Sitting is the New Smoking

Ryan the authorResearch by Ryan
Updated: July 7, 2019

When you think of something that could threaten your life, you probably don't think about your chair at work. But according to many researchers, it’s one of the biggest potential threats to your health.

Research shows that you can reduce your chances of cancer, type 2 diabetes, cardiovascular disease, and back pain, all with one simple lifestyle change: reduce the time you spend sitting.

"Sitting is more dangerous than smoking, kills more people than HIV, and is more treacherous than parachuting. We are sitting ourselves to death," says James Levine, a professor of medicine at the Mayo Clinic, in an interview with the LA Times. "The chair is out to kill us."

You may have heard the saying, “sitting is the new smoking,” which is credited to Dr. Levine. He’s not the only one who believes that we're sitting ourselves to death. There’s a growing body of research that supports his claim and the benefits of standing desks.

"We weren't designed to sit,” claims Dr. Joan Vernikos, former director of NASA's Life Sciences Division and author of the “Sitting Kills, Moving Heals”. "The body is a perpetual motion machine."

Dr. Levine estimates that, in the US, we spend more than half of our waking hours sitting down, either watching TV, driving, or sitting at a desk at work or at home.

Exercise Doesn’t Negate Extended Periods of Sitting

You may be thinking, “But I work out several times per week.” The research shows that though exercise is good for you, it doesn’t negate the damage done by extended periods of sitting.

Professor Marc Hamilton, Ph.D., from the Pennington Biomedical Research Center, tells Men’s Health, “We see it in people who smoke and people who don’t. We see it in people who are regular exercisers and those who aren’t. Sitting is an independent risk factor.”

He further explains, “The cure for too much sitting isn’t more exercise. Exercise is good, of course, but the average person could never do enough to counteract the effect of hours and hours of chair time.”

As Katy Bowman, a scientist and author of the book: Move Your DNA: Restore Your Health Through Natural Movement, told Reuters: "You can't offset 10 hours of stillness with one hour of exercise."

The reason why is that marathon sitting sessions change your body's metabolism. Gavin Bradley, director of Active Working, an international group aimed at reducing excessive sitting, explains part of the process, “Metabolism slows down 90 percent after 30 minutes of sitting. The enzymes that move the bad fat from your arteries to your muscles, where it can get burned off, slow down. The muscles in your lower body are turned off. And after two hours, good cholesterol drops 20 percent. Just getting up for five minutes is going to get things going again. These things are so simple they’re almost stupid.”

Toni Yancey, a professor of health services at UCLA's Fielding School of Public Health, describes the process: "Sitting shuts down electrical activity in the legs. It makes the body less sensitive to insulin, causes calorie-burning to plummet, and slows the breakdown of dangerous blood fats, lowering 'good' HDL cholesterol."

Sitting and the Increased Chance of Obesity

Dr. Levine actually started his research into the hazards of sitting and the benefits of standing desks because he was trying to figure out why some people seem to gain weight and others don’t. For his study, he put office workers who weren’t exercisers on a 1,000 calorie diet and had them not change their exercise routine. The result: some gained weight, some lost weight.

He then had the participants wear underwear that was lined with sensors that would tell him how much each worker was moving throughout the day. They discovered the missing link: the group that was losing weight was moving around 2.25 more hours per day than the group that put on weight.

You burn on average of 50 calories more per hour by standing. If you stand for 3 hours per day, five days per week, it adds up to 750 calories burned. In a year that adds up to 30,000 calories, which is almost 9 pounds. This is the equivalent of around 10 marathons per year and why Dr. Levine is a huge proponent of standing desks.

Read more about sitting and obesity...

Back, Neck, & Sciatica Pain From Sitting

At Cornell University Department of Ergonomics, researchers found that up to 90% more pressure is applied to your lower back when you sit versus when you stand.

According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, back pain is one of the American’s most common health problems, with 1 out of 4 people experiencing back pain 1 day out of every 3 months.

One of the most common benefits of transitioning to a sit-to-stand desk is the reduction of back and neck pain. If your monitor is lower than eye level, and you look down at your phone countless times per day, you may develop postural kyphosis, where your head tips forward, and your shoulders round forward. Postural kyphosis can cause neck and back pain, as well as fatigue.

Loretta DiPietro, chairman of the Department of Exercise Science at the Milken Institute School of Public Health at George Washington University, has been researching the detrimental effects of excessive sitting. After she stopped sitting for hours per day, she lost weight and no longer gets shooting pains in her legs.

If you have back or neck pain, you sit for hours per day, and you don’t have great posture, this could be the source of your problem.

Read more about back pain and sitting...

Excessive Sitting and Cancer

There are several types of cancer that are believed to be caused by inactivity. Christine Friedenreich, an epidemiologist at Alberta Health Services-Cancer Care in Canada, estimates that 173,000 cases of cancer in the U.S. are due to inactivity, with 49,000 cases of breast cancer and 43,000 cases of colon cancer. The other cancers linked to inactivity are lung cancer (37,200), prostate cancer (30,600 cases), endometrial cancer (12,000 cases), and ovarian cancer (1,800 cases). Each of these could also be related to excessive sitting.

According to Live Science, the underlying mechanism by which sitting increases cancer risk is still unclear, but scientists have found a number of biomarkers, such as a C-reactive protein that is present in higher levels in people who sit for long periods of time.

Read more about Cancer, Increased Mortality, and Excessive Sitting...

Excessive Sitting and Cardiovascular Disease

An interesting study done in 1953, on London bus drivers,  can be found on the University of Minnesota’s History of Cardiovascular Disease Epidemiology website. British researchers compared rates of heart disease in London bus drivers who sat versus the bus conductors who stood. The research found that the drivers who sat all day experienced far more heart attacks and other problems than the group that stood.

Dr. James Levine cited one study that compared adults who spent less than 2 hours a day in front of the TV or other types of screens with those who watched more than 4 hours a day. Those with greater screen time had:

  • A nearly 50 percent increased risk of death from any cause
  • About a 125 percent increased the risk of events associated with cardiovascular diseases, such as chest pain (angina) or heart attack.

Even when the researchers controlled for the amount of exercise, excessive sitters were still 34 percent more likely to develop heart failure than those who were standing or moving.

Dr. Deborah Rohm, a researcher at Kaiser Permanente in Pasadena, California, explains “The risk of heart failure was more than double for men who sat for at least five hours a day outside of work and didn't exercise very much, compared with men who were physically active and sat for less than two hours a day.”

Another study from the University of South Carolina's Arnold School of Public Health in 2010, showed that men who reported more than 23 hours a week of sedentary activity had a 64 percent greater risk of dying from heart disease compared to those who reported less than 11 hours per week.

Read more about sitting and increased rates of cardiovascular disease...

Sitting and Increased Rates of Type 2 Diabetes

Olivia Judson, an evolutionary biologist and research fellow in biology at Imperial College London, explains in her New York Times article: “Men who normally walk a lot (about 10,000 steps per day, as measured by a pedometer) were asked to cut back (to about 1,350 steps per day) for two weeks, by using elevators instead of stairs, driving to work instead of walking, and so on. By the end of the two weeks, all of them had become worse at metabolizing sugars and fats. Their distribution of body fat had also altered — they had become fatter around the middle. Such changes are among the first steps on the road to diabetes.”

The Cancer Prevention Research Centre at the University of Queensland in Brisbane, Australia, published a study in 2008 that concluded that people who took the most breaks from sitting had a reduced triglyceride count (as well as smaller waists and a lower body mass index). A higher triglyceride count is associated with an increased risk of diabetes.

Several studies, including one published in the National Institute of Health, correlate extended periods of sitting with a reduced ability to regulate glucose in the bloodstream, a condition known as metabolic syndrome, which dramatically increases your chances of type 2 diabetes. A 2013 study concluded that the amount of time sitting was a more important factor than the amount of time exercising.

The American Diabetes Association published a study regarding the risks of sitting time, and television viewing time, and their effect on the heart and metabolic risks. The results:

“For both women and men, sitting time was detrimentally associated with waist circumference, BMI, systolic blood pressure, fasting triglycerides, HDL cholesterol, 2-h post-load plasma glucose, and fasting insulin (all P < 0.05), but not with fasting plasma glucose and diastolic blood pressure (men only). With the exception of HDL cholesterol and systolic blood pressure in women, the associations remained significant after further adjustment for waist circumference. TV viewing time was detrimentally associated with all metabolic measures in women and all except HDL cholesterol and blood pressure in men. Only fasting insulin and glucose (men only) remained deleteriously associated with TV viewing time after adjustment for waist circumference.”

Read more about sitting and diabetes...

Excessive Sitting Shortens Your Lifespan

A 2010 Australian study found that for each extra hour participants spent sitting daily during a 7 year period, their overall risk of dying increased by 11 percent. A 2012 study found that if the average American reduced their sitting time to 3 hours per day, life expectancy would climb by two years.

Researchers in Australia found that adults who sat 11 hours or more a day had a 40 percent increased risk of dying during the next 3 years, compared to those who sat for less than 4 hours a day (and they took into account the exercise levels and health of the participants).

Researchers from the American Cancer Society discovered that women who sat more than 6 hours a day were at a 37 percent increased risk of early death, compared to women who sat less than 3 hours. Men had a 17 percent increased risk (even among those who exercise).

Read more about increased mortality and sitting desks...

Transitioning to a Sit to Standing Desk

If you’re looking to start using an adjustable sit-to-standing desk, you’re not alone. Thomas Jefferson, Ben Franklin, Ernest Hemingway, Leonardo DaVinci, and Winston Churchill (who lived to be 90 years old) all stood at their desks. More than 90 percent of workers in Scandinavia have access to them, and more and more employers are giving their employees the option to stand. The National Institutes of Health, the United Nations Secretariat, the Federal Reserve Bank, and many other corporations use standing desks. If you're interested in getting a standing desk I created this guide summarizing everything you need to know about buying one. My top pick is still the Jarvis available on Amazon.

If you’re used to sitting for hours per day, it’s not a good idea to start standing all day. Studies have shown that standing can cause minor issues as well (though not nearly as pernicious as sitting). You need to give your body time to adjust to your new habit, especially if you’re a mostly sedentary person.

Dan Kois jumped head first into the standing desk revolution by standing for a month straight! He details his challenges in a great article for New York Magazine: cramps in his heels, hips, and calves; watching movies with his wife standing up, eating at restaurants standing up, his sore back, and even watching a movie in a movie theater standing up! His conclusion: “My month has been an ordeal, but it’s clearly succeeded. I’ve lost almost five pounds and gained muscle in my legs, especially my calves. I’ve cut my time-wasting drastically, editing and writing more than in any month I can remember. I’ve walked 92.5 miles, basically without trying.”

Don’t do what Dan Kois did. Take your time and find what works for you.

Some professionals do certain work better standing, and other work sitting. According to UCLA Ergonomics, sitting is preferable when “visually intensive or precise work is required.” They recommend standing for these situations:

  • your job requires you to move your arms where your elbows are away from your body.
  • you’re working with objects greater than 6 inches high
  • you can’t reach your work area comfortably when seated
  • you work in more than one workspace to perform job duties and must move around frequently
  • dealing with heavy objects weighing more than 10 pounds, or when you need to have a strong grip on an object. In general, more strength can be exerted while standing (Mital & Faard, 1990).
  • when you need to maximize your grip (Catovic, Catovic, Kraljevic & Muftic, 1991), or complete static or dynamic lifts (Yates, & Karwowksi, 1992).
  • the surface you’re working on doesn’t allow you to put your legs underneath
  • your job requires frequent application of downward pressures (such as loading bags or inserting screws).

The general rule is that the heavier the weight you’re lifting, and the further the weight is away from your body, the more pressure you're putting on your back. Also, leaning forward tends to cause you to use bad posture (unless you’ve been trained on how to move properly).

Remember that one of the greatest benefits of standing desks, and standing, is the act of standing --- the key is to keep moving. Every time you stand, you’re using large muscles, especially those of your legs and back, which has a positive effect on how the body uses and stores sugars and fats.

Dr. Joan Vernikos explains, “Every time you stand up, the body initiates a shift in fluids, volume, and hormones, and causes muscles to contract. And almost every nerve in the body is stimulated."

Ken Tameling, an ergonomic seating expert at the furniture company Steelcase, explains in a U.S. News & World Report article, “It doesn’t matter if you’re standing or sitting if you’re doing it statically, your body wasn’t designed that way. You need to move.”

He goes on, “Even if you just fidget, any kind of micro-movement is going to give you some value,” Tameling says. “The worst thing you can do is sit in one posture – basically what you want to do is ignore your first-grade teacher.”

Many experts recommend that the best way to start is to set an alert on your phone or computer to remind you to stand up every 20 minutes, even if it’s just for a few minutes. Gradually extend your periods of standing, and increase your frequency of taking short walks. Many standing desk users will stand or walk every time they have to make a phone call.

If you can start standing at your desk and moving around 2 hours per day in the beginning, you’re off to a great start. Professor John P. Buckley, from the Institute of Medicine at the University of Chester in England, recommends that the goal is to spend half of your work day standing and moving (referred to as “light-intensity activities.”)

If you’re getting too tired or sore, you may want to stretch a few times a day or reduce your standing time by a little bit.

David Dunstan, associate professor at the Baker IDI Heart and Diabetes Institute in Melbourne, Australia, says that "The frequency of physical movement is the most important consideration, not the intensity of the movement." So you don’t need to do Crossfit while standing at your desk, just make sure you’re not sitting for more than 20 minutes at a time.

New users of standing desks are often surprised to find that they have more energy, their mood improves, and they no longer have an afternoon slump. They often report increased productivity. Many standers are constantly shifting, even dancing and doing yoga!

What’s the Ideal Ratio for Standing to Sitting at Your Desk?

Mark Lukach, of, advises the following: “We recommend moderation with your standing. My uber-healthy sister is about an 85:15 ratio of standing to sitting, and Shane Harris from Washingtonian Magazine is at a similar ratio. Gina Trapini, formerly of LifeHacker is more like 70:30. Find your own workable ratio.”

Tips for Using a Sit to Standing Desk

Some standing desk users push themselves too hard and force themselves to stand more than they’re comfortable They eventually stop standing. Very commonly they don’t use an anti-fatigue mat. Though not necessary, an anti-fatigue mat will reduce the pressure on your legs and back. If you’re working with a budget, you can start without one, or come up with a temporary solution, such as standing on a folded up yoga mat.


Loretta DiPietro, Chairman of the Exercise Science Department at George Washington University, uses memory foam flip-flops for comfort while standing.

If you wear orthotics, you’ll definitely want to use them while standing (if you don’t you’ll feel the difference). If you don’t wear orthotics, make sure you have comfortable shoes.

And for women, don’t wear heels while standing for extended periods, wear flats (many chiropractors advise women to not wear high heels at all). Your feet are the foundation of your body and significantly influence your posture. With high heels, your Achilles gets shortened, and you put extra stress on your lower back.


In his article about his 30-day standing experiment, Dan Kois explains  “Dr. Jack Callaghan of the University of Waterloo tells me that in his research on standing and back pain, the primary difference he sees between “pain developers” and “non–pain developers” is posture.”

If you’re like most people, you slouch. You’re probably looking down at your phone several times per day. At work, you’re looking down at a screen. Try to keep your chest out and shoulders back, and pull your chin back so your head is centered over your shoulders while sitting and standing. Develop the habit of squeezing your shoulder blades together several times per day to train yourself not to slouch.

Read more about proper posture when sitting...

Laptops & Back Pain

Many experts recommend making modifications for laptop use. The first issue is that to see the screen, you have to look down. When you look down, you tend to slouch forward. With your head weighing on average around 10 lbs, even a slight tip forward will strain your muscles in your neck and upper back. Your screen is supposed to be eye level. Most standing desks will have space for you to put your laptop at eye level, but typing will be difficult, so you can get a keyboard that you can place at a comfortable position to type.

Read more about how to prevent back pain...


The further your elbows are away from your body, the more tension there's going to be on your back. Ideally, your keyboard will be at or even a little below your hips, with your hands on a downward angle. This will put less strain on your wrists.

Creative Ideas

There are lots of things you can do while standing to burn even more calories and make standing more comfortable:

  • Squats --- you can do small squats if you don’t want to call attention to yourself, or squat on one leg. Your quadriceps are the largest muscles in your body and will burn a lot of calories if you give them extra work.
  • Leg lifts --- straight leg lifts to the front, sides, and back will strengthen your quads, glutes, and hips, which will burn calories and help support good posture.
  • Foot massage mat --- these usually have some kind of rough surface to massage your feet while you’re standing.
  • A golf ball or ball for feet massage --- you won’t necessarily stand on these, but it will feel great on your feet and will keep you moving. These will be a little less noticeable than a massage mat.
  • Put a towel on the ground and use your toes to scrunch the towel up. This will strengthen your feet, which can be really helpful in developing good posture and reducing fatigue in your feet.
  • An overturned garbage can --- you can use this brace your weight on to shift your weight and stretch.
  • Instead of sitting on a chair, sit on a physio-ball. This way even while you’re sitting, you’re using your core muscles, and your posture will probably be better than if you were sitting on a normal chair.

    How to Develop a Movement-Based Lifestyle

    If you start using a sit-stand desk, remember that this is just one part of a lifestyle that will keep you healthy. "The goal is to minimize sitting, especially continuous sitting, and follow a regular exercise program," says Timothy Church, a researcher at the Pennington Biomedical Research Center.

    When you’re at work, there are a lot of things you can do to keep moving:

    • Drink a lot of water. Besides being a good habit, it will make you get up and walk to the bathroom often. And use a bathroom that’s further away if possible.
    • Go to a colleague's desk if you have a question as opposed to sending them an email.
    • Have walking meetings.
    • Set an alarm on your phone or computer to stand or move every 20 minutes.
    • Park further from the entrance.
    • If you take public transportation, get off one stop early and walk further.
    • Take the stairs instead of the elevator.

    Read more about how to add more movement to your day...

    Why Employers Should Consider Standing Desks

    The American Medical Association, in June of 2013, issued the following statement:

    “Today, the AMA adopted a policy recognizing potential risks of prolonged sitting and encouraging employers, employees, and others to make available alternatives to sitting, such as standing workstations and isometric balls.”

    “Prolonged sitting, particularly in work settings, can cause health problems and encouraging workplaces to offer employees alternatives to sitting all day will help to create a healthier workforce,” said Dr. Harris.

    One notable study was published by the Center for Disease Control, in an article entitled Reducing Occupational Sitting Time and Improving Worker Health: The Take-a-Stand Project, 2011. Results showed that 87% of the study participants felt more comfortable, 87% felt energized, 75% felt healthier, 71% felt more focused, 66% felt more productive, 62% felt happier, and 33% felt less stressed as a result of having the sit-stand device installed at their workstations.

    Dr. James Levine helps companies reduce their healthcare costs. He explains, "For every person, we help prevent get diabetes, we save the company $10,000 per year ... every year.”

    According to an article in U.S. News & World Report, After Replacements Ltd., a retailer in Greensboro, N.C., introduced regular activity breaks into employees' daily schedules several years ago. They found that morale went up and complaints of musculo­skeletal disorders went down among those who participated.

    Not all employers allow standing, and some require a doctor’s note for an employee to have permission. Even at offices that are open to the shift, employees are often expected to pay for their standing desk.

    Some experts predict that eventually companies will be fined if they don’t give employees the option of a standing desk. If you're a company looking to invest in standing desks, check out our standing desk recommendations for businesses

    Sit to Stand Desks for Children

    There’s some evidence that giving children the option of standing reduces obesity, and can positively affect their grades and mood.

    According to the US Library of Medicine, children spend an average of 6 hours in front of a screen. Combine that with the fact that many children don’t walk to and from school, standing during the day will help them ward off obesity by burning extra calories. Additionally, children with any degree of ADHD are allowed to fidget, which may improve their focus and behavior.

    In a CNBC article “Why your chair might be killing you?” Dr. Levine referred to studies run in Sweden, Germany, and the U.S. which found "on average, kid's grades improve 10-15 percent against (average) equivalent child equivalents".

    Read more about standing desks for children...

    Should You Use a Standing Desk or a Sit to Stand Desk?

    The first important distinction is that there are standing desks, and there are sit-to-stand desks. With a standing desk, you don’t have the option of sitting, which isn’t preferable. The healthiest option, though more expensive, is the sit-to-stand desks, or an adjustable standing desk. With a sit-to-stand desk, you have the option of slowly transitioning to more standing. If standing makes you tired, you can reduce that by alternating between sitting and standing. And as far as health benefits are concerned, the greatest benefits of having a sit-stand desk is that you avoid extended periods of unhealthy sitting and that you’re moving. Moving is what prevents all of the negative outcomes from sitting.

    If you’re thinking about transitioning to a standing desk for 100% of your work time, read the article by Dan Kios, in New York Magazine. Then read Gwynn Guilford’s article, “There’s a huge hidden downside to standing desks that no one told me about.” If you buy a standing only desk, and you don’t like standing all day, you've wasted your money. If you buy an adjustable sit-to-stand desk, and you don’t like standing very much, you can still use the desk primarily for sitting.

    Convert Your Existing Desk to a Standing Desk

    There are 2 main options, the first being do-it-yourself. This option may not look great, but it will save you money. And it won’t be as convenient as you’ll need to move your keyboard or laptop from high to low every time you switch. Depending on your setup, this might not be a big deal. But if you have a lot of cords, a heavy monitor, and not a lot of room to move your things, it will keep you from switching. And to make your setup look a little better, you can cover the books or box with a sheet.

    Converting your desk to give yourself a standing option is as simple as placing a small table, chair, box, or even a stack of books on your desk to rest your monitor. Remember to get your monitor to eye level, and make sure that whatever you put on your desk is stable. If your keyboard isn’t at hip level, you can use another box, small table, or stack of books to get it to a comfortable typing position. If you’re having to reach up to type, it’s going to make your arms very tired, and that isn’t good for your back.

    If you have a laptop, the cheapest option is to attach a keyboard to your laptop so you’re looking at the laptop screen, and typing on the keyboard below. If you prefer to type on your laptop, and you have an extra monitor, you can attach it to your laptop. Otherwise, you'll have to buy a monitor, which will cost you a lot more than buying a keyboard.

    The second option is to purchase a standing desk converter that sits on top of your existing desk. If you’re searching online, most of what you’ll find is labeled as a standing desk, whether it’s a sit-to-stand desk, a standing desk that’s only for standing, or a desk that sits on top of your desk to convert your desk. The only way is to read the descriptions and look at the pictures.

    Adjustable Sit-to-Stand Desks

    Though generally more expensive, sit-to-stand desks, or adjustable standing desks, will look better than creating your own, (unless you’re a carpenter or really handy) and are generally more convenient.

    One of the biggest considerations in buying a sit-to-stand desk is how it transitions from high to low. The most convenient, and most expensive, is to have a mechanized desk that will switch positions by pressing a button. These often have memory settings so you don’t have to adjust it each time you move.

    Other sit-to-stand desks have to be manually adjusted. Read reviews extensively to see what will work best for you. Some desks are cumbersome to switch, taking several minutes each time. You don’t want to spend a lot of time switching --- it will discourage you from switching, and if you switch a lot, it can eat up a lot of time throughout your day.

    Treadmill and Exercise Bike Desks

    Some people are big fans of these options, but you’ll need a regular desk, or a sit-to-stand desk as well. Some users claim to think more clearly while walking or riding a bike.

    Dr. Levine has estimated that users burn 100-130 calories per hour on a treadmill desk by walking less than 2 miles per hour (which will prevent you from sweating). In a Mayo Clinic 12 month study, users lost 5 to 7.7 lbs.

    For more information, check out our Beginner's Guide to Treadmill Desks.




      1. Thanks for the kind words Jonathan! We’d love to be able to help your patients with our resources. I’m going to email you privately so that we can discuss things further.

      1. Hi Chan, thanks for pointing out an issue on this page. We recently encountered a bug and are working on a fix.

    1. thanks! this’ll be in my rrl (ofc i won’t forget citations to avoid plagiarism)

    2. I read all the information and it was very helpful. I will be improving in my movement and try to do better with my life style changes. Thanks again

    3. Good article. Would like to share with my kids who sit endlessly looking at their phone.

    4. Hey,

      Really great website with a lot of inspiring ideas!
      I am working as an anesthesist an we are sitting quite a lot during surgery. I would really like to introduce a standing workspace at my hospital. Do you know any publications concerning standing at the anesthesia workspace?

      Thank you very much for your help


      1. Hi Friedemann, that’s a great idea! However, we aren’t aware of any studies or publications talking about that use-case. Thanks!

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