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

g.healy@uq.edu.au

Workplace Health Promotion Network (WHPN) Meeting

Before we start…

Please feel free to stand, and move and sit and stand and sit etc…

Too much sitting is bad for our health

http://sitlessmovemore.ca

Why all this interest in sitting?

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)

The landscape has changed

45 ± 14 kcal/day

27 ± 9 kcal/day

80 ± 28 kcal/day

54 ± 19 kcal/day

Lanningham-Foster et al., Obesity Research, 2003

Physical activity expended at the workplace has dropped dramatically

Church et al., PLoS One 2011

1 in 2 men 1 in 5 men

Merging of wellness and ergonomics

Physical activity Ergonomics

Reducing prolonged

sitting time

Key sedentary events (public health)

Sitting & Health

1950’s & 60’s

2000

2003

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;

Key sedentary events (public health)

Sitting & Health

More accurate measurement

7164 GT1M GT3x+

activPAL3

Data from an activPAL3 monitor

Time Sitting Time Standing Time Moving

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

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

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

Released July 2011. New UK-wide Guidelines for PA

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

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

“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”

1. Understanding the problem

Thorp et al., IJBNPA, 2012

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+

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

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

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

Workstation used

Height adjustable workstation: WorkFit-S: Ergotron

Product kindly donated by Ergotron for Stand Up Comcare & Stand Up UQ

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

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

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

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

Environmental change

• Individual adjustments • Follow-up checks

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

Example: individual feedback

24%

56%

11%

9%

Focus on reducing prolonged, unbroken sitting ≥30 minutes

Sitting Standing Stepping

Stand Up Australia

Example: identifying strategies

Documenting goals: workstation tracker

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

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

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

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

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

Next question…

How much did the organisational & individual elements add to the change?

Maike Neuhaus Doctoral candidate, UQ

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

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

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]

.

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

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

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

Evaluate the impact make the business case for change

• Partner with research • Existing measures

• Absenteeism, productivity, engagement surveys • Technology

• Social media

What are the opportunities?

Scientific, media, workplace & industry interest

Multidisciplinary partnerships are key

• Consistent message, consistent language

Reducing prolonged

sitting Public Health

Health Promotion

Physical activity

Ergonomists OHS

Industry

Occupational psychologists

+++

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

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 g.healy@uq.edu.au