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Getting office workers to Stand Up, Sit Less and Move More Why? What works?
Genevieve Healy, PhD MPH
National Health and Medical Research Council & Heart Foundation Research Fellow The University of Queensland, Australia
Workplace Health Promotion Network (WHPN) Meeting
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Before we start…
Please feel free to stand, and move and sit and stand and sit etc…
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Too much sitting is bad for our health
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http://sitlessmovemore.ca
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Why all this interest in sitting?
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It has personal relevance
Everyone sits Everyone has a sitting story … I get aches and pains when I sit too long (83 yr old women) … In my new job I am run off my feet – I’ve lost 8kg (51 yr old women) … Going back to work after paternity leave – sitting all day – I
felt so achy and flat (40 yr old man)
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The landscape has changed
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45 ± 14 kcal/day
27 ± 9 kcal/day
80 ± 28 kcal/day
54 ± 19 kcal/day
Lanningham-Foster et al., Obesity Research, 2003
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Physical activity expended at the workplace has dropped dramatically
Church et al., PLoS One 2011
1 in 2 men 1 in 5 men
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Merging of wellness and ergonomics
Physical activity Ergonomics
Reducing prolonged
sitting time
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Key sedentary events (public health)
Sitting & Health
1950’s & 60’s
2000
2003
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Detrimental impact of too much sitting
High sitting time associated with: • Diabetes • Cardiovascular diseases • Cardiovascular and all-cause mortality • Metabolic syndrome • Weight gain & development of obesity • Chronic kidney disease • Breast & colon cancer • Musculoskeletal symptoms • ++++
Wilmot et al., 2012 & 2013 Diabetologia; Thorpe et al., AJPM 2011; http://www.who.int/occupational_health/publications/en/oehmsd3.pdf;
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Key sedentary events (public health)
Sitting & Health
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More accurate measurement
7164 GT1M GT3x+
activPAL3
Data from an activPAL3 monitor
Time Sitting Time Standing Time Moving
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Key sedentary events (public health)
Sitting & Health
Day of Week
Hou
r of D
ay
10
12
14
16
18
M T W Th F S Su
0
500
1000
1500
2000
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Not just about total sitting time
• More breaks associated with lower waist circumference1
Experimental evidence • Interrupting prolonged sitting associated with better
postprandial glucose & insulin response2
• One hour of exercise does not offset the negative effects on inactivity on insulin & lipids if the rest of the day is spent sitting3
1 Healy et al., EHJ, 2011; 2 Dunstan et al., Diabetes Care, 2012; 3 Duvivier et al., PLoS ONE, 2013
Glucose Insulin
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Key sedentary events (public health)
Sitting & Health
Day of Week
Hou
r of D
ay
10
12
14
16
18
M T W Th F S Su
0
500
1000
1500
2000
2011
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Released July 2011. New UK-wide Guidelines for PA
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Getting on the same page…
“Man is designed for movement, in other words to switch between sitting, standing, walking and all postures in between”
Source: German Federal Institute for Occupational Safety and Health (2008) Up and Down – Up and Down. How dynamic sitting and standing can improve health in the office.
Sit less throughout the day
Stand up at least every 30 minutes
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Key sedentary events (public health)
Sitting & Health
Day of Week
Hou
r of D
ay
10
12
14
16
18
M T W Th F S Su
0
500
1000
1500
2000
Interventions
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“The results suggest that simple interventions that can be implemented in the workplace and domestically to decrease passive sitting time and increase the number of breaks can also lead to substantial health improvements.”
“Workplaces are best placed to provide the supportive cultures often needed to sustain lifestyle change”
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1. Understanding the problem
Thorp et al., IJBNPA, 2012
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1. Understanding the problem
• Office workers spend a lot of work time sitting • A lot of this sitting time is unbroken (30mins+)
Thorp et al., IJBNPA, 2012
Proportion of prolonged (≥30 mins) sedentary time (%) at work
55.5% 21.5%
Sitting <30mins Sitting 30mins+
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2. Review of previous strategies
5 key approaches (2010) 1. Increasing the number of breaks
from sitting 2. Postural changes 3. Ergonomic changes to individual
workspace 4. Altering the built design of the
broader workplace 5. Multiple strategies
http://www.vichealth.vic.gov.au/Publications/Economic-participation/Creating_Healthy_Workplaces.aspx
Ergonomic focus
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3. Intervention development
Sitting
Policy Context
Physical Environment
Interpersonel
Intrapersonel
Ecological Model of sedentary behavior change
WHO Healthy Workplace Model
Multiple influences Participatory approach
Strong evaluation framework
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Adding the environmental element
Timeline of events • Oct: Ergotron offered a single trial sit-stand workstation
• Dec: CPRC purchased sit-stand workstations
• Jan – April: controlled clinical trial evaluating impact of workstation installation (Stand Up CPRC)1
• May – protocol of large trial modified to include workstations
• July – Sep: Pilot (Stand Up Comcare)2 + other formative research
• Jan – Jan 2013: WS vs. multicomponent (Stand Up UQ)3
• March: Recruitment for large trial begins (Stand Up Victoria)
• Oct 2013: Baseline recruitment for Stand Up Vic to be completed
2010
2011
2012
2013
1 Alkahajah et al., AJPM 2011; 2 Healy et al., Prev Med 2013; 3 Neuhaus et al., AJPM In Press
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Workstation used
Height adjustable workstation: WorkFit-S: Ergotron
Product kindly donated by Ergotron for Stand Up Comcare & Stand Up UQ
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Outcomes measured Behaviour / cost
effectiveness Health Work / environment
• Sitting, standing, moving time
• Postural transitions • MVPA
Anthropometric • Height, weight, waist
circumference • Body composition (%
fat, fat-free mass)
• Productivity • Presenteeism • Absenteeism • Work performance
Diet, smoking Cardio-metabolic • Glucose, cholesterol,
triglycerides, insulin* • Blood pressure
• Work environment • Workstation utilisation
& acceptability
Health related quality of life
Musculoskeletal
• Preferences, strategies, perceived norms
Health care utilisation Stress-related symptoms, eyestrain
Employment status
Adverse events Health history
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Key message
Stand Up, Sit Less, Move More Aiming to: • Reduce total workplace sitting time (Sit Less) • Reduce the number of sitting bouts (Sit Less) • Reduce the length of the sitting bouts (Stand Up)
– particularly those 30mins+ • Increase standing and moving time (Move More) • Make changes throughout the day
• both in and out of the workplace
Achieve this via environmental & organizational & individual strategies
Stand Up Australia
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Organizational strategies
1. Senior management consultation (~30-45mins) • Background & rationale • Identification of relevant OHS policies & organizational
structures, team champions & any additional resources
2. Representatives consultation workshop (~2-4hrs) • Participatory approach: reps from various levels • Identification of organizational-appropriate strategies to
support key message “Stand Up, Sit Less, Move More” • Manager emails, champion for change
Stand Up Australia
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Organizational strategies
1. Senior management consultation (~30-45mins) • Background & rationale • Identification of relevant OHS policies & organizational
structures, team champions & any additional resources
2. Representatives consultation workshop (~2-4hrs) • Participatory approach: reps from various levels • Identification of organizational-appropriate strategies to
support key message “Stand Up, Sit Less, Move More” • Manager emails, champion for change
3. Staff information & brainstorming (~30-45mins) • Background & intervention details to all staff • Build on strategies identified in (2) • Summary email & electronic info book post-session
Stand Up Australia
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Environmental change
• Individual adjustments • Follow-up checks
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Individual strategies
• One face-to-face coaching session (~30mins) • Delivered by motivational interviewing trained health coach • Individual feedback reviewed in relation to key messages • Specific goals for each key message developed &
documented (workstation tracker) • Email summary post session
Stand Up Australia
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Example: individual feedback
24%
56%
11%
9%
Focus on reducing prolonged, unbroken sitting ≥30 minutes
Sitting Standing Stepping
Stand Up Australia
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Example: identifying strategies
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Documenting goals: workstation tracker
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Individual strategies
• One face-to-face coaching session (~30mins) • Delivered by MI trained health coach • Individual feedback reviewed in relation to key messages • Specific goals for each key message developed &
documented (workstation tracker) • Email summary post session
• Four support telephone calls (~10mins each) • Delivered by health coach • Staggered intervals (e.g. 1, 3, 6, 10 weeks post coaching) • General check-in & identification of barriers, problem solving,
potential adjustment of goals • Phone call 3: strategies outside workplace
Stand Up Australia
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Delivery of the intervention
Stand Up Comcare
Feasibility study
Stand Up Victoria
Cluster-RCT
“Reducing Prolonged Workplace Sitting Time in Office Workers: A
Cluster-Randomised Controlled Trial” - The Stand Up Victoria Study
Prof David Dunstan
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Stand Up Comcare
Aim: to assess the short term feasibility and efficacy of a multicomponent intervention to reduce workplace sitting
DESIGN: Intervention: Multicomponent (n=18) Control: Assessment only (n=18)
PARTICIPANTS: Comcare office staff, Melbourne, Australia
2 ASSESSMENTS: Baseline, 4 weeks
Healy et al., Prev Med, July 2013
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Results: at the workplace (%)
*Based on an 8h workday
Control (n=18)
Intervention (n=18)
Baseline Follow-up
Sitting
Standing
Stepping
Healy et al., Preventive Medicine, 2013
21.7
43.4
24.4
10.5
24.3
43.1
22.6
10.0
26.3
40.8
21.9
11
12.7
29.3 47.5
10.5
Sitting ≥30m
Workplace sitting reduced
by >2 hrs (range -262 to -
29mins)
No significant impacts on health or
productivity
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Comcare: since the research study…
• Sedentary work practices toolkit http://www.comcare.gov.au/safety__and__prevention/your_working_environment/sedentary_work_practices_toolkit
• Installing workstations for all employees
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Next question…
How much did the organisational & individual elements add to the change?
Maike Neuhaus Doctoral candidate, UQ
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Stand Up UQ
Aim: to assess the efficacy of a multicomponent intervention in comparison to height-adjustable workstations only to reduce workplace sitting
DESIGN: Intervention I: Multicomponent (n=16) Intervention II: Height-adjustable desks only (n=14) Control: Assessment only (n=14)
PARTICIPANTS: UQ admin staff, Brisbane (Herston, St Lucia, Gatton) Australia
3 ASSESSMENTS: Baseline, 3 months, 12 months
Neuhaus et al., in Press, AJPM
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Results: sitting, standing, stepping
Control
Sitting
Standing
Stepping
78%
14% 8%
76%
16%
8%
Baseline
76%
17% 7%
74%
18%
8%
72%
19%
9%
50% 43%
7%
3 months 12 months
71%
18%
11%
55% 38%
7%
~33 mins
~89 mins
No significant impacts on health
or productivity
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Qualitative feedback: participants
… just having the option to sit or stand was great … everyone now more aware of sitting/standing; everyone
still walking to colleagues to talk; there is more standing in meetings (when prompted) [Multicomponent participant]
…. The manager emails were very useful, bringing everyone
onto the same page and encourage to try things (tips of the week), reinforcing support; thinks if [manager] did that again it would help her group to get into better habits again [Multicomponent participant]
.
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Stand Up UQ: since the research study
Study groups • Workstation only group purchased workstations • Multicomponent: looking to refurbish
UQ wide • Working with OHS: prolonged sitting as part of risk
assessment training • Enabling height adjustable desks to be an option as
part of a refurbishment / replacement • Gradual dissemination of practice
Enabling height adjustable desks to be an option as
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Summary of finding (so far…)
Changing the individual physical environment …. but need support Key support elements • Information • Participatory approach • Champions for change • Visible support (e.g. signs, emails) • Individual coaching
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Easy to start the change
• Become a champion • Online materials
• Juststand.org • Sedentary work practices toolkit (Comcare)
• Post signs • “This is a stand friendly workplace” • “We support standing meetings” • “Stand up for your health”
• Walking office tracks
http://www.interiorsbygreenstreet.com/blog.html
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Evaluate the impact make the business case for change
• Partner with research • Existing measures
• Absenteeism, productivity, engagement surveys • Technology
• Social media
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What are the opportunities?
Scientific, media, workplace & industry interest
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Multidisciplinary partnerships are key
• Consistent message, consistent language
Reducing prolonged
sitting Public Health
Health Promotion
Physical activity
Ergonomists OHS
Industry
Occupational psychologists
+++
![Page 52: Getting office workers to Stand Up, Sit Less and …...Getting office workers to Stand Up, Sit Less and Move More Why? What works? Genevieve Healy, PhD MPH National Health and Medical](https://reader033.vdocument.in/reader033/viewer/2022050503/5f9518caccf4a725025d7595/html5/thumbnails/52.jpg)
Multidisciplinary partnerships are key
• Consistent message, consistent language
Reducing prolonged
sitting Public Health
Health Promotion
Physical activity
Ergonomists OHS
Industry
Occupational psychologists
+++
Rapidly advance the science, the translation, and the uptake
![Page 53: Getting office workers to Stand Up, Sit Less and …...Getting office workers to Stand Up, Sit Less and Move More Why? What works? Genevieve Healy, PhD MPH National Health and Medical](https://reader033.vdocument.in/reader033/viewer/2022050503/5f9518caccf4a725025d7595/html5/thumbnails/53.jpg)
Thank you for listening
Acknowledgements Investigators and participants
Funding bodies: NHMRC, VicHealth, Heart Foundation, UQ, Ergotron
Particular thanks: Prof David Dunstan, Prof Elizabeth Eakin, Prof Anthony LaMontagne, Prof Neville Owen, A/Prof Maureen Ashe, Dr Glen Wiesner, Dr Elisabeth Winkler, Maike Neuhaus, Erin Gorman
Contact Details Dr Genevieve Healy The University of Queensland, Brisbane, Australia [email protected]