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NIHR Signal Standing desks with a support package reduce time sitting at work

Published on 29 January 2019

doi: 10.3310/signal-000717

An office-based intervention involving a height-adjustable workstation and instruction package reduced the amount of time spent sitting. Workers sat for around 60 to 90 minutes less per day at six and 12 months compared with the control group.

Sitting for long periods is a risk factor for ill health even in people meeting recommended levels of physical activity. Reducing time sitting at work could have health and economic benefits, but the evidence is limited. This trial was fairly small, involving 146 NHS workers. No firm conclusions can be drawn as to whether reduced sitting time may translate into effects on musculoskeletal health, work performance or sickness absence. However, the results are promising and will be important if shown to be effective and cost-effective for individuals and their employers when implemented more widely.

A larger NIHR-funded study involving council workers is underway which may provide further evidence and cost data.

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Why was this study needed?

It’s estimated that over a third of people in the UK (about 20 million) do not meet suggested physical activity targets. Low levels of physical activity are linked with cardiovascular disease, type 2 diabetes, certain cancers and general ill health. Prolonged sitting is thought to slow the body’s metabolism, affect blood sugar regulation, blood pressure and amount of fat burned. It’s a recognised risk factor even among people who meet government physical activity targets. The NHS advises people to get up after sitting for 30 minutes.

Office workers are estimated to spend three-quarters of their working hours sitting. A 2018 Cochrane review looked at interventions to reduce sedentary time at work. There was insufficient evidence for most interventions, but low-quality evidence that height-adjustable desks may reduce sitting time at work by 100 minutes a day at up to three months. This study was commissioned to look at sitting time after longer follow-up.

What did this study do?

The NIHR-funded SMarT cluster randomised trial assigned 37 office departments within the three hospitals of the University Hospitals of Leicester NHS Trust to the 12-month intervention or control. One hundred and forty-six people working at least three days weekly at the same desk chose to participate.  

The intervention involved an initial seminar covering the health consequences of prolonged sitting; tracking of participants’ normal daily sitting and activity levels using a wearable wrist device that captures time spent in moderate or vigorous activity (the activePAL device); a personalised action plan; provision of a height-adjustable desk and chair cushion that vibrated after pre-set periods to remind the person to get up. Educational/motivational leaflets and brief coaching sessions were provided every few months.

The activePAL data was shared with intervention participants at each follow-up. Activity levels were measured in the control group, but they received no feedback. Assessors were unaware of group assignment. Thirty three per cent of control and 17% of intervention participants did not complete follow-up.

What did it find?

  • At 12 months, people using the SMarT Work intervention sat for 81.64 minutes less at work each day than people in the control group (95% confidence interval [CI] 112.27 to 51.01 minutes less). This was analysis of all participants by intention-to-treat, though analysis of only those who completed follow-up gave similar results (-83.28, 95% CI -116.57 to -49.98).
  • Reductions in occupational sitting time were also seen at three (-50.62, 95% CI -78.71 to -22.54) and six month (-64.40, 95% CI -97.31 to -31.50) follow-up (data for complete cases only).
  • There was a similar reduction in total daily sitting time, and increases in occupational standing time and total daily standing time at all time-points compared with the control group. However, there was no difference between groups in either total daily activity or daily stepping time at any follow-up.
  • The SMarT intervention gave some improvement in work-related outcomes of work engagement and job performance at six and 12 months (about 0.5 point improvement on a 7-point scale). It also gave some improvement in presenteeism (continuing at work with health problems) but had no effect on sickness absence.
  • Effects of the intervention on musculoskeletal problems, mood, and quality of life were mixed.

What does current guidance say on this issue?

NICE’s 2008 guideline on physical activity in the workplace has no recommendations on standing desks. Recommendations aimed at workers focus on encouraging walking and cycling to work, using stairs instead of lifts, and moving around more in the workplace. Other recommended actions include employers providing information on walking and cycling routes and encouraging people to set goals for distances walked or cycled.

An update review by NICE in January 2019 found that this study's findings supported existing recommendations to reduce sitting time at work. NICE plans to update the physical activity in the workplace guideline to include the ongoing SMArT Work & Life trial (expected 2021).

What are the implications?

The findings provide encouragement for organisations thinking about introducing standing desks. However, people choosing to participate in the study may be more motivated to standing at work than other employees.

The study was also small and did not have power to detect reliable differences for outcomes other than time sitting. As these results are promising it is likely that the characteristics or workplaces and the people that benefit will need further study before costs can be justified.

The results of the larger study of the SMarT intervention will assess longer-term outcomes over two years in 660 office workers in England. This may assist in any review of guidance and would be an opportunity to gather cost data too. This will be important for employers and the NHS if wider use is recommended.

Citation and Funding

Edwardson CL, Yates T, Biddle SJH et al. Effectiveness of the Stand More AT (SMArT) Work intervention: cluster randomised controlled trial. BMJ. 2018;363:k3870.

This project was funded by the National Institute for Health Research Department of Health Policy Research Programme (project number PR-R5-0213-25004).

Bibliography

British Heart Foundation. Physical inactivity and sedentary behaviour report 2017. Birmingham: British Heart Foundation; 2017.

NHS website. Why we should sit less. London: Department of Health; updated 2016.

NICE. Physical activity in the workplace. PH13. London: National Institute for Health and Care Excellence; 2008.

NICE. 2019 exceptional surveillance of physical activity in the workplace (NICE guideline PH13). London: National Institute for Health and Care Excellence; 2019.

Shrestha N, Kukkonen‐Harjula  KT, Verbeek  JH et al. Workplace interventions for reducing sitting at work. Cochrane Database Syst Rev. 2018;(12):CD010912.

Why was this study needed?

It’s estimated that over a third of people in the UK (about 20 million) do not meet suggested physical activity targets. Low levels of physical activity are linked with cardiovascular disease, type 2 diabetes, certain cancers and general ill health. Prolonged sitting is thought to slow the body’s metabolism, affect blood sugar regulation, blood pressure and amount of fat burned. It’s a recognised risk factor even among people who meet government physical activity targets. The NHS advises people to get up after sitting for 30 minutes.

Office workers are estimated to spend three-quarters of their working hours sitting. A 2018 Cochrane review looked at interventions to reduce sedentary time at work. There was insufficient evidence for most interventions, but low-quality evidence that height-adjustable desks may reduce sitting time at work by 100 minutes a day at up to three months. This study was commissioned to look at sitting time after longer follow-up.

What did this study do?

The NIHR-funded SMarT cluster randomised trial assigned 37 office departments within the three hospitals of the University Hospitals of Leicester NHS Trust to the 12-month intervention or control. One hundred and forty-six people working at least three days weekly at the same desk chose to participate.  

The intervention involved an initial seminar covering the health consequences of prolonged sitting; tracking of participants’ normal daily sitting and activity levels using a wearable wrist device that captures time spent in moderate or vigorous activity (the activePAL device); a personalised action plan; provision of a height-adjustable desk and chair cushion that vibrated after pre-set periods to remind the person to get up. Educational/motivational leaflets and brief coaching sessions were provided every few months.

The activePAL data was shared with intervention participants at each follow-up. Activity levels were measured in the control group, but they received no feedback. Assessors were unaware of group assignment. Thirty three per cent of control and 17% of intervention participants did not complete follow-up.

What did it find?

  • At 12 months, people using the SMarT Work intervention sat for 81.64 minutes less at work each day than people in the control group (95% confidence interval [CI] 112.27 to 51.01 minutes less). This was analysis of all participants by intention-to-treat, though analysis of only those who completed follow-up gave similar results (-83.28, 95% CI -116.57 to -49.98).
  • Reductions in occupational sitting time were also seen at three (-50.62, 95% CI -78.71 to -22.54) and six month (-64.40, 95% CI -97.31 to -31.50) follow-up (data for complete cases only).
  • There was a similar reduction in total daily sitting time, and increases in occupational standing time and total daily standing time at all time-points compared with the control group. However, there was no difference between groups in either total daily activity or daily stepping time at any follow-up.
  • The SMarT intervention gave some improvement in work-related outcomes of work engagement and job performance at six and 12 months (about 0.5 point improvement on a 7-point scale). It also gave some improvement in presenteeism (continuing at work with health problems) but had no effect on sickness absence.
  • Effects of the intervention on musculoskeletal problems, mood, and quality of life were mixed.

What does current guidance say on this issue?

NICE’s 2008 guideline on physical activity in the workplace has no recommendations on standing desks. Recommendations aimed at workers focus on encouraging walking and cycling to work, using stairs instead of lifts, and moving around more in the workplace. Other recommended actions include employers providing information on walking and cycling routes and encouraging people to set goals for distances walked or cycled.

An update review by NICE in January 2019 found that this study's findings supported existing recommendations to reduce sitting time at work. NICE plans to update the physical activity in the workplace guideline to include the ongoing SMArT Work & Life trial (expected 2021).

What are the implications?

The findings provide encouragement for organisations thinking about introducing standing desks. However, people choosing to participate in the study may be more motivated to standing at work than other employees.

The study was also small and did not have power to detect reliable differences for outcomes other than time sitting. As these results are promising it is likely that the characteristics or workplaces and the people that benefit will need further study before costs can be justified.

The results of the larger study of the SMarT intervention will assess longer-term outcomes over two years in 660 office workers in England. This may assist in any review of guidance and would be an opportunity to gather cost data too. This will be important for employers and the NHS if wider use is recommended.

Citation and Funding

Edwardson CL, Yates T, Biddle SJH et al. Effectiveness of the Stand More AT (SMArT) Work intervention: cluster randomised controlled trial. BMJ. 2018;363:k3870.

This project was funded by the National Institute for Health Research Department of Health Policy Research Programme (project number PR-R5-0213-25004).

Bibliography

British Heart Foundation. Physical inactivity and sedentary behaviour report 2017. Birmingham: British Heart Foundation; 2017.

NHS website. Why we should sit less. London: Department of Health; updated 2016.

NICE. Physical activity in the workplace. PH13. London: National Institute for Health and Care Excellence; 2008.

NICE. 2019 exceptional surveillance of physical activity in the workplace (NICE guideline PH13). London: National Institute for Health and Care Excellence; 2019.

Shrestha N, Kukkonen‐Harjula  KT, Verbeek  JH et al. Workplace interventions for reducing sitting at work. Cochrane Database Syst Rev. 2018;(12):CD010912.

Effectiveness of the Stand More AT (SMArT) Work intervention: cluster randomised controlled trial

Published on 10 October 2018

C Edwardson, T Yates, S Biddle, M Davies, D Dunstan, D Esliger, Laura J Gray, B Jackson, S O’Connell, G Waheed, F Munir

BMJ , 2018

Objectives To evaluate the impact of a multicomponent intervention (Stand More AT (SMArT) Work) designed to reduce sitting time on short (three months), medium (six months), and longer term (12 months) changes in occupational, daily, and prolonged sitting, standing, and physical activity, and physical, psychological, and work related health. Design Cluster two arm randomised controlled trial. Setting National Health Service trust, England. Participants 37 office clusters (146 participants) of desk based workers: 19 clusters (77 participants) were randomised to the intervention and 18 (69 participants) to control. Interventions The intervention group received a height adjustable workstation, a brief seminar with supporting leaflet, workstation instructions with sitting and standing targets, feedback on sitting and physical activity at three time points, posters, action planning and goal setting booklet, self monitoring and prompt tool, and coaching sessions (month 1 and every three months thereafter). The control group continued with usual practice. Main outcome measures The primary outcome was occupational sitting time (thigh worn accelerometer). Secondary outcomes were objectively measured daily sitting, prolonged sitting (≥30 minutes), and standing time, physical activity, musculoskeletal problems, self reported work related health (job performance, job satisfaction, work engagement, occupational fatigue, sickness presenteeism, and sickness absenteeism), cognitive function, and self reported psychological measures (mood and affective states, quality of life) assessed at 3, 6, and 12 months. Data were analysed using generalised estimating equation models, accounting for clustering. Results A significant difference between groups (in favour of the intervention group) was found in occupational sitting time at 12 months (−83.28 min/workday, 95% confidence interval −116.57 to −49.98, P=0.001). Differences between groups (in favour of the intervention group compared with control) were observed for occupational sitting time at three months (−50.62 min/workday, −78.71 to −22.54, P<0.001) and six months (−64.40 min/workday, −97.31 to −31.50, P<0.001) and daily sitting time at six months (−59.32 min/day, −88.40 to −30.25, P<0.001) and 12 months (−82.39 min/day, −114.54 to −50.26, P=0.001). Group differences (in favour of the intervention group compared with control) were found for prolonged sitting time, standing time, job performance, work engagement, occupational fatigue, sickness presenteeism, daily anxiety, and quality of life. No differences were seen for sickness absenteeism

Expert commentary

Sedentary behaviour at work is a risk factor for various health outcomes and may also affect productivity. 

This important study showed that sitting time at work can be reduced substantially by introducing a comprehensive intervention involving height adjustable desks, as well as seminars and group and individual coaching session to encourage interrupting of sitting.  Positive impacts were also observed on some other outcomes such as musculoskeletal symptoms, fatigue, performance, presenteeism, etc.

What is unclear is to what extent to coaching and feedback sessions need to continue to maintain the effect of the intervention.

Martie van Tongeren, Professor of Occupational and Environmental Health, The University of Manchester

The commentator declares no conflicting interests