Shrestha Nipun, Kukkonen-Harjula Katriina T, Verbeek Jos H, Ijaz Sharea, Hermans Veerle, Pedisic Zeljko
Institute for Health and Sport (IHES), Victoria University, Melbourne, Victoria, Australia.
Cochrane Database Syst Rev. 2018 Jun 20;6(6):CD010912. doi: 10.1002/14651858.CD010912.pub4.
A large number of people are employed in sedentary occupations. Physical inactivity and excessive sitting at workplaces have been linked to increased risk of cardiovascular disease, obesity, and all-cause mortality.
To evaluate the effectiveness of workplace interventions to reduce sitting at work compared to no intervention or alternative interventions.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, OSH UPDATE, PsycINFO, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal up to 9 August 2017. We also screened reference lists of articles and contacted authors to find more studies.
We included randomised controlled trials (RCTs), cross-over RCTs, cluster-randomised controlled trials (cluster-RCTs), and quasi-RCTs of interventions to reduce sitting at work. For changes of workplace arrangements, we also included controlled before-and-after studies. The primary outcome was time spent sitting at work per day, either self-reported or measured using devices such as an accelerometer-inclinometer and duration and number of sitting bouts lasting 30 minutes or more. We considered energy expenditure, total time spent sitting (including sitting at and outside work), time spent standing at work, work productivity and adverse events as secondary outcomes.
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.
We found 34 studies - including two cross-over RCTs, 17 RCTs, seven cluster-RCTs, and eight controlled before-and-after studies - with a total of 3,397 participants, all from high-income countries. The studies evaluated physical workplace changes (16 studies), workplace policy changes (four studies), information and counselling (11 studies), and multi-component interventions (four studies). One study included both physical workplace changes and information and counselling components. We did not find any studies that specifically investigated the effects of standing meetings or walking meetings on sitting time.Physical workplace changesInterventions using sit-stand desks, either alone or in combination with information and counselling, reduced sitting time at work on average by 100 minutes per workday at short-term follow-up (up to three months) compared to sit-desks (95% confidence interval (CI) -116 to -84, 10 studies, low-quality evidence). The pooled effect of two studies showed sit-stand desks reduced sitting time at medium-term follow-up (3 to 12 months) by an average of 57 minutes per day (95% CI -99 to -15) compared to sit-desks. Total sitting time (including sitting at and outside work) also decreased with sit-stand desks compared to sit-desks (mean difference (MD) -82 minutes/day, 95% CI -124 to -39, two studies) as did the duration of sitting bouts lasting 30 minutes or more (MD -53 minutes/day, 95% CI -79 to -26, two studies, very low-quality evidence).We found no significant difference between the effects of standing desks and sit-stand desks on reducing sitting at work. Active workstations, such as treadmill desks or cycling desks, had unclear or inconsistent effects on sitting time.Workplace policy changesWe found no significant effects for implementing walking strategies on workplace sitting time at short-term (MD -15 minutes per day, 95% CI -50 to 19, low-quality evidence, one study) and medium-term (MD -17 minutes/day, 95% CI -61 to 28, one study) follow-up. Short breaks (one to two minutes every half hour) reduced time spent sitting at work on average by 40 minutes per day (95% CI -66 to -15, one study, low-quality evidence) compared to long breaks (two 15-minute breaks per workday) at short-term follow-up.Information and counsellingProviding information, feedback, counselling, or all of these resulted in no significant change in time spent sitting at work at short-term follow-up (MD -19 minutes per day, 95% CI -57 to 19, two studies, low-quality evidence). However, the reduction was significant at medium-term follow-up (MD -28 minutes per day, 95% CI -51 to -5, two studies, low-quality evidence).Computer prompts combined with information resulted in no significant change in sitting time at work at short-term follow-up (MD -10 minutes per day, 95% CI -45 to 24, two studies, low-quality evidence), but at medium-term follow-up they produced a significant reduction (MD -55 minutes per day, 95% CI -96 to -14, one study). Furthermore, computer prompting resulted in a significant decrease in the average number (MD -1.1, 95% CI -1.9 to -0.3, one study) and duration (MD -74 minutes per day, 95% CI -124 to -24, one study) of sitting bouts lasting 30 minutes or more.Computer prompts with instruction to stand reduced sitting at work on average by 14 minutes per day (95% CI 10 to 19, one study) more than computer prompts with instruction to walk at least 100 steps at short-term follow-up.We found no significant reduction in workplace sitting time at medium-term follow-up following mindfulness training (MD -23 minutes per day, 95% CI -63 to 17, one study, low-quality evidence). Similarly a single study reported no change in sitting time at work following provision of highly personalised or contextualised information and less personalised or contextualised information. One study found no significant effects of activity trackers on sitting time at work.Multi-component interventions Combining multiple interventions had significant but heterogeneous effects on sitting time at work (573 participants, three studies, very low-quality evidence) and on time spent in prolonged sitting bouts (two studies, very low-quality evidence) at short-term follow-up.
AUTHORS' CONCLUSIONS: At present there is low-quality evidence that the use of sit-stand desks reduce workplace sitting at short-term and medium-term follow-ups. However, there is no evidence on their effects on sitting over longer follow-up periods. Effects of other types of interventions, including workplace policy changes, provision of information and counselling, and multi-component interventions, are mostly inconsistent. The quality of evidence is low to very low for most interventions, mainly because of limitations in study protocols and small sample sizes. There is a need for larger cluster-RCTs with longer-term follow-ups to determine the effectiveness of different types of interventions to reduce sitting time at work.
大量人员从事久坐不动的职业。工作场所缺乏身体活动以及过度久坐与心血管疾病、肥胖症和全因死亡率风险增加有关。
评估与无干预措施或替代干预措施相比，工作场所干预措施减少工作时久坐时间的有效性。
我们检索了截至2017年8月9日的Cochrane对照试验中心注册库（CENTRAL）、MEDLINE、Embase、CINAHL、职业安全与健康更新数据库（OSH UPDATE）、心理学文摘数据库（PsycINFO）、临床试验.gov以及世界卫生组织（WHO）国际临床试验注册平台（ICTRP）搜索门户。我们还筛选了文章的参考文献列表并联系作者以查找更多研究。
我们纳入了减少工作时久坐时间干预措施的随机对照试验（RCT）、交叉RCT、整群随机对照试验（整群RCT）和半随机对照试验。对于工作场所安排的变化，我们还纳入了前后对照研究。主要结局是每天工作时久坐的时间，可通过自我报告或使用加速度计 - 倾角仪等设备测量，以及持续30分钟或更长时间的久坐时段的持续时间和次数。我们将能量消耗、总久坐时间（包括工作时和工作外的久坐时间）、工作时站立时间、工作效率和不良事件视为次要结局。
两位综述作者独立筛选标题、摘要和全文文章以确定研究的合格性。两位综述作者独立提取数据并评估偏倚风险。如有需要，我们会联系作者获取额外数据。
我们发现了34项研究，包括两项交叉RCT、17项RCT、七项整群RCT和八项前后对照研究，共有3397名参与者，均来自高收入国家。这些研究评估了工作场所物理变化（16项研究）、工作场所政策变化（4项研究）、信息与咨询（11项研究）以及多成分干预措施（4项研究）。一项研究同时包括了工作场所物理变化以及信息与咨询成分。我们未发现任何专门研究站立会议或步行会议对久坐时间影响的研究。工作场所物理变化与坐式办公桌相比，使用升降桌单独或与信息和咨询相结合的干预措施在短期随访（长达三个月）时平均每个工作日减少工作时久坐时间100分钟（95%置信区间（CI）-116至-84，10项研究，低质量证据）。两项研究的汇总效应显示，与坐式办公桌相比，升降桌在中期随访（3至12个月）时平均每天减少久坐时间57分钟（95%CI -99至-15）。与坐式办公桌相比，使用升降桌时总久坐时间（包括工作时和工作外的久坐时间）也有所减少（平均差（MD）-82分钟/天，95%CI -124至-39，两项研究），持续30分钟或更长时间的久坐时段的持续时间也减少了（MD -53分钟/天，95%CI -79至-26，两项研究，极低质量证据）。我们发现站立式办公桌和升降桌在减少工作时久坐方面的效果没有显著差异。诸如跑步机办公桌或骑行办公桌等主动式工作站对久坐时间的影响不明确或不一致。工作场所政策变化在短期（MD -15分钟/天，95%CI -50至19，低质量证据，一项研究）和中期（MD -17分钟/天，95%CI -61至28，一项研究）随访时，实施步行策略对工作场所久坐时间没有显著影响。与长时间休息（每个工作日两次15分钟休息）相比，短期随访时短时间休息（每半小时一到两分钟）平均每天减少工作时久坐时间40分钟（95%CI -66至-15，一项研究，低质量证据）。信息与咨询在短期随访时，提供信息、反馈、咨询或所有这些措施导致工作时久坐时间没有显著变化（MD -19分钟/天，95%CI -57至19，两项研究，低质量证据）。然而，在中期随访时减少是显著的（MD -28分钟/天，95%CI -51至-5，两项研究，低质量证据）。计算机提示与信息相结合在短期随访时工作时久坐时间没有显著变化（MD -10分钟/天，95%CI -45至24，两项研究，低质量证据），但在中期随访时产生了显著减少（MD -55分钟/天，95%CI -96至-14，一项研究）。此外，计算机提示导致持续30分钟或更长时间的久坐时段的平均次数（MD -1.1，95%CI -1.9至-0.3，一项研究）和持续时间（MD -74分钟/天，95%CI -124至-24，一项研究）显著减少。与指示步行至少100步的计算机提示相比，指示站立的计算机提示在短期随访时平均每天减少工作时久坐时间14分钟（95%CI 10至19，一项研究）。在中期随访时，正念训练后工作场所久坐时间没有显著减少（MD -23分钟/天，95%CI -63至17，一项研究，低质量证据）。同样，一项研究报告称，提供高度个性化或情境化信息与较少个性化或情境化信息后，工作时久坐时间没有变化。一项研究发现活动追踪器对工作时久坐时间没有显著影响。多成分干预在短期随访时，多种干预措施相结合对工作时久坐时间（573名参与者，三项研究，极低质量证据）和长时间久坐时段的时间（两项研究，极低质量证据）有显著但异质性的影响。
目前有低质量证据表明，在短期和中期随访时，使用升降桌可减少工作场所的久坐时间。然而，没有证据表明其对更长随访期的久坐时间有影响。其他类型干预措施的效果，包括工作场所政策变化、提供信息与咨询以及多成分干预措施，大多不一致。大多数干预措施的证据质量低至极低，主要是由于研究方案的局限性和样本量小。需要进行更大规模的整群RCT并进行长期随访，以确定不同类型干预措施减少工作时久坐时间的有效性。
