Why Flying Economy Could be a Health Risk and What You Can do About It

May 21, 2015

If you’re planning on flying domestically via economy class this summer, the last thing you want to worry about is your health. With those darned shrinking seats, air travel is becoming a legitimate health risk–especially for certain travelers.  What types of travel gear can help protect your health and safety? And what about those darned seats? Sit back (not too far back) and let’s talk about how those seats came to be so cozy and how you can stay healthy and comfortable before, during, and after your flight.

Less Room for Big Bird in the Big Bird

Although travel is said to be broadening, when seated in coach, it may not always feel that way.

Since deregulation in 1978, the airline industry has fought to cut costs, keep fares reasonable, and remain competitive (depending on your views of the airlines in a free market, insert own adjectives here).

Although the infrastructure of air travel (airports, air traffic control, and air security) is still regulated in America by the government, the experience of flying has become more Spartan. Passengers across seating classes have felt a pinch in service; those who fly economy get pinched the hardest.

Right in the seat.

It’s not easy to finagle 165 seats into a cabin space intended to hold only 150 seats—and to do so without consequence. Thus, when airlines try to cram extra seating into the same amount of real estate, it is no surprise that passengers cannot recline without fear of hurting themselves or someone else.

Uncomfortable seats in economy class have long been a concern from airline customersSpineUniverse found that 75% of travelers would pay more out of pocket for a seat that does not give them neck or back pain. Those who suffer the most said they would pay up to $50 more for a comfortable seat, and 20% would pay up to $100 more. Short of taking lessons from Zlata the contortionist, nonstandard-size passengers on a budget face the task of how to compress their bodies into a space not especially designed for them. 

Methods exist that allow some people to lose weight; what kind of crunches can be done to help tall people lose height?

Although the too tall passenger who enjoys science fiction may fantasize about jumping into an electromagnetic shrinking machine preflight, reality would have it otherwise.

Wider Bodies, Narrower Seats

Although there is a debate about whether Americans are getting taller, the Centers for Disease Control and Prevention cites that, since 1980, the obesity rate has doubled among adults and has tripled among children regardless of age, gender, social class, race, ethnicity, and region.

That the width and pitch of economy airline seats for domestic travel have become narrower as Americans have become wider is irony writ large.

Pitch is the distance from the back of one seat to the back of the next. It is an accurate measure of legroom. Depending on the carrier and class, the pitch of plane seats has been reduced. In economy class, pitch is down from around 32+ inches to as close as 28 inches (fly Spirit: be scandalously Spartan).

Width means the distance between the two armrests of your seat.  Consider the seating of a Delta Boeing 757-200.

Distance between airline seats

On Delta, from First Class to Economy Comfort and Economy Class, your seating width diminishes from 21.0 inches to only 17.2 inches:

Type of Seat Pitch Width Other Seating Details
First 37 21.0 22 recliner seats
Economy Comfort 34-35 17.2 18 standard seats
Economy 30-32 17.2 141 standard seats

The width between coach seats is narrowing; if you’re lucky, you can find a width of 8.25 inches, but it is usually less. Coach once featured nine seats across, whereas the new standard is 10 seats across in a 3-4-3 layout, as seen in the American Airlines’ Boeing 777-300ER model.

Different airline classes

Visit Seatguru.com

Flying domestically via coach?  Internationally via business class?  Want the best seat on the plane? Seatguru.com is a straightforward guide for travelers who appreciate details. Type in the plane model you want to use, and Seatguru.com shows you that not all seats are created equal.

Oh, My Aching Legs: Prevent Blood Clots During Long Trips


There has long been the debate in the medical community about the risk of developing a blood clot during air travel in coach class. The economy-class syndrome was coined in 1988 by Cruickshank and colleagues at ICI Pharmaceuticals in Macclesfield (UK), who theorized that the limited legroom in coach seats meant that passengers would be less likely to stand up and walk around the cabin during flight. It was believed that such inactivity could lead to the development of blood clots in large veins, usually in the calf of the leg, a condition known as deep vein thrombosis (DVT).  Another risk is the blockage of arteries in the lungs, or a pulmonary embolism (PE).

Planes, Trains, Automobiles…and Accountants?

The economy-class syndrome is somewhat of a misnomer; traveler’s syndrome or even sitting duck syndrome might be more accurate terminology.

The operative phrase is sitting upright for long hours. You needn’t be sitting upright in an airplane for this to happen; a clot can also develop after a long trip by train or car.

If you sit upright at a desk for hours without break and have other risks factors, you could be at risk of developing a clot (there must be many accountants who have developed blood clots after tax season).

In the case of flying, a DVT could develop regardless of whether you fly in coach class or first class. Although research varies a bit in its definition of a long time, the highest risk seems to set in at the 8-10 hour mark.

New Guidelines for Blood Clot Prevention During Long-Distance Travel

In 2012, the American College of Chest Physicians (ACCP) published new evidence-based guidelines to manage risk factors of DVT and VTE related to long-distance travel.

It is important that you identify whether or not you have these risk factors since the ACCP has found that many patients unnecessarily take blood thinner medication or aspirin before travel.

Are You at Risk for Travel-Related Blood Clots?

Developing a DVT or PE from air travel is rare, but it can happen, and you should protect yourself (per AACP, the likelihood of an incident is one in 4,600 flights; your risk goes up by 18% for each two-hour increase in the duration of travel).

For Long-Distance Flights, the Following Factors Place You at Higher Risk for Clots:

  •       Do you have a past history of DVT/PE or have a known thrombophilic disorder?
  •       Do you have active cancer?
  •       Have you had recent surgery (especially abdominal or orthopedic) or trauma?
  •       Are you restricted in your movement or immobile?
  •       Do you take birth control pills or hormone replacement pills?
  •       Are you pregnant?
  •       Do you have a window seat? (especially risky if you are obese)

Follow These AACP Guidelines During Flight:

  •       Stand up and walk up and down the aisle at least once an hour
  •       Make an effort to stretch your calf muscles
  •       Sit in an aisle seat when you can
  •       Use below-knee graduated compression stockings

Oh, My Aching Neck and Back: Minimize/Relieve Pain

flying cat

SpineUniverse surveyed flyers in the summer of 2008 and found that 88% of people who had flown in North America in the past year reported back or neck pain after flying.

Alan Hedge, Ph.D., CPE, professor of ergonomics at Cornell University, and member of the SpineUniverse Editorial Board, recommends that flyers purchase an inflatable air pillow to support the head and neck while flying.

For back pain, Hedge suggests making your own support by rolling a pillow, blanket or sweater and using that to support the lower back; ideally with one support on each side of your back.

Other Travel Tips to Stay Healthy and Comfortable:
  1. Use Good Wipes to feel fresh and clean in transit.  These 9.5” x 11.5” extra large and durable wipes are what John Candy in the film Planes, Trains, and Automobiles should have used to remain fresh and odor free in flight. Good Wipes refresh a greasy face in midday, provide extra cleanliness in the airline powder room, and help you feel confident you smell great any time you cannot access a shower.
  2. Bring Your Own Ear Buds or Lightweight Headphones. Plug them into the armrest, and you’ll never notice anything besides what’s on your iPod or iPad for six hours. Make sure your battery is fully charged. If flying coach, use Seatguru.com to find out if you’ll have an outlet.
  3. Pack Chewable Dramamine in Your Pocket. If you haven’t flown for a while, you could get airsick this time. Skipping Dramamine could mean the first time you throw up in public.
  4. Buy Pressure-Reducing Ear Plugs. If you have a cold or a history of sinus or ear problems and fly often, these are a lifesaver. Without them, your ears could be popping long after the flight.
  5. Keep a Sweater or Jacket Aboard. It can get chilly at 30,000 ft.

Here’s to your healthy trip!

Written by Katie Anton