On the balance sheet, we retired a significant majority of the 2021 convertible notes, leaving just over $1 million maturing in February of next year.
Additionally, adjusted EBITDA improved year-over-year and grew nearly 50% sequentially, driven by higher net sales and lower SG&A expenses.
With 95% of our sales in Northern Hemisphere, we anticipate continued elevated demand as winter weather forces more people indoors with pandemic blues occurring as a result.
As a result, reported net sales in Europe improved over 38% sequentially, although still lower than third quarter 2019.
We saw a similar type of recovery in North America in the form of higher quote volumes in the third quarter, which we anticipate will lead to increase sales through the end of the year.
This consolidates operations across Germany and is expected to generate approximately $5 million in annual cost savings beginning in 2021.
Reported net sales declined 10.1%, primarily due to lower sales of mobility and seating and lifestyle products, partially offset by growth in respiratory products.
Gross profit was lower by 40 basis points to 28.3% due to unfavorable manufacturing variances as a result of the lower sales volume.
To offset this, we were able to drive constant currency SG&A down 12.5% or $7.8 million through reduced employment cost, lower commercial expenses and favorable foreign exchange.
As a result, operating income improved by 21.2% or $500,000 and adjusted EBITDA was $9.8 million, up 2.5%, including the benefit of reduced SG&A expenses.
Free cash flow usage was $1.8 million, unfavorable to the third quarter 2019 by $14.1 million due to working capital needed to support operating activities.
Sequentially, reported net sales increased 8% and constant currency net sales increased 4.3%, driven by higher sales of mobility and seating products, including a 30% increase in Europe.
Gross profit was lower by 60 basis points to 28.3% due to unfavorable manufacturing variances as a result of lower sales volume and the expected mix of lower acuity products as elective care resumed.
Constant currency SG&A decreased 6% or $3.4 million, driven by lower stock compensation expense, which is typically higher in the second and fourth quarters of the year.
Operating income improved by $5.2 million, and adjusted EBITDA improved 48.7% or $3.2 million, driven by higher net sales and lower SG&A expenses.
As a result of the initial easing of public healthcare restrictions, constant currency sequential net sales increased by 8%, driven by a 30.4% increase in sales of mobility and seating products, reflecting an early rebound in demand, particularly in France.
Gross profit was 230 basis points lower due to the reduced net sales and unfavorable manufacturing variances, both impacted by the pandemic, which affected sales volume and product mix.
Operating income was lower by $3.8 million due to reduced gross profit from lower net sales, partially offset by actions reducing SG&A expenses, such as furloughs and reduced work hours.
Constant currency net sales increased 1.2%, with growth in respiratory products partially offset by lower sales of mobility and seating and lifestyle products.
Sequentially, constant currency net sales of mobility and seating products increased 0.2%.
Gross profit increased 170 basis points or $2.6 million, driven by higher net sales and lower material and freight costs from prior transformation initiatives, partially offset by unfavorable variances and higher warranty expense.
Operating income was $3 million, an improvement of $4.7 million, driven primarily by actions which lowered SG&A expense.
Turning to Slide 13, all other, which includes the sales of the Asia-Pacific region, decreased by 3.1% on a constant currency basis, driven by lower sales of mobility and seating products, partially offset by higher sale of lifestyle products.
Operating loss increased by $500,000 due to lower operating profit as a result of the dynamic control divestiture in the first quarter 2020 and improved $1.6 million sequentially, primarily driven by lower stock compensation expense.
As of September 30, 2020, the company had total debt of $273 million, excluding operating and finance lease obligations.
As of September 30, 2020, the company had $87 million of cash on its balance sheet, which was sequentially lower, primarily as a result of proactively repurchasing $24.5 million of convertible notes in the third quarter.
We are pleased to have retired the significant majority of these notes, which increased our financial flexibility, reduced ongoing interest expense and leave a balance of less than $1.3 million maturing in February of 2021.
For the full year 2020, the company now expects reported net sales of at least $840 million, up from the previous range of $810 million to $840 million, driven by the expected recovery of sales based on the recent trends we've seen in the early part of the fourth quarter.
Adjusted EBITDA in the range of $28 million to $32 million, up from the previous range of $27 million to $30 million due to the benefit of prior transformation actions and our continued ability to optimize cost.
And free cash flow usage in the range of $8 million to $12 million, changed from the previous range of 7% to 10%, given the timing of the recognition of sales during the fourth quarter delaying the collection of cash into the first quarter of 2021.

Summary:
We saw a similar type of recovery in North America in the form of higher quote volumes in the third quarter, which we anticipate will lead to increase sales through the end of the year.
For the full year 2020, the company now expects reported net sales of at least $840 million, up from the previous range of $810 million to $840 million, driven by the expected recovery of sales based on the recent trends we've seen in the early part of the fourth quarter.
Adjusted EBITDA in the range of $28 million to $32 million, up from the previous range of $27 million to $30 million due to the benefit of prior transformation actions and our continued ability to optimize cost.
And free cash flow usage in the range of $8 million to $12 million, changed from the previous range of 7% to 10%, given the timing of the recognition of sales during the fourth quarter delaying the collection of cash into the first quarter of 2021.