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

The effects of standing desks within the school classroom: A systematic review

© 2016 The Authors. Background: The school classroom environment often dictates that pupils sit for prolonged periods which may be detrimental for children's health. Replacing traditional school desks with standing desks may reduce sitting time and provide other benefits. The aim of this systematic review was to assess the impact of standing desks within the school classroom. Method: Studies published in English up to and including June 2015 were located from online databases and manual searches. Studies implementing standing desks within the school classroom, including children and/or adolescents (aged 5-18 years) which assessed the impact of the intervention using a comparison group or pre-post design were included. Results: Eleven studies were eligible for inclusion; all were set in primary/elementary schools, and most were conducted in the USA (n = 6). Most were non-randomised controlled trials (n = 7), with durations ranging from a single time point to five months. Energy expenditure (measured over 2 h during school day mornings) was the only outcome that consistently demonstrated positive results (three out of three studies). Evidence for the impact of standing desks on sitting, standing, and step counts was mixed. Evidence suggested that implementing standing desks in the classroom environment appears to be feasible, and not detrimental to learning. Conclusions: Interventions utilising standing desks in classrooms demonstrate positive effects in some key outcomes but the evidence lacks sufficient quality and depth to make strong conclusions. Future studies using randomised control trial designs with larger samples, longer durations, with sitting, standing time and academic achievement as primary outcomes, are warranted

ActivPAL-measured sitting levels and patterns in 9-10 year old children from a UK city.

Background: There is insufficient evidence of sitting time in UK children from validated objective measures. This study explored sitting patterns in primary school children from Bradford, UK, using the validated activPAL inclinometer. Methods: Overall, 79 children (9.8 (SD 0.3) years old, 52% boys; 70% South Asian) wore activPALs for 7 days. Total sitting time, sitting time accumulated in different bout lengths, and the proportion of wear time spent in these variables were explored and compared across different periods of the week. Results: Children spent 614 ± 112 (median ± IQR) min/day on school days and 690 ± 150 min/day on weekend days sitting. The proportion of time spent sitting was significantly higher on weekend days compared to school days (mean±SD: 74 ± 10% versus 68 ± 8%,P 30 min sitting bouts (mean±CI: 28 ± 27-33% versus 20 ± 20-22%, P 30 min) sitting bouts (mean±CI: 19 ± 16-22% versus 11 ± 10-14%, P < 0.001). Conclusions: Children spent large proportions of their waking day sitting, often accumulated in prolonged uninterrupted bouts and particularly after school and on weekends. Interventions to reduce sitting time in children are urgently needed

Attenuated cardiovascular reactivity to acute psychological stress predicts future fatigue symptoms in truck drivers

Objectives: This study aimed to investigate the impact of a 6-month health intervention on truck drivers’ CVR to stress and whether CVR was predictive of depression, anxiety, or fatigue symptoms at 6-months follow-up. Methods: 238 truck drivers completed a 6-month cluster RCT to increase physical activity and completed a stress protocol (Stroop and Mirror tracing tasks) with measurements of heart rate (HR), systolic (SBP), and diastolic (DBP) blood pressure taken, alongside fatigue, anxiety, and depressive symptoms assessment. Measures were taken at 0-months and 6-months. Results: Analyses showed a negative relationship between 0-month DBP reactivity and 6-month persistent fatigue. Trends towards negative relationships between SBP reactivity and future anxiety and fatigue symptoms at 6-months were evident. Conclusions: Our findings may have serious implications, as fatigue can be a major cause of road traffic collisions in truck drivers.</p

Attenuated cardiovascular reactivity to acute psychological stress predicts future fatigue symptoms in truck drivers

Objectives: This study aimed to investigate the impact of a 6-month health intervention on truck drivers’ CVR to stress and whether CVR was predictive of depression, anxiety, or fatigue symptoms at 6-months follow-up. Methods: 238 truck drivers completed a 6-month cluster RCT to increase physical activity and completed a stress protocol (Stroop and Mirror tracing tasks) with measurements of heart rate (HR), systolic (SBP), and diastolic (DBP) blood pressure taken, alongside fatigue, anxiety, and depressive symptoms assessment. Measures were taken at 0-months and 6-months. Results: Analyses showed a negative relationship between 0-month DBP reactivity and 6-month persistent fatigue. Trends towards negative relationships between SBP reactivity and future anxiety and fatigue symptoms at 6-months were evident. Conclusions: Our findings may have serious implications, as fatigue can be a major cause of road traffic collisions in truck drivers.</p

Impacts of a standing desk intervention within an English primary school classroom: a pilot controlled trial

Traditional classroom furniture dictates that children predominantly sit during class time. This study evaluated the impact of providing standing desks within a deprived UK primary school setting over 8 months using mixed-method approaches. All children within a Year 5 class (9–10-year-olds, n = 30) received an adjustable sit–stand desk, while another Year 5 class (n = 30) in a nearby school retained traditional furniture as a control classroom. At baseline, 4 months, and 8 months, activPAL monitors (PAL Technologies, Glasgow, UK) were worn for 7 days to provide time spent sitting and standing. Behavior-related mental health, musculoskeletal discomfort surveys, and a cognitive function test battery were also completed at all three timepoints. Intervention experiences from pupils and the teacher were captured using focus groups, interviews, and classroom observations. At both 4 months and 8 months, multi-level models revealed a reduction in class time sitting in the intervention group compared to the control group ((β (95%CI) 4 months −25.3% (−32.3, −18.4); 8 months −19.9% (−27.05, −12.9)). Qualitative data revealed challenges to teaching practicalities and a gradual decline in behavior-related mental health was observed (intervention vs. control: 4 months +5.31 (+2.55, +8.08); 8 months +7.92 (+5.18, +10.66)). Larger trials within similar high-priority settings are required to determine the feasibility and cost-effectiveness of providing standing desks to every child in the classroom

Attenuated cardiovascular reactivity is related to higher anxiety and fatigue symptoms in truck drivers

Depression and anxiety have been linked with reduced stress-induced cardiovascular reactivity (CVR), which could be indicative of autonomic dysregulation. Less is known about the association between work-related fatigue and CVR. Truck drivers experience high levels of depression, anxiety, and fatigue, with repeated psychophysiological stressors on the road, yet little is known about the effects of these conditions on their CVR. 386 truck drivers completed the Hospital Anxiety and Depression Scale (HADS) and the Occupational Fatigue Exhaustion/Recovery Scale (OFER-15). Systolic (SBP) and diastolic (DBP) blood pressure, and heart rate (HR) were measured at rest and during a stressor protocol to measure CVR. Multivariate regression analyses were used to determine relationships between variables and adjusted for nine key covariates. Higher symptoms of persistent fatigue were related to a reduced SBP reactivity (β = -0.237, p = .008) and reduced DBP reactivity (β = -0.256, p = .005), whilst there was a positive trend between acute fatigue and DBP reactivity (β = 0.168, p = .053). Higher symptoms of anxiety were related to a reduced SBP reactivity (β = -0.167, p = .011). This study demonstrated in a population of truck drivers, both anxiety and persistent fatigue were related to an attenuated SBP reactivity in a combined model, whereas there was a positive trend between acute fatigue solely and DBP reactivity. These novel findings may have serious implications for cardiovascular disease risk in truck drivers, and future research should attempt to establish the causal effect of these associations and the underlying physiological mechanisms.</div

Physical activity is inversely associated with hepatic fibro-inflammation: a population-based cohort study using UK Biobank Data

Background & aims:  Physical activity (PA) is recommended in the management of non-alcoholic fatty liver disease (NAFLD) given beneficial effects on liver fat and cardiometabolic risk. Using data from the UK Biobank population-cohort, this study examined associations between habitual PA and hepatic fibro-inflammation.  Methods:  840 men and women aged 55-70 years were included in this cross-sectional study. Hepatic fibro-inflammation (iron-corrected T1 [cT1]) and liver fat were measured using MRI, whilst body fat was measured using dual-energy X-ray absorptiometry. PA was measured using accelerometry. Generalised linear models examined associations between PA (light [LPA], moderate [MPA], vigorous [VPA], moderate-to-vigorous [MVPA] and mean acceleration) and hepatic cT1. Models were fitted for the whole sample and separately for upper and lower median groups for body and liver fat. Models were adjusted for sociodemographic and lifestyle variables.  Results:  In the full sample, LPA (-0.08 ms [-0.12 to -0.03]), MPA, (-0.13 ms [-0.21 to -0.05]), VPA (-1.16 ms [-1.81 to -0.51]), MVPA (-0.14 ms (-0.21 to -0.06]) and mean acceleration (-0.67 ms [-1.05 to-0.28]) were inversely associated with hepatic cT1. With the sample split by median liver or body fat, only VPA was inversely associated with hepatic cT1 in the upper-median groups for body (-2.68 ms [-4.24 to -1.13]) and liver fat (-2.33 [-3.73 to -0.93]). PA was unrelated to hepatic cT1 in the lower-median groups.  Conclusions:  Within a population-based cohort, device-measured PA is inversely associated with hepatic fibro-inflammation. This relationship is strongest with VPA and is greater in people with higher levels of body and liver fat.</p

Time in nature associated with decreased fatigue in UK truck drivers

Heavy goods vehicle (HGV) driving is recognised as a highly hazardous occupation due to the long periods of sedentary behaviour, low levels of physical activity and unhealthy food options when working. These risk factors combine with shift work and concomitant irregular sleep patterns to increase the prevalence of fatigue. Fatigue is closely linked with stress and, subsequently, poor physiological and psychological health. In parallel, a wealth of evidence has demonstrated the health and wellbeing benefits of spending time in nature. Here, we sought to examine whether spending time in nature was associated with lower levels of fatigue, anxiety and depression in HGV drivers. 89 long-distance drivers (98.9% male, mean ± SD age: 51.0 ± 9 years, body mass index: 29.8 ± 4.7 kg/m2) participating in a wider health promotion programme reported time spent in nature (during and before the Covid-19 pandemic) and symptoms of occupational fatigue, depression and anxiety. After controlling for covariates, truck drivers who visited nature at least once a week exhibited 16% less chronic fatigue prior to the pandemic, and 23% less chronic fatigue and 20% less acute fatigue during the pandemic. No significant differences were observed for either anxiety or depression. As fatigue has a range of physical and mental health sequelae, we propose that increased exposure to natural settings may make a valuable contribution to interventions to promote the health and wellbeing of this underserved group