Musculoskeletal disorders and prolonged static sitting
Nicolien de Langen, Kees Peereboom, vhp human performance, The NetherlandsNicolien de Langen, Kees Peereboom, vhp human performance, The Netherlands
- 1 Introduction
- 2 Magnitude of the problem
- 3 Health effects of prolonged static sitting
- 4 Static and dynamic work
- 5 Workers at risk
- 6 Regulations and guidelines
- 7 Interventions
- 7.1 What employers can do
- 7.2 What workers can do
- 8 Links for further reading
- 9 References
Prolonged static sitting is a type of sedentary behaviour. Sedentary behaviour occurs when activities are characterized by low energy consumption in combination with a sitting or lying position.
Sedentary behaviour is widespread. It is to be expected that more and more workers will be confronted with sedentary type of tasks due to further automation and computerization. Sedentary behaviour leads to various health risks. Besides musculoskeletal disorders (MSDs), prolonged sitting may also lead to health risks in other domains, such as diabetes, heart- and vascular disease, depression and even mortality. Sedentary behaviour is increasing both at work and in private life, this is why attention must be paid to this health risk. Replacing sitting by standing is not always the solution, as prolonged standing can also may result in health risks. This is why it is considered important to change between postures as much as possible. For the best health and safety outcome, workers should be able to adopt a variety of body positions: preferably workers should be able to vary between sitting, standing and moving about.
Magnitude of the problem
Prolonged sitting is an increasing occupational health risk in the workplace. Due to the use of computers and other similar devices, many workers are tied to their desks for prolonged periods of time. Prolonged sitting for instance is also seen with workers working at service desks, workers at production lines, workers working in laboratories, air traffic control workers, control room workers and long-distance drivers. Where previously the nature of work required workers to move around in the office, e.g. to put something in a filing cabinet, now many tasks just require a mouse click. Over the past decades, a shift in the activity profile of workers has been observed with a tendency for physical activity to be replaced by cognitive work.
On average, 3 to 4 hours of this sedentary behaviour occurs at work. In the EU, 28% of workers report that their work involves sitting almost all the time and a further 30% report sitting a quarter to three quarters of the time, and throughout Europe, 18% of the workers sit more than 7.5 hours a day. Dutch workers sit, on average, more than 8 hours a day. This percentage is also substantial in Denmark and the Czech Republic.
In EU-OSHA’s ESENER 2019 survey, asking establishments about their current management of occupational safety and health, the third most frequently reported risk factor in the EU28 (59% of establishments) was prolonged sitting. By sector, it was most frequently reported by establishments in financial and insurance activities (92% of establishments in the sector in the EU28), information and communication (92%) and public administration (89%).
Health effects of prolonged static sitting
Prolonged sitting is a risk factor for various health problems.
Musculoskeletal health effects
The musculoskeletal health effects related to prolonged static sitting are low back pain and neck- shoulder complaints.
Low back pain Sitting influences intervertebral spacing within the spine. Low back intervertebral disc pressures rises significantly when seated compared to standing or walking. It is long known, depending on how a person sits, that intervertebral disc pressure levels vary. When sitting upright with no back support, the low back intervertebral disc pressure is 140% compared to standing disc pressure. When sitting with a forward trunk lean, the low back intervertebral disc pressure is 190% of standing disc pressure. In addition to an increase in disc pressures, sitting increases ligament strains and may locally place higher loads on muscles and tendons. This increases the risk of pain, discomfort, strains and injuries associated with postural stress disorders, joint compression and soft-tissue (muscles, tendons and ligaments) injuries. More recent studies confirm that back pain within the last 24 hours shows a clear trend connected to static sitting behaviour.
Sitting can also weaken back muscles. Those who sit for long periods of time tend to hunch their shoulders and head forward, causing tight chest muscles and weaker upper-back muscles (imbalance). The abs and muscles of the lower back are also prone to muscular imbalances. The abs are typically weak while the muscles of the lower back are put under a lot of stress from sitting. If you also have tight hamstrings, your lower back will start to cave in, protruding the stomach. This all can lead to painful conditions.
In addition, the more general picture is that sitting comes with a monotonous low overall energy consumption. This may lead to a situation where the body’s energy demand for the back region is well below what is recommended for a healthy lifestyle. In this way the combination of a low metabolic level and lowered blood circulation can eventually lead to muscle degeneration and osteoporosis. At the same time, not moving can lead to stiffness in joints.
The long-standing doctrine of the ideal sitting position, which is to maintain a posture that is “as upright as possible” has been strongly questioned and has been slowly replaced by the concept of “dynamic sitting”, where sitting positions are continuously altered. Using a dynamic sitting behaviour one is able to vary the loading conditions of spinal segments, which induces an effective pump mechanism in the vertebral discs. This mechanism is thought to be critically important for intervertebral disc nutrition as well as resistance against degenerative changes. This is increasingly important considering the fact that the official retirement ages are increasing means we are required to work longer. In particular, sitting behaviour in an upright and a forward inclined sitting position combined with few breaks and no changing in seated position is believed to be connected to back pain.
Neck- shoulder complaints
Sitting time at work is associated with neck–shoulder pain. An unfavourable working posture can lead to an increased muscle tension in the neck and shoulders. When neck and shoulder muscles are "overstrained", the pressure on the blood vessels will increase, meaning that the blood vessels towards the arm can become partially pinched. The result can be a painful neck, shoulder muscles and cold hands due to reduced blood flow, or a combination of these.
Lower limbs While prolonged standing is a risk factor for the development of lower limb disorders (ankles, knees, hips), an analysis of self-reported complaints among EU workers found no such relationship between sitting and MSD complaints in lower limbs. Sitting breaks will contribute to protection from lower limb disorders from standing work. However, prolonged sitting may result in muscle discomfort and joint stiffness in the lower limbs on standing up and prolonged sitting can result in a build-up of fluid in the leg veins which can cause discomfort and pain in the lower limbs.
Other health risks
Prolonged sitting is also associated with a spectrum of other health risks, including diminished cardiovascular health (including vascular function, circulation and blood pressure problems and heart disease), cancer, diabetes, weight gain, metabolic syndromes, higher risk of psychological distress, muscle degeneration, osteoporosis and a higher rate of mortality.
Diabetes and cardiovascular health
Prolonged sitting increases the risk of diabetes and the risk of cardiovascular disease. The crux seems to be in the leg muscles, the largest muscles of the human body. When you sit down, you hardly use these muscles. This increases the concentration of fats while decreasing the insulin sensitivity (which causes the sugars to be absorbed into the blood). Both processes (called fatigue and saccharification) play an important role in developing cardiovascular disease and diabetes. Muscle activity in the legs gets the blood pumping and is therefore important. MortalityFor individuals sitting for up to 7 hours/day, the all-cause mortality risk increases by 2% per extra sitting hour. In addition, each hour spent sitting beyond 7 hours/day leads to a 5% increase to the all-cause mortality risk. Adults sitting for 10 hours/day have a 34% increased risk of all-cause mortality compared to sitting for 1 hour/day, even when accounting for physical activity. The American National Health and Nutrition Examination Survey (NHANES) reported that inactivity in excess of ≥8.6 hours/day was significantly associated with increased all-cause mortality. It is important to realise that regardless of whether a person who sits a lot is also active during the (working) day (walking, cycling, doing sports etc.) the evidence suggests that these increased health risks occur still occur.
Other risks Sitting has been associated with an increased risk of mental disorders and depression. To date, evidence on the impact of workplace sitting on workplace mental wellbeing issues, including job stress, depression and fatigue, is limited with no strong evidence having been reported yet. There are indications of a positive relationship with some forms of cancer (in particular breast and colon cancer). There is still insufficient evidence to confirm a relationship between sedentary behaviour and overweight / obesity.
Static and dynamic work
Studies in work physiology have shown that static load as opposed to dynamic muscle leads to longer recuperation times. The lack of movement reduces the muscular activity and leads sooner or later to tension, in short:
- lack of movement places a higher load on the intervertebral discs;
- lack of movement impairs circulation of the blood and the supply of oxygen to muscles and organs.
The advantages of alternating postures and more dynamic work, are clear:
- It prevents shortening of the thigh muscles – a known problem for habitual sitters
- It eases the return of blood to the heart and stimulates circulation.
- It keeps intervertebral discs in a better shape.
- It can reduce vein weaknesses and varicose veins.
Workers at risk
Types of work
Groups most at risk of experiencing prolonged sitting are those working in offices. However, workers in transportation (taxi drivers, truck drivers, bus drivers, aeroplane pilots) and highly mechanised trades (crane operators, bulldozer operators, single driver garbage collectors, sewing machine operators and other factory line workers), call centre workers are also at risk of exposure to prolonged sitting. Other professions concerned include casino workers, cashiers micro assembly line workers and control room workers.
For older workers, health is an important issue regarding the decision to retire. The fact that the occurrence of MSDs increases with age is part of this. There are a large number of studies worldwide that show that the level of prevalence of MSDs increases with age. While ageing plays a part, this is partly due to the length of cumulative exposure to MSD hazards over the work-life course.
Also, due to the increased sedentary nature of work and increases in the official retirement age, young workers today may have an increased exposure to sedentary work across the life course compared to previous generations of workers.
Prolonged sitting is a particular issue for workers who have developed chronic conditions such as rheumatic diseases, as long periods of sitting may provoke the pain associated with such conditions. As the workforce ages, there will be more workers with such conditions, therefore avoiding prolonged sitting is an issue for sustainable working and avoiding early exit from work. In the EU 31% of women report that their work involves sitting almost all the time compared to 25% of men. Women are over represented in a number of predominantly seated jobs (office work, micro assembly) which are also of low-grade. This can mean that they have a lack of control over how they work, including when they can take breaks to get up and move around. For women, work pace is more problematic: 61% have to respond to an external demand immediately and to interrupt their tasks for another one (compared with 50% for men).
Sedentary behaviour is also a problem with both young students and workers. Young people spend up to 11 hours a day sitting. Activities that make an important contribution to this high score are sitting at work, during class, doing homework, using computers or using tablets. School furniture can already lead to neck and back pain among school pupils and prolonged sitting will exacerbate any problems. The school environment can contribute to problems and solution. Learning to promote musculoskeletal health can be integrated into the school curriculum and into the way the school is run. Children and students can be encouraged to vary how they study other than just sitting at the desk in their bedroom.
Regulations and guidelines
While prolonged sitting is not specifically covered by any EU regulations or directives, all employers in the EU have general duties to carry out risk assessments and bring in preventive measures based in the assessments. In selecting the measures, they should avoid risks where possible and adapt work to the worker. They must provide information, instruction and training. Any workers who habitually use display screen equipment as a significant part of their normal work are covered by regulations on display screen equipment, which include providing them with a suitable workstation and chair and breaks. General provisions on the prevention of musculoskeletal disorders in Sweden state that workstations, jobs and work environment conditions should be designed and arranged in such a way that risks of physical loads both static and dynamic which are dangerous to health or unnecessarily fatiguing or stressful are averted.
Besides general requirements, there are few official guidelines specifically related to the reduction of the risks of sedentary behaviour. The Netherlands is one exception. The Dutch Ministry of Social Affairs provides the following guidelines for working seated and/or standing.
- Sit for a maximum of 2 hours, then take a break of sitting for at least 10 minutes (standing, walking, cycling)
- Sit for a maximum of 5 hours totally at work on a working day
Guidance from The Netherlands also advices working in an active manner and alternating between sitting, standing and walking.
In Switzerland’s textile industry as a sector policy it is agreed that the following division on a working day is considered to be ideal.
- Sit about 60%
- Stand about 30%
- Walk about 10%
The Belgian Ergonomic Society advocates.
At work: after every 30 minutes stand up for 10 minutes, in this case at least 12 standing moments of 10 minutes per day will be obtained.
Australia’s Beupstanding campaign, devised by the University of Queensland, simply proposes:
- Spend 50% or less of your work day time sitting
- Avoid long periods of sitting – aim to get up every 30 minutes
Visual display unit (VDU) work The European Display Screen Equipment Directive 2007, which is implemented in each EU Member State, states that “the employer must plan the worker's activities in such a way that daily work on a display screen is periodically interrupted by breaks or changes of activity reducing the workload at the display screen”. The directive does not specify the frequency and duration of work breaks when working with VDU's, nor is there any generally accepted standard.
Some countries provide more specificity on how their national regulations should be implemented. In Austria, display screen equipment (DSE) workers are entitled to a 10-minute break after each 50-minute period of working in front of a screen. In France employers must adapt the working time of employees working on a screen after a risk assessment is carried out and a worker’s activity must be scheduled in such way that daily screen time is periodically interrupted by breaks or changes of activity. In Poland, employees are entitled to a break of at least five minutes after each hour of work. In Italy, DSE workers are entitled to a 15-minute break for every two hours of continuous use. In Estonia, DSE workers have the right to breaks of at least 10% of the time the employee works with the computer (for example, 6 minutes for every 60 minutes of work or 3 minutes for every 30 minutes).
In Ireland, the Health and Safety Authority’s official guidance on work breaks and display screen equipment work covers four important points:
- Rest breaks or changes in the pattern of work, where they are necessary, should be taken before fatigue sets in. Some employees suffer symptoms from the effort used to keep up performance while fatigued.
- The employee should not sit in the same position for long periods and make sure to change posture as often as practicable.
- Short frequent rest breaks are more satisfactory than longer breaks taken occasionally.
- Rest breaks should be taken away from the VDU. Other duties may be assigned during this period, provided they are not too intensive.
In some countries there are also employer trade union agreements at the company level regarding working with display screen equipment.
Conclusions regarding guidelines
Taking into account: that unfavourable health effects due to prolonged sitting may occur after 2 hours of daily exposure; that both sitting at work and sitting during leisure time should be taken into account and; that a more active work style (and life style) including alternating between different types of postures is favourable, the following advice about sitting at work can be given:
- Spend 50% or less of your work day sitting
- Avoid prolonged periods of sitting – aim to get up and take short micro breaks at least every 20 - 30 minutes
- Always get up after 2 hours of sitting for at least 10 minutes
- Try to maximise sitting on the job to 5 hours daily
- Work in an active manner and alternate between sitting, standing and walking
In the workplace, four key elements are considered important to limit (the consequences of) sedentary behaviour, being:
- work organisation and workplace culture that promotes active and dynamic ways of working
- a correct working posture including correct workplace design and adjustment possibilities of the workplace, use the adjustment possibilities of your chair
- reducing sitting time by working more dynamically
- training and instruction to create awareness, including exercises during work.
What employers can do
To prevent MSDs caused by prolonged sitting, it is important that the workplace design is adapted to the tasks and activities that the worker needs to perform. When designing workplaces, a first important choice is whether the work can be carried out standing or sitting or combined. In addition, it is important that the workplace is well designed and complies with applicable guidelines Take into account the following topics:
- Sitting or standing or a combination (keep moving around in mind).
- Working surface height: The correct working height depends on the type of tasks that are performed.
- Foot, knee and leg space:
- Reaching distance: Items that are used a lot must be within reach distance, items that are used less frequently can be placed farther away, so one has to get up to reach them.
External expertise should be sought where necessary in order to help the employer make the right choices. A correct workplace design helps to prevent unfavourable working positions. The use of the following flowchart can help with making the right basic choices.
Reduce sitting time
Recently, there has been a shift towards (office) workstations that also accommodate standing postures. This shift is attributable to avoiding negative health and musculoskeletal issues from sedentary exposures. However, changing exposures from sitting to standing does not automatically eliminate MSD risks, as evidence clearly indicates that prolonged standing also induces problems. Nevertheless, reducing exposure and rotating frequently between sitting and standing has been shown to result in positive health outcomes, reduced discomfort and increased work performance. A height-adjustable desk also allows a worker to set the desk height correctly for sitting work too.
The best posture is the next posture
Design work, workstations and the workplace with motion in mind. The body is not designed for static postures over sustained periods of time. People are not designed to sit in a chair and stare at a monitor all day. The body needs movement. Remember: “Your best seated posture is your next one. And: ”People must find ways to interject movement into each day.
Design of common areas
Meetings rooms, cafeterias, utility rooms and mailrooms are common areas that can influence workers behaviour. Designing these spaces to facilitate and encourage standing, either full-time or part-time, can increase the amount of time workers stand each day8. Meeting rooms can be designed to have stand-up meetings, cafeterias can be equipped with counters where people can stand, waiting areas (lobbies, offices and areas where people sit casually) can consider removing unnecessary chairs.
Special furniture that interrupts prolonged sitting
There is evidence that a sit/stand desk and a workplace with a treadmill or bicycle reduce sitting time at work. If properly implemented, these measures can lead to a reduced sitting time.
Motivate people to take breaks
Encourage people to feel free to stand up, move and walk. Introduce this into meetings, so people can move when they feel the need
Encourage workers to take regular breaks and move while teleworking. Get workers to share their ideas for avoiding prolonged sitting while working from home (see additional tips for teleworking).
Driving for work
Plan journey times to allow time for breaks and a stretch on long journeys (also important for combating fatigue). Inform and promote good practice among drivers (see tips for drivers). Purchase vehicles with adjustable seating features.
Promote exercising at work
There are many possibilities for injecting more movement and dynamism into the daily work routine, there is growing evidence that workplace physical activity interventions can positively influence physical activity behaviour.
Educating and encouraging workers to modify work habits and individual behaviours can prompt them to change daily habits. Simple activities that workers can be encouraged to do throughout the day include:
- Walk during lunch breaks and during down times.
- Conduct face-to-face conversations with other workers rather than emailing, texting or calling.
- Provide cordless phones, so people can stand/walk when receiving and making phone calls.
- For secondary work, such as reading and writing, provide secondary work surfaces (100 – 110 cm) so workers can perform these tasks while standing.
- Remove redundant shared resources (e.g., policy manuals, reference books, procurement catalogues, phone books) from individual workstations and locate them in common resource areas.
- Take stairs, rather than the elevator for short jaunts, or get out one floor down if you have to go up many floors.
- Have standing up or walking meetings rather than sit-down meetings.
- If the workplace has a restroom, provide some basic exercise equipment in it such as a floor mat and the Pilates ball.
Read more in Promoting exercise at work.
Improve sitting work
- Promoting less sitting needs to be combined with improving the ergonomics of the seated work and how we work when seated: Provide ergonomic seating which allows dynamic sitting- the use of various postures-leaning back, inclining from side to side, rocking on the seat. As mentioned “Your best seated posture is your next one”.
- For computer work, provide ergonomic keyboards, mice, footrests, height-adjustable desks etc.
- Provide information and training about setting up workstations, adjusting ergonomic seating and changing posture while sitting (see dynamic sitting).
Consultation, training and instruction
It is important that the health consequences of prolonged sitting, the use of alternative workplaces and other interventions are encouraged by information, instructions and a corporate culture in which healthy behaviour is accepted.
Workers should also be consulted on and participate in the development of ways to reduce sitting at work and promote more movement. Their involvement helps to ensure the right approach and measures are taken, as well as motivating them. Encourage them to make suggestions. Workers and their representatives have a right to be consulted over health and safety measures such as the selection of seating. EU-OSHA resources provide support for running workplace discussions on MSDs and work, including on moving more at work as do Napo films.
Showing leadership and setting a good example is key to promoting changes in work culture and organisation.
What workers can do
Ergonomic sitting posture
The general principal is to always keep in mind the importance of working in an active manner which includes alternating between sitting, standing and walking and preferably doing some exercises on the job (e.g. shoulder rolling, standing up-sitting down, stretching hands, arms and shoulders).
With an ergonomic sitting posture, we mean correct sitting in the physiological sense. In ergonomics this is taken to mean a sitting posture where the spine largely adopts its natural double-S shape. This is possible if you tilt your pelvis slightly forward when seated, which will mean that the ribcage is slightly upright and the cervical spine is stretched. In this position a person can breathe freely, organs are not squeezed and the spine is in almost as a good a shape compared to standing.
Use the available seating support: backrest, sitting surface, armrests, seat height. With a good support you can stay sitting in a chair for a time. But no sitting posture can be maintained continuously! What is needed is movement...
If one has to sit, one shouldn’t stick rigidly to the chair, but change postures while seated:
- Rock your pelvis back and forward!
- Shift your weight sometimes more to the right and sometimes more to the left half of your behind!
- Push your rib cage forward and backward or to the side!
- Every now and again stretch your neck by pushing your head back!
- When sitting forward, support yourself on the desk!
- Lean back in a relaxed fashion against the back rest in the rear sitting position!
- Try to gyrate your hips!
- Utilise the positive effects of breathing on the spine and muscles: Breathe in as deeply as possible quite consciously, then breathe out slowly and press the residual breath out of your lungs. Try the exercise once more while stretching your arms and shoulders backwards as you breathe in and make yourself small like a parcel as you breathe out!
Stand up and Move!
There are many possibilities to move more during the working day, for example:
- If possible, cycle to work!
- If you go by car, park a little way away and walk to the office!
- Use the stairs instead of the lift!
- Remove whatever you use frequently out of your reach!
- If you have to sit, do it actively and dynamically!
- If you have a sit-stand height adjustable desk, use it to frequently to alternate between sitting and standing.
- Use a standing desk for everything that doesn’t require you to sit down!
- Occasionally conduct brief meetings, read mail and make phone calls standing up!
- Within the office do not deal with everything by mail or phone, but go personally to the person you want to communicate with!
- Use breaks as an opportunity to move! Incorporate micro breaks into the way you work, to frequently stand up stretch and sit down again.
Additional tips for teleworking
Teleworking is becoming increasingly common. Three principles for staying active and healthy when teleworking are: setting up a proper work environment; taking active break: and moving more while sitting. Tips for sitting less and moving more when working from home include
- Take advantage of the opportunity to wear comfortable clothing you can move easily in
- Take regular breaks during the day to get out of your chair and move around. Whether that’s to make a cup of tea or simply walk up and down the stairs a couple of times will help you stretch, relax and refresh, ready to concentrate again. Do some exercises while you wait for the kettle to boil.
- Set reminders on your phone or computer to take micro-breaks and get up and stretch every 20 to 30 minutes
- Put your mobile phone away from your desk
- Take a walk around your garden. If you have a dog, have a run around the yard with them as a break. Take out the rubbish as a break. If you live in an apartment block, walk back up the stairs
- Do a small house household task. This gives you a sitting break and has you moving as well
- Since your home is more private than an office environment, it is easy to do some stretching, yoga, a few strength exercises, jogging on the spot, push ups, or jumping jacks during a break of a few minutes
- On a conference call, if your camera is turned off and you have a wireless headphone and mic, you have much more freedom to move around, stretch and adopt different postures than in an office meeting
- Suggest scheduling a standing break at the start, middle and end of online meetings, so everyone gets up for a few seconds. Such breaks can be made part of remote meeting etiquette
- Get out and go for a walk around your neighbourhood during your lunch break
- Invest in a height-adjustable standing desk converter that can turn any ordinary desk into a sit-to-stand desk. Some low-cost home furnishing stores sell reasonably priced sit-stand desks
- Avoid eating lunch at your desk
- Move more whilst sitting, fidget in your seat, stretch a little, turn your head occasionally
- Treat exercise with the same priority as a work phone call. Blocking out time away from your desk means that you are more likely to do it
- Are there different ways you could work for short periods, other than sitting at your desk the whole time?
Tips for drivers
Compared to office workers, for drivers whether car, truck / bus drivers, it is even harder to stand-up during the working day. Advice for drivers include:
- Adjust your seating: frequent and excessive vibrations can hurt the body.
- Watch your posture as you drive and avoid leaning into the wheel while driving. Move around, change postures while seated.
- Back care for drivers.
- Take regular breaks to move around and do back stretches.
- Increase physical activity during leisure time to improve cardiovascular health.
- A guide to good practice for managing work related vehicle risks in the EU, with a specific focus on driving for work can be found at EU-OSHA
Links for further reading
- Up and Down – Up and Down, How dynamic sitting and standing can improve health in the office.
- Checklist for lower limb disorders.
- Standing up to sedentary work – A news site about workplace wellbeing.
- Reducing prolonged sitting in the workplace – An evidence review: summary report. VicHealth. 2012.
- EU-OSHA database on practical tools and guidance on MSDs – resources on sitting
- EU-OSHA report: Avoiding prolonged static sitting. EU-OSHA. (In press). Link will be added here: https://osha.europa.eu/en/research-work-related-msds
- Fitting the task to the Human, Textbook of work ergonomics, Taylor & Francis, 1997.
- Inqa buero, ‘Up and Down – Up and Down: How dynamic sitting and standing can improve health in the workplace’. Bundesanstalt für Arbeitsschutz und Arbeitsmedizin, Dortmund, 2008. Available at: https://www.baua.de/DE/Angebote/Publikationen/Praxis/A65.html?__blob=publicationFile&v=9
- Eurofound, ‘Sixth European Working Conditions Survey – Overview report (2017 update)’, Publications Office of the European Union, Luxembourg, 2017. Available at: https://www.eurofound.europa.eu/surveys/european-working-conditionssurveys/sixth-european-working-conditions-survey-2015
- Loyen A, van der Ploeg HP, Bauman A, Brug J, Lakerveld J, ‘European Sitting Championship: Prevalence and Correlates of Self-Reported Sitting Time in the 28 European Union Member States’ PLoS One, 11(3) 2016. Available at: https://www.ncbi.nlm.nih.gov/pubmed/26934701
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