This article examines whether standing is an affordable and feasible solution to compensate for the harmful health effects of excessive sitting.

For decades, interest in the cardiometabolic risks of prolonged sedentary lifestyles has overshadowed the health implications of perhaps the biggest behavioural change in the transition from hunter-gatherers to modern humans: the remarkable increase in time spent standing.

For example, there is evidence to suggest that in modern western society adults spend more than twice as much time standing and less time walking, compared to typical hunter-gatherers.

There may be many differences between populations that may complicate the associations and limit the conclusions we can draw, but the data suggest that globally, adults may have a different composition of physical behaviours depending on whether they live in agricultural, industrial or informational communities.

A large proportion of today's adults spend a significant part of their day standing up, with recent data from international cohorts showing that daily standing accounts for a staggering 3.1-4.6 hours/day or about 19%-29% of the total time in the waking state.

While standing is very often presented as an affordable and feasible solution to offset the harmful health effects of excessive sedentary lifestyles, the effects of standing on cardiometabolic health have not been well researched.

IS STANDING A SOLUTION TO THE HARMFUL EFFECTS OF A SEDENTARY LIFESTYLE?

Previous studies on the cardiometabolic effects of prolonged standing have given conflicting outcomes.

However, recent advances in measurement techniques, such as accelerometers worn on the thighs and wrists, now provide researchers with the measurement accuracy needed to examine the cardiometabolic health effects of standing.

For example, recent data on more than 83,000 adults wearing wrist accelerometers, showed that each additional 30 min/day of standing was associated with a 11% higher risk of orthostatic circulatory disease, while no beneficial or harmful associations were found for the risk of major cardiovascular disease (coronary heart disease and stroke). In addition, replacement of physical activity with standing was found to be associated with worse cardiometabolic profiles in a recent pooled analysis of seven cohorts using thigh accelerometry.

The problem with standing is that it can have positive effects, but it also has many negative effects:

• Higher daily energy expenditure compared to the sitting position: Standing can contribute to higher daily energy expenditure compared to sitting, with beneficial effects on maintaining a healthy body weight and long-term cardiometabolic health.
• Glucose and lipid metabolism: moving from sitting to standing, and less so maintaining standing posture, involves activation of the large leg muscles, which can improve lipid and glucose metabolism, insulin sensitivity and endothelial function and thus promote cardiometabolic health.
• Venous stasis: Gravitational pull and the absence of forceful contractions during prolonged standing can lead to a build-up of blood in the veins of the legs. Over time, this could manifest as varicose veins and potentially contribute to deep vein thrombosis, posing a potential risk to cardiometabolic health.
• Increase in heart rate and blood pressure: The increased workload of the heart during standing, pumping against gravity, can lead to increased 24-hour heart rate and cardiac output. Prolonged exposure to these conditions could explain why standing may increase the risk of cardiometabolic disease.
• Enhanced oxidative stress: Prolonged standing can cause enhanced oxidative stress due to the ongoing activation of leg muscles, which is known to contribute to cardiometabolic disease.
• Fatigue and musculoskeletal pain: Prolonged periods of standing can cause fatigue and pain in the lower legs and back, acting as barriers to engaging in physical activities that promote cardiometabolic health.

Therefore, there is little evidence to support the common narrative that standing mitigates the potential negative (cardiovascular) health effects of sitting - probably a remnant of the 'sitting is the new smoking' dogma.

-Suprastratum: The authority on health, fitness and nutrition

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