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Reducing sitting time at work: What's the evidence?

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Health Evidence hosted a 60 minute webinar examining the effectiveness of workplace interventions for reducing sitting at work. Click here for access to the audio recording for this webinar: https://youtu.be/psmac6jkbMM

Dr. Nipun Shrestha, MBBS, MPH, Postgraduate Student at Victoria University led the session and presented findings from his recent Cochrane review:

Shrestha N, Kukkonen-harjula KT, Verbeek JH, Ijaz S, Hermans V, & Bhaumik S. (2016). Workplace interventions for reducing sitting at work. Cochrane Database of Systematic Reviews, 2016(3), Art. No.: CD010912.
http://healthevidence.org/view-article.aspx?a=workplace-interventions-reducing-sitting-work-28404

Office work has become sedentary in nature. Increased sitting has been linked to increase in cardiovascular disease, obesity and overall mortality. This review examines the impact of workplace interventions to reduce sitting at work. Two cross-over randomized control trials, 11 cluster randomized trials and 4 controlled before-and-after studies, including 2180 participants are included in this review. Findings suggest that sit-stand desks may decrease workplace sitting. This webinar examined the effectiveness and components of interventions that reduce sitting at work.

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Reducing sitting time at work: What's the evidence?

  1. 1. Welcome! Reducing sitting time at work: What's the evidence? You will be placed on hold until the webinar begins. The webinar will begin shortly, please remain on the line.
  2. 2. Poll Questions: Consent • Participation in the webinar poll questions is voluntary • Names are not recorded and persons will not be identified in any way • Participation in the anonymous polling questions is accepted as an indication of your consent to participate Benefits: • Results inform improvement of the current and future webinars • Enable engagement; stimulate discussion. This session is intended for professional development. Some data may be used for program evaluation and research purposes (e.g., exploring opinion change) • Results may also be used to inform the production of systematic reviews and overviews Risks: None beyond day-to-day living
  3. 3. After Today • The PowerPoint presentation and audio recording will be made available • These resources are available at: – PowerPoint: https://www.slideshare.net/HealthEvidence/presentations – Audio Recording: https://www.youtube.com/user/healthevidence/videos
  4. 4. What’s the evidence? Shrestha N, Kukkonen-harjula KT, Verbeek JH, Ijaz S, Hermans V, & Bhaumik S. (2016). Workplace interventions for reducing sitting at work. Cochrane Database of Systematic Reviews, 2016(3), Art. No.: CD010912. http://healthevidence.org/view- article.aspx?a=workplace-interventions-reducing-sitting- work-28404
  5. 5. • Use CHAT to post comments / questions during the webinar – ‘Send’ questions to All (not privately to ‘Host’) • Connection issues – Recommend using a wired Internet connection (vs. wireless) • WebEx 24/7 help line – 1-866-229-3239 Participant Side Panel in WebEx Housekeeping
  6. 6. Housekeeping (cont’d) • Audio – Listen through your speakers – Go to ‘Communicate > Audio Broadcast’ • WebEx 24/7 help line – 1-866-229-3239
  7. 7. Poll Question #1 How many people are watching today’s session with you? A. Just me B. 2-3 C. 4-5 D. 6-10 E. >10
  8. 8. The Health Evidence™ Team Maureen Dobbins Scientific Director Heather Husson Manager Susannah Watson Project Coordinator Students: Emily Belita (PhD candidate) Jennifer Yost Assistant Professor Olivia Marquez Research Coordinator Emily Sully Research Assistant Liz Kamler Research Assistant Zhi (Vivian) Chen Research Assistant Research Assistants: Lina Sherazy Claire Howarth Rawan Farran
  9. 9. What is www.healthevidence.org? Evidence Decision Making inform
  10. 10. Why use www.healthevidence.org? 1. Saves you time 2. Relevant & current evidence 3. Transparent process 4. Supports for EIDM available 5. Easy to use
  11. 11. A Model for Evidence- Informed Decision Making National Collaborating Centre for Methods and Tools. (revised 2012). A Model for Evidence-Informed Decision-Making in Public Health (Fact Sheet). [http://www.nccmt.ca/pubs/FactSheet_EIDM_EN_WEB.pdf]
  12. 12. Stages in the process of Evidence-Informed Public Health National Collaborating Centre for Methods and Tools. Evidence-Informed Public Health. [http://www.nccmt.ca/eiph/index-eng.html]
  13. 13. Poll Question #2 Have you heard of PICO(S) before? A. Yes B. No
  14. 14. Searchable Questions Think “PICOS” 1.Population (situation) 2.Intervention (exposure) 3.Comparison (other group) 4.Outcomes 5.Setting
  15. 15. How often do you use Systematic Reviews to inform a program/services? A. Always B. Often C. Sometimes D. Never E. I don’t know what a systematic review is Poll Question #3
  16. 16. Nipun Shrestha, Active Living & Public Health Group, Institute of Sport, Exercise and Active Living (ISEAL), Victoria University
  17. 17. Workplace Sitting Review Team • Katriina T Kukkonen-Harjula, UKK Institute for Health Promotion Research, Tampere, Finland • Jos Verbeek, Cochrane Work Review Group, Finnish Institute of Occupational Health, Kuopio, Finland • Sharea Ijaz, Cochrane Work Review Group, Finnish Institute of Occupational Health, Kuopio, Finland • Veerle Hermans, Faculty of Psychology & Educational Sciences, Faculty of Medicine & Pharmacy, Vrije Universiteit Brussel, Brussels • Soumyadeep Bhaumik, Kolkata, India
  18. 18. Changing patterns of sedentary behaviour in the workplace
  19. 19. • Data from a representative sample of US adults show that over 50% of waking hours are spent sedentary (Healy et al. 2011) Changing patterns of sedentary behaviour • 21% of Australian adults spend > 8 hours a day being sedentary (Bennie et al. 2016) • Data from 28 European Union countries show that 18.5% of adults spend >7.5 hours a day being sedentary at work and during leisure (Loyen et al. 2016)
  20. 20. Changing patterns of sedentary behaviour 0 5 10 15 20 25 30 35 40 45 2000 2005 2010 2015 2020 Averagehoursperweekbeingsedentary Year US India
  21. 21. Increased risk of various chronic conditions • All cause mortality ↑↑ • Cardiovascular disease mortality ↑↑ • Cardiovascular disease incidence ↑ • Cancer mortality ↑↑ • Cancer incidence ↑ The Chairman’s curse Metabolic Diabetes Cardiovascular Hypertension Many chronic disease and conditions Mechanical Arthritis Back pain Malignancy Breast Mental Depression ‘Creativity’
  22. 22. Growing interest in the field Is sitting a new smoking?Is sitting a new smoking?Is sitting a new smoking? Is sitting the new smoking? • 39% of news articles stated that being physically active does not matter if you sit for prolonged periods of time
  23. 23. • From inception to February 2014: 8 studies identified • From March 2014 to June 2015 : 12 new studies identified • Almetric score: 983 with 90 news stories from 83 outlets including Time magazine & The Guardian Growing interest in the field
  24. 24. Workplace interventions 1. Physical changes in workplace environment Layout of the workplace: moving Office desks printers away from desk• •
  25. 25. Organisation of work policy2. Social environment support Walking strategies • • Information and counseling3. Signs/prompts E-health intervention Counseling 4. Workplace interventions • • • Multiple category intervention
  26. 26. Research question Are there good studies that show that these interventions work ?
  27. 27. •RCTs , Cluster RCTs, Controlled before-after studies (CBAs)Study design •Employees working behind the deskParticipants •Physical changes in the workplace environment •A policy to change the organisation of work •Information and counselling Intervention •Self-reported or objectively measured time spent seated at work •Adverse events Outcome Inclusion criteria Comparison • No intervention / other active intervention
  28. 28. • Cochrane Central Register of Controlled Trials (CENTRAL), • MEDLINE, • EMBASE, • CINAHL, • OSH UPDATE, • PsycINFO, • Clinical trials.gov and • World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal SearchSearch
  29. 29. • 20 studies • 2174 participants • very low to low quality evidence (GRADE) • Risk of bias high: non randomised, unblinded, unconcealed allocation • Small sample size Results
  30. 30. Results Physical changes in workplace environment: 9 studies (5 RCTs, 4 CBAs) •Sit-stand desk: 6 studies (3 CBAs, 3 RCTs) •Sit-stand desk + counselling: 2 studies (2 CBAs) •Treadmill desk: 1 RCT •Cycling workstation : 1 RCT 1. Organisation of work policy • Walking strategies: 2 RCTs 2.
  31. 31. Information and counseling: 7 RCTs • Counselling: 2 RCTs • E-newsletter: 1 RCT • Computer prompts: 2 RCTs • Computer prompts to stand vs. computer prompts to step: 1 RCT • Mindfulness training: 1 RCT Multiple category intervention: 2 RCTs4. 3. Results
  32. 32. Results: Change in sitting time at work Physical changes in workplace environment : • Sit-stand desk: between half to two hours at short term (up to 3 months') follow-up • Sit-stand desk + counselling: reduction in same range at 3 months' follow up • Treadmill desk: half hour reduction at 12 weeks' follow-up • Cycling workstation: no effect
  33. 33. Results
  34. 34. Results
  35. 35. Results Policy changes: • Walking groups: no effect Information and counselling: • Counselling: half hour reduction at medium term follow-up (3 months to 12 months) • E-newsletter: no effect • Computer prompting: inconsistent effect • Mindfulness training: no effect Multiple category intervention inconsistent effect
  36. 36. Secondary outcomes • Musculoskeletal symptoms: no effect seen with sit-stand desk • Work productivity: no effect seen with sit-stand desk • Sick leave: no effect seen with sit-stand desk • Varicose veins : no studies were found that assessed if standing at work increases the risk of varicose veins
  37. 37. Sitting review conclusion • Sit-stand desk may decrease workplace sitting between half an hour to two hours per day without having adverse effects • Very low quality evidence likely to change in the future
  38. 38. Sitting review conclusion It remains unclear if standing can repair the harms of sitting because there is hardly any extra energy expenditure • Be careful with buying a sit-stand desk or treadmill desk since it is not proven yet that by using this we can avoid health problems or that it causes sufficient movement/energy expenditure • No studies from low-middle income countries •
  39. 39. Expert Statement
  40. 40. Key unanswered questions in sedentary behaviour research Can we change sitting behaviour over the long- term in real-world? • If so, how much change is realistically possible?• What intervention approaches would be most effective at inducing long-term sitting behaviour reduction? • Does changing sitting behaviour have a positive effect on long-term health outcomes? i.e. body weight, cholesterol, blood pressure, blood glucose •
  41. 41. A Model for Evidence- Informed Decision Making National Collaborating Centre for Methods and Tools. (revised 2012). A Model for Evidence-Informed Decision-Making in Public Health (Fact Sheet). [http://www.nccmt.ca/pubs/FactSheet_EIDM_EN_WEB.pdf]
  42. 42. Poll Question #4 The information presented today was helpful A. Strongly agree B. Agree C. Neutral D. Disagree E. Strongly disagree
  43. 43. What can I do now? Visit the website; a repository of 5,000+ quality-rated systematic reviews related to the effectiveness of public health interventions. Health Evidence™ is FREE to use. Register to receive monthly tailored registry updates AND monthly newsletter to keep you up to date on upcoming events and public health news. Tell your colleagues about Health Evidence™: helping you use best evidence to inform public health practice, program planning, and policy decisions! Follow us @HealthEvidence on Twitter and receive daily public health review- related Tweets, receive information about our monthly webinars, as well as announcements and events relevant to public health. Encourage your organization to use Health Evidence™ to search for and apply quality-rated review level evidence to inform program planning and policy decisions. Contact us to suggest topics or provide feedback. info@healthevidence.org
  44. 44. Poll Question #5 What are your next steps? [Check all that apply] A. Access the full text systematic review B. Access the quality assessment for the review on www.healthevidence.org C. Consider using the evidence D. Tell a colleague about the evidence
  45. 45. Thank you! Contact us: info@healthevidence.org For a copy of the presentation please visit: http://www.healthevidence.org/webinars.aspx

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