Efficacy of the 'Stand and Move at Work' multicomponent workplace intervention to reduce sedentary time and improve cardiometabolic risk: a group randomized clinical trial

Stand-Capable Workstations Reduce Occupational Sedentary Time Among Administrative Workers

OCCUPATIONAL APPLICATIONSIn this study, we found that workers who use stand-biased desks stood more and sat less during their workday compared to workers who use traditional desks. Stand-biased users also experienced significantly less lower back discomfort compared to both traditional and sit-stand workstation users. Based on these findings, we recommend that the use of stand-biased workstations be considered when designing or renovating work office workspaces. The health risks of sedentary behavior are inherent in most office work, but these risks can be alleviated with intentional equipment choices. Using stand-biased desks can encourage workers to move more throughout the workday without their productivity or comfort being disturbed.

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.

Venous disorders as an occupational disease - a systematic review on epidemiology, pathophysiology, and modification strategies

Forced postures are common in the workplace. Work in the primary economic sector is characterised by a high degree of physical activity and movement; however, activities in the secondary and tertiary sectors commonly require workers to stand or sit. An expansion of the tertiary sector in recent decades has meant that people in industrialised and emerging economies primarily sit or stand at work. The aim of the systematic review was to identify occupational factors relating to the presence of chronic venous disease (CVD), to place these in the context of developments in the workplace, and to determine whether measures are in place to prevent CVD. We performed a systematic literature review to analyse studies assessing work-related risk factors for CVD. We searched for publications in the PubMed database, the clinic library of BG Hospital Bergmannstrost Halle, and the registry of the German Statutory Accident Insurance. Using occupation-specific keyword combinations, we identified 27,522 publications. The publications underwent an automatic and manual filtering process according to the PRISMA guidelines and 81 publications qualified for the review. Ultimately 25 studies were included in the systematic review. All of the subjects of the studies worked in the secondary and tertiary sectors. No studies looked at the relationship between venous disorders and primary sector occupations. Standing at work for more than four hours a day, repeated heavy lifting, and cumulative time working in a sitting or standing position are risk factors for the development of CVD. Sitting is less of a risk factor than standing or walking. Occupational history and the patient's activity profile are important diagnostic tools which can help confirm a diagnosis and justify treatment when findings are inconsistent. Compression therapy is the primary form of secondary and tertiary prevention. There continues to be a lack of primary preventive measures related to workplace design.

Effectiveness of workplace interventions with digital elements to reduce sedentary behaviours in office employees: a systematic review and meta-analysis

BACKGROUND

Digital interventions are potential tools for reducing and limiting occupational sedentary behaviour (SB) in sedentary desk-based jobs. Given the harmful effects of sitting too much and sitting for too long while working, the aim of this systematic review and meta-analysis was to examine the effectiveness of workplace interventions, that incorporated digital elements, to reduce the time spent in SB in office workers.

METHODS

Randomised control trials that evaluated the implementation of workplace interventions that incorporated digital elements for breaking and limiting SB among desk-based jobs were identified by literature searches in six electronic databases (PubMed, Web of Science, Scopus, CINAHL, PsycINFO and PEDro) published up to 2023. Studies were included if total and/or occupational SB were assessed. Only studies that reported pre- and postintervention mean differences and standard deviations or standard errors for both intervention arms were used for the meta-analysis. The meta-analysis was conducted using Review Manager 5 (RevMan 5; Cochrane Collaboration, Oxford, UK). Risk of bias was assessed using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields QUALSYST tool.

RESULTS

Nineteen studies were included in the systematic review. The most employed digital elements were information delivery and mediated organisational support and social influences. Multicomponent, information, and counselling interventions measuring total and/or occupational/nonoccupational SB time by self-report or via device-based measures were reported. Multicomponent interventions were the most represented. Eleven studies were included in the meta-analysis, which presented a reduction of 29.9 (95% CI: -45.2, -14.5) min/8 h workday in SB (overall effect: Z = 3.81).

CONCLUSIONS

Multicomponent interventions, using a wide range of digital features, have demonstrated effectiveness in reducing time spent in SB at the workplace among desk-based employees. However, due to hybrid work (i.e., work in the office and home) being a customary mode of work for many employees, it is important for future studies to assess the feasibility and effectiveness of these interventions in the evolving work landscape.

TRIAL REGISTRATION

The review protocol was registered in the Prospero database (CRD42022377366).

Improving movement behavior in office workers: effects of two multi-level cluster-RCT interventions on mental health

BACKGROUND

We have previously reported on the design and efficacy of two cluster-randomized multi-level workplace interventions, attempting to decrease sedentary behavior (SED) or increase moderate to vigorous physical activity (MVPA) among office workers to improve mental health outcomes. The aim of this study was to investigate intervention effects on mental health outcomes, i.e., mental wellbeing, depression or anxiety symptoms, and stress immediately after the 6-month intervention period.

METHODS

Teams of 263 office workers were cluster-randomized to one of two interventions or a waitlist control group. The PA intervention (iPA) focused on increasing MVPA and the SED intervention (iSED) on reducing SED. Both multi-level interventions targeted individual office workers and their social, physical, and organizational work environment, incorporating counseling based on cognitive behavioral therapy and motivational interviewing. Mental health outcomes were assessed using validated questionnaires before and immediately after the intervention. Intervention effects were analyzed using linear mixed effects models.

RESULTS

Participants were mostly female and highly educated, with a mean age of 42 years and had favorable levels of mental health at baseline. Mental wellbeing improved for the iSED group (β = 8, 95% CI 1 to 15, p = 0.030) but not for the iPA group (β = 6, 95% CI -1 to 12, p = 0.072) compared to the control group. No effects were found for depression or anxiety symptoms or stress.

CONCLUSIONS

The multi-level interventions improved mental wellbeing among this population of office workers, reaching statistical significance in the iSED group. The size of the effect can be regarded meaningful, considering favorable mental health and high PA level at baseline. Thus, workplace interventions that provide support on multiple levels appear to have potential for improving mental wellbeing, but not reducing ill-health variables, among healthy office workers. More research is needed to understand the mechanisms through which such improvements can be achieved and to identify the most effective intervention components.

TRIAL REGISTRATION

ISRCTN92968402 (27 February 2018).

StandUPTV: Preparation and optimization phases of a mHealth intervention to reduce sedentary screen time in adults

Recreational sedentary screen time (rSST) is the most prevalent sedentary behavior for adults outside of work, school, and sleep, and is strongly linked to poor health. StandUPTV is a mHealth trial that uses the Multiphase Optimization Strategy (MOST) framework to develop and evaluate the efficacy of three theory-based strategies for reducing rSST among adults. This paper describes the preparation and optimization phases of StandUPTV within the MOST framework. We identified three candidate components based on previous literature: (a) rSST electronic lockout (LOCKOUT), which restricts rSST through electronic means; (b) adaptive prompts (TEXT), which provides adaptive prompts based on rSST behaviors; and (c) earning rSST through increased moderate-vigorous physical activity (MVPA) participation (EARN). We also describe the mHealth iterative design process and the selection of an optimization objective. Finally, we describe the protocol of the optimization randomized controlled trial using a 23 factorial experimental design. We will enroll 240 individuals aged 23-64 y who engage in >3 h/day of rSST. All participants will receive a target to reduce rSST by 50% and be randomized to one of 8 combinations representing all components and component levels: LOCKOUT (yes vs. no), TEXT (yes vs. no), and EARN (yes vs. no). Results will support the selection of the components for the intervention package that meet the optimization objective and are acceptable to participants. The optimized intervention will be tested in a future evaluation randomized trial to examine reductions in rSST on health outcomes among adults.

Internal but Not External Building Design Associated With More Occupational Physical Activity

BACKGROUND

Few studies have explored the impact of internal building design features on physical activity. The purpose of this study is to determine building design features associate with physical activity and sedentary behaviors.

METHODS

Full-time workers (n = 114) wore an ActivPal monitor for 4 work days to measure physical activity and sedentary behaviors. Participants completed a 25-item survey about the presence of external, internal, and staircase design features at their worksite. Participants also reported their desk type. General linear models were used to examine relations between the number of features present for each category and physical activity (steps per hour) and sedentary behavior (sitting time per hour).

RESULTS

Internal design scores were positively associated with occupational physical activity. Each single item increase in facilitating internal design features was associated with +64.5 steps/hr (p = .045) at work. Workers who reported having a desk job walked 538 fewer steps/hr (p < .01) and sat 17 min more/hr at work than workers who reported not having a desk.

CONCLUSION

These results suggest that internal design features can promote more movement and less sitting at work. Future studies that examine the longitudinal effect of changing internal design features on occupational physical activity and sedentary behaviors are warranted.

Ukumela impilo randomised trial: preliminary findings of height-adjustable sit-to-stand workstations on health outcomes of South African office workers

BACKGROUND

The prevalence of sedentary behaviour has concurrently risen with multiple cardiometabolic risk markers independent of physical activity levels. Office-based workers accumulate the highest levels of sitting time during occupational times. This study aims to investigate the short-term effects of using height-adjustable sit-to-stand workstations on cardiometabolic risk markers of office-based workers in South Africa.

RESULTS

Sixty-two office-based workers were randomized into intervention (n = 44), and the control group (n = 18). Small improvements were observed in BMI, blood pressure, and cholesterol levels in this cohort.

CONCLUSION

This preliminary investigation confirms that short-term height-adjustable sit-stand interventions are effective in reducing workplace sitting time and selected health outcomes. South Africa has been attributed with the highest burden of obesity in Sub-Saharan Africa, as a result, there is a need to implement long-term workplace intervention to reverse these implications.

TRIAL REGISTRATION

Pan African Clinical Trial Registry, PACTR201911656014962 on the 12th of November 2019.

Sedentary behavior and physical inactivity from a comprehensive perspective

OBJECTIVE

To characterize the prevalence of physical activity in the population aged ≥16 years integrating sedentarism and physical inactivity.

METHOD

A cross-sectional study using data from the Galician Risk Behavior Data System (n=12,928) was conducted. The population was classified into four categories: physically active (active and non-sedentary), active but sedentary (active and sedentary), lightly active (inactive and non-sedentary), and extremely sedentary (inactive and sedentary). Prevalences were calculated for each category and a multinomial logistic regression model was fitted.

RESULTS

58.0% of the population was physically active and the remaining 42.0% presented some degree of sedentarism and/or physical inactivity. Men were more likely to be extremely sedentary. The risk of sedentarism decreased with age, and workers and/or students were prone to a higher risk of extreme sedentarism in comparison to those who reported other status. Extremely sendentary behaviors were also more common in people with higher educational levels, individuals living alone, residents of urban environments, and smokers.

CONCLUSIONS

Joint evaluation of sedentarism and physical inactivity provides a more comprehensive and realistic picture of population behaviors related with physical activity. Since sedentarism is the most prevalent behavior, this study recommends that interventions be conducted at work and at academic environments.

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

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSION

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

TRIAL REGISTRATION

NL7503 - registered 1 February 2019.

Participant and workplace champion experiences of an intervention designed to reduce sitting time in desk-based workers: SMART work & life

BACKGROUND

A cluster randomised controlled trial demonstrated the effectiveness of the SMART Work & Life (SWAL) behaviour change intervention, with and without a height-adjustable desk, for reducing sitting time in desk-based workers. Staff within organisations volunteered to be trained to facilitate delivery of the SWAL intervention and act as workplace champions. This paper presents the experiences of these champions on the training and intervention delivery, and from participants on their intervention participation.

METHODS

Quantitative and qualitative feedback from workplace champions on their training session was collected. Participants provided quantitative feedback via questionnaires at 3 and 12 month follow-up on the intervention strategies (education, group catch ups, sitting less challenges, self-monitoring and prompts, and the height-adjustable desk [SWAL plus desk group only]). Interviews and focus groups were also conducted at 12 month follow-up with workplace champions and participants respectively to gather more detailed feedback. Transcripts were uploaded to NVivo and the constant comparative approach informed the analysis of the interviews and focus groups.

RESULTS

Workplace champions rated the training highly with mean scores ranging from 5.3/6 to 5.7/6 for the eight parts. Most participants felt the education increased their awareness of the health consequences of high levels of sitting (SWAL: 90.7%; SWAL plus desk: 88.2%) and motivated them to change their sitting time (SWAL: 77.5%; SWAL plus desk: 85.77%). A high percentage of participants (70%) reported finding the group catch up session helpful and worthwhile. However, focus groups highlighted mixed responses to the group catch-up sessions, sitting less challenges and self-monitoring intervention components. Participants in the SWAL plus desk group felt that having a height-adjustable desk was key in changing their behaviour, with intrinsic as well as time based factors reported as key influences on the height-adjustable desk usage. In both intervention groups, participants reported a range of benefits from the intervention including more energy, less fatigue, an increase in focus, alertness, productivity and concentration as well as less musculoskeletal problems (SWAL plus desk group only). Work-related, interpersonal, personal attributes, physical office environment and physical barriers were identified as barriers when trying to sit less and move more.

CONCLUSIONS

Workplace champion and participant feedback on the intervention was largely positive but it is clear that different behaviour change strategies worked for different people indicating that a 'one size fits all' approach may not be appropriate for this type of intervention. The SWAL intervention could be tested in a broader range of organisations following a few minor adaptations based on the champion and participant feedback.

TRIAL REGISTRATION

ISCRCTN registry (ISRCTN11618007).

Physiology of sedentary behavior

Sedentary behaviors (SB) are characterized by low energy expenditure while in a sitting or reclining posture. Evidence relevant to understanding the physiology of SB can be derived from studies employing several experimental models: bed rest, immobilization, reduced step count, and reducing/interrupting prolonged SB. We examine the relevant physiological evidence relating to body weight and energy balance, intermediary metabolism, cardiovascular and respiratory systems, the musculoskeletal system, the central nervous system, and immunity and inflammatory responses. Excessive and prolonged SB can lead to insulin resistance, vascular dysfunction, shift in substrate use toward carbohydrate oxidation, shift in muscle fiber from oxidative to glycolytic type, reduced cardiorespiratory fitness, loss of muscle mass and strength and bone mass, and increased total body fat mass and visceral fat depot, blood lipid concentrations, and inflammation. Despite marked differences across individual studies, longer term interventions aimed at reducing/interrupting SB have resulted in small, albeit marginally clinically meaningful, benefits on body weight, waist circumference, percent body fat, fasting glucose, insulin, HbA1c and HDL concentrations, systolic blood pressure, and vascular function in adults and older adults. There is more limited evidence for other health-related outcomes and physiological systems and for children and adolescents. Future research should focus on the investigation of molecular and cellular mechanisms underpinning adaptations to increasing and reducing/interrupting SB and the necessary changes in SB and physical activity to impact physiological systems and overall health in diverse population groups.

A multicomponent intervention to reduce daily sitting time in office workers: the SMART Work & Life three-arm cluster RCT

Background

Office workers spend 70-85% of their time at work sitting. High levels of sitting have been linked to poor physiological and psychological health. Evidence shows the need for fully powered randomised controlled trials, with long-term follow-up, to test the effectiveness of interventions to reduce sitting time.

Objective

Our objective was to test the clinical effectiveness and cost-effectiveness of the SMART Work & Life intervention, delivered with and without a height-adjustable workstation, compared with usual practice at 12-month follow-up.

Design

A three-arm cluster randomised controlled trial.

Setting

Councils in England.

Participants

Office workers.

Intervention

SMART Work & Life is a multicomponent intervention that includes behaviour change strategies, delivered by workplace champions. Clusters were randomised to (1) the SMART Work & Life intervention, (2) the SMART Work & Life intervention with a height-adjustable workstation (i.e. SMART Work & Life plus desk) or (3) a control group (i.e. usual practice). Outcome measures were assessed at baseline and at 3 and 12 months.

Main outcome measures

The primary outcome was device-assessed daily sitting time compared with usual practice at 12 months. Secondary outcomes included sitting, standing, stepping time, physical activity, adiposity, blood pressure, biochemical measures, musculoskeletal issues, psychosocial variables, work-related health, diet and sleep. Cost-effectiveness and process evaluation data were collected.

Results

A total of 78 clusters (756 participants) were randomised [control, 26 clusters (n = 267); SMART Work & Life only, 27 clusters (n = 249); SMART Work & Life plus desk, 25 clusters (n = 240)]. At 12 months, significant differences between groups were found in daily sitting time, with participants in the SMART Work & Life-only and SMART Work & Life plus desk arms sitting 22.2 minutes per day (97.5% confidence interval -38.8 to -5.7 minutes/day; p = 0.003) and 63.7 minutes per day (97.5% confidence interval -80.0 to -47.4 minutes/day; p < 0.001), respectively, less than the control group. Participants in the SMART Work & Life plus desk arm sat 41.7 minutes per day (95% confidence interval -56.3 to -27.0 minutes/day; p < 0.001) less than participants in the SMART Work & Life-only arm. Sitting time was largely replaced by standing time, and changes in daily behaviour were driven by changes during work hours on workdays. Behaviour changes observed at 12 months were similar to 3 months. At 12 months, small improvements were seen for stress, well-being and vigour in both intervention groups, and for pain in the lower extremity and social norms in the SMART Work & Life plus desk group. Results from the process evaluation supported these findings, with participants reporting feeling more energised, alert, focused and productive. The process evaluation also showed that participants viewed the intervention positively; however, the extent of engagement varied across clusters. The average cost of SMART Work & Life only and SMART Work & Life plus desk was £80.59 and £228.31 per participant, respectively. Within trial, SMART Work & Life only had an incremental cost-effectiveness ratio of £12,091 per quality-adjusted life-year, with SMART Work & Life plus desk being dominated. Over a lifetime, SMART Work & Life only and SMART Work & Life plus desk had incremental cost-effectiveness ratios of £4985 and £13,378 per quality-adjusted life-year, respectively.

Limitations

The study was carried out in one sector, limiting generalisability.

Conclusions

The SMART Work & Life intervention, provided with and without a height-adjustable workstation, was successful in changing sitting time.

Future work

There is a need for longer-term follow-up, as well as follow-up within different organisations.

Trial registration

Current Controlled Trials ISRCTN11618007.

Life Course Cardiovascular Health: Risk Factors, Outcomes, and Interventions

Since it was first defined by the American Heart Association in 2010, cardiovascular health (CVH) has been extensively studied across the life course. In this review, we present the current literature examining early life predictors of CVH, the later life outcomes of child CVH, and the relatively few interventions which have specifically addressed how to preserve and promote CVH across populations. We find that research on CVH has demonstrated that prenatal and childhood exposures are consistently associated with CVH trajectories from childhood through adulthood. CVH measured at any point in life is strongly predictive of future cardiovascular disease, dementia, cancer, and mortality as well as a variety of other health outcomes. This speaks to the importance of intervening early to prevent the loss of optimal CVH and the accumulation of cardiovascular risk. Interventions to improve CVH are not common but those that have been published most often address multiple modifiable risk factors among individuals within the community. Relatively few interventions have been focused on improving the construct of CVH in children. Future research is needed that will be both effective, scalable, and sustainable. Technology including digital platforms as well as implementation science will play key roles in achieving this vision. In addition, community engagement at all stages of this research is critical. Lastly, prevention strategies that are tailored to the individual and their context may help us achieve the promise of personalized prevention and help promote ideal CVH in childhood and across the life course.

Psychosocial and behavioral outcomes in the adult workforce during the COVID-19 pandemic: a 1-Year longitudinal survey

BACKGROUND

Efforts to limit the spread of COVID-19 have included public space closures, mask usage, and quarantining. Studies regarding the impact of these measures on the psychosocial and behavioral health outcomes of the workforce have focused frequently on healthcare employees. To expand the literature base, we deployed a one-year longitudinal survey among mostly non-healthcare employees assessing changes in select psychosocial outcomes, health behaviors, and COVID-19-related transmission prevention behaviors and perceptions.

METHODS

We deployed the CAPTURE baseline survey across eight companies from November 20, 2020-February 8, 2021. The baseline survey included questions on psychosocial outcomes, health behaviors, and COVID-19 transmission prevention behaviors, with several questions containing a retrospective component to cover the time period prior to the pandemic. Additional questions on vaccination status and social support were subsequently added, and the updated survey deployed to the same baseline participants at three, six, and 12 months after baseline survey deployment. We analyzed data descriptively and performed Friedman's and subsequent Wilcoxon-signed rank tests, as appropriate, to compare data within and between time points.

RESULTS

A total of 3607, 1788, 1545, and 1687 employees completed the baseline, 3-month, 6-month, and 12-month CAPTURE surveys, respectively, with 816 employees completing all four time points. Employees reported higher stress, anxiety, fatigue, and feelings of being unsafe across all time points compared to pre-pandemic. Time spent sleeping increased initially but returned to pre-pandemic levels at follow-up. Lower rates of physical activity and higher rates of non-work screen time and alcohol consumption relative to pre-pandemic were also reported. Over 90% of employees perceived wearing a mask, physical distancing, and receiving the COVID-19 vaccine as 'moderately' or 'very important' in preventing the spread of COVID-19 across all time points.

CONCLUSIONS

Relative to pre-pandemic, poorer psychosocial outcomes and worsened health behaviors were observed across all time points, with values worse at the baseline and 12-month time points when COVID-19 surges were highest. While COVID-19 prevention behaviors were consistently deemed to be important by employees, the psychosocial outcome and health behavior data suggest the potential for harmful long-term effects of the pandemic on the well-being of non-healthcare employees.

Public Health Concern on Sedentary Behavior and Cardiovascular Disease: A Bibliometric Analysis of Literature from 1990 to 2022

Background and Objectives: Cardiovascular disease is a long-term threat to global public health security, while sedentary behavior is a modifiable behavior among cardiovascular risk factors. This study aimed to analyze the peer-reviewed literature published globally on sedentary behavior and cardiovascular disease (SB-CVD) and identify the hotspots and frontiers within this research area. Materials and Methods: Publications on SB-CVD from 1990 to 2022 were retrieved from the Web of Science Core Collection. CiteSpace and VOSviewer were applied to perform bibliometric and knowledge mapping visualization analyses. Results: A total of 2071 publications were retrieved, presenting a gradual growing trend. Authors from the USA topped the list with 748 (36.12%), followed by authors from England (373, 18.01%) and Australia (354, 17.09%). The University of Queensland, Australia, led with 95 (4.5%) publications. The top five active authors were all from Australia, while Dunstan D and Owen N published the most documents (56, 2.7%). A total of 71.27% of the publications received funding, and the United States Department of Health and Human Services provided 363 (17.53%) grants. Public Environmental Occupational Health (498, 24.05%), Sport Sciences (237, 11.44%), and Cardiac Cardiovascular Systems (212, 10.24%) were the three most popular disciplines, while PLOS One (96, 4.64%) and BMC Public Health (88, 4.25%) were the two most popular journals. Investigations within the SB-CVD research area addressed the entire lifespan, the most popular type of research was the epidemiological study, and the accelerometer was the primary instrument for measuring sedentary behavior. In terms of variables, physical activity and sedentary behavior were the dominant lifestyle behaviors, while obesity and hypertension were common health problems. Occupational physical activity and guidelines are at the frontier and are currently in the burst stage. Conclusions: The last three decades have witnessed the rapid development of the SB-CVD research area, and this study provided further research ideas for subsequent investigations.

Effect of Weight Goals on Sitting and Moving During a Worksite Sedentary Time Reduction Intervention

Introduction/Purpose

Although many US adults report trying to lose weight, little research has examined weight loss goals as a motivator for reducing workplace sitting and increasing physical activity. This exploratory analysis examined weight goals and the association with changes in workplace sitting, physical activity, and weight.

Methods

Employees (N = 605) were drawn from worksites participating in Stand and Move at Work. Worksites (N = 24) were randomized to a multilevel behavioral intervention with (STAND+) or without (MOVE+) sit-stand workstations for 12 months; MOVE+ worksites received sit-stand workstations from 12 to 24 months. At each assessment (baseline and 3, 12, and 24 months), participants were weighed and wore activPAL monitors. Participants self-reported baseline weight goals and were categorized into the "Lose Weight Goal" (LWG) group if they reported trying to lose weight or into the "Other Weight Goal" (OWG) group if they did not.

Results

Generalized linear mixed models revealed that within STAND+, LWG and OWG had similar sitting time through 12 months. However, LWG sat significantly more than OWG at 24 months. Within MOVE+, sitting time decreased after introduction of sit-stand workstations for LWG and OWG, although LWG sat more than OWG. Change in physical activity was minimal and weight remained stable in all groups.

Conclusions

Patterns of change in workplace sitting were more favorable in OWG relative to LWG, even in the absence of notable weight change. Expectations of weight loss might be detrimental for reductions in workplace sitting. Interventionists may want to emphasize non-weight health benefits of reducing workplace sitting.

Changes in physical activity and sedentary time in United States adults in response to COVID-19

Physical activity is associated lower risk for a broad range of non-communicable diseases and early mortality, and even small changes in daily activity levels could have a profound effect on public health at the population level. The COVID-19 pandemic reshaped daily life for United States (US) adults resulting in reductions in physical activity early in the pandemic, but its longer-term effects on daily activities are unknown. To examine the longer-term impact of the pandemic on daily activity levels, we conducted a nationwide longitudinal study of 1,635 adults (20–75 years) in AmeriSpeak. Previous-day recalls of time-use, sedentary time, and physical activity were completed on randomly selected days in Fall 2019 (pre-pandemic) and Fall 2020. Overall, US adults reported less time in transportation (-0.47 hrs/d), more total discretionary time (0.40 hrs/d), but no changes in total sedentary time (0.10 hrs/d) or leisure-time physical activity (-0.06 hrs/d). Women reported significantly less total activity (-0.36 hrs/d) and participants with children < 13 yrs reported more sedentary time (0.60 to 0.82 hrs/d) and less moderate-to-vigorous intensity activity (-0.84 to -0.72 hrs/d). Adults without children reported no changes in sedentary time (0.02 hrs/d) or moderate-vigorous intensity activity (-0.06 hrs/d). Adults who started working from home reported no changes in physical activity, but they were among the most sedentary and least active population groups at both timepoints. Our findings describe the complex inter-play between competing behaviors as time-use demands have changed in response to the pandemic, particularly for adults with younger children. Many US adults are likely to continue working from home; therefore, implementation of evidence-based approaches to increase physical activity and reduce sedentary time in this growing population subgroup appears warranted.

Sit-Stand Desks and Physical Self-care Behaviors in a Family Medicine Residency

INTRODUCTION

More than 50% of primary care physicians' practice involves sedentary desk work. Growing evidence suggests a link between sedentary workplace behaviors and increased morbidity and mortality. Research on the effects of sit-stand desks in the workplace suggests that sit-stand desks reduce sedentary behaviors. This study examined the use and satisfaction of adjustable desks with a height of sit-stand and their association with physical self-care behaviors among family medicine residents.

METHODS

We conducted a longitudinal cohort survey study at a 9-9-9 family medicine residency after the clinic installed height-adjustable sit-stand desks in January 2020. Standardized questions about the use and satisfaction of adjustable sit-stand desks and physical self-care behaviors were administered in June 2020, December 2020, and December 2021. The survey also included an open text box for feedback.

RESULTS

Median time spent standing at the sit-stand desks was 55.0%. The percentage of time standing was similar across June 2020, December 2020, and December 2021. The average satisfaction rate with the desks across all time points was 71.4%. We did not observe significant differences in the proportion of residents' satisfaction with the adjustable desks over time. Residents who reported standing at the adjustable desk reported increased satisfaction with the desks (Kendall's τ=.38, P<.001) and with physical self-care behaviors (Kendall's τ=.25, P<.05). Themes associated with desk dissatisfaction revolved around limited desktop space.

CONCLUSION

Over a nearly 1.5-year period, more than half of family medicine residents reported standing at their adjustable desks and being satisfied with them. Residents who reported standing at adjustable desks also reported increased physical self-care behaviors. Residency programs investing in sit-stand desks may consider options that allow for increased desktop surface space.

Effectiveness of an intervention for reducing sitting time and improving health in office workers: three arm cluster randomised controlled trial

OBJECTIVES

To evaluate the effectiveness of an intervention, with and without a height adjustable desk, on daily sitting time, and to investigate the relative effectiveness of the two interventions, and the effectiveness of both interventions on physical behaviours and physical, biochemical, psychological, and work related health and performance outcomes.

DESIGN

Cluster three arm randomised controlled trial with follow-up at three and 12 months.

SETTING

Local government councils in Leicester, Liverpool, and Greater Manchester, UK.

PARTICIPANTS

78 clusters including 756 desk based employees in defined offices, departments, or teams from two councils in Leicester, three in Greater Manchester, and one in Liverpool.

INTERVENTIONS

Clusters were randomised to one of three conditions: the SMART Work and Life (SWAL) intervention, the SWAL intervention with a height adjustable desk (SWAL plus desk), or control (usual practice).

MAIN OUTCOMES MEASURES

The primary outcome measure was daily sitting time, assessed by accelerometry, at 12 month follow-up. Secondary outcomes were accelerometer assessed sitting, prolonged sitting, standing and stepping time, and physical activity calculated over any valid day, work hours, workdays, and non-workdays, self-reported lifestyle behaviours, musculoskeletal problems, cardiometabolic health markers, work related health and performance, fatigue, and psychological measures.

RESULTS

Mean age of participants was 44.7 years, 72.4% (n=547) were women, and 74.9% (n=566) were white. Daily sitting time at 12 months was significantly lower in the intervention groups (SWAL -22.2 min/day, 95% confidence interval -38.8 to -5.7 min/day, P=0.003; SWAL plus desk -63.7 min/day, -80.1 to -47.4 min/day, P<0.001) compared with the control group. The SWAL plus desk intervention was found to be more effective than SWAL at changing sitting time (-41.7 min/day, -56.3 to -27.0 min/day, P<0.001). Favourable differences in sitting and prolonged sitting time at three and 12 month follow-ups for both intervention groups and for standing time for the SWAL plus desk group were observed during work hours and on workdays. Both intervention groups were associated with small improvements in stress, wellbeing, and vigour, and the SWAL plus desk group was associated with improvements in pain in the lower extremity, social norms for sitting and standing at work, and support.

CONCLUSIONS

Both SWAL and SWAL plus desk were associated with a reduction in sitting time, although the addition of a height adjustable desk was found to be threefold more effective.

TRIAL REGISTRATION

ISRCTN Registry ISRCTN11618007.

Health effects of reduced occupational sedentary behaviour in type 2 diabetes using a mobile health intervention: a study protocol for a 12-month randomized controlled trial-the ROSEBUD study

BACKGROUND

Short-term trials conducted in adults with type 2 diabetes mellitus (T2DM) showed that reducing sedentary behaviour by performing regular short bouts of light-intensity physical activity enhances health. Moreover, support for reducing sedentary behaviour may be provided at a low cost via mobile health technology (mHealth). There are a wide range of mHealth solutions available including SMS text message reminders and activity trackers that monitor the physical activity level and notify the user of prolonged sitting periods. The aim of this study is to evaluate the effects of a mHealth intervention on sedentary behaviour and physical activity and the associated changes in health in adults with T2DM.

METHODS

A dual-arm, 12-month, randomized controlled trial (RCT) will be conducted within a nationwide Swedish collaboration for diabetes research in primary health care. Individuals with T2DM (n = 142) and mainly sedentary work will be recruited across primary health care centres in five regions in Sweden. Participants will be randomized (1:1) into two groups. A mHealth intervention group who will receive an activity tracker wristband (Garmin Vivofit4), regular SMS text message reminders, and counselling with a diabetes specialist nurse, or a comparator group who will receive counselling with a diabetes specialist nurse only. The primary outcomes are device-measured total sitting time and total number of steps (activPAL3). The secondary outcomes are fatigue, health-related quality of life and musculoskeletal problems (self-reported questionnaires), number of sick leave days (diaries), diabetes medications (clinical record review) and cardiometabolic biomarkers including waist circumference, mean blood pressure, HbA1c, HDL-cholesterol and triglycerides.

DISCUSSION

Successful interventions to increase physical activity among those with T2DM have been costly and long-term effectiveness remains uncertain. The use of mHealth technologies such as activity trackers and SMS text reminders may increase awareness of prolonged sedentary behaviour and encourage increase in regular physical activity. mHealth may, therefore, provide a valuable and novel tool to improve health outcomes and clinical management in those with T2DM. This 12-month RCT will evaluate longer-term effects of a mHealth intervention suitable for real-world primary health care settings.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04219800 . Registered on 7 January 2020.

Qualitative comparative analysis of the implementation fidelity of a workplace sedentary reduction intervention

BACKGROUND

Stand and Move at Work was a 12-month, multicomponent, peer-led (intervention delivery personnel) worksite intervention to reduce sedentary time. Although successful, the magnitude of reduced sedentary time varied by intervention worksite. The purpose of this study was to use a qualitative comparative analysis approach to examine potential explanatory factors that could distinguish higher from lower performing worksites based on reduced sedentary time.

METHODS

We assessed 12-month changes in employee sedentary time objectively using accelerometers at 12 worksites. We ranked worksites based on the magnitude of change in sedentary time and categorized sites as higher vs. lower performing. Guided by the integrated-Promoting Action on Research Implementation in Health Services framework, we created an indicator of intervention fidelity related to adherence to the protocol and competence of intervention delivery personnel (i.e., implementer). We then gathered information from employee interviews and surveys as well as delivery personnel surveys. These data were aggregated, entered into a truth table (i.e., a table containing implementation construct presence or absence), and used to examine differences between higher and lower performing worksites.

RESULTS

There were substantive differences in the magnitude of change in sedentary time between higher (-75.2 min/8 h workday, CI₉₅: -93.7, -56.7) and lower (-30.3 min/8 h workday, CI₉₅: -38.3, -22.7) performing worksites. Conditions that were present in all higher performing sites included implementation of indoor/outdoor walking route accessibility, completion of delivery personnel surveys, and worksite culture supporting breaks (i.e., adherence to protocol). A similar pattern was found for implementer willingness to continue role and employees using face-to-face interaction/stair strategies (i.e., delivery personnel competence). However, each of these factors were also present in some of the lower performing sites suggesting we were unable to identify sufficient conditions to predict program success.

CONCLUSIONS

Higher intervention adherence and implementer competence is necessary for greater program success. These findings illustrate the need for future research to identify what factors may influence intervention fidelity, and in turn, effectiveness.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02566317 . Registered 2 October 2015, first participant enrolled 11 January 2016.

Effects of Sedentary Behavior Interventions on Mental Well-Being and Work Performance While Working from Home during the COVID-19 Pandemic: A Pilot Randomized Controlled Trial

Sedentary behavior negatively impacts mental health, which can decrease employee productivity. Employee mental well-being and work performance may improve with sedentary reduction interventions, especially strategies that include environmental workplace modifications and behavior-changing strategies. However, such interventions have not been examined among employees working remotely during the COVID-19 pandemic. As part of the Stand Up Kansas program, 95 sedentary university employees working from home were randomized into one of four intervention arms: height-adjustable desk provision (Desk Only), online sedentary behavior modification program (Program Only), Desk + Program, or Control. The outcomes were measured at a baseline (November 2020) and following the 12-week intervention (February 2021). Employees reported mood (positive and negative affect), stress, fatigue (duration, interference with activities and severity) and work performance (irritability, focus, work satisfaction, non-work satisfaction and productivity) were measured using established self-report instruments. The effect sizes, by comparing the Control arm to the Desk + Program arm, revealed large improvements in mood (positive affect, d = 1.106). Moderate improvements were also seen in fatigue (duration, d = −0.533, and interference with activities, d = −0.648) and several aspects of work performance (focus, d = 0.702, work satisfaction, d = 0.751, and productivity, d = 0.572). Moderate effect sizes were also seen for positive affect (d = 0.566) and fatigue severity (d = 0.577) among the Program Only arm, whereas no noteworthy effect sizes were observed among the Desk Only arm. Combining an online sedentary behavior modification program with height-adjustable desk provisions appeared to positively affect mental well-being and work performance among remote employees.

Entorno laboral saludable en Asia y América del Norte revisión de alcance

Objetivos Realizar una revisión de alcance sobre entorno laboral saludable (ELS) en países de Asia y América del Norte. Métodos Revisión de documentos de diversos diseños metodológicos resultantes de la matriz PRISMA obtenidos en bases de datos como Scopus, PubMed, Biblioteca Virtual de la Salud (BVS) y otros motores de búsqueda entre los años 2015 y 2020 empleando los descriptores Healthy, Workplace, Enviroment Work y conectores AND y OR. Resultados Se obtuvo un total de 36 documentos finales. El 66,7% de los estudios encontrados fueron en países de América del Norte. El 44,4% de las publicaciones se realizaron en el año 2019 y 2020. Se halló que la base de datos que más arrojó publicaciones acerca de ELS fue Scopus y la revista que más publicó fue BVS; igualmente los temas más relevantes para alcanzar ELS fueron la promoción de la salud en el lugar de trabajo mediante la intervención de estrategias encaminadas a los estilos de vida saludables y el impacto de la productividad. Conclusiones Las estrategias de ELS permiten que los programas de promoción de la salud sean implementados en las empresas con el fin de mejorar los estilos de vida y las condiciones laborales de los trabajadores, incentivando la actividad física, la alimentación balanceada, disminuyendo la ingesta de bebidas alcohólicas y el tabaquismo. Los ELS se relaciona con la mejora continua debido a que favorece el aumento de la productividad y por ende es importante que se puedan implementar en el contexto de la educación, negocios, comercio y desarrollo económico.

Proposal of a Comprehensive and Multi-Component Approach to Promote Physical Activity among Japanese Office Workers: A Qualitative Focus Group Interview Study

Office workers spend up to two-thirds of their working hours sitting and are less physically active than other occupational groups. It is necessary to develop an effective approach to promote physical activity among office workers. We conducted a focus group interview with seven Japanese office workers to investigate the current status (topic 1) of, and their opinions on (topic 2), physical activity promotion programs in their workplace. Data were analyzed using qualitative data analysis. We classified the data from topic 1 into individual, socio-cultural, physical, and organizational environments. Most participants indicated that they spent a lot of time sitting and needed programs for a wide range of corresponding employee demands. We classified the data from topic 2 into capability, opportunity, and motivation. Most participants indicated that they wanted evidence-based information, a standing desk, and a conducive workplace environment to enhance physical activity. Thus, we proposed a comprehensive and multi-component approach comprising individual (information delivery), socio-cultural environment (team building, supportive atmosphere), physical environment (standing desk, use of poster), and organizational (incentive, encouraging message from an executive, workplace policy) strategies. Future studies should evaluate the effectiveness of this proposal.

Reducing Occupational Sitting While Working From Home: Individual and Combined Effects of a Height-Adjustable Desk and an Online Behavioral Intervention

OBJECTIVE

This study examined the individual and combined effects of a height-adjustable desk and an online behavioral intervention on sedentary behavior and health among university employees working from home.

METHODS

Participants (N = 95) were randomly assigned to one of four conditions: Desk Only, Program Only, Desk + Program, or Control. Desk participants received a height-adjustable desk; program participants received a 12-week web-based intervention. Outcomes measured at baseline and post-intervention included workday sitting and cardiometabolic health outcomes.

RESULTS

Reductions in sitting were largest in the Desk + Program condition (-206 min/workday; d = 1.84), followed by the Desk Only condition (-122 min/workday; d = 0.98), and the Program Only condition (-96 min/workday; d = 1.13). There were no significant changes in the health outcomes assessed.

CONCLUSIONS

Both a height-adjustable desk and an online behavioral intervention effectively reduced occupational sitting, and a combined approach was most effective.

The Effects of UPcomplish on Office Workers' Sedentary Behaviour, Quality of Life and Psychosocial Determinants: A Stepped-Wedge Design

BACKGROUND

Sedentary behaviour (SB) affects cardiometabolic health and quality of life (QoL). We examine the effects of UPcomplish, a 12-week data-driven intervention, on SB, QoL and psychosocial determinants among office workers.

METHODS

Participants were recruited via judgement sampling. Five groups starting with time-lags of 7 weeks (n = 142, 96 females) received 14 feedback messages (FBMs) which were tailored to SB patterns, goals and hurdles. Participants received questionnaires at the beginning, middle and end of the intervention and wore an accelerometer measuring SB, operationalized as proportions (compositional data approach, CoDA) and summed squared sitting bouts (SSSB). We used linear mixed-effects models with random intercepts for weeks (between-subjects) and individuals (within-subjects).

RESULTS

UPcomplish did not reduce SB. Within-subjects compared to baseline, FBM #3 (βCoDA = 0.24, p < .001, 95% CI [0.15, 0.33]; βSSSB = 20.83, p < .001, 95% CI [13.90, 27.28]) and #4 (βCoDA = 0.20, p < .001, 95% CI [0.11, 0.29]; βSSSB = 24.80, p < .001, 95% CI [15.84, 33.76]) increased SB. QoL was unaffected. Perceived susceptibility was lower after FBMs #6 to #8 (βbetween = - 0.66, p = .04, 95% CI [- 1.03, - 0.30]; βwithin = - 0.75, p = .02, 95% CI [- 1.18, - 0.32]). Within-subjects, intentions to sit less were higher after FBMs #1 to #5 (1.14, p = .02, 95% CI [0.61, 1.66]). Improvements in determinants and in SB were not associated, nor were improvements in SB and in QoL.

CONCLUSIONS

Compared to VitaBit only, UPcomplish was not beneficial. Environmental restructuring might be superior, but detailed analyses of moderators of effectiveness are needed.

Prolonged sitting time links to subclinical atherosclerosis

BACKGROUND

This study investigates the association between daily sitting time and subclinical atherosclerosis by using coronary computed tomography angiography (CCTA).

METHODS

The study enrolled 203 subjects (age 57.6 ± 8.8 years) who underwent CCTA at annual medical checkups. Sitting time was categorized as < 5 hours/day (short), 5 to 9 hours/day (moderate) and ≥10 hours/d (long). We analyzed the coronary calcium score, plaque characteristics, and severity of coronary artery stenosis, including the segment involvement score (SIS) and segment stenosis score (SSS).

RESULTS

Subjects with longer sitting times tended to be male gender and have lower levels of high-density lipoprotein cholesterol (p for trend < 0.05). In addition, those with longer sitting time had higher SIS (1.2 ± 1.5 vs. 1.6 ± 2.1 vs. 2.3 ± 2.0 for short, moderate, and long sitting time, respectively) (p for trend = 0.015) and SSS (1.4 ± 2.0 vs. 1.9 ± 2.7 vs. 2.7 ± 2.6) (p for trend = 0.015), suggesting longer sitting time-correlated with the severity of coronary atherosclerosis. When considering the coronary plaque patterns, subjects with shorter sitting time (<5 hours/d) tended to have more calcified plaque and subjects with longer sitting time (≥10 hours/d) had more mixed plaque (p for trend = 0.018). After adjusting for age, gender, comorbidities, body mass index, and lipid profiles, increased sitting time was independently associated with the presence of mixed plaque, suggesting longer sitting time may be associated with higher risk of the formation of vulnerable plaque.

CONCLUSION

Longer sitting time was linked to the severity of subclinical atherosclerosis and the presence of high-risk vulnerable plaque in the general population.

Co-Production at Work: The Process of Breaking Up Sitting Time to Improve Cardiovascular Health. A Pilot Study

Prolonged sitting negatively affects several cardiovascular disease biomarkers. Current workplace physical activity interventions to reduce sitting result in inconsistent uptake and adherence rates. Co-production attempts to improve the translation of evidence to practice through engaging the participants within the intervention design, improving the context sensitivity and acceptability of the intervention. A needs analysis questionnaire was initially conducted (n = 157) to scope workplace behaviours and attitudes. A development group (n = 11) was consulted in focus groups around the needs analysis findings and asked to comment on the feasibility of a proposed intervention. A pilot intervention was then carried out (n = 5). The needs analysis indicated that only 1.8% (n = 4) engaged in occupational physical activity, and 68.7% (n = 103) sat for ≥6 h during their working day. Through the focus groups, an intervention breaking up sitting time hourly with five-minute walking breaks was co-produced. Cultural and pragmatic issues concerning the implementation of frequent physical activity breaks from sitting and the subsequent impact on work productivity were highlighted. The pilot intervention increased the number of breaks from sedentary behaviour from 2 to 11. The co-production methodology resulted in a research- and stakeholder-guided compromise. Large-scale intervention implementation is required before firm effectiveness conclusions can be made.

ActivPAL accuracy in determining metabolic rate during walking, running and cycling

To evaluate the ActivPAL's (AcP) ability to estimate METs during walking, running and cycling. Twenty physically active participants performed two submaximal exercises using a treadmill and cycle ergometer. The treadmill session involved varying speeds with a fixed grade and varying grade at fixed walking and running speeds. The cycling session involved fixed power, while cadence was varied and fixed cadence, while power was varied. Four AcPs (two AcP3 & two AcP4) were worn. ActivPAL MET estimations were compared to METS determined via indirect calorimetry. The AcP MET estimations between units and models did not differ. The AcP underestimated (-15% to -61%) METs with increasing speed and was unable to detect an increase in metabolic rate with a change in grade for walking and running. The AcP underestimated (-33% to -60%) METs during cycling and was unable to detect increases in metabolic rate when cadence was fixed, while power increased. The AcP can identify when exercise occurs and provides consistent information across units/models. However, the current AcP algorithm does not provide accurate estimates of METs during walking, running and cycling in a controlled laboratory setting, which would suggest limited accuracy in the field.

Protocol for a randomized controlled trial of sitting reduction to improve cardiometabolic health in older adults

Older adults with obesity spend the majority of their waking hours sedentary. Given substantial barriers to regular physical activity in this population, approaches to reduce sedentary time could be an effective health promotion strategy. We present the protocol of a randomized controlled trial to reduce sitting time in older adults with a body mass index of 30 kg/m² or above. Participants (N = 284) will be randomized to receive a sitting reduction intervention (termed I-STAND) or a healthy living focused attention control condition. I-STAND includes 10 contacts with a health coach (10 sessions total) and participants receive a wrist-worn prompting device and portable standing desk. The healthy living condition includes 10 sessions with a health coach to set goals around various topics relating to healthy aging. Participants receive their assigned intervention for 6 months. After 6 months, those receiving the I-STAND condition are re-randomized to receive five booster health coaching sessions by 'phone or no further contact; healthy living participants receive no further contact and those in both conditions are followed for an additional 6 months. Measurements initially included wearing an activPAL device and completing several biometric tests (e.g., blood pressure, HbA1c), at baseline, 3 months, 6 months, and 12 months; however, during the COVID-19 pandemic we shifted to remote assessments and were unable to collect all of these measures. The primary outcomes remained activPAL-assessed sitting time and blood pressure. Recruitment is anticipated to be completed in 2022.

Psychosocial and Behavioral Outcomes and Transmission Prevention Behaviors: Working During the Coronavirus Disease 2019 Pandemic

Objective

To investigate the impact of coronavirus disease 2019 (COVID-19) on psychosocial and behavioral responses of the non–health care workforce and to evaluate transmission prevention behavior implementation in the workplace.

Participants and Methods

We deployed the baseline questionnaire of a prospective online survey from November 20, 2020, through February 8, 2021 to US-based employees. The survey included questions on psychosocial and behavioral responses in addition to transmission prevention behaviors (e.g., mask wearing). Select questions asked employees to report perceptions and behaviors before and during the COVID-19 pandemic. Data were analyzed descriptively and stratified by work from home (WFH) percentage.

Results

In total, 3607 employees from 8 companies completed the survey. Most participants (70.0%) averaged 90% or more of their time WFH during the pandemic. Employees reported increases in stress (54.0%), anxiety (57.4%), fatigue (51.6%), feeling unsafe (50.4%), lack of companionship (60.5%), and feeling isolated from others (69.3%) from before to during the pandemic. Productivity was perceived to decrease for 42.9% of employees and non–work-related screen time and alcohol consumption to increase for 50.7% and 25.1% of employees, respectively, from before to during the pandemic. Adverse changes were worse among those with lower WFH percentages. Most employees reported wearing a mask (98.2%), washing hands regularly (95.7%), and physically distancing (93.6%) in the workplace.

Conclusion

These results suggest worsened psychosocial and behavioral outcomes from before to during the COVID-19 pandemic and higher transmission prevention behavior implementation among non–health care employees. These observations provide novel insight into how the COVID-19 pandemic has impacted non–health care employees.

Sedentary Work and Physiological Markers of Health

The purpose of this study is to examine associations between objectively measured workplace sedentary behavior and physiological markers of health. We hypothesize that increased sedentary time and more frequent bouts of uninterrupted sitting are associated with increased hemoglobin A1c, increased blood pressure, and impaired endothelial function. Call center employees (N = 241) were enrolled from four worksites in the United States. Participants completed a survey and a physical health assessment. Sedentary behavior and sitting/standing time at work were quantified using an accelerometer. Hemoglobin A1c was measured using a finger-prick and portable analyzer. Blood pressure was measured with an automated cuff, and vascular endothelial function was assessed in a subsample of participants (n = 56) using EndoPAT. We analyzed data with two series of ordinary least squares regressions, first to examine relationships between bouts of uninterrupted sitting and physiological outcomes, and second to examine relationships between physical activity and sitting/standing time at work and physiological outcomes. The sample was primarily female, and on average was obese, prehypertensive, and prediabetic. There were no significant relationships between bouts of uninterrupted sitting or physical activity/sitting/standing time at work and physiological outcomes. In a sample that is predominantly sedentary, at risk for cardiovascular disease, and prediabetic, there are no significant associations between workplace sedentary behavior and physiological markers. The lack of associations could be related to either physiological adaptations or ceiling effects in this sample.

The active workplace study: Protocol for a randomized controlled trial with sedentary workers

OBJECTIVES

Sedentary behavior is pervasive in the workplace and is harmful to health. Research on the effectiveness of comprehensive workplace interventions to reduce sedentary behavior and improve worker health and safety is crucial as sedentary jobs become more common.

METHODS

We developed a Total Worker Health intervention targeting sedentary behavior in call centers, and are evaluating intervention effectiveness in a randomized controlled trial. Four worksites will be randomly assigned to an intervention or control condition. The intervention condition includes the provision of active workstations along with programs and procedures at environmental, organizational, and individual levels. Control worksites will receive active workstations with no additional support, following common organizational practices.

RESULTS

Outcomes include objectively measured physical activity, biological markers of health, and self-report survey data at baseline, after the 6-month intervention or control period, and at a 12-month follow-up.

CONCLUSIONS

The aims of the study are to determine whether a Total Worker Health intervention has stronger impacts on workplace sedentary behavior, uninterrupted bouts of sitting, and worker health and safety compared to a usual practice control condition. The study will inform future workplace sedentary behavior intervention and dissemination research, along with organizational best practices for reducing sedentary behavior in the workplace.