TECHNICAL FIELD

The present invention relates to standing desks designed for use by people while standing and to techniques for reducing fatigue caused by standing for prolonged periods.

BACKGROUND

Many people spend most of their day sitting with relatively idle muscles. Physical inactivity has many known deleterious effects on the body. Obesity, heart disease, and metabolic diseases such as type 2 diabetes are just a few examples of the consequences of a sedentary lifestyle. Exercise is generally viewed as important to the promotion of good health and slowing the effects of aging, particularly for the cardiovascular and musculoskeletal systems. Exercise also is thought to improve brain function, particularly cognition (Kramer et al., 2006). Although exercise therapy has the potential to treat both cognitive and motor decline in the elderly, long-term compliance with intense exercise regimens may be limited.

Advances in diabetes mellitus and obesity research have touted the benefits of “upright” standing or low-intensity walking activities while performing routine activities of daily living. A novel approach in combating metabolic disorders such as diabetes and obesity has been developed by the Mayo Clinic endocrinologist James Levine (Levine et al., 2005) who noted that non-exercise activity thermogenesis (NEAT), which reflects human energy expenditure through changes in posture and movement associated with routines of daily life, predicts obesity in office workers. Levine developed an “office of the future” by creating a “walk-and-work” desk for office workers (U.S. Patent No. 7,892,148 Stauffer) (Levine and Miller, 2007).

Although Levine’s work focused on office workers, there are many activities of daily living like talking on the phone, watching television, reading the newspaper, playing games, or using the home computer that can be done just as enjoyably upright. Hamilton et al. found that more standing and less sitting, promoted “optimal metabolism” (Hamilton et al., 2007). These authors found that sitting has negative effects on fat and cholesterol metabolism because of lack of lipase enzyme activation when muscles are idle. In contrast, standing and other non-exercise activities can double the metabolic rate in most adults even if they do no formal exercise at all. These metabolic effects come on top of physical conditioning benefits, including training of postural reflexes.

A disadvantage of the more intense walking movements in Levine's "office of the future" treadmill desk is that it may limit cognitive or office productivity performance when the user must focus on small objects on a computer screen and/or enter precision data on a keyboard. For example, a 2009 study investigated the effects of different workstation conditions — sitting, static standing, walking, and cycling — on standardized computerized tasks (Straker et al., 2009). Computer task performances were lower when walking and slightly lower when cycling, compared with chair sitting. Standing performance was not different from sitting performance. Computer mouse performances were more affected than typing performance. Performance decrements were equal for females and males and for touch typists and no touch typists (Straker et al., 2009). Another study of performance on a cognitive and fine motor test battery in young adults in seated and walking conditions found that treadmill walking causes a 6% to 11% decrease in measures of fine motor skills and math problem solving, but did not affect selective attention and processing speed or reading comprehension (John et al. , 2009). Another study evaluated the productivity of transcriptionists using a treadmill desk and found that, despite no significant change in the accuracy of transcription, the speed of typing was 16% slower while walking than while sitting (Thompson and Levine, 2011). Although dynamic and able to provide a relatively high amount of physical exercise, the treadmill workstation may have a cognitive cost that potentially reduces work performance in users in spite of any health benefits. Furthermore, long-term utilization of treadmill desk in office workers is limited.

While static standing may overcome some of the cognitive and task performance disadvantages of the treadmill desktop, actual use of available height-adjustable standing tends to decline over the long-term. This may be due to poor human tolerance of prolonged static postural conditions. Declining use over time of an available height-adjustable table in the standing position reduces or eliminates the metabolic and productivity benefit of such a workstation. Commercially available height-adjustable tables provide a heavy base of support that allow a user to alternate between standing and sitting positions to use the table. The table can be lowered to a sitting level or raised to a standing level using an electronic controller or hand crank when desired. Occupational studies have demonstrated short-term benefits associated with the use of height-adjustable tables when provided to workers in an office setting, including increased office productivity, reduced low back pain, and reduced absenteeism (Nerhood and Thompson, 1994). When height adjustable tables are provided to office workers, a majority of office work participants prefer the height adjustable table over a normal desk (Hedge and Ray, 2004). But these studies also show that the use of stand-up desks tends to rapidly decline after about a month — likely because people may not tolerate standing all day. Prolonged use of such stand-up desks can result in physical discomfort in the legs, spine, and/or other body regions due to relative lack of leg or body movements when standing at a static location. Lack of lower extremity or body weight shifting movements may be the most important contributor to the physical discomfort of prolonged standing.

Sedentariness is not only a common problem in office workers but also in persons with neurological or medical conditions that limit gait and balance functions because of poor postural or gait control or limitations in energy expenditure, such as metabolic disorders. Consequently, these persons will enter a vicious cycle where increasing sedentariness results in physical deconditioning and frailty that in turn will aggravate gait and balance disturbances increasing their risk of falls and traumatic fractures. Current clinical practice recommends a series of physical therapy to try to break the vicious cycle. However, clinical experience and studies have shown that, after completion of physical therapy, any early gains in mobility functions in these patient populations are short-lived, and afflicted persons quickly return to their sedentary lifestyle and continuing a downward clinical course. SUMMARY

In accordance with an aspect of the invention, there is provided a dynamic standing desk comprising a work surface configured to move with planar motion parallel with the ground and with a range of movement that adjusts as a function of the size of a user of the desk.

In various embodiments, the standing desk may include one or more of the following features, either singly or any technically -feasible combination.

- The planar motion is mediolateral motion with respect to the user.

- The planar motion includes mediolateral and anteroposterior motion with respect to the user.

- The range of movement is a function of a length of a leg of the user and, optionally, wherein the range of movement is between 25% and 35% of said length, the range of movement is between 55% and 65% of said length, or the range of movement is not between 40% and 50% of said length.

- The planar motion is at a rate between 2 millimeters per second and 10 millimeters per second.

- The dynamic standing desk further includes: a base, a tabletop that includes the work surface, a frame that movably couples the tabletop to the base, and at least one actuator configured to provide the planar motion. Optionally, the tabletop includes a cut-out at which the user stands and/or optionally the at least one actuator includes a first actuator configured to move the tabletop with respect to the frame along a first direction and a second actuator configured to move the frame with respect to the base along a different second direction, the frame being stationary with respect to the tabletop in the second direction.

- The dynamic standing desk further includes a controller configured to receive information pertinent to the size of the user and to set the range of movement based on the received information.

- The dynamic standing desk further includes a sensor configured to detect the presence of the user and, optionally, the sensor is configured to differentiate the user from a different user, the desk being further configured to adjust the range of movement based on information from the sensor. - A height of the work surface is adjustable.

- The dynamic standing desk further includes a tether for attaching the user to the desk.

In accordance with another aspect of the invention, there is provided a method of reducing lower musculoskeletal discomfort of a user of a standing desk, the method comprising the step of oscillating a work surface of the desk with a range of movement based on a length of a limb of the user.

In various embodiments, the standing desk may include one or more of the following features, either singly or any technically -feasible combination.

- The range of movement is between 25% and 35% and/or between 55% and 65% of the length of a leg of the user.

- A rate of movement of the work surface is between 2 millimeters per second and

10 millimeters per second.

- The step of oscillating includes mediolateral and anteroposterior motion of the work surface with respect to the user.

In accordance with one or more other embodiments, a dynamic standing desk may be provided with a table base and attached tabletop which is controlled electronically and moveable independently both in the X (left-right) and Y (anterior-posterior) directions. The table base may be height-adjustable, controlled manually or electronically, so that it is moveable in the Z-direction (up-down). Programmable continuous unidirectional or multidirectional XY movements or patterns of movements of the tabletop encourage or require a user of the desk to continuously take small steps in order to remain centered in front of the tabletop. An optional in-cut or cutout in the tabletop allows for additional human user step cueing. The tabletop is continuously or intermittently moveable and can be programmed with a predetermined rate of movement and range of movement in the X- and/or Y-directions or variable combinations of these. These parameters of tabletop movement can be input via a tabletop-mounted or remote Human Interface Device (HID). Planar XY tabletop movement can be enabled by mounting the tabletop on independent support bases movable in the X and Y directions. X and Y support base movement may be established through linear actuators directly moving the X and Y support bases, via rotary actuators moving the X and Y tabletop support bases by cogwheel or other directional switch transfer of rotary movement to linear movement, or other mechanisms of displacement.

The desk may include one or more controllers and electronic memory for collecting the user's stepping physical activity measurements either wired or wireless from body- attached accelerometers and other activity measurement devices. The desk may be configured to provide visual feedback of the user's activity levels, such as via an electronic display. The standing desk may be used with an anti-fatigue mat on which the user stands during use of the desk. Such a mat may be part of the dynamic standing desk itself or may be separately provided. An optional desk-attached fall-prevention belt attachment system may also be provided.

Another available safety feature is the use of individualized start-up and use of the dynamic standing desk based on user-worn sensors, such as radiofrequency identification (RFID) tagging, and desk-mounted sensors that track the height of the table and will allow automatic shut-off once the individual users stops using the desk. The tabletop of the desk can be vertically adjusted to the particular human user’s individual height preference or preference to intermittent alternations between sitting and standing. The dynamic standing desk may be an effective solution to combat sedentariness, the quick development of musculoskeletal discomfort when standing at a stationary height-adjustable workstation, and/or inactivity and prolonged sitting in populations with conditions that affect mobility or energy expenditure during physical activity and that generally benefit from low-intensity physical activity.

BRIEF DESCRIPTION OF THE DRAWINGS

One or more embodiments will hereinafter be described in conjunction with the appended drawings, wherein like numerals denote like elements, and wherein:

FIG. 1 is an isometric view of an exemplary dynamic standing desk with the tabletop in cutaway view; FIG. 2 is an exploded view of a dynamic standing desk with a coupling assembly similar to that of FIG. 1 ;

FIG. 3 is a rear view of a user standing at the dynamic standing desk at various positions relative to the tabletop;

FIG. 4 is a bottom view of the tabletop of an exemplary dynamic standing desk illustrating another example of the coupling assembly;

FIG. 5 is a side cutaway view of the tabletop of FIG. 4;

FIG. 6 is a perspective view of a portion of the coupling assembly of FIG. 4, illustrating actuators for moving the tabletop in different directions;

FIG. 7 is a chart illustrating musculoskeletal discomfort over time for users in a seated position, users in a static standing position, and users of the dynamic standing desk;

FIG. 8 is a chart illustrating musculoskeletal discomfort over time for users of a standing desk with various ranges of work surface movement;

FIG. 9 is a chart illustrating frequency of postural adjustments of users as a function of range of work surface movement;

FIG. 10 is a chart illustrating musculoskeletal discomfort as a function of range of work surface movement;

FIG. 11 is a chart illustrating musculoskeletal discomfort over time for diabetic users in same three conditions as the users of FIG. 7;

FIGS. 12A and 12B are charts illustrating results of “Timed getUp and Go” (TUG) evaluations for groups of physical therapy patients before starting physical therapy, immediately after completing physical therapy, and at 16 weeks after completing physical therapy, with results shown for patients who used the dynamic standing desk after completing physical therapy and for patients who used no desk after completing physical therapy; FIGS. 12C and 12D are charts illustrating walking times for the patients of FIGS. 12A and 12B; and

FIG. 13 is a chart illustrating average daily in-home use of the dynamic standing desk by physical therapy patients over time after completion of physical therapy.

DESCRIPTION OF ILLUSTRATED EMBODIMENTS

Described below is a dynamic standing desk capable of reducing musculoskeletal fatigue normally caused by prolonged standing. The desk has a movable work surface that causes the user to repeatedly shift their body weight and alter their posture, thereby providing the health and productivity benefits of a standing position without the discomfort that normally sets in after standing for prolonged periods in a static posture. These benefits extend beyond the office environment and into rehabilitation therapy for persons afflicted with health conditions, including metabolic or neurological conditions.

FIG. 1 is an isometric view of an exemplary dynamic standing desk 10, which includes a base 12, a tabletop 14 (shown in cutaway view), and a coupling assembly 16 that movably couples the tabletop with the base. A work surface 18 at the top side of the tabletop 14 is configured to move with planar motion parallel with the ground or floor — i.e., in an x-y plane of FIG. 1. This movement is with respect to the ground, the base 12, and with a user standing at the desk 10. The planar motion has a range of movement that adjusts as a function of the size of the user of the desk 10, as discussed in further detail below.

The illustrated base 12 is intended to remain static with respect to the ground and may be made from a relatively heavy material (e.g., steel or other metal) and/or with longer support legs for stability. The base 12 of FIG. 1 has a pair of upright and laterally spaced structural members, each with an elongated foot at a bottom end. The upright members may be spaced apart as far as is practical, and the feet may extend away from their respective upright structural member as far as is practical for stability as the tabletop 14 and its center of gravity move. The illustrated base 12 also has horizontal cross-members — one near the vertical center of the upright members, and one near the top of the upright members. Although not shown explicitly in the figures, the base 12 may have a manually or electrically adjustable height (e.g., telescopic uprights) so that the work surface 18 can be set at different heights for different users.

The work surface 18 of the tabletop 14 may be generally flat and designed to support items such as a desktop or laptop computer, computer monitor, video screen, and, at times, part of the weight of the user. The illustrated tabletop 14 is generally rectangular with an optional vertical wall extending downward away from the work surface 18 at its perimeter. A cavity or recess is can thus be formed beneath the work surface 18, which houses the coupling assembly 16 and/or other components. Other non-rectangular work surfaces are possible, such as more oval or shell-shape configurations. The tabletop 14 may additionally include a cut-out 20 along its perimeter as a visual or tactile cue to the user as to where to stand when using the desk 10. The cut-out 20 can be made deeper into the tabletop 14 so that the user is partly surrounded by the work surface 18. In some cases, the effective depth of the cut-out 20 is enhanced by extensions 22 in the y-direction (see FIG. 3). Deep cut-outs 20 and/or extensions 22 can provide movement cues to the user to prompt them to shift their weight away from a part of the tabletop 14 that has moved closer to the user during use.

With continued reference to FIG. 1 and additional reference to the exploded view of FIG. 2, the coupling assembly 16 includes a frame 24, one or more first guide sets 26, and one or more second guide sets 28. Relative movement between the tabletop 14 and the frame 24, along with independent relative movement between the frame 24 and the base 12, is provided via one or more actuators 30, 32 with particular degrees of freedom provided by and/or limited by the guide sets 26, 28.

The illustrated frame 24 is rectangular with a symmetric cross-shape connecting its pairs of opposite sides. One half of each of the guide sets 26, 28 is rigidly mounted to the frame 24. Each of the first guide sets 26 includes a guide 34 and a follower 36. The guides 34 in this case are rails with a U-shaped channel and are rigidly mounted to the frame 24. The followers 36 are sliders rigidly mounted to the tabletop 14 with downward-facing protrusions complimentary in shape with the guide channels. The first guide sets 26 thus provide a single linear degree of freedom of movement between the tabletop 14 and the frame 24 and restrict movement of the tabletop 14 relative to the frame 24 in other directions. In other words, the first guide sets 26 permit movement of the tabletop 14 with respect to the frame 24 in a first (x) direction and prevent relative movement of the tabletop 14 and frame 24 in a different second (y) direction.

Each of the second guide sets 28 also includes a guide 38 and a follower 40. The guides 38 in this case are rails with a U-shaped channel and are rigidly mounted to the frame 24. The followers 40 are sliders rigidly mounted to the base 12 with downwardfacing protrusions complimentary in shape with the guide channels. The second guide sets 28 thus provide a single linear degree of freedom of movement between the frame 24 and the base 12 in a first direction (along the y-axis in the figures) and restrict movement of the frame 24 relative to the base 12 in a different second direction (along the x-axis in the figures).

In this example, one of the actuators 30 is configured to provide movement of the tabletop 14 with respect to the base 12 in the first (x) direction. The illustrated actuator 30 is an electric motor rigidly mounted to the frame 24 with its axis of rotation oriented parallel with the y-axis. Rotational motion of the actuator 30 is converted to linear motion via a transmission, which in this case includes a pinion or worm gear mounted to the motor shaft and engaged with a toothed linear rack rigidly mounted to the tabletop 14. The other actuator 32 (FIG. 2) is configured to provide movement of the frame 24 — and, thereby, the tabletop 14 — with respect to the base 12 in the second (y) direction. The illustrated actuator 32 is an electric motor rigidly mounted to the base 12 with its axis of rotation oriented parallel with the z-axis. Rotational motion of the actuator 32 is converted to linear motion via a transmission, which in this case includes a pinion or worm gear mounted to the motor shaft and engaged with a toothed linear rack rigidly mounted to the frame 24.

This configuration provides independently controllable movement of the work surface 18 in two perpendicular directions parallel with the ground, including simple mediolateral (left-to-right) movement, simple anteroposterior movement, and any combination of those movements, such as circular, elliptical, or oblique movement in an x- y plane. The illustrated configuration also permits the x- and y-guide sets 26, 28 to be located within the same layer of the stack-up of the coupling assembly 16. The weight of the tabletop 14 is borne by bearings 42 mounted along the base 12. The illustrated coupling assembly 16 is merely illustrative and can be embodied in numerous variations, such as with the x- and y- directions switched, the guides and followers inverted, the uses of linear actuators and/or omission of transmission components, etc. The desk of FIG. 3, for example, is a variation of the desk of FIG. 2 in which the guide sets 26, 28 are oriented with the U-shaped channels opening in the horizontal rather that the vertical direction.

Both the range of movement and the rate of movement of the work surface 18 relative to the ground are controllable and adjustable. More particularly, the range of movement of the work surface 18 is adjusted as a function of the size of the user of the desk 10. It has been determined that particular amounts and rates of work surface movement relative to the user can reduce musculoskeletal discomfort enough to encourage the user to remain in the standing position longer than they otherwise would and to continue daily use of the standing desk for weeks or months longer than they otherwise would. As used herein, the “range of movement” of the work surface 18 or tabletop 14 is the extent of movement in an arbitrary direction in the XY plane before the work surface at least partially reverses direction. Generally speaking, the optimal ranges of movement are relatively greater for relatively tall users and relatively less for relatively short users. In particular, the optimal ranges of movement are related to the length of one of the user’s limbs. For example, the optimal ranges of movement of the work surface relative to the user is a function of the length (L) of a leg of the user or the average length of the legs of the user. This length (L) can be measured from the center of the hip joint to the heel of the user or from the anterior superior iliac spine to the medial malleolus.

In one embodiment, the work surface 18 is configured to move relative to the user with a range of movement equal to an amount between 25% and 35% of the length (L) of the leg of the user. In another embodiment, the range of movement is equal to an amount between 55% and 65% of the length (L) of the leg of the user. In another embodiment, the range of movement is exclusive of amounts between 40% and 50% of the length (L) of the leg of the user. The range of tabletop movement may be measured in the mediolateral (x) direction and/or the anteroposterior (y) direction. The rate of movement of the work surface 18 with respect to the user may be in a range from 2 mm/sec to 10 mm/sec in any planar direction, or between 2 mm/sec and 7 mm/sec in the mediolateral (x) direction and/or the anteroposterior (y) direction. In a specific embodiment, the rate of movement in the mediolateral (x) direction and/or the anteroposterior (y) direction is between 6 mm/sec and 7 mm/sec.

The standing desk 10 may further include a controller 44 configured to receive information pertinent to the size of the user and to set the range of movement based on the received information. The controller 44 can receive this information (e.g., length of user leg information) from a variety of sources, such as a human interface device (HID), a dial or switch, a sensor, a measurement device, a communication device such as a wireless transceiver, or from computer memory. In one embodiment, the standing desk 10 includes a sensor that determines the resonant frequency of an RFID tag carried by the user. The controller 44 receives the information from the sensor, matches it to a known user stored in computer memory, and sets the range of movement based on the known leg length of that user. In another embodiment, a vision system is used to determine the leg length of the user with the controller subsequently receiving that information and using it to set the range of movement. In another embodiment, the leg length of the user is entered by the user or another person manually, such as via touch screen, keyboard, or dial setting, or by voice command, and the controller 44 receives the information and sets the range of movement accordingly.

Where a sensor such as a vision system or RFID is employed, the presence or absence of the user may also be determined by the controller with the actuators being deactivated in the absence of the user. Other types of sensors such as motion or proximity sensors can be used to provide this safety function. A tether or safety harness may also be used to attach the user to the desk or to a nearby structure for further safety.

FIG. 3 illustrates a user from behind while performing tasks at an exemplary dynamic standing desk 10. As shown in FIG. 3, the user shifts their weight from left (a) to center (b) to right (c) while using the desk. While this may occur naturally when the user is at a static standing desk, the frequency of weight shifts and postural adjustments in that case may generally be based on discomfort; that is to say that the user shifts weight and changes posture to move from a posture that has already become uncomfortable to a different more comfortable posture. In other words, the frequency is too low or triggered too late to prevent the initial discomfort from being experienced. If the user shifts their weight more frequently — i.e., prior to discomfort setting in — the standing position is tolerable for extended periods of time. The dynamic standing desk and the controlled movement of the work surface as a function of the size of the user forces the user to shift weight and change posture more frequently and from the beginning of desk use.

FIG. 4 illustrates another embodiment of the standing desk 10 and is a bottom view of the tabletop 14 and coupling assembly 16. Here, the first and second actuators 30, 32 are linear. The frame 24 is embodied by x-direction guide rails 34 and y-direction guide rails 38, all of which move together. The frame 24 moves in the x-direction only with respect to the tabletop 14 under the power of the first actuator. Independently, the frame 24 moves in the y-direction only with respect to the base 12. Additional views are illustrated in FIGS. 5 and 6.

Various other features, benefits, and experimental verification of benefits of the dynamic standing desk are provided below.

Use of the dynamic standing desk may be referred to as a "step-and-work" autoexercise or "step-and-treat" clinical rehabilitation and is a time- and cost-effective lifestyle modification to facilitate lower extremity or body weight shifting movements. Targeted users are, but not limited to, office workers, fitness workers, or clinical rehabilitation patients, including those with metabolic or neurological disorders that affect gait and balance functions. Users stand at the desk with an automatically moving tabletop that moves in the transverse plane (X-Y movements). The range of X-Y movements can be adjusted such that the tabletop moves away farther than practical physical arm length use when using, for example, a keyboard. Tabletop movement necessitates physical and bodyweight shifting adjustment steps by the user to stay centered in front of the work surface. Built-in or attached cueing systems, such as a centered cut-out in the tabletop, attached flexible and adjustable gooseneck or cutouts at the level of the torso, or sensory (e.g., tactile, visual, auditory) sensor-driven cueing signals may produce the same effects.

The dynamic standing desk will generate variable work surface movement parameters — i.e., from slow to fast in terms of rate of movement, from continuous to discontinuous work surface movement, and from smaller to larger ranges of displacements. Relatively slow rates of movement will provide more smooth and slow stepping movements and will allow non-disrupted visual focus on an object on the desk, such as a display screen. Slow rates of movement will also allow non-disrupted use of a small object on the desk, such as a computer mouse, and will not interfere with handwriting, for example. Faster rates of movement and/or large ranges of movement of the work surface will increase the physical activity of the user. Bidirectional or multidirectional displacements (left-to-right or anterior-to-posterior or rotational variations of these) will induce weight-shifting stepping movements with truncal adjustments for the user. The dynamic standing table will increase physical activity and mobility compared to the sitting position and prevent or slow down the development of musculoskeletal discomfort associated with prolonged static body positions. Unlike the treadmill walk station mentioned above, the dynamic standing table can allow the user to maintain a stable eye- to-computer screen position and distance, which will allow continued fine oculomotor desktop activities. This may prevent cognitive cost and ocular strain effects while using a desktop computer or screens.

Advantages and features of the dynamic standing desk disclosed herein may include the programmable human use movable tabletop for office, personal, recreational, or clinical therapy uses. Built-in physical activity monitoring functions and monitoring systems can provide the user's advantageous functions of losing weight, improving energy and fitness functions, improving mobility and balance, maintaining cognitive productivity, and preventing or reducing musculoskeletal and mental fatigue and stress symptoms.

As described above, a height-adjustable (e.g., electrical, hydraulic, or hand- cranked) table base (one or multi-legged) may include, among other components, a moveable tabletop, a software-controlled programmable controller, a physical activity measurement device (e.g., user-mounted accelerometer), feedback device (e.g., electronic display or auditory information), and an optional tabletop cut-out or attached or cut-out physical cueing device. Tabletop XY planar movement can be established by mounting the tabletop on independent support bases movable in the X and Y directions. X and Y support base movement can established via linear actuators directly moving the X and Y support bases or rotary actuators or other motors moving the X and Y support bases by cogwheel transfer of the rotary movement to linear movement or other mechanisms of displacement. The tabletop is continuously or intermittently moveable and positioned with a predetermined rate and range of X and/or Y movement. These parameters may be input via a tabletop-mounted or remote computer and/or controller containing human-user activated software selections.

The computer and/or controller may include an input/output assembly that can be mounted to the tabletop or controlled remotely via wireless control. The computer may include components (e.g., numerical, light, voice, video-type or touch-screen buttons and displays) that enable the user to input control command to the actuator and/or actuator controller and to receive feedback regarding an exercise or use session (e.g., calories burned, distance traveled, heart rate, time elapsed, time remaining, limb and truncal movements, etc.).

The moveable tabletop may include at least one top layer (e.g., the work surface layer) with or without a variable number of one to two or more support layers (e.g., the coupling assembly). Displacement of one layer relative to the base can include a sliding, gliding, wheeled, cogwheeled, or gear-based mechanical translation or rotation mechanism. Variants of the dynamic standing table include an X-X' oscillating tabletop capable of exclusive left-to-right bidirectional movement relative to the user, or a Y-Y' oscillating tabletop capable of exclusive anterior-to-posterior bidirectional movement relative to the user. The construction of an exclusively X-X' or Y-Y' oscillating tabletop will be simplified compared to a multi-directional moving tabletop, as they do not require the extra materials (e.g., actuators) and/or translation layer for the opposite direction. The physical activity monitoring and fitness feedback system may include a portable monitoring device with a feedback system to collect information wired or wirelessly from body-attached accelerometers and other activity measurement devices to enable feedback of the user's activity levels, such as by displaying the feedback.

Embodiments of the dynamic standing table can be made to include one or more of the following features:

- An oscillating tabletop on a stand-up desk or height-adjustable table with relatively faster or slower displacement movements (e.g., 45 seconds per foot) forcing the user to make frequent adjustment steps in order to stay connected to the desktop.

- An oscillating tabletop on a stand-up desk or height-adjustable table where the motion of the tabletop is created by a system of motors and gears allowing multidirectional movement of the working surface. Rotational motors may have a gear affixed to their rotating shafts to rotate along with the motor shaft. The teeth of the gear may interlock with a gear rack in order to move the gear rack, and everything it is attached to, in a linear but adjustable direction. Transfer bearings, clamps, and/or slider assemblies support the weight of the tabletop while also allowing the tabletop to move along a safe, confined path. A frame of the coupling assembly with sliders may be used to spatially separate x-axis motion from y-axis motion while also connecting them to allow tabletop movement in diagonal, circular, oblique, rectangular, square, or other patterns.

- An oscillating tabletop coupled with a desk base via a single layer sliding system permitting multidirectional movement of the tabletop driven by one or more non-linear actuators or other mechanical non-linear movement system (e.g., FIGS. 1 and 2).

- An oscillating tabletop on a stand-up desk or height-adjustable table with smooth biomechanical means of element displacement that is not based on cogwheel mechanics or wheels but on minimal to no noise producing mechanics based on ultra-smooth gliders and engines, such as actuators with minimal to no noise. The oscillating stand-up desk or height-adjustable desk may be motorized, including by brushless or other quiet actuators or hydraulic motors, and may be located on a system of sound absorbing material covering the motor and mechanical part of the oscillating desktop or surrounded by sound-absorbing cover materials.

- A multi-directional oscillating tabletop on a stand-up desk or height-adjustable table with a single lightweight tabletop support frame where motors or actuators are built-in and attached simultaneously to the tabletop in such way that their individual perpendicular excursion ranges do not spatially interfere or overlap with each other. For example, one approach is shown in FIGS. 4-6, where the mediolateral and anteroposterior actuators 30, 32 are positioned along an imaginable 'L' configuration without touching or overlapping each other. This construction can reduce production costs, material expenditure, and overall weight of the oscillating tabletop with the additional benefit of reduced noise due to a light but robust design. This configuration allows perpendicular directional movements, such as square stepping movements to enable an increasing activation of various and different extremity and truncal muscle groups.

- An oscillating tabletop on a stand-up desk or height-adjustable table that promotes not only lower extremity stepping movements but also causes shifts between upper body forward or side-way leaning posture with a transfer of weight from the lower trunk and extremities to the desktop which is equipped with a robust metal or other suitably strong material and a heavy base that prevents tabletipping movements.

- An oscillating tabletop on a stand-up desk or height-adjustable table with sufficiently slow or fast, sufficiently wide, mediolateral, anteroposterior, or multidirectional (e.g., patterned, circular, oblique, etc.) movements to provide a therapeutic means to alleviate debilitating symptoms in afflicted patients.

- An integrated NEAT or limited exercise office, therapy, or home set-up that includes standing at an oscillating tabletop on a stand-up desk or height-adjustable table with the additional use of applied low weight lower extremity weights to synergistically combine stepping movements with weight-bearing leg lifting that may result in improved bodily functions dependent on weight bearing. - An oscillating tabletop on a stand-up desk or height-adjustable table or sitting desk where user feedback about movements and/or physiological parameters are fed back to the user to enable incentive use of the set-up.

- An oscillating tabletop on a stand-up desk or height-adjustable table configured to disrupt any sedentary activity and promote bipedal stance and stepping. Individual tolerance of static standing is limited (e.g., 30 minutes or less), making static standing insufficient to achieve worthy bipedal use exceeding 4- 6 hours or more per day. Stepping movements induced by the dynamic stepping desk will result in less complaints of lower extremity and truncal discomfort, thereby providing a means to achieve longer duration bipedal body use and reciprocally reduced sedentariness.

- The dynamic standing desk may be used with particular flooring features, such as anti-fatigue mats or slightly sloped standing surfaces.

- An oscillating tabletop on a stand-up desk or height-adjustable table with a cueing system, such as a cutout in the tabletop, which can be semicircular or square in nature as demonstrated in FIGS. 1, 3 and 4. Additional cueing may be provided in the form of L-shaped forms or other extensions 22 (FIGS. 3 and 4) attached to an adjustable slide system, which will allow for adjustment to anthropometric dimensions of the human body. The cutout and form will provide gentle nudging providing users cues for position changes as the tabletop moves.

- An oscillating tabletop on a stand-up desk, height-adjustable table or regular desk, which provides user feedback about accomplished health benefits. An integrated feedback system can provide information about the number of steps taken, average heart rate, and calorie use. Integrated force plates or other form of force measurement (e.g. Wii™ balance board) can provide additional feedback about symmetry of weight shifting which may allow users to make postural corrections and improve posture.

- An oscillating tabletop on a stand-up desk or height-adjustable table configured to specifically stimulate conditioning of postural reflexes and force weight and postural adjustment lower extremity stepping movements as a means of nonexercise thermogenesis (NEAT) or in physically deconditioned persons afflicted with medical disease low to intermediate aerobic exercise activities and physical activity to improve their clinical motor, cognitive, metabolic, and other health-related functions in clinical outpatient, hospital, rehabilitation, physical therapy, or in-home therapy settings.

Experimental Results

The dynamic standing desk has been found to provide physical activity in users while at the same time reducing development of musculoskeletal discomfort and providing health benefits compared to regular height-adjustable standing desk use and sitting in healthy adults.

FIG. 7 is a chart illustrating total musculoskeletal discomfort, as rated by healthy adult participants, as a function of time in three different conditions: sitting, static standing at a desk, and standing at the dynamic standing desk. In this study, each participant completed three 4-hour sessions, including the baseline sitting session first, followed by either a static desktop standing session or a dynamic desktop standing session. The third session was whichever of the static or dynamic sessions that had not yet been completed. Oxygen consumption by the test subjects progressively increased from sitting to static standing (+17%; p=0.008) to dynamic standing desk use (+28%; p<0.001), where an additional 14% increase in oxygen consumption was observed from static to dynamic standing desk use (p=0.047). Overall physical activity and weight-shifting movements progressively increased from sitting to static standing (+106%; p=0.006) and from static standing to dynamic standing desk use (+75%; p=0.010) use. In FIG. 7, the rate of total musculoskeletal discomfort development is indicated by the slope of the dashed lines for each condition. The rate of development of musculoskeletal discomfort was lowest in the sitting condition (1.01 ± 1.25mm/min) and highest during static standing desk use (1.76 ± 1.86 mm/min). Use of the dynamic standing desk had a lower rate of development of musculoskeletal discomfort (1.35 ± 2.14 mm/min) than static standing. There was no significant evidence of cognitive or typing skills worsening between the dynamic versus standing desk use and sitting. The effects of range of movement of the work surface of the dynamic standing desk were also studied. Among three different ranges of work surface movement, including 30%, 45%, and 60% of the individual user’s leg length, the shorter and longer ranges of movement resulted in additional attenuation of the levels and rates of development of musculoskeletal discomfort in healthy adults. Participants first completed a baseline sitting session, then completed a 2-hour static or dynamic standing desk session, then completed whichever 2-hour static or dynamic standing desk session had not yet been completed. The dynamic standing sessions were completed with the aforementioned different ranges of movement. As shown in FIG. 8, the highest levels of musculoskeletal discomfort at all time points was in the static standing condition, as was the highest rate of increase of discomfort. The rate of increase of musculoskeletal discomfort was similar for the 30% and 60% of leg length ranges of movement, with the 45% of leg length range of movement falling between static and 30/60%. These results show that optimized use of the dynamic standing desk favors either a shorter range of tabletop movement (30%) or a longer range of tabletop movement (60%), which result in additional attenuation of the level and rate of musculoskeletal symptom development compared to a 45% of leg length range of movement in healthy adults.

As shown in FIG. 9, increasing ranges of tabletop movement of the dynamic standing desk results in higher but flattening increases in physical activity from 30%, 45% to 60% of leg length in healthy adults, as measured by frequency of postural adjustments. Increased user physical activity with the dynamic standing workstation was due to more frequent postural adjustments, especially in the medio-lateral direction, and not to larger postural adjustments. The average magnitude of the postural adjustments was constant among all tabletop conditions, in both the medio-lateral and the antero-posterior directions. Combining information from musculoskeletal discomfort ratings (FIG. 8) and total physical activity (FIG. 9) showed that a 60% of leg length range of movement of the tabletop during dynamic standing desk use maximizes physical activity lowering the amount of musculoskeletal discomfort and the rate of increase of musculoskeletal discomfort in healthy adults. As shown in FIG. 10, at a range of movement of 60% of user leg length, participants developed less than 20% of the musculoskeletal discomfort that was developed when the tabletop was stationary. Stated differently, the musculoskeletal discomfort during static standing was 5.3 times more than when the tabletop moved with a range of movement equal to 60% of user leg length. Use of the dynamic standing desk may better exploit the motor benefits of standing by increasing physical activity and by reducing the development of musculoskeletal discomfort — one of the major negative side effects of prolonged standing. The dynamic standing desk may therefore be beneficial to populations that perform desktop work in prolonged sitting positions, such as office workers, and especially to those individuals who inherently stand rather statically and/or require cues to make postural adjustments to maximize physical activity. Other populations that may benefit from the dynamic standing desk are those with conditions that affect mobility, and as such, tend to be inactive. In such patient populations, standing can have positive effects in terms of physical functioning, strength, and balance compared to the detrimental effects of sedentariness.

The dynamic standing desk has also been shown to provide metabolic health improvements in persons with metabolic disorders, such as diabetes mellitus. FIG. 11 is a chart illustrating total musculoskeletal discomfort, as rated by older adult diabetic participants, as a function of time in three different conditions: sitting, static standing at a desk, and standing at the dynamic standing desk. In this study, each participant completed three 4-hour sessions, including the baseline sitting session first, followed by either a static desktop standing session or a dynamic desktop standing session. The third session was whichever of the static or dynamic sessions that had not yet been completed. Oxygen consumption and overall movements by the test subjects progressively increased from sitting to static standing to dynamic standing desk use (p<0.001). The duration of breaks during standing (p=0.024) and rate of total musculoskeletal discomfort development (p=0.043) were lower with use of the dynamic standing desk compared to static standing sessions. There was no evidence of cognitive worsening during either standing session compared to sitting. There was also no significant worsening of leg swelling during 4-hour dynamic standing use compared to sitting.

The dynamic standing desk has also been shown to extend clinical effects of physical therapy in physically deconditioned persons afflicted with age or disease-related conditions affecting mobility, such as persons with Parkinson's disease. As the benefits of physical therapy in patients with mobility impairments may be short-lived, a clinical rehabilitation dynamic standing desk may augment or extend the early clinical gain of physical therapy to serve as a post-physical therapy extension or supplementation that can be provided in the home of the person with the mobility condition with long-term sustained clinical benefits and without serious adverse effects. For example, data from a clinical trial in patients with Parkinson's disease who had gait and balance disturbances received 12 sessions of physical therapy, after which the patients improved on walking and balance control (functional mobility) measures, such as the Timed Up and Go (TUG) test and walking time at the time of completion of the therapy. The patients were then randomized into one of two groups. One group used a dynamic standing desk at home after completion of physical therapy, while the other group use no desk at home (the usual care) for a 4- month post-physical therapy extension period. Clinical assessment was repeated at the end of the 4-month extension period and compared to assessments prior to and at the time of completion of the physical therapy.

Analysis of the group differences showed a clinical effect in favor of maintaining the post-physical therapy effects in the dynamic standing desk group compared to the control (usual care) group. In FIGS. 12A-12D, lower is better for TUG time and Walking Time. As shown in FIGS. 12B and 12D, the control group tended to return to pre-physical therapy performance levels at the end of the 4-month extension period. As shown in FIGS. 12A and 12C, dynamic standing desk users maintained or improved their TUG time and walking time results obtained immediately after completion of physical therapy. In the nodesk control group, the initial physical therapy benefit of 9.8% improvement in TUG time reversed after cessation of the physical therapy (-10%) (FIG. 12B). In contrast, the dynamic standing desk group lost only 1.3% of the initial 9.8% physical therapy improvement during the post-physical therapy extension period. Interestingly, these differential trends occurred despite the relatively slower baseline score times in the dynamic standing desk group compared to the usual care control group. This suggests that the use of the dynamic standing desk is of benefit in patients with relatively more functional mobility deficits. It also suggests that loss of early physical therapy benefits occurs even in patients with relatively less severe functional mobility deficits. Similar results were observed for the 8.5 m walking task (FIGS. 12C and 12D). The study also confirmed both feasibility and safety (no serious adverse effects) of in-home use of the dynamic standing rehabilitation desk.

Additionally, as shown in FIG. 13, there was very good long-term compliance of daily use of the dynamic standing desk over the 4-month post-PT period with an average of 2.2 ± 0.4 hours per day for at least five days per week without a significant drop-off of daily use duration with trial progression. In-home use of the dynamic standing rehabilitation desk will allow integration of routine activities of daily living, such as using a computer, watching television, mail sorting, cooking, or sewing.

The dynamic standing desk may thus provide one of more of the following benefits:

- Increases in oxygen consumption and overall physical movement by the user while concurrently attenuating musculoskeletal discomfort compared to static standing desk use in healthy adults.

- Additional attenuation of the level and rate of musculoskeletal symptom development with ranges of movement of 30% or 60% of user leg length.

- No reduction of cognitive or typing skills compared to sitting in healthy adults.

- A therapeutic means to alleviate debilitating symptoms in certain patient populations.

- In-home use as an adjunct to physical therapy.

- As an adjunct to physical therapy, safe at-home use in patients with gait and balance disturbances, such as Parkinson's disease.

- As an adjunct to physical therapy, feasible in-home use in patients with gait and balance disturbances, such as Parkinson's disease, allowing sustained long-term daily use.

- Integration of routine activities of daily living avoiding traditional barriers to exercise.

- As an adjunct to physical therapy, in-home use that maintains improvements in walking and balance functions in patients with gait and balance disturbances, such as Parkinson's disease.

- Feasibility of prolonged (e.g., 4-hour) sessions in older adults with type 2 diabetes and results in metabolic benefits (increased oxygen consumption and increased physical activity. - No reduction of cognitive or typing skills compared to sitting in elderly persons with type 2 diabetes.

- No increased leg swelling compared to sitting in elderly persons with type 2 diabetes.

It is to be understood that the foregoing description is of one or more embodiments of the invention. The invention is not limited to the particular embodiment s) disclosed herein, but rather is defined solely by the claims below. Furthermore, the statements contained in the foregoing description relate to the disclosed embodiment s) and are not to be construed as limitations on the scope of the invention or on the definition of terms used in the claims, except where a term or phrase is expressly defined above. Various other embodiments and various changes and modifications to the disclosed embodiment s) will become apparent to those skilled in the art.

As used in this specification and claims, the terms “e.g.,” “for example,” “for instance,” “such as,” and “like,” and the verbs “comprising,” “having,” “including,” and their other verb forms, when used in conjunction with a listing of one or more components or other items, are each to be construed as open-ended, meaning that the listing is not to be considered as excluding other, additional components or items. Other terms are to be construed using their broadest reasonable meaning unless they are used in a context that requires a different interpretation. In addition, the term “and/or” is to be construed as an inclusive OR. Therefore, for example, the phrase “A, B, and/or C” is to be interpreted as covering all of the following: “A”; “B”; “C”; “A and B”; “A and C”; “B and C”; and “A, B, and C.”