Acceptability and feasibility of potential intervention strategies for influencing sedentary time at work: focus group interviews in executives and employees

Participatory Approaches in the Context of Research Into Workplace Health Promotion to Improve Physical Activity Levels and Reduce Sedentary Behavior Among Office-Based Workers: Scoping Review

BACKGROUND

Participatory research (PR) involves engaging in cocreation with end users and relevant stakeholders throughout the research process, aiming to distribute power equitably between the end users and research team. Engagement and adherence in previous workplace health promotion (WHP) studies have been shown to be lacking. By implementing a PR approach, the insights of end users and stakeholders are sought in the co-design of feasible and acceptable intervention strategies, thereby increasing the relevance of the research.

OBJECTIVE

This scoping review aims to explore, identify, and map PR techniques and their impact when used in office-based WHP interventions designed to improve physical activity (PA) or reduce sedentary behavior (SB).

METHODS

The reporting of this scoping review followed the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews). A systematic literature search of 5 electronic databases-Web of Science, PubMed, Scopus, Google Scholar, and OpenGrey-was conducted, searching from January 1, 1995, to February 8, 2023. In total, 2 independent reviewers first screened the retrieved articles by title and abstract, and then assessed the full texts based on the inclusion and exclusion criteria. The search strategy and eligibility criteria were developed and guided by an a priori population (office-based working adults), intervention (a PA WHP intervention that took a PR approach), comparison (no comparison required), and outcome (PA or SB) framework. Data were charted and discussed via a narrative synthesis, and a thematic analysis was conducted. The included studies were evaluated regarding the degree of end user engagement throughout the research process and power shared by the researchers, using Arnstein's ladder of citizen participation.

RESULTS

The search retrieved 376 records, of which 8 (2.1%) met the inclusion criteria. Four key strategies were identified: (1) end user focus groups, (2) management involvement, (3) researcher facilitators, and (4) workplace champions. The degree of engagement and power shared was relatively low, with 25% (2/8) of the studies determined to be nonparticipation studies, 25% (2/8) determined to be tokenistic, and 50% (4/8) determined to provide citizen power.

CONCLUSIONS

This review provides a foundation of evidence on the current practices when taking a PR approach, highlighting that previous office-based PA WHP studies have been largely tokenistic or nonparticipative, and identified that the end user is only engaged with in the conception and implementation of the WHP studies. However, a positive improvement in PA and reduction in SB were observed in the included studies, which were largely attributed to implementing a PR approach and including the end user in the design of the WHP intervention. Future studies should aim to collaborate with workplaces, building capacity and empowering the workforce by providing citizen control and letting the end users "own" the research for a sustainable WHP intervention.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1136/bmjopen-2021-054402.

The Development of an Oral Health Nursing Tool for Patients with a Psychotic Disorder: A Human-Centred Design with a Feasibility Test

Patients with psychotic disorders frequently report oral health problems, while mental health nurses (MHNs) seem not to be fully aware of these problems and the risk factors. Therefore, this study aimed to develop supportive tools for MHNs regarding oral health to increase sensitisation among MHNs and provide MHNs with the knowledge to recognise (potential) oral health problems in patients with a psychotic disorder. We used a human-centred design in which the user, MHNs and experts by experience were placed at the centre of the research process. Problems and needs in MHNs working with patients with a psychotic disorder were addressed. To identify key issues of problems as well as needs in terms of resources, we started with focus groups (n = 9). We analysed the data thematically based on the context of patients and MHNs in practice regarding oral health, preferred oral health tools focused on MHNs, and the intended outcomes of tools. A multi-criteria decision matrix was developed and analysed (n = 9) to identify the most optimal and viable solution based on established criteria and issues that are prevalent in the work of MHNs. The most promising result was the development of a brochure with an awareness screener. The brochure with the awareness screener was developed as a low-fidelity prototype for MHNs regarding oral health in patients with a psychotic disorder based on the latest scientific evidence. After testing it, the feasibility was tested through semi-structured interviews (n = 19). MHNs and experts by experience were satisfied with the tool and provided recommendations for adjustments to the content. Significant augmentations to the brochure included a clinical lesson and a toothbrush with toothpaste for patients. We can conclude that a brochure with an awareness screener is feasible for MHNs. Future steps aiming to further refine and optimise care processes for oral health tools in MHNs should take refining eligibility criteria for psychiatric populations and the language level of the target group of a tool into account.

Enhanced muscle activity during interrupted sitting improves glycemic control in overweight and obese men

The efficacy of interrupting prolonged sitting may be influenced by muscle activity patterns. This study examined the effects of interrupting prolonged sitting time with different muscle activity patterns on continuously monitored postprandial glycemic response. Eighteen overweight and obese men (21.0 ± 1.2 years; 28.8 ± 2.2 kg/m2) participated in this randomized four-arm crossover study, including uninterrupted sitting for 8.5 h (SIT) and interruptions in sitting with matched energy expenditure and duration but varying muscle activity: 30-min walking at 4 km/h (ONE), sitting with 3-min walking at 4 km/h (WALK) or squatting (SQUAT) every 45 min for 10 times. Net incremental area under the curve (netiAUC) for glucose was compared between conditions. Quadriceps, hamstring, and gluteal muscles electromyogram (EMG) patterns including averaged muscle EMG amplitude (aEMG) and EMG activity duration were used to predict the effects on glucose netiAUC. Compared with SIT (10.2 mmol/L/h [95%CI 6.3 to 11.7]), glucose netiAUC was lower during sitting interrupted with any countermeasure (ONE 9.2 mmol/L/h [8.0 to 10.4], WALK 7.9 mmol/L/h [6.4 to 9.3], and SQUAT 7.9 mmol/L/h [6.4 to 9.3], all p < 0.05). Furthermore, WALK and SQUAT resulted in a lower glucose netiAUC compared with ONE (both p < 0.05). Only increased aEMG in quadriceps (-0.383 mmol/L/h [-0.581 to -0.184], p < 0.001) and gluteal muscles (-0.322 mmol/L/h [-0.593 to -0.051], p = 0.022) was associated with a reduction in postprandial glycemic response. Collectively, short, frequent walking or squatting breaks effectively enhance glycemic control in overweight and obese men compared to a single bout of walking within prolonged sitting. These superior benefits seem to be associated with increased muscle activity intensity in the targeted muscle groups during frequent transitions from sitting to activity.

Exploring environmental cues to instigate physical movement in the workplace

Background

With the increase of sedentary jobs and the health risks associated with a sedentary lifestyle, finding novel methods to increase physical activity should be a priority. Environmental cues within the workplace can serve as cues to action for initiating light physical activity.

Aim

To qualitatively explore the environmental cues that can instigate light physical activity within an office workplace context. Identification of these cues can inform behaviour change programmes designed to promote habitual physical movement within the workplace.

Method

Purposive sampling was used to recruit full-time sedentary office workers who self-report as having a highly sedentary job. Interviews followed a semi-structured design and thematic analysis was used to explore environmental cues within commercial, home, and mixed office settings.

Results

Forty-three office workers were interviewed, 16 from a commercial office, 12 from a home office, and 15 with a flexible work arrangement whereby they worked from both a commercial and home office. The findings of this study indicate that across all three groups the main instigator of movement was influenced by office layout (e.g. getting up for beverages and taking bathroom breaks), social environment (e.g. informal and formal meetings), and taking active breaks, both job-related (e.g. printing and filing) and non-job-related (e.g. household chores).

Conclusions

These findings provide valuable insight for behaviour change programmes utilising environmental cues to inform habit-based interventions designed to instigate movement within the workplace.

"It depends on the boss" - a qualitative study of multi-level interventions aiming at office workers' movement behaviour and mental health

PURPOSE

This embedded qualitative study explored the acceptability, feasibility, and fidelity of two multi-level RCT interventions among office workers, aiming at improving movement behaviour to enhance mental health and cognition. The interventions addressed the organizational, environmental, and individual level.

METHODS

Semi-structured interviews and focus group discussions were conducted with 38 stakeholders after completion of the interventions. Data were analysed using reflexive thematic analysis.

RESULTS

The interventions were well appreciated, and office workers attributed improvements in movement behaviour and wellbeing to the interventions. Especially the cognitive behavioural therapy (CBT) based counselling and free gym access were appreciated, feasible and delivered as planned. Participants described existing workplace norms as barriers to more activity, particularly for reducing sitting. Support from managers and team support were considered crucial components. However, delivering these components was difficult.

CONCLUSIONS

The findings support the design of the multi-level interventions for changing movement behaviour. Results highlight the potential of CBT for this target group and the importance of manager and team support. Desired effects of similar multi-level interventions, including CBT, might be achieved in future studies that carefully address the issues with feasibility and acceptability and the resulting low fidelity of some intervention components that were identified in this study.

The Effect of an Electronic Passive Prompt Intervention on Prolonged Occupational Sitting and Light-Intensity Physical Activity in Desk-Based Adults Working from Home during COVID-19 in Ireland

This study aimed to assess the effect of passive prompts on occupational physical behaviours (PBs) and bouts of prolonged sitting among desk-based workers in Ireland who were working from home during the COVID-19 pandemic. Electronic passive prompts were delivered every 45 min, asking participants to walk for five minutes, during working hours. Twenty-eight participants (aged 30-67 years) completed the six-week intervention between October 2020 and April 2021. PBs were measured using an activPAL3TM accelerometer, following a 24 h wear protocol, worn for the duration of the study. Participants were highly sedentary at both baseline (77.71% of work hours) and during the intervention (75.81% of work hours). However, the number of prolonged occupational sedentary bouts > 90 min was reduced compared to baseline (0.56 ± 0.08 vs. 0.77 ± 0.11, p = 0.009). Similar reductions were observed in the time spent in sustained sitting > 60 and >90 min when compared to baseline sedentary patterns (60 min: -31.27 ± 11.91 min, p = 0.014; 90 min: -27.97 ± 9.39 min, p = 0.006). Light-intensity physical activity (LIPA) significantly increased during the intervention (+14.29%, p = 0.001). This study demonstrates that passive prompts, delivered remotely, can both reduce the number and overall time spent in prolonged bouts of occupational sedentary behaviour and increase occupational LIPA.

Feasibility and Acceptability of Policies and Environmental Strategies for Improving Physical Activity and Healthy Eating in Japanese Small and Medium Corporations

OBJECTIVE

We assessed the implementation status of policies and environmental strategies for increasing physical activity (PA) and healthy eating (HE) in small and medium corporations to identify feasible and acceptable interventions.

METHODS

An anonymous self-administered questionnaire was administered to 655 small and medium corporations to determine whether they implemented PA (18 items) and HE (17 items) policies and environmental strategies and, if not, their intention to do so in the future. We compared differences in the implementation and intention to implement rate by corporation size.

RESULTS

The implementation and intention rates of costly items for PA and HE were low, regardless of corporation size, but were significantly lower in small corporations than in medium corporations.

CONCLUSIONS

To overcome cost barriers, employee participation must be encouraged, and employee knowledge of PA and HE must be improved.

Determinants of nutrition practice and food choice in UK construction workers

The workplace is considered an effective setting for health and wellbeing interventions, including programmes focusing on nutrition, and provides opportunities to tailor programmes to meet the specific needs of industry and employees. This study explored nutrition practices amongst construction workers and managers to inform the design of a nutrition intervention. Five focus groups were conducted on three construction sites: two with managers (n = 11) and three with workers (n = 27). Construction workers and managers identified several unhealthy nutrition-related behaviours, including high consumption of convenient and fast foods, excessive coffee, alcohol, energy drinks and low fruit and vegetable intake. These behaviours were often attributed to high workloads, long working hours and physically demanding jobs. Snacking and skipping meals were repeatedly reported, attributed to short breaks and poor accessibility to food outlets. The nutritional quality of meals differed between individuals (homemade vs fast food), depending on the type of sites (temporary vs permanent) and site location. Nutrition knowledge, establishing routines, meal planning and preparation were recognized as important in sustaining healthy nutrition habits. However, meal preparation depended on the facilities available, which differed between managers and workers, highlighting the complex relationship between the workplace context and eating behaviours. Construction workers were interested in learning about nutrition and improving their eating habits through nutrition intervention. However, they highlighted that better cooking and storage facilities on site, together with fewer job demands and longer break times, would enhance the sustainability of the intervention and their ability to make healthier food choices.

Monitoring calf circumference: changes during prolonged constrained sitting

Prolonged sitting has been associated with negative health effects; however, short-term time-varying exposure and response data is lacking. Twenty-two young and healthy participants were seated for 2 hours with the instruction to avoid the confounding effects of large leg movements while calf circumference, perceived discomfort, and lower limb muscle activity were collected. Calf circumference increased significantly (0.90 ± 0.32 cm) during sitting with no statistical differences between sexes. Perceived discomfort increased significantly over time in the low back and gluteal regions (p = 0.001-0.072, η_p²=0.080-0.360). On average, it took 20.31 ± 10.87 minutes of walking for calf measures to return to pre-sitting baseline. These results suggest that sitting for 2 hours without activity breaks may not be advisable and that recovery may take longer than expected. The exposure/response data from this study may be helpful in the design of future studies, with a larger and more general population, aiming to better define recommended duration/activity ratios for sitting-focused occupations. Practitioner summary: Leg swelling is a concern in prolonged sitting. In this study of young, healthy participants, we found a 2 hour constrained sitting exposure (controlling for large leg movements) induced significant increases in calf circumference that took an average of 20.31 ± 10.87 min of walking to return to baseline.Abbreviations: FMD: flow-mediated dilation, GSC: gastrocnemius; TA: tibialis anterior; EMG: electromyography; VAS: visual analog scale; MVC: maximum voluntary contractions.

Evaluating a multi-component intervention to reduce and break up office workers' sitting with sit-stand desks using the APEASE criteria

Objective

Sedentary workplace interventions have had success in reducing excessive sitting time in office workers, but barriers to implementation and uptake remain. This study formally assessed a theory-derived, sit-stand desk intervention using the APEASE (Acceptability, Practicability, Effectiveness, Affordability, Side-effects, Equity) criteria.

Methods

Thirteen adults (eight female, mean age 38 ± 10 years) from the treatment arm of a sedentary behaviour intervention participated in semi-structured interviews. Thematic codes were inductively assigned to data items followed by deductive charting using the APEASE criteria.

Results

The intervention was highly acceptable, practicable, safe to deploy, and helped workers reduce workplace sitting time, though individual preferences and workload mediated engagement. Affordability of sit-stand desks and Equity of access were potential barriers to uptake.

Conclusions

Through the lens of the APEASE criteria, this theory-derived, multi-component sit-stand desk intervention showed acceptability, practicability and effectiveness in reducing and breaking up sedentary time at work with minimal side effects. Using this approach with further tailoring and personalisation may help workers achieve greater reductions in workplace sitting, though affordability and equity should be considered further.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12794-w.

Factors impacting workplace investment in sit-stand workstations from the perspective of purchasing decision-makers

This explanatory sequential mixed-method study explored the factors associated with the investment (or not) in sit-stand workstations (SSWs) and alternative initiatives to reduce prolonged sitting at work from the perspective of furniture purchasing decision-makers in Australian workplaces. Participants (n = 270) from >200 organisations across 19 industry sectors completed an online survey. Seven interviews were conducted in a sub-sample of participants from organisations without SSWs. The majority (80%) of workplaces reported having invested in SSWs. Workplaces without SSWs, opposed to those with SSWs, were more likely to be private (79.6% vs. 43.5%), of small/medium size (70.4% vs. 35.6%) and without a wellness program (57.4% vs. 22.2%) (all p < 0.05). Financial implications were the main reason for not investing in SSWs. Exercise and stretch breaks were alternative initiatives to reducing sedentary behaviour at work. Better evidence on the return on investment is needed to support purchasing decisions on SSWs.

Perceived influences on reducing prolonged sitting in police staff: a qualitative investigation using the Theoretical Domains Framework and COM-B model

Background

Workplace interventions have shown promise for reducing sitting in office workers. Police office staff remain an understudied population group that work within a disciplined organisation with distinctive work tasks around public safety, potentially affecting their capability, opportunity, and motivation to change sitting behaviour. This study aimed to assess the perceived influences on reducing workplace sitting in non-operational, desk-based police staff in order to derive theoretical determinants for behaviour change.

Methods

Ten police staff from a single police force in Bedfordshire, England [eight female; 39.5 ± 11.5 years] took part in face-to-face semi-structured interviews lasting 46 ± 11 min on average. Thematic analysis identified key themes which were then mapped onto the Theoretical Domains Framework (TDF) and linked to the Capability, Opportunity, Motivation-Behaviour (COM-B) model.

Results

Seven themes were identified: ‘Work tasks are seated’, ‘Social norm is to sit’, ‘Belief in ability to regulate behaviour’, ‘Knowledge of health risks’, ‘Organisational support’, ‘Impact on productivity’, and ‘Perceived autonomy for sitting reduction’.

Conclusions

Awareness of behaviour and health impacts (Capability), social and physical support to sit less (Opportunity), and habit formation techniques (Motivation) are recommended considerations in sitting reduction workplace interventions for police staff.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12019-6.

Effects of a Workplace Sit-Stand Desk Intervention on Health and Productivity

In Japan, standing while working has not yet become commonplace, and there is little evidence to support the benefits of standing during the workday. Therefore, this study assessed the relationship between the introduction of a sit–stand desk and its ability to reduce the negative effects of sitting too long and increase employees’ general health and productivity. Seventy-four Japanese desk workers participated in this three-month intervention study. Using a randomized controlled trial, the participants were divided into intervention (n = 36) and control (n = 38) groups. The participant characteristics were ascertained using a questionnaire. The intervention effectiveness was assessed by measuring health-, physical activity-, and work-related outcomes. The results indicate that the intervention group significantly decreased their sitting time at work (p = 0.002) and had reduced neck and shoulder pain (p = 0.001). There was a significant increase in subjective health (p = 0.002), vitality in work-related engagement (p < 0.001), and self-rated work performance over a four-week period (p = 0.017). These findings indicate a significant difference between the two groups, demonstrating the effectiveness of a sit–stand desk in reducing sedentary behavior and improving workers’ health and productivity. Future research can accumulate further evidence of best practice use of sit–stand desks.

Rise and Recharge: Exploring Employee Perceptions of and Contextual Factors Influencing an Individual-Level E-Health Smartphone Intervention to Reduce Office Workers' Sedentary Time at Work

This feasibility study explored the contextual factors influencing office workers' adherence to an e-health intervention targeting total and prolonged sedentary time over 12 weeks. A three-arm quasi-randomized intervention included prompts at 30 or 60 min intervals delivered via a smartphone application, and a no-prompt comparison arm. Fifty-six office workers completed baseline (64% female) and 44 completed the 12 week follow-up (80% retention). Ecological momentary assessments (EMA) captured contextual data, with 82.8 ± 24.9 EMA prompt questionnaires completed weekly. Two focus groups with n = 8 Prompt 30 and 60 participants were conducted one-month post-intervention to address intervention acceptability and feasibility. Contextual findings indicate that when working on a sedentary task (i.e., reading or screen-based work) and located at an individual workstation, hourly prompts may be more acceptable and feasible for promoting a reduction in total and prolonged sedentary time compared to 30 min prompts. Interpersonal support also appears important for promoting subtle shifts in sedentary working practices. This novel study gives a real-time insight into the factors influencing adherence to e-health prompts. Findings identified unique, pragmatic considerations for delivering a workplace e-health intervention, indicating that further research is warranted to optimize the method of intervention delivery prior to evaluation of a large-scale intervention.

Using Focus Groups and Interviews to Inform the Design of a Workplace Exercise Programme: An Example From a High-Intensity Interval Training Intervention

OBJECTIVE

Using a formative evaluation of a high-intensity interval training (HIIT) intervention, we illustrate how qualitative data can inform the development of workplace exercise interventions.

METHOD

Eight focus groups and four interviews were conducted with employees (n = 38) and management (n = 4) from six office-based organisations before intervention implementation.

RESULTS

Some participants thought workplace-based HIIT would be practical, given the limited time required. Others perceived it may not be acceptable for all individuals, given the exercise intensity. With consideration of identified barriers (workload/family commitments effecting time availability) and facilitators (flexible working conditions) participants' perspectives were incorporated into the intervention protocol. A short-term group-based intervention was preferred, with a choice of exercise modes (based on stair climbing, stepping or boxing).

CONCLUSION

This study provides a framework to incorporate stakeholders' perspectives into the development of workplace exercise interventions.

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.

Development of culturally sensitive pain neuroscience education materials for Hausa-speaking patients with chronic spinal pain: A modified Delphi study

This study aimed to develop culturally sensitive pain neuroscience education (PNE) materials for Hausa speaking patients with chronic spinal pain (CSP). PNE is a program of teaching patients about pain that has gained considerable attention in research and is increasingly used during physical therapy for patients with chronic pain. It helps in decreasing pain, disability, fear-avoidance, pain catastrophization, movement restriction, and health care utilization among patients with chronic pain. However, existing PNE materials and their application are limited to few languages and cultural inclinations. Due to the variations in pain perceptions, beliefs, and related outcomes among different population groups, culture-sensitive PNE materials addressing these outcomes are warranted. A focus-group discussion comprising 4 experts was used to adapt and develop preliminary PNE materials. Thereafter, an internet-based 3-round modified Delphi-study involving 22 experts ensued. Experts’ consensus/recommendations concerning the content were used in modifying the PNE materials. Consensus was predefined as ≥75% level of (dis)agreement. Eighteen experts completed the Delphi rounds. Nineteen, 18 and 18 experts participated in rounds 1, 2 and 3 respectively, representing 86%, 94% and 100% participation rate respectively. Consensus agreement was reached in every round and content of the materials, including drawings, examples, figures and metaphors were adapted following the experts’ suggestions. We therefore concluded that, culture-sensitive PNE materials for Hausa speaking patients with CSP were successfully produced. The present study also provides a direction for further research whereby the effects of culturally-sensitive PNE materials can be piloted among Hausa speaking patients with CSP.

Does It Work for Everyone? The Effect of the Take a Stand! Sitting-Intervention in Subgroups Defined by Socio-Demographic, Health-Related, Work-Related, and Psychosocial Factors

OBJECTIVE

Take a Stand! was a multicomponent workplace-based intervention reducing sitting among office-workers. This study tested whether the effect of Take a Stand! differed across subgroups.

METHODS

A cluster-randomized controlled trial with objectively measured sitting-time as primary outcome evaluated Take a Stand! Main analysis was reanalyzed in strata defined by four levels of preselected factors: socio-demographic (eg, sex); health-related (eg, smoking); work-related (eg, workhours); and psychosocial (eg, motivation to change sitting).

RESULTS

No notable differences in the effect were observed: across all assessed subgroups sitting time was ∼60 minutes less after 1 month and ∼40 minutes less after 3 months in intervention as compared with control group.

CONCLUSION

There was no differential effect of Take a Stand! indicating that the intervention was effective in all groups. This knowledge is advantageous when disseminating similar interventions to different populations of office workers.

Exploring the Views of Desk-Based Office Workers and Their Employers' Beliefs Regarding Strategies to Reduce Occupational Sitting Time, With an Emphasis on Technology-Supported Approaches

OBJECTIVE

Employee and employer views regarding how technology-supported strategies can best meet their needs to reduce occupational sitting are not well known. This study explored target user and key stakeholder beliefs regarding strategies to reduce occupational sitting focusing on technology-supported approaches.

METHODS

Nine focus groups and two interviews (employees, n = 27; employers, n = 19; board members, n = 2) were conducted, transcribed, and analyzed thematically.

RESULTS

The main barrier to reducing sitting was job-related tasks taking primary priority. Intervention designers should consider individual preferences, environmental factors, judgmental culture, productivity concerns, and staff knowledge. Technology-supported strategies such as smartphone applications, computer software, wearables, and emails were deemed to be useful tools to provide prompts and allow behavioral self-monitoring in an easily individualized manner.

CONCLUSIONS

Technology-supported strategies were seen to be valuable approaches and might fruitfully be incorporated into future interventions to reduce sitting time.

"It Feels Unhealthy to be Sitting for 40 hours a Week": A Qualitative Analysis of Employee Perceptions of Standing Desk Use in the Workplace

OBJECTIVE

Reducing sedentary behavior (SB) is an important public health concern. The purpose of this study was to explore motivation to acquire a standing desk and strategies for using a standing desk through one-on-one interviews.

METHODS

Thirty-seven university employees (89% staff; 51% women) participated in the study. Data were collected using a semi-structured interview guide and brief demographic questionnaire.

RESULTS

Data analysis yielded five themes about motivation to acquire a standing desk: (1) pain management; (2) health risk; (3) movement opportunity; (4) workspace flexibility; and (5) productivity and three themes about typical use strategy: (1) task-dependent; (2) time-dependent; and (3) threshold.

CONCLUSIONS

Motivating factors for using a standing desk should be considered when encouraging standing desk use. Interventions should provide realistic strategies to establish a sit-stand routine that address employees' unique job demands and preferences.

Acceptability and Impact of Office-Based Resistance Exercise Breaks

BACKGROUND

Breaking up sedentary behavior with standing or walking can decrease discomfort, fatigue, and sleepiness. However, less is known about acceptability and impact of resistance exercise breaks on these outcomes. Therefore, we evaluated the acceptability of resistance exercise breaks and their influence on discomfort, physical and mental fatigue, and sleepiness during occupational sitting.

METHODS

Workers completed two 4-hour conditions in random order: prolonged sitting (SIT) and sitting with hourly resistance exercise breaks (REX). All outcomes were measured at baseline and every hour thereafter with five total breaks. Linear mixed models evaluated overall condition effects and differences at each hour. Cohen's d estimated magnitudes of effect. Acceptability was assessed via questionnaire after the REX condition and reported as percentages.

FINDINGS

Fourteen adults (age: 53.4 ± 9.5 years, body mass index [BMI]: 30.9 ± 4.8 kg/m²) were enrolled. Although ratings of discomfort, fatigue, and sleepiness were typically lower during REX as compared with SIT, overall outcomes were not significantly different between conditions (p > .05). However, a significant reduction in mental fatigue at hour 4 in favor of the REX condition (β = -0.48 log-points, p < .05, d = 0.37) was observed. Program acceptability questions revealed the majority (>50%) of participants reported a "4" or "5" on a 5-point Likert-type scale for all questions, indicating high acceptability for implementation.

CONCLUSIONS/APPLICATION TO PRACTICE

Resistance exercise breaks had high acceptability and provided preliminary evidence of improving ratings of mental fatigue. More research is needed to better understand the role of resistance training to reduce sedentary behavior.

Associations of working from home with occupational physical activity and sedentary behavior under the COVID-19 pandemic

OBJECTIVES

To compare physical activity (PA) and sedentary behavior (SB) levels during work time between those who work from home (WFH) and at workplaces (no WFH), and by WFH subgroups.

METHODS

This cross-sectional internet-based survey included 1239 workers (mean age [standard deviation], 44.7 [13.7] years; 59.2% men) living in the Tokyo Metropolitan Area. Time spent sitting (SB), standing (light-intensity PA; LPA), walking, and engaging in heavy labor (moderate-to-vigorous PA; MVPA) during work time was measured using the Work-related Physical Activity Questionnaire. Workers reported weekly WFH percentages (eg, 0% implies no WFH and 100% implies full WFH), and WFH percentages were categorized into no WFH (0% WFH) and WFH (1%-100% WFH) groups. The WFH group was further subcategorized into 1%-25%, 26%-50%, 51%-75%, and 76%-100% subgroups.

RESULTS

Overall, 494 workers (39.9%) worked from home. During working hours, SB time was longer in the WFH group than in the no WFH group (mean minutes [% working-time SB]: 335.7 vs 224.7 min [74% vs 50%]). Significantly shorter LPA and MVPA times (%) were reported in the WFH group than in the no WFH group (LPA, 59.6 vs 122.9 min [14% vs 29%]; MVPA, 55.3 vs 91.9 min [13% vs 22%], all P < .001). Among the WFH subgroups, longer SB time and shorter LPA and MVPA times were observed in the highest WFH group (WFH 76%-100%) than in the WFH 1%-25% and 26%-50% subgroups.

CONCLUSIONS

Workers who telecommuted were less physically active and had longer sedentary during work time than those who worked at the workplaces.

Rise and Recharge: Effects on Activity Outcomes of an e-Health Smartphone Intervention to Reduce Office Workers' Sitting Time

This feasibility study evaluated the effects of an individual-level intervention to target office workers total and prolonged sedentary behaviour during working hours, using an e-health smartphone application. A three-arm (Prompt-30 or 60 min Intervention arm and a No-Prompt Comparison arm), quasi-randomised intervention was conducted over 12 weeks. Behavioural outcomes (worktime sitting, standing, stepping, prolonged sitting, and physical activity) were monitored using accelerometers and anthropometrics measured at baseline, 6 weeks and 12 weeks. Cardiometabolic measures were taken at baseline and 12 weeks. Fifty-six office workers (64% female) completed baseline assessments. The Prompt-60 arm was associated with a reduction in occupational sitting time at 6 (-46.8 min/8 h workday [95% confidence interval = -86.4, -6.6], p < 0.05) and 12 weeks (-69.6 min/8 h workday [-111.0, -28.2], p < 0.05) relative to the No-Prompt Comparison arm. Sitting was primarily replaced with standing in both arms (p > 0.05). Both Intervention arms reduced time in prolonged sitting bouts at 12 weeks (Prompt-30: -27.0 [-99.0, 45.0]; Prompt-60: -25.8 [-98.4, 47.4] min/8 h workday; both p > 0.05). There were no changes in steps or cardiometabolic risk. Findings highlight the potential of a smartphone e-health application, suggesting 60 min prompts may present an optimal frequency to reduce total occupational sedentary behaviour.

"Occupational sitting kills; but who cares?": Quantitative analysis of barriers and facilitators of sedentary behavior in Indian white-collar workers

The knowledge, attitude and practices of employees and employers toward reducing sedentary behavior (SB) and improving physical activity (PA) at Indian workplaces remain unclear. A bespoke questionnaire assessing barriers and facilitators of occupational SB and PA practices as informed by the theoretical framework and behavioral change wheel model was adapted. Two hundred and three white-collar workers (both employees and managers) from eight corporate sectors were inquired about the SB, and PA practices at workplaces. The dichotomous variables of barriers and facilitators were analyzed by nonparametric tests. Excessive sitters had good knowledge (>75%), good attitude (>85%) but poor workplace SB and PA practice (>90%). Workplace SB, or PA practices differed between employers and employees. Low practice of workplace PA or SB interventions may be due to lack of workplace policies for SB interventions.

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 Sedentary Behavior and Productivity: A Cross-Sectional Study

Reducing sedentary behavior in the workplace has become an important public health priority; however, some employers have expressed concerns regarding the potential for reduced productivity if employees are not seated while at work. Therefore, the aim of this study was to determine the relationship between workplace sedentary behavior (sitting time) and work productivity among full-time office-based employees, and further to investigate other potential factors associated with productivity. A 19-item online self-report survey was completed by 2068 government employees in Kansas. The survey assessed workplace sedentary behavior, work productivity, job satisfaction, and fatigue. Overall, office workers reported high levels of sedentary time (mean > 78%). The primary results indicated that sitting time was not significantly associated with productivity (β = 0.013, p = 0.519), but job satisfaction and fatigue were positively (β = 0.473, p < 0.001) and negatively (β = −0.047, p = 0.023) associated with productivity, respectively. Furthermore, participants with the highest level of sitting time (>91% of the time) reported lower job satisfaction and greater fatigue as compared with the lowest level of sitting time (<75% of the time). Taken together, these results offer promising support that less sitting time is associated with positive outcomes that do not seem to come at the expense of productivity.

Using the Behavior Change Wheel to Understand University Students' Prolonged Sitting Time and Identify Potential Intervention Strategies

BACKGROUND

Several national public health guidelines recommend individuals to minimize time spent in prolonged, continuous periods of sitting. Developing effective interventions to break up sitting, however, requires in-depth understanding of the behavior as well as identification of the key elements that need to be targeted to achieve change. This qualitative study focused on university students-a highly sedentary group-with the aim of the following: (i) exploring the factors influencing prolonged sitting time in this population; and (ii) identifying potential avenues for future intervention, based on the Behavior Change Wheel framework.

METHOD

Eighteen ambulatory undergraduate students participated in semi-structured one-on-one interviews, using the Capability, Opportunity, Motivation, Behavior (COM-B) model and the complementary Theoretical Domains Framework (TDF) as the theoretical framework. Data were analyzed using a directed content analysis approach, followed by inductive thematic analysis.

RESULTS

All COM-B components and eight TDF domains were identified as relevant for influencing the target behavior.

CONCLUSION

Findings suggest that interventions and policies aimed at reducing prolonged sitting time in university students should (i) raise awareness about negative health implications; (ii) address productivity concerns; (iii) provide training in behavioral self-regulation; (iv) use external reminders; (v) implement habit formation techniques; and (vi) promote social acceptability for breaking up sitting.

Effects of Interrupting Prolonged Sitting with Physical Activity Breaks on Blood Glucose, Insulin and Triacylglycerol Measures: A Systematic Review and Meta-analysis

BACKGROUND

Physical activity (PA) breaks in sitting time might attenuate metabolic markers relevant to the prevention of type 2 diabetes.

OBJECTIVES

The primary aim of this paper was to systematically review and meta-analyse trials that compared the effects of breaking up prolonged sitting with bouts of PA throughout the day (INT) versus continuous sitting (SIT) on glucose, insulin and triacylglycerol (TAG) measures. A second aim was to compare the effects of INT versus continuous exercise (EX) on glucose, insulin and TAG measures.

METHODS

The review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) recommendations. Eligibility criteria consisted of trials comparing INT vs. SIT or INT vs. one bout of EX before or after sitting, in participants aged 18 or above, who were classified as either metabolically healthy or impaired, but not with other major health conditions such as chronic obstructive pulmonary disease or peripheral arterial disease.

RESULTS

A total of 42 studies were included in the overall review, whereas a total of 37 studies were included in the meta-analysis. There was a standardised mean difference (SMD) of - 0.54 (95% CI - 0.70, - 0.37, p = 0.00001) in favour of INT compared to SIT for glucose. With respect to insulin, there was an SMD of - 0.56 (95% CI - 0.74, - 0.38, p = 0.00001) in favour of INT. For TAG, there was an SMD of - 0.26 (95% CI - 0.44, - 0.09, p = 0.002) in favour of INT. Body mass index (BMI) was associated with glucose responses (β = - 0.05, 95% CI - 0.09, - 0.01, p = 0.01), and insulin (β = - 0.05, 95% CI - 0.10, - 0.006, p = 0.03), but not TAG (β = 0.02, 95% CI - 0.02, 0.06, p = 0.37). When energy expenditure was matched, there was an SMD of - 0.26 (95% CI - 0.50, - 0.02, p = 0.03) in favour of INT for glucose, but no statistically significant SMDs for insulin, i.e. 0.35 (95% CI - 0.37, 1.07, p = 0.35), or TAG i.e. 0.08 (95% CI - 0.22, 0.37, p = 0.62). It is worth noting that there was possible publication bias for TAG outcomes when PA breaks were compared with sitting.

CONCLUSION

The use of PA breaks during sitting moderately attenuated post-prandial glucose, insulin, and TAG, with greater glycaemic attenuation in people with higher BMI. There was a statistically significant small advantage for PA breaks over continuous exercise for attenuating glucose measures when exercise protocols were energy matched, but no statistically significant differences for insulin and TAG. PROSPERO Registration: CRD42017080982.

PROSPERO REGISTRATION

CRD42017080982.

The user and non-user perspective: Experiences of office workers with long-term access to sit-stand workstations

OBJECTIVE

Sit-stand workstations have been shown to be effective in reducing sitting time in office workers. The aim of this study was to explore reasons for use and non-use of sit-stand workstations and strategies to decrease sitting and increase physical activity in the workplace from perspectives of users and non-users, as well as from managers and ergo-coaches.

METHODS

Six group interviews with employees who have had access to sit-stand workstations for several years were conducted in a large semi-governmental organisation in the Netherlands. Verbatim transcripts were analysed using thematic analysis. Open coding was conducted by three researchers and codes and themes were discussed within the research team.

RESULTS

Thematic analysis resulted in two major themes: 1) Reasons for use and non-use and 2) Strategies to increase standing and physical activity in the workplace. Shared and distinct reasons for use and non-use were identified between users and non-users of the sit-stand workstations. The most important reasons for use indicated by users were that they had experiencing immediate benefits, including staying alert and increasing focus; these benefits were not acknowledged by non-users. Non-users indicated that sitting was comfortable for them and that they were therefore not motivated to use the standing option. Strategies to increase the use of the standing option included an introductory phase to become familiar with working while standing and to experience the immediate benefits that come from using the standing option. Furthermore, providing reminders to use the standing option was suggested as a strategy to increase and sustain the use of sit-stand workstations. Increased use may lead to a change in the sitting culture within the organisation, as more employees would adopt active movement behaviours.

CONCLUSION

Immediate benefits of the use of the standing option-only mentioned by the users-was the most distinct reason to use sit-stand workstations. Future research should explore how to motivate potential users to adhere to an introductory phase in order to experience these immediate benefits, whether it is linked to the use of sit-stand workstations or other interventions to reduce sitting time.

Cost-Effectiveness and Return-on-Investment of the Dynamic Work Intervention Compared With Usual Practice to Reduce Sedentary Behavior

OBJECTIVE

To assess the cost-effectiveness and return-on-investment (ROI) of the Dynamic Work (DW) Intervention, a worksite intervention aimed at reducing sitting time among office workers.

METHODS

In total, 244 workers were randomized to the intervention or control group. Overall sitting time, standing time, step counts, quality-adjusted life years (QALYs), and costs were measured over 12 months. The cost-effectiveness analysis was performed from the societal perspective and the ROI analysis from the employers' perspective.

RESULTS

No significant differences in effects and societal costs were observed between groups. Presenteeism costs were significantly lower in the intervention group. The probability of the intervention being cost-effective was 0.90 at a willingness-to-pay of 20,000&OV0556;/QALY. The probability of financial savings was 0.86.

CONCLUSION

The intervention may be considered cost-effective from the societal perspective depending on the willingness-to-pay. From the employer perspective, the intervention seems cost-beneficial.

Perceptions of an online 'train-the-champion' approach to increase workplace movement

Prolonged sitting is now recognized as an emergent work health and safety issue. To address the need for a scalable sitting-reduction intervention for workplaces, the BeUpstanding™ Champion Toolkit was developed. This free, online toolkit uses a 'train-the-champion' approach, providing a step-by-step guide and resources to workplace champions to assist them in raising awareness and building a supportive culture to reduce sitting time in their team. This qualitative study explored champion and staff perceptions of the beta (test) version of the toolkit. Seven work teams, from a range of workplace sectors (blue-/white-collar), sizes (small/medium/large) and locations (urban/regional) participated; all team members were exposed to the program (n = 603). Approximately 4 months after program initiation, semi-structured interviews were conducted with all champions (n = 7); focus groups were conducted with a random sample of staff (n = 40). Champions were followed-up again at 12 months (n = 5). Transcripts were coded by two researchers, with codes organized into overarching themes. All champions found the 'train-the-champion' approach, and the toolkit acceptable. Common enablers for intervention delivery included: champion passion for staff health and wellbeing; perceived fit of the program within existing practice; and, management support. Champions and staff reported improvements in knowledge/awareness about sitting, cultural norms, perceived stress, productivity and resilience. Facilitators for sustained change over time included a stable organizational climate and ongoing management support; barriers included workload intensification. The beta version of the BeUpstanding™ Champion Toolkit was highly acceptable to workplace champions and staff, and was perceived to have benefits for team culture and staff knowledge and wellbeing.

Physical activity in paid work time for desk-based employees: a qualitative study of employers' and employees' perspectives

Background

Poor physical and mental health of employees create significant problems in the workplace. Physical activity (PA) has been shown as an effective strategy for preventing and treating numerous physical and mental health issues as well as work performance outcomes. However, there are many barriers to taking part in PA (such as lack of time) with participation rates typically low. Providing PA in paid work time might be a way to overcome these issues, yet employers’ and employees’ opinions of this concept are unknown. The aim of this study was to explore employee and employer perspectives of PA in paid work time.

Methods

Workplaces were recruited through existing contacts on the research team. Focus groups and interviews were conducted with employees and managers at one University and two executive non-departmental public bodies in central Scotland with mainly desk-based employees. Both managers and employees were involved to gain perspectives throughout the organisational hierarchy and were interviewed separately to reduce social desirability bias. All discussions were digitally recorded and transcribed verbatim. Data were analysed thematically for both managers and employees but due to significant overlap in themes between the groups, these are reported together in the results.

Results

Three out of five organisations approached took part in this qualitative study. Two individual interviews were held with strategic managers, five focus groups with middle managers (n = 16) and nine with employees (n = 45). Benefits were anticipated by managers and employees for both employees themselves and the organisation and included improved mental health, productivity and more favourable perceptions of the employer. Despite these widely acknowledged benefits, significant barriers were identified and included the structure and nature of the working day (high workload, front line job requirements), workplace culture and norms (resentment from colleagues, no break culture) and organisational concerns (cost of lost time, public perceptions).

Conclusion

This study suggests that there are significant barriers to PA in paid work time. Whilst numerous anticipated benefits were conveyed by both employees and managers, PA in paid work time is unlikely to become common place until changes in attitudes and the culture towards movement at work occur.

Impact of a low-cost standing desk on reducing workplace sitting (StandUP UBC): A randomised controlled trial

Sit-stand desks can reduce occupational sitting time, however, their cost can limit scalability. The purpose of this study was to evaluate the impact of a low-cost standing desk on objectively-measured occupational sitting and prolonged sitting bouts over 3- and 6-months. Secondary outcomes included self-report work engagement and occupational fatigue. Forty-eight office employees (91.7% female, M_age = 39.8 ± 10.1) were randomized to receive a low-cost standing desk or to a control group. At 3-months, the intervention group sat 0.7 h (42min) less at work compared to the control group; F(1, 45) = 5.90, partial η² = 0.12, p = .019. The effect was small, yet comparable to findings from studies using costlier alternatives. However, these reductions were not maintained at 6-months. No changes in prolonged sitting bouts or secondary outcomes were found. There is some potential for low-cost standing desk converters as a scalable workplace health intervention. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03375749, Registered 18 December 2017, https://clinicaltrials.gov/ct2/show/NCT03375749?term=NCT03375749&rank=1.

Stand-Biased Desk Intervention on Sleep Quality of High School Students: A Pilot Study Using Tri-Axial Accelerometery

Prolonged sitting is related to a sedentary inactive lifestyle and related to obesity and many metabolic problems caused by inactivity. The problem gets more serious for people who spent most of their work time in a seated position like students or office workers. In this study, we provided standing desk and stool to the local public high school and observed the changes in their behavior in terms of physical activity using tri-axial accelerometer before and after intervention. Previously published study using the same dataset under the larger project reported increased physical activity during school hours. In this study, we extracted more diverse features directly from the raw data instead of using data processed by the software that manufacturer provided. Hence, we were able to analyze the same features (sedentary, physically active time) as well as sleep-related variables. Of the interest, sleep is another important feature that can tell us about participants’ health conditions. Even if the intervention contributed to updating their behavioral patterns, the result might be nullified in the long run if their sleep pattern was compromised. The quantity and quality of sleep was not changed after the intervention. Therefore, the efficacy of standing desks has been confirmed again.

Implementing a Physical Activity Promoting Program in a Flex-Office: A Process Evaluation with a Mixed Methods Design

The aim of this study was to investigate facilitating and hindering factors when implementing a physical activity (PA)-promoting program among office workers moving to a flex office, by conducting a process evaluation. Additionally, we evaluated self-reported and perceived PA behaviors. With a mixed methods design, analyses were based upon data from interviews with 70 employees and repeated questionnaires from 152 employees. The PA-promoting program was fully implemented and supported by management. There was a strong health promoting culture, encouraging PA in the organization already at the start of the study. The lecture and the office design were rated as the most motivating program components. The use of stairs, breaks during meetings and social acceptance for standing and walking at work increased. Employees described a strive for variation, and how managers, the office environment, productivity and ergonomic aspects influenced sedentary behavior (SB) and PA. The need for the PA-promoting program was questioned, and the timing of the program was debated. To conclude, a strong organizational health culture combined with a facilitating physical environment can create sustainable positive PA behaviors in office settings. A thorough understanding of organizational needs and a participatory process are needed to tailor organizational interventions to decrease SB.

What Do Workers Do to Reduce Their Sitting Time? The Relationships of Strategy Use and Workplace Support With Desk-Based Workers' Behavior Changes in a Workplace-Delivered Sitting-Reduction and Activity-Promoting Intervention

OBJECTIVE

To explore workers' sitting-reduction and activity-promoting strategy use following an intervention targeting these changes, and whether strategy use and perceived workplace support impacted on 3-month sitting and activity outcomes.

METHODS

This secondary analysis in desk-based workers (n = 83) utilized data collected on questionnaire-derived strategy use and workplace support, and activPAL3-derived sitting (total; prolonged, ≥30 minutes) and activity (standing; stepping) at work.

RESULTS

Fourteen strategies were commonly used during the intervention. Increased usage of some strategies were significantly (P < 0.05) associated with beneficial changes in prolonged sitting or stepping only. Workplace support was significantly beneficially associated with changes in sitting, prolonged sitting, and stepping; these associations were largely independent of strategy use changes.

CONCLUSIONS

Strategies were highly used, with increased use associated with some behavioral improvements. Workplace support appears essential for improving sitting and activity in the workplace.

Understanding and Influencing Occupational Sedentary Behavior: A Mixed-Methods Approach in a Multiethnic Asian Population

We aim to assess sedentary behavior (SB) and its determinants, as well as potential strategies to reduce SB among employees in a tertiary hospital in Singapore, using a mixed-methods approach grounded in the socioecological framework. All employees with email and security guards of a tertiary hospital in Singapore were invited to complete a questionnaire that captured sociodemographics and self-reported domain-specific SB. Environmental influences of occupational SB were assessed using an adapted version of the Checklist for Health Promotion Environments at the Worksite (CHEW). Focus group discussion (FGD) addressed perceptions, barriers, and strategies toward reducing workplace SB. Analyses were performed separately and integrated using an inductive comparative approach. The median occupational sitting time (n = 938) was 300 minutes/day, and highest among administrative staff (administrative, 421 minutes/day; allied health, 300 minutes/day; ancillary, 300 minutes/day; nursing, 120 minutes/day; medical/dental/others, 240 minutes/day; p value: <.001). The CHEW assessment identified poor physical and information environment contributing to occupational SB. FGDs confirmed an unsupportive environment and elicited barriers such as low SB awareness, nature of work, and workplace norms. Besides environmental approaches, participants suggested having face-to-face communication and social modelling to promote more breaks from sitting. This mixed-methods study among diverse professional groups of a tertiary hospital indicated a large amount of occupational SB, particularly among administrative staff. Raising awareness of the health risks of SB and building a supportive organizational culture, information, and physical environment emerged as significant factors. To reduce occupational SB, multicomponent interventions addressing these diverse factors are warranted.

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.

Sitting less at work: a qualitative study of barriers and enablers in organisations of different size and sector

BACKGROUND

Prolonged sitting is associated with a range of chronic health conditions and working in office-based jobs is an important contributor to total daily sitting time. Consequently, interventions to reduce workplace sitting have been developed and tested; however, no single intervention strategy consistently produces reductions in workplace sitting time. Exploring barriers and enablers to sitting less at work has been shown to support the development of more effective interventions. In order to address these barriers and enablers during the development and implementation of sit less at work interventions, it is important to understand how they may differ in different types of organisation, an area which has not yet been explored. The main aim of this study was to determine whether barriers and enablers to sitting less at work varied between organisations of different size and sector.

METHODS

A qualitative study design was used. Four organisations of different sizes and sectors participated: a small business, a charity, a local authority and a large corporation. A total of ten focus groups comprising 40 volunteer employees were conducted. Focus groups were audio-recorded and transcribed verbatim. Transcripts were then thematically analysed using pre-defined themes, but analysis also allowed for emergence of additional themes.

RESULTS

Barriers and enablers which were consistently raised by participants across all four organisations primarily included: individual-level factors such as habits and routines, and personal motivations and preferences; and factors relating to the internal physical environment. Barriers and enablers that differed by organisation mainly related to: organisational-level factors such as organisational culture, organisation size, and ways of working; and factors relating to the broader social, economic and political context such as the idea of presenteeism, and the impact of wider economic and political issues.

CONCLUSIONS

This study found that although some themes were consistently raised by participants from organisations of different size and sector, participants from these organisations also experienced some different barriers and enablers to sitting less at work. For future research or practice, the study findings highlight that organisation-specific barriers and enablers need to be identified and addressed during the development and implementation of sit less at work interventions.

Who Uses Action Planning in a Web-Based Computer-Tailored Intervention to Reduce Workplace Sitting and What do Action Plans Look Like? Analyses of the Start to stand Intervention among Flemish Employees

BACKGROUND

Action planning plays an important role in many web-based behaviour change interventions. As such, it is important to identify who engages in action planning and what action plans look like. This study examines (1) attributes of users creating an action plan and (2) the content of action plans made during a web-based intervention to reduce workplace sitting.

METHODS

Users answered "what" (short standing breaks and/or longer periods of standing), "when" (working hours, work breaks, commuting), "where" (workplace, transport mode), and "how" (frequency, duration, implementation intentions) questions. MANOVA and chi-squared tests were conducted to compare those creating an action plan with those who did not. Descriptive statistics were used to examine the content of the action plans.

RESULTS

Those creating an action plan (n = 236/1,701) were significantly older, more sedentary at work, and more aware of health risks related to excessive sitting compared to those not planning (n = 1,465). The majority planned standing breaks (n = 212) every 30 minutes, and periods of standing (n = 173) for 1 to 2 hours.

CONCLUSIONS

Future interventions should promote action planning more, especially among younger employees and those with less health-related knowledge about sitting. Action plans were compatible with current sitting messages used in health promotion.

Citizen Science to Communicate about Public Health Messages: The Reach of a Playful Online Survey on Sitting Time and Physical Activity

There is a lack of research on how to communicate public health guidelines. Citizen science (CS) has been an effective way to involve the public in research. This study analyses the reach of a well-established CS experiment, launched during an annual national science event, to understand if it could be used as communication strategy for public health issues. A short playful online survey contained tailored health-related messages associated to an "animal totem" profile, based on the combination of sitting and physical activity levels (koala: high sitting, low activity; gorilla: high sitting, high activity; zebra: low sitting, low activity; bee: low sitting, high activity). Tweets, radio interviews, radio and online advertisements, press articles, and a press conference were used to promote the CS experiment. Google Analytics and Facebook Graph API (application programming interface) (use and spread of experiment) and descriptive statistics (attributes of adults completing the experiment) were used. A total of 6,246 adults completed the experiment, with a peak of views (n = 5,103) and completions (n = 1,209) a couple of days before the event. Completers were mostly female (65.8%), on average 37.5 years old, and had a healthy body mass index (23.8 kg/m²). Nearly half (46.4%) had the most beneficial profile ("bee"), 26.5% had the least healthy profile ("koala"). CS as part of a national science event is a good platform for health communication as 1 in 1,000 Flemish adults were reached. However, those completing the experiment were not representative of the general Flemish adult population and reported to be more physically active. Abbreviations: API: application programming interface; BMI: body mass index; CVD: cardiovascular disease; METs: metabolic equivalents.

Australian employee perceptions of an organizational-level intervention to reduce sitting

Stand Up Lendlease-a cluster-randomized trial targeting reductions in sitting time in Australian office workers (n = 153, 18 manager-led teams, 1 organization)-effectively reduced sitting time during work hours and across the day after 12 months. The trial included two arms: organizational-support strategies (e.g. manager support, emails) with or without an activity tracker. The current study aimed to examine participant perceptions of the intervention, and perceived barriers and facilitators for reducing sitting time. Telephone interviews (n = 50 participants; conducted at 6-10 months) and three focus groups (n = 21 participants; conducted at 16 months) evaluated the intervention with qualitative data analysed thematically. Several consistent themes emerged across both short and long-term time points and intervention groups. Support and role modelling of desired behaviours from important organization personnel and receiving feedback on sitting levels were key drivers of change. Improvements in awareness about sitting, and workplace culture changes supporting active work practices were positive impacts of the intervention, but some participants also reported that initial cultural effects had dissipated and the intervention needed 'reinvigoration'. Participants desired additional 'tools' to maintain sitting less and being active, such as sit-stand desks, standing meeting tables and activity trackers. In summary, the intervention raised awareness and initiated cultural changes towards active work practices, however, additional support may be required to maintain changes in organizational culture long term. Practical tools to support sitting changes, organizational and management support and role modelling, as well as ongoing 'reinvigoration' are key strategies for short and long-term intervention success in office workplaces.

A multi-component intervention to sit less and move more in a contact centre setting: a feasibility study

BACKGROUND

Call agents spend ~ 90% of their working day seated, which may negatively impact health, productivity, and wellbeing. This study aimed to explore the acceptability and feasibility of a multi-component workplace intervention targeting increased activity and decreased prolonged sitting in the contact centre setting prior to a full-scale effectiveness trial.

METHODS

An 8-week non-randomised pre-post feasibility study was conducted. Using a mixed methods approach, focus groups and interviews were thematically analysed to explore the acceptability and feasibility of key study phases, and provide context to agents' process evaluation and survey responses. The multi-component intervention, conducted in a single call centre, included height-adjustable workstations, emails, education and training sessions, and support from team leaders and a workplace champion.

RESULTS

Six (of 20) team leaders were recruited, with 17 of 84 call agents (78% female, 39.3 ± 11.9 years) completing baseline assessments and 13 completing follow-up. High workload influenced recruitment. Call agents perceived assessments as acceptable, though strategies are needed to enhance fidelity. Education sessions, height-adjustable workstations and emails were perceived as the most effective components; however, height-adjustable hot-desks were not perceived as feasible in this setting.

CONCLUSIONS

This study has identified unique, pragmatic considerations for conducting a multi-level, multi-component PA and SB intervention and associated evaluation in highly sedentary call agents in the challenging contact centre setting. The intervention was largely perceived positively, with call agents and team leaders describing numerous perceived positive effects on behavioural, health and work-related outcomes. Findings will be of value to researchers attempting to intervene in contact centres and will be used by the current authors to design a subsequent trial.

"In Initiative Overload": Australian Perspectives on Promoting Physical Activity in the Workplace from Diverse Industries

Introduction: With two thirds of adults in paid employment and one third physically inactive, workplaces are an important setting for promoting more physical activity. We explored the attitudes and practices of employees and managers from different industries towards sitting and moving at work, to inform the development of acceptable solutions for encouraging businesses to adopt activity-promoting workplaces. Method: We conducted focus groups with employees and structured interviews with upper/middle managers from 12 organisations in a range of industries (e.g., education, healthcare, manufacturing, construction, insurance, mining). Topics focused on past and current workplace health and wellness initiatives, workplace culture and environment related to physical activity, responsibility for employee physical activity patterns at work, and enablers of/barriers to activity promoting workplaces. Results: Physical activity was not an explicit priority in existing occupational health and wellness initiatives. Instead, there was a strong focus on education about preventing and managing injuries, such as manual handling among non-office workers and desk-based ergonomics for office workers. Physical activity was viewed as a strategy for maintaining work ability and preventing injury, particularly in blue-collar staff, rather than for chronic disease prevention. Managers noted structural/organisational barriers/enablers to promoting physical activity at work (e.g., regulations, costs, competing concerns), while employees tended to focus on individual constraints such as time and geographic location. The issues of "initiative overload" and making physical activity a part of "business as usual" emerged as strong themes from employees and managers. Conclusions: While there is stakeholder enthusiasm for creating activity-promoting workplaces, multi-level support is needed to make physical activity an integral part of day-to-day business. The synergism between occupational health and safety priorities could be leveraged to facilitate the creation of activity-promoting workplaces.

Integrating Taxonomies Into Theory-Based Digital Health Interventions for Behavior Change: A Holistic Framework

Digital health interventions (DHIs) have been emerging in the last decade. Due to their interdisciplinary nature, DHIs are guided and influenced by theories (eg, behavioral theories, behavior change technologies, and persuasive technology) from different research communities. However, DHIs are always coded using various taxonomies and reported in insufficient perspectives. This inconsistency and incomprehensiveness will cause difficulty in conducting systematic reviews and sharing contributions among communities. Therefore, based on existing related work, we propose a holistic framework that embeds behavioral theories, behavior change technique taxonomy, and persuasive system design principles. Including four development steps, two toolboxes, and one workflow, our framework aims to guide DHI developers to design, evaluate, and report their work in a formative and comprehensive way.

What strategies do desk-based workers choose to reduce sitting time and how well do they work? Findings from a cluster randomised controlled trial

Background

Large amounts of sitting at work have been identified as an emerging occupational health risk, and findings from intervention trials have been reported. However, few such reports have examined participant-selected strategies and their relationships with behaviour change.

Methods

The Stand Up Victoria cluster-randomised controlled trial was a workplace-delivered intervention comprising organisational, environmental and individual level behaviour change strategies aimed at reducing sitting time in desk-based workers. Sit-stand workstations were provided, and participants (n = 134; intervention group only) were guided by health coaches to identify strategies for the ‘Stand Up’, ‘Sit Less’, and ‘Move More’ intervention targets, including how long they would stand using the workstation. Three-month workplace sitting and activity changes (activPAL3-assessed total sitting, prolonged sitting (i.e., sitting ≥30 min continuously) and purposeful walking) were evaluated in relation to the number (regression analysis) and types of strategies (decision-tree analysis).

Results

Over 80 different strategies were nominated by participants. Each additional strategy nominated for the ‘Stand Up’ intervention target (i.e. number of strategies) was associated with a reduction in prolonged sitting of 27.6 min/8-h workday (95% CI: -53.1, − 2.1, p = 0.034). Types of strategies were categorised into 13 distinct categories. Strategies that were task-based and phone-based were common across all three targets. The decision tree models did not select any specific strategy category as predicting changes in prolonged sitting (‘Stand Up’), however four strategy categories were identified as important for total sitting time (‘Sit Less’) and three strategy categories for purposeful walking (‘Moving More’). The uppermost nodes (foremost predictors) were nominating > 3 h/day of workstation standing (reducing total workplace sitting) and choosing a ‘Move More’ task-based strategy (purposeful walking).

Conclusions

Workers chose a wide range of strategies, with both strategy choice and strategy quantity appearing relevant to behavioural improvement. Findings support a tailored and pragmatic approach to encourage a change in sitting and activity in the workplace. Evaluating participant-selected strategies in the context of a successful intervention serves to highlight options that may prove feasible and effective in other desk-based workplace environments.

Trial registration

This trial was prospectively registered with the Australian New Zealand Clinical Trials register (ACTRN12611000742976) on 15 July 2011,

Electronic supplementary material

The online version of this article (10.1186/s12966-018-0731-z) contains supplementary material, which is available to authorized users.

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.

Long-Term Access to Sit-Stand Workstations in a Large Office Population: User Profiles Reveal Differences in Sitting Time and Perceptions

Background: To decrease the detrimental health effects of prolonged sitting, the implementation of sit-stand workstations is a commonly used intervention for office workers. Most studies on this topic evaluated the effects of newly introduced sit-stand workstations. The objective of this study was to determine how often and how long the standing option is used and how the use of sit-stand workstations is perceived in office workers with long-term access to these workstations. Methods: Using an online survey, 1098 office employees responded to questions about frequency of usage of the sit-stand workstation, sitting time, physical activity, and positive and negative perceptions of the use of the sit-stand workstations. Results: Based on the frequency of use, three user groups were identified: non-users (32.1%), monthly/weekly users (37.5%) and daily users (30.4%). Non-users reported to sit more, stand less and have longer bouts of sitting, compared to monthly/weekly users, and these differences were even larger compared to daily users. A higher proportion of daily users perceived the use of the sit-stand workstation as being more healthy and appealing and making them more productive and energetic compared to the non-users. A higher proportion of the non-users perceived it as being uncomfortable, distracting, and unpractical, compared to the other user groups. Conclusions: The differences between the three identified user groups with respect to sitting, standing and perceptions of sit-stand workstations, might be helpful in tailoring future interventions to reduce occupational sitting time, to increase the reach, effectiveness and sustainability.