Sedentary work. Evidence on an emergent work health and safety issue

Safe Work Australia’s Emerging Issues Programme involves a 3-stage process to identify, prioritise and systematically consider emerging work health and safety (WHS) issues of national importance. The programme involves extensive consultation with all of Safe Work Australia’s tripartite stakeholders. As part of this programme Safe Work Australia commissioned a team of experts to examine the most recent evidence from Australia and overseas on sedentary work, its likely consequences and potential control options. The literature review was conducted by academics from Curtin University, the Baker IDI group and the University of Queensland

Physicians' role in patient ergonomics: a pilot study

With the ever-increasing rate of the integration of technology, and office workers making up the largest single sector of occupations, many workers are spending an increasingly large portion of their work time in the prolonged sitting or standing position and while on computer-based systems. Evidence-based research suggests that increased sedentary time is associated with diabetes, hypertension and other mortality causing diseases such as cardiovascular disease. There is a lack of occupational medicine considerations, specifically ergonomics, incorporated into the patient plan of care in the primary care setting. This is likely due to the decreased number of physicians specializing in occupational medicine (OM), and the lack of OM education in medical school curriculum. The current time constraints of the medical system may make the integration of additional screening seem unreasonable. With the introduction of occupational therapy as a contributing member of the primary care team, the burden of ergonomic training and education for at-risk patients can be reduced. Through participation in the Physicians’ Role in Patient Ergonomics workshop, a 20-minute online video aimed at explaining the connection between occupational risks and common health issues seen in the primary care setting, physicians can learn about the implications of occupational risks on patient health, and how to utilize brief screening questions and decision trees to efficiently determine which patients may benefit from ergonomic education and training

Physical implications of prolonged sitting in a confined posture - a literature review

The main purpose of this review article was to highlight some of the physical consequences of sitting for prolonged periods in a confined setting. More specifically, the review relates this research to call centre work and where applicable comments on the limited literature relating specifically to ergonomics research within call centre settings. In particular the article explores the biomechanical stresses placed on the musculoskeletal system during prolonged sitting at a workstation, and the physiological consequences thereof. The paper then provides possible solutions to reduce the physical strain placed on these workers by looking at workstation design and work organisation emphasizing worker education and the promotion of worker well being

Evaluating short-term musculoskeletal pain changes in desk-based workers receiving a workplace sitting-reduction intervention

This paper explores changes in musculoskeletal pain among desk-based workers over three months of a workplace-delivered, sitting-reduction intervention. Participants (n = 153, 46% female; mean ± SD aged 38.9 ± 8.0 years) were cluster-randomized (n = 18 work teams) to receive an organizational change intervention, with or without an activity tracker. A modified Nordic Musculoskeletal Questionnaire assessed pain intensity (0–9; none–worst possible) in the neck, upper and lower back, upper and lower extremities, and in total. The activPAL3 (7 days, 24 h/day protocol) measured sitting and prolonged sitting in =30 min bouts at work. Mixed models adjusting for cluster and intervention arm examined changes in pain (n = 104), and their associations with reductions in sitting and prolonged sitting (h/10 h at work) (n = 90). Changes in pain were nonsignificant (p = 0.05) and small for total pain (-0.06 [95% CI: -0.27, 0.16]) and for each body area (-0.26 [-0.66, 0.15] for upper back to 0.09 [-0.39, 0.56] for lower back). Sitting reduction was associated with reduced lower back pain (-0.84 [-1.44, -0.25] per hour, p = 0.005); other effects were small and non-significant. No substantial average changes in pain were seen; some improvement in lower back pain might be expected with larger sitting reductions. Larger samples and diverse interventions are required for more definitive evidence

The effect of total standing duration during sit-stand regimes on cognitive performance, rating of perceived exertion and heart rate frequency

Although there may be numerous health benefits of sit-stand workstations, the effects of sedentary or non-sedentary work configurations on cognitive performance and executive function remain unclear (Bantoft et al., 2016). It is essential to determine any performance effects of these different work configurations; as improvements in the workplace, working posture and discomfort need to be justified in terms of improvements (or no deterioration) in work performance (Liao and Drury, 2000). The aim of the current research was to investigate the effect of two sit-stand regimes differing in total standing duration, on cognitive task performance, physiological responses and subjective ratings of perceived exertion. This laboratory based investigation incorporated a repeated measures design, where a test battery was utilized. Three experimental conditions were tested during three separate testing sessions by 30 participants. Condition 2 (15 minutes standing, followed by 45 minutes seated) and Condition 3 (15 minutes seated, followed by 15 minutes standing, followed by 15 minutes seated, followed by 15 minutes standing) were compared to each other and Condition 1 (60 minutes seated). The findings of this study show that even though the two different sit-stand regimes did not result in a significant impact on cognitive task performance, an immediate postural effect for psychomotor response time and a delayed postural effect for working memory were found. The participants perceived Condition 3 as the most physically exerting condition. Heart rate frequency was not significantly different between the conditions, but the immediate seated posture had a significantly lower heart rate frequency compared to the standing posture; indicating that being seated elicited lower energy expenditure compared to standing. Heart rate frequency while standing had a greater degree of variation compared to being seated. Taking the findings of this study into account, it is recommended that: one should be seated while performing this type of working memory task; that one should be standing while performing this type of psychomotor task; that the recommendation that implementing standing at work can be used as a blanket strategy to increase energy expenditure in all individuals needs to be explored further and that individual differences may impact energy expenditure

The impact of standing desks within the school classroom on sedentary behaviour, physical activity, health and development

Internationally, children spend most of their waking hours sedentary. Growing evidence indicates that sedentary behaviour tracks and continually increases from childhood through to adulthood. This is of public health concern because in adulthood excessive sedentary time is clearly associated with an increased risk of morbidity and mortality. Consequently, early intervention is essential before sedentary habits become entrenched and years of potentially harmful exposure are endured. Standing desks within the school classroom have emerged as one of the most promising strategies for reducing total sedentary time in children. This thesis focuses on sedentary behaviour in children and the implementation of standing desks in the school environment and the influence of standing desks on reducing sedentary time.Chapter 2 describes a systematic review of the impact of standing desks within the school classroom. Systematic reviews are an essential component of evidence-based practice and provided vital information and direction for the research described in later chapters. The systematic review demonstrated that standing desk interventions implemented within the school classroom is a rapidly emerging area of research. There were promising early findings from pilot studies on important outcomes related to health, feasibility and development. However, more long-term studies and studies specifically measuring sitting behaviour as an outcome are needed.Chapter 3 outlines and critically evaluates the methods and data reduction decisions made for both the activPAL and ActiGraph measurement devices relating to the research reported in Chapters 4 and 5. Many decisions made for data reduction procedures were standard practice and recommended within sedentary behaviour and physical activity research. However, with small initial samples in Chapters 4 and 5, there was a conflict between retaining as much of these samples as possible while also gaining the most valid and representative data of behaviour. Data compliance was modest in Chapter 4 and somewhat poor within intervention groups in Chapter 5, which is a limitation of the evidence presented within these chapters.Chapter 4 describes a cross-sectional surveillance study that was designed to fill gaps in the literature about children’s objectively-measured levels and patterns of sedentary time and physical activity accumulation, and to gain a greater insight into times of the day and week where interventions could be best targeted. Children in Year 5 of primary5school and of South Asian and White British ethnicity of lower socio-economic position were the population of interest. The results demonstrated that children were highly sedentary during different periods of the week; over 10 hours/day on school days and 11 hours/day on weekend days was spent sitting. This also included high proportions of waking hours spent in prolonged sitting bouts (30+ mins), particularly after school and on weekends, which has not been observed in European children previously. To inform interventions, further longitudinal research is required, with larger sample sizes spread across multiple UK areas, to better understand the levels and patterns of sitting accumulated at and away from school in children.Chapters 5 describe the impact of the Stand Out In Class intervention pilot, the first longer-term standing desk study based in the primary school classroom in Europe. The Stand Out In Class intervention was underpinned by the Behaviour Change Wheel framework, COM-B model and Behavioural Change Taxonomy (v1). This chapter describes the impact of two different intervention designs; full desk allocation (FDA) (one per child) and partial desk allocation (PDA) (children rotated between sit-stand desks and traditional seated desks) on objectively measured classroom sitting time and physical activity in Year 5 children based in a school in Bradford, UK. Changes in sitting time and physical activity in these two classes were compared to a control class located within a nearby school. Sitting time (activPAL data) and physical activity (activPAL and ActiGraph data) were measured during a 7-day period at baseline (autumn/winter) 4 months (spring) and 8 months (summer) of desk exposure. Children were not rotated on a regular basis (as planned) within the PDA group and therefore the intervention was not implemented sufficiently. Consequently, data from this group were difficult to interpret with any clarity. Large reductions were observed in the proportion of wear time spent sitting during class time and during a total week day in the FDA group compared to the control group at both 4 months (class time -25.3%, full week day -7.7%) and 8 months (class time -19.9%, full week day -5.5%). Chapter 5 also describes the impact of the Stand Out In Class intervention on adiposity, cognitive function, musculoskeletal discomfort and behaviour-related mental health at 4 months and 8 months of intervention exposure in FDA and PDA groups. The intervention demonstrated no influence on adiposity outcomes. The sit-stand desks appeared to have a negative influence on behaviour related mental health over time in both intervention groups. No changes were observed in musculoskeletal discomfort scores or in cognitive function6scores. Chapters 5 together suggest sit-stand desks in the classroom may influence reductions in sitting time over the longer-term within an FDA system although careful consideration are needed for day-to-day teaching practicalities.Chapter 6 evaluated the implementation of the Stand Out In Class intervention within the FDA and PDA classes using focus groups with pupils and interviews with teachers. Within the FDA class, standing classes were delivered by the lead teacher, however, acceptance of sufficient intervention delivery was based on the word of the teacher and a single classroom observation only, with no other evidence available. Within the PDA class, insufficient child rotation appeared to be due to a lack of motivation from the teacher, a behaviourally challenging group of pupils, curriculum pressures, lack of space, lack of time and the distracting nature of the desks. Overall this intervention encountered many barriers to effective implementation which should be considered in future standing desk interventions adopting a PDA system. Evaluation in this study would have benefitted from daily or weekly implementation logs for teachers in both FDA and PDA classes. Future qualitative research should attempt to explore barriers and solutions to effective PDA intervention implementation as this is the more economically feasible system.This thesis found that sit-stand desks in the classroom may influence a reduction in children’s sitting time using a full allocation approach and provides important evidence for sedentary behaviour patterns, intervention design and public health and education policy for UK children. The evidence provided in this thesis is pertinent in children of South Asian and White British ethnicity of lower socio-economic position. The utilisation of standing desks in the classroom environment holds potential for reducing children’s sitting time</div