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.

1. Welcome!
Reducing sitting time at work:
What's the evidence?
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2. Poll Questions: Consent
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and research purposes (e.g., exploring opinion change)
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and overviews
Risks: None beyond day-to-day living

3. After Today
• The PowerPoint presentation and audio
recording will be made available
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– PowerPoint:
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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

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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. The Health Evidence™ Team
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9. What is www.healthevidence.org?
Evidence
Decision
Making
inform

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. 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. 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. Poll Question #2
Have you heard of PICO(S) before?
A. Yes
B. No

14. Searchable Questions Think “PICOS”
1.Population (situation)
2.Intervention (exposure)
3.Comparison (other group)
4.Outcomes
5.Setting

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. Nipun Shrestha,
Active Living & Public Health
Group, Institute of Sport,
Exercise and Active Living
(ISEAL), Victoria University

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. Changing patterns of sedentary behaviour in the workplace

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. 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. 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. 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. • 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. Workplace interventions
1. Physical changes in workplace environment
Layout of the workplace: moving
Office desks
printers away from desk•
•

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. Research question
Are there good studies that show that these interventions work ?

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. • 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. • 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. 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. 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. 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. Results

34. Results

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. 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. 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. 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. Expert Statement

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. 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. Poll Question #4
The information presented today was
helpful
A. Strongly agree
B. Agree
C. Neutral
D. Disagree
E. Strongly disagree

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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. Thank you!
Contact us:
info@healthevidence.org
For a copy of the presentation please visit:
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