Prolonged standing carries health risks

Workers primarily standing on job twice as likely to suffer heart attack, congestive heart failure: Study
By Sarah Dobson
|Canadian HR Reporter|Last Updated: 09/20/2017

For all the talk about the perils of sitting too much on the job, what about workers who stand for a long time? That’s also not good, according to a study.

Even after taking into account a range of personal, health and work factors, people who primarily stand on the job are twice as likely as those who primarily sit to have a heart attack or congestive heart failure, according to a study by the Institute for Work & Health (IWH) and the Institute for Clinical Evaluative Sciences (ICES) in Toronto.

The risk of heart disease among people who stand on the job (at 6.6 per cent) is even higher than among daily smokers (5.8 per cent), found the 12-year study.

“We do a lot in the workplace to prevent people from being exposed to smoke because we understand it’s a risk factor for cardiovascular disease, but we do virtually nothing to prevent people from being exposed to prolonged standing,” said Peter Smith, a senior scientist at IWH who led the research.

“And if we think about it as a risk factor of a similar magnitude to smoking, that really provides an impetus to start focusing on it as a risk factor and something that should be modified within the workplace.”


The study followed 7,300 workers in Ontario who were initially free of heart disease and were respondents to the 2003 Canadian Community Health Survey (CCHS), which collected information on personal factors, health conditions, health behaviours and work conditions.

It also collected job title information to estimate if a job primarily involved sitting, standing/walking, a combination of the three or other body postures (such as bending or kneeling).

The most common jobs with prolonged standing included retail salespeople and sales clerks, cooks, food and beverage servers, machine operators and customer service representatives in financial services.

The study estimated nine per cent of the group predominantly stood at work while 37 per cent predominantly sat. The researchers then linked the information from CCHS to health records at ICES to identify those people who had a new case of heart disease from the years 2003 to 2015.

During this period, 3.4 per cent of the study group developed heart disease and, without taking any other factors into account, the risk of heart disease was higher among people whose jobs required mostly standing (6.6 per cent) than among people whose jobs involved mostly sitting (2.8 per cent).

Even after adjusting for a wide range of factors — such as age, gender, education, ethnicity, marital status, health conditions, health behaviour and work — the risk of heart disease was twice as high for people who primarily stood on the job.

There are three main mechanisms involved when it comes to standing and the human body, according to Smith.

There’s a pooling of blood that occurs in the legs when standing, because of gravity, and then most of the blood is pumped back to the heart, so there’s an increase in venous pressure.

There are also increases in oxidated stress, related to the level of antioxidants in the blood that occurs due to the pooling of blood and increased venous pressures.

Over a prolonged period of time, those factors can lead to an increased risk of cardiovascular disease.

The study’s results are consistent with what the Canadian Centre for Occupational Health and Safety (CCOHS) has been saying, but takes it to that next step by actually looking at health outcomes, said Jan Chappel, senior technical specialist at CCOHS.

“Traditionally, we’ve said, ‘You’ll get sore feet, your legs will swell, muscle fatigue’ and people notice when they’re tired,” she said.

“If you’re just standing, not walking, but just standing, your blood will pool and you get inflammation in your veins, and now they’re saying you’re twice as likely to get heart disease, so you can see where they would be linked.”

While recently there has been more concern around too much sitting at work, the evidence around the risk factors is pretty weak, said Smith.

And the message that having a sit-stand desk is somehow going to reduce your risk of long-term health conditions has been misinterpreted, he said.

“There isn’t any evidence that standing a little bit more if you’re in a sitting occupation will reduce your risk of long-term health conditions. There’s evidence it’s important around people with chronic back pain; there is some evidence it does increase creativity and productivity, but there isn’t any long-term evidence.”

But there has not been a lot of attention paid to those occupations requiring prolonged standing, he said.

“There hasn’t been, really, any public health messages around people who stand a lot, and providing them with opportunities to sit a lot.”

Potential solutions

For the most part, people standing all day in the workplace don’t really think about the risks, they just do the job — despite sore backs, sore legs and fatigue, according to Chris Watson, senior health and safety representative at United Food and Commercial Workers (UFCW), Local 175 in Cambridge, Ont.

But there are several approaches that could help alleviate the situation, he said, such as ergonomic assessments by employers.

“If they follow through with some of the recommendations… it may help alleviate some of the stress that’s put on the body at that time.”

Job rotations could also help by altering the positions of the body, along with changing the floor surface people are standing on, and ensuring proper footwear is worn, said Watson.

However, some employers aren’t so keen to use ergo mats as they can be a tripping hazard or contain bacteria, he said.

Even initiating an exercise program at the start of the day could help people warm up before their shifts, said Watson.

“It’s got to come from the employer and work its way down.”

Changing culture

But it’s also about changing the culture, changing habits and perceptions. In England, for example, cashiers often have a sit-stand stool, he said.

“That’s an accepted practice over there.”

Both perceptions and the need to always stand in a job need to change, said Smith.

“It is quite a North American phenomenon, this necessity for service occupations to stand… it’s not necessary in a lot of situations and it’s a detriment to people’s health.”

In sales and service occupations, there’s a perception that if people are sitting, they’re bored or disinterested — but that doesn’t have to be the case, according to Smith.

“If we think about prolonged standing as a risk factor, we could easily provide people in service occupations with stools and if we just change the public perception that… just because someone is sitting doesn’t mean they’re not interested in talking with you or not interested in serving you.”

Simple solutions such as chairs, rest breaks or rotations would help, said Smith.

“We’re not saying that people should sit down, we’re saying that certainly being in a prolonged, fixed position in any occupation is probably going to be bad for you, and what we want to try and do is have employers give people the flexibility to be able to get into different body positions that feel comfortable for them throughout the day.”

The solution lies somewhere in-between sitting and standing, and it’s about providing flexibility, said Chappel.

“The employer needs to give (workers) the mechanisms to do that, so you can get away from your work station for 10 minutes an hour and whether it’s go to the bathroom, do some filing, whatever, but get up and walk a bit, instead of just being glued to your station, whether you’re sitting or standing,” she said.

“That very much relates to giving people a little bit of control over what their day is going to be like, what they get done when — those factors go a long way to helping people to at least feel more comfortable at work.”

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