Health experts have long known that an excessively sedentary lifestyle is bad for you in many ways, raising risks of so many health problems — diabetes, weight gain, depression, dementia, multiple cancers — that it's often equated with the dangers of smoking cigarettes.

Mark Pereira, a professor of epidemiology and community health at the University of Minnesota, doesn't like that analogy. Evidence doesn't actually show that sitting is just as hazardous as smoking. But the two unhealthy habits do have one thing in common, he said.

Both smoking and sitting are highly influenced by social norms and peer pressure.

People tend to start smoking because their friends smoke, and they quit if nobody around them smokes. Similarly, they're more likely to get up out of their chairs at work if others are doing the same.

"It's difficult to stand up in a meeting if everybody's seated," Pereira said. "It takes courage."

That finding could be helpful to companies' managers, who have a vested interest in encouraging worksite wellness programs that can lower health care costs and potentially increase productivity.

And it could be useful as people gradually return to their offices after a few years of being "losers," as Minneapolis Mayor Jacob Frey (jokingly!) characterized remote workers a few weeks ago. Those who work at home aren't necessarily losers, but they may notice that their physical fitness has slipped a bit after spending their days in a setting where everything they needed is just a few steps away.

Working at home generally doesn't require as much movement as walking to an office from a bus stop or parking spot, stopping by colleagues' cubicles, visiting the restroom, going up and down stairs to different departments, prowling skyways in search of lunch. Those who wear a step-counting device (such as a Fitbit or Apple watch) have discovered that they put on many more steps when they're in the office, even if they aren't intentionally "exercising."

In a study called Stand & Move at Work, conducted between 2016 and 2017, Pereira partnered with Matthew Buman, director of the College of Health Solutions at Arizona State University, to measure the effects of using sit-stand desks (desks whose height can be adjusted for use in either position).

They wanted to see whether the desks and encouragement to move during the workweek would prompt people to spend less time sitting and more time standing, and to find out how it affected their health. The results were promising, and the study in some cases triggered habits that stuck around long after it was over.

The researchers selected 24 workplaces and divided them into two groups of 12. They gave everyone activPAL devices that, like Fitbits but even more accurate, measure movement throughout the day. Everyone in both groups was encouraged to spend time moving at work, and received emails with suggestions.

But one of the two groups also received free sit-stand desks, courtesy of the National Institutes of Health (NIH).

After a year, the researchers met with people with the adjustable desks and found they were spending about an hour a day standing. Although that was an improvement, differences in health metrics were minimal for the group overall.

But a subgroup of 95 participants with elevated blood sugar in the prediabetes or diabetes range saw more dramatic improvements to blood sugar, blood pressure and body fat.

Meanwhile, the control group of the 12 workplaces that did not get new desks initiated workplace movement activities, including standing in meetings. The researchers originally planned to give that group desks of their own after 24 months, but found when they talked to them after just one year the employees were so disappointed not to have received desks they moved up the schedule.

"We were a little bit surprised at how bummed out they were," Pereira said. "We had such pushback from the group that ... we went back to the NIH and got permission to give them the sit-stand workstations at 12 months."

Becoming a 'true believer'

Not everyone in that second group was bummed out — or at least many enjoyed the first segment of the study, even when they didn't yet have sit-stand desks but were encouraged to move more.

Jesse Pearson was selected as a "champion," or a leader of the study in his workplace, which at the time was the Minnesota Department of Transportation (he has since moved to Minnesota IT Services, the state government's information-technology department). Champions were encouraged to suggest movement activities to their colleagues. For example, Pearson held a mountain-climbing challenge based on the number of steps it takes to ascend various mountains (for example, Minnesota's Eagle Mountain, 14,000 steps roundtrip, Mount Everest, 125,000 steps roundtrip).

"I put out numerous signs on the floor to remind people to take the stairs, change up their normal patterns of walking — maybe use the bathrooms two floors up or two floors down to increase your steps," he said.

He encouraged employees to hold one-on-one meetings while walking. He made a point of standing during group meetings, encouraging others to do the same.

John Wilson, an economic policy analyst also at MnDOT, recalls that the novelty of the movement activities had started to wear off. Then the sit-stand desks arrived. He became a "true believer" in the desks, getting one for his home when COVID forced him to start working remotely and eventually getting one for his father.

The benefits have "expanded beyond the workweek, too," he said. "Watching my son play a soccer game, it feels natural to me to stand on the sideline for an hour and a half, and I don't even really think about it."

When Njia Lawrence-Porter's department at Normandale Community College got sit-stand desks, "it was really new and exciting," she said. Coworkers started having walking meetings, walking at lunch, teasing each other about not standing enough.

Having the "sense of community around it to encourage people to do it as a group" was a powerful motivator, reducing any self-consciousness people might have, said Lawrence-Porter, an academic adviser.

"It was major in changing the culture around standing and moving at work," she said. "It gave us permission to be healthy at work. It really was like, yeah, this is what you're supposed to do take care of yourself."

Since the study, Lawrence-Porter has noticed a bit of decline in desk standing, particularly among new hires.

"We probably need some kind of a reminder about why that's cool," she said. "Behavior has to be reinforced or people revert. ... We all just go back to bad habits eventually."