Workplace interventions for reducing sitting at work

doi:10.1002/14651858.CD010912.pub4

Meta-Analysis

. 2018 Jun 20;6(6):CD010912.

doi: 10.1002/14651858.CD010912.pub4.

Workplace interventions for reducing sitting at work

Nipun Shrestha¹, Katriina T Kukkonen-Harjula, Jos H Verbeek, Sharea Ijaz, Veerle Hermans, Zeljko Pedisic

Affiliations

PMID: 29926475
PMCID: PMC6513236
DOI: 10.1002/14651858.CD010912.pub4

Meta-Analysis

Workplace interventions for reducing sitting at work

Nipun Shrestha et al. Cochrane Database Syst Rev. 2018.

. 2018 Jun 20;6(6):CD010912.

doi: 10.1002/14651858.CD010912.pub4.

Authors

Nipun Shrestha¹, Katriina T Kukkonen-Harjula, Jos H Verbeek, Sharea Ijaz, Veerle Hermans, Zeljko Pedisic

Affiliation

¹ Institute for Health and Sport (IHES), Victoria University, Melbourne, Victoria, Australia.

PMID: 29926475
PMCID: PMC6513236
DOI: 10.1002/14651858.CD010912.pub4

Update in

Workplace interventions for reducing sitting at work.
Shrestha N, Kukkonen-Harjula KT, Verbeek JH, Ijaz S, Hermans V, Pedisic Z. Shrestha N, et al. Cochrane Database Syst Rev. 2018 Dec 17;12(12):CD010912. doi: 10.1002/14651858.CD010912.pub5. Cochrane Database Syst Rev. 2018. PMID: 30556590 Free PMC article.

Abstract

Background: A large number of people are employed in sedentary occupations. Physical inactivity and excessive sitting at workplaces have been linked to increased risk of cardiovascular disease, obesity, and all-cause mortality.

Objectives: To evaluate the effectiveness of workplace interventions to reduce sitting at work compared to no intervention or alternative interventions.

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, OSH UPDATE, PsycINFO, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal up to 9 August 2017. We also screened reference lists of articles and contacted authors to find more studies.

Selection criteria: We included randomised controlled trials (RCTs), cross-over RCTs, cluster-randomised controlled trials (cluster-RCTs), and quasi-RCTs of interventions to reduce sitting at work. For changes of workplace arrangements, we also included controlled before-and-after studies. The primary outcome was time spent sitting at work per day, either self-reported or measured using devices such as an accelerometer-inclinometer and duration and number of sitting bouts lasting 30 minutes or more. We considered energy expenditure, total time spent sitting (including sitting at and outside work), time spent standing at work, work productivity and adverse events as secondary outcomes.

Data collection and analysis: Two review authors independently screened titles, abstracts and full-text articles for study eligibility. Two review authors independently extracted data and assessed risk of bias. We contacted authors for additional data where required.

Main results: We found 34 studies - including two cross-over RCTs, 17 RCTs, seven cluster-RCTs, and eight controlled before-and-after studies - with a total of 3,397 participants, all from high-income countries. The studies evaluated physical workplace changes (16 studies), workplace policy changes (four studies), information and counselling (11 studies), and multi-component interventions (four studies). One study included both physical workplace changes and information and counselling components. We did not find any studies that specifically investigated the effects of standing meetings or walking meetings on sitting time.Physical workplace changesInterventions using sit-stand desks, either alone or in combination with information and counselling, reduced sitting time at work on average by 100 minutes per workday at short-term follow-up (up to three months) compared to sit-desks (95% confidence interval (CI) -116 to -84, 10 studies, low-quality evidence). The pooled effect of two studies showed sit-stand desks reduced sitting time at medium-term follow-up (3 to 12 months) by an average of 57 minutes per day (95% CI -99 to -15) compared to sit-desks. Total sitting time (including sitting at and outside work) also decreased with sit-stand desks compared to sit-desks (mean difference (MD) -82 minutes/day, 95% CI -124 to -39, two studies) as did the duration of sitting bouts lasting 30 minutes or more (MD -53 minutes/day, 95% CI -79 to -26, two studies, very low-quality evidence).We found no significant difference between the effects of standing desks and sit-stand desks on reducing sitting at work. Active workstations, such as treadmill desks or cycling desks, had unclear or inconsistent effects on sitting time.Workplace policy changesWe found no significant effects for implementing walking strategies on workplace sitting time at short-term (MD -15 minutes per day, 95% CI -50 to 19, low-quality evidence, one study) and medium-term (MD -17 minutes/day, 95% CI -61 to 28, one study) follow-up. Short breaks (one to two minutes every half hour) reduced time spent sitting at work on average by 40 minutes per day (95% CI -66 to -15, one study, low-quality evidence) compared to long breaks (two 15-minute breaks per workday) at short-term follow-up.Information and counsellingProviding information, feedback, counselling, or all of these resulted in no significant change in time spent sitting at work at short-term follow-up (MD -19 minutes per day, 95% CI -57 to 19, two studies, low-quality evidence). However, the reduction was significant at medium-term follow-up (MD -28 minutes per day, 95% CI -51 to -5, two studies, low-quality evidence).Computer prompts combined with information resulted in no significant change in sitting time at work at short-term follow-up (MD -10 minutes per day, 95% CI -45 to 24, two studies, low-quality evidence), but at medium-term follow-up they produced a significant reduction (MD -55 minutes per day, 95% CI -96 to -14, one study). Furthermore, computer prompting resulted in a significant decrease in the average number (MD -1.1, 95% CI -1.9 to -0.3, one study) and duration (MD -74 minutes per day, 95% CI -124 to -24, one study) of sitting bouts lasting 30 minutes or more.Computer prompts with instruction to stand reduced sitting at work on average by 14 minutes per day (95% CI 10 to 19, one study) more than computer prompts with instruction to walk at least 100 steps at short-term follow-up.We found no significant reduction in workplace sitting time at medium-term follow-up following mindfulness training (MD -23 minutes per day, 95% CI -63 to 17, one study, low-quality evidence). Similarly a single study reported no change in sitting time at work following provision of highly personalised or contextualised information and less personalised or contextualised information. One study found no significant effects of activity trackers on sitting time at work.Multi-component interventions Combining multiple interventions had significant but heterogeneous effects on sitting time at work (573 participants, three studies, very low-quality evidence) and on time spent in prolonged sitting bouts (two studies, very low-quality evidence) at short-term follow-up.

Authors' conclusions: At present there is low-quality evidence that the use of sit-stand desks reduce workplace sitting at short-term and medium-term follow-ups. However, there is no evidence on their effects on sitting over longer follow-up periods. Effects of other types of interventions, including workplace policy changes, provision of information and counselling, and multi-component interventions, are mostly inconsistent. The quality of evidence is low to very low for most interventions, mainly because of limitations in study protocols and small sample sizes. There is a need for larger cluster-RCTs with longer-term follow-ups to determine the effectiveness of different types of interventions to reduce sitting time at work.

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Conflict of interest statement

Nipun Shrestha: None known.

Jos Verbeek: I am employed by the Finnish Institute of Occupational Health to co‐ordinate the Cochrane Work Group.

Sharea Ijaz: None known.

Katriina T Kukkonen‐Harjula: None known.

Veerle Hermans: None known.

Zeljko Pedisic: None known.

Figures

**Figure 2**
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

**Figure 3**
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

**Figure 4**
Funnel plot of comparison: 1 Sit‐stand desk with or without information and counselling versus sit‐desk, outcome: 1.1 Mean difference in time spent sitting at work: short‐term follow‐up.

**Analysis 1.1**
Comparison 1 Sit‐stand desk with or without information and counselling versus sit‐desk, Outcome 1 Mean difference in time spent sitting at work follow‐up short‐term.

**Analysis 1.2**
Comparison 1 Sit‐stand desk with or without information and counselling versus sit‐desk, Outcome 2 Mean difference in time spent sitting at work, follow‐up short‐term ‐ sensitivity analysis.

**Analysis 1.3**
Comparison 1 Sit‐stand desk with or without information and counselling versus sit‐desk, Outcome 3 Mean difference in time spent sitting at work. follow‐up medium‐term (CBA).

**Analysis 1.4**
Comparison 1 Sit‐stand desk with or without information and counselling versus sit‐desk, Outcome 4 Mean difference in time in sitting bouts lasting 30 minutes or more, follow‐up short‐term (CBA).

**Analysis 1.5**
Comparison 1 Sit‐stand desk with or without information and counselling versus sit‐desk, Outcome 5 Mean difference in total time spent sitting (including sitting at and outside work), follow‐up short‐term.

**Analysis 1.6**
Comparison 1 Sit‐stand desk with or without information and counselling versus sit‐desk, Outcome 6 Mean difference in time spent standing at work, follow‐up short‐term.

**Analysis 1.7**
Comparison 1 Sit‐stand desk with or without information and counselling versus sit‐desk, Outcome 7 Mean difference in time spent standing at work, follow‐up short‐term (RCT only).

**Analysis 1.8**
Comparison 1 Sit‐stand desk with or without information and counselling versus sit‐desk, Outcome 8 Mean difference in time spent stepping at work follow‐up short‐term.

**Analysis 1.9**
Comparison 1 Sit‐stand desk with or without information and counselling versus sit‐desk, Outcome 9 Mean difference in time spent standng at work, follow‐up medium‐term (CBA).

**Analysis 1.10**
Comparison 1 Sit‐stand desk with or without information and counselling versus sit‐desk, Outcome 10 Work performance (1‐10 scale), follow‐up short‐term (CBA).

**Analysis 1.11**
Comparison 1 Sit‐stand desk with or without information and counselling versus sit‐desk, Outcome 11 Proportion with ≥ 1 sick days in the last three months (CBA).

**Analysis 1.12**
Comparison 1 Sit‐stand desk with or without information and counselling versus sit‐desk, Outcome 12 Proportion with ≥ 1 sick days in the last month (CBA).

**Analysis 1.13**
Comparison 1 Sit‐stand desk with or without information and counselling versus sit‐desk, Outcome 13 Mean difference in musculoskeletal symptoms, follow‐up short‐term.

**Analysis 1.14**
Comparison 1 Sit‐stand desk with or without information and counselling versus sit‐desk, Outcome 14 Mean difference in musculoskeletal symptoms, follow‐up Medium‐term.

**Analysis 2.1**
Comparison 2 Standing desk versus sit‐stand desk, Outcome 1 Mean difference in time spent sitting at work, follow‐up short‐term.

**Analysis 2.2**
Comparison 2 Standing desk versus sit‐stand desk, Outcome 2 Mean difference in time spent sitting at work, follow‐up medium‐term.

**Analysis 3.1**
Comparison 3 Active workstation versus sit desk, Outcome 1 Mean difference in time spent sitting at work, follow‐up short‐term.

**Analysis 3.2**
Comparison 3 Active workstation versus sit desk, Outcome 2 Mean difference in time spent in inactive sitting at work, follow‐up medium term.

**Analysis 4.1**
Comparison 4 Walking strategies versus no intervention, Outcome 1 Mean difference in time spent sitting at work, follow‐up short term.

**Analysis 4.2**
Comparison 4 Walking strategies versus no intervention, Outcome 2 Mean difference in time spent sitting at work, follow‐up medium‐term.

**Analysis 4.3**
Comparison 4 Walking strategies versus no intervention, Outcome 3 Percentage of lost work productivity (WLQ Index Score) follow‐up medium‐term.

**Analysis 5.1**
Comparison 5 Short break versus long break, Outcome 1 Mean difference in time spent sitting at work, follow‐up short‐term.

**Analysis 6.1**
Comparison 6 Information, feedback and/or reminder versus information only or no intervention, Outcome 1 Mean difference in time spent sitting at work, follow‐up short term.

**Analysis 6.2**
Comparison 6 Information, feedback and/or reminder versus information only or no intervention, Outcome 2 Mean difference in time spent sitting at work, follow‐up medium‐term.

**Analysis 6.3**
Comparison 6 Information, feedback and/or reminder versus information only or no intervention, Outcome 3 Mean difference in total time spent sitting (including sitting at and outside work), follow‐up short‐term.

**Analysis 6.4**
Comparison 6 Information, feedback and/or reminder versus information only or no intervention, Outcome 4 Mean difference in total time spent sitting (including sitting at and outside work), follow‐up medium term.

**Analysis 6.5**
Comparison 6 Information, feedback and/or reminder versus information only or no intervention, Outcome 5 Mean difference in time spent standing at work follow‐up short‐term.

**Analysis 6.6**
Comparison 6 Information, feedback and/or reminder versus information only or no intervention, Outcome 6 Work engagement (0‐6 scale), follow‐up medium‐term.

**Analysis 7.1**
Comparison 7 Prompts plus information versus information alone, Outcome 1 Mean difference in time spent sitting at work, follow‐up short term.

**Analysis 7.2**
Comparison 7 Prompts plus information versus information alone, Outcome 2 Mean difference in time spent sitting at work, follow‐up medium‐term.

**Analysis 7.3**
Comparison 7 Prompts plus information versus information alone, Outcome 3 Mean difference in number of sitting bouts lasting 30 minutes or more, follow‐up short‐term.

**Analysis 7.4**
Comparison 7 Prompts plus information versus information alone, Outcome 4 Mean difference in time in sitting bouts lasting 30 minutes or more, follow‐up short‐term.

**Analysis 7.5**
Comparison 7 Prompts plus information versus information alone, Outcome 5 Mean difference in total time spent sitting (including sitting at and outside work), follow‐up short‐term.

**Analysis 7.6**
Comparison 7 Prompts plus information versus information alone, Outcome 6 Mean difference in time spent standing at work follow‐up short‐term.

**Analysis 7.7**
Comparison 7 Prompts plus information versus information alone, Outcome 7 Mean difference in energy expenditure, follow‐up medium‐term.

**Analysis 8.1**
Comparison 8 Computer prompts to step versus computer prompts to stand, Outcome 1 Mean difference in time spent sitting at work, follow‐up short‐term.

**Analysis 8.2**
Comparison 8 Computer prompts to step versus computer prompts to stand, Outcome 2 Mean difference in number of sitting bouts lasting 30 minutes or more, follow‐up short‐term.

**Analysis 8.3**
Comparison 8 Computer prompts to step versus computer prompts to stand, Outcome 3 Mean difference in time spent standing at work, follow‐up short‐term.

**Analysis 8.4**
Comparison 8 Computer prompts to step versus computer prompts to stand, Outcome 4 Mean difference in time spent stepping at work, follow‐up short‐term.

**Analysis 9.1**
Comparison 9 High personalised or contextualised information versus less personalised or contextualised information, Outcome 1 Mean difference in time in sitting bouts lasting 30 minutes or more, follow‐up short‐term.

**Analysis 10.1**
Comparison 10 Mindfulness training versus no intervention, Outcome 1 Mean difference in time spent sitting at work, follow‐up medium‐term.

**Analysis 10.2**
Comparison 10 Mindfulness training versus no intervention, Outcome 2 Work engagement (0‐6 scale), follow‐up medium‐term.

**Analysis 11.5**
Comparison 11 Activity tracker combined with organisational support versus organisational support only, Outcome 5 Mean difference in total time spent sitting (including sitting at and outside work), follow‐up short‐term.

**Analysis 11.6**
Comparison 11 Activity tracker combined with organisational support versus organisational support only, Outcome 6 Mean difference in total time spent sitting (including sitting at and outside work), follow‐up medium‐term.

**Analysis 11.7**
Comparison 11 Activity tracker combined with organisational support versus organisational support only, Outcome 7 Mean difference in time spent standing at work follow‐up short‐term.

**Analysis 11.8**
Comparison 11 Activity tracker combined with organisational support versus organisational support only, Outcome 8 Mean difference in time spent stepping at work, follow‐up short‐term.

**Analysis 11.9**
Comparison 11 Activity tracker combined with organisational support versus organisational support only, Outcome 9 Mean difference in time spent standing at work follow‐up medium‐term.

**Analysis 11.10**
Comparison 11 Activity tracker combined with organisational support versus organisational support only, Outcome 10 Mean difference in time spent stepping at work, follow‐up medium‐term.

**Analysis 12.1**
Comparison 12 Multi‐component intervention versus no intervention, Outcome 1 Mean difference in time spent sitting at work, follow‐up short‐term.

**Analysis 12.2**
Comparison 12 Multi‐component intervention versus no intervention, Outcome 2 Mean difference in time spent sitting at work, follow‐up medium‐term.

**Analysis 12.3**
Comparison 12 Multi‐component intervention versus no intervention, Outcome 3 Mean difference in number of sitting bouts lasting 30 minutes or more, follow‐up short‐term.

**Analysis 12.4**
Comparison 12 Multi‐component intervention versus no intervention, Outcome 4 Mean difference in time in sitting bouts lasting 30 minutes or more, follow‐up short‐term.

**Analysis 12.5**
Comparison 12 Multi‐component intervention versus no intervention, Outcome 5 Mean difference in time in sitting bouts lasting 30 minutes or more, follow‐up medium‐term.

**Analysis 12.6**
Comparison 12 Multi‐component intervention versus no intervention, Outcome 6 Mean difference in total time spent sitting (including sitting at and outside work), follow‐up short‐term.

**Analysis 12.7**
Comparison 12 Multi‐component intervention versus no intervention, Outcome 7 Mean difference in total time spent sitting (including sitting at and outside work), follow‐up medium‐term.

**Analysis 12.8**
Comparison 12 Multi‐component intervention versus no intervention, Outcome 8 Mean difference in time spent standing at work follow‐up short‐term.

**Analysis 12.9**
Comparison 12 Multi‐component intervention versus no intervention, Outcome 9 Mean difference in time spent stepping at work follow‐up short‐term.

**Analysis 12.10**
Comparison 12 Multi‐component intervention versus no intervention, Outcome 10 Mean difference in time spent standing at work follow‐up medium‐term.

**Analysis 12.11**
Comparison 12 Multi‐component intervention versus no intervention, Outcome 11 Mean difference in time spent stepping at work follow‐up medium‐term.

**Analysis 12.12**
Comparison 12 Multi‐component intervention versus no intervention, Outcome 12 Work engagement (0‐6 scale), follow‐up short‐term.

**Analysis 12.13**
Comparison 12 Multi‐component intervention versus no intervention, Outcome 13 Mean difference in musculoskeletal symptoms all sites (score 0–6) at short‐term follow‐up.

See this image and copyright information in PMC

Update of

Workplace interventions for reducing sitting at work.
Shrestha N, Kukkonen-Harjula KT, Verbeek JH, Ijaz S, Hermans V, Bhaumik S. Shrestha N, et al. Cochrane Database Syst Rev. 2016 Mar 17;3(3):CD010912. doi: 10.1002/14651858.CD010912.pub3. Cochrane Database Syst Rev. 2016. Update in: Cochrane Database Syst Rev. 2018 Jun 20;6:CD010912. doi: 10.1002/14651858.CD010912.pub4. PMID: 26984326 Free PMC article. Updated.

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References

References to studies included in this review

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References to studies excluded from this review

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[1] Alkhajah TA, Reeves MM, Eakin EG, Winkler EA, Owen N, Healy GN. Sit‐stand workstations: a pilot intervention to reduce office sitting time. American Journal of Preventive Medicine 2012;43(3):298‐303. - PubMed

Healy G, Alkhajah T, Winkler E, Owen N, Eakin E. Reducing sitting time in office workers: efficacy and acceptability of sit‐stand workstations. Journal of Science and Medicine in Sport 2012;15:S196.

[2] Alkhajah TA, Reeves MM, Eakin EG, Winkler EA, Owen N, Healy GN. Sit‐stand workstations: a pilot intervention to reduce office sitting time. American Journal of Preventive Medicine 2012;43(3):298‐303. - PubMed

[3] Healy G, Alkhajah T, Winkler E, Owen N, Eakin E. Reducing sitting time in office workers: efficacy and acceptability of sit‐stand workstations. Journal of Science and Medicine in Sport 2012;15:S196.

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Brakenridge CL, Fjeldsoe BS, Young DC, Winkler EA, Dunstan DW, Straker LM. Evaluating the effectiveness of organisational‐level strategies with or without an activity tracker to reduce office workers' sitting time: a cluster‐randomised trial. International Journal of Behavioural Nutrition and Physical Activity 2016;13(1):115. - PMC - PubMed

Brakenridge CL, Fjeldsoe BS, Young DC, Winkler EA, Dunstan DW, Straker LM. Organizational level strategies with or without an activity tracker to reduce office workers' sitting time: rationale and study design of a pilot cluster‐randomized trial. JMIR research protocols 2016;5(2):e73. - PMC - PubMed

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[6] Brakenridge CL, Fjeldsoe BS, Young DC, Winkler EA, Dunstan DW, Straker LM. Evaluating the effectiveness of organisational‐level strategies with or without an activity tracker to reduce office workers' sitting time: a cluster‐randomised trial. International Journal of Behavioural Nutrition and Physical Activity 2016;13(1):115. - PMC - PubMed

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[8] Carr LJ, Leonhard C, Tucker S, Fethke N, Benzo R, Gerr F. Total worker health intervention increases activity of sedentary workers. American Journal of Preventive Medicine 2015;49:[Epub ahead of print]. - PubMed

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[9] Carr LJ, Leonhard C, Tucker S, Fethke N, Benzo R, Gerr F. Total worker health intervention increases activity of sedentary workers. American Journal of Preventive Medicine 2015;49:[Epub ahead of print]. - PubMed

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[11] ACTRN12612000072819. The Stand@Work Pilot Study. A randomised controlled trial to see if using sit‐stand workstations reduces sitting time in office workers. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=1261... (accessed 3 June 2015).

Chau JY, Daley M, Dunn S, Srinivasan A, Do A, Bauman AE, et al. The effectiveness of sit‐stand workstations for changing office workers' sitting time: results from the Stand@Work randomized controlled trial pilot. International Journal of Behavioral Nutrition and Physical Activity 2014;11:127. - PMC - PubMed

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[13] Chau JY, Daley M, Dunn S, Srinivasan A, Do A, Bauman AE, et al. The effectiveness of sit‐stand workstations for changing office workers' sitting time: results from the Stand@Work randomized controlled trial pilot. International Journal of Behavioral Nutrition and Physical Activity 2014;11:127. - PMC - PubMed

[14] Chau JY, Daley M, Srinivasan A, Dunn S, Bauman AE, Ploeg HP. Desk‐based workers’ perspectives on using sit‐stand workstations: a qualitative analysis of the Stand@Work study. BMC Public Health 2014;14:752. - PMC - PubMed

[15] Chau JY, Sukala W, Fedel K, Do A, Engelen L, Kingham M, et al. More standing and just as productive: effects of a sit‐stand desk intervention on callcenter workers’ sitting, standing, and productivity at work in the Opt to Standpilot study. Preventive Medicine Reports 2016;3:68‐74. - PMC - PubMed

[16] Chau JY, Sukala W, Fedel K, Do A, Engelen L, Kingham M, et al. More standing and just as productive: effects of a sit‐stand desk intervention on callcenter workers’ sitting, standing, and productivity at work in the Opt to Standpilot study. Preventive Medicine Reports 2016;3:68‐74. - PMC - PubMed

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