# Exercise as it relates to Disease/Decreasing Sedentary Time in Office Workers: Utilizing a Multi Component Intervention
## What is the background to this research?

The Australian Government’s Department of Health states ‘Being physically active and limiting your sedentary behaviour every day is essential for health and wellbeing.’ Sedentary behaviour describes a distinct class of activities that involve low levels of energy expenditure between 1.0-1.5 metabolic equivalent units (METs), such as sitting, lying down, watching TV or driving a car. Research has shown the relationship between excessive sitting time and cardiovascular disease, type 2 diabetes and premature mortality. Sedentary behaviour is thus highly established within the office-based workplace. It has been estimated that two-thirds of time spent at work is spent sitting, with the majority of this time spent as accumulated lengthy, uninterrupted bouts of 20 to 30 minutes.
Recently, there has been a large increase in marketing for ergonomic aids such as standing desks however the proposed benefits outweigh the current evidence based research. However there are results that positively show the breakup of prolonged sedentary behaviours improves glucose and insulin levels as well as reducing the build-up of fat around vital organs.

## Where is the research from?

Healy et al., from the University of University of Queensland, The University of Melbourne, Monash University, The University of Western Australia conducted this research in metropolitan Melbourne, with the 130 participants being Comcare employees. The research was funded by the National Health and Medical Research Council and the Victorian Health Promotion Foundation.

## What kind of research was this?

This study was a multi-component non-randomized controlled trial conducted over 4 weeks separated by office floors. The study was set out this way to minimize contamination across the organisation and allowed the researches to evaluate the different outcomes.

## What did the research involve?

The 130 Participants were contacted via phone and screened to meet the following criteria
* Aged 18-65 years
* Working at least 0.6 full time
* Workplace access to a telephone
* Internet and a desk
* Ambulatory
* Not pregnant
* Not having any pre-existing musculoskeletal disorder
* Not planning any absence of > 1 week during the study
The participants provided written informed consent and attended a baseline assessment. The allocation to a group was determined by the building floor, with the intervention group primarily consisting of administrative staff and the control floor comprising of predominately senior administrative staff. The intervention communicated three key messages “Stand Up, Sit Less, Move More.” The intervention began with a consultation outlining background information and the importance of organisational support for successful intervention adoption. A workshop was then conducted for all intervention participants offering additional information on the health consequences of excessive sitting and discussing and adjusting the identified strategies. To assist with the intervention dual display sit-stand workstations were installed allowing subjects to alternate their posture.
Data was collected from the activPAL3 activity monitor, the subject’s wore as well as completing a self-administered questionnaire and underwent morning anthropometric and fasting blood measurement.

## What were the basic results?

| Activity | Time Spent |
| At The Workplace | 8.3 ± 1.3 Hrs/day |
| Sitting | 5.6 ± 0.7 Hrs/day (70.1%) |
| Standing | 1.7 ± 0.6 Hrs/day (21.1%) |
| Stepping | 0.7 ± 0.2 Hrs/day (8.8%) |
| Prolonged sitting in bouts ≥30 min | 2.2 Hrs/day (39% of sitting time, 27% of total time at the workplace) |
Healy et al., found that at the starting point, each group showed no substantial differences however at the follow-up there were substantial intervention changes favouring the intervention group for both ‘stand up’ and ‘sit less’ outcomes. Interestingly the ‘move more’ outcomes had no significant difference between the groups.
Further results:
* Standing time was increased by 95%
* Almost 2 additional sit-stand transitions per hour of sitting
* Roughly one less hour of prolonged sitting
* Glucose improved considerably

## What conclusions can we take from this research?

For the first time, this research has verified that a multicomponent workplace intervention, applying organisational, environmental and individual components are attainable within an office setting. The intervention managed to reduce sitting time in the workplace by a considerable amount (>2-h per 8-h workday). It is important to note that the reduction of 26.5% of workplace sitting time is consistent with workplace interventions conducted in the past.,13) Gilson, N.D., Suppini, A., Ryde, G.C., Brown, H.E., Brown, W.J., 2011. Does the use of standing ‘hot’ desks change sedentary work time in an open plan office? Prev. Med. 54, 65–67.,,15) Pronk, N.P., Katz, A.S., Lowry, M., Payfer, J.R., 2012. Reducing occupational sitting time and improving worker health: the take-a-stand project, 2011. Prev. Chronic Dis. 9, E154.,Winkel, J., Oxenburgh, M., 1991. Towards optimizing physical activity in VDT/office work. In: Sauter, S., Dainoff, M., Smith, M. (Eds.), Promoting Health and Productivity in the Computerized Office. Taylor & Francis/Hemisphere, Bristol, PA, USA, pp. 94–117.
Overall, the positive changes all occurred without the disruption of work performance or adverse musculoskeletal outcomes. The approximately 50% reduction in prolonged sitting time demonstrates that consistent postural changes may be realistic among office workers carrying out administrative tasks.

## Practical advice

Though the findings of this research show support for improvements of health through reducing prolonged sitting time via beneficial changes in lipoprotein lipase activity and skeletal muscle gene expression, the short duration, small sample size and failure to truly randomise the allocation of the intervention equate to further studies needing to be conducted. To overcome these limitations, forthcoming trials should implement cluster-randomised controlled strategies across multiple component settings to truly evaluate each intervention component. Using a more diverse setting may also lead to greater ‘move more’ outcomes as the Comcare environment may limit opportunity for physical activity (e.g. walking to a meeting room).

## Further information/resources

For further reading on sedentary behaviour outcomes and reducing sedentary time in the workplace read below:
* Thorp, A.A., Owen, N., Neuhaus, M., Dunstan, D.W., 2011. Sedentary behaviors and subsequent health outcomes in adults a systematic review of longitudinal studies, 1996–2011. Am. J. Prev. Med. 41, 207–215.
* Evans, R.E., Fawole, H.O., Sheriff, S.A., Dall, P.M., Grant, P.M., Ryan, C.G., 2012. Point-of choice prompts to reduce sitting time at work: a randomized trial. Am. J. Prev. Med. 43, 293–297.
* Ryan, C.G., Dall, P.M., Granat, M.H., Grant, M., 2011. Sitting patterns at work: objective measurement of adherence to current recommendations. Ergonomics 54, 531–538.
* Alkhajah, T.A., Reeves, M.M., Eakin, E.G., Winkler, E.A., Owen, N., Healy, G.N., 2012. Sit–stand workstations: a pilot intervention to reduce office sitting time. Am. J. Prev. Med. 43, 298–303.

## References

* ↑ Australian Government, Department of Health. Australia’s physical activity and sedentary behaviour guidelines
* ↑ Pate et al (2008). The evolving definition of “sedentary”. Exercise and Sport Science Reviews. 36(4): 173-8.
* 1 2 Thorp, A.A., Owen, N., Neuhaus, M., Dunstan, D.W., 2011. Sedentary behaviors and subsequent health outcomes in adults a systematic review of longitudinal studies, 1996–2011. Am. J. Prev. Med. 41, 207–215.
* 1 2 3 Evans, R.E., Fawole, H.O., Sheriff, S.A., Dall, P.M., Grant, P.M., Ryan, C.G., 2012. Point-of choice prompts to reduce sitting time at work: a randomized trial. Am. J. Prev. Med. 43, 293–297.
* 1 2 5) Ryan, C.G., Dall, P.M., Granat, M.H., Grant, M., 2011. Sitting patterns at work: objective measurement of adherence to current recommendations. Ergonomics 54, 531–538. 6)
* ↑ 6) Healy, G.N., Lawler, S.P., Thorp, A., et al., 2012. Reducing prolonged sitting in the workplace (an evidence review: full report). Available at: http://www.vichealth.vic.gov.au/
* ↑ 7) Publications/Economic-participation/Creating_Healthy_Workplaces.aspx. Victorian Health Promotion Foundation, Melbourne, Australia
* ↑ Buckley, J., Mellor, D., Morris, M,. et al (2014), "Standing-based office work shows encouraging signs of attenuating post-prandial glycemic excursion" Occupational and Environmental Medicine, vol. 71, no. 2, pp. 109-11
* 1 2 3 4 5 6 7 8 9 10 11 10) Healy, G., Eakin, E., LaMontagne, A., Owen, N., Winkler, E., & Wiesner, G. et al. (2013). Reducing sitting time in office workers: Short-term efficacy of a multicomponent intervention. Preventive Medicine, 57(1), 43-48. http://dx.doi.org/10.1016/j.ypmed.2013.04.004
* 1 2 Alkhajah, T.A., Reeves, M.M., Eakin, E.G., Winkler, E.A., Owen, N., Healy, G.N., 2012. Sit–stand workstations: a pilot intervention to reduce office sitting time. Am. J. Prev. Med. 43, 298–303.
* ↑ 12) Ellegast, R., Weber, B., Mahlberg, R., 2012. Method inventory for assessment of physical activity at VDU workplaces. Work 41, 2355–2359
* ↑ 14) Hedge, A., 2004. Effects of an Electric Height-Adjustable Worksurface on Self-Assessed Musculoskeletal Discomfort and Productivity in Computer Workers. Cornell University, Design & Environment Analysis, Ithaca, NY
* ↑ Hamilton, M.T., Hamilton, D.G., Zderic, T.W., 2007. Role of low energy expenditure and sitting in obesity, metabolic syndrome, type 2 diabetes, and cardiovascular disease. Diabetes 56, 2655–2667.
* ↑ Latouche, C., Jowett, J.B., Carey, A.L., et al., 2013. Effects of breaking up prolonged sitting on skeletal muscle gene expression. J. Appl. Physiol. 114, 453–460