JustStand Summit 2013 - Dr. Genevieve Healy

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Getting Office Workers to Stand Up, Sit Less and Move More—What Works?

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  • Just providing the physical environment may not be enough
  • JustStand Summit 2013 - Dr. Genevieve Healy

    1. 1. 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.
    2. 2. Getting office workers to Stand Up, Sit Less and Move More Why? What works?
    3. 3. Before we start…  Please feel free to stand,  and move  and sit  and stand  and sit etc…
    4. 4. Too much sitting is bad for our health
    5. 5.  http://sitlessmovemore.ca
    6. 6. Why all this interest in sitting?
    7. 7. 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)
    8. 8. The landscape has changed
    9. 9. 45 ± 14 kcal/day 27 ± 9 kcal/day 80 ± 28 kcal/day 54 ± 19 kcal/day Lanningham-Foster et al., Obesity Research, 2003
    10. 10. Physical activity expended at the workplace has dropped dramatically Church et al., PLoS One 2011 1 in 2 men 1 in 5 men
    11. 11. Incidence of coronary heart disease Conductors Morris JN et al. Lancet 1953: ii 1053-1057 2.7 per 1000 p.a. 1.9 per 1000 p.a. Drivers
    12. 12. 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  ++++
    13. 13. Scientific interest in “sedentary” Source: Scopus database July 2013
    14. 14. More accurate measurement 7164 GT1M GT3x+ activPAL3
    15. 15. Data from an activPAL monitor Time Sitting Time Standing Time Moving Night Morning
    16. 16. 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%)
    17. 17. You can be active & highly sedentary! Average 2 hours of moving BUT 11 hours of sitting!
    18. 18. 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.
    19. 19. Not just about total sitting time Sitting 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
    20. 20. How much sitting is too much? Stay tuned… Sit less throughout the day Stand up at least every 30 minutes
    21. 21. Can we change prolonged sitting time?
    22. 22. A simple solution? April Fools Day 2013  See the video: SFU launches ‘healthy campus’ initiative http://www.youtube.com/watch?v=sMWCw9G8Txg
    23. 23. Multiple influences on health behaviors Sitting Policy Context Physical Environment Interpersonel Intrapersonel Owen et al., AJPM 2011
    24. 24. The workplace is a key setting to address these influences Social / Cultural Workplace Design Workplace Arrangements/ Conditions Organisational & Policy Individuals Reducing prolonged sitting in the workplace
    25. 25. 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
    26. 26. Program of research investigating benefits from reducing sitting time in the workplace The Stand Up Australia program of research
    27. 27. 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
    28. 28. 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+
    29. 29. 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
    30. 30. 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
    31. 31. 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
    32. 32. How have we addressed workplace sitting? Australia
    33. 33. Social / Cultural Workplace Design Workplace ArrangementsCon ditions Organisational & Policy Individuals Reducing prolonged sitting in the workplace Health and Work Building the case
    34. 34. 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
    35. 35. Study 1: Whole of workplace environment Macquarie Bank (Australia) Sydney Office
    36. 36. 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?
    37. 37. 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
    38. 38. Staircase comparisons Conventional vs. Innovative
    39. 39. Standing options in innovative workplace A. Individual offices B. Meeting rooms C.Multipurpose room A B C C
    40. 40. What were the findings? (n=24)  ~19 minute switch between sitting & standing  No significant / meaningful impact on health 0 100 200 300 400 500 600 Conventional Innovative Minsper8-hrworkday Sitting Standing Stepping Gorman et al., 2012 under review
    41. 41. 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
    42. 42. Study 2: Multicomponent
    43. 43. We use an multicomponent approach, incorporating organisational, environmental, and individual change elements Social / Cultural Workplace Design Workplace Arrangements/ Conditions Organisational & Policy Individuals Reducing prolonged sitting in the workplace What is the impact on workplace sitting, health and work outcomes when…
    44. 44. 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
    45. 45. 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
    46. 46. 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
    47. 47. Example: management emails
    48. 48. 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
    49. 49. Environmental change Height adjustable workstation: WorkFit-S: Ergotron Product kindly donated by Ergotron for Stand Up Comcare & Stand Up UQ
    50. 50. Individual strategies 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
    51. 51. Example: individual feedback 24% 56% 11% 9% Focus on reducing prolonged, unbroken sitting ≥30 minutes Sitting Standing Stepping Stand Up Australia
    52. 52. Example: identifying strategies
    53. 53. Documenting goals: workstation tracker
    54. 54. 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
    55. 55. 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
    56. 56. 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
    57. 57. 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
    58. 58. Phase 1 1-2 weeks Phase 2: 4 -weeks Intervention: Baseline Reps consult Group consult Work- 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
    59. 59. 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
    60. 60. 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
    61. 61. 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
    62. 62. 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 0 2 4 6 8 10 Baseline Follow-up Hoursattheworkplace Stepping Standing Sitting Intervention group Healy et al., Prev Med, 2013
    63. 63. 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
    64. 64. Comcare: since the research study… Sedentary work practices toolkit http://www.comcare.gov.au/safety__and__prevention/your_working_environment/s edentary_work_practices_toolkit Installing activity permissive desks for all employees
    65. 65. 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
    66. 66. Stand Up Victoria – Partner Organization
    67. 67. Study 3: Multicomponent vs. workstation only
    68. 68. Height-adjustable desks only VS Multicomponent workplace programs Maike Neuhaus What is the impact on workplace sitting, health and work outcomes when…
    69. 69. Participants & assessment N=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
    70. 70. 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
    71. 71. 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
    72. 72. 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]
    73. 73. 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-
    74. 74. Stand Up UQ: since the research study Study 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
    75. 75. Getting office workers to Stand Up, Sit Less, Move More: What worked? Australia
    76. 76. 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
    77. 77. 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
    78. 78. Evaluate the impact make the business case for change  Partner with research  Existing measures  Absenteeism, productivity, engagement surveys  Technology  Social media
    79. 79. What are the opportunities? Scientific, media, workplace and industry interest
    80. 80. Multidisciplinary partnerships are key Consistent message, consistent language Reducing prolonged sitting Public Health Health Promotion Physical activity Ergonomists OHS Industry Occupational psychologists +++
    81. 81. 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
    82. 82. Thank you Dr Genevieve Healy g.healy@uq.edu.au 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
    83. 83. Getting office workers to Stand Up, Sit Less and Move More Why? What works?

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