Sit–Stand Workstations

A Pilot Intervention to Reduce Office Sitting Time

Taleb A. Alkhajah, MIPH, Marina M. Reeves, PhD, Elizabeth G. Eakin, PhD,
Elisabeth A.H. Winkler, PhD, Neville Owen, PhD, Genevieve N. Healy, PhD

Background: Sitting time is a prevalent health risk among offıce-based workers.

Purpose: To examine, using a pilot study, the effıcacy of an intervention to reduce offıce workers’
sitting time.

Design: Quasi-experimental design with intervention-group participants recruited from a single

workplace that was physically separate from the workplaces of comparison-group participants.

Setting/participants: Offıce workers (Intervention, n⫽18; Comparison, n⫽14) aged 20 – 65 years

from Brisbane, Australia; data were collected and analyzed in 2011.
Intervention: Installation of a commercially available sit–stand workstation.
Main outcome measures: Changes from baseline at 1-week and 3-month follow-up in time
spent sitting, standing, and stepping at the workplace and during all waking time (activPAL3 activity
monitor, 7-day observation). Fasting total cholesterol, high-density lipoprotein (HDL) cholesterol,
triglycerides, and glucose levels were assessed at baseline and 3 months (Cholestech LDX Analyzer).
Acceptability was assessed with a 5-point response scale (eight items).

Results: The intervention group (relative to the comparison group) reduced sitting time at 1-week
follow-up by 143 minutes/day at the workplace (95% CI⫽ ⫺184, ⫺102) and 97 minutes/day during
all waking time (95% CI⫽ ⫺144, ⫺50). These effects were maintained at 3 months (⫺137 minutes/
day and ⫺78 minutes/day, respectively). Sitting was almost exclusively replaced by standing, with
minimal changes to stepping time. Relative to the comparison group, the intervention group
increased HDL cholesterol by an average of 0.26 mmol/L (95% CI⫽0.10, 0.42). Other biomarker
differences were not signifıcant. There was strong acceptability and preference for using the work-
stations, though some design limitations were noted.

Conclusions: This trial is the fırst with objective measurement and a comparison group to demon-
strate that the introduction of a sit–stand workstation can substantially reduce offıce workers’ sitting
time both at the workplace and overall throughout the week.
(Am J Prev Med 2012;43(3):298 –303) © 2012 American Journal of Preventive Medicine

Introduction world’s population spend an average one third of their

adult life at work,8 the workplace is a key setting in which

P
rolonged sitting is detrimentally associated with
to introduce strategies to reduce sitting time and break
several health outcomes.1–3 For many full-time
employed adults, the bulk of this sedentary time up periods of prolonged sitting to improve health.9 –11
occurs at work,4,5 where typically they spend an average Offıce-based workers are one of the largest occupa-
of over 8 hours of their weekdays.6 Given that workers tional groups12,13 and are also highly sedentary,14 mak-
represent half the world’s population,7 and most of the ing them an important candidate group for preventive
approaches.15,16
From the University of Queensland, School of Population Health, Queens- Three studies17–19 have evaluated the impact of indi-
land, Australia vidual workspace modifıcations on workplace sitting
Address correspondence to: Genevieve N. Healy, PhD, The University
of Queensland, Cancer Prevention Research Centre, School of Population time, with all reporting reductions, whereas a separate
Health, Level 3 Public Health Building, Herston Rd, Herston, QLD 4006, study20 using standing “hot desks” in an open-plan offıce
Australia. E-mail: [email protected].
0749-3797/$36.00
did not report any change in workplace sedentary time.
http://dx.doi.org/10.1016/j.amepre.2012.05.027 However, none of these studies concurrently included

298 Am J Prev Med 2012;43(3):298 –303 © 2012 American Journal of Preventive Medicine • Published by Elsevier Inc.
 Alkhajah et al / Am J Prev Med 2012;43(3):298 –303 299
comparison groups, adequate follow-up periods, and ob-
jective measurement of sitting and activity time during
both work and nonwork time. Further, none assessed the
intervention effects on health outcomes that have been
associated with prolonged sitting.
This pilot study assessed the short- (1-week) and
medium-term (3-month) changes in objectively mea-
sured sitting time and activity levels at the workplace and
during all waking time in offıce-based employees who
had a sit–stand workstation installed (intervention),
compared with employees without workspace modifıca-
tions (comparison). Workstation acceptability and changes
in health- and work-related outcomes also were assessed. It
was hypothesized that workplace sitting time in the inter-
vention group would be reduced by at least 30 minutes
relative to the comparison group, and this primarily would
be replaced by standing.

Methods
Study Design
Data for this two-arm quasi-experimental trial were collected
February–June 2011 and analyzed in August–September 2011. The
study was approved by The University of Queensland’s School of
Population Health Research Ethics Committee.
Figure 1. Ergotron WorkFit-S, Single LD Sit-Stand Workstation
Printed with permission from Ergotron, Inc. (www.ergotron.com/
Participant Recruitment tabid/65/PRDID/379/Default.aspx)

Offıce workers aged 20 – 65 years who used a nonadjustable work

surface and desktop computer were eligible. Exclusion criteria Comparison Group
were as follows: nonambulatory, pregnant at baseline, working Workspaces were not modifıed and participants were advised to
⬍0.5 full-time equivalent, and/or planning relocation to another maintain their usual day-to-day activity.
worksite during the study period. Participants were recruited from
public health research centers within two academic institutions in Data Collection
Brisbane, Australia. Intervention group participants (n⫽18) were Participants underwent three 7-day assessment phases: baseline,
recruited from a single center, which has a sedentary-behavior 1-week follow-up, and 3-month follow-up. The 1-week follow-up
research focus. To minimize contamination, comparison-group took place 1–3 days after the completion of the baseline assessment,
participants (n⫽14; none who worked in physical activity re- with this assessment also corresponding with the fırst 7 days fol-
search) were recruited from locations separated from intervention lowing workstation installation for intervention participants. Par-
participants by at least one building level. All participants provided ticipants wore an activPAL3 activity monitor and completed a
written informed consent. This sample size was chosen a priori to self-administered questionnaire at all assessments; anthropometric
achieve 80% power (two-tailed, p⬍0.05) to detect a minimum and fasting (minimum 10 hours) blood assessments were con-
difference of 35 minutes/8-hour workday for the primary outcome ducted at the research center at baseline and 3-month follow-up.
of sitting at the workplace (not secondary outcomes), based on an For intervention participants, the fırst day of activPAL3 observa-
SD of 35 and pre–post correlation of 0.6.4 tion (at 1-week follow-up) was the fırst day of workstation usage.
Sitting, standing, and stepping time and sit-to-stand transitions
Intervention Group were measured using thigh-mounted activPAL3 monitors, worn 24-
hours/day across a 7-day observation period. The activPAL3 classifıes
Following baseline assessment, intervention participants had a Ergot- posture directly (by inclinometer) and has excellent validity and reli-
ron WorkFit-S, Single LD Sit-Stand Workstation (www.ergotron. ability.21 Participants recorded in a log all times at their primary
com; ⬃$380 U.S. each; Figure 1) installed. The workstation facili- workplace, awake/asleep, and of monitor removals (if any).
tates regular transitions between sitting and standing postures. For BMI, weight (Taylor 7023WA Lithium Electronic Scale;
Brief (approximately 2 minutes) verbal instruction on its use, as nearest 0.1 kg without shoes or heavy clothing) and height (PE087
well as written instructions on the correct ergonomic posture for Portable Height Scale; nearest 0.1 cm without shoes) were mea-
both sitting and standing and the importance of regular postural sured in duplicate.22 For body composition, fat-free mass and fat
change throughout the day, as recommended by the product affıl- mass (kilogram) were measured using the Impedimed SFB7 bioim-
iates (www.computingcomfort.org/educate1.asp), was given. pedance spectroscopy (BIS) device.23 Waist and hip circumfer-

September 2012
300 Alkhajah et al / Am J Prev Med 2012;43(3):298 –303
ences were measured in duplicate (nearest 0.1 cm) using a nonex-
Intervention Group Comparison Group
pandable tape measure at the superior border of the iliac crest24 and
the greatest gluteal protuberance,25 respectively.
For fasting blood lipids and glucose, measures were fasting total 1 workplace recruited 3 workplaces recruited
cholesterol; high-density lipoprotein (HDL) cholesterol; triglycer-
24 employees contacted 78 employees contacted
ides; and glucose levels assessed using a 35-␮L whole-blood

Enrollment
sample via fınger stick and the Cholestech LDX Analyzer.26,27 18 interested and screened 18 interested and screened
Self-reported outcomes: for possible benefıt or adverse outcomes, for eligibility for eligibility
fatigue,28 eye strain,29 and self-rated work performance30 were
3 ineligible
measured at all assessments; headaches, digestion, sleep prob-
lems,28 musculoskeletal health,31 and absenteeism (sick days in 18 eligible and enrolled 15 eligible and enrolled
the past 3 months) were assessed at baseline and 3 months. 1 withdrew
Workstation acceptability was assessed with eight items using a consent

Allocation
5-point response format (strongly disagree to strongly agree).
18 completed baseline 14 completed baseline
Sociodemographic and general offıce layout data were collected assessment assessment
at baseline.
18 completed 1-week 14 completed 1-week
assessment assessment
Data Processing

Follow-up
1 lost to
The activPAL3 records for each 15-second epoch (version 6.0.8) follow-up
the number of sit-to-stand transitions and seconds spent sit-
18 completed 3-month 13 completed 3-month
ting/lying (referred to as sitting throughout), standing, and assessment assessment
stepping that occurred. Using SAS, version 9.1, self-reported
removal and sleep times were excluded, then sit-to-stand tran- 18 analyzed for 1-week 13 analyzed for 1-week
Analysis

sitions and time spent sitting, standing, and stepping were changes changes
18 analyzed for 3-month 12 analyzed for 3-month
summed for each day over the periods of interest (at the work- changes changes
place and during all waking time). Averages were calculated
from days when the monitor was not substantially removed Figure 2. Flow diagram of participant progress through the trial
(worn ⱖ90% at the workplace [n⫽377/377 days] and removed
ⱕ90 minutes during waking time [n⫽609/637 days]). No re-
strictions were made on number of observed days. To account Intervention Effects
for variations in observed time, outcomes were standardized to
Changes in sitting, standing, stepping time, and tran-
an 8-hour workday or a 16-hour day; transitions are reported
per hour of sitting. sitions (Table 2). In the intervention group (relative to
the comparison group), sitting at the workplace was reduced
by more than 2 hours at both the 1-week and 3-month
Statistical Analyses
follow-ups (p⬍0.001 for both). Sitting reductions were
Analyses were conducted in PASW Statistics, version 18.0.0, and driven primarily by increases in standing time, although
Stata Statistical Software, version 11.1. To determine intervention benefıcial intervention effects also were observed for transi-
effects, regression models were conducted separately for each out-
tions (both follow-ups) and stepping (1-week). Changes in
come, adjusting for baseline values as covariates.32,33 Models were
sitting time and activity during overall waking time also
linear regression (one follow-up period); linear mixed models (two
follow-up periods); or Tobit regression for truncated outcomes favored the intervention group for all outcomes except step-
(triglycerides). Estimated marginal means with 95% CIs are re- ping at both follow-ups and transitions at 3 months.
ported. Signifıcance was set at p⬍0.05 (two-tailed). Anthropometrics, fasting blood lipids and glucose
outcomes (Appendix A, available online at www.
Results ajpmonline.org). Relative to the comparison group,
Figure 2 shows participants’ progress through the study. HDL cholesterol increased in the intervention group by
One participant (comparison) was excluded from sitting an average of 0.26 mmol/L (95% CI⫽0.10, 0.42;
and activity analyses because of a monitor malfunction. p⫽0.003). Other differences were not signifıcant.
Table 1 shows the participants’ characteristics at baseline Self-report outcomes. Self-reported health and work
by group. Both groups were primarily Caucasian, female, performance outcomes did not change markedly within
married, working full-time, and had completed tertiary- groups or between groups at either follow-up (Appendix B,
level education. Baseline sitting time and activity were available online at www.ajpmonline.org). At 3 months, the
similar for both groups during overall waking time; how- majority of intervention participants either agreed or
ever, at the workplace, sitting time was markedly less in strongly agreed that the workstation was easy to use (94%);
the intervention than comparison group. enjoyable (94%); and comfortable (83%). However, many

www.ajpmonline.org
 Alkhajah et al / Am J Prev Med 2012;43(3):298 –303 301
Table 1. Baseline sociodemographic, workplace, sitting, use. Despite this, none of the participants indicated that they
and activity characteristics of office workersa would rather return to their original workspace setup, with
83% disagreeing or strongly disagreeing with this statement.
Intervention Comparison
(n⫽18) (n⫽14)b When asked if the new workstation improved their produc-
tivity, 33% agreed and 22% disagreed.
Age, years 33.5 ⫾ 8.7 39.9 ⫾ 7.2

Women 94.4 (17) 85.7 (12) Discussion

Caucasian 94.4 (17) 78.6 (11)
This pilot study provides novel evidence that a low-cost
Married 66.7 (12) 100.0 (14) sit–stand workstation can reduce sitting time in offıce
Doctorate 27.8 (5) 71.4 (10) workers. The intervention, which was highly acceptable,
Tenure at current workplace (years) had substantial effect in the short- and medium-term on
ⱕ1 16.7 (3) 14.3 (2) sitting and standing at the workplace and during all wak-
ing time. Epidemiologic evidence suggests that these re-
1– ⱕ3 44.4 (8) 28.6 (4)
ductions could have a considerable impact on cardiovas-
3– ⱕ5 16.7 (3) 28.6 (4)
cular disease and type 2 diabetes prevention.3
⬎5 22.2 (4) 28.6 (4) Although studies are too heterogeneous to compare
1.0 full-time-equivalent 72.0 (13) 57.0 (8) directly, this sit–stand workstation intervention (which
Staff type reduced workplace sitting time by ⬎27%) appears at least
Student 27.8 (5) 7.1 (1)
as successful as other workstation interventions.17,19 The
intervention group also increased (relative to the com-
General 44.4 (8) 21.4 (3)
parison group) the number of sit-to-stand transitions per
Academic 27.8 (5) 71.4 (10)
sitting hour at the workplace, suggesting that sitting time
Share office with how many others was not only reduced but also interrupted more fre-
0 16.7 (3) 35.7 (5) quently. This improvement occurred despite the absence
1–3 83.3 (15) 14.3 (2) of quantifıed targets for postural change.19
⬎3 (open plan) 0.0 (0) 50.0 (7)
This pilot study was not powered a priori to detect
meaningful changes in secondary outcomes. Thus, lack of dif-
Never smoker 77.8 (14) 78.6 (11)
ferences should not be interpreted as ruling out potentially
BMI 22.6 ⫾ 2.6 21.5 ⫾ 2.6
important benefıts or harm of the intervention. Notably, the
c
At the workplace (minutes/8-hour workday) direction of effects for HDL cholesterol (⫹0.26, 95% CI⫽0.10,
Sitting 329 ⫾ 55 377 ⫾ 56 0.42 mmol/L; p⫽0.003) and fasting glucose (⫺0.27, 95%
Standing 110 ⫾ 48 73 ⫾ 48 CI⫽ ⫺0.65, 0.11 mmol/L; p⫽0.159) are congruent with inac-
Stepping 41 ⫾ 14 29 ⫾ 16
tivity physiology research.34–36 Similarly, the average reduction
in weight over 3 months (⫺0.9, 95% CI⫽ ⫺1.9, 0.2 kg;
Sit-to-stand transitions, n/hours of sitting 9⫾9 4⫾2
p⫽0.675) is comparable to workplace physical activity inter-
During overall waking time (minutes/16-hour day)d ventions in a recent meta-analysis (mean change ⫺1.08 kg;
Sitting 551 ⫾ 75 607 ⫾ 82 8–52 weeks’ follow-up).37 Given that the difference in energy
Standing 260 ⫾ 52 219 ⫾ 62 expenditure between sitting and standing in an offıce setting is
Stepping time 150 ⫾ 38 134 ⫾ 41 minimal,38 these health effects are most likely due to the in-
creased muscular contractions associated with standing.
Sit-to-stand transitions (n/hours sitting) 7⫾1 6⫾3
Strengths of the study are the real-world applicability, the
a
Table presents M⫾SD or % of group (n). objective, high-quality measure of sitting and activity in the
b
Sitting and activity data excluded for one comparison participant with a
monitor malfunction context of interest (at the workplace) and overall (to demon-
c
Minutes/8-hour workday ⫽ minutes at the workplace, standardized to 8 hours strate wider benefıt). However, the study was not randomized
of work time (i.e., standardized minutes ⫽ minutes X 480/observed minutes
at the workplace)
and recruited small numbers of participants using convenience
d
Minutes/16-hour day ⫽ minutes during overall waking time, standardized to sampling. Thus, the sample is not widely representative of
a 16-hour waking day (i.e., standardized minutes ⫽ minutes X 960/observed
workplaces and workers, and some confounding is possible.
minutes)
Further, models adjusted for baseline levels but not for other
potential confounders because of insuffıcient sample size. Key
noted insuffıcient support for their hands and wrists while issues may include workplace layout and the intervention par-
typing (44%); insuffıcient room to use the mouse (67%); and ticipants’ knowledge of the health impact of prolonged sitting.
33% indicated changing their footwear due to workstation Larger, cluster-randomized trials are needed as these can better

September 2012
302 Alkhajah et al / Am J Prev Med 2012;43(3):298 –303
Table 2. Changes in sitting, standing, stepping, and sit-to-stand transitions at the workplace and during overall waking timea

Intervention–comparison
Intervention Comparison
n⫽18 n⫽13b Difference p-value

AT THE WORKPLACE (MINUTES/8-HOUR WORKDAY)

Sitting time
1 week ⫺137 (⫺162, ⫺111)ⴱ 6 (⫺24, 36) ⫺143 (⫺184, ⫺102) ⬍0.001
ⴱ
3 months ⫺125 (⫺150, ⫺99) 12 (⫺20, 44) ⫺137 (⫺179, ⫺95) ⬍0.001
Standing time
1 week 130 (105, 155)ⴱ ⫺4 (⫺34, 25) 134 (95, 174) ⬍0.001
ⴱ
3 months 124 (99, 149) ⫺6 (⫺37, 24) 131 (90, 171) ⬍0.001
Stepping time
1 week 6 (3, 9)ⴱ ⫺1 (⫺4, 3) 7 (2, 11) 0.005
3 months 0 (⫺4, 4) ⫺5 (⫺10, 0) 4 (⫺2, 11) 0.194
Sit-to-stand transitions, n/hour sitting at work
1 week 3 (2, 5)ⴱ ⫺2 (⫺4, 0) 5 (3, 7) ⬍0.001
3 months 1 (⫺1, 2) ⫺2 (⫺4, 0) 3 (0, 5) 0.039
DURING OVERALL WAKING TIME (MINUTES/16-HOUR DAY)
Sitting time
1 week ⫺69 (⫺98, ⫺39)ⴱ 28 (⫺7, 63) ⫺97 (⫺144, ⫺50) ⬍0.001
ⴱ
3 months ⫺79 (⫺109, ⫺50) ⫺2 (⫺38, 35) ⫺78 (⫺125, ⫺30) 0.002
Standing time
1 week 71 (51, 91)* ⫺17 (⫺41, 7) 88 (56, 120) ⬍0.001
3 months 90 (61, 118)* 7 (⫺27, 42) 83 (37, 128) ⬍0.001
Stepping time
1 week ⫺1 (⫺10, 8) ⫺13 (⫺23, ⫺2)* 11 (⫺3, 25) 0.112
3 months ⫺10 (⫺19, ⫺1) ⫺7 (⫺18, 4) ⫺2 (⫺17, 12) 0.750
Sit-to-stand transitions, n/hour sitting
1 week 0 (0, 1) ⫺1 (⫺1, 0)ⴱ 1 (1, 2) 0.002
3 months 0 (⫺1, 1) 0 (⫺1, 1) 0 (⫺1, 1) 0.946

Note: Boldface on values indicates significance.

a
Mean change from baseline (95% CI), adjusted for baseline value
b
n⫽13 due to exclusion of one participant with a monitor malfunction; n⫽12 at 3 months due to drop-out (n⫽1).
*p⬍0.05 for change from baseline

controlconfounding,improvegeneralizability,havecapacityto 511001); Owen is supported by an NHMRC Senior Principal Re-

explore effect modifıcation, and will yield more-precise esti- search Fellowship (No. 1003960); and Healy is supported by an
mates of potential effects on anthropometric, biomarker, NHMRC Early Career Fellowship (No. 569861). No other authors
health- and job-related outcomes. reported fınancial disclosures.
The authors sincerely thank the participants involved in this
This study was funded by a University of Queensland Major Equip- research.
ment and Infrastructure grant. Alkhajah is supported by a United
Arab Emirates Ministry of Higher Education and Scientifıc Research
Scholarship; Reeves is supported by a National Health and Medical References
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Appendix
Francis/Hemisphere, 1991:94 –117. Supplementary data
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