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Associations of occupational standing with musculoskeletal symptoms: a systematic review with meta-analysis
  1. Pieter Coenen1,
  2. Lisa Willenberg2,
  3. Sharon Parry1,
  4. Joyce W Shi3,
  5. Lorena Romero4,
  6. Diana M Blackwood5,
  7. Christopher G Maher6,
  8. Genevieve N Healy1,7,8,
  9. David W Dunstan7,8,9,10,11,12,13,
  10. Leon M Straker1
  1. 1School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
  2. 2Centre for International Health, Burnet Institute, Melbourne, Victoria, Australia
  3. 3Monash Health, Melbourne, Victoria, Australia
  4. 4Alfred Hospital, Melbourne, Victoria, Australia
  5. 5Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
  6. 6Musculoskeletal Division, Sydney Medical School, The George Institute for Global Health, The University of Sydney, Sydney, New South Wales, Australia
  7. 7School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
  8. 8Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
  9. 9School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  10. 10School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
  11. 11Department of Medicine, Monash University, Melbourne, Victoria, Australia
  12. 12School of Sport Science, Exercise and Health, The University of Western Australia, Perth, Western Australia, Australia
  13. 13Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
  1. Correspondence to Professor Leon M Straker, School of Physiotherapy and Exercise Science, Curtin University, Perth 6845, Western Australia, Australia; L.Straker{at}


Objective Given the high exposure to occupational standing in specific occupations, and recent initiatives to encourage intermittent standing among white-collar workers, a better understanding of the potential health consequences of occupational standing is required. We aimed to review and quantify the epidemiological evidence on associations of occupational standing with musculoskeletal symptoms.

Design A systematic review was performed. Data from included articles were extracted and described, and meta-analyses conducted when data were sufficiently homogeneous.

Data sources Electronic databases were systematically searched.

Eligibility criteria Peer-reviewed articles on occupational standing and musculoskeletal symptoms from epidemiological studies were identified.

Results Of the 11 750 articles screened, 50 articles reporting 49 studies were included (45 cross-sectional and 5 longitudinal; n=88 158 participants) describing the associations of occupational standing with musculoskeletal symptoms, including low-back (39 articles), lower extremity (14 articles) and upper extremity (18 articles) symptoms. In the meta-analysis, ‘substantial’ (>4 hours/workday) occupational standing was associated with the occurrence of low-back symptoms (pooled OR (95% CI) 1.31 (1.10 to 1.56)). Evidence on lower and upper extremity symptoms was too heterogeneous for meta-analyses. The majority of included studies reported statistically significant detrimental associations of occupational standing with lower extremity, but not with upper extremity symptoms.

Conclusions The evidence suggests that substantial occupational standing is associated with the occurrence of low-back and (inconclusively) lower extremity symptoms, but there may not be such an association with upper extremity symptoms. However, these conclusions are tentative as only limited evidence was found from high-quality, longitudinal studies with fully adjusted models using objective measures of standing.

  • Review
  • Meta-analysis
  • Lower back
  • Work
  • Lower limb

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  • Twitter Follow Pieter Coenen @coenen_pieter, Christopher Maher @CGMMaher, Genevieve Healy @genevieve_healy and Leon Straker @Leon_Straker

  • Contributors PC, LW, SP and JWS conducted literature screening and data extraction of all included papers. LR and DMB conducted the literature search in electronic data bases. All authors (PC, LW, SP, JWS, LR, DMB, CGM, GNH, DWD and LMS) analysed the data and reviewed the manuscript for important intellectual content. LMS is the guarantor.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.