Elsevier

Contemporary Clinical Trials

Volume 53, February 2017, Pages 11-19
Contemporary Clinical Trials

An intervention to reduce sitting and increase light-intensity physical activity at work: Design and rationale of the ‘Stand & Move at Work’ group randomized trial

https://doi.org/10.1016/j.cct.2016.12.008Get rights and content

Abstract

Background

American workers spend 70–80% of their time at work being sedentary. Traditional approaches to increase moderate-vigorous physical activity (MVPA) may be perceived to be harmful to productivity. Approaches that target reductions in sedentary behavior and/or increases in standing or light-intensity physical activity [LPA] may not interfere with productivity and may be more feasible to achieve through small changes accumulated throughout the workday

Methods/design

This group randomized trial (i.e., cluster randomized trial) will test the relative efficacy of two sedentary behavior focused interventions in 24 worksites across two states (N = 720 workers). The MOVE + intervention is a multilevel individual, social, environmental, and organizational intervention targeting increases in light-intensity physical activity in the workplace. The STAND + intervention is the MOVE + intervention with the addition of the installation and use of sit-stand workstations to reduce sedentary behavior and enhance light-intensity physical activity opportunities. Our primary outcome will be objectively-measured changes in sedentary behavior and light-intensity physical activity over 12 months, with additional process measures at 3 months and longer-term sustainability outcomes at 24 months. Our secondary outcomes will be a clustered cardiometabolic risk score (comprised of fasting glucose, insulin, triglycerides, HDL-cholesterol, and blood pressure), workplace productivity, and job satisfaction

Discussion

This study will determine the efficacy of a multi-level workplace intervention (including the use of a sit-stand workstation) to reduce sedentary behavior and increase LPA and concomitant impact on cardiometabolic health, workplace productivity, and satisfaction.

Trial registration: ClinicalTrials.gov Identifier: NCT02566317 (date of registration: 10/1/2015).

Introduction

The health benefits of moderate-vigorous physical activity (MVPA) are well-established, and progress is being made toward the 2008 Physical Activity Guidelines for Americans [1]. In addition to recommendations for MVPA, the Guidelines state the need to “avoid inactivity” and suggest any amount of physical activity will produce a health benefit. American adults spend an average of 7.5 h/day sedentary [2]. While the strongest benefit on health is conferred from MVPA, recent studies suggest replacing sedentary time (i.e., sitting/reclining with low energy expenditure while awake [3]) with standing or other non-exercise activities - even when holding MVPA constant - is associated with lower cardiometabolic risk [4], [5] and longevity [6], [7].

Sedentary behavior has been identified as important health target for workplaces [8]. American workers, especially those with primarily desk-based jobs, can spend up to 70–80% of their time at work being sedentary [9]. Traditional approaches to increase MVPA may be unsustainable in workplace settings as they require time away from work, and may be perceived as harmful to productivity [10]. Sedentary behavior interventions (i.e., approaches targeting reductions in sitting and/or increases in standing or light-intensity physical activity [LPA]) may not interfere with productivity [11], [12], and may be more feasible to achieve through small changes accumulated throughout the workday. Additionally, intervention strategies that incorporate environmental and policy-level changes - which are likely necessary for sustained behavior change - may be more feasible to implement in workplaces than other contexts.

Sedentary behavior interventions in the workplace have shown promising effects [13]. Multi-level approaches targeting individual, social, and environmental factors have been most effective [14], [15]. The most robust environmental support has been the use of sit-stand workstations, providing opportunities for workers to reduce sitting while maintaining productivity [13]. However, a recent Cochrane review rated sit-stand workstation interventions to be “of very low methodological quality” due to small sample sizes, short follow-up (≤ 4 months), and quasi-experimental designs. Notably, there are feasibility problems for trials randomizing individuals within a single worksite to different environmental conditions (i.e., dependency among observations) [16].

Two recent group randomized trials [17], [18] have addressed this by selecting worksites as the unit of randomization. Both studies delivered programs that targeted individual, social, environmental, and policy factors, alongside the installation of sit-stand workstations, to reduce sedentary time. Danquah et al. [17], in a 3-month intervention among Danish public and private health workers (n worksites = 19; n subjects = 317), observed 48 min/8-h workday reductions relative to a usual practice control. Healy et al. [18], in a 12-month intervention of Australian public health workers (n worksites = 14; n subjects = 231), observed 45 min/8-h workday reductions relative to a usual practice control.

While the results of these studies address critical issues raised in the Cochrane Review [16], three important limitations warrant further study. First, effects on sedentary time were smaller at the most distal time point compared to interim time points, suggesting “novelty” effects may exist. Longer-term follow-up of sustained impacts needs to be examined. Second, a relatively homogenous set of worksites within a single workplace sector were included. More diversity in worksite type is necessary to demonstrate generalizability. Finally, the interventions were compared to a usual practice control. Given the ongoing presence of alternative health promotion activities, it is important to compare sedentary behavior interventions to more robust comparison conditions. The purpose of this paper is to describe the development and design of a multi-level group randomized controlled worksite intervention aimed at reducing employee's sedentary time.

Section snippets

Study aims

Our primary aim is to evaluate the efficacy of a workplace-delivered, multicomponent intervention and the provision of a sit-stand workstation, relative to a multicomponent comparison without a workstation, for reducing sitting and increasing LPA in the workplace over 12 months. Additional process outcomes at 3 months and maintenance outcomes at 24 months will be collected. Our secondary aim is to evaluate relative changes between intervention arms in cardiometabolic risk (composite measure of

Discussion

This project stands to be one of the most definitive studies to date on the efficacy of multi-level workplace interventions to increase LPA, reduce sitting, and improve cardiometabolic health. Findings will inform the potential health benefits of sit-stand workstations, an increasingly popular environmental intervention among employers. The findings will be highly generalizable to much of the sedentary workforce, and will inform employer and insurer decisions regarding cost, investment, and

Competing interests

The authors declare that they have no competing interests.

Funding sources

This work was supported by the National Institutes of Health [R01CA198971].

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  • Cited by (37)

    • Stand and Move at Work sedentary behavior questionnaire: validity and sensitivity to change

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      Citation Excerpt :

      Participants were eligible if they meet all of the following criteria: (1) ≥18 years old, (2) able to safely reduce sitting and increase light physical activity (LPA), (3) working full time, (4) not currently pregnant, (5) predominant worksite occupation being seated office work, (6) not currently using a sit-stand workstation, (7) willing to have a sit-stand workstation, and (8) willing to be randomized to an intervention arm. The study design and protocol has been published elsewhere [20]. Worksites were randomized to one of two active behavioral interventions: (1) multicomponent intervention (e.g., support from worksite leaders and advocates, signage, and e-newsletters) to decrease sitting and increase standing and LPA at work or (2) multicomponent intervention to decrease sitting and increase standing and LPA at work along with the use of a sit-stand workstation.

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