A systematic review and meta-analysis of the effect of treadmill desks on energy expenditure, sitting time and cardiometabolic health in adults

Impact of Sedentary Behaviors on Blood Pressure and Cardiovascular Disease: An Umbrella Review of Systematic Reviews and Meta-Analyses

BACKGROUND

Cardiovascular diseases (CVD) are among the leading causes of mortality in the western world, and high blood pressure is among the greatest risk factors for CVD. Given that most of a person's waking hours are spent in sedentary behaviors, understanding the cardiovascular impact of a sedentary lifestyle is imperative. Although limiting sedentary time is encouraged in public health messaging, individual reviews analyzing its impact on clinically relevant cardiovascular outcomes such as blood pressure and CVD exhibit conflicting results.

OBJECTIVE

We conducted an umbrella review of systematic reviews and meta-analyses synthesizing the effects of sedentary time/behaviors on blood pressure or CVD.

METHODS

To be included, studies had to be a systematic review and/or meta-analysis that studied the impact of sedentary time or a sedentary posture on blood pressure or CVD incidence/mortality. The review was preregistered in PROSPERO (CRD4202342568) and conducted in May 2023. The Joanna Briggs Institute and Risk of Bias in Systematic Reviews tools assessed study quality. PRISMA reporting was followed.

RESULTS

Our umbrella review screened 2215 citations with 40 review studies meeting our inclusion criteria (n = 22 meta-analyses) that included 234 unique individual studies of 3,769,755 unique participants. The average study quality was high (9.2 ± 1.7 out of 11). A minority of studies (n = 7/20) supported that less sedentary time was associated with lower blood pressure, with reviews of interventional studies typically not observing a consistent effect (n = 9/12), whereas reviews of cross-sectional studies observed a positive effect (n = 5/7). When hypertension rates were used as the outcome, most (n = 3/4) studies observed a deleterious impact of sedentary time. For CVD incidence/mortality, less sedentary time or screen time was consistently associated with a lower CVD incidence/mortality (n = 17/23), with studies exhibiting a null effect generally including small sample sizes and being of a lower study quality. Total sedentary time and specific behaviors (i.e., television and screen time) exhibited similar findings.

CONCLUSIONS

Based on a high quality of evidence and large sample size, existing systematic reviews and meta-analyses demonstrate the negative impact of sedentary behaviors on CVD incidence/mortality, with conflicting reports for blood pressure that vary based on the study design.

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.

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.

Interventions in the workplace to reduce risk factors for noncommunicable diseases: an umbrella review of systematic reviews of effectiveness

BACKGROUND

Workplaces are an important setting to deliver programs to reduce risk factors for noncommunicable diseases (NCDs). To help decision makers understand the most current and relevant evidence regarding effectiveness of workplace programs, we conducted an umbrella review to present a comprehensive synthesis of the large volume of literature.

METHODS

Systematic reviews of workplace interventions targeting primary risk factors for NCDs-unhealthy diet, insufficient physical activity, overweight/obesity, tobacco use, and/or excessive alcohol use-published since 2010 were sourced. For each risk factor, reviews were categorized by intervention type and quality. The most recent, high-quality review was included for each intervention type. Evidence for the effectiveness of each intervention type was then broadly classified based on the review summary findings.

RESULTS

Twenty-one reviews were included. Most reviews focused on diet (n = 5), physical activity (n = 7), or obesity (n = 9) interventions, with fewer targeting alcohol (n = 2) or tobacco (n = 2) use. Reviews of interventions focusing on individual behavior (such as education or counseling) were most common. Across diet, obesity, physical activity, and tobacco use, multicomponent interventions were consistently likely to be classified as "likely effective." Motivational interviewing and broad health promotion interventions were identified as "promising" for alcohol use.

CONCLUSION

This umbrella review identified that multicomponent workplace interventions were effective to reduce NCD risk factors. There is a gap around interventions targeting alcohol use as most syntheses lacked enough studies to draw conclusions about effectiveness. Exploring the impact of interventions that utilize policy and/or environmental strategies is a critical gap for future research.

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.

Examining health risk behaviors of self-employed and employed workers in Japan: a cross-sectional study

OBJECTIVES

Self-employed workers have a higher risk for adverse health outcomes than employed workers. However, the differences in health risk behaviors by employment status are largely unknown. This study examined differences in health risk behaviors between self-employed and employed (permanent/non-permanent) workers by sex and age (20-59 years, 60-79 years).

STUDY DESIGN

This was a cross-sectional study involving community-dwelling adults living in urban cities in Japan.

METHODS

In 2019, we conducted a mail survey in Wako city, Saitama, and Fuchu city, Tokyo. In total, 30,315 adults aged ≥18 years were randomly selected, and 14,185 completed the survey (response rate: 46.8%). The participants for analysis were 8538 workers. Health risk behaviors included physical inactivity (<150 min/wk of moderate-to-vigorous physical activity), prolonged sitting (>480 min/d), high-frequency drinking (≥3 d/wk), tobacco use (current smoker), and overweight (body mass index ≥ 25 kg/m²). We also calculated the total number of health risk behaviors.

RESULTS

Self-employed workers had more health risk behaviors than permanent and non-permanent employees, with this difference more significant among younger males. In younger males, compared with self-employment, permanent employment was associated with less tobacco use, and non-permanent employment was associated with less physical inactivity, prolonged sitting, high-frequency drinking, and overweight. In younger females, non-permanent employment was associated with less prolonged sitting and overweight than self-employment. In older males and females, the prevalence of physical inactivity was lower in non-permanent employed than in self-employed workers.

CONCLUSIONS

Promoting health behaviors among self-employed may be beneficial for reducing health inequalities between self-employed and employed workers.