Stand Out in Class: restructuring the classroom environment to reduce sitting time – findings from a pilot cluster randomised controlled trial

Abstract

Background: Excessive sedentary behaviour (sitting) is a risk factor for poor health in children and adults. Incorporating sit-stand desks in the classroom environment has been highlighted as a potential strategy to reduce children's sitting time. The primary aim of this study was to examine the feasibility of conducting a cluster randomised controlled trial (RCT) of a sit-stand desk intervention within primary school classrooms. Methods: We conducted a two-armed pilot cluster RCT involving 8 primary schools in Bradford, United Kingdom. Schools were randomised on a 1:1 basis to the intervention or usual practice control arm. All children (aged 9-10 years) in participating classes were eligible to take part. Six sit-stand desks replaced three standard desks (sitting 6 children) in the intervention classrooms for 4.5-months. Teachers were encouraged to use a rotation system to ensure all pupils were exposed to the sit-stand desks for > 1 h/day on average. Trial feasibility outcomes (assessed using quantitative and qualitative measures) included school and participant recruitment and attrition, intervention and outcome measure completion rates, acceptability, and preliminary effectiveness of the intervention for reducing sitting time. A weighted linear regression model compared changes in weekday sitting time (assessed using the activPAL accelerometer) between trial arms. Results: School and child recruitment rates were 33% (n = 8) and 75% (n = 176). At follow-up, retention rates were 100% for schools and 97% for children. Outcome measure completion rates ranged from 63 to 97%. A preliminary estimate of intervention effectiveness revealed a mean difference in change in sitting of − 30.6 min/day (95% CI: − 56.42 to − 4.84) in favour of the intervention group, after adjusting for baseline sitting and wear time. Qualitative measures revealed the intervention and evaluation procedures were acceptable to teachers and children, except for some problems with activPAL attachment.

Impacts of a Standing Desk Intervention within an English Primary School Classroom: A Pilot Controlled Trial

“…Overall, few studies have explored the influence of standing desks on classroom behavior [ 20 , 21 , 23 , 31 , 62 ], and of which there is little evidence of a negative impact. There are previous examples, albeit scarce, of space issues in the classroom and conflict between children within standing desk classrooms.…”

“…Within this school, all pupils within a single class received an Ergotron LearnFit height adjustable sit–stand desk that allows the user to manually shift between sitting and standing. These desks have been used in recent school-based standing desk studies [ 22 , 23 , 47 ] The sit–stand desks were installed in the intervention classroom two weeks after baseline measurements (November 2015) and traditional classroom stools were retained for use with the new desks. Before the intervention began, pupils and teaching staff were trained by research team members in how to position the desk to the correct height while sitting and standing according to the manufacturer guidelines.…”

“…Sitting data were explored during class time (based on timetables), after school, and during total waking hours on weekdays. Participants were included in the analyses if they provided ≥8 h of activPAL data per day [ 22 ] on ≥2 weekdays [ 18 , 23 ]. Sleep time (11pm–6am) was removed from the data [ 49 ].…”

“…Standing desk studies within the primary school classroom to date have mostly been limited to relatively short (<4 weeks) to mid-length (<6 months) intervention durations, with contrasting intervention approaches and study designs [ 13 , 17 ]. Studies have demonstrated reductions in time spent sitting in class and increases in standing or stepping time [ 18 , 19 , 20 , 21 , 22 , 23 ]. Intervention effects on health outcomes such as body mass index (BMI) [ 21 , 23 , 24 ], waist circumference, blood pressure [ 22 ] and musculoskeletal discomfort have been mixed [ 22 , 25 , 26 ], but consistent increases in energy expenditure have been observed [ 27 , 28 , 29 ].…”

“…South Asians (the second most common ethnic group in the UK [ 39 ]) have demonstrated an increased risk of type 2 diabetes and cardiovascular disease compared to White Europeans in childhood [ 40 , 41 ]. However, to date, just two standing desk studies [ 18 , 23 ] have been implemented in the UK within such higher-risk populations…”