Efficacy of the ‘Stand and Move at Work’

multicomponent workplace intervention to reduce

sedentary time and improve cardiometabolic risk: a
group randomized clinical trial
Mark A. Pereira, Sarah L. Mullane, Meynard John Lapore
Toledo, Miranda L. Larouche, Sarah A. Rydell, Brenna
Vuong, Linda H. Feltes, Nathan R. Mitchell, Junia N. de
Brito, Kristina Hasanaj, Neil G. Carlson, Glenn A. Gaesse ,
Noe C. Crespo, J. Michael Oakes and Matthew P. Buman
 Background
• Standing and light-intensity physical activity (LPA)
especially among those not sufficiently engaged in
moderate-vigorous physical activity (MVPA) 🡺 improved
cardio metabolic health and lower mortality risk.
• Most developed countries 🡺 increasing automation and
reliance on computers 🡺 workers in the spend 70–80% of
their work time sedentary.
• Interventions (individual level and environmental
changes) 🡺 the largest reductions in sedentary time 🡺 low
power, lack of diversity, lack of comparison.
 Aim
Testing the Stand and Move at Work intervention, a
12-month multilevel workplace intervention that
included the use of sit-stand workstations and
workplace policy, environmental, social, and
individual-level changes.
 Methods

Study Type : Interventional  (Clinical Trial)

Actual Enrollment : 630 participants
Allocation : Randomized
Intervention Model : Parallel Assignment
Masking : None (Open Label)
Primary Purpose : Prevention
Actual Study Start Date : January 15, 2016
Actual Primary Completion : December 15, 2017
Date
 Methods
Participants – Worksite eligibility
(a) small to moderate workgroup size
(b) 80% of full timer employees
(c) predominantly seated desk-based office work
(d) not currently undergoing same programe
(e) < 10% of employees using a sit-stand workstation
(f) willing to have sit-stand workstations installed
(g) leadership willing to be randomized to either
study arm.
 Methods
Participants – Employee eligibility
(a) 18 years or older
(b) generally good health and able to safely reduce
sitting and increase LPA
(c) working full-time on-site
(d) not currently pregnant
(e) predominantly seated office work
(f) not currently using a sit-stand workstation
(g) willing to have a sit-stand workstation installed
(h) willing to be randomized to either study arm
 Study design
• Two-arm group-randomized trial
• Worksites randomization:
– MOVE+ ⇒ multilevel behavioral intervention targeting
increases in LPA at the worksite
– STAND+, the MOVE+ ⇒ sit-stand workstations
• Three sectors randomization ⇒ academic,
industry/healthcare, and government
• Four worksites were enrolled every 2 months to
avoid seasonal effects.
 Interventions
• Multi-component interventions ⇒ reduce sitting
and increase LPA.
• Duration ⇒ 12 months
• Target ⇒ individual, social environment, physical
environment, workplace policies
• The MOVE+ ⇒ ≥30 min of additional LPA
throughout workday
• The STAND+ ⇒ LPA target as MOVE+ and standing
time to 50% of desk-based worktime
 Measures and Demographic
• All assessments were completed at 0 (baseline), 3
(interim), and 12 (posttest) months.
• Clinical and biomarker assessments were conducted
at each worksite.
• Demographic variables age, race, sex, education,
and job type were assessed
 Workplace sitting time

• The activPAL3c micro accelerometer 24 h/day

• Exclusion from analysis:
– Long bouts of continuous sedentary or standing time (> 6 h)
– Sleep periods
– Wake periods with ≤10 h of wear time
– Work periods with < 4 h of wear time
• Outcomes analysis:
– Work periods ⇒ 8 h workday
– Total wake time ⇒ 16 h workday
• Outcomes reported:
– sitting, standing, LPA, MVPA, total physical activity,
combined LPA and MVPA ⇒ min/ day
– Sit-to-stand transitions ⇒ number of transitions/h of sitting
– Sitting time accrued in bouts ≥30 m (min/ day)
 Cardiometabolic risk biomarkers
• Body weight
• Resting blood pressure
• Fasting and venous serum concentrations (glucose,
insulin, triglycerides, and LDL- and HDL-cholesterol)
• Cardiometabolic risk assessment ⇒ metabolic risk
score (CMR)
• Dysglycemic subgroup ⇒ previous diabetes
diagnosis or a fasting blood glucose ≥100 mg/dL
 Sample size and statistical analysis
• Analyses were performed in SAS 9.4
• Intention to treat procedures
• Final analysis ⇒ complete baseline and FU data
• Senior statistician was blinded to group assignment
• Analyst/programmer was blinded until final
statistical models.
• The study has 80% power (alpha = 0.05)
Results
Worksite and participant flow
Results
Worksite and participant flow
Result
Baseline characteristics
Result
Baseline characteristics
Result
Baseline characteristics
 Result
Intervention effects

Waking activPAL wear time

was high both in MOVE+ and
STAND+ arms.

Nearly all the sitting reduction

for STAND+ was replaced by
standing.

Changes in LPA and MVPA

activity at work were small and
favored STAND+.

Changes in total sitting time

were modestly attenuated
compared to work time only at
3 and 12 months.
Result
Workplace sitting time in STAND+ and MOVE+
There is large
difference
between groups
(67.5 ± 9.0 min)

The difference
was largely
sustained at 12
months (59.2 ±
7.4 min)
Result
Between-arm differences in clustered metabolic risk score

These effects, in the total sample

between intervention arms, were small
and not statistically significant but
generally favored the STAND+ arm.

The effect sizes were larger for blood

glucose, triglycerides, systolic blood
pressure, glycated hemoglobin, LDL
cholesterol, body weight and body fat.
 Limitation
• The study did not include a non-intervention
control group.
• This study only included fulltimer sedentary
employees in relatively good health with no
contraindications to standing and LPA.
 Conclusion
• This is the largest and most comprehensive group-
randomized trial to test the efficacy of sit-stand
workstations to date.
• Sit-stand workstations can reduce sitting time at
work by approximately one hour/work day over 12
months.
• In those with prediabetes and diabetes, there was
trends towards clinical improvement in
cardiometabolic risk and body weight.
 Critical Appraisal
P Healthy fulltimer sedentary employees at least 18 yo
with no contraindications to standing and LPA
I The STAND+ (≥30 min of additional LPA + standing time
to 50% of desk-based work time)
C The MOVE+ (≥30 min of additional LPA)
O Mean change in Light-intensity Physical Activity (LPA)
and sitting time at work from baseline to 12 Months
Critical Appraisal

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Critical Appraisal

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Result
Baseline characteristics
Result
Baseline characteristics
Result
Baseline characteristics
Critical Appraisal

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Critical Appraisal

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Critical Appraisal

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Critical Appraisal
Critical Appraisal