# Exercise as it relates to Disease/A comparison of efficient treatments regarding workplace sitting time and its impact

This is a critique of the article American Journal of the Cancer prevention research centre: Workplace sitting and height-adjustable workstations: A randomised controlled trial.

## What is the background to this research?

Desk-based office employees are spending most of their days sitting at a desk. Not only is this unhealthy but, prolonged bouts of inactivity can cause increases in BMI, increased risk of mortality, and increased risk of multiple types of cancer as-well as other health complications. Sitting times should be interrupted regularly to prevent these issues. This trial aims to address the issue of excessive sitting using a multi-component approach. The issue being that this approach is resource intensive and knowledge about the relative impact is inadequate. The authors of the study specifically considered the impact in the context of cancer risk on the employees. Additional risks of living a sedentary life involve obesity, diabetes and cardiovascular disease.
Understanding the issues associated with sedentary behaviour can decrease its impact on the work force. Not only is the research beneficial to a working environment, it is also beneficial to similar contexts such as excessive bouts of video gaming and class timing structures in schools. Whilst the research may not fill any gaps in existing knowledge, it allows for a more practical analysis of the working environment and the results of certain interventions.

## Where is the research from?

Research was conducted at the University of Queensland in Heston by the cancer prevention research centre. The data was collected in January to June 2012 and was analysed in the same year. The environment in which the research was conducted is representative of the entire Australian population. All authors have been a part of a multitude of studies. These include studies regarding:
* Outcomes of living with diabetes and its correlation with weight loss, physical activity and glycemic control
* Beneficial associations of physical activity with 2-h fasting glucose
* Television viewing time and mortality
Despite being involved in separate studies, the majority of work completed by the authors is based around sedentary behaviours and its effect. This means that the authors have both credibility and experience on this subject. The conclusion from the authors correlates with the results of the study. There is no evidence to support the idea that there was any bias in a certain result.

## What kind of research was this?

The study involved a three-arm quasi-randomised control trial ran by three separate administrative units of the University of Queensland. This type of trial allocates different arms of the trial to receive either: the multi-component intervention, height-adjustable work stations and a comparison group in usual practice. Participants and research staff were not blinded to group allocation. The participants were recruited by the university’s wellness program manager, supplying groups from three separate campuses. The issue with using quasi-randomised trials is that there is a greater risk that the investigators will be aware of which participants are in which group, increasing the chance of selection bias. However, since the participants have been chosen from pre-set groups from an outside source, there is a decreased chance of selection bias.

## What did the research involve?

The interventions were based on the social cognitive theory, which focussed on elements of self-efficacy, outcome expectancies and sociostructural factors. There were three groups supplied by the university of Queensland. The first was the multi-component intervention group, the second was the height-adjustable work station group, and third was the comparison group (usual practice; assessment-only). Since one of the units was located 90 km away from the university, that two local units were randomized to the intervention arms, while the remote unit was located to be the comparison group. Strategies that referenced normative feedback in comparison to average sitting time among Australian office workers was used. the key messages of the intervention were to:
* Stand up
* Sit less
* Move more
The main prompt was ‘stand up’ to break up long bouts of sitting (≥30 minutes). ‘sit less’ stressed the importance of reducing the overall sitting time. Participants were encouraged to implement periods of standing or walking by primary use of the height-adjustable desks. While the intervention worked to prevent periods of inactivity, it did little in terms of increasing levels of exercise to counteract sedentary behaviour. Despite using ‘move more’ as a que to walk up the stairs, one of the biggest issues with sedentary behaviour is that adults aren’t getting enough exercise at a correct intensity. Perhaps implementing under desk mini bikes (or other exercise instruments of a similar function) could’ve had a more beneficial acute and long-term impact.
An activPAL3 monitor was used for 7 consecutive days to record results. The monitor was replaced once a week till the 3-month period finished. 3-months was an appropriate amount of time to use the monitors. The monitors were waterproofed and attached on the midline of the right thigh so it wouldn’t distract the participants. Participants were required to record monitor removal times and their wake, sleep and work hours in a diary. This allowed for accurate data collection which adds to the validity of the overall results. Issues could have occurred from human error in terms of recording data.

## What were the basic results?

The researchers interpreted a positive outcome experienced for the multi-component group compared to the component group, with an average reduction in workplace sitting of 89 minutes. When the multi-component group was compared to the workstations-only group there was a difference of only 56 minutes. The authors gave a simplified solution for what was the best approach for reducing workplace sedentary behaviours. There was a substantial decrease in inactivity when compared to the average 8 hour working periods.

## What conclusions can we take from this research?

The results show that the multi-component model is the most appropriate in the context of reducing workplace sedentary behaviour. It shows that consistent stimulus of prompts to move, sit or stand up will substantially reduce the chance of being sedentary for extensive periods of time. Further research has concluded that physical movement implementation during working hours is both beneficial and will result in a more economic working environment.

## Practical advice

While the use of a multi-component approach should be used, individuals should also participate in high intensity exercise outside of work. Ideally, healthier behaviours would increase the motivation for further life changes whether it be diet, exercise, time management etc., An under desk mini bike an example of exercise equipment that can and should be used when working.

## Further information/resources

For any readers interested in the benefits of decreasing sedentary time, improving diet, and increasing time spent exercising, the following links will give necessary information.
https://www.medicalnewstoday.com/articles/322910.php
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4743603/
https://www.tandfonline.com/doi/full/10.1080/17437199.2015.1082146
https://www.helpguide.org/articles/healthy-living/how-to-start-exercising-and-stick-to-it.htm
https://www.nerdfitness.com/blog/healthy-eating/
https://www.helpguide.org/articles/healthy-eating/healthy-eating.htm

## References

* ↑ Epstein, Leonard H., and James N. Roemmich. "Reducing sedentary behavior: role in modifying physical activity." Exercise and Sport Sciences Reviews 29.3 (2001): 103-108.
* ↑ Eakin, Elizabeth G., et al. "Living Well with Diabetes: a randomized controlled trial of a telephone-delivered intervention for maintenance of weight loss, physical activity and glycaemic control in adults with type 2 diabetes." BMC public health 10.1 (2010): 452.
* ↑ Healy, Genevieve N., et al. "Beneficial associations of physical activity with 2-h but not fasting blood glucose in Australian adults: the AusDiab study." Diabetes care 29.12 (2006): 2598-2604.
* ↑ Dunstan, David, et al. "Television viewing time and mortality: the Australian diabetes, obesity and lifestyle study (AusDiab)." Circulation 121.3 (2010): 384.
* ↑ Bandura, Albert. "Human agency in social cognitive theory." American psychologist 44.9 (1989): 1175.