Uplifting Workspaces: A Brief Review of Sit-to-Stand Workstations Among Different Occupations

Abstract

Adults, on average, spend between 55% and 70% of their waking hours primarily in prolonged sitting, and such sedentary behavior has been associated with several health problems. Prolonged sitting postures during work hours are often mandated by the nature of the work task performed. Sit-to-stand workstations offer the benefit of transitioning from and between sitting to standing postures. However, most of the literature on sit-to-stand workstations is focused on generalized office workers, but different occupations have a whole different set of work-specific tasks that can inhibit the appropriate use of sit-to-stand workstations. Therefore, this narrative review aims to summarize various occupations that utilize or can utilize sit-to-stand workstations, including their nature of work tasks, the associated needs, benefits, pitfalls, and recommendations for improved workplace ergonomics. This narrative review summarizes important but less researched occupations such as emergency dispatchers, architects, customer support representatives, general practitioners, engineers, pharmacists, and laboratory research scientists, along with generalized office workers. The review will be of benefit to different health care professionals, work safety and ergonomic professionals, and individuals in each of the occupations discussed to better understand sit-to-stand workstations and their use to promote health and safety in the workplace.

1. Introduction

Sedentary behavior, which includes prolonged sitting in static postures, has been associated with several health risks. A major contributing factor that leads to sedentary behavior is the occupational demands to successfully complete work tasks by maintaining a static posture, such as sitting on a chair at a desk, for a prolonged period, as with office workers. One of the ways to avoid such sedentary behavior is to move out of the assumed static posture, or change postures, with an increased frequency throughout the workday [1]. Such adjustments could be made within the sitting posture, such as moving from a slouched sitting posture to an erect sitting posture, or transitioning between static postures, such as from sitting to standing [1]. An ergonomic solution for transitioning from sitting to standing postures, and repeating in periodic sequences, all while being able to complete the occupation-mandated work tasks, is through sit-to-stand workstations. There are several research studies, along with many systematic reviews, that provide evidence towards the benefits of using sit-to-stand workstations as an intervention, justified by different outcome measures such as an increase in worker productivity, decrease in health risks, decrease in body discomfort, specifically of the upper and lower extremities and lower back, minimizing work-related musculoskeletal disorders, minimizing sedentary behavior, all while not negatively affecting occupational work tasks and performance [1,2]. A scoping review on the effects of sit-to-stand workstations identified significant impacts on behavioral, physiological, work performance, psychological, subjective discomfort, and postural changes, leading to effective behavioral modifications, reduced body discomfort, with mild effects on health outcomes [3].

While extensive reviews of past research with systematic and scoping reviews already exist, these reviews predominantly focus on the effectiveness of the sit-to-stand workstation as an intervention, with emphasis on use, adoption, dosage, continued and correct use, along with ergonomics training and counseling. While these factors are all critical in workplace health and safety, there has been less focus on the specificity of the occupation and its associated work tasks, as different occupations have different sets of work-specific tasks that can inhibit the appropriate use of sit-to-stand workstations. Additionally, with more sit-to-stand workstation research focusing on generalized office workers, this narrative review attempts to summarize different occupations that use or can use sit-to-stand workstations, their nature of the work task, the need, the benefits, the pitfalls, along with recommendations for better workplace ergonomics. A systematic review of such topics was not feasible, as current literature on the targeted, less researched occupations either is minimal or not well documented, or currently does not exist. Hence, this narrative review summarizes important but less researched occupations such as emergency dispatchers, customer support representatives, architects, engineers, general practitioners, pharmacists, laboratory research scientists, and generalized office workers, along with the selection process of these occupations. The review will be of benefit to different health care professionals, work safety and ergonomic professionals, as well as to individuals in each of the occupations discussed, to better understand sit-to-stand workstations and their use to promote health and safety in the workplace.

2. Health Problems from Sedentary Behavior

Sedentary behavior has been defined as the extended period of sitting, characterized by an energy expenditure of less than or equal to 1.5 metabolic equivalents (METS) [4,5]. Adults, on average, spend more than half of their waking hours primarily in prolonged sitting. Recent evidence supports a relationship between too much prolonged sitting and increased risk of type 2 diabetes, cardiovascular disease, other chronic health problems, and obesity [6,7]. Low back pain or upper back pain was significantly associated with sedentary office workers [8]. There is increasing evidence that sedentary behavior has negative effects on cardiometabolic health [9]. Prolonged sitting promotes deconditioning that may result in a worker’s inability to perform physical tasks [10]. Prolonged sitting is associated with low back pain, knee pain, arthritis, and general musculoskeletal pain. The workplace was associated with neck and shoulder pain and low back pain. The meta-analysis of 79 studies reported a positive association of sedentary office workers with self-reported risk of low back pain and neck/shoulder pain. Neck/shoulder pain increases were associated with greater than 4 h of computer time [11]. Even pulmonary function measured values were significantly different before sitting and after one hour of sitting [12].

Due to the increased health risks associated with sedentary behavior, the most recent World Health Organization (WHO) guidelines, for the first time, addressed this health impact and provided recommendations [13]. They defined sedentary behavior as “any waking behavior characterized by an energy expenditure of 1.5 METs or lower while sitting, reclining, or lying” and noted that most desk-based office work presented sedentary behaviors. The WHO recommended that all adults should limit the amount of time spent sedentary and stated that some physical activity is better than none. Additionally, the guidelines operationalized sedentary behavior to include “self-reported low movement sitting (leisure time, occupational and total), TV viewing or screen time and low levels of movement measured by devices that assess movement or posture” which by definition could expand the risks to occupations that are not considered desk-based office work. Additionally, two other concepts of such occupational postures need to be clarified in the context of sedentary behavior in occupations, which include extra-occupational sedentary behavior, which is defined as prolonged periods of sitting or lying down during a person’s non-working or leisure hours, and prolonged maintenance of static postures beyond sitting or standing, which includes occupation-demanding awkward postures. However, the scope of this review is limited to occupational sedentary behavior that includes predominantly prolonged sitting, and occasionally prolonged standing, and the use of sit-to-stand workstations to combat this sedentary behavior health problem.

3. Health Benefits of Rest Breaks and Standing from Prolonged Sedentary Behavior

The vast majority of healthy adults, ages 18–65, worldwide spend 50–75% of their waking time in sitting positions [14]. Desk workers spend a significant amount of time in the sitting position (ranging from 65% to 82% of their waking hours, depending on the study) [15,16]. Although insufficient evidence to provide recommendations on the frequency and/or duration of breaks from sedentary behavior is available [13], the health benefits of breaks from prolonged sitting are well documented. Productivity, comfort, and physiological measures are important outcomes to assess the efficacy of sit-to-stand workstations [17].

One approach to prevent or help manage many chronic diseases is to participate in regular exercise [18]. The risk of contracting chronic diseases of type 2 diabetes, cardiovascular disease, and breast and colon cancer is reduced with regular exercise [18]. There is a significant reduction in all-risk mortality for individuals who exercise as compared to individuals who are sedentary [19]. Even with prolonged sitting, evidence shows that taking breaks has been correlated with “lower health risk related to waist circumference, body mass index, triglyceride levels, and 2 h plasma glucose levels. Regular, short, standing breaks reduce the incidence of low back pain in office workers [20]. Light intensity walking breaks decreased fatigue in office workers [21]. Regular activity breaks increased blood flow, shear stress, and improvements in postprandial metabolism [22]. Taking standing breaks during prolonged sitting attenuates postprandial glucose compared to sitting, but light intensity walking was a superior activity break [9]. In addition, cardiovascular and cerebrovascular risk reduction could potentially be achieved with long-term reduction in sedentary behavior by improved peripheral vascular function and cerebral blood flow [23]. However, determining the best frequency/duration of these sedentary breaks to increase the potential health benefits remains an area for further research [14].

4. Sit-to-Stand Workstations

As evidence exposing the risks of sedentary behavior increased, the ergonomic industry produced a sit-to-stand workstation that could modify the workplace to reduce prolonged sitting by the user, alternating between positions during the workday. Just as the words describe, a sit-to-stand workstation is a height-adjustable desk that can be adjusted for sitting and moved to standing. A sit-to-stand workstation has been defined as a workstation that allows a worker to perform the same task from either a seated or standing position with a self-adjustable worksurface height (Figure 1). Primarily, the sit–stand work paradigm has consisted of a worker performing their duties while periodically alternating between sitting and standing positions throughout the day [1,24]. Over time, some have proposed definitions for ‘active’ and ‘passive’ standing, with corresponding METs of >2.0 METs and ≤2.0 METs, respectively [25], and have included complementary interventions for longer extensions of time, up to 18 months [26]. Sit-to-stand workstations enable mobility for the employees. The station functions with all the features of a seated-height desk when the user is utilizing a chair. However, it is engineered to be raised, electrically or manually, to a standing position to allow the worker to perform desk work with correct ergonomic positioning for the use of the upper body to complete work while standing.

Sit-to-stand workstation protocols have varied as interventions. For example, one standing schedule entailed the use of the Ergotron Workfit S for four weeks for all workdays (3 to 5 workdays per week, depending on full-time or part-time employment status) after a brief training on the unit and an ergonomic self-assessment prior to use [27]. Others have based the sit-to-stand workstation unit on a more formal ergonomic evaluation prior to participant use and used various adjustable units such as the Workfit-S^®, a setup that attaches to the front of one’s existing desk that can hold a computer monitor, keyboard, and mouse; Workfit-A^®, a setup that is identical to Workfit-S^® but attaches to the back of one’s existing desk; or Workfit-D^®, a whole desk that is easily moved up and down [28]. Alternatives to sit-to-stand workstations to reduce sedentary behavior have included other active workstations, such as treadmill workstations and bicycle workstations, although less data is available for evaluating the efficacy of treadmill and bicycle workstations [17]. Likewise, active workstations may be less suitable for mouse-intensive occupations than sit-to-stand workstations [29]. Multicomponent interventions that contained a more comprehensive combination of diverse modalities to reduce prolonged sitting, such as coaching, promotion, education, and environmental modification, have been found to be most effective; however, sit-to-stand workstations alone were found in a recent network meta-analysis of 23 randomized control trials to effectively reduce work-specific sedentary time compared to typical desks [30].

5. Selected Specific Occupations

The purpose of this section, and essentially the focus of this paper, is to provide the readers with a brief narrative review of the need, use, benefits, pitfalls, and recommendations for sit-to-stand workstations in different occupations. Some occupations are commonly and automatically identified as ideal for sit-to-stand workstation use, such as computer software professionals and office workers, and have been well researched and documented. However, other occupations, such as emergency dispatchers or professional gamers, are not often immediately thought of as an ideal population for sit-to-stand workstation use, but have similar health problems due to occupation-mandated sedentary lifestyles. The process of selecting these specific occupations below involved a search for literature on databases such as PubMed, EBSCO, and Google Scholar with specific prompts. The occupations were narrowed down by searching for “prolonged sitting” and “prolonged sedentary”, which identified a set of occupations, and then separately searched for “sit-to-stand workstations” and “standing desks” and removed the commonly researched occupations (example: computer software professionals). Hence, this paper explores both the commonly identified and less commonly identified occupations that use sit-to-stand workstations and provides recommendations for adoption and correct use.

5.1. Emergency Dispatchers

Emergency dispatchers or public safety telecommunicators, as defined by the United States (US) Bureau of Labor Statistics (BLS), serve as the first point of contact between civilians who need or require emergency and non-emergency services and the emergency responders that include law enforcement, firefighting, and emergency medical services (EMS). They receive emergency and non-emergency calls and other forms of alerts such as alarm systems and text messages, and are responsible for assessing and prioritizing the emergency, providing instructions until emergency personnel arrive at the scene and coordinating responses with different emergency units and communication centers. The dispatchers have an extremely critical job along with it being a very high stress job, as they handle life-threatening situations but with limited control over the actual emergency situation, subsequently having a greater risk of developing post-traumatic stress disorder (PTSD), even in the absence of a physically traumatic event [31]. The dispatcher’s work environment is usually in emergency communication centers called public safety answering points (PSAPs), and their work schedule includes shift work in the mornings, evenings, nights, weekends, and holidays to make sure there is 24/7 coverage [32]. The work posture commonly adopted among emergency dispatchers is a seated position on a chair with table with multiple screens along with a predominant use of hands-free devices for calling. They also have little opportunity to move away from their workstations due to the nature of the job. The dimensions of the work table and chair as well as screen size (large screens vs. computer monitors), screen number (multiple vs. few), screen orientation (horizontal vs. vertical) and screen arrangement (side-by-side vs. top-to-bottom), can all be designed and adopted for their optimal work posture, the seated position, especially for long durations of the work shift, still persists and leads to all the problems associated with chronic sedentary behavior in the workplace.

For all the reasons discussed, sedentary behavior among emergency call dispatchers tends to be one of the major problems that can lead to a multitude of different acute and chronic health problems associated with prolonged sitting. The literature on ergonomics of emergency dispatchers is limited. However, a similar comparison, but without any of the occupational threats and stress of an emergency call dispatcher, can be made to employees at centers, in which the majority of the operators have been identified to be in a seated position for an alarmingly high 80–90% of their work shift [33,34]. Subsequently, ergonomic interventions that focus on attempts to increase standing, increase rest periods, and increase physical activity-based interventions are critical for emergency dispatchers. Thus, a relatively simple modification of this sedentary workplace is the adoption of sit-to-stand workstations. In a previous work among emergency dispatchers, the use of a commonly adopted manually adjusted electrically controlled sit-to-stand workstation was compared to a programmable workstation that automatically changed between seated and standing heights, made positional forward and backward adjustments, and rotated in 20 min automatic cycles. The programmable workstation was identified to improve posture, significantly lower incidence of at-risk posture in the neck and the back and increase frequent standing, over the manually adjusted workstation [35]. With the lack of research on emergency dispatchers and ergonomics, more recently, a study protocol was published to assess the use of a sit-to-stand desk and a cycle ergometer on sedentary behavior, highlighting the importance of such sit-to-stand interventions among emergency dispatchers [36].

A sit-to-stand workstation is one of the effective interventions to combat sedentary behavior among emergency dispatchers. Given the nature of the high stress job with constant increased mental/cognitive workload, and less opportunity to move away from the work desk, automated and programmable sit-to-stand workstations appear to be the choice for recommendation, that allows these employees to focus on the work and not on remembering when to stand or move in regular intervals, as specifically supported [35]. However, the recommendations for the adoption and continued correct use of sit-to-stand workstations has to be rooted in proper instruction and user training, as programmable workstations, even though it improved posture, did cause an increase in perception of pain and general discomfort which can be attributed to the instruction and correct use [35] further emphasizing the need for proper education and support for the employees [37]. Additionally, even with existing sit-to-stand workstations for emergency dispatchers, the unrelenting stress and challenging nature of the job appear to overshadow the sit-to-stand workstation benefits, as unlike other sit-to-stand office workers, musculoskeletal complaints are less identified by the emergency dispatchers, compared to their complaints of sleep and stress [37]. Based on these findings, a sit-to-stand workstation alone may not be sufficient to combat sedentary behavior among emergency dispatchers but can be an effective intervention when combined with proper instruction for use.

5.2. Architects

Architects, as defined by the United States BLS, plan and design houses, factories, office buildings, and other structures in both public and private sectors, both indoors and outdoors. They can be commissioned for anything from a single room to an entire building complex. Their job duties can entail many responsibilities, including meeting with clients to understand their needs, creating estimates on cost and construction time, preparing structure specifications, producing scaled drawings, preparing contract documents, and visiting worksites. Their plans show the building’s appearance and include drawings of the structural system, air-conditioning, heating, electrical systems, communication systems, and plumbing, all while following state and local building codes, zoning laws, fire regulations, and other ordinances. Architects often use computer-aided design and drafting (CADD) and building information modeling (BIM) software to produce accurate and efficient designs. However, hand-drawing skills are still needed, especially during the conceptual stages of a project or when the architect is on the job site. Most architects work full-time standard business hours, typically over 8 h on weekdays, but many architects work additional hours when facing important deadlines [38]. An architect’s typical workstation may have some flexibility with regard to the number, size, and orientation of the monitors to meet user preferences. They typically have multiple screens on a large desk with a tiltable drafting table for hand renderings while seated, potentially for extended periods, contributing to numerous health issues associated with chronic sedentary behavior in the workplace. While architects will spend a portion of their time in a standing position while visiting worksites, they will inherently have to spend additional time in a seated position during travel to these locations, adding to the already heavily biased sedentary time while in the office.

Given the factors discussed, prolonged sedentary behavior poses significant health risks, including risk of type II diabetes, metabolic syndrome, cancer, obesity, and all-cause cardiovascular disease mortality [39]. There is limited research focused solely on architects using sit-to-stand workstations. However, there is substantial evidence for their use to reduce sitting time in office workers and the adverse outcomes associated with prolonged sedentary behavior. Australian office workers were shown to spend between 66 and 82% of their working day being sedentary [40], confirming that the workplace is a highly suitable place to intervene to reduce overall sitting time [41]. Therefore, a simple solution to disrupt this sedentary behavior without impacting productivity is implementing sit-to-stand desks at their workstations [42]. However, architects may still prefer to perform their renderings while in a more stable, seated position, which may limit how often they use the standing function. While there has not been sufficient evidence to suggest that overall productivity increases, incorporating standing-capable desks leaves its users significantly more relaxed, calmer, more energetic, less tired, less sluggish, and has a higher overall sense of well-being [28]. Previous work among office workers using manually adjusted electrically controlled sit-to-stand workstations with a default software setting for the frequency of the reminders set to 30 min sitting and 20 min standing resulted in a doubling of position changes in the workstation and a 76% reduction in workers who never used the sit-to-stand function of the desk [43]. Therefore, using computer-based behavioral intervention can be an effective strategy to increase the frequency of position changes when using a sit-to-stand desk.

Sit-to-stand workstations are an effective option to reduce sedentary behavior among architects while working in an office. Given the nature of the job requiring increased attention to detail for work projects, computer-based software reminders allow the employee to focus on work tasks rather than divert attention away in an attempt to remember to change positions at regular intervals. The ratio of sit-to-stand time can vary based on individual tolerance, as one can experience increased fatigue in the lower back and lower extremities upon initial use, but it resolves for most within two weeks when used as instructed [28]. Architects who prefer to complete renderings of projects while in a seated position should either plan to complete these tasks when the window for sitting comes around or adjust the software settings to include seated time in the timeframe that fits their schedule better, while still allowing for regular positional changes. An educational session on proper use should ensure that good ergonomic positioning is followed for effective outcomes and to reduce the likelihood of musculoskeletal strain [27].

5.3. Customer Service Representatives

Customer Service Representatives (CSRs) at business process outsourcing (BPO) centers answer questions or requests from customers or the public, typically by phone, but some also interact by email or text, via live chat, and through social media. They work with customers to resolve complaints, process orders, and provide information about an organization’s products and services. Those who work in call centers, specifically, communicate via phone and use computers to explore solutions for customers. They typically work in large rooms alongside other employees with individual workstations. The workstation commonly adopted among CSRs is a seated position on a chair with a table, at least one computer monitor, and the predominant use of a hands-free device for calling. CSRs often need to work during busy times, which may include evenings, weekends, holidays, and nightshifts for international call centers due to the need for 24 h service to fulfill international calls. Offshoring allows corporations to farm out peripheral and repetitive tasks to contracted international labor. The work is repetitive, routine, highly pressurized, and carefully monitored, with limited call handling time and breaks, leaving minimal interaction between employees. The employees must endure monotonous work, respond quickly to orders, and withstand customer-induced stress [44]. Due to the high work pressure, the employees, at times, must work nonstop with minimal breaks between calls. By eliminating ‘idle time,’ nominal working hours remain the same, but real working hours are lengthened. In a day, they can handle around two hundred calls, lasting between one and five minutes, with only five to ten seconds between calls, limiting their opportunity to move away from their workstations [45]. Although adjustments to equipment orientation can promote optimal static working posture, CSRs typically perform their duties in a seated position for extended periods, contributing to numerous health issues associated with chronic sedentary behavior in the workplace.

Given the factors discussed, prolonged sedentary behavior among CSRs poses a significant health risk, contributing to various acute and chronic conditions associated with physical inactivity. CSRs can spend anywhere from 80 to 90% of their shift in a seated posture [33,34]. In a study on women call centers in Mumbai, the effect of work on health was felt by more than four-fifths of the respondents, with musculoskeletal disorders (83%) being the highest reported health problem, with more than 80% believing these were a direct result of their job and their resultant lifestyle [15]. Other health problems faced by employees of call centers include obesity, hypertension, type II diabetes, metabolic syndrome, venous thromboembolism, cardiovascular disease, cancer, and increased mortality [34]. Sit-to-stand workstations, having the option to switch between sitting and standing quickly, offer the potential to reduce not only total sitting time but also interrupt long periods of sitting with evidence of reducing physical complaints, lessened fatigue, and increased expenditure, mostly all without interruption on workflow performance [33]. Stand-capable desk users are ~45% more productive daily when compared to their seated counterparts, with productivity increasing over time when assessed over 6 months [46]. While there is limited evidence directly linked to long-term follow-up of use in call center users, some cross-sectional studies observing use in settings where sit-to-stand desks were present anywhere from six months to many years revealed there was a much smaller impact on seated time and lower daily usage of the stand function indicating that usage may decline over time as the novelty of the desk wears off [47].

Sit-to-stand workstations are a viable option to combat prolonged sedentary behavior among CSRs at call centers. Having the option for intermittent changes in positioning can combat the lack of opportunities to leave the workstation without negatively impacting productivity. However, it should be paired with an individual ergonomic assessment and education of proper use to have the most effective outcome [27,37,48]. While offering sit-to-stand workstations can decrease sedentary time, it is most effective when paired with an individual assessment and advice for good working posture to reduce musculoskeletal strain [49], as there have been reports of neck pain in those assigned stand-biased workstations, highlighting the importance of having a proactive ergonomic approach to enhance good working posture. Based on these findings, a sit-to-stand workstation implemented in call centers can decrease sedentary time without negatively impacting productivity, but it should be paired with an individual ergonomic assessment and education on use to be most effective.

5.4. General Practitioners

The World Health Organization (WHO) classifies general practitioners (GPs) as health care professionals who provide primary care to patients of all ages and manage various medical conditions. Due to the nature of this practice, GPs spend much of their day sitting while talking with patients and completing documentation. This creates opportunities for sedentary behavior, which, as previously noted, leads to health risks such as musculoskeletal concerns, cardiac dysfunction, diabetes, and death [50]. Physicians who practice general medicine are often the first point of contact with patients and follow them for extended periods, allowing for stronger and more intimate relationships than other medical specialists. GPs also play a vital role in primary and secondary prevention of health concerns through evidence-based practice (EBP) and individualization of health care [51]. This type of care can be accomplished within long-term relationships built over time to understand the clients personally at different stages and in context to the person, not just the illness or diagnosis [52]. Compounding knowledge provides insight into the client’s lifestyle, health choices, and previous treatments or consultations. Due to these factors, GPs are the ideal source of health promotion, which is strengthened by the demonstration of being physically active. Using sit-to-stand workstations allows the GPs to modify posture for self-benefit while also providing an opportunity to educate patients on the need for physical activity to promote a healthy lifestyle through discussion and recommendations. It significantly increases strategies for increased physical activity throughout the day while encouraging behaviors important to patient health and maintenance [53]. While studies are needed on the variability between sitting and sit–stand ratios, the sit-to-stand workstations encourage GPs to stand more frequently, reducing time spent in sedentary positions. This reduction may also provide cost-effective changes for organizations by improving overall health, as sedentary behavior is well studied regarding the correlation between morbidity and mortality rates [54]. Health care systems may prioritize ergonomic strategies and equipment to increase supportive work environments for the integration of evidence-based occupational health practices.

Patients are more likely to follow GP orders if the practitioners are physically active and follow the same suggestions for health maintenance and prevention [51]. The same can also be said: if a GP is more physically active, the likelihood of recommending increased physical activity to patients is also high [51]. Society can also be impacted by observing GPs standing during appointments and demonstrating behaviors that could positively affect patient outcomes and long-term and short-term health benefits [51]. Sit-to-stand workstations allow for postural changes while in the presence of patients and for required clinical activities. Biddle et al. performed the first study, which focused on sit-to-stand workstations using interventions with GPs and patients’ response to standing versus sitting during clinic visits. Sit-to-stand workstations allowed face-to-face interaction at the patient level unless the patient was seated in a chair. GPs stated they preferred to be at the patient’s level, whether standing or sitting. Patients largely did not report having negative feelings when the GP was standing during appointments when they were seated [53].

5.5. Engineers

Engineers are technical professionals who design, develop, and analyze systems, structures, materials, and processes across various mechanical, civil, electrical, chemical, and software engineering disciplines. Most engineers work 40 h or more per week across multi-decade careers [55]. Software, electrical, mechanical, and biomedical engineers typically spend most of their workday seated at computers using specialized software, making these roles highly sedentary. In contrast, civil, industrial, and environmental engineers spend more time in the field or on factory floors, requiring more walking or standing, although desk-based analysis remains common. Prolonged sedentary posture is associated with increased risks of musculoskeletal disorders, lower back pain, cardiovascular disease, and other work-related health concerns [56].

There is growing recognition of the necessity for sit-to-stand workstations in highly sedentary engineering roles, particularly for software, electrical, and mechanical engineers. Recent meta-analysis of randomized controlled trials shows that multicomponent interventions—including installing sit-to-stand desks—significantly reduce occupational sitting time and prolonged sitting, while increasing standing time when combined with promotion strategies [30]. Moreover, implementation of sit-to-stand desks has been confirmed to boost productivity: one study measured effective computer interactions and found participants were ~6.5% more productive while standing versus sitting [57]. Despite these benefits, the widespread adoption of sit-to-stand workstations remained inconsistent in engineering offices. Limited funding, underestimation of sedentary risks, and a lack of long-term behavior reinforcement contributed to low uptake and minimal impact in some workplaces. Utilization was also shaped by task type, individual preference, and professional role, with engineers among those less likely to adjust posture unless prompted by discomfort or task fit [58].

Engineering firms should adopt sit-to-stand workstations as standard ergonomic equipment in office-based roles to optimize impact. Recommendations include pairing desk installation with education on correct posture and optimal sit-to-stand ratios, using behavioral prompts or mobile reminders, and integrating usage monitoring and ergonomic consultations. Employers should also foster a workplace culture that supports movement and posture variety. Mobile alternatives (e.g., standing meetings, portable laptop stands) can complement static sit-to-stand workstations for engineers in hybrid or field roles. Regular evaluation of usage and health outcomes ensures adherence and long-term benefit [30,57].

5.6. Pharmacists

According to the United States BLS, pharmacists are responsible for distributing prescription medications and educating patients about their medications [59]. Pharmacists guide physicians and other health care professionals on the selection, dosage, interactions, and side effects of medications to treat health problems. In addition, pharmacists administer immunizations, advise on general health topics, and provide information on the use of over-the-counter medications. Pharmacists’ work environment includes retail pharmacies as community pharmacists, in hospitals and clinics as clinical pharmacists, as consultant pharmacists advising health care facilities and insurance providers, and as pharmaceutical industry pharmacists in marketing, research, and sales. Pharmacists’ work schedules vary, including nights, weekends, and holidays; pharmacists generally work full-time. Moreover, pharmacists can work 24 h in hospitals and other health care facilities. As pharmacists may spend most of their time standing, they are also exposed to harmful substances; thus, proper precautions must be taken by pharmacists wearing lab coats and gloves that may reduce injury [59]. Prolonged standing in the pharmacist’s work environment can lead to low back pain, cardiovascular problems, discomfort, fatigue, and pregnancy-related health issues. Workers should generally alternate positions between sitting, standing, and walking around in the workspace to reduce health issues. The workstation should be adaptable to the worker so the worker can adapt various postures and the use of shoe inserts, mats, and sit-to-stand workstations [60].

The need for pharmacists to have sit-to-stand workstations is imperative due to their work environment, which often involves prolonged periods of standing during a work shift. In contrast to other professionals positioned more sedentarily at a chair in an office setting, pharmacists tend to demonstrate prolonged standing during their workday. Ergonomic intervention is needed among pharmacists in their workspace to increase the recommendation for sit-to-stand workstations to help alleviate health problems and improve the quality of the work environment. In addition to using sit-to-stand workstations, the use of floor mats, shoes, and shoe inserts is suggested to reduce the risk of prolonged standing [60].

Sit-to-stand workstations should be considered an ergonomic intervention for prolonged sitting or standing workers during their work shifts. Also, dynamic movement appeared to be the best solution for reducing the risk of these health problems, including low back pain, cardiovascular problems, and pregnancy outcomes due to prolonged standing. Workstations should be allowed for workers to transition to different postures, including sitting, standing, leaning forward, and the use of sit-to-stand workstations should be accessible [60].

5.7. Laboratory Research Scientists, Such as Biophysicists

According to the United States BLS, biophysicists research how nerve cells communicate and how proteins work. Biophysicists, alongside biochemists, help develop products such as tests to detect infections and improve lives. Biophysicists’ work environment includes laboratories and offices where they conduct research and interpret results. In working full-time regular hours, biophysicists also tend to work extra hours to adhere to deadlines for projects and experiments with strict timing requirements. As biophysicists, many spend time in the laboratory, which can contribute to laboratory-related musculoskeletal disorders, in which neck, shoulder, and back pain are the most prevalent. Ergonomics can decrease the prevalence of laboratory-related musculoskeletal disorders [61].

Biophysicists can benefit from sit-to-stand workstations to help alleviate the prevalence of musculoskeletal-related conditions. In the laboratory setting, biophysicists work at laboratory desks and stand to mobilize within the lab. Without proper body mechanics, musculoskeletal disorders, including neck, shoulder, and back pain, can occur [61]. Sit-to-stand workstations can assist with alternating sitting and standing positions to help reduce musculoskeletal disorders. Work-related musculoskeletal disorders are prevalent in the laboratory setting. Training in proper ergonomics is imperative in limiting injury due to the nature of the work environment, including repetitive laboratory movements. In comparison, neck and lower back pain are prevalent in clinical laboratory technicians who work in the laboratory setting, similar to biophysicists. Biophysicists can benefit from sit-to-stand workstations to improve ergonomics, assist in alleviating health problems, and improve the workers’ way of life [62]. The workstation should be adaptable to the worker, allowing them to adjust to various postures. Sit-to-stand workstations would help achieve this goal [60]. The importance of ergonomic adjustments, guidance with instruction, and skilled demonstration of corrective posture during routine laboratory tasks can help decrease the prevalence of musculoskeletal disorders in the laboratory setting for biophysicists [62].

5.8. Generalized Office Workers

Office tasks have changed with the technological advances of computers and labor-saving devices. Workers are no longer required to stand from their desks to file paperwork or deliver mail, resulting in office workers having increased sedentary time at work [18]. Although the tasks of office workers vary greatly, there are typical physical activities that workers perform. Office workers may spend up to 75 percent of their time in prolonged sitting. Falling into the category of sitting at a desk for long periods makes office workers vulnerable to the health risks of prolonged sitting and sedentary behavior, as have already been identified [56]. Musculoskeletal disorders are the fourth cause of global disability among office workers [63]. Musculoskeletal pain has been associated with decreased quality of life and productivity, as well as increased workplace sickness absence and burden [64,65]. Computer office workers had increased psychological distress that was associated with shoulder and upper back pain [66]. Neck pain is the 4th leading cause of disability worldwide, with office workers having the highest reported annual incidence of neck symptoms in the working population [64,65,67].

Past research has demonstrated that physical activity offers numerous benefits for the musculoskeletal system [68]. It has been reported that changing positions from sitting to standing and taking a walk every hour has been associated with reduced musculoskeletal disease (particularly neck, shoulder, and back complaints) by more than 30% [7]. It has been shown that the use of SSW (Ergotron, Inc. (Eagan, MN, USA using different model such as Workfit-S^®, Workfit-A^®, and Workfit-D^® setups) increased light movement during the workday [28]. Evidence showed that the use of SSW can increase overall sense of well-being, energy, and decrease fatigue without impacting productivity [28]. A decrease in musculoskeletal symptoms was seen with changing from sitting to standing, with as little as changing position 2 to 4 times a day, 5 min every 50 min [69], or replacing 50% of sitting time with standing. Introducing sit-to-stand workstations to the office would reduce prolonged sitting or, at a minimum, give breaks from sitting to decrease the detrimental effects of prolonged sitting.

6. Occupation-Specific Summary

Most of these occupations discussed have the similar problem of occupation-demanded prolonged sedentary behavior, which can lead to similar health problems that can be musculoskeletal, such as low back pain, shoulder pain, neck pain, or cardiovascular, such as reduced physical activity tolerance, reduced endurance, hypertension, venous thromboembolism, or metabolic, such as metabolic syndrome or diabetes, which all lead to decreased overall productivity and decreased quality of life [60]. However, each of the occupations can influence these health outcomes differently based on their job characteristics.

Table 1. Sit-to-Stand Workstations: Occupation-Specific Summary.

Occupation	Key Job Characteristics	Interventions/Supporting Strategies	Reported Outcomes	Practical Takeaways
Emergency Dispatchers	Assess and manage emergency and non-emergency calls or alerts to coordinate and provide instruction to emergency personnel. Seated for the majority of 8–12 h shifts during high-stress situations. Limited opportunity to move away from the workstation.	Automated programmable sit-to-stand workstations. Ergonomist evaluation with mandatory ergonomic training prior to use.	A programmable moving workstation should be pursued, but with refinements combined with training to reduce the perception of pain and general discomfort.	Automate and program posture shifts and combine with training. Additional stress management and sleep hygiene training to combat musculoskeletal complaints, with the challenging nature of the job.
Architects	Plan and design structures, meet with clients, and conduct field visits to review project progress. Long design sessions with a mix of manual drawings and CADD. Field visits create additional stationary time during travel but allow for increased mobility upon arrival.	Manually adjustable workstations with software reminders for position changes. Ergonomic setup training.	Limited research on outcomes specific to this occupation. May use general office workers for reference.	Use reminders Adapt cycles to tasks
Customer Service Representatives	Answer questions or requests, resolve complaints, process orders, and provide information about products to the public, typically by phone, email, live chat, or social media. Work in a seated position at a table within a large room at individual workstations. Highly monitored, repetitive work with 80–90% of time spent sitting. Limited opportunity to move away from the workstation.	Either spring or electrical sit-to-stand workstations for quick and convenient adjustments to reduce workflow disruption. Ergonomic assessment and user education.	Stand-capable desk users are ~45% more productive daily. Limited evidence for long-term follow-up use. Usage may decline over time as the novelty of the desk wears off.	Combine height-adjustable desk with ergonomic guidance.
General Practitioners	Provide primary care to patients of all ages and manage their various health conditions. Extended periods of sitting during patient interaction and documenting encounters.	Sit-to-stand workstation options within patient rooms and at office stations for documentation. Encourage patient education during use through modeling healthy physical habits.	Significantly increases strategies for increased physical activity. Studies are needed on specific sit–stand ratios. Still allow for face-to-face interaction during patient encounters.	Integrate postural changes during consultations to demonstrate movement behavior.
Engineers	Design, develop, and analyze systems, structures, materials, and processes across various disciplines. Certain disciplines spend most of their workday sitting at a computer to utilize specialized software. Others may spend more time in the field or on factory floors, although desk-based analysis remains a common practice.	Sit-to-stand workstation with behavior prompts or mobile reminders. Ergonomic assessment and education. Mobile alternatives (e.g., standing meetings, portable laptop stands).	Installing sit-to-stand workstations reduces occupational sitting time and prolonged sitting when combined with behavioral strategies. ~6.5% more productive while standing. Widespread adoption is inconsistent due to multiple factors.	Reinforce sit–stand variety combined with behavioral strategies.
Pharmacists	Distribute and guide the public on the utilization of their prescribed medication, provide information on over-the-counter medication, guide physicians on selection, dosage, interactions, and side effects of medications, and administer immunizations. Long hours, mostly standing at counters or dispensaries.	Sit-to-stand workstation, anti-fatigue mats, compression stockings, and shoe inserts. Dynamic movement breaks.	Limited research on outcomes specific to this occupation regarding sit-to-stand workstations. The data does suggest that the use of sit-to-stand workstations should be considered for workers who must either stand or sit for long periods.	Encourage seated time during tasks that do not require standing position to promote positional changes.
Laboratory Research Scientists	Work alongside other scientists to develop products. The work environment includes laboratories and offices to conduct research and interpret results. Tend to work extra hours to adhere to strict deadlines for projects.	Sit-to-stand workstation for alternating posture. Ergonomic training and posture correction during lab work. Modify lab benches as needed for optimal ergonomic positioning.	Limited research on outcomes specific to this occupation. May use general office workers for reference.	Adapt to benches Ergonomic education
Generalized Office Workers	Tasks may vary depending on specific job titles, but employees typically spend up to 75% of their workday seated.	Sit-to-stand workstation with software or mobile reminders every 50 min. Walking or light activity may be added during a break from sitting if possible.	Increased light movement. Increased overall sense of well-being, energy, and decreased fatigue. Decreased MSK symptoms.	Attempt to replace half of sitting time with standing. Adjust position 2–4×/shift.

Risk Factors across all listed occupations are similar: Musculoskeletal disorders, including neck, shoulder, and back pain, and psychological distress, decreased overall productivity and quality of life; however, emergency dispatchers are at higher risk for PTSD-related conditions due to the stress of their challenging setting.

summarizes these job characteristics and provides intervention strategies, outcomes, and practical takeaways for all occupations discussed.

7. Suggestions and Recommendations

Ergonomic principles are crucial when evaluating sit-to-stand workstations, particularly in terms of optimal viewing angles and functional reach. Proper monitor height, screen tilt, and viewing distance help limit visual strain and reduce excessive neck flexion or extension during both sitting and standing. Likewise, organizing the workspace so that frequently used items remain within the primary reach zone minimizes unnecessary bending, twisting, and repetitive upper extremity strain. Desk height is recommended with elbows at a 90-degree angle to allow for proper wrist, hand, and trunk positioning. Ensuring correct alignment and reach distances supports postural stability, allowing users to transition between positions with reduced risk to the musculoskeletal system. Proper workstation selection is a crucial component of ergonomic intervention, and your decisions in this area can significantly impact your health. Sit-to-stand workstations are available in various configurations, each offering different levels of adjustability and integration tailored to user needs. Whether it is a manual or electric height-adjustable desk, a desktop converter that sits on top of a traditional desk, or a fully integrated system designed for dynamic postural changes, each type has its unique advantages. By considering factors such as cost, ease of adjustment, available workspace, and suitability for specific tasks, you can make choices that support long-term musculoskeletal health.

Planned rest breaks are not just a suggestion, but a vital element of healthy sit-to-stand workstation use. By emphasizing the importance of short, frequent breaks, ergonomic guidance shows that your health is a priority. These breaks encourage movement, reduce muscle fatigue, and promote circulation, enhancing the overall effectiveness of sit-to-stand workstations. Incorporating brief rest breaks every 30 min to vary your posture and reduce static loading on muscles and joints is a small but significant way to support your long-term musculoskeletal health. A study by Buckley et al. (2015) [70] recommended increasing standing postures to two hours/day, with a gradual increase up to four hours per day, along with adopting a healthy diet and reducing alcohol consumption to promote a comprehensive lifestyle change.

Reminders to alternate static sit-to-stand positions are very important and can be handled by automation. A study by Sharma et al. (2019) [43] utilized validated software to record patterns of sit-to-stand positions during computer usage, in combination with lab-validated USB accelerometer sensors, to track changes in desk position. The Phase I data was utilized to then send emails to participants with reminders to sit for 30 min and stand for 20 min. This was also coupled with statistics on peers’ compliance with the study. Results showed that 51% of participants were influenced by peer statistics provided by the software to adjust their standing patterns using the sit-to-stand workstations, as well as by member discussions and observations of use by participants. In line with the suggestions discussed above, an easy-to-use checklist outlining these suggestions and recommendations is provided in

Table 2. Checklist for suggestions for sit-to-stand workstation use.

Topic	Suggestions
Workstation Setup	✓ Seat: breathable upholstery, adjustable lumbar support, adjustable armrests, a rounded front border, an adjustable seat, and a five-caster base with 360-degree swivel ✓ Monitor: top of screen at, or slightly below, eye level, body centered in front of the monitor and keyboard, screen 18–22″ away ✓ Keyboard and mouse at elbow height (90–100° flexion) ✓ Anti-fatigue mats for any prolonged standing
Recommended Use Patterns	✓ Start in 15–20 min increments, gradually increasing over 2 weeks ✓ Alternate positions every 30–45 min ✓ No optimal sit–stand ratio currently exists. The optimal ratio may vary for each worker, depending on their job requirements.
Behavior Strategies	✓ Use software/mobile reminders for position changes ✓ Programmable desks for highly focused roles ✓ Make posture changes at task transitions
Education	✓ Have ergonomic instructions available prior to use ✓ Review setup intermittently for minor adjustments as needed ✓ Report any persistent discomfort to make adequate adjustments
When to Use Programmable or Automated Desk	✓ For occupations with high cognitive load or when minimal task interruption is a priority ✓ To sustain long-term adherence and reduce manual adjustment fatigue

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8. Limitations

This review has its limitations as it does not attempt to replicate a systematic review, or scoping review or a meta-analysis of all sit-to-stand workstation research as with previously available papers and does not incorporate systematic PRISMA guidelines as literature on these less researched occupations are minimal, or not well documented or currently do not exist. Additionally, with the minimal focus emphasized on the occupations addressed in the review and even less literature on such specific occupations, a systematic review, or scoping review, or a meta-analysis was not possible. However, to the best of the author’s knowledge, a narrative review of sit-to-stand workstations focused on different types of occupations does not exist. Hence, this review attempts to provide health care providers, occupational health and safety experts, researchers in the ergonomics discipline, and individuals with the occupations addressed in this paper, a review of current adoption, use, benefits, pitfalls, and recommendations of the sit-to-stand workstation to different occupations, while exploring their nature of the work tasks. Future research should focus on multiple aspects of the sit-to-stand workstation use, which can include unique and less researched occupations, the use of automated or programmable sit-to-stand workstations, as well as the efficacy, feasibility, adoption, and continued use of such devices.

9. Conclusions

Based on past research, sit-to-stand workstations are beneficial to minimize sedentary behavior and avoid prolonged static sitting postures, with the benefit of transitioning between sitting and standing postures as needed, while not negatively impacting the work task performance. While sit-to-stand workstations are commonly reviewed for their intervention, different occupations have different work task demands that have to be taken into consideration with sit-to-stand workstation use. Overall, sit-to-stand workstations induce changes in reducing sedentary behaviors and reducing body discomfort with health benefits. The mere adoption of sit-to-stand workstations does not solve problems of sedentary behavior, and there is a need for ergonomics training on the correct and continued use of sit-to-stand workstations, which needs to be specific to each occupation.