Work Site-Based Environmental Interventions to Reduce Sedentary Behavior: A Systematic Review

Continuous work-related sitting time and its association with perceived workplace support for health among workers in the Greater Accra Municipality: a cross-sectional analysis with sensitivity analyses

BACKGROUND

Research to date has shown that work-related sitting time can be a major occupational health risk. This understanding has encouraged several workplace health promotion efforts. Even so, some domains of work-related sitting time and their associations with Perceived Workplace Support for Health (PWSH) have not been considered in research. This study aims to compare domains of work-related sitting time between employee characteristics (e.g., gender and age) and assess their associations with PWSH.

METHODS

This study adopted a cross-sectional design with a sensitivity analysis against confounding and measures against common methods bias. The study population was employees of private and public firms in Accra, Ghana. In all, 1000 employees participated in the study. The hierarchical linear regression analysis and the independent samples t-test were used to present the results.

RESULTS

Employees working in service firms, compared with those working in manufacturing firms, reported longer sitting time for lunchtime. After adjusting for physical function, we found a negative association between PWSH and the sum of continuous sitting time as well as its domains (p < 0.001), except for 'sitting with a desk' (p > 0.05).

CONCLUSION

Work-related sitting time was associated with employee characteristics and was lower at higher PWSH. This study reinforces the importance of workplace support for health and its role in work-related sitting.

Conceptualising a theoretical framework for planning and evaluating workplace oral health promotion programs

ISSUED ADDRESSED

Workplaces have considerable potential for enhancing personal resources and providing a supportive working environment for staff health, including oral health and well-being. To date, assessments of workplace oral health promotion (WOHP) activities have observed benefits ranging from self-reported oral health to clinical parameters. However, previous WOHP actions were not based on a theoretical framework and did not consider the working environment as part of the planning and evaluation process.

METHODS

This article used evidence-based health promotion theoretical frameworks, and associated facilitators and barriers, in constructing an integrated and theoretically robust approach to planning and evaluating oral health promotion activities in the workplace.

RESULTS

The PRECEDE-PROCEED Model for planning and evaluation, the reach effectiveness adoption implementation maintenance, and the Salutogenic Model of Health were chosen to complement each other in the planning and evaluation process, based on their different features and the applicability of those features to the workplace setting. Because of the limited literature in this area, the current article also used evidence from oral health promotion in other settings (including schools and the community) and general health promotion in the workplace to construct a theoretical framework for planning and evaluating WOHP activities.

CONCLUSIONS

The theoretical framework developed could assist in planning or improving existing workplace health promotion programs that focus on or incorporate oral health elements. SO WHAT?: Future research on applying and adapting the proposed framework is required.

Precision prevention in occupational health: a conceptual analysis and development of a unified understanding and an integrative framework

Introduction

Precision prevention implements highly precise, tailored health interventions for individuals by directly addressing personal and environmental determinants of health. However, precision prevention does not yet appear to be fully established in occupational health. There are numerous understandings and conceptual approaches, but these have not yet been systematically presented or synthesized. Therefore, this conceptual analysis aims to propose a unified understanding and develop an integrative conceptual framework for precision prevention in occupational health.

Methods

Firstly, to systematically present definitions and frameworks of precision prevention in occupational health, six international databases were searched for studies published between January 2010 and January 2024 that used the term precision prevention or its synonyms in the context of occupational health. Secondly, a qualitative content analysis was conducted to analyze the existing definitions and propose a unified understanding. Thirdly, based on the identified frameworks, a multi-stage exploratory development process was applied to develop and propose an integrative conceptual framework for precision prevention in occupational health.

Results

After screening 3,681 articles, 154 publications were reviewed, wherein 29 definitions of precision prevention and 64 different frameworks were found, which can be summarized in eight higher-order categories. The qualitative content analysis revealed seven themes and illustrated many different wordings. The proposed unified understanding of precision prevention in occupational health takes up the identified themes. It includes, among other things, a contrast to a "one-size-fits-all approach" with a risk- and resource-oriented data collection and innovative data analytics with profiling to provide and improve tailored interventions. The developed and proposed integrative conceptual framework comprises three overarching stages: (1) data generation, (2) data management lifecycle and (3) interventions (development, implementation and adaptation).

Discussion

Although there are already numerous studies on precision prevention in occupational health, this conceptual analysis offers, for the first time, a proposal for a unified understanding and an integrative conceptual framework. However, the proposed unified understanding and the developed integrative conceptual framework should only be seen as an initial proposal that should be critically discussed and further developed to expand and strengthen both research on precision prevention in occupational health and its practical application in the workplace.

Workplace oral health promotion activities among community-aged care workers: A qualitative exploration

BACKGROUND

The workplace is an ideal-and priority-setting for health promotion activities. Developing and implementing workplace health promotion interventions, including oral health promotion activities, can help create health-supporting workplace environments.

OBJECTIVE

To pilot workplace oral health promotion activities among staff working in the aged care sector, report their impact and explore participants' views on the factors that contribute to participation and effectiveness.

METHODS

This study comprised three phases: (i) the development and face validation of the resources, (ii) a 3-h educational session and (iii) five interview sessions with participants 4-6 weeks following the education session. The recorded interviews were transcribed verbatim and analysed thematically.

RESULTS

Eleven community-aged care workforce were invited to five feedback sessions. Ten participants were female and ranged in age from 18 to 64. All participants gave favourable comments about the content and delivery of the training session and accompanying resources. The participants felt that the benefits of WOHP include improved staff knowledge, awareness and oral care routine, the ability to share (and put into practice) the gained knowledge and information with their dependants, a lower risk of having poor oral health that adversely affects their well-being and work tasks, and potentially beneficial impacts on the organization's staff roster. Their attendance in the WOHP was facilitated by being paid to attend and scheduling the sessions during work time. Future WOHP suggestions include the possibility of a one-stop dental check-up at the workplace or staff dental care discounts from local dental practitioners and combining oral health with other health promotion activities.

CONCLUSIONS

Planning and implementing WOHP was deemed acceptable and feasible in this study context and successfully achieved short-term impacts among community-aged care workers. Appropriate times and locations, organizational arrangements and a variety of delivery options contributed to successful programme planning and implementation.

Effectiveness of interventions on sedentary behaviors in office workers: a systematic review and meta-analysis

OBJECTIVES

Various interventions have sought to break sedentariness among office workers, but their pooled effect on sitting time reduction remains unknown. Also, it is essential to compare the effectiveness of different intervention types.

STUDY DESIGN

Systematic review and meta-analysis.

METHODS

A literature search was conducted in the PubMed, EMBASE, Scopus, Web of Science, MEDLINE (via EBSCO), PsycINFO, and Cochrane Library databases from inception to May 2, 2023. Two independent reviewers screened eligibility, extracted data, and assessed the risk of bias using the Cochrane risk of bias tool 2.0. Randomized controlled trials aiming to reduce sitting at work were included. The primary outcome was sitting time at work per day. The secondary outcomes included cardiometabolic risk factors, psychological well-being, and work engagement. A random effects model was performed to synthesize continuous data as mean differences with 95% confidence intervals (95% CIs).

RESULTS

Twenty-four studies with 3169 participants were included. All intervention types in combination significantly reduced workplace sitting by 38 min per workday (95% CI: -47.32 to -28.72; P < 0.001; I2 = 49.78%). Interventions using environmental support (ES), motivational strategies (MS), or multiple components (multi) had all shown a significant reduction in work-time sedentary behavior (SB) relative to control groups. Regarding secondary outcomes, no significant effects were observed in physical or psychological outcomes besides high-density lipoprotein.

CONCLUSIONS

Findings suggest that SB reduction interventions are generally effective for reducing workplace sitting. Multi interventions with both ES and MS are recommended for future clinical applications. Future studies should aim not only to reduce SB but also to attain the benefits of SB reduction interventions on physical and psychological well-being.

The sedentary behavior reduction in pregnancy intervention (SPRING) pilot and feasibility randomized trial

Pregnant individuals rarely achieve moderate-to-vigorous intensity physical activity recommendations.Purpose The sedentary behavior reduction in pregnancy intervention (SPRING) pilot and feasibility randomized trial aimed to demonstrate feasibility, acceptability, and initial efficacy of a lower intensity intervention targeting reduced sedentary behavior and increased standing and steps.Methods First trimester pregnant individuals at risk for high sedentary behavior and adverse pregnancy outcomes (APO) were randomized 2:1 to a multi-component sedentary behavior reduction intervention or no-contact control. Intervention components included biweekly remote health coaching, wearable activity monitor, height-adjustable workstation, and a private Facebook group. Evidence-based behavioral targets included sedentary time < 9 h/day, increasing standing by 2-3 h/day, and ≥ 7500 steps/day. Participants completed all-remote assessments (baseline, second trimester, third trimester) of sedentary behavior and activity (thigh-worn activPAL) along with exploratory pregnancy health outcomes abstracted from medical records. Intervention effects vs. control were evaluated using generalized mixed models and an intention-to-treat approach. Intervention participants also provided feedback on perceived benefits and acceptability.Results Participants (34 intervention; 17 control) had mean age 32 years, were 83% White, with mean pre-pregnancy BMI 28 kg/m2. Retention was high (90% and 83% at second and third trimester follow-up visits). Intervention participants decreased sedentary time (-0.84 h/day, p = 0.019) and increased standing (+0.77 h/day, p = 0.003), but did not increase steps/day (+710, p = 0.257) compared to controls. Intervention participants reported many perceived benefits and identified the wearable, height-adjustable workstation, and behavioral lessons as most useful.Conclusion For pregnant individuals at risk for high sedentary behavior and APOs, a sedentary behavior reduction intervention is feasible, acceptable, and may offer a viable alternative to more intense physical activity recommendations during pregnancy. Further testing in a fully powered clinical trial is warranted.Trial registration NCT05093842 on clinicaltrials.gov.

Active time at work following the introduction of a standing and a cycling workstation into worker's office space

Objectives. Active workstations have been proposed to counteract sedentary behavior at work. This study describes office workers' use of and perceptions toward standing and cycling workstations, and assesses whether the two active workstations were sufficient to break sitting time and replace it with 2-4 h of light activity per workday. Methods. This mixed-method study utilized video recording, semi-structured interviews and a questionnaire. The quantitative data covered time spent sitting, standing and on a cycling workstation. The qualitative data were analyzed based on preferences, barriers and facilitators. Results. Participants (n = 15) used active workstations 125.3 (74.5) min/day and spent 79.0 (63.6) min/day using standing versus 46.3 (47.6) min/day using cycling workstations (p = 0.153, d = 0.58). Following the interviews, the standing workstation was preferred over cycling. The ergonomics of the cycling workstation were not optimal and caused discomfort in use. Seven participants broke their sitting time and accumulated 2+ h of light physical activity per workday. Those participants meeting recommendations were older, had a higher body fat percentage and engaged in less physical activity per week. Conclusion. With a preference for standing workstations, our results showed that 47% of workers used standing and cycling workstations to accumulate 2+ h of active time per day.

Physical activity interventions in workplace health promotion: objectives, related outcomes, and consideration of the setting-a scoping review of reviews

Background

The workplace is a recognized setting for promoting health among adults, and physical activity (PA) interventions are an integral part of workplace health promotion (WHP).

Objectives

The present review of reviews aims to provide an overview of the main objectives and related outcomes addressed in WHP-related PA interventions, as well as the setting-specific aspects considered in the research field.

Methods

A scoping review of reviews was conducted. Reviews were included if they were peer-reviewed, written in English, and focused on PA interventions conducted in the context of WHP. A literature search was conducted in PubMed, SPORTDiscus, and Web of Science. Reviews were included if they had been published after the year 2000. Information on the following dimensions was extracted: author, region, number of primary studies included, target group(s), PA interventions included, main objective(s), related outcomes, and setting-specific aspects.

Results

A total of 17 reviews were included. Six reviews aimed at solely identifying the effectiveness of promoting daily PA and reducing sedentary behavior. Eleven reviews showed a combined approach considering physical activity behavior and/or health and job-related outcomes. Outcomes in the primary studies were heterogeneous. None of the reviews had an explicit definition of WHP and setting-specific information was very general and sparse. The reported setting-specific information was referred to the general importance of the workplace setting, the specific importance as an access route to target groups, and implementation aspects. Regarding the additional characteristics of the reviews, the selection of primary studies was restricted to a specific region in 2 of the 17 reviews in advance. Three reviews restricted the target group (sedentary workers, women, desk-based workers), while eleven reviews included working adults in general and, three reviews gave no information about the target group. Eleven intervention approaches of the reviews were behaviorally oriented, two focused solely on environmental interventions, and four reviews can be attributed to a combined approach considering behavioral and environmental interventions.

Conclusion

For sustainable future developments, the present results indicate a strong need for conceptual consolidation of WHP in the research field of PA interventions. Therefore, both WHP and health-related PA interventions need to take a comprehensive approach comprising behavioral and environmental interventions.

Moderators of the Effectiveness of UPcomplish on Office Workers' Sedentary Behaviour, Quality of Life, and Psychosocial Determinants: A Stepped Wedge Design

BACKGROUND

In the earlier developed and evaluated 12-week UPcomplish intervention, the aim was to reduce sedentary behaviour (SB) among office workers and increase their quality of life (QoL). In the current study, we explored moderators of effectiveness.

METHOD

We applied a stepped wedge design with five intervention groups starting with time lags of seven weeks (n = 142, 96 females). Participants wore the VitaBit to continuously measure SB and received surveys about QoL and psychosocial determinants at the beginning, middle, and end of the intervention. We regressed baseline participant characteristics and behaviours onto intra-individual improvements (centred around calendar week means) in determinants, SB, performance objectives, and QoL.

RESULTS

Those scoring high in baseline intention, task performance, stress, vitality, and emotional well-being improved less in these variables. Baseline stress (β =  - 0.05 [SE = 0.01; 95% CI =  - 0.08, - 0.02; pcorrected = .02]) and emotional well-being (β = 0.02 [SE = 0.01; 95% CI = 0.01, 0.03; pcorrected = .02]) were associated with improvement in contextual performance. Baseline attitude (β =  - 12.92 [SE = 3.93; 95% CI =  - 20.80, - 5.04; pcorrected = .02]) and perceived behavioural control (PBC; β =  - 9.27 [SE = 3.04; 95% CI =  - 15.37, - 3.16; pcorrected = .03]) were negatively associated with improvements in emotional well-being. Post hoc analyses with a sub-group scoring lower in determinants revealed that improvement in PBC was positively associated with SB registration.

CONCLUSION

Participants scoring low in baseline determinants might profit from UPcomplish via an increase in PBC. In combination with changes within organizations (e.g. the implementation of standing desks), UPcomplish might potentially reduce SB.

TRIAL REGISTRATION

NL7503 - registered 1 February 2019.

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.

A Social Cognitive Assessment of Workplace Sedentary Behavior among a Sample of University Employees

Sedentary behavior (SB) is an important public health concern. Adults working in desk-based occupations spend a considerable proportion of the workday sitting. More information is needed regarding the factors that contribute to occupational SB. The aim of this study was to assess the utility of social cognitive theory (SCT) to explain work-related SB using a quantitative, cross-sectional design by administering an online questionnaire. Participants included 381 full-time employees at a large, public university in the south-central United States. Hierarchical multiple linear regression was used to determine the relationship between SCT constructs and SB. Mean work-related SB was 5.95 (SD = 1.30) h/8 h workday. In model 1, 9.6% of the total variance in SB was accounted for by standing desk ownership and physical activity level (p = 0.001; R2 = 0.096). In model 2, SCT constructs led to a statistically significant R2 increase of 4.9% (p < 0.001), where standing desk ownership, physical activity, and self-efficacy explained 13.3% of the variance in work-related SB. Findings from this study suggest that self-efficacy may be an important factor in explaining variation in occupational SB. Public health researchers and practitioners should consider strategies to address self-efficacy when developing workplace interventions to target occupational SB.

The effects of active workstations on reducing work-specific sedentary time in office workers: a network meta-analysis of 23 randomized controlled trials

BACKGROUND

Active workstations have been proposed as a feasible approach for reducing occupational sedentary time. This study used a network meta-analysis (NMA) to assess and compare the overall efficacy of active workstation interventions according to type and concomitant strategy for reducing work-specific sitting time in office workers.

METHODS

PubMed, Web of Science, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched from database inception until May 2022 to obtain randomized controlled trials (RCTs) assessing the efficacy of active workstations with or without concomitant strategies for reducing occupational sedentary time in office workers. The risk of bias of the RCTs included in this study was assessed according to the Cochrane Handbook. An NMA with STATA 15.1 was used to construct a network diagram, league figures, and the final surface under the cumulative ranking curve (SUCRA) values. The certainty of evidence was assessed using the grading of recommendations, assessment, development, and evaluation (GRADE) approach.

RESULTS

A total of 23 eligible studies including eight different types of interventions with 1428 office workers were included. NMA results showed that compared to a typical desk, multicomponent intervention (standardized mean difference (SMD) =  - 1.50; 95% confidence interval (CI) - 2.17, - 0.82; SUCRA = 72.4%), sit-stand workstation + promotion (Reminders of rest breaks, posture variation, or incidental office activity) (SMD =  - 1.49; 95%CI - 2.42, - 0.55; SUCRA = 71.0%), treadmill workstation + promotion (SMD =  - 1.29; 95%CI - 2.51, - 0.07; SUCRA = 61.6%), and sit-stand workstation (SMD =  - 1.10, 95%CI - 1.64, - 0.56; SUCRA = 50.2%) were effective in reducing occupational sedentary time for office workers.

CONCLUSIONS

Multicomponent intervention, sit-stand workstation + promotion, treadmill workstation + promotion, and sit-stand workstation appear to be effective in reducing work-specific sedentary time for office workers. Furthermore, multicomponent interventions and active workstations + promotion better reduced work-specific sedentary time than active workstation alone. However, the overall certainty of the evidence was low.

TRIAL REGISTRATION

Our study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO); registration number: CRD42022344432.

Dropout and compliance to physical exercise in menopausal osteopenic women: the European "happy bones" project

Introduction

Decline in muscle mass and bone density seem to be two of the most disabling side effects of menopause that negatively affect women's quality of life. Promoting physical activity protocols in the workplace can represent a focal point in the prevention and management of several diseases. The study aims to evaluate the compliance and drop-out of menopausal osteopenic women engaged in combined training performed inside and outside the workplace. Strength and balance were analyzed to evaluate the effect of this protocol on osteoporosis prevention and the risk of falling.

Methods

73 menopausal women were enrolled in 5 European countries. They performed 72 lessons of a combined training proposed in the working place (IW) or sport center (SC).

Results

Out of the total 39 women enrolled in the IW, 12.8% had to leave the program, while out of the 34 women enrolled in SC, 41.2% did not complete the training. According to the compliance results, 47% of women that completed the trained IW and 85% in the SC recorded high compliance (p = 0.019). Moreover, the strength of the lower limbs (p < 0.001) and static balance (p = 0.001) significantly improved in the whole group.

Discussion

In conclusion, proposing well-structured training in the workplace for menopausal women seems to reduce drop-out. Strength and balance results suggest its positive impact on bone health and risk of falls, despite where it is performed.

Rationale, Design, and Methods for the Sedentary Behavior Reduction in Pregnancy Intervention (SPRING): Protocol for a Pilot and Feasibility Randomized Controlled Trial

BACKGROUND

Adverse pregnancy outcomes (APOs) identify cardiovascular disease risk, but few effective interventions are available. High sedentary behavior (SED) has recently been associated with APOs, but very few randomized controlled trials (RCTs) have tested SED reduction in pregnancy.

OBJECTIVE

The Sedentary Behavior Reduction in Pregnancy Intervention (SPRING) pilot and feasibility RCT addresses this gap by testing the feasibility, acceptability, and preliminary pregnancy health effects of an intervention to reduce SED in pregnant women. The objective of this manuscript is to describe the rationale and design of SPRING.

METHODS

Pregnant participants (n=53) in their first trimester, who are at risk for high SED and APO and without contraindications, are randomized in a 2:1 ratio to an intervention or control group. SED (primary outcome) and standing durations, and steps per day, are measured objectively in each trimester for 1 week with a thigh-mounted activPAL3 accelerometer. SPRING also seeks to demonstrate feasibility and acceptability while estimating preliminary effects on maternal-fetal health outcomes assessed during study visits and abstracted from medical records. The pregnancy-customized intervention promotes daily behavioral targets of less than 9 hours of SED and at least 7500 steps, achieved via increased standing and incorporating light-intensity movement breaks each hour. The multicomponent intervention provides a height-adjustable workstation, a wearable activity monitor, behavioral counseling every 2 weeks (through videoconference), and membership in a private social media group. Herein, we review the rationale, describe recruitment and screening processes, and detail the intervention, assessment protocols, and planned statistical analyses.

RESULTS

This study was funded by the American Heart Association (20TPA3549099), with a funding period of January 1, 2021, and until December 31, 2023. Institutional review board approval was obtained on February 24, 2021. Participants were randomized between October 2021 and September 2022, with final data collection planned for May 2023. Analyses and submission of results are expected for winter of 2023.

CONCLUSIONS

The SPRING RCT will provide initial evidence on the feasibility and acceptability of an SED-reduction intervention to decrease SED in pregnant women. These data will inform the design of a large clinical trial testing SED reduction as a strategy to reduce APO risk.

TRIAL REGISTRATION

ClincialTrials.gov NCT05093842; https://clinicaltrials.gov/ct2/show/NCT05093842.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/48228.

Interventions Designed to Support Physical Activity and Disease Prevention for Working from Home: A Scoping Review

Working from home (WfH) has public health implications including changes to physical activity (PA) and sedentary behavior (SB). We reviewed published and grey literature for interventions designed to support PA or reduce SB in WfH contexts. From 1355 published and grey literature documents since 2010, we screened 136 eligible documents and extracted ten intervention studies. Interventions designed specifically for WfH were limited and included structured exercise programs, infrastructure (e.g., sit-stand workstations), online behavioral and educational programs, health professional advice and peer support, activity trackers and reminder prompts. Evidence of interventions to improve PA and reduce SB in WfH contexts is emergent but lacking in variety and in utilization of local environments to promote good health. Evidence is needed on the adaptation of existing workplace interventions for home environments and exploration of opportunities to support PA through alternative interventions, such as urban planning and recreational strategies.

Feasibility of a theory-based intervention to reduce sedentary behaviour among contact centre staff: the SUH stepped-wedge cluster RCT

Background

Sedentary behaviour is linked to increased risk of type 2 diabetes, cardiovascular disease, musculoskeletal issues and poor mental well-being. Contact (call) centres are associated with higher levels of sedentary behaviour than other office-based workplaces. Stand Up for Health is an adaptive intervention designed to reduce sedentary behaviour in contact centres.

Objectives

The objectives were to test the acceptability and feasibility of implementing the intervention; to assess the feasibility of the study design and methods; to scope the feasibility of a future health economic evaluation; and to consider the impact of COVID-19 on the intervention. All sites received no intervention for between 3 and 12 months after the start of the study, as a waiting list control.

Design

This was a cluster-randomised stepped-wedge feasibility design.

Setting

The trial was set in 11 contact centres across the UK.

Participants

Eleven contact centres and staff.

Intervention

Stand Up for Health involved two workshops with staff in which staff developed activities for their context and culture. Activities ranged from using standing desks to individual goal-setting, group walks and changes to workplace policies and procedures.

Main outcome measures

The primary outcome was accelerometer-measured sedentary time. The secondary outcomes were subjectively measured sedentary time, overall sedentary behaviour, physical activity, productivity, mental well-being and musculoskeletal health.

Results

Stand Up for Health was implemented in 7 out of 11 centres and was acceptable, feasible and sustainable (objective 1). The COVID-19 pandemic affected the delivery of the intervention, involvement of contact centres, data collection and analysis. Organisational factors were deemed most important to the success of Stand Up for Health but also the most challenging to change. There were also difficulties with the stepped-wedge design, specifically maintaining contact centre interest (objective 2). Feasible methods for estimating cost-efficiency from an NHS and a Personal Social Services perspective were identified, assuming that alternative feasible effectiveness methodology can be applied. Detailed activity-based costing of direct intervention costs was achieved and, therefore, deemed feasible (objective 3). There was significantly more sedentary time spent in the workplace by the centres that received the intervention than those that did not (mean difference 84.06 minutes, 95% confidence interval 4.07 to 164.1 minutes). The other objective outcomes also tended to favour the control group.

Limitations

There were significant issues with the stepped-wedge design, including difficulties in maintaining centre interest and scheduling data collection. Collection of accelerometer data was not feasible during the pandemic.

Conclusions

Stand Up for Health is an adaptive, feasible and sustainable intervention. However, the stepped-wedge study design was not feasible. The effectiveness of Stand Up for Health was not demonstrated and clinically important reductions in sedentary behaviour may not be seen in a larger study. However, it may still be worthwhile conducting an effectiveness study of Stand Up for Health incorporating activities more relevant to hybrid workplaces.

Future work

Future work could include developing hybrid (office and/or home working) activities for Stand Up for Health; undertaking a larger effectiveness study and follow-up economic analysis (subject to its success); and exploring organisational features of contact centres that affect the implementation of interventions such as Stand Up for Health.

Trial registration

This trial is registered as ISRCTN11580369.

Funding

This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 13. See the NIHR Journals Library website for further project information.

Stand Up for Health: Programme theory for an intervention to reduce sedentary behaviour in contact centres

BACKGROUND

Contact centre staff spend up to 95 % of their day seated, which can lead to a range of negative health outcomes. The aim of this study was to develop a programme theory for a complex intervention to reduce sedentary behaviour in contact centres.

METHODS

The 6SQuID model was used. A literature review, and focus groups at one contact centre were used to: understand the problem (step 1); identify modifiable factors (step 2); and develop a theory of change (step 3). A workshop shaped a theory of action (step 4), and the programme theory was refined after testing activities over 6 months (step 5). The intervention is currently undergoing further evaluation and feasibility testing in a larger scale stepped wedge randomised controlled study in 11 contact centres (Step 6).

RESULTS

Step 1: Limited opportunity to sit less, and move more at work was identified as the main problem. Step 2: Modifiable factors were identified at four levels of the centre. Step 3: A theory of change was developed around cultural norms and individual behaviour change. Step 4: Actions were developed to 'activate' the theory of change. Step 5: Activities were implemented, and adapted over 6 months and the programme theory was refined.

CONCLUSION

The programme theory behind this intervention is robust, evidence based, adaptive and transferable.

Designing and Usability testing of a New Prototype Active Footrest for Knee Extension Exercise Among Office Workers

OBJECTIVES

The active factor along with light exercise can reduce static muscle work and increase muscle flexibility and endurance. Accordingly, this study aimed to design and prototype a new active footrest, implemented in conventional sitting workstations and to test its usability among office workers.

METHODS

The steps taken to design and prototype the active footrest were a) selection of an exercise appropriate for goals of ergonomic interventions, b) idea development, c) selection of the best conceptual design, d) design with SOLIDWORKS version 2016 software, and e) fabrication of a prototype. Afterward, the usability of the active footrest prototype was assessed among 20 office workers (10 females) using field data by the System Usability Scale.

RESULTS

Upon the completion of the design steps, the active footrest prototype was prototyped by taking into account design criteria (e.g. functionality, inclusive design, easy application, and reduction of additional body movement), anthropometric data and mechanical properties. The participants rated the usability of the active workstation as 89 ± 8.21 (out of 100) and indicating good usability results.

CONCLUSION

In this study, an active footrest was designed and prototyped to perform knee extension exercise with the capability of being implemented in conventional sitting workstations.

Adherence to a Lifestyle Exercise and Nutrition Intervention in University Employees during the COVID-19 Pandemic: A Randomized Controlled Trial

Healthy lifestyles should be encouraged in the workplace through the occupational health teams of the companies. The objective of the present study was to evaluate the adherence to a lifestyle intervention carried out in university employees during the COVID-19 pandemic and its impact on health-related quality of life (HrQoL). A randomized controlled trial following the CONSORT guidelines was performed, consisting of three supervised interventions lasting for 18 weeks: an educational intervention on healthy habits, a nutritional intervention, and a telematic aerobic and strength exercise intervention. Lifestyle and HrQoL were analyzed six months post-intervention to assess adherence. Twenty-three middle-aged participants completed the study. The intervention group significantly improved their lifestyle according to the Health Promoting Lifestyle Profile II questionnaire, especially in the categories of Health Responsibility, Physical Activity, and Nutrition, with a large effect size. Sitting time was reduced by 2.5 h per day, with a moderate effect size. Regarding HrQoL, the intervention group showed a clinically significant improvement in the Physical Component Summary. Despite the lockdown and the mobility restrictions caused by the COVID-19 pandemic, this intervention performed on university employees achieved adherence to a healthier lifestyle and improved their HrQoL, which is of great clinical relevance.

Understanding the Implementation of "Sit Less at Work" Interventions in Three Organisations: A Mixed Methods Process Evaluation

Long periods of workplace sitting are associated with poor health outcomes. Interventions to reduce workplace sitting time have had variable impacts, the reasons for which require further investigation. In this paper, we report on a process evaluation aiming to determine the intervention fidelity of three "sit less at work" interventions and to explore barriers and enablers to implementation, using a mixed methods "before and after" intervention study design. Convenience samples of staff were recruited from three diverse organisations to participate in pre- and post-intervention online questionnaires, objective measures of sitting time (using activPAL3™ devices) and post-intervention focus groups. Intervention implementers and key personnel were also recruited to participate in post-intervention focus groups and interviews. The process evaluation found that none of the interventions were implemented as intended, with no consistent reductions in sitting time. Contextual and organisational cultural barriers included workload pressures and the social norms of sitting, competing priorities, lack of management buy-in, and perceptions of where the responsibility for behaviour change should come from. To ensure effective implementation of future initiatives, deeper organisational-level change, requiring buy-in from all levels of management and staff, may be needed to shift organisational culture and associated social norms.

Concurrent and discriminant validity of ActiGraph waist and wrist cut-points to measure sedentary behaviour, activity level, and posture in office work

Background

Sedentary Behaviour (SB) gets an increasing attention from ergonomics and public health due to its associated detrimental health effects. A large number of studies record SB with ActiGraph counts-per-minute cut-points, but we still lack valid information about what the cut-points tell us about office work. This study therefore analysed the concurrent and discriminant validity of commonly used cut-points to measure SB, activity level, and posture.

Methods

Thirty office workers completed four office tasks at three workplaces (conventional chair, activity-promoting chair, and standing desk) while wearing two ActiGraphs (waist and wrist). Indirect calorimetry and prescribed posture served as reference criteria. Generalized Estimation Equations analysed workplace and task effects on the activity level and counts-per-minute, and kappa statistics and ROC curves analysed the cut-point validity.

Results

The activity-promoting chair (p < 0.001, ES ≥ 0.66) but not the standing desk (p = 1.0) increased the activity level, and both these workplaces increased the waist (p ≤ 0.003, ES ≥ 0.63) but not the wrist counts-per-minute (p = 0.74) compared to the conventional chair. The concurrent and discriminant validity was higher for activity level (kappa: 0.52–0.56 and 0.38–0.45, respectively) than for SB and posture (kappa ≤0.35 and ≤ 0.19, respectively). Furthermore, the discriminant validity for activity level was higher for task effects (kappa: 0.42–0.48) than for workplace effects (0.13–0.24).

Conclusions

ActiGraph counts-per-minute for waist and wrist placement were – independently of the chosen cut-point – a measure for activity level and not for SB or posture, and the cut-points performed better to detect task effects than workplace effects. Waist cut-points were most valid to measure the activity level in conventional seated office work, but they showed severe limitations for sit-stand desks. None of the placements was valid to detect the increased activity on the activity-promoting chair. Caution should therefore be paid when analysing the effect of workplace interventions on activity level with ActiGraph waist and wrist cut-points.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10387-7.

Underlying Factors Explaining Physical Behaviors among Office Workers-An Exploratory Analysis

Studies using technical measurements of physical behavior show wide interindividual variations. This study aimed to explore underlying factors related to sitting, standing and walking among office workers. Cross-sectional data for background characteristics, work-related variables, and device-based measures for sitting, standing and walking were collected among office workers in either a cell office or a flex office with activity-based work. Data were analyzed by Factor Analysis of Mixed Data (FAMD) and multiple robust linear regression. The FAMD resulted in the combination of underlying factors describing six character types. The (1) harmonic and healthy, (2) disabled with poor health, (3) manager that spend a lot of time in meetings and has very high workload, (4) engaged with high workload, (5) employee with creative and computer intense work, with high workload and, (6) employee with high BMI with creative and collaborative work. Regression analysis showed that the character type that was "engaged with high workload" sat more and stood less, while the character type with "high BMI and with creative and collaborative work" sat less. The results suggest that physical behavior among office workers is influenced by a complex combination of factors, which should be taken into account in the evaluation of future studies of larger cohorts.

Workplace neighbourhood built environment and workers' physically-active and sedentary behaviour: a systematic review of observational studies

Background

Many desk-based workers can spend more than half of their working hours sitting, with low levels of physical activity. Workplace neighbourhood built environment may influence workers’ physical activities and sedentary behaviours on workdays. We reviewed and synthesised evidence from observational studies on associations of workplace neighbourhood attributes with domain-specific physical activity and sedentary behaviour and suggested research priorities for improving the quality of future relevant studies.

Methods

Published studies were obtained from nine databases (PubMed, Web of Science, PsycINFO, Scopus, Transport Research International Documentation, MEDLINE, Cochrane, Embase, and CINAHL) and crosschecked by Google Scholar. Observational studies with quantitative analyses estimating associations between workplace neighbourhood built environment attributes and workers’ physical activity or sedentary behaviour were included. Studies were restricted to those published in English language peer-reviewed journals from 2000 to 2019.

Results

A total of 55 studies and 455 instances of estimated associations were included. Most instances of potential associations of workplace neighbourhood built environment attributes with total or domain-specific (occupational, transport, and recreational) physical activity were non-significant. However, destination-related attributes (i.e., longer distances from workplace to home and access to car parking) were positively associated with transport-related sedentary behaviour (i.e., car driving).

Conclusions

The findings reinforce the case for urban design policies on designing mixed-use neighbourhoods where there are opportunities to live closer to workplaces and have access to a higher density of shops, services, and recreational facilities. Studies strengthening correspondence between the neighbourhood built environment attributes and behaviours are needed to identify and clarify potential relationships.

Protocol registration

The protocol of this systematic review was registered on the International Prospective Register of Systematic Reviews (PROSPERO) on 2 December 2019 (registration number: CRD42019137341).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-020-01055-x.

Comportamento sedentário em diferentes domínios de mulheres adultas do sul do Brasil: um estudo de base populacional

Resumo O objetivo deste estudo foi descrever o comportamento sedentário (CS) nos domínios lazer, ocupação e deslocamento e verificar fatores associados ao excesso deste comportamento (ECS). Estudo transversal, com amostra representativa de 1.126 mulheres, 20-69 anos, de São Leopoldo/RS. CS, variáveis demográficas, socioeconômicas, comportamentais e relacionada à saúde foram avaliados através de questionário, aplicado em forma de entrevista. Considerou-se ECS valores acima da mediana. Utilizou-se regressão de Poisson com variância robusta. As medianas e intervalos interquartílicos (min/dia), para o CS no lazer, ocupação e deslocamento foram, respectivamente, 163,9 (86,6-2710,5), 51,4 (0-257,1) e 17,1 (5,7-37,3). A probabilidade do ECS no lazer aumentou com a escolaridade, foi maior entre as mulheres que não trabalhavam, sem crianças em casa e fumantes. Nos demais domínios, a probabilidade aumentou inversamente com a idade, foi maior entre mulheres brancas e aumentou com a classe econômica, escolaridade e renda. A probabilidade de ECS no deslocamento também aumentou com o número de carros no domicílio e foi 30% menor entre mulheres que não trabalhavam. O maior tempo de CS observado foi no domínio do lazer. As associações diferiram segundo o domínio, indicando distintas intervenções.

Temporal dynamics of sitting behavior at work

Sitting for prolonged periods of time impairs people's health. Prior research has mainly investigated sitting behavior on an aggregate level, for example, by analyzing total sitting time per day. By contrast, taking a dynamic approach, here we conceptualize sitting behavior as a continuous chain of sit-to-stand and stand-to-sit transitions. We use multilevel time-to-event analysis to analyze the timing of these transitions. We analyze ∼30,000 objectively measured posture transitions from 156 people during work time. Results indicate that the temporal dynamics of sit-to-stand transitions differ from stand-to-sit transitions, and that people are quicker to switch postures later in the workday, and quicker to stand up after having been more active in the recent hours. We found no evidence for associations with physical fitness. Altogether, these findings provide insights into the origins of people's stand-up and sit-down decisions, show that sitting behavior is fundamentally different from exercise behavior, and provide pointers for the development of interventions.

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.

Process Evaluation of the BearStand Behavioral Intervention: A Social Cognitive Theory-Based Approach to Reduce Occupational Sedentary Behavior

OBJECTIVE

Describe the process evaluation of the behavioral intervention group of a multicomponent workplace intervention, BearStand, to reduce employees' sitting time using sit-stand workstations and behavioral strategies.

METHODS

Process evaluation metrics: dose delivered, dose-received exposure, dose-received satisfaction, and context were collected using an online survey. Participants included employees of a US university.

RESULTS

Overall, 38 of 52 participants completed the process evaluation. The majority were satisfied (53%) with the intervention. Participants' interactions with intervention materials decreased over time (73.7%, week 1, to 52.6%, week 13), and 42% and 33% of participants used suggested videos and apps, respectively. Participants found goal setting and self-regulation strategies to be the most helpful and identified workplace-related contextual barriers that impacted intervention engagement.

CONCLUSIONS

Future interventions should incorporate more engaging materials for participants, reduce contextual barriers, and facilitate use of apps and videos.

The effects of sedentary behaviour interventions on work-related productivity and performance outcomes in real and simulated office work: A systematic review

This review examined the impact of environmental, behavioral, and combined interventions to reduce occupational sedentary behaviour on work performance and productivity outcomes. Productivity outcomes were defined as variables assessing work-related tasks (e.g., typing, mouse), whereas performance outcomes were categorized as any variables assessing cognition that did not mimic work-related tasks. Nine databases were searched for articles published up to January 2018. Sixty-three studies were identified that met the inclusion criteria: 45 examined a productivity outcome (i.e., typing, mouse, work-related tasks, and absenteeism), 38 examined a performance outcome (i.e., memory, reading comprehension, mathematics, executive function, creativity, psychomotor function, and psychobiological factors), and 30 examined a self-reported productivity/performance outcome (i.e., presenteeism or other self-reported outcome). Overall, standing interventions do not appear to impact productivity/performance outcomes, whereas walking and cycling interventions demonstrate mixed null/negative associations for productivity outcomes. Hence, standing interventions to reduce occupational sedentary behaviour could be implemented without negatively impacting productivity/performance outcomes.

The effects of introducing electric adjustable height desks in an office setting on workplace physical activity levels: A randomised control field trial

BACKGROUND

Electric adjustable height desks (EAHD) have been promoted as an opportunity for desk based workers to stand at work but there is limited evidence that they have an effect on light physical activity.

OBJECTIVE

The main objective was to determine if there would be a change in light physical activity with the introduction of EAHD. The secondary objective was to assess if there was an associated change in leisure time activity.

METHODS

Activity levels were measured by step counts, self-reported activity levels and pre- and post-trial recall levels. Statistical analysis of the data was performed with the software R. Generalised linear models were fitted to the data. A Poisson regression was used for count data. Statistical hypotheses were deemed significant if their p values were less than 0.05.

RESULTS

There was a significant (p < 0.001) effect on step counts associated with allocation of EAHD and a significant (p < 0.001) increase in self-reported activity for the Intervention (EAHD) group. Having an EAHD was associated with increased activity during leisure (p = 0.039).

CONCLUSIONS

Activity levels, especially light physical activity, were significantly increased with the allocation of an electric adjustable height desk. This pilot study showed that the environmental change of introduction of electric adjustable height desks into an office workplace can increase physical activity and reduce sitting durations. There is limited evidence that the increase in work activity has a positive impact on leisure time activity.

Health and productivity at work: which active workstation for which benefits: a systematic review

In order to reduce sedentary behaviour at work, research has examined the effectiveness of active workstations. However, despite their relevance in replacing conventional desks, the comparison between types of active workstations and their respective benefits remains unclear. The purpose of this review article is thus to compare the benefits between standing, treadmill and cycling workstations. Search criteria explored Embase, PubMed and Web of Science databases. The review included studies concerning adults using at least two types of active workstations, evaluating biomechanical, physiological work performance and/or psychobiological outcomes. Twelve original articles were included. Treadmill workstations induced greater movement/activity and greater muscular activity in the upper limbs compared with standing workstations. Treadmill and cycling workstations resulted in elevated heart rate, decreased ambulatory blood pressure and increased energy expenditure during the workday compared with standing workstations. Treadmill workstations reduced fine motor skill function (ie, typing, mouse pointing and combined keyboard/mouse tasks) compared with cycling and standing workstations. Cycling workstations resulted in improved simple processing task speeds compared with standing and treadmill workstations. Treadmill and cycling workstations increased arousal and decreased boredom compared with standing workstations. The benefits associated with each type of active workstation (eg, standing, treadmill, cycling) may not be equivalent. Overall, cycling and treadmill workstations appear to provide greater short-term physiological changes than standing workstations that could potentially lead to better health. Cycling, treadmill and standing workstations appear to show short-term productivity benefits; however, treadmill workstations can reduce the performance of computer tasks.

A Brief Self-Directed Intervention to Reduce Office Employees' Sedentary Behavior in a Flexible Workplace

OBJECTIVE

The aim of the study was to assess changes in employees' sedentary behavior after a brief self-directed intervention in a flexible workplace.

METHODS

A total of 30 employees (69% female; 39.5 ± 9 years) completed an online questionnaire before and after a 6-week intervention. The intervention comprised one group-based action planning session, using a smart activity tracker for self-monitoring, weekly email reminders, and a healthy living seminar.

RESULTS

Total self-reported sitting time (including occupational and nonoccupational sitting) decreased nonsignificantly on days when working at the office (MΔ = -56 min/d, 95% confidence interval [CI], -128.5 to 17.0) and increased nonsignificantly when working at home (MΔ = 20.5 min/d, 95% CI, -64.5 to 105.5). The program had high acceptability in this participant group.

CONCLUSIONS

Brief self-directed interventions using activity tracker devices show promise and may be highly acceptable in a flexible workplace. Additional strategies may be needed to create change in sedentary behavior.

The development, implementation and evaluation of interventions to reduce workplace sitting: a qualitative systematic review and evidence-based operational framework

BACKGROUND

Prolonged sitting is associated with increased risks of cardiovascular disease, Type 2 diabetes, some cancers, musculoskeletal disorders and premature mortality. Workplaces contribute to a large proportion of daily sitting time, particularly among office-based workers. Interventions to reduce workplace sitting therefore represent important public health initiatives. Previous systematic reviews suggest such interventions can be effective but have reported wide variations. Further, there is uncertainty as to whether effectiveness in controlled trials can be replicated when implemented outside the research setting. The aims of this review are to identify factors important for the implementation of workplace sitting interventions and to translate these findings into a useful operational framework to support the future implementation of such interventions.

METHODS

A qualitative systematic review was conducted. Four health and social science databases were searched for studies set in the workplace, with office-based employees and with the primary aim of reducing workplace sitting. Extracted data were primarily from author descriptions of interventions and their implementation. Inductive thematic analysis and synthesis was undertaken.

RESULTS

Forty studies met the inclusion criteria. Nine descriptive themes were identified from which emerged three higher-order analytical themes, which related to the development, implementation and evaluation of workplace sitting interventions. Key findings included: the importance of grounding interventions in theory; utilising participative approaches during intervention development and implementation; and conducting comprehensive process and outcome evaluations. There was a general under-reporting of information relating to the context within which workplace sitting interventions were implemented, such as details of local organisation processes and structures, as well as the wider political and economic landscape, which if present would aid the translation of knowledge into "real-world" settings.

CONCLUSIONS

These findings provided the basis for an operational framework, which is a representation of all nine descriptive themes and three higher-order analytical themes, to support workplace sitting intervention development, implementation and evaluation. Once tested and refined, this framework has the potential to be incorporated into a practical toolkit, which could be used by a range of organisations to develop, implement and evaluate their own interventions to reduce workplace sitting time amongst staff.

Ecological Influences on Employees' Workplace Sedentary Behavior: A Cross-Sectional Study

PURPOSE

The purpose of this study was to explore the relationship between ecological factors and occupational sedentary behavior (SB).

DESIGN

Cross-sectional online survey.

SETTING

Participants were employees recruited from a large, public university in the Southeastern United States from August to November 2016.

PARTICIPANTS

The final sample included 527 (56% response rate) employees.

MEASURES

Data were collected through an 87-item survey using previously validated scales that assessed occupational SB, perceived behavioral control, barrier self-efficacy, self-regulation strategies, organizational social norms, office environment, and worksite climate.

ANALYSIS

One-way analysis of variance analyses were used to determine differences in occupational SB by demographic factors. A multivariate regression model was used to determine significant ecological determinants of occupational SB.

RESULTS

Mean SB was 342.45 (standard deviation = 133.25) minutes. Significant differences in SB were found by gender, education, and employment classification. Barrier self-efficacy and workplace connectivity, which evaluates the spatial layout of the office setting that may impact mobility within the workplace, were significant predictors of SB in the multivariate model.

CONCLUSION

Results from this study provide new information regarding the potential impact of workplace barriers and connectivity on occupational SB. The findings from this study support the inclusion of intervention modalities to minimize workplace barriers and increase workplace connectivity to increase workplace mobility and decrease SB.