A multicomponent intervention to reduce daily sitting time in office workers: the SMART Work & Life three-arm cluster RCT
Authors: Edwardson Charlotte L , Maylor Benjamin D , Biddle Stuart JH , Clemes Stacy A , Cox Edward , Davies Melanie J , Dunstan David W , Eborall Helen , Granat Malcolm H , Gray Laura J , Hadjiconstantinou Michelle , Healy Genevieve N , Jaicim Nishal Bhupendra , Lawton Sarah , Mandalia Panna , Munir Fehmidah , Richardson Gerry , Walker Simon , Yates Thomas , Clarke-Cornwell Alexandra M 
Published: October 2023

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.