title: Workplace interventions for reducing sitting at work.
abstract: BACKGROUND
  Office work has changed considerably over the previous couple of decades and has become sedentary in nature. Physical inactivity at workplaces and particularly increased sitting has been linked to increase in cardiovascular disease, obesity and overall mortality.
  
  
  OBJECTIVE
  To evaluate the effects of workplace interventions to reduce sitting at work compared to no intervention or alternative interventions.
  
  
  METHODS
  We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, OSH UPDATE, PsycINFO, Clinical trials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal up to 2 June, 2015. We also screened reference lists of articles and contacted authors to find more studies to include.
  
  
  METHODS
  We included randomised controlled trials (RCTs), cluster-randomised controlled trials (cRCTs), and quasi-randomised controlled trials of interventions to reduce sitting at work. For changes of workplace arrangements, we also included controlled before-and-after studies (CBAs) with a concurrent control group. The primary outcome was time spent sitting at work per day, either self-reported or objectively measured by means of an accelerometer-inclinometer. We considered energy expenditure, duration and number of sitting episodes lasting 30 minutes or more, work productivity and adverse events as secondary outcomes.
  
  
  METHODS
  Two review authors independently screened titles, abstracts and full-text articles for study eligibility. Two review authors independently extracted data and assessed risk of bias. We contacted authors for additional data where required.
  
  
  RESULTS
  We included 20 studies, two cross-over RCTs, 11 RCTs, three cRCTs and four CBAs, with a total of 2180 participants from high income nations. The studies evaluated physical workplace changes (nine studies), policy changes (two studies), information and counselling (seven studies) and interventions from multiple categories (two studies). One study had both physical workplace changes and information and counselling components. We did not find any studies that had investigated the effect of periodic breaks or standing or walking meetings. Physical workplace changesA sit-stand desk alone compared to no intervention reduced sitting time at work per workday with between thirty minutes to two hours at short term (up to three months) follow-up (six studies, 218 participants, very low quality evidence). In two studies, sit-stand desks with additional counselling reduced sitting time at work in the same range at short-term follow-up (61 participants, very low quality evidence). One study found a reduction at six months' follow-up of -56 minutes (95% CI -101 to -12, very low quality evidence) compared to no intervention. Also total sitting time at work and outside work decreased with sit-stand desks compared to no intervention (MD -78 minutes, 95% CI -125 to -31, one study) as did the duration of sitting episodes lasting 30 minutes or more (MD -52 minutes, 95% CI -79 to -26, two studies). This is considerably less than the two to four hours recommended by experts. Sit-stand desks did not have a considerable effect on work performance, musculoskeletal symptoms or sick leave. It remains unclear if standing can repair the harms of sitting because there is hardly any extra energy expenditure.The effects of active workstations were inconsistent. Treadmill desks combined with counselling reduced sitting time at work (MD -29 minutes, 95% CI -55 to -2, one study) compared to no intervention at 12 weeks' follow-up. Pedalling workstations combined with information did not reduce inactive sitting at work considerably (MD -12 minutes, 95% CI -24 to 1, one study) compared to information alone at 16 weeks' follow-up. The quality of evidence was low for active workstations. Policy changesTwo studies with 443 participants provided low quality evidence that walking strategies did not have a considerable effect on workplace sitting time at 10 weeks' (MD -16 minutes, 95% CI -54 to 23) or 21 weeks' (MD -17 minutes, 95% CI -58 to 25) follow-up respectively. Information and counsellingCounselling reduced sitting time at work (MD -28 minutes, 95% CI -52 to -5, two studies, low quality evidence) at medium term (three months to 12 months) follow-up. Mindfulness training did not considerably reduce workplace sitting time (MD -2 minutes, 95% CI -22 to 18) at six months' follow-up and at 12 months' follow-up (MD -16 minutes, 95% CI -45 to 12, one study, low quality evidence). There was no considerable increase in work engagement with counselling.There was an inconsistent effect of computer prompting on sitting time at work. One study found no considerable effect on sitting at work (MD -17 minutes, 95% CI -48 to 14, low quality evidence) at 10 days' follow-up, while another study reported a significant reduction in sitting at work (MD -55 minutes, 95% CI -96 to -14, low quality evidence) at 13 weeks' follow-up. Computer prompts to stand reduced sitting at work by 14 minutes more (95% CI 10 to 19, one study) compared to computer prompts to step at six days' follow-up. Computer prompts did not change the number of sitting episodes that last 30 minutes or longer. Interventions from multiple categories Interventions combining multiple categories had an inconsistent effect on sitting time at work, with a reduction in sitting time at 12 weeks' (25 participants, very low quality evidence) and six months' (294 participants, low quality evidence) follow-up in two studies but no considerable effect at 12 months' follow-up in one study (MD -47.98, 95% CI -103 to 7, 294 participants, low quality evidence).
  
  
  CONCLUSIONS
  At present there is very low to low quality evidence that sit-stand desks may decrease workplace sitting between thirty minutes to two hours per day without having adverse effects at the short or medium term. There is no evidence on the effects in the long term. There were no considerable or inconsistent effects of other interventions such as changing work organisation or information and counselling. There is a need for cluster-randomised trials with a sufficient sample size and long term follow-up to determine the effectiveness of different types of interventions to reduce objectively measured sitting time at work.
authors.affiliation: Health Research and Social Development Forum, Thapathali, Kathmandu, Nepal, 24133.
authors.forename: Nipun
authors.initials: N
authors.lastname: Shrestha
authors.forename: Katriina T
authors.initials: KT
authors.lastname: Kukkonen-Harjula
authors.forename: Jos H
authors.initials: JH
authors.lastname: Verbeek
authors.forename: Sharea
authors.initials: S
authors.lastname: Ijaz
authors.forename: Veerle
authors.initials: V
authors.lastname: Hermans
authors.forename: Soumyadeep
authors.initials: S
authors.lastname: Bhaumik
mesh_terms: D061725:Accelerometry; D065187:Controlled Before-After Studies; D004734:Energy Metabolism; D006804:Ergonomics; D006801:Humans; D011187:Posture; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors; D017132:Workplace / Q000706:statistics & numerical data*