*** W7 - Sedentary Behaviour:

• Sedentary for 9.5 hours a day Accelerometer data from 175 office workers (Clemes et al. 2014) • Using an accelerometer

Time spent sedentary - working adults:

• HGV drivers are among those with the lowest life expectancies in England - they show bad signs in health and lack of PA

What about those with 'compulsory sedentary occupations'

o Solutions exsit for reducing sitting in most office works o Kinch bus - they were sitting for 11 hours

What about those with 'compulsory sedentary occupations'?

compensation affect - sitting at work, means you sit at home more.

What are the effects of a sit-stand desk intervention on sitting at home

• Lifestyle changes to behaviour • Technological advancements - in workplace and home - more manual tasks before replaced by automated - Home food deliveries - Tech hoovers - Drive thro ATM - Electric Lawn mowers • Increased use of cars - everyone owns one • Sedentary jobs - desk spaces • Cities are getting larger, people are being forced to live further away from work • Leisure time is being relatively inactive • TV viewing, tablets, smart phones etc

What factors are responsible for high levels of sedentary behaviour?

• Activities under 1.5 met • Any waking behaviour characterised by an energy expenditure of less than 1.5 MET • Sitting, lying or reclining posture why waking • Different to sleep • The met value is there to distinguish it from activity forms of sitting

What is sedentary behaviour?

• Poor health

Why should we be interested in reducing sedentary behaviour?

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

compulsory reading

targetted - National Health Service trust, England - 7 office clusters (146 participants) of desk based workers: 19 clusters (77 participants) were randomised to the intervention and 18 (69 participants) to control. recieved: height adjustable workstation 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.

intervention

how you accumulate your sitting time

its not just about how long you sit for its also about...

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.

key aims

looked at 1 million adults from previous stidies grouped into 4 groups based on PA • Increased sitting is linked with increased all-cause mortality • Those active for 60-75 mins/day seem to have NO increased risk even if they sit for >8 hs/day INACTIVE - higher mortality rates

links between Sedentary, PA and health : Sedentary behaviour and health (Ekelund et al 2016)

SMArT Work successfully reduced sitting time over the short, medium, and longer term, and positive changes were observed in work related and psychological health. 12 months : decrease by 83 mins / day

main results

US - 1960S - manual jobs have decreases: • Adults spend most of their waking hours in work - sedentary

reasons for change in sedentary behaviour - changes to the workplace:

• children who sit a lot show cardiometabolic health (obesity, blood pressure, cholesterol, insulin) have been reported • Adverse associations with children's fitness, cognitive development and academic achievement • given lifestyle behaviours established during childhood can track into adulthood not as bad as adults

results of sedentary behaviour in children:

children who sit a lot, increase chances of going into adulthood sitting

why they are a concern

Accelerometer data from 1,862 9-10 year olds (Steele et al. 2009) • 2/3rds of their waking hours sedentary

• Using an accelerometer Time spent sedentary - children:

"Breaking up prolonged sitting appears to lead to favourable changes in metabolic parameters such as blood glucose control, with the biggest affects seen in diabetic patients and/or those who are physically inactive, overweight or obese" (Benatti et al. 2015)

Breaking up prolonged sitting:

• Solutions exist for reducing sitting in most office workers • But what about those who have to sit for prolonged periods whilst at work?

Compulsory sedentary workers:

between sitting and mortality - those who sat for longer had increased mortality.

Dose response relationship

o followed by after 3,6,12 months o each follow up time point there is a reduction in sedentary

Findings:

• Sitting at work decreased by 20% • Sitting outside of work increased by 6%

Headline findings:

Independent of physical activity, total sitting and TV viewing time are associated with greater risk for several major chronic disease outcomes. For premature mortality and CVD mortality, a threshold of 6-8 hrs/day of total sitting and 3-4 hrs/day of TV viewing was identified, above which the risk is increased. Analyses based on 1,331,468 participants.

How much sitting time is too much?

8-9 hours ish (quite typical)

How much time do you spend sitting on a typical day?

Stand in advert breaks Get a dog Stand up every time you go on your phone Stand and take a break Walk and talk on the phone

How to reduce daily sitting at home

Standing desks No lifts - just stairs Standing meetings Encourage people to use gym during lunch Incentive schemes Take a break from your computer every 30 mins Stand during phone calls Move your bin away from your desk Use pooled printers Walk to colleagues desks instead of phoning/emailing Drink more water Park further away from work Eat you lunch away from your desk Stand at the back during lectures Standings/walking meetings

How to reduce daily sitting in office workers?

• 91% increase risk of developing diabetes • 17% increase risk of cancer mortality • 18% increase risk of cardiovascular mortality • 24% increase risk of all-cause mortality

In a review of 47 studies..... The greatest sedentary time compared with the lowest was associated with:

increased risk of health risk

People sitting 8 hours a day

• overall cardiometabolic risk score In "healthy" workers the intervention showed a small benefit for improving biomarkers of cardiometabolic risk, but only with 12 months of intervention (Healy et al., 2017, MSSE, 49(10), 2032-2039)

Positive effects of the intervention at 12 months follow-up were also observed for:

• standing time • job performance • work engagement • occupational fatigue • sickness presenteeism • daily anxiety • quality of life

Positive effects of the intervention at 12 months follow-up were also observed for:

- Felt more engaged and focused - Redcued sitting time by 63 minutes per day

Positive of sit stand desks

AIM: Assessing the for the effectiveness of a program designed to reduce sitting time at work 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 • coaching sessions (month 1 and every three months thereafter)

SMArT Work trial:

Cardiovascular disease (CVD) events in bus drivers and conductors (Morris et al. BMJ 1953) • higher CVD in drivers then the conductors (be on their feet collecting money)

STUDY : 1950s - in bus conductors and drivers:

- better behaviour and increased self-control - Children's behaviour improved - No negative effects of intervention - Control group - sedentary behaviour reduced too - awareness of taking part

Secondary outcomes:

Adults should aim to minimise the amount of time spent being sedentary, and when physically possible should break up long periods of inactivity with at least light physical activity. 150 mins per week Minimise sedentary time Similar to old ones - but in addition which says when possible we should break up periods of inactivity.

Sedentary behaviour guidelines: (2019)

• In northern Ireland - civil servants • How much time they spent sitting in different domains • Over 60 % of day sitting - working hours • Individuals that sit the most at work are more likely to then sit more in leisire time - no compensation happening in this group. • 10 hours a day - average - working day. non working days - 7.5 hours a day - tv viewing is the main also found - those who are more sednatry at work - more sedentary at home

Sedentary behaviour in office workers

retail - 6 hours a day office workers -(lorry drivers) - 10 hours bus drivers- 12 hours call centre workers - 12.5 hours

Sedentary behaviour in working adults: other examples retail, office workers, bus drivers, call centre workers

NIHR Public Health Research funded study: A three arm cluster randomised controlled trial to test the effectiveness and cost-effectiveness of the SMArT Work & Life intervention for reducing daily sitting time in office workers (2018 - 2021)

Sedentary behaviour interventions in adults:

o Total sitting on a school day: 10 hrs, 14 mins (68% of wake time) o Total sitting on a non-school day: 11 hrs 30 mins (74% of wake time)

Sitting time in Bradford school children (9-10 years)

The first published RCT to examine a multicomponent intervention in the workplace Stand up: • reduce the length of sitting bouts, increase standing Sit less: • reduce total workplace sitting time and the number of sitting bouts Move More: • increase moving time what that did: staff info evening management emails to staff

Stand up Inventerntion - Oz

increase in people working for cycle based work e.g. Deliveroo - contrast between one group being active and the other getting the food are being less active

Sunday times article

Multicomponent intervention - 400 drivers into this study pre health assessment education session health coach support post-health assessment

The SHIFT programme : Intervention for drivers

o waist circumference (-2.3 cm) o fasting blood glucose (-0.5 mmol/l) o LDL (bad) cholesterol (-0.8 mmol/l) o total cholesterol (-0.9 mmol/l) o diastolic blood pressure (-1.8 mmHg)

The following reductions were also observed:

NIHR Public Health Research funded study: Stand Out in Class: Restructuring the classroom environment to reduce sedentary behaviour - a pilot cluster randomised controlled trial (2016 - 2018) The mean between group difference in change in sitting was -30.6 mins/day (95% CI: -56.42 to -4.83) No evidence of compensation

The stand out in class study: