Eminent NHS physician and health policy influencer Sir Muir Gray is on a crusade to get people to work standing up instead of sitting down to improve their health. He himself is in his 70s and works in his north Oxford home at a standing desk. 

Sir Muir GrayProfessor Sir Muir Gray offers practical advice on how to fit walking and standing into our daily lives

By Olivia Gordon

Sir Muir Gray is doing this interview standing up. He has trained himself no longer to automatically search for a seat when entering a room. Instead the leading medical professor who has spent decades guiding the NHS in disease prevention works standing up in his north Oxford home and Summertown office, and talks to me in his office’s hallway where there are no chairs.

The man who believes ‘sitting is the new smoking’ looks at the world differently from most people. Most people think older people should be offered seats on trains. Gray thinks that the older you are, the more you should stand. From his perspective, not getting a seat on public transport is lucky, as is having to queue, or not finding a parking space near where you want to be – these situations force us to stand up and use our bodies. The worst thing a person can do for their health, he says, is to spend their life sitting down.  

Walking with Sir Muir Gray

The humorous Glaswegian, once described by the former chief medical officer Liam Donaldson as ‘undoubtedly one of the most creative minds in British medicine’, has been instrumental in shaping NHS health strategies for ageing, cancer screening and smoking cessation, and helped create NHS Choices and the National Library for Health; he is the chief knowledge officer of the NHS. Now the honorary professor based at Oxford’s Nuffield department of Primary Care Health Sciences is on a crusade to warn people of the lethal dangers of sitting. He believes the NHS will in the future look back on early 21st century Western sedentary culture as a public health disaster.

‘We now live in a very dangerous environment, for three reasons: the car, the desk job, and the Internet,’ he says. ‘We’ve got a Neanderthal body in a post-Neanderthal world. In the last 50 years we’ve seen medical miracles but our environment is as harmful as it was in the 19th century. We’re waking up now to the public health danger of the environment we live in and the need to build more energy expenditure into daily life. The evidence is very clear.’Professor Sir Muir Gray offers practical advice on how to fit it into our daily livesStudents hard at work at St Antony's College's library in north Oxford

The need to stand up rather then sit sounds obvious, but most people in Britain spend most of their waking lives sitting down. Sir Gray has long been among doctors advising the benefits of walking for health (his 2009 book, Dr. Gray’s Walking Cure, advises taking 3000 extra steps or 30 minutes’ extra walking daily). But the latest advice is not only to walk more, but to stand more. Over recent years, Sir Gray explains, research on the dangers of sitting has grown exponentially. One of his bibles, the 2014 book Get up! Why your chair is killing you and what you can do about it, by American obesity scientist James Levine, says that sitting is actually ‘worse than smoking’ for health. 

Levine’s revolutionary book explains that what makes people fat and unhealthy in body and mind is not so much how many calories they eat or how often they do a gym workout (which doesn’t burn that many calories), but how much time they spend standing up and moving in the course of everyday life – that is how hundreds or even thousands of daily calories can be burned. After all, slimmer people in the past ate more calories than we do today, but they spent their lives on their feet. The difference between lean and obese people, Levine’s research found, is that obese people sit for two hours, 15 minutes a day longer than lean people. The benefits are obvious - standing doubles your calorie expenditure. We burn one calorie a minute sitting, two calories standing, four walking. Professor Sir Muir Gray offers practical advice on how to fit it into our daily livesMany of us these days spend hours a day at a desk, as pictured here at Oxford's Taylor Institute Library, but Gray recommends walking or standing as much as possible

As a result, Gray not only walks and cycles as much as possible but usually now stands for about a quarter of his working hours, or half an hour every two hours, which, he says, is the minimum to aim for. If he has sat at a desk for 30 minutes, he gets up and does Pilates-style stretches for a few minutes – though he says even just walking to the printer or to get a drink will do. The standing desk is becoming more mainstream as companies have picked up on medical advice, but Gray says a makeshift one will do – putting the computer on a couple of boxes so that hands are at right angles is what he does.

If he needs to talk on the phone, he does it while walking. In London he gets off the tube stops two stops early and in Oxford instead of driving to work he walks to the bus stop and gets the bus to build in more steps, or he cycles. He aims to do work meetings while walking and instead of seeking a seat on the train to London he finds the buffet car and stands there with his laptop resting on the bar. At 72, Sir Gray is lithe, with an enviable body mass index of 19.

Professor Sir Muir Gray offers practical advice on how to fit it into our daily lives‘The older you get the more you’ve got to do,’ he stresses. ‘Older workers should be up more than younger workers. Ageing by itself isn’t a big problem – look at the Queen or David Attenborough, still working at 90.’ In the early 1980s, Sir Gray posited the idea of the ‘fitness gap’ – the difference between the best possible rate of physical decline we all experience after middle age and the far worse decline most people experience because of lack of fitness. His 2015 book Sod 70! made clear that unfitness and ill health need not be inevitable in one’s seventies.

And sitting down, he notes, doesn’t just make you fat and miserable, but also causes disease. ‘Some disease is bad luck and there are genetic factors but the rest is environmental – heart disease, stroke, type 2 diabetes…it’s the way we live.’ He explains that our bodies’ inbuilt stress reactions are designed to help us in active situations (like fighting for berries or running from wild animals) but when we’re sitting in an office feeling stressed, the body responds with inflammation, and ‘inflammation is thought to be the cause of many diseases – type 2 diabetes, dementia, vascular disease – most common problems.’

Homeworking, says Sir Gray, is the most dangerous work lifestyle because it demands so little activity. ‘Then taking your car to work - you walk from door to car. Then public transport – people like me have to avoid the eyes of young people and say I don’t want a seat. You’re luckiest if you can walk or cycle to work but not many can do that.’

Increasingly we are seeing schools and businesses bring standing desks and exercise equipment into the classroom. And university life will change, too. Gray has asked the Bodleian to introduce more standing lecterns for reading – he thinks the academic lifestyle spent sitting hunched over a book or screen needs to return to the ways of the past, when scholars routinely read and wrote standing up.

‘Most academics,’ he wrote to the Bodleian, ‘suffer from…Hyper Sitting Syndrome, spending at least eight hours a day sitting, and often more. Standing may not seem a great form of exercise but if someone who sat eight hours a day even stood two hours a day, the net effect is equivalent to running six marathons a year. It may be that the construction industry is now safer than the academic industry because academics have to spend so much of their time in that dangerous activity of sitting…What is needed is to make lecterns available in the Bodleian and I would be pleased to lead a sponsored walk to raise funds for their purchase.’

Gray has just finished a new book on health for people in middle age, including the need to walk and stand, which will be published in December. 

(This article was written standing up)

Images: Oxford University Images, Avalon, BBC


By Simon Mitton

How did academics write and read and talk in antiquity and the middle ages. Did monks in the scriptorium stand? Did Isaac Newton work standing at a lectern, or is that just a Cambridge Fairy tale?

Simon Mitton, MA PhD FRAS FGS FRHistS
St Edmund's College, Cambridge

By Chandrasekhar

Right on, Muir Gray! The people in Munich know that standing is good for the old: at 88 I am rarely offerres a seat. I stand at my computer and this means that I spend less time at it than I might sitting down.
Now off for a 30-minute walk.

By Simon Altmann

I am 92 and fit, and I walk as much as possible. But could somebody look at the design of pavements. The camber is often excessive and car entrances are totally unnecessary and if not dangerous surely it must do something wrong to your skeleton to walk with one foot 5 cm below the other. They could perfectly well be replaced by wedges on the gutter some 10 cm deep. I find walking on a horizontal surface a real (but rare) gift. Please give it back to us.

By michael crawford

Sir Muir Gray is to be saluted. I've had a standing desk for a couple of years now and I try to stand on trains as much as I can. However, I'd like to know whether *lying down* is just as bad as sitting. If we're simply talking about energy expenditure — and this is all the article focuses on — then presumably it is. But is energy expenditure the only issue? Or are there other factors, such as blood circulation? Standing to read, e.g. is no doubt the best posture to take, but could lying down to read at least be better, ceteris paribus, than sitting to read?

By Zufi Deo

Don't you think sitting in a different posture would be useful ! I was thinking about using yoga based poses to sit - they have been proven to help you focus for longer.

By Chris Chapman

Never stand when you can sit.
Never sit when you can lie.
Never lie when you can tell the truth....

By J P C Toalster

If the gentleman's name is Muir Gray, then now that he has been knighted he should be referred to as "Sir Muir Gray" (as at the beginning of the article) or as "Sir Muir".

What dimwit allowed the solecism "Sir Gray" to get into the article? He too should be made to stand - in the corner.


We are probably seeing only the tip of the iceberg. Many children today do almost no exercise (including standing) and have never done any, what condition will they be in when they are in their forties or fifties?
Standing may be better than sitting but I know of many people (myself included) who suffer from back pain due to standing for more than a relatively brief period, but who can do hard physical work all day with no problem.
I'm not convinced by Levine's research. If obese people sit for 15 minutes longer than lean people it is perhaps because they get tired more quickly on their feet than lean people. Perhaps they are obese for other reasons - metabolism, stress, depression - and need to rest more. Its not necessarily the sitting that leads to the obesity.
In the article, the advice of standing more moves on quickly to advice of doing more exercise in general, which is not new. The problem is actually persuading sedentary people to do more physical work, which is very difficult to accomplish. As the comparison is made with smoking, its only when a smoker has a heart attack or discovers he has lung cancer that he'll think about stopping smoking.
Thank you Sir Grey for alerting us all to this major health problem of modern society.

By David Roberts

What does he think about sedentary sports such as cycling and rowing?

By Tim Roberts

Interesting. At 79, (haiir - what there is of it - still mostly black) I often get offered a seat on trains by considerate youngsters. Wondering if I should challenge the next pretty young woman who does this with wanton disregard for my health and well-being?
Still - appears that there is little possibility of my being accused of endangering the health of others by 'passive sitting'.

By Gary

One consequence of the fact that more and more children are sitting in front of screens rather than running and playin outside is that they are failing to develop their long range vision. This is becoming a serious problem.

By Richard Orlando

Us old folks should at the very least remember the three G's, all of which involve standing up and walking:
Get up
Get dressed
Get out

By Angelo Gallina

Physical activity is good for health but has nothing to do with getting slimmer. Increasing work out activity is beneficial to the body's organs and systems which are thus kept in better conditions by increasing their functioning. But using "calories" as a unit for defining the food's attitude to make us more or less fatter is a terrible mistake and speaking of "burning calories" is a tale that we need to get rid of as our body is not a steam engine, neither a stove or an eater. Getting slimmer, or fatter if one prefers, is determined only and exclusively by what food we eat, in what combination and at what time of the day we eat it. And we need to replace calories with glycemic and insuline indexes, which are the fuel of lipo synthesis.

By Hoda Tabbarah R...

I like that combination of sitting & standing but probably for more then half hour standing for 2 hours sitting , I prefer sitting a shorter time than standing an equal time ! keeping on the go !I also like to know more about laying down in this combination of mouvement !!!

By Hoda Tabbarah R...

I like that combination of sitting & standing but probably for more then half hour standing for 2 hours sitting , I prefer sitting a shorter time than standing an equal time ! keeping on the go !I also like to know more about laying down in this combination of mouvement !!!

By Muir Gray

Thank you very much for your comments. i am preparing a paper for the Boolean where they used to have lecterns but took them out (decades ago) about, to misquote Chaucer

the pore skolar somdel stope in academe
from years of books and years of screene

By Clare Chardin

May be this is part of the reason why women (who cook etc.) and clergy (who pray) often live longer?


would love to be able to do it more, my orthopaedic surgeon has nagged me to stand on one leg whilst cleaning teeth (result toothpaste in hair) and when washing up dishes. Unfortunately RA, OA dyspraxia and neuro problems make it tough! As a walking orthopaedic and neuro disaster area, I would just love to try to be more mobile and stand as much as possible, and I have incorporated as much walking and moving as I can manage. I often work with disabled Uni sports science students, many of whom have sporting prowess and determination that puts old wrecks like me to shame! Wish Id been able to keep it up from a younger age and perhaps I wouldnt be in the mess Im in now!

By Plum Buddle

Members of the Bar know this well. When I changed from doing criminal law (where you mostly stand to address a court) to family law (where you mostly sit) at the end of my 40s, I put on 10lb in a few months. Outside court, clients are always offering us chairs but we never have a moment to sit with so much liaison to do in different parts of the building. Great to hear that other professions are taking this on board.