Reducing prolonged sitting time in the office: impact of sit-to-stand workstations on health and productivity

1. Reducing Prolonged Sitting Time in the
Office: Impact of Sit-to-Stand Workstations
on Health and Productivity
Ergotron Summit
Eagan, MN
July 10, 2012
Nico Pronk, Ph.D., MA, FACSM, FAWHP
VP and Health Science Officer
HealthPartners, Minneapolis, MN
Adj. Professor of Society, Human Development, and Health
Harvard School of Public Health, Boson, MA

2. Agenda
• Introduction
• Project “Take-A-Stand”
– Purpose
– Approach
– Methods
– Results
• Dissemination of findings
• Discussion

3. Introduction
• Physical inactivity is a major public health burden in the U.S.
today
• Prolonged sitting is recognized as an independent risk factor
for a variety of health issues, including back pain, metabolic
syndrome, hypertension, stroke, cardiovascular disease,
diabetes, and all-cause as well as cardiovascular disease
mortality
• In the contemporary workplace, sedentary work tasks have
become increasingly prevalent with many workers involved in
activities characterized by extended and prolonged sitting
time
• Reducing prolonged sitting time among employees may prove
beneficial for selected health outcomes, productivity, mood
states, and overall worker well-being

4. Project “Take-a-Stand”
• Purpose
– To conduct a practice-based evaluation of a
sit-to-stand device on prolonged sitting time,
selected health-related factors, mood states,
and other indices of work performance and
office behavior
• Design
– Practice-based project
– Non-randomized, interrupted time series with
a two-group pre-post comparison

5. Project “Take-a-Stand”
• Approach
– 7 week project with intervention (n=24) and comparison groups (n=10)
– Experience sampling method (ESM) used to gather insight into sitting,
standing, or walking behaviors
• All subjects provided with pre-paid cell phones
• All subjects received 3 text messages at random times throughout the
workday during the 7 week period and were asked to respond with a
return text indicating:
– “0” for sitting
– “1” for standing
– “2” for walking
– 3 messages x 5 days/wk x 7 wks = 105 observations over 35 days per subject
– 105 observations x 34 subjects = 3,570 observations
– Surveys conducted at baseline, end of week 5, and end of week 7
– All participants monitored daily step count with pedometers throughout the 7
weeks
– Change scores calculated for baseline to week 5 and week 5 to week 7
– Independent samples t-tests used to test for significance (at p<.05 and with
Bonferroni correction at p<.017)

6. Project “Take-a-Stand”
• Approach
– During weeks 2-5, only the intervention group was
provided with a sit-to-stand device (Ergotron, Eagan, MN)
• WorkFit S (n=18) or WorkFit C (n=6)

7. Results
• Demographics
• ESM data on sitting, standing, and walking behavior
• Survey data on sitting time at work, TV-viewing, and
commuting time
• Profile of mood states (POMS) data
• Selected health factors
– Back pain, upper neck and back pain
– Productivity (WPAI)
– Selected office behaviors
– Other perceptions and observations

8. Project Participant Demographics by Group
Intervention Group Comparison Group
• N = 24 • N = 10
• Age = 38.4 yrs • Age = 44.2 yrs
• Gender = 96% female • Gender = 80% female
• BMI = 22.8 kg/m2 • BMI = 22.8 kg/m2
• VO2max = 35.6 ml/kg/min • VO2max = 34.0 ml/kg/min
(good/excellent) (excellent)
• Physical activity = 474.6 min/wk • Physical activity = 305.5 min/wk
• General health excellent or good: • General health excellent or good:
79% 100%
• Job role • Job role
– Administrative support: 8.3% – Administrative support: --%
– Customer service: 12.5% – Customer service: --%
– Account management: 12.5% – Account management: 10%
– Health coach: 54.2% – Health coach: 60%
– Manager: 4.2% – Manager: 20%
– Other: 8.3% – Other: 10%

9. Experience Sampling Method (ESM) Data
• Individual-level daily ESM by group
• Individual-level daily average ESM by group
• Daily average ESM by group
• Weekly average ESM by group
• ESM data by project period and group
– Note: 1 subject missed more than 4 weeks of ESM due to PTO and was not
included in the ESM data analysis
– Experience Sampling Method is based on the work by M. de Vries (1992)

10. Individual-Level Daily ESM Data by Group
Walk
Stand
Sit

11. Individual-Level Daily Average ESM Data by Group
WorkFit Stations Installed
Walk
Intervention
Group Stand
Sit
Walk Days
Control
Group Stand
Sit
Days

12. Daily Average ESM Data by Group
Walk
WorkFit Stations Installed
Stand
Sit

13. Weekly Average ESM Scores by Group
WorkFit Stations Installed

14. Average Experience Sampling Score by Period and Group
WorkFit Stations Installed
224% reduction
in sitting time
Note: ESM = Experience Sampling Method; ESM Score represents the average arbitrary score by period generated by
participants responding to the questions whether they were sitting, standing, or walking with a “0”, “1”, or “2”, respectively;
Period 1 represents the pre-intervention period (average across 1 wk); Period 2 represents the intervention period (average
across 4 wks); Period 3 represents the post-intervention period (average across 2 wks).

15. Sitting Time While at Work
Based on surveys conducted at
baseline, 5 weeks, and 7
weeks:
* • Significant reduction in
sitting time of 66.8 min/d
(p<0.05) for the intervention
group only
• No change in daily sitting
time related to TV-viewing
or during commuting time
for either group

16. Back and Neck Pain Outcomes
Low Back Pain or Discomfort Upper Back, Neck, and Shoulder Pain
*
Low back (NS) and upper back and neck (p=0.008) pain showed
improvements for the Intervention Group but not the Comparison Group.
Back pain scales on a 0 to 10 rating (no discomfort – extremely uncomfortable)

17. Profile of Mood States (POMS) Outcomes
*
*
* * *
*
(Total Mood
Disturbance)
No significant changes noted in POMS variables for the Comparison Group

18. Selected Office Behaviors
Percent time spent on e-Mail, telephone, scheduled meetings, informal business-related face-to-
face meetings with co-workers, and “moving” breaks
Intervention Group Comparison Group
*
Face-to-face (business-related) meetings with co-workers were significantly
reduced between week 5 and week 7 (p < 0.05) for the Intervention Group.

19. Productivity and Perceived Support
Productivity
• No significant changes were observed for either group in
absenteeism, presenteeism, overall health-related
productivity loss, or other indicators of health on function
Perceived Support
• The addition of the WorkFit stations showed a non-
statistically significant increase in perceived departmental
support for employee health in both groups and reduced
upon removal of the devices

20. Correlations
• Pearson’s correlation coefficients were calculated to
test the association between changes in sitting time
for all participants (N=34) during period 1 and 2 of
the project while at work and changes in back pain,
office behaviors, and mood states.
• Reductions in sitting time were significantly
associated with reductions in:
– Upper back and neck pain (r = .47; p = .006)
– Fatigue (r = .44; p = .01)
– Confusion (r = .46; p = .007)
– Total mood disturbance (r = .35; p = .046)

21. Use of WorkFit Device
Intervention Group only
• 67% used the device to alternate between sitting and standing for most of
the day
• 75% indicated the typical duration when they chose to stand was 60 min
or longer
• Overall, alternating between a seated and standing position while working
made 67% feel a lot better and 33% feel better
• When asked about specific benefits gained by alternating between a
seated and standing position while working,
– 87% felt more comfortable
– 76% felt more energized
– 75% felt healthier
– 71% felt more focused
– 66% felt more productive
– 62% felt happier
– 33% indicated feeling less stressed

22. Conclusions
• Introduction of the WorkFit sit-to-stand devices among a group of highly active,
fit, normal weight, apparently healthy, mostly female employees with relatively
sedentary work tasks:
– Increased non-sitting time by more than an hour per day
– Reduced upper back, neck and shoulder pain
– Improved mood states
– Increased face-to-face time during work
• Participants felt the WorkFit devices made them feel:
– More comfortable (87%)
– More energized (76%)
– Healthier (75%)
– More focused (71%)
– More productive (66%)
– Happier (62%)
– Less stressed (33%)
• Removal of the devices after four weeks eliminated most improvements
generated due to the intervention, in many cases to below baseline levels

23. Media Coverage
• PR and News releases
• Newspaper interviews
• Feature stories in local press
• PR Newswire in Times Square, New York
• AHIP Solutions SmartBriefs
• ABC12.com
• (Google search on “healthpartners standing at
work” gets 5,230,000 hits)

24. Dissemination
• HealthPartners (13,000 employees) has integrated sit-to-stand
devices into the workstations of all employees with sedentary
work tasks AND who are interested in trying one out
• HealthPartners Health and Well-Being /JourneyWell division
has integrated the sit-to-stand device into its worksite health
and productivity suite of solutions (reach of approximately
450,000 employees nationwide) using a deployment strategy
with Ergotron (dedicated web portal)
• Ergotron has integrated the result of this project into its
marketing and advertising campaigns
• Manuscript on the “Take-a-Stand” project has been accepted
for publication and is currently in press (Preventing Chronic
Disease)

25. Discussion
Thank you