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This study aimed to investigate differences in energy expenditure (EE), heart rate (HR), productivity, fatigue, and pain while performing desk work while sitting (SIT), standing (STAND), and standing on a balance board (BOARD).Thirty healthy adults (60% female, age = 39.7 ± 11.8 yr, body mass index = 26.7 ± 5.0 kg·m−2) employed in sedentary-based jobs volunteered for this randomized crossover trial. Participants performed typing work in three different positions: SIT, STAND, and BOARD, each condition lasting 30 min. Oxygen consumption (V˙O2) was measured via indirect calorimetry, and EE was calculated using respiratory quotient and corresponding caloric equivalent values. Productivity was quantified by measuring words typed per minute, accuracy, and typing mistakes. Overall feelings of fatigue and pain were self-reported three times during each position using validated 10-cm visual analog scales. Repeated-measures ANOVA was used to assess differences in outcome variables across conditions.V˙O2 was significantly different among all conditions regardless of current standing desk use (SIT = 3.35 ± 0.53, STAND = 3.77 ± 0.48, BOARD = 3.92 ± 0.54 mL·kg−1·min−1, P < 0.001). EE (kcal·min−1) also differed (P < 0.001) among SIT (1.27 ± 0.22), STAND (1.42 ± 0.26), and BOARD (1.48 ± 0.29). Compared with sitting (67 ± 9 bpm), HR was higher in STAND (76 ± 11 bpm) and BOARD (76 ± 11 bpm, P < 0.001). Measures of productivity were not different across conditions (P > 0.05). Fatigue progressively increased over each 30-min condition, whereas pain in SIT and BOARD increased from minute 10 to minute 20 and then leveled off between minutes 20 and 30. For STAND, pain continued to increase over time.Compared with sitting, a balance board may be effective for increasing EE without interfering with productivity in an occupational setting.