An Integrative, Systematic Review Exploring the Research, Effectiveness, Adoption, Implementation, and Maintenance of Interventions to Reduce Sedentary Behaviour in Office Workers

Breaking the Habit? Identifying Discrete Dimensions of Sitting Automaticity and Their Responsiveness to a Sitting-Reduction Intervention

BACKGROUND

Growing evidence suggests that sitting is activated automatically on exposure to associated environments, yet no study has yet sought to identify in what ways sitting may be automatic.

METHOD

This study used data from a 12-month sitting-reduction intervention trial to explore discrete dimensions of sitting automaticity, and how these dimensions may be affected by an intervention. One hundred ninety-four office workers reported sitting automaticity at baseline, and 3 months, 6 months, 9 months and 12 months after receiving one of two sitting-reduction intervention variants.

RESULTS

Principal component analysis extracted two automaticity components, corresponding to a lack of awareness and a lack of control. Scores on both automaticity scales decreased over time post-intervention, indicating that sitting became more mindful, though lack of awareness scores were consistently higher than lack of control scores.

CONCLUSION

Attempts to break office workers' sitting habits should seek to enhance conscious awareness of alternatives to sitting and afford office workers a greater sense of control over whether they sit or stand.

ASOC Osuntokun Award Lecture 2022: Partnership for stroke prevention and treatment in Africa: Qualitative research processes and findings

BACKGROUND/OBJECTIVES

Africa has one of the highest rates of stroke and stroke deaths in the world. The burden of stroke is increasing with a 3-year mortality rate of up to 84%. Stroke disproportionately affects the young and middle-aged population contributing to morbidity and mortality affecting families, communities, health systems, and economic progress. My objectives of the 2022 Osuntokun Award Lecture at the African Stroke Organization Conference were to explore our qualitative research findings from our communities and to propose future qualitative methods for improving stroke outcomes in Africa.

METHODS

Qualitative research processes and findings related to stroke prevention, treatment/ongoing care, recovery, and knowledge and attitudes influencing ethical, legal and social implications related to stroke neuro-biobanking were explored. For each qualitative study, methods were developed by the research team including: (1) plans to implement aims and ethics review; (2) guides and detailed steps for implementation; (3) training for team; (4) pilot testing, data collection, transport, transcription, storage; (5) data analysis and manuscript development.

RESULTS

The research focused on genetics, genomics and phenomics of stroke and more recently on exploring the ethical, legal, and social implications of stroke neuro-biobanking. All included a qualitative component to obtain input and guidance from the community. As in quantitative research, questions were developed by the research team, reviewed for clarity by a small group of community members, and 1,289 community members (ages 22-85) participated in the focus groups and key informant interviews from 2014 through 2022. Answers to questions were diverse with some knowledgeable about the science of stroke prevention and treatment, but many had ideas about prevention and causes of stroke that were not supported by science and many reported using traditional healers for treatment and religious beliefs preventing brain biobanking.

CONCLUSIONS

In addition to our current qualitative research related to stroke in Africa and beyond, we must form research partnerships with communities that not only answer researchers' and community members' questions but identify and implement ways to prevent stroke and improve stroke outcomes.

A Standardised Core Outcome Set for Measurement and Reporting Sedentary Behaviour Interventional Research: The CROSBI Consensus Study

Heterogeneity of descriptors and outcomes measured and reported in sedentary behaviour (SB) research hinder the meta-analysis of data and accumulation of evidence. The objective of the Core Research Outcomes for Sedentary Behaviour Interventions (CROSBI) consensus study was to identify and validate, a core outcome set (COS) to report (what, how, when to measure) in interventional sedentary behaviour studies. Outcomes, extracted from a systematic literature review, were categorized into domains and data items (COS v0.0). International experts (n = 5) provided feedback and identified additional items, which were incorporated into COS v0.1. A two round online Delphi survey was conducted to seek consensus from a wider stakeholder group and outcomes that achieved consensus in the second round COS (v0.2), were ratified by the expert panel. The final COS (v1.0) contains 53 data items across 12 domains, relating to demographics, device details, wear-time criteria, wear-time measures, posture-related measures, sedentary breaks, sedentary bouts and physical activity. Notably, results indicate that sedentary behaviour outcomes should be measured by devices that include an inclinometry or postural function. The proposed standardised COS is available openly to enhance the accumulation of pooled evidence in future sedentary behaviour intervention research and practice.

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

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

Implementation Evaluation of a Cluster Randomized Controlled Trial to Promote the Use of Respiratory Protective Equipment Among Migrant Workers Exposed to Organic Solvents in Small and Medium-Sized Enterprises

Background

While the effectiveness of several occupational healthcare interventions has been demonstrated, successful implementation of such programs among internal migrant workers (IMWs) in small and medium-sized enterprises (SMEs) has been limited. This study aimed to evaluate the implementation of a three-arm cluster randomized controlled trial promoting respiratory protective equipment (RPE) use among IMWs exposed to organic solvents in SMEs and to assess the association between participants' compliance and effectiveness of intervention.

Methods

A total of 60 SMEs were randomly allocated to a low- or high-intensive intervention group, or a control group that did not receive any intervention. The low-intensive intervention group was subjected to both traditional and mHealth occupational health education. The high-intensive intervention group was subjected to the low-intensive group activities and peer education. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to guide implementation evaluation of this 6-months intervention. Generalized linear mixed models (GLMMs) were used to evaluate the effects of participants' compliance with the intervention on the primary outcomes, regarding the appropriate use of RPE.

Results

Of 4,527 potentially eligible participants, 1,211 individuals were enrolled, with a reach rate of 26.8%. Sixty of the 66 SMEs approached (90.9%) SMEs adopted the intervention. Fidelity to traditional education (100.0%) and mHealth intervention (97.5%) was higher than fidelity to peer education (20.0%). Peer leaders cited inconvenient time and unfamiliarity with peers as two major barriers to delivering peer education. Compared with the control group, IMWs who complied with the interventions in both groups were more likely to wear RPE appropriately [low-intensive group: adjusted odds ratio (aOR) = 2.58, 95% confidence interval (CI): 1.56–4.28; high-intensive group: aOR = 7.52, 95% CI: 3.72–15.23]. Most participants (95.8%) were satisfied with the program and 93.1% stated that they would maintain the use of RPE in the future.

Conclusions

A multi-component occupational health intervention to promote the use of RPE among IMWs in SMEs was feasible and acceptable. Peer education had great potential to enhance the occupational health behavior of IMWs, and thus strategies to improve participants' adherence to this component warrant further investigation.

Clinical Trial Registration

http://www.chictr.org.cn, identifier: ChiCTR-IOR-15006929.

Systematic Review of the Influence of Physical Work Environment on Office Workers' Physical Activity Behavior

BACKGROUND

Many American workers spend over 7 hours a day at work in primarily sedentary office work. Physical activity is a key aspect of optimizing health and preventing disease; yet, 80% of American adults do not meet the recommended guidelines for physical activity. In this systematic review, the relationship between physical work environment and physical activity among office workers was explored.

METHODS

Of the 321 studies screened, 26 studies met the eligibility criteria and were included for evaluation in this systematic review.

RESULTS

Of the 26 studies, four were cross-sectional studies, 14 were quasi-experimental studies, and eight were randomized control trials. Physical activity during the workday was measured using self-report surveys and electromechanical devices such as accelerometers. Physical work environments examined by the studies included different types of desks (n = 16), office arrangements (n = 5), and building design (n = 5). In nine studies, office environments and building work environments designed to promote activity using active design principles such as stairs and flexible workspaces were associated with increased physical activity. Sit-stand desks reduced overall sitting time, but had a minimal effect on physical activity.

CONCLUSION/APPLICATION TO PRACTICE

Offices and buildings designed for activity had the largest impact on physical activity among office workers. To increase physical activity in office workers, focus should be placed on opportunities to increase incidental movement that can increase physical activity throughout the workday. Occupational health nurses should advocate workspace designs that can increase physical activity in workers.

Persistent autism-relevant behavioral phenotype and social neuropeptide alterations in female mice offspring induced by maternal transfer of PBDE congeners in the commercial mixture DE-71

Polybrominated diphenyl ethers (PBDEs) are ubiquitous persistent organic pollutants (POPs) that are known neuroendocrine disrupting chemicals with adverse neurodevelopmental effects. PBDEs may act as risk factors for autism spectrum disorders (ASD), characterized by abnormal psychosocial functioning, although direct evidence is currently lacking. Using a translational exposure model, we tested the hypothesis that maternal transfer of a commercial mixture of PBDEs, DE-71, produces ASD-relevant behavioral and neurochemical deficits in female offspring. C57Bl6/N mouse dams (F0) were exposed to DE-71 via oral administration of 0 (VEH/CON), 0.1 (L-DE-71) or 0.4 (H-DE-71) mg/kg bw/d from 3 wk prior to gestation through end of lactation. Mass spectrometry analysis indicated in utero and lactational transfer of PBDEs (in ppb) to F1 female offspring brain tissue at postnatal day (PND) 15 which was reduced by PND 110. Neurobehavioral testing of social novelty preference (SNP) and social recognition memory (SRM) revealed that adult L-DE-71 F1 offspring display deficient short- and long-term SRM, in the absence of reduced sociability, and increased repetitive behavior. These effects were concomitant with reduced olfactory discrimination of social odors. Additionally, L-DE-71 exposure also altered short-term novel object recognition memory but not anxiety or depressive-like behavior. Moreover, F1 L-DE-71 displayed downregulated mRNA transcripts for oxytocin (Oxt) in the bed nucleus of the stria terminalis (BNST) and supraoptic nucleus, and vasopressin (Avp) in the BNST and upregulated Avp1ar in BNST, and Oxtr in the paraventricular nucleus. Our work demonstrates that developmental PBDE exposure produces ASD-relevant neurochemical, olfactory processing and behavioral phenotypes that may result from early neurodevelopmental reprogramming within central social and memory networks.

Efficacy, characteristics, behavioural models and behaviour change strategies, of non-workplace interventions specifically targeting sedentary behaviour; a systematic review and meta-analysis of randomised control trials in healthy ambulatory adults

BACKGROUND

Sedentary behaviour (SB) research has grown exponentially but efficacy for interventions to reduce sedentary behaviour is often contaminated by interventions primarily or co-targeting other behaviours and outcomes. The primary aim of this research therefore, was to systematically review the efficacy of interventions specifically targeting sedentary behaviour reduction, as a sole primary outcome, from randomised control trials in healthy ambulatory adults. This research also sought to identify the successful interventions characteristics, behaviour change techniques (BCT's) and underlying theories, and their relation to intervention effectiveness.

METHODS

We followed PRISMA reporting guidelines for this systematic review. Six electronic databases were searched and a grey literature review conducted. Only randomised or cluster randomised controlled trials, from 2000 to 2020, in adult populations with a sole primary outcome of change in sedentary behaviour were included. Data codebooks were developed, data were extracted, and a narrative synthesis and meta-analysis was conducted using mixed methods random effects models.

RESULTS

Of 5589 studies identified, 7 studies met the inclusion criteria. Six studies reported activPAL3 measures of mean daily sitting time, and four reported mean daily standing time, stepping time and number of sedentary breaks. Pooled analysis of weighted mean differences revealed a reduction in mean daily sitting time of -32.4mins CI (-50.3, -14.4), an increase in mean daily standing time of 31.75mins CI (13.7, 49.8), and mean daily stepping time of 9.5mins CI (2.8, 16.3), and an increase in rate of sedentary breaks per day of 3.6 (CI 1.6, 5.6). BCTs used exclusively in two of the three most effective interventions are 'feedback on behaviour' and 'goal setting behaviour' whilst all three most effective interventions included 'instruction on how to perform the behaviour' and 'adding objects to the environment', BCTs which were also used in less effective interventions.

CONCLUSIONS

Although limited by small sample sizes and short follow up periods, this review suggests that interventions specifically designed to change sedentary behaviour, reduce overall daily sitting time by half an hour, with an equivalent increase in standing time, in the short to medium term. Effective characteristics and behaviour change strategies are identified for future development of high quality interventions targeting change in sedentary behaviour.

PROSPERO REGISTRATION

PROSPERO 2020 CRD42020172457 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020172457.

A Mixed Methods Evaluation of a Digital Intervention to Improve Sedentary Behaviour Across Multiple Workplace Settings

BACKGROUND

Prolonged sedentary behaviour (SB) is associated with risk of chronic diseases. Digital interventions in SB require mixed method evaluations to understand potential for impact in real-world settings. In this study, the RE-AIM QuEST evaluation framework will be used to understand the potential of a digital health promotion application which targets reducing and breaking up SB across multiple workplace settings.

METHODS

Four companies and 80 employees were recruited to use a digital application. Questionnaires were used to measure SB, and additional health and work-related outcomes at baseline, one month, three month and six month follow-up. Qualitative data was collected through focus groups with employees and interviews with stakeholders. Questionnaire data was analysed using Wilcoxon Sign Rank tests and qualitative data was thematically analysed.

RESULTS

The digital application significantly increased standing time at one month for the total group and transitions per hour in one of the companies. Facilitators and barriers were identified across RE-AIM.

CONCLUSIONS

Addressing the barriers which have been identified, while maintaining the positive attributes will be critical to producing an effective digital application which also has the potential for impact in the real world.

Taking a Stand for Office-Based Workers' Mental Health: The Return of the Microbreak

There is evidence that movement-based microbreaks can improve the cardiovascular health of desk-based employees, but their effect on mood states is yet to be investigated. As daily work tasks can potentially result in the loss of physical and psychological resources, the objective of this study was to measure the effect of movement microbreaks during formal work time on mood states. In a randomized-controlled pilot study with repeated measures (baseline, post-test, washout) of self-reported job stress and mood states (fatigue and vigor), police officers (N = 43) were exposed to movement microbreaks during work hours. A multivariate significant difference between groups was noted after the intervention period. Further analysis revealed that the experimental group reported a latent reduction in job-related stress after the 3-months washout period. Although the study was conducted with a small sample, our preliminary findings suggest that interrupting sedentary work with movement microbreaks may have beneficial effects on employee mental health. The implications of movement microbreaks for mitigating work-related stress of first responders, including police, is discussed, along with directives for future research.

Should We Scale-Up? A Mixed Methods Process Evaluation of an Intervention Targeting Sedentary Office Workers Using the RE-AIM QuEST Framework

Background: Interventions targeting a reduction in sedentary behaviour in office workers need to be scaled-up to have impact. In this study, the RE-AIM QuEST framework was used to evaluate the potential for further implementation and scale-up of a consultation based workplace intervention which targeted both the reduction, and breaking up of sitting time. Methods: To evaluate the Springfield College sedentary behaviour intervention across multiple RE-AIM QuEST indicators; intervention participant, non-participant (employees who did not participate) and key informant (consultation delivery team; members of the research team and stakeholders in workplace health promotion) data were collected using interviews, focus groups and questionnaires. Questionnaires were summarized using descriptive statistics and interviews and focus groups were transcribed verbatim, and thematically analysed. Results: Barriers to scale-up were: participant burden of activity monitoring; lack of management support; influence of policy; flexibility (scheduling/locations); time and cost. Facilitators to scale up were: visible leadership; social and cultural changes in the workplace; high acceptability; existing health and wellbeing programmes; culture and philosophy of the participating college. Conclusions: There is potential for scale-up, however adaptations will need to be made to address the barriers to scale-up. Future interventions in office workers should evaluate for scalability during the pilot phases of research.

Move-It: A Cluster-Randomised Digital Worksite Exercise Intervention in China: Outcome and Process Evaluation

We evaluate the outcomes and processes of a video and web-based worksite exercise intervention for sedentary office workers in China, in a 2-arm cluster-randomised wait-list control trial (n = 282: intervention (INT) n = 196 and wait-list control (WLC) n = 86). Eligible clusters were two sites of a major organisation in China randomly allocated to each group (INT: Guangzhou; WLC: Beijing); eligible participants were site employees (n = 690). A theoretically informed digital workplace intervention (Move-It) involving a 10 min Qigong exercise session (video demonstration via website) was delivered twice a day at set break times during the working day for 12 consecutive weeks. Individual-level outcomes were assessed. Participants' physical activity increased significantly from baseline to post-intervention similarly in both the intervention and the control group. There was a significantly smaller increase in weekday sitting hours in intervention than controls (by 4.66 h/week), and work performance increased only in the control group. Process evaluation (including six focus groups) was conducted using the RE-AIM (reach, effectiveness, adoption, implementation and maintenance) framework. The intervention had wide reach and was successfully marketed to all employees with good uptake. The participatory approach increased perceived organisational support and enhanced adoption. The intervention was implemented broadly as planned. Qigong worksite exercise intervention can be successfully delivered to sedentary office workers in China using video and web-based platforms. It may increase physical activity and does not adversely affect perceived work performance. The study highlights the complexity of conducting health promotion research in real-world organisational settings.