EE: Body Positions (2014)


Levine JA, Schleusner SJ, Jensen MD. Energy expenditure of non-exercise activity. Am J Clin Nutr. 2000; 72: 1,451-1,454.

PubMed ID: 11101470
Study Design:
Non-Randomized Controlled Trial
C - Click here for explanation of classification scheme.
Quality Rating:
Neutral NEUTRAL: See Quality Criteria Checklist below.
Research Purpose:

To investigate the thermogenic responses to fidgeting-like activities.

Inclusion Criteria:

Understand and give written consent.

Exclusion Criteria:

Refusal to consent.

Description of Study Protocol:
  • Recruitment: Procedures not specified
  • Design: Repeat measures, fixed order
  • Blinding used: Not applicable
  • Intervention: Not applicable.

Statistical Analysis

  • Mean energy expenditure for each 20-minute activity was calculated. All values are given as means ±SDs
  • Repeated-measures ANOVA was used to compare changes in energy expenditures, with post-hoc testing by paired T-test with Bonferroni adjustment
  • Linear regression analysis was used where appropriate.
Data Collection Summary:

Timing of Measurements

One measurement time.

Dependent Variables

Measured REE [(VO2, liters per minute), VCO2 (liters per minute; ml/kg per minute), RQ, ventilation (liters per minute)]. 

  • IC type: SensorMedics 229
  • Equipment of calibration: Yes
  • Coefficient of variation using standard gases: Not specified
  • Rest before measure (state length of time rested if available): 60 minutes
  • Baseline RMR: 30 minutes
  • Sitting, standing and treadmill: 20 minutes
  • Steady state: Continuous monitoring throughout measurement; all movement and activities recorded
  • Fasting length: Eight hours
  • Exercise restrictions XX hours prior to test? Eight hours
  • Room temperature: Thermal comfortable temperature
  • Number of measures within the measurement period: Data stored every 30 seconds
  • Were some measures eliminated? Not reported
  • Were a set of measurements averaged? Yes, for a 20-minute measure
  • Coefficient of variation in subjects measures? Not reported
  • Training of measurer? Not reported
  • Subject training of measuring process: Yes
  • Monitored heart rate? Not reported
  • Body temperature? Not reported
  • Dietary: No restrictions reported.

Independent Variables

Energy expenditure measured for 20 minutes under each of the following conditions:

  • Sitting motionless sitting in armchair with back, arms and legs supported and no movement
  • Sitting and allowed to freely move arms and legs
  • Standing with arms hanging by their sides and feet spaced six inches apart
  • Stand and move freely and emulate ADL
  • Walking on a treadmill (one miles per hour)
  • Walking on a treadmill (two miles per hour)
  • Walking on a treadmill (three miles per hour).
Description of Actual Data Sample:

Initial N
Not given.

Final N

  • Seven males
  • 17 females.


38±11 years.


Not specified; volunteers were all white.

Other Relevant Demographics

None specified.


  • Weight range: 48kg to 109kg
  • 10 with BMI under 25.0 (normal weight)
  • Nine with BMI between 25.0 and 29.9 (overweight)
  • Five with BMI over 29.9 (obese).


Mayo Clinic, USA.

Summary of Results:

Test-retest differences for duplicate measurement of RMR and motionless sitting and standing energy expenditure were less than 3%.


The SD of RQ for the last 15 minutes of measurement was less than 1% of the mean.

Group Mean: Energy Expenditure and RQ Associated with Activities

  Energy Expenditure
kcal per minute
Respiratory Quotient
kcal per minute
Resting 1.29±0.38 0.76±0.05
Sitting motionless 1.34±0.39 0.76±0.04
Sitting with fidgeting 1.96±0.55 0.76±0.04
Standing motionless 1.46±0.41 0.76±0.04
Standing with fidgeting 10.3±2.9 0.76±0.04
Walking (1.6km per hour) 3.3±1.02 0.76±0.04
Walking (3.2km per hour) 3.9±1.29 0.77±0.44
Walking (4.8km per hour) 5.1±1.9 0.77±0.03

[Analyst's note: When extrapolated to 24 hours, RMR=1,858kcal per day; sitting motionless was 1,958kcal per day)

  Energy Expenditure
percent above RMR
Sitting motionless 3.7±6.3
Sitting with fidgeting 54±29
Standing motionless 13±8
Standing with fidgeting 94±38
Walking (1.6 km per hour) 154±38
Walking (3.2 km per hour) 202±45
Walking (4.8 km per hour) 292±81
  • Fidgeting-like activities increased energy expenditure in each subject compared with the relevant motionless state 
  • The energy expenditure of fidgeting-like activities while seated was 2.6±1.5kJ per minute greater (0.62±0.38kcal per minute; P<0.0001)
  • Fidgeting-like activities while standing increased energy expenditure by 4.2±1.9kJ per minute (P<0.0001), compared with standing motionless. 

Correlation Coefficients for Body Weight (Dependent) and Energy Expenditure (Independent)1

  Energy Expenditure
Change in Energy Expenditure
Resting   0.342  --
Sitting motionless3   0.444  NS
Sitting while fidgeting5   0.464  NS
Standing motionless3   0.494  0.362
Standing while fidgeting6   0.484  0.187
Walking at 1.6km per hour6   0.494  0.384
Walking at 3.2km per hour6   0.564  0.524
Walking at 4.8km per hour6   0.644  0.614

1Left-hand column represents the relations between body weight and total energy expenditure for the activity indicated. Right-hand column represents the relations between body weight and change in energy expenditure for the activity indicated.
3Change in energy expenditure above resting values
5Change in energy expenditure above values for sitting motionless
6Change in energy expenditure above values for standing motionless

  • Total energy expenditure correlated significantly with body weight for each activity
  • There were significant correlations between the changes in energy expenditure that accompanied each activity conducted while standing and body weight
  • There was no significant relation between the change in energy expenditure of sitting activities and body weight.


Percentage change above resting energy expenditure (%).

[Analyst's note: Individual percentage change above RMR can be viewed from Figure 1 on page 1,453 of article, however interval markings on y-axis are too large to report range.]

Author Conclusion:

“In this study, we examined the components of non-exercise activity and their thermogenic potential and studied the changes in energy expenditure that accompany fidgeting-like movements in a group of healthy volunteers who varied two-fold in weight. An all the subjects studied, fidgeting-like movements at very low work intensities were associated with substantial increases in energy expenditure."

“Measures taken in highly controlled laboratory conditions but limitations include the no control over the amount of movement and that subjects’ self-selected, non-exercise activities in their home or office may be different. In contrast, [we were] able to obtain careful baseline RMR and during wide variety of self-selected activity."

“In conclusion, lean and obese subjects show substantial responses in energy expenditure to fidgeting-like and strolling-equivalent activities. The potential for weight loss may exist in increasing these activities or there are individuals who may be born with fidgeting."

Funding Source:
Government: US PHS
University/Hospital: Mayo Clinic
Reviewer Comments:

[Note: This quality rating is different from that assigned for the same study when answering the alcohol evidence analysis question. This is due to a research design designation, because this evidence analysis question is different from the researcher plan.]

This study does not have any information or testing related to consumption of alcohol. There is another worksheet by Levine and Harris that is related to energy expenditure with alcohol consumption.


  • Adequate description between movements in "motionless sitting vs. fidgeting while sitting"
  • Addressed criteria for accurate IC measure.

Generalizability or Weaknesses

  • Unable to identify gender of five obese subjects
  • Convenience sampling bias
  • IC components not discussed: Abstinence from smoking or alcohol prior to measure
  • Training of measurer not specified although likely due to prior publications abstracted for other sub-questions.
Quality Criteria Checklist: Primary Research
Relevance Questions
  1. Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies) Yes
  2. Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about? Yes
  3. Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice? Yes
  4. Is the intervention or procedure feasible? (NA for some epidemiological studies) Yes
Validity Questions
1. Was the research question clearly stated? Yes
  1.1. Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified? Yes
  1.2. Was (were) the outcome(s) [dependent variable(s)] clearly indicated? Yes
  1.3. Were the target population and setting specified? Yes
2. Was the selection of study subjects/patients free from bias? No
  2.1. Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study? No
  2.2. Were criteria applied equally to all study groups? N/A
  2.3. Were health, demographics, and other characteristics of subjects described? ???
  2.4. Were the subjects/patients a representative sample of the relevant population? ???
3. Were study groups comparable? N/A
  3.1. Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT) N/A
  3.2. Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline? N/A
  3.3. Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.) N/A
  3.4. If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis? N/A
  3.5. If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.) N/A
  3.6. If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")? N/A
4. Was method of handling withdrawals described? ???
  4.1. Were follow-up methods described and the same for all groups? N/A
  4.2. Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.) ???
  4.3. Were all enrolled subjects/patients (in the original sample) accounted for? ???
  4.4. Were reasons for withdrawals similar across groups? N/A
  4.5. If diagnostic test, was decision to perform reference test not dependent on results of test under study? N/A
5. Was blinding used to prevent introduction of bias? No
  5.1. In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate? N/A
  5.2. Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.) N/A
  5.3. In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded? N/A
  5.4. In case control study, was case definition explicit and case ascertainment not influenced by exposure status? N/A
  5.5. In diagnostic study, were test results blinded to patient history and other test results? N/A
6. Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described? Yes
  6.1. In RCT or other intervention trial, were protocols described for all regimens studied? N/A
  6.2. In observational study, were interventions, study settings, and clinicians/provider described? Yes
  6.3. Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect? Yes
  6.4. Was the amount of exposure and, if relevant, subject/patient compliance measured? Yes
  6.5. Were co-interventions (e.g., ancillary treatments, other therapies) described? N/A
  6.6. Were extra or unplanned treatments described? N/A
  6.7. Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups? Yes
  6.8. In diagnostic study, were details of test administration and replication sufficient? N/A
7. Were outcomes clearly defined and the measurements valid and reliable? Yes
  7.1. Were primary and secondary endpoints described and relevant to the question? Yes
  7.2. Were nutrition measures appropriate to question and outcomes of concern? N/A
  7.3. Was the period of follow-up long enough for important outcome(s) to occur? Yes
  7.4. Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures? Yes
  7.5. Was the measurement of effect at an appropriate level of precision? Yes
  7.6. Were other factors accounted for (measured) that could affect outcomes? ???
  7.7. Were the measurements conducted consistently across groups? N/A
8. Was the statistical analysis appropriate for the study design and type of outcome indicators? Yes
  8.1. Were statistical analyses adequately described and the results reported appropriately? Yes
  8.2. Were correct statistical tests used and assumptions of test not violated? Yes
  8.3. Were statistics reported with levels of significance and/or confidence intervals? Yes
  8.4. Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)? N/A
  8.5. Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)? N/A
  8.6. Was clinical significance as well as statistical significance reported? Yes
  8.7. If negative findings, was a power calculation reported to address type 2 error? N/A
9. Are conclusions supported by results with biases and limitations taken into consideration? Yes
  9.1. Is there a discussion of findings? Yes
  9.2. Are biases and study limitations identified and discussed? Yes
10. Is bias due to study's funding or sponsorship unlikely? Yes
  10.1. Were sources of funding and investigators' affiliations described? Yes
  10.2. Was the study free from apparent conflict of interest? Yes