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      Efficacy of the ‘Stand and Move at Work’ multicomponent workplace intervention to reduce sedentary time and improve cardiometabolic risk: a group randomized clinical trial

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          Abstract

          Background

          Sedentary time is associated with chronic disease and premature mortality. We tested a multilevel workplace intervention with and without sit-stand workstations to reduce sedentary time and lower cardiometabolic risk.

          Methods

          Stand and Move at Work was a group (cluster) randomized trial conducted between January 2016 and December 2017 among full-time employees; ≥18 years; and in academic, industry/healthcare, and government worksites in Phoenix, Arizona and Minneapolis/St. Paul, Minnesota, USA. Eligible worksites were randomized to (a) MOVE+, a multilevel intervention targeting reduction in sedentary time and increases in light physical activity (LPA); or (b) STAND+, the MOVE+ intervention along with sit-stand workstations to allow employees to sit or stand while working. The primary endpoints were objectively-measured workplace sitting and LPA at 12 months. The secondary endpoint was a clustered cardiometabolic risk score (blood pressure, glucose, insulin, triglycerides, and HDL-cholesterol) at 12 months.

          Results

          Worksites ( N = 24; academic [ n = 8], industry/healthcare [ n = 8], and government [ n = 8] sectors) and employees ( N = 630; 27 ± 8 per worksite; 45 ± 11 years of age, 74% female) were enrolled. All worksites were retained and 487 participants completed the intervention and provided data for the primary endpoint. The adjusted between arm difference in sitting at 12 months was − 59.2 (CI: − 74.6,-43.8) min per 8 h workday, favoring STAND+, and in LPA at 12 months was + 2.2 (− 0.9,5.4) min per 8 h workday. Change in the clustered metabolic risk score was small and not statistically significant, but favored STAND+. In an exploratory subgroup of 95 participants with prediabetes or diabetes, the effect sizes were larger and clinically meaningful, all favoring STAND+, including blood glucose, triglycerides, systolic blood pressure, glycated hemoglobin, LDL-cholesterol, body weight, and body fat.

          Conclusions

          Multilevel workplace interventions that include the use of sit-stand workstations are effective for large reductions in sitting time over 12 months. Among those with prediabetes or diabetes, clinical improvements in cardiometabolic risk factors and body weight may be realized.

          Trial registration

          ClinicalTrials.gov Identifier: NCT02566317. Registered 2 October 2015, first participant enrolled 11 January 2016.

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          Most cited references27

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          An Ecological Perspective on Health Promotion Programs

          During the past 20 years there has been a dramatic increase in societal interest in preventing disability and death in the United States by changing individual behaviors linked to the risk of contracting chronic diseases. This renewed interest in health promotion and disease prevention has not been without its critics. Some critics have accused proponents of life-style interventions of promoting a victim-blaming ideology by neglecting the importance of social influences on health and disease. This article proposes an ecological model for health promotion which focuses attention on both individual and social environmental factors as targets for health promotion interventions. It addresses the importance of interventions directed at changing interpersonal, organizational, community, and public policy, factors which support and maintain unhealthy behaviors. The model assumes that appropriate changes in the social environment will produce changes in individuals, and that the support of individuals in the population is essential for implementing environmental changes.
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            Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women.

            High amounts of sedentary behaviour have been associated with increased risks of several chronic conditions and mortality. However, it is unclear whether physical activity attenuates or even eliminates the detrimental effects of prolonged sitting. We examined the associations of sedentary behaviour and physical activity with all-cause mortality.
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              Validation of wearable monitors for assessing sedentary behavior.

              A primary barrier to elucidating the association between sedentary behavior (SB) and health outcomes is the lack of valid monitors to assess SB in a free-living environment. The purpose of this study was to examine the validity of commercially available monitors to assess SB. Twenty overweight (mean ± SD: body mass index = 33.7 ± 5.7 kg·m(-2)) inactive, office workers age 46.5 ± 10.7 yr were directly observed for two 6-h periods while wearing an activPAL (AP) and an ActiGraph GT3X (AG). During the second observation, participants were instructed to reduce sitting time. We assessed the validity of the commonly used cut point of 100 counts per minute (AG100) and several additional AG cut points for defining SB. We used direct observation (DO) using focal sampling with duration coding to record either sedentary (sitting/lying) or nonsedentary behavior. The accuracy and precision of the monitors and the sensitivity of the monitors to detect reductions in sitting time were assessed using mixed-model repeated-measures analyses. On average, the AP and the AG100 underestimated sitting time by 2.8% and 4.9%, respectively. The correlation between the AP and DO was R2 = 0.94, and the AG100 and DO sedentary minutes was R2 = 0.39. Only the AP was able to detect reductions in sitting time. The AG 150-counts-per-minute threshold demonstrated the lowest bias (1.8%) of the AG cut points. The AP was more precise and more sensitive to reductions in sitting time than the AG, and thus, studies designed to assess SB should consider using the AP. When the AG monitor is used, 150 counts per minute may be the most appropriate cut point to define SB.
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                Author and article information

                Contributors
                map@umn.edu
                mbuman@asu.edu
                Journal
                Int J Behav Nutr Phys Act
                Int J Behav Nutr Phys Act
                The International Journal of Behavioral Nutrition and Physical Activity
                BioMed Central (London )
                1479-5868
                27 October 2020
                27 October 2020
                2020
                : 17
                : 133
                Affiliations
                [1 ]GRID grid.17635.36, ISNI 0000000419368657, University of Minnesota, School of Public Health, ; 1300 South Second Street, Minneapolis, MN 55455 USA
                [2 ]GRID grid.215654.1, ISNI 0000 0001 2151 2636, Arizona State University, College of Health Solutions, ; 500 North 3rd Street, Phoenix, AZ 85004 USA
                [3 ]GRID grid.434247.2, ISNI 0000 0000 8943 2686, Fairview Health Services, ; Minneapolis, MN USA
                [4 ]GRID grid.280248.4, ISNI 0000 0004 0509 1853, Minnesota Department of Health, ; Minneapolis, MN USA
                [5 ]GRID grid.263081.e, ISNI 0000 0001 0790 1491, San Diego State University, ; San Diego, CA USA
                Author information
                http://orcid.org/0000-0002-5130-3162
                Article
                1033
                10.1186/s12966-020-01033-3
                7592578
                33109190
                a3eb823e-600f-4327-9be1-91e8ae6ecab1
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 29 June 2020
                : 1 October 2020
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100000054, National Cancer Institute;
                Award ID: R01CA198971
                Award Recipient :
                Categories
                Research
                Custom metadata
                © The Author(s) 2020

                Nutrition & Dietetics
                Nutrition & Dietetics

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