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Getting Office Workers to Stand Up, Sit Less and Move More—What Works?
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DR. GENEVIEVE HEALY, Ph.D, MPH School of Population Health—The University of Queensland, Australia
Dr. Healy’s PhD research reported some of the first evidence regarding the importance of regularly interrupting sitting time for heart health. Her current research builds on this work to examine how sitting time varies across populations, as well as the feasibility and acceptability of reducing this behavior in key settings, such as the workplace. This includes being a main investigator for “Stand Up Australia” and “Stand Up Comcare” – programs of research focused on understanding and reducing prolonged sitting time in Australian office workers.
Dr. Healy’s research receives extensive worldwide recognition, with over 1,000 articles throughout more than 30 countries. Getting office workers to stand up, sit less and move
more—what works?For most office workers, the majority of their workday is spent sitting. Dr. Healy will present evidence on how all that sitting may be impacting on their health. She will also present findings from the Stand Up Australia program of research. Across several studies, this program is investigating how much office workers sit, and what strategies are effective at reducing and changing their sitting time.
Getting office workers toStand Up, Sit Less and Move More
Why? What works?
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
Incidence of coronary heart diseaseConductors
Morris JN et al. Lancet 1953: ii 1053-1057
2.7 per 1000 p.a.
1.9 per 1000 p.a.
Drivers
Health risks of too much sitting Diabetes Cardiovascular diseases Cardiovascular and all-
cause mortality Musculoskeletal symptoms Chronic kidney disease
Wilmot et al., 2012 & 2013 Diabetologia; Thorpe et al., AJPM 2011; http://www.who.int/occupational_health/publications/en/oehmsd3.pdf;
Breast & colon cancer Weight gain &
development of obesity Metabolic syndrome ++++
Scientific interest in “sedentary”
Source: Scopus database July 2013
More accurate measurement
7164GT1MGT3x+
activPAL3
Data from an activPAL monitor
Time Sitting Time Standing Time Moving
Night
Morning
We spend most of our day sitting ~60% of the day spend sitting Very little time in moderate & vigorous activity Consistent findings around the world
Sedentary (60%)
Moderate-vigorous activities(5%)
Light-intensity (35%)
You can be active & highly sedentary!
Average 2 hours of moving BUT 11 hours of sitting!
But we all need to sit…
“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.
Not just about total sitting timeSitting accumulation & health Prolonged sitting and musculoskeletal outcomes1
More breaks associated with lower waist circumference2
Experimental evidence Interrupting prolonged sitting associated with better
postprandial glucose & insulin response3
One hour of exercise does not offset the negative effects on inactivity on insulin & lipids if the rest of the day is spent sitting4
1 http://www.who.int/occupational_health/publications/en/oehmsd3.pdf; 2 Healy et al., EHJ, 2011; 3 Dunstan et al., Diabetes Care, 2012; 4 Duvivier et al., PLoS ONE, 2013
Glucose
Insulin
How much sitting is too much?
Stay tuned…
Sit less throughout the day
Stand up at least every 30 minutes
Can we change prolonged sitting time?
A simple solution?
April Fools Day 2013
See the video:
SFU launches ‘healthy campus’ initiativehttp://www.youtube.com/watch?v=sMWCw9G8Txg
Multiple influences on health behaviors
Sitting
Policy Context
Physical Environment
Interpersonel
Intrapersonel
Owen et al., AJPM 2011
The workplace is a key setting to address these influences
Social /Cultural
Workplace Design
WorkplaceArrangements/
Conditions
Organisational & Policy
Individuals
Reducing prolonged
sitting in the workplace
Epidemiology Experimental laboratory Interventions
Translational research
Program of research investigating benefits from reducing sitting time in the workplace
The Stand Up Australia program of research
A National collaboration between the
Baker IDI Heart & Diabetes Institute
University of Queensland,
University of Melbourne,
Deakin University
Government & Non-Government Partner Organizations
Program of research investigating benefits from reducing sitting time in the workplace
The Stand Up Australia program of research
Key Research Questions
What is the extent of the problem?
What are the health risks?
Who are the target population(s)?
What can we do to reduce it?
What is the translation and uptake?
Australia
What is the extent of the problem? Office workers spend a lot of time sitting A lot of this sitting time is unbroken (30mins+)
Proportion of prolonged (≥30 mins)sedentary time (%)
Activity distribution (%)
Thorp et al., IJBNPA, 2012
Work time
77.0%
21.1%
1.9%
Sedentary Light MVPA
55.5%21.5%
Sitting <30mins Sitting 30mins+
What are the health risks?Detrimental associations with: overweight and obesity1
risk of obesity and type 2 diabetes2
Workplace settings with high sedentary behaviour (ie. call centres) report: weight gain3 high prevalence of musculoskeletal symptoms4-5
Systematic review6 concluded: Not enough evidence / heterogenity Need more studies with better measures
1Mummery et al. 2005; 2Hu et al. 2003; 3Boyce et al. 2008; 4Karlqvist et al. ; 5Toomingas et al. 2003; 6van Uffelen et al., 2010
What about sitting and work outcomes?
Interventions typically had a beneficial or neutral impact on productivity, absenteeism and injury costs.
No studies suggested likely harm from sensibly implemented breaks from or reductions in workplace sitting time
Healy et al., 2012
Who are the target populations?
Population groups that are most at risk of prolonged sitting include those working in offices, transportation, and highly mechanised trades.
Healy et al., 2012
How have we addressed workplace sitting?
Australia
Social /Cultural
Workplace Design
WorkplaceArrangementsCon
ditions
Organisational & Policy
Individuals
Reducing prolonged sitting in the workplace
Health and Work
Building the case
Reducing workplace sitting
Whole of workplace environment
Vancouver workplace study
Multicomponent
Stand Up Comcare, Stand up Victoria
Individual environment vs. multicomponent
Stand Up UQ
Australia
Study 1: Whole of workplace environment
Macquarie Bank (Australia)
Sydney Office
What is the impact on workplace sitting,health & work outcomes when…
Office workers move from a
conventional workplace environment
to a
innovative, movement oriented environment?
Vancouver workplace study Natural experiment with pre-post design (n=24) No other health advice given
Benefits of design
Intervention ongoing Potential benefits for all employees
Erin Gorman
With thanks to A/Prof Maureen Ashe
Staircase comparisons
Conventional vs.
Innovative
Standing options in innovative workplace
A. Individual officesB. Meeting roomsC.Multipurpose room
A
B
C C
What were the findings? (n=24) ~19 minute switch between sitting & standing No significant / meaningful impact on health
Conventional Innovative0
100200300400500600
Sitting Standing Stepping
Min
s pe
r 8-h
r wor
kday
Gorman et al., 2012 under review
But…
All enjoyed the new workplace Most believed that it increased their productivity
Implication
Just providing the broader physical environment may not be enough for substantial changes in sitting
Study 2: Multicomponent
We use an multicomponent approach, incorporating organisational, environmental, and individual change elements
Social /Cultural
Workplace Design
WorkplaceArrangements/
Conditions
Organisational & Policy
Individuals
Reducing prolonged
sitting in the workplace
What is the impact on workplace sitting, health and work outcomes when…
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+
Stand Up Australia
Key message
Stand Up, Sit Less, Move More
Aiming to: Increase standing and moving time (Move More)
Make changes throughout the day
both in and out of the workplace
Achieve this via organizational, environmental & individual strategies
Stand Up Australia
Organizational strategies1. 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
Example: management emails
Organizational strategies1. 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 changeHeight adjustable workstation: WorkFit-S: Ergotron
Product kindly donated by Ergotron for Stand Up Comcare & Stand Up UQ
Individual strategiesFace-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%8% 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
Individual strategies
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 sittingDESIGN: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
Phase 11-2 weeks
Phase 2: 4 -weeks
Intervention: BaselineReps consult Group
consultWork-station install
Individual consult(Day 1-3)
Call 1(wk 2)
Call 2(wk 3)
Call 3(wk4)
Assessment 2(end of Ix)
Control:
Baseline Assessment 2
Study timeline: Stand Up Comcare
Stand Up Comcare
Representatives’ input “laps” around office - defined circuit
introduction of more standing into meetings (initiated by Chairperson from the outset)
use printers further away
ergonomically sound exercises at scheduled times
wireless headsets for conference calls (to enable standing)
Stand Up Comcare
Representatives’ input
breaks compliance software
use the stairs (reduced access during intervention period)
“no bins” policy – no personal bins
timed walking routes in vicinity of building
Stand Up Comcare
Common individual change strategies
Stand Up Set a timer (e.g. outlook)
Stand up when someone enters the office / phone rings
Stand up when someone else does
Sit Less Determine certain ‘standing times’, i.e.
morning; after lunch
Standing meetings
Stand Up Comcare
Move More Use the stairs instead of the lift
Walking laps
More active lunch breaks (e.g. walking around the block)
Fill water bottle / pick up printing more often
iMails
Changes in sitting, standing and stepping Participants sat ~70% of the workday at baseline Sitting reduced by >2 hrs per 8hr workday in Ix compared to
control group Sitting mostly replaced with standing
Baseline Follow-up0123456789
StandingSittingSitting 30mins+
Hou
rs a
t the
wor
kpla
ce
Intervention group
Healy et al., Prev Med, 2013
Further evaluation of intervention
All Ix participants reduced sitting time (range -262 to -29 mins per 8-hr workday)
Sitting ≥30 mins reduced by 45% (~73 minutes)
Sitting reduced across the day
No significant Ix effects on health or work outcomes
Healy et al., Prev Med, 2013; Stevens et al., in preparation
Comcare: since the research study…
Sedentary work practices toolkithttp://www.comcare.gov.au/safety__and__prevention/your_working_environment/sedentary_work_practices_toolkit
Installing activity permissive desks for all employees
Stand Up Victoria
CIs: David Dunstan, Genevieve Healy, Neville Owen, Elizabeth Eakin, Anthony LaMontagne, Marj Moodie
• 3-year cluster-randomised controlled trial 320 participants (160 per group)
14+ worksites from one organisation
• 3 months of intervention + 9 months maintenance
• Cost-effectiveness analysis
• Baseline completed end 2013
Stand Up Sit Less Move More
Stand Up Victoria – Partner Organization
Study 3: Multicomponent vs. workstation only
Height-adjustable desks onlyVS
Multicomponent workplace programs
Maike Neuhaus
What is the impact on workplace sitting, health and work outcomes when…
Participants & assessmentN=44
• n= 16• Multi-component
intervention group
• n= 14• Height-adjustable
workstations only
• n= 14• Control group
• Assessments at baseline, 3 months (all groups), and 12 months (Ix only)
Neuhaus et al., under review
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
Results: health, work & acceptability
No significant or meaningful changes in health and work related outcomes
Acceptability of workstations high 3.9/5 in multicomponent; 3.7/5 in workstation only Some limitations noted (e.g. reduced desk space) Mixed qualitative feedback on impact on productivity Desks need to be tailored to tasks
Acceptability of other intervention elements high All rated either as useful or very useful
Neuhaus et al., under review
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]
Qualitative feedback: participants
What are the advantages / disadvantages of standing more at work?
… just having the option to sit or stand was great
… physical health, but also mental – being able to concentrate better
Decreased lower back pain and increased productivity
Disadvantages: desk design and choosing which shoes to wear in the morning
Has your workplace culture changed around sitting/standing?
Yes: more accepted to stand while working
Yes: everyone more aware; everyone still walking to colleagues to talk; stands when answering the phone; more standing in meetings (when prompted) [Multicomponent participant]
-No-
Stand Up UQ: since the research studyStudy groups
Workstation only: purchased height adjustable desks
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
Getting office workers to Stand Up, Sit Less, Move More:
What worked?
Australia
SUA summary: what worked?Changing the individual physical environment
…. with complementary 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 impactmake the business case for change
Partner with research Existing measures
Absenteeism, productivity, engagement surveys
Technology Social media
What are the opportunities?
Scientific, media, workplace and industry interest
Multidisciplinary partnerships are keyConsistent message, consistent language
Reducing prolonged
sitting
Public Health
Health Promotion
Physical activity
ErgonomistsOHSIndustry
Occupational psychologists
+++
Multidisciplinary partnerships are keyConsistent message, consistent language
Reducing prolonged
sitting
Public Health
Health Promotion
Physical activity
ErgonomistsOHSIndustry
Occupational psychologists
+++Rapidly advance the science, the translation, and the uptake
Thank you
Dr Genevieve Healy
Acknowledgements Ergotron
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
Getting office workers toStand Up, Sit Less and Move More
Why? What works?
