Using Total Worker Health® Concepts to 

Reduce the Health Risks from Sedentary Work

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Institute for Occupational Safety and Health

Summary 

U.S. workplaces have become increasingly sedentary, with resulting 

negative health effects. Through its 

Total Worker Health® Program, the 

National Institute for Occupational Safety and Health (NIOSH) recommends an integrated approach 

to addressing sedentary work environments. An integrated approach 

is one that protects workers from 

work-related injury and illness and 

helps them advance their overall 

health and well-being, on and off 

the job. This document describes 

organizational practices that can reduce the risks associated with sedentary work. 

Sedentary Work

A sedentary job is defined as one that 

involves mainly sitting; though occasional walking, standing, and lifting (no more than 10 pounds) may be 

necessary to carry out duties [20 CFR*

404.1567]. More than 5 million U.S. 

workers hold management and professional positions, and 21 million work 

in office and administrative support 

*Code of Federal Regulations. See CFR in 

References.

occupations that involve long periods 

of sitting. More than 8 million people 

work in retail and sales jobs, most of 

which are either sedentary or stationary. Examples of retail occupations include cashiers, data entry, and call centers where service or sales employees 

often work in small cubicles or confined spaces [BLS 2016]. The number of 

workers who are sedentary is increasing worldwide [Shrestha et al. 2016], 

and long hours spent seated at work 

can increase health risks. 

Health Effects of 

Sedentary Work

Prolonged sitting is associated with back 

and shoulder pain, premature mortality, diabetes, chronic diseases, metabolic syndrome, and obesity†

 [Pronk et al. 

2012; Schulte et al. 2007]. These risks 

may persist even if a worker engages in 

†

Other workplace factors, such as shift work, job 

stress, and certain chemical exposures are also 

associated with an increased risk of obesity. For 

more information, see Pandalai et al. 2013.
2

recommended levels of physical activity during free time (150 

minutes of cardiovascular activity per week)‡ [Shrestha et al. 

2016; HHS 2008]. Obesity is associated with occupational injury and decreased productivity at work. It may also be a corisk factor for occupational asthma and can affect a worker’s 

response to chemical exposures [Schulte et al. 2007]. 

Prolonged standing can lead to venous disorders, back pain, and 

other musculoskeletal disorders [Waters and Dick 2014]. Grandjean [1988] notes how sitting and standing impose stress on different muscles, and therefore states that, “a workplace which allows the operator to sit or stand, as he wishes, is to be highly 

recommended from a physiological and orthopaedic point of 

view.” Thus, mobility is a key factor in counteracting the negative effects of both prolonged sitting and prolonged standing. Interruptions in prolonged sitting have been associated with improved metabolic profiles in adults [Pronk et al. 2012].

Total Worker Health®: An 

Integrated Approach

Total Worker Health (TWH) approaches are defined as policies, programs, and practices that integrate protection from 

work-related safety and health hazards with promotion of injury and illness prevention efforts in order to advance employee well-being. According to NIOSH research on TWH, 

comprehensive practices and policies that take into account 

the work environment (both physical and organizational), 

while also addressing personal health risks, are more effective in preventing disease and promoting safety and health 

than each approach taken separately [NIOSH 2015a; Sorensen et al. 2013]. Traditional workplace safety and health 

programs have concentrated on the safety of the work itself 

and on protection from exposure. Traditional health promotion programs have promoted personal health and individual interventions as something separate from these issues. But 

TWH recognizes how work itself is a determinant of health 

and how factors such as stress, workload, autonomy, hours 

of work, and being sedentary can influence health outcomes 

(such as obesity and cardiovascular disease) [NIOSH 2015a; 

Schulte et al. 2007]. 

Organizational Support for

Total Worker Health®

TWH prioritizes an emphasis on organizational-level policies, programs, and practices designed to protect workers 

and improve their health [NIOSH 2015a]. Organizations can 

lead through example and support positive peer influences within the work environment. Opportunities for organizations to help decrease sedentary time include offering the 

‡

Eighty percent of Americans don’t meet the minimum guidelines of 150 

minutes of cardiovascular activity per week.

flexibility to have standing or walking meetings, or providing 

sit-stand workstations. Flexible rest breaks can be allowed to 

break up static posture if a job involves prolonged standing. 

Rest breaks can be implemented without a resulting decrease 

in performance [Galinsky et al. 2000].

Organizational Benefits of

Total Worker Health®

Although TWH contends that the safety, health, and wellbeing of the worker are of primary importance, providing 

opportunities for promoting worker health (such as decreasing sedentary time and allowing time for physical activity) also has benefits to the employer. These benefits can 

be direct, such as the reduction of health-related expenditures and absenteeism, as well as indirect such as improved 

employee morale, advantages in recruitment and retention, 

and even reduced injury rates [Fabius et al. 2013]. Employers, workers, their families and communities all benefit from 

the prevention of disease and from sustained health that can 

result from increased physical activity [CDC 2014; Goetzel 

and Ozminkowski 2008]. 

Ergonomic Benefits

Addressing the health effects of sedentary work through 

management support and flexible rest breaks to promote 

health and prevent musculoskeletal injuries reflects the goals 

outlined in both the Occupational Safety and Health Administration (OSHA) Ergonomics Plan and the NIOSH Elements of Ergonomics Programs. For more information, see 

Elements of Ergonomic Programs: A Primer Based on Workplace Evaluations of Musculoskeletal Disorders and Protecting Workers from Ergonomic Injuries.

Potential Barriers to Reducing 

Sedentary Time at Work

Employers should also consider potential barriers to incorporating workplace strategies that can reduce sedentary time 

and improve worker health. 

The lack of job control is a key barrier: jobs that have high 

demands but little employee input in decisions increase the 

risk for obesity [Schulte et al. 2007]. One study noted that 

workers most affected by diseases associated with sedentary jobs also had the lowest levels of autonomy at work. This 

study also noted job autonomy as the greatest facilitator of 

acceptance of active workstations [Cifuentes et al. 2015]. 

Environmental and facility-related issues are also important 

barriers. If changing facilities, showers, or locker rooms are 

not available at work, workers may not choose to take walks 
3

outside, do intense stair climbing, or take advantage of interventions such as treadmill desks. Other barriers to acceptance of active workstations might include space considerations, noise of treadmills, speed of treadmills that affects 

productivity, and muscle pain (if workers are not trained in 

the use of active stations [Robertson et al. 2013]). Employers may also hesitate to accept active workstations since the 

health benefits are not seen as quickly as with cardiovascular 

exercise [see NIOSH 2015b for more information about the 

Total Worker Health webinar on sedentary work]. 

Another barrier to incorporating practices at work to promote health might be the physical demands of a job. It is important to note that physical exertion at work may not promote cardiovascular fitness [Holterman 2011]. Workers who 

perform heavy labor are often unable to control the intensity and duration of labor and frequency of rest breaks, which 

may lead to increased risk of cardiovascular disease. Fatigue 

from physically demanding jobs may prevent participation 

in physical activity during leisure time (i.e., walking during 

breaks) [Morse et al. 2012; Champagne et al. 2013; Baron et 

al. 2014]. 

As described in the principles of TWH, when addressing 

worker safety and health, an employer should consider these 

potential barriers and other factors that are part of the physical and organizational work environment [NIOSH 2015c]. 

Using a TWH approach to address these barriers offers opportunities to help reduce the effects of sedentary work.

Recommendations for 

Incorporating Total Worker 

Health® Concepts Into Workplace 

Safety and Health Programs

Employers should consider the following TWH concepts to 

reduce workers’ sedentary time while at work [CDC 2014; 

Cifuentes et al. 2015; OHSU 2014; NIOSH 2015d; Goetzel and Ozminkowski 2008; Morse et al. 2012; Goetzel et al. 

2014; HHS 2008, 2016; Waters and Dick 2014; Robertson et 

al. 2002; Grandjean 1988]:

 Include senior management support and worker participation in all health initiatives. 

 Involve workers and labor representatives in designing 

and implementing procedures and practices to reduce 

sedentary work and promote physical activity.

 Ensure that any program striving to advance worker wellbeing has the commitment of organizational leadership.

 Evaluate existing resources and current policies, programs, and practices to assess what works to promote 

physical activity and what the future needs are. 

 Offer workers more job autonomy, control over schedules and workloads, and control over the workstation and 

its setup so that they can take physical activity breaks after periods of sitting, or take rest breaks after prolonged 

standing or heavy labor.

 Educate management and supervisors on ways to reduce 

the job stress faced by workers, such as reducing demands 

or supporting rest and physical activity breaks.

 Ensure privacy: 

— Adhere to regulatory requirements such as the 

Americans with Disabilities Act, Health Insurance Portability and Accountability Act, Affordable 

Care Act, and applicable State laws. Make it clear 

to workers that they are protected from discrimination, adverse changes to health insurance status or 

costs, and confidentiality breeches. 

— Train all staff (including supervisors and managers) 

in privacy and confidentiality. 

— Remember that employee participation in any intervention is voluntary. Coercive incentives or disincentives should be avoided [Gellar 2005].

 Link existing worker safety and health programs to related programs such as employee assistance programs or related training efforts.

 Offer organizational and social support to encourage 

physical activity such as walking or biking to work or during breaks.

 Be aware of how the built environment can influence a 

worker’s level of physical activity, and where possible, 

provide input into constructing a built environment that 

encourages activity (e.g., a work station that allows for 

movement, safe trails around the workplace, or fitness facilities onsite or nearby).

 Evaluate the program and make adjustments as needed.

 Include health education (information dissemination and 

awareness) about the effects of sedentary work and prolonged postures (in combination with the policies, programs, and practices that allow workers to reduce their 

sedentary time at work).

Employers should consider the following to help workers incorporate movement into their workday:

 Design workstations to allow for mobility and posture change:

— Provide sit-stand workstations that allow workers 

to easily shift between seated and standing work 

tasks as best suits their needs.

— If sit-stand workstations or treadmill desks are adopted, ensure that workers are trained in their use 
4

in order to maximize their effectiveness and to prevent muscular discomfort or eye strain.§

 Allow for several short breaks throughout the day during 

which workers can engage in intense activity such as fast 

walking or stair climbing, or moderate mobility.

Workers can do the following to incorporate movement into 

their workday: 

 Stand or move around every 30 minutes (or as needed).

 Stand while talking on the phone.

 Hold walking meetings.

 Park farther away from the worksite to increase walking time.

 Take the stairs instead of the elevator.

In addition, the Department of Health and Human Services 

recommends resistance training and 150 minutes per week 

of moderate to vigorous physical activity [HHS 2008].

Acknowledgments

This document was prepared by Susan Afanuh of the NIOSH 

Education and Information Division, and Antoinette I. 

Johnson, formerly with NIOSH. The authors would like to 

acknowledge the NIOSH Office for Total Worker Health® and 

Vern Anderson for their review and guidance.

Suggested Citation

NIOSH [2017]. Using total worker health concepts to reduce 

the health risks from sedentary work. By Afanuh S, Johnson 

AI. DHHS (NIOSH) Publication No. 2017–131.

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§

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E9803F785C74490CAAF46BE62F6B.f01t04
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DHHS (NIOSH) Publication No. 2017-131

Using Total Worker Health® Concepts to Reduce the 

Health Risks from Sedentary Work

March 2017