Reducing sedentary behavior in the workplace: implications for the

health of all Kansans

Kansas Public Health Association ConferenceSeptember 17th, 2015

Sara Rosenkranz PhD, Brooke Cull, MPH, Emily Mailey PhD, Kelsey Casey, BA

Departments of Human Nutrition and Kinesiology Kansas State University

Session Outline• The dangers of sitting too much• Results from the S.I.T. study• Results from the Up4Health trial• Practical ways to reduce sedentary behavior and improve

health behaviors in the workplace

What is sedentary behavior?

What are the dangers?

• Our bodies aren’t built for such a sedentary lifestyle

• During prolonged sitting:– Large muscle groups are at rest and don’t need to

use glucose (affects insulin sensitivity)– The enzyme that breaks down fat in the blood is

deactivated (contributes to weight gain)– Circulation is poor, particularly in lower body– Blood flow and oxygen to the brain are reduced

(impacts concentration)

What are the dangers?• Acute effects:

– Glucose tolerance and insulin sensitivity decrease– Triglycerides and LDL increase

• When accumulated over months and years, risk of chronic disease and mortality increases

Reducing sitting time: Immediate benefits

• Improved focus and concentration• Reduced fatigue• Increased energy• Enhanced productivity?

Reducing sitting time: Health benefits

• Replacing each hour of daily sitting with equal amounts of standing may reduce mortality risk by up to 5 percent per hour of sitting replaced.

• -Dr. Emmanuel Stamatakis, University of Sydney

Reducing sitting time: caloric benefits

• Standing up 3-4 hours a day at work would be the [caloric] equivalent of running about 10 marathons a year. If you stand for 3 hours a day for 5 days that's around 750 calories burnt. Over the course of a year it would add up to about 30,000 extra calories, or around 8 lbs of fat.

• -Dr. Buckley, University of Chester

Stand up!

The S.I.T. Study• Large potion of research has been cross-sectional or

extreme experiments

Research Project: The Seated Inactivity Trial (S.I.T)• Does ten hours of imposed sedentary time per week for

eight weeks impact the health risk profile of physically active adults?

www.cancercouncil.com.au

+ = ?www.osha.gov

S.I.T. Study Design

16 Young Adults(Physically active and healthy)

CON GroupN=8

SIT GroupN=8 10 hours/wk

imposed sedentary time for 8

weeks

No intervention

provided

Methods: Laboratory Assessments

Baseline Assessment

Week 4 Assessment

Week 8 Assessment

Sedentary Intervention or No Intervention Control

Baseline Characteristics CON Group (n=8) SIT Group (n=8)

mean ± SD mean ± SD p-value

Age (yr) 21.6 ± 1.4 22.4 ± 3.4 0.575

Body Mass (kg) 69.6 ± 12.4 73.5 ± 13.3 0.547

Body Mass Index 23.5 ± 2.2 24.4 ± 3.6 0.586

Body Fat % 20.6 ± 10.3 17.5 ± 7.4 0.490

MVPA (min/day) 155.8 ± 111.0 185.9 ± 60.9 0.512

Sedentary Time (min/day)789.5 ± 322.3 684.1± 91.0 0.388

Kilocalories per day 2,501± 1,087 2,734 ± 894 0.648

Systolic Blood Pressure121.4 ± 11.5 112.6 ± 14.0 0.193

Fasting Glucose 92.4 ± 6.0 91.3 ± 7.4 0.743

Systolic Blood Pressure Results

Baseline Week 4 Week 840

50

60

70

80

90

100

110

120

130

CONSIT

Sy

sto

lic

Blo

od

p

res

su

re (

mm

Hg

)

* Significantly different than baseline † Change from baseline to week 4 is different between groupsError bars indicate SD

Total Cholesterol Results

Baseline Week 4 Week 8100

110

120

130

140

150

CONSIT

To

tal

Ch

ole

ste

rol

(m

g/d

L)

*

* Significantly different than baselineError bars indicate SD

Caloric Intake Results

Baseline Week 4 Week 8500

1000

1500

2000

2500

3000

CONSIT

Kil

oc

alo

rie

s P

er

Da

y

*Significantly different than baseline Error bars indicate SD

*

Conclusion • In response to imposed sedentary time:

• ↑Systolic Blood Pressure• ↑ Total Cholesterol

• No changes in other cardiometabolic risk factors• In this young, healthy, active sample, imposing 10 hours

of sedentary time per week did not lead to global changes in cardiometabolic disease risk

Stand up!

The Up4Health Study• Workplace is an ideal setting for implementing

interventions to reduce sitting time• No currently established guidelines for how one should go

about incorporating activity throughout the workday• Purpose: Compare two approaches to breaking up sitting

time at work• Short, frequent breaks (1-2 minutes every half hour)• Longer, planned breaks (two 15-minute walks)

• Any differential effects on health outcomes?• Any differences in adherence?

Study Design

Baseline

• Accelerometer• Food Diary• Questionnaires• Health Outcomes

Post-intervention

• Accelerometer• Food Diary• Questionnaires• Health Outcomes

8-Week Intervention

Randomization• Short Breaks (n=24)• Long Breaks (n=25)

Health Outcomes Assessed:• Cholesterol• Triglycerides• Fasting blood glucose• Blood pressure

Inclusion Criteria:• Female (premenopausal)• Working >35 hr/wk• Spend >80% of workday sitting• <60 min/wk of physical activity• Not pregnant or actively dieting

Intervention• Orientation Session

• Received group assignment• Developed specific plans for accomplishing goal• Devised strategies for overcoming possible barriers

• Weekly emails from research team• Health benefits of reducing sitting time, seeking social support from

coworkers, using technology to prompt activity breaks, etc.

• Daily activity logs• Recorded the time and duration of all activity breaks for the 8-week

duration of the study

Participant characteristicsVariable Mean (SD)/Freq (%)

Age 38.71 (8.19)

Hours worked per week 41.52 (3.36)

Race  

White 41 (83.7%)

Other race 8 (16.3%)

Education  

High school graduate 7 (14.3%)

College graduate 42 (85.7%)

Annual household income  

<$60,000 20 (40.8%)

>$60,000 23 (46.9%)

Not disclosed 6 (12.3%)

Results: Adherence• Of 49 randomized participants, 38 completed the study

• 87.5% retention in short break group• 68.0% retention in long break group

• Adherence: % of working days participant followed recommended protocol• Short break group (>12 activity breaks per 8-hour workday): 69.2%• Long break group (at least 2 activity breaks totaling ≥25 minutes): 60.8%

Results: Sedentary Behavior

Baseline Week 8300

320

340

360

380

400

420

440

460

480

500

Accelerometer Data

ShortLong

Sed

enta

ry M

inu

tes

per

Wo

rkd

ay

Short Breaks Long Breaks0

10

20

30

40

50

60

70

80

90

Activity Log Data

Min

ute

s o

f S

tan

din

g

-35.6 min; d=-0.75

80.3

46.3

Results: Health OutcomesVariable Group Baseline M(SD) Post-intervention M(SD) Cohen’s d

Total cholesterol Short 170.7 (29.4) 160.7 (30.8) -0.33

Long 196.2 (27.0) 191.4 (27.4) -0.18

Triglycerides Short 136.2 (52.6) 115.4 (56.2) -0.38

Long 145.3 (69.6) 143.3 (76.1) -0.03

Glucose Short 98.8 (15.2) 94.6 (13.8) -0.29

Long 102.2 (37.8) 102.4 (39.8) 0.004

Systolic BP Short 113.1 (11.8) 110.3 (11.8) -0.23

Long 113.4 (14.6) 112.1 (17.5) 0.08

Overall, small to moderate improvements in short break group only

Results: Psychosocial outcomes

aActivation Deactivation Checklist; bFatigue Symptom Inventory (Interference subscale); cPositive and Negative Affect Scale

Variable Group Baseline M(SD) Post-intervention M(SD) Cohen’s d

Energya Short 9.05 (3.4) 11.75 (3.7) 0.76

Long 8.80 (4.0) 9.6 (4.0) 0.20

Tensiona Short 7.45 (2.1) 6.00 (1.5) -0.81

Long 8.27 (3.2) 7.73 (3.2) -0.17

Fatigueb Short 2.81 (1.9) 1.69 (1.5) -0.65

Long 3.15 (2.4) 2.44 (2.6) -0.28

Positive affectc Short 27.75 (7.2) 32.15 (7.6) 0.60

Long 28.94 (8.5) 28.63 (10.3) -0.03

Negative affectc Short 16.05 (4.7) 13.45 (3.8) -0.61

Long 17.38 (4.4) 17.44 (6.5) 0.01

Overall, moderate to large improvements in short break group

Participant testimonials• “I will continue to take breaks every hour,

because it makes me more productive when I walk away for a minute. I love having more energy!”

• “Being mindful of my activity at work has prompted me to try and incorporate more physical activity out of the office, even if it is just parking a bit farther away.”

Conclusions• To our knowledge, this was the first intervention to

manipulate frequency of activity breaks and examine effects on health outcomes in a real-world context

• Participants assigned to the short break group performed better than participants assigned to the long break group on all outcomes

• Taking short, frequent breaks from sitting is a feasible and effective approach to reducing sedentary time and improving health outcomes

• Public health messages need to address sedentary behavior

Stand up!

Up 4 Health Dietary Data• Participants in the Up 4 Health study kept 3-day food

journals at each of the 3 time points• When one lifestyle change is made, it is often seen that

other components of health change as well• Interested to see if participants changed their eating

patterns without receiving any dietary counseling • Did participants reduce caloric intake?• Did the composition of their diet change?

Change in Caloric Intake

0

500

1000

1500

2000

2500

Average Kilocalories Per Day

Baseline

Kilo

calo

rie

s

**

Week-4 Post-intervention

* Significantly different than baselineError bars indicate SD

Macronutrient Composition

Baseline Macronu-trients

Post-intervention Macronutrients

Diet Quality

Conclusions• Women making changes to reduce sedentary time may

also reduce the amount of calories they are consuming

• With a reduction in calories participants could have potentially impacted the quality of their diet due to fewer opportunities throughout the day to intake key nutrients, however participants did not show a significant change in diet quality while reducing their caloric intake.

• Reducing sedentary time may be an effective way to also have a positive impact on dietary habits

Nutrition ConsiderationsWe CAN do something about it!Convenient vs. less convenientAttractive vs. less attractiveNormative vs. abnormal?

Candy bowls? Donuts for morning meetings? Vending machines?

Fresh fruits and vegetables? Water as beverage? Birthday ___________?

Stand up!

How should I break up sitting time?• STAND UP: interrupt sitting frequently• SIT LESS: substitute some sitting time with

standing or moving• MOVE MORE: incorporate bits of activity

throughout the workday

Considerations for individuals• Set an alarm to remind you to get up and move• Create or buy a standing or height-adjustable desk• Incorporate movement with work-related tasks

• Stand while talking on the phone• Send work to a remote printer• Walk to a colleague’s office to ask a question• Conduct walking meetings• Use the restroom on another floor

Other ideas?

Considerations for Workplaces• Create a culture of wellness that values employee health

and well-being• Develop a wellness committee with representation from

various units/divisions/levels• Solicit input from all employees during all phases of

program development, implementation, and assessment• Make wellness programs fun by incorporating team

activities, friendly competition, etc.• Implement small changes immediately

• Post signs to encourage stair use• Incentive programs • Standing breaks during meetings• Movement-friendly dress codes

Considerations for Researchers• Interventions targeting sedentary behavior should

incorporate organizational and environmental changes to bolster intervention effects

• Identify which strategies for reducing sedentary behavior are most effective (and cost-effective)

• Develop toolkit/resources that can be distributed to workplaces

• Use ActivPAL or similar device that can differentiate sitting from standing

• Assess a variety of outcomes (behavior, health, quality of life, productivity, feasibility, social norms, cost, etc.)

Thank You!• Physical Activity and Nutrition-Clinical Research

Consortium at Kansas State University• Aaron Swank• Alyssa Baquero Garcia