Workplace interventions for reducing sitting at work

Why do people sit? A framework for targeted behavior change

To improve health and wellbeing, it is crucial that people regularly interrupt their sitting. In this paper, we propose a framework for examining and changing sitting behavior that addresses two key steps in the process towards developing effective interventions. First, we suggest that research should move away from its current focus on sitting time, which is an outcome of behavior. Rather, researchers should focus on stand-to-sit and sit-to-stand transitions, which are discrete units of behavior. Second, drawing on goal hierarchy models, we suggest that people rarely engage in stand-to-sit and sit-to-stand transitions for the purpose of being in a sitting or standing position; rather, we suggest that these transitions are means to higher-order goals (e.g., to complete work tasks, to watch television, to eat dinner). To improve adherence to and effectiveness of sitting behavior interventions, intervention designers should aim to increase the frequency of sit-to-stand (and stand-to-sit) transitions. To achieve this aim, intervention designers should capitalize on the higher-order goals that are typically served by these transitions. We suggest four concrete intervention strategies to increase sit-to-stand transitions in congruence with people's everyday goals. We also describe the implications of our framework for theory and methods in sitting behavior research.

Exploring Work-Time Affective States Through Ecological Momentary Assessment in an Office-Based Intervention to Reduce Occupational Sitting

BACKGROUND

The aim of this study was to examine whether a low-cost standing desk intervention that reduced occupational sitting was associated with changes in work-time cognitive-affective states in real time using ecological momentary assessments at the start and end of the trial.

METHODS

Forty-one office employees (91.7% female, mean age = 39.8 [10.1] y) were randomized to receive a low-cost standing desk or a waitlist control. Participants received 5 surveys each day for 5 workdays via smartphone application prior to randomization and at trial's end. Ecological momentary assessment assessed current work-time psychological states (valence and arousal, stress, fatigue, and perceived productivity). Multilevel models assessed whether changes in work-time outcomes over the course of the intervention were significantly different between treatment groups.

RESULTS

There were no significant differences in outcomes between the groups except for fatigue, with the control group reporting a significant decrease in daily fatigue following the intervention (P < .001). The intervention group reported no significant changes in any of the work-time outcomes across the study period (P > .05).

CONCLUSIONS

A low-cost standing desk intervention to reduce occupational sedentary behavior did not negatively impact work-time outcomes such as productivity and fatigue in the short term.

Preliminary investigation of the effects of sitting with and without short active breaks on muscle stiffness assessed with shear-wave elastography

Purpose

The purpose of this preliminary study was to compare the effects of 1-h sitting with and without short active breaks on muscle stiffness as measured by shear-wave elastography (SWE).

Methods

The participants (7 females, 3 males; age: 24.9 ± 1.2 years) completed two (with and without active breaks) 1-h sitting exposures on separate days. Active breaks (2–3 min) were performed at 20 min and 40 min time marks and comprised simple stretching and activation exercises. Before, during (30 min) and after (1 h) of sitting, shear modulus of upper trapezius, lumbar region of erector spinae and rectus femoris muscles was measured with SWE.

Results

Statistically significant effects of sitting exposure in erector spinae muscle stiffness were noted (p = 0.041; η2 = 0.38). There were no other statistically significant effects of sitting exposure or condition (with/without breaks).

Conclusions

Although few statistically significant effects were detected, the trends in this preliminary trial suggest that prolonged sitting increases muscle stiffness and warrants further investigation of short active breaks with larger sample sizes.

The Importance of Research on Occupational Sedentary Behaviour and Activity Right Now

The workplace has been identified as a key setting for public health interventions to 'promote and maintain the highest degree of physical, mental and social well-being of workers in all occupations' by the World Health Organisation [...].

A-REST (Activity to Reduce Excessive Sitting Time): A Feasibility Trial to Reduce Prolonged Sitting in Police Staff

The aim of this study was to evaluate the acceptability and feasibility of a theory-derived sedentary workplace intervention for police office staff. Twenty-four staff participated in an 8-week intervention (single arm, pre-post design) incorporating an education session, team competition with quick response (QR) codes, team trophy, weekly leaderboard newsletters, a self-monitoring phone app, and electronic prompt tools. The intervention supported participants to reduce and break up their sitting time with three minutes of incidental movement every 30 min at work. Feasibility and acceptability were assessed using mixed methods via the RE-AIM QuEST and PRECIS-2 frameworks. The intervention was highly pragmatic in terms of eligibility, organisation, adherence, outcome, and analysis. It was slightly less pragmatic on recruitment and setting. Delivery and follow-up were more explanatory. Reach and adoption indicators demonstrated feasibility among police staff, across a range of departments, who were demographically similar to participants in previous office-based multi-component interventions. The intervention was delivered mostly as planned with minor deviations from protocol (implementation fidelity). Participants perceived the intervention components as highly acceptable. Results showed improvements in workplace sitting and standing, as well as small improvements in weight and positive affect. Evaluation of the intervention in a fully powered randomised controlled trial to assess behaviour and health outcomes is recommended.

Barriers and facilitators influencing the implementation of the occupational health intervention 'Dynamic Work': a qualitative study

Background

Sedentary behavior is associated with an increased risk of morbidity and mortality. To reduce occupational sitting time of office workers, the multi-component intervention ‘Dynamic Work’ was implemented in a Dutch insurance company. Although the results showed no significant reductions in sitting time, associations were found between higher levels of implementation and reductions in sitting time. Building upon these findings, this qualitative study aimed to identify barriers and facilitators from an organizational perspective for the implementation of Dynamic Work. In addition, we explored differences in barriers and facilitators between departments with a low, middle and high level of implementation.

Methods

In total, eighteen semi-structured interviews were conducted with two Dynamic Work coordinators, three occupational physiotherapists who delivered the intervention, and thirteen department managers. All participants were purposively sampled. The data was coded in Atlas.ti and a thematic analysis was performed guided by The Integrated Checklist of Determinants (TICD).

Results

Implementation factors were related to the organization; working culture and financial support facilitated implementation. Factors related to the implementing department mainly hindered implementation, i.e. lack of information at start of the project, late delivery of Dynamic Work equipment, large group sizes, employee’s workload and work tasks, and an ongoing reorganization. The facilitating role of managers was experienced as both enabling and hindering. The pre-existing familiarity of the occupational physiotherapists with the departments and alignment amongst the three implementers facilitated implementation. Yet, the non-obligatory nature of the intervention as well as limited availability and technical problems of equipment did not support implementation.

Conclusions

Various barriers and facilitators influenced the implementation of the Dynamic Work intervention, where the key role of the department manager, late delivery of dynamic work equipment and groups sizes varied between low and high implementing departments. These results can contribute to developing and improving implementation strategies in order to increase the effectiveness of future occupational health interventions.

Trial registration

The study protocol was registered on April 14, 2017 in the ClinicalTrials.gov Protocol Registration and Results System under registration number NCT03115645.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13230-9.

Technology-based contingency management for walking to prevent prolonged periods of workday sitting

Sedentary behavior is an emerging public health issue. Frequent, brief bouts of walking are recommended by experts to reduce the health risks correlated with physical inactivity and prolonged sedentary periods. The purpose of the current study was to extend the literature by evaluating a remote, technology-based contingency management (CM) intervention that reinforced frequent, brief bouts of walking to decrease prolonged periods of sitting during the workday. A packaged intervention consisting of a contingency contract, monetary incentives, goal setting, textual prompts, and performance feedback was implemented with individuals with sedentary job responsibilities working from home during the COVID-19 pandemic. The intervention increased the number of physically active intervals to mastery for 4 participants, thereby disrupting prolonged periods of sedentary time. For 2 participants, the intervention did not meaningfully increase the number of physically active intervals. Results suggest that a remote, digital CM intervention can decrease sedentary behavior in home office environments.

Activity space, office space: Measuring the spatial movement of office workers

A key to the development of more effective interventions to promote movement and reduce physical inactivity in office workplaces may be to measure and locate individual's spatial movement. Using an activity space estimation method, high resolution location data collected from 15 office workers over 12 days were used to estimate and analyse the location and extent of their daily spatial movement whilst in an office work-based setting. The results indicated that the method, kernel density estimation, combined with location data offers significant opportunities to not only measure and compare spatial movement behaviours but also simultaneously identify the locations where the behaviours occur. Combined with other data streams, this method will allow researchers to further investigate the influence of different environmental characteristics on these behaviours, potentially leading the development of more effective, longer lasting interventions to promote movement and reduce stationary behaviour, ultimately improving the health of office workers.

Alternatives for Measuring Sitting Accumulation in Workplace Surveys

OBJECTIVES

To develop and assess the measurement properties of self-report measures of accumulation of sitting time.

METHODS

Seven candidate measures were collected in 51 workers from three office environments (79% women) via online questionnaire administered immediately before and after 7-day monitoring periods (activPAL3 24-hour protocol with diary recorded work hours).

RESULTS

Three measures had some validity (P < 0.05 vs activPAL): % of sitting in long bouts more than or equal to 30 minutes, sitting strategy frequency (0 to 100), and interruption rate (n/h sitting). Agreement was limited. Some reliability (intraclass correlation or kappa P < 0.05) was seen for these measures, strategy variety (0 to 100), typical day (five categories), and making a conscious effort to sit less (yes/no).

CONCLUSIONS

Two brief and one longer option may suit workplace studies requiring self-report measures of sitting accumulation. Validity was weaker for sitting accumulation than sitting time.

Industry Context as an Essential Tool for the Future of Healthy and Safe Work: Illustrative Examples for Occupational Health Psychology from the Hospitality Industry

Contextual nuance holds value for occupational health and safety, particularly as workplace challenges and solutions become more complex. However, disciplines that inform occupational safety and health vary in the degree to which they target breadth and depth of understanding. The future of work presents challenges related to work, the workplace, and the workforce, and an appreciation of the context of industry will ready researchers and practitioners with the most informed solutions. Broadly developed solutions for future of work challenges may flounder without an appreciation for the context of industry, as evidenced by two examples provided in this review. As occupational safety and health disciplines answer the call provided by the future of work, this review provides an account for the value of industry context and recommendations for achieving both breadth and depth of scientific inquiry and practical reach.

SMART STEP - SMARTphone-driven exercise and pedometer-based STEP intervention to promote physical activity among desk-based employees: Study protocol for a three-arm cluster randomized controlled trial

BACKGROUND

Prolonged sitting in desk-based office workers is found to be associated with increased cardiometabolic risk and poor cognitive performance. Technology-based physical activity (PA) interventions using smartphone applications (SmPh app) to promote PA levels might be effective in reducing cardiometabolic risk among sedentary population but the evidence remains inconclusive.

OBJECTIVE

The objective is to investigate the effects of a technology-based PA intervention compared to PA education with a worksite manual or no intervention on PA levels, cardiometabolic risk, cognitive performance, and work productivity among desk-based employees.

METHOD

A three-arm clustered randomized trial will be conducted. The study will be conducted among various administrative offices of a multifaceted university in India. Desk-based employees aged between 30 and 50 years (n = 159; 53 in each arm) will be recruited. Employees from various constituent institutions (clusters) of the university will be randomized into one of the three following groups - SMART: SmPh app-driven break reminders (visual exercise prompts) plus pedometer-based step intervention, TRADE: worksite PA education with a manual plus American College of Sports Medicine guided PA prescription, or CONTROL: usual work group. At baseline and after the 1st, 3rd and 6th month of the trial period, accelerometer-measured sitting time and PA levels, cardiometabolic risk (fasting blood glucose, triglycerides, insulin, blood pressure, heart rate variability, functional capacity, and subcutaneous fat), cognitive performance (executive function), sickness absenteeism and work limitations will be assessed by a blinded assessor. Therapist delivering interventions will not be blinded.

CONCLUSION

This trial will determine whether a combined SmPh-app and pedometer-based intervention is more effective than education or no intervention in altering PA levels, cardiometabolic risk and cognitive performance among desk-based employees in India. This study has the potential to foster institutional recommendations for using SmPh-based technology and pedometers to promote PA and reduce sedentary behavior at work.

Occupational Health: Does Compliance with Physical Activity Recommendations Have a Preventive Effect on Musculoskeletal Symptoms in Computer Workers? A Cross-Sectional Study

A lack of physical activity in computer workers (CW) can contribute to the development of musculoskeletal symptoms (MSS). Aim: (i) Evaluate MSS over a 12 month and 7 days period, (ii) determine physical activity (PA) levels and compliance with World Health Organization (WHO) PA recommendations, and (iii) assess the relationship between compliance with WHO PA recommendations and MSS. Methods: A cross-sectional observational study comprising 119 computer workers. The Nordic Musculoskeletal Questionnaire (NMQ) was used to evaluate the MSS and the International Physical Activity Questionnaire (IPAQ) was used to analyse the perception of the level of PA. Results: MSS occurred in the lumbar region (56.3%), neck (43.7%), and shoulders (39.5%). 44.7% of the participants reported a low level of PA. The percentage of compliance was similar among women and men (62.2% vs. 58.5%, respectively). Negative correlations were found between pain intensity and metabolic equivalent values. The participants who followed the WHO PA recommendations reported a lower frequency of MSS compared to those who did not, but the differences were not statistically significant. Conclusion: It was possible to conclude that computer workers presented a higher frequency of MSS in the lower back, neck, and shoulders. Regarding the level of PA, participants were mostly classified as low. Participants who followed the WHO PA recommendations reported lower MSS than those who did not. This finding could be important in obtaining successful programs that promote health-oriented physical activity in this group of workers.

Effects of two types of dynamic office workstations (DOWs) used at two intensities on cognitive performance and office work in tasks with various complexity

This study examines the possible effects on objective work performance while using two types of dynamic office workstations (DOWs). 20 participants each used one type with three intensities (seated, light, moderate) and completed a task battery assessing cognitive performance and office work with two levels of complexity. Repeated measures MANOVA showed a significant interaction effect for work performance between the type of workstation and intensity for the simple level and a significant main effect for intensity for the complex level. Comparing the types of DOWs to each other, accuracy of text processing differed when working sedentary. Using both devices with light and moderate intensity had a significant detrimental effect on mouse tasks compared to working sedentary, but none comparing the intensities. No further results indicated neither a detrimental nor an enhancing effect of using DOWs on cognitive performance and office-work related tasks, regardless of the intensity of use or the task complexity. Practitioner Summary: By using DOWs, light physical activity can be integrated while working at a desk. Results showed that using different types of DOWs with different intensities does have a detrimental effect on tasks requiring a high motor control, but not on cognitive or further office work-related tasks of various complexity. Abbreviations: DOW: dynamic office workstation; aLT: activeLife Trainer; DB: deskbike; RPE: rated perceived exertion; MANOVA: multivariate analysis of variance; ANOVA: analysis of variance.

Healthy Teleworking: Towards Personalized Exercise Recommendations

Home-based teleworking, associated with sedentary behavior, may impair self-reported adult health status. Current exercise recommendations, based on universal recipes, may be insufficient or even misleading to promote healthy teleworking. From the Network Physiology of Exercise perspective, health is redefined as an adaptive emergent state, product of dynamic interactions among multiple levels (from genetic to social) that cannot be reduced to a few dimensions. Under such a perspective, fitness development is focused on enhancing the individual functional diversity potential, which is better achieved through varied and personalized exercise proposals. This paper discusses some myths related to ideal or unique recommendations, like the ideal exercise or posture, and the contribution of recent computer technologies and applications for prescribing exercise and assessing fitness. Highlighting the need for creating personalized working environments and strengthening the active contribution of users in the process, new recommendations related to teleworking posture, home exercise counselling, exercise monitoring and to the roles of healthcare and exercise professionals are proposed. Instead of exercise prescribers, professionals act as co-designers that help users to learn, co-adapt and adequately contextualize exercise in order to promote their somatic awareness, job satisfaction, productivity, work–life balance, wellbeing and health.

Cardiac autonomic responses to different tasks in office workers with access to a sit-stand table - a study in real work setting

The aim of this study was to characterise the cardiac autonomic modulation of different office tasks performed by office workers with access to a sit-stand table. Heart rate variability (HRV) of 24 office workers was measured for two hours during three days in the last week of sit-stand table use. HRV indexes and the percentage of heart rate reserve (%HRR) were calculated during computer and non-computer work tasks while sitting or standing, non-computer tasks away from the work desk, and informal work breaks. All cardiac autonomic responses demonstrated a statistically significant interaction effect between the tasks (all p < 0.05) except for the logarithmically-transformed high frequency power (ln HF ms²; p = 0.14). Tasks performed while standing and away from the desk had higher sympathetic modulation; in addition, the observed higher %HRR demonstrated that these tasks were more physically demanding in comparison to other tasks. Practitioner Summary: Prior reports indicated benefits based on alternated body postures using sit-stand table. Nevertheless, the cardiac autonomic responses of different tasks performed by office workers are unknown. This cross-sectional study showed that different tasks stimulate the cardiac autonomic nervous system in different ways, which could bring positive effects to the cardiovascular system.

Reducing sedentary behaviour and physical inactivity in the workplace: protocol for a review of systematic reviews

BACKGROUND AND OBJECTIVE

Increasing rates of urbanisation have been accompanied by higher levels of sedentary behaviour (SB) and reduced physical activity (PA) worldwide. While physical inactivity has long been identified as a major risk factor for morbidity and mortality, increased concerns about the detrimental associations between SB and health has led to the development of many interventions aimed at reducing SB and/or promoting PA. Due to the prominence of sedentary time spent at work, the workplace has been identified as a key setting to implement such interventions. Building an evidence base of effective strategies to reduce SB and/or promote PA at work is needed to help reduce the health risks faced by many employees.

METHODS AND ANALYSIS

We aim to conduct a review of reviews (RoR) to identify, evaluate and synthesise all systematic reviews (SRs) of workplace interventions aimed at reducing SB and/or promoting PA among adults. Systematic searches for relevant SRs will be conducted in six databases: Cochrane Systematic Review Database, Cumulative Index to Nursing & Allied Health Literature through EBSCOhost, EMBASE, PubMed including MEDLINE, Scopus and Web of Science. Selection for final inclusion and data extraction will be performed by two independent reviewers. SRs will be included if they assessed interventions aimed at reducing SB or promoting PA in the workplace, and if they report on changes in the respective behavioural outcomes in the occupational domain.

DISCUSSION

This RoR will be valuable to policy-makers and employers who are looking for strategies to promote health at work. This will also allow potential research gaps to be identified, so that the design of future studies can be better informed.

TRIAL REGISTERATION

This study has been registered with the PROSPERO International Prospective Register of Systematic Reviews (registration number CRD42020171774).

Interventions outside the workplace for reducing sedentary behaviour in adults under 60 years of age

BACKGROUND

Adults spend a majority of their time outside the workplace being sedentary. Large amounts of sedentary behaviour increase the risk of type 2 diabetes, cardiovascular disease, and both all-cause and cardiovascular disease mortality.

OBJECTIVES

Primary • To assess effects on sedentary time of non-occupational interventions for reducing sedentary behaviour in adults under 60 years of age Secondary • To describe other health effects and adverse events or unintended consequences of these interventions • To determine whether specific components of interventions are associated with changes in sedentary behaviour • To identify if there are any differential effects of interventions based on health inequalities (e.g. age, sex, income, employment) SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, Cochrane Database of Systematic Reviews, CINAHL, PsycINFO, SportDiscus, and ClinicalTrials.gov on 14 April 2020. We checked references of included studies, conducted forward citation searching, and contacted authors in the field to identify additional studies.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) and cluster RCTs of interventions outside the workplace for community-dwelling adults aged 18 to 59 years. We included studies only when the intervention had a specific aim or component to change sedentary behaviour.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened titles/abstracts and full-text articles for study eligibility. Two review authors independently extracted data and assessed risk of bias. We contacted trial authors for additional information or data when required. We examined the following primary outcomes: device-measured sedentary time, self-report sitting time, self-report TV viewing time, and breaks in sedentary time.

MAIN RESULTS

We included 13 trials involving 1770 participants, all undertaken in high-income countries. Ten were RCTs and three were cluster RCTs. The mean age of study participants ranged from 20 to 41 years. A majority of participants were female. All interventions were delivered at the individual level. Intervention components included personal monitoring devices, information or education, counselling, and prompts to reduce sedentary behaviour. We judged no study to be at low risk of bias across all domains. Seven studies were at high risk of bias for blinding of outcome assessment due to use of self-report outcomes measures. Primary outcomes Interventions outside the workplace probably show little or no difference in device-measured sedentary time in the short term (mean difference (MD) -8.36 min/d, 95% confidence interval (CI) -27.12 to 10.40; 4 studies; I² = 0%; moderate-certainty evidence). We are uncertain whether interventions reduce device-measured sedentary time in the medium term (MD -51.37 min/d, 95% CI -126.34 to 23.59; 3 studies; I² = 84%; very low-certainty evidence) We are uncertain whether interventions outside the workplace reduce self-report sitting time in the short term (MD -64.12 min/d, 95% CI -260.91 to 132.67; I² = 86%; very low-certainty evidence). Interventions outside the workplace may show little or no difference in self-report TV viewing time in the medium term (MD -12.45 min/d, 95% CI -50.40 to 25.49; 2 studies; I² = 86%; low-certainty evidence) or in the long term (MD 0.30 min/d, 95% CI -0.63 to 1.23; 2 studies; I² = 0%; low-certainty evidence). It was not possible to pool the five studies that reported breaks in sedentary time given the variation in definitions used. Secondary outcomes Interventions outside the workplace probably have little or no difference on body mass index in the medium term (MD -0.25 kg/m², 95% CI -0.48 to -0.01; 3 studies; I² = 0%; moderate-certainty evidence). Interventions may have little or no difference in waist circumference in the medium term (MD -2.04 cm, 95% CI -9.06 to 4.98; 2 studies; I² = 65%; low-certainty evidence). Interventions probably have little or no difference on glucose in the short term (MD -0.18 mmol/L, 95% CI -0.30 to -0.06; 2 studies; I² = 0%; moderate-certainty evidence) and medium term (MD -0.08 mmol/L, 95% CI -0.21 to 0.05; 2 studies, I² = 0%; moderate-certainty evidence) Interventions outside the workplace may have little or no difference in device-measured MVPA in the short term (MD 1.99 min/d, 95% CI -4.27 to 8.25; 4 studies; I² = 23%; low-certainty evidence). We are uncertain whether interventions improve device-measured MVPA in the medium term (MD 6.59 min/d, 95% CI -7.35 to 20.53; 3 studies; I² = 70%; very low-certainty evidence). We are uncertain whether interventions outside the workplace improve self-reported light-intensity PA in the short-term (MD 156.32 min/d, 95% CI 34.34 to 278.31; 2 studies; I² = 79%; very low-certainty evidence). Interventions may have little or no difference on step count in the short-term (MD 226.90 steps/day, 95% CI -519.78 to 973.59; 3 studies; I² = 0%; low-certainty evidence) No data on adverse events or symptoms were reported in the included studies.

AUTHORS' CONCLUSIONS

Interventions outside the workplace to reduce sedentary behaviour probably lead to little or no difference in device-measured sedentary time in the short term, and we are uncertain if they reduce device-measured sedentary time in the medium term. We are uncertain whether interventions outside the workplace reduce self-reported sitting time in the short term. Interventions outside the workplace may result in little or no difference in self-report TV viewing time in the medium or long term. The certainty of evidence is moderate to very low, mainly due to concerns about risk of bias, inconsistent findings, and imprecise results. Future studies should be of longer duration; should recruit participants from varying age, socioeconomic, or ethnic groups; and should gather quality of life, cost-effectiveness, and adverse event data. We strongly recommend that standard methods of data preparation and analysis are adopted to allow comparison of the effects of interventions to reduce sedentary behaviour.

Supporting Workers to Sit Less and Move More Through the Web-Based BeUpstanding Program: Protocol for a Single-Arm, Repeated Measures Implementation Study

BACKGROUND

The web-based BeUpstanding Champion Toolkit was developed to support work teams in addressing the emergent work health and safety issue of excessive sitting. It provides a step-by-step guide and associated resources that equip a workplace representative-the champion-to adopt and deliver the 8-week intervention program (BeUpstanding) to their work team. The evidence-informed program is designed to raise awareness of the benefits of sitting less and moving more, build a supportive culture for change, and encourage staff to take action to achieve this change. Work teams collectively choose the strategies they want to implement and promote to stand up, sit less, and move more, with this bespoke and participative approach ensuring the strategies are aligned with the team's needs and existing culture. BeUpstanding has been iteratively developed and optimized through a multiphase process to ensure that it is fit for purpose for wide-scale implementation.

OBJECTIVE

The study aimed to describe the current version of BeUpstanding, and the methods and protocol for a national implementation trial.

METHODS

The trial will be conducted in collaboration with five Australian workplace health and safety policy and practice partners. Desk-based work teams from a variety of industries will be recruited from across Australia via partner-led referral pathways. Recruitment will target sectors (small business, rural or regional, call center, blue collar, and government) that are of priority to the policy and practice partners. A minimum of 50 work teams will be recruited per priority sector with a minimum of 10,000 employees exposed to the program. A single-arm, repeated-measures design will assess the short-term (end of program) and long-term (9 months postprogram) impacts. Data will be collected on the web via surveys and toolkit analytics and by the research team via telephone calls with champions. The Reach, Effectiveness, Adoption, Implementation, and Maintenance Framework will guide the evaluation, with assessment of the adoption/reach of the program (the number and characteristics of work teams and participating staff), program implementation (completion by the champion of core program components), effectiveness (on workplace sitting, standing, and moving), and maintenance (sustainability of changes). There will be an economic evaluation of the costs and outcomes of scaling up to national implementation, including intervention affordability and sustainability.

RESULTS

The study received funding in June 2018 and the original protocol was approved by institutional review board on January 9, 2017, with national implementation trial consent and protocol amendment approved March 12, 2019. The trial started on June 12, 2019, with 48 teams recruited as of December 2019.

CONCLUSIONS

The implementation and multimethod evaluation of BeUpstanding will provide the practice-based evidence needed for informing the potential broader dissemination of the program.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12617000682347; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372843&isReview=true.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/15756.

Effect of workplace physical activity interventions on the cardio-metabolic health of working adults: systematic review and meta-analysis

Background

Adults in urban areas spend almost 77% of their waking time being inactive at workplaces, which leaves little time for physical activity. The aim of this systematic review and meta-analysis was to synthesize evidence for the effect of workplace physical activity interventions on the cardio-metabolic health markers (body weight, waist circumference, body mass index (BMI), blood pressure, lipids and blood glucose) among working adults.

Methods

All experimental studies up to March 2018, reporting cardio-metabolic worksite intervention outcomes among adult employees were identified from PUBMED, EMBASE, COCHRANE CENTRAL, CINAHL and PsycINFO. The Cochrane Risk of Bias tool was used to assess bias in studies. All studies were assessed qualitatively and meta-analysis was done where possible. Forest plots were generated for pooled estimates of each study outcome.

Results

A total of 33 studies met the eligibility criteria and 24 were included in the meta-analysis. Multi-component workplace interventions significantly reduced body weight (16 studies; mean diff: − 2.61 kg, 95% CI: − 3.89 to − 1.33) BMI (19 studies, mean diff: − 0.42 kg/m², 95% CI: − 0.69 to − 0.15) and waist circumference (13 studies; mean diff: − 1.92 cm, 95% CI: − 3.25 to − 0.60). Reduction in blood pressure, lipids and blood glucose was not statistically significant.

Conclusions

Workplace interventions significantly reduced body weight, BMI and waist circumference. Non-significant results for biochemical markers could be due to them being secondary outcomes in most studies. Intervention acceptability and adherence, follow-up duration and exploring non-RCT designs are factors that need attention in future research.

Prospero registration number: CRD42018094436.

Improving Physical Activity and Body Composition in a Medical Workplace Using Brief Goal Setting

Objective

To evaluate the use of a wearable activity tracker and brief feedback in the workplace to motivate employees to improve activity.

Patients and Methods

A total of 135 adult participants were randomized to 1 of 3 groups: control group (blinded to their step activity), intervention group (received counseling based on their step count), or no step-tracking device group. Participants were recruited from June 27, 2016, through February 21, 2018.

Results

Most of the 135 participants were women (84%), with a mean ± SD age of 42.6±10.1 years. Most participants (96%) completed 11 of the 12 weeks of step counts. Comparing treatment groups at week 12 (end of treatment), the intervention group (vs the control group) had significantly more steps (644.8; P<.01), had an 11.1% increase in step count from baseline (P<.01), was more likely to achieve goal (odds ratio=1.73; P=.02), increased distance traveled per week (0.46 miles; P<.01) and calories burned (90.6; P<.01), and had a decrease in some bioelectrical impedance measurements over time, including a greater loss in body fat mass (–0.90 kg; P=.01), percentage fat (–0.96; P<.01), and visceral fat level (–0.60; P<.01). Finally, the intervention group indicated significantly greater satisfaction with their assigned randomization (89% vs 77%; P=.01) and greater confidence in the effectiveness of their activity tracker (P<.01).

Conclusion

Brief counseling accompanied by use of a step-counting device can improve workplace activity, which, in turn, can increase steps and decrease body fat, including visceral fat.

Trial Registration

clinicaltrials.gov Identifier: NCT02794727

Evidence of Workplace Interventions-A Systematic Review of Systematic Reviews

Work environment factors are highly correlated with employees’ health and well-being. Our aim was to sum up current evidence of health promotion interventions in the workplace, focusing on interventions for the prevention of musculoskeletal disorders, psychological and behavioral disorders as well as interventions for older employees and economic evaluations. We conducted a comprehensive literature search including systematic reviews published from April 2012 to October 2017 in electronic databases and search engines, websites of relevant organizations and institutions. It consisted of simple and specific terms and word combinations related to workplace health promotion based on the search strategy of a previous review. After full-text screening, 74 references met the eligibility criteria. Using the same search strategy, there was a higher proportion of relevant high-quality studies as compared with the earlier review. The heterogeneity of health promotion interventions regarding intervention components, settings and study populations still limits the comparability of studies. Future studies should also address the societal and insurer perspective, including costs to the worker such as lost income and lost time at work of family members due to caregiving activities. To this end, more high-quality evidence is needed.

Perceived Barriers and Facilitators to Breaking Up Sitting Time among Desk-Based Office Workers: A Qualitative Investigation Using the TDF and COM-B

High amounts of sedentary behaviour, such as sitting, can lead to adverse health consequences. Interventions to break up prolonged sitting in the workplace have used active workstations, although few studies have used behaviour change theory. This study aimed to combine the Theoretical Domains Framework (TDF) and the Capability, Opportunity, and Motivation to Behaviour system (COM-B) to investigate perceived barriers and facilitators to breaking up sitting in desk-based office workers. Semi-structured interviews with 25 desk-based employees investigated barriers and facilitators to breaking up sitting in the workplace. Seven core inductive themes were identified: ‘Knowledge-deficit sitting behaviour’, ‘Willingness to change’, ‘Tied to the desk’, ‘Organisational support and interpersonal influences’, ‘Competing motivations’, ‘Emotional influences’, and ‘Inadequate cognitive resources for action’. These themes were then deductively mapped to 11 of the 14 TDF domains and five of the six COM-B constructs. Participants believed that high amounts of sitting had adverse consequences but lacked knowledge regarding recommendations and were at times unmotivated to change. Physical and social opportunities were identified as key influences, including organisational support and height-adjustable desks. Future research should identify intervention functions, policy categories and behaviour change techniques to inform tailored interventions to change sitting behaviour of office workers.

Medium-term effects of a two-desk sit/stand workstation on cognitive performance and workload for healthy people performing sedentary work: a secondary analysis of a randomised controlled trial

Implementing sit/stand workstations in sedentary work environments is a common way to reduce sedentary time, but their medium-term effect on cognitive performance is unclear. To address this circumstance, eighteen office workers participated in a two-arm, randomised controlled cross-over trial (ClinicalTrials.gov Identifier: NCT02825303), either working at a traditional (sit) or an interventional (sit/stand) workplace for 23 weeks. Cognitive performance (working speed, reaction time, concentration performance, accuracy), workload and relevant covariates (salivary cortisol level, heart rate, physical activity, sitting time) were measured pre- and post-intervention under laboratory conditions. MANOVA and RMANOVA results did not show differences in performance parameters and workload, respectively, between sit/stand and traditional workplace users. Differences in text editing accuracy and cortisol levels for sit/stand workstation users indicate potential connectivity to cognitive parameters which should be further examined with large-scale studies. Practitioner summary: Medium-term effects of working at sit/stand workstations on cognitive performance and workload are unexplored. This randomised controlled trial suggests that cognitive performance and workload are unaffected for sit/stand workstation users after 23 weeks of use. However, accuracy appeared to improve and physiological stress appeared to be altered. Abbreviations: BMI: body mass index; IPAQ: International physical activity questionnaire; MET: metabolic equivalent of task; MANOVA: multivariate ANOVA; NASA TLX: NASA task load index; RMANOVA: repeated measures ANOVA.

Moving to an "Active" Biophilic Designed Office Workplace: A Pilot Study about the Effects on Sitting Time and Sitting Habits of Office-Based Workers

Promising initial insights show that offices designed to permit physical activity (PA) may reduce workplace sitting time. Biophilic approaches are intended to introduce natural surroundings into the workplace, and preliminary data show positive effects on stress reduction and elevated productivity within the workplace. The primary aim of this pilot study was to analyze changes in workplace sitting time and self-reported habit strength concerning uninterrupted sitting and PA during work, when relocating from a traditional office setting to “active” biophilic-designed surroundings. The secondary aim was to assess possible changes in work-associated factors such as satisfaction with the office environment, work engagement, and work performance, among office staff. In a pre-post designed field study, we collected data through an online survey on health behavior at work. Twelve participants completed the survey before (one-month pre-relocation, T₁) and twice after the office relocation (three months (T₂) and seven months post-relocation (T₃)). Standing time per day during office hours increased from T₁ to T₃ by about 40 min per day (p < 0.01). Other outcomes remained unaltered. The results suggest that changing office surroundings to an active-permissive biophilic design increased standing time during working hours. Future larger-scale controlled studies are warranted to investigate the influence of office design on sitting time and work-associated factors during working hours in depth.

What factors explain socioeconomic inequalities in adults' television-related sitting time?

BACKGROUND

There are considerable socioeconomic inequalities in television-related sitting time, but there is little evidence for the explanatory mechanisms. We used a cohort of Belgian adults (25-60 years) and older adults (≥65 years) to examine the social cognitive, home environmental and health-related factors contributing to socioeconomic differences in television-related sitting.

METHODS

We included 301 adults and 258 older adults (total n = 559). Linear regression analyses were used to examine the associations of education and occupational status with television-related sitting time, adjusted for age and gender. We assessed the explanatory power of social cognitive, home environmental and health-related factors using the traditional 'change-in-estimation method'.

RESULTS

Those with low and medium education, respectively, engaged in 54 and 28 minutes per day more television-related sitting time than those with high education. We found no association between occupational status and television-related sitting time. Social cognitive factors explained 54% of the difference in television-related sitting time between those with low and high education, while home environmental factors only explained 6%, and health-related variables explained 10% of these differences.

CONCLUSION

We found no occupational inequalities in television-related sitting time. Social cognitive variables such as attitude and modelling of the partner explained a large part of the educational inequalities in television-related sitting time. If confirmed by future studies, a focus on social cognition may help reduce sedentary behaviours in low-educated adults and diminish inequalities in sedentary behaviours.

Association of Personality on Changes in Weekday Sitting Time: Cross-Sectional and Prospective Evaluation

Background

The purpose of this study was to examine the prospective association of personality typology on changes in sitting (sedentary) time.

Methods

Young adults (N = 126; M_age = 21.6 yrs) completed self-report assessments of personality and sitting time at baseline and at an approximate 5-month follow-up. At baseline, personality was assessed via the Neuroticism-Extraversion-Openness Five Factor Inventory (NEO-FFI) questionnaire. At both baseline and the follow- up period, sitting time was self-reported using the International Physical Activity Questionnaire (IPAQ) short form.

Results

Both extraversion (β = −5.8; 95% CI: −11.7, 0.21; p = 0.05) and conscientiousness (β = −5.7; 95% CI: −11.3, −0.2; p = 0.04) were inversely associated with baseline sitting time. Regarding the prospective results, the only personality trait associated with changes in sitting time was openness to experience. Independent of changes in physical activity as well as other potential confounders, for every 1 unit increase in openness to experience, there was an associated 6.6 min/day increased change score in sitting time over the 5-month follow-up period (β = 6.6; 95% CI: 0.13, 13.0; p = 0.04).

Conclusion

Personality was differentially associated with sitting time based on the study design, with the personality trait of openness to experience being prospectively associated with increases in sitting time.

One-year follow-up of a sit-stand workstation intervention to decrease sedentary time in office workers

BACKGROUND

Prolonged sedentary time is associated with adverse health outcomes, after controlling for the role of moderate-to-vigorous physical activity. We previously reported on a four-week randomized trial using a sit-stand desk (SSD) intervention that decreased sedentary time at work without changing activity level during non-work hours.

PURPOSE

The purpose of this study was to measure the impact of the SSD on sitting time and activity level one year after the original intervention.

METHODS

A pre-post design was used where the control period from the original study was regarded as "pre" and the measurements made in the follow-up study as "post." The follow-up study was conducted in the same office workers over a two-week period in June 2013.

RESULTS

Fifteen out of the 23 participants took part in the follow-up study. Self-reported sitting time during work-hours was decreased by 22% (95% CI: 15% to 29%; p < 0.001), replaced almost entirely by standing. Activity measured by Gruve accelerometer during work-hours were significantly higher in the one-year follow-up period compared to baseline (+24,748 AU/h; 95% CI: 7150 to 42,347; p < 0.01). Sedentary time during work-hours was decreased by 0.77 min per work-hour (95% CI: -1.88 to 0.33 min/h; p = 0.17). Qualitative findings through focus group sessions suggested the workers had overall favorable experiences with the SSDs without negatively impacting productivity.

CONCLUSION

One year following the original intervention, participants continue to have increased activity and decreased sedentary time at work with the use of SSDs.

The Dynamic Work study: study protocol of a cluster randomized controlled trial of an occupational health intervention aimed at reducing sitting time in office workers

Background

Large volumes of sitting time have been associated with multiple health risks. To reduce sitting time of office workers working for a Dutch insurance company, the Dynamic Work intervention was developed. The primary objective of this paper is to describe the study protocol of the Dynamic Work study, which aims to evaluate if this multicomponent intervention is (cost-)effective in reducing total sitting time on the short-term (≈3 months) and longer-term (≈12 months) compared to usual practice.

Methods/design

This two-arm cluster randomized controlled trial will recruit 250 desk-based office workers working at different locations of an insurance company in the Netherlands. After baseline measurements, departments will be matched in pairs and each pair will be randomly assigned to the control or intervention condition. The multicomponent intervention contains organizational (i.e. face to face session with the head of the department), work environmental (i.e. the introduction of sit-stand desks and cycling workstations), and individual elements (i.e. counselling and activity/sitting tracker with a self-help program booklet). The counselling involves two group intervention sessions and four on-site department consultations with an occupational physiotherapist. Sitting time (primary outcome), upright time and step counts will be assessed objectively using the activPAL activity monitor at baseline, short-term (approximately 3 months) and longer-term (12 months). Other outcomes will include: self-reported lifestyle behaviours, anthropometrics, work-related outcomes (i.e. absenteeism, presenteeism, work performance, work-related stress), health-related outcomes (i.e. vitality, musculoskeletal symptoms, need for recovery, quality of life), and costs from both company and societal perspective. The study will include economic and process evaluations.

Discussion

This study will assess the longer-term (cost-) effectiveness of a multicomponent workplace intervention aimed at reducing sitting time in comparison with usual practice. Furthermore, the process evaluation will provide insights in factors associated with successful implementation of this intervention.

Trial registration

ClinicalTrials.govNCT03115645; Registered 13 April 2017. Retrospectively registered.

Digital Interventions to Reduce Sedentary Behaviors of Office Workers: Scoping Review

Background

There is a clear public health need to reduce office workers’ sedentary behaviors (SBs), especially in the workplace. Digital technologies are increasingly being deployed in the workplace to measure and modify office workers’ SBs. However, knowledge of the range and nature of research on this topic is limited; it also remains unclear to what extent digital interventions have exploited the technological possibilities.

Objective

This study aimed to investigate the technological landscape of digital interventions for SB reduction in office workers and to map the research activity in this field.

Methods

Terms related to SB, office worker, and digital technology were applied in various combinations to search Cochrane Library, Joanna Briggs Institute Database of Systematic Reviews, MEDLINE, PsycARTICLES, PsycINFO, Scopus, Association for Computing Machinery Digital Library, Engineering index Compendex, and Google Scholar for the years 2000 to 2017. Data regarding the study and intervention details were extracted. Interventions and studies were categorized into development, feasibility and/piloting, evaluation, or implementation phase based on the UK Medical Research Council (MRC) framework for developing and evaluating complex interventions. A novel framework was developed to classify technological features and annotate technological configurations. A mix of quantitative and qualitative approaches was used to summarize data.

Results

We identified 68 articles describing 45 digital interventions designed to intervene with office workers’ SB. A total of 6 common technological features had been applied to interventions with various combinations. Configurations such as “information delivery and mediated organizational and social support” and “digital log and automated tailored feedback” were well established in evaluation and implementation studies; in contrast, the integration of passive data collection, connected devices, and ATF or scheduled prompts was mostly present in development and piloting research.

Conclusions

This review is the first to map and describe the use of digital technologies in research on SB reduction in office workers. Interdisciplinary collaborations can help to maximize the potential of technologies. As novel modes of delivery that capitalize on embedded computing and electronics, wireless technologies have been developed and piloted in engineering, computing, and design fields, efforts can be directed to move them to the next phase of evaluation with more rigorous study designs. Quality of research may be improved by fostering conversations between different research communities and encouraging researchers to plan, conduct, and report their research under the MRC framework. This review will be particularly informative to those deciding on areas where further research or development is needed and to those looking to locate the relevant expertise, resources, and design inputs when designing their own systems or interventions.

Current and ceased users of sit stand workstations: a qualitative evaluation of ergonomics, safety and health factors within a workplace setting

Background

Many workplaces have implemented sit-stand workstations (SSW), which enable a worker to transition between sitting and standing as they perform their work activities. The factors which determine the initial adoption, sustainability or cessation of use for a SSW, remain largely unexamined. This study investigates the experiences of workers who had previously used or were currently using a SSW.

Methods

The study setting was within an Australian university. Participants who were current or past SSW users, as well as workplace key informants, were interviewed for the study. All interviews were recorded, transcribed and analysed. Transcripts were coded by two researchers for concepts and themes regarding uptake and sustainability of SSW. Discussion and validation of themes was undertaken by the team of three researchers.

Results

A total of 24 interviews were conducted. Twenty-two interviews were with ceased and current users (16 current and six ceased users) and two interviews were with workplace key informants. Analysis of the interviews with current and ceased users identified three main themes: Personal considerations for use/sustainability; Posture; and Usability. Analysis of the interviews with key informants identified two themes: Considerations and concerns and Policies and procedures. Little information was provided to workers when first using a SSW. Workers who were able to adopt their working style to the new workstations were able to sustain ongoing use of a SSW. Key informants were concerned that employees believed using a SSW would provide a health benefit in its own right without an understanding of the possible risks that might be associated with use.

Conclusions

Sustainable usage of this type of SSW is achievable, however, it requires some element of adaptation at the individual worker level. Participants spoke about how the use of the SSW in a standing position was typically associated with the time of day, specific task selection and musculoskeletal comfort or fatigue factors. The provision of education to new SSW users with relevant supporting information by a subject matter expert should enable the worker to obtain a more holistic understanding of the safety and health risks and benefits embedded in the use of a SSW.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-6296-6) contains supplementary material, which is available to authorized users.

Measuring Sedentary Behavior by Means of Muscular Activity and Accelerometry

Sedentary Behavior (SB) is among the most frequent human behaviors and is associated with a plethora of serious chronic lifestyle diseases as well as premature death. Office workers in particular are at an increased risk due to their extensive amounts of occupational SB. However, we still lack an objective method to measure SB consistent with its definition. We have therefore developed a new measurement system based on muscular activity and accelerometry. The primary aim of the present study was to calibrate the new-developed 8-CH-EMG+ for measuring occupational SB against an indirect calorimeter during typical desk-based office work activities. In total, 25 volunteers performed nine office tasks at three typical workplaces. Minute-by-minute posture and activity classification was performed using subsequent decision trees developed with artificial intelligence data processing techniques. The 8-CH-EMG+ successfully identified all sitting episodes (AUC = 1.0). Furthermore, depending on the number of electromyography channels included, the device has a sensitivity of 83–98% and 74–98% to detect SB and active sitting (AUC = 0.85–0.91). The 8-CH-EMG+ advances the field of objective SB measurements by combining accelerometry with muscular activity. Future field studies should consider the use of EMG sensors to record SB in line with its definition.

Introducing a Dynamic Workstation in the Office: Insights in Characteristics of Use and Short-Term Changes of Well-Being in a 12 Week Observational Study

The present field study evaluates the use of dynamic workstations (cycling devices) in a real-life office environment. Specific characteristics of use were recorded and possible relationships with short-term changes in well-being were investigated. For a period of 12 weeks, 36 employees were given free access to eight devices. Frequency, duration and speed of use were self-determined but registered objectively for every event of use. Immediately before and after using a cycling device, employees rated their well-being with a modified version of the EZ-scale from Nitsch to assess changes in the short-term. In total, 817 events of use were registered. On each day of the intervention period one of the devices was used. Participants used the devices between one day to all days present at the office, for 21.09 (SD 0.58) to 31.58 (SD 2.19) minutes on average per event of use per day. Comparing the pre- and post-measurements, a significant increase in well-being after using a cycling device was found. Results of a Generalized Estimating Equations (GEE) analysis showed mixed effects for the duration of use, the speed and variation of speed on the probability of reporting positive changes in recovery, calmness and mood. Therefore, using cycling devices in the office might improve short-term well-being.

Effectiveness of the Stand More AT (SMArT) Work intervention: cluster randomised controlled trial

OBJECTIVES

To evaluate the impact of a multicomponent intervention (Stand More AT (SMArT) Work) designed to reduce sitting time on short (three months), medium (six months), and longer term (12 months) changes in occupational, daily, and prolonged sitting, standing, and physical activity, and physical, psychological, and work related health.

DESIGN

Cluster two arm randomised controlled trial.

SETTING

National Health Service trust, England.

PARTICIPANTS

37 office clusters (146 participants) of desk based workers: 19 clusters (77 participants) were randomised to the intervention and 18 (69 participants) to control.

INTERVENTIONS

The intervention group received a height adjustable workstation, a brief seminar with supporting leaflet, workstation instructions with sitting and standing targets, feedback on sitting and physical activity at three time points, posters, action planning and goal setting booklet, self monitoring and prompt tool, and coaching sessions (month 1 and every three months thereafter). The control group continued with usual practice.

MAIN OUTCOME MEASURES

The primary outcome was occupational sitting time (thigh worn accelerometer). Secondary outcomes were objectively measured daily sitting, prolonged sitting (≥30 minutes), and standing time, physical activity, musculoskeletal problems, self reported work related health (job performance, job satisfaction, work engagement, occupational fatigue, sickness presenteeism, and sickness absenteeism), cognitive function, and self reported psychological measures (mood and affective states, quality of life) assessed at 3, 6, and 12 months. Data were analysed using generalised estimating equation models, accounting for clustering.

RESULTS

A significant difference between groups (in favour of the intervention group) was found in occupational sitting time at 12 months (-83.28 min/workday, 95% confidence interval -116.57 to -49.98, P=0.001). Differences between groups (in favour of the intervention group compared with control) were observed for occupational sitting time at three months (-50.62 min/workday, -78.71 to -22.54, P<0.001) and six months (-64.40 min/workday, -97.31 to -31.50, P<0.001) and daily sitting time at six months (-59.32 min/day, -88.40 to -30.25, P<0.001) and 12 months (-82.39 min/day, -114.54 to -50.26, P=0.001). Group differences (in favour of the intervention group compared with control) were found for prolonged sitting time, standing time, job performance, work engagement, occupational fatigue, sickness presenteeism, daily anxiety, and quality of life. No differences were seen for sickness absenteeism.

CONCLUSIONS

SMArT Work successfully reduced sitting time over the short, medium, and longer term, and positive changes were observed in work related and psychological health.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN10967042.

Perceptions of the acceptability and feasibility of reducing occupational sitting: review and thematic synthesis

BACKGROUND

Reducing workplace sedentary behaviour (sitting) is a topic of contemporary public health and occupational health interest. Understanding workers' perspectives on the feasibility and acceptability of strategies, and barriers and facilitators to reducing workplace sitting time, can help inform the design and implementation of targeted interventions. The aim of this qualitative synthesis was to identify and synthesise the evidence on factors perceived to influence the acceptability and feasibility of reducing sitting at work, without, and with, an associated intervention component.

METHODS

A systematic search of the peer-reviewed literature was conducted across multiple databases in October 2017 to identify studies with a qualitative component relating to reducing workplace sitting time. Relevant data were extracted and imported into NVivo, and analysed by three of the authors by coding the results sections of papers line-by-line, with codes organised into sub-themes and then into overarching themes. Studies with and without an associated intervention were analysed separately.

RESULTS

Thirty-two studies met the inclusion criteria, 22 of which had collected qualitative data during and/or following a workplace intervention. Sample sizes ranged from five through to 71 participants. Studies predominately involved desk-based workers (28/32) and were most frequently conducted in Australia, USA or the United Kingdom (26/32). Similar themes were identified across non-intervention and intervention studies, particularly relating to barriers and facilitators to reducing workplace sitting. Predominately, work and social environment attributes were identified as barriers/facilitators, with desk-based work and work pressures influencing the perceived feasibility of reducing sitting, particularly for low-cost interventions. Support from co-workers and managers was considered a key facilitator to reducing sitting, while social norms that discouraged movement were a prominent barrier. Across all studies, some consistent perceptions of benefits to reducing sitting were identified, including improved physical health, enhanced emotional well-being and associated work-related benefits.

CONCLUSION

Common barriers and facilitators to reducing workplace sitting time were identified across the literature, most prominently involving the social environment and job-related demands. These findings can inform the design and implementation of workplace sitting reduction strategies. To increase the generalisability of findings, further research is needed in a more diverse range of countries and industries.

A three arm cluster randomised controlled trial to test the effectiveness and cost-effectiveness of the SMART Work & Life intervention for reducing daily sitting time in office workers: study protocol

BACKGROUND

Office-based workers typically spend 70-85% of working hours, and a large proportion of leisure time, sitting. High levels of sitting have been linked to poor health. There is a need for fully powered randomised controlled trials (RCTs) with long-term follow-up to test the effectiveness of interventions to reduce sitting. This paper describes the methodology of a three-arm cluster RCT designed to determine the effectiveness and cost-effectiveness of the SMART Work & Life intervention, delivered with and without a height-adjustable desk, for reducing daily sitting.

METHODS/DESIGN

A three-arm cluster RCT of 33 clusters (660 council workers) will be conducted in three areas in England (Leicester; Manchester; Liverpool). Office groups (clusters) will be randomised to the SMART Work & Life intervention delivered with (group 1) or without (group 2) a height-adjustable desk or a control group (group 3). SMART Work & Life includes organisational (e.g., management buy-in, provision/support for standing meetings), environmental (e.g., relocating waste bins, printers), and group/individual (education, action planning, goal setting, addressing barriers, coaching, self-monitoring, social support) level behaviour change strategies, with strategies driven by workplace champions. Baseline, 3, 12 and 24 month measures will be taken.

PRIMARY OUTCOME

Objectively measured daily sitting time (activPAL3).

SECONDARY OUTCOMES

objectively measured sitting, standing, stepping, prolonged sitting and moderate-to-vigorous physical activity time and number of steps at work and daily; objectively measured sleep (wrist accelerometry). Adiposity, blood pressure, fasting glucose, glycated haemoglobin, cholesterol (total, HDL, LDL) and triglycerides will be assessed from capillary blood samples. Questionnaires will examine dietary intake, fatigue, musculoskeletal issues, job performance and satisfaction, work engagement, occupational and general fatigue, stress, presenteeism, anxiety and depression and sickness absence (organisational records). Quality of life and resources used (e.g. GP visits, outpatient attendances) will also be assessed. We will conduct a full process evaluation and cost-effectiveness analysis.

DISCUSSION

The results of this RCT will 1) help to understand how effective an important simple, yet relatively expensive environmental change is for reducing sitting, 2) provide evidence on changing behaviour across all waking hours, and 3) provide evidence for policy guidelines around population and workplace health and well-being.

TRIAL REGISTRATION

ISRCTN11618007 . Registered on 21 January 2018.

Empowered with Movement to Prevent Obesity & Weight Regain (EMPOWER): Design and methods

Promoting lasting weight loss among older adults is an important public health challenge. Participation in physical activity aids in weight loss and is important for the maintenance of physical function and quality of life. However, traditional intensive lifestyle interventions place a focus on discrete bouts of structured activity, leaving much of the remainder of the day for sedentary behavior. Structured exercise and weight loss programs often produce short-term weight loss that is typically followed by weight regain, and older adults are more likely to regain weight as fat mass rather than lean mass. Preliminary evidence suggests a focus on day-long movement intended to minimize time spent sitting produces better short-term weight loss and weight maintenance. Herein we describe the design and methods for a three-arm randomized controlled trial comparing mHealth-supported weight loss (WL) + structured exercise (EX); WL + a novel daily movement intervention (SitLess); and WL + EX + SitLess. Older adults (N = 180) will be randomly assigned to one of the three interventions, each comprised of a 6-month intensive phase; a 3-month transition phase; and a 9-month maintenance phase. The primary aim of the study is to determine whether the addition of SitLess to a traditional intensive lifestyle intervention comprised of dietary weight loss and structured exercise produces a larger 18-month reduction in body weight relative to WL + EX and WL + SitLess.

Assessing the Feasibility and Pre-Post Impact Evaluation of the Beta (Test) Version of the BeUpstanding Champion Toolkit in Reducing Workplace Sitting: Pilot Study

BACKGROUND

The Web-based, evidence-informed BeUpstanding Champion Toolkit was developed to provide employers (via a "train-the-champion approach") with resources and support to help in reducing prolonged sitting in their own desk-based workplace. As part of a five-phase research-to-dissemination process, this study reports on the evaluation of the beta (test) version of this toolkit (Phase 2).

OBJECTIVE

The objective of our study was to evaluate (1) the implementation of the toolkit by workplace champions and (2) the impact of the toolkit on sitting (primary outcome), standing, and moving; use of activity-promoting strategies; knowledge and attitudes; and indicators of health and work performance.

METHODS

An implementation study using a pre-post design was conducted in 7 desk-based workplaces in Australia (September 2015 to May 2016), with work teams (one per workplace) purposively recruited to ensure representation across a range of sectors (white- or blue-collar), organizational sizes (small or medium or large), and locations (metropolitan or regional). All staff within participating teams were invited to participate in the relevant toolkit activities. Implementation outcomes (time commitment required by champions and toolkit activities completed) were collected from each champion via telephone interviews. Changes in impact outcomes, measured via a Web-based questionnaire completed by employees at baseline and 3 months postimplementation, were assessed using mixed models, correcting for clustering.

RESULTS

Champions reported a 30-60 minutes per week time commitment to the toolkit activities. All teams formed a wellbeing committee and sent the staff surveys at both time points; most champions held a staff consultation workshop (6/7), identified team-level strategies within that workshop (5/7), used the communication resources provided within the toolkit (emails, posters; 6/7), and completed the action plan (5/7). In total, 52% (315 of ≈600) employees participated in at least one survey and 97 (16%) participated in both. At follow-up, there was a significant (P<.05) reduction in self-reported workplace sitting time compared to baseline (-6.3%, 95% CI -10.1 to -2.5; n=85) equating to ≈30 minutes per workday. Significant benefits were also observed for the use of activity-promoting strategies, with small, nonsignificant changes observed for knowledge and attitudes and indicators of health and work performance.

CONCLUSIONS

The beta version of the BeUpstanding Champion Toolkit was feasible to implement and effective in reducing self-reported workplace sitting across a broad range of desk-based workplaces. The next phase (Phase 3) will build on these findings to optimize the toolkit for wider-scale implementation and longer term evaluation.

Understanding how outcomes are measured in workplace physical activity interventions: a scoping review

Background

An inverse relationship exists between physical activity and many non-communicable diseases, such as obesity. Given the daily time spent, a logical domain to reach an adult population for intervention is within and around the workplace. Many government bodies, including the World Health Organization (WHO), include worksite health promotions (WHPs) targeted at increasing physical activity as a public health intervention. The aim of this scoping review was to determine what was measured (outcomes) and how they were measured (evaluation tools) during workplace physical activity interventions in order to identify gaps and implications for policies and practice.

Methods

A scoping review was executed in April 2017 via PubMed, SPORTDiscus, EBSCOhost and the Cochrane Library. This search included articles published between January 2008 to February 2017 in order to coincide with the WHO’s Global Plan of Action on Worker’s Health. Extracted information was arranged into data collection grids. Cross-analysis of measured outcomes with their corresponding evaluation tools was completed. A quality assessment based on study design was executed.

Results

Identification of 732 records was made and ultimately 20 studies and reviews that met criteria were selected. Researchers themed 9 primary measured outcomes. Studies utilized various forms of both objective and subjective evaluation methods. Three primary evaluation methods were categorized: biologic, electronic and declarative tools. The researchers discovered 92 unique tools: 27 objective and 65 subjective, within these parameters.

Conclusion

Study quality, measurement tools and data collection were heterogeneous making analysis of effect comparisons problematic and unreliable. Much of the published research does not employ robust statistical analysis making effects difficult to ascertain. Considering the variety of both measured outcomes and evaluation tools, only educated inferences can be made as to the effectiveness and efficiency of WHPs. More standardized measurement practices are therefore suggested for assessment efficiency.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5980-x) contains supplementary material, which is available to authorized users.

Many Kansas Worksites Offer Few Interventions to Reduce Occupational Sedentary Behavior

The purpose of this study was to identify the extent to which sedentary behavior interventions are being implemented in Kansas worksites. The WorkWell KS Physical Activity Assessment was administered online to 111 worksites across Kansas from October 2016 through April 2018. Each worksite identified a point of contact to complete the worksite-level assessment. Four of the WorkWell KS Physical Activity Assessment's items assessed interventions that may reduce employees' sedentary behavior: offering point-of-decision prompts to reduce employees' sedentary behavior, offering a program for employees to reduce their sedentary time at work, having an organizational norm that allows employees to stand, stretch, and/or move during meetings at least every 30 minutes, and offering standing desks. All 111 worksites that participated in the WorkWell KS Physical Activity Workshop completed the WorkWell KS Physical Activity Assessment, resulting in a 100% response rate. Most worksites (59%, n = 65) reported offering no information, program, policy, or environmental change interventions aimed to reduce sedentary behavior. The most commonly reported intervention offered by worksites to reduce employees' sedentary behavior was standing desks (32%, n = 35). Overall, participating worksites reported implementing a few interventions that are designed to reduce sedentary behavior.

Targeting Postprandial Hyperglycemia With Physical Activity May Reduce Cardiovascular Disease Risk. But What Should We Do, and When Is the Right Time to Move?

Physical inactivity and excessive postprandial hyperglycemia are two major independent risk factors for type 2 diabetes and cardiovascular-related mortality. Current health policy guidelines recommend at least 150 min of physical activity per week coupled with reduced daily sedentary behavior by interrupting prolonged sitting with bouts of light activity every 30-min. This evidence-based strategy promotes health and quality of life. Since modern lifestyle enforces physical inactivity through motorized transportation and seated office working environments, this review examines the practical strategies (standing, walking, stair climbing, and strength-based circuit exercises) for reducing sitting time and increasing activity during the workday. Furthermore, since postprandial hyperglycemia poses the greatest relative risk for developing type 2 diabetes and its cardiovascular complications, this review examines a novel hypothesis that interrupting sitting time would be best focused on the postprandial period in order to optimize blood glucose control and maximize cardiometabolic health. In doing so, we aim to identify the science gaps which urgently need filling if we are to optimize healthcare policy in this critical area.

Health outcomes associated with reallocations of time between sleep, sedentary behaviour, and physical activity: a systematic scoping review of isotemporal substitution studies

Background

During a 24-h day, each given period is spent in either sedentary behaviour, sleeping, light physical activity (LPA), or moderate-to-vigorous physical activity (MVPA). In epidemiological research most studies have traditionally analysed the associations of these behaviours in isolation from each other; that is, without taking into account the displacement of time spent in the remaining behaviours. In recent years, there has been a growing interest in exploring how all the behaviours across the energy expenditure spectrum influence health outcomes. A statistical model used to investigate these associations is termed an isotemporal substitution model (ISM). Considering the increasing number of ISM-based studies conducted in all age groups, the present paper aimed to: (i) review and summarise findings from studies that employed ISM in sleep, sedentary behaviour, and physical activity research; (ii) appraise the methodological quality of the studies; and (iii) suggest future research directions in this area.

Methods

A systematic search of ten databases was performed. The Newcastle–Ottawa scale was used to assess the methodological quality of the included studies.

Results

Fifty-six studies met the inclusion criteria, all being of moderate or high methodological quality. Associations were reported for exchanged time varying from one minute to 120 min/day across the studies, with 30 min/day being the most common amount of time reallocated. In total, three different ISM methodologies were used. The most commonly studied health outcomes in relation to isotemporal substitutions were mortality, general health, mental health, adiposity, fitness, and cardiometabolic biomarkers. It seems that reallocations of sedentary time to LPA or MVPA are associated with significant reduction in mortality risk. Current evidence appears to consistently suggest that reductions in mortality risk are greater when time spent sedentary is replaced with higher intensities of physical activity. For adiposity, it seems that reallocating sedentary time to physical activity may be associated with reduced body mass index, body fat percentage, and waist circumference in all age groups, with the magnitude of associations being greater for higher intensities of physical activity. While there is a relatively large body of evidence reporting beneficial associations between the reallocation of time from sedentary behaviour to LPA or MVPA and cardiometabolic biomarkers among adults, there is a lack of studies among children, adolescents, and older adults. Although some studies investigated general health, mental health, and fitness outcomes, further investigation of these topics is warranted. In general, it seems that the strongest association with health outcomes is observed when time is reallocated from sedentary behaviour to MVPA. Most studies did not account for sleep time, which is a major limitation of the current evidence.

Conclusions

The current evidence indicates that time reallocation between sleep, sedentary behaviour, LPA, and MVPA may be associated with a number of health outcomes. Future studies should employ longitudinal designs, take into account all movement behaviours, and examine a wider range of health, psychological, social, economic, and environmental outcomes.

Electronic supplementary material

The online version of this article (10.1186/s12966-018-0691-3) contains supplementary material, which is available to authorized users.

"Could you sit down please?" A qualitative analysis of employees' experiences of standing in normally-seated workplace meetings

Office workers spend most of their working day sitting, and prolonged sitting has been associated with increased risk of poor health. Standing in meetings has been proposed as a strategy by which to reduce workplace sitting but little is known about the standing experience. This study documented workers' experiences of standing in normally seated meetings. Twenty-five participants (18+ years), recruited from three UK universities, volunteered to stand in 3 separate, seated meetings that they were already scheduled to attend. They were instructed to stand when and for however long they deemed appropriate, and gave semi-structured interviews after each meeting. Verbatim transcripts were analysed using Framework Analysis. Four themes, central to the experience of standing in meetings, were extracted: physical challenges to standing; implications of standing for meeting engagement; standing as norm violation; and standing as appropriation of power. Participants typically experienced some physical discomfort from prolonged standing, apparently due to choosing to stand for as long as possible, and noted practical difficulties of fully engaging in meetings while standing. Many participants experienced marked psychological discomfort due to concern at being seen to be violating a strong perceived sitting norm. While standing when leading the meeting was felt to confer a sense of power and control, when not leading the meeting participants felt uncomfortable at being misperceived to be challenging the authority of other attendees. These findings reveal important barriers to standing in normally-seated meetings, and suggest strategies for acclimatising to standing during meetings. Physical discomfort might be offset by building standing time slowly and incorporating more sit-stand transitions. Psychological discomfort may be lessened by notifying other attendees about intentions to stand. Organisational buy-in to promotional strategies for standing may be required to dispel perceptions of sitting norms, and to progress a wider workplace health and wellbeing agenda.

Common Perceived Barriers and Facilitators for Reducing Sedentary Behaviour among Office Workers

Qualitative studies identified barriers and facilitators associated with work-related sedentary behaviour. The objective of this study was to determine common perceived barriers and facilitators among office workers, assess subgroup differences, and describe sedentary behaviour. From two Swedish companies, 547 office workers (41 years (IQR = 35–48), 65% women, 66% highly educated) completed questionnaires on perceived barriers and facilitators, for which subgroup differences in age, gender, education, and workplace sedentary behaviour were assessed. Sedentary behaviour was measured using inclinometers (n = 311). The most frequently reported barrier was sitting is a habit (67%), which was reported more among women than men (Χ² = 5.14, p = 0.03) and more among highly sedentary office workers (Χ² = 9.26, p < 0.01). The two other most reported barriers were that standing is uncomfortable (29%) and standing is tiring (24%). Facilitators with the most support were the introduction of either standing- or walking-meetings (respectively 33% and 29%) and more possibilities or reminders for breaks (31%). The proportion spent sedentary was 64% at the workplace, 61% on working days, and 57% on non-working days. This study provides a detailed understanding of office workers’ ideas about sitting and means to reduce sitting. We advise to include the supported facilitators and individualized support in interventions to work towards more effective strategies to reduce sedentary behaviour.

The influence of a consumer-wearable activity tracker on sedentary time and prolonged sedentary bouts: secondary analysis of a randomized controlled trial

Objective

A recent meta-analysis surmised pedometers were a useful panacea to independently reduce sedentary time (ST). To further test and expand on this deduction, we analyzed the ability of a consumer-wearable activity tracker to reduce ST and prolonged sedentary bouts (PSB). We originally conducted a 12-month randomized control trial where 800 employees from 13 organizations were assigned to control, activity tracker, or one of two activity tracker plus incentive groups designed to increase step count. The primary outcome was accelerometer measured moderate-to-vigorous physical activity.

Results

We conducted a secondary analysis on accelerometer measured daily ST and PSB bouts. A general linear mixed model was used to examine changes in ST and prolonged sedentary bouts, followed by between-group pairwise comparisons. Regression analyses were conducted to examine the association of changes in step counts with ST and PSB. The changes in ST and PSB were not statistically significant and not different between the groups (P < 0.05). Increases in step counts were concomitantly associated with decreases in ST and PSB, regardless of intervention (P < 0.05). Caution should be taken when considering consumer-wearable activity trackers as a means to reduce sedentary behavior.

Trial registration NCT01855776 Registered: August 8, 2012

Electronic supplementary material

The online version of this article (10.1186/s13104-018-3306-9) contains supplementary material, which is available to authorized users.

Stand More AT Work (SMArT Work): using the behaviour change wheel to develop an intervention to reduce sitting time in the workplace

BACKGROUND

Sitting (sedentary behaviour) is widespread among desk-based office workers and a high level of sedentary behaviour is a risk factor for poor health. Reducing workplace sitting time is therefore an important prevention strategy. Interventions are more likely to be effective if they are theory and evidence-based. The Behaviour Change Wheel (BCW) provides a framework for intervention development. This article describes the development of the Stand More AT Work (SMArT Work) intervention, which aims to reduce sitting time among National Health Service (NHS) office-based workers in Leicester, UK.

METHODS

We followed the BCW guide and used the Capability, Opportunity and Motivation Behaviour (COM-B) model to conduct focus group discussions with 39 NHS office workers. With these data we used the taxonomy of Behaviour Change Techniques (BCTv1) to identify the most appropriate strategies for facilitating behaviour change in our intervention. To identify the best method for participants to self-monitor their sitting time, a sub-group of participants (n = 31) tested a number of electronic self-monitoring devices.

RESULTS

From our BCW steps and the BCT-Taxonomy we identified 10 behaviour change strategies addressing environmental (e.g. provision of height adjustable desks,), organisational (e.g. senior management support, seminar), and individual level (e.g. face-to-face coaching session) barriers. The Darma cushion scored the highest for practicality and acceptability for self-monitoring sitting.

CONCLUSION

The BCW guide, COM-B model and BCT-Taxonomy can be applied successfully in the context of designing a workplace intervention for reducing sitting time through standing and moving more. The intervention was developed in collaboration with office workers (a participatory approach) to ensure relevance for them and their work situation. The effectiveness of this intervention is currently being evaluated in a randomised controlled trial.

TRIAL REGISTRATION

ISRCTN10967042 . Registered on 2 February 2015.

Personalized Physical Activity Coaching: A Machine Learning Approach

Living a sedentary lifestyle is one of the major causes of numerous health problems. To encourage employees to lead a less sedentary life, the Hanze University started a health promotion program. One of the interventions in the program was the use of an activity tracker to record participants' daily step count. The daily step count served as input for a fortnightly coaching session. In this paper, we investigate the possibility of automating part of the coaching procedure on physical activity by providing personalized feedback throughout the day on a participant's progress in achieving a personal step goal. The gathered step count data was used to train eight different machine learning algorithms to make hourly estimations of the probability of achieving a personalized, daily steps threshold. In 80% of the individual cases, the Random Forest algorithm was the best performing algorithm (mean accuracy = 0.93, range = 0.88-0.99, and mean F1-score = 0.90, range = 0.87-0.94). To demonstrate the practical usefulness of these models, we developed a proof-of-concept Web application that provides personalized feedback about whether a participant is expected to reach his or her daily threshold. We argue that the use of machine learning could become an invaluable asset in the process of automated personalized coaching. The individualized algorithms allow for predicting physical activity during the day and provides the possibility to intervene in time.

A randomised feasibility study to investigate the impact of education and the addition of prompts on the sedentary behaviour of office workers

Background

Office workers have been identified as being at risk of accumulating high amounts of sedentary time in prolonged events during work hours, which has been associated with increased risk of a number of long-term health conditions.

There is some evidence that providing advice to stand at regular intervals during the working day, and using computer-based prompts, can reduce sedentary behaviour in office workers. However, evidence of effectiveness, feasibility and acceptability for these types of intervention is currently limited.

Methods

A 2-arm, parallel group, cluster-randomised feasibility trial to assess the acceptability of prompts to break up sedentary behaviour was conducted with office workers in a commercial bank (n = 21). Participants were assigned to an education only group (EG) or prompt and education group (PG). Both groups received education on reducing and breaking up sitting at work, and the PG also received hourly prompts, delivered by Microsoft Outlook over 10 weeks, reminding them to stand. Objective measurements of sedentary behaviour were made using activPAL monitors worn at three time points: baseline, in the last 2 weeks of the intervention period and 12 weeks after the intervention. Focus groups were conducted to explore the acceptability of the intervention and the motivations and barriers to changing sedentary behaviour.

Results

Randomly generated, customised prompts, delivered by Microsoft Outlook, with messages about breaking up sitting, proved to be a feasible and acceptable way of delivering prompts to office workers. Participants in both groups reduced their sitting, but changes were not maintained at follow-up. The education session seemed to increase outcome expectations of the benefits of changing sedentary behaviour and promote self-regulation of behaviour in some participants. However, low self-efficacy and a desire to conform to cultural norms were barriers to changing behaviour.

Conclusions

Prompts delivered by Microsoft Outlook were a feasible, low-cost way of prompting office workers to break up their sedentary behaviour, although further research is needed to determine whether this has an additional impact on sedentary behaviour, to education alone. The role of cultural norms, and promoting self-efficacy, should be considered in the design of future interventions.

Trial registration

This study was registered retrospectively as a clinical trial on ClinicalTrials.gov (ID no. NCT02609282) on 23 March 2015.

Correlates of occupational, leisure and total sitting time in working adults: results from the Singapore multi-ethnic cohort

Background

Evidence on the health risks of sitting is accumulating. However, research identifying factors influencing sitting time in adults is limited, especially in Asian populations. This study aimed to identify socio-demographic and lifestyle correlates of occupational, leisure and total sitting time in a sample of Singapore working adults.

Methods

Data were collected between 2004 and 2010 from participants of the Singapore Multi Ethnic Cohort (MEC). Medical exclusion criteria for cohort participation were cancer, heart disease, stroke, renal failure and serious mental illness. Participants who were not working over the past 12 months and without data on sitting time were excluded from the analyses. Multivariable regression analyses were used to examine cross-sectional associations of self-reported age, gender, ethnicity, marital status, education, smoking, caloric intake and moderate-to-vigorous leisure time physical activity (LTPA) with self-reported occupational, leisure and total sitting time. Correlates were also studied separately for Chinese, Malays and Indians.

Results

The final sample comprised 9384 participants (54.8% male): 50.5% were Chinese, 24.0% Malay, and 25.5% Indian. For the total sample, mean occupational sitting time was 2.71 h/day, mean leisure sitting time was 2.77 h/day and mean total sitting time was 5.48 h/day. Sitting time in all domains was highest among Chinese. Age, gender, education, and caloric intake were associated with higher occupational sitting time, while ethnicity, marital status and smoking were associated with lower occupational sitting time. Marital status, smoking, caloric intake and LTPA were associated with higher leisure sitting time, while age, gender and ethnicity were associated with lower leisure sitting time. Gender, marital status, education, caloric intake and LTPA were associated with higher total sitting time, while ethnicity was associated with lower total sitting time. Stratified analyses revealed different associations within sitting domains for Indians compared to Chinese and Malays.

Conclusion

Our findings highlight the need to focus on separate domains of sitting (occupational, leisure or total) when identifying which factors determine this behavior, and that the content of intervention programs should be tailored to domain-specific sitting rather than to sitting in general. Finally, our study showed ethnic differences and therefore we recommend to culturally target interventions.