Effectiveness of the Stand More AT (SMArT) Work intervention: cluster randomised controlled trial

Charlotte L Edwardson, Tom Yates, Stuart J H Biddle, Melanie J Davies, David W Dunstan, Dale W Esliger, Laura J Gray, Benjamin Jackson, Sophie E O'Connell, Ghazala Waheed, Fehmidah Munir, Charlotte L Edwardson, Tom Yates, Stuart J H Biddle, Melanie J Davies, David W Dunstan, Dale W Esliger, Laura J Gray, Benjamin Jackson, Sophie E O'Connell, Ghazala Waheed, Fehmidah Munir

Abstract

Objectives: To evaluate the impact of a multicomponent intervention (Stand More AT (SMArT) Work) designed to reduce sitting time on short (three months), medium (six months), and longer term (12 months) changes in occupational, daily, and prolonged sitting, standing, and physical activity, and physical, psychological, and work related health.

Design: Cluster two arm randomised controlled trial.

Setting: National Health Service trust, England.

Participants: 37 office clusters (146 participants) of desk based workers: 19 clusters (77 participants) were randomised to the intervention and 18 (69 participants) to control.

Interventions: The intervention group received a height adjustable workstation, a brief seminar with supporting leaflet, workstation instructions with sitting and standing targets, feedback on sitting and physical activity at three time points, posters, action planning and goal setting booklet, self monitoring and prompt tool, and coaching sessions (month 1 and every three months thereafter). The control group continued with usual practice.

Main outcome measures: The primary outcome was occupational sitting time (thigh worn accelerometer). Secondary outcomes were objectively measured daily sitting, prolonged sitting (≥30 minutes), and standing time, physical activity, musculoskeletal problems, self reported work related health (job performance, job satisfaction, work engagement, occupational fatigue, sickness presenteeism, and sickness absenteeism), cognitive function, and self reported psychological measures (mood and affective states, quality of life) assessed at 3, 6, and 12 months. Data were analysed using generalised estimating equation models, accounting for clustering.

Results: A significant difference between groups (in favour of the intervention group) was found in occupational sitting time at 12 months (-83.28 min/workday, 95% confidence interval -116.57 to -49.98, P=0.001). Differences between groups (in favour of the intervention group compared with control) were observed for occupational sitting time at three months (-50.62 min/workday, -78.71 to -22.54, P<0.001) and six months (-64.40 min/workday, -97.31 to -31.50, P<0.001) and daily sitting time at six months (-59.32 min/day, -88.40 to -30.25, P<0.001) and 12 months (-82.39 min/day, -114.54 to -50.26, P=0.001). Group differences (in favour of the intervention group compared with control) were found for prolonged sitting time, standing time, job performance, work engagement, occupational fatigue, sickness presenteeism, daily anxiety, and quality of life. No differences were seen for sickness absenteeism.

Conclusions: SMArT Work successfully reduced sitting time over the short, medium, and longer term, and positive changes were observed in work related and psychological health.

Trial registration: Current Controlled Trials ISRCTN10967042.

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work (other than the Department of Health noted in the acknowledgments section); no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work. DWD reports grants from National Health and Medical Research Council (Australia), grants from Victorian Health Promotion Foundation (VicHealth), during the conduct of the study. MJD reports personal fees from Novo Nordisk, Sanofi-Aventis, Lilly, Merck Sharp and Dohme, Boehringer Ingelheim, AstraZeneca, Janssen, Servier, Mitsubishi Tanabe Pharma, and Takeda Pharmaceuticals International, and grants from Novo Nordisk, Sanofi-Aventis, Lilly, Boehringer Ingelheim, and Janssen, outside the submitted work.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Figures

Fig 1
Fig 1
CONSORT flow diagram
Fig 2
Fig 2
Forest plot of intervention effect at 12 months on occupational and daily sitting time by subgroup. *Adjusted for cluster effect, baseline occupational sitting, baseline overall sitting, stratification category (office size ≤4 or >4 participants) and average activPAL wear times during work hours/average activPAL waking wear time across baseline and 12 months. †Interaction between intervention group and subgroups
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/6174726/bin/edwc044237.va.jpg

References

    1. Wilmot EG, Edwardson CL, Achana FA, et al. Sedentary time in adults and the association with diabetes, cardiovascular disease and death: systematic review and meta-analysis. Diabetologia 2012;55:2895-905. 10.1007/s00125-012-2677-z
    1. de Rezende LF, Rey-López JP, Matsudo VK, do Carmo Luiz O. Sedentary behavior and health outcomes among older adults: a systematic review. BMC Public Health 2014;14:333. 10.1186/1471-2458-14-333
    1. Shen D, Mao W, Liu T, et al. Sedentary behavior and incident cancer: a meta-analysis of prospective studies. PLoS One 2014;9:e105709. 10.1371/journal.pone.0105709
    1. Biswas A, Oh PI, Faulkner GE, et al. Sedentary time and its association with risk for disease incidence, mortality, and hospitalization in adults: a systematic review and meta-analysis. Ann Intern Med 2015;162:123-32. 10.7326/M14-1651
    1. Teychenne M, Costigan SA, Parker K. The association between sedentary behaviour and risk of anxiety: a systematic review. BMC Public Health 2015;15:513. 10.1186/s12889-015-1843-x
    1. Zhai L, Zhang Y, Zhang D. Sedentary behaviour and the risk of depression: a meta-analysis. Br J Sports Med 2015;49:705-9. 10.1136/bjsports-2014-093613
    1. Boberska M, Szczuka Z, Kruk M, et al. Sedentary behaviours and health-related quality of life. A systematic review and meta-analysis. Health Psychol Rev 2017;22:1-16.
    1. Healy GN, Eakin EG, Lamontagne AD, et al. Reducing sitting time in office workers: short-term efficacy of a multicomponent intervention. Prev Med 2013;57:43-8. 10.1016/j.ypmed.2013.04.004
    1. Clemes SA, O’Connell SE, Edwardson CL. Office workers’ objectively measured sedentary behavior and physical activity during and outside working hours. J Occup Environ Med 2014;56:298-303. 10.1097/JOM.0000000000000101
    1. van Uffelen JG, Wong J, Chau JY, et al. Occupational sitting and health risks: a systematic review. Am J Prev Med 2010;39:379-88. 10.1016/j.amepre.2010.05.024
    1. Hallman DM, Gupta N, Mathiassen SE, Holtermann A. Association between objectively measured sitting time and neck-shoulder pain among blue-collar workers. Int Arch Occup Environ Health 2015;88:1031-42. 10.1007/s00420-015-1031-4
    1. Munir F, Houdmont J, Clemes S, Wilson K, Kerr R, Addley K. Work engagement and its association with occupational sitting time: results from the Stormont study [See comment in PubMed Commons below]. BMC Public Health 2015;15:30. 10.1186/s12889-015-1427-9
    1. Brown HE, Ryde GC, Gilson ND, Burton NW, Brown WJ. Objectively measured sedentary behavior and physical activity in office employees: relationships with presenteeism. J Occup Environ Med 2013;55:945-53. 10.1097/JOM.0b013e31829178bf
    1. ERS Research and Consultancy. Health at Work Economic Evidence Report. 2016. file:///C:/Users/localuser/Downloads/health_at_work_economic_evidence_report_2016.pdf.
    1. Henson J, Davies MJ, Bodicoat DH, et al. Breaking up prolonged sitting with standing or walking attenuates the postprandial metabolic response in postmenopausal women: A randomised acute study. Diabetes Care 2016;39:130-8. 10.2337/dc15-1240
    1. Thorp AA, Kingwell BA, Sethi P, Hammond L, Owen N, Dunstan DW. Alternating bouts of sitting and standing attenuate postprandial glucose responses. Med Sci Sports Exerc 2014;46:2053-61. 10.1249/MSS.0000000000000337
    1. Dunstan DW, Kingwell BA, Larsen R, et al. Breaking up prolonged sitting reduces postprandial glucose and insulin responses. Diabetes Care 2012;35:976-83. 10.2337/dc11-1931
    1. Larsen RN, Kingwell BA, Sethi P, Cerin E, Owen N, Dunstan DW. Breaking up prolonged sitting reduces resting blood pressure in overweight/obese adults. Nutr Metab Cardiovasc Dis 2014;24:976-82. 10.1016/j.numecd.2014.04.011
    1. Bailey DP, Locke CD. Breaking up prolonged sitting with light-intensity walking improves postprandial glycemia, but breaking up sitting with standing does not. J Sci Med Sport 2015;18:294-8. 10.1016/j.jsams.2014.03.008
    1. Bailey DP, Maylor BD, Orton CJ, Zakrzewski-Fruer JK. Effects of breaking up prolonged sitting following low and high glycaemic index breakfast consumption on glucose and insulin concentrations. Eur J Appl Physiol 2017;117:1299-307. 10.1007/s00421-017-3610-4
    1. McCarthy M, Edwardson CL, Davies MJ, et al. Fitness Moderates Glycemic Responses to Sitting and Light Activity Breaks. Med Sci Sports Exerc 2017;49:2216-22. 10.1249/MSS.0000000000001338
    1. Peddie MC, Bone JL, Rehrer NJ, Skeaff CM, Gray AR, Perry TL. Breaking prolonged sitting reduces postprandial glycemia in healthy, normal-weight adults: a randomized crossover trial. Am J Clin Nutr 2013;98:358-66. 10.3945/ajcn.112.051763
    1. Thorp AA, Kingwell BA, Owen N, Dunstan DW. Breaking up workplace sitting time with intermittent standing bouts improves fatigue and musculoskeletal discomfort in overweight/obese office workers. Occup Environ Med 2014;71:765-71. 10.1136/oemed-2014-102348
    1. Bergouignan A, Legget KT, De Jong N, et al. Effect of frequent interruptions of prolonged sitting on self-perceived levels of energy, mood, food cravings and cognitive function. Int J Behav Nutr Phys Act 2016;13:113. 10.1186/s12966-016-0437-z
    1. Shrestha N, Kukkonen-Harjula KT, Verbeek JH, Ijaz S, Hermans V, Bhaumik S. Workplace interventions for reducing sitting at work. Cochrane Database Syst Rev 2016;3:CD010912.
    1. Neuhaus M, Healy GN, Dunstan DW, Owen N, Eakin EG. Workplace sitting and height-adjustable workstations: a randomized controlled trial. Am J Prev Med 2014;46:30-40. 10.1016/j.amepre.2013.09.009
    1. Hendriksen IJM, Bernaards CM, Steijn WMP, Hildebrandt VH. Longitudinal Relationship Between Sitting Time on a Working Day and Vitality, Work Performance, Presenteeism, and Sickness Absence. J Occup Environ Med 2016;58:784-9. 10.1097/JOM.0000000000000809
    1. Dunstan DW, Wiesner G, Eakin EG, et al. Reducing office workers’ sitting time: rationale and study design for the Stand Up Victoria cluster randomized trial. BMC Public Health 2013;13:1057. 10.1186/1471-2458-13-1057
    1. Healy GN, Eakin EG, Owen N, et al. A Cluster Randomized Controlled Trial to Reduce Office Workers’ Sitting Time: Effect on Activity Outcomes. Med Sci Sports Exerc 2016;48:1787-97. 10.1249/MSS.0000000000000972
    1. Healy GN, Winkler EAH, Eakin EG, et al. A cluster RCT to reduce workers’ sitting time: Impact on cardiometabolic biomarkers. Med Sci Sports Exerc 2017;49:2032-9. 10.1249/MSS.0000000000001328
    1. Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci 2011;6:42. 10.1186/1748-5908-6-42
    1. Munir F, Biddle SJH, Davies MJ, et al. Stand More AT Work (SMArT Work): using the behaviour change wheel to develop an intervention to reduce sitting time in the workplace. BMC Public Health 2018;18:319. 10.1186/s12889-018-5187-1
    1. O’Connell SE, Jackson BR, Edwardson CL, et al. Providing NHS staff with height-adjustable workstations and behaviour change strategies to reduce workplace sitting time: protocol for the Stand More AT (SMArT) Work cluster randomised controlled trial. BMC Public Health 2015;15:1219. 10.1186/s12889-015-2532-5
    1. Edwardson CL, Winkler EAH, Bodicoat DH, et al. Considerations when using the activPAL monitor in field based research with adult populations. J Sport Health Sci 2017;6:162-78 10.1016/j.jshs.2016.02.002.
    1. Sellers C, Dall P, Grant M, Stansfield B. Validity and reliability of the activPAL3 for measuring posture and stepping in adults and young people. Gait Posture 2016;43:42-7. 10.1016/j.gaitpost.2015.10.020
    1. Edwardson CL, Rowlands AV, Bunnewell S, et al. Accuracy of Posture Allocation Algorithms for Thigh- and Waist-Worn Accelerometers. Med Sci Sports Exerc 2016;48:1085-90. 10.1249/MSS.0000000000000865
    1. Kozey-Keadle S, Libertine A, Lyden K, Staudenmayer J, Freedson PS. Validation of wearable monitors for assessing sedentary behavior. Med Sci Sports Exerc 2011;43:1561-7. 10.1249/MSS.0b013e31820ce174
    1. Winkler EA, Bodicoat DH, Healy GN, et al. Identifying adults’ valid waking wear time by automated estimation in activPAL data collected with a 24 h wear protocol. Physiol Meas 2016;37:1653-68. 10.1088/0967-3334/37/10/1653
    1. Reid N, Eakin E, Henwood T, et al. Objectively measured activity patterns among adults in residential aged care. Int J Environ Res Public Health 2013;10:6783-98. 10.3390/ijerph10126783
    1. van Hees VT, Gorzelniak L, Dean León EC, et al. Separating movement and gravity components in an acceleration signal and implications for the assessment of human daily physical activity. PLoS One 2013;8:e61691. 10.1371/journal.pone.0061691
    1. van Hees VT, Fang Z, Langford J, et al. Autocalibration of accelerometer data for free-living physical activity assessment using local gravity and temperature: an evaluation on four continents. J Appl Physiol (1985) 2014;117:738-44. 10.1152/japplphysiol.00421.2014
    1. da Silva IC, van Hees VT, Ramires VV, et al. Physical activity levels in three Brazilian birth cohorts as assessed with raw triaxial wrist accelerometry. Int J Epidemiol 2014;43:1959-68. 10.1093/ije/dyu203
    1. Hildebrand M, VAN Hees VT, Hansen BH, Ekelund U. Age group comparability of raw accelerometer output from wrist- and hip-worn monitors. Med Sci Sports Exerc 2014;46:1816-24. 10.1249/MSS.0000000000000289
    1. Kuorinka I, Jonsson B, Kilbom A, et al. Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon 1987;18:233-7. 10.1016/0003-6870(87)90010-X
    1. Schaufeli WB, Salanova M, González-Romá V, Bakker AB. The measurement of engagement and burnout: a confirmative analytic approach. J Happiness Stud 2002;3:71-92 10.1023/A:1015630930326.
    1. Business in the Community. Embedding employee wellness and engagement into corporate culture. A Workwell Report. 2010.
    1. Nagy MS. Using a single-time approach to measure facet job satisfaction. J Occup Organ Psychol 2002;75:77-86 10.1348/096317902167658Page: 23 Page: 23
    1. Bond FW, Bunce D. Job control mediates change in a work reorganization intervention for stress reduction. J Occup Health Psychol 2001;6:290-302. 10.1037/1076-8998.6.4.290
    1. Van Veldhoven M, Meijman TF. Het meten van psychosociale arbeidsbelasting met een vragenlijst: de vragenlijst beleving en beoordeling van de arbeid (VBBA). [The measurement of psychosocial work load with a questionnaire: the questionnaire experience and evaluation of work (QEEW)] Nederlands Instituut voor Arbeidsomstandigheden, 1994. [Dutch Institute for Working Conditions]
    1. van Veldhoven M, Broersen S. Measurement quality and validity of the “need for recovery scale”. Occup Environ Med 2003;60(Suppl 1):i3-9. 10.1136/oem.60.suppl_1.i3
    1. Lerner D, Amick BC, 3rd, Rogers WH, Malspeis S, Bungay K, Cynn D. The work limitations questionnaire. Med Care 2001;39:72-85. 10.1097/00005650-200101000-00009
    1. Reilly MC, Zbrozek AS, Dukes EM. The validity and reproducibility of a work productivity and activity impairment instrument. Pharmacoeconomics 1993;4:353-65. 10.2165/00019053-199304050-00006
    1. Wechsler D. The measurement and appraisal of adult intelligence. The Williams & Wilkins Company, 1958. 10.1037/11167-000.
    1. Stroop JR. Studies of interference in serial verbal reactions. J Exp Psychol 1935;18:643-62 10.1037/h0054651.
    1. Brandt J. The Hopkins verbal learning test: development of a new memory test with six equivalent forms. Clin Neuropsychol 1991;5:2 10.1080/13854049108403297.
    1. Newcombe F. Missile wounds of the brain. Oxford University Press, 1969.
    1. Zuckerman M, Lubin B, Rinck C. Construction of new scales for the Multiple Affect Adjective Check List. J Behav Assess 1983;5:119-29 10.1007/BF01321444.
    1. World Health Organisation. WHOQOL-BREF introduction, administration, scoring and generic version of the assessment: Field Trial Version. 1996. .
    1. Bandura A. Social foundations of thought and action: A social cognitive theory. Prentice-Hall, 1986.
    1. Steckler A, Goodmna RM, Kegler MC. Mobilizing organisations for health enhancement: theories of organisational change. In Glanz K. Lewis CE, Rimer BK (eds.) Health Behavior and helath education: theory, research and practice (3rd Edition) pp. 335-360. San Francisco, Jossey-Bass. 2002.
    1. Verplanken B, Aarts H. Habit, attitude, and planned behaviour: Is habit an empty construct or an interesting case of goal-directed automaticity? Eur Rev Soc Psychol 1999;10:101-34 10.1080/14792779943000035.
    1. Baumeister RF, Vohs KD. Handbook of self-regulation: research, theory and applications. The Guilford Press, 2004.
    1. Marlatt GA, George WH. Relapse prevention: introduction and overview of the model. Br J Addict 1984;79:261-73. 10.1111/j.1360-0443.1984.tb03867.x
    1. Alkhajah TA, Reeves MM, Eakin EG, Winkler EAH, Owen N, Healy GN. Sit-stand workstations: a pilot intervention to reduce office sitting time. Am J Prev Med 2012;43:298-303. 10.1016/j.amepre.2012.05.027
    1. Pronk NP, Katz AS, Lowry M, Payfer JR. Reducing occupational sitting time and improving worker health: the Take-a-Stand Project, 2011. Prev Chronic Dis 2012;9:E154. 10.5888/pcd9.110323
    1. Danquah IH, Kloster S, Holtermann A, et al. Take a Stand!-a multi-component intervention aimed at reducing sitting time among office workers-a cluster randomized trial. Int J Epidemiol 2017;46:128-40.
    1. Biddle SJH, Edwardson CL, Gorely T, et al. Reducing sedentary time in adults at risk of type 2 diabetes: process evaluation of the STAND (Sedentary Time ANd Diabetes) RCT. BMC Public Health 2017;17:80. 10.1186/s12889-016-3941-9
    1. Patterson R, McNamara E, Tainio M, et al. Sedentary behaviour and risk of all-cause, cardiovascular and cancer mortality, and incident type 2 diabetes: a systematic review and dose response meta-analysis. Eur J Epidemiol 2018;33:811-29; Epub ahead of print. 10.1007/s10654-018-0380-1.
    1. Crespo NC, Mullane SL, Zeigler ZS, Buman MP, Gaesser GA. Effects of Standing and Light-Intensity Walking and Cycling on 24-h Glucose. Med Sci Sports Exerc 2016;48:2503-11. 10.1249/MSS.0000000000001062
    1. Pulsford RM, Blackwell J, Hillsdon M, Kos K. Intermittent walking, but not standing, improves postprandial insulin and glucose relative to sustained sitting: A randomised cross-over study in inactive middle-aged men. J Sci Med Sport 2017;20:278-83. 10.1016/j.jsams.2016.08.012
    1. Centre for Mental Health. Mental health at work. The business case 10 years on. 2017.
    1. Schaufeli WB. Work engagement in Europe: Relations with national economy, governance and culture. Organ Dyn 2018;11: [forthcoming]. 10.1016/j.orgdyn.2018.01.003.
    1. Swaen GM, Van Amelsvoort LG, Bültmann U, Kant IJ. Fatigue as a risk factor for being injured in an occupational accident: results from the Maastricht Cohort Study. Occup Environ Med 2003;60(Suppl 1):i88-92. 10.1136/oem.60.suppl_1.i88
    1. Sluiter JK, de Croon EM, Meijman TF, Frings-Dresen MH. Need for recovery from work related fatigue and its role in the development and prediction of subjective health complaints. Occup Environ Med 2003;60(Suppl 1):i62-70. 10.1136/oem.60.suppl_1.i62
    1. van Amelsvoort LG, Kant IJ, Bültmann U, Swaen GM. Need for recovery after work and the subsequent risk of cardiovascular disease in a working population. Occup Environ Med 2003;60(Suppl 1):i83-7. 10.1136/oem.60.suppl_1.i83
    1. Rongen A, Robroek SJ, Schaufeli W, Burdorf A. The contribution of work engagement to self-perceived health, work ability, and sickness absence beyond health behaviors and work-related factors. J Occup Environ Med 2014;56:892-7. 10.1097/JOM.0000000000000196
    1. de Croon EM, Sluiter JK, Frings-Dresen MH. Need for recovery after work predicts sickness absence: a 2-year prospective cohort study in truck drivers. J Psychosom Res 2003;55:331-9. 10.1016/S0022-3999(02)00630-X
    1. Health and Safety Executive. Work-related Musculoskeletal Disorders (WRMSDs) Statistics in Great Britain 2017.
    1. Gao Y, Nevala N, Cronin NJ, Finni T. Effects of environmental intervention on sedentary time, musculoskeletal comfort and work ability in office workers. Eur J Sport Sci 2016;16:747-54. 10.1080/17461391.2015.1106590
    1. E F Graves L, C Murphy R, Shepherd SO, Cabot J, Hopkins ND. Evaluation of sit-stand workstations in an office setting: a randomised controlled trial. BMC Public Health 2015;15:1145. 10.1186/s12889-015-2469-8
    1. Ognibene GT, Torres W, von Eyben R, Horst KC. Impact of a Sit-Stand Workstation on Chronic Low Back Pain: Results of a Randomized Trial. J Occup Environ Med 2016;58:287-93. 10.1097/JOM.0000000000000615
    1. Agarwal S, Steinmaus C, Harris-Adamson C. Sit-stand workstations and impact on low back discomfort: a systematic review and meta-analysis. Ergonomics 2018;61:538-52. 10.1080/00140139.2017.1402960
    1. Boberska M, Szczuka Z, Kruk M, et al. Sedentary behaviours and health-related quality of life. A systematic review and meta-analysis. Health Psychol Rev 2017;22:1-16.
    1. Kolt GS, George ES, Rebar AL, et al. Associations between quality of life and duration and frequency of physical activity and sedentary behaviour: Baseline findings from the WALK 2.0 randomised controlled trial. PLoS One 2017;12:e0180072. 10.1371/journal.pone.0180072

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅