Review question:

What workplace interventions are effective in reducing sitting at work compared to no intervention or alternative interventions?

Nursing Implications:

The number of people working while seated at a desk keeps increasing worldwide. As sitting increases, occupational physical strain declines at the same time. This has contributed to increases in cardiovascular disease, obesity and diabetes. Therefore, reducing and breaking up the time that people spend sitting while at work is important for health.

These implications would not apply to staff nurses, who spend almost all of their shifts standing, walking, and running between patients. It would be a value to their patients, upon recovery from the hospital.

Review Characteristics:

This review included randomized controlled trials (RCTs), clustered randomized controlled trials (CRCTs), and quasi-randomized controlled trials of interventions to reduce sitting at work. For changes of workplace arrangements, they also included 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 measured by means of an accelerometer coupled with an inclinometer. They considered energy expenditure, duration, and number of sitting episodes lasting thirty minutes or more, work productivity and adverse events as secondary outcomes. Reviewers searched Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, OSH UPDATE, PsycINFO, ClinicalTrials.gov, and the World Health Organization (WHO), and the reference lists of articles and contacted authors. Search was current as of 14 February 2014.

Summary of Key Evidence:

Eight studies were included, four RCTs, three CBAs, and one CRCT. This was a total of 1125 participants. Studies evaluated workplace changes (three studies), policy changes (one study), and information and counseling (four studies). No studies investigated the effect of treadmill desks, stepping devices, periodic breaks, or standing or walking meetings. All of the studies were at high risk of bias. The quality of the evidence was very low to low.

Studies examined these types of interventions: 1) physical changes in workplace environment; 2) policy to change the organization of work; 3) information and counseling to encourage workers to sit less; 4) Counseling versus usual care; and 5) mindfulness training versus no intervention. This study dealt with these interventions only, not whether a stand-up, or sit-stand desk lead to improved health.

Best Practice Recommendations:

There is very low quality evidence that the use of sit-stand desks alone, or in combination with information and counseling, can reduce workplace sitting time. There was no clear effect on musculoskeletal symptoms or workplace performance. Walking strategies had no effect on workplace sitting, while computer prompting plus information had an inconsistent effect on workplace sitting. There was low quality evidence for a small reduction in workplace sitting with guideline-based counseling by occupational physicians compared to usual care. The effect of mindfulness training on sitting in the workplace was non-significant and showed a non-significant increase in work performance.

Summary Authors

Anna Sabia, RN, BSN
The Stamford Hospital
Stamford, CT, USA

William H. Anger, Jr., MLIS
The Miriam Hospital
Providence, RI, USA