P-ISSN: 2808-5957
E-ISSN: 2808-6724
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REVIEWING PUBLIC HEALTH INTERVENTIONS ON REDUCING
SEDENTARY BEHAVIOR IN WORKPLACES
Sri Indra Kurnia
School of Public Health, The University of Queensland, Australia
Email :
s.kurnia@uqconnect.edu.au
ARTICLE INFO
ABSTRACT
Date received : 05 September 2022
Revision date : 16 September 2022
Date Approved : 25 September 2022
Changing behavior is a complex and major challenge.
Thus, identifying effective public health interventions is
important to do. This review has the main objective to
identify and examine the most effective and appropriate
practice to reduce sedentary behavior in the occupational
environment. The main hypothesis of this review is “there
is a significant reduction and interruption of sitting time
among office-based workers after the implementation of
the interventions”. Database searching was conducted in
PubMed using the following search strategy: ("Sedentary
Behavior"[MAJR]) AND ("office" [tiab] OR "workplace"
[tiab])) AND ("adults" [tiab] OR "workers") AND
("intervention*" [tiab] or "program"). The search strategy
resulted 124 relevant papers published within 2010-2021.
Manual scanning and reviewing was done to deem
eligibility of the studies as well as to eliminate irrelevant
study design and topic. For example, studies which did
not carry out public health intervention and studies only
exploring the experiences of workers were excluded to the
review group. The aim of this literature review is to
critically evaluate the implemented public health
interventions at reducing sedentary behavior among
office-based workers. Overall, the findings from four
different studies included in this review showed conflicting
outcomes. This may be due to the nature of their
approaches used during delivering the interventions
(single-component intervention vs. multi-component
strategies). howed that this strategy was unsuccessful
and was not effective no changes in the primary outcome
of the study (sedentary behavior was not reduced and
physical activity was not increased). Thus, future
intervention implementation will be more appropriate and
friendly towards the general population.
Keywords: Public Health,
Reducing Sedentary Behavior,
Workplaces
This work is licensed under CC BY-SA 4.0
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INTRODUCTION
Sedentary behavior, characterized by a low energy expenditure (1.5 metabolic
equivalent or less), has been found to increase the risk of non-communicable diseases
(NCDs) such as cardiovascular diseases, diabetes, obesity, cancer and premature
mortality (Biswas et al., 2015; Thorp, Owen, Neuhaus, & Dunstan, 2011; Mark S Tremblay
et al., 2017; Mark Stephen Tremblay, Colley, Saunders, Healy, & Owen, 2010). NCDs
contribute 80% of the total global burden diseases and require immediate action to
reduce the risks (Wang & Wang, 2020). Aligned with the global action plan for the
prevention and control of NCDs, member states of WHO agreed that by 2025, the
prevalence of insufficient physical activity must be reduced by 10% (WHO, 2013). To
achieve that goal, public health interventions in reducing sedentary behavior have been
massively developed, especially in workplace settings (Dunstan et al., 2013). This is due
to the fact that sedentary behaviors are mostly performed by office-based workers
requiring long prolonged sitting while working with less physical activity performed
(Dunstan et al., 2013). Therefore, specific public health interventions aiming at reducing
sedentary behavior in workplaces are highly needed, not only emanated to address
ergonomic problems (i.e., musculoskeletal disorders) but also focused to reduce and
interrupt sitting time.
Changing behavior is a complex and major challenge, it is difficult to sustain
(Bouton, 2014). Thus, identifying effective public health interventions is important to do.
This review has the main objective to identify and examine the most effective and
appropriate practice to reduce sedentary behavior in the occupational environment. The
main hypothesis of this review is “there is a significant reduction and interruption of sitting
time among office-based workers after the implementation of the interventions”.
METHOD
Database searching was conducted in PubMed using the following search strategy:
("Sedentary Behavior"[MAJR]) AND ("office" [tiab] OR "workplace" [tiab])) AND ("adults"
[tiab] OR "workers") AND ("intervention*" [tiab] or "program"). The search strategy
resulted 124 relevant papers published within 2010-2021. Manual scanning and reviewing
was done to deem eligibility of the studies as well as to eliminate irrelevant study design
and topic. For example, studies which did not carry out public health intervention and
studies only exploring the experiences of workers were excluded to the review group. In
addition, to assess the quality of the articles, Cochrane’s risk of bias for randomized
control trial was used as a guideline. This method has identified four eligible articles to
include in this review. Those four articles were deemed eligible as they included (i)
workplace setting (ii) carried out public health intervention at reducing sedentary
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behavior and/or increasing physical activity (iii) measured sedentary behavior as a
primary and/or secondary outcome.
RESULT AND DISCUSSION
Table 1. Taylor et al. (2016)
Study Population
Target group:
Office-based workers
Sample size (n):
185 enrolled participants
Mean age:
43 years
Gender:
Female (82%), Male (18%)
Recruitment:
Participants were recruited from 35
departments at 4 worksites in
Texas, USA from 2010 through 2013
Attrition:
Among the 3 arms, drop-out was estimated
at 42%
Intervention Content
Theory:
World Health Organization’s Healthy
Workplace Framework (consistent
with Theory of Planned Behavior
[TPB])
Strategies/components:
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1. Booster Break arm:
structured physical activity
sessions led by peer;
participant attendance was
recorded.
2. Computer-prompt arm:
computer-based prompts
encouraging workers to stop
working and make physical
movements; self-report by
completing a daily log
3. Usual-break arm (control
group): practicing usual
breaks without intervention
4. $25 payment for participants
completing assessments
(baseline and follow-up)
Intervention Outcomes
Change in outcome:
Consistent attendees in the Booster Break arm showed a greater weekly
pedometer counts and had decreased their sedentary time compared to other
intervention groups.
Author’s conclusion:
Booster Breaks intervention is potential to achieve significant positive results in
reducing sedentary behavior and increasing physical activity. However, it
requires sufficient fidelity, dose and routine practice in the workplace.
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Table 2. Parry et al. (2013)
Study Population
Target group:
Office-based workers
Sample size (n):
133 enrolled participants
Mean age:
41.4 years (SD= 10.9)
Gender:
Female (82%), Male (18%)
Recruitment:
Recruitment was done at regular
monthly staff meetings from 2010 to
2011
Attrition:
Intervention A: 30 participants
Intervention B: 16 participants
Intervention C: 25 participants
Total: 53.38% overall
Intervention Content
Theory:
Cognitive Behavioral Therapy (CBT)
Strategies/components:
1. Intervention A “Active office
work”: introducing “Active
workstation” by providing a
treadmill for workers to
practice light intensity activity
while working. Computer
terminals and phones were
available in the workstation
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to perform normal office
duties.
2. Intervention B “Traditional
physical activity”: promoting
light to moderate activity,
using active transport before
and after work. Pedometers
were provided to all
participants in this
intervention group
3. Intervention C “Office
ergonomics” (control group):
computer workstation setup,
active sitting, and breaking
up computer tasks.
4. Emails from facilitator (every
2-3 weeks)
5. Feedback form to gather
inputs from participants
6. Structured meeting to
personalise intervention
(meeting 1: brain-storming
ideas, meeting 2: sharing
ideas)
Intervention Outcomes
Change in outcome:
Sedentary time among office workers during working hours was significantly
reduced and the light intensity activity was increased after implementing a
participatory workplace intervention program. However, there was no clear
evidence which one of the 3 interventions had a greater impact in improving
occupational sedentary behavior.
Author’s conclusion:
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Participatory workplace intervention, especially office work modification (i.e.,
providing treadmill in the workstation) is potential to reduce sedentary behavior
among office workers
Table 3. Nooijen et al. (2020)
Study Population
Target group:
Office workers
Sample size (n):
263 enrolled participants
Mean age:
42 years (SD= 9)
Gender:
Female (73%), Male (27%)
Recruitment:
Participants were recruited from 3
different locations of 2 Swedish
companies from 2018 to 2019
Attrition:
93 participants dropped out
(35.36%)
Intervention Content
Theory:
Ecological model of health behavior
Strategies/components:
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- Counselling sessions
(individual and group
session)
- Leadership program to
deliver environmental and
organizational components
Intervention Outcomes
Change in outcome:
No changes in the primary outcome
Author’s conclusion:
Both multi-component interventions showed unsuccessful result at increasing
physical activity and reducing sedentary time
Table 4. De Cocker et al. (2016)
Study Population
Target group:
Office-based workers
Sample size (n):
213 enrolled participants
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Mean age:
40.3 years (SD= 9.1)
Gender:
Female (68.5%), Male (31.5%)
Recruitment:
Participants were recruited from 3
departments of a university and 3
departments of an environmental
agency in East Flanders.
Recruitment information was sent
via phone and email.
Attrition:
42.7% overall
Intervention Content
Theory:
Theory-driven, web-based,
computer-tailored advice (based on
Theory of Planned Behavior [TPB])
Strategies/components:
1. Computer tailored
intervention: providing
personalized feedback on
participants’ sitting time after
completing an assessment
questionnaire; feedback
messages will be available on
the users’ screen. An action
plan offered
2. Generic Intervention:
providing generic information
about the importance of
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reducing and interrupting
sitting
Intervention Outcomes
Change in outcome:
- Self-reported sitting measurement: Tailored group showed greater
reduction in their sitting time (at work and during leisure time) than those
in the generic group
- Objective measurement: no changes in total sitting time between the 3
group; tailored group showed a slight increase in breaks at work
Author’s conclusion:
A web-based computer-tailored intervention may have potential in reducing and
interrupting sitting at work
Discussion
The aim of this literature review is to critically evaluate the implemented public
health interventions at reducing sedentary behavior among office-based workers. Among
the four studies included, objective measurement to detect sedentary behavior (including
sitting, standing, and stepping) was done using a high validity accelerometry-based
device either ActivPal or ActiGraph (An, Kim, & Lee, 2017; De Cocker, De Bourdeaudhuij,
Cardon, & Vandelanotte, 2015), except the study conducted by Taylor et al. (2016). They
were utilizing pedometers and validated questionnaires to measure physical activity and
sedentary time while self-reported checklist (potential recall and social desirability biases)
was used to log sedentary leisure time. This study was aligned with the study conducted
by Parry et al. (2013) in terms of their primary aim, which was increasing physical activity
while working. Conversely, the other study more focused on reducing sitting time (De
Cocker, De Bourdeaudhuij, Cardon, & Vandelanotte, 2016) while Nooijen et al. (2020)
assessed both increased physical activity and reduced sedentary behavior using multi-
component interventions. Therefore, due to the nature of different focuses of the studies,
it is noteworthy that different measurement instruments used in this study have created
difficulties in making comparative analyses.
The blinding of participants and personnel of these studies were not feasible; only
Nooijen et al. (2020) performed blinding of personnel involved in data collection and
processing, while the researcher was not blinded to group allocation in the study by Parry
et al., (2013). The other two did not specify participant and personnel blinding. Most of
them addressed this issue by adhering to their pre-specified intervention components,
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while only Taylor et al. (2016) failed to do so. The fidelity of the Booster Break program
was not clearly outlined which made the effectiveness of this intervention limited.
Furthermore, all studies included in this review were using a randomized controlled
trial as their study design. Risks of contamination between groups were reduced given
the cluster randomization methods were employed in these studies except for Parry et al.
(2013) study. However, Parry et al. (2013) did not use individuals and/or team
departments in the same organization as the unit of randomization, hence, it reduced the
opportunity of cross contamination risks. Nevertheless, although a cluster randomized
was a strength in the study by Nooijen et al. (2020), risks of cross contamination could
not be ruled out due to the randomization of office workers into the same teams.
Of the four studies reviewed, the attrition rates were relatively high. However,
Parry et al. (2013) and Taylor et al. (2016) did not clearly explain reasons for attrition
rate. Although only based on researchers’ speculations, Nooijen et al. (2020) with an
overall 53.38% attrition rate outlined the reasons behind the number. They speculated
that high workload, high staff turnover, and lack of time in doing physical activity were
the reasons for participants not completing the intervention. Likewise, De Cocker et al.
(2016) explained the drop-out rate based on two different points of views (methodological
and compliance). ActivPal, a monitoring device, was not randomly allocated as it was
better to provide the monitoring device to those who agreed to wear it based on the pre-
scheduled time. This had lowered the drop-out rate compared to those who did not wear
ActivPal and only completed the questionnaires. Additionally, all studies employed the
analysis principle of intention to treat (ITT) to reduce the potential bias arising from
missing values with detailed imputation steps outlined in the study by Nooijen et al.
(2020).
Moreover, the external validity of the studies is another point to consider. 82% of
the study sample population in both Taylor et al. (2016) and Parry et al. (2013) were
women. This potentially could create selection bias and reduce the generalizability which
warrants further investigations. The generalizability limitation was further noticed in the
study by Parry et al. (2013) due to the recruitment of the study participants; they did the
recruitment and delivered the intervention within the same organization. Instead, the
other three studies recruited the participants from different companies (De Cocker et al.,
2016; Nooijen et al., 2020; Taylor et al., 2016). The findings applicability to the general
population were also limited, as the three studies reviewed did not include any
explanations on ethnicities and only Taylor et al. (2016) reported the diversity of the
study participants; racially and ethnically diverse (35% African American, 33% non-
Hispanic white, and 32% Hispanic).
Overall, the findings from four different studies included in this review showed
conflicting outcomes. This may be due to the nature of their approaches used during
delivering the interventions (single-component intervention vs. multi-component
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strategies). On one hand, surprisingly, from the three multi-component intervention
strategies conducted, Nooijen et al. (2020) showed that this strategy was unsuccessful
and was not effective; no changes in the primary outcome of the study (sedentary
behavior was not reduced and physical activity was not increased). On the other hand,
a single-component intervention targeting environmental level reported a promising
result in reducing sedentary behavior among office workers by modifying workstation
(i.e., providing treadmill) (Parry et al., 2013). Although the availability of physical activity
equipment such as treadmills in the workstation has conferred benefits in increasing
physical activity, this intervention did not confirm the hypothesis of reduced and/or
interrupted sedentary behavior (prolonged sitting) among office-based workers.
CONCLUSION
There have been an increasing number of studies addressing sedentary behavior
with successful outcomes, however, there is still a large number of potential gaps found,
especially the long-term effectiveness of different promising interventions (Chu et al.,
2016). Future studies also need to focus on identifying which population groups that will
receive the most benefit from the interventions implemented, this highlights the urgent
need to evaluate health inequities that exist among different cultures and ethnicities
(Newman, Baum, Javanparast, O'Rourke, & Carlon, 2015). Thus, future intervention
implementation will be more appropriate and friendly towards the general population.
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