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The office workplace is a key setting in which to address excessive sitting time and inadequate physical activity. One major influence on workplace sitting is the organizational environment. However, the impact of organizational-level strategies on individual level activity change is unknown. Further, the emergence of sophisticated, consumer-targeted wearable activity trackers that facilitate real-time self-monitoring of activity, may be a useful adjunct to support organizational-level strategies, but to date have received little evaluation in this workplace setting.
The aim of this study is to evaluate the feasibility, acceptability, and effectiveness of organizational-level strategies with or without an activity tracker on sitting, standing, and stepping in office workers in the short (3 months, primary aim) and long-term (12 months, secondary aim).
This study is a pilot, cluster-randomized trial (with work teams as the unit of clustering) of two interventions in office workers: organizational-level support strategies (eg, visible management support, emails) or organizational-level strategies plus the use of a waist-worn activity tracker (the LUMOback) that enables self-monitoring of sitting, standing, and stepping time and enables users to set sitting and posture alerts. The key intervention message is to ‘Stand Up, Sit Less, and Move More.’ Intervention elements will be implemented from within the organization by the Head of Workplace Wellbeing. Participants will be recruited via email and enrolled face-to-face. Assessments will occur at baseline, 3, and 12 months. Time spent sitting, sitting in prolonged (≥30 minute) bouts, standing, and stepping during work hours and across the day will be measured with activPAL3 activity monitors (7 days, 24 hours/day protocol), with total sitting time and sitting time during work hours the primary outcomes. Web-based questionnaires, LUMOback recorded data, telephone interviews, and focus groups will measure the feasibility and acceptability of both interventions and potential predictors of behavior change.
Baseline and follow-up data collection has finished. Results are expected in 2016.
This pilot, cluster-randomized trial will evaluate the feasibility, acceptability, and effectiveness of two interventions targeting reductions in sitting and increases in standing and stepping in office workers. Few studies have evaluated these intervention strategies and this study has the potential to contribute both short and long-term findings.
The workplace is a key health promotion setting [
Sedentary and light intensity behaviors occupy much of the waking day [
For office workers, workplace sedentary time is a large contributor to overall sedentary time [
Office workers generally have the advantage of being colocated, which means a wide range of influences can be targeted within intervention approaches. Based on workplace health promotion frameworks [
Despite these frameworks, workplace interventions targeting MVPA have typically targeted the individual and not the organizational- or environmental-level influences [
While organizational-level strategies may be sufficient on their own, it is also important to consider individualized elements to possibly enhance the success of the intervention. Evidence suggests that individual, self-monitoring devices such as pedometers are a common element of successful workplace physical activity interventions [
There has been minimal research on the feasibility, acceptability, and effectiveness of activity trackers as intervention tools. A recent review highlighted the large heterogeneity in the small field of research studies and the mixed quality of the research [
As such, the current study will pilot a waist-worn activity tracker (the LUMOback) that measures and notifies wearers of their sitting time, and also measures activities across the spectrum including number of steps and time spent standing, walking, and running [
The primary aims of this pilot study are to assess two interventions (organizational-level strategies only; organizational-level strategies plus an activity tracker) in office workers regarding their feasibility, acceptability, and short-term (3 month) effectiveness for sitting reduction. The primary effectiveness outcomes are sitting time at work and overall. Secondary aims are to examine the short-term effectiveness of the interventions for other activities, and health- and work-related outcomes; the relative effectiveness of the two interventions for changes in sitting time and other activities; predictors of changes in sitting and activity; and the long-term (12 month) feasibility, acceptability, and effectiveness of the interventions.
A cluster-randomized design will be used, with data collection occurring at baseline, 3, and 12 months (see
Overview of study design, consent processes, intervention, and assessment elements.
Participants will be office workers, recruited from work teams from two Australian capital cities (~1000-km apart) within the one organization, Lendlease, an international property and infrastructure group. Inclusion criteria are office-based workers, working at least 0.6 full-time equivalent (ie, at least 60% of full-time work hours) and ambulatory (able to walk at least 10 meters). Exclusion criteria are pregnancy at baseline, allergies to adhesive tape (Opsite and Hypafix required for assessments), and a planned absence from work for longer than 2 weeks during the first 3-month study period. Employees who have their own activity-permissive workstation at the baseline assessment will also be ineligible.
The study liaison and workplace champion for the trial will be the Lendlease Head of Workplace Wellbeing (DCY). The workplace champion, located in Sydney (site A), will work in partnership with the research team to tailor the intervention to Lendlease and to create strong buy-in from senior management. Project staff will be based in Brisbane (site B).
Workplace teams (typically with 10-15 individuals in each team) will be selected from site A and site B by the workplace champion. Teams will be defined as having a line manager, being physically colocated, and having regular group meetings. Eligible teams will need to be desk-based and have a sufficient number of team members with access to a Bluetooth-enabled mobile phone required for the activity tracker to function. Team managers will be approached by the workplace champion for their consent.
Once the team manager has consented, the workplace champion will email individual team members the information sheet detailing the study and the required level of commitment, along with the consent form. Teams randomized to receive the activity tracker will receive additional details regarding the LUMOback. Interested team members will be invited to attend a face-to-face information session where they will have their eligibility assessed by project staff, and then be invited to sign the consent form and proceed to the baseline assessment. Initial consent will only be for baseline and 3-month assessments; participants will be invited to reconsent for the 12-month assessment (see
Following manager consent, and prior to the information session, each team will be numbered randomly, using a random number generator, and then listed in numeric order. Teams will then be randomized to either Group 1 (organizational-level strategies only) or Group 2 (organizational-level strategies plus activity tracker), across location strata (site A and B) and team size strata within site A (small/large) using a randomization website [
All participants will receive the organizational-support intervention elements, which are based on the
All participants will receive a booklet from the workplace champion, developed by the research team and customized to Lendlease’s branding and corporate style requirements. The booklet will cover the study rationale (ie, evidence on prolonged sitting and detrimental health outcomes) and purpose; general guidelines on optimal workplace activity; behavior change strategies related to the key intervention messages; and general information about the study procedure and timeline. All participants will also receive a summary email from the workplace champion of the aggregate results from the baseline assessment regarding sitting, standing and stepping, as well as individual feedback on sitting, standing and stepping time after each of the assessment points (to be emailed individually by project staff; adapted from a previous study [
The workplace champion will create five emails in consultation with project staff (adapted from a previous study [
In addition to the staff, managers and senior managers participating in the trial, senior global executives (eg, Chief Executive Officer) will also take part in the baseline assessment and will receive the information booklet and ‘Stand Up, Sit Less, Move More’ emails. The participation of the global executives, which demonstrates visible support for the intervention, will be communicated to staff by the workplace champion.
Participants in Group 2 will be given the LUMOback activity tracker in addition to the organizational-level strategies. The LUMOback is worn around the waist as a belt, collecting information, and providing real-time feedback on sitting, standing, stepping, breaks from sitting, posture, and sleep. The LUMOback assesses activity by inertial sensors, which collect data at a constant 25 Hz [
The LUMOback shows strong correlations and good agreement, in free-living conditions, with measures from the activPAL activity monitor in total time spent sitting (
A LUMOback and a four-page instruction booklet that covers an introduction to the device, set-up instructions, and frequently asked questions will be distributed to Group 2 participants by the workplace champion following baseline assessments. On receipt of the device, participants will be asked to download the free app and sync the LUMOback with their phone. Participants will be asked to use their work email to set up their device as this will later be used to request the data from the company LUMO Bodytech. Participants can wear the device as much or as little as they like and their self-directed usage will be tracked. However, participants will be instructed by project staff to wear their LUMOback during the 3-month assessment period both to gather validity data and to estimate the intervention effectiveness while wearing the LUMOback. Participants will be allowed to keep the LUMOback.
Representation of the LUMOback avatar while seated in a good posture.
Data collection will occur at baseline, 3, and 12 months, and has been approved by the organization to occur during work hours. At each assessment, participants will be asked to wear an activPAL3 activity monitor continuously (24 hours/day) for 7 days, and to complete a concurrent electronic work and sleep diary. They will also be emailed a link to a Web-based questionnaire, using LimeService [
Individual qualitative interviews on the feasibility and acceptability of both of the interventions will occur following the 3-month assessment via telephone. Focus groups covering the long-term feasibility and acceptability of the interventions will be conducted as part of the 12-month assessment. Project staff will request LUMOback usage data from Lumo Bodytech every 2 weeks during the initial 3-month intervention period and then periodically throughout the rest of the study.
An overview of the study feasibility, acceptability, and effectiveness outcome measures is provided in
Feasibility information will be examined in terms of participation, retention rates, and intervention delivery indicators, including the number of emails received (for the organizational intervention) and the degree of usage of the LUMOback activity tracker and app (assessed from the device and self-report). Ease of LUMOback data download and amount of lost or missing LUMOback data will also be evaluated.
The LUMOback data will be used to determine number of days, hours, and peak levels of usage. The data is expressed as a percentage of a 5-minute window spent in each activity type (sitting and standing in a good or bad posture, lying, sitting in a car, walking, and running), and step counts, calorie counts, and not worn/charging. No data is recorded over periods the device self-registers as off.
Telephone interviews and focus groups will be used to further evaluate both organizational support and LUMOback intervention strategies. Telephone interviews will identify: strategies implemented by the managers and organization; key facilitators and barriers of the intervention (including those specific to the LUMOback); and, any organizational culture changes that occurred (see
Participants will be asked via questionnaire to rate how useful the emails and tips were, their satisfaction with the emails and information, and if they had experienced any discomfort or injury as a result of their study participation. Participants who indicate they have used a LUMOback device will also be asked to rate their comfort, ease of use, and perceived usefulness of the LUMOback (see
The activPAL3 activity monitor will be used to measure the primary and secondary activity outcomes. The activPAL is a small device worn on the thigh (53×35×7 mm; 15 g). It has excellent interdevice reliability (ICC=0.79-0.99 [
The primary activity outcomes are time spent sitting at work and time spent sitting overall (ie, across all waking hours on work and nonwork days). The other activity outcomes relating to the ‘Stand Up, Sit Less, Move More’ message are listed in
Physical and mental health-related quality of life [
Work-related outcomes will be measured via questionnaire at all assessments. These are work performance [
Overview of study outcomes.
Measurement tools | Outcomes | |
Feasibility | ||
Organizational support questionnaire items | Number of emails received | |
What participants did with email (eg, read then delete) | ||
Perceived level of support to ‘Stand Up, Sit Less and Move More’ from (1) organization, (2) main manager, and (3) colleagues | ||
LUMOback questionnaire items | Ever used (eg, yes, given but never used, no) | |
Date of first use | ||
Setting of use (eg, workplace) | ||
Frequency of recalibration, app checking, goal checking, vibration and sitting alerts | ||
LUMOback data | Days of usage | |
Hours of usage/day | ||
Peak levels of usage | ||
Ease of data download | ||
Amount of missing data | ||
Telephone interviews | Strategies implemented by manager and organization, organizational culture change, key elements of intervention, barriers of wearing the LUMOback at work and at home | |
Focus groups | Long term sustainability of changes, barriers and facilitators, key themes | |
Acceptability | ||
Organizational support questionnaire items | Usefulness of emails and tips | |
Satisfaction with emails and information received | ||
Adverse experiences from program in general | ||
LUMOback questionnaire items | Comfort of LUMOback | |
Ease of set up of LUMOback and app, navigating app, calibrating LUMOback | ||
Usefulness of LUMOback and app | ||
Likelihood of using LUMOback in next 6 months, adverse experiences from LUMOback, comments about the LUMOback | ||
Telephone interviews | Acceptability of program, acceptability of the LUMOback | |
Focus groups |
Acceptability of program, acceptability of long-term LUMOback wear | |
Effectiveness | ||
Activity | ||
activPAL | Stand up: standing time at work and overall | |
Sit less: sitting time at work and overall (primary effectiveness outcomes); prolonged (>=30 mins) sitting time at work and overall | ||
Move more: stepping time at work and overall | ||
Health | ||
SF-12 v1 | Physical and Mental health-related quality of life | |
Health and Work Questionnaire | Overall stress | |
Work | ||
Work performance rating scale | Work performance | |
Health and Work Questionnaire | Work satisfaction, job control |
Height and weight will be measured with shoes removed using a stadiometer (to the nearest 0.1 cm) and calibrated electronic scales (to the nearest 0.1 kg) at baseline only. Similarly, participants will be asked at baseline only their age, gender, Aboriginal or Torres Strait Islander status, highest level of education completed, and length of time at the workplace. Pregnancy status will be measured at 3- and 12-month follow-ups only, while current smoking status and smoking while at work will be measured at each assessment.
Full-time equivalence, job category, and percent of work time spent at desk, away from desk, and outside the workplace [
Several additional individual, work, health, and intervention factors will be assessed to explore whether they predict changes in sitting and activity, and for consideration as potential confounders for relative effectiveness. The additional individual factors to be assessed include: confidence with technology and use of any other apps or wearable devices to help increase activity (see
At baseline, the activPAL monitors and required adhesive materials (several Hypafix patches and alcohol swabs) will be provided to participants during a face-to-face assessment session. An in-person demonstration will be given at this session on how to wear the device (ie, on the dominant thigh on the midline, approximately one-third of the way down between the hip and the knee, attached using hypoallergenic adhesive material (Hypafix)). Participants will be asked to wear the monitor for seven consecutive days, 24 hours per day, removing only in circumstances during which the monitor is likely to be lost or damaged, but not for routine showering/bathing or swimming, as monitors will be waterproofed (with latex finger cots and hypoallergenic Opsite). Instructions will also be sent by email. Participants not able to attend the face-to-face baseline assessment session will receive an activPAL from the workplace champion after the session. At follow-up assessments, the activPALs will be distributed to participants by the workplace champion (site A) and either the workplace champion or by project staff to participants at site B. Site A participants will be instructed to return their monitor in sealed packs to the workplace champion, who will post these packs to project staff for download and processing. Site B assessment packs will be collected in person by project staff.
Concurrent diaries, covering waking hours, periods wearing/removing the activPAL, work days and times that are similar to previous paper-based versions [
The measures for activity overall and activity during work hours will be extracted from the events-based activPAL data using procedures similar to a previous study [
Quality control checks will be performed both prior to processing for the diary (missing information, nonconsecutive dates, activities finishing prior to starting, short waking days <10 hours), and postprocessing. The processed data will be checked visually (heatmaps) to verify the activity patterns were consistent with the classifications of the data as included (waking wear on valid days) or excluded (removal, sleep, or invalid days) and data will be reprocessed when errors are identified.
At baseline, 3-, and 12-month assessments participants will be emailed a link to a Web-based questionnaire (LimeService) by project staff after they have finished wearing the activPAL. At baseline, questionnaires are to be completed before the intervention begins. At all stages, participants will be provided with the opportunity to opt out of the questionnaire.
Semistructured telephone interviews will be conducted at the 3-month assessment. Attempts will be made to contact all participants in Group 2, with a similar number of participants recruited from Group 1, sampling purposively for diversity, starting with the two most disparate team members per team on age, gender, job category, and sitting time change. All team managers will also be approached for a telephone interview. All interviews will include questions to evaluate the organizational support intervention; Group 2 interviews will also assess the LUMOback. Interviews will be recorded using Audacity (version 2.0.6) and transcribed verbatim with idiosyncratic elements of speech removed. All participants who remain in the study at 12-month follow-up will be invited to take part in focus group interviews, which will be capped at 10 participants each. Participants will be offered a chance to win an activity tracker (single prize; randomized prize draw; value ~AU$500) for participating in the focus groups. Focus group interviews will be audio-recorded and transcribed.
For this pilot study, the sample size was selected based on what the workplace deemed feasible (18 teams). With a usual team size of 10 to 15, and two-thirds expected to be eligible and participate (just over eight per team), we anticipate approximately 150 participants in total, with 75 randomized to each group. This sample size will provide adequate power (≥80% power) with 5% two-tailed significance, to detect short term (3 month) changes within groups (primary effectiveness aim) of our minimum difference of interest (MDI) in our primary outcomes of work and overall sitting time (see
Power to detect changes within groups (effectiveness) and minimum detectable differences between groups (relative effectiveness) with 5% significance, two-tailed.
Outcome | MDIa | Assumed values | Effectiveness | Relative effectiveness | |
SDb,c | Pre-post |
Power | MDDd | ||
Primary outcomes | |||||
Work sitting time | 45 minutes | 90 | 0.6 | 90% | 50 minutes |
Overall sitting time | 45 minutes | 90 | 0.6 | 90% | 50 minutes |
Secondary outcomes | |||||
Work prolonged sitting time | 45 minutes | 120 | 0.6 | 67% | 65 minutes |
Overall prolonged sitting time | 45 minutes | 120 | 0.6 | 67% | 65 minutes |
Work standing time | 30 minutes | 70 | 0.6 | 79% | 35 minutes |
Overall standing time | 30 minutes | 70 | 0.6 | 79% | 35 minutes |
Work stepping time | 15 minutes | 20 | 0.7 | >99% | 10 minutes |
Overall stepping time | 15 minutes | 30 | 0.7 | 96% | 15 minutes |
aminimum difference of interest.
bstandard deviation.
cassumed values based on unpublished data from the
dminimum detectable difference with 80% power
Statistical analyses will be conducted in SPSS Statistics version ≥22 and Stata version ≥13 with statistical significance set at
Feasibility and acceptability data acquired by questionnaire, LUMOback data, and participation and retention rates will be reported using descriptive statistics. Content analyses in NVivo (version 10) will be conducted with the telephone interviews to derive reception toward both interventions, barriers and facilitators, and any other themes. Data from the focus groups will be thematically analyzed by two independent authors and discussed with a third author. Any discrepancies in themes will be discussed until consensus is reached.
Baseline and follow up data collection has finished. Results are expected in 2016.
This paper describes the background, design, and methods of a pilot, cluster-randomized trial that will compare two interventions, one that targets organizational-level strategies and another that targets organizational-level strategies plus the use of a wearable activity tracker, the LUMOback, in office workers. The study will determine if either intervention can produce changes in sitting (during all waking hours and work hours), as well as prolonged sitting, standing, and stepping in the short (3 month) and long-term (12 month), as well as the feasibility and acceptability of each intervention. The impact of each intervention on health- and work-related outcomes, and the predictors of sitting and activity change will also be examined. In addition, the study will provide preliminary evidence regarding the additional impact of the LUMOback on sitting and activity compared with organizational-level strategies alone.
The interventions in this study are designed to be easily disseminated on a large scale. Specifically, the intervention elements will come from the Head of Workplace Wellbeing, making the implementation of the intervention similar to that which may realistically occur in office workplaces. The intervention messages are delivered via a low cost, feasible mechanism (emails), with the LUMOback device also being relatively low cost, and comparable in price with other popular fitness trackers on the market (~US$150). Another strength of the intervention is that support and participation will come from multiple levels of the organization (ie, general staff, managers, senior global executives). In addition, sitting, standing and stepping will be measured at and away from the workplace, with a validated and objective measure. Many workplace studies have only measured workplace activity, and have often not used objective, posture-based measures.
Because we will work in partnership with the organization, it will not be possible to recruit a control group who will not receive the organizational intervention. As such, the effectiveness of each intervention can only be evaluated as per a single-group pre–post design. Accordingly, effectiveness findings will be considered in light of the usual findings within other studies’ control groups. For example, in prior
The interventions evaluated in this study have the potential to decrease sitting and increase standing and stepping in the office workplace. There has been minimal evaluation of organizational-level strategies alone, and whether these strategies can impact on sitting and activity behaviors when delivered as part of a worksite driven, ‘real-world’ intervention. Furthermore, there is minimal evidence on the feasibility, acceptability, and effectiveness of activity trackers for use in office workers and their effectiveness for reducing sitting and increasing standing and stepping. Despite the detrimental effects of sitting, very few activity trackers measure or target this behavior. If effective, the findings from this research may prompt developers to include sitting measures and prompts in their activity trackers. While only a pilot, this study aims to address these gaps and will provide information to guide future physical activity and sedentary behavior interventions and workplace health promotion programs.
Questionnaire items created or modified for study.
Telephone interview questions.
Focus group questions.
intraclass correlation coefficient
mean absolute percent error
minimum detectable difference
minimum difference of interest
metabolic equivalents
moderate- and vigorous-intensity physical activities
Occupational Sitting and Physical Activity Questionnaire
standard deviation
short form
This work is supported by a Vanguard Grant (Award ID: 100216) from the National Heart Foundation of Australia. The authors would also like to acknowledge Lendlease for providing additional support for this work and for the Office Ergonomics Research Committee (OERC) for providing funding to conduct the 12-month follow-up. The National Health and Medical Research Council (NHMRC) of Australia through a Centre of Research Excellence Grant (#1057608) to GNH and DWD, provides salary support to EAHW, and a top up scholarship to CLB. CLB is also supported by an Australian Postgraduate Award. DWD is supported by an NHMRC Senior Research Fellowship (#1078360). LMS is supported by an NHMRC Australia Senior Research Fellowship (#1019980). GNH is supported by a Heart Foundation Postdoctoral Fellowship (#PH 12B 7054) and NHMRC Career Development Fellowship (#108029).
CLB participated in the design and lead the coordination of the study, and drafted the manuscript. BSF, EAHW, DWD, and LMS participated in the design of the study and helped draft the manuscript. DCY and CJB participated in the design and coordination of the study. GNH conceived the study, participated in the design and helped draft the manuscript. All authors contributed to, read and approved the final manuscript.
None declared.