JustStand Summit 2013 - Morning Panel


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Jeff Sanford, Humantech*; Gabe Koepp, Mayo Clinic; Dr. Mark Pereira, University of Minnesota; Dr. Kathleen Horst, Stanford University

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  • Thanks for coming. Feel free to stand/pace back and forth. Explain the logos. Explain the title. Why do this study?
  • NEAT may be important for body weight regulation.
  • Personal experience – developed upper back pain, received a WorkFit-S, and found the back pain dissipated within a few weeksBegin to think of this as a research question and could not find any published studies related to back pain and a sit-stand workstationContacted Ergotron who was enthusiastic to collaborate on a research projectAgreed to provide the workstations and install assistance
  • Experts in the field of pain, orthopedics, ergonomics, and physical activityIntra- and Inter variability cuz pain can change due to many factors  pain changes from day to day for each person but is also different from person to person in how they experience and what makes it worse and betterRan pilot study – used this data to perform a power calculationNeed 46 participants to have 80% power to detect a 2-point reduction in pain with an alpha level of .05 that is the result of one’s access to a sit-stand workstationPain is variable
  • Over the course of the study, participants report pain and other variables via electronic surveys.If pain result of trauma or some type of accident, medications, alternative medicine (acupunture, etc), and whether or not they had an ergonomic evaluation of their desk
  • In order to assist with retention, we offered those in the control group a workfit as well at the end of the study
  • of 0-10 with 10 being the worst pain imaginable and 0 being no pain at all Grad students who sit upwards of 15 hours a day working on their thesis> 3 months pain  group who stand to benefit most
  • Didn’t want to enroll participants who suffer from 10/10 pain and could not sufficiently utilize the sit-stand workstation
  • On map  One potential criticism of the study is the homogeneity of the sample since it is limited to SU, but we really found it to be heterogeneous due to the large size of SU with employees located in vastly different physical locations and with different desk and work environments with different job roles and responsibilities
  • If hypothesis correct & sit-stand workstations improves back pain, we anticipate future studies that will include….Cytokines – (Human immune monitoring center) measures wide range of inflammatory markers, both conventional and experimentalUse accelerometer as opposed to self-report.
  • JustStand Summit 2013 - Morning Panel

    1. 1. GABRIEL KOEPP, M.H.A., B.S. Program Manager of Obesity Solutions Research Operations—Mayo Clinic Gabriel has developed and managed over 100 translational research projects creating scalable obesity solutions for companies, schools, and communities under the direction of Dr. James Levine of the Mayo Clinic. Numerous research projects have been publicized around the world, including nationally on the American Broadcasting Company and the National Broadcasting Company. Gabriel was also the Director of Clinical Services for Muve Incorporated, an award winning Mayo Medical Venture company founded in 2007. N.E.A.T. in Schools Gabe will introduce new research integrating Non Exercise Activity Thermogenesis in schools. Some of the methods we use include modifications to school curriculum, physical activity monitoring, and classroom redesign.
    2. 2. N.E.A.T in Schools Physical activity promotion in schools today
    3. 3. School of the Future
    4. 4. Data logger in waist pack Accelerometer attachment at thigh
    5. 5. Children in School (n=24) Children on vacation (n=16) Age (yrs) 10.2 ± 0.6 9.9 ± 1.4 Height (cm) 142.0 ± 8.7 145.1 ± 11.6 Sex (Male:Female) 10:14 10:6 Weight (kg) 40.7 ± 15.1 44.8 ± 12.7 BMI (kg/m2) 19.7 ± 4.9 21.1 ± 4.7 BMI percentile 62.8 ± 29.8 65.1 ± 29.0 BMI z-score 1.84 ± 0.34 1.95 ± 0.35
    6. 6. Results  Traditional classroom: 71 ± 0.4 m/s²  Activity Permissive Environment: 115 ± 3 m/s²  Summer Vacation: 113 ± 8 m/s² ***P<0.0001
    7. 7. Bamber Valley School District Rochester, MN
    8. 8. Methods  First grade students in an elementary public school (7F, 7M, 6.9 ± 0.4 years old, 24 ± 5.4 kg, 15.8 ± 2.57 kg/m2) accessed an Active Classroom for 30 minutes each day throughout the school year  Physical activity was measured using validated accelerometery for each of the four quarters for the duration of one week throughout the school year (1 week matched control days and 3 weeks Active Classroom days)
    9. 9. 0 500 1000 1500 2000 2500 3000 9:14 10:04 10:54 11:44 12:34 13:24 14:14 15:04 PhysicalAcvity(A.U.) Time of Day Ac ve Classroom Control Classroom
    10. 10. 30000 35000 40000 45000 50000 55000 60000 65000 Control Classroom Ac ve Classroom PhysicalAcvity(A.U) Time Matched Physical Ac vity Rest of the day
    11. 11. Minnesota Teacher and School Administrator Needs Assessment on Student Health
    12. 12. Teachers
    13. 13. School Administrators
    14. 14.  Increasing physical activity was school administrators #1 health concern for their students.  99.9% of teachers and administrators surveyed believe physical activity enhances academic performance.  90% of teachers and school administrators support integrating physical activity into existing curriculum
    15. 15. Nay Ah Shing Primary School
    16. 16. The Future…
    17. 17. Thank you GABRIEL KOEPP, M.H.A., B.S. Program Manager of Obesity Solutions Research Operations—Mayo Clinic
    18. 18. DR. MARK PEREIRA Associate Professor and Program Director of Public Health Nutrition— Faculty, Epidemiology & Community Health, School of Public Health, University of Minnesota Dr. Pereira‟s research is trans-disciplinary and spans from small controlled trials to large-scale epidemiologic cohort studies. It focuses on non-communicable disease etiology and epidemiology, with emphasis on pathways between environmental / lifestyle factors and chronic disease risk; it also has a special focus on type 2 diabetes. Dr. Pereira‟s publication record includes over 100 peer-reviewed scientific journal articles, reviews, editorials, and book chapters. Experiences with Sit-Stand Workstations in Sedentary Office Workers: Focus Group Analysis of a Randomized Trial In this presentation we will report on participants' experiences switching from typical sitting workstations to adjustable sit-stand workstations during a randomized cross-over trial in 28 sedentary office workers. Individual interviews, focus group sessions, and self- reported productivity surveys were conducted. In 2012, Dr. Pereira received the Outstanding Faculty Award from the Council of Graduate Students of the University of Minnesota.
    19. 19. Experience of Switching from a Traditional Sitting Workstation to a Sit-Stand Workstation in Sedentary Office Workers Mark A. Pereira, PhD Nirjhar Dutta, MS Thomas Walton, MPH Division of Epidemiology & Community Health School of Public Health University of Minnesota
    20. 20. Purpose  To examine how the installation and use of sit-stand workstations impacts personal and workplace experiences in sedentary office workers.
    21. 21. Experimental Design  Randomized within-person cross-over pilot study.  Twenty-nine adults were randomly assigned to use a sit-stand workstation or their usual sitting desk for two four-week periods. Period 1: Sitting/Sit-stand Two Week Washout Period 2: Sitting/Sit-stand
    22. 22. Setting  Caldrea, Inc. headquarters in Minneapolis, MN from January to April 2012.  One floor of a large office building with about 50 employees, all working in close proximity to one another in short-walled cubicles.
    23. 23. Intervention  Use an adjustable sit-or-stand desk with the goal of gradually decreasing sitting time over the month by 50%  One email was sent at the beginning of each week to reach/maintain goals.  During the control period the subjects were asked to maintain their usual work habits.
    24. 24. Workfit-S
    25. 25. Methodologies 1. One-on-one Interviews 2. Focus Groups
    26. 26. Structured Interviews  Open and closed-ended questions  Overall experience with sit-stand desks (SSDs)  Benefits and drawbacks of use  Potential for long-term use of SSD  „Likes‟ and „dislikes‟  Health effects  Impact on interaction with coworkers Data Analysis: Descriptive statistics and key themes
    27. 27. Focus Groups  Five focus groups conducted at the end of the study  3 groups for participants, 2 for non-participants  Stratified on employment level  supervisors v. non-supervisors  Conducted in private conference room for ~ 60 minutes
    28. 28. Focus Groups  Semi-structured approach, with respondents allowed to steer the conversation to issues they deemed relevant  Perceptions and opinions of the research design and study impact  How the workplace was transformed by the SSDs  Interactions with co-workers  Perceptions of productivity  Physical and health-related experiences
    29. 29. Focus Groups  Focus group sessions were recorded and transcribed verbatim.  Data were analyzed using grounded theory techniques.  Open coding: general themes were identified and applied to blocks of text.  Axial coding: connections between concepts and properties of general themes were identified and a second set of specific themes were generated.
    30. 30. Demographic Information Male Female Age Mean (SD) Individual interviews Participants in original study 9 19 41 (9) Focus groups Supervisors 3 5 36 (10) Non-supervisors 5 5 43 (5) Sitters (not part of the original study) 1 6
    31. 31. Positive Experiences Overall positive experience 96% Increased energy, focus, alertness 74% Increased “social energy” 59% Alleviation of back pain from prolonged sitting 19% Themes from Individual Interviews
    32. 32. Negative Experiences Reduction of desk space 25% Musculoskeletal soreness (legs and lower back) and fatigue for the first couple of weeks only (resolved thereafter) 37% Increased “social energy” as a distraction, not able to concentrate on difficult tasks while standing, standing causing invasion of privacy. 11% Themes from Individual Interviews, cont.
    33. 33. Theme Quotation Changes to the Physical Environment: Limited the availability of desk surface space “I did notice that when I wanted to have a workspace for writing there wasn‟t a lot of good workspace for that. So, that was a little bit irritating. I didn‟t end up sitting as much I guess. We had a table right next to us so I just kinda walked over there when I needed to do something like that.” Focus Group Themes
    34. 34. Theme Quotation Health Changes: Short-term discomfort and fatigue which subsided after a few weeks “At first I think I was really ambitious about it like „I‟m going to do it [stand] for most of the day right away…I spent like six or seven hours on it right off the bat trying to stand and that was maybe too much at first and so my feet would be sore, my lower back would be sore, but after two weeks I felt really adjusted and I felt better than I had in a long time.” Focus Group Themes
    35. 35. Theme Quotation Health Changes: Had to learn new postures for comfort “I found myself locking my knees which was part of the reason I had lower back issues [during the transition to a SSD]. And then when I had to consciously think about not locking my knees…it is definitely a learning curve…You have to think about how to stand and after time your body learns to stand the right way, but it is definitely not a natural thing to stand all day.” “I think what helped me was to learn how to stand differently throughout the day. Like don‟t just lock into one posture and, mix it up” Focus Group Themes
    36. 36. Theme Quotation Changes to Social Environment: Standing may facilitate interactions and communication “Somebody mentioned to me the other day how when they were just sitting or people around them were just sitting they would be more likely to send an email even though the person might be, I don‟t know, ten feet away but now if they see someone standing then the interaction is easier. It feels less invasive.” Focus Group Themes
    37. 37. Theme Quotation Productivity and Other Individual- Level Changes: Observed increased energy and focus without change in overall productivity “I think it [productivity] probably averages out to being the same as before because in some ways it allowed you to focus more so that I might get certain tasks done faster, especially computer tasks, email and talking on the phone; you just felt more awake in the morning and more focused, but paperwork things, sorting things, those things were really inconvenient to do [because of reduced desk surface area] and so you had to figure out how to do them and… that took up extra time… to try and figure that out. So it probably evens out to the same productivity. In the end because some things were better and some things were worse.” Focus Group Themes
    38. 38. Productivity Results Control Intervention P-value Hours Worked 38.3 37.1 0.16 Hours Missed due to Vacation/holiday etc. 1.52 1.58 0.93 Hours Missed due to Health Reasons 2.25 1.24 0.44 Health Negatively Impacting Productivity During Work 0.66 0.66 0.99 Health Negatively Impacting Productivity for Non-work Activity 1.01 0.74 0.28 “Work Productivity and Activity Impairment Questionnaire” Reilly MC, Zbrozek AS, Dukes EM. The validity and reproducibility of a work productivity and activity impairment instrument. Pharmacoeconomics 1993 Nov;4(5):353-365.
    39. 39. Recommendations for employers  Create enthusiasm! … informational sessions about the correlation between prolonged sedentary time and adverse health outcomes.  Ensure that managers and supervisors are using sit-stand desks along with employees.  Provide ergonomic evaluation for each employee before they start using SSDs.  Provide anti-fatigue mat for standing comfort but explain that it may be difficult to bring the chair to the desk when they want to sit down.  Allow employees to wear comfortable shoes at work.
    40. 40. Recommendations for employers  Make employees aware that there will likely be increased in face-to-face interaction and “social energy”, and this behavior is encouraged.  Build enthusiasm by communication of certain possible benefits including greater energy, alertness, and postural awareness.  Mark the implementation of SSDs part of a culture change focused on healthy eating, more movement, and less sitting.
    41. 41. Forewarnings  Requires at least two weeks to adjust to working with the SSDs. New habits may need development, and there may be loss of work-surface area.  Some physical discomfort for first two weeks, such as fatigue and low-back pain, but this typically subsides as the muscles adapt/strengthen.  There may be some perceived loss of privacy at the beginning. Suggest computer screen protectors, wireless headsets, and try to reduce the expectation of privacy at work so that employees feel more comfortable being visible.
    42. 42. Future Research Recommendations  Long-term impact of using SSDs on health of employees in the real-world setting over the long term  Developing job-specific tools to measure productivity easily, accurately, and reliably  Qualitative studies focused on the impact of using SSDs and workplace culture change
    43. 43. Acknowledgements  University of Minnesota‟s Obesity Prevention Center.  Nirjhar Dutta, MS and Thomas Walton, MPH  Dr. James Levine and Gabe Koepp, Mayo Clinic  Dr. Steven Stovitz  Carrie Schmitz, Michelle Judd, Jane Payfer, and others, Ergotron Inc.  Nancy Dykhoff, Caldrea Inc.  Nick Kuvaas  Employees of Caldrea
    44. 44. Neer and Matt… hard at work in „The Cave‟
    45. 45. Thank you DR. MARK PEREIRA Associate Professor and Program Director of Public Health Nutrition— Faculty, Epidemiology & Community Health, School of Public Health, University of Minnesota
    46. 46. DR. KATHLEEN HORST Assistant Professor—Stanford University A Stanford-trained physician and current faculty member, Dr. Kathleen Horst is a radiation oncologist with an interest in the psychological and physical impact a cancer diagnosis has on a patient. She has authored multiple scientific papers and book chapters, and has presented at conferences worldwide. She is currently exploring the effect radiation therapy has on a person's physical activity level. GRANT OGNIBENE Clinical Research Assistant—Stanford University A former emergency medical technician at a fire department in California, Grant has always had an interest in fitness and physical activity. In 2012, he joined Stanford University as a clinical research assistant and has applied for medical school. Stanford University is conducting an IRB-approved study that seeks to understand the changes in back pain from access to a sit-stand workstation. Participants are randomized upfront versus delayed intervention. Stanford has collaborated with Ergotron to provide WorkFits to study participants. Length of study: 12 weeks; measurement type: self-reported, electronic To Evaluate the Changes in Back Pain from the Use of a Sit-Stand Workstation
    47. 47. Does Access to a Sit-Stand Workstation Improve Back Pain? A Prospective Evaluation Dr. Kathleen Horst Grant Ognibene Stanford University
    48. 48. Background  Personal experience  WorkFit-S  Pain free within a few weeks  Developed research question  No published studies related to back pain and sit-stand workstation  Collaboration with Ergotron
    49. 49. Background  Met with Stanford University physicians, researchers, and biostatisticians  Experts in the field of pain, orthopedics, ergonomics, and physical activity  Pilot study to assess for intra- and inter-participant variability  Sample Size: 46 participants
    50. 50. Study Design  Hypothesis  Participants given a sit-stand workstation will have less back pain  Two-arm, randomized study  Intervention Group = Sit-stand workstation  Control Group = No sit-stand workstation  12 weeks of active participation  Primary Endpoint: Change in back pain  Secondary Endpoint: Change in other pain
    51. 51. Study Design – Instruments  Comprehensive Pain Survey – Week 1, 6, and 12  Validated instruments related to pain and quality of life  Lifestyle behaviors  Daily Pain Survey – Each Work Day  Pain in various body parts and medication/analgesic use.  Follow-Up Survey – 8 Weeks After Study Completion
    52. 52. Study Timeline = WorkFit Installed = Intervention Arm X = Follow-Up Survey 206 121 C = Comprehensive Survey 3 C C C X CC = Control Arm
    53. 53. Inclusion Criteria  Stanford University Employees  Recently opened to Stanford University graduate students due to overwhelming interest by this group  Self-reported back pain score ≥ 4 on scale  Sit for ≥ 6 hours in an 8 hour day  Back pain > 3 months duration
    54. 54. Exclusion Criteria  Unable to stand for 10 minutes without considerable pain  Currently using a sit-stand workstation
    55. 55. Implementation of Study  Opened April 22, 2013  Received excellent response  Advertised by email lists, wellness program, and flyers around campus  WorkFit A and WorkFit S
    56. 56. Location of Participants
    57. 57. Current Status of Study  40 participants enrolled  22 in intervention group  18 in control group  4-6 participants per week  First participants completed the study on July 12  Expect to meet accrual goal by end of summer and full analysis of data by end of year
    58. 58. Challenges  Many different desk set-ups  Different size monitors, overhead bins, etc  Intended to install sit-stand workstation during Week 3 of study  Many not installed until Week 4-6  Vacations
    59. 59. Future Directions  Objective measurement of sit-stand time using accelerometer  Analysis of biomarkers related to health  High sensitivity C-reactive protein, cholesterol, hemoglobin A1C, cytokines, and telomeres
    60. 60. Acknowledgments  Ergotron  Stanford University Employees and Graduate Students  Wilson Torres
    61. 61. Thank you DR. KATHLEEN HORST Assistant Professor—Stanford University GRANT OGNIBENE Clinical Research Assistant—Stanford University
    62. 62. Thank YOU, Panelists! Questions, audience?