failure. So listen to what your body is kind of telling you, and try to get more movement into your day any way that you can. If you can manage to get up and go for a walk every thirty minutes, that’s clearly the solution, but if not, engineer some other way to get more movement into your day.

Kevin Pho: Turner, thank you so much for sharing your perspective and insight, and thanks again for coming on the show.

Turner Osler: Oh, it’s been terrific, and thanks for keeping me on task. It’s not easy.

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