Effectiveness of an intervention for reducing sitting time and improving health in office workers: three arm cluster randomised controlled trial

Abstract

Objectives To evaluate the effectiveness of an intervention, with and without a height adjustable desk, on daily sitting time, and to investigate the relative effectiveness of the two interventions, and the effectiveness of both interventions on physical behaviours and physical, biochemical, psychological, and work related health and performance outcomes. Design Cluster three arm randomised controlled trial with follow-up at three and 12 months. Setting Local government councils in Leicester, Liverpool, and Greater Manchester, UK. Participants 78 clusters including 756 desk based employees in defined offices, departments, or teams from two councils in Leicester, three in Greater Manchester, and one in Liverpool. Interventions Clusters were randomised to one of three conditions: the SMART Work and Life (SWAL) intervention, the SWAL intervention with a height adjustable desk (SWAL plus desk), or control (usual practice). Main outcomes measures The primary outcome measure was daily sitting time, assessed by accelerometry, at 12 month follow-up. Secondary outcomes were accelerometer assessed sitting, prolonged sitting, standing and stepping time, and physical activity calculated over any valid day, work hours, workdays, and non-workdays, self-reported lifestyle behaviours, musculoskeletal problems, cardiometabolic health markers, work related health and performance, fatigue, and psychological measures. Results Mean age of participants was 44.7 years, 72.4% (n=547) were women, and 74.9% (n=566) were white. Daily sitting time at 12 months was significantly lower in the intervention groups (SWAL −22.2 min/day, 95% confidence interval −38.8 to −5.7 min/day, P=0.003; SWAL plus desk −63.7 min/day, −80.1 to −47.4 min/day, P<0.001) compared with the control group. The SWAL plus desk intervention was found to be more effective than SWAL at changing sitting time (−41.7 min/day, −56.3 to −27.0 min/day, P<0.001). Favourable differences in sitting and prolonged sitting time at three and 12 month follow-ups for both intervention groups and for standing time for the SWAL plus desk group were observed during work hours and on workdays. Both intervention groups were associated with small improvements in stress, wellbeing, and vigour, and the SWAL plus desk group was associated with improvements in pain in the lower extremity, social norms for sitting and standing at work, and support. Conclusions Both SWAL and SWAL plus desk were associated with a reduction in sitting time, although the addition of a height adjustable desk was found to be threefold more effective. Trial registration ISRCTN Registry ISRCTN11618007 .

The Cost-Effectiveness of the SMART Work & Life Intervention for Reducing Sitting Time

“…Over the course of the trial, the degrees of data completion for the resource use, EQ-5D-5L and absenteeism follow-up data ranged between 61.8–83.5%, 69.0–93.0% and 65.6–87.4%, respectively. Participant characteristics are reported elsewhere [ 26 ].…”

“…Intervention and healthcare costs were measured in UK pounds sterling (2019–2020) from a public sector perspective [ 25 ]. Office-worker outcomes included quality adjusted life-years (QALY), absenteeism days, measures of productivity, psychological health, job satisfaction, and work engagement [ 7 , 26 ]. In line with UK guidelines, costs and QALYs were discounted at 3.5% per annum [ 25 ].…”

“…Randomisation was stratified by council area (Leicester, Liverpool, and Greater Manchester) and cluster size (<10 and ≥10 participants). Trial participants consisted of consenting, English speaking, non-pregnant and mobile (able to walk unassisted) adult office workers (≥60% full time equivalent) nested within shared office spaces [ 26 ]. Follow-up measurements were taken at 3 and 12 months with activity data recorded using a thigh-worn accelerometer-based device.…”

The importance of sitting less and moving more

“…In a linked paper, Edwardson and colleagues (doi:10.1136/bmj-2021-069288) report on a cluster randomised controlled trial of the SMART Work and Life (SWAL) intervention in local government council offices in England aimed at supporting staff to sit less and move more, not only at work but also outside working hours 11. SWAL is a theoretically informed, multilevel (organisational, environmental, group, individual) intervention delivered by workplace champions.…”

The best response to US criminalisation of abortion is decriminalisation elsewhere

“…Abortion, of course, isn’t the only medical issue where the voice of the evidence is lost amid populist clamour and political opportunism. This week’s examples are the “zombie policy” of user charges for missed appointments 9 and introducing prostate cancer screening under the guise of “case finding.”10 Isolating the evidence signals from the noise–whether it is about the safety of covid vaccines in pregnancy,11 the new clinical features of monkeypox,1213 or how best to limit sitting time in office based work 14–is as much a responsibility of policy and law makers as it is of clinicians.…”