L18: Sedentary behaviour at Work

Question 1

What is sedentary behaviour?

Answer 1

Any waking behaviour characterized by an energy expenditure ≤1.5 METs while in a sitting or reclining position

Question 2

How much time do we spend sitting?

Answer 2

Adults report spending 50-60% of their day in sedentary pursuits accumulated in the domains of work, travel and leisure time. Office workers are at greatest risk of sedentary behaviour

Question 3

Why are we sitting more? (4)

Answer 3

1. Mechanisation of work and leisure activities
2. Introduction of computers means we are ‘chained’ to our desks to work
3. Industrialisation of home duties – washing machines, dishwashers
4. Increasing population – have to drive / commute longer to work

At risk workers – office workers, transport drivers (truck, bus, taxi), mechanised trades (crane and dozer operators)

Question 4

Why is prolonged sitting at work a problem? What is the sitting disease?

Answer 4

1. Greater risk of mortality
2. “long hours sitting are causing severe musculoskeletal problems”

Question 5

What is high sedentary/sitting time associated with (7)?

Answer 5

1. 112% increase risk of Diabetes
2. 147% increase risk of Cardiovascular events
3. 90% increase risk of death due to cardiovascular events
4. 49% increase in over all mortality
5. Colon cancer
6. Weight gain & development of obesity
7. Musculoskeletal symptoms

Prolonged sitting is thought to slow the metabolism, which affects the body’s ability to regulate blood sugar, blood pressure and break down body fat.

Question 6

What are 3 hierachy levels as strategies to limit harmful effects of prolonged sitting?

Answer 6

Aim for frequent changes between sitting and standing

Becoming more active = Increase dynamic sitting workplace

Question 7

What are the 4 benefits of work in standing?

Answer 7

1. Higher caloric expenditure
2. Reduced BMI
3. Improved metabolic health
4. Improved cardiovascular health

Question 8

What are 12 strategies to break up prolonged sitting in the work place? (encourage movement)

Answer 8

Postural variation

1. stand and take a break from your desk every 30 minutes
2. use stairs and not lifts
3. use separately located bins and /printers
4. Mini bin –> encourage physical activity (go and empty the bin)
5. take standing breaks in long sitting meetings
6. stand to greet a visitor and for phone calls
7. walk to colleagues desk instead of phoning or emailing
8. have standing and / or walking meetings
9. use headsets / speaker during teleconferencing enabling standing
10. eat your lunch away from your desk
11. stand at the back of the room during presentations
12. Water bottle on desk –> more frequent toilet breaks (increase physical activity)

Question 9

What are 5 problems with sit-stand desks (workstations)?

Answer 9

1. Lack of known guidelines for sitstand transitions
2. Prolonged standing replaced by prolonged sitting
3. Compliance an issue
4. Poor posture can be adopted in standing
5. Workstation not adjusted between postures

Risk of developing gluteal tendinopathy from prolonged standing

Question 10

What is the compliance with sit-stand desks? Why (3 reasons for low utilisation? How does this increase (2)?

Answer 10

60% of people used them less than once a month and only 20% used them frequently

1. not bother to use the function,
2. small standing table surface
3. difficulty getting comfortable in the standing position
4. With education & motivation
5. Those receiving desk due to physical discomfort most motivated

Question 11

What does the set up for sitting workstation VS standing work station look like?

Answer 11

Question 12

What are 8 eveidence for sit-stand workstations as part of the solution?

Answer 12

1. Reduce Low back pain
2. Impact of sit-stand workstations on neck pain is mixed
3. On average, burn an extra 0.5-2 kcal per minute vs sitting still
4. Induce postural variation
5. Reduced time spent sitting by ~57’/day 3-12 mths after implementation
6. Increased time spent standing
7. Reduce cardio-metabolic markers
8. BUT, the effects are small, greater effects with education and behavioural changes

Question 13

What is evidence from sit stand workstations?

Answer 13

1. Active workstations (eg treadmill desks or cycling desks) had unclear or inconsistent effects on sitting time
2. no significant effects for implementing walking strategies on workplace sitting time at short-term or medium term
3. Short breaks (1-2’ every half hour) reduced time spent sitting at work on average by 40’ per day compared to long breaks (two 15-minute breaks per workday) at short-term follow-up.
4. Providing information, feedback, counselling, or all of these resulted in no significant change in time spent sitting at work at short-term
5. Computer prompts combined with information resulted in no significant change in sitting time at work at short-term follow-up
6. Computer prompts with instruction to stand reduced sitting at work on average by 14’ per day

Question 14

What are the 3 harms associated with prolonged standing?

Answer 14

1. General fatigue
2. Varicose Veins and risk of CVD
3. Musculoskeletal discomfort – predominantly back and legs

Question 15

What are 3 characteristics of general fatigue in standing?

Answer 15

1. Heart rate is higher during standing than sitting
2. Standing more tiring as it requires ~20% more energy thansitting
3. Thigh muscle activity during standing has been reported to be 2.5 times the level during sitting

Question 16

Whta is the energy expenditure in sit VS stand?

Answer 16

1. Standing performing clerical work increased EE 7.5 kcal/h over sitting in an office chair;
2. not likely to promote weight loss but may help to slow weight gain or weight regain

Question 17

What are 2 characteristics of energy expenditure in standing?

Answer 17

1. It would take over 2 h of standing to burn as much energy as 30 min of walking.
2. It would take nearly 6 h of standing to burn as much energy as 30 min of running.

Question 18

What are 2 main associations between standing and health/disease?

Answer 18

1. Significant relationships between amount of standing at work & atherosclerotic progression
   
   • Atherosclerotic changes in the carotid arteries over 4 years
2. Significant relationship between prolonged standing at work and varicose veins
   
   • Varicose veins with prolonged standing in 2165 workers
   • Hospitalization for Varicose veins in workers standing or walking at least 75% of their time at work
   • 12 years of follow up, relative risk was 1.78

Question 19

What are characteristics of standing increasing carotid atherosclerososis?

Answer 19

• Increase of Carotid Intima Media Thickness (IMT) over 4 years associated with time spent standing.
• Analysis adjusted for Age, Technical, Physical and Psychosocial Job Factors, Income, Biological and Behavioral Factors

Question 20

What are characteristics of standing compared to smoking?

Answer 20

Men with carotid stenosis are vulnerable to the adverse effects of prolonged standing at work

Question 21

What are 3 characteristics lower limb discomfort in standing?

Answer 21

1. Lower limb volume and circumference due to venous pooling
2. Strain on the circulatory system
3. Varicose veins

Question 22

What are characteristics knee loading in standing?

Answer 22

For the same duration, 30’ of standing accumulates the same total knee joint load accumulated as walking and over half the load of running, even though peak knee joint loads in running are tremendous compared to standing

Question 23

What are 7 characteristics of LBP in standing?

Answer 23

1. Low-back problems after standing over 50% of the work shift
2. 5 hr of standing work induced lower extremity muscle fatigue, even with regular rest breaks and persisted at least 30 min post- work
3. 40-70% of previously asymptomatic people will experience
4. LBP within 1 hour of standing
5. Greater compression loads on the spine in standing
6. Low-level muscle fatigue
7. Increase in coactivity of the gluteus medius and fatigue of gluteus medius
8. Greater Lumbar lordosis in standing

Question 24

Can risk of LBP with standing be predicted?

Answer 24

Active hip abduction test discriminated between pain-developer groups with OR of 3.8

Question 25

What are 5 interventions to reduce LBP while decreasing sitting time?

Answer 25

1. behavioural counselling (twice/month in person and telephone) 2. a sit stand desk 3. wrist worn activity prompting device and 4. CBT for LBP self management 5. Supervisor support Results: 1. Sitting time reduced by 1.5hr/day 2. Oswestry back disability significantly reduced

Question 26

What are 6 strategies as the 3 hierachy levels to limit discomfort with standing?

Answer 26

Question 27

Does Postural Variation reduce standing induced LBP?

Answer 27

Work–rest ratio of 3:1 (45’ stand to 15’ sit) was not enough to completely rid the LBP for 11 participants

Question 28

Is there an optimal sit–stand ratio?

Answer 28

Question 29

What are the advantages and disadvantages of anti-fatigue matting?

Answer 29

1. Softer floors reduced perceived discomfort compared with hard floors possibly due to postural sway BUT 1. chair wheels may not roll over the matting; 2. ?trip hazard; 3. Infection control concerns in health industry and food production

Question 30

What is the evidence for shoe insoles and foot pain?

Answer 30

1. 7hrs/day for 5 weeks 2. Walked an average 4.8km/day 3. Significant reduction in feet tiredness at end of day 4. no change in back or leg discomfort **Strong evidence that the use of insoles does not prevent or alleviate back pain**

Question 31

What is the evidence for compression stockings?

Answer 31

1. Ready to wear stockings with pressure grades 8 – 15 or 2. 15- 20mmHg 3. Both showed significant positive benefit in decreasing leg discomfort, swelling, fatigue and aching 4. Effectiveness depends on level of compression, presence of cardio-vascular insufficiency 5. Recommend for workers who need to stand long periods e.g. flight attendants, nursing staff

Question 32

What is the evidence for exercise for LBP?

Answer 32

* 4 week exercise program reduced the severity of * LBP during prolonged standing * Exercise + standing desk no more effective than Standing alone

Question 33

What do exercises at the workstation to reduce LBP look like?

Answer 33

Question 34

What are 7 characteristics of prescribing and using a sit to stand workstation?

Answer 34

1. Why do you think you need a sit to stand workstation? 2. What is the company policy? Health provider recommendation required? 3. History of LBP – if relieved by standing, recommend strategies to interrupt sitting before trialling desk; 4. Desk top height adjustable workstation (eg varidesk) NOT recommended for person with current LBP 5. History of CVD or Myocardial infarct – recommend avoid prolonged standing 6. History of hip/knee OA – regular postural change 7. If sit-stand desk recommended, training in safe use essential

Question 35

What are 6 summaries of evidence for sit-stand workstations?

Answer 35

1. Consult guidelines prior to purchase: 2. Limited evidence that sit-stand desks reduce risk of MSK symptoms in healthy population 3. In those with history of LBP, sit-stand desk may not be enough 4. No evidence that sit-stand desks decrease CVD 5. Training is needed to ensure worker knows how to adjust the monitor / desk to suit 6. Optimal sit – stand ratio unknown

Question 36

What are 5 guidelines if transitioning to standing?

Answer 36

1. Start slowly with bouts of 10’ changing posture every 30’ 2. Build up to 2 hrs standing and light activity during workday; 3. Progress to total of 4 hrs across the day 4. Continuous standing for ≤ 1hour and total/day ≤ 4 hrs 5. Listen to you’re your body & avoid asymmetrical postures

Question 37

\_\_\_\_\_\_\_ without ability to ____ (whether Standing or Sitting) is not recommended ie work should NOT be static

Answer 37

Constrained postures; move

Question 38

Occupational sitting _____ (does/does not)increase CVD

Answer 38

does not

Question 39

Predominantly standing at work _____ (does/does not) increase risk of CVD

Answer 39

does

Question 40

Metabolism increases with standing ______ (is/is not) sufficient to decrease BMI

Answer 40

is not

Question 41

Threshold for excessive sitting / standing is \_\_\_\_\_\_

Answer 41

unknown

Question 42

\_\_\_\_\_\_ is a better alternative

Answer 42

Postural variation

Question 43

Consider\_\_\_\_\_, \_\_\_\_\_\_\_, _______ for sedentary behaviour

Answer 43

exercise and fidgeting for LBP; matting / shoe insoles / exercise for foot pain; compression stockings for leg pain

Question 44

The increase in energy expenditure induced by standing ______ (is/is not) sufficient for wt loss

Question 45

* An office worker of 54 years has knee OA, BMI of 28 kg/m2 * She asks if she can use a standing workstation Q: * Is standing at work an occupational hazard for knee OA? * Would you recommend a standing workstation? * If so, what precautions would you suggest?

Answer 45

Sit less, stand sometimes, move more