The Standing Paradox: Why a Simple Health Behavior Fix Is Not So Simple

In the fight against excessive sedentary behavior’s (SB) contribution to cardiovascular disease (CVD), and morbidity and mortality risk1 standing has been championed as a simple replacement behavior.2 The move toward standing desks seemed like a victory for public health. Yet, this enthusiasm has outpaced science. Due to the limited evidence, current public health guidelines offer vague or conflicting advice for standing as a strategy to interrupt SB. The World Health Organization and US guidelines recommend light-intensity physical activity (PA) as a SB interruption strategy but stop short of encouraging standing.3,4 The Canadian Guidelines endorse standing without specifying how or how much.2 This ambiguity has created a problem for public health: standing is recommended and adopted without fully understanding its impact on CVD.

Before crafting clear public health messaging and addressing the mismatch between the strength of the evidence and the public’s adoption of standing, we must: (1) ensure that standing is clearly defined and understood; (2) better understand the mechanistic relationship between standing and CVD; (3) understand why standing behavior has been associated with decreased, increased, and no change in CVD risk; and (4) identify optimal methodological approaches for tracking standing behavior and its association with CVD.